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Abstract Background Gingival phenotype (GP), comprising gingival thickness (GT) and keratinized tissue width (KTW), plays a crucial role in preserving the integrity of gingival and periodontal tissues, thereby enhancing their resistance to trauma and mechanical irritation. This systematic review and meta-analysis aimed to evaluate the current evidence about the changes in GT and KTW following the injection of injectable platelet-rich fibrin (i-PRF) in patients with thin GP. Methods A thorough search was conducted up to April 2024 across the following nine databases: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed®, Scopus®, Web of Science®, Google Scholar, Trip, CINAHL via EBSCO, EMBASE via OVID, and ProQuest. This review covered parallel-group and split-mouth randomized controlled trials (RCTs) which investigated the changes in GT and KTW following i-PRF injection on the buccal anterior region in both jaws for individuals with thin GP. The risk of bias in the included studies was evaluated using Cochrane’s tool (RoB 2), and the GRADE framework was utilized to assess the overall strength of evidence. Agreement between the authors was assessed using Cohen’s kappa statistic. Results Seven RCTs were included in this review, five of which were appropriate for the quantitative synthesis of data. The meta-analysis showed a statistically significant increase in the GT in the i-PRF group at all assessment times compared to baseline (MD ranged from 0.12 mm to 0.38 mm). Regarding KTW, 4-time injections led to a significant increase in KTW after 3-month and 6-month follow-ups compared to baseline (MD = 0.31 mm, and MD = 0.37 mm, respectively). In contrast, 3-time injections yielded a non-significant increase in KTW after 1 and 3 months of follow-up (MD = 0.14 mm at both assessment times). The strength of evidence supporting these findings ranged from low to moderate. However, when comparing the i-PRF group and the i-PRF + microneedling (MN) group, the pooled estimate exhibited significant differences in the GT at both assessment times, with superiority for the MN + i-PRF group (MD = 0.04 mm after 3 months, MD = 0.11 mm after 6 months). In contrast, there were no statistically significant differences in KTW between the two comparisons (MD = 0.03 mm at both assessment times). The strength of evidence supporting these findings was moderate. Conclusions For patients with a thin GP, i-PRF administration resulted in a significant increase in GT at all assessment times compared to baseline. Regarding the KTW, the results varied depending on the number of injection sessions. When the injections were carried out four times, there was an observed increase in KTW, while repeating the intervention three times revealed a non-significant increase in KTW. Protocol registration The protocol was registered in the PROSPERO database (CRD42024543374) on 16 May 2024. Level of evidence According to the GRADE recommendations, the strength of evidence regarding the effect of i-PRF injection on GT and KTW ranged from low to moderate. The evidence strength for differences between the i-PRF group and the i-PRF + MN group in both GT and KTW was moderate. The overall quality of evidence for these outcomes is presented in Table 4.

Integrating AI-powered tutoring systems in higher education represents a significant advancement in educational technology, offering personalized and adaptive learning experiences. This study investigates the perceptions and expectations of higher education students in Hungary and Spain regarding AI tutors. Despite extensive research on the technological efficacy of AI systems, there is limited understanding of student attitudes in these specific cultural contexts. This research aims to fill this gap by exploring student expectations, satisfaction levels, and perceived benefits of AI tutors compared to human instructors. To achieve this, a validated questionnaire was administered to 184 higher education students from Hungary and Spain, capturing data on various dimensions of their expectations. The study's findings indicate that students appreciate the adaptability and continuous guidance provided by AI tutors, with Hungarian students showing higher overall expectations compared to their Spanish counterparts. These insights suggest that AI tutoring systems can enhance the learning experience by addressing individual student needs more effectively. The implications of this study are significant for higher education institutions seeking to integrate AI technologies.

Background: the human leukocyte antigen (HLA) loci have been widely characterized to be associated with viral infectious diseases. Several studies including various ethnic groups and populations suggested associations between certain HLA alleles and SARS-CoV-2 infection. Despite the numerous associations identified, the role of HLA polymorphisms in determining the individual response to SARS-CoV-2 infection is controversial among different Saudi populations. Method: Here, we performed HLA typing by next-generation sequencing to investigate if variations in polymorphic HLA genes are linked to COVID-19 severity in the Saudi population. Namely, we analyzed HLA loci at allele level in 575 Saudi patients with SARS-CoV-2 infection. HLA class I and class II frequencies in patients were compared with allele frequency data from healthy Saudi population. Results: in our cohort HLA-A* 02:01:01 G was associated with mild disease but was not associated with moderate and severe disease. HLA-B* 51:01:01 G was protective from severe disease while HLA-B* 50:01:01 G, HLA-C* 06:02:01 G and HLA-DRB1 * 07:01:01 G were associated with risk to severe disease as well as the total COVID-19 cohort. HLA-DRB1 * 15:01:01 G was associated with risk to all severity groups. Conclusion: in conclusion, we found significant associations between HLA alleles and COVID-19 disease severity in Saudis. Further studies are warranted to include HLA typing in the workup for any new COVID-19 patients.

Detection of anti-class II antibodies by panel response assay (PRA) and flow cross-match techniques carries an important value in terms of graft function. Even low levels of pre-formed alloantibodies to HLA class II antigens represent a risk of rejection. We present here a method for blocking non-specific flow crossmatch reactions using pooled, heat-inactivated rabbit serum. This method shows very low background and minimal non-specific reactions. In addition, it avoids the use pronase enzyme that can non-specifically digest different cell surface proteins.

Abstract Background Low-intensity electrical stimulation (LIES) is considered a relatively recent technology that has received little attention in orthodontics as a method of acceleration. This study aimed to evaluate patient-reported outcome measures when LIES is used to accelerate the en-masse retraction of the upper anterior teeth. Materials and methods The sample consisted of 40 patients (8 males, 32 females; mean age 21.1 ± 2.3 years), with Class II division I malocclusion who required extraction of the first premolars to retract upper anterior teeth. They were randomly assigned to the LIES group (n = 20) and the conventional en-masse retraction group (CER; n = 20). Patient responses regarding pain, discomfort, burning sensation, swelling, chewing difficulty, speech difficulty, and painkillers’ consumption were recorded at these nine assessment times: 24 h (T1), 3 days (T2), and 7 days (T3) after force application, then in the second month after 24 h (T4), 3 days (T5), and 7 days (T6) of force re-activation, and finally after 24 h (T7), 3 days (T8), and 7 days (T9) of force re-activation in the third month. Results The mean values of pain perception were smaller in the LIES group than those in the CER group at all assessment times with no statistically significant differences between the two groups except during the second and third months (T5, T6, T8, and T9; P

Abstract Objectives To evaluate the accuracy of a semi-automatic 3D digital setup process in predicting the orthodontic treatment outcome achieved by labial fixed appliances. Subjects and Methods Twenty-five adult patients (18 to 24 years old) with class I malocclusion and moderate crowding were prospectively enrolled and received treatment on both jaws through the straight-wire technique. Prior to treatment commencement, a semi-automatic digital setup simulating the predicted treatment outcome was performed for each patient through Orthoanalyzer software (3Shape®, Copenhagen, Denmark) to obtain the prediction model. This was compared to the final outcome model through 3D superimposition methods. Metric variables and inspection of color-coded distance maps were used to detect how accurately the digital setup predicts the actual treatment outcome. Results The mean absolute distances (MAD) between the superimposed dental arches of the predicted and the final models were: 0.77 ± 0.13 mm following superimposition on the palate, 0.52 ± 0.06 mm following superimposition on the maxillary dental arch, and 0.55 ± 0.15 mm following superimposition on the mandibular dental arch. The MAD at the palatal reference area was 0.09 ± 0.04 mm. Visualization of color-coded distance maps indicated that the digital setup accurately predicted the final teeth position in a few cases. Almost half of the cases had posteriorly wider upper and lower dental arches and palatally/lingually positioned or inclined anterior teeth, whereas the rest still showed errors within 2–3 mm, distributed over the entire dental arches with no distinct pattern. Conclusions The accuracy of semi-automatic prediction of the labial fixed appliance treatment outcome in Class I cases with moderate crowding is not yet sufficient. While average measures showed deviations less than 1 mm, examination of individual color-coded distance maps revealed significant disparities between the simulated and the actual results.

Background: Frictional resistance is a critical factor influencing the efficacy of orthodontic treatment. Archwire-ligature combinations play a significant role in determining frictional forces within the orthodontic system. This study aimed to conduct a comparative analysis of the frictional resistance exhibited by various archwire-ligature combinations commonly used in orthodontics. Materials and Methods: A total of five archwire-ligature combinations were evaluated in this study: stainless steel archwire with elastic ligatures, stainless steel archwire with metal ligatures, nickel-titanium archwire with elastic ligatures, nickel-titanium archwire with metal ligatures, and beta-titanium archwire with metal ligatures. Frictional resistance was measured using a universal testing machine under standardized conditions, with a constant load applied to simulate clinical conditions. Results: The frictional resistance varied significantly among the different archwire-ligature combinations. The mean frictional resistance values (in arbitrary units) recorded were as follows: stainless steel archwire with elastic ligatures (X), stainless steel archwire with metal ligatures (Y), nickel-titanium archwire with elastic ligatures (Z), nickel-titanium archwire with metal ligatures (A), and beta-titanium archwire with metal ligatures (B). Statistical analysis revealed that combination A exhibited the lowest frictional resistance, followed by combination B, combination Z, combination X, and combination Y. Conclusion: The choice of archwire-ligature combination significantly affects the frictional resistance within the orthodontic system. Nickel-titanium archwires combined with metal ligatures demonstrated lower frictional resistance compared with stainless steel archwires, regardless of the ligature type. Among the combinations tested, nickel-titanium archwire with metal ligatures exhibited the lowest frictional resistance, suggesting its potential for reducing friction and improving treatment efficiency in orthodontic practice.

Background: Orthodontic treatment involves the use of various materials, including brackets and wires, which come into direct contact with oral tissues. Biocompatibility of these materials is crucial to ensure patient safety and treatment success. This study aims to evaluate the biocompatibility of orthodontic brackets and wires through an in-vitro investigation. Materials and Methods: Orthodontic brackets and wires commonly used in clinical practice were selected for this study. A series of in-vitro tests were conducted to assess the biocompatibility of these materials. Cell culture assays were performed to evaluate cytotoxicity, cell proliferation, and inflammatory response. In addition, scanning electron microscopy (SEM) was used to examine the surface characteristics of the materials. Results: The cytotoxicity assays revealed minimal adverse effects on cell viability, with cell viability percentages ranging from 90% to 95% for all materials tested. Cell proliferation assays demonstrated similar rates of cell growth on the surfaces of both brackets and wires. SEM analysis indicated smooth surfaces with minimal irregularities, suggesting favorable biocompatibility. Conclusion: The findings of this in-vitro study suggest that the orthodontic brackets and wires examined exhibit satisfactory biocompatibility characteristics. Minimal cytotoxicity and favorable cell proliferation indicate that these materials are well suited for use in orthodontic treatment. Further clinical studies are warranted to validate these findings and ensure the safety and efficacy of orthodontic appliances in patient care.

Background: Orthodontic appliances can influence the oral environment, including salivary pH levels, which play a crucial role in maintaining oral health. Understanding how different orthodontic appliances affect salivary pH levels can help in improving treatment outcomes and minimizing potential side effects. Materials and Methods: In this in vitro study, we evaluated the effects of various orthodontic appliances on salivary pH levels using a simulated oral environment. Four different types of orthodontic appliances were tested: traditional metal braces, ceramic braces, lingual braces, and clear aligners. Saliva samples were collected and subjected to pH measurements using a standardized method. The pH measurements were recorded at three different time intervals: immediately after appliance placement, after 24 hours, and after 48 hours. Results: The initial pH values varied among the different orthodontic appliances: metal braces (pH 7.2), ceramic braces (pH 7.4), lingual braces (pH 7.1), and clear aligners (pH 7.5). After 24 hours, there was a decrease in pH levels for all groups: metal braces (pH 6.8), ceramic braces (pH 7.0), lingual braces (pH 6.7), and clear aligners (pH 7.2). After 48 hours, the pH levels continued to decrease: metal braces (pH 6.5), ceramic braces (pH 6.8), lingual braces (pH 6.4), and clear aligners (pH 6.9). Conclusion: Our findings suggest that different orthodontic appliances have varying effects on salivary pH levels. Metal braces and lingual braces tend to cause a more pronounced decrease in salivary pH compared to ceramic braces and clear aligners. Monitoring salivary pH levels during orthodontic treatment may be beneficial in identifying potential risks to oral health and implementing appropriate interventions.

Background: Orthodontic bonding materials are extensively used in dentistry, but their antimicrobial properties are of growing concern due to the risk of biofilm formation and associated complications. Understanding the antimicrobial efficacy of these materials is crucial for maintaining oral health during orthodontic treatment. Materials and Methods: In this in vitro study, we evaluated the antimicrobial properties of various orthodontic bonding materials against common oral pathogens. Samples of bonding materials were prepared and exposed to microbial strains including Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans. Antimicrobial activity was assessed using agar diffusion assays and microbial viability assays. Results: The tested orthodontic bonding materials exhibited varying degrees of antimicrobial activity. Material A showed a zone of inhibition of 12 mm against S. mutans, 8 mm against P. gingivalis, and 6 mm against C. albicans. Material B exhibited slightly higher antimicrobial activity with inhibition zones of 14 mm, 10 mm, and 8 mm against S. mutans, P. gingivalis, and C. albicans, respectively. Material C displayed the highest antimicrobial activity, with inhibition zones of 16 mm against S. mutans, 12 mm against P. gingivalis, and 10 mm against C. albicans. Microbial viability assays confirmed the efficacy of these materials in reducing microbial growth. Conclusion: Our findings demonstrate that orthodontic bonding materials possess varying degrees of antimicrobial properties. Material C exhibited the highest efficacy against the tested microbial strains. Incorporating antimicrobial agents into orthodontic bonding materials may contribute to the prevention of oral infections during orthodontic treatment.

The evaluation of publication growth is a vital indicator to assess any branch of knowledge. The present study aimed to investigate the Scopus-indexed publications on orthodontics produced by the Arab League Nations in the last two decades (2002–2021). Quantitative research method based on bibliometric analysis has been used and the meta-data for the study was retrieved from Elsevier's Scopus database on November 14, 2022. The bibliographic description of all types of literature published on orthodontics from 2002 to 2021 by the authors affiliated with the Arab countries has been downloaded. The selected bibliometric indicators of the data were analyzed by using Microsoft Excel, VOSviewer and SPSS software. The Arab League Nations contributed 5.02 % to global orthodontic research. This segment has demonstrated an amazing escalation of documents from a global perspective between 2002 and 2021 from 1.24 % to 10.94 %. Slightly more than 60 % of documents were published during the last five years of study (2017–2021). The highest number of documents (41 %) was produced by Saudi Arabia, whereas documents contributed by Jordan gained the maximum citation impact. The majority of collaboration was done with the United States, but documents produced in collaboration with Turkey gained the highest citation impact. The paper highlighted that the share of Arab League Nations in orthodontic research has been growing, and Saudi Arabia emerged as the most productive country. The constructive evolution of orthodontic literature with international collaboration display an ambitious approach by Arab countries.

The main objective of this study is to investigate the efficiency of coagulation-flocculation process for surface water treatment, using the conventional coagulants (ferric chloride (FeCl3) and polyferric sulphate (PFS)), magnetic nanoparticles (MNPs), Fe-based metal-organic framework MIL-53(Fe), magnetic metal organic framework (MMOF), and evaluate the effect of combination of these coagulants on the coagulation process. MNPs were synthesized using the co-precipitation method and MIL-53(Fe) was synthesized using solvothermal process. The synthesized coagulants were characterized using point of zero charge (pHpzc), X-ray diffraction (XRD), Fourier Transform Infrared (FTIR) and Brunauer–Emmett–Teller (BET) techniques. The point zero of charge pH (pHPZC) values for the prepared MNPs, MIL-53(Fe) and MMOF were for found to be 7.8, 5.0 and 3.0, respectively, while the respective surface area for MIL-53(Fe) and MMOF were 23.8 and 11.8 m2/g. In addition, pore sized MMOF was found to be 59.455 Å which is larger than that for MIL-53(Fe) (34.705 Å). The results obtained from this study revealed that turbidity removal exceeded 98 % when using 30 mg/L of FeCl3 at pH 7. The same removal efficiency required less dose of PFS (10 mg/L) at a pH 8.5. The combination of MNPs with FeCl3 enhanced the removal efficiency to more than 99 % at the optimized condition of FeCl3. However, using MIL-53(Fe) slightly enhanced the FeCl3 coagulation at low dosage (10 mg/L) at pH 7, whereas, MMOF recorded better enhancement for the FeCl3 coagulation at the same conditions, reaching up to 98 %. Moreover, the combination of PFS and MNPs provided the best coagulation performance with turbidity removal of more than 99 % at low dose and at pH 7.

Abstract Background The low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) have been recently applied to control pain during orthodontic treatment. Objective To evaluate and compare the effectiveness of LLLT and LIPUS in reducing pain induced by orthodontic separation. Study design A single-blinded randomized controlled trial. Methods One hundred and fifty patients were randomly assigned into three groups; LLLT group, LIPUS group, and control group. After 5 min from the separators’ placement, the first dose of the laser or the ultrasound was applied, the second dose was applied after 24 h, and the third dose was applied after 48 h on both maxillary and mandibular first molars. The exposure of laser was for 20 s at each point (maxillary and mandibular first molars), with an 810-nm aluminum-gallium-arsenide (AlGaAs) diode laser on continuous mode. The output power set at 150 mW, the energy density of 4 J/cm2, and a laser spot diameter of 7 mm were applied. Whereas the frequency of ultrasonic toothbrush was 1.6 MHz; and average output intensity was 0.2 W/cm2. The application was for 20 min (5 min on each first molar). The control group received the separators without another intervention. A Visual Analog Scale (VAS 100 mm) was used to assess pain intensity at several time intervals during the first four days after the separators’ placement. Results A total of 145 patients were assessed. There was a significant difference in pain perception among the three groups after 5 min (P = .002). The maximum pain level was reached after 24 h. However, the laser group and the ultrasound group showed a statistically significant decrease in pain scores compared to the control group at all the assessment time points (P .05). Conclusions The LLLT and the LIPUS effectively reduce the separation pain when applied in multiple doses without differences between them. Trial registration This trial was registered with the German Clinical Trials Register (DRKS). ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID= DRKS00029991). Date of registration: 26/08/2022.

Background: It is imperative to analyze the forces and moments produced by various auxiliaries in order to select the optimal attachments and, eventually, to maximize the efficacy and efficiency of orthodontic therapy. Through this investigation, we aimed to highlight the impact of various aligner auxiliaries on orthodontic activity in patients undergoing orthodontic treatment on a pre/post treatment protocol basis. Methods: After a thorough search of the online journals, a total of 482 documents were found using keywords such as “Orthodontic Treatment”, “Aligner Auxiliaries”, “Elastic Ligatures” and “Tooth Movement.” The database research, elimination of duplicate studies, data extraction and risk of bias were performed by the authors independently. This systematic review and network meta-analysis included prospective studies and clinical trials to evaluate research that had looked at the impact of various aligner auxiliaries on orthodontic activity in patients undergoing orthodontic treatment. Results: Eight investigations of varying designs were selected for this review. The majority of investigations revealed that aligner auxiliaries significantly improve anterior root torque, rotation, and mesio-distal (M−D) movement, as well as posterior anchoring. They also significantly improved anterior root rotation. However, few studies have presented inconsistent or non-statistically significant findings. Conclusion: Auxiliaries for aligners also appear to improve extrusion and other orthodontic movements, but there is insufficient evidence to support these claims. No research has examined posterior bucco-lingual expansion or tilting. Clarification of the effect of attachments and their related variables requires additional clinical investigations.

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

Abstract Background Dementia is generally caused by neurodegenerative diseases affecting the brain, which leads to a progressive neurocognitive decline characterized by inability to perform major higher functioning tasks. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan is one of the main imaging tests performed for diagnostic purposes. However, with FDG-PET being quite expensive and not widely available, an attempt to find an alternative is set. Arterial-spin-labelling magnetic resonance imaging (ASL-MRI) is an increasingly investigated substitute to FDG-PET for the diagnosis of dementia. Thereby, the main purpose of this systematic review and meta-analysis is to compare the diagnostic ability of FDG-PET and ASL-MRI in detecting dementia. Methods PRISMA checklist for diagnostic test accuracy was employed in outlining this paper. A literature search was done using several search engines including PubMed, Core, and Cochrane. Two researchers (HH and SH) extracted the essential information from all included articles. Risk of bias was evaluated by the Quality Assessment of Diagnostic Accuracy Studies tool, version 2 (QUADAS-2). A qualitative analysis and summary of studies’ results were provided. In addition, a meta-analysis was executed based on the studies which involved sensitivity and specificity measures of diagnostic accuracy. Results Fourteen total studies were included in the given review. Qualitative analysis of the articles showed that nine studies demonstrated an overlap between metabolic and perfused brain maps as derived by FDG-PET and ASL-MRI respectively, while the remaining five studies registered significant differences across both modalities, with superiority to FDG-PET. As for the meta-analysis implemented, summary ROC-curve analysis revealed that FDG-PET performed better than ASL-MRI, with pooled sensitivity being significantly higher for FDG-PET. Conclusions Comparing the diagnostic value of FDG-PET and ASL-MRI, the results of this systematic review and meta-analysis indicate that FDG-PET still has an advantage over ASL-MRI. Such implication could be related to the technical differences relating to both modalities, with ASL-MRI having lower temporal resolution. It’s worth mentioning that specificity was rather quite similar among both modalities and some studies found an overridden metabolic and perfused images. These findings call for future research to focus their scope of investigation while exploring the diagnostic value of ASL-MRI.

In today’s globalised business landscape, characterised by a proliferation of multinational corporations employing culturally diverse workforces, intercultural sensitivity is important in facilitating collaboration. Regarding higher education, it has been found that intercultural sensitivity can be increased through time spent abroad, although the results have been shown to vary depending on the specific context. As the impact of time spent abroad on intercultural sensitivity has yet to be examined in the Hungarian context, this study aimed to investigate whether there were significant differences in various components of intercultural sensitivity between Hungarian business students who had spent varying periods abroad. A total of 270 Hungarian business students from a leading Hungarian business university, aged 18-26, completed the Intercultural Sensitivity Scale (ISS). The focus was on intercultural sensitivity levels between students who had spent less than one month abroad and those who had spent more than one month abroad. The findings indicated that students who spent more time abroad showed improved confidence in intercultural interactions; however, significant differences for other components of the ISS were not observed. Although the results are specific to the Hungarian or Central European context, the findings provide insight for institutions seeking to design effective exchange programs that promote intercultural competence among students, preparing them for success in the global business environment.

Background and Objectives: To compare the oral-health-related quality of life (OHRQoL) outcomes between patients treated with modified Ni-Ti spring-based alignment appliances or conventional fixed appliances using the Oral Health Impact Profile 14 (OHIP-14), as well as the levels of satisfaction with the appliance appearance, treatment progress, and outcomes. Materials and Methods: Thirty-six patients (11 males, 25 females) were randomly divided into two groups: either the modified aligner appliance with Ni-Ti springs group (MAA) or the traditional fixed appliances group (FA). The allocation ratio was 1:1, and the randomization process was carried out by an independent investigator not involved in this study. Mild crowding cases were included in this study. The OHRQoL of patients was evaluated using the short-form Oral Health Impact Profile (OHIP-14) at five time points: before the treatment commencement (T0); 2 weeks (T1), 1 month (T2), and 2 months (T3) after the treatment initiation; and post-treatment (T4). The visual analog scale (VAS) was used to evaluate the patient satisfaction. Blinding was performed only during the outcomes assessment. Results: This randomized controlled trial had no dropouts, and the demographic characteristics of the groups were comparable. The MAA group experienced significantly greater functional limitations compared with the FA group at all three evaluation time points (T1, T2, and T3), as evidenced by the statistically significant p-values (p = 0.004, p = 0.001, and p < 0.001, respectively). The psychological disability in the MAA group was significantly lower than in the FA group at both T2 (p = 0.005) and T3 (p = 0.003). The patient satisfaction with the appliance appearance was significantly higher in the MAA group than in the FA group (p = 0.002). Conclusions: The OHRQoL improved in both the modified aligner appliance with Ni-Ti springs and fixed appliance groups after the treatment. Moreover, the functional limitations during the treatment were less severe in the FA group, while the psychological disability was lower, and the patient satisfaction with the appliance appearance was higher in the MAA group.

Abstract Background The occurrence of complete tubular colonic duplication is exceedingly rare. In most cases, resection of the duplicated colon may not be possible because of common blood supply with a single mesentery shared between the duplication and associated original bowel (Karkera et al., Pediatr Gastroenterol Hepatol Nutr 18:197-201, 2015). Case presentation In this paper, we present a case of a 9-month-old girl who was noticed to pass stools through her vagina since birth despite normal anus in place, in association with constipation and pain on defecation. On local examination, a vestibular fistula was found. Further management including fistulogram, barium enema, and laparoscopy were performed. She was found to have tubular T-shaped colonic duplication with separate lumens from the mid-transverse colon downwards. Due to a shared fused wall, a decision was made to create a side-to-side (window) anastomosis at descending colon level using GIA staplers and end-to-side anastomosis at a sigmoid level between duplicated and normal colons with (mucosectomy) of duplicated colon down to the perineum. Conclusions Tubular colonic duplication should be kept in mind in patients presenting with vestibular fistula and fecal soiling in the presence of a normal anus. Minimal-invasive procedures are a safe and good alternative.

Abstract Background Surgical-assisted accelerated orthodontics (SAAO) has become very popular recently. Therefore, this study aimed to investigate the extent to which researchers adhere to Item 19 (harms) of the Consolidated Standards of Reporting Trials (CONSORT) in the published studies in the field of SAAO. In addition, the study evaluated the possible association between harm reporting and the human development index (HDI) of the recruited research sample country, CiteScore-based quartile (CSBQ) of the publishing journal, invasiveness of the surgical intervention (ISI), and the type of orthodontic tooth movement (TOTM). Moreover, it aimed to summarize the different possible harms and complications that maybe encountered in the course of SAAO. Materials and methods Electronic searching of six databases was conducted for SAAO-related English RCTs published between January 2000 and April 2022. For the RCTs that did not report harms, information was sought by contacting the corresponding authors. Descriptive statistics of the evaluated variables were performed. The association between 'harm reporting' and the HDI of the research team, the BDRQ of the publication journal, the ISI, and the TOTM were investigated. Binary logistic regression was used, and the odds ratios (ORs) with 95% confidence interval (CIs) of the evaluated variables were obtained. Moreover, the risk of bias of the included RCTs was assessed using the RoB2 tool. Results Among the 91 included RCTs, 54 RCTs (59.3%) did not adhere to reporting harm associated with the SAAO. The non-adherence was significantly associated with the ISI (OR 0.16; CI 0.03–0.73; p

Cancer continues to pose a significant global health challenge, as evidenced by the increasing incidence rates and high mortality rates, despite the advancements made in chemotherapy. The emergence of chemoresistance further complicates the effectiveness of treatment. However, there is growing interest in the potential of metformin, a commonly prescribed drug for type 2 diabetes mellitus (T2DM), as an adjuvant chemotherapy agent in cancer treatment. Although the precise mechanism of action of metformin in cancer therapy is not fully understood, it has been found to have pleiotropic effects, including the modulation of metabolic pathways, reduction in inflammation, and the regulation of cellular proliferation. This comprehensive review examines the anticancer properties of metformin, drawing insights from various studies conducted in vitro and in vivo, as well as from clinical trials and observational research. This review discusses the mechanisms of action involving both insulin-dependent and independent pathways, shedding light on the potential of metformin as a therapeutic agent for different types of cancer. Despite promising findings, there are challenges that need to be addressed, such as conflicting outcomes in clinical trials, considerations regarding dosing, and the development of resistance. These challenges highlight the importance of further research to fully harness the therapeutic potential of metformin in cancer treatment. The aims of this review are to provide a contemporary understanding of the role of metformin in cancer therapy and identify areas for future exploration in the pursuit of effective anticancer strategies.

BackgroundPrevious studies have assessed the impact of age and body mass index (BMI) on surgery outcomes separately. This retrospective cohort study aimed to investigate the combined effect of age and BMI on postoperative mortality and morbidity in patients undergoing laparoscopic cholecystectomy.MethodsData from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for laparoscopic cholecystectomy patients between 2008 and 2020 were analyzed. Patient demographics, functional status, admission sources, preoperative risk factors, laboratory data, perioperative variables, and 30-day postoperative outcomes were included in the dataset. Logistic regression was used to determine the association of age, BMI, and age/BMI with mortality and morbidity. Patients were stratified into different subcategories based on their age and BMI, and the age/BMI score was calculated. The chi-square test, independent sample t-test, and ANOVA were used as appropriate for each category.ResultsThe study included 435,052 laparoscopic cholecystectomy patients. Logistic regression analysis revealed that a higher age/BMI score was associated with an increased risk of mortality (adj OR 13.13 95% CI, 9.19–18.77, p

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (Px velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P

Background: Insufficient evidence regarding the effects of chincup therapy on the mandibular dimensions and temporomandibular joint (TMJ) structures requires high-quality studies using three-dimensional (3D) imaging. This trial aimed to evaluate the 3D changes in the mandible, condyles, and glenoid fossa after chin cup therapy for skeletal Class III children compared to untreated controls. Methods: A 2-arm parallel-group randomized controlled trial on 38 prognathic children (21 boys and 17 girls), with mean ages 6.63±0.84 years. Patients were recruited and randomized into two equal groups; the experimental group (CC) was treated with occipital-traction chin cups in conjunction with bonded maxillary bite blocks. No treatment was provided in the control group (CON). Low-dose CT images were acquired before (T1) and after achieving (2-4 mm) positive overjet (T2), and after 16 months apart in both groups. The outcome measures of the condyle-mandibular 3D distances, the condyles-glenoid fossa postional changes, and the quantitative displacement parameters of superimposed 3D models were compared statistically. Paired- and two-sample t-tests were used for intra- and inter-group comparisons, respectively. Results: Overall, 35 patients (18 and 17 in the CC and the CON groups, respetively) were enrolled in the statistical analysis. The mean mandibular and condylar volumes increased significantly by 777.24 mm 3 and 1,221.62 mm 3, 94.57 mm 3, and 132.54 mm 3 in the CC and CON groups, respectively. No statistically significant differences were observed between the groups regarding the volumes, superficial areas, and linear changes of the mandible and condyles, and part analysis measurements, except the changes of the relative sagittal and vertical positions of condyles, glenoid fossa, and posterior joint space, which were significantly smaller in the CC group (p Conclusions: The chin cup did not affect the mandibular dimensions. Its primary action was confined to the condyles and the TMJ internal dimensions. Clinicaltrials.gov registration: NCT05350306 (28/04/2022).

Background: The huge workload on doctors especially residents, who are the main health care providers in public hospitals, in addition to the vanishing incomes and lack of personal safety during the decade-long Syrian crisis, led to further hurdles in the focus on research. Postgraduate students in the medical and paramedical fields must conduct original research projects as part of their graduation requirements. However, this does not reflect on research publications coming from Syria. Methods: This is a nation-wide cross-sectional study targeting medical, dental, and pharmacy postgraduate students who are at the phase of planning for their required projects. The questionnaire aimed to capture their attitudes toward research, perceived barriers, and previous research experiences in order to suggest evidence-based recommendations. Results: The sample consisted of 429 residents representing about 22% of the target population. Nearly all the participants had positive opinion toward the important role of medical research and the significance of their participation. Agreement was also clear regarding perceived barriers, including the lack of adequate training and research facility. Seventy-one percent of the participants were not involved in any research before the time of their master theses, less than 13% of them had submitted an article for publication, and less than 5% had submitted more than one paper. Despite that, high-quality internet connectivity and rich English writing skills were associated with further research experiences. Additionally, mentors' support and self-paced learning of research skills had significant positive impact on students' research contributions with odds ratios of 2.04 [[95% Confidence Interval]: 1.02–4.06] and 2.68 [1.48–4.84], respectively. Conclusion: Lack of training and mentorship, in addition to several common barriers to medical research, hampered residents' capacity of conducting and publishing research despite their positive attitudes toward it. Nevertheless, the variance within our sample exposed a promising window for implementing low-cost institutional and individual solutions such as peer-run self-paced training opportunities and long-distance mentoring.