The management of atrophies classified as V class according to Cawood & Howell by piezo-electric surgery

Introducción: Los casos analizados presentaban atrofias severas (V clase según Cawood y Howell) (1), que se caracterizan por presentar una densidad de la cresta transversal inferior a 4 mm y vertical inferior a 6 mm; ello hace pensar en la posibilidad de una rehabilitación implanto-soportada. Objetivo: Evaluación de la rehabilitación de pacientes afectados por severa atrofia del maxilar superior clase V según Cawood y Howell) (1) rehabilitados con elevación del seno maxilar e injerto de hueso autólogo. Materiales y métodos: Estudio longitudinal a partir de una muestra de 32 pacientes, con atrofia maxilar severa y edentulismo parcial o total. En todos los pacientes se ha colocado un injerto con técnica de reconstrucción onlay mono o bicortical y se ha adoptado la cirugía piezoeléctrica para realizar el elevación del seno, el cual podía ser mono o bilateral, de hueso autólogo procedente de la cresta ilíaca anterior. Seguimiento realizado durante 2 años. Resultados: A los dos años del control final, el 94,05% de todos los implantes colocados tras la intervención de elevación se presentan osteointegrados y cargados protésicamente. La cresta ilíaca anterior resulta ser la zona idónea para la extracción medular, necesaria para la elevación del seno. Las posibilidades de supervivencia del implante son realmente elevadas si se espera el tiempo clínico necesario para la recuperación y la integración del injerto. El éxito de todas las intervenciones de elevación del seno maxilar se debe a la adopción de la cirugía piezoeléctrica, que permite efectuar la incisión de entrada y realizar el desprendimiento de los tejidos con un traumatismo mínimo para la membrana de Schneider. La integridad de la membrana y la utilización de bone-chips de origen autólogo no ha hecho necesario recurrir a la utilización de membranas reabsorbibles, simplificando así el procedimiento quirúrgico. La utilización de la cresta ilíaca anterior como zona donante, permite disponer de abundante tejido óseo cortical, necesario para colocar los onlay y para reconstruir el defecto óseo. Introduction: Valutation of rehabilitated patients by sinus lift in upper jaw and by autologous bone graft from iliac crest. Materials and methods: Rehabilitation of 32 patients with severe atrophies of upper jaw and partial or total edentulism by positioning of mono- or bicortical onlay with piezosurgery to obtain a sinus lift mono- or bilateral by autologous bone grafts from anterior iliac crest. Results: 94.05% of successes after a two years follow-up. Conclusions: Respecting of timing surgery, a correct use of the piezosurgery technique and of the autologous bone graft from anterior iliac crest let a successful implantological rehabilitation. Moreover the iliac crest is a very good donor site of bone tissue for the management of severe atrophies in the upper jaw. An accidental laceration of Schneider's membrane was observed in filling phase in the 5.26% of cases

A multi analytical characterization of a small bronze figurine from Gran Carro site (Bolsena Lake, Italy)

This paper presents the results of an archaeometric analysis carried out on an early Iron Age anthropomorphic figurine discovered in the area of the Gran Carro on Bolsena Lake (Latium, Italy) site, currently interpreted as a place of worship. This statuette is considered a unicum, both because of the context in which it was found and because of its stylistic characteristics similar to those of bronzes from the Nuragic civilization (Sardinia, Italy). Its discovery and the data obtained from this work provide further evidence in support of numerous previous studies suggesting the presence of trade and direct exchanges between Sardinia and southern Etruria. The research was performed through some non-destructive investigations such as Energy Dispersive X-Ray Fluorescence (EDXRF) combined with Monte Carlo Simulation (MC) and micro-invasive investigations such as Scanning Electron Microscopy coupled by Energy Dispersive Spectroscopy (SEM–EDS) and by Electron Probe Micro-Analysis (EPMA), metallography and lead isotope analyses (LIA), performed on a selected micro-fragment. The combination of non-destructive techniques (EDXRF-MCS) for the characterization of the artefact allowed us to obtain data similar to those obtained with micro-invasive surveys, further demonstrating the effectiveness of the method. The results indicate that the statuette is made of a bronze alloy and that the copper metal was extracted from Sardinian deposits

Evans Syndrome: A case report

Evans syndrome, a combined clinical condition of autoimmune haemolytic anaemia (AHA) and idiopathic thrombocytopaenic purpura (ITP) and has non-specific pathogenesis. The clinical cases are extremely rare, since only 4% of AHA or ITP are incorporated with Evans. It is distinguished from differentials, such as lupus, IgA deficiency, and acquired immunodeficiency, by peripheral blood film, bone marrow, Coombs test, and coagulation profile. A case of adult female from Pabna, Bangladesh is documented in this report. She complained of high grade intermittent fever, exertional dyspnea, icteric skin and sclera. Other features included mild splenomegaly, dark urine, and profuse sweating after fever. Investigation reports were consistent with AHA and ITP, with normal coagulation and viral profile. However, the patient was treated with corticosteroids, platelet and blood transfusion. And in follow-up visits, there was a pattern of gradual decline in erythrocyte sedimentation rate (ESR) and reticulocyte count, with normalization of haemoglobin, red cell, and white cell count. No association with other diseases was found in this case. Bangladesh Med J. 2018 Jan; 47 (3): 37-4

A neurally-interfaced hand prosthesis tuned inter-hemispheric communication

Purpose: This work investigates how a direct bidirectional connection between brain and hand prosthesis modifies the bi-hemispheric sensorimotor system devoted to the movement control of the lost limb. Hand prostheses are often unable to satisfy users' expectations, mostly due to the poor performance of their interfacing system. Neural Interfaces implanted inside nerves of the stump offer the advantage of using the bidirectional neural pathways 'naturally' dispatching signals to control proper hand actions and feed-back sensations. Learning to control a neurally-interfaced hand prosthesis and decode sensory information was previously observed to reduce the inter-hemispheric asymmetry of cortical motor maps and the clinical symptoms of phantom limb syndrome. Methods: Electroencephalographic (EEG) data was analysed using Functional Source Separation (FSS), a semi-blind method that incorporates prior knowledge about the signal of interest into data decomposition to give access to cortical patch activities. Results: Bi-hemispheric cortices showed normalization of their activity (topographical and spectral patterns) and of functional connectivity between homologous hand controlling areas, during the delivery of the motor command to the cybernetic prosthesis. Conclusions: The re-establishment of central-peripheral communication with the lost limb induced by a neurally-interfaced hand prosthesis produces beneficial plastic reorganization, not only restructuring contralateral directly-connected control areas, but also their functional balance within the bi-hemispheric system necessary for motor control

Contradictory reasoning network:an EEG and FMRI study

Contradiction is a cornerstone of human rationality, essential for everyday life and communication. We investigated electroencephalographic (EEG) and functional magnetic resonance imaging (fMRI) in separate recording sessions during contradictory judgments, using a logical structure based on categorical propositions of the Aristotelian Square of Opposition (ASoO). The use of ASoO propositions, while controlling for potential linguistic or semantic confounds, enabled us to observe the spatial temporal unfolding of this contradictory reasoning. The processing started with the inversion of the logical operators corresponding to right middle frontal gyrus (rMFG-BA11) activation, followed by identification of contradictory statement associated with in the right inferior frontal gyrus (rIFG-BA47) activation. Right medial frontal gyrus (rMeFG, BA10) and anterior cingulate cortex (ACC, BA32) contributed to the later stages of process. We observed a correlation between the delayed latency of rBA11 response and the reaction time delay during inductive vs. deductive reasoning. This supports the notion that rBA11 is crucial for manipulating the logical operators. Slower processing time and stronger brain responses for inductive logic suggested that examples are easier to process than general principles and are more likely to simplify communication. © 2014 Porcaro et al

IL-1 receptor antagonist ameliorates inflammasome-dependent inflammation in murine and human cystic fibrosis

Dysregulated inflammasome activation contributes to respiratory infections and pathologic airway inflammation. Through basic and translational approaches involving murine models and human genetic epidemiology, we show here the importance of the different inflammasomes in regulating inflammatory responses in mice and humans with cystic fibrosis (CF), a life-threatening disorder of the lungs and digestive system. While both contributing to pathogen clearance, NLRP3 more than NLRC4 contributes to deleterious inflammatory responses in CF and correlates with defective NLRC4-dependent IL-1Ra production. Disease susceptibility in mice and microbial colonization in humans occurrs in conditions of genetic deficiency of NLRC4 or IL-1Ra and can be rescued by administration of the recombinant IL-1Ra, anakinra. These results indicate that pathogenic NLRP3 activity in CF could be negatively regulated by IL-1Ra and provide a proof-of-concept evidence that inflammasomes are potential targets to limit the pathological consequences of microbial colonization in CF

When one size does not fit all: Reconsidering PCOS etiology, diagnosis, clinical subgroups, and subgroup-specific treatments

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects a large proportion of women. Due to its heterogeneity, the best diagnostic strategy has been a matter of contention. Since 1990 scientific societies in the field of human reproduction have tried to define the pivotal criteria for the diagnosis of PCOS. The consensus Rotterdam diagnostic criteria included the presence of hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology (PCOM), and have now been updated to evidence based diagnostic criteria in the 2018 and 2023 International Guideline diagnostic criteria endorsed by 39 societies internationally. Within the Rotterdam Criteria, at least two out of three of the above-mentioned features are required to be present to diagnose PCOS, resulting in four phenotypes being identified: phenotype A, characterized by the presence of all the features, phenotype B, exhibiting hyperandrogenism and oligo-anovulation, phenotype C, presenting as hyperandrogenism and PCOM and finally the phenotype D that is characterized by oligo-anovulation and PCOM, lacking the hyperandrogenic component. However, it is the hypothesis of the EGOI group that the Rotterdam phenotypes A, B, and C have a different underlying causality to phenotype D. Recent studies have highlighted the strong correlation between insulin resistance and hyperandrogenism, and the pivotal role of these factors in driving ovarian alterations, such as oligo-anovulation and follicular functional cyst formation. This new understanding of PCOS pathogenesis has led the authors to hypothesis that phenotypes A, B, and C are endocrine-metabolic syndromes with a metabolic clinical onset. Conversely, the absence of hyperandrogenism and metabolic disturbances in phenotype D suggests a different origin of this condition, and point towards novel pathophysiological mechanisms; however, these are still not fully understood. Further questions have been raised regarding the suitability of the “phenotypes” described by the Rotterdam Criteria by the publication by recent GWAS studies, which demonstrated that these phenotypes should be considered clinical subtypes as they are not reflected in the genetic picture. Hence, by capturing the heterogeneity of this complex disorder, current diagnostic criteria may benefit from a reassessment and the evaluation of additional parameters such as insulin resistance and endometrial thickness, with the purpose of not only improving their diagnostic accuracy but also of assigning an appropriate and personalized treatment. In this framework, the present overview aims to analyze the diagnostic criteria currently recognized by the scientific community and assess the suitability of their application in clinical practice in light of the newly emerging evidence

Inositols: From established knowledge to novel approaches

Myo-inositol (myo-Ins) and D-chiro-inositol (D-chiro-Ins) are natural compounds involved in many biological pathways. Since the discovery of their involvement in endocrine signal transduction, myo-Ins and D-chiro-Ins supplementation has contributed to clinical approaches in ameliorating many gynecological and endocrinological diseases. Currently both myo-Ins and D-chiro-Ins are well-tolerated, effective alternative candidates to the classical insulin sensitizers, and are useful treatments in preventing and treating metabolic and reproductive disorders such as polycystic ovary syndrome (PCOS), gestational diabetes mellitus (GDM), and male fertility disturbances, like sperm abnormalities. Moreover, besides metabolic activity, myo-Ins and D-chiro-Ins deeply influence steroidogenesis, regulating the pools of androgens and estrogens, likely in opposite ways. Given the complexity of inositol-related mechanisms of action, many of their beneficial effects are still under scrutiny. Therefore, continuing research aims to discover new emerging roles and mechanisms that can allow clinicians to tailor inositol therapy and to use it in other medical areas, hitherto unexplored. The present paper outlines the established evidence on inositols and updates on recent research, namely concerning D-chiro-Ins involvement into steroidogenesis. In particular, D-chiro-Ins mediates insulin-induced testosterone biosynthesis from ovarian thecal cells and directly affects synthesis of estrogens by modulating the expression of the aromatase enzyme. Ovaries, as well as other organs and tissues, are characterized by a specific ratio of myo-Ins to D-chiro-Ins, which ensures their healthy state and proper functionality. Altered inositol ratios may account for pathological conditions, causing an imbalance in sex hormones. Such situations usually occur in association with medical conditions, such as PCOS, or as a consequence of some pharmacological treatments. Based on the physiological role of inositols and the pathological implications of altered myo-Ins to D-chiro-Ins ratios, inositol therapy may be designed with two different aims: (1) restoring the inositol physiological ratio; (2) altering the ratio in a controlled way to achieve specific effects

The Relative Contribution of High-Gamma Linguistic Processing Stages of Word Production, and Motor Imagery of Articulation in Class Separability of Covert Speech Tasks in EEG Data

Word production begins with high-Gamma automatic linguistic processing functions followed by speech motor planning and articulation. Phonetic properties are processed in both linguistic and motor stages of word production. Four phonetically dissimilar phonemic structures “BA”, “FO”, “LE”, and “RY” were chosen as covert speech tasks. Ten neurologically healthy volunteers with the age range of 21–33 participated in this experiment. Participants were asked to covertly speak a phonemic structure when they heard an auditory cue. EEG was recorded with 64 electrodes at 2048 samples/s. Initially, one-second trials were used, which contained linguistic and motor imagery activities. The four-class true positive rate was calculated. In the next stage, 312 ms trials were used to exclude covert articulation from analysis. By eliminating the covert articulation stage, the four-class grand average classification accuracy dropped from 96.4% to 94.5%. The most valuable features emerge after Auditory cue recognition (~100 ms post onset), and within the 70–128 Hz frequency range. The most significant identified brain regions were the Prefrontal Cortex (linked to stimulus driven executive control), Wernicke’s area (linked to Phonological code retrieval), the right IFG, and Broca’s area (linked to syllabification). Alpha and Beta band oscillations associated with motor imagery do not contain enough information to fully reflect the complexity of speech movements. Over 90% of the most class-dependent features were in the 30-128 Hz range, even during the covert articulation stage. As a result, compared to linguistic functions, the contribution of motor imagery of articulation in class separability of covert speech tasks from EEG data is negligible