Search

Objectives: Anti‐resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti‐resorptive agents and with the risk of developing MRONJ. Materials and Methods: An 18‐item questionnaire was submitted by e‐mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro–Wilk test. Results: Four hundred and fifty‐one questionnaires were returned by e‐mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti‐resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti‐resorptive therapy for osteometabolic disorders. One or more MRONJ‐affected patients were encountered by 63.2% of the respondents. Conclusions: This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti‐resorptive agents. [ABSTRACT FROM AUTHOR]

Discrepancies in magnetic field maps produced by confinement coils in thermonuclear fusion reactors may drive plasma to lose stability and must be carefully controlled during the whole time evolution of each shot using suitable correction coils. Even when kept below safety thresholds, these error fields (EFs) may alter the geometry of magnetic flux lines, defining the plasma geometry. This paper, using high accuracy 3-D magnetic field computations for confinement coils, addresses the issue of evaluating the effect of EFs on the plasma boundary shape during the shot, modeled as a sequence of equilibrium configurations. In particular, a procedure that can compute the shape perturbations due to given deformations of the coils has been set up and used to carry out an analysis of relationship between the EF and shape perturbations during the time evolution of International Tokamak Experimental Reactor programmed scenario. [ABSTRACT FROM AUTHOR]

This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior. Highlights: AR drugs such as bisphosphonates (BPs), denosumab (DNB) and romosozumab (RMB) are very effective in the treatment of osteoporosis and in the prevention of fragility bone fractures. Periodontitis is a widespread infective inflammatory disease that is the major cause of tooth loss, and it is strongly connected with other systemic diseases, including osteoporosis. MRONJ is a serious and rare complication associated with the use of AR drugs in osteoporotic patients. The reported incidence is rather low and ranges between 0.01 and 0.9%, but may be higher in the presence of comorbidities. Periodontitis and MRONJ share some risk factors, such as diabetes, smoking, steroids, cardiovascular diseases and rheumatoid arthritis. The risk of developing MRONJ in a case of successfully treated periodontitis is much lower than the risk of fragility fracture in a high-risk person such as one with a previous fracture. Oral and periodontal conditions should be assessed before starting an AR therapy, and local intra-oral inflammation should be brought under control. Periodontal therapy is effective at reducing the risk of teeth extraction and therefore the need for major bone reconstructive intervention and implant placement. Control of periodontal inflammation should be achieved and maintained over time in osteoporosis-affected patients treated with AR. Peri-implant diseases rather than dental implant placement may be considered a trigger for MRONJ; for this reason, periodontitis and peri-implant inflammatory disease control and the inclusion of patients in a supportive periodontal program are critical. AR therapy should not be discontinued or deferred by the dentist unless done in accordance with the prescriber. The suspension of BP therapy is not recommended on a routine basis, as BP binds to the skeletal sites and continue to be released for months or years after treatment, with a long tail effect on bone metabolism. DNB administration should not be withdrawn because the rebound effect may increase the risk of bone fractures. A therapeutic window in which to perform dento-alveolar surgical procedures is suggested. It is advisable to calibrate the timing of dental extraction and surgical procedures between the dentist and prescribers according to the oral condition, the general health condition, and the time and type of AR drugs used. A more integrated approach between prescriber, dentist, periodontist and dental hygienist should be encouraged, particularly in the management of periodontitis-affected patients who are taking AR drugs for osteometabolic disorders. Prescribers and dentists must educate patients regarding the potential risk associated with long-term use of AR therapy. [ABSTRACT FROM AUTHOR]

With reference to toroidal fusion devices, we solve axisymmetric nonlinear evolutionary equilibrium equations, describing the plasma behaviour, self-consistently coupled to eddy currents equations, describing surrounding three-dimensional (3D) structures. This formulation allows the analysis of nonlinear plasma quasi-static evolution in the presence of 3D volumetric conductors. Several validations and test cases are presented, suggesting the potential applications of the proposed method to the analysis of various situations of scientific and technical interest for future fusion devices such as ITER and DEMO, like for instance disruptions. [ABSTRACT FROM AUTHOR]

Summary. The aim of this trial was to evaluate the effects of the COMT inhibitor entacapone on both the pharmacokinetic profile and clinical efficacy of controlled release levodopa in Parkinson’s disease (PD) patients. Twelve PD patients experiencing ‘end-of-dose’ type motor fluctuations were evaluated in this single-blind, randomized cross-over study. A single dose of either entacapone (200 mg) or placebo was co-administered with controlled release levodopa. Blood samples were taken every 30 minutes for 3 hours, and in 6 patients, sampling was continued for a further 3 hours. The clinical response to treatment was evaluated using the Unified Parkinson’s Disease Rating Scale motor score. Addition of entacapone to levodopa treatment prolonged the ‘on’ phase of the PD patients by 37% (p<0.05). This increased duration of ‘on’ time was concomitant with a significant increase in levodopa bioavailability (AUC). These data confirm the ability of entacapone to enhance the clinical efficacy of controlled release levodopa formulations, and provide further evidence that entacapone is of value in extending the benefits of levodopa in PD patients experiencing motor fluctuations. [ABSTRACT FROM AUTHOR]

The presently predicted total heating power of the demonstration fusion reactor DEMO is ∼3 times the ITER value, while the major radius is only 1.5 times larger (R. Wenninger, et al., The DEMO Wall Load Challenge, Nucl. Fusion 57 (2017) 046002 (11pp)) [1] . The current DEMO technological wall heat load removal capability is limited to ∼1 MW/m 2 , due to structural material limitations and the tritium breeding requirements, while the ITER first wall (FW) is designed for values up to 4.7 MW/m 2 . This paper focuses on the evaluation of the effect of the engineering constraints on the required limitation of charged particle heat load. First, a 2D field-mapping tool is used together with a simple model to take into account the peaking factors present on an engineering 3D wall design. A sensitivity analysis is performed on a set of realistic FW 3D features considering a preliminary estimate of misalignments. The impact on the heat flux to the wall due to different machine geometries, plasma shapes variation, stationary plasma and plasma transients, is presented. An automatic procedure to define the 2D poloidal contour of the FW for minimized particle loads is presented. A subset of the resulting engineering wall design is analyzed using the 3D field line tracing code PFCflux. [ABSTRACT FROM AUTHOR]

An Al2O3-based catalyst was employed for the first time in the H2S oxidative decomposition in order to obtain simultaneous sulfur and hydrogen. The influence of the reaction temperature (in the range of 700-1100 °C) and the contact time (in the range of 17-33 ms) were investigated in terms of H2S conversion, H2 yield, and SO2 selectivity. Good catalytic performances were obtained at 1000 and 1100 °C with experimental values very close to those ones expected from the thermodynamic equilibrium. At a temperature of 1000 °C, the H2S conversion and H2 yield were, respectively, about 50% and 17%; in particular, the SO2 selectivity decreased of a magnitude order ~0.5% with respect to the value observed in the homogeneous case (4%). A predictive mathematical model of H2S oxidative decomposition in the presence of a catalyst was developed through the identification of the main reactions occurring in the system. The results obtained from the kinetic investigations evidenced that the catalyst, in addition to the H2S decomposition reaction and the partial oxidation reaction to sulfur, was able also to promote the SO2 conversion by the Claus reaction allowing it to avoid the presence of SO2 at the reactor outlet. [ABSTRACT FROM AUTHOR]

An Al2O3-based catalyst was employed for the first time in the H2S oxidative decomposition in order to obtain simultaneous sulfur and hydrogen. The influence of the reaction temperature (in the range of 700-1100 °C) and the contact time (in the range of 17-33 ms) were investigated in terms of H2S conversion, H2 yield, and SO2 selectivity. Good catalytic performances were obtained at 1000 and 1100 °C with experimental values very close to those ones expected from the thermodynamic equilibrium. At a temperature of 1000 °C, the H2S conversion and H2 yield were, respectively, about 50% and 17%; in particular, the SO2 selectivity decreased of a magnitude order ~0.5% with respect to the value observed in the homogeneous case (4%). A predictive mathematical model of H2S oxidative decomposition in the presence of a catalyst was developed through the identification of the main reactions occurring in the system. The results obtained from the kinetic investigations evidenced that the catalyst, in addition to the H2S decomposition reaction and the partial oxidation reaction to sulfur, was able also to promote the SO2 conversion by the Claus reaction allowing it to avoid the presence of SO2 at the reactor outlet. [ABSTRACT FROM AUTHOR]

In the development of the DEMO Physics Basis an important role is played by the prediction of the plasma disruption features and by the evaluation of the electro-magnetic (EM) and thermal loads associated with these events. Indeed, the kind and number of foreseen plasma disruptions drive the development of the DEMO operation scenarios and the design of vessel and in-vessel components. To characterize a plausible macroscopic plasma dynamics during these events, we will carry out an extrapolation from present-day machines of the main parameters characterizing the disruptions: thermal and current quench time, evolution of plasma current, β and l i , safety factor limits, halo current fraction and width, radiated heat fraction. In particular, we will focus on extrapolations for the thermal and current quench characteristic times, due to their importance for the subsequent simulations aimed at the evaluation of the EM and thermal loads. The different options for DEMO design will be taken into account and the possible range of variation of the parameters will be estimated. The 2D axysimmetric MAXFEA and the 3D CarMa0NL codes will be used to evaluate the effects of the induced currents and the EM loads during a disruptive event and to analyze the various design options obtained by the PROCESS code. The results of these simulations, modeled as worst expected events, will be used as input for the system level analysis and design of the vessel and relevant in-vessel components. First simulations with CarMa0NL code including 3D structures are here presented to show the significant effects due to the large access ports. [ABSTRACT FROM AUTHOR]

Essential tremor (ET) is the most common movement disorder, with a prevalence of 4% in patients aged >65 years. Alchol sensitivity is a secondary criteria for ET diagnosis. A discordance between patient’s perceived disability and real disability could be observed in real world, so requiring a most objective diagnostic tool to measure reproducible parameters. Neurophysiological tremor study (NTS) may be useful to this aim. NTS has been conducted by an accelerometer, placed in the distal extremity of the more involved upper limb, which measures the amplitude and the frequency of the tremor, at rest, during posture maintenance and voluntary movement. We performed NTS before and after alchol test. The amount of alchol to be dispensed to each patient is calculated by Widmark formula, in order to obtain an alcholemia within a range of 0.6–0.7 mg/dl. Five patients affected by ET have been registered. A significant (>50%) decrease of tremor’s amplitude has been observed, while a less evident effect on tremor’s frequency has been found. Alchol responsivness of neurophysiological registration parameters may be an adjunctive method to objectively quantify clinical improvement, and, according to our experience, to predict therapy responsiveness. [ABSTRACT FROM AUTHOR]

Fluctuations in motor disability and dyskinesias are the major problem in the long-term treatment of Parkinson's disease (PD). Many authors and ourselves have shown that by giving patients a continuous infusion of levodopa it is possible to control motor fluctuations. Levodopa can be administered continuously only by intravenous, intragastric or intrajejunal delivery. Continuous dopaminergic stimulation can be achieved more easily by infusing dopamine agonists subcutaneously. Apomorphine is a potent water-soluble dopamine receptor agonist that has been shown to successfully control motor fluctuation when subcutaneously infused in complicated parkinsonian patients. We report the clinical data of 30 PD patients having at least five years of treatment with subcutaneous continuous apomorphine infusion. [ABSTRACT FROM AUTHOR]

Tremor is the most common movement disorder encountered in the clinical practice. A complete study of the tremor should evaluate the circumstances in which it occurs (rest, holding a position against gravity, doing an action), the frequency, amplitude, topography and activation conditions, considering the subjective influence of the emotive and psychological conditions. Neurophysiological investigations can give objective measures to assess tremor in different conditions, and are useful in the differential diagnosis between tremor and other movement disorders (i.e. pseudorhythmic myoclonus) and to evaluate the co-activation in the psychogenic tremor. In our protocol, we use an accelerometer to measure frequency and magnitude of the tremor oscillatory cycles and surface EMG to show whether antagonist muscles are working at the same time (co-contraction) or alternately to produce tremor. However this approach does not assess the impact of the tremor on living activities and the quality of life; therefore, we add to clinical evaluation and neurophysiological tests the Tremor Activities Daily Living Scale and the Quality of Life in Essential Tremor. Preliminary results of our study will be shown. [ABSTRACT FROM AUTHOR]