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Objectives: The aim of this systematic review and meta-analysis was to evaluate the current literature on the effect of implant surface characteristics on peri-implant marginal bone levels (MBL), soft tissue periodontal parameters, peri-implantitis, and implant failure rates. Materials and Methods: Randomized controlled trials were searched in electronic databases. Risk of bias within the selected studies was assessed using the Risk of Bias Tool 2. Meta-analyses were performed using Review Manager software for studies with similar comparisons reporting same outcome measures. Results: Ten randomized control trials were included in the present review. The primary outcome of changes in peri-implant MBL favoured implants with machined surfaces, however, the difference was not statistically significant (P = .18). The changes in probing pocket depths significantly favoured the use of machined surfaces (P = .01), while the implant failure rates favoured roughened surface implants. However, the difference was not statistically significant (P = .09). Conclusion: Machined surface implants were favoured in terms of lesser peri-implant MBL, though the difference was not significant. The analysis also demonstrated limited favourable outcomes in terms of periodontal parameters for machined surfaces, with slightly significantly better outcomes in terms of probing pocket depths. However, rough surface implants tended to display a lower implant failure.

Abstract Neuromuscular diseases (NMD) are a group of neurological diseases that manifest with various clinical symptoms affecting different components of the peripheral nervous system, which play a role in voluntary body movements control. The primary objective of this study is to explore the diagnostic efficacy of a combined genetic and biochemical testing approach for patients with neuromuscular diseases with diverse presentations in a population with high rate of consanguinity. Genetic testing was performed using selected Next Generation Sequencing (NGS) gene panels and whole exome sequencing on the peripheral blood sample from the patients. The study results revealed that the majority of patients in our cohort had a history of consanguinity (83%). Genetic testing through gene panels and Whole Exome Sequencing yielded similar result. Out of the patients tested, 66% underwent gene panels testing, 56% had Whole Exome Sequencing, 32% received array Comparative Genomic Hybridization (CGH) assays, and 40% underwent metabolic testing. Overall, 58 patients (61%) received definitive results after following all tests. Among the remaining 36 patients, 19 exhibited variants of unknown significance (VOUS) (21%).

Abstract Background Infections caused by biofilm-forming bacteria have significantly linked to dental plaque and caries. The aim of this study is to assess efficacy of some natural compounds in inhibition and eradication of biofilm formed by bacterial isolates from dental infections. Results Bacterial isolates were recovered from dental plaque/caries and identified using standard microbiological tests and 16S rDNA sequencing. The isolated bacterial strains include Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. The antibiotic susceptibility was determined by disk diffusion method and revealed that the majority of isolates showed high antibiotic resistance, and 61% of isolates were found to be multidrug resistant. The biofilm formation capacity of isolates was investigated using microtiter plate assay. Among the 77 bacterial isolates, seventeen showed moderate biofilm formation capacity, twenty-two showed near-moderate, thirty-four had weak biofilm-forming capacity, and four were non-biofilm producers. The antibiofilm activity of tested compounds (rose and jasmine oils, propolis, vanillin, and vinegar) was evaluated against isolates with highest biofilm-forming capacity. The in vitro antibiofilm ability of tested substances were investigated alone or in combination with each other to evaluate their ability to prevent biofilm formation or destroy preformed single-/multispecies biofilms. Finally, antibiofilm ability of tested combination was evaluated ex vivo on natural teeth. Our results showed that vanillin in combination with rose or jasmine oils showed promising biofilm inhibition and biofilm eradication activities in both the in vitro and ex vivo models. Conclusions Dental plaque and caries can be successfully prevented using combination of vanillin with rose or jasmine oils, and these compounds can be incorporated in new anticaries dental formulations.

Abstract Background Sex disparities in cardiovascular disorders are well‐documented, but data on hospitalization and readmission outcomes in the context of sex for Complete Heart Block (CHB) remains limited. Methods We analyzed the 2016–2020 Nationwide Readmission Database to identify patients with a principal diagnosis of CHB. Men served as the control group, while women comprised the study cohort. The primary outcome was mortality. Secondary outcomes included odds of cardiac arrest, ventricular tachycardia, heart failure, mechanical ventilation use, all‐cause 30‐day readmission, total and early pacemaker use, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models adjusted for confounders. Results Among 175,257 patients with CHB, 45% were female. Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.42, 95% CI 1.3–1.55) compared to males. Additionally, females had higher odds of cardiac arrest (aOR 1.13, 95% CI 1.06–1.2), ventricular tachycardia (aOR 1.1, 95% CI 1.05–1.17), heart failure (aOR 1.18, 95% CI 1.14–1.22), mechanical ventilation use (aOR 1.1, 95% CI 1.03–1.17), and all‐cause 30‐day readmission (aOR 1.1, 95% CI 1.03–1.14). Women also had lower odds of total pacemaker use (aOR 0.92, 95% CI 0.88–0.96) and early pacemaker use (aOR 0.89, 95% CI 0.86–0.82). Female patients exhibited longer LOS (4.13 days vs. 3.86 days, p

Purpose The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas. Patients and methods This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon. Results The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month. Conclusion Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.

Abstract Background Seepage control measures are essential in earth dams to enhance their safety against seepage and slope failures. A diaphragm is a thin impervious wall that is used in the core area of the dam to prevent the seepage of water. Any crack in the diaphragm can reduce its efficiency and threaten the safety and stability of the dam. Extensive evaluation of the influence of diaphragm fracturing on dam safety is required to establish a safe design and offer the appropriate measures. This study investigates the effect of diaphragm cracking on the safety of the dam for seepage and slope stability. A permeability tank is first used to validate the numerical model; then, different scenarios for cracked diaphragm walls are studied numerically. The crack’s height, width, direction, and number are all investigated. The effect of having a downstream horizontal blanket drain with cracked internal diaphragms is also evaluated. Results The results showed that the internal diaphragm enhances the safety of earth dams as it reduced the seepage discharge by 98% and increased the downstream slope safety by 34%. Considering the development of a crack in the internal diaphragm, the most critical location was at the base of the dam, wider cracks were more destructive, and the most critical direction was the horizontal crack. The fracturing of the diaphragm at multiple locations proved to be detrimental to the safety of the dam. Having three cracks caused the seepage discharge to reach 74% of its value for no diaphragm, the pore water pressure to raise drastically, and the downstream critical factor of safety to be higher than the case of no diaphragm by 8% only. Conclusions According to the findings, it is advised to continuously monitor the components of diaphragm-type earth dams and perform the necessary maintenance works whenever any sign of damage or water seepage appears. Furthermore, using a well-graded horizontal drain of sufficient length and high permeability with the internal diaphragm is highly recommended as a mitigation measure if diaphragm fracturing occurs. This helps to quickly release the seeping water and keep the phreatic line away from the downstream slope. Graphical abstract

Musculoskeletal ultrasound (US) imaging faces challenges such as operator experience, limited spatial flexibility, and high personnel costs. This study introduces an Automated Robotic Ultrasound Scanning (ARUS) system that integrates key technological advancements to automate the ultrasound scanning procedure with the robot, including anatomical target localization, automatic trajectory generation, deep-learning-based segmentation, and 3D reconstruction of musculoskeletal structures. The ARUS system consists of a robotic arm, ultrasound imaging, and stereo vision for precise anatomical area detection. A Graphical User Interface (GUI) facilitates a flexible selection of scanning trajectories, improving user interaction and enabling customized US scans. To handle complex and dynamic curvatures on the skin, together with anatomical area detection, the system employs a hybrid position–force control strategy based on the generated trajectory, ensuring stability and accuracy. Additionally, the utilized RA-UNet model offers multi-label segmentation on the bone and muscle tissues simultaneously, which incorporates residual blocks and attention mechanisms to enhance segmentation accuracy and robustness. A custom musculoskeletal phantom was used for validation. Compared to the reference 3D reconstruction result derived from the MRI scan, ARUS achieved a 3D reconstruction root mean square error (RMSE) of 1.22 mm, with a mean error of 0.94 mm and a standard deviation of 0.77 mm. The ARUS system extends 3D musculoskeletal imaging capacity by enabling both bones and muscles to be segmented and reconstructed into 3D shapes in real time and simultaneously. These features suggest significant potential as a cost-effective and reliable option for musculoskeletal examination and diagnosis in real-time applications.

ABSTRACT Objectives There is a growing evidence to suggest augmenting peri‐implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta‐analyses was to evaluate the clinical and patient‐reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Material and Methods Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri‐implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval −0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri‐implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Conclusions Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short‐term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.

Abstract Background Carbapenems represent the first line treatment of serious infections caused by drug-resistant Klebsiella pneumoniae. Carbapenem-resistant K. pneumoniae (CRKP) is one of the urgent threats to human health worldwide. The current study aims to evaluate the carbapenemase inhibitory potential of coumarin and to test its ability to restore meropenem activity against CRKP. Disk diffusion method was used to test the antimicrobial susceptibility of K. pneumoniae clinical isolates to various antibiotics. Carbapenemase genes (NDM-1, VIM-2, and OXA-9) were detected using PCR. The effect of sub-MIC of coumarin on CRKP isolates was performed using combined disk assay, enzyme inhibition assay, and checkerboard assay. In addition, qRT-PCR was used to estimate the coumarin effect on expression of carbapenemase genes. Molecular docking was used to confirm the interaction between coumarin and binding sites within three carbapenemases. Results K. pneumoniae clinical isolates were found to be multi-drug resistant and showed high resistance to meropenem. All bacterial isolates harbor at least one carbapenemase-encoding gene. Coumarin significantly inhibited carbapenemases in the crude periplasmic extract of CRKP. The checkerboard assay indicated that coumarin-meropenem combination was synergistic exhibiting a fractional inhibitory concentration index ≤ 0.5. In addition, qRT-PCR results revealed that coumarin significantly decreased carbapenemase-genes expression. Molecular docking revealed that the binding energies of coumarin to NDM1, VIM-2, OXA-48 and OXA-9 showed a free binding energy of -7.8757, -7.1532, -6.2064 and − 7.4331 Kcal/mol, respectively. Conclusion Coumarin rendered CRKP sensitive to meropenem as evidenced by its inhibitory action on hydrolytic activity and expression of carbapenemases. The current findings suggest that coumarin could be a possible solution to overcome carbapenems resistance in CRKP.

Background: Prediction of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) success is crucial in counselling patients about their real chance of getting a live birth before commencing treatment. A multivariate scoring system proposed by Younis et al., 2010, was amongst the predictive models used to evaluate IVF/ICSI success. The score entitles basal endocrine, clinical and sonographic parameters. Aims: The objective of this study is to assess the predictability of the Younis multivariate score for pregnancy outcomes in ICSI cycles. Settings and Design: This prospective observational cohort study (NCT03846388) included patients who pursued IVF or ICSI in a tertiary infertility unit between February 2019 and December 2021. Materials and Methods: The score variables were age, body mass index, antral follicle count, basal follicle-stimulating hormone (FSH), basal FSH/luteinising hormone ratio, infertility duration, number of previous cancellations and mean ovarian volume. For each woman included in the study, Younis multivariate score was calculated. Then, we correlate the different reproductive outcomes with score levels to validate the score predictability. A score of ≤14 was defined as a low score based on the previous study’s results. Statistical Analysis Used: The student’s t-test and Mann–Whitney test were used to compare numerical variables, whereas categorical variables were analysed using the Chi-square test. A receiver operating curve (ROC) and a multivariate logistic regression model were used to investigate the predictability of the Younis scoring model for cycle outcomes. Results: Two hundred ninety-two ICSI-ET cycles were analysed. Of the total cohort, 143 (48.97%) women included showed a low score (≤14), whereas 149 (51.03%) women showed a high score (>14). Women with low scores had significantly higher pregnancy and live birth rates compared to women with high scores (60.1% vs. 7.4%, respectively, P < 0.001; 44.7% vs. 6.7%, respectively, P < 0.001). The area under the curve (AUC) in the ROC curve analysis showed a higher predictability for the scoring system for live birth rate with an AUC of 0.796, with a sensitivity of 86.5% and specificity of 63.8% when using a cut-off level of ≤14. For pregnancy prediction, the AUC was 0.829, with a sensitivity of 88.66% and a specificity of 70.77% when using the same cut-off. Women who have a low score have a high chance of having frozen embryos. Likewise, women who have a high score have a very high chance of cycle cancellation. Conclusions: The Younis multivariate score can be used for the prediction of ICSI cycle outcomes and to calculate the chance of cycle cancellation, pregnancy and take-home baby before ICSI.

Soft pneumatic actuators (SPAs) have applications in various domains due to their compliance, low cost, and lightweight characteristics. Herein, a geometric origami design for 3‐degree of freedom (DoF) SPAs is presented, which enables manufacturing using 3D printing at one go without any support structure. The proposed method uses a general design parameterization that works for multiple types of cylindrical origami patterns (Kresling, cylindrical Miura, Yoshimura, and Accordion). It is shown that a 3‐DoF pneumatic actuator capable of bending and extension can be constructed by superimposing two cylindrical origami patterns to create a separation of chambers inside of the module. In addition, the design parameters are chosen to reduce the strain during deformation and maximize the output forces of the origami actuator. The actuator is manufactured, and its motion and force profiles are experimentally characterized. The designed origami actuator can bend from −12.2°±0.2° to 94.7°±0.9° and the length during operation can vary between 50% and 126% of the initial length.

Abstract Pseudomonas aeruginosa is an important pathogen that causes serious infections. Bacterial biofilms are highly resistant and render bacterial treatment very difficult, therefore necessitates alternative antibacterial strategies. Phage therapy has been recently regarded as a potential therapeutic option for treatment of bacterial infections. In the current study, a novel podovirus vB_PaeP_PS28 has been isolated from sewage with higher lytic activity against P. aeruginosa. Isolated phage exhibits a short latent period, large burst size and higher stability over a wide range of temperatures and pH. The genome of vB_PaeP_PS28 consists of 72,283 bp circular double-stranded DNA, with G + C content of 54.75%. The phage genome contains 94 open reading frames (ORFs); 32 for known functional proteins and 62 for hypothetical proteins and no tRNA genes. The phage vB_PaeP_PS28 effectively inhibited the growth of P. aeruginosa planktonic cells and displayed a higher biofilm degrading capability. Moreover, therapeutic efficacy of isolated phage was evaluated in vivo using mice infection model. Interestingly, survival of mice infected with P. aeruginosa was significantly enhanced upon treatment with vB_PaeP_PS28. Furthermore, the bacterial load in liver and kidney isolated from mice infected with P. aeruginosa and treated with phage markedly decreased as compared with phage-untreated P. aeruginosa-infected mice. These findings support the efficacy of isolated phage vB_PaeP_PS28 in reducing P. aeruginosa colonization and pathogenesis in host. Importantly, the isolated phage vB_PaeP_PS28 could be applied alone or as combination therapy with other lytic phages as phage cocktail therapy or with antibiotics to limit infections caused by P. aeruginosa.

Interventional radiologists mainly rely on visual feedback via imaging modalities to steer a needle toward a tumor during biopsy and ablation procedures. In the case of CT-guided procedures, there is a risk of exposure to hazardous X-ray-based ionizing radiation. Therefore, CT scans are usually not used continuously, which increases the chances of a misplacement of the needle and the need for reinsertion, leading to more tissue trauma. Interventionalists also encounter haptic feedback via needle–tissue interaction forces while steering a needle. These forces are useful but insufficient to clearly perceive and identify deep-tissue structures such as tumors. The objective of this paper was to investigate the effect of enhanced force feedback for sensing interaction forces and guiding the needle when applied individually and simultaneously during a virtual CT-guided needle insertion task. We also compared the enhanced haptic feedback to enhanced visual feedback. We hypothesized that enhancing the haptic feedback limits the time needed to reach the target accurately and reduces the number of CT scans, as the interventionalist depends more on real-time enhanced haptic feedback. To test the hypothesis, a simulation environment was developed to virtually steer a needle in five degrees of freedom (DoF) to reach a tumor target embedded in a liver model. Twelve participants performed in the experiment with different feedback conditions where we measured their performance in terms of the following: targeting accuracy, trajectory tracking, number of CT scans required, and the time needed to finish the task. The results suggest that the combination of enhanced haptic feedback for guidance and sensing needle–tissue interaction forces significantly reduce the number of scans and the duration required to finish the task by 32.1% and 46.9%, respectively, when compared to nonenhanced haptic feedback. The other feedback modalities significantly reduced the duration to finish the task by around 30% compared to nonenhanced haptic feedback.

Abstract Objectives The coronavirus disease‐19 (COVID‐19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID‐19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID‐19 pandemic. Material and Methods An online survey was designed to assess oral home care, smoking habits, and attitude toward dental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression. Results A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID‐19 (p

Abstract Irreversible electroporation (IRE) has emerged as an appealing non‐ionizing, non‐thermal ablation therapy, independent of antineoplastic drugs. Limited but successful outcomes in IRE conducted in vivo, in small focal hepatocellular carcinomas (HCC), have been reported. Nonetheless, the electric parameters of IRE are usually delivered in an unplanned manner. This work investigates the integration of computational modeling to hydrogels mimicking the HCC microenvironment, as a powerful framework to: circumvent ethical concerns of in vivo experimentation; safely tune the electric parameters reaching the IRE electric field threshold; and propel the translation of IRE as a routine clinical alternative to the treatment of HCC. Therefore, a parametric study served to evaluate the effects of the pulse amplitude, the number of pulses and electrodes, the treatment time, the hydrogel–tumor size, and the cell type. The ablation extent was surveyed by confocal microscopy and magnetic resonance imaging (MRI) in cylindrical and realistic tumor‐shaped hydrogels, respectively. A large ablation (70%–100%) was verified in all constructs.

Introduction: Crown lengthening is one of the most common periodontal surgical procedures carried out to increase the amount of supragingival tooth structure. There is a lot of literature on crown lengthening surgeries, but very few systematic reviews comparing treated and adjacent sites over a six-month period. The purpose of this systematic review and meta-analysis was to evaluate the outcomes of crown lengthening surgery in terms of changes in periodontal clinical parameters and periodontal tissue stability between treated and adjacent sites. Methods: Electronic databases were searched up to 28 February 2022 with no restriction on publication status. A manual search of journals was also performed. Predefined inclusion and exclusion criteria were used to select the relevant articles that assessed dimensional changes in periodontal tissues after crown lengthening surgery. The risk of bias was assessed using the JBI critical appraisal checklist. Data meta-analysis was performed using a statistical software program. Results: A total of 78 studies were identified, of which, four clinical controlled trials containing 182 crown lengthening surgical procedures across 111 participants were included. Meta-analysis showed no statistically significant changes after three or six months in terms of supracrestal tissue attachment levels, bone level and probing pocket depth between treated and adjacent sites. However, clinical attachment level changes were statistically significant, favouring adjacent teeth at six months. Conclusions: Within the limitation of this systematic review, crown lengthening surgery results in stable periodontal tissues over time according to the acceptable periodontal healing parameters. Further evidence is still required to substantiate these findings.

Aim: The objective of this research was to measure the labial bone thickness (LBT) in relation to the 6 anterior maxillary teeth at different levels along the long axis and the distance between cementoenamel junction and bone crest (CEJ-BC) based on cone beam computed tomography (CBCT) scans retrieved from patients of Arab ethnicity and identify any association with patients’ characteristics. Materials and methods: A total of 100 CBCT scans were evaluated by one calibrated examiner. The thickness of the labial bone was measured perpendicular to the long axis of the tooth at 1, 3, and 5 mm from the alveolar crest (LBT-1, LBT-3, and LBT-5, respectively) and CEJ-BC using a medical imaging viewer. Results: CBCT scans of 58 female patients and 42 male patients with a mean age of 39.7 ± 9.5 years were included. A high variation of CEJ-BC was observed (range, 0.55-3.90 mm). Statistically significant higher CEJ-BC values were associated with men and increased age (>50 years). The overall means of LBT-1 were 0.76 ± 0.26, 0.79 ± 0.26, and 0.83 ± 0.37 mm; LBT-3: 0.92 ± 0.36, 1.05 ± 0.46, and 1.03 ± 0.48 mm; LBT-5: 1.17 ± 0.52, 0.80 ± 0.45, and 0.81 ± 0.40 mm for central incisors, lateral incisors, and canines, respectively. The LBT was

Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air–water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 μg and 34.44 ± 6.08 μg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 μm to 1.25 ± 0.24 μm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 μm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 μm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination.

ABSTRACT: The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], −0.36; 95% confidence interval [CI], −0.88 to 0.16; P = .18) or bleeding on probing (MD, −0.71; 95% CI, 1.58–0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.

Abstract Background Biofilm-related infections are difficult to be treated because of higher resistance to antimicrobial agents. Current study aims to characterize the influence of zinc oxide nanoparticles (ZnO-NPs) on both S. aureus susceptibility to antibiotics and pathogenesis. Methods The influence of ZnO-NPs on biofilm formation by S. aureus was characterized by the crystal violet and tube assay. The synergistic effect of ZnO-NPs in combination with antibiotics on S. aureus was characterized using the checkerboard method. The effect of ZnO-NPs on S. aureus cell surface hydrophobicity and blood hemolysis was investigated. RT-qPCR was used to investigate the effect of ZnO-NPs on the expression of biofilm related genes (icaA, icaR and sarA), katA and sigB. The impact of ZnO-NPs on S. aureus pathogenesis was evaluated using mice infection model. Results ZnO-NPs exhibited a good antibiofilm activity against S. aureus. The findings indicate a synergistic antibiofilm effect of combination between ZnO-NPs and tested antibiotics. ZnO-NPs were capable of decreasing S. aureus cell surface hydrophobicity which could account for observed decrease in bacterial biofilm forming capacity. Moreover, ZnO-NPs-treated bacteria exhibited a significant decrease in blood hemolysis relative to control untreated S. aureus. The expression of biofilm related genes was significantly repressed in ZnO-NPs treated bacteria as compared to untreated cells. Finally, the effect of ZnO-NPs on S. aureus pathogenesis was investigated using mice infection model where ZnO-NPs accelerated healing of wounds in mice as compared to control untreated mice. Conclusions Present data support the efficiency of ZnO-NPs as antibiofilm agent in treatment of S. aureus infections. This study recommends the incorporation of ZnO-NPs as adjuvant with other antibiotics targeting S. aureus based on the promising findings obtained herein in order to control infection with this pathogen.

Abstract Background Antimicrobial resistance is growing substantially, which necessitates the search for novel therapeutic options. Terbinafine, an allylamine antifungal agent that exhibits a broad spectrum of activity and is used in the treatment of dermatophytosis, could be a possible option to disarm S. aureus virulence. Methods Terbinafine inhibitory effect on staphyloxanthin was characterized by quantitative measurement of staphyloxanthin intermediates and molecular docking. The effect of terbinafine on S. aureus stress survival was characterized by viable counting. The anti-biofilm activity of terbinafine on S. aureus was assessed by the crystal violet assay and microscopy. Changes in S. aureus membrane following treatment with terbinafine were determined using Fourier transform infrared (FTIR) analysis. The synergistic action of terbinafine in combination with conventional antibiotics was characterized using the checkerboard assay. qRT-PCR was used to evaluate the impact of terbinafine on S. aureus gene expression. The influence of terbinafine on S. aureus pathogenesis was investigated in mice infection model. Results Terbinafine inhibits staphyloxanthin biosynthesis through targeting dehydrosqualene desaturase (CrtN). Docking analysis of terbinafine against the predicted active site of CrtN reveals a binding energy of − 9.579 kcal/mol exemplified by the formation of H-bonds, H-arene bonds, and hydrophobic/hydrophilic interactions with the conserved amino acids of the receptor pocket. Terbinafine treated S. aureus was more susceptible to both oxidative and acid stress as well as human blood killing as compared to untreated cells. Targeting staphyloxanthin by terbinafine rendered S. aureus more sensitive to membrane acting antibiotics. Terbinafine interfered with S. aureus biofilm formation through targeting cell autoaggregation, hydrophobicity, and exopolysaccharide production. Moreover, terbinafine demonstrated a synergistic interaction against S. aureus when combined with conventional antibiotics. Importantly, terbinafine attenuated S. aureus pathogenesis using mice infection model. qRT-PCR revealed that terbinafine repressed expression of the transcriptional regulators sigB, sarA, and msaB, as well as icaA in S. aureus. Conclusions Present findings strongly suggest that terbinafine could be used safely and efficiently as an anti-virulent agent to combat S. aureus infections.

Abstract Background Staphylococcus aureus is a leading cause of human infections. The spread of antibiotic-resistant staphylococci has driven the search for novel strategies to supersede antibiotics use. Thus, targeting bacterial virulence rather than viability could be a possible alternative. Results The influence of celastrol on staphyloxanthin (STX) biosynthesis, biofilm formation, antibiotic susceptibility and host pathogenesis in S. aureus has been investigated. Celastrol efficiently reduced STX biosynthesis in S. aureus. Liquid chromatography-mass spectrometry (LC–MS) and molecular docking revealed that celastrol inhibits STX biosynthesis through its effect on CrtM. Quantitative measurement of STX intermediates showed a significant pigment inhibition via interference of celastrol with CrtM and accumulation of its substrate, farnesyl diphosphate. Importantly, celastrol-treated S. aureus was more sensitive to environmental stresses and human blood killing than untreated bacteria. Similarly, inhibition of STX upon celastrol treatment rendered S. aureus more susceptible to membrane targeting antibiotics. In addition to its anti-pigment capability, celastrol exhibits significant anti-biofilm activity against S. aureus as indicated by crystal violet assay and microscopy. Celastrol-treated cells showed deficient exopolysaccharide production and cell hydrophobicity. Moreover, celastrol markedly synergized the action of conventional antibiotics against S. aureus and reduced bacterial pathogenesis in vivo using mice infection model. These findings were further validated using qRT-PCR, demonstrating that celastrol could alter the expression of STX biosynthesis genes as well as biofilm formation related genes and bacterial virulence. Conclusions Celastrol is a novel anti-virulent agent against S. aureus suggesting, a prospective therapeutic role for celastrol as a multi-targeted anti-pathogenic agent.

Pituitary or adrenal lesions can cause Cushing syndrome, which has an incidence of 10–15 per million people. A growing variety of tumor subtypes make up the heterogeneous illness known as renal cell carcinoma (RCC). Herein, we described a case with renal clear cell carcinoma and an adrenal adenoma. As was mentioned, it is recommended that these patients routinely have their pituitary-adrenal axis evaluated. The primary etiology of these two illnesses occurring simultaneously is extremely rare.

Fiber reinforced soft pneumatic actuators are hard to control due to their non-linear behavior and non-uniformity introduced by the fabrication process. Model-based controllers generally have difficulty compensating non-uniform and non-linear material behaviors, whereas model-free approaches are harder to interpret and tune intuitively. In this study, we present the design, fabrication, characterization, and control of a fiber reinforced soft pneumatic module with an outer diameter size of 12 mm. Specifically, we utilized the characterization data to adaptively control the soft pneumatic actuator. From the measured characterization data, we fitted mapping functions between the actuator input pressures and the actuator space angles. These maps were used to construct the feedforward control signal and tune the feedback controller adaptively depending on the actuator bending configuration. The performance of the proposed control approach is experimentally validated by comparing the measured 2D tip orientation against the reference trajectory. The adaptive controller was able to successfully follow the prescribed trajectory with a mean absolute error of 0.68° for the magnitude of the bending angle and 3.5° for the bending phase around the axial direction. The data-driven control method introduced in this paper may offer a solution to intuitively tune and control soft pneumatic actuators, compensating for their non-uniform and non-linear behavior.

Abstract Study objective The objective of this study is to evaluate the prognostic accuracy of existing rules (San Francisco Syncope Rule [SFSR], Canadian Syncope Risk Score [CSRS], and FAINT score) in older adults. Methods This is a cohort study of adults aged ≥60 years presenting to an academic emergency department (ED) with syncope or near syncope. We used original criteria for all rules except for the FAINT score, in which N‐terminal pro–brain natriuretic peptide was largely missing from the extracted data. Patients were deemed positive for each rule if classified as non‐low risk. The primary outcome was the presence of 30‐day serious outcome, as defined by syncope research guidelines. Sensitivity and negative likelihood ratio (NLR) were calculated with 95% confidence intervals (CIs). Results A total of 404 ED visits (mean age of patients, 75.5 years) were included. Of these, 44 (10.9%) had a 30‐day serious outcome, and 24 (5.9%) had incomplete 30‐day follow‐up. SFSR was positive for 280 of 380 visits with complete follow‐up. Its sensitivity and NLR for predicting 30‐day serious outcomes were 86.4% (95% CI, 72.0%–94.3%) and 0.53 (95% CI, 0.25–1.15), respectively. The CSRS was positive for 299 of 380 visits (sensitivity was 88.6% [95% CI, 76.4%–95.7%], and NLR was 0.50 [95% CI, 0.22–1.17]). The modified FAI(N)T score was positive for 318 of 380 visits (sensitivity was 90.9% [95% CI, 77.4%–97.0%], and NLR was 0.53 [95% CI, 0.20–1.38]). Conclusion Existing rules are suboptimal to predict 30‐day serious outcomes in older adults presenting with syncope or near syncope to the ED.

Gas sensors that can measure multiple pollutants simultaneously are highly desirable for on-site air pollution monitoring at various scales, both indoor and outdoor. Herein, we introduce a low-cost multi-parameter gas analyzer capable of monitoring multiple gaseous pollutants simultaneously, thus allowing for true analytical measurement. It is a spectral sensor consisting of a Fourier-transform infrared (FTIR) gas analyzer based on a mid-infrared (MIR) spectrometer. The sensor is as small as 7 × 5 × 2.5 cm3. It was deployed in an open-path configuration within a district-scale climatic chamber (Sense City, Marne-la-Vallée, France) with a volume of 20 × 20 × 8 m3. The setup included a transmitter and a receiver separated by 38 m to enable representative measurements of the entire district domain. We used a car inside the climatic chamber, turning the engine on and off to create time sequences of a pollution source. The results showed that carbon dioxide (CO2) and water vapor (H2O) were accurately monitored using the spectral sensor, with agreement with the reference analyzers used to record the pollution levels near the car exhaust. Furthermore, the lower detection limits of CO, NO2 and NO were assessed, demonstrating the capability of the sensor to detect these pollutants. Additionally, a preliminary evaluation of the potential of the spectral sensor to screen multiple volatile organic compounds (VOCs) was conducted at the laboratory scale. Overall, the results demonstrated the potential of the proposed multi-parameter spectral gas sensor in on-site gaseous pollution monitoring.

BackgroundBone is one of the most common metastatic sites of advanced lung cancer, and the median survival time is significantly shorter than that of patients without metastasis. This study aimed to identify prognostic factors associated with survival and construct a practical nomogram to predict overall survival (OS) in lung cancer patients with bone metastasis (BM).MethodsWe extracted the patients with BM from lung cancer between 2011 and 2015 from the Surveillance, Epidemiology, and End Result (SEER) database. Univariate and multivariate Cox regressions were performed to identify independent prognostic factors for OS. The variables screened by multivariate Cox regression analysis were used to construct the prognostic nomogram. The performance of the nomogram was assessed by receiver operating characteristic (ROC) curve, concordance index (C-index), and calibration curves, and decision curve analysis (DCA) was used to assess its clinical applicability.ResultsA total of 7861 patients were included in this study and were randomly divided into training (n=5505) and validation (n=2356) cohorts using R software in a ratio of 7:3. Cox regression analysis showed that age, sex, race, grade, tumor size, histological type, T stage, N stage, surgery, brain metastasis, liver metastasis, chemotherapy and radiotherapy were independent prognostic factors for OS. The C-index was 0.723 (95% CI: 0.697-0.749) in the training cohorts and 0.738 (95% CI: 0.698-0.778) in the validation cohorts. The AUC of both the training cohorts and the validation cohorts at 3-month (0.842 vs 0.859), 6-month (0.793 vs 0.814), and 1-year (0.776 vs 0.788) showed good predictive performance, and the calibration curves also demonstrated the reliability and stability of the model.ConclusionsThe nomogram associated with the prognosis of BM from lung cancer was a reliable and practical tool, which could provide risk assessment and clinical decision-making for individualized treatment of patients.

Abstract Background Information regarding the prevalence of PKU in the Middle East in comparison to other world regions is scarce, which might be explained by difficulties in the implementation of national newborn screening programs. Objective This study seeks for the first time to genotype and biochemically characterize patients diagnosed with hyperphenylalaninemia (HPA) at the Pediatric Metabolic Genetics Clinic at the King Hussein Medical Center, Amman, Jordan. Methods A total of 33 patients with HPA and 55 family members were investigated for pterins (neopterin and biopterin) and dihydropteridine reductase (DHPR) activity in dried blood spots. Patients with HPA were genotyped for phenylketonuria (PKU) and the genes involved in tetrahydrobiopterin (BH4) metabolism. Results In total 20 patients were diagnosed with PKU due to phenylalanine hydroxylase (PAH) deficiency, 2 with GTP cyclohydrolase I (GTPCH) deficiency, 6 with DHPR deficiency, and 3 with the 6‐pyruvoyl‐tetrahydropterin synthase (PTPS) deficiency. Diagnosis was not possible in 2 patients. This study documents a high percentage of BH4 deficiencies within HPA patients. With one exception, all patients were homozygous for particular gene variants. Conclusions This approach enables differentiation between PKU and BH4 deficiencies and, thus, allows for critical selection of a specific treatment strategies.

Objective: To investigate the presence of titanium particles in peri-implant tissues in cases diagnosed with peri-implantitis, and to identify immunological reactions that these particles may elicit. Methods: Ten peri-implant tissue biopsies of patients diagnosed clinically and radiographically with peri-implantitis were obtained from the archives of Oral Pathology Centre, University of Otago. The inclusion criteria involves: bleeding on probing, ≥6 mm probing depth and ≥3 mm radiographic bone loss around the dental implant. Peri-implant tissue samples were evaluated using scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-EDS) to identify of sites with/without titanium particles. Antibodies against human transforming growth factor beta 1 (TGF-β1), receptor activator of nuclear factor kappa-B ligand (RANKL), interleukin 33 (IL-33) and cluster of differentiation 68 (CD68) were used to stain the specimens. ImageJ software was used to standardise the sampling area, compare and characterise the inflammatory infiltrate in tissues with/without titanium particles. Inflammatory cytokines positivity was assessed using the immunoreactive scores (IRSs). Results: Light microscopy and SEM-EDS analysis identified titanium wear particles in 90% of the tissue samples, associated with a mixed chronic inflammatory infiltrate. Quantification analysis of RANKL revealed significantly higher IRS and intensity scores (p

Background and Objective. Several risk factors have been implicated in onset and development of peri-implant diseases. The impact of these factors, however, remains controversial across the different clinical settings and populations. The aim of this retrospective study was to evaluate the risk factors for peri-implant diseases among an Emirati population. Methods. A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. The strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors. Results. A total of 162 patients with 301 implant-supported restorations were included in the study. The age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. The binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis. Conclusion. Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.

Alveolar ridge preservation (ARP) reduces dimensional changes following tooth extraction. We evaluated the changes in alveolar ridge dimensions after ARP using bone substitutes and collagen membranes. Objectives included the tomographic evaluation of sites prior to extraction and six months after ARP and the assessment of the extent ARP preserved the ridge and reduced the need for additional augmentation at the time of implant placement. A total of 12 participants who underwent ARP in the Postgraduate Periodontics Clinic (Faculty of Dentistry) were included. Cone beam computed tomography images were used to retrospectively assess 17 sites prior to and six months after dental extraction. Alveolar ridge changes were recorded and analysed using reproducible reference points. The alveolar ridge height was measured at buccal and palatal/lingual aspects, whilst width was measured at crestal level, 2 mm, 4 mm and 6 mm below the crest. Statistically significant changes were found in alveolar ridge width at all four heights, with mean reduction differences ranging from 1.16 mm to 2.84 mm. Likewise, significant changes in the palatal/lingual alveolar ridge height (1.28 mm) were observed. However, changes of 0.79 mm in buccal alveolar ridge height were not significant (p = 0.077). Although ARP reduced dimensional changes following a tooth extraction, some degree of alveolar ridge collapse could not be avoided. The amount of resorption on the buccal aspect of the ridge was less compared to the palatal/lingual after ARP. This indicated that the use of bone substitutes and collagen membranes was effective in reducing changes in the buccal alveolar ridge height.

Introduction: Once the COVID-19 pandemic was declared, the world was waiting for the clue that would be able to cut down the progression of the disease. Vaccines play a crucial role in reducing the disease and saving many people worldwide. However, there are several side effects of these vaccines, like pain, fatigue, fever, and neurological defects like Bell’s palsy. In this systematic review, we presented evidence about the occurrence of Bell’s palsy followed by COVID-19 vaccination. Methods: We searched PubMed, SCOPUS, EBSCO, and Web of Science (WOS) from inception till October 2022. The quality assessment was conducted using the Joanna Briggs Institute, National Institute of Health, and Newcastle-Ottawa. The analysis was conducted on SPSS. Results: Thirty-five records were involved in our study. The results of our cases revealed that most of the patients (62.8%) experienced unilateral facial paralysis. Also, the majority of the cases were reported after the first dose, and most cases were after Pfizer, AstraZeneca, and Sputnik V vaccines, respectively. The patients who were treated with corticosteroids, IVIG, and anti-viral drugs, showed marked recovery afterward. Conclusion: The rate ratio of Bell’s palsy after COVID-19 vaccination was 25.3 per 1,000,000. The ratio was higher after the first dose compared to the second dose and was higher among those who took Oxford/AstraZeneca vaccine compared to other vaccines. However, this condition was reported in a small number of cases among a large number of vaccinated people worldwide. It is important to note that the benefits of getting vaccinated far outweigh any potential risks.

Liquid biopsies have the potential to revolutionize cancer care through non-invasive early detection of tumors. Developing a robust liquid biopsy test requires collecting high-dimensional data from a large number of blood samples across heterogeneous groups of patients. We propose that the generative capability of variational auto-encoders enables learning a robust and generalizable signature of blood-based biomarkers. In this study, we analyze orphan non-coding RNAs (oncRNAs) from serum samples of 1050 individuals diagnosed with non-small cell lung cancer (NSCLC) at various stages, as well as sex-, age-, and BMI-matched controls. We demonstrate that our multi-task generative AI model, Orion, surpasses commonly used methods in both overall performance and generalizability to held-out datasets. Orion achieves an overall sensitivity of 94% (95% CI: 87%-98%) at 87% (95% CI: 81%-93%) specificity for cancer detection across all stages, outperforming the sensitivity of other methods on held-out validation datasets by more than  ~ 30%.

Tick-transmitted Babesia are a major global veterinary threat and an emerging risk to humans. Unlike their Plasmodium relatives, these erythrocyte-infecting Apicomplexa have been largely overlooked and lack specific treatment. Selective targeting of the Babesia proteasome holds promise for drug development. In this study, we screened a library of peptide epoxyketone inhibitors derived from the marine natural product carmaphycin B for their activity against Babesia. Several of these compounds showed activity against both the asexual and sexual blood stages of Plasmodium falciparum. These compounds inactivate β5 proteasome subunit activity in the lysates of Babesia divergens and Babesia microti in the low nanomolar range. Several compounds were tested with the purified B. divergens proteasome and showed IC50 values comparable to carfilzomib, an approved anticancer proteasome inhibitor. They also inhibited B. divergens growth in bovine erythrocyte cultures with solid EC50 values, but importantly, they appeared less toxic to human cells than carfilzomib. These compounds therefore offer a wider therapeutic window and provide new insights into the development of small proteasome inhibitors as selective drugs for babesiosis.