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Abstract The reconstruction of craniomaxillofacial bone defects remains clinically challenging. To date, autogenous grafts are considered the gold standard but present critical drawbacks. These shortcomings have driven recent research on craniomaxillofacial bone reconstruction to focus on synthetic grafts with distinct materials and fabrication techniques. Among the various fabrication methods, additive manufacturing (AM) has shown significant clinical potential. AM technologies build three-dimensional (3D) objects with personalized geometry customizable from a computer-aided design. These layer-by-layer 3D biomaterial structures can support bone formation by guiding cell migration/proliferation, osteogenesis, and angiogenesis. Additionally, these structures can be engineered to degrade concomitantly with the new bone tissue formation, making them ideal as synthetic grafts. This review delves into the key advances of bioceramic grafts/scaffolds obtained by 3D printing for personalized craniomaxillofacial bone reconstruction. In this regard, clinically relevant topics such as ceramic-based biomaterials, graft/scaffold characteristics (macro/micro-features), material extrusion-based 3D printing, and the step-by-step workflow to engineer personalized bioceramic grafts are discussed. Importantly, in vitro models are highlighted in conjunction with a thorough examination of the signaling pathways reported when investigating these bioceramics and their effect on cellular response/behavior. Lastly, we summarize the clinical potential and translation opportunities of personalized bioceramics for craniomaxillofacial bone regeneration.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Abstract Apical periodontitis (AP) is a dental-driven condition caused by pathogens and their toxins infecting the inner portion of the tooth (i.e., dental pulp tissue), resulting in inflammation and apical bone resorption affecting 50% of the worldwide population, with more than 15 million root canals performed annually in the United States. Current treatment involves cleaning and decontaminating the infected tissue with chemo-mechanical approaches and materials introduced years ago, such as calcium hydroxide, zinc oxide–eugenol, or even formalin products. Here, we present, for the first time, a nanotherapeutics based on using synthetic high-density lipoprotein (sHDL) as an innovative and safe strategy to manage dental bone inflammation. sHDL application in concentrations ranging from 25 µg to 100 µg/mL decreases nuclear factor Kappa B (NF-κB) activation promoted by an inflammatory stimulus (lipopolysaccharide, LPS). Moreover, sHDL at 500 µg/mL concentration markedly decreases in vitro osteoclastogenesis (P

Abstract Background Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. Methods In this study, 382 infants born at 24+0–27+6 weeks’ gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks’ postmenstrual age. The secondary outcomes are BPD at 36 weeks’ postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). Discussion This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0–27+6 weeks’ gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks’ postmenstrual age of life. Trial registration ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

Abstract Understanding the factors influencing mosquitoes’ fecundity and longevity is important for designing better and more sustainable vector control strategies, as these parameters can impact their vectorial capacity. Here, we address how mating affects midgut growth in Aedes aegypti, what role Juvenile Hormone (JH) plays in this process, and how it impacts the mosquito’s immune response and microbiota. Our findings reveal that mating and JH induce midgut growth. Additionally, the establishment of a native bacterial population in the midgut due to JH-dependent suppression of the immune response has important reproductive outcomes. Specific downregulation of AMPs with an increase in bacteria abundance in the gut results in increased egg counts and longer lifespans. Overall, these findings provide evidence of a cross-talk between JH response, gut epithelial tissue, cell cycle regulation, and the mechanisms governing the trade-offs between nutrition, immunity, and reproduction at the cellular level in the mosquito gut.

While attitudes toward gay men in sport have improved, sexual prejudice persists in sport, with the potential to decrease team social bonds. We examined the relationship between heterosexist attitudes and cohesion in men's collegiate sports. Male college athletes (N = 264) completed the Heterosexist Attitudes in Sport–Gay Men scale and the Group Environment Questionnaire. We found a significant multivariate relationship among heterosexist attitudes and cohesion, Λ =.88, F(8, 518) = 4.28, p <.001, with 10.6% overlapping variance between the two variate sets. Cognitive/affective heterosexist attitudes, attraction to group-task, group integration-task, and group integration-social contributed to the relationship. Heterosexism and sexual prejudice may serve as distractions from team objectives. Mental performance consultants working within men's college sport should challenge negative stereotypes of lesbian, gay, bisexual, and queer individuals; reward inclusive efforts; and leverage team building to reduce heterosexism in sport. [ABSTRACT FROM AUTHOR]

Abstract Land use change and atmospheric composition, two drivers of climate change, can interact to affect both local and remote climate regimes. Previous works have considered the effects of greenhouse gas buildup in the atmosphere and the effects of Amazon deforestation in atmospheric general circulation models. In this study, we investigate the impacts of the Brazilian Amazon savannization and global warming in a fully coupled ocean-land-sea ice-atmosphere model simulation. We find that both savannization and global warming individually lengthen the dry season and reduce annual rainfall over large tracts of South America. The combined effects of land use change and global warming resulted in a mean annual rainfall reduction of 44% and a dry season length increase of 69%, when averaged over the Amazon basin, relative to the control run. Modulation of inland moisture transport due to savannization shows the largest signal to explain the rainfall reduction and increase in dry season length over the Amazon and Central-West. The combined effects of savannization and global warming resulted in maximum daily temperature anomalies, reaching values of up to 14 °C above the current climatic conditions over the Amazon. Also, as a consequence of both climate drivers, both soil moisture and surface runoff decrease over most of the country, suggesting cascading negative future impacts on both agriculture production and hydroelectricity generation.

Resumo Introdução: O hálux valgo (HV) é uma deformidade complexa do antepé, onde ocorre um desvio progressivo do hálux centrado na primeira articulação metatarsofalangeana, frequentemente acometendo mulheres, caracterizada por um desvio lateral do hálux e medial do primeiro metatarso. A etiologia inclui fatores intrínsecos como a predisposição genética e extrínsecos, sendo o mais importante o uso de calçados inadequados. É uma deformidade amplamente estudada que afeta os pés e que embora existam mais de 130 técnicas convencionais descritas para sua correção, a melhor técnica não ainda foi determinada. Objetivos: Este estudo visa investigar o crescimento das publicações científicas sobre as técnicas de cirurgias minimamente invasivas no tratamento do HV, realizando uma análise comparativa da adoção dessas metodologias pelos cirurgiões ortopédicos, além de fornecer uma previsão estatística do panorama das publicações futuras. Metodologia: Utilizou-se uma série temporal de publicações científicas entre 2000 e 2023, com dados coletados na plataforma PubMed. A tendência linear foi determinada pelos mínimos quadrados, analisando-se as publicações que mencionam técnicas cirúrgicas minimamente invasivas e abertas. Foram considerados artigos em português e inglês que abordam técnicas cirúrgicas no tratamento do HV. Resultados: A análise incluiu 997 artigos, mostrando um aumento substancial nas publicações sobre técnicas minimamente invasivas nos últimos cinco anos. A técnica de Chevron é a mais citada entre as cirurgias abertas (178 referências). Artigos mencionando técnicas minimamente invasivas passaram de 1 em 2000 para 54 em 2023. As previsões indicam um crescimento contínuo nas publicações sobre cirurgias minimamente invasivas até 2030. Discussão: O aumento nas publicações reflete a disseminação e o interesse acadêmico e clínico nas técnicas minimamente invasivas, que oferecem benefícios como menor trauma tecidual com boa correção óssea. No entanto, os desafios técnicos e a necessidade de treinamento especializado persistem. A osteotomia de Chevron, uma técnica aberta, continua a ser amplamente utilizada como referência comparativa, evidenciando sua importância contínua no campo da ortopedia. Conclusão: Há uma tendência crescente na literatura científica em favor das técnicas minimamente invasivas para a correção do HV. A comparação entre as abordagens minimamente invasivas e as técnicas abertas têm se intensificado, sublinhando a necessidade de avaliar suas aplicações para proporcionar os melhores desfechos clínicos. Este estudo contribui para uma melhor compreensão da evolução e adoção dessas técnicas na prática cirúrgica ortopédica.

A Doença de Müller-Weiss gera alterações biomecânicas complexas dos pés, sendo sua verdadeira prevalência desconhecida. Muitos casos são subdiagnosticados, visto que alguns pacientes não apresentam sintomas, mas principalmente porque o diagnóstico não faz parte do escopo do ortopedista em geral. Quando presente, a característica clínica mais marcante é a presença do pé plano paradoxal com dor no mediopé de início insidioso, dificuldade para caminhar e desabamento progressivo do arco plantar. Frequentemente acomete mulheres com envolvimento bilateral. O tratamento inicial compreende mudanças no estilo de vida (como perda de peso e prática de atividades físicas) modificações no uso de calçados e palmilhas sob molde com elevação de toda borda lateral. Nos casos não responsivos ao tratamento clínico, a cirurgia é uma opção viável. A artrodese talo-naviculo-cuneiforme é uma das opções cirúrgicas para melhora da dor e correção da deformidade com recuperação do alinhamento do retropé. Essa revisão sistemática visa discutir a importância do tema, uma vez que comumente subdiagnosticado, chega ao médico ortopedista com complexas alterações anatômicas e biomecânicas, trazendo maiores dificuldades para obtenção de um resultado satisfatório.

IntroductionAs individuals with occupational status and power, sport leaders (e.g., coaches and athletic administrators) are responsible for enforcing cultures of inclusion within institutions of athletics. Yet, sport leaders who possess LGBTQ+ sexual identities are frequently marginalized and stigmatized by entities within and outside of athletics (e.g., athletes, parents of athletes, colleagues). Therefore, LGBTQ+ sport leaders are often faced with a challenging set of circumstances: negotiate the authenticity of their sexual orientation in the context of sport, or leave the profession entirely.MethodsThe purpose of this study was to conduct a systematic review of research related to LGBTQ+ sport leader experiences. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), research across six countries (China/Taiwan/Hong Kong, Italy, New Zealand, Norway, United Kingdom, United States) between 1997 and 2021 was analyzed.ResultsThemes across included studies (N = 34) describe intrapersonal experiences of LGBTQ+ sport leaders, interpersonal studies examining stakeholder attitudes (i.e., parents and athletes) toward LGBTQ+ sport leaders, and sport manager attitudes toward LGBTQ+ topics.DiscussionFindings convey that sport leaders continue to face marginalization due to the presence of heterosexism and heteronormativity in athletics. Future research should continue to explore LGBTQ+ sport leader experiences, behaviors, attitudes, and identities to determine their impact on fostering inclusion and belonging within athletic spaces.

Summary: Cooperation and competition shape everyday human interactions and impact individuals’ chances of success in different domains. Using a virtual Stroop test, classically employed to assess general cognitive interference, we examined the impact of social context (cooperation and competition) and other’s ability (higher and lower performers) on performance, perceived stress, and autonomic activity. In Experiment 1, we found that both cooperation with a lower performer and competition with a higher performer led to similar enhancement in performance. However, only competition with a more skilled opponent induced an increase in perceived stress and physiological activity. Experiment 2 further demonstrated that these effects persisted even with prolonged exposure to these contexts. In summary, cooperation can be just as effective as competition in improving individuals’ performance. However, cooperation does not carry the same level of stress and physiological burden as the competitive context, representing a healthier and more optimal way to boost individual performance.

The present article discusses the dynamics of system resilience, focusing on the case of a university college in Brazil. It investigates the experience of lecturers of this educational institution in the initial months of the COVID-19 pandemic. This is exploratory basic qualitative research, aiming at understanding how the university college self-organized in this period. This research focused on local adaptation processes and was conducted through interviews with a sample of lecturers from the study programs offered by the university college. A text analysis software was used to analyze the data generated according to the three aspects of social-ecological resilience. The analytical framework of this research applies the concept of resilience in a socio-ecological system to discuss emergent organizational changes and learning in higher education. Systems resilience highlights adaptation processes characterized by an interplay of previous experience and emerging new knowledge. The findings describe the emergence of new practices and learning as faculty members encountered challenges brought on by the pandemic. Beyond learning new technological tools, the pandemic raised awareness of students' socio-economic backgrounds in the context of inequality in Brazil. However, resilience requires open communication among staff and across organizational levels about adaptation processes that have taken place during the pandemic.

Given the ongoing COVID-19 pandemic, there is a need to identify SARS-CoV-2 and to differentiate it from other respiratory viral infections, especially influenza A and B, in various critical settings. Since their introduction, the use of rapid antigen tests has spread worldwide, but there is variability in their diagnostic accuracy. In the present study, we evaluated the clinical performance of the ID NOW™ COVID-19 2.0, a molecular point-of-care test (POCT) based on enzymatic isothermal amplification for the differential diagnosis of SARS-CoV-2 and influenza A/B in a pediatric emergency setting. A cohort of pediatric patients admitted between December 2022 and February 2023 were simultaneously tested with the POCT and standard laboratory molecular assay. Our findings showed high negative agreement of the POCT assay across the different age groups for SARS-CoV-2, influenza A, and influenza B (more than 98.0%), while its positive agreement varied significantly for the abovementioned viral species from 50.0% to 100%. These results highlight the potential of the ID NOW™ COVID-19 2.0 POCT assay as a reliable and rapid tool for excluding SARS-CoV-2 and influenza A/B infections in symptomatic pediatric patients, although its variable positive agreement suggests a need for confirmatory RT-qPCR testing in certain clinical and epidemiological settings in order to ensure accurate diagnosis and appropriate patient management.

Over the past few years, there has been a notable increment in scientific literature aimed at unraveling the genetic foundations of vitamin D signaling and its implications for susceptibility to autoimmunity, however, most of them address isolated diseases. Here, we conducted a systematic review of genetic variants related to vitamin D and autoimmune diseases and we discussed the current landscape of susceptibility and outcomes. Of 65 studies analyzed, most variants cited are in vitamin D binding protein (VDBP; rs2282679 GC gene), 25-hydroxylase (rs10751657 CYP2R1), 1α-hydroxylase (rs10877012, CYP27B1) and the nuclear hormone receptor superfamily [FokI (rs2228570), BsmI (rs1544410), ApaI (rs7975232), and TaqI (rs731236) in VDR gene]. Therefore, our findings confirmed the associations of several genetic variants of vitamin D signaling with a broad spectrum of autoimmune diseases/traits. In addition, given the low number of papers found with functional analysis, further studies to elucidate the real effect that the variants exert on Vitamin D signaling are recommended.

Objectives: The goal of this systematic review was to analyze, in randomized controlled clinical trials (RCTs), regenerative techniques used to treat peri-implantitis (PI). Methods: Three databases (PubMed/Medline, EMBASE, and On-Line Knowledge Library) were accessed, applying the PICO strategy (Population [P], Intervention [I], Comparison [C], and Outcomes [O]), with the following focused questions: (i) “In patients who received regenerative treatments for peri-implantitis (P), is the regenerative surgical treatment (I) clinically effective and predictable compared to non-regenerative (C) to treat PI (O)?”; and (ii) “In patients who received regenerative treatments for peri-implantitis (P), the regenerative approach (I), compared to non-regenerative (C), significantly increase the prognosis and implant survival rate in the mid- and long-term (O)?” The inclusion criteria were RCTs published in English between 2012 and 2022, with at least a one-year follow-up, which applied regenerative techniques to treat peri-implantitis. Cochrane’s collaboration tool for assessing the risk of bias was used. Main results: Nine articles were included with 404 patients (225 females and 179 males; mean age of 60.44 years). One study evaluated patients after 48 months and another after 88 months. The techniques and devices used were: (i) implantoplasty with Er:YAG laser, (ii) blood concentrate (growth factors), and (iii) EMD, with no statistically significant outcome. Two studies considered the use of titanium granules with a significant increase in radiographic bone identification, whereas regenerative techniques with bone graft (autogenous, alloplastic, and xenograft) were the majority chosen, associated or not, with a collagen membrane. Xenograft had better results radiographically when compared to the autogenous bone graft and presented better results for bone level. There was an overall decrease in bleeding on probing, independent of the control or test group, and a reduction in pocket depth in the groups analyzed. Titanium granules, EMD, Er:YAG laser, and CGF had non-significant results; better results were observed when using bone grafts. The RoB showed a low risk in four studies (44.44%), three with moderate (33.33%), and two with high risk (22.23%). Conclusion: Surgical regenerative treatment was a predictable option in the management of PI and in improving the clinical parameters of peri-implant tissues in the short term, mainly when using porous titanium granules, alloplastic bone grafts, and xenografts.

Abstract This study presents novel insight into the mechanisms of Atlantic Meridional Overturning Circulation (AMOC) reduction and its recovery under a warmer climate scenario. An one-thousand-year-long numerical simulation of a global coupled ocean–ice–atmosphere climate model, subjected to a stationary atmospheric radiative forcing, depict a coherent picture of the Arctic sea ice melting as a trigger for the initial AMOC reduction, along with decreases in the northward fluxes of salt and heat. Further atmospheric-driven ocean processes contribute to an erosion of the stable stratification of the fresher, yet colder waters in the surface layers of the North Atlantic, contributing to the recovery of a permanently altered AMOC.