Chiarella Sforza

University of Milan, Milano, Lombardy, Italy

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Publications (282)364.28 Total impact

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    ABSTRACT: Purpose The purpose of this study was to assess the modifications in body center of mass (CoM), total mechanical work and walking characteristics during low-heeled and high-heeled gait performed in ecological conditions. Methods The 3D coordinates of 19 body landmarks were recorded by an optoelectronic motion analyzer in 13 women while walking overground at self-selected speed with either low-heeled or high-heeled shoes (minimum height, 70 mm). Using mean anthropometric data, the CoM was estimated, and its position evaluated during normalized gait cycles. Shoulders, pelvic and knee orientations were also assessed together with estimates of total mechanical work. Results High-heeled walking was performed with significantly lower horizontal speed (p < 0.05) but with the same cadence than low-heeled walking. During the whole gait cycle, the CoM (calculated from the malleolus landmarks) was 3 % lower during high-heeled walking (p < 0.05), had higher vertical displacements and vertical velocity modifications (p < 0.001), and it was significantly more anterior (p < 0.01). On average, walking with high heels at self-selected speed required a 16 % higher total mechanical work, but the difference was not significant. At heel strike with high heels, the shoulders were more inclined (p < 0.05), the support limb knee was significantly more flexed (p < 0.05), with a 12 % reduced total range of motion (p < 0.001), while the back limb knee was less flexed (p < 0.05). Conclusions Wearing high-heeled shoes significantly alters the normal displacement of human CoM; high-heeled gait exaggerated female walking characteristics with a more anterior CoM position, a wider vertical movement and a slower velocity.
    Sport Sciences for Health 08/2014; 10(2).
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    ABSTRACT: Email address of the presenting author: marina.codari@unimi.it Forensic medicine, craniofacial surgery and orthodontics make wide use of cephalometric analysis in identification, diagnosis and surgical planning. In order to measure linear distances, angular apertures and geometric features of the individual skull bones, an expert usually annotates by hand a set of cephalometric landmarks onto two-dimensional radiographic images or three-dimensional surface renderings of CT or Cone Beam CT volumes. Currently, the development of CBCT scanners has led the 3D cephalometric analysis to become a normal procedure, due to the improvement in the evaluation of three-dimensional morphology of subjects. Accuracy and repeatability of this manual approach are limited by intra-and inter-subject variability in landmark identification, even if an expert user takes care of the task. In order to improve the manual annotation, we propose a nearly-automatic method that gives the user an estimate of the positions of nine selected landmarks and a confidence region for each point, using as reference an accurate, manually annotated, single-subject CBCT volume. The method is based on intensity-based registration, on segmentation and on surface extraction of the CBCT target volumes. The confidence regions for each landmark have been preliminary estimated by testing the method on 21 CBCT volumes and by calculating Euclidean three-dimensional distances between the automatically annotated point and a standard manual cephalometric annotation done by an expert user. The obtained results are promising, annotation errors are acceptable for most points and the algorithm has good performances even in the presence of metal artifacts. Method improvements and a strong validation are currently in preparation.
    ICCFS2014 - International Conference of Craniofacial Superimposition, Dundee; 06/2014
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    ABSTRACT: Facial paralysis is a severe pathological condition, negatively affecting patients' quality of life. The altered tone and mobility of the mimetic musculature provoke both functional and morphological deficits. In the present study, we longitudinally measured facial movements in 14 patients (21-69 years) affected by unilateral facial paralysis not lasting longer than 23 months. The patients were analyzed before and after surgical masseteric to facial nerve neurorrhaphy. Examinations were performed at least 3 months after they had clinically started to regain facial mimicry. The displacement of selected facial landmarks was measured using an optoelectronic three-dimensional motion analyzer during: maximum smile without clenching (pre- and postsurgery), maximum smile by clenching on their posterior teeth (only postsurgery), and spontaneous smile (recorded during the vision of a funny video in both examinations). Before facial surgery, in all smiles facial landmarks moved more in the healthy than in the paretic side; after surgery, the differences decreased for both reduction of the healthy-side motion, and increment of the paretic-side motion (motion ratio before 52%, after 87%, p < 0.05, Students' t-test). The ratio between the paretic and healthy-side total motion (asymmetry) did not modify for maximum and spontaneous smiles, but significantly increased for the maximum smiles made with teeth clenching (asymmetry before 32%, after 11%, p < 0.001). Spontaneous smiles were recorded only in a subset of patients, but their execution was modified by surgery, with more symmetrical movements of the rehabilitated-side landmarks (asymmetry before 33%, after 10%), and reduced motion of the healthy-side ones (motion ratio before 51%, after 83%). In conclusion, the significant asymmetry in the magnitude of facial movements that characterized the analyzed patients before surgery reduced after surgery, at least in those facial areas interested by the masseteric to facial nerve reanimation.
    Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 06/2014;
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    ABSTRACT: Objective: To identify esthetic characteristics of the orbital soft tissues of attractive Italian adult women and men. Materials and Methods: Three-dimensional computerized digitizers were used to collect the coordinates of facial landmarks in 199 healthy, normal subjects aged 18 to 30 years (71 women, 128 men; mean age, 22 years) and in 126 coetaneous attractive subjects (92 women, 34 men; mean age, 20 years) selected during beauty competitions. From the landmarks, six linear distances, two ratios, six angles, and two areas were calculated. Attractive subjects were compared with normal ones by computing z-scores. Results: Intercanthal width was reduced while eye fissure lengths were increased in both genders. Orbital heights (os-or) were increased only in attractive women, with a significant gender-related difference. The inclinations of the eye fissure were increased in attractive subjects, while the inclinations of the orbit were reduced. For several of the analyzed measurements, similar patterns of z-scores were observed for attractive men and women (r = .883). Conclusion: Attractive women and men had several specific esthetic characteristics in their orbital soft tissues; esthetic reference values can be used to determine optimal goals in surgical treatment.
    The Angle Orthodontist 05/2014; · 1.18 Impact Factor
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    ABSTRACT: Because temporomandibular disorders (TMDs) rehabilitation continues to be a challenge, a more comprehensive picture of the orofacial functions in patients with chronic pain is required. This study assessed the orofacial functions, including surface electromyography (EMG) of dynamic rhythmic activities, in patients with moderate-severe signs and symptoms of chronic TMD. It was hypothesized that orofacial motor control differs between patients with moderate-severe chronic TMD and healthy subjects. Seventy-six subjects (46 with TMD and 30 control) answered questionnaires of severity of TMD and chewing difficulties. Orofacial functions and EMG during chewing were assessed. Standardized EMG indices were obtained by quantitative analysis of the differential EMG signals of the paired masseter and temporal muscles, and used to describe muscular action during chewing. TMD patients showed significant greater difficulty in chewing; worse orofacial scores; longer time for free mastication; a less accurate recruitment of the muscles on the working and balancing sides, reduced symmetrical mastication index (SMI) and increased standardized activity during EMG test than healthy subjects. SMI, TMD severity and orofacial myofunctional scores were correlated (P<0.01). Impaired orofacial functions and increased activity of the muscles of balancing sides during unilateral chewing characterized the altered orofacial motor control in patients with moderate-severe chronic TMD. Implications for rehabilitation are discussed.
    Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology 04/2014; · 2.00 Impact Factor
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    ABSTRACT: To better manage dental treatment outcome, a previsualization of desired appearances can be used to understand patients' wishes. A deeper comprehension of labial modifications related to hard-tissue movements is advantageous. The purpose of the study was to evaluate tooth restoration-induced labial displacements in three dimensions. In a group of 20 healthy Caucasian individuals, simulations of vestibular translations of maxillary anterior crowns were obtained by placing an acrylic resin veneer on the labial surfaces of maxillary incisors and canines. Three-dimensional stereophotogrammetric acquisitions were made to evaluate soft-tissue changes induced by the simulations. Linear dislocation of selected landmarks and labial surfaces were quantified using dedicated software. All paired and two midline labial landmarks had significant displacements, ranging from 13% (Subnasale landmark) to 103% (left Cheilion landmark) of veneer thickness (2 mm thick). A significant positive correlation was obtained between the lower lip displacement and overjet values. The vestibular shift of maxillary incisors and canines affect both upper and lower vermilion areas, without involving cutaneous perilabial landmarks.
    Journal of Prosthodontics 02/2014; · 0.68 Impact Factor
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    ABSTRACT: Background This study tested the validity of, and describes, a novel method of constructing an average morphology of the dental arch. Methods Upper dental arches of adult patients with a sound full permanent dentition were selected for the study. Laser-scanned images of the dental casts were obtained with an optical laser scanning device. The scanned images were analyzed using 3-dimensional graphic visualization and quantification software. Seventy-nine landmarks were identified on each dental arch on the basis of a protocol previously validated for dental analysis. An average dental arch (ADA) shell was then created and analyzed. Linear measures (crown height and mesiodistal width, intermolar and intercanine distances) and angular measures (inclination of the tooth on a reference plane), derived from the created ADA, were compared with the traditional average of measures, derived from single models, using 1-sample Student's t test (P < 0.05). After validation, the ADA was used as a template for comparison with other dental arches presenting some form of malocclusion. Results A total of 24 upper dental arches of adult patients with a sound full permanent dentition (mean [SD] age 28.8 [5.6] years) were selected for the study. The differences between the upper ADA and the average of single models were small (<0.1 mm/1.0°) and nonsignificant, except for canine angulation. The linear measurements were highly precise. The angular measurements exhibited a higher, but acceptable, degree of precision. Conclusion The construction of the ADA is reliable and may serve as a method for measuring changes in groups of patients.
    Journal of the World Federation of Orthodontists. 01/2014;
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    ABSTRACT: Facial paralysis is a severe pathological condition, negatively affecting patients’ quality of life. The altered tone and mobility of the mimetic musculature provoke both functional and morphological deficits. In the present study, we longitudinally measured facial movements in 14 patients (21-69 years) affected by unilateral facial paralysis not lasting longer than 23 months. The patients were analyzed before and after surgical masseteric to facial nerve neurorrhaphy. Examinations were performed at least three months after they had clinically started to regain facial mimicry. The displacement of selected facial landmarks was measured using an optoelectronic three-dimensional motion analyzer during: maximum smile without clenching (pre- and post-surgery); maximum smile by clenching on their posterior teeth (only post-surgery); spontaneous smile (recorded during the vision of a funny video in both examinations). Before facial surgery, in all smiles facial landmarks moved more in the healthy than in the paretic side; after surgery, the differences decreased for both reduction of the healthy side motion, and increment of the paretic side motion (motion ratio before 52%, after 87%, p < 0.05, Students’ t). The ratio between the paretic and healthy side total motion (asymmetry) did not modify for maximum and spontaneous smiles, but significantly increased for the maximum smiles made with teeth clenching (asymmetry before 32%, after 11%, p < 0.001). Spontaneous smiles were recorded only in a subset of patients, but their execution was modified by surgery, with more symmetrical movements of the rehabilitated side landmarks (asymmetry before 33%, after 10%), and reduced motion of the healthy side ones (motion ratio before 51%, after 83%). In conclusion, the significant asymmetry in the magnitude of facial movements that characterized the analyzed patients before surgery reduced after surgery, at least in those facial areas interested by the masseteric to facial nerve reanimation.
    Journal of Plastic Reconstructive & Aesthetic Surgery 01/2014; · 1.44 Impact Factor
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    ABSTRACT: Purpose We wanted to investigate the gait kinematic parameters during stairs ascent and descent after a fibula free flap (FFF) removal for facial reconstruction. Methods Eight patients who underwent facial reconstruction with FFF ascended and descended three standard steps. Their movements were recorded by a motion analyzer; gait kinematic parameters were obtained and compared to those calculated in eight control subjects. Results Stride time, percentage of swing and support phases did not differ among healthy or operated limb, and control subjects (Kruskal Wallis, p>0.05). No significant differences were found for hip and knee movements, pelvis rotation and tilt, and body center of mass displacements. During stair descent, the patients had a significantly larger pelvis inclination than the control subjects (p<0.05). Conclusion No functional limitations during stair performance were found. The only significant difference could indicate a minor control of the pelvis, and should be used to define specific rehabilitative interventions.
    Journal of Oral and Maxillofacial Surgery. 01/2014;
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    ABSTRACT: Forensic anthropologists and pathologists are more and more requested to answer questions on bone trauma. However limitations still exist concerning the proper interpretation of bone fractures and bone lesions in general. Access to known skeletal populations which derive from cadavers (victims of violent deaths) who underwent autopsy and whose autopsy reports are available are obvious sources of information on what happens to bone trauma when subjected to taphonomic variables, such as burial, decomposition, post mortem chemical and mechanical insults; such skeletal collections are still however quite rare. This study presents the results of the comparative analysis between the autopsy findings on 7 cadavers (6 of which victims of blunt, sharp or gunshot wounds) and those of the anthropological assessment performed 20 years later on the exhumed dry bones (part of the Milano skeletal collection). The investigation allowed us to verify how perimortem sharp, blunt and gunshot lesions appear after a long inhumation period, whether they are still recognizable, and how many lesions are no longer detectable or were not detectable at all compared to the autopsy report. It also underlines the importance of creating skeletal collections with known information on cause of death and trauma.
    Forensic Science International. 01/2014;
  • Virgilio F. Ferrario, Chiarella Sforza
    British Journal of Oral and Maxillofacial Surgery 01/2014; · 2.72 Impact Factor
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    ABSTRACT: The purpose of this study was to verify the characteristics of surface electromyography (sEMG) of masticatory muscles in different temporomandibular disorder (TMD) patients. Twenty-four TMD patients were categorized according to the RDC/TMD; Magnetic Resonance Images (MRI) classified patients with disk displacement (DD, mean age 22 years, SD 5; M/F: 3/6), and osteoarthrosis and/or disk displacement (OA, mean age 37 years, SD 10; M/F: 4/11); sEMG was performed according to a standardized protocol. The MRI score was significantly correlated to torque coefficient (r=0.57), temporalis (r=0.85) and masseter (r=0.46) muscle standardized symmetry. The discriminating ability of subject age and EMG scores in separating the two groups was assessed by ROC analysis. Each of the EMG scores showed a significant ability in discriminating between osteoarthrosis and disc displacement. The recording of the masticatory muscle function through sEMG can be a first diagnostic approach to TMD patients, reserving MRI assessment to selected cases.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 01/2014; · 1.50 Impact Factor
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    ABSTRACT: The objective of this study was to assess the accuracy of displacements of tracing landmarks in standardized facial movements. Forty healthy persons were evaluated in 2 different groups (20 men and 20 women, aged 18-30 years) with optoelectronic motion analyzer and surface laser scanning. The displacements of tracing landmarks in brow lift and smile were calculated, and the 2 methods (optoelectronic motion analyzer and surface laser scanning) were compared in healthy persons. Side-related differences were found in the tracing landmark (superciliare) during brow lift movements between both methods (the largest movements were found on the right side, P = 0.044), whereas in smile movements the tracing landmark cheilion did not show significant differences between the 2 sides.In both movements, the differences of the tracing landmark displacements between the 2 systems and sexes were on average less than 2 mm, without statistically significant differences (P > 0.05). In conclusion, normal young adult men and women had similar standardized facial movements. The 2 analyzed movements can be measured by both optical instruments with comparable results.
    The Journal of craniofacial surgery 01/2014; 25(1):e65-70. · 0.81 Impact Factor
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    ABSTRACT: Objectives Three-dimensional virtual models are described. Since orthodontic manufacturers have been for long almost the only operators in the field, orthodontists are non familiar with this imaging instrument. Times are ripe for the use of three-dimensional virtual casts in everyday clinical practice and research. Materials and methods This paper reports about the instruments for processing a stone model into a virtual model. Possible advantages like storage of 3D files and the possibility of taking conventional measures (space analysis), are then discussed. Finally the question of the superimposition is considered. Results and conclusions Clinical experience is the key factor when judging biological plausibility of dental movement led by a technician, when preparing a virtual setup. The possibility of superimposing virtual models opens up unusual visual perspectives and comparison when considering treatment results of a single patient or a group of patients.
    Dental Cadmos 01/2014; 82(2):109–116.
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    ABSTRACT: No current age- and gender-related normative data exist for the dimensions of facial structures in Northern Sudanese subjects. In the current study information about normal sex- and age-related linear distances is provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4-30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft tissue facial dimensions were significantly larger in men than in women (p < 0.01), except mouth width (ch-ch), upper facial height (n-sn), mandibular body length (pg-go) and width (go-go). All measurements underwent significant modifications as a function of age (p < 0.01), with significant age × sex interactions (p < 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 11/2013; · 1.25 Impact Factor
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    ABSTRACT: Diagnosis of bruxism is difficult since not all contractions of masticatory muscles during sleeping are bruxism episodes. In this paper, we propose the use of both EMG and ECG signals for the detection of sleep bruxism. Data have been acquired from 21 healthy volunteers and 21 sleep bruxers. The masseter surface EMGs were detected with bipolar concentric electrodes and the ECG with monopolar electrodes located on the clavicular regions. Recordings were made at the subjects' homes during sleeping. Bruxism episodes were automatically detected as characterized by masseter EMG amplitude greater than 10% of the maximum and heart rate increasing by more than 25% with respect to baseline within 1 s before the increase in EMG amplitude above the 10% threshold. Furthermore, the subjects were classified as bruxers and nonbruxers by a neural network. The number of bruxism episodes per night was 24.6 ± 8.4 for bruxers and 4.3 ± 4.5 for controls ( P < 0.0001). The classification error between bruxers and nonbruxers was 1% which was substantially lower than when using EMG only for the classification. These results show that the proposed system, based on the joint analysis of EMG and ECG, can provide support for the clinical diagnosis of bruxism.
    IEEE journal of biomedical and health informatics. 11/2013; 17(6):994-1001.
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    ABSTRACT: With increasing age, the smile becomes elongated and less appealing. Currently, several methods are proposed for analysis of lip morphology including lateral cephalograms, profile and frontal photographs, video images, and three-dimensional systems. Despite several descriptions of morphologic and histologic age-related changes in the literature, no scientific well-supported model of the labial aging process is reported. For this study, 33 healthy volunteers were selected and divided into two groups according to age: a youthful group (ages 21-34 years) and an aged group (ages 45-65 years). Their dental and labial stone casts were obtained, digitized, and virtually reproduced using a computerized electromechanical digitizer and applying nonuniform rational B-spline geometry. To obtain a synthetic parameter describing local surface deformation, average curvature and curvature variability indexes were computed and compared. No significant age- or sex-related differences in the average curvature were detected. In contrast, the curvature variability was significantly greater in the young than in the aged subjects. The labial arch surface remains macroscopically constant between the third and the sixth decades of life, but with local modifications that influence the standard deviation of its curvature. A high standard deviation described the protruding labial appearance of the young subjects, whereas a reduced one described the flat lips of the aged subjects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    Aesthetic Plastic Surgery 10/2013; · 1.26 Impact Factor
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    ABSTRACT: It is well known that obese and elderly subjects show modifications in joint range of motion (ROM) and spatio-temporal gait parameters. This is presumably due to a reduction in muscle strength and flexibility [1], but there are few quantitative studies that objectively measure the influence of physical performance on gait pattern. In this study, we investigated if different levels of strength and flexibility could affect the kinematics of lower limbs in a group of healthy adults. Sixteen normalweight subjects (age, 27.1±5.0 yr; BMI, 22±2.1 kg/m2; preferred walking speed 5.5±0.5 km/h) performed an isometric maximal voluntary contraction (iMVC) on a horizontal leg press equipped with two force plates. The V-sit and reach test was used to assess flexibility. An optoelectronic system was used to measure kinematics while subjects performed 10 min of treadmill walking at 5.5 km/h. We calculated the main spatio-temporal parameters, the ROM and the angular values of pelvis and lower limbs joints at heel strike and toe off events. To find possible associations between physical fitness and biomechanical values, we used the stepwise backward logistic regression analysis, adjusted for age, height and weight. Significant negative associations were identified between iMVC and knee angle at heel strike (F=7.831, p<0.01). Pelvic rotation ROM (F=7.31, p<0.01), knee ROM (F=5.061, p<0.05) and plantarflexion at heel strike (F=4.154, p<0.05) were positively associated with iMVC, as much as flexibility with hip extension at toe off (F=4.355, p<0.05). We found that, in accord with Ko et al. [2], the maximum knee extensor strength was related to modifications of knee ROM. In conclusion, it seems that even in adulthood, different values of strength and flexibility could affect some components of gait kinematics.
    67° National Congress SIAI, Brescia; 09/2013
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    ABSTRACT: Since strictly related to balance and stability control, body center of mass (CoM) kinematics is a relevant quantity in sport surveys. Many methods have been proposed to estimate CoM displacement. Among them, segmental method appears to be suitable to investigate CoM kinematics in sport: human body is assumed as a system of rigid bodies, hence the whole-body CoM is calculated as the weighted average of the CoM of each segment. The number of landmarks represents a crucial choice in the protocol design process: one have to find the proper compromise between accuracy and invasivity. In this study, using a motion analysis system, a protocol based upon the segmental method is validated, adopting an anatomical model comprising 14 landmarks. Two sets of experiments were conducted. Firstly, our protocol was compared to the ground reaction force method (GRF), accounted as a standard in CoM estimation. In the second experiment, we investigated the aerial phase typical of many disciplines, comparing our protocol with: (1) an absolute reference, the parabolic regression of the vertical CoM trajectory during the time of flight; (2) two common approaches to estimate CoM kinematics in gait, known as sacrum and reconstructed pelvis methods. Recognized accuracy indexes proved that the results obtained were comparable to the GRF; what is more, during the aerial phases our protocol showed to be significantly more accurate than the two other methods. The protocol assessed can therefore be adopted as a reliable tool for CoM kinematics estimation in further sport researches.
    Gait & posture 09/2013; · 2.58 Impact Factor

Publication Stats

3k Citations
364.28 Total Impact Points

Institutions

  • 1989–2014
    • University of Milan
      • • Department of Biomedical Sciences for Health
      • • Department of Human Morphology and Biomedical Sciences "Cittá Studi"
      • • Faculty of Medicine
      Milano, Lombardy, Italy
  • 2009–2013
    • University of São Paulo
      • Faculty of Medicine (FM)
      Ribeirão Preto, Estado de Sao Paulo, Brazil
  • 2010
    • Università degli Studi dell'Aquila
      Aquila, Abruzzo, Italy
  • 1991–2009
    • Università degli Studi del Sannio
      Benevento, Campania, Italy
  • 1990–2009
    • Università Politecnica delle Marche
      • Faculty of Medicine and Surgery
      Ancona, The Marches, Italy
  • 2008
    • University CES
      Medellín, Antioquia, Colombia
  • 2007
    • Università degli Studi di Modena e Reggio Emilia
      Modène, Emilia-Romagna, Italy