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Since SARS-CoV-2-based disease (COVID-19) spreads as a pandemic, the necessity of a highly sensitive molecular diagnosis that can drastically reduce false negatives reverse transcription PCR (rtPCR) results, raises as a major clinical need. Here we evaluated the performance of a ddPCR-based assay to quantify SARS-CoV-2 titer in 55 suspected COVID-19 cases with negative rtPCR results thanks to in-house ddPCR assay (targeting RdRp and host RNaseP). Samples were collected at ASST-GOM Niguarda between February and May 2020 at hospital admission. Clinical and imaging data were obtained for clinical staging and definition of disease severity. Patients were mainly female (45.5%) with a median age of 73 (57-84) years. ddPCR-based assay detected SARS-CoV-2 genome in nasopharyngeal samples of 19 (34.5%) patients (median viral-load: 128 copies/mL, IQR: 72-345). In 15 of them (78.9%), chest CT showed a classical COVID-19 bilateral interstitial pneumonia; 14 patients (73.7%) showed severe COVID-19 manifestations. ddPCR did not identify any trace of SARS-CoV-2 genome in the respiratory samples of the remaining 36 patients. The serological assay performed in a subgroup of 34 patients at the later stage of illness (from 3 days to 90 days after) confirmed the presence of SARS-CoV-2 antibodies in all patients tested positive for SARS-CoV-2 in ddPCR (100%). Contrariwise, negative tests were observed in 95.0% ddPCR negative patients (P<0.001). Thanks to a ddPCR-based assay, we achieved a rapid and accurate SARS-CoV-2 diagnosis in rtPCR-negative respiratory samples of individuals with COVID-19 suspect, allowing the rapid taking care and correct management of these patients.

Introduction: This study highlights the importance of maintaining dental implants, particularly in the context of peri-implantitis. It emphasizes the need for dental hygienists to choose appropriate instruments that will not damage implant surfaces while effectively cleaning them. Materials and Methods: The research involved in vitro tests using 4 ultrasonic inserts for peri-implant mechanical instrumentation on one machined and one etched healing abutment, with a focus on how these instruments affect surface roughness. For each insert, four surface roughness measurements were recorded on each abutment. The data were then analyzed in two separate designs, one for the machined abutments and one for the etched abutments. The significance of the factors was determined by analyzing them using an ANOVA test. Results: The study found significant effects of surface treatment and instrument type on surface roughness parameters. Instrumentation tended to alter the roughness of machined surfaces more than etched ones, with notable differences in performance among the various inserts. Discussion: The results suggest that surface treatment has a more substantial impact on roughness than the choice of instrument. Future studies are encouraged to explore other parameters related to bacterial biofilm retention and the potential release of material from non-metallic inserts. Conclusions: Key findings include that surface treatment significantly influences surface roughness and that specific instruments can either increase or decrease roughness based on the type of surface.

IntroductionRetroperitoneal soft tissue sarcomas (RPSs) are mesenchymal neoplasms. The prevalence of protein energetic malnutrition (PEM) and its impact in RPS patients who were candidates for surgery is unknown.Materials and MethodsA prospective feasibility study enrolled 35 patients with primary RPS who were candidates for extended multivisceral resection. PEM was screened at enrollment. Preoperative high protein β-hydroxy-β-methyl butyrate oral nutritional support (ONS) was provided according to the degree of PEM. After surgery, nutritional support followed standard practice, targeting at least 1 g/kg/day protein and 20 kcal/kg/day caloric intake within the third postoperative day (POD). PEM was re-evaluated before surgery on POD 10, and at 4 and 12 months after surgery. Primary outcomes were the patient’s compliance to preoperative ONS and the physician’s compliance to postoperative nutritional targets.ResultsPEM was documented in 46% of patients at baseline; ONS met a 91% adherence (overall well tolerated). After ONS, PEM reduced to 38% (p = 0.45). The postoperative caloric target was reached on day 4.1 (standard error ± 2.7), with a protocol adherence rate of 52%. On POD 10, 91% of patients experienced PEM, the worsening of which was greater after resection of four or more organs (p = 0.06). At 4 and 12 months after surgery, almost all patients had fully recovered. A significant correlation between PEM at surgery and postoperative complications was found (p = 0.04).ConclusionsRelevant PEM prevalence in RPS is documented for the first time. PEM correlates with greater morbidity. In this setting, preoperative ONS was feasible and well-tolerated. Disease-related factors for PEM and the ideal perioperative caloric target in the context of extended multivisceral resection need to be further investigated. Nutritional support should be included in enhanced recovery after surgery programs for RPS.Trial RegistryClinicalTrials.gov identifier: NCT03877588.

Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p<0.001). Previous exposure to antimicrobial drugs within the ICU was higher in MDRO patients than in non-MDRO patients (116/197 [58.9%] vs. 18/140 [12.9%]; p<0.001). Our findings might serve as warnings for future respiratory viral pandemics and call for increased measures of antimicrobial stewardship and infection control.

Background Recent studies showed that plasma SARS-CoV-2 RNA seems to be associated with worse COVID-19 outcome. However, whether specific population can be at higher risk of viremia are to date unexplored. Methods This cross-sectional proof-of-concept study included 41 SARS-CoV-2-positive adult individuals (six affected by haematological malignancies) hospitalized at two major hospital in Milan, for those demographic, clinical and laboratory data were available. SARS-CoV-2 load was quantified by ddPCR in paired plasma and respiratory samples. To assess significant differences between patients with and patients without viremia, Fisher exact test and Wilcoxon test were used for categorical and continuous variables, respectively. Results Plasma SARS-CoV-2 RNA was found in 8 patients (19.5%), with a median (IQR) value of 694 (209–1023) copies/mL. Viremic patients were characterized by an higher mortality rate (50.0% vs 9.1%; p  = 0.018) respect to patients without viremia. Viremic patients were more frequently affected by haematological malignancies (62.5% vs. 3.0%; p  < 0.001), and had higher viral load in respiratory samples (9,404,000 [586,060-10,000,000] vs 1560 [312–25,160] copies/mL; p  = 0.002). Conclusions Even if based on a small sample population, this proof-of-concept study poses the basis for an early identification of patients at higher risk of SARS-CoV-2 viremia, and therefore likely to develop severe COVID-19, and supports the need of a quantitative viral load determination in blood and respiratory samples of haematologic patients with COVID-19 in order to predict prognosis and consequently to help their further management.

Professional oral hygiene is fundamental to prevent peri-implant disease. Appropriate instruments should be used in patients with restorations supported by dental implants: they should be effective in deposits removal without damaging the implant components surface. The aim of the present study is to investigate and summarize the results regarding the efficacy of oral hygiene techniques described in the literature in the last 10 years in patients rehabilitated with dental implants not affected by perimplantitis. The present systematic review was conducted according to guidelines reported in the indications of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The focused question was: “Which are the most effective instruments for professional oral hygiene on implants not affected by perimplantitis?”. The initial database search yielded a total of 934 entries found in PubMed®/MEDLINE and Cochrane Library. After full text review and application of the eligibility criteria, the final selection consisted of 19 articles. The risk of bias of included studies was assessed using the Newcastle Ottawa scale (NOS) and the Cochrane Handbook for Systematic Reviews of Interventions. Curette, scalers and air polishing were the devices most frequently investigated in the included studies. In particular, glycine powder air polishing appeared to be significantly effective in reducing peri-implant inflammation and plaque around implants. The application of the more recent erythritol powder air polishing also yielded good clinical outcomes. Further studies are needed to improve the knowledge on the topic in order to develop standardized protocols and understand the specific indications for different types of implant-supported rehabilitations.

Background: Tooth extraction techniques have been refined over the years in order to be less traumatic and to better preserve alveolar bone. A recently introduced extraction method involves the use of the Magnetic Mallet®, which allows clinicians to be more precise and perform extractions faster. Moreover, the instrument enables the procedure to be less traumatic for patients. The aim of the present study was to clinically evaluate whether extractions performed using the Magnetic Mallet® can lead to less buccolingual bone resorption. Methods: Between February 2023 and June 2023, nine patients with an average age of 62 years underwent 29 extractions using the Magnetic Mallet®. Sectorial CBCTs were performed in order to measure buccolingual bone thickness at time 0 (T0, before extraction) and 3 months after extraction (T3M). All the extractions were performed by two different expert operators exclusively using the Magnetic Mallet®. For statistical analysis, a two-sample t-test was performed to determine the difference between the measurements taken at T0 and those taken at T3M in the 29 dental elements and the difference in bone loss between the surgeries conducted by the two clinicians. Results: A total of 22 teeth were extracted in the upper jaw and 7 in the lower jaw. The average degree of mobility was 1. The average degree of force impressed by the instrument to extract the teeth was 2, while the average frequency of blows administered was 7. The average time taken for the extractions was 3½ min. After 3 months, the mean buccolingual bone resorption was 1.54 mm (SD: ±). The difference in buccolingual bone thickness between T0 and T3 was significant at an alpha significance level of 0.01. No difference in bone resorption was found between the surgeries conducted by the two clinicians. Conclusions: The use of the Magnetic Mallet® results in bone loss in the buccolingual direction comparable with existing data in the literature on healing the post-extraction socket. This tool seems to be predictable in producing the same results between different operators.

New surgical techniques using narrow, tilted implants positioned through a magneto-dynamic tool in guided surgery for a Toronto restoration. A 69-year-old woman wanted fixed rehabilitation to replace her removable complete dentures. A cone-beam computed tomography showed significant bone resorption in both the maxillary and mandibular regions. The plan was to load the entire upper arch with six implants immediately, while removable partial dentures were recommended for the lower jaw. The guided surgery project was aligned with the new dentures, and the laboratory created a printed cast with dental implant analogues in planned positions. A metal-reinforced denture was constructed, and surgery was performed to place six narrow implants using the magneto-dynamic instrument. The denture was directly screwed onto multi-unit abutments. Final rehabilitation was completed after 6 months. Narrow implants can be a good option for fixed, full-arch rehabilitations. Further research is needed to confirm these findings on a larger scale.

Key Clinical Message This report describes the successful use of a new intervention to improve respiratory mechanics and gas exchange in a relatively homogeneous group of infants with severe bronchiolitis‐induced PARDS after failure of conventional treatment. These results may open a new interesting area of research and management for PARDS patients. This report describes the successful use of a new intervention to improve respiratory mechanics and gas exchange in a relatively homogeneous group of infants with severe bronchiolitis‐induced PARDS after failure of conventional treatment. These results may open a new interesting area of research and management for PARDS patients.

Aim. To evaluate the correlation between insertion torque (IT) and implant stability quotient (ISQ) in tapered implants with knife-edge threads. Methods. Seventy-five identical implants (Anyridge, Megagen) were inserted by using a surgical drilling unit with torque control and an integrated resonance frequency analysis module (Implantmed, W&H). IT (N/cm) and ISQ were recorded and implants were divided into three groups ( n = 25 ) according to the IT: low (<30), medium (30 < IT < 50), and high torque (>50). ISQ difference among groups was assessed by Kruskal-Wallis test, followed by Bonferroni-corrected Mann–Whitney U -test for pairwise comparisons. The strength of the association between IT and ISQ was assessed by Spearman Rho correlation coefficient ( α = 0.05 ). Results. At the pairwise comparisons, a significant difference of ISQ values was demonstrated only between low torque and high torque groups. The strength of the association between IT and ISQ value was significant for both the entire sample and the medium torque group, while it was not significant in low and high torque groups. Conclusions. For the investigated implant, ISQ and IT showed a positive correlation up to values around 50 N/cm: higher torques subject the bone-implant system to unnecessary biological and mechanical stress without additional benefits in terms of implant stability. This trial is registered with NCT03222219.