Progress in Dental Adhesive Materials.

There have been significant advances in adhesive dentistry in recent decades, with efforts being made to improve the mechanical and bonding properties of resin-based dental adhesive materials. Various attempts have been made to achieve versatility, introducing functional monomers and silanes into the materials' composition to enable the chemical reaction with tooth structure and restorative materials and a multimode use. The novel adhesive materials also tend to be simpler in terms of clinical use, requiring reduced number of steps, making them less technique sensitive. However, these materials must also be reliable and have a long-lasting bond with different substrates. In order to fulfill these arduous tasks, different chemical constituents and different techniques are continuously being developed and introduced into dental adhesive materials. This critical review aims to discuss the concepts behind novel monomers, bioactive molecules, and alternative techniques recently implemented in adhesive dentistry. Incorporating monomers that are more resistant to hydrolytic degradation and functional monomers that enhance the micromechanical retention and improve chemical interactions between adhesive resin materials and various substrates improved the performance of adhesive materials. The current trend is to blend bioactive molecules into adhesive materials to enhance the mechanical properties and prevent endogenous enzymatic degradation of the dental substrate, thus ensuring the longevity of resin-dentin bonds. Moreover, alternative etching materials and techniques have been developed to address the drawbacks of phosphoric acid dentin etching. Altogether, we are witnessing a dynamic era in adhesive dentistry, with advancements aiming to bring us closer to simple and reliable bonding. However, simplification and novelty should not be achieved at the expense of material properties.

ADRIS: The new open-source accessible driving simulator for training and evaluation of driving abilities.

BACKGROUND AND OBJECTIVE: Independent living and transportation are crucial aspects for people living with a disability. After an injury, it is important to assess driving ability, in terms of physical and psychological conditions, and to test the effects of prescribed drugs. Within this framework, driving simulators are suitable tools for training driving skills; however, available tools are expensive or lack appropriate sets of behavioral measures to fully characterize the drivers' ability. METHODS: This work presents the first step toward the development of ADRIS, a new open-source, accessible, realistic virtual reality simulator for training and testing driving skills of people with sensory-motor disability. This includes a prototype based on an open-source simulator for autonomous driving research (CARLA), with the addition of customized features such as adaptable driving controllers, a virtual reality headset, and the possibility to collect behavioral and physiological data. Also, the new system allows to set different environmental conditions, to include and control the timing of potentially dangerous situations, and to set scenarios with various difficulty levels. RESULTS: Tests on 17 healthy participants demonstrated that the simulator is well tolerated in terms of discomfort, physical fatigue, and mental effort. Also, the system is easy to use and is capable of providing a realistic driving experience, allowing the extraction of reliable behavioral parameters. CONCLUSIONS: ADRIS combines a high-fidelity virtual world, with customizable features specifically designed for the training and testing of people living with a disability, thus making it usable in many contexts such as home training, rehabilitation, education, and research.

Kinetics of polymerization and contraction stress development in self-adhesive resin cements.

OBJECTIVES: The aim of the study was to evaluate the contraction stress, microhardness and polymerization kinetics of three self-adhesive cements vs. conventional dual-cure resin cement. METHODS: Cements tested were: RelyX Unicem (3M ESPE, St. Paul, MN, USA), MaxCem Elite (Kerr, Orange, CA, USA), Clearfil SA Cement (Kuraray, Tokyo, Japan) and Duolink (Bisco Inc., Schaumburg, IL, USA). Cements were irradiated with a LED-curing unit (bluephase, IvoclarVivadent) for 20 or 40 s and the contraction forces (N) generated during polymerization were continuously recorded for 6 h with a universal testing machine. Polymerization kinetics were monitored using micro-Raman spectroscopy and degree of conversion was calculated. Vickers microhardness was also recorded. All measurements were performed at 10 min and 6h. Data were statistically analyzed by three-way ANOVA with repeated measures and Tukey's post hoc test (α=0.05). RESULTS: Irrespective of exposure time, stress analysis ranked in the following order: Clearfil SA Cement

Comparative study of the in vitro activity of various antifungal drugs against Scedosporium spp. in aerobic and hyperbaric atmosphere versus normal atmosphere.

INTRODUCTION: Scedosporium spp. have been observed with increasing frequency over the last decade in immunocompromised patients and trauma patients. This mould is often multi-drug resistant and its mortality rate remains very high. AIM: The primary goal of this study was to obtain data concerning the in vitro susceptibility of 13 Scedosporium strains comparing the in vitro incubation in aerobic versus hyperbaric conditions. MATERIALS AND METHODS: Chemosensitivity of thirteen Scedosporium strains was evaluated after a 72h-incubation in a normoxic (21% O2) normobaric (1 ATA) atmosphere versus a hyperoxic (100% O2) hyperbaric (2-3 ATA), and after a re-incubation at room temperature for an additional 72h. RESULTS: All S. apiospermum and S. prolificans strains showed no growth after incubation in hyperbaric hyperoxic atmosphere. However, when plates were then maintained at room temperature in aerobic conditions, growth was systematically observed from 36 to 96h, and Minimal inhibitory concentration (MIC) values were the same obtained after incubation in aerobic conditions. CONCLUSIONS: These results suggest impressive in vitro fungistatic activity of the hyperoxic hyperbaric atmosphere, even if its effect is strictly time-dependent. This preliminary in vitro study has potential clinical relevance because it focuses on examining in vitro combination therapy using hyperoxic hyperbaric conditions plus a single antifungal agent, rather than using combinations of different antifungal drugs, to potentially increase the antifungal activity.

Influence of chlorhexidine on the degree of conversion and E-modulus of experimental adhesive blends.

OBJECTIVES: This study examined the effect of chlorhexidine (CHX) content on degree of conversion (DC) and E-modulus of experimental adhesive blends. The hypothesis tested was that increasing concentrations of CHX result in decreased DC and E-modulus in relation to adhesive hydrophilicity. METHODS: Experimental adhesive blends with increasing hydrophilicity R2 (70% bisGMA, 28.75% TEGDMA); R3 (70% BisGMA, 28.75% HEMA); R4 (40% BisGMA, 30% TCDM, 28.75% TEGDMA); R5 (40% BisGMA, 30% BisMP, 28.75% HEMA) and different CHX concentrations (1 and 5%) were analyzed. 5% CHX could not be dissolved in R2. A differential scanning calorimeter was used to measure the DC of resin blends. Photopolymerized disks of the experimental comonomer mixtures (n=10/gp) were used to measure the E-modulus of each specimen using a biaxial flexure test. Data were analyzed with two-way ANOVA (resin type and CHX concentration) and Tukey's post hoc test. RESULTS: The addition of 1% CHX did not significantly alter the DC of R2 and R3. Significant decrease in R3 DC values was observed when 5% CHX was added. CHX significantly increased the DC of R4 and R5. 1% CHX reduced the E-modulus of all resins (p<0.05) except for R2, in which the E-modulus was significantly increased (p<0.05). 5% CHX significantly reduced the E-modulus of resins R3 to R5 (p<0.05). SIGNIFICANCE: In conclusion, increasing concentrations of CHX dissolved in resin blends had little adverse effect on DC but decreased the E-modulus 27-48% compared to controls. Solvation of CHX in ethanol prior to incorporation of CHX into R2 may permit higher CHX concentrations without lower polymer stiffness.

[Identification of the patient with sepsis]. / L'individuazione del paziente settico.

Sepsis may be defined as a clinical syndrome caused by an organism's response to infection. The complex alterations triggered by the infection include inflammation and systemic coagulopathy in the absence of effective fibrinolysis. Possible manifestations vary in entity and severity, ranging from systemic inflammatory response syndrome (SIRS) to septic shock and multiorgan dysfunction syndrome (MODS). The nurse can play a fundamental role in the timely recognition of SIRS and in the early identification of the onset of signs of organ damage. In this way, an additional aid to establishing diagnosis can be provided and targeted treatment instituted. Following a brief presentation of the pathophysiology and epidemiology of sepsis, the manifestations and attendant risks are described, the most appropriate monitoring methods and the main nursing tasks in treating sepsis are discussed. We present the results of our experience in identifying patients with sepsis through the application of selection criteria adopted from clinical studies on the use of activated protein C.

[Role of nurses in the evaluation of septic patients]. / Ruolo infermieristico nella valutazione del paziente settico.

ICU nurses hold an important role in the management of septic patients underlining with their ability to recognize SIRS that is the first step in the proinflammatory and procoagulant cascade following an infection. Early and timely approach to organ dysfunction can indeed modify the damages due to hypoperfusion. The ability to recognize organ dysfunction using different monitoring devices available should be part of the nursing attitudes.

Validation of automated oscillometric sphygmomanometer (HDBPM) for arterial pressure measurement during haemodialysis.

An HDBPM oscillometric sphygmomanometer used for the automatic measurement of arterial blood pressure is evaluated according to the ANSI/AAMI SP10-1992 standard. The accuracy of the HDBPM is ascertained by comparing it against the standard Riva-Rocci ascultatory method. Following the ascultatory method, two independent observers use the HDBPM devise to simultaneously measure the arterial blood pressure in 92 subjects of varying ages and having different blood pressures and arm sizes. High agreement is found when comparing the observers' pressure determinations (within 10 mmHg for 100% of observations). Correlation between the average of two ascultatory determinations and the HDBPM is high both for the systolic (r = 0.98) and diastolic (r = 0.94) pressures. The mean of the differences between the pressures measured by the observers and the HDBPM device are 0.2 mmHg (systolic) and -0.4 mmHg (diastolic). The percentages of readings within 10 mmHg between those taken by the observers and those taken by the HDBPM are 88% (systolic) and 97% (diastolic). These results largely satisfy current requirements.

[Gastric tumors with fatty components. CT findings and differential diagnosis]. / Tumori gastrici con componente adiposa. Aspetti con Tomografia Computerizzata e diagnostica differenziale.

PURPOSE: To assess the role of CT in diagnosing and characterizing gastric fatty tumors. MATERIAL AND METHODS: We reviewed the CT scans of 16 patients (8 men, 8 women, mean age 52 years) with gastric fatty tumors (11 lipomas, 3 liposarcomas, 1 angiolipoma, 1 teratoma) examined from 1990 to 1999. The differential diagnosis considered primary and secondary lipomatosis, carcinoma engulfing the perivisceral fat and thus mimicking a liposarcoma, mesenchymal gastric and primary peritoneal tumors. RESULTS: Lipomas involved the fundus (7/11), the body (3/11), the antrum (1/11). Multifocality was found in one case. Lesions size ranged 25 to 65 mm (mean 35 mm). All the lipomas showed homogeneous structure with negative (-30 -100) HU values. A pseudocapsule was demonstrated in 7/11 cases. No infiltrative growth was demonstrated. The angiolipoma located in the fundus showed a vascular component with strong contrast enhancement. All the liposarcomas were bigger than 10 cm and there was a strong correlation between pathologic specimen and CT findings. The differentiated liposarcomas showed the classic heterogeneous fatty density; on the contrary the myxoid and the pleomorphic types showed an aspecific structure with necrotic/cystic changes, mostly demonstrated in the myxoid type. The teratoma was a solid mass with fatty, solid, necrotic and calcified components. CONCLUSION: CT allows the diagnosis and characterization of gastric fatty tumors. The preoperative diagnosis of lipomas plays a major clinical role because it often makes surgery unnecessary.

[Hormone evaluation in brain death]. / Alcune valutazioni ormonali nella morte cerebrale.

BACKGROUND: In this study, the level and the variation of a number of hormone and metabolic parameters during brain death treatment in potential organ donors have been monitored. METHODS: Thirty-nine consecutive brain-dead patients were enrolled in 3 Intensive Care Units of Regional Hospitals of the North of Italy. All patients were potential organ donors and free from diseases before the accident leading to death. The levels of ADH, ACTH, TSH, prolactin, cortisol, aldosterone, FT3, FT4, renin, serum lactate and plasma osmolality were measured immediately after the diagnosis of brain death (T0), certified following the Italian law of December 29, 1993, n. 578, and after 6 hours (T6). RESULTS: Hormone levels were normal in the majority of subjects, and there was no significant variation during the 6 hours of the observation period. No correlation was found between the hormone levels considered and the metabolic parameters; ADH levels were not correlated with plasma osmolality. FT3 levels were below the normal range in the majority of subjects, but were not associated with a higher lactate level, which is used as a marker of a shift toward tissue anaerobic metabolism. CONCLUSIONS: In conclusion, triiodothyronine administration to improve metabolic order and thus the function of organs for transplantation is not justified in brain-dead patients.

Sensory nerves affect the recruitment and differentiation of rat periovarian brown adipocytes during cold acclimation.

Rat periovarian adipose tissue contains a low number of uncoupling protein-expressing brown adipocytes scattered into lobules of white fat. Their increase following cold acclimation is matched by a major increase in noradrenergic and neuropeptide Y-, substance P- and calcitonin gene-related peptide-containing nerves. To ascertain whether periovarian fat is provided with sensory nerves, and whether any relationship exists between such nerves (in particular the calcitonin gene-related peptide-containing fibers found in cold-acclimated rats in close association with brown adipocytes) and brown fat recruitment, the effects of capsaicin desensitization on neuropeptide-containing nerves and brown adipocyte density were studied in the periovarian tissue of rats kept at 20 degrees C and on a group acclimated to 4 degrees C for 14 days. In both groups, systemic capsaicin administration considerably reduced the expression of substance P and calcitonin gene-related peptide in vascular-nerve bundles and parenchyma. In cold-acclimated rats, the increase in brown adipocyte density was significantly checked by capsaicin administration (21.11 versus 7.96 brown adipocytes/mm2, P<0.05). Finally, ultrastructural investigation showed the occurrence of brown adipocyte precursors filled with aggregates of glycogen and poorly differentiated multilocular adipocytes in capsaicin-treated cold-acclimated rats. These data suggest that periovarian adipose tissue is indeed provided with sensory neuropeptide-containing nerves and that they play a role in the recruitment and differentiation of brown adipocytes.

[Alcohol and smoking. The risk factors for the oral cavity]. / Alcol e fumo. Fattori di rischio per il cavo orale.

A higher risk for the development of oral cancer was associated with heavy smoking and heavy drinking, but alcohol drinking and tobacco smoking are also correlated with other oral cavity disease. Tobacco is the most important factor of leukoplakia, but other diseases like ANUG, periodontitis, median rhomboid glossitis, chronic hyperplastic candidiasis and others are also correlated to cigarette smoking. It was observed that smokers have more plaque than non-smokers, even if no difference in the bacteria composition was found between smokers and non-smokers samples, and the vascular reaction associated with plaque induced gingivitis is suppressed in smokers. Periodontitis are generally considered to be a consequence of an unfavourable host-parasite interaction, but personal factors that diminish the efficiency of the host defence, like tobacco smoking and alcohol drinking, can play an important role in the development of periodontal diseases. Cigarette smoking may be considered a major risk factor for periodontitis and it can also increase its severity; therefore, alveolar bone loss increases with tobacco smoking. Recent investigations show that smokers respond less favourably than no smokers to the different modalities of periodontal therapy, as surgical and non surgical, or guided tissue regeneration. Moving from these observations the authors critically analyze the literature concerning these important risk factors which appear to be strongly correlated with periodontal diseases.

Tyrosine hydroxylase, neuropeptide Y, substance P, calcitonin gene-related peptide and vasoactive intestinal peptide in nerves of rat periovarian adipose tissue: an immunohistochemical and ultrastructural investigation.

Rat periovarian adipose tissue contains unilocular adipocytes and some multilocular adipocytes that, following acclimation to cold, become more numerous and give rise to periovarian brown fat areas. We studied the occurrence and distribution of tyrosine hydroxylase, neuropeptide Y, substance P, calcitonin gene-related peptide, vasoactive intestinal peptide, methionine enkephalin, neurotensin, galanin, and cholecystokinin 9-20 in the nerves of rat periovarian tissue maintained at 20 degrees C (control rats), acclimated at 4 degrees C (cold acclimated rats) and at 28 degrees C (warm-acclimated rats). In the periovarian tissue of control and warm-acclimated rats, tyrosine hydroxylase-like, neuropeptide Y-like, substance P-like and calcitonin gene-related peptide-like immunoreactive elements (putative nerves) were present in the blood vessels. In the periovarian tissue of cold-acclimated rats, we found: (1) a more widespread vascular distribution of these neuropeptides; (2) tyrosine hydroxylase-like and calcitonin gene-related peptide-like immunoreactive elements among paucilocular and multilocular adipocytes (parenchymal-like nerves); (3) vasoactive intestinal peptide-like immunoreactive elements in some arteries. Investigation by EM showed the presence of heterogeneous non-myelinated axons both associated with capillaries and among paucilocular and multilocular adipocytes (parenchymal fibres) in periovarian brown fat areas. In conclusion, periovarian brown fat contains the same neuropeptides, with the same vascular and parenchymal distribution, already seen in typical depots of brown fat.

Low-grade non-Hodgkin B-cell lymphoma presenting as sensory neuropathy.

Low-grade non-Hodgkin B-cell lymphoma was found during the evaluation of 3 aged patients with predominantly sensory neuropathy of mild to moderate severity. Presenting manifestations were sensory ataxia and right ulnar mononeuropathy in a 75-year-old man, and painful dysesthesias of the legs in two 78-year-old women. A neurophysiological study showed mainly axonopathic alterations. M-protein was present in all cases (Ig-kappa in two, triclonal gammopathy IgG(kappa)/IgM(kappa)/IgM-gamma in one). The male patient had IgM antisulfatide antibody in high titer, whereas the other 2 patients had cryoglobulinemia (type II and type III, respectively). Our report emphasizes the occurrence of mild polyneuropathy as presenting manifestation of low-grade non-Hodgkin lymphoma, different from the clinicopathological entity of neurolymphomatosis, in which severe nerve damage occurs in association with manifest lymphoma, related to nerve infiltration by lymphomatous cells. Alternative pathogenetic mechanisms, such as antibody-mediated nerve damage, or vasa nervorum changes caused by cryoglobulin, may be implicated in our cases. Non-Hodgkin lymphoma should be considered in the diagnostic evaluation of polyneuropathy of unknown cause, especially in patients with paraproteinemia and/or cryoglobulinemia.

The therapeutic role of naltrexone in negative symptom schizophrenia.

1. Naltrexone (50 mg bid, p.o.) was administered in a double-blind fashion (with placebo control) to chronic schizophrenic patients who maintained their routine neuroleptic and anxiolytic therapy. 2. Both positive and negative symptom patients who received naltrexone improved with regard to symptoms involving deterioration and social withdrawal. No significant amelioration was recorded in subjects assuming placebo relative to the same psychopathological areas. 3. Favourable results were obtained mainly from patients affected by negative symptom schizophrenia. 4. Naltrexone may have acted by direct or indirect neurochemical mechanisms related to negative symptom schizophrenia.

The efficacy and safety of tianeptine in the treatment of depressive disorder: results of a controlled double-blind multicentre study vs. amitriptyline.

Three hundred in- and outpatients suffering from depressive disorder, as diagnosed using DSM-III criteria were treated for 6 weeks under double-blind conditions in a multicenter controlled study of tianeptine vs. amitriptyline. Both groups presented steady improvement of depressive syndrome from day 7 up to the end of the treatment, as shown by all evaluation scales: HDRS, SAD, CGI. Furthermore, anxiety linked to the depressive syndrome decreased equally in both groups, as shown by the HARS measurements. In addition to the improvement of mood, the tianeptine-treated patients presented less somatic complaints and side effects when compared to the reference antidepressant. These results confirm previous findings that tianeptine is an effective antidepressant with a lower side effect profile than amitriptyline.