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Background: Increased spatial and temporal dispersion of repolarization contributes to ventricular arrhythmogenesis. Beat-to-beat fluctuations in T-wave timing are thought to represent such dispersion and may predict clinical events.Objective: The purpose of this study was to assess whether a novel noninvasive measure of beat-to-beat instability in T-wave timing would provide additive prognostic information in post-myocardial infarction patients.Methods: We studied 678 patients from 12 hospitals with 32-lead 5-minute electrocardiogram recordings 6-8 weeks after myocardial infarction. Custom software identified R wave-to-T wave intervals (RTIs) and diastolic intervals (DIs). Repolarization scatter (RTI:DI(StdErr)) was then calculated as the standard error about the RTI:DI regression line. In addition, left ventricular ejection fraction (LVEF), short-term heart rate variability (HRV) parameters, and QT variability index were measured. Patients were followed for the composite endpoint of death or life-threatening ventricular arrhythmia.Results: After a mean follow-up of 63 months, 134 patients met the composite endpoint. An RTI:DI(StdErr) >5.50 ms was associated with a 210% increase in arrhythmias or deaths (P <.001). After adjusting for LVEF, RTI:DI(StdErr) remained an independent predictor (P <.001). RTI:DI(StdErr) was also independent of short-term HRV parameters and the QT variability index.Conclusions: Increased repolarization scatter, a measure of high-frequency, cycle-length-dependent repolarization instability, predicts poor outcomes in patients after myocardial infarction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic right ventricular pacing has been reported to promote cardiac dyssynchrony. The PAVE trial prospectively compared chronic biventricular pacing to right ventricular pacing in patients undergoing ablation of the AV node for management of atrial fibrillation with rapid ventricular rates. METHODS AND RESULTS: One hundred and eighty-four patients requiring AV node ablation were randomized to receive a biventricular pacing system (n = 103) or a right ventricular pacing system (n = 81). The study endpoints were change in the 6-minute hallway walk test, quality of life, and left ventricular ejection fraction. Patient characteristics were similar (64% male; age: 69 +/- 10 years, ejection fraction: 0.46 +/- 0.16; 83%, NYHA Class II or III). At 6 months postablation, patients treated with cardiac resynchronization had a significant improvement in 6-minute walk distance, (31%) above baseline (82.9 +/- 94.7 m), compared to patients receiving right ventricular pacing, (24%) above baseline (61.2 +/- 90.0 m) (P = 0.04). There were no significant differences in the quality-of-life parameters. At 6 months postablation, the ejection fraction in the biventricular group (0.46 +/- 0.13) was significantly greater in comparison to patients receiving right ventricular pacing (0.41 +/- 0.13, P = 0.03). Patients with an ejection fraction

Dry-electrode heart rate monitors allow display of heart rate by transmitting a signal to the receiving device, which typically is on the wrist or exercise machine, but due to the potential for electromagnetic interference, their use has been contraindicated in patients with pacemakers. In 12 patients, we found no adverse effect on pacemaker function; in addition, the monitors generally were accurate in measuring heart rate during pacing. [ABSTRACT FROM AUTHOR]

Aims: To investigate the mediating role of spiritual well-being in the association between compassion fatigue and moral resilience among nurses., Background: Nurses are inevitably placed in situations of compassion fatigue. Their moral resilience and spiritual well-being may play a crucial role in mitigating the impacts of compassion fatigue. Nonetheless, spiritual well-being, which mediates the influence between compassion fatigue and moral resilience, remains scarce among nurses., Design: Cross-sectional and correlational design., Methods: Nurses (n = 465) from four government-owned tertiary hospitals in Saudi Arabia were recruited and completed three self-report scales from July to December 2023. Descriptive statistics (e.g., mean, standard deviation, frequency, and proportions) and inferential statistics (Spearman rho and structural equation modeling) were used for data analysis., Results: The emerging model afforded acceptable model fit parameters. Moral resilience had a negative effect on compassion fatigue (β = -0.05, p = 0.003) and a positive influence on spiritual well-being (β = 0.51, p = 0.003). Spiritual well-being negatively influenced compassion fatigue (β = -0.90, p = 0.003). Moral resilience had a moderate, negative, indirect effect on compassion fatigue through the mediation of spiritual well-being (β = -0.47, p = 0.002)., Conclusion: Our study offered a model that validated the mediating role of spiritual well-being in the association between moral resilience and compassion fatigue. Moral resilience directly and indirectly influences spiritual well-being and compassion fatigue, respectively., Implications for Nursing Practice and Policy: Healthcare institutions that employ nurses must continually assess compassion fatigue levels and provide necessary interventions. Nurses, nurse managers, and healthcare institutions may leverage moral resilience to improve nurses' spiritual well-being while averting the negative effects of compassion fatigue. Healthcare institutions may incorporate spiritual care into their mainstream support interventions to enhance their compassion, reduce fatigue, and enhance their mental well-being., (© 2024 International Council of Nurses.)

Long-term stability of blood-derived eye drops is required to adapt the use of this treatment to prolonged clinical treatments and more green pharmacy. This study has been designed to assess the long-term storage life of freeze-dried plasma rich in growth factors (PRGF) eye drops, maintaining their biological content and activity. Thus, blood from five healthy donors was extracted and centrifuged for obtaining PRGF. The obtained PRGF eye-drops after platelet activation were freeze- stored or were lyophilized and then stored for 18 and 24 months at room temperature (RT) or at + 4 ºC. Growth factor content and proliferative potential of PRGF eye drops on primary human corneal fibroblasts (HK) was evaluated at each storage time and condition. All growth factors maintained their levels at each time and storage condition. No differences were observed on the proliferative activity of keratocytes after treatment with freeze-dried PRGF eye-drops stored at RT or + 4 ºC for 18 or 24 months in comparison with fresh samples. No microbial contamination was observed in any of the PRGF eye-drops. Accepting the limitations of this study, it is observed that freeze-dried PRGF eye drops retain both key growth factors and biological activity when stored at room temperature or + 4°C for up to 18-24 months., (Copyright © 2025. Published by Elsevier Inc.)

Objectives: This study aimed to assess the impact of a deep learning model on oral radiologists' ability to detect periapical radiolucencies on periapical radiographs. The secondary objective was to conduct a regression analysis to evaluate the effects of years of experience, time to diagnose, and specialty., Methods: This study used an annotated dataset and a beta version of a deep learning model (Denti.AI). The testing subset comprised 68 intraoral periapical radiographs confirmed with cone-beam computed tomography for the presence/absence of apical radiolucencies. Four oral radiologists participated in a cross-over reading scenario, analysing the radiographs under 2 conditions: initially without AI assistance and later with AI predictions. The study evaluated reader performance using Alternative Free-Response Receiver Operating Characteristic - Area Under the Curve (AFROC-AUC), sensitivity, specificity, and Receiver Operating Characteristic-Area Under the Curve (ROC-AUC) per case. It also assessed sensitivity per lesion. Regression analysis investigated how experience, time spent on images, and specialty influenced reader performance., Results: No statistically significant differences were found in AFROC-AUC, sensitivity, specificity, and ROC-AUC. Regression analysis identified factors influencing diagnostic outcomes: unaided reading significantly prolonged diagnostic time (β = 12, 95% CI, 11-13, P < 0.001), while radiologists' professional status was positively associated with diagnostic accuracy (β = 0.02, 95% CI, 0.00-0.04, P = 0.015). These findings underscore the impact of AI on diagnostic efficiency and the critical role of radiologists' experience in diagnostic accuracy., Conclusion: AI did not significantly enhance radiologists' overall diagnostic accuracy. However, it showed potential to enhance efficiency, particularly advantageous for non-expert clinicians. The expertise of radiologists remains vital for accuracy, underscoring the complementary role of AI in dental diagnostics., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology and the International Association of Dentomaxillofacial Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Competing Interests: Disclosures Drs Hamdan, Brignole, Michelet, Deharo, and Guieu have an approved (EU) and pending (US) patent application entitled Sublingual Formulation for Hypotension and Syncope.

Background : Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods : A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher's exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p -value < 0.05. Results : The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions : Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates.

Background and Objectives : Age-related macular degeneration (AMD) is the leading cause of low vision and legal blindness in adults in developed countries. Wet AMD can be successfully treated using vascular endothelial growth factor (VEGF) inhibitors; however, dry AMD currently has no effective treatment. The purpose of this study is to analyze the efficacy of intraocular injection of plasma rich in growth factors (PRGF) in an AMD mouse model induced by intraperitoneal administration of sodium iodate. Materials and Methods : Intravitreal application of PRGF (experimental group) and saline (control group) was performed immediately after intraperitoneal injection of sodium iodate. Retinographies were performed at 2 and 7 days after treatment administration. The eyes were retrieved for histological and immunohistological analysis. Statistical analysis was performed to compare the outcomes between the study groups. Results : In comparison to saline solution, PRGF significantly decreased the depigmentation of the RPE, showing a more reddened retina. PRGF intravitreal treatment significantly reduced the glial fibrillary acidic protein (GFAP) stained processes, suggesting a significant reduction in the risk of scar formation. Moreover, the myofibroblast invasion into the RPE cell layer was significantly reduced in the PRGF-treated group of mice. There was a tendency for better preservation of the photoreceptors in the PRGF group. Conclusions : Within the limitations of this study, intravitreal injection of PRGF provided significant protection against the degeneration of the photoreceptors and the RPE induced by the systemic administration of NaIO 3 .

Bifid mandibular canals are common anatomical findings with variations based on direction and location of branching, which carry significant clinical implications for endodontic and surgical dental procedures. This case report describes a previously unreported ectopic dental canal that branches off the superior border of the mandibular canal, enters the apex of a mandibular second molar, traverses through the root, anastomoses with the root canal system, and subsequently exits through the lingual aspect of the root. The anastomosis of this ectopic dental canal with the mesial lingual canal led to significant bleeding during rotary instrumentation. This unique anatomical variation demonstrates the importance of a thorough cone-beam computed tomography analysis to identify critical structures prior to undertaking dental procedures involving the root apices of mandibular posterior teeth and adjacent areas., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Schwannomas are rare, benign tumors that develop from Schwann cells in the peripheral nervous system, and they make up only a small fraction of cases found in the upper limbs. Oftentimes, these tumors do not show symptoms until they start pressing on nearby structures. In this case report, we share the case of a 34-year-old woman who had painless swelling in her right distal forearm for three years. Unfortunately, this swelling eventually led to numbness and pain along the distribution of her median nerve. An MRI revealed a well-defined lesion associated with the median nerve, and a biopsy confirmed it as a schwannoma. After surgically removing the tumor, she experienced complete relief from her symptoms. This case underscores the importance of considering schwannomas when evaluating forearm masses and provides insight into the diagnostic and surgical approaches involved in managing these tumors., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohd Ibrahim et al.)

Introduction: Digital workflow and intraoral scanners (IOSs) are used to clinically obtain data for a wide range of applications in restorative dentistry. The study aimed to compare two different IOSs with inexperienced users in the digital workflow of oral split manufacturing. Material and Methods: Anonymous stone models of upper and lower dentate patients were used. Both models were scanned with a desktop 3D scanner 3Shape D2000 to obtain the reference models (STL R ). Ten inexperienced operators scanned each model three times with each IOS system (3Shape TRIOS 3 and Carestream CS 3800). Finally, 20 intraoral scanners were randomly chosen from the obtained dataset (10 per IOS system) to design and manufacture 20 nightguards. All the nightguards were scanned. Trueness and precision were calculated and compared between the two IOS systems. Results: All the mean errors both for trueness and precision were below 40 µm, more than acceptable for the design and manufacturing of intraoral devices such as nightguards. All the mean errors (except one) for trueness between the inner part of the nightguards and the upper control model were below 100 µm, less than a printed layer height. For inexperienced operators, both IOSs are suitable for a digital workflow of manufacturing occlusal splints.

Objective: This randomized controlled split-mouth trial compared the performance of 5.5 mm length implants (test group; TG) splinted within the same fixed prosthesis as longer implants (≥6.5 mm; control group; CG) in posterior regions. Methods: The primary hypothesis was that implant length does not affect marginal bone loss (MBL) one year post-implantation, while the secondary hypotheses included implant survival, peri-implant clinical variables, and prosthetic complications. Fifteen patients (eight males, seven females) with a mean age of 67 ± 9 years were included. Results: No significant difference in the implant position between groups ( p = 0.808) was observed. Implant diameters ranged from 3.00 to 4.25 mm, and the most common bone type was type I (67%). Bone density ( p = 0.574) and implant insertion torque ( p = 0.888) were similar between groups. Mesial MBL (mean: -0.1; range: -1.19 to 0.24 for TG, and -0.03; -1.75 to 0.45 for CG; p = 0.955) and distal MBL (mean: -0.05; range: -1.41 to 0.27 for TG, and 0.08; -1.45 to 0.72 for CG; p = 0.118) did not show statistical differences. There were no implant failures or technical complications. Conclusions: These findings suggest that 5.5 mm length implants could be a viable option for use in posterior regions, providing similar clinical outcomes to longer implants one year post-implantation.

Objective: Sleep bruxism (SB) is a repetitive rhythmic and nonrhythmic activity. It can be a comorbid condition for other disorders, such as sleep breathing disorders (SBD). However, a clear causal link between these factors is yet to be established. Moreover, this relationship is even more unknown in children. Thus, this systematic review aimed to determine the relationship between SB and SBD in children and teenagers and consolidate the current knowledge about the possible association between both phenomena at the pediatric age., Materials and Methods: Advanced searches were performed in five electronic databases with the last search updated on February 1, 2023. The methodological quality of the selected studies was analyzed using the quality assessment tool for experimental bruxism studies., Results: Twenty-nine of 6378 articles were selected for detailed analyses. Most articles found a comorbid relationship between SB and SBD, though no study analyzed a temporary relationship. Due to the heterogeneity of the studies, a meta-analysis could not be performed., Conclusion: Despite the limitations of this systematic review, it can be concluded that there is an association between SB and SBD in children. However, the level of evidence is low., (© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Background: Oral microbiota comprises polymicrobial communities shaped by mutualistic coevolution with the host, contributing to homeostasis and regulating immune function. Nevertheless, dysbiosis of oral bacterial communities is associated with a number of clinical symptoms that ranges from infections to oral cancer. Peri-implant diseases are biofilm-associated inflammatory conditions affecting the soft and hard tissues around dental implants. Characterization and identification of the biofilm community are essential for the understanding of the pathophysiology of such diseases. For that sampling methods should be representative of the biofilm communities Therefore, there is a need to know the effect of different sampling strategies on the biofilm characterization by next generation sequencing., Methods: With the aim of selecting an appropriate microbiome sampling procedure for periimplant biofilms, next generation sequencing was used for characterizing the bacterial communities obtained by three different sampling strategies two months after transepithelial abutment placement: adjacent periodontal crevicular fluid (ToCF), crevicular fluid from transepithelial abutment (TACF) and transepithelial abutment (TA)., Results: Significant differences in multiple alpha diversity indices were detected at both the OTU and the genus level between different sampling procedures. Differentially abundant taxa were detected between sample collection strategies, including peri-implant health and disease related taxa. At the community level significant differences were also detected between TACF and TA and also between TA and ToCF. Moreover, differential network properties and association patterns were identified., Conclusions: The selection of sample collection strategy can significantly affect the community composition and structure., Trial Registration: This research is part of a randomized clinical trial that was designed to assess the effect of transepithelial abutment surface on the biofilm formation. The trial was registered at Trial Registration ClinicalTrials.gov under the number NCT03554876., (© 2024. The Author(s).)

Controlling the hazard of sclerotia produced by the Sclerotinia sclerotiorum is very complex, and it is urgent to adopt an effective method that is harmonious environmentally to control the disease. Among the six isolates isolated from the rhizosphere of lettuce, the isolate HZA84 demonstrated a high activity in its antagonism towards Sclerotinia sclerotiorum in vitro, and produces siderophore. By amplification of internal transcribed spacer (ITS), translation elongation factor 1-alpha (TEF1-α), and RNA polymerase II subunit (RPB2) genes, the isolate HZA84 was identified as Trichoderma asperellum, which was confirmed by analysis of phylogenetic tree. The Scanning electron microscope monitoring detected that the isolate HZA84 spread over the sclerotial surface, thus, damaging, decomposing, and distorting the globular cells of the outer cortex of the sclerotia. The Real-time polymerase chain reaction (RT-qPCR) analysis disclosed the overexpression of two genes (chit33 and chit37) encoding the endochitinase in addition to one gene (prb1) encoding the proteinase during 4 and 8 days of the parasitism behavior of isolate HZA84 on the sclerotia surface. These enzymes aligned together in the sclerotia destruction by hyperparasitism. On the other hand, the pots trial revealed that spraying of isolate HZA84 reduced the drop disease symptoms of lettuce. The disease severity was decreased by 19.33 and the biocontrol efficiency was increased by 80.67% within the fourth week of inoculation. These findings magnify the unique role of Trichoderma in disrupting the development of plant diseases in sustainable ways., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs)., Background: Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines., Design: Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines., Methods: Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis., Results: The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs., Conclusions: Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance., Implications for Nursing Policy and Practice: Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance., (© 2024 International Council of Nurses.)

Introduction: Although COVID-19 has entered the endemic phase, individuals infected with COVID-19 are required to adhere to home quarantine measures. By exploring the public's knowledge and attitude towards recommended home quarantine measures, their readiness in containing potential COVID-19 outbreak can be determined. This study aimed to assess the public knowledge and attitude towards home quarantine instructions and their association with history of COVID-19 infections., Methods: This was a web-based cross-sectional study conducted among the public in Malaysia between August to October 2022. All Malaysian adults over 18 years of age were included. Knowledge on home quarantine instructions and COVID-19 warning signs were measured using "True," "False," or "I'm not sure", while attitude towards home quarantine instructions was measured using a five-point Likert Scale. The questionnaire was initially constructed in English and then translated into the national language, Bahasa Malaysia. Face and content validation were performed. The internal consistency of the questionnaire was found to be satisfactory., Results: 1,036 respondents were analyzed, comprised mostly of females (743, 71.6%) with a history of COVID-19 (673, 64.9%). In the knowledge domain, more than 80% of the respondents answered 9 out of 11 home quarantine instructions statements correctly. 457 (44.1%) were unaware or unsure about the minimum distance of the infected individual's bed from the rest of the occupants in a shared bedroom. The respondents reported relatively weaker knowledge in identifying uncommon warning signs of COVID-19 deterioration, including anuria (162, 44.5%), ingestion problems (191, 52.5%), and immobility (195, 53.6%). In the attitude domain, more than 90% of respondents answered correctly in 8 out of 9 questions. Respondents with a previous history of COVID-19 infections had better knowledge than COVID-19 infection-naïve individuals towards both home quarantine instructions and COVID-19 warning signs., Conclusion: Most respondents had good knowledge and attitude towards home quarantine instructions, with those previously infected with COVID-19 showing greater awareness of uncommon warning signs. However, there was a notable lack of awareness regarding physical distancing within shared rooms, appropriate disinfectant use and mobility limitation within the household. This study highlights the knowledge gaps to be improved in future educational campaigns., (© 2024. The Author(s).)

The osteogenic differentiation process, by which bone marrow mesenchymal stem cells and osteoprogenitors transform into osteoblasts, is regulated by several growth factors, cytokines, and hormones. Plasma Rich in Growth Factors (PRGF) is a blood-derived preparation consisting of a plethora of bioactive molecules, also susceptible to containing epigenetic factors such as ncRNAs and EVs, that stimulates tissue regeneration. The aim of this study was to investigate the effect of the PRGF clot formulation on osteogenic differentiation. Firstly, osteoblast cells were isolated and characterised. The proliferation of bone cells cultured onto PRGF clots or treated with PRGF supernatant was determined. Moreover, the gene expression of Runx2 (ID: 860), SP7 (ID: 121340), and ALPL (ID: 249) was analysed by one-step real-time quantitative polymerase chain reaction (RT-qPCR). Additionally, alkaline phosphatase (ALPL) activity determination was performed. The highest proliferative effect was achieved by the PRGF supernatant in all the study periods analysed. Concerning gene expression, the logRGE of Runx2 increased significantly in osteoblasts cultured with PRGF formulations compared with the control group, while that of SP7 increased significantly in osteoblasts grown on the PRGF clots. On the other hand, despite the fact that the PRGF supernatant induced ALPL up-regulation, significantly higher enzyme activity was detected for the PRGF clots in comparison with the supernatant formulation. According to our results, contact with the PRGF clot could promote a more advanced phase in the osteogenic process, associated to higher levels of ALPL activity. Furthermore, the PRGF clot releasate stimulated a higher proliferation rate in addition to reduced SP7 expression in the cells located at a distant ubication, leading to a less mature osteoblast stage. Thus, the spatial relationship between the PRGF clot and the osteoprogenitors cells could be a factor that influences regenerative outcomes.

Accidental events or surgical procedures usually lead to tissue injury. Fibrin sealants have proven to optimize the healing process but have some drawbacks due to their allogeneic nature. Autologous fibrin sealants present several advantages. The aim of this study is to evaluate the performance of a new autologous fibrin sealant based on Endoret®PRGF® technology (E-sealant). One of the most widely used commercial fibrin sealants (Tisseel®) was included as comparative Control. E-sealant´s hematological and biological properties were characterized. The coagulation kinetics and the microstructure were compared. Their rheological profile and biomechanical behavior were also recorded. Finally, the swelling/shrinkage capacity and the enzymatic degradation of adhesives were determined. E-sealant presented a moderate platelet concentration and physiological levels of fibrinogen and thrombin. It clotted 30 s after activation. The microstructure of E-sealant showed a homogeneous fibrillar scaffold with numerous and scattered platelet aggregates. In contrast, Control presented absence of blood cells and amorphous protein deposits. Although in different order of magnitude, both adhesives had similar rheological profiles and viscoelasticity. Control showed a higher hardness but both adhesives presented a pseudoplastic hydrogel nature with a shear thinning behavior. Regarding their adhesiveness, E-sealant presented a higher tensile strength before cohesive failure but their elastic stretching capacity and maximum elongation was similar. While E-sealant presented a significant shrinkage process, Control showed a slight swelling over time. In addition, E-sealant presented a high enzymatic resorption rate, while Control showed to withstand the biodegradation process in a significant way. E-sealant presents optimal biochemical and biomechanical properties suitable for its use as a fibrin sealant with regenerative purposes., (© 2024. The Author(s).)

Purpose: The aim of this study was to assess implant survival and complications rate of modern subperiosteal implants (CAD designed and additively manufactured)., Methods: A systematic review was conducted using three electronic databases; Medline (Pubmed), Cochrane library, and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: "In patients with bone atrophy (P), do additively manufactured subperiosteal implants (I), compared to subperiosteal implants manufactured following traditional approaches (c), present satisfactory implant survival and complication rates (O)? The study was pre-registered in PROSPERO (CRD42023424211). Included articles quality was assessed using the "NIH quality assessment tools"., Results: Thirteen articles were finally selected (5 cohort studies and 8 case series), including 227 patients (121 female / 106 male; weighted mean age 62.4 years) and 227 implants. After a weighted mean follow-up time of 21.4 months, 97.8% of implants were in function (5 failures reported), 58 implants (25.6%) presented partial exposure, 12 patients (5.3%) suffered soft tissue or persistent infection. Fracture of the interim prosthesis was reported in 8 of the155 patients (5.2%) in which the use of a provisional prosthesis was reported. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible., Conclusions: Within the limitations of this study, modern additively manufactured subperiosteal implants presented a good survival in the short-time, but a noticeable number of soft-tissue related complications were reported. Further studies are needed to assess the clinical behavior in the medium- and long-term., (© 2024. The Author(s).)

The aim of this systematic review is the assessment of the effect of mouth breathing on the prevalence of tongue thrust. The review was performed according to the PRISMA 2020 checklist guidelines, and the protocol was registered with PROSPERO (CRD42022339527). The inclusion criteria were the following: studies of clinical trials and cross-sectional and longitudinal descriptive studies that evaluate the appearance of tongue thrust in patients with mouth breathing; healthy subjects of any age, race or sex; and studies with a minimum sample group of five cases. The exclusion criteria were the following: studies with syndromic patients, articles from case reports, and letters to the editor and/or publisher. Searches were performed in electronic databases such as The National Library of Medicine (MEDLINE via PUBMED), the Cochrane Central Register of Controlled Trials, Web of Science and Scopus, including studies published until November 2023, without a language filter. The methodological quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) tool was used for descriptive cross-sectional studies and cross-sectional prevalence studies. A meta-analysis was conducted on studies that provided data on patients' classification according to mouth breathing (yes/no) as well as atypical swallowing (yes/no) using Review Manager 5.4. From 424 records, 12 articles were selected, and 4 were eligible for meta-analysis. It was shown that there is no consensus on the diagnostic methods used for mouth breathing and tongue thrust. The pooled risk ratio of atypical swallowing was significantly higher in the patients with mouth breathing (RR: 3.70; 95% CI: 2.06 to 6.66). These studies have several limitations, such as the heterogeneity among the individual studies in relation to the diagnostic tools and criteria for the assessment of mouth breathing and atypical swallowing. Considering the results, this systematic review shows that patients with mouth breathing presented higher risk ratios for atypical swallowing.

This study compared the survival, marginal bone loss (MBL), and prosthetic complications of 4.5-mm extra-short implants and longer implants splinted to the short implants via the restoration. A retrospective controlled cohort study was performed. The 4.5-mm extra-short group (study group; SG) included 48 consecutively placed implants. The control group (CG) included 48 implants splinted to the extra-short implants. The same surgical team treated the 39 included patients, and all implants were restored with a screw-retained fixed restoration and intermediate abutments. Im- mediate and conventionally loaded implants were included. All implants were in function during the follow-up period (14 ± 3.4 and 17 ± 13 months for SG and CG, respectively). No differences in techni- cal complications were observed between the groups (one and two cases of screw loosening for SG and CG, respectively; two provisional prosthesis fractures for SG; P &#61; .310). Marginal bone stability was similar for SG and CG at the mesial level (-0.01 ± 0.28 mm for SG vs -0.18 ± 0.72 mm for CG; P &#61; .270) and at the distal level (0.02 ± 0.39 mm for SG vs -0.18 ± 0.68 mm for CG; P &#61; .076). The same good clinical performance could be observed for 4.5-mm implants and longer implants under the same prosthesis.

Background: Moral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage remains an unexplored concept among middle eastern nurses., Aim: This study investigated the mediating role of moral courage in the relationship between burnout, professional competence, and compassion fatigue among Saudi Arabian nurses., Research Design: Correlational, cross-sectional design following the STROBE guidelines., Participants and Research Context: Convenience sampling was used to recruit nurses ( n = 684) for four government hospitals in Saudi Arabia. Four validated self-report questionnaires (Nurses' Moral Courage Scale, Nurse Professional Competence Scale-Short Form, Maslach Burnout Inventory, and Nurses Compassion Fatigue Inventory) were used to collect data between May to September 2022. Spearman rho and structural equation modeling analyses were employed to analyze the data., Ethical Considerations: The ethics review committee of a government university in Ha'il region, Saudi Arabia, approval this study (Protocol no.: H-2021-012; Approved: 08/022,021). Participants were fully explained the study aims, and consent was voluntarily secured., Results: The emerging model showed that burnout had a direct and positive influence on compassion fatigue, while professional competence had a direct, negative effect on compassion fatigue. Moral courage had a small and direct but negative influence on compassion fatigue. Mediation analyses also indicated that moral courage significantly mediated the indirect effects of burnout and professional competence on compassion fatigue., Conclusion: Moral courage can be a crucial aspect in preserving the psychological and mental health of nurses, particularly under stressful conditions. Therefore, it is advantageous from an organizational and leadership standpoint to implement measures such as programs and interventions to foster moral courage among nurses., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The main objective of this prospective study was the evaluation of 1 mm step titration of mandible advancement in the success of treating obstructive sleep apnea (OSA). For that, a multicenter prospective study was designed to recruit patients with OSA who were eligible to receive a mandibular advancement device. Gradual titration of mandibular advancement (steps of 1 mm) from maximum intercuspidation was performed to determine the optimal mandibular advancement (highest reduction in the apnea-hypopnea index (AHI)). The principal variable was the percentage of patients where a reduction ≥50% of the AHI was achieved at the end of the titration phase. A total of 102 patients participated in this study. Fifty-six percent of the participants were males and 67% had a BMI ≥ 25 kg/m 2 . Most of the patients (79%) had an age ≥ 50 years and the majority (74%) were either non-smokers or ex-smokers. Excessive daytime sleepiness was reported by 40% of the patients. The mean AHI at baseline was 20.6 ± 12.7 events/h. The mean advancement of the mandible was 3.1 ± 1.6 mm. The device achieved a reduction in the AHI in 93% of the patients and success (≥50% reduction in the AHI) in 69% of the patients. Success was achieved in 50%, 81.6%, and 73.3% of the patients with mild, moderate, and severe OSA, respectively. Decreasing the magnitude of mandibular advancement could be possible by controlling the vertical mouth opening and step-by-step titration.

Purpose: Increasing scientific evidence support extending the application of short dental implants to non-atrophic dental arches. The purpose of this study has been the evaluation of extra-short implants (≤ 6.5 mm in length) that were placed in atrophic and non-atrophic anatomical sites to support the same prosthesis., Methods: For that, a retrospective study was conducted by including complete dentures that were solely supported by extra-short implants in the maxilla and/or the mandible. Clinical data about patients, implants, anatomy, and prosthesis were obtained. Statistical analysis was performed to assess implant- and prosthesis-survival, changes in the marginal bone level and prosthetic complications., Results: A total of 87 implants in 15 screw-retained complete dentures were assessed. None of the prostheses nor the extra-short implant failed during the follow-up of 27.2 ± 15.4 months. The changes in the mesial and distal marginal bone level were + 0.15 ± 0.51 mm and + 0.11 ± 0.50 mm, respectively. Comparing the implants according to the availability of sufficient bone to place longer implants, indicated the absence of significant differences in the changes of the mesial marginal bone level. However, the changes in the distal marginal bone level showed a statistically significant difference in favor of implants that were placed in non-atrophic sites. Two events of screw loosening were reported that were resolved by retightening the screws., Conclusions: Implant- and prosthesis-related outcomes support the use of extra-short implants in atrophic and non-atrophic site to support complete prosthesis., (© 2023. Deutsche Gesellschaft für Implantologie im Zahn‐, Mund‐ und Kieferbereich e.V., Japanese Society of Oral Implantology.)

Background: The nursing profession has significant importance in delivering high-quality healthcare services. Nursing practitioners who have essential competencies and who are satisfied with their job are vital in achieving optimum patient outcomes. Understanding the effects of technology integration on nurse workforce competencies and job satisfaction is crucial due to the fast progress of technology in healthcare settings. Furthermore, many elements, including self-efficacy, social support, and prior experience have been recognized as possible mediators or moderators within this association. The primary objective of this quantitative research was to examine the influence of nursing education and the integration of technology on the competencies and job satisfaction of nursing professionals. Additionally, this study aimed to explore the potential mediating and moderating effects of self-efficacy and social support in this relationship., Methods: This cross-sectional, quantitative study employed an online survey questionnaire with standardized scales to measure nursing workforce competencies, job satisfaction, self-efficacy, social support, and prior experience. It was completed by 210 registered nurses from various healthcare settings in the Kingdom of Saudi Arabia. Data were analyzed by descriptive statistics, Pearson correlation analysis, multiple regression analysis, and structural equation modeling performed with SPSS 23 and SmartPLS 3.0 software., Results: The study's findings revealed that nursing workforce competencies and job satisfaction were significantly predicted by nursing training and technology integration. The relationship between nursing training and technology integration, as well as nursing workforce competencies and job satisfaction, was partially mediated by self-efficacy and social support. Furthermore, prior experience moderated the relationship between nursing education and technological integration, nursing workforce competencies, and job satisfaction., Conclusions: The study's findings suggest that nursing training and technology integration can improve nursing workforce competencies and job satisfaction and that self-efficacy and social support play an important role in mediating this relationship. Furthermore, prior experience can have an impact on the efficacy of nursing training and technology integration programs for developing nursing workforce competencies. The study has several practical implications for nursing education, training, and professional development programs, as well as strategies used by healthcare organizations to improve nursing workforce competencies and job satisfaction. To maximize their impact on nursing workforce competencies and job satisfaction, this study recommends that nursing training and technology integration programs focus on enhancing self-efficacy and social support. Furthermore, the study emphasizes the significance of prior experience when designing and implementing nursing training and technology integration programs., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Osteomyelitis of the jaws presents a clinical challenge to conventional treatment, often requiring multiple surgical interventions resulting in significant deformity and presenting significant problems to satisfactory rehabilitation. While benign odontogenic cysts, such as the radicular cyst, are generally predictably treated, they can cause significant localized bone destruction and thus can present significant problems in satisfactory rehabilitation. In this case report, patients were treated combining conventionally appropriate surgical debridement and oral antibiotics with adjunctive plasma rich in growth factors (PRGF). Patients showed a complete soft tissue and osseous regeneration to their pre-pathologic state, with successful implant rehabilitation. PRGF appears to be highly successful in minimizing or eliminating osseous deformities normally associated with conventional treatment of osteomyelitis of the jaw and treatment of large odontogenic cysts. Future trials must be performed to confirm these results in comparison to controls using conventional treatment alone.

Background: The COVID-19 pandemic is a global health crisis that affected nurses' professional values and competence., Aim: Our study examined the relationship between nurses' professional values and competence in Saudi Arabia during the COVID-19 pandemic., Methods: This study used a descriptive cross-sectional design with 748 nurses from Saudi Arabia. Two self-report instruments were used to collect data. Structural equation modelling was conducted to analyse the data., Findings: The emerging model showed acceptable model-fit indices. Two dimensions of nurse professional values significantly affected professional competence: professionalism and activism. Professionalism significantly affected the other four facets (e.g., caring, activism, trust, and justice) of nurse professional values. The dimension of caring had a strong direct effect on activism. Justice had a moderate direct impact on trust, while activism had a weak direct impact on trust. Professionalism and caring had strong indirect effects on professional competence by mediating the dimension of activism., Discussion: The study's findings highlight the need for strategies to evaluate and strengthen the various areas of professional values to foster professional competence among nurses. Moreover, nurse administrators should encourage nurses to participate in continuing nursing education programs or provide in-service educational training to promote professional values and competence., Conclusion: This study provides a structural model of the interaction between nurses' professional values and competence during the pandemic. Nurse administrators can leverage the presented model to develop policies and strategies to evaluate and strengthen nurses' professional values and competence., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Australian College of Nursing Ltd. Published by Elsevier Ltd.)

Assisted reproductive technology (ART) is used to enhance pregnancy in infertile women. In this technique, the eggs are removed from the ovary and fertilized and injected with sperm to make embryos. Unfortunately, embryo implantation failures still occur in many of these women. Platelet-rich plasma (PRP) therapies use a patient's own platelets to promote tissue healing and growth, including endometrium. The growth factors provided by the platelets play a criterial role on the regenerative ability of PRP. In the last years, PRP treatments have been gaining a lot of popularity to treat women with repeated ART failures. In this study, we collected and summarized all information published in the scientific literature to assess the evidence of the PRP effect on pregnancy. We only considered randomized controlled trials (RCT), a type of study designed to be unbiased and considered at the highest level of evidence. Our analysis indicates that PRP therapies might be an effective treatment in cases of poor responsiveness to conventional ART. However, additional studies (well-designed) are necessary to confirm this beneficial effect of PRP.

Several factors in the pathophysiology of obstructive sleep apnea (OSA) may increase the likelihood of excessive occlusal loads. Increased occlusal loads may compromise a tooth's mechanical resistance. This prospective controlled study assessed the frequency of OSA in patients presenting with tooth fracture. Patients with and without tooth fractures were selected in a consecutive manner from a private dental clinic between February 2018 and January 2020. Demographic and dental variables were registered. A parafunctional habits questionnaire, anthropometric measurements, and validated respiratory polygraphy were performed. Descriptive, comparative, and correlation statistical analyses were performed. Multiple regression analysis was also performed. Fifty-nine patients were included, and 29 presented tooth fracture. Patients with a tooth fracture formed the case group and patients without tooth fracture formed the control group. Patient age was significantly higher in the case group (59 ± 13 years) compared to the control group (44 ± 11 years). Most of the fractured teeth were molars, had a natural tooth as an antagonist, and were not endodontically treated. Twenty-one patients had OSA (apnea-hypopnea index: ≥ 5 events per hour) in the case group compared with 12 patients in the control group (P = .027). Moreover, the patients in the case group had a significantly higher apnea-hypopnea index (P = .000). Multiple regression analysis showed that only age had a significant effect on tooth fracture (P = .002). However, there was a statistically significant relationship between OSA and the presence of tooth fracture in patients aged ≥ 40 years (P = .041). OSA was more frequent in patients presenting with tooth fractures.

The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. A systematic review was conducted using 4 electronic databases: MEDLINE (PubMed), Cochrane Library, Directory of Open Access Journals, and Scopus, following the PRISMA (Preferred Reporting Items for Systematic Reviews) statement recommendations to answer the PICO (Population, Intervention, Comparison, Outcome) question: "In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)? The study was pre-registered in PROSPERO (CRD42021229479). Included article quality was assessed using the "NIH quality assessment tool", "The Newcastle-Ottawa scale," and "JBI critical appraisal tools for case reports." Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range: 89.2%-100%). No statistical differences could be inferred between the treatments performed in 1- or 2-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system and based on the study quality level, the strength of evidence attending the SORT (Strength Of Recommendation Taxonomy) was B.

Background: The objective of this systematic review is to assess the effect of the adjuvant use of platelet-rich plasma (PRP) and its type on new bone formation by anorganic bovine bone during maxillary sinus floor augmentation procedure., Methods: PubMed, Cochrane Central Register of Controlled Trials, and Ovid databases were searched for relevant studies published up to 16 September 2021. Randomized clinical trials (RCTs) and non-randomized controlled clinical trials (CCTs) that reported data on the new bone formation (measured by histomorphometric analysis) were considered. Risk of bias and quality assessment of included studies were evaluated following the Cochrane Handbook for Systematic Reviews of Interventions and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Strength of evidence was assessed following the approach of the Agency for Healthcare Research and Quality (AHRQ) through its evidence-based practice center (AHRQ EPC). The meta-analysis was based on the primary outcome of newly formed bone, for which the standard mean difference was calculated., Results: After the application of eligibility criteria, six clinical trials (three RCTs and three CCTs) covering 85 maxillary sinus floor elevation procedures were included. The pooled new bone formation value for PRP was 1.67 (95% CI: -0.15 to 3.49; I 2 : 86%), indicating the absence of significant effect. Plasma rich in growth factors (PRGF) was the pure PRP tested in five of the included studies. When sub-group (type of PRP) meta-analysis was performed, significantly higher new bone formation was observed in the PRGF group [2.85 (95% CI: 0.07 to 5.64; I 2 : 88%)] in comparison to the control group., Conclusions: A beneficial effect on new bone formation after maxillary sinus floor elevation can be obtained when anorganic bovine bone is mixed with PRGF., Competing Interests: E.A. is the head of Eduardo Anitua Foundation and the Scientific Director of BTI Biotechnology Institute. M.A. and M.H.A. are researchers at BTI Biotechnology Institute, a biotechnological company that investigates in the field of regenerative medicine and PRGF-Endoret technology. A.E. is a member of Eduardo Anitua Foundation.

Purpose: To compare the survival, changes in marginal bone level and prosthetic complications rate of short (≤ 6.5 mm) and longer implants (≥ 7.5) supporting a single-crown restoration in the maxillary/mandibular premolar or molar region., Methods: This cohort study was conducted following the STROBE statement recommendations for observational studies. Clinical outcomes of 88 short implants in 78 patients and 88 long implants in 88 patients were examined. All the implants had been placed by the same surgeon and restored following the same prosthetic concept; using a transepithelial abutment (intermediate abutment) and a screw retained restoration., Results: All the implants were in function after the follow-up period since insertion (median: 31 months; range 11 to 84 for SiG vs median: 35 months; range: 6-117 for CG; p = 0.139). No statistical differences (p = 0.342) were observed related to prosthetic complications (screw loosening 2/88 vs 5/88 CG, ceramic chipping 1/88 vs 0/88, temporary crown resin chipping 1/88 vs 0/88 for SiG and CG, respectively) or related to marginal bone level (Mesial or Distal MBL ≥ 2 mm in 1/88 implants for SiG vs 3/88 for CG; p = 0.312)., Conclusions: Within the limitations of this study, no survival differences have been observed between short implants and longer implants in single-crown restorations in posterior maxilla/mandible., (© 2022. The Author(s).)

Introduction: Academic success requires grit and positive thinking. However, research on Middle Eastern nursing students' grit and positive thinking is limited. This study investigated the demographic variables that correlate to and predict Saudi nursing students' grit and positive thinking., Method: A descriptive cross-sectional design guided this study. We used the 12-item Short Grit Scale (Grit-S) and 8-item Positive Thinking Skills Scale (PTSS) to collect data from 338 nursing students. The Pearson correlation coefficient and linear regression analysis were utilized to analyze the data., Findings: Nursing students' Grit-S mean score is more significant than their PTSS score. The year level is inversely associated with Grit-S, while gender and Grit-S had a weak direct correlation. Regarding PTSS, only the year level was inversely correlated. Finally, both the year level and gender were significant predictors of Grit-S and PTSS., Discussion: Participants' responses to Grit-S and PTSS scores vary greatly depending on their demographics. The nursing students' grit and positive thinking did not develop as they progressed in the nursing program, which is viewed differently by each gender., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.)

Background: This systematic review aims to evaluate the efficacy of the available platelet-rich plasma (PRP) products and composition to regenerate alveolar bone after tooth extraction., Methods: PubMed, Cochrane Central Register of Controlled Trials, and EBSCO databases were searched up to 2 July 2021. Only randomized clinical trials using leukocyte-rich plasma (L-PRP) or pure-platelet rich plasma (P-PRP) for bone regeneration in alveolar ridge preservation were selected. The following outcomes were considered: (1) new bone formation (primary outcome) and (2) bone density (secondary outcome). A meta-analysis for PRP, P-PRP, and L-PRP using a fixed effect model was performed with Review Manager 5.4 software. Overall evidence was qualified using GRADE., Results: Six randomized clinical trials from 2639 unique articles initially identified met the inclusion criteria. The meta-analysis showed a significant effect of the P-PRP on the outcome of new bone formation (SMD, 1.44; 95% CI, 0.84 to 2.03) for P-PRP treatment. No information was retrieved for L-PRP. A statistically significant difference was also observed in the P-PRP group for bone density outcome (SMD, 1.24; 95% CI, 0.81 to 1.68). The L-PRP treated sockets also showed higher bone density (SMD, 0.88; 95% CI, 0.31 to 1.45) in comparison to control sockets. The quality of evidence was moderate for both outcomes in the P-PRP group and low for the L-PRP group., Conclusions: Despite the limitations of the included studies, our data suggest that P-PRP, in comparison to unassisted healing, can improve alveolar bone regenerative potential. However, more high-quality clinical studies are needed.

Plasma rich in growth factors (PRGF) has several applications in dentistry that may require repeated applications of PRGF. Furthermore, it has been used for ex vivo expansion of human origin cells for their clinical application. One of the most relevant issues in these applications is to guarantee the genetic stability of cells. In this study, the chromosomal stability of gingival fibroblasts and alveolar osteoblasts after long-term culture was evaluated. Cells were expanded with PRGF or foetal bovine serum (FBS) as a culture medium supplement until passage 7 or 8 for gingival fibroblast or alveolar osteoblasts, respectively. A comparative genomic hybridization (CGH) array was used for the genetic stability study. This analysis was performed at passage 3 and after long-term culture with the corresponding culture medium supplements. The cell proliferative rate was superior after PRGF culture. Array CGH analysis of cells maintained with all the three supplements did not reveal the existence of alterations in copy number or genetic instability. The autologous PRGF technology preserves the genomic stability of cells and emerges as a safe substitute for FBS as a culture medium supplement for the clinical translation of cell therapy.

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

The high biomechanical loads in molar region wounds challenge the indication for short implants to be used as a single-unit implant. This study reports on the outcomes of single-unit short implants (≤ 8.0 mm) in the maxillary and mandibular molar regions. Forty-nine short implants were placed in 48 patients to replace a missing molar tooth. Two-piece restorations with screw retention were fabricated. During the follow-up, implant survival and marginal bone loss (MBL) were assessed. The known implant length was used as a reference to calibrate the linear measurements on digital periapical radiographs, and descriptive statistical analysis was performed. The implants were followed over a period of 47 ± 12 months. No implant failure was recorded, and no prosthesis failure was observed. The average MBL was 0.15 ± 0.5 mm. The mean crown height space was 13 ± 3 mm. The overall crown-to-implant ratio was 1.7 ± 0.4. Two technical complications occurred due to the loosening of the unit abutment. After screw re-tightening, no more screw loosening was observed. This study supports the use of short implants as a single-unit implant in the maxillary and mandibular molar regions.

Objectives: To determine the efficacy of a deep-learning (DL) tool in assisting dentists in detecting apical radiolucencies on periapical radiographs., Methods: Sixty-eight intraoral periapical radiographs with CBCT-proven presence or absence of apical radiolucencies were selected to serve as the testing subset. Eight readers examined the subset, denoted the positions of apical radiolucencies, and used a 5-point confidence scale to score each radiolucency. The same subset was assessed by readers under two conditions: with and without Denti.AI DL tool predictions. For the two sessions, the performance of the readers was compared. The comparison was performed with the alternate free response receiver operating characteristic (AFROC) methodology., Results: Localization of lesion accuracy (AFROC-AUC), specificity and sensitivity (by lesion) detection demonstrated improvements in the DL aided session in comparison with the unaided reading session. Subgroup performance analysis revealed an increase in sensitivity for small radiolucencies and in radiolucencies located apical to endodontically treated teeth.., Conclusion: The study revealed that the DL technology (Denti.AI) enhances dental professionals' abilities to detect apical radiolucencies on intraoral radiographs., Advances in Knowledge: DL tools have the potential to improve diagnostic efficacy of dentists in identifying apical radiolucencies on periapical radiographs.

Middle Saudi Arabia has weather conditions where the temperature is high in summer with low humidity. Conventional air conditioning systems operated by a vapor compression cycle are not economical because of the high electrical power consumption. Therefore, evaporative cooling through evaporative coolers is one of the best and most economical solutions. The present study experimentally investigates the factors affecting the performance of evaporative coolers. Pad materials and airflow rate are the main variables to investigate the evaporative cooler's performance in terms of saturation effectiveness, pressure drop across the pads, and coefficient of performance (COP). Pads material are the local palm tree "Nakheel" waste that are leaflet, leaf base, bulb, and roots. The maximum COP of the cooling system in the case of bulb pad material is 80% more than that of leaflet pad material. The saturation effectiveness of the bulb pad was a maximum which is 61.93% at an airflow of 2.25 m/s, which is more than two times that of the saturation effectiveness of the leaflet pad. The pressure drop across the bulb pad is almost 2.5 times to 9.5 times than that of leaflet pad. Results show that bulb pad performance best, whereas the leaflet pad material has the lowest performance in terms of pressure drop, saturation effectiveness, and COP., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Purpose: The term "intentional injuries" refers to a spectrum of injuries resulting from self-inflicted injuries, interpersonal violence, and group acts of violence. Intentional injuries are underreported in Saudi Arabia. This study aimed to analyze and evaluate the characteristics of intentional injuries in patients who presented to the emergency department of a primary trauma center in Medina, Saudi Arabia in 2013., Methods: A prospective cohort database analysis of the clinical patterns and treatment outcomes of 252 patients who had intentional injuries between January and December 2013 was done., Results: The proportion of trauma patients with intentional injuries was 1.3%. The mean age was 34.2±9.4 years, 141 patients (56.0%) were male, and 111 (44.1%) were female (male to female ratio, 1.27:1). The majority (n=159, 63.1%) of injuries occurred at night. Most occurred outside the home (n=180, 71.0%). Financial problems (n=62, 24.6%) and social disputes (n=61, 24.2%) were the most common reasons. Sharp objects (n=93, 36.9%) were the most common weapons used. The head and neck were the most commonly injured areas (n=63, 54.4%). Superficial cuts (n=87, 34.5%), were the most common type of injury. Suturing of wounds (n=54, 21.4%) and surgical debridement (n=47, 18.7%) were the most commonly performed modalities of management., Conclusions: We conclude that intentional injuries in Saudi Arabia are a health care hazard that is, unfortunately, underreported. The clinical pattern is similar in most aspects to international reports but differs in certain features due to the specific religious and conservative characteristics of the community. Nationwide clinical studies are strongly recommended., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2022 The Korean Society of Traumatology.)

The use of plasma rich in growth factors (PRGF) is a treatment for erosive oral lichen planus (OLP) resistant to steroid therapy. An anonymous database at a clinical center was reviewed to collect demographic data, lesion type, treatment protocol, number of infiltrations, pain score, and healing time of the lesions. Fifteen patients were included in this study. All patients were diagnosed with erosive OLP. The lesions in all patients were refractory to steroid therapy (topical and systemic). Results showed that the use of plasma rich in growth factors (PRGF) could be a promising alternative for the treatment of erosive OLP refractory to steroid therapy, though new prospective studies are needed to confirm these preliminary observations.

Background & Aims: The role of prophylactic vitamin D supplementation in prevention and treatment of respiratory infections and other related pathologies has been extensively explored with conflicting results. The aim of this systematic review and meta-analysis was to evaluate the prophylactic and therapeutic effects of vitamin D administration on respiratory infections., Methods: A systematic search was performed and randomized controlled trials (RCTs) of vitamin D supplementation and a total of 65 RCTs involving 50,554 participants were included., Results: The overall incidence of respiratory infections in terms of count data (OR: 0.87; 95%CI [0.80-0.95]; p = 0.0028; I 2  = 43%) and event rate (IRR: 0.81; 95%CI [0.70-0.95]; p = 0.010; I 2  = 79%) was significantly reduced in the intervention group. However, no effect of vitamin D on duration or upper respiratory tract infection severity was observed following the overall analysis. Subgroup analyses revealed more details regarding the protective effect of particular dose ranges, administration frequencies and trial durations on different disease types., Conclusions: Despite between-study heterogeneity was high for most outcomes and publication bias may have led to an effect size overestimation of incidence count data, vitamin D supplementation could be beneficial in improving resistance to overall respiratory infections, particularly when administered on a daily basis., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Vasovagal syncope is a common cause of syncope which, if recurrent, can have multiple negative consequences such as injury and occupational disability. Various medications can be used to decrease the recurrence of vasovagal syncope but there are no drugs that can be used by patients to interrupt a perceived vasovagal episode., Methods: A phase I study was performed to evaluate the tolerability and safety of a gel formulation containing capsaicin (1 mg), phenylephrine HCL (PE) and caffeine citrate (200 mg) (CPC) in normal adult volunteers. Secondary objectives were to characterize the pharmacokinetics (PK) of the CPC formulation and the highest dose of PE needed to achieve a target increase in systolic BP of at least 40 mmHg. After receiving the first dose, a second dose of the CPC mixture was administered at 2 h. Suboptimal changes in systolic blood pressure (SBP) were noted at PE doses of 0.6, 1.2, and 1.8 mg, therefore a second cohort was studied at PE doses of 10, 20, and 30 mg. Blood samples were collected in rapid sequence and were assayed for all three drugs., Results: A total of 17 subjects received the drug with no serious adverse effects reported. All doses were well tolerated, although the capsaicin content usually caused expected temporary oral and gastric discomfort. One subject did not complete the study because of a vasovagal reaction that was associated with the frequent blood sampling. There was a 5-25 min lag in the appearance of measurable blood concentrations of capsaicin and phenylephrine. Most subjects had baseline caffeine concentrations from dietary use, with a gradual increase noted after 15 min consistent with GI absorption. Although the intended criterion of a 40 mmHg increase in SBP was not reached, a clinically significant increase in BP for at least 15 min was noted in the six subjects who received the highest dose of PE (30 mg), with a gradual decline over the next 2 h., Conclusion: The ternary mixture of capsaicin, phenylephrine, and caffeine was well tolerated when administered as two sublingual/oral doses over a 2-h period., (© 2022. The Author(s).)