Search

Purpose: To compare the outcomes of immediate and delayed implant placement with bone-level tapered implants. Materials and Methods: In this post-market, multicenter prospective randomized controlled study with a primary endpoint of 1 year, 53 patients were randomized to receive either immediate implant placement (test group) or delayed implant placement (control group). The mean crestal bone level changes from implant loading to 12 months postloading were measured using standardized digital periapical radiographs. Changes in facial plate thickness (as measured on CBCT images), implant success and survival, implant stability, soft tissue changes, patient-centered outcomes, and adverse events were measured to assess outcomes between the test and control treatments at 12 months postloading. Results: Of the original 53 patients, 46 patients completed the study (23 in each group). Mean bone changes from loading to the 12-month follow-up were recorded with no statistically significant difference (P = .950) between the groups. The hypothesis was confirmed that immediate implant placement (test) in extraction sockets produces in similar outcomes as delayed placement (control). The test group was found to be similar to the control group (P = .022) in terms of mean changes in facial plate thickness. Implant survival and success were 95.8% in the test group and 92% in the control group. Stability in the control group was superior at the time of surgery, but there was no difference between the groups at implant loading, producing a nonsignificant P value of .563). Conclusions: This randomized controlled multicenter study showed comparable outcomes 1 year after prosthetic loading in the immediate and delayed implant placement groups. [ABSTRACT FROM AUTHOR]

Ectopic calcifications occur in tendons, ligaments, entheses, muscles, and fasciae, and are often associated with pain and inflammation. In clinical settings, these calcifications are commonly treated by physical therapy and/or surgical interventions. However, there is not enough understanding of pharmacological treatments as primary cures, supportive therapy to physical or surgical treatment, or even preventive measures to avoid or diminish the development of ectopic calcifications. Here, we summarize preclinical and clinical evidence for pharmacological candidates for treatment/prevention of ectopic calcification in the context of painful syndromes in the musculoskeletal field. Specifically, we discuss the potential mechanisms of nonsteroidal anti-inflammatory drugs, corticosteroids, H2-receptor blockers, bisphosphonates, minocycline, biologics, ACTH analogues, colchicine, calcium channel blockers, vitamins K2 and D, magnesium, zinc, curcumin, and phytates. Given that ectopic calcification is sometimes paradoxically associated with reduced bone mineralization, it appears particularly reasonable to employ strategies that can both inhibit ectopic calcification and promote bone mineralization, such as bisphosphonates and the combination of vitamin K2 and vitamin D, along with other supplements such as magnesium and zinc. Future studies need to test whether differential therapeutic approaches are needed in different phases of the disease and whether different mechanisms of ectopic calcification require different therapeutic strategies. A precondition for such approaches is further clinical and/or imaging delineation and differentiation of various types and phases of calcific diseases. Finally, it is essential to ensure that anti-calcification effects of new treatment strategies do not harm bone formation and skeletal mineralization. Key Points • Ectopic calcifications are common in the rheumatic field. • Here, we discuss pharmacological candidates for curative treatment, supportive treatment, or prevention of ectopic calcification, including nonsteroidal anti-inflammatory drugs, corticosteroids, H2-receptor blockers, bisphosphonates, minocycline, biologics, ACTH analogues, colchicine, calcium channel blockers, vitamins K2 and D, magnesium, zinc, curcumin, and phytates. • It is reasonable to employ strategies that can both inhibit ectopic calcification and promote bone mineralization, such as bisphosphonates and the combination of vitamin K2 and vitamin D, along with other supplements such as magnesium and zinc. [ABSTRACT FROM AUTHOR]

Solitary fibrous tumors (SFTs) are uncommon mesenchymal tumors that primarily develop in the visceral pleura. The chest wall is an extremely rare site for the origin of these tumors and therefore presents unique challenges for diagnosis and management. We present a rare case of solitary fibrous tumors of the chest wall (SFTCW), necessitating extensive resection and complex reconstruction. [ABSTRACT FROM AUTHOR]

A 23-year-old female patient presented with radicular back pain, perineal numbness, and urinary retention. The patient was diagnosed with cauda equina syndrome and magnetic resonance imaging (MRI) of the spine revealed an enhancing osseous lumbar lesion causing severe central stenosis. A core needle biopsy of the lumbar spine showed microscopic features compatible with a small round blue cell tumor. CD99 and FLI1 were positive in the tumor cells. Next-generation sequencing demonstrated a EWSR1::FLI1 fusion. Given these findings, the spine lesion was diagnosed as Ewing sarcoma. The patient underwent surgical decompression of L2. On further workup, an MRI revealed an ill-defined enhancing mass of the right distal femur. This area was biopsied, demonstrating a fibro-osseous lesion with osteoblast proliferation containing nuclear atypia, low mitotic activity, and SATB2 positivity, diagnosed as low-grade central osteosarcoma (LGCOS). The patient underwent resection, which showed a classic LGCOS by histomorphology. Although fluorescence in-situ hybridization study for MDM2 gene amplification was negative, the overall findings are most consistent with LGCOS. These neoplasms are considered to be synchronous due to the presentation of each entity within 6 months. Considering the aggregate yearly incidence of Ewing sarcoma (approximately 1 case per 750 000 per year) and LGCOS (approximately 1 case per 10 million per year), the aggregate yearly probability of developing both of these genetically unrelated tumors in a single individual is 1 per 7.5 trillion per year, and it is likely such an event has never happened in the past. [ABSTRACT FROM AUTHOR]

Background Lateral crura surface problems are one of the most difficult challenges in nose tip surgery. Closed preservation rhinoplasty (CPR) is a revolutionary concept that keeps nose tip flexibility and elasticity. By solving lateral crura surface problems and keeping tip flexibility the surgeon will accomplish a sharper supraalar groove transition between the dorsum and the tip. Objectives The convex-concave lateral crura deformity (CCLCD) or S-shaped lateral crura is one of the biggest constraints to accomplishing a beautiful tip and dorsum-tip transition (DTT). This deformity is the reason for the commonly called parenthesis deformity of cephalic malposition. This LLC convex-concave shape creates a C-shaped shadow. This DTT is one of the key areas for accomplishing natural results, and it depends on different nose structures, not just the lower lateral cartilages (LLC). Methods A total of 560 rhinoplasty cases were studied retrospectively between September and December 2023. Three hundred and twenty patients had at least 1 year of follow-up. Patients had follow-up at 2 weeks, 1 month, 3 months, 6 months, and 1 year after surgery. No secondary rhinoplasty was included. Only 2 secondary septoplasty cases were included, without any nose skin undermining in the previous surgery. Surgical details were documented, including the 6 fundamental steps of this technique: (1) mucosal lower lateral incision, (2) dorsum subperichondral dissection and vertical scroll release, (3) lateral crura tail caudal release, lateral crura steal and slide-under flap lateralization, (4) upper lateral caudal resection, (5) vertical scroll reconstruction, and (6) turning point extension graft. Results Three hundred and twenty patients had at least 1 year of follow-up. In total, 516 patients underwent a closed approach and 47 patients an open approach. All patients had subperichondral dissection of the hump envelope. All patients who underwent a closed approach had a low-strip letdown dorsal preservation technique. All patients who underwent an open approach had a structural technique with spreader flaps or grafts at the keystone area. All the patients underwent osteotomies with a piezoelectric device. Twenty-three revisional surgeries were necessary. Conclusions CPR taught us how important ligament and soft tissue preservation are. We learned that the less damage you do to the nose soft tissues and scaffold, the less support you need for it. Surgeons have been overgrafting the lateral crura to solve postoperative problems mainly because of dissection problems and lack of lateral crura support. This paper describes how to solve lateral crura surface problems, keeping the tip flexible and elastic, and also creating a nice and natural supraalar groove transition, by applying 6 surgical maneuvers. Level of Evidence: 4 (Therapeutic) [ABSTRACT FROM AUTHOR]

Intrahepatic cholangiocarcinoma (ICC)originates from the epithelial cells of the intrahepatic bile ducts, with insidious onset and strong invasiveness, and most of the cases are found in the advanced stage, with extremely poor prognosis. In advanced stages, distant metastases to the lungs, bones, and brain are common, but distant soft tissue (subcutaneous and skeletal muscle) and breast metastases are rare, and simultaneous metastases to all three rare sites had not been reported. We report a 69-year-old woman with right upper abdominal pain who underwent a plain and enhanced CT scan of the upper abdomen, which revealed an intrahepatic space-occupying lesion, as well as subcutaneous and peritoneal nodules in the abdomen. To further evaluate the presence of other metastases, an 18F-FDG PET/CT scan was performed, which showed abnormal FDG uptake in the liver, peritoneum, left upper femur, right breast, subcutaneous tissues of the thoracic and abdominal regions, and skeletal muscle, while the corresponding CT densities of part of the skeletal muscle and the left upper femur did not show any significant abnormality. Pathologic confirmation of ICC with multiple metastases was obtained by puncture biopsy of the liver and subcutaneous nodes. This case demonstrates the advantages of 18F-FDG PET/CT in comprehensively evaluating systemic metastasis of ICC and detecting occult metastases, which is of great significance in its clinical diagnosis and staging. [ABSTRACT FROM AUTHOR]

Background: The nasolabial angle (NLA) is one of the most critical parameters of the soft tissue profile when orthodontic treatment is required. The primary aim of this prospective cohort study was to compare the differences in the evaluation made on lateral photographs and cephalograms. The secondary aim was to evaluate the modifications of the NLA (nasal and labial components) after orthodontic treatment, including upper first premolar extraction. Methods: The pre- and post-treatment lateral radiographs and profile photographs of 60 subjects (18 male and 42 female) treated with upper premolar extraction and fixed orthodontic appliances were evaluated. The nasolabial angle was measured in both investigations, while cephalometric parameters (skeletal, dental, and soft tissue parameters) were evaluated using lateral radiographs. Results: No statistically significant difference was observed between the results of the two types of measurements on the photographs and radiographs. The soft tissue parameters (ULT and UL-e) showed significant changes after orthodontic treatment, with ULT changing from 21.4 mm ± 4.07 mm to 22.9 mm ± 4.06 mm (p = 0.03) and UL-e changing from 8.42 mm ± 4.84 mm to 10.35 mm ± 4.23 mm (p < 0.001). In patients with thinner lips, the upper lip repositioning was more significant (p = 0.001). No statistically significant difference (p = 0.67) was found between the two evaluation methods. Conclusions: Both cephalometric and photographic evaluations of the nasolabial angle were similar. The soft tissue parameters (ULT and UL-e) showed significant changes after the orthodontic treatment. The repositioning of the upper lip was more acute when the lip thickness decreased. [ABSTRACT FROM AUTHOR]

Objective: The surgical team in this study examined the efficacy of a modified reverse sural neurocutaneous flap repair in treating soft tissue defects of the ankle and foot caused by accidents. Methods: This study enrolled 89 patients treated for soft tissue defects of the ankle or foot between January 2007 and December 2023. The patients were divided into two groups: 44 patients underwent a modified reverse sural neurocutaneous flap repair, while 45 received traditional treatment. The modified technique involved repairing various anatomical structures, including fascia, the saphenous nerve, the great saphenous vein, subcutaneous tissue, and skin, with flap sizes ranging from 14 to 152 cm². In the traditional treatment group, the distal perforator of the peroneal artery was identified 5 cm above the lateral malleolus. Island fasciocutaneous flaps were designed along the sural nerve and lesser saphenous vein, elevated subfascially, rotated 180 degrees, and inset without tension. Donor sites were closed with grafts or direct sutures. Results: Of the 44 patients, who underwent the modified technique, 35 were male and 9 were female. Follow-up periods ranged from 2 to 24 weeks to monitor outcomes and recovery. The average size of the affected soft tissue was 71 cm2. Thirty-nine flaps survived completely, while three experienced partial necrosis and two had marginal necrosis. No cases of severe venous congestion were reported. The complication rate was lower with the modified method compared to the traditional repair (p < 0.05). Conclusion: The modified reverse neurocutaneous flap repair is a reliable and structured approach to treating soft tissue defects of the ankle and foot. This method has demonstrated favorable patient outcomes and presents a promising avenue for future studies and clinical practice. [ABSTRACT FROM AUTHOR]

Background: The mechanical properties of biological tissues change over time and with disease progression. Quantifying these mechanical properties can thus be instrumental for medical diagnosis and for evaluation of tissue viability for transplant. However, soft and biological materials are exceptionally challenging to mechanically characterize using conventional testing methods, which are hindered by limitations of sample size, fixturing capabilities, and sample preparation. Objective: We hypothesize that Volume Controlled Cavity Expansion (VCCE) is well-suited to capture subtle mechanical differences in biological tissue. The objective of this work is therefore twofold: first, we seek to quantify how stiffness of liver and gelatin evolve with age. In achieving this understanding, we aim to demonstrate the precision of VCCE in measuring subtle changes in the mechanical properties of biological tissues. Methods: Performing VCCE tests over 15 days in samples of gelatin and liver (porcine and bovine), we track the evolving pressure-volume response and deformation limits of the materials. Results: In both materials, we observed time-dependent variation of the stiffness and fracture thresholds. In gelatin VCCE repeatably captured stiffening over time, which was correlated with a higher fracture stress. This was in contrast to observations in bovine liver, where stiffening corresponded to a lower fracture stress. Porcine liver initially stiffened, then reversed this trend and relaxed. Conclusion: Through this work we show that liver and gelatin stiffen with age, and that this trend is measurable via VCCE. These results highlight the utility of VCCE and call attention to the need for a new class of mechanism based constitutive models that are capable of capturing variations in material over time with a minimal number of parameters. [ABSTRACT FROM AUTHOR]

In this paper, a sliding mode control method based on improved intelligent decision (IID-SMC) algorithm is proposed to improve the accuracy of the puncture needle to reach the target and reduce the time required in the puncture process. First of all, around the straight line of the puncture needle and the direction of the rotation of the needle, the independent control law is designed to realise the mutual decoupling and reduce the mutual interference. Secondly, the error range of this method in the process of puncture is analysed, and the upper bound of the error in the process of puncture is given. Finally, the method is verified by simulation and experiment platform. [ABSTRACT FROM AUTHOR]

Introduction Military Physical Training programs represent a constant challenge for the Armed Forces to improve body composition indices and physical fitness levels. This study aimed to verify the influence of the type of training on the physical fitness and body composition of army cadets, using 2 strategies: a sports program (Athletes group) and conventional physical training (Traditional group). Materials and Methods This study involved new entrant male cadets who were selected for the Athletes group (n = 243, 19.08 ± 1.23 years) or the Traditional group (n = 356, 18.89 ± 0.97 years), with assessments occurring before and after the period of training (31.4 ± 3.9 weeks). Dual-energy X-ray absorptiometry was used to measure the bone mineral content (BMC), fat mass (FM), percentage of fat mass (%FM), and lean soft tissue (LST). The physical tests evaluated the 3,000 m run (RUN), 50 m swim (SWIM), pull-ups (PULL) on the horizontal bar, push-ups (PUSH) on the ground, and abdominal flexion (SITUP). Results Time × group interaction effects were observed for BMC (P  < .001), LST (P  < .023), RUN (P  < .001), PULL (P  = .006), PUSH (P  < .001), SITUP (P  = .007), and SWIM (P  < .001). A significant effect of time was noted for all variables analyzed in both groups, except %FM. The Athletes group achieved better results in body composition and in PULL, PUSH, RUN, and SWIM at baseline and after the training period. The Traditional group demonstrated higher relative changes (%) after the training period in the LST (P  = .001), PULL (P  < .001), PUSH (P  < .001), SITUP (P  < .004), and SWIM (P  < .001) compared to the Athletes group. Conclusion Both physical training programs improved body composition and physical performance. [ABSTRACT FROM AUTHOR]

Background: Moderately hypofractionated, preoperative radiotherapy in patients with soft tissue sarcomas (HYPORT‐STS; ClinicalTrials.gov identifier NCT03819985) investigated a radiobiologically equivalent, moderately hypofractionated course of preoperative radiotherapy (RT) 15 × 2.85 Gy in patients with soft tissue sarcoma (STS). Here, the authors report longer term follow‐up to update local control and report late toxicities, as well as functional and patient‐reported outcomes. Methods: HYPORT‐STS was a single‐center, open‐label, single‐arm, prospective phase 2 clinical trial that enrolled 120 eligible adult patients with localized STS of the extremities or superficial trunk between 2018 and 2021. Patients received a 3‐week course of preoperative RT followed by surgery 4–8 weeks later. End points and follow‐up were analyzed from the date of surgery. Results: The median follow‐up was 43 months (interquartile range, 37–52 months), and the 4‐year local recurrence‐free survival rate was 93%. Overall RT‐related late toxicities improved with time from local therapy (p <.001), and few patients had grade ≥2 toxicities (9%; n = 8 of 88) at 2 years. These included: 2% grade ≥2 skin toxicity, 2% fibrosis, 3% lymphedema, and 1% joint stiffness. Four patients (3%) had bone fractures. Both functional outcomes, as measured by the Musculoskeletal Tumor Society Rating Scale (p <.001), and quality of life, as measured by the Functional Assessment of Cancer Therapy‐General (p <.001), improved with time from treatment, and both measures were better in follow‐up at 2 years compared with baseline. Conclusions: Long‐term follow up suggests that moderately hypofractionated preoperative RT for patients with STS is safe and effective. Higher grade late toxicities affect a minority of patients. Late toxicities decrease over time, whereas functional outcomes and health‐related quality of life seem to improve with more time from combined modality treatment. Favorable local control is maintained with long‐term follow‐up, late toxicities are lower than historical controls, and functional outcomes and quality of life improve with time. These findings suggest that preoperative, moderately hypofractionated radiotherapy delivered over 3 weeks for patients with soft tissue sarcoma is safe and effective, but a multicenter phase 3 trial comparing hypofractionated and conventionally fractionated radiotherapy is warranted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the ideal anteroposterior position of incisors in lateral smiling profiles with different chin prominences and to relate these positions to nose and chin landmarks based on the perceptions of orthodontists and laypersons. Methods: A lateral smiling profile image of a female subject was adjusted to create five levels of chin prominence (-6, -3, 0, +3, +6 mm). For each level, the anteroposterior positions of the maxillary incisors were adjusted across five positions (-4, -2, 0, +2, +4 mm). Thirty-six orthodontists and 36 laypersons rated the attractiveness of each profile using a visual analog scale. The maxillary incisor position (U1) was measured relative to the external nose and chin landmarks (E-lines). Differences in perceptions between orthodontists and laypersons were analyzed. Results: For profiles with 6 and 3 mm chin retrusion, the most favored incisor positions were the 2 mm retrusion and unaltered positions, respectively. For the unaltered chin prominence, orthodontists preferred unaltered incisors, while laypersons favored 2 mm protrusion. Conversely, for 3 and 6 mm chin protrusion, both groups preferred 4 and 2 mm protrusion, respectively. The distance between U1 and the E-line is the most attractive images ranged from 8.5 to 11.5 mm. Based on the regression model, an optimal U1-E-line distance of 8.95 mm was recommended. Conclusions: The preferred incisor position is influenced by chin prominence, with the incisor position shifting in the same direction as the chin. The U1 E-line can be a useful clinical tool for determining the proper incisor positioning. Esthetic perceptions were generally consistent between orthodontists and laypersons. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the accuracy of Qlone, Magiscan, and 3dMD with that of direct anthropometry (DA). Methods: The study involved 41 patients. Sixteen facial landmarks, including six individual and five paired points, were marked on each participant's face. Subsequently, 18 linear measurements were assessed using a 3dMD device (multicamera photogrammetry), Qlone, Magiscan smartphone applications (single-camera photogrammetry), and DA. The Qlone and Magiscan images were calibrated using a reference point 10 mm from the nasion during DA to ensure a 1:1 correspondence. Results: Concerning the precision of the digital methods compared to DA, the mean intraclass correlation coefficient values of 3dMD, Qlone and Magiscan were 0.989, 0.980 and 0.982, respectively. Compared with DA, 3dMD achieved excellent trueness with the lowest average absolute differences in the measurements (highest value = 0.95 ± 0.62 mm). The highest values for Qlone and Magiscan were 1.51 ± 1.11 mm and 2.14 ± 1.69 mm, respectively. According to the number of parameters, the ranking of unreliable values (> 2 mm) was Magiscan (n = 46), Qlone (n = 35), and then, 3dMD (n = 4). Furthermore, reliability (less than 1 mm) was the highest for 3dMD (n = 517), followed by Magiscan (n = 457), and then, Qlone (n = 415). Conclusions: The 3dMD achieved excellent trueness with the lowest average absolute differences in the measurements. Based on statistical analysis, the trueness values of Magiscan and Qlone were close to that of 3dMD. To apply these smartphone applications clinically, more studies are necessary. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Prevention & Treatment For Stomatological Diseases is the property of Journal of Prevention & Treatment For Stomatological Diseases Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chondroblastomas are very rare benign primary bone tumors that typically develop in bones in young adults. Extraosseous chondroblastomas are extremely rare, with a few case reports documented in the literature. The treatment is surgical with a high healing rate. MRI is a key examination for bony forms, and our study has strengthened the MRI description reported in some cases of the extraosseous form. We describe the case of a 40-year-old woman with a chondroblastoma of the soft tissues of the hip more precising in the quadratus femoris muscle and its clinical, radiological, and MRI appearance. The patient underwent complete surgical excision of the mass, and no clinical or MRI signs of recurrence were detected after 18 months of follow-up.

The interaction between the needle and the soft tissue during medical procedures can damage tissue, hindering performance. Reducing tissue damage can improve target accuracy in some procedures, such as biopsies, electrode placement, or drug delivery. This research aims to study the effect of needle speed on tissue damage. For this purpose, we propose a damage model that incorporates the dynamic needle-tissue interaction and the plane strain problem related to the hole left in the tissue after needle extraction. The optimization of the model provides a speed which minimizes tissue damage. A hypodermic needle was inserted into ex vivo turkey breast tissue at different insertion speeds. The size of the tissue hole and the friction stress from the needle-tissue interaction were used to measure damage and develop the damage model. The results revealed significant differences in the hole sizes and the friction stress measurements when different insertion speeds were used. Finally, the damage model was fitted to the experimental data and a speed value that minimizes tissue damage could be obtained.

Objective To explore the changes of periodontal soft and hard tissue parameters of the maxillary central incisors after the distant migration of the maxillary total dentition in adult patients with different periodontal phenotypes, so as to provide a reference for orthodontic treatment. Methods The study was approved by the hospital ethics committee, and the patients signed the informed consent form. Fifty-two adult patients in the orthodontic department of Hefei Stomatological Hospital were selected and divided into thick gingival and thin gingival groups, with 26 cases in each group. The labial and palatal alveolar bone parameters and various periodontal indexes of the maxillary central incisor teeth of the two groups were collected and recorded before and after treatment. SPSS 26.0 statistical software was used to statistically analyze the intra-group and inter-group differences. Results After orthodontic treatment, the differences in sella-nasion-subspinale angle (SNA), sella-nasion-supramental angle (SNB), and subspinale-nasion-supramental angle (ANB) were not statistically significant (P > 0.05). However, the inclination of the upper middle incisor teeth (U1-NA) decreased significantly (P < 0.05), and there was no significant difference in SNA, SNB, ANB, and U1-NA between the two groups after treatment (P > 0.05). The thickness of the labial alveolar bone of the maxillary central incisors in both groups increased at the labial neck 1/3 and labial middle 1/3 (P < 0.05), and decreased at the apical 1/3 (P < 0.05). The thickness of the palatal alveolar bone decreased at the labial neck 1/3 and labial middle 1/3 (P < 0.01), and increased at the apical 1/3 (P < 0.01). In both groups, the height of the lip and palate of the upper jaw decreased to different degrees, and the height of the palatal alveolar bone was lower in the thin gingival group (P < 0.05). There were no significant differences in maxillary central incisor probing depth (PD), lip keratinized tissue width (KTW), or lip gingival recession (GR) between the two groups after treatment (P > 0.05). Conclusion In the process of maxillary central incisor adduction, the labial-palatine alveolar bone remodeling is not uniform, and the alveolar bone of palatine side is mainly absorbed, which should be paid attention to clinically. Palatal alveolar bone height decreased more significantly in patients with thin gingiva after orthodontic treatment, and the risk of bone fenestration and bone dehiscence was greater.

Objective: This study aimed to compare the alveolar sealing performance between free gingival graft (FGG) and porcine collagen membrane (MS) and qualitatively assess patient-centered outcomes via a visual analog scale. Method and materials: Eighteen patients were randomly divided into control (FGG) and test (MS) groups. After extraction, all the alveoli were filled with bovine bone grafts (small granules) and sealed. Follow-up was during the immediate postoperative period and after 3, 7, 15, 30, 60, 90, and 120 days. After 180 days, before implant placement, tissue samples were obtained for histologic analysis. The epithelial tissues were morphometrically measured for each sample. Qualitative information on the patient's perception of the treatment was collected after 7 days. Results: A faster healing was observed for the MS group. After 60 days, all the sites from the MS were partially healed, in contrast with only five from the FGG. The histologic results after 120 days showed for the FGG group a predominant acute inflammatory process, whereas chronic processes were observed for the MSgroup. The mean epithelial heights found for the FGG and MS were 535.69 pm and 495.33 pm, respectively (P = .54). The intragroup analysis showed significant variance among the data (P<.001) for both groups. The qualitative result showed statistically more significative comfort for the MS group (P < .05). Conclusion: Within the limitations of the study, both techniques effectively promote alveolar sealing. However, the visual analog scale result was superior and more signiffcant for the MS group, with faster wound healing and lower discomfort. [ABSTRACT FROM AUTHOR]

Background: Facial soft tissue trauma cases are often encountered in the emergency room. Soft tissue trauma, especially to the face, is rarely life threatening. It varies in shape, size, and depth and can also affect surrounding organs. The treatment of soft tissue trauma can be complicated and may have a significant impact on facial function and, especially, facial aesthetics. Children are easily injured due to their active nature. Soft tissue trauma to the faces of toddlers is challenging even for experienced surgeons; however, wound debridement and suture management under general anesthesia should be considered. Purpose: The aim of this article is to deliver a thorough overview of the evaluation and treatment of soft tissue injuries in children, covering initial assessments, physical examinations, the application of antimicrobial therapies, and preparation for surgical procedures. Case: An 11-month-old girl went to the emergency department of Hasan Sadikin General Hospital, Bandung, with injuries to her left cheek and upper left lip sustained when she fell, and her face hit the edge of a cement pot at home. There was no history of unconsciousness, nausea and vomiting. The injury was diagnosed as vulnus laceratum of the left face and upper lip region. Case management: Emergency management was carried out by triage, Tetagam injection, and early wound debridement and suture under general anesthesia because the patient was uncooperative. Wounds on the face and lips were primary sutured layer by layer, returning the wound edges to their normal anatomical position. Conclusion: The management of facial soft tissue injuries in toddlers requires general anesthesia for adequate and accurate wound debridement and suture, so that functional and aesthetic effects can be satisfactorily obtained.

Introduction: With the advancements in chemotherapy for malignant bone tumors, the number of patients eligible for limb salvage surgery has increased. Surgeons face a subsequent challenge in limb-sparing resection due to the need for reconstructing soft tissue coverage. The aim of this review is to focus on the present state of the field in these areas, highlighting recent advancements. Methods: A literature research was conducted using keywords such as “soft tissue”, “integration”, “reconstruction”, “megaprosthesis”, and “soft tissue coverage”, on different databases, and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria, a total of 35 studies were selected. Results: In recent times, there has been a growing emphasis on different techniques such mesh application, allograft-prosthesis composites, allograft reconstruction, a polyethylene terephthalate (PET) tube, prosthesis itself and certain metals utilized for implant coatings are used in soft tissue reconstruction. Conclusion: While tissue-engineered constructs and advancements in biological and cellular approaches have shown potential for enhancing osseointegration and interactions with soft tissues and implants, the actual clinical outcomes have frequently fallen short of expectations. The success of soft tissue integration is crucial for achieving functional outcomes, minimizing complications, and ensuring the long-term stability of orthopedic implants.

ABSTRACT Background Aim Methods Results Conclusion Recently, the importance of peri‐implant soft tissue integration quality has been recognised as an essential factor in the long‐term success of dental implant rehabilitation.The aim of this study was to explore the influence of three materials commonly used in implant dentistry, namely titanium (Ti), dental adhesive resin (Re) and polyetheretherketone (PEEK), on the peri‐implant soft tissues.In this clinical randomised comparative study, 37 bone‐level implants were placed, and experimental transmucosal healing abutments made of different materials were randomly assigned to each implant. These abutments were removed together with the surrounding soft tissues after 8 weeks. Immunohistochemical analyses were performed to determine the presence and localisation of different immune cells. In addition, clinical and radiographic data were collected and peri‐implant bone remodeling was assessed.Compared to the Ti and PEEK groups, Re abutments revealed a higher infiltration of macrophages in the connective tissue (p = 0.04) and neutrophils in the adjacent epithelium (p = 0.03). In the Re abutments, peri‐implant bone remodeling was higher compared to the other groups (p = 0.01).The use of resin material as a transmucosal healing abutment should be carefully considered as it was associated with a higher presence of inflammatory cells at 8 weeks post‐implantation as well as superior bone remodeling compared to PEEK and Ti. [ABSTRACT FROM AUTHOR]

Featured Application: This study introduces a 3D-printed capstan-based clamping system that enhances uniaxial tensile testing of tendon tissues by reducing stress concentrations and preventing premature failures at the clamping region, resulting in more reliable biomechanical data. Standardized testing methods for the mechanical characterization of biological soft tissues remain underdeveloped in several domains. Existing clamping methods often induce high stress levels in the clamping region, thereby affecting experimental outcomes. This study introduces a 3D-printed clamping system based on the capstan principle. The capstan system was designed and manufactured using 3D printing technology and optimized to minimize the required gripping pressure while maintaining the natural, non-tapered state of specimens. This optimization helps reduce experimental artifacts and prevents premature tissue failure in the clamping region caused by local stress peaks. Usability trials were conducted using human flexor digitorum profundus (FDP) tendons (n = 15). Results showed that 80% of the tendons failed at the midpoint region, indicating the desired load distribution achieved by the clamping mechanism. The elastic moduli, averaging 316.18 ± 86.73 MPa, and failure load properties, averaging 79.25 ± 19.10 MPa, fell within the range of FDP values reported by other researchers, thereby supporting the validity of the capstan design. Capstan clamping offers a promising add-on for biomechanical testing of soft tissues. Further development is necessary to tailor the clamping design to various tissue geometries and to address issues related to tissue moisture regulation, thereby enhancing the reliability and versatility of the clamping system. [ABSTRACT FROM AUTHOR]

Imaging has transformed the understanding of inflammatory and degenerative arthritis in both peripheral and axial disease. In axial inflammation, fat suppression magnetic resonance imaging (MRI) has unravelled the role of sub-fibrocartilaginous osteitis in axial spondyloarthritis and the role of peri-entheseal vertebral body osteitis and subsequent spinal new bone formation. Established or late-stage axial psoriatic arthritis (PsA) cases often exhibit impressive para-marginal or chunky syndesmophytosis on conventional X-ray that pathologically represents entheseal soft tissue ossification. However, the spinal entheseal soft tissue and contiguous ligamentous tissues are poorly visualized on MRI in subjects with early inflammatory back pain including those with axial PsA. In this article, we highlight the need for imaging modalities to discern the crucial soft tissue "ligamentous" component of axial PsA towards diagnosis, prognosis and therapy validation. We issue a clarion call to focus advanced imaging methodology on spinal ligamentous soft tissue that represents the last hidden backwater of PsA immunopathology that needs visualization to fully decipher axial PsA pathogenesis. This in combination with the existing ability to visualize ligamentous bony anchorage site osteitis is needed to define a gold standard test for axial PsA. [ABSTRACT FROM AUTHOR]

Mesenchymal tumors may display morphologic and immunohistochemical overlap with melanocytic tumors, presenting a pitfall for misdiagnosis. We report a 62‐year‐old woman who presented with a recurrent dermal and subcutaneous tumor over the Achilles tendon 15 years following complete excision. Both the primary and the recurrent tumors were characterized by nests and sheets of epithelioid and spindle cells with eosinophilic cytoplasm and uniform ovoid nuclei. The tumor was positive for S100, SOX10, HMB45, cathepsin K, and p63 (weak), while negative for Melan‐A, MiTF, smooth muscle actin, and desmin. Gene fusion analysis of the recurrent tumor revealed a NONO::TFE3 fusion which has been recently reported in two similar cutaneous cases. Our case highlights the potential of a NONO::TFE3 cutaneous epithelioid and spindle cell tumor to recur after a prolonged disease‐free interval without evidence of high‐grade transformation or distant metastasis. Our findings support its classification as a cutaneous mesenchymal neoplasm of intermediate malignancy. [ABSTRACT FROM AUTHOR]

Constrained mixture models have successfully simulated many cases of growth and remodeling in soft biological tissues. So far, extensions of these models have been proposed to include either intracellular signaling or chemo-mechanical coupling on the organ-scale. However, no version of constrained mixture models currently exists that includes both aspects. Here, we propose such a version that resolves cellular signal processing by a set of logic-gated ordinary differential equations and captures chemo-mechanical interactions between cells by coupling a reaction-diffusion equation with the equations of nonlinear continuum mechanics. To demonstrate the potential of the model, we present 2 case studies within vascular solid mechanics: (i) the influence of angiotensin II on aortic growth and remodeling and (ii) the effect of communication between endothelial and intramural arterial cells via nitric oxide and endothelin-1. [ABSTRACT FROM AUTHOR]

Aims: Superficial CD34‐positive fibroblastic tumour (SCD34FT) is an uncommon but distinctive low‐grade neoplasm of the skin and subcutis that shows frequent CADM3 expression by immunohistochemistry (IHC). In this study, prompted by an index case resembling 'atypical fibrous histiocytoma (FH)' that was positive for CADM3 IHC, we systematically examined a cohort of tumours previously diagnosed as 'atypical FH' by applying CADM3 and fluorescence in situ hybridization (FISH) for PRDM10 rearrangement, to investigate the overlap between these tumour types. Methods and Results: Forty cases of atypical FH were retrieved, including CD34‐positive tumours (n = 20) and CD34‐negative tumours (n = 20). All tumours were stained for CADM3. All CADM3‐positive tumours were evaluated by FISH to assess for PRDM10 rearrangement. Eleven CD34‐positive tumours (11/20, 55%) coexpressed CADM3 and were reclassified as SCD34FT. None (0/20) of the CD34‐negative atypical FH were CADM3‐positive. Reclassified SCD34FT (10/11) arose on the lower extremity, with frequent involvement of the thigh (n = 8). Features suggestive of atypical FH were observed in many reclassified cases including variable cellularity, spindled morphology, infiltrative tumour margins, collagen entrapment, epidermal hyperpigmentation, and acanthosis. Variably prominent multinucleate giant cells, including Touton‐like forms, were also present. An informative FISH result was obtained in 10/11 reclassified tumours, with 60% (6/10) demonstrating PRDM10 rearrangement. Conclusion: A significant subset of tumours that histologically resemble atypical FH, and are positive for CD34, coexpress CADM3 and harbour PRDM10 rearrangement, supporting their reclassification as SCD34FT. Awareness of this morphologic overlap and the application of CADM3 IHC can aid the distinction between SCD34FT and atypical FH. [ABSTRACT FROM AUTHOR]

Aim: To assess the impact of the timing of implant placement following alveolar ridge preservation (ARP) on the need for soft‐tissue augmentation (STA) and to identify the risk factors for horizontal and vertical soft‐tissue loss. Materials and Methods: Patients with a single failing tooth in the anterior maxilla (15–25) were treated at six centres. Following tooth extraction, they were randomly allocated to the test group (immediate implant placement, IIP) or control group (delayed implant placement, DIP). ARP was performed in both groups and implants were immediately restored with an implant‐supported provisional crown. Six months after tooth extraction and ARP, a panel of five blinded clinicians assessed the need for STA on the basis of anonymized clinical pictures and a digital surface model. Lack of buccal soft‐tissue convexity and/or mid‐facial recession qualified for STA. Pre‐operative and 6‐month digital surface models were superimposed to assess horizontal and vertical soft‐tissue changes. Results: Thirty patients were included per group (test: 20 females, 10 males, mean age 53.1; control: 15 females, 15 males, mean age 59.8). The panel deemed STA as necessary in 24.1% and 35.7% of the cases following IIP and DIP, respectively. The difference was not statistically significant (odds ratio [OR] = 1.77; 95% confidence interval [CI] [0.54–5.84]; p =.343). Loss of buccal soft‐tissue profile was higher following DIP (estimated mean ratio = 1.66; 95% CI [1.10–2.52]; p =.018), as was mid‐facial recession (mean difference [MD] = 0.47 mm; 95% CI [0.12–0.83]; p =.011). Besides DIP, regression analysis identified soft‐tissue thickness (−0.57; 95% CI [−1.14 to −0.01]; p =.045) and buccal bone dehiscence (0.17; 95% CI [0.01–0.34]; p =.045) as additional risk factors for mid‐facial recession. Surgeons found IIP significantly more difficult than DIP (visual analogue scale MD = −34.57; 95% CI [−48.79 to −20.36]; p <.001). Conclusions: This multi‐centre randomized controlled trial failed to demonstrate a significant difference in the need for STA between IIP and DIP when judged by a panel of blinded clinicians. Based on objective soft‐tissue changes, patients with thin buccal soft tissues, with a buccal bone dehiscence and treated with a delayed approach appeared particularly prone to soft‐tissue loss. [ABSTRACT FROM AUTHOR]

Subcutaneous metastasis in the operative route after intracranial meningioma resection is extremely rare. Here we describe the case of a 69-year-old male who was operated on in our department for a convexity meningioma that spread a few years after surgery in the soft tissues next to the craniotomy site. Twenty-one other cases have been found in the medical literature. In this article, we discuss mechanisms of growth, presentation and management of subcutaneous meningiomas. [ABSTRACT FROM AUTHOR]

Necrotising fasciitis is an uncommon life-threatening surgical emergency. While most commonly seen in the lower limb it can also affect the upper limb. This article reviews and summarises the current literature on necrotising fasciitis in the upper limb, covering common predisposing factors, clinical presentations, scoring systems, common organism types and the timing of surgical treatment. The key to managing this condition continues to be early clinical diagnosis and aggressive surgical debridement to attempt to reduce the morbidity and mortality of this condition. [ABSTRACT FROM AUTHOR]

Pseudomyogenic hemangioendothelioma (PHE) is a rare, usually multifocal neoplasm typically affecting individuals in the second-to-fourth decade of life, with a male predominance. It often arises in the distal extremities and characteristically involves multiple tissue planes. Presentation of this neoplasm as a primary penile lesion is exceedingly rare, with only five cases previously documented in the literature. We report the clinicopathologic features of five additional PHEs presenting as primary penile tumors and review previously published cases. Tumors affected young to middle-aged adult patients and had a relatively bland clinical appearance, mimicking indolent lesions such as epidermal inclusion cysts. Microscopically, they were ill-defined nodules composed of plump spindle cells and round neoplastic cells with abundant, densely eosinophilic cytoplasm and eccentric nuclei resembling rhabdomyoblasts. Neoplastic cells demonstrated infiltrative growth, including foci of perineural invasion. Immunohistochemistry demonstrated invariable co-expression of keratins, endothelial markers (CD31 and/or ERG), and FOSB. In conclusion, penile PHE is rare but should be considered in the differential diagnosis of penile lesions with spindle cell and/or rhabdomyoblast-like morphology affecting young to middle-aged adult patients. [ABSTRACT FROM AUTHOR]

The evaluation of soft tissue biomechanical properties is of paramount importance not only for a comprehensive understanding of human physiology and physiopathology, but also in the research and development of bio-compatible artificial tissues with viscoelastic properties. Contrarily to standard tensile testing devices, a system intended for biomaterials testing should consider low stress and high strain ranges, characteristic of human tissues; moreover, such a system should enable the ex vivo simulation of biological environmental conditions. Commercial solutions address these challenges, although they are expensive for most academic and research institutions. This study presents a low-cost open-source design solution for soft tissue tensile testing, offering an affordable solution, yet without compromising the high quality and precision of the results. The proposed uniaxial tensile system allows for sample testing at room temperature as well as in a temperature-controlled liquid environment. Moreover, custom clamps ensure the fixation of tissue samples without slipping or tearing. System validation is performed using the tensile testing of springs and 3D-printed soft polymeric samples, demonstrating accurate results compared to the available data. The system is suitable for educational, research, and development applications. [ABSTRACT FROM AUTHOR]

Background: Facial soft tissue trauma cases are often encountered in the emergency room. Soft tissue trauma, especially to the face, is rarely life threatening. It varies in shape, size, and depth and can also affect surrounding organs. The treatment of soft tissue trauma can be complicated and may have a significant impact on facial function and, especially, facial aesthetics. Children are easily injured due to their active nature. Soft tissue trauma to the faces of toddlers is challenging even for experienced surgeons; however, wound debridement and suture management under general anesthesia should be considered. Purpose: The aim of this article is to deliver a thorough overview of the evaluation and treatment of soft tissue injuries in children, covering initial assessments, physical examinations, the application of antimicrobial therapies, and preparation for surgical procedures. Case: An 11-month-old girl went to the emergency department of Hasan Sadikin General Hospital, Bandung, with injuries to her left cheek and upper left lip sustained when she fell, and her face hit the edge of a cement pot at home. There was no history of unconsciousness, nausea and vomiting. The injury was diagnosed as vulnus laceratum of the left face and upper lip region. Case management: Emergency management was carried out by triage, Tetagam injection, and early wound debridement and suture under general anesthesia because the patient was uncooperative. Wounds on the face and lips were primary sutured layer by layer, returning the wound edges to their normal anatomical position. Conclusion: The management of facial soft tissue injuries in toddlers requires general anesthesia for adequate and accurate wound debridement and suture, so that functional and aesthetic effects can be satisfactorily obtained. [ABSTRACT FROM AUTHOR]

Background: Recently, a new World Health Organization Reporting System for Soft Tissue Cytopathology (WHO System) was introduced. To analyze the value of this system, routine fine‐needle aspiration soft tissue tumor (STT) cases were reviewed. Methods: Cytology samples of STTs collected between 1954 and 2022 at the Institut Curie were used (2214 cases, including 1376 primary tumors). All specimens were classified according to the predominant cytomorphological pattern and the WHO System. The diagnostic accuracy and risk of malignancy (ROM) in each category were calculated. Results: Final diagnoses revealed 1236 malignancies and 978 benign or low‐risk tumors. The original cytological evaluation led to 21 false‐negative results (0.85%) and 29 false‐positive results (1.17%). Sensitivity, specificity, positive predictive value, and negative predictive value were 98.3%, 92.1%, 97.5%, and 94.2%, respectively. Overall diagnostic accuracy was 94.2%. The ROM calculated according to the WHO System was 29.87%, 2.49%, 39.62%, 51.43%, 68.42%, and 97.69% in the nondiagnostic, benign, atypical, soft tissue neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories, respectively; however, it varied broadly depending on the morphological pattern (62.78% in spindle cell tumors, 84.58% in myxoid tumors, 3.00% in lipomatous tumors, 78.15% in epithelioid tumors, 94.26% in pleomorphic tumors, and 100% in round cell tumors). Conclusions: Cytology of STTs is a powerful diagnostic method. Some cytological patterns overlap in different morphological groups, and the possibility of false‐negative and false‐positive diagnoses may persist. This analysis evidenced utility of the WHO System, especially when combined with morphological pattern assessment. Subclassification in particular diagnostic categories allowed for calculation of the ROM, which is crucial for optimal patient management. The cytological evaluation of soft tissue tumors seems to be a powerful diagnostic method and can be successfully applied in adult and pediatric populations. However, some cytological patterns may overlap in different morphological groups of lesions and the possibility of a false‐negative and false‐positive diagnosis may persist. [ABSTRACT FROM AUTHOR]

Background Injectable poly-D,L-lactic acid (PDLLA), under the brand name of AestheFill (REGEN Biotech, Inc. Seoul, South Korea), is a biocompatible, biodegradable, and biostimulatory product utilized to correct soft tissue volume loss. Its efficacy and safety have not been fully studied in a large cohort. Objectives The aim of the study was to evaluate the efficacy and safety of a novel dermal filler injectable, poly-D,L-lactic acid. Methods This was an evaluator-blinded, multicenter, randomized controlled trial to compare the efficacy and safety of PDLLA vs hyaluronic acid in the correction of the nasolabial fold. Two hundred and sixty patients with moderate to severe nasolabial folds were enrolled and randomized to the treatment group (PDLLA) or control group (hyaluronic acid). Each patient received a PDLLA or hyaluronic acid injection for nasolabial fold augmentation and was followed for 52 weeks. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were applied to evaluate topical nasolabial fold augmentation and overall improvement, respectively. Results At 24 weeks, 67.6% of patients in the PDLLA group had an at least 1-grade improvement on the WSRS, compared to 60.9% of patients in the control group with an at least 1-grade improvement on the WSRS (P <.05). At each visit, the PDLLA group showed more improvement on the baseline WSRS than the control group. PDLLA was safe and well tolerated, with no severe adverse events. Conclusions PDLLA shows noninferior efficacy in correcting nasolabial folds compared to hyaluronic acid. Level of Evidence: 2 (Therapeutic) [ABSTRACT FROM AUTHOR]

Background Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce. Objectives The purpose of this study was to assess long-term outcomes with utilization of P4HB in various aesthetic breast procedures. Methods A retrospective review of all patients undergoing breast procedures with P4HB was performed by the senior author between July 2012 and March 2022. All patients with greater than 1 year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time. Results A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3 years). The most common surgical indication was breast ptosis, which comprised 68% (n = 167) of patients. The overall complication rate was 8.0% (n = 20), with an unplanned reoperation rate of 2.8% (n = 7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, P =.89, degrees of freedom [df]= 2), suggesting stability of satisfaction over time. Conclusions This study presents the senior author's entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be a both safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Copyright of Ordnance Industry Automation is the property of Editorial Board for Ordnance Industry Automation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Individual facial soft tissue properties are necessary for creating individualized finite element (FE) models to evaluate medical devices such as continuous positive airway pressure (CPAP) masks. There are no standard tools available to measure facial soft tissue elastic moduli, and techniques in literature require advanced equipment or custom parts to replicate. Methods: We propose a simple and inexpensive soft tissue measurement (STM) indenter device to estimate facial soft tissue elasticity at five sites: chin, cheek near lip, below cheekbone, cheekbone, and cheek. The STM device consists of a probe with a linear actuator and force sensor, an adjustment system for probe orientation, a head support frame, and a controller. The device was validated on six ballistics gel samples and then tested on 28 subjects. Soft tissue thickness was also collected for each subject using ultrasound. Results: Thickness and elastic modulus measurements were successfully collected for all subjects. The mean elastic modulus for each site is Ec = 53.04 ± 20.97 kPa for the chin, El = 16.33 ± 8.37 kPa for the cheek near lip, Ebc = 27.09 ± 11.38 kPa for below cheekbone, Ecb = 64.79 ± 17.12 kPa for the cheekbone, and Ech = 16.20 ± 5.09 kPa for the cheek. The thickness and elastic modulus values are in the range of previously reported values. One subject's measured soft tissue elastic moduli and thickness were used to evaluate custom-fit CPAP mask fit in comparison to a model of that subject with arbitrary elastic moduli and thickness. The model with measured values more closely resembles in vivo leakage results. Conclusion: Overall, the STM provides a first estimate of facial soft tissue elasticity and is affordable and easy to build with mostly off-the-shelf parts. These values can be used to create personalized FE models to evaluate custom-fit CPAP masks. [ABSTRACT FROM AUTHOR]