Maxillary fungus ball: zinc-oxide endodontic materials as a risk factor

open7openNICOLAI, Piero; MENSI, Magda; Marsili, F.; Piccioni, M.; SALGARELLO, Stefano Alessandro; GILBERTI, Maria Enrica; Apostoli, P.Nicolai, Piero; Mensi, Magda; Marsili, F.; Piccioni, M.; Salgarello, Stefano Alessandro; Gilberti, Maria Enrica; Apostoli, P

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 � 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage

Long-term bond strength and endogenous enzymatic activity of a chlorhexidine-containing commercially available adhesive

10siObjectives: The aim of this study was to investigate, by the means of microtensile bond strength (μTBS) test, gelatin and in situ zymography, the influence of 0.2% CHX contained within a commercially available adhesive on long-term bond strength and endogenous enzymatic activity. Methods: Non-carious teeth were subjected to μTBS test (N = 15 for each group) and stressed until failure. μTBS was evaluated immediately and after 12-month storage in artificial saliva at 37 °C. Dentin powder was obtained from additional teeth (N = 7) for gelatin zymography, while for in situ zymography, 3 teeth for each group were selected. Gelatin and in situ zymography were performed in dentin powder and slices of dentin, respectively, to assess the ability of 0.2% CHX blended within the adhesive to inhibit endogenous enzymatic activity. Results: μTBS bond strength was higher in the CHX-containing groups, immediately as well as after aging. The bond strength significantly decreased after 12-month aging. The activation of endogenous MMPs was found to be related to the presence of CHX within the adhesive system and the bonding strategy employed. Conclusions: Under this perspective 0.2% CHX blended within Peak Universal adhesive monomer seems to in- crease immediate bond strength, to preserve bond strength over time and to efficiently inhibit endogenous enzymatic activity in dentin. Hence, blending the CHX in low concentrations within the adhesive could be recommended as a feasible technique in every-day clinical practice. Clinical significance: Using CHX-containing adhesives could be recommended due to several benefits: it seems to increase the longevity of the hybrid layer; the inhibitor appears to be efficiently delivered to the dentinal substrate and to inhibit endogenous enzymatic activity, without prolonging chair time.openopenMaravić, Tatjana; Comba, Allegra; Cunha, Sandra Ribeiro; Angeloni, Valeria; Cadenaro, Milena; Visinitini, Erika; Navarra, Chiara Ottavia; Salgarello, Stefano; Breschi, Lorenzo*; Mazzoni, AnnalisaMaravić, Tatjana; Comba, Allegra; Cunha, Sandra Ribeiro; Angeloni, Valeria; Cadenaro, Milena; Visinitini, Erika; Navarra, Chiara Ottavia; Salgarello, Stefano; Breschi, Lorenzo; Mazzoni, Annalis

Effect of benzalkonium chloride on dentin bond strength and endogenous enzymatic activity

Objective: This in vitro study evaluated at baseline (T0) and over time (T12 months), the effect of a multi-mode universal adhesive compared with two experimental formulations blended with different concentrations of benzalkonium chloride (BAC), on bond strength and endogenous enzymatic activity. Methods and materials: Specimens were assigned to the following groups according to the adhesive protocol: G1) All-Bond Universal (ABU) self-etch (SE); G2) ABU + 0.5% BAC SE; G3) ABU + 1% methacrylate BAC SE; G4) ABU etch-and-rinse (E&R); G5) ABU + 0.5% BAC E&R; G6) ABU + 1% methacrylate BAC E&R. Gelatin zymography was performed on dentin powder obtained from eight human third molars. Endogenous enzymatic activity within the hybrid layer was examined using in situ zymography after 24 h (T0) or 1-year storage in artificial saliva (T12). Forty intact molars were prepared for microtensile bond strength test at T0 and T12. Results were statistically analyzed with three-way ANOVA (\u3b1 = 0.05). Results: Gelatin zymography assay and in situ zymography quantification analyses indicated that all the BAC-containing formulations decreased matrix metalloproteinase expression. However, in situ zymography showed a general trend of enzymatic activity increase after aging. Microtensile bond-strength testing showed decrease in bond strength over time in all the tested groups; performances of the 1% methacrylate BAC experimental groups were worse than the control. Conclusions: BAC-containing adhesives reduce endogenous enzymatic activity both immediately and over time. However, independently from the adhesive employed, increase in the gelatinolytic activity over time and decrease in bond strength was found (especially in the BAC + 1% methacrylate groups), probably due to impaired polymerization properties. Clinical significance: Adhesives containing protease inhibitors are practical and efficient tools in clinical practice for enhancement of the longevity of dental restorations. However, extensive investigation of the mechanical and adhesive properties of the material is necessary prior to their clinical use

Should breast reconstruction and breast oncoplastic procedures be performed during the coronavirus pandemic?

The onset of the COVID-19 pandemic has changed the face of the treatment of breast cancer and breast reconstruction globally. Mastectomy with immediate implant-based breast reconstruction was on the rise due to advances in meshes and implants. However, due to the prioritisation of the critically ill and diversion of the work force, breast cancer treatment has drastically changed. This is an opinion paper written by the authors with experience and importance in the scenario of breast reconstructive surgery. The authors are from different countries with the COVID-19 pandemic in different stages

Regenerative strategy for persistent periprosthetic leakage around tracheoesophageal puncture: Is it an effective long-term solution?

Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 ± 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage

Surgical treatment of a giant tibial high-grade mixofibrosarcoma with preservation of limb function: a case report

Myxofibrosarcoma is one of the most common sarcomas in elderly patients showing a slight male prevalence. The tumor is mainly located in lower and upper extremities and rarely in trunk, neck and feet. We present a case of a 84-year-old man referred to our tumour center with a giant and neglected high-grade tibial myxofibrosarcoma in the anteromedial side of tibial mid-diaphysis. Large size lesions in association with older age may jeopardise the maintenance of limb vitality, vascularity and stability

Dopaminergic Neurotransmission in Patients With Parkinson's Disease and Impulse Control Disorders: A Systematic Review and Meta-Analysis of PET and SPECT Studies

Background: Around 30% Parkinson's disease (PD) patients develop impulse control disorders (ICDs) to D2/3 dopamine agonists and, to a lesser extent, levodopa. We aim to investigate striatal dopaminergic function in PD patients with and without ICD.Methods: PubMed, Science Direct, EBSCO, and ISI Web of Science databases were searched (from inception to March 7, 2018) to identify PET or SPECT studies reporting striatal dopaminergic function in PD patients with ICD (ICD+) compared to those without ICD (ICD–). Studies which included drug naïve patients, explored non-pharmacological procedures (e.g., deep brain stimulation), and those using brain blood perfusion or non-dopaminergic markers were excluded. Standardized mean difference (SDM) was used and random-effect models were applied. Separate meta-analyses were performed for dopamine transporter level, dopamine release, and dopamine receptors availability in the putamen, caudate, dorsal, and ventral striatum.Results: A total of 238 studies were title and abstract screened, of which 19 full-texts were assessed. Nine studies (ICD+: N = 117; ICD–: N = 175 patients) were included in the analysis. ICD+ showed a significant reduction of dopamine transporter binding in the putamen (SDM = −0.46; 95% CI: −0.80, −0.11; Z = 2.61; p = 0.009), caudate (SDM = −0.38; 95% CI: −0.73, −0.04; Z = 2.18; p = 0.03) and dorsal striatum (SDM = −0.45; 95% CI: −0.77, −0.13; Z = 2.76; p = 0.006), and increased dopamine release to reward-related stimuli/gambling tasks in the ventral striatum (SDM = −1.04; 95% CI: −1.73, −0.35; Z = 2.95; p = 0.003). Dopamine receptors availability did not differ between groups. Heterogeneity was low for dopamine transporter in the dorsal striatum (I2 = 0%), putamen (I2 = 0%) and caudate (I2 = 0%), and pre-synaptic dopamine release in the dorsal (I2 = 0%) and ventral striatum (I2 = 0%); heterogeneity was high for dopamine transporter levels in the ventral striatum (I2 = 80%), and for dopamine receptors availability in the ventral (I2 = 89%) and dorsal (I2 = 86%) striatum, putamen (I2 = 93%), and caudate (I2 = 71%).Conclusions: ICD+ patients show lower dopaminergic transporter levels in the dorsal striatum and increased dopamine release in the ventral striatum when engaged in reward-related stimuli/gambling tasks. This dopaminergic imbalance might represent a biological substrate for ICD in PD. Adequately powered longitudinal studies with drug naïve patients are needed to understand whether these changes may represent biomarkers of premorbid vulnerability to ICD

L’impatto della ricostruzione mediante lembo microvascolare nei tumori del cavo orale: la nostra esperienza su 130 casi

Obiettivo del presente studio è stato valutare i risultati oncologici della nostra casistica di pazienti affetti da tumore del cavo orale trattati mediante chirurgia compartimentale radicale seguita da ricostruzione mediante lembo microvascolare. Abbiamo condotto un’analisi retrospettiva su 130 casi. Tutti i pazienti sono stati sottoposti ad una resezione chirurgica della neoformazione seguita da una ricostruzione immediata mediante lembo libero e, quando necessario, in accordo con la valutazione espressa dal nostro tumor board e con le linee guida internazionali, ad un trattamento chemioradioterapico adjuvante. Le curve di sopravvivenza specifica per malattia (DSS) sono state ottenute mediante il metodo di Kaplan-Meier. Il test Long Rank e il Wilcoxon sono stati utilizzati per investigare i più importanti fattori influenzanti la sopravvivenza specifica per malattia a 5 anni. Per calcolare l’HR e il RR per le singole variabili è stato utilizzato un modello di Cox. L’88,5% dei pazienti è risultato affetto da una neoplasia a istologia squamocellulare. Il campione è risultato essere composto da 46 (35,4%) donne e 84 (64,6%) uomini con un età media di 58,5 anni. Al termine del periodo di follow up, 36 pazienti (27,7%) erano deceduti, 3 dei quali per altre cause. Il DSS è stato del 67,8% (S.E. = 4,9%). All’analisi univariata secondo Kaplan-Meier ed alla analisi multivariata con regressione di Cox sono state individuate sette differenti variabili aventi una relazione significativa con il DSS: T (p = 0,026) ed N (p = 0,0001), lo staging clinico (UICC TNM Sixth Edition) (p = 0,007), i margini di resezione (p = 0,001), l’extracapsular spread (p = 0.005), la recidiva di malattia (p = 0,00002) e la modalità di trattamento (sola chirurgia o chirurgia + RT/CHT) (p = 0,004). In nostri risultati sono risultati in linea con le osservazioni in letteratura, e ci permettono di sottolineare come la chirurgia ricostruttiva mediante lembo libero microvascolare possa incrementare la sopravvivenza nei pazienti con tumore del cavo orale