Laterolateral teleradiography of the skull as a screening method for OSA/OSAS, in patients in orthodontic treatment

Aim: Obstructive sleep apnea syndrome (OSAS) is the most common type of sleep apnea and it is caused by complete or partial obstruction of the upper airway. Adenotonsillar hypertrophy, obesity, cranio-facial anomalies and neuromuscular diseases are the main risk factors for the development of OSAS in the pediatric age. Specially several studies identify the relationship between respiratory disorders in sleep and obesity, and, in particular, between OSAS and obesity, designing a prevalence of OSAS among obese subjects between 14 and 78%. The diagnosis of OSAS in the child is of great importance as it can lead to neurocognitive and behavioral complications, growth retardation, systemic arterial hypertension, pulmonary hypertension, cardiovascular disease and metabolism. The WHO (World Health Organization) has established the new criteria for the classification of Obesity on the basis of BMI and the risk of comorbidities, identifying a moderate risk for underweight subjects, a very low risk for normal weights and an increased risk from severe to severe for overweight and obese individuals respectively. According to that the aim of this study is to evaluate the correlation between obstructive sleep apnea syndrome and cephalometric variables in children considering age and BMI. Materials and methods: Children aged 7–10 years and 11-14 years with no genetic syndrome, previous otorhinolaryngologic or orthodontic therapy treatments are being selected from our Departments of Paediatric Dentistry, University of Palermo, and from the Department of Orthodontics, University of Messina (Italy). All patients so far recruited and visited for orthodontic problems were in mixed or early permanent dentition phase, with the first upper molars fully erupted and presented to the history of several symptoms of Osas, such as recurring episodes of shallow or paused breathing during sleep, waking up frequently to urinate, morning headaches, memory or learning problems and not be able to concentrate or feeling irritable. Dental records and lateral cephalometric radiographs were obtained for all of the patients and than they have been subjected to paediatric, otolaryngology and polysomnography visits. Subject with a positive diagnosis of Osas were studied and they were divided in group based on their BMI. In all groups the inter-molar distance in dental records was measured, and the cephalometric traces have been calculated. As reported by the study by Galeotti et al. the cephalometric measurements analysed are S-PNS, ad1-PNS, and ad2-PNS for the nasopharynx; p-pp and pa for oropharynx; H-H’ for the Hyoid bone; SNA for the maxilla; SNB;ANB and Go-Me for the mandible; S-Go, N-Me and P-A for facial Height; SN for cranial base; SN-MP and PP-MP for the typology, and angle ArGoMe for Growth prevision. At the time that children are still in the way of recruitment the results may not yet be defined; however it is necessary to emphasize the importance of the study, because in the child respiratory disturbances in the sleep, and in particular the OSAS, are often underestimated, despite representing the third place between the threats of health after the smoke and the excess of weight

Le aree protette e la valorizzazione del territorio: il Parco fluviale dell'Alcantara

Partendo dall’analisi del ruolo che i Parchi e le aree Protette ricoprono per la salvaguardia di zone ambientali di particolare interesse paesaggistico, con il loro patrimonio di specie animali e vegetali, spesso in pericolo di estinzione, il mio studio si è incentrato sul Parco Fluviale dell’alcantara, il più giovane dei parchi regionali siciliani, istituito a protezione e salvaguardia dell’ecosistema fluviale, dell’ambiente naturale e del paesaggio attraversato dal fiume Alcantara. Starting from the analysis of the role that the Parks and Protected Areas cover for the Protection of environmental areas of special landscape interest, with their wealth of animal and plant species, often in danger of extinction, my study focused on River Park Alcantara, the youngest of the sicilian regional parks, established to preserve and protect the river ecosystem, the natural environment and landscape crossed by the river Alcantara

Chronic Migraine: A Narrative Review on the Use of Botulinum Toxin with Clinical Indications and Future Directions

Chronic migraine belongs to the "chronic long-duration headaches", and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. Chronic migraine belongs to the "chronic long-duration headaches", and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. The pathophysiology of CM is characterized by an abnormal activation of the trigemino-vascular system in the meninges causing a neurogenic inflammation, which explains the use of anti-inflammatory during attacks. It seems that the objective of the preventive therapy with the botulin toxin OnaBoNT-A consists in interrupting the release of CGRP and other neuropeptides as well as the activation of C-fiber nociceptor and of the nearby A-delta fibers. The protocol for migraine treatment with OnaBoNT-A injections consists of 31-39 pericranial injection sites involving seven muscle groups bilaterally in specific areas of the head and neck, with a total dose of between 155 and 195 units, every three months. The severe adverse events reported with high doses of botulin toxin for spasticity, have not been reported for CM treated with OnabotA at the labeled dose. The established improvement with onabotulinumtoxinA treatment in CM patients had a positive impact not only in reduction monthly headache days but also in improving quality of life, with reduction in both healthcare resource utilisation (HRU) and work impairment. Aim of this review was to give an overview on the use of BoNT-A in patients with CM, giving practical advices on the clinical indications

The Effect of Genetic Background and Dose on Non-Targeted Effects of Radiation

Purpose: This work investigates the hypothesis that genetic background plays a significant role in the signalling mechanisms underlying induction and perpetuation of genomic instability following radiation exposure. Materials and methods: Bone marrow from two strains of mice (CBA and C57) were exposed to a range of X-ray doses (0, 0.01, 0.1, 1 and 3 Gy). Different cellular signalling endpoints: Apoptosis, cytokine levels and calcium flux, were evaluated at 2 h, 24 h and 7 d post-irradiation to assess immediate and delayed effects. Results: In CBA (radiosensitive) elevated apoptosis levels were observed at 24 h post X-irradiation, and transforming growth factor-β (TGF-β) levels which increased with time and dose. C57 showed a higher background level of apoptosis, and sustained apoptotic levels 7 days after radiation exposure. Levels of tumor necrosis factor-α (TNF-α were increased in C57 at day 7 for higher X-ray doses. TGF-β levels were higher in CBA, whilst C57 exhibited a greater TNF-α response. Calcium flux was induced in reporter cells on exposure to conditioned media from both strains. Conclusions: These results show genetic and dose specific differences in radiation-induced signalling in the initiation and perpetuation of the instability process, which have potential implications on evaluation of non-targeted effects in radiation risk assessment

Maxillary orthodontic expansion assisted by unilateral alveolar corticotomy and low-level laser therapy: a novel approach for correction of posterior unilateral cross-bite in adults

Introduction: The treatment of a true unilateral posterior crossbite often requires asymmetric maxillary expansion; however, this is challenging to achieve with conventional expansion methods because of several biomechanical limitations. In this paper, we introduce a new protocol for the treatment of a unilateral posterior crossbite in adults based on maxillary orthodontic expansion assisted by corticotomy and low-level laser therapy (LLLT) performed on the crossbite side. Methods: The study sample included 15 adults (8 females, 7 males) affected by a true unilateral posterior crossbite, with a mean age of 21.6 ± 3.1 years at the at the beginning of treatment. After the application of orthodontic appliances (palatal expander and self-ligating brackets), corticomy was performed at the buccal aspect of the crossbite side while LLLT was monthly administered up to the correction of the crossbite. The efficacy of the technique was evaluated through measurements performed on maxillary digital models. Results: All subjects reported successful correction of the posterior unilateral crossbite, and functional occlusion was achieved as well. The average expansion was greater at the crossbite side compared to the unaffected side and such difference was significant at the levels of first premolars (P < 0.05), second premolars (P < 0.05) and first molars (P < 0.05). Conclusion: Orthodontic maxillary expansion assisted by unilateral corticotomy and LLLT was effective in the treatment of the true unilateral crossbite

diagnosis and treatment of bilateral respiratory epithelial adenomatoid hamartomas with and without sinonasal polyposis

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Emerging Role of PPAR-β/δ in Inflammatory Process Associated to Experimental Periodontitis

The aim of the present study was to evaluate the contribution of peroxisome proliferator-activated receptor (PPAR-β/δ) in animal model of periodontitis. Male Sprague-Dawley rats were lightly anaesthetized with pentobarbitone (35 mg/kg). Sterile, 2-0 black braided silk thread was placed around the cervix of the lower left first molar and knotted medially. Animals received GW0742 (0.3 mg/kg, 10% DMSO, i.p. after the ligature placement and daily for eight days). At day 8, the gingivomucosal tissue encircling the mandibular first molar was removed. One the eighth day after placement of the ligature, we evaluated (1) NF-κB expression, (2) cytokines expression, (3) iNOS expression, (5) the nitration of tyrosine, (6) apoptosis, and (8) the degree of gingivomucosal tissues injury. Administration of GW0742 significantly decreased all of the parameters of inflammation as described above. Taken together, these results demonstrate that GW0742 exerts an anti-inflammatory role during experimental periodontitis and is able to ameliorate the tissue damage

Integrins in masseter muscle in unilateral crossbite patients: an immunohistochemical and molecular study

Integrins are a large family of transmembrane heterodimeric receptors that play a key role in cell adhesion, differentiation, remodelling and tissue repair. b1D isoform is detected only in skeletal and cardiac muscle, while very low amounts of b1A were detected by immunoblot in striated muscles. b1D isoform was associated with a7A and a7B in adult skeletal muscle. Although many studies have been performed on the integrins in adult skeletal muscle, insufficient data exist on behaviour of these proteins in masseter muscle. About this muscles it was demonstrated that they have several differences in respect to limb and trunk muscles. Generally, fibers in the masseter muscle are smaller than fibers in limb and trunk muscles. Consequently, the smaller muscle fibers may be advantageous for the jaw muscles. On this basis, we performed an immunohistochemical and molecular study in order to analyze the behaviour of integrins in normal masseter muscle of both side; moreover, to better comprehend the role of these proteins, we also analyzed masseter muscles of patients affected by unilateral crossbite. Interestingly, our result, integrating with astatistical analysis, showed that, on patients affected by right crossbite, the integrins are substantially less, in both masseters, than those observed in control subjects; in right masseter, the amount of integrin appeared less than the amount of integrins detected in left counterpart. Since kinematics and electromyography study have been demonstrated that masseters of the crossbite side were less active than non-affected side, our results, showing a decrease of integrins in the masseter of crossbite side, allow to hypothesize that the integrins, and in particular alfa7A and beta1A integrins, could play a crucial role in the control of contraction activity

An immunohistochemical study of the human periodontal ligament during sperimental orthodontic movement

Orthodontic tooth movement is characterized by remodeling changes in dental and paradental tissues, including dental pulp, periodontal ligament (PDL), alveolar bone, and gingiva. These tissues, when exposed to varying degrees of magnitude, frequency, and duration of mechanical loading, express macroscopic and microscopic changes. The different modification of periodontal ligament during load deformation can be monitored by analysis of the expression of different collagen types, fibronectin and vascular endothelial growth factor. The aim of this study was to evalue PDL collagen types I and IV, fibronectin and vascular endothelial growth factor (VEGF) modification induced by application of a precalibrated and constant orthodontic strength at different stages of treatment. For the study we utilized a coilspring NiTi 50 gr. and in vivo samples of 20 maxillaries and mandibular premolars of patients aged from 13 to 18 years subject to orthodontic treatment. These teeth was extracted at 1, 7, 14, 21 and 28 days from application of force respectively. The extraction of the PDL was effectuated scarifying the radicular surface on the pressure and tension side. The results were compared with periodontal ligament samples of the normal homologous teeth (control). The periodontal ligament samples were fixed in 3% paraformaldehyde in a 0,2M phosphate buffer at pH 7,4. The following primary antibodies were used: anti collagen I, anti collagen IV, anti fibronectin and mouse monoclonal anti-VEGF. Section were then observed and photographed using Zeiss LSM 510 confocal microscope. Were analyzed fluorescence intensity and compared with the control side. The signal of type I collagen is negative in tension and pressure side after 1 day, showed an increased respect to control, in the tension and pressure side, until 7, 14 and 21 days. After this stage in both sides maintained the same values of the control. The immunofluorescence of type IV collagen is negative, in both sides, after 1 and 7 days. At 14, 21 and 28 days from treatment, increased gradually in pressure side and manteined the same values of the control in tension side. The observation of fibronectin showed strongly immunofluorescence at all stages of treatment. After 1, 7 and 14 days the immunofluorescence of VEGF is negative in pressure side, and positive in tension side. In the last observation periods at 21 and 28 days, VEGF signal showing, in both sides, significant increase when compared with the control group. These findings suggest that: the increase of collagen type I and fibronectin could indicate that the solicitation by orthodontic force could determinate an increase of metabolic activity in the periodontal ligament. The rapid modification after the start of tooth movement, suggest that VEGF may be involved in the early stages of periodontal remodeling during orthodontic tooth movement, when occur rapid changes in local blood circulation. The initial decrease of collagen type IV, indicate a loss of vascular component in the early stages of movement infact this protein is localized in perivessel zones