Correlation of periodontal pathogens in concurrent endodontic-periodontal diseases

Objectives: This study investigated the correlation between Tannerella forsythia, Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans at dual sites in concurrent endodonticperiodontal diseases. Material and methods: Samples were collected from endodontium and periodontium in cases of concurrent endodontic-periodontal diseases from thirty participants. The sensitivity and specificity of SYBR Green real-time PCR was used to identify the targeted species. Absolute number of targeted genome copies in tested samples were extrapolated from respective calibration curve. Results: No statistical difference was found in the number of detected endodontic-periodontal pathogens between the endodontium and periodontium. The Pearson test detected significant correlation (P\u3c0.001) between targeted bacteria; T. forsythia, F. nucleatum, and P. gingivalis from endodontic-periodontal lesions. Synergistic component observed separately in endodontic biofilm was found only between T. forsythia and F. nucleatum (r=0.380, P=0.03) while in periodontal biofilm T. forsythia, F. nucleatum and P. gingivalis gave high synergism result (P\u3c0.0001). Correlation analysis showed that T. forsythia in primary endodontic infection and in periodontal lesion was significantly decreased with the increase of patients age (r=-0.308, P=0.017). Conclusions: Correlation between targeted bacterial species levels from concurrent endodonticperiodontal diseases confirmed that coronal and cervical dentinal tubules may represent a viable pathway that allows spreading and maintaining of dual sites infection. Periodontal bacteria detected in root canal of concurrent endodontic-periodontal infections may originate from the local periodontal lesions

Antimicrobial stewardship in the emergency department: a prospective cohort study

Antibiotic resistance is increasing globally. Implementing antibiotic stewardship programs (ASPs) to optimize the everyday use of antibiotics while preventing development and progression of resistance is of utmost importance. One of the most crucial points where the implementation of these programs can have a clinical impact is the emergency room, where often the antibiotic treatments are started. The evidence-based data concerning ASPs in the emergency room are scarce. In the following study, we implemented a 4-year non-restrictive, multi-faced ASP in the non-surgical emergency room at the university hospital of Tübingen, Germany. The study was divided in four phases (Prospective epidemiological and clinical data collection (Phase I, 2014); Prospective audit and feedback (Phase III, Jan- Dec 2016); Active infection diseases consultation service (Phase III, Jan – Dec 2016); Random audit and periodical feedback (Phase IV, Jan- Dec 2017)). Additionally we assessed the impact of an ASP on the length of stay (LOS) and incidence rate of clostridium difficile infections (CDI) as well as the mortality rate in the patients’ group admitted from ED to medical wards. The implementation of the ASP was linked to a reduction of antibiotic usage from 31.12. DDD/100PDs ((CI) 95% - 67,50 to 5,27, p 0,0092) at the beginng of phase II and a further reduction of 7.20 DDD/100 (CI 95% -40.94 to 26.54, p 0.669) at the beginning of phase III (table 2, figure 7). The cost was reduced by 691,5€/100PDs (SD: 263 EUROs/100 PDs) in phase I to 358.7€/100 PDs (SD: 189 €/100 PDs) in phase II, 262.5 €/100 PDs (SD: 162 €/100 PDs) in phase III and 263.3 €/100 PDs (SD: 162 €/100 PDs) in phase IV (p < 0.001). We also observed a non-significant yet sustained decline in LOS in all departments of the medical clinic (table 3) and a significant reduction of CDI-rates (table 4) while mortality did not significantly change (table 3). In conclusion, that implementation of an ASP has demonstrated to be feasible and safe and might clinically benefit the hospital admitted patients’ group. Further studies are required to identify the most beneficial ASP-design for emergency rooms and the key outcome measures to reliably assess its effectiveness

Systematizing Virtual Reconstructionof Lost or Never Built Architectures

European Architectural Cultural Heritage is immense. Yet part of this Heritage is invisible: churches, synagogues, mosques that have either been destroyed or never been built. Now the digital world offers the possibility to bring these artefacts to a new life, through 3D reconstruction. This way of studying and representing the past has become increasingly important in the academic world and the domain of digital entertainment. These applications make use of the so-called ‘virtual 3D reconstructions’, which are 3D models based on figurative/textual sources or ruins of artefacts that no longer exist or have never been built.This paper aims to present ‘CoVHer’ (Computer-based Visualisation of Architectural Cultural Heritage), an Erasmus Plus Project that deals with this vast theme and involves five universities and two private companies from five European countries (Italy, Spain, Portugal, Poland and Germany). The main objective of CoVHer is to define applicable/practice guidelines and operational methodologies aimed at the study, implementation, visualization and critical evaluation of the 3D models. Some of the ongoing theoretical studies developed in the project will be presented. In particular, this paper will focus on the systematization of the reconstruction process. It defines and classifies different aspects of 3D digital modelling; and other aspects concerning visualization in the field of architectural hypothetical reconstruction

Minimally invasive access cavities in endodontics

Background: The access cavity is a critical stage in root canal therapy and it may influence the subsequent steps of the treatment. The new minimally invasive endodontic access cavity preparation concept aims to preserve sound tooth structure by conserving as much intact dentine as possible including the pulp chamber's roof, to keep the teeth from fracturing during and after endodontic treatment. While there is great interest in such access opening designs in numerous publications, still there is a lack of scientific evidence to support the application of such modern access cavity designs in clinical practice. This review aims to critically examine the literature on minimal access cavity preparations, explain the effect of minimally invasive access cavity designs on various aspects of root canal treatment, and identify areas where additional research is required. Data: An electronic search for English-language articles was performed using the following databases: Google Scholar, PubMed, and Research Gate. The following keywords were used: "minimally invasive access cavity", "conservative endodontic cavity ", and "classification of access cavity". Study selection: 64 papers that were the most relevant to the topics in this review were selected between 1969 to 26 February 2022. Conclusions: Minimally invasive access cavities can be classified into conservative, ultraconservative, truss access, caries and restorative-driven cavities. There is a deficiency of proof that a minimally invasive access cavity maintains the resistance to fracture of endodontically treated teeth greater than traditional access cavities. There was no difference in the percentage of untouched walls and debris removal in teeth with conservative vs traditional access cavities, however, truss and ultraconservative access cavities resulted in poor irrigation efficacy compared to traditional ones. Also, the lower cyclic fatigue resistance of rotary instruments and root canal obturation with voids were associated with minimally invasive access cavities. The studies about minimally invasive access cavities still have a wide range of methodological disadvantages or register unsatisfactory or inconclusive results. Therefore, further research on this topic is needed especially with the everyday advancement of techniques and armamentarium used in endodontics

Bacterial Percolation and Sealer Tubular Penetration in a Polymer-based Obturation System Compared with Warm Vertical Condensation Technique: An in Vitro Study

Introduction: This study compared bacterial percolation and sealer penetration of a novel obturation technique with the ones of warm vertical condensation technique. Methods and Materials: A bacterial percolation test was carried out with 80 single rooted human teeth divided into 5 groups;&nbsp; A (n=20): warm vertical condensation and AH-Plus, B (n=20): CPoint with AH-Plus, C (n= 20): CPoint with EndoSequence BC, +ve Control (n=10): teeth with no canal obturation, -ve Control (n=10): teeth with no access cavity. The samples were inoculated with a multispecies bacterial incoulum. Bacterial percolation was evaluated by turbidity. Confocal laser scanning microscopy (CLSM) was used to observe the presence of gaps and voids. Further 48 extracted human mandibular single-canal premolars were used to determine the sealer penetration. Slices of the samples were observed by CLSM to evaluate tubules penetration of the sealer. Kaplan Meyer survival, ANOVA one way and Tuckey HSD test and a Wilcoxon signed-rank test were utilised. Results: A Kaplan-Meier test showed no significant difference overall (P&gt;0.05) between groups A, B and C. At 43 days, the group B showed a significantly inferior ability to prevent bacterial passage (P&lt;0.05). The group C showed a deeper sealer penetration than group A and B with statistically significant differences (P&lt;0.05) for the total penetration (ANOVA one way and Tukey HSD). A Wilcoxon signed-rank test showed statistically significant differences for the penetration in the middle-and apical third of the 3 groups. Conclusion: Based on this in vitro study, the single polymer-cone obturation technique with a resin based- and bioceramic based-sealer behaved similarly to the warm vertical obturation technique in preventing bacterial passage. The bioceramic sealer showed the deepest penetration but did not fully prevent bacterial leakage

The reconstruction of drawn architecture

Among the many cases concerning the process of digital hypothetical 3D reconstruction a particular case is constituted by never realized projects and plans. They constitute projects designed and remained on paper that, albeit documented by technical drawings, they pose the typical problems that are common to all other cases. From 3D reconstructions of transformed architectures, to destroyed/lost buildings and part of towns. This case studies start from original old drawings which has to be implemented by different kind of documentary sources, able to provide - by means evidence, induction, deduction, analogy - information characterized by different level of uncertainty and related to different level of accuracy. All methods adopted in a digital hypothetical 3D reconstruction process show us that the goal of all researchers is to be able to make explicit, or at least intelligible, through a graphical system a synthetic/communicative level representative or the value of the reconstructive process that is behind a particular result. The result of a reconstructive process acts in the definition of three areas intimately related one each other which concur to define the digital consistency of the artifact object of study: Shape (geometry, size, spatial position); Appearance (surface features); Constitutive elements (physical form, stratification of building/manufacturing systems) The paper, within a general framework aimed to use 3D models as a means to document and communicate the shape and appearance of never built architecture, as well as to depict temporal correspondence and allow the traceability of uncertainty and accuracy that characterizes each reconstructed element.  

recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship

Objectives To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area. Methods A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review. Results The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%). Conclusions Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment

Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review

Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients