Depression symptoms increase the risk for initiation or switching to biologic therapy in pediatric inflammatory bowel disease patients in remission.

BACKGROUND AND AIMS: Anxiety and depression symptoms are common in IBD population, both adult and pediatric patients. Increased psychological distress might contribute to initiation and switching to biologic therapy in adult patients with IBD or other chronic inflammatory diseases. Aim of the present study are to evaluate anxiety and depression symptoms in IBD pediatric patients with disease remission and investigate their role in initiation or switching to biologic therapy. METHODS: We performed a retrospective analysis on IBD pediatric patients, assessing for anxiety (GAD-7) and depression (PHQ-9) symptoms. Demographic and disease characteristics were obtained from medical records. RESULTS: Eighty-six patients [31 (36%) females - mean age = 15.6 (SD = 2.8) years] were included. Patients scored above cut-off (> 10) on PHQ-9 and GAD-7 were 17 (19.7%) and 18 (20.9%), respectively. No differences were found between UC and CD patients. Baseline clinically relevant depression symptoms were significantly associated with the odds of initiating or switching to biologic therapy within 2 years [OR = 4.5 (1.4-14.3)], even after confounders adjustment [4.2 (1.2-14.9)]. Relationship was not significant with anxiety symptoms. CONCLUSION: Anxiety and depression symptoms is relatively common in pediatric IBD population, even with disease remission. Pediatric IBD patients with high depression symptoms are at increased risk of initiating or switching to biologic therapy. Mental health screening programs should be incorporated in routine clinical practice, especially for depression, regardless of disease activity and disease type. Early diagnosis and proper intervention for mental illness should be part of routine IBD management.

Xenogeneic collagen matrix versus connective tissue graft for soft tissue augmentation at immediately placed implants: a prospective clinical trial.

The advantages of immediate implant placement for patients include a reduced number of surgical procedures and a shorter overall treatment time. Disadvantages include a higher risk of aesthetic complications. The aim of this study was to compare xenogeneic collagen matrix (XCM) versus a subepithelial connective tissue graft (SCTG) used for soft tissue augmentation in combination with immediate implant placement without provisionalization. Forty-eight patients requiring a single implant-supported rehabilitation were selected and assigned to one of two surgical procedures: immediate implant with SCTG (SCTG group) or immediate implant with XCM (XCM group). Marginal changes in the peri-implant soft tissue and the facial soft tissue thickness (FSTT) were assessed after 12 months. Secondary outcomes included peri-implant health status, aesthetics, patient satisfaction, and perceived pain. All of the implants placed were successfully osseointegrated, resulting in 1-year survival and success rates of 100%. The patients in the SCTG group had a significantly lower mid-buccal marginal level (MBML) recession (P = 0.021) and a greater increase in FSTT (P < 0.001) than the patients in the XCM group. Using xenogeneic collagen matrix during immediate implant placement significantly increased FSTT from the baseline, leading to good aesthetic and patient satisfaction results. However, the connective tissue graft yielded better MBML and FSTT results.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants.

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

A transition clinic model for inflammatory bowel disease between two tertiary care centers: outcomes and predictive factors.

OBJECTIVE: Few models of transition have been proposed for inflammatory bowel disease (IBD). The aim of the present study is to evaluate the feasibility of a transition model and the predictive factors for success/failure. PATIENTS AND METHODS: Patients with low activity or remission IBD were enrolled. Proposed model: three meetings every four-six weeks: the first one in the pediatric center (Bambino Gesù Children's Hospital); the second one, in the adult center (Foundation Polyclinic University A. Gemelli), with pediatric gastroenterologists; the last one, in the adult center, with adult gastroenterologists only. Questionnaires included anxiety and depression clinical scale, self-efficacy, quality of life, visual-analogic scale (VAS). Transition was considered successful if the three steps were completed. RESULTS: Twenty patients were enrolled (range 18-25 years; M/F: 12/8; Ulcerative Colitis/Crohn's Disease 10/10); eight accepted the transition program, four delayed the process and eight refused. Patients who completed transition generated higher scores on the resilience scale, better scores on well-being perception, and had lower anxiety scores. Patients who failed transition were mostly women. The perceived utility of the transition program was scored 7.3 on a VAS scale. CONCLUSIONS: The proposed transition program seems to be feasible. Psychological scores may help in selecting patients and predicting outcomes.

Study of cellular toxicity in vitro of two resins for orthodontic use.

OBJECTIVE: The objective of this work is to compare cellular toxicity in vitro of two resins for orthodontic use: an auto-polymerizable composite and a photo-polymerizable composite. MATERIALS AND METHODS: Samples were obtained by joining a couple of steel orthodontic brackets by using auto-polymerizing or photo-polymerizing resin. We used a halogen lamp, a mini LED lamp and a fast LED lamp used for orthodontics cure for 40 seconds. The 3T3 Swiss cellular line of fibroblasts was used. The samples obtained were used to determine the cellular toxicity in vitro using the Neutral Red Up-take (NRU) and the 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: Toxicity of the extract appraised at a low level at MTT and NRU assays. There were statistically relevant differences between the toxicity induced by the auto-polymerizing material and the toxicity induced by the photo-polymerizing composite material, polymerized with the blue-light lamp (p < 0.001) and with the mini LED lamp (p < 0.05). CONCLUSIONS: From the data collected in this study, we can conclude that both resins show a low level of cytotoxicity that, in the case of photochemical polymerizing resin, depends on the characteristics of the lamp.

Evaluation of the periodontal healing of the second mandibular molar distal site following insertion of PRF in the third molar post extraction alveolus.

The aim of this study was to evaluate the periodontal healing of the distal sites of the mandibular second molars, comparing the extraction therapy of the third molar with and without PRF adjunct into the postextraction alveolus. The study sample was composed by 40 consecutive patients who underwent extraction of mandibular third molars. Patients were divided in two groups: the last 20 participants who have only been subjected to extraction (spontaneous healing group, SHG) and the first 20 patients who had PRF adjunct (PRF group, PG). Healing was evaluated by analyzing the variations in terms of PPD (Probing Pocket Depth), REC (Recession), CAL (Level of Clinical Attachment), BoP (Bleeding on Probing) and GI (Gingival Index) from Baseline to further follow-ups at 1 month and 3 months. The disto-vestibular (DV) and disto-lingual (DL) PPD values of the second mandibular molar were measured at Baseline and after three months in the two groups. Patients of the PG group showed lower PPD values at 1 month and 3 months postoperatively: DV: 3.6±1.09 - DL: 3.5±1.15 and DV: 2.5±0.83 - DL: 2.6±1.09, respectively. Patients belonging to the SHG also showed lower PPD values, reporting respectively the following DV values after 3 months: 2.7±0.86 - DL: 2.75±0. 85. However, there was no statistically significant difference comparing the results obtained in PG and SHG groups at 1 and 3 months (p>0.05). The insertion of PRF inside the post-extraction alveolus of the mandibular third molar leads to limited improvement in terms of periodontal healing, compared to extraction therapy only.

Functional relationships between leaves and stem across canopy layers in two contrasting clones of Populus nigra L.

Populus nigra L. represents a model system for plant biology and has a productive interest in breeding for short rotation forestry. The growth potential and adaptive capacity of this species are well characterized, but the canopy effect is poorly investigated. We analyzed morphological and functional leaf traits across a multilayer canopy profile in two contrasting clones of this species, 58-861 and Poli, respectively from northern and southern Italy, grown in field plantation. The results revealed how the variation of leaf functional traits was structured within the canopy. The two clones showed differences in leaf morphology and water use efficiency, but organized a similar functional canopy structure along a vertical profile, related to a gradient of light radiation. An acropetal enrichment gradient of carbon stable isotope was found both in leaves and stem wood across a vertical canopy profile and a tight correlation was found between carbon stable isotopes of leaves and of the respective stem section. Such a functional relationship indicates that substrates for stem growth were sourced from leaf assimilates of the closest canopy layer. These results characterize the physiology of black poplar under micro-environmental conditions at intra-canopy scale and contribute to clarify the canopy effect in young trees.

Lipofilling as refinement procedure in maxillo-mandibular malformations.

Maxillo-mandibular asymmetry has numerous aetiologies: congenital, traumatic, iatrogenic and post-oncologic. Patients with congenital dentofacial malformations are generally submitted to orthognathic surgery and/or additional procedures (genioplasty, alloplastic implants) with satisfactory results. However, despite achieving skeletal symmetry, noticeable facial asymmetry may persist.This study was performed in 45 patients (29 women and 16 men) operated between December 2012 and June 2014. All patients were affected by maxilla-mandibular asymmetry and underwent orthognatic surgery for hard tissue correction of the deformity. Residual facial alterations were then treated with lipofilling refinement proceure. In all cases good integration of the grafted fat was observed in the recipient sites. Retrospective analysis of photographic documentation showed progressive volumetric decrease for up to approximately 6 months after surgery; after that graft volume remained relatively stable. There were no significant surgical complications, either from the fat harvest site or the reconstructed site. Mild oedema and bruising were frequent during the first post-operative week. No haematomas, infections, vascular or nervous injuries were recorded. Twenty-four patients felt the need to have a second procedure. A second fat transfer was performed in 22 cases, and a third in 2 (total of 69 procedures). Based on the observations of our study, fat grafting is a simple, effective and reproducible technique, with a high satisfaction rate and few disadvantages or complications. We demonstrated that the success of lipofilling is dependent on the treated aesthetic subunits of the face. The malar and lateral cheek regions seem to be highly favourable for fat grafting, unlike the upper and lower lips subunits. Composite procedures using orthognathic surgery and autologous fat provide the surgeon with an additional, more customisable option for patients with maxillo-mandibular malformations.

Study of short-term plasticity in two contrasting genotypes of Populus nigra L.

Species like black poplar characterized by an indeterminate growth, can acclimate to the changing environmental conditions during the seasons through a modification of morphological and physiological features. The acclimation results fundamental for the increasing evapo-transpirative demand and water availability. In this perspective, each generation of leaf becomes an indicator of physiologic performance, determining the short-term plasticity (acclimation) of a genotype to different environmental conditions. The main objective of this work is to analyse the physiological adjustment by morphological and physiological features of leaves in two contrasting genotypes of Populus nigra L., growing in a common environment. The mesic genotype 58-861 (Northern Italy) reacts to the increasing dry conditions keeping constantly higher values of δ(13)C while the xeric genotype Poli (Southern Italy) shows lower values, despite no significant differences in the gas exchanges. Morphological and stomatal leaf traits were the main drivers of the different behaviour in the two genotypes to face the "temporal" environment, but different from the provenance. In particular the results, especially in the development phases, demonstrate how phenotypic plasticity is evident at seasonal scale, playing a role for the success of an indeterminate-growing species. They could also be generalized for similar experiments and could support further investigation about short-term plasticity.

Paediatric ulcerative colitis surgery: Italian survey.

BACKGROUND AND AIMS: Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons. METHODS: This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected. RESULTS: Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight-Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively. CONCLUSIONS: This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.

Thalidomide as rescue therapy for acute severe ulcerative colitis.

INTRODUCTION: Acute severe exacerbations of Ulcerative Colitis (UC) represent a medical emergency in children and adults. Intravenous steroids remain the first line therapy for this condition, although the steroid refractoriness is common. Second-line therapy, based on the infliximab or thiopurines should be started if no response to corticosteroids is noted. The use of infliximab in children with acute severe UC, nevertheless, does not avoid the colectomy in all cases. METHODS: We present a case of severe acute UC in a paediatric patient successfully treated with thalidomide following the failed treatment with infliximab and a review of the literature. CONCLUSIONS: This is the first case of a patient presenting with acute severe UC who was treated with thalidomide, with favorable evolution. In our case the use of this drug was able to avoid the colectomy that represent the conventional but very invasive recommended therapeutic option of this condition. Therefore, thalidomide may be considered as rescue therapy in selected and carefully monitored cases of acute severe CU.

Dynamic esophageal stents.

Esophageal stenting represents a new strategy in the treatment of resistant or recurrent stenosis that obviates the need for multiple dilations. Our custom dynamic stent (DS) improves esophageal motility unlike the widespread self-expandable plastic or metallic esophageal stents. The DS allows food and secretions to pass in the space between the esophageal wall and the stent wall. This contrasts with the other types of stent, in which food passes into the stent that presses into the esophageal wall. Until the stent patent is complete, we use slices of silicon drains overlapped with each other to fashion the stent to the desired length and diameter (7-, 9-, or 12.7-mm external diameter). It is built coaxially on a nasogastric tube that guarantees the correct position. The two ends are tailored to allow an easy introduction and food passage between stent and esophageal wall. The stent is inserted after stricture dilations (Savary-Gilliard dilators) under fluoroscopic guidance. All patients who underwent stenting were treated with dexamethasone (2 mg/kg/day) for 3 days and proton pump inhibitors (omeprazole or lansoprazole, 1-2 mg/kg/day). From 1992 to 2012, 387 patients (mean age 38.6 months; range 3-125 months) with post-surgical esophageal stricture because of esophageal atresia correction were enrolled in this study. Twenty-six of 387 patients (6.7%) underwent custom DS placement for recurrent stricture instead of a program of serial dilations. The stent was left in place for at least 40 days and was effective in 21 (80.7%) of 26 patients. There were two stent-related major complications (subclavian-esophageal fistula). Our custom stent represents an effective and safe option in the treatment of severe and recurrent post-surgical esophageal strictures. Surgery with stricture resection, and reanastomosis or jeunoplasty represents the rescue strategy.

ERCP with intracholedocal biopsy for the diagnosis of biliary tract rhabdomyosarcoma in children.

Rhabdomyosarcoma is the most common tumor of the biliary tract in children. Although some features at preoperative radiographic studies (ultrasound, CT, MRI) may be suggestive of BT-RMS, until few years ago the final diagnosis was obtained by either operative or transcutaneous biopsy, thus exposing to a risk of regional dissemination. More recent and still anecdotal, is the histological diagnosis on tissue obtained by transluminal biopsy either during transhepatic cholangiography or endoscopic retrograde cholangio-pancreatography (ERCP), the latter having the major advantage of a much lower risk of loco-regional dissemination. We present two cases of BT-RMS that were histologically diagnosed by intracholedocal biopsy performed during ERCP, after being suspected at conventional imaging.

Impact of fresh and saline water flooding on leaf gas exchange in two Italian provenances of Tamarix africana Poiret.

In Mediterranean coastal areas, changes in precipitation patterns and seawater levels are leading to increased frequency of flooding and to salinization of estuaries and freshwater systems. Tamarix spp. are often the only woody species growing in such environments. These species are known for their tolerance to moderate salinity; however, contrasting information exists regarding their tolerance to flooding, and the combination of the two stresses has never been studied in Tamarix spp. Here, we analyse the photosynthetic responses of T. africana Poiret to temporary flooding (45 days) with fresh or saline water (200 mm) in two Italian provenances (Simeto and Baratz). The measurements were conducted before and after the onset of flooding, to test the possible cumulative effects of the treatments and effects on twig aging, and to analyse the responses of twigs formed during the experimental period. Full tolerance was evident in T. africana with respect to flooding with fresh water, which did not affect photosynthetic performances in either provenance. Saline flooding was differently tolerated by the two provenances. Moreover, salinity tolerance differently affected the two twig generations. In particular, a reduction in net assimilation rate (-48.8%) was only observed in Baratz twigs formed during the experimental period, compared to pre-existing twigs. This reduction was a consequence of non-stomatal limitations (maximum carboxylation rate and electron transport), probably as a result of higher Na transport to the twigs, coupled with reduced Na storage in the roots.

Utility of a stool antigen test to detect the incidence of helicobacter pylori infection and familial and community enviromental risk factors for this infection in pediatric age.

BACKGROUND: Helicobacter pylori (Hp) infection is mainly acquired during childhood; it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by World Health Organization. The exact mode of transmission is as yet, not known. Aim of our study has been to identify risk factors associated with Helicobacter pylori infection in a preschool and school population and to confirm if Hp antigen in faeces is useful as screening in epidemiological studies. METHODS: We interviewed, with questionnaire, 400 children (203 male; age range 3-10 years; mean age 6 years) of 3 different schools and stool samples were collected of all children too. 35 of 400 (8%) children underwent to upper gastrointestinal endoscopy because of a suspect of upper gastrointestinal disease. RESULTS: stool were collected from 400 school children and 35 of them shown positivity of Hp antigen test. A questionnaire about presence of nausea, vomit, recurrent abdominal pain, family size, parent's occupations and education, use of antibiotics, country of birth of child and parents, personal hygiene, breast feeding, presence of the animals was completed. 35 children with positive Hp stool antigen test and a suspicious of upper gastrointestinal disease (recurrent abdominal pain, diurnal or nocturnal abdominal pain, nausea, vomiting, iron deficiency) underwent to esophagogastroduodenoscopy (EGDS) that demonstrated antral gastritis and positive histology and urease rapid test. CONCLUSIONS: the results of this study suggest that risk factors for Hp infection are low socioeconomics factors, hygiene and living conditions and that Hp antigen in faeces is useful as screening test.

Soil [N] modulates soil C cycling in CO2-fumigated tree stands: a meta-analysis.

Under elevated atmospheric CO(2) concentrations, soil carbon (C) inputs are typically enhanced, suggesting larger soil C sequestration potential. However, soil C losses also increase and progressive nitrogen (N) limitation to plant growth may reduce the CO(2) effect on soil C inputs with time. We compiled a data set from 131 manipulation experiments, and used meta-analysis to test the hypotheses that: (1) elevated atmospheric CO(2) stimulates soil C inputs more than C losses, resulting in increasing soil C stocks; and (2) that these responses are modulated by N. Our results confirm that elevated CO(2) induces a C allocation shift towards below-ground biomass compartments. However, the increased soil C inputs were offset by increased heterotrophic respiration (Rh), such that soil C content was not affected by elevated CO(2). Soil N concentration strongly interacted with CO(2) fumigation: the effect of elevated CO(2) on fine root biomass and -production and on microbial activity increased with increasing soil N concentration, while the effect on soil C content decreased with increasing soil N concentration. These results suggest that both plant growth and microbial activity responses to elevated CO(2) are modulated by N availability, and that it is essential to account for soil N concentration in C cycling analyses.

The transcriptome of Populus in elevated CO reveals increased anthocyanin biosynthesis during delayed autumnal senescence.

*The delay in autumnal senescence that has occurred in recent decades has been linked to rising temperatures. Here, we suggest that increasing atmospheric CO2 may partly account for delayed autumnal senescence and for the first time, through transcriptome analysis, identify gene expression changes associated with this delay. *Using a plantation of Populus x euramericana grown in elevated [CO2] (e[CO2]) with free-air CO2 enrichment (FACE) technology, we investigated the molecular and biochemical basis of this response. A Populus cDNA microarray was used to identify genes representing multiple biochemical pathways influenced by e[CO2] during senescence. Gene expression changes were confirmed through real-time quantitative PCR, and leaf biochemical assays. *Pathways for secondary metabolism and glycolysis were significantly up-regulated by e[CO2] during senescence, in particular, those related to anthocyanin biosynthesis. Expressed sequence tags (ESTs) representing the two most significantly up-regulated transcripts in e[CO2], LDOX (leucoanthocyanidin dioxgenase) and DFR (dihydroflavonol reductase), gave (e[CO2]/ambient CO(2) (a[CO2])) expression ratios of 39.6 and 19.3, respectively. *We showed that in e[CO2] there was increased autumnal leaf sugar accumulation and up-regulation of genes determining anthocyanin biosynthesis which, we propose, prolongs leaf longevity during natural autumnal senescence.

Alterations of sperm DNA integrity during cryopreservation procedure and in vitro incubation of bull semen.

An association between sperm DNA integrity and fertility was recently shown for frozen-thawed Norwegian Red (NRF) bull semen diluted in skimmed milk egg yolk (SMEY). In general the fertility of NRF cattle is high, however, in comparison with NRF semen in SMEY, NRF semen diluted in Tris EY based extenders has shown reduced fertility. The aim of the present study was to do a split-sample comparison of sperm DNA integrity of NRF bull semen (n=20) in SMEY and Triladyl (Tris EY based) during routine cryopreservation procedure and during in vitro incubation of frozen-thawed semen in modified synthetic oviduct fluid (mSOF). In contrast to the high fertility of NRF cattle, Holstein cattle are experiencing a marked decline in fertility. Therefore, the present study also aimed to compare sperm DNA integrity of NRF (n=20) and Holstein (n=20) semen diluted in Triladyl during in vitro incubation. The sperm DNA integrity was measured by susceptibility to in situ acid induced denaturation by the Sperm chromatin structure assay (SCSA). Compared to initial values of frozen neat semen, an increase in DNA damage was observed after dilution and cooling (5 degrees C) and after freezing-thawing of NRF semen in SMEY, but only after freezing-thawing for NRF semen diluted in Triladyl. Sperm DNA damage of NRF semen increased during in vitro incubation in mSOF; the increase in percentage of spermatozoa with DNA damage was more prominent in SMEY than in Triladyl, while the degree of damage was higher in Triladyl, throughout the incubation period. However, while the correlation between DNA damage and sperm survival was negative in SMEY throughout the incubation period, a positive correlation was observed in Triladyl after 9h of incubation, indicating a higher presence of DNA damage in the live sperm population. In comparison with Holstein spermatozoa, the sperm DNA integrity of NRF semen reflected a better ability to withstand alterations induced during in vitro incubation in mSOF. In conclusion, sperm DNA integrity of NRF bull semen was altered during the cryopreservation procedure and in vitro incubation in mSOF. Dilution in Triladyl maintained bull sperm DNA integrity better than dilution in SMEY. Furthermore, alterations in Holstein sperm DNA integrity was more pronounced during in vitro incubation in mSOF compared to NRF bull spermatozoa.