Urolastic®, a new bulking agent for treatment of stress urinary incontinence: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: The aim of the present systematic review and meta-analysis was to assess the effectiveness and safety of injections of the new bulking agent Urolastic® in the treatment of patients with stress urinary incontinence (SUI). METHODS: A systematic search was carried out to select observational and experimental studies on Urolastic® in female patients with SUI. Three different databases, Pubmed, the Cochrane Central Register of Controlled Trials, and Scopus, were used to retrieve scientific articles published from their inception to 31 January 2018. RESULTS: Eight full texts were evaluated but only five were selected for the qualitative and quantitative analyses. Duration of follow-up after Urolastic® injections was significantly heterogeneous, ranging from 6 to 24 months. Secondary injections were needed in 16.7%-35.0% of the treated patients. The pooled proportion of secondary injections was 20% (95% CI: 15%-24%; I2: 0%). Subjective improvement, measured by different means (i.e., patient global impression of improvement PGI-I score) was only assessed by 40% of the selected papers and was > 80% in two cohorts. The objective treatment success was evaluated by four (80.0%) papers and was achieved in all cohorts with a wide proportional range: from 32.7% (i.e., patients without objective SUI symptom cough tests and with a negative pad test) to 67.0%. Its pooled proportion was 57% (95% CI: 38%-75%; I2: 82.3%). CONCLUSIONS: Urolastic® showed effectiveness in patients with SUI during a follow-up period of 6-24 months.

Short-term response of three resin-based materials as desensitizing agents under oral environmental exposure.

OBJECTIVE: This paper focuses on clinical responses after 7 days of oral exposure to two resin-based materials as desensitizing agents compared to a fluoride varnish and on morphological and analytical study as a means to elucidate the mechanism of action. MATERIALS AND METHODS: The elemental composition of Vertise™ Flow (VF), Universal Dentine Sealant (UDS) and Flor-Opal® Varnish (FOV) were investigated by using an X-ray energy dispersive spectrometer (EDX) in conjunction with a scanning electron microscope (SEM). SEM morphology of the material-treated dentine surfaces and pain reduction ability according to the Visual Analogue Scale (VAS) were evaluated in selected hypersensitive teeth. Post treatments and 7 day controls were recorded with SEM and VAS measurements. Clinical data was analysed with the Student's t-test for paired data, with a 5% significance level. RESULTS: Silicon, ytterbium and alumina were the most present elements in VF, whilst calcium, chloride, silicon and alumina were highest in UDS. Within a 7 day oral environment all the tested materials modified the treated-dentine surfaces showing tubular occlusion of different morphology. Clinically, the efficacy of all materials was similar after a 7-day examination. However, VAS scores were significantly reduced if compared with the baseline (p < 0.05). CONCLUSIONS: Within the limits of this study, data indicate that both resins are effective in sealing tubules and reducing VAS. A resin-related effect on the dentine's morphology was observed, which may influence the long-term response of the resins in the treatment of dental hypersensitivity, which requires further investigation.

Cerium Coatings on Pristine and Nanostructured Ti and Ti6Al4V Surfaces: Bioactivity, Resistance in Simulated Inflammatory Conditions, and Antibacterial Performance.

Despite the significant contribution of titanium and its alloys for hard tissue regenerative medicine, some major issues remain to be solved. Implants' long-term stability is threatened by poor osseointegration. Moreover, bacterial adhesion and excessive inflammatory response are also to be considered in the design of a device intended to be integrated into the human body. Here, a cerium mixed oxide (CeOx) coating was realized on pristine and nanotubular-structured Ti and Ti6Al4V surfaces using a simple layer-by-layer drop-casting technique. Bioactivity, resistance in simulated inflammatory conditions, and bactericidal capacity were evaluated as a function of morphological surface characteristics combined with the cerium quantity deposited. The results obtained suggest that the presence of CeOx on the surfaces with nanotubes enhanced osseointegration, while on the non-nanostructured surfaces, this coating improved resistance under oxidative stress and provided excellent antibacterial properties.

Amikacin liposome and Mycobacterium avium complex: A systematic review.

INTRODUCTION: The prevalence of Mycobacterium avium complex (MAC) is increasing globally. Macrolide-based multidrug regimens have been recommended as the first-line treatment for patients with MAC pulmonary disease. However, developing macrolide resistance was associated with poor treatment outcomes and increased mortality. In 2018, the U.S. Food and Drug Administration approved liposomal amikacin for inhalation (LAI) to treat refractory MAC pulmonary disease. The current systematic review aimed to evaluate LAI's outcomes and adverse events in MAC pulmonary disease. METHODS: The systematic search was performed in PubMed/Medline, EMBASE, and the Cochrane Controlled Register of Trials (CENTRAL) up to March 8, 2022. The search terms included Mycobacterium avium complex, MAC, amikacin, and liposomal amikacin. RESULTS: After reviewing 1284 records, four papers met the inclusion criteria, including three clinical trials and one prospective cohort study. These studies showed that adding LAI to guideline-based therapies can increase sputum culture conversion rate and achieve early sustained (negative sputum culture results for 12 months with treatment) and durable (negative sputum culture results for three months after treatment) negative sputum culture. In addition, extended LAI use was a potential benefit in patients considered refractory to initial treatment. The most prevalent treatment-emergent adverse events (TEAE) reported in the LAI group were the respiratory TEAE. CONCLUSIONS: LAI could increase the sputum culture conversion rate and achieve early sustainable, durable negative sputum culture. However, additional large-scale research is required to confirm the results.

A Simple Cerium Coating Strategy for Titanium Oxide Nano-tubes' Bioactivity Enhancement.

Despite the well-known favorable chemical and mechanical properties of titanium-based materials for orthopedic and dental applications, poor osseointegration of the implants, bacteria adhesion, and excessive inflammatory response from the host remain major problems to be solved. Here, the antioxidant and anti-inflammatory enzyme-like abilities of ceria (CeOx) were coupled to the advantageous features of titanium nanotubes (TiNTs). Cost-effective and fast methods, such as electrochemical anodization and drop casting, were used to build active surfaces with enhanced bioactivity. Surface composition, electrochemical response, and in vitro ability to induce hydroxyapatite (HA) precipitation were evaluated. The amount of cerium in the coating did not significantly affect wettability, yet a growing ability to induce early HA precipitation from simulated body fluid (SBF) was observed as the oxide content at the surface increased. The presence of 4%wt CeOx was also able to stimulate rapid HA maturation in a (poorly) crystalline form, indicating an interesting potential to induce rapid in vivo osseointegration process.

Monitoring COVID-19 Transmission Risks by Quantitative Real-Time PCR Tracing of Droplets in Hospital and Living Environments.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination occurs through droplets and biological fluids released in the surroundings from patients or asymptomatic carriers. Surfaces and objects contaminated by saliva or nose secretions represent a risk for indirect transmission of coronavirus disease 2019 (COVID-19). We assayed surfaces from hospital and living spaces to identify the presence of viral RNA and the spread of fomites in the environment. Anthropic contamination by droplets and biological fluids was monitored by detecting the microbiota signature using multiplex quantitative real-time PCR (qPCR) on selected species and massive sequencing on 16S amplicons. A total of 92 samples (flocked swabs) were collected from critical areas during the pandemic, including indoor (three hospitals and three public buildings) and outdoor surfaces exposed to anthropic contamination (handles and handrails, playgrounds). Traces of biological fluids were frequently detected in spaces open to the public and on objects that are touched with the hands (>80%). However, viral RNA was not detected in hospital wards or other indoor and outdoor surfaces either in the air system of a COVID hospital but only in the surroundings of an infected patient, in consistent association with droplet traces and fomites. Handled objects accumulated the highest level of multiple contaminations by saliva, nose secretions, and fecal traces, further supporting the priority role of handwashing in prevention. In conclusion, anthropic contamination by droplets and biological fluids is widespread in spaces open to the public and can be traced by qPCR. Monitoring fomites can support evaluation of indirect transmission risks for coronavirus or other flu-like viruses in the environment.IMPORTANCE Several studies have evaluated the presence of SARS-CoV-2 in the environment. Saliva and nasopharyngeal droplets can land on objects and surfaces, creating fomites. A suitable indicator would allow the detection of droplets or biofluids carrying the virus. Therefore, we searched for viral RNA and droplets and fomites on at risk surfaces. We monitored by qPCR or next generation sequencing (NGS) droplets through their microbiota. Although the study was performed during the pandemic, SARS-CoV-2 was not significantly found on surfaces, with the only exception of environmental areas near infectious patients. Conversely, anthropic contamination was frequent, suggesting a role for biofluids as putative markers of indirect transmission and risk assessment. Moreover, all SARS-CoV-2-contaminated surfaces showed droplets' microbiota. Fomite monitoring by qPCR may have an impact on public health strategies, supporting prevention of indirect transmission similarly to what is done for other communicable diseases (e.g., influenza and influenza-like infections).

Efficacy and effectiveness of bulking agents in the treatment of stress and mixed urinary incontinence: A systematic review and meta-analysis.

The objective of this systematic review and meta-analysis was to evaluate the efficacy and the effectiveness, as well as the safety and tolerability, of urethral bulking agents (UBAs) in women with mixed or stress urinary incontinence. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were used to identify relevant articles. In total, 3510 records were found. A total of 42 full texts were evaluated but only 21 (48.8 %) were selected for the qualitative and quantitative analysis. The pooled improvement rate in studies with a follow-up of ≤1 and >1 year was 46.0 % (95 % CI: 37.0 %-57.0 %; I2: 88.9 %) and 57.0 % (95 % CI: 39.0 %-74.0 %; I2: 89.6 %), respectively. The outcome 'cure/dryness' ranged from 9.1 % to 56.7 %. The pooled cure rate was 26.0 % (95 % CI: 21.0 %-32.0 %; I2: 89.9 %) and 21.0 % (95 % CI: 16.0 %-27.0 %; I2: 34.2 %) in females with a follow-up of ≤1 and >1 year, respectively. The treatment success rate ranged from 32.7 % to 93.3 % in 12 studies; it was objectively assessed with different tools (e.g., the Stamey scale in 5 studies). The pooled objective treatment success rate was 7.0 % (95 % CI: 59.0.0 %-75.0 %; I2: 82.4 %) and 46.0 % (95 % CI: 37.0 %-55.0 %; I2: 55.3 %) in women with a follow-up of ≤12 and >12 months, respectively. The percentage of adverse events was 0.4 % (vaginal infection, irritation, lichen sclerosus, worsening urinary incontinence). However, the use of UBAs as the first-line therapy should be demonstrated in more comparative studies (randomized studies MUSs vs. UBAs). UBAs should be considered a first-line surgical therapy only for women with SUI and mixed UI with high anaesthesia risk, elderly patients, or patients reluctant to undergo surgery. Thus, UBAs should not be offered as first-line therapy for those women desiring a "one-time" durable solution for primary or recurrent SUI.

Chitosan functionalization of titanium and Ti6Al4V alloy with chloroacetic acid as linker agent.

In this work, a new covalent grafting of chitosan on titanium and Ti6Al4V alloy surfaces is reported using chloroacetic acid as linker agent. Good results were obtained both on titanium and on Ti6Al4V alloy. The effect of the surface acid pretreatments on the subsequent functionalization with chitosan is evaluated. The morphological aspect of acid etched metal surfaces before chitosan grafting has been characterized by scanning electron microscopy (SEM). The presence of carboxylic groups on metal surfaces and then the efficiency of chitosan covalent immobilization were detected by Fourier transformed infrared-Attenuated Total Reflectance (FTIR-ATR) and X-Ray photoelectron spectroscopy (XPS). Cyclic voltammetry tests, using the functionalized titanium and Ti6Al4V samples as electrodes, were conducted in different aqueous solutions, to detect the presence of the homogeneous overlayer of chitosan on the surface, and to evaluate the importance of the carboxyl groups as linker agent.

Effectiveness of Calcium Phosphate Desensitising Agents in Dental Hypersensitivity Over 24 Weeks of Clinical Evaluation.

BACKGROUND: Calcium phosphate-based compounds are used to treat dental hypersensitivity (DH). Their long-term clinical behaviour needs further research. This study compared the 24-week effectiveness of Teethmate Desensitizer (TD), a pure tetracalcium phosphate (TTCP) and dicalcium phosphate dihydrate (DCPD) powder/water, to that of Dentin Desensitizer (DD), and Bite & White ExSense (BWE), both of calcium phosphate crystallites. METHODS: A total of 105 subjects were selected. A random table was utilised to form three groups of 35 subjects. DH was evaluated using the evaporative sensitivity, tactile sensitivity tests, and the visual analogue scale (VAS) of pain. Response was recorded before the application of the materials (Pre-1), immediately after (Post-0), at 1 week (Post-1), 4 weeks (Post-2), 12 weeks (Post-3) and 24 weeks (Post-4). The non-parametric distribution was assessed with the Shapiro-Wilk statistical test. Intra-group differences for the six time points were evaluated with the Friedman statistical test and the Kruskal-Wallis test. RESULTS: All the materials decreased DH after 24 weeks in comparison to Pre-1. However, the TTCP/DCPD cement showed the greatest statistical efficiency. CONCLUSIONS: The significant decrease of VAS scores produced by TD in the long term suggest the material as the most reliable in the clinical relief of DH.

What statistical method should be used to evaluate risk factors associated with dmfs index? Evidence from the National Pathfinder Survey of 4-year-old Italian children.

BACKGROUND: Traditional approaches to the analysis of dmfs/DMFS count data pose analytical challenges, considering the increasing proportion of zeroes in the distribution. The aim of this paper was to predict the probability of 'caries-free' subjects and the dependence of dmfs index on the influence of childhood sociodemographic factors, through the application of regression models. METHODS: Data were gathered as part of the National Pathfinder Survey of 4-year-old Italian children. Clinical data on caries disease (dmfs) and childhood sociodemographic factors were collected. The predicted probability for Poisson, negative binomial and zero-inflated models (Poisson and negative binomial) were estimated using STATA commands for count outcomes. The outcome variable in the regression models was the severity of the disease (dmfs index), while statistically significant variables on bivariate analysis were considered as covariates. RESULTS: Out of 5538 children, 4344 (78.44%) had a dmfs = 0. The mean dmfs index was 1.36 (range: 0-104). The statistical significance of the dispersion parameter (O = 141.6, P < 0.0001) showed the inappropriateness of the Poisson model when compared with the negative binomial model. Vuong's test indicated that the zero-inflated models (ZIP and ZINB) fitted the data significantly better than the others (P < 0.001). A significative likelihood ratio statistic indicates that the ZINB regression model fitted better than ZIP model (P < 0.0001). The father's educational level was significant in both parts of the ZINB regression model (P < 0.05), implying that the degree of caries experience increases in children whose fathers have a low level of education, while the excess of caries-free children decreases. Moreover, the increase of coefficients in the zero-inflated part of ZINB regression model implies that the excess of caries-free subjects increases with the later age of tooth eruption. The observed underestimation of the frequencies of zero dmfs counts by the Poisson model is a common result when a dual-group process is not taken into account. CONCLUSIONS: These regression models provide a useful approach to handling count outcomes as dmfs/DMFS index in caries epidemiology.