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Background The introduction of recombinant human growth and differentiation factors (rhGFs) for intrabony defects regeneration has represented a considerable breakthrough in recent years. However, they have been used in different concentrations, doses and combined with various scaffolds, and there is no evidence on the most effective formulation for periodontal regeneration is. Therefore, we aimed to evaluate and rank the various formulations of such bioactive agents through network meta-analysis of clinical studies. Methods The protocol registration was done on PROSPERO with registration ID CRD42020213753. To report NMA, we followed PRISMA guidelines and searched PUBMED, Embase, Web of Science and Cochrane Central electronic databases. Studies were screened based on specific inclusion criteria. Primary outcomes extracted from included studies were the most common indexes for periodontal regeneration (PPD, CAL, %bone filling). The NMA analysis included network plots, contribution plots, inconsistency plots (if eligible to form the loop), predictive interval plots, SUCRA rankings and multidimensional scale ranking plots. SUCRA would demonstrate the rankings of multiple competing bioactive agents based on their best performance. Results Twelve clinical studies for qualitative and quantitative analysis were considered. Network meta-analysis found that rhFGF+hydroxyapatite was ranked highest in PPD and CAL outcome. rhPDGF-BB+β-tricalcium phosphate was ranked highest in the percentage of bone filling. In addition, all bioactive agents performed better than control groups without rhGFs. Conclusion Despite clear benefits deriving from rhGFs for periodontal regeneration, the present results should interpret with caution due to several confounding factors affecting the outcome. Nevertheless, further well designed randomized clinical trials will allow establishing guidelines for an appropriate indication of the use of rhGFs. This article is protected by copyright. All rights reserved.

Purpose The purpose of this study was to determine whether the adjunctive use of plasma rich in growth factors in postextraction sites could be beneficial in terms of hard- and soft-tissue healing and patients' comfort. Materials and Methods An electronic search was performed on MEDLINE, EMBASE, Scopus, and CENTRAL. Only controlled clinical trials or randomized clinical trials that used plasma rich in growth factors in the test group were included. The primary outcomes were pain assessment, complications, and adverse events. Secondary outcomes were hard-tissue healing, bone remodeling, and soft-tissue healing. Results Eight comparative studies (5 randomized clinical trials) were included. Four studies had a split-mouth design. Six hundred fourteen teeth were extracted in 338 patients. Only qualitative analysis could be performed. Postoperative pain and the incidence of complications such as alveolar osteitis were consistently lower in the test group. Hard-tissue healing, evaluated by clinical, radiographic, histologic, and histomorphometric techniques, showed significantly better results for the test group in almost all studies. Better epithelialization, keratinized tissue thickness, and healing score were also reported. Conclusion Plasma rich in growth factors may bring advantages in some relevant clinical and radiographic outcomes, such as bone density and soft-tissue healing, after tooth extraction. It could also represent a useful tool for reducing adverse events, complications, and patients' discomfort, although it is still not quantifiable.

Manual detection and characterization of liver cancer using computed tomography (CT) scan images is a challenging task. In this paper, we have presented an automatic approach that integrates the adaptive thresholding and spatial fuzzy clustering approach for detection of cancer region in CT scan images of liver. The algorithm was tested in a series of 123 real-time images collected from the different subjects at Institute of Medical Science and SUM Hospital, India. Initially the liver was separated from other parts of the body with adaptive thresholding and then the cancer affected lesions from liver was segmented with spatial fuzzy clustering. The informative features were extracted from segmented cancerous region and were classified into two types of liver cancers i.e., hepatocellular carcinoma (HCC) and metastatic carcinoma (MET) using multilayer perceptron (MLP) and C4.5 decision tree classifiers. The performance of the classifiers was evaluated using 10-fold cross validation process in terms of sensitivity, specificity, accuracy and dice similarity coefficient. The method was effectively detected the lesion with accuracy of 89.15% in MLP classifier and of 95.02% in C4.5 classifier. This results proves that the spatial fuzzy c-means (SFCM) based segmentation with C4.5 decision tree classifier is an effective approach for automatic recognition of the liver cancer.

The infectious diseases with a viral origin are of significant worldwide concern. In recent times, pandemics are creating havoc across the entire globe. This paper presents a constructive analysis of a new mathematical concept that will help the medical authorities to predict and to take controlling measures. In this work, we use ordinary first-order differential equations and compartmental model analysis for calculation of infection rate, transmission rate, and reproduction number of the patients. A new Advanced Susceptible-Exposed-Infectious-Recovered model has been introduced, which has greater accuracy of the reproduction number. The prediction of mode of disease transmission demonstrates the performance characteristics of the proposed model.

The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions.An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking.CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone.CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.

Dentinal hypersensitivity (DHS) can be defines as a short sharp pain that occurs as a response to variousstimuli on exposure of dentinal tubules to the external environment and which cannot be described as anyother disease. The most important part of the treatment is to identify the etiology behind the sensitivity andtreating the condition accordingly. Differential diagnosis may include pulpitis, carious teeth, chipped tooth,cracked tooth syndrome etc. The treatment modalities depend upon whether the sensitivity is due to gingivalrecession, tooth wear lesion or periodontitis or related causes. This review highlights various strategies tocounter this disease as well discusses various desensitizing agents recently in use like Novamin, Biomin,Calcium phosphate dentifrices, Nanoparticles and herbal desensitizing agents.

Extraction of teeth leads to loss of alveolar bone in several patterns. The bone loss can occur in a horizontalor vertical direction or a combination of both. Horizontal ridge width deficiency possesses a challenge for theclinician to obtain primary stability during loading and there is risk of fracture of bone segment. Thereforedifferent techniques have been described to gain the ridge width. One of the techniques used is ridge splittechnique which was first described by Simion et al in 1992. It is a technique of bone manipulation in sucha way that it becomes a site for implant placement without removing any bone. Various types of techniqueslike 3 staged approach, one staged approach etc are described for various sites and situation that help inobtaining an adequate width for loading. This article specifically deals with the different types of ridge splittechniques and its description in a simplified manner.

OBJECTIVES This systematic review and network meta-analysis aimed to answer to the following questions: (a) In patients undergoing alveolar ridge preservation after tooth extraction, which grafting material best attenuates horizontal and vertical ridge resorption, as compared to spontaneous healing?, and (b) which material(s) promotes bone formation in the extraction socket? MATERIALS AND METHODS The MEDLINE, SCOPUS, CENTRAL, and EMBASE databases were screened in duplicate for RCTs up to March 2021. Two independent authors extracted the data and assessed the risk of bias of the included studies. Primary outcomes were ridge horizontal and vertical dimension changes and new bone formation into the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes and compare different grafting materials. RESULTS Eighty-eight RCTs were included, with a total of 2805 patients and 3073 sockets. Overall, a total of 1740 sockets underwent alveolar ridge preservation with different materials (1432 were covered by a membrane). Pairwise meta-analysis showed that, as compared to spontaneous healing, all materials statistically significantly reduced horizontal and vertical shrinkage. According to the multidimensional scale ranking of the NMA, xenografts (XG) and allografts (AG), alone or combined with bioactive agents (Bio + AG), were the most predictable materials for horizontal and vertical ridge dimension preservation, while platelet concentrates performed best in the percentage of new bone formation. CONCLUSIONS Alveolar ridge preservation is effective in reducing both horizontal and vertical shrinkage, as compared to untreated sockets. NMA confirmed the consistency of XG for ridge dimension preservation, but several other materials and combinations like AG, Bio + AG, and AG + alloplasts, produced even better results than XG in clinical comparisons. Further evidence is needed to confirm the value of such alternatives to XG for alveolar ridge preservation. Bio + AG performed better than the other materials in preserving ridge dimension and platelet concentrates in new bone formation. However, alloplasts, xenografts, and AG + AP performed consistently good in majority of the clinical comparisons. CLINICAL RELEVANCE XG and Bio + AG demonstrated significantly better performance in minimizing post-extraction horizontal and vertical ridge dimension changes as compared with other grafting materials or with spontaneous healing, even if they presented the worst histological outcomes. Allografts and other materials or combinations (AG + AP) presented similar performances while spontaneous healing ranked last.

Wound healing is a multistep regeneration process that requires immunological and microenvironmental conditions occurring simultaneously. Since platelets and their granules play a pivotal role in wound healing, their use as medication is extensively been evaluated in several fields, spacing from chronic wounds to aesthetics. In this chapter, we focused on wound healing and specifically on the contribution exerted by platelet-rich plasma (PRP) in different wounds. We performed a comprehensive literature review, including randomized clinical trials, prospective studies, case--control, and case series, to investigate clinical long-term outcomes (>12 months) of topical PRP. Our results suggest that PRP improves healing, sustaining a faster tissue regeneration, reducing scar formation, improving neo-vascularization, and decreasing recurrences. Remarkably, patients display lower pain and discomfort resulting in an increased satisfaction. Since this effective technique is ideal to be performed in hospital as well as in private practice, authors encourage the use of PRP in all patients with wounds, both chronic and acute.

Due to increased number of breast cancer cases, there is rise in concern about the disease. So, in today’s era, machine learning classification can play a vital role in classifying the degree of malignancy of the cancer. This paper uses four different classifiers such as KNN, logistic regression, naive Bayes and decision tree to classify the cancer into two classes of benign and malignant. The proposed model is simulated over Wisconsin diagnostic breast cancer dataset and evaluated by accuracy metric. The model classifies the disease based on the most accurate classifier. The KNN model shows significantly better result than the other classifier.

The need of the hour is an accurate and timely diagnosis for an effective treatment plan to cure or eliminatethe disease. Clinical measurements, traditionally available, have their limitations in helping diagnose an“active” disease. Hence, novel chairside diagnostic kits are essential to detect active disease, predict itsprogression and help in the evaluation of response, of a patient, to therapy, thereby aiding in the managementof periodontal patients. This review article, therefore, discusses the various chairside diagnostic aids availableto aid Periodontists, in diagnosing and treating periodontal patients.

Gingival enlargement (GE) is defined as an increase in the size of the gingiva. It is also known as gingivalovergrowth. A wide variety of etiological factors play an important role in the development of GE. GE maybe acute or chronic. However chronic inflammatory GE is most commonly found. Prolonged exposureof dental plaque is the most common etiological factor of chronic GE. A 23-year-old girl came to theDepartment of Periodontics, with a chief complaint of swelling of gums in lower front teeth regions. Onclinical examination, there was grade II GE in 33 to 43 regions along with the presence of calculus in thelingual side, and poor oral hygiene too. It was planned for phase I therapy followed by phase II therapy.So scaling and root planing was performed and after 4 weeks curettage was done under infiltration localanesthesia. The subject was instructed to maintain oral hygiene. After 2 months, it was found completeresolution of GE. She was very satisfied with the result.

To diagnose and to treat, is a crucial part of management of an endo-perio lesion. The sign and symptomsof endo-perio lesion are difficult to accountable for a general dental surgeon. For that reason, it needs moredetailed examination and definite treatment plan. The outcomes of endo-perio lesion are highly unpredictabledue its multiple etiological factors. The primary and secondary etiological factors of endo-perio lesionsmay have numerous variation and ultimately concludes the definite treatment plan complex. A 43-year-oldfemale patientcame to Department of Periodontics, with a chief complaint of pain in right posterior lowertooth region.On clinical examination, there was 5mm of periodontal pocket, occlusal restoration in 47. Thetreatment plan was made as first endodontic treatment followed by periodontal treatment. So endodontictreatment was carried out first in 47 after oral prophylaxis. Then under local anesthesia, open debridementwas done in 47 and bone graft was placed in the defect. Resorbable membrane was placed over the graft.Suture was placed and periodontal dressing was given and followed up to 9 months. She was very satisfiedwith the result.

The Mouth is the mirror of the human body that reflects systemic disorders, and various systemic pathologiesfind expression in the oral region. Oral manifestations may be the initial feature or the only presenting signin mucocutaneous diseases. Mucocutaneous disorders share two features in common: An immune-mediatedpathogenesis and possibly common clinical appearance termed as ‘Desquamative gingivitis’. Desquamativegingivitis is mostly a manifestation of a wide array of vesiculobullous disorders; however, it may also resultdue to endocrine disturbances, chronic infections, and allergic/chemical reactions. Hereby, presenting a caseof oral lichen planus with Desquamative gingivitis as the sole manifestation in a 35-year-old female patient.

Gingival recession (GR) is a condition in which there is an apical shift of gingival margin leading to exposureof root surface. On exposure of root surface, there will be root sensitivity, pain, root caries, poor aesthetic,and ultimately tooth loss. There are various techniques used to treat gingival recession. In this case report,a laterally positioned pedicle graft technique was used to treat gingival recession. A 37-year-old male cameto the Department of Periodontics, with a chief complaint of sensitivity in lower left front teeth regions.On clinical examination, there was Miller Class III in 33 with the presence of generalized mild plaque andcalculus. It was planned for phase I therapy followed by phase II therapy. So scaling and root planing wasperformed to reduce inflammation and after 4 weeks, lateral positioned pedicle graft technique was doneunder infiltration local anesthesia. The subject was instructed to maintain oral hygiene. After 2 months, itwas found significant coverage of root with keratinized gingiva. He was very satisfied with the result.

Periodontal disease isprevalent each in advanced and growing nations and affect about 20-50% of the worldpopulation. Several hazard factors inclusive of smoking,heredity,diabetes,bad oral hygiene,age,pressureand medication which is related to periodontal illness. The devaluation inside occurrence and popularityof periodontitis can decrease its correlated fundamental illness and diminish their economic impact onhealth care systems. Periodontitisis one of the most important diseases which is chronic and leads to deathand disability worldwide. The speediest increase in the hardship of the chronic disease is acquiring in thegrowing nations.

Recent developments in In-band Network Telemetry (INT) provide granular monitoring of performance and load on network elements by collecting information in the data plane. INT enables traffic sources to embed telemetry instructions in data packets, avoiding separate probing or infrequent management-based monitoring. INT sink nodes track and collect metrics by retrieving INT metadata instructions appended by different sources of INT information. However, tracking the INT state in packets arriving at the sink is both compute intensive (requiring complex operations on each packet), and challenging for the standard P4 match-action packet processing pipeline to maintain line-rate. We propose a network telemetry platform in which the INT sink is implemented using distinct (C-based) algorithms on a SmartNIC in the monitoring host, complementing the P4 packet processing pipeline. This design accelerates packet processing and handles complex INT-related operations more efficiently than P4 match-action processing alone. While the P4 pipeline parses INT headers, a general-purpose Micro-C algorithms performs complex INT tasks (e.g. aggregation, event-detection, notification, etc.). We demonstrate that partitioning of INT processing significantly reduces processing overhead vs. a P4-on1y implementation, providing accurate, timely and almost loss-free event notification.

This paper explores the security vulnerability of Personal Identification Number (PIN) or numeric passwords. Entry Device (PEDs) that use small strings of data (PINs, keys or passwords) as means of verifying the legitimacy of a user. Today, PEDs are commonly used by personnel in different industrial and consumer electronic applications, such as entry at security checkpoints, ATMs and customer kiosks, etc. In this paper, we propose a side-channel attack on a 4&ndash, 6 digit random PIN key, and a PIN key user verification method. The intervals between two keystrokes are extracted from the acoustic emanation and used as features to train machine-learning models. The attack model has a 60% chance to recover the PIN key. The verification model has an 88% accuracy on identifying the user. Our attack methods can perform key recovery by using the acoustic side-channel at low cost. As a countermeasure, our verification method can improve the security of PIN entry devices.

Background: Accurate imaging assessment of cardiovascular invasion by mediastinal masses is essential for determining surgical feasibility. This can sometimes be difficult on CT owing to limited space available in the mediastinum, resulting in mediastinal masses abutting and indenting adjacent cardiovascular structures. Cine MRI may aid in such situations by demonstrating differential mobility. Aims and Objectives: To evaluate the role of cine MRI in assessing cardiovascular invasion by mediastinal masses, by evaluating sliding motion and the presence of chemical shift artifact between the mediastinal mass and apposing structures. Material and Methods: Retrospective study of 44 patients with mediastinal masses, with equivocal involvement of 162 cardiovascular structures on CT scan, in whom cine MRI was done. Involvement on CT was considered equivocal when there was a loss of intervening fat plane and broad surface (>3 cm) or angle (>90°) of contact between the mediastinal mass and cardiovascular structure. The presence of either sliding movement or type 2 chemical shift artifact or both between mass and the cardiovascular structure was considered as no adherence or invasion. The absence of both the parameters was considered as the presence of invasion or adhesion. Imaging findings were correlated with intraoperative findings. Results: After excluding 25 cardiovascular structures in 7 patients, 137 cardiovascular structures whose involvement was suspected on CT were evaluated in 37 patients with mediastinal masses. In all, 31 cardiovascular structures showed invasion on MRI out of which 28 structures were invaded or adhered intraoperatively and 106 cardiovascular structures showed no invasion on MRI out of which 97 structures were intraoperatively not invaded/adhered. The sensitivity, specificity and accuracy of our study are 75.7%, 97% and 91.2%, respectively. Conclusion: Cine MRI can be used as an effective tool in patients with equivocal cardiovascular invasion by mediastinal masses on CT scans.

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed.

Purpose:This prospective study is aimed at investigating clinically and histologically the effectiveness of a biomimetic magnesium-enriched-hydroxyapatite (MgHA)/collagen-based bone substitute for alveolar socket preservation. Materials:Patients scheduled for posterior single tooth extraction were included. The alveolar socket was filled either with MgHA or deproteinized bovine bone matrix (DBBM). In DBBM group, a punch of mucosa was taken from the palate and used to cover the graft. Vertical and horizontal dimensional changes of the alveolar process were assessed clinically with a periodontal probe and with 3-dimensional (3D) analysis of a cast model. Postoperative quality of life was assessed through a questionnaire. After 6 months of healing, an alveolar tissue biopsy was taken for histologic and histomorphometric analysis of the newly formed tissue. After checking normality of the distributions, parametric or nonparametric tests were used for statistical comparisons. Results:Twenty patients (12 males, 8 females, mean age 42.8 ± 5.1 years, range 33-50 years) were treated. After 6 months, vertical and horizontal alveolar ridge resorption was similar in the 2 groups. The 3D analysis of the models showed a significantly higher resorption at the buccal side than at the palatal/lingual side. Histomorphometric analysis showed similar new bone formation for MgHA group (23.07 ± 10.3%) and DBBM (22.77 ± 6.95%), and a significantly higher residual material% for DBBM (15.77 ± 1.95%) than MgHA (5.01 ± 1.04%). Significantly less pain was reported in the first 3 days after surgery in patients of the MgHA group. Conclusion:The MgHA was as safe and effective as DBBM and may represent a feasible bone substitute for alveolar socket preservation.

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed.

Background: The diagnosis of cerebral venous sinus thrombosis (CVST) requires a high index of suspicion owing to the wide spectrum of clinical manifestations. Amongst the different presentations, radiological evidence of subarachnoid haemorrhage (SAH) often leads to diagnostic errors. Methods: Between March 2005 and December 2007, 233 patients with CVST were reviewed at our centre, and this report summarizes 10 cases that presented with SAH. The early clinico-radiological pointers towards a diagnosis of CVST are highlighted and previously published reports are reviewed. Results: The mean age at presentation was 33 years (range 25–50), and the median duration from onset of symptoms to admission was 5 days (range 2–15). In all cases, there was radiological evidence of SAH with or without associated parenchymal bleeding or other signs of CVST. SAH was usually localized, involving the sulci of the cerebral convexity and sparing the basal cisterns. Aetiologically, there were two cases with both hyperhomocysteinaemia and polycythaemia and one case each of antiphospholipid antibody (APLA) syndrome, post-partum state, oral contraceptive use and dehydration because of diarrhoea. Eight patients improved with anticoagulant therapy despite the presence of SAH. Conclusions: Localized SAH (whether focal, unilateral or bilateral), especially when confined to the parasagittal or dorsolateral convexity of the brain and without involvement of the basal cisterns, may provide an early pointer towards an underlying CVST. The presence of predisposing factors for CVST accords a further diagnostic hint.