The ovarian stimulation regimen does not affect aneuploidy or blastocyst rate.

RESEARCH QUESTION: Could the total dose (<3000 IU or ≥3000 IU) and type of exogenous gonadotrophin (i.e. recombinant FSH and/or human menopausal gonadotrophin [HMG]) influence aneuploidy and blastulation rates and produce different reproductive outcomes? DESIGN: This retrospective, observational, multicentre cohort study included a total of 8466 patients undergoing IVF using autologous oocytes and preimplantation genetic testing for aneuploidies. Participants were divided according to the dosage of total gonadotrophins and stratified by maternal age. RESULTS: The aneuploidy rates, pregnancy outcomes and cumulative live birth rates (CLBR) were similar among women who received total gonadotrophin dosages of <3000 or ≥3000 IU. No statistical differences were reported in the blastulation rate with lower or higher gonadotrophin dosages. Women receiving a higher amount of HMG during ovarian stimulation had a lower aneuploidy rate (P = 0.02); when stratified according to age, younger women with a higher HMG dosage had lower aneuploidy rates (P< 0.001), while no statistical differences were observed in older women with higher or lower HMG dosages. No significant differences were observed in IVF outcomes or CLBR. CONCLUSIONS: High doses of gonadotrophins were not associated with rate of aneuploidy. However, an increased fraction of HMG in younger women was associated with a lower aneuploidy rate. The study demonstrated that the total gonadotrophin dosage did not influence aneuploidy, reproductive outcomes or CLBR. The increased gonadotrophin and HMG dosages used for ovarian stimulation did not precede aneuploidy, and the use of HMG should be evaluated on a case-by-case basis, according to the individual's characteristics and infertility type.

The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial.

AIM: To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS: Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS: Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS: The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS: gov identification number: NCT05456555.

Genomic Characterization of Listeria monocytogenes and Other Listeria Species Isolated from Sea Turtles.

Listeria monocytogenes is a ubiquitous pathogen found both in the environment and food. It can cause listeriosis in a wide range of animals as well as in humans. Investigations on presence, spread and virulence are still limited to terrestrial and human environments. Embracing the One Health Approach, investigating the presence and spread of L. monocytogenes in marine ecosystems and among wildlife, would provide us with useful information for human health. This study investigated the presence of L. monocytogenes and Listeria spp. in two species of sea turtles common in the Mediterranean Sea (Caretta caretta and Chelonia mydas). A total of one hundred and sixty-four carcasses of sea turtles (C. caretta n = 161 and C. mydas n = 3) stranded along the Abruzzo, Molise, Campania, and Calabria coasts, were collected. Brain and fecal samples were taken, enriched, and cultured for the detection of Listeria spp. From the specimens collected, strains of L. monocytogenes (brain n = 1, brain and feces n = 1, multiorgan n = 1 and feces n = 1), L. innocua (feces n = 1 and brain n = 1), and L. ivanovii (brain n = 1) were isolated. Typical colonies were isolated for Whole Genome Sequencing (WGS). Virulence genes, disinfectants/metal resistance, and antimicrobial resistance were also investigated. L. monocytogenes, L. innocua, and L. ivanovii were detected in C. caretta, whilst only L. monocytogenes and L. innocua in C. mydas. Notable among the results is the lack of significant differences in gene distribution between human and sea turtle strains. Furthermore, potentially pathogenic strains of L. monocytogenes were found in sea turtles.

Enhancing walking efficiency of adolescents with neurological impairments using an exosuit for ambulatory activities of daily living.

Introduction: Children and adolescents with neurological impairments face reduced participation and independence in daily life activities due to walking difficulties. Existing assistive devices often offer insufficient support, potentially leading to wheelchair dependence and limiting physical activity and daily life engagement. Mobile wearable robots, such as exoskeletons and exosuits, have shown promise in supporting adults during activities of daily living but are underexplored for children. Methods: We conducted a cross-sectional study to examine the potential of a cable-driven exosuit, the Myosuit, to enhance walking efficiency in adolescents with diverse ambulatory impairments. Each participant walked a course including up-hill, down-hill, level ground walking, and stairs ascending and descending, with and without the exosuit's assistance. We monitored the time and step count to complete the course and the average heart rate and muscle activity. Additionally, we assessed the adolescents' perspective on the exosuit's utility using a visual analog scale. Results: Six adolescents completed the study. Although not statistically significant, five participants completed the course with the exosuit's assistance in reduced time (time reduction range: [-3.87, 17.42]%, p-value: 0.08, effect size: 0.88). The number of steps taken decreased significantly with the Myosuit's assistance (steps reduction range: [1.07, 15.71]%, p-value: 0.04, effect size: 0.90). Heart rate and muscle activity did not differ between Myosuit-assisted and unassisted conditions (p-value: 0.96 and 0.35, effect size: 0.02 and 0.42, respectively). Participants generally perceived reduced effort and increased safety with the Myosuit's assistance, especially during tasks involving concentric contractions (e.g., walking uphill). Three participants expressed a willingness to use the Myosuit in daily life, while the others found it heavy or too conspicuous. Discussion: Increased walking speed without increasing physical effort when performing activities of daily living could lead to higher levels of participation and increased functional independence. Despite perceiving the benefits introduced by the exosuit's assistance, adolescents reported the need for further modification of the device design before using it extensively at home and in the community.

Optically stimulated luminescence system as an alternative for radiochromic film for 2D reference dosimetry in UHDR electron beams.

Radiotherapy is part of the treatment of over 50% of cancer patients. Its efficacy is limited by the radiotoxicity to the healthy tissue. FLASH-RT is based on the biological effect that ultra-high dose rates (UHDR) and very short treatment times strongly reduce normal tissue toxicity, while preserving the anti-tumoral effect. Despite many positive preclinical results, the translation of FLASH-RT to the clinic is hampered by the lack of accurate dosimetry for UHDR beams. To date radiochromic film is commonly used for dose assessment but has the drawback of lengthy and cumbersome read out procedures. In this work, we investigate the equivalence of a 2D OSL system to radiochromic film dosimetry in terms of dose rate independency. The comparison of both systems was done using the ElectronFlash linac. We investigated the dose rate dependence by variation of the (1) modality, (2) pulse repetition frequency, (3) pulse length and (4) source to surface distance. Additionally, we compared the 2D characteristics by field size measurements. The OSL calibration showed transferable between conventional and UHDR modality. Both systems are equally independent of average dose rate, pulse length and instantaneous dose rate. The OSL system showed equivalent in field size determination within 3 sigma. We show the promising nature of the 2D OSL system to serve as alternative for radiochromic film in UHDR electron beams. However, more in depth characterization is needed to assess its full potential.

One-Year Outcomes of Subcrestal Platform-Switched Implants With and Without Sterile Prosthetic Abutments: A Randomized Controlled Trial.

Surface contaminants on customized implant abutments could trigger inflammatory response in the peri-implant tissues. The aim of this randomized controlled study was to assess the radiographic bone changes around implants restored with customized, platform-switched abutments, with and without autoclave treatment, 12 months after definitive restoration. Dental implants were placed 1 mm subcrestally in 64 systemically healthy patients (mean age 63.3 ± 10.0 years, 31 with history of periodontitis) to replace single or multiple missing teeth. According to a randomization list, abutments were subjected to steam and autoclave sterilization (43 implants, test group) or steam cleaning alone (44 implants, control group). Periapical standardized radiographs were taken at the time of implant insertion, prosthetic abutment connection and 12 months after definitive cement-retained restoration. All implants were clinically stable without any sign of infection at the 12-month follow-up. An average marginal bone loss of 0.25 ± 0.19 mm was found in the test group compared to 0.35 ± 0.23 mm in the control group without statistically significant difference, while the percentage of bleeding sites was significantly higher in the control group (8.7 ± 13.1% versus 19.1 ± 19.8%, P = .035). Autoclave treatment of customized abutments would seem to reduce the inflammatory response around subcrestally placed implants.

Pocket closure after repeated subgingival instrumentation: a stress test to the EFP guideline for stage III-IV periodontitis.

OBJECTIVES: To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy. MATERIALS AND METHODS: Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated. RESULTS: At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI. CONCLUSIONS: RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases. CLINICAL RELEVANCE: These findings may support the administration of one/two cycles of RSI prior to surgical approach. PROTOCOL REGISTRATION: ClinicalTrials.gov identification number: NCT04826926.

Reproductive outcomes of oocyte donation in patients with uterine Müllerian anomalies.

OBJECTIVE: To evaluate live-birth rates per embryo transfer in patients with uterine Müllerian anomalies (UMAs). Secondary objectives were to compare reproductive outcomes between the normal uterus group, the different UMA types, and UMA subgroups with and without required surgery. DESIGN: This retrospective study compared two cohorts, one with UMAs and other with normal uteri of our oocyte donation program at 12 Instituto Valenciano De Infertilidad/Reproductive Medicine Associates University affiliated clinics from January 2000 to 2020. The oocyte donation reduces confounding because of differences in embryo quality. The primary outcome was the live-birth rate per embryo transfer. Secondary outcomes included the rates of implantation, clinical pregnancy, miscarriage, and ongoing pregnancy. We calculated odds ratios with 95% confidence intervals. PATIENTS: Infertile women undergoing oocyte donation with UMAs. INTERVENTION: None. MAIN OUTCOME MEASURES: The rates of implantation, clinical pregnancy, miscarriage, ongoing pregnancy, and live birth. RESULTS: We analyzed 58,337 cycles of oocyte donation: 57,869 patients had no uterine malformation, and 468 women had UMAs. Compared with patients with normal uteri, patients with UMAs had lower rates of live births (36.67% [32.84-40.65] vs. 38.1% [95% confidence intervals {CI}: 37.82-38.42]) and ongoing pregnancy (39.74% [35.93-43.66] vs. 41.5% [41.24-41.83]). The miscarriage rate was higher in patients with UMAs (19.5% [16.55-22.85] vs. 16.6% [16.47-16.92]). Specifically, patients with a unicornuate uterus (n=29) had lower rates of implantation (24.07% [13.49-37.64] vs. 42.85% [95% CI: 42.6-43.09]), pregnancy (41.86% [27.01-57.87] vs. 59.51% [59.22-59.81]), ongoing pregnancy (16.67% [6.97-31.36] vs. 41.54% [41.24-41.83]), and live births (16.67% [6.97-31.36] vs. 38.12% [37.83-38.42]). In addition, patients with a partial septate uterus (n=91) had a higher miscarriage rate (26.50% [18.44-34.89] vs. 16.7% [16.47-16.92]). Compared with the normal uterus group, the live-birth rates were lower in the UMA without surgery group (33.09% [27.59-38.96] vs. 38.12% [37.83-38.42]). CONCLUSION: Among patients who received embryos derived from donated oocytes, live birth and ongoing pregnancy rates were lower in patients with UMAs compared with patients with normal uteri. A higher miscarriage rate was found in patients with UMAs. Patients with a unicornuate uterus had worse reproductive outcomes. Our results show that the uterus is less competent in patients with UMAs. TRIAL REGISTRATION: This study was registered at clinicaltrial.gov (NCT04571671).

Effect of post-surgical flap position on soft tissue regrowth and keratinized tissue increase following fibre retention osseous resective surgery: a 6-month randomized study with multilevel analysis.

BACKGROUND: The aim of this randomized split-mouth study was to assess the influence of primary flap position on the amount of coronal soft tissue regrowth and keratinized tissue (KT) 6 months after osseous resective surgery with fiber retention technique (FibReORS). MATERIALS AND METHODS: Two contralateral posterior sextants in 16 patients were treated with FibReORS and randomly assigned to flap positioning either 2 mm below the bone crest (apical group) or at the level of bone crest (crestal group). Clinical parameters were recorded at 1, 3 and 6 months and patient-related outcomes during the first two post-operative weeks. RESULTS: Healing period was uneventful. Patient's discomfort was similar in both groups. The overall soft tissue rebound was higher in the apical than in the crestal group (2.0 ± 1.3 mm versus 1.3 ± 0.7 mm), but the difference was statistically significant only interproximally (2.2 ± 1.3 mm versus 1.6 ± 0.8 mm). Multilevel analyses showed higher soft tissue rebound in sites with normal compared to thin phenotype (1.5 mm, p < 0.0001) and treated with flap positioned 2 mm apically to the bone crest (0.7 mm, p < 0.001). An additional 0.5 mm KT increase was observed at interdental sites in the apical group. CONCLUSIONS: Apical flap positioning increases soft tissue rebound and KT width, mainly at the interdental sites, with reduced patient discomfort. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (ID: NCT05140681, Registration date: 1/12/2021, retrospectively registered).

Effect of psychosocial stress and coping strategies on non-surgical periodontal therapy in patients with generalized stage III/IV periodontitis: a longitudinal intervention study.

OBJECTIVES: The aim of this longitudinal intervention study was to assess the impact of psychosocial stress and coping response strategies on the clinical outcomes in periodontitis patients treated with non-surgical periodontal therapy (NSPT). MATERIALS AND METHODS: After the administration of psychological questionnaires, patients diagnosed with generalized stage III-IV periodontitis were categorized into different groups depending on their stress levels (10-item perceived stress level (PSS-10)) and coping response strategies (coping responses inventory (CRI)). Clinical data were collected 1 week before and 3 months after the completion of NSPT. RESULTS: Of the 90 patients included at baseline, 27 presented major and 63 minor stress levels, while 40 had avoidance and 50 approach coping behavior. All clinical parameters were similar at the baseline across different categories. At re-evaluation, full-mouth bleeding score (FMBS), mean probing pocket depth (PPD), and number of residual pathological pockets were significantly superior in groups with higher stress levels (p <0.001, p =0.001, and p =0.020, respectively), while higher full-mouth plaque scores (FMPS) and FMBS were found in patients with avoidance coping strategies (p =0.009 and p <0.001, respectively). When jointly evaluated, an added detrimental effect of coping styles on allostatic load was observed. Multivariate analysis confirmed a significant effect of stress levels and coping strategies on final FMBS, but not of coping on mean PPD. CONCLUSION: Psychosocial stress and avoidance coping strategy seem to negatively influence the clinical outcomes of NSPT at short term (NCT04739475; 9/1/2017). PRACTICAL IMPLICATIONS: Based on these findings, patients reflecting these psychological profiles should be considered at greater risk for poor NSPT response and may benefit from complementary stress management strategies.

Dietary Preferences of Loggerhead Sea Turtles (Caretta caretta) in Two Mediterranean Feeding Grounds: Does Prey Selection Change with Habitat Use throughout Their Life Cycle?

According to their life stage, the loggerhead sea turtle (Caretta caretta) is found in a wide range of habitats, from neritic to more oceanic areas. Their feeding habits are expected to change as they develop, along with habitat use. Juvenile sea turtles are hypothesized to feed on pelagic species in oceanic areas, shifting to more benthic prey during the subadult and adult stages. We analyzed the gastrointestinal content from 150 loggerhead sea turtles stranded and/or bycaught along the Adriatic coast of the Abruzzo and Molise regions (n = 89) and the Tyrrhenian coast of the Lazio and Campania regions (n = 61) from 2018 to 2021. Food items were identified to the lowest taxonomic level, and the frequency of occurrence was calculated for each taxon and most recurrent species to assess changes in prey selection during the development. The marine litter was categorized, and the frequency of occurrence was calculated for the ingestion of litter. The most recurrent taxonomic prey group recorded in the Adriatic sample was Arthropoda (94%), followed by Mollusca (63%) and Chordata (34%). In the Tyrrhenian sample, loggerhead sea turtles fed mostly on Mollusca (84%), Arthropoda (38%), and Chordata (26%). Surprisingly, the Adriatic-Tyrrhenian sample groups showed similar feeding behavior between juveniles, subadults, and adults. A similar correlation has been observed concerning the ingestion of litter. Moreover, this study confirms the opportunistic feeding behavior of loggerhead sea turtles and their high adaptability.

Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits.

This retrospective study described the clinical and radiographic long-term outcomes of combined periodontal and orthodontic treatment (OT) with fixed appliances in patients with Stage IV periodontitis and pathologic tooth migration (PTM) in the anterior sextants. OT was performed in either one or both arches, using tooth-supported or skeletal anchorage, following completion of active periodontal treatment and accurate planning of tooth movement biomechanics. Twenty-nine patients were identified and retrospectively examined when presenting for a supportive periodontal care (SPC) appointment. The mean SPC duration was 8.9 years (range 5 to 12 years). All anterior-migrated teeth showed statistically significant periodontal improvement compared to baseline values and stable radiographic bone levels at the final follow-up. Residual probing depths were 2.9 ± 0.5 mm at the end of active periodontal treatment, and they remained stable at the completion of OT (2.9 ± 0.6 mm) and at the last follow-up visit (2.8 ± 0.5 mm). These findings suggest that OT is a safe and effective treatment in improving the long-term prognosis of teeth with PTM in Stage IV periodontitis provided that periodontal health has been re-established and maintained with individualized SPC sessions.

A new calculation method for the free electron fraction of an ionization chamber in the ultra-high-dose-per-pulse regimen.

The free electron fraction is the fraction of electrons, produced inside the cavity of an ionization chamber after irradiation, which does not bind to gas molecules and thereby reaches the electrode as free electrons. It is a fundamental quantity to describe the recombination processes of an ionization chamber, as it generates a gap of positive charges compared to negative ones, which certainly will not undergo recombination. The free electron fraction depends on the specific chamber geometry, the polarizing applied voltage and the gas thermodynamic properties. Therefore, it is necessary to evaluate such fraction in an accurate and easy way for any measurement condition. In this paper, a simple and direct method for evaluating the free electron fraction of ionization chambers is proposed. We first model the capture process of the electrons produced inside an ionization chamber after the beam pulse; then we present a method to evaluate the free electron fraction based on simple measurements of collected charge, by varying the applied voltage. Finally, the results obtained using an Advanced Markus chamber irradiated with a Flash Radiotherapy dedicated research Linac (ElectronFlash) to estimate the free electron fraction are presented. The proposed method allows the use of a conventional ionization chamber for measurements in ultra-high-dose-per-pulse (UHDP) conditions, up to values of dose-per-pulse at which the perturbation of the electric field due to the generated charge can be considered negligible.

Chlorinated Persistent Organic Pollutants (PCDD/Fs and PCBs) in Loggerhead Sea Turtles Stranded along the Central Adriatic Coast.

Persistent organic pollutants are widespread in the marine environment. They can bioaccumulate and biomagnify in marine organisms through the food web with a potentially toxic effect on living organisms. The sea turtle Caretta caretta is a carnivorous animal with opportunistic feeding behavior. These turtles tend to bioaccumulate pollutants through food, and hence they can be considered an indicator of chemical pollutants in the marine ecosystem. In this study, 44 loggerhead sea turtles were considered, and liver and fat tissue were sampled from each of them to investigate the levels of dioxins (PCDD/Fs) and polychlorinated biphenyls (PCBs) in sea turtles and their potential correlation with sex and size in terms of curved carapace length (CCL). Results suggested that these contaminants were easily bioaccumulated, and PCBs were predominant compared to dioxins in both liver and fat tissue. The congener patterns were similar to those found in sea fish. Moreover, there were no differences in the contamination levels between females and males, nor was there a correlation with the size. There is a need to harmonize the methodological approaches to better evaluate the results and trends over time and to monitor the species and indirectly the health status of the marine environment.

Point scintillator dosimetry in ultra-high dose rate electron "FLASH" radiation therapy: A first characterization.

FLASH radiation therapy is a novel technique combining ultra-high dose rates (UHDR) with very short treatment times to strongly decrease normal tissue toxicity while preserving the anti-tumoral effect. However, the radiobiological mechanisms and exact conditions for obtaining the FLASH-effect are still under investigation. There are strong indications that parameters defining the beam structure, such as dose per pulse, instantaneous dose rate and pulse repetition frequency (PRF) are of importance. UHDR irradiations therefore come with dosimetric challenges, including both dose assessment and temporal ones. In this work, a first characterization of 6 real-time point scintillating dosimeters with 5 phosphors (Al2O3:C,Mg; Y2O3:Eu; Al2O3:C; (C38H34P2)MnBr4 and (C38H34P2)MnCl4, was performed in an UHDR pulsed electron beam. The dose rate independence of the calibration was tested by calibrating the detector at conventional and UHDR. Dose rate dependence was observed, however, further investigation, including intermediate dose rates, is needed. Linearity of the response with dose was tested by varying the number of pulses and a linearity with R2> 0.9989 was observed up to at least 200 Gy. Dose per pulse linearity was investigated by variation of the pulse length and SSD. All point scintillators showed saturation effects up to some extent and the instantaneous dose rate dependence was confirmed. A PRF dependence was observed for the Al2O3:C,Mg and Al2O3:C- based point scintillators. This was expected as the luminescence decay time of these materials exceeds the inter-pulse time.

Combined Periodontal and Orthodontic Treatment of Severely Compromised Teeth in Stage IV Periodontitis Patients: How Far Can We Go?

This retrospective study evaluated the effect of combined periodontal-orthodontic treatment in terms of clinical, radiographic, and patient-reported outcomes in 40 stage IV periodontitis patients with advanced attachment loss and pathologic migration of anterior teeth. Full-mouth periodontal parameters were recorded at baseline (after diagnosis; T0), at the end of active periodontal therapy (APT; T1), at completion of orthodontic tooth movement (OTM; T2), and at the last supportive periodontal care (SPC) visit (T3). Radiographic analysis was performed at T0, T2, and T3. A total of 115 teeth were lost during APT, including 5 molars at T2 (used as orthodontic anchorage) and 10 premolars at T3 (due to root fracture). All anterior migrated teeth were in function at T3 (mean duration: 9.5 years). Significant mean probing pocket depth reduction (1.5 ± 1.1 mm) and attachment level gain (0.9 ± 1.0 mm) were observed after APT, whereas OTM and SPC were associated with furthering small changes. The alveolar bone level at T3 was slightly increased from T0 values. Patient-reported outcome measurements significantly improved in terms of esthetics and masticatory function. OTM should be considered an essential part of the comprehensive treatment plan to change the prognosis of severely compromised teeth in stage IV periodontitis patients.

Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis.

OBJECTIVE: To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?" METHODS: Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses. RESULTS: Twenty-two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55], p = .26), even if with substantial heterogeneity. CONCLUSIONS: No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).

A new solution for UHDP and UHDR (Flash) measurements: Theory and conceptual design of ALLS chamber.

Ultra-High dose-per-pulse regimens (UHDP), necessary to trigger the "FLASH" effect, still pose serious challenges to dosimetry. Dosimetry plays a crucial role, both to significantly improve the accuracy of the radiobiological experiments necessary to fully understand the mechanisms underlying the effect and its dependencies on the beam parameters, and to be able to translate such effect into clinical practice. The standard ionization chamber in UHDP region is significantly affected by the effects of the electric field generated by the enormous density of charges produced by the dose pulse. This work describes the theory and the conceptual design of a gas chamber (the ALLS chamber) which overcomes the above-mentioned problems.

Application of a novel diamond detector for commissioning of FLASH radiotherapy electron beams.

PURPOSE: A diamond detector prototype was recently proposed by Marinelli et al. (Medical Physics 2022, https://doi.org/10.1002/mp.15473) for applications in ultrahigh-dose-per-pulse (UH-DPP) and ultrahigh-dose-rate (UH-DR) beams, as used in FLASH radiotherapy (FLASH-RT). In the present study, such so-called flashDiamond (fD) was investigated from the dosimetric point of view, under pulsed electron beam irradiation. It was then used for the commissioning of an ElectronFlash linac (SIT S.p.A., Italy) both in conventional and UH-DPP modalities. METHODS: Detector calibration was performed in reference conditions, under 60 Co and electron beam irradiation. Its response linearity was investigated in UH-DPP conditions. For this purpose, the DPP was varied in the 1.2-11.9 Gy range, by changing either the beam applicator or the pulse duration from 1 to 4 µs. Dosimetric validation of the fD detector prototype was then performed in conventional modality, by measuring percentage depth dose (PDD) curves, beam profiles, and output factors (OFs). All such measurements were carried out in a motorized water phantom. The obtained results were compared with the ones from commercially available dosimeters, namely, a microDiamond, an Advanced Markus ionization chamber, a silicon diode detector, and EBT-XD GAFchromic films. Finally, the fD detector was used to fully characterize the 7 and 9 MeV UH-DPP electron beams delivered by the ElectronFlash linac. In particular, PDDs, beam profiles, and OFs were measured, for both energies and all the applicators, and compared with the ones from EBT-XD films irradiated in the same experimental conditions. RESULTS: The fD calibration coefficient resulted to be independent from the investigated beam qualities. The detector response was found to be linear in the whole investigated DPP range. A very good agreement was observed among PDDs, beam profiles, and OFs measured by the fD prototype and reference detectors, both in conventional and UH-DPP irradiation modalities. CONCLUSIONS: The fD detector prototype was validated from the dosimetric point of view against several commercial dosimeters in conventional beams. It was proved to be suitable in UH-DPP and UH-DR conditions, for which no other commercial real-time active detector is available to date. It was shown to be a very useful tool to perform fast and reproducible beam characterizations in standard clinical motorized water phantom setups. All of the previously mentioned demonstrate the suitability of the proposed detector for the commissioning of UH-DR linac beams for preclinical FLASH-RT applications.

Comparing Ionic Profile of Gingival Crevicular Fluid and Saliva as Distinctive Signature of Severe Periodontitis.

Although increasing evidence is emerging on the contribution of chemical elements in periodontal health, no studies have concomitantly evaluated the ionic profile in gingival crevicular fluid (GCF) and saliva in relation to the underlying periodontal status. Our hypothesis is that these biofluids have distinctive ionic content. Therefore, the aim of this cross-sectional study was to analyze the elemental composition of GCF and saliva in order to explore which biological matrix and which combination of elements could discriminate between periodontitis and periodontal health. Twelve ions were analyzed in GCF and unstimulated saliva from 54 subjects (18 periodontally healthy, 18 untreated severe periodontitis and 18 treated severe periodontitis) using inductively coupled plasma-mass spectrometry (ICP-MS) and inductively coupled plasma-optical emission spectroscopy (ICP-OES). These analytical techniques were able to determine levels of sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg), while the other elements were below the detection threshold. Na and K ions were detected at elevated concentration in untreated periodontitis compared with treated periodontitis and healthy periodontium. Ca was increased in untreated periodontitis, but the difference was not significant. In saliva, only Na was significantly associated with periodontitis. The combination of Na and K in GCF enabled the correct assignment of a subject to the periodontitis or healthy group. Based on these preliminary results, GCF demonstrated higher clustering potential than saliva.