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BackgroundAim was to systematically search the literature and assess the available evidence regarding the clinical effectiveness of the Invisalign® system.MethodsElectronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were examined for additional studies. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThree RCTs, 8 prospective, and 11 retrospective studies were included. In general, the level of evidence was moderate and the risk of bias ranged from low to high, given the low risk of bias in included RCTs and the moderate (n = 13) or high (n = 6) risk of the other studies. The lack of standardized protocols and the high amount of clinical and methodological heterogeneity across the studies precluded a valid interpretation of the actual results through pooled estimates. However, there was substantial consistency among studies that the Invisalign® system is a viable alternative to conventional orthodontic therapy in the correction of mild to moderate malocclusions in non-growing patients that do not require extraction. Moreover, Invisalign® aligners can predictably level, tip, and derotate teeth (except for cuspids and premolars). On the other hand, limited efficacy was identified in arch expansion through bodily tooth movement, extraction space closure, corrections of occlusal contacts, and larger antero-posterior and vertical discrepancies.ConclusionsAlthough this review included a considerable number of studies, no clear clinical recommendations can be made, based on solid scientific evidence, apart from non-extraction treatment of mild to moderate malocclusions in non-growing patients. Results should be interpreted with caution due to the high heterogeneity.

In recent years, remarkable advancements in elucidating the intricate molecular underpinnings of type 2 diabetes mellitus (T2D) have been achieved. Insulin resistance (IR) has been unequivocally acknowledged as the driving pathogenetic mechanism of T2D, preceding disease onset by several years. Nonetheless, diagnostic tools for ascertaining IR are lacking in current clinical practice, representing a critical unmet need; use of the hyperinsulinemic-euglycemic glucose clamp, widely accepted as the gold standard method for evaluating IR at present, is cumbersome in a clinical setting. Thus, the development of well-validated, reliable, and affordable biomarkers of IR has attracted considerable attention from the research community. The biomarkers under investigation can be divided into two major categories: (1) indices or ratios, comprising parameters obtained from a basic or comprehensive metabolic panel and/or derived from anthropometric measurements, and (2) circulating molecules implicated in pathophysiological processes associated with IR. Furthermore, numerous novel biomarkers, including markers of β-cell dysfunction, radiographic quantification of excess visceral adipose tissue, T2D prediction models, certain microRNAs and metabolomic biomarkers, have also provided promising preliminary results. This narrative review aims to present current evidence pertaining to the most notable and exciting biomarkers of IR that are under rigorous evaluation.

The techno-economic performance evaluation of a combined cooling heating and power (CCHP) system installed in a hospital building in Greece is presented. The aim was to verify performance standards and evaluate real behavior, while highlighting the economic gains. In this research, system performance was evaluated using actual and year-round field measurements. The data were used to calculate the recovered heat and the generated electric energy. Furthermore, the performance was modeled and compared to the manufacturer specifications. Financial assessment was conducted through energy cost analysis to verify the operating viability of the system, both for its heating and cooling functions. The results showed that, overall, after eight years of operation, the energy efficiency was still within design standards. Electrical efficiency was constantly above 30%, while thermal efficiency was around 40–45%. Total efficiency was usually above the 75% threshold, characterizing the system as fully CHP operating. The analysis also pointed out the economic effectiveness of the system in the Greek energy market. The results verified the potential of a CCHP system for improving the energy and economic performance of a building.

A systematic method to evaluate the economic operating performance of existing combined heat and power (CHP) or combined cooling heat and power (CCHP) generation systems is applied. Two key performance indicators are selected to evaluate both the technical and the economic performance, based on operating recording data; the capacity factor and the capital recovery. The case study for eight projects in Athens is presented with the purpose to reveal the current situation of CHP in Greece and identify reasons that are hindering its penetration. Interesting conclusions were reached from the analysis. Only two out of the eight projects managed to achieve the break-even point in less than four years since the beginning of their operation, while oversizing phenomena were noticed in many cases leading in extremely low capacity factors.

BackgroundFixed orthodontic appliances might be associated with intraoral adverse effects on enamel, due to plaque accumulation and their colonization by oral microbes. At the same time, the demand for esthetic alternatives to orthodontic treatment, like thermoplastic aligners, is growing. However, thermoplastic aligners may behave differently intraorally than fixed appliances in terms of bacterial colonization and biofilm formation. Therefore, the aim of this prospective cohort study was to assess the salivary prevalence of the cariogenic bacteria Streptococcus mutans, Lactobacillus acidophilus, and Streptococcus sanguinis among adolescents treated orthodontically with thermoplastic aligners or fixed appliances.MethodsThirty adolescent patients (17 girls/13 boys; mean age 13.8 years old) were assigned to treatment with either (i) self-ligating fixed appliances with nickel-titanium archwires or (ii) aligners constructed from clear transparent polyethylenterephthalat-glycol copolyester (PET-G) thermoplastic sheets. Whole stimulated saliva was collected from each patient at three time points: at baseline (before bonding and initiation of orthodontic therapy or before insertion of the thermoplastic aligners), after 2 weeks, and after 1 month. A simplified plaque index, a simplified gingival index, and the decayed, missing, and filled teeth (DMFT) index were assessed from the clinical examination of the patients. Microbiological analysis of salivary bacteria was performed by quantitative polymerase chain reaction, followed by descriptive and inferential statistics at the 5% level.ResultsAlthough patients treated with aligners had significantly lower plaque and gingivitis scores throughout treatment compared to patients treated with fixed appliances, no significant difference could be found between the S. mutans counts of the two groups at any time through treatment (P > 0.05). On the other hand, patients treated with aligners had significantly lower salivary S. sanguinis counts at all time points than patients treated with fixed appliances (P < 0.05). Finally, almost no L. acidophilus were identified in the collected saliva samples in either of the treated samples.ConclusionsWithin the limitations of this study, there were no differences in the salivary counts of S. mutans or L. acidophilus among adolescent patients treated for 1 month with thermoplastic aligners or self-ligating appliances. On the other hand, patients treated with aligners had lower salivary levels of S. sanguinis compared to those treated with self-ligating appliances.

To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Atopic dermatitis (AD) is a chronic inflammatory dermatosis with periods of exacerbation and remissions. AD is characterized by intense, persistent pruritus and heterogeneity in clinical symptomatology and severity. Therapeutic goals include the amelioration of cutaneous eruptions, diminishing relapses and eventually the disease burden. To date, topical corticosteroids (TCS) and calcineurin inhibitors (TCI) have yet been deemed the mainstay of topical treatments in AD management. Nevertheless, despite their indisputable efficiency, TCS and TCI are not indicated for continuous long-term use given their safety profile. While research in AD has concentrated predominantly on systemic therapies, more than 30 novel topical compounds are under development. The existing data appear encouraging, with some regimens that are already FDA-approved (ruxolitinib was the most recent in September 2021) and several pharmaceutical pipeline products for mild-to-moderate AD that are in an advanced stage of development, such as tapinarof, difamilast and roflumilast. Larger, long-term studies are still required to evaluate the efficacy and safety of these novel compounds in the long run and weigh their advantages over present treatments. In this review, we aim to provide an overview of the latest knowledge about AD topical treatments, echoing upcoming research trends.

Background/Objectives: Mediterranean diet (MD) adherence is associated with a lower risk of developing several chronic diseases, including cardiovascular and metabolic disorders, cancer, and mental health diseases. University students are vulnerable to mental disorders that considerably affect their well-being and quality of life, which may be ascribed to the stressful environment during their academic studies. This cross-sectional survey designed to explore the relationship between MD compliance and perceived stress levels as well as sleep quality in a representative sample of university students from Greece. Methods: This survey assigned 5433 university students from 10 Greek regions. We used qualified questionnaires to examine the socio-demographics of the assigned students. Anthropometrics were determined by qualified methods. Validated questionnaires were used to determine diverse lifestyle factors like physical activity, perceived stress, sleep quality and MD adherence. Results: Concerning the primary objectives of this study, greater MD compliance was independently and significantly related to lower incidence of perceived stress and poor sleep quality in university students. As far as the secondary objectives of this study concern, greater MD compliance was independently and significantly related to female gender, rural type of residence, living with family, smoking, biomedicine studies, being normal weight, and having enhanced physical activity. Conclusions: This study reinforces the idea that healthy dietary patterns like MD could be a significant modifiable factor against perceived stress and poor sleep quality of university students. Based on this evidence, longitudinal studies should be performed to confirm whether MD can exert a causal effect on perceived stress and sleep quality.

Background/Objectives: The Mediterranean diet (MD) is well-studied for its health-promoting effects, while the factors influencing adherence in children remain an important research focus. This study examines the sociodemographic, maternal, perinatal, and lifestyle determinants associated with MD adherence among children aged 6–9 years in an effort to identify key predictors and their impact on long-term nutritional habits. Methods: This study recruited 4851 children from diverse Greek rural and urban regions. The mothers of the enrolled children completed relevant questionnaires on their children’s sociodemographics, perinatal outcomes, anthropometric parameters, breastfeeding practices, and physical activity status. The enrolled children completed the Children’s Depression Inventory (CDI) and the State–Trait Anxiety Inventory for Children—State (STAIC-S) form to assess the presence of depression and anxiety symptoms, respectively. The KIDMED score was used to assess the MD compliance of the enrolled children. Results: The outcomes demonstrated that higher maternal education and family economic status gravitated toward increased MD adherence (p = 0.0071, p ˂ 0.0001), while exclusive breastfeeding (p ˂ 0.0001) and higher physical activity levels (p = 0.0101) were strong predictive factors for MD adherence, highlighting the role of early-life interventions in shaping dietary habits. In contrast, cesarean delivery (p = 0.0173) and higher birth weight (p ˂ 0.0001) were linked to lower MD adherence, indicating potential metabolic and behavioral predispositions. Notably, higher MD adherence correlated with lower prevalence of depressive and anxiety symptoms (p ˂ 0.0001, p = 0.0001), underscoring its potential protective role in mental health. Conclusions: Our findings highlight a complex interplay between early-life and dietary behaviors, while further longitudinal studies are needed to establish causality and optimize evidence-based nutritional strategies and education for childhood health and well-being.

The application of advanced next-generation sequencing (NGS) technologies in the analysis of circulating tumor DNA (ctDNA) enabled the comprehensive evaluation of tumor-derived alterations in the bloodstream. In this study, we evaluated the analytical performance and clinical utility of a large-scale liquid biopsy assay in patients with metastatic cancer. A total of 1,110 unique patients underwent ctDNA NGS testing using a 1021-gene panel; matched tissue biopsy data were available for 145 cases. In 16.18% of the cases, at least one on-label variant was identified. In addition, off-label, clinical trial–related, and resistance-associated findings collectively increased the proportion of clinically actionable results by 40.65%. Importantly, 8.65% of the total population could also benefit from immune checkpoint inhibitors (ICI) therapy, based on the high tumor mutational burden (TMB-H) and/or high microsatellite instability (MSI-H) status. Simultaneous analysis in plasma and white blood cells enabled clonal hematopoiesis-associated variants detection, hence increasing the specificity value for ctDNA analysis and confirming the presence of pathogenic germline variants for 11.26% patients. Of interest, concordance for actionable on-label candidates using tissue and plasma analysis was 90.34%, thereby confirming the reliability of liquid biopsy results. Notably, the combination of liquid biopsy analysis, and tissue-based profiling, increased the total number of actionable biomarkers, facilitating targeted therapy and immunotherapy selection, resistance monitoring, and faster clinical decision-making. The broad genomic coverage of the liquid biopsy NGS assay used enabled clinically meaningful genomic characterization across multiple tumor histological types, although tumor-specific generalization is limited by the heterogeneity of the tumor types analyzed. Overall, this study shows that large-scale LB profiling may increase the number of actionable findings detected beyond guideline-based targets. In addition, it provides a more accurate understanding of tumor biology and ctDNA shedding in circulation, while offering the advantage of parallel germline analysis.