The female pelvic floor through midlife and aging

Female pelvic floor is a complex functional unit involved in multiple functions that extend beyond the sole support of pelvic organs. Pelvic floor dysfunction globally affects micturition, defecation and sexual activity. Evolutionary modifications such ad adaptation to upright standing, walking and the need to deliver fetuses with larger head diameters made the fascial and muscle support of the pelvic floor vulnerable, therefore predisposing women to pelvic organ prolapse and incontinence. Different than in males, the female pelvic floor undergoes a number of adaptive changes related to life and endocrine events. Most of the clinical manifestations of these changes become apparent after menopause and throughout aging in women. This review article summarizes the key aspects of the pathophysiology and the clinics of the modifications of the pelvic floor in women through midlife and beyond. A particular focus is given to the relationship between urinary and bowel dysfunction.     

Qualitative smell/taste disorders as sequelae of acute COVID-19

Neurological Sciences - Qualitative smell/taste disorders (such as phantosmia, parosmia, phantogeusia, and parageusia) have not yet been fully characterized in patients who had COVID-19, whereas...     

Evaluation of the commercial AD fosfomycin test for susceptibility testing of multidrug-resistant Enterobacterales and Pseudomonas aeruginosa

ObjectivesTo compare fosfomycin susceptibility testing with the commercial agar dilution (AD) test, AD Fosfomycin (Liofilchem, Roseto degli Abruzzi, Italy) and the reference AD method, using a collection of multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa clinical isolates.MethodsThe collection included 119 carbapenemase-producing Enterobacterales, 53 Enterobacterales producing acquired AmpC-type and/or extended-spectrum β-lactamases and 38 carbapenemase-producing P. aeruginosa, including representatives of different high-risk clones. AD Fosfomycin and AD reference method (ISO 20776-1:2019) were performed starting from the same microbial suspension. Results were interpreted according to EUCAST clinical breakpoints (10.0). Essential agreement (EA), category agreement (CA) and error rates were calculated as described by the International Organization for Standardization.ResultsOf 172 Enterobacterales, 143 (83.1%, including 92.9% (52 of 56) of the NDM-producers and 84.2% (48 of 57) of the KPC-producers) were susceptible to fosfomycin using reference AD. A CA of 91.9% (158 of 172; 95% CI 87.1%–95.3%) and an EA of 92.5% (136 of 147; 95% CI 87.4%–96.0%), respectively, were calculated for the commercial AD Fosfomycin test, with 9.8% (14 of 143) of major errors and no very major errors (0 of 29). Overall, 86.8% (33 of 38) of P. aeruginosa showed a fosfomycin MIC ≤128 mg/L using reference AD. An EA of 84.8% (95% CI 66.3%–92.0%) was calculated for the commercial AD Fosfomycin test, with a CA of 100% (95% CI 93.6%–100%) when considering a tentative breakpoint at 128 mg/L.ConclusionsAD Fosfomycin showed an overall good concordance compared with reference AD.     

Potential Benefits of Holmium-166 Radioembolization as a Neoadjuvant Treatment of Intrahepatic Cholangiocarcinoma

CardioVascular and Interventional Radiology -     

Clinical outcome of bonded partial indirect posterior restorations on vital and non-vital teeth: a systematic review and meta-analysis

Clinical Oral Investigations - The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a...     

Evaluation of a 3D serious game for advanced life support retraining

ObjectiveAdvanced life support (ALS) knowledge and skills decrease in as little as three months, but only a few ALS providers actually attend retraining courses. We assess the effectiveness of a 3D serious game as a new tool for frequent ALS retraining.MethodsWe developed a 3D serious game for scenario-based ALS retraining. The serious game, called EMSAVE, was designed to promote self-correction while playing. We organized a retraining course in which 40 ALS providers played two cardiac arrest scenarios with EMSAVE and took a test with 38 multiple-choice questions before and after playing. We administered the same test again 3 months later to evaluate retention. Participants also rated EMSAVE and the overall retraining experience.ResultsAfter using EMSAVE, the number of correct answers per participant increased by 4.8 (95%CI +3.4, +6.2, p < 0.001) and all but one participant improved. After 3 months, despite an expected decrease in ALS knowledge and skills (?1.9 correct answers, 95%CI ?0.6, ?3.3, p < 0.01), there was a significant retention benefit (+2.9 correct answers per participant, 95%CI +1.5, +4.2, p < 0.001). Moreover, all but one participant regarded EMSAVE as a valuable tool to refresh ALS knowledge and skills, and 85% of participants were also willing to devote 1 h/month to retrain with the serious game.ConclusionsA 3D serious game for scenario-based retraining proved effective to retrain in ALS and supported retention of acquired knowledge and skills at 3 months. EMSAVE also positively engaged and motivated participants.     

Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: A finite element study

Objective:To evaluate, using the finite element method, the orthodontic rotational movement of a lower second premolar obtained with clear aligners, analyzing different staging and attachment configurations.Materials and Methods:A CAD model including a complete lower dental arch (with element 4.5 mesially rotated 30°) and the corresponding periodontal ligaments, attachments, and aligner was designed and imported to finite element software. Starting from the CAD model, six projects were created to simulate the following therapeutic combinations for correcting element 4.5 position: (1) without attachments, (2) single attachment placed on the buccal surface of element 4.5, (3) three attachments placed on the buccal surfaces of teeth 4.4 to 4.6. For each project, both 1.2° and 3° of aligner activation were considered.Results:All the analyzed configurations revealed a clockwise rotation movement of element 4.5 on the horizontal plane. Models with attachments showed a greater tooth displacement pattern than models without attachments. Simulations with attachments and 3° of aligner activation exhibited the best performance concerning tooth movement but registered high stresses in the periodontal ligaments, far from the ideal stress levels able to produce tooth rotational movement.Conclusions:The model with a single attachment and 1.2° of aligner activation was the most efficient, followed by the three attachment model with the same degree of activation. Aligner activation should not exceed 1.2° to achieve better control of movement and reasonable stress in periodontal structures.