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Objectives: To evaluate the effect of sonic oscillation on penetration depth and marginal adaptation of resin-based fissure sealants. Method and materials: Thirty-six extracted human third molars were randomized into three groups: in the HF group, teeth were sealed with a filled-resin-based sealant (Helioseal F); in the Sonic-HF group, teeth were sealed with Helioseal F and subjected to sonic oscillation (Compothixo Device, 140 Hz vibration frequency and ± 150 µm amplitude) before curing; in the CO group, teeth were sealed with an unfilled-resin-based sealant (Clinpro). All teeth were thermocycled for 1,500 cycles at 5°C and 55°C, then sectioned buccolingually into four sections (mesial, two middle, and distal). Sections were evaluated under SEM for marginal adaptation and scored. For penetration depth, three independent measurements from each tooth were recorded under SEM, and data were subjected to statistical analysis. Results: The group subjected to sonic oscillation (Sonic HF) resulted in significantly superior penetration depth and marginal adaptation compared with the HF group, but with no significant difference compared with the CO group. Conclusions: Sonic activation of resin-based sealant increased penetration depth into fissures and marginal adaptation to the enamel wall without decreasing filler load or compromising sealant mechanical properties. [ABSTRACT FROM AUTHOR]

Purpose: To assess the ablation efficiency of the Superpulsed Thulium Fiber Laser (SP-TFL) and investigate the thermal effects of SP-TFL. Methods: A SP-TFLwas employed to evaluate ablation efficiency. Fresh ex-vivo pig kidneys and ureters were utilized to evaluate the renal pelvis and ureter temperature changes, different irrigation rates(0, 15, 38mL/min) and a long pulse width were used. Results: The research indicated that as laser output power increased, ablation rates significantly increased. Ablation rates(mg/min) were higher and the energy per ablated mass(J/mg) was lower at lower frequencies(10–50 Hz). Under the same frequency and single pulse energy, super short and short pulse widths demonstrated higher ablation rates at higher frequencies (exceeding 100 Hz). The temperature of the renal pelvis and ureter decreased with increasing irrigation rates. In the renal pelvis, without irrigation, the temperature quickly reached the critical threshold of 43℃. The irrigation rate was 15 ml/min and power was no more than 18 W, the renal pelvis temperature did not reach 43℃. When the irrigation rate were 38 ml/min, the temperature did not risen to 43℃. In the ureter, without irrigation, the temperature also quickly reached 43℃. The temperature reached 43℃ when the power exceeded to12W with an irrigation rate of 15 ml/min. With an irrigation rate of 38 ml/min, the temperature reached 43℃ at a laser power of 30 W. Conclusions: The SP-TFL demonstrated promising ablation effectiveness especially for lower frequencies and super short and short pulse widths model. Proper irrigation rates, single pulse energy, frequency and pulse width are crucial during lithotripsy. [ABSTRACT FROM AUTHOR]

Objective: To determine if knee arthroplasty without sonographically visible effusion needs to undergo lavage to rule out infection. Methods: Patients were accrued by a retrospective search of a longitudinally maintained radiology database looking for patients referred for ultrasound guided aspiration of suspected TKA infection. Clinical presentations, laboratory tests, intraoperative findings, and follow-up were reviewed. Results: Four hundred sixty-nine patients were included (mean age of 67 years (range, 36–91)) including 251 females. Four hundred three patients had effusions, of which 57 were infected based on ultrasound-guided and surgical aspirates. Sixty-four patients lacked effusions, of which 47 underwent lavage at the clinicians' request, with 6/47 infected. Nineteen patients without effusion were not lavaged at the clinicians' request due to low suspicion, and none were infected. Patients with positive lavage cultures all had clinical risk factors. Infection rates were significantly higher in patients with joint effusion and clinical suspicion for infection compared to absent joint effusion and absent clinical suspicion. A significantly higher proportion of patients with hyperemia or moderate-severe synovial thickening on ultrasound were symptomatic and had joint effusion and positive joint cultures. Aspiration of native fluid had 85% sensitivity and 100% specificity while lavage had a sensitivity of 57% and specificity of 100%. Negative predictive value for native aspirates was 94% compared to 86% for lavage. Conclusion: A TKA with low clinical suspicion of infection does not need to undergo lavage in the absence of a sonographically visible effusion. [ABSTRACT FROM AUTHOR]

Understanding the apical pressure and irrigant flow patterns in root canals is crucial for safe and effective irrigation. Therefore, this study aimed to assess the flow characteristics of irrigants in root canal models with varying tapers during final irrigation by employing various needle designs, including a back-to-back double-side-vented needle, through computational fluid dynamics. The root canal model was configured as a closed geometrical cone with a simulated apical zone (size 30) and features tapers of 4%, 6%, and 8%. Three needle types—open-ended needle (OEN), single side-vented needle (SSVN), and double side-vented needle (DSVN)—were investigated. The results indicated that for the 4% taper models, the open-ended needle generated the maximum apical pressure, followed by the double side-vented needle and the single side-vented needle. However, in the 6% and 8% tapering root canal models, the double-side-vented needle applied the lowest maximum apical pressure. Consequently, the DSVN can pose a risk for irrigant extrusion in minimally prepared canals due to heightened apical pressure. In wider canals, the DSVN exhibited lower apical pressure. The maximum irrigant replacement was observed with OEN compared to that of the closed-ended group for both flow rates. Additionally, compared with OENs, closed-ended needles exhibited nonuniform and lower shear wall stress. [ABSTRACT FROM AUTHOR]

Extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous lavage (UGPL or barbotage) are among those used to treat the pain of rotator cuff calcific tendinopathy (RCCT). This meta-analysis was done to review the effect ESWT and UGPL in reducing the pain of RCCT. A comprehensive search was done based on the PRISMA. PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar were reviewed for articles published by Feb 1, 2024, on ESWT vs. UGPL. The main keywords searched are as follows: "rotator cuff calcific tendinopathy", "tendinitis", " ESWT", " ultrasound-guided percutaneous lavage", " RCCT ″, " UGPL", " extracorporeal shock wave therapy" and titles or abstracts may contain one or a mix of these elements. This study was registered at PROSPERO with code" CRD42022385068". STATA version 13 was applied to analyze. In general, 779 patients from 22 studies were analyzed. The mean age was 51.85 ± 3.41 years. The patients were referred after 18.69 months of suffering from tendinopathy symptoms. Right-sided and supraspinatus locations were affected more. ESWT has been effective in a decrease of calcium deposit (−1.70 SMD after 1 week for ESWT, −0.96 SMD after 12 weeks for ESWT and −1.20 SMD after 12 weeks UPGL). ESWT has been effective in decreasing VAS by −4.32 SMD after 1 week while UPGL showed −0.23 SMD reductions in VAS After 1 week but in time >1 week, UPGL showed better effect by more reduction in VAS. ESWT has been effective in an increase of CMS by 1.60 SMD after 4–6 weeks, by 1.79 SMD after 12 weeks, by 2.44 SMD after 24 weeks, and 2.53 SMD after 48 weeks. Based on the results, ultrasound-guided lavage is more effective in reducing pain than ESWT, and this effect becomes more evident in the long term. In terms of CMS score, over time, the efficiency of ESWT becomes more visible. In long-term follow-up, UPGL had a better effect on the calcium deposit reduction. [ABSTRACT FROM AUTHOR]

This ex vivo study devised an analytical ex vivo method for infection/disinfection of simulated lateral canals located in the middle and apical segments of the root. The antibacterial effects of supplementary approaches were tested in this model. Extracted mandibular premolars had their main root canals enlarged and then two lateral canals (100 μm in diameter) were created in the root, one in the apical and the other in the middle portion. Micro-computed tomography was used for specimen selection and to confirm the quality of the simulated ramifications. The specimens were contaminated with a mixed bacterial culture from subgingival bacterial biofilm added to pure Enterococcus faecalis strain ATCC 29212 grown overnight, using special strategies to facilitate culture medium penetration within the lateral canals. The following procedures were tested for disinfection: NaOCl/passive ultrasonic irrigation (PUI), NaOCl/XP-endo Finisher, ozonated water/continuous ultrasonic irrigation (CUI), and NaOCl/conventional irrigation with 30-G needles (control). Bacteriological samples were taken from the main canal before (S1) and after (S2) each supplementary protocol, and also from each lateral canal after treatment (S3). DNA extracted from the samples was subjected to quantitative real-time polymerase chain reaction. All S1 main canal samples were positive for bacterial presence. Bacterial counts in the main root canal substantially decreased by 99.2% after PUI, 99.1% after ozone/CUI, 99% after XP-endo Finisher, and 96% in the control group (P < 0.01 for all groups). There were no significant differences between groups (P > 0.05). The same was observed when comparing the effects of the supplementary approaches in the apical and middle lateral canals (P > 0.05). Only a few lateral canals showed no detectable bacteria. The method proposed here proved effective for ex vivo infection/disinfection studies. All supplementary approaches induced a substantial bacterial reduction in the main canal, with no significant differences between them. However, in terms of lateral canal disinfection, none of the tested approaches showed significant effects when compared to the control group. [ABSTRACT FROM AUTHOR]

Background: Infected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment. Methods: A total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05). Results: In the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05). Conclusions: UI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments.A Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre‐ and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality‐of‐life improvements.The CoSI assesses surgical extent on a scale of 0–100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT‐22 scores improved at 6 months postoperatively, with durable and consistent improvement at 24 months (p < 0.001). Preoperative CoSI scores in revision surgery patients were 49.4 ± 26.0, improving to 91.0 ± 8.1 postoperatively. SNOT‐22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p = 0.029).It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention. [ABSTRACT FROM AUTHOR]

AimMethodologyResultsConclusionsTo evaluate the behaviour of the XP‐Endo Finisher and the variation in the intracanal temperature of the irrigant at rest and when activated over time.Differential scanning calorimetry (DSC) determined the transformation temperatures of XP‐Endo Finisher instruments. A digital thermocouple was used to measure the temperature of the irrigant inside the pulp chamber. Two measurements were performed for each tooth (n = 12): with the irrigant at rest and during XP‐Endo agitation for 60 s to observe the temperature evolution. The data were statistically analysed using a t‐test with a confidence level of 95%.DSC results suggested that the XP‐Endo Finisher had a mixed R‐phase and austenitic structure at room temperature. The temperature values at predetermined time points (0, 10, 40, 70, 120 and 240 s) were measured, and no statistical difference was observed between the values of the resting and activated solutions at any of the selected points (p > .05). For the protocol performed with the XP‐Endo file, the mean irrigant temperature observed at instrument insertion inside the root canal was 28.65°C. After 60 s of agitation, the temperature was 34.02°C. The solution temperature stabilized inside the canal only after 211 s at 35.5°C. The mean maximum irrigation solution temperature recorded inside the canal was 35.5°C without agitation and after XP‐endo agitation (p > .05).Although the XP‐Endo Finisher system does not promote heating of the irrigation solution, file expansion responsible for improved instrument cleaning starts at a temperature below the expected value. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo emphasise the importance of “soft” observations during lacrimal irrigation in diagnosing lacrimal outflow dysfunction and reporting outcomes of soft factors post-DCR.A retrospective study of patients with ≤ 20% of regurgitation on lacrimal irrigation who underwent DCR surgery. A comparative analysis of percentage reflux of saline (RFX), initial mucus in reflux (IMR), patient-reported transit time of saline (PR-TTS), and resistance encountered (RES) during LS was performed. Validated TEARS score was used. Subjective success was defined as ≥ 2-point improvement in T subscale of TEARS score. Objective success, as a decrease in RFX, RES, PR-TTS and absence of IMR, post-operatively.From a total of 253 patients who underwent DCR surgery, 8 patients met the inclusion criteria. All patients were T4 (wiping >10× daily) indoors and outdoors. TEARS score improved after surgery with a mean reduction of T = 2.62, E = 1.63 and A = 1.35 (p < .05) with no significant change in R scores (p = .10). A mean reduction in RFX of 11.75 ± 6.74% and a median improvement of 1 point in PR-TTS and 2 point in RES was observed (p < .05). No significant changes of these parameters occurred in the contralateral side during this period. Subjective and objective success of DCR was 75% and 100%, respectively.This study is the first to attempt to combine qualitative “soft” observations during lacrimal irrigation such as IMR, RES and PR-TTS for identifying nasolacrimal outflow dysfunction and reporting outcomes using these parameters of DCR in patients with epiphora and ≤ 20% of fluid regurgitation. These parameters were greater in the more symptomatic side and successfully improved after DCR, making them a valuable tool to reach a provisional diagnosis. [ABSTRACT FROM AUTHOR]

Colostomy irrigation is a procedure that allows patients to achieve a certain degree of bowel control, and a period free of stoma effluent. It has the potential to improve quality of life, body image and confidence, and reduce patient anxiety. It may also help reduce odour and flatus, prevent/address peristomal skin irritation and alleviate constipation. Because it can reduce or eliminate the need for a colostomy bag, it may also cut expenditure on stoma appliances. However, colostomy irrigation is not offered to patients as standard. A protocol was drawn up to ensure colostomy irrigation was routinely offered to suitable patients and to provide them with a structured follow-up to ensure they were well supported throughout the first year of carrying out the procedure. Quality of life and the efficacy of colostomy irrigation can be monitored using questionnaires on these two issues. Two case studies demonstrate how patients' quality of life can improve when using colostomy irrigation as part of their stoma care routine. [ABSTRACT FROM AUTHOR]

Background: Chondrocyte viability is associated with the clinical success of osteochondral allograft (OCA) transplantation. Purpose: To investigate the effect of distal femoral OCA plug harvest and recipient site preparation on regional cell viability using traditional handheld saline irrigation versus saline submersion. Study Design: Controlled laboratory study. Methods: For each of 13 femoral hemicondyles, 4 cartilage samples were harvested: (1) 5-mm control cartilage, (2) 15-mm OCA donor plug harvested with a powered coring reamer and concurrent handheld saline irrigation ("traditional"), (3) 15-mm OCA donor plug harvested while submerged under normal saline ("submerged"), and (4) 5-mm cartilage from the peripheral rim of a recipient socket created with a 15-mm cannulated counterbore reamer to a total depth of 7 mm with concurrent handheld saline irrigation ("recipient"). The 15 mm–diameter plugs were divided into the central 5 mm and the peripheral 5 mm (2 edges) for comparisons. Samples were stained using calcein and ethidium, and live/dead cell percentages were calculated and compared across groups. Results: Compared with the submerged group, the traditional group had significantly lower percentages of live cells across the whole plug (71.54% ± 4.82% vs 61.42% ± 4.98%, respectively; P =.003), at the center of the plug (72.76% ± 5.87% vs 62.30% ± 6.11%, respectively; P =.005), and at the periphery of the plug (70.93% ± 4.51% vs 60.91% ± 4.75%, respectively; P =.003). The traditional group had significantly fewer live cells in all plug regions compared with the control group (77.51% ± 9.23%; P <.0001). There were no significant differences in cell viability between the control and submerged groups (whole: P =.590; center: P =.713; periphery: P =.799). There were no differences between the central and peripheral 5-mm plug regions for the traditional (62.30% ± 6.11% vs 60.91% ± 4.75%, respectively; P =.108) and submerged (72.76% ± 5.87% vs 70.93% ± 4.51%, respectively; P =.061) groups. The recipient group (61.10% ± 5.02%) had significantly lower cell viability compared with the control group (P <.0001) and the periphery of the submerged group (P =.009) but was equivalent to the periphery of the traditional group (P =.990). Conclusion: There was a significant amount of chondrocyte death induced by OCA donor plug harvesting using a powered coring reamer with traditional handheld saline irrigation, which was mitigated by harvesting the plug while the allograft was submerged under saline. Clinical Relevance: Mitigating this thermally induced damage by harvesting the OCA plug while the allograft was submerged in saline maintained chondrocyte viability throughout the plug and may help to improve the integration and survival of OCAs. [ABSTRACT FROM AUTHOR]

(1) Background: This study aims to evaluate how different irrigation settings and the use of ureteral access sheaths (UASs) of varying sizes impact intrarenal pressure (IRP) during flexible ureteroscopy (fURS) procedures in pigs. (2) Methods: This study utilized three anesthetized female pigs. A novel flexible ureteroscope with the ability to continuously record live intrarenal pressure was used to perform ureteroscopy in different settings. Ureteroscopy was performed without UAS and with the use of 11/13 and 12/14 UAS at the ureteropelvic junction. Two different irrigation methods were employed for each parameter: one using gravity flow and the other using manual pumping with a commercial pump. IRP was also recorded with the presence of a laser fiber or lithotripsy basket. (3) Results: The recorded mean IRP during flexible URS without UAS was 28.25 (±11.2) under gravity irrigation; 35.46 (±10.08) under manual pumping; 22.5 (±3.05) and 30.75 (±5.79) with a laser fiber under gravity irrigation and manual pumping, respectively; and 16.45 (±1.27) and 17.27 (±3.69) with a lithotripsy basket under gravity irrigation and manual pumping, respectively. With an 11/13 UAS, the mean IRP was 15.41 (±8.57) and 19.33 (±4.26) under gravity and manual pumping irrigation, respectively; 14.56 (±2.50) and 18.64 (±5.13) with a laser in each irrigation setting, respectively; and 13.10 (±3.39) and 13.86 (±4.63) with a lithotripsy basket, respectively. With a 12/14 UAS, the mean IRP was 7.64 (±3.08) and 9.25 (±1.42) under gravity and manual pumping irrigation, respectively; 9.50 (±6.04) and 10.28 (3.46), respectively, in each setting when the laser fiber was used; and 5.32 (±1.57) and 6.26 (±1.79), respectively, when the lithotripsy basket was inserted. (4) Conclusion: Novel flexible ureteroscopes with integrated pressure sensors are both a feasible and reliable tool during fURS, giving the surgeon the ability to live-track the IRP. The results of the IRP measurements with and without UAS are in accordance with the current literature and exhibit a consistent pattern with previous studies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal stones. One potentially significant complication of PCNL is blood loss, which can result in transfusion requirement and poorer stone-free outcomes. Tranexamic acid (TXA) has emerged as a promising intervention, administered systemically (TXA-S) or as part of irrigation fluid (TXA-I) in endourology. This study aimed to comprehensively analyze existing evidence regarding the applications of TXA in PCNL through a Bayesian network meta-analysis, offering insights into its efficacy and comparative effectiveness. METHODS: In February 2022, a PRISMA-compliant systematic review (PROSPERO registration number CRD42021270593) was performed to identify randomized controlled clinical trials (RCT) on TXA as either systemic therapy or in irrigation fluid. Studies in languages other than English and Spanish were not considered. A Bayesian network was built using results from identified studies to create models that were later run through Markov Chain Monte Carlo sampling through 200 000 iterations. RESULTS: Eight RCTs compared TXA-S vs. placebo, one TXA-I vs. placebo, and one TXA-I vs. TXA-S. TXA-I had lower risk of transfusion (relative risk [RR] 0.63 [0.47,0.84], SUCRA 0.950) than TXA-S (RR 0.79 [0.65,0.95], SUCRA 0.545). TXA-I had a lower risk of complications (RR 0.38 [0.21,0.67], SUCRA=0.957) compared to TXA-S (RR 0.55 [0.39, 0.78], SUCRA 0.539). TXA-I had a lower postoperative decrease in hemoglobin (mean difference [MD] -1.2 [1.3, 1.0], SUCRA 0.849) compared to TXA-S (MD-0.97 [-1.0, -0.93], SUCRA 0.646]). CONCLUSIONS: TXA, regardless of the route of administration, is an effective intervention in decreasing bleeding, postoperative complications, and risk of transfusion when compared with placebo. Further studies directly comparing TXA-S to TXA-I would be useful to determine the optimal route of delivery. [ABSTRACT FROM AUTHOR]

Aim: To investigate the dynamic recovery of biofilms within dentinal tubules after primary irrigation with different protocols, and to evaluate the efficacy of various re‐irrigation protocols on recovered biofilm, considering factors such as smear layer, nutrient conditions, and primary irrigants. Methodology: A total of 416 mono or multi‐species biofilms samples were prepared from human teeth and incubated for 3 weeks. After inducing a smear layer on half of the samples, all specimens were irrigated with one of the following irrigant sequences: (1) 6% NaOCl +17% EDTA, (2) 6% NaOCl +8.5% EDTA, (3) 6% NaOCl and (8.5% EDTA +10 μg/mL DJK‐5 antimicrobial peptide), or (4) sterile water. Thirty‐two samples were used to assess immediate effect, whilst the rest were re‐incubated to assess biofilms recovery. Nutrient conditions were defined based on whether culture media were changed (nutrient‐rich) or not (nutrient‐poor) during re‐incubation. After 16 weeks, recovered biofilms underwent re‐irrigation using four additional protocols, with or without DJK‐5 peptide, based on primary irrigants. Confocal laser scanning microscopy was employed to evaluate immediate irrigant effects, biofilms recovery intervals (1, 3, 5, 8, 12, and 16 weeks after primary irrigation), and re‐irrigation effects at the 16‐week. Statistical analysis included one‐way anova and two‐way mixed anova tests. Results: The DJK‐5 peptide irrigation protocols demonstrated the highest killing rates during primary irrigation and resulted in a longer biofilms recovery time of 16 weeks compared to non‐peptide protocols (p <.001). Both primary irrigation type and smear layer presence significantly influenced biofilms recovery (p <.001). In the absence of smear layer, re‐irrigation efficacy didn't significantly differ from primary irrigation, regardless of primary irrigation type or nutrient conditions. However, with a smear layer present, re‐irrigation led to significantly higher proportion of dead bacteria compared to primary irrigation (p <.05). Inclusion of the DJK‐5 peptide into the re‐irrigation protocol displayed superior killing rate compared to other protocols (p <.001). Conclusions: Biofilms exhibited susceptibility to both peptide and non‐peptide protocols during re‐irrigation, irrespective of nutrient conditions or primary irrigation protocols. The DJK‐5 peptide irrigation protocols consistently displayed superior effectiveness compared to non‐peptide protocols. [ABSTRACT FROM AUTHOR]

Aim: This study was twofold: (i) it aimed to investigate the morphometric changes of three temperature‐sensitive nickel–titanium (NiTi) instruments at different temperatures, and (ii) to conduct an in vivo real‐time analysis of intracanal temperature changes. Methods: Changes in the shape and length of XP‐Endo Shaper, XP‐Endo Finisher, and XP‐Endo Finisher‐R were evaluated in real time whilst heated in a temperature‐controlled water bath from 22 to 45°C. Instruments were fixed to a laminated water‐resistant 1 mm graph paper attached to a stone block. Instruments were imaged whilst subjected to increasing temperature using a digital camera attached to an operating microscope. From recorded videos, still frames were extracted at 10‐s intervals and changes in the length and shape of each instrument were measured and changes were plotted against time. Moreover, the intracanal temperature of distal roots of lower molars was measured in vivo for patients attending the clinic for non‐surgical root canal treatments. The temperature was measured using a K‐type thermocouple probe inserted into the mid‐root level after irrigating the canal with a solution set at room temperature (22°C) or heated to 45°C. The intraoral and intracanal temperatures were recorded using a video camera for 180 s at 5‐s intervals to plot the change in the intraoral and intracanal temperature, after both irrigation solution temperatures, with time. Results: The shape transformation of XP‐Endo Shaper began at 31.5 ± 2.0°C and reached its optimal transformation at 35.1 ± 1.0°C. For the Finisher and Finisher‐R, shape transformations began at 29.2 ± 1.9 and 26.9 ± 2.2°C reaching the optimal transformation at 33.9 ± 1.4 and 32.7 ± 1.7°C, respectively. The average decreases in lengths of XP‐Endo Shaper, Finisher, and Finisher‐R after full transformation were 0.43 ± 0.23, 1.07 ± 0.22, and 1.15 ± 0.22 mm, respectively. The intracanal temperature reached 32.9 ± 0.8 and 33.2 ± 1.0°C after 3 min of application of irrigation solutions set at 22 or 45°C, respectively. Conclusion: The tested instruments exhibited diverse changes in their shapes and lengths at varying temperatures. Despite the temperature of the irrigation solution, the intracanal temperature consistently remained lower than the intracanal temperature once equilibrium was reached. This highlights the importance of considering the temperature of irrigation solution during in vitro testing of endodontic instruments. [ABSTRACT FROM AUTHOR]

Pain often occurs after root canal treatment due to unavoidable mechanical or chemical damage. The purpose of the present study was to investigate the efficacy of a nickel-titanium (NiTi) device combined with ultrasonic irrigation and multiple antibiotic creams in the treatment of periapical inflammation of deciduous teeth, so as to improve the understanding of root canal treatment and optimize clinical practice. Evaluation of efficacy was conducted using X-rays and the Visual Analog Scale. This treatment significantly reduced pain and also improved patient compliance and treatment outcomes. The findings of the present study may have scientific and clinical significance for optimizing root canal treatment in pediatric dentistry and requires further in-depth research in clinical practice. These outcomes may provide potential new ideas and directions for improving patients' quality of life and the efficacy of clinical treatment and have further impacts on future related research and medical practice. [ABSTRACT FROM AUTHOR]

Statement of the Problem: During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness. Purpose: This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants. Materials and Method: Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA). Results: All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43± 1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study. Conclusion: Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants. [ABSTRACT FROM AUTHOR]

Featured Application: All-on-4 dental implants provide support for an entire dental arch. They are inserted in properly mineralized regions of the alveolar bone, and their performance depends on accurate positioning and angulation. Surgical guides ensure accurate implant placement, but they block the access of the irrigation fluid during surgical drilling. In this study, guided drilling was performed sequentially, in four target sites, with gradually increased diameters, according to the All-on-4 dental implant procedure. We monitored intraosseous temperatures next to each osteotomy, in the presence of two types of surgical guides: a classical guide, composed of a splint with a cylindrical sleeve, and a guide with internal cooling, which (i) incorporates an irrigation channel that orients the coolant jet toward the drill's point of entry into the target tissues and (ii) provides space for the evacuation of the irrigation fluid. The results of this study point to the use of surgical guides with internal cooling as the most effective method. Dental implant bed preparation involves surgical drilling. Heat generated in this process can cause a temperature elevation beyond the bone damage limit (10 °C), affecting the osseointegration of the implant. Surgical templates ensure accurate implant placement, but they limit the access of the irrigation fluid. This study evaluated the hypothesis that surgical guides with internal cooling prevent bone heating more effectively than classical guides. To eliminate biological variability, this study was conducted on artificial bone pieces that mimic the bone density of the human mandible. We created a surgical template that incorporated four pairs of guides—one classical (CLA) and one with internal cooling (INT) in each pair. For each specimen, we randomly selected the type of surgical guide to start with and performed four osteotomies with a 2.7 mm-diameter drill; then, we widened each hole with a 3.3 mm drill and finalized it with a 3.7 mm drill. The temperature was recorded by thermocouples placed at 0.8 mm from the prospective edge of the final osteotomy. In 168 measurements (12 osteotomies on 14 specimens) conducted for each type of surgical guide, the mean temperature rise was 7.2 ± 4.9 °C (mean ± standard deviation) for CLA and 5.0 ± 3.8 °C for INT. The mean differences between temperature elevations were 1.5 °C, 2.1 °C, and 3.0 °C for the first, second, and third drill, and they were statistically significant: the p-values of Student's t-test were 0.004, 0.01, and 0.001, respectively. Although the mean temperatures remained safe, temperature rises exceeded 10 °C in 23.8% (9.5%) of the osteotomies performed in the presence of CLA (INT). Taken together, our results suggest that surgical guides with internal cooling ensure a significant drop in the temperature rise caused by implant site drilling. [ABSTRACT FROM AUTHOR]

Copyright of China Rural Water & Hydropower is the property of China Rural Water & Hydropower Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

(1) Background and Objectives: Catheter-related bladder discomfort (CRBD), a common and distressing consequence of indwelling urinary catheters, can significantly impact postoperative recovery. This study aimed to determine the effectiveness of bladder irrigation with a 0.05% lidocaine normal saline solution for the prevention of CRBD following transurethral surgery. (2) Materials and Methods: In this randomized, double-blind, placebo-controlled trial, patients were assigned to either a control group receiving normal saline or a treatment group receiving 0.05% lidocaine (2% lidocaine 25 mL in 1000 mL saline) for bladder irrigation. Both groups were administered fentanyl (1 μg/kg) for analgesia at the end of the procedure. The primary endpoint was the assessment of the incidence and severity of CRBD upon awakening within the first 6 h postoperatively, using a four-grade scale based on the patients' reports of discomfort. (3) Results: Out of 79 patients completing the study, the incidence of moderate to severe CRBD was significantly lower in the lidocaine group (5.1%, 2/39) compared to the control group (25%, 10/40) at 10 min after waking from anesthesia (p = 0.014). Furthermore, the lidocaine group experienced significantly less CRBD at 1 and 2 h postoperative (2.6% and 0%, respectively) compared to the control group (20% and 10%, respectively) (p = 0.015, p = 0.043), with no significant differences at 6 h (p = 0.317). (4) Conclusions: The results suggest that bladder irrigation with 0.05% lidocaine reduces the occurrence of moderate to severe CRBD by nearly 80% in the initial 2 h postoperative period after transurethral surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the efficacy of different techniques in removing calcium silicate intracanal medicament (Bio-C Temp). Forty human single-canaled premolars were randomly distributed into five groups (n = 8). All root canals were instrumented, then filled with Bio-C Temp. Following 1-week incubation, the intra-canal medicament was removed using one of five techniques according to tooth group: conventional syringe irrigation, Endo Activator, passive ultrasonic irrigation (PUI), ProTaper Universal F3 and XP-endo Finisher (XPF). Micro-CT scanning was performed before and after removal of Bio-C Temp. All techniques significantly reduced the volume of Bio-C Temp (p < 0.001) without reaching complete elimination. The percentage of Bio-C Temp removed was significantly higher in the XPF group (98.2%) compared to conventional syringe irrigation (70.6%), the Endo Activator (75.7%), and the ProTaper Universal (76.6%). There was no significant difference between the XPF and PUI (95.1%) groups. None of the removal techniques were able to completely remove Bio-C Temp from the root canal. However, XPF was the most effective method, but was not statistically significant when compared to PUI. Clinical Relevance: This study demonstrated that both XPF and PUI outperform conventional irrigation in removing Bio-C Temp intracanal medicament. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the effect of different irrigation activation methods on root canal sealer penetration in teeth with simulated internal root resorption (IRR) and calcium hydroxide (CH) applied using a confocal laser scanning microscope (CLSM). 60 incisors with a single root and a single canal were included in the study. IRR cavities were created in the middle third of the root canal, and CH was placed. The samples were randomly divided into 4 groups (n = 15) according to the irrigation activation method to be tested: standard needle irrigation (SNI), sonic activation (EDDY), photon-induced photoacoustic flow (PIPS), and shock wave enhanced emission photoacoustic flow (SWEEPS). After irrigation activation applications, the root canals were obturated. Sections of 1.0 ± 0.1 mm were taken from the apical, middle, and coronal regions of each sample. The penetration area (µm2) and maximum penetration depth (µm) of the root canal sealer were examined by CLSM and analyzed using ImageJ software. Statistical analysis was performed with a one-way ANOVA and post-hoc Tukey test at the P < 0.05 significance level. Among all irrigation activation methods tested, both the penetration area and maximum penetration depth of the root canal sealer were greater in the coronal region than in the apical region (p < 0.05). In the IRR region, there was no difference in terms of maximum penetration depth between PIPS and SWEEPS (p > 0.05), it was highest in SWEEPS (p < 0.05). PIPS and SWEEPS were better than other irrigation activation methods in the penetration of root canal sealer in the resorption areas of teeth with IRR. [ABSTRACT FROM AUTHOR]

Background: Vital pulp therapy maintained functionality, vitality, and asymptomatic teeth. Compared to normal root canal treatment, pulpotomy was more helpful for irreversible pulpitis in adult permanent teeth. The research was aimed to assess effectiveness of vital pulp therapy using mineral trioxide aggregate with Apple Vinegar and Ethylene diamine tetra acetic acid (17%) for five minutes in adult carious exposed pulp of permanent teeth. Methods: Forty patients between 18 and 50 years old with a clinical diagnosis of symptomatic irreversible pulpitis but no periapical radiolucency were then divided randomly into two groups based on the irrigation method; ethylene diamine tetraacetic acid or apple vinegar. If pulpal bleeding could not be managed in less than six minutes, the assigned procedure was abandoned. After mineral trioxide aggregate application as a pulpotomy agent, glass ionomer and composite restoration were placed. Using a visual analogue scale, the pre and post-operative pain were recorded after 2,6,24,48, and 72 h. Success was assessed using radiographic and clinical examination data at three, six, and twelve months. Results: The success rate was discovered to be non-statistically significant in both groups after a year follow-up. Apple vinegar had a lower mean value than ethylene diamine tetra acetic acid at the preoperative baseline pain level, which was significant.Postoperatively, the ethylene diamine tetraacetic acid group reported the greatest mean value after two hours while Apple vinegar group reported the lowest mean values after 48 h (P < 0.05). After 72 h, pain level recorded insignificant difference. Conclusion: Apple vinegar yielded a marginally successful outcome but substantially improved pain alleviation. Trial registration: The trial was registered in Clinical trials.gov with this identifier NCT05970536 on 23/7/2023. [ABSTRACT FROM AUTHOR]

Objective: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. Results: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. Conclusion: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decades, arthroscopic surgery has become increasingly relevant as its minimally invasive approach offers many benefits. To investigate the risks of orthoscopic surgery at the elbow, this study aimed to investigate the development of temperatures in elbow joints while performing radiofrequency ablation in arthroscopic surgery. Materials and methods: We performed standard arthroscopic surgeries with posterolateral, transtricipital and anterolateral approaches on seven cadaveric elbows and performed ablation on predefined locations with or without irrigation. Two temperature probes were positioned into the olecranon fossa and between the ulnar nerve and the medial joint capsule. The temperature data were recorded using a real-time data logger. A bipolar radiofrequency ablation (bRFA) device was used at the medial and lateral recess and in the fossa olecrani over a defined period. Data was then analyzed using Matlab. Results: Using bRFA without irrigation results in rapidly increasing temperature within the joint. A significant temperature increase was found within only 5 s without irrigation (p = 0.0052) in the fossa olecrani. We did not observe critical temperatures above 41 °C close to the ulnar nerve within 30 s under constant irrigation (p = 0.0747). Conclusions: Radiofrequency ablation (RFA) can be safely used in elbow arthroscopy with irrigation. The continuous use without irrigation should be limited to 3 s. Despite the anatomical proximity of the ulnar nerve and capsule, we were able to show that a possible rise in temperature most likely does not affect the ulnar nerve. [ABSTRACT FROM AUTHOR]

Background: Chronic apical periodontitis is a persistent inflammatory condition affecting the periapical tissues of a tooth. Effective disinfection of the root canal system is crucial for successful endodontic treatment. This study aims to compare the efficacy of ultrasonic irrigation (UI) and laser-activated irrigation (LAI) in promoting healing in chronic apical periodontitis. Materials and Methods: A total of 100 patients diagnosed with chronic apical periodontitis were randomly assigned to two groups: the UI group (n=50) and the LAI group (n=50). Patients in the UI group received endodontic treatment using ultrasonic irrigation, while those in the LAI group received treatment with laser-activated irrigation. The primary outcome measure was the reduction in periapical lesion size, assessed using digital radiographs at baseline, 3 months, and 6 months post-treatment. Secondary outcomes included pain reduction and overall treatment success, defined as the absence of clinical symptoms and radiographic evidence of healing. Results: At the 3-month follow-up, the UI group showed a 60% reduction in periapical lesion size, while the LAI group exhibited a 75% reduction. At the 6-month follow-up, the UI group demonstrated an 80% reduction, and the LAI group achieved a 90% reduction in lesion size. Pain scores decreased significantly in both groups, with the LAI group reporting a more rapid decline in pain levels. Overall treatment success was observed in 85% of patients in the UI group and 95% in the LAI group at the 6-month follow-up. Conclusion: Both ultrasonic irrigation and laser-activated irrigation are effective in promoting healing in chronic apical periodontitis. However, laser-activated irrigation showed superior outcomes in terms of periapical lesion size reduction and overall treatment success. These findings suggest that LAI may be a more effective adjunctive technique in endodontic therapy for chronic apical periodontitis. [ABSTRACT FROM AUTHOR]

Background: Given the lack of an ideal endodontic irrigant on the market, this study evaluates the antimicrobial potential of a formulated solution of 2′-fucosyllactose and lacto-N-neotetraose against E. faecalis within infected root canals, and explores any associated impacts related to the duration of irrigation. Methods: 32 single-rooted teeth extracted for periodontal reasons were infected with Enterococcus faecalis, and subsequently subjected to endodontic treatment with two different irrigation systems: sodium hypochlorite or a solution of 2′-fucosyllactose and lacto-N-neotetraose. These samples were then incubated in sterile culture media at 37 °C to observe microbial activity through turbidity. The culture broth of each individual sample was assessed as positive or negative by observing the turbidity or lack of turbidity in the culture at the time of evaluation. Results: the analysis of the results obtained from the comparison of groups irrigated with sodium hypochlorite or a solution of 2′-fucosyllactose and lacto-N-neotetraose demonstrates that the case solution has no bactericidal effect against E. faecalis inoculated in the endodontic system. Conclusions: the HMOs used in this study do not have a bactericidal effect on E. faecalis inoculated in an endodontic system. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the application of choledochoscopy combined with double-cannula lavage in the treatment of acute pancreatitis (AP) with encapsulated necrosis and analyzed related inflammatory indexes. Methods: Thirty patients with AP with encapsulated necrosis were enrolled and treated with choledochoscopy and double-cannula lavage. Serum white blood cell (WBC), procalcitonin (PCT), C-reactive protein (CRP), interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha (TNF-α), and related inflammatory indexes were detected before and after surgery. Results: All of the participants who underwent the surgery recovered well and were discharged without serious complications; no deaths occurred. The serum WBC, PCT, and CRP of patients after surgery decreased compared with before the procedure, and the differences in WBC and CRP were statistically significant (P < 0.05); the difference in PCT was not statistically significant (P > 0.05). Postoperatively, IL-6, IL-8, and TNF-α levels were higher than before surgery, and the differences were statistically significant (P < 0.05). Conclusion: The surgical method presented herein effectively controlled and alleviated the infection of patients; it also did not increase the risk of infection and can thus be considered a safe and effective surgical method. [ABSTRACT FROM AUTHOR]

(1) Background: Aquafilling, a filler initially designed for contouring the face, was developed in 2005 by the company Biomedica, Czech Republic. It is composed of 98% hydrophilic gel and 2% copolyamide. Since 2008 the use was expanded for augmentation of the breast and gluteal region. It is suitable as a nonsurgical method for patients who want discreet augmentation and would like to avoid undergoing an operation. This method promises long-term results lasting up to 10 years. However, according to the literature Aquafilling gel can cause long-term complications; (2) Methods: This case report presents a male patient who experienced severe complications following Aquafilling injections for breast augmentation after ten years of treatment; (3) Results: A 51-year-old male patient presented to our emergency room with complaints of pain, firmness, major pre-pectoral swelling and asymmetry in his breasts. Due to the severity of the clinical appearance and the patient's discomfort, surgical intervention was deemed necessary. After undergoing three operations the patient was treated successfully and could be discharged for outpatient controls. The patient still did not show any signs of complications, three months after the event; (4) Conclusions: Although the patient has made a rapid recovery, as a result of the surgical procedure, we would recommend treating the breast region with small incisions and drainage in the future. This would have a better aesthetic result. Still there is no antidote available for the treatment of Aquafilling gel. It can only be removed by surgical debridement or irrigation and drainage. [ABSTRACT FROM AUTHOR]

Background: To compare retention times of various ophthalmic viscosurgical devices (OVDs) and soft‐shell combinations. Methods: Experimental study. Eighteen rabbit eyes were divided into six groups of three eyes, based on OVDs tested. A: Endocoat, B: HealonPro, C: Viscoat, D: Provisc, E: Endocoat and HealonPro and F: Viscoat and Provisc. OVDs were stained with 10% fluorescein dye before being injected into the anterior chamber. Phacoemulsification, using fixed parameters, was performed. If OVD persisted after 60 s, a standardised irrigation and aspiration technique replaced phacoemulsification. The time until central and complete clearance of the OVD were video‐recorded and measured. Results: Mean central retention times (CRT) were found to be: HealonPro—5.33 ± 2.56 s, Provisc—3.33 ± 1.11 s, Endocoat—75.0 ± 3.26 s, Viscoat—62.33 ± 5.19 s, combining HealonPro with Endocoat—22.67 ± 4.75 s and Provisc with Viscoat—11.0 ± 0.82 s. The mean total retention time (TRT) was: Endocoat—80.0 ± 8.17 s, Viscoat—81.67 ± 2.09 s, HealonPro with Endocoat—81.33 ± 3.35 s, and Provisc with Viscoat—71.0 ± 2.94 s. For HealonPro and Provisc, CRT and TRT remained identical across all trials. Conclusions: Retention times varied, with cohesive OVDs exhibiting shorter durations than dispersive OVDs. Among dispersive OVDs, TRTs were comparable; however, Endocoat displayed an extended CRT. In soft shell trials, the combination of HealonPro and Endocoat exhibited prolonged CRT and TRT, suggesting enhanced corneal protection. [ABSTRACT FROM AUTHOR]

Objective: Intraventricular hemorrhage (IVH) of prematurity occurs in 20–38% of infants born < 28 weeks gestational age and 15% of infants born in 28–32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL. Methods: We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL. Results: Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels. Conclusions: A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) poses a substantial postoperative challenge, affecting patient recovery and healthcare costs. While surgical wound irrigation is pivotal in SSI reduction, consensus on the optimal method remains elusive. We developed a novel device for surgical wound irrigation and conducted preclinical and clinical evaluations to evaluate its efficacy and safety. Two preclinical experiments using swine were performed. In the washability test, two contaminated wound model were established, and the cleansing rate between the device and the conventional method were compared. In the contamination test, the irrigation procedure with a fluorescent solution assessed the surrounding contamination of drapes. Subsequently, a clinical trial involving patients undergoing abdominal surgery was conducted. The washability test demonstrated significantly higher cleansing rates with the device method (86.4% and 82.5%) compared to the conventional method (65.2% and 65.1%) in two contamination models. The contamination test revealed a smaller contaminated region with the device method than the conventional method. In the clinical trial involving 17 abdominal surgery cases, no superficial SSIs or adverse events related to device use were observed. Our newly developed device exhibits potential for achieving more effective and safe SSI control compared to conventional wound irrigation. [ABSTRACT FROM AUTHOR]

The purpose of the study: to study the surface irrigation method, as well as to obtain the necessary results about the optimal irrigation regimes needed during the study, as well as to prepare a set of ideas and concepts about this method and its special effectiveness in the design of species related to this method. Methodology of the research: the methodology of the research involves reviewing the literature related to surface irrigation, investigating the application of surface irrigation and its types, and based on these, determining the most optimal regime and also the suitability indicators for the plant to be applied and which areas. The applied importance of the research: the applied importance of the research is to select the optimal surface irrigation method suitable for certain areas and agricultural plants, and to learn the features of organizing sustainability in the design of this method even after the design of this method by achieving the efficiency due to the design of the surface irrigation method. The results of the research: the characteristics and indicators obtained in the research and design of surface irrigation methods and types, the negative and positive aspects of the characteristics of this method and its types, as well as the steps to be taken to solve the problems that arise in the design, the changes in the characteristics of water during the methods of this method. Scientific innovation: to increase efficiency and productivity by applying hydroaggregates in the surface irrigation method, to organize the joint activity of this method and the irrigation techniques of this method, and to develop a new integrated application technique by carrying out the integrated application of other irrigation types and irrigation types with aggregates. Also, to create a new manifestation of innovation, to obtain innovations in the organization of this irrigation method. [ABSTRACT FROM AUTHOR]

There are three therapeutic modalities in the Unani medical system: Ilaj bit Tadbeer (Regimenal Therapy), Ilaj bid Dawa (pharmacotherapy), and Ilaj bil Yad (surgery). Ilaj bit Tadbeer includes several regimenal therapies such as Hijāma (Cupping Therapy), Ta'līq or Irsal-e-'Alaq (Leech Therapy), Fasd (Venesection), Dalk (Massage), Nutūl (Therapeutic Irrigation), Qai (Emesis), Idrār-i-Bawl (Diuresis), Tariq (Diaphoresis), Mundij wa Mu'shil therapy (Concoction and purgation), Bukhoor (Medicated Steam), Kaiyy (Cauterization), Huqna (Enema) etc. Since ancient times, these therapies have been widely used for their preventive, therapeutic, and rehabilitative effects. One of the most significant regimenal therapies, Irsal-e-Alaq (Leech therapy), is still in use. Renowned Unani physicians Razi, Majoosi, Zahrawi, and Ibne Sina have discussed and recommended the use of non-poisonous (or medicinal) leeches in the prevention and treatment of a variety of illnesses, including joint disorders, chronic non-healing ulcers, and numerous skin disorders like eczema, p [ABSTRACT FROM AUTHOR]

Copyright of Journal of Spine Research is the property of Japanese Society for Spine Surgery & Related Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Syringe irrigation, commonly used for delivering sodium hypochlorite (NaOCl) during root canal treatment, requires careful handling to prevent NaOCl extrusion into periapical tissues. This randomised controlled in vitro study aimed to quantify syringe plunger forces exerted by dental undergraduates and to assess the impact of an educational intervention on adherence to safe irrigant delivery parameters. Methods: Fifty-two undergraduates performed syringe irrigation at three intervals: baseline (T1), after two weeks (T2), and after 12 weeks (T3). At T1, irrigation was conducted without prior educational intervention, while at T2, it was preceded by an intervention. The educational intervention involved a short video highlighting safe irrigation practices, including plunger force and time recommendations for syringe irrigation. At T3, the undergraduates were randomly allocated to two groups: One received a repeated intervention, while the other did not. Syringe irrigation was performed on a 3D-printed tooth using two side-vented cannulas: one of 25 Gauge (G) and another of 30 G. A syringe equipped with a force sensor recorded the plunger forces. Based on earlier research, plunger forces exceeding 10 Newtons (N) for the 25 G cannula and 40 N for the 30 G cannula were deemed critical. The data were subjected to descriptive statistical analyses. Results: Overall, the mean of maximum values of plunger forces remained under 10 N for the 25 G and below 20 N for the 30 G cannulas, with only a few measurements exceeding 40 N. Instances of surpassing the critical plunger force threshold were more common with the 25 G side-vented cannula than with the 30 G variant. At T3, the group that received the repeated educational intervention exhibited lower average maximum plunger forces for both cannulas than the group that did not receive the intervention. Conclusion: Integrating plunger force measurements with targeted educational interventions presents an effective approach for instructing undergraduates in the proper techniques of syringe irrigation. The findings suggest that, generally, undergraduates do not apply excessive plunger forces that could risk apical irrigant extrusion. Implementing repeated educational interventions decreased the plunger forces exerted by undergraduates, underscoring its effectiveness in fostering safe endodontic irrigation. [ABSTRACT FROM AUTHOR]

(1) Background: This study aimed to evaluate how laser-activated irrigation (LAI) influences the retention of a fiber post when used before an endodontic filling, as well as after post space preparation. (2) Materials and Methods: Sixty freshly extracted human incisors were selected. The teeth were randomly assigned to three groups—CONVENTIONAL (CONV), PIPS or SWEEPS—and treated endodontically. Each group received irrigation with 1 × 5 mL EDTA (17%) and 3 × 5 mL NaOCl (5.25%). In the first group, the irrigants were not activated, while in the second and third group, LAI was adopted using PIPS and SWEEPS protocols (Lightwalker from Fotona, Ljubliana, Slovenia). After post space preparation, each group received the same irrigation protocol initially established. Sticky posts (everStick Post, GC AUSTRIA GmbH Swiss) were individually adapted to the corresponding post spaces and cemented using dual cure resin cement (Gradia Core, GC Austria GmbH Swiss). All specimens were vertically embedded into self-curing acrylate (Duracryl plus, Spofa Dent, Europe), and each was sectioned into three segments of type A and type B samples for debonding through push-out and pull-out tests. The results were statistically analyzed. (3) Results: The pull-out test showed the superiority of the SWEEPS group, with a mean fracture force of 133.0 ± 50.7 N, followed by the PIPS group, with 102 N, with a lower standard deviation of ± 34.5 N. The CONV group registered the lowest fracture force. Concerning the push-out test, the SWEEPS group showed superior shear stress in comparison to the other two groups (13.45 ± 4.29 MPa); the CONV group was inferior, with shear tension values of 8.31 ± 4.67 MPa. (4) Conclusions: It can be stated that the SWEEPS and PIPS protocols resulted in considerably higher fiber post retention than the conventional method, whereas the SWEEPS protocol was superior to the PIPS protocol. [ABSTRACT FROM AUTHOR]

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The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy. [ABSTRACT FROM AUTHOR]

Tooth auto transplantation is becoming a predictable method to replace a missing tooth, especially in young patients, with many benefits. This case report presents a 14-year-old male with an un restorable, decayed mandibular first molar with bifurcation and periapical lesions. After the extraction, the socket was debrided and prepared for an immediate auto transplantation of the immature mandibular third molar. Radiologic and clinical follow‑up for 1 year showed periodontal healing with the absence of any complications despite the auto transplantation into an infected site. Thus, third-molar auto transplantation was a good solution to replace an un restorable first molar with a satisfactory result. Despite the existence of periradicular lesion, the curettage, debridement, and irrigation were enough to perform successful immediate tooth auto transplantation in this case. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Maintaining an adequate temperature at the target site is essential for effective ablation. We hypothesized that a tissue temperature‐controlled (T‐Con) catheter for cavotricuspid isthmus (CTI) ablation could improve the procedural ablation parameters.To evaluate the efficacy and safety of the T‐Con (DiamondTemp™) catheter for CTI ablation compared with non‐irrigation (Non‐Irri) and irrigation (Irri) catheters.We analyzed 150 patients who underwent prophylactic CTI ablation combined with pulmonary vein isolation. The Non‐Irri, Irri, and T‐Con catheter groups comprised 50 patients each, and the ablation procedural parameters and complications were compared between these groups.There were no significant differences in clinical background characteristics among the three groups. The Kruskal–Wallis and post hoc tests demonstrated that the T‐Con group showed the lowest total radiofrequency energy delivery time among the three groups (median [25 and 75 percentiles]: 340 [209, 357], 147 [100, 199], and 83 [61, 109] s, respectively in the Non‐Irri, Irri, and T‐Con groups; T‐Con versus Non‐Irri, p < .01; T‐Con versus Irri, p < .01). The total procedural time and acute reconnection rate in the T‐Con group (264 s and 4%, respectively) were lower than those in the Non‐Irri group (438 s and 24%) but were similar to those in the Irri group (268 s and 6%). No significant complications were observed in any group.The T‐Con catheter achieved a short energy delivery time and a low acute reconnection rate, indicating its potential as an alternative catheter for CTI ablation. [ABSTRACT FROM AUTHOR]

Needle syringe irrigation is frequently used in root canal therapy, and the flow pattern during irrigation can be efficiently manipulated by means of passive flow control technique, resulting in expected irrigation performance improvement. Therefore, novel needles with composite flow control structures are numerically investigated and optimized in this study. Based on the 30G needle, six single/double side‐vented needles with dimple and protrusion are proposed. Two flow rates in line with clinical applications, 5.3 and 8.6 m/s, are used in the analysis. Three performance parameters are investigated. The safety of the irrigation system is evaluated by the root canal apical pressure, whereas the irrigant extension and the flushing efficiency are evaluated by the extending depth and the effective cleaning area, respectively. The results demonstrate that the shear stress of the double‐side‐vented needle is higher while the irrigant extension is enhanced with a dimple structure. The performance of the double‐side‐vented needle with a dimple is superior to that of other designs, with up to 33% improvement in extending depth and a 22% increase in effective cleaning area over the prototype. New needles do not raise risk of irrigant extrusion. Furthermore, the effect of dimple depth and outlet angle are investigated. The needle with a dimple of 0.04 mm depth shows the highest extending depth within the confines of the investigation. The effective cleaning area is significantly influenced by the needle outlets, and the effective cleaning area expands with an increase in needle outlet angle, while the extending depth gradually declines. [ABSTRACT FROM AUTHOR]

Object: To evaluate the effectiveness of selective bipolar plasmakinetic technology based on bladder irrigation fluid color on hemostasis in HoLEP surgwery Methods: A total of 209 patients who underwent HoLEP surgery from October 2021 to July 2023 were included and divided into Hemostasis Management Group and control group. the color of the irrigation fluid was categorized into 5 levels and the bipolar plasmakinetic technology was applied when the color came to level 4 or up. The following was analyzed: postoperative use of balloon compression, blood loss, irrigation time, length of hospital stay, and the number of a second operation. Results: Only 4 patients in Hemostasis Management Group required postoperative urinary catheter balloon compression, while there are 15 in the control group(p=0.03). The average irrigation time for patients in the HM Group with bipolar plasmakinetic hemostasis was 21.88±13.76 hours, compared to that in patients with catheter balloon compression(p=0.007). Conclusion: Based on the bladder irrigation color chart, the selective application of bipolar plasmakinetic hemostasis led to a significant reduction in the number of patients requiring postoperative bladder catheter balloon compression. Secondly, the irrigation time of patients who underwent bipolar plasmakinetic hemostasis also decreased. [ABSTRACT FROM AUTHOR]

Purpose: To report real-time IRP and FR while performing flexible ureteroscopy in porcine kidney model utilizing LithoVue™ Elite (Boston Scientific®) with different irrigation systems, including automated pumps. Methods: Using an ex-vivo model of porcine kidney, IRPs were measured with LithoVue Elite. Ureteroscopic settings (US) were tested with all permutations of irrigation methods (IM), working channel occupant (WCO), and ureteral access sheaths (UAS). IMs included: Single Action Pumping System (SAPS™, Boston Scientific), Thermedx FluidSmart™ (Stryker®), and ENDOMAT™ (Karl Storz®). Pumps were tested at 50, 100, and 150 mmHg. WCOs included a 1.9Fr zero-tip basket, 200 µm, and 365 µm laser fibers. UASs utilized 11/13Fr and 12/14Fr 36 cm. Results: 84 different US were tested (252 experiments). ENDOMAT had higher IRP but the same FR as Thermedx at the same US for 50 and 100 mmHg (p < 0.01). SAPS had higher IRP and FR than pumps in all US studies (p < 0.01). There was positive correlation between pressure set by the pump and both IRP and FR (rho > 0.9). As the diameter of the WCO increased, lower IRP and FR were observed with the pumps (p < 0.01). With SAPS, IRP was similar regardless of WCO, but FR was decreased with the increased diameter of WCO (p = 0.81 and p < 0.01, respectively). There was significantly higher IRP when using 11/13Fr UAS than 12/14Fr (p < 0.01). Conclusion: IRP was higher with SAPS than automated pumps. ENDOMAT showed higher IRP than Thermedx when under 150 mmHg. IRP and FR increase with higher pump pressure and decrease with larger diameter WCO. Likewise, a larger UAS significantly reduced IRP. [ABSTRACT FROM AUTHOR]

Purpose: Transduodenal surgical ampullectomy (tAMP) with papillary reimplantation is a valid alternative to pancreaticoduodenectomy for lesions of the periampullary region not amenable to endoscopic resection. As tAMP is burdened by high rates of biliopancreatic-enteric anastomotic leak, we tested preventive endoluminal vacuum therapy (eVAC) combined with post-operative continuous perianastomotic irrigation (CPI) to reduce such anastomotic leak. Methods: Between 10/2013 and 09/2023, 37 patients undergoing laparotomic tAMP (with or without jejunal transposition) and papillary reimplantation at Hirslanden Klinik Zurich were retrospectively analysed; of these, 16 received prophylactic eVAC combined with CPI, while the remaining represented the historical cohort. Results: The eVAC-CPI-group and the historical-cohort were homogeneous in demographic characteristics. Surgery in the prophylactic eVAC-CPI-group lasted about 30 min longer due to eVAC application (p = 0.008). The biliopancreatico-enteric anastomotic leak rates were 6.2% in the eVAC-CIP-group vs. 19.0% in the historical-cohort (p = 0.266). Along, a strong trend of less severe post-operative complications in general (p = 0.073), and borderline-significantly less cases of acute pancreatitis (p = 0.057) and tAMP-related re-operations or re-interventions (p = 0.057) in particular, were observed in the eVAC-CPI-group. The only anastomotic leak in the eVAC-CPI-group was successfully managed through repeated cycles of eVAC. The device was well tolerated by all patients; no vacuum/irrigation-related complications or malfunctioning occurred. Conclusion: Our study is the first to provide some technical insights demonstrating the safety and feasibility of a prophylactic approach with eVAC and perianastomotic irrigation to reduce anastomotic leak after tAMP. Increasing the number of subjects will confirm the benefit of our promising results. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of SWEEPS mode of the Er: YAG laser(SL) and passive ultrasonic irrigation(PUI) in the eradication of microorganisms and in the inflammation detection by IL-1β. Thirty patients with chronic apical periodontitis(AP) were allocated into two groups: Group SL–SWEEPS laser activated irrigation(n = 15) and Group PUI–passive ultrasonic irrigation(n = 15). Bacteriological samples were taken before(S1) and after chemomechanical preparation(S2), and then after final irrigation activation(S3). The levels of total bacteria and Streptococci were measured by means of PCR. Blood samples were collected before and 3rd day after treatment. Enzyme-linked immunosorbent assay was used to measure the levels of IL-1β. The bacterial reduction showed no differences between groups after chemo-mechanical treatment and after irrigant activation(p = 0.590). Post-treatment IL-1β levels were lower than pretreatment levels in both groups(p < 0.001). SL or PUI application in addition to chemomechanical preparation has similar effects on total bacterial level and inflammation detected by IL-1β in patients with AP. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to describe a case of bilateral keratoconjunctivitis after exposure to the toxic sap of Euphorbia lathyris. Case Report: A 76-year-old gentleman presented after exposure to E. lathyris whilst he was gardening. He had 6/12 visual acuity in his right eye, and 6/4 in his left. Examination revealed marked periocular dermatitis, conjunctival injection and corneal oedema in the right eye with diffuse punctate epithelial staining. He was treated with ocular irrigation, topical steroids, antibiotics, cycloplegics and lubricants. Over 48 h, his left eye started to become symptomatic. He developed bilateral corneal epithelial defects and anterior chamber inflammation. His visual acuity worsened to 6/36 right and 6/24 left. At his 3-week follow-up, there was marked improvement in the resolution of the toxic keratoconjunctivitis in both eyes. Conclusion: Toxic sap from E. lathyris can cause severe keratoconjunctivitis. Irrigation of both eyes despite unilateral symptoms and early follow-up should be considered signs of toxicity may only become evident after 24–48 h. [ABSTRACT FROM AUTHOR]

Background. Surgical site infections (SSIs) are a significant complication following spine surgery, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Traditional methods to prevent SSIs, including perioperative antibiotics, have limited efficacy, necessitating innovative approaches. Objective. This systematic review aims to evaluate the efficacy and low toxicity advantages of intraoperative irrigation combining three elements: povidone-iodine (PVP-I), hydrogen peroxide (H2O2), and pulsed irrigation technique in preventing SSIs in spine surgery. Methods. A comprehensive literature search was conducted in MEDLINE, Cochrane Library, and Scopus databases, covering publications from 1980 to May 2024. Articles were selected based on their relevance to the use of PVP-I and H2O2 in pulsed irrigation during spine surgeries. While there are studies that use H2O2 and PVP-I separately or in combination without pulsed irrigation, the combination of all three elements (pulsed irrigation, H2O2, and betadine) has not been previously explored. The inclusion criteria focused on clinical trials, observational studies, case-control studies, cohort studies, review or case series that reported on SSI prevention with a minimum follow-up of three months. Results. The review identified a significant gap in the literature concerning the combined use of PVP-I and H2O2 in pulsed irrigation for spine surgeries. Studies primarily investigated these agents individually or in combinations of two, but not all three together. The findings suggest that the combination of PVP-I and H2O2 can enhance antimicrobial effects and reduce toxicity, potentially lowering SSI rates. Conclusions. Intraoperative pulsed irrigation with PVP-I and H2O2 shows promise in reducing SSIs in spine surgery, with potential benefits over traditional methods. However, the risks associated with the use of H2O2 require careful evaluation and prudent application, especially in the presence of dural tears. Further large-scale clinical studies are needed to confirm these preliminary results and optimize protocols for the combined use of these agents. [ABSTRACT FROM AUTHOR]