A Rationale for the Use of Clotted Vertebral Bone Marrow to Aid Tissue Regeneration Following Spinal Surgery.

Vertebral body bone marrow aspirate (V-BMA), easily accessible simultaneously with the preparation of the site for pedicle screw insertion during spinal procedures, is becoming an increasingly used cell therapy approach in spinal surgery. However, the main drawbacks for V-BMA use are the lack of a standardized procedure and of a structural texture with the possibility of diffusion away from the implant site. The aim of this study was to evaluate, characterize and compare the biological characteristics of MSCs from clotted V-BMA and MSCs from whole and concentrate V-BMAs. MSCs from clotted V-BMA showed the highest cell viability and growth factors expression (TGF-ß, VEGF-A, FGF2), the greatest colony forming unit (CFU) potency, cellular homogeneity, ability to differentiate towards the osteogenic (COL1AI, TNFRSF11B, BGLAP) and chondrogenic phenotype (SOX9) and the lowest ability to differentiate toward the adipogenic lineage (ADIPOQ) in comparison to all the other culture conditions. Additionally, results revealed that MSCs, differently isolated, expressed different level of HOX and TALE signatures and that PBX1 and MEIS3 were down-regulated in MSCs from clotted V-BMA in comparison to concentrated one. The study demonstrated for the first time that the cellular source inside the clotted V-BMA showed the best biological properties, representing an alternative and advanced cell therapy approach for patients undergoing spinal surgery.

Dental caries and childhood obesity: analysis of food intakes, lifestyle.

AIM: The aims of this cross-sectional statistical study were to evaluate the association between obesity and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the incidence of dental caries in obese paediatric patients, analysed by Dual X-ray Absorptiometry (DXA). MATERIALS AND METHODS: A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified in relation to body composition assessment and McCarthy growth charts and cut- offs. Body composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements, was determined by means of a DXA fan beam scanner. The subjects underwent dental examination to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight - caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D (pre-obese/obese with caries). STATISTICS: The statistical analysis was performed using SPSS software (version 16; SPSS Inc., Chicago IL, USA). Spearman's correlation was performed to evaluate the correlation between dmft/DMFT and FM%. The chi-square test was performed to assess the categorical variables, while the non-parametric Kruskal Wallis test and the Mann Whitney test were employed for the quantitive variables. Statististical significance was set at a P-value of 0.05. RESULTS: The preobese-obese children had higher indexes of dental caries than normal weight subjects, both for deciduous teeth (dmft 2.5 ± 0.54 vs 1.4 ± 0.38; p=0.030) and permanent teeth (DMFT 2.8 ± 0.24 vs 1.93 ± 1.79; p=0.039). The correlations between dmft/DMFT indexes and body composition parameters were analysed and a significant correlation between dmft/DMFT indexes and FM% was observed (p=0.031 for dmft, p=0.022 for DMFT). According to the data recorded, there was no statistically significant difference between Groups A, B, C and D in terms of food intake between meals (p=0.436), frequency of starch intake limited to the main meals (p=0.867), home oral hygiene (p=0.905), dental hygiene performed at school (p=0.389), habit of eating after brushing teeth (p=0.196), participation in extracurricular sport activities (p=0.442) and educational level of parents: father (p=0.454), mother (p=0.978). In contrast, there was a statistically significant difference between Groups A, B, C and D in terms of intake of sugar-sweetened drinks (p=0.005), frequency of sugar intake limited to the main meals (p<0.001), frequency of food intake between meals (p=0.038) and sedentary lifestyle (p=0.012). Successive analysis revealed a statistically significant difference between Group A and D in terms of intake of sugar-sweetened drinks (p=0.001), frequency of sugar intake limited to the main meals (p=0.008), and frequency of food intake between meals (p=0.018), and between Group C and D in terms of frequency of sugar intake limited to the main meals (p<0.001), and frequency of food intake between meals (p=0.040). CONCLUSION: This study shows a direct association between dental caries and obesity evident from a correlation between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%, measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks, frequency of sugar intake limited to main meals, frequency of food intake between meals) may be considered risk factors that are common to both dental caries and childhood obesity.

Childhood obesity and skeletal-dental maturity.

AIM: The aim of this cross-sectional study was to evaluate the skeletal maturation assessed through cervical vertebral maturation (CVM) and dental age, in normal weight, pre-obese and obese patients, using the Body Mass Index (BMI) and the Dual energy X-ray Absorptiometry (DXA). MATERIALS AND METHODS: A group of 107 healthy patients, aged between 6 and 12 years (mean age 8.77∓1.79), underwent anthropometric measurements, BMI calculation, and DXA exam at the Department of Neuroscience, Human Nutrition Unit, University of Rome "Tor Vergata" and the assessment of skeletal and dental age at the Paediatric Dentistry Unit of PTV Hospital, University of Rome "Tor Vergata". The subjects were classified as underweight, normal weight, pre-obese and obese according to FM% McCarthy cut-offs classification and BMI classification. STATISTICS: The analyses were performed using the SPSS software (version 16; SPSS Inc., Chicago IL, USA). The assessment of differences through the means of continuous variables among the different groups were analysed using the One-Way-Anova test. The Student's t test was also applied for each group of children (using McCarthy and BMI classifications) between chronological and skeletal-dental age; the Fisher's exact test was performed between the gender categorical variable and McCarthy cut-offs classification, and between McCarthy and BMI classifications. Besides, to evaluate the association between skeletal and dental age, a Pearson correlation coefficient was calculated. In all the assessments a significant level of alpha = 0.05 was considered. RESULTS: The comparison between BMI and DXA data shows statistically significant differences between BMI- FM% (McCarthy cut-offs) classifications (p≤0.001). According to FM% (McCarthy cut-offs) classification, from the Anova analysis among the groups a statistically significant difference between skeletal age (p=0.03) and dental age (p=0.02) was observed, while the difference related to the chronological age (p=0.22) among the groups, was not significant. The correlation between dental and skeletal age is almost the highest (Pearson correlation coefficient=0.994) and statistically significant (p=0.01). According to FM% McCarthy classification, it is observed that with an increase in the FM% , that is passing from normal weight to obese children, the skeletal-dental age always increases with respect to the chronological age. The difference between chronological and skeletal-dental age is statistically significant for pre-obese (p=0.01) and obese (p<0.001) children, while it is not significant for underweight (p=0.46) and normal weight (p=0.33) children. According to the BMI classification, from the Anova analysis no statistically significant differences were observed among the groups as for chronological, dental and skeletal age. Applying the same inferential analyses and taking into account the BMI classification, in the obese subjects were observed not statistically significant differences as for chronological and skeletal-dental age (p=0.09). CONCLUSION: The results highlighted a relation between skeletal-dental age acceleration and body fat percentage measured by DXA.

Cervical vertebral maturation and dental age in coeliac patients.

AIM: The aim of the study was to evaluate the cervical vertebral maturation and dental age, in group of patients with coelic disease (CD), in comparison with a control group of healthy subjects. METHODS: At the Paediatric Dentistry Unit of PTV Hospital, "Tor Vergata" University of Rome, 120 female patients, age range 12.0-12.9 years were recruited. Among them, 60 subjects (Group 1) were affected by CD, while the control group (Group 2) consisted of 60 healthy subjects, sex and age-matched. The Group 1 was subdivided, according to the period of CD diagnosis, in Group A (early diagnosis) and Group B (late diagnosis). The skeletal age was determined by assessing the cervical vertebral maturation, while the dental age has been determined using the method codified by Demirjiyan. STATISTICS.: The analyses were performed using the SPSS software (version 16; SPSS Inc., Chicago IL, USA). In all the assessments a significant level of alpha = 0.05 was considered. RESULTS: There are no statistically significant differences between Group 1 and Group 2 as for chronological age (p=0.122). Instead, from the assessment of skeletal-dental age, there are statistically significant differences between Group 1 - Group 2 (p<0.001) and Group A - Group B (p<0.001). The statistical analysis carried out to assess the differences between chronological and skeletal-dental age within the single groups, show a statistically significant difference in Group 1 (p<0.001) and in Group B (p<0.001), while there are no statistically significant differences in Group 2 (p=0.538) and in Group A (p=0.475). A correlation between skeletal and dental age was registered; for Groups 1-2 and for Groups A-B the Pearson coefficient was respectively equal to 0.967 and 0.969, with p<0.001. Through the analysis of data it is possible to assess that the percentage of subjects with skeletal and dental age delay corresponds to 20% in healthy subjects, 56.7% in coeliac subjects, 23% in coeliac subjects with early diagnosis and 90% in coeliac subjects with late diagnosis. From the comparison between Group 2 and Group A there are no statistically significant differences (p=0.951). Conclusions. The skeletal age and dental age delay may be two predictive indexes for a CD diagnosis. The dental age and cervical vertebral maturity can be assessed with a low cost, non invasive, easy to perform exam carried out through the routine radiographic examinations such as orthopanoramic and lateral teleradiography.

[The supply of long-term care services for the elderly in Italian regions]. / L'offerta di servizi di Long-Term Care per gli ultrasessantacinquenni nelle regioni italiane.

In Italy, as in other European Countries, ageing population drives policymakers to redesign the Long Term Care (LTC) system for the elderly. This study analyses the LTC supply for elderly considering the distribution of different components: formal care (institutional and alternative), and informal one in Italian regions. An observational, cross-sectional, ecological study was carried out using statistical data drawn from the Italian National Institute of Statistics and Ministry of Health referred to 2004. Factorial analysis selected the most important components of LTC phenomenon. These components were used for the application of cluster analysis. Cluster Analysis was performed on main components of Factorial Analysis. Then, the ratio of mean value in each cluster on national mean value was calculated for each indicator. Factorial analysis showed three factors characterized by autovalue > 1 that accounted for 61% of the total variance. Cluster analysis highlighted four groups of regions with different way of supply. High level of home care (141,9) and social network (121,3) emerged in group 1. High level of family who received help and family paying a caregiver (108,3 e 121,1) resulted in group 2. High level of no profit LTC (168) supply was reported in group 3. High level of public residential care (451,4) was found in group 4. These remarkable differences in the way of service supply, highlight the need of improvement of the information system on LTC. Thus LTC policy and practice might be better supported both in planning and organizational targets.

Factors associated with health-related quality of life: the role of social relationships among the elderly in an Italian region.

OBJECTIVES: This study examines the association between social relationships and health-related quality of life (HRQL) in the elderly in Lazio Region, Italy, a Mediterranean country where the shape and role of social links has dramatically changed. METHODS: Data were extracted from a national cross-sectional survey in Italy, representative of the non-institutionalised population aged 60 years and over resident in Lazio Region during 1999--2000. HRQL was measured with the Short Health Survey Questionnaire (SF-12). Data analysis was performed using multiple linear regression models using adjustment for the main confounders. RESULTS: Among the sample, 40.4% of the elderly were not married and 27.1 % were living alone. While being married and not living alone were associated with higher scores in the physical and mental quality-of-life components (P-value<0.001), more frequent visiting/seeing friends was likely to be associated with higher scores in both the physical and the mental health components (P-value<0.05). Multiple logistic regression analysis demonstrated that low physical health scores were associated with a low frequency of meeting with relatives and with living far from relatives. CONCLUSIONS: In a region covering 9.2% of the whole Italian population, only a small proportion of the elderly lack frequent social ties, yet low frequency of relationships with friends is associated with a decline in quality of life measured through mental and physical scores. Our findings will be useful for drawing up welfare strategies both at the national and at the Mediterranean level, in countries, like Italy, where the primacy of family support of the elderly has been decreasing in recent years.

The symptom of headache in emergency departments. The experience of a neurology emergency department.

Although the symptom of headache is a frequent cause of Emergency Department examinations, it is often considered to be of little clinical relevance in comparison with other emergencies and is usually treated only symptomatically. But how frequently does a simple headache mask a severe cerebral pathology? To answer this question, we studied a consecutive series of patients examined at the Neurology Emergency Department of Turin's Ospedale Molinette over a period of three months; the patients were then followed-up for more than two years in order to confirm the diagnoses. Of 215 cases of "acute" headache, 121 (56%) were essential and 94 (44%) symptomatic; of the latter, 18 (8.3%) were the only clinical manifestation of a severe cerebral pathology (10 hemorrhages, 2 ischemias, 6 tumours). In diagnosing these 18 cases, 72 EEG, 57 CT and 4 rachicentesis examinations were carried out and their diagnostic efficacy is here analysed. Our data show the importance of a careful evaluation of the symptom of headache in Emergency Departments and the need to send any doubtful cases to a facility specialised in coping with such emergencies.

Retraction-convergence nystagmus: clinical and radiological study of 4 cases of vascular origin.

Retraction-convergence nystagmus is a classic finding in extensive and bilateral lesions of the dorsal midbrain, usually neoplastic and, as such, considered to signal a poor prognosis. We report 4 cases of retraction-convergence nystagmus associated with Parinaud syndrome arising from circumscribed lesions of vascular origin--3 hemorrhagic and 1 ischemic--with a completely benign course. The neuroimaging study enabled us to identify involvement of the pretectal areas and posterior commissure as well as of the dorsomedial thalamic nuclei in all cases. It thus seems that one or more of these areas must be involved in the genesis of this nystagmus.

Sustained visual aura: a totally new variation of migraine.

An unusual case of an abnormally long-lasting (over 12 months) visual migraine aura is reported. The absence of signs of a structural lesion, as shown by neuro-imaging and clinical investigations, make difficult the differential diagnosis between a new variation and a complication of migraine.

[Glossopharyngeal neuralgia]. / La nevralgia del glossofaringeo.

Glossopharyngeal neuralgia, such less common than trigeminal neuralgia, is characterized by paroxysm of unilateral pain with sudden onset radiating from the oropharynx and base of the tongue, to the ear. Often precipitated by swallowing the glossopharyngeal neuralgia is occasionally accompanied by bradycardia or syncope. Conservative treatment consists of anticonvulsant drugs. Surgical treatment consists of section of the rootlets of the ninth and, in part, tenth cranial nerves. In some selected patients microvascular decompression without section of rootlets is also been made.

Multiple diverse intracranial and intramedullary spinal tumors. Report of a case.

A case of spinal ependymoma diagnosed 26 years after the removal of an acoustic neurinoma in a patient free of von Recklinghausen's disease is described. The extreme rarity of such a finding and the pathogenetic hypotheses regarding multiple primary tumors of the nervous system are discussed at the light of the literature.

Solitary neurinoma of the anterior cranial fossa. Case report.

A case of solitary neurinoma of the anterior cranial fossa, protruding into the ethmoidal region and into the right orbita, in a 44-year old woman is reported. The four cases previously described are reviewed and the possible origin of these tumors is discussed.