Submental intubation in complex maxillofacial trauma: Pilot balloon protection.

AIMS: This study aims to describe our refined technique of submental intubation to avoid the recorded intraoperative complications related to tube passage and pilot balloon rupture. CASE SERIES: This is a retrospective case series of 21 patients with complex maxillofacial trauma who underwent submental intubation from January 2019 to January 2023. All the patients underwent to the same procedure with a new technique of pilot balloon protection: the pilot balloon was not deflated because, once the connector was removed, only the tube was curved and passed through the incision extraorally while the cuff remained inflated. The wire of the pilot balloon was passed behind the last tooth so as not to interfere with the maxillary-mandibular fixation, remaining extraorally under the anesthetist's view. DISCUSSION: Only 2 patients (9.5%) reported complications related to submental intubation: in particular a patient (4.8%) reported oral floor infection, and in another patient (4.8%) an unesthetic skin scar was observed. No patients reported intraoperative complications related to the procedure. CONCLUSION: The technique of pilot balloon protection that we have proposed seems to be effective in reducing the intraoperative complications related to the passage of the pilot balloon, such as rupture, damage or early extubation.

Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients.

BACKGROUND: Uncooperative children require sedative approach for dental treatment. The aim was to assess the effectiveness of Propofol in "Non-Operating Room Anesthesia" (NORA) for paediatric dental treatment; intraoperative side effects; postoperative side effects; post-discharge effects. METHODS: a prospective study, involving 109 uncooperative children undergoing sedation in NORA using Propofol for dental treatment, was performed. Working sessions, success/failure, intraoperative and postoperative side effects, number of treatment; type of procedure were assessed. Parents completed a post-discharge questionnaire on: pain; crying; fever; vomiting; headache; drowsiness; excitability; irritability; ability to eat; drugs and medical care needing. RESULTS: Success: 96.7%. Intraoperative side effects: 33.3%. Postoperative side effects: 6.4%. Statistically significant association between: intraoperative side effects and age (p = 0.001), health status (p = 0.0007), weight (p = 0.038), respectively; intraoperative side effects and number/ type of dental treatment (p = 0.0055) and scaling (p = 0.0001), respectively. For post-discharge questionnaires, statistically significant association between: age and crying (p = 0.0001) and headache (p = 0.002), respectively; health status and crying (p = 0.015) and drugs needing (p = 0.04), respectively; weight and crying (p = 0.0004); extraction and pain (p = 0.0001) and crying (p= 0.0073), respectively; scaling and crying (p = 0.04), excitability and irritability (p = 0.03), respectively. CONCLUSION: Propofol in NORA was effective with minimal side effects.

Experimental antibacterial therapy with puroindolines, lactoferrin and lysozyme in Listeria monocytogenes-infected mice.

Puroindoline A and puroindoline B from plant seeds, bovine lactoferrin and chicken eggs lysozyme are antimicrobial proteins of innate immune system that lyse invading organisms. We investigate their potential antibacterial activity against Listeria monocytogenes in a mouse model. Bacteria were isolated from various organs for 7 days after challenge. Livers displayed consistently higher bacterial count (up to 10(7)cfu/g) than spleens, kidneys and brains. The efficacy of the AMPs was therefore established by measuring the infection level (cfu number) of these organs. Puroindoline A and puroindoline B (5mg/mouse), lactoferrin and lysozyme (1.25mg/mouse), intravenously injected individually, inhibited bacterial growth completely. Puroindoline A, puroindoline B and lactoferrin were effective when administered 24h before infection; lysozyme was effective at the time of infection or 5 days after. Their combined use resulted in the enhancement of individual antibacterial activities. Complete inhibition of bacterial growth was observed using concurrently 0.059mg/mouse of puroindoline A and 0.019mg/mouse of puroindoline B, lactoferrin and lysozyme. Individual antimicrobial proteins reduced significantly the expression level of pro-inflammatory cytokines (IL-6, IL-8, INF-gamma and TNF-alpha), acute phase proteins (C-reactive protein and fibrinogen) and the T lymphocyte antigens CD4, CD8a, CD8b and CD25. These results suggest their potential use for the control of L. monocytogenes infections.

Role played by human mannose-binding lectin polymorphisms in pulmonary tuberculosis.

BACKGROUND: Mannose-binding lectin (MBL) activates the complement system in an antibody-independent manner, enhances complement-mediated phagocytosis, and plays a major role in the regulation of inflammatory cytokine release by monocytes. METHODS: Case patients (277 patients with pulmonary tuberculosis) and control subjects (288 household contacts) were tested by polymerase chain reaction (PCR) for polymorphisms at the promoter and the exon 1 regions of the MBL gene. Diagnosis of pulmonary tuberculosis, based on findings from chest radiography and sputum smear examination, was confirmed by PCR and bacteriological tests. RESULTS: HYA/HYA subjects were protected against tuberculosis (odds ratio [OR], 0.09 [95% confidence interval {CI}], 0.023-0.408; P < 1 X 10 (-6)). LYB/LYD subjects were susceptible to disease (OR, 49 [95% CI, 2.9-812.5]; P < 1 X 10(-6)). CONCLUSIONS: This study supports the conclusion that MBL can protect or predispose the host to tuberculosis, depending on the host's haplotype pair.

Tobacco BY-2 cells as effective bioreactor for the production of puroindolines.

Puroindolines are two small proteins so called for the presence of an hydrophobic tryptophan-rich domain. Associated to wheat starch granules in Triticum aestivum, puroindolines have been shown to be responsible for the softness of the wheat endosperm. Moreover, have been proved to possess bactericide and anti-fungal properties together with the capacity of forming very stable foams. All these features make puroindolines very attractive for medical, pharmaceutical and food industrial applications. The aim of this study was to explore a plant molecular farming approach for producing a recombinant puroindolines. Three specific recombinant constructs, aimed for the expression in the apoplast and chloroplast compartments, were prepared and used for transformation of Nicotiana tabacum cv BY-2 cells. Recombinant PINB targeted to the chloroplast was obtained as 0.35% of BY-2 cell TSP. Antimicrobial activity experiments demonstrated that at MIC concentration recombinant PINB is responsible for about 91% growth inhibition of E. coli.

Fungistatic activity of iron-free bovin lactoferrin against several fungal plant pathogens and antagonists.

Lactoferrin (LF) is a member of the transferrin family of iron-binding glycoproteins. It is also a multifunctional protein of 80 kDa that is synthesized by glandular epithelial cells and secreted into mucosal fluid. High levels of LF are present in colostrom and milk and low levels in tears, saliva, and gastrointestinal and reproductive secretions. Data regarding the antifungal effects of LF are limited. Studies have been performed on Candida albicans, which demonstrated that LF inhibits the growth of this fungus. This study reports the results of experiments carried out in order to evaluate the effects of LF on the growth of 11 fungi, which were isolated from plants and soils. These experiments employed the methods of amended agar utilizing nine different concentration levels of LF (0, 0.001, 0.01, 0.1, 1, 10, 100, 1000, 5000 mg L(-1)). The effects of LF on the growth of these fungi were based on measures of the radial growth of the fungal colonies expressed both as percentage of inhibition and as IC(50) values (the concentration at which the fungal growth was inhibited by 50% relative to controls). LF had no effects on Alternaria alternata, Gliocladium roseum, Fusarium solani and Colletotrichum lindemuthianum. It did, however, inhibit the growth of Aspergillus niger, Trichoderma viride, Sclerotinia sclerotiorum, Sclerotium rolfsii, Rhizoctonia solani and Phoma exigua to the point that their IC(50) values ranged from 31.1 mg L(-1) for S. sclerotiorum to 952 mg L(-1) for T. viride.

Expression of recombinant puroindolines for the treatment of staphylococcal skin infections (acne vulgaris).

Puroindolines are antimicrobial peptides that occur in wheat seed, and are characterized by broad antimicrobial activity. We describe the heterologous expression of puroindoline A and B in the Origami strain of Escherichia coli. The recombinant puroindolines showed the same antimicrobial activity on Staphylococcus epidermidis as compared to the native peptides (MIC(90)=30microgml(-1)). The bactericidal activity was 125microgml(-1) for recombinant puroindoline A and 42microgml(-1) for recombinant puroindoline B. Neither protein shows in vitro haemolytic activity or toxicity towards the murine macrophage cell line J774, but they are able to kill intracellular staphylococci. Our preliminary results suggest that recombinant puroindolines deserve further attention as alternatives to the conventional antibiotics in the control of S. epidermidis skin infections.

Use of molecular markers and flow cytometry to preserve ancient Annurca apple germplasm.

The old Annurca apple cultivar (Malus domestica), particularly appreciated for its peculiar flavor and crispy flesh, was studied in order to preserve its ancient germplasm. Twelve clones of Annurca were analyzed using random amplified polymorphic DNA (RAPD) and simple-sequence repeat (SSR) markers. Two out of 30 RAPD primers and nine out of ten SSR primers were able to discriminate all the clones analyzed. Data were confirmed by measuring DNA content using flow cytometry. The results provide a good procedure to improve germplasm field management, in order to removing redundant material in the Annurca collection. This represents an efficient way to create a data bank in order to preserve the genetic variability of the Annurca cultivar.

Clinical spectrum and critical care management of Posterior Reversible Encephalopathy Syndrome (PRES).

BACKGROUND: Posterior Reversible Encephalopathy (PRES) is characterized by acute-onset headache, altered mental status, cortical blindness and seizures, with parietal-occipital involvement. We report all cases of PRES diagnosed in our intensive care unit during the last 4 years, and evaluate their outcome in terms of the different medical treatments used. Even if usually reversible, PRES can sometimes result in death or irreversible neurological deficit, such as chronic epilepsy. MATERIAL/METHODS: From January 2001 to January 2005, we identified 8 female patients with PRES. All patients underwent basal and follow-up brain MRI. Patients referred to Epilepsy Center (about 3000 patients) were reviewed in order to identify subjects with a clinical history of PRES. These latter were clinically re-evaluated and underwent video-EEG, MRI study and neuropsychological testing. RESULTS: Of the 8 patients, 5 had hypertensive encephalopathy during pregnancy; 2 had eclampsia during the postpartum period; 1 patient with chronic renal failure developed symptoms after immunosuppressive treatment. In all patients but 1, neurological and radiological abnormalities resolved after appropriate treatment. In addition, we found 2 patients with temporal lobe epilepsy subsequent to a previous PRES. MRI revealed cortical-subcortical malacia in the parietal-occipital regions. CONCLUSIONS: The widespread use of MRI technology has made PRES familiar to many clinicians. Although PRES is reversible when treatment is instituted, delayed diagnosis and therapy can result in chronic neurological sequelae. The relationship between hypertensive encephalopathy and chronic epilepsy needs to be confirmed by longitudinal studies. Normalization of blood pressure and treatment of seizures deserves particular attention.

Two plant puroindolines colocalize in wheat seed and in vitro synergistically fight against pathogens.

Puroindolines, for years largely investigated for their involvement in wheat kernel hardness, have recently attracted attention thanks to their possible role as antimicrobial proteins. With the aim to enhance our knowledge of these proteins we studied their localization in the kernel, and their antimicrobial activity in vitro against six different bacterial strains. Immunolocalization showed that both the PINs are strongly concentrated in the aleurone layer, but also highly present in the endosperm. Interestingly we observed that puroindolines not only have the same spatial distribution in the kernel, they are also always found co-localized. Their co-localization suggests that they could cooperate in defending the plant against pathogens. We therefore tested antimicrobial activity of PINA and PINB, and a putative synergism between these proteins. The results showed that the two polypeptides can in vitro inhibit growth of all the bacteria tested; furthermore when combined together they are able to enhance each other's toxicity. In view of their antimicrobial activity and of their natural presence in Triticum aestivum wheat flour, puroindolines look promising antibacterial agents and thus deserve further studies aimed at establishing their possible future applications in fields of food and health care. Since PINs were still detectable in bakery products, these proteins may be promising tools in investigating natural ways of food preservation.