Regenerative endodontic treatment of an immature incisor tooth with a novel platelet-rich product: A five-year follow-up case report

This case report presents a five-year follow-up and the management of a necrotic, immature incisor tooth treated by a novel platelet-rich plasma/platelet extract solution and platelet-rich fibrin (PRP-PES/PRF) and the restoration by using a stress-reduced direct composite restoration (SRDC) technique. The patient with a broken maxillary lateral tooth was referred to our clinic. Extra/intra-oral examinations were within normal limits. The nonvital tooth having an apical lesion and open-apical apex was treated with a regenerative endodontic treatment procedure (REP), and further root development with continued apical closure was shown in the follow-ups up to 60 months. In conclusion, the SRDC and PRP-PES/PRF combination can be an opportunity for the teeth requiring post-restoration. In contrast to the treatment strategy susceptible to weakening or fracturing the patient's tooth root, the REP approach may lead to a better prognosis for the patient's tooth.

Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review

Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a progressive alteration of the motor and non-motor function. PD influences the patient's daily living and reduces participation and quality of life in all phases of the disease. Early physical exercise can mitigate the effects of symptoms but access to specialist care is difficult. With current technological progress, telemedicine, and telerehabilitation is now a viable option for managing patients, although few studies have investigated the use of telerehabilitation in PD. In this systematic review, was investigated whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed. The usage of telerehabilitation technologies in the management of cognitive impairment was not addressed.

Method: An electronic database search was performed using the following databases: PubMed/MEDLINE, COCHRANE Library, PEDro, and SCOPUS for data published between January 2005 and December 2019 on the effects of telerehabilitation systems in managing motor and non-motor symptoms. This systematic review was conducted in accordance with the PRISMA guideline and was registered in the PROSPERO database (CRD42020141300).

Results: A total of 15 articles involving 421 patients affected by PD were analyzed. The articles were divided into two categories based on their topic of interest or outcome. The first category consisted of the effects of telerehabilitation on gait and balance (3), dexterity of the upper limbs (3), and bradykinesia (0); the second category regarded non-motor symptoms such as speech disorders (8) and dysphagia (0). Quality of life (7) and patient satisfaction (8) following telerehabilitation programs were also analyzed, as well as feasibility and costs.

Conclusion: Telerehabilitation is feasible in people affected by PD. Our analysis of the available data highlighted that telerehabilitation systems are effective in maintaining and/or improving some clinical and non-clinical aspects of PD (balance and gait, speech and voice, quality of life, patient satisfaction).

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020141300.

The severity of acute exacerbations of COPD and the effectiveness of pulmonary rehabilitation

BACKGROUND AND AIM

Pulmonary rehabilitation is effective also in patients recovering from acute exacerbations of COPD (AECOPD). We aimed to evaluate whether levels of dyspnoea affect the outcome of pulmonary rehabilitation in patients recovering from AECOPD requiring different levels of care.

MATERIALS AND METHODS

Retrospective data analysis of 1057 patients recovering from AECOPD requiring either hospital (Hospital group: 291) or home management (Home group: 766), undergone post AECOPD in-patient pulmonary rehabilitation. The 6-min walking distance (6MWD) test was the primary outcome, stratified by the Barthel index Dyspnoea (Bid). Data of modified Medical Research Council scale, Short Physical Performance Battery, COPD Assessment Test were also analysed, when available.

RESULTS

In overall population 6MWD improved significantly from 278 (129) to 335 (139) meters (p < 0.001). As compared to Home, 6MWD improved more in Hospital group [by 81.9 (79.6) vs 48.9 (94.4) meters respectively, p < 0.001] also when stratified by Bid levels (all: p < 0.01). In Hospital group, 6MWD improved significantly more in patients with Bid level 3 than levels 4 and 5 (p < 0.05). Hospital group showed a greater proportion of patients reaching the Minimal Clinically Important Difference for 6MWD (75.9 vs 56.7% in Hospital and Home group respectively p < 0.001). All other available outcome measures significantly (p < 0.01) improved independent of the Bid levels. There was no significant correlation between baseline severity of airflow obstruction and effect of the program.

CONCLUSIONS

In-patient pulmonary rehabilitation results in clinically meaningful improvement in patients recovering from AECOPD, independent of severity of dyspnoea. However, the levels of dyspnoea severity and the care required by AECOPD influenced the magnitude of success.

[Death certification of pleural malignant mesothelioma from the Italian National Institute of Statistics: a comparison on 269 clinical diagnosis confirmed at autopsy (1997-2016)]

OBJECTIVES

To evaluate the agreement between pleural malignant mesothelioma diagnosis in life, with diagnoses confirmed at autopsy, and the certification of the cause of death in the form of the Italian National Institute of Statistics (Istat).

DESIGN

comparison between autopsic cases and cases from Istat.

SETTING AND PARTICIPANTS

two series of autopsy diagnoses of pleural malignant mesothelioma placed from 1997 to 2016; 185 in shipyard workers and 90 in Brescia province inhabitants, for whom the Istat death form was acquired for 180 and 89 subjects, respectively.

RESULTS

the general agreement between pleural malignant mesothelioma clinical diagnosis in life and death certification was about 91% for the first group and 92% for the second one. In the first group, the age at diagnosis does not affect the accuracy of the death certification, which instead increased over time to become total in the period 2010-2016.

CONCLUSIONS

the study suggests that the agreement between pleural malignant mesothelioma clinical diagnosis and certification of the cause of death appears to be very high.

Pulmonary Rehabilitation in Patients Recovering from COVID-19

BACKGROUND

In hospitalized patients recovering from the SARS-coronavirus-2 disease 19 (COVID-19), high prevalence of muscle weakness and physical performance impairment has been observed.

OBJECTIVES

The aim of this study was to evaluate the effectiveness of pulmonary rehabilitation in these subjects in a real-life setting.

METHODS

Retrospective data analysis of patients recovering from COVID-19, including those requiring assisted ventilation or oxygen therapy, consecutively admitted to an in-patient pulmonary rehabilitation program between April 1 and August 15, 2020. Short Physical Performance Battery (SPPB: primary outcome), Barthel Index (BI), and six-min walking distance were assessed as outcome measures.

RESULTS

Data of 140 patients were analyzed. After rehabilitation, patients showed improvements in SPPB {from: (median [IQR]) 0.5 (0-7) to 7 (4-10), p < 0.001} and BI (from 55 [30-90] to 95 [65-100], p < 0.001), as well as in other assessed outcome measures. The proportion of patients unable at admission to stand, rise from a chair and walk was significantly reduced (p < 0.00).

CONCLUSIONS

Pulmonary rehabilitation is possible and effective in patients recovering from COVID-19. Our findings may be useful to guide clinicians taking care of patients surviving COVID-19 infection.

Airway Clearance Techniques: The Right Choice for the Right Patient

The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. Cough Assist, Vacuum Techniques, systems that modulate airflow have more and more scientific evidence. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us.

Relationship between preterm birth and developmental defects of enamel: A systematic review and meta-analysis

BACKGROUND

A putative relationship between preterm birth and developmental defects of enamel (DDE) has been described in the literature. Although systematic reviews have found preterm birth may lead to DDE, the effect size has not been quantified.

AIM

The aim of this systematic review and meta-analysis was to determine the association between preterm birth and DDE.

DESIGN

An electronic search was performed in PubMed, Cochrane Library, Scopus, and Web of Science to identify relevant studies. Two independent reviewers selected the studies in a two-stage process in accordance with the PRISMA statement. The risk of bias was also analysed using the Newcastle-Ottawa Scale criteria.

RESULTS

A total of 1041 publications were considered after an electronic search, 20 of which were included in the systematic review. Of these 20 publications, 18 articles were included in a meta-analysis. The meta-analysis detected an increased risk of developing DDE in preterm children [OR: 3.27 (95% CI 2.02, 5.30; P < .001)], with a greater risk in the primary dentition. In addition to this, a subgroup analysis showed a greater risk in the development of hypoplasia in preterm children.

CONCLUSIONS

The results of this meta-analysis showed a three times increased risk of developing DDE in preterm children.

High-Flow Oxygen Therapy During Exercise Training in Patients With Chronic Obstructive Pulmonary Disease and Chronic Hypoxemia: A Multicenter Randomized Controlled Trial

OBJECTIVE

The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD).

METHODS

A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated.

RESULTS

Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = -18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively.

CONCLUSION

In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity.

IMPACT STATEMENT

The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance.

Factors influencing the recurrence of keratocysts: monocentric study

Introduction: The purpose of the study was to retrospectively analyse the recurrence rate of odontogenic keratocysts and to identify eventual features of the lesions that may influence recurrence. Material and methods: This was a retrospective study carried out for a period of 3 years. The medical records of patients treated in our institution were analysed to identify all the cases of odontogenic keratocysts. Results: A total of 16 odontogenic keratocysts were recorded. These lesions were treated with simple enucleation with or without adjuvant Carnoy's solution. The relapse occurred in 4 patients treated with simple enucleation and in none of the patients that underwent enucleation and Carnoy's solution application. The kind of treatment appeared not to influence recurrence rate at statistical analysis. Conclusions: Odontogenic keratocyst is a lesion with a locally aggressive behavior and a high tendency to relapse. This tendency of recurrence may be greater with syndromic presentation of odontogenic keratocyst, with soft tissue involvement, and with teeth proximity to the lesion. The application of Carnoy's solution may be useful to minimize recurrence rate in those odontogenic keratocysts with an aggressive clinical behavior and secondly may be used for all the other lesions treated with simple enucleation that experienced relapse.

A pilot study on the non-invasive management of tracheobronchial secretions in tracheostomised patients

INTRODUCTION/OBJECTIVES

The aim of our study was to assess the safety, efficacy and feasibility of an Expiratory Flow Accelerator (EFA) device, Free Aspire, in reducing the need for daily suctions in tracheostomised (TCS) patients.

METHODS

Twenty-five patients (13 males, 12 females, aged 69.88 ± 9.06 years) were investigated. The number of superficial/deep suctions, shallows, arterial blood gas (ABG) analysis, perception of mucus encumbrance (Visual Numeric Scale, VNS) and adverse event were recorded for five days. On the first two days (T1-T2), suctioning was performed as usual, on the following three days (T3, T4, T5), patients were treated also with Free Aspire (20 min, 3 times a day).

RESULTS/CONCLUSION

The use of the non-invasive device was associated with a decrease of total number of aspirations from T2 to T5 (8.48 ± 2.62 vs 4.48 ± 3.08, P = 0.0003). Total number of daily aspirations decreased over the five days (8.68 ± 3.64 vs 4.48 ± 3.08, P = 0.0009). Deep aspirations decreased from T1 to T5 (6.16 ± 3.53 vs 1.80 ± 1.50, P = 0.0001). ABG data confirmed that no significant side effects occurred. VNS score decreased from 7.03 ± 1.42 at T1 to 4.05 ± 1.80 at T5 (P < 0.0001). These data suggest that EFA may be useful for managing secretions in TCS patients, as it can reduce the number of daily suctions, particularly the deep ones, and may improve the perception of mucus encumbrance, without side effects. More studies are needed to confirm these data and to understand in which categories of TCS patients this device can be introduced.

Is Two Better Than One? The Impact of Doubling Training Volume in Severe COPD: A Randomized Controlled Study

Patients with severe chronic obstructive pulmonary disease (COPD) are unable to exercise at high intensities for sufficiently long periods of time to obtain true physiological training effects. It therefore appears sensible to increase training duration at sub-maximal exercise intensities to optimize the benefit of exercise training. We compared the effects on exercise tolerance of two endurance cycloergometer submaximal exercise protocols with different cumulative training loads (one (G1) versus two (G2) daily 40 min training sessions) both implemented over 20 consecutive days in 149 patients with COPD (forced expiratory volume at first second (FEV₁): 39% predicted) admitted to an inpatient pulmonary rehabilitation program. Patients in G2 exhibited greater improvement (p = 0.011) in submaximal endurance time (from 258 (197) to 741 (662) sec) compared to G1 (from 303 (237) to 530 (555) sec). Clinically meaningful improvements in health-related quality of life, 6MWT, and chronic dyspnea were not different between groups. Doubling the volume of endurance training is feasible and can lead to an additional benefit on exercise tolerance. Future studies may investigate the applicability and benefits of this training strategy in the outpatient or community-based pulmonary rehabilitation settings to amplify the benefits of exercise interventions.

Low-grade intraductal carcinoma of salivary glands: A systematic review of this rare entity

Background

Low-grade intraductal carcinomas are rare, malign tumors of salivary glands most commonly affecting parotid gland. It is a slow-growing tumor considered with a favourable prognosis after surgical excision.

Methods

To define the characteristics and management of low-grade intraductal carcinoma a systematic review was performed using the electronic databases Pubmed, Cochrane and Scopus. A new case report was also described.

Results

Including this case the review of literature identified only 54 cases reported thus far. Demographics, clinical presentation, diagnostic tools, treatment, follow-up and recurrence rate, histological and immunohistochemical patterns of this kind of tumor were summarized.

Conclusion

Low-grade intraductal carcinoma has already been well defined but is important to focus on the fact that in few cases component of high-grade infiltrations have been reported: this may modify surgical approach because a simple tumorectomy may not be enough.

Health effects among a cohort exposed to low-level arsenic in a geothermal area of Tuscany, Italy

BACKGROUND

Studies on low-level As exposure have not found an association with cancer, while increased risks were reported for skin lesions, respiratory and cardiovascular diseases and reproductive outcomes. Prospective observational studies with individual exposure measures are needed to study low-level As exposure effects. In a geothermal area in Southern Tuscany (Italy), characterized by a natural presence of As in drinking water (< 50 µg/l), As urinary concentrations were measured in a survey in 1998 and cohort members were followed to evaluate the effects on health.

METHODS

Around 900 subjects (20-55 years old) randomly sampled in 4 municipalities of the area (Monte Amiata), have been followed from 1999 to 2015, by hospitalisation and mortality registries. Standardized Hospitalisation Ratios (SHRs) were performed, compared to a reference area. Competing-risks regression models were performed to test the association between As urinary concentration and risk of first hospitalisation.

RESULTS

SHRs show various increased risks, more frequently among males. Internal analyses show a positive association between As and skin diseases in the general population, the Hazard Ratio (HR) for 1 µg/l increase of As urinary concentration is 1.06 (90%CI 1.01-1.11) and in males, HR 1.08 (90%CI 1.02-1.14), between As and circulatory system diseases in males, HR 1.03 (90%CI 1.01-1.05).

CONCLUSIONS

The results suggest an effect on skin diseases and circulatory system diseases and, considering the relative young age of cohort members, they could be considered also as predictive of future severer diseases.

Malignant Mesothelioma in Rome and Latium Region, 1993-2001

Aims and background

Epidemiological studies on malignant mesothelioma have provided evidence on the etiologic role of occupational asbestos exposure and, to some extent, domestic and residential exposures. Less attention has been given to the occurrence of mesothelioma in urban areas where large quantities of asbestos have been employed in the past. The purpose of the study was to investigate the occurrence of mesothelioma in patients living in the urban area of Rome and in other parts of the Latium Region and the patterns of asbestos exposure.

Methods and study design

A pathology-based, malignant mesothelioma archive operating in Rome, Italy, was the source of cases. Included in the survey were cases resident in Latium and diagnosed in the period January 1, 1993, through December 31, 2001. Information on asbestos exposure was derived from interviews to the patient or his/her next of kin and from available medical records.

Results

The case series included: 114 males and 53 females; total, 167. Information on asbestos exposure was available for 138 cases (83%). Occupational exposure was ascertained or suspected for 33% of cases resident in Rome and 63% of those resident in other municipalities of Latium. Sex ratio was 1.6 in Rome and 3.3 in Latium.

Conclusions

The high prevalence of women among mesothelioma cases and lower proportion of occupational exposure in Rome versus the other municipalities of Latium suggest a possible role of environmental asbestos exposure in the urban area.

Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis

Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban; DOACs) have been introduced to improve safety and superior therapeutic value compared to their predecessors such as warfarin or enoxaparin. The aim of this systematic review and meta-analysis was to assess the postoperative bleeding risk of DOACs during oral surgery procedures. Systematic searches were performed in electronic databases including PubMed, Scopus, Web of Science and Cochrane Library. Thirteen studies were included in the qualitative synthesis: two retrospective case-control studies, five prospective case-control studies, three cross-sectional studies, two case series and a case report; while only six studies were statistically analysed. The risk ratio of postoperative bleeding in DOACs patients was significantly greater than in healthy patients (3.04; 95% confidence interval (CI)=1.31-7.04). This is especially true for rivaroxaban (4.13; 95% CI=1.25-13.69), and less so for dabigatran which presented a risk ratio similar to that of healthy patients (1.00; 95% CI=0.21-4.82). However, further research is required to support these results. Both apixaban and edoxaban were excluded from statistical analysis due to the lack of clinical studies.

[Very late but too early... prof. Angelo Chiavaro and the Italian degree in dentistry]

The birth of the Degree in Dentistry in Italy has been very troubled, and only in 1980 saw its effective implementation. Very "instructive" in this regard is the history on the establishment in 1924 (the period of the seizure of power by Fascism) of a "National School of Dentistry" at the University of Rome, which was withdrawn after only ten months. The biggest supporter and proponent of the School, Prof. Angelo Chiavaro, after a few years, was "punished" with the transfer from the University of Rome to that of Genoa. We present some brief notes on the biography of this courageous pioneer and the matter of which he was the protagonist.

National funding for mental health research in Finland, France, Spain and the United Kingdom

As part of the Roamer project, we aimed at revealing the share of health research budgets dedicated to mental health, as well as on the amounts allocated to such research for four European countries. Finland, France, Spain and the United Kingdom national public and non-profit funding allocated to mental health research in 2011 were investigated using, when possible, bottom-up approaches. Specifics of the data collection varied from country to country. The total amount of public and private not for profit mental health research funding for Finland, France, Spain and the UK was €10·2, €84·8, €16·8, and €127·6 million, respectively. Charities accounted for a quarter of the funding in the UK and less than six per cent elsewhere. The share of health research dedicated to mental health ranged from 4·0% in the UK to 9·7% in Finland. When compared to the DALY attributable to mental disorders, Spain, France, Finland, and the UK invested respectively €12·5, €31·2, €39·5, and €48·7 per DALY. Among these European countries, there is an important gap between the level of mental health research funding and the economic and epidemiologic burden of mental disorders.

The steroid response to human chorionic gonadotropin (hCG) stimulation in men with Klinefelter syndrome does not change using immunoassay or mass spectrometry

PURPOSE

Liquid-chromatography tandem mass-spectrometry (LC-MS/MS) was developed in parallel to Immunoassays (IAs) and today is proposed as the "gold standard" for steroid assays. Leydig cells of men with Klinefelter syndrome (KS) are able to respond to human chorionic gonadotropin (hCG) stimulation, even if testosterone (T) production was impaired. The aim was to evaluate how results obtained by IAs and LC-MS/MS can differently impact on the outcome of a clinical research on gonadal steroidogenesis after hCG stimulation.

METHODS

A longitudinal, prospective, case-control clinical trial. (clinicaltrial.gov NCT02788136) was carried out, enrolling KS men and healthy age-matched controls, stimulated by hCG administration. Serum steroids were evaluated at baseline and for 5 days after intramuscular injection of 5000 IU hCG using both IAs and LC-MS/MS.

RESULTS

13 KS patients (36 ± 9 years) not receiving T replacement therapy and 14 controls (32 ± 8 years) were enrolled. T, progesterone, cortisol, 17-hydroxy-progesterone (17OHP) and androstenedione, were significantly higher using IAs than LC-MS/MS. IAs and LC-MS/MS showed direct correlation for all five steroids, although the constant overestimation detected by IAs. Either methodology found the same 17OHP and T increasing profile after hCG stimulation, with equal areas under the curves (AUCs).

CONCLUSIONS

Although a linearity between IA and LC-MS/MS is demonstrated, LC-MS/MS is more sensitive and accurate, whereas IA shows a constant overestimation of sex steroid levels. This result suggests the need of reference intervals built on the specific assay. This fundamental difference between these two methodologies opens a deep reconsideration of what is needed to improve the accuracy of steroid hormone assays.

Ultrastructural Correlates of in vivo/in vitro Bond Degradation in Self-etch Adhesives

The morphologic correlates of bond degradation in self-etching primers have not been fully elucidated. We hypothesized that there is no difference between the mechanism of degradation of self-etching primers in vivo and in vitro. Class I cavities prepared in vivo in 24 caries-free human molars were bonded with Clearfil SE Bond or Clearfil Protect Bond, and restored with resin composites. Eight teeth were extracted after 24 hrs, and the rest after 1 yr. The same protocol was repeated in vitro with extracted molars. Degradation of resin-dentin bonds was assessed by microtensile bond testing and TEM of interfaces after tracer immersion. Both in vivo and in vitro bond strengths decreased with time for SE Bond but not for Protect Bond, with more pronounced water treeing observed in the former adhesive under both aging conditions. There is no difference between the mechanism of degradation of self-etch adhesives in vivo or in vitro.

Development of a Barthel Index based on dyspnea for patients with respiratory diseases

Background

As Barthel Index (BI) quantifies motor impairment but not breathlessness, the use of only this index could underestimate disability in chronic respiratory disease (CRD). To our knowledge, no study evaluates both motor and respiratory disability in CRD during activities of daily living (ADLs) simultaneously and with a unique tool. The objective of this study was to propose for patients with CRD an additional tool for dyspnea assessment during ADLs based on BI items named Barthel Index dyspnea.

Methods

Comprehensibility, reliability, internal consistency, validity, responsiveness, and ability to differentiate between disease groups were assessed on 219 subjects through an observational study performed in an in-hospital rehabilitation setting.

Results

Good comprehensibility, high reliability (interrater intraclass correlation coefficient was 0.93 [95% confidence interval 0.892–0.964] and test–retest intraclass correlation coefficient was 0.99 [95% confidence interval 0.983–0.994]), good internal consistency (Cronbach’s alpha 0.89), strong concurrent validity with 6 minute walking distance (Pearson r=−0.538, P<0.001) and Medical Research Council (Spearman r_S=0.70, P<0.001), good responsiveness after rehabilitation (P<0.001), and good appropriateness of the index were found evidencing patients with different dyspnea severity. Divergent validity showed weak correlation (Pearson r=−0.38) comparing Barthel Index dyspnea and BI.

Conclusion

The BI based on dyspnea perception proved to be reliable, sensitive, and adequate as a tool for measuring the level of dyspnea perceived in performing basic daily living activities. A unique instrument simultaneously administered may provide a global assessment of disability during ADLs incorporating both motor and respiratory aspects.

Human chorionic gonadotropin stimulation gives evidence of differences in testicular steroidogenesis in Klinefelter syndrome, as assessed by liquid chromatography-tandem mass spectrometry

BACKGROUND

Men with Klinefelter syndrome (KS) show hypergonadotropic hypogonadism, but the pathogenesis of hypotestosteronemia remains unclear. Testicular steroidogenesis in KS men was evaluated over three decades ago after human chorionic gonadotropin (hCG) stimulation, but inconclusive results were obtained. Intriguingly, some recent studies show increased intratesticular testosterone concentrations in men with KS.

OBJECTIVE

To analyze serum steroid profile, as a proxy of testicular steroidogenesis, after hCG stimulation in KS compared with control men.

DESIGN

A prospective, longitudinal, case-control, clinical trial.

METHODS

Thirteen KS patients (36±9 years) not receiving testosterone (TS) replacement therapy and 12 eugonadic controls (32±8 years) were enrolled. Serum steroids were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) at baseline and for five consecutive days after intramuscular injection of 5000IU hCG.

RESULTS

Progesterone (P), 17-hydroxyprogesterone (17OHP), TS, and estradiol (E2) showed a significant increase (P<0.001) after hCG stimulation in both groups. On the contrary, androstenedione (AS) and dehydroepiandrosterone did not increase after hCG stimulation. The 17OHP/P ratio increased in both groups (P<0.001), the TS/AS ratio (17β-hydroxysteroid dehydrogenase type 3 (17βHSD3) activity) did not increase after hCG in any group, and the E2/TS ratio (aromatase activity) increased significantly in both groups (P=0.009 in KS and P<0.001 in controls). Luteinizing hormone decreased after hCG in both groups (P=0.014 in KS and P<0.001 in controls), whereas follicle-stimulating hormone decreased only in control men (P<0.001).

CONCLUSION

This study demonstrates for the first time using LC-MS/MS that Leydig cells of KS men are able to respond to hCG stimulation and that the first steps of steroidogenesis are fully functional. However, the TS production in KS men is impaired, possibly related to reduced hydroxysteroid deydrogenase activity due to an unfavorable intratesticular metabolic state.

Density functional theory for chiral nematic liquid crystals

Even though chiral nematic phases were the first liquid crystals experimentally observed more than a century ago, the origin of the thermodynamic stability of cholesteric states is still unclear. In this Rapid Communication we address the problem by means of a density functional theory for the equilibrium pitch of chiral particles. When applied to right-handed hard helices, our theory predicts an entropy-driven cholesteric phase, which can be either right or left handed, depending not only on the particle shape but also on the thermodynamic state. We explain the origin of the chiral ordering as an interplay between local nematic alignment and excluded-volume differences between left- and right-handed particle pairs.

Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease

PURPOSE

The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus.

METHODS

Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of intergluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences.

RESULTS

A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 +/- 4.7 months and average length of follow-up was 29.4 +/- 3.6 months. Average length of hospital stay was 4.2 +/- 0.8 days, and time to return to work was 16.3 +/- 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence.

CONCLUSION

Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons

AIM

The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty.

SUBJECTS AND METHODS

Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist-90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/CV, SCID-II).

RESULTS

Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality.

CONCLUSION

Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

Depletion-induced biaxial nematic states of boardlike particles

With the aim of investigating the stability conditions of biaxial nematic liquid crystals, we study the effect of adding a non-adsorbing ideal depletant on the phase behavior of colloidal hard boardlike particles. We take into account the presence of the depletant by introducing an effective depletion attraction between a pair of boardlike particles. At fixed depletant fugacity, the stable liquid-crystal phase is determined through a mean-field theory with restricted orientations. Interestingly, we predict that for slightly elongated boardlike particles a critical depletant density exists, where the system undergoes a direct transition from an isotropic liquid to a biaxial nematic phase. As a consequence, by tuning the depletant density, an easy experimental control parameter, one can stabilize states of high biaxial nematic order even when these states are unstable for pure systems of boardlike particles.

Psychopathological evaluation of patients requesting cosmetic rhinoplasty: a review

OBJECTIVE

The goal of this review is to discuss possible underlying psychopathological situations in patients requesting surgical cosmetic rhinoplasty operation and to examine potential problems that might arise.

SUBJECTS AND METHODS

An extensive search was conducted through PubMed, Ambase and Psychlnfo by using related keywords in English, like "rhinoplasty and psychiatric comorbidities", "rhinoplasty and psychopathology".

RESULTS

Patients who demand cosmetic rhinoplasty operation appealed to the surgeon since they wanted to feel better about themselves after the surgery. Indeed, some long-term studies determined that such a situation can take place at high rates. However, some studies reported the possibility of serious psychological disorders after such surgical operations. Studies relating to the analysis of psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD).

CONCLUSIONS

Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.

The plasticity of adolescent cognitions: data from a novel cognitive bias modification training task

Many adult anxiety problems emerge in adolescence. Investigating how adolescent anxiety arises and abates is critical for understanding and preventing adult psychiatric problems. Drawing threat interpretations from ambiguous material is linked to adolescent anxiety but little research has clarified the causal nature of this relationship. Work in adults using Cognitive Bias Modification of Interpretations (CBM-I) training show that manipulating negative interpretational style alters negative affect. Conversely, 'boosting' positive interpretations improves affect. Here, we extend CBM-I investigations to adolescents. Thirty-nine adolescents (13-18 years), varying in trait anxiety and self-efficacy, were randomly allocated to receive positive or negative training. Training-congruent differences emerged for subsequent interpretation style. Induced negative biases predicted a decline in positive affect in low self-efficacious adolescents only. Tentatively, our data suggest that cognitive biases predict adolescent affective symptoms in vulnerable individuals. The acquisition of positive cognitions through training has implications for prevention.

Residential proximity to industrial sites in the area of Taranto (Southern Italy). A case-control cancer incidence study

The association between cancer incidence and the residence near polluting facilities in an industrial area nearby Taranto has been investigated. Age, sex and occupational exposure were controlled as confounding variables in a case-control study (658 cases, 2092 controls). High risks were evidenced close to the steel mill (OR: 3.54), coke plant (OR: 4.80), mineral deposit (OR: 3.33) and shipbuilding (OR: 4.29) for pleural neoplasm, and to the steel mill (OR: 1.65) and shipbuilding (OR: 1.79) for lung cancer. After adjustment for occupational exposure, increasing trends of risk were observed both for lung and bladder cancers. Cancer risks were evidenced near industrial sites and the introduction of "occupational exposure" as a confounder modified significantly the risks with respect to distance from the source of pollution, particularly for pleural, lung and bladder cancers.

Polydispersity stabilizes biaxial nematic liquid crystals

Inspired by the observations of a remarkably stable biaxial nematic phase [van den Pol et al., Phys. Rev. Lett. 103, 258301 (2009)], we investigate the effect of size polydispersity on the phase behavior of a suspension of boardlike particles. By means of Onsager theory within the restricted orientation (Zwanzig) model we show that polydispersity induces a novel topology in the phase diagram, with two Landau tetracritical points in between which oblate uniaxial nematic order is favored over the expected prolate order. Additionally, this phenomenon causes the opening of a huge stable biaxiality regime in between uniaxial nematic and smectic states.

Monoblocks in root canals: a finite elemental stress analysis study

AIM

To investigate using finite element stress analysis (FEA) primary, secondary and tertiary monoblocks created either by adhesive resin sealers or by different adhesive posts and to evaluate the effect of interfaces on stress distribution in incisor models.

METHODOLOGY

Seven maxillary incisor FEA models representing different monoblocks using several materials were created as follows: (a) primary monoblock with Mineral Trioxide Aggregate; (b) secondary monoblock with sealer (MetaSEAL) and Resilon; (c) tertiary monoblock with EndoREZ; (d) primary monoblock with polyethylene fibre post-core (Ribbond); (e) secondary monoblock with glass-fibre post and resin cement; (f) tertiary monoblock with bondable glass-fibre post; (g) tertiary monoblock with silane-coated ceramic post. A 300 N load was applied from the palatal surface of the crown with a 135° angle to the tooth long axis. Materials used in the study were assumed to be homogenous and isotropic except the glass-fibre post; the results are expressed in terms of von Mises criteria.

RESULTS

Maximum stresses were concentrated on force application areas (18-22.1 MPa). The stresses within the models increased with the number of interfaces both for the monoblocks created by the sealers (1.67-8.33 MPa) and for the monoblocks created by post-core systems (1.67-11.7 MPa).

CONCLUSIONS

Stresses within roots increased with an increase in the number of the adhesive interfaces. Creation of a primary monoblock within the root canal either by an endodontic sealer or with an adhesive post-core system can reduce the stresses that occur inside the tooth structure.

Influence of several fibre-reinforced composite restoration techniques on cusp movement and fracture strength of molar teeth

AIM

To compare mean cusp movement in molar teeth with endodontic access and mesial-occlusal-distal (MOD) cavities before and after restoration with several fibre-reinforced composite restoration techniques under loading and to evaluate the effect of restoration technique on fracture strength.

METHODOLOGY

Reference points were marked at the mesial cusp ridges of extracted human mandibular molar teeth. Digital images were taken under loading (300 N) using a stereomicroscope (Leica MZ16A; Wetzlar, Germany). Three-dimensional (3D) distances between the reference points were recorded (Leica, Stereo-Explorer, 2.1) as controls. Standard MOD cavities were prepared and restored as follows (n = 10), group 1: composite restoration (Clearfil AP-X; Kuraray, Tokyo, Japan); group 2: cavity lined with polyethylene fibre (Ribbond, Ribbond Inc., Seattle, WA, USA) in combination with flowable resin (Protect-Liner F; Kuraray, Tokyo, Japan) before composite restoration; group 3: polyethylene fibre inserted on occlusal surface of the tooth from buccal to lingual after finishing the composite restoration; group 4: missing walls were restored with composite resin and inner surfaces of the axial walls were then reinforced with polyethylene fibre placed circumferentially before the composite restoration. The restored teeth were re-loaded, digital images were re-taken and the 3D distance between the reference points was recorded in μm. Comparisons of the restoration techniques, the effectiveness of restoration for each group were analysed statistically (Kruskall-Wallis, paired-samples t-test). The teeth were then loaded until failure (5 mm min(-1) ), the data were recorded (N) and analysed statistically (Kruskall-Wallis test).

RESULTS

A significant difference occurred amongst the groups in terms of cusp movement (P = 0.018). All the groups revealed a decrease in inter-cuspal width when compared to their initial records. The mean values of these decreases were as follows: group 1 17.6 (P = 0.003), group 2 6.7 (not sig), group 3 6.6 (not sig) and group 4 0.85 (not sig) μm. No significant difference was found amongst the fracture strength values (P = 0.22). In group 1, 90% of the fractures were non-restorable, whereas in group 3 100% of the fractures were restorable.

CONCLUSIONS

Regardless of restoration technique, fibre reinforcement of composite restorations decreased cusp movement in molar teeth with MOD and endodontic access cavities but did not affect fracture strength.

Emergent surgical treatment of radiation-induced enteropathies for patients with urogynecological and colorectal carcinomas

AIM

The aim of this study is to describe our 10-year experience in patients with urogynecological and colorectal carcinomas with radiation enteropathy treated surgically as an emergency, and to reassess symptoms and mortality.

PATIENTS AND METHODS

The study included 17 patients receiving emergency surgery for complications of radiotherapy. Data about the patients and outcomes of the treatment alternatives used were retrospectively analyzed.

RESULTS

Of 17 patients, nine had colorectal cancer, six had gynecological cancer, and two had cancer of the urinary system. As an emergency, 12 patients had ileus only, one patient had intestinal fistulae and ileus, two patients had bleeding and ileus and two patients had perforation on admission. Seven patients underwent resection and anastomosis, two patients intestinal by-pass, four patients resection and ostomy and four patients bridectomy. Morbidity (75% for early complications and 100% for late complications) and mortality in the early postoperative period (25%) were higher in the patients undergoing bridectomy than in the patients undergoing other surgical methods. The rate of early and late complications (71.4% and 66.6%, respectively) was lower in the patients undergoing resection-anastomosis with a higher of quality life. Only 11 patients survived during a long follow-up period (64.7%).

CONCLUSION

As the postoperative complication rate, overall and operative mortality of patients treated for radiation enteropaties as emergent surgery are high, specialists following this group of patients may favor removal of the pathologic tissue to avoid complications in the early and late postoperative period.