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Endodontic treatment is based on chemical-surgical preparation, which includes cleaning, shaping and irrigation of the root canal system, in addition to three-dimensional endodontic filling. These fundamentals, when raised satisfactorily, fulfill their goals, which have to correct the scarring and repair of periapical tissues, thus keeping the tooth in the oral cavity. In this sense, intraoperative irrigation of the root canal system plays an important role in the success of endodontic therapy. Several techniques were corrected to perform this operative step, including: convencional irrigation, PUI and vacuum. Thus, the objective of the article is to review the current knowledge about the process of intraoperative endodontic irrigation under negative pressure (vacuum). For this, ​​with databases from Scielo, Bireme, Lilacs and Medline were used, with “endodontic”, “Irrigation”, “negative-pressure” and “endovac” as descriptors. 81 articles were found, of which 14 were used and the others were excluded for not meeting the exclusion criteria. Upon review, it is noted that endodontic irrigation changes satisfactory results, being predictable for use during endodontic therapy. La preparación químico-quirúrgica, que es una de las principales etapas del tratamiento endodóntico, comprende la limpieza, modelado e irrigación del sistema de conductos radiculares, que junto con el relleno endodóntico tridimensional son los pilares de la terapia endodóntica. Cuando se realizan satisfactoriamente, su objetivo es reparar los tejidos periapicales, manteniendo así el diente en la cavidad bucal. La irrigación intraoperatoria del sistema de conductos radiculares juega un papel importante en el éxito de la terapia endodóntica. Se han descrito y se utilizan varias técnicas para realizar este paso operatorio, que incluyen: irrigación convencional, irrigación pasiva, irrigación ultrasónica pasiva (PUI) y vacío. Por tanto, el objetivo de este estudio es revisar los conocimientos actuales sobre el proceso de irrigación endodóntica intraoperatoria bajo presión negativa (vacío). Para ello se utilizaron los descriptores "endodoncia", "Irrigación", "presión negativa" y "endovac" en las bases de datos Scielo, Bireme, Lilacs y Medline. Se encontraron 81 artículos, se utilizaron 14 y los demás se excluyeron por no cumpliendo los criterios de exclusión. Tras la revisión, se observa que la irrigación por vacío endodóntica mostró resultados satisfactorios, siendo predecible para su uso durante la terapia endodóntica. O preparo químico-cirúrgico, que é uma das principais etapas do tratamento endodôntico, compreende a limpeza, modelagem e irrigação do sistema de canais radiculares, que juntamente com a obturação endodôntica tridimensional, são os pilares da terapia endodôntica. Quando executados de forma satisfatória têm como finalidade o reparo dos tecidos periapicais, mantendo assim, o dente na cavidade oral. A irrigação transoperatória do sistema de canais radiculares tem papel de destaque para o sucesso da terapia endodôntica. Várias técnicas foram descritas e são utilizadas para executar essa etapa operatória, dentre as quais: irrigação convencional, irrigação ultrassônica passiva (PUI) e a vácuo. Sendo assim, o objetivo desse estudo é revisar os conhecimentos atuais sobre o processo de irrigação transoperatória endodôntica sobre pressão negativa (a vácuo). Para isso foram utilizados os descritores “endodontic”, “Irrigation”, “negative-pressure” e “endovac” nas bases de dados da Scielo, Bireme, Lilacs e Medline Foram encontrados 81 artigos, sendo que 14 foram utilizados e os demais foram excluídos por não satisfazerem os critérios de exclusão. Após a revisão, nota-se que a irrigação endodôntica a vácuo demonstrou resultados satisfatórios, sendo previsível para o uso durante a terapia endodôntica.

Author(s): David, Abel P; Jiam, Nicole T; Reither, Joshua M; Gurrola, Jose G; Aghi, Manish K; El-Sayed, Ivan H | Abstract: BackgroundThe coronavirus disease (COVID-19) pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery.MethodsRetrospective review. We introduce the negative-pressure otolaryngology viral isolation drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient's head and surgical field with a smoke evacuator suction placed inside the chamber.ResultsFour patients underwent endonasal (4) and endo-oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein-treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high-speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination.ConclusionsNegative-pressure aspiration of air under a chamber barrier, which appears to successfully keep aerosol and droplet contamination to a minimum.

Background: The open abdomen with mesh implantation, followed by early reoperation with fascial closure, is a modern surgical approach in difficult clinical situations such as severe abdominal sepsis. As early fascial closure is not possible in many cases, mesh-mediated fascial traction is helpful for conditioning of a minimized ventral hernia after open abdomen. The aim of this study was to evaluate the clinical utilization of an innovative elastic thermoplastic polyurethane mesh (TPU) as an abdominal wall inlay in a minipig model. Methods: Ten minipigs were divided in two groups, either receiving an elastic TPU mesh or a nonelastic polyvinylidene fluoride (PVDF) mesh in inlay position of the abdominal wall. After 8 weeks, mesh expansion and abdominal wall defect size were measured. Finally, pigs were euthanized and abdominal walls were explanted for histological and immunohistochemical assessment. Results: Eight weeks after abdominal wall replacement, transversal diameter of the fascial defect in the TPU group was significantly smaller than in the PVDF group (4.5 cm vs. 7.4 cm; p = 0.047). Immunhistochemical analysis showed increased Ki67 positive cells (p = 0.003) and a higher number of apoptotic cells (p = 0.047) after abdominal wall replacement with a TPU mesh. Collagen type I/III ratio was increased in the PVDF group (p = 0.011). Conclusion: Implantation of an elastic TPU mesh as abdominal wall inlay is a promising approach to reduce the size of the ventral hernia after open abdomen by mesh-mediated traction. However, this effect was associated with a slightly increased foreign body reaction in comparison to the nonelastic PVDF.

Objective: To establish recommendations related to negative pressure therapy with instillation according to effectiveness, safety, efficiency, consensus guidelines and stability data of instillation solutions. Method: A literature search was conducted to compare the available evidence regarding effectiveness, safety and efficiency of negative pressure therapy with instillation, as well as the existence of consensus guidelines for use. The articles were classified according to the “Scale of evidence classification for therapeutic studies” of the American Society of Plastic and Reconstructive Surgery. Results: A total of 13 studies were included, of which five were comparative cohort studies (level II and III of evidence), and the rest corresponded to case series (level IV of evidence). Two consensus guidelines were selected with recommendations regarding the type of wound, instillation solution, solution retention time, vacuum pressure and appropriate vacuum time. According to literature and available evidence, recommendations were proposed and established on negative pressure therapy with instillation in our hospital, including stability data of the proposed solutions. Conclusions: This paper provides preliminary guidelines on the application of negative pressure therapy with instillation until new evidence supports or modifies these recommendations. Resumen Objetivo: Establecer recomendaciones relacionadas con la terapia de presión negativa con instilación según efectividad, seguridad, eficiencia, guías de consenso y estabilidades contrastadas de las soluciones de instilación. Método: Se realizó una búsqueda bibliográfica para contrastar la evidencia disponible en cuanto a efectividad, seguridad y eficiencia de la terapia de presión negativa con instilación, así como la existencia de guías de consenso de utilización. Se clasificaron los artículos en función de la “Escala de clasificación de evidencia para estudios terapéuticos” según la Sociedad Americana de Cirugía Plástica y Reconstructiva. Resultados: Se incluyeron 13 estudios, de los cuales cinco fueron estudios de cohortes comparativos (nivel II y III de evidencia), y el resto correspondieron a series de casos (nivel IV de evidencia). Se seleccionaron dos guías de consenso con recomendaciones según tipo de herida, solución de instilación, tiempo de retención de solución, presión de vacío y tiempo de vacío apropiado. Según la literatura y la evidencia disponible, se propusieron y establecieron recomendaciones sobre la terapia de presión negativa con instilación en nuestro hospital, incluyendo datos de estabilidad de las soluciones propuestas. Conclusiones: Este manuscrito proporciona pautas preliminares para la aplicación de la terapia de presión negativa con instilación hasta que nuevas evidencias apoyen o modifiquen estas recomendaciones.

OBJECTIVE: The "gold standard" treatment of intermittent claudication (IC) is supervised exercise therapy (SET). Intermittent vacuum therapy (IVT) has recently been promoted as an additional treatment of IC. During IVT, negative pressure and atmospheric pressure are alternatingly applied to the lower extremities, possibly resulting in improved circulation. The aim of this study was to determine a potential additional effect of IVT in IC patients undergoing a standardized SET program.METHODS: IC patients were recruited from three Dutch general hospitals between December 2015 and July 2017. They received a standardized SET program but were also randomly assigned to an intervention group receiving an IVT treatment (-50 mBar negative pressure) or a control group receiving a sham treatment (-5 mBar negative pressure). IVT was provided in a dedicated clinic during 12 sessions of 30 minutes during a 6-week period. The primary outcome measure was a change in maximal treadmill walking distance. Secondary outcome measures were a change in functional treadmill walking distance, 6-minute walk test, ambulatory ability, and quality of life.RESULTS: A total of 78 patients were randomized, of whom 70 were available for intention-to-treat analysis (control, n = 34; intervention, n = 36). At 6 and 12 weeks, increases in walking distance were of equal magnitude. Median (interquartile range) change in maximal treadmill walking distance during 12 weeks was +335 (205-756) meters in control patients and +250 (77-466) meters in intervention patients (P = .109), whereas functional treadmill walking distance increased +230 (135-480) meters and +188 (83-389) meters (P = .233), respectively. Mean ± standard deviation change in the 6-minute walk test was +36 ± 48 meters and +55 ± 63 meters (P = .823), respectively. Ambulatory ability and quality of life improved equally in both groups.CONCLUSIONS: IVT does not confer any additional beneficial effects in IC patients undergoing a standardized SET program.

Drought stress can result in significant impairment of the plant hydraulic system via blockage of xylem conduits by gas emboli. Recovery after drought stress is an essential component of plant survival but is still a poorly understood process. In this study, we examined the capacity of woody species from two genera (Eucalyptus and Quercus) to refill embolized xylem vessels during a cycle of drought and recovery. Observations were made on intact plants of Eucalyptus calmudulensis, E. grandis, E. saligna and Quercus palustris using X-ray microtomography. We found no evidence of an effective xylem refilling mechanism in any of the plant species. Despite rehydration and recovery of plant water potential to near pre-drought levels, embolized vessels were not refilled up to 72 h after rewatering. In E. saligna, water droplets accumulated in previously air-filled vessels for a very small percentage of vessels. However, no instances of complete refilling that would restore embolized vessels to hydraulic function were observed. Our observations suggest that rapid refilling of embolized vessels after drought may not be a wide spread mechanism in woody plants and that embolism formed during drought represents long term cost to the plant hydraulic system.

Key message: Direct, non-invasive X-ray microtomography and optical technique observations applied in stems and leaves of intact seedlings revealed that laurel is highly resistant to drought-induced xylem embolism. Contrary to what has been brought forward, daily cycles of embolism formation and refilling are unlikely to occur in this species and to explain how it copes with drought. Context: There has been considerable controversy regarding xylem embolism resistance for long-vesselled angiosperm species and particularly for the model species for refilling (Laurus nobilis L.). Aims: The purpose of this study was to resolve the hydraulic properties of this species by documenting vulnerability curves of different organs in intact plants. Methods: Here, we applied a direct, non-invasive method to visualize xylem embolism in stems and leaves of intact laurel seedlings up to 2-m tall using X-ray microtomography (microCT) observations and the optical vulnerability technique. These approaches were coupled with complementary centrifugation measurements performed on 1-m long branches sampled from adult trees and compared with additional microCT analyses carried out on 80-cm cut branches. Results: Direct observations of embolism spread during desiccation of intact laurels revealed that 50% loss of xylem conductivity (Psi(50)) was reached at - 7.9 +/- 0.5 and - 8.4 +/- 0.3 MPa in sterns and leaves, respectively, while the minimum xylem water potentials measured in the field were - 4.2 MPa during a moderate drought season. Those findings reveal that embolism formation is not routine in Laurus nobilis contrary to what has been previously reported. These Psi(50) values were close to those based on the flow-centrifuge technique (- 9.2 +/- 0.2 MPa), but at odds with microCT observations of cut branches (- 4.0 +/- 0.5 MPa). Conclusion: In summary, independent methods converge toward the same conclusion that laurel is highly resistant to xylem embolism regardless its development stage. Under typical growth conditions without extreme drought events, this species maintains positive hydraulic safety margin, while daily cycles of embolism formation and refilling are unlikely to occur in this species.

Management of a patient with an open abdomen is difficult, and the primary closure of the fascial edges is essential to obtain the best patient outcome, regardless of the initial etiology of the open abdomen. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with mesh-mediated fascial traction as the proposed standard of care. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. As shown for other high-risk patient subgroups, such as obese patients, patients with an abdominal aneurysm, and patients with former -ostomy sites, the prevention of incisional hernias might be key to further optimize patient outcomes after open abdomen treatment. In this overview, current available modalities to decrease the incidence of incisional hernia are discussed. Most of these preventive options have been shown effective in giant ventral hernia repair and might work effectively in this patient cohort with open abdomen as well.

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

We present a first-principles study of the energy and elastic properties of solid helium at pressures below the range in which it is energetically stable. We find that the limit of mechanical stability in hcp He is bar, which lies significantly below the spinodal pressure found in the liquid phase (i.e., bar). Furthermore, we show that the pressure variation of the transverse and longitudinal sound velocities close to does not follow a power law of the form , in contrast to what is observed in the fluid.

Objectives: Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation. Methods: This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate. Results: Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N = 103), compared with secondary operation (N = 88), was associated with less severe initial open abdomen status (p = .006), less intestinal ischaemia (p = .002), shorter duration of open abdomen (p = .007), and less renal replacement therapy (RRT, p

Background: Vacuum-assisted closure therapy is a relatively new concept described in the literature that increases wound-healing capacity. The authors aimed to investigate the effect of vacuum-assisted closure therapy on wound healing, granulation tissue formation, bacterial clearance, pain, time involvement of the staff, and total costs in all types of wounds in comparison with modern wound dressings.Methods: Sixty-five patients with a chronic or acute wound were randomized to initial treatment with vacuum-assisted closure or modern dressings. The authors' primary endpoint was a granulated wound or a wound ready for skin grafting or healing by secondary intention.Results: The time to the primary endpoint with vacuum-assisted closure therapy was not significantly shorter, except for patients with cardiovascular disease and/or diabetics. Vacuum-assisted closure therapy did not result in significantly faster granulation or wound surface reduction or better bacterial clearance, but patient comfort was an important advantage. Time involvement and costs of nursing staff were significantly lower for the vacuum-assisted closure therapy, but overall costs were similar for both groups.Conclusions: With vacuum-assisted closure therapy, wound healing is at least as fast as with modern wound dressings. Especially cardiovascular and diabetic patients benefit from this therapy. The total costs of vacuum-assisted closure are comparable to those of modern wound dressings, but the advantage is its comfort for patients and nursing staff.

The objective of this study was to compare patient-ventilator interaction during pressure-support ventilation (PSV) and proportional-assist ventilation (PAV) in the course of increased ventilatory requirement obtained by adding a dead space in 12 patients on weaning from mechanical ventilation. With PSV, the level of unloading was provided by setting the inspiratory pressure at 20 and 10 cmH2O, whereas with PAV the level of unloading was at 80 and 40% of the elastic and resistive load. Hypercapnia increased (P < 0.001) tidal swing of esophageal pressure and pressure-time product per breath at both levels of PSV and PAV. During PSV, application of dead space increased ventilation (VE) during PSV (67 +/- 4 and 145 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001). This was due to a relevant increase in respiratory rate (48 +/- 4 and 103 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001), whereas the increase in tidal volume (VT) played a small role (13 +/- 1 and 21 +/- 2% during 20 and 10 cmH2O PSV, respectively, P < 0.001). With PAV, the increase in VE consequent to hypercapnia (27 +/- 3 and 64 +/- 4% during 80 and 40% PAV, respectively, P < 0.001) was related to the increase in VT (32 +/- 1 and 66 +/- 2% during 80 and 40% PAV, respectively, P < 0.001), respiratory rate remaining unchanged. The increase in pressure-time product per minute and per liter consequent to acute hypercapnia and the sense of breathlessness were significantly (P < 0.001) higher during PSV than during PAV. Our data show that, after hypercapnic stimulation of the respiratory drive, the capability to increase VE through changes in VT modulated by variations in inspiratory muscle effort is preserved only during PAV; the compensatory strategy used to increase VE during PSV requires greater muscle effort and causes more pronounced patient discomfort than during PAV.