Treatment of BRONJ with ozone/oxygen therapy and debridement with piezoelectric surgery

OBJECTIVE

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is progressive bone destruction in the maxillofacial region of patients under current or previous treatment with Bisphosphonates. The present case series study aimed to evaluate if ozone/oxygen therapy and debridement with piezoelectric surgery may improve the treatment of BRONJ.

PATIENTS AND METHODS

The treatment modality of the patients included ozone/oxygen mixture from medical oxygen. The protocol for ozone/oxygen mixture therapy appointments was set as twice a week for 10 weeks, for a total of 20 applications for each patient. The evaluation of the lesions was based on the clinical and radiologic parameters. The primary outcome was the necrotic lesion reduction during ozone/oxygen therapy sessions and up to the end of follow up periods. The healing of the lesion was taken as a positive result. The level of significance was taken as p <0.05.

RESULTS

A total of 14 patients affected by osteonecrosis were included. The mean follow-up of the patients was 14.3 months. The overall success rate after treatment was 64.2%.

CONCLUSIONS

According to the results, ozone/oxygen therapy and debridement with Piezoelectric surgery for BRONJ treatment is a safe procedure with successful outcomes.

Social support among people with mental illnesses on probation

OBJECTIVE

Justice-involved people with mental illnesses, in general, experience poor criminal justice outcomes (i.e., high rates of recidivism and probation revocations) and are at increased risk of homelessness, unemployment, stigma, trauma, and poor physical health. Low social support is repeatedly associated with worse mental health outcomes in the general population but little is known about social support among probationers with serious mental illnesses.

METHOD

To address these gaps in the literature, we used an observational cross-sectional study design and data from a large, randomized controlled trial of specialty mental health probation to examine self-reported social support and its relationships with mental health functioning and other outcomes for individuals with serious mental illnesses on supervised probation.

RESULTS

Probationers who self-reported lower levels of social support also reported greater mental health symptomatology and reported lower quality relationships with their probation officers.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Low social support among probationers with mental illnesses has important implications for mental health and criminal justice practice and policy. Coordinating services between the criminal justice and mental health systems to offer opportunities for social support and meaningful community engagement for those with mental illnesses who are on probation could improve a number of mental health and criminal justice outcomes for this population. Peer support and supported employment services, for example, in addition to outpatient mental health services, could be two strategies that could address social isolation and help individuals living with mental illnesses optimize their recovery and rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Polymeric micelles in drug delivery: An insight of the techniques for their characterization and assessment in biorelevant conditions

Polymeric micelles, i.e. aggregation colloids formed in solution by self-assembling of amphiphilic polymers, represent an innovative tool to overcome several issues related to drug administration, from the low water-solubility to the poor drug permeability across biological barriers. With respect to other nanocarriers, polymeric micelles generally display smaller size, easier preparation and sterilization processes, and good solubilization properties, unfortunately associated with a lower stability in biological fluids and a more complicated characterization. Particularly challenging is the study of their interaction with the biological environment, essential to predict the real in vivo behavior after administration. In this review, after a general presentation on micelles features and properties, different characterization techniques are discussed, from the ones used for the determination of micelles basic characteristics (critical micellar concentration, size, surface charge, morphology) to the more complex approaches used to figure out micelles kinetic stability, drug release and behavior in the presence of biological substrates (fluids, cells and tissues). The techniques presented (such as dynamic light scattering, AFM, cryo-TEM, X-ray scattering, FRET, symmetrical flow field-flow fractionation (AF4) and density ultracentrifugation), each one with their own advantages and limitations, can be combined to achieve a deeper comprehension of polymeric micelles in vivo behavior. The set-up and validation of adequate methods for micelles description represent the essential starting point for their development and clinical success.

E2F1 copy number variations contribute to spermatogenic impairment and cryptorchidism by increasing susceptibility to heat stress

BACKGROUND

Copy number variations (CNVs) play an important role in the onset of several diseases, and recently research focused on the relationship between these structural variants and diseases of the reproductive tract, including male infertility and cryptorchidism.

OBJECTIVES

To evaluate the contribution of copy number variations of E2F1 gene to idiopathic male infertility and the factors influencing expression of this gene.

MATERIALS AND METHODS

We performed a retrospective study on 540 subjects recruited from September 2014 to February 2015. TaqMan CNV assay was used to analyze E2F1 CNV. Real-time PCR was used to assess E2F1 and HSP70 expression level in heat stressed and transfected cells with three E2F1 copies.

RESULTS

We found a significant difference in the frequency of altered E2F1 copies in patients (12/343, 3.5%) compared with controls (0/197) (p = 0.005). Six patients with E2F1 CNV had history of cryptorchidism, but the prevalence between men with idiopathic infertility (6/243, 2.5%) and infertile men with history of cryptorchidism (6/100, 6.0%) was not statistically different (p = 0.1). E2F1 expression increased under heat stress conditions, especially in cells carrying more copies of gene and this was associated with increased expression of HSP70.

DISCUSSION

Our data suggest that an abnormal E2F1 expression caused by multiple copies of E2F1 gene predisposes to the onset of infertility and that the risk further increases if subjects with altered E2F1 copies have stressful conditions, such as heat stress or history of cryptorchidism.

CONCLUSION

This study shows a link between E2F1 CNV and male infertility, suggesting that the increased risk of spermatogenic impairment associated with higher E2F1 copies might be due to higher susceptibility to stressful conditions.

Role of vitamin D levels and vitamin D supplementation on bone mineral density in Klinefelter syndrome

This manuscript describes the role of low vitamin D in bone metabolism of Klinefelter subjects. Low vitamin D is frequent in this condition and seems to be more important than testosterone in inducing low bone mineral density (BMD) and osteoporosis. Supplementation with vitamin D restores BMD after 2 years of treatment, whereas testosterone alone seems to be ineffective.

INTRODUCTION

Decreased bone mineral density (BMD) in Klinefelter syndrome (KS) is frequent, and it has been traditionally related to low testosterone (T) levels. However, low BMD can be observed also in patients with normal T levels and T replacement therapy does not necessarily increase bone mass in these patients. Nothing is known about vitamin D levels and supplementation in KS. In this study, we determine vitamin D status and bone mass in KS subjects and compare the efficacy of T therapy and vitamin D supplementation on BMD.

METHODS

A total of 127 non-mosaic KS patients and 60 age-matched male controls were evaluated with reproductive hormones, 25-hydroxyvitamin D, PTH, and bone densitometry by dual-energy X-ray absorptiometry (DEXA). Patients with hypogonadism and/or 25-hydroxyvitamin D deficiency were treated with T-gel 2% and/or calcifediol and re-evaluated after 24 months of treatment.

RESULTS

25-hydroxyvitamin D levels were significantly lower in KS patients with respect to controls, and they had significantly lower lumbar and femoral BMD. The percentage of osteopenia/osteoporosis in subjects with 25-hydroxyvitamin D deficiency was higher with respect to subjects with normal 25-hydroxyvitamin D and was not related to the presence/absence of low T levels. Subjects treated with calcifediol or T + calcifediol had a significant increase in lumbar BMD after treatment. No difference was found in T-treated group.

CONCLUSIONS

These data highlight that low 25-hydroxyvitamin D levels seem to have a more critical role than low T levels in inducing low BMD in KS subjects. Furthermore, vitamin D supplementation seems to be more effective than T replacement therapy alone in increasing BMD.

Growth factors and metabolic markers in cord blood: relationship to birth weight and length

Low birth weight and length for gestational age are associated with a high risk of short stature and metabolic syndrome in adulthood. The mechanisms that link prenatal growth to adult stature and metabolic syndrome have not yet been entirely clarified. The aim of our study was to evaluate the relationship between standardized anthropometric measures at birth and insulin-like growth factor (IGF)-I, IGF-II, insulin, adiponectin, and non-esterified fatty acid (NEFA) cord blood levels in the general population. One hundred fifty-eight random newborn subjects (77F, 81M) from Genoa, Italy, were analyzed. Anthropometric parameters were measured and standardized according to standard Italian tables. Insulin values were treated as categorical, since in several cases the results fell below detection cut-off. Mean birth weight was 3,214.23&#x2213;488.99 gr and mean length was 49.82&#x2213;2.17 cm. Females had higher mean IGF-I (p=0.04), and were more likely to have insulin values either <2 &#956;U/ml or >4.5&#956;U/ml (p= 0.04) compared to males. Weight and length SD scores (SDS) were higher in subjects with elevated insulin levels (p=0.002). A moderate correlation was found between weight and IGF-II (r=0.354). Multivariable analysis demonstrated that standardized birth weight was associated with IGFII and insulin values. Our data highlight the importance of IGF-II in fetal growth and suggest that gender differences should be taken into consideration when evaluating prenatal growth.

Quantitative ultrasound detects bone changes following bone marrow transplantation in pediatric subjects with hematological diseases: a longitudinal study

BACKGROUND

Bone marrow transplantation (BMT) is associated with bone morbidity. We investigated bone status with quantitative ultrasound (QUS) in pediatric patients with hematological diseases prior to and up to 3 yr following BMT.

METHODS

Phalangeal QUS measures for amplitude- dependent speed of sound (Ad-SoS) and bone transmission time (BTT) were obtained in 40 hematological patients (25 with malignant, 15 with non-malignant disease; 9.7+/-4.9 yr) before BMT and 6, 12, 24, and 36 months after BMT. Bone parameters were expressed as Z-scores based on age-sex-matched normal controls.

RESULTS

Mean Ad-SoS and BTT Z-scores were normal before BMT and reduced at 36 months (analysis of variance: p=0.0542 and p=0.0233). Ad-SoS and BTT Z-scores remained relatively stable in the first 6 months after BMT and then progressively decreased reaching a plateau at 12-36 months. In non-malignant patients, BTT Z-score decreased at 6-12 months (p=0.029) and subsequently increased, while in malignant patients BTT Z-score showed a decrease at 12-24 months. Pre-pubertal subjects displayed a drop of BTT Z-Score values at both 12 (p=0.023) and 36 months after BMT (p=0.049), while BTT Z-score remained relatively unchanged in pubertal subjects. Early impairment of BTT Z-score was found in patients who suffered acute graft versus host disease (GVHD) compared to patients without this clinical condition; BTT Z-score was lower at 36 months (p=0.045).

CONCLUSIONS

Longitudinal assessment by QUS of pediatric BMT survivors evidenced that bone status is mildly affected up to 36 months after BMT, mainly in malignant patients, in pre-pubertal subjects at BMT and in patients who suffered acute GVHD.

Clinical variability of cardio-facio-cutaneous syndrome: report of two additional cases

We describe two new cases of cardio-facio-cutaneous (CFC) syndrome, and underline the clinical variability of the CFC phenotype in our two patients presenting with border-line psychomotor development. The first patient showed some additional clinical manifestations, such as cryptorchidism and scoliosis, and the second one had atypical skin lesions.

Concentrations of progesterone during storage of whole blood from llama (Lama glama): effects of anticoagulants, storage time and temperature

Reproductive studies usually utilizes measurement of progesterone in various fluids such as plasma, serum or milk. It has been shown that progesterone concentrations in bovine whole blood decrease proportionally to: i) the time elapsed between the collection of the sample and the separation of plasma or serum from the erythrocytes and ii) the temperature of storage during this period (Breuel et al, 1988, Pulido et al. 1991). The addition of anticoagulants cause a more rapid decline in progesterone concentrations (Wiseman et al. 1982). In equine, porcine and canine blood samples storage time and temperature has a negligible effect on progesterone concentrations (Wiseman et al. 1982; Oltner & Edqvist 1982). Cordero et al. (1991) working with llama and alpaca whole blood, treated with EDTA as anticoagulant, reported a slight progesterone metabolization in alpaca plasma, but not in llama plasma.

Variable penetrance of hypogonadism in a sibship with Kallmann syndrome due to a deletion of the KAL gene

We report on the clinical and molecular characterization of 3 sibs with X-linked ichthyosis and variable expression of Kallmann syndrome. One of the affected brothers had mild hyposmia and showed normal pubertal progression. However, we demonstrated the same partial deletion of the X-linked Kallmann gene, sparing the first exon in the mildly affected patient as well as in one of his severely affected brothers.

Antiphospholipid antibodies syndrome and cerebral ischemia

Antiphospholipid antibodies are acquired circulating immunoglobulins that interact with phospholipids. These factors may manifest anticoagulant properties in vitro, interfering with phospholipid-dependent coagulation tests. They are not, however, associated with a hemorrhagic diathesis. Indeed, far from exerting the anticoagulant properties they possess in vitro, they are associated with episodes of thromboembolism, systemic and cerebral. We report the clinical and instrumental findings in 7 patients with ischemic stroke and circulating antiphospholipid antibodies classifiable as antiphospholipid antibodies syndrome.

Clinical evaluation of CAP System and RAST in the measurement of specific IgE

We investigated the diagnostic value of a new in vitro test, Pharmacia CAP System (Pharmacia Diagnostics AB, Uppsala, Sweden), for the quantitative measurement of allergen-specific IgE antibodies by comparison with RAST in 2 groups of patients, 71 atopic and 48 non-atopic. In the last 20 years RAST has supplied a good diagnostic tool, but this test presents some problems, the main one being sensitivity. The new test has a solid phase able to bind even very small amounts of specific IgE and an anti-IgE tracer with very low cross-reactivity with other immunoglobulins, thus presenting more favourable conditions. From the analysis of our results, Pharmacia CAP System gave higher sensitivity (94% compared to 88% of RAST) with no loss of specificity (96% for both tests). The reliability of these results is ensured by the proper selection of patients who were all suffering from pollinosis and were clinically diagnosed as certainly hypersensitive to a single pollen. A positive trend was found between severity of asthma and levels of specific IgE for timothy. Pharmacia CAP System appears to identify a larger number of atopic patients than RAST.

The primary antiphospholipid syndrome: case report

Lupus anticoagulant antibodies and anticardiolipin antibodies are acquired circulating immunoglobulins that interact with phospholipids. These factors may exert anticoagulant properties in vitro and so interfere with coagulation tests that use phospholipids. These antibodies are not, however, associated with a hemorrhagic diathesis. Indeed, despite their name and their in vitro anticoagulant properties, they have been associated right from the earliest reports with systemic and cerebral thromboembolic episodes. We report the clinical and instrumental findings in a patient with ischemic stroke and anticoagulant antibodies in the serum.

C3 fixed in vivo to cornea from horses inoculated with Leptospira interrogans

C3 was detected bound in vivo to the opaque cornea of horses inoculated with killed Leptospira interrogans. Employing epithelial corneal cells isolated from a monolayer in tissue culture, we proved that C3 is fixed in vitro to the intact cell surface after incubation with a fresh equine anti-Leptospira serum. These findings, in addition to the infiltration of cornea with neutrophils and lymphocytes, may explain the mechanisms of tissue damage in recurrent uveitis of horses with leptospirosis.

[Antiphospholipid antibodies and cerebral ischemia]

Lupus anticoagulants (LAs) and anticardiolipin antibodies (ACAs) are acquired circulating immunoglobulins that cross-react with anionic and neural phospholipids. These factors may display anticoagulant properties in vitro by interfering with phospholipid-dependent coagulation tests. These antibodies are usually not associated with a bleeding tendency. In fact, paradoxically to their name, since the initial recognition they have been related to systemic and cerebral thromboembolisms, despite their in vitro "anticoagulant" properties. We report the clinical and laboratory findings in 4 LAs and ACAs positive patients with brain ischemia.

[Oculopharyngeal muscular dystrophy. Description of a case with involvement of the central nervous system]

A sporadic case of oculopharyngeal muscular dystrophy occurred in a 74-year-old woman is described. High levels of IgA and IgG in the serum, and esophageal smooth muscle involvement are shown. Electromyography of several limb muscles displayed myopathic pattern with giant polyphasic motor unit potentials, suggesting superimposed denervation. The histological examination of peroneus brevis muscle biopsy specimen showed myopathic changes with dystrophic features, associated with neurogenic changes, including atrophic angulated fibers, small-group atrophy and type-grouping: concomitant involvement of spinal motor neuron pathway is hypotized, normal values of motor and sensory nerve conduction velocities excluding associated polineuropathy. Furthermore, Somatosensory Evoked Potentials recording revealed bilaterally increased Central Conduction Time. Referring to other similar cases previously reported in the literature, the significance of neurogenic involvement in oculopharyngeal muscular dystrophy is discussed.

Neuromyelitis optica in the old age: a clinico-pathological contribution

We present a case of neuromyelitis optica (NMO) in a previously healthy 64-year-old woman. While CT scan and MRI investigations of the brain as well as myelography were normal, CSF revealed a pathological increase of IgG. Notwithstanding an intensive steroid therapy the patient died after 4 1/2 months. Microscopic examination showed, besides extensive demyelination of the optic nerves and spinal cord (especially in its cervico-dorsal tract), several small demyelinating plaques in the white matter of the pons and near the right lateral ventricle. These findings confirm once again that NMO is a clinical variant of multiple sclerosis and that this disease may make it first appearance at an old age.

A case of benign recurrent meningitis of Mollaret

A 72-year-old woman, previously in good health, suffered for 2 years from attacks of a complex neuropsychiatric syndrome lasting from 2 days to 4 weeks. These episodes, which were followed by intervals of nearly complete recovery, were usually marked by fever, headache, mental confusion, vomiting ataxia, anisocoria, epileptic seizures and stiffness of the neck. Neuroradiological investigation revealed only slight ventricular dilatation. In 13 CSF examinations, there was reduced glucose, increased protein, considerable rise of the IgG index and constant oligoclonal bands. There was also an increase of polymorphonuclear leucocytes, lymphocytes or epithelial-like cells. As all microbial, viral or mycotic tests were negative and the patient recovered, the case was considered to be benign recurrent meningitis of Mollaret. The nosological position of this rare disease, as well as its probable pathogenetic mechanisms, are discussed.

[The incidence of the X-linked progressive muscular dystrophies in Tuscany from 1966 to 1974 (author's transl)]

An investigation was carried out to establish the incidence of X-linked progressive muscular dystrophies in Tuscany from 1966 to 1974. 52 cases were identified, the incidence being 23,95 X 10(-5) with reference to live-born males. The frequency of new mutations calculated according to Haldane's method was 7,97 X 10(-6). These data practically correspond to those reported by other AA. in Italy and abroad. There was also a remarkable variability in the incidence among individual districts with values ranging from 7,60 X 10(-5) to 41,91 X 10(-5). It was noticed that the number of new cases tended to decrease in the last few years.

[Immunological and therapeutic aspects of myasthenia gravis (author's transl)]

In the treatment of Myasthenia Gravis (M.G.) new therapeutic techniques have been gradually added to the usual anticholinesterase drugs. Steroids, immunosuppressive drugs, plasma exchange have been employed whereas thymectomy is still the most useful surgical treatment. On the basis of both personal experience and data from the literature the AA. reviewed the therapeutic techniques. Thymectomy is practically indicated for all patients particularly young ones. However there are some reserves in the presence of thymomas as sometimes deterioration may occur. Steroids are mostly employed in cases resistant to other therapies. Immunosuppressive drugs are usually associated with plasma-exchange. The latter has been recently preferred because of the absence of side effects; however its real therapeutic value has not yet been fully assessed.