Emergence and Spread of SARS-CoV-2 Lineages B.1.1.7 and P.1 in Italy

Italy’s second wave of SARS-CoV-2 has hit hard, with more than three million cases and over 100,000 deaths, representing an almost ten-fold increase in the numbers reported by August 2020. Herein, we present an analysis of 6515 SARS-CoV-2 sequences sampled in Italy between 29 January 2020 and 1 March 2021 and show how different lineages emerged multiple times independently despite lockdown restrictions. Virus lineage B.1.177 became the dominant variant in November 2020, when cases peaked at 40,000 a day, but since January 2021 this is being replaced by the B.1.1.7 ‘variant of concern’. In addition, we report a sudden increase in another documented variant of concern—lineage P.1—from December 2020 onwards, most likely caused by a single introduction into Italy. We again highlight how international importations drive the emergence of new lineages and that genome sequencing should remain a top priority for ongoing surveillance in Italy.     

Early loading of sandblasted, acid-etched implants in the posterior maxilla and mandible: a 1-year follow-up report from a multicenter 3-year prospective study

PURPOSE: The aim of the present study was to evaluate the concept of an immediate loading protocol in the posterior maxilla and mandible through analysis of implant survival at 1 year. MATERIALS AND METHODS: One year follow-up data of a multicenter study are reported. Eighty-two ITI sandblasted, acid-etched (SLA) implants in 40 patients were loaded between 0 and 11 days after implant placement (mean 4.3 +/- 2.8 days). The restorations consisted of either 2 splinted crowns or a 3-unit fixed prosthesis. All restorations were put into full functional occlusion. Periapical radiographs were evaluated for changes in crestal bone level from baseline to 1 year postloading. Primary stability of the implants was checked initially and before the fitting of the definitive prosthesis. The restorations were evaluated by the practitioners for retention, stability, and esthetics. RESULTS: Three patients' implants were not loaded because of lack of primary stability, and a fourth patient was excluded from the study because of a protocol violation (more than 4 implants were used). All 4 patients were successfully treated outside the protocol. The overall survival rate of the remaining implants at 1 year was 98.8%. The mean bone loss at 1 year was 0.52 +/- 0.98 mm, which is within the reported limits of less than 1 mm (range 0.4 to 1.4 mm) loss in the first year. DISCUSSION AND CONCLUSION: The early results from this study indicate that early and immediate loading of 2 implants in the posterior maxilla and mandible may be suitable in selected patients. On the basis of 1 year of observation, the results appear similar to those achieved with a delayed procedure.     

MMP-2 assay within the hybrid layer created by a two-step etch-and-rinse adhesive: biochemical and immunohistochemical analysis

Objective

Degradation of hybrid layers (HLs) within resin-infiltrated dentine results from multiple degradation factors, including collagenolytic activity of specific matrix metalloproteinases (MMPs). Inhibition of host-derived MMPs may, therefore, slow the degradation of HL. The null hypothesis tested is that the presence of MMP-2 is similar regardless of chlorhexidine (CHX) pre-treatment or the use of an adhesive.

Methods

Powdered dentine prepared from extracted human teeth was divided into 4 groups: (G1) mineralised powder (control group); (G2) dentine powder treated with 1% phosphoric acid for 1 min; (G3) 1% phosphoric acid-etched dentine treated with Adper Scotchbond 1 XT (SB1XT; 3M ESPE); (G4) 1% phosphoric acid-etched dentine treated with 0.2% CHX followed by SB1XT. The concentration of detectable pro-MMP-2 and MMP-2 was assayed using a colorimetric assay system (QuantiSir). In addition, the presence of MMP-2 in the HL was assessed in 1 year-aged adhesive-dentine interfaces using an immunohistochemical approach under FEI-SEM/TEM.

Results

In dentine powder treated with 1% phosphoric acid (G2), MMP-2 level decreased compared to controls (G1); the application of SB1XT (G3) resulted in an increase of MMP-2, whilst 0.2% CHX before SB1XT application (G4), reduced MMP-2. The FEI-SEM/TEM analysis revealed MMP-2 distribution within the HL of aged interfaces showing increase MMP-2 patterns in the control group and minor labelling in the CHX-pretreated specimens.

Conclusion

The results of this study support the use of non-toxic MMPs inhibitors, such as CHX, as an appropriate additional step in bonding procedures in order to increase the longevity of the adhesive restorations.     

Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients

Purpose

To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients.

Methods

Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Policlinico “Umberto I°”, Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists.

Results

There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12–24 months after surgery, while the mean percentage excess weight loss at 3–5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients.

Conclusions

Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy.     

Changes in spino-pelvic alignment after surgical treatment of high-grade isthmic spondylolisthesis by a posterior approach: a report of 41 cases

Purpose

To analyze changes in spino-pelvic parameters (SPPs) after surgery of high-grade lumbar isthmic spondylolisthesis (HDIS).

Methods

We analyzed 41 patients affected by HDIS operated upon by attempt of reduction and posterior spinal fusion with pedicle screw systems with or without interbody fusion. Pelvic tilt (PT), lumbar lordosis (LL), pelvic incidence (PI), and sacral slope (SS) were measured, and patients were further divided into balanced and unbalanced pelvis subgroups.

Results

SS passed from 46.8° ± 9.8° preoperatively to 50.1° ± 10.1° (p = 0.02). PT passed from 26.7° ± 6.7° preoperatively to 22.9° ± 7.5° (p = 0.003). Unbalanced patients showed significantly higher PT and lower SS compared to the balanced patients preoperatively, and these corrected after surgery. Patients with instrumentation failure (n = 5) had significant increase in PT values postoperatively (p = 0.018).

Conclusions

We confirmed the positive effect of surgery on the SPPs in patients affected by HDIS, which showed different patterns of corrections with surgery for balanced and unbalanced pelvis patients.

     

Functional disability and death wishes in older Europeans: results from the EURODEP concerted action

Purpose

Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life.

Methods

Data from 11 population studies on depression in persons aged 65 and above were pooled, yielding a total of 15,890 respondents. Level of functional disability was trichotomised (no, intermediate, high). A person was considered to have death wishes if the death wish/suicidal ideation item of the EURO-D scale was endorsed. Odds ratios for death wishes associated with functional disability were calculated in a multilevel logistic regression model.

Results

In total, 5 % of the men and 7 % of the women reported death wishes. Both intermediate (OR 1.89, 95 % CI 1.42; 2.52) and high functional disability (OR 3.22, 95 % CI 2.34; 4.42) were associated with death wishes. No sex differences could be shown. Results remained after adding depressive symptoms to the model.

Conclusions

Functional disability was independently associated with death wishes in older adults. Results can help inform clinicians who care for older persons with functional impairment.     

Predicting Survival of Patients with Node-positive Prostate Cancer Following Multimodal Treatment

Background

According to the TNM staging system, patients with prostate cancer (PCa) with lymph node invasion (LNI) are considered a single-risk group. However, not all LNI patients share the same cancer control outcomes.

Objective

To develop and internally validate novel nomograms predicting cancer-specific mortality (CSM)–free rate in pN1 patients.

Design, setting, and participants

We evaluated 1107 patients with pN1 PCa treated with radical prostatectomy, pelvic lymph node dissection, and adjuvant therapy at two tertiary care centers between 1988 and 2010.

Outcome measurements and statistical analysis

Univariable and multivariable Cox regression models tested the relationship between CSM and patient clinical and pathologic characteristics, which consisted of prostate-specific antigen (PSA) value, pathologic Gleason score, pathologic tumor stage, status of surgical margins, number of positive lymph nodes, and status of adjuvant therapy. A Cox regression coefficient-based nomogram was developed and internally validated.

Results and limitations

All 1107 patients received adjuvant hormonal therapy (aHT). Additionally, 35% of patients received adjuvant radiotherapy (aRT). The 10-yr CSM-free rate was 84% in the entire cohort and 87% in patients treated with aRT plus aHT versus 82% in patients treated with aHT alone (p = 0.08). At multivariable analyses, PSA value, pathologic Gleason score, pathologic tumor stage, surgical margin status, number of positive lymph nodes, and aRT status were statistically significant predictors of CSM (all p ≤ 0.04). Based on these predictors, nomograms were developed to predict the 10-yr CSM-free rate in the overall patient population and in men with biochemical recurrence. These models showed high discrimination accuracy (79.5–83.3%) and favorable calibration characteristics. These results are limited by their retrospective nature.

Conclusions

Some patients with pN1 PCa have favorable CSM-free rates at 10 yr. We developed and internally validated the first nomograms that allow an accurate prediction of the CSM-free rate in these patients at an individual level.