Short term dentoskeletal effects of mandibular advancement clear aligners in Class II growing patients. A prospective controlled study according to STROBE Guidelines.

AIM: To evaluate the dentoskeletal effects of the Invisalign® Mandibular Advancement (MA) (Align Technology, San José, CA, USA) feature in skeletal Class II growing patients with mandibular retrusion, at pre-pubertal and pubertal stages. MATERIALS AND METHODS: Study design: Forty skeletal Class II patients were prospectively recruited and treated with Invisalign® MA. They were divided into two subgroups according to the CVM stage of growth (CVM2 and CVM3) at the beginning of treatment (T0). For each patient, lateral radiographs were collected at the beginning (T0) and at the end of the mandibular advancement treatment (T1) and their measurements were compared with those obtained by an untreated control group of 32 subjects, matched for growth stage and malocclusion. RESULTS: Patients in CVM2 showed significant reduction of ANB angle, A:Po, Wits index, 11^Spp angle and significant increase of 11^41 and B Downs point. In CVM3 significant reduction of the Wits index and of 41^GoGn angle, and significant increase of the linear Co-Gn measurement, were revealed. STATISTICS: The STROBE guidelines were followed. Linear regression analysis was performed to estimate the differences of ? (T1 - T0) means between group (control was used as reference) stratifying by CVM levels. CONCLUSION: The use of Invisalign® MA is effective in treating Class II growing patient with retrognathic mandible in the short term period. While treatment at prepubertal stage of growth results in dentoalveolar rather than skeletal effects, treatment during the pubertal spurt produces skeletal effects with an annual rate of change of 5.8 mm.

Interceptive treatment effects of EF preformed appliance in pre-pubertal and pubertal skeletal Class II growing patients: A retrospective controlled study.

AIM: Interceptive treatment has been devised to improve the outcomes on growth stage and mandibular repositioning in Class II patients. The aim of this study is to test the effectiveness of Functional education (EF) (OrthoPlus, Igny, France) preformed appliance in skeletal Class II growing patients at CVM2 and CMV3 stages. MATERIALS AND METHODS: Study design: retrospective controlled study. Eighty skeletal Class II growing subjects were recruited for the study. Lateral X-rays and cephalograms were required at the beginning (T0) and at the end (T1) of the EF treatment to evaluate dento-skeletal changes. The same sub-division and sample size were adopted for respective untreated control groups. RESULTS: At prepubertal stage, the EF device showed a significant reduction of upper incisors proclination. When comparing dentoskeletal variables in the pubertal groups, significant differences were shown. In the treated group the SN^B angle increased, with the B Downs landmark moving forward. Wits index improved by 2.16 mm in the study group with an increase of all mandibular linear measurements. Fewer but significant dental changes were shown for 11^41 angle, with a mean increase of 8.90°. STATISTICS: For multiple comparisons, the Tukey test at 95% family-wise confidence level was used. The level of significance was set at p < 0.05. Statistical analyses were conducted using the R statistical package (version 3.0.3, R Core Team, Foundation for Statistical Computing, Vienna, Austria). CONCLUSIONS: EF appliance seems to be effective in the treatment of Class II growing patients. Significant improvements in upper incisors proclination and mandibular elongation are shown.

New Insights and Perspectives in Fanconi Anemia Research.

Fanconi anemia is a rare, cancer-prone disease with mutations in 22 genes. The primary defect results in altered DNA repair mechanisms that fuel a severe proinflammatory condition in the bone marrow, leading to cellular depletion of the hematopoietic system and eventually to bone marrow failure. During the past three decades, a plethora of dysfunctions have been highlighted in the Fanconi anemia phenotype, but recent research allows us to glimpse an even more complex scenario where defective lipid metabolism could have important consequences in hematopoietic stem cell differentiation.

Oxidative stress in myelin sheath: The other face of the extramitochondrial oxidative phosphorylation ability.

Oxidative phosphorylation (OXPHOS) is not only the main source of ATP for the cell, but also a major source of reactive oxygen species (ROS), which lead to oxidative stress. At present, mitochondria are considered the organelles responsible for the OXPHOS, but in the last years we have demonstrated that it can also occur outside the mitochondrion. Myelin sheath is able to conduct an aerobic metabolism, producing ATP that we have hypothesized is transferred to the axon, to support its energetic demand. In this work, spectrophotometric, cytofluorimetric, and luminometric analyses were employed to investigate the oxidative stress production in isolated myelin, as far as its respiratory activity is concerned. We have evaluated the levels of malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), markers of lipid peroxidation, as well as of hydrogen peroxide (H2O2), marker of ROS production. To assess the presence of endogenous antioxidant systems, superoxide dismutase, catalase, and glutathione peroxidase activities were assayed. The effect of certain uncoupling or antioxidant molecules on oxidative stress in myelin was also investigated. We report that isolated myelin produces high levels of MDA, 4-HNE, and H2O2, likely through the pathway composed by Complex I-III-IV, but it also contains active superoxide dismutase, catalase, and glutathione peroxidase, as antioxidant defense. Uncoupling compounds or Complex I inhibitors increase oxidative stress, while antioxidant compounds limit ROS generation. Data may shed new light on the role of myelin sheath in physiology and pathology. In particular, it can be presumed that the axonal degeneration associated with myelin loss in demyelinating diseases is related to oxidative stress caused by impaired OXPHOS.

Tubulin posttranslational modifications induced by cadmium in the sponge Clathrina clathrus.

As sessile filter feeders, sponges are exposed to environmental stress due to pollutants of both anthropogenic and natural origins and are able to accumulate harmful substances. Thus, sponges are considered a good tool for the biomonitoring of coastal areas. In this study, we used biochemical and immunocytochemical analyses to provide new data on the cadmium-related changes in sponge cells. In particular, we analyzed the effects of different concentrations of cadmium on the microtubule network in the calcisponge Clathrina clathrus. Quantitative densitometry of the immunoblots showed that, while the levels of α- and ß-tubulin remained relatively constant in C. clathrus when exposed to 1 and 5 µM CdCl2, there were progressive shifts in the levels of some tubulin isoforms. Exposure for 24h to sublethal concentrations of cadmium reduced the level of tyrosinated α-tubulin and enhanced the levels of acetylated and detyrosinated α-tubulin relative to the levels in controls. Confocal microscopy analysis of immunolabeled tissue sections showed that the inhibitory effect of cadmium was associated with a decrease in the labeling of the cells with a monoclonal antibody that recognizes tyrosinated α-tubulin. By contrast, the reactivity with a monoclonal antibody that recognizes acetylated α-tubulin and with a polyclonal antibody specific for detyrosinated α-tubulin was enhanced at the same time points. Because the acetylation and detyrosination of α-tubulin occur on stable microtubules, the marked enhancement of α-tubulin acetylation and detyrosination in Cd(2+)-treated cells indicates that divalent Cd ions stabilize microtubules. The possibility that Cd(2+) may increase the stability of cytoplasmic microtubules was tested by exposing Cd(2+)-treated cells to a cold temperature (0°C). As shown, the microtubule bundles induced by Cd(2+), which were labeled by the monoclonal antibodies against acetylated and detyrosinated α-tubulin, were resistant to cold.

Creatine ethyl ester: a new substrate for creatine kinase.

The creatine kinase/phosphocreatine system plays a key role in cell energy buffering and transport, particularly in cells with high or fluctuating energy requirements, like neurons, i.e. it participates in the energetic metabolism of the brain. Creatine depletion causes several nervous system diseases, alleviated by phosphagen supplementation. Often, the supplementation contains both creatine and creatine ethyl ester, known to improve the effect of creatine through an unknown mechanism. In this work we showed that purified creatine kinase is able to phosphorilate the creatine ethyl ester. The K(m) and V(max) values, as well as temperature and pH optima were determined. Conversion of the creatine ethyl ester into its phosphorylated derivative, sheds light on the role of the creatine ethyl ester as an energy source in supplementation for selected individuals.

Extra-mitochondrial aerobic metabolism in retinal rod outer segments: new perspectives in retinopathies.

Vertebrate retinal rods are photoreceptors for dim-light vision. They display extreme sensitivity to light thanks to a specialized subcellular organelle, the rod outer segment. This is filled with a stack of membranous disks, expressing the proteins involved in visual transduction, a very energy demanding process. Our previous proteomic and biochemical studies have shed new light on the chemical energy processes that supply ATP to the outer segment, suggesting the presence of an extra-mitochondrial aerobic metabolism in rod outer segment, devoid of mitochondria, which would account for a quantitatively adequate ATP supply for phototransduction. Here the functional presence of an oxidative phosphorylation in the rod outer limb is examined for its relationship to many physiological and pathological data on the rod outer segment. We hypothesize that the rod outer limb is at risk of oxidative stress, in any case of impairment in the respiratory chain functioning, or of blood supply. In fact, the electron transfer chain is a major source of reactive O(2) species, known to produce severe alteration to the membrane lipids, especially those of the outer segment that are rich in polyunsaturated fatty acids. We propose that the disk membrane may become the target of reactive oxygen species that may be released by the electron transport chain under pathologic conditions. For example, during aging reactive oxygen species production increases, while cellular antioxidant capacity decreases. Also the apoptosis of the rod observed after exposure to bright or continuous illumination can be explained considering that an overfunctioning of phototransduction may damage the disk membrane to a point at which cytochrome c escapes from the intradiskal space, where it is presently supposed to be, activating a putative caspase 9 and the apoptosome. A pathogenic mechanism for many inherited and acquired retinal degenerations, representing a major problem in clinical ophthalmology, is proposed: a number of rod pathologies would be promoted by impairment of energy supply and/or oxidative stress in the rod outer segment. In conclusion we suppose that the damaging role of oxygen, be it hypoxia or hyperoxia invoked in most of the blinding diseases, acquired and even hereditary is to be seeked for inside the photoreceptor outer segment that would conceal a potential for cell death that is still to be recognized.

Oligomerization studies of Leuconostoc mesenteroides G6PD activity after SDS-PAGE and blotting.

Glucose-6-phosphate 1 dehydrogenase (G6PD) is a ubiquitous enzyme catalyzing the oxidation of D-glucose 6-phosphate to D-glucono-lactone 6-phosphate, in the first step of the pentose phosphate pathway. Based on the currently available structural information on Leuconostoc mesenteroides G6PD, it is believed that the enzyme only works as a homodimer. Here we show that both after non-denaturing and after denaturing electrophoretic separation (SDS-PAGE) and blotting L. mesenteroides G6PD retains its complete catalytic activity. In the two latter cases the molecular weight of the band corresponded to that of a G6PD monomer. Conversely, when the same technique was applied to G6PD from Saccharomyces cerevisiae, another fermentative organism, the monomer activity was not detectable after SDS-PAGE and blotting. The results are discussed in terms of molecular evolution of the oligomeric state in the various G6PD sources.

[Controversial issues in the Giornale Italiano di Nefrologia: how to treat patients with focal segmental glomerular sclerosis]. / Le contoversie del Giornale Italiano di Nefrologia: come trattare i pazienti con glomerulosclerosi focale segmentaria?

Primary focal segmental glomerular sclerosis (FSGS) commonly presents with nephrotic syndrome. Spontaneous remission is rare and persistent nephrotic syndrome is a marker of poor prognosis. For this reason, obtaining remission using drugs with minimal side effects is desirable. The treatment of FSGS, however, represents a challenge. Not only is there a lack of prospective controlled trials, but FSGS is a syndrome of unknown pathophysiology, generally treated with drugs having a mechanism of action that is poorly understood in this setting, the use of which has often drawn criticism because it is based on empirical assumptions rather than pathogenetic evidence. At present, corticosteroids are the standard first-line approach in patients with idiopathic FSGS. Cytotoxic agents and cyclosporin A constitute a good therapeutic option for steroid-dependent patients or frequent relapsers. Mycophenolate mofetil, rituximab and plasmapheresis should be used as rescue treatment because further studies are required to determine their safety and efficacy. Clearly, real progress in FSGS treatment can only be obtained by research focused on the pathophysiology of this disease, so that a therapeutic approach can be defined that is based on reason rather than chance.

Epiphytic lichens as indicators of environmental quality in Rome.

A synthesis of the studies on lichen diversity carried out in Rome over the period 1982-2003 is presented. In this work, the Lichen Diversity (LD) method has been applied. Besides air pollution, the most important variable affecting the epiphytic lichen flora of Rome, currently updated to 102 taxa, is the influence of the Tyrrhenian Sea. Significant changes in the lichen flora have been noted over the past 20 years, with the lowest diversity now being found in the urban centre and in the eastern and southern sectors, while the "lichen desert" area has decreased in parallel with decreasing concentrations of CO, NO(x) and SO2.

Effects of extremely low frequency electromagnetic fields on membrane-associated enzymes.

The effects of extremely low frequency electromagnetic fields of 75 Hz were studied on different membrane-associated enzymes. Only the activities of three enzymes out of seven exposed to the field decreased approximately of about 54-61% with field amplitudes above a threshold of 73-151 microT depending on the enzyme. The same field had no effect on the activities of either integral membrane enzymes such as Ca,ATPase, Na/K,ATPase, and succinic dehydrogenase or peripheral membrane enzymes such as photoreceptor PDE. The decrease in enzymatic activity of the field-sensitive enzymes was independent of the time of permanence in the field and was completely reversible. When these enzymes were solubilized with Triton, no effect of the field was obtained on the enzymatic activity, suggesting the crucial role of the membrane in determining the conditions for enzyme inactivation. The role of the particular linkage of the field-sensitive enzymes to the membranes is also discussed.

Effects of extremely low frequency electromagnetic fields on the adenylate kinase activity of rod outer segment of bovine retina.

Extremely low frequency electromagnetic fields (ELF-EMFs) of 75 Hz with amplitudes above a threshold of about 125 microT have a dramatic effect on the adenylate kinase (AK) activity of the rod outer segment (ROS) membranes. In fact, the ATP production by ROS membranes or by purified disk membranes placed in the field decreased by approximately 54%. The decrease in enzymatic activity was independent of the time of exposure to the field and was completely reversible. When disk membranes were solubilized with Triton or a soluble isoform of AK was used, negligible effects of the field were obtained on the enzymatic activity, suggesting that the membrane has an important role in determining the conditions for the enzyme inactivation.

Electromagnetic field of extremely low frequency decreased adenylate kinase activity in retinal rod outer segment membranes.

Adenylate kinase activity in rod outer segment membranes of bovine retina decreased of about 55% when exposed to an extremely low frequency electromagnetic field of 75 Hz and 250 microT. The effect was independent of the time of permanence in the field. Negligible effects of the field were found on the enzymatic activity of a soluble isoform of adenylate kinase or of rod outer segment membranes solubilized with Triton, suggesting the importance of the membrane in determining the conditions of the enzyme inactivation.

Development of an AFLP-based linkage map and localization of QTLs for seed fatty acid content in condiment mustard (Brassica juncea).

A genetic linkage map of Brassica juncea based on AFLP and RAPD markers was constructed using 131 F1-derived doubled-haploid (DH) plants from a cross between two mustard lines. The map included 273 markers (264 AFLP, 9 RAPD) arranged on 18 linkage groups, and covered a total genetic distance of 1641 cM; 18.3% of the AFLP markers showed a segregation distortion (P < 0.01). The markers with biased segregation were clustered on seven linkage groups. QTLs for oil contents, palmitic acid (16:0), stearic acid (18:0), oleic acid (18:1), linoleic acid (18:2), linolenic acid (18:3), eicosenoic acid (20:1), and erucic acid (22:1), were mapped on the AFLP linkage map. Correlation studies among fatty acids in the DH population and the localization of QTLs involved in their control indicated that a major gene located on linkage group (LG) 2 controlled the elongation step of erucic acid.

Medicines for children licensed by the European Agency for the Evaluation of Medicinal Products.

OBJECTIVE: . The aim of this study was to evaluate the number and the characteristics of medicines approved for children in Europe by the European Agency for the Evaluation of Medicinal Products (EMEA) and whether the paediatric studies supporting the authorisation were in accordance with the Note for Guidance on the Clinical Investigation of Medicinal Products in children (CPMP/ICH/2711/99). We also considered any possible difference between the EMEA and the Food and Drug Administration (FDA) paediatric medicines evaluations. METHODS: . We examined the drugs authorised by the EMEA through the centralised procedure from January 1995 to September 2001 deriving information from the "European Medicines - Database" (EMD) set up in 1998 by the Italian Group for Pharmacoeconomic Studies (GISF) and sponsored by the Italian Ministry of Health. The analysis of paediatric data has been managed by experts belonging to the Clinical Pharmacology Working Group of the Italian Paediatric Society. The following parameters were assessed: active substance, year of approval, anatomical therapeutic and chemical (ATC) code, therapeutic indications, age for which the drug is authorised, interest to children and paediatric studies supporting a paediatric authorisation. European Public Assessment Reports (EPARs) were considered as reference sources. RESULTS: . The median percentage of drugs authorised for children from 1995 to 2001 (September) is 35% of the total of commercially available drugs; only 16 medicines have been approved for children under 2 years of age (11%), ten of these being vaccines. Medicines for children shared out 9 ATC classes, 24 belonging to the J- (anti-infective agents) -ATC class. Thirty-nine medicines were authorised on the basis of at least one clinical trial (27 phase III, 6 phase II, 6 phase I) while eight active substances have been licensed without any paediatric investigation. CONCLUSIONS: . Under the EMEA centralised procedure, several active substances have been licensed for children. Consequently serious and life-threatening diseases as AIDS and diabetes are now treatable, in a legal framework overcoming the orphan status of the past years. Despite the reported encouraging results, the number of drugs devoted to children remain low and important ATC classes, as L-(oncology) or N-(neurology), are still 'orphans' of innovative medicines. At the same time few medicinal products are specifically studied in children. Consequently, more efforts have to be made to increase the number of drugs assessed and licensed for the paediatric population, and manufacturers should be required to supply data on the effects of new drugs in children when the products are expected to offer a benefit over existing therapies.