Background/Objectives: The prevalence of atrial fibrillation (AF) has been on the rise over the last 20 years. It is considered to be the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The need for in-hospital management of patients having AF is increasing. Acute decompensation of cardiac rhythm is an indication for hospital admission. In the existing literature, several studies on different pathologies have observed that the risk of death was greater for patients with an increased neutrophil-to-lymphocyte ratio (NLR) and suggested that the NLR can be a useful biomarker to predict in-hospital mortality. This study aims to evaluate the link between the neutrophil-to-lymphocyte ratio at admission and death among the patients admitted to the medical ward for the acute manifestation of AF, and to gain a better understanding of how we can predict in-hospital all-cause death based on the NLR for these patients. Methods: A single-center retrospective study in an academic medical clinic was conducted. We analyzed if the NLR at in-hospital admission can be related to in-hospital mortality among the patients admitted for AF at the Medical Ward of Municipal Emergency University Hospital Timisoara between 2015 and 2016. After identifying a total of 1111 patients, we divided them into two groups: in-hospital death patients and surviving patients. We analyzed the NLR in both groups to determine if it is related to in-hospital mortality or not. One patient was excluded because of missing data. Results: Our analysis showed that patients who died during in-hospital admission had a significantly higher NLR compared to those who survived (p < 0.0001, 95% CI (1.54 to 3.48)). The NLR was found to be an independent predictor of in-hospital death among patients with AF, even for the patients with no raised level of blood leukocytes (p < 0.0001, 95% CI (0.6174 to 3.0440)). Additionally, there was a significant correlation between the NLR and the risk of in-hospital death for patients admitted with decompensated AF (p < 0.0001), with an area under the ROC curve of 0.745. Other factors can increase the risk of death for these patients (such as the personal history of stroke, HAS-BLED score, and age). Conclusions: The NLR is a useful biomarker to predict in-hospital mortality in patients with AF and can predict the risk of death with a sensitivity of 72.8% and a specificity of 70.4%. Further studies are needed to determine the clinical utility of the NLR in risk stratification and management of patients with AF.

Background: Ischemic stroke remains the most feared complication of atrial fibrillation (AF), and thromboembolic risk is commonly estimated using clinical scores that may not fully capture the cardiometabolic dimension of cerebrovascular vulnerability. The aim of this research was to assess whether additional parameters can be used, to predict ischemic stroke risk in patients with AF, in order to explore whether TG/HDL-C may complement conventional clinical risk scores for ischemic stroke risk stratification in PAF, and to better characterize a metabolically high-risk phenotype beyond the recommendations provided by the CHA₂DS₂-VA score, which is useful but still far from perfect in predicting AF-associated ischemic stroke risk. Methods: In this retrospective, single-center observational study, we evaluated whether the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLc), a simple surrogate of atherogenic dyslipidemia and insulin resistance, is associated with ischemic stroke risk in patients with paroxysmal atrial fibrillation (PAF). We screened 1111 consecutive AF admissions between 1 January 2015 and 31 December 2016 and, from these 1111 AF cases, we extracted only the patients with PAF for analysis. Patients were stratified based on TG/HDLc values into two groups, Group 1 (TG/HDLc > 2.5; n = 155) and Group 2 (TG/HDLc < 2.5; n = 194). Statistical analysis was performed with MedCalc v23.4.0 using Chi-square and unpaired/Welch’s t-tests as appropriate, Pearson correlations, Kaplan–Meier analysis with log-rank testing, Cox regression for first ischemic stroke, and multivariable logistic regression to identify independent correlates of TG/HDLc > 2.5. Results: Patients with TG/HDLc > 2.5 had a significantly higher prevalence of ischemic stroke after AF onset compared with those with TG/HDLc < 2.5 (37.4% vs. 21.1%, p = 0.0008), despite similar CHA₂DS₂-VA and HAS-BLED scores, and also exhibited a higher burden of cerebrovascular and neurodegenerative findings, including cortical atrophy and cerebral lacunarism. Ischemic stroke-free survival curves diverged significantly over time (log-rank p = 0.0186), and an elevated TG/HDLc ratio was associated with a 68% higher hazard of first ischemic stroke (HR 1.68; 95% CI 1.09–2.60). In multivariable analysis, type 2 diabetes mellitus (OR 4.53), hyperuricemia (OR 3.83), dyslipidemia (OR 1.94), stroke (OR 1.77), and cortical atrophy (OR 4.48) were independently associated with TG/HDLc > 2.5. Conclusions: These findings suggest that TG/HDLc identifies a metabolically high-risk PAF phenotype associated with greater cerebrovascular burden and reduced ischemic stroke-free survival, providing an inexpensive and broadly available marker that may complement conventional clinical risk scores.

Background and Objectives: ACTIVA BioACTIVE Restorative is a resin–ionomer hybrid marketed as a bioactive material for pediatric restorations, yet its specific performance in primary teeth has not been systematically synthesized. The study aim was to evaluate clinical and laboratory outcomes of ACTIVA in primary dentition compared with established restorative materials. Methods: Following a PRISMA-aligned, OSF-registered protocol, PubMed, Scopus, and Web of Science were searched to 18 October 2025 for full-text clinical trials and in vitro studies involving ACTIVA in primary teeth or primary dentin. Eligible designs included randomized or prospective clinical studies and standardized in vitro experiments. Primary outcomes were clinical and radiographic success; secondary outcomes included placement time, shear bond strength, and calcium-ion release. Results: Three randomized clinical trials (86 children, 305 restorations) and one in vitro study met the inclusion criteria. At 12 months, clinical success with ACTIVA ranged from 97.5 to 97.8% versus 95.0–97.8% for bulk-fill and conventional composites. At 24 months, a split-mouth trial reported clinical success of 93.0% for ACTIVA and 95.3% for compomer, with radiographic success of 86.0% and 88.3%, respectively, remaining within the predefined non-inferiority margin. ACTIVA required a mean of 2.4 ± 0.6 min less placement time than compomer. In vitro, shear bond strength to primary dentin was higher for ACTIVA than for an RMGIC (4.29 ± 0.65 vs. 2.47 ± 0.32 MPa), with greater calcium-ion release at 21 days (0.77 ± 0.13 vs. 0.53 ± 0.12 ppm). Conclusions: Within 1–2 years of follow-up, ACTIVA shows clinical performance in primary molars comparable to compomer, bulk-fill, and conventional composites, while offering shorter placement time and favorable bio-interactive behavior.

Background and Objectives: Halitosis is a prevalent oral concern that meaningfully affects oral health-related quality of life (OHRQoL), yet how active dental treatment is associated with short-term changes in the objective–subjective halitosis–QoL nexus remains poorly quantified. Interpretation is complicated by the multifactorial nature of malodor and by baseline differences between patients selected for different dental procedures. We compared changes in volatile sulfur compound (VSC) emissions, organoleptic ratings, tongue-coating burden, and OHIP-14 across three contrasting treatment modalities and explored whether VSC change statistically accounted for OHRQoL change. Methods: In a non-randomized prospective comparative study, 119 adults (18–67 y) commencing one of three procedures were assessed at baseline and at 8 weeks: scaling and root planing (Group A, n = 42), fixed prosthodontic rehabilitation (Group B, n = 38), or fixed orthodontic appliance bonding (Group C, n = 39). Outcomes included Halimeter^® VSC (ppb), Rosenberg organoleptic score (0–5), Winkel tongue-coating index (TCI), self-perceived halitosis, and OHIP-14 total and seven-domain scores. Mixed-design ANOVA, ANCOVA, prespecified multivariable regression, mediation (5000 bootstrap resamples), receiver operating characteristic analysis, and four-class latent class analysis were performed. A sensitivity-analysis framework including expanded covariate adjustment, propensity-score overlap weighting, and baseline-severity strata was also applied to address residual baseline imbalance. Secondary mediation, ROC, and latent-class analyses were considered exploratory. Results: At 8 weeks, VSCs fell by 116.4 ± 38.7 ppb in Group A and 35.4 ± 29.1 ppb in Group B but rose by 34.3 ± 28.6 ppb in Group C (p < 0.001). OHIP-14 improved by 10.3 and 4.9 points in A and B and worsened by 3.7 in C (p < 0.001). ΔVSC correlated with ΔOHIP-14 (ρ = 0.51, p < 0.001) and most strongly with the psychological discomfort domain (ρ = 0.58). VSC change mediated 35.1% of the periodontal-versus-orthodontic association on QoL (indirect β = −4.7; 95% CI −6.3 to −3.1). Because VSC and OHIP-14 changes were measured over the same interval, mediation was interpreted cautiously. A ΔVSC threshold of −63 ppb predicted clinically meaningful OHIP-14 improvement (AUC = 0.81). Latent class analysis identified four distinct responder phenotypes. The cutoff and responder classes were internally derived and require external validation. Sensitivity analyses preserved the direction of the primary contrasts, but residual confounding remains possible. Conclusions: Treatment modality was associated with the direction and magnitude of halitosis and QoL change, with orthodontic patients constituting a vulnerable subgroup. Targeted oral-hygiene reinforcement during fixed-appliance therapy is warranted.

Background: Intra-oral halitosis is sustained by tongue-coating biofilm, but ecological and host inflammatory responses to adjunctive therapy remain unclear. Methods: In a 4-week randomized pragmatic trial (117 adults; 39 per arm; ClinicalTrials.gov NCT05876321), we compared standard care, Streptococcus salivarius K12 lozenges, and a zinc lactate/CPC/chlorhexidine rinse. Mechanistic endpoints reported here included a qPCR-derived tongue-coating dysbiosis index and salivary IL-6, IL-8, TNF-α, and MMP-8. Between-arm effects were assessed by baseline-adjusted ANCOVA, with correlation, responder, GEE, PCA, and mediation analyses. Results: Baseline values were comparable. The probiotic produced the largest dysbiosis-index reduction (−0.7 ± 0.5 vs. −0.5 ± 0.3 with zinc and −0.2 ± 0.4 with standard care, although this difference was attenuated in sensitivity analyses that removed S. salivarius from the index denominator; p < 0.001), whereas the zinc lactate/CPC/chlorhexidine rinse produced the greatest reductions in IL-8, TNF-α, and MMP-8 (all p < 0.001). Dysbiosis-index change correlated strongly with VSC change (ρ = 0.82). The probiotic effect on malodor was statistically consistent with near-complete mediation by dysbiosis reduction, versus approximately half for the rinse. Conclusions: The two adjunctive strategies showed complementary ecological and inflammatory response patterns. The dysbiosis index and mediation findings warrant external validation, and durability beyond 4 weeks remains unknown. Because S. salivarius is both a denominator constituent of the index and the administered probiotic, and because the rinse delivers three active agents together, effects cannot be attributed to a single organism or ingredient; local adverse events were more frequent with the rinse (53.8% vs. 15.4% and 10.3%).

Background: Halitosis in elderly dental patients is rarely attributable to a single etiology; tongue coating, periodontal inflammation, denture biofilm, and reduced salivary flow may coexist and modify treatment response. We compared three procedure pathways and examined whether tongue-coating reduction mediates procedure-related improvement. Methods: A prospective cohort of 94 patients aged 65 years or older was assigned by dominant indication to periodontal debridement with tongue cleaning (PDT, n = 33), denture biofilm management (DBM, n = 31), or restorative/prosthetic maintenance (RPM, n = 30). This was a single-center, nonrandomized prospective cohort study; assignment followed the dominant clinical indication rather than randomization. All clinical assessments were made by a single examiner who was masked to the formal procedure-group assignment; masking was partial because the clinical picture at follow-up could sometimes reveal the care delivered. The primary outcome was percentage reduction in volatile sulfur compound (VSC) concentration at 8 weeks. Secondary outcomes included organoleptic score, HALT, OHIP-14, tongue-coating index, denture plaque index, and a composite clinical response (≥30% VSC reduction plus ≥ 1-point organoleptic improvement plus ≥ 8-point HALT improvement). Linear mixed-effects, multivariable regression, and bootstrap mediation analyses were performed. Results: All three procedures reduced VSC at 8 weeks, but PDT produced the largest absolute reduction (−102.6 ± 20.2 ppb) and the highest composite response rate (57.6%), versus 9.7% in DBM and 3.3% in RPM (p < 0.001). Adjusted analyses showed PDT improved VSC reduction by 22.8 percentage points and DBM by 11.7 percentage points relative to RPM. Tongue-coating reduction mediated 29.5% of the PDT effect and 35.6% of the DBM effect. Xerostomia and reduced salivary flow attenuated the response in DBM and RPM but not in PDT. Conclusions: Periodontal debridement with tongue cleaning was the most effective procedure pathway for elderly halitosis. Tongue-coating reduction was a meaningful, though statistically rather than experimentally established, mediator of treatment benefit, supporting an oral-ecological framework for managing geriatric oral malodor that warrants confirmation in randomized studies.