Influence of the Antithrombotic Therapy in the Healing of Simple Post-Extraction Sockets: A Randomized Clinical Trial

Background: An adequate blood supply plays a leading role in the healing process of the post-extractive socket; its coagulation leads to fibrin clot formation, which acts as a physical barrier able to prevent postoperative bleeding and microbial infection. The purpose of this study was to evaluate the effectiveness of antiaggregant drugs in healing post-extraction sockets compared to natural wound healing. Methods: This was a single-center prospective clinical trial. Extraction sockets allocated in healthy patients and in patients assuming antiplatelet drugs were considered. Thirty consecutive patients under (treated with/in treatment with) oral antiplatelet treatment were enrolled in the test group. In order to provide a control group, 30 consecutive patients meeting all the exclusion and inclusion criteria were enrolled. The extraction of the mono-radicular tooth was atraumatically performed without gingivoplasty or osteotomy procedures that could influence the healing process. Photographs were obtained before and immediately after surgery and at 3-, 7-, 14-and 28-days follow-up. Results: All patients assumed the prescribed therapy and their postoperative recovery was uneventful without any kind of post-extractive complications. The results of inter-group comparison show that on the third and seventh days of follow-up, the antiplatelet group expressed a statistically significant higher level of healing compared to the control group (p < 0.05), while no statistically significant differences were recorded at 14-and 28-days follow-up. Conclusions: Patients treated with antiplatelet agents seemed to show that this therapy can positively affect the healing process after tooth extractions

Rationale, experimental data, and emerging clinical evidence on early and preventive use of levosimendan in patients with ventricular dysfunction

Acute ventricular dysfunction (AVD) is a complex condition with substantial morbidity and mortality, still featuring unique therapeutic challenges. Levosimendan is a calcium sensitizer and ATP-dependent potassium channel opener that was developed as an inodilating drug for the treatment of acute heart failure and cardiogenic shock. Differently from other more widely used inotropic agents, levosimendan has some exclusive characteristics, in terms of mechanisms of action, pharmacodynamic profile, and haemodynamic effects. This may have important clinical implications. In particular, in patients with AVD or in patients with pre-existing severe ventricular impairment undergoing planned myocardial stress, the administration of levosimendan before the onset of overt symptoms or before cardiovascular therapeutic procedures may have the potential to bridge the patient through the critical phase. In this review, we will focus on the rationale, the existing experimental data, and the emerging clinical experience supporting an early, even preventive use of levosimendan in severe ventricular dysfunction, beyond its recognized indications

Aligning taxation and international financial reporting standards: Evidence from Italian listed companies

We estimate the effect of adopting International Financial Reporting Standards results (IFRS) as the base for the regional business tax (IRAP). Analysing the unconsolidated financial statements of non-financial Italian listed companies, we simulate the change in the IRAP base where companies move from Italian Generally Accepted Accounting Principles (GAAP) to IFRS. The results show that the impact of the use of IFRS for the computation of tax figures is relatively important and that the sector in which companies operate has a decisive influence on the amount by which the taxable base differs. The empirical analysis suggests that the transition increases, on average, the IRAP base of around 15% and that companies in the constructions and utilities sectors suffer an additional burden of around 29% and 31%, respectively. Similarly to Italy, many European Member States are characterized by creditor protection oriented domestic GAAP and by a close link between tax and financial reporting and could therefore experience similar effects due to the use of a IFRS-based tax accounting.We estimate the effect of adopting International Financial Reporting Standards results (IFRS) as the base for the regional business tax (IRAP). Analysing the unconsolidated financial statements of non-financial Italian listed companies, we simulate the change in the IRAP base where companies move from Italian Generally Accepted Accounting Principles (GAAP) to IFRS. The results show that the impact of the use of IFRS for the computation of tax figures is relatively important and that the sector in which companies operate has a decisive influence on the amount by which the taxable base differs. The empirical analysis suggests that the transition increases, on average, the IRAP base of around 15% and that companies in the constructions and utilities sectors suffer an additional burden of around 29% and 31%, respectively. Similarly to Italy, many European Member States are characterized by creditor protection oriented domestic GAAP and by a close link between tax and financial reporting and could therefore experience similar effects due to the use of a IFRS-based tax accounting

Advanced platelet-rich fibrin as a therapeutic option in the treatment of dry socket: Literature review and case series

Alveolar osteitis (AO) is one of the complications that occur after tooth extraction. The aim of this study has been to evaluate the efficacy of Advanced Platelet-rich Fibrin (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of AO. Consecutive patients who were diagnosed with AO, recruited from patients referred to the Oral Surgery Department of the University of Naples Federico II, were enrolled. After local anesthesia, the dry socket was curetted and irrigated with saline. The Platelet-rich Fibrin (PRF) clot was placed in the socket and then covered with an A-PRF membrane. Clinical parameters, such as the degree of pain and rate of granulation tissue (GT) formation, were measured before treatment and after 1, 3, 7, 14, and 21 days. The Friedman test for dependent samples was used to detect the treatment and time effect. Four patients with established AO were included. On all the examination days, the post-operative recovery was uneventful. The pain scores progressively reduced, from an average of 8.5 before treatment to 0.25 on the third day, and the GT formation improved over time. The use of A-PRF in the treatment of AO significantly reduced the pain level and enhanced the wound-healing process

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration

Thermography as a method to detect dental anxiety in oral surgery

(1) Background: the aim of this study was to evaluate if dental anxiety can be measured objectively using thermal infrared imaging. (2) Methods: Patients referred to the Department of Oral Surgery of the University of Naples Federico II and requiring dental extractions were consecutively enrolled in the study. Face thermal distribution images of the patients were acquired before and during their first clinical examination using infrared thermal cameras. The data were analyzed in relation to five regions of interest (ROI) of the patient’s face (nose, ear, forehead, zygoma, chin). The differences in the temperatures assessed between the two measurements for each ROI were evaluated by using paired T‐test. The Pearson correlation and linear regression were performed to evaluate the association between differences in temperatures and Modified Dental Anxiety Scale (MDAS) questionnaire score, age, and gender; (3) results: sixty participants were enrolled in the study (28 males and 32 females; mean age 57.4 year‐old; age range 18–80 year‐old). Only for nose and ear zone there was a statistically significant difference between measurements at baseline and visit. Correlation between the thermal imaging measurements and the scores of the MDAS questionnaire was found for nose and ear, but not for all of the other regions. (4) Conclusions: the study demonstrated a potential use of thermal infrared imaging to measure dental anxiety

Trials in "true" dyslipidemic patients are urged to reconsider comprehensive lipid management as a means to reduce residual cardiovascular risk

Randomized cardiovascular trials aimed to reduce the excessive residual risk in high-risk patients through a more aggressive LDL-cholesterol control or targeting triglycerides or HDL-cholesterol levels have shown a null or, at best, limited incremental benefit. In some cases, the treatment produced meaningful effects only in study subgroups. As a consequence, some compounds were withdrawn (e.g. nicotinic acid derivatives and CETP inhibitors), whereas others (fibrates) are utilized with reluctance due to the low level of evidence-based data. By reviewing these trials analytically, we identified a common feature that might explain their meagre results: most of them involved patients generically at high cardiovascular risk with normal or near normal lipid levels and not patients with "true" dyslipidemia, who would receive the treatment if it were part of usual care. These observations may warrant reexamining a central criterion of pragmatism, eligibility, in the outline of forthcoming cardiovascular trials with novel lipid-modifying drugs