Osseointegration evaluation of an experimental bone graft material based on hydroxyapatite, reinforced with titanium-based particles.

Bone graft materials are more and more frequently used in dentistry for improving the periodontal support and for creating a bone support favorable for the insertion of dental implants. The experimental study carried out on laboratory animals aimed to evaluate the biocompatibility and the manner of integration of an experimental bone augmentation material, based on hydroxyapatite (HAp), reinforced with titanium-based particles by comparison with a commercial synthetic graft material already existing on the profile market, also based on HAp. We noticed a common pattern of evolution, although there were differences related to the speed of new bone tissue formation and implicitly the morphological elements captured at the two moments of time. In the presence of both synthetic materials, ossification also begins from the center of the cavity at distance from the margins of the bone defect, with a common pattern with an appearance with the presence of osteon-like structures. The experimental material generally determined a more intense initial inflammatory reaction, followed by the generation of a repair bone tissue with a denser appearance but with a less uniform structure and a greater number of residual particles.

Modeling and Simulating an Orthodontic System Using Virtual Methods.

Cone beam computed tomography (CBCT) is a modern imaging technique that uses X-rays to investigate the structures of the dento-maxillary apparatus and obtain detailed images of those structures. The aim of this study was to determine a functional mathematical model able to evaluate the elastic force intensity on each bracket and tube type element and the ways in which those components act on the orthodontic system being used. To analyze a real orthodontic system, we studied the case of a 13-year-old female patient. To transfer geometric information from tomographic images, we used the InVesalius software. This software can generate three-dimensional reconstructions based on sequences and files in the DICOM format and was purchased from CBCT equipment. We analyzed and processed the geometries of the converted tissues in InVesalius using the Geomagic software. After using the Geomagic software, we exported the resulting model to the SolidWorks software used in computer-aided design. In this software, the model is transformed into a virtual solid. After making the geometric model, we analyzed the model using the Ansys Workbench software, which incorporates finite element analysis techniques. Following the simulations, we obtained result maps, which showed the complete mechanical behavior of the analyzed structures.

TEM,CTX-M,SHV Genes in ESBL-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Clinical Samples in a County Clinical Emergency Hospital Romania-Predominance of CTX-M-15.

BACKGROUND: CTX-M betalactamases have shown a rapid spread in the recent years among Enterobacteriaceae and have become the most prevalent Extended Spectrum Beta-Lactamases (ESBLs) in many parts of the world. The introduction and dissemination of antibiotic-resistant genes limits options for treatment, increases mortality and morbidity in patients, and leads to longer hospitalization and expensive costs. We aimed to identify the beta-lactamases circulating encoded by the genes blaCTX-M-15, blaSHV-1 and blaTEM-1 in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains. Furthermore, we established the associated resistance phenotypes among patients hospitalized in the Intensive Care Unit (ICU) from County Clinical Emergency Hospital of Craiova, Romania. METHODS: A total of 46 non-duplicated bacterial strains (14 strains of E. coli and 32 strains of K. pneumoniae), which were resistant to ceftazidime (CAZ) and cefotaxime (CTX) by Kirby-Bauer disk diffusion method, were identified using the automated VITEK2 system. Detection of ESBL-encoding genes and other resistance genes was carried out by PCR. RESULTS: E. coli strains were resistant to 3rd generation cephalosporins and moderately resistant to quinolones, whereas K. pneumoniae strains were resistant to penicillins, cephalosporins, and sulfamides, and moderately resistant to quinolones and carbapenems. Most E. coli strains harbored blaCTX-M-15 gene (13/14 strains), a single strain had the blaSHV-1 gene, but 11 strains harbored blaTEM-1 gene. The mcr-1 gene was not detected. We detected tet(A) gene in six strains and tet(B) in one strain. In K. pneumoniae strains we detected blaCTX-M-15 in 23 strains, blaSHV-1 in all strains and blaTEM-1 in 14 strains. The colistin resistance gene mcr-1 was not detected. The tetracycline gene tet(A) was detected in 11 strains, but the gene tet(B) was not detected in any strains. CONCLUSIONS: The development in antibiotic resistance highlights the importance of establishing policies to reduce antibiotic use and improving the national resistance surveillance system in order to create local antibiotic therapy guidelines.

COVID-19 and Artificial Intelligence: An Approach to Forecast the Severity of Diagnosis.

(1) Background: The new SARS-COV-2 pandemic overwhelmed intensive care units, clinicians, and radiologists, so the development of methods to forecast the diagnosis' severity became a necessity and a helpful tool. (2) Methods: In this paper, we proposed an artificial intelligence-based multimodal approach to forecast the future diagnosis' severity of patients with laboratory-confirmed cases of SARS-CoV-2 infection. At hospital admission, we collected 46 clinical and biological variables with chest X-ray scans from 475 COVID-19 positively tested patients. An ensemble of machine learning algorithms (AI-Score) was developed to predict the future severity score as mild, moderate, and severe for COVID-19-infected patients. Additionally, a deep learning module (CXR-Score) was developed to automatically classify the chest X-ray images and integrate them into AI-Score. (3) Results: The AI-Score predicted the COVID-19 diagnosis' severity on the testing/control dataset (95 patients) with an average accuracy of 98.59%, average specificity of 98.97%, and average sensitivity of 97.93%. The CXR-Score module graded the severity of chest X-ray images with an average accuracy of 99.08% on the testing/control dataset (95 chest X-ray images). (4) Conclusions: Our study demonstrated that the deep learning methods based on the integration of clinical and biological data with chest X-ray images accurately predicted the COVID-19 severity score of positive-tested patients.

Use of optical coherence tomography in orthodontics.

Optical coherence tomography (OCT) is a modern imaging method with applicability in orthodontics. In recent years, there has been an increasing trend in the use of ceramic brackets. The aim of the present study was to investigate the effects of bonding metallic and ceramic brackets on tooth enamel, using optical coherence tomography. For this purpose, 20 permanent teeth we bonded and were subsequently debonded using a side cutter or anterior bracket removal pliers. Using the OCT technique, the enamel, the amount of adhesive remaining and the bracket fragments remaining on the tooth surface were analyzed following the debonding procedure. It was demonstrated that enamel cracks were present only in the samples bonded with ceramic brackets. At the same time, it was noted that the type of pliers did not affect the incidence and extent of damage to the enamel. The type of debonding technique (using the side cutter or the anterior removal pliers) used did not markedly affect the amount of adhesive remaining on the teeth. Thus, as demonstrated herein, by analyzing the enamel structure through the use of OCT, the quality of the processes and the materials used for manufacturing brackets can be increased.

Prevalence and Antimicrobial Resistance of Klebsiella Strains Isolated from a County Hospital in Romania.

The study evaluated the evolution of the incidence of infections with Klebsiella in the County Clinical Emergency Hospital of Craiova (SCJUC), Romania. Also, we monitored antibiotic resistance over more than two years and detected changes in resistance to various antimicrobial agents. Our study included 2062 patients (823 women and 1239 men) hospitalised in SCJUC during the period 1st of September 2017 to 30 June 2019. In 458 patients (22.21%) from the 2062 total patients, the collected samples (1116) were positive and from those, we isolated 251 strains of Klebsiella spp. We conducted a longitudinal analysis of the prevalence of Klebsiella spp. over calendar months, which showed a prevalence in surgical wards that ranged between 5.25% and 19.49% in June 2018, while in medical wards the variation was much wider, between 5.15% and 17.36% in April 2018. Klebsiella spp. strains showed significant resistance to Amoxicillin/Clavulanate, Aztreonam and Cephalosporins such as Ceftriaxone, Ceftazidime and Cefepime. We examined the possible link with the consumption of antibiotics in the same month by performing a multiple linear regression analysis. The evolution of antibiotic resistance in Klebsiella was correlated with the variation of resistance in other bacteria, which suggests common resistance mechanisms in the hospital environment. By performing the regression for dependency between antibiotic resistance and antibiotic consumption, we observed some correlations between antibiotic consumption and the development of antibiotic resistance after 1, 2 and even 3 months (e.g., resistance to meropenem was influenced by the consumption in the hospital ward of imipenem 1 month and two months before, but only 1 month before by the consumption of meropenem). The clustering of strains showed filiation between multiresistant Klebsiella spp. strains isolated from specific patients from the ICU. The evolution of prevalence and antibiotic resistance in Klebsiella correlated with the resistance in other bacteria, which suggest common resistance mechanisms in the hospital environment, and also with the consumption of antibiotics.

The Study of Clinical and Biochemical Parameters in Assessing the Response to the Antiviral Therapy in the Chronic Viral Hepatitis B.

Background and Objectives: Hepatitis B virus infection remains a major public health concern. The interaction between hepatitis B virus (HBV) hepatitis B virus and the host inflammatory response is an important contributing factor driving liver damage and diseases outcomes. The management of chronic hepatitis B virus infection is an area of massive unmet clinical need worldwide. Our primary aim for this study was to evaluate biological response rates and sustained virological response in patients with chronic hepatitis B treated with Peg-IFN α-2a/b. The second aim of the study was the identification of metabolic changes and insulin resistance. Materials and Methods: We enrolled in this study 166 patients who fulfilled all inclusion and exclusion criteria. These treatment-naive patients with chronic HBV were treated with Pegylated Interferon α-2a/b. HBV infection was defined by the presence of HBV serological markers (HBsAg, anti-HBsAb, anti-HBcAb, HBeAg, anti HBeAb) by Enzyme-Linked Immuno Sorbent Assay (ELISA) and serum HBV-DNA levels were estimated by a commercially available quantitative polymerase chain reaction (PCR) assay. Results: Patients' recovery progress has been evaluated by determining the following: age, gender; biochemical tests; alanine aminotransferase, aspartate aminotransferase; serological assays for HBV serological markers (HBsAg, anti-HBsAc/Ab, anti-HBcAc/Ab, HBeAg, anti HBeAc/Ab); molecular tests to detect viral particles, testing for HBV DNA (PCR) to confirm the diagnosis and quantify the number of viral copies in the blood (viremia); liver ultrasound-performed through epigastric and intercostal approach (transversal and longitudinal sections). Conclusions: Our results indicated that only HOMA index values, that of fasting insulin, together with baseline HBV DNA, alanine aminotransferase values, mean blood glucose at the beginning of treatment may be predictive of the early viral response in chronic hepatitis B.

Frequency of Bone Augmentation Materials Use in a General Dental Practice.

This retrospective study aimed to evaluate the frequency of bone augmentation materials used for implant or periodontal surgical treatment depending on the age and sex of the patients from a dental practice in Essen, Germany, but also the implants dimensions and respectively the stage and progression grade of the periodontitis. The analysis of the data showed that bone augmentation materials are used much more frequently in the implant surgical cases (43,33%) compared to periodontal surgical cases (13,33%). While the correlations with sex and age were less obvious, the use of bone augmentation materials in the implant surgical cases was correlated with the use of shorter implants, while their use in the periodontal surgical cases was correlated with the stage 3 periodontitis.

Predictors of early and sustained virological response of viral hepatitis C.

Due to complex interplay between host and viral factors, pathogenesis of chronic hepatitis C (CHC) is considered a challenging issue. Infection with hepatitis C virus (HCV) is not confined only to liver but can induce disturbances in many other organs and systems. Our primary aim for this study was to evaluate biological response rates and sustained virological response (SVR) in patients diagnosed with CHC, treated with Interferon-alpha (IFN-α), Pegylated (PEG)-IFN-α2a or -α2b plus Ribavirin. The second aim of the study was the identification of predictive factors for a favorable response to antiviral therapy in patients diagnosed with CHC. We enrolled in this study 210 patients diagnosed with CHC who have accomplished all inclusion and exclusion criteria, treated with PEG-IFN plus Ribavirin. Patients' recovery progress has been evaluated by determining: age, gender; biochemical tests: alanine aminotransferase (ALT), aspartate aminotransferase (AST); serological assays - detect anti-HCV antibody and molecular assays - detect, quantify and/or characterize hepatitis C viral load (ribonucleic acid) (HCV-RNA); liver histopathological (HP) examination. According to their response to treatment, they were classified into responders (n=145) and non-responders (n=65). Liver biopsies were histopathologically evaluated for necroinflammatory grade and fibrosis stage according to the modified Ishak and Metavir scoring systems for chronic hepatitis. Demographic, laboratory, and HP results were introduced in statistical analysis. These parameters were included in area under curve (AUC) analysis in order to estimate their degree of influence on getting early virological response (EVR) and SVR. Our study demonstrates that factors connected to treatment failure in CHC are linked to older age, high hepatitis C viral load, and impaired glucose tolerance at beginning of treatment [high fasting glucose and insulin, high homeostatic model assessment of insulin resistance (HOMA-IR) index] and also to liver histology features (high fibrosis score, liver steatosis, iron infiltration, and more or less high necroinflammatory activity). Analyzing results of our study shows that HOMA-IR index, serum insulin levels, baseline HCV-RNA, baseline mean blood glucose and HP score like Ishak fibrosis score, steatosis score and liver iron score may have a predictive value for obtaining an EVR in patients diagnosed with CHC.

A microscopic insight of the morphological changes induced by dental zirconia prosthetic structures.

As zirconia is today probably the dental material with the largest increase in the frequency of use in dental prosthetics, the reason for this study was based on a series of clinical observations made following its use in clinical prosthetics. Thus, we were interested in two aspects: the histological evaluation of the response of the oral soft tissues to the presence of the prosthetic structures in zirconia, and the microscopic evaluation of the abrasion lesions that appeared in the hard dental tissues of the zirconia prostheses antagonists. For the first part, samples from three zirconia-based dental prosthetics commercial products were implanted submucosal in the oral cavity of male Wistar rats. After six weeks, the oral soft tissue reaction was clinically and then histologically investigated. For the second part, we made two study groups to investigate the influence of the zirconia-glazed surface vs. polished surface to the wear pattern of the antagonist enamel, using a tribological equipment and a dedicated software. Our study showed a good clinical response of the oral soft tissues surrounding the inserted zirconia samples, with subclinical, only histological revealed, signs of inflammation, of a foreign body reaction, while polished zirconia samples determined abrasion surfaces, with a different pattern and significantly smaller dimensions, compared to zirconia glazed samples, at the level of the hard dental tissues of the antagonist teeth. Despite the generally good response of the biological structures to the presence of zirconia prosthetic structures in the oral environment, more scientifically proved information is needed to obtain the desired biological responses in all clinical situations.

The prognostic value of CXCR4, α-SMA and WASL in upper lip basal cell carcinomas.

Lip cancers account for 10-12% of the total head and neck cancers and, although squamous cell carcinoma is by far the most common lower lip cancer, the basal cell carcinoma (BCC) seems to be more common for the upper lip. Most BCCs have a clinically indolent behavior, but there are also local aggressive and∕or metastatic cases, with the incidence of such cases being estimated at about 1-10% of all cases of BCC. Many of the molecular mechanisms underlying this aggression are still unknown, which is why our study aimed to investigate the potential prognosis of a few markers, such as C-X-C chemokine receptor type 4 (CXCR4), alpha-smooth muscle actin (α-SMA) and Wiskott-Aldrich syndrome like (WASL) in upper lip BCCs. For this purpose, 24 basocellular cancers with this localization have been investigated immunohistochemically, histopathologically belonging to the next varieties: superficial, nodular, micronodular, adenoid cystic, keratotic, sclerodermiform and mixed. Regardless of the histopathological subtype, for all invasive cases we have recorded an increased reactivity of the three markers especially in the invasion front, reactivity also present at the stroma level, especially at the stroma-parenchyma interface. The most intense immunoreactivity was obtained for the micronodular and sclerodermiform subtypes, confirming their biological behavior to be more aggressive than the rest of the investigated strains. All these results confirm the prognostic value of the CXCR4∕α-SMA∕WASL panel in assessing the biological behavior of the upper lip BCC.

A patient with pilomatricoma in the parotid region: case report and review of the literature.

Pilomatricoma is a benign skin tumor originating from the matrix cells of the hair follicles. Sometimes, its diagnosis can be difficult, especially in the preauricular region, where in the differential diagnosis, in addition to other dermal and subcutaneous masses, primary and secondary parotid gland tumor lesions must be also considered. A 34-year-old female was referred to our Institution with a right preauricular swelling over 12 months, which enlarged in the last two months. The ultrasonography confirms the origin of the tumoral mass in the skin of the preauricular region and not from the superficial lobe of the right parotid gland. The patient underwent complete tumor excision and the histopathology and immunohistochemical exams confirmed the diagnosis of a conventional pilomatricoma evolving to a late regressive lesion. She was discharged considered as cured and no recurrences were reported within a period of eight months of follow-up. This is the first reported case in the last 30 years, in this location, in the Department of Oral and Maxillofacial Surgery our Institution. Regarding the rarity of these tumors, especially in this location, we must keep in mind to consider a broader differential diagnosis that includes both tumoral and non-tumoral skin lesion and also parotid gland lesions.

Morphological features of tongue squamous cell carcinoma diagnosed in Dolj County population between 2012-2014.

Tongue squamous carcinoma can be found in many forms, having a lot of risk factors, and whose morphological characteristics can be used as a prognostic. The purpose of this study was to histologically characterize a number of 54 patients diagnosed between 2012-2014, with tongue squamous carcinoma. Surgical resection specimens of tongue tumors were processed by paraffin inclusion technique. The diagnose samples were reevaluated according to the World Health Organization (WHO) criteria for head and neck tumors diagnosis, by screening the Hematoxylin-Eosin staining sections. The most common histopathological variety of tongue carcinoma observed in our cases was the non-keratinized form, the basaloid and sarcomatoid types of carcinoma being ranked on the last places. The study outlined the prevalence of non-keratinized forms of tongue squamous carcinoma and all types of tumoral invasion patterns have been observed in different percentages.