Comparative efficacy of akathisia treatments: A network meta-analysis

OBJECTIVE

Akathisia, a common side effect of psychotropic medications, poses a significant challenge in neuropsychiatry, affecting up to 30% of patients on antipsychotics. Despite its prevalence, akathisia remains poorly understood, with difficulties in diagnosis, patient reporting, and treatment efficacy. This research aimed to shed light on effective interventions to improve akathisia management.

METHODS

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, encompassing controlled trials in English and Italian languages. Databases, such asPubMed, Scopus, and EMBASE, were searched until July 9, 2023. Treatment effectiveness was assessed using standardized mean differences (SMDs) in post-treatment akathisia scores.

RESULTS

Thirteen studies involving 446 individuals met the inclusion criteria. Benzodiazepines, beta-blockers, and NaSSA demonstrated significant efficacy as compared with placebo. Anticholinergic, anticonvulsant, triptan, and other treatments did not show significant differences. Benzodiazepines ranked highest in P-scores (0.8186), followed by beta-blockers and NaSSA.

CONCLUSIONS

Effective management of akathisia is crucial, with benzodiazepines, beta-blockers, and NaSSA offering evidence-based options. Treatment rankings provide guidance for clinicians. Future research should prioritize larger, more robust studies to address limitations associated with small sample sizes and publication bias. This research enhances our understanding of interventions for akathisia, offering promising options to improve patient quality of life and prevent complications related to non-adherence and mismanagement.

Borderline rejection: To treat or not to treat?

INTRODUCTION

It is unclear whether kidney transplant recipients with a biopsy diagnosis as a "borderline" acute T-cell mediated rejection (TCMR) requires the treatment with intravenous (iv) steroids pulse plus/minus intensification of the maintenance therapy (TRT) in comparison with the simple clinical follow-up (F-UP).

METHODS

We retrospectively followed a consecutive series of kidney transplant recipients diagnosed with a borderline acute TCMR at biopsy by surveillance or clinical indication for 12 months and compared TRT and F-UP groups. We evaluated trends in renal function by measuring estimated glomerular filtration rate (eGFR) using multiple regression models. Repeated eGFR measures (REML) were adjusted for potential confounding factors for 12 months. The difference in 12-month eGFR values were observed in the TRT vs F-UP groups, type of biopsy, as well as the surveillance vs. clinical outcomes.

RESULTS

Out of 59 included patients, 37% of them were in the TRT group and remaining 63% in the F-UP group. As expected, the TRT group had, at the time of biopsy, lower eGFR value of 39.0 ml/min/m2 [16.5] in comparison to 49.6 [19.6] ml/min/m2 in the F-UP group (P = 0.043), Similarly, the TRT group required more frequent clinical biopsies vs. F-UP group (68% vs. 32%; P = 0.014). However, the TRT group recovered kidney function reaching the eGFR values of the F-UP group at 12 months; the increase being significant only in patients who received indication biopsies (P < 0.001). The estimated adjusted TRT effect on 12-month eGFR change after indication biopsy was improved by +15.8 ml/min/1.73m2 (95%CI: +0.1 to +31.4 ml/min/1.73 m2; P = 0.048 by three-way interaction term) compared to the F-UP group.

CONCLUSION

Our preliminary study supports the indication for the treatment of acute borderline TCMR only in cases with biopsies performed by clinical indication.

Food supplements consumption and the role of pharmacies: a north-eastern Italy observational study

Background

Even if the food supplement industry is one of the fastest growing worldwide, the inappropriate use of these products can potentially cause harms. Considering the key role played by pharmacists in advising citizens on the purchase of food supplements, this cross-sectional observational study evaluates pharmacists' knowledge, attitudes and practice on this topic.

Methods

From September 2020 to February 2021, an online questionnaire implemented through the EU-Survey tool, was administered to pharmacists of both public and private authorized pharmacies of the Friuli-Venezia Giulia (FVG) Region (Italy). The 47 multiple-choice questions about pharmacists' knowledge (20), attitudes and practice (27), were followed by a sociodemographic section (7 items) collecting data about sex, age, years of experience, degree, role within pharmacy (owner, employee). Descriptive analyses, Chi-square, Shapiro-Wilk and Mann Whitney tests were used and a p-value&lt;0.05 was considered as statistically significant.

Results

A sample of 232 questionnaires was collected, 70.7% of which from women. Most responders (77.2%) had a Pharmacy degree, with owners representing the 34.5%. The 61.2% of pharmacists had at least 10 years of experience. Knowledge was generally poor with just 49.2% of the sample scoring above the median value of 11 but higher among pharmacists with more than 11 years of experience. Lesser-known aspects were the possible link between cancer and multivitamin's abuse and presence of non-labeled agents in food supplements. Responders &lt; =10 years of experience felt more unprepared about vitamin's dosage and in counselling particular groups of patients (p &lt; 0.05). Employees more frequently reported the attitude to purchase food supplements under patient specifical request (p &lt; 0.05).

Conclusions

Pharmacists' knowledge about food supplements is scarce and young professionals in particular need further education to ensure a safe and effective purchase of these products to patients.

Key messages

The use of vitamin supplements is growing but their consumption needs to be evaluated by expert and qualified professionals. Pharmacists play a key role in counselling people about food supplements but need continuous professional education to give adequate advice.

Effect of a laser-ablated micron-scale modification of dental implant collar surface on changes in the vertical and fractal dimensions of peri-implant trabecular bone

BACKGROUND

Marginal bone loss (MBL) represents an important indicator of peri-implant health and the measure of its level is considered a determining factor in the evaluation of the quality of survival. Aim of this study is to compare radiographic changes in the fractal and mesial/distal vertical dimensions of peri-implant trabecular bone of dental implants with a laser-ablated micron-scale modication (LAM) of collar surface after a 5-year follow-up period.

MATERIALS AND METHODS

Thirty-four implants with LAM of collar surface (test group = TG) and 31 implants without LAM of collar surface (control group = CG) were placed in 45 non-smoking, periodontally healthy patients. Fractal and vertical dimensions of peri-implant trabecular bone were measured by comparing radiographs taken immediately after prosthesis delivery with those taken 3 years and 5 years after functional loading.

RESULT

At the end of the 5-year follow-up, the MBL in the TG was 0.87±0.21 and 0.75±0.25 mm at the mesial and distal aspects, respectively, while a MBL of 2.05±0.25 mm at the mesial aspect and 2.01±0.34 mm at the distal site was recorded in the CG. A statistically significant difference was noted. In the TG the mean fractal dimension before loading was 1.4213±0.0525. It increased significantly to 1.4329±0.0479 at 3 years after loading and remained almost stable at 5 years after loading (1.4327±0.0291). In the CG the mean fractal dimension before loading was 1.4119±0.0414. It increased significantly to 1.4282±0.0324 at 3 years after loading and decreased significantly to 1.4111±0.0624 at 5 years after loading. At the end of the follow-up, differences between both study groups were statistically significant.

CONCLUSION

The increased fractal dimension and the reduced MBL around TG implants after 5 years of functional loading indicates a positive effect of a laser-ablated micron-scale modication of collar surface on peri-implant trabecular bone remodeling.

Online Gait Learning for Modular Robots with Arbitrary Shapes and Sizes

Evolutionary robotics using real hardware is currently restricted to evolving robot controllers, but the technology for evolvable morphologies is advancing quickly. Rapid prototyping (3D printing) and automated assembly are the main enablers of robotic systems where robot offspring can be produced based on a blueprint that specifies the morphologies and the controllers of the parents. This article addresses the problem of gait learning in newborn robots whose morphology is unknown in advance. We investigate a reinforcement learning method and conduct simulation experiments using robot morphologies with different size and complexity. We establish that reinforcement learning does the job well and that it outperforms two alternative algorithms. The experiments also give insights into the online dynamics of gait learning and into the influence of the size, shape, and morphological complexity of the modular robots. These insights can potentially be used to predict the viability of modular robotic organisms before they are constructed.

High-Energy Cosmic Ray Self-Confinement Close to Extra-Galactic Sources

The ultrahigh-energy cosmic rays observed on the Earth are most likely accelerated in extra-Galactic sources. For the typical luminosities invoked for such sources, the electric current associated to the flux of cosmic rays that leave them is large. The associated plasma instabilities create magnetic fluctuations that can efficiently scatter particles. We argue that this phenomenon forces cosmic rays to be self-confined in the source proximity for energies E<E_{cut}, where E_{cut}≈10^{7}L_{44}^{2/3} GeV for low background magnetic fields (B_{0}≪nG). For larger values of B_{0}, cosmic rays are confined close to their sources for energies E<E_{cut}≈2×10^{8}λ_{10}L_{44}^{1/4}B_{-10}^{1/2} GeV, where B_{-10} is the field in units of 0.1 nG, λ_{10} is its coherence lengths in units of 10 Mpc, and L_{44} is the source luminosity in units of 10^{44} erg/s.

A new approach to the use of α-fetoprotein as surveillance test for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND

Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis. As α-fetoprotein (AFP) is considered a poor surveillance test, we tested the performance of its changes over time.

METHODS

Eighty patients were diagnosed with HCC (cases) during semiannual surveillance with ultrasonography and AFP measurement were recruited and matched for age, gender, etiology and Child-Pugh class with 160 contemporary cancer-free controls undergoing the same surveillance training group (TG). As a validation group (VG) we considered 36 subsequent patients diagnosed with HCC, matched 1 : 3 with contemporary cancer-free controls. α-Fetoprotein values at the time of HCC diagnosis (T0) and its changes over the 12 (Δ12) and 6 months (Δ6) before cancer detection were considered.

RESULTS

In both TG and VG, >80% of HCCs were found at an early stage. In TG, AFP significantly increased over time only in cases. T0 AFP and a positive Δ6 were independently associated with HCC diagnosis (odds ratio: 1.031 and 2.402, respectively). The area under the curve of T0 AFP was 0.76 and its best cutoff (BC) was 10 ng ml(-1) (sensitivity 66.3%, specificity 80.6%). The combination of AFP >10 ng ml(-1) or a positive Δ6 composite α-fetoprotein index (CAI) increased the sensitivity to 80% with a negative predictive value (NPV) of 86.2%. Negative predictive value rose to 99%, considering a cancer prevalence of 3%. In the VG, the AFP-BC was again 10 ng ml(-1) (sensitivity 66.7%, specificity 88.9%), and CAI sensitivity was 80.6% with a NPV value of 90.5%.

CONCLUSIONS

CAI achieves adequate sensitivity and NPV as a surveillance test for the early detection of HCC in cirrhosis.

152 EVALUATION OF POMEGRANATE (PUNICA GRANATUM) AS REPLICATION INHIBITOR OF BoHV-1 COLORADO STRAIN DURING IN VITRO MATURATION OF INFECTED BOVINE OOCYTES

The widespread use of biotechnologies in animal breeding in Brazil has enabled greater control over the transmission of pathogens. Nevertheless, disease transmission continues to be a significant concern and justifies the search for better control agents. The objective of this study was to evaluate whether the detrimental effects of the experimental infection of oocytes with BoHV-1 (Colorado strain, 108 TCID 50 mL–1) during in vitro maturation (24 h) could be reduced by the viral inhibitor ethanolic extract of Punica granatum (PG). Cattle ovaries were obtained from a local slaughterhouse (unknown breed), and transported to the laboratory. Cumulus–oocyte complexes (COC) were aspirated from follicles and allocated into four groups, which were exposed to: 10 µL of sterile physiological solution (G1 [control], n = 125); 10 µL of PG extract in 0.01% sterile saline solution (G2, n = 149); 10 µL of BoHV-1 virus (G3, n = 151); or 10 µL of PG extract in 0.01% and 10 µL of BoHV-1 virus (G4, n = 144). All groups were matured in 100 mL of IVM for 24 h at 37.5°C, 5% CO2 in air. After in vitro maturation, we evaluated COC expansion and presence of a polar body by optical microscope, and viral replication by titration (Reed and Muench test) after 72 h co-culture with Madin-Darby bovine kidney (MDBK) cells. Differences among groups in maturation rates were compared by chi-square test, and in titration by t-test. The G1, G2, and G4 showed steady expansion of the cumulus cells and ooplasm with uniform appearance. The G3 did not show expansion of the cumulus cells and ooplasma showed degenerative appearance. The maturation rates were as follows: G1 52% (65/125); G2 45.63% (68/149); G3 27.81% (42/151); G4 41.66% (60/144). We used the χ2 test (P ≤ 0.05) for the rate of maturation and the t-test (P ≤ 0.05) for the titration data. A reduction (P ≤ 0.05) in maturation rate was observed in G3, when compared to the G1 [control]. Oocytes exposed to BoHV-1 virus and matured in the presence of PG extract (G4) had lower (P ≤ 0.05) rates of viral replication than those matured in the absence of PG (G3). These results support the conclusion that PG extract reduces the viral rate of replication without interfering in oocyte maturation, and may be an alternative to sanitary control protocols.

Interação do Mycoplasma bovigenitalium com células do cumulus in vitro após o período de maturação oocitária bovina

O Mycoplasma é considerado cosmopolita, podendo ser disseminado através do comércio internacional de animais, sêmen industrializado e de produtos de transferência de embriões. A expansão de células do cumulus é utilizada como parâmetro de avaliação de oócitos bovinos cultivados in vitro e suas alterações morfológicas são representativas. O objetivo deste trabalho foi avaliar a interação do Mycoplasma bovigenitalium, exposto experimentalmente à cultura primária de célula do cumulus, após o período de maturação. Complexos oócitos cumulus (COCs) obtidos através de punção folicular de ovários bovinos, provenientes de abatedouro, foram divididos em dois grupos para serem maturados durante 24h em meio de maturação (TCM199 + hormônios) em estufa a 38º C, 5% de CO2, 95% de umidade. Posteriormente, os oócitos foram retirados das placas, permanecendo somente com as células do cumulus aderidas. Com o monoestrato celular formado, um grupo foi infectado com 30 mL de M. bovigenitalium, replicado em meio Hayflick modificado a 37º C em estufa de microaerofilia, enquanto o outro foi mantido como controle. Os resultados mostraram que, com 24h de exposição ao patógeno, as culturas apresentaram um pequeno número de células arredondadas e granulosas, quando comparadas as dos controles. Esse efeito persistiu até o sétimo dia, onde se iniciou um processo de descolamento das células. Pode-se concluir que uma contaminação por micoplasma pode ser imperceptível às manipulações da FIV, pois células infectadas por esse grupo de bactérias não apresentam turvações no meio de cultura e, quando não lisam a célula hospedeira, tornam mais suscetível ao ambiente e outros agentes infecciosos.

Hydrogen-induced surface metallization of SrTiO3(001)

Surface metallization of SrTiO3(001) by hydrogen adsorption is experimentally confirmed for the first time by photoemission spectroscopy and surface conductivity measurements. The metallic state is assigned to a quantized state in the space-charge layer induced by electron doping from hydrogen atoms. The measured two-dimensional (2D) conductivity is well above the 2D Ioffe-Regel limit indicating that the system is in a metallic conduction regime. The mean free path of the surface electron is estimated to be several nanometers at room temperature.

Eficácia dos tratamentos estabelecidos pelo Manual da IETS, em oócitos, expostos à Leptospira interrogans

Avaliou-se a eficácia dos tratamentos, definidos pela International Embryo Transfer Society (IETS), de oócitos bovinos, maturados in vitro e expostos experimentalmente à Leptospira interrogans sorovar Grippotyphosa. Os oócitos foram obtidos por meio de punção folicular, selecionados e distribuídos em quatro grupos, expostos ao patógeno e submetidos aos diferentes tipos de tratamentos. Foram expostos à cepa na concentração de 4,7.10(5)/µL, virulenta e não adaptada ao meio de manutenção EMJH, e, de 6,3.10(5)/µL, avirulenta e adaptada ao meio, por 24 horas. Os grupos tratados com tripsina ou antibióticos apresentaram eficácia de 21,7%, e o grupo lavado sequencialmente 33,4%. Os tratamentos não foram eficazes para os contaminados com a cepa avirulenta. Concluiu-se que as normas de controle de qualidade estabelecidas pela IETS poderiam ser revisadas e, possivelmente, redefinidas, uma vez que a eficácia dos tratamentos, provavelmente, não depende somente da espécie do patógeno, pois há interferência da virulência e de ação dos tratamentos sobre o tipo de patógeno.

Synthesis of 3C-SiC nanocrystals at the SiO2/Si interface by CO2 thermal treatment

We report 3C-SiC nano-crystals synthesis by thermal annealing of SiO2/Si wafers in CO2 gas. The nano-crystals have been characterized using scanning electron microscopy and atomic force microscopy. These results are correlated with selective area electron diffraction paterns, and transmission electron microscopy observations that evidence the formation of cubic SiC nano-crystals epitaxied on Si. In our experimental conditions, the crystals size is in the range 10-60 nm, increasing with the treatment time, as the crystals density. Using isotopic labelled SiO2 associated with Nuclear Reaction Analysis (NRA) and Nuclear Narrow Resonance Profiling (NRP), oxygen exchanges between CO2 and SiO2 could be evidenced.

Kidney transplantation from older donors

BACKGROUND

The use of kidneys from older donors has become generally accepted and increasingly common, despite the knowledge that donor age is a well-known risk factor for graft failure.

AIM

To review our experience with the utilization of kidneys from donors older than 60 years.

PATIENTS AND METHODS

Among two hundred eight patients, 32 (group A) received an organ obtained from a donor older than 60 years. The organs were age-matched with a maximum gap of 20 years between donors and recipients. Organs from older donors were assigned to recipients presenting a body mass index lower than that of the donor. The primary end point was patient and graft survival. Secondary endpoints were incidences of delayed graft function and of acute rejection episodes as well as renal function at 3 months and yearly.

RESULTS

The two groups were comparable in terms of demographic features, indications for transplantation, comorbidities, as well as cold and warm ischemia times. The Mean lengths of follow up were 31.4 ± 20.3 months and 30.3 ± 20.1 months, respectively. Graft and patient survivals were comparable. Mean creatinine values at the study intervals were significantly lower among group B who received grafts from younger donors. The incidence of delayed graft function and acute rejection episodes were similar: 15.6% (5/32) versus 20.5% (36/176; P=0.35) and 15.6% (5/32) and 12.1% (21/167; P=0.136) in groups A and B, respectively.

CONCLUSIONS

Donor age older than 60 years showed a negative impact on kidney function. Though, given the escalating disparity between organ supply and demand, this precious source of organs cannot be neglected. We need better ways to use the available organs.

154 EVALUATION OF THE EFFECTIVENESS OF TREATMENT WITH TRYPSIN IN MURINES EMBRYOS EXPERIMENTALLY EXPOSED TO BOVINE HERPES VIRUS TYPE-1 (BoHV-1) BY THE NESTED-PCR TECHNIQUE

The cryopreservation of bovine embryos has allowed an increase in their commercialization causing concern about the transmission of pathogens through the production and transfer of in vitro embryos. The International Society of Embryo Transfer (IETS) suggests the treatment of embryos with trypsin or antibiotics in alternating washes with culture medium in order to remove and/or inactivate infectious agents that may interfere with the final product. The aim of this study was to evaluate the effectiveness of trypsin treatment in the elimination and/or removal of bovine herpes virus type-1 (BoHV-1), Colorado strain, in murine embryos. Viral detection was made by n-PCR and cytopathic effect in Madin Darby bovine kidney (MDBK) cells. Six- to 8-wk-old female mice (Swiss) were superovulated and mated with fertile males of the same strain. After 24 h, the zygotes (n = 262) were divided into 3 groups: control group submitted to sequential wash (CSW), the group exposed to the virus (30 μL; 106.5 virus mL–1) and submitted to sequential wash (ESW), and the group exposed to the virus and submitted to the trypsin treatment (ETT). All the groups of zygotes and the last sequential wash drops were tested by nested-PCR and inoculated in MDBK cells to allow observation of cytopathic effects. All groups except for CSW showed positive results for the nested-PCR for both zygotes and for the last wash drops. A cytopathic effect was observed in all groups except for CSW, demonstrating the viability of the virus after treatment. These results demonstrated that trypsin treatment was not effective in eliminating or removal of BoHV-1. The need for such studies is fundamentally important when considering the potential risk of pathogen transmission by reproductive biotechnologies.

Regenerative medicine applied to solid organ transplantation: where do we stand?

The objective of regenerative medicine (RM) and Tissue Engineering (TE) is to create living functional tissues to repair or replace tissues or organ functions. This field holds the promise of regenerating damaged tissues and organs in the body. It has the potential to solve the problems of organ shortage and of toxicities deriving from life-long immunosuppression. In fact, cells in the regenerated organ would match those of the patient, from whom they would normally be derived. In the past decade, RM/TE has achieved striking results which are of interest to the transplant community. However, major roadblocks on the avenue to full success include the need for a deeper understanding of cell biology and of interactions with the extracellular matrix. We are presently not able to grow and expand cells indefinitely and safely in various scenarios where RM/TE may be indicated. The production of adequately vascularized scaffolds to optimize nutrients and oxygen delivery, assessment of the viability and function of the cells in the bioengineered construct, and the costs remain areas of scientific research.

Fatal hemorrhage in two renal graft recipients with multi-drug resistant Pseudomonas aeruginosa infection

Pseudomonas aeruginosa (PA) infections occurring after renal transplantation (RT) represent a potentially life-threatening complication. We present 2 cases of early death following RT in which PA was transmitted, possibly from the donor to the recipients, despite preoperative cultures that were negative. The donor had developed PA-related bilateral pneumonia while in the intensive care unit. However, after appropriate antibiotic therapy, no signs of infection were present at the time of organ retrieval and cultures were negative. Both recipients received a renal graft from the same donor and developed multi-drug resistant (MDR)-PA infections with bacterial phenotypes and resistances similar to the donor. The first recipient died 9 days after RT from rupture of a false aneurysm of the external iliac artery, caused by a fully thickened PA-related arteritis. The second recipient died postoperatively on day 10 after rupture of an aneurysm in the right vertebral artery. Our experience shows that MDR-PA infection early after RT may be a catastrophic event. Specific anti-PA antibiotic therapy in RT patients during the perioperative period is recommended in the case of PA infection in the donor, even after apparent successful therapy with negative cultures.

The association between periodontal diseases and cardiovascular diseases: a narrative review

A possible relationship between periodontal diseases (PDs) and cardiovascular diseases (CVDs) has been supposed and investigated. This review of the literature focuses exclusively on published studies on current theories and models of correlation between PDs and CVDs. A literature search of clinical and observational studies, in the English language, was performed in MEDLINE/PubMed, OVID database and Cochrane Oral Health Group's Trial Register. In addition, references cited in reviewed studies were evaluated for relevant papers. Various mechanisms are described in order to explain this possible association such as a hyper-responsive inflammatory response to chronic infections in predisposed individuals, and systemic effects of periodontal microorganisms including blood platelet aggregation, atheroma formation, increase in lipid levels, activation of acute phase reaction and systemic production of proinflammatory mediators, but a ultimate relation as well as the potential mechanisms have not been defined yet. Controversial result can be related to different method or objectives of studies including different study design, exposure evaluation, outcome variables and clinical endpoints considered. This paper provides a narrative review of the epidemiological studies dealing with the potential association between PDs and cardiovascular events. A precise association between PDs and CVDs, as well as the involved mechanisms are not yet well defined. Additional large-scale longitudinal epidemiological and intervention studies are necessary to validate this association.

Evaluation of trypsin treatment on the inactivation of bovine herpesvirus type 1 on in vitro produced pre-implantation embryos

The aim of this study was to evaluate the efficiency of trypsin treatment on the inactivation of bovine herpesvirus type 1 (BoHV-1) on in vitro produced by fertilization and artificially infected bovine embryos. Bovine embryos on day 7 were exposed with 10 microl of BoHV-1, Los Angeles strain 10(7.5) TCID. These embryos and control embryos were divided in two groups: submitted to the sequential washes or to the trypsin treatment according to the International Embryo Transfer Society (IETS) guidelines. The embryos and the last washing drop of each group were used as inoculum to infect Madin Darby bovine kidney (MDBK) cells and submitted to nested PCR reaction using the primer that encodes the gene conserved region of virus glycoprotein gB. The data have shown that the control embryos and their last washing drop were negative. The exposed embryos that were treated with trypsin have shown positive results on the n-PCR and MDBK culture, and their last washing drop were negative. Our data have demonstrated that the trypsin treatment was not able to eliminate the BHV-1 of the embryos, suggesting an interaction between virus and embryo.

The Role of Liver Transplantation in the Treatment of Hereditary Hemorrhagic Telangiectasia: A Short Literature Review

The liver is involved in up to 73% of patients suffering from hereditary hemorrhagic telangiectasia (HHT), but only some of them become symptomatic. Although management is often conservative, sometimes a more aggressive approach is required. The role of surgery is still undefined. Open ligation, banding, or closure of the arteriovenous malformation feeding artery have been proposed but rejected, as they are followed by an unacceptably high incidence of complications, derived from ischemia of the biliary tree. Orthotopic liver transplantation (OLT) has been successfully attempted in 28 patients with cardiac, biliary, or portal hypertension as well as mixed clinical presentations. Twenty-four were alive at time of data collection. Cardiovascular and pulmonary functions have improved after the operation in most cases. Intrahepatic relapse of the hallmark lesion of the disease (telangiectasia and arterovenous malformation) has been recently described in two cases. OLT represents a valuable therapeutic option for hepatic-based HHT, provided early diagnosis and referral to a specialized unit.

A combined treatment regimen for desquamative gingivitis in patients with oral lichen planus

BACKGROUND

Chronic desquamative gingivitis (DG) is a condition characterized by erythema, ulceration, and desquamation of the free and attached gingiva, usually expression of a district-systemic disease, such as oral lichen planus (OLP).

METHODS

A combined protocol of oral hygiene and topic corticosteroid therapy was applied in 30 patients with DG associated with OLP. Plaque index (PI) and bleeding on probing (BoP) were evaluated at baseline and after 3 months.

RESULTS

PI scoring was significantly lower after treatment in anterior, posterior, and all sites (P < 0.0001) as well as in vestibular and lingual ones (P < 0.0001 and P = 0.0001, respectively). BoP measures were found to be reduced significantly to 22.94% in a full-mouth evaluation (P < 0.0001; OR = 2.633; 95% CI: 2.2685-3.0561) as well as in each specific site (P < 0.0001).

CONCLUSION

This clinical trial validated the efficacy, in patients with DG associated with OLP, of a protocol based on professional oral hygiene and self-performed plaque control measures in improving of gingival health status.

HPV infection in relation to OSCC histological grading and TNM stage. Evaluation by traditional statistics and fuzzy logic model

We aimed to evaluate if in oral squamous cell carcinoma (OSCC) there is a relationship between histological grading (HG), TNM clinical stage and HPV infection; and to study the performance of fuzzy logic compared to traditional statistics, in the analysis of HPV status and correlates of OSCC. In cross-sectional analysis, the study group comprised 63 patients (mean age 68.89 years (SD +/-11.78), range (32-93); males 28 (44.4%), females 35 (55.6%)) with OSCC histologically diagnosed. HPV-DNA was studied in exfoliated oral epithelial cells by nested PCR (MY09/MY11 and GP5+/GP6+ primers). Data were analysed in parallel by traditional statistics with multivariate analysis and a fuzzy logic (FL) technique (membership functions as input, the ANFIS methodology, and the Sugeno's model of first order). HPV infection was detected in 24/63 (38.1%) of OSCC, as being HPV+ve 14/36 (38.9%) in G1, 7/18 (38.9%) in G2, and 3/9 (33.3%) in G3; HPV+ve 8/33 (24.2%) in Stage I, 9/12 (75.0%) in Stage II, 6/11(54.5%) in Stage III, and 1/7 (14.3%) in Stage IV. In both methods of analysis, no significantly increased risk of HPV infection was found for any HG score; whereas, TNM stage II was significantly associated to HPV infection (p=0.004; OR=9.375 (95% CI=2.030:43.30); OR'=11.148 (95% CI=1.951:43.30)), and, in particular, to primary tumour size T2 (p=0.0036; OR=7.812 (95% CI=1.914:31.890); OR'=9.414 (95% CI=1.846:48.013)); FL (% of prevision: 79.8; Root Mean-Square Error (RMSE): 0.29). No association was found between HPV infection and any demographical variable. Our findings show an association between HPV infection with TNM (stage II-T2), but not with histological grading of OSCC. Also, FL seems to be an additional effective tool in analysing the relationship of HPV infection with correlates of OSCC.

Urologic complications in kidney transplantation

Urologic complications in kidney transplantation have an incidence ranging from 3% to 20%, representing an important cause of organ loss. From January 2001 to September 2004, 123 renal transplantations were performed using an immunosuppressive protocol including basiliximab, mycophenolate mofetil, calcineurin inhibitors, and steroids. The surgical technique was vascular anastomoses to external iliac vessels, and ureteral anastomosis according to Lich Gregoire technique using a JJ ureteral stent. We report 5 renal complications (4.2%) and 4 extrarenal complications (3.5%), the majority of which required corrective surgery. The surgical strategy uses the clinical condition of the donor and the recipient; the anatomic anomalies of the graft, and a reduced cold ischemia time. Moreover, a reduction in acute rejection episodes and immediate renal function has been fundamental to reduce urologic complications. In fact, the main cause of urologic complications is ureteral ischemia, linked both to backtable surgery and to rejection episodes. Another important factor in the reduction of early urologic complications has been the routine use of a JJ stent, which allowed us a conservative approach in this setting.

Malignancies After Kidney Transplantation

The most effective treatment of end-stage renal disease is renal transplantation; its superiority to prolong the longevity of patients is well established. Patient and graft survivals have improved with more potent immunosuppression but this advance has been associated with an increased incidence of cancer. The aim of this study was to assess the prevalence of cancer among 265 kidney transplant recipients engrafted between 1968 and October 2004. The overall prevalence of de novo malignancies was 3%. The mean age at diagnosis was 53.3 years (range, 28-63 years) and the duration of the transplant was 11.6 years (range, 0.3-33 years). One patient among 127 (0.8%) who had a history of less than 3 years under immunosuppression, developed a posttransplantation lymphoproliferative disorder (PTLD). Among the 138 patients who had more than 3 years immunosuppression, 7 (5%) developed neoplasms of vulva, colon, native kidneys, prostatic gland, and ovary. One patient was affected by de novo carcinoma in the transplanted kidney. Compared with other published studies, our early cancer prevalence is low, possibly due to a careful history before grafting, good HLA matching, and abstinence from anti-T-cell therapy for treatment of acute rejection episodes. The low level of immunosuppression may account for the low prevalence of neoplasia. The risk of developing a malignancy increases with long-term immunosuppression, comparable with most reports.

Infectious Complications in the Renal Transplant Recipient

The aim of this study was to estimate the incidence of infectious diseases in a group of patients who underwent kidney transplantation from January 1, 2004 to September 30, 2004, including 121 operations, with 119 from cadaveric and 2 from living donors. The protocol sought herpes viruses (CMV, VZV, and EBV), hepatitis viruses, human immunodeficiency virus, T. gondii, M. tubercolosis, and T. pallidum. Therapy for CMV was used both as prophylaxis in immunoglobulin (Ig)G-negative recipients from IgG-positive donors and preemptive therapy, that is, before the appearance of clinical symptoms, but after viremia reached borderline levels. For VZV infections, the treatment started after the appearance of papulo-vesicular cutaneous eruptions and antibody positivity. The treatment for pneumonia consisted of empirical therapy after radiography; for pyelonephritis, antibiotic therapy was based on the results of kidney echography, blood culture, and urine culture. Infectious complications appeared in 25 patients (20.7%), 3 of the which were polymicrobic: 12 CMV infections, 9 VZV infections, 3 pneumoniae, 4 pyelonephritis, and 1 salmonellosis. The most frequent infection was CMV, which occurred in the first 3 months after transplantation in 9 of 12 cases. This study showed that a knowledge of infection prevalence can help the physician to establish a more specific, efficacious antimicrobial therapy, despite the laboratory response not being available in a short time.

Transbuccal tablets of carbamazepine: formulation, release and absorption pattern

Tranbsuccal drug administration is an attractive method, as it has several advantages especially with respect to peroral delivery. Here we report: i) the aptitude of carbamazepine (CBZ) to penetrate porcine buccal mucosa and reconstituted human oral (RHO) epithelium; ii) three different tablet formulations for transbuccal administration; iii) the drug release rate from tablets. CBZ permeation through the buccal mucosa was investigated by using two different bi-compartmental open models: Franz cells for porcine buccal mucosa and Transwell diffusion cells system for RHO epithelium. Results, expressed as drug flux (Js) and permeability coefficients (Kp), indicated that CBZ well penetrates the membrane and arrives in the acceptor phase. Js and Kp resulted 7x10(-2) mg/cm2h and 0.23 cm/h for in vitro experiments and 1.81 x 10(-2) mg/cm2h and 4.57 x 10(-2) cm/h for ex vivo experiments. The flux is extensively affected by the membrane thickness. The CBZ release from three different formulations of tablets, prepared with loaded microspheres, loaded matrices, and conventional compressed physical mixture of components was studied. Using the new formulated "non-conventional" tablets prolonged drug release was obtained. Loaded matrix tablets discharged CBZ faster than microsphere tablets (17% and 12% in about 2.5 h respectively). Results indicate the possibility of administering CBZ on buccal mucosa.

Life at depth: Photobacterium profundum genome sequence and expression analysis

Deep-sea life requires adaptation to high pressure, an extreme yet common condition given that oceans cover 70% of Earth's surface and have an average depth of 3800 meters. Survival at such depths requires specific adaptation but, compared with other extreme conditions, high pressure has received little attention. Recently, Photobacterium profundum strain SS9 has been adopted as a model for piezophily. Here we report its genome sequence (6.4 megabase pairs) and transcriptome analysis. The results provide a first glimpse into the molecular basis for life in the largest portion of the biosphere, revealing high metabolic versatility.

p53 can inhibit cell proliferation through caspase-mediated cleavage of ERK2/MAPK

Stimulation of the Ras/MAPK cascade can either activate p53 and promote replicative senescence and apoptosis, or degrade p53 and promote cell survival. Here we show that p53 can directly counteract the Ras/MAPK signaling by inactivating ERK2/MAPK. This inactivation is due to a caspase cleavage of the ERK2 protein and contributes to p53-mediated growth arrest. We found that in Ras-transformed cells, growth arrest induced by p53, but not p21(Waf1), is associated with a strong reduction in ERK2 activity, phosphorylation, and protein half-life, and with the appearance of caspase activity. Likewise, DNA damage-induced cell cycle arrest correlates with p53-dependent ERK2 downregulation and caspase activation. Furthermore, caspase inhibitors or expression of a caspase-resistant ERK2 mutant interfere with ERK2 cleavage and restore proliferation in the presence of p53 activation, indicating that caspase-mediated ERK2 degradation contributes to p53-induced growth arrest. These findings strongly point to ERK2 as a novel p53 target in growth suppression.

Proliferative verrucous vs conventional leukoplakia: no significantly increased risk of HPV infection

Proliferative verrucous leukoplakia (PVL) is a very aggressive form of oral leukoplakia (OL) with high morbidity and mortality rates, hypothesised to be linked to HPV infection. This study aimed to determine the presence of HPV DNA in PVL in comparison with OL, and in relation to social-demographical variables (age, gender, smoking and drinking habits) in an Italian multi-centric hospital-based study. The study group consisted of 58 cases of PVL and 90 cases of OL as controls (47 homogeneous (H) and 43 non-homogeneous (non-H) form), both recruited from four Italian cohorts. HPV DNA was identified in exfoliated mucosal cells by nested PCR (nPCR) with MY09/MY11 and GP5+/GP6+ primer pairs and the HPV genotype determined by direct DNA sequencing. HPV DNA was found in 24.1% (14/58)of PVL and in 25.5% (23/90) of OL; there was thus no significant difference found between PVL and OL (both forms) for risk of HPV infection (OR=0.93; 95% IC:0.432-1.985). Similarly, in both groups of PVL and OL lesions, no statistic association was found between any demographical variable considered and HPV infection. HPV-18 was the most frequently detected genotype in all tissues, being found in 78.5% and 60.8% of HPV+ve PVL and OL, respectively. Other more rarely detected genotypes were HPV-16 (28.6% in PVL and 13% in OL), HPV-6 (17.4% in OL) and HPV-53 (8.8% in OL). PVL does not appear more likely to be associated to HPV infection than conventional OL lesions.

The small bovine amelogenin LRAP fails to rescue the amelogenin null phenotype

Amelogenins are the most abundant secreted proteins in developing dental enamel. These evolutionarily-conserved proteins have important roles in enamel mineral formation, as mutations within the amelogenin gene coding region lead to defects in enamel thickness or mineral structure. Because of extensive alternative splicing of the primary RNA transcript and proteolytic processing of the secreted proteins, it has been difficult to assign functions to individual amelogenins. To address the function of one of the amelogenins, we have created a transgenic mouse that expresses bovine leucine-rich amelogenin peptide (LRAP) in the enamel-secreting ameloblast cells of the dental organ. Our strategy was to breed this transgenic mouse with the recently generated amelogenin knockout mouse, which makes none of the amelogenin proteins and has a severe hypoplastic and disorganized enamel phenotype. It was found that LRAP does not rescue the enamel defect in amelogenin null mice, and enamel remains hypoplastic and disorganized in the presence of this small amelogenin. In addition, LRAP overexpression in the transgenic mouse (wildtype background) leads to pitting in the enamel surface, which may result from excess protein production or altered protein processing due to minor differences between the amino acid compositions of murine and bovine LRAP. Since introduction of bovine LRAP into the amelogenin null mouse does not restore normal enamel structure, it is concluded that other amelogenin proteins are essential for normal appearance and function.

Genotyping and antifungal susceptibility of human subgingival Candida albicans isolates

Subgingival colonization by Candida albicans has been described in human immunodeficiency virus (HIV)-infected individuals, but subgingival isolates have scarcely been characterized, particularly with respect to genotype and antifungal susceptibility. A series of 29 subgingival strains of C. albicans isolated from nine HIV-infected individuals was typed by electrophoretic karyotyping and tested for susceptibility to fluconazole, itraconazole, the new investigational triazole posaconazole and amphotericin B. DNA typing showed genetic heterogeneity within subgingival isolates, as almost every individual harbored his/her own specific isolate. Genetic identity was usually demonstrated within oral and subgingival isolates simultaneously collected from the same individual, but a number of DNA types were found to be unique to subgingival strains. These findings suggest that colonization is not just the result of Candida spreading from oral surfaces, and that subgingivally adapted strains could be involved. All isolates were susceptible to all the triazole drugs tested and amphotericin B. Additional studies on subgingival Candida colonization and further characterization of subgingival isolates are now required to clarify the role of Candida as opportunistic periodontal pathogen.

[The effect of instrumentation on original apical foramen shape using steel vs niti rotatory: computerized analysis]

BACKGROUND

A fundamental requirement to obtain a correct endodontic preparation depends on the respect, during cleaning and shaping, of the original morphology of the apical foramen, (AF), so that the filling material will form a complete seal.

METHODS

In our previous studies, in order to verify if this presumption was respected using rotary NiTi instruments with cutting tip, we instrumented extracted teeth characterised by a different degree of root curvatures. Using a standardized system to replace the sample, the original shape of the apical foramen of each tooth was recorded using a computerised technique and then compared to the shape after instrumentation. The data showed differences on AF shapes depending on the degree of root canal curvatures. In fact, the teeth with straight canals showed the least alterations on the original AF shape; on the contrary, the teeth with curved canals showed apical foramen enlargement or transportation. Therefore, in the current study we aimed to compare the in vitro effects of stainless steel, (Flexofile, Dentsply Maillefer, Baillaigues, Switzerland), vs NiTi safe cutting tip (Quantec SC, (Tycom Dental, Irvine CA, U:S.A.), vs NiTi non cutting tip, (Quantec LX, Tycom Dental, Irvine CA, U:S.A.), instrumentation on original apical foramen shape. We used NiTi instruments according to standard technique suggested by Tycom, and hand steel files, to instrument the apical third, according to the Crown-Down technique. Working length was fixed at -0.5 from AF.

RESULTS AND CONCLUSIONS

Our results suggested that in the presence of accentuated canal curves rotary Niti, with cutting tip, cause significantly more enlargement of the AF area. At the same time, we also observed that NiTi rotary files, with both cutting and non-cutting tip, cause eccentric enlargement of AF in curved canals. Therefore, NiTi engine-driven instruments should be used carefully in the presence of accentuated canal curves to avoid enlargement or transportation of AF, probably because rotary NiTi files may slip out of operative control, leaving a mark on the foramen shape. In the presence of severe curves, we suggest modifying the operative sequences by alternating rotary NiTi with hand NiTi or stainless steel instruments, especially in the preparation of apical third.