Accuracy of CGM Systems During Continuous and Interval Exercise in Adults with Type 1 Diabetes.

BACKGROUND: continuous glucose monitoring systems (CGMs) play an important role in the management of T1D, but their accuracy may reduce during rapid glucose excursions. The aim of study was to assess the accuracy of recent rt-CGMs available in Italy, in subjects with T1D during 2 sessions of physical activity: moderate continuous (CON) and interval exercise (IE). METHOD: we recruited 22 patients with T1D, on CSII associated or integrated with a CGM, to which a second different sensor was applied. Data recorded by CGMs were compared with the corresponding plasma glucose (PG) values, measured every 5 minutes with the glucose analyzer. To assess the accuracy of the CGMs, we evaluated the Sensor Bias (SB), the Mean Absolute Relative Difference (MARD) and the Clarke error grid (CEG). RESULTS: a total of 2355 plasma-sensor glucose paired points were collected. Both average plasma and interstitial glucose concentrations did not significantly differ during CON and IE. During CON: 1. PG change at the end of exercise was greater than during IE (P = .034); 2. all sensors overestimated PG more than during IE, as shown by SB (P < .001) and MARD (P < .001) comparisons. Classifying the performance according to the CEG, significant differences were found between the 2 sessions in distribution of points in A and B zones. CONCLUSIONS: the exercise affects the accuracy of currently available CGMs, especially during CON, suggesting, in this circumstance, the need to maintain blood glucose in a "prudent" range, above that generally recommended. Further studies are needed to investigate additional types of activities.

Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study.

BACKGROUND: The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologous contralateral sites over a long period of time (10 to 27 years). METHODS: Fifty-five subjects with 73 sites (test group) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts (SMFGGs) and marginal free gingival grafts (MFGGs). The 73 contralateral homologous sites (control group), with or without recession and with or without attached gingiva, were not treated. Patients were recalled every 4 months during the follow-up period (10 to 27 years). Clinical variables, including recession depth, amount of keratinized tissue (KT), and probing depth (PD), were measured in treated and untreated sites at baseline, at 1 year, and at the end of the follow-up period. RESULTS: At the end of the follow-up period, recession was reduced in all treated sites (1.5 +/- 1.0 mm for SMFGG and 1.3 +/- 0.9 mm for MFGG), whereas it was increased in the untreated sites (-0.7 +/- 0.7 mm for SMFGG and -1.0 +/- 0.5 mm for MFGG). In the treated sites, the increased KT remained quite stable during the follow-up period. PD remained stable (1 mm) in the treated and untreated sites. CONCLUSIONS: The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.

ZAP-70 expression, as detected by immunohistochemistry on bone marrow biopsies from early-phase CLL patients, is a strong adverse prognostic factor.

Zeta-associated protein-70 (ZAP-70), mostly assessed by flow-cytometry (FC), recently emerged as reliable prognostic factor in chronic lymphocytic leukaemia (CLL) at presentation. We evaluated ZAP-70 expression in 156 CLL patients by immunohistochemistry (IHC) on formalin-fixed bone marrow (BM) biopsies at diagnosis. At presentation, 117 patients (75%) were with Binet stage A, 27 (17%) stage B and 12 (8%) stage C. Median follow-up was 61 months (range 6-242). ZAP-70 was expressed in neoplastic lymphocytes of 69 patients (44%). Concordance between ZAP-70 by IHC and ZAP-70 by FC, immunoglobulin heavy chain variable genes (IGHV) mutational status and CD38 expression was found in 41/46 (89%), 41/49 (80%) and in 60/88 (68%) tested cases, respectively. ZAP-70 expression significantly correlated with advanced Binet stage (B-C), diffuse BM infiltration, increased lactate dehydrogenase (LDH) and beta2-microglobulin serum levels and lymphocyte doubling time <12 months. ZAP-70 positivity was significantly related to poorer time to progression (median 16 months vs 158 of ZAP-70-negative cases) (P<0.0001) and overall survival (median 106 months vs not reached) (P=0.0002); this correlation was confirmed at multivariate analysis. ZAP-70 expression correlated with poorer outcome also when evaluated only in the 117 stage A patients. In conclusion, immunohistological detection of ZAP-70 on formalin-fixed BM biopsies at diagnosis appears a useful methodological approach to identify patients with poor prognosis in CLL.

Histologic assessment of new attachment following the treatment of a human buccal recession by means of a guided tissue regeneration procedure.

A deep, long-standing recession on a mandibular incisor was treated in a 56-year-old female patient. The tooth was tilted buccally and was scheduled for extraction. The recession was 8 mm deep, with a pocket depth of 1 mm and no keratinized tissue. The recession was treated by guided tissue regeneration; the membrane was left in place for 4 weeks. The tooth was extracted along with marginal tissues 5 months after the removal of the membrane. At the time of extraction, 4 mm of root coverage had been achieved and 3 mm of keratinized tissue were measured buccally. Histologic measurements showed that 3.66 mm of new connective tissue attachment had been obtained associated with newly formed cementum (2.48 mm) and bone growth (1.84 mm). The crestal bone level after treatment was located coronal to the preoperative location of the gingival margin.

Periodontal regeneration of human infrabony defects. I. Clinical measures.

A series of investigations was undertaken to evaluate the extent and predictability of periodontal regeneration with barrier membranes in deep infrabony defects. This study reports the clinical outcomes in terms of probing attachment level (PAL) gains, probing pocket depth (PPD) reduction, and recession (REC) of marginal gingiva. Forty deep 1, 2, and 3-wall combination infrabony defects treated with membranes were evaluated 1 year postoperatively following a strict plaque control regimen (mean plaque score = 6.1%, bleeding score = 4% at 1 year). A PAL gain of 6.1 +/- 2.5 mm along with a PPD reduction of 5.9 +/- 2.5 mm were observed. A PAL gain of 2 mm or more was detected in almost 90% of the treated sites. No site lost attachment. Residual PPD was 3 mm or shallower in 95% of the sites. It is concluded that treatment of deep infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen represents an efficacious and predictable treatment alternative.

Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures.

This paper evaluates the osseous healing response of 40 infrabony defects treated with guided tissue regeneration. The selected sites presented with deep periodontal lesions with a 1-, 2-, and 3-wall combination infrabony component of 6.1 +/- 2.5 mm. Baseline intrasurgical clinical measurements were compared with intrasurgical clinical measurements obtained at the 1 year surgical re-entry. A significant regeneration of bone of 4.3 +/- 2.5 mm was observed, along with a 0.4 +/- 1.9 mm resorption of the alveolar bone crest, which resulted in a 4.7 mm reduction of the original infrabony defect. Almost 90% of the sites showed a bone gain of 2 mm or more, while no site lost supporting bone; 73 +/- 31.2% of the original defect was filled with bone. The 3- and 2-wall components were filled 95 +/- 6.2% and 82 +/- 18.7% of their original depth, respectively; however, the 1-wall component was filled only 39 +/- 62.4%. It is concluded that treatment of infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen resulted in clinically significant and highly predictable bone regeneration.

Interproximal free gingival grafts after membrane removal in guided tissue regeneration treatment of intrabony defects. A randomized controlled clinical trial.

The purpose of this controlled clinical trial was to compare the efficacy of two surgical approaches to protect the regenerated tissue following membrane removal in guided tissue regeneration (GTR) treated intrabony defects. Twenty-eight (28) defects, one each in 28 patients were randomly assigned after placement of the membrane to one of two treatment groups by blocking to prognostic variables. The test group received free gingival grafts on the interproximal regenerated tissue. In the control group the surgical flaps were coronally positioned over the regenerated tissue. The two groups were well balanced with respect to all prognostic variables. The results indicated that: 1) similar amounts of regenerated tissue were obtained in the two groups at membrane removal (7.6 +/- 2.8 mm, test; 8.3 +/- 2.3 mm, control); 2) a significantly greater amount of probing attachment level gain was observed in the test group (5.0 +/- 2.1 mm, test; 3.7 +/- 2.1 mm, control). This study indicated that placement of free gingival grafts on the interdental regenerated tissue further improves the clinical outcome of GTR in deep intrabony defects.

Periodontal regeneration of human intrabony defects with titanium reinforced membranes. A controlled clinical trial.

The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects. Forty-five (45) defects in 45 patients were randomly assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test group was treated with titanium reinforced membranes positioned just apical to the cemento-enamel junction and the modified papilla preservation technique; the second group received conventional expanded polytetrafluoroethylene (ePTFE) barrier membranes applied at the alveolar crest; the third group was treated with an access flap procedure. The groups were well balanced with respect to all prognostic variables. During the 1-year observation period, patients were subjected to a stringent infection control program including: professional tooth cleaning every week for the first 6 weeks (all groups) and in the 4 weeks following membrane removal (guided tissue regeneration groups), then at monthly intervals (all groups). The results indicated that: 1) all treatment modalities resulted in clinical and statistically significant improvements in clinical attachment level (CAL) and probing depths (PD) at 1 year; 2) a significantly greater amount of CAL gain (P = 0.0003, analysis of variance) was observed in the test group (5.3 +/- 2.2 mm) with respect to both the ePTFE group (4.1 +/- 1.8 mm) and the flap control group 2.5 +/- 0.8; 3) in the test group the 1 year CAL (4.7 +/- 1.8 mm) was located more coronally than the baseline position of the interproximal alveolar crest (5.9 +/- 2 mm; P = 0.003, t test).(ABSTRACT TRUNCATED AT 250 WORDS)

The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures.

A modification of the papilla preservation technique has been applied to achieve primary closure of the interproximal tissue over barrier membranes placed coronal to the alveolar crest. Fifteen patients with deep intrabony interproximal defects were treated. Defects had a probing attachment level loss of 9.9 +/- 3.2 mm and a recession of the gingival margin of 1.7 +/- 1.6 mm. The depth of the intrabony component was 5.5 +/- 2.9 mm; while the suprabony component was 5.9 +/- 2.0 mm. Titanium-reinforced teflon membranes were placed 1.3 +/- 0.7 mm from the cemento-enamel junction, 4.5 +/- 1.6 mm coronal to the interproximal alveolar bone crest. Primary closure over the interproximal portion of the membrane was obtained in 93% of cases. In 73% of the cases complete coverage of the membrane was maintained until its removal at 6 weeks. These data indicate that the modified papilla preservation technique can be successfully applied to obtain primary closure of the interdental space in regenerative procedures with barrier membranes.

Periodontal regeneration of human intrabony defects with bioresorbable membranes. A controlled clinical trial.

The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects. Thirty-six (36) defects in 36 patients were randomly assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test was treated with bioresorbable membranes positioned coronal to the interproximal bone crest; the second group (membrane control) was treated with conventional non-resorbable (ePTFE) barrier membranes applied coronal to the alveolar crest; the third group (flap Control) was treated with an access flap procedure (MWF). No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups, indicating that the blocking approach was effective. A stringent infection control program was enforced for 1 year. The results indicated that: 1) at 1 year all treatment modalities resulted in clinically significant improvements in clinical attachment levels (CAL) and reductions in probing depths; 2) a statistically significant treatment effect (P < 0.0001, ANOVA) was observed comparing the test (4.6 +/- 1.2 mm), the membrane control (5.2 +/- 1.4 mm), and the flap control groups (2.3 +/- 0.8 mm) in terms of CAL gain; 3) differences in terms of CAL gain between the test (bioresorbable) and the membrane control (ePTFE) groups were not statistically significant (P = 0.19, t-test); 4) both the test and the membrane control groups gained significantly more CAL at 1 year than the MWF group (P < 0.0001, t-test). CAL gains > or = 4 mm were observed in 83.3% of cases in both GTR groups, while CAL gains of this magnitude were not detected in the MWF group. We concluded that clinically significant CAL gains can be obtained with GTR procedures using both bioresorbable and non-resorbable membranes. Patients' morbidity, however, was lower in the group treated with bioresorbable membranes.

Fibrin and fibronectin sealing system in a guided tissue regeneration procedure. A case report.

A case is reported showing an iatrogenic, chronic abscess of six years' duration associated with a bony defect between the maxillary right central and lateral incisors. The osseous defect was treated by a guided tissue regeneration procedure with the use of a fibrin and fibronectin sealing system. The system was employed to fix the membranes and keep them apart from the root surface, thereby maintaining room for bone regeneration. This operation resulted in a 9-mm clinical attachment gain and in an 11-mm filling of the osseous defect. The second surgical stage after a three-month reentry procedure was strictly for cosmetic improvement by means of a free gingival graft.

Human fibrin glue versus sutures in periodontal surgery.

A fibrin-sealing system consisting of symmetrical flap and graft procedures versus silk sutures in a split-mouth clinical trial was tested in 51 patients. Clinical parameters and operative times were recorded and compared. In clinical use, the fibrin glue provided quick hemostasis and adequate tissue adhesion on the whole inner surface of grafts or flaps. Its use saved remarkable amounts of time and made it easier to fix tissues in difficult areas. The time saved ranged from 3 to 19.5 minutes per procedure, and 1 to 8.5 minutes per tooth. The convenience of the fibrin glue was especially appreciated in pedicle flap procedures.

Periodontal regeneration of human infrabony defects. III. Diagnostic strategies to detect bone gain.

Assessment of actual treatment outcome by simple and available diagnostic tests represents an important aspect in the evaluation of periodontal regenerative procedures. This report focuses on the diagnostic accuracy of different strategies to detect the original extent of bone loss and bone gain in deep vertical defects following guided tissue regeneration. Characteristics of probing attachment level and radiographic bone linear measurements were compared to a gold standard obtained as intrasurgical clinical measurements at baseline and at the 1 year re-entry operation. Radiographic linear measurements underestimated bone loss (CEJ-BD) in 55% of cases while the estimate was within 1 mm in 25% of cases. The goodness of agreement could be significantly described by a general linear model incorporating measures of defect morphology. The original level of bone loss could be best detected by an approach which consisted of adding 1.5 mm to the measured attachment level loss. Such an approach correctly estimated bone loss within 1 mm in 85% of sites. In terms of ability to detect bone gain, radiographic measurements underestimated bone gain in 55% and overestimated it in 15% of sites. Diagnostic accuracy was assessed at different threshold values of true gain. The sensitivity and specificity plots intersected at a threshold value of 2.7 mm bone gain. Conversely, measures of probing attachment level gain agreed with the gold standard within 1 mm 45% of times. Intersection of the specificity and sensitivity plots occurred at 3 mm. Classification tables are presented for both diagnostic tests at different threshold values.2+é

Oral Acanthosis nigricans as a marker of internal malignancy. A case report.

BACKGROUND: Acanthosis nigricans (AN) is a rare mucocutaneous condition that can involve the oral tissues. There are 2 clinical forms of AN: benign and malignant. Benign AN is related to systemic diseases such as diabetes and obesity or can be induced by drugs such as systemic corticosteroids, nicotinic acid, estrogens, insulin, and fusidic acid. Malignant AN appears in association with tumors such as lung, ovarian, breast, and gastric carcinoma. METHODS: A rare case of malignant AN that initially manifested in the oral cavity of a 73-year-old patient is reported. RESULTS: A bladder and lung carcinoma were detected following the diagnosis of AN. CONCLUSIONS: The diagnostic importance of oral AN is emphasized because, in our patient, its recognition led to the detection of 2 occult malignant tumors.

Mucogingival interceptive surgery of buccally-erupted premolars in patients scheduled for orthodontic treatment. I. A 7-year longitudinal study.

BACKGROUND: Mucogingival interceptive therapy in patients with buccally erupting teeth is performed to prevent the ectopic permanent tooth from developing periodontal lesions. The keratinized tissue entrapped between the erupting tooth and the deciduous tooth is retained to maintain a satisfactory width of the gingiva for the permanent tooth. The aim of the present study on buccally-erupted premolars scheduled for orthodontics was to evaluate the keratinized tissue width 3 months, 2 years, and 7 years subsequent to mucogingival interceptive therapy and orthodontic treatment. METHODS: Twenty-nine patients participated. Three different surgical techniques were used according to specific indications. Eight patients were treated with double pedicle flaps (DPF), 10 patients with apically positioned flaps (APF), and 11 with free gingival grafts (FGG). RESULTS: The amount of keratinized tissue on the treated (test) sites was not significantly less than on the control (untreated) sites showing normally erupting premolars at all observation periods. All 3 surgical procedures appeared to be effective in saving the keratinized tissue for the permanent tooth. Preoperative periodontal parameters such as gingival width, probing depth, and bleeding on probing significantly influenced the outcome 3 months after surgery (P <0.01). CONCLUSIONS: Mucogingival interceptive surgery is an effective approach to conserve the keratinized buccal gingiva of ectopically erupting premolars.

Mucogingival interceptive surgery of buccally-erupted premolars in patients scheduled for orthodontic treatment. II. Surgically treated versus nonsurgically treated cases.

BACKGROUND: The aim of this 2-year longitudinal study was to compare the width of keratinized gingiva after orthodontic therapy for buccally erupting premolars that had been pretreated by extraction of deciduous teeth alone versus interceptive mucogingival surgery. METHODS: In 8 patients (aged 9 to 12 years) who presented with bilateral buccal eruption of homologous teeth (premolars), one side was randomly treated with extraction of the deciduous molar and mucogingival surgery (test site), while the other side was treated only by extraction of the deciduous molar (control site). All of the subjects underwent orthodontic treatment with fixed appliances. RESULTS: At the baseline visit prior to any treatment, there was no significant difference between the mean amount of keratinized gingiva at test sites (3.06 mm) and control sites (2.93 mm). Two years later, upon completion of orthodontic treatment, there was a significant difference between test (2.93 mm) and control (1.37 mm) sites in the mean width of keratinized tissue. In the control (untreated) group, 2 sites exhibited 1 mm of gingival recession after orthodontic treatment. CONCLUSIONS: Mucogingival interceptive surgery is an effective technique to maintain keratinized tissue in correspondence with buccally-erupted teeth.

Viral etiology of gingival recession. A case report.

Herpes simplex virus-type I (HSV-1) is responsible for both primary and recurrent infections of the oral mucosa. The aim of this case report is to show how HSV-1 may cause periodontal damage such as gingival recession. A 26-year-old male patient presented in a private office for the treatment of gingival recessions. He reported that the recessions had appeared suddenly with marginal inflammation of the gingiva and vesicle formation; within a few hours, the gingival tissue had been completely destroyed. The lesions were accompanied by pain, fever, and regional lymphadenopathy. Two weeks later, the patient returned complaining of a recurrence accompanied by pain and lymphadenopathy. The following day, the patient's condition had worsened and the depth of the recession had increased. A biopsy was taken for histological examination. A free epithelial-connective tissue graft was performed. Histological and direct immunofluorescence examinations confirmed the herpetic origin of the lesion. Eight months after surgery, a new herpetic lesion was detected in correspondence to the gingival margin of the first lower right premolar; therefore, acyclovir was prescribed. After 1 week, the antiviral therapy was completely successful; the gingival lesion disappeared, and no recession of the soft tissue margin was observed. Based on these clinical features, diagnosis of gingival recession induced by HSV-1 must be carried out at an early stage to establish a successful therapy.

Guided tissue regeneration in the treatment of human facial recession. A 12-case report.

A guided tissue regeneration procedure was used to treat human buccal recessions, 3 to 7 mm deep, in 12 patients. No procedure for increasing the width of keratinized tissue was performed prior to treatment. A thick bipedicled flap was raised with a semilunar incision in the alveolar mucosa and a marginal incision was extended to the adjacent papilla. The root surface was made concave by curets and burs to create space for regeneration. The membrane was fixed to the cemento-enamel junction and covered by the flap which consisted of the residual gingiva and of alveolar mucosa. The membranes were removed 4 weeks after placement. The patients were recalled 6 months after the reentry procedure. The average reduction in recession was 2.50 mm (P less than 0.01) and the average attachment gain was 2.84 (P less than 0.01). Pocket depth was slightly reduced (0.33 mm), although the degree of reduction was not of statistical significance. The width of keratinized tissue increased slightly (0.83 mm). These results demonstrate the possibility of treating human buccal recessions by means of a guided tissue regeneration procedure, with predictable recession reduction and attachment gain. A minimal amount of keratinized tissue was needed.

TT virus infection of periodontal tissues: a controlled clinical and laboratory pilot study.

BACKGROUND: A novel single-strand, circular DNA virus has been recently isolated and named TT virus (TTV). It has been demonstrated that peripheral blood cells harbor TTV DNA, suggesting that the virus might replicate in lymphoid cells and contribute to lymphocyte imbalances with consequent immunosuppressive effects. The purpose of this study was to investigate the prevalence of TTV DNA in healthy and periodontally compromised subjects, evaluating the presence of the virus in the gingiva and saliva, and comparing virological results with clinical data. METHODS: Twenty-one patients (seven males and 14 females, aged 25 to 76 years) were enrolled in the study. Eleven subjects were diagnosed with moderate periodontitis, while 10 were periodontally healthy. A sample of saliva was taken from each patient before recording the periodontal data; subsequently, a gingival biopsy was performed. A real-time polymerase chain reaction was used to quantify the presence of TTV DNA in saliva and gingival specimens. RESULTS: A statistically significant association was found between TTV in gingival tissue and the presence of periodontitis (P = 0.0351), while no association was observed between TTV in saliva and the presence of periodontitis (P = 0.4762). CONCLUSIONS: A new DNA virus (TTV) was first identified in the gingival tissue and was found to be significantly associated with the presence of periodontitis. These findings need to be investigated in further studies.