Clinical evaluation of bond failures and survival between mandibular canine-to-canine retainers made of flexible spiral wire and fiber-reinforced composite

Objectives: The purpose of this longitudinal prospective randomized study was to evaluate the clinical reliability of two different types of postorthodontic treatment retainers: a silanised-treated glass fibers-reinforced resin composite (FRC) and a directly bonded multistranded stainless steel wire. The hypothesis of the study was to assess if significant differences are present between failure rates of the two retainers. Study Design: This prospective study was based on an assessment of 87 patients (35 men and 52 women),with an average age of 24 years who required a lower arch fixed retainer after orthodontic treatment. Patients were divided in two groups. Assignment was carried out with random tables. A follow-up examination was carried out once a month. The number, cause, and date of single bond adhesive failures were recorded for both retainers over 12 months. Teeth that were rebonded after failure were not included in the success analysis. Statistical analysis was performed by means of a Fisher's exact test, Kaplan-Meier survival estimates, and log rank test. Results: Bond failure rate was significantly higher (P=0.0392) for multistranded metallic wire than for FRC. Conclusions: Glass fiber-reinforced resin composite retainers and multistranded metallic wires showed no significant difference in single bond failure rates over a one-year follow up

Rehabilitation of COVID-19 patients

n/

COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units

Objective: The COVID-19 pandemic has caused significant motor, cognitive, psychological, neurological and cardiological disabilities in many infected patients. Functional rehabilitation of infectious COVID-19 patients has been implemented in the acute care wards and in appropriate, ad hoc, multidisciplinary COVID-19 rehabilitation units. However, because COVID-19 rehabilitation units are a clinical novelty, clinical and organizational benchmarks are not yet available. The aim of this study is to describe the organizational needs and operational costs of such a unit, by comparing its activity, organization, and costs with 2 other functional rehabilitation units, in San Raffaele Hospital, Milan, Italy. Methods: The 2-month activity of the COVID-19 Rehabilitation Unit at San Raffaele Hospital, Milan, Italy, which was created in response to the emergency need for rehabilitation of COVID-19 patients, was compared with the previous year's activity of the Cardiac Rehabilitation and Motor Rehabilitation Units of the same institute. Results: The COVID-19 Rehabilitation Unit had the same number of care beds as the other units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs. Discussion: The COVID-19 Rehabilitation Unit was twice as expensive as the 2 other units studied. World health systems are organizing to respond to the pandemic by expanding capacity in acute intensive care and sub-intensive care units. This study shows that COVID-19 rehabilitation units must be organized and equiped according to the clinical and rehabilitative needs of patients, following specific measures to prevent the spread of infection amongs patients and workers

Ceftriaxone-induced cholestatic hepatitis in a child: A case report and a review of the literature

Ceftriaxone, a third-generation cephalosporin, is commonly used in pediatric patients and is generally well tolerated. Its more frequent adverse effects are biliary pseudolithiasis, urolithiasis, and hemolytic anemia. On the other hand, ceftriaxone-induced acute cholestatic hepatitis is a very rare condition, especially in children. Here, we describe a case of this condition in a young male child to highlight the importance of suspecting this drug-induced liver injury to achieve a prompt diagnosis

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial

BACKGROUND: As lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.METHODS: We carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.RESULTS: Of 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.CONCLUSIONS: The present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00927550

Role of Pd loading and dispersion on redox behaviour and CH4 combustion activity of Al2O3 supported catalysts

none4P. Castellazzi; A. Baylet; G. Groppi; P. ForzattiCastellazzi, Paola; A., Baylet; Groppi, Gianpiero; Forzatti, Pi

VALUTAZIONE DELL'EFFICACIA DI UN PROTOCOLLO DI TRATTAMENTO AGOPUNTURA SUI SEGNI MOTORI DELLA MALATTIA DI PARKINSON E SUI CORRELATI DI NEUROIMAGING FUNZIONALE. STUDIO PILOTA RANDOMIZZATO CONTROLLATO

LA MALATTIA DI PARKINSON (MDP) E' LA SECONDA PIU' COMUNE PATOLOGIA NEURODEGENERATIVA; ESSA PUO' COMPORTARE UN ELEVATO GRADI DI DISABILITA' CON RIPERCUSSIONI SULLA FUNZIONE DEL SOGGETTO, SULL'AUTONOMIA NELLE ADL E SULLA QUALIT\uc0' DI VITA. SEBBENE MOLTE STRATEGIE FARMACOLOGICHE E NON SIANO STATE PROPOSTE PER IL TRATTAMENTO DELLA MDP, NON ESISTE AL MOMENTO NE' UNA TERAPIA EZIOLOGICA NE' UN TRATTAMENTO EFFICACE SUI SEGNI MOTORI E NON DELLA MALATTIA, IN ASSENZA DI POSSIBILI EFFETTI COLLATERALI. SCOPO DELLO STUDIO E' QUELLO DI VALUTARE L'EFFICACIA DI UN TRATTAMENTO AGOPUNTURA SUL MIGLIORAMENTO DEI SEGNI MOTORI NELLA MDP E DI EVIDENZIARE EVENTUALI CORRELATI DI NEUROIMAGING FUNZIONALE DURANTE COMPITI DI MOTOR IMAGERY. STUDIO RANDOMIZZATO-CONTROLLATO IN DOPPIO CIECO.SONO STATI RECLUTATI SOGGETTI CON MDP IDIOPATICA NON TREMORIGENA ED IN TERAPIA FARMACOLOGICA STABILE DA ALMENO 2 MESI. CRITERI DI INCLUSIONE:MMSE>24, H&Y 2-3, CAPACITA' DI CAMMINARE SENZA ASSISTENZA. I PAZIENTI SONO STATI SUDDIVISI IN GRUPPO REAL E SHAM.TRATTAMENTO: DIECI SEDUTE DI AGOPUNTURA A FREQUENZA QUOTIDIANA (30 MIN/SEDUTA); I SOGGETTI REAL SONO STATI SOTTOPOSTI A TRATTAMENTO AGOPUNTURA VERO;AI SOGGETTI SHAM VENIVANO INFISSI AGHI MOLTO SUPERFICIALMENTE, NON IN PUNTI DI AGOPUNTURA E NON STIMOLATI. TIMING DI VALUTAZIONE: PRIMA (T0) ED AL TERMINE (T1) DEL CICLO DI TRATTAMENTO.MISURE DI OUTOCOME: PARAMETRI SPAZIO-TEMPORALI DEL CAMMINO RETTILINEO (GAITRITE), EQUILIBRIO IN STATICA (POSTUROGRAFIA), PARAMETRI ST NEL CAMMINO IN CURVA (G-WALK), IMAGING NEUROFUNZIONALE (F-MRI DURANTE MOTOR IMAGERY). ANALISI STATISTICA. MANN-WHITNEY E WILKOXON. SONO STATI RECLUTATI 10 PAZIENTE, NESSUN DROP-OUT. I DUE GRUPPI ERANO OMOGENEI PER CARATTERISTICHE CLINICHE E DEMOGRAFICHE. ANALISI INTRA-GRUPPO: RIDUZIONE SIGNIFICATIVA DELLA CADENZA T1-T0 IN REAL, AUMENTO SIGNIFICATIVO CADENZA IN SHAM. ANALISI TRA-GRUPPI: DIFFERENZA SIGNIFICATIVA DI VELOCITA' T1-T0, DIFFERENZA SIGNIFICATIVA DI CADENZA T1-T0 ED DI CADENZA A T1. NON ULTERIORI DIFFERENZE SIGNIFICATIVE NELLE ALTRE MISURE DI OUTCOME. IL TRATTAMENTO AGOPUNTURALE POTREBBE MOSTRARE UTILITA' NEL CONTRIBUIRE AL MIGLIORAMENTO DEL PATTERN DEAMBULATORIO DEI SOGGETTI CON MDP, MODIFICANDONE LA CADENZA. IDEALE ED AUSPICABILE L'ASSOCIAZIONE TRA DIFFERENTI TRATTAMENTI, IN AMBITO RIABILITATIVO

Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial

Purpose: Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke. Methods: Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n\u200a=\u200a10) or sham tDCS + cathodal tsDCS (group 2; n\u200a=\u200a10) or tDCS + cathodal tsDCS (group 3; n\u200a=\u200a10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment. Results: Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P\u200a=\u200a0.015; 2-week follow-up P\u200a=\u200a0.001) and between group 3 and group 2 (post-treatment P\u200a=\u200a0.010; 2-week follow-up P\u200a=\u200a0.015). No difference was found between group 2 and group 1. Conclusions: Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke