Answering the Rehabilitation 2030 Call.

In 2017, the World Health Organization initiated a global effort to improve rehabilitative services by 2030, with the overall goal of helping individuals with disabilities achieve maximal independence and improved well-being. Though more than 1 billion people worldwide live with a disability, a significant portion do not have access to appropriate rehabilitative services. In low-income countries, such as Zambia, where rehabilitative services are greatly lacking, disability can further exacerbate economic disparities in the context of personal, cultural, and environmental factors that limit participation in society. Therefore, expansion of rehabilitative services in low-income countries is a pressing global need, and such efforts must be tailored to the societal and cultural framework in which they are implemented. Community-based rehabilitation programs are uniquely poised to provide services in similar low-to-middle-income countries as they eliminate travel barriers to care, allow for regular follow-up, and address the societal determinants of disability by encouraging greater community engagement and by decreasing cultural stigma around disability. Special Hope Network (SHN), a community-based rehabilitation organization in Lusaka, Zambia that serves families caring for children with physical and cognitive disabilities, represents a cost-effective, sustainable, and culturally practical model to provide rehabilitative care. We propose this organization's model as one that can be reproduced and expanded upon in other low-to-middle-income countries to answer the World Health Organization's call to action.

Effect of Dewaxed Coffee on Gastroesophageal Symptoms in Patients with GERD: A Randomized Pilot Study.

Gastroesophageal Reflux Disease (GERD) is multifactorial pathogenesis characterized by the abnormal reflux of stomach contents into the esophagus. Symptoms are worse after the ingestion of certain foods, such as coffee. Hence, a randomized pilot study conducted on 40 Italian subjects was assessed to verify the effect of standard (SC) and dewaxed coffee (DC) consumption on gastroesophageal reflux symptoms and quality of life in patients with gastrointestinal diseases. The assessment of patient diaries highlighted a significant percentage reduction of symptoms frequency when consuming DC and a significant increase in both heartburn-free and regurgitation-free days. Consequentially, patients had a significant increase of antacid-free days during the DC assumption. Moreover, the polyphenolic profile of coffee pods was ascertained through UHPLC-Q-Orbitrap HRMS analysis. Chlorogenic acids (CGAs) were the most abundant investigated compounds with a concentration level ranging between 7.316 (DC) and 6.721 mg/g (SC). Apart from CGAs, caffeine was quantified at a concentration level of 5.691 mg/g and 11.091 for DC and SC, respectively. While still preliminary, data obtained from the present pilot study provide promising evidence for the efficacy of DC consumption in patients with GERD. Therefore, this treatment might represent a feasible way to make coffee more digestible and better tolerated.

Particle size and variety of coffee used as variables in mitigation of furan and 2-methylfuran content in espresso coffee.

In this study, the concentration of furan and 2-methylfuran in espresso coffee (EC) obtained from Arabica and Robusta coffee varieties was determined as a function of specific particle size. The particle size and coffee variety significantly influenced the level of furan and 2-methylfuran. In Arabica variety, furan and 2-methylfuran level increased with increasing particle size. Particularly, from C<200µm to C>425µm fractions, furan increased from 68.27 to 91.48 ng mL-1 while 2-methylfuran from 404.31 to 634.64 ng mL-1. In Robusta variety, the highest concentration of furan and 2-methylfuran occurred in ECs prepared using C300-425µm fraction showing values of 116.39 ng mL-1 and 845.14 ng mL-1, respectively, for furan and 2-methylfuran. On the basis of this experiment, it is possible to establish a mitigation strategy by manipulating the particle size and coffee variety in order to reduce the level of furan and 2-methylfuran in EC up to 11.4% and 18.8%, respectively.

Espresso coffee design based on non-monotonic granulometric distribution of aromatic profile.

Coffee beverages may be obtained using several extraction methods, among which espresso coffee (EC) represents now a worldwide adopted system. Recent advances in coffee grinding equipment allow today to achieve a detailed control of granulometric distribution, and the grinding process is an essential step of coffee production cycle both for the aromatic profile composition and for the chemical properties of the beverage (Severini, 2015). The comminution process consists of the breaking down particles into smaller fragments; as well-known, its main objective is to increase the overall particle surface area exposed to water leading to a more efficient extraction of soluble substances (Illy, 2005a). Basically, the coffee brewing process includes two steps: a washing phase concerning the snapshot dissolution of free solubles at the particle surface followed by diffusion phase of solubles within the porous particles (Spiro 1992, Baggenstoss 2008). The variability in particle size distribution on the quality of EC has been studied by various authors. Severini et al. has tackled the influence of the grinding level on the aromatic profiles and chemical attributes (percolation time, caffeine content, pH and titratable acidity) as a consequence of changes in the microstructural properties of the coffee cake. Generally speaking such results would imply that the final effect in terms of aromatic compounds extraction follows a monotonic law respect to granulometric size. This result is true in an average sense but it cannot be given for granted for any aromatic compounds if we refine the resolution of granulometric class. The reasons for which some aromatic compounds do not follow the supposed trend (the lower the grain size, the higher the aromatic compound content) can be most probably related to the internal distribution of precursors and to the different non-isotropic roasting grade of the bean, where the external part undergoes to an increased thermal load. This will change at the same time the kinetics and formation of aromatic compounds, and the mechanical properties as well, strictly correlated to the way the bean is crashed during the grinding phase and consequently to the granulometric distribution of different parts of the coffee bean. Results presented in this work allow to correlate choices in terms of granulometric distribution to characteristics aromatic compounds, in order to enhance specific flavors in espresso coffee.

In vitro analysis of the fracture resistance of CAD-CAM monolithic zirconia molar crowns with different occlusal thickness.

OBJECTIVES: To compare the fracture resistance and mode of failure of CAD-CAM monolithic zirconia crowns with different occlusal thickness. MATERIAL AND METHODS: Forty CAD-CAM monolithic zirconia crowns with different occlusal thickness were randomly distributed into 4 experimental groups: 2.0mm (group 1), 1.5mm (group 2), 1.0mm (group 3) and 0.5mm (group 4). The restorations were cemented onto human molars with a self-adhesive resin cement. The specimens were loaded until fracture; the fracture resistance and mode of failure were recorded. The data were statistically analyzed with the one-way ANOVA followed by the Fisher׳s Exact test with Bonferroni׳s correction (p=0.05). RESULTS: The fracture resistance values of all the specimens exceeded the maximum physiological occlusal loads in molar regions. All the crowns showed cohesive microcracks of the zirconia core; only 1 crown with a thickness of 0.5mm was interested by a complete fracture. CONCLUSIONS: The occlusal thickness of CAD-CAM monolithic zirconia crowns did not influence either the fracture resistance and the mode of failure of the restorations; the occlusal thickness of CAD-CAM monolithic zirconia crowns can be reduced up to a lower bound of 0.5mm keeping a sufficient strength to withstand occlusal loads; CAD-CAM monolithic zirconia crowns showed sufficient fracture resistance to be used in molar regions, even in a thin configuration (0.5mm).

3-Year Randomized Controlled Prospective Clinical Trial on Different CAD-CAM Implant Abutments.

BACKGROUND: Zirconia abutments were introduced to restore esthetic regions and showed sufficient stability to support implant restorations. Nonetheless, to date the observation periods are shorter than those of titanium abutments. PURPOSE: To assess the survival of implant crowns supported by computer aided design-computer aided manufacturing (CAD-CAM) abutments after 3 years. MATERIALS AND METHODS: Fifty-six patients were selected for this prospective clinical study. Each patient received at least 1 titanium implant for a total of 89 fixtures. A two-stage surgical technique and no additional soft or hard tissue graft were used. The implants were randomly divided into 3 groups receiving different CAD-CAM abutments: titanium, titanium nitride, and zirconia. Zirconia or metal-ceramic crowns were used as final restorations. Cementation was the baseline and the restorations were checked after 6 months, 1, 2, and 3 years, assessing any mechanical complication. Statistical analyses were performed to evaluate the 3-year success rates. RESULTS: Five failures were reported in the zirconia group; all the failed restorations showed fractures of the abutment connection. Four failures occurred in posterior regions and one more occurred while screwing the abutment. Titanium and titanium nitride abutments had significantly higher 3-year success rates than zirconia abutments (p < .05). CONCLUSIONS: Atlantis titanium and titanium nitride abutments showed optimal clinical performances after 3 years. Conversely, Atlantis zirconia abutments should be avoided to restore posterior regions.

Interferon-Beta combined with interleukin-2 restores human natural cytotoxicity impaired in vitro by ionizing radiations.

It is well known that ionizing radiations induce a marked downregulation of antigen-dependent and natural immunity for a prolonged period of time. This is due, at least in part, to radiation-induced apoptosis of different lymphocyte subpopulations, including natural killer (NK) cells. Aim of this study was to investigate the capability of Beta Interferon (ß-IFN) and Interleukin-2 (IL2), alone or in combination, to restore the functional activity of the natural immune system. Mononuclear cells (MNCs) obtained from intact or in vitro irradiated human peripheral blood were treated in vitro with ß-IFN immediately before or at the end of the 4-day treatment with IL2. Time-course analysis was performed on the NK activity, the total number and the apoptotic fraction of CD16+ and CD56+ cells, the 2 main NK effector cell subpopulations. The results indicate that radiation-induced impairment of natural cytotoxicity of MNC could be successfully antagonized by the ß-IFN+IL2 combination, mainly when exposure to ß-IFN preceded IL2 treatment. This radioprotective effect is paralleled by lower levels of radiation-induced apoptosis and increased expression of the antiapoptotic Bcl-2 protein. Since natural immunity can play a significant role in antitumor host's resistance, these results could provide the rational basis for a cytokine-based pharmacological strategy able to restore immune responsiveness and to afford possible therapeutic benefits in cancer patients undergoing radiotherapy.

Resveratrol down-regulates the growth and telomerase activity of breast cancer cells in vitro.

A number of previous studies investigated the in vitro effects of resveratrol on malignant human breast epithelial cell replication. The aim of the present study was to evaluate the activity of resveratrol on human metastatic breast cancer cells. The study was performed on the MCF-7 tumor cell line. Cell growth, cell cycle perturbation and apoptosis were evaluated by trypan blue dye exclusion assay, flow cytometric analysis and confocal fluorescence microscopy. TRAP assay and Western blot analysis respectively detected levels of telomerase activity and levels of hTERT in intracellular compartments of MCF-7 cells treated with resveratrol. Resveratrol has a direct inhibitory effect on cell proliferation. The results demonstrate that the drug induces apoptosis in MCF-7 cells, in a time- and concentration-related manner. Our results also show that the growth-inhibitory effect of resveratrol on malignant cells is mainly due to its ability to induce S-phase arrest and apoptosis in association with reduced levels of telomerase activity. In particular, TRAP assay and Western blot analysis respectively showed that resveratrol treatment down-regulates the telomerase activity of target cells and the nuclear levels of hTERT, the reverse transcriptase subunit of the telomerase complex. In our experimental model of breast cancer, resveratrol shows direct antiproliferative and pro-apoptotic effects. Studies on telomerase function and intracellular hTERT distribution point out that this agent is endowed with additional suppressive functions on critical tumor biological properties. These results speak in favor of a potential role of resveratrol in chemoprevention/chemotherapy of breast cancer.

In vitro antitumour activity of resveratrol in human melanoma cells sensitive or resistant to temozolomide.

Resveratrol, a polyphenol present in many plant species, exhibits a wide range of biological and pharmacological activities both in vitro and in vivo. It has been shown to exert a potent chemopreventive effect in carcinogenesis models and to induce cell growth inhibition and apoptosis in human tumour cells, including melanoma cells. Malignant melanoma is considered to be a chemotherapy-refractory tumour, and the commonly used anticancer drugs do not seem to modify the prognosis of metastatic disease. To further evaluate the therapeutic potential of resveratrol in the treatment of melanoma, we selected three human melanoma cell lines with different levels of resistance to temozolomide (TMZ), an antitumour triazene compound. The cell lines were subjected to resveratrol treatment and analysed for cell growth inhibition, cell cycle perturbation and apoptosis induction. We found that resveratrol markedly impaired proliferation of both the TMZ-sensitive M14 and the TMZ-resistant SK-Mel-28 and PR-Mel cell lines. The latter cell line was two-fold more resistant to the drug than M14 and SK-Mel-28 cells. The sensitivity of normal human keratinocytes to resveratrol was found to be significantly higher than that of M14 and SK-Mel-28 cells and similar to that of the PR-Mel cell line. This suggests a possible good in vivo therapeutic index for resveratrol. Our results also show that the growth-inhibitory effect of resveratrol on melanoma cells is mainly due to its ability to induce S-phase arrest and apoptosis. Taken together, our data indicate that resveratrol is an interesting candidate for the treatment of advanced melanoma.

Effects of chronic maternal ethanol exposure on hippocampal and striatal morphology in offspring.

Astrocytes and serotoninergic neurons play a role in central nervous system (CNS) development, probably through serotonin (5HT) stimulation of the glial 5HT(1A) receptor. Activation of 5HT(1A) receptors causes the release of S-100 beta, a glial derived growth factor. In vitro, astrocytes are profoundly altered by chronic maternal ethanol exposure (CMEE). CMEE is also associated with reduced 5HT brain levels and abnormal development of the serotoninergic system. In the present study we analyzed the hippocampal and striatal serotoninergic innervation and astroglial cells in the offspring of CMEE mothers. Female Wistar rats were orally exposed to ethanol 6.6% (v/v) ad libitum for 6 weeks before breeding and during gestation. After parturition, rat mothers continued receiving ethanol until pups reached 21 days old. The control group received water ad libitum. Rat offspring brains were processed by immunocytochemistry using antibodies directed to GFAP, serotonin transporter (5HTT), or S-100 beta protein. Hippocampus and striatum were studied by computer-assisted image analysis. Cell area of GFAP(+) astrocytes, surface of 5HTT(+) fibers per area unit, and relative optical density (ROD) of S-100 beta(+) astrocytes were measured and statistically processed. Our results show that astroglial GFAP was increased (astrocytes were hypertrophied) and 5HTT(+) fibers were increased in both the hippocampal CA-1 area and the striatum. On the other hand, S-100 beta ROD was increased only in the hippocampal CA-1 area but not in the striatum. The different response of the studied regions is an interesting result considering evidence of a close 5HT/astroglial relation during CNS development. These differences could be due to different gradients of development in the studied areas and/or different responses of those areas to the effect of maternal ethanol exposure since the first stages of embryonic development.