An amino acid mixture, enriched with Krebs cycle intermediates, enhances extracellular matrix gene expression in cultured human fibroblasts

: In the human body, the skin is one of the organs most affected by the aging process. Nutritional approaches aimed to counteract the age-induced decline of extracellular matrix (ECM) deposition could be a valuable tool to decrease the degenerative processes underlying skin aging. Here, we investigated the ability of a six-amino acid plus hyaluronic acid (6AAH) formulation enriched with tricarboxylic acid (TCA) intermediates to stimulate ECM gene expression. To this aim, human BJ fibroblasts were treated with 6AAH alone or plus succinate or malate alone or succinate plus malate (6AAHSM), and mRNA levels of several ECM markers were evaluated. 6AAHSM increased the expression of all the ECM markers significantly above 6AAH alone or plus only succinate or malate. Furthermore, in an in vitro oxidative damage model, 6AAHSM blunted the hydrogen peroxide-induced decline in ECM gene expression. Our data suggest that feeding cells with 6AAH enriched with TCAs could efficiently be employed as a non-pharmacological approach for counteracting skin aging

Implant surfaces exposed to the oral cavity and treated with toothpaste containing oxygen releasing compound : a morphological controlled clinical trial

Aim of the present in vivo study is to assess if a toothpaste containing an oxygen releasing compound (AX) is able to reduce the biofilm formation on implants with rough surface compared to a control toothpaste, without affecting the microstructure of the tested surface. Methods: In this double blind, cross-over, controlled clinical trial, a total of fourteen healthy volunteers were recruited. For each subject, two mandibular splints (test and control) were created with one implant fixed on the right lingual side of the mandibular arch. The splint was continuously worn for 5 days and the daily hygiene was performed wearing the splint and using the test (AX) or control toothpaste. Implants were analyzed at scanning-electron-microscopy and at laser profilometer for the assessment of biofilm adhesion (% of areas free from biofilm-FA) and surface changes (morphology and roughness). Results: FA resulted significantly higher in test than in control implants. No differences were found between groups in term of biofilm organization, surface microstructure and roughness. Discussion: Daily use of toothpaste containing AX seems to reduce the amount of biofilm adherent to the rough implant surface without corrosion or degradation of the titanium surface

Dental treatment of a rare case of pyoderma gangrenosum with aggressive periodontal disease

Background and Overview: Pyoderma gangrenosum (PG) is a rare neutrophil-mediated autoinflammatory dermatosis that can involve the oral mucosa. Dental surgery is a potential triggering factor for the onset of PG lesions. The authors describe and discuss the dental management of a rare case of aggressive periodontitis in a patient with PG, from multiple tooth extractions to prosthetic rehabilitation, including administration of systemic steroid prophylaxis before surgery to prevent the potential onset of PG-related lesions. Case Description: A 22-year-old man who had a diagnosis of PG and who had aggressive periodontal disease underwent dental extractions, gingivoplastic surgery, and prosthetic rehabilitation. The patient received 8 milligrams of betamethasone intramuscularly 20 minutes before the oral surgery. The tissues healed perfectly, and no adverse effects were reported. Conclusions and Practical Implications: For minor oral surgery, prophylactic corticosteroids might help reduce the risk of developing PG-related lesions. The clinician should plan the prosthetic devices to be as atraumatic as possible

Hypertrophic cardiomyopathy: two-dimensional echocardiographic score versus clinical and electrocardiographic findings.

The severity and site of hypertrophy is important in determining the clinical picture and the natural history of hypertrophic cardiomyopathy (HCM). We evaluated left ventricular hypertrophy by means of two-dimensional echocardiographic score and score index, and correlated these findings with symptoms, electrovector-cardiographic data, and ventricular arrhythmias. A total of 42 patients with HCM were studied by clinical examination, ECG, VCG, M-mode and 2D echocardiography, and 24-h Holter monitoring. The extent and severity of the hypertrophic process were calculated by a score system. The left ventricle was divided into 11 segments and a hypertrophic score (HS) was given to each segment. A hypertrophy score index (HSI) was also calculated by dividing the number of hypertrophied segments by 13. No correlation was found between symptoms and HS and HSI, nor ECG-VCG abnormalities and HS and HSI. A statistically significant relationship between the severity of ventricular arrhythmias and HS and HSI was found (p less than 0.01). The mechanism responsible for ventricular tachyarrhythmias in severe and diffuse hypertrophy might reside in the high intraventricular pressures which produce or worsen areas of myocardial ischemia

Antimicrobial activity of zinc-doped hydroxyapatite coatings formed on titanium Ti6A14V surface for orthopedic implant

Prosthetic joint infection (PJI) is one of the most serious complications of prosthetic joint implantation leading to a longer hospitalization. S. aureus is the predominant cause of PJI followed by Pseudomonas aeruginosa and Stafilococci spp. coagulase negative. Several studies focused on the development of effective antibacterial surfaces that prevent bacterial adhesion, colonisation and proliferation into the surrounding tissues and it has been widely demonstrated that zinc ions (Zn2+) exhibit antimicrobial activity against various bacterial and fungal strains. In addition to its antimicrobial activities, zinc is important in healthy bone growth and development. The aim of this study was to evaluate the in vitro activity of Zn2+ generated from the partial dissolution of Zn particles on surface of titanium discs, against S. aureus ATCC 29213. Hydroxyapatite (HA), and HA/Zn2+ doped discs were used. Each disc was incubated with bacterial suspension following standard ASTM (American Society for Testing and Materials) method. After, colony-forming unit (CFU) were counted. The results showed 1,7 log10 (97,8 %) CFU decrease vs untreated samples (p< 0.05), after 6 hours of incubation. To confirm quantitative data, morphological analysis was performed by Scanning Electron Microscope (SEM). On HA disc, bacteria, recognized by the typical spherical shape, colonized micro and nano porosities surface assuming an homogeneous distribution, while on the surface doped with Zn2+, being smoother and less porous, the bacteria adhered to the surface in small colonies of about 2-10 bacteria. This new formulation of zinc coating could represent a promising approach for prevention and treatment of peri-implant diseases

Beta-tricalcium phosphate ceramic triggers fast and robust bone formation by human mesenchymal stem cells

Due to their osteoconductive and inductive properties, a variety of calcium phosphate (CaP) scaffolds are commonly used in orthopaedics as graft material to heal bone defects. In this study, we have used two CaP scaffolds with different hydroxyapatite (HA) and \u3b2-tricalcium phosphate (\u3b2-TCP) ratios (MBCP\uae; 60/40 and MBCP+\uae; 20/80) to investigate their intrinsic capacity to favour human bone marrow stem cells (hBMSCs) osteogenic differentiation capacity. We report that MBCP+\uae showed in in vitro culture model a higher rate of calcium ion release in comparison with MBCP\uae. In two defined coculture systems, the hBMSC seeded onto MBCP+\uae presented an increased amount of VEGF secretion, resulting in an enhanced endothelial cell proliferation and capillary formation compared with hBMSC seeded onto MBCP\uae. When both ceramics combined with hBMSC were implanted in a nude mouse model, we observed a faster osteogenic differentiation and enhancement mature bone deposition sustained by the presence of a vast host vasculature within the MBCP+\uae ceramics. Bone formation was observed in samples highly positive to the activation of calcium sensing receptor protein (CaSr) on the surface of seeded hBMSC that also shown higher BMP-2 protein expression. With these data we provide valuable insights in the possible mechanisms of ossification and angiogenesis by hBMSC that we believe to be primed by calcium ions released from CaP scaffolds. Evidences could lead to an optimization of ceramic scaffolds to prime bone repair

O Sistema Nacional de Pesquisa Agropecuária: proposta de implentação para um novo modelo de gestão e governança.

A agropecuária há muitos anos vem desempenhando um papel de grande relevância para o crescimento econômico brasileiro, possibilitando ao país ser um dos maiores exportadores mundiais de produtos agrícolas. Uma importante estrutura que contribui para este resultado positivo é o Sistema Nacional de Pesquisa Agropecuária (SNPA), que atualmente se encontra fragilizado devido à falta de coordenação e cooperação entre os atores, além da redução de recursos. Neste contexto, o Centro de Gestão e Estudos Estratégicos (CGEE), propôs uma alternativa de arranjo para a pesquisa agropecuária, que compreende a estruturação, no médio e longo prazo, de uma plataforma, que possibilitará a articulação, alinhamento e sinergia entre os atores envolvidos no processo de pesquisa e inovação para a agricultura do País. Este trabalho objetiva apresentar uma proposta de implementação, no curto prazo, para se alcançar o modelo formulado pelo CGEE. Realizamos um estudo de caso sobre o SNPA, por meio de uma breve revisão bibliográfica de conceitos pertinentes às necessidades de análise do Sistema. Descrevemos os principais eventos da trajetória do SNPA ocorridos entre 1972 e 2015 para entender seu funcionamento e sua dinâmica. A análise do Sistema foi realizada por meio do estudo de artigos, livros e teses sobre o caso e, em especial, por meio das entrevistas efetuadas com diferentes atores que representam o Sistema: acadêmicos, dirigentes e colaboradores das Organizações Estaduais de Pesquisa Agropecuária (OEPAs), dirigentes dos conselhos de representação, gestores públicos e representantes do setor privado. Constatamos que a implementação do modelo, para ser factível no curto prazo, deveria ser realizada por uma instituição que ocupasse papel preponderante no SNPA e que já dispusesse de mecanismos legais e de capacidade técnico-operacional necessários à validação e à execução do novo modelo. Foi possível identificar também a necessidade de inovações institucionais e organizacionais do Sistema, principalmente para atender às demandas dos produtores e da sociedade. Por fim, uma das mais relevantes constatações é a de que: a efetividade do novo arranjo só ocorrerá se as instituições e atores envolvidos se reconhecerem como coautores, tiverem proatividade e perceberem seu papel e suas responsabilidades.Orientada por Ana Cristina Braga Martes, FGV

Heart Rate Turbulence Predicts Survival Independently From Severity of Liver Dysfunction in Patients With Cirrhosis

Background: Reduced heart rate variability (HRV) is an independent predictor of mortality in patients with cirrhosis. However, conventional HRV indices can only be interpreted in individuals with normal sinus rhythm. In patients with recurrent premature ventricular complexes (PVCs), the predictive capacity of conventional HRV indices is compromised. Heart Rate Turbulence (HRT) represents the biphasic change of the heart rate after PVCs. This study was aimed to define whether HRT parameters could predict mortality in cirrhotic patients. Materials and Methods: 24 h electrocardiogram recordings were collected from 40 cirrhotic patients. Turbulence Onset was calculated as HRT indices. The enrolled patients were followed up for 12 months after the recruitment in relation to survival and/or transplantation. Results: During the follow-up period, 21 patients (52.5%) survived, 12 patients (30%) died and 7 patients (17.5%) had liver transplantation. Turbulence Onset was found to be strongly linked with mortality on Cox regression (Hazard ratio = 1.351, p < 0.05). Moreover, Turbulence Onset predicted mortality independently of MELD and Child-Pugh's Score. Conclusion: This study provides further evidence of autonomic dysfunction in cirrhosis and suggests that HRT is reliable alternative to HRV in patients with PVCs

Il Percorso Diagnostico Terapeutico Assistenziale del paziente con melanoma metastatico presso l\u2019Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo come strumento applicativo della clinical governance

L\u2019evoluzione dello scenario internazionale relativo alla sanit\ue0 identifica cinque specifiche dimensioni come driver del cambiamento: il sistema, la finanza, le persone, i processi e la tecnologia. In linea con tali elementi, il patto per la salute 2014-2016 esplicita la necessit\ue0 di una rivisitazione a tutti i livelli del sistema salute, sia organizzativo che gestionale, con l\u2019intento di aumentare l\u2019efficienza e l\u2019efficacia, sviluppando nuovi modelli assistenziali, anche nella logica delle reti cliniche, dove tra gli \u201cstrumenti\u201d viene identificata l\u2019attivazione di Percorsi Diagnostico Terapeutico Assistenziali (PDTA). I percorsi condivisi e codificati per i vari stadi di patologia, con un sistema di raccolta dei dati clinici che possa generare gli indicatori di processo e di esito, sono ritenuti indispensabili per innescare il miglioramento della qualit\ue0 e valutare l\u2019efficacia e l\u2019efficienza. Tenendo conto di queste premesse, nell\u2019ambito dell\u2019Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo \ue8 stata sviluppata una progettualit\ue0 al fine di formalizzare e studiare il PDTA del paziente con melanoma metastatico, identificando il percorso ideale e descrivendo il percorso applicabile con le relative leve del cambiamento. Il progetto ha reso evidente come la gestione consapevole del \u201cprofondo cambiamento\u201d in essere nelle organizzazioni clinico assistenziali pu\uf2 essere \u201cgovernata\u201d grazie anche alla \u201cdocumentazione\u201d del proprio modo di operare in riferimento alle Linee Guida di riferimento e alle relative raccomandazioni. Il progetto ha reso evidente inoltre come la sostenibilit\ue0 dei percorsi passa anche attraverso la definizione di opportuni indicatori, correlati alle diverse fasi ed attivit\ue0 chiave, da poter monitorare nella \u201cvita corrente dell\u2019organizzazione\u201d

Arm position as a source of error in blood pressure measurement

The present study was designed to assess the value of correct positioning of a patient's arm when measuring blood pressure (BP). A total of 181 subjects were examined, 141 hypertensives on treatment, 25 untreated hypertensives, 15 normotensives. All the subjects underwent three BP measurements after a 5-min resting period in supine position. Then two BP readings were recorded in standing position with the arm either positioned by the patient's side or supported passively at patient's heart level. Average systolic BP (SBP) in standing position were 144.6 +/- 20.2 mmHg with the arm at the side and 136.4 +/- 21.1 mmHg with the arm at the heart level (p less than 0.001); average diastolic pressures were 99.0 +/- 12.0 mmHg and 90.2 +/- 12.3 mmHg (p less than 0.001), respectively. A fall in SBP greater than or equal to 20 mmHg from the supine to the upright position was detected in 18.2% of cases when measurement was performed at heart level; such a reduction was inapparent in two-thirds of cases when the arm was placed at the patient's body side. Incorrect positioning of a patient's arm during BP measurements in standing position leads to overestimation of BP values and masks the presence of postural hypotension