Closing Water Cycles in the Built Environment through Nature-Based Solutions: The Contribution of Vertical Greening Systems and Green Roofs

Water in the city is typically exploited in a linear process, in which most of it is polluted, treated, and discharged; during this process, valuable nutrients are lost in the treatment process instead of being cycled back and used in urban agriculture or green space. The purpose of this paper is to advance a new paradigm to close water cycles in cities via the implementation of naturebased solutions units (NBS_u), with a particular focus on building greening elements, such as green roofs (GRs) and vertical greening systems (VGS). The hypothesis is that such “circular systems” can provide substantial ecosystem services and minimize environmental degradation. Our method is twofold: we first examine these systems from a life-cycle point of view, assessing not only the inputs of conventional and alternative materials, but the ongoing input of water that is required for irrigation. Secondly, the evapotranspiration performance of VGS in Copenhagen, Berlin, Lisbon, Rome, Istanbul, and Tel Aviv, cities with different climatic, architectural, and sociocultural contexts have been simulated using a verticalized ET0 approach, assessing rainwater runoff and greywater as irrigation resources. The water cycling performance of VGS in the mentioned cities would be sufficient at recycling 44% (Lisbon) to 100% (Berlin, Istanbul) of all accruing rainwater roof–runoff, if water shortages in dry months are bridged by greywater. Then, 27–53% of the greywater accruing in a building could be managed on its greened surface. In conclusion, we address the gaps in the current knowledge and policies identified in the different stages of analyses, such as the lack of comprehensive life cycle assessment studies that quantify the complete “water footprint” of building greening systems.info:eu-repo/semantics/publishedVersio

The Effect of Chairside Verbal Instructions Matched with Instagram Social Media on Oral Hygiene of Young Orthodontic Patients: A Randomized Clinical Trial

Objective: To investigate the effectiveness of Instagram in improving oral hygiene compliance and knowledge in young orthodontic patients compared to traditional chairside verbal instructions. Design: Single-center, parallel, randomized controlled trial. Setting: Section of Dentistry of University of Pavia. Participants: 40 patients having fixed appliances in both arches were recruited and randomly divided into an intervention (n = 20) and a control group (n = 20). Intervention: At a first appointment, both groups were given verbal instructions and motivated to oral hygiene. In addition, multimedia contents on Instagram were sent weekly to trial participants for six months. Main outcome measures: For all participants, the bleeding index (BI), modified gingival index (MGI), and plaque index (PI) were assessed at baseline (T0), after one (T1), three (T2), and six months (T3). A questionnaire was administered at the beginning (T0) and at the end of the study (T3) to assess participants’ knowledge. Results: In both groups, BI, MGI, and PI significantly decreased (p < 0.05) at T1 (means control group: BI 0.26 ± 0.22, MGI 0.77 ± 0.36, PI 0.53 ± 0.20; means test group: BI 0.24 ± 0.22, MGI 0.65 ± 0.46, PI 0.49 ± 0.21) compared to baseline (means control group: BI 0.56 ± 0.27, MGI 1.23 ± 0.41, PI 0.87 ± 0.23; means test group: BI 0.54 ± 0.26, MGI 1.18 ± 0.39, PI 0.93 ± 0.20) but no significant differences in clinical measures were showed between T1, T2, and T3 (p > 0.05) (intragroup differences). Trial patients demonstrated significant improvements in knowledge with respect to controls comparing scores at T0 and T3 (p < 0.05) but despite this result in the test group clinical outcomes did not report significant intergroup differences at any time (p > 0.05). Conclusions: Presenting multimedia information through Instagram resulted in a significant improvement in knowledge. Therefore, this social media represents an aid to the standard verbal motivation performed by orthodontists towards young patients under an orthodontic treatment

Impacted Palatal Canines and Diode Laser Surgery: A Case Report

Introduction. Maxillary canine is the most frequent dental element that could likely remain impacted in the bone structure, with a percentage between 1 and 5%. This study presents a case report using a diode laser for surgical-orthodontics disinclusion of a palatal mucosal impacted permanent left upper canine (2.3) and the simultaneous application of an orthodontic bracket. Methods. After cementation of the trans-palatal bar to the upper first molars with a hook for orthodontic traction, local anaesthesia with articaine was performed, followed by surgical operculectomy using a diode laser (810nm wavelength, continuous wave mode with a power output of 3W, and a 0.4mm diameter optical fiber), and the orthodontic bracket with a passive metal looped ligature was applied. Subsequently, active elastic traction was applied on 2.3 and the upper arch was bonded for the application of a series of orthodontic wires, lace-back, and metal ligatures. A progressive reactivation of the elastic traction and extraction of 6.3 was necessary to translate the canine into the correct arch position. Results. Diode laser surgical-orthodontic disinclusion of impacted upper canine was performed successively, resulting in a dry surgical field ideal for orthodontic bracket adhesion. No pain and no swelling have been reported from the patient. The orthodontic treatment allowed the canine to be moved to the correct position in the arch. Conclusions. This case showed that the diode laser is a valid alternative for the surgical-orthodontic disinclusion of an included tooth element

Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases

Abstract Electrochemotherapy is now in routine clinical use to treat cutaneous metastases of any histology, and is listed in national and international guidelines for cutaneous metastases and primary skin cancer. Electrochemotherapy is used by dermatologists, surgeons, and oncologists, and for different degrees and manifestations of metastases to skin and primary skin tumours not amenable to surgery. This treatment utilises electric pulses to permeabilize cell membranes in tumours, thus allowing a dramatic increase of the cytotoxicity of anti-cancer agents. Response rates, often after only one treatment, are very high across all tumour types. The most frequent indications are cutaneous metastases from malignant melanoma and breast cancer. In 2006, standard operating procedures (SOPs) were written for this novel technology, greatly facilitating introduction and dissemination of the therapy. Since then considerable experience has been obtained treating a wider range of tumour histologies and increasing size of tumours which was not originally thought possible. A pan-European expert panel drawn from a range of disciplines from dermatology, general surgery, head and neck surgery, plastic surgery, and oncology met to form a consensus opinion to update the SOPs based on the experience obtained. This paper contains these updated recommendations for indications for electrochemotherapy, pretreatment information and evaluation, treatment choices, as well as follow-up

European e-Delphi process to define expert consensus on electrochemotherapy treatment indications, procedural aspects, and quality indicators in melanoma

The application of electrochemotherapy in patients with melanoma lacks consensus regarding treatment indications, procedural aspects, and quality indicators. A large European expert panel engaged in a Delphi process, and provided consensus recommendations on patient selection criteria, procedural aspects of electrochemotherapy, and quality indicators with benchmarks to improve future research and current clinical practice.Lay summary Electrochemotherapy is an effective locoregional therapy for skin metastases from melanoma, a problem faced by almost half of patients with metastatic disease. The lack of comparative studies and the heterogeneity of its clinical application among centres make it challenging to support consistent, evidence-based recommendations. To address this unmet need, a three-round online survey was conducted to establish a consensus on treatment indications, standard operating procedures, and quality indicators. In the survey, a panel of 100 European melanoma experts agreed on 56 statements that can be used to improve patient selection, homogenize treatment application, and monitor outcomes.Background Skin metastases are an important co-morbidity in melanoma. Despite broad adoption, electrochemotherapy implementation is hindered by a lack of treatment indications, uncertainty regarding procedural aspects, and the absence of quality indicators. An expert consensus may harmonize the approach among centres and facilitate comparison with other therapies. Methods An interdisciplinary panel was recruited for a three-round e-Delphi survey. A literature-based 113-item questionnaire was proposed to 160 professionals from 53 European centres. Participants rated each item for relevance and degree of agreement on a five-point Likert scale, and received anonymous controlled feedback to allow revision. The items that reached concordant agreement in two successive iterations were included in the final consensus list. In the third round, quality indicator benchmarks were defined using a real-time Delphi method. Results The initial working group included 122 respondents, of whom 100 (82 per cent) completed the first round, thus qualifying for inclusion in the expert panel (49 surgeons, 29 dermatologists, 15 medical oncologists, three radiotherapists, two nurse specialists, two clinician scientists). The completion rate was 97 per cent (97 of 100) and 93 per cent (90 of 97) in the second and third rounds respectively. The final consensus list included 54 statements with benchmarks (treatment indications, (37); procedural aspects, (1); quality indicators, (16)). Conclusion An expert panel achieved consensus on the use of electrochemotherapy in melanoma, with a core set of statements providing general direction to electrochemotherapy users to refine indications, align clinical practices, and promote quality assurance programmes and local audits. The residual controversial topics set future research priorities to improve patient care