Angelo Martella

Background: Histiocytoses are rare diseases and represent a heterogeneous group of pathologies with variable clinical features, determined by the tissue accumulation of cells of presumed dendritic or macrophage origin. Oral manifestations may constitute an early clinical sign and sometimes the only initial evidence of the pathology. The aim of this systematic review with meta-analysis was to investigate the prevalence of oral manifestations in patients affected by LCH, describing their clinical and histopathological characteristics. Methods: A systematic search was conducted on three major databases (PubMed, Scopus and ScienceDirect) and on Google Scholar grey literature. Relevant articles were selected based on inclusion and exclusion criteria, following the guidelines of the Cochrane handbook. The primary outcome was the prevalence of oral manifestations, calculated as the proportion of affected patients compared to the total cohort in each study. A fixed-effects meta-analysis was performed. A sensitivity analysis was also performed excluding studies with high heterogeneity and a correlation analysis between the mean age at diagnosis and the prevalence of oral lesions, weighted by sample size. Results: 16 studies were included for a total of 2,174 patients. The aggregate prevalence of oral manifestations was 14.86% (95% CI: 11.80–18.58%), reduced to 10.57% in sensitivity analysis. The most frequently involved sites were the mandible and the gums, with osteolytic, ulcerative or periodontal lesions. The weighted correlation analysis between age and prevalence showed a very weak and non-significant correlation (r = 0.007, p = 0.991; Spearman ρ = − 0.258, p = 0.734), confirmed even after the exclusion of outliers. Conclusions: Oral manifestations represent a relevant clinical component in LCH and may constitute an early diagnostic sign. However, the prevalence varies widely between studies. No significant correlation was observed between age at diagnosis and the presence of oral manifestations. However, the interpretation of these findings is limited by the predominance of retrospective studies and the overall moderate methodological quality of the available evidence. Therefore, further standardized prospective studies are needed to better clarify the clinical impact of oral lesions in LCH.

Dysregulated microRNA (miR) expression has emerged as a potential prognostic tool in head and neck squamous cell carcinoma (HNSCC), but the clinical value of miR-34a remains unclear. This systematic review, meta-analysis, and trial sequential analysis (TSA) evaluated the association between tumor tissue miR-34a expression and survival outcomes in HNSCC. Following a protocol registered in PROSPERO (n. CRD420251238772), PubMed/MEDLINE, Scopus, ScienceDirect, CENTRAL, Google Scholar, and grey literature sources were searched for studies reporting overall survival (OS) or disease-free survival (DFS) stratified by miR-34a expression in HNSCC or its subsites. Hazard ratios (HRs) were extracted directly or reconstructed from Kaplan–Meier (KM) curves using the Tierney method, supported by a dedicated Python application (KM2HR). Four retrospective studies, corresponding to six study/site-specific cohorts and 318 patients, met the inclusion criteria. For OS (four cohorts), the fixed-effects model yielded a pooled HR of 2.25 (95% CI 1.48–3.41) for low versus high miR-34a expression, indicating worse survival in the low-expression group. However, the random-effects model attenuated the association (HR 1.32, 95% CI 0.32–5.54), with substantial heterogeneity (I² ≈ 77%). For DFS (two studies), the fixed-effects model suggested poorer outcomes with low miR-34a (HR 2.92, 95% CI 1.24–6.88), whereas the random-effects model reversed the direction of effect with extremely wide confidence intervals (HR 0.19, 95% CI ≈ 0.00–129.34; I² = 91%). TSA for OS (accrued information size 225 patients; estimated power ≈66%) crossed the monitoring boundary but did not reach the a priori information size, supporting only a tentative signal. A bioinformatic exploration of the TCGA HNSCC cohort (n = 522) showed a non-significant trend towards worse OS with low miR-34a (HR 1.24, 95% CI 0.93–1.65) and was excluded from pooling. Overall, low tumor miR-34a expression appears to be associated with poorer OS, but the evidence is limited by retrospective design, small sample size, and marked heterogeneity. miR-34a is a promising biomarker for prognostic stratification in HNSCC, yet larger, prospective, site-specific studies with standardized assays, pre-defined cut-offs, and appropriate adjustment for HPV status and clinical covariates are required before clinical implementation can be recommended.

Purpose of Review: The accurate execution of endodontic access is crucial for the success of therapy, influencing various phases of canal treatment. Traditional approaches prioritize a convenient form and broad endodontic opening to facilitate subsequent procedures. Minimally invasive dentistry, which prioritizes dentin preservation, is increasingly being embraced. Nonetheless, the scientific evidence supporting this approach remains limited, and concerns have been raised regarding its influence on the various phases of root canal treatment. Recent findings: Clinical studies explore the risk of dental fractures during endodontic treatment, considering the removal of dental tissue. Traditional openings may increase fracture risk due to reduced resistance to masticatory loads. This review aims to compare the fracture resistance of teeth prepared with minimally invasive access preparation to those treated with traditional endodontic access cavities. The review protocol was developed in accordance with the Cochrane Handbook guidelines and was registered in INPLASY, while the manuscript was drafted following the PRISMA statement; after the study identification and selection process, included a total of 5 studies. We pooled fracture-load data using the standardised mean difference (SMD) because studies used different scales. SMD > 0 favours minimally invasive access cavities (NAC) (i.e., teeth with NAC sustained a greater load than teeth with traditional endodontic access (TEC); the magnitude expresses the difference in standard deviations). Given the expected variability between studies, a random-effects model was applied alongside the fixed-effects model: 0.97 [0.65, 1.29]; Chi2 36.88, df = 9 ( P < 0.0001), I ² = 76%. Summary: The data derived from the meta-analyses may offer valuable insights for clinicians performing endodontic treatments using specific access cavity designs. The minimally invasive approach to endodontics with an ultraconservative or minimally invasive access preparation may be a viable solution in cases where the fracture resistance of a tooth is crucial. Future studies should focus primarily on aspects related to the increased difficulty in localizing orifices and the presence of debris that could affect the advantages obtained on fracture resistance with NAC. Ultraconservative techniques are characterized by cavity designs that show superior fracture resistance, suggesting enhanced resilience to masticatory loads when compared to traditional endodontic access cavities.

The deployment of Deep Learning (DL) models on edge devices remains challenging due to constrained computational resources, energy limitations, and hardware heterogeneity. This paper presents a deployment-phase benchmarking study of a YOLOv12s model previously trained in a federated learning (FL) environment using ten grape detection datasets. The study focuses exclusively on post-training inference performance, evaluating the global model across three heterogeneous edge devices: Titan 300 TGL-UP3, ASUS NUC 14 Pro+, and NVIDIA Jetson AGX Orin 64 GB. Using Dockerized environments and two DL frameworks (PyTorch and OpenVINO), we systematically assess inference latency, accuracy, CPU utilization, memory footprint, and energy consumption. The results reveal trade-offs between accuracy, latency, and energy efficiency, highlighting the influence of hardware-framework interaction on real-time performance. Importantly, this work does not analyze the FL process itself but benchmarks the deployment efficiency of the trained global model. Findings provide quantitative guidelines for selecting suitable frameworks and configurations for energy-aware, low-latency edge AI deployments, with implications for smart agriculture, industrial vision, and urban intelligence applications.

Objectives: The radiographic diagnosis of dental caries is often complicated by the presence of radiographic optical effects, such as the Mach band effect and triangular-shaped radiolucencies (TSR). These phenomena can give rise to false-positive diagnoses, especially in bite-wing radiographs, thus influencing clinical decision-making and possibly leading to overdiagnosis and overtreatment. The aim of this systematic review and meta-analysis was to clarify the real prevalence of these radiographic optical effects in dental radiographs and to quantify their influence on diagnostic errors in caries detection. Methods: This systematic literature review follow the PRISMA guidelines and registered in PROSPERO (CRD420251083823), prior to its execution. Electronic searches were conducted on PubMed, Scopus and the Cochrane Library, with the addition of Grey literature and references of the main reviews on the topic. Inclusion criteria included clinical, in vitro and ex vivo studies evaluating the impact of TSR and Mach band effects on intraoral radiographs (bitewing or periapical), reporting diagnostic performance, prevalence or misinterpretation rates. Data extraction and risk of bias assessment (AXIS, QUADAS-2) were performed independently by two reviewers. Meta-analyses were performed using random effects models. Results: Of 640 identified reports, only five studies were included. The overall prevalence of non-carious TSR on maxillary molars was 26.44%, 270/1021. The meta-analysis showed that effects (TSR or Mach band) led to false positive diagnoses of caries or fractures, in approximately 13% of observations (60/464). Heterogeneity was high (I² > 90%) and the certainty of the evidence was classified as low to very low due to the type of studies included and the consistency indices. Conclusions: Radiographic optical effects, especially TSR and Mach band effect, are highly prevalent in bitewing images and significantly increase the risk of false positive caries diagnoses, especially in children. Given the low certainty of the available evidence, clinicians should interpret radiographic findings with caution and always correlate them with a thorough clinical examination. Further high-quality research is needed to develop standardized diagnostic criteria and strategies to mitigate radiographic optical effects in dental practice.

Background: Periodontal dysbiosis contributes to liver injury through systemic inflammation, oral–gut microbial translocation, and endotoxemia. Lipopolysaccharides (LPSs) and virulence factors derived from periodontal pathogens, particularly Porphyromonas gingivalis (P. gingivalis) activate Toll-like receptor (TLR) signaling, trigger NF-κB-mediated cytokine release (e.g., TNF-α, IL-1β, IL-6), and promote oxidative stress and Kupffer cell activation within the liver. The present systematic review summarized clinical evidence supporting these mechanistic links between periodontal pathogens and hepatic outcomes, highlighting the role of microbial crosstalk in liver pathophysiology. Methods: A PRISMA-compliant systematic review was conducted by searching PubMed, Scopus, and the Cochrane library, as well as gray literature. Eligible study designs were observational studies and trials evaluating P. gingivalis and other periodontal pathogens (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythia) for liver phenotypes (Non-Alcoholic Fatty Liver Disease [NAFLD]/Metabolic Dysfunction-Associated Steatotic Liver Disease [MASLD], fibrosis/cirrhosis, acute alcoholic hepatitis [AAH], and Hepatocellular carcinoma [HCC]). Risk of bias was assessed using the Newcastle–Ottawa Scale adapted for cross-sectional studies (NOS-CS) for observational designs and the RoB 2 scale for single randomized controlled trials (RCTs). Due to the heterogeneity of exposures/outcomes, results were summarized narratively. Results: In total, twenty studies (2012–2025; ~34,000 participants) met the inclusion criteria. Population-level evidence was conflicting (no clear association between anti-P. gingivalis serology and NAFLD), while clinical cohorts more frequently linked periodontal exposure, particularly to P. gingivalis, to more advanced liver phenotypes, including fibrosis. Microbiome studies suggested stage-related changes in oral communities rather than the effect of a single pathogen, and direct translocation into ascitic fluid was not observed in decompensated cirrhosis. Signals from interventional and behavioral research (periodontal therapy; toothbrushing frequency) indicate a potential modifiability of liver indices. The overall methodological quality was moderate with substantial heterogeneity, precluding meta-analysis. Conclusions: Current evidence supports a biologically plausible oral–liver axis in which periodontal inflammation, often involving P. gingivalis, is associated with liver damage. Causality has not yet been proven; however, periodontal evaluation and treatment may represent a low-risk option in periodontitis-associated NAFLD. Well-designed, multicenter prospective studies and randomized trials with standardized periodontal and liver measurements are needed.

Background: Instrument separation is a frequent issue in root canals, often complicated by intriguing anatomical variations that make treatment more challenging. These variations in canal structure can lead to various iatrogenic complications, such as missed canals, instrument separation, gouging, perforation, and overextension of obturation materials. One such complication is instrument breakage, which can disrupt the cleaning and shaping processes and potentially cause pain or discomfort. Materials and Methods: The present systematic review was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The present systematic review aimed to identify all clinical trials focused on the removal of separated instruments from endodontic canals using an endodontic surgical approach. Results: A total of 21 studies were included, reporting 22 cases involving surgical approaches for separated instrument removal. Conclusions: The analysis of available evidence, although prim Information added.arily based on clinical cases and case series, emphasizes that surgical approaches for removing separated endodontic instruments are a viable therapeutic option when non-surgical treatments are ineffective or not feasible. Techniques such as apicoectomy, intentional replantation, surgical removal, and the technique provide innovative, customized solutions for addressing complications related to separated instruments, showing favorable clinical and radiographic success rates in follow-up assessments.

Real-time risk assessment has become essential in modern risk management, enabling organizations to effectively react to dynamic threats in various sectors. Real-time risk assessment leverages advanced technologies such as machine learning, data analytics, and Internet of Things ((loT) devices to provide timely insights for decision-making. Cyber-physical systems can play a crucial role by integrating computational and physical processes, allowing real-time monitoring and control of complex systems. The synergy between cyber-physical systems and real-time risk assessment is particularly crucial in urban environments, where the complexity of risks makes it essential for them to be mutually dependable and resilient. Digital twins can further enhance urban management by providing virtual representations that facilitate real-time monitoring and analysis. This paper proposes an architectural framework compliant with the Digital Twin Space model, which integrates digital twins and data spaces to improve urban data management while ensuring privacy and security. A case study on hydrogeological risk management is proposed to demonstrate the effectiveness of the framework through a minimal FIWARE-based early warning system. The findings highlight the importance of developing systematic methodologies for urban digital twin design to ensure its functionality, reliability, and adaptability in increasingly complex urban environments.

Background/Objectives: The correlation between cardiovascular diseases, particularly infective endocarditis, and oral disorders such as periodontitis and dental caries has been widely discussed in the scientific literature. In this mapping review, we aim to examine the available evidence on the link between these conditions, focusing on the pathogenetic mechanisms that underlie the development of endocarditis in patients with oral diseases. Methods: A systematic search was conducted across three major databases—PubMed, Scopus, and ScienceDirect—as well as grey literature in Google Scholar. Relevant articles were selected based on inclusion and exclusion criteria, focusing primarily on systematic reviews. The data extracted included study characteristics, main outcomes, and risk-of-bias evaluations. Results: A total of 13 systematic reviews were included in this mapping review. The findings suggest there is a significant connection between periodontal disease, dental caries, and the incidence of infective endocarditis. The evidence highlights that oral bacteria, particularly Streptococcus species, can enter the bloodstream during daily activities and invasive dental procedures, contributing to the development of endocarditis in susceptible individuals. However, the role of antibiotic prophylaxis in preventing endocarditis following dental procedures remains controversial. Conclusions: This review reinforces the importance of oral health in preventing cardiovascular complications, especially infective endocarditis. Although antibiotic prophylaxis may reduce the risk in high-risk individuals, further research is needed to clarify its effectiveness. Enhanced awareness of and education on the shared risks between oral and cardiovascular health could improve prevention strategies and patient outcomes.