From Caves to the Savannah, the Mitogenome History of Modern Lions (Panthera leo) and Their Ancestors

Lions (Panthera leo) play a crucial ecological role in shaping and maintaining fragile ecosystems within Africa. Conservation efforts should focus on genetic variability within wild populations when considering reintroduction attempts. We studied two groups of lions from two conservation sites located in Zambia and Zimbabwe to determine their genetic make-up, information that is usually unknown to the sites. In this study, we analysed 17 specimens for cytb and seven microsatellite markers to ascertain family relationships and genetic diversity previously obtained by observational studies. We then produced a standardised haplogroup phylogeny using all available entire mitogenomes, as well as calculating a revised molecular clock. The modern lion lineage diverged ~151 kya and was divided into two subspecies, both containing three distinct haplogroups. We confirm that Panthera leo persica is not a subspecies, but rather a haplogroup of the northern P.l. leo that exited Africa at least ~31 kya. The progenitor to all lions existed ~1.2 Mya, possibly in SE Africa, and later exited Africa and split into the two cave lion lineages ~175 kya. Species demography is correlated to major climactic events. We now have a detailed phylogeny of lion evolution and an idea of their conservation status given the threat of climate change.

Covid-19 pandemic and clinical activity stop: oral health study in a group of children

AIM

Public and private health services, which provide both preventive and health promotion interventions, were forced to suddenly stop their activities to limit the risk of infections during the pandemic emergency. Oral health administration, including that of children, was affected by these planned medical service closures, from both therapeutic and preventive perspectives. This study aims to analyse the consequences, at the oral cavity level, of failures to treat patients of childhood age, considering the impact of carious pathology on quality of life and incorrect eating and oral hygiene habits, which may occur in this age group.

METHODS

This is a cross-sectional, single-center, observational study. One hundred patients from the Odontostomatological University Center (C.O.U.) of Perugia were randomly enrolled.

CONCLUSION

Oral health status of the examined sample is satisfactory overall, considering the clinic's interruption of treatments with the resulting long period of no follow-up and the emotional and economic stress generated by the pandemic condition for both the young patients and their caregivers.

A chromosome-level reference genome and pangenome for barn swallow population genomics

Insights into the evolution of non-model organisms are limited by the lack of reference genomes of high accuracy, completeness, and contiguity. Here, we present a chromosome-level, karyotype-validated reference genome and pangenome for the barn swallow (Hirundo rustica). We complement these resources with a reference-free multialignment of the reference genome with other bird genomes and with the most comprehensive catalog of genetic markers for the barn swallow. We identify potentially conserved and accelerated genes using the multialignment and estimate genome-wide linkage disequilibrium using the catalog. We use the pangenome to infer core and accessory genes and to detect variants using it as a reference. Overall, these resources will foster population genomics studies in the barn swallow, enable detection of candidate genes in comparative genomics studies, and help reduce bias toward a single reference genome.

The worldwide spread of Aedes albopictus: New insights from mitogenomes

The tiger mosquito (Aedes albopictus) is one of the most invasive species in the world and a competent vector for numerous arboviruses, thus the study and monitoring of its fast worldwide spread is crucial for global public health. The small extra-nuclear and maternally-inherited mitochondrial DNA represents a key tool for reconstructing phylogenetic and phylogeographic relationships within a species, especially when analyzed at the mitogenome level. Here the mitogenome variation of 76 tiger mosquitoes, 37 of which new and collected from both wild adventive populations and laboratory strains, was investigated. This analysis significantly improved the global mtDNA phylogeny of Ae. albopictus, uncovering new branches and sub-branches within haplogroup A1, the one involved in its recent worldwide spread. Our phylogeographic approach shows that the current distribution of tiger mosquito mitogenome variation has been strongly affected by clonal and sub-clonal founder events, sometimes involving wide geographic areas, even across continents, thus shedding light on the Asian sources of worldwide adventive populations. In particular, different starting points for the two major clades within A1 are suggested, with A1a spreading mainly along temperate areas from Japanese and Chinese sources, and A1b arising and mainly diffusing in tropical areas from a South Asian source.

The Italian wall lizard, Podarcis siculus campestris, unexpected presence on Gorgona Island (Tuscan Archipelago)

We here report the unexpected presence of the Italian wall lizard (Podarcis siculus campestris) on Gorgona Island, in the Parco Nazionale Arcipelago Toscano (Tuscan Archipelago, Tyrrhenian Sea, Tuscany, Central Italy). Field observations were carried out in 2020 confirming its presence on the island, where it had never been reported before. We recorded 37 GPS points of the species in three major areas of Gorgona (with 50 lizard records) and about 180 visual counts regarding all age classes (newborns, juveniles and adults). The species was found in the urban area (site of state prison) and in two grassy and bushed areas, around and along olive tree plantations. Seven individuals were captured and their tails were used to assess the sequence variation of the mitochondrial CYB gene. Biometrical parameters were also evaluated for six of these individuals. We detected three distinct CYB haplotypes that were compared to Podarcis siculus CYB sequences available in public databases. They resulted identical or phylogenetically closest to those found in mainland Tuscany. One haplotype, found in three specimens, was identical to one previously detected at Orti Bottagone (WWF Oasis in Piombino), while the other two haplotypes were most similar to haplotypes reported in the Giannella peninsula and Pisa, respectively.

P-745 Telemedicine during the COVID -19 pandemic: let us give the floor to the patients

Study question

Could telemedicine be an efficient instrument in reproductive medicine?

Summary answer

Telemedicine could be a safe and efficacious tool to reduce waiting time to follow-up appointments, to treatments and some discomfort of in-visit person.

What is known already

During pandemic COVID- 19 in Italy the infertility centers procedures were suspendend, except of fertility preservation treatments for oncological patients. In order to stay close to our patients, to minimize exposure risks for patients and staff and to avoid an extension of waiting lists, we introduced a telemedicine service, that we called “smart ART'' for the follow-up consultations, that do not require a physical examination and for the planning of frozen embryo transfer cycles.

Study design, size, duration

All the patients, who recevied a consultation via telemedicine, had given a written consent. At our public infertility center, patients who had a telemedicine visit from May 4th, 2020 to December 21st, 2021 were surveyed to ascertain their satisfaction and perspectives using an online anonymous questionnaire, that contained 10 questions with graduated responses according to 5-point Likert scale and a free response. The questionnaire was active from 11th November 2021 until 10th January 2022.

Participants/materials, setting, methods

Three hundred twenty-nine patients received satisfaction surveys by email. Emails were sent from 11th November 2021 to 23th December 2021, with a reminder a week later to improve the completion rate. Survey responses were collected in real time via a secure, web application. We assessed the level of patients satisfaction with several aspects of the visit (technical quality, care received, convenience, comfort, and overall satisfaction). Participants were also invited to leave a comment.

Main results and the role of chance

There was an overall response rate of 66.3%. The survey was entirely completed by 89.9% of patients. By analyzing the survey responses, we noted that 90% of responders would use telemedicine services again and were satisfied with the telehealth system. Smart ART improved access to healthcare for 50% patients in terms of less discomfort for cost and time for transportation and work. 85% of responders believed that telemedicine preserves privacy, 39% of responders considered that on line consultations should probably be maintained in the future in non pandemic times and 46% absolutely maintained. 87% of patients stated that telemedicine platform was easy to access. The audio’s quality was good for 50% of patients and very good for 31% of patients. 79% of responders were satisfied with video quality and 60% of responders were very satisfied with medical approach despite non in-person visit. 32% of patients were not satisfied with transmission of documents with our platform, while 48% of patients are willing to repeat telemedicine for future visits and 34% will probably repeat it. Most patients stated that they are ‘‘very satisfied’’ with telehealth overall.Telemedicine allowed to reduce waiting time for follow-up consultations from 4 months to less than one month.

Limitations, reasons for caution

This is a monocentric study and we are aware of the small sample size. Patients were self-selected and this could introduce a bias regarding the level of satisfaction. Patients who are less technologically inclined may be more comfortable with in-person visit and coud feel uncomfortable, when discussing sensitive topics.

Wider implications of the findings

Infertility centers should continue to maintain telemedicine after the pandemic, in the interest of patients, doctors and economy. Telehealth has the potential to improve clinic flow, reduce time to treatments and drop-out, decrease costs without compromise the valuable patient–physician relationship. Further research is needed to better define these implications.

Trial registration number

not applicable

The Mitogenome Relationships and Phylogeography of Barn Swallows (Hirundo rustica)

The barn swallow (Hirundo rustica) poses a number of fascinating scientific questions, including the taxonomic status of postulated subspecies. Here we obtained and assessed the sequence variation of 411 complete mitogenomes, mainly from the European H. r. rustica, but other subspecies as well. In almost every case, we observed subspecies-specific haplogroups, which we employed together with estimated radiation times to postulate a model for the geographical and temporal worldwide spread of the species. The female barn swallow carrying the Hirundo rustica ancestral mitogenome left Africa (or its vicinity) around 280 thousand years ago (kya), and her descendants expanded first into Eurasia and then, at least 51 kya, into the Americas, from where a relatively recent (< 20 kya) back migration to Asia took place. The exception to the haplogroup subspecies specificity is represented by the sedentary Levantine H. r. transitiva that extensively shares haplogroup A with the migratory European H. r. rustica and, to a lesser extent, haplogroup B with the Egyptian H. r. savignii. Our data indicate that rustica and transitiva most likely derive from a sedentary Levantine population source that split at the end of the Younger Dryas (11.7 kya). Since then, however, transitiva received genetic inputs from and admixed with both the closely related rustica and the adjacent savignii. Demographic analyses confirm this species' strong link with climate fluctuations and human activities making it an excellent indicator for monitoring and assessing the impact of current global changes on wildlife.

Autism spectrum disorder and paediatric dentistry: A narrative overview of intervention strategy and introduction of an innovative technological intervention method

AIM

When treating patients with Autism Spectrum Disorder (ASD) the doctor-patient relationship can be very challenging. The dentist is often forced to work under general anaesthesia or conscious sedation. Children with ASD are patients with an increased risk of caries due to poor oral hygiene, a cariogenic diet and the use of xerostomal drugs. In this work therapeutic strategies used to treat this kind of patients are evaluated and a new method to treat children with ASD is presented in order to increase awareness about this condition in the dental field.

METHODS

The Atlas Center (a non-profit organisation in Peurgia, Italy) has developed a software, called paINTeraction, that allows these special children to immerse themselves in a virtual reality with the help of an operator. Through this system the child can explore the dental office (and all its sounds and noises) before the real dental visit, thus connecting to the dental professional, achieving greater compliance and reducing anxiety.

CONCLUSION

paINTeraction, with the use of digital technology tools, may be particularly well suited to introduce patients to the therapeutic environment, particularly in the dental setting.

Weaving Mitochondrial DNA and Y-Chromosome Variation in the Panamanian Genetic Canvas

The Isthmus of Panama was a crossroads between North and South America during the continent’s first peopling (and subsequent movements) also playing a pivotal role during European colonization and the African slave trade. Previous analyses of uniparental systems revealed significant sex biases in the genetic history of Panamanians, as testified by the high proportions of Indigenous and sub-Saharan mitochondrial DNAs (mtDNAs) and by the prevalence of Western European/northern African Y chromosomes. Those studies were conducted on the general population without considering any self-reported ethnic affiliations. Here, we compared the mtDNA and Y-chromosome lineages of a new sample collection from 431 individuals (301 males and 130 females) belonging to either the general population, mixed groups, or one of five Indigenous groups currently living in Panama. We found different proportions of paternal and maternal lineages in the Indigenous groups testifying to pre-contact demographic events and genetic inputs (some dated to Pleistocene times) that created genetic structure. Then, while the local mitochondrial gene pool was marginally involved in post-contact admixtures, the Indigenous Y chromosomes were differentially replaced, mostly by lineages of western Eurasian origin. Finally, our new estimates of the sub-Saharan contribution, on a more accurately defined general population, reduce an apparent divergence between genetic and historical data.

Archaeogenomic distinctiveness of the Isthmo-Colombian area

The recently enriched genomic history of Indigenous groups in the Americas is still meager concerning continental Central America. Here, we report ten pre-Hispanic (plus two early colonial) genomes and 84 genome-wide profiles from seven groups presently living in Panama. Our analyses reveal that pre-Hispanic demographic events contributed to the extensive genetic structure currently seen in the area, which is also characterized by a distinctive Isthmo-Colombian Indigenous component. This component drives these populations on a specific variability axis and derives from the local admixture of different ancestries of northern North American origin(s). Two of these ancestries were differentially associated to Pleistocene Indigenous groups that also moved into South America, leaving heterogenous genetic footprints. An additional Pleistocene ancestry was brought by a still unsampled population of the Isthmus (UPopI) that remained restricted to the Isthmian area, expanded locally during the early Holocene, and left genomic traces up to the present day.

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.

PET imaging shows no changes in TSPO brain density after IFN-α immune challenge in healthy human volunteers

Depression is associated with peripheral inflammation, but its link with brain microglial activity remains unclear. In seven healthy males, we used repeated translocator protein-Positron Emission Tomography (TSPO-PET) dynamic scans with [¹¹C]PBR28 to image brain microglial activation before and 24 h after the immune challenge interferon (IFN)-α. We also investigated the association between changes in peripheral inflammation, changes in microglial activity, and changes in mood. IFN-α administration decreased [¹¹C]PBR28 PET tissue volume of distribution (Vt) across the brain (-20 ± 4%; t₆ = 4.1, p = 0.01), but after correction for radioligand free-plasma fraction there were no longer any changes (+23 ± 31%; t = 0.1, p = 0.91). IFN-α increased serum IL-6 (1826 ± 513%, t₆ = -7.5, p < 0.001), IL-7 (39 ± 12%, t₆ = -3.6, p = 0.01), IL-10 (328 ± 48%, t₆ = -12.8, p < 0.001), and IFN-γ (272 ± 64%, t₆ = -7.0, p < 0.001) at 4-6 h, and increased serum TNF-α (49 ± 7.6%, t₆ = -7.5, p < 0.001), IL-8 (39 ± 12%, t₆ = -3.5, p = 0.013), and C-reactive protein (1320 ± 459%, t₆ = -7.2, p < 0.001) at 24 h. IFN-α induced temporary mood changes and sickness symptoms after 4-6 h, measured as an increase in POMS-2 total mood score, confusion and fatigue, and a decrease in vigor and friendliness (all p ≤ 0.04). No association was found between changes in peripheral inflammation and changes in PET or mood measures. Our work suggests that brain TSPO-PET signal is highly dependent of inflammation-induced changes in ligand binding to plasma proteins. This limits its usefulness as a sensitive marker of neuroinflammation and consequently, data interpretation. Thus, our results can be interpreted as showing either that [¹¹C]PBR28 is not sensitive enough under these conditions, or that there is simply no microglial activation in this model.

Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies

AIM

Caries lesions begin with enamel acid demineralisation mediated by microorganisms. Lasers with sub-ablative energy might act as a prophylactic intervention to reinforce enamel against lesions caused by acid.

MATERIALS AND METHODS

A systematic review of the literature was performed evaluating only in vitro studies published from 2010 to 2018. The research was performed using the following databases: Medline, Embase and the Web Of Science. A further search was performed consulting the list of references of the included studies as well as book chapters which dealt with this topic.

RESULTS

A total of 347 records were retrieved and, after their evaluation, 36 studies were included. CO2 lasers were the most described and effective device in preventing acid demineralisation. This type of laser was unique in improving the already positive results obtained with fluoride-based interventions. Er,Cr:YSGG (with fluencies > 8.5J/cm2), diode and argon lasers also improved enamel acid resistance (p-values ranging from 0.05 to 0.001) producing similar effects with fluoride-based interventions. Regarding the sealant retention outcome, the Er:YAG laser was able to perform an enamel etching which was as effective as the traditional acid etching with the advantage of being easier and usually well accepted by low-compliant patients (i.e. younger children). Nd:YAG presented the worst results. The most common structural changes after the laser irradiation were water and carbonate reduction in the enamel combined with a phosphate and calcium enamel content increase. Moreover, the calcium/phosphate ratio was found to reach the 1.67 ideal ratio.

CONCLUSION

The in vitro studies that examined the prophylactic use of lasers for increasing enamel acid resistance presented interesting results that are enough to support a further in vivo experiment. This would entail the use of a clinical laser as an alternative or in combination with fluoride-based interventions.

Biological effects of resin monomers on oral cell populations: descriptive analysis of literature

AIM

Recently, the application of restorative materials containing metacrilate monomers in the conservative and paediatric dentistry has focused on the possible negative effects due to the use of these composites. In particular the release of monomers from reconstructions as a result of an insufficient polymerisation, can spread along the mucosal and dental tissues with potential immunological ed cytotoxic effects. Regarding to the importance of this issue, the aim of this study is to provide a descriptive review of the literature on potential local and systemic interactions of metacrylic and acrylic monomers with the immune system, both in vitro and in vivo.

RESULTS

The most highly used monomers in composite materials applied in conservative dentistry include: 2-hydroessietil- methacrylate (HEMA), triethylene glycol-dimethacrylate (TEGDMA), bisphenol A glycidyl-methacrylate (BisGMA) and urethane- dimethacrylate (UDMA). Different investigations have been performed for better understanding of the potential side effects of metacrylic monomers on immune system cells. Different factors such as cell population, exposure time and parameters more strictly connected to these materials, such as molecular weight, chemical composition and mechanical characteristics, seem to be directly involved in these reactions.

Identifying crossing collagen fibers in human corneal tissues using pSHG images

Polarization sensitive second harmonic generation (pSHG) microscopy has been used previously to characterize the structure of collagen fibers in corneal samples. Due to the typical organization of the corneal stroma, the information that pSHG provides may be misleading in points where two different collagen fiber bundles orient along different direction crossings. Here, a simulation that illustrates the problem is presented, along with a novel method that is capable of identifying these crossing points. These results can be used to improve the evaluation of corneal collagen structure, and it has been applied to analyze pSHG data acquired from healthy and keratoconic human corneal samples.

Dental fear/anxiety among children and adolescents. A systematic review

AIM

The aim of this paper was to review the published scientific literature to quantify the prevalence and mean score of dental fear/anxiety (DFA) in children/adolescents and its variation according to several variables.

MATERIALS AND METHODS

Cross- sectional and cohort studies published from 2000 to 2014, that measured DFA in children /adolescents (aged 0-19 years), in the general population, or visiting private or public dental services (general or pediatric) or attending school and kindergarten, were searched, with specific terms, in 3 electronic databases (Medline, Embase, Web Of Science). Primary data, collected with specific questionnaires of demonstrated reliability and/or validity, were extracted.

RESULTS

After screening 743 abstracts and evaluating 164 full-text publications, 36 articles were selected. Dental fear/anxiety prevalence rates were 12.2%, 10.0%, 12.2%,11.0% and 20.0% for the CFSS-DS, DAS, MDAS, DFS, and DFSS-SF scores, respectively. In the studies that used MCDAS Dental fear/prevalence rates varied from 13.3% to 29.3%. In the studies that used CFSS-DS ratings, the prevalence and the mean score of dental fear/anxiety was lower in Northern Europe than the remaining countries, the prevalence decreased with increasing age and the frequency was higher in females than males.

CONCLUSIONS

Dental fear/anxiety is a common problem in children/adolescents worldwide, therefore, new strategies to overcome this relevant children/adolescent condition should be encouraged.

Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale

AIM

Children's dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS).

MATERIALS AND METHODS

The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4-11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach's alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists.

RESULTS

Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score &#8804;2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents.

CONCLUSION

The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4-11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.

Dental caries, parents educational level, family income and dental service attendance among children in Italy

AIM

The aim of this study was to verify whether socioeconomic determinants, such as parents' educational level, family income and dental service attendance by children, are associated with the presence of caries among an Italian population of children.

MATERIALS AND METHODS

An observational retrospective study was carried out in a population of children aged 4-14 years who visited the Paediatric Dentistry Department of the University of Perugia, Italy. Children were stratified according to familial socioeconomic level (father's and mother's educational level, family income) and dental service attendance of children. Age- and sex- adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated by means of multivariate logistic regression models.

RESULTS

A sample of 231 children (mean age 8.1 yrs, SD 2.6; 127 males, 104 females) was recruited. One hundred and sixty three (70.46%) children in the study had caries. Caries presence in children was higher in children where the mothers' educational level was lower (OR =6.1; 95% CI = 3.1 to 12.7), in children where the fathers' educational level was lower (OR =2.9; 95% CI =1.6 to 5.5) and in children with lower family income (OR = 9.9; 95% 95% CI = 5.1 to 20.1). No statistically significant difference were observed in terms of caries presence between the children who were visited at least once by a dentist and children who were not previously seen by a dental practitioner (OR = 0.8; 95% CI = 0.4 to 1.6).

CONCLUSION

Socioeconomic level was an important predictor of caries presence among children. Both low income and low parental educational level were related to an increased presence of caries, whereas previous dental visits experience did not affect caries presence in children.

Nanofat 2.0: experimental evidence for a fat grafting rich in mesenchymal stem cells

Different strategies have been developed in the last decade to obtain fat grafts as rich as possible of mesenchymal stem cells, so exploiting their regenerative potential. Recently, a new kind of fat grafting, called "nanofat", has been obtained after several steps of fat emulsification and filtration. The final liquid suspension, virtually devoid of mature adipocytes, would improve tissue repair because of the presence of adipose mesenchymal stem cells (ASCs). However, since it is probable that many ASCs may be lost in the numerous phases of this procedure, we describe here a novel version of fat grafting, which we call "nanofat 2.0", likely richer in ASCs, obtained avoiding the final phases of the nanofat protocol. The viability, the density and proliferation rate of ASCs in nanofat 2.0 sample were compared with samples of nanofat and simple lipoaspirate. Although the density of ASCs was initially higher in lipoaspirate sample, the higher proliferation rate of cells in nanofat 2.0 virtually filled the gap within 8 days. By contrast, the density of ASCs in nanofat sample was the poorest at any time. Results show that nanofat 2.0 emulsion is considerably rich in stem cells, featuring a marked proliferation capability.

Isolated transverse process fractures: insignificant injury or marker of complex injury pattern?

INTRODUCTION

This study investigates the incidence of isolated transverse process fractures (ITPFx) amongst vertebral fractures in trauma patients, and specific-associated injury patterns present in patients with ITPFx.

MATERIALS AND METHODS

A retrospective, 4-year review of our Level 1 Trauma Center registry was performed. Patients with blunt spinal column fractures were identified. Data collected included patient demographics, Injury Severity Score (ISS), type of imaging obtained, and concomitant injuries, including rib and pelvic fractures, liver, spleen, and kidney injury (SOI).

RESULTS

Of the 10,186 patients admitted during the study period, 881 (8.6%) suffered blunt thoraco-abdominal trauma resulting in vertebral fractures; 214/881 (24%) had ITPFx. All patients (10,186) underwent dedicated spinal multi-detector CT (MDCT) imaging; 26/214 (12.1%) patients had MRI. In all 26 patients, the MRI confirmed the CT findings. 202/214 (94.4%) had associated injuries: rib and pelvic fractures, 45.5 and 20.2%, respectively, and splenic, liver and kidney injury with an incidence of 13.8, 10.9, and 9.4%, respectively. A higher incidence of rib fractures was associated with ITPFx at the T1-4 levels, whereas ITPFx at the level of L5 were associated with pelvic fractures and SOI. Multiple logistic regression analysis identified T1-4 and L5 fractures as predictors of rib fractures and pelvic fractures independent of ISS, with OR: 2.55 (95% CI: 1.12-5.82) and 6.81 (95% CI: 3.14-14.78), respectively.

CONCLUSIONS

Based on the results of this study, we conclude that: (1) the use of MDCT imaging has increased the rate of identification of ITPFx; (2) dedicated spinal MDCT reconstruction and MRI may not be necessary to diagnose isolated thoracic and lumbar ITPFx; and (3) ITPFx of the thoracic spine and lower lumbar spine are markers of associated rib fractures and pelvic ring fractures, respectively, as well as of solid organ injuries.

Is pit and fissure sealing of buccal surfaces useful in reducing incidence of caries of first permanent molars?

AIM

The aim of the study was to establish whether caries prevalence on the buccal surfaces of first lower permanent molars (FLPMs) can be compared to those on the occlusal surfaces in order to justify the utility of extending pit and fissure sealing also to the extra-occlusal surfaces.

MATERIALS AND METHODS

Design: an observational study was carried out in the children population (n=779) aged ≤14 years (mean age 7.68, SD 3.53) that presented at the Paediatric Dentistry Department of the University of Perugia. In the study were included 460 patients, and absolute frequency (number) of FLMP occlusal and buccal caries, together with their ratio and their difference in percentage, were recorded and analysed. Moreover, FLMP buccal caries variation related to age, sex and parent's nationality were calculated.

RESULTS

Among the 460 children included (243 males) aged 5-14 years, 103 erupted FLPMs were analysed. Of their decayed surfaces (n=115), the occlusal surfaces were 62 (53.9%) and the buccal surfaces 53 (46.1%); the absolute frequency ratio was 1.17 and the percentage difference was 7.8%. The female gender was significantly related to buccal caries of FLPMs [OR = 2.66 (95% CI; 1.27-5.59; p=0.0096)] as was the age ranging between 10-14 years [OR = 2.73 (95% CI; 1.36-5.50; p =0.004)]. The parents nationality was not significantly related to buccal caries [Odds Ratio =1.47 (95% CI; 0.70-3.06; p = 09040)].

CONCLUSIONS

The similar caries susceptibility of buccal and occlusal surfaces of FLPMs stimulates further comparative studies about the usefulness of extending pit and fissure sealing to the buccal surfaces in addition to the occlusal prophylactic intervention, particularly with regard to the female sex and during the early eruption stages of these teeth.

The impact of subcrestal placement on short locking-taper implants placed in posterior maxilla and mandible: a retrospective evaluation on hard and soft tissues stability after 2 years of loading

AIM

Objective of this study was to assess the influence of the subcrestal placement level of short implants with a locking-taper connection design on crestal bone levels and soft tissues health.

METHODS

A clinical retrospective case-control study was conducted between May 2013 and September 2013. The sample was composed of patients who had received at least one 5-to-8-mm-long, plateau-design implant with a locking-taper connection system (Bicon LLC, Boston, MA, USA) in posterior areas of maxilla and mandible, in the period between January 2009 and Dicember 2011. A radiographic evaluation of the degree of subcrestal positioning(t0) was conducted to identify two implant groups: Group 1 was composed of implants placed less than 2 mm under the crestal bone; Group 2 was composed of implants placed 2 mm or more under the crest. The primary outcome variables were the crestal bone levels and the peri-implant bone loss between prosthetic loading and last control visit (t1àt2). Clinical parameters including the keratinized gingival (KG) width, modified bleeding index (mBI), modified plaque index (mPI), and probing depth (PD) were assessed at the follow-up visit. T tests were conducted to identify statistically significant differences between implants groups. Linear regression models were developed to test the dependence of the study variables by the degree of subcrestal surgical implant placement. Significance level was set at P<0.05.

RESULTS

One hundred and thirty-seven implants were followed for an average period of 31 months. At the surgery, the implants were placed, on average, 2.04 mm (mesial) and 1.86 mm (distal) subcrestally. Eighty implants were placed less than 2 mm under the crest (average 1.28 mm), while fifty-seven implants were placed more than 2 mm under the crestal bone (average 2.97 mm). At the prosthetic loading (t1), the average crestal bone level was 1.11 mm, 0.79 mm in Shallow group and 1.86 mm in Deep group, with statistically significant differences between implant groups (P<0.05). At the follow-up visit (t2) the mean crestal bone levels were respectively 0.51 mm and 1.35 mm, with statistically significant differences between implant groups (P<0.05). The average peri-implant bone loss between prosthetic loading and control visit (t1àt2) was 0.04 mm in the Group 1 and 0.33 mm in Group 2. The average keratinized mucosa width was 2.16 mm, the average mBI was 0.24 , the average mPI was 0.17 and the average PD was 2.34 mm. Significant difference between groups was observed regarding to keratinized gingival width (Group 1: 1.97 mm; Group 2: 2.41 mm; P<0.05) but not for the other clinical parameters. Linear regression models confirmed the dependence of crestal bone levels by the degree of subcrestal placement (P<0.05).

CONCLUSION

After two years of observation, the implant of this study have shown minimal peri-implant bone resorption. The greater subcrestal implant placement has resulted in a higher level of the peri-implant bone crest, both after the osseointegration period and after the loading period. Both the study implants groups have shown good health of peri-implant soft tissues.

Biaxial coherence length in a nematic π-cell

In a highly frustrated calamitic nematic phase, the strain can be relaxed by lowering the nematic order: the starting uniaxial symmetry can be broken and it can be replaced locally with transient biaxial domains. Using simple optical retardation measurements, we estimate the length scale over which the biaxial disturbance decays in space within a π-cell submitted to a weak electric field. We also characterise the transition cascade from the uniaxial splay texture to a bend texture through slow defect motion.

Role of internal medicine in a new model of hospital: a proposal of Tuscany’s FADOI

BACKGROUND The Tuscany’s FADOI society proposes the role of internal medicine in a new model of hospital care. The cornerstones of this new model are the “care intensity” and the “department”. We propose that hospital care should be organized so that the patient and his needs represent the core of this care system, in accordance with the idea of the progressive patient care. This aim can be obtained by dividing the hospital’s areas for intensity of care and, therefore, going beyond the present model of hospital care, where the patients are treated in specialty divisions. This new model of care may find its own execution within the department. For medical area, the department of medicine undoubtedly offers a strong multidisciplinary integration and favours the organization for intensity of care. The management of a large amount of patients should be left to the internist. In fact, because of his olistic formation, this clinician seems more appropriate than the other specialists to play this role. The specialists will take care of those patients who suffer from disturbances with a strong specialistic characterization, and in other cases acting as consultants. CONCLUSIONS In Tuscany we can now view various experiences which are trying to experiment this model. Results are encouraging. Starting from these results and greatly believing in them, we offer this contribute to the internists who work in hospital, persuaded to draw from them useful matters for discussion.

Surface and bulk contributions to nematic order reconstruction

Nematic molecules confined in an asymmetric π cell and subjected to strong electric fields exhibit textural distortions involving nematic order variations, described by the Landau-de Gennes Q-tensor theory. We investigated the evolution of order variations as function of the applied electric pulse amplitude and of the nematic surface pretilt anchoring angles by implementing a Q-tensor model with a moving mesh finite element method. The proposed technique is able to clearly distinguish the bulk and the surface order reconstruction which occur in the cell.

Biaxial surface order dynamics in calamitic nematics

Thermotropic nematic materials relax strong distortions by lowering the nematic order: the uniaxial symmetry is broken and is locally replaced by biaxial domains. We investigated the dynamics of the nematic order near a boundary surface of an asymmetric π-cell submitted to an external electric field, close to the electric order reconstruction threshold. An unexpected phenomenon is observed close, but below the threshold: the biaxial order spreads on the surface inducing a consequent bulk topological behaviour equivalent to the splay-bend fast transition allowed by order reconstruction at higher voltage.

Psychological distress and coping strategies in patients attending a dermatology outpatient clinic

BACKGROUND

  Psychological distress is frequent among dermatological patients. The development of a positive attitude toward diagnosis and treatment is thought to be critical for successful coping and mental health outcomes.

OBJECTIVE

  The aim of this study was to assess the coping strategies and the psychological distress, due to anxiety and depression, in an unselected sample of dermatological patients.

METHODS

  Self-administered questionnaires (HADS, COPE) were given to 603 dermatological patients.

RESULTS

  Out of 567 participants, 149 (26.2%) scored positive for Anxiety, and 52 (9.2%) scored positive for Depression. Multivariate analysis, adjusting for gender, age, socio-economic status, and disease, showed that both Anxiety and Depression are associated with a less frequent use of Positive attitude coping.

CONCLUSION

  Our results reinforce the notion that while planning the treatment of dermatological patients, evaluating their mental health might help to provide optimal treatment. Since coping ability was found to be important for mental health status, policy implications could include emphasis on social programs to assist individuals to manage stress, as well as psychological support.

Composition and epigenetic markers of heterochromatin in the aphid Aphis nerii (Hemiptera: Aphididae)

A detailed karyotype analysis of the oleander aphid Aphis nerii focusing on the distribution, molecular composition and epigenetic modifications of heterochromatin was done in order to better understand the structure and evolution of holocentric/holokinetic chromosomes in aphids. The female karyotype (2n = 8) consisted of 3 pairs of autosomes and a pair of X chromosomes that were the longest elements in the karyotype and carried a single, terminally located nucleolar organizer region. Males showed 2n = 7 chromosomes due to the presence of a single X chromosome. Heterochromatin was located in the X chromosomes only and consisted of 4 satellite DNAs that have been identified. A. nerii constitutive heterochromatin was enriched in mono-, di- and tri-methylated H3 histones and HP1 proteins but, interestingly, it lacked DNA methylation that was widespread in euchromatic chromosomal regions. These results suggest that aphid heterochromatin is assembled and condensed without any involvement of DNA methylation.

[Hemostatic effectiveness of TachoSil® patches in radiofrequency assisted minor hepatic resection]

AIM

Intra- and postoperative bleeding represents an extremely serious and frequent complication of hepatic surgery. The aim of this study was to evaluate the effectiveness of TachoSil® to improve hemostasis in radiofrequency assisted minor hepatic resection.

METHODS

Between July 2008 and June 2010, 31 patients underwent radiofrequency assisted minor hepatic resection. At the end of the liver resection a sponge of TachoSil® was applied on the liver.

RESULTS

The mean intraoperative bleeding from the liver was 56.1 mL (range 0-300 mL). No patients received intra- and postoperative blood transfusion. Surgical drains were removed between the first and the sixth-eight postoperative day.

CONCLUSION

According to the authors Tacho-sil® is helpful to improve hemostasis and biliary leakage in patients undergoing radiofrequency assisted minor hepatic resection.

Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria

In Italy, only one study was conducted on the detection of serum thyroid autoantibodies (ATA) in patients with urticaria. This northern-Italy study reported a 23% rate of ATA positiveness in 52 patients with chronic idiopathic urticaria (CIU). During the years 1998-2006, 688 patients with urticaria were hospitalized at our Division of Allergy and Clinical Immunology. Thyroglobulin and thyroperoxidase autoantibodies (TgAb and TPOAb) were assayed at admission in 144/688 patients. Of the 144 patients (mean age: 42.3+/-15.8 yr, range 17-84), 95 (72 women and 23 men) had an history of CIU (CIU group) and 49 (44 women and 5 men) did not [acute urticaria group or (AU)]. Of the 144 patients, 37 (25.7%) tested positive for at least one ATA: 31 with CIU (32.6%) and 6 with AU (12.2%, chi2=7.037, p=0.008). Positiveness for TPOAb or TgAb was 30/37 (81.1%) or 17/37 (45.9%); 10/37 (27.0%). Pre-hospitalization duration of CIU was longer in the 31 ATA positive patients compared to the 64 ATA negative patients (207.2+/-273.4 vs 81.6+/-106.3 weeks, p=0.015). Pre-hospitalization duration of CIU correlated positively with the log10-transformed serum concentration of TPOAb in the 25 CIU patients who tested TPOAb positive (r=0.42, p=0.039). We conclude that our rate of 31/95 (32.6%) positiveness for at least one type of ATA in CIU is greater than that of 6 representative international studies published between the years 2000 and 2006 (111/488 or 22.7%, range 15-29%, chi2=4.884, p=0.027).

Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: a prospective study

BACKGROUND

Neoplastic seeding of hepatocellular carcinoma may arise after radiofrequency ablation.

AIMS

In order to clarify the real risk of seeding, we observed a prospective cohort of patients undergoing radiofrequency ablation.

METHODS

Ninety-three (22.9%) out of 406 consecutive patients with hepatocellular carcinoma superimposed to cirrhosis diagnosed at our Liver Unit (2000-2005) were selected for radiofrequency ablation according to the Barcelona 2000 EASL guidelines. Seventy-one patients were treated by a percutaneous approach and 22 at laparotomy. After radiofrequency ablation ultrasound scan was repeated every 3 months and spiral-computed tomography every 6 months.

RESULTS

Overall 145 sessions were performed in 93 patients: 113 (77.9%) by a percutaneous approach and 32 (22.1%) at laparotomy. The median follow-up was 23 months (range 1-60). Only 1 of the 71 patients (1.4%; 95% C.I. 0.25-7.56) treated percutaneously and none of the 22 (0%; 95% C.I. 0-14.8) treated at laparotomy showed neoplastic seeding.

CONCLUSION

In our experience the risk of seeding of hepatocellular carcinoma after radiofrequency ablation was small (1.1% per patient, 95% C.I. 0.19-5.84; 0.7% per procedure, 95% C.I. 0.12-3.80). A stringent selection of patients for radiofrequency ablation and retraction of the needle with a hot tip may have been instrumental in obtaining this low frequency.

Dynamical numerical model for nematic order reconstruction

In highly frustrated calamitic nematic liquid crystals, a strong elastic distortion can be confined on a few nanometers. The classical elastic theory fails to describe such systems and a more complete description based on the tensor order parameter Q is required. A finite element method is used to implement the Q dynamics by a variational principle and it is shown that a uniaxial nematic configuration can evolve passing through transient biaxial states. This solution, which connects two competing uniaxial nematic textures, is known as "nematic order reconstruction."

The Medicinal Mushroom Agaricus blazei Murrill: Review of Literature and Pharmaco-Toxicological Problems

Agaricus blazei Murrill (ABM) popularly known as 'Cogumelo do Sol' in Brazil, or 'Himematsutake' in Japan, is a mushroom native to Brazil, and widely cultivated in Japan for its medicinal uses, so it is now considered as one of the most important edible and culinary-medicinal biotechnological species. It was traditionally used to treat many common diseases like atherosclerosis, hepatitis, hyperlipidemia, diabetes, dermatitis and cancer. In vitro and in vivo ABM has shown immunomodulatory and antimutagenic properties, although the biological pathways and chemical substances involved in its pharmacological activities are still not clear. The polysaccharides phytocomplex is thought to be responsible for its immunostimulant and antitumor properties, probably through an opsonizing biochemical pathway. Clinical studies are positive confirmations, but we are still at the beginning, and there are perplexing concerns especially relative to the content of agaritine. Argantine is a well-known carcinogenic and toxic substance in animals, that must be completely and fully evaluated.

Inhomogeneous bulk nematic order reconstruction

A two-dimensional model within the Q-tensor description of liquid crystals is used to describe the inhomogeneous order reconstruction in a nematic cell driven by tony modulation in the anchoring conditions. Homogeneous and inhomogeneous reconstruction are contrasted: the former is defectless, the latter is defect mediated. While the transition thresholds are comparable in both cases and in good agreement with experimental data, the biaxial wall breaking is considerably slower in the inhomogeneous transition than in the homogeneous one. The shape of the signal given by the electric current flowing through the cell allows us to distinguish the actual path followed by the transition.

[Evaluation of the hematochemical parameters and bone mineral density of women in physiological menopause treated with hormone replacement therapy with nomegestrol acetate and surgical menopause treated with estrogen replacement. Part II]

AIM

The purpose of this paper was to estimate the effectiveness of the use of acetate nomegestrol in relation to indicator hematochemical parameters and bone mineral density (BMD) regarding patients in physiological menopause treated with hormone replacement therapy (HRT), compared to patients in surgical menopause treated with HRT by only administering transdermally hemi hydrate estradiol (estrogen replacement therapy, ERT).

METHODS

Sixty women in menopause for at least 6 months ago, aged between 40 and 55 years, were recruited. Thirty of them were given HRT with acetate nomegestrol, and 30 were given only ERT, because they were subjected to general hysterectomy with bilateral adnexectomy. The standards for inclusion were: level of FSH >or= to 30 UI beta-estradiol <to 50 pg/mL, in women who hadn't had any hormonal treatment for osteoporosis in the last 6 months. The patients were tested at the beginning of therapy, at 3 months and after 12 months.

RESULTS

Both groups at the end of treatment showed an increase in BMD level, whereas haematochemical tests were regular or at least stabilized in a large percentage of patients.

CONCLUSION

This research has shown the validity of HRT on BMD, underlining a more noteworthy improvement in the patients' group that used acetate nomegestrol than in those that only used estrogens.

[Evaluation of the climacteric symptomatology modifications and clinical-instrumental parameters in women in physiological menopause treated with hormone replacement therapy with nomegestrol acetate and in surgical menopause treated with estrogen replacement therapy. Part I]

AIM

The purpose of this study was to evaluate the effect of the use of nomegestrol acetate in relation to climacteric symptomatology, at clinical, instrumental and hematochemical levels. Regarding patients in physiological menopause treated with hormone replacement therapy (HRT) compared to patients in surgical menopause treated with hemihydrate estradiol hormone replacement therapy (ERT) administered transdermally.

METHODS

Sixty women in menopause for at least 6 months between the ages of 40 and 55 years were enrolled in the study; 30 women were given HRT with nomegestrol acetate and 30 were only given ERT as they had undergone a total hysterectomy with a bilateral adnexectomy. The standards for inclusion were levels of FSH >or= to 30 UI, levels of 17Beta-estradiol <or= to 50 pg/mL, in women who hadn't had any hormonal treatment for osteoporosis in the last 6 months. The women were tested at the beginning of the therapy, at 6 months and after 12 months.

RESULTS

In the patients treated with nomegestrol acetate the climacteric symptoms were reduced or had disappeared and the quality of life both as to relationship and sexuality had improved after 12 months. In the group of women who had only been treated with ERT there was a significant reduction of the climacteric symptoms and the subjective symptoms had improved within 6 months and the reduction continued at the follow-up at 12 months.

CONCLUSION

This study confirms the value of hormone replacement therapy in both groups, underlining a more remarkable improvement in the patients treated with nomegestrol acetate than in those treated with estrogens only.

Protective effects of estradiol on TRAIL-induced apoptosis in a human oligodendrocytic cell line: evidence for multiple sites of interactions

Demyelinating diseases are high impact neurological disorders. Steroids are regarded as protective molecules in the susceptibility to these diseases. Here, we studied the interactions between tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), a potent proapoptotic molecule toxic to oligodendrocytes, and 17-beta-estradiol (E-17-beta), in human oligodendrocytic MO3.13 cells. Exposure of cells to TRAIL resulted in the upregulation of both death receptors DR4 and DR5 and apoptosis, as well as the activation of caspase-8 and -3, increased phosphorylation of Jun-N-terminal kinase and p38 kinase, and the reduction of bcl-2 and bcl-xL proteins. TRAIL-mediated MO3.13 cell apoptosis was abrogated by the dominant-negative form of the adaptor protein FADD and by caspase inhibitors. Preincubation with E-17-beta completely prevented both TRAIL-induced DR4 and DR5 upregulation and apoptosis. Estrogen-induced cytoprotection was time and concentration dependent and reverted by antiestrogens. Estrogen treatment per se reduced kinase phosphorylation, and upregulated bcl-2 and bcl-xL proteins. In conclusion, our data show that the detrimental role of TRAIL on oligodendrocytes can be effectively counteracted by estrogens, thus suggesting that the underlying molecular interactions can be of potential relevance in characterizing novel targets for therapy of demyelinating disorders.

Time resolved experimental analysis of the electric field induced biaxial order reconstruction in nematics

We present the time resolved experimental characterization of the biaxial switching between two topologically distinct textures of a nematic liquid crystal cell submitted to a strong electric field. This fast electro-optical effect is governed by the electric induced order reconstruction in the nematic bulk, which is an actual challenge for a complete theoretical description of the nematodynamics. The electric measurements across the cell are suitable to this purpose since they well discriminate among the dielectric, the ionic, and the order reconstruction contributions. A phenomenological model describes the experimental data, allowing the measurements of the order reconstruction characteristic time.

Zygotic and nucellar embryo survival following dehydration and cryopreservation of citrus intact seeds

A cryopreservation procedure by dehydration and direct immersion in liquid nitrogen was developed for seeds of four polyembryonic Citrus species, and the sexual or nucellar origin of the recovered seedlings was investigated. Seeds of three species could be desiccated in a sterile air flow to 16 percent (C. sinensis) or 10 percent (C. aurantium and C. limon) moisture content with a negligible reduction in germination levels. Differently, the germinability of C. deliciosa seeds dropped to 50 percent after drying to 15 percent moisture content. Following dehydration treatments, a reduction in the average number of seedlings per germinated seed was always observed. However, all four species benefited from desiccation in terms of protection during immersion in liquid nitrogen, with C. sinensis and C. aurantium showing the greatest survival (93 percent germination) after cryopreservation. The Inter-Simple Sequence Repeat analysis of seedlings recovered from cryopreserved seeds showed that the dehydration/cryopreservation procedure promotes the germination of zygotic embryos and reduces the number of apomictic seedlings per seed.

Heme oxygenase-1 expression levels are cell cycle dependent

Heme oxygenase-1 (HO-1) is a stress protein, which has been suggested to participate in defense mechanisms against agents that may induce oxidative injury, such as angiotensin II (Ang II). The purpose of the present study was to examine the role of human HO-1 in cell-cycle progression. We investigated the effect of Ang II on HO-1 gene expression in serum-deprived media to drive human endothelial cells into G(0)/G(1) (1% FBS) compared to exponentially grown cells (10% FBS). The addition of Ang II (100 ng/ml) to endothelial cells increased HO-1 protein and activity in G(0)/G(1) in a time-dependent manner, reaching a maximum HO-1 level at 16 h. Real-time RT-PCR demonstrated that Ang II increased the levels of HO-1 mRNA in G(0)/G(1) as early as 1 h. The rate of HO-1 induction in response to Ang II was several-fold higher in serum-starved cells compared to cells cultured in continuous 10% FBS. The addition of Ang II increased the generation of 8-epi-isoprostane PGF(2 alpha). Inhibition of HO-1, by Stannis mesoporphyrin (SnMP), potentiated Ang II-mediated DNA damage and generation of 8-epi-isoprostane PGF(2 alpha). These results imply that expression of HO-1 in G(0)/G(1), in the presence of Ang II, may be a key player in attenuating DNA damage during cell-cycle progression. Thus, exposure of endothelial cells to Ang II causes a complex response involving generation of superoxide anion, which may be involved in DNA damage. Upregulation of HO-1 ensures the generation of bilirubin and carbon monoxide (CO) in G(0)/G(1) phase to counteract Ang II-mediated oxidative DNA damage. Inducibility of HO-1 in G(0)/G(1) phase is essential and probably regulated by a complex system involving oxygen species to assure controlled cell growth.

Results of double-blind placebo-controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis

BACKGROUND

The aetiology of recurrent aphthous stomatitis (RAS) has so far not been completely clarified. Recently, several studies reported that patients affected by cutaneous diseases (i.e. dermatitis, eczema and urticaria) with positive patch test to nickel have a positive oral nickel challenge.

OBJECTIVE

A retrospective data analysis of patch test and oral nickel challenge in 380 patients (204 women and 176 men) affected by RAS was performed.

PATIENTS AND METHODS

We examined 380 consecutive patients affected by RAS during the period 1990-1999. In 28/380 patients the appearance of their oral symptoms coincided with the fitting of orthodontic appliance, while 352/380 reported that their oral symptoms worsened after the fitting of orthodontic appliance. All patients were studied with the series (European standard series and series for dental materials) for patch tests.

RESULTS

Seventy out of 380 patients (18.4%) presented a contact sensitization to nickel sulphate (positive patch test). In all of these, the orthodontic appliance was replaced with one made of nickel-free materials. All patients were re-examined by the dentist 6 months after the removal of the orthodontic appliance. The symptoms had completely remitted in 28/70 patients, partially had improved in 31/70 patients and had remained unchanged in 11/70 patients. In all patients (n = 70) with a positive patch test to nickel we performed an oral double-blind placebo-controlled challenge (DBPC) test with nickel sulphate. The DBPC was positive in 32/70 patients, 21 of whom had partially improved and 11 had not, even after the replacement of the orthodontic appliance with material not containing nickel. None of the 28 patients in complete remission showed an adverse reaction to oral nickel challenge.

CONCLUSION

The results of this study demonstrate that, in some patients with a positive patch test to nickel sulphate, the perpetuation of RAS can be related to a hypersensitivity to ingested nickel salts, independently of local contact to nickel.