Sugary and salty former food products in pig diets affect energy and nutrient digestibility, feeding behaviour but not the growth performance and carcass composition

Former foodstuff products (FFPs) are promising alternative ingredients for reducing the waste of natural resources and the environmental impact of food production. This study investigates the effects of salty and sugary FFPs on growth performance, apparent total tract digestibility (ATTD), and growing-finishing pigs' empty body and carcass composition. Thirty-six Swiss Large White male castrated pigs were assigned to three growing (G) and finishing (F) diets: (1) standard diet (ST), 0% FFPs; (2) 30% conventional ingredients replaced by sugary FFPs (SU); and (3) 30% conventional ingredients replaced by salty FFPs (SA). Faecal samples from 24 selected pigs were collected to assess the ATTD of gross energy, crude fibres, and CP. The BW was measured weekly, while feed intake was determined daily. Average daily gain (ADG), average daily feed intake (ADFI), feed conversion ratio (FCR), and ATTD were calculated for both the growing and finishing periods. Pigs' body composition was determined at ≥20 and ≥98 kg using dual-energy X-ray absorptiometry. In the growing but not finishing period, the FCR was lower (P < 0.05) in ST compared to SA and SU pigs. Considering the entire growing and finishing period, neither the inclusion level nor the type of FFPs influenced (P > 0.05) ADG, ADFI, FCR, or BW at slaughter. In both the growing and finishing periods, the gross energy ATTD was higher (P < 0.05) in the SA than in the ST group, with intermediate values in the SU group. In the growing period, the CP ATTD was higher (P < 0.05) in the SA than in the SU and ST groups. In the finishing period, the crude fibre ATTD was lower (P < 0.05) in the SA and SU than in the ST group. Throughout the overall period, the average daily fat intake was higher (P < 0.05) in pigs fed an SU diet, even though both categories of FFPs had no (P > 0.05) effects on the parameters related to the pigs' body composition (e.g., average daily fat weight gain). Finally, the carcasses of the SU group had the thickest belly fat, even though the total fat content was similar among the groups. This study confirms that including FFPs has no detrimental effects on growth performance or live body/carcass composition in growing and finishing pigs.

A Decision Support System to Provide an Ongoing Prediction of Robot-Assisted Rehabilitation Outcome in Stroke Survivors

Clinicians often deal with complex robotic platform and serious games in stroke patients rehabilitation contexts, and they face two main problems: 1) the interpretation of either the performance in game or measures of a robotic system from the motor recovery point of view, and 2) the duration and complexity of clinical scales administration that makes repetitive assessments during the therapy unpractical. In this paper, a Random Tree Forest based system was trained and tested to provide a prediction of different clinical outcomes (i.e. FMA, ARAT, and MI) along the whole therapy duration, having non-clinical measures only as inputs, acting as a simulated decision support system. The dataset includes 30 post-stroke patients, that underwent a 30-session robot-assisted rehabilitation treatment. Results have shown that the system is able to produce very accurate and reliable predictions about the motor recovery of the patient at the end of the therapy, already in the first phases of the rehabilitation (i40% of therapy execution), just using robotic platform measures. Such a tool would provide a great benefit in terms of rehabilitation objectives planning, as a decision support tool for highly personalized rehabilitation treatments.

Review: Pig-based bioconversion: the use of former food products to keep nutrients in the food chain

The primary challenge of agriculture and livestock production is to face the growing competition between food, feed, fibre, and fuel, converting them from resource-intensive to resource-efficient. A circular economy approach, using agricultural by-products/co-products, in the livestock production system would allow to reduce, reuse, and redistribute the resources. Former food products (FFPs), also named ex-foods, could represent a valid option in strengthening resilience in animal nutrition. FFPs have a promising potential to be included regularly in animal diets due to their nutritive value, although their potential in animal nutrition remains understudied. A thorough investigation of the compositional and dietary features, thus, is essential to provide new and fundamental insights to effectively reuse FFPs as upgraded products for swine nutrition. Safety aspects, such as the microbial load or the presence of packaging remnants, should be considered with caution. Here, with a holistic approach, we review several aspects of FFPs and their use as feed ingredients: the nutritional and functional evaluation, the impact of the inclusion of FFPs in pigs' diet on growth performance and welfare, and further aspects related to safety and sustainability of FFPs.

Maternal mental health and children oral health: a literature review

AIM

Recently, serious considerations regarding mental health conditions and their impact on the whole organism have been made. This area is still quite unknown within the dental community, despite the potential impact these conditions can have on both oral care and health. Previous studies have concluded that both pregnant women and mothers have been found to be particularly sensitive to the risk of developing mental disorders such as anxiety and major depression. There is a very high possibility for the children of these mothers to experience neglect and disregard due to of the development of these conditions, which will negatively affect their behavioural and physical growth as a result. This impact stretches into oral health as well, as these children have been reported to be more inclined to develop early childhood caries, bruxism, and after-birth enamel defects, in addition to illnesses like diabetes and disabilities.

MATERIALS

A literature search was conducted in Pubmed, Medline, and Scopus for the keywords 'maternal depression', 'oral health' and 'children', combined with 'AND' or 'OR' Boolean Operators.

CONCLUSION

The results of the present literature suggest a strong connection between maternal mental disorders and poor children's oral care, and as a result, dental professionals should be extremely careful when treating and communicating with these patients.

Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit

AIM

Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children.

METHODS

A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators.

CONCLUSION

The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

A Random Tree Forest decision support system to personalize upper extremity robot-assisted rehabilitation in stroke: a pilot study

Robotic-based rehabilitation administered by means of serious games certainly represents the frontier of rehabilitation treatments, offering a high degree of customization of therapy, to meet individual patients' needs and to tailor a proper rehabilitation therapy. Despite the rush on developing complex rehabilitation systems, they often do not provide clinicians with long-term information about the outcome of rehabilitation, thus, not supporting them in the initial set-up phase of the therapy. In this paper, a Random-Forest based system was trained and tested to provide a prediction at discharge of several clinical scales outcomes (i.e. FMA, ARAT, and MI), having clinical scale scores and measures from the robotic system at the enrollment as inputs. The dataset includes 25 post-stroke patients from different clinics, that underwent a variable number of days of rehabilitation with a robotic treatment. Results have shown that the system is able to predict the final outcome with an accuracy ranging from 60% to 73% on the selected scales. Also results provide information on which variables are more relevant for the prediction of outcome of therapy, in particular clinical scales scores such as FMA, ARAT, MI, NRS, PCS, and MCS and robotic automatically extracted measurements related to patient's work expenditure and time. This supports the idea of using such a system in a clinical environment in a decision support tool for clinicians.

Pain perception in paediatric patients: evaluation of computerised anaesthesia delivery system vs conventional infiltration anaesthesia in paediatric patients

AIM

The aim of the present study is to compare the effectiveness of a computerised system (QuickSleeper) compared to traditional syringe in injection of local anaesthetic focusing on the perception of anxiety and pain in paediatric patients.

METHODS

Study design: 100 children aged between 3 and 15 years in need of two dental treatments that required local anaesthesia were selected and treated randomly but alternately with computerised and traditional local anaesthesia. After each anaesthetic injection, patient's anxiety was measured using the Venham test.

RESULTS

Electronic anaesthesia showed statistically significant better results than traditional anaesthesia according to the Venham pain scale, in both mandibular and maxillary sites. Statistics: Data were analysed using the paired Wilcoxon test.

CONCLUSION

The computer-assisted anaesthesia system resulted in a significantly lower pain perception score and yielded to helpful, cooperative behaviour. For this reason, it is an advantageous alternative to traditional injection anaesthesia and can avoid invasive treatments and trauma for young patients.

P05.02 A phase I/IIa dose escalation study evaluating the safety and efficacy of autologous CD34+ enriched hematopoietic progenitor cells genetically modified for human interferon-α2 in patients with GBM and an unmethylated MGMT promoter (TEM-GBM-001)

BACKGROUND

Glioblastoma (GBM) remains the most common malignant primary brain tumor in adults. Most patients with GBM & an unmethylated O-6-methylguanine-DNA methylase (MGMT) gene promoter, have a poor prognosis with approximately 20% of patients surviving to 2 years. Poor prognosis is likely related to a number of factors including a highly immunosuppressive tumor microenvironment (TME). The TME in GBM is mainly composed of tumor associated macrophages (TAMs) & microglia. A subset of tumor-infiltrating macrophages characterized by expression of the angiopoietin receptor Tie2 (TEMs) have features of M2-TAMs, promote tumor angiogenesis & are infrequently found in normal organs. Tie2 is significantly upregulated upon homing to tumors. Gene therapy technology has allowed TEMs to be used as carriers for the local and tumor restricted release of interferon-α (IFN). IFN has antitumor effects, inhibits angiogenesis & modulates the immune system. Cell-based delivery of IFN into the TME by TEMs is expected to provide efficacy, taking advantage of pleiotrophic anti-tumor effects & avoiding tolerability issues associated with systemic IFN treatment.

MATERIAL AND METHODS

We are currently conducting a Phase I/IIa clinical study in Milan to evaluate this therapeutic approach (Temferon) in 21 patients with GBM & unmethylated MGMT promoter (EudraCT Number 2018- 001404-11). The study recruits & follows up patients at a specialist neurosurgical & neuro-oncology unit (INCB); administration of Temferon & hematological follow up takes place at a specialist hematology & bone marrow transplantation unit at OSR. Potentially eligible patients are identified immediately after first surgical resection of GBM once the MGMT promoter methylator status is known. Once screening procedures have been completed, harvesting of HSPCs occurs followed by 6 weeks of radiotherapy. Patients receive a non-myeloablative conditioning regimen consisting of BCNU & thiotepa. This is followed by administration of non-manipulated HSPCs and Temferon. In-patient monitoring occurs until hematological recovery. Thereafter, regular follow-up of patients occurs up to 2 years (+720 days) and patients will be invited to participate in a long term follow-up study lasting an additional 6 years.

RESULTS

In Part A of the study, 3 cohorts of 3 patients will receive escalating doses of Temferon. On completion of Part A, a single dose of Temferon will be selected to be studied in a further 12 patients in Part B. Criteria for study eligibility are the same for both Part A and Part B. In the event that GBM disease progression occurs, patients will be managed with second line therapies including second surgery, TMZ, BCNU, fotemustine or any other approved therapy for GBM. Patient recruitment for Part A is ongoing with the first dose of Temferon administered in July 2019.

Upper limb robot-assisted therapy in subacute and chronic stroke patients using an innovative end-effector haptic device: A pilot study

BACKGROUND

Significant results have been shown when an upper limb robot-assisted rehabilitation is delivered to stroke patients.

OBJECTIVE

To evaluate the effects of upper limb robot-assisted rehabilitation on motor recovery in stroke patients who underwent a treatment based on a haptic device.

METHODS

Thirty-nine stroke patients (twenty-three subacute and sixteen chronic) underwent rehabilitation training by using MOTORE/Armotion haptic system. Thirteen healthy subjects were recruited for comparison purpose.The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FM), Medical Research Council, Motricity Index (MI), Box and Block Test (B&B) and Modified Barthel Index (mBI).The following parameters were computed: mean speed, maximum speed, mean time, path length, normalized jerk, mean force, mean error, mean energy expenditure and active patient-robot interaction percentage.The assessments were carried-out before and after treatment.

RESULTS

Significant changes were observed in both groups in the FM, MI, B&B and mean speed. Significant changes were observed in mBI, mean time, mean force, mean energy expenditure and active patient-robot interaction percentage in subacute stroke patients. In chronic stroke patients significant changes were found on the MAS-elbow.

CONCLUSIONS

The haptic device used is at least as effective as an existing device used in similar studies.

An integrated gait rehabilitation training based on Functional Electrical Stimulation cycling and overground robotic exoskeleton in complete spinal cord injury patients: Preliminary results

The aim of this study is to investigate the effects of an integrated gait rehabilitation training based on Functional Electrical Stimulation (FES)-cycling and overground robotic exoskeleton in a group of seven complete spinal cord injury patients on spasticity and patient-robot interaction. They underwent a robot-assisted rehabilitation training based on two phases: n=20 sessions of FES-cycling followed by n= 20 sessions of robot-assisted gait training based on an overground robotic exoskeleton. The following clinical outcome measures were used: Modified Ashworth Scale (MAS), Numerical Rating Scale (NRS) on spasticity, Penn Spasm Frequency Scale (PSFS), Spinal Cord Independence Measure Scale (SCIM), NRS on pain and International Spinal Cord Injury Pain Data Set (ISCI). Clinical outcome measures were assessed before (T0) after (T1) the FES-cycling training and after (T2) the powered overground gait training. The ability to walk when using exoskeleton was assessed by means of 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Timed Up and Go test (TUG), standing time, walking time and number of steps. Statistically significant changes were found on the MAS score, NRS-spasticity, 6MWT, TUG, standing time and number of steps. The preliminary results of this study show that an integrated gait rehabilitation training based on FES-cycling and overground robotic exoskeleton in complete SCI patients can provide a significant reduction of spasticity and improvements in terms of patient-robot interaction.

Implant-abutment connections on single crowns: a systematic review

Different implant-abutment connections have been developed in the effort of reducing mechanical and biological failure. The most frequent complications are screw loosening, abutment or implant fracture and marginal bone loss due to overload and bacterial micro-leakage. Ideal connection should work as a one-piece implant avoiding the formation of a micro-gap at the implant-abutment interface. Different in vitro and in vivo researches have been published to compare the implant-abutment connections actually available: external hexagon, internal hexagon and conical finding different amount of micro-gap, micro-leakage and marginal bone loss. The aim of this article is to describe, according to the most recent literature, different kind of fixture-abutment connections and their clinical and mechanical advantages or disadvantages.

FES-cycling training in spinal cord injured patients

Among the objectives of spinal cord injury (SCI) rehabilitation, (i) prevention of bony, muscular and joint trophism and (ii) limitation of spastic hypertone represent important goals to be achieved. The aim of this study is to use functional electrical stimulation (FES) to activate pedaling on cycle-ergometer and analyse effects of this technique for a rehabilitation training in SCI persons. Five spinal cord injured subjects were recruited and underwent a two months FES-cycling training. Our results show an increase of thigh muscular area and endurance after the FES-cycling training, without any increase of spasticity. This approach, which is being validated on a larger pool of patients, represents a potential tool for improving the rehabilitation outcome of complete and incomplete SCI persons.

Upper-limb kinematic reconstruction during stroke robot-aided therapy

The paper proposes a novel method for an accurate and unobtrusive reconstruction of the upper-limb kinematics of stroke patients during robot-aided rehabilitation tasks with end-effector machines. The method is based on a robust analytic procedure for inverse kinematics that simply uses, in addition to hand pose data provided by the robot, upper arm acceleration measurements for computing a constraint on elbow position; it is exploited for task space augmentation. The proposed method can enable in-depth comprehension of planning strategy of stroke patients in the joint space and, consequently, allow developing therapies tailored for their residual motor capabilities. The experimental validation has a twofold purpose: (1) a comparative analysis with an optoelectronic motion capturing system is used to assess the method capability to reconstruct joint motion; (2) the application of the method to healthy and stroke subjects during circle-drawing tasks with InMotion2 robot is used to evaluate its efficacy in discriminating stroke from healthy behavior. The experimental results have shown that arm angles are reconstructed with a RMSE of 8.3 × 10(-3) rad. Moreover, the comparison between healthy and stroke subjects has revealed different features in the joint space in terms of mean values and standard deviations, which also allow assessing inter- and intra-subject variability. The findings of this study contribute to the investigation of motor performance in the joint space and Cartesian space of stroke patients undergoing robot-aided therapy, thus allowing: (1) evaluating the outcomes of the therapeutic approach, (2) re-planning the robotic treatment based on patient needs, and (3) understanding pathology-related motor strategies.

Evaluation of three different manual techniques of sharpening curettes through a scanning electron microscope: a randomized controlled experimental study

OBJECTIVE

The purpose of this study was to compare the effectiveness of three different techniques for manually sharpening of periodontal curettes (PCs) by examining the blades with the aid of scanning electron microscope (SEM).

METHODS

Three groups were considered based on three sharpening methods used: group A (moving a PC over a stationary stone); group B (moving a stone over a stationary PC) and group C (moving a PC over a stone fixed, placed on a 'sharpening horse'). After the sharpening, the blades were examined using SEM. The SEM images were assessed independently by five different independent observers. An evaluation board was used to assign a value to each image. A preliminary pilot study was conducted to establish the number of samples. Pearson's correlation test was used to assess the correlations between measurements. anova test with Bonferroni's post hoc test was used to compare the three groups.

RESULTS

Sixty PCs (20 PCs per group) were used in this study. Statistically significant differences emerged between the three groups (P-value = 0.001). Bonferroni's test showed that the difference between groups A and B was not statistically significant (P-value = 0.80), while it was significant for the comparisons between groups A and C (P-value = 0.005) and between groups B and C (P-value = 0.001).

CONCLUSIONS

The sharpening technique used in group C, which involved the use of the sharpening horse, proved the most effective.

Mechanisms of motor recovery in chronic and subacute stroke patients following a robot-aided training

The aim of this article is to propose a methodology for analyzing different recovery mechanisms in subacute and chronic patients through evaluation of biomechanical parameters. Twenty-five post-stroke subjects, eight subacute and seventeen chronic, participated in the study. A 2-DoF robotic system was used for upper limb training. Two clinical scales were used for assessment. Forces and velocities at the robot's end-effector during the execution of upper limb planar reaching movements were measured. Clinical outcome measures show a significant decrease in motor impairment after the treatment both in chronic and subacute patients (MSS-SE, p<0.001; FM, p<0.05). Movement velocity increases after the robot-aided treatment in both groups. Mean values of forces exerted by subacute patients are lower than those observed in chronic patients, both at the beginning and at the end of robotic treatment, as in the latter the pathological pattern is already structured. Our results demonstrate that the monitoring of the forces exerted on the end-effector during robot-aided treatment can identify the specific motor recovery mechanisms at different stages. If the pathological pattern is not yet structured, rehabilitative interventions should be addressed toward the use of motor re-learning procedures; on the other hand, if the force analysis shows a strong pathological pattern, mechanisms of compensation should be encouraged.

Lateral periodontal cyst (LPC) mimicking periodontal socket in a young patient: report of a case and review of the literature

Background: Lateral Periodontal cyst (LPC) is an uncommon development odontogenic cyst. Most papers are single case reports or series. Methods: We present a case of LPC occurred in a patient which symptoms and signs could mislead the diagnosis. A review of the literature is reported, emphasizing the clinical, radiographic and histopathological features of LPC. Results: A 28-years old female patient presented reporting pain and swelling at the lingual site of the #31.Spot lingual probing depth was 9 mm; sulcus bleeding and suppuration were found at probing. Radiographically well-defined radiolucency appeared in periodontal foramen area. The patient was treated with non-surgical and surgical therapy. Conclusions: LPC is an infrequent cystic lesion that occurs on lateral root vital tooth. In this case, the cyst mimicked a periodontal lesion. The surgical LPC excision solved the symptoms reported by the patient and improved periodontal parameters of the dental element. After 18 months since surgical treatment there aren't signs or symptoms of recurrence.

In vitro comparison of the bond strength to the enamel of conventional and self-etching dental fissure sealants

AIM

Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure.

METHODS

The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine.

RESULTS

The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

Experimental assessment of oral hygiene achieved by children wearing rapid palatal expanders, comparing manual and electric toothbrushes

OBJECTIVES

The aim was to compare the efficacy of the electric versus the manual toothbrush in terms of the oral hygiene achieved by patients wearing rapid palatal expanders (RPEs).

METHODS

Forty patients were randomly divided into two groups; one equipped with a manual toothbrush (Group A), the other with an electric toothbrush (Group B). Each child's plaque index (PI) and gingival index (GI) were calculated at banded molar level at times T0 (before banding), T1 (a month later), T2 (3 months later) and T3 (when the expander was removed). At each appointment, the PI and GI were recorded and the patient was remotivated.

RESULTS

The level of oral hygiene achieved by the group using an electric toothbrush produced a greater improvement in the two indexes than in the group using the manual toothbrush that showed no statistically significant improvement (PI T0-T3: P = 0.309; GI T0-T3: P = 0.141). Both indexes dropped considerably in both groups from T0 to T2, but more so in the group B. From T2 to T3, although the electric toothbrush continued to be substantially more effective, Group B showed a statistically significant deterioration in the oral hygiene (PI +20%; GI +33%). Other assessments conducted on particular areas of the tooth showed improvements in the PI (-33%) for the vestibular region, and for the GI (-57%) in the palatal region among the patients in Group B, while there were no significant changes in these indexes in Group A.

CONCLUSIONS

Our findings show that the electric toothbrush is statistically more efficient in performing an adequate level of oral hygiene in children wearing RPE.

Conscious sedation with diazepam and midazolam for dental patient: priority to diazepam

AIM

The aim of this paper was to determine whether the use of midazolam is a better technique than the use of diazepam, in relation with the definition of conscious sedation in dentistry.

METHODS

Eighty-eight patients undergoing oral surgery were divided into 2 groups in which the sedation was randomly achieved with equipotent cumulative doses of diazepam and midazolam, up to a maximum dose of 8 and 4 mg respectively. Patient's tranquillity was assessed after every dose, using a visual analogue score to ten points and the sedation was evaluated as mild, moderate or deep. Blood pressure, heart rate and SpO2 were also recorded. Psychomotor conditions, by Newman test, and the incidence of amnesia and the patient's satisfaction, by telephone interview, were both evaluated.

RESULTS

The number of patients who reached maximum subjective tranquillity was greater already after the third dose of diazepam. The average scores of tranquillity were higher after diazepam. Patients treated with diazepam experienced a higher incidence of mild sedation, patients treated with midazolam a higher incidence of moderate and deep sedation. In patients treated with midazolam blood pressure, heart rate and SpO2 were lower. Postoperative recovery was similar in the 2 groups. After midazolam patients experienced greater amnesia for local anesthesia and drowsiness. Satisfaction was high with both treatments.

CONCLUSION

The study shows that sedation with diazepam is more in line with the definition of conscious sedation in dentistry. Diazepam guarantees the persistence of consciousness and maximum subjective tranquillity levels. The recovery and satisfaction were comparable in the 2 groups.

Robot-assisted upper limb rehabilitation in chronic stroke patients

The goal of this study is to evaluate the effects of upper limb robot-assisted treatment in chronic post-stroke patients using clinical outcome measures and kinematic parameters. Thirty-two chronic stroke patients participated in the study. Fugl-Meyer (FM) Assessment scale and Motricity Index (MI) were used for clinical assessment, and a set of kinematic parameters was computed. A significant decrease in motor impairment after the robotassisted treatment (FM p<0.001 and MI p<0.001) was found. Movement mean velocity (p<0.001) and accuracy (p<0.05) increased. Robotic treatment is effective to reduce motor impairment in chronic stroke patients. The exclusive use of clinical scales do not provide an exhaustive evaluation of effectiveness of treatment and our study suggests that kinematic parameters should be computed as well.

Age limit for infiltration anaesthesia for the conservative treatment of mandibular first molars. A clinical study on a paediatric population

AIM

The aims of this study were to assess the age limit for infiltration anaesthesia as an effective technique in treating carious lesions of first permanent molars in the paediatric age and if differences exist between males and females.

MATERIALS AND METHODS

A total of 51 teeth from 48 different patients aged between 6 and 14 years were included in the study. The anaesthetic solution used was 1.8 ml of 2% mepivacaine with 1:100000 epinephrine. The effectiveness of anaesthesia was assessed by electrical pulp test after 3, 5, 7 and 10 minutes.

RESULTS

In 56.9% of the treated cases a single mandibular infiltration was sufficient to induce complete pulpal anaesthesia of the tooth to be treated. Under 10 years of age, the infiltration technique was effective in 85.2% of cases. The success rate of anaesthesia also decreased significantly and not linearly in function of age. The success of infiltration anaesthesia was not related to gender.

CONCLUSION

Mandibular infiltration anaesthesia is a successful technique for most patients under 10 years (success rate: 85.2%) especially for the younger ones, with no differences between males and females. After this age that success rate dramatically drops.

Changes on EMG activation in healthy subjects and incomplete SCI patients following a robot-assisted locomotor training

The aim of this study was to understand and measure the lower limbs muscular activation patterns both in healthy and spinal cord injured (SCI) subjects during robot-assisted locomotor exercise. Electromyographic (EMG) activity of four leg's muscles (rectus and biceps femoris, tibialis anterioris and gastrocnemius) was recorded and analyzed at two different percentages of body weight support, three stepping velocities and three different modalities. SCI subjects were recorded also after four weeks training to evaluate the effectiveness of lower limb robot-assisted rehabilitative treatment. A multi-factor ANOVA on the integrated muscle activity (IEMG) parameters both in healthy and SCI subjects was performed. Higher muscular activities both in healthy subjects and SCI patients were found during the exercises using the "DGO active" modality and higher stepping velocities. A significant increased bilateral muscular activity was observed in each SCI subject after the rehabilitation treatment. The method proposed to analyze EMG data provides a quantitative description of the lower limb muscular recruitment and can contribute to identify the optimal rehabilitation treatment's conditions.

Experimental evaluation of two methodologies for the restoration of crown fracture in permanent anterior teeth

AIM

The purpose of this study is to compare, by means of mechanical tests, the resistance of two types of dental restoration in the uncomplicated crown fracture of human permanent maxillary central incisor: rebonding of the fractured tooth fragment and application of ceramic veneers.

MATERIALS AND METHODS

Thirty human maxillary central incisors were divided into three groups of ten teeth each. The teeth of the first group (Group A) were kept intact and used as controls, while the remaining teeth were sectioned, in order to simulate a crown fracture, and restored respectively with either the rebonding of the fragment (Group B) or with the use of ceramic veneers (Group C). All samples underwent mechanical tests by means of a universal test machine.

RESULTS

The mean resistance to fracture recorded is respectively 425.2N for Group A, 233.3N for Group B, and 347.3N for Group C. One-way ANOVA analysis demonstrates statistical significance for at least one couple of values (Group B compared to Group A). The group of restorations with rebonding of fractured fragments has a mean value of resistance to fracture that is lower than both intact teeth and teeth restored with ceramic veneers. The resistance of teeth with rebonded restorations is 54.9% of that of, intact teeth, and resistance increases for teeth restored with ceramic veneers (81.8% of that of intact teeth).

CONCLUSION

Ceramic veneers showed a higher resistance than rebonding and resulted to be more reliable in case of further trauma.

Robot-aided therapy on the upper limb of subacute and chronic stroke patients: a biomechanical approach

The goal of this study is to propose a methodology for evaluating recovery mechanisms in subacute and chronic post-stroke patients after a robot-aided upper-limb therapy, using a set of biomechanical parameters. Fifty-six post-stroke subjects, thirteen subacute and forty-three chronic patients participated in the study. A 2 dof robotic system, implementing an "assist-as-needed" control strategy, was used. Biomechanical parameters related (i) to the speed measured at the robot's end-effector and (ii) to the movement's smoothness were computed. Outcome clinical measures show a decrease in motor impairment after the treatment both in chronic and subacute patients. All the biomechanical parameters show an improvement between admission and discharge. Our results show that the robot-aided training can contribute to reduce the motor impairment in both subacute and chronic patients and identify neurophysiological mechanisms underlying the different stages of motor recovery.

Reliability and reproducibility of linear mandible measurements with the use of a cone-beam computed tomography and two object inclinations

OBJECTIVE

The aim of this study was to assess the influence of inclination of the object on the reliability and reproducibility of linear measurements of anatomic structures of the mandible on images obtained using cone-beam CT (CBCT).

METHODS

Ten linear dimensions between anatomical landmarks were measured in a dry mandible. The measurements were performed with a manual calliper three times by three observers. The mandible was scanned with Planmeca Promax 3D cone-beam CT (Planmeca Oy, Helsinki, Finland) with the base of the mandible parallel as well as tilted 45° to the horizontal plane. Computer measurements of the linear dimension were performed by three observers. The radiographic measurements were performed four times for each experimental setting. A total of 240 measurements were performed. Reproducibility was evaluated through comparison of standard deviation (SD) and estimation of intraclass correlation coefficient (ICC). The error was estimated as the absolute difference between the radiographic measurements and the mean manual calliper measurements.

RESULTS

The mean SD for the radiographic measurements was 0.36 mm for the horizontally positioned mandible and 0.48 mm for the inclined mandible. The ICC between examiners was 0.996 mm, between sessions was 0.990 mm and between CBCT measurements and calliper was 0.992 mm. The overall absolute mean measurement error was 0.40 mm (SD 0.39 mm). The percentage of errors that exceeded 1 mm was 6.7%.

CONCLUSION

The results revealed high reliability of measurements performed on CBCT images independently from object position, examiner's experience and high reproducibility in repeated measurements settings.

Patients appreciation for information on anesthesia and anxiolysis in dentistry

AIM

The research regards information on anesthesia to patients undergoing oral surgery. Every patient evaluated the information received at the end of the preoperative visit and in the postoperative period.

METHODS

One hundred-fifty dental patients were asked about the most appreciated information received in the preoperative visit on the anxiolytic technique, local anesthesia and treatment of the perioperative pain. Afterwards the patients had to report on their reaction to the content of the preoperative visit and information quality. On a phone interview they had to evaluate their appreciation of the anxiolytic technique, their perception during loco-regional anesthesia and incidence of pain and edema.

RESULTS

The most appreciated details were those on the intervention, pharmacologic treatment, postoperative complicances, postoperative pain and operative competence; less appreciated were those on loco-regional anesthesia, duration of the intervention, anxiolytic techniques, hospital reception and permanence in the hospital. Ninety-eight percent of the patients considered to have been adequately informed on a context judged to be extraordinary (99.3%), 96.6% indicated the information as necessary, 98.6% appreciated the treatment of the intraoperative and postoperative (99.3%) pain and 99.3% the anxiolytic treatment. On the telephone interview, 100% of patients expressed satisfaction for the experienced intraoperative tranquillity, 91.3% complained for not having received in the past a similar preoperative visit, 99.3% wished a diffused application of the information. The loco-regional anesthesia was associated to psychological detachment in 84% of the cases and the incidence of postoperative pain was of 36%.

CONCLUSION

The information on the anxiolytic techniques, loco-regional anesthesia, treatment of perioperative pain and postoperative distress was enthusiastically accepted and albeit initially induced feelings of astonishment resulted to be appreciated and preferred in the whole of the patients.

Social differences in tooth decay occurrence in a sample of children aged 3 to 5 in north-east Italy

OBJECTIVE

To correlate the occurrence of tooth decay with a social class indicator (occupational level) and the immigrant status in a sample of pre-school children in Veneto region.

BASIC RESEARCH DESIGN

Cross-sectional survey.

CLINICAL SETTING

Twenty nursery schools in the area of Health District n.15.

PARTICIPANTS

A total of 1,410 children aged 3 to 5 years old visited between September 2005-May 2006.

OUTCOMES

Occurrence of dental caries into dentine threshold was made visually and confirmed with a probe when necessary by two calibrated examiners. Information on immigrant status and occupational level of parents was obtained by a questionnaire. Children were categorized as immigrant or non-immigrant on the basis of their mother's country of origin. Means and standard deviation were calculated for continuous variables; for categorical variables the results were provided as proportions. Comparisons between groups were made using Pearson chi-square test. The association between caries occurrence and the independent variables gender, age, immigrant status and family social class was evaluated by means of a logistic regression model.

RESULTS

Caries occurrence was higher among children from lower social class families (1.7 +/- 3.2) than among children from higher social class (0.8 +/- 2.1). The prevalence of dental caries in immigrant preschool children was significantly higher than in indigenous ones (15% vs 40%; p = 0.000) while the severity in immigrants was almost 4 times higher (2.2 +/- 3.6 vs 0.6 +/- 1.8).

CONCLUSIONS

Our data on preschoolers confirm the worldwide literature shared statement that social class as well as immigration status are determinants of oral health.

Tooth fragment reattachment through the use of a nanofilled composite resin

AIM

The purpose of this study is to evaluate resistance to fracture with static tests of dental fragments reattached through the use of different light-curing composite resins. For this purpose 40 bovine inferior incisors were utilised, which were randomised into 4 groups; one control group and 3 experimental groups.

MATERIALS AND METHODS

All teeth of the 3 experimental groups were sawed at 3 mm from the incisal margin, and the respective fragments were then reattached utilizing different composite resins: in group 2_EI the hybrid composite Tetric EvoCeram (Ivoclar Vivadent AG) was used, in group 3_ZI the hybrid composite FiltekTM Z250 (3M ESPE) was used, and in group 4_SN the nanofilled composite FiltekTM Supreme (3M ESPE) was used. After reattachment, on each tooth were performed a chamfer on the buccal surface and an overcontour on the lingual surface along the fracture line, which were then filled with the composite resin corresponding to the respective group. Finally, all teeth were embedded in plaster blocks, and a force was applied on the buccal surface.

RESULTS

All teeth in groups 2, 3, and 4 showed a significant loss of resistance to fracture compared to the teeth of the control group (P<0.0001). Resistance to fracture of the teeth belonging to groups 2_EI and 3_ZI was 37.35% and 47.35% of that of intact teeth respectively; in group 4_SN resistance to fracture reached 60.05%. Teeth of group 2 exhibited values of resistance to fracture statistically significant from those of group 4 (P=0.024), but no difference was found between group 2 and group 3 (P=0.298). The difference in resistance between group 3 and group 4 was not statistically significant (P=0.199).

CONCLUSION

Static test showed that reattachment of coronal fragments do not restore resistance to fracture to the value of intact teeth. Resistance to fracture in in vitro studies is influenced by the type of composite resin utilised.

Solitary neurofibroma of the palate. A case report

The neurofibroma is a benign tumor of neuronal origin not frequently located in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as Von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. The diagnosis is, in most cases, quite complex, because of the neurofibroma's strong similarities with a great number of benign neoformations of the connective tissue, of the epithelium, and of the bone. The histology represents, therefore, the fundamental diagnostic criterion, in particular, through the use of appropriate immunohistochemical analysis. This articles presents the case of a solitary neurofibroma, subtype I (common Schwann cell type), detected on the left-hand side of the posterior region of the palate in a 56-year-old woman, which presented itself as an otherwise non-symptomatic ulcerated mass. After a careful anamnesis, an incisional biopsy was performed in order to establish the histological nature of the neoformation. The immunohistochemical test, which resulted positive for S-100 and negative for the epithelial membrane antigen and keratin, allowed the diagnosis of a presumably benign lesion deriving from a neural differentiation. The surgical excision of the entire mass was accompanied by the extraction of the upper left-hand second molar, which was attached to the mass through its palatal root.

Oral health problems and needs in nursing home residents in Northern Italy

OBJECTIVE

To describe the oral health status and treatment needs of a sample of elderly people residing in nursing homes in Northern Italy.

RESEARCH DESIGN

a sample of 595 elderly residents (mean age 83.2+/-9.2 yrs), with adequate cognitive skills were examined by six calibrated dentists.

RESULTS

The sample (82% women) was divided into two groups: edentulous (43%) and dentate. In the edentulous group 58% wore dentures in both jaws, 8% in only one jaw and 34% had no dentures. The main problems were dirty or loose dentures and poor oral hygiene. In the dentate group the mean number of teeth was 8.4+/-7.4, 53% wore dentures (removable, fixed or a combination). Poor oral hygiene was found in 86%, root caries in 51% and coronal caries in 46%. Their main needs were professional cleaning (72%), oral hygiene instructions (62%) and tooth/root extractions (56%). While normative needs were noted for 82% of the whole sample, oral treatment needs were accurately perceived by only 20% of residents, poorly by 24%, while 46% indicated that they had no oral treatment needs.

Dental caries in children with asthma undergoing treatment with short-acting beta2-agonists

AIM

This study sought to evaluate possible higher risk for dental caries among asthmatic children undergoing treatment with short-acting beta2-agonists.

METHODS

Dental clinical assessments, saliva analysis and a questionnaire survey were carried out on 60 children aged 6-12, of whom 30 were asthmatic subjects undergoing treatment with short-acting beta2-agonists and 30 were used as controls. The obtained data for DMFT/dmft scores, Silness-Löe plaque index, buffer capacity and bacteria counts for Streptococcus mutans and Lactobacillus in the saliva, oral hygiene and dietary habits were compared using Student t-test and Pearson chi-square test.

RESULTS

We registered a higher DMFT score among asthmatics of 1.2-/+1.8 (SD) and 0.3-/+0.8 among non-asthmatic patients (p<0.05), while comparison of dmft scores between the examined groups showed not significant (Student t-test). Saliva analysis revealed lower buffer capacity in 43.3% of the asthmatic children, followed by higher cariogenic bacteria counts in their saliva (p<0.05 Student t-test). These results show the lower plaque index in the asthmatic group (1.6+/-0.4) compared with the control (2.1+/-0.3). Asthmatic children expressed better oral-health habits with more frequent tooth- brushing and usage of fluorides.

CONCLUSION

The results from our study suggest a higher caries-susceptibility among asthmatic children undergoing treatment with short-acting beta2-agonists, but a clear association between these drugs, salivary changes and dental caries among children, still remains to be demonstrated.

Preschoolers' dental caries experience and its trend over 20 years in a North-East Italian Health District

AIM

To describe dental caries occurrence among preschool children in a Health District in the North-East of Italy by age, gender and immigrant background; 2) to plot a trend of primary dentition dental caries over a 20 year time span.

STUDY DESIGN

Observational cross-sectional survey.

METHODS

41 out of 88 kindergartens were randomly selected, originating a sample of 3470 preschoolers out of 7,061 overall school attenders. Dentinal caries occurrence was evaluated by 2 calibrated examiners at school on 2,524 3-5-year-olds from October 2004 to June 2005. The participants were divided into 2 subgroups depending on the country of origin of their mothers: non-western (IG or immigrant group) and western (WG). Two previous surveys performed in the same area were used to plot a trend over a 20 year period.

STATISTICS

Comparisons between groups were made using the Pearson chi-squared test and caries risk estimation was established by logistic regression analysis to assess the influence of sex, age and ethnicity (independent variables) on caries experience (dependent variable). Risk was summarised as odds ratio plus 95% CI.

RESULTS

Prevalence (%) and severity (mean dmft +/- SD) increased by age (15% - 0.6 +/- 1.9 at 3 years of age; 25% - 1.1 +/- 2.6 at 4; 32% - 1.3 +/- 2.7 at 5) and were significantly different (p<0.01) between the two groups: 23% (WG) vs 54% (IG) and 0.9 +/- 2.2. (WG) vs 3.4 +/- 4.3. The level of untreated caries was high: 88.9% in WG vs 97.1% in IG. From 1984 to 2004 prevalence and severity of dental caries declined at all examined ages.

CONCLUSION

The current dental scores in preschoolers are low and similar to those reported in other Western European countries. These good scores have been achieved through a strong decline occurred over the last two decades. As regards the Italian recent social phenomenon of immigration, nowadays being an immigrant child is a strong determinant of dental caries.

Comparative evaluation of different techniques of surface preparation for occlusal sealing

AIM

Aim of this experiment is the efficacy evaluation of three different types of surface preparation techniques by microleakage assessment of two different sealing materials.

MATERIALS AND METHODS

Sixty teeth were used for the experiment: half were treated with Admira seal (Voco) and the remaining half with Delton FS+ (Dentsply). Each group was then divided into three subgroups, which underwent three different preparation techniques before sealant placement: mechanical brushing, air abrasion and Intensive bur FG 40D4, respectively. After immersion of the specimens in methylene blue solution, the degree of microleakage was assessed by mean of optic microscope.

RESULTS

Results show no microleakage in samples treated with air abrasion, followed by the samples treated with mechanical brushing. The teeth prepared by bur treatment before sealant application show a significant number and degree of marginal infiltration.

CONCLUSION

It can be concluded that air abrasion technique is able to guarantee a reliable seal of occlusal surfaces.

Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence

AIM

To investigate dental caries experience among preschool children aged 3-5 years living in 2 Health Districts in North- Eastern Italy and to compare caries experience between indigenous and immigrant children.

STUDY DESIGN

Cross-sectional observational survey. METHODS AND STATISTICS: In this study 4,198, 3-5-year-old children, drawn from a total population of 9,829 were asked to participate. The examinations were performed at school between October 2004 and June 2005 and only lesions that penetrate the dentine were recorded (according to the BASCD criteria, 1997), by 2 calibrated examiners using artificial light, mouth mirrors and dental probes. The participants were categorised into 2 subgroups according to the country of origin of their mothers: indigenous mothers, almost all born in Italy, plus a very small number of mothers born in other highly developed western countries--"western origin"--(Nordic countries, Western Europe, North America, New Zealand and Australia), and immigrant mothers from Eastern Europe, Asia, Africa, Turkey, South and Central America, "non-western origin". Comparisons between groups were made using Pearson chi-squared test. Caries risk estimation was established by logistic regression analysis to assess the influence of gender, age and ethnicity on caries experience. Risk was summarised as odds ratio plus 95% CI.

RESULTS

A total of 3,401 pre-school children were examined. The overall prevalence of dentinal caries was: 15.4% in 3-year-olds, 24.2% in 4-year-olds and 31.1% in 5-year-olds. At the same ages, children of immigrant mothers ("non-western origin") showed a significantly higher prevalence of caries compared with their counterparts of "western origin". As expected, older children had more caries. "Non-western origin" had a negative effect on caries experience.

CONCLUSIONS

Inequalities associated with mothers with an immigrant background were observed in the distribution of caries experience among the children. These children represent the first generation settling in and growing up in Italy, and their dental status-related data are comparable to those observed at the same ages in first generation "non-western" children living in other industrialised countries.