Search Results (810)

Background/Objectives: Pelvic floor muscle (PFM) training is widely recommended during pregnancy and postpartum as both a preventive and therapeutic intervention. The addition of electromyography (EMG) biofeedback may further enhance training effectiveness. This study aimed to evaluate the effectiveness of a 6-week BeBo^® PFM training program (BeBo^®, derived from the German Beckenboden, “pelvic floor”) and to compare it with BeBo^® training combined with EMG biofeedback in women after vaginal delivery (VD) and cesarean section (CS), relative to control groups. Methods: A total of 120 primiparous women (mean age 29.0 ± 1.9 years), 6–8 weeks postpartum after VD (n = 60) or CS (n = 60), were randomly assigned to BeBo^® training, BeBo^®+EMG-biofeedback, or control group. Neuromuscular PFM activity was assessed before and after intervention using surface electromyography (sEMG; Noraxon G2 TeleMyo 2400) with a vaginal probe. Results: Women performing BeBo^® training with EMG-biofeedback demonstrated significantly greater improvements in PFM endurance (p < 0.001, η² = 0.423) in both VD and CS groups compared with controls and BeBo^® training alone. Regarding maximal fast contraction, significant improvements (p = 0.042, η² = 0.097) were observed in both delivery groups within the EMG-biofeedback group, whereas BeBo^® training alone was effective only in the VD group. Conclusions: PFM training based on the BeBo^® concept, particularly when supported by EMG-biofeedback, effectively enhances neuromuscular function, with the greatest benefits observed in women after VD. EMG-biofeedback should be considered as an adjunct in standard postpartum preventive care, with training protocols tailored to delivery mode: relaxation-focused for CS and strengthening-focused for VD. Full article

Anecdotal reports have recently circulated suggesting that intramuscular injection of bacteriostatic saline (BS)—which contains benzyl alcohol (BnOH)—can reverse botulinum toxin type A (BoNTA)-induced brow ptosis. Given the well-established intracellular persistence of BoNTA’s light chain and its irreversible cleavage of SNAP-25, such rapid functional recovery challenges existing pharmacological understanding. This study employed high-resolution pharmacokinetic/pharmacodynamic (PK/PD) modelling using the AesthetiSim™ platform to systematically evaluate this hypothesis. A total of 30,000 virtual patients were randomized to receive BoNTA alone, BoNTA followed by BS injection, or BoNTA followed by normal saline (NS) at Day 7. The model incorporated BoNTA diffusion, internalization, SNAP-25 cleavage, neuromuscular output, and transient BS effects on membrane permeability and endosomal trafficking. Simulated recovery trajectories were tracked over 90 days. The primary outcome, time to 80% restoration of baseline frontalis muscle force (T₈₀), averaged 42.0 days in the BoNTA-only group and 35.5 days in the BS group (Δ = −6.5 days; p < 0.001). Only 13.9% of BS-treated patients reached the T₈₀ threshold by Day 30. Partial reactivation (T₃₀) occurred earlier with BS (21.8 ± 5.3 days vs. 27.3 ± 4.9 days), and the area under the effect curve (AUEC) was increased by 9.7%, reflecting higher overall muscle function over time. In molecular simulations, BnOH produced a minor rightward shift in the BoNTA–SNAP-25 dissociation curve, but receptor occupancy remained above 90% at therapeutic toxin concentrations, suggesting no meaningful impairment of binding affinity. A global Sobol sensitivity analysis demonstrated that the primary driver of recovery kinetics was intracellular LC degradation (49% of T₈₀ variance), while BS-modulated extracellular parameters collectively contributed less than 20%. These findings indicate that BS does not reverse the molecular action of BoNTA but may transiently influence recovery kinetics via non-receptor-mediated pathways such as increased membrane permeability or altered vesicular trafficking. The magnitude and variability of this effect do not support the notion of a true pharmacologic reversal. Instead, these results emphasize the need for mechanistic scrutiny when evaluating rapid-reversal claims, particularly those propagated through anecdotal or social media channels without supporting biological plausibility. Full article

Background: Refractory overactive bladder (OAB) poses a significant clinical burden, often severely impacting quality of life (QoL). While intradetrusor onabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are established therapeutic options, a direct comparison of their efficacy and safety profiles is essential to guide clinical decision-making. This study compares BoNT-A against placebo and SNM for the management of refractory OAB in women. Methods: Following PRISMA guidelines, PubMed, Scopus, CENTRAL, and Google Scholar were searched until February 2025 for randomized controlled trials (RCTs) and cohort studies on treatment alternatives for refractory OAB. Treatment outcomes at 3- (BoNT-A vs. placebo) and 6-month (BoNT-A vs. SNM) follow-up were analyzed. Odds ratios (ORs) and mean differences (MDs) were calculated for dichotomous and continuous variables, respectively, with heterogeneity assessed via I² test. Study quality was evaluated using CASP tools. Results: Pooled data from 12 studies (2645 patients) indicated that BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo (p = 0.02) and SNM (p = 0.0008). Additionally, a ≥75% reduction in UUI episodes was more likely with BoNT-A compared to both placebo (p < 0.00001) and SNM (p < 0.00001). Complete resolution of UUI was more likely with BoNT-A compared to placebo (p < 0.00001); however, when compared to SNM, the latter demonstrated a higher rate of complete UUI resolution (p < 0.00001). Patient-reported QoL did not show significant differences between BoNT-A and SNM (p = 0.2). Urinary tract infection (UTI) risk was higher with BoNT-A than both comparators. Conclusions: While BoNT-A offers robust symptom control, its safety profile necessitates careful patient selection. SNM remains a viable alternative for those prioritizing fewer adverse events. The study highlights the need for standardized outcome reporting, long-term cost-effectiveness analyses, and personalized treatment approaches. Full article

Background/Objectives: Periodontal disease, the most widespread chronic inflammatory non-communicable disease, is caused by the host-mediated inflammatory and immune responses to the bacterial biofilm. Fusobacterium nucleatum contributes to its progression and is associated with gastrointestinal cancers, including gastric cancer (GC), by promoting inflammation and immune evasion. Additionally, cathepsin K (CTSK) enhances tumor invasiveness and metastasis, playing a crucial role in GC progression. Aim: The present study was carried out to evaluate the possible association between the amount of F. nucleatum from gingival crevicular fluid and the periodontal status with the characteristics of GC. Methods: This cross-sectional study included 48 GC patients with periodontal changes, presenting to the Surgery Department in Craiova, Romania, from March 2023 to February 2024. Clinical assessments, where the number of teeth present, probing depth (PD), and bleeding on probing (BOP) were recorded, gingival crevicular fluid sampling, qPCR for Fusobacterium nucleatum, and ELISA for cathepsin K were performed. Histological analysis evaluated tumor characteristics, where tumor dimension (TD) and differentiation grade (DG) were recorded, and statistical analysis was conducted using R software. Results: Smokers presented higher PD and F. nucleatum levels than non-smokers. Gender had no impact on PD, BOP, CTSK, F. nucleatum, or TD. PD correlated with F. nucleatum, TD, and CTSK. F. nucleatum strongly correlated with CTSK and TD, and CTSK was strongly correlated with TD. Conclusions: These results suggest an association between F. nucleatum, periodontal parameters, and characteristics of GC but future studies are needed. Full article

This study develops a multi-agent evolutionary game model that incorporates both retailers and heterogeneous logistics providers, extending beyond prior dyadic models that typically isolate either channel choice or logistics competition. By comparing scenarios with and without the BOPS channel, the framework captures the dynamic interactions between retailers and logistics providers. The results show that introducing In-Store Pickup significantly increases market demand and retailer revenue by reducing consumer waiting time, but it also produces a revenue crowding effect for slow logistics providers. For fast providers, the impact depends on their ability to adjust service quality: lowering service levels helps retain market share, while efficiency improvement enhances profitability. Furthermore, consumer product valuation plays a critical role in driving retailers toward dual-provider or hybrid strategies. The methodological innovation lies in integrating heterogeneous logistics service differentiation with channel strategy selection into a unified evolutionary game framework. The study contributes by proposing a dynamic “efficiency threshold–channel selection” mechanism, offering both theoretical advancement in omnichannel retailing research and managerial insights for retailers and logistics providers seeking to optimize logistics capabilities and channel collaboration. Full article

Background: Rheumatoid arthritis and periodontitis are chronic inflammatory diseases linked to systemic complications, including increased cardiovascular risk. The impact of glycemia, lipid profile and atherogenic cardiovascular risk indices in patients with rheumatoid arthritis (RA) and periodontitis, compared to controls, has not yet been evaluated. We aimed to analyze whether periodontitis acts as an aggravating factor in this relationship. Methods: In a case–control study, we assessed biochemical, RA-related markers and four atherogenic indices (Atherogenic Index of Plasma, Castelli Risk Index I, Castelli Risk Index II, and Triglyceride–Glucose Index). Periodontitis was evaluated using a gingival inflammation index (BOP) and a periodontal severity index (PIRIM). Multiple linear regression models were used to analyze whether periodontitis had a differential effect in RA cases versus controls. Results: A total of 46 participants were included (32 RA cases, 14 controls). Periodontitis was more prevalent among cases (62.5% vs. 28.5%). BOP was significantly higher in RA patients (p < 0.001) and associated with LDLC (p = 0.031). Both BOP and PIRIM correlated with higher CRI-1 and CRI-2 values across groups. PIRIM was also linked to increased LDLC (p = 0.018) and decreased HDLC (p = 0.003). Conclusions: RA and periodontitis appear to interact synergistically and are associated with a more atherogenic profile. These findings highlight periodontal health as a potentially modifiable factor in reducing cardiovascular risk in RA patients. Full article

The low fertility of tropical Oxisols challenges sustainable agriculture. While biochar-based granular fertilizers (BBGFs) offer a solution, the influence of different organic binders is unclear. This study investigated how BBGFs formulated with bio-oil (BO), pyroligneous extract (PE), and cassava wastewater (CW) impact soil enzyme activities and nutrient dynamics over time. Eucalyptus biochar (B) and natural phosphate (NP) were granulated with three binders at four doses. These treatments, plus controls (unfertilized soil, NP, B with NP, and B alone), were incubated in an Oxisol, assessing soil samples after 10 and 40 days of incubation. All BBGFs significantly enhanced β-glucosidase, acid phosphatase, and arylsulfatase activities over controls, with increases exceeding 8%. While the BBGFs-BO formulation sustained the highest enzymatic activity, BBGFs-PE at 125% maximized acid phosphatase at 10 days, with a subsequent decline, and inhibited arylsulfatase at the 150% dose. BBGFs-CW was most effective for increasing P availability (up to 24.0 mg kg⁻¹). BBGFs-BO and BBGFs-PE also enhanced soil organic carbon and cation exchange capacity by up to 430% and 163%, respectively. The BBGFs-BO at 150% dose is the most effective and stable formulation to enhance nutrient cycling and soil health, offering a viable pathway to convert agricultural residues into high-value fertilizers. Full article

Background: Periodontitis is linked to a range of systemic non-communicable diseases, including hepatic diseases. The aim of this study was to investigate whether periodontal health status is associated with liver cirrhosis (LC). Methods: Patients were recruited from the Department of Internal Medicine at the University Clinical Hospital “Sestre Milosrdnice” and categorized into two groups. The case group comprised patients with LC, while age-matched individuals without LC served as controls. Systemic health status was evaluated through laboratory tests, medical history, and clinical parameters, and the Model for End-Stage Liver Disease (MELD) score was calculated for each participant. A comprehensive clinical periodontal assessment was conducted, measuring bleeding on probing (BoP), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), and the Periodontal Inflamed Surface Area (PISA) score. Stepwise logistic regression was employed to assess possible predictors of LC, including periodontal status. Results: A total of 100 patients were included in the analysis, consisting of 50 cases with LC and 50 controls. The mean age was 56.79 years (SD = 11.16) of participants, and 58% were male. The majority of LC cases were attributed to alcohol abuse (41/50, 82%), and the median MELD score was 16 (IQR 6–33). Comparison of the two groups revealed significantly worse clinical periodontal parameters in the LC group and a higher prevalence of periodontitis (p = 0.012). Among the 50 LC patients, 46 (92%) exhibited severe forms of periodontitis (stages III and IV). Logistic regression analysis identified alcohol consumption and the PISA score as independent predictors of LC (OR = 23.81, 95% CI 4.48–126.47, p < 0.001; OR = 1.006, 95% CI 1.003–1.01, p < 0.001, respectively). Conclusions: Within the limits of the present study, the higher prevalence of periodontal disease in the LC group suggests an association between LC and periodontitis. Full article

Peri-implant mucositis is an inflammatory condition that affects the peri-implant mucosa, without bone involvement. Peri-implant mucositis can include erythema, swelling, and bleeding, and the mucosa can be painful even with the traditional oral hygiene procedures. Peri-implant mucositis is always a reversible condition but, if left untreated, it can degenerate into peri-implantitis. Although biofilm control is considered the gold-standard therapy, some adjunctive therapies can be employed. The aim of this study is to investigate the efficacy of postbiotics in peri-implant mucositis management. Forty patients in good systemic health with at least one implant diagnosed with peri-implant mucositis were enrolled in this case–control study. The control group received professional biofilm removal and home care instructions, while the test group was also asked to use a postbiotic gel. Clinical indices of inflammation, such as probing pocket depth (PPD), plaque index (PI), bleeding on probing (BoP), erythema, pain, suppuration and swelling, were collected at four timepoints during observation and analyzed at both the patient and site levels. After one year, clinical indices statistically significantly improved in both groups compared to baseline. The test group showed greater reductions. PPD was statistically significantly lower at the site level in the test group than in the control group. The results of this study confirm that biofilm control is an effective therapy for peri-implant mucositis. Our findings showed that postbiotics used as an adjunctive in home therapy have been effective in managing clinical indices in patients with peri-implant mucositis. Full article

Background/Objectives. Periodontitis is a chronic inflammatory disease influenced by systemic and psychological factors, including depression. Selective serotonin reuptake inhibitors (SSRIs), widely used to treat depression, may also affect periodontal healing. This study aimed to evaluate the clinical efficacy of full-mouth disinfection (FMD) in patients with periodontitis, with or without comorbid depression and SSRI therapy. Methods. Eighty participants were enrolled and divided into two groups: periodontitis only (n = 40) and periodontitis with depression (n = 40), the latter subgrouped by SSRI usage. Clinical parameters, including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), were assessed at baseline and 12 weeks after FMD. Results. Following FMD, significant improvements were observed in PD, PI, and BOP across all groups (p < 0.001). In the non-depressed group, mean PD decreased from 4.26 ± 0.97 mm to 2.76 ± 0.56 mm (p < 0.001) and PI from 3.85 ± 0.70 to 1.05 ± 0.99. Patients with depression had higher initial PD (4.98 ± 1.05 mm) but still showed improvement to 3.08 ± 0.69 mm (p < 0.001). CAL improved significantly only in non-depressed individuals (p = 0.008), while no statistically significant CAL changes were observed in depressed patients (p > 0.05). SSRI therapy did not significantly influence treatment outcomes (p > 0.05). Conclusions. FMD is clinically effective in reducing periodontal inflammation in patients with or without depression. However, improvements in CAL were more pronounced in non-depressed individuals, suggesting that depression may partially attenuate periodontal healing. Full article

Background/Objectives: Conventional logistic regression is widely used in the field of dentistry, specifically for prediction purposes in longitudinal studies. This study aimed to compare the validity of different supervised machine learning (ML) models to the conventional logistic regression (LR) model to predict the outcomes of nonsurgical periodontal treatment (NSPT). Methods: Patients diagnosed with periodontitis received full periodontal charting, including bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment loss (CAL). Furthermore, the tooth type, tooth location, tooth surface, arch type, and gingival phenotype were also collected as site-specific predictors. Later, root surface debridement was provided and treatment outcomes were evaluated after 3 months. Site-specific predictors were used to train five ML models, including random forest (RF), decision tree (DT), support vector classifier (SVC), K-nearest neighbors (KNN), and Gaussian naïve Bayes (GNB), to develop predictive models. Results: Site-specific predictors of 1108 examined sites were used, and the overall accuracy prediction of the conventional LR model was 70.4%, with PPD statistically significantly associated with the outcome of NSPT (odds ratio = 0.577, p = 0.001). Among the ML models examined, only GNB and SVC showed comparable prediction accuracy (71.0% and 70.4%, respectively) to the LR model, whereas the prediction accuracies of KNN, RF, and DT were 65.0%, 62.0%, and 61.0%, respectively. Similarly, baseline PPD was shown to be the most important featured predictor by both the RF and DT models. Conclusions: The evidence suggests that supervised ML models do not outperform the LR model in predicting the outcomes of NSPT. A larger sample size and more predictors of periodontitis are necessary to enhance the accuracy of ML models over the LR model in predicting the outcomes of NSPT. Full article

Background: Chromosomal instability (CIN) may underlie a subset of idiopathic infertility, and chronic periodontitis could contribute to genomic fragility. We tested whether periodontal status is associated with cytogenetic instability in adults with idiopathic infertility. Methods: This was a cross-sectional study of 60 adults aged 20–40 years, comprising idiopathic infertility (n = 30) and fertile controls (n = 30), each with 18 women and 12 men. Significant exclusions included systemic inflammatory disease, pregnancy/lactation, recent antibiotics/NSAIDs, and periodontal therapy within 6 months. Periodontal examination recorded probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). Cytogenetic testing used mitomycin C-induced chromosomal breakage to derive the Breakage Index (BI); CIN was defined as BI ≥ 4.0. Analyses compared infertile with CIN (n = 19), infertile without CIN (n = 11), and controls (n = 30). Results: Infertile participants with CIN had a higher periodontitis burden compared to infertile participants without CIN and to controls (moderate–severe: 89.5% vs. 54.5% vs. 26.7%); mean BI also differed (5.2 ± 0.9 vs. 1.3 ± 0.5 vs. 0.4 ± 0.2). Periodontal measures followed the same gradient, with greater CAL and PD in CIN-positive infertility. Conclusions: In idiopathic infertility, CIN was cross-sectionally associated with more severe periodontitis, and the BI correlated with CAL, PD, and BOP. Causality cannot be inferred and residual confounding cannot be excluded. Periodontal screening is a feasible adjunct that may help identify a modifiable inflammatory burden; prospective and interventional studies are warranted. Full article

This paper presents the optimization of the power required to activate a jaw-type blowout preventer (BOP) in the oil industry using an axial piston pump. Experimental and numerical methods were combined to analyze the effects of pressure, flow rate, volumetric efficiency, and clearance leakage on energy consumption. Taguchi methodology with an orthogonal array and the “smaller-is-better” criterion was used in the experiments, while regression analysis provided a predictive model. Optimization was performed using the Grey Wolf Optimizer (GWO) in Python 3.13. The results show that pressure and flow rate significantly affect power consumption, while higher volumetric efficiency leads to notable energy savings. The optimal configuration reduced the power demand to 5.0001 kW. Based on this, reliability models were created to assess deviations from optimal conditions. The study demonstrates the effectiveness of combining statistical and optimization techniques for improving safety systems in the oil industry. The key contribution of this study lies in the integration of experimental Taguchi-based modeling with Grey Wolf Optimizer (GWO) metaheuristic techniques to optimize the energy-efficient activation of jaw-type blowout preventers, representing a novel methodological approach in the field of hydraulic safety systems in the oil industry. Full article

Background: Bone regeneration is a key therapeutic objective in periodontology, particularly in the treatment of alveolar defects caused by periodontal disease, dentoalveolar trauma, or surgical interventions. Among current regenerative strategies, collagen-enriched biomaterials have demonstrated an active role in modulating cellular behavior during bone repair. However, the specific effects of different collagen formulations on human dental pulp stem cells (hDPSCs) have not yet been fully characterized. Objective: To evaluate the impact of xenogeneic bone grafts with and without collagen—OsteoBiol^® Gen-Os^® (GO), OsteoBiol^® GTO^® (GTO), and Geistlich Bio-Oss^® (BO)—on cell viability, adhesion, migration, osteogenic differentiation, and mineralization potential of hDPSCs, and to explore the molecular mechanisms underlying their effects. Methods: In vitro assays were conducted to assess viability (MTT and fluorescence staining), adhesion (SEM), migration (wound healing assay), and mineralization (Alizarin Red S staining). Gene expression analyses (RT-qPCR) were performed for adhesion/migration markers (FN, SDF-1, COL1A1), angiogenic/proliferation markers (VEGF, FGF2), and osteogenic differentiation markers (RUNX2, ALP, COL1A1). Results: GO showed a higher early expression of genes associated with adhesion, migration, angiogenesis (FN, SDF-1, VEGF and FGF2: p < 0.05; COL1A1: p < 0.01), and osteogenic differentiation (7 days: COL1A1 and ALP (p < 0.001)); (14 days: RUNX2, ALP: p < 0.001; COL1A1: p < 0.05), indicating a sequential activation of molecular pathways and mineralization capacity comparable to the control group. GTO demonstrated the best biocompatibility, with significantly higher cell viability (p < 0.05), strong adhesion, and markedly increased mineralization at 21 days (p < 0.001), despite moderate early gene expression. BO showed reduced cell viability at 10 mg/mL (p < 0.05) and 20 mg/mL (p < 0.001), with mineralization levels similar to the control group. Conclusion: Collagen-based xenografts demonstrate favorable interactions with hDPSCs, enhancing viability and promoting osteogenic differentiation. Our findings suggest that beyond the presence of collagen, the specific formulation of these biomaterials may modulate their biological performance, highlighting the importance of material design in optimizing regenerative outcomes. Clinical Significance: The formulation of collagen in xenogeneic bone substitutes may be a determining factor in enhancing periodontal regenerative outcomes by modulating the early cellular response and osteogenic activity in stem cell-based tissue engineering. Full article

Oral diseases remain prevalent, although most of them can be prevented. Oral health inequities represent a critical problem of social injustice worldwide. Health literacy has emerged as a potential determinant of oral health disparities, comparable in impact to socioeconomic factors. This study explored the impact of socioeconomic factors and health literacy on oral health in young adults in Norway using data from the third wave of the Fit Futures study (n = 705), which included questionnaires and clinical oral examinations. Measures included self-reported oral health, oral health-related quality of life (OIDP-8), caries experience (DMFT), gingivitis (BOP), health literacy (HLS-Q12) and socioeconomic factors. Multivariable logistic regression analyses showed that lower health literacy was associated with poorer self-reported oral health (OR: 0.95, 95% CI: 0.93–0.98) and lower oral health-related quality of life (OR: 0.94, 95% CI: 0.90–0.98). Higher health literacy was associated with a greater caries experience (OR: 1.05, 95% CI: 1.01–1.09). Lower educational attainment was associated with less favorable outcomes across all oral health measures (OR: 1.7–2.6, all p < 0.05). These findings suggest that both health literacy and education influence oral health. Interventions aimed at enhancing health literacy and reducing barriers should be tested to empower young people and support their long-term oral health. Full article