Ulcerative oral lesions: an overview of non-pharmacologic treatment options

Background and Objective: Ulcerative diseases frequently affect the oral cavity and are disabling conditions. The management is challenging, and traditional treatments are associated with potential side effects. Alternative non-pharmacologic strategies have become available to effectively manage these conditions. This review aims at providing a synthesis of the most common erosive-ulcerative oral diseases and an updated overview of the main non-pharmacologic options for their management, such as laser therapy, ozone applications, and photodynamic therapy. Methods: A narrative review was conducted by searching PubMed/MEDLINE for the most recent relevant systematic reviews or, alternatively, clinical trials or case reports. Results: Laser photobiomodulation therapy (PBMT), ozone therapy and photodynamic therapy (PDT) generally resulted in rapid relief of painful symptoms, reduced healing time and improved oral functions and patients’ quality of life. No major side-effects were reported. Regardless of the primary etiology, photodynamic therapy proved particularly effective in case of infections. Ozone was used in gaseous, ozonized water and oil formulations. The most used light sources were Nd:YAG, He:Ne, Er,Cr:YSGG, red and infrared diode lasers and LED for PBMT, while red diode lasers prevailed for PDT. The most common photosensitizers were methylene blue and toluidine blue O. Conclusions: There is growing evidence for an efficacy of PBMT, ozone and PDT for the treatment of ulcerative oral lesions, and therefore these approaches should be considered as valid non-pharmacologic strategies. However, due to the great heterogeneity of protocols, additional well-designed research to identify the best therapeutic protocols is needed. (www.actabiomedica.it)

Large-sized pleomorphic adenoma of the cheek treated with Nd:Yag laser: Report of a case and review of the literature

Pleomorphic adenoma (PA) mostly involves parotid glands, while extra-parotid localizations are relatively uncommon. Particularly, PAs of the cheek minor salivary glands with a size larger than 4 cm are exceedingly rare, with only few cases reported. Surgical treatment of PA usually consists in radical excision. However, despite a presumptive radicality, recurrences, sometimes followed by malignant transformation, may occur. Here we report a case of a large-sized (6 cm) PA of the cheek minor salivary glands in a 70 year-old female patient, successfully treated through a conservative approach, based on the use of Nd:YAG Laser (λ=1064 nm). No recurrences were observed after a 2-year follow-up. A concise review of the literature, describing the features of 14 cases is also provided. Advantages of laser treatment include a precise cut, reduction of trauma on surrounding tissues, the possibility of a very good intraoperative hemostasis. Such features may sometimes allow to avoid general anesthesia, even for removal of big lesions. Post-operative course, in terms of pain and swelling, is usually better for intervention performed with laser, when compared to traditional surgery

Large-sized pleomorphic adenoma of the cheek treated with Nd:Yag laser: Report of a case and review of the literature

Pleomorphic adenoma (PA) mostly involves parotid glands, while extra-parotid localizations are relatively uncommon. Particularly, PAs of the cheek minor salivary glands with a size larger than 4 cm are exceedingly rare, with only few cases reported. Surgical treatment of PA usually consists in radical excision. However, despite a presumptive radicality, recurrences, sometimes followed by malignant transformation, may occur. Here we report a case of a large-sized (6 cm) PA of the cheek minor salivary glands in a 70 year-old female patient, successfully treated through a conservative approach, based on the use of Nd:YAG Laser (λ=1064 nm). No recurrences were observed after a 2-year follow-up. A concise review of the literature, describing the features of 14 cases is also provided. Advantages of laser treatment include a precise cut, reduction of trauma on surrounding tissues, the possibility of a very good intraoperative hemostasis. Such features may sometimes allow to avoid general anesthesia, even for removal of big lesions. Post-operative course, in terms of pain and swelling, is usually better for intervention performed with laser, when compared to traditional surgery

Understanding the Role of Nature in Urban-Rural Linkages: Identifying the Potential Role of Rural Nature-Based Attractive Clusters That Serve Human Well-Being

Rural areas provide unique amenities for recreational purposes which are highly appreciated by urban inhabitants. This generates an important but often hidden relationship between the urban and the rural. The aim of our study is first to provide empirical evidence for this linkage and then to identify for Italy, at the municipal level, those rural areas which actually function as nature-based attractive clusters. We used the data coming from a participatory webGIS survey that asked 1632 Italian respondents to mark attractive nature related places locally, regionally, nationally and world-wide to explain quantitatively and qualitatively the relationship between urban and rural. From the survey, indicators were developed to rank the nature-based attractive clusters. Our results pointed out a major (almost double) flow from urban to rural for natural amenities, which increased with the spatial level at which attractive nature areas were marked. This analysis allowed for the identification rural clusters of Italian municipalities that form nodal points for nature-based urban well-being; shedding light on an often neglected urban-rural relationship. The method is applicable in other countries and may stimulate better planning and management strategies for improving rural areas, taking an urban-rural perspective

Optical Performance of Ag-based Back Reflectors with different Spacers in Thin Film Si Solar Cells

Abstract We have compared different Ag-based back reflectors (BRs) applied to superstrate-type microcrystalline Si devices grown on Asahi U glass. In particular, substitution of the conventional ZnO:Al layer by MgF 2 , with lower refractive index and no free-carrier absorption, has been investigated. As electrical issues can mask the optical performance of the BR when evaluated by EQE measurements, a purely optical method that compares the intensity of Raman spectra generated with long wavelength excitation light has been applied. Based on this investigation, MgF 2 /Ag is potentially superior to ZnO:Al/Ag, even when MgF 2 is used in the form of ultrathin layer (few nm, likely island-like). Nevertheless, the novel dual-function n-SiO x /Ag BR outperforms all the other BRs

Optimal time to definitive enucleation of large cysts following marsupialization: A single center, retrospective study

Objectives: Optimal time to enucleation following marsupialization of large odontogenic mandibular cysts is undefined. We aim to assess volume reduction throughout follow-up, to indicate optimal time to enucleation. Secondary objectives include the identification of factors influencing cyst reduction. Study design: We retrospectively enrolled 15 patients with mandibular cysts of different histological types treated with marsupialization at our center between 2018 and 2022. Cyst volume was assessed with cone-beam computed tomography (CBCT) and a semi-automatic segmentation algorithm, at baseline and between 6 and 8 months post marsupialization. Results: The overall mean cyst volume reduction percent (VR%) was 57.7 % or 0.2 % per day. VR% at 8 months was significantly higher than those assessed at 6 and 7 months (67.1% vs 47.1 %, p = 0.003). Time to CBCT was the only independent variable influencing cyst VR%. Conclusion: Our study proves that the optimal time to enucleation for mandibular cyst is 8 months, independent of histological cyst type, patient age, baseline cyst volume and the number of pre-operative residual bone walls

The Educational Bias in Commuting Patterns: Micro-Evidence for the Netherlands

This study analyses the relation between education and commuting behaviour of Dutch workers. Results show that, ceteris paribus, higher educated workers commute further, both in terms of distance and time. In addition, higher educated workers are more frequent users of public transport and of bicycles. Furthermore, we find that higher educated workers are relatively more likely to commute towards agglomerated areas and areas that pay relatively high wages, while they are more likely to live in and commute from areas with higher land rents

SARS-CoV-2 has been circulating in northern Italy since december 2019: evidence from environmental monitoring

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease COVID-19, a public health emergency worldwide, and Italy is among the most severely affected countries. The first autochthonous Italian case of COVID-19 was documented on February 21, 2020. We investigated the possibility that SARS-CoV-2 emerged in Italy earlier than that date, by analysing 40 composite influent wastewater samples collected - in the framework of other wastewater-based epidemiology projects - between October 2019 and February 2020 from five wastewater treatment plants (WWTPs) in three cities and regions in northern Italy (Milan/Lombardy, Turin/Piedmont and Bologna/Emilia Romagna). Twenty-four additional samples collected in the same WWTPs between September 2018 and June 2019 (i.e. long before the onset of the epidemic) were included as ‘blank’ samples. Viral concentration was performed according to the standard World Health Organization procedure for poliovirus sewage surveillance, with modifications. Molecular analysis was undertaken with both nested RT-PCR and real-rime RT-PCR assays. A total of 15 positive samples were confirmed by both methods. The earliest dates back to 18 December 2019 in Milan and Turin and 29 January 2020 in Bologna. Virus concentration in the samples ranged from below the limit of detection (LOD) to 5.6 × 104 genome copies (g.c.)/L, and most of the samples (23 out of 26) were below the limit of quantification of PCR. Our results demonstrate that SARS-CoV-2 was already circulating in northern Italy at the end of 2019. Moreover, it was circulating in different geographic regions simultaneously, which changes our previous understanding of the geographical circulation of the virus in Italy. Our study highlights the importance of environmental surveillance as an early warning system, to monitor the levels of virus circulating in the population and identify outbreaks even before cases are notified to the healthcare system

Non-specific oral and cutaneous manifestations of coronavirus disease 2019 in children

Background: Coronavirus Disease 2019 (COVID-19) seems to affect children only marginally, as a result, there is less knowledge of its manifestations in childhood. The purpose of this retrospective cross-sectional study was to investigate the oral and cutaneous manifestations in children affected by COVID-19. Material and Methods: All the medical records of children with COVID-19 admitted to the Pediatric Clinic-ASST Spedali Civili of Brescia from March to April 2020 were reviewed. The following data were recorded: Age, temperature, clinical presentation, oral mucosa lesions, taste alteration and cutaneous lesions. Results: The medical records of twenty-seven pediatric patients (mean age 4,2 years + 1,7) were analyzed. The clinical presentation of the disease mainly included elevated body temperature and cough. The following oral lesions were recorded: Oral pseudomembranous candidiasis (7.4 %), geographic tongue (3.7%), coated tongue (7.4 %) and hyperaemic pharynx (37 %). Taste alteration was reported by 3 patients. Six patients presented cutaneous flat papular lesions. Conclusions: As for our paediatric sample, COVID-19 resulted to be associated with non-specific oral and cutaneous manifestations

First detection of SARS-CoV-2 in untreated wastewaters in Italy

Several studies have demonstrated the advantages of environmental surveillance through the monitoring of sewage for the assessment of viruses circulating in a given community (wastewater-based epidemiology, WBE). During the COVID-19 public health emergency, many reports have described the presence of SARS-CoV-2 RNA in stools from COVID-19 patients, and a few studies reported the occurrence of SARS-CoV-2 in wastewaters worldwide. Italy is among the world's worst-affected countries in the COVID-19 pandemic, but so far there are no studies assessing the presence of SARS-CoV-2 in Italian wastewaters. To this aim, twelve influent sewage samples, collected between February and April 2020 from Wastewater Treatment Plants in Milan and Rome, were tested adapting, for concentration, the standard WHO procedure for Poliovirus surveillance. Molecular analysis was undertaken with three nested protocols, including a newly designed SARS-CoV-2 specific primer set. SARS-CoV-2 RNA detection was accomplished in volumes of 250 ml of wastewaters collected in areas of high (Milan) and low (Rome) epidemic circulation, according to clinical data. Overall, 6 out of 12 samples were positive. One of the positive results was obtained in a Milan wastewater sample collected a few days after the first notified Italian case of autochthonous SARS-CoV-2. The study confirms that WBE has the potential to be applied to SARS-CoV-2 as a sensitive tool to study spatial and temporal trends of virus circulation in the population