This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific ...rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior.
Highlights
AR drugs such as bisphosphonates (BPs), denosumab (DNB) and romosozumab (RMB) are very effective in the treatment of osteoporosis and in the prevention of fragility bone fractures.
Periodontitis is a widespread infective inflammatory disease that is the major cause of tooth loss, and it is strongly connected with other systemic diseases, including osteoporosis.
MRONJ is a serious and rare complication associated with the use of AR drugs in osteoporotic patients. The reported incidence is rather low and ranges between 0.01 and 0.9%, but may be higher in the presence of comorbidities.
Periodontitis and MRONJ share some risk factors, such as diabetes, smoking, steroids, cardiovascular diseases and rheumatoid arthritis.
The risk of developing MRONJ in a case of successfully treated periodontitis is much lower than the risk of fragility fracture in a high-risk person such as one with a previous fracture.
Oral and periodontal conditions should be assessed before starting an AR therapy, and local intra-oral inflammation should be brought under control. Periodontal therapy is effective at reducing the risk of teeth extraction and therefore the need for major bone reconstructive intervention and implant placement.
Control of periodontal inflammation should be achieved and maintained over time in osteoporosis-affected patients treated with AR.
Peri-implant diseases rather than dental implant placement may be considered a trigger for MRONJ; for this reason, periodontitis and peri-implant inflammatory disease control and the inclusion of patients in a supportive periodontal program are critical.
AR therapy should not be discontinued or deferred by the dentist unless done in accordance with the prescriber.
The suspension of BP therapy is not recommended on a routine basis, as BP binds to the skeletal sites and continue to be released for months or years after treatment, with a long tail effect on bone metabolism.
DNB administration should not be withdrawn because the rebound effect may increase the risk of bone fractures. A therapeutic window in which to perform dento-alveolar surgical procedures is suggested.
It is advisable to calibrate the timing of dental extraction and surgical procedures between the dentist and prescribers according to the oral condition, the general health condition, and the time and type of AR drugs used.
A more integrated approach between prescriber, dentist, periodontist and dental hygienist should be encouraged, particularly in the management of periodontitis-affected patients who are taking AR drugs for osteometabolic disorders.
Prescribers and dentists must educate patients regarding the potential risk associated with long-term use of AR therapy.
Abstract Aim A healthy diet could help to prevent both oral and systemic diseases, with dentists and nutritionists supplementing their skills. The dental setting, where patients periodically refer to ...seeking oral health care, represents a powerful opportunity for nutritional counselling. To the best of our knowledge, no study is available on patients’ attitudes towards dietary counselling in the dental setting. This cross-sectional study investigates patients’ attitude towards receiving nutritional support within the dental setting and it elucidates whether a transdisciplinary approach would be well accepted. Materials and Methods A questionnaire was administered to patients attending three different clinics: a private clinic, a hospital dental clinic of the national healthcare system and the private dental practice within the same hospital. Results Three hundred thirteen questionnaires were collected. Most dental patients acknowledged receiving nutritional advice from both dentists and nutritionists. The nutritionist within the dental setting was positively perceived, providing useful advice to prevent oral and systemic diseases and also drawing up a diet with periodic follow-ups. Discussion and conclusion These findings support the positive attitude of patients towards receiving nutritional counselling within the dental setting. The dental clinics can be pivotal in oral and systemic disease screening and prevention and a multidisciplinary approach is highly encouraged.
Anti-resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian ...Society of Periodontology and Implantology members in the management of patients treated with anti-resorptive agents and with the risk of developing MRONJ.
An 18-item questionnaire was submitted by e-mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro-Wilk test.
Four hundred and fifty-one questionnaires were returned by e-mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti-resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti-resorptive therapy for osteometabolic disorders. One or more MRONJ-affected patients were encountered by 63.2% of the respondents.
This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti-resorptive agents.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Cognitive Multisensory Rehabilitation (CMR) is a promising therapy for upper limb recovery in stroke, but the brain mechanisms are unknown. We previously demonstrated that the parietal operculum ...(parts OP1/OP4) is activated with CMR exercises. In this exploratory study, we assessed the baseline difference between OP1/OP4 functional connectivity (FC) at rest in stroke versus healthy adults to then explore whether CMR affects OP1/OP4 connectivity and sensorimotor recovery after stroke. We recruited 8 adults with chronic stroke and left hemiplegia/paresis and 22 healthy adults. Resting-state FC with the OP1/OP4 region-of-interest in the affected hemisphere was analysed before and after 6 weeks of CMR. We evaluated sensorimotor function and activities of daily life pre- and post-CMR, and at 1-year post-CMR. At baseline, we found decreased FC between the right OP1/OP4 and 34 areas distributed across all lobes in stroke versus healthy adults. After CMR, only four areas had decreased FC compared to healthy adults. Compared to baseline (pre-CMR), participants improved on motor function (MESUPES arm p = 0.02; MESUPES hand p = 0.03; MESUPES total score p = 0.006); on stereognosis (p = 0.03); and on the Frenchay Activities Index (p = 0.03) at post-CMR and at 1-year follow-up. These results suggest enhanced sensorimotor recovery post-stroke after CMR. Our results justify larger-scale studies.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. ...Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries.
Aim of the study
The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations.
Materials and methods
We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis.
Results
Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others.
Conclusions
Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Tumor cells in chronic lymphocytic leukemia (CLL) are more prone to apoptosis when cultured ex vivo, because they lack prosurvival signals furnished in vivo via B-cell receptor (BCR)-dependent and ...-independent pathways. This study compared the susceptibility of unmutated (UM) and mutated (M) CLL B cells to spontaneous apoptosis and prosurvival signals. UM CLL B cells showed a significantly higher rate of spontaneous apoptosis than M CLL B cells. Nuclear factor-kB (NF-kB) was rapidly inactivated, and B-cell leukemia/lymphoma 2 (Bcl-2) expression progressively down-regulated in the UM CLL B cells. CD40-Ligand, interleukin-4 and stromal cells significantly improved their viability and partially recovered Bcl-2, but not NF-kB expression. Peripheral blood mononuclear cells also offered protection of UM CLL B cells, and recovered both NF-kB and Bcl-2 expression. T cells, rather than nurse-like cells, were responsible for protecting UM CLL B cells by means of cell-to-cell contact and soluble factors. Despite their more aggressive features, UM CLL B cells are more susceptible to spontaneous apoptosis and depend from environmental prosurvival signals. This vulnerability of UM CLL B cells can be exploited as a selective target of therapeutic interventions.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract This paper presents an equipment dedicated to the monitoring of synchronous generator through the measurements of the external magnetic field time derivative. The equipment uses a ...methodology which can be an additional technique to those applied currently on the faults detection, mainly when monitoring the incipient faults type. Based on frequency spectra (magnetic signatures), the faults detection is performed by the analysis of the components evolution. As it is not possible to test the ability of the equipment in detecting several types of faults of generators faults in a power plant, a testbench was constructed for this purpose. Faults inserted deliberately in the generators of the testbench are detected by the equipment, showing its capacity. This equipment has been also installed in power plants.
Nerve terminals are specific sites of action of a very large number of toxins produced by many different organisms. The presynaptic neurotoxins which interfere directly with the process of ...neurotransmitter release can be grouped in three large families: (1) the clostridial neurotoxins which act inside nerves and block neurotransmitter release via their metalloproteolytic activity directed specifically on SNARE proteins; (2) the snake presynaptic neurotoxins with phospholipase A
2 activity whose site of action is still undefined and which induce the release of acetylcholine followed by impairment of synaptic functions; (3) the excitatory latrotoxin-like neurotoxins which induce a massive release of neurotransmitter at peripheral and central synapses. In this paper, the first two families are considered in terms of their modes of action and in relation to their potential use in cell biology and neuroscience as well as the therapeutic utilisation of the botulinum neurotoxins in human diseases characterised by hyperfunction of cholinergic terminals.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background and ImportanceCOPD is currently the third leading cause of death worldwide with 3.23 million deaths in 2019. Despite recommendations, many care non-conformities are observed in COPD ...patients.Aim and ObjectivesThe aim of the study was to describe the intervention of a clinical pharmacist focused on the respect of COPD management recommendations emitted by the French Health Authority.Material and MethodsOur study is an observational study conducted between January and July 2022. Clinical pharmacist included COPD patients and performed a pharmaceutical interview focused on COPD management. This interview assessed medical follow-up by a pneumologist, smoking, vaccination against pneumococcus, COPD medication, medication adherence and proper use of inhalation devices. The number of non-conformities to recommendations and their distribution were collected at the end of the intervention. Propositions emitted by clinical pharmacist were collected and factors that may have an impact on the recommendations non-compliance were identified.ResultsA total of 85 patients were included in the study. The mean age was 70.5 years. A total of 173 non-conformities were detected on 79 patients, i.e., two non-conformities per patient. At least one non-conformity was observed in 93% of patients. The most frequent non-conformities were the misuse of inhalation devices (77.2%) and the absence of vaccination against pneumococcus (67.1%). Follow up by a pneumologist concerned 64.7% of patients, 32.9% of patients were active smokers and 31.2% of the prescriptions were considered to be non-compliant. After interview, 89 propositions were emitted and clinical pharmacist intervention allowed to change COPD medication on 14.1% of patients. Follow-up by a pneumologist increases significantly pneumococcal vaccination coverage and proper use of inhaler devices.Conclusion and RelevanceOur study shows that clinical pharmacist can detect non-conformities and make recommendations to optimise COPD management during patient hospitalisation. This kind of intervention could also be used for patients suffering from other chronic disease as heart failure, asthma or diabetes.References and/or AcknowledgementsConflict of InterestNo conflict of interest.
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