Objective: This prospective study evaluated the effectiveness of clear aligner treatment (CAT) in achieving dentoalveolar upper arch expansion in patients with mixed dentition and transverse maxillary deficiency. Methods: Forty patients with mixed dentition and a transverse discrepancy of ≤ 5 mm were treated using clear aligners. Pre- and post-treatment digital dental models were measured using specific landmarks and compared with the programmed expansion in the virtual treatment plan. Statistical analyses included the inter-class correlation coefficient to evaluate inter-rater reliability. A paired t test was employed to compare pre- and post-treatment values and to examine the significance of the changes. Multiple regression analysis was conducted to estimate the relationship between the prescribed and observed measurements, stratified by inter-dental measurements (deciduous canines, first deciduous molars, and permanent molars, at cusp and gingival levels). Results: Excellent measurement reproducibility was observed. The accuracy of dentoalveolar maxillary arch expansion varied among different tooth regions. The inter-canine accuracy was 87.7% at the cusp level and 82.7% at the gingival level. The inter-first deciduous molars exhibited accuracies of 84.9% (cusp level) and 80.5% (gingival level). The inter-first molars showed accuracies of 77.8% (cusp level) and 67.9% (gingival level). Significant differences were observed between the planned and obtained measurements for specific tooth regions. Conclusions CAT demonstrated reliable predictability in achieving dentoalveolar expansion of the maxillary arch in patients with mixed dentition. A higher accuracy was observed in the anterior region than in the posterior region. These findings suggest that CAT could be an effective option for treating transverse maxillary deficiencies in patients with mixed dentition with moderate inter-arch transverse discrepancies, considering tooth-specific predictability differences.

Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.

Background/Aims: Optimization of bowel preparation for small bowel capsule endoscopy (SBCE) is debated. Guidelines recommend 2 L of iso-osmolar polyethylene glycol (PEG) to improve SBCE visibility. We compared the efficacy of the standard 2 L PEG solution with a 1 L PEG plus ascorbate (PEG-ASC) preparation, which has already been established for large-bowel preparation. Methods: Between October 2020 and February 2022, patients undergoing SBCE were assigned to receive 2 L PEG or 1 L PEG-ASC bowel preparation on an even- or odd-day basis. Bowel cleanliness was evaluated using the small bowel mucosal visibility scoring system (SBMVSS). Results: Following propensity score matching using a random forest method, two comparable populations of patients treated with 2 L PEG (n=74, male 41%, 53±17 years) and 1 L PEG-ASC (n=74, male 42%, 55±21 years) were obtained from the original cohort of 221 consecutive SBCE patients. Our results showed a trend towards more frequent adequate mucosal visibility with 1 L PEG-ASC compared to 2 L PEG (small bowel mucosal visibility ≥2 in all three small bowel tertiles, p=0.07), as per the SBMVSS score. No significant differences were observed in the diagnostic yield (p=1.00), visibility score=9 (p=0.85), SBCE completeness (p=0.33), or adequate mucosal visibility in each tertile (p=0.61, p=0.74, and p=0.70 for the first, second, and third tertiles, respectively). Conclusions Our study suggests the non-inferiority of the 1 L PEG-ASC solution over the standard 2 L PEG for SBCE preparation.

Objective: This prospective study evaluated the effectiveness of clear aligner treatment (CAT) in achieving dentoalveolar upper arch expansion in patients with mixed dentition and transverse maxillary deficiency. Methods: Forty patients with mixed dentition and a transverse discrepancy of ≤ 5 mm were treated using clear aligners. Pre- and post-treatment digital dental models were measured using specific landmarks and compared with the programmed expansion in the virtual treatment plan. Statistical analyses included the inter-class correlation coefficient to evaluate inter-rater reliability. A paired t test was employed to compare pre- and post-treatment values and to examine the significance of the changes. Multiple regression analysis was conducted to estimate the relationship between the prescribed and observed measurements, stratified by inter-dental measurements (deciduous canines, first deciduous molars, and permanent molars, at cusp and gingival levels). Results: Excellent measurement reproducibility was observed. The accuracy of dentoalveolar maxillary arch expansion varied among different tooth regions. The inter-canine accuracy was 87.7% at the cusp level and 82.7% at the gingival level. The inter-first deciduous molars exhibited accuracies of 84.9% (cusp level) and 80.5% (gingival level). The inter-first molars showed accuracies of 77.8% (cusp level) and 67.9% (gingival level). Significant differences were observed between the planned and obtained measurements for specific tooth regions. Conclusions CAT demonstrated reliable predictability in achieving dentoalveolar expansion of the maxillary arch in patients with mixed dentition. A higher accuracy was observed in the anterior region than in the posterior region. These findings suggest that CAT could be an effective option for treating transverse maxillary deficiencies in patients with mixed dentition with moderate inter-arch transverse discrepancies, considering tooth-specific predictability differences.

Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.

Objective: This prospective study evaluated the effectiveness of clear aligner treatment (CAT) in achieving dentoalveolar upper arch expansion in patients with mixed dentition and transverse maxillary deficiency. Methods: Forty patients with mixed dentition and a transverse discrepancy of ≤ 5 mm were treated using clear aligners. Pre- and post-treatment digital dental models were measured using specific landmarks and compared with the programmed expansion in the virtual treatment plan. Statistical analyses included the inter-class correlation coefficient to evaluate inter-rater reliability. A paired t test was employed to compare pre- and post-treatment values and to examine the significance of the changes. Multiple regression analysis was conducted to estimate the relationship between the prescribed and observed measurements, stratified by inter-dental measurements (deciduous canines, first deciduous molars, and permanent molars, at cusp and gingival levels). Results: Excellent measurement reproducibility was observed. The accuracy of dentoalveolar maxillary arch expansion varied among different tooth regions. The inter-canine accuracy was 87.7% at the cusp level and 82.7% at the gingival level. The inter-first deciduous molars exhibited accuracies of 84.9% (cusp level) and 80.5% (gingival level). The inter-first molars showed accuracies of 77.8% (cusp level) and 67.9% (gingival level). Significant differences were observed between the planned and obtained measurements for specific tooth regions. Conclusions CAT demonstrated reliable predictability in achieving dentoalveolar expansion of the maxillary arch in patients with mixed dentition. A higher accuracy was observed in the anterior region than in the posterior region. These findings suggest that CAT could be an effective option for treating transverse maxillary deficiencies in patients with mixed dentition with moderate inter-arch transverse discrepancies, considering tooth-specific predictability differences.

Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.