Efficacy and Safety of Treatment of Complex Idiopathic Fistula-in-Ano Using Autologous Centrifuged Adipose Tissue Containing Progenitor Cells: A Randomized Controlled Trial.

BACKGROUND: Mesenchymal stem cells derived from adipose tissue have been successfully used to promote sphincter-saving anal fistula healing. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the use of autologous centrifuged adipose tissue in the healing process of cryptoglandular complex anal fistulas. DESIGN: This is a randomized controlled trial. SETTINGS: This study was conducted at a single center. PATIENTS: Patients with complex perianal fistulas not associated with Crohn's disease were included. Rectovaginal fistulas were not included. INTERVENTIONS: Patients were randomly allocated to receive treatment with centrifuged adipose tissue injection (experimental group) and without injection (control group) in combination with fistula surgery. MAIN OUTCOME MEASURES: The primary outcome was defined as the proportion of patients with complete fistula closure at 4 weeks (short-term outcome) and 6 months after surgery (long-term outcome). Healing was defined as when the external opening was closed with no perianal discharge on clinical assessment. The secondary outcome was safety that was evaluated by the analysis of adverse events up to 3 months after surgery. Pelvic MRI was performed at 3 months to assure safety and the accuracy of the clinical determination of healing. Postoperative pain, return to work/daily activities, persistent closure at 6 months, fecal incontinence, and patient satisfaction were evaluated. RESULTS: Fifty-eight patients who received centrifuged adipose tissue injection and 58 patients who did not receive centrifuged adipose tissue injection were included in the safety and efficacy analysis. After 4 weeks, the healing rate was 63.8% in the experimental group compared with 15.5% in the control group (p < 0.001). No major adverse events were recorded. Postoperative anal pain was significantly lower in the injection group. Time taken to return to work/daily activities was significantly shorter in the experimental group (3 days) than in the control group (17 days). At 6 months, persistent closure was similar in the 2 groups (86.2% vs 81%). Fecal Incontinence Score at 6 months after surgery was identical to the preoperative score. Patient satisfaction was high in both groups. LIMITATIONS: The absence of blinding, the lack of correlation between stem cell content, and the clinical outcome were limitations of the study. CONCLUSIONS: Autologous centrifuged adipose tissue injection may represent a safe, efficacious, and inexpensive option for the treatment of complex fistula-in-ano. See Video Abstract at http://links.lww.com/DCR/B607. CLINICAL TRIALS REGISTRATION: URL: https://www.clinicaltrials.gov. Identifier: NCT04326907. EFICACIA Y SEGURIDAD DEL TRATAMIENTO DE LA FSTULA ANAL COMPLEJA IDIOPTICA UTILIZANDO TEJIDO ADIPOSO CENTRIFUGADO AUTLOGO QUE CONTIENE CLULAS PROGENITORAS UN ENSAYO CONTROLADO ALEATORIO: ANTECEDENTES:Las células madre mesenquimales derivadas del tejido adiposo se han utilizado con éxito para promover la curación de la fístula anal con preservación de esfínter.OBJETIVO:El objetivo de este estudio fue evaluar la eficacia y seguridad del uso de tejido adiposo autólogo centrifugado en el proceso de cicatrización de fístulas anales complejas de origen criptoglandular.DISEÑO:Ensayo controlado aleatorio.ENTORNO CLÍNICO:Estudio unicéntrico.PACIENTES:Se incluyeron pacientes con fístulas perianales complejas no asociadas a Enfermedad de Crohn. No se incluyeron las fístulas rectovaginales.INTERVENCIONES:Los pacientes fueron asignados aleatoriamente para recibir tratamiento con inyección de tejido adiposo centrifugado (grupo experimental) y sin inyección (grupo de control) en combinación con cirugía de fístula.PRINCIPALES MEDIDAS DE VALORACIÓN:El resultado primario se definió como la proporción de pacientes con cierre completo de la fístula a las 4 semanas (resultado a corto plazo) y 6 meses después de la cirugía (resultado a largo plazo). La curación se definió cuando orificio externo se cerró sin secreción perianal en la valoración clínica. El resultado secundario fue la seguridad que se evaluó mediante el análisis de los eventos adversos (EA) hasta 3 meses después de la cirugía. La resonancia magnética pélvica se realizó a los 3 meses para garantizar la seguridad y la precisión clínica de la curación. Se evaluó el dolor postoperatorio, el regreso al trabajo / actividades diarias, el cierre persistente a los 6 meses, la incontinencia fecal y la satisfacción del paciente.RESULTADOS:Cincuenta y ocho pacientes que recibieron inyección de tejido adiposo centrifugado y 58 pacientes que no recibieron inyección de tejido adiposo centrifugado se incluyeron en el análisis de seguridad y eficacia. Después de 4 semanas, la tasa de curación fue del 63,8% en el grupo experimental en comparación con el 15,5% en el grupo de control (p <0,001). No se registraron eventos adversos importantes. El dolor anal posoperatorio fue significativamente menor en el grupo de inyección. El tiempo necesario para volver al trabajo / actividades diarias fue significativamente menor en el grupo experimental (3 días) con respecto al grupo de control (17 días). A los 6 meses, el cierre persistente fue similar en los dos grupos (86,2% vs 81%). La puntuación de incontinencia fecal a los 6 meses después de la cirugía fue idéntica a la puntuación preoperatoria. La satisfacción del paciente fue muy alta en ambos grupos.LIMITACIONES:Ausencia de cegamiento, falta de correlación entre el contenido de células madre y el resultado clínico.CONCLUSIONES:La inyección de tejido adiposo centrifugado autólogo puede representar una opción segura, eficaz y económica para el tratamiento de la fístula anal compleja.Registro de ensayos clínicos: www.clinicaltrials.gov, identificador NCT04326907; No patrocinado.Consulte Video Resumen en http://links.lww.com/DCR/B607.

A phase II randomized clinical trial for the treatment of recalcitrant chronic leg ulcers using centrifuged adipose tissue containing progenitor cells.

BACKGROUND AIMS: Preclinical and observational reports indicate that adipose tissue (AT) is a safe and promising tool to treat non-healing venous leg ulcers (VLUs). METHODS: From an initial cohort of 38 patients, 16 patients affected by non-healing VLUs were randomly allocated to the experimental arm (5 men and 3 women) and control arm (5 men and 3 women). In the experimental arm, wounds were treated by debridement, centrifuged adipose tissue (CAT), advanced dressings and compression. No experimental treatment (CAT) was administered to the control arm. We investigated the functional and the immunophenotypical features of the harvested CAT-derived stem cells. The primary outcome measures were healing time and safety of the cell treatment. Secondary outcomes were pain evaluated by numeric rating scale (NRS), complete wound healing at 24 weeks by Margolis Index and wound-healing process expressed in square centimeters per week. The various immunophenotypic and functional characteristics of CAT-derived stem cells were then correlated with the clinical outcomes. RESULTS: No major adverse events were recorded. The healing time was significantly faster by applying CAT, 17.5 ± 7.0 weeks versus 24.5 ± 4.9 weeks recorded in the control arm (P < 0.036). NRS dropped after the first week to 2.7 ± 2.0 in the experimental arm versus 6.6 ± 3.0 in the control group (P < 0.01). The rate of healing at the 24th week was not significantly different between arms. Interestingly, we found a strong reverse correlation between the percent of CD34+/CD45- non-hematopoietic cells, respectively, with the healing time (r = -0.894, P < 0.041) and NRS (r = -0.934, P < 0.020). CONCLUSIONS: CAT is safe and may accelerate healing time in VLUs as well as reduce wound pain. The percentage of CD34+/CD45- cells in stromal vascular fraction (SVF) seems to be a predictive biomarker of successful CAT treatment in these patients.

Eyelid reconstruction following excision of cutaneous malignancy.

PURPOSE: With advancing age, cutaneous malignancy around the eye becomes more prevalent. Different kinds of malignant tumors of the eyelid have features particular to their subtype, and a diagnosis should be obtained before definitive treatment if possible. The aim of treatment is total tumor eradication with the smallest recurrence risk, using the most cost-effective method that is acceptable to the patient. Reconstruction of periocular defects following excision of eyelid malignancy can present difficulties, and various reconstructive procedures can be applied. METHODS: The retrospective study carried out has analyzed 173 patients submitted to surgery for skin cancers located in the eyelid region with particular reference to the period January 2005 to January 2012. We analyzed certain data (age, sex, histological types, affected portion of eyelid, incidence recurrence by histological type, incidence recurrent tumors previously treated by surgery [secondary], type of removal, type of reconstruction, and mean time elapsed between the demolitive act and disease recurrence) both individually and in correlation with each other. Multivariate analysis (Cox algorithm) was used to identify those variables that had a clear statistical significance. RESULTS: Melanoma and lentigo maligna have the highest tendency to relapse (33%), but squamous cell carcinoma has more rapid replicative capacity. CONCLUSIONS: Extensive demolition should always be followed by extensive reconstruction. Even through intervention with an extensive demolition in cases of large tumors in the eyelid and cantus, it has not been possible to avoid the recurrence of the disease. The average time of recurrence when compared with reconstruction varies between 28 (minimum) and 39 months (maximum).

Anatase-based implants nanocoating on stem cells derived from adipose tissue.

PURPOSE: The aim of this study was to investigate the effect of a new anatase coating with antibacterial properties (Bactercline anatase coating [BAC]) on dental implants in the commitment of stem cells derived from adipose tissue to osteoblasts. MATERIALS AND METHODS: Using real-time reverse transcription polymerase chain reaction, the quantitative expression of specific genes, such as transcriptional factors (runx2 and sp7), bone-related genes (spp1, col1a1, col3a1, alpl, and fosl1), and mesenchymal stem cells marker (eng), was examined. RESULTS: BAC caused induction of bone-related genes such as sp7, fosl1, alpl, and spp1. In contrast, the expression of runx2, col3a1, and col1a1 was decreased in stem cells treated with BAC with respect to untreated cells. CONCLUSION: The obtained results are relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.

Adverse Drug Reactions of Acetaminophen and Ibuprofen in the Paediatric Population: Analysis of the Italian Spontaneous Reporting Database.

BACKGROUND: Acetaminophen and ibuprofen are the only antipyretics drugs approved in children, and are considered safe and well tolerated. However, data regarding the adverse drug reaction (ADR) profile of these drugs in children are scattered. AIM: The aim of our study is to evaluate the ADRs of acetaminophen and ibuprofen through an observational study over a period of 15 years (January 2005-April 2020). Reports of suspected ADRs to the active substances 'acetaminophen' and 'ibuprofen' are listed and accessible through the Italian spontaneous reporting database (RAM system) by AIFA (Pharmacovigilance of the Italian Drug Agency). METHODS: Acetaminophen ADRs in paediatric populations were 15% of cases, with more frequent involvement of skin and soft tissue (54.36%) and gastrointestinal apparatus (44.09%); liver dysfunction accounts for 5.67%. RESULTS: Ibuprofen paediatric ADRs were 26%: skin and soft tissues in 63.16% of cases, gastrointestinal tract in 47.75%, hematemesis and melena in 6.38%; kidney injury in 2.25% of cases. CONCLUSION: Children aged 2 to 11 are more frequently affected by ADRs than infants and adolescents. The risk of gastrointestinal and renal side effects is significantly higher with ibuprofen. Hepatobiliary side effects are more frequently linked to acetaminophen. Potentially fatal ADRs have been reported sporadically for both drugs.

Computer planning and bone density evaluation of jaws reconstructed with bone grafts from living donors.

Bone augmentation to reconstruct atrophic jaws provides the base for sufficient functional and aesthetic implant-supported oral rehabilitation. Although autografts are the standard procedure for bone grafting, the use of homolog bone provides a reasonable alternative because it is safe, cheap, and available in adequate amount. Five patients were grafted with femur bone derived from living donors, and in 2 of them, 16 implants were inserted after 6 months. Pearson χ test was used to investigate the difference in bone density (BD) between native and grafted bone and between peri-implant and bone far from fixtures. The BD of the grafted bone is about double that of the native bone. Peri-implant BD is higher than BD far from fixtures, demonstrating that implant loading increase BD. Computed tomography is a valuable and accurate preoperative and follow-up method to obtain information about bone quality and quantity (ie, volume of available bone). Femur graft has a high density that improves under loading, thus suggesting that early implant loading should be performed whenever possible. However, a larger implant series and a longer observation period are mandatory to have a stronger support to these preliminary data.

Biological effect of resorbable plates on normal osteoblasts and osteoblasts derived from Pfeiffer syndrome.

Biodegradable fixation devices made of the polymers polylactide, polyglycolide and their copolymers are used routinely during maxillofacial, craniofacial, and orthopedic reconstructive surgical procedures, thanks to their property of biodegradation that avoid the need for implant removal. In particular, they are used in the treatment of craniosynostosis in pediatric patients affected by Pfeiffer syndrome, where the resorption time of 1 year or less does not interfere with the normal growth of the skull. To study the mechanism how polylactide-polyglycolide (PLPG) acid plates can induce osteoblast differentiation and proliferation in normal osteoblasts and in osteoblasts derived from a patient with Pfeiffer syndrome, the expression levels of bone-related genes were analyzed using real-time reverse transcription-polymerase chain reaction. Osteoblasts grown on the PLPG acid plates resulted in significant upregulation of mRNA expression of many genes related to osteodifferentiation during the treatment, indicating that polylactide, polyglycolide biopolymers enhance proliferation, differentiation, and deposition of matrix in osteoblasts. This study also revealed some differences in gene expression between normal osteoblasts and osteoblasts derived from patients with Pfeiffer syndrome, cultivated on PLPG acid plates.

Effectiveness of fresh frozen and cryopreserved homologue iliac crest grafts used in sinus lifting: a comparative study.

In the last decade, several investigators have reported that autologous and homologous fresh frozen bones (FFB) are effective materials to restore alveolar ridges previous to insert dental implants. Recently we have used cryopreserved homologue grafts (CFFB). Here we reported a retrospective comparative study between implants inserted in FFB and CFFB evaluate their clinical outcome. Patients were treated with a split mouth scheme for bone grafting with FFB and CFFB and spiral family implants (SPI) were inserted in the same surgical time. Several variables (patient, grafts, anatomic site, implant, prosthetic restoration) were investigated. Implant' failure and peri-implant bone resorption were considered as predictor of clinical outcome. A total of 84 SFIs were inserted in 12 patients. Implants were inserted to replace 8 incisors, 4 cuspids, 31 premolars and 41 molars. The mean follow-up was 14 months. Three out of 84 implants was lost (i.e. survival rate SVR = 96.4%) and no differences were detected among the studied variables. Similar result was obtained by analyzing the crestal bone resorption around implant' neck (i.e. success rate). FFB and CFFB have high and comparable survival and success rate. Implants inserted with one step surgical procedure in native (i.e. not grafted) bone, FFB and CFFB have similar clinical outcome.

Spiral implants bearing full-arch rehabilitation: analysis of clinical outcome.

A spiral implant (SPI) is a conical internal helix implant with a variable thread design which confers the characteristic of self drilling, self tapping, and self bone condensing. The effectiveness of this type of implant has been reported in several clinical situations. However, because there are no reports that specifically focus on one of the biggest challenges in oral rehabilitation, that is, full arch rehabilitation, it was decided to perform a retrospective study. The study population was composed of 23 patients (12 women and 11 men, median age 57 years) for evaluation and implant treatment between January 2005 and June 2009. Two-hundred six spiral family implants (SFIs) were inserted with a mean postloading follow-up of 23 months. Several variables were investigated: demographic (age and gender), anatomic (maxilla and mandible, tooth site), implant (type, length, and diameter), surgical (surgeon, postextractive, flapless technique, grafts), and prosthetic (implant/crown ratio, dentition in the antagonist arch, type of loading, and computerized tomography [CT] planning) variables. Implant loss and peri-implant bone resorption were evaluated. Univariate and multivariate tests were performed. Survival and success rates were 97.1% and 82.5%, respectively. Only implant length and implant/crown ratio showed statistical significance in determining a better clinical outcome. In conclusion, SFIs are a reliable tool for the most difficult cases of oral rehabilitation. No differences were detected among implant type. Length and implant/crown ratio can influence the crestal bone resorption with better result for longer fixtures and a higher implant/crown ratio. In addition, banked bone derived from living donors can be used to restore alveolar ridge augmentation without adverse effects. Finally, flapless and CT-planned surgery did not significantly increase the clinical outcome in most complex rehabilitation.

Implant treatment in grafted and native bone in patients affected by ectodermal dysplasia.

Ectodermal dysplasia (ED) is a congenital syndrome characterized chiefly by abnormalities of tissues of ectodermal origin, namely skin, nails, hair, and teeth. Dental treatment of patients with ED is necessary because it affords the opportunity to develop normal forms of speech, chewing, swallowing, and normal facial support. Because there are few reports focusing on implants inserted in bone grafted in patients with ED, we therefore performed a retrospective study on 44 implants inserted in 4 patients to detect those variables acting on survival and crestal bone remodeling around implant neck in such subjects. Forty-four fixtures were analyzed. Several patient-related (age and sex), anatomic (maxilla and mandible and tooth site), implant (type, length, and diameter), surgical (sites and types of grafts), and prosthetic (type of loading) variables were investigated. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome. Implant length and diameter ranged from 11.5 to 15 mm and from 3.5 to 4.0 mm, respectively. Implants were inserted to replace 12 incisors, 12 cuspids, 11 premolars, and 9 molars. No implant was lost. On the contrary, implant's length, grafted sites, and type of loading affected univariate analysis, but these data were not confirmed by multivariate algorithm. Dental implants and bone grafts to orally rehabilitate patients with ED are valuable devices with no difference if compared with unaffected patients, at least in adults.

Implant rehabilitation in grafted and native bone in patients affected by ectodermal dysplasia: evaluation of 78 implants inserted in 8 patients.

OBJECTIVES: Ectodermal dysplasia (ED) is a congenital syndrome characterized chiefly by abnormalities of tissues of ectodermal origin, namely skin, nails, hair, and teeth. Dental treatment of patients with ED is necessary, because it affords the opportunity to develop normal forms of speech, chewing, swallowing, and normal facial support. Because there are few reports focusing on implants inserted in bone grafted in patients affected by ED. This is a retrospective study of 78 implants inserted in 8 patients to detect those variables acting on survival and crestal bone remodeling around the implant neck in such subjects. MATERIALS: Seventy-eight fixtures were analyzed. Several patient-related (age and gender), anatomical (maxilla and mandible, tooth site), implant (type, length, and diameter), surgical (sites and types of grafts), and prosthetic (type of loading and implant/crow ratio) variables were investigated. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome. RESULTS: Implant length and diameter ranged from 11.5 to 18 mm and from 3.5 to 6.0 mm, respectively. Implants were inserted to replace 19 incisors, 19 cuspids, 21 premolars, and 19 molars. One implant was lost. On the contrary, implant' length, grafted sites, and type of loading have an impact on univariate analysis, but this datum was not confirmed by multivariate algorithm. CONCLUSION: The use of dental implants and bone grafts to orally rehabilitate patients affected by ED is a valuable service with no difference in the results compared with unaffected patients, at least in adults.

Ectodermal dysplasia treated with one-step surgical rehabilitation: a case report.

Ectodermal dysplasia (ED) comprises a large heterogeneous group of inherited disorders that are characterized by primary defects in the skin, hair, nails, eccrine glands and teeth. The most characteristic findings are the reduced number of teeth. All rehabilitative programmes involve proper evaluation of skeletal relationships. Prosthetic-implantological treatment at the end of bony growth can be used. In this article a case of ED treated with Le Fort I for maxillary advancement, femur homografts, implants' insertion and immediate loading is described. In December 2007, a 38-year-old female was referred to the Maxillofacial Department of Galeazzi Hospital (Milan, Italy) who had a diagnosis of ED. Twelve implants were inserted in one-step surgical procedure. No implant was lost and all are stable. The occlusion is stable after 15 months of follow-up. The results indicate that the one-step oral rehabilitation can be performed in adults who are affected by ED. Also, this significantly reduces the time of oral and facial rehabilitation.

Scoring mandibular fractures: a tool for staging diagnosis, planning treatment, and predicting prognosis.

BACKGROUND: Mandibular fractures (MF) are a daily problem in maxillofacial surgery. A staging system for classifying MF is of paramount importance to plan surgery, to define prognosis, and to exchange information among trauma centers. In this article, a classification for MF is proposed. METHODS: The mandible is divided into six sites (symphysis, body, angle, ramus, coronoid, and condyle) and the mandibular nerve divides the alveolar process (i.e., the upper part containing teeth) from the basal bone (placed caudally with respect to the nerve). MF can be summarized using three abbreviations: A = alveolar, B = basal, and C = complete. Consequently, MFs are staged as follows: F in situ = a greenstick fracture; F1 = a single mobile fragment of alveolar or basal bone; F2 = double mobile fractures of the alveolar or basal portion or a single complete separation of the mandibular arch continuity; F3 = a complete double separation of the mandibular arch continuity; F4 = triple or more mandibular arch fragments. To evaluate the suitability of the proposed classification, a retrospective study on a series of 128 patients (and 205 MFs) was performed. Age, gender, stage, clinical diagnosis at admission, type of surgery, and outcome were considered. RESULTS: A good correlation between the proposed classification and the studied variables was detected. CONCLUSIONS: The new classification is a simple and precise method for staging MF. It can summarize MFs and be used in daily practice. It is our understanding, however, that a multicenter study should be performed before the effectiveness of the proposed classification can be clearly stated.

Comparison between implants inserted with and without computer planning and custom model coordination.

PURPOSE: In the last decade, several systems for computer-planned implantology have been reported. Among them is a system that uses software and a three-dimensional parallelometer able to transfer the implant position from the virtual project to the master model. To verify the effectiveness of this system, a retrospective comparative study has been planned. MATERIALS AND METHODS: A series of 300 implants were analyzed. Sixty-six were inserted with computer planning. Several variables related to patient, anatomic site, implant, and surgery were investigated. Implants' failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier method and Cox regression analysis were then performed to detect those variables statistically associated with the clinical outcome. RESULTS: Implant length and diameter ranged from 10 to 16 mm and from 3.75 to 6.0 mm, respectively. Implants were inserted to replace 66 incisors, 39 canines, 116 premolars, and 79 molars. Mean follow-up was 14 months. Nine implants were lost (survival rate, 97%), but no differences were detected among the studied variables. On the contrary, lower crestal bone resorption was detected for implants inserted in healed bone and in anterior jaws. CONCLUSIONS: Computer-planned and cast model-transferred implantology give good clinical results in survival and success rate. It is a useful technology that should be used in most difficult cases such as totally edentulous patients and reduced crestal bone volume.

Evaluation of clinical prognostic factors in T1 N0 M0 head and neck basal cell carcinoma.

This retrospective study was carried out to assess the clinical outcome of stage I (ie, T1 N0 M0) head and neck basal cell carcinoma (HNBCC) and verify the impact of some clinical parameters on prognosis. The cases of 220 patients with stage I (ie, T1 N0 M0) histologically proven HNBCC were analyzed.The global disease-specific survival rate at 36 months was 100%, irrespective of the type of surgery, and thus, it was demonstrated that radical tumor resection is a viable procedure for stage I HNBCC. However, 11 (5%) of 220 cases had a recurrence. A second procedure was performed in 10 (90.9%) of 11 cases. In 3 of the 10 patients operated on twice (30%), a second recurrence was detected. Thus, a second surgical procedure on a recurring tumor is possible, but the multimodality treatment regimen should be considered for recurring tumors.

Mandibular condyle fractures: evaluation of the Strasbourg Osteosynthesis Research Group classification.

Condylar fractures (CFs) are about 30% of mandibular fractures. Condylar fractures are treated with several protocols, and unsatisfying outcome is achieved in some cases. A staging system for classifying CFs is of paramount importance to plan therapy, to define prognosis, and to exchange information among trauma centers. The Strasbourg Osteosynthesis Research Group proposed a classification system for CFs, but no report focusing to its effectiveness is still available. Thus, we performed a retrospective study on a series of patients affected by CFs.The Strasbourg Osteosynthesis Research Group classification defines 3 main types of CFs: diacapitular fracture (i.e., through the head of the condyle [DF]), fracture of the condylar neck, and fracture of the condylar base (CBF). A series of 66 patients (and 84 CFs) was evaluated, and age, sex, clinical diagnosis at admission, treatment, and outcome were considered.Fractures of the condylar base and DFs are the most (52.4%) and the least (4.8%) frequent fractures, respectively. Conversely, associated fractures of the facial skeleton are found in most cases of DFs (75%) and in few cases of CBFs (20.5%). Surgery was performed in about 15% of all cases: no DF was operated, whereas fractures of the condylar neck and CBFs have an open reduction and an internal rigid fixation in 57% and 43%, respectively. Postsurgical and late sequelae were 22.3% and 19%. Temporomandibular joint symptoms and malocclusion cover about 80% and 90% of postsurgical and late sequelae.The new classification is a simple method to define CFs and can give some elements about the prognosis.

One-step oral rehabilitation by means of implants' insertion, Le Fort I, grafts, and immediate loading.

PURPOSE: In the last decade, several investigators have reported that autologous and homologous fresh frozen bones are effective materials to restore alveolar ridges before insertion of dental implants. Recently, we have used femur homograft derived from living donors. Here, we reported a 1-step oral rehabilitation of the severely resorbed maxilla by means of implants' insertion, Le Fort I osteotomy for maxillary advancement, grafts, and immediate loading. METHODS: Patients were treated with 1-step oral rehabilitation. Age, sex, implant length and diameter, tooth site, loading, and grafts were the investigated variables. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome. RESULTS: Eighty-four implants were inserted in 11 patients. Implants were inserted to replace 22 incisors, 21 cuspids, 20 premolars, and 21 molars. The mean follow-up was 17 months. Two of 84 implants were lost (ie, survival rate = 97.6%), and no differences were detected among the studied variables. By using the 82 fixtures processed with Kaplan-Meier and Cox regression, only implant site has an impact on clinical outcome, and molars have a worse outcome than incisors. CONCLUSION: One-step oral rehabilitation can be used in selected patients. It significantly shortened the time of rehabilitation without adverse effects. Femur homograft derived from living donors is a valuable material for grafting jaw: it is safer, cheap, and available in programmed amounts and avoids a second operation field.

Mandibles grafted with fresh-frozen bone: an evaluation of implant outcome.

In the last decade several studies have been performed to evaluate the clinical outcome of implants inserted into grafted mandibles with autologous bone, but none is available on mandibles grafted with fresh-frozen bone. Thus, we planned a retrospective study on a series of implants inserted into homologue fresh-frozen bone to evaluate their clinical outcome. Twenty-one patients were operated on, 28 onlay grafts were inserted into the mandible, and 63 implants placed. Patients had total and partial edentulism in 11 and 10 cases, respectively. The mean follow-up was 20 months. No or reduced crestal bone resorption was considered an indicator of success rate to evaluate the effect of several host-, implant-, and occlusal-related factors. The difference between the implant-abutment junction and the bone crestal level was defined as the implant abutment junction (IAJ) and calculated at the time of operation and during follow-up by means of radiographs. Delta IAJ, the difference between theIAJ at the last check-up and the IAJ recorded just after the operation, were stratified according to variables of interests. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the delta IAJ. Only 2 of 63 implants were lost (i.e., survival rates = 96.8%) and no differences were detected among the studied variables. On the contrary, Cox regression showed that prosthetic restoration (i.e., removable dentures) was the only factor correlated with a statistically significant lower delta IAJ (i.e., reduced crestal bone loss) and thus a better clinical outcome. Implants inserted into mandibles grafted with fresh-frozen bone allografts have high survival rates and success rate, which are comparable with those obtained with autologous iliac crest bone grafts.

Breast milk: To each his own. From metabolomic study, evidence of personalized nutrition in preterm infants.

OBJECTIVES: The composition of milk from mothers delivering prematurely differs from that of full-term mature milk and changes over time. The aim of this study is to test the hypothesis that changes in milk metabolomic profile from mothers delivering prematurely persist over time when compared with mothers delivering at term. METHODS: Nuclear magnetic resonance spectroscopy was used to analyze the metabolome pattern of human milk samples collected from 18 mothers. Twelve mothers collected 12 term milk samples (one for each mother) once between 4 and 7 d after delivery. Six mothers delivering prematurely (29-31 wk of gestational age) and collected three samples each, once a week after delivery until the third week after birth. RESULTS: Principal component analysis identified two distinct metabolite groups, one represented by the 18 preterm milk samples and the other by term milk samples. Metabolite profiling identified that lactose and oligosaccharide levels were significantly more represented in preterm than in milk term samples. CONCLUSIONS: The preterm milk metabolome pattern undergoes maturation during the first 3 wk after birth, but at the end of the third week it still does not resemble the term milk pattern. The specific changes in mothers' milk metabolomic profiles according to their offspring might reflect the different nutritional requirement of each preterm infant. This knowledge is crucial to move from standardized nutritional protocols to tailored, individualized nutrition in preterm infants.

PerioGlas regulates osteoblast RNA interfering.

PURPOSE: PerioGlas (PG) is an alloplastic material that has been used for grafting periodontal osseous defects since the 1990s. In animal models, it has been proven that PG achieves histologically good repairs of surgically created defects. In clinical trials, PG is effective as an adjunct to conventional surgery in the treatment of intrabony defects; however, how PG alters osteoblast activity to promote bone formation is poorly understood. We therefore attempted to address this question by using microRNA (miRNA) microarray techniques to investigate the translation process in osteoblasts exposed to PG. MATERIALS AND METHODS: By using miRNA microarrays containing 329 probes designed from human miRNA sequences, we identified several miRNA whose expression was significantly modified in osteoblast-like cell lines (MG-63) cultured with PG. RESULTS: There were ten up-regulated miRNA (mir-337, mir-377, mir-9, mir-516, mir-515-3p, mir-496, mir-200b, mir-489, mir-25, mir-423) and two down-regulated miRNA (mir-26a, mir-30d). CONCLUSION: PG acts on miRNAs, which in turn regulate several messengers. Among them there are mRNAs related to bone formation and skeletal and cartilage development. The vast majority of detected genes are down-regulated, and some are homeobox genes like NOG, EN1, and CHRD. Other down-regulated genes are receptors (like GHRHR) and extracellular matrix proteins (like COMP). Although the exact mechanism of PG action on osteoblasts is still incompletely understood, these data demonstrate that PG has not only an osteoconductive effect, but also regulates bone formation.