Assessment of oil refinery wastewater and effluent integrating bioassays, mechanistic modelling and bioavailability evaluation

Water is used in petroleum oil refineries in significant volumes for cooling, steam generation and processing of raw materials. Effective water management is required at refineries to ensure their efficient and responsible operation with respect to the water environment. However, ascertaining the potential environmental risks associated with discharge of refinery effluents to receiving waters is challenging because of their compositional complexity. Recent European research and regulatory initiatives propose a more holistic approach including biological effect methods to assess complex effluents and surface water quality. The study presented here investigated potential effects of effluent composition, particularly hydrocarbons, on aquatic toxicity and was a component of a larger study assessing contaminant removal during refinery wastewater treatment (Hjort et al 2021). The evaluation of effects utilised a novel combination of mechanistic toxicity modelling based on the exposure composition, measured bioavailable hydrocarbons using biomimetic solid phase microextraction (BE-SPME), and bioassays. The results indicate that in the refinery effluent assessments measured bioavailable hydrocarbons using BE-SPME was correlated with the responses in standard bioassays. It confirms that bioassays are providing relevant data and that BE-SPME measurement, combined with knowledge of other known non-hydrocarbon toxic constituents, provide key tools for toxicity identification. Overall, the results indicate that oil refinery effluents treated in accordance to the EU Industrial Emissions Directive requirements have low to negligible toxicity to aquatic organisms and their receiving environments. Low-cost, animal-free BE-SPME represents a compelling tool for rapid effluent characterization.

Psychological impact of COVID-19 pandemic on TMD subjects

OBJECTIVE

The aim of the study was to assess the psychological impact of COVID-19 pandemic on subjects with temporomandibular disorders (TMD), as for symptomatology and presence of parafunctions and sleep disorders.

PATIENTS AND METHODS

Two hundred fourteen subjects completed an online questionnaire, including Perceived Stress Scale (PSS), a temporomandibular screening and a specific item about the impact of such event on the psycho-physical side. Non-parametric tests - Mann-Whitney and Kruskal-Wallis - were performed to compare sex and age groups, as for PSS and "COVID-19 pandemic impact score (CpIS)", and the groups Improved/stationary and Worsened in symptomatology as for the "CpIS". Data of subjects undergoing gnathological therapy and not were compared, using Chi-squared test. Orofacial symptomatology values before and during pandemic were compared. The level of statistical significance was set at p<0.05.

RESULTS

The most prevalent category of perceived stress was the one of "moderate stress". Participants on average attributed to the pandemic a medium-low impact. The reported symptomatology actually showed a significant negative trend only as for neck pain. The intensity of orofacial symptomatology during pandemic was lower than before. Differences between age groups were statistically significant, as for CpIS. Subjects belonging to the group Worsened in one or more fields examined - TMD symptoms, comorbidities, sleep disturbances and fatigue - reported a significantly higher CpIS (p<0.0001). Awake and sleep bruxism, dental grinding, alteration in the quality and quantity of sleep and fatigue increased. Gnathological therapy was not a protective factor.

CONCLUSIONS

The most evident fact during pandemic was the increase of parafunctions and sleep disorders. The trend of symptoms was more variable and complex.

Knowledge, attitude, barriers, professional behaviour and possible interventions: a survey on healthcare-associated infections among the healthcare workers of an intensive care unit in a large teaching hospital in Rome

Methods

A questionnaire of 36 questions was developed and administered to assess socio-occupational characteristics, knowledge of Healthcare-associated infections, attitudes and barriers encountered in compliance with hygiene standards, self-analysis of professional behaviour, and proposals for new interventions. Variables were evaluated by univariate analysis, and multivariable logistic regression models were constructed to identify predictors of adequate knowledge, positive attitude and appropriate professional behaviour.

Background

Healthcare-associated infections are the main complications of hospitalization. A bottom-up approach, where the Healthcare workers involved play a key role, can be adopted to limit the Healthcare-associated infections burden. To this end, a survey was conducted in the main intensive care unit of Umberto I Teaching Hospital of Rome, where an active surveillance system has been in place since April 2016.

Results

Overall, 79/89 Healthcare workers completed the questionnaire. Multivariate analysis showed that Healthcare workers, who participated in ward meetings to share active surveillance reports, were more likely to have adequate knowledge (aOR=4.21, 95% CI: 1.36-13.07). Only job type seemed to be a predictor of adequate behaviour, since nurses and physicians were more likely to show adequate behaviour than residents in training (aOR=0.21, 95% CI: 0.06-0.74). Direct observation of compliance with standard hygiene precautions and the identification of 'local champions' to manage Healthcare-associated infections' issues were the most requested interventions.

Conclusions

Our study suggests that the training of healthcare professionals is a key factor in preventing and containing the spreading of Healthcare-associated infections. Moreover, by encouraging greater Healthcare workers' involvement, we conclude that a bottom-up approach is likely to improve Healthcare-associated infections' prevention and management.

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Summary

Objective. The purpose of the study was to describe the characteristics of patients experiencing hypersensitivity reactions (HRs) to iodinated contrast media (ICM) in a large Italian population and to investigate potential risks factors in order to obtain a risk stratification, helpful in the management of these patients. Methods. Data of 407 patients investigated in 9 Italian Allergy Centers for suspected HRs to ICM were analyzed and compared with a control group of 152 subjects that tolerated one or more ICM-enhanced examinations. The univariate and multivariate logistic regression model was used to evaluate associated factors. Results. The mean age of reactive patients was 61 years and 60% were female; 67% of patients reported immediate reactions and 35% experienced the reaction, more frequently with immediate onset, at the first examination in life. Iomeprol, iopromide and iodixanol were the most frequent culprit agents and 20% of patients showed a positive skin test result. Previous adverse reactions to ICM were reported by 15.6% of patients, whereas 35% of subjects experienced the reaction, more frequently immediate, after the first ICM-enhanced examination in their life. The multivariate analysis showed that male gender and age > 65 were associated with ICM reactions as protective factors [OR_adja = 0.51; 95% CI: 0.33-0.77 and OR_adja = 0.60; 95% CI: 0.39-0.92 respectively]. Cardio-vascular disease [OR_adja = 2.06; 95% CI: 1.22-3.50)], respiratory allergy [OR_adja = 2.30; 95% CI: 1.09-4.83)] and adverse drug reactions [OR_adja = 1.99; 95% CI: 1.05-3.77)] were identified as risk factors for ICM reactions. Food allergy was not significantly associated with reactions [OR_adja = 1.51; 5% CI: 0.41-5.56]. Conclusions. This is the largest study on Italian patients experiencing hypersensitivity reactions to ICM. Most results are in line with other studies, showing some association with factors that could influence the incidence of hypersensitivity reactions but not allowing an easy risk stratification.

Gnathological and osteopathic treatments with digital evalua- tions before and after therapies: a case report of a patient with ehlers-danlos syndrome

Background

Ehlers-Danlos syndromes (EDS) are inherited connective tissue disorders, requiring specific care along with a multidisciplinary approach by an expert medical staff, as for both the diagnosis and the treatment management. Chronic generalized pain and musculoskeletal dysfunctions due to joint hypermobility are common traits. Temporomandibular disorders (TMDs) are among the most frequent complaints. The authors report the diagnostic and therapeutic management of an EDS subject.

Case presentation

A 33-year old woman with Ehlers-Danlos syndrome, hypermobile type, was clinically evalu-ated and treated. She underwent a gnathological therapy with an anterior repositioning splint and proprioception ex-ercises, and a physical rehabilitation through an osteopathic manipulation treatment (OMT). Technology - surface Elec-tromyography (sEMG) of masticatory muscles, T-scan and stabilometric platform- supported diagnostic and therapeutic phases, giving objective and quantifiable information on the patient's assessment before and after treatments.

Conclusion

According to a targeted therapeutic strategy, both the gnathological and the osteopathic therapy proved to be effective in improving patient's symptomatology and functionality, as confirmed by digital findings.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

BACKGROUND

Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.

METHODS

PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.

RESULTS

The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).

DISCUSSION

We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.

PROSPERO REGISTRATION

CRD42019133377.

Muscular pattern in patients with temporomandibular joint disc displacement with reduction: an electromyographical assessment

OBJECTIVE

Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group.

MATERIALS AND METHODS

Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ < 0.05.

RESULT

The t-test showed statistically significant results only in BAR and SMI scores (ρ value < 0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed.

CONCLUSION

Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one.

Subjects with temporomandibular joint disc displacement and body posture assessment via rasterstereography: a pilot case-control study

OBJECTIVE

The possible relationship between temporomandibular disorders (TMDs) and body posture is still controversial. Rasterstereography has been introduced as a radiation-free, reliable and non-invasive method to analyze three-dimensional spinal posture. The aim of this case-control study is to evaluate, through rasterstereography, body posture parameters in a group of patients with reducible unilateral dislocation of the articular disc, compared to healthy volunteers.

PATIENTS AND METHODS

Rasterstereographic recordings obtained were compared between the two groups with a paired t-student test. Furthermore, the relationship between Rasterstereographic recordings and clinical data in the TMD group were analyzed by means of multiple regression analysis.

RESULTS

Only lateral deviation was statistically significant different between the two groups (rms VPDM Control group 40% > TMD group, p=0.02; 43% control group VPDM max > TMD group, p<0.02). In the TMD group, a significant relationship (p<0.05) was found out between lateral and rotational deviations of the column and muscular pain, therefore suggesting a possible overactivity of the masticatory muscles, especially of lateral pterygoids' bilaterally and the left masseter.

CONCLUSIONS

Patients with reducible unilateral disc displacement showed limited postural alterations compared to healthy volunteers, only lateral deviations (VPDM rms and VPDM-max) were statistically significant (Π<0.05) between the two groups.

Multimodal surveillance of healthcare associated infections in an intensive care unit of a large teaching hospital

BACKGROUND

Healthcare-associated infections (HAIs), or nosocomial infections, represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients hospitalized in intensive care units (ICUs). Surveillance systems are recommended by national and international institutions to gather data on HAIs in order to develop and evaluate interventions that reduce the risk of HAIs.

STUDY DESIGN

Here we describe the methodology and the results of the surveillance system implemented in the ICU of the Policlinico Umberto I, a large teaching hospital in Rome, from April 2016 to October 2018.

METHODS

The multimodal infection surveillance system integrates four different approaches: i) active surveillance of inpatients; ii) environmental microbiological surveillance; iii) surveillance of isolated microorganisms; and iv) behavioral surveillance of healthcare personnel. Data were collected on catheter-related bloodstream infections, ventilation-associated pneumonia, catheter-associated urinary tract infections and primary bloodstream infections that developed in patients after 48 h in the ICU. For environmental surveillance 14 points were selected for sampling (i.e. bed edges, medication carts, PC keyboards, sink faucets). The system of active surveillance of HAIs also included surveillance of microorganisms, consisting of the molecular genotyping of bacterial isolates by pulsed-field gel electrophoresis (PFGE). From 1 November 2016, monitoring of compliance with guidelines for hand hygiene (HH) and proper glove or gown use by healthcare personnel was included in the surveillance system. After the first six months (baseline phase), a multimodal intervention to improve adherence to guidelines by healthcare personnel was conducted with the ICU staff.

RESULTS

Overall, 773 patients were included in the active surveillance. The overall incidence rate of device-related HAIs was 14.1 (95% CI: 12.2-16.3) per 1000 patient-days. The monthly device-related HAI incident rate showed a decreasing trend over time, with peaks of incidence becoming progressively lower. The most common bacterial isolates were Klebsiella pneumoniae (20.7%), Acinetobacter baumannii (17.2%), Pseudomonas aeruginosa (13.4%) and Staphylococcus aureus (5.4%). Acinetobacter baumannii and Klebsiella pneumoniae showed the highest proportion of isolates with a multidrug-resistant profile. A total of 819 environmental samples were collected, from which 305 bacterial isolates were retrieved. The most frequent bacterial isolates were Acinetobacter baumannii (27.2%), Staphylococcus aureus (12.1%), Enterococcus faecalis (11.1%), Klebsiella pneumoniae (5.2%) and Pseudomonas aeruginosa (4.7%). All Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae environmental isolates were at least multidrug-resistant. Genotyping showed a limited number of major PFGE patterns for both clinical and environmental isolates of Klebsiella pneumoniae and Acinetobacter baumannii. Behavioral compliance rates significantly improved from baseline to post-intervention phase.

CONCLUSIONS

By integrating information gathered from active surveillance, environmental microbiological surveillance, surveillance of bacterial isolates and behavioral surveillance of healthcare personnel, the multimodal infection surveillance system returned a precise and detailed view of the infectious risk and microbial ecology of the ICU.

Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis

Background

Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of non-adequate HL (NAHL) in European countries and outline the main needs for interventions.

Methods

The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified meta-analyses were carried out. We also performed a meta-regression analysis to test the association between variables and NAHL.

Results

In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients.

Conclusions

Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed.

Key messages

Despite several variations, a significant proportion of European population has non-adequate health literacy. Targeted public health strategies of intervention are crucial to address this deficit.

Multimodal Surveillance of HAI in an Intensive Care Unit of a Large Teaching Hospital

Background

Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICU). Surveillance systems are recommended to gather data in order to elaborate and evaluate intervention to reduce HAIs risk. Here we describe results of the multimodal surveillance system implemented in the ICU of a large teaching hospital in Rome from April 2016 to October 2018.

Methods

The surveillance system integrated four different approaches: i) active surveillance focused on inpatients; ii) environmental microbiological surveillance; iii) surveillance focused on isolated microorganisms; iv) behavioral surveillance of the healthcare personnel. The system included the molecular genotyping of bacterial isolates through the pulsed field gel electrophoresis (PFGE). Moreover, an intervention to improve personnel adherence to hand hygiene (HH) guidelines was conducted.

Results

Overall, 773 patients were included in the surveillance. The global incidence rate of the device related HAIs was 14.1 (95%CI: 12.2-16.3) per 1000 patient day. Monthly device related HAIs incidence rate showed a decreasing, from 26.9 per 1000 patient day in October 2016, to 4.9 in September 2018. The most common bacterial isolate was K. pneumoniae (20.7%), the 94.0% of which were multidrug-resistant. A total of 305 environmental bacterial isolates were retrieved and the most frequent was A. baumannii (27.2%), that was always multidrug-resistant. Genotyping showed a limited number of major PFGE patters in clinical and environmental isolates. Behavioral compliance to HH guidelines improved after the educational intervention.

Conclusions

The data showed an overall slight decrease over time of the adjusted risk HAIs rates. Through the integration of information gathered from the four approaches, the application of this model returns a precise and detailed view of the infectious risk and of the microbial ecology of the ICU.

Key messages

Multimodal surveillance systems are effective to monitor HAI incidence and to determine the infectious risk. Genotyping techniques allows to characterize and link the clinical and environmental isolates.

A novel universal device"LINGUAL RING Ri.P.A.Ra" for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial

OBJECTIVE

The aim of this study was to evaluate functionality and clinical application of a novel immediate device in the treatment of temporomandibular disorders (TMDs). To address the research purpose, authors developed and implemented a randomized control clinical trial.

PATIENTS AND METHODS

Eighty patients were enrolled in this study and were randomly divided into two subgroups based on the treatment applied: patient group (PG) and control group (CG). The CG was not subjected to any kind of treatment, even placebo, in order to be able to assess the spontaneous development of the pathology over time. The PG was treated applying the novel device for a maximum of three months. The following parameters were evaluated at baseline (T0) and at the end of therapy (T1): presence/absence of articular noises, painful symptomatology (articular pains, muscle pains, headache, cervicalgia), parafunctional habits and duration of symptoms. The x2-index of association was performed, with a p-value < 0.05 considered as statistically significant.

RESULTS

No patient in the PG worsened its symptomatology. Thirteen patients (33%) declared themselves cured from their symptoms and were included in a monitoring protocol. Twenty-seven patients (67%) improved their symptoms and were treated with other conservative conventional methods to complete the therapeutic cycle. Therefore, 100% of PG obtained benefits from the application of the new therapeutic approach. In contrast, among patients of CG, eighteen subjects (45%) worsened their symptoms, while eighteen (45%) were defined as stationaries compared to T0 and only four (10%) were defined as improved.

CONCLUSIONS

The device presented the following advantages: immediacy of use, reduction of waiting times for its application, good tolerability and comfort and specificity in the execution of tongue rehabilitation exercises.

An ecotoxicological view on neurotoxicity assessment

The numbers of potential neurotoxicants in the environment are raising and pose a great risk for humans and the environment. Currently neurotoxicity assessment is mostly performed to predict and prevent harm to human populations. Despite all the efforts invested in the last years in developing novel in vitro or in silico test systems, in vivo tests with rodents are still the only accepted test for neurotoxicity risk assessment in Europe. Despite an increasing number of reports of species showing altered behaviour, neurotoxicity assessment for species in the environment is not required and therefore mostly not performed. Considering the increasing numbers of environmental contaminants with potential neurotoxic potential, eco-neurotoxicity should be also considered in risk assessment. In order to do so novel test systems are needed that can cope with species differences within ecosystems. In the field, online-biomonitoring systems using behavioural information could be used to detect neurotoxic effects and effect-directed analyses could be applied to identify the neurotoxicants causing the effect. Additionally, toxic pressure calculations in combination with mixture modelling could use environmental chemical monitoring data to predict adverse effects and prioritize pollutants for laboratory testing. Cheminformatics based on computational toxicological data from in vitro and in vivo studies could help to identify potential neurotoxicants. An array of in vitro assays covering different modes of action could be applied to screen compounds for neurotoxicity. The selection of in vitro assays could be guided by AOPs relevant for eco-neurotoxicity. In order to be able to perform risk assessment for eco-neurotoxicity, methods need to focus on the most sensitive species in an ecosystem. A test battery using species from different trophic levels might be the best approach. To implement eco-neurotoxicity assessment into European risk assessment, cheminformatics and in vitro screening tests could be used as first approach to identify eco-neurotoxic pollutants. In a second step, a small species test battery could be applied to assess the risks of ecosystems.

The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study

Background

The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone.

Material and Methods

10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different.

Results

The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique.

Conclusions

In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized.

Key words:Implant primary stability, resonance frequency analysis, implant site preparation.

A new aid in temporomandibular joint disorders' therapy: the universal neuromuscular immediate relaxing appliance

Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes.

Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders

Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.

The condyle-fossa relationship in temporomandibular disorders. Considerations on the pathogenetic role of the disc

AIM

The purpose of this study is to evaluate the condylar position and its variation in patients with temporomandibular joint (TMJ) disorders before and after therapy with occlusal gnathologic devices.

METHODS

Twenty-five TMJ of 25 patients with temporomandibular joint disorder were examined by linear measurement of the anterior, posterior and superior joint space between the condyle and glenoid fossa through cephalometric analysis on X-ray tomography of the TMJ and by calculating the condylar position with the Pullinger and Hollender method.

RESULTS

The average condylar position in the TMJ with DTM was posterior with a mean value of 22.2% and a range from 14.3% to 36%. The condylar position of 25 TMJs was: anterior 0(0%); centric 8(32%) and posterior 17(68%). After therapy with occlusal gnathologic devices the average condylar position was centric with a mean value of 0.6% and a range from 5.3% to 6.6%. The condylar position of 25 TMJs was: anterior 2(8%); centric 22(88%) and posterior 1 (14%).

CONCLUSIONS

The hypothesis can be advanced that joint pathology is the consequence of the alteration of the condyle position and therefore of the mandibular movement and vice versa. Therapy with occlusal devices makes it possible to modify the condylar position by increasing the condylar capability to recapture the joint disc.

Long term follow-up of patients affected by temporomandibular joint dysfunction treated with orthodontic and/or prosthetic occlusal therapy

AIM

Clinical evidences about therapeutic effectiveness of splint therapy and modern concept concerning the etiopathogenesis of temporomandibular disorders (TMD) lead to a review of the therapeutic approach accepted until the middle 90s for the solution of this derangement of the stomathognatic system. Aim of this study is to produce a long term follow-up of a sample of TMD patients, to estimate the validity and utility of the present therapeutic procedures.

METHODS

After diagnostical classification of the patients observed, they have been included in a therapeutic protocol. The outcomes obtained (46 patients at the 1st control in 1994 and 38 patients at the last control in 2001) are re-examined with an average follow-up of 10 years.

RESULTS

The results obtained showed the efficacy of the therapeutic procedures carried out (36 healed, 9 improved and 1 worsened at the 1994 check-up: on the whole, a successful result in 98% of cases; 17 healed, 21 improved and 8 lost at the 2001 check-up: on the whole, a successful result in 100% of cases), but at present their application has to be reviewed according to a more conservative and careful therapeutic approach, based on the evaluation of some fundamental parameters.

CONCLUSION

The rehabilitative occlusal therapy, in its various aspects, is successful in the long term treatment of TDMs, as long as it is used only when it is possible to determine a correct indication.

[Posterior vertical dimension and condylo-discal non-coordination of the temporomandibular joint. Hypothesis on correlation]

BACKGROUND

On the basis of clinical evidence, an analytic study has been carried out to verify the hypothetic correlation between reduction of the posterior vertical overlap and internal derangements.

METHODS

58 patients with temporomandibular disorders have been observed; they presented clinically a reduction of the posterior vertical dimension (RPVD) due either to the loss of molar teeth or to the molar occlusal surface abrasion or to a wrong prosthetic rehabilitation. A cephalometric exam showed a significative correspondence between the RPVD and the retruded condylar position in the glenoidae fossa with a reduction of posterior joint space in comparison with the standard values purposed by Farrar.

RESULTS

The results obtained showed a possible relation between occlusal alterations and the TMJ pathology.

CONCLUSIONS

The conclusion is drawn that the clinical evaluation brings to consider occlusal factors, and in particular the reduction of posterior vertical dimension may be considered as possible etiologic factors of TMJ disorders.

Intramolecular backfolding of the carboxyl-terminal end of MxA protein is a prerequisite for its oligomerization

Mx proteins are large GTPases, which play a pivotal role in the interferon type I-mediated response against viral infections. The human MxA inhibits the replication of several RNA viruses and is organized in oligomeric structures. Using two different experimental approaches, the mammalian two-hybrid system and an interaction dependent nuclear translocation approach, three domains in the carboxyl-terminal moiety were identified that are involved in the oligomerization of MxA. The first consists of a carboxyl-terminal amphipathic helix (LZ1), which binds to a more proximal part of the same molecule. This intramolecular backfolding is a prerequisite for the formation of an intermolecular complex. This intermolecular interaction is mediated by two domains, a poorly defined region generated by the intramolecular interaction and a domain located between amino acids 363 and 415. Co-expression of wild-type MxA with various mutant fragments thereof revealed that the presence of the carboxyl-terminal region comprising the amphipathic helices LZ1 and LZ2 is necessary and sufficient to exert a dominant negative effect. This finding suggests that the functional interference of the carboxyl-terminal region is due to competition for binding of an as yet unidentified cellular or viral target molecules.

Human MxA protein protects mice lacking a functional alpha/beta interferon system against La crosse virus and other lethal viral infections

The human MxA protein is part of the antiviral state induced by alpha/beta interferon (IFN-alpha/beta). MxA inhibits the multiplication of several RNA viruses in cell culture. However, its antiviral potential in vivo has not yet been fully explored. We have generated MxA-transgenic mice that lack a functional IFN system by crossing MxA-transgenic mice constitutively expressing MxA with genetically targeted (knockout) mice lacking the beta subunit of the IFN-alpha/beta receptor (IFNAR-1(-/-) mice). These mice are an ideal animal model to investigate the unique antiviral activity of human MxA in vivo, because they are unable to express other IFN-induced proteins. Here, we show that MxA confers resistance to Thogoto virus, La Crosse virus, and Semliki Forest virus. No Thogoto virus progeny was detectable in MxA-transgenic mice, indicating an efficient block of virus replication at the primary site of infection. In the case of La Crosse virus, MxA restricted invasion of the central nervous system. In contrast, Semliki Forest virus multiplication in the brain was detectable in both MxA-expressing and nonexpressing IFNAR-1(-/-) mice. However, viral titers were clearly reduced in MxA-transgenic mice. Our results demonstrate that MxA does not need the help of other IFN-induced proteins for activity but is a powerful antiviral agent on its own. Moreover, the results suggest that MxA may protect humans from potential fatal infections by La Crosse virus and other viral pathogens.

Condylar fractures during growth: follow-up of 16 patients

Fractures of the mandibular condyle represent 20% to 35% of all mandibular fractures. There are several clinical variants of this type of fracture that give rise to different problems in relation to their classification and treatment. A sample of 16 patients (of a total of 280 patients examined and treated from 1985 through 1995) with mono- and bilateral, displaced and decomposed, condylar fractures that occurred during growth were examined by the authors, who assessed, by a 2-year follow-up, the relevant clinical, functional, and instrumental parameters. On the basis of the data gathered by this study, a plan was drawn up for treating these patients that takes into account the different situations, such as either a nonsurgical or surgical treatment (by the use of condylectomy or external rigid fixation), and points out the advantages and disadvantages of each method.

[Retrospective study on the application of occlusal splints in 312 patients with temporomandibular disorders]

BACKGROUND

Temporo-mandibular disorders are classified into disorders involving TMJ components (articular disk displacement, deviation in form) and masticatory muscle disorders.

METHODS

In this study the authors describe their experience of the non-surgical treatment of these pathologies. They review a total of 312 patients suffering from TMJ disorders treated with occlusal splint therapy applied for any TMJ dysfunction. The sample was monitored before and after occlusal therapy with an average follow-up of 30 months.

RESULTS AND CONCLUSIONS

The results were evaluated by comparing the authors' method of assessment with the parameters put forward by Levitt in 1993. Both methods of evaluation gave comparable results with a percentage of long-term success in excess of 87%.

Human MxA protein confers resistance to Semliki Forest virus and inhibits the amplification of a Semliki Forest virus-based replicon in the absence of viral structural proteins

Mx proteins form a small family of interferon (IFN)-induced GTPases with potent antiviral activity against various negative-strand RNA viruses. To examine the antiviral spectrum of human MxA in homologous cells, we stably transfected HEp-2 cells with a plasmid directing the expression of MxA cDNA. HEp-2 cells are permissive for many viruses and are unable to express endogenous MxA in response to IFN. Experimental infection with various RNA and DNA viruses revealed that MxA-expressing HEp-2 cells were protected not only against influenza virus and vesicular stomatitis virus (VSV) but also against Semliki Forest virus (SFV), a togavirus with a single-stranded RNA genome of positive polarity. In MxA-transfected cells, viral yields were reduced up to 1,700-fold, and the degree of inhibition correlated well with the expression level of MxA. Furthermore, expression of MxA prevented the accumulation of 49S RNA and 26S RNA, indicating that SFV was inhibited early in its replication cycle. Very similar results were obtained with MxA-transfected cells of the human monocytic cell line U937. The results demonstrate that the antiviral spectrum of MxA is not restricted to negative-strand RNA viruses but also includes SFV, which contains an RNA genome of positive polarity. To test whether MxA protein exerts its inhibitory activity against SFV in the absence of viral structural proteins, we took advantage of a recombinant vector based on the SFV replicon. The vector contains only the coding sequence for the viral nonstructural proteins and the bacterial LacZ gene, which was cloned in place of the viral structural genes. Upon transfection of vector-derived recombinant RNA, expression of the beta-galactosidase reporter gene was strongly reduced in the presence of MxA. This finding indicates that viral components other than the structural proteins are the target of MxA action.

[A longitudinal analysis of dysfunctional TMJ pathology: an assessment of a sample of patients undergoing nonsurgical therapy]

One the different interpretation of the pathological and clinical evolution of TMJ dysfunctions, the most-common of these pathologies is the condyle-disk uncoordination. This study analyzes the evolution of the treatment on the sample of patients affected by TMJ dysfunction and examined at the maxillo-facial department of the University of Rome "La Sapienza". After the TMJ dysfunction has been diagnosed the patients were informed of the individual therapeutic program which consisted of a temporary and definitive occlusal therapy. The aim of this scientific work is to control the efficiency within this therapeutic program in relation to the uncoordination of TMJ. In order to validate this approach the study was compared with another that considered the evolution of TMJ pathology in patients examined at the first diagnostic, visit but who had not undergone any treatment.

[A longitudinal analysis of dysfunctional pathology of the TMJ: an assessment of a sample of patients not undergoing therapy]

Concerning the different interpretation on the pathological and clinical evolution of the TMJ dysfunctions, the most common of these pathology is the condyle-disk incoordination. This study analyzed the evolution of TMJ dysfunctions examined at the maxillo-facial department of the University of Rome "La Sapienza". The non therapeutic approach does not consider an addition al control-sample of the non treated being itself a control-sample of a parallel work whose aim was to analyze patients who had undergone a complete therapeutic cycle.

[The diagnosis and surgical therapy of maxillofacial malformations. The statistical considerations]

In this report the authors develop a thorough statistic analysis upon the past 12-year activity (1980-1991) of the University of Rome, Department of Maxillo-Facial Surgery, in the field of the diagnosis and treatment of congenital or acquired maxillofacial malformations. They point out, in particular, the high frequency rate of bimaxillary osteotomy use in the surgical treatment of dentoskeletal malformations, that are the most frequent malformations in maxillofacial clinical practice. They also point out how wide the use of the rigid internal fixation technique in this surgical field has become.

[Neuromuscular assessment and postural examination in patients with TMJ condylo-meniscal incoordination]

The neuromuscular system plays a primary role in the development of a myofascial syndrome of the temporomandibular joint. Patients suffering from this disease very often show changes in muscular functions. In biomechanical clinical pictures of temporomandibular myofascial syndrome the motor apparatus is involved only in the second stage. In order to determine the efficiency of the motor apparatus and to schedule a physiotherapeutic treatment program to improve condylar-meniscus coordination of the joint, an analysis of muscular function associated with postural examination has been performed, and this with a view to evidence possible skeletal changes, with particular regard to the spine. The study has been carried out in a group of healthy individuals in front of an other group of patients affected by the pathology mentioned.

[A statistical evaluation of the surgical therapy of TMJ condyle-disk incoordination]

Biomechanical pathology of the TMJ occurs most frequently in 4 clinical variants: anterior dislocation of the jaw, reciprocal click, closed lock, osteoarthrotic degeneration. The aim of this study was to evaluate the efficacy of TMJ surgery, using statistical comparative analysis, in resolving condylo-meniscal incoordination. Eighty-one patients were included in the study who had been treated surgically for various symptoms of condylo-discal incoordination from 1982 to 1989, assessing a series of objective and subjective parameters and making a statistical comparison of results.

[Electrognathographic imaging of the articular click]

The study of TMJ phisiopathology by means of computerizing devices is necessary in order to make a correct diagnosis and verify the therapeutic programme. In this study the Authors analyse articular click that is one of the first and characteristic symptom of the internal derangement. The Authors show by means of elettrognatography, chewing cicles and mandibular border movements of patients affected with this particular pathology. Trascing of 135 patients suffering from tmj reciprocal click have been examined in the department of maxillary-facial of Roma "La Sapienza", surgery during the period 1987-88.

[Maxillo-mandibular fracture outcome. Therapeutic program]

The ill-consolidated outcomes of the maxillo and jaw fractures often show ill-positions of the mandible and/or of the jaw in the three space-levels. In order to program a suitable surgical correction of such pathologic pictures it is necessary to make a cephalometric test and a gnathologic one. The result of these tests will guide the therapeutical choise which will be either the re-opening of the surgical treatment to be effected through the usual osteotomy of the mandible.

[Prosthetic rehabilitation in the sequelae of labiopalatoschisis]

Labiopalatoschisis patients present functional and aesthetic alterations in the maxillomandibular area that often require prosthetic correction. Given the features of these malformations therapy and rehabilitation should be programmed as soon as possible after birth and the plastic surgeon should be informed of the factors that cause the malformations and influence the growth of such patients. The present paper briefly outlines the pathogenesis of L.P.S. and proposes a classification system for L.P.S. since both are considered essential for the understanding and assessment of its sequelae. The prosthetic-reconstructive problems in cases of cheilognathopalatoschisis subjected to orthodontic and surgical treatment are described since this is considered the most difficult form of rehabilitation the prosthesis is faced with.

Five-year follow-up of Le Fort I osteotomies

The outcome of a five-year radiographic follow-up study of 150 patients with maxillo-mandibular malformations who had undergone Le Fort I osteotomy of the maxilla is reported. A superimposition technique made possible an exact evaluation of the adjustments effected. The results confirm the validity of a study conducted in 1977 and the five-year stability of the maxilla. The importance of the relationship between the Frankfort plane, occlusal plane and the osteotomy line is emphasized. In operations in which Le Fort I osteotomy of the maxilla is combined with a sagittal osteotomy of the mandible the maxilla undergoes minute displacements in the weeks following surgery, which can easily be predicted and allowed for at the planning stage. The long-term stability of the maxilla is assured.