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Background and aims: To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). Methods: Period of observation: March 1st, 2020 March 1st, 2021. Inclusion criteria: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. Results: Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. Conclusions: In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COV

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10–18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Biostimulants are gaining increasing interest because of their ability to provide a green and effective strategy towards sustainable crop production. Nonetheless, their mode of action remains often unknown. The object of this work was to unravel the mechanisms through which 4-Vita, a biostimulant plant extract, can mitigate drought stress in tomato. To this aim, tomato plants were treated with two foliar applications of 4-Vita and drought stress imposed to both treated and control plants. Phenomics investigations were coupled to mass spectrometric untargeted metabolomics, and raw data were elaborated by multivariate statistics and pathway analysis. The biostimulant elicited a broad reprogramming of the tomato’s secondary metabolism, including its phytohormones profile, corroborating an improved ability to cope with drought stress. A series of mechanisms could be identified in response to the biostimulant treatment under drought, pointing to the preservation of photosynthetic machinery functionality. The modulation of thylakoid membrane lipids, the increase in xanthins involved in ROS detoxification, and the modulation of chlorophylls synthesis could also be observed. Overall, a series of coordinated biochemical mechanisms were elicited by the biostimulant treatment, supporting the increased resilience to drought stress in tomato.

Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. Materials and Methods: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. Results: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. Conclusions: Given the best evidence-based information regarding patients’ medical condition, we highlight the need to provide an ethical-based comprehen

The applications of computer-guided technologies for three-dimensional image analysis provide a unique opportunity to quantify the morphological dimensional changes of the face in a practical and convenient way. Symmetry of the nasolabial area is one of the main factors of facial attractiveness as well as being the main objective of the treatment of cleft lip and palate (CLP). Technological advances in computer-guided visualization modes and their applications to three-dimensional stereophotogrammetry provide more practical opportunities and alternatives for facial analysis. Each study, however, uses different protocols for the acquisition and analysis of three-dimensional images. In addition, each study identifies different anthropometric points and calculates linear and angular measurements with overlapping protocols. Therefore, it is appropriate to define a standardization of the three-dimensional analysis of CLP patients to compare the studies of different research centers. The aim of this report is to propose a protocol to standardize the acquisition and analysis of three-dimensional images to evaluate the three-dimensional changes in the nasolabial area in cleft lip and palate patients undergoing pre-surgical nasoalveolar molding (PNAM).

Introduction: Anterior crossbite (AC) is defined as a reverse sagittal relationship between maxillary and mandibular incisors. According to an evidence-based orthodontic triage, the treatment need of AC is indicated if any occlusal interference is forcing the mandible towards a Class III growth pattern. Removable and fixed appliances have been suggested to correct AC. Objective: The present report aims at presenting the benefits of an alternative therapy for the early treatment of anterior crossbite using clear aligners. Methods: Two cases of anterior crossbite corrected using clear aligners in 8-years-old children are presented. Results: In both cases, AC was successfully corrected within 5 months. At the end of the treatment, overjet and overbite were corrected. No major discomfort or speech impairment was noticed by the parents. Conclusions: Due to the perceived shortcomings of alternative approaches, the use of clear aligners for correcting AC in mixed dentition should be considered as a comfortable and well tolerated appliance for young patients.

Background and Purpose. Following the new directives of the European Union, which foresee the amalgam ban, the debate on its hypothetical toxicity has started again. So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids. Methods. A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA). Results. From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant (p = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached. Conclusions. The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.

Background: We report a prospective, nationwide cohort evaluating the safety and effectiveness of CT-P13. Methods: A structured database was used to record serious adverse events (SAEs), clinical remission/response, inflammatory biomarkers (CRP and calprotectin), and endoscopic findings. Results: Eight hundred ten patients with inflammatory bowel disease (IBD) (452 Crohn's disease [CD]) were enrolled. Four hundred fifty-nine patients were naïve to anti-TNFα (group A), 196 had a previous exposure (group B), and the remaining 155 were switched to CT-P13 (group C). All patients were included in the safety evaluation with a mean follow-up of 345 ± 215 days and a total number of 6501 infusions. One hundred fifty-four SAEs were reported (19%), leading to cessation of the biosimilar in 103 subjects (12.7%). Infusion reactions were 71, leading to cessation of the biosimilar in 53 subjects (6.5%), being significantly more frequent in patients pre-exposed to anti-TNFα (P = 0.017). The efficacy of therapy was calculated in 754 IBD patients, with a mean follow-up of 329 ± 202 days. Forty-eight patients had a primary failure (6.4%), and 188 (25.6%) lost response during follow-up. Six hundred twenty-eight (364 CD) and 360 IBD patients (222 CD) completed the follow-up at 6 and 12 months, respectively. At 12 months, patients without loss of response were 71%, 64%. and 82% in groups A, B, and C, respectively (log rank P = 0.01). Clinical/endoscopic scores and inflammatory biomarkers dropped significantly in CD and UC patients (P = 0.01 and P < 0.0001) compared with baseline. Conclusions: In this large prospective cohort, no further signals of difference in safety and effectiveness of CT-P13 in IBD has been observed.

OBJECTIVES: To introduce a new, fast, reliable, and free from software-related bias method to predict three-dimensionally the root position and angulation during and after orthodontic treatment. The final goal is to keep to a minimum the use of ionizing radiation by eliminating the necessity of multiple radiation exposure for checking root alignment. SETTING AND SAMPLE POPULATION: Pre- and post-treatment digital models and cone-beam computed tomographic (CBCT) scans from a patient were retrieved. MATERIAL AND METHODS: The post-treatment digital model (post-model) was set as the reference; pre- and post-treatment CBCT scans were pre-aligned to the post-model with a point set registration; iterative closest point algorithm was then employed for final adjustments. The accuracy of the proposed method was assessed by comparing the average distance between the expected root position setup with the true position of the roots, as from the post-treatment CBCT. RESULTS: After crown superimposition, 3D colour maps showed that the accuracy of the root prediction was below 0.1 mm. CONCLUSION: The proposed digital workflow allows to predict in an accurate and truly three-dimensional way the final position of roots, when an initial CBCT is available, without the need of an extra X-ray examination for the patient at the end of treatment. The limitation of the exposure to mid- and post-treatment X-rays is in accordance with the ALARA (As Low As Reasonably Achievable) principle and it is even more relevant in growing patients.

Local anaesthesia in dentistry is usually given by conventional injection through a syringe. In this randomised, single-blind, split-mouth clinical study we evaluated the perception of pain and changes in heart rate in children being given dental local anaesthesia using a computer-controlled device compared with that given using a traditional syringe. Participants were in good general health with no contraindications to local anaesthetics. One half of each maxilla was anaesthetised using each technique, the order having been randomly selected according to a computer-generated sequence. The hypothesis was that the controlled anaesthetic flow rate results in virtually imperceptible injections. The outcomes were the perception of pain and the heart rate. Seventy-six children aged from 5–12 years old participated in this study. The mean (SD) pain score of the conventional injection was 5.51 (2.46) and the mean (SD) heart rate was 2.72 (6.76), which were significantly higher than those of the computerised delivery system, which were 4.74 (2.8) and 0.34 (7.3) (p = 0.04). More patients anaesthetised with the traditional syringe technique required a second injection (n = 21). These results suggest that dental anaesthesia given to children with a computer-controlled delivery system reduced pain better than that given with a conventional syringe.

BACKGROUND: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis. CASE REPORT: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic results

Aim: Cleidocranial dysostosis (CCD) is a rare congenital bone disorder with an autosomal dominant hereditary inheritance pattern. This disorder can be caused by mutation in the transcription factor CBFA1 (RUNX2). The CBFA1 gene is essential for membranous as well as endochondral bone formation. The estimated prevalence of CCD is one per million, but it is most likely underdiagnosed because of the relative lack of medical complications in comparison to other skeletal dysplasias. CCD is reported in all ethnic groups, and there is no sex predilection. Clinically, CCD is characterized by hypoplastic/aplastic clavicles, brachycephalic skull, midface hypoplasia, delayed closure of fontanelles and moderately short stature. The most common dentoalveolar characteristics of CCD are: over-retained deciduous teeth with unresorbed roots, supernumerary teeth, retarded eruption, reduced height of the lower third of the face and a skeletal Class III tendency due to an underdevelopment of the maxilla and to an upward and forward mandibular rotation, seriously delayed root development of the permanent teeth. The multidisciplinary treatment procedure consists of a surgical phase followed by an orthodontic treatment, in which extrusion forces are applied. Methods: A 18-years-old male student presented at Gemelli Hospital in June 2016 because of pain in the upper right back-molar region. Clinical and radiographic examinations revealed an extensive cavity in the upper right first molar and impactation of numerous teeth. In addition, supernumerary teeth were evident at orthopantomography. During treatment, an accidental pulp exposure occurred, so an interim medication with calcium hydroxide was performed. After 1 week, the patient keep on being symptomatic and returned for a recall evaluation, reporting pain and sensitivity. After local anesthesia (3% mepivacaine with noradrenaline 1:100.000) and rubber dam isolation, the pulp chamber was accessed using a spherical diamond bur and further

The aim of ESCODD, a European Commission funded Concerted Action, is to improve the precision and accuracy of methods for measuring 8-oxo-7,8-dihydroguanine (8-oxoGua) or the nucleoside (8-oxodG). On two occasions, participating laboratories received samples of different concentrations of 8-oxodG for analysis. About half the results returned (for 8-oxodG) were within 20% of the median values. Coefficients of variation (for three identical samples) were commonly around 10%. A sample of calf thymus DNA was sent, dry, to all laboratories. Analysis of 8-oxoGua/8-oxodG in this sample was a test of hydrolysis methods. Almost half the reported results were within 20% of the median value, and half obtained a CVof less than 10%. In order to test sensitivity, as well as precision, DNA was treated with photosensitiser and light to introduce increasing amounts of 8-oxoGua and samples were sent to members. Median values calculated from all returned results were 45.6 (untreated), 53.9, 60.4 and 65.6 8-oxoGua/10(6) Gua; only seven laboratories detected the increase over the whole range, while all but one detected a dose response over two concentration intervals. Results in this trial reflect a continuing improvement in precision and accuracy. The next challenge will be the analysis of 8-oxodG in DNA isolated from cells or tissue, where the concentration is much lower than in calf thymus DNA.

The distribution of estrogen receptor between the cytosolic and nuclear compartments were evaluated in liver of male rats to determine whether a circadian rhythm exists. Cytosolic receptor reached a maximum level at 400 hours and a minimum at 2000 and 2400 hr. Nuclear receptor reached a maximum level at 800 hr and was lowest at 1600 and 2000 hr. Serum estradiol levels were also highest at 800 hr and lowest at 1600 hr. The variations in cytosolic and nuclear receptors are not reciprocal; in fact, the overall content of receptor in the liver is not constant and also displays a circadian rhythm. © 1986 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Spironolactone and potassium canrenoate are diuretics that are used widely for management of cirrhotic ascites. The administration of spironolactone frequently leads to feminization, which has been noted less frequently with the use of potassium canrenoate, a salt of the active metabolite of spironolactone. The use of these two drugs has been associated with decreases in serum testosterone levels and spironolactone with a reduction in androgen receptor (AR) activity. This decrease in AR has been cited as the cause of the antiandrogen effect of these drugs. We therefore assessed the effect of both drugs on levels of androgen and estrogen receptors (ER) in the liver, a tissue that is responsive to sex steroids. Three groups of male rats (n = 12 rats each) were studied. Group 1 (control) received vehicle only; group 2 received spironolactone (5 mg/day); group 3 received potassium canrenoate (5 mg/day). After 21 days of treatment, the animals of all groups were killed and liver tissue was assayed for nuclear and cytosolic AR and ER, and for male specific estrogen binder (MEB), an androgen-responsive protein. Both drugs drastically decreased the nuclear AR content, as compared with the control group, but only spironolactone decreased cytosolic AR. When the total hepatic content of AR is considered, a highly significant decrease is observed only in rats treated with spironolactone. This reduction in hepatic AR content suggested loss of androgen responsiveness of liver. We confirmed this by assessing levels of MEB, and found that livers from group 2 animals had no detectable MEB activity, whereas livers from both group 1 and 3 had normal MEB activity. No changes were observed in nuclear ER and cytosolic ER of group 3 as compared with group 1. Nuclear estrogen receptor decreased and cytosolic ER increased in group 2, but with no change in total ER content. These results indicate that (a) only spironolactone appears to act as an antiandrogen in liver, resulting in a decrease