Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review

Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

Periodic Limbic Movement Disorder during Sleep as Diabetes-Related Syndrome? A Polysomnographic Study

Introduction. Periodic limb movements during sleep (PLMs) is common in the elderly. When quality-of-life drops due to sleep disturbances, we speak about periodic limb movement disorder during sleep (PLMD). Another similar disorder, restless legs syndrome (RLS), is considered to be related to diabetes; RLS and PLMDs are genetically related. Our aim was to detect PLMDs in a population of diabetic patients and identify them as possible hallmarks of these autonomic disorders. Material and Methods. We selected 41 type-2 diabetics with no sleep comorbidity, and compared them with 38 healthy matched volunteers. All participants underwent the Epworth Sleepiness Scale (ESS) and polysomnography (PSG). A periodic limb movement (PLM) index >5, that is, the higher number of PLMs/sleep hour for the entire night, was considered as abnormal. Results. Diabetics showed lower sleep efficiency than controls on the ESS, lower proportions of REM and non-REM sleep, and higher arousal and PLM indexes, as assessed through PSG. PLMDs were diagnosed in 13 of 41 diabetic patients (31%); the latter showed lower sleep efficiency, lower non-REM slow-wave sleep, and increased arousal and PLM indexes. Conclusion. The relationship between PLMs-related sleep fragmentation and endocrine carbohydrate metabolism regulation might be casual or genetically determined. This deserves further investigations.

Prevalence and factors associated with idiopathic hypercalciuria in HIV patients on combination antiretroviral therapy

Idiopathic hypercalciuria may lead to bone loss via three pathogenic mechanisms described in HIV-negative patients: intestinal hyperabsorption, kidney loss and bone hyperabsorption. We conducted a cross-sectional study in a cohort of 217 HIV-positive antiretroviral-experienced patients, identifying hypercalciuria in 67 patients: the prevalence was 30.9% (95% confidence interval 27.4-37.0). The occurrence of hypercalciuria in subjects with normal values of parathormone may indicate an absorptive form of hypercalciuria. In this sample, other bone turnover markers and T-scores were not related to the condition. The results of this study show a high prevalence of idiopathic hypercalciuria in a group of antiretroviral-experienced patients. The consequences and the exact causes of this metabolic complication are not yet known and further investigation is needed.

Immunomodulatory effects of 1,25-dihydroxyvitamin D3 on TH1/TH2 cytokines in inflammatory bowel disease: an in vitro study

Crohn's disease (CD) is associated with a higher type-1-helper T cell (Th1) cytokine expression, whereas ulcerative colitis (UC) appears to express a modified Th2 response. In addition to its classic role in calcium homeostasis, calcitriol, the hormonal active form of vitamin D, exerts immunoregulatory effects such as modulation of Th1/Th2 cytokines. Therefore, calcitriol administration could modify immune dysfunction in CD and UC. Nine patients with UC (M/F: 5/4; mean age 47 years, remission(R)/active(A) disease: 7/2), 8 patients with CD (M/F: 2/6; mean age 36, R/A 5/3) and 6 healthy controls (HC) (M/F: 3/3, mean age 4) were enrolled. Peripheral blood was collected after a drug-washout of 15 days and peripheral blood mononuclear cells were stimulated with mitogens alone or in the presence of physiological concentrations of calcitriol (100 pg/ml). Type 1 (IL-2, TNF-alpha, IFN-gamma) and type 2 (IL-10) cytokine production was assayed on supernatants by ELISA. Compared to HC, TNF-alpha production was significantly higher both in UC (p=0.0002) and CD (p=0.0001) patients, at baseline and after incubation with calcitriol (UC p=0.0003, CD p=0.0009). The effects of calcitriol incubation were: 1) reduced IFN-gamma (p=0.024) and increased IL-10 (p=0.06) production in UC patients; 2) reduced TNF-alpha production in CD (p=0.032); 3) no significant effects in HC. Calcitriol increased, albeit not significantly, IL-10 production in UC compared to CD patients (p=0.09). These results suggest an important modulatory role of vitamin D in the Th1/Th2 immune response. The observation that the effect of this modulation was different in CD compared to UC patients provides an interesting area of research into the pathogenesis and treatment of these inflammatory conditions.

Industrial and occupational ergonomics in the petrochemical process industry: a regression trees approach

This work is an attempt to apply classification tree methods to data regarding accidents in a medium-sized refinery, so as to identify the important relationships between the variables, which can be considered as decision-making rules when adopting any measures for improvement. The results obtained using the CART (Classification And Regression Trees) method proved to be the most precise and, in general, they are encouraging concerning the use of tree diagrams as preliminary explorative techniques for the assessment of the ergonomic, management and operational parameters which influence high accident risk situations. The Occupational Injury analysis carried out in this paper was planned as a dynamic process and can be repeated systematically. The CART technique, which considers a very wide set of objective and predictive variables, shows new cause-effect correlations in occupational safety which had never been previously described, highlighting possible injury risk groups and supporting decision-making in these areas. The use of classification trees must not, however, be seen as an attempt to supplant other techniques, but as a complementary method which can be integrated into traditional types of analysis.

Induction of vascular endothelial growth factor release by transcutaneous frequency modulated neural stimulation in diabetic polyneuropathy

BACKGROUND

Pharmacological treatment for diabetic polyneuropathy (DP) has shown limited benefit; frequency-modulated electrical stimulation (FREMS) has shown positive results in pain control and nerve conduction velocity in DP.

OBJECTIVE

To investigate the effects of FREMS vs transcutaneous electrical nerve stimulation (TENS) on the release of vascular endothelial growth factor (VEGF) in Type 2 diabetic and in non-diabetic subjects.

METHODS

10 non-diabetic [mean age 37+/-5 yr; females (F)/males (M): 6/4] and 10 Type 2 diabetic subjects (mean age 52+/-6 yr; F/M: 5/5) with DP underwent TENS (for 10 min) followed by 30 min interval without electrical stimulation, and then FREMS (for 10 min) over the forearm volar surface. Blood samples for VEGF measurements were obtained from the contra-lateral arm every 2 min during TENS/FREMS application and every 10 min during the intervals.

RESULTS

We observed a significant rise in plasma VEGF during FREMS in both non-diabetic and diabetic subjects (maximal response 89.4+/-80.3 pg/ml and 48.5+/-18.3 pg/ml, respectively; p<0.01 vs basal) with a lower, but still significant response in diabetics. No changes in VEGF were observed during TENS application.

CONCLUSION

VEGF release during FREMS may help explain the positive effects on nerve conduction velocity in DP, possibly mediated by favorable effects on vasa nervorum microangiopathy.

First Italian Consensus Statement on Diagnosis, Prevention and Treatment of Cardiovascular Complications in HIV-infected Patients in the HAART Era (2006)

The present document contains recommendations for assessment, prevention and treatment of cardiovascular risk for HIV-infected patients. All recommendations were graded according to the strength and quality of the evidence and were voted on by 73 members of the Italian Cardiovascular Risk Guidelines Working Group which includes both experts in HIV/AIDS care and in cardiovascular and metabolic medicine. Since antiretroviral drug exposure represents only one risk factor, continued emphasis on an integrated management is given. This should include prevention and treatment of known cardiovascular risk factors (such as dyslipidaemia, diabetes, insulin resistance, healthy diet, physical activity, avoidance of smoking), but also rational switch of antiretroviral drugs. A rational switch strategy should consider both metabolic and anthropometric disturbances and effectiveness of antiretroviral regimens.

Atrial Natriuretic Peptide in Diabetic and Nondiabetic Patients With and Without Heart Transplantation

BACKGROUND

Natriuretic peptides are useful markers for risk stratification of patients with heart disease. However, conflicting results have been reported about circulating atrial natriuretic peptide (ANP) concentration in heart transplant recipients.

METHODS

To ascertain the effects of diabetes and acute insulin administration on plasma ANP concentrations in a model of heart denervation, we studied 12 diabetic (D-OHT) and 6 nondiabetic heart-transplanted (OHT) patients using the euglycemic-hyperinsulinemic clamp and oral glucose tolerance tests. Five patients with type 2 diabetes without heart transplantation (D) and 9 healthy subjects (NOR) matched for anthropometric features served as the controls.

RESULTS

Means baseline plasma ANP concentration was higher in D-OHT (82 +/- 15 pg/mL) than in OHT or NOR (27 +/- 4 or 30 +/- 5; P < .01), but was not different than D (69 +/- 12; P = .82). During the clamp plasma ANP showed similar increases in all groups (49 +/- 4, 39 +/- 3, 59 +/- 4, and 49 +/- 3% in D-OHT, OHT, D, and NOR; P < .02 vs basal, P = NS among groups). Plasma osmolarity and catecholamines were also not different among groups and did not increase during the clamp. Fasting plasma ANP concentrations correlated with plasma glucose concentrations measured 120 minutes after oral glucose tolerance testing.

CONCLUSIONS

Among heart transplantation recipients fasting plasma ANP concentrations were not different at 5 to 6 years after the surgical procedure than in nondiabetic controls. Increased ANP concentrations were observed among recipients with diabetes and among nontransplanted diabetic patients. Although the insulin-induced increment in ANP concentrations was not different among groups, circulating ANP was strongly associated with glucose tolerance status.

Frequency rhythmic electrical modulation system (FREMS) on H-reflex amplitudes in healthy subjects

AIM

Changes in the amplitude of Hoffmann reflex (H-reflex) may reflect variations in the characteristics of the largely monosynaptic circuitry that is explored and are a possible target for diagnostic and physical therapeutic intervention. However, previous attempts to induce predictable changes in the H-reflex amplitude by transcutaneous electrical nervous stimulation (TENS) have generally failed. Previous workers applied fixed frequency in the low- (2-5 Hz) or in the high- (100 Hz) field, but they did not attempt to vary frequency and/or impulse duration in time.

METHODS

We evaluated the effect of a new type of painless electric stimulation, i.e. frequency rhythmic electrical modulation system (FREMS). FREMS is characterized by the use of transcutaneous electric pulses with sequentially modulated frequency (f: 1-39 Hz) and width (w: 10-40 micro s) at constant, perceptive threshold voltage (approximately 150 V). FREMS was applied at the abductor hallucis muscle (AHM), as conditioning stimulus of the H-reflex which was recorded ipsilaterally at the soleus muscle, according to the classic method, in 10 normal volunteers (age range 21-40 years).

RESULTS

H-reflex amplitude was substantially decreased (-50%) during FREMS and H-reflex amplitude variations were influenced by w/f variation in time during FREMS subphase C in a predictable way (r(2)=0.43; P<0.001). Our results suggest an effective ability of FREMS to modulate H reflex amplitude.

CONCLUSIONS

The ability to achieve large and predictable changes of the H-reflex amplitude simply by modulating both frequency and duration of a conditioning painless electrical stimulation offers new possibilities for the treatment of diseases characterized by motoneuron excitability abnormalities.

Treatment of morbid obesity by intraparietogastric administration of botulinum toxin: a randomized, double-blind, controlled study

OBJECTIVE

The stomach is the main target organ for bariatric surgery, but no medical treatment has been developed to increase satiety and decrease food intake via gastric pathways. The aim of our study was to investigate whether or not the intraparietogastric administration of botulinum toxin A (BTX), able to modify the motility patterns of the stomach, could be useful for treatment of obesity.

DESIGN

Double blind controlled study.

SUBJECTS

Twenty-four morbidly obese patients (mean weight (s.e.m.) 116.1+/-4.89 kg, mean body mass index (BMI) 43.6+/-1.09 kg/m(2)) were blindly randomized to receive 200 IU BTX or placebo into the antrum and fundus of the stomach by intraparietal endoscopic administration.

MEASUREMENTS

We evaluated weight loss, BMI changes, satiety score, the maximal gastric capacity for liquids and the gastric emptying time (octanoic acid breath test).

RESULTS

The two groups were homogeneous for anthropometric characteristics. Eight weeks after treatment, BTX patients had significantly higher weight loss (11+/-1.09 vs 5.7+/-1.1 kg, P<0.001) and BMI reduction (4+/-0.36 vs 2+/-0.58 kg/m(2), P<0.001) and a higher satiety score on a visual analogic scale (7.63+/-0.38 vs 4.72+/-0.44, P<0.001) than controls. Furthermore, BTX patients showed a significantly greater reduction in maximal gastric capacity for liquids (266.6+/-48 vs 139+/-31, P<0.001) and a greater prolongation in gastric emptying time (+18.93+/-8 vs -2.2+/-6.9 min, P<0.05). No significant side effects or neurophysiologic changes were found.

CONCLUSIONS

Topical intragastric BTX was effective in reducing food intake and body weight in morbidly obese patients.

Bisphosphonates and atherosclerosis: why?

The increasing knowledge on bone calcification processes has revealed some similarities with vascular tissue, where calcifications of arteries and cardiac valves contribute to several cardiovascular problems, such as heart failure, systolic hypertension, and myocardial and peripheral ischemic disease. Bisphosphonates have been used extensively for over two decades for the treatment of diseases associated with excessive bone resorption, i.e., osteoporosis, osteolytic bone metastasis, hypercalcemia and Paget's disease, by blocking osteoclastic function. Etidronate, pamidronate and clodronate has been shown to inhibit the development of experimental atherosclerosis, and proposed mechanisms for this action include inhibition of arterial calcification and lipid accumulation, degradation of atherogenic LDL-cholesterol and reduced foam cell formation. Bisphosphonates inhibit various enzymes involved in cholesterol biosynthesis and suppress macrophages in atheromatous lesions. The possibility of pharmacological agents that effectively treat both osteoporosis and atherosclerosis is attractive, however, current evidence is not conclusive and further research is necessary to confirm these actions in the clinical setting.

Vertical Banded Gastroplasty Modifies Plasma Ghrelin Secretion In Obese Patients

BACKGROUND

Restrictive bariatric surgery causes weight loss through substantial decline of appetite with satiety after meals. Reduction of plasma ghrelin levels after Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding could contribute to these effects, although contradictory results have been reported. The only restrictive operation still not yet investigated is vertical banded gastroplasty (VBG). We studied the effects of VBG on basal plasma ghrelin levels and meal-mediated inhibition.

METHODS

12 morbidly obese patients, 11 female and 1 male, were studied before and after VBG, when the BMI fell by 20%. The control group consisted of 6 lean volunteers. Active ghrelin was determined by RIA after overnight fasting and after the administration of a liquid meal.

RESULTS

Obese patients preoperatively had significantly lower basal plasma ghrelin levels than lean volunteers, and the meal did not inhibit ghrelin secretion. After VBG and 20% BMI loss, basal plasma ghrelin levels increased and the reduction caused by a meal recovered.

CONCLUSIONS

Weight loss caused by VBG is associated with higher plasma ghrelin levels in obese patients. The operation restores the normal adaptation of the A- cells of the stomach to a meal.