Platelet-Rich Plasma,Mesenchymal Stem Cell,and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

BackgroudWe performed a systematic review on the management of patellar fracture nonunion and report a novel suture-based non-metallic fixation technique associated with platelet-rich plasma and mesenchymal stem cell injections in the management of this injury.MethodsA systematic search was performed up to August 2020 in PubMed and Scopus electronic databases of scholarly articles evaluating different surgical techniques used for nonunion of patellar fractures, with no restrictions on language or year of publication. Furthermore, we describe our novel non-metallic suture fixation technique and a patient in whom this technique was applied.ResultsA total of 9 articles were included in the systematic review. Tension band wiring was the most commonly used procedure (62.7%). Nonoperative procedures (8.1%) resulted in nonunion in all patients. The most common complication after open reduction and internal fixation was infection (7.8%). Our patient at the latest follow-up reported full functional recovery and full extension and flexion of the affected knee with no pain and subjectively normal strength.ConclusionsThe management of patella nonunions is still a challenge. The technique reported here can be used in patellar fracture nonunion, as well as in primary patellar fractures.     

Balancing harms and benefits of service mammography screening programs: a cohort study

Introduction  

The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs.     

Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure

ABSTRACT: According to a fundamental law of radiobiology ("Law of Bergonie and Tribondeau", 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant to stochastic effects of radiation. This assumption has been challenged by recent evidence discussed in the present review. The brain is among the most critical dose-limiting organs in radio-therapy, mainly due to the development of cognitive dysfunction following white matter disruption, since radio-sensitive oligodendrocyte precursor stem cells have mitotic activity and are responsible for white matter integrity and repair in the adult brain. The neuro-vascular unit is also vulnerable to radiation effects, and cerebro-vascular atherosclerotic damage is now considered proven with epidemiological evidences for doses > 500 mSv. Ionizing radiation is an established environmental cause of brain cancer. Although direct evidence is lacking in contemporary fluoroscopy due to obvious sample size limitation, limited follow-up time and lack of focused research, anecdotal reports of clusters have appeared in the literature, raising the suspicion that brain cancer may be a professional disease of interventional cardiologists. In addition, although terminally differentiated neurons have reduced or mild proliferative capacity, and are therefore not regarded as critical radiation targets, adult neurogenesis occurs in the dentate gyrus of the hippocampus and the olfactory bulb, and is important for mood, learning/memory and normal olfactory function, whose impairment is a recognized early biomarker of neurodegenerative diseases. The head doses involved in radiotherapy are high, usually above 2 Sv, whereas the low-dose range of professional exposure typically involves lifetime cumulative whole-body exposure in the low-dose range of <200 mSv, but with head exposure which may (in absence of protection) arrive at a head dose equivalent of 1 to 3 Sv after a professional lifetime (corresponding to a brain dose around 500 mSv). At this point, a systematic assessment of brain (cancer and non-cancer) effects of chronic low-dose radiation exposure in interventional cardiologists and staff is needed.     

Role of Hormone Receptor Expression in Patients With Advanced-Stage Lung Cancer Treated With Chemotherapy

BackgroundEvidence that supports a role for hormonal status in lung cancer has been inconsistently reported and is still unclear. We retrospectively assessed the potential correlation between sex-linked hormone receptor expression and the clinical outcome of patients with advanced-stage lung cancer treated with chemotherapy.Patients and MethodsBased on tissue availability, 130 consecutive patients diagnosed at San Luigi Hospital from January 2008 to June 2010 were collected, including 24 small-cell lung cancer, 57 adenocarcinomas, 34 squamous cell carcinomas, 5 large-cell carcinomas, and 10 non–small-cell lung cancer–not otherwise specified. The immunohistochemical expression of estrogen receptors (ER-α and ER-β) and progesterone receptor, aromatase, epidermal growth factor receptor (EGFR), and excision repair cross-complementing 1 (ERCC1) was assessed.ResultsER-β nuclear expression was higher than ER-α and progesterone receptor, whose expression was null or weak (mainly in women). ER-β expression was significantly higher in patients with metastatic disease compared with all other disease stages (P = .02). EGFR expression was strongly correlated with non–small-cell lung cancer histology, being higher in squamous types and stage related. In men, aromatase positive cases had a worse outcome (P = .03) as well as in men with non–small-cell lung cancer and high ER-β expression. In the latter group, the combined aromatase negative and/or low ER-β expression and low ERCC1 and/or low ER-β expression showed a better outcome (P = .026; P = .03, respectively).ConclusionIn patients with advanced-stage lung cancer treated with chemotherapy, the prognostic and predictive role of sex-linked hormone receptor expression, if any, is of borderline significance and is restricted to selected subgroups of patients.     

Toxicological database of soil and derived products (BDT)

The Toxicological database of soil and derived products is a project firstly proposed by the Regional Environmental Authority of Apulia. Such a project aims to provide comprehensive and updated information on the regional environmental characteristics, on the pollution state of the regional soil, on the main pollutants and on the reclaim techniques to be used in case of both non-point (agricultural activities) and point (industrial activities) sources of pollution. The project's focus is on the soil pollution because of the fundamental role played by the soil in supporting the biological cycle. Furthermore, the reasons for the project are related both to the reduction of human health risks due to toxic substances ingestion (these substances are present in some ring of the eating chain), and to the recognition of the importance of the groundwater quality safety (primary source of fresh water in many Mediterranean Regions). The essential requirements of a data entry are the following: speed and simplicity of the data entry; reliability and stability of the database structures; speed, easiness and pliability of the queries. Free consultation of the database represents one of the most remarkable advantages coming from the use of an "open" system.     

Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection

Objectives: (a) To evaluate retrospectively the clinical outcome of non‐vascularized bone grafts used for the reconstruction of mandibular defects following tumor resection; (b) to evaluate the clinical outcome of implants and implant‐supported prostheses placed in the reconstructed areas; and (c) to evaluate patients' satisfaction regarding function and esthetics after oral rehabilitation. Material and methods: In a 9‐year period (1995–2003), 29 patients affected by mandibular tumors involving to tooth bearing areas were treated by means of tumor resection and immediate or delayed reconstruction with autogenous non‐revascularized calvarial or iliac bone grafts. Among these patients, 16 patients were selected for dental rehabilitation of the lost dentition with implant‐supported 3fixed prosthese333s. For to 7 months later, the patients received 60 oral implants for the prosthetic rehabilitation of the reconstructed edentulous areas. Results: No total failure of the graft was observed, while partial loss of the graft was observed in one patient. The mean follow‐up of patients after the start of prosthetic loading of implants treated was 94 months (range: 36–132 months). Two patients dropped out of the follow‐up after 3 and 4 years of observation, respectively. Two implants were removed due to loss of osseointegration, while two implants, although still integrated, presented peri‐implant bone resorption values higher than those proposed by Albrektsson et al. for successful implants. Cumulative survival and success rates of implants were 96.7% and 93.3%, respectively. Conclusion: Results from this study demonstrated that bone defects following resection of mandibular tumors can be predictably reconstructed with autogenous bone grafts taken from the calvarium or the anterior iliac crest. It has also been shown that the long‐term survival and success rates of implants placed in the reconstructed areas (96.7% and 93.3%, respectively) may guarantee an excellent prognosis of implant‐supported prostheses.     

Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study

BACKGROUND: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. METHODS: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) > or =5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. RESULTS: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. Moreover, the PD was reduced in the SRP + CHX treatment group compared to the SRP treatment group at 3 and 6 months, whereas the RAL was similar for both treatments at 3 months and was reduced in the SRP + CHX treatment group at 6 months. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001). The TBCs decreased significantly with both treatments. A similar, although less evident, pattern was noted when only the pockets with an initial PD > or =7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and 1 month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P <0.01 and P <0.05, respectively). Over time, both treatments generally reduced the percentages of sites positive for the eight putative periodontopathic bacteria, although greater reductions were seen often for the SRP + CHX treatment group. CONCLUSIONS: The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota.     

Temporomandibular disorders and orthognathic surgery

The relations between temporomandibular dysfunctions (TMDs) and maxillomandibular malformations requiring orthognathic surgery for correction have been the object of different studies in medical literature. The authors have performed a bibliographic revision on this issue to show the state of the art. This study, an analysis of the literature of the last 20 years, is chronologically presented. It analyzes the prevalence of TMD in patients with different types of maxillomandibular deformities undergoing orthognathic surgery and the TMD changes that occurred after an orthognathic surgical treatment. Medical studies reported in literature show a high variation of results related both to the prevalence of TMD in patients with maxillomandibular deformities and to the changes ensuing from an orthognathic surgical treatment. It has been difficult to compare the different studies because of the different methods used to individuate TMD signs and symptoms in the groups of patients analyzed, as well as the different types of orthognathic surgery performed and the specific TMD treatments used when required. It is concluded that despite the different results provided by the various studies, a certain prevalence of TMD is always present in patients with maxillomandibular deformity. This can be assumed to be within a correlation between dysgnathia and TMDs, and it asserts the necessity to treat patients who have maxillomandibular deformities and TMD by performing a specific treatment of TMD.