Hypertrophic cardiomyopathy (HCM) is the most frequently cited cause of exercise-related sudden cardiac death (SCD) in young individuals and has claimed the lives of some high-profile athletes. The circumstantial link between exercise and SCD from HCM has resulted in conservative exercise recommendations which focus on activities that should be avoided rather than the minimal amount of physical activity required to reap the multiple rewards of exercise. Consequently, most patients with HCM are confined to a sedentary lifestyle through fear of SCD, with accruing risk factors such as obesity and low cardiorespiratory fitness that confer a worse prognosis. Recent exercise programmes in asymptomatic and symptomatic individuals with HCM have shown that mild and moderate exercise is safe and accompanied by increased functional capacity and improved quality of life. Population studies also reveal that individuals with HCM in the higher quartiles of self-reported physical activity have lower total cardiovascular mortality compared with those in the lower quartiles. The impact of vigorous exercise on the natural history of HCM is unknown, although current experience suggests that affected adults with mild morphology and absence of high-risk factors may partake in such activity without adverse events. This review highlights the evidence base that has resulted in a paradigm shift in the approach to exercise in HCM and liberalised recent international exercise guidelines in HCM. Practical tips for prescribing exercise in symptomatic patients and relevant precautions are provided to aid clinicians when recommending exercise as part of the management plan for all patients with HCM.

Keywords: cardiac rehabilitation; cardiomyopathy, hypertrophic; diagnostic imaging.

Pancreatic cancer (PC) is a lethal disease where most tumors are too advanced at diagnosis for resection, leaving chemotherapy as the mainstay of treatment. Although the prognosis of unresectable PC is poor, it has been dramatically improved by new chemotherapy treatments, such as the combination of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) or gemcitabine plus nab-paclitaxel. However, as oxaliplatin and paclitaxel are common neurotoxic drugs, chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe adverse effect of both treatments. As there are no agents recommended in the ASCO guidelines, we review the methods used to treat CIPN caused by PC treatment. The efficacy of duloxetine was observed in a large randomized controlled trial (RCT). In addition, pregabalin was more effective than duloxetine for CIPN in two RCTs. Although duloxetine and pregabalin can be effective for CIPN, they have several side effects. Therefore, the choice between the two drugs should be determined according to effect and tolerability. Mirogabalin is also used in patients with PC and there is hope it will yield positive outcomes when treating CIPN in the future.

Keywords: Chemotherapy; Nab-paclitaxel; Oxaliplatin; Paclitaxel; Pancreatic cancer; Peripheral neuropathy.

As a vertebrate model organism, zebrafish has many unique advantages in developmental studies, regenerative biology, and disease modeling. However, tissue-specific gene knockout in zebrafish is challenging due to technical difficulties in making floxed alleles. Even when successful, tissue-level knockout can affect too many cells, making it difficult to distinguish cell autonomous from noncell autonomous gene function. Here, we present a genetic system termed zebrafish mosaic analysis with double markers (zMADM). Through Cre/loxP-mediated interchromosomal mitotic recombination of two reciprocally chimeric fluorescent genes, zMADM generates sporadic (<0.5%), GFP⁺ mutant cells along with RFP⁺ sibling wild-type cells, enabling phenotypic analysis at single-cell resolution. Using wild-type zMADM, we traced two sibling cells (GFP⁺ and RFP⁺) in real time during a dynamic developmental process. Using nf1 mutant zMADM, we demonstrated an overproliferation phenotype of nf1 mutant cells in comparison to wild-type sibling cells in the same zebrafish. The readiness of zMADM to produce sporadic mutant cells without the need to generate floxed alleles should fundamentally improve the throughput of genetic analysis in zebrafish; the lineage-tracing capability combined with phenotypic analysis at the single-cell level should lead to deep insights into developmental and disease mechanisms. Therefore, we are confident that zMADM will enable groundbreaking discoveries once broadly distributed in the field.

Keywords: single-cell gene knockout; lineage tracing; mosaic analysis with double markers; zebrafish.

Biodentine (BD) is a bioactive material with many indications in endodontic therapy. The purpose of this study was to compile and review the outcomes of in vitro and in vivo studies of BD in terms of antimicrobial effectiveness. An electronic search was carried out in PubMed, from January 2009-April 2021 using the keywords: (Biodentine or dentine substitute or "Ca₃SiO₅" or tricalcium silicate cement or bioceramic cement) and (antimicrobial activity or antimicrobial effect or antimicrobial effectiveness or antibacterial activity or antibacterial effect or antibacterial effectiveness or antibiofilm activity or antibiofilm effectiveness). Two independent reviewers evaluated the studies for eligibility. All studies that did not include BD or its antimicrobial properties, as well as abstracts not written in English, were excluded. This review identified the need to develop standardized methods to evaluate antimicrobial activity in vitro. Most of the studies were against planktonic bacteria and gave conflicting results. Studies ex vivo and in vivo against biofilm are required to elucidate the antimicrobial activity of BD.

Keywords: antibiofilm; antimicrobial; tricalcium silicate cements.

Background: Identification of modifiable factors associated with poor mental health is crucial to develop targeted and effective intervention strategies for prevention of mental distress and illness in the general population. Thus, the aim of the present study was to examine the association between low level of leisure-time physical activity, high sedentary time, low participation in organized activities, low social support, sleep problems, and mental distress in a large sample of Norwegian adults.

Methods: A cross-sectional study was completed by 28,047 adults (≥18 years old) in southern Norway by filling out an online self-report questionnaire. Multivariable binary logistic regression models, stratified according to gender and adjusted for age and perceived financial situation, were used to examine possible associations between unhealthy lifestyle behaviors, participation in organized activities, social support, and mental distress.

Results: Our results showed an increased odds of having mental distress among men reporting low leisure-time physical activity (OR: 1.18; 95%CI: 1.03-1.37), high sedentary time (1.32; 1.16-1.51), low involvement in organized activities (1.43; 1.25-1.64), low social support (2.55; 2.18-2.99), and sleep problems (7.29; 6.35-8.37) compared to the rest of the male population. For women, the results showed increased odds of mental distress among those reporting high sedentary time (1.25; 1.11-1.39), low involvement in organized activities (1.60; 1.42-1.80), low social support (2.71; 2.39-3.06), and sleep problems (5.78; 5.15-6.50) compared to the rest of the female population. For both men and women, results also indicated that mental distress was increased among younger adults and among those reporting financial difficulties compared to the rest of the population.

Conclusion: Our results showed an association between unhealthy lifestyle behaviors, low participation in organized activities, low social support and mental distress, and that the strength of the association varied substantially. These findings provide increased knowledge about the relationship between modifiable lifestyle factors and mental health which should have implications for future public health efforts.

Keywords: Mental distress; Organized activities; Physical activity; Sedentary time; Sleep; Social support; Symptoms of anxiety and depression.

Background: Vaccines for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are being promoted worldwide. In this study, we analyzed the relationship between adverse reactions and the profile of vaccinated recipients.

Methods: Vaccinated subjects who received two doses of BNT162b2 between May 17 and June 11, 2021, at Osaka University Dental Hospital were included in this study. Adverse reactions and profiles were collected by questionnaires, and the relationship between the presence of adverse reactions and the profiles of the vaccinated persons was analyzed by logistic regression analysis. The correlation between the severity of adverse reactions and age was analyzed by Spearman's rank correlation.

Results: Logistic regression analysis showed that, for many kinds of adverse reactions, the incidence was significantly higher in females than in males and in younger than in older people. There was a very weak but significant negative correlation between age and the severity of many kinds of adverse reactions. The relationship between sex and the incidence of each adverse reaction was significant for injection site reactions and fatigue in the first vaccination, whereas significant relationships were found for fatigue, chills, fever, arthralgia, myalgia and headache in the second vaccination, all of which were clearly more likely to occur in females.

Conclusion: Adverse reactions to BNT162b2 were found to be more frequent and more intense in females and younger people in Japan, especially after the second vaccination.

Keywords: Adverse effect; COVID-19; Correlation; SARS-CoV-2; Vaccination.

Background: The Goldilocks Work Principle expresses that productive work should be designed to promote workers' health. We recently showed that it is feasible to develop and implement modifications to productive work that change physical behaviors (i.e. sitting, standing and being active) in a direction that may promote health among industrial workers. Therefore, the aim of the present study is to conduct a cluster randomised controlled trial investigating health effects of implementing the Goldilocks Work intervention among industrial workers.

Methods: Our implementation plan consists of educating work teams, organizing implementation meetings, and providing feedback to workers. Three meetings with a preselected local workplace group will be scheduled. The first meeting educates the group to use a planning tool by which work can be planned to have 'just right' physical behaviors. The second and third meetings will focus on supporting implementation of the tool in daily work. An expected 28 clusters of work teams across two participating production sites will be randomized to either intervention or control group. Data collection will consist of 1) questionnaires regarding work and musculoskeletal health, 2) wearable sensor measurements of the physical behavior, and 3) assessment of general health indicators, including BMI, blood pressure, and fat percentage. The primary outcome is musculoskeletal health, measured by low back pain intensity, and secondary outcomes are 1) physical behaviors at work, 2) accumulated time in long bouts of sitting, standing, and being active and 3) perceived fatigue and energy during work. Furthermore, implementation and cost of the intervention will be evaluated based on questionnaires and data from the planning tool completed by the workers.

Discussion: This study will evaluate the effectiveness and implementation of a 12 - weeks Goldilocks Work intervention with the aim of improving musculoskeletal health among industrial workers. The cluster randomized controlled study design and the evaluation of the implementation, results and costs of the intervention will make it capable of contributing with valuable evidence of how productive work may be designed to promote industrial workers' health.

Trial registration: Clinical trial registration was assigned 10-09-2021 (ISRCTN80969503). https://doi.org/10.1186/ISRCTN80969503.

Keywords: Goldilocks Work Principle; Health; Intervention; Physical Behavior.

Background: To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population.

Methods: In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts.

Results: The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients' quality of life; increasing healthcare staff skills; decreasing patients' symptoms; decreasing family caregiver burden; increasing patients' satisfaction with care; and increasing family doctor continuity of care.

Conclusions: Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.

Keywords: Patient outcome assessment; Person-centered care; Quality improvements; Quality indicators.

Background: Early parenthood is a sensitive period for parents. Parents may feel uncertain about their new roles and unsure about where to find trusted information and support. The aim of this study was to explore the association between breastfeeding and early home visits and a proactive telephone support intervention and to describe parental experiences.

Method: This study was conducted as a mixed method study with a convergent design using qualitative data from the written comments of parents, and the quantitative data consisted of demographics, breastfeeding, and Likert questions about parents' satisfaction with the early home visit and telephone support. Historic control (2017-2018) and intervention (2019-2020) data were collected from one family health care centre, and control (2019-2020) data were collected from another family health care centre.

Results: In total, 838 infants, 42 mothers and 38 fathers contributed to the data in the study. The intervention group had a statistically significantly earlier home visit than the control groups. Early home visits and proactive telephone support to parents with newborn infants were not associated with breastfeeding outcomes up to six months after birth, but we could not exclude the possibility that this was a consequence of our observational study design. However, the early home visit was appreciated by the parents where they received both practical and emotional support.

Conclusions: Although the intervention was not associated with breastfeeding, the parents appreciated the service. This shows the importance of continuing to investigate how and which support parents of newborn infants need and the effects of such support, including interventions to provide optimal support to facilitate continued breastfeeding.

Background: Leukotriene B₄ (LTB₄) is a potent lipid mediator that stimulate the immune response. Because dental pulp inflammation and dentin repair are intrinsically related responses, the aim of this research was to investigate the potential of LTB₄ in inducing differentiation of dental pulp stem cells.

Methods: Microspheres (MS) loaded with LTB₄ were prepared using an oil emulsion solvent extraction evaporation process and sterility, characterization, efficiency of LTB₄ encapsulation and in vitro LTB₄ release assay were investigated. Mouse dental pulp stem cells (OD-21) were stimulated with soluble LTB₄ or MS loaded with LTB₄ (0.01 and 0.1 μM). Cytotoxicity and cell viability was determined by lactate dehydrogenase and methylthiazol tetrazolium assays. Gene expression were measured by quantitative reverse transcription polymerase chain reaction after 3, 6, 24, 48 and 72 h. Mineralized nodule formation was assessed after 28 days of OD-21 cell stimulation with LTB₄ in mineralized media or not. Groups were compared using one-way ANOVA test followed by Dunnett's post-test (α = 0.05).

Results: Treatment with LTB₄ or MS loaded with LTB₄ (0.01 and 0.1 µm-μM) were not cytotoxic to OD-21 cells. Treatment with LTB₄ modulated the expression of the Ibsp (integrin binding sialoprotein) and Runx2 (runt-related transcription factor 2) genes differently depending on the experimental period analyzed. Interestingly LTB₄ loaded in microspheres (0.1 μM) allowed long term dental pulp cell differentiation and biomineralization.

Conclusion: LTB₄, soluble or loaded in MS, were not cytotoxic and modulated the expression of the Ibsp and Runx2 genes in cultured OD-21 cells. When LTB₄ was incorporated into MS, odontoblast differentiation and mineralization was induced in long term culture.

Keywords: Dental pulp stem cells; Differentiation; Leukotriene; Microspheres; Odontoblast.

Background: Leg length inequalities are a frequent condition in every population. It is common clinical practice to consider LLIs of 2 cm and more as relevant and to treat those. However, the amount of LLIs that need treatment is not clearly defined in literature and the effect of real LLIs on the musculoskeletal system above and below 2 cm have not been studied biomechanically before.

Methods: By using surface topography, we evaluated 32 patients (10 females, 22 male) with real LLIs of ≥ 2 cm (mean: 2.72 cm; n = 10) and compared their pelvic position and spinal posture to patients with LLIs < 2 cm (mean: 1.24 cm; n = 22) while standing and walking. All patients were measured with a surface topography system during standing and while walking on a treadmill. To compare patient groups, we used Student t-tests for independent samples.

Results: Pelvic obliquity was significantly higher in patients with LLI ≥ 2 cm during the standing trial (p = 0.045) and during the midstance phase of the longer leg (p = 0.023) while walking. Further measurements did not reveal any significant differences (p = 0.06-0.706).

Conclusions: The results of our study suggest that relevant LLIs of ≥ 2 cm mostly affect pelvic obliquity and do not lead to significant alterations in the spinal posture during a standing trial. Additionally, we demonstrated that LLIs are better compensated when walking, showing almost no significant differences in pelvic and spinal posture between patients with LLIs smaller and greater than 2 cm. This study shows that LLIs ≥ 2 cm can still be compensated; however, we do not know if the compensation mechanisms may lead to long-term clinical pathologies.

Keywords: Gait; Leg length discrepancy; Leg length inequalities; Rasterstereography; Surface topography.

Background: The coronavirus disease 2019 (COVID-19) caused by a novel coronavirus (SARS-CoV-2) has gained worldwide attention and proved to hold an impact to humankind in all aspects of life. Dental students' performances may indirectly be affected following the preventive measures in containing the disease. This study aims to evaluate the impact of COVID-19 pandemic on physical, mental, financial health and academic concern among dental students in Malaysia.

Methods: The current research implemented a cross sectional study among dental students in Malaysia. Assessment of the impact of COVID-19 on dental education was done by the distribution of a set of online survey consisting of 28 questions to dental students (n = 353) from public and private universities in Malaysia. The questionnaires include sociodemographic backgrounds and assessment on the mental health, financial health, physical health and academic concern. Kruskal Wallis test and Mann-Whitney U test were used to analyse the impact of COVID-19 to these 4 domains according to sociodemographic background.

Results: A total number of 353 respondents was recorded and 76.2% comprised of female. 59.7% were clinical students and 40.3% were preclinical students. Most of students were concerned about their own emotional health, financial concern, physical wellbeing, in which Year 3 students were found to be more concerned about their mental and financial health concern.

Conclusions: COVID-19 pandemic had indeed significantly affected Malaysian dental students mainly due to fear of the quality of online learning and the amount of clinical skills acquired. Therefore, it is important to identify dental stressors and lessen the impact of COVID-19 to dental students.

Keywords: COVID-19; Dental education; Dentistry; Medicine; Mental health; Pandemic.

Background: Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species.

Case presentation: We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG.

Conclusions: FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.

Keywords: Actinomyces; Case report; Fournier's gangrene; Necrotizing fasciitis; Skin grafting.

Cryo-electron microscopy (cryo-EM) has emerged as an unprecedented tool to resolve protein structures at atomic resolution. Structural insights of biological samples not accessible by conventional X-ray crystallography and NMR can be explored with cryo-EM because measurements are carried out under near-native crystal-free conditions, and large protein complexes with conformational and compositional heterogeneity are readily resolved. RNA has remained underexplored in cryo-EM, despite its essential role in various biological processes. This review highlights current challenges and recent progress in using cryo-EM single-particle analysis to determine protein-free RNA structures, enabled by improvement in sample preparation and integration of multiple structural and biochemical methods.

Aim: The aim of the current research was to evaluate the efficacy of different fluoride-releasing bonding products in preventing enamel demineralization around orthodontic brackets by using a scanning electron microscope (SEM).

Materials and methods: This research was performed using 80 healthy human premolar teeth that were extracted in course of orthodontic therapy. Until use, the sample premolars were subjected to storage in 0.1% thymol. Each premolar was thereafter cleansed with pumice for 10 seconds. Stainless steel brackets for premolars were employed. The 80 samples were allocated at random to one of the four groups (20 in each) as follows: Group I, control; group II, Transbond Plus color change adhesive; group III, GC Fuji Ortho LC; and group IV, Vitremer. An hour following bonding, all samples were subjected to pH cycling at a temperature of 37°C for a 14-day period. The premolar teeth were assessed below SEM. Analysis was performed with the one-way analysis of variance. Statistical significance was set at a p-value less than 0.05.

Results: The extreme area of demineralization was abridged by the use of Transbond^™ Plus color change adhesive (108.19 ± 0.68), trailed by GC Fuji Ortho LC (119.24 ± 0.37) use, Vitremer (121.56 ± 0.92) as well as the control group (141.88 ± 1.09) in that order. And there was a statistically significant difference found between the groups (p <0.001). Tukey's honestly significant difference (HSD) was employed in an overall comparison of mean areas of enamel demineralization, which depicted that differences were significant statistically with the exception of group III and group IV.

Conclusion: The current research came to a conclusion that the Transbond Plus color change adhesive group was more potent in significant inhibition of demineralization areas in comparison to GC Fuji Ortho LC group and Vitremer group.

Clinical significance: In course of fixed orthodontic therapy, demineralization of enamel is an inherent occurrence. Multiple approaches are being continually developed to avoid the formation of white spot lesions (WSLs) that compromise esthetics and cause deprived remineralization that enhances the menace of dental caries. Bonding agents that can release fluorides are thus considered highly efficacious.

Keywords: Bonding agents; Enamel demineralization; Fluoride release Premolar brackets..

Introduction: Angle's classification is the most widely used instrument for evaluation of malocclusion. The dental esthetic index (DAI) is a reliable, valid, and universally accepted cross-cultural index adopted by the World Health Organization (WHO) that links objective, clinical, and subjective esthetic factors to produce a single score that reflects the severity and the treatment needs of the malocclusion. The present study aims to evaluate Angle's classification and DAI to assess the severity of malocclusion and treatment needs.

Materials and methods: This retrospective cross-sectional study was done on pretreatment orthodontics records of 145 male patients and 153 female patients in the age-group 9-42 years with malocclusion who had received or were undergoing orthodontic treatment in the orthodontic department clinics of the College of Dentistry, Jazan University. Preorthodontic study casts, orthopantomography, and lateral cephalometric X-rays were analyzed. DAI scores were calculated, and treatment needs were assessed. Angle's classification of malocclusion was also noted.

Results: Among patients with normal or minor malocclusion (DAI score ≤25), a significantly higher percentage of patients were class I (58%) than any other class of malocclusion. Among patients determined to have handicapping malocclusion (DAI score ≥36), significantly higher percentage of patients were class II/1 (44%) than any other class of malocclusion. Class II/1 showed the highest percentage of definite (24%) (DAI score 26-30), severe (19%) (DAI score 31-35), and handicapping malocclusions (44%) (DAI score ≥36). A total of 26% of patients had skeletal class I. A total of 38% of patients had skeletal class II. A total of 36% of patients had skeletal class III. Approximately 13% of patients had maxillary canine impactions and 3% of patients had mandibular canine impactions.

Conclusion: The study reported 35% of patients were having handicapping malocclusion (DAI ≥36) and 14% having severe malocclusion (DAI score 31-35). The malocclusion was characterized by a high frequency of anterior crowding. Thus, the complementary use of DAI and Angle's classification, with improvements, helps establish an all-inclusive criterion for screening and prioritizing of patients eligible for receiving subsidized, publicly funded orthodontic care and thus allows better use of limited available resources.

Keywords: Angle's classification; Dental esthetic index; Malocclusion Orthodontics..

Aim: This study aimed to evaluate Olea europaea (olive) leaves and Morus nigra (black mulberry) leaves as potential natural alternatives to sodium hypochlorite (NaOCl) endodontic irrigant. Their antimicrobial activity against Enterococcus faecalis (E. faecalis) and their effects on both root dentin microhardness and push-out bond strength of resin sealer/root dentin were assessed.

Methodology: Fifty-four extracted teeth were selected. Samples were grouped according to the irrigant used: group I (control): 2.5% NaOCl, group II: 8% ethanolic extract of Olea europaea, and group III: 2% ethanolic extract of Morus nigra. Antibacterial activity (n = 6) was evaluated after each canal was autoclaved, inoculated with E. faecalis, and incubated. Canals were sampled before and after chemicomechanical canal preparation with 2 mL of irrigant. The colony-forming units (CFUs) were counted at 1/10 and 1/100 broth concentrations. Vickers hardness number (VHN) of root dentin (n = 6) was measured before and after root canal preparation and irrigation. Push-out bond strength testing (n = 9) was carried out following preparation, irrigation, obturation, and thermocycling. Results were considered statistically significant at p ≤0.05.

Results: Following irrigation, the CFUs of E. faecalis were significantly reduced with no significant difference in the CFU count between all groups at both broth concentrations. A significant reduction in root dentin microhardness resulted in all groups following irrigation, with Morus nigra resulting in the lowest percentage reduction (26.42 ± 1.12). The lowest significant mean push-out bond strength was revealed in the Olea europaea group (3.372 ± 1.513 MPa).

Conclusion: The use of 2% mulberry (Morus nigra) leaf extract and 8% olive (Olea europaea) leaf extract as alternatives to NaOCl provides promising antimicrobial action against E. faecalis.

Clinical significance: 2% Morus nigra extract may represent a promising natural endodontic irrigant.

Keywords: Endodontic irrigant;Enterococcus faecalis; Herbal extracts; Microbiology Microhardness..

Background: This study aimed to quantitatively evaluate myocardial perfusion single-photon emission computed tomography (SPECT) using an original analysis tool in the compartment model for detecting regional significant coronary artery disease (CAD).Methods and Results:This study analyzed 41 patients (median age, 76 years) with suspected or known CAD who underwent both dynamic SPECT using ^{99 m}Tc-tetrofosmin and invasive coronary angiography. The quantitative analysis was performed using a single-tissue compartment model to evaluate the diagnostic performance of the myocardial flow reserve (MFR) for regional significant CAD, excluding infarcted territories. In the regional analysis, 114 vessels were assessed, of which 31 were diagnosed as significant coronary lesions (≥70% stenosis and/or fraction flow reserve ≤0.8). The MFR of regional significant CAD was significantly lower than that of non-significant CAD (1.11 [0.97-1.31] vs. 1.74 [1.30-2.27]; P<0.001). In the receiver operating characteristic curve analysis, the MFR displayed an area under the curve (AUC) of 0.81. While analyzing each coronary artery territory, the diagnostic performance of the MFR value in the left anterior descending (LAD) artery territory was found to be significantly higher than that found in qualitative assessment (AUC: 0.84 vs. 0.61).

Conclusions: A quantitative analysis of dynamic SPECT data facilitated detecting regional CAD. For the LAD artery, the MFR displayed a higher diagnostic performance than the qualitative assessment of conventional myocardial perfusion SPECT.

Keywords: Coronary artery disease; Flow reserve; Myocardial perfusion imaging; Single photon emission computed tomography.

Exercise has beneficial effects on metabolic syndrome (MS). However, the exercise prescriptions that best support plasma glucose and lipid control remain unknown. We evaluated the effects of different combinations of aerobic and resistance training programs on plasma glucose and lipid metabolism and sleep quality in elderly MS patients. Eighty-five elderly MS patients were randomly assigned to five groups: aerobic training (AT), resistance training (RT), high aerobic with low resistance training (HALRT), high resistance with low aerobic training (HRLAT), or control. The exercise groups performed supervised moderate-intensity exercise during three 50-min sessions per week for 12 weeks. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), handgrip strength (HGS), fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) levels and sleep quality were evaluated at baseline and after 12 weeks. All intervention groups showed significant improvements in SBP, HGS, FPG, 2hPG, and Pittsburgh Sleep Quality Index (PSQI) scores compared to baseline (all p < 0.05), while DBP, TC, TG, and LDL-C levels were significantly improved only in the HRLAT and HALRT groups (p < 0.05). The HALRT group showed the largest improvements in WC, SBP, DBP, HGS, FPG, 2hPG, and PSQI score (p < 0.001). The largest improvements in BMI, TC, and LDL-C were observed in the HRLAT group (p < 0.001). The combined exercise prescriptions were more effective than aerobic or resistance training alone at improving plasma glucose and lipid metabolism and sleep quality in elderly MS patients.

Keywords: Aerobic exercise; Glucolipid metabolism; Metabolic syndrome; Resistance training; Sleep quality.

Aim and objective: The aim of this finite element method (FEM) study was to assess the safety of 125-150 Hz vibrational frequency electric toothbrush on teeth and associated structures.

Materials and methods: A three-dimensional (3D) geometric model of entire skull having maxilla, mandible, and their dentitions was created using a computed tomography (CT) image of a healthy male patient. Linear static analysis was carried out by applying 15 g of force on anterior part of maxilla and mandible from labial and lingual sides each to calculate the primary displacement (sagittal, vertical, and transversal) and principal stress levels generated on the maxillary and mandibular dentition, on the maxilla and mandible and on the whole skull.

Results: A force of 15 g applied to maxillary anterior teeth from labial side caused a mean deflection of 0.003 mm and stress of 0.004 MPa on the teeth and supporting structures. A force of 15 g applied to maxillary anterior teeth from palatal side caused a mean deflection of 0.017 mm and stress of 0.017 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from labial side caused a mean deflection of 0.078 mm and stress of 0.051 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from lingual side caused a mean deflection of 0.077 mm and stress of 0.051 MPa on the teeth and supporting structures.

Conclusion: For the applied loads and boundary conditions, very small or negligible amount of stresses were observed in maxilla, mandible, and their dentitions. The vibrational frequency of 150 Hz producing 15 g of force did not produce any harmful effects on maxilla, mandible, and their dentitions. Hence, 125-150 Hz of vibrational frequency can be considered optimum.

Clinical significance: An electric toothbrush using the vibration of 125-150 Hz produces negligible stress on teeth and associated structures.

Keywords: Electric toothbrush; Finite element analysis; Finite element model; Mechanical vibration; Safe range Vibrational frequency..

Purpose: This study explores novel solutions other than standard SBF for biomimetic evaluations of mineralization particularly for resin composites containing bioactive glass (BAG).

Methods: Experimental UDMA/TEGDMA resin composites with 0.0, 1.9, 3.8 or 7.7 vol% of 45S5 BAG fillers were prepared. Besides simulated body fluid (SBF) as control, the specimens were immersed in three other solutions either with bicarbonate which are Hank's balanced salt solution (HBSS) and cell culture medium (MEM), or without bicarbonate which is a novel Simple HEPES-containing Artificial Remineralization Promotion (SHARP) solution, for 3, 7 and 14 days. These solutions were then analyzed by ICP-OES and pH, and the surfaces of the BAG composites were analyzed by SEM, XRD and FTIR.

Results: ICP-OES revealed Ca and P concentration continuously decrease, while Si concentration increases with time in the solutions other than SBF, which showed almost unchanged elemental concentration. Only SHARP solution is able to maintain a constant pH over the immersion time. SEM, together with XRD and FTIR, showed nano-sized octacalcium phosphate (OCP) nanospheres formation on 3.8 and 7.7 vol% BAG composites after 14 days immersion in HBSS (500-600 nm) and MEM (300-400 nm). SHARP solution enabled OCP formation after 3 days and then self-assembled into urchin-like carbonated hydroxyapatite (CHA) microspheres encompassed with nanorods of 100 nm width and 8 µm length after 14 days of immersion for 7.7 vol% BAG composites.

Conclusion: This study suggests SHARP solution can evaluate mineralization biomimetically whereas CHA microspheres can be formed on BAG-containing resin composites.

Keywords: Bioactive glass; Biomimetic; Hydroxyapatite; Mineralization; Resin composite.

Objectives: Severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic has had a heavy impact on national health system, especially in the first wave. That impact hit principally the intensive care units (ICUs). The large number of patients requiring hospitalization in ICUs lead to a complete upheaval of intensive wards. The increase in bed, the fewer number of nurses per patient, the constant use of personal protective equipment, the new antimicrobial surveillance protocols could have had deeply effects on microbiological flora of these wards. Moreover, the overconsumption of antimicrobial therapy in COVID-19 patients, like several studies report, could have impact of this aspect. Aim of this study is to evaluate the changing pattern of microbiological respiratory isolates during and before COVID-19 pandemic in a tertiary hospital ICUs.

Methods: A retrospective, observational study was conducted in ICUs of "ASST Papa Giovanni XXIII", a large tertiary referral hospital in Northern Italy. We have retrospectively collected the microbiological data from bronchoalveolar lavage (BAL) and tracheal aspirate (TA) of patients with COVID-19, hospitalized in ICUs from 22nd February 2020 to 31st May 2020 (Period 1), and without COVID-19, from 22nd February 2019 to 31st May 2019 (Period 2). We compared the prevalence and the antibiotic profile of bacterial and fungal species in the two time periods.

Results: The prevalence of Pseudomonas spp. shows a statistically significant increase from patients without COVID-19 compared to COVID-19 positive as well as the prevalence of Enterococcus spp. On the contrary, the prevalence of Gram negative non fermenting bacteria (GN-NFB), Haemophilus influenzae and Streptococcus pneumoniae showed a significant reduction between two periods. There was a statistically significant increase in resistance of Pseudomonas spp. to carbapenems and piperacillin/tazobactam and Enterobacterales spp. for piperacillin/tazobactam, in COVID-19 positive patients compared to patients without COVID-19. We did not observe significant changing in fungal respiratory isolates.

Conclusions: A changing pattern in prevalence and resistance profiles of bacterial and fungal species was observed during COVID-19 pandemic.

Background: Many migrant birds have been returning to Europe earlier in spring since the 1980s. This has been attributed mostly to an earlier onset of spring in Europe, but we found the timing of Willow Warblers' passage to be influenced by climate indices for Africa as much as those for Europe. Willow Warblers' spring passage through northern Europe involves populations from different wintering quarters in Africa. We therefore expected that migration timing in the early, middle and late periods of spring would be influenced sequentially by climate indices operating in different parts of the winter range.

Methods: Using data from daily mistnetting in 1 April-15 May over 1982-2017 at Bukowo (Poland, Baltic Sea coast), we derived an Annual Anomaly (AA, in days) of Willow Warbler spring migration. We decomposed this anomaly into three main periods (1-26 April, 27 April-5 May, 6-15 May); one-third of migrants in each period. We modelled three sequential time series of spring passage using calendar year and 15 large-scale climate indices averaged over the months of Willow Warblers' life stages in the year preceding spring migration as explanatory variables in multiple regression models. Nine climate variables were selected in the best models. We used these nine explanatory variables and calculated their partial correlations in models for nine overlapping sub-periods of AA. The pattern of relationships between AA in these nine sub-periods of spring and the nine climate variables indicated how spring passage had responded to the climate. We recommend this method for the study of birds' phenological responses to climate change.

Results: The Southern Oscillation Index and Indian Ocean Dipole in Aug-Oct showed large partial correlations early in the passage, then faded in importance. For the Sahel Precipitation Index (PSAH) and Sahel Temperature Anomaly (TSAH) in Aug-Oct partial correlations occurred early then peaked in mid-passage; for PSAH (Nov-March) correlations peaked at the end of passage. NAO and local temperatures (April-May) showed low correlations till late April, which then increased. For the Scandinavian Index (Jun-Jul) partial correlations peaked in mid-passage. Year was not selected in any of the best models, indicating that the climate variables alone accounted for Willow Warblers' multiyear trend towards an earlier spring passage.

Discussion: Climate indices for southern and eastern Africa dominated relationships in early spring, but western African indices dominated in mid- and late spring. We thus concluded that Willow Warblers wintering in southern and eastern Africa dominated early arrivals, but those from western Africa dominated later. We suggest that drivers of phenological shifts in avian migration are related to changes in climate at remote wintering grounds and at stopovers, operating with climate change in the north, especially for species with complex and long-distance migration patterns.

Keywords: Annual anomaly; Climate change; IOD; Large-scale climate indices; Migration timing; NAO; Phylloscopus trochilus; SOI; Sequential migration; Spring phenology.