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Objective: This prospective randomized match-paired controlled trial aimed to evaluate the impact of implant platform diameter on marginal bone level around implants restored according to the platform switching (PS) concept., Material and Methods: A total of 24 implants were examined in 12 patients. All patients received two adjacent implants inserted at the crestal level: 4.3 mm (control group) and 4.8 mm (test group) in diameter. Mesio-distal implant position was randomly performed. According to the PS concept, for restoration, a 3.8 and 4.3 mm diameter abutment was used, respectively in the control and test groups, resulting, in both groups, with 0.25 mm of implant/abutment mismatching. Implant restorations were splinted. Eighteen months after final restoration, periapical standardized digital radiographs were taken to evaluate marginal bone level alterations after loading. The Wilcoxon Signed-Rank Test was selected to identify differences between groups., Results: At the last follow-up, control implants exhibited a mean bone loss value of 1.10 mm (SD: 0.47 mm); the test group showed a mean value of 1.09 mm (SD: 0.08 mm). No statistically significant differences were found between test and control groups., Conclusions: Within the limits of this study, the present results suggest that bone resorption is mostly related to biologic (biologic width re-establishment) rather than to biomechanical factors (implant platform diameter). Furthermore long-term studies with a wider sample size are needed to confirm the platform diameter influence on hard tissue response around implants restored according to the PS concept., (© 2011 John Wiley & Sons A/S.)

Objectives: The concept of platform switching has been introduced to implant therapy, however long-term data are sparse. The aim of this study was to biochemically investigate the inflammatory response mediated by MMP-8 to platform switching after 3 years of loading, in order to understand the long-term effect of implant/abutment mismatching on peri-implant health., Methods: A total of 70 implants had been inserted in the posterior maxilla in 26 patients and were randomly assigned to one of the four treatment regimens (implant diameter 3.8 [control group], 4.3 [Test group 1, T(1)], 4.8 [Test group 2, T(2)] and 5.5 mm [Test group 3, T(3)]). All implants were restored using a 3.8 mm abutment. In the test groups, this restoration resulted in a mismatching of 0.25-0.85 mm of implant-abutment diameters., Results: Thirty-six months after prosthetic rehabilitation, peri-implant sulcular fluid samples were taken from two aspects of all implants and from periodontally healthy adjacent teeth. Samples were processed in a conventional ELISA using monoclonal antibodies recognizing the active entity of MMP-8. In the test groups, MMP-8 mean values were 2.76 ng for T(1) (SD: 2.91), 3.30 ng for T(2) (SD: 1.94) and 3.18 ng for T(3) (SD: 2.46). For the control group, MMP-8 mean value was 3.6 ng (SD: 2.23), whereas 3.38 ng (SD: 2.2) was recorded at the adjacent teeth. There were no statistically significant differences in MMP-8 values between the groups (P=0.113, Kruskal-Wallis)., Conclusions: The presence of an implant/abutment mismatching specific for this prosthetic concept is compatible with long-term peri-implant health as demonstrated by analysis of a sensitive biomarker of the peri-implant inflammatory response., (© 2011 John Wiley & Sons A/S.)

Objectives: This case series aimed to explore the clinical outcome of sinus floor elevation surgery using a crestal approach technique in case of severely resorbed maxillae., Material and Methods: Seventeen edentulous patients received 20 implants and sinus floor elevation in posterior maxillae with residual crestal height of 1.2-5.0 mm and >7 mm. Drilling perforation was performed until the sinus floor was felt; the sinus mucosa was then lifted and magnesium-enriched hydroxyapatite granules (Mg-e HAP) were placed; and implants were immediately inserted. Four months later, definitive crowns were cemented, and patients were followed up for 24 months. Implant failures and complications 24 months after prosthetic loading were noted, and radiographic regenerated bone height was measured., Results: No patient dropped out, and all implants were successfully osseointegrated. There was minimal postoperative patient discomfort, and the only complication was a minimal perforation of the sinus membrane with no negative consequences. At the time of implant insertion, the residual crestal height mean value was 4.12 mm. After surgery and at the last follow-up, the mean heights of bone were 13.51 and 12.98 mm, respectively., Conclusion: The procedure was able to obtain sinus elevation and implant osseointegration.

Background: The study aimed to evaluate the diagnostic sensitivity (SE) and specificity (SP) of chronic alcohol misuse diagnosis by comparing traditional biomarkers with ethyl glucuronide (EtG), an ethanol direct metabolite, detected in the keratinic matrix., Methods: Seventy-six subjects tested for chronic alcohol abuse for different purposes were recruited. EtG was detected in hair, whereas the analyses of carbohydrate-deficient transferrin (CDT), alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, mean corpuscular volume, and mean corpuscular hemoglobin were performed in serum samples., Results: Of the 76 patients examined, 26 were judged by the medical doctors as subjects with alcohol abuse problems and, therefore, not eligible for driving license renewal or liver transplant. EtG in hair (SE = 0.68, SP = 1.00) showed the best diagnostic SE and SP compared with the other biomarkers investigated. Among the traditional biomarkers, only CDT proved to be suitable for forensic purposes because of the high diagnostic specificity (SP = 1.00) although it showed poor diagnostic SE (0.27). The percentage of positive samples decreased for all the biomarkers by excluding the subjects with hepatic diseases, except for EtG and CDT, suggesting that these 2 biomarkers could be less affected by false positive results, because of hepatic diseases., Conclusions: This study showed that when EtG in hair and CDT results are combined, diagnostic SE in chronic alcohol abuse diagnosis clearly improved, suggesting that complementary analysis of both these biomarkers provides the best diagnostic tool in suspected cases of chronic excessive alcohol consumption.

The recommended method for antinuclear antibodies (ANA) detection is IIF but it is influenced by many different factors. In order to pursue a high image quality without artefacts and to reduce inter-observer variability, this study aims to evaluate the reliability of using automatically acquired digital images for diagnostic purposes. In this paper we present SLIM-system a comprehensive system that supports the two sides of IIF tests classification. It is based on two systems: the first labels the fluorescence intensity, whereas the second recognizes the staining pattern of positive wells. We populated a dataset of 600 images obtained from sera screened for ANA by IIF on Hep-2 cells. The error rate has been evaluated according to eight-fold cross validation method; the rates reported in the following are the mean of the tests. Performance of the system in positive/negative recognition ranges from 87% up to more than 94%. Staining pattern classification accuracy of main classes ranges from 71% to 74%. The system provides high and reliable identification of negative samples and a flexibility that permits to use this application for different purposes. The analysis of its perspective performance shows the system potential in lowering the method variability, in increasing the level of standardization and in reducing the specialist workload of more than 80%. Our data represent a first step to validate the use of Computer Aided Diagnosis (CAD), thus offering an opportunity for standardizing and automatizing the detection of ANA by IIF., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Purpose: This case series aimed to evaluate the clinical outcome of a crestal approach technique in sinus floor elevation surgery with insertion of an alloplastic material., Material and Methods: A total of 50 edentulous patients received 64 implants and sinus floor elevation in posterior maxillae with residual crestal height 1.2 to 9.8 mm, and larger than 7 mm in width. Drilling perforation was performed until the sinus floor was felt. The sinus mucosa was then lifted. Hydroxyapatite granules were placed and implants were immediately inserted. Three months later, definitive crowns were cemented and patients were followed up for 18 months. Outcome measures were implant failures, complications and radiographic bone height gain measured 18 months after prosthetic loading., Results: No patient dropped out and all implants were successfully osseointegrated. Only minimal postoperative patient discomfort was reported. Only one complication occurred: a minor perforation of the sinus membrane with no negative consequences. At the time of implant insertion, the residual bone height mean value was 6.20 mm (±2.22). After surgery and at the last follow-up, the mean height of bone was 15.26 (±3.19) and 15.40 mm (±4.21), respectively., Conclusion: The procedure was able to obtain sinus elevation and implant osseointegration.

Purpose: This study sought to determine whether there was a correlation between bone resorption and individual bone patterns in patients treated with implants restored conventionally or using the platform-switching concept., Materials and Methods: Ten patients (24 implants) were randomly assigned to receive implants with different platform diameters (3.8, 4.3, 4.8, or 5.5 mm), all of which were restored with standard 3.8-mm-diameter abutments. Biopsy specimens were obtained prior to implant placement, and histologic and immunohistochemical analyses were performed. Standardized radiographs were made at each site after implant placement and at 36 months after prosthetic loading and bone levels were determined., Results: One patient dropped out, resulting in a total of 9 patients and 22 implants. Mean bone resorption was 1.358 mm for non-platform-switched implants; mean resorption was 0.832, 0.486, and 0.375 mm for implant platforms of 4.3, 4.8, and 5.5 mm, respectively. After standardization of peri-implant bone remodeling values, a borderline direct correlation between peri-implant bone changes and levels of biglycans was found. At the same time, a borderline indirect correlation between bone changes and levels of tumor necrosis factor-a was found., Conclusions: Within the limit of this study, which was conducted in a small patient sample over a short observation period, an individual resorption trend was detected and paralleled by immunohistochemical findings. Individual local bone structure and quality seemed to be correlated to peri-implant bone resorption. Correlations between biglycan and tumor necrosis factor-a and bone resorption should be confirmed by a larger patient sample.

Objective: Systemic lupus erythematosus is a connective tissue disease affecting multiple organ systems and characterised by a chronic inflammatory process. It is considered a very serious sickness, further to be classified as an invalidating chronic disease. The recommended method for its detection is the indirect immunofluorescence (IIF) based on Crithidia Luciliae (CL) substrate. Hoverer, IIF is affected by several issues limiting tests reliability and reproducibility. Hence, an evident medical demand is the development of computer-aided diagnosis tools that can offer a support to physician decision., Methods: In this paper we propose a system that classifies CL wells integrating information extracted from different images. It is based on three main decision phases. Two steps, named as threshold-based classification and single cells recognition, are applied for image classification. They minimise false negative and false positive classifications, respectively. Feature extraction and selection have been carried out to determine a compact set of descriptors to distinguish between positive and negative cells. The third step applies majority voting rule at well recognition level, enabling us to recover possible errors provided by previous phases., Results: The system performance have been evaluated on an annotated database of IIF CL wells, composed of 63 wells for a total of 342 images and 1487 cells. Accuracy, sensitivity and specificity of image recognition step are 99.4%, 98.6% and 99.6%, respectively. At level of well recognition, accuracy, sensitivity and specificity are 98.4%, 93.3% and 100.0%, respectively. The system has been also validated in a daily routine fashion on 48 consecutive analyses of hospital outpatients and inpatients. The results show very good performance for well recognition (100% of accuracy, sensitivity and specificity), due to the integration of cells and images information., Conclusions: The described recognition system can be applied in daily routine in order to improve the reliability, standardisation and reproducibility of CL readings in IIF., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Hepatitis B virus (HBV) and hepatitis delta virus (HDV) interplay was investigated by examining liver and serum samples from 21 coinfected and 22 HBV-monoinfected patients with chronic liver disease. Different real-time PCR assays were applied to evaluate intrahepatic amounts of HBV DNA, covalently closed circular DNA (cccDNA), pregenomic RNA (pgRNA), pre-S/S RNAs, and HDV RNA. Besides HBV DNA and HDV RNA levels, HBsAg concentrations in the sera were also determined. HDV-coinfected cases showed significantly lower median levels of serum HBV DNA (-5 log), intrahepatic relaxed-circular DNA (-2 log), and cccDNA (-2 log) than those of HBV-monoinfected cases. Interestingly, pgRNA and pre-S/S RNA amounts were significantly lower (both -1 log) in HDV-positive patients, whereas serum HBsAg concentrations were comparable between the two patient groups. Pre-S/S RNA and HBsAg amounts per cccDNA molecule were higher in HDV-positive patients (3-fold and 1 log, respectively), showing that HBV replication was reduced, whereas synthesis of envelope proteins was not specifically decreased. The ratios of cccDNA to intracellular total HBV DNA showed a larger proportion of cccDNA molecules in HDV-positive cases. For these patients, both intrahepatic and serum HDV RNA amounts were associated with cccDNA but not with HBsAg or HBV DNA levels. Finally, HBV genomes with large deletions in the basal core promoter/precore region were detected in 5/21 HDV-positive patients but in no HDV-negative patients and were associated with lower viremia levels. These findings provide significant information about the interference exerted by HDV on HBV replication and transcription activities in the human liver.

Purpose: The aim of this randomised clinical trial was to evaluate the influence of restoration on marginal bone loss (MBL) using immediately definitive abutments (one abutment–one time concept) versus provisional abutments later replaced by definitive abutments., Materials and Methods: In three private clinics, 32 patients with 32 hopeless maxillary premolars were selected for post-extractive implant-supported immediate restoration and randomised to provisional abutment (PA) and definitive abutment (DA) groups, 16 sites in each group. After tooth extraction, 7 patients had to be excluded for buccal wall fracture at tooth extraction or lack of sufficient primary implant stability (< 35 Ncm). The remaining 25 patients (10 PA, 15 DA) received a post-extractive wide-diameter implant. Immediately after insertion, the PA group were immediately restored using a platform-switched provisional titanium abutment. In the DA group, definitive platform-switched titanium abutments were tightened. In both groups, provisional crowns were adapted, avoiding occlusal contacts. All implants were definitively restored after 3 months. In the PA group, a traditional impression technique with coping transfer was adopted, dis/reconnecting abutments several times; in the DA group, metal prefabricated copings were used and final restorations were seated, avoiding abutment disconnection. Digital standardised periapical radiographs using a customised film holder were recorded at baseline (T₀ = implant insertion), final restoration (T₁ = 3 months later), and at 18-month (T₂) and 3-year (T₃) follow-ups. The MBL was evaluated with a computerised measuring technique and digital subtraction radiography (DSR) software was used to evaluate radiographic density., Results: At the 3-year follow-up a success rate of 100% in both groups was reported. In the PA group, peri-implant bone resorption was 0.36 mm at T₁, 0.43 mm at T₂, and 0.55 mm at T₃. In the DA group, peri-implant bone resorption was 0.35 mm at T₁, 0.33 mm at T₂, and 0.34 mm at T₃. Statistically significant lower bone losses were found at T₂ (0.1 mm) and T₃ (0.2 mm) for the DA group. At T₃, significantly higher DSR values around implant necks were recorded in the DA group (72 ± 5.0) when compared with the PA group (52 ± 9.5)., Conclusions: The current trial suggests that the 'one abutment–one time' concept might be a possible additional strategy in post-extraction immediately restored platform-switched single implants to further minimise peri-implant crestal bone resorption, although a 0.2 mm difference may not have any clinical effect. Additional clinical trials with larger groups of patients should be performed to better investigate this hypothesis.

Objective: Recent research has successfully introduced the application of robotics and mechatronics to functional assessment and motor therapy. Measurements of movement initiation in isometric conditions are widely used in clinical rehabilitation and their importance in functional assessment has been demonstrated for specific parts of the human body. The determination of the voluntary movement initiation time, also referred to as onset time, represents a challenging issue since the time window characterizing the movement onset is of particular relevance for the understanding of recovery mechanisms after a neurological damage. Establishing it manually as well as a troublesome task may also introduce oversight errors and loss of information., Methods: The most commonly used methods for automatic onset time detection compare the raw signal, or some extracted measures such as its derivatives (i.e., velocity and acceleration) with a chosen threshold. However, they suffer from high variability and systematic errors because of the weakness of the signal, the abnormality of response profiles as well as the variability of movement initiation times among patients. In this paper, we introduce a technique to optimise onset detection according to each input signal. It is based on a classification system that enables us to establish which deterministic method provides the most accurate onset time on the basis of information directly derived from the raw signal., Results: The approach was tested on annotated force and torque datasets. Each dataset is constituted by 768 signals acquired from eight anatomical districts in 96 patients who carried out six tasks related to common daily activities. The results show that the proposed technique improves not only on the performance achieved by each of the deterministic methods, but also on that attained by a group of clinical experts., Conclusions: The paper describes a classification system detecting the voluntary movement initiation time and adaptable to different signals. By using a set of features directly derived from raw data, we obtained promising results. Furthermore, although the technique has been developed within the scope of isometric force and torque signal analysis, it can be applied to other detection problems where several simple detectors are available., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)

Objectives: This randomized-controlled trial aimed to evaluate marginal bone level alterations at implants restored according to the platform-switching concept, using different implant/abutment mismatching., Material and Methods: Eighty implants were divided according to the platform diameter in four groups: 3.8 mm (control), 4.3 mm (test group(1)), 4.8 mm (test group(2)) and 5.5 mm (test group(3)), and randomly placed in the posterior maxilla of 31 patients. After 3 months, implants were connected to a 3.8-mm-diameter abutment and final restorations were performed. Radiographic bone height was measured by two independent examiners at the time of implant placement (baseline), and after 9, 15, 21 and 33 months., Results: After 21 months, all 80 implants were clinically osseointegrated in the 31 patients treated. A total of 69 implants were available for analysis, as 11 implants had to be excluded from the study due to early unintentional cover screw exposure. Radiographic evaluation showed a mean bone loss of 0.99 mm (SD = 0.42 mm) for test group(1), 0.82 mm (SD = 0.36 mm) for test group(2) and 0.56 mm (SD = 0.31 mm) for test group(3). These values were statistically significantly lower (P<0.005) compared with control (1.49 mm, SD = 0.54 mm). After 33 months, five patients were lost to follow-up. Evaluation of the remaining 60 implants showed no difference compared with 21 months data except for test group(2) (0.87 mm) and test group(3) (0.64 mm). There was an inverse correlation between the extent of mismatching and the amount of bone loss., Conclusions: This study suggested that marginal bone level alterations could be related to the extent of implant/abutment mismatching. Marginal bone levels were better maintained at implants restored according to the platform-switching concept.

Aim: To evaluate the soft tissue response to immediately placed implants using the platform switching concept., Material and Methods: In 22 patients, 22 implants of 5.5 mm platform diameter were placed immediately into fresh extraction sockets in maxillae without compromised bone tissue. Eventual post-extraction bone defects were filled using bovine bone matrix mixed with collagen. Immediately after insertion, implants were randomly divided: 11 implants were connected with a 3.8 mm diameter abutment (test group) and 11 with a 5.5 mm diameter abutment (control group). A provisional crown was adapted and adjusted for non-functional immediate positioning. Two months later, definitive prosthetic rehabilitation was performed. Periodontal parameter, buccal peri-implant mucosal changes (REC), mesial and distal papilla height (PH) and vertical height of jumping distance (VHG) were measured at the time of implant placement, of definitive prosthesis insertion and every 6 months thereafter., Results: The mean follow-up was 25 months. All implants were clinically osseointegrated. The test group showed a +0.18 mm REC gain. PH gain was +0.045 mm on average. The mean values were statistically significant (P< or =0.005) compared with the control group (PH=-0.88 mm; REC=-0.45 mm). No difference between the two groups in periodontal parameters was found. The mean value of bone filling was 7.51 mm in the test group (97.4% of VHG) and 8.57 mm in the control group (95.2% of VHG). No statistically significant difference was found between the two groups., Conclusions: This study suggests that, in a limited time period of 2 years, immediately placed implants with subsequent platform switching can provide peri-implant tissue stability.

Background: The recommended method for antinuclear antibodies (ANA) detection is indirect immunofluorescence (IIF). To pursue a high image quality without artefacts and reduce interobserver variability, this study aims at evaluating the reliability of automatically acquired digital images of IIF slides for diagnostic purposes., Methods: Ninety-six sera were screened for ANA by IIF on HEp-2 cells. Two expert physicians looking at both the fluorescence microscope and the digital images on computer monitor performed a blind study to evaluate fluorescence intensity and staining pattern. Cohen's kappa was used as an agreement evaluator between methods and experts., Results: Considering fluorescence intensity, there is a substantial agreement between microscope and monitor analysis in both physicians. Agreement between physicians was substantial at the microscope and perfect at the monitor. Considering IIF pattern, there was a substantial and moderate agreement between microscope and monitor analysis in both physicians. Kappa between physicians was substantial both at the microscope and at the monitor., Conclusions: These preliminary results suggest that digital media is a reliable tool to help physicians in detecting autoantibodies in IIF. Our data represent a first step to validate the use of digital images, thus offering an opportunity for standardizing and automatizing the detection of ANA by IIF.

2003 is the year of disability. This paper briefly illustrates the multiform relationships between occupational medicine and disability, discussing the complex legislation on this matter. A historiographic account is presented of the image of the disabled individual through the centuries. The main terms regarding disability are defined according to current legislation. Current Italian laws are difficult to interpret and to be put into effect. In this process, the occupational physician may be asked to perform several duties, including diagnosis and certification, fitting the disabled to work, safeguarding his/her moral and legislative rights, prevention and sanitary surveillance. Some professional experiences of the authors (regarding certification of the working capability, medico-legal recognition, and adaptation to work) are finally presented.

Principal spirometric parameters have been measured in a sample group of 1641 male subjects. Due to the significant difference in values often found when using the standards proposed by CECA (1983) (particularly in the medico-legal field) in order to obtain reference values as close as possible to the local norm the chosen subjects are clinically and functionally healthy and come from different parts of Sicily. The regression plots obtained using three independent variables (age, weight, height) other than demonstrating a good affinity with the original sample and an elevated predictivity level, underline the difference between obtained reference values and European ones (higher for VC and FEV 1; lower for FRC and RV) even though evolutive trend and ageing overlap. The above mentioned difference, found also for some parameters (VC and FEV 1) using normal Italian standards can be explained; not only by different evaluations of normal conditions, respiratory risk, smoking etc., but also by the existence of a different ethnic constitution which influences in various ways the ventilatory parameters.