Introduction. Anesthesia is widely used in various fields of dentistry to reduce patient discomfort when the treatment would be painful. The dentist may need to infiltrate the anesthetic into multiple locations and this is usually done with the same needle which passes through the soft tissues several times to distribute the anesthetic solution over a larger area. The present study aims to evaluate, through a morphological analysis under a scanning electron microscope (SEM), how the beveled tip of a 30G needle, used to inject anesthetic several times into different areas of the vestibular mucosa, changes. Materials and methods. 30G needles with two different brands were tested, in vivo used for a variable number of sequential injections from 1 to 6 on 192 patients. The specimens were analyzed under SEM observation to evaluate any deformations induced by contact with the vestibular soft tissues. Results. The amount of deformation, measured along the axis parallel to the needle, was proportional to the number of injections. The protrusion of deformations, measured on an axis perpendicular to the needle, were maximum on the needles used 3 times. For the needles used 4,5 and 6 injections, no further increase in deformations was noted. Conclusion. From the data it seems that the tested needles are not produced to withstand multiple injections consequently after the first injection on soft tissues, they undergo a deformation which could increase the risk of injury to the mucosa itself or to nerves and vessels with which they come into contact. It would be advisable to use the single needle for a reduced number of injections.

Background and Objectives: A degenerative joint disease that primarily affects the elderly, osteoarthritis (OA) causes pain, decreased mobility, and a lower quality of life. The effectiveness of GerovitalH3, a biotrophic medication created by Ana Aslan, in reducing pain and enhancing function in older people with osteoarthritis in the knee and hip is assessed in this study. Materials and Methods: Two groups of 201 patients aged 65 and older participated in a randomized, case-control clinical trial. One group received physical therapy and GerovitalH3 periarticular injections, while the other group received just physical therapy. In addition to functional evaluations using the Lequesne Index, Activities of Daily Living (ADL), and Instrumental ADL (IADL) scores, pain was assessed using a Visual Analogue Scale (VAS). Results: The GerovitalH3 group showed a substantial decrease in pain (p<0.001) and an improvement in daily activities (p<0.001) when compared to the control group. However, there was no significant difference in walking scores (p = 0.171). There were no significant adverse effects noted. GerovitalH3 did not outperform physical therapy for reducing depression, even though both groups displayed some improvement in this area. Conclusions: This study opens a new possibility for periarticular injections of Gerovital H3 treatment combined with physical therapy, which may represent a safe and effective non-surgical option for elderly individuals struggling with OA pain and functional limitations. The findings of this study reinforce the need for further research, particularly randomized controlled trials with larger sample sizes and longer follow-up periods.

The absence of interdental papillae leads to the appearance of black triangle. For most patients, the appearance of these triangles is an important reason for concern and affects their social relationships. Multiple reconstruction techniques have been developed with different degrees of success and predictability. The main aim of this study was to evaluate the efficiency of hyaluronic acid (HA) injected into interproximal papillae six months after injection and to perform a systematic review and meta-analysis. After a systematic review, five articles were selected: a clinical randomised controlled trial and four clinical trials. In total, eighty-five patients with a deficiency in upper papillae in the front of the maxilla and jaw were included in the study. The height variable was evaluated (mm) six months after HA injection. In total, one hundred and four interproximal papillae were studied. Three articles showed an important difference in favour of intervention. The total result regarding in the injection of AH was favourable with an approximate average filling of 0.7 mm in the height of the interdental papilla. The injection of HA for the reconstruction of deficient papillae in the region of the upper and lower maxilla was a possible option treatment strategy.

Cartilage degeneration is a characteristic of osteoarthritis (OA) which is often observed in aging populations. This degeneration is due to the breakdown of articular cartilage (AC) mechanical and tribological properties, primarily attributed to lubrication failure. Understanding the reasons behind these failures and identifying potential solutions could have significant economic and societal implications, ultimately enhancing the quality of life. This review provides an overview of developments in the field of AC, focusing on its mechanical and tribological properties. The emphasis is on the role of lubrication in degraded AC, offering insights into its structure and function relationship. Further it explores the fundamental connection between AC mechano-tribological properties and the advancement of its degradation and puts forth recommendations for strategies to boost its lubrication efficiency.

As in many points in this middle section of the Ebro Valley (Spain), the risks of sinkholes are be-coming particularly severe, affecting urban areas and roads, where land subsidence due to karst-ic processes is frequent. However, knowledge of the area, its geological-geotechnical configura-tion and the carrying out of specific research studies are allowing solutions to be tested in an at-tempt to resolve these situations. The present analysis of the seating problems recorded on a sec-tion of the access road to the town of Gallur from the east (Camino Real) in the province of Zara-goza (Spain), is a good example. Numerous surface manifestations of the recent activity of sub-sidence and/or collapse processes have been reproduced throughout the surrounding area. The latter, appearing in the form of craters, undercuts in the ground, sometimes several metres in di-ameter. The presence of highly karstifiable materials in the area, as indicated by the existence of several pockets of subsidence and collapse dolines, constitutes a serious problem for safety, in this case for traffic and access to the town. For this reason, the road has been closed for several years. The local and provincial administrations have been undertaking studies to try to recognise this type of situation. The detailed definition of the karstification processes, the geomechanical analy-sis of subsidence and cavity collapse, and the justified technical proposal of the measures to be adopted to control and mitigate the risk, were the objectives of several reports in which possible technical solutions were proposed. Finally, a consolidation solution was proposed based on the injection at depth of columns of mortar with special characteristics, combined with the replace-ment and reinforcement of the most superficial soil by means of high tensile strength geotextile meshes.

Patients' functional adaptation to pain can affect global sagittal alignment. This study evaluated the short-term spinal sagittal alignment change after Transforaminal Epidural Steroid Injection (TFESI) in lumbar spinal stenosis patients. Patients with lumbar spinal stenosis who underwent TFESI were retrospectively examined. Clinical outcomes were Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Before and two weeks after the intervention, whole spine lateral standing view radiographs were taken. Radiographic parameters, e.g., Sagittal Vertical Axis (SVA), C2C7 Cobb, Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), and Lumbopelvic Mismatch (PI-LL), were measured. Ninety-nine patients (mean age 64.3 ± 9.2 years) were included in this study. Both VAS and ODI outcomes were statistically improved after two weeks of intervention. Radiographic parameters showed that SVA, PT, and PI-LL mismatch were significantly decreased, while C2C7 Cobb, TK, SS, and LL were significantly increased after the intervention. SVA was improved by 29.81% (52.76 ± 52.22 mm to 37.03 ± 41.07 mm, P &lt; 0.001). PT was also decreased significantly from 28.71° ± 10.22° to 23.84° ± 9.96° (P &lt; 0.001). Transforaminal Epidural Steroid Injection (TFESI) significantly improves VAS, ODI, and global sagittal parameters in lumbar spinal stenosis patients.

Pathologic angiogenesis is responsible for much of the vision loss that stems from several chorioretinal vascular diseases including neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), and retinal vein occlusion (RVO). Because vascular endothelial growth factor (VEGF) serves as a pivotal angiogenic molecule, it has emerged as the primary target for therapeutic drugs. Current anti-VEGF therapy is dominated by bevacizumab, ranibizumab, and aflibercept, all of which have been available for more than a decade, but new drugs, both biosimilars (Byooviz and Cimerli) and drugs whose primary aim is to decrease treatment burden (brolucizumab, faricimab, and the ranibizumab port delivery system), have been approved. Recent failures (conbercept, abicipar, and KSI-301) emphasize the complexity of drug development and the difficulties faced by innovators. Most therapies under development, including tyrosine kinase inhibitors and gene therapy, include VEGF-A blockade as their primary function and aim to extend durability rather than increase peak efficacy. But even as many new drugs look to extend durability, cost containment with mandated use of biosimilars serves to balance the therapeutic landscape.

There are currently no effective treatments for retinal pigment epithelial (RPE) cell loss in atrophic AMD (aAMD). However, our research on Prom1, a known structural protein in photoreceptors (PRs), has revealed its distinct role in RPE and offers promising insights. While pathogenic Prom1 mutations have been linked to macular diseases with RPE atrophy, the broader physiological impact of dysfunctional Prom1 in RPE loss is unclear. We have shown that Prom1 plays a crucial role in regulating autophagy and cellular homeostasis in human and mouse RPE (mRPE) cells in vitro. Nevertheless, a comprehensive understanding of its in vivo expression and function in mRPE remains to be elucidated. To characterize Prom1 expression in RPE in situ, we used RNAscope assays and immunogold electron microscopy. Our use of chromogenic and fluorescent RNAscope assays in albino and C57BL/6J mice retinal sections has revealed Prom1 mRNA expression in perinuclear regions in mRPE in situ. Immunogold imaging showed Prom1 expression in RPE mitochondria. To confirm Prom1 expression in RPE, we interrogated human RPE single-cell RNA-sequencing datasets using an online resource, Spectacle. Our analysis showed Prom1 expression in human RPE. To investigate Prom1's function in RPE homeostasis, we performed RPE-specific Prom1-knockdown (KD) using subretinal injections of AAV2/1.CMV.saCas9.U6.Prom1gRNA in male and female mice. Our data show that RPE-specific Prom1-KD in vivo resulted in abnormal RPE morphology, sub-retinal fluid accumulation, and secondary PR loss. These changes were associated with patchy RPE cell death and reduced a-wave amplitude, indicating retinal degeneration. Our findings underscore the central role of Prom1 in cell-autonomous mRPE homeostasis. The implications of Prom1-KD in causing aAMD-like RPE defects and retinal degeneration in a mouse model are significant and could lead to novel treatments for aAMD.

Currently, for the serious air pollution and global warming effect caused by the substance released from the present vehicle, it is expected that the regulatory requirements for the emission will become more stringent. A new concept of the combustion technology that can reduce the NOx and PM related to combustion is urgently needed. To cope with such social demands, many developed countries are efforts to develop the environment friendly vehicle engine at the national lever in order to satisfy with strengthening emission control. As a main combustion technology among new combustion technology for the new generation engine, the homogenous charge compression engine (HCCI) is expanding its application range by employing multiple combustion mode, catalyst, direct fuel injection and partially premixed combustion. In this paper, a multi-injection method in order to apply the HCCI combustion method without mainly altering engine specifications and practicality by referring to the results of the HCCI engine was investigated. Applied with forced charging, exhaust gas recirculation (EGR) and compression ratio change, it was evaluated to the possibility of securing optimum fuel economy and emission reduction in the IMEP 0.8 MPa range.

The preservation of the authenticity of a building artefact is a responsible practice. On the other side, the need to save the building artefact from the natural and anthropic degradation, to ensure the structural reliability to the different actions, to define an efficient maintenance program are big challenges, that involves the cooperation of several professionals, responsible use of innovative techniques and materials that are nowadays available. This paper focuses on a specific design approach for the rehabilitation works of ancient constructions in archaeological sites. The proposed conceptual design approach implies different steps that allow the optimization of the design at an increasing level of knowledge on the existing structures and their materials. The design procedure on historical constructions generally includes the following steps: the collection of data, the structural identification, hazard, and vulnerability analysis, damage and risk analysis, a cost-benefit analysis, so only at the end of the process, the final design is achieved. In the archaeological area, some important design aspects cannot be defined before the execution work phase, since some elements could be revealed and identified during work execution, as a consequence, the final design has been often optimized after all this information has been acquired. A studied case in the archaeological site of Pompeii is herein presented to prove the efficiency of the proposed approach.

Congenital breast asymmetry represents a particular challenge to the classical techniques of plastic surgery due to a young group of patients. This study compares traditional breast augmentation using silicone implants to the more innovative lipograft technique regarding long-term results. To achieve this, we not only captured subjective parameters like satisfaction with outcome and symmetry, but also objective parameters such as breast volume and anthropometric measurements. Objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. Patients who underwent implant augmentation and lipograft both showed no significant differences in patient´s satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % in both groups was reported. Likewise, no statistically significant volume difference between left and right breast was observed in both groups (p<0.41). However, on average, lipograft patients needed 1.3 procedures more until the desired result was achieved. In contrast, patients treated with implant-based breast augmentation usually need several implant changes during their life. In conclusion, both methods should be considered for patients with congenital breast asymmetry.