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This article describes a novel concept for treatment planning and execution in the digital era. The aim of the presented workflow was to design, plan, communicate, perform, fabricate, deliver, and maintain a smile makeover restoration entirely through digital technology. The interdisciplinary treatment plan is described from the planning through the diagnostic mock-up to the final restoration. In digital designing, the dental morphology and tooth shape seen by the clinician and technician are interpreted by the computer as a 3D geometric mathematic model. Controlling the geometry provides freedom for the clinician to develop a restorative digital plan that can be followed throughout the patient's treatment. Moreover, new ceramic materials used with computer-assisted techniques have considerably broadened the choices for dental teams and have enhanced the results that can be achieved.

Background: Tricuspid regurgitation (TR) has been associated with cardiac rhythm device (CRD) implantation with intracardiac lead insertion. However, data on the incidence of postdevice TR are limited and largely from retrospective studies. We hypothesized that permanent lead implantation would be associated with an increase in TR. Methods: We prospectively included consecutive patients with a clinical indication for CRD. Patients underwent transthoracic echocardiography 1 month before and 1 year after CRD implantation. Results: A total of 328 patients were prospectively enrolled (69 +/- 15 years, 38% female). Echocardiograms before and 1 year after CRD were available in 290 patients (15 died, 23 lost to follow-up). Compared with baseline, there was a significant change in TR grade 1 year after CRD insertion (no/trivial TR: 66% vs 29%; mild TR: 29% vs 61%; moderate TR: 3% vs 8%; severe TR 2% vs 2%; P < 0.001 for an increase in TR by at least 1 grade). Compared with baseline, there was a higher prevalence of moderate or severe TR in the 247 patients with CRD without cardiac resynchronization therapy (4% vs 10%, P = 0.004), but no progression in the 43 patients who received cardiac resynchronization therapy (14% vs 11%, P = 1). Multivariable analysis in the patients with less than moderate TR at baseline (n = 274) showed that only a history of atrial fibrillation was independently associated with progression to moderate or severe TR after correction for baseline TR grade (P = 0.013). Conclusions: One year after endocardial lead insertion, there was a 5% increase in the prevalence of moderate or severe TR, which may be clinically relevant.

Background The Embolic Stroke of Undetermined Source (ESUS) is a recently developed clinical construct which describes stroke patients for whom the embolic source remains undetermined despite recommended investigations. The aim of the study was to characterize the ESUS population according to the abnormality in the P-wave terminal force in lead V1 (PTFV1). Methods We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria. The PTFV1 was obtained from the admission 12-lead ECG. Increased PTFV1 was defined a value > 5000 μV·ms. Baseline and diagnostic work-up findings were compared between the PTFV1 patient groups. Results Among 109 patients with ESUS, 31 (28.4%) had evidence of increased PTFV1. The patients with the ECG-defined left atrial abnormality had higher rates of hypertension (77.4% versus 55.1%; p = 0.031), history of prior stroke or TIA (35.5% versus 16.7%; p = 0.032), and moderate to severe left atrial enlargement (29.0% versus 7.7%; p = 0.004) and ventricular hypertrophy (35.5% versus 16.7%; p = 0.032), whereas they were less likely to have patent foramen ovale (9.7% versus 28.2%, p = 0.038) and unstable sub-stenotic atherosclerosis of aortic arch and cranial arteries (12.9% versus 32.1%, p = 0.041). Conclusions The abnormally increased PTFV1 was observed in about one third of patients with ESUS and it was inversely associated with artery-to artery and paradoxical potential sources of stroke. Left atrial cardiopathy could be involved in the ESUS pathogenesis and the ECG-defined abnormality could point towards the risk of cardiac embolism.

BackgroundInflammatory mediators may be relevant to explain the frequent comorbidity between depression, neurocognitive disorders and HIV. HIV induces activation of inflammatory mediators, mainly cytokines, that have been involved in the onset of depression and response to antidepressant treatment.AimTo identify recurring profiles of inflammatory biomarkers subtending depression, effectiveness of antidepressants and neurocognitive disorders among HIV-infected individuals.MethodsAll adult newly HIV-diagnosed out-patients attending HIV clinics in three towns of Northern Italy were screened, assessed for depression and studied immunologically and for neurocognitive disorders.ResultsTwenty-five patients have been enrolled so far: of these, 35% were positive to PHQ-9 screening, of which 6 were positive to the diagnostic assessment for depression. No neurocognitive disorders were found among the patients. As the project will develop, it is expected that frequency of depression, neurocognitive disorders and effective antidepressant treatment will be found to correlate to the profile of immune biomarkers. These findings might help to understand the etiology of depression in HIV, and specifically the role of inflammation and immunological changes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Several drugs and toxins can act on the cardiovascular system, either at therapeutic level or secondary to overdose and poisoning. They may cause ECG abnormalities, heart rhythm disturbances, depression of myocardial contractility, and vasodilation. There are two main mechanisms underlying the adverse cardiovascular effects of pharmacological and toxin agents: a direct action on ion channels and the effects on the autonomic nervous system. Often there are combinations of several mechanism that are able to produce a lot of adverse events.

Heart failure (HF) is a clinical diagnosis combining characteristic symptoms with physical or instrumental findings. No single tests can absolutely establish its presence or absence. An episode of acute heart failure is a complex clinical condition defined as a rapid or gradual onset of symptoms and signs of heart failure requiring immediate medical attention. Despite therapeutic advances in the care of chronic HF, the prognosis of patients with acute heart failure syndromes (AHFS) remains poor, with substantial morbidity and mortality and high health care cost. Management of AHFS remains a major challenge in current clinical practice given the heterogeneity of underlying pathophysiological mechanisms and clinical presentations. No single treatment algorithm may be feasible for all patients. Identification of the acute precipitating factors as well as noninvasive characterization of cardiac filling pressures and output is necessary in order to align therapeutic strategies to patient clinical profile. Improving hemodynamics and minimizing adverse events are the key goals of early in-hospital therapies traditionally including oxygen, noninvasive ventilation (NIV), diuretics, vasodilators and inotropic agents. However, still today we lack robust evidence linking hospital management with post-discharge outcomes, therefore the use available pharmacological agents for AHFS are largely empirical. In this chapter currently available data on diagnosis, clinical assessment and management of patients presenting with AHFS will be discussed.

Emotional facial expression is an important low-level mechanism contributing to the experience of empathy, thereby lying at the core of social interaction. Schizophrenia is associated with pervasive social cognitive impairments, including emotional processing of facial expressions. In this study we test a novel paradigm in order to investigate the evaluation of the emotional content of perceived emotions presented through dynamic expressive stimuli, facial mimicry evoked by the same stimuli, and their functional relation. Fifteen healthy controls and 15 patients diagnosed with schizophrenia were presented with stimuli portraying positive (laugh), negative (cry) and neutral (control) emotional stimuli in visual, auditory modalities in isolation, and congruently or incongruently associated. Participants where requested to recognize and quantitatively rate the emotional value of the perceived stimuli, while electromyographic activity of Corrugator and Zygomaticus muscles was recorded. All participants correctly judged the perceived emotional stimuli and prioritized the visual over the auditory modality in identifying the emotion when they were incongruently associated (Audio-Visual Incongruent condition). The neutral emotional stimuli did not evoke any muscle responses and were judged by all participants as emotionally neutral. Control group responded with rapid and congruent mimicry to emotional stimuli, and in Incongruent condition muscle responses were driven by what participants saw rather than by what they heard. Patient group showed a similar pattern only with respect to negative stimuli, whereas showed a lack of or a non-specific Zygomaticus response when positive stimuli were presented. Finally, we found that only patients with reduced facial mimicry (Internalizers) judged both positive and negative emotions as significantly more neutral than controls. The relevance of these findings for studying emotional deficits in schizophrenia is discussed.

Given the increasing numbers of cardiac device implantations worldwide, it is important to determine whether permanent endocardial leads across the tricuspid valve can promote tricuspid regurgitation (TR). Virtually all current data is retrospective, and indicates a signal of TR being increased after permanent lead implantation. However, the precise incidence of moderate or greater TR post-procedure, the exact mechanisms (mechanical, traumatic, functional), and the hemodynamic burden and clinical effects of this putative increase in TR, remain uncertain. We have therefore designed a multicenter, international, prospective study of 300 consecutive patients (recruitment completed, baseline data presented) who will undergo echocardiography and clinical assessment prior to, and at 1-year post device insertion. This prospective study will help determine whether cardiac device-associated TR is real, what are its potential mechanisms, and whether it has an important clinical impact on cardiac device patients.