Pain Management Optimisation by an Ultrasound-Guided Analgesic Technique in Outpatients with Plantar Fasciitis during High-Energy Extracorporeal Shock Wave Therapy.

OBJECTIVE: Several studies have demonstrated the efficacy of high-energy extracorporeal shock wave therapy (HESWT) for the treatment of painful foot diseases. A crucial complication of HESWT is the appearance of pain with the subsequent interruption of the procedure. The aim of this study was the evaluation of ultrasound (US)-guided posterior tibial nerve block (PTNB) efficacy in outpatients who discontinued the first application of HESWT due to surge of moderate-severe pain. METHODS: Twenty-one patients, scheduled for HESWT due to plantar fasciitis, who interrupted the treatment for surge of pain (numeric rating scale [NRS] 5), were enrolled. After interruption of the first treatment, the patients received US-guided PTNB for every subsequent HESWT session. The same skilled anaesthesiologist performed an US-guided PTNB all the times. Once the nerve was identified, the needle was inserted and 5ml mepivacaine 1% were injected. Intensity of pain during each procedure by NRS and evaluation of patient's adherence to the treatment were detected. RESULTS: The HESWT was split into only three applications giving in average about 0.25 mJ mm-2, and all patients completed the treatment sessions. US-guided PTNB showed a significant reduction of NRS (P < 0.01) between the first HEWST without anaesthesia and the three subsequent treatments under peripheral block. CONCLUSION: US-guided PTNB resulted a valid support for the HEWST in outpatients with plantar fasciitis because it reduced the pain during the procedure, allowing to minimise the patient discomfort and to give the therapeutic doses just in three sessions.

Comparison of two curing protocols during adhesive cementation: can the step luting technique supersede the traditional one?

This study aims to compare the degree of conversion of two different curing protocols used during adhesive cementation. The following resin luting agents were tested: Hri Flow (MF) and pre-heated Hri Micerium (MH); light-cure Nexus Third Generation (NX3L) and dual-cure Nexus Third Generation (NX3D); dual cured RelyX Ultimate (RXU) and light-cure RelyX Veneers (RXL). For each tested material, ten samples were prepared and divided into two groups which had different curing protocols (P1 and P2): in P1, samples were cured for 40 s; in P2, samples were cured for 5 s, and then, after 20 s, cured again for additional 40 s. The degree of conversion (DC) was evaluated both during the first 5 min of the curing phase and after 1, 2, 7, 14 and 28 days (p = 0.05). Different trends were observed in DC values after 5 min by comparing P1 and P2. In both P1 and P2, DC decreased as follows, MH > MF > NX3L > RXL > RXU > NX3D. There were significant differences of DC values among all resin luting agents (p < 0.05) in P1, while no significant differences existed between MH and MF, and NX3L and RXL in P2. At 1, 2, 7, 14 and 28 days the light curing luting agents had a higher DC than the dual luting agents (p < 0.05). P1 and P2 were not statistically different at each time point (p > 0.05). Both P1 and P2 protocols let achieve an acceptable DC after 28 days. The tested P2 can be safely used to lute indirect restorations, simplifying the removal of cement excesses.

How Can Different Polishing Timing Influence Methacrylate and Dimethacrylate Bulk Fill Composites? Evaluation of Chemical and Physical Properties.

The polishing procedure is commonly performed after direct composite restorations, and little information exists regarding the right timing during which it should be performed on bulk fill composites. This study investigated the effect of polishing timing on the degree of conversion (DC), Vickers microhardness (VMH), and surface morphology of a methacrylate- (MET-) and dimethacrylate- (DMET-) based bulk fill composite, by using FT-NIR, microhardness tester, and SEM. Composite samples were divided as follows: in Group I (immediate), samples were polished immediately after curing (t 0); in Group D (delayed), samples were polished after 24 h from curing (t 24), whereas the unpolished samples were considered as controls (Group C). The DC and VMH values were evaluated before and after polishing, at t 0 and t 24. Statistical analysis was performed with a significance level set at p < 0.05. At t 0, DC increased after polishing in both tested composites (p < 0.05), while at t 24, Group I and Group D were not different. By considering VMH, in the case of MET, all groups were not different both at t 0 and t 24. On the other hand, at t 0, VMH values of DMET increased after polishing. At t 24, DMET Group I and DMET Group D were not different. Qualitative evaluations of scanning electron micrographs showed that the surface morphology of MET presented a more irregular aspect than the DMET one. In summary, since the immediate polishing of MET can improve the DC, without negatively affecting VMH, but showing an irregular surface, it is suggested to wait 24 hours before proceeding with polishing. Otherwise, for DMET, the immediate polishing could definitively be recommended, since it improves both DC and VMH, also producing a regular surface. Therefore, clinicians may always safely polish a restoration performed using DMET-based bulk fill composites in one-chair appointment, avoiding a second appointment.

Investigation of human pancreatic cancer tissues by Fourier Transform Infrared Hyperspectral Imaging.

Fourier-transform infrared hyperspectral imaging (FTIR-HSI) provides hyperspectral images containing both morphological and chemical information. It is widely applied in the biomedical field to detect tumor lesions, even at the early stage, by identifying specific spectral biomarkers. Pancreatic neoplasms present different prognoses and are not always easily classified by conventional analyses. In this study, tissue samples with diagnosis of pancreatic ductal adenocarcinoma and pancreatic neuroendocrine tumor were analyzed by FTIR-HSI and the spectral data compared with those from healthy and dysplastic samples. Multivariate/univariate approaches were complemented to hyperspectral images, and definite spectral markers of the different lesions identified. The malignant lesions were recognizable both from healthy/dysplastic pancreatic tissues (high values of phospholipids and triglycerides with shorter, more branched and less unsaturated alkyl chains) and between each other (different amounts of total lipids, phosphates and carbohydrates). These findings highlight different metabolic pathways characterizing the different samples, well detectable by FTIR-HSI.

Morphological, Physicochemical and FTIR Spectroscopic Properties of Bee Pollen Loads from Different Botanical Origin.

Bee pollen loads generally have a homogeneous and monospecific pollen content and assume a typical form and color, due to the typical bee foraging habits, thus having a typical composition related to the botanical origin. The present study aims to characterize bee pollen loads belonging to different botanical species using morphological, spectroscopic and color properties and to find relationships between these variables. IR spectra analysis allowed to have a reliable picture of the components present in the different samples; color and granulometry permits a visual identification of pollen load belonging to different species. Multivariate analysis enabled differentiation among the botanical origin of most of the bee pollen samples, grouping them according to the family and the genus and confirming the possibility to use IR and color measurements for the evaluative analysis and classification of bee pollen samples, to promote the consumption of this bee product as functional food.

Adsorption of indium by waste biomass of brown alga Ascophyllum nodosum.

The biosorption capacities of dried meal and a waste product from the processing for biostimulant extract of Ascophyllum nodosum were evaluated as candidates for low-cost, effective biomaterials for the recovery of indium(III). The use of indium has significantly grown in the last decade, because of its utilization in hi-tech. Two formats were evaluated as biosorbents: waste-biomass, a residue derived from the alkaline extraction of a commercial, biostimulant product, and natural-biomass which was harvested, dried and milled as a commercial, "kelp meal" product. Two systems have been evaluated: ideal system with indium only, and double metal-system with indium and iron, where two different levels of iron were investigated. For both systems, the indium biosorption by the brown algal biomass was found to be pH-dependent, with an optimum at pH3. In the ideal system, indium adsorption was higher (maximum adsorptions of 48 mg/g for the processed, waste biomass and 63 mg/g for the natural biomass), than in the double metal-system where the maximum adsorption was with iron at 0.07 g/L. Good values of indium adsorption were demonstrated in both the ideal and double systems: there was competition between the iron and indium ions for the binding sites available in the A. nodosum-derived materials. Data suggested that the processed, waste biomass of the algae, could be a good biosorbent for its indium absorption properties. This had the double advantages of both recovery of indium (high economic importance), and also definition of a virtuous circular economic innovative strategy, whereby a waste becomes a valuable resource.

Nitrogen and chlorophyll status determination in durum wheat as influenced by fertilization and soil management: Preliminary results.

Handheld chlorophyll meters as Soil Plant Analysis Development (SPAD) have proven to be useful tools for rapid, no-destructive assessment of chlorophyll and nitrogen status in various crops. This method is used to diagnose the need of nitrogen fertilization to improve the efficiency of the agricultural system and to minimize nitrogen losses and deficiency. The objective of this study is to evaluate the effect of repeated conservative agriculture practices on the SPAD readings, leaves chlorophyll concentration and Nitrogen Nutrition Index (NNI) relationships in durum wheat under Mediterranean conditions. The experimental site is a part of a long-term-experiment established in 1994 and is still on-going where three tillage managements and three nitrogen fertilizer treatments were repeated in the same plots every year. We observed a linear relationship between the SPAD readings performed in the central and distal portion of the leaf (R2 = 0.96). In fertilized durum wheat, we found all positive exponential relationships between SPAD readings, chlorophyll leaves concentration (R2 = 0.85) and NNI (R2 = 0.89). In the unfertilized treatment, the SPAD has a good attitude to estimate leaves chlorophyll concentration (R2 = 0.74) and NNI (R2 = 0.77) only in crop grow a soil with relative high content of soil organic matter and nitrogen availability, as observed in the no tilled plots. The results show that the SPAD can be used for a correct assessment of chlorophyll and nitrogen status in durum wheat but also to evaluate indirectly the content of soil organic matter and nitrogen availability during different growth stages of the crop cycle.

In vitro FTIR microspectroscopy analysis of primary oral squamous carcinoma cells treated with cisplatin and 5-fluorouracil: a new spectroscopic approach for studying the drug-cell interaction.

In the present study, human primary oral squamous carcinoma cells treated with cisplatin and 5-fluorouracil were analyzed, for the first time, by in vitro FTIR Microspectroscopy (FTIRM), to improve the knowledge on the biochemical pathways activated by these two chemotherapy drugs. To date, most of the studies regarding FTIRM cellular analysis have been executed on fixed cells from immortalized cell lines. FTIRM analysis performed on primary tumor cells under controlled hydrated conditions provides more reliable information on the biochemical processes occurring in in vivo tumor cells. This spectroscopic analysis allows to get on the same sample and at the same time an overview of the composition and structure of the most remarkable cellular components. In vitro FTIRM analysis of primary oral squamous carcinoma cells evidenced a time-dependent drug-specific cellular response, also including apoptosis triggering. Furthermore, the univariate and multivariate analyses of IR data evidenced meaningful spectroscopic differences ascribable to alterations affecting cellular proteins, lipids and nucleic acids. These findings suggest for the two drugs different pathways and extents of cellular damage, not provided by conventional cell-based assays (MTT assay and image-based cytometry).

Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age.

AIM: To report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years. METHODS: A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent's satisfaction. RESULTS: Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10. CONCLUSION: TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.

Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites.

Objectives: The aims of this study were to in vitro evaluate the degree of conversion and the microhardness properties of five bulk fill resin composites; in addition, the performance of two curing lamps, used for composites polymerization, was also analyzed. Materials and Methods: The following five resin-based bulk fill composites were tested: SureFil SDR®, Fill Up!™, Filtek™, SonicFill™, and SonicFill2™. Samples of 4 mm in thickness were prepared using Teflon molds filled in one increment and light-polymerized using two LED power units. Ten samples for each composite were cured using Elipar S10 and 10 using Demi Ultra. Additional samples of SonicFill2, (3 and 5 mm-thick) were also tested. The degree of conversion (DC) was determined by Raman spectroscopy, while the Vickers microhardness (VMH) was evaluated using a microhardness tester. The experimental evaluation was carried out on top and bottom sides, immediately after curing (t0), and, on bottom, after 24 h (t24). Two-ways analysis of variance was applied to evaluate DC and VMH-values. In all analyses, the level of significance was set at p < 0.05. Results: All bulk fill resin composites recorded satisfactory DCs on top and bottom sides. At t0, the top of SDR and SonicFill2 showed the highest DCs-values (85.56 ± 9.52 and 85.47 ± 1.90, respectively), when cured using Elipar S10; using Demi Ultra, SonicFill2 showed the highest DCs-values (90.53 ± 2.18). At t0, the highest DCs-values of bottom sides were recorded by SDR (84.64 ± 11.68), when cured using Elipar S10, and Filtek (81.52 ± 4.14), using Demi Ultra. On top sides, Demi Ultra lamp showed significant higher DCs compared to the Elipar S10 (p < 0.05). SonicFill2 reached suitable DCs also on bottom of 5 mm-thick samples. At t0, VMH-values ranged between 24.4 and 69.18 for Elipar S10, and between 26.5 and 67.3 for Demi Ultra. Using both lamps, the lowest VMH-values were shown by SDR, while the highest values by SonicFill2. At t24, all DC and VMH values significantly increased. Conclusions: Differences in DC and VMH among materials are suggested to be material and curing lamp dependent. Even at t0, the three high viscosity bulk composites showed higher VMH than the flowable or dual curing composites.

Vibrational mapping of sinonasal lesions by Fourier transform infrared imaging spectroscopy.

Fourier transform infrared imaging (FTIRI) is a powerful tool for analyzing biochemical changes in tumoral tissues. The head and neck region is characterized by a great variety of lesions, with different degrees of malignancy, which are often difficult to diagnose. Schneiderian papillomas are sinonasal benign neoplasms arising from the Schneiderian mucosa; they can evolve into malignant tumoral lesions (squamous cell carcinoma). In addition, they can sometimes be confused with the more common inflammatory polyps. Therefore, an early and definitive diagnosis of this pathology is mandatory. Progressing in our research on the study of oral cavity lesions, 15 sections consisting of inflammatory sinonasal polyps, benign Schneiderian papillomas, and sinonasal undifferentiated carcinomas were analyzed using FTIRI. To allow a rigorous description of these pathologies and to gain objective diagnosis, the epithelial layer and the adjacent connective tissue of each section were separately investigated by following a multivariate analysis approach. According to the nature of the lesion, interesting modifications were detected in the average spectra of the different tissue components, above all in the lipid and protein patterns. Specific band-area ratios acting as spectral markers of the different pathologies were also highlighted.

FTIR microspectroscopic characterization of Spitz nevi.

In the last 10 years, few efforts have been carried out to apply vibrational spectroscopy in the study of dermal pathologies in order to characterize the most relevant spectral markers for distinguishing benign from cancerous lesions. Spitz nevi are a special group of benign melanocytic lesions, characterized by spindled and/or epithelioid nevomelanocytes, with peculiar clinical, dermoscopic and histopathological features. The "atypical forms" of Spitz nevi are among the commonest problems of differential diagnosis with the so-called "spitzoid melanomas". The clinical and histological criteria for discriminating these two entities are very subtle and often still quite subjective, and, in a significant percentage of cases, can lead to diagnostic pitfalls and inadequate therapies. Therefore, it is noteworthy to outline that the diagnosis of melanocytic lesions still represents a challenging problem and a continue matter of discussion. We exploited FTIR microspectroscopy to study the different kinds of spitzoid melanocytes, in order to define the most relevant spectral markers of each specimen and to achieve objective information on "borderline" histologically atypical lesions. In particular, the spectroscopic investigation was carried out on melanocytes deriving from normal skin (as a normal control), malignant melanoma and Spitz nevi. The presence of the characteristic bands of melanin was investigated, too.

FTIR microspectroscopy of melanocytic skin lesions: a preliminary study.

Fourier transform infrared (FTIR) microspectroscopy has been employed to investigate benign (ordinary dermal and Reed nevi), dysplastic and malignant (invasive melanoma) skin lesions through the analysis of spectral changes of melanocytes as well as in the evaluation of the presence of melanin. Hierarchical cluster analysis and principal component analysis led to a satisfactory separation of malignant from dysplastic and normal melanocytes. Also, on enlarging the clustering with spectra from Reed and dermal nevi, the multivariate analysis segregated well the spectral data into discrete clusters, allowing the obtaining of reliable average spectra for analysis at the molecular level of the main groups or components responsible for the biological and biochemical changes. The most significant spectral characteristics appear to be related to differences in secondary protein structures, in nucleic acid conformation, in intra- and intermolecular bonding. In all cases, supervised and unsupervised spectral analyses resulted in satisfactory agreement with histopathological findings.

Effects of Lactobacillus rhamnosus on zebrafish oocyte maturation: an FTIR imaging and biochemical analysis.

The aim of this study was to verify the effects of probiotic Lactobacillus rhamnosus on zebrafish oocyte maturation using FPA (focal plane array) FTIR imaging together with specific biochemical assays (SDS-PAGE, real-time PCR and enzymatic assay). Oocyte growth is prevalently due to a vitellogenic process which consists of the hepatic synthesis of vitellogenin and its selective uptake during maturation. The administration of L. rhamnosus IMC 501 for 10 days induced chemical changes to oocyte composition, promoting the maturation process. Some interesting biochemical features, linked to protein secondary structure (amide I band) and to phospholipidic and glucidic patterns, were detailed by vibrational analysis. The spectroscopic results were supported by the early increase of the lysosomal enzyme involved in the final oocyte maturation, the cathepsin L. This enzyme increases during follicle maturation, with the highest levels in class IV oocytes. In treated females, class III oocytes showed higher cathepsin L gene expression and enzymatic activity, with levels comparable to class IV oocytes isolated from controls; this can be related to the proteolytic cleavage of the higher molecular mass yolk protein components, as evidenced by SDS-PAGE.

Short-term chemical and physical changes in invisalign appliances.

OBJECTIVE: To investigate the short-term optical, chemical and morphological changes in Invisalign appliances. METHODS: One 'as-received' Invisalign aligner, one 'as-received' Invisalign aligner immersed in artificial saliva for 14 days and 10 Invisalign aligners worn by 10 randomly selected patients for 14 days were used. Fourier'transform infra-red microspectroscopy was used to characterise any molecular changes on the surfaces of the appliances, spectrophotometry was used to evaluate any changes in colour and transparency, scanning electron microscopy and energy dispersive X-ray microanalysis were used to examine the surface morphology and elemental composition of deposits on the surfaces of the aligners and gas chromatography-mass spectrometry was used to identify substances released from the aligners into the artificial saliva. RESULTS: Aligners worn for 14 days had microcracks, abraded and delaminated areas, localised calcified biofilm deposits and loss of transparency. Monomers and/or by-products were not released from the aligner suspended in artificial saliva for 14 days, which suggests that the material is chemically stable. CONCLUSIONS: Further studies are required to evaluate how intra-oral conditions may influence the optical properties and chemical stability of the aligners.

Microimaging FTIR of head and neck tumors. IV.

On continuing our studies on head and neck neoplasia, specimens from salivary gland tumors have been explored by using infrared microimaging spectroscopy to discern healthy from neoplastic tissues. Samples with Warthin tumor, epithelial displasia, marginal B-cell lymphoma, low-grade adenocarcinoma, and adenoid cystic carcinoma pathologies have been investigated by using conventional light sources. Changes were monitored at the molecular level, probing spectral markers such as Amide I and II, phosphate, nucleic acids, and carbohydrates vibrational modes. In all cases, supervised and unsupervised spectral analyses resulted in satisfactory agreement with histopathological findings.

[Anaesthesia for shock wave therapy in orthopaedics]. / Anestesia nel trattamento con onde d'urto in patologia ortopedica.

Shock wave therapy (orthotripsy) is a non-invasive method to treat or ameliorate many musculoskeletal disorders. When higher energies are applied on bones pain is associated with treatment, and anaesthesia is necessary, but there is no need of analgesia after shock wave application. Patients usually receive treatments during a short hospital stay: therefore, short duration drugs and techniques should be preferred, avoiding those causing unpleasant postanaesthetic sequelae. Between February 2002 and October 2004, a series of 136 patients have been treated with orthotripsy requiring some kind of anaesthesia. Anaesthetic techniques and agents suitable for orthotripsy are discussed.