Full Tilt Epub

[Aimon Jardine]

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Review methods: This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies.The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool.

Results: 6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria: five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness.

In clinical practice the degree of pelvic tilt is commonly assessed because of its reported relationship to pelvic, spinal and lower limb pathologies. There is little normative data presented within the literature establishing typical findings within an asymptomatic population from which to make comparisons in pathological populations. The aim of this study was to report typical pelvic angle in an asymptomatic populations and also the degree of side-to-side asymmetry which might exist within the pelvis. Pelvic angle was measured by finding the angle from horizontal of a line between the anterior superior and posterior superior iliac spines of the ilium using a PALM palpation meter in 120 healthy subjects (65 males, 55 females) with a mean age of 23.8(2.1) years. 85% of males and 75% of females presented with an anterior pelvic tilt, 6% of males and 7% of females with a posterior tilt and 9% of males and 18% of females presented as neutral. There was significant difference in pelvic angle between sides for males (p = 0.002) but a non-significant difference between sides for females (p = 0.314). But the difference in angle for males between sides was less than the smallest detectable difference statistic found in the reliability study, so most likely to be due to measurement error.

Hypothesis/background: Reverse shoulder arthroplasty is being used with greater frequency for patients with severe rotator cuff deficiency. There are several commercially available reverse shoulder devices, each with different glenosphere options. The purpose of this study was to determine: (1) forces at the baseplate-bone interface in glenospheres with centers of rotation located concentrically and eccentrically to the center of the baseplate; and (2) if baseplate-bone forces can be optimized by altering tilt of the baseplate.

Methods: A validated computer model was used to compare concentric glenospheres with neutral offset to eccentrically offset glenospheres (6 mm inferior or 6 mm lateral) in 3 baseplate tilts: 15 inferior, neutral, or 15 superior. A baseplate, simulated bone, screws, and humeral component were modeled, and forces underneath the baseplate were calculated as the arm was abducted through 90 of glenohumeral motion.

Results: For lateral and concentric glenospheres, inferior tilt provides the most even distribution of forces (mean difference in force between superior and inferior portions of baseplate: 11.3 N and 24.7 N, respectively) and superior tilt provides the most uneven distribution of forces (109.3 N and 78.7 N, respectively). For inferior eccentric glenospheres, inferior tilt provides the most uneven distribution of forces (58.7 N) and neutral tilt provides the most even distribution of forces (27.7 N).

Conclusion: This is the first study to investigate force distribution under the baseplate in inferior eccentric glenospheres. Although inferior tilting of the baseplate is recommended for concentric and laterally offset glenospheres, this same recommendation may be detrimental to inferiorly offset glenospheres and warrants further investigation.

Syncope in pediatrics represents an important cause of visits to the emergency units. For this reason, excluding a cardiac or malignant origin is essential at the time of the initial approach to determine what is the next step in management, or if they need to be referred to a pediatric cardiologist and/or electrophysiologist. Vasovagal syncope is the most frequent cause of syncope in pediatrics, in which a detailed clinical history is enough to make the diagnosis. If no diagnosis is concluded by the history, or if it is necessary to define the hemodynamic response of the patients, the head-up-tilt-test is indicated; this will trigger syncope due to an orthostatic stress caused by the angulated table (passive phase). If a negative response remains, it can be followed by a pharmacologic challenge to trigger the hemodynamic response, which is still controversial in pediatrics. The pharmacologic challenge increases the sensitivity with a slight reduction in test specificity. Although there is not a specific drug for the challenge in pediatric patients yet, the most commonly drugs used are nitrates and isoproterenol, the latter related to a great number of adverse effects. Sublingual administration of nitrates in the challenge has been proven to be ideal, effective, and safe in this specific age group. The aim of this article is to make a literature search to demonstrate the effectiveness and safety of the pharmacologic challenge during the head-up-tilt-test in pediatrics, emphasizing a study conducted at the National Institute of Cardiology with isosorbide dinitrate.

When presented with atrophic arches, clinicians often turn to invasive techniques such as bone grafting or maxillary sinus augmentation. However, using tilted implants instead can avoid these aggressive procedures, allowing the implant support to be moved posteriorly and for longer implants to be chosen. The implants can be loaded immediately to support a full-arch fixed prosthesis in multiple configurations, such as All-on-4, transsinus implants, zygomatic implants, or the authors' signature V-II-V technique. This book first presents the science and clinical evidence behind the various protocols using tilted implants, then proceeds to discuss patient evaluation, diagnostics, and planning before diving into the methods themselves. Procedures are discussed separately for each arch, highlighted by dozens of clinical cases representing a diverse range of initial situations. In addition to the surgical protocols, methods for fabricating provisional and definitive prostheses are laid out with each step illustrated and explained. This comprehensive volume truly covers everything a clinician needs to know to use tilted implants with great success for their patients.

Contents

Chapter 01. The Biology of Osseointegration

Chapter 02. Osseointegration in Immediate Loading

Chapter 03. Immediate Loading with Tilted Implants

Chapter 04. Advantages of Tilting Dental Implants

Chapter 05. Evaluation of Edentulous Patients

Chapter 06. Diagnostics and Planning for Complex Rehabilitation

Chapter 07. Rehabilitation of the Compromised Patient

Chapter 08. Rehabilitation Protocols for the Maxilla

Chapter 09. Rehabilitation Protocols for the Mandible

Chapter 10. Provisional Prosthetic Solutions

Chapter 11. Definitive Prosthetic Solutions

Dr Agliardi graduated with honors from the University of Milan in 1994, specializing in medicine and surgery. At the same university, he attained a specialization in maxillofacial surgery in 2000 and a specialization in orthodontics in 2005. Since 2009, Dr Agliardi has been in charge of the Special Rehabilitation Surgery department at the Department of Dentistry of IRCCS San Raffaele of Milan, and he is also a professor in the Special Rehabilitation Surgery Department at Vita-Salute San Raffaele University. For over 15 years, he has been involved in the implant-prosthetic rehabilitation of compromised patients with tilted and zygomatic implants.

Dr Romeo graduated with honors from the University of Milan in 2005, specializing in dentistry and dental prosthetics and with a thesis on the clinical efficacy of the All-on-4 protocol. He later obtained a doctorate from research in innovative techniques in oral implantology and implant-prosthetic rehabilitation, attending the dental clinic of the Galeazzi Institute of Milan before completing a year of study in periodontology at the Department of Periodontology and Implantology at New York University. He has been collaborating with Dr Enrico Agliardi for 14 years, carrying out clinical and research activities on immediate and partial and complete rehabilitations.

Coplanar arcs are used with limited arc range to prevent direct beam entrance through the lens, which is challenging for satisfactory planning of hippocampal sparing in whole brain radiotherapy (HS-WBRT) with VMAT. We evaluated the dosimetric impact of applying a head-tilting technique during VMAT, which allows unrestricted use of the arc range.

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