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regarding the clinical effectiveness of the Invisalign® system.MethodsElectronic database searches of published and unpublished literature were performed.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.Electronic supplementary materialThe online version of this article (10.1186/s40510-018-0235-z) contains supplementary material, which is available to authorized users.

Summary Background Social media are one of the most common and easily accessible ways of gaining information about orthodontic treatment. Objective The main objective of this study was to systematically search the literature and determine the various aspects of the interrelationship between social media and orthodontics from the patient’s perspective. Search methods Electronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were hand-searched for additional studies. Selection criteria Randomized clinical trials (RCTs), prospective, retrospective, and cross-sectional studies were included. Data collection and analysis Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate by the first two authors. Results One RCT, three retrospective, and four cross-sectional studies were deemed as eligible for inclusion in this review. The studies included patient’s statements in social media or results from questionnaires given to patients. The social media reported were with order of frequency: Twitter, YouTube, Facebook, Google+, Pinterest, and Instagram. The feelings the patients expressed seemed to be more positive than negative: enthusiasm, self-esteem and pleasure, excitement about the aesthetic result, excitement after braces removal but also antipathy, annoyances, reduced self-esteem, and impatience for removing mechanisms. In addition, one study referred to bullying through Twitter. Limitations The high amount of heterogeneity precluded a valid interpretation of the results through pooled estimates. Conclusions and implications This systematic review demonstrated that information about orthodontics, how the patient feels, and other psychosocial facets are spread through social media. It is intuitive that research relating to the effects and impact of orthodontic interventions should account not only for the physical impacts of treatment but also to encompass patient-centered outcomes. Registration The protocol of this study was not registered in publicly assessable database. Conflicts of interest None to declare.

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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.

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.

Neonatal sepsis due to gram-negative bacteria is associated with severe hemorrhagic conditions, such as intracranial hemorrhage (ICH). The aim of the study was to investigate the significance of platelet (PLT) count and platelet mass (PM) in predicting promptly neonatal ICH. Demographics, species, PLT, PM, ICH, and outcome for neonates with gram-negative sepsis for the period 2005 to 2012 were retrospectively recorded. Eighty-four infants were enrolled with median gestational age 30 weeks, median birthweight 1481.5 g, and median age at sepsis diagnosis 23 days. The most frequently isolated bacteria were Enterobacter spp. (38.1%). ICH occurred in 16 neonates (19%), whereas the mortality rate was 25% (21 neonates). The median PLT count and PM at days 1, 2, and 3 after diagnosis of gram-negative sepsis was significantly associated with the presence of ICH. Regression analysis revealed the cutoff predictive value of 355 fL/nL for the PM at day 3 (area under the curve: 75, sensitivity 90%, P=0.002). PM levels could play an important role in predicting the occurrence of ICH in high-risk neonates.

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.

INTRODUCTION: Routine immunization against measles and mumps has substantially reduced the number of these infections annually. However, outbreaks have been reported recently, even in highly vaccinated populations. OBJECTIVE: Our goal was to determine the levels of serum antibodies against measles and mumps in a population of children who were vaccinated against measles-mumps-rubella (MMR). METHODS: The study population consisted of 260 healthy children (aged 15 months to 14.5 years) who were separated into 2 groups according to the number of MMR vaccine doses previously administered: groups A (1 dose) and B (2 doses). Immunoglobulin G (IgG) and IgM antibody levels for measles and mumps were determined in blood serum by the enzyme-linked immunosorbent assay (Genzyme Virotech, Rüsselsheim, Germany) semiquantitive method. RESULTS: Groups A and B consisted of 53 children aged 15 months to 8 years and 207 children aged 5 to 14.5 years old, respectively. A majority (93.08%) of the children were protected against measles. Group A and B protection rates were similar (92.27% and 96.23%, respectively). Although most of the children were protected against mumps, the total protection rate was significantly less (81.92%) (P &lt; .01). The protection rate against mumps in group A was significantly lower than that in group B (67.92% vs 85.51%; P &lt; .03). CONCLUSIONS: Our results indicate high protection rates against measles conferred even by a single dose of the MMR vaccine. A respected percentage of the children were found to be susceptible to mumps even after completion of a 2-dose immunization schedule. Primary vaccine failure may be implicated as a cause of recent mumps outbreaks, but additional studies are needed.