Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study.

OBJECTIVE: to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS: multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS: 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS: The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.

Reliability and Accuracy of YouTube Peri-Implantitis Videos as an Educational Source for Patients in Population-Based Prevention Strategies.

Considering the need to improve patient knowledge, awareness, and compliance for peri-implantitis prevention, and patients' demand for better, quick, and convenient access to medical information, the present study primarily assessed the reliability and accuracy of YouTube videos on peri-implantitis and secondarily evaluated their educational value for the patients, and the related suitability, as part of population-based preventive strategies, to deliver valid information, potentially capable of improving patient knowledge and educational skills. This study's protocol was developed in advance, and computer history and cookies were cleared to avoid limitations based on preferred user histories. The search term "peri-implantitis" was defined using the Google Trends website, and videos were searched on YouTube on 5 December 2022. Video inclusion and data collection were conducted by independent pre-calibrated investigators. Descriptive statistics were performed on the videos' characteristics, source, category, target audience, popularity, source reliability, video information and quality (VIQI), content, and educational value. Pearson's correlation between educational value and all parameters was calculated. Videos with very low/low and medium/good/excellent educational value were compared using the Mann-Whitney U test. A total of 44 videos with medium values for popularity, VIQI, content, and educational value were analyzed. Most videos covered peri-implantitis treatment rather than etiology and prevention, about half were uploaded by dentists/specialists, and only 10% specifically targeted patients. Only 2% of YouTube videos about peri-implantitis had excellent educational value, and 5% had good educational value. Video educational value was correlated with VIQI and content beyond video length and source reliability. When comparing the very low/low and medium/good/excellent educational value YouTube videos on peri-implantitis, a significant difference was found in the Video Information and Quality Index, VIQI, and video content.

CAR t-cell therapy in BOlogNa-NEUrotoxicity TReatment and Assessment in Lymphoma (CARBON-NEUTRAL): proposed protocol and results from an Italian study.

OBJECTIVE: To investigate neurotoxicity clinical and instrumental features, incidence, risk factors, and early and long-term prognosis in lymphoma patients who received CAR T-cell therapy. METHODS: In this prospective study, consecutive refractory B-cell non-Hodgkin lymphoma patients who received CAR T-cell therapy were included. Patients were comprehensively evaluated (neurological examination, EEG, brain MRI, and neuropsychological test) before and after (two and twelve months) CAR T-cells. From the day of CAR T-cells infusion, patients underwent daily neurological examinations to monitor the development of neurotoxicity. RESULTS: Forty-six patients were included in the study. The median age was 56.5 years, and 13 (28%) were females. Seventeen patients (37%) developed neurotoxicity, characterized by encephalopathy frequently associated with language disturbances (65%) and frontal lobe dysfunction (65%). EEG and brain FDG-PET findings also supported a predominant frontal lobe involvement. The median time at onset and duration were five and eight days, respectively. Baseline EEG abnormalities predicted ICANS development in the multivariable analysis (OR 4.771; CI 1.081-21.048; p = 0.039). Notably, CRS was invariably present before or concomitant with neurotoxicity, and all patients who exhibited severe CRS (grade ≥ 3) developed neurotoxicity. Serum inflammatory markers were significantly higher in patients who developed neurotoxicity. A complete neurological resolution following corticosteroids and anti-cytokines monoclonal antibodies was reached in all patients treated, except for one patient developing a fatal fulminant cerebral edema. All surviving patients completed the 1-year follow-up, and no long-term neurotoxicity was observed. CONCLUSIONS: In the first prospective Italian real-life study, we presented novel clinical and investigative insights into ICANS diagnosis, predictive factors, and prognosis.

Image postproduction analysis as a tool for evaluating topical photodynamic therapy in the treatment of oral lichen planus.

BACKGROUND: Topical Photodynamic Therapy (PDT) is a minimally invasive technique used in various medical specialties. The method involves the use of a light source and a photosensitizer leading to the release of Reactive Oxygen Species and a cytotoxic effect on lesional tissue. PDT can treat various lesions , and in particular Oral Potentially Malignant Disorders (OPMD). CASE PRESENTATION: We present a case illustrating the feasibility of PDT in the treatment of oral lichen planus (OLP). To objectively evaluate the clinical evolution, we used postproduction analysis of the photo taken before (T0), seven days after (T1), and twenty-eight days (T2) after PDT. Lesional measures were used to rate each picture on the Thongprasom score, Clinical Severity Index, and Efficacy Index. CONCLUSIONS: Postproduction analysis showed a significant decrease in dimensions and concomitant improvement on all evaluated scales. Our results ar in line with previous literature on the application of PDT to OPMD and specifically confirm the benefit of this therapeutic approach in OLP. Postproduction analysis appears to be a useful tool to further validate this technique.

Frontal predominant encephalopathy with early paligraphia as a distinctive signature of CAR T-cell therapy-related neurotoxicity.

Chimeric antigen receptor (CAR) T-cell therapy is an emerging highly effective treatment for refractory haematological malignancies. Unfortunately, its therapeutic benefit may be hampered by treatment-related toxicities, including neurotoxicity. Early aggressive treatment is paramount to prevent neurological sequelae, yet it potentially interferes with the anti-cancer action of CAR T-cells. We describe four CAR T-cells infused patients who presented with reiterative writing behaviours, namely paligraphia, as an early manifestation of neurotoxicity, and eventually developed frontal predominant encephalopathy (one mild, three severe). Paligraphia may represent an early, specific, and easily detectable clinical finding of CAR T-cell therapy-related neurotoxicity, potentially informing its management.

Hereditary gingival fibromatosis associated with the missense mutation of the KCNK4 gene.

Hereditary gingival fibromatosis (HGF) is a rare oral condition that may appear as an isolated entity or as part of a genetic disease or syndrome. Molecular and biochemical mechanisms that trigger this pathologic process are not completely understood. In this article, we present a rare case of hereditary gingival fibromatosis in conjunction with a syndromic phenotype, associated with a rare missense mutation of the KCNK4 gene. This mutation induces a change in the structure of the TRAAK channel belonging to the 2-pore potassium channels. The gain of function promoted by the mutation could represent the pathogenetic basis of gingival fibromatosis.

Association of tooth agenesis with dental anomalies in young subjects.

AIM: The aim of the current study is to correlate the presence of tooth agenesis with other dental anomalies in 7- to 15-year-old patients. MATERIALS AND METHODS: After evaluating 4000 panoramic radiographs of young subjects, 430 revealed the presence of tooth agenesis, except for the third molar, and are retrospectively observed and compared with a non-agenesis control group of 500 subjects, in order to investigate the existence of other associated dental anomalies in both groups. RESULTS: The prevalence of tooth agenesis was approximately 9.30% (430/4000); no significant gender differences were found. A significantly higher prevalence of microdontia of the maxillary lateral incisors (p < 0.001) and delayed tooth development (p = 0.0001) was observed in the agenesis group (group A), while delayed development of permanent teeth (p < 0.0001) and hypo-occlusion of the primary molars (p = 0.0130) were found in the control group (group B). CONCLUSIONS: Agenesis patients presented a significantly higher prevalence of microdontia of the maxillary lateral incisors. Instead, non-agenesis patients presented a high prevalence of delayed permanent tooth development and hypo-occlusion of the primary molars. Moreover, further researches are needed to elucidate the role of genetics and environmental factors in the current sample group.

Prognostic significance of CD68+ and CD163+ tumor associated macrophages in head and neck squamous cell carcinoma: A systematic review and meta-analysis.

OBJECTIVE: Tumor associated macrophages (TAMs) are among the most abundant cells of the tumor microenvironment. Several studies have been performed to investigate whether TAM markers, namely CD68 and CD163, could serve as prognostic factors in patients with squamous cell carcinoma of the head and neck (SCCHN). The aim of this systematic review and meta-analysis was to synthetize the available evidence of the literature about the role of CD68+ and CD163+ TAMs as prognostic factors in SCCHN. MATERIALS AND METHODS: This systematic review was performed according to the guidelines reported in the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Meta-analysis of overall survival, disease-free survival and progression-free survival was performed using the inverse of variance test. A random- or a fixed- effect model was used on the basis of the presence of heterogeneity. Risk of bias assessment and subgroup analysis were also performed. RESULTS: High stromal expression of CD163+ TAMs correlated with both poor overall survival (HR, 2.26; 95% CI: [1.47, 3.47]; P < 0.001) and progression-free survival (HR, 2.29; 95% CI: [1.11, 4.71]; P = 0.03). Conversely, abundance of CD68+ TAMs was not associated with overall survival (HR, 1.25; 95% CI: [0.86, 1.80]; P = 0.24) and disease-free survival (HR, 2.06; 95% CI: [0.84, 5.05]; P = 0.11). CONCLUSIONS: Findings from this study revealed that whilst IHC analysis of the generic macrophage marker CD68+ has no prognostic utility in patients with SCCHN, the M2-like marker CD163+ predicts poor prognosis. Our data suggest that assessment of CD163+ TAMs in SCCHN has potential for future clinical use. Further well-standardized studies should be performed to confirm these results.

Molecular Biomarkers Related to Oral Carcinoma: Clinical Trial Outcome Evaluation in a Literature Review.

BACKGROUNDS: The objective of the present research was to systematically revise the international literature about the genetic biomarkers related to oral cancer (OC) evaluating the recent findings in clinical studies. METHODS: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database. The authors conducted the search of articles in the English language published from 2008 to 2018. The present systematic review included only papers with significant results about correlation between wound healing, genetic alteration, and OC. Prognostic capacity of genetic markers was not evaluated in vivo. RESULTS: The first analysis with filters recorded about 1884 published papers. Beyond reading and consideration of suitability, only 20 and then 8 papers, with case report exclusion, were recorded for the revision. CONCLUSION: All the researches recorded the proteomic and genetic alterations in OC human biopsy cells. The gene modification level in the different studies, compared with samples of healthy tissues, has always been statistically significant, but it is not possible to associate publications with each other because each job is based on the measurement of different biomarkers and gene targets. Further investigations should be required in order to state scientific evidence about a clear advantage of using these biomarkers for diagnostic purpose.

Non-invasive analysis of bleaching effect of hydrogen peroxide on enamel by reflectance confocal microscopy (RCM): study of series of cases.

The aim of this study is to evaluate in vivo the effects of in-office tooth whitening hydrogen peroxide (HP) agent on enamel-microstructured surface by a reflectance confocal microscopy (RCM). Ten healthy volunteers assisted at the Dental School presenting teeth with vital pulp were selected. The 35% HP whiteness product was applied in two visits on discolored teeth, 1-week interval between, via 20-min applications. A commercially available hand-held RCM (Vivascope3000®, Lucid, Rochester, NY, USA) was used to image in vivo the dental surface of the selected tooth of each volunteer. Twenty upper central incisors' vestibular surfaces were imaged, before bleaching (T0), immediately after (T1) and 1 week later (T2). The peculiar structure of the enamel was seen at T0. After bleaching, white reflective circular bodies were found all over the teeth surfaces, which disappear 1 week later (T2). When the HP gel® was imaged, the same white circular areas were observed. Going deeper, the regular enamel architecture was preserved. Textural analysis of the images in T0 and T2 was performed: GLCM parameters were extracted. Mann-Whitney U test was performed to evaluate statistical differences between two groups of data (p > 0.05). Finally, 35 prisms were randomly selected from T0 and T2 image and diameters were measured; a paired t test was performed (p = 0.381). The RCM is a promisor tool for investigating the features of enamel in vivo, immediately after bleaching procedures, as well as longitudinally.

Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma.

BACKGROUND: ADAR1 is an enzymatic protein, which catalyzes a RNA editing reaction by converting Adenosine to Inosine, and its expression has been found to be dysregulated in many cancer types. The aim of this study was to analyze the expression of ADAR1 in oral squamous cells carcinoma. METHODS: In order to analyze the ADAR1 mRNA expression, data from The Cancer Genome Atlas (TCGA) database were downloaded and analyzed. In addition, immunohistochemistry analysis was performed on an institutional database including 46 samples of oral squamous cell carcinoma in a tissue microarray (TMA). RESULTS: No statistically significant correlation linked the mRNA ADAR1 expression to any clinic-pathological variables in the TCGA database. Immunohistochemistry analysis of ADAR1 showed different expressions between normal mucosa and tumor tissue. Focusing on the subcellular localization, the nuclear expression of ADAR1 correlated with higher grading of differentiation (ρ = 0.442; P-value = 0.002); the general expression of ADAR1 either in cytoplasm or in nuclei, correlated with the Gender of patients (Cytoplasm expression: ρ = -0.295; P-value = 0.049; while for nuclear expression: ρ = +0.374; P = 0.011); cytosol expression resulted to be an independent protective prognostic factor (HR = 0.047; C.I. 95% 0.007-0.321; P-value = 0.002). CONCLUSION: Higher expression of ADAR1 into the cytoplasm resulted to be an independent prognostic factor. In order to understand ADAR1 role in cancer, further studies should be performed, in bigger cohort and under a bio-molecular point of view.

Oral Health Impact Profile in Celiac Patients: Analysis of Recent Findings in a Literature Review.

The increment of recording atypical oral manifestation in young patients often related to systematic disease is today a challenge for the therapists. Sometime, the presence of tooth enamel lesions correlated with soft tissue lesions is just a symptom or a trigger sign for a deeper and undetermined disease. Recently, high impact has been developed toward the influence of the diet as a controlled and modifiable factor in patients affected by celiac pathologies. The celiac disease (CD) is a chronic immune-mediated disorder triggered by the ingestion of gluten that appears in genetically predisposed patients. Gluten is a proline-rich and glutamine-rich protein present in wheat (gliadin), barley (hordein), and rye (secalin). The gluten-free diet (GFD) seems to better influence the oral health status of the CD patients. For this reason, the main objective of this revision was to analyze the international data highlighting the relationship between celiac patients and the oral health impact profile. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database. Authors conducted the search of articles in the English language published from 2008 to 2018. The first analysis with filters recorded 67 manuscripts accordingly with the selected keywords. Finally, a number of 16 appropriate published papers were comprehended in the review. The studies were different in terms of the structure, findings, outcomes, and diet quality evaluation, and for this reason, it was not possible to accomplish a meta-analysis of the recorded data. This manuscript offers some observational evidence to justify the advantages of gluten-free diets related to a better oral health status in the patients involved.

In vivo confocal microscopy analysis of enamel defects after orthodontic treatment: A preliminary study.

After orthodontic treatment with fixed appliances, bonded brackets and residual adhesive must be removed. This procedure should lead to restitutio ad integrum of the enamel or, at least, restore the enamel surface as closely as possible to its pre-treatment conditions. The purpose of this study is the in vivo assessment at a microscopic resolution of enamel surfaces after bracket debonding while avoiding the tooth extraction. Nine orthodontic patients who had brackets removed at the conclusion of orthodontic treatment were enrolled. In vivo reflectance confocal microscopy imaging of dental enamel surface after debonding was performed for each patient. Eighteen upper incisors were analyzed, 10 in which the enamel demineralization appeared after the treatment and 8 in which the demineralization was present before the treatment. RCM analyses showed some speckled or roundish dark areas within the enamel. Moreover enamel alterations were detected at different levels of depth. The present in vivo microscopic study allowed for highlighting structural features in dental enamel, after debonding, at a microscopic resolution in real-time and in a non-invasive way, without the need for extraction or processing of the samples.

In vivo microstructural analysis of enamel in permanent and deciduous teeth.

Confocal microscope was used to analyze human enamel from 10 deciduous and 10 permanent teeth. Optically sectioned images were obtained. A more intense autofluorescence was found in primary teeth. This finding might be due to the greater presence of organic substances in deciduous enamel. The mean prism diameter measurement in permanent teeth enamel was 3.150 µm and 2.602 µm in deciduous teeth. The mean prism diameter in deciduous teeth was statistically least. The results indicate that a confocal microscope may be of help in analyzing and defining the microscopic features of human enamel.

Non-invasive in vivo visualization of enamel defects by reflectance confocal microscopy (RCM).

The enamel defects (EDs) may present with a variety of clinical manifestations with increasing severity from the sole appearance of pale discoloration to remarkable structural alterations. EDs are responsible for higher caries receptivity. In vivo reflectance confocal microscopy (RCM) allows to image in vivo at microscopic resolution of the dental surface, thus avoiding the tooth extraction and the sample preparation because of its ability to optically scan living tissues along their depth. Aim of this study is the in vivo assessment at microscopic resolution of dental surfaces affected by EDs without resorting to invasive methods such as teeth extractions, to define histological findings occurring in chromatic and/or structural EDs. For the purpose, 15 children, referring at the Dental Clinic of the Second University of Naples, affected by several degrees of EDs, were enrolled and underwent in vivo RCM imaging to microscopically define the ED confocal features using a commercially available hand-held reflectance confocal microscope with neither injuries nor discomfort. Totally, 29 teeth were imaged. Results demonstrated images good in quality and the capability to detect EDs such as unevenness, grooves, and lack of mineralization according to their clinical degree of disarray. The present in vivo microscopic study on EDs allowed to highlight structural changes in dental enamel at microscopic resolution in real-time and in a non-invasive way, with no need for extraction or processing the samples. Further experiments could define the responsiveness to remineralizing procedures as therapeutic treatments.