The Capability of ‘Models’ to Withstand Change The Bologna Area in the Wake of Law 132/2018

This essay aims to reflect about the impact of the recent Italian Law 132/2018 and its effects on the reception policies for asylum seekers in the area of the Metropolitan City of Bologna. Starting to the fact that the system of developed in Bologna is considered a model of excellence, this contribution aims to examine its ability to deal the erosion of rights for asylum seekers provided by recent legislation. Will the integrated territorial system of reception and services react to the restrictions in access and protection imposed by Law 132/2018? The contribution is intended to give back the evolutions of the territorial system, trying to bring out the ambiguities and the founding causes of the criticalities that have become structural. Is it appropriate to speak of a model? If so, with what risks arising from the bureaucratic action that characterises the system at the apical level? A last paragraph will also be dedicated to the effects of the COVID-19 pandemic on the territorial reception system, having affected the dynamics exposed in the essay.

Microtomography Evaluation of The Efficacy of Reciprocating And Rotary Instruments Followed By Different Complementary Steps In The Retreatment of Curved Root Canals

Objectives: The purpose of this study was to evaluate the efficacy of steps, isolated or in cumulative means, in the endodontic retreatment of curved canals. Methodology: Forty mesial roots of mandibular molars were divided into two groups. In the group 1 the filling removal was done with NiTi reciprocating M-wire and NiTi control memory wire rotary instruments followed by a passive ultrasonic irrigation solution agitation. In the group 2, the initial filling removal was done with NiTi reciprocating M-wire and conventional NiTi wire rotary instruments followed by a rotary plastic instrument for irrigation solution agitation. The results were analyzed through micro-computed tomography. Results: The filling material was not completely removed for both groups. All steps did not statically differ between groups regarding to the filling removal. In the intragroup analyses, the results differed in some levels, mainly in the apical level, but did not statistically differ in all the different levels after each step. A statistical significant increase (P<.05), for both groups, in the volume of filling material in the isthmus was observed. Conclusions: None of the protocols completely removed the filling material. The better results were found for the apical level and after passive ultrasonic irrigation. Vertical warm condensation filling technique enhanced the volume of filling material in the root canal system including the isthmus. Clinical relevance: the control memory NiTi instruments could be considered a good choice for use as an additional step in the procedure of filling removal from curved mesial root canals.

Comparison of the Effect of Three Irrigation Techniques and Root Canal Preparation Size on Sodium Hypochlorite Penetration into Root Canal Dentinal Tubules

Objective. This study aims to compare the effects of conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and innovative sonic-powered irrigation (EDDY) on the penetration of sodium hypochlorite (NaOCl) solutions into root canal dentinal tubules at different levels of the root canal. Materials and Methods. One hundred ninety-two extracted first mandibular premolars of 17- to 25-year-old patients were decoronated 13 mm from the root apices and separated into two groups according to apical preparation sizes (APS) 25 and 40. The root canals were dried with a paper point and stained in crystal violet for 72 hours. Each APS group was separated into three groups according to irrigation techniques, as follows: CSI, PUI, and EDDY. Roots were perpendicularly resected to the long axis at three levels (coronal, middle, and apical). Photomicrographs were taken of all three cross-sections of each tooth under a stereomicroscope. The depth of the bleached zone was measured with ImageJ software. The data were analyzed by Welch’s analysis of variance and an independent t-test ( p = 0.05). Results No penetration was found at the apical level in the CSI25, CSI40, and PUI25 groups. The EDDY25 and EDDY40 groups showed the most significant penetration at the middle and apical levels compared to the other groups ( p < 0.05). Conclusions. Within the limitations of this study, irrigation techniques and APS affect the penetration depth of NaOCl into the root canal dentinal tubules. In terms of irrigation techniques, the penetration was deepest when EDDY was used, followed by PUI and CSI. In terms of APS, NaOCl penetrated deeper into APS40 than APS25. The use of the EDDY irrigation technique in APS25 can improve the penetration of NaOCl into root canal dentinal tubules at the apical level.

Does number of volumes affect regional deformation measurements when using volume stitched 3D speckle tracking?

Funding Acknowledgements Type of funding sources: None. Background Optimal 3D speckle tracking echocardiography (STE) requires volume stitching, a technique prone to errors, such as patient movements, respiration and arrhythmias. With different resolution at different depths (Figure 1A), such errors may cause stitching artefacts that affect STE derived deformation measurements at different levels of the left ventricle. Methods In this cross-sectional study, 62 patients with variable degree of aortic stenosis participated. 3D images were recorded using 3 different methods (2-, 4- and 6-beat volume stitching at 22 ± 2, 29 ± 4 and 36 ± 6 volumes per second, respectively). Strain, rotation and torsion were analyzed at 3 different levels (basal, mid and apical) (Figure 1B). Results were compared using one-way analysis of variance between methods. Inter-segmental variation was estimated using the coefficient of variation (CV) of the segments involved for each level. Results were interpreted as more accurate if low values of inter-segmental variation between segments in a level was present. Results Neither longitudinal strain (LS) nor circumferential strain (CS) showed any difference between methods in the basal level (Table 1). LS was higher in mid and apical level for 2-beat, while CS was higher only in apical level for 2-beat. Inter-segmental CV showed no significant difference between methods for LS and CS. Between levels, both had higher CV in basal than apical level, but CS had much higher values, indicating lower accuracy in basal level. Rotation measurements showed negative values in basal level and positive in apical level. None of the methods differed significantly. Torsion showed higher values for 2 beat images only. Conclusion 3D STE from both 4- and 6 beat images have insignificant differences for strain, as well as low inter-segmental variability. LS is accurate in all levels while CS has high accuracy in apical, and poor in basal level. Both rotation and torsion differ insignificantly when using 4- and 6-beat images. Table 1 Level Mean ± SD ANOVA P CV 2-beat 4-beat 6-beat 2-beat 4-beat 6-beat Longitudinal strain (%) Basal -17.82 ± 4.83 -16.81 ± 4.48 -17.05 ± 3.56 0.402 34.5 34.9 31.5 Mid -16.34 ± 4.30 -14.91 ± 3.62 -14.46 ± 3.53 0.019 31.4 29.9 29.9 Apical -16.80 ± 4.33 -15.06 ± 3.12 -15.09 ± 3.02 0.008 30.6 28.5 24.9 Circumferential strain (%) Basal -12.93 ± 4.42 -14.16 ± 4.21 -13.05 ± 3.24 0.168 106.7 71.7 74.4 Mid -17.59 ± 3.86 -16.73 ± 3.56 -16.98 ± 3.51 0.406 43.0 36.9 30.3 Apical -22.14 ± 6.20 -19.04 ± 4.81 -20.32 ± 5.40 0.008 26.8 29.4 23.4 Abstract Figure 1

Abstract 15116: The Prognostic Value of Left Ventricular Mechanical Dyssynchrony in Patients With Idiopathic Dilated Cardiomyopathy

Backgrounds: The mechanical dyssynchrony has been commonly observed in idiopathic dilated cardiomyopathy (DCM) patients, and several cardiac magnetic resonance (CMR) imaging techniques were used to evaluate the mechanical dyssynchrony. Standard deviation of time-to-peak (T2Psd) and uniformity ratio estimate (URE) indices are two widely used parameters to reflect the incoordinate movement of the left ventricle. However, the prognostic value of mechanical dyssynchrony in DCM patients is not clear. Methods and Results: We prospectively enrolled 402 DCM patients undergoing CMR imaging between Jun 2012 to Sep 2018. Mechanical dyssynchrony was measured as T2Psd and URE indices by CMR deformable registration algorithm (DRA) analysis. The primary endpoint was defined as all-cause mortality and heart transplantation, and the secondary endpoint was a combination of primary endpoint, aborted sudden cardiac death, and heart failure readmission. Univariate and multivariate Cox regression analyses were performed to identify the association between variables and outcome. Survival curves were obtained by Kaplan-Meier survival analysis and compared by log-rank test. During a median follow-up of 25.1 months (IQR: 16.2-41.6), there were 57 patients reached primary endpoints, and secondary endpoints occurred in 132 patients. Circumferential uniformity ratio estimate (CURE) at basal, mid and apical level, radial uniformity ratio estimate (RURE)at mid and apical level and longitudinal uniformity ratio estimate (LURE) were significantly worse in patients with primary endpoint compared to patients without primary endpoint. While no significant differences were observed regarding the T2Psd value between patients with and without primary endpoints. In multivariate analysis, CURE at apical level was independently associated with primary endpoints (HR 0.214, P=0.005) and secondary endpoints (HR 0.402, P=0.018). Furthermore, among patients with LVEF <35% or presence of LGE, those with decreased CURE at apical level (<0.917) showed a significantly higher rate of adverse outcome. Conclusion: The CURE at apical level is an independent predictor of adverse cardiac events in DCM patients. Compared with T2Psd, URE index is a better predictor of adverse events.

In Vitro Evaluation of Different Irrigation Protocols on Intracanal Smear Layer Removal in Teeth with or without Pre-Endodontic Proximal Wall Restoration

To investigate the influence of pre-endodontic coronal wall restoration on smear layer removal during different root canal irrigation strategies, single-root premolars were prepared with a mesio-occlusal cavity. Half were left untreated (G1), while the mesial walls of the remaining half were reconstructed using a resin composite (G2). The specimens were divided into control (ctrl) groups, which used the conventional needle irrigation method, and four experimental subgroups according to irrigation strategy: Sonic activation using the Endoactivator, sonic activation using the EQ-S, mechanical activation using the XP-Endo finisher, and ultrasonic activation using the EndoUltra. Smear layer removal was assessed through SEM and the results were statistically analyzed. At the coronal and middle thirds, no significant difference (p > 0.05) was detected for G1 and G2, except for the control subgroups (G1ctrl vs G2 ctrl) at the middle third. At the apical third, the smear layer removal was significantly greater for G2 than G1. In G1, both at the middle and apical level, EQ-S and EndoUltra showed greater smear layer removal (p < 0.05) compared to the others G1 subgroups. In G2, at the apical level, the EQ-S and EndoUltra were the most effective in smear layer removal. Pre-endodontic coronal wall restoration may improve the smear layer removal during root canal irrigation.

Comparison of Shaping Ability of Different Single-File Systems Using Microcomputed Tomography

Objectives To evaluate the shaping ability of four different single-file systems using micro-computed tomography (micro-CT). Materials and Methods Eighty mesiobuccal and mesiolingual canals of permanent mandibular molars were randomly assigned to four groups according to the file used; WaveOne Gold, RECIPROC Blue, HyFlex EDM, and One Shape (n = 20). The samples were scanned using micro-CT for the preinstrumentation record; then the canals were instrumented and scanned for the postinstrumentation records. Statistical Analysis The data were then analyzed statistically using one-way analysis of variance (ANOVA) with the level of significance set at α = 0.05. Results The results of canal centering ratio and canal transportation showed that no significant difference was found among the four file groups at the middle and the coronal levels. However, a significant difference was found at the apical level (p < 0.05), where WaveOne Gold showed the best centering ratio and the least amount of canal transportation. The change in the canal volume was significant at the coronal level (p < 0.05), whereas the change in the canal volume was higher for the HyFlex EDM group than the other groups. No significant difference was found between the other groups at the apical level, middle level, or in the total percentage of canal volume. Conclusion WaveOne Gold produced a more centralized canal preparation with a lesser amount of transportation at the apical level. HyFlex EDM showed the highest canal volumetric change at the coronal level. The interim design of the endodontic files has a high impact on the behavior of the file inside the root canal.

Left Ventricular Chamber Shape During Vena Caval Occlusion: Improved MRI-based Measurement of the End-Systolic Pressure-Volume Relationship in Normal Sheep

The left ventricular (LV) end-systolic pressure volume relationship (ES; ESPVR) is the cornerstone of systolic LV function analysis. Recently, it became possible to measure 2D LV chamber shape during vena cava occlusion (VCO) with MRI. We used an improved level-set semi-automatic segmentation method (LSSM) to determine the effect of VCO on LV geometry, ES pressure area (PA) and ESPVR.10 healthy adult sheep were anesthetized. LV pressure transducer and inferior vena cava (IVC) balloon catheter were percutaneously inserted. Ferumoxytol (0.125 ml/kg iv; AMAG Pharmaceuticals, Waltham, MA) was given to enhance blood pool contrast. LV pressure and 2D retrospectively-gated cine MRI of LV cross sections 25 (Apex), 50 (Mid) and 75% (Base) of the distance from the apex to the base of the LV were obtained during separate IVC balloon inflations (VCO). LV pressure was digitally filtered and LV chamber segmented with the LSSM. Cross sectional area, major and minor axes, major axis orientation, ESPAR and ESPVR were calculated.The LSSM had excellent reliability. All cross sections became more elliptical during VCO. The orientation (angle) of each major axis relative to the anterior RV insertion shifted during VCO. However, the orientation remained toward the septum. There was chamber collapse (LV area < 0.25 cm2) at the apical level during VCO (7 cases). ESPAR was non-linear at all levels. ESPVR was non-linear because of apical collapse.In conclusion, MRI-based measurement of LV geometry, ESPAR and ESPVR during VCO is a valuable method that may lead to improved understanding of systolic LV function.New and NoteworthyReal-time MRI was used to continuously measure the LV PA relationship as loading conditions were transiently varied in anesthetized sheep. All three examined cross-sections became more elliptical during VCO. The ESPAR were non-linear at all three cross-sections. Chamber collapse at the apical level during VCO resulted in a non-linear ESPVR. The heart contracted in a non-concentric manner during VCO which could inform modeling studies and elucidate mechanisms underlying LV adaptations to sudden load changes.

Evaluation of single root canals filled using the lateral compaction, tagger's hybrid, microseal and guttaflow techniques

The aim of this study was to determine the percentage of voids, gutta-percha and root canal sealer using 4 different filling techniques. Fifty-two extracted maxillary lateral incisors were prepared using the crown-down pressureless technique. The teeth were randomly divided in 4 groups (n=13): Lateral compaction (LC), Tagger's hybrid (TH), MicroSeal (MS) and GuttaFlow (GF) techniques. Horizontal cross-sections were made at the 2, 10 and 15 mm levels from the apex. Digital images of the root canal areas were acquired using a stereomicroscope and examined using the Image Tool 3.0 software. Statistical analysis was performed using the Kruskal-Wallis test (α=0.05). In general, a significant decrease in the gutta-percha filled area and increase of sealer area were observed at the apical level for all the evaluated techniques (p<0.05). With regard to the presence of voids, no significant difference was found. MS and TH techniques showed a larger gutta-percha filled area than LC and GF techniques at the coronal and middle third level (p<0.05). From the results of the present study, it may be concluded that the gutta-percha filled area of fillings decrease at the apical level, regardless of the filling technique used.