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Covid-19 pandemic and clinical activity stop: oral health study in a group of children. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2024; 25:1. [PMID: 38323516 DOI: 10.23804/ejpd.2024.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
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.
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Potent broadly neutralizing antibody VIR-3434 controls hepatitis B and D virus infection and reduces HBsAg in humanized mice. J Hepatol 2023; 79:1129-1138. [PMID: 37459920 DOI: 10.1016/j.jhep.2023.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND & AIMS Chronic hepatitis B is a global public health problem, and coinfection with hepatitis delta virus (HDV) worsens disease outcome. Here, we describe a hepatitis B virus (HBV) surface antigen (HBsAg)-targeting monoclonal antibody (mAb) with the potential to treat chronic hepatitis B and chronic hepatitis D. METHODS HBsAg-specific mAbs were isolated from memory B cells of HBV vaccinated individuals. In vitro neutralization was determined against HBV and HDV enveloped with HBsAg representing eight HBV genotypes. Human liver-chimeric mice were treated twice weekly with a candidate mAb starting 3 weeks post HBV inoculation (spreading phase) or during stable HBV or HBV/HDV coinfection (chronic phase). RESULTS From a panel of human anti-HBs mAbs, VIR-3434 was selected and engineered for pre-clinical development. VIR-3434 targets a conserved, conformational epitope within the antigenic loop of HBsAg and neutralized HBV and HDV infection with higher potency than hepatitis B immunoglobulins in vitro. Neutralization was pan-genotypic against strains representative of HBV genotypes A-H. In the spreading phase of HBV infection in human liver-chimeric mice, a parental mAb of VIR-3434 (HBC34) prevented HBV dissemination and the increase in intrahepatic HBV RNA and covalently closed circular DNA. In the chronic phase of HBV infection or co-infection with HDV, HBC34 treatment decreased circulating HBsAg by >1 log and HDV RNA by >2 logs. CONCLUSIONS The potently neutralizing anti-HBs mAb VIR-3434 reduces circulating HBsAg and HBV/HDV viremia in human liver-chimeric mice. VIR-3434 is currently in clinical development for treatment of patients with chronic hepatitis B or D. IMPACT AND IMPLICATIONS Chronic infection with hepatitis B virus and co-infection with hepatitis D virus place approximately 290 million individuals worldwide at risk of severe liver disease and cancer. Available treatments result in low rates of functional cure or require lifelong therapy that does not eliminate the risk of liver disease. We isolated and characterized a potent human antibody that neutralizes hepatitis B and D viruses and reduces infection in a mouse model. This antibody could provide a new treatment for patients with chronic hepatitis B and D.
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Neutralization, effector function and immune imprinting of Omicron variants. Nature 2023; 621:592-601. [PMID: 37648855 PMCID: PMC10511321 DOI: 10.1038/s41586-023-06487-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
Currently circulating SARS-CoV-2 variants have acquired convergent mutations at hot spots in the receptor-binding domain1 (RBD) of the spike protein. The effects of these mutations on viral infection and transmission and the efficacy of vaccines and therapies remains poorly understood. Here we demonstrate that recently emerged BQ.1.1 and XBB.1.5 variants bind host ACE2 with high affinity and promote membrane fusion more efficiently than earlier Omicron variants. Structures of the BQ.1.1, XBB.1 and BN.1 RBDs bound to the fragment antigen-binding region of the S309 antibody (the parent antibody for sotrovimab) and human ACE2 explain the preservation of antibody binding through conformational selection, altered ACE2 recognition and immune evasion. We show that sotrovimab binds avidly to all Omicron variants, promotes Fc-dependent effector functions and protects mice challenged with BQ.1.1 and hamsters challenged with XBB.1.5. Vaccine-elicited human plasma antibodies cross-react with and trigger effector functions against current Omicron variants, despite a reduced neutralizing activity, suggesting a mechanism of protection against disease, exemplified by S309. Cross-reactive RBD-directed human memory B cells remained dominant even after two exposures to Omicron spikes, underscoring the role of persistent immune imprinting.
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Therapeutic and vaccine-induced cross-reactive antibodies with effector function against emerging Omicron variants. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.17.523798. [PMID: 36711984 PMCID: PMC9882201 DOI: 10.1101/2023.01.17.523798] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Currently circulating SARS-CoV-2 variants acquired convergent mutations at receptor-binding domain (RBD) hot spots. Their impact on viral infection, transmission, and efficacy of vaccines and therapeutics remains poorly understood. Here, we demonstrate that recently emerged BQ.1.1. and XBB.1 variants bind ACE2 with high affinity and promote membrane fusion more efficiently than earlier Omicron variants. Structures of the BQ.1.1 and XBB.1 RBDs bound to human ACE2 and S309 Fab (sotrovimab parent) explain the altered ACE2 recognition and preserved antibody binding through conformational selection. We show that sotrovimab binds avidly to all Omicron variants, promotes Fc-dependent effector functions and protects mice challenged with BQ.1.1, the variant displaying the greatest loss of neutralization. Moreover, in several donors vaccine-elicited plasma antibodies cross-react with and trigger effector functions against Omicron variants despite reduced neutralizing activity. Cross-reactive RBD-directed human memory B cells remained dominant even after two exposures to Omicron spikes, underscoring persistent immune imprinting. Our findings suggest that this previously overlooked class of cross-reactive antibodies, exemplified by S309, may contribute to protection against disease caused by emerging variants through elicitation of effector functions.
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Maturation of SARS-CoV-2 Spike-specific memory B cells drives resilience to viral escape. iScience 2023; 26:105726. [PMID: 36507220 PMCID: PMC9721160 DOI: 10.1016/j.isci.2022.105726] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Memory B cells (MBCs) generate rapid antibody responses upon secondary encounter with a pathogen. Here, we investigated the kinetics, avidity, and cross-reactivity of serum antibodies and MBCs in 155 SARS-CoV-2 infected and vaccinated individuals over a 16-month time frame. SARS-CoV-2-specific MBCs and serum antibodies reached steady-state titers with comparable kinetics in infected and vaccinated individuals. Whereas MBCs of infected individuals targeted both prefusion and postfusion Spike (S), most vaccine-elicited MBCs were specific for prefusion S, consistent with the use of prefusion-stabilized S in mRNA vaccines. Furthermore, a large fraction of MBCs recognizing postfusion S cross-reacted with human betacoronaviruses. The avidity of MBC-derived and serum antibodies increased over time resulting in enhanced resilience to viral escape by SARS-CoV-2 variants, including Omicron BA.1 and BA.2 sublineages, albeit only partially for BA.4 and BA.5 sublineages. Overall, the maturation of high-affinity and broadly reactive MBCs provides the basis for effective recall responses to future SARS-CoV-2 variants.
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Maturation of SARS-CoV-2 Spike-specific memory B cells drives resilience to viral escape. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2022.09.30.509852. [PMID: 36203553 PMCID: PMC9536037 DOI: 10.1101/2022.09.30.509852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Memory B cells (MBCs) generate rapid antibody responses upon secondary encounter with a pathogen. Here, we investigated the kinetics, avidity and cross-reactivity of serum antibodies and MBCs in 155 SARS-CoV-2 infected and vaccinated individuals over a 16-month timeframe. SARS-CoV-2-specific MBCs and serum antibodies reached steady-state titers with comparable kinetics in infected and vaccinated individuals. Whereas MBCs of infected individuals targeted both pre- and postfusion Spike (S), most vaccine-elicited MBCs were specific for prefusion S, consistent with the use of prefusion-stabilized S in mRNA vaccines. Furthermore, a large fraction of MBCs recognizing postfusion S cross-reacted with human betacoronaviruses. The avidity of MBC-derived and serum antibodies increased over time resulting in enhanced resilience to viral escape by SARS-CoV-2 variants, including Omicron BA.1 and BA.2 sub-lineages, albeit only partially for BA.4 and BA.5 sublineages. Overall, the maturation of high-affinity and broadly-reactive MBCs provides the basis for effective recall responses to future SARS-CoV-2 variants.
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P-745 Telemedicine during the COVID -19 pandemic: let us give the floor to the patients. Hum Reprod 2022. [PMCID: PMC9384442 DOI: 10.1093/humrep/deac107.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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
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Autism spectrum disorder and paediatric dentistry: A narrative overview of intervention strategy and introduction of an innovative technological intervention method. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2022; 23:54-60. [PMID: 35274543 DOI: 10.23804/ejpd.2022.23.01.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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SARS-CoV-2 RBD antibodies that maximize breadth and resistance to escape. Nature 2021; 597:97-102. [PMID: 34261126 PMCID: PMC9282883 DOI: 10.1038/s41586-021-03807-6] [Citation(s) in RCA: 296] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
An ideal therapeutic anti-SARS-CoV-2 antibody would resist viral escape1-3, have activity against diverse sarbecoviruses4-7, and be highly protective through viral neutralization8-11 and effector functions12,13. Understanding how these properties relate to each other and vary across epitopes would aid the development of therapeutic antibodies and guide vaccine design. Here we comprehensively characterize escape, breadth and potency across a panel of SARS-CoV-2 antibodies targeting the receptor-binding domain (RBD). Despite a trade-off between in vitro neutralization potency and breadth of sarbecovirus binding, we identify neutralizing antibodies with exceptional sarbecovirus breadth and a corresponding resistance to SARS-CoV-2 escape. One of these antibodies, S2H97, binds with high affinity across all sarbecovirus clades to a cryptic epitope and prophylactically protects hamsters from viral challenge. Antibodies that target the angiotensin-converting enzyme 2 (ACE2) receptor-binding motif (RBM) typically have poor breadth and are readily escaped by mutations despite high neutralization potency. Nevertheless, we also characterize a potent RBM antibody (S2E128) with breadth across sarbecoviruses related to SARS-CoV-2 and a high barrier to viral escape. These data highlight principles underlying variation in escape, breadth and potency among antibodies that target the RBD, and identify epitopes and features to prioritize for therapeutic development against the current and potential future pandemics.
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MESH Headings
- Adult
- Aged
- Animals
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/immunology
- Antibodies, Viral/chemistry
- Antibodies, Viral/immunology
- Antibody Affinity
- Broadly Neutralizing Antibodies/chemistry
- Broadly Neutralizing Antibodies/immunology
- COVID-19/immunology
- COVID-19/virology
- COVID-19 Vaccines/chemistry
- COVID-19 Vaccines/immunology
- Cell Line
- Cricetinae
- Cross Reactions/immunology
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Female
- Humans
- Immune Evasion/genetics
- Immune Evasion/immunology
- Male
- Mesocricetus
- Middle Aged
- Models, Molecular
- SARS-CoV-2/chemistry
- SARS-CoV-2/classification
- SARS-CoV-2/genetics
- SARS-CoV-2/immunology
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
- Vaccinology
- COVID-19 Drug Treatment
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Antibodies to the SARS-CoV-2 receptor-binding domain that maximize breadth and resistance to viral escape. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.04.06.438709. [PMID: 33851154 PMCID: PMC8043444 DOI: 10.1101/2021.04.06.438709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An ideal anti-SARS-CoV-2 antibody would resist viral escape 1-3 , have activity against diverse SARS-related coronaviruses 4-7 , and be highly protective through viral neutralization 8-11 and effector functions 12,13 . Understanding how these properties relate to each other and vary across epitopes would aid development of antibody therapeutics and guide vaccine design. Here, we comprehensively characterize escape, breadth, and potency across a panel of SARS-CoV-2 antibodies targeting the receptor-binding domain (RBD), including S309 4 , the parental antibody of the late-stage clinical antibody VIR-7831. We observe a tradeoff between SARS-CoV-2 in vitro neutralization potency and breadth of binding across SARS-related coronaviruses. Nevertheless, we identify several neutralizing antibodies with exceptional breadth and resistance to escape, including a new antibody (S2H97) that binds with high affinity to all SARS-related coronavirus clades via a unique RBD epitope centered on residue E516. S2H97 and other escape-resistant antibodies have high binding affinity and target functionally constrained RBD residues. We find that antibodies targeting the ACE2 receptor binding motif (RBM) typically have poor breadth and are readily escaped by mutations despite high neutralization potency, but we identify one potent RBM antibody (S2E12) with breadth across sarbecoviruses closely related to SARS-CoV-2 and with a high barrier to viral escape. These data highlight functional diversity among antibodies targeting the RBD and identify epitopes and features to prioritize for antibody and vaccine development against the current and potential future pandemics.
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Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2020; 21:115-122. [PMID: 32567942 DOI: 10.23804/ejpd.2020.21.02.05] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Prophylactic Activity of Orally Administered FliD-Reactive Monoclonal SIgA Against Campylobacter Infection. Front Immunol 2020; 11:1011. [PMID: 32582158 PMCID: PMC7296071 DOI: 10.3389/fimmu.2020.01011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Campylobacter infection is one of the most common causes of bacterial gastroenteritis worldwide and a major global health threat due to the rapid development of antibiotic resistance. Currently, there are no vaccines approved to prevent campylobacteriosis, and rehydration is the main form of therapy. Secretory immunoglobulin A (SIgA) is the main antibody class found in mucous secretions, including human milk, and serves as the first line of defense for the gastrointestinal epithelium against enteric pathogens. In this study, we describe the prophylactic activity of orally delivered recombinant SIgA generated from two human monoclonal antibodies (CAA1 and CCG4) isolated for their reactivity against the flagellar-capping protein FliD, which is essential for bacteria motility and highly conserved across Campylobacter species associated with severe enteritis. In an immunocompetent weaned mouse model, a single oral administration of FliD-reactive SIgA CAA1 or CCG4 at 2 h before infection significantly enhances Campylobacter clearance at early stages post-infection, reducing the levels of inflammation markers associated with epithelial damage and polymorphonuclear (PMN) cells infiltration in the cecum lamina propria. Our data indicate that the prophylactic activity of CAA1 and CCG4 is not only dependent on the specificity to FliD but also on the use of the SIgA format, as the immunoglobulin G (IgG) versions of the same antibodies did not confer a comparable protective effect. Our work emphasizes the potential of FliD as a target for the development of vaccines and supports the concept that orally administered FliD-reactive SIgA can be developed to prevent or mitigate the severity of Campylobacter infections as well as the development of post-infection syndromes.
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PET imaging shows no changes in TSPO brain density after IFN-α immune challenge in healthy human volunteers. Transl Psychiatry 2020; 10:89. [PMID: 32152285 PMCID: PMC7063038 DOI: 10.1038/s41398-020-0768-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/22/2022] Open
Abstract
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.
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Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2019; 20:295-301. [PMID: 31850772 DOI: 10.23804/ejpd.2019.20.04.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Biological effects of resin monomers on oral cell populations: descriptive analysis of literature. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2019; 20:224-232. [PMID: 31489823 DOI: 10.23804/ejpd.2019.20.03.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Identifying crossing collagen fibers in human corneal tissues using pSHG images. BIOMEDICAL OPTICS EXPRESS 2019; 10:3875-3888. [PMID: 31452981 PMCID: PMC6701537 DOI: 10.1364/boe.10.003875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
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.
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Dental fear/anxiety among children and adolescents. A systematic review. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2019; 18:121-130. [PMID: 28598183 DOI: 10.23804/ejpd.2017.18.02.07] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2019; 18:305-312. [PMID: 29380617 DOI: 10.23804/ejpd.2017.18.04.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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 ≤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.
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The relevance of counseling in patients with nasal polyps. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:326-327. [PMID: 27734987 PMCID: PMC5066470 DOI: 10.14639/0392-100x-1315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
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A non-invasive optical method for mapping temperature polarization in direct contact membrane distillation. J Memb Sci 2017. [DOI: 10.1016/j.memsci.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dental caries, parents educational level, family income and dental service attendance among children in Italy. EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2017; 18:15-18. [PMID: 28494596 DOI: 10.23804/ejpd.2017.18.01.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Nanofat 2.0: experimental evidence for a fat grafting rich in mesenchymal stem cells. Physiol Res 2017; 66:663-671. [PMID: 28406706 DOI: 10.33549/physiolres.933451] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
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Isolated transverse process fractures: insignificant injury or marker of complex injury pattern? Eur J Trauma Emerg Surg 2016; 43:657-661. [PMID: 27913838 DOI: 10.1007/s00068-016-0745-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
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.
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Is pit and fissure sealing of buccal surfaces useful in reducing incidence of caries of first permanent molars? EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2016; 17:193-196. [PMID: 27759407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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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. MINERVA STOMATOLOGICA 2014; 63:391-402. [PMID: 25503340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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.
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Notizen: Das Studium der Blutliquorschranke mittels radiojodierten Serumalbumins. Untersuchungen am normalen und am experimentell meningitischen Hund. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1963-0923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Notizen: Beitrag zum Studium der Protein-Durchlässig-keit der Blut-Liquorschranke bei Entzündungszuständen der Hirnhäute. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1964-0318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Biaxial coherence length in a nematic π-cell. THE EUROPEAN PHYSICAL JOURNAL. E, SOFT MATTER 2013; 36:115. [PMID: 24122278 DOI: 10.1140/epje/i2013-13115-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 08/01/2013] [Accepted: 09/11/2013] [Indexed: 06/02/2023]
Abstract
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.
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Role of internal medicine in a new model of hospital: a proposal of Tuscany’s FADOI. ITALIAN JOURNAL OF MEDICINE 2013. [DOI: 10.4081/itjm.2007.1.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Surface and bulk contributions to nematic order reconstruction. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2012; 85:061705. [PMID: 23005112 DOI: 10.1103/physreve.85.061705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Indexed: 06/01/2023]
Abstract
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.
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Biaxial surface order dynamics in calamitic nematics. THE EUROPEAN PHYSICAL JOURNAL. E, SOFT MATTER 2012; 35:32. [PMID: 22592817 DOI: 10.1140/epje/i2012-12032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/19/2012] [Accepted: 04/23/2012] [Indexed: 05/31/2023]
Abstract
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.
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Analisi al SEM delle interferenze tra bleaching ed etching dello smalto. DENTAL CADMOS 2011. [DOI: 10.1016/j.cadmos.2011.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Psychological distress and coping strategies in patients attending a dermatology outpatient clinic. J Eur Acad Dermatol Venereol 2011; 26:746-54. [PMID: 21707771 DOI: 10.1111/j.1468-3083.2011.04159.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
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.
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Efficacia di un flow nel gradino cervicale delle II Classi. Analisi sperimentale. DENTAL CADMOS 2011. [DOI: 10.1016/j.cadmos.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Composition and epigenetic markers of heterochromatin in the aphid Aphis nerii (Hemiptera: Aphididae). Cytogenet Genome Res 2011; 133:67-77. [PMID: 21273762 DOI: 10.1159/000323510] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2010] [Indexed: 11/19/2022] Open
Abstract
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.
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[Hemostatic effectiveness of TachoSil® patches in radiofrequency assisted minor hepatic resection]. MINERVA CHIR 2010; 65:627-633. [PMID: 21224797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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Abstract
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).
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Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: a prospective study. Dig Liver Dis 2008; 40:684-9. [PMID: 18294940 DOI: 10.1016/j.dld.2007.12.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 12/19/2007] [Accepted: 12/20/2007] [Indexed: 12/11/2022]
Abstract
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.
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Dynamical numerical model for nematic order reconstruction. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2008; 77:051708. [PMID: 18643088 DOI: 10.1103/physreve.77.051708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 03/26/2008] [Indexed: 05/26/2023]
Abstract
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."
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The Medicinal Mushroom Agaricus blazei Murrill: Review of Literature and Pharmaco-Toxicological Problems. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2008; 5:3-15. [PMID: 18317543 PMCID: PMC2249742 DOI: 10.1093/ecam/nem007] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 01/10/2007] [Indexed: 12/11/2022]
Abstract
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.
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Inhomogeneous bulk nematic order reconstruction. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2008; 77:020702. [PMID: 18351976 DOI: 10.1103/physreve.77.020702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 11/04/2007] [Indexed: 05/26/2023]
Abstract
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.
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P086 Allogeneic stem cell transplantation for advanced cutaneous T-cell lymphopma: unicentric experience. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[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]. MINERVA GINECOLOGICA 2007; 59:215-22. [PMID: 17576400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
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.
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[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]. MINERVA GINECOLOGICA 2007; 59:205-14. [PMID: 17576399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
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.
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Recommendations for airway control and difficult airway management in paediatric patients. Minerva Anestesiol 2006; 72:723-48. [PMID: 16871154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Protective effects of estradiol on TRAIL-induced apoptosis in a human oligodendrocytic cell line: evidence for multiple sites of interactions. Cell Death Differ 2005; 11:503-11. [PMID: 14739940 DOI: 10.1038/sj.cdd.4401367] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
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.
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Time resolved experimental analysis of the electric field induced biaxial order reconstruction in nematics. PHYSICAL REVIEW LETTERS 2004; 93:137801. [PMID: 15524762 DOI: 10.1103/physrevlett.93.137801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Indexed: 05/24/2023]
Abstract
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.
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Zygotic and nucellar embryo survival following dehydration and cryopreservation of citrus intact seeds. CRYO LETTERS 2004; 25:81-90. [PMID: 15216389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
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.
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Abstract
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.
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