Publications by authors named "Marco Ferrari"

513 Publications

Objective evaluation of orbito-zygomatic reconstruction with scapular tip free flaps to restore facial projection and orbital volume.

Oral Oncol 2021 Apr 10;117:105268. Epub 2021 Apr 10.

Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada. Electronic address:

Background: Restoring anatomical contour and position of the malar eminence and orbital rim following ablative mid-face procedures is critical in maintaining facial contour and orbit position.

Objective: To report our reconstructive approach using the scapular tip free-flap (STFF) for orbito-zygomatic defects, evaluating contour and overall shape restoration.

Methods: The study included 2 series: a clinical cohort of 15 consecutive patients who underwent an orbito-zygomatic reconstruction with a STFF and a cohort of 10 patients who had CT scan imaging but did not have orbito-zygomatic surgical resection or reconstruction. Using a 3D software, overall conformance (OC) and contour conformance (CC) with respect to the mirrored contralateral (clinical cohort) or native zygoma (preclinical cohort) were analyzed. Postoperative orbital volumes were also measured in the clinical cohort. Mean, median, root-mean-square (RMS), minimum and maximum measurements were obtained both for OC and CC. Conformance values of clinical and preclinical cohort were compared to objectively evaluate the quality of reconstruction in terms of orbito-zygomatic framework restoration (Mann-Whitney test).

Results: All measurements for OC and CC between scapular tip and the zygoma showed no differences, both on the clinical (RMS: OC 3.29 mm vs CC 3.32 mm -p = NS-) and preclinical (RMS: OC 2.03 mm and CC 2.31 mm -p = NS-) cohorts. Moreover, there were no differences in post-operative orbital volumes in the clinical cohort. Clinical outcomes of the case-series are also reported.

Conclusion: The STFF is highly effective in restoring facial projection and orbital volume in orbito-zygomatic reconstruction.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105268DOI Listing
April 2021

Diagnosis and Molecular Profiling of Lung Cancer by Percutaneous Ultrasound-Guided Biopsy of Superficial Metastatic Sites Is Safe and Highly Effective.

Respiration 2021 Apr 7:1-8. Epub 2021 Apr 7.

Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.

Background: Diagnosis, staging, and molecular profiling of lung cancer are mostly carried out with bronchoscopy or CT-guided aspiration/biopsy. However, patients with locally advanced or advanced disease often harbor "superficial" metastases for which a percutaneous, ultrasound-assisted needle aspiration/biopsy (US-NAB) might represent an equally effective yet less invasive and costly alternative.

Patients And Methods: We reviewed a prospectively collected database of consecutive patients with known/suspected lung cancer who underwent a US-NAB of a suspected "superficial" metastasis. Cancer genotyping was carried out with next-generation sequencing using the Oncomine™ Focus DNA and RNA fusion panels. PD-L1 immunohistochemistry was performed with the SP263 antibody. Feasibility, diagnostic yield for tissue diagnosis, sensitivity for malignancy, diagnostic yield for the molecular profiling, and complications were the study endpoints.

Results: A total of 98 lesions were evaluated, and 93 were biopsied (95% feasibility). The spectrum of sampled sites included lymph nodes (63 patients), bone (11), subcutaneous tissue (8), muscle (7), and the pleura (4). The diagnostic yield for a tissue diagnosis was 93% (91/98). US-NAB correctly identified 85 of the 87 patients finally diagnosed with malignancy (98% sensitivity). Cancer genotyping and PDL1 testing were successfully completed in 41/42 patients (98%) and in 40/50 patients (80%) for whom these tests were requested, respectively. No complications were observed.

Conclusion: US-NAB of "superficial" metastasis of lung cancer is safe and is associated with high success for diagnosis and molecular profiling. In this clinical setting, using US-NAB as a first-step technique would significantly limit the use of more invasive and costly diagnostic procedures.
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http://dx.doi.org/10.1159/000514316DOI Listing
April 2021

Endoscopic-assisted multi-portal compartmental resection of the masticatory space in oral cancer: Anatomical study and preliminary clinical experience.

Oral Oncol 2021 Apr 4;117:105269. Epub 2021 Apr 4.

Unit of Otorhinolaryngology, "San Maurizio" Hospital of Bolzano, Bolzano, Italy.

Objectives: To present an anatomical cadaver dissection study and our preliminary surgical experience with endoscopic-assisted multi-portal compartmental resection of the masticatory space (MS) in locally advanced oral squamous cell carcinoma (OSCC) of the retromolar area.

Materials And Methods: Two fresh-frozen cadaver heads were dissected in the Laboratory of Anatomy to define the surgical steps of an endoscopic-assisted multi-portal compartmental approach to the MS. After this preclinical anatomical study, patients affected by locally advanced OSCC originating from the retromolar area with extension to the MS were prospectively enrolled and operated at two Italian referral centers for head and neck cancer between October 2019 and May 2020.

Results: Surgical technique of endoscopic-assisted multi-portal compartmental resection of the MS was preclinically defined step by step in 3 phases: transnasal, transoral/trancervical, and multi-portal. Compartmental resection of the MS was successfully completed in all specimens (4 MSs dissected). The surgical technique was subsequently applied in 3 patients affected by primary OSCC of the retromolar area, providing satisfactory results in terms of negative resection margins and local control.

Conclusions: Multi-portal compartmental resection of the MS combining the transnasal and transoral/transcervical corridors is technically feasible. Such an approach to the MS in locally advanced OSCC provides different angles of incidence to the target and full control of tumor margins.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105269DOI Listing
April 2021

Analysis of The Reproducibility of Subgingival Vertical Margins Using Intraoral Optical Scanning (IOS): A Randomized Controlled Pilot Trial.

J Clin Med 2021 Mar 1;10(5). Epub 2021 Mar 1.

Department of Prosthodontics and Dental Materials, University of Siena, 53100 Siena, Italy.

Background: The aim of this randomized controlled trial was to evaluate the capability of an IOS (Intra Oral Scanner) device, used in standardized conditions, to detect margins of abutments prepared with knife-edge finishing line located at three different levels in relation to the gingival sulcus.

Methods: sixty abutment teeth for treatment with full crowns were selected and randomly divided in three groups accordingly to the depth of the finishing line: Group A: supragingival margin; Group B: 0.5-1.0 mm into the sulcus; Group C: 1.5-2.0 mm into the sulcus. Temporary crowns were placed for two weeks and then digital impressions (Aadva IOS 100, GC, Japan) were made of each abutment. As controls, analog impressions were taken, poured, and scanned using a laboratory scanner (Aadva lab scanner, GC, Japan). Two standard tessellation language (STL) files were generated for each abutment, subsequently processed, and superimposed by Exocad software (Exocad GmbH, Darmstadt, Germany), applying the "best-fit" algorithm in order to align the scan of the conventional with the digital impressions. The distances between each preparation margin and the adjacent gingival tissue were measured. Four measures were taken, two interproximally and buccally, for a total of six measures of each abutment considering three modes of impressions. The data were statistically evaluated using two-way analysis of variance (ANOVA) for each site and the Bonferroni test.

Results: there was no difference between the two kinds of impression in Group A in both sites, in Group B a difference of 0.483 mm and 0.682 mm at interproximal and buccal sites, respectively, and in Group C 0.750 mm and 0.964 mm at interproximal and buccal sites, respectively. The analysis performed on a site level (mesial/distal/vestibular) for the depth of both vertical preparations revealed significant differences ( < 0.0001). After a post hoc analysis (Bonferroni), vestibular sites of the shallow vertical preparations resulted in significantly lower values compared to the other sites prepared deeply.

Conclusions: the results showed that the location of the margin is an important factor in making a precise and complete impression when IOS (Intra Oral Scanner) is used. Moreover, deep preparation into the sulcus is not recommended for IOS (Intra Oral Scanner) impressions.
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http://dx.doi.org/10.3390/jcm10050941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957624PMC
March 2021

Recurrent Erythema Annulare Centrifugum due to Influenza Type A.

Case Rep Dermatol 2021 Jan-Apr;13(1):134-140. Epub 2021 Feb 18.

Skinlab, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.

Erythema annulare centrifugum (EAC) is a rare erythema characterized by erythematous and urticarial papules or annular plaques that enlarges centrifugally. The lesions usually involve the thighs and the legs. Several disorders are occasionally associated with EAC, infections, including mycoses, bacteria, or viruses and drugs have also been regarded as possible causes of this eruption. We present a 42-year-old dark-skinned woman affected by recurrent EAC that appeared secondary to influenza type A (H1N1). Histopathology showed a superficial form of EAC. In our case, a previous cytomegalovirus and Epstein-Barr virus (EBV) infection were identified and no underlying other diseases were found. Clarithromycin with calcipotriol betamethasone treatment was temporarily efficacious. In the last 3 years, the lesions started to appear every 2 weeks and tended to regress with local treatment after a variable period. We believe that the latent cytomegalovirus and the reactivity induced by EBV combined with influenza can determine, in our case, a cell mediate cutaneous immune response, which leads to the peculiar inflammatory disease known as EAC.
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http://dx.doi.org/10.1159/000512869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989671PMC
February 2021

Sinonasal cancers treatments: state of the art.

Curr Opin Oncol 2021 05;33(3):196-205

Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy.

Purpose Of Review: The present review provides the reader with the state-of-the-art concepts of sinonasal oncology in view of the latest literature data.

Recent Findings: Most recent publications in sinonasal oncology assessed treatment timing, centralization, surgical approach, margin status, orbit/neck management, salvage strategies, emerging surgical technologies, intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), particle radiotherapy, and neoadjuvant chemotherapy.

Summary: Indications to endoscopic surgery for sinonasal cancer have plateaued and are unlikely to further expand. Endoscopic surgery provides noninferior results compared to open surgery and best suits timing constraints imposed by multimodal treatment. Management of orbit-encroaching sinonasal cancer is remarkably improving mostly owing to optimal use of nonsurgical strategies. Prognostic value of the margin status and management of the nodal basin and recurrent sinonasal tumors are far from being fully elucidated. Most promising surgical technologies are surgical navigation, optical imaging, and radiofrequency-aided ablation. IMRT and VMAT have theoretical technical advantages that are in the process of being clinically demonstrated. Pieces of evidence are progressively confirming the physical and radiobiological advantages offered by particle radiotherapy. Systemic therapy is being tested mostly in the neoadjuvant setting with the aim of improving outcomes in locally advanced sinonasal cancers; response to induction chemotherapy could better select a further locoregional approach.
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http://dx.doi.org/10.1097/CCO.0000000000000726DOI Listing
May 2021

Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years.

J Clin Med 2021 Feb 25;10(5). Epub 2021 Feb 25.

Department of Prosthodontics and Dental Materials, University of Siena, 53100 Siena, Italy.

Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT).

Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed ( = 0.05). A Cox regression model was made.

Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan-Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1-98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68-56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03-23.38), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205-1.61). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively).

Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.
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http://dx.doi.org/10.3390/jcm10050908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956800PMC
February 2021

Bioengineering for head and neck reconstruction: the role of customized flaps.

Curr Opin Otolaryngol Head Neck Surg 2021 Apr;29(2):156-160

Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network.

Purpose Of Review: The purpose of this review is to provide the reader with an overview of the present and future applications of bioengineering for head and neck reconstruction, ranging from the application of Computed Assisted Surgery (CAS) to the most recent advances in 3D printing and tissue engineering.

Recent Findings: The use of CAS in head and neck reconstruction has been demonstrated to provide shorter surgical times, improved reconstructive accuracy of bone reconstruction, and achieves better alignment of bone segments in osteotomized reconstructions. Beyond its classical application in bone reconstructions, CAS has demonstrated reliability in the planning and harvesting of soft tissue flaps. To date, literature regarding bioengineering for head and neck reconstruction is mainly focused on in-vitro and animal model experiments; however, some pioneering reports on human patients suggest the potential feasibility of this technology.

Summary: Bioengineering is anticipated to play a key role in the future development of customized flaps for head and neck reconstruction. These technologies are particularly appealing as a new technology to address certain unsolved challenges in head and neck reconstruction.
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http://dx.doi.org/10.1097/MOO.0000000000000705DOI Listing
April 2021

The future of noninvasive neonatal brain assessment: the measure of cerebral blood flow by diffuse correlation spectroscopy in combination with near-infrared spectroscopy oximetry.

J Perinatol 2021 Mar 1. Epub 2021 Mar 1.

Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.

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http://dx.doi.org/10.1038/s41372-021-00996-wDOI Listing
March 2021

Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study.

Clin Oral Investig 2021 Feb 23. Epub 2021 Feb 23.

Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy.

Objectives: Oral surgery morbidity is highly variable based on patients' characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation.

Materials And Methods: Data from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VAS) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRS: 0 to 4) and willingness to repeat the same surgical procedure (VRS: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded.

Results: VAS showed moderate values in the first 2 days (< 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 ± 3.03. Discomfort level (VRS) after surgery was low (median: 1; IR: 1-0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed.

Conclusions: Maxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise.

Clinical Relevance: The analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.
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http://dx.doi.org/10.1007/s00784-020-03755-xDOI Listing
February 2021

Influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors.

Dent Mater J 2021 Feb 20. Epub 2021 Feb 20.

Department of Medical Biotechnologies, Unit of Endodontics and Restorative Dentistry, University of Siena.

The aim is to evaluate the influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors. 150 maxillary central incisors were divided into three groups, Group 0, intact teeth; Group 1, removal of distal wall; Group 2, removal of mesial and distal walls, and further into two subgroups A,A,A and B,B,B according to post-endodontic restoration (post/no-post), then loaded to fracture. Interactions among variables and intergroup significance were tested with two-way ANOVA and Kruskal Wallis's tests (p≤0.05). Tukey's test was applied for multiple comparisons. Statistically significant differences were found between groups B-A, and B-A, but they were not found between B-A. Intragroup analysis showed statistically significant differences in both groups post/no-post with decreasing dental substance. Fiber post placement causes an increase in fracture strength and a reduction of irreparable fractures in endodontically treated maxillary central incisors that lost at least one wall.
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http://dx.doi.org/10.4012/dmj.2020-220DOI Listing
February 2021

Sinonasal cancer encroaching the orbit: Ablation or preservation?

Oral Oncol 2021 Mar 28;114:105185. Epub 2021 Jan 28.

Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.

Background: Encroachment on the orbital cavity represents a challenge in the management of sinonasal cancer. Criteria guiding orbital preservation lack univocal consensus. Stage of orbital involvement is best assessed through magnetic resonance imaging (MRI).

Methods: Patients affected by orbit-encroaching sinonasal cancer with available preoperative MRI, receiving surgery-based treatment at the University of Brescia between May 2005 and October 2018 were included. All cases were reviewed by expert radiologists and pathologists. Diagnostic performance of MRI was calculated using pathological information as reference. Survival analysis was performed.

Results: The study included 123 patients. The orbit was abutted in 53 (43.1%) patients, whereas orbital invasion reached the periorbit in 18 (14.6%), extraconal fat and/or medial lacrimal sac in 29 (23.6%), extrinsic ocular muscles in 7 (5.7%), intraconal compartment in 4 (3.3%), and orbital apex in 12 (9.8%). Seventy-six (61.8%) patients received orbit-sparing surgery, 47 (38.2%) underwent orbital ablation (OA). Accuracy of MRI in detecting involvement by cancer was ≥80.0% for the orbital wall, extraconal fat, and muscles, and <80.0% for the periorbit and intraconal compartment. Previous surgery, neoadjuvant chemotherapy, and perineural invasion decreased MRI accuracy. Age, histology, tumor grade, pT category, N status, perineural invasion, orbital invasion stage, and need for OA were found to affect prognosis. Five-year orbital dysfunction-free survival was 92.8%.

Conclusion: Conservative management of sinonasal cancers encroaching the orbit is feasible. MRI is essential to preoperatively stage orbital invasion, yet with some limitation. Given the dismal prognosis despite aggressive surgery, neoadjuvant non-surgical therapies should be considered in patients requiring OA.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105185DOI Listing
March 2021

Comparing Contour Restoration of Mandibular Body Defects With Fibula, Iliac Crest, and Scapular Tip Flaps: A Conformance Virtual Study.

J Oral Maxillofac Surg 2020 Dec 29. Epub 2020 Dec 29.

Professor, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.

Purpose: The purpose of this study was to determine which of the most commonly used flaps restore contour more accurately in mandibular body reconstructions using conformance analyses and virtual measurements.

Methods: Using normal computed tomography (CT) scans and a 3D software, mandibular body defects were virtually created. "Single shot" and osteotomized fibula flaps (SS-FF and O-FF), iliac crest flaps (ICF) and scapular tip flaps (STF) were digitally harvested and coregistered to reconstruct those defects. Conformance analyses were performed by calculating the root mean square (RMS) for overall and contour conformance.

Results: Ten patients normal CT scans were included. The STF demonstrated improved overall conformance compared with the ICF, the SS-FF and the O-FF (RMS = 2.03 mm vs 4.53 mm vs 2.76 vs 2.37 mm, respectively; p<.001). Similar trends were seen for contour conformance in STF compared with the ICF and the SS-FF (RMS = 2.48 mm vs 4.50 mm vs 3.28 mm, respectively), whereas the O-FF performed better than STF (RMS = 1.85 mm vs 2.48 mm; p<.001).

Conclusions: The osseous component of the STF resembles the mandibular body more accurately than the one in the ICF and FF without the need for an osteotomy. Future clinical studies can help to elucidate the clinical impact of these virtual findings.
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http://dx.doi.org/10.1016/j.joms.2020.12.031DOI Listing
December 2020

A new landmark for lingual artery identification during transoral surgery: Anatomic-radiologic study.

Head Neck 2021 Jan 25. Epub 2021 Jan 25.

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Background: A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT).

Methods: Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA.

Results: Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm.

Conclusions: LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding.
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http://dx.doi.org/10.1002/hed.26606DOI Listing
January 2021

Immunomodulatory Potential of Cannabidiol in Multiple Sclerosis: a Systematic Review.

J Neuroimmune Pharmacol 2021 Jan 25. Epub 2021 Jan 25.

Center for Research in Medical Pharmacology and Center for Research in Neuroscience, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy.

Multiple sclerosis (MS) is the most common chronic autoimmune disease of the central nervous system. Efficacy of treatments for MS is associated with risk of adverse effects, and effective and well-tolerated drugs remain a major unmet need. Cannabis (Cannabis sativa L., fam. Cannabaceae) and cannabinoids are popular among MS patients to treat spasticity and pain. Cannabinoids are endowed with remarkable immunomodulating properties, and in particular the non-psychotropic cannabinoid cannabidiol (CBD) is increasingly recognized as anti-inflammatory and immunosuppressive, nevertheless with excellent tolerability even at high doses. In this systematic review, we retrieved and critically evaluated available evidence regarding the immune and disease-modifying effects of CBD in experimental autoimmune encephalomyelitis (EAE) and in MS. Evidence in rodent models of EAE strongly supports CBD as effective, while clinical evidence is still limited and usually negative, due to paucity of studies and possibly to the use of suboptimal dosing regimens. Better characterization of targets acted upon by CBD in MS should be obtained in ex vivo/in vitro studies in human immune cells, and higher doses should be tested in well-designed clinical trials with clinically relevant efficacy endpoints. Graphical Abstract.
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http://dx.doi.org/10.1007/s11481-021-09982-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829325PMC
January 2021

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description.

Neurosurg Rev 2021 Jan 22. Epub 2021 Jan 22.

Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Transorbital endoscopic approaches are increasing in popularity as they provide corridors to reach various areas of the ventral skull base through the orbit. They can be used either alone or in combination with different approaches when dealing with the pathologies of the skull base. The objective of the current study is to evaluate the surgical anatomy of transorbital endoscopic approaches by cadaver dissections as well as providing objective clinical data on their actual employment and morbidity through a systematic review of the current literature. Four cadaveric specimens were dissected, and step-by-step dissection of each endoscopic transorbital approach was performed to identify the main anatomic landmarks and corridors. A systematic review with pooled analysis of the current literature from January 2000 to April 2020 was performed and the related studies were analyzed. Main anatomical landmarks are presented based on the anatomical study and systematic review of the literature. With emphasis on the specific transorbital approach used, indications, surgical technique, and complications are reviewed through the systematic review of 42 studies (19 in vivo and 23 anatomical dissections) including 193 patients. In conclusion, transorbital endoscopic approaches are promising and appear as feasible techniques for the surgical treatment of skull base lesions. Surgical anatomy of transorbital endoscopic approaches can be mastered through knowledge of a number of anatomical landmarks. Based on data available in the literature, transorbital endoscopic approaches represent an important complementary that should be included in the armamentarium of a skull base team.
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http://dx.doi.org/10.1007/s10143-020-01470-5DOI Listing
January 2021

A randomized controlled clinical trial of two types of lithium disilicate partial crowns.

Am J Dent 2020 Dec;33(6):291-295

Department of Prosthodontics and Dental Materials, University of Siena, Siena, Italy,

Purpose: This randomized controlled clinical trial evaluated the behavior of lithium disilicate partial crowns by means of a novel Functional Index for Teeth (FIT).

Methods: 105 subjects in need of at least a single prosthetic restoration in posterior areas were treated with adhesive partial crowns (for a total of 170 restorations) onto natural vital abutment teeth and followed-up annually for 4 years. Subjects were randomly divided into two experimental groups: Group 1, e.max Press and Group 2, Initial LiSi Press. FIT was used for the objective assessment of outcomes including clinical and radiographic examinations. A dropout rate of 4.25% in Group 1 and 3.4% in Group 2 was recorded. FIT is made up of seven variables (interproximal, occlusion, design, mucosa, bone, biology and margins); each of them to be evaluated using a 0-1-2 score. The Mann-Whitney U test was applied for statistical analysis and the level of significance was set at P< 0.05.

Results: In Group 1, five complications were recorded, and four in Group 2, with a failure rate of 6.25% and 6.17%, respectively. No statistically significant difference was found between the experimental groups in any of the assessed variables. The tested lithium disilicate material brands showed comparable clinical performances after 4 years of clinical service.

Clinical Significance: Clinicians can use either of the tested lithium disilicate materials to make adhesively luted partial crowns.
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December 2020

Dwarf planet (1) Ceres surface bluing due to high porosity resulting from sublimation.

Nat Commun 2021 01 12;12(1):274. Epub 2021 Jan 12.

University Grenoble Alpes, CNRS, Institut de Planétologie et d'Astrophysique de Grenoble (IPAG), Grenoble, 38000, France.

The Dawn mission found that the dominant colour variation on the surface of dwarf planet Ceres is a change of the visible spectral slope, where fresh impact craters are surrounded by blue (negative spectral-sloped) ejecta. The origin of this colour variation is still a mystery. Here we investigate a scenario in which an impact mixes the phyllosilicates present on the surface of Ceres with the water ice just below. In our experiment, Ceres analogue material is suspended in liquid water to create intimately mixed ice particles, which are sublimated under conditions approximating those on Ceres. The sublimation residue has a highly porous, foam-like structure made of phyllosilicates that scattered light in similar blue fashion as the Ceres surface. Our experiment provides a mechanism for the blue colour of fresh craters that can naturally emerge from the Ceres environment.
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http://dx.doi.org/10.1038/s41467-020-20494-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804090PMC
January 2021

The Role of Methemoglobin and Carboxyhemoglobin in COVID-19: A Review.

J Clin Med 2020 Dec 25;10(1). Epub 2020 Dec 25.

Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.

Following the outbreak of a novel coronavirus (SARS-CoV-2) associated with pneumonia in China (Corona Virus Disease 2019, COVID-19) at the end of 2019, the world is currently facing a global pandemic of infections with SARS-CoV-2 and cases of COVID-19. Since severely ill patients often show elevated methemoglobin (MetHb) and carboxyhemoglobin (COHb) concentrations in their blood as a marker of disease severity, we aimed to summarize the currently available published study results (case reports and cross-sectional studies) on MetHb and COHb concentrations in the blood of COVID-19 patients. To this end, a systematic literature research was performed. For the case of MetHb, seven publications were identified (five case reports and two cross-sectional studies), and for the case of COHb, three studies were found (two cross-sectional studies and one case report). The findings reported in the publications show that an increase in MetHb and COHb can happen in COVID-19 patients, especially in critically ill ones, and that MetHb and COHb can increase to dangerously high levels during the course of the disease in some patients. The medications given to the patient and the patient's glucose-6-phospate dehydrogenase (G6PD) status seem to be important factors determining the severity of the methemoglobinemia and carboxyhemoglobinemia. Therefore, G6PD status should be determined before medications such as hydroxychloroquine are administered. In conclusion, MetHb and COHb can be elevated in COVID-19 patients and should be checked routinely in order to provide adequate medical treatment as well as to avoid misinterpretation of fingertip pulse oximetry readings, which can be inaccurate and unreliable in case of elevated MetHb and COHb levels in the blood.
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http://dx.doi.org/10.3390/jcm10010050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795966PMC
December 2020

Organic Material on Ceres: Insights from Visible and Infrared Space Observations.

Life (Basel) 2020 Dec 24;11(1). Epub 2020 Dec 24.

Earth Planetary and Space Sciences, University of California, Los Angeles, CA 90095, USA.

The NASA/Dawn mission has acquired unprecedented measurements of the surface of the dwarf planet Ceres, the composition of which is a mixture of ultra-carbonaceous material, phyllosilicates, carbonates, organics, Fe-oxides, and volatiles as determined by remote sensing instruments including the VIR imaging spectrometer. We performed a refined analysis merging visible and infrared observations of Ceres' surface for the first time. The overall shape of the combined spectrum suggests another type of silicate not previously considered, and we confirmed a large abundance of carbon material. More importantly, by analyzing the local spectra of the organic-rich region of the Ernutet crater, we identified a reddening in the visible range, strongly correlated to the aliphatic signature at 3.4 µm. Similar reddening was found in the bright material making up Cerealia Facula in the Occator crater. This implies that organic material might be present in the source of the faculae, where brines and organics are mixed in an environment that may be favorable for prebiotic chemistry.
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http://dx.doi.org/10.3390/life11010009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823631PMC
December 2020

Management of anterior fossa cephaloceles: an overview.

J Neurosurg Sci 2020 Dec 15. Epub 2020 Dec 15.

Section of Otorhinolaryngology, Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Skull base cephaloceles (SBCs) are defined as herniation of intracranial content through the skull base and are classified based on composition, etiology, and topographic location. Anterior SBCs frequently protrude in the sinonasal cavity, and consequently are at potential risk of infection. Therefore, the current recommendation is to treat SBCs with the primary intent of preventing meningitis, and surgery represents the mainstay of treatment. Anterior SBCs may display a wide spectrum of severity and complexity, and in each case the risks and benefits of surgical approaches are to be carefully weighted based on thorough assessment of symptoms, age, general conditions, location and size of the lesion, as well as expertise of the surgeon. In the last 30 years, the evolution and diffusion of transnasal endoscopic surgery have substantially changed the surgical management of the majority of SBC. In the past, they were treated exclusively with open transcranial approaches that may be burdened by relevant morbidity and risk for severe complications. The transnasal endoscopic corridor now provides easy access to the lesion and different reconstructive strategies using endonasal pedicled flaps, without any external incision, cranioplasty or brain manipulation. However, there are still scenarios in which an exclusive transnasal endoscopic route is contraindicated. The aim of the present review is to provide an overview on the comprehensive management of anterior SBC, with a particular focus on lesions suitable for endoscopic surgery. Furthermore, special aspects of SBC management in children and adults will be highlighted.
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http://dx.doi.org/10.23736/S0390-5616.20.05099-7DOI Listing
December 2020

Temporal Artery Posterior Auricular Skin Free Flap for Secondary Oral Cavity Reconstruction.

Laryngoscope 2020 Dec 15. Epub 2020 Dec 15.

Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1002/lary.29250DOI Listing
December 2020

Treatment of congenital nasolacrimal duct cyst: the role of endoscopic marsupialisation.

Acta Otorhinolaryngol Ital 2020 Oct;40(5):377-382

Unit of Pediatric Otorhinolaryngology, ASST Spedali Civili of Brescia, Italy.

Objective: Congenital nasolacrimal duct cyst (NLDC) is a rare disorder, which can present with ophthalmological and nasal signs and symptoms. The authors analyse their personal experience to identify diagnostic criteria for NLDC, which were treated by endoscopic transnasal procedure.

Methods: Clinical records of patients with a diagnosis of NLDC were retrospectively reviewed. All patients underwent rhinoscopy and ophthalmologist evaluation before surgery, whereas imaging was performed in selected cases. All neonates underwent transnasal endoscopic marsupialisation after failure of conservative medical therapy.

Results: Five patients were included in the study. One patient presented bilateral NLDC. In 3 cases, CT scan of the sinus was carried out. A total of 6 marsupialisation procedures were performed and a bi-canalicular lacrimal stent was positioned in 1 case. Complete remission of symptoms was observed in all cases.

Conclusions: Nasal endoscopy is mandatory to diagnose NLDCs, and, in some cases, it can be complemented by radiological procedures. When symptoms persist after systemic and topical therapy, nasal endoscopic marsupialisation is the treatment of choice. This surgical procedure is effective, safe and can be repeated if needed.
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http://dx.doi.org/10.14639/0392-100X-N0759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726643PMC
October 2020

Comparison of different intraoral scanning techniques on the completely edentulous maxilla: An in vitro 3-dimensional comparative analysis.

J Prosthet Dent 2020 Dec 24;124(6):762.e1-762.e8. Epub 2020 Oct 24.

Research Professor, Division of Prosthodontics and Digital Dentistry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy.

Statement Of Problem: Information about the accuracy of intraoral scanners for the edentulous maxilla is lacking.

Purpose: The purpose of this in vitro study was to compare the accuracy of 3 different intraoral scanner techniques on a completely edentulous maxilla typodont.

Material And Methods: Two completely edentulous maxillary typodonts with (wrinkled typodont) and without (smooth typodont) palatal rugae were used as reference and were scanned by using an industrial metrological machine to obtain 2 digital reference scans in standard tessellation language (STL) format (dWT and dST). Three different scanning techniques were investigated: in the buccopalatal technique, the buccal vestibule was scanned with a longitudinal movement ending on the palatal vault with a posteroanterior direction; the S-shaped technique was based on an alternate palatobuccal and buccopalatal scan along the ridge; in the palatobuccal technique, the palate was scanned with a circular movement and then with a longitudinal one along the buccal vestibule. Consecutively, 6 types of scans were obtained (n=10), namely wrinkled typodont/buccopalatal technique, wrinkled typodont/S-shaped technique, wrinkled typodont/palatobuccal technique (wrinkled typodont), smooth typodont/buccopalatal technique, smooth typodont/S-shaped technique, and smooth typodont/palatobuccal technique (smooth typodont). Scans in STL format were imported into a dedicated software program, and trueness and precision were evaluated in μm. In addition to descriptive statistics (95% confidence interval), a 2-factor ANOVA on the data ranks, the Kruskal-Wallis, and the Dunn tests were performed to analyze differences among groups (α=.05).

Results: Mean values for trueness (95% confidence interval) were wrinkled typodont/buccopalatal technique=48.7 (37.8-59.5); wrinkled typodont/S-shaped technique=65.9 (54.9-77.4); wrinkled typodont/palatobuccal technique=109.7 (96.1-123.4); smooth typodont/buccopalatal technique=48.1 (42.4-53.7); smooth typodont/S-shaped technique=56.4 (43.9-68.9); smooth typodont/palatobuccal technique=61.1 (53.3-69), with statistically significant differences for wrinkled typodont/buccopalatal technique versus wrinkled typodont/palatobuccal technique (P<.001), buccopalatal technique versus palatobuccal technique (P<.001), and wrinkled typodont versus smooth typodont (P=.002). Mean values for precision (95% confidence interval) were wrinkled typodont/buccopalatal technique=46.7 (29.7-63.7); wrinkled typodont/S-shaped technique=53.6 (37.6-69.7); wrinkled typodont/palatobuccal technique=90 (59.1-120.9); smooth typodont/buccopalatal technique=46 (39.7-52.3); smooth typodont/S-shaped technique=76 (55.5-96.6); smooth typodont/palatobuccal technique=52.9 (41.9-63.8); with statistically significant differences for buccopalatal technique versus palatobuccal technique (P=.032) and wrinkled typodont/buccopalatal technique versus wrinkled typodont/palatobuccal technique (P=.012).

Conclusions: Smooth typodont scans showed better trueness than wrinkled typodont scans. Buccopalatal technique showed better mean values for trueness and precision than palatobuccal technique only in the wrinkled typodont scenario, while the other scanning approaches did not show significant differences in either tested configuration.
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http://dx.doi.org/10.1016/j.prosdent.2020.07.017DOI Listing
December 2020

Accuracy of a chairside intraoral scanner compared with a laboratory scanner for the completely edentulous maxilla: An in vitro 3-dimensional comparative analysis.

J Prosthet Dent 2020 Dec 24;124(6):761.e1-761.e7. Epub 2020 Oct 24.

Research Professor, Division of Prosthodontics and Digital Dentistry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy.

Statement Of Problem: Intraoral scanners are promising options for removable prosthodontics. However, analog aids, including occlusion rims, are still used, as a completely digital workflow is challenging and scientific evidence on the topic is scarce.

Purpose: The purpose of this in vitro study was to assess and compare the trueness and precision of scans obtained from a reference typodont of a completely edentulous maxilla by using an intraoral scanner (TRIOS 3 Pod; 3Shape A/S) with scans obtained by using a laboratory scanner (DScan 3; EGS S.R.L.) from both Type IV stone casts and polysulfide impressions.

Material And Methods: The polyurethane resin reference typodont was replicated from a clinical cast and was scanned with a metrological machine to obtain a reference scan. Ten digital casts were obtained by applying standardized scanning strategies to the reference typodont with the intraoral scanner. A device was created to make 10 consistent polysulfide impressions, and a scan of each impression was made with the laboratory scanner and then digitally reversed to obtain 10 digital reversed casts. Ten Type IV stone casts were poured and then scanned with the laboratory scanner to obtain 10 digital extraoral scanner casts. The scans in standard tessellation language (STL) format were imported into a dedicated software program, and the trueness and precision were calculated in μm. In addition to descriptive statistics (confidence interval 95%), 1-way ANOVA followed by the Bonferroni test or the Kruskal-Wallis and the Dunn tests were used to analyze differences among groups (α=.05).

Results: The trueness values (95% confidence interval) were digital intraoral scanner cast=48.7 (37.8-59.5), digital reversed cast=249.9 (121.3-378.5), and digital extraoral scanner cast=308.8 (186.6-430.9); significant differences were detected between digital intraoral scanner cast and digital reversed cast (P<.001) and between digital IOS casts and digital extraoral scanner cast (P<.001). The precision values (95% confidence interval) were digital intraoral scanner cast=46.7 (29.7-63.7), digital reversed cast=271.2 (94.6-447.8), and digital extraoral scanner cast=341.4 (175.5-507.3); significant differences were detected between digital intraoral scanner cast and digital reversed cast (P=.003) and between digital intraoral scanner cast and digital extraoral scanner cast (P=.001).

Conclusions: Directly scanning a solid typodont of a completely edentulous maxilla with the intraoral scanner produced better trueness and precision than scanning the polysulfide impressions or the stone casts with a laboratory scanner.
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http://dx.doi.org/10.1016/j.prosdent.2020.07.018DOI Listing
December 2020

Early Postoperative Magnetic Resonance in the Diagnosis of Persistent Juvenile Angiofibroma.

Laryngoscope 2020 Nov 27. Epub 2020 Nov 27.

Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Objectives/hypothesis: Despite improvements in the treatment of juvenile angiofibroma (JA), the rate of persistence (pJA) is still not negligible. In the present study, we assessed the value of early postoperative magnetic resonance imaging (MRI) in depicting unintentional pJAs and designed a MRI-driven decisional flow-chart for pJA management and follow-up.

Study Design: Observational study.

Methods: Patients undergoing early postoperative MRI after endoscopic resection of JA in the Unit of Otorhinolaryngology - ASST Spedali Civili, University of Brescia from 2007 to 2017 were enrolled. MRI was defined as negative or positive based on defined radiological criteria. The diagnostic performance of MRI was evaluated.

Results: The analysis included 26 patients, with a mean age of 16.5 years (range, 11-25). Early MRI was negative for pJA in 21 (80.8%) patients and positive in five (19.2%). No patient with a negative finding was found positive at subsequent follow-up MRIs. The accuracy of a positive finding was confirmed by pathologic examination (three cases) or follow-up MRIs (two cases). The diagnostic performance of MRI was excellent with sensitivity and specificity of 100%. An MRI-driven flow-chart for pJA management and follow-up was designed.

Conclusions: Early postoperative MRI demonstrated a high diagnostic accuracy in the detection of unintentional pJA. Our MRI-driven strategy and decisional flow-chart could aid in the decision-making process in the management of pJA and definition of postoperative surveillance.

Level Of Evidence: 4 Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.29293DOI Listing
November 2020

Influence of single post, oval, and multi-post restorative techniques and amount of residual tooth substance on fracture strength of endodontically treated maxillary premolars.

J Oral Sci 2020 Dec 25;63(1):70-74. Epub 2020 Nov 25.

Department of Medical Biotechnologies, Unit of Endodontics and Restorative Dentistry, University of Siena.

Purpose: The aim of this study was to compare the influence of the number of coronal walls and post-endodontic restorations on the mechanical strength of 165 recently extracted endodontically treated maxillary premolars.

Methods: The teeth were divided into 3 control (no post) and 3 test groups according to the number of residual walls. Each test group was divided into subgroups according to the type of post-endodontic restoration (single, oval, and multi-post techniques). Samples were prepared conforming to the assigned subgroup. A universal loading machine applied a load parallel to the longitudinal axis of the teeth, thus simulating physiological occlusion. ANOVA and the Kruskal Wallis test were used for comparisons (P ≤ 0.05), and Tukey's test for multiple comparisons.

Results: For intact teeth, significant differences were found among all 3 subgroups, with single post showing the highest values. For 3 residual walls, oval post resulted in significantly lower values than single and multi-post systems. For 2 residual walls, the multi-post technique showed almost twice the resistance of oval post restorations.

Conclusion: In oval canals the use of a single or multi-post technique increased post-and-core resistance even in intact teeth, whereas oval fiber posts showed no improvements. Multi-post design improved fracture resistance mostly in maxillary premolars lacking both marginal ridges.
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http://dx.doi.org/10.2334/josnusd.20-0338DOI Listing
December 2020

Effect of concomitant medications with immune-modulatory properties on the outcomes of patients with advanced cancer treated with immune checkpoint inhibitors: development and validation of a novel prognostic index.

Eur J Cancer 2021 Jan 16;142:18-28. Epub 2020 Nov 16.

Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Background: Concomitant medications are known to impact on clinical outcomes of patients treated with immune checkpoint inhibitors (ICIs). We aimed weighing the role of different concomitant baseline medications to create a drug-based prognostic score.

Methods: We evaluated concomitant baseline medications at immunotherapy initiation for their impact on objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) in a single-institution cohort of patients with advanced cancer treated with ICIs (training cohort, N = 217), and a drug-based prognostic score with the drugs resulting significantly impacting the OS was computed. Secondly, we externally validated the score in a large multicenter external cohort (n = 1012).

Results: In the training cohort (n = 217), the median age was 69 years (range: 32-89), and the primary tumours were non-small-cell lung cancer (70%), melanoma (14.7%), renal cell carcinoma (9.2%) and others (6%). Among baseline medications, corticosteroids (hazard ratio [HR] = 2.3; 95% confidence interval [CI]: 1.60-3.30), systemic antibiotics (HR = 2.07; 95% CI: 1.31-3.25) and proton-pump inhibitors (PPIs) (HR = 1.57; 95% CI: 1.13-2.18) were significantly associated with OS. The prognostic score was calculated using these three drug classes, defining good, intermediate and poor prognosis patients. Within the training cohort, OS (p < 0.0001), PFS (p < 0.0001) and ORR (p = 0.0297) were significantly distinguished by the score stratification. The prognostic value of the score was also demonstrated in terms of OS (p < 0.0001), PFS (p < 0.0001) and ORR (p = 0.0006) within the external cohort.

Conclusion: Cumulative exposure to corticosteroids, antibiotics and PPIs (three likely microbiota-modulating drugs) leads to progressively worse outcomes after ICI therapy. We propose a simple score that can help stratifying patients in routine practice and clinical trials of ICIs.
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http://dx.doi.org/10.1016/j.ejca.2020.09.033DOI Listing
January 2021

The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium.

J Prosthodont 2021 Apr 10;30(4):305-317. Epub 2020 Dec 10.

Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.

Purpose: To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses.

Materials And Methods: PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design.

Results: While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs.

Conclusions: Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.
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http://dx.doi.org/10.1111/jopr.13292DOI Listing
April 2021

The impact of nodal status in major salivary gland carcinoma: A multicenter experience and proposal of a novel N-classification.

Oral Oncol 2021 Jan 30;112:105076. Epub 2020 Oct 30.

Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Objectives: Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma.

Materials And Methods: A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodal metastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R.

Results: Intra-parotid nodes, ON and LD of nodal metastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1-3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R indices when compared to current N-classification.

Conclusion: All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105076DOI Listing
January 2021