Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord experience.

OBJECTIVE: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referred to as COVID-19 (Coronavirus Disease 19), is a public health emergency as it carries high morbidity, mortality, and has no approved specific pharmacological treatments. In this case series, we aimed to report preliminary data obtained with anti-complement C5 therapy with eculizumab in COVID-19 patients admitted to intensive care unit (ICU) of ASL Napoli 2 Nord. PATIENTS AND METHODS: This is a case series of patients with a confirmed diagnosis of SARS-CoV2 infection and severe pneumonia or ARDS who were treated with up to 4 infusions of eculizumab as an off-label agent. Patients were also treated with anticoagulant therapy with Enoxaparin 4000 IU/day via subcutaneous injection, antiviral therapy with Lopinavir 800 mg/day + Ritonavir 200 mg/day, hydroxychloroquine 400 mg/day, ceftriaxone 2 g/day IV, vitamine C 6 g/day for 4 days, and were on Non-Invasive Ventilation (NIV). RESULTS: We treated four COVID-19 patients admitted to the intensive care unit because of severe pneumonia or ARDS. All patients successfully recovered after treatment with eculizumab. Eculizumab induced a drop in inflammatory markers. Mean C Reactive Protein levels dropped from 14.6 mg/dl to 3.5 mg/dl and the mean duration of the disease was 12.8 days. CONCLUSIONS: Eculizumab has the potential to be a key player in treatment of severe cases of COVID-19. Our results support eculizumab use as an off-label treatment of COVID-19, pending confirmation from the ongoing SOLID-C19 trial.

Postoperative pain after removal of gutta-percha from root canals in endodontic retreatment using rotary or reciprocating instruments: a prospective clinical study.

OBJECTIVES: The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments. MATERIALS AND METHODS: One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors. RESULTS: Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P < .05). No significant differences were observed between the two groups regarding postoperative pain (P > .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P < .05). CONCLUSIONS: The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men. CLINICAL RELEVANCE: One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures.

Quadriceps muscles activity during gait: comparison between PFPS subjects and healthy control.

PURPOSE: The purpose of the study was to evaluate if during a common activity as walking, altered quadriceps muscular activity may be present in patellofemoral pain syndrome (PFPS) patients. METHODS: Forty subjects with clinically diagnosed PFPS and forty healthy males matching in age, weight, height and level of sport activity were enrolled in the study. Subjects were asked to walk on an instrumented walking path at their self-selected speed. Force platform and motion tracking system were used for the analysis of the gait. Wireless surface EMG probes were used to evaluate quadriceps muscles activity. Rectus femoris, vastus medialis and lateralis activity percentage, onset and offset time, walking speed, cadence, step length, stride length, knee ROM during gait were measured and reported. Tegner activity questionnaire was reported. RESULTS: Patient group showed a significant increasing in all quadriceps muscles activity when compared to the control (p < 0.05). In particular, for VM and VL muscle onset time was anticipated and offset time was postponed in PFPS group when compared with healthy group (p < 0.05). Knee range of motion during walking was significantly decreased in the patient group. CONCLUSIONS: Young athletes with PFPS showed increased length of quadriceps muscles activity and reduced functional knee Rom while walking, comparing with healthy subjects, in particular muscular onset was anticipated in respect of the loading response event of the gait. Nonetheless, walking parameters were not affected by these alterations.

Biomechanical evaluation of medial patello-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique.

BACKGROUND: Several MPFL reconstructions are commonly performed for recurrent patellar dislocation, but misleading data are currently available in the literature on the ability of the different techniques to re-create a functioning ligament. MATERIALS AND METHODS: In this study, we showed the biomechanical properties of two different procedures for MPFL reconstruction using a natural orientation during uniaxial tensile testing. Eighteen fresh-frozen human knees were randomly assigned to two groups of nine each. In the group A, the reconstruction was performed using a double converging tunnels technique and in the group B was used a single-tunnel technique with semitendinosus autograft. The specimens were loaded in natural orientation using an Instron tensile test machine, and the stiffness and ultimate load were determined. RESULTS: The ultimate load was 213 ± 90 and 171 ± 51 N using our double-bundle technique (group A) and the single-bundle technique (group B), respectively. One (11 %) specimen failed at the patellar side due to patellar fracture in the group B. There was no statistical significant difference (p > 0.05) between the two groups in terms of stiffness and ultimate load. CONCLUSION: This study is the first biomechanical evaluation of the MPFL reconstructions in natural orientation. Both the procedures achieved safe fixation of the graft at the femoral attachment; however, the single-bundle technique reported 11 % of failure at the patellar side due to patellar fracture. In addition, the double-bundle technique can better restore the anatomy of the native ligament.

Patient-specific instrumentation for total knee arthroplasty: a literature review.

During the past decade, total knee arthroplasty (TKA) has been markedly increased. Recently, patient-specific custom cutting guides have been commercially introduced in order to achieve an accurate component alignment during TKA. In fact, these cutting blocks are specific to a patient's knee anatomy and should help the surgeons to perform bone cuts, reducing the complexity of conventional alignment and sizing tools. Nevertheless, there are critical arguments against patient-specific cutting guides for routine use, such as poor evidence and higher costs. Additionally, there are still no mild and long-term results available that describe the clinical outcomes following patient-specific instrumentation of TKR, cost-effectiveness and lower revision rates. Aim of the current manuscript was to describe the recent improvements of the surgical technique and instrumentation of TKA, reviewing the recent literature concerning the PSI technology.

Evaluación de la deformación de conductos en función del uso de la lima de permeabilidad apical en estudiantes mediante la técnica de instrumentación Profile 0'06 / Students canal transportation assessment, depending on the use of a patency file what filing with Profile 0.06 files

El objetivo de la instrumentación es limpiar y conformar los conductos sin deformarlos. Para evitar cometer errores durante la instrumentación se ha propuesto el uso de la lima de pasaje o permeabilidad apical. El objetivo de este estudio es valorar si el uso de la lima de permeabilidad junto con la técnica de instrumentación rotatoria Profile permite reducir los errores de procedimiento en operadores inexpertos. Se seleccionaron 65 molares inferiores y se dividieronen 2 grupos. En el grupo 1 se utilizó la lima de pasaje entre cada lima rotatoria y en el grupo 2 no se usó lima de pasaje. Se realizaron radiografías pre y postoperatorias en visión vestíbulo-lingual y mesiodistal, se midieron los ángulos de curvatura según el método Schneider y se restó el valor del ángulo final e inicial para ver si existía deformación. Según los resultados, no existen diferencias significativas entre los ángulos finales e iniciales en los dos grupos. Ni la fractura de limas ni la pérdida de longitud de trabajo se asocia a la utilización o no de la lima de pasaje

The main objective of chemico-mechanical preparation is to clean and shape the root canal system. To avoid errors during shaping procedures a patency file has been proposed. The aim of this study to assess if the use of this file helps to prevent procedural errors in canals shaped by novice students. 65 molars were chosen and divided in 2 groups. Group 1 was shaped with profile 0.06 files using the patency file and Group 2 with profile 0.06 withoutthe use of a patency file. Pre and postoperative radiographs were taken in bucolingual and mesiodistal projections and the degree of curvaturewas measured according to Schneider method. The difference between the initial and final angle was measured to calculate the degree of transportation. According to the results there were no significant differences among the two groups in terms of transportation, loss of working length and fracture rate

MET receptor is overexpressed but not mutated in oral squamous cell carcinomas.

Oral squamous cell carcinoma (SCC) is a neoplasm characterized by a high degree of local invasion and an elevated rate of metastasis to cervical lymph nodes. It has been shown that the Hepatocyte Growth Factor/Scatter Factor Receptor Met is constitutively activated in many human tumors of epithelial origin and that it plays a critical role to confer invasive properties to neoplastic cells. Most frequently, Met activation is due to receptor overexpression, but also point mutations in the tyrosine kinase domain can lead to deregulated activation. Here we show that in all the primary tumors examined this receptor is overexpressed. Direct sequencing of Met mRNAs failed to find any activating mutation in its intracellular domain. Moreover, in cell lines derived from squamous cell carcinomas, HGF-induced activation of Met resulted in the acquisition of invasive properties. All together these data suggest that the MET oncogene is involved in progression of squamous cell carcinoma toward an invasive-metastatic behavior.

Rifaximine versus neomycin in the treatment of portosystemic encephalopathy.

In 14 patients with cirrhosis and chronic portosystemic encephalopathy, the effectiveness of treatment with a new non-assorbable antibiotic (rifaximine) was compared to neomycin. The parameters evaluated were: bradylalia, flapping tremor, performance, visual evoked potentials and the trial making test. Both treatments were combined with lactulose. The analysis of results showed a rate of positive results in the patients treated with rifaximine greater than that with neomycin. Differences, however, were not significant.

Effect of topically administered epidermal growth factor on corneal wound strength.

A 9-mm perforating corneal wound was created in one eye of New Zealand albino rabbits, sutured, and treated with mouse-derived epidermal growth factor (1 mg/L), human-derived epidermal growth factor (1.0 mg/L to 100 mg/L), or buffered saline, instilled once, twice, or four times daily. Both mouse-derived epidermal growth factor and human-derived epidermal growth factor significantly increased the tensile strength of full-thickness corneal wounds after 9 days of topical therapy. For human-derived epidermal growth factor, a concentration of 10 mg/L administered twice daily produced the maximal effect. An increase in either the concentration of epidermal growth factor or its frequency of administration failed to induce a further increase in wound strength. Indeed, at a concentration of 100 mg/L, human-derived epidermal growth factor appeared to lose its ability to accelerate healing of full-thickness corneal wounds.