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We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution. A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time. A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8–24). The burr-hole irrigation + MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features. MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8–24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months. [ABSTRACT FROM AUTHOR]

Introduction: Intrarenal pressure is emerging as an important monitoring parameter during flexible ureteroscopy (fURS). We measure how intraoperative conditions affect intrarenal pressure using a novel pressure sensing ureteroscope. Methods: The LithoVue Elite (LVE) single-use digital flexible ureteroscope (Boston Scientific) is the first commercial ureteroscope that senses pressure at its tip. LVE was used in a porcine model to measure intrarenal pressure with and without a ureteral access sheath (UAS) with various sizes and placement locations, irrigation methods, and working channel accessories. LVE pressure accuracy was measured in a bench model. This abstract shows the least-square means from multiway analysis of variances used for analysis. Results: Intrarenal pressures were the highest without a UAS (64 mm Hg), followed by the 11/13 UAS (51 mm Hg) and the 12/14 and 13/15, which were not statistically different (39–40 mm Hg). The pressures were highest with UASs placed at the ureteropelvic junction (61 mm Hg), and lowest if placed in the renal pelvis (24 mm Hg). Irrigation methods showed the highest pressures with syringe (57 mm Hg), while irrigation bags (pressurized at 150–300 mm Hg) produced 43 to 46 mm Hg and 25 mm Hg when applied with 80 cm of gravity. Placing a 200 μm laser fiber reduced pressures from 44 to 41 mm Hg. Finally, the bench model showed that LVE was 96% accurate up to 300 mm Hg. Conclusion: Intrarenal pressure significantly varied based on UAS sizes, placement, and irrigation methods. Accordingly, fURS with LVE is poised to be an invaluable tool for clinical decision-making and future studies of intrarenal pressure. [ABSTRACT FROM AUTHOR]

Introduction: 7.5F digital fURS and 9.5/11.5F ureteral access sheaths (UAS), both conventional (cUAS) and vacuum-assisted (vaUAS), are commercially available. Irrigation increases intrarenal pressure (IRP). This study analyzes the IRP with various irrigation rates using 7.5F fURS without UAS or with either cUAS or vaUAS in an ex-vivo porcine model. Pyelo-tubular backflow was also studied during these experiments. Materials and methods: 11 porcine kidneys were used. 7.5F digital fURS was tested without UAS and with 9.5/11.5F cUAS and vaUAS. 6F pressure monitor catheters were placed into the upper and lower calyces. IRPs were recorded under different irrigation rates. When vaUAS was used, the air vent was either open or closed. 300 mmHg aspiration pressure was chosen. Lastly, contrasted irrigation fluid was delivered until IRP reached above 30 mmHg. Fluoroscopy images were obtained at 5 mmHg intervals over this threshold to study the pyelo-tubular backflow. Results: Using cUAS, IRP reached 30 mmHg with irrigation rates between 60 and 70 cc/min. Using vaUAS with vent closed, IRP never exceeded 10 mmHg with irrigation up to 120 cc/min. vaUAS with vent open performed marginally better than cUAS. fURS without UAS performed better than cUAS. Pyelo-tubular backflow became prominent at 40 mmHg. Conclusion: In an ex-vivo porcine model, 7.5F fURS could be used safely without UAS with irrigation rates up to 120 cc/min. The safety margin dropped to 60–70 cc/min with cUAS. vaUAS with vent closed maintained IRP < 10 mmHg with irrigation rates up to 120 cc/min. Pyelo-tubular backflow was observed with IRP > 35 mmHg. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the splatter contamination generated by rotary instrumentation and irrigation during simulations of surgical extractions. Specifically, comparisons of the splatters generated were made between traditional assistant-based irrigation and self-irrigating drills and between saline and hydrogen peroxide irrigant. Materials and methods: A fluorescein solution was infiltrated into the irrigation system of high-speed drills, and the surgical extraction procedures were performed on manikins with the typodont teeth. Filter papers were placed at the predetermined locations around the operatory to absorb the fluorescein splatters; these samples underwent photographic image analysis. Results: The patient chest showed the largest area of splatters, followed by the assistant's face shield. Procedures using the hydrogen peroxide irrigant generated a larger area of splatter than those using the saline irrigant. There was no difference between the splatters produced by assistant irrigation and self-irrigating drill procedures. Conclusions: Clinicians should observe and disinfect the locations contaminated by splatters to prevent the spread of infection, since using alternative irrigant or irrigation methods did not reduce the formation of splatters. Clinical relevance: Oral surgery drills with irrigation generate aerosols and splatters, which have potential to spread airborne pathogens. It is important to understand the patterns of splatters to mitigate contamination. [ABSTRACT FROM AUTHOR]

Introduction: Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here, the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high risk for morbidity and mortality. Methods: Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency, and shunt revisions within a year of ventriculitis resolution. Results: Patients demonstrated a mean 74% decrease in cerebrospinal fluid (CSF) protein following each neuroendoscopic lavage and trended toward a shorter time to infection clearance in comparison to previously published literature. Patients required 0–2 shunt revisions at 1-year follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/− 0.8). Conclusions: Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the CSF protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to find incidence of infection-related complications and the optimal volume and duration (days) of rectal NSS irrigation that would result in the low post-operative complications following transanal endorectal pull-through (TERPT) in patients with Hirschprung’s disease. Materials and Methods: We conducted a retrospective chart reviews of 131 patients diagnosed with Hirschsprung’s disease who underwent TERPT at Siriraj Hospital between January 2006 and December 2020. Results: Infection-related complications were observed in 23(17.6%) patients, comprising 22(16.8%) cases of anastomotic strictures, 3(2.3%) cases of anastomotic leakages, and 2(1.5%) cases of intraabdominal collections. The median (Q1, Q3) volume of NSS irrigation (ml/kg/day) for those without complications (38.1 (33.9,50)) and those with complications (39.5 (35,45)) was statistically identical (p = 0.945). Similary, the median duration of for both groups was the same (p = 0.854). The mean (SD) volume of irrigated NSS in those with leakage (55.6 (32.7)) and those without leakage (44.3 (17.9)) showed no statistically significant difference (p = 0.291). Patients with post-operative stricture received the same amount of irrigated NSS (40.7 (11.9)) as those without stricture (45.4 (19.2)) (p = 0.138). Similarly, those with hyponatremia received the same amount of irrigated NSS as those without hyponatrema (p = 0.475). Conclusion: The volume of rectally irrigated NSS did not correlate with infection-related complications such as anastomotic leakage, stricture and intraabdominal collection. However, this study observed a low complication rate, thus, future research should cover a larger population. [ABSTRACT FROM AUTHOR]

Background and objectives: Implant-related complications leading to implant loss contribute to major morbidity in immediate breast reconstruction (IBR). Various techniques have been advocated to improve rates of reconstruction salvage. The objective of our study was to assess if a peri-prosthetic irrigation system was an effective adjunct to the conventional wash-out technique in improving reconstruction salvage rates. Methods: The study included patients who had immediate implant-based breast reconstruction from January 2015 to November 2020. The conventional technique of reconstruction salvage, using debridement, wash-out, and implant/expander exchange with systemic use of antibiotics, was performed for patients undergoing exploration for infection until May 2019. A simple technique using a continuous peri-prosthetic irrigation system with vancomycin (1 g/L normal saline over 24 h) for 2 days was added as an adjunct to the conventional technique. Treatment details and clinical outcomes were compared between the groups. The study was approved by the Clinical Governance department. Results: During the study period, 335 patients underwent IBR. A total of 65 patients (19.4%) returned to the theatre due to post-operative complications, of which 45 (13.4%) were due to infection. A conventional technique was used in 38 (84.4%) patients, and peri-prosthetic irrigation was used as an adjunct in 7 patients (15.6%). A total of 16 (42.1%) in the conventional group and all 7 (100%) in the irrigation group had successful reconstruction salvage. No patients had complications due to antibiotic irrigation. Conclusions: The peri-prosthetic irrigation system is a simple, safe, and effective adjunct to conventional techniques in improving reconstruction salvage in IBR. [ABSTRACT FROM AUTHOR]

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics due to the antimicrobial properties against bacteria, the powerful oxidative activity, and the ability to dissolve organic soft tissues. When NaOCl extrudes the apex of the root, commonly referred as "sodium hypochlorite accident," it can lead to devastating outcomes leading to long-term functional and esthetic deficits. Currently, no clear guidelines exist as to how these patients should be managed. The purpose of this paper is to present a case report and a review of literature and to propose an adequate surgical treatment protocol for this unfortunate event. [ABSTRACT FROM AUTHOR]

We present here-in the technical details of harvesting the left radial artery in a 50-year-old man undergoing coronary artery bypass grafting. The radial artery has been harvested atraumatically using a Harmonic scalpel (Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA) and two vessel loops by "No touch" technique, thereby preventing perioperative spasm. The postoperative recovery was uneventful. [ABSTRACT FROM AUTHOR]

Watch a video of this article. [ABSTRACT FROM AUTHOR]

Objectives: This 6-month randomized controlled study aimed at evaluating the clinical outcomes of multiple irrigations of 10% povidone-iodine (PVP-I) as an adjunct to full-mouth scaling and root planing (SRP) in the treatment of chronic periodontitis. Method and materials: Seventeen patients were included. A split-mouth design randomly assigned one side as the test side (SRP + PVP-I) and the other side as the control side (SRP + NaCl). After full-mouth SRP, the control side received subgingival irrigation with 10 mL 0.9% NaCl solution. The test side received 10 mL of PVP-I 10%. Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 3 and 6months. During recall visits (3 and 6 months), residual deep periodontal pockets of = 6mm were cleaned with the same protocol and randomization. Results: PI, BOP, PPD, and CAL were improved in both sides after 6 months. No significant differences were seen between control and test sides for the all clinical parameters after 6months. Conclusion: Multiple subgingival irrigations of 10% PVP-I or 0/9% NaCl combined to one-stage full mouth SRP in patients with chronic periodontitis showed a reduction of all clinical parameters until 6months. There was a trend in favor of the povidone group for PPD. [ABSTRACT FROM AUTHOR]

This is a letter to the editor on a study by Ding et al. on the role of the three-tube method via precise interventional placement for esophagojejunal anastomotic fistula after gastrectomy. They suggest using transnasal insertion of abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy as a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula. Compared to Ding et al.'s method, we presented a new procedure for the esophagojejunal anastomotic fistula. In this procedure, we precisely place a homemade triple-cavity drainage tube by guide wire exchange method near the esophagojejunal anastomotic fistula for continuous irrigation and negative pressure suction, which can provide adequate drainage and result in fistula's self-healing. This procedure can also be performed at bedside without any anesthesia; therefore, it is a more simple, minimally invasive, effective, and safe treatment for esophagojejunal anastomotic fistula. [ABSTRACT FROM AUTHOR]

This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient's suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse. [ABSTRACT FROM AUTHOR]

Background: To investigate the effect of silver diamine fluoride (SDF) application and activation on the bond strength of gutta-percha to dentin and resin bonded post to dentin. Methods: Thirty-six human premolar teeth were used. The coronal part tooth was removed, and endodontic mechanical preparation was performed for all the teeth. The teeth were divided according to final rinse protocol (n = 9) as follows: Control group; no SDF application, SDF/NA; 38% SDF as a final rinse with no activation, SDF/MDA; 38% SDF as a final rinse with manual dynamic activation and SDF/US; 38% SDF as a final rinse with ultrasonic activation. Root canal obturation using lateral condensation technique followed by fiber post insertion after 48 h in the root canal after corresponding preparations. The roots were cut with a low-speed precision saw creating 2 mm thickness sections. A total of 4 sections were obtained from each tooth, 2 coronal specimens (with post) and 2 apical specimens (with Gutta percha). Each specimen was subjected to push-out bond strength test with a universal testing machine. Data were analyzed using two-way ANOVA. Results: The Push-out bond strength at the apical root section was significantly higher in SDF/MDA and SDF/US groups compared to control group. While for the coronal part, all SDF treated specimen showed reduced Push-out bond strength. Conclusion: SDF application as final rinse may reduce the bonding performance between fiber post and dentine. Activation with manual and ultrasonic methods improved the bond strength at the apical root section. [ABSTRACT FROM AUTHOR]

Vestibular stimulation causes postural unsteadiness accompanied by a sensation of tilt. The mechanism of the sensation of tilt needs to be assessed by accurate calculation of the rotational axis of torsional eye position under various vestibular stimulations. Twenty-two healthy subjects participated in the study. Thirteen subjects underwent bilateral vestibular stimulation by on-axis yaw rotation under various head positions, and eighteen subjects underwent unilateral vestibular stimulation by caloric irrigation under various head positions. Listing's Plane was plotted for the eye movement data obtained by three-dimensional video-oculography. The offset of Listing's Plane showed sustained deviation of torsional eye position that was more prominent in head positions that stimulated lateral semicircular canals more than vertical semicircular canals. There was a less prominent and directionally reversed offset in head positions that stimulated vertical canals more than lateral semicircular canals. The sustained torsional eye position was validated by accurate assessment using Listing's Plane. The mechanism behind the deviation may be due to a combination of multiple anatomical components within the vestibular apparatus, with potentially stronger influence from lateral semicircular canals. [ABSTRACT FROM AUTHOR]

Background: Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH)2) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient‐related outcomes requires further understanding. Objectives: To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP). Methods: A search was conducted in the PubMed‐MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk‐of‐bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta‐analyses were performed using the fixed‐effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta‐analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta‐analysis was possible for the comparison of single‐visit (SV) versus multiple‐visits including the use of Ca(OH)2 demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03–1.19; p =.007; I2 = 0). RoB of included studies was moderate to low. Discussion: The use of Ca(OH)2 for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings. Conclusions: There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH)2. Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar. Registration: PROSPERO database CRD42021260271. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is the most commonly done procedure for gallstone diseases and is characterized by a short hospital stay. However, pain is one of the most important reasons for overnight stay following laparoscopic cholecystectomy. This study aims to evaluate the effect of infiltration of bupivacaine at the laparoscopic port sites and intraperitoneal wash of gallbladder bed with bupivacaine on post operative pain after laparoscopic cholecystectomy. This study included 60 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n = 30) received a saline wash without bupivacaine installed into the gallbladder bed. The bupivacaine group (n = 30) received an intraperitoneal wash of the gallbladder bed with 30 cc of 0.5% bupivacaine and another 20 cc of 0.5% bupivacaine was infiltrated into the port sites. Pain was assessed at 1, 2, 6, 12 and 24 h post surgery using a visual analogue scale (VAS). Rescue analgesics used and duration of hospital stay were also recorded. The visual analogue score was significantly lower immediately after laparoscopic cholecystectomy for the bupivacaine group. Patients in the bupivacaine group also required a lower total amount of rescue analgesics during their hospital stay. They also had a shorter hospital stay after laparoscopic cholecystectomy compared to the patients in the placebo group. Combined port site infiltration and intraperitoneal irrigation of gallbladder bed with bupivacaine after laparoscopic cholecystectomy significantly decreased early post operative pain and may explain the reduced use of rescue analgesics and earlier discharge of the patients in our study. [ABSTRACT FROM AUTHOR]

Introduction: Passive Microvolume Irrigation (PMI) with Sodium Hypochlorite (NaOCl) has been proposed as a new method for root canal disinfection. It is based on the concept that irregular surface characteristics of endodontic instruments can carry NaOCl into the canal space with controlled fluid volume, without applying any pressure. Aim: To compare and evaluate the efficacy of 3% and 5% NaOCl PMI, Saline PMI, and 3% NaOCl Standard Irrigation (SI) in removing the Smear Layer (SL) from the root canal walls at the cervical, middle, and apical thirds of single-rooted teeth. Materials and Methods: This study was conducted in the Department of Conservative Dentistry and Endodontics at Vishnu Dental College, Andhra Pradesh, India. The study was conducted in February 2018. Forty maxillary central incisors with a single canal, extracted within three months of the study, were collected. The teeth were divided into four groups (n=10) based on the irrigation method: Group-1 (3.0% NaOCl SI), Group-2 (3.0% NaOCl PMI), Group-3 (5.0% NaOCl PMI), and Group-4 (Saline PMI). All samples were instrumented upto F4 size with Protaper rotary files, and a final rinse of 17% Ethylenediaminetetraacetic Acid (EDTA) was used. SL removal was evaluated using Scanning Electron Microscope (SEM). The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0. Statistical tests used were Kruskal Wallis and Mann-Whitney-U tests. A p-value of <0.05 was considered statistically significant for all comparisons. Results: There was no significant difference (p>0.05) in SL removal between 3.0% NaOCl SI, 3.0% NaOCl PMI, and 5.0% NaOCl PMI in the middle and apical thirds of the root canals. However, 5.0% NaOCl PMI showed significantly higher efficiency in SL removal at the cervical third compared to the other groups (p<0.05). Conclusion: Passive microvolume irrigation with 3% and 5% NaOCl showed comparable efficacy to 3% hypochlorite SI in the middle and apical thirds of the root canal. [ABSTRACT FROM AUTHOR]

Diverticulosis is defined as the presence of diverticula in the intestine, when these diverticula become inflamed diverticulitis occurs, but this complication happens in less than 5% of these patients. Surgical treatment is indicated in complicated diverticulitis cases. Traditionally, the Hartmann procedure is carried out in patients with Hinchey III and IV acute diverticulitis. Currently, individualized surgical procedures are indicated in patients with non-fecal purulent peritonitis with laparoscopic peritoneal lavage as an optional choice. Objective: To report the results of laparoscopic peritoneal lavage in four patients with Hinchey III acute diverticulitis performed at a private clinic. Methods: Case series for which a review of patient clinical files was done. Results: No post-operative complications or mortality was found. Conclusions: based on authors judge, laparoscopic peritoneal lavage leads to an adequate post-operative evolution resulting in better quality of life. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and compare the apical depth of penetration and postoperative pain associated with the use of 9% 1-Hydroxyethylidene-1, 1-Bisphosphonate (HEBP) along with 3% sodium hypochlorite (NaOCl) as continuous chelation and standard irrigation protocol in endodontic treatment of adult permanent nonvital teeth. Methods: In this parallel arm double-blind single-center randomized controlled trial, standard irrigation protocol was compared to continuous chelation protocol (HEBP/NaOCl combination) with respect to the apical depth of penetration of irrigant and the postoperative pain. Forty-six patients aged between 18 and 45 years presenting with nonvital teeth requiring root canal treatment were randomly divided into two groups (n = 23) based on irrigation regime. After the final irrigation protocol, the apical depth of penetration of the irrigant was evaluated using a radiovisiography and radiopaque dye. Postoperative pain levels were evaluated at 6 h and 24 h after treatment using the numerical rating scale. Results: The results revealed that there was no statistically significant difference between the two groups in terms of the apical depth of penetration of the irrigant. While, with respect to postoperative pain, a statistically significant difference was found between the two groups at 24 h, with lower pain values observed in the continuous chelation group. Conclusion: The use of soft chelating agents like HEBP in continuous chelation has the apical depth of penetration comparable to that of ethylenediaminetetraacetic acid (EDTA) in standard irrigation protocol with lower postoperative pain at 24 h. Therefore, HEBP with NaOCl in continuous chelation can be seen as a viable, economical, and less technique-sensitive alternative to the use of EDTA for an effective three-dimensional disinfection of the root canal system up to the apical third of the root, which can be easily incorporated into daily clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The focus of the present research is to analyze the potential role of irrigants along with the activation system in the disinfection of the root canal space. Methods: Ninety root canals were randomly divided into two experimental groups based on the irrigants: Group I (n = 45) – Sodium hypochlorite irrigant and Group II (n = 45) –Chlorhexidine irrigant. The two groups are further subdivided into three subgroups base on the activation devices, i.e., passive ultrasonic irrigation, endoactivator, and laser. The first sample as a baseline, and the second sample was collected after the disinfection procedure. All the samples were streaked in brain − heart infusion agar plate to analyze the bacterial colony growth. The confirmatory analysis for the presence of Enterococcus faecalis was done using gram staining, biochemical analysis, and polymerase chain reaction. The nonparametric analysis was done using Kruskal–Wallis, Mann–Whitney U, and Wilcoxon signed-rank test and P < 0.05 was considered to be statistically significant. Results: The mean colony-forming unit was significantly reduced and there exhibited a statistically significant difference in pretreatment and posttreatment irrigated with sodium hypochlorite and chlorhexidine activated with passive ultrasonic activation with (P = 0.001), endoactivator with (P = 0.001), and laser with (P = 0.001). Conclusion: In consideration with advantage of the properties of both irrigants, the present study concludes a combined use with sodium hypochlorite during instrumentation followed by laser activation and a final rinse with chlorhexidine for a better eradication of the microbes from the root canal system thus preventing re-infection. [ABSTRACT FROM AUTHOR]

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Bioceramic cements used for filling root canals in cases of endo-perio lesion of endodontic origin seem to be promising due to having the potential of promoting faster and more predictable healing of the periapical lesion as they stimulate osteogenesis. An effective treatment plan depends on the precise diagnosis of endo-perio lesions. The origin of an infection, being exclusive to the root canal, from the periodontium, or both, is extremely important for devising the treatment plan. In both cases, no clinical evidence of periodontal disease (bleeding, calculus, etc.) was found; however, primary endodontic lesions with the possibility of drainage through the gingival crevice were present. In addition to the disinfection strategies used during the root canal treatments, the bioceramics Bio C Sealer, Bio C Repair and Bio Root RCS were used to fill in the root canals. Both cases presented an impressive bone gain within 8 months for case 1 and 5 months for case 2. Regarding case 1, in the palatal root canal an apical plug with a bioceramic repair cement was used. Based on the literature studied, it can be concluded that after adequate disinfection of the root canals, using bioceramic cements in filling the root canals shows the potential of supporting capabilities in remineralization of osteolytic lesions in endo-perio diseases. [ABSTRACT FROM AUTHOR]

Introduction: This in vitro study aimed to evaluate the effect of different irrigation regimens on the chemical composition and cleanliness of root canal dentin. Materials and Methods: Forty-eight extracted single-rooted permanent human teeth were collected. Root canals were instrumented using step-back technique up to master apical file size 60. Samples were divided into 3 groups (n=16) based on the type of the irrigant used. The irrigation solutions were 5.25% sodium hypochlorite, 2% chlorhexidine gluconate, and saline solution as a control. Root canal cleanliness was assessed using stereomicroscope and scanning electron microscope. Scanning electron microscope energy dispersive X-ray was used for the inorganic analysis. Fourier transform infrared spectrometer was used for the organic analysis. One-way analysis of variance (ANOVA) and multiple comparison post hoc test were used for comparison between the three groups. Results: The highest mean percentage of remaining debris was in saline group followed by chlorhexidine gluconate group. Sodium hypochlorite group showed the lowest mean value of remaining debris. Furthermore, our results showed that canal irrigation with sodium hypochlorite affected the chemical structure of root canal dentin more than chlorhexidine gluconate. Conclusions: Based on the results, 5.25% sodium hypochlorite emerges as the preferred irrigant for root canal treatment. This research sheds light on the significance of irrigation regimens in endodontics and emphasizes the need for careful consideration of irrigant selection in clinical practice. [ABSTRACT FROM AUTHOR]

Thermal effects during bone surgery pose a common challenge, whether using mechanical tools or lasers. An irrigation system is a standard solution to cool the tissue and reduce collateral thermal damage. In bone surgery using Er:YAG laser, insufficient irrigation raises the risk of thermal damage, while excessive water lowers ablation efficiency. This study investigated the potential of optical coherence tomography to provide feedback by relating the temperature rise with the photo-thermal expansion of the tissue. A phase-sensitive optical coherence tomography system (central wavelength of λ=1.288 μm, a bandwidth of 60.9 nm and a sweep rate of 104.17 kHz) was integrated with an Er:YAG laser using a custom-made dichromatic mirror. Phase calibration was performed by monitoring the temperature changes (thermal camera) and corresponding cumulative phase changes using the phase-sensitive optical coherence tomography system during laser ablation. In this experiment, we used an Er:YAG laser with 230 mJ per pulse at 10 Hz for ablation. Calibration coefficients were determined by fitting the temperature values to phase later and used to predict the temperature rise for subsequent laser ablations. Following the phase calibration step, we used the acquired values to predict the temperature rise of three different laser-induced cuts with the same parameters of the ablative laser. The average root-mean-square error for the three experiments was measured to be around 4 °C. In addition to single-point prediction, we evaluated this method's performance to predict the tissue's two-dimensional temperature rise during laser osteotomy. The findings suggest that the proposed principle could be used in the future to provide temperature feedback for minimally invasive laser osteotomy. [ABSTRACT FROM AUTHOR]

Fast-setting bioactive cements were developed for the convenience of retrograde fillings during endodontic microsurgery. This in vitro study aimed to investigate the effect of irrigation on the washout of relatively fast-setting materials (Biodentine, EndoCem Zr, and MTA HP) in comparison with MTA Angelus White and IRM in an apicectomy model. Washout resistance was assessed using artificial root ends. A total of 150 samples (30 for each material) were tested. All samples were photographed using a microscope, and half of them were also scanned. The samples were irrigated and immersed in saline for 15 min. Then the models were evaluated. Rinsing and immersing the samples immediately after root-end filling and after 3 min did not disintegrate the fillings made of all tested materials except Biodentine. Root-end fillings made of Biodentine suffered significant damage both when rinsing was performed immediately and 3 min after the filling. Quantitative assessment of washed material resulted in a slight loss of IRM, EndoCem MTA Zr, and MTA HP. MTA Angelus White showed a slightly greater washout. Rinsing and immersion of Biodentine restorations resulted in their significant destruction. Under the conditions of the current study, the evaluated materials, excluding Biodentine, showed good or relatively good washout resistance. [ABSTRACT FROM AUTHOR]

Endometritis is a common disease in the reproductive system, which is the infection and inflammation of the endometrium. In severe cases, it can affect the myometrium and adversely affect the subsequent fertility of dairy cows. We used a mass spectrometry-based technique to compare proteomics of uterine lavage fluid between healthy cows and cows with cytological endometritis classified according to 100-day postpartum pregnancy results and diagnosis result. The uterine lavage fluid of dairy cows collected at 15 and 30 days after delivery was analyzed. 15 days postpartum, we identified a total of 1129 proteins in the control and cytological endometritis (CEM) groups. Among them, 160 proteins were accurately screened out. 30 days postpartum, we identified a total of 846 proteins in the control and cytological endometritis (CEM) groups. Among them, 186 proteins were accurately cytological endometritis (CEM). Endometritis is a costly reproductive disease in lactating cows, which needs to be diagnosed in time. Using proteomics method based on gel mass spectrometry, we compared the proteome of uterine lavage fluid of dairy cows with and without cytological endometritis to characterize the changes of proteomic characteristics associated with postpartum uterine disease. To provide reference for clinical application and basic research. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Continuous bladder irrigation (CBI) is used in a variety of clinical settings, including post-transurethral surgery and the emergency department. Currently, CBI administration relies on nurses to diligently monitor and switch irrigation bags, as well as titrate the inflow rate based on effluent color. Inappropriate administration can result in discomfort to patients, clot urinary retention, repeat injury to the pathologic or surgical site, extended hospital stays, and even operative management. Our objective was to create an autonomous CBI system that decreases the incidence of disrupted irrigation flow and monitors the outflow to alert clinicians of critical events. Methods: 3D printing and off-the-shelf microcontrollers were used to design a device to fit the needs identified by stakeholders at our institution. An in vitro model of the bladder was created to test our design. The mechanical, electrical, and software subsystems were adjusted accordingly to meet our design requirements. Results: Our in vitro CBI model was able to simulate routine CBI administration with sudden bleeding. Bovine blood was used to simulate the bleeding events. A device was created that met identified stakeholder needs. Accurate detection of critical bleeding events, catheter blockage, and empty irrigation bags were achieved. The device responds to bleeding appropriately by increasing the irrigation rate. When the catheter is blocked, it stops the irrigation and alerts the nurse. Our system accurately titrated the irrigation rate to match a set outflow blood level parameter, conserving irrigation and minimizing nursing workload. Continuous monitoring of CBI effluent was recorded. Conclusions: We anticipate our device will decrease the cognitive load on nurses in busy clinical settings and improve workflow. Moreover, the detection of critical events will likely decrease patient morbidity. Continuous monitoring of the CBI outflow may prove to be a new clinical decision-making tool for ongoing hematuria. Clinical trial is pending. [ABSTRACT FROM AUTHOR]

Purpose: Prevention and management of postoperative pancreatic fistula (POPF) after pancreatic resections is still an unresolved issue. Continuous irrigation of the peripancreatic area is frequently used to treat necrotizing pancreatitis, but its use after elective pancreatic surgery is not well-known. With this systematic review, we sought to evaluate the current knowledge and expertise regarding the use of continuous irrigation in the surgical area to prevent or treat POPF after elective pancreatic resections. Methods: A systematic search of the literature was conducted according to the PRISMA 2020 guidelines, screening the databases of Pubmed, Scopus, Web of Science, and Ovid MEDLINE. Because of the heterogeneity of the included articles, a statistical inference could not be performed and the literature was reviewed only descriptively. The study was pre-registered online (OSF Registry). Results: Nine studies were included. Three studies provided data regarding the prophylactic use of continuous irrigation after distal and limited pancreatectomies. Here, patients after irrigation showed a lower rate of clinically relevant POPF, related complications, lengths of stay, and mortality. Six other papers reported the use of local lavage to treat clinically relevant POPF and subsequent fluid collections, with successful outcomes. Conclusion: In the current literature, only a few publications are focused on the use of continuous irrigation after pancreatic resection to prevent or manage POPF. The included studies showed promising results, and this technique may be useful in patients at high risk of POPF. Further investigations and randomized trials are needed. [ABSTRACT FROM AUTHOR]

Bowel management in the person with a permanent colostomy is important and the burden of continuous use of bags and adapters (base plates / skin barriers) on health care costs and the environment is known. When applied regularly, colostomy irrigation (CI) contributes to improving the quality of life (QOL) of the individual with a permanent colostomy by enabling improved faecal continence and reducing costs. The aim of this article was to examine the positive impact of CI on an individual's QOL and health expenditures. In this case, it was found that a patient with a permanent colostomy who had performed CI for 21 years could eliminate many of the physical and psychological problems as well as peristomal skin complications (PSCs), arising from using a colostomy appliance only. It was also determined in this case scenario that bowel management using CI was three times more cost-effective than the colostomy bag system. [ABSTRACT FROM AUTHOR]

The body's natural reaction is to heal a wound or an ulcer. In the event that there is no doshic invasion or infection, a wound will normally heal in one week. Dusta vrana(infected wound), which is defined as a vrana lasting longer than a week, infected with microorganism and that fails to heal for an extended length of time to produce a chronic wound, requires sthanika shodana. Materials and methods: Aragwadadhi kwatha dhavana was used for doing shodana in dusta vrana whom pseudomonas aeruginosa was isolated and the impact was observed. Conclusion:it was concluded that ARAGWADADHI kwatha dhavana was beneficial in destroying the gram -negative bacteria (pseudomonas aeruginosa). [ABSTRACT FROM AUTHOR]

To compare the efficiency of conventional needle irrigation, passive ultrasonic irrigation, sonic irrigation and XP‐endo Finisher in removing Vitapex paste from root canals. The root canals of human single‐rooted teeth were prepared and obturated with Vitapex paste. After 2 weeks, the 48 teeth were randomly allocated into four groups: conventional needle irrigation (CNI) group, passive ultrasonic irrigation (PUI) group, sonic irrigation (SI) group and XP‐endo Finisher (XP) group. The specimens of four groups were scanned using a micro‐computed tomography after the Vitapex pastes was removed. The results showed that more residual paste was left in the CNI group than in the other three groups (p < 0.05). There was no significant difference among the PUI, SI and XP group (p > 0.05). And, the majority of the residual Vitapex was found in the apical third, with a small amount in the middle third after using any of the three agitated irrigation techniques. [ABSTRACT FROM AUTHOR]

This study is aimed to assess the efficacy of different final irrigation agitation techniques on dentin tubule penetration of nanoparticle calcium hydroxide (NCH) dressing. Ninety‐six extracted upper incisors were shaped up to #40file. Then, Four experimental groups were formed according to the final irrigation procedure: conventional needle irrigation (CNI), manual dynamic agitation (MDA), sonic agitation (SA) and ultrasonic irrigant agitation (UIA). According to the intracanal drug used, these groups were divided into two subgroups: calcium hydroxide (CH) and NCH. Prepared CH preparations were labelled with Rhodamine B, and CH or NCH were placed in root canals. In the UIA group, both CH and NCH had the highest penetration depth and percentage compared to the other groups (p < 0.05). The penetration depth and percentage of NCH in the UIA and SA groups were significantly higher than in the CH groups (p < 0.05). UIA is more effective than other groups in increasing dentinal tubule penetration of CH and NCH. [ABSTRACT FROM AUTHOR]

The present study aims to assess the efficacy of different irrigation agitation systems in removing calcium silicate‐based sealers from artificial standardised apical grooves. After the root canal instrumentation of 96 teeth, artificial apical grooves were created in half of each root. The samples were divided into two main groups according to the sealer type (AH Plus Jet [APJ] and Sure‐Seal Root™ [SSR]) (n = 48). The root halves were then reassembled and divided into four experimental groups based on the final irrigation technique used: Conventional Syringe Irrigation (CSI), Ultrasonic Irrigant Agitation (UIA), Sonic Agitation (SA) and Manual Dynamic Agitation (MDA). The roots were then dissembled to assess the amount of root canal sealer. UIA significantly removed more of SSR sealer than CSI, MDA and SA while there was no statistical difference between CSI, MDA, SA and UIA groups in the APJ group. None of the irrigation agitation systems used had completely removed the APJ and SSR sealers. However, UIA was more effective in removing SSR sealer from the standardised apical groove than were CSI, MDA and SA. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the debridement efficacy of sonic irrigation (EDDY; VDW, Munich, Germany and EndoActivator; Dentsply‐Sirona, Ballaigues, Switzerland) and ultrasonically activated irrigation (Irrısafe; Satelec Acteon, Merignac, France) in a simulated canal isthmus connecting curved canals. Transparent resin blocks were produced containing two curved canals connected with an isthmus. The isthmus was then filled with dentin debris. Three irrigant activation cycles were performed and the amount of remaining debris was compared analysing pictures taken after each activation cycle. Data were statistically analysed using one‐way ANOVA and post hoc Tukey tests at a significance level of p < 0.05. EDDY showed greater efficiency in removing dentin debris from the simulated isthmus than the other techniques tested. An increase in the activation time enhanced the efficiency of both EDDY and ultrasonically activated irrigation in debris removal. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate radiographic periapical repair after endodontic treatment using QMix or NaOCl irrigation in single‐rooted teeth with apical periodontitis. In this randomised clinical trial, 60 patients were selected and randomised into two groups (n = 30). After instrumentation of root canals, QMix or NaOCl was used as a final irrigation and the canals obturated with gutta‐percha and AH Plus sealer. All the participants were recalled after 12 months and 15 patients were lost to the study so 45 patients were evaluated radiographically according to periapical index (PAI) scores. A significant decrease was seen in PAI scores after 1 year in all patients (p < 0.001). In the QMix and NaOCl group, absence or reduction of radiolucency was observed in 23 of 25 teeth (92%) and 20 of 20 teeth (100%), respectively. There was no significant difference between two groups according to the decrease in PAI score (p = 0.508). Root canal treatments with or without QMix irrigation contributed equally to periapical healing. [ABSTRACT FROM AUTHOR]

This study compared the efficacy of several passive ultrasonic irrigation (PUI) systems in removing intracanal medicament using 3‐dimensionally printed root canal model assembled with dentin specimen. After the placement of the model in the agar container (37°C), the intracanal medicament was removed using three different PUI instruments including CK file, Irrisafe and Endosonic Blue. Then, the area coated by the medicament and the volumetric percentage of the remaining medicament was measured. Irrisafe and Endosonic Blue showed higher removal efficacy than CK and the control regarding both the coated area and remaining volume (p < 0.05). CK showed the lowest efficacy among the tested PUI systems (p > 0.05). Notably, Endosonic Blue group showed the smallest coated area among the tested groups (p < 0.05). Conclusively, PUI systems made of nickel‐titanium alloy with small dimensions, such as Endosonic Blue, have advantages for the removal of intracanal medicaments from curved root canals. [ABSTRACT FROM AUTHOR]

Simple Summary: One of the most valuable methods to diagnose lower airway disorders such as equine asthma is broncho alveolar lavage (BAL), whereby a solution, usually saline, is inserted in a distal part of a lung lobe. The solution is then collected and contains cells present in the deeper airways. It is a safe procedure, but saline can cause local inflammation (neutrophilia). This study aimed to investigate if there are better solutions for the procedure, for example, less acidic ones, to avoid causing inflammation, and whether the BAL fluid retrieved from one lung lobe is representative for the whole lung. Since it is not necessary to use horses with respiratory disorders to answer these research questions, healthy horses were used. Four horses were used (using four lung lobe locations and four different solutions per horse twice with an interval of 48 h) and generated enough data to answer the questions. The findings were that the BAL composition is not affected by either the solution used or the lung lobe sampled. These findings are positive because they support keeping the procedure easy and practical. Equine bronchoalveolar lavage (BAL) is usually performed with 250–500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer's solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148® have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed twice with a 48 h interval using 250 mL of solution. Automated total nucleated cell counts (TNCs) were recorded, and differential cell counts in lavage fluid were determined by two investigators blinded to treatments. The mean volume of BAL fluid retrieved was 51 ± 14%. The mean neutrophil percentage (%N) increased from 1.5 ± 0.9% to 14.7 ± 9.6% at 48 h (p < 0.001) but was not significantly affected by the solution used or the lung lobe sampled. In conclusion, in this study, the influx of neutrophils into airways after BAL was independent of the type of isotonic solution used and the lung lobe sampled. Saline remains an appropriate solution for BAL in horses. [ABSTRACT FROM AUTHOR]

Background: Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. Methods: The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. Results: The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events. [ABSTRACT FROM AUTHOR]

This paper aims to study the removal of a vapor lock located in the apical ramification of an oval distal root of a human mandibular molar, simulating different needles and irrigation depths with computational fluid dynamic. A geometric reconstruction of the micro‐CT of the molar shaped up to a WaveOne Gold Medium instrument was used. A vapor lock located in the apical 2 mm was incorporated. Geometries with positive pressure needles (side‐vented [SV], flat or front‐vented [FV] and notched [N]) and the EndoVac microcannula (MiC) were created to run the simulations. Irrigation key parameters (flow pattern, irrigant velocity, apical pressure, wall shear stress) and vapor lock removal were compared among the different simulations. Each needle behaved differently that is, FV removed the vapor lock from one ramification and had the highest apical pressure and shear stress values; SV removed the vapor lock in the main root canal but not in the ramification and reached the lowest apical pressure from the positive pressure needles; N was not able to completely remove the vapor lock and showed low apical pressure and shear stress; MiC removed the vapor lock from one ramification, had negative apical pressure and the lowest maximum shear stress. The main conclusion is that none of the needles showed complete removal of vapor lock. MiC, N, and FV were able to partially remove the vapor lock from one out of the three ramifications. However, SV needle was the only simulation that showed high shear stress with low apical pressure. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of irrigating solutions containing 5% boric acid + 1% citric acid or 1% peracetic acid + high concentration hydrogen peroxide on root cleaning and bond strength of cementation systems after 24 h and 6 months of glass fiber post cementation. One hundred and twenty roots were endodontically treated. The specimens were randomized into one of four treatments (n = 10): DW (distilled water); NaOCl2.5% + EDTA17% (2.5% sodium hypochlorite solution + 17% EDTA); PA1% + HP (1% peracetic acid solution + high concentration of hydrogen peroxide); BA5% + CA1% (5% boric acid associated with 1% citric acid). The cleaning efficacy in the cervical, middle, and apical thirds of the post‐space, and the push‐out bond strength at 24 h and 6 months after post cementation were evaluated by Kruskal‐Wallis and two‐way ANOVA tests, respectively. BA5% + CA1% showed statistically significantly superior cleaning efficacy compared to the other solutions. This irrigation protocol also resulted in higher bond strength at 24 h and 6 months, regardless of the root third considered, and this was statistically significantly higher than those seen for DW and PA1% + HP. For BA5% + CA1% irrigation protocol, type 1 adhesive failure was the most prevalent. Post‐space irrigation with BA5% + CA1% provided both higher cleaning efficacy and better bond strength. [ABSTRACT FROM AUTHOR]

To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia. 238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3 months after surgery. CW-ThuFLEP showed shorter operative time (61.5 vs 67.4 minutes, P =.04). Enucleation time (50.2 vs 53.3 minutes, P =.12), enucleation efficiency (0.8 vs 0.7 g/min, P =.38), catheterization time (2.2 vs 2.1 days, P =.29), irrigation volume (32.9 vs 32.8 L, P =.71), hospital stay (2.8 vs 2.6 days, P =.29) and hemoglobin drop (0.38 vs 0.39 g/dL, P =.53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value. PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences. [ABSTRACT FROM AUTHOR]

Background: Ductal lavage (DL) involves cannulating the nipple aspirate fluid (NAF)- producing ducts with a microcatheter and lavaging with saline to retrieve cells for cytological and molecular analysis. This method improves upon NAF and fine-needle aspiration and can provide important data on cellular yield and molecular markers in DL fluid. Aims and Objectives: The present study aims to evaluate a non-invasive method called DL for obtaining epithelial cells from breast ducts of women at risk for breast cancer, to study the cytology of DL in women at risk of/clinicoradiological possibility of breast carcinoma, and to correlate the cytology of DL with Gail risk score and with histopathology (wherever available). Materials and Methods: The present study, conducted at Hindu Rao Hospital, Delhi, between 2012 and 2014, examined 36 patients with nipple discharge. Nipple aspiration and DL were performed, and the results were analyzed and compared. The present study also looked at the correlation between DL results and the patient's Gail score and correlated histopathology with DL cytology. Results: The present study enrolled 36 women and studied 50 ducts from 46 breasts. Nipple fluid was aspirated from 34 patients, with inadequate cellular material for diagnosis in 24 breasts, benign in 18, atypia in 2, and no malignancy found. The correlation of DL with Gail score was statistically significant, as was the correlation between epithelial cells in DL and NAF samples. The correlation between DL and histopathological findings was statistically insignificant. Conclusion: DL samples may miss atypical cells, and have higher epithelial cell count than NAF. Higher Gail score correlates with mild atypical cells in DL (P=0.003). [ABSTRACT FROM AUTHOR]

The disinfection and removal of biofilm from titanium dental implants remains a great challenge in oral medicine. Here we present results of novel photoacoustic irrigation laser modalities for biofilm removal in model geometries mimicking the peri-implant pocket. The efficacy of single pulse (Er:YAG-SSP) and dual pulse (Er:YAG-AutoSWEEPS) photoacoustic irrigation modalities were determined for Enterococcus faecalis biofilm decontamination from titanium surfaces in narrow cylindrical and square gap geometries. The density of bacteria as well as the number of live bacteria were determined prior and after different photoacoustic treatments. Both SSP and AutoSWEEPS photoacoustic irrigation techniques removed at least 92% of biofilm bacteria during the 10 s photoacoustic treatment. The effectiveness of cleaning was better in the narrow square gap geometry compared to the cylindrical geometry. The dual pulse Er:YAG-AutoSWEEPS photoacoustic irrigation showed better results compared to SSP modality. No chemical adjuvants were needed to boost the effectiveness of the photoacoustic irrigation in the saline solution. The results imply that photoacoustic irrigation is an efficient cleaning method for debridement and decontamination in narrow geometries and should be considered as a new therapeutic option for the treatment of peri-implant diseases. [ABSTRACT FROM AUTHOR]

After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations. [ABSTRACT FROM AUTHOR]

Aim: This aim of this study was to compare the effects of different chelating agents [ethylenediaminetetraacetic acid (EDTA), glycolic acid (GA) and citric acid (CA)] on the push-out bond strength (POBS) of two calcium silicate-based silicate cements (CSC) (Biodentine and PD MTA White). Methodology: Dentin discs of 1 ± 0.2 mm thickness were taken from the middle root region of thirty-nine extracted mandibular premolar teeth and two holes (1 mm diameter) were drilled in each disc (n = 78 holes). The samples were then randomly divided into three groups (n = 26 holes) according to the final irrigation agents: Group 1: 20% CA, Group 2: 17% EDTA, Group 3: 10% GA. Then, two different materials were applied to the holes in each group (n = 13 holes): a: PD MTA White, b: Biodentine. POBS test was performed at a crosshead speed of 0.5 mm/min. The dentin discs were examined under stereomicroscope (25x) to assess the bond failure type. Data were analyzed using a two-way analysis of variance (ANOVA) and comparison of main effects was examined with the Bonferroni test, and multiple comparisons were analysed with the Tukey HSD test. The level of signifcance was 5%. Results: Biodentine showed significantly higher POBS than PD MTA White (p < 0.05). There was no significant difference between the final irrigation agents (p > 0.05). CA -- Biodentine group showed substantially higher POBS than EDTA -- PD MTA White, CA -- PD MTA White, and GA -- Biodentine groups (p < 0.05). Conclusion: While CA increased the POBS of Biodentine significantly, the POBS of PD MTA White was not affected by the final irrigation agents. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of shockwave-enhanced emission photoacoustic streaming (SWEEPS), sonic activation with EDDY, and passive ultrasonic irrigation (PUI) in the removal of calcium hydroxide medicaments from artificial internal resorption cavities. Methodology: Ninety mandibular premolars with single oval canals were prepared to size 50/0.04 and split longitudinally. Standardized cavities were prepared in the apical third of the root canal and filled with calcium hydroxide. The root halves were reassembled and divided into three groups (n = 30) according to the removal methods used. The amount of residual calcium hydroxide was evaluated using a four-grade scoring system. The differences between the groups were analyzed using the Kruskal--Wallis H test (p < 0.05). Results: SWEEPS removed significantly more calcium hydroxide than PUI (p < 0.003) and EDDY (p < 0.035). There was no significant difference between the EDDY and PUI groups (p = 1.000). Conclusion: None of the systems tested were able to completely remove the calcium hydroxide paste from the simulated internal resorption cavities; however, SWEEPS removed more calcium hydroxide than the EDDY and PUI techniques. [ABSTRACT FROM AUTHOR]

Background: Shock wave-enhanced emission photoacoustic streaming (SWEEPS) is a novel irrigation activation method based on photoacoustic streaming. The aim of this study was to look into the impact of SWEEPS on the attachment and survival of dental pulp stem cells (DPSCs). Materials and Methods: In this in vitro study, 34 standardized root segments were randomly allocated into two groups: SWEEPS and the conventional conditioning group. After the irrigation, human DPSCs were seeded on the internal walls of these samples, and the attachment and survival of 30 of them were assessed on different days. The remaining two samples were observed using a scanning electron microscope (SEM). Independent sample t-test, Mann-Whitney U-test, one-way ANOVA, Kruskal-Wallis, and two-way ANOVA were used for data analysis with the level of significance = 0.05. Results: The viability of DPSCs was significantly greater in the SWEEPS group in comparison with the conventional conditioning group (P = 0.029). Both groups have shown a significant increase in the viability of DPSCs over time (P = 0.0001, P = 0.003). SEM results have shown a smear layer-free surface with firmly attached DPSCs in the SWEEPS group. Conclusion: The results of this study indicated that active irrigation using SWEEPS could provide a superior surface in terms of viability and attachment of DPSCs compared to the conventional conditioning method. [ABSTRACT FROM AUTHOR]

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As a synergistic treatment approach with systemic antimicrobial therapy or a systemic antibiotic-sparing strategy, the local administration of antimicrobial agents has been proposed as an alternative route for complicated infections. With the rationale of concentrating the active principle in the desired target site, avoiding potentially toxic systemic levels and bypassing anatomical and physiological barriers, local irrigation or infusion of antibiotics may effectively shorten the antimicrobial therapy course and reduce both infection-related and systemic therapy-related complications. Although evidence from the adult population supports its use in selected patients with an acceptable safety profile, data specifically focused on the pediatric population are limited. To provide a rapid and easily accessible tool for clinical practice, we synthesized the most relevant evidence on the use of local antimicrobial agents in common severe infections in children: meningitis, mediastinitis, pleural infections, recurrent urinary infections, and peritonitis. A literature search was performed using predefined combined keywords through an electronic research database (PubMed). Described molecules, dosages, routes, treated age groups, and related efficacy have been summarized for prompt application to clinical practice. It should, however, be noted that the evidence for the pediatric population remains limited, and the local administration of several molecules remains off-label. A careful multidisciplinary and patient-tailored evaluation, as well as a rational use of available guidelines, should always be the basis of clinical decision making in settings where local administration of antibiotics may be considered. [ABSTRACT FROM AUTHOR]