Visual and thermal stimuli modulate mosquito-host contact with implications for improving malaria vector control tools

Malaria prevention relies on mosquito control interventions that use insecticides and exploit mosquito behavior. The rise of insecticide resistance and changing transmission dynamics urgently demand vector control innovation. To identify behavioral traits that could be incorporated into such tools, we investigated the flight and landing response of Anopheles coluzzii to human-like host cues. We show that landing rate is directly proportional to the surface area of thermal stimulus, whereas close-range orientation is modulated by both thermal and visual inputs. We modeled anopheline eye optics to theorize the distance at which visual targets can be detected under a range of conditions, and experimentally established mosquito preference for landing on larger targets, although landing density is greater on small targets. Target orientation does not affect landing rate; however, vertical targets can be resolved at greater distance than horizontal targets of the same size. Mosquito traps for vector control could be significantly enhanced by incorporating these features.

Customized-3D zirconia barriers for guided bone regeneration (GBR): clinical and histological findings from a proof-of-concept case series

OBJECTIVES

The aim of this case series was to evaluate, clinically and histologically, customized-3D zirconia barriers manufactured for guided bone regeneration (GBR) procedures.

METHODS

Seven healthy consecutive patients with severe bone atrophy (two of them with a bilateral atrophy) were selected for a GBR procedure with a zirconia barrier. In a 3D software (DentalCad, Exocad GmbH, Germany), a virtual bone graft was designed and a shell was designed covering the graft; a standard tessellation language (.STL) file was obtained and milled (M1, Zirkonzahn, Italy) using a 1200 MPa zirconia (Prettau, Zirkonzahn, Italy). Nine GBR surgeries (8 upper-posterior jaw, 1 lower-posterior jaw) were performed using autogenous bone chips mixed with xenograft (SmartBone, IBI-SA, Switzerland / BioOss, Geistlich, Switzerland) covered with a zirconia barrier, fixed by means of screws. After healing, implant sites were prepared with a trephine bur, collecting a bone biopsy, and dental implants were inserted (Neodent, Straumann Group, Switzerland). Specimens were histologically analyzed.

RESULTS

Eight successful surgeries were recorded; one zirconia barrier got exposed after one month of healing but no signs of infection were present till the barrier was removed. In all cases it was possible to insert implants with no additional bone augmentation procedures. Histological evaluations showed the presence of intense deposition of new bone.

CONCLUSIONS

Within the limitations of the present case series, the tested customized-3D zirconia barriers confirmed good clinical and histological performances, and, even in case of premature exposure, did not show signs of infection. Preliminary results suggest they are effective for GBR procedures. Further research is necessary with a larger sample size.

CLINICAL SIGNIFICANCE

The presented barriers could be a viable alternative to titanium-reinforced polytetrafluoroethylene membranes and customized meshes.

Collagen Fibres Orientation in the Bone Matrix around Dental Implants: Does the Implant's Thread Design Play a Role?

The aim of this study was to analyse the influence of different thread shapes of titanium dental implant on the bone collagen fibre orientation (BCFO) around loaded implants. Twenty titanium dental implants, divided for thread shapes in six groups (A–F) were analysed in the present study. All implants were immediately loaded and left in function for 6 months before retrieval. The parameters evaluated under scanning electron microscope were the thread width, thread depth, top radius of curvature, flank angle, and the inter-thread straight section. Two undecalcified histological sections were prepared from each implant. Birefringence analysis using circularly polarized light microscopy was used to quantitively measure BCFO. For groups A–F, respectively, transverse BCFO was 32.7%, 24.1%, 22.3%, 18.2%, 32.4%, and 21.2%, longitudinal BCFO was 28.2%, 14.5%, 44.9%, 33.1%, 37.7%, and 40.2%. The percentage differences between transverse and longitudinal orientation were 4.50% (A), 9.60% (B), −22.60% (C), −14.90% (D), −5.30% (E), and −19.00% (F). Following loading, the amount of transverse and longitudinal BCFO were significantly influenced by the thread shape. The greater flank angles and narrower inter-thread sections of the “V” shaped and “concave” shaped implant threads of groups A and B, respectively, promoted the predominance of transverse BCFO, compared to groups C-F (p < 0.05). A narrow inter-thread straight section promotes transverse BCFO, as do “V” shaped and “concave” shaped threads, which can thus be considered desirable design for implant threads.

Healing of Post-Extraction Sockets Filled with Anorganic Bovine Bone and Covered with a Xenogeneic Collagen Matrix. Radiological 2D and 3D Results of a Pilot Study to Assess Dimensional Stability

Analysis of short-term results regarding dimensional stability of post-extraction sockets managed via a preservation protocol using deproteinized bovine bone matrix and a xenogeneic collagen matrix. Materials and methods Fifteen patients needing extraction of one single-rooted premolar tooth were treated in a pilot study. Five patients were treated in each centre. After tooth extraction, sockets were filled with anorganic bovine bone matrix and covered with a xenogeneic collagen matrix. Six months later, implants were placed. Dimensional changes in the treated sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Results After six months of healing, the vertical reduction of the grafted sites was 0.31 ± 0.24 mm (p < 0.001). Volumetric analysis of superimposed models showed an average palatal-lingual contraction of 0.33 ± 0.51 mm³ (p = 0.02). At the vestibular level, the average contraction was found to be 0.8 ± 0.3 mm³ (p < 0.001). Finally, the analysis of linear variations in the treated sites on a single sagittal section at the crystal level, and at 3 and 7 mm apically respect to the crest, both towards the vestibule and palate, generally showed more marked resorption at the crestal level compared to apical measurements. Conclusion: The clinical protocol herein employed for socket preservation showed a positive effect in preventing the physiological post-extraction remodeling.

Solid index versus intraoral scanners in the full-arch implant impression: in vitro trueness evaluation

Objectives

To assess the trueness of a solid index (SI) in the full-arch (FA) implant impression, and to compare it with that of two intraoral scanners (IOSs). A type-IV gypsum model of a completely edentulous patient with 8 implant scanbodies (SBs) was scanned with a desktop scanner (7Series®) to obtain a reference virtual model (RVM), and with two IOSs (CS 3700® and Emerald S®). Five scans were taken with each IOS. Based on the RVM, an SI (custom tray consisting of hollow cylinders connected by a bar) was fabricated and used to capture a physical impression of the model; from this, a second gypsum model was derived and scanned with a desktop scanner (D15®). The SI-derived and the IOSs-derived models were superimposed onto the RVM, to evaluate trueness.

Results

The overall mean trueness was 29 μm (± 26) for the SI-derived model, versus 42.4 μm (± 14.7) for CS 3700® and 52.2 μm (± 4.6) for Emerald S®. Despite its limitations (in vitro design, a limited number of models evaluated, RVM captured with a desktop scanner) this study supports the use of SI for FA implant impressions. Further studies are needed to confirm this evidence.

Solid index impression protocol: a hybrid workflow for high accuracy and passive fit of full-arch implant-supported restorations

AIM

The purpose of this article is to present the preliminary clinical results obtained with a novel hybrid digital-analog technique, the solid index impression protocol (SIIP), which uses a solid index to capture accurate impressions of multiple implants for the fabrication of implant-supported fixed full arches (FFAs).

MATERIALS AND METHODS

This pilot study was based on five patients, each treated with a FFA supported by four implants. Three months after implant placement, impressions were taken for all patients with an intraoral scanner (IOS) (direct digital impression) and with the SIIP, using a custom tray consisting of four hollow cylinders connected with a bar. This index was linked to the implant transfers and transferred to the laboratory, and the definitive FFAs were fabricated based on it. The outcomes of the study were the passive fit of implant superstructures and the accuracy of the models generated by the SIIP, inspected using a coordinate measuring machine (CMM) and reverse engineering software, and compared with the accuracy of direct digital impressions.

RESULTS

Excellent clinical precision and passive fit were obtained in all five implant-supported FFAs fabricated with the SIIP. One year after delivery, all FFAs were functional without any complication. Differences in accuracy were found between the SIIP and direct intraoral scanning.

CONCLUSIONS

The SIIP seems to represent a viable option for capturing accurate impressions for the fabrication of clinically precise implant-supported FFAs with a hybrid digital-analog workflow. Further studies are needed to confirm these results.

Biomimetic implant restoration made of human enamel and CAD/CAM block: a short report

This short report describes a clinical case in which an implant-supported crown was made using an extracted natural tooth as the outer shell. The same tooth had been previously relined for immediate loading without occlusal contacts. Using digital software, a composite resin mesostructure was fabricated in order to place the crown in the correct occlusal position, and the natural crown was ground using a computer-controlled milling machine to perfectly fit on the mesostructure.

Unusual Dermatologic Toxicity of Long-Term Therapy with Hydroxyurea in Chronic Myelogenous Leukemia

The unusual appearance of extensive skin ulcerations was observed in 17 patients with chronic myelogenous leukemia on continuous chemotherapy with hydroxyurea. The strict relationship between ulcers and therapy was proved by the complete (14 cases) or almost complete (3 cases) healing of lesions after therapy was discontinued. The possible pathogenetic mechanisms responsible for skin alterations are considered. The particular importance of the continuous hydroxyurea administration modality clearly emerges, suggesting the use of different administration modalities to reduce such serious side effects.

The ability of marginal detection using different intraoral scanning systems: A pilot randomized controlled trial

PURPOSE

To assess the clinical ability of marginal detection of different intraoral optical scanning (IOS) systems.

METHODS

The Ethics Committee of the University of Siena, Italy approved the research project. Thirty patients in need of an onlay/inlay with supra-gingival margins were included and randomly divided in three groups of 10 (3× n=10) according to the IOS for chairside capturing:(A) GC-Europe (Aadva); (B) True-Definition-TD; (C) Trios. A total of 1 scans from each IOS test group (A-C), were obtained clinically and stored as STL-files. In addition, corresponding conventional impressions were taken for all 30 patients, poured with stone, and then processed by a laboratory scanner (Aadva), serving as controls. All 60 STL-files were imported to the Exocad platform for analysis. The horizontal distance between each preparation margin and the adjacent tooth was measured using the ruler tool in the software. The distance at which the detection of the margin started to become visibly unclear was recorded for the horizontal distances. Data was processed statistically by one-way ANOVA (P> 0.05).

RESULTS

No statistically significant inter-test group differences could be identified (IOS A-C). The minimum distance from which a clear margin was visible, was 4.5 (SD 0.1) mm for all images, regardless of which IOS was used. Under these experimental clinical conditions, all tested IOS performed similarly. In contrast, all margins of the controls were clearly visible.

CLINICAL SIGNIFICANCE

None of the tested intraoral scanning systems in this study were capable of recording a clear impression when the cervical margin for a posterior partial crown was located at a distance of less than 0.5 mm from the interproximal neighbor.

Comparison Between Subcutaneous and Intravenous DDAVP in Mild and Moderate Hemophilia A

Sixteen patients with mild and moderate hemophilia were given Desmopressin (DDAVP) subcutaneously in the absence of any actual bleeding. The response to the drug – in terms of factor VIII coagulant activity rise – became apparent 15 min after the injection, reaching the maximal response after one hour (x̄ 3.2 times the baseline levels; SD 1.21). This response was not different from that elicited using the intravenous route in 18 hemophiliacs of comparable severity after the same time interval. No local or general side-effects were recorded after the subcutaneous administration of DDAVP. We therefore conclude that the subcutaneous route adds further evidence to the reliability of this alternative treatment in mild factor VIII deficiencies, thus making home treatment with this vasopressin analogue possible.

MOPP Treatment of Resistant Hodgkin's Disease following ABVD Failure

Fourteen patients with Hodgkin's disease resistant to ABVD were treated with MOPP chemotherapy (nitrogen mustard, vincristine, procarbazine, prednisone). Complete remission was obtained in 6 patients (43%). Four of the 6 complete responders are disease free after 5, 20, 23, 35 months. The actuarial median survival after MOPP of all patients is 20 months. These data confirm that there is no «cross-resistance» among the drugs included in the two schedules.

Hairy Cell Leukemia: Preliminary Results with Alpha2 (r) Interferon

Ten patients with hairy cell leukemia are being treated at our institution with a therapeutic schedule of α2(r) interferon (2 × 106 IU/m2 s.c. three times per week). Five patients underwent splenectomy from 4 to 108 months before treatment; nonsplenectomized patients had spleens palpable 6 to 12 cm UCM. According to Quesada's response criteria, at the sixth month of therapy, one patient was considered a complete responder, 8 partial responders and one a minor responder, with no differences between splenectomized and nonsplenectomized patients. In nonsplenectomized patients the spleen returned to normal. Our data confirm that interferon, even at low dosages, is a very effective approach for hairy cell leukemia. No evidence was found to contraindicate such therapy.

Involvement of the Bone Marrow by Non-Hodgkin's Lymphomas: Incidence, Histology and Pathologic Correlations

The Lukes and Collins system of classification was applied to 151 cases of non-Hodgkin's lymphoma who had bone marrow biopsies taken immediately after histologic diagnosis. Incidence and histologic pattern of bone marrow involvement at the time of initial diagnosis were determined for each subtype of lymphoma. Thirty-three patients (21.8 %) had bone marrow involvement. The frequency of bone marrow involvement was high for undefined and convoluted lymphocyte lymphomas (66.6 %) and low to intermediate for follicular centre cell (20.3 %) and small lymphocyte lymphomas (20.0 %). Within the FCC lymphomas the non-cleaved cell type had a higher incidence of marrow involvement than the cleaved cell type (41.6 % vs 8.9 %). The follicular and diffuse histologic patterns in the diagnostic node did influence the incidence of marrow invasion in the non-cleaved cell type (75 % vs 25 %). A low incidence of marrow involvement was observed for the immunoblastic lymphomas (14.2 %); evidence of marrow infiltration was never observed in patients with true histiocytic lymphoma.

Peripheral T Cell Lymphoma in Adults: Morphological and Phenotypical Study of Four Cases

In the present study we investigated the lymph node morphology and distribution of cell surface phenotypes in four cases of adult peripheral T cell lymphoma. Histologically, the tumors were classified as T zone lymphoma, T cell lymphoma with large multilobated nuclei and T cell immunoblastic sarcoma. In the T zone lymphoma the neoplastic lymphocytes were E+ (90 %) and exhibited intensive focal staining for acid phosphatase (93 %) and acid esterase (92 %); the phenotype distribution revealed low expression of the T-3 antigen (49 %), selective expression of the T-4 antigen (72 %) and poor expression of T-6 (10 %) and T-10 antigens (22 %). Some of these features are present in normal and in neoplastic immature T cells. In the remaining three cases the majority of lymph node cells were E+ (59–75 %), T-3+ (67–80 %) and T-8+ (43–55 %). A distinctive feature of the T cell immunoblastic sarcoma was the presence of high percentages of DR+ cells (62 %; 63 %). Thus our results indicate that the morphological heterogeneity of peripheral T cell lymphoma is also paralleled by a variety of surface phenotypes and that phenotype studies may provide a useful contribution to identification and accurate classification of peripheral T cell neoplasms.

Treatment by Splenic Irradiation in 22 Chronic Lymphocytic Leukemia Patients

Twenty-two patients with chronic lymphocytic leukemia, score 2 according to Rai et al. (10), who received only a course of splenic irradiation are reviewed. Splenic doses ranged from 420 to 1080 rad. Response to splenic irradiation was rated by evaluating peripheral lymphocytosis, hepatosplenomegaly, adenomegaly and disease-related symptoms. Following splenic irradiation, 8 patients showed a significant reduction in splenomegaly; 7 patients showed a significant reduction in peripheral lymphocytosis (< 10,000/mm3), which has lasted from 15–42 months without any other treatment. In 14 patients, response to splenic irradiation was partial, and it has successively been necessary to treat 12 patients with chemotherapy. Methods of splenic irradiation, survival, clinical and hematologic behavior are discussed in detail.

Treatment of Multiple Myeloma with Autologous Blood Stem Cell Transplantation. Preliminary Results of an Italian Multicentric Pilot Study

Starting from May, 1991, 35 untreated myeloma patients entered a multicentric pilot study to evaluate the feasibility of a program of PBSC transplantation for previously untreated myeloma patients. The schedule was as follows: 2 cycles of VAD followed by CY, 7 g/mq + G-CSF (Granulokine, Roche) for 14 days, to increase and collect PBSC. The subsequent conditioning regimen was Melphalan + Busulfan followed by G-CSF. As maintenance R alpha-2 IFN was given, until relapse. The median follow-up is 14 months (4-22). On April 1993, 34 patients received at least 2 cycles of VAD, 27 were submitted to PBSC collection, 22 received conditioning regimen plus PBSC and 16 of them are in the maintenance treatment with IFN. Considering 28 patients for an intention to treat evaluation (35 -7 in treatment), responding patients are 71% with 46% who achieved CR. White cells and platelets raised to > 1000/mmc and >50,000/mmc after a median period of 10 and 13 days, from CY, and 11 and 14 days from transplant, respectively. Two patients relapsed, 2 others died while in PR because of CMV epatitis and candida pneumonia. The median number of CD34+ cells and CFU-GM was 24.75 x 106/kg b.w. and 28.1 x 104/kg b.w. respectively. In conclusion this treatment seems to be feasible and with low toxicity, but a longer follow-up is needed to evaluate the progression free survival of the high proportion of responding patients that we observed.

The Biological Properties of OGI Surfaces Positively Act on Osteogenic and Angiogenic Commitment of Mesenchymal Stem Cells

Osteogenesis process displays a fundamental role during dental implant osteointegration. In the present work, we studied the influence of Osteon Growth Induction (OGI) surface properties on the angiogenic and osteogenic behaviors of Mesenchymal Stem cells (MSC). MSC derived from dental pulp and HUVEC (Human Umbilical Vein Endothelial Cells) were grown in on OGI titanium surfaces, and cell proliferation and DNA synthesis were evaluated by MTT [3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide] test and DNA quantification. Gene expression has been performed in order to evaluate the presence of mRNA related to endothelial and osteogenesis markers. Moreover, morphological and biochemical analyses of osteogenesis commitments has been performed. On OGI surfaces, MSC and HUVEC are able to proliferate. Gene expression profiler confirms that MSC on OGI surfaces are able to express endothelial and osteogenic markers, and that these expression are higher compared the expression on control surfaces. In conclusion On OGI surfaces proliferation, expression and morphological analyses of angiogenesis-associated markers in MSC are promoted. This process induces an increasing on their osteogenesis commitment.

Improvement of a Digital Impression with Conventional Materials: Overcoming Intraoral Scanner Limitations

Intraoral digital impression is a viable alternative to conventional impression techniques and has been proven to be even more accurate than conventional materials. Nevertheless, there are cases in which the rheologic properties of conventional materials can be helpful. This article describes a method to overcome an insufficient sulcus-depth reading of intraoral scanners in challenging cases.

Alveolar socket preservation with demineralised bovine bone mineral and a collagen matrix

PURPOSE

The aim of the present study was to evaluate the healing of post-extraction sockets following alveolar ridge preservation clinically, radiologically, and histologically.

METHODS

Overall, 7 extraction sockets in 7 patients were grafted with demineralised bovine bone mineral and covered with a porcine-derived non-crosslinked collagen matrix (CM). Soft tissue healing was clinically evaluated on the basis of a specific healing index. Horizontal and vertical ridge dimensional changes were assessed clinically and radiographically at baseline and 6 months after implant placement. For histological and histomorphometric analysis, bone biopsies were harvested from the augmented sites during implant surgery 6 months after the socket preservation procedure.

RESULTS

Clinically, healing proceeded uneventfully in all the sockets. A trend towards reduced horizontal and vertical socket dimensions was observed from baseline to the final examination. The mean width and height of resorption were 1.21 mm (P=0.005) and 0.46 mm (P=0.004), respectively. Histologically, residual xenograft particles (31.97%±3.52%) were surrounded by either newly formed bone (16.02%±7.06%) or connective tissue (50.67%±8.42%) without fibrous encapsulation. The CM underwent a physiological substitution process in favour of well-vascularised collagen-rich connective tissue.

CONCLUSIONS

Socket preservation using demineralised bovine bone mineral in combination with CM provided stable dimensional changes of the alveolar ridge associated with good re-epithelialisation of the soft tissues during a 6-month healing period.

High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT

The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85-1.59; P=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (P=0.26), and the 5-year OS 50% and 55% (P=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.

A novel technique to prevent the loss of graft material through the antrostomy after sinus surgery: technical note

Maxillary sinus surgery has been shown to be a reliable procedure for increasing vertical bone height prior to implant placement. A variety of grafting materials have been proposed, with particulate bone substitutes showing similar clinical results to autogenous bone when rough surfaces implants are used. A barrier membrane is usually placed external to the grafted sinus, covering the antrostomy. In this technical report, the membrane is placed over the window and its borders gently tucked between the inner side of the bony wall and the graft material. This procedure stabilizes the membrane without tacks and prevents graft dislodgement through the antrostomy.

Tilted trans-sinus implants for the treatment of maxillary atrophy: case series of 35 consecutive patients

PURPOSE

To evaluate tilted trans-sinus implants for rehabilitation of the atrophic maxilla.

MATERIALS AND METHODS

A case series of 35 patients (32 consecutive edentulous and 3 partially edentulous patients) treated with trans-sinus dental implants is presented. Edentulous patients received 4 or 6 implants depending on anatomic conditions and a 12-unit final restoration; partially edentulous patients received 2 implants supporting a 3-unit partial fixed bridge.

RESULTS

Thirty-five patients (14 men, 21 women) underwent rehabilitation. Thirty-two patients with 190 implants placed received a full-arch fixed prosthesis supported by axial and trans-sinus tilted implants. Three patients each received 2 implants with a 3-unit fixed restoration. The mean age at surgery was 59.2 ± 9.5 years. The cumulative survival rate was calculated only for the full-arch fixed prosthesis group and was 98.42%. Crestal bone loss averaged 0.9 ± 0.4 and 0.8 ± 0.5 mm for the axial and tilted implants, respectively, at the 12-month evaluation. Biological complications at the implant level were 1 case of peri-implantitis and 3 cases of mucositis; no patient developed sinus infections. The prosthetic complications encountered were screw loosening in 17.5% of cases and chipping of the esthetic part in 30% of cases. These complications were easily resolved chairside and did not lead to prosthetic failure.

CONCLUSIONS

Trans-sinus tilted implants and sinus membrane distal displacement appear to be a viable minimally invasive alternative for the treatment of maxillary atrophy.

Letter regarding a case report of severe bleeding after sinus floor elevation using the transcrestal approach published in EJOI in 2012

A case report of severe bleeding after sinus floor elevation using the transcrestal approach was published in EJOI in the third issue of 2012 by Dr Simon Storgård Jensen and coworkers1. EJOI has received a letter regarding this case report from Dr Federico Mandelli and Dr Tiziano Testori. EJOI has decided to publish this letter together with the answers from the authors as well as minor comments from the EJOI editors. It is our hope that the letter and the reply will provide readers with improved interpretation and understanding of the case report presented.

Sinus floor elevation with crestal approach and immediately loaded post-extraction implants

Alveolar ridges in the posterior maxilla are often compromised by reduced bone volume. This anatomic condition often limits dental implant placement, mostly because of limited vertical bone availability without prior or simultaneous sinus augmentation. When at least 5 mm of residual bone are present, osteotome techniques are used as a less invasive alternative to the lateral window approach to increase bone volume in the posterior posterior region of the maxillary jaw. Implants are generally placed simultaneously for four to six months after performing osteotome-mediated sinus floor elevation, depending upon the residual crestal bone remaining beneath the sinus floor. However, unlike common indications, in order to shorten the treatment period, this report aims to show a challenging case where, through a thorough surgical protocol, two compromised maxillary teeth were replaced by two immediately loaded post-extraction implants contextually to an osteotome-mediated sinus floor elevation.

Investigating factors associated with adherence behaviour in patients with chronic myeloid leukemia: an observational patient-centered outcome study

Background:

Optimal adherence to imatinib therapy is of paramount importance to maximise treatment effectiveness in patients with chronic myeloid leukaemia (CML). The main objective of this study was to investigate patient-reported personal factors associated with adherence behaviour.

Methods:

Analysis was conducted on 413 CML patients receiving long-term therapy with imatinib. Adherence behaviour was measured with the Morisky Medication Adherence Scale and personal factors investigated included: quality of life, perceived social support, fatigue, symptom burden, psychological wellbeing and desire for additional information. Key socio-demographic and treatment-related factors were also taken into account. Univariate and multivariate logistic regression analyses were used to investigate factors associated with optimal adherence to therapy.

Results:

In all, 53% of patients reported an optimal adherence behaviour. The final multivariate model retained the following variables as independent predictors of optimal adherence to therapy: desire for more information (ref. no), odds ratio (OR)=0.43 (95% confidence interval (CI), 0.29–0.66; P<0.001), social support (higher score representing greater support), OR=1.29 (95% CI, 1.11–1.49; P<0.001) and concomitant drug burden (ref. no), OR=1.82 (95% CI, 1.18–2.80; P=0.006).

Conclusion:

This study suggests that a higher level of social support, satisfaction with information received and concomitant drug burden are the main factors associated with greater adherence to long-term imatinib therapy.

Homecare-based Motor Rehabilitation in Musculoskeletal Chronic Graft Versus Host Disease

Chronic graft versus host disease (cGVHD) is a frequent complication of allogeneic stem cell transplantation. Extensive musculoskeletal and skin involvement may induce severe functional impairment, disability and quality of life deterioration. Physical rehabilitation is recommended as ancillary therapy in these forms, but experiences are sparse. A 39-year-old man affected by musculoskeletal and skin chronic graft versus host disease (cGVHD) was treated with a homecare-based motor rehabilitation program during palliation for disease progression. Significant functional improvement was obtained. Motor rehabilitation should be strongly considered for patients with musculoskeletal cGVHD, both in the palliative and in the curative phase of disease.

Use of interleukin-2 in the management of haematological malignancies: focus on minimal residual disease

Interleukin (IL)-2 is a glycoprotein lymphokine which induces proliferation of all subclasses of T-lymphocytes, natural killer cells and lymphokine activated killer cells, differentiation of cytotoxic cells and secretion of other cytokines, especially interferon-gamma. A fundamental property of IL-2 activated effector cells is to selectively lyse freshly isolated tumour cells. Work carried out on animal tumour models and application in human therapeutics has suggested the potential value of an immunotherapeutic approach in haematological malignancies, especially in the setting of minimal residual disease. Extensive phase I/II trials have been conducted in all haematological diseases, but the most interesting results have been obtained in acute myeloid leukaemia and non-Hodgkin's lymphoma, where the possibility of achieving partial and complete responses in patients with advanced disease has been reported. The feasibility and immunomodulatory effects of IL-2 treatment in patients with minimal residual disease after high-dose chemotherapy have also been explored. However, the heterogeneity of cases treated and administration schedules used does not allow definitive conclusions to be drawn about the true impact of IL-2 treatment on the prognosis of these patients. The clearly encouraging results reported in the literature deserve further investigation from a biological and clinical point of view; until the role of IL-2 in haematological malignancies has been identified, it should be used only in the investigative setting of clinical trials.

Alpha-2b recombinant interferon (Intron) in Hodgkin's lymphoma: therapeutic perspective

In an ongoing phase II study we are evaluating the role of alpha-2b recombinant interferon in Hodgkin's disease; the study design includes patients with high-risk parameters who are treated by combination chemotherapy MOPP, ABVD, MOPP + ABVD or equivalent combinations. At the end of the therapeutic program which could include also radiotherapy, patients will be randomly assigned to receive alpha-2b interferon at 3 MU/day over 3 months and then 3 MU/three times/week over 9 months or no further treatment. Up to September 1989, 107 patients were randomized; evaluable patients with a minimum follow-up of 3 months are 95, 56 in the arm of interferon and 39 in the arm of no further treatment. The results are preliminary and differences could not be disclosed between the two arms concerning either the relapse rate or the incidence of infections. Tolerance and toxicity due to alpha-2b interferon in patients with Hodgkin's disease could be defined as acceptably good considering that mild and reversible hematological toxicity was experienced in 12 (21%) patients; objective clinical toxicity was recorded in 4 (7%) patients although 7 (12%) patients refused to continue the treatment. Definite conclusions will be drawn when 100 patients per arm become evaluable.

Interferon alpha-2a in cutaneous T-cell lymphoma

23 newly diagnosed patients affected by cutaneous T-cell lymphoma were treated with sub-cutaneous interferon alpha-2a to evaluate the therapeutic efficacy and the toxicity of this agent. IFN was administered daily with dose escalation from 3 to 18 million units for 12 weeks; thereafter, patients induced into complete (CR) or partial (PR) remission were given IFN at maximal tolerated dose 3 times weekly for 6 or 9 months. The objective tumor response was observed in 17 patients (74%): 8 (35%) were CR and 9 (39%) were PR. A 74-yr-old patient died because of neutropenia and sepsis at the end of induction phase, while receiving IFN at dose of 18 million units. Disease stage is the initial feature predictive of response to IFN therapy. The dose schedule of this study was well tolerated: only 3 patients developed liver toxicity, while leukopenia was evident in 6 patients. Only 2 CR patients have relapsed, 18 and 24 months from response; the remaining 6 CR patients are in continuous complete remission with a median follow-up of 41.8 months. 6 PR patients have progressed from 8 to 17 months after response, and in the 3 PR patients not yet progressed the response duration ranges from 20 to 24 months. In conclusion, interferon alpha-2a is a very effective agent in therapy of untreated cutaneous T-cell lymphoma with an overall response rate of 74%.

Alpha-2b-interferon as single therapy for patients with chronic myeloid leukemia relapsing after T-cell depleted allogeneic bone marrow transplantation

20 CML patients with hematological (5 pts) or only cytogenetic (15 pts) relapse occurring after allogeneic BMT have been treated with alpha-2b-interferon (IFN) at a starting dose of 5 x 10(6) IU/m2, subcutaneously, three times a week. All 5 patients with hematological relapse achieved hematological remission without reduction of bone marrow Ph1-positive cells. With a median follow-up of 43 months (range 6-48) from the hematological relapse, 3 patients are alive and 2 patients died from non-lymphoid blast crisis. 7 out of 15 patients with only cytogenetic relapse remain in hematological remission at a median of 37 months (range 3-45) from cytogenetic relapse, with 2 patients achieving complete cytogenetic remission confirmed at the molecular level by disappearance of the bcr rearranged band. With a median follow-up of 21 months (range 6-46), 8 patients progressed from cytogenetic to hematological relapse: 4 patients died from blast crisis and the other 4 patients are currently alive in chronic phase. For the 15 patients, the actuarial survival from BMT is 71% at 5 years.

Chronic lymphocytic leukemia: studies on the effect of drug treatment on different lymphocytic subpopulations

In the present work the effect of drug treatment on different lymphocyte populations in chronic lymphocytic leukemia was studied. During therapy there was evidence of an increased number of cells unidentifiable by conventional surface markers, provisionally termed lymphocyte surface-marker-negative cells. In addition, evidence of increased numbers of T lymphocytes in untreated patients and further evidence of IgG chronic lymphocytic leukemia cells were obtained.

Evaluation of the effectiveness of DDAVP in surgery and in bleeding episodes in haemophilia and von Willebrand's disease. A study on 43 patients

1-deamino-8-D-arginine-vasopressin (DDAVP), was used in a wide spectrum of clinical situations employing two different dosages (0.3 and 0.4 microgram/kg b.w.) for the management of 43 patients with factor VIII deficiencies--mild and moderate haemophilia A and von Willebrand's disease (vWD). In most instances, the drug was given in association with antifibrinolytics. Twenty-five dental extractions were carried out with two different protocols: one based upon a single infusion and the other based upon three infusions. Bleeding occurred in three patients regardless of the protocol used. The vasopressin analogue promptly stopped bleeding in 12 'spontaneous' open bleeds (haematuria, epistaxis, menometrorrhagia, gum bleeding) and it appears to be also effective in closed bleeds. DDAVP was used to minimize blood loss during surgical interventions and to avoid haemorrhage in the postoperative period. Nine surgical procedures were carried out in six vWD patients and three haemophiliacs. Bleeding occurred late in the postoperative period on one occasion only. No difference was demonstrated between the two doses of the drug either in terms of clinical benefit or rise of factor VIII coagulant activity. The efficacy of DDAVP and the absence of side-effects make this vasopressin analogue worthy of consideration as a reliable alternative to factor VIII concentrates in a wide variety of clinical situations.

Occurrence of thrombotic events in acute promyelocytic leukemia correlates with consistent immunophenotypic and molecular features

Although the occurrence of thrombosis in acute promyelocytic leukemia (APL) has been reported during retinoic acid treatment, no studies carried out in large clinical cohorts have specifically addressed this issue. We analyzed 124 APL patients treated with the all-trans retinoic acid and idarubicin protocol and compared clinico-biologic characteristics of 11 patients who developed thrombosis with those of 113 patients who had no thrombosis. In seven patients, the events were recorded during induction, whereas in four patients deep vein thrombosis occurred in the post-induction phase. Comparison of clinico-biological characteristics of patients with and without thrombosis revealed in the former group higher median white blood cell (WBC) count (17 x 10(9)/l, range 1.2-56, P=0.002), prevalence of the bcr3 transcript type (72 vs 48%, P=0.01), of FLT3-ITD (64 vs 28%, P=0.02), CD2 (P=0.0001) and CD15 (P=0.01) expression. No correlation was found with sex, age, French-American-British subtype, all-trans-retinoic acid syndrome or with thrombophilic state that was investigated in 5/11 patients. Our findings suggest that, in APL patients consistent biologic features of leukemia cells may predict increased risk of developing thrombosis.

Non-infusional vs intravenous consolidation chemotherapy in elderly patients with acute myeloid leukemia: final results of the EORTC-GIMEMA AML-13 randomized phase III trial

In this trial, acute myeloid leukemia patients (pts) aged 61-80 years received MICE (mitoxantrone, etoposide and cytarabine) induction chemotherapy in combination with different schedules of granulocyte colony-stimulating factor administration. Pts in complete remission were subsequently randomized for two cycles of consolidation therapy: mini-ICE regimen (idarubicin, etoposide and cytarabine) given according to either an intravenous (i.v.) or a 'non-infusional' schedule. Among the 346 pts randomized for the second step, 331 pts received consolidation-1 and 182 consolidation-2. A total of 290 events (255 relapses, 35 deaths in first CR) have been reported. The median follow-up was 4.4 years. No significant differences were detected in terms of disease-free survival (median 9 vs 10.4 months, P=0.15, hazard ratio (HR) =1.18, 95% confidence interval (CI) 0.94-1.49) - primary end point - and survival (median 15.7 vs 17.8 months, P=0.19, HR=1.17, 95% CI 0.92-1.50). In the 'non-infusional' arm grade 3-4 vomiting (10 vs 2%; P=0.001) and diarrhea (10 vs 4%; P=0.03) were higher than in the 'i.v.' arm, whereas time to platelet recovery >20 x 10(9)/l (median: 19 vs 23 days; P=0.02) and duration of hospitalization (mean: 15 vs 27 days; P<0.0001) was shorter. The 'non-infusional' consolidation regimen resulted in an antileukemic effect similar to the intravenous regimen, which was less myelosuppressive and associated with less hospitalization days.