analysis

Purpose:Accurate patient positioning is crucial in radiation therapy. To fully benefit from the preciseness of proton therapy, image guided patient positioning and verification system is typically utilized in proton therapy. The purpose of this study is to evaluate the inter-observer variability of image alignment using a commercially available patient positioning and verification system in proton therapy. Methods:The VeriSuite patient positioning and verification system (MedCom GmbH, Darmstadt, Germany) provides a six degrees of freedom correction vector by registering two orthogonal x-ray images to digitally reconstructed radiograph (DRR) images that are rendered in real time from the planning computed tomography (CT) images. Six cases of various disease sites, including brain, head & neck, lung, prostate, pelvis, and bladder, were used in this study. For each case, the planning CT images and a daily orthogonal x-ray portal image pair were loaded into the VeriSuite system. The same set of x-ray images and CT images for each case were reviewed and aligned separately by each of the 10 radiation therapist, following the clinical procedure for the corresponding disease site. The resulting correction vectors were then recorded and analyzed. Results:Our study shows that the inter-observer variation (One standard deviation) in image alignment using the VeriSuite system ranged from 1.2 to 2.0 mm for translational correction and from 0.6 to 1.3 degrees for rotational correction for the six cases. The use of fiducial markers for prostate patient alignment achieved the least inter-observer variation while the bladder case produced the largest. Conclusions:Inter-observer variation in image alignment could be relatively large, depending on the complexity of patient anatomy, image alignment approach, and user experience and software limitations. Automatic registration and fiducial markers could potentially be used to align patient more accurately and consistently. To ensure adequate tumor coverage in proton therapy, inter-observer variability in patient alignment should be carefully evaluated and accounted for in patient setup uncertainty analysis and treatment planning margin determination.

Veterinary and agricultural surfactants are supposed to be inert additives, yet these substances commonly exert biological side-effects, in given cases synergistic with those of the active ingredients of these preparations. This is explicitly seen in altered toxicity of veterinary or pesticide formulations compared to their active ingredients alone. Neither the individual effects of these excipients, nor such combination effects are well-studied in toxicology, and therefore, possible toxicity consequences are occasionally not being considered at sufficient significance in the authorization, use and control of these substances. Risk assessment of these substances should cover all hazards they may represent, and corresponding levels of exposure. Surfactants used in veterinary and pesticide formulation enter the environment either by direct dispersion or by indirect release through excrement, leaching, sewage waters or sludge, and in turn, create potential exposure to a number of non-target organisms. Biochemical and (eco)toxicological hazards recently identified regarding certain agricultural surfactants include cytotoxicity (on cell lines of epithelial, neural and other tissues, as well as stem cells and tumor cells), endocrine disrupting effects, as well as aquatic ecotoxicity. This Mini Review summarizes toxicological effects identified in our studies in aquatic toxicity tests, in cell viability and cytotoxicity tests, in estrogenic activity assays, correlated with biochemical analysis of the surfactants and their decomposition. The conclusions are hoped to facilitate environmentally precautious revision of surfactants widely used in agriculture.

In gamma-ray spectrometry, the analysis of the environmental radioactivity samples (soil, sediment and ash of a living organism) needs to know the linear attenuation coefficient of the sample matrix. This coefficient is required to calculate the self-absorption correction factor through the sample bulk. In addition, these parameters are very important because the unidentified samples can be different in the composition and density from the reference liquid sources which are usually used for efficiency calibration in the radioactive monitoring process. The present work is essentially concerned to introduce a mathematical method to calculate the linear attenuation coefficient without using any collimator. This method was based mainly on the calculations of the effective solid angle subtended by the source-to-the detector configurations, the efficiency transfer technique and the average path lengths through the samples itself. The method can be used as a tool for the calculation of the linear attenuation coefficient of unidentified materials with good facility to use it in the calibration process of γ-ray detectors, particularly in the study of soil samples. The results are compared with the data from NIST-XCOM to show how much the results are in close agreement and to give the validity of the approach.

Determination of the detector efficiency using volumetric cylindrical sources is very important in various scientific and industrial fields, especially in the field of quantitative analysis. To calculate the absolute activity of any sample, the full-energy peak efficiency (FEPE) of the detector is needed. By applying the efficiency transfer method, the FEPE of the detector would be determined easily without using the standard sources. This approach depends on two main factors. The first one, is the reference efficiency of the reference source, which is determined experimentally, and the second one, is the calculation of the effective solid angle ratio between the sample and the reference source geometries. This work introduces an empirical formula for calculating the second factor for using two different sizes of NaI(Tl) detectors. The validity of this empirical formula was successfully demonstrated by comparing the calculating values with the experimental values.

Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years. In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results. Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum. Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis. Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.  

Before discussing the crux of the matter, it is important to understand what “wild” signifies and the characteristics that define a wild animal. As contrasted to domesticated animals, a wild animal can be defined as an animal living freely in his natural habitat, independently of Man. These animals are only exposed to variations in the biological equilibrium, to the imperatives of their genetic program and live in a habitat that gives them the possibility of expressing it themselves. However, this definition is very narrow as there exist a number of species of wild animals that don’t live freely in their natural habitat. These animals are constrained by Man, who by creating a relationship of dependence, controls them and in turn becomes responsible for their sustenance. In such a situation, their habitat is no more their natural habitat but than which has been imposed on them by Man; such animals are said to be “held in captivity” or even “tamed”. In short, when talking about law and ethics related to wild animals, there are two things to be taken into account: wild animals that live in the wild and wild animals that live held in captivity by Man.

A survey was carried out to determine the prevalence and seasonal variations of eggs of gastrointestinal nematodes in goats in four provinces of Mozambique, from November 2016 to October 2017 in Tete and Cabo Delgado, and from November 2016 to October 2018 in Maputo and Gaza. In each province, flocks were selected from both lowlands, located within the valleys of the rivers, and uplands which are located outside the valleys. Faecal samples were collected at monthly intervals to monitor faecal egg counts fluctuations. The modified McMaster technique was used for quantitative analysis of nematode eggs and for detecting cestode eggs in faecal samples. The sedimentation technique for detecting trematode eggs in faecal samples was used. A total of 2 703 samples were examined for nematode eggs and 2 587 for trematode eggs. Faecal examination indicated that between 18% and 100% of goats sampled were infected with gastro-intestinal nematodes. The prevalence varied according to the season of the year and the ecological conditions. The highest prevalence and worm egg counts were recorded at about the peak of the rainy season. Strongyloides papillosus, Calicophoron spp., Fasciola spp. and Schistosoma mattheei eggs were also found. Moniezia expansa and Moniezia benedeni eggs were found in all the four study areas but its prevalence was low and irregular. Based on the results of this study, which showed a clear seasonal pattern, strategic anthelmintic medications to effectively control helminth infections in goats in the different ecological zones of Mozambique are suggested.

The main method for evaluation of healing processes of the jaws in oral and maxillofacial surgery are radiological diagnostics. Quantitative description is possible by measuring the relative bone density, which puts the mean grey value of a certain area in relation to the surrounding bone tissue. In this research the intra- and interindividual variability is determined for this method and a standard operation procedure is elaborated. Therefore ten panoramic radiographs of typical surgical indications in oral a maxillofacial surgery were analyzed by three different members of the workgroup, five times each. The measurements were analyzed with descriptive and comparative statistical methods. The mean coefficient of variation was 2.972% ± 2.361%. The measurements of defect regions were more consistent (2.252% ± 1.928%) than the measurements of surrounding bone (3.691% ± 2.626%). The analysis of variance did not show a statistically significant influence of the different raters to the measurements (ANOVA, Pr>F = 0.9462). Following the standard operation procedure this method seems to be an easy, cheap and close to practice way to visualize healing process of the jaws. Especially in the mandibula, but also in the maxilla with special reconsideration of the sinus-region, it seems to be suitable.

Aim: To evaluate sexual dimorphism in horizontal lip position in adults with different skeletal patterns. Material and Methods: The sample comprised of 120 patients (Females 18 years and above, Males 21 years and above) with no history of previous orthodontic treatment or functional jaw orthopaedic treatment. They were divided into different groups based on the ANB angle and gender. Group I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0-4 degree). Group III and IV included 30 males and 30 females with skeletal class II malocclusion respectively (ANB above 4 degree). Results: When comparison between males and females (Class I+Class II) was done S-line (p<0.001), B-line (p<0.001), E-line (p<0.001), Holdaways angle (p<0.001) and Merrifield angle (p<0.001) were found to be statistically significant. S-line (p<0.001), E-line (p<0.001) and Holdaways angle (p<0.001) were found to be statistically significant when comparison was done between males and females (Class I). When comparison was done between males and females (Class II) only Holdaways angle (p<0.001) showed a significant statistical difference. Conclusion: Sexual dimorphism was found in various lip parameters. Significant amount of differences were found between Class I and Class II (male and female) subjects.

Objectives: The aim of the study was to develop a mathematical model for the visualization and evaluation of transversal palatal soft tissue changes; and to carry out a statistical evaluation of the changes in vertical and sagittal dimensions after rapid maxillary expansion treatment. Material and Methods: 33 Caucasian children with posterior crossbite, 10 boys and 23 girls, aged 7 to 10 years (median 8 years 8 months) were treated with tooth-borne Haas type expander. Dental casts were digitalized by scanner and on the basis of quantitative mesh shape CPD-DCA analysis, coloured morphometrical maps were created. The statistical significance of individual vertex displacements was calculated by performing Hotelling’s T2 paired test. To determine the significance of the vertical and sagittal profile changes, the paired t-test and Wilcoxon signed rank test were carried out in 20 patients Results: Visualization of the palatal soft tissue widening showed it to be greatest in the areas of the second deciduous and first permanent molars with maximum of 0.75 mm for each palatal side. Hotelling’s T2 paired test showed significant differences of p<0.01 in transversal width dimension. Cephalometric measurements of the changes to vertical and sagittal dimensions were statistically evaluated using the Wilcoxon and paired t-tests, and were shown to have insignificant values of p>0.05. Conclusion: The expansion appliance in children resolved the crossbite and led to palatal widening, which was clearly visualized by creating mathematical morphometric models. The cephalometric measurements carried out did not reveal statistically significant relevance in changes to facial vertical or sagittal dimensions.

Background & Objectives: Fluoride releasing bonding agents can help the orthodontist to minimize enamel demineralization independent of patient cooperation. This in vivo study was conducted to evaluate the efficacy of resin modified glass ionomer cement (RMGIC) on reducing enamel demineralization around orthodontic brackets and confirm the superior caries-preventive effect of RMGIC by assessing the mutans streptococci (S. mutans) in plaque samples in vitro. Methods: 60 subjects (aged 14-20 years) scheduled to have premolar extractions as part of the orthodontic treatment plan were selected and randomly divided into 2 groups of 30 each (group 1: the brackets were bonded on the teeth using light cure composite resin and group 2: the brackets were bonded using RMGIC). Plaque scores (modification of plaque index by Silness and Loe) were recorded and plaque samples were collected before bonding, one week and one month after bonding. S.mutans colonies were recorded from the plaque samples inoculated on MSB agar plates, incubated under 95% N2 and 5% CO2 for 48 hours at 370C in a CO2 jar. After 1 month, the right maxillary and mandibular first premolars were debonded, extracted and depth of enamel demineralization area was estimated using polarized light microscope. Results: After statistical analysis, a significantly higher mean depth of demineralized lesions was noticed in group 1 as compared to group 2. A significant difference between occlusal and gingival depth was seen only in group 2, thus illustrating a wedge effect. In group 1, a statistically significant increase in the mean colony forming units (CFU) of S.mutans has been noticed at different time intervals whereas in group2, a significant increase was observed only at 1month. Unlike at 1 month, a statistically significant difference in mean CFU between group 1 and group 2 has been observed at 1 week (P<0.05). Conclusions: Enamel lesions adjacent to the bracket base on teeth bonded with the RMGIC were smaller than those on teeth bonded with a composite resin. The high “burst effect” of fluoride release for the first few days of RMGIC after bonding is confirmed by statistically significant reduction in CFU counts of S. mutans in plaque.

Necrotizing fasciitis is a quickly progressing soft tissue infection that can be described with diffuse necrosis of subcutaneous tissue and superficial fascia. The cause of this can be infectious process of odontogenic origin, most commonly caused by mixed gram+ and gram- , aerobic and anaerobic microorganisms that are found in patients that are predisposed to infections. In a case of undiagnosed illness, there is a possibility of life threatening complications. This case analysis introduces the diagnostic criteria of the disease and treatment plan, encouraging doctors to devote more attention to prevention of infections. 

Background: Post abortion family planning (PAFP) is the initiation and use of family planning methods immediately after, and within 48 hours of an abortion, before fertility returns. In most women fertility returns on average about two weeks after an abortion; however, ovulation can occur as early as 11 days post-abortion. Objective: To assess utilization of post abortal contraceptive use and associated factors among women who came for abortion service at Debre Berhan Referral Hospital, Debre Berhan, Ethiopia March 2019. Methodology: Institutional based cross sectional study design was conducted using hospital data obtained from Gynecology ward in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia, from March 1 -10, 2019. A systematic random sampling technique was used from the abortion register log book. Data was cleaned manually, coded and entered into Epi-data version 3.1 then exported to and analyzed by SPSS version 21 software. Multivariate analysis with AOR, 95% CI and p-value< 0.05 were used to identify variables which have significant association. Result: The finding of the current study showed that among 371 study subjects 170(45.8%) utilized post abortal family planning. There was a significant association between utility of post abortal family planning and post abortion family planning counseling [AOR: 19.245, 95% CI: (10.199, 36.313), p-value= 0.001] and women who were primiparous had 5 times more likely to utilize post abortal family planning as compared to the women who were nullyparous [AOR: 5.314, 95%CI (1.089, 24.210), p value=0.001]. Conclusion and Recommendation: From a total of 371 study subjects 45.8% have utilize contraceptive after abortion service received. This study also showed that parity and counseling’s of family planning were statistically significant associated with utilization of post abortal family planning. We recommend Debre Berhan hospital to scale up activities on post abortal care to increase the number of clients who post abortal family planning.

Background: Accessibility to healthcare is a major component of primary health care campaign for maintaining population health. Owing to this, the government of Ghana has instituted the free maternal care and focused antenatal care policies into the maternal health care policies to woefully control maternal mortality, morbidity and to ensure improved access, quality and continuous ANC use among pregnant women. Despite these interventions, pregnant women in the Kwabre East Municipality do not fully use ANC services as recommended by the World Health Organization. Methods: Using an in-depth interview and two focus groups conducted with women of reproductive age (15-49) in the Kwabre East Municipality. The study investigated women’s opinions, perceptions and experiences on their ANC visits. Results: The study revealed that physical accessibility and the social context of pregnant women continue to influence their ANC use even after the introduction of the free maternal care and focused antenatal care policies. Conclusion: The study suggests that in order to fully utilize ANC visits as recommended by the WHO in the Kwabre East Municipality, the Municipal Health Directorate should liaise with collaborating stakeholders if not eliminating to limit the influence of restrictive factors to women’s quest of using ANC. It is further recommended that management do away with hindrances that delay women who seek for ANC services in health facilities and adopt strategies and procedures that aim at increasing ANC uptake.

Background: Previous studies highlighted the negative effect of premature progesterone elevation (PE) during IVF cycles on the cycle outcomes. The aim of this study was to assess the validity of progesterone level on hCG day (P4) in the prediction of IVF/ICSI cycles’ outcome. Methods: In a retrospective cohort study, all fresh cycles of 256 patients who underwent IVF or ICSI cycles in 2017 at reproductive endocrinology & infertility unit/ Obg/Gyn department at King Abdulaziz Medical city, Riyadh, Saudi Arabia, were followed up. They were started on gonadotropin medications for ovarian hyperstimulation, followed by serial transvaginal U/S and serum estrogen levels each visit. Patients having 2 or more 18mm follicles were triggered by hCG 10,000 IU and ovum pickup was done 34-36 hrs after. Data were collected on patients’ characteristics [age, BMI infertility type], cycles’ characteristics [number of follicles and endometrium thickness on hCG day, P4 and estrogen levels], rates of pregnancy and pregnancy outcomes. Receiver operating characteristic curve was applied to determine the cut-off of P4 that corresponds with a negative pregnancy test. Logistic regression analysis was used and significance was considered at p - value of ≤0.05. Results: Pregnancy rate in the study sample was 36.7%. The mean P4 level in cycles with negative pregnancy tests was significantly higher than the mean in cycles with positive tests (p = 0.018). After adjusting for confounders, significant negative association between P4 and pregnancy rate was evident (p < 0.03). The optimum trade-off of P4 for prediction of a negative pregnancy test was 1.5nmol/L. This cut-off level had a 59% sensitivity, 51% specificity and 68% positive predictive value and 10% & 15% absolute and relative risk reductions respectively. Cycles with mean P4 of ≥1.5nmol/L were significantly associated with primary infertility (p = 0.011), lower mean BMI (p = 0.009) higher mean estrogen level (p < 0.001), lower live birth rate (p = 0.048), higher abortion rate (p = 0.039), and higher ovarian hyperstimulation rate (p = 0.027). Conclusion: Premature elevation of progesterone level on the hCG day in IVF/ICSI cycles may have adversely impacted the pregnancy rate and pregnancy outcome. The cutoff point of 1.5nmol/L for this P4 was not valid in predicting pregnancy outcomes. 

Purpose: To evaluate changes in children with bilateral cleft lip and palate (BCLP) who premaxillary osteotomy and secondary alveolar bone grafting as compared to children with BCLP who are not indicated for surgery, and to determine variables that differentiate patients who do or do not require osteotomy. Material and methods: Twenty-four children with BCLP were included in the study: 12 who underwent osteotomy (intervention group) and 12 who had no surgery (control group). Radiographic and model values of the intervention group were compared before (T1) and after (T2) premaxillary osteotomy, and measurements were compared with those from the control group at T1. Results: Convexity, ANB (point A-nasion-point B), and maxillary depth was more diminished at T2 in children in the intervention group. Point A, anterior nasal spine, and pogonion were retroposed after surgery, and the anterior spine was higher. At T2, the upper incisors were proinclinated and intruded, and overbite was improved. Models revealed increased intermolar intercanine width as well as intrusion of upper incisor after surgery. Premaxilla and upper molars were more extruded, had a higher total maxillary height and increased extrusion of upper incisor in children who underwent osteotomy. Conclusion: After surgery, children who undergo surgery have a premaxilla that is more normalized and more level with the occlusal plane, as well as improved dental inclination. Variables that differentiate children who require osteotomy from those who do not include more extrusion and protrusion of the premaxilla, and a greater extrusion of the upper incisors.

A clinical case of treatment of two severe intrabony defects on the aesthetic zone is reported and followed for one year. The biomaterial of choice was enamel matrix derivative (Emdogain®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique. After surgical treatment, the patient was kept in a supportive periodontal therapy programme with 6-month interval between appointments. In the one year after surgery appointment, clinical and radiographic changes were observed, showing periodontal health and stability. 

Background: The effect of salpingectomy on ovarian response is a matter of debate. Due to conflicting data, alternative techniques were developed to perform salpingectomy for treatment of hydrosalpinges in infertile patients. This study aims to evaluate the effect of salpingectomy on ovarian response after stimulation with gonadotropins. Methods: In a retrospective analysis, one hundred fifty-seven patients with tubal infertility were divided into three groups according to their surgical histories: bilateral salpingectomy (BS group); unilateral salpingectomy (US group); and no history of salpingectomy (NS group). Ovarian response and IVF outcomes were compared between groups by analysis of variance. Prognostic factors for ovarian response were estimated by linear regression models. Results: In the BS group, the total numbers of oocytes retrieved, and embryos obtained were significantly lower than those in the NS group (p = 0.02). Poor ovarian response was also more frequent in the BS group (p = 0.02). In the US group, follicle development was reduced on the operated side. This effect was more pronounced when salpingectomies were performed for hydrosalpinges than when performed for ectopic pregnancies, and significant decreases were observed in follicle recruitment (p = 0.005) and oocyte retrieval (p = 0.02) on the operated side. Conclusion: Salpingectomy could have a minor negative effect on ovarian response. This is particularly true with bilateral salpingectomies, in which the ovarian blood supply could be disrupted, with no possible compensation by the contralateral side.

The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques. Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO “Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine” from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in “before hemorrhage” period, in acute or “cold” period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as “Effective”. Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the “effective” reconstructive occlusion of AA cavity. The evaluation of the AA complexity criteria prognostic significance to achieve the “effective” primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II. There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS. It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and “cold” periods. There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p>0.05). It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion. Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn’t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability.

Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could influence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern. Methods: Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed: √ a statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test √ a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off √ a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2 √ a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4 √ a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4 √ in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses Interpretation: In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re-learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability. The proprioceptive profile of our rehabilitative program could promote the pro-adaptive and facilitation properties of a personalized gait control, induced by an innovative dynamic ankle foot orthoses with a modulable ankle joint system called Neuroswing. In the daily clinical practice, the personalized integration of a neurorehabilitative program and DAFONS can perform an individualized peripheral neuro-facilitation of gait cycle (peripheral perceptive facilitation), a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation DAFONS induced) and an increase of patient’s motor abilities and quality of life in all daily performances.