Gingival hyperplasia around dental implants in jaws reconstructed with free vascularized flaps: a case report series

Free vascularized flaps are the gold standard for reconstruction of the facial skeleton after surgical ablation of pathologies or when important atrophy of the jaws exists. A frequent problem seen during prosthetic rehabilitation after reconstruction with free vascularized flaps is the onset of hyperplastic granulomatous reactive tissue around the prosthetic abutment of the implant. The features of this phenomenon seem to be directly related to the characteristics of the periimplant tissue and of the manufacturing materials of the prosthesis and abutments. This complication can be seen quite often; we found it in 7 of 40 patients (17.5%). It does not seem to significantly affect the survival rate of implants. The aim of the study was to analyze the behavior of such lesions and to suggest our clinical approach with the management of these kinds of patients and complications. To remove gingival hyperplasia, we used either a traditional cold scalpel or an electric cautery or laser. We had good results using these tools. The onset of this phenomenon was not influenced by either the kind of implant and free flaps used or by the local conditions of the patients (such as radiotherapy). The number of recurrences was highly influenced by the oral hygiene of the patients

Editorial: Drug resistance, global epidemiology and virulence of Acinetobacter

International audienc

Brittle asthma: still on board?

(1) Background: “Brittle Asthma” was considered an asthma clinical phenotype and deemed to be life-threatening in the early 2000s; then, this definition disappeared. The purpose of this review is to examine what has historically been referred to as this term and see whether it may be applied to modern clinical practice, thus acquiring fresh relevance and meaning. (2) Methods: A non-systematic search of the literature was conducted using both MeSH and free-text phrases. No limitations on the research design or type of publication were applied. (3) Results: Reliable data regarding “Brittle Asthma” are lacking due to the paucity of current data and the few studies available. After a few years of reworking, it was divided into two sub-classes: one characterized by a wide PEF variability despite high-dose therapy and the other by sudden acute attacks in otherwise apparently normal airway functions or well-controlled asthma. Their characteristics were hardly defined because of their low prevalence. Data regarding risk factors, atopy, mechanisms, and treatments were analyzed. (4) Conclusions: Over time, different terminology has been introduced to define asthma severity and control. It would be worth investigating whether the term “Brittle Asthma” previously used may be helpful to find new hints to stratify patients and improve disease management

Expanding drug resistance through integron acquisition by IncFI plasmids of Salmonella enterica Typhimurium.

We conducted a 30-year retrospective analysis of IncFI plasmids from Salmonella enterica serotype Typhimurium. These plasmids have been associated with the emergence of epidemic clones of multidrug-resistant Salmonella. Molecular and genetic evidence indicates that IncFI plasmids are evolving through sequential acquisition of integrons carrying different arrays of antibiotic- resistance genes

Neutron sources based on medical Linac

The paper proposes the study of a novel photo-neutron source based on a medical high-energy electron Linac. Previous studies by the authors already demonstrated the possibility to obtain with this technique a thermal neutron flux of the order of 107 cm−2 s−1. This paper shows possible Linac’s setup and a new photo-converter design to reach a thermal neutron flux around 6 × 107 cm−2 s−1, keeping a reasonable high quality of the beam with respect to fast neutron and gamma contaminations

Oral health conditions and cardiovascular diseases in elderly italian patient

BACKGROUND: The objective of this study was to investigate the associations between oral health status and presence of cardiovascular diseases (CVD) in elderly patients. METHODS: The study population consisted of 533 patients (308 females, 225 males) aged 65 to 98 years. The mean age of patients was 73.93 (±7.8 standard deviation (SD)). Patients were asked to visit the Geriatric Dentistry Department of “Policlinico Umberto I” of Rome for a routine check of their oral health status. All subjects gave informed, signed consent to participate in the study. A predesigned medical history questionnaire including social status, habits, medical history, general health and drug assumption were filled by each patient. Medical history, particularly focused on CV D and common atherosclerotic risk factors (arterial hypertension, diabetes, body mass index, etc.) have been recorded. Dental status was detected measuring the Decayed, Missing, and Filled Teeth (DMFT) and Community Periodontal Index (CPI) indexes. Geriatric Oral Health Assessment Index (GOHAI ) was also used to evaluate masticatory function, oral self-perception and psychosocial impact on patients. The chi-square test with a 95% confidence level was used to assess qualitative variables. Odds ratios (ORs) and stepwise logistic regression were used to calculate risk estimates; the independent variables: age, gender, DMFT, CPI index, GOHAI index score, and tooth loss were included in the statistical model. P value <0.05 was considered a statistically significant cut-off. RESULT S:S: The mean of the DMFT was 13.8 (SD: 7.1). Among all patients, 8.6% (n = 46) had more than 12 decayed teeth, 43.7% (n = 233) had more than 12 missing teeth. A total of 122 patients (52.4%) had more than 18 missing teeth. No difference between females and males was seen in DMFT and CPI index. GOHAI data were worst for females and it significantly decreased with age. Vascular diseases affected 69.8% of subjects (n = 372). Patients with CVD had less education and oral care (P < 0.05), higher CPI index and lower of filled teeth (P < 0.05). Moreover, the number of missing teeth was higher in patients with vascular disease and patients with more than 18 missing teeth have 2.5 times greater risk of CVD. CVDs are also associated with type 2 diabetes mellitus, underweight, and obesity (P < 0.05).CONCLUSIONS: From the finding of this study, it can be confirmed a significant link between CVD and oral health. A cooperation among geriatrician, cardiologist, and dentist is suitable to counteract the development of CVD and to early identify patients risk of CVD

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10% buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens

Evaluation of physical activity before and after respiratory rehabilitation in normal weight individuals with asthma: a feasibility study

Background: Individuals with asthma spend less time engaging in physical activity compared to the general population. Increasing physical activity has become a patient-centered goal for the treatment of treatable traits of individuals with asthma. There are data showing the possible effects of a pulmonary rehabilitation program on physical activity in obese individuals with asthma but not in normal-weight asthmatics. The objective of this feasibility study is to estimate the number of daily steps and time spent on activity in normal-weight individuals with asthma, measured before and after a pulmonary rehabilitation program. Methods: Normal-weight individuals with moderate to severe asthma were evaluated. The individuals measured their daily steps with an accelerometer for 5 days before and after a pulmonary rehabilitation program. The study was registered on ClinicalTrials.gov: NCT05486689. Results: In total, 17 participants were enrolled; one dropout and data on the time in activity of two individuals are missing due to a software error during the download. Data from 16 patients were analyzed. The median number of steps/day at baseline was 5,578 (25th, 75th percentiles = 4,874, 9,685) while the median activity time was 214 min (25th, 75th percentiles = 165, 239). After the rehabilitation program, the number of daily steps increased by a median value of 472 (p-value = 0.561) and the time in activity reduced by 17 min (p-value = 0.357). We also found a significant difference in quality of life, muscle strength, and exercise capacity. Conclusions: The results of this study make it possible to calculate the sample size of future studies whose main outcome is daily steps in normal-weight individuals with asthma. The difficulties encountered in downloading time in activity data do not allow the same for this outcome