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Abstract Stride velocity 95th centile (SV95C) is a wearable-derived endpoint representing the 5% fastest strides taken during everyday living. In July 2023, SV95C received European Medicines Agency (EMA) qualification for use as a primary endpoint in trials of patients with Duchenne muscular dystrophy (DMD) aged ≥ 4 years—becoming the first digital endpoint to receive such qualification. We present the data supporting this qualification, providing insights into the evidentiary basis of qualification as a digital clinical outcome assessment. Clinical trials, natural history studies, and patient surveys (ages 5 − 14 years) showed that SV95C is accurate, valid, reliable, sensitive, and clinically meaningful. SV95C significantly correlated with traditional DMD assessments, increased rapidly after steroid initiation (0.090 m/s 3 months post-treatment), and declined steadily in patients on stable steroid regimens. Compared with traditional assessments, SV95C demonstrated earlier sensitivity to disease progression (3 vs 9 months) and greater sensitivity at 12 months. Distribution- and anchor-based approaches revealed a change of − 0.10 to − 0.20 m/s as clinically meaningful. The EMA qualification of SV95C illustrates the willingness of regulators to accept novel digital endpoints for drug approval, setting an important precedent for the evidentiary basis of regulatory digital endpoint qualification that could transform clinical development in disorders affecting movement.

Abstract The response of European precipitation variability to climate change is still poorly understood. Here we present a high-resolution speleothem record of Eastern Central European (ECE) autumn/winter precipitation to study decadal to centennial hydroclimatic variations in the European-Atlantic sector since the Last Glacial Maximum. The Cloşani Cave δ18O record shows that the reorganization of the North Atlantic jet following the demise of the Northern Hemispheric ice sheets lasted until c. 6000 to 5000 years before present. Trace element-derived semi-quantitative autumn/winter precipitation amount reveals that the late Glacial and the early to mid-Holocene experienced about 20–30% higher precipitation than present. During the deglaciation, we detect an increased decadal to centennial precipitation variability decoupled from millennial-scale North Atlantic temperature changes. The findings suggest that dynamic (rather than thermodynamic) processes determine regional precipitation variability and the probability of extreme precipitation events in ECE, highlighting the importance of understanding such dynamics for future predictions.

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient’s medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery.

Objectives. Esophageal cancer is one of the most aggressive types of cancer, with a 5-year relative survival rate of only 18%-20.5%. Survival is highly dependent on accurate positive diagnosis and staging, in which the imaging modalities available have a primary role. The study is focused on the analysis of the preoperative T and M staging strategy and the reliability of computed tomography and endoscopic esophageal ultrasound in predicting resectability. A second objective was to evaluate the influence of preoperative imaging modalities on decreasing the number of unnecessary thoracotomies and laparotomies. Material and Methods. This study was conducted on a lot of 97 consecutive esophageal cancers, admitted in the Second General Surgery Clinic of Emergency County Hospital No. 1 of Craiova, between January 2007 to December 2019. We recorded patient data, imaging details and staging, as well as intraoperative aspects and tactics. For statistical analysis we have used chi square test. Conclusions. Computed tomography is not a basic investigation in the T-category evaluation of the TNM stage, the accuracy of the method being extremely variable with the T-stage, the type of CT scan. The maximum utility of CT remains in the identification of invasion of neighboring organs and the operability of the case. Despite the differences in the accuracy, sensitivity and specificity of computed tomography and endoscopic ultrasound in esophageal cancer, the use of these imaging methods is essential in staging esophageal cancer and establishing the therapeutic indication.

Providing joint fire support is an indispensable capability for joint forces that facilitates the achievement of set objectives in all types of operations. Starting from the idea that the development of a fire support doctrine, currently non-existent at the national level, is not sufficient to achieve this capability at the joint force level, I have argued in this paper, other changes that I consider necessary using the NATO capability development model, described by the acronym DOTMLPF-I. In the first part of the article, I have briefly presented the components of the NATO model and then, in the second part, I address the fire support capability as a whole, in terms of doctrine, force structure organization, training, the need to review the available resources, the training of military leaders and fire support personnel, the existing infrastructure and the level of interoperability required to make this capability truly available to the armed forces structures. The actions identified in the eight strands of the NATO model can provide a perspective for developing or enhancing the capability to provide nationally-led joint fire support.

The article highlights the usefulness of the operational framework described by the joint functions to understand the impact that an available capability has on the operation from an actional point of view. At the same time, this framework can also be exploited for the purpose of identifying a need for capabilities at the level of the current joint force in order to be able to accomplish the assigned missions. In order to argue the above, I have focused on a fire support capability that has recently become part of the national armed forces structures - the M142 HIMARS (High Mobility Artillery Rocket System). If in the first part of the article I briefly detailed aspects of the operational framework described by the joint functions, in the second part I presented a reasoned perspective on the impact that the capabilities of HIMARS systems have on the way of conceptualizing operations. The article aims to argue, through a concrete example, the possibility of using the operational framework described by the joint functions to understand the full potential of an existing or prospective capability for national armed forces structures.

This study aims to analyze the influence of adding Aeroshell 500 oil on physicochemical properties. It was found that the oil’s kinematic viscosity is much higher than that of diesel and Jet A, with a higher density and flash point as well. Elemental analysis revealed a higher carbon content and lower hydrogen content in Aeroshell oil compared to Jet A and diesel, with lower calorific power. Adding 5% oil increases the mixture viscosity, flash point, and density; decreases the calorific power; and increases the carbon content for both diesel and Jet A. In the second part, mathematical models determined the combustion temperatures for Jet A, diesel, Jet A plus 5% Aeroshell 500 oil, and diesel plus 5% Aeroshell 500 oil, based on an air excess from one to five. Elemental analysis determined the oxygen and air quantities for these mixtures and stoichiometric combustion reaction for CO2 and H2O. Regarding the CO2 quantity, adding 5% Aeroshell 500 to Jet A increases it from 3.143 kg to 3.159 kg for each kilogram of mixture burned in the stoichiometric reaction. Similarly, adding the oil to diesel in a 5% proportion increases the CO2 quantity from 3.175 to 3.190 in the stoichiometric reaction. Through experimentation with the Jet Cat P80 microturbine engine across four operating regimes, it was observed that the combustion chamber temperature and fuel flow rate are lower when using diesel with a 5% addition of Aeroshell 500 oil compared to Jet A with the same additive. However, the thrust is slightly higher with diesel + 5% Aeroshell 500 oil. Moreover, the specific fuel consumption is higher in regimes one and two for diesel + 5% Aeroshell 500 oil compared to Jet A + 5% Aeroshell 500 oil, while the differences are negligible in regimes three and four. At maximum operating conditions, the excess air was determined from the measured values, comparing the combustion chamber temperature with the calculated value, with a 7% error, extrapolating the results for the scenario when oil is not used. Also, during the testing campaign, the concentrations of CO and SO2 in the exhaust gas jet were measured, with higher concentrations of CO and SO2 observed for diesel compared to Jet A.

Summary: Background: The advent of disease-modifying treatments (DMT) has changed natural history in 5q Spinal muscular atrophy (SMA). The aim of this study was to report survival and functional aspects in all the Italian type I children born since 2016. Methods: The study included all symptomatic children with type I SMA born since January 1st, 2016, when DMTs became available in Italy. All the Italian SMA referral centers provided data on survival and motor, respiratory, and nutritional status. To compare survival rate pre and post DMTs approval, we also included similar data from SMA I patients born between January 1st, 2010, and December 31st, 2015. A two-proportion z-test was conducted to compare the two cohorts. The significance level was set at p 16 h/day ventilation or tracheostomy with continuous invasive ventilation. 130 of the 199 survivors (65%) achieved independent sitting, and 175 (87.9%) did not require tube feeding. Interpretation: Our study provides a picture of the ‘new natural history’ of type I SMA, confirming the impact of the new therapies on the progression of type I with longer survival r and has better motor, respiratory and nutritional. Funding: This research was partially funded by grants from the Italian Ministry of Health.

This article argues for the usefulness of adopting the case study as an effective and sufficient strategy from the perspective of developing research papers in the field of Military Science. In the first stage, using Saunders’ model, I showed the logical course of a researcher’s reasoning up to the moment of establishing a suitable research strategy according to his object of study, the topic of interest or the problem formulated at the initiation of the scientific approach. Afterwards, I justified the motivation for choosing the case study as a research strategy, bringing to attention the main advantages and disadvantages that it entails. I thus had two objectives in writing this article: to emphasize the importance of clarifying and establishing certain research design, exemplified by going through the layers of Saunders’ model, and subsequently to highlight the versatility and flexibility of the case study as a research strategy, as it is accepted and used in all fields of scientific research.

The purpose of this paper is to highlight the relevance of fire preparation in offensive operations and to argue for the need to update the current algorithm for planning such an action. The article presents the national and allied perspectives on the concept of fire preparation, aiming, on the one hand, to emphasise the relevance of this action in the current battlefield, including examples from the ongoing Russian-Ukrainian conflict, and, on the other hand, to highlight similar aspects of the characteristic elements and purpose of this action, found both in the presented normative framework and in relevant examples from the conflict. The differences between the two perspectives presented are not significant, as the same main ideas regarding the relevance and purpose of fire preparation are addressed, but the level of equipping with modern military equipment together with the availability of high-performance striking systems with diversified possibilities of target engagement are what allow for a different approach to preparatory fires at group force level. In the last section, the article argues for the need to revise and update the fire preparation planning algorithm to include current and future changes in the organisation, manning and equipping of national armed forces structures.

Biological invasions pose an increasing risk to nature, social security and the economy, being ranked amongst the top five threats to biodiversity. Managing alien and invasive species is a priority for the European Union, as outlined in the EU Biodiversity Strategy for 2030 and the Kunming-Montreal Global Biodiversity Framework. Alien plant species are acknowledged to impact the economy and biodiversity; thus, analysing the distribution of such species provides valuable inputs for the management and decision-making processes. The database presented in the current study is the first consolidated checklist of alien plant species that are present in Romania, both of European Union concern and of national interest. This database complements a prior published distribution, based only on records from literature, bringing new information regarding the occurrence of alien plants in Romania, as revealed by a nationwide field survey. We consider this database a valuable instrument for managing biological invasions at both national and regional levels, as it can be utilised in further research studies and in drafting management and action plans, assisting stakeholders in making informed decisions and implementing management actions.We present the results of the first nationwide survey of alien plant species in Romania, conducted between 2019 and 2022, in the framework of a national project coordinated by the Ministry of Environment, Waters and Forests and the University of Bucharest. The present database complements and updates the database published by Sirbu et. al (2022), which included occurrence records published until 2019. The new database includes 98323 occurrence records for 396 alien plant species in 77 families, with most species belonging to the Asteraceae family. One alien plant species in our database, the black locust Robinia pseudoacacia L., had more than 10,000 occurrence records. The distribution database also includes information on newly-reported invasive alien plant species of European Union concern in Romania (i.e. the floating primrose-willow Ludwigia peploides (Kunth) P.H.Raven) and documents the presence of plants in 44 additional families compared to Sirbu et al. (2022). Each entry includes information on species taxonomy, location, year, person who recorded and identified the alien plant, geographical coordinates and taxon rank.

Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions.

Objectives. Hydatid disease is a potentially lethal parasitic condition caused by the larvae of Echinococcus Granulosus; it is found in humans and more commonly in domestic and wild animals in endemic areas. This pathology is frequently encountered in the liver, the hydatid cyst with retroperitoneal location representing a rarely encountered form of evolution. Materials and Methods. In the present paper, we present a study carried out on 6 patients hospitalized in the Surgery Department of the Craiova County Emergency Clinical Hospital. These patients were diagnosed between 2002-2022 with retroperitoneal hydatid cyst or with multiple cysts (including retroperitoneal), being operated and monitored postoperatively at a distance. Results. The diagnosis was generally established by clinical examination, laboratory investigations and CT imaging, while the MRI evaluation was performed only in two of the cases, in order to provide additional data necessary for the surgeon. Conclusions. The difficulty of surgical interventions was determined by the size and local/multilocular extension of the disease; in the case of one patient, a double approach, abdominal and thigh, was necessary.

Objectives. Low anterior resection is a common surgical procedure for rectal cancer, but it is associated with a distressing complication known as Low Anterior Resection Syndrome (LARS). The incidence of LARS varies, with severe symptoms persisting in some patients even years after surgery. This study aimed to investigate the association between anastomotic leak and LARS severity in rectal cancer patients. Methods. A retrospective analysis was conducted on 100 rectal cancer patients who underwent LAR between 2017 and 2021. Patients were categorized based on LARS questionnaire responses into groups with anastomotic leakage and LARS, LARS alone, or no LARS. Various factors, including demographics, comorbidities, tumor characteristics, and surgical details, were analyzed for their association with LARS. Results. In our study, anastomotic leakage was observed in 23 patients, and 17 of them subsequently developed LARS. Male gender, age over 70, and neoadjuvant therapy were identified as risk factors for LARS. Additionally, LARS was more prevalent in patients with medium and low rectal cancers and those with a protective ostomy. Conclusion. Our findings suggest that male sex and neoadjuvant chemoradiotherapy are associated with the development of LARS in rectal cancer patients undergoing low anterior resection. The timing of stoma closure and the extent of neorectal reservoir may also impact LARS severity.

In recent years, the development of technology and the process of accelerated digitalization have radically transformed the way in which society interacts, communicates and manages information, this led to the change of the socio-economic environment in a dynamic environment. In order to achieve greater performance and efficiency in this ever-evolving era of digitalization, the optimization of internal processes is becoming increasingly important. The combination of ERP (Enterprise Resource Planning) and RPA (Robotic Process Automation) technologies is an innovative way to achieve the strategic objectives of an organization by automating repetitive tasks, optimization of workflows and reduction of manual intervention. This article aims to analyze the impact resulting from the combination of these technologies within the modern organization, with a special emphasis on presenting the benefits brought.

Background: Placenta accreta spectrum (PAS) refers to abnormal placental attachment, categorized into placenta accreta, increta, and percreta, with varying severity. The incidence of PAS has risen alongside the increasing rate of caesarean sections. PAS is a significant cause of maternal complications, including bleeding, hysterectomies of necessity and intestinal or urinary surgical complications, and of foetal complications, preterm birth or foetal anaemia. Early diagnosis is crucial for its management and for improving its outcomes. Materials and Methods: This retrospective study, conducted at the County Emergency Clinical Hospital “Saint Andrew the Apostle”, Constanța, analysed cases of placenta praevia and PAS from 2018 to 2022. Data were collected from observation sheets and operative protocols, involving 13,841 patients. Placenta praevia and PAS were diagnosed using ultrasound and MRI and confirmed by histopathology. Results: Among the 13,841 deliveries, 25 cases of placenta praevia (0.82% incidence) and 17 cases of PAS (0.57% incidence) were identified. Ultrasound demonstrated 88% sensitivity, and MRI 94% sensitivity for PAS detection. Of the 17 PAS cases, 11 were diagnosed as placenta accreta, 3 were diagnosed as placenta increta, and 3 as placenta percreta, with all percreta cases involving bladder invasion. Hysterectomy was the standard surgical treatment. Discussion: The risk factors for PAS included previous caesarean sections (94.1% of PAS cases), smoking, and uterine fibroids. The study confirmed the importance of early imaging and the involvement of a multidisciplinary team in managing PAS, particularly in complex cases with bladder involvement. Caesarean section followed by hysterectomy was the preferred surgical approach. Conclusions: Smoking, uterine scars, and uterine fibroids are significant risk factors for placenta praevia with pathological adhesion. Ultrasound and MRI are highly accurate in diagnosing PAS, with histopathology providing definitive confirmation. Multidisciplinary care is essential in managing complex cases, ensuring optimal maternal and foetal outcomes. The surgical treatment involves caesarean section and hysterectomy, with additional interventions for bladder invasion in percreta cases.

This work investigated the physical properties of Jet-A blended with n-heptane and various n-alcohols. The mixtures contained 10%, 20%, and 30% n-alcohols, including n-propanol, n-butanol, n-pentanol, n-hexanol, n-heptanol, and n-octanol. These alcohols are either derived from biomass or have significant potential for bio-based production. The blends were assessed against American Society for Testing and Materials (ASTM) D1655 standards for Jet-A in terms of the density, viscosity, and flash point. Additionally, the refractive index and Fourier Transform Infrared Spectroscopy (FTIR) analysis were employed to gain insights into the blend chemical composition. Density measurements for the blends fell within the ASTM specifications (0.7939 to 0.8075 g·cm−3). Viscosity measurements at −20 °C were not directly conducted due to technical limitations. However, extrapolating viscosity–temperature data suggests that the blends would meet the ASTM standard. Flash point measurements revealed that all mixtures exhibited values below the ASTM specification of 38 °C. Regression equations were developed to estimate the density, kinematic viscosity, and refractive index of the studied mixtures as a function of alcohol volume. Furthermore, a correlation study was conducted to estimate density and viscosity from refractive index measurements, given their simplicity, and minimal sample volume requirements. The R2 values for these correlations exceeded 0.99, indicating a strong relationship between the refractive index and the other properties.

Background: This is a prospective study. Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after the menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and localized estrogen treatments, such as estriol. However, many women with moderate-to-severe VVA may not fully benefit from estrogen therapy alone. Non-hormonal adjunctive treatments, such as pelvic floor exercises (e.g., Kegel exercises), are being explored to enhance clinical outcomes. Objectives: This study investigates the combined effect of local estriol therapy and Kegel exercises in improving VVA symptoms in postmenopausal women. Methods: Fifty postmenopausal women diagnosed with VVA were enrolled and divided into three severity groups: mild, moderate, and severe. All participants received estriol therapy (0.5 mg vaginal tablets daily for 10 days each month) for the first three months. Following this, Kegel exercises were introduced for an additional three-month period, alongside continued estriol therapy. Symptom improvement was evaluated after six months, with outcomes categorized as complete remission, partial remission, or no remission. Results: Significant improvements in symptom remission were observed, particularly in the moderate and severe groups. In the mild VVA group, 81.82% achieved complete remission with combined therapy compared to 68.18% with estriol alone. In the severe group, complete remission was observed in 40% of patients receiving combined therapy compared to 20% with estriol therapy alone. These findings suggest that Kegel exercises enhance the effectiveness of estriol by improving local blood circulation, which facilitates better estrogen absorption and distribution. Conclusions: The addition of Kegel exercises to local estriol therapy significantly improves symptom remission rates, especially in moderate and severe VVA cases. This approach offers a promising strategy for managing postmenopausal VVA, particularly in cases that do not fully respond to estrogen therapy alone.

Background/Objectives: Diabetes mellitus (DM) is a prevalent disease with an increased risk of complications. Identifying risk factors for mortality in these patients is crucial, as early recognition can facilitate prompt therapeutic intervention. Machine learning (ML) models have proved to be valuable tools in different scenarios of healthcare decision making. We aimed to develop and test an ML model to predict all-cause mortality in a large cohort of subjects with DM. Methods: We included 1969 consecutive patients with DM type 1 (T1DM, n = 255) and type 2 (T2DM, n = 1714). eXtreme Gradient Boosting (XGBoost) was used for the prediction of all-cause mortality in this cohort and the Shapley additive explanation (SHAP) was used to assess the importance of each feature of the classifier. The missing values were imputed using the Missforest methodology. Results: The all-cause mortality rate was 21% during 5.5 ± 1.1 years of follow-up. The ML model achieved 90% sensitivity and 87% specificity with an AUC of 0.88 and an accuracy of 88% for predicting all-cause mortality. The SHAP analysis identified a lower glomerular filtration rate (eGFR), duration of insulin therapy, and a lower level of hemoglobin as the first three factors that contribute to the higher mortality rate. Conclusions: ML models can become valuable tools in clinical practice due to their unique ability to simultaneously assess the cumulative influence of multiple parameters and discover high-order interactions. The application of such models in clinical practice could improve the early identification of subjects at risk for complications and mortality and prompt early therapeutical interventions.

This study aimed to evaluate the efficacy of Kegel exercises, or pelvic floor muscle training (PFMT), in reducing symptoms of urinary incontinence among women with overactive bladder (OAB) and mixed urinary incontinence (MUI). A randomized control trial was conducted with a total of 50 participants (young women ages 18-35) out of which 35 were diagnosed with OAB and 15 with MUI. The participants were monitored for six months: In the first three months received only pharmacological therapy, solifenacin succinate 10 mg per day, and after this period the same group associated to the pharmacological treatment daily Kegel exercises. The primary outcome measured was the reduction in urinary incontinence episodes, while secondary outcomes included changes in quality of life (QoL) and bladder control as assessed by standardized questionnaires. After three months, group demonstrated a reduction in the frequency of urinary incontinence episodes. However, receiving both solifenacin succinate and Kegel exercises showed a statistically significant improvement in urinary control and QoL scores at six months evaluation. These findings suggest that the combination of pharmacological treatment with solifenacin succinate and Kegel exercises is more effective in managing urinary incontinence symptoms associated with OAB and MUI than pharmacological treatment alone. This approach may represent a beneficial strategy for patients requiring enhanced symptom relief

Introduction Apathy is a prominent and persistent syndrome in late-life depression (LLD) associated with poor functional outcomes (1) such as reduced response to antidepressant medication (2,3) or an increased risk [...], Background: Apathy is associated with reduced antidepressant response and dementia in late-life depression (LLD). However, the functional cerebral basis of apathy is understudied in LLD. We investigated the functional connectivity of 5 resting- state networks (RSN) hypothesized to underlie apathy in LLD. Methods: Resting-state functional MRI data were collected from individuals with LLD who did not have dementia as well as healthy older adults between October 2019 and April 2022. Apathy was evaluated using the diagnostic criteria for apathy (DCA), the Apathy Evaluation Scale (AES) and the Apathy Motivation Index (AMI). Subnetworks whose connectivity was significantly associated with each apathy measure were identified via the threshold-free network-based statistics. Regions that were consistently associated with apathy across the measures were reported as robust findings. Results: Our sample included 39 individuals with LLD who did not have dementia and 26 healthy older adults. Compared with healthy controls, individuals with LLD had an altered intraRSN and inter-RNS connectivity in the default mode, the cingulo-opercular and the frontoparietal networks. All 3 apathy measurements showed associations with modified intra-RSN connectivity in these networks, except for the DCA in the cingulo-opercular network. The AMI scores showed stronger associations with the cingulo-opercular and frontoparietal networks, whereas the AES had stronger associations with the default mode network and the goal-oriented behaviour network. Limitations: The study was limited by the small number of participants without apathy according to the DCA, which may have reduced the statistical power of between-group comparisons. Additionally, the reliance on specific apathy measures may have influenced the observed overlap in brain regions. Conclusion: Our findings indicate that apathy in LLD is consistently associated with changes in both intra-RSN and inter-RSN connectivity of brain regions implicated in goal-oriented behaviours. These results corroborate previous findings of altered functional RSN connectivity in severe LLD.

Excess atmospheric precipitation is part of the category of climatic risk phenomena and is located at the opposite pole to the phenomena of dryness and drought (Octavia Bogdan, Ion Marinică, 2007). They are possible in any season of the year and can be determined by both rains and heavy snowfalls, produced mainly by cyclonic activity on the continent. Precipitation is one of the important factors that can compete with triggering the phenomena of dryness and drought, but also of excess humidity. The causes of excess precipitation are related to the dynamics of the atmosphere, but it can also be maintained by other factors that depend on the characteristics of the active surface. The precipitation deficit is characterized by precipitation that is below the values of daily averages and monthly averages (below normal values). A multitude of factors participate in the triggering of drought and dryness phenomena with the climatic parameters that define the state of dry and arid weather ( Ion Marinică, 2006).

As well known success in orthodontics is related to a correct diagnosis and to a carefull treatment planning. Our study aims to provide clinician with a reproducible and precise method, for orthodontic indirect bonding, thanks to CBCT images and due to a CAD-CAM process. Methods: A case of an orthodontic treatment plan, of a female patient, 37 years old, was selected. Plaster models were digitally acquired using the Extra-Oral scanner Maestro 3D and processed within the Studio Maestro 3D software. CBCT images in DICOM format were imported into the MIMICS software, in order to perform the segmentation of the dental elements, and to obtain a three-dimensional coronal-root dental arches model. The DICOM file thus processed was exported in an STL file, reworked with Meshmixer software to improve image quality, and imported into the 3D Maestro software to be superimposed on the digital model. In this way a three-dimensional real model of the dental arches was developed. After an accurate orthodontic virtual set-up, we proceeded to brackets positioning on the 3D model of the dental arches. Subsequently, a virtual transfer template was created, in order to carry out the digital printing of a thermo-printed mask necessary to perform an indirect bonding of the orthodontic appliance. Results: The original digital workflow proposed in this study allows the development of a real and non-ideal three-dimensional coronal-root model of the dental arches; this model can be used for indirect orthodontic bonding eliminating any errors in the expression of 1st, 2nd and 3rd order information of the pre-informed orthodontic appliance. Conclusions: Technological advancements in oral scanning and 3D printing will allow the achievement of an easy and reproducible ideal positioning of the orthodontic brackets.