Open Access

Background and Objectives The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study investigated the treatment recommendations of dentists actively practicing pediatric dentistry in Germany regarding different patient cases with caries in primary teeth. Materials and Methods The questionnaire was distributed on paper or online to pediatric dentists and general dentists practicing pediatric dentistry. Five cases of children with dental treatment needs representing a variety of clinical situations were selected for the questionnaire. Considering four different scenarios regarding pain symptoms (yes/no) and cooperation level (good/low) for each case resulted in 20 questions, where the preferred treatment option could be chosen out of 21 options ranging from observation only to extraction with/without different sedation techniques. The answers were categorized into three categories for each case and scenario according to guidelines, recent scientific evidence, and recommendations (recommended, acceptable, or not recommended/contraindicated). Results In total, 222 participants responded to the survey (161 female; 72.5%). In 55.2% of the total 4440 answers, the participants chose a “recommended” treatment option, in 16.4% “acceptable”, but in 28.4%, a “not recommended” treatment, which ranged for the five cases between 18.7 and 36.1%. While pain and low cooperation levels led to more invasive and justified treatment choices (only 26.3% “not recommended”), less severe scenarios resulted more often in “not recommended” options (pain with good cooperation: 31.0%; or low cooperation without pain: 32.6%). The dentist’s age, experience, and educational background did not significantly correlate to choosing “not recommended” treatment options. Conclusions A child’s pain and cooperation level greatly impact the treatment decisions made by dentists, with a risk of too invasive treatment options in low-severity cases. Substantial disparities in treatment recommendations for caries in primary teeth persist among dental practitioners regardless of their age, experience, and educational background.

Background The integration of artificial intelligence (AI) into radiology aims to improve diagnostic accuracy and efficiency, particularly in settings with limited access to expert radiologists and in times of personnel shortage. However, challenges such as insufficient validation in actual real-world settings or automation bias should be addressed before implementing AI software in clinical routine. Methods This cross-sectional study in a maximum care hospital assesses the concordance between diagnoses made by a commercial AI-based software and conventional radiological methods augmented by AI for four major thoracic pathologies in chest X-ray: fracture, pleural effusion, pulmonary nodule and pneumonia. Chest radiographs of 1506 patients (median age 66 years, 56.5% men) consecutively obtained between January and August 2023 were re-evaluated by the AI software InferRead DR Chest ® . Results Overall, AI software detected thoracic pathologies more often than radiologists (18.5% vs. 11.1%). In detail, it detected fractures, pneumonia, and nodules more frequently than radiologists, while radiologists identified pleural effusions more often. Reliability was highest for pleural effusions (0.63, 95%-CI 0.58–0.69), indicating good agreement, and lowest for fractures (0.39, 95%-CI 0.32–0.45), indicating moderate agreement. Conclusions The tested software shows a high detection rate, particularly for fractures, pneumonia, and nodules, but hereby produces a nonnegligible number of false positives. Thus, AI-based software shows promise in enhancing diagnostic accuracy; however, cautious interpretation and human oversight remain crucial.

Active inference describes (Bayes-optimal) behaviour as being motivated by the minimisation of surprise of one’s sensory observations, through the optimisation of a generative model (of the hidden causes of one’s sensory data) in the brain. One of active inference’s key appeals is its conceptualisation of precision as biasing neuronal communication and, thus, inference within generative models. The importance of precision in perceptual inference is evident—many studies have demonstrated the importance of ensuring precision estimates are correct for normal (healthy) sensation and perception. Here, we highlight the many roles precision plays in action, i.e., the key processes that rely on adequate estimates of precision, from decision making and action planning to the initiation and control of muscle movement itself. Thereby, we focus on the recent development of hierarchical, “mixed” models—generative models spanning multiple levels of discrete and continuous inference. These kinds of models open up new perspectives on the unified description of hierarchical computation, and its implementation, in action. Here, we highlight how these models reflect the many roles of precision in action—from planning to execution—and the associated pathologies if precision estimation goes wrong. We also discuss the potential biological implementation of the associated message passing, focusing on the role of neuromodulatory systems in mediating different kinds of precision.

Background/Objective Endoprostheses might fail due to complications such as implant loosening or periprosthetic infections. The surface topography of implant materials is known to influence osseointegration and attachment of pathogenic bacteria. Laser-Induced Periodic Surface Structures (LIPSS) can improve the surface topography of orthopedic implant materials. In this preclinical in vitro study, laser pulses with a wavelength in the ultraviolet (UV) spectrum were applied for the generation of LIPSS to positively influence formation of extracellular matrix by primary human Osteoblasts (hOBs) and to reduce microbial biofilm formation in vitro . Methods Laser machining was employed for generating UV-LIPSS on sample disks made of Ti6Al4V and Ti6Al7Nb alloys. Sample disks with polished surfaces were used as controls. Scanning electron microscopy was used for visualization of surface topography and adherent cells. Metal ion release and cellular metal levels were investigated by inductively coupled plasma mass spectrometry. Cell culture of hOBs on sample disks with and without UV-LIPSS surface treatments was performed. Cells were investigated for their viability, proliferation, osteogenic function and cytokine release. Biofilm formation was facilitated by seeding Staphylococcus aureus on sample disks and quantified by wheat germ agglutinin (WGA) staining. Results UV-LIPSS modification results in topographies with a periodicity of 223 nm ≤ λ ≤ 278 nm. The release of metal ions was found increased for UV-LIPSS on Ti6Al4V and decreased for UV-LIPSS on Ti6Al7Nb, while cellular metal levels remain unaffected. Cellular adherence was decreased for hOBs on UV-LIPSS Ti6Al4V when compared to controls while proliferation rate was unaffected. Metabolic activity was lower on UV-LIPSS Ti6Al7Nb when compared to the control. Alkaline phosphatase activity was upregulated for hOBs grown on UV-LIPSS on both alloys. Less pro-inflammatory cytokines were released for cells grown on UV-LIPSS Ti6Al7Nb when compared to polished surfaces. WGA signals were significantly lower on UV-LIPSS Ti6Al7Nb indicating reduced formation of a S. aureus biofilm. Conclusion Our results suggest that UV-LIPSS texturing of Ti6Al7Nb positively influence bone forming function and cytokine secretion profile of hOBs in vitro . In addition, our results indicate diminished biofilm formation on UV-LIPSS treated Ti6Al7Nb surfaces. These effects might prove beneficial in the context of long-term arthroplasty outcomes.

F. nucleatum, involved in carcinogenesis of colon carcinomas, has been described as part of the commensal flora of the female upper reproductive tract. Although its contribution to destructive inflammatory processes is well described, its role as commensal uterine bacteria has not been thoroughly investigated. Since carcinogenesis shares similar mechanisms with early pregnancy development (including proliferation, invasion, blood supply and the induction of tolerance), these mechanisms induced by F. nucleatum could play a role in early pregnancy. Additionally, implantation and placentation require a well-balanced immune activation, which might be suitably managed by the presence of a limited amount of bacteria or bacterial residues. We assessed the effect of inactivated F. nucleatum on macrophage-trophoblast interactions. Monocytic cells (THP-1) were polarized into M1, M2a or M2c macrophages by IFN-γ, IL-4 or TGF-β, respectively, and subsequently treated with inactivated fusobacteria (bacteria:macrophage ratio of 0.1 and 1). Direct effects on macrophages were assessed by viability assay, flow cytometry (antigen presentation molecules and cytokines), qPCR (cytokine expression), in-cell Western (HIF and P-NF-κB) and ELISA (VEGF secretion). The function of first trimester extravillous trophoblast cells (HTR-8/SVneo) in response to macrophage-conditioned medium was microscopically assessed by migration (scratch assay), invasion (sprouting assay) and tube formation. Underlying molecular changes were investigated by ELISA (VEGF secretion) and qPCR (matrix-degrading factors and regulators). Inflammation-primed macrophages (M1) as well as high bacterial amounts increased pro-inflammatory NF-κB expression and inflammatory responses. Subsequently, trophoblast functions were impaired. In contrast, low bacterial stimulation caused an increased HIF activation and subsequent VEGF-A secretion in M2c macrophages. Accordingly, there was an increase of trophoblast tube formation. Our results suggest that a low-mass endometrial/decidual microbiome can be tolerated and while it supports implantation and further pregnancy processes.