Investigating cortical excitability and inhibition in patients with schizophrenia: A TMS-EEG study.

BACKGROUND: Transcranial magnetic stimulation (TMS) combined with electromyography (EMG) has widely been used as a non-invasive brain stimulation tool to assess excitation/inhibition (E/I) balance. E/I imbalance is a putative mechanism underlying symptoms in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a detailed examination of cortical excitability to assess the pathophysiology of schizophrenia. This study aimed to investigate differences in TMS-evoked potentials (TEPs), TMS-related spectral perturbations (TRSP) and intertrial coherence (ITC) between patients with schizophrenia and healthy controls. MATERIALS AND METHODS: TMS was applied over the motor cortex during EEG recording. Differences in TEPs, TRSP and ITC between the patient and healthy subjects were analysed for all electrodes at each time point, by applying multiple independent sample t-tests with a cluster-based permutation analysis to correct for multiple comparisons. RESULTS: Patients demonstrated significantly reduced amplitudes of early and late TEP components compared to healthy controls. Patients also showed a significant reduction of early delta (50-160 ms) and theta TRSP (30-250ms),followed by a reduction in alpha and beta suppression (220-560 ms; 190-420 ms). Patients showed a reduction of both early (50-110 ms) gamma increase and later (180-230 ms) gamma suppression. Finally, the ITC was significantly lower in patients in the alpha band, from 30 to 260 ms. CONCLUSION: Our findings support the putative role of impaired GABA-receptor mediated inhibition in schizophrenia impacting excitatory neurotransmission. Further studies can usefully elucidate mechanisms underlying specific symptoms clusters using TMS-EEG biometrics.

Child abuse and neglect: oral and dental signs and the role of the dentist.

Historically, the law, dental and forensic literature has included numerous articles concerning abused children. The orofacial structures are injured frequently in the maltreated child. Injuries of the neck, head, face, and oral cavity represent the most affected areas of the victim's body that routinely sustain physical trauma in child maltreatment cases. This literature review aimed to report the state of art of child abuse from the point of view of the dentist with focus on studies in dental aspects of child abuse and neglect of the last ten years. Considering the time slot, 20 papers were included with the following inclusion criteria: papers published in English, all keywords included in the title, articles available on PubMed. Many of the injuries are within the scope of dentistry or easily observed by the dental professional during routine dental treatment, and it is essential that the dentist recognizes them. Concerning neglect, it is appropriate to make a distinction between deliberate parental behavior that has the consequence of unavoidable and voluntary neglect towards their children and those conditions of involuntary carelessness determined by socio-economic and cultural factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health. Therefore, it is relevant that the dentist pays attention to the cases to report and those that only need help.

Reverse engineering in forensic investigations: a new approach to bite mark analysis.

The study of bite marks provides crucial elements that contribute towards identifying the biter. In many cases, it assumes importance when bite marks are detected on the body of a victim of violence, but it could also be relevant when the bite marks are seen on food substances at the crime scene. In both circumstances, comparing the bite marks with a suspect's dentition can be decisive in confirming or excluding the culpability. In this case report, a bun (bread roll) with the sign of a bite was found at the crime scene. We report a pilot study using 3D reproduction of the bite mark on the bun and dental models of the alleged biter and the victim. A reverse engineering process was used to obtain digital 3D models of the bitten bun and the dental models by taking numerous photographs and stitching them together using a software called Metashape by Agisoft. The last step was to compare the bitemark to the two dental models, evaluating the spatial distance, the degree of overlap, and the degree of interpenetration. The results confirmed the usefulness of reverse engineering in forensic investigations showing the compatibility between the victim's teeth and the bite mark on the bun.

Facial approximation for identification purposes: soft tissue thickness in a Caucasian population. Sex and age-related variations.

The aim of this study was to collect soft tissue thickness (STT) values of an Italian population from 12 bone landmarks, to improve the facial approximation process for identification purposes. 100 Italian adults (50 males and 50 females), who had undergone head CT for clinical purposes, were analysed in order to expand the database of the Italian population. Average values, standard deviation and range were collected according to gender and age and the obtained values were statistically analysed in order to evaluate any possible significant difference. Only one landmark was statistically significant associated with sex, females showed significantly higher values for para-zygomaxillary. Two landmarks were statistically significant associated with age, upper incisor and pogonion. The obtained results were compared with the existing literature. Such information can be useful in the forensic craniofacial reconstruction process and can facilitate choosing the most suitable STT values according to osteological analysis of the human remains.

Spontaneous and TMS-related EEG changes as new biomarkers to measure anti-epileptic drug effects.

Robust biomarkers for anti-epileptic drugs (AEDs) activity in the human brain are essential to increase the probability of successful drug development. The frequency analysis of electroencephalographic (EEG) activity, either spontaneous or evoked by transcranial magnetic stimulation (TMS-EEG) can provide cortical readouts for AEDs. However, a systematic evaluation of the effect of AEDs on spontaneous oscillations and TMS-related spectral perturbation (TRSP) has not yet been provided. We studied the effects of Lamotrigine, Levetiracetam, and of a novel potassium channel opener (XEN1101) in two groups of healthy volunteers. Levetiracetam suppressed TRSP theta, alpha and beta power, whereas Lamotrigine decreased delta and theta but increased the alpha power. Finally, XEN1101 decreased TRSP delta, theta, alpha and beta power. Resting-state EEG showed a decrease of theta band power after Lamotrigine intake. Levetiracetam increased theta, beta and gamma power, while XEN1101 produced an increase of delta, theta, beta and gamma power. Spontaneous and TMS-related cortical oscillations represent a powerful tool to characterize the effect of AEDs on in vivo brain activity. Spectral fingerprints of specific AEDs should be further investigated to provide robust and objective biomarkers of biological effect in human clinical trials.

Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections.

INTRODUCTION: Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS: We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS: Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS: DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.

Age estimation from dry bone measurements: evidence from a sample of soldiers exiled in two concentration camps in Bari.

The mandible undergoes remodelling and morphological alterations throughout the life of an individual, and it is subjected to sex- and age-related structural changes. Personal identification from skeletal remains represents one of the most difficult challenges for a forensic anthropologist. The study of mandibular morphology is an important aid in determining the sex and age of skeletal remains. The objective of this study was to evaluate the age-related changes of three mandibular dimensions through dry bone measurements: bigonial width, ramus height and gonial angle. A total of 93 skeletal remains were included in this study, from a group of soldiers of Yugoslav origin who lived in two concentration camps in Bari (southern Italy) during World War II. These are included in the collection of the Forensic Anthropology Laboratory of the Institute of Forensic Medicine of Bari. The measurements were recorded after comprehensive examination by a forensic anthropologist and a forensic odonto-stomatologist. The data obtained were analysed statistically using a bivariate test and a multivariate linear regression model, using the Statal 13MP software. The results indicate that the bigonial width and gonial angle vary significantly according to age. In conclusion, this study confirms that the mandible is useful for age estimation in the identification of skeletal remains using these specific mandibular measurements when performed on dry bone without radiological distortion.

Bilberry pomace in rabbit nutrition: effects on growth performance, apparent digestibility, caecal traits, bacterial community and antioxidant status.

Agricultural by-products could be used as alternative raw materials in rabbit nutrition as they have been found to be highly nutritious and low cost feeding sources. The aim of this study was to estimate the nutritive value and potential use of bilberry pomace (BP) for growing rabbits. A total of 144 Grimaud rabbits (35 days old) were allotted to four groups and fed with a diet containing increasing level of BP: BP0 (basal diet), BP5, BP10 and BP15 containing 0, 50, 100 and 150 g/kg respectively. Growth trial lasted 48 days; apparent digestibility was evaluated, starting at 46 days of age, over 4 consecutive days. The nutritive value of BP was measured using the mean digestibility of the experimental diets. At 83 days of age, rabbits were slaughtered: blood, and liver and kidney samples were collected in order to determine the blood parameters and the antioxidant enzyme activities of the tissues. Moreover, caecal content was sampled and gut microbiota assessed by means of amplicon-based high-throughput 16S rRNA sequencing and PCR-denaturing gradient gel electrophoresis. The digestible protein was estimated to 104 g/kg of DM while digestible energy to 9.44 MJ/kg DM for incorporation rate up to 150 g/kg. During the finishing period, average daily feed intake and feed conversion ratio showed linear response to BP increase (P=0.008 and <0.001, respectively). During all the period, both parameters decreased linearly and quadratically with increasing BP inclusion levels (P<0.001) up to 100 g/kg of BP. A significant effect of the antioxidant status was found in the kidneys and liver (P<0.05) where the glutathione peroxidase activity increased as the BP increased. As far as gut microbiota is concerned, BP increased the relative abundance of the Clostridium, Oscillospira, Ruminococcus and Ruminococcaceae species which were clearly associated with the BP inclusion level. In conclusion, BP showed a potential use as an alternative protein and fibre sources for growing rabbits.

Personal identification through digital photo superimposition of dental profile: a pilot study.

The usefulness of teeth for personal identification lies mainly in their vast individual variability, making them virtually unique for every subject. Odontological identification represents a reliable and important complement to forensic inquiries, in particular in the event of unidentifiable human remains. However, this technique is based on the availability of ante-mortem records containing significant evidence. In the absence of dental records, the only available ante-mortem elements are often photographs. In the present study, dental profile photographs of selected smiling subjects were compared to the relevant plaster study models through digital image analysis. In order to ascertain the reliability of the technique, the comparison was carried out both in a homologous and heterologous manner with the Facecomp software. The results confirm the ability of Facecomp software to identify even the smallest variations in dental elements to reach a positive identification. The method is useful in forensic practice since a forensic inquiry may obtain plaster models from cadavers for comparison with photographs of missing people's anterior teeth.

Voluntary termination of pregnancy: An opportunity for Measles, Mumps and Rubella vaccination in an Italian healthcare local unit.

In Italy, the National Plan for the Elimination of Measles and Congenital Rubella 2010-15 suggests offering Measles, Mumps and Rubella (MMR) vaccination to susceptible women who underwent voluntary termination of pregnancy (VTP) In Rome, S. Eugenio Hospital is one of the structures where VTP is practised in an Operative Unit called "Family Planning" The primary goal of this study was to estimate the prevalence of susceptibility to rubella, using IgG and IgM immunoassays, among women accessing VTP and to offering MMR vaccination to susceptible women. Secondarily, this study evaluated acceptance of the vaccination offer From 2013 to 2015, data were collected from 1513 voluntary termination of pregnancy (VTP) cases The results show a significant increase of 5 percent in susceptibility prevalence in the target group from 13.6% in 2013 and 2014 to 18.4% in 2015 The association between rubella susceptibility and age was statistically significant (p<0.01) Throughout the entire period, acceptance of the vaccine proposal was 19% (45/232) among susceptible women; 58% (135/232) refused the vaccine and 23% (52/232) took time to think about it This study shows an increase of 5 percent in the prevalence of rubella susceptibility over two years. This result is worrying, even considering the short span of the data collection The rate of acceptance of vaccination is unsatisfactory considering the possibility of future pregnancies This issue deserves continued action, which, going forward, might transform a "project" into a shared strategy as part of a wider network with the goal of aligning Italy with international recommendations.

A singular case of asphyxia by choking on a handkerchief: accidental event or suicide to "shut-up" spirits.

Choking in adults can prove fatal, despite resuscitation attempts. The manner of death can be natural, homicide or accident. When a death is due to choking, one must consider what conditions contributed to or predisposed the person to choking (eg. alcohol, drugs and physical and mental impairments). Homicidal deaths by choking are relatively uncommon, being more frequently accidental. The diagnosis of death by choking is made at autopsy when the airway is found occluded. If the individual had an occluded airway and the object or food was removed during resuscitation, the only way to make the diagnosis would be on the history. Here, we present a case of asphyxia (accidental or suicidal) by choking on a handkerchief in a patient with a long history of schizophrenia. The woman had attempted a previous suicide driven by evil spirits coming from inside her body, especially from the head and throat; in order to "shut-up" the spirit, she was trying to suffocate it with her hands or by a belt from her pants.

Evaluating the photocatalytic treatment of stevioside by TiO2 in different aqueous matrices and identification of transformation products.

The present study reports the photocatalytic transformation of stevioside, under simulated solar irradiation using TiO2 as a photocatalyst. As a tool of investigating the effect of various aqueous matrices, as well as, the initial stevioside concentration on the variation of the photocatalytic efficiency, a fully nested experimental design was employed. A significant impact on the degradation rate of the sweetener was observed: degradation rate decreases in the order distilled water>river water>lake water, attributed to the increased natural organic matter content of the respective natural water samples. Moreover, the investigation has involved the identification of intermediate compounds, as well as the assessment of mineralization and toxicity evaluation. More than one hundred unknown transformation products, most of them in the form of several isobaric species, were identified. By employing accurate mass determination, we were able to attribute an empirical formula to each species and through MSn analyses we were capable to distinguish several isobaric species. The overall transformation mechanism was assessed and involved the hydroxylation/oxidation of the molecule and the subsequent loss of the glucose units bound to the parent compound.

Iodinated X-ray contrast agents: Photoinduced transformation and monitoring in surface water.

Conventional wastewater treatment methods have shown to be unsuitable for a complete elimination of iodinated X-ray contrast agents (ICMs), which have thus been found in wastewater treatment plant (WWTP) effluent and in surface water. Once in the surface water, they could be transformed through different processes and form several transformation products that may need to be monitored as well. To this end, we studied the abatement and transformation of ICMs by combining laboratory experiments with in field analyses. We irradiated different aqueous solutions of the selected pollutants in the presence of TiO2 as photocatalyst, aimed to promote ICMs degradation and to generate photoinduced transformation products (TPs) similar to those occurring in the environment and effluent wastewater. This experimental strategy has been applied to the study of three ICMs, namely iopromide, iopamidol and diatrizoate. A total of twenty-four, ten, and ten TPs were detected from iopamidol, diatrizoate and iopromide, respectively. The analyses were performed using a liquid chromatography-LTQ-FT-Orbitrap mass spectrometer. The mineralization process and acute toxicity evolution were assessed as well over time and revealed a lack of mineralization for all ICMs and the formation of harmful byproducts. After characterizing these transformation products, WWTP effluent and surface water taken from several branches of the Chicago River were analyzed for ICMs and their TPs. HRMS with MS/MS fragmentation was used as a confirmatory step for proper identification of compounds in water and wastewater samples. All three of ICM were detected in the effluent and surface water samples, while no significant amount of TPs were detected.

The role of direct photolysis and indirect photochemistry in the environmental fate of ethylhexyl methoxy cinnamate (EHMC) in surface waters.

The aquatic environmental fate of ethylhexyl methoxy cinnamate (EHMC), one of the most used UVB filters worldwide, was studied by assessing its environmental persistence and photoinduced transformations. The role of direct and indirect photolysis was evaluated. Direct photolysis was shown to play a key role, and this process is expected to be the main attenuation route of EHMC in sunlit surface waters. In contrast, the reaction with OH radicals would be negligible and that with (3)CDOM* would at most be a secondary process. The measurement of the quantum yield of direct photolysis and of the rate constants of reaction with photogenerated transient species (or, sometimes, the use of reasonable values for the latter) allowed the prediction of the EHMC half-life time in surface waters, by means of a validated photochemical model. The predicted EHMC lifetime is of the order of hours to a few days in fair-weather summertime, and the main factors controlling the EHMC phototransformation in sunlit surface waters would be the water depth and the dissolved organic carbon (DOC) content. The formation of transformation products (TPs) was followed as well via HPLC/HRMS. Three TPs were detected in the samples exposed to UVA radiation, while one additional TP was detected in the samples exposed to UVB radiation. The detected TPs comprised 4-methoxybenzaldehyde, a hydroxylated derivative and dimeric species. Through the use of heterogeneous photocatalysis with TiO2, seven additional TPs were identified, most of them resulting from the further degradation of primary TPs formed through direct photolysis and that might be detected in aquatic systems as well. The photodegradation of EHMC in the presence of TiO2 yielded more toxic TPs than the parent compound (as determined with the Vibrio fischeri Microtox assay). The increased toxicity is partially accounted for by the formation of 4-methoxybenzaldehyde.

Bodies in sequestered and non-sequestered aquatic environments: a comparative taphonomic study using decompositional scoring system.

The study of decomposition by using accumulated degree days (ADDs) has been suggested not only in terrestrial decay but also for water-related deaths. Previous studies have demonstrated that the accumulation of thermal energy as a function of the post-mortem submersion interval (PMSI) can be derived from a descriptive decompositional scoring system (DSS). In order to verify how useful can the total aquatic decomposition score (TADS) for ADD prediction be, a comparative taphonomic study has been performed between two series of bodies: 16 corpses found floating in shallower waters with a presumptive PMSI from 3 to 118 days and exposed to water temperatures (Tw) between 10.5 and 20.3 °C approximately equating from a minimum of 46 to 1.392 ADD; 52 bodies, all victims of a single shipwreck, found in sequestered environments and subjected to constant Tw of 4 °C for 210 days approximately equating to 840 ADD. The two series of bodies have revealed different stages of decay and a large DSS variability. In most of bodies, freshly formed adipocere was able to delay the appearance of later decompositional stages explaining why most of the bodies were in relatively good condition. Although promising, the accuracy of the TADS model can be affected by adipocere and animal activity. The TADS model suffers of the same limitations for ADD calculations as they can give a false perception of accuracy due to the complexity of integrating all changing factors affecting human decay in sequestered and non-sequestered marine environments (currents, animal activity, water temperatures, depth of submersion).

Early childhood caries (ECC) and neglect in child care: analysis of an Italian sample.

AIM: Dental caries was identified as the single most common chronic childhood disease; its prevention should be a priority for dentists. With the aim of describing the correlation between early childhood caries (ECC) and the phenomenon of child neglect, a questionnaire which recorded socio-economic and dental service use data was provided to a randomly chosen sample of parents at three pediatric health service centers in Bari (Italy). MATERIALS AND METHODS: In order to evaluate the association among risk factors and ECC, contingency tables were created and the value of the Odds Ratio (OR) was calculated, indicating the confidence intervals and chi square values. A student's t-test for independent samples was performed to evaluate the differences between the averages. A value of p≤0.5 was considered to be significant for all tests used. RESULTS: Of the 63 children examined, 61.9% (n=39; 95%CL=49.9- 73.9) presented with ECC, of which 47.6% (n=30; 95%CL=34.9-60.6) were classified as Wyne's Type I; 12.7% (n=8; 95%CL=5.6-23.5) were classified as Type II; and 1.6% (n=1; 95%CL=0-8.5) as Type III. Interestingly, the frequency of Types II and III were shown to be higher in low-income families (chi-square=8.50; p=0.03). CONCLUSION: Dentists should recognize children's susceptibility to ECC and their exposure to risk factors for neglect, thus facilitating a primary prevention visit.

Estimating the size of the effects of co-medications on plasma clozapine concentrations using a model that controls for clozapine doses and confounding variables.

AIM: The purpose of this study was to estimate the effect sizes of drug interactions on plasma clozapine concentrations, adjusting for potentially confounding factors such as smoking. METHODS: The estimation was performed by using a mixed model, and a combination of unpublished (N=83) and published (N=172) data that included patients taking phenobarbital, valproic acid, fluvoxamine, fluoxetine, paroxetine, sertraline, citalopram and reboxetine, and patients not taking co-medications. RESULTS: The 255 patients provided a total of 415 steady-state trough plasma clozapine concentrations. Each patient provided 1 to 15 measures of plasma clozapine concentrations. Total plasma clozapine concentration, defined as the sum of plasma clozapine and norclozapine concentrations, was also investigated. A random intercept linear model of the natural log of plasma clozapine concentration with the natural log of dose and other variables as independent variables was built. The model confirmed that phenobarbital induces clozapine metabolism (effect size, E=-28%), and that fluoxetine (E=+42%), fluvoxamine (E=+263%) and paroxetine (E=+30%) inhibit it. Valproic acid appeared to inhibit clozapine metabolism in non-smokers (effect size, E=+16%), whereas it appeared to induce clozapine metabolism in smokers (E=-22%). The effect sizes of smoking on plasma clozapine concentration were -20% in patients not taking valproic acid, and -46% in patients taking valproic acid. Thus, smoking induces clozapine metabolism, and this induction may be stronger when the patient is taking valproic acid. The effect sizes allowed the computation of clozapine dose-correction factors for phenobarbital, 1.4 [95% confidence interval, CI, (1.1, 1.7)]; paroxetine, 0.77 (0.67, 0.89); fluoxetine, 0.70 (0.64, 0.78); fluvoxamine, 0.28 (0.22, 0.35); and valproic acid [0.86 (0.75, 1.0) in non-smokers, and 1.3 (0.96, 1.73) in smokers]. Sertraline, reboxetine and citalopram had no obvious effects. DISCUSSION: The results for total plasma clozapine concentrations are similar to those for plasma clozapine concentrations. The main limitations of this study were that the computed effect sizes reflect only the doses and treatment-durations of the co-medications studied, and that the substantial "noise" of the clinical environment may make it difficult to detect the effects of some variables, particularly those with small effect sizes. Gender was not significant probably due to its relatively small effect size in the studied population, and age was not significant probably due to the limited age variability. CONCLUSION: This article contributes to the clozapine literature by describing a possible interaction between taking valproic acid and smoking, which modifies plasma clozapine concentrations, by estimating the effect sizes of other compounds on plasma clozapine concentrations after correcting for confounders, and by providing dose-correction factors for clinicians.

Esthetics and implantology: medico-legal aspects.

In recent years the high number of malpractice lawsuits in dentistry has attracted closer attention of dental practitioners to its medico-legal aspects. Implantology, in particular, presents many points of medico-legal concern connected with the difficulties inherent to dental procedures and objectives (both functional and esthetic), as well as full patient collaboration as an essential part of successful treatment. An accurate assessment of each case by the clinician is fundamental, especially in circumstances where esthetic considerations are preponderant as, for instance, in the frontal sectors. In such cases, the options of implantology or of a traditional fixed prosthesis need to be carefully weighed in light of the patient's anatomic condition. The patient should therefore receive complete information and be made fully aware of the risk of treatment failure, as well as possible complications, limits to the procedures, and the fact that successful outcome will also depend on her/his scrupulous observance of the practitioner's instructions. In short, the aim is to make the patient an active ''accomplice'' in treatment. To this end, the use of an extremely detailed information leaflet is strongly advised; after careful clarification of any doubts the patient may have, the patient's written informed consent should be obtained. Nevertheless, there is the risk that excessive intrusion of bureaucracy into medical procedures in defence of the practitioner against malpractice suits may hinder the principal aim of traditional medicine, i.e. to provide the best care for the patient through mutual trust fostered within the doctor-patient relationship.

Poor reliability of facial indices for comparative metric facial identification without parametrical superimposition.

The relationship between the craniometric indices that can be evinced from the comparison of two faces for identification purposes is considered a reliable method for the personal identification of faces. Our study aims to assess whether facial indices are susceptible to substantial variations even if the two faces being compared are a different size, looking in a different direction, or differently angled. Our results showed high variability as regards both the facial indices thus obtained and the relative relations. This underlines the fact that regardless of the validity of the metric analysis method used, no numerical comparison can be reliable unless prior parametrical somato-physical superimposition of the images of the subjects has been performed to assess the complete comparability of the faces of the suspects. In conclusion, no reliable identification can be made with the simplified techniques that bypass this difficult, demanding and time-consuming phase of parametric superimposition, as we have shown that they can lead to gross errors.

Clinical and therapeutic experience in twenty eight patients with burning mouth syndrome.

AIM: Burning mouth syndrome (BMS) is a chronic painful syndrome in clinically normal oral mucosa. There are many local, systemic and/or psychogenic pathological conditions that may clinically appear as burning and painful sensation of the oral mucosa. There are essential or idiopathic BMS and organic or secondary BMS. A diagnostic and therapeutic protocol is proposed by the authors evaluating, the effectiveness of the estroprogestinic replacement therapy in post-menopausal women suffering from idiopathic BMS. METHODS: A total of 28 patients suffering from persistent burning and painful oral sensation underwent to careful clinical and laboratory examination in order to distinguish primary forms from secondary ones. Patients suffering from primary BMS underwent to incisional biopsy for the research of estrogens receptors. RESULTS: Only 8 out of the 28 studied patients (28.5%) were negative to the clinical oral and laboratory examinations listed in our protocol and they were diagnosed for primary BMS. All of them were females. CONCLUSIONS: The use of a valid diagnostic and therapeutic protocol allows a better management of patients suffering from oral pain and a reduction if not a disappearance of the burning symptomatology in most of them. In post-menopausal patients suffering from idiopathic BMS good results may be obtained by an estroprogestinic replacement therapy.