Hybrid mandibular Bologna midline distractor in combination with surgically assisted rapid maxillary expansion for transverse facial expansion: clinical and cephalometric results.

Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit>7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.

A systematic review of the literature on the role of tracheostomy in COVID-19 patients.

The Coronavirus Disease 2019 (COVID-19) is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which emerged in East Asia and spread around the world from December 2019. The most severe stage of COVID-19 pathology is characterized by respiratory distress requiring intubation. In specific cases, tracheostomy is indicated to ensure the safety of the procedure. The aim of our study was to analyze the scientific literature identifying the indications for tracheostomy and safety precautions to reduce contamination. We analyzed the literature from February 2003 to April 2020, including papers on pandemics of other coronaviruses, such As Severe Acute Respiratory Syndrome Coronavirus 1 and Middle East Respiratory Syndrome Coronavirus, to obtain a variety of relevant information. We focused on indications for tracheostomy in patients affected by COVID-19 or related viruses and the measures adopted to perform a safe procedure. We included 35 papers, of which 24 (68.57%) discussed guidelines for tracheostomy indications. All 35 studies discussed the procedures for performing tracheostomy safely. Data obtained indicated that the authors generally agreed on safety measures but expressed different opinions about indications. Therefore, we provided guidelines addressing safety recommendations. After the pandemic has been resolved, we plan to conduct an international retrospective study to identify the criteria for tracheostomy indications.

Preliminary Results of Bone Regeneration in Oromaxillomandibular Surgery Using Synthetic Granular Graft.

Traumatic, neoplastic, inflammatory, or infective dental removal promotes a gradual resorption process of bone which leads to a "nonuse" atrophy of the alveolar ridges. Many techniques allows restoring an appropriate bone thickness, but nowadays the attention is focused on the use of natural or synthetic grafts. Numerous studies have been conducted to develop and test new synthetic materials. In this article, the authors report their experience using a synthetic bone substitute in combination with Platelet Rich Fibrin (PRF). This technique was applied in different zones of the maxillomandibular district. The procedure showed a very satisfying bone regeneration without important complications.

Security "high-tech" individual extra-light device mask 2.0: CAD/CAM evolution.

In 2008, we presented our security "high-tech" individual extra-light device mask (SHIELD), a protective shield based on the face cast of an injured soccer player that can be customised. It allows a shortened convalescent period, is comfortable, fits well, and allows the patient to continue to play at a professional level in their chosen sport or activity in the shortest time possible. It has been used often in both amateur and professional categories of many sports, and we now present an update.

Toll-like receptor 4 expression in the epithelium of inflammatory periapical lesions. An immunohistochemical study.

Toll-like receptors (TLR) are essential for the innate immune response against invading pathogens and have been described in immunocompetent cells of areas affected by periapical disease. Besides initiating the inflammatory response, they also directly regulate epithelial cell proliferation and survival in a variety of settings. This study evaluates the in situ expression of TLR4 in periapical granulomas (PG) and radicular cysts, focusing on the epithelial compartment. Twenty-one periapical cysts (PC) and 10 PG were analyzed; 7 dentigerous non-inflamed follicular cyst (DC) served as control. TLR4 expression was assessed by immunohistochemistry. TLR4 immunoreaction products were detected in the epithelium of all specimens, with a higher percentage of immunostained cells in PG. Although TLR4 overexpression was detected in both PG and PC, there were differences that seemed to be related to the nature of the lesion, since in PG all epithelial cells of strands, islands and trabeculae were strongly immunoreactive for TLR4, whereas in PC only some areas of the basal and suprabasal epithelial layers were immunostained. This staining pattern is consistent with the action of TLR4: in PG it could promote formation of epithelial cell rests of Malassez and in epithelial strands and islands the enhancement of cell survival, proliferation and migration, whereas in PC TLR4 could protect the lining epithelium from extensive apoptosis. These findings go some way towards answering the intriguing question of why many epithelial strands or islands in PG and the lining epithelium of apical cysts regress after non-surgical endodontic therapy, and suggest that TLR4 plays a key role in the pathobiology of the inflammatory process related to periapical disease.

Differential expression of TLR3 and TLR4 in keratocystic odontogenic tumor (KCOT): A comparative immunohistochemical study in primary, recurrent, and nevoid basal cell carcinoma syndrome (NBCCS)--associated lesions.

BACKGROUND: Toll-like receptors (TLRs) play an essential role in the activation of innate immunity and they can promote cancer cell survival and tumor progression. It has been claimed that TLRs can somehow predict the clinical behavior in oral squamous cell carcinoma (OSCCs). AIM: To elucidate the molecular basis underlying keratocystic odontogenic tumor (KOCTs) aggressive behavior and recurrence we carried out this immunohistochemical study on TLR3 and TLR4 expression in sporadic primary KCOTs (sp-KCOTs), sporadic recurrent KCOTs (sp-KCOTs), and NBCCS-associated KCOTs (NBCCS-KCOTs). METHOD: 40 cases of KOCTs removed from 23 men and 17 women were the sample. Paraffin-embedded blocks were processed for immunohistochemistry. Sections were incubated with TLR3 and TLR4 antibodies and immunoreactivity evaluated on a semi-quantitative score. RESULTS: Both TLR3 and TLR4 were expressed in KCOTs epithelium, although with a different extent. TLR3 was not expressed in sp-KCOTs and sr-KCOTs, but it showed a faint staining in NBCCS-KCOTs. On the other hand, both cytoplasmic and nuclear staining for TLR4 was detected in all the 3 types of lesions; however being significantly more expressed in sr-KCOT and NBCCS-KCOTs (p < 0.0001). Our results, demonstrated an association between TLR4, but not TLR3 expression to recurrence behavior of KCOTs. In fact, TLR4 was up-regulated in sr-KCOTs and NBCCS-KCOTs but not in sp-KCOTs. CONCLUSIONS: According these findings it seems conceivable to assume that the up-regulation of TLR4 in some KCOTs can be correlated somehow to their tendency recurrence.

Hypertension and related risk factors in type 2 diabetes mellitus.

METHODS: The correlation between hypertension and related risk factors has been studied in 733 type 2 diabetic patients. Hypertension was more frequent in women (65.35%) than in men (50.35%) (p < 0.0001). RESULTS: Hypertensive patients showed older age (p < 0.0001) and greater Body Mass Index (BMI) (p < 0.03) than normotensive. In the diabetic group on diet only basal insulinaemia was higher (p < 0.05) in hypertensive than in normotensive diabetic men, but not in women. Such a difference, was not seen in patients of both sexes treated with oral hypoglycaemic agents; besides there was no difference in fasting C-peptide levels between hypertensive and normotensive insulin treated patients. In both sexes hypertension was independently correlated with age, BMI, increased urinary albumin excretion, triglycerides. The strongest correlation was with the family history of hypertension. On the contrary there was no correlation between hypertension and waisthip ratio. CONCLUSIONS: In conclusion, the association between hypertension and type 2 diabetes depends on various risk factors, but a relationship with insulin levels is not surely demonstrable.

Hypertension and related risk factors in type 2 diabetes mellitus.

METHODS: The correlation between hypertension and related risk factors has been studied in 733 type 2 diabetic patients. Hypertension was more frequent in women (65.35%) than in men (50.35%) (p < 0.0001). RESULTS: Hypertensive patients showed older age (p < 0.0001) and greater Body Mass Index (BMI) (p < 0.03) than normotensive. In the diabetic group on diet only basal insulinaemia was higher (p < 0.05) in hypertensive than in normotensive diabetic men, but not in women. Such a difference, was not seen in patients of both sexes treated with oral hypoglycaemic agents; besides there was no difference in fasting C-peptide levels between hypertensive and normotensive insulin treated patients. In both sexes hypertension was independently correlated with age, BMI, increased urinary albumin excretion, triglycerides. The strongest correlation was with the family history of hypertension. On the contrary there was no correlation between hypertension and waist-hip ratio. CONCLUSIONS: In conclusion, the association between hypertension and type 2 diabetes depends on various risk factors, but a relationship with insulin levels is not surely demonstrable.

Frequency of coronary heart disease and related risk factors in a diabetic and nondiabetic population: a comparative study.

The aim of the study was to evaluate the frequency of Coronary Heart Disease (CHD) and some related risk factors since as hyperlipidemia, hypertension, obesity and visceral distribution of adipose tissue on 733 type 2 diabetic patients in ambulatory care compared to 3500 nondiabetic subjects, matched for age and sex. The frequency of CHD, hyperlipidemias, hypertension, obesity and visceral distribution of adipose tissue was significantly higher in diabetic than in nondiabetic subjects. The risk for CHD was greater in diabetic vs nondiabetic women (4.22) as compared to diabetic vs nondiabetic men (2.6). CHD was mostly associated (over 50% of cases) with hypertension, hyperlipidemia and visceral distribution of adipose tissue. Both cholesterol and triglyceride values, such as CHD frequency, were higher in diabetic patients with poor glycemic control with respect to those with acceptable glycemic, especially in women.

Microalbuminuria and severity of diabetic retinopathy in type 1 diabetic patients: association and relationship with some risk factors.

To investigate the relationship between microalbuminuria and severity of retinal damage, we studied 86 Albustix-negative insulin-dependent diabetic patients whose disease duration was more than 5 years (age 31.9 +/- 10.9 years; duration 14.7 +/- 7.1 years). Retinopathy was evaluated by fluorescein angiography in four groups of patients: a) 37 (43%) without retinopathy, b) 29 (34%) with background retinopathy, c) 10 (12%) with pre-proliferative retinopathy and d) 10 (12%) with proliferative retinopathy. Microalbuminuria (urinary albumin excretion > 30 mg/24 h) was calculated from timed 24-h urine collection and measured by a radioimmunoassay method. Microalbuminuria was found in 20 patients (23%); 16 of whom showed both retinopathy and microalbuminuria. Diabetic retinopathy was more frequent than microalbuminuria (57% vs 23%). The prevalence of microalbuminuria was significantly higher in the proliferative retinopathy group compared to the group without retinopathy (p < 0.0005) and the background retinopathy group (p < 0.007). The frequency of diabetic retinopathy was significantly higher (p < 0.04) in patients with than without microalbuminuria. These results indicate that microalbuminuria is associated with the presence and severity of diabetic retinopathy in insulin-dependent diabetic patients.

No important differences in glycaemic responses to common fruits in type 2 diabetic patients.

The aim of this study was to determine the glycaemic indices (GIs), peak incremental indices (PI), and time of peak increment (TPI) of eight kinds of fruits and their relationship with the type and amount of simple sugars directly assayed in the fruits. Sixty-one type 2 diabetic patients randomized into eight groups--one for each category of fruit--participated in the study. GIs consisted of the following: pears = 60 +/- 4.9; apples = 63 +/- 8.3; oranges = 68 +/- 6.5; grapes = 70 +/- 7.5; plums = 75 +/- 8.4; peaches = 80 +/- 7.4; apricots = 82 +/- 9.1; bananas = 83 +/- 8.5. The PI values (mmol I-1) were the following: grapes = 2.52 +/- 0.26; apples = 3.13 +/- 0.75; pears = 3.48 +/- 0.55; oranges = 4.02 +/- 0.42; peaches = 4.07 +/- 0.38; apricots = 4.08 +/- 0.47; plums = 4.2 +/- 0.45; bananas = 4.45 +/- 0.39. There was no statistical differences in GI, and PI, within the different fruits. TPI of grapes (43.3 +/- 5.2 min), oranges (45 +/- 5.6 min), and peaches (45 +/- 5.6 min) were statistical different (p < 0.01) in respect to apricots (81.4 +/- 5.5 min). GIs were positively correlated with total glucose contained in the fruits (p < 0.05) and with PI (p < 0.0002); negatively with fructose both free (p < 0.02) and total (sum of free and present in sucrose (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Miscibility of semisynthetic human ultralente insulin with short-acting insulin in insulin-dependent diabetic patients.

In 15 insulin dependent diabetics (IDDM), treated with human monocomponent insulin, the absorption of Actrapid HM mixed with Ultratard HM was evaluated. Thirty U of Ultratard HM and 10 U of Actrapid HM were injected separately or together immediately after mixing. Free insulin and plasma glucose (PG) were measured four hours after the administration. Free insulin levels were significantly higher after 15 (2p less than 0.01), 60 (2p less than 0.05) and 90 min (2p less than 0.005) when the two insulins were injected separately. PG values were significantly lower (2p less than 0.05) (7.63 +/- 4.06 mmol/l) at 120 min when the two insulins were injected separately compared to the mixture (9.45 +/- 4.22 mmol/l). In conclusion, mixing Ultratard HM and Actrapid HM 3:1, we observed a decrease of early Actrapid absorption and a slower lowering of PG values.