Inflammation, mitochondrial dysfunction and physical performance: a possible association in older patients with persistent atrial fibrillation-the results of a preliminary study.

BACKGROUND: Atrial fibrillation (AF) is associated with chronic inflammation, a hallmark of ageing process. The aim of this study was to determine interleukin-6 (IL-6)-associated variables, also exploring acylcarnitines, expression of mitochondrial abnormalities. METHODS: We evaluated 22 controls and 50 patients with persistent AF. IL-6 and acylcarnitines were measured with ELISA kits and mass spectrometry techniques. RESULTS: IL-6 concentration (mean: 3.9 ± 3.1 pg/mL) was lower in controls and increased in AF patients, especially with heart failure. The CHA2DS2-VASc, the MMSE and the SPPB scores were 3.8 ± 1.6, 28 ± 2 and 9.4 ± 2.1. Thirteen acylcanitines correlated with IL-6. At multivariable analysis, IL-6 was directly associated with C4-OH-a short-chain acylcarnitine, fibrinogen and alanine aminotransferase values, and with hyperuricemia. An inverse association existed with calcium concentration and SPPB score. CONCLUSIONS: In older AF patients, IL-6 correlated with acylcarnitines and lower physical performance. Alterations in energy production, reduced physical function and inflammation could contribute to frailty development.

Atrial fibrillation in older patients and artificial intelligence: a quantitative demonstration of a link with some of the geriatric multidimensional assessment tools-a preliminary report.

Atrial fibrillation (AF) associates with disability and frailty. Aim of this study was to evaluate in older AF patients, using artificial intelligence (AI), the relations between geriatric tools and daily standing and resting periods. We enrolled thirty-one > 65 years patients undergoing electrical cardioversion of AF (age: 79 ± 6 years; women: 41.9%; CHA2DS2-VASc: 3.7 ± 1.2; MMSE: 27.7 ± 2.7; GDS: 3.0 ± 2.8). The data of the first day following the procedure were analyzed using machine-learning techniques in a specifically designed cloud platform. Standing, activity, time (582 ± 139 min) was directly associated with MMSE and inversely with GDS. Sleep length was 472 ± 230 min. Light sleep, the longer resting phase, was inversely related to GDS. The Chest Effort Index, a measure of obstructive sleep apnea, grew with GDS. In conclusion, AI devices can be routinely used in improving older subjects' evaluation. A correlation exists between standing time, MMSE, and depressive symptoms. GDS associates to length and quality of sleep.

Influence of crown-implant ratio on implant success rate of ultra-short dental implants: results of a 8- to 10-year retrospective study.

OBJECTIVES: The use of short implants has been suggested in recent years as an option for facilitating prosthetic restoration in resorbed jawbones. The aim of the present study was to determine how implant success rate is affected in the long term when ultra-short implants are rehabilitated with fixed restorations, resulting in a crown to implant (C/I) ratio of more than 3:1. MATERIALS AND METHODS: The study was conducted as an analysis on all patients operated from December 2005 to November 2007 with ultra-short dental implants. All implants were sintered porous-surfaced (SPS) with a length of 5 mm and a diameter of 5 mm (5 × 5 mm) and were restored with a single crown or a fixed dental prosthesis (FDP). Data collected included implant positioning site, crestal bone levels (CBL), and clinical and anatomical C/I ratios, and pre-established success criteria were used to evaluate the success rate of the implants. Statistical analysis was used to determine any significant differences or correlations (p = 0.05). RESULTS: Forty-one patients completed the follow-up and were eligible for this retrospective study on a total of 50 ultra-short SPS implants. The mean follow-up was 9.5 years (range 8.3 to 10.2 years). Three of the 50 implants failed because they were lost due to peri-implantitis, while all the other 47 met the pre-established success criteria giving an overall implant success rate of 94%. During the follow-up period, the mean peri-implant bone loss (PBL) was 0.41 + 0.36 mm. CONCLUSIONS: This study shows that ultra-short SPS implants can prove a reliable solution for prosthetic restoration in patients with severe alveolar bone atrophy. In selected patients with a sufficient bone width, ultra-short implants with a resulting C/I ratio of more than 3:1 presented no contraindications. CLINICAL RELEVANCE: In selected cases, ultra-short implants may represent an alternative to bone augmentation procedures and a long-term predictable solution.

Development of Nanobodies Against Hemorrhagic and Myotoxic Components of Bothrops atrox Snake Venom.

Snake envenoming is a globally neglected public health problem. Antivenoms produced using animal hyperimmune plasma remain the standard therapy for snakebites. Although effective against systemic effects, conventional antivenoms have limited efficacy against local tissue damage. In addition, potential hypersensitivity reactions, high costs for animal maintenance, and difficulties in obtaining batch-to-batch homogeneity are some of the factors that have motivated the search for innovative and improved therapeutic products against such envenoming. In this study, we have developed a set of nanobodies (recombinant single-domain antigen-binding fragments from camelid heavy chain-only antibodies) against Bothrops atrox snake venom hemorrhagic and myotoxic components. An immune library was constructed after immunizing a Lama glama with whole venom of B. atrox, from which nanobodies were selected by phage display using partially purified hemorrhagic and myotoxic proteins. Biopanning selections retrieved 18 and eight different nanobodies against the hemorrhagic and the myotoxic proteins, respectively. In vivo assays in mice showed that five nanobodies inhibited the hemorrhagic activity of the proteins; three neutralized the hemorrhagic activity of whole B. atrox venom, while four nanobodies inhibited the myotoxic protein. A mixture of the anti-hemorrhagic and anti-myotoxic nanobodies neutralized the local tissue hemorrhage and myonecrosis induced by the whole venom, although the nanobody mixture failed to prevent the venom lethality. Nevertheless, our results demonstrate the efficacy and usefulness of these nanobodies to neutralize important pathologies of the venom, highlighting their potential as innovative therapeutic agents against envenoming by B. atrox, a viperid species causing many casualties in South America.

Invisalign appliance: aesthetic and efficiency.

BACKGROUND: The patients' request for treatment with clear aligners is constantly increasing. The aligners permit to the clinicians a valid way to solve a lot of orthodontic cases but the patients' compliance and the clinicians' capabilities and knowledge of the technique is fundamental for the outcome. METHODS: Seventy-two digital models of 18 consecutive patients treated with Invisalign and Smart Track aligners for 14 weeks were analyzed. The operator positioned 24 points on each model and were obtained the values of arch depth and perimeter of arch before and after the treatment. The variations of measurement were calculated with t student test. RESULTS: A decrease of arch depth and perimeter was found from t0 to t1 and the most relevant difference was observed in the upper arch depth with a decrease of 1.3 mm and in the upper arch perimeter with a difference of 1.1 mm. CONCLUSIONS: There was always a decrease of the values of arch depth and arch perimeter at the end of the treatment, especially in the upper arch. These changes must be considered by the clinicians to perform a better treatment to obtain the most predictable results and a patient's higher satisfaction.

Oral mucosal complications in orthodontic treatment.

BACKGROUND: Orthodontic therapy is used to solve numerous oral problems, but the use of fixed oral devices can also impact negatively the oral cavity, if the treatment is not steadily under control. The aim of this study is to evaluate tooth, bone and soft tissues lesions due to the presence of fixed orthodontic appliances. METHODS: One hundred patients with fixed orthodontic appliances were included in the study. In particular, 20 patients with rapid palatal expander (RPE), 20 patients with Forsus appliance, 20 patients with a fixed multibracket appliance treatment, 20 patients with just the lower vestibular multibracket treatment and 20 patients with both upper and lower vestibular multibracket treatment. An accurate oral examination of the oral cavity, comprehending teeth, bone and soft tissues, was carried out thoroughly, in order to find possible lesions caused by the fixed orthodontic treatment. RESULTS: Concerning RPE, 35% patients had reversible palatal lesions, while 45% patients had the impression of the appliance on the tongue. Periodontal damages were observed in 5% of the patients, as well as tooth lesions (i.e. dental caries). 20% of the patients with Forsus appliance experienced the lesion on the cheek mucosa, while 10% individuals reported periodontal problems, and 15% of the subject suffered for WSL (white spot lesion) and dental caries. Upper vestibular multibracket appliance caused superior labial lesions (15%), cheek mucosal lesions (20%), gingivitis (55%), white spot lesions (WSL) of superior teeth (15%), while dental recessions and periodontitis due to the appliance were rarely observed (5%). Lower vestibular multibracket appliance was frequently the cause of inferior labial lesions (15%), cheek mucosal lesions (15%), gingivitis (50%), WSL of inferior teeth (20%) and also in lower arch dental recessions and periodontitis due to the appliance were rarely observed (5%). Patients with both superior and inferior multibracket appliance experienced upper and/or lower lip lesions (25%), lesions of cheek mucosa (25%), gingivitis (65%) and WSL (30%), and just in few cases periodontitis (10%). Data shows a more critical oral situation in patients with both superior and inferior appliances than people with one-arch therapy. CONCLUSIONS: Orthodontic therapy offers a considerable number of advantages, but it is important to underline what may be the adverse consequences also. This allows the orthodontist to inform the patient of all the possible effects of their therapeutic choice. In most cases, RPE can cause an impression of the device on the tongue and reversible lesions of the palate. On the other hand, the orthodontic fixed therapy can cause gingivitis, followed by mucosal lesions, labial lesions and WSL. For these reasons, an accurate assessment of the patients before the application of fixed orthodontic treatment is necessary. Oral hygiene instructions and motivation are very important, as well as periodic controls of the fixed oral device.

Alveolar splitting with Piezosurgery®, bone bank grafts and NobelActive implants as an alternative to major bone grafting for maxillary reconstruction.

BACKGROUND: Piezosurgery® represents a novel alternative technique. The Piezosurgery® is well tolerated and permits a large number of applications in described literature. The principle of Piezosurgery® consists into inducing micro-vibrations to a metallic insert with a particular custom. The aim of this article is to study and to evaluate the use of NobelActive implants in combination with piezosurgical split-crest technique in severe atrophy of the upper maxilla. This approach allows avoiding the use of onlay grafts, due to rise the trasversal width of the crestal bone, which could have more complications and uncertain prognosis. This technique allows reducing timing of implant insertion because it is not necessary to wait for the graft to heal. METHODS: Ten patients (age 45-58) are selected, presenting from class 4 to 5 by Cawood and Howell of jaws. Those underwent piezosurgical split-crest technique and simultaneous implants surgery and bone grafts. Preoperative X-ray evaluation included standard X-panoramic and CT Dental-scan. Standard chemoprophylaxis was administered to each patient. The piezosurgical split-crest procedure was combined with tissue bank fresh frozen chips and double-layer collagen membrane to improve the thickness of alveolar bone and simultaneous implant surgery. Every patient received simultaneously from 3 to 6 implants which diameter was 4.3 mm and length 10-11.5 mm. Healing abutments have been applied at 5 months from the first procedure. RESULTS: Patients were clinically monitored, and marginal bone changes were calculated using periapical radiographs, which were taken with O-ring technique at placement and upon subsequent appointments and a 1-mm measurement grid for marginal bone remodeling, again at baseline and thereafter 3 months within loading. Cumulative implant survival was 97.8% (N.=45). Mean marginal bone resorption (SD) was 1.19 (1.01) mm for the early loading group after 1 year. The use of NobelActive implants seem to reduce peak stress in both cortical and trabecular bone. CONCLUSIONS: The use of NobelActive implants was revealed ideal in patients presenting jaw atrophy. The tapered designs show an ability to dissipate the interfacial stresses of bone, therefore improving the stability and the osteointegration if used in association to split crest made with piezosurgical device.

Cone-beam volumetric imaging in craniofacial medicine.

With the development of X-ray computed tomography (CT) in the 1960s and its first use for clinical studies in 1972 by Sir Godfrey Hounsfield, radiological tomography attained widespread use and today is one of the essential imaging techniques in medical radiology. It is a technically mature and clinically widely accepted method and complements classical X-ray panoramic radiography in many areas. The technology is frequently used in craniofacial radiology, because of its characteristic low radiation dose, high spatial resolution and lower cost compared with CT. The aim of this work was to describe the principles of cone beam computed tomography, to make a brief description of the existing devices, to present briefly the use of 3D diagnosis in craniofacial medicine.

Regenerative potential of the Bichat fat pad determined by the quantification of multilineage differentiating stress enduring cells.

Published studies regarding Bichat fat pad focused, quite exclusively, on the implant of this adipose depot for different facial portions reconstruction. The regenerative components of Bichat fat pad were poorly investigated. The present study aimed to describe by an ultrastructural approach the Bichat fat pad, providing novel data at the ultrastructural and cellular level. This data sets improve the knowledge about the usefulness of the Bichat fat pad in regenerative and reconstructive surgery. Bichat fat pads were harvested form eight patients subjected to maxillofacial, dental and aesthetic surgeries. Biopsies were used for the isolation of mesenchymal cell compartment and for ultrastructural analysis. Respectively, Bichat fat pads were either digested and placed in culture for the characterization of mesenchymal stem cells (MSCs) or, were fixed in glutaraldehyde 2% and processed for transmission or scanning electron microscopy. Collected data showed very interesting features regarding the cellular composition of the Bichat fat pad and, in particular, experiments aimed to characterized the MSCs showed the presence of a sub-population of MSCs characterized by the expression of specific markers that allow to classify them as multilineage differentiating stress enduring cells.  This data set allows to collect novel information about regenerative potential of Bichat fat pad that could explain the success of its employment in reconstructive and regenerative medicine.