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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]

Context: The North American Great Plains contains > 80,000 wetlands (playas) that are habitat resources for birds. This region has also undergone recent expansion of wind energy development. Areas of overlap between playas and wind energy structures are potential wildlife hazards. Objectives: We identified areas where conservation values of playas may be compromised by proximity to wind turbines. Methods: We mapped where playas co-occur with wind-energy structures in a 902,765 km2 area encompassing portions of six U.S. states. At a smaller focal level (59 ~458 km2 Christmas Bird Count [CBC] circles), we developed a habitat quality index based on playa area, density, and inundation frequency, and spatially associated values with locations of wind turbines; we then examined CBC data for three focal species from 1984-2015. Results: Over 38% of playas were within 8 km of at least one structure, and 1.3% were within 100 m; ~90% of turbines/structures were within 8 km of a playa (2.7% within 100 m). Six CBC circles had high-quality habitat overlapping with high density of wind turbines. Another seven were high quality with few structures, representing valuable areas for future conservation efforts. However, lack of consistent time-series data constrained our ability to detect effects of wind-energy infrastructure installation on birds. Conclusions: Mapping high-quality habitat areas coincident with wind turbines is a way of identifying overlapping areas of wildlife habitat and sources of mortality without relying on population surveys that may be problematic or lacking altogether. Establishment of innovative protocols will be critical for detecting effects of wind-energy installation, a growing economic sector. [ABSTRACT FROM AUTHOR]

We used Landsat imagery to examine surface-water dynamics over the past 27 years in 39 salt lakes (salinas) of the Southern High Plains of the U.S. These groundwater- and precipitation-fed wetlands are regionally unique habitats with high salt concentrations and halophytic biota that may be vulnerable to hydrological changes from groundwater extraction for agriculture coupled with drought. We documented amounts and occurrences of water within the 39 salinas, comparing summer and winter (representing periods of high and low groundwater demand, respectively) in 1986-2013. During this span in our study area, total and irrigated cropland acreage increased, and the saturated thickness of the Ogallala Aquifer decreased by ~18.3%. There was variation in inundation frequency by salina, with two never holding water during our study. A third of the salinas went dry at least once, slightly more in summer than winter. Occurrence of water was not simply a function of basin size or to depth to the aquifer. These wetlands are being impacted by human changes to the landscape that are diminishing groundwater inputs, effectively creating novel wetlands that are now primarily supplied by precipitation rather than groundwater, with altered hydrological and ecological traits that may exacerbate regional vulnerability to climate change. [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]

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]