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Purpose: The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting. Methods: A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard. Results: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%). Conclusions: Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults.

This study investigates the long-term effects of demographic trends and admission rules on common properties in the Province of Trento, Italy, which we refer to as historical commons. Historical commons have evolved into socio-ecological systems over the centuries, meaning that communities governed collectively natural resources and lands essential for community survival. Communities and the admission rules that determine their composition are an important constituting element of historical commons because they have developed local ecological knowledge and practices of sustainable use of natural resources. Our study hypothesizes that commons continuity is endangered because of the declining trend of the size of communities being influenced by demographic trends coupled with admission rules. Grounding our research in systems dynamics, we use empirical data including demographic projections and existing admission rules to simulate their effect on the site of the community using the Province of Trento, Italy, as our study region. To achieve that, three types of historical commons are identified: open, semi-open, and closed, each with different admission criteria based on inheritance and/or residency. Results indicate that inheritance-based admission rules can significantly reduce the number of commoners over time, potentially endangering the continuity of these self-governance institutions. The study discusses the results in light of the literature on historical commons’ continuity to evaluate different policies affecting the size of the community grounding on different mental models. The study concludes that a simulation approach can promote an anticipatory approach to the co-design of policies to ensure inclusive continuity of historical commons.

La comunicazione del rischio ha un ruolo cruciale nella fase di preparazione e gestione degli eventi calamitosi come anche nella costruzione della fiducia tra cittadini e istituzioni. Le calamità naturali possono innescare processi di abbandono dei territori o indebolire ulteriormente comunità già fragili. La preparazione e la capacità di ripresa e adattamento delle comunità di fronte ad eventi come frane, alluvioni, o terremoti dipendono da una serie variabili, quali: percezione diffusa dei rischi, reciprocità e fiducia tra cittadini e tra cittadini e istituzioni, risorse disponibili (umane e materiali), preparazione e applicazione collettiva di comportamenti funzionali. L’obiettivo della ricerca qui presentata, parte del progetto MITIGO, è stato di raccogliere elementi utili a definire modelli di comunicazione e di auto-protezione in grado di aumentare la resilienza di comunità. Per raccogliere elementi riguardo questi processi è stato definito un questionario, somministrato in quattro piccoli comuni della Basilicata. Il questionario ha permesso non solo di trovare alcune risposte alle domande di ricerca ma anche di porne di nuove; ad esempio, ha permesso di identificare alcuni aspetti cruciali, quali: la variabilità del numero di abitanti effettivamente nel proprio comune tra giorni festivi e giorni lavorativi e tra diverse fasce orarie, il diverso livello di fiducia nella amministrazione comunale e nelle istituzioni in generale, il diverso grado di conoscenza dei rischi e dei comportamenti da attuare in caso di emergenza. Anche la reciprocità tra abitanti si è rivelata diversa. Le comunità di territori fragili hanno differenze ricorrenti; queste differenze se riconosciute possono guidare più efficaci programmi di comunicazione del rischio e di supporto alla resilienza di comunità. Dopo una panoramica sulle teorie e sui modelli di comunicazione del rischio si presentano alcuni suggerimenti utili a impostare progetti di comunicazione del rischio specifici per le comunità esplorate e per analoghe aree interne della Basilicata e per le aree montane in generale.

The amniotic membrane (AM) is the innermost part of the fetal placenta, which surrounds and protects the fetus. Due to its structural components (stem cells, growth factors, and proteins), AMs display unique biological properties and are a widely available and cost-effective tissue. As a result, AMs have been used for a century as a natural biocompatible dressing for healing corneal and skin wounds. To further increase its properties and expand its applications, advanced hybrid materials based on AMs have recently been developed. One existing approach is to combine the AM with a secondary material to create composite membranes. This review highlights the increasing development of new multilayer composite-based AMs in recent years and focuses on the benefits of additive manufacturing technologies and electrospinning, the most commonly used strategy, in expanding their use for tissue engineering and clinical applications. The use of AMs and multilayer composite-based AMs in the context of nerve regeneration is particularly emphasized and other tissue engineering applications are also discussed. This review highlights that these electrospun multilayered composite membranes were mainly created using decellularized or de-epithelialized AMs, with both synthetic and natural polymers used as secondary materials. Finally, some suggestions are provided to further enhance the biological and mechanical properties of these composite membranes.

The increasing uncertainties of all contemporary communities require future literacy, and strengthening the participatory dimension of foresight practice is part of the solution. The “Montagna 4.0 FutureAlps'” project involved high school students, teachers, businesses and stakeholders of Valtellina, Northern Italy, in local laboratories of participatory foresight through a co-design approach. This article briefly reports the project framework and the visioning exercises undertaken to build meaningful images of the future (2040). Such images should be able to question and broaden the current development visions of the Alpine Valley and inspire a collective design of its development trajectories by raising the community’s awareness of current and future changes. The activities took place over six workshops with three meetings each from September to December 2020, involving students (“@Scuola”), local stakeholders (“community lab”) and the general public and experts (“Open talk”). Each workshop focused on a specific topic, such as the mountain of tomorrow, sustainable innovation, social innovation and sustainable communities, protection, production and promotion, sustainable mobility and events for Alpine tourism. The outputs consisted of uncertainty scenarios, postcards from different futures and indications to make development strategies future-proof, which are all elaborated on in this article.

Purpose: To test a short 2-[18F]Fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET dynamic acquisition protocol to calculate Ki using regional Patlak graphical analysis in patients with non-small-cell lung cancer (NSCLC).Methods: 24 patients with NSCLC who underwent standard dynamic 2-[18F]FDG acquisitions (60 min) were randomly divided into two groups. In group 1 (n = 10), a population-based image-derived input function (pIDIF) was built using a monoexponential trend (10–60 min), and a leave-one-out cross-validation (LOOCV) method was performed to validate the pIDIF model. In group 2 (n = 14), Ki was obtained by standard regional Patlak plot analysis using IDIF (0–60 min) and tissue response (10–60 min) curves from the volume of interests (VOIs) placed on descending thoracic aorta and tumor tissue, respectively. Moreover, with our method, the Patlak analysis was performed to obtain Ki,s using IDIFFitted curve obtained from PET counts (0–10 min) followed by monoexponential coefficients of pIDIF (10–60 min) and tissue response curve obtained from PET counts at 10 min and between 40 and 60 min, simulating two short dynamic acquisitions. Both IDIF and IDIFFitted curves were modeled to assume the value of 2-[18F]FDG plasma activity measured in the venous blood sampling performed at 45 min in each patient. Spearman's rank correlation, coefficient of determination, and Passing–Bablok regression were used for the comparison between Ki and Ki,s. Finally, Ki,s was obtained with our method in a separate group of patients (group 3, n = 8) that perform two short dynamic acquisitions.Results: Population-based image-derived input function (10–60 min) was modeled with a monoexponential curve with the following fitted parameters obtained in group 1: a = 9.684, b = 16.410, and c = 0.068 min−1. The LOOCV error was 0.4%. In patients of group 2, the mean values of Ki and Ki,s were 0.0442 ± 0.0302 and 0.33 ± 0.0298, respectively (R2 = 0.9970). The Passing–Bablok regression for comparison between Ki and Ki,s showed a slope of 0.992 (95% CI: 0.94–1.06) and intercept value of −0.0003 (95% CI: −0.0033–0.0011).Conclusions: Despite several practical limitations, like the need to position the patient twice and to perform two CT scans, our method contemplates two short 2-[18F]FDG dynamic acquisitions, a population-based input function model, and a late venous blood sample to obtain robust and personalized input function and tissue response curves and to provide reliable regional Ki estimation.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign vasoproliferative tumor characterized by nodules, papules or plaques localized principally in the head and neck region. Histopathological examination reveals hyperplastic blood vessels lined by large endothelial cells, accompanied by an infiltrate of inflammatory cells including eosinophils. The pathogenetic mechanism remains unclear, although different theories have been proposed. Various treatment strategies have been described, but surgery remains the treatment of choice. We describe the case of a young woman with ALHE taking an oral contraceptive pill suggesting a possible etiopathogenetic relationship.

Purpose: To evaluate the performance of artificial neural networks (aNN) applied to preoperative 18F-FDG PET/CT for predicting nodal involvement in non-small-cell lung cancer (NSCLC) patients.Methods: We retrospectively analyzed data from 540 clinically resectable NSCLC patients (333 M; 67.4 ± 9 years) undergone preoperative 18F-FDG PET/CT and pulmonary resection with hilo-mediastinal lymphadenectomy. A 3-layers NN model was applied (dataset randomly splitted into 2/3 training and 1/3 testing). Using histopathological reference standard, NN performance for nodal involvement (N0/N+ patient) was calculated by ROC analysis in terms of: area under the curve (AUC), accuracy (ACC), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV). Diagnostic performance of PET visual analysis (N+ patient: at least one node with uptake ≥ mediastinal blood-pool) and of logistic regression (LR) was evaluated.Results: Histology proved 108/540 (20%) nodal-metastatic patients. Among all collected data, relevant features selected as input parameters were: patients' age, tumor parameters (size, PET visual and semiquantitative features, histotype, grading), PET visual nodal result (patient-based, as N0/N+ and N0/N1/N2). Training and testing NN performance (AUC = 0.849, 0.769): ACC = 80 and 77%; SE = 72 and 58%; SP = 81 and 81%; PPV = 50 and 44%; NPV = 92 and 89%, respectively. Visual PET performance: ACC = 82%, SE = 32%, SP = 94%; PPV = 57%, NPV = 85%. Training and testing LR performance (AUC = 0.795, 0.763): ACC = 75 and 77%; SE = 68 and 55%; SP = 77 and 82%; PPV = 43 and 43%; NPV = 90 and 88%, respectively.Conclusions: aNN application to preoperative 18F-FDG PET/CT provides overall good performance for predicting nodal involvement in NSCLC patients candidate to surgery, especially for ruling out nodal metastases, being NPV the best diagnostic result; a high NPV was also reached by PET qualitative assessment. Moreover, in such population with low a priori nodal involvement probability, aNN better identify the relatively few and unexpected nodal-metastatic patients than PET analysis, so supporting the additional aNN use in case of PET-negative images.

Abstract Background The validation of the most appropriate compartmental model that describes the kinetics of a specific tracer within a specific tissue is mandatory before estimating quantitative parameters, since the behaviour of a tracer can be different among organs and diseases, as well as between primary tumours and metastases. The aims of our study were to assess which compartmental model better describes the kinetics of 18F-Fluorodeoxygluxose(18F-FDG) in primary lung cancers and in metastatic lymph nodes; to evaluate whether quantitative parameters, estimated using different innovative technologies, are different between lung cancers and lymph nodes; and to evaluate the intra-tumour inhomogeneity. Results Twenty-one patients (7 females; 71 ± 9.4 years) with histologically proved lung cancer, prospectively evaluated, underwent 18F-FDG PET-CT for staging. Spectral analysis iterative filter (SAIF) method was used to design the most appropriate compartmental model. Among the compartmental models arranged using the number of compartments suggested by SAIF results, the best one was selected according to Akaike information criterion (AIC). Quantitative analysis was performed at the voxel level. K 1, V b and K i were estimated with three advanced methods: SAIF approach, Patlak analysis and the selected compartmental model. Pearson’s correlation and non-parametric tests were used for statistics. SAIF showed three possible irreversible compartmental models: Tr-1R, Tr-2R and Tr-3R. According to well-known 18F-FDG physiology, the structure of the compartmental models was supposed to be catenary. AIC indicated the Sokoloff’s compartmental model (3K) as the best one. Excellent correlation was found between K i estimated by Patlak and by SAIF (R 2 = 0.97, R 2 = 0.94, at the global and the voxel level respectively), and between K i estimated by 3K and by SAIF (R 2 = 0.98, R 2 = 0.95, at the global and the voxel level respectively). Using the 3K model, the lymph nodes showed higher mean and standard deviation of V b than lung cancers (p

Abstract Although rare, masses and mass-like lesions of developmental and genetic origin may affect the paediatric craniofacial skeleton. They represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation and disfigurement. The most common lesions include fibrous dysplasia, dermoid cysts, vascular malformations and plexiform neurofibromas. Less common lesions include torus mandibularis and torus palatinus, cherubism, nevoid basal cell carcinoma syndrome, meningoencephalocele and nasal sinus tract. This article provides a comprehensive approach for the evaluation of children with masses or mass-like lesions of developmental and genetic origin affecting the craniofacial skeleton. Typical findings are illustrated and the respective roles of computed tomography (CT), cone beam CT (CBCT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences and ultrasonography (US) are discussed for the pre-therapeutic assessment, complex treatment planning and post-treatment surveillance. Key imaging findings and characteristic clinical manifestations are reviewed. Pitfalls of image interpretation are addressed and how to avoid them. Teaching points • Masses of developmental and genetic origin may severely impair the craniofacial skeleton. • Although rare, these lesions have characteristic imaging features. • CT, MRI and ultrasonography play a key role in their work-up. • Recognition of pivotal imaging pearls and diagnostic pitfalls avoids interpretation errors.

The purpose of the present study was to investigate and compare craniomaxillofacial fracture (CMF) type in patients with intracranial hemorrhage (ICH) versus blunt cerebrovascular injury (BCVI). A retrospective cohort study was performed. The predictor variables were the types of CMF. The primary outcomes variables were ICH and BCVI. Secondary outcomes were death and survival with or without neurological sequelae. Descriptive, bivariate, and multiple logistic regression statistics were computed, and the significance level was set at P ≤ 0.05. The sample was composed of 1440 patients with a mean age of 46.6 years ±24 years, and 71% were men. Pure orbital wall (odds ratio [OR]), 3.62; 95% confidence interval [CI], 1.32-12.69; P < 0.022), Le Fort III (OR, 16.08; 95% CI, 5.89-43.50; P < 0.001), cranial vault (OR, 9.74; 95% CI, 3.83.24.32; P < 0.001), skull base (OR, 9.42; 95% CI, 3.86-24.02; P < 0.001) and cervical fractures (OR, 5.50; 95% CI, 1.65-15.97; P = 0.003) were significantly associated with BCVI. All of the CMFs (P < 0.001), except for Le Fort I (OR, 0.79; 95% CI, 0.18-2.63; P = 0.731), nasal (OR, 1.05; 95% CI, 0.77-1.42; P = 0.758), and mandibular (OR, 0.68; 95% CI, 0.45-1.01; P = 0.066) fractures, were significantly associated with ICH. Secondary outcomes were negatively influenced by ICH and BCVI (P < 0.001). Within the limitations of the study it seems that Le Fort I and nasal fractures could be protective of cerebrovascular injuries, by cushioning impact forces. On the other hand it seems that patients with pure orbital wall, Le Fort III and cranio-cervical fractures are more prone to having concomitant life-threatening cerebrovascular injuries. This category of patients should have an immediate and comprehensive neurological assessment and CT angiography to rule out BCVI and to determine its severity. [ABSTRACT FROM AUTHOR]

The high visual quality of lakes bolsters aesthetic and recreational experiences, but little is known about the specific visual preferences related to mountain lakes. This study therefore aimed at assessing people’s preferences on visual characteristics of mountain lakes using an online questionnaire. Adopting a qualitative approach, we first identified major recognised characteristics of mountain lakes, i.e., respondents indicated that mountain lakes are typically small-sized lakes with clear, cold and blue water and are embedded in a natural mountain landscape. Then, we used different picture sets related to water clarity, water colour, presence of algae, lake shore and surrounding land cover to quantify preferences. Our results indicated a clear preference for blue, clear water and the absence of algae as well as large rocks at the lake shore and forest around the lake. In particular, preferences related to visual water characteristics were highly homogeneous across socio-cultural groups and confirmed previous findings. To illustrate the applicability of our findings, we integrated our results with spatial and limnological data to quantify aesthetic values for four selected study lakes in the European Alps. Finally, we discuss our findings in the context of increasing demand for nature-based experiences and the implications for decision-making.

La malattia renale policistica autosomica dominante (ADPKD) è la più comune malattia genetica renale, con incidenza stimata di fra 1:400 e 1:1.000 e causata da mutazioni genetiche di PKD1 (85%) o PKD2 (15%). La caratteristica principale di ADPKD è la presenza di cisti multiple piene di liquido che si ingrandiscono nel tempo. L'espansione e l'iniziazione delle cisti è un complesso processo caratterizzato da anomalie nella proliferazione cellulare, nella secrezione di fluidi, nella formazione della matrice extracellulare e nella polarità delle cellule. Attualmente le strategie terapeutiche maggiormente indagate sono tre: 1) riduzione del livello di cAMP; 2) inibizione della proliferazione cellulare; 3) riduzione della secrezione di fluidi nelle cisti.

Ecosystems are an irreplaceable support for a region’s quality of life, thanks to the goods and services that they provide (ecosystem services). These ecosystem services can be assessed in economic terms, considering the economic weight of natural capital in resources management and in landscape planning (e.g. strategic plans, rural development plans) and recognizing the crucial role of those territories that have natural resources and a sustainable strategic planning. This approach can be translated in a territorial equalization between those territories that consume natural resources and those that produce them.

The purpose of this study was to determine the effects of season, locality and the different altitudes at which farms are located, on the physico-chemical composition, morphometric characteristics of fat globules, fatty acid composition and cheese making aptitude of milk of Massese ewe’s raised in 11 flocks from two provinces of north-west Tuscany (Massa Carrara and Lucca). The winter lactation shows higher percentages of casein, lactose and not fat dry matter (P≤0.01); curd firming time (k20) is significantly lower and there is a greater curd firmness (a30) (P≤0.01); while in the summer there is a higher percentage of lipids (P≤0.01). The effect of the season significantly influences (P≤0.01) the size of the fat globules and impacted significantly on the fatty acids composition of the milk. In the hills the milk has a higher percentage of dry matter, protein, casein, fat, phosphorous and not fat dry matter (P≤0.01), whereas it has a lower percentage of lactose and calcium (P≤0.05). The Somatic Cell Count (SCC) and the Total Bacterial Count (TBC) are statistically greater on the plains (P≤0.01), while milk produced in the hills shows higher quantity of α-linolenic acid and lower saturated fatty acids (P≤0.05). In the two typical rearing areas for Massese ewes we found differences amongst dry matter, fat, phosphorous and SCC, higher (P≤0.01) in the province of Massa Carrara that also had the best rheological parameters, but we found the highest cheese yield (P≤0.05) in the province of Lucca where there are also the greatest weight loss (P≤0.01). The milks produced in the winter season and in hilly areas present the best physico-chemical and nutritional characteristics. However, we found that the technological side should be improved by diversifying cheese-making techniques in relation to the characteristics of milk. In fact, currently these techniques do not fully exploit the potential to transform those milks with the best qualitative characteristics.

A basic diet of hay and concentrate, the latter supplemented with olive oil calcium soap (7% as fed) was given to 11Massese ewes (group S) for a 3-month period, while a basic diet without the supplement was given to 11 control Masseseewes (group C) during the same period. Fatty acid composition of milk produced from the 5th to the 16th week post-partumwas evaluated monthly.In group S, the fatty acids C6:0, C8:0, C10:0, C12:0, C14:0, C14:1, C18:3n-6 and C20:3n-3 (Pand C16:0, C18:1, total CLA, C20:0, C20:1, C20:2, C20:5n-3 (EPA), C23:0 (Pincreased with respect to the control group C. This trend lead to a decrease in short-chain fatty acids (Pincrease in unsaturated fatty acids (Plactation phase also significantly influenced fatty acid composition: the unsaturated/saturated fatty acids ratio was higherat the end of the lactation period.It can be concluded that the addition of protected olive oil fats to the diet of lactating ewes may improve fatty acid milkcomposition. In addition, the final phase of production positively affects milk quality relative to human health.

In this study the morphometric characteristics of fat globules from ewe’s milk have been correlated with the chemicaland technological parameters of the milk.Milk samples were taken from twenty-five Massese ewes, subdivided according to the parity; the animals were homogeneousfor lactation phase and diet. The morphometric analysis of fat globules (n./ml, diameter, surface area/volume),the standard chemical analysis, SCC and determination of the rheological parameters were performed on milk samplesobtained during the morning milking.The mean number of fat globules/ml was 3.09 x 109, with a mean diameter of 3.93 μm, ranging from 1.20 μm to 12.30μm. For all parities, a fat globule diameter ranging from 3.21 to 4.20 μm was found most frequently. Animals in the firstlambing order showed a significantly lower percentage (5.26%) of large globules (>5.21μm), while animals in the fifthlambing order showed a higher percentage (20.75%). The number of globules/ml was negatively correlated to milk production(P≤0.01) and curd firmness at 45 min (P≤0.05); whereas it was positively correlated to protein content, non-fatdry matter, and curd firming time (P≤0.05). Fat globule dimensions varied according to the parity of the animals andinfluenced various qualitative parameters of the milk.

The milk in 57 Italian Fresian cows in mid lactation was analysed in order to define the relationship between some qualitative milk parameters and the size of milk fat globules. The study focused on the morphometric evaluation of milk fat globules, chemical parameteres and fatty acid composition of the milk. The results show that a prevalence of milk fat globules with a diameter < 6um is positively correlated (P6 um was associated (P

INTRODUCTION – The study of the morphometric parameters of milk fat globules can aid in increasing our knowledge of the relationship between the number and dimensions of globules and the chemical, nutritional and technological characteristics of milk and its by-products. It is well-known that the fat globules secreted from the mammary cell are of heterogeneous dimensions, and at present the process of their synthesis in the cell is not yet entirely clear (Keenan, 2001). The few studies previously carried out on livestock mainly concern dairy cattle....

Several studies have pointed out that even under similar environmental conditions, fatty acid composition in milk from dairy cattle of different breeds may be not homogeneous (Beaulieu and Palmquist, 2000; Palmquist et al., 1993; Bitman et al., 1995). The higher percentage of polyunsaturated fatty acids in Friesian milk, compared to that of Jerseys, may be related to the physical characteristics of fat globules (Timmen and Patton, 1988; Jensen et al., 1991; Scolozzi, 2002). Milk fat globules of heterogeneous dimensions have been described for many years (Walstra, 1969), but it is still uncertain whether a link exists between the morphometric characteristics of fat globules and their chemical composition (Polidori et al., 1995). In this study we proposed to investigate the relationship between milk fatty acid composition and the morphometric characteristics of fat globules.

Purpose: Orbital fractures (OFs) are common, but their association with concomitant traumatic ocular nerve palsy (TONP) is exceptional and may potentially cause confusing clinical pictures of oculomotor involvement. The purpose of the present study is to describe a series of patients with OFs and concomitant TONP following facial trauma and to evaluate clinical features, diagnostic pitfalls, and final functional outcome.Methods: The investigators designed and implemented a retrospective case series and enrolled a sample of patients with OFs and concomitant TONP who had been managed at the University Hospitals of Geneva between 2013 and 2020. The primary outcomes were clinical pitfalls (diagnosis of neurogenic vs restrictive ocular motility pattern at baseline) and final functional outcome (persistent symptomatic diplopia). Other study variables included demographic and injury related parameters.Results: The sample was composed of 10 patients with a mean age of 40.7 ± 12.3 years (range 21 to 53 years) and 80% were men. In all patients, the diagnosis of the neurogenic component accounted for the main diagnostic pitfalls associated to the baseline post-traumatic limitation of ocular motility and diplopia. Six patients (60%) had a full spontaneous recovery of their diplopia. Four patients (40%) had a partial recovery with residual diplopia. Of these 4 patients, 1 patient underwent corrective strabismus surgery, 2 had temporary occlusion of 1 eye, and 1 had Fresnel prisms. At the final follow-up visit none of the patients had persistent symptomatic diplopia.Conclusions: The present study has shown that OFs with concomitant TONP entail complex ocular motility patterns of neurogenic and/or restrictive origin; the diagnosis of the neurogenic component represents the main clinical pitfall that warrants a careful orthoptic evaluation to ensure the appropriate management; the final outcome was favorable with no persistent symptomatic diplopia in any of the patients. [ABSTRACT FROM AUTHOR]

The management of blow-out orbital fractures (BOFs) continues to be controversial and regularly questioned. In recent years, treatment decision-making has shifted from a clinically dominated emphasis to a more objective data-based approach. This has come about through the refinement of imaging technologies that can more precisely define the fracture itself. Decision-making is now mainly driven by computed tomography (CT) parameters among which the fracture's size is by far the most often used. The variability in a patient's clinical presentation and outcomes for similar types of BOFs raises serious doubts about the pertinence of applying standardized guidelines based on quantitative data for the treatment of individual patients. An approach that fails to include patient variability and relies too heavily on average objective results with an emphasis on the application of quantitative rather than qualitative methods can lead to poor patient outcomes. A review of the knowledge accumulated over the many years of treatment of BOFs has demonstrated that despite the exceptional imaging-based technologies available, clinical acumen remains the most sophisticated decision-assistive tool. Thus, the treatment of BOFs must be regarded as a patient rather than merely a geometrical imaging issue. Imaging then becomes a valuable diagnostic rather than a final decision-making tool. This more conservative approach leads to a substantial decrease in indications for surgical repair. [ABSTRACT FROM AUTHOR]