Upper-lip laser frenectomy with a diode laser in a pediatric patient: a case report.

The case report aims to describe the parameters of performing upper labial frenectomy with the use of diode laser beams without infiltrated local anaesthesia. A 6-year-old patient was referred by the orthodontist for assessment of the upper anterior labial frenum. The dental treatment plan reported only the presence of caries on deciduous teeth and seals on the first permanent molars. The clinical examination reported the presence of a high attachments of labial frenum with a pathologically attachment and the presence of a diastema supports this theory. The laser used to remove the frenulum was a diode laser used with a wavelength of 980 nm with 320 microns of fiber in contact with a power of 2.0 W in continuous wave mode. The clinical examination showed an acceptable healing by secondary intention of the wound and the initial functional recovery of a physiological upper lip movements. The patient reported that the procedure was well tolerated. The diode laser can be used with good result for the removal of pathological frenum. The diode laser can be used in pediatric dentistry because of its application, adequate coagulation, no need for sutures and less inflammation and pain.

The role of periodontal bacteria, Porphyromonas Gingivalis, in Alzheimer's disease pathogenesis and aggravation: a review.

The aim of this study was to establish the role of Porphyromonas gingivalis in Alzheimer's disease. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; in vitro analysis; in vivo on animals and postmortem biopsies on humans; studies analyzing the correlation between periodontal disease and Alzheimer. The search resulted in 262 titles. Only 9 articles were included in the quantitative analysis. An inflammatory status in the oral cavity might be connect to a brain degeneration syndrome such as dementia and AD. However, a strictly connection is still not evincible. More trials are recommended in order to investigate the role of periodontal bacteria and Porphyromonas gingivalis in AD pathogenesis and aggravation.

Diode laser as an adjunct to nonsurgical chronic periodontitis therapy: a review.

The aim of this review was to investigate the additional effects of diode laser irradiation in combination with nonsurgical periodontal therapy. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were all studies published in English language, randomized controlled trials, based on human subjects. All trials were designed to evaluate the efficacy of the diode laser therapy as an adjunct to nonsurgical periodontal therapy in the treatment of chronic periodontitis patients. All studies analyzed are not older than five years. The search resulted in 188 titles. After the analysis of the abstracts, an article was excluded because it was not relevant for the study and two because it treated aggressive periodontitis. At the end only 6 articles were included in the qualitative analysis. The potential role in chronic periodontal disease treatment of diode laser is still not demonstrated. Several studies regard the diode laser therapy, but there is still heterogeneity for what it concerns research and clinical protocols. As a result, several randomized controlled trials are needed to obtain certain data.

Comparison of the accuracy of intraoral scanning and conventional impression techniques on implants: a review.

The aim of this review was to collect available evidence and evaluate accuracy outcomes of dental implant impression techniques, and to compare the accuracy of conventional implant impression versus digital implant impression. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; studies no older than five years; analyzing the accuracy of digital vs conventional technique impression on implants. The exclusion criteria were: publications that reported the same data as later publications by the same authors and systematic reviews; commentaries and letters to the editor; case report and case series. The search resulted in 106 titles. Following the first stage of screening, after the records identification through database manual searching, 112 potentially relevant studies were identified. After the second stage screening, 33 full text publications were obtained and analyzed and 17 were excluded. Afterwards, 18 articles resulted eligible after full text reading and a cross search of the articles' references was accomplished; 3 articles were consequently added. At the end only 7 articles were included in the quantitative analysis. Within the limitations of this systematic review, digital impression on dental implants offers a comparable accuracy compared with conventional impressions technique. More clinical trials are recommended to investigate the accuracy of these scanners and their validity in clinical use.

Fit evaluation of cad/cam fabricated all-ceramic restorations based on direct and indirect digitalization in vivo: a systematic review.

The aim of this study was to compare the fit of all-ceramic restorations on natural teeth fabricated through a direct digital workflow or an indirect digital workflow. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. The detailed search design and strategies, including keywords, are presented below. The authors used two filters to follow data for the research: papers written in English and published in the last 5 years. The search resulted in 3042 titles. Following the first stage of screening, after the records identification through database manual searching, 3047 potentially relevant studies were identified. After the second stage screening, 38 full text publications were obtained and analyzed and 17 were excluded. Afterwards, 22 articles resulted eligible after full text reading and a cross search of the articles references was accomplished and 5 articles were consequently added. At last, 6 articles were included in the quantitative analysis. This study was designed to compare the fit of restorations obtained by means of a direct or indirect digital workflow. The values reported on the maximum acceptable gap in scientific literature range from 50 to 200 µm, so there does not seem to be an objective limit based on scientific evidence. According to the most accepted marginal discrepancy in the literature, most of the values of the studies examined are in the 200 µm acceptability range. Within the limitations of this systematic review, computer-aided design and computer-aided manufacturing (CAD/CAM) fabricated restorations obtained by means of an intraoral scanner (IOS) showed better marginal and internal fit than restorations obtained through conventional impression and subsequent laboratory scanning. According to the results of this systematic review, the direct digital workflow resulted as a valid alternative to the indirect digital workflow to produce CAD/CAM all-ceramic restorations.

Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes.

BACKGROUND AND PURPOSE: Chronic hypoperfusion from athero-stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation (AF) versus stroke patients with cervical atherosclerotic steno-occlusive disease (CASOD). METHOD: This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre-treatment computed tomography angiography (CTA) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals (CTA collateral score 0-1) versus moderate/good collaterals (CTA collateral score 2-4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. RESULTS: A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD. Patients with AF were older (P < 0.01) and less often males or smokers (P = 0.04 and P < 0.01 respectively). Baseline National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were comparable between groups. Collateral scores were lower in the AF group (P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group (P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P < 0.01) were higher in the CASOD group. On multivariable analysis, CASOD was an independent predictor of moderate/good collaterals (odds ratio 4.70; 95% confidence interval 1.17-18.79; P = 0.03). CONCLUSIONS: Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF-related stroke.

Endocrine dysfunction in hereditary hemochromatosis.

Hereditary hemochromatosis (HH) is a genetic disorder of iron overload and subsequent organ damage. Five types of HH are known, classified by age of onset, genetic cause, clinical manifestations and mode of inheritance. Except for the rare form of juvenile haemochromatosis, symptoms do not usually appear until after decades of progressive iron loading and may be triggered by environmental and lifestyle factors. Despite the last decades discovery of genetic and phenotype diversity of HH, early studies showed a frequent involvement of the endocrine glands where diabetes and hypogonadism are the most common encountered endocrinopathies. The pathogenesis of diabetes is still relatively unclear, but the main mechanisms include the loss of insulin secretory capacity and insulin resistance secondary to liver damage. The presence of obesity and/or genetic predisposition may represent addictive risk factor for the development of this metabolic disease. Although old cases of primary gonad involvement are described, hypogonadism is mainly secondary to selective deposition of iron on the gonadotropin-producing cells of the pituitary gland, leading to hormonal impaired secretion. Cases of hypopituitarism or selected tropin defects, and abnormalities of adrenal, thyroid and parathyroid glands, even if rare, are reported. The prevalence of individual gland dysfunction varies enormously within studies for several bias due to small numbers of and selected cases analyzed, mixed genotypes and missing data on medical history. Moreover, in the last few years early screening and awareness of the disease among physicians have allowed hemochromatosis to be diagnosed in most cases at early stages when patients have no symptoms. Therefore, the clinical presentation of this disease has changed significantly and the recognized common complications are encountered less frequently. This review summarizes the current knowledge on HH-associated endocrinopathies.

[Multilevel segmental interbody fusion versus vertebral body replacement: comparison of two operative methods]. / Mehrsegmentale interkorporelle Fusion vs. Wirbelkörperersatz: Vergleich zweier operativer Methoden.

BACKGROUND: The surgical techniques of interbody fusion and vertebral body replacement represent two concurrent options for multilevel anterior decompression and arthrodesis of the cervical spine. PATIENTS AND METHODS: In a retrospective study the data from 61 patients who received either interbody fusion (n = 38) as anterior cervical discectomy and fusion (ACDF) or vertebral body replacement (n = 23) (as anterior cervical corpectomy and fusion (ACCF) because of degenerative disc disease of the cervical spine were collected. RESULTS: The clinical outcome was better at all time points in the patient group with ACDF than in those with ACCF but with no statistically significant differences. The operated segments showed a more rapid fusion progress after ACDF during the time course in comparison to ACCF; however, there was no relationship between the grade of fusion and the clinical result. CONCLUSION: In direct comparison multisegmental interbody fusion showed better results with respect to the clinical outcome and bony fusion with a lower rate of complications than vertebral body replacement. However, the differences did not reach statistical significance.

Hyperprolactinemia and male sexual function: focus on erectile dysfunction and sexual desire.

The present paper aims to analyze and discuss the available evidence supporting the relationship between male sexual function and elevated prolactin (PRL) levels (HPRL). Two different sources of data were analyzed. Clinical data were derived from a series of patients seeking medical care for sexual dysfunction at our Unit. Out of 418 studies, 25 papers were used with a meta-analytic approach to evaluate the overall prevalence of HPRL in patients with erectile dysfunction (ED) and to study the influence of HPRL and its treatment on male sexual function. Among 4215 patients (mean age 51.6 ± 13.1 years) consulting for sexual dysfunction at our Unit, 176 (4.2%) showed PRL levels above the normal range. Meta-analytic data showed that HPRL is a rare condition among patients with ED (2 [1;3]%). Either clinical and meta-analytic data confirm a stepwise negative influence of PRL on male sexual desire (S = 0.00004 [0.00003; 0.00006]; I = -0.58915 [-0.78438; -0.39392]; both p < 0.0001 from meta-regression analysis). Normalization of PRL levels is able to improve libido. The role of HPRL in ED remains inconclusive. Data from a meta-analytic approach showed that either HPRL or reduced T levels were independently associated with ED rates. The normalization of PRL levels only partially restored ED. HPRL did not significantly contribute to ED severity, in our clinical setting. In conclusion, treating HPRL can restore normal sexual desire, whereas its effect on erection is limited.

Sexual function in men undergoing androgen deprivation therapy.

Androgen deprivation therapy (ADT) has a deleterious effect on sexual functions and general well-being in men. Despite this evidence, however, patient and couple knowledge about ADT side effects as well as their management is poor. Similar considerations can be made for physician endorsement of management strategies. In this paper, we summarize and critically discuss available evidence regarding the possible associations between ADT and sexual dysfunction as well as the best therapeutical options. Preclinical data show that ADT is associated with penile contractility impairment as well as lower response to phosphodiesterase type 5 inhibitors (PDE5i). Available data indicate that ADT resulted in a five to sixfold increased risk of reduced libido and in a threefold increased risk of ED confirming the main role of testosterone in regulating sexual desire. Despite this evidence, sexuality remains an important aspect of health and well-being for men and their partner. The best therapeutical options depend on patient and couple desires and needs. When nonpenetrative erections are still possible, nonpenetrative activities should be encouraged to maintain sexual intimacy. A combined and personal educational program including the collaboration of different professional figures (including general physicians, oncologists, andrologists, sexologists, and psychologists) trained in sexual medicine is advisable in order to provide the best support to subjects undergoing ADT.

Mitochondrial genome instability in cancer.

The relevant role of mitochondrial mutations in cancer is the most frequent conclusion found in most early publications on the subject. However, it is now clear that this assumption was in many cases based on circumstantial or even flawed evidence. Presently, we know that normal mitochondria structure and functions depend on the concerted interaction between mitochondrial (mt)-genes and different groups of nuclear genes. Thus, somatic mutations of mt- or nuclear genes controlling mitochondrial physiology would influence the cancer transformation process through a disruption of nuclear<-->mitochondrial gene interactions. In this regard, somatic mt-mutations influencing carcinogenesis have been detected in preneoplastic lesions. Furthermore, an abnormal respiration process with the subsequent increase in reactive oxygen species production seems to be one of the basic mechanisms favoring oncogenesis. Many mt-genes exhibit inherited polymorphisms associated with their mitochondrial phylogenetic history. In this report we shall summarize data showing that some of these ethnic mt- mutations may increase or alternatively decrease the susceptibility to various forms of malignancy. The interference of mt-mutations with anticancer therapies and the use of body fluids for the analysis of mt-mutations to obtain tumor samples avoiding invasive techniques are two promising fields to be further investigated.

Single-use, patient-specific instrumentation technology in knee arthroplasty: a comparative study between standard instrumentation and PSI efficiency system.

Patient-specific instrumentation is a surgical technique that was created to improve the accuracy of implantation, surgical time and workflow in total knee arthroplasty. This study is a single-center, single-surgeon randomized clinical trial. The aim of this work was to evaluate clinical efficacy of PSI versus standard surgical instrumentation in malalignment risk and blood loss reduction. From April 2015 to September 2016, 40 patients for a total of 40 knees were included in the randomization process. Each patient underwent CT scan of the lower limb including hip, knee and ankle joint with the realization of the PSI system and the TKA with Medacta GMK Primary®. Patients were evaluated 1 month after surgery with X-ray and after 2 months with clinical examination and assessment by Knee Society Score (KSS). Blood loss was detected by adding the values calculated in the operative room and the blood loss in the vacuum systems. In the study group, mean value of KSS was 85.2 (IC 95% 81.2-88.5), mean blood loss was 657 ml (IC 95% 580.6-735.4), and mean value of femorotibial angle was 178.8° (IC 95% 178.5-179.3). In the control group, mean value of KSS was 87.2 (IC 95% 85.3-89.4), mean blood loss was 866.5 ml (IC 95% 763.3-972.5), and mean value of femorotibial angle was 178.9°(IC 95% 177.6-180.3). The Student t test detected a significant difference in blood loss between groups (p < 0.05), and no differences were found between KSS. The single-use instrumentation should improve precision, operative time, turnover time, sterilization and maintenance costs and could help to reduce infection risks. Our results confirm only the improvement on reducing blood loss. In our opinion, this technique should be used in selected patients when the surgeon could have some difficulties to perform femoral cuts on coronal plane or when patients need to have a very little blood loss due to other conditions.

Observation of the naive-T-odd Sivers effect in deep-inelastic scattering.

Azimuthal single-spin asymmetries of leptoproduced pions and charged kaons were measured on a transversely polarized hydrogen target. Evidence for a naive-T-odd, transverse-momentum-dependent parton distribution function is deduced from nonvanishing Sivers effects for pi(+), pi(0), and K(+/-), as well as in the difference of the pi(+) and pi(-) cross sections.

Carbonic anhydrase integrated into a multimarker approach for the detection of the stress status induced by pollution exposure in Mytilus galloprovincialis: A field case study.

The work was addressed to study the sensitivity of the enzyme carbonic anhydrase (CA) to chemical pollution in the hepatopancreas of the bioindicator organism Mytilus galloprovincialis in the context of a multimarker approach in view of ecotoxicological biomonitoring and assessment application. The study was carried out by means of a transplanting experiment in the field, using caged organisms from an initial population exposed in the field in two areas of interest: Augusta-Melilli-Priolo, an heavy polluted industrial site (eastern Sicily, Italy), and Brucoli (eastern Sicily, Italy) an area not affected by any contamination and selected as a reference site. Mussels in Augusta presented a significant increase in the digestive gland CA activity and gene expression compared to the animals caged in the control site of Brucoli. The CA response in animals from the polluted site was paralleled by proliferation/increase in the size of lysosomes, as assessed by Lysosensor green charged cells, induction of metallothionein, up-regulation of hif-α (hypoxia-inducible factor), metabolic changes associated with protein metabolism, and changes in the condition factor. Biological responses data were integrated with information about sediment chemical analysis and metal residue concentration in animal soft tissues. In conclusion, obtained results highlighted the induction of CAs in the hepatopancreas of Mytilus galloprovincialis following to pollution exposure, and demonstrated its suitability to be integrated into a multimarker approach for the detection and characterization of the stress status induced by pollution exposure in this bioindicator organism.

Calgranulin B (S100A9) levels in bronchoalveolar lavage fluid of patients with interstitial lung diseases.

Calgranulins are small calcium-binding proteins with several immunological functions involved in inflammatory processes. Calgranulin A is reported to be mainly associated with acute inflammation while calgranulin B seems to play a role in chronic inflammatory disorders. In this study we used a proteomic approach to analyse calgranulin B expression in bronchoalveolar lavage (BAL) from a group of patients with different interstitial lung diseases. Two dimensional electrophoresis analysis of BAL was performed in 11 idiopathic pulmonary fibrosis patients, nine sarcoidosis patients, 11 with systemic sclerosis patients and five healthy controls. Significantly higher (p<0.001) calgranulin B percentage volumes were observed in BAL from IPF patients than controls and other ILD patients. This result sustains the hypothesis that calgranulin B could be involved in chronic lung diseases, probably through increased expression and enhanced activation of alveolar polymorphonuclear cells related to idiopathic pulmonary fibrosis. Quantitative analysis by an easier method applied to a larger population will be necessary to determine whether calgranulin B could be a good marker of disease severity.

Expression of metallothionein mRNAs by in situ hybridization in the gills of Mytilus galloprovincialis, from natural polluted environments.

Metallothioneins (MTs), metal-inducible proteins, are crucial proteins for the regulation of essential metals, and are transcriptionally induced in all organisms by certain heavy metals, oxidative stress and inflammation. The gills represent an organ of uptake and loss of metals in which different mechanisms are present controlling the functions directly involved in the maintenance of homeostasis. In this study, the morphological and histomorphological aspects of branchial epithelium in Mytilus galloprovincialis from polluted environment (Faro swamp, Messina, Italy) have been investigated. The reverse transcriptase-polymerase chain reaction (PCR) has been used to isolate complementary DNA of both MT isoforms present from RNA extracted from mussel gills. The respective mRNAs on histological sections have been visualized by in situ hybridization. These methods showed that MT-10 mRNA is expressed at the basal level. In contrast, the MT-20 expression level was very low under basal conditions, while its mRNA increased dramatically in individuals collected in Faro. The presence of acid mucocytes and MTs in the gills may be considered a further defensive mechanism also related to the significantly higher concentration of Cd, Pb and Cr found in gills of M. galloprovincialis from Faro than specimens from the reference site (Goro). The results obtained show that, in stressed mussels, the defensive processes increase to maintain the normal functions of the organs more exposed to the action of polluted substances.

Analysis of trace elements in bronchoalveolar lavage of patients with diffuse lung diseases.

Airborne trace elements are implicated in the etio-pathogenesis of a large number of pulmonary diseases. The aim of this study was to evaluate the reliability and effectiveness of direct determination of Cd, Cr, Cu, Fe, Mn, Ni, Pb, V, and Zn concentrations in bronchoalveolar lavage (BAL) samples from patients with sarcoidosis, idiopathic pulmonary fibrosis, and Langerhans cell histiocytosis and healthy (smoking and non-smoking) controls. A total of 44 individuals were recruited among sarcoidosis, idiopathic pulmonary fibrosis, and Langerhans cell histiocytosis patients and healthy (smoking and non-smoking) controls. Average Mn concentrations in BAL from patients were 45% lower than in controls (p < 0.01) and remarkable decreases in average concentrations of Cr, Ni and Zn were also found in BAL from patients with idiopathic pulmonary fibrosis and Langerhans cell histiocytosis. As these diseases are characterized by the enhanced activation of certain immunomodulatory cells and by generation of free radicals, the depressed Mn, Zn, Cr and Ni concentrations in BAL from patients may be due to oxidative stress. These preliminary results indicate that assessment of the elemental composition of BAL is a promising approach to study the pathogenesis of diffuse lung diseases and Langerhans cell histiocytosis.

Allele and genotype frequencies of metabolic genes in Native Americans from Argentina and Paraguay.

Interethnic differences in the allele frequencies of CYP2D6, NAT2, GSTM1 and GSTT1 deletions have been documented for Caucasians, Asians, and Africans population. On the other hand, data on Amerindians are scanty and limited to a few populations from southern areas of South America. In this report we analyze the frequencies of 11 allele variants of CYP2D6 and 4 allele variants of NAT2 genes, and the frequency of GSTM1 and GSTT1 homozygous deleted genotypes in a sample of 90 donors representing 8 Native American populations from Argentina and Paraguay, identified as Amerindians on the basis of their geographic location, genealogical data, mitochondrial- and Y-chromosome DNA markers. For CYP2D6, 88.6% of the total allele frequency corresponded to *1, *2, *4 and *10 variants. Average frequencies for NAT2 *4, *5, *6 and *7 alleles were 51.2%, 25%, 6.1%, and 20.1%, respectively. GSTM1 deletion ranged from 20% to 66%, while GSTT1 deletion was present in four populations in less than 50%. We assume that CYP2D6 *2, *4, *10, *14; NAT2 *5, *7 alleles and GSTM1 and GSTT1 *0/*0 genotypes are founder variants brought to America by the first Asian settlers.

[Evaluation of the occupational risk related to exposure to electromagnetic fields according to the EC Directive 2004/40 EC: exposure during pregnancy]. / La valutazione del rischio da campi elettromagnetici al sensi della Direttiva Comunitaria 2004/40 CE: esposizione professionale in corso di gravidanza.

The EU Directive 2004/40/EC on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (electromagnetic fields) will introduce the need of an evaluation of the risk related to EMF occupational exposure in pregnancy. Nevertheless, data from research in this field are scarcely conclusive to date. Furthermore knowledge on this risk seems insufficient among OH physicians in Italy. Accordingly, there is an urgent need for further research, and for a diffusion of knowledge among OH physicians on possible risk to pregnancy due to occupational exposure to EMF.