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Τετάρτη 14 Δεκεμβρίου 2022

Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities

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Semin Plast Surg 2022; 36: 149-157
DOI: 10.1055/s-0042-1754387

Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperat ive planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.
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Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 1 0001, USA

Article in Thieme eJournals:
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Determinants of dietary diversity among children 6‐23 months

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Abstract

Background

The Prenatal, perinatal, postnatal and nutritional support study (A3PN), was a four-year initiative aimed to reduce maternal mortality in Haiti. A cross-sectional study was developed to collect baseline data for evaluation purposes of the A3PN. The current study aims to determine the factors contributing to dietary diversity (DD) in Haitian children aged 6 to 23 months.

Methods

A cross-sectional study during two seasons (the lean season and the harvest season) was carried out in Haiti to assess the DD of children and their mothers using non-quantitative 24-hour recalls. Indicators of DD were Minimum Dietary Diversity for Children (MDD-C) and Minimum Dietary Diversity for Women (MDD-W). Mid-Upper Arm Circumference (MUAC) was measured in women and children and food security was assessed using the Household Hunger Scale (HHS). Focus groups were also conducted to gain a better understanding of quantitative findings.

Results

Only 7.3% of t he children included in this study met the MDD-C. Factors associated with MDD-C were the season (OR: 0.141 [0.039-0.513]), land ownership or rental (OR: 4.603 [1.233-17.188]), maternal education (OR: 0.092 [0.011-0.749]), the mother's responsibility for the main or secondary source of income for the household (OR: 2.883 [1.030-8.069]), and her DD (OR: 5.690 [1.916-16.892]). Focus groups revealed the existence of various food restrictions.

Conclusion

The results indicated that the low prevalence of MDD-C in three regions of study in Haiti is indicative of a serious public health concern that might be further aggravated by local food taboos. They also suggest that to fight against hunger it is necessary to focus on women's well-being.

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

We describe the results of exome sequencing for genetic diagnosis of hearing loss among a clinically heterogeneous cohort of 218 pediatric patients. We found a higher diagnostic rate for unilateral hearing loss than previously reported as well as a significant number of syndromic forms of hearing loss. Based on these results, we advocate for expanded access to genetic testing for phenotypically diverse hearing loss patients.


Objectives

Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL.

Methods

Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL.

Results

ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%).

Conclusion

ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis.

Level of Evidence

Level IV Laryngoscope, 2022

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Induced Paresis for Awake Laryngoscopy Procedures

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Induced Paresis for Awake Laryngoscopy Procedures

This article describes an anesthetic technique that induces temporary adductor vocal fold paresis and dense sensory loss of the posterior glottis. This method allows for improved precision of treatment and patient tolerance during awake office-based laryngeal surgery.


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