Relation of the work ability index to fitness for work in healthcare and public employees in a region of Northeastern Italy

PURPOSE

Work ability indicates an individual's capacity to match job demands according to his/her physical and mental conditions and work circumstances. Occupational physicians should take into consideration the global health status of a worker in order to correctly assess if he/she is fit for the job. The aim of this study was to verify the association between fitness for work evaluation and Work Ability Index scores, as well as individual factors (age, gender, and anthropometric characteristics) and work-related variables (job type, years of working duration).

METHODS

A cross-sectional study was conducted within the occupational health surveillance of health and public employers in the Friuli-Venezia Giulia region (2018-2022). The participants voluntarily agreed to answer the standard Work Ability Index questionnaire. Data were investigated by univariable as well as multivariable regression analysis.

RESULTS

The Work Ability Index of the workers included in the study (N = 6893) resulted negatively associated with age, female sex, and body mass index. It was averagely lower in nurses and assistive personnel, and the highest in medical doctors and public employers. The fitness for work assessments was also statistically related to WAI scores. The results obtained from the univariable and the multivariable analysis were consistent.

CONCLUSIONS

The Work Ability Index is an efficient tool to measure an individual's capability to sustain job demands, and can be taken into account to produce a correct fitness for work evaluation and consequently preserve workers' health status.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

Incidence of shoulder disorders in a cohort of healthcare workers from 2009 to 2020

PURPOSE

To estimate the incidence of shoulder disorders in a cohort of Health Care Workers (HCWs).

METHODS

4406 workers employed from 2009 to 2020, were included in the study. Occupational risk factors and jobs were assessed according to working history. Incident cases were defined in case of shoulder pain associated with functional limitations during the medical examination. The Cox regression model was used to calculate the Hazard Ratio (HR) for different work activities, adjusted for age, sex, body mass index, and previous musculoskeletal injuries, using clerks as the reference category.

RESULTS

The incidence rates of shoulder musculoskeletal disorder for men and women were 13.1 for 1000 person-years (CI 95% 10.6-16.3) and 20.1 for 1000 person-years (CI 95% 17.8-22.6) respectively. The adjusted HR was significantly increased with age (1.06, CI 95% 1.05-1.07), outpatient health activities (2.82, CI 95% 1.89-4.219), and wards health activity (2.37, CI 95% 1.68-3.33).

CONCLUSION

HCWs with high biomechanical risk such as nurses and healthcare assistants had a higher incidence of shoulder disorders. Actions are needed for better prevention in health care assistance.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Quantum Backaction on kg-Scale Mirrors: Observation of Radiation Pressure Noise in the Advanced Virgo Detector

The quantum radiation pressure and the quantum shot noise in laser-interferometric gravitational wave detectors constitute a macroscopic manifestation of the Heisenberg inequality. If quantum shot noise can be easily observed, the observation of quantum radiation pressure noise has been elusive, so far, due to the technical noise competing with quantum effects. Here, we discuss the evidence of quantum radiation pressure noise in the Advanced Virgo gravitational wave detector. In our experiment, we inject squeezed vacuum states of light into the interferometer in order to manipulate the quantum backaction on the 42 kg mirrors and observe the corresponding quantum noise driven displacement at frequencies between 30 and 70 Hz. The experimental data, obtained in various interferometer configurations, is tested against the Advanced Virgo detector quantum noise model which confirmed the measured magnitude of quantum radiation pressure noise.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

Increasing the Astrophysical Reach of the Advanced Virgo Detector via the Application of Squeezed Vacuum States of Light

Current interferometric gravitational-wave detectors are limited by quantum noise over a wide range of their measurement bandwidth. One method to overcome the quantum limit is the injection of squeezed vacuum states of light into the interferometer's dark port. Here, we report on the successful application of this quantum technology to improve the shot noise limited sensitivity of the Advanced Virgo gravitational-wave detector. A sensitivity enhancement of up to 3.2±0.1  dB beyond the shot noise limit is achieved. This nonclassical improvement corresponds to a 5%-8% increase of the binary neutron star horizon. The squeezing injection was fully automated and over the first 5 months of the third joint LIGO-Virgo observation run O3 squeezing was applied for more than 99% of the science time. During this period several gravitational-wave candidates have been recorded.

Search for Subsolar Mass Ultracompact Binaries in Advanced LIGO's Second Observing Run

We present a search for subsolar mass ultracompact objects in data obtained during Advanced LIGO's second observing run. In contrast to a previous search of Advanced LIGO data from the first observing run, this search includes the effects of component spin on the gravitational waveform. We identify no viable gravitational-wave candidates consistent with subsolar mass ultracompact binaries with at least one component between 0.2  M_{⊙}-1.0  M_{⊙}. We use the null result to constrain the binary merger rate of (0.2  M_{⊙}, 0.2  M_{⊙}) binaries to be less than 3.7×10^{5}  Gpc^{-3} yr^{-1} and the binary merger rate of (1.0  M_{⊙}, 1.0  M_{⊙}) binaries to be less than 5.2×10^{3}  Gpc^{-3} yr^{-1}. Subsolar mass ultracompact objects are not expected to form via known stellar evolution channels, though it has been suggested that primordial density fluctuations or particle dark matter with cooling mechanisms and/or nuclear interactions could form black holes with subsolar masses. Assuming a particular primordial black hole (PBH) formation model, we constrain a population of merging 0.2  M_{⊙} black holes to account for less than 16% of the dark matter density and a population of merging 1.0  M_{⊙} black holes to account for less than 2% of the dark matter density. We discuss how constraints on the merger rate and dark matter fraction may be extended to arbitrary black hole population models that predict subsolar mass binaries.

Effect of Thermosetting Gel with Doxycycline Hyclate 3% + Ketorolac Tromethamine 0.5% on Postoperative Discomfort after Third Molar Surgery: A Prospective Randomized Study

This study compared the analgesic and anti-inflammatory efficacy of intra-alveolar administration of a thermosetting gel containing Doxycycline Hyclate 3% + Ketorolac Tromethamine 0.5% (Tg-DHKT) (Thermosetting gel, Monteresearch, Bollate, Italy) on patient discomfort after third molar surgery. This study was a single-blind, randomized clinical trial, including two study groups of 39 and 41 patients each, who required surgical removal of a single mandibular impacted third molar. After the extraction the test group received an intra-alveolar injection with Tg-DHKT and the second group a thermosetting gel containing only Doxycycline Hyclate 3% (Tg-DH). Each patient's symptoms (pain, swelling, reddening, bleeding and body temperature) was assessed with a follow-up questionnaire (PoSSe scale). Nimesulide 100 mg, a painkiller, every 8 hours was prescribed to the Control and Test groups if necessary (maximum 3 doses); if they needed to assume it they were asked to mark it on the questionnaire. Results showed that on the second day after surgery pain, oedema and reddening decreased faster in the Control group (Tg-DH). There was no difference between the two groups when postoperative bleeding was evaluated. In both groups bleeding decreased in the same way, probably due to the mechanical characteristics of the gel itself. 46% of patients of the Test group did not require to take any painkiller at home. Our data demonstrate that the use of Tg-DHKT is less effective in the prevention of postoperative symptoms after third molar extraction compared to Tg-DH. However, almost half of patients in the Test group did not need to take more pain medication at home, suggesting that a single postoperative local administration of Tg-DHKT is a safe and effective concept for controlling pain, oedema and inflammation after third molar extraction.

Anharmonic Force Fields of Naphthalene-h8and Naphthalene-d8

The cubic and the quartic semidiagonal anharmonic force fields of naphthalene-h8 and -d8 are obtained using density functional theory (DFT) with the B9-71 functional and a triple-zeta plus double polarization (TZ2P) basis set. The fundamental frequencies computed by second-order vibrational perturbation theory are in very good agreement with the experimental data, with a mean absolute deviation (MAD) of 4 cm(-1) for C(10)H(8) and 6 cm(-1) for C(10)D(8). Some of the fundamental frequencies have been reassigned on the basis of the present results. Only CH stretchings seem to be significantly affected by Fermi resonances, with two shifts larger than 10 cm(-1). Calculated infrared harmonic intensities reproduce the experimental data within 15%, with the exception of CH stretchings affected by a larger error. Scale factors from C(10)H(8) have been tested by deriving the fundamental frequencies of C(10)D(8) from the theoretical harmonic ones. These fundamentals are in nice agreement with those obtained from the C(10)D(8) anharmonic force field. These results support the use of scale factors to calculate the vibration spectra of larger polycyclic aromatic hydrocarbons of great astrophysical interest.

Deuterium isotope effects in A:T and A:U base pairs: a computational NMR study

Recent measurements of trans-hydrogen bond deuterium isotope effects (DIEs) on 13C chemical shifts in nucleic acids (Vakonakis, I.; LiWang, A. C. J. Biomol. NMR 2004, 29, 65; J. Am. Chem. Soc. 2004, 126, 5688) have led to intriguing results: (i) the DIEs of A:T pairs in DNA are about 5 ppb smaller than those of A:U in RNA and (ii) A:T DIEs vary by as much as 13 ppb among the oligonucleotides. The first observation suggests that inter-base H-bonds in RNA may be stronger than those in DNA, while the second indicates that the conformation of the base pair modulates the transmission of the isotope effect across the hydrogen bond. In an effort at providing a rationale--so far unknown--for the observed DIEs in nucleic acids, density functional theory and hybrid Car-Parrinello/molecular mechanical calculations of DIEs on nucleosides and nucleotides in the gas phase and in aqueous solution have been performed. The calculations suggest that (i) the DIE in an isolated A:T base pair differs from that in an A:U base pair because of the changes in the magnetic properties caused by the replacement of a methyl group on passing from U to T, (ii) the DIEs depend crucially on the conformation of the base pairs, and (iii) the DIEs are strongly affected by magnetic and electrostatic interactions with the surrounding environment.

Structure and Raman Spectrum of Clavulanic Acid in Aqueous Solution

The calculation of the vibrational Raman spectrum of enzyme-bound beta-lactamase inhibitors may be of help to understand the mechanisms responsible for bacterial drug resistance. Here, we present a study of the solvation structure and the vibrational properties of clavulanate, an important beta-lactamase inhibitor, in aqueous solution as obtained from full quantum and hybrid empirical/quantum molecular dynamics simulations at ambient conditions. The analysis of the vibrational density of states indicates that hybrid empirical/quantum mechanical simulations are able to properly describe the vibrational levels of clavulanate in solution. In addition, we propose a computationally efficient protocol to calculate the vibrational Raman effect for large solute molecules in water, which is able to faithfully reproduce the experimentally recorded clavulanate Raman spectrum and discloses the possibility to employ hybrid simulations to assign the experimental Raman spectra of inhibitors bound to beta-lactamases.

Can ortho–para transitions for water be observed?

The spectrum of water can be considered as the juxtaposition of the spectra of two molecules, with different total nuclear spin: ortho-H2O, and para-H2O. No transitions have ever been observed between the two different nuclear-spin isotopomers. The interconversion time is unknown and it is widely assumed that interconversion is forbidden without some other intervention. However, weak nuclear spin-rotation interaction occurs and can drive ortho to para transitions. Ab initio calculations show that the hyperfine nuclear spin-rotational coupling constants are about 30 kHz. These constants are used to explore the whole vibration-rotation spectrum with special emphasis on the coupling between nearby levels. Predictions are made for different spectral regions where the strongest transitions between ortho and para levels of water could be experimentally observed.

A comparision between rapid Golgi and Golgi-Cox impregnation methods for 3-D reconstruction of neurons at the confocal scanning laser microscope

We utilized two widely used impregnation methods, the silver "rapid Golgi" and the mercuric Golgi-Cox methods, for three-dimensional (3-D) reconstruction of neurons at the confocal scanning laser microscope (CSLM), to determine which of them was more suitable for this application. The Golgi-Cox method is the most consistent arid the cleanest procedure with respect to the "rapid Golgi" one which always produces samples with scattered reflective granules that interfere with the image formation at the CSLM. The interneuronal tissue in the case of Golgi-Cox impregnated specimens (i.e. the non-impregnated tissue among impregnated neurons) contributes less to the decrease of reflected light during z-sectioning than in the case of "rapid Golgi" impregnation, but the mercury impregnated samples reflect less than the silver impregnated ones. Owing to the necessity during deep z-scanning to adjust the sensitivity of the CLSM detector the acquisition of images from the deeper planes of the sample may be difficult. In our opinion the "sandwich" mounting of the specimen between two coverslips is indispensable in order to make it possible to scan it from both sides and, thus reduce the penetration in the sample and the consequent distortion of the image. Neither of the impregnation methods used is completely suitable for CLSM observations due both to their intrinsic limitations and to those imposed by the sample thickness.

Asymmetry of normal mandibular condylar shape

Morphological studies of the facial skeleton in human beings are usually made from radiographs (frontal and lateral projections and orthopantomographs). The conventional linear and angular measurements provide quantitative information only about size, and fail to define the shape and form of the skeletal features and their variations. Mathematical methods such as the Fourier series allow a correct quantitative analysis of the shape and its variations. The outlines of the mandibular condyles in the orthopantomographs of 20 men and 20 women (mean age 29 years) were traced and digitized. All subjects had a good dentition, no temporomandibular joint problems, and were referred to a dental surgery for periodontal problems. A Fourier analysis of the outlines was performed. Fourier coefficients and reconstructed outlines were compared to analyze the condylar symmetry of shape on an intra- and intersubject basis. A significant condylar asymmetry for shape as distinct from size was found on an intrasubject basis, i.e. the left and right condyles of a single individual had a different shape with a large interindividual variability. Conversely, the mean condyle shape of the male and female groups was symmetric.

Simplified cephalometric lines for the estimation of muscular lines of action

In the study of masticatory muscle performance, one of the biomechanical variables that can be estimated is the mechanical advantage of the masticatory muscles, namely, the ratio between the muscular moment arm and the bite force moment arm. In the present study, the position of the estimated line of action of the masseter muscle, drawn between gonion and orbitale (Go-Or) relative to dental (occlusal plane) and skeletal (Frankfort plane) references was analyzed in 431 pretreatment lateral cephalograms of orthodontic patients (195 males, 236 females) aged 6 to 50 years, and in the lateral tracings of the Bolton standards (6 to 18 years of age). The following measurements were evaluated: (1) skeletocutaneous class (soft tissue equivalent of Wits appraisal, linear distance in millimeters between the projections of points A' and B' on the occlusal plane); (2) angle between the Go-Or line and the perpendicular to the occlusal plane at the molar occlusal point; and (3) angle between the Go-Or line and the Frankfort plane. In the patients, the skeletocutaneous class ranged between--14.5 and 15.5 mm, without any sex- or age-related differences. The angle between the Go-Or line and the perpendicular to the occlusal plane was, on average, 39 degrees (range 15 to 53 degrees), and it decreased with advancing age; while the average angle between Go-Or and Frankfort plane was 42 degrees (range 30 to 54 degrees), and it increased in older patients. No effects of sex were found. The two angles were significantly correlated to each other, while no correlations were found with the sagittal jaw discrepancy. Similar results were obtained on the Bolton tracings. Overall, the present cephalometric analogue could be useful in biomechanical simulations.

The use of linear and angular measurements of maxillo-mandibular anteroposterior discrepancies

OBJECTIVES

To extend the assessment of the clinical significance of the measurement of the anteroposterior discrepancy between maxilla and mandible on the bisector of the palatal plane to mandibular plane angle to a large group of randomly selected patients of both sexes, and to verify the correlation of this measurement to well established angular and linear assessments of anteroposterior discrepancy.

DESIGN

Retrospective analysis of pre-treatment lateral cephalometric radiographs.

SETTING AND SAMPLE POPULATION

The Laboratory of Functional Anatomy of the Stomatognathic Apparatus at Milan University, Italy. Three hundred and six orthodontic patients (165 males, 141 females) aged between 6 and 50 years.

EXPERIMENTAL VARIABLE

ANB angle; corrected ANB* angle which compensates for the position of the maxilla and rotation of the mandible relative to the cranial base; Wits appraisal; MM-Wits: linear distance between the projections of A and B points on the bisector of the palatal plane to mandibular plane angle.

RESULTS

The MM-Wits distance was significantly correlated to two angles (ANB and ANB*), as well as to the Wits appraisal. All the correlations performed did not show sex- or age-characteristic patterns. The correlation to the corrected ANB* was the best among the three, with a correlation coefficient of 0.915, MM-Wits (mm) = 1.497 x ANB* (degrees) -6.784. From the correlation, reference values for the new measurement have also been estimated, and found to be between -0.65 and -6.85 mm for skeletal Class I individuals.

CONCLUSION

It is recommended that the diagnosis of orthodontic anomalies should be performed taking into consideration more than a single anteroposterior appraisal.

A three-dimensional computerized mesh diagram analysis and its application in soft tissue facial morphometry

A modified computerized mesh diagram analysis that allows rapid and independent quantifications of soft tissue facial size and shape in the three-dimensional space is presented. Normal references are provided, and the application of the method is also exemplified by the analysis of two maxillofacial surgical patients. The Three-Dimensional Facial Morphometry method has been used for the collection of the x, y, z coordinates of 22 soft tissue landmarks in 50 men and 50 women (all healthy young white adults). The method detects the three-dimensional coordinates of retroreflective, wireless markers positioned on selected facial landmarks with two charge-coupled device cameras, working in the infrared field. The midpoint between the right and left tragus landmarks served as the origin of the coordinate axes, and the landmark coordinates were rotated, setting the intercantheal line horizontal on both the frontal and the horizontal planes, and the Camper's plane inclined at -7.5 degrees on the sagittal plane. A standardized mesh of equidistant horizontal (dimension: half the upper face width), vertical (half the vertical projection of upper face height), and anteroposterior (half the horizontal projection of upper face depth) lines was consequently constructed. The lattice was replicated on the entire face and comprised 84 parallelepipeds. Both male and female reference meshes had a harmonious and symmetric appearance, with gender differences in facial size but not in facial shape. The standard normal reference was superimposed on the patient's tracing, and the global (size plus shape) difference was then evaluated by the calculation of the relevant displacement vectors for each soft tissue landmark. A global difference factor was calculated as the sum of the modules of all the displacement vectors. Consequently, a size normalization was performed, and the shape difference (size-standardized) was then evaluated by the calculation of new relevant displacement vectors for each landmark, as well as a shape--global difference vectors.

Femoral asymmetry in healthy adults: elliptic Fourier analysis using computerized tomographic scout views

Morphology (both size and shape) of paired structures differ in the left and right sides of body. Size and shape characteristics should be analyzed separately to supply information about the normal variations of human organs. In the present study, the within-subject size and shape asymmetries of normal human femur were analyzed from a mathematical standpoint. On the standardized frontal computerized tomographic scout views of both thighs of 14 healthy adults (7 women and 7 men aged 22-26 years), the outline of the femur was identified, and its size and shape were separately quantified. The left and right femur of each subject were compared, and size and shape asymmetry separately quantified on an intra-subject basis. Subjects were also grouped for sex, and mean values computed. Within-subject symmetry in femoral size and shape was high, with coefficients of superimposition ranging between 91% and 96.5%. In women, a slightly higher symmetry (up to 99.9%) was observed when the femoral outlines were standardize for size. Moreover, in the same group the asymmetry in the form of femoral outline seemed to be partly related to the asymmetry in femoral length. Conversely, no similar relations were found in men.

Functional anatomy of cavernous helicine arterioles in potent subjects

PURPOSE

We investigated the morphological and functional features of cavernous helicine arterioles in male potent subjects.

MATERIALS AND METHODS

Ten young men reporting normal rigid erections which were confirmed by polysomnographic recording underwent power Doppler sonography of the cavernous helicine arterioles during flaccidity, after intracavernous injection of alprostadil, and after subsequent genital and audiovisual sexual stimulation.

RESULTS

During flaccidity the helicine arterioles were never detected by power Doppler imaging while they became evident in all cases after alprostadil injection. They usually originated from the cavernous artery forming an acute angle and showed 3 orders of ramifications. Systolic and diastolic flow was present. After genital and audiovisual sexual stimulation, and achievement of maximum rigidity, the helicine arterioles were still evident but with only 1 or 2 orders of distal ramifications. Only systolic flow was present. During penile tumescence the helicine arterioles disappeared in all cases.

CONCLUSIONS

Using power Doppler sonography it is possible to investigate the functional anatomy of the cavernous helicine arterioles during the various phases of the erectile cycle. Our preliminary study suggests that the helicine arterioles are functionally inactive during penile flaccidity while they are activated during penile tumescence and continue to supply blood to the corpora also during maximum penile rigidity.

Genital plus audiovisual sexual stimulation following intracavernous vasoactive injection versus re-dosing for erectile dysfunction--results of a prospective study

PURPOSE

We assessed whether re-dosing of a vasoactive agent or the combination of a vasoactive injection and genital plus audiovisual sexual stimulation caused the greatest erectile effect to determine which of the 2 procedures would be better for dynamic penile color Doppler sonography in patients with erectile dysfunction.

MATERIALS AND METHODS

A total of 20 consecutive patients with erectile dysfunction underwent 2 sessions under real-time RigiScan* recording of penile erection. Session 1 consisted of adaptation in 10 minutes, intracavernous injection of 10 micrograms. alprostadil in 10 minutes and re-dosing of 10 micrograms. alprostadil in 10 minutes. Session 2 consisted of adaptation in 10 minutes, injection of 10 micrograms. alprostadil in 10 minutes and genital plus audiovisual sexual stimulation in 10 minutes. The total duration of each session was 30 minutes. The order of the 2 sessions was randomly assigned with a week interval between each session.

RESULTS

Re-dosing and genital plus audiovisual sexual stimulation caused a significant increase in erectile response compared to the result seen after the first injection (re-dosing p < 0.05, injection plus stimulation p < 0.01). However, erectile response after the genital stimulation session was significantly greater than that after re-dosing (p < 0.01). An erection comparable to the greatest spontaneous erection reported by the patient was much more frequently achieved after genital stimulation than after the re-dosing session (p < 0.01).

CONCLUSIONS

The combination of injection and stimulation caused a significantly greater erectile response than re-dosing. We suggest that the former should always be used during color Doppler sonography to optimize the accuracy of the test. Re-dosing is suggested when an incomplete erectile response occurs after the injection plus stimulation phase.

Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial

PURPOSE

This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy.

MATERIALS AND METHODS

A total of 30 potent patients with clinically localized prostate cancer (clinical stage B1 or B2, Gleason sum 7 or greater, prostatic specific antigen less than 20 ng./ml.) underwent nerve-sparing radical retropubic prostatectomy and was subsequently randomized to alprostadil injections 3 times per week for 12 weeks (group 1, 15 patients) or observation without any erectogenic treatment (group 2, 15 patients). Patients were assessed at the 6-month followup by sexual history, physical examination, color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections.

RESULTS

In group 1, 12 patients (80%) completed the entire treatment schedule and were evaluated at the long-term followup. Eight patients in this group (67%) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse, compared with 3 patients (20%) in group 2. The difference between the 2 groups was statistically significant (p <0.01). In group 1, all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing, whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them. In these patients, failures were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients with normal erections showed both normal nocturnal testing and penile hemodynamics, whereas failures were the result of cavernous veno-occlusive dysfunction (8 cases, 53%), cavernous arterial insufficiency (2 cases, 13%) or cavernous nerve injury (3 cases, 20%). Complications in patients treated with alprostadil injections accounted for 2 cases (13%) of a penile nodule and 1 further case (6%) of prolonged penile erection. Complications were not seen in group 2 patients.

CONCLUSIONS

Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. It is our belief that programmed vasoactive injections improve cavernous oxygenation, thereby limiting the development of hypoxia-induced tissue damage. The potential complications related to the use of intracavernous injections must be clearly explained to patients.

A size-standardized analysis of soft tissue facial profile during growth

A method for the quantitative and qualitative analysis of the facial soft tissue profile has been developed and applied to analyze the age differences in lateral cephalograms for the annual Bolton standards from ages 1 to 18 years. To standardize for different facial sizes, profiles were traced in polar coordinates without modifications of facial shape. Most of the soft tissue landmarks showed progressive modifications from birth to 18 years of age. Soft tissue nasion and lower lip had a steep change between 2 and 3 years of life, pronasale between 3 and 5 years of life, A', upper lip, and stomion between 4 and 5 years of life. Hereafter, all these landmarks but N' had several minor modifications progressing toward the adult value. Soft tissue nasion did not modify significantly after 2 years of age. Conversely, changes in the relative positions of B' and Pg' were more scattered in the analyzed period. Age-related size differences were more linear than shape modifications, with gradual increments from 1 to 18 years of age. The method allowed a simple and rapid quantitative evaluation of soft tissue profiles during facial growth. An approximate evaluation of the soft tissue thickness at nose, lips, and chin was also possible. No particular mathematical knowledge was required at any step of the analysis. Results were in good agreement with the well-known patterns of normal growth and development, thus confirming the practical possibilities of the method.

Statistical evaluation of Monson's sphere in healthy permanent dentitions in man

The three-dimensional curvature of the mandibular dental arch was studied in 20 men and 20 women with sound dentitions and free from temporomandibular joint problems. The x, y, z coordinates of cusp tips of all but the third molars were obtained with a three-dimensional digitizer, and used to derive a spherical model of the curvature of the occlusal surfaces. From the best interpolating sphere the radii of the left and right curves of Spee (quasi-sagittal plane) and of the canine and molar curves of Wilson (frontal plane) were computed. The occlusal curvature of the mandibular arch was not significantly influenced by gender, even if, on average, all the computed variables were larger in men than women. The radii of the overall sphere, right and left curves of Spee, and curve of Wilson in the molar area were about 105 mm in men, and about 100 mm in women. A relatively large intrasample variability in arch curvature was found. The mean sphere radius in men was very close to the classical value of 4 in, confirming Monson's observations, but the relatively large intrasample variability prevented any definitive determination of a sexual dimorphism in the three- dimensional characteristics of occlusal curvature.

Open-close movements in the human temporomandibular joint: does a pure rotation around the intercondylar hinge axis exist?

Mandibular movements near the maximum intercuspal position were analysed for the location of the mean instantaneous centre of curvature of the interincisal point path. Measurements were performed using a kinesiograph in 28 healthy young adults with sound dentitions and free from temporomandibular joint disorders. The subjects performed habitual open-close cycles at different speeds; opening movements starting from the centric relation occlusion were also analysed. In none of the 28 subjects was the interincisal point path derived from pure rotation movements performed around the intercondylar axis, not even in the first millimetres of motion. Translation and rotation were always combined, and the position of the centre of curvature changed during the motion, showing different characteristics in the open and close movements; these patterns were also dependent upon motion speed. The results show that the hinge axis theory cannot explain the mandibular movements because a pure rotation did not occur around the intercondylar axis.

AMS 700 CX inflatable penile implants for Peyronie's disease: functional results, morbidity and patient-partner satisfaction

This study was designed to clarify the functional results, morbidity and the patient-partner satisfaction observed with, the American Medical System 700 CX three-piece inflatable prosthesis in the treatment of impotence associated with Peyronie's disease. Thirty-three patients were treated and additional plaque surgery was performed in 13 cases (40%). Within 10 days of surgery, four patients (12%) developed a wound infection which was treated conservatively and one patient (3%) experienced glandular ischemia. At the 6-week follow-up, complete penile straightening was achieved in 23 patients (70%), while penile rigidity was considered optimal by all patients. On the contrary, the penis was considered short by 10 patients (30%). Five diabetic patients (15%) complained of severe scrotal and penile pain during full activation of the implant and in one of these patients (3%) the implant had to be removed. Due to spontaneous erections occurring after implant activation one patient (3%) required replacement of the reservoir from the Retzius space into the peritoneum. At the long-term follow-up (mean +/- SE: 17 +/- 2.2 months), 23 patients were evaluated and all found to be engaging in intercourse with the prosthesis. However, five patients (21%) and three of the 13 partners (25%) assessed were not yet completely satisfied. The American Medical System CX700 inflatable penile prosthesis obtains complete penile straightening in 70% and rigidity in 100% of impotent patients with Peyronie's disease. Patients should be fully informed about possible surgical morbidity and actual post-operative penile length.

The effect of intracorporeal injection plus genital and audiovisual sexual stimulation versus second injection on penile color Doppler sonography parameters

PURPOSE

We assessed whether genital and audiovisual sexual stimulation following 1 or 2 intracorporeal injections caused the greatest changes in penile hemodynamics as recorded by color Doppler sonography.

MATERIALS AND METHODS

A total of 50 impotent patients underwent multiphasic color Doppler sonography of the cavernous arteries before and after intracorporeal injection (phase 1), subsequent genital and audiovisual sexual stimulation (phase 2), a second injection (phase 3) and repeat genital and audiovisual sexual stimulation (phase 4). Peak systolic velocity, end diastolic velocity, resistance index and erectile response were studied.

RESULTS

Penile erection after injection 1 was upgraded in 41 patients (82%) by genital and audiovisual sexual stimulation. Further upgrading due to injection 2 with stimulation was noted in 11 patients (22%). Among the patients who completed the 4 phases of the test the maximal peak systolic velocity was noted after 1 and 2 injections in 20 (59%) and 14 (41%), respectively. The resistive index was always increased by genital and audiovisual sexual stimulation compared to post-injection values. The maximal resistive index occurred after initial and repeat genital and audiovisual sexual stimulation in 15 (48%) and 16 (52%) patients, respectively. After injection 1 with genital and audiovisual sexual stimulation, impotence was diagnosed as nonvasculogenic in 14 patients (28%), arteriogenic in 9 (18%), venogenic in 17 (34%) or mixed arteriovenogenic in 10 (20%). After injection 2 with stimulation these results were noted in 18 (36%), 9 (18%), 13 (26%) and 10 (20%) patients, respectively. Thus, there were 4 false-positive cases (8%) of venogenic impotence.

CONCLUSIONS

To study cavernous artery inflow and veno-occlusive function, color Doppler sonography should be performed after injection plus genital and audiovisual sexual stimulation. When the erectile response does not equal the maximal physiological erection reported by the patient, a second injection with stimulation should be given.

Fourier analysis of human soft tissue facial shape: sex differences in normal adults

Sexual dimorphism in human facial form involves both size and shape variations of the soft tissue structures. These variations are conventionally appreciated using linear and angular measurements, as well as ratios, taken from photographs or radiographs. Unfortunately this metric approach provides adequate quantitative information about size only, eluding the problems of shape definition. Mathematical methods such as the Fourier series allow a correct quantitative analysis of shape and of its changes. A method for the reconstruction of outlines starting from selected landmarks and for their Fourier analysis has been developed, and applied to analyse sex differences in shape of the soft tissue facial contour in a group of healthy young adults. When standardised for size, no sex differences were found between both cosine and sine coefficients of the Fourier series expansion. This shape similarity was largely overwhelmed by the very evident size differences and it could be measured only using the proper mathematical methods.

A computerized non-invasive method for the assessment of human facial volume

The three-dimensional coordinates of 22 standardized soft-tissue facial landmarks were used in the definition of a three-dimensional model of the adult human face. The model allows the estimation of the volume of the face in toto and of its parts (upper, middle and lower thirds, nose). Landmark coordinates were collected in 80 healthy young adults (40 men and 40 women selected according to criteria of dentofacial normality) by infrared photogrammetry by an automated instrument, and facial volumes calculated. Sample variability was larger in women than in men; the nose and the upper third of face had the largest variability regardless of gender. On average, all volumes computed in men were significantly larger than the corresponding values computed in women. Also the lower-to-middle third face ratio was significantly higher in men than in women. The sexual dimorphism in human facial volume did not involve the different parts of the face to the same extent: a large part of male facial volume preponderance was explained by the lower third of face. The proposed facial model could adequately represent the human face in all those research and clinical fields where noninvasive surface measurements could be employed alone or in support of conventional radiographic data.

Is there a role for transrectal microwave hyperthermia in the treatment of benign prostatic hyperplasia? A critical review of a six-year experience

We critically reviewed our 6-year experience with transrectal microwave hyperthermia of the prostate for benign prostatic hyperplasia (BPH) in 320 patients either at high surgical risk or refusing surgery. Transrectal prostatic hyperthermia was given in five to ten 60-minute sessions with an intraprostatic temperature ranging from 42 degrees to 43.5 degrees C. Although an amelioration of symptoms and urodynamic measures was seen initially in most patients, only residual urine volume showed a statistically and clinically significant improvement at the long-term follow-up. According to maximum flow nomograms, bladder outlet obstruction was not resolved by the treatment. We conclude that although the transrectal hyperthermia proved to be a safe procedure, it did not cure BPH in the long term. Considering the results seen with newer nonsurgical procedures such as prostatic stents and prostatic lasers, we believe that transrectal hyperthermia should not be recommended to symptomatic BPH patients.