White spot lesions in orthodontics: prevention and treatment. A descriptive review.

White spot lesions (WSL) are demineralizations of the enamel found on the tooth surfaces. WSL are considered incipient non-cavitated caries caused by bacterial plaque activity. Subjects with malocclusion such as dental crowding and fixed orthodontic appliances have a greater number of retention sites and consequently difficulty in cleaning and greater predisposition to caries. In fact, WSL are a frequent side effect of orthodontic fixed treatments. The prevention and resolution of this problem is the goal of any orthodontist because untreated WSL can lead to the formation of deeper dental caries and restorative treatment with consequent compromise of patient satisfaction with the aesthetic result obtained at the end of the orthodontic treatment. This review is intended not only for orthodontists but also for general and pediatric dentists who want to learn how to correctly prevent, and treat this unsightly problem. On the market there are many products sold to achieve this goal, some of them can be managed independently by the patient at home, others require the intervention of the dentist. The purpose of this literature review is to understand how these substances work, to identify with which of the currently most widespread the best results have been obtained and then to provide useful information to guide the clinician in choosing the most suitable one for the patient.

Stabilized zirconia ceramics for dental applications.

The research is aiming to obtain at room temperature a new ceramic material containing partially stabilized zirconia with different oxides after sintering used for dental and other technological purposes. Our research proposes a new method based on the use of stabilized zirconia with other oxides to obtain optimized dental material with a lower cost price and / or improved properties to allow wider use of these products to an increased number of patients in dental offices. X-ray diffraction, SEM analysis. FTIR spectroscopy, UVVis and density measurements were accomplished for the three ceramic systems. The correlation between the microstructure and the spectroscopic properties of zirconium stabilized by FTIR spectroscopy, UV-Vis helps understanding the mechanisms associated with the formation of high (tetragonal and / or cubic) temperature zirconia. Along with the simple, less costly preparation method and high purity of the ceramic products our study offers a highly desirable product for technological applications.

The bad relationship, osteo-decay and diabetes type 2 searching for a link: a literature review.

The diabetes and osteoporotic metabolic diseases are characterized by a wide prevalence of the population worldwide and correlated to alteration of the bone tissues. Several cofactors could influence the clinical course and the biochemistry of the pathologies such as human microbiome, nutrition characteristics, gut microbiota activity and interactions with vitamin K and D across IGF/GH and TP53 signaling pathways and the glucose/energy as mechanism for bone tissue health. Moreover, also the calories and sugar consumption seem to be correlated to an increased inflammatory state with several consequences for hematopoiesis and host tissues response. The aim of the present literature review was to highlight the role of osteoporotic diseases and diabetes type 2 link for the bone metabolism. The literature cases showed that a correlation between bone-gut-kidney-heart-CNS-Immunity crosstalk seems to be linked with bone metabolism and health regulation. Moreover, also the aging process could represent a valuable co-factor for the sustaining of the metabolic disorders upon a multi-systemic level.

Management of anterior open-bite in the deciduous, mixed and permanent dentition stage: a descriptive review.

Anterior open bite is one of the most complex malocclusions to manage. The interaction of skeletal, dental, and soft tissue effects can contribute to develop an anterior open bite. The skeletal open bite requires a more complex approach of treatment to reach function, aesthetics, and stability. The approaches vary depending on the causative factors and the age of patients. Treatment approaches for open bite patients differ when dealing with adults and growing patients. The aim of this descriptive review was to summarize the main existing treatment strategies for anterior open bite, from the noninvasive behavioural shaping to the orthodontic intrusion with skeletal anchorage.

Compliance of children with removable functional appliance with microchip integrated during covid-19 pandemic: a systematic review.

Treatments with removable appliances are widely used in Europe to correct dento-skeletal dysgnatia in the growth phase that is a period of poor cooperation of the patients. Adherence to the wear-time prescription is often not achieved and it represent the main argument against the use of removable devices. Suspected non-compliant behavior with the wear time prescription is often the subject of medico-legal disputes, which can deteriorate doctor-patient relationship. The use of microchips allows to document objectively and clarify the patient's behavior. To conduct a systematic review of the orthodontic literature to identify the factors associated with compliance in orthodontic treatment. We conduct a systematic review that aimed to identity the factors associate with compliance in orthodontic treatment. The main purpose was to assess the objective levels of time of use of the removable appliances and the self-reported levels. A literature search was conducted by the electronic databases PubMed and Cochrane Library. The following search terms were used: compliance functional removable orthodontic appliance. Randomized and nonrandomized controlled trials, prospective cohort studies, case series, qualitative and mixed-methods studies objectively assessing compliance levels were included in the study. A total of 94 articles were identified by PubMed and 14 articles by Cochrane. The papers selected were included for the qualitative analysis and categorized according to the subjects age, the clinical appliance, compliance factors, wear time and monitoring. Removable appliances are an important part of orthodontic treatment, used in growth phase of the patient. Collaboration with removable functional devices determines success / failure in treatment.

Cardiac transplantation from a carbon monoxide intoxicated donor.

Heart transplantation is a demonstrated successful and life-saving treatment for an increasing number of patients. The growth of heart transplantation surgery is limited by the relative lack of suitable donors, and the increasing demand has lead to the expansion of acceptance criteria. Patients succumbing to carbon monoxide (CO) poisoning are usually considered not suitable organ donors and they are routinely rejected in many centers. Although organs from CO poisoning donors have been occasionally used, cardiac transplantation in this scenario remains very uncommon. We report the successful heart transplantation from a CO intoxicated donor, who was previously refused by two other transplantation teams. Standard donor evaluation criteria, transplantation techniques and management were used. Limited cases are described in literature. The present case may increase awareness among emergency department physicians, as well as transplantations teams, that patients dying of CO exposure may be acceptable cardiac donors.

Intraoperative rupture of the donor aorta during heart transplantation: surgical management with a Bentall-de Bono procedure.

Aortic complications are uncommon in cardiac allograft recipients. Primary acute aortic rupture is an extremely rare and dramatic event that can occur in the early phase after transplantation. In this article we describe a case of acute intraoperative rupture of the donor aorta just after aortic declamping during orthotopic cardiac transplantation procedure, successfully treated with a Bentall-De Bono operation.

Dilated cardiomyopathy in dialysis patients--beneficial effects of carvedilol: a double-blind, placebo-controlled trial.

OBJECTIVES: The aim of this study was to investigate in dialysis patients with symptomatic heart failure New York Heart Association (NYHA) functional class II or III whether the addition of carvedilol to conventional therapy is associated with beneficial effects on cardiac architecture, function and clinical status. BACKGROUND: Congestive heart failure (CHF) in chronic hemodialyzed patients, particularly when associated with dilated cardiomyopathy, represents an ominous complication and is an independent risk factor for cardiac mortality. METHODS: We enrolled 114 dialysis patients with dilated cardiomyopathy. All patients were treated with carvedilol for 12 months in a double-blind, placebo-controlled, randomized trial. The patients underwent M-mode and two-dimensional echocardiography at baseline, 1, 6 and 12 months after the randomization. Each patient's clinical status was assessed using an NYHA functional classification that was determined after 6 and 12 months of treatment. RESULTS: Carvedilol treatment improved left ventricular (LV) function. In the active-treatment group, the increase in LV ejection fraction (from 26.3% to 34.8%, p < 0.05 vs. basal and placebo group) and the reduction of both LV end-diastolic volume (from 100 ml/m2 to 94 ml/m2, p < 0.05 vs. basal and placebo group) and end-systolic volume (from 74 ml/m2 to 62 ml/m2, p < 0.05 vs. basal and placebo group) reached statistical significance after six months of therapy, compared with baseline and corresponding placebo values, and they remained constant at one year of treatment (p < 0.05 vs. basal and placebo group). The clinical status of patients, assessed by NYHA functional classification, improved during the treatment period. Moreover, at the end of the trial, there were no patients in NYHA functional class IV in the carvedilol group, compared with 5.9% of the patients in the placebo arm. CONCLUSIONS: One year of therapy with carvedilol in dialysis patients with CHF and dilated cardiomyopathy reduces LV volumes and improves LV function and clinical status.

Substantial amounts of gonadotrophin-like materials in sera of normal subjects.

Ultrafiltration of human sera resulted in increased levels of human chorionic gonadotrophin (hCH), LH and FSH measured by radioimmunoassay. The effect was greatly enhanced by chromatography of serum through Sepharose-protein A (which specifically binds immunoglobulin G) followed by ultrafiltration of the unretarded fractions. Serum from a normally menstruating women was treated by ultrafiltration and the retained fraction from 200 mul serum further chromatographed on a Sephadex G-150 Superfine column. The amounts of LH and FSH measured in the eluate by radioimmunoassay were higher by three orders of magnitude than those found in the untreated serum. Comparable amounts of hCG were also found in the eluate by two specific radioimmunoassays, and a value of 45 i.u. hCG was recovered in the eluate by bioassay. Serum from another normally menstruating women was applied to DEAE-cellulose and eluted stepwise using an elution gradient. The ultrafiltrate of one eluted fraction led to separation of a low molecular weight material which was able to neutralize the biological activity of a large dose of hCG. The data support the hypothesis that substantial amounts of gonadotrophins are normally present in serum but that binding to inhibitor(s) prevents their assay in untreated sera.

Extracorporeal right to left atrial bypass to treat right ventricular failure.

Graft right ventricular failure after heart transplantation, secondary to preoperative functional pulmonary hypertension, was successfully managed in a 49-year-old patient using an extracorporeal right to left atrial bypass. We comment on the case and discuss the type of mechanical assistance used.

Activity-rest stimulation of latissimus dorsi for cardiomyoplasty: 1-year results in sheep.

BACKGROUND: In dynamic cardiomyoplasty electro-stimulation achieves full transformation of the latissimus dorsi (LD); therefore, its slowness limits the systolic support. Daily activity-rest could maintain partial transformation of the LD. METHODS: Sheep LD were burst-stimulated either 10 or 24 hours/day. Before and 2, 4, 6, and 12 months after stimulation, LD power output, fatigue resistance, and tetanic fusion frequency were assessed. Latissimus dorsi were biopsied at 6 months, and sheep sacrificed at 12 months. RESULTS: After 1 year of 10 hours/day stimulation LD was substantially conserved and contained large amounts of fast type myosin. From 2 months to 1 year of stimulation the power per muscle of the daily rested LD was greater than that of the left ventricle, being three to four times higher than in the 24-hour/day stimulation. CONCLUSIONS: If extended to humans, these results could be the rationale for the need of a cardiomyostimulator, whose discontinuous activity could offer to patients the long-standing advantage of a faster and powerful muscle contraction.

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

Effects of cadmium on cytotoxic functions of human natural killer cells.

The effect of cadmium (Cd(2+)) was studied on natural killer (NK) cell-mediated cytotoxicity as well as on antibody-dependent cellular cytotoxicity (ADCC) of human peripheral blood lymphocytes. The results show that cadmium chloride inhibits human NK and ADCC activities against K562 and Ab-coated P815 target cells in a dose- and time-dependent manner. Maximal inhibition (80-90%) was observed in the presence of 100 mum-cadmium chloride, and it does not appear to be due to toxic effects on effector cells. Purification of large granular lymphocytes by Percoll density gradient centrifugation suggests that Cd(2+) acts directly on this cell population. No effects of Cd(2+) could be found after pre-exposure of either effector or target cells separately. The inhibitory effect of Cd(2+) was manifested only when effector and target cells were present simultaneously. The greatest inhibition of NK and ADCC activities occurred when cadmium chloride was added to the assay within the first 60 min, suggesting that an early event was affected by Cd(2+). However, Cd(2+) did not block effector-target conjugate formation or affect leucocyte function associated Ag-1 expression on effector cells. This indicates that an initial triggering of effector cells by target cells was required before Cd(2+) could exert its effect. Cd(2+)-induced inhibition of cytotoxic functions of NK cells could be only partially prevented by increasing the external Ca(2+) concentration or by adding Zn(2+) to the culture medium.

Early thrombosis of an aortic St. Jude valve in spite of effective anticoagulant treatment.

A case of early thrombosis of a St. Jude Medical valve in aortic position in a patient under full anticoagulant treatment is presented. Possible etiologic factors are discussed.

Surgical approach to combined carotids and coronaries lesions.

A preoperative carotid evaluation by a Duplex Scanner ATL Mark V has been carried out in 338 patients candidates to CABG. When a critical lesion was detected a digital angiography was subsequently performed. In 19 patients an operation was done because the coexistence of lesions in the carotids and the coronaries. The indications, the timing of the operations and the surgical approach are discussed. In the Author's minds the combined procedure seems to be advisable.

[Skeletal changes in non-Hodgkin lymphoma]. / Le alterazioni scheletriche nei linfomi non-Hodgkin.

140 patients affected by non-Hodgkin lymphoma (NHL) are performed by the A. Skeletal involvement of metastatic nature is observed in 14 of these (10%). Only the aggressive lymphomas have radiographic bone disseminations. At beginning of disease no patient has interested by bone changes. The most frequent roentgenographic finding observed by the A. include high incidence of osteolityc lesions: in particularly, pattern so called "permeative" is present in 35.6% of cases. Osteosclerotic and mixed manifestations were much less commonly observed (7,2% respectively). Periosteal reactions is not observed in any cases. The value of roentgen skeletal investigation in diagnosis, staging and therapy of NHL is discussed by the A.

[One hundred years old and under haemodialysis treatment for 5 years...a case to ponder]. / Cento anni di vita, da cinque anni in dialisi...un caso che fa riflettere.

BACKGROUND: The average age of the patients, introduced in the dialytic programme, is progressively increasing in relation to the prolonging of life and to the technological progresses. All this places the nephrologist to ask himself if the age has to be considered a limiting factor for the introduction of a patient in the dialytic programme. CASE REPORT: We report on a patient who started her dialytic programme when she was 95. After 5 years, at the age of 100, she uneventfully completed 60 months of haemodialytic treatment. Right from the start we decided to use as vascular access a double Tesio catheter, which was never replaced because it was the most appropriate for the patient's age. During the follow-up period the patient was not hospitalised and her clinical condition was satisfactory. DISCUSSION: According to the latest epidemiological and clinical data, this case emphasises the concept that it would be wrong to refuse the haemodialytic treatment to such patients only because of their frailty. Moreover, the lack of either univocal prognostic indications, based on scientific criteria, or special national laws confirm that the decision to treat the patient depends exclusively on the physician's ethical and professional background as well as the patient's autonomy and conscience.

[Type of newborn infant feeding and an epidemiological approach to SIDS]. / Uno studio sul tipo di allattamento del neonato e approccio epidemiologico alla SIDS.

There are many etiopathogenetic theories that hypothesize several causes or factors supporting the onset of Sudden Infant Death Syndrome (SIDS). Among the SIDS factors there are bacterial endotoxins which can be conveyed into the organism in large amounts, by contaminated milk. An epidemiologic research was carried out on a sample of 258 mothers of children and boys attending some schools of L'Aquila district in 1988. It supplied data on the nursing procedures and about diseases with unknown aetiology related to nursing periods. The results obtained refer to the years 1974-84: 33.6% of sample was normal breast-fed infants. We found increasing percentage values referred to bottle-fed infants the first month of life (45% of sample in 1984); 22.5% of sample was bottle-fed infants only. Cows' milk was less and less used and it reached the 5% value in 1984. A case of hypothetic near-SIDS (0.4%) was found and another case which can be defined at SIDS-risk. It concerns two bottle-fed infants whose milk was diluted with simple drinking water. In addition a case of SIDS in a family was found: she was a girl aged 23 weeks who had begun drinking neat cows' milk only twenty days before the disease.

Microbiological characterization of freatobiont organisms: trial of an analytical protocol and hygienic implications.

The objective of the present study lies in verifing the applicability of an analytical protocol to characterize the microbiology of the surface and gut of freatobiont organisms. The fundamental hypothesis of the study is that the subsurface microinvertebrates represent a protective condition for bacteria, whose presence in potable spring water is rigorously excluded by european standards of quality. The study was conducted between August 1996 and March 1998. Sediment samples were collected from the spring system of "Presciano", whose waters come from the regional aquifer of the Gran Sasso Massif in Italy (L'Aquila, Abruzzo). Drawings of samples were conducted at two different depths (-70 cm and -150 cm). The extration of the fauna (including copepodes) from sediments were achieved with the aid of a Wild M3 microscope. Isolate freatobiont organisms were placed in a sterile Petri plate and subjected to three washings. The liquids of the second and third washings were microbiological analyzed proceeding, in the course of the third washing, to squash the organisms with the aid of a sterile iron handle. Among the microinvertebrates, the copepod Harpacticoida Nitocrella pescei is the most represented species from the two levels of depth. In all, were isolated and identified 106 bacterial species; of these species only 12 (11.3%) did not show any adaptation to the temperature of 35 degrees C. The analytical protocol permitted to make evident a different distribution of microbial species between the two kinds of washing liquids, and this leads to considerate appropriate the adopted protocol. Even if the number of sediment samples analyzed was a few it was identified a great variety of microbial genera and species the greater part of which were mesophilic. This is a consequence of an adaptability that could be favoured by the presence of freatobiont fauna and that concern even microorganisms usually considered "faecal contamination indicators".