Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Observed and estimated prevalence of Covid-19 in Italy: How to estimate the total cases from medical swabs data

During the Covid-19 pandemic in Italy, official data are collected with medical swabs following a pure convenience criterion which, at least in an early phase, has privileged the exam of patients showing evident symptoms. However, there are evidences of a very high proportion of asymptomatic patients. In this situation, in order to estimate the real number of infected (and to estimate the lethality rate), it should be necessary to run a properly designed sample survey through which it would be possible to calculate the probability of inclusion and hence draw sound probabilistic inference. Unfortunately, the survey run by the Italian Statistical Institute encountered many field difficulties. Some researchers proposed estimates of the total prevalence based on various approaches, including epidemiologic models, time series and the analysis of data collected in countries that faced the epidemic in earlier times. In this paper, we propose to estimate the prevalence of Covid-19 in Italy by reweighting the available official data published by the Istituto Superiore di Sanità so as to obtain a more representative sample of the Italian population. Reweighting is a procedure commonly used to artificially modify the sample composition so as to obtain a distribution which is more similar to the population. In this paper, we will use post-stratification of the official data, in order to derive the weights necessary for reweighting the sample results, using age and gender as post-stratification variables, thus obtaining more reliable estimation of prevalence and lethality. Specifically, for Italy, we obtain a prevalence of 9%. The proposed methodology represents a reasonable approximation while waiting for more reliable data obtained with a properly designed national sample survey and that it could be further improved if more data were made available.

Frequency and severity of dental caries in foster care children of Turin, Italy: a retrospective cohort study

AIM

Aim of this retrospective cohort study was to assess the frequency and severity of dental caries (DC) among foster care children in the city of Turin, in North West Italy, and to compare these data with those of a general paediatric population.

MATERIALS AND METHODS

From May 2016 to September 2018, 75 paediatric subjects between the age of 4 and 12, located in 11 residential child care communities were recruited. Instructions were provided concerning oral health, caries and correlation with dietary habits. Oral and dental examination were carried out to establish frequency and severity of caries (not-penetrating, nPC, corresponding to the International Caries Detection and Assessment System (ICDAS) codes: 1-4, vs. penetrating, PC, corresponding to ICDAS codes: 5-6). Decayed, missed, filled teeth (DMFT) index was used. Data for comparison were acquired from the WHO Collaboration Center For Epidemiology and Community Dentistry of Milan (WHO-CCOMS), belonging to a nationwide sample of 2,141 Italian children.

RESULTS

Only 13 subjects (17%) were caries-free; 187 caries were identified: 133 were PC, whereas 54 were nPC. Overall, 76% of the caries were found in deciduous teeth. Mean DMFT was 3.43 (D = 2.97; M = 0.24; F = 0.22). When the study data were compared to those from WHO-CCOMS, a significantly higher DMFT (3.43 vs 0.96; p <0.00001) and D (2.97 vs 0.62; p <0.00001) was detected.

CONCLUSION

A significant higher frequency of caries in foster care children in Turin, Italy compared to the general population was detected.

The prevalence and clinical relevance of tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ of the breast

Background

Tumor-infiltrating lymphocytes (TILs) are a robust prognostic adjunct in invasive breast cancer, but their clinical role in ductal carcinoma in situ (DCIS) has not been ascertained.

Patients and methods

We evaluated the prevalence and clinical relevance of TILs in a well annotated series of 1488 consecutive DCIS women with a median follow-up of 8.2 years. Detailed criteria for TILs evaluation were pre-defined involving the International Immuno-Oncology Biomarker Working Group. TILs percentage was considered both as a continuous and categorical variable. Levels of TILs were examined for their associations with ipsilateral breast event (IBE), whether in situ or invasive.

Results

Of the 1488 patients with DCIS under study, 35.1% had <1%, 58.3% 1-49% and 6.5% ≥50% peri-ductal stromal lymphocytes. The interobserver agreement in TILs evaluation, measured by the intraclass correlation coefficient (ICC) was 0.96 (95% CI 0.95-0.97). At univariable analysis, clinical factors significantly associated with TILs (P ≤0.001) were intrinsic subtype, grade, necrosis, type of surgery. Her-2 positive DCIS were more frequently associated with TILs (24% of patients with TILs ≥50%), followed by the triple negative (11%), Luminal B/Her-2 positive (9%) and Luminal A/B subtypes (1%) (P < 0.0001). We did not find any association between TILs as a continuous variable and the risk of IBEs. Likewise, when patients were stratified by TILs percentage (<1%, between 1% and 49.9%, and ≥50%), no statistically significant association was observed (10-year cumulative incidence of IBEs: 19%, 17.3%, and 18.7% respectively, P = 0.767).

Conclusion

TILs occur more frequently in the Her-2 positive DCIS. Although we did not find a significant association between TILs and the 10-year risk of IBE, our data suggest that immunotherapies might be considered in subsets of DCIS patients.

Tailoring treatment for ductal intraepithelial neoplasia of the breast according to Ki-67 and molecular phenotype

Background:

The post-surgical management of ductal intraepithelial neoplasia (DIN) of the breast is still a dilemma. Ki-67 labelling index (LI) has been proposed as an independent predictive and prognostic factor in early breast cancer.

Methods:

The prognostic and predictive roles of Ki-67 LI were evaluated with a multivariable Cox regression model in a cohort of 1171 consecutive patients operated for DIN in a single institution from 1997 to 2007.

Results:

Radiotherapy (RT) was protective in subjects with DIN with Ki-67 LI ≥14%, whereas no evidence of benefit was seen for Ki-67 LI <14%, irrespective of nuclear grade and presence of necrosis. Notably, the higher the Ki-67 LI, the stronger the effect of RT (P-interaction <0.01). Hormonal therapy (HT) was effective in both Luminal A (adjusted hazard ratio (HR)=0.56 (95% CI, 0.33–0.97)) and Luminal B/Her2neg DIN (HR 0.51 (95% CI, 0.27–0.95)).

Conclusion:

Our data suggest that Ki-67 LI may be a useful prognostic and predictive adjunct in DIN patients. The Ki-67 LI of 14% could be a potential cutoff for better categorising this population of women at increased risk for breast cancer and in which adjuvant treatment (RT, HT) should be differently addressed, independent of histological grade and presence of necrosis.

Objective assessment of mandibular motor control using a 'reach-and-hold' task

Mandibular motor function is well known to be impaired in the presence of temporomandibular disorders. However, while a vast literature is available concerning accuracy of motor control in limbs, quantitative and objective assessment of mandibular motor control has been seldom performed, also because of the lack of adequate investigative tools. Aim of this work is to present a technique for reliable evaluation of the motor performance of the mandible based on a kinesiography-monitored reach-and-hold task. Nineteen healthy subjects were engaged in a task in which they had to drive a cursor on a screen by corresponding movements of the mandible in the frontal plane and reach 30 random targets sequentially displayed on the screen. The whole task was repeated three times per session in two different days. The individual performance was assessed by different indices evaluating precision and steadiness of target matching. The performance progressively improved in the three trials of the first session, further improved and stabilised in the second session, with an average positioning error of 0·59 ± 038 mm and was slightly correlated with the horizontal dimension of the mandible border movement (r = 0·55). Intraclass correlation coefficient ranged between 0·76 and 0·94 for the different indices indicating good repeatability. The kinesiographic technique allowed for objective and reliable assessment of the voluntary control of the mandible position. Its potential applications include support to the characterisation of temporomandibular disorders and to motor training and progress monitoring in rehabilitation treatments.

Circulating tumor cells in operable breast cancer: a pilot study

Abstract #5028

Background. Circulating tumor cells (CTCs) in the peripheral blood are an ideal source for the detection of disseminated tumor cells because of an easy sampling procedure. Their prognostic significance has been demonstrated in metastatic breast cancer, while little data exist in operable patients. Aims of this study are the evaluation of the prevalence and kinetics of CTCs before and after surgical treatment and the possible correlation between CTCs and clinico-pathological characteristics and biological features. Methods. We analyzed 30 ml of peripheral blood from 60 T1-T3, any N, M0 breast cancer pts, before surgery and after 5 days. In case of positivity of one of the perioperative samples, a further sample was taken after 30 days. The presence of CTCs was assessed with the CellSearch System (Veridex, USA). Samples were subjected to immunomagnetic enrichment with an anti-Epcam-antibody: CTCs were defined as nucleated cells expressing cytokeratin 8, 18 and 19 but lacking CD45. A sample was considered positive when 1 or more cells were detected. Results. Data are available for 50 pts. We found ≥1 CTC in 28% of the pts (n=14/50) before surgery, and in 29% of the patients (n= 12/42 ) at 5 days. The median number of CTCs was 1, with a range of 1-3. We found a borderline significant association between the presence of CTCs at baseline and the presence of vascular invasion (p=0.09). The presence of CTCs at baseline did not correlate with tumor size (p=0.66), grading (p=0.88), presence of estrogens receptor (p=0.30), presence of progesteron receptor (p=0.30), HER2/neu status of the tumor (p=1.0), or with the presence of lymph node metastases (p=0.71). In 42 pts we have the data of CTCs determined at baseline and at day 5: 27 patients showed concordant results (23 negative and 4 positive). Among the 15 patients with different results, 8 were negative at baseline and positive at day 5: 6 out of the 8 patients had positive nodes. At day 30 we analyzed samples from 18 subjects: persistence of at least 1 CTC was found in 18 % of patients (n=5). Conclusions. The results of this explorative study are very preliminary and a larger number of patients and a long-term follow-up will be required. However, it is of interest the borderline correlation between presence of CTCs at baseline and vascular invasion, and between appearance of CTCs and nodal involvement in postoperative samples. The study is ongoing and the patients will be followed during and after adjuvant treatment to explore the prognostic significance of persistency of CTCs. Complete data will be presented.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5028.

[Conservative approach for breast cancer. The experience of the European Institute of Oncology]

Conservative surgery represents the standard care for patients with early breast cancer. The aim of this review was to discuss the extension of conservative surgery in controversial fields such as after primary chemotherapy for large tumours or the possibility to repeat conservative surgery for a local reappearance. The project of a conservative approach to breast cancers continues with sentinel node biopsy which is worldwide performed more and more frequently. In our institute sentinel node biopsy is the standard procedure in the axillary staging of breast cancer even in those clinical scenarios which were previously considered either controversial or a contraindication such as in multicentric breast cancer, during pregnancy, in intra-ductal neoplasias, after primary chemotherapy, and male breast cancer. This conservative approach is completed by the possibility to deliver a partial breast irradiation and to provide patients with more personalized adjuvant treatments tailored on the biological features of the tumour.

Development of glass-ceramic scaffolds for bone tissue engineering: characterisation, proliferation of human osteoblasts and nodule formation

Glass-ceramic macroporous scaffolds for tissue engineering have been developed using a polyurethane sponge template and bioactive glass powders. The starting glass (CEL2) belongs to the system SiO(2)-P(2)O(5)-CaO-MgO-Na(2)O-K(2)O and has been synthesised by a conventional melting-quenching route. A slurry of CEL2 powder, polyvinyl alcohol and water has been prepared in order to coat, by impregnation, the polymeric template. An optimised thermal treatment was then use to remove the sponge and to sinter the glass powders, leading to a glass-ceramic replica of the template. Morphological observations, image analyses, mechanical tests and in vitro tests showed that the obtained devices are good candidates as scaffolds for bone-tissue engineering, in terms of pore-size distribution, pore interconnection, surface roughness, and both bioactivity and biocompatibility. In particular, a human osteoblast cell line (MG-63) seeded onto the scaffold after a standardised preconditioning route in simulated body fluid showed a high degree of cell proliferation and a good ability to produce calcium nodules. The obtained results were enhanced by the addition of bone morphogenetic proteins after cell seeding.

Internal adaptation of fixed prosthodontics at shoulder preparation level evaluated by horizontal sections

AIM

The precision of fixed prosthodontic restorations is fundamental for clinical success: well-fitting crowns reduce the risk of recurrent caries and periodontal disease. The aim of this study is to evaluate the internal fit of fixed prosthodontics at the shoulder preparation level by examining horizontal sections.

METHODS

Twenty-four extracted teeth were resin-embedded and prepared on the platform of an iso-parallelometer with a 90 degrees shoulder with a rounded internal angle. Auro Galva Crown (AGC) copings were cemented in place. The preparations were observed by 3 different assessors at 8 points, first externally and then internally at 2 levels by grinding the specimen perpendicular to the long axis at 0.5 mm and at 0.2 mm from the margin of the preparation. A correction factor was calculated to derive real values from measured values. The results were analyzed using a linear regression with robust standard errors, accounting for within-subject correlation introduced by multiple measurements. Shrout-Fleiss Intraclass Correlation Coefficient (ICC) for Inter-Rater Reliability were calculated at each stage.

RESULTS

Internal measurements at 0.5 and 0.2 mm from the margin provided data similar to the external margin data. Average inter-assessor differences were in the range of 2 mm. ICC ranged from 0.93 for the 0.5 mm level to 0.97 for the external level.

CONCLUSIONS

External measurements effectively predict the internal precision at the shoulder level. Horizontal perimarginal sections allow the fit to be studied through the evaluation of a great number of points. Traditional vertical sections for the evaluation of internal fit enable only a few points to be observed. This internal observation method may be suitable for testing new materials.

Inhibition of phospholipase A2 activity reduces membrane fluidity in rat hippocampus

Phospholipase A2 (PLA2) is a family of key enzymes in membrane phospholipid metabolism. In rats, the inhibition of PLA2 activity in the hippocampus was found to impair memory formation. Because memory function is largely dependent on the fluidity of brain membranes, we performed the present study to investigate the effects of in vivo PLA2 inhibition (with PACOCF3) on the fluidity of hippocampal membranes from rats trained in a learning task. Hippocampal tissue from rats injected with 100 microM PACOCF3 showed reduced membrane fluidity as compared to vehicle (p < 0.01), and the reduction of membrane fluidity was highly correlated with PLA2 inhibition (r = .76, p < 0.03). This finding is of interest because reduction of brain membrane fluidity impairs memory formation and both decreased PLA2 activity and reduced membrane fluidity have been reported in the brain from patients with Alzheimer's disease.

Diagnostic dilemmas in biliary strictures mimicking cholangiocarcinoma

BACKGROUND/AIMS

Bile duct strictures may be malignant or benign. In the absence of previous biliary surgery a precise preoperative diagnosis is often difficult, in particular when a tumor mass is absent in the preoperative radiologic findings.

METHODOLOGY

A review of 179 patients observed between 1982 and 2001 by the same surgical team with a preoperative diagnosis of malignant stricture of the biliary tree. A surgical procedure was performed in 153 of these cases.

RESULTS

The presence of a malignant stricture was confirmed by final pathologic examination in 32 of 38 cases (96%) in which a curative resection was performed. A final diagnosis of inflammatory stricture secondary to choledocholithiasis was made in 3 of the remaining 6 cases (4%), along with one case each of sclerosing cholangitis, granular cell tumor and Mirizzi's syndrome, respectively.

CONCLUSIONS

Precise preoperative evaluation of biliary structures can be very difficult when a tumor mass is absent. Despite the use of invasive procedures and new techniques such as magnetic resonance cholangiopancreatography, a false-positive rate of 4% may be expected. However, whenever a malignancy is not definitely excluded, biliary strictures should be treated as a cholangiocarcinoma.

Three-dimensional CT imaging and virtual endoscopy for the placement of self-expandable stents in oesophageal and tracheobronchial neoplastic stenoses

We examined the value of multislice computed tomography (CT) with three-dimensional (3D) reconstruction of the images as a pre-treatment examination in order to plan endoluminal stenting in 14 patients with large tumours involving the oesophagus and/or the tracheobronchial tree. The measurement of the stenosis obtained during 3D reconstruction of the CT images corresponded to that obtained by endoscopy and to the prosthesis chosen in all cases, with the exception of one patient undergoing double stenting due to inadequate gaseous distension of the oesophageal lumen. 3D CT may add information with respect to axial imaging, and be helpful to better plan and perform stenting of the oesophagus and airways without burdening the preoperative work-up.

The problem of the accuracy of intraoperative examination of axillary sentinel nodes in breast cancer

BACKGROUND

Sentinel node (SN) biopsy has become accepted as a reliable method of predicting the state of the axilla in breast cancer. The key issue, however, is the accuracy of the pathological evaluation of the biopsied node, which should be done intraoperatively whenever possible.

METHODS

In our initial experience on 192 patients using a conventional intraoperative frozen section method, the false-negative rate was 6.3%, and the negative predictive value was 93.7%. We devised a new and exhaustive intraoperative method, requiring about 40 minutes, in which pairs of sections are taken every 50 microm for the first 15 sections and every 100 microm thereafter, sampling the entire node. Sentinel node metastases were found in 143 of the 376 T1N0 cases examined (38%).

RESULTS

Metastases were always identified on hematoxylin and eosin sections, although in 4% of cases, cytokeratin immunostaining on adjacent sections was useful for confirming malignancy. In 233 patients the SNs were disease-free; of these patients, 222 had metastasis-free axillary nodes, and 11 (4.7%) had another metastatic node.

CONCLUSION

Extensive intraoperative examination of frozen sentinel nodes correctly predicts an uninvolved axilla in 95.3% of cases (negative predictive value). This method is, therefore, suitable for identifying patients in whom axillary dissection can be avoided.

Influence of the thickness of the resin palatal vault on the closest speaking space with complete dentures

The closest speaking space (CSS) has been considered stable over time, and therefore useful to determine the vertical dimension of occlusion (VDO) in edentulous patients. Clemençon affirms that, in complete denture wearers, CSS is not constant but depends on the thickness of the resin palatal vault, and that is the air volume needed to pronounce words to remain constant. The aim of this study was to evaluate Clemençon hypothesis in a group of edentulous patients rehabilitated with traditional maxillary denture and mandibular implant anchored overdenture. The CSS was determined by means of a kinematics method using the Elite System(R) at 30, 60, 90, 180, 360 days from delivery. The CSS was assessed twice at each stage: with the unmodified denture and a second time after thickening the resin palatal vault by 2 mm with a calibrated wax layer. The CSS after thickening the resin palatal vault was wider. The wider CSS observed can be because of oro-sensory feedback excited by contact between tongue and palatal vault. As hypothesized by Clemençon thickening the resin palatal vault could be a useful procedure to increase the VDO, in cases in which it is too low from the aesthetic stand point.

Coronary artery bypass grafting in patients with dialysis-dependent renal failure: ten-year results

BACKGROUND

Coronary artery disease has been reported to be accelerated in patients with chronic renal failure on maintenance dialysis. Coronary artery bypass grafting (CABG) in patients on long-term dialysis is still a debated issue.

METHODS

We retrospectively reviewed 19 patients (12 men, 7 women, mean age 64 +/- 11.2 years) with end-stage renal disease who underwent CABG between 1990 and 2000. Operative procedures were CABG alone in 15 (78.9%) patients and CABG associated with valve procedures in 4 (21.1%) patients.

RESULTS

The early (30-day) mortality rate was 10.5% (2 of 19 patients). Non-fatal complications occurred in 6 patients (31.5%). Four delayed deaths occurred; the actuarial survivals at 1, 2, 5 and 10 years were 0.86 +/- 0.14, 0.78 +/- 0.10, 0.68 +/- 0.13 and 0.54 +/- 0.15 respectively. Among 13 survivors the mean Canadian Cardiovascular Society class was 1.3 +/- 0.3 (p < 0.001 vs preoperatively). ANOVA procedures showed age (p = 0.01), Canadian Cardiovascular Society class > or = III (p < 0.001), urgent/emergency operation (p < 0.001), left ventricular ejection fraction < 0.50 (p < 0.001), a prior myocardial infarction (p = 0.01), a preoperative mean creatinine level > or = 5 mg/dl (p = 0.02) and a duration of dialysis > or = 60 months (p = 0.03) to be strongly related to early and delayed mortality.

CONCLUSIONS

CABG in patients with dialysis-dependent chronic renal failure is associated with acceptable results. Accurate patient selection, early referral to surgery, and adequate perioperative management are advisable.

Evaluation of the utility of cephalometric parameters in constructing complete denture. Part II: placement of anterior teeth

Various types of parameters, including cephalometric ones, have been used in the construction of complete denture. This study aimed to evaluate the utility of cephalometric parameters for this purpose. The position of the anterior teeth in a group of 42 edentulous patients, successfully rehabilitated with complete denture according to clinical parameters, was evaluated by cephalometrics following the Ricketts' design. Data obtained were then compared statistically with those reported by Ricketts for dentate subjects, the position of the maxillary incisors was slightly anterior.

Evaluation of the utility of cephalometric parameters in constructing complete denture. Part I: placement of posterior teeth

Various types of parameters, including cephalometric ones, have been used in the construction of complete denture. This study aimed to evaluate the utility of cephalometric parameters for this purpose. The position of the posterior teeth in a group of 42 edentulous patients, successfully rehabilitated with complete denture according to clinical parameters, was evaluated by cephalometrics. The following were determined: vertical dimension of occlusion (VDO); orientation of the occlusal plane; and subdivision of the denture space. The cephalometric parameters do not correspond to the clinical positioning of the posterior teeth in successful rehabilitation with complete denture.

Detection of platelet-activating factor in gingival tissue surrounding failed dental implants

BACKGROUND

Dental implant therapy has entered routine clinical practice. However, the failure rate of implants at 5 years, due to biological factors, is still around 7%. The pathogenesis of implant loss involves a complex network of cells and inflammatory mediators. This study evaluated platelet-activating factor (PAF), a potent phospholipid mediator of inflammation, in soft tissue surrounding failed dental implants versus healthy implants.

METHODS

PAF was estimated on extracted lipids by bioassay on washed rabbit platelets; inflammatory cell populations were assessed semiquantitatively after staining, and microvessel density was evaluated after immunohistochemical staining.

RESULTS

Biologically active PAF was detected in the lipid extracts of samples excised from gingival tissue of patients with failed implants, but not in samples from patients with osseointegrated implants or from healthy edentulous subjects. The amount of PAF detected in failed implants was significantly higher than in healthy implants, suggesting a local production of this mediator.

CONCLUSIONS

The presence of PAF was associated with histopathological findings of local inflammation and increased blood vessel density.

Norepinephrine can be useful for the treatment of right ventricular failure combined with acute pulmonary hypertension and systemic hypotension. A case report

A 48-year-old woman who underwent emergency cardiac surgery for removal of a thrombus partially occluding the mitral valve, developed pulmonary hypertension right ventricular failure and systemic hypotension, in the immediate postoperative period, a clinical condition not well controlled by high doses of epinephrine and dobutamine. The addition of a continuous infusion of norepinephrine in incremental dosages, caused the rise in cardiac index accompanied before by the reduction in the pulmonary pressure and the stability in the systemic pressure, than by the further reduction in the pulmonary pressure and the increase in the systemic pressure. The conclusion is drawn that norepinephrine is useful in the treatment of right ventricular failure which follows a condition of acute pulmonary hypertension, because the improvement of cardiac performance established without adverse effects on the pulmonary pressures whose values on the contrary progressively declined.

Comparison of marginal fit of 3 different metal-ceramic systems: an in vitro study

PURPOSE

The aim of this study was to compare the marginal adaptation of metal-ceramic crowns made with 3 different metal substructures.

MATERIALS AND METHODS

Seventy-five gypsum dies were fabricated from a master steel die. They were randomly divided into 3 groups of 25 dies each. A metal coping was prepared on each die using a different technique for each group: composite alloy, electroforming, and cast high-noble alloy. Ceramic was baked on all of the samples following the same protocol and simulating the shape and size of a maxillary central incisor. All specimens were evaluated under a stereomicroscope at 200x magnification. The marginal gap was measured at 8 different points on each specimen before and after ceramic application and also on the master steel die. A total of 3,600 measurements was evaluated. The results were statistically elaborated by means of a t test and one-way analysis of variance (ANOVA).

RESULTS

The ANOVA revealed a significant difference in mean marginal gap before and after ceramic application within each group. Electroforming (mean 32 microns) and high-noble alloy (mean 31 microns) showed better marginal fit after ceramic application and on the master steel die compared to composite alloy (mean 68 microns; P < 0.0001).

CONCLUSION

Marginal gaps are influenced by the application of ceramic and by the alloy used for the substructure, and the values obtained were within the limits of clinical acceptability (70 microns).

Cytokine production and bone remodeling in patients wearing overdentures on oral implants

The stability of titanium dental implants is determined by osseointegration. Bone is a dynamic tissue continuously remodeled through resorption and formation, processes controlled by local cytokine production. This study investigated osseotropic cytokine expression in gingival mucosa, in the intraforamina and inferior first molar zones, during rehabilitation with implant-retained overdentures. Specimens were taken from six patients prior to placement of implants in the intraforamina bone; at connection of healing abutments; and 4, 8, and 12 months after prosthetic anchorage. Through semi-quantitative reverse-transcriptase polymerase chain-reaction, the following constitutively expressed cytokines were found at first surgical stage: interleukin-1, -6, and -8; small amounts of interleukin-11; stem cell factor; and transforming growth factor-beta1, -beta2, and -beta3. From the connection of healing abutments to 12 months after prosthetic anchorage, transforming growth factor-beta1, -beta2, and -beta3 were markedly higher than initial values. Expression of interleukin-6 and -8 decreased 8 months after prosthetic anchorage, while that of interleukin-1 increased at 12 months. In cultured gingival fibroblasts, modulation of cytokine secretion was also time-dependent. Cell culture supernatants influenced osteoclast-like multinucleated cell formation in long-term human marrow culture or osteoblast function, depending on the cytokine profile produced. These results are consistent with functional contributions of cytokines to osseointegration and minimization of posterior edentulous zone bone resorption.

Bond between gold alloy and ceramic in relation to the thickness of the oxide layer

BACKGROUND

The chemical bonding between metal and ceramic is aided by non-precious metal atoms and their oxides present on the metal surface. Aim of the study was to correlate metal-ceramic bonding with thickness oxide layer on a new gold alloy.

METHODS

Thirty-two specimens were constructed in gold alloy and ceramic, with the aim of evaluating the degree (using shear test) and quality (using optical microscope) of bonding resistance between these materials, in relation to the thicknesses of the oxide layer produced on the metallic parts by means of different thermal procedures.

RESULTS

Bond strength was practically the same with different thicknesses of the oxide layer. A slight reduction in the degree of bonding was observed in the non-oxidised models.

CONCLUSIONS

For the gold-alloy here tested, the oxide layer seems to be not influent in the chemical metal-ceramic bond strength.

Bone density in human dentate and edentulous mandibles using computed tomography

Mandibular bone density, vertebral density and resorption of the edentulous ridge were correlated in a group of 17 partially edentulous subjects. Bone density was quantified by Quantitative Computerized Tomography; resorption was evaluated on panoramic radiographs. Mean bone density in dentate areas was significantly higher than that in edentulous areas; mandibular bone density was not found to relate significantly to vertebral bone density, nor to ridge resorption. In programming osseointegrated implants in the partially edentulous mandible, CT may give a more accurate evaluation of trabecular bone. However, further studies are necessary to clarify its clinical utility.

Effects of progesterone on human spermatozoa: clinical implications

Progesterone is a physiological stimulus of human sperm acrosome reaction. The effects of the steroid, which is present in high levels in the cumulus matrix that surrounds the oocyte, are mediated by an increase of intracellular calcium concentrations, tyrosine phosphorylation of proteins, efflux of chloride and stimulation of activity of phospholipases. These effects are due to activation of a nongenomic pathway. Two different types of receptors for progesterone, distinct from the genomic ones, have been identified on the surface of human spermatozoa. We demonstrated that sperm responsiveness to progesterone is impaired in subfertile patients and that is strictly correlated to the ability of fertilize the oocyte. In addition, the determination of sperm responsiveness is predictive of fertilizing ability with a positive predictive value of 90% and can be clinically useful for the preliminary assessment of the male partner to select the appropriate assisted reproductive technique.

In vitro evaluation of fit of adhesively luted ceramic inlays

PURPOSE

The purpose of this study was to evaluate both marginal and overall adaptation of 4 adhesively luted ceramic inlay systems.

MATERIALS AND METHODS

A total of 40 extracted teeth were restored with mesio-occlusodistal ceramic inlays using 4 different techniques: Colorlogic, IPS Empress, Celay direct, and Celay indirect. After cementation with a resin luting agent, the samples were sectioned along a mesiodistal line passing through the center of the restoration. The thickness of the cement was measured at the margins and at several points along the inside of the restorations by means of a stereomicroscope fitted with a measuring grid.

RESULTS

The results were analyzed by one-way analysis of variance. The marginal precision of IPS Empress and Colorlogic inlays averaged below 50 microns. Marginal precision of Celay inlays averaged between 110 and 130 microns. IPS Empress and Celay inlays showed a uniform distribution of the cement along the entire prepared surface. Colorlogic inlays showed an uneven distribution of the cement film.

CONCLUSION

IPS Empress inlays showed the best clinical features compared to Colorlogic and Celay inlays.

[Preliminary study of the behavior of the rest position and the minimum phonetic distance in edentulous patients rehabilitated with prostheses with modification of the palatal thickness]

BACKGROUND

Various clinical parameters, as well aesthetics, must be taken into account in determining the vertical dimension of occlusion (VDO) when rehabilitating edentulous subjects. These include the freeway space (FS), the physiological rest position (PRP) and the minimum speaking space (MSS).

METHODS

Eight edentulous patients were rehabilitated firstly with complete denture; FS and MSS were monitored using a non-invasive computerized system, and increasing the thickness of the denture palate vault.

RESULTS

FS and MSS do not appear to be correlated; MSS appears to be more reliable parameter than FS, as it is not influenced by the patient's will.

CONCLUSIONS

Increasing the thickness of the palate vault causes a marked lowering of the mandible during speech, in agreement with Clemencon.

Elite system: recording of condylar movements using a modified computerized technique

BACKGROUND

The aim was to develop a method to measure condylar movements using a computerized system. The Elite system is a computerized device for the graphic recording of mandibular movements by processing images of marks recorded with two video cameras. The Elite system has traditionally been used to measure mandibular movements; it was modified to record condylar movements as well.

METHODS

The position of the markers was altered to enable 3-D recording not only of mandibular movements but also of condylar movements. New software was developed. Ten subjects (young adults; good complete dentition; no temporo-mandibular disorders; no orthodontic treatment) underwent recording with traditional and then with modified Elite system. The subjects were asked to perform the following movements: maximum opening and closing; protrusive and retrusive movements; border movements on the frontal plane. The sequence of movements was repeated three times on three different days. Data processing was effected using the Spline-smoothing method.

RESULTS

The modified Elite system technique records condylar movements with extreme reliability, reproducibility and the resulting graphics are comparable.

CONCLUSIONS

This method provides the chance to obtain more information about condylar movements in healthy subjects with good dentition, but also in patients with joint dysfunction.

All-ceramic restorations: an overview

Advantages and disadvantages of metal-ceramic and all-ceramic restorations are reviewed particularly from the aesthetic point of view. All-ceramic restorations offer the best results because they let the light through optimally. In constructing all-ceramic crowns on teeth which have been endodontically treated, the material used to rebuild the pin-abutments must be taken into consideration if the best aesthetic results are to be achieved. Materials which, because of their translucent characteristics, are the most aesthetic alternatives to metal alloy pin-abutments in rebuilding teeth which have been endodontically treated, are then described.

Clinical and surgical relevance of the progressive phases of intrathoracic migration of the gastroesophageal junction in gastroesophageal reflux disease

OBJECTIVE

The pathophysiologic influence of progressive intrathoracic migration of the gastroesophageal junction axial to the esophagus on gastroesophageal reflux disease was investigated.

METHODS

A radiologic-manometric study was performed on hiatal insufficiency, concentric hiatus hernia, and short esophagus, the three radiologic steps of intrathoracic gastroesophageal junction migration, and on healthy volunteers. The distances between inferior and superior margins of the lower esophageal sphincter and the diaphragm were measured. Endoscopic, manometric, and pH-metric evaluations were performed after barium swallow in 38 patients with severe gastroesophageal reflux disease and sliding hiatus hernia with intraabdominally reducible gastroesophageal junction, in 35 patients with hiatal insufficiency, in 40 with concentric hiatus hernia, and in 19 with short esophagus.

RESULTS

The distance from the lower esophageal sphincter inferior margin to the diaphragm was different in healthy volunteers (-2.6 +/- 0.9 cm [standard deviation]) versus that in patients with hiatal insufficiency (-1.0 +/- 0.7 cm; p = 0.02), concentric hiatus hernia (-0.8 +/- 1.0 cm; p = 0.02), and short esophagus (4.0 +/- 2.5 cm; p = 0.0002), and in patients with short esophagus versus hiatal insufficiency (p = 0.0002) and concentric hiatus hernia (p = 0.0002). Lower esophageal sphincter tone was reduced between healthy volunteers (19 +/- 9.1 mm Hg [standard deviation]) and patients with sliding hiatus hernia (12 +/- 7.2 mm Hg;p = 0.02), hiatal insufficiency (10 +/- 5.9 mm Hg; p = 0.0001), concentric hiatus hernia (7 +/- 3.1 mm Hg; p = 0.00002), and short esophagus (7 +/- 3.7 mm Hg; p = 0.00003) and between concentric hiatus hernia versus sliding hiatus hernia (p = 0.007). Acid gastroesophageal reflux total time percent was increased between healthy volunteers (2.4% +/- 1.8% [standard deviation]) and patients with sliding hiatus hernia (12.8% +/- 7.8%;p = 0.02), hiatal insufficiency (17.2% +/- 15.8%; p = 0.0001), concentric hiatus hernia (24.0% +/- 19.6%;p = 0.00002), and short esophagus (26.1% +/- 19.6%;p = 0.00002) and between sliding hiatus hernia versus concentric hiatus hernia (p = 0.002) and short esophagus (p = 0.01).

CONCLUSIONS

Permanent gastroesophageal junction orad migration axial to the esophagus has greater pathophysiologic relevance on gastroesophageal reflux disease than sliding hiatus hernia with an intraabdominally reducible gastroesophgeal junction. Hiatal insufficiency, concentric hiatus hernia, and short esophagus are markers of progressively increasing irreversible cardial incontinence and therefore indications for surgical therapy.

Implant anchored complete mandibular denture: evaluation of masticatory efficiency, oral function and degree of satisfaction

Masticatory efficiency, oral function and degree of satisfaction with the treatment received were analysed in a group of fully edentulous patients with severe atrophy of the mandibular bone, rehabilitated with complete removable dentures, before and after anchoring the dentures to osseointegrated implants. Masticatory efficiency increased significantly and chewing cycles increased in amplitude after anchoring the denture. The component of the chewing cycle that most influenced the increase in functional area was the lateral one. A correlation was found between the increase in the lateral component of the chewing cycle and the increased masticatory efficiency achieved with implant-anchored dentures. The degree of satisfaction with their rehabilitation reported by the subjects was correlated neither to increased masticatory efficiency nor to improved oral function.

Oral stereognosis in edentulous subjects rehabilitated with complete removable dentures

Oral stereognosis was analysed in a group of edentulous subjects rehabilitated with complete removable dentures. Stereognosis was evaluated with and without the denture in place. The results showed that the older subjects had poorer stereognostic ability than the younger ones, whereas the duration of edentulism appeared not to influence this ability. The presence of a correct prosthetic rehabilitation appeared to improve stereognostic ability. Subjects with poorer stereognostic ability appeared more satisfied with their rehabilitation than did those with better stereognostic ability.