Argonaute3-SF3B3 complex controls pre-mRNA splicing to restrain type 2 immunity

Argonaute (AGO) proteins execute microRNA (miRNA)-mediated gene silencing. However, it is unclear whether all 4 mammalian AGO proteins (AGO1, AGO2, AGO3, and AGO4) are required for miRNA activity. We generate Ago1, Ago3, and Ago4-deficient mice (Ago134Δ) and find AGO1/3/4 to be redundant for miRNA biogenesis, homeostasis, or function, a role that is carried out by AGO2. Instead, AGO1/3/4 regulate the expansion of type 2 immunity via precursor mRNA splicing in CD4+ T helper (Th) lymphocytes. Gain- and loss-of-function experiments demonstrate that nuclear AGO3 interacts directly with SF3B3, a component of the U2 spliceosome complex, to aid global mRNA splicing, and in particular the isoforms of the gene Nisch, resulting in a dysregulated Nisch isoform ratio. This work uncouples AGO1, AGO3, and AGO4 from miRNA-mediated RNA interference, identifies an AGO3:SF3B3 complex in the nucleus, and reveals a mechanism by which AGO proteins regulate inflammatory diseases.

Steroid-induced fibroblast growth factors drive an epithelial-mesenchymal inflammatory axis in severe asthma

Asthma and inflammatory airway diseases restrict airflow in the lung, compromising gas exchange and lung function. Inhaled corticosteroids (ICSs) can reduce inflammation, control symptoms, and improve lung function; however, a growing number of patients with severe asthma do not benefit from ICS. Using bronchial airway epithelial brushings from patients with severe asthma or primary human cells, we delineated a corticosteroid-driven fibroblast growth factor (FGF)-dependent inflammatory axis, with FGF-responsive fibroblasts promoting downstream granulocyte colony-stimulating factor (G-CSF) production, hyaluronan secretion, and neutrophilic inflammation. Allergen challenge studies in mice demonstrate that the ICS, fluticasone propionate, inhibited type 2-driven eosinophilia but induced a concomitant increase in FGFs, G-CSF, hyaluronan, and neutrophil infiltration. We developed a model of steroid-induced neutrophilic inflammation mediated, in part, by induction of an FGF-dependent epithelial-mesenchymal axis, which may explain why some individuals do not benefit from ICS. In further proof-of-concept experiments, we found that combination therapy with pan-FGF receptor inhibitors and corticosteroids prevented both eosinophilic and steroid-induced neutrophilic inflammation. Together, these results establish FGFs as therapeutic targets for severe asthma patients who do not benefit from ICS.

Oncostatin M expression induced by bacterial triggers drives airway inflammatory and mucus secretion in severe asthma

[Figure: see text].

CD4+ Th2 cells are directly regulated by IL-10 during allergic airway inflammation

Interleukin-10 (IL-10) is an important regulatory cytokine required to control allergy and asthma. IL-10-mediated regulation of T cell-mediated responses was previously thought to occur indirectly via antigen-presenting cells. However, IL-10 can act directly on regulatory T cells and T helper type 17 (Th17) cells. In the context of allergy, it is therefore unclear whether IL-10 can directly regulate T helper type 2 (Th2) cells and whether this is an important regulatory axis during allergic responses. We sought to determine whether IL-10 signaling in CD4⁺ Th2 cells was an important mechanism of immune regulation during airway allergy. We demonstrate that IL-10 directly limits Th2 cell differentiation and survival in vitro and in vivo. Ablation of IL-10 signaling in Th2 cells led to enhanced Th2 cell survival and exacerbated pulmonary inflammation in a murine model of house dust mite allergy. Mechanistically, IL-10R signaling regulated the expression of several genes in Th2 cells, including granzyme B. Indeed, IL-10 increased granzyme B expression in Th2 cells and led to increased Th2 cell death, identifying an IL-10-regulated granzyme B axis in Th2 cells controlling Th2 cell survival. This study provides clear evidence that IL-10 exerts direct effects on Th2 cells, regulating the survival of Th2 cells and severity of Th2-mediated allergic airway inflammation.

Bacterial genotoxin functions as immune-modulator and promotes host survival

Bacterial genotoxins are effectors that cause DNA damage in target cells. Many aspects of the biology of these toxins have been characterised in vitro, such as structure, cellular internalisation pathways and effects on the target cells. However, little is known about their function in vivo. Salmonella enterica serovar Typhi (S. Typhi) is a Gram-negative, intracellular bacterium that causes typhoid fever, a debilitating disease infecting more than 20 million people every year. S. Typhiproduce a genotoxin named typhoid toxin (TT), but its role in the contest of host infection is poorly characterized. The major obstacle in addressing this issue is that S. Typhi is exclusively a human pathogen. To overcome this limitation, we have used as model bacterium S. Typhimurium, and engineered it to produce endogenous levels of an active and inactive typhoid toxin, hereby named as TT (or genotoxic) and cdtB (or control), respectively. To our surprise, infection with the genotoxin strain strongly suppressed intestinal inflammation, leading to a better survival of the host during the acute phase of infection, suggesting typhoid toxin may exert a protective role. The presence of a functional genotoxin was also associated with an increased frequency of asymptomatic carriers.

The Typhoid Toxin Promotes Host Survival and the Establishment of a Persistent Asymptomatic Infection

Bacterial genotoxins, produced by several Gram-negative bacteria, induce DNA damage in the target cells. While the responses induced in the host cells have been extensively studied in vitro, the role of these effectors during the course of infection remains poorly characterized. To address this issue, we assessed the effects of the Salmonella enterica genotoxin, known as typhoid toxin, in in vivo models of murine infection. Immunocompetent mice were infected with isogenic S. enterica, serovar Typhimurium (S. Typhimurium) strains, encoding either a functional or an inactive typhoid toxin. The presence of the genotoxic subunit was detected 10 days post-infection in the liver of infected mice. Unexpectedly, its expression promoted the survival of the host, and was associated with a significant reduction of severe enteritis in the early phases of infection. Immunohistochemical and transcriptomic analysis confirmed the toxin-mediated suppression of the intestinal inflammatory response. The presence of a functional typhoid toxin further induced an increased frequency of asymptomatic carriers. Our data indicate that the typhoid toxin DNA damaging activity increases host survival and favours long-term colonization, highlighting a complex cross-talk between infection, DNA damage response and host immune response. These findings may contribute to understand why such effectors have been evolutionary conserved and horizontally transferred among Gram-negative bacteria.

Salmonella enterica delivers its genotoxin through outer membrane vesicles secreted from infected cells

Cytolethal-distending toxins (CDTs) belong to a family of DNA damage inducing exotoxins that are produced by several Gram-negative bacteria. Salmonella enterica serovar Typhi expresses its CDT (named as Typhoid toxin) only in the Salmonella-containing vacuole (SCV) of infected cells, which requires its export for cell intoxication. The mechanisms of secretion, release in the extracellular space and uptake by bystander cells are poorly understood. We have addressed these issues using a recombinant S. Typhimurium strain, MC71-CDT, where the genes encoding for the PltA, PltB and CdtB subunits of the Typhoid toxin are expressed under control of the endogenous promoters. MC71-CDT grown under conditions that mimic the SCV secreted the holotoxin in outer membrane vesicles (OMVs). Epithelial cells infected with MC71-CDT also secreted OMVs-like vesicles. The release of these extracellular vesicles required an intact SCV and relied on anterograde transport towards the cellular cortex on microtubule and actin tracks. Paracrine internalization of Typhoid toxin-loaded OMVs by bystander cells was dependent on dynamin-1, indicating active endocytosis. The subsequent induction of DNA damage required retrograde transport of the toxin through the Golgi complex. These data provide new insights on the mode of secretion of exotoxins by cells infected with intracellular bacteria.

Dental implants inserted in native bone: Cases series analyses

Background:

The concept of osseointegration, i.e., the direct anchorage of endosseous implants made of commercially pure or titanium alloy to the bone caused a breakthrough in oral rehabilitation. The identification of factors for long-term survival and success rate are the main goal of the recent literature. Several variables can influence the final result, and in general they are grouped in surgery-, host-, implant-, and occlusion-related factors.

Materials and Methods:

A retrospective analysis on a large series of dental implants was performed to detect those variables influencing the clinical outcome. In the period between January 2007 and December 2009, 157 patients were operated. A total of 429 implants were inserted. Dental implants are reliable devices to be used in oral rehabilitation.

Results:

Globally, very few implants were lost at the end of the follow-up period. Slight but significant differences existed among different implants types with regard to peri-implant bone resorption.

Conclusion:

A better clinical outcome was revealed for Sweden and Martina global implant.

Chronic exposure to the cytolethal distending toxins of Gram-negative bacteria promotes genomic instability and altered DNA damage response

Epidemiological evidence links chronic bacterial infections to the increased incidence of certain types of cancer but the molecular mechanisms by which bacteria contribute to tumour initiation and progression are still poorly characterized. Here we show that chronic exposure to the genotoxin cytolethal distending toxin (CDT) of Gram-negative bacteria promotes genomic instability and acquisition of phenotypic properties of malignancy in fibroblasts and colon epithelial cells. Cells grown for more than 30 weeks in the presence of sublethal doses of CDT showed increased mutation frequency, and accumulation of chromatin and chromosomal aberrations in the absence of significant alterations of cell cycle distribution, decreased viability or senescence. Cell survival was dependent on sustained activity of the p38 MAP kinase. The ongoing genomic instability was associated with impaired activation of the DNA damage response and failure to efficiently activate cell cycle checkpoints upon exposure to genotoxic stress. Independently selected sublines showed enhanced anchorage-independent growth as assessed by the formation of colonies in semisolid agarose. These findings support the notion that chronic infection by CDT-producing bacteria may promote malignant transformation, and point to the impairment of cellular control mechanisms associated with the detection and repair of DNA damage as critical events in the process.

Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction

This report describes the successful management of a documented necrotizing pneumonia due to Streptococcus pneumoniae in a child with pandemic influenza A (H1N1). The importance of early recognition of bacterial superinfection in patients with influenza and the immunologic interactive mechanisms between viruses and bacteria in determining respiratory diseases are highlighted. The role of modern molecular techniques in improving diagnostic microbiology sensitivity and informing consequent clinical care is emphasized.

Bacterial genotoxin triggers FEN1-dependent RhoA activation, cytoskeleton remodeling and cell survival

The DNA damage response triggered by bacterial cytolethal distending toxins (CDTs) is associated with activation of the actin-regulating protein RhoA and phosphorylation of the downstream-regulated mitogen-activated protein kinase (MAPK) p38, which promotes the survival of intoxicated (i.e. cells exposed to a bacterial toxin) cells. To identify the effectors of this CDT-induced survival response, we screened a library of 4492 Saccharomyces cerevisiae mutants that carry deletions in nonessential genes for reduced growth following inducible expression of CdtB. We identified 78 genes whose deletion confers hypersensitivity to toxin. Bioinformatics analysis revealed that DNA repair and endocytosis were the two most overrepresented signaling pathways. Among the human orthologs present in our data set, FEN1 and TSG101 regulate DNA repair and endocytosis, respectively, and also share common interacting partners with RhoA. We further demonstrate that FEN1, but not TSG101, regulates cell survival, MAPK p38 phosphorylation, RhoA activation and actin cytoskeleton reorganization in response to DNA damage. Our data reveal a previously unrecognized crosstalk between DNA damage and cytoskeleton dynamics in the regulation of cell survival, and might provide new insights on the role of chronic bacteria infection in carcinogenesis.

The biology of the cytolethal distending toxins

The cytolethal distending toxins (CDTs), produced by a variety of Gram-negative pathogenic bacteria, are the first bacterial genotoxins described, since they cause DNA damage in the target cells. CDT is an A-B(2) toxin, where the CdtA and CdtC subunits are required to mediate the binding on the surface of the target cells, allowing internalization of the active CdtB subunit, which is functionally homologous to the mammalian deoxyribonuclease I. The nature of the surface receptor is still poorly characterized, however binding of CDT requires intact lipid rafts, and its internalization occurs via dynamin-dependent endocytosis. The toxin is retrograde transported through the Golgi complex and the endoplasmic reticulum, and subsequently translocated into the nuclear compartment, where it exerts the toxic activity. Cellular intoxication induces DNA damage and activation of the DNA damage responses, which results in arrest of the target cells in the G1 and/or G2 phases of the cell cycle and activation of DNA repair mechanisms. Cells that fail to repair the damage will senesce or undergo apoptosis. This review will focus on the well-characterized aspects of the CDT biology and discuss the questions that still remain unanswered.

Myc is required for activation of the ATM-dependent checkpoints in response to DNA damage

Background

The MYC protein controls cellular functions such as differentiation, proliferation, and apoptosis. In response to genotoxic agents, cells overexpressing MYC undergo apoptosis. However, the MYC-regulated effectors acting upstream of the mitochondrial apoptotic pathway are still unknown.

Principal Findings

In this study, we demonstrate that expression of Myc is required to activate the Ataxia telangiectasia mutated (ATM)-dependent DNA damage checkpoint responses in rat cell lines exposed to ionizing radiation (IR) or the bacterial cytolethal distending toxin (CDT). Phosphorylation of the ATM kinase and its downstream effectors, such as histone H2AX, were impaired in the myc null cell line HO15.19, compared to the myc positive TGR-1 and HOmyc3 cells. Nuclear foci formation of the Nijmegen Breakage Syndrome (Nbs) 1 protein, essential for efficient ATM activation, was also reduced in absence of myc. Knock down of the endogenous levels of MYC by siRNA in the human cell line HCT116 resulted in decreased ATM and CHK2 phosphorylation in response to irradiation. Conversely, cell death induced by UV irradiation, known to activate the ATR-dependent checkpoint, was similar in all the cell lines, independently of the myc status.

Conclusion

These data demonstrate that MYC contributes to the activation of the ATM-dependent checkpoint responses, leading to cell death in response to specific genotoxic stimuli.

Clinical outcome of narrow diameter implants inserted into allografts

Objective:

Narrow diameter implants (NDI) (i.e. diameter <3.75 mm) are a potential solution for specific clinical situations, such as reduced interradicular bone, thin alveolar crest and replacement of teeth with small cervical diameter. NDI have been available in clinical practice since the 1990s, but only few studies have analyzed their clinical outcome and no study have investigated NDI inserted in fresh-frozen bone (FFB) grafts. Thus, a retrospective study on a series of NDI placed in homologue FFB was designed to evaluate their clinical outcome.

Material and Methods:

In the period between December 2003 and December 2006, 36 patients (22 females and 14 males, mean age 53 years) with FFB grafts were selected and 94 different NDI were inserted. The mean follow-up was 25 months. To evaluate the effect of several host-, surgery-, and implant-related factors, marginal bone loss (MBL) was considered an indicator of success rate (SCR). The Kaplan Meier algorithm and Cox regression were used.

Results:

Only 5 out of 94 implants were lost (i.e. survival rate - SVR 95.7%) and no differences were detected among the studied variables. On the contrary, the Cox regression showed that the graft site (i.e. maxilla) reduced MBL.

Conclusions:

NDI inserted in FFB have a high SVR and SCR similar to those reported in previous studies on regular and NDI inserted in non-grafted jaws. Homologue FFB is a valuable material in the insertion of NDI.

The clinical outcomes of 234 spiral family implants

AIM

Spiral family implants (SFIs) are a new type of implant fixture with a conical internal helix and a variable thread design. The aim of this retrospective study was to evaluate the clinical outcomes of a series of SFIs.

METHODS AND MATERIALS

A total of 234 SFIs were placed in 86 patients (55 females and 31 males, median age 53 years) during the period between May 2004 and November 2007. The mean follow-up was 13 months. Several host, surgery, and implant-related factors were investigated, and the Kaplan Meier algorithm and the Cox regression were used to detect variables associated with the clinical outcome.

RESULTS

Only nine out of 234 implants were lost (i.e., survival rate (SVR) of 96.2%) and no differences were detected among the studied variables.

CONCLUSION

SFIs have a high SVR similar to those reported in previous studies on different implant types.

CLINICAL SIGNIFICANCE

SFIs demonstrated a very high primary stability which offers the potential for use of a specific implant device for immediate loading. However, additional studies are necessary to verify their outcome on the medium/long period.

Osseotite implants inserted into fresh frozen bone grafts

BACKGROUND

In the last decade, several investigators have reported that double etched implants have achieved excellent results. However, no report regarding double etched implants inserted into fresh frozen bone is available.

AIMS

We planned to perform a retrospective study on double etched implants inserted into fresh frozen bone grafts.

SETTING AND DESIGN

28 patients (17 females and 11 males with a median age of 52 years) were operated on and 114 double etched implants inserted. Implant diameter and length ranged from 3.25 to 5.0 mm and from 10.0 to 15 mm, respectively. Implants were inserted to replace 14 incisors, 5 cuspids, 47 premolars and 48 molars.

RESULTS

Since only 4 out of 114 implants were lost (i.e. Survival Rate SVR = 96.5%) and no statistical differences were detected among the studied variables. The type of prosthetic restoration (i.e. fixed prostheses) correlated with a statistically significant lower delta Implant Abutment Junction (i.e. reduced crestal bone loss) and thus a better clinical outcome.

CONCLUSION

Double etched implants inserted into fresh frozen bone had a high survival and success rate similar to those reported in previous studies of two-stage procedures in non-grafted bone, although a higher marginal bone loss has to be expected when removable prosthetic restorations are used.

CaPO4 Blasted Implants Inserted Into Iliac Crest Homologue Frozen Grafts

In the last decade, some investigations have reported that the resorbable blast media surface (also named CaPO4 blasted implants [CaPO4-BIs]) has achieved excellent results. However, no report regarding CaPO4-BIs inserted into fresh frozen bone (FFB) is available. Thus, we planned a retrospective study on a series of CaPO4-BIs inserted into FFB to evaluate their clinical outcome. In the period between December 2003 and December 2006, 16 patients (10 females and 6 males, median age of 55 years) were operated on, and 76 CaPO4-BIs were inserted. The mean implant follow-up was 23 months. Implant diameter and length ranged from 3.25 to 4.5 mm and from 11.5 to 15 mm, respectively. Implants were inserted to replace 7 incisors, 11 cuspids, 31 premolars, and 27 molars. Only 1 out of 76 implants was lost (ie, survival rate [SVR] = 98.7%), and no differences were detected among the studied variables. When peri-implant crestal bone resorption was used as an indicator of clinical success (ie, success rate), it was possible to identify some variables that correlated with a better clinical outcome. Specifically, Cox regression showed that removable prosthetic restoration and longer implant length correlated with a statistically significant lower delta implant abutment junction (IAJ; ie, reduced crestal bone loss) and thus a better clinical outcome. In this study, CaPO4-BIs had high survival and success rates, similar to those reported in previous reports of 2-stage procedures in nongrafted bone. CaPO4-BIs inserted into FFB are reliable devices, although greater marginal bone loss occurs when fixed prosthetic restorations and short implants are used.

A new device for impression transfer for non-parallel endosseus implants

The three-dimensional orientation of dental implant is transferred to a model by means of transfer device and impression material. If more than one implant is inserted and fixtures are not perfectly parallel, the impression may become distorted when removed from the mouth. In this case, a transfer that can be disengaged from the internal implant-abutment connection and removed together with the tray could be useful. An impression transfer device composed of a proper transfer, an inner hexagon and a central screw is described. When the central screw and the hexagon are removed, the proper transfer is free to move horizontally and the tray can be removed from the mouth without distortion of the impression material.

Implants inserted in fresh-frozen bone: a retrospective analysis of 88 implants loaded 4 months after insertion

OBJECTIVE

In the previous decade, several reports have been published regarding implants inserted in autografts, but none have analyzed implants inserted in fresh-frozen bone allografts. Thus, a retrospective study was planned to verify if 4-months' delay from grafting to implant insertion is a safe period before prosthetic rehabilitation of implants placed in fresh-frozen bone allografts.

METHOD AND MATERIALS

Between December 2003 and December 2006, 22 patients (10 women and 12 men with a median age of 51 years) underwent grafting with horizontal augmentation without membrane and 88 implants inserted thereafter. The mean implant follow-up was 27 months. Implants used were 30 double etched (3i, Osseotite, Biomet), 10 SLA1 (Astratech), 26 anodic oxidized (Nobel Biocare), 12 CaPO4 ceramic-blasted (Lifecore Biomedical), 7 SLA2 (Sweden and Martina Spa), 2 ITI (Straumann), and 1 Biotec (Povolaro di Dueville). Implant diameter and length ranged from 3.25 to 5.0 mm and from 8.0 to 15.0 mm, respectively. Implants were inserted to replace 10 incisors, 7 canines, 36 premolars, and 35 molars.

RESULTS

No implants were lost (ie, survival rate = 100%). No difference was detected when comparing implants loaded after 4 months versus those loaded after 6 or more months (209 implants).

CONCLUSION

Four-months' delay from grafting to implant insertion is a safe period to obtain a high survival rate and success rate for implants inserted in fresh-frozen bone.

Implants inserted into homografts bearing fixed restorations

PURPOSE

In the last decade several studies have evaluated the clinical outcome of implants inserted into autografts and rehabilitated with fixed restorations in either one- or two-step surgical protocols. However, no study has investigated implants placed into homografts; thus, a case series analysis was performed to verify the clinical outcome of implants inserted into fresh frozen bone (FFB) and bearing fixed prosthetic restorations.

MATERIALS AND METHODS

Fifty-eight patients underwent iliac crest homograft transplants and 238 implants were inserted. Seventy-one double-etched, 19 sandblasted and acid-etched-1 (SLA1), 10 grit-blasted and acid-etched, 73 anodic oxidized, 39 CaPo4 ceramic-blasted, 19 SLA2, and seven additional implants of various types were used. Implant diameter and length ranged from 3 to 5 mm and from 7 to 16 mm, respectively. Implants were inserted to replace 15 incisors, 14 canines, 102 premolars, and 107 molars. A total of 111 restorations were performed.

RESULTS

No implants were lost. Cox regression analysis showed that implant type and type of edentulism directly correlated with a lower bone resorption and thus had a better clinical outcome and success rate.

CONCLUSION

Implants bearing fixed restorations and inserted into FFB have higher survival and succes rates compared to those placed in nongrafted and grafted jaws reported in previous studies.

Retrospective study of standard-diameter implants inserted into allografts

PURPOSE

In the last decade, several investigators reported that standard-diameter implants (SDIs) achieved excellent results. However, no report is available regarding SDIs inserted into fresh-frozen bone (FFB). We conducted a retrospective study on a series of SDIs (diameter, 3.75 mm) inserted into homologous FFB to evaluate their clinical outcome.

MATERIALS AND METHODS

The SDIs inserted with FFB were analyzed. Several variables were investigated regarding patients, anatomic sites, implants, and prosthetic restoration. Implant failure and peri-implant bone resorption were considered predictors of clinical outcome. A Kaplan-Meier algorithm and Cox regression were performed to detect those variables statistically associated with clinical outcomes.

RESULTS

One hundred thirty-three SDIs were inserted in 41 patients. Implant length ranged from 10 to 15 mm. Implants were inserted to replace 6 incisors, 13 cuspids, 60 premolars, and 54 molars. The mean follow-up was 23 months. Only 1 of 133 implants was lost (ie, survival rate=99.2%), and no differences were detected among study variables. On the contrary, crestal bone resorption correlates with type of prosthetic restoration, with a better outcome for removable dentures.

CONCLUSION

The SDIs had high survival and success rates, similar to those reported in previous studies of 2-stage procedures in nongrafted bone. The SDIs inserted into FFB are reliable, although a greater marginal bone loss is to be expected if fixed prosthetic restorations are used.

A 2-year follow-up study on standard length implants inserted into alveolar bone sites augmented with homografts

OBJECTIVE

In the last decade, several investigators have reported that standard length implants (SLIs) have achieved excellent results but no report regarding SLIs (i.e. SLI, length=13 mm) inserted into alveolar bone sites previously augmented with frozen bone (FB) is available. The aim of this study was to evaluate the clinical outcome of SLIs inserted into alveolar bone sites previously augmented with FB.

PATIENTS AND METHODS

The survival and success rate of standard dental implants was evaluated after surgical placement into alveolar bone sites previously augmented with FB. The distance between Implant Abutment Junction and crestal bone level (i.e. delta IAJ) was measured to evaluate the peri-implant bone loss over time. Kaplan-Meier algorithm and Cox regression were used.

RESULTS

The implant survival rate was 97.6% and no differences were detected among the studied variables by using implant loss. On the contrary, the Cox regression showed that implant surface (i.e. sandblasted and acid-etched-SLA- and CaPO(4)ceramic-blasted implants, p=0.0037), graft site (i.e. maxilla, p=0.0438) and prosthetic restoration (i.e. removable dentures, p=0.0003) correlated with a statistically significant reduced crestal bone loss (i.e. success rate).

CONCLUSION

SLIs had a high survival and success rate similar to those reported in previous studies of two-stage procedures in non-grafted bone. FB is a reliable material for alveolar reconstruction and implant insertion.

Localization of small esophageal cancers for radiation planning using endoscopic contrast injection: report on a series of eight cases

Recently, Barrett's esophagus and early adenocarcinomas have been detected increasingly frequently in routine follow-up of patients with gastroesophageal reflux. Although surgery is the treatment of choice, some patients are medically unfit for esophagectomy and, in this case, the only alternative curative therapy is radical chemoradiation therapy. In addition, some patients who present with symptoms have small tumors that cannot be localized accurately using routine imaging techniques. This report describes a series of eight patients with small esophageal cancers in whom the tumors were successfully localized following endoscopic injection of contrast, and treated with chemoradiation therapy. The treatment was successful in seven patients. This method of tumor localization demonstrated that conventional techniques are mostly unreliable when applied to very early cancers.

[Nutritional status disorders prevalence rates in a sample of pediatric oncology Day Hospital patients]

BACKGROUND

Nutritional status is more important in children than in adults because it is necessary to support normal growth and development. In industrialized countries the prevalence of nutritional status disorders in the pediatric population are as follows: 35-40% of children are overweight/obese, while the underweight status disappeared in some reports or, when it is present, it is associated with other diseases. The aim of this study was to investigate the prevalence rates of nutritional status disorders among an unselected sample of Pediatric Oncology Day Hospital patients.

METHODS

Anthropometric parameters of weight and height have been measured in patients affected with solid tumor either on-therapy or off-therapy (0-24 mo). Then Real Body Weight (% RBW) was estimated referring to National Center for Health Statistic percentiles. The sample was then divided into 4 weight classes (under-weight, normal-weight, over-weight and obese) according to % RBW.

RESULTS

Overweight patients (overweight + obese) were 44.4%, and 13.9% underweight. Dividing the patients according to whether they are on-therapy or off-therapy, the prevalence of overweight was 36.9% in the former group and 52.9% in the latter, and the underweight prevalence was 26.3 vs 0%.

CONCLUSIONS

Our preliminary data show that in this sample of patients on treatment obesity and overweight are present in a similar percentage of the healthy population, but underweight status prevalence is 26.3%. In the sample of patients off-therapy the underweight status disappeared while the overweight status increased. These data suggest that nutritional assessment in oncologic patients is required in order to provide nutritional strategies.

[Nutritional status, obesity, and metabolic balance in pediatric patients with type I diabetes mellitus]

BACKGROUND AND AIMS

The aim of this study was to evaluate the nutritional status of children with type 1 diabetes and to search for possible influences of changes in body composition on aspects of diabetes.

METHODS

A group of 96 diabetic subjects (41 males and 55 females) were studied, aged between 3 and 19 years old. The following parameters were examined: weight, stature, 5 skin folds, 7 circumferences, bioelectric impedance, arterial pressure, cholesterolemia, triglyceridemia, insulin dose, HbA1c and duration of disease.

RESULTS

Obesity and overweight were present in 34.5% of the sample, but obesity was only observed in females (25.5%). There was also a high percentage of underweight subjects (11.5% of the entire sample). The mean values of weight BMI, 5 skin folds, 4 circumferences, FM (calculated using fold measurement and BIA) and AFA were higher in females, whereas mean values of waist/hip ratio and waist/thigh ratio and FFM (in % of body weight) were higher in males. A close correlation was also found between the 4 weight classes (underweight, normal weight, overweight, obese) and the majority of marker parameters for adiposity (5 folds, 4 circumferences, BIA, FM calculated using BIA, fold measurement and AFA). Of the other parameters examined (mean duration of disease, HbA1c assay, daily insulin dose, total cholesterolemia, triglycerididemia, arterial pressure), only the daily insulin dose showed higher values in females in 3 weight classes (underweight, normal weight and obese). Following a comparison with the control population (2469 subjects), higher mean values were found in the latter compared to diabetic subjects, but only in relation to 3 skin folds (tricipital, subscapular and suprailiac) and one circumference (forearm).

CONCLUSIONS

The study shows a high frequency of overweight and obesity in children with type 1 diabetes, comparable to that in the healthy population. The finding of a higher frequency of obesity in diabetic females might be explained by their advanced puberal status, given that almost all the obese diabetic females were aged between 10 and 19 years old. The study confirms the validity of a number of anthropometric measurements (BMI, folds, circumference) and BIA in the evaluation of nutritional status in terms of body composition.

[Nutritional status, obesity and metabolic control in children with type 1 diabetes mellitus]

BACKGROUND AND AIMS

The aim of this study was to evaluate the nutritional status of children with type 1 diabetes and to search for possible influences of changes in body composition on aspects of diabetes.

METHODS

A group of 96 diabetic subjects (41 males and 55 females) were studied, aged between 3 and 19 years old. The following parameters were examined: weight, stature, 5 skin folds, 7 circumferences, bioelectric impedance, arterial pressure, cholesterolemia, triglyceridemia, insulin dose, HbA1c and duration of disease.

RESULTS

Obesity and overweight were present in 34.5% of the sample, but obesity was only observed in females (25.5%). There was also a high percentage of underweight subjects (11.5% of the entire sample). The mean values of weight BMI, 5 skin folds, 4 circumferences, FM (calculated using fold measurement and BIA) and AFA were higher in females, whereas mean values of waist/hip ratio and waist/thigh ratio and FFM (in % of body weight) were higher in males. A close correlation was also found between the 4 weight classes (underweight, normal weight, overweight, obese) and the majority of marker parameters for adiposity (5 folds, 4 circumferences, BIA, FM calculated using BIA, fold measurement and AFA). Of the other parameters examined (mean duration of disease, HbA1c assay, daily insulin dose, total cholesterolemia, triglycerididemia, arterial pressure), only the daily insulin dose showed higher values in females in 3 weight classes (underweight, normal weight and obese). Following a comparison with the control population (2469 subjects), higher mean values were found in the latter compared to diabetic subjects, but only in relation to 3 skin folds (tricipital, subscapular and suprailiac) and one circumference (forearm).

CONCLUSIONS

The study shows a high frequency of overweight and obesity in children with type 1 diabetes, comparable to that in the healthy population. The finding of a higher frequency of obesity in diabetic females might be explained by their advanced puberal status, given that almost all the obese diabetic females were aged between 10 and 19 years old. The study confirms the validity of a number of anthropometric measurements (BMI, folds, circumference) and BIA in the evaluation of nutritional status in terms of body composition.

[Usefulness of the "targeted" clinical examination in the screening of breast tumors]

The authors report the findings from over 10,000 mammographic exams performed on female patients from 1980 to 1989. The results demonstrated that, even though mammography is still the only instrumental method available for mass screening of breast cancer, the role of clinical examination should not be underestimated. If adopted for patients with positive nodes and dense breasts, clinical examination can dramatically reduce the number of false negative cases. Biopsies required on the grounds of clinical examination only, i.e. when no malignant lesions had been detected at mammography, led to the identification of 21 breast carcinomas, a figure almost equal to the number of cases (23) detected by mammography in the absence of suspect clinical signs.

[Bezoar of the stomach. Clinical case report]

A clinical case of bezoar of the stomach accompanied by peptic and gastric ulcer is presented. The different types of bezoar and the reasons for their formation are described, and the clinical, laparotomic and anatomopathological picture is illustrated.

[Treatment of acute cholecystitis. Clinico-statistical findings]

A series of 354 patients suffering from gall bladder and/or bile way conditions and who had undergone operation in the acute phase has been reviewed. The usefulness of early operation over more wait-and-see tactics is confirmed. Shortening of mean hospitalization is particularly significant. The difference in hospital mortality is insignificant. The only complication reported is the higher frequency of suppurative accidents in the surgical wound.

[Non-appendicular primary pathology of the large intestine as a cause of emergency surgery. Clinico-statistical evaluation of its incidence in a provincial hospital]

Reference is made to the relevant literature in a description of cases of non-appendicular primary diseases of the large intestine necessitating emergency surgery at the Tradate District Hospital over the last five years. Emphasis is placed on the wide aetiological variety of these cases, their different clinical pictures, the types of operation performed, the possible complications, and the causes of death prior to discharge.

[Neoplasms of the male breast. Case report and review of the literature]

Fourteen cases of breast cancer in males observed between 1950 and 1974 at the Busto Arsizio Hospital Surgery Divsion are presnted. The literature is reviewed and attention is given to the incidence of this form, its symptoms and treatments, and to the length of survival after surgical management.