Short-term dentoalveolar effects of aesthetic lip bumper appliance: A longitudinal cases-series and pilot study

Background

To investigate the short-term dentoalveolar effects on the mandibular arch of a modified, aesthetic lip bumper (ALBAa). The study sample comprised 23 patients (13 boys and 10 girls, with a mean age of 9.5 ± 1.8 years) in mixed dentition, with no previous orthodontic treatment. For each patient, a scan of the mandibular arch was digitally acquired pre-treatment (T0), and at 3 months (T1), 6 months (T2) and 9 months (T3) post-treatment. Linear intra-arch measurements, Little's irregularity index of the amount of mandibular anterior crowding, and the crown tipping values on all mandibular teeth were measured and compared statistically between time points. ANOVA and subsequent post-hoc tests were performed, considering a p-value of < 0.05 as significant.

Results

Linear intra-arch distances and crown tipping values on the mandibular teeth increased between the following time points: T0vsT1, T1vsT2, T0vsT2 and T0vsT3 (p < 0.05), although in the last three months of observation (T2vsT3) they only reached statistical significance at the lower incisors and lower left premolar concerning crown tipping values. There was a statistically significant decrease in anterior crowding throughout the observational period (p < 0.05), and this effect was equally distributed across the different time points investigated.

Conclusions

ALBAa therapy led to an increase in both linear intra-arch distances and crown tipping values, with a reduction in Little's index. The distribution of the effects reported across the observational period depended on the mechanism of action (mechanical vs. functional).

Treatment of severe Class II skeletal malocclusion in a hyperdivergent adult patient via hybrid clear aligner approach: A case report of successful camouflage therapy

This case report describes the camouflage treatment of an adult patient with hyperdivergent facial pattern presenting with severe Class II skeletal malocclusion, through the use of a hybrid clear aligner approach, that relies on both a partial lingual fixed appliance and the continuous use of Class II elastics throughout therapy. After 11 months of treatment, the goals had been achieved, highlighting that the correct diagnostic framework, proper patient selection and careful digital planning of a compromise treatment can provide satisfactory aesthetic and functional outcomes.

Observation of Rayleigh-Lamb waves generated by the 2022 Hunga-Tonga volcanic eruption with the POLA detectors at Ny-Ålesund

The eruption of the Hunga-Tonga volcano in the South Pacific Ocean on January 15, 2022, at about 4:15 UTC, generated a violent explosion, which created atmospheric pressure disturbances in the form of Rayleigh-Lamb waves detected all over the globe. Here we discuss the observation of the Hunga-Tonga shock-wave performed at the Ny-Ålesund Research Station on the Spitsbergen island, by the detectors of the PolarquEEEst experiment and their ancillary sensors. Online pressure data as well as the results of dedicated offline analysis are presented and discussed in details. Results include wave arrival times, wave amplitude measurements and wave velocity calculation. We observed five passages of the shock wave with a significance larger than 3 [Formula: see text] and an amplitude up to 1 hPa. The average propagation velocity resulted to be (308 ± 0.6) m/s. Possible effects of the atmospheric pressure variation associated with the shock-wave multiple passages on the cosmic-ray rate at ground level are also investigated. We did not find any significant evidence of this effect.

Analysis of biological and structural factors implicated in the clinical success of orthodontic miniscrews at posterior maxillary interradicular sites

OBJECTIVE

This study aims to evaluate success factors implicated in clinical orthodontic miniscrew stability after their interradicular placement in maxilla.

MATERIALS AND METHODS

Six hundred seventy-six miniscrews were inserted in maxillary interradicular sites in a sample of 276 patients (109 males and 167 females; mean age 19 ± 1.7 years) and immediately loaded. Percentage failure rate was recorded, and the influence of the following factors was investigated: structural (miniscrew length, diameter and body shape), operative (side of insertion site, pilot hole drilling or not) and biological (maximal insertion torque [MIT] and type of gingiva). A chi-square test with Monte Carlo correction was performed to detect the influence of these variables on the failure rate of orthodontic miniscrews. Then both multivariate logistic regression and post hoc analysis were performed, followed by classification and regression tree (CART) analysis.

RESULTS

The average success rate was 88%. The principal factors implicated in the failure rate were miniscrew length, MIT values and type of gingiva. Specifically, 8 mm miniscrew length, alveolar mucosa and 5-10 Ncm MIT values were linked to higher failure rates. According to CART, the main variable influencing failure is miniscrew length (≤ 8 mm for higher failure rates). For others, MIT values of 5-10 Ncm are linked to higher failure rates (p < 0.05).

CONCLUSION

Orthodontic miniscrews inserted in the maxilla display good success rates. However, clinicians should be discouraged from using miniscrews of length ≤ 8 mm and MIT values < 10 Ncm, even with longer miniscrews.

CLINICAL RELEVANCE

Information about factors related to failure rate of miniscrews placed at posterior maxillary interradicular sites is given.

Nine weeks versus 1 year adjuvant trastuzumab in combination with chemotherapy: final results of the phase III randomized Short-HER study‡

Background

Chemotherapy plus 1-year trastuzumab is the standard adjuvant treatment of HER2-positive breast cancer. The efficacy of less extended trastuzumab exposure is under investigation. The short-HER study was aimed to assess the non-inferiority of 9 weeks versus 1 year of adjuvant trastuzumab combined with chemotherapy.

Patients and methods

HER2-positive breast cancer patients with node-positive or, if node negative, with at least one risk factor (pT>2 cm, G3, lympho-vascular invasion, Ki-67 > 20%, age ≤35 years, or hormone receptor negativity) were randomly assigned to receive sequential anthracycline-taxane combinations plus 1-year trastuzumab (arm A, long) or plus 9 weeks trastuzumab (arm B, short). This study was designed as a non-inferiority trial with disease-free survival (DFS) as primary end point. A DFS hazard ratio (HR) <1.29 was chosen as the non-inferiority margin. Analyses according to the frequentist and Bayesian approach were planned. Secondary end points included 2-year failure rate and cardiac safety.

Results

A total of 1254 patients from 82 centers were randomized (arm A, long: n = 627; arm B, short: n = 626). Five-year DFS is 88% in the long and 85% in the short arm. The HR is 1.13 (90% CI 0.89-1.42), with the upper limit of the CI crossing the non-inferiority margin. According to the Bayesian analysis, the probability that the short arm is non-inferior to the long one is 80%. The 5-year overall survival (OS) is 95.2% in the long and 95.0% in the short arm (HR 1.07, 90% CI 0.74-1.56). Cardiac events are significantly lower in the short arm (risk-ratio 0.33, 95% CI 0.22-0.50, P < 0.0001).

Conclusions

This study failed to show the non-inferiority of a shorter trastuzumab administration. One-year trastuzumab remains the standard. However, a 9-week administration decreases the risk of severe cardiac toxicity and can be an option for patients with cardiac events during treatment and for those with a low risk of relapse.

Trial Registration

EUDRACT number: 2007-004326-25; NCI ClinicalTrials.gov number: NCT00629278.

Efficacy of swm appliance in the expression of first-, second- and third-order information in Class I and Class II

Background

To assess the efficacy of a multibracket appliance—Straight-wire Mirabella (SWM) prescription—in terms of achieving the ideal first-, second- and third-order values proposed by Andrews.

Material and Methods

A total sample of 46 Caucasian subjects was divided into two groups: 23 with class I malocclusion (Group 1), and 23 with class II malocclusion (Group 2). The treatment protocol involved fixed multibracket appliances—SWM prescription—for both groups, with the addition of class II elastics for Group 2. Values for ΔU1-PP, ΔIMPA, in-out, tip and torque were measured on digital scans, and the results obtained were compared with the ideal values proposed by Andrews.

Results

Statistically significant differences were revealed between the entire sample and Andrews’ values for: in-out on upper lateral incisors and upper canines; tip on the upper first premolars, upper second premolars, upper first molars and upper canines; and torque on the lower central incisors, lower lateral incisors, lower canines and lower first premolars. However, comparison of Groups 1 and 2 revealed statistically significant differences only at the lower lateral incisors. The use of class II elastics influenced ΔIMPA values, but not ΔU1-PP.

Conclusions

The efficacy of the multibracket appliance—SWM prescription—in expressing first- second- and, to a lesser extent, third-order information was demonstrated in both class I and class II malocclusions. Class II elastics only influenced the third-order expression on the lower lateral incisors and the ΔIMPA.

Key words:Straight wire fixed appliances, prescription efficacy, Class I malocclusions, Class II malocclusions.

Unexpected artefacts and occult pathologies under CBCT

Purpose

To present the most frequent occult pathologies unexpectedly encountered via cone-beam computed tomography (CBCT), with particular reference to the diagnostic role of the dentist and that of the radiographer, with a view to clarifying where the diagnostic responsibility lies.

Material and methods

A narrative literature review on the most diffused occult pathologies under CBCT was conducted, with iconographical guide as an example for each category.

Results

The most frequent forms of unexpected pathologies encountered are: the presence of foreign bodies, airway anomaly, and the presence of radio-opacity or -transparency in the maxillofacial district.

Conclusions

The orthodontists must know that they are responsible to recognize these frequent, and potentially serious, pathologies of the head and neck. If the dentist feels unable to take on this responsibility, he or she should, however, be sure to have the scans read by a specialist radiologist.

Phonetic analysis during treatment with rapid maxillary expander

OBJECTIVES

To investigate possible changes and/or device-related impairments in phonetic habits produced by rapid maxillary expansion (RME).

MATERIALS AND METHODS

Thirty-five patients scheduled for RME were divided into two groups: Group A (banded two-arm Hyrax) and Group B (banded four-arm Hyrax). Speech samples were collected at six time points, before, during and after RME removal. Acoustical analysis was performed using PRAAT and BioVoice analysis tools. Ten volunteers completed a questionnaire on the acceptability of patient's speech. Maxillary dimensions and palatal volume were measured on dental casts before and after expansion using a digital gauge.

RESULTS

Voice analysis showed an increase in the peak frequency of fricative consonants (/s/,/ʃ/) after expansion, whereas there was no change of formant frequencies of palatal consonants (/ɲ/,/ʎ/). Vowel /i/ displayed a lowering of the first formant frequency, and an increase in the second and third formant frequencies. After bonding, Group B showed both a greater reduction in the peak frequency of fricatives and a greater increase in the formant frequencies of palatal consonants than Group A.

CONCLUSION

Rapid maxillary expansion causes a slight phonetic change in the acoustical parameters of both consonants and vowels. The two-arm Hyrax caused less speech impairment than the four-arm Hyrax during the treatment.

Quantitive evaluation of dentin sialoprotein (DSP) using microbeads - a potential early marker of root resorption

PURPOSE

This study had the aim of comparing two different methods of analysing dentin sialoprotein (DSP) in the gingival crevicular fluid (GCF): the conventional eLISA approach and a new method involving the use of magnetic micro-beads coated with an antibody specific for DSP prior to eLISA analysis.

MATERIALS AND METHODS

GCF was taken from six patients following twelve weeks of orthodontic treatment using paper strips inserted into the mesial and distal sulci of the upper incisors, and analysed using both methods.

RESULTS

Statistical analysis of the results using the Mann-Whitney non-parametric test showed that the micro-bead approach conferred more reliability and less variability on the conventional eLISA approach. Furthermore, this method, for the first time, enables the quantification of the DSP in the sample in ng/μl.

CONCLUSIONS

The innovative micro-bead/eLISA approach proposed provides a reliable means of quantifying the DSP in the GCF.

A prospective evaluation of outcomes of two tapered implant systems

The purpose of this prospective clinical study was to evaluate survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around the implant neck) of two tapered implant systems. Both systems were equipped with a tapered connection, one requiring bone-level (BL) placement, while the other required soft-tissue-level (STL) placement. In the period between January 1996 and October 2011, 133 fixtures were inserted, 90 in females and 43 in males, with a mean age of 60±11 years. The mean post-surgical follow-up was 64±38 months. Several clinical parameters were evaluated as potential outcome conditioners. An SPSS program was used for statistical analysis and a Cox analysis was performed. The SVR was 100% since no fixtures were lost. SCR, expressed through the mean marginal bone loss, was 88%. No significant differences were found, for most of the variables investigated with the exception of bone grafting and implant type: STL implants showed a better clinical outcome than BL implants when bone grafting was performed simultaneously with implant placement. Tapered implants are reliable devices for oral rehabilitation of jaws.

Retrospective study on bone-level and soft-tissue-level cylindrical implants

The purpose of this prospective clinical study was to evaluate the survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around implant neck) of two cylindrical implant systems. Both systems were equipped with a tapered connection, one requiring a bone-level (BL) placement, while the other a soft-tissue-level (STL) placement. In the period between January 1996 and October 2011, a total of 150 implants (76 in females and 74 in males, mean age 60±11 years) were inserted. The mean post-surgical follow-up was 84±47 months. Several parameters were evaluated as potential outcome conditioners: age, gender, diabetes, smoking, periodontitis, type of edentulism, replaced tooth, jaw location (i.e. maxilla or mandible), bone graft, immediate loading, post-extractive, type of prosthesis, implant diameter and length. An SPSS program was used for statistical analysis. Only two fixtures were lost, therefore SVR was 98.7%. SCR, expressed through the mean marginal bone loss, was 92%. The mean peri-implant bone loss was 0.121.47 mm for BL implants and 0.041.3 mm for STL implants. None of the studied variables had a statistical significant impact on SVR or SCR. Cylindrical implants are reliable for oral rehabilitation.

Guided bone regeneration in distal mandibular atrophy by means of a preformed titanium foil: a case series

The aim of this case series was to evaluate the clinical outcome of preformed titanium foil (PTF) to perform guided bone regeneration (GBR) in posterior mandibular atrophies. Thirteen patients (4 male; 9 female; mean age 58.85±10.16 years), with class II division C atrophy, according to Misch, were selected to perform GBR by means of PTF, using a moldable allograft paste as graft material. The devices, made of a 0.2mm thick pure titanium foil, were pre-shaped using stereolithographic models obtained from CT-scan of the patients’ recipient sites. In the second stage, performed at 6.35±2.15 months, 23 cylindrical two-piece implants were placed and the devices removed. At four months, the implants were exposed and submitted to progressive prosthetic load for a span of 4 months. The cases were finalized by means of metal-ceramic cementable restorations. The post finalization follow-up was at 12 months. Survival rate (i.e. SVR) was 100% since no fixtures were lost. At the one-year follow up, the clinical appearance of the soft tissues was optimal and no pathological signs on probing were recorded. The success rate (i.e. SCR) was 82.6% and the average peri-implant bone reabsorption was 0.99±0.59 mm. The results suggest good potentialities of this method for bone volume augmentation in distal mandibular atrophies, allowing to maximize the outcome and simplifying the surgical phase.

Clinical outcome of a two-piece implant system with an internal hexagonal connection: a prospective study

The purpose of this prospective clinical study was to evaluate the survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around implant neck) of an implant system characterized by cylindrical and tapered implants, both provided with an internal hexagonal connection. In the period between January 1996 and October 2011, 52 implants with internal hexagonal connection were inserted in 21 females and 31 males, mean age 54±11 years. The mean post-surgical follow-up was 44.6±34.4 months. Several parameters were evaluated as potential outcome conditioners: age, gender, smoking, replaced tooth, periodontal disease, fixture shape (i.e. cylindrical or tapered), jaw location (i.e. maxilla or mandible), bone graft, immediate loading, post-extractive placement, type of prosthesis (i.e. single crown or bridge), edentulism, implant diameter and length. An SPSS statistical program was used and Cox regression analysis performed. SVR was 100% since no fixtures were lost. SCR, expressed through the mean marginal bone loss, was 77%. No significant differences were found, for most of the parameters analyzed, with the exception of prosthetic bridges, where implants supporting this type of rehabilitation showed a worse clinical outcome in comparison to single crown rehabilitations. Internal hexagonal connection is a reliable tool for oral rehabilitation.

Modified connective tissue punch technique to increase the vestibular/buccal keratinized tissue on flapless implant surgery: a case series

The aim of this article is to show a simple and predictable technique to enhance both the vestibular/buccal (V/B) gingival thickness (GT) and keratinized tissue width (KTW) improving the soft-tissue profile after flapless implant placement. The technique proposed was named Modified Connective Tissue Punch (MCTP). Fourteen patients (6 men and 8 women) aged between 35 and 69 years (mean value 48.07±13.023 years) were enrolled in this case series. Seventeen implant sites were submitted to flapless procedure. The connective punch (CP) was harvested with a motor-driven circular tissue punch and then a full-split dissection was executed, in order to create a deep pouch, beyond the mucogingival junction, on the V/B side. In this recipient site the CP was placed. The normal flapless surgical protocol was used; implants were inserted and covered with transgingival healing cap screws. GT and KTW were measured: both immediately before and after surgery; at the time of the prosthetic finalization (3-4months, respectively, for mandible and maxilla); 1 year post surgery follow-up. GT was measured at 1 mm, 2 mm and 5 mm on the V/B side, from the outline of the punch. Both KTW and GT at 1 and 2 mm can be effectively increased, while no significant effects for GT at 5 mm can be expected from this technique. Furthermore, the mean values of KTW and GT at 1 mm and 2 mm show significant increases at 3-4 months post-operative, while no further significant increments are shown at 1 year post-operative follow-up. The Authors recommend the use of the MCTP technique to reduce the number of aesthetic complications and soft tissue defects in flapless implant surgery. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time.

Clinical outcome of 215 transmucosal implants with a conical connection: a retrospective study after 5-year follow-up

The purpose of this retrospective clinical study was to evaluate the survival rate (i.e. SVR – fixtures still in place at the end of the observation period) and success rate (i.e. SCR - bone resorption around implant neck) of an implant system characterized by cylindrical and tapered implants, both types of implant being equipped with a conical connection with an internal octagon (COC), both implant types having a 1.8 mm smooth neck, positioned above the bone crest level. A total of 65 subjects received 215 COCs between January 1996 and October 2011. All COCs were placed and restored by three experienced dental surgeons. The mean follow-up was 84±44 months. The patients involved in the study were both male (30) and female (35), of whom 30 were smokers (less than 20 cigarettes/day) and none was diabetic. The implants differed in terms of diameter and length, and were inserted both in the mandible (97) and in the maxilla (118). Sixty-seven implants were single tooth rehabilitations, and 148 prosthetic bridges. Fourteen had guided bone regeneration (GBR), and 10 were placed in post-extractive sites. Forty of the implants were provided with passing-screw abutments and 175 with full-screw abutments. The data were analyzed using descriptive statistics. None of the implants failed before prosthetic restoration, resulting in an SVR=100% after loading. The radiographic and clinical data revealed well-maintained, hard and soft tissue around the COCs, with an SCR=92.6%. Cox regression analyses did not detect any variables with statistical impact on the clinical outcome. In conclusion, Shiner XT implants are reliable tools for oral rehabilitation.

Maxillary sinus by-pass with tilted implants via tapered-screw bone expanders in low density bone: one year follow -up of a case series

In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors named the procedure: Tilted Implant Expansion Osteotomy (TIEO). Fifteen patients (10 females and 5 males, mean age 47.8±8.15 years) with distal edentulous maxillae were enrolled in this study. For each edentulous site 2 implants were placed, the anterior implant in the area of the most anterior missing tooth while, the posterior implant, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 34 cylindrical two-piece implants were placed, 17 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 4-6 months, the second stage surgery was performed. The cases were finalized by metal-ceramic cementable restorations with a variable number of elements, from 2 to 4, without any cantilever element. The post finalization follow-up was at 12 months. Survival rate was 100% since no fixtures were lost. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for oral rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

Guided bone regeneration by means of a preformed titanium foil: A case of severe atrophy of edentulous posterior mandible

The aim of this case report was to evaluate the potential of preformed titanium foil (PTF) as membrane, used together with a mouldable allograft paste, for guided bone regeneration in a case of severe mandibular posterior atrophy involving the alveolar nerve. In order to create a rigid barrier to the competitive growth of soft tissues and a stable volume for the colonization of the osteoprogenitor cells, a foil of pure titanium was pre-shaped by means of a stereolithographic model, obtained from a CT-scan of the patient. This procedure showed promising results, allowing to maximize the outcome and simplifying the surgical phase.

Endoscopically controlled hydraulic sinus lift in combination with rotary instruments: one-year follow-up of a case series

The aim of this study was to evaluate a sinus lift via crestal approach (SLVCA) case series, performed with rotary instruments and hydraulic pressure, analyzed under endoscopic control. Sixteen patients (11 female, 5 male, mean age 47.13±8.07 years) candidates for SLVCA were enrolled in this study. Twenty-two cylindrical two-piece implants were placed. After a suitable period of time needed for the consolidation of the graft (mean value 5.78±1.49 months), the bone augmentation was assessed by means of intraoral X-ray exams before the surgical procedure of re-entry. After a functional load with temporary acrylic fixed prosthesis, on Peek abutments, for a span of 4 months, the cases were finalized with cemented metal-ceramic prosthesis (10 single crowns, 6 bridges). The post finalization follow-up was at 12 months. During the perforation of the sinus floor via rotary instruments no perforations of the sinus membrane were observed either during the hydraulic detachment or simultaneous filling of the subantral space with the graft material. Survival rate was 94.5% since one fixture was lost, but immediately replaced with a new one. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. The SLVCA performed with rotary instruments and hydraulic pressure is a reliable grafting procedure for oral rehabilitation of maxillary edentulous sites.

The influence of “conical plus octagonal” internal connection on implant survival and success rate: a retrospective study of 66 fixtures

Implant oral rehabilitation has become one of the most successful dentistry techniques over the last 30 years. However, peri-implantitis is the most important complication in implant dentistry. Peri-implantits can be caused by inadequate implant-abutment connections (IAC). The aim of our study is to evaluate the influence of “conical plus octagonal” (i.e. I-Fix connection) on implant survival and success rate. All the implants included in this study were of a completely new type (I-Fix implants and abutments by FMD Falappa Medical Devices S.p.A. Rome, Italy). Sixty-six implants were inserted in males and females. The implants were of different diameters and lengths, inserted both in the mandible and in the maxilla with immediate or delayed loading, with guided bone regeneration (GBR), and post-extractive surgery. All implants were provided with I-Fix connection, 64 abutments using passing screws and 2 using full screws. None of the 66 implants were lost (i.e. survival rate - SVR = 100%). Cox-regression analysis demonstrated that diabetes (p=0.0074), GBR (p=0.0115), maxilla (p=0.0117) and smoking (p=0.0194) have a statistical significant impact on clinical outcome (i.e. greater bone resorption around implant neck). Our data show that I-Fix connection did not influence SVR. This finding demonstrates that I-Fix design seemed to significantly affect the survival rate of the implants in a recent meta-analysis. In spite of the limits of our study, I-Fix connection has been demonstrated to be efficient in closing the gap between implant and abutment and maintaining a good connection over time.

Orthofile®: a new approach for mechanical interproximal reduction : a scanning electron microscopic enamel evaluation

PURPOSE

The aim of this in vitro study was to evaluate the stripping achieved on different teeth (incisors, canines, and premolars) by two grades of abrasive strips used for the first and tenth time. Our second aim was to test the efficacy of these strips by calculating the time necessary to perform interproximal reductions of 0.10, 0.20, and 0.30 mm.

METHODS

Four models were constructed using extracted teeth affixed in wax. The upper and lower arches were set on plaster bases and fixed in wax, carefully creating contact points. All model mouths were treated with artificial saliva (Oral Balance®) in order to simulate the biological conditions in the oral cavity. We then tested specific air-rotor strips of different grades and degrees of wear (15-µm-grain and 25-µm-grain Orthofile® strips). Afterwards the teeth from all samples were cut lengthwise in half, and each mesial and distal portion was gold-plated and observed under SEM at incremental magnification (30, 60, and 100 µm).

RESULTS

The 25-µm-grain strip was more effective than the 15-µm-grain strip, irrespective of the tooth involved. Second, the finishing phase with specific polishing strips after interproximal reduction was fundamental in reducing the number of abrasions and irregularities created by stripping, in particular after using the 25-µm-grain strip. To achieve the best result, the entire abraded area must be polished.

CONCLUSION

This system permits a rapid and effective stripping procedure in direct proportion to the strip's grain and in inverse proportion to the wear from its use. Further research will enable us to compare this system with similar procedures.

Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men

Associations between social support network characteristics and sexual risk among racially/ethnically diverse young men who have sex with men (YMSM) were examined using egocentric network data from a prospective cohort study of YMSM (n = 501) recruited in New York City. Bivariate and multivariable logistic regression analyses examined associations between social support network characteristics and sexual risk taking behaviors in Black, Hispanic/Latino, and White YMSM. Bivariate analyses indicated key differences in network size, composition, communication frequency and average relationship duration by race/ethnicity. In multivariable analyses, controlling for individual level sociodemographic, psychosocial and relationship factors, having a sexual partner in one's social support network was associated with unprotected sexual behavior for both Hispanic/Latino (AOR = 3.90) and White YMSM (AOR = 4.93). Further examination of key network characteristics across racial/ethnic groups are warranted in order to better understand the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.

Cross-cultural standardization of the South Texas Assessment of Neurocognition in India

BACKGROUND & OBJECTIVES

Despite the central role of cognition for mental disorders most studies have been conducted in western countries. Similar research from other parts of the world, particularly India, is very limited. As a first step in closing this gap this cross-cultural comparability study of the South Texas Assessment of Neurocognition (STAN) battery was conducted between USA and India.

METHODS

One hundred healthy adults from Kerala, India, were administered six language independent subtests of the Java Neuropsychological Test (JANET) version of the STAN, assessing aspects of general intellectual ability (Matrix Reasoning), attention (Identical Pairs Continuous Performance, 3 Symbol Version Test; IPCPTS), working memory (Spatial Capacity Delayed Response Test; SCAP), response inhibition (Stop Signal Reaction Time; SSRT), Emotional Recognition and Risk taking (Balloon Analogue Risk Task; BART). Test results were compared to a demographically matched US sample.

RESULTS

Overall test performance in the Kerala sample was comparable to that of the US sample and commensurate to that generally described in studies from western countries.

INTERPRETATION & CONCLUSIONS

Our results support the metric equivalence of currently available cognitive test batteries developed in western countries for use in India. However, the sample was restricted to individuals who were literate and had completed basic primary and secondary education.

Ionic liquid-based membranes as electrolytes for advanced lithium polymer batteries

Gel-type polymer electrolytes are formed by immobilizing a solution of lithium N,N-bis(trifluoromethanesulfonyl)imide (LiTFSI) in N-n-butyl-N-ethylpyrrolidinium N,N-bis(trifluoromethanesulfonyl)imide (Py₂₄TFSI) ionic liquid (IL) with added mixtures of organic solvents, such as ethylene, propylene and dimethyl carbonates (EC, PC, and DMC, respectively), into a poly(vinylidenefluoride-co-hexafluoropropylene) (PVdF-HFP) matrix, and their properties investigated. The addition of the organic solvent mixtures results in an improvement of the ionic conductivity and in the stabilization of the interface with the lithium electrode. Conductivity values in the range of 10⁻³-10⁻²  S cm⁻¹ are obtained in a wide temperature range. These unique properties allow the effective use of these membranes as electrolytes for the development of advanced polymer batteries based on a lithium metal anode and an olivine-type lithium iron phosphate cathode.

MGMT methylation status as a prognostic factor in anaplastic astrocytomas

2052

Background: MGMT methylation status has been found to be an important prognostic factor in glioblastoma patients (pts). However, further data on the epigenetic feature are needed before its role in rare diseases such as anaplastic astrocytomas (AA) can be established. Methods: A retrospective analysis was made on a database of 139 AA pts followed prospectively from January 1995 and August 2008. We evaluated only pts who met the following inclusion criteria: age >18 years; PS 0–2; histological diagnosis of AA; postoperative radiotherapy (RT) and chemotherapy (CT). MGMT status was determined with methylation specific PCR. The study aim was to evaluate the role of MGMT methylation status in AA. The log-rank test was employed to evaluate the significance of the prognostic variables. Results: 80 pts (m/f: 46/34, median age: 41 years, range: 18–71 years) were enrolled. MGMT was assessable in 71 of 80 pts (88.8%), being methylated in 30 (42.9%), and unmethylated in 41 (57.7%) pts. Median PFS was 48.6 months (95% CI: 33.7 - 63.5), being 96 months (95% CI: 29–163) and 38 months (95%CI: 18.9–57.2) in MGMT methylated and unmethylated pts, respectively (p = 0.09). At univariate analysis, complete resection (p = 0.02), age (p = 0.002), and KPS (p = 0.003) were significantly correlated with PFS. At multivariate analysis only age remains correlated with PFS (p = 0.01). Median survival (OS) was 93.7 months (95% CI: 63.5–123.8), being not reached and 77 months (95% CI: 20–134.2), in MGMT methylated and unmethylated pts, respectively (p = 0.03). MGMT methylation (p = 0.03), age (p = 0.0003), and KPS (p = 0.03) were significantly correlated with OS at univariate analysis. At multivariate analysis, age (p = 0.0002) and MGMT methylation (p = 0.01) were correlated with a better OS. Conclusions: MGMT methylation status is an independent prognostic factor together with age in AA. This datum should provide the background to improve the therapeutic index with temozolomide concurrent with and adjuvant to RT in AA.

No significant financial relationships to disclose.

Epidural plus general anesthesia vs general anesthesia alone for elective aortic surgery: effects on gastric electrical activity and serum gastrin secretion

BACKGROUND

The aim of this study was to evaluate differences in electrogastrographic activity and serum gastrin secretion in patients subjected to general anesthesia (GA) vs blended anesthesia (BA = GA plus epidural analgesia) for abdominal aortic surgery.

METHODS

Thirty-four patients (all males: 28 with abdominal aorta aneurysm, 6 with obstructive aorto-iliac disease; mean age: 68+/-7 years) were randomly assigned either to GA (N.=17) or to BA (N.=17) for abdominal aortic surgery. Each patient was evaluated for serum gastrin secretion at the time of electrogastrography (EGG) 24 h before and after surgery, using ambulatory equipment. Gastrin levels were tested under fasting conditions and after a standard meal. EGG shows gastric electrical activity that parallels gastric motor activity.

RESULTS

Before surgery, no significant difference was found for any of the EGG parameters or the serum gastrin integrated value (area under the curve [AUC]) between the two groups of patients. After surgery, an increased frequency of electrical waves (tachygastria) was observed in 22% of those undergoing GA and in 5% of patients undergoing BA. The power ratio (postprandial/fasting total power) was exceedingly high (>4) in 53% of the GA patients and in 11% of the BA patients (P<0.05). The gastrin AUC was 263+/-58 pg/mL in the GA group and 179+/-92 pg/mL in the BA group (P<0.01).

CONCLUSIONS

An excess of EGG activity and serum gastrin secretion was observed in patients undergoing GA vs those submitted to BA. Thus, the latter procedure seems to affect gastric function less than GA alone.

New insights into Lactobacillus and functional intestinal disorders

Intestinal microflora can be considered as a ''dynamic system'' that actively interacts with the intestinal epithelium and the local immune system. It synthesizes antimicrobial substances (bacteriocins), vitamins (PP, B1, B6, B12), it produces a major intestinal nutrient (butyric acid) and interacts in a competitive fashion with the pathogens. Lactobacilli concentration (Gram+, Gram variable, facultative anaerobes) is generally decreased in irritable bowel syndrome (IBS) patients. This syndrome has, until recently been considered to be ''functional'', whereas, in fact, it may result from previous enteritis (in up to 31% of patients), featuring a persistent low-grade intestinal inflammation and a reduction in interleukin-10 (IL-10) concentration. Some Lactobacilli strains (e.g. L. paracasei subsp. paracasei) in vitro lead to normalisation of the hypercontractility of the smooth muscle cells. A growing body of clinical findings indicates that some ''genetically stable'' strains of Lactobacilli may be useful in the treatment, even long term, of IBS, and reduce the postoperative infection rate, especially in critically ill patients (orthotopic liver transplant, severe pancreatitis). However, some Lactobacilli, ''not genetically stable'', used in the treatment of neutropenic patients during chemotherapy and in pediatric patients submitted to gastrojejunostomy, have been reported to lead to bacteremia and endocarditis. These effects may be due to transfer of bacteria and genetic material. Therefore, the confirmed genetic stability and the fact that no antibiotic resistance occurs are fundamental requisites for the use of Lactobacilli in certain disorders of the gastrointestinal tract, such as, for instance, IBS. In conclusion, ''genetically stable'' Lactobacilli (L. paracasei subsp. Paracasei F19) have recently become available, representing an exiting new field in clinical studies and for treatment purposes, offering guarantees of safety also for long-term use. Careful personalized evaluation, as always in medical practice, is necessary in order to gain further insight into, and to validate with additional studies, the role of ''genetically stable'' Lactobacilli in the treatment of IBS.

Lichen metabolites prevent UV light and nitric oxide-mediated plasmid DNA damage and induce apoptosis in human melanoma cells

In humans both UV-A and UV-B can cause gene mutations and suppress immunity, which leads to skin cancer, including melanoma. Inhibition of reactive oxygen species (ROS) and reactive nitrogen species (RNS) appears particularly promising as ROS and RNS production by both UV-A and UV-B contributes to inflammation, immunosuppression, gene mutation and carcinogenesis. We evaluated the effect of two lichen compounds, sphaerophorin (depside) and pannarin (depsidone) on pBR322 DNA cleavage induced by hydroxyl radicals (()OH), and by nitric oxide (NO), and their superoxide anion (O(2)(-)) scavenging capacity. In addition, we investigated the growth inhibitory activity of these compounds against human melanoma cells (M14 cell line). Sphaerophorin and pannarin showed a protective effect on plasmid DNA and exhibited a superoxide dismutase like effect. The data obtained in cell culture show that these lichen metabolites inhibit the growth of melanoma cells, inducing an apoptotic cell death, demonstrated by the fragmentation of genomic DNA (COMET and TUNEL Assays) and by a significant increase of caspase-3 activity, and correlated, at least in part, to the increase of ROS generation, These results confirm the promising biological properties of sphaerophorin and pannarin and encourage further investigations on their molecular mechanisms.

[Fibers glass induced cytotoxicity and genotoxicity]

Man-made vitrous fibers, have been widely used as a substitute for asbestos, as an insulation material. However the fibrous morphology of MMVFs raises concern about potential health hazard. The aim of our study was to assess cytotoxic and genotoxic effects induced on a human alveolar cell line A549 by exposure to glass wool fibers (GW). Cells were exposed for 72 h to 5, 50, 100 microg/ml of glass wool, after incubation the cell viability was determined by a MTT reduction assay. The genotoxic effect was studies by Comet test. An undamaged cell appeared as a nucleoid and a cell with damaged DNA as a comet. Measurement of Comet parameters: % DNA in the tail, tail length and tail momente (the product of relative tail intensity and lenght, that provides a parameter of DNA damage) were obtained from the analysis. A MTT assay indicated that glass wool caused a decrease in cell viability and this decrease was concentration-dependent. The results of the Comet test for DNA damage detection indicated in cell exposed to glass wool fibers a significant increase of mean TM value. All these results provide that the glass wool fibers can induce cytotoxicity and genotoxicity

Demalonyl thyrsiflorin A, a semisynthetic labdane-derived diterpenoid, induces apoptosis and necrosis in human epithelial cancer cells

In a previous study, we isolated thyrsiflorin A, a new diterpene with the scopadulane skeleton, from Calceolaria thyrsiflora (Scrophulariaceae family). Experimental evidences on the semisynthetic analogues of scopadulane diterpenes have permitted to hypothesize that a polar substituent is important for the antitumor activity of this class of compounds. Therefore, the present study was undertaken to investigate the effect of the semisynthetic compound, demalonyl thyrsiflorin A, on cell growth and death in two human epithelial cell lines, DU-145 cells (androgen-insensitive prostate cancer cells) and KB cells (oral squamous carcinoma cells). The results obtained, show that our compound, exhibited comparable degrees of antigrowth effect on cancer cells examined as judged by IC(50) values, 9.77 microM (2.73 microg/ml) and 10.86 microM (3.04 microg/ml) in DU-145 and KB cells, respectively, and support the hypothesis that also for diterpenoid compounds an available hydroxyl group is important for decreased cancer cell viability. In addition, we demonstrated an apoptotic response after treatment of DU-145 and KB cells with this semisynthetic compound at 6-12 microM concentrations, together with a necrosis process at higher doses (25-50 microM). Both apoptotic and necrotic pathway implicated in demalonyl thyrsiflorin A-treated cells are correlated with the elevation of ROS generation.

Putrescine-1,4-dicinnamide from Pholiota spumosa (Basidiomycetes) inhibits cell growth of human prostate cancer cells

Previously, it was isolated from the fruiting bodies of the gilled mushroom Pholiota spumosa (Basidiomycetes, Strophariaceae), putrescine-1,4-dicinnamide, a phenylpropanoid derivative conjugated with polyamine putrescine never isolated before as a natural compound. Recently, polyamine analogs that are similar in structure to the natural polyamines but that cannot mimic their functions that are essential for cellular growth and differentiation, have shown antitumor activity in several types of human cancer cells. Therefore, we have now investigated the response of DU-145 cells, a well characterized androgen-independent human prostate cancer (PCA) cell line, to this phenylpropanoid derivative. The results presented here demonstrate that putrescine-1,4-dicinnamide, as suggested for polyamine analogs synthesized artificially, inhibits the cell growth of cancer cells inducing apoptosis cell death, mediated, at least in part, by the activation of caspase cascades, that at higher doses shift to necrosis, through the increase of reactive oxygen species (ROS) generation.

In vitro study of biofunctional indicators after exposure to asbestos-like fluoro-edenite fibres

The in vitro biological response to fluoro-edenite (FE) fibres, an asbestos-like amphibole, was evaluated in lung alveolar epithelial A549, mesothelial MeT-5A and monocyte-macrophage J774 cell lines. The mineral has been found in the vicinity of the town of Biancavilla (Catania, Sicily), where an abnormal incidence of mesothelioma has been documented. Cell motility, distribution of polymerized actin, and synthesis of vascular endothelial growth factor (VEGF) and of beta-catenin, critical parameters for tumour development, progression and survival, were investigated in A549 and MeT-5A cells exposed to 50 microg/ml FE fibres for 24 hr and 48 hr. The levels of cyclooxygenase (COX-2) and prostaglandin (PGE2), two molecules involved in cancer pathogenesis by affecting mitogenesis, cell adhesion, immune surveillance and apoptosis, were measured in J774 cells treated with FE fibres under the same experimental conditions. Finally, FE fibres were studied by SEM and EDS analysis to investigate their chemical composition. Exposure of A549 and MeT-5A cells to FE fibres affected differentially phalloidin-stained cytoplasmic F-actin networks, cell motility and VEGF and beta-catenin expression according to the different sensitivity of the two cell lines. In J774 cells it induced a significant increase in COX-2 expression, as assessed by Western blot analysis, and in the concentration of PGE2, measured in culture media by ELISA. SEM-EDS investigations demonstrated two types of FE fibres, edenite and fluoro-edenite, differing in chemical composition and both recognizable as calcic amphiboles. Fibre width ranged from less than 1 microm (prevalently 0.5 microm) to 2-3 microm (edenite) up to several microm (fluoro-edenite); length ranged from about 6 to 80 microm (edenite) up to some hundred microm (fluoro-edenite). Results provide convincing evidence that FE fibres are capable of inducing in vitro functional modifications in a number of parameters with crucial roles in cancer development and progression. Inhaled FE fibres have the potential to induce mesothelioma, even though their ability to penetrate lung alveoli depends on their aerodynamic diameter.

Efficacy and tolerability of gefitinib in pretreated elderly patients with advanced non-small-cell lung cancer (NSCLC)

The activity and toxicity profile of gefitinib in non-small cell lung cancer (NSCLC) patients aged 70 years or older has been only partially evaluated. The aim of this study was to evaluate the response rate and safety of gefitinib in elderly NSCLC patients. Elderly NSCLC patients pretreated with chemotherapy and with at least one measurable lesion received gefitinib at the daily dose of 250 mg until disease progression, unacceptable toxicity or refusal. From August 2001 to May 2003, 40 consecutive elderly patients have been enrolled onto the study in three Italian institutions. We observed one complete (2.5%) and one partial response (2.5%), 18 disease stabilisations (NC: 45%) lasting at least 2 months, including six patients (15%) who had disease stabilisation of 6 months or longer, for an overall disease control rate of 50% (95% CI: 34.5-65.5%). The median duration of response was 4.4 months (range 1.7-9.2). The side effects were generally mild and consisted of diarrhoea and skin toxicity. Grade 1-2 diarrhoea occurred in 23.6%, and one patient experienced grade 4 diarrhoea, requiring hospitalisation. Grade 1-2 skin toxicity, including rash, pruritus, dry skin, and acne, occurred in 20 patients (52.6%). Gefitinib is safe and well tolerated in elderly pretreated NSCLC patients. The disease-control rate achieved suggests that this drug could represent a valid option in the management of this unfavourable subgroup of patients.

Multiple sampling 13C-urea breath test: improvement of diagnosis in postgastrectomy patients

AIM

Partial gastrectomy and Helicobacter pylori (H. pylori) infection are considered 2 risk factors for gastric cancer development. False negative urea breath test (UBT) results have been described in patients with gastric surgery, due to rapid gastric emptying of urea solution from the stomach. On the other hand, a rapid 10-minute 14C-UBT proved to be highly reliable for diagnosis of H. pylori infection when delaying test meal was omitted. Aim of this study was to improve the diagnostic accuracy of 13C-UBT in patients with gastric resection.

METHODS

UBT was performed in 100 gastrectomised patients with breath collection at 0, 10, 15, 20, 25 and 30 minutes (multi-UBT) after 100 mg 13C urea ingestion and 100 ml of marketed fruit juice. In 28 cases contemporary histological data from biopsy specimens (within 1 month, in absence of treatment) were also available.

RESULTS

Multi-UBT was persistently negative or positive in all the samplings in 34% and 25% of cases, respectively. Positivity only at 30 minutes was found in 10% of cases, while 19% of subjects were positive at 15-25 minutes but not at 30 minutes. In 12% of cases the test was positive only at 10 minutes.

CONCLUSIONS

Multi-UBT offers a not negligible diagnostic improvement over the standard UBT: at least 19%, and up to 31% if positivity at ''10-minute only'' is taken into account. This method can be useful when accurate diagnosis of H. pylori infection is required in gastrectomised patients.

Effectiveness of Helicobacter pylori eradication treatments in a primary care setting in Italy

AIM

To evaluate the choice and relative effectiveness of Helicobacter pylori eradication regimens in a primary care setting.

PATIENTS AND METHODS

Patients referred to our department, who had been treated for H. pylori infection during the preceding 6 months, were enrolled between September 1998 and July 1999. H. pylori status was assessed by urea breath test. Information on the drugs administered, compliance and side-effects was recorded.

RESULTS

The mean eradication rate was 72% in patients receiving their first course of treatment (1863 cases; 45% male; mean age, 53 +/- 14 years); a double therapy regimen was prescribed to 14% of patients, triple therapy to 85% and quadruple therapy to 1%. Maastricht Consensus proton pump inhibitor-based regimens were prescribed in 80% of cases, with a mean eradication rate of 73%. No statistically significant correlation was found between eradication failure and sex, age, endoscopic findings or administered treatment.

CONCLUSIONS

In Italy, in a primary care setting, first-line H. pylori eradication therapies reflect international guidelines. The efficacy of such regimens is lower than that reported by controlled trials. These results are relevant when making pharmacoeconomic evaluations of H. pylori management.

Modality of treatment and outcome of Helicobacter pylori infection in primary care. An Italian experience

BACKGROUND

Aim of the present study was to evaluate the selection and the relative efficacy of H. pylori eradication regimens in primary care setting.

METHODS

Patients referred to our Department, treated for H. pylori infection during the last 6 months, were enrolled during September 1998-July 1999. H. pylori status was assessed by urea breath test and recorded together with information about administered drugs, compliance, side effects.

RESULTS

In patients undergone the first treatment course (1863 cases, 45% M, mean age 53+/-14 yrs) the mean eradication rate (ER) was 72%: a double therapy was prescribed in 14% of cases, a triple therapy in 85% and a quadruple in 1%. Maastricht Consensus PPI-based regimens were prescribed in 80% of total cases with a mean ER of 73%. No statistical significant correlation was found between eradication failure and sex, age or administered treatment.

CONCLUSIONS

In Italy, in primary care setting: 1) first line H. pylori eradication therapies reflect international guidelines; 2) the efficacy of such regimens is lower than the one reported by controlled trials: such data should be kept in mind when pharmacoeconomic evaluations of H. pylori management are drawn.

Impact of urea breath test (UBT) in the management of H. pylori infection in a primary care setting

BACKGROUND

Aim of the present study was to evaluate the use of UBT in a primary care setting.

METHODS

From September 1998 to July 1999 we studied 2810 consecutive patients, referred to the Department of Gastroenterology, Mauriziano Hospital, Torino. A structured questionnaire was used to record information on demographic characteristics and clinical history. 13C-UBT was performed by means of isotope ratio mass spectrometer.

RESULTS

The results shown that: 1) the main indication to perform UBT was the evaluation of treatment success (72% of cases); 2) in patients aged less than 45 years and never assessed before for H. pylori infection, UBT was used as first line procedure in 68% of cases: this finding stand for an initial adoption of the ''test and treat'' strategy; 3) first line H. pylori eradication therapies reflect international guidelines.

CONCLUSIONS

The effectiveness of therapeutic regimens results to be decreased when translated into routine clinical practice.

Fecal pancreatic elastase 1 in the work up of patients with chronic diarrhea

BACKGROUND

Quantitative determination of pancreatic elastase-1 (E1) in stools has been proposed as a novel, noninvasive test of pancreatic function. The aim of the study was to verify its role in the differential diagnosis of chronic diarrhea.

METHODS

E1 was measured in spot stool samples of 50 patients with pancreatic disease (PD), 62 with inflammatory bowel disease (IBD), 45 with chronic diarrhea (CD), 34 with other gastroduodenal and liver disease (gastrointestinal; GI), and in 18 normal controls, by a commercial kit (Schebo-Tech., Wettemburg, Germany).

RESULTS

In PD, patients with severe damage and diarrhea displayed E1 levels below 100 microg/g; normal values were found in mild-moderate disease. Abnormal values were detected in 4 CD and in 14 IBD patients, either in the presence of severe protein malnutrition or in patients with previous ileo-anal pouch anastomosis and pouchitis. In nine cases, values reverted to normal after adequate treatment. Diagnostic accuracy of E1 in discriminating diarrhea of pancreatic and nonpancreatic origin was: SS, 97%; SP, 84%; VP+, 66%; VP-, 100%.

CONCLUSION

1) The finding of a normal E1 value rules out a malabsorption of pancreatic origin. 2) in CD and IBD, decreased E1 might be owing to bacterial elastase degradation (pouchitis) or transient defective pancreatic enzyme secretion.

CagA seropositivity and the severity of Helicobacter pylori infection in dyspeptic children

AIM

To assess the incidence of cagA (cytotoxin-associated protein) and to evaluate its correlation with endoscopic-histologic findings and with eradication rate in a series of children affected by Helicobacter pylori (H. pylori) gastritis.

METHODS

Fifty consecutive H. pylori gastritis children (27M; median age 10 y and 11 mo) were tested for IgG cagA protein (Western Blot technique). Pretreatment H. pylori infection was assessed on the grounds of endoscopic antral biopsy specimens by means of rapid urease test and histologic examination (Giemsa staining). All the children were treated with omeprazole (1 mg/kg/d), clarithromycin (15 mg/kg/d) and amoxycillin (50 mg/kg/d) for 2 wk. According to universally accepted clinical practice, outcome of treatment was assessed by 13C urea breath test at least 6 wk after the end of therapy.

RESULTS

Thirty-five children (70%) were seropositive to cagA+ protein (median age 11 y and 1 mo). Endoscopic findings of cagA+ patients were similar to those of cagA- patients. In cagA seropositive patients the severity of histologic gastritis was higher (p < 0.05) and the granulocytic infiltration more marked (p < 0.01) than in seronegative ones. In cagA+ children, H. pylori eradication rate was significantly lower (p < 0.02).

CONCLUSIONS

cagA testing may be of useful clinical interest because its positivity can imply a more severe gastritis and a lower susceptibility to eradication treatment.

Helicobacter pylori infection in type 2 diabetic patients

BACKGROUND AND AIM

A high prevalence of Helicobacter pylori (Hp) infection in diabetic patients has been described in recent years. This study investigates its prevalence in type 2 diabetics and its correlation with the degree of metabolic control and the presence of chronic complications.

METHODS AND RESULTS

Forty-one consecutive type 2 diabetics (21 males, 20 females aged 46-78, mean 62) and 31 age-matched controls participated. Hp infection was assessed by means of the 13C-urea breath test. Fasting glucose and glycated haemoglobin (HbA1c) levels were measured to evaluate metabolic control. Chronic complications were assessed by means of albumin excretion rate (AER), fundoscopy, vibratory perception threshold (VPT), ECG, clinical history of coronary, cerebral or peripheral arteriopathy, foot examination and cardiovascular autonomic function tests. A higher prevalence of Hp infection was found in diabetic than in control women (80% vs 37.5%; p < 0.05), whereas there was no difference between males. A higher prevalence correlated with macroangiopathy and neuropathy and higher BMI, blood pressure, fasting glucose and HbA1c values. By contrast, microangiopathy was significantly more prevalent (p < 0.05) in Hp negative (85%) than in Hp positive patients (48%).

CONCLUSIONS

There is a high prevalence of Hp infection in type 2 diabetic women. The absence of microangiopathy may be a predisposing factor: microvascular changes in the gastric mucosa may create an unfavourable environment for the establishment or survival of Hp.

Discrepancy between Helicobacter pylori stool antigen assay and urea breath test in the detection of Helicobacter pylori infection

BACKGROUND

The reference diagnostic methods available for detection of Helicobacter pylori infection are either invasive (histology) or expensive and highly sophisticated (Urea Breath Test). A new enzyme immunoassay, which can be easily performed in any laboratory, has been developed to detect Helicobacter pylori in stool specimens (HpSA-Meridian Diagnostics, Cincinnati, USA). Aim of the study was to compare HpSA to Urea Breath Test.

PATIENTS AND METHODS

A total of 125 patients (52 never treated for Helicobacter pylori infection and 73 after Helicobacter pylori eradication therapy) referring to our Department, underwent both tests within two weeks.

RESULTS

Contrasting results between the two tests were found in 30% of cases: in 19% of the untreated patients and in 37% of the treated patients (p<0.001). The main discrepancy consisted in positive HpSA associated with negative Urea Breath Test. Mean HpSA value in such conditions was 0.273 optical density, while in patients with both positive tests, it was 1.192 optical density. In untreated, but not in treated patients, raising the HpSA cut off value significantly decreased the percentage of conflicting results.

CONCLUSIONS

Some disagreement was detected between HpSA and Urea Breath Test results, especially in treated patients. Possible explanations for our findings are a low HpSA cut off value together with the identification of Helicobacter pylori coccoid forms by the immunoassay but not by the urease based Urea Breath Test. The higher percentage of discrepancy detected in treated patients might support this hypothesis.