ZeroExpander® effectiveness assessment in PEEK or PA12 in a group of paediatric patients with transverse maxillary deficiency

AIM

The aim of this article is to compare the performance of ZeroExpander® realised using PEEK or PA12 for the expansion of the maxilla in paediatric patients, exploring a new concept for approaching maxillary expansion with a metal-free fixed automatic appliance, based on pre-programmed set-up and anchored on deciduous teeth.

MATERIALS

It is a retrospective comparative study with a sample of 40 children in early or mixed deciduous dentition and transversal maxillary deficit, 20 treated with ZeroExpander® in PEEK and 20 treated with ZeroExpander® in PA12 with a mean age of 7.3 years old. The intraoral scans at T0 and at the end of the expansion were all performed by the same operator to obtain digital models on which were performed measurements by two other different operators. A descriptive analysis was conducted using frequencies and percentages for nominal variables and means and standard deviations for continuous variables.

CONCLUSION

In cases of allergy or hypersensitivity to metals or to specific chronic or acute pathological conditions, which may require periodic magnetic resonance imaging (MRI), it may not be possible to use traditional and metal fixed expansion devices. Moreover the concept of autonomous driving in paediatric orthodontics is not only possible, but it is and will be more real and very useful in the future. The "ortho-paediatric dentistry concept" will increase the range of benefits for children and their families which, in addition to care and thanks to technology, demand well-being, safety, comfort and quality of life beyond clinics.

An Industry Perspective on the use of Forced Degradation Studies to Assess Comparability of Biopharmaceuticals

Forced degradation, also known as stress testing, is used throughout pharmaceutical development for many purposes including assessing the comparability of biopharmaceutical products according to ICH Guideline Q5E. These formal comparability studies, the results of which are submitted to health authorities, investigate potential impacts of manufacturing process changes on the quality, safety, and efficacy of the drug. Despite the wide use of forced degradation in comparability assessments, detailed guidance on the design and interpretation of such studies is scarce. The BioPhorum Development Group is an industry-wide consortium enabling networking and sharing of common practices for the development of biopharmaceuticals. The BioPhorum Development Group Forced Degradation Workstream recently conducted several group discussions and a benchmarking survey to understand current industry approaches for the use of forced degradation studies to assess comparability of protein-based biopharmaceuticals. The results provide insight into the design of forced degradation studies, analytical characterization and testing strategies, data evaluation criteria, as well as some considerations and differences for non-platform modalities (e.g., non-traditional mAbs). This article presents survey responses from several global companies of various sizes and provides an industry perspective and experience regarding the practicalities of using forced degradation to assess comparability.

The effect of drug-induced sleep endoscopy on surgical outcomes for obstructive sleep apnea: a systematic review

PURPOSE

Drug-induced sleep endoscopy (DISE) is the most widespread diagnostic tool for upper-airway endoscopic evaluation of snoring and obstructive sleep apnea (OSA). However, a consensus on the effectiveness of DISE on surgical outcomes is still lacking. This study aimed to quantify the effect of DISE on surgical outcomes and to compare DISE with awake examination using the Müller Maneuver (MM).

METHODS

This systematic review was performed according to the PRISMA guidelines. Published studies from the last 30 years were retrieved from the Cochrane Library, MEDLINE, SCOPUS, and PubMed databases. Studies comparing DISE with awake examination, or MM were included. Surgical success rate was defined according to Sher's criteria, achieving a postoperative apnoea-hypopnea index (AHI) value < 20 events per hour and a 50% improvement from preoperative AHI. Outcomes are presented in terms of surgical success, pre- and postoperative AHI, Epworth sleepiness score (ESS), oxygen desaturation index (ODI) and lowest oxygen saturation (LOS).

RESULTS

This review included 8 studies comprising 880 patients. DISE group showed a higher LOS increase, ODI decrease, ESS decrease than non-DISE group (6.83 ± 3.7 versus 3.68 ± 2.9, p<0.001; 19.6 ± 11.2 versus 12.6 ± 10.4, p<0.001; 6.72 ± 4.1 versus 3.69 ± 3.1, p<0.001). Differences in surgical success rate were significant only between DISE and MM (64.04% versus 52.48%, p = 0.016). AHI decrease resulted higher in non-DISE than in DISE group (39.92 ± 24.7 versus 30.53 ± 21.7, p<0.001).

CONCLUSION

Results of this systematic review suggest that the evidence is mixed regarding a positive effect of DISE on surgical outcomes.

New 3D printed polymers in orthodontics: a scoping review

AIM

The aim of this scoping review is to assess the application of new 3D printed polymeric materials in orthodontics, including polyamide-12 (PA-12) and Shape Memory Polymers (SMPs).

METHODS

A search for articles published until January 2023 was carried out using PubMed, Scopus, Web of Knowledge, Lilacs, Opengrey, Embase and Cochrane Library databases and by applying the search terms (orthodontic* OR paediatric* OR paedodontic*) AND ("3D printed" OR "three-dimensional printed") AND (polymer* OR material* OR resin* OR technopolymer*). Additional records were also screened through hand or electronic search. No restriction in terms of language or publication period was applied.

CONCLUSION

Due to their mechanical, aesthetic and biocompatibility characteristics, PA12 and SMPs can be used in orthodontic practice. However, additional studies should be performed to evaluate the clinical efficiency of these recent materials.

Effects of an Educational Book on Paediatric Oral Health knowledge in a sample of Italian women

AIM

Parents and caregivers, particularly in Italy, often have limited knowledge about their children's oral health. The primary objective of the study is to evaluate the educational effectiveness of a book on nutrition and prevention of oral diseases entitled "Oral health of mother and child in the first 1000 days of life".

MATERIALS

The sample for this study was composed of 103 adult Italian women who were potential caregivers of one or more children (e.g., mothers, grandmothers, babysitters, and educators). The enrolled women completed a preliminary online survey which included questions about their socio-demographic characteristics and their knowledge on oral health in the first 1000 days of life of newborns (30 questions). Following the survey, they received the educational book. After reading it, the participants completed a second online survey with the same 30 questions, to measure any improvement in their knowledge.

CONCLUSION

It appears that our educational book about nutrition and prevention of oral diseases was effective in enhancing knowledge among the participants in our study. These findings suggest that this educational resource has the potential to be a valuable tool in preventing oral diseases in paediatric populations. However, further confirmation of these results should be obtained through randomised controlled trials.

The impact of pandemics on labour organization: insights from an Italian company archive during the Spanish Flu

In this paper, we discuss the classical modelling approach of pandemics as a negative labour shock. We perform an archival analysis of one of the largest Italian banks (Credito Italiano) during the First World War - Spanish Flu period (1914-1920). In particular, we scrutinise the circulars that the central management of the bank sent out to the local branches, with the aim to assess whether the Spanish Flu has been perceived by contemporaries as an event seriously affecting personnel management. Though restricted to a single case-study, archival evidence does not support the existence of a remarkable negative labour supply shock affecting personnel management because of the Spanish Flu pandemic. Other war-related events probably increased the system's resilience.

Patent Licensing and Capacity in a Cournot Model

We consider the problem of patent licensing in a Cournot duopoly in which the innovator (patentee) is one of the firms and it is capacity constrained. We show that when the patentee can produce a relatively small (relatively large) quantity, it prefers licensing by means of a fixed fee (unit royalty). When the patentee can set two-part tariffs in the form of combinations of fixed fees and unit royalties, it charges a positive fixed fee if and only if it is limited to producing a relatively small quantity. We also show that with combinations of fixed fees and royalties, the royalty rate is lower than is true for the standard case.

Pharmacological Interventions versus Combined Treatment of Depression: A Prospective Study

Introduction

Depression is a common disease worldwide but still, the role of combined treatment (pharmacological and psychological interventions) needs to be clarified. The study aims to compare the effectiveness of integrated treatment versus exclusive pharmacological intervention of depression.

Materials and methods

The observational prospective study provided the collection of data relating to outpatients evaluated through the administration of the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Clinical Global Impression Scale (CGI) both at T0 and at a 3-month follow up visit (T1).

Results

A statically significant association between sex (female) and psychotherapy utilization emerged. A statistically significant association between education (graduated patients) and psychotherapy use was observed. The other qualitative variables showed no statistically significance associations. No significant association between drop out and type of treatment emerged.

Discussion

Clinical research has not yet conclusively demonstrated the superiority of combined therapy over single treatments. As regards sex, the result is in line with the professional literature and provides support in describing how men have more stigmatizing beliefs about treatment of mental health. As regards education, graduated people present higher rates of adherence probably because they may have major introspective capacity and predisposition to communication.

Conclusions

Limitations consist in small sample and short duration of the follow-up (3 months). The strengths, in the type of setting and the respect for routine clinical practice. Future perspective of the research could focus on application of rating instruments to highlight the variables involved in depressive disorder.

P03.10.B A successful case of Histiocytic sarcoma

Background

Histiocytic sarcoma (HS) is an extremely rare malignant neoplasm accounting for less than 1% of all hemato-lymphoid neoplasms. Sixty percent of all cases are metastatic at presentation and the prognosis is really poor. Currently, there are limited treatment options for HS, and no standard treatment can be recommended. Surgery and/or chemotherapy are the most commonly employed treatment modalities for HS, while radiotherapy seems to be an effective option in patients with localized lesions.

Material and Methods

A 48-year-old woman admitted to our hospital for a drug-resistant neck pain. Her medical record review was relevant for hypothyroidism in replacement therapy, hystero-adnexectomy for fibromatosis (2 years ago), anxiety-depressive syndrome. A Brain and Head-and-Neck Magnetic Resonance Imaging (MRI) showed a left expansive osteolytic occipito-cervical vertebral lesion at level C1-C2, measuring 3.4cm x 2.3 cm x 2.6 cm. The mass was completely resected on July 12,2021 and pathological and immunohistochemical staining confirmed the diagnosis of HS with positive immunohistochemistry for CD163, CD4, CD68, CD14, CD45 / LCA; weak expression of S100 and focal positivity for lysozyme; Ki67 = 45%.On August 10, 2021 a 18F-FDG PET/CT imaging of the total body did not reveal any distal metastases. On August 13, 2021 a bone marrow aspirate showed no neoplastic cells. She underwent to an adjuvant chemotherapy regimen that consisted of ifosfamide administered as an infusion with bolus carboplatin, and etoposide (ICE). On August 28,2021 a concomitant radiotherapy is given, with a total dose of 45 Gy delivered in 15 fractions plus a sequential boost to 54 Gy.Results: VMAT was used to deliver a conformal RT plan. The patient tolerated the entire treatment very well, with a Grade 1 dysphagia immediately after the completion of radiotherapy, with a complete resolution about a week later. At last Brain Head-and-Neck RMN and 18F-FDG PET/CT on March 28, 2022 there is no evidence of recurrent disease.

Conclusion

The favorable outcome of our patient with combined chemotherapy and radiotherapy should promote future research to explore treatment protocols in patients with localized or favorable subtypes of HS.For patients with a good PS, young age, long life expectancy, advanced RT techniques may be used to customize safe treatment.

P03.04.B Garcin syndrome and hippocampal-sparing WBRT: successful resolution of a rare case

Background

first case of a rare Garcin syndrome resolution in a young metastatic breast cancer(BC) patient treated with a hippocampal-sparing approach.

Material and Methods

we report a case of a 49-year-old caucasian female. The medical record review was relevant for BC diagnoses in 1997, when she was 26yo; complicated by bone and liver metastasis appeared in 2008. In March 2020, she was referred to our department complaining about increasingly worsening left otalgia with initial hearing loss, left facial numbness, and homolateral decreased facial sensitivity, left increased lacrimation, and tingling tongue. Clinical presentation was suggestive for a Guillain-Alajouanine-Garcin Syndrome (Garcin Syndrome), caused by a lytic lesion in the left sphenoid wing. A contrast MRI (02/04/2020) of the brain demonstrated a lytic lesions in the left sphenoid wing, that was noted to infiltrate surrounding bone of the sphenoid sinus wall, including clivus, left pterygoid process and petrous bone; two parietal and occipital bone lesions were identified with a partial leptomeningeal involvement. According to the good PS, she underwent to a hippocampal-sparing WBRT VMAT plus a sequential boost on sphenoid lesion. PTV and OARs were delineated according to a fused planning MRI/CT image. Bilateral hippocampal contours were generated on the set according to RTOG 0933 contouring atlas. After that, a hippocampal avoidance(HA) region was created by expanding the hippocampal contours by 5 mm in all directions according to Brown et al.The PTV-HA was defined as the WB parenchyma, meninges and skull, excluding the HA-region, dose prescription 30Gy/10fx; the PTV-Boost was defined as the sphenoidal metastases, dose prescription of sequential boost was 12Gy/4fx. VMAT was used to deliver the conformal RT plan. Planning priorities that should be followed were:Hippocampus, OpticChiasm, OpticNerve_L or OpticNerve_R, Lens_L or Lens_R.

Results

The neurological symptoms improved after the end of RT with a complete resolution two months later. At the last MRI, a year and a half from the end of RT, there was no evidence of brain lesion, and no neurological symptoms were referred. These are our results of plan sum: for PTV-HA D2%=43.43 Gy, D98%=26.36 Gy, V30=94.96%; for Hippocampus D100%=8.78 Gy, Dmax=17.24 Gy; for Left OpticNerve Dmax=33.51%; for Right OpticNerve Dmax=29.25%; for OpticChiasm Dmax=35.93%.

Conclusion

To our knowledge, this is the first described case using the VMAT technique to spare the hippocampus plus a boost in a rare case of Garcin Syndrome. Prevention of neurocognitive sequelae by hippocampal avoidance has shown promise in several studies as in this case. Sequential boost demonstrated to be feasible and effective.Advanced RT techniques may be used to customize a treatment that allows preserving cognitive impairment achieving good clinical results in the long-term survival of metastatic patients.

Competing or coopeting? Italian banking rivalry in Egypt, 1924–1940

Purpose

The purpose of this paper is to investigate the key drivers of coopetition by adopting a managerial and economic framework. A case of coopetition failure is investigated by means of a historical example focused on the Egyptian adventure of the Italian banks in the first decades of the XX century.

Design/methodology/approach

The authors adopt a qualitative case study and a flexible pattern matching approach to develop theoretical ideas. Because the flexible pattern matching approach was adopted, the authors build the analysis on a tentative analytical framework specified a priori to provide guidance and focus. This approach allows a theory-driven research paradigm. The historical case study is mainly grounded on original sources drawn from some major banking and institutional archives.

Findings

While several scholars emphasised the relevance of external drivers, the literature has paid less attention to how relational and internal drivers combine. The historical case suggests that key mechanisms supporting the success of coopetition concern planning of common goals, conflicts management, alignment and formalisation of governance. In this vein, internal and relational dimensions seem to be more relevant than environment-context dimension. In addition, the historical example shows that an intra- and inter-firm alignment is required to pursue the implementation of a coopetitive strategy. This suggests the relevance of a holistic approach to investigate coopetition. Further evidence confirms the role of governance mechanisms for the success of coopetition.

Originality/value

The main contribution of this study is the re-consideration of the drivers of coopetition. In particular, the role of coopetition drivers has been investigated using a historical event: the Italian multinational banking in Egypt in the interwar years.

Targeted inducible delivery of immunoactivating cytokines reprograms glioblastoma microenvironment and inhibits growth in mouse models

Glioblastoma multiforme (GBM) is the most common and lethal brain tumor characterized by a strongly immunosuppressive tumor microenvironment (TME) that represents a barrier also for the development of effective immunotherapies. The possibility to revert this hostile TME by immunoactivating cytokines is hampered by the severe toxicity associated with their systemic administration. Here, we exploited a lentiviral vector–based platform to engineer hematopoietic stem cells ex vivo with the aim of releasing, via their tumor-infiltrating monocyte/macrophage progeny, interferon-α (IFN-α) or interleukin-12 (IL-12) at the tumor site with spatial and temporal selectivity. Taking advantage of a syngeneic GBM mouse model, we showed that inducible release of IFN-α within the TME achieved robust tumor inhibition up to eradication and outperformed systemic treatment with the recombinant protein in terms of efficacy, tolerability, and specificity. Single-cell RNA sequencing of the tumor immune infiltrate revealed reprogramming of the immune microenvironment toward a proinflammatory and antitumoral state associated with loss of a macrophage subpopulation shown to be associated with poor prognosis in human GBM. The spatial and temporal control of IL-12 release was critical to overcome an otherwise lethal hematopoietic toxicity while allowing to fully exploit its antitumor activity. Overall, our findings demonstrate a potential therapeutic approach for GBM and set the bases for a recently launched first-in-human clinical trial in patients with GBM.

PEEK polymer in orthodontics: a scoping review

AIM

The aim of this scoping review was to evaluate the application of polyether-ether-ketone (PEEK) in orthodontics.

METHODS

Search strategies were executed for electronic databases through PubMed, Scopus, Web of Science, Lilacs, Opengrey, Embase, Cochrane Library and records identified through hand or electronic search. The keywords used were: "PEEK" OR "Polyether-ether-ketone" AND "orthodontics". The period selected of article publication was from January 2015 to June 2021.

CONCLUSION

Due to excellent physical, mechanical, aesthetic properties and biocompatibility, its low plaque affinity and flexural modulus close to enamel and dentin, PEEK can be used also in orthodontics. However, more clinical research should be done to find out all the advantages and disadvantages of this material.

Innovative and conventional "conservative" technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment

BACKGROUND

To evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard "conservative" procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE).

METHODS

A Health Technology Assessment was conducted, assuming the payer's perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients' clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids' experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy).

RESULTS

Literature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients' perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients' productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of - 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs.

CONCLUSIONS

Results suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.

FSH and bone: Comparison between males with central versus primary hypogonadism

OBJECTIVE

Experimental studies proposed a direct effect of follicle-stimulating hormone (FSH) on the skeletal metabolism, but results of human studies mainly conducted in females are controversial. The present study aims to investigate the possible role of FSH excess in male bone health, by comparing for the first time primary and central hypogonadism.

DESIGN AND METHODS

119 men were enrolled in this cross-sectional observational study at the time of the first diagnosis of hypogonadism. All participants had spontaneous pubertal development. Regarding patients with hypergonadotropic hypogonadism (Hyper-H), Klinefelter syndrome (KS) patients were distinguished from the other forms (non-KS-Hyper-H) based on the onset of FSH elevation. Bone mineral density (BMD) at both lumbar spine (LS) and femoral neck (FN), as well as the prevalence of morphometric vertebral fractures (VFx), were assessed.

RESULTS

Across the whole cohort, higher LS and FN BMD were associated with older age at diagnosis and higher body mass index (BMI), respectively. After adjusting for potential confounders (age at diagnosis, BMI, smoking habits, degree of hypogonadism defined by calculated free testosterone, and 25OH vitamin D levels), non-KS-Hyper-H patients showed significantly lower LS BMD and tended to show lower FN BMD values, as compared to those with hypogonadotropic hypogonadism (Hypo-H). In KS men, LS BMD was significantly lower than in those with non-KS-Hyper-H. No significant differences in the prevalence of VFx were found between the groups.

CONCLUSIONS

These findings suggest a potential negative effect of FSH excess on the male bone mass, especially at spine. The duration of high FSH levels may also contribute to these findings.

Clinical outcome after MitraClip procedure: role of right ventricle

Background

MitraClip system is a device for percutaneous edge-to-edge repair of the mitral valve in symptomatic patients with severe mitral regurgitation (MR) not eligible for surgery, but frequently heart failure symptoms remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in heart failure but little is known about its prognostic role in patients after MitraClip implantation.

Purpose

To identify echocardiographic predictors of clinical outcome after MitraClip procedure, with a particular focus on RV-PA coupling.

Methods

We retrospectively analyzed the data of patients with severe MR who underwent MitraClip implantation between April 2015 and October 2019 at our Institution. Echocardiographic data were assessed at baseline, 3 and 12 months after the procedure; RV to PA coupling was assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Functional class was assessed at 12 months of follow-up. Significance level was set to 0.05 and SPSS was used for statistical analysis.

Results

41 patients were included (age 77.1±7.3, 71% male, BMI 25.8±5.5). MR was primary, functional and mixed in 22, 76 and 2% of patients, respectively. 1/2/3 mitraclips were implanted in 39/56/5% of patients, respectively.

Echocardiographic data at baseline, at 3 and 12 months follow-up are shown in Table.

NYHA class at 12 months significantly correlated with TAPSE and PASP at 3 months follow-up echocardiogram (beta coefficient −0.83 and 0.78 respectively). On the contrary, NYHA class did not show a correlation with left ventricular ejection fraction (LVEF) or residual MR grade.

At 12 months 44% of patients showed an improvement in NYHA class; these patients had a better TAPSE (22.7±1.3 vs 19.4±4.6 mm), a lower PASP (37.9±10.2 vs 48.5±12.9 mmHg) and a better TAPSE/PASP (0.61±0.2 vs 0.42±0.2) compared to patients who did not improve their functional class, while LVEF and residual MR did not differ.

Conclusion

In this sample of significant MR undergoing repair with MitraClip System, patients with functional class improvement at 12 months follow-up showed a better RV-coupling without difference in LV function and residual MR.

Funding Acknowledgement

Type of funding sources: None. Table 1

ZeroExpander: Metal-free automatic palatal expansion for special-needs patients

AIM

The aim of this paper is to illustrate a new concept for approaching maxillary expansion in paediatric orthodontics with a metal-free fixed automatic appliance in special-needs patients.

CASE REPORTS

The ZeroExpander is a complete CAD-CAT full digital and automatic metal-free fixed device. It is designed to expand the maxilla in a pre-programmed automatic way using deciduous teeth as anchorage. Two cases of growing patients with a narrow upper arch are illustrated to present this innovative system, one in complete deciduous dentition and the second in mixed dentition. Both patients were successfully treated with palatal expansion. In the first case we present the use of PEEK, and in the second one the use of PA12.

CONCLUSION

The ZeroExpander, fabricated using metal-free technopolymers and anchored on deciduous teeth, proved to be comfortable and efficient in treating palatal transverse deficiency, without the need of any compliance, even in young patients who must periodically undergo MRI.

Location-Price Equilibria when Traditional Retailers Compete Against an Online Retailer

We consider a location-then-price game where two traditional retailers compete with a location-irrelevant online retailer. We characterize the existing equilibria, and we show that in any possible equilibrium there is direct competition between the traditional retailers. Furthermore, the traditional retailers locate at neither a maximal nor minimal distance. In equilibrium, the price of the online retailer might be higher or lower than the price of the traditional retailers, depending on the relative competitiveness of the online retailer and the traditional retailers.

The impact of pandemics: revising the Spanish Flu in Italy in light of models’ predictions, and some lessons for the Covid-19 pandemic

We consider some descriptive analysis of the main short- and medium-term economic indicators in Italy in the aftermath of the Spanish Flu pandemic. We analyse them in the light of the main neoclassical macroeconomic models of pandemics. Since most of the existing economic models about the consequences of a pandemic deal the pandemic event merely as a negative labour supply shock, we observe that some predictions of the theory about the economic impact of a pandemic seem not to be confirmed in the case of the Spanish Flu in Italy. In particular, economic indicators in Italy in the upsurge of the Spanish Flu need to be explained also in light of the consequences of the First World War. We use this evidence to discuss the predictions on the effects of the Covid-19 pandemic. We stress the importance of putting the analysis of the economic consequences of the current pandemic into the appropriate historical context.

Impacted post-traumatic maxillary central incisor: A multidisciplinary approach

AIM

The aim of this paper is to provide clinicians useful information for the management of impacted central incisor due to early childhood trauma.

CASE REPORT

It is reported the case of an impacted right maxillary central incisor in an 8-year-old male patient who had an intrusive luxation trauma of primary tooth at the age of 4. After clinical and radiographic evaluation, a multidisciplinary treatment plan was planned. Therapy involved a surgical and orthodontic approach in order to expose the tooth and move the incisor in the normal position with a self-ligating appliance system.

RESULTS

Through a multidisciplinary approach it was possible to move the impacted incisor in the occlusal plane, preserving periodontal tissues and tooth vitality.

CONCLUSION

When a permanent tooth is impacted, the multidisciplinary approach of surgery and orthodontic treatment is the best way to obtain a suitable outcome in terms of gingival contour, occlusal plane and aesthetics, when compared with other treatment options.

Paediatric endodontics. Part. 1: Portland Cements Apical Plug

Treatment of necrotic immature permanent anterior teeth with Portland cements apical plug. The long-term success of endodontic treatment depends on the quality of the apical and coronal seal. In necrotic immature teeth the treatment can be challenging for the clinician as the endodontic anatomy and the presence of bacterial infection need to be addressed with special techniques and materials in order to obtain an effective and biocompatible apical seal. Unfortunately, despite the best treatments, immature permanent teeth have a reduced resistance to fracture due to the arrest of root walls development.

Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis

AIM

The aim of this review is to quantify the prevalence and type of malocclusion among children and adolescents during the different stages of dentition worldwide.

MATERIALS AND METHODS

Recent studies (from 2009 to 2019), published in Medline, Web of Science and Embase and orthodontic text-books have been comprehensively reviewed herein. The methodological quality of the included studies was assessed using STROBE criteria.

RESULTS

After screening 450 records and analysing 284 relevant full-text publications, 77 studies were included in this review. A good degree of evidence was obtained due to the medium-high methodological quality level of included studies. The worldwide prevalence of malocclusion was 56% (95% CI: 11-99), without differences in gender. The highest prevalence was in Africa (81%) and Europe (72%), followed by America (53%) and Asia (48%). The malocclusion prevalence score did not change from primary to permanent dentition with a common score of 54%. Malocclusion traits such as Angle's classes, overjet, overbite, and asymmetrical midline shift essentially did not change their prevalence during different dentitions. Conversely, traits such as cross-bite and diastema reduced their prevalence during permanent dentition, while scissor-bite and dental crowding increased their scores.

CONCLUSION

The worldwide high prevalence of malocclusion and its early onset during childhood should induce policymakers as well as paediatric physicians and dentists to devise policies and adopt clinical strategies for preventing malocclusion since younger children's ages.

Prevalence and determinants of early childhood caries in Italy

AIM

Still limited data from representative surveys are available on the prevalence of Early Childhood Caries (ECC; i.e., the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a child aged 71 months or younger), particularly for infant. We conducted a survey in Italian children aged 0 to 71 months.

MATERIALS AND METHODS

A cross-sectional study on ECC was conducted in Italy in 2018 on a sample of parents who were members of an online panel. Using an online questionnaire, 2,522 parents provided information on a total sample of 3,000 children, representative of the Italian population aged 0-71 months.

RESULTS

ECC prevalence was 8.2% overall, 2.9% in children aged 0-23 months, 6.2% in children aged 24-47 and 14.7% in children aged 48-71 months (p for trend<0.001). ECC was more frequently observed among children using baby bottle with milk to fall asleep (multivariate odds ratio, OR, 1.36, 95% confidence interval, CI: 1.03-1.78), baby bottle with sugary beverages (OR 2.87, 95% CI: 2.05-4.03) and pacifier with sugary substances (OR 2.49, 95% CI: 1.79-3.47), consuming beverages other than water (OR for ?1/day vs never 2.29, 95% CI: 1.35-3.90), a higher number of snacks between meals (OR for ?3 vs <2 meals 2.05, 95% CI: 1-38-3.06), a lower frequency of tooth brushing (OR for <1 vs ?2 times/day 2.26, 95% CI: 1.42-3.58) and a high number of siblings (compared to 0, OR for ?2 siblings 2.28, 95% CI: 1.56-3.34). ECC increased with parents' mean age (p for trend=0.048), parents' smoking habit (OR for at least one smoker 1.54, 95% CI: 1.17-2.03), parents' poor oral hygiene (OR for ?1 vs >1 time/day of tooth brushing 1.42, 95% CI: 1.03-1.96) and high number of caries (OR for ?7 vs 0 caries was 2.38, 95% CI: 1.35-4.20).

CONCLUSION

The present large and representative survey for the first time shows that ECC might be frequent also among infants. We confirm that ECC might be prevented if parents follow simple good practices. Information campaign and intervention programmes are needed to inform parents about unfavourable habits that favour the onset of ECC.

The effect of added sugars on children's health outcomes: Obesity, Obstructive Sleep Apnea Syndrome (OSAS), Attention-Deficit/Hyperactivity Disorder (ADHD) and Chronic Diseases

Increasing attention has been paid to how dietary sugars affect not only tooth decay, but also obesity, Type 2 diabetes mellitus, and cardiometabolic and kidney diseases. Therefore, possible connections of these diseases with oral health and diet are analysed. Healthy approaches to beverage and dietary consumption should be recommended and hopefully established in infancy, with the aim of preventing negative effects on general health in later childhood and adulthood.

Dental Sealants. Part 1: Prevention First

BACKGROUND

Tooth decay is still one of the most common chronic childhood diseases in the world, even if during the last five decades measures to combat dental caries have been developed, tested and applied in many populations. Preventive care and education programmes are essential to keeping children's mouths healthy. Within the prevention methods, dental sealants play an important role in preventing the onset and the development of dental cavities.

Perinatal oral health: focus on the mother

AIM

In this paper we focus on the perinatal period, that is the time from the beginning of pregnancy to two months after birth. Indication for oral care providers are supplied about pregnancy-related oral conditions as well as recommendations about ealthy approaches to diet and oral care to expecting mothers, which should be established since infancy and childhood, with the aim of preventing tooth decay and negative effects on general health.

Dental Sealants Part 4: Bisphenol A: What dentists should know

Bisphenol A (BPA) is a synthetic chemical resin used worldwide to produce plastic products. It is also a component of the bisphenol A diglycidylether methacrylate (Bis-GMA), which is a monomer found in dental resin-based materials (including resin-based dental sealants, RBSs). The controversy about its possible toxicity begins around the early '30s. Even if the amount of BPA released by dental sealants is well below the limit proposed by the U.S. Environmental Protection Agency and the European Food Safety Authority, we can reduce the risk of exposure, particularly for children, following precautionary measures.

Role of Temperate Bacteriophage ϕ20617 on Streptococcus thermophilus DSM 20617T Autolysis and Biology

Streptococcus thermophilus DSM 20167^T showed autolytic behavior when cultured in lactose- and sucrose-limited conditions. The amount of cell lysis induced was inversely related to the energetic status of the cells, as demonstrated by exposing cells to membrane-uncoupling and glycolysis inhibitors. Genome sequence analysis of strain DSM 20617^T revealed the presence of a pac-type temperate bacteriophage, designated Φ20617, whose genomic organization and structure resemble those of temperate streptococcal bacteriophages. The prophage integrated at the 3'-end of the gene encoding the glycolytic enzyme enolase (eno), between eno and the lipoteichoic acid synthase-encoding gene ltaS, affecting their transcription. Comparative experiments conducted on the wild-type strain and a phage-cured derivative strain revealed that the cell-wall integrity of the lysogenic strain was compromised even in the absence of detectable cell lysis. More importantly, adhesion to solid surfaces and heat resistance were significantly higher in the lysogenic strain than in the phage-cured derivative. The characterization of the phenotype of a lysogenic S. thermophilus and its phage-cured derivative is relevant to understanding the ecological constraints that drive the stable association between a temperate phage and its bacterial host.

Dental Sealants Part 3: Which material? Efficiency and effectiveness

Determining the best choice between the different sealant materials might be complicated. The products that dentists can choose have different properties, such as caries' preventive effect, fluoride release and retention rate. According to the literature, fissure sealant materials fall into two main categories: resin-based sealants and glass ionomer sealants. Even if the "fluoride-releasing resin sealants" are better than "glass ionomer", with regards to retention of the material, the literature shows that their effectiveness in preventing fissure caries in permanent molars does not differ significantly over 24 months.

Dental Sealants. Part 2: Who should get dental sealants and when

Despite the remarkable achievements in recent decades in oral prevention, sealants are still underused even if their efficacy is well documented and clinical practice guidelines are available in almost every developed country. The clinician should know who needs dental sealants and when, with particular focus on high risk patients and pre-school children.

Transforming nanomedicine manufacturing toward Quality by Design and microfluidics

Nanopharmaceuticals aim at translating the unique features of nano-scale materials into therapeutic products and consequently their development relies critically on the progression in manufacturing technology to allow scalable processes complying with process economy and quality assurance. The relatively high failure rate in translational nanopharmaceutical research and development, with respect to new products on the market, is at least partly due to immature bottom-up manufacturing development and resulting sub-optimal control of quality attributes in nanopharmaceuticals. Recently, quality-oriented manufacturing of pharmaceuticals has undergone an unprecedented change toward process and product development interaction. In this context, Quality by Design (QbD) aims to integrate product and process development resulting in an increased number of product applications to regulatory agencies and stronger proprietary defense strategies of process-based products. Although QbD can be applied to essentially any production approach, microfluidic production offers particular opportunities for QbD-based manufacturing of nanopharmaceuticals. Microfluidics provides unique design flexibility, process control and parameter predictability, and also offers ample opportunities for modular production setups, allowing process feedback for continuously operating production and process control. The present review aims at outlining emerging opportunities in the synergistic implementation of QbD strategies and microfluidic production in contemporary development and manufacturing of nanopharmaceuticals. In doing so, aspects of design and development, but also technology management, are reviewed, as is the strategic role of these tools for aligning nanopharmaceutical innovation, development, and advanced industrialization in the broader pharmaceutical field.

Anti-tuberculosis drug combination for controlled oral delivery using 3D printed compartmental dosage forms: From drug product design to in vivo testing

The design and production of an oral dual-compartmental dosage unit (dcDU) was examined in vitro and in vivo with the purpose of physically isolating and modulating the release profile of an anti-tuberculosis drug combination. Rifampicin (RIF) and isoniazid (ISO) are first line combination drugs for treatment of tuberculosis (TB) that negatively interact with each other upon simultaneous release in acidic environment. The dcDUs were designed in silico by computer aided design (CAD) and fabricated in two steps; first three-dimensional (3D) printing of the outer structure, followed by hot-melt extrusion (HME) of the drug-containing filaments. The structure of the fabricated dcDUs was visualized by scanning electron microscopy (SEM). The 3D printed compartmentalized shells were loaded with filaments containing active pharmaceutical ingredient (API) and selectively sealed to modulate drug dissolution. The drug release profile of the dcDUs was characterized by pH-transfer dissolution in vitro and pharmacokinetics studies in rats, and resulted in modified release of the APIs from the dcDUs as compared to the free filaments. Furthermore, the selective physical sealing of the compartments resulted in an effective retardation of the in vitro API release. The findings of this study support the development of controllable-by-design dcDU systems for combination therapies to enable efficient therapeutic translation of oral dosage forms.

Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units

INTRODUCTION

Healthcare associated infections (HAIs) are a cause of high morbidity, disability and reduced quality of life, as well as mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health.

METHODS

The study aimed to evaluate the presence of procedures and protocols for infection control, to assess the adhesion to the different aspects of hand hygiene (HH) and hand washing technique by healthcare workers in six ICUs. A perspective observational study was conducted in six ICUs. In each ICU, the adherence by health care workers to both hand hygiene practices and standard precautions was assessed, as well as the presence of procedures and written protocols.

RESULTS

The findings showed that in all the involved ICUs, 73 of 142 required protocols and procedures were available. Specifically, 59 of 79 were available for general measure of risk control, 12 of 15 for hand hygiene, and 24 of 48 for standard precautions and isolation measures. Also, the results showed highly variable levels of adherence to the best hygiene practices in all the ICUs involved in the study, with compliance rates ranging from 3% to 100%, and 73 of 142 required protocols were available at the study time.

CONCLUSIONS

Overall, the involved ICUs showed low levels of adherence to best hygiene practices. This suggests the need to implement immediate strategies for infection control in the ICUs. A multidisciplinary intervention could be effective in preventing and control the HAI risk.score was reached only by the third year students with regard to the proper HH. The level of knowledge about HAI was inadequate.A periodically check of nursing students' knowledge would be advisable in order to fill any gaps, improve training, reduce HAI and increase prevention measures compliance.

Recurrent Pituicytoma with Pseudoaneurysm: Report of a Challenging Case

BACKGROUND

Pituicytoma is a rare tumor originating from glial cells of the adult neurohypophysis and infundibulum. Surgical removal is the treatment of choice for this neoplasm. In recent years the endoscopic endonasal approach has proven to be a viable and effective alternative to standard craniotomy.

CASE DESCRIPTION

We report a case of a patient submitted to surgical treatment for a recurrence of pituicytoma, which was operated on transcranially at another hospital approximately 5 years previously. After transcranial surgery, the patient developed a symptomatic recurrence and an undisclosed intrasellar pseudoaneurysm that were treated with an endoscopic endonasal approach, but still required an intracranial approach to complete the resection.

CONCLUSIONS

An intrasellar pseudoaneurysm can endanger the endoscopic removal of the pituicytoma, forcing the surgeon to reevaluate a microscopic transcranial approach or to consider a staged procedure.

Viromes As Genetic Reservoir for the Microbial Communities in Aquatic Environments: A Focus on Antimicrobial-Resistance Genes

Despite studies of viromes isolated from aquatic environments are becoming increasingly frequent, most of them are limited to the characterization of viral taxonomy. Bacterial reads in viromes are abundant but the extent to which this genetic material is playing a role in the ecology of aquatic microbiology remains unclear. To this aim, we developed of a useful approach for the characterization of viral and microbial communities of aquatic environments with a particular focus on the identification of microbial genes harbored in the viromes. Virus-like particles were isolated from water samples collected across the Lambro River, from the spring to the high urbanized Milan area. The derived viromes were analyzed by shotgun metagenomic sequencing looking for the presence, relative abundance of bacterial genes with particular focus on those genes involved in antimicrobial resistance mechanisms. Antibiotic and heavy metal resistance genes have been identified in all virome samples together with a high abundance of reads assigned to cellular processes and signaling. Virome data compared to those identified in the microbiome isolated from the same sample revealed differences in terms of functional categories and their relative abundance. To verify the role of aquatic viral population in bacterial gene transfer, water-based mesocosms were perturbed or not perturbed with a low dose of tetracycline. The results obtained by qPCR assays revealed variation in abundance of tet genes in the virome and microbiome highlighting a relevant role of viral populations in microbial gene mobilization.