25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Oral amelanotic melanoma: a case report

Objectives. Primary oral melanoma is a very rare malignancy, representing about 0.5% of all melanomas, characterized by a wide clinical-histological variability and a very aggressive behavior. Aim of the present study is to describe a case of oral amelanotic melanoma, an infrequent variant with a poorer prognosis than that of pigmented melanomas for a more aggressive biological behavior and frequent delays for the correct diagnosis and for starting the treatment. Case report. A 53-year-old white man referred at the Department Surgical, Oncological and Oral Sciences for a macular, scarsely pigmented lesion with irregular margins, located on anterior region of hard palate. The lesion, completely asymptomatic and without any history of trauma or injury, was observed by his dentist some months ago. The patient was a smoker (about 20 cigarettes a day for 30 years) and his anamnesis was negative for any systemic diseases and drug assumption. Histological examination, following the incisional biopsy, showed the hyperplasia of the junctional melanocytes with occasionally dendritic appearance and light atypia; on the recommendation of pathologist, a second incisional biopsy was performed, and a definitive diagnosis of “amelanotic melanoma in situ” was confirmed. After diagnosis, the patient was referred to the unit of Head and Neck Surgery for staging and surgical approach of the lesion. Conclusions. This case report underlines the importance to perform biopsy of all lesions of the oral cavity to rule out malignancy, even when slightly colored, asymptomatic and with a clinically harmless presentation. Besides benign diseases (e.g melanotic macules, nevi, extravasation of blood pigments, amalgam tattoos and deposition of other exogenous/endogenous pigments), rare variant of non-pigmented melanoma should be considered in order to avoid a dangerous diagnostic and therapeutic delay

High hole mobility and light-harvesting in discotic nematic dendrimers prepared: Via 'click' chemistry

We report a new family of liquid crystalline porphyrin-core dendrimers with coumarin units at the periphery of the dendrimer. These compounds have been prepared by copper-catalyzed azide-alkyne "click" cycloaddition (CuAAC). The mesomorphic properties have been investigated via polarized optical microscopy (POM), differential scanning calorimetry (DSC) and X-ray diffraction (XRD). The peripheral coumarin units play a key role in the liquid crystal behavior, contributing to the appearance of discotic nematic mesophases with hole mobility values among the highest values reported for discotic liquid crystals (of the order of 1 cm 2 V -1 s -1 ). It has also been demonstrated that excitation of the coumarin moieties leads to energy transfer (antenna effect) to the luminescent porphyrin core. Therefore, this strategy, which involves ''click'' chemistry, has been proven to be a powerful and elegant synthetic tool for the preparation of optoelectronic materials based on complex dendritic architectures

Corneal confocal microscopy in dry eye treated with corticosteroids

Purpose To evaluate, by in vivo laser scanning confocal microscopy (LSCM), the corneal findings in moderate-to-severe dry eye patients before and after treatment with topical corticosteroid and to associate the confocal findings to the clinical response. Methods Fifty eyes of 50 patients with moderate-to-severe dry eye were included in this open-label, masked study. Exclusion criteria were any systemic or ocular condition (other than dry eye) and any systemic or topical treatment (except artificial tears), ongoing or performed in the previous 3 months, with known effect on the ocular surface. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% qid for 4 weeks. Baseline and follow-up (day 30 \ub1 2) visits included Ocular Surface Disease Index (OSDI) questionnaire, full eye examination, and central cornea LSCM. We compared data obtained before and after treatment and looked for associations between baseline data and steroid-induced changes. Based on the previously validated OSDI Minimal Clinically Important Difference, we reanalyzed the baseline findings comparing those patients clinically improved after steroids to patients not clinically improved after steroids. Results Ocular Surface Disease Index score and LSCM dendritic cell density (DCD) significantly decreased after treatment. Baseline DCD correlated with both OSDI and DCD steroid-related changes (r = -0.44, p 2, p < 0.01; independent samples t test). Conclusions Laser scanning confocal microscopy examination of DCD allows detection of treatment-related inflammation changes and shows previously unknown associations between confocal finding and symptoms improvement after treatment. These promising preliminary data suggest the need for future studies testing the predictive value of DCD for a clinical response to topical corticosteroids

Reptile enamel matrix proteins: Selection, divergence, and functional constraint

The three major enamel matrix proteins (EMPs): amelogenin (AMEL), ameloblastin (AMBN), and enamelin (ENAM), are intrinsically linked to tooth development in tetrapods. However, reptiles and mammals exhibit significant differences in dental patterning and development, potentially affecting how EMPs evolve in each group. In most reptiles, teeth are replaced continuously throughout life, while mammals have reduced replacement to only one or two generations. Reptiles also form structurally simple, aprismatic enamel while mammalian enamel is composed of highly organized hydroxyapatite prisms. These differences, combined with reported low sequence homology in reptiles, led us to predict that reptiles may experience lower selection pressure on their EMPs as compared with mammals. However, we found that like mammals, reptile EMPs are under moderate purifying selection, with some differences evident between AMEL, AMBN, and ENAM. We also demonstrate that sequence homology in reptile EMPs is closely associated with divergence times, with more recently diverged lineages exhibiting high homology, along with strong phylogenetic signal. Lastly, despite sequence divergence, none of the reptile species in our study exhibited mutations consistent with diseases that cause degeneration of enamel (e.g. amelogenesis imperfecta). Despite short tooth retention time and simplicity in enamel structure, reptile EMPs still exhibit purifying selection required to form durable enamel.We calculated the percent identity between amino acid sequences of ameloblastin from various reptile groups. Crocodilians exhibit the highest sequence identity, while identity across squamates was substantially lower. Upon closer examination of the individual squamate clades, however, we found that identity values are actually much higher in snakes, with much of the variation existing between the various lizard infraorders.HIGHLIGHTSReptile enamel matrix proteins are under moderate purifying selection despite polyphyodonty and simple enamel structure.Sequence identity in reptile enamel matrix proteins exhibit correlation with divergence times in spite of differences in substitution rates.Reptile amelogenin operates under a distinct selection regime compared with ameloblastin and enamelin.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/1/jezb22857.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/2/jezb22857-sup-0001-Supplementary_file.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/3/jezb22857-sup-0007-Supplementary_file_S8-DAMBE-Saturation.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/4/jezb22857-sup-0002-Supplementary_file_S1-SpeciesTable.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/5/jezb22857-sup-0003-Supplementary_file_S2_Alignments.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/6/jezb22857-sup-0008-Supplementary_File_S9.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/7/jezb22857-sup-0005-Supplementary_file_S6.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/8/jezb22857_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/9/jezb22857-sup-0009-Supplementary_file_Reptiles.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150577/10/jezb22857-sup-0006-Supplementary_file_S7-DIVERGE.pd

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements

Mineral maturity and crystallinity index are distinct characteristics of bone mineral

The purpose of this study was to test the hypothesis that mineral maturity and crystallinity index are two different characteristics of bone mineral. To this end, Fourier transform infrared microspectroscopy (FTIRM) was used. To test our hypothesis, synthetic apatites and human bone samples were used for the validation of the two parameters using FTIRM. Iliac crest samples from seven human controls and two with skeletal fluorosis were analyzed at the bone structural unit (BSU) level by FTIRM on sections 2–4 lm thick. Mineral maturity and crystallinity index were highly correlated in synthetic apatites but poorly correlated in normal human bone. In skeletal fluorosis, crystallinity index was increased and maturity decreased, supporting the fact of separate measurement of these two parameters. Moreover, results obtained in fluorosis suggested that mineral characteristics can be modified independently of bone remodeling. In conclusion, mineral maturity and crystallinity index are two different parameters measured separately by FTIRM and offering new perspectives to assess bone mineral traits in osteoporosis

Photoconductive properties and electronic structure in 3,5-disubstituted 2-(2′-pyridyl)pyrroles coordinated to a Pd(II) salicylideneiminate synthon

The synthesis and the electrochemical, photophysical, structural, and photoconductive properties of three new heteroleptic Pd(II) complexes with various 3′,5′- disubstituted-2-(2′-pyridil) pyrroles H(N^N) as coordinated ligands are reported. The coordination of the metal center was completed by a functionalized Schiff base H(O^N) used as an ancillary ligand. The [(N^N)Pd(O^N)] complexes showed highly interesting photoconductive properties which have been correlated to their electronic and molecular structures. Theoretical density functional theory (DFT) and time-dependent DFT calculations were performed, and the results were confronted with the organization in crystalline phase, allowing to point out that the photoconductive properties are mainly a consequence of an efficient intramolecular ligand-to-metal charge transfer, combined to the proximity between the central metal and the donor moieties in the solid-state molecular stacks. The reported results confirm that these new Pd(II) complexes form a novel class of organometallic photoconductors with intrinsic characteristics suitable for molecular semiconductors applications.Supported by Ministero dell’Istruzione, dell’Universitàe della Ricerca by the ELIOTROPO.Peer reviewe

Developmental language disorder: Early predictors, age for the diagnosis, and diagnostic tools. A scoping review

Background. Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. Methods. We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. Results. Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. Conclusions. Monitoring risk situations and employing caregivers\u2019 reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions