A practical approach for anabolic treatment of bone fragility with romosozumab.

BACKGROUND: Romosozumab, a fully humanized anti-sclerostin-antibody, is a bone-builder stimulating osteoblasts and inhibiting osteoclast by activation of the canonical Wnt-beta catenin signaling. This unique mechanism of action has the potential to address unmet needs in osteoporosis management. METHODS: The multifaceted practical clinical issues related to romosozumab are discussed, especially focusing on the rationale of employing a sclerostin inhibitor to target bone fragility as first line or second line treatment in post-menopausal osteoporosis and in males at increased risk of fractures. RESULTS: Four randomized clinical trials with several post-hoc analyses and more than ten observational studies have consistently demonstrated that romosozumab is effective in rapidly increasing bone mineral density (BMD) and decreasing risk of vertebral, non-vertebral and hip fractures in post-menopausal women at very-high risk of fractures. In male osteoporosis, only data on BMD are available. Noteworthy, romosozumab was shown to be more effective and rapid than teriparatide in improving BMD, bone structure and strength at the hip, especially in women already treated with anti-resorptive drugs. Interestingly, even if romosozumab displays best results in treatment-naïve patients, its favourable effects on BMD were observed even in women previously treated with teriparatide or denosumab, although to a lesser extent. CONCLUSIONS: Based on the available evidence, romosozumab could be proposed as ideal drug in several clinical settings, such as non-fractured post-menopausal women at very-high risk of fractures, patients with recent hip fracture, patients non responder to bisphosphonates and short-term denosumab therapy.

Correlation between vegetarian diet and oral health: a systematic review.

OBJECTIVE: Nutrition plays a significant role in preserving the balance of the human body. Considering each person's particular characteristics, diet can directly and indirectly alter the body's immune response. The purpose of this study is to draw attention to the connection between a vegetarian diet and its impact on oral health. MATERIALS AND METHODS: To determine the connection between a vegetarian diet and dental health, a search of the literature was conducted on the PubMed, Scopus, and Web of Science databases. English language and a publication year between January 1, 2013, and March 1, 2023, were the inclusion criteria for the search. RESULTS: There were 167 articles in total that addressed the subject of interest, and 18 of them were chosen for qualitative analysis. CONCLUSIONS: This study suggests that a vegetarian diet may alter oral health, namely periodontal health, tooth erosion, and oral microbiome. Even if the data collected prevents the effect of a vegetarian diet on oral health from being confirmed, this study acts as a starting point for future, more focused research.

Ceramic biomaterials in dentistry: chemical structure and biosafety - a review and a bibliometric visual mapping on Scopus database.

OBJECTIVE: A biomaterial is any non-pharmaceutical substance or a mixture of synthetic or natural substances used independently or as part of a system for any amount of time with the aim of mending, supporting the growth, or replacing tissues, organs, or functions of the body. It is a non-renewable material that interacts with biological systems. The purpose of this study was to assess the advances in ceramic biomaterials and perform a bibliometric mapping of the literature on the subject. MATERIALS AND METHODS: The Scopus database was used for manuscript screening (Elsevier, Amsterdam, The Netherlands). The effect of the scientific production has been assessed using scientometric citational metrics. RESULTS: A total of 2,554 pieces of literature, including 2,234 papers, 170 conference proceedings, 109 reviews, 35 book chapters, 3 editorial letters, and 3 short surveys, were retrieved. Based on the research conducted, it is noted that ceramic materials are high-performing by being porous or glassy and can, therefore, serve as fillers, covering materials, and scaffolds in medicine and biotechnology. They are frequently employed not only in orthopedic and maxillofacial surgery but also in dentistry for dental prostheses. CONCLUSIONS: Materials monitoring methods enable us to track the three-dimensional evolution of ceramics' volume, as well as flaws or micro-cracks.

A study survey on molnupiravir treatment in COVID-19 patients at home in Ninh Thuan province, Vietnam.

OBJECTIVE: Molnupiravir (MOV) is an oral antiviral drug that received use authorization in Vietnam for the treatment of mild COVID-19 (F0). There was a need to develop alternative approaches that allowed patients to access medication, decongest hospitals, clinics, and facilities, and protect people from infection. During the COVID-19 crisis, the Ninh Thuan Health Authorities implemented the home delivery of medication by community health workers. This study conducted in collaboration with two important Italian entities [the Aldo Moro University of Bari City and the 118 Department of Territorial Emergency System (118 SET) of Taranto City] aimed to evaluate the implementation of home delivery F0 treatment package assessing the rate of infection recovering during the coronavirus pandemic in Ninh Thuan province, Vietnam. PATIENTS AND METHODS: A convergent mixed methods research, based on a longitudinal study with quantitative research and qualitative assessments, evaluated four implementation outcomes: the feasibility, fidelity, coverage, sustainability, and effectiveness of the initiative. Data sources included routinely collected data, a telephonic survey of patients, an analysis of set-up and recurrent costs, as well as descriptive exploratory qualitative and quantitative analysis. RESULTS: After taking the MOV for 5 days, only 35 out of the initial 400 F0 patients remained positive, while 365 patients (91.2%) were negative (CT≥30). Whilst, the successful rate after using the drug during the course accounted for 99.85% and 100% after the entire treatment course, without any death. After 5 days of taking the drug, a positive test result (CT<30) was associated with age group ≥60 (OR=2.7) and comorbidities (OR=3.0) (p<0.05) compared to negative and positive results (CT≥30). Negative factors impacting F0 at home include a shortage of healthcare workers, inadequate supply of thermometers and SpO2 meters, and insufficient financial support for healthcare workers. CONCLUSIONS: MOV caused a reduction in the risk of hospitalization or death in mild COVID-19 patients, and molnupiravir was also found to be well tolerated and safe without any major adverse events during the administration period.

The importance of arterial blood gas analysis as a systemic diagnosis approach in assessing and preventing chronic diseases, from emergency medicine to the daily practice.

Blood gas analysis is a diagnostic tool to evaluate the partial pressures of gas in blood and acid-base content. The use of blood gas analysis enables a clear understanding of respiratory, circulatory, and metabolic disorders. The arterial blood gas (ABG) explicitly analyzes blood taken from an artery, assessing the patient's partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) pH (acid/base). PaO2 indicates the oxygenation status, and PaCO2 indicates the ventilation status (chronic or acute respiratory failure). PaO2 is affected by hyperventilation, characterized by rapid or deep breathing, and hypoventilation, characterized by slow or shallow breathing. The acid-base balance tested by the ABG procedure measures the pH and PaCO2 directly, while the use of the Hasselbach equation gives the serum bicarbonate (HCO3) and base deficit or excess. The measured HCO3 is based on a strong alkali that frees all CO2 in serum, including dissolved CO2, carbamino compounds, and carbonic acid. The calculation uses a standard chemistry analysis, giving the amount of "total CO2"; the difference will amount to around 1.2 mmol/L. Though ABG is frequently ordered in emergency medicine contests for acute conditions, it may also be needed in other clinical settings. The ABG analysis shows to be an exceptional diagnostic tool, including the group of diseases known as acid-base diseases (ABDs), which include a great variety of conditions such as severe sepsis, septic shock, hypovolemic shock, diabetic ketoacidosis, renal tubular acidosis, chronic respiratory failure, chronic heart failure, and diverse metabolic diseases.

Caries prevention and treatment in early childhood: comparing strategies. A systematic review.

OBJECTIVE: Early childhood caries is a common condition that poses a serious risk to children's health because it can progress quickly, resulting in pain, abscesses, and a general decline in health. As a result, invasive therapies are needed, which call for highly skilled personnel. This systematic review of the literature aims to identify the most recent and widely applied early childhood caries (ECC) prevention and treatment approaches. Only substances that act topically and minimally invasive interventions were considered. MATERIALS AND METHODS: The database search was restricted to randomized clinical trials completed within the last five years, specifically those that examined the following procedures: sodium fluoride (NaF) varnish, alternative restorative technique (ART), nano-silver fluoride, silver diamine fluoride, and silver modified atraumatic restorative treatment sealants (SMART). RESULTS: A total of 815 articles were found. After removing duplicates, 584 articles were included, and 567 of them were excluded due to not meeting the predefined inclusion criteria. CONCLUSIONS: Every method considered has been proven to be successful in halting the progression of ECC and is well-liked by patients, even those who are unwilling to cooperate, as well as by parents. The most common unfavorable effect of SDF is irreversible black discoloration in treated tooth surfaces, but this is typically not a problem. They are all low-cost, minimally invasive techniques that might also be widely used in large communities and low socioeconomic settings.

Dental erosion and the role of saliva: a systematic review.

OBJECTIVE: This review evaluates the relationship between saliva and dental erosion. The acidic environment that can be established in the mouth leads to dental erosion. Acid pH, low salivary flow, systemic pathologies of patients, intake of acidic foods, and poor oral hygiene contribute to an oral environment that favors the development of dental erosion. MATERIALS AND METHODS: A literature search was performed on PubMed, Scopus, and Web of Science databases to assess the role of saliva and dental erosion. The inclusion criteria for the search were: year of publication from January 1st, 2013, to March 1st, 2023, and English language. RESULTS: A total of 3,597 articles covering our topic were found, of which 15 were selected for qualitative analysis. CONCLUSIONS: Saliva protects against erosion by neutralizing and removing intrinsic and extrinsic acids, promoting the formation of an acquired protective film, and providing mineral substrates for remineralization by maintaining homeostasis in the digestive tract and oral cavity.

New biograft solution, growth factors and bone regenerative approaches in neurosurgery, dentistry, and orthopedics: a review.

Bone regeneration following surgery, trauma, or any other condition is an autologous process that can fail, necessitating the requirement of novel procedures and materials. Recently, significant progress has been made in the research related to regenerative medicine. At the same time, biomedical implants in spine surgery, orthopedics, and dentistry are facing many challenges and posing clinical concerns. A PubMed, MEDLINE, and Scopus review was carried out to identify all studies dealing with bone regenerative approaches in dentistry, orthopedics, and neurosurgery from database inception to December 2022. There has been an upsurge in the implication of a multitude of materials in the enhancement of bone regeneration and/or neo-bone formation, including blood-derived growth factors, new biografts, biosynthetic polymers, inorganic compounds, and sea corals, in the very recent years. Stem cells (SCs) have been found to be efficacious and safe modalities in osteogenesis. Furthermore, bone regeneration/formation depends on the host's immune system and metabolic condition. Epidermal growth factors (EGFs) and their receptors (EGFRs) are important in the mechanism of wound repairing and healing through the recruitment of stromal stem cells for epidermal and dermal regeneration. Similarly, biocomposite developed from Silica assembled with calcium and phosphorous has been utilized in the treatment of broken bones. In this review, we summarized the clinical and laboratory evidence of bone regenerative approaches in the field of spine surgery, orthopedics, and dentistry. An accurate pre-operative screening is the key to managing and carefully planning all surgical steps and achieving the final success.

Direct and indirect bonding techniques in orthodontics: a systematic review.

OBJECTIVE: Some of the most significant aspects in orthodontics for achieving favorable treatment outcomes include correct bracket positioning and a shorter period to accomplish bracket bonding. Two different brackets bonding techniques - direct and indirect bonding - are described in the literature. The aim of this review is to evaluate the differences, advantages, and disadvantages of the two techniques. MATERIALS AND METHODS: A literature search was conducted on PubMed, Scopus, and Web of Science databases in a period from January 2013 to April 2023 with English language restriction using the following Boolean keywords: "orthodontic bracket* AND (bonding OR placement)". RESULTS: A total of 3,820 articles were identified by the electronic search, and after duplicate removal, screening, and eligibility, a total of 11 papers were included for the qualitative analysis. CONCLUSIONS: Indirect bonding is more predictable and precise than direct bonding. Indirect bonding has a greater impact on minimizing bracket placement errors than direct bonding, but it still takes longer to complete than the traditional procedure. However, further studies on the differences between direct and indirect bonding, as well as digital bonding, are needed.

Autologous tooth for bone regeneration: dimensional examination of Tooth Transformer® granules.

OBJECTIVE: Since 1967, when the osteoinduction properties of autogenous demineralized dentin matrix were discovered, autologous tooth grafts have been advocated as a viable option to autologous or heterologous bone graft. Tooth graft materials may be extracted from the patient's whole tooth using a granulating device. The aim of this study was to examine the size of granules obtained by the Tooth Transformer (TT)® device, using a laser instrument with high precision. MATERIALS AND METHODS: The TT® device can obtain bone graft material in a short period from an extracted tooth. The resulting material can act as an osteoconductive scaffold, providing a mineral substrate during resorption, including platelet growth factors and morphogenetic proteins. Different studies have investigated the dimension and behavior of various graft material particles, since the size of the grafted particles may play a role in osteogenesis and bone regeneration. RESULTS: Different dimensions of granules are available: small (< 400 µm), medium (400 µm-1,000 µm) and large (1,000 µm-2,000 µm). From 4.03 µm to 100 µm the percentage of granules was 14.52 ± 1.93%. A larger part of the granules was up to 100 µm, while 85.47 ± 1.93% of the granules were from 100 µm to 1,000 µm. CONCLUSIONS: 85% of the granules produced were in accordance with the dimensions suggested in the literature.

The effect of inflorescence display size and flower position on pollination success in two deceptive and one rewarding orchid.

Inflorescence display size and flower position on the inflorescence play important roles in plant reproduction, in the formation of fruits and are primarily linked to pollinator behaviour. We used three orchids to determine how visitation rates and choice of pollinator depend on number and position of the flowers along the inflorescence. We measured reproductive success in (1) natural conditions, (2) hand-pollination experiments and (3) an experimental design, by modifying composition of inflorescences in populations of two deceptive orchids, Orchis anthropophora and O. italica, and one rewarding orchid, Anacamptis coriophora subsp. fragrans. There were no differences in natural fruit production in relation to flower position on the inflorescence (i.e. upper versus lower part), suggesting no preference of pollinators for different parts of the inflorescence. Hand-pollination experiments highlighted low pollen limitation in A. coriophora subsp. fragrans but high limitation in O. italica and O. anthropophora. Reproductive success of deceptive orchids in experimental plots decreased significantly when flowers on the upper half of the inflorescence were removed leading to reduced floral display, while reproductive success of the nectariferous species did not differ significantly. Our data highlight that in the examined orchids there is no clear relationship between fruit formation and flower position along inflorescences. Thus we can affirm that, for orchids, the entire inflorescence plays a dominant role in insect attraction but the part of the flower spike does not influence the choice of the insect. This implies that all flowers have the same possibility of receiving visits from pollinators, and therefore each flower has the same opportunity to set fruit.

A human donor (cadaveric) observation study of three needle placements in the piriformis muscle.

OBJECTIVE: To compare the safety and accuracy of three dry needling locations in the piriformis muscle using human donors. DESIGN: Observational dissection study of embalmed human donors. METHODS: A licensed physical therapist of 17 years clinical experience and 5 years teaching dry needling placed three needles in a medial, midpoint, and lateral location of 14 piriformis muscles of seven embalmed human donors. Block dissection allowed for observation of tissues the needles traversed and recording of the structures that the needles pierced. RESULTS: The lateral needle pierced piriformis in 3/14 trials, and contacted sciatic nerve in 0/14 trials. The medial needle pierced both piriformis and sciatic nerve in 11/14 trials. The midpoint needle pierced the piriformis in 11/14 trials, and contacted sciatic nerve in 3/14 trials. Fisher's Exact test (p < 0.001) found a nonrandom association between dry needle placement, and dry needle contact. CONCLUSIONS: When dry needling the piriformis, a lateral approach can avoid the sciatic nerve, but cannot accurately pierce the piriformis tendon. Furthermore, while a midpoint and medial approach finds the piriformis muscle with the same accuracy, the midpoint location avoided the sciatic nerve more often.

Efficacy of guided autofluorescence laser therapy in MRONJ: a systematic review.

OBJECTIVE: This review aims to explore the efficacy of fluorescence-guided excision in the treatment of necrotic bone and highlights the importance of fluorescence in distinguishing viable margins from necrotic ones for a more targeted and predictable management of MRONJ. MATERIALS AND METHODS: The review was conducted according to PRISMA guidelines using PubMed, Scopus, and Web of Science databases from January 1, 2008, to May 17, 2023. The Boolean search strategy with the following keywords "osteonecrosis" AND "fluorescence" was performed. Then, the articles were subjected to screening and eligibility phases. The papers about the use of autofluorescence-guided laser therapy in patients with jaw osteonecrosis were included. RESULTS: A total of 320 articles were initially identified through an electronic search, and ultimately, 17 papers were included in the qualitative analysis. CONCLUSIONS: In conclusion, our findings demonstrate that the VELscope system allows for clear visualization of the bone, making guided autofluorescence a precise, safe, and reliable technique.

Cancer prevalence in the subcategories of the indeterminate class III (AUS/FLUS) of the Bethesda system for thyroid cytology: a meta-analysis.

PURPOSE: The indeterminate cytologic report represents a major challenge in the field of thyroid nodule. The indeterminate class III of the Bethesda classification system (i.e., AUS/FLUS) includes a heterogeneous group of subcategories characterized by doubtful nuclear and/or architectural atypia. The study aim was to  conduct a systematic review and meta-analysis to evaluate the rate of malignancy in each subcategory of Bethesda III. METHODS: PubMed, CENTRAL, and Scopus databases were searched until April 2020. Original articles reporting data on the subcategories of Bethesda III were included. The histological diagnosis was the reference standard to classify true/false negative and true/false positive cases. RESULTS: The pooled cancer prevalence in each subcategory of Bethesda III was estimated using a random-effects model. Twenty-three papers with 4241 nodules were included. Overall, 1163 (27.4%) were malignant. The cancer rate observed in the subcategories ranged from 15%, in "Hürthle cell aspirates with low risk pattern", to 44%, in "Focal cytologic atypia". CONCLUSIONS: The overall cancer rate found in the Bethesda III ranged more largely than that originally estimated (10-30%) and varied among any scenarios. These evidence-based data represent a reference for the clinical management of these patients.

Local Polarization and Isothermal Local Equilibrium in Relativistic Heavy Ion Collisions.

We show that the inclusion of a recently found additional term of the spin polarization vector at local equilibrium which is linear in the symmetrized gradients of the velocity field, and the assumption of hadron production at constant temperature restore the quantitative agreement between hydrodynamic model predictions and local polarization measurements in relativistic heavy ion collisions at sqrt[s_{NN}]=200 GeV. The longitudinal component of the spin polarization vector turns out to be very sensitive to the temperature value, with a good fit around 155 MeV. The implications of this finding are discussed.

Pollen viability of Euro-Mediterranean orchids under different storage conditions: The possible effects of climate change.

The future impact of climate change and a warmer world is a matter of great concern. We therefore aimed to evaluate the effects of temperature on pollen viability and fruit set of Mediterranean orchids. The in vitro and controlled pollination experiments were performed to evaluate the ability of pollinia stored at lower and higher temperatures to germinate and produce fruits and seeds containing viable embryos. In all of the examined orchids, pollen stored at -20 °C remained fully viable for up to 3 years, reducing its percentage germination from year 4 onwards. Pollinia stored at higher temperatures had a drastic reduction in vitality after 2 days at 41-44 °C, while pollinia stored at 47-50 °C did not show any pollen tube growth. The different levels of pollen viability duration among the examined orchids can be related to their peculiar reproductive biology and pollination ecology. The germinability of pollinia stored at lower temperatures for long periods suggests that orchid pollinia can be conserved ex situ. In contrast, higher temperatures can have harmful effects on the vitality of pollen and consequently on reproductive success of the plants. To our knowledge, this is the first report demonstrating the effects of global change on orchid pollen, and on pollen ability to tolerate, or not, higher air temperatures. Although vegetative reproduction allows orchids to survive a few consecutive warm years, higher temperatures for several consecutive years can have dramatic effects on reproductive success of orchids.

Early Aspirin Nonresponders Identification by Routine Use of Aggregometry Test in Patients With Left Ventricle Assist Devices Reduces the Risk of Pump Thrombosis.

Left ventricular assist device (LVAD) management is very challenging since many adverse events can occur in ongoing patients. Inadequate anticoagulation treatment can lead to life-threatening situations like ischemic stroke or pump thrombosis. The main intention of our study was to investigate if early identification of aspirin nonresponders by using aggregometry can improve anticoagulation management, reducing the risk of pump thrombosis. METHODS: From December 2010 to May 2018, 24 patients were implanted with a HeartMate II (HMII), 6 received a HeartWare HVAD system--full support VAD (HVAD), and 22 received a HeartMate III (HMIII). All patients were maintained with a target INR of 2.0 to 3.0. When the aggregometry test revealed a normal platelet function, 100 mg of aspirin were initiated. Only aspirin nonresponders were early identified by repeating the aggregometry after 7 days of aspirin administration. In acetylsalicylic acid nonresponder patients, 75 mg of clopidogrel was used, and the patients were tested again. Ticlopidine (250 mg) was used when clopidogrel was unsuccessful. RESULTS: Four patients required modification in antiplatelet therapy. Three patients (5%), 2 HVAD and 1 HMII, suffered from pump thrombosis. One patient died as a consequence of a large intracranial hemorrhagic event following thrombolytic treatment. One patient required a pump exchange; in 1 patient, thrombolytic infusion was conducted successfully. CONCLUSION: Reported rates of pump thrombosis at 12 months for patients implanted with commonly used LVADs were 6% to 12% for axial-flow pumps and 8% with centrifugal-flow devices. In our series, the reported 5% overall incidence of pump thrombosis encourages the routine use of an aggregometry test for early identification of aspirin nonresponders.