Influence of simulated apical resorption following orthodontic treatment on working length determination: an in vitro study.

AIM: External apical root resorption (EARR) is a common complication that may occur during and after orthodontic treatment. In case of need of endodontic therapy for a tooth with EARR, it has not been clarified yet which benefits can be derived by the use of electronic apex locators (EALs). The present study aimed to assess the accuracy of EALs on extracted teeth before and after simulation of EARR subsequent to orthodontic treatment. MATERIALS AND METHODS: Standard access cavities were prepared on 64 single-rooted teeth. After working length (CWL) determination, specimens were embedded in an alginate mass, connected to two EALs (Apit, Osada, Tokyo, Japan; Root ZX, Morita Corp., Tokyo, Japan) and the electronic working length (EWL) was measured. The apical portion of the specimens was then modified to simulate EARR, and the EWL was determined again. The discrepancy between CWL and EWL was regarded as statistical unit. Collected data underwent statistical analysis by means of non-parametric tests (p < 0.05). RESULTS: Within a range of ± 0.5 and ± 1.0 mm from CWL, the accuracies were 79.7% and 98.4% (Apit/intact tooth); 82.8% and 96.9% (Apit/simulated EARR); 81.3% and 98.4% (Root ZX/intact tooth); 76.6% and 96.9% (Root ZX/simulated EARR). No statistically significant differences in relation to device or apical condition emerged (p > 0.05). CONCLUSION: The two considered EALs showed similar accuracy, which was not affected by the EARR simulation. The use of EALs in the treatment of teeth with EARR following orthodontic treatment may be useful.

7T mMR in the assessment of acute arterial mesenteric ischemia in a rat model.

To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro and microscopic changes in the small bowel. Thirty Sprague-Dawley rats were assigned to two experimental groups (Group I and Group II) of fifteen rats each. Group I underwent surgical procedure of superior mesenteric artery (SMA) ligation, followed by macroscopic observation. In Group II, a loop was tied loosely around the SMA without occluding the vessel. Three days after surgery, the loop was tied by external tips to completely occlude the artery. 7T microMR (7Tesla microMR) was performed before and 8 hours after SMA occlusion. At predetermined time-points the histopathological examinations were performed in both of groups. Macroscopic monitoring revealed thinning of mesenteric vessels, hypotonic reflex ileus and chromatic change of some loops. 7T microMR sequences evidenced loop dilation with gas-fluid mixed stasis, intraperitoneal free fluid and bowel wall hyperintensity. There were no significant differences in the histological analysis between the two groups. The gap of three days from surgery, adopted in the Group 2, allowed to avoid signs of peritoneal and mesenteric irritation which could bias imaging patterns. MR succeeded to identify the signs of arterial mesenteric ischemia.

Entero-colpo-defecography vs supine entero-MRI: which one is the best tool in the differentiation of enterocele, elytrocele and edrocele?

Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduction of quality of life. It represents a very common clinical problem that afflicts women three to seven time more often than men. The purpose of this study was to assess the diagnostic tools available to define the imaging strategy in patients with pelvic floor dynamic dysfunctions and to investigate their abilities in the diagnosis of enterocele, elytrocele and edrocele. From January 2008 to May 2011, 614 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in our retrospective study. After anamnesis and clinical examination, entero-colpo-defecography (ECD) and supine entero-magnetic resonance (SE-MR) exams were performed in all patients. This study showed that the diagnostic efficacy of ECD is higher than that of SE-MR in the detection of enterocele and edrocele. Furthermore, elytrocele can be visualized only with ECD considering the position of patient during SE-MR examination. In addition, in patients planned for surgery, SE-MR is more useful to clarify the intra-pelvic interaction of multiple organ prolapse and to better define the pelvic anatomy and functioning.

Implant platform switching concept: a literature review.

BACKGROUND: The platform switching concept involves the reduction of the restoration abutment diameter with respect to the diameter of dental implant. Long-term follow up around these wide-platforms showed higher levels of bone preservation. AIM: The aim of this article is to carry out a literature review of studies which deal with the influence of platform-switched implants in hard and soft oral tissues. MATERIALS AND METHODS: All papers involving "platform switching" that are indexed in MedLine and published between 2005 and 2011 were used. Clinical cases, experimental and non-experimental studies were included, as well as literature reviews. RESULTS: In our search, we analized 18 clinical cases and 3 reviews. The results indicate that peri-implant bone resorption is reduced with platform switching system. CONCLUSIONS: All papers written by different researchers show an improvement in peri-implant bone preservation and satisfactory aesthetic results. Further long-term studies are necessary to confirm these results.

Role of autophagy inhibitors and inducers in modulating the toxicity of trimethyltin in neuronal cell cultures.

Trimethyltin (TMT) is a triorganotin compound which determines neurodegeneration of specific brain areas particularly damaging the limbic system. Earlier ultrastructural studies indicated the formation of autophagic vacuoles in neurons after TMT intoxication. However, no evaluation has been attempted to determine the role of the autophagic pathway in TMT neurotoxicity. To assess the contribution of autophagy to TMT-induced neuronal cell death, we checked the vulnerability of neuronal cultures to TMT after activation or inhibition of autophagy. Our results show that autophagy inhibitors (3-methyladenine and L-asparagine) greatly enhanced TMT neurotoxicity. Conversely, known activators of autophagy, such as lithium and rapamycin, displayed neuroprotection against this toxic compound. Due to its diverse targets, the action of lithium was complex. When lithium was administered according to a chronic treatment protocol (6 days pretreatment) it was able to rescue both hippocampal and cortical neurons from TMT (or from glutamate toxicity used as reference). This effect was accompanied by an increased phosphorylation of glycogen synthase kinase 3 which is a known target for lithium neuroprotection. If the pre-incubation time was reduced to 2 h (acute treatment protocol), lithium was still able to counteract TMT toxicity in hippocampal but not in cortical neurons. The neuroprotective effect of lithium acutely administered against TMT in hippocampal neurons can be completely reverted by an excess of inositol and is possibly related to the inactivation of inositol monophosphatase, a key regulator of autophagy. These data indicate that TMT neurotoxicity can be dramatically modified, at least in vitro, by lithium addition which seems to act through different mechanisms if acutely or chronically administered.

In vivo accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II.

AIM: To compare in vivo three different electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. METHODOLOGY: Thirty single-rooted permanent teeth scheduled for extraction because of periodontal disease were selected from 10 adult patients (ranging from 45 to 67 years) and divided into three groups of 10 teeth. Before the extraction, an access cavity was prepared and the crown was adjusted to establish a stable reference point for all measurements. The working length in Group 1 was determined using the Dentaport ZX apex locator. A K-file with the largest diameter that could reach the last green bar on the screen was stabilized in the canal using a dual-curable flow resin composite. The same procedure was used for the Raypex 5 (the file reached the last yellow bar) and Propex II (0.0 orange bar) apex locators. The teeth were then extracted and cleared. The distance between the tip of the file and the major foramen was then calculated for each tooth using digital photography according to Axiovision AC software (Carl Zeiss). Positive values were assigned when the file tip passed beyond the major foramen, negative values when the tip was short of the foramen and zero value when the file tip and the foramen coincided. Statistical analysis was performed using the chi-squared test or Fisher's exact test (P ≤ 0.05). RESULTS: Dentaport ZX, Raypex 5 and ProPex ΙΙ produced, respectively, 6, 2 and 4 out of 10 correct measurements, 0, 6 and 5 long measurements and 4, 2, and 1 short measurements. The differences between the three electronic root canal length measurement devices were not significant (P = 0.507). CONCLUSIONS: Under the in vivo conditions of this study, the three electronic root canal length measurement devices were not significantly different in terms of locating the major foramen.

Thrombin and thrombin-derived peptides promote proliferation of cardiac progenitor cells in the form of cardiospheres without affecting their differentiation potential.

Many studies demonstrated that human adult cardiac progenitor cells in the form of cardiospheres (CSps) could represent a powerful candidate for cardiac cell therapy. To achieve the clinical translation of this biotechnological product, the development of well-defined culture conditions is required to optimize their proliferation and differentiation. Thrombin, a serine protease acting through the protease-activated receptor 1 (PAR-1) signalling to modulate many cellular functions such as proliferation and differentiation in several cell types, is one of the factors included in the CSps medium. Therefore, the assessment of the effective dependence of the thrombin related cellular effects from PAR-signalling is strategic both for understanding the biological potential of these cells and for the GMP translation of the medium formulation, using synthesised analogs. In this study the effects of thrombin on human CSps and their potential relationship with the specific proteolytic activation of PAR-1 have been investigated in different culture conditions, including thrombin inhibitor hirudin and PAR-1 agonist/ antagonist peptides TFLLR and MUMB2. In this study we show that, in the presence of thrombin and TFLLR, CSps, in which PAR-1 expression was evidenced by immunofluorescence and western blot analysis, increase their proliferation activity (BrdU assay). Such increased proliferative rate was consistently associated with a higher phosphorylation level of the cell cycle inhibitor GSK3. Concerning the assessment of the potential effects of thrombin and its agonist on differentiation, both western blot and real-time PCR analysis for stemness, cardiac and vascular markers (such as cKit, cx43 and KDR) showed that CSps commitment was substantially unaffected, except for GATA4 mRNA, whose transcription was down-regulated in the presence of the natural protease, but not after treatment with TFLLR. In conclusion, activation of PAR-1-dependent signalling is important to support CSps proliferative potential, keeping unaltered or at best stable their differentiation properties. The availability of thrombin agonists, such as TFLLR, able to guarantee the required growth effect without affecting CSps lineage commitment, could represent a technological improvement for cost-effective, easy-to-handle and GMPtranslatable synthetic media.

Oral inflammatory process and general health. Part 2: How does the periapical inflammatory process compromise general health?

At present, the focal infection theory still has very controversial aspects. In spite of the great number of studies, there is no evidence that focal infections or even antigenic mimicry are responsible for anything other than sporadic abscesses/infections and possibly rare autoimmune disorders. linflammation of endodontic origin (i.e., apical periodontitis--AP) has not received the same attention as inflammation originating from the periodontium. Endodontics is a microbiological problem, since the bacterial infection is the "prime mover" of pulp (before) and periapical (later) disease. The aims of endodontic treatment have to be considered from a microbiological viewpoint. Considering these problems in this second part of their study, the Authors, after close examination of the virulence of microorganisms and of the host defense, analyze the endodontic infection and microbiological species. They emphasize the possibility of a relationship between periapical inflammatory lesions and bacterial endocarditis in preventing metafocal disease. Bacterial endocarditis deserves special mention because despite involving specialists of two scientific fields, its prophylaxis is almost always assigned to medical practice, and especially, to dentistry. Given the dangers of the disease, antibiotic prophylaxis is both absolutely necessary and can be very effective, and it should be used especially in clinical situations with high risk individuals. However, the ability of antibiotic therapy to prevent or reduce the frequency, magnitude or duration of bacteremia associated with a dental procedure is controversial. Studies should also be undertaken to determine to compare the efficacy of endodontic treatment with alternative therapy such as implants, prosthetic replacements or no treatment other than extraction. To date, these studies have not been carried out, and there is no evidence to support the theory that modern endodontic therapy is not safe and effective.

Diabetes mellitus: biochemical, histological and microbiological aspects in periodontal disease.

Relationship between diabetes mellitus (DM) and periodontal disease has been the subject of many studies that underline that diabetic patients are two/three times more susceptible to have an increased risk of periodontal disease, especially when metabolic control is inadequate. In this review the authors analyze, in diabetic patient, biochemical, histological and microbiological aspects of periodontal disease. Recent studies reported the results obtained in not diabetic patients, both periodontopatic and not: in periodontopatic subjects, the value of glycated hemoglobin was higher. As regards type 2 DM has a positive relationship between periodontal inflammation and glycemia, with good probabilities of disease development. Some Authors showed how the hygiene and the professional/domiciliary control could support a reduction of the glycate hemoglobin and, therefore, of the periodontal disease. The glucose accumulation in the crevicular fluid, noticed in pockets with a depth >4 mm, causes an increase of spirochetes and bacteria. Some research reported that scarcely controlled patients show high levels of interleukin-1beta (IL-1beta). This alteration together with the prolonged expression of tumor necrosis factor (TNF) could represent a mechanism used by bacteria to cause a major damage during the inflammation process, sometimes favoured by immunological defects, due to the mobilization of lymphocytes subpopulations. By measuring the values of TNF-a, fibrinogen, high sensitive capsule reactive protein (hs-CRP), IL-4, IL-6, IL-8, IL-10, at the beginning of non-surgical periodontal therapy and it has been after 3 months of treatment, noticed a relevant reduction only of TNF-a and fibrinogen. Concerning vascular alteration, vascular endothelium growing factor (VEGF) could play a major role in the tissues ischemia. The VEGF should determine the tissue ischemia, the angiogenesis and the alteration of glucose haematic level, in patients affected by microvasculopathies due to diabetes and to periodontal diseases. Particularly, the angiogenesis should favor the chronic inflammation, caused by increasing concentration of cytokines and other pro-inflammatory factors.

Quality of thermoplasticized and single point root fillings assessed by micro-computed tomography.

AIM: To evaluate ex vivo the quality of root fillings completed by two thermoplasticized gutta-percha techniques (Thermafil and System B) and a cold gutta-percha technique (single point) by µCT analysis. METHODOLOGY: A total of 30 freshly extracted human single-rooted permanent teeth were selected. Root canals were prepared with ProTaper Universal instruments and then randomly divided into three groups (n = 10) depending on the filling technique. In group 1, canals were filled with a single-point technique; group 2 was filled with Thermafil; in group 3 System B was used. In group 1 and group 3, the root filling was performed using ProTaper Universal gutta-percha points, in group 2 Thermafil obturators were used; AH-Plus sealer was used in all groups. Assessment of the root filling was carried out by µCT, using a desktop X-ray micro focus CT scanner. Percentage of root canal filling materials and voids was calculated for each specimen. Data were statistically analysed using Kruskal-Wallis test (P < 0.05). RESULTS: Mean percentages of filling materials were 98.379 ± 1.204 in the single-point group, 99.023 ± 1.457 in Thermafil group, and 98.167 ± 3.432 in System B group. No statistically significant difference was found amongst the groups. CONCLUSION: All techniques produced comparable results in terms of percentage of filling and void distribution.

Seven-Tesla micro-MRI in early detection of acute arterial ischaemia: evolution of findings in an in vivo rat model.

PURPOSE: Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution. METHODS: Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the first group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI. RESULTS: Macroscopically, a reflex spastic ileus followed by reflex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fluid levels, free intraperitoneal fluid and bowelwall oedema. Histological analysis confirmed ischaemia and earlier damage involving the central portion of the ileum. CONCLUSIONS: This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.

Oral inflammatory process and general health. Part 1: The focal infection and the oral inflammatory lesion.

A focal infection is a localized or generalized infection caused by the dissemination of microorganisms or toxic products from a focus of infection in various organic districts, including the oral district. In the Part 1 of this two-part review article, after historical signs, the Authors describe the current pathogenic concepts like the "immuno-allergic theory" and the formation of auto-antibodies in human body, contributing to the genesis of autoimmune illnesses sustained by individual reactivity linked to eredo-constitutionality. Some theories suppose a focal origin even for general pathology such as cancer, sarcoidosis, multiple sclerosis, amyotrophic lateral sclerosis, autism, Guillain-Barré syndrome, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), Tourette's syndrome, myasthenia gravis, polycystic kidney disease, obesity, Alzheimer's disease and diabetes mellitus. Laboratory analyses (leucocytic formula, protein electrophoresis, C-reactive protein, REUMA test VES, TAS, etc.) are suggestive of the presence of an inflammatory process or of the presence of an aspecific answer to an inflammatory situation. The DNA-Polymerase Chain Reaction method (PCR) is fundamental for the diagnosis of bacterial and viral infections, particularly for those that have non-culturable microorganisms or in cases where are present but in extremely small number in the sample to be analyzed. A positive result confirms the diagnosis, but negative result is not indicator of the absence of illness. Even for oral inflammatory lesions, different basic mechanisms concerning the possible association with systemic diseases exist. They concern local spread, metastatic spread or immunologic cross-reactivity. In this case we assume that most of the ailments come from dental or periodontal foci, as in the bacterial endocarditis, but instead of considering them as possible pathogenetic mechanism of an immune nature, we consider them as originated by the body's response to the presence of bacterial antigens through the formation of specific antibodies. Much researche, sometimes contrasting, has evaluated periodontal pathogens in atheromatous plaques isolated from patients with chronic periodontitis. Oral inflammatory lesions have been shown unequivocally to contribute to elevated systemic inflammatory responses. In some researches intensive periodontal therapy showed a significant reduction of lymphocyte formula, of CRP levels, of interleukin-6 (IL-6) and of LDL cholesterol after two months.

Expression of parathyroid hormone-related protein in human inflamed dental pulp.

INTRODUCTION: The aim of this study was to investigate the presence and the role of the parathyroid hormone-related protein (PTH-rP) in the inflamed pulp. MATERIALS AND METHODS: Thirty-four pulp tissue specimens (24 inflamed and 10 normal pulps) from extracted third molars were studied. The presence of PTH-rP was observed by using immunohistochemistry. Negative controls were performed using non immunized rabbit or mouse serum, omitting the primary antibody. RESULTS: The analysis of all the sections of normal pulps showed the presence of PTHrP positive cells only in the odontoblastic zone and in few fibroblasts. Instead all inflamed pulps showed PTHrP positive cells both in vascular zone and in pulp stroma, as well as in the odontoblastic and subodontoblastic zone. CONCLUSION: Several works proved that this peptide plays a role even in angiogenesis process, but its function is controversial. It is possible to hypothesize that PTHrP stimulates angiogenesis, but it is recommended to further conduct research on this area.

Root canal morphology of the mesiobuccal root of maxillary first molars: a micro-computed tomographic analysis.

AIM: To investigate ex vivo, the root canal morphology of the MB root of maxillary first molar teeth by means of micro-computed tomography. METHODOLOGY: Thirty extracted intact human maxillary first molar teeth were selected for micro-tomographic analysis (SkyScan 1072, Aartselaar, Belgium) with a slice thickness of 38.0 mum. The following data regarding the MB root were analysed and recorded: number and type of root canals, prevalence of isthmuses, prevalence of intercanal connections, presence of accessory canals, presence of loops and number of apical foramina. RESULTS: The MB2 canal was present in 80% of specimens and was independent in 42% of these cases. When present, the MB2 canal merged with the MB1 canal in 58% of cases. Communications between the two canals were found in all specimens, with isthmuses in 71% of the cases. These communications and isthmuses were respectively in 42% and 54% of the cases in the coronal third, in 59% and 79% of the cases in the middle third and in 24% and 50% of the cases in the apical third. A single apical foramen was found in 37% of specimens, two apical foramina were present in 23% of the cases, with three or more separate apical foramina occurring in 40% of the specimens. CONCLUSIONS: The MB root canal anatomy was complex: a high incidence of MB2 root canals, isthmuses, accessory canals, apical delta and loops was found.

Influence of surface remodelling using burs on the macro and micro surface morphology of anatomically formed fibre posts.

AIM: To evaluate the effect of modifying preformed fibre-reinforced composite (FRC) endodontic posts on their surface morphology and to determine how this procedure affects the integrity of the posts. SUMMARY: Surfaces of 10 preformed glass-fibre posts (group 1) and carbon-fibre posts (group 2) were compared with those of individually formed glass-fibre posts (group 3). Ten FRC posts were modelled in order to give them a shape as close as possible to the anatomy of oval root canals. Starting from a preformed cylindrical fibre post 2.5 mm in diameter, it was modelled in such a way as to passively occupy the entire post-space length, using a cast previously created as a guide. Microscopic analyses (optical stereomicroscope and scanning electron microscope) of the post surfaces revealed similar features in all three groups. All posts had regular surfaces after cutting with a diamond bur. Smear layer mainly attributable to the cutting procedures covered the cut surface of some specimens. In conclusion, modulation of a fibre post using a diamond-coated bur did not show a loss of integrity of the post. *Because of the importance of micromechanical retention, the surface integrity of fibre posts may be important for adhesion between post and composite resin. *Modification of a fibre post using a diamond-coated bur did not damage the surface integrity of the posts. *Fibre posts can be ground to a different shape without losing their surface integrity, resulting in posts with a surface that is not visibly different from unmodified commercially available fibre posts.

Using a GIS transfer model to evaluate pollutant loads in the Lake Kinneret watershed, Israel.

Lake Kinneret (Sea of Galilee) is the only large surface water body in Israel, encompassing an area of 167 km2 and supplying some 30% of the country's fresh water. Pollution from anthropogenic sources and water abstraction for domestic and agricultural uses has long been threatening the water quality of the lake. Point-source pollution in the watershed has decreased drastically with the development of wastewater treatment. However, diffuse pollution from agricultural activities is still an unresolved issue. In this paper we present an application of AVGWLF (a GIS-based watershed load model) to the Lake Kinneret watershed. The model allows one to simulate daily stream flows and monthly sediment, nitrogen, and phosphorus loads discharged to the lake from the surrounding watershed. Results from simulations yield a satisfactory correspondence between simulated and measured daily water volume. Partition by source of total phosphorus delivered to the lake in the period of 2000-04 confirms the reduction in point source nutrient contribution due to improvement of wastewater treatment facilities in the area. Future management should focus on reduction of nutrients originating from septic systems (point sources) and pasture and cropland areas (diffuse sources). Results from simulations will enable watershed managers to prioritize effective management alternatives for protecting the water quality in the lake.

Gene activating and proapoptotic potential are independent properties of different CD4 epitopes.

CD4 engagement triggers an early signaling cascade which initiates late events such as transcription factor activation. The outcome of CD4 engagement is T-cell commitment to alternative, dramatically different fates, such as activation and apoptosis. We have tested a panel of anti-CD4 mAbs specific for different CD4 epitopes, as well as HIV-1 gp120, for the capacity to activate crucial early events such as enhancement of p56(lck) kinase activity and Shc phosphorylation. The same CD4 epitopes were characterized for their capacity both to deliver a gene activating signal and to program T-cells to activation dependent death. No correlation could be found between capacity of specific CD4 epitopes to deliver a gene activating signal and capacity to prime T-cells to apoptosis, suggesting that gene activating and proapoptotic potential are independent functions of CD4 epitopes. Furthermore, while triggering of the calcium pathway appears critical in NF-AT activation, optimal p56(lck) activation and Shc phosphorylation might be required for initiation of the apoptotic pathway.

Renovascular anatomic variants at CT angiography.

AIM: The aim of this paper was to assess the origin and course variations of vessels forming the renal vascular pedicle. METHODS: The IRB approved study retrospectively evaluated 921 consecutive patients (503 females, 418 males; mean age, 54 years), who underwent multidetector computed tomographic (MDCT) of the abdomen for various purposes at our Department of Radiology, between January 2012 and December 2013. Multiplanar and volumetric reformations were performed in all cases. For each set of images, the locations of renal artery origins and renal venous drainage, such as all renal vessels variations, including division variations and presence of extrarenal vessels, were investigated. RESULTS: The tract of the aorta between the upper margin of L1 and the lower margin of L2 originated 96% of main renal arteries and 72% of extra renal arteries. The most common location for renal artery origin was the L1- L2 intervertebral disc level. Sixty-nine percent of patients showed a single renal artery, with multiple arteries in 31%, bilateral multiple arteries in 11%, and early division in 6% of cases. Additional renal arteries were detected on the right side in 5% and on the left side in 12% of cases. With regard to the venous drainage, 89.8% of patients showed a single renal vein, with multiple vein in 10.2%, while 23.8% showed a retro-aortic course of the renal vein. CONCLUSION: Renal arteries and veins variations of origin and course are not infrequent. Extrarenal vessels may compromise renal surgery. The awareness of any possible renovascular anomaly is crucial in case of a non-invasive diagnostic search for renal artery stenosis, and when renal surgery related to renal arteries is performed, such as in case of interventional radiological procedures, urological and vascular operations, and renal transplantation.

Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps.

OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients' preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible.

Fluorescence imaging of submicrometric lattices of colour centres in LiF by an apertureless scanning near-field optical microscope.

We report fluorescence imaging of colour centres in Lithium Fluoride (LiF) using an apertureless Scanning Near Field Optical Microscope (SNOM). The sample consists of periodically spaced submicrometric coloured areas F2 laser-active colour centres produced by low-energy electron beam lithography on the surface of a LiF thin film. A silicon Atomic Force Microscope (AFM) tip is used as an apertureless optical probe. AFM images show a uniform surface roughness with a RMS of 7.2 nm. The SNOM images of the red fluorescence of colour centres excited at lambda = 458 nm with an argon ion laser show that the local photon emission is unambiguously related to the coloured areas and that topographic artefacts can be excluded.