Einfluss neurologischer Krankheitsbilder auf die Vigilanz gemessen mit dem Pupillographischen Schläfrigkeitstest

Zahlreiche neurologische Erkrankungen wie Morbus Parkinson oder Epilepsien sind mit nicht erholsamem Schlaf und erhöhter Tagesschläfrigkeit assoziiert. Andere Erkrankungen wie Multiple Sklerose induzieren zwar Fatigue / Müdigkeit, aber keine objektivierbar erhöhte Einschlafneigung. Aufgrund der komplexen Interaktionen von Grunderkrankung, Krankheitsfolgen und Medikationseffekten differieren subjektive Einschätzung und objektive Maße von Schläfrigkeit oft erheblich. Der pupillographische Schläfrigkeitstest (PST) ist ein effizientes und objektives Verfahren zur Bestimmung der Vigilanz bzw. Tagesschläfrigkeit, für neurologische Patienten unter naturalistischen Bedingungen liegen aber nur wenige Daten vor.

Gesù continuatore di Giovanni. Studio storico-esegetico sulla relazione tra Gesù di Nazaret e Giovanni il Battista

L’enigma della relazione tra Gesù e Giovanni il Battista ha da sempre stimolato l’immaginazione storica degli studiosi, suscitando una varietà di ipotesi e valutazioni, spesso assai diverse. Ciò nonostante, tutti concordano su un punto: che, almeno nella sua fase maggiore in Galilea, il ministero di Gesù fosse una realtà essenzialmente autonoma, diversa, originale e irriducibile rispetto alla missione di Giovanni. In controtendenza con questa “impostazione predefinita”, il presente studio sostiene la tesi secondo cui Gesù portò avanti la sua missione come intenzionale e programmatica prosecuzione dell’opera prematuramente interrotta di Giovanni. Nella prima parte, si esamina approfonditamente quale memoria della relazione sia conservata nelle fonti più antiche, cioè Q (qui analizzata con particolare attenzione) e Marco – a cui si aggiunge Matteo, che, in ragione dello stretto legame storico-sociologico con Q, offre un esempio illuminante di rinarrazione della memoria altamente originale eppure profondamente fedele. La conclusione è che la memoria più antica della relazione Gesù-Giovanni è profondamente segnata da aspetti di accordo, conformità e allineamento. Nella seconda parte si esaminano una serie di tradizioni che attestano che Gesù era percepito pubblicamente in relazione al Battista e che egli stesso condivideva e alimentava tale percezione riallacciandosi a lui in polemica con i suoi avversari, e dipingendolo come una figura di capitale importanza nella predicazione e nell’insegnamento a seguaci e discepoli. Infine, si argomenta l’esistenza di ampie e sostanziali aree di accordo tra i due a livello di escatologia, istruzioni etiche e programma sociale, missione penitenziale verso i peccatori e attività battesimale. L’ipotesi che Gesù portasse avanti l’attività riformatrice di Giovanni, in termini di una campagna purificatoria “penitenziale-battesimale-esorcistica” in preparazione dell’avvento di Dio, consente infine di armonizzare in modo soddisfacente i due aspetti più caratteristici dell’attività di Gesù (normalmente giustapposti, quando non contrapposti): escatologia e miracoli, il Gesù profeta e il Gesù taumaturgo.

Linking rural tourism to agriculture. Evidences from comparative case studies in Kosovo, Italy and Spain

Rural tourism has been widely promoted in the European Union as an effective measure counteracting economic and social challenges facing rural areas especially those with declining agriculture economies. Particularly its role is seen in provision and maintenance of public goods which are more and more demanded by the public and considered in the policymaking. In Kosovo, rural tourism has been developed through the support of the international organizations and private sector initiatives, with primary aim to generate additional income for rural households and sustainable management of natural and cultural resources. Anyhow, it could be stated that the use of territorial capital to enhance the quality of the tourist offer and undertake promotion at wider circles of people has not been well explored so far, particularly possible links with agriculture that would satisfy visitors demand. In this regard this research study analyzes involvement of local stakeholders and use of territorial capital to develop tourist offer in rural areas of Kosovo. Beside, study applies comparative approach with other two areas of the European Union, Appennino Bolognese in Italy and Alpujara in Spain, to understand and compare the process of rural tourism development and demand characteristics between Kosovo and these areas. A survey has been conducted in all three study areas with rural tourism visitors to understand their preferences for public and private goods and services when visiting rural areas and the role of agriculture in sustaining rural tourism. Results show that there is a potential to link rural tourism with agriculture in Kosovo, which would help in sustaining agriculture and add additional value to local food products, which in return would enhance the tourist offer and make it more attractive for the visitors but also for the farmers as an additional revenue generating sector.

Giardini per rivivere: orticoltura e giardinaggio a fini terapeutici in contesti sanitari

Questa tesi riassume il lavoro di ricerca da me effettuato per studiare i meccanismi della relazione uomo - pianta su cui si basa l’orticoltura terapeutica, le sue modalità di attuazione e le risposte dei pazienti al lavoro in giardino. La ricerca si è svolta in due diversi giardini terapeutici con pazienti adulti con varie tipologie di disabilità fisica o psichica. Partendo dalla analisi delle basi teoriche su cui si fonda l’ortoterapia, l’obiettivo era di capire come creare le condizioni migliori per ottenere i massimi benefici dall’uso dell’orticoltura e del giardinaggio per il benessere delle persone. Due elementi sono apparsi fondamentali per il raggiungimento degli obiettivi terapeutici: il primo è lo stretto legame esistente tra la forma del giardino e delle piante e la sua funzione terapeutica; il secondo sta nella necessità di creare nel paziente una connessione profonda con il giardino e il lavoro con le piante è risultato essere un fattore determinante per farlo. Utilizzando questionari e osservazioni degli utenti, sono stati raccolti ed elaborati dati relativi al benessere dei pazienti durante e dopo le attività in giardino e si è cercato di trovare un indice, individuato poi nella variazione di percezione del pollice verde, che potesse essere utilizzato per esprimere la soddisfazione del paziente. Infine si è cercato di capire come potesse variare la capacità ristorativa del giardino, in funzione della frequenza di visita e dell’attività che vi si svolgeva, attraverso la somministrazione della versione italiana della scala PRS a chi era impegnato nelle attività di orticoltura e giardinaggio, a chi passeggiava nel parco e a chi invece non lo frequentava regolarmente ma lo conosceva bene: è risultato che le tre modalità di fruizione del giardino davano ai fruitori un potenziale rigenerativo diverso e significativamente più alto per chi metteva le mani nella terra.

A multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta and open bite deformity: a case report

The treatment of amelogenesis imperfecta (AI) with an anterior open bite (AOB) is a challenge for the clinician and often requires a multidisciplinary team of specialists. Most often, patients suffering from these conditions are young and a good functional and esthetic long-term result must be aspired. This clinical report illustrates the orthodontic, maxillofacial, restorative, and prosthodontic rehabilitation of a 20-year-old woman with a hypoplastic form of AI and an AOB malocclusion, having received treatment for the last 6 years. It included adhesive resin composite restorations, orthodontical and maxillofacial surgery with a one-piece Le Fort I osteotomy, and a genioplasty. Subsequent prosthodontic therapy consisted of 28 all-ceramic crowns whereby a solid interdigitation, a canine guidance, and consistent and regular contacts between tooth crowns could be achieved to assure a good functional and esthetic oral situation. The tooth preparation techniques guaranteed minimally invasive treatment. The patient was affected very positively. CLINICAL SIGNIFICANCE: This article describes an interdisciplinary approach to the successful treatment of a patient with a hypoplastic form of amelogenesis imperfecta over a period of 6 years. It starts with a discussion of the conservative steps taken during adolescence and concludes with the final prosthetic rehabilitation with all-ceramic crowns after reaching adulthood.

Treatment of hemispatial neglect by means of rTMS--a review

Hemispatial neglect - defined as the failure to attend, explore, and act upon the contralesional side of space - is a frequent and disabling neurological syndrome. Interhemispheric rivalry is considered as a major pathophysiological mechanism underlying hemispatial neglect. According to this account, the contralesional, intact hemisphere undergoes a pathological hyperactivity due to a deficient transcallosal inhibition from the damaged hemisphere. This model offers a framework for possible therapeutic interventions with repetitive transcranial magnetic stimulation (rTMS), i.e. a reduction of the pathological hyperactivity with a rTMS protocol that has lasting inhibitory effects. In the present work, we will first review evidence for the interhemispheric rivalry account coming from animals and humans. We will then describe studies showing the possibility to perturb and to restore interhemispheric balance in healthy subjects as a proof of concept for therapeutic rTMS application. Finally, we will consider studies applying rTMS as a therapeutic approach in hemispatial neglect. We conclude that rTMS is a promising approach to reduce the interhemispheric imbalance in neglect patients and to ameliorate symptoms. Newly developed protocols such as Theta Burst Stimulation (TBS) - with short stimulation times and long offline effects - seem to be particularly convenient. However, future studies should assess stimulation effects not only in clinical testing, but also on disability, considering combination with traditional therapies as well.

Influence of curing rate on softening in ethanol, degree of conversion, and wear of resin composite

PURPOSE: To investigate the effect of curing rate on softening in ethanol, degree of conversion, and wear of resin composites. METHOD: With a given energy density and for each of two different light-curing units (QTH or LED), the curing rate was reduced by modulating the curing mode. Thus, the irradiation of resin composite specimens (Filtek Z250, Tetric Ceram, Esthet-X) was performed in a continuous curing mode and in a pulse-delay curing mode. Wallace hardness was used to determine the softening of resin composite after storage in ethanol. Degree of conversion was determined by infrared spectroscopy (FTIR). Wear was assessed by a three-body test. Data were submitted to Levene's test, one and three-way ANOVA, and Tukey HSD test (alpha = 0.05). Results: Immersion in ethanol, curing mode, and material all had significant effects on Wallace hardness. After ethanol storage, resin composites exposed to the pulse-delay curing mode were softer than resin composites exposed to continuous cure (P< 0.0001). Tetric Ceram was the softest material followed by Esthet-X and Filtek Z250 (P< 0.001). Only the restorative material had a significant effect on degree of conversion (P< 0.001): Esthet-X had the lowest degree of conversion followed by Filtek Z250 and Tetric Ceram. Curing mode (P= 0.007) and material (P< 0.001) had significant effect on wear. Higher wear resulted from the pulse-delay curing mode when compared to continuous curing, and Filtek Z250 showed the lowest wear followed by Esthet-X and Tetric Ceram.

The Peri-Implant Sulcus Compared with Internal Implant and Suprastructure Components: A Microbiological Analysis

Purpose: A recent in vivo study has shown considerable contamination of internal implant and suprastructure components with great biodiversity, indicating bacterial leakage along the implant-abutment interface, abutment-prosthesis interface, and restorative margins. The goal of the present study was to compare microbiologically the peri-implant sulcus to these internal components on implants with no clinical signs of peri-implantitis and in function for many years. Checkerboard DNA-DNA hybridization was used to identify and quantify 40 species. Material and Methods: Fifty-eight turned titanium Brånemark implants in eight systemically healthy patients (seven women, one man) under regular supportive care were examined. All implants had been placed in the maxilla and loaded with a screw-retained full-arch bridge for an average of 9.6 years. Gingival fluid samples were collected from the deepest sulcus per implant for microbiological analysis. As all fixed restorations were removed, the cotton pellet enclosed in the intra-coronal compartment and the abutment screw were retrieved and microbiologically evaluated. Results: The pellet enclosed in the suprastructure was very similar to the peri-implant sulcus in terms of bacterial detection frequencies and levels for practically all the species included in the panel. Yet, there was virtually no microbial link between these compartments. When comparing the abutment screw to the peri-implant sulcus, the majority of the species were less frequently found, and in lower numbers at the former. However, a relevant link in counts for a lot of bacteria was described between these compartments. Even though all implants in the present study showed no clinical signs of peri-implantitis, the high prevalence of numerous species associated with pathology was striking. Conclusions: Intra-coronal compartments of screw-retained fixed restorations were heavily contaminated. The restorative margin may have been the principal pathway for bacterial leakage. Contamination of abutment screws most likely occurred from the peri-implant sulcus via the implant-abutment interface and abutment-prosthesis interface.

Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed tomography

The purpose of this retrospective radiographic study was to analyze the thickness of the facial bone wall at teeth in the anterior maxilla based on cone beam computed tomography (CBCT) images, since this anatomical structure is important for the selection of an appropriate treatment approach in patients undergoing postextraction implant placement. A total of 125 CBCT scans met the inclusion criteria, resulting in a sample size of 498 teeth. The thickness of the facial bone wall in the respective sagittal scans was measured perpendicular to the long axis of the tooth at two locations: at the crest level (4 mm apical to the cementoenamel junction; MP1) and at the middle of the root (MP2). No existing bone wall was found in 25.7% of all teeth at MP1 and in 10.0% at MP2. The majority of the examined teeth exhibited a thin facial bone wall (< 1 mm; 62.9% at MP1, 80.1% at MP2). A thick bone wall (? 1 mm) was found in only 11.4% of all examined teeth at MP1 and 9.8% at MP2. There was a statistically significant decrease in facial bone wall thickness from the first premolars to the central incisors. The facial bone wall in the crestal area of teeth in the anterior maxilla was either missing or thin in roughly 90.0% of patients. Both a missing and thin facial wall require simultaneous contour augmentation at implant placement because of the well-documented bone resorption that occurs at a thin facial bone wall following tooth extraction. Consequently, radiographic analysis of the facial bone wall using CBCT prior to extraction is recommended for selection of the appropriate treatment approach.

RNA editing in kinetoplastids

RNA editing in kinetoplastid protozoa is a post-transcriptional process of uridine insertion or deletion in mitochondrial mRNAs. The process involves two RNA species, the pre-edited mRNA and in most cases a trans-acting guide RNA (gRNA). Sequences within gRNAs define the position and extend of mRNA editing. Both mRNAs and gRNAs are encoded by mitochondrial genes in the kinetoplast DNA (kDNA), which consists of thousands of small circular DNA molecules, called minicircles, encoding thousands of gRNAs, catenated together and with a few mRNA encoding larger circles, the maxicircles, to form a huge DNA network. Editing has been shown to result in translatable mRNAs of bona fide mitochondrial genes as well as novel alternatively edited transcripts that are involved in the maintenance of the kDNA itself. RNA editing occurs within large protein-RNA complexes, editosomes, containing gRNA, preedited and partially edited mRNAs and also structural and catalytically active proteins. Editosomes are diverse in both RNA and protein composition and undergoe structural remodeling during the maturation. The compositional and structural diversity of editosomes further underscores the complexity of the RNA editing process.

Unconventional implants for distal cantilever fixed full-arch prostheses: a long-term evaluation of four cases

Excessive cantilever lengths of fixed implant-supported prostheses may have functional and biomechanical disadvantages. This study reports the clinical outcomes of unconventional implants placed for distal support of a fixed implant-supported prostheses. Seven extraoral implants with intraosseous lengths of 2.5 to 4.0 mm were placed in four patients. Distal cantilevers had a mean length of 29.8 mm (range, 18.6 to 39.3 mm). No bone loss or other adverse events were found. The prosthetic plan was maintained in all patients. Within the limits of the employed research design, this concept seems to be a successful option for fixed complete implant-supported prosthesis treatment.

Bacterial leakage through temporary fillings in core buildup composite material - an in vitro study

To evaluate the ability of the provisional filling material Cavit-W alone or in combination with different restorative materials to prevent bacterial leakage through simulated access cavities in a resin buildup material.

Single crowns versus conventional fillings for the restoration of root filled teeth

Endodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth which may influence long term survival and cost. The comparative in service clinical performance of crowns or conventional fillings used to restore root filled teeth is unclear.

[Prosthetic rehabilitation of a traumatic occlusion due to bulimia nervosa. Case report]

Because of the typical localisation of erosions in anorectic/bulimic patients, the dentist is frequently the first medical person to discern this general illness (anorexia and bulimia nervosa). From the dental viewpoint, the aim should be to preserve sound dental tissue and to prevent further toothwear. A restorative treatment is to be carried out only after causal therapy and after resolving the basic disease. By means of this procedure a good long-term prognosis can be expected. Considering the patient's young age, dentistry should be preservative using the adhesive technique. This case report documents the systematic procedure of the functional and esthetic rehabilitation of an eroded dentition and shows factors essential to the treatment.

Bone dimensions in the posterior mandible: a retrospective radiographic study using cone beam computed tomography. Part 1--analysis of dentate sites

This retrospective radiographic study analyzed the dimensions of the alveolar bone in the posterior dentate mandible based on cone beam computed tomography (CBCT) images. A total of 56 CBCT images met the inclusion criteria, resulting in a sample size of 122 cross sections showing posterior mandibular teeth (premolars and molars). The thickness of the buccal and lingual bone walls was measured at two locations: 4 mm apical to the cementoenamel junction (measurement point 1, MP1) and at the middle of the root (measurement point 2, MP2). Further, alveolar bone width was assessed at the level of the most coronal buccal bone detectable (alveolar bone width 1, BW1) and at the superior border of the mandibular canal (alveolar bone width 2, BW2). The vertical distance between the two as well as the presence of a lingual undercut were also analyzed. There was a steady increase in buccal bone wall thickness from the first premolar to the second molar at both MP1 and MP2. BW1 at the level of the premolars was significantly thinner than that for molars. Alveolar bone height was constant for all teeth examined. For the selection of an appropriate postextraction treatment approach, analysis of the alveolar bone dimensions at the tooth to be extracted by means of CBCT can offer valuable information concerning bone volume and morphology at the future implant site.