Non-pegylated liposomal doxorubicin plus cyclophosphamide as first-line therapy in elderly women with HER2 negative metastatic breast cancer.

Background: The use of anthracyclines in metastatic breast cancer (MBC) is limited by cumulative dose-dependent cardiotoxicity mostly in elderly women with comorbidities. The aim of this observational retrospective study was to evaluate the efficacy of non-pegylated liposomal doxorubicin (Myocet®) and cyclophosphamide in elderly women as HER2 negative first-line MBC treatment. Methods: 84 elderly women >70 years of age (median age 78 years) with MBC HER2 negative were enrolled. Performance Status in 58 patients was ECOG-0 and in 26 patients was ECOG-1. Results: The drug was well tolerated, with overall response rates were >40%, median overall survival was 16.2 months (95%CI:14.6-18.8) and median progression free survival was 5.8 months (95%CI:4.4-8.6). Hematologic toxicity with neutropenia was the most frequent adverse event, but the treatment was well tolerated maintained a manageable cardiotoxicity. Conclusion: Non-pegylated liposomal doxorubicin may represent a valid therapeutic option in first-line for elderly patients with HER/2 negative MBC improving survival, anti-tumor response rate and de-creases cardiotoxicity.

Tumour cell population growth inhibition and cell death induction of functionalized 6-aminoquinolone derivatives.

OBJECTIVES: A number of previous studies has provided evidence that the well-known anti-bacterial quinolones may have potential as anti-cancer drugs. The aim of this study was to evaluate potential anti-tumour activity and selectivity of a set of 6-aminoquinolones showing some chemical similarity to naphthyridone derivative CX-5461, recently described as innovative anti-cancer agent. MATERIALS AND METHODS: In-house quinolones 1-8 and ad hoc synthesized derivatives 9-13 were tested on Michigan Cancer Foundation-7 (MCF-7) breast cancer cells and mesenchymal progenitor (MePR2B) cell lines, analysing their effects on the cell cycle and cell death using FACS methodology. Activation of p53 was evaluated by western blotting. RESULTS: Benzyl esters 4, 5 and their amide counterparts 12, 13 drastically modulated MCF-7 cell cycles inducing DNA fragmentation and cell death, thus proving to be potential anti-tumour compounds. When assayed in non-tumour MePR2B cells, compounds 4 and 5 were cytotoxic while 12 and 13 had a certain degree of selectivity, with compound 12 emerging as the most promising. Western blot analysis revealed that severe p53-K382ac activation was promoted by benzylester 5. In contrast, amide 12 exerted only a moderate effect which was, however, comparable to that of suberoylanilide hydoxamic acid (SAHA). CONCLUSIONS: Taken together, these results further reinforce evidence that quinolones have potential as anti-cancer agents. Future work will be focused on understanding compound 12 mechanisms of action, and to obtain more potent and selective compounds.

Second order root control of self-ligating brackets and traditional brackets: a "typodont" study.

AIM: Aim of the study was to evaluate if self-ligating brackets (SLB) and conventional brackets (CB) have the same degree of second order root control in closing extraction spaces. METHODS: Two resin models, left and right sides of an upper arch, with two wells in the premolar area, were used. Wells have been filled with wax and resin premolars with anatomic root structure were placed in them. Resin premolars were bonded with CB and SLB. We performed 20 pairwise runs: CB on one side against SLB on the other side. We tested 0.018 and 0.016x0.022 stainless steel arches. Models were put in warm water to allow teeth to move in the softened wax by the force excerpted by NiTi coils. Root control in the second order was evaluated with the aid of metallic markers on the roots and digital radiographies taken before and after each run. RESULTS: On 0.018 wires CB moved 4.0 mm (SD 1.06 mm), mean root control angle was 14.8° (SD 9.15°), while SLB moved 4.1 mm (SD 1.33 mm), mean angle in the second order was 11.8° (SD 5.01°). On 0.016x0.022 wires CB moved 3.6 mm (SD 1.24 mm), mean angle in the second order was 9.7° (SD 5.48°) while SLB moved 3.4 mm (SD 1.05 mm), mean angle was 10.7° (SD 3.92°). CONCLUSION: It seems that, on typodont, CB and SLB are equally efficient in moving teeth crowns and have the same degree of second order root control, both when 0.018 and 0.016x0.022 stainless steel wires are used.

Diagnosis of dental and mandibular asymmetries in children according to Levandoski Panoramic Analysis.

AIM: The purpose of this study was to evaluate the use of the Levandoski Panoramic Analysis in the diagnosis of dental and mandibular asymmetries and its contribution to clinical patient's evaluation and treatment planning. MATERIALS AND METHODS: Thirty-one randomly selected panoramic radiographs of children from 7 to 14 year old were analysed using 10 linear measurements. Right and left values were compared with Student's paired T tests. For each value, mean and standard deviation were computed separately for each side. RESULTS: Statistics. A dominance for the left side over the right side was observed. The data obtained were not statistically significant with the exception of maxillary length: the right side length of the maxilla was shorter (p<0.05) compared to the left side. CONCLUSIONS: Levandosky Panoramic Analisys represents a useful screening method in the diagnosis of dental and mandibular asymmetries.

Premature loss of maxillary primary incisor and delayed eruption of its successor: report of a case.

BACKGROUND: Traumatic injuries to primary teeth represent one of the most common aetiologic factors of time-related eruption disturbances of permanent teeth. These include premature eruption, delayed eruption or impactions. CASE REPORT: A case of a 7.5-year-old male with delayed eruption of the maxillary permanent left incisor is presented. The case history revealed a trauma around the age of 3 involving its primary tooth predecessor and its extraction by a dentist about one year later due to frequent abscesses. The clinical examination showed an early mixed dentition and the single presence of tooth 11 in the dental arch, with an obvious aesthetic problem that affected the child's self image. The periapical x-ray ruled out any dimorphism on the impacted tooth, and it showed a root developed by two thirds. About 2 months after the examination, a simple gingivectomy was carried out, and the tooth could erupt completely 3 months later without any need for orthodontic traction. One year after surgery, a complete root development could be observed, as well as the presence of the lateral incisors with a moderate crowding.

A "typodont" study of rate of orthodontic space closure: self-ligating systems vs. conventional systems.

AIM: The aim of this study was to compare the effectiveness of space closure of two bracket systems, self-ligating and conventional ones, considering two systems with the same design and prescription. The experimental model of this study aims to identify in general if one type of system is more suitable for planning the extractive therapy, without considering the clinical aspect necessary for an adequate orthodontic approach. METHODS: A resin maxilla without the first premolars was used to test the self-ligating and conventional brackets system. Space closure was achieved on 0.016x0.022" in stainless steel wires with nickel-titanium coil springs 150 grams in strength and 10 mm in length. Two experiment settings have been prepared. The first setting was made bonding conventional bracket on the right side and self-ligating on the left; the last one was made bonding self-ligating bracket on the right side and conventional on the left. All measurements (runs) have been repeated seven times for both settings. RESULTS: During the closing phase of extraction spaces both systems are equable since there are no significant statistical differences (P=0.70). CONCLUSION: Our typodont model showed no significant difference in the efficiency of space closure between the self-ligating bracket and conventional bracket tied with stainless steel ligatures.

Sports-related dental injuries: knowledge of first aid and mouthguard use in a sample of Italian children and youngsters.

AIM: The purpose of this study was to evaluate the awareness of sports as risk factor of dental injuries, the emergency management when a tooth avulsion occurs and the compliance about mouthguards. MATERIALS AND METHODS: Two hundred children and youngsters 8- to 15-year-old (147 boys and 53 girls) attending Sports Societies in Isernia, a town in Southern Italy, participated to the investigation. The sports involved were soccer, martial arts, tennis, swimming, volleyball, basketball and cycling. The questionnaire was structured into three parts: 1) questions about age, sex, type and time of sports practice; 2) questions about dental injuries, particularly personal experience, awareness of first aid and procedure about tooth avulsion; 3) questions about knowledge and use of mouthguards. RESULTS: Sixty-five per cent of the athletes were aware of the possibility of oral injuries during sports practice and 8.5% referred an experience of dental trauma; 71.5% of the participants think that the immediate management of dental injuries by a dentist is very important to increase the rate of success; 31% know that the avulsed tooth may be reimplanted: 33.9% would reimplant the tooth within an hour and 62.9% would keep it in a wet storage medium. Finally, 80.5% of the athletes knew about mouthguards as protective devices, but only 5% actually used them; eight out of ten were provided by the dentist. CONCLUSION: Educational programs organized by the sports dentistry community are needed to inform coaches, teachers, athletes and parents about dental injuries and to promote the mouthguards use, especially in contact sports practice.

Comparative evaluation of the group of teeth with the best prediction value in the mixed dentition analysis.

AIM: Mixed dentition analysis allows the prediction of the tooth width of non erupted permanent canines and premolars (SPCP). It is an essential factor in treatment planning since it could predict a tooth-size to arch-length discrepancy. The aim of this study was to determine which group of permanent teeth presented the best prediction capability for the width sums of the unerupted canine and premolars in an Italian sample. MATERIALS AND METHODS: A total of 150 subjects with complete permanent dentition were selected. Their dental casts were measured to 0.01 mm with a digital caliper. Pearson correlation and T-test were used for the statistical analysis. RESULTS/STATISTICS: The combination of the sums of the four lower incisors and the first upper molars showed the best prediction capability for the SPCP in the Italian sample. Moreover new regression equations were formulated including sex and arch as additional predictor variables. In 80% of the cases estimated differences between the predicted and the actual values were smaller than 1 mm. CONCLUSION: It can be concluded that the new regression equations proposed seemed to show good accuracy.

Impaired endothelium-dependent vascular reactivity in patients with familial combined hyperlipidaemia.

BACKGROUND: Familial combined hyperlipidaemia (FCHL) is associated with a markedly increased risk of premature coronary artery disease. This study was designed to evaluate whether preclinical atherosclerotic functional abnormalities are detectable in the arteries of patients with FCHL. METHODS: 60 subjects were recruited for the study: 30 probands of families with FCHL (mean (standard deviation (SD)) age 48 (10) years, 77% men), defined by fasting total plasma cholesterol or triglyceride concentration >250 mg/dl (>6.5 mmol/l cholesterol, >2.8 mmol/l triglyceride) and by the occurrence of multiple lipoprotein phenotypes within a family, and 30 age-matched and sex-matched healthy controls. All subjects underwent high-resolution B-mode ultrasound examination and the brachial arterial reactivity, a marker of endothelial function, was measured by a semiautomated computerised program. Lipid profile, resting blood pressure, body mass index (BMI), smoking status, insulin and homocysteine levels were also determined. RESULTS: Compared with controls, patients with FCHL had significantly higher BMI, diastolic blood pressure and insulin levels. No difference was observed in baseline brachial diameter between the two groups (mean (SD) 3.45 (0.51) mm for FCHL v 3.60 (0.63) mm for controls; p = 0.17). In response to flow increase, the arteries of the controls dilated (mean (SD) 8.9% (4.9%), range 2.3-20.8%), whereas in the patients with FCHL, brachial arterial reactivity was significantly impaired (5.5% (2.5%), range 0-10.1%; p = 0.002). In multivariate linear regression analysis, apolipoprotein B and BMI were independent determinants of brachial artery response to reactive hyperaemia. CONCLUSIONS: The findings of our study suggest that vascular reactivity is impaired in the arteries of patients with FCHL.

Implant repositioning for esthetic reasons: a clinical report.

This article describes the correction of an unesthetic implant position that resulted from unexpected postpubertal growth. Surgical implant repositioning, a technique similar to single-tooth osteotomies, was used. The implant and surrounding bone were mobilized, and a green stick fracture was made on the buccal plate. With pivoting on the buccal plate, the implant was moved to a more palatal position and restored. Although some degree of asymmetry could still be detected, a satisfactory esthetic result was achieved.

[Efficacy of and tolerance to topical ketoprofen lysinate solution in acute inflammation of the mouth in orthodontic therapy. Randomized single blind study, with parallel groups, versus benzidamine hydrochloride]. / Efficacia e tollerabilità nel ketoprofene sale di lisina ad uso topico nelle flogosi acute del cavo orale in corso di terapia ortognatodontica. Studio randomizzato, in singolo cieco, per gruppi paralleli verso benzidamina cloridrato.

BACKGROUND: The study was carried out to value the analgesic efficacy of ketoprofen lysinate solution administered by oral route. Ketoprofen lysinate solution is an efficacious topical drug for pain relief and control of inflammation agents. METHODS: The study was carried out in 120 patients submitted to orthodotic therapy by oral route, under single blind conditions at the "San Raffaele" Hospital in Milan. The 120 patients who underwent orthodonthic therapy were males and females, from 18 to 40 years old. One group was treated with ketoprofen lysinate solution at the doses of 160 mg in 100 ml (60 patients), the other group with benzidamine hydrochloride 15 ml (60 patients), twice a day for seven days. Pain relief and control of inflammation agents have been evaluated. RESULTS: The study showed ketoprofen lysinate solution to be very effective for pain relief and control of inflammation agents. In fact, on the basis of the visual analogue scale of Scott-Huskisson and of the patient's judgement, ketoprofen proved significantly better than benzidamine. CONCLUSIONS: The analgesic efficacy of ketoprofen lysinate solution administered by oral route was prompt and long lasting than benzidamine. Both treatments were very well tolerated.

[Etiopathogenic, clinical-diagnostic and therapeutic aspects of the burning mouth syndrome. Research and treatment protocols in a patient group]. / Aspetti eziopatogenetici, clinico-diagnostici e terapeutici della sindrome della bocca bruciante. Protocolli di ricerca e cura su un gruppo di pazienti.

BACKGROUND: Burning mouth syndrome (BMS) is a frequently seen pathology characterised by burning tongue and oral pain without macroscopic structural lesions to the mucose. BMS etiopathology isn't known and therapy is merely empirical and unsatisfactory. METHODS: To evaluate the hypothesis that this syndrome would originate by a small diameter peripheral neuropathy combined to a mucosal trophic lesion, 37 patients, (7 male, 30 female, between 36 and 79 years, mean 54 years) affected by BMS, consecutively observed in our dispensary were submitted to a series of examinations and to therapeutical approach used in neuropathic painful syndromes. All patients were submitted to a complete stomatological exam and X-ray pantomography to exclude mucosal macroscopical lesions and dentistry illnesses. All patients executed sierological exams (glycemia, etc.), neurological exam, tongue and foot dorsum quantitative sensory examination, tongue and face telethermography. A few patients (3 male, 10 female; age 34 to 53, mean 49) were submitted to mucosal tongue biopsy, analyzed by optic microscopy and immunofluorescency following treatment with anticytoplasmatic neuronal proteins antibodies (protein gene product 9.5). RESULTS: These examinations showed subclinical polyneuropathy in 50% of patients. In particular, a loss of function in small diameter nervous fibres in about 50% of patients was observed. Histological examination of tongue mucose revealed a moderate atrophy in 70% patients. CONCLUSIONS: All patients were submitted to an antalgic therapy, with non-antiflammatory drugs used in neuropathic painful syndromes (quercetine, antiepileptic drugs benzodyazepinein and gabaergic, topical application of capsaicine solutions).

[Atrophy of the oro-pharyngeal mucosa caused by vitamin B12 and folic acid deficiency. Etiopathologic aspects and clinico-therapeutic problems]. / Atrofia delle mucose oro-faringee da carenza di vitamina B12 ed acido folico. Aspetti eziopatogenetici e problematiche clinico-terapeutiche.

BACKGROUND: By atrophy, the decrease in volume of the cell due to loss of cell substances is intended. When a sufficiently high number of cells is involved, the whole tissue or organ decreases in volume or becomes atrophic. The oropharyngeal mucous membrane can be the site of processes of mainly atrophic type whose causes can be found in various pathologies. These pathologies can be caused by alterations in the endocrin-metabolic conditions, such as vitamin deficiencies, especially of vitamin B12 and folic acid. MATERIALS AND METHODS: Twenty-three patients who on objective examination were affected by mucous atrophies, both of the oral cavity and of the oropharyngeal area probably due to vitamin B12 and/or folic acid deficiency have been identified. Indicatively the therapies prescribed consisted of administration of N5calcium methyltetrahydrofolate for 1 month, and of pharmaceutical products containing vitamin B12, again for 1 month. After a month of therapy, the overall clinical situation of all the patients who were included in our protocol was reassessed. RESULTS AND CONCLUSIONS: On clinical examination, 20 patient showed pink oral mucous membrane. The patients also reported disappearance of pyrotic symptoms and the laboratory tests showed values within normal limits. The erethistic ulcers on the lips had disappeared even if the vermilion did not appear fully re-epithelialized in 9 patients. The other 3 patients, who still had values under normal limits, were subjects who had undergone long-term chemotherapy. For these patients the therapy was continued for a further month. At the third check-up and careful objective examination, the lingual mucous membrane appeared pink and re-epitheliated. The patients reported disappearance of the painful oral symptoms. The laboratory tests were repeated again for all the patients and these confirmed values within normal limits for vitamin B12 and folic acid.

[Sucralfate in odontostomatology. Clinical experience]. / Il sucralfato in odontostomatologia. Nostra esperienza clinica.

BACKGROUND: We here describe the pharmacological and pharmacodynamic characteristics of the molecule sucralfate, the aluminum subsalt of sucrose-8-sulphate, introduced in Japan in 1968 as a mucoprotector for the treatment of peptic ulcers. For many years, attempts have been made to broaden the therapeutic indications of this molecule as has happened in oral medicine. This paper describes the results of the clinical trials reported in the international literature which were designed to investigate the use of sucralfate in the treatment of mucositis secondary to radio- and/or chemotherapy and during the course of recurrent aphtous stomatitis (RAS). METHODS: The authors carried out a pilot study with the aim of testing the efficacy and the tolerability of two formulations of sucralfate (20% suspension and 1 gram chewable tablets) in a total of 28 patients [14 with RAS: group A; and 14 with burning mouth syndrome (BMS): group B]. Each group was further divided into two subgroups [A1, A2, B1, B2] of 7 patients each. RESULTS: The results obtained in the RAS patients were encouraging, with an improvement in symptomatology in respectively 71.4% and 42.8% of the patients in subgroups A1 and A2; a number of authors have previously suggested that this is due to a primarily mucoprotective mechanism similar to that occurring in patients with peptic ulcer. The results were less favourable in the BMS patients: symptoms improved in respectively 42.8% and 28.6% of the patients in subgroups B1 and B2, but worsened in 28.6% and 28.6% in teh same subgroups. CONCLUSIONS: In conclusion we believe that sucralfate can be considered a valid therapeutic support in the context of the lenitive pharmacological protocols in which it is currently used, but our results do not allow a definitive judgement of its efficacy in patients with BMS.

Treatment of dehiscences and fenestrations around dental implants using resorbable and nonresorbable membranes associated with bone autografts: a comparative clinical study.

This study was carried out to evaluate the efficacy of poly(lactic acid) and poly(glycolic acid) (PLA/PGA) resorbable membranes in conjunction with autogenous bone grafts when used for the treatment of implant dehiscences and/or fenestrations. Nine patients with a total of 18 implants participated. Nine implants were associated with dehiscences, and 9 with fenestrations; 16 implants were in the maxilla, and 2 in the mandible. Nine defects were treated with PLA/PGA membranes (test group), and the nine were treated with expanded polytetrafluoroethylene (e-PTFE) membranes (control group). Second-stage surgery was performed after 6 to 7 months of healing. Overall results of the regenerative therapy of the 18 defects showed a highly significant (P < .001) defect reduction, with a 93.38% (SD = 15.88) bone fill. A slightly higher percentage of bone fill was found in the e-PTFE group (98.20%) than in the PLA/PGA group (88.56%), but the difference was not statistically significant (P = .207). This study demonstrated that resorbable PLA/PGA membranes can be equally effective as e-PTFE in the treatment of implant dehiscences and fenestrations when associated with autogenous bone chips.

Bacterial penetration through Resolut resorbable membrane in vitro. An histological and scanning electron microscopic study.

The aim of this study was to evaluate the characteristics of resorption and the pattern of bacterial collonisation of polyglycolic and polylactic resorbable membranes under controlled experimental conditions. A removable cobalt-chromium device was applied to the lower jaw of 5 students for a period of 4 weeks. 8 composite resin chambers were glued to the device, 4 on each side of the mouth. A small piece of PLA/PGA membrane separated the composite chambers into 2 parts. The subjects wore the devices 24 h a day, except for the time necessary for oral hygiene procedures, during which time, the structure was submerged in a 0.2% chlorexidine solution. Every week, 2 of the chambers were removed; one was processed for scanning electron microscopy, to be observed both on the external and internal surface, and the other one for light microscopy examination. Both the electron microscopic and histologic observations showed a progressive increase in the plaque layer on the external surface of the membrane during the period of observation. The light microscopy showed an early invasion of the membrane, starting about 1 week after the exposure. On all the 3- and 4-week specimens, a complete bacterial invasion over the whole thickness of the membrane was visible. After 3 weeks of plaque accumulation, bacterial colonisation of the inner portion of the membrane was detectable in all the specimens. At 3-weeks, we observed in the light microscopy group in 4 out of 5 specimens, a large reduction of the thickness of the material and small voids in the membrane structure. In 1 specimen, the membrane was no more detectable. Only in 5 specimens of the 4-week group was the membrane still recognizable, though reduced to fragments. In conclusion, once exposed to the oral cavity, the PLA/PGA membranes start to resorb in the early stages: this process concludes itself between the 3rd and 4th weeks of exposure. However, the particular conditions of the experimental design nevertheless classify this study as an in vitro, more than as an in vivo experimentation.

[Oral cavity diseases in HIV and AIDS infections. Clinical, preventive and therapeutic aspects]. / Malattie del cavo orale in corso di infezione da HIV e AIDS. Aspetti clinici, preventivi e terapeutici.

Few people with HIV infection fail to experience oral opportunistic lesions during the course of their disease. These are several oral mucosa and salivary gland manifestations that were not seen before the AIDS epidemic, while others are more severe in this population. Oral lesions reflect HIV status and the stage of immunosuppression are important clinical elements in HIV staging and classification schemes: these elements raise pertinent questions about mucosal aspects of immunosuppression and provide therapeutic challenges. Their pervasive nature and biological significance emphasize the importance of a careful oral examination as part of the general clinical evaluation. Prevention and treatment of oral diseases are required to maintain and improve the lifestyle of the patients infected with HIV. Odontoiatric and stomatologic managements require a team approach and a close collaboration with the appropriate responsible physicians and other health care workers are necessary.

Assessing the efficacy of three dentifrices in the treatment of dentinal hypersensitivity.

A multicenter clinical trial conducted by the authors compared the desensitizing efficacy of a new 5 percent potassium nitrate: 0.243 percent sodium fluoride dentifrice along with two clinically proven, commercially available desensitizing dentifrices to a placebo dentifrice. Sensitivity to cold air and tactile stimulation, along with patients' subjective assessments, were evaluated to assess the dentinal desensitizing efficacy of the test dentifrices. Results demonstrated that after four weeks, participants who used the new dentifrice formulation experienced significant decreases in dentinal sensitivity compared to the placebo group for all measured indexes.

[HIV infection. The risks for health providers and prevention and control measures]. / Infezione da HIV. Rischi per gli operatori sanitari, misure preventive e di controllo.

The odontostomathologist and the dentist expose themselves to pathogenic agents present in the oral cavity. Taking in consideration at the present time the increasing number of seropositive patients, HIV infection and its pathogenic manifestations are of great interest. Considering that the main transmission of the virus is the ematic, the professional men who practise dentistry and the oral hygiene represent a particular risky class. For this reason they must adopt a series of preventive measures to protect themselves, their collaborators and the patient himself too.

[Confronting AIDS. Prevention programs and therapeutic strategies]. / Affrontare l'AIDS. Programmi di prevenzione e strategie terapeutiche.

HIV pathology and AIDS patterns represent a topical and serious reality. Now AIDS syndrome affects many types of population all ever the world. These types have different epidemiologic ratings according to the localization of the countries (3rd world or developed areas). Global Programme on AIDS (GPA) had a rapid development from its beginning (February 1987) with the aid of more than 150 national programs; in fact a lot of countries have developed and applied their own AIDS projects. OMS helped these programs giving indications and informative material about: promotion of health, check-up of HIV infections, prevention, epidemiologic control, services for laboratory and transfusion centres, treatment in general and counselling activities. Therefore it is very important to integrate medical activities and every intervention on AIDS in every sanitary and social service. To fight this dramatic reality, we must operate on two fronts: the first is the prevention and the second is the correct diagnostic and therapeutic approach. These are the purposes of medicine in general and odontostomatology in particular.