Emx1, Emx2 and Pax6 in Specification, Regionalization and Arealization of the Cerebral Cortex

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Lo studio FAST: FAringotonsillite STreptococcica in età pediatrica Impatto farmacoeconomico delle Linee Guida dell'American Academy of Pediatrics sulla pratica clinica di 600 pediatri italiani

The American Academy of Pediatrics (AAP) has recently published its new guidelines for the treatment of pediatric tonsillopharyngitis; a diagnostic test for the detection of streptococci is recommended, followed by a treatment with penicillins (10 days) or cephalosporins (5 days) in case of positivity, and by no treatment otherwise. The success of a guideline, in general, depends on its diffusion in practice and on its adaptability to different local settings. The aim of the present study (FAST) was the evaluation of the clinical and economical impact of the application of the AAP guidelines in the Italian reality. The study was conducted with the cooperation of 600 pediatricians, uniformly distributed on the Italian territory, and involved 3072 patients. The pediatricians were left free to decide whether to follow the guidelines or not. The results of the analysis indicate that only some 20% of the pediatricians adhered to the suggested protocol; the total cost (calculated in the perspective of the National Health System, with a time horizon of about 3 months) per patient, nonetheless, resulted inferior in the group treated according to the proposed protocol (50,45 • vs. 53,30 •). Furthermore, a lower incidence of complications occurred in these patients. Among the "off-protocol" behaviors, two showed particularly evident misuse of health resources: inappropriate treatment after test positivity (59,15 •/patient), and treatment after test negativity (14% of the total population). Another interesting, although not surprising, result of this study was the evidence that penicillins are as effective as cephalosporins in the short-term, but significantly inferior in terms of complications, positivity for streptococci at the control test, and complications detected at follow-up

Proteomic identification of salivary biomarkers in 20 patients with Oral Squamous Cell Carcinoma

Objectives. Saliva has been proposed as a potential diagnostic fluid combined with proteomic analysis. The aim of this study is to assess the proteomic salivary profile using SELDI-TOF-MS technology in patients with Oral Squamous Cell Carcinoma (OSCC), grouped in relation to the TNM staging and compared with healthy subjects. Methods. In this secondary hospital based case-control study, patients with confirmed histopathological diagnosis of primary untreated OSCC as “cases” and healthy age- and sex-matched subjects as “controls” were consecutively enrolled, after informed consent. Saliva (5 mL) was collected by spitting directly into a clean 15 mL conical tube, aliquoted and stored at -80°C until use. SELDI-TOF Q10 ProteinChip system was used to screen for differentially expressed proteins in the saliva samples according to the manufacturer’s instructions (BioRad Inc). Univariate statistics and Roc plot were used for data analysis. Results. Twenty cases (6 M, 14 F, middle age 66.8 yy) and 20 controls (8 M, 12 F, middle age 61.9 yy) were included. In cases, seven were early-EsOSCC (3 stage I and 4 stage II) and 13 were late-LsOSCC (7 stage III and 6 stage IV). Proteomic analysis showed significant statistical differences in peptide profile in control vs OSCC and in EsOSCC vs LsOSCC samples (p<0.05). The differentiated pattern between overall OSCC and controls consisted of one peptide peak (8940-ROC:1), between EsOSCC and controls of four peptide peaks (7096-ROC 0.93; 12712–ROC:0.89; 8086 – ROC: 0.93 and 11002 – ROC:0.93) and between LsOSCC and EsOSCC of one peptide peak (6026-ROC 0.80). Conclusions. Although with limitation of the small sample size, this first study suggests that saliva contains proteomic signatures that could serve as biomarkers for OSCC at different stages. Once validated on a large clinical cohort, oral fluid proteomic based on SELDI-TOF-MS technology may be extensively used as a promising new non-invasive tool for early diagnosis in oral cancer patients

The management of dental practices in the post-covid 19 era: An economic and operational perspective

Background: In order to protect dental teams and their patients during the COVID-19 pandemic, dentists have had to adopt several measures (operating and post-operating procedures) which may increase the total treatment time and costs relating to individual protective measures. This paper will propose a thorough analysis of operating dentistry procedures, comparing the economic performance of the activity in a dental surgery before and after the adoption of these protective measures, which are required to contain the risk of SARS-COV-2 infections. Methods: The economic analysis is articulated in three approaches. Firstly, it assesses a reduction in markup by maintaining current charges (A); alternatively, it suggests revised charges to adopt in order to maintain unvaried levels of markup (B). And the third Approach (C) examines available dental treatments, highlighting how to profitably combine treatment volumes to reduce markup loss or a restricted increase in dental charges. Results: Maintaining dental charges could cause a loss in markup, even rising to 200% (A); attempting to maintain unvaried levels of markup will result in an increase in dental charges, even at 100% (B); and varying the volumes of the single dental treatments on offer (increasing those which current research indicates as the most profitable) could mitigate the economic impact of the measures to prevent the transmission of SARS-COV-2 (C). Conclusions: The authors of this paper provide managerial insights which can assist the dentist-entrepreneur to become aware of the boundaries of the economic consequences of governmental measures in containing the virus infection

Salivary proteomic biomarkers of oral squamous cell carcinoma

Objectives. The aim of the present study is to investigate the presence of proteomic signatures of Oral Squamous Cell Carcinoma (OSCC) in saliva and their use as potential biomarkers for early and non-invasive diagnosis, as well as prognostication. Methods. Saliva from 45 OSCC patients and 30 healthy controls was analysed by SELDI-TOF mass spectrometry and ProteinChip\uae technology. Proteomic profiles were tested with differential expression analysis and fold change of protein peaks, principal component analysis, Spearman rank correlation test and hierarchical clustering in order to identify a list of peaks of interest representative of controls, N- and N+ cases. Those peaks were used in a supervised artificial neural network in order to classify samples according to the following conditions: controls vs OSCC, controls vs N-, and controls vs N+. Results. When compared with controls, four peaks (i.e. 6913, 11948, 13287 and 27280 m/z) were significantly altered in both N- group and N+ group; four peaks (i.e. 3353, 3433, 3482 and 4136 m/z) were selectively altered in Ngroup; eight peaks were selectively altered in N+ group (i.e. 4038, 7133, 11755, 13746, 13841, 14264, 16807, 17127 m/z). Those peaks were capable to classify 100% of cases and controls, thus being potential diagnostic and prognostic biomarkers for OSC

Osteonecrosis of the jaw related to everolimus and bisphosphonate: a unique case report?

Osteonecrosis of the jaw (ONJ) is a rare but serious lesion of the jaw, characterized mainly by exposed necrotic bone;it is related to various drugs, usually used for treating patients with advanced malignancies. Drugs implicated in ONJ are: nitrogen-containing bisphosphonates (NBPs), denosumab, anti-angiogenic drugs (e.g bevacizumab, sunitinib,sorafenib) and the selective mammalian target of rapamycin mTOR, everolimus. Previous data regarding the combining of NBPs with antiangiogenic agents conflict with some reports (indicating a similar risk of ONJ compared with the use of NBPs alone1); other reports show significantly higher rates (18% vs 1% with NBPs alone) of the incidence of ONJ2. The mTOR is a serine/threonine kinase, a component of a complex signaling pathway, involved in cell growth and metabolism, reducing VEGF levels and inhibiting the growth and proliferation of tumor cells, endothelial cells, fibroblasts and blood vassels. Everolimus has been approved for the treatment of advanced breast cancer, neuroendocrine tumors of pancreatic origin (pNET), and advanced renal cell carcinoma (RCC). This case report may help to explain the temporal relationship between therapy and the occurrence of ONJ with the sequential use of NBPs and mTOR. A 64-year-old male patient underwent a left, radical nephrectomy in 1992 for clear-cell renal carcinoma. In July 2010 he developed a bone metastasis and he was treated with zoledronic acid 4 mg IV every 4 weeks between 7 July 2010 and 17 August 2012. In February 2011 he had another recurrence, a lung metastasis treated with lobectomy and everolimus 10 mg/die for 6 months from 11 April 2011 to 31 October 2012. In 13 October 2012 the patient showed a facial enlargement and oral fistula in the first quadrant with no history of tooth extraction. A bone scan revealed an ill-defined radiolucency and an orosinusal communication. In January 2013 the patient underwent a right and partial left maxillectomy and is currently being followed up to minimize the risk of new adverse reactions

Spontaneous bisphosphonate-related osteonecrosis of the left hemi-mandible: Similarities with phossy jaw.

Intravenous bisphosphonates (BP) play a key role in the treatment of bone metastases. As a long-term side effects BP, a form of avascular osteonecrosis of the jaw has been reported. Although, invasive oral local procedures are often present in clinical history of patients suffering from bisphosphonates-related osteonecrosis of the jaws (BRONJ), about up to 50% of BRONJ are spontaneous. We report a case of a 68-year-old female with a spontaneous wide bone sequestration of the left mandibular body onset after infusion of zoledronic acid for 18 cycles for osseous metastasis due to metastatic anaplastic thyroidal carcinoma. Surprisingly the clinical aspects of the patient initially reminded us of the famous pathology described in 1899 called phossy jaw. This case is remarkable not only for the spontaneity of the osteonecrosis, but, above all, for the clinical similarity with cases of phossy jaw, described for the first time in the literature, thereby suggesting a potential common pathogenesis

Infodemiological patterns in searching medication errors: Relationship with risk management and shift work

INTRODUCTION: Western world health care systems have been trying to improve their efficiency and effectiveness in order to respond properly to population aging and non-communicable diseases epidemic. Treatment of the elderly population is becoming complex due to the high number of prescribed drugs because of multimorbidity. Errors in drugs administration in different health care related settings are an actual important issue due to different causes. Aim of this observational study is to measure the online interest in seeking medication errors information related to risk management and shift work. MATERIALS AND METHODS: We investigated Google Trends® for popular search relating to medication errors, risk management and shift work. Relative search volumes (RSVs) were evaluated from 2008 to 2018. A comparison between RSV curves related to medication errors, risk management and shift work was carried out. Then, we compared the world to Italian search. RESULTS: RSVs were persistently higher for risk management than for medication errors (mean RSVs 069 vs. 48%) and RSVs were stably higher for medication errors than shift work (mean RSVs 48 vs. 22%). In Italy, RSVs were much lower compared to the rest of the world, and RSVs for medication errors during the study period were negligible. Mean RSVs for risk management and shift work were 3 and 25%, respectively. RSVs related to medication errors and clinical risk management were correlated (r=0.520, p&lt;0.0001). CONCLUSIONS: Google Trends® search query volumes related to medication errors, risk management and shift work are different. RSVs for risk management are higher, and they are correlated with medication errors. Also, shift work search appears to be lower. These results should be interpreted in order to correctly evaluate how to decrease the number of medication errors in different health care related setting