Search

Introduction: Bony surface cleaning using a pulse lavage device (PLD) is essential for modern cementation of hip and knee arthroplasties. This costly single-use device is a medical waste and unaffordable for some patients. Reprocessing is a worldwide standard strategy to solve this problem. To determine the technical properties and biological safety of a reprocessed PLD handpiece and compare its performance under different power supplies. Materials and methods: Eight brand-new disposable PLDs were tested for baseline technical properties (flow rate, pulse frequency, and peak pressure). Thereafter, they were reprocessed and retested for 10 rounds using two different power supplies. An adenosine triphosphate (ATP) swab test was performed on the PLD accessory parts after cleansing and disinfection. Passed-through isotonic sodium chloride solution ejected from the reprocessed PLD underwent aerobic bacterial culture. The unit costs of production were analysed. Results: The mean flow rate of the disposable PLD (1.5±0.1 L/min) was less than that of reprocessed PLD using DC15V battery (2.5±0.3 L/min, p

Purpose: To investigate the relationship between urine cytology results after overnight continuous saline irrigation (OCSI) following transurethral resection of bladder tumor (TURBT) and bladder tumor recurrence in non-muscle invasive bladder cancer (NMIBC). Materials and Methods: A retrospective study was conducted on patients diagnosed with NMIBC between 2016 and 2020 after undergoing TURBT at our hospital. All patients received OCSI following TURBT and had urine cytology test at postoperative 1 day. Urine cytology was classified into three groups: Negative, low-grade urothelial neoplasm (LGUN)+atypical urothelial cells (AUC), and suspicious for high-grade urothelial carcinoma (SHGUC)+high-grade urothelial carcinoma (HGUC). Recurrence-free survival (RFS) in each group was compared using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate independent prognostic factors. Results: A total of 172 patients were included in this study. Based on urine cytology group (after OCSI), RFS did not reach the median value in the Negative group. In the LGUN+AUC group, the median RFS was 615.00 days. In the SHGUC+HGUC group, the median RFS was 377.00 days. In survival analysis, the Negative group had a longer RFS than the SHGUC+HGUC group (p=0.013). However, Cox regression analysis showed that SHGUC+HGUC was not an independent prognostic factor for recurrence. Conclusions: Urine cytology results after OCSI following TURBT in NMIBC were associated with bladder tumor recurrence. Specifically, SHGUC or HGUC in urine cytology after OCSI showed earlier recurrence than negative cases. However, further research is needed to accurately determine whether it is an independent prognostic factor.

Neonates have different cellular composition in their bronchoalveolar lavage fluid (BALF) when compared to foals and adult horses; however, little is known about the non-cellular components of BALF. The objective of this study was to determine the proteomic composition of BALF in neonatal horses and to compare it to that of foals and adult horses. Bronchoalveolar lavage fluid samples of seven neonates (< 1 week age), four 5 to 7-week-old foals, and six adult horses were collected. Quantitative proteomics of the fluid was performed using tandem mass tag labeling followed by high resolution liquid chromatography tandem mass spectrometry and protein relative abundances were compared between groups using exact text. A total of 704 proteins were identified with gene ontology terms and were classified. Of these, 332 proteins were related to the immune system in neonates, foals, and adult horses. The most frequent molecular functions identified were binding and catalytic activity and the most common biological processes were cellular process, metabolic process, and biological regulation. There was a significant difference in the proteome of neonates when compared to foals and to adult horses. Neonates had less relative expression (FDR < 0.01) of many immune-related proteins, including immunoglobulins, proteins involved in the complement cascade, ferritin, BPI fold-containing family B member 1, and macrophage receptor MARCO. This is the first report of equine neonate BALF proteomics and reveals differential abundance of proteins when compared to BALF from adult horses. The lower relative abundance of immune-related proteins in neonates could contribute to their susceptibility to pulmonary infections.

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7–7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders. [ABSTRACT FROM AUTHOR]

Aims: To investigate the efficacy of ethylenediaminetetraacetic acid-normal saline (EDTA-NS) in dispersing biofilms and reducing bacterial infections. Methods: EDTA-NS solutions were irrigated at different durations (1, 5, 10, and 30 minutes) and concentrations (1, 2, 5, 10, and 50 mM) to disrupt Staphylococcus aureus biofilms on Matrigel-coated glass and two materials widely used in orthopaedic implants (Ti-6Al-4V and highly cross-linked polyethylene (HXLPE)). To assess the efficacy of biofilm dispersion, crystal violet staining biofilm assay and colony counting after sonification and culturing were performed. The results were further confirmed and visualized by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). We then investigated the efficacies of EDTA-NS irrigation in vivo in rat and pig models of biofilm-associated infection. Results: When 10 mM or higher EDTA-NS concentrations were used for ten minutes, over 99% of S. aureus biofilm formed on all three types of materials was eradicated in terms of absorbance measured at 595 nm and colony-forming units (CFUs) after culturing. Consistently, SEM and CSLM scanning demonstrated that less adherence of S. aureus could be observed on all three types of materials after 10 mM EDTA-NS irrigation for ten minutes. In the rat model, compared with NS irrigation combined with rifampin (Ti-6Al-4V wire-implanted rats: 60% bacteria survived; HXLPE particle-implanted rats: 63.3% bacteria survived), EDTA-NS irrigation combined with rifampin produced the highest removal rate (Ti-6Al-4V wire-implanted rats: 3.33% bacteria survived; HXLPE particle-implanted rats: 6.67% bacteria survived). In the pig model, compared with NS irrigation combined with rifampin (Ti-6Al-4V plates: 75% bacteria survived; HXLPE bearings: 87.5% bacteria survived), we observed a similar level of biofilm disruption on Ti-6Al-4V plates (25% bacteria survived) and HXLPE bearings (37.5% bacteria survived) after EDTA-NS irrigation combined with rifampin. The in vivo study revealed that the biomass of S. aureus biofilm was significantly reduced when treated with rifampin following irrigation and debridement, as indicated by both the biofilm bacterial burden and crystal violet staining. EDTA-NS irrigation (10 mM/10 min) combined with rifampin effectively removes S. aureus biofilm-associated infections both in vitro and in vivo. Conclusion: EDTA-NS irrigation with or without antibiotics is effective in eradicating S. aureus biofilm-associated infection both ex and in vivo. Cite this article: Bone Joint Res 2024;13(1):40–51.

Objective: To evaluate the feasibility, safety, and efficacy of massive continuous irrigation (MCI) and endoscopic debridement for the treatment of refractory abscess–fistula complexes. Methods: This was a retrospective single‐center observational study involving 12 patients with refractory abscess–fistula complexes. All patients had experienced long‐term treatment failure or had failed multiple treatment modalities. We used over two catheters and inserted them via the gastrointestinal (GI) tract or percutaneously to form a circulation pathway to achieve MCI of normal saline, endoscopic debridement was then performed. The treatment success rate, irrigation volume and treatment duration, time to abscess–fistula complex closure, intra‐treatment complications, and recurrence rate were recorded. Results: The treatment success rates were 100%. The median time of previous treatment was 32 days (range 7–912 days). The mean time from the use of the novel treatment strategy to abscess–fistula complex healing was 18.8 ± 11.0 days. The mean volume of irrigation was 10 804 ± 1669 mL/24 h. The mean irrigation time was 16.5 ± 9.2 days, and a median of two irrigation tubes (range 2–5) were used. No complications occurred either during or after the procedure. During the follow‐up of 23.1 ± 18.1 months, no recurrence or adverse events were noted. Conclusions: MCI and endoscopic debridement may be a feasible, safe, and effective alternative treatment for refractory abscess–fistula complexes. Large prospective studies are needed to validate our results. [ABSTRACT FROM AUTHOR]

Introduction. There are multiple tools available to optimize defecation in patients with anorectal malformation (ARM), such as habits, laxatives, and retrograde or anterograde irrigations, which are usually adapted in a progressive and combined fashion. The objective of this study was to assess the incorporation of transanal irrigation (TAI) to constipation and fecal incontinence treatment in patients with ARM. Materials and methods. A retrospective study of ARM patients with indication of TAI according to the colorectal pathology unit's intestinal management protocol from 2015 to 2022 was carried out. Following use for over 3 months, patients or their guardians completed a phone survey of our own approved by the ethics committee. Results. 39 ARM patients participated in the study. Pathologies included 11 rectourethral fistulas, 6 rectovesical fistulas, 16 cloacae, 2 rectovaginal fistulas, 2 perineal fistulas, and 2 vestibular fistulas. 44% of them had a sacral index < 0.4. 62% had constipation, and 38% had incontinence. Thanks to TAI, confidence and safety improved in a very high and a high degree in 89% of the patients, whereas time devoted to intestinal management decreased a lot in 68% of them. 79% reported a 9- and 10-point quality-of-life improvement. 92% rated overall satisfaction with TAI with a score of 8, 9, and 10 -- 10 meaning "completely satisfied." 100% recommend TAI. Conclusion. TAI is a good alternative for the intestinal management of fecal incontinence and constipation. [ABSTRACT FROM AUTHOR]

Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0–18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children’s workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information. Plain language summary Between 5% and 30% of children experience constipation at some stage. In one-third of these children, this progresses to chronic functional constipation. Chronic functional constipation affects more children with additional needs. We aimed to find and bring together published information about treatments for chronic functional constipation, to help establish best treatments and treatment combinations. We did not cover assessment or diagnosis of chronic functional constipation. This project was guided by a ‘stakeholder group’, including parents of children with constipation, people who experienced constipation as children, and healthcare professionals/continence experts. We carried out a ‘scoping review’ and a series of ‘systematic reviews’. Our ‘scoping review’ provides an overall picture of research about treatments, with 651 studies describing 48 treatments. This helps identify important evidence gaps. ‘Systematic reviews’ are robust methods of bringing together and interpreting research evidence. Our stakeholder group decided to structure our systematic reviews to reflect who delivered the interventions. We brought together evidence about how well treatments worked when delivered by families/carers (32 studies), the wider children’s workforce (e.g. general practitioner, health visitor) (21 studies), continence teams (31 studies) or specialist consultant-led teams (42 studies). We also considered complementary therapies (15 studies) and behavioural strategies (4 studies). Care is affected by what is done and how it is done. We brought together evidence about different models of delivering care (15 studies), barriers and facilitators to implementation of treatments (106 studies) and costs (31 studies). Quality of evidence was mainly low to very low. Despite numerous studies, there was often insufficient information to support generalisable conclusions. Our findings generally agreed with current clinical guidelines. Management of childhood chronic functional constipation should be child-centred, multifaceted and adapted according to the individual child, their needs, the situation in which they live and the health-care setting in which they are looked after. Research is needed to address our identified evidence gaps. Scientific summary Background Chronic functional constipation (CFC) in childhood is common; it is estimated to affect 5–30% of school-aged children, becoming chronic in around one-third of cases. CFC has negative effects on quality of life (QoL) of children, families and carers, with increasing impact as the child gets older. Although rarely life-threatening, CFC is an unpleasant and distressing condition, associated with a wide range of complications, including physical discomfort, missed school, poor school performance, social isolation and reduced involvement in group activities. More than a third of children with CFC will present clinically with behavioural problems as a result of the constipation. The healthcare costs of childhood CFC are significant. Treatments are usually directed at symptom control since limited diagnostics mean no underlying cause is identified in more than 95% of cases, thus limiting ability to stratify treatments. There are a number of different interventions available for the management of CFC; however, the optimal strategy for combining and implementing interventions for individual circumstances remain unclear. National Institute for Health and Care Research (NIHR) commissioned this work to address the question: ‘What are the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation (CFC), and how can they best be implemented?’ Objectives Specific research questions (RQs) answered by this project were: RQ1: What is the current evidence relating to management strategies for childhood CFC? (Scoping review). RQ2: What are the most effective childhood CFC strategies and combinations of strategies in relation to outcomes of importance to stakeholders and/or cost to the patient/NHS? [Systematic review (SR) of evidence of effectiveness and cost effectiveness]. RQ3: What factors are associated with implementation success or failure of childhood CFC strategies and combinations of strategies for different subgroups? (SR of factors affecting implementation). RQ4: What are the evidence gaps in childhood CFC management strategies? Design We conducted a three-stage pragmatic mixed-method study. In stage 1, we completed a broad, comprehensive scoping review. In stage 2, we conducted focused SRs evaluating effectiveness, cost effectiveness and factors affecting implementation. In stage 3, we integrated findings, generating interactive evidence maps, exploring complementarity between our findings and published clinical guidelines, and identifying evidence gaps. Methods Patient and public involvement Stakeholder involvement was central to our project. We formed a stakeholder group (SG) from across the UK, comprising people with lived experience of childhood CFC, parents of children with CFC, healthcare professionals and representatives of relevant charities. We adhered to key principles for research co-production. The SG provided continuous project oversight and completed specific activities. These activities included development of an intervention taxonomy and logic model, agreement on outcomes for the review, identifying evidence gaps and reaching consensus on clinical implications. Scoping review Our scoping review was based on a systematic search of several electronic databases including medical literature analysis and retrieval system online (MEDLINE), excerpta medica database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; January 2011 to March 2020), as well as searches of grey literature, contacting experts and forward citation tracking. We included papers, regardless of study design, which investigated, reported or discussed any strategy, delivered in any setting, aimed at improving any outcomes in children (aged 0–18 years) with a clinical diagnosis of CFC. We did not include studies of assessment/diagnosis. We included studies involving children with or without additional needs but excluded those with a recognisable cause of constipation such as anorectal malformation, Hirschsprung’s disease, intestinal nerve abnormalities, metabolic or endocrine causes. Eligible abstracts and full texts were independently reviewed by two reviewers. Data were extracted by one reviewer and cross-checked by a second. Two reviewers independently applied descriptive codes to categorise the type of study, aim/focus of the study, outcomes, types of interventions/intervention combinations, and availability of data relating to effectiveness, economics or implementation factors. In keeping with scoping review methodology, we did not formally assess research quality. Data were summarised within an evidence gap map. Systematic reviews of evidence of effectiveness For our SRs of evidence of effectiveness, we considered all studies identified in the scoping review and ‘tagged’ them as studies of effectiveness. We included any studies investigating effectiveness of any intervention, or combination of interventions, aimed at improving outcomes in children with CFC. Informed by our stakeholders, we grouped studies according to whether the intervention was one that would be delivered by families/carers (‘Level 0’), the wider children’s workforce (e.g. general practitioner, health visitor) (‘Level 1’), continence teams (‘Level 2’) or specialist consultant-led teams (‘Level 3’). We also considered different models of service delivery, and complementary and psychosocial therapies. For each different intervention, we adopted a hierarchical, step-wise approach to inclusion of different study designs. If there was a comprehensive SR, judged to be low risk of bias (ROB) [using risk of bias assessment tool for systematic reviews (ROBIS) criteria, assessed by two independent reviewers], this was also included. Where we included a SR, we also included any randomised controlled trials (RCTs) published after the date of the search in the review. Where there was no SR, we included RCTs and other primary studies of intervention effectiveness. Data were extracted on study methods, participant characteristics, intervention characteristics [using template for intervention description and replication (TIDieR) framework], outcomes and key findings. ROB was judged using tools appropriate to the study design [e.g. Cochrane ROB tool for RCTs, critical appraisals skills programme (CASP) tools for cohort studies, Joanna Briggs Institute (JBI) tools for qualitative evidence, Ways of Evaluating Important and Relevant Data (WEIRD) tool for other study designs]. Relevant meta-analyses within included SRs were updated with any new RCTs following the methods reported in the SR. A narrative synthesis of evidence of effectiveness for each intervention, delivered within ‘level’ 0 to 3 was presented, with a process of considered judgement used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic evaluation For our SR of economic studies, we considered any economic evidence identified in our scoping review and conducted additional searching of electronic databases and citation tracking following best practice guidance. We included all types of study detailing costs related to interventions aimed at children with CFC that were published in English, regardless of study design. One reviewer extracted data, including details of economic evaluations, and these were checked by a second reviewer. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit and their quality evaluated using the consensus health economic criteria (CHEC) checklist, and data were brought together into a narrative synthesis. Systematic review of factors affecting implementation For our SR of factors affecting implementation, we included studies which were identified in the scoping review as explicitly reporting data relating to key participant variables, barriers, facilitators, equity factors and adherence. One reviewer systematically identified, extracted and coded [using the consolidated framework for implementation research (CFIR)] barriers and facilitators, and a second reviewer checked this. We used a best fit framework synthesis approach combining deductive and inductive thematic approaches to identify barriers and facilitators. Data were brought together in a narrative synthesis organised around the CFIR domains. Integration of findings Our integration of findings from the SRs was informed by decisions taken by our stakeholders, including development of a logic model. We explored agreements between our findings and recommendations within previously published guidelines. We brought our findings together within interactive evidence maps, and systematically identified evidence gaps. Results The scoping review included 651 studies, including 190 RCTs and 236 primary studies. Forty-eight interventions (or combinations of interventions) were reported. Studies were mainly conducted in high-income countries; no studies from low-income countries were identified. The most frequently reported interventions were delivered by carers, prior to healthcare professional involvement (22%); these were primarily lifestyle interventions focused on diet. The least frequently reported were psychosocial interventions (3%). Children were recruited from a variety of settings including hospitals, clinical outpatients, and other community settings. Interventions were generally delivered face to face either at home or within a variety of hospital settings such as the emergency department. Interventions were rarely delivered in education settings (e.g. school-based settings) (n = 5) or residential care/looked after population (n = 1) settings. The most frequently reported outcome measurement was defaecation frequency, which was reported in one-third of studies within the scoping review. School attendance or absenteeism was the least frequently reported outcome (n = 8 studies). Our SRs of effectiveness included 32 studies (including 2 SRs) which explored effectiveness of interventions delivered by families/carers (‘Level 0’); 21 studies (including 2 SRs) which explored effectiveness of interventions delivered by wider children’s workforce (‘Level 1’); 31 studies (including 1 SR) which explored effectiveness of interventions delivered by continence teams (‘Level 2’); 42 studies (no SRs) which explored effectiveness of interventions delivered by specialist consultant-led teams (‘Level 3’); 15 studies (no SRs) which explored effectiveness of different models of service delivery; 15 studies (2 SRs) which explored effectiveness of complementary therapies; and 4 studies (1 SR) which explored effectiveness of psychosocial interventions. Interventions for which there was some evidence of potential benefit included, within Level 0: a trial of cows’ milk-free diet, educational interventions for parents, selenium supplements. Within Level 1: laxatives, physical exercise focused on pelvic floor muscle, combined pharmacological, diet and behaviour programme. Within Level 2: combined oral and enema therapy, transanal irrigation, biofeedback (for children with abnormal defaecation dynamics), combined treatment programmes. Within Level 3: botulinum toxin, antegrade continence enema (ACE)/Malone antegrade continence enema (MACE), sacral modulation. Models of care delivery which may be beneficial included nurse-led clinics, an algorithm, or care pathway, used in primary care settings, specialist (Level 2) services and web-based information, following an appointment with a specialist. Complementary therapies for which there was some evidence of effectiveness included: connective tissue manipulation (CTM) for children with cerebral palsy (CP), and some herbal/traditional medicines. There was some evidence in favour of behavioural therapy. Interventions which evidence suggests may not be beneficial include, probiotics, additional dietary fibre, increased fluid intake and biofeedback (for children with normal defaecation dynamics). Evidence relating to probiotics was judged to be moderate quality, but for all other interventions was considered low to very low quality. There was insufficient evidence to support conclusions relating to several other interventions. We identified 31 studies which reported some evidence relating to cost or resource use, of which 20 were cost-of-illness studies. Fewer than 30% of the studies employed a formal economic evaluation study design. Most studies were poorly reported with limited details. Data included in this review were insufficient to support any generalisable conclusions relating to cost or resource use. One hundred and six studies described multiple barriers and facilitators across the five domains of the CFIR framework. The most commonly reported factors related to ‘successfulness’ of an intervention included; whether the intervention was adaptable, flexible and offered an advantage over an alternative solution; understanding the tension for change (i.e. why clinicians and families felt that the changes were needed now); the taboo nature of constipation and the reluctance of children, families, healthcare professionals and wider society to openly engage in discussion about constipation; a lack of understanding of what children and their families need; self-efficacy, coupled with individual knowledge and beliefs; and engagement of champions to support children. Research gaps were identified through evidence maps and stakeholder discussions. Key topics considered priorities for future research relate to recognition of CFC; information provision; diet; laxatives and combinations of laxatives; behavioural therapy and psychological support. Future research studies should address what works for which individual child, and when, including children with and without additional needs. Research to explore the optimal delivery of services, including identification of key components and features of effective teams and criteria for referring children from one ‘level’ to the next, is needed. Conclusions We conducted a comprehensive review of all evidence relating to interventions, and combinations of interventions, for children with CFC. The finding from our review are generally in agreement with the current guideline recommendations, where recommendations exist. A significant proportion of interventions for which we found evidence had not been addressed within current guidelines. This project has highlighted that research in this field often does not adhere to recognised standards for conduct and reporting or consider the complexities of interventions for CFC. We found no evidence which gave us high certainty in the findings; and we only had moderate certainty relating to one intervention (probiotics, with evidence demonstrating that probiotics may not have any beneficial – or harmful – effect). Our certainty about all other findings was low to very low or, in many cases, we judged that the evidence was insufficient to support any generalised conclusions. The current evidence base rarely measured outcomes deemed of highest priority to children and families, and many studies failed to describe the complex nature of the treatments that a child may be receiving. This limits the conclusions that can be made from the current evidence. Further, the limitations within the evidence base reduce confidence in recommendations and create a barrier to implementation of best practice, impairing progress in efforts to improve outcomes for this group of children. Our findings do not indicate that changes are necessarily needed to the treatment recommendations within current clinical guidelines. However, management of childhood CFC is complex, and there is no simple ‘one size fits all’ approach. Clinical care and future studies must consider the individual characteristics of each child with constipation, and the context – or environment – within which they live. Key goals of successful management of CFC should be early recognition of symptoms and delivery of interventions by families/carers, achieved by providing children and families/carers with effective education and support from members of the wider children’s workforce (primary care services). Development, evaluation and implementation of strategies to enhance the delivery of services focused on individualised care, combining lifestyle and behavioural strategies with laxatives are a priority. To avoid further research waste, it is essential that future research addresses the questions which are of the highest priority to key stakeholders and has the highest possible standards of conduct and reporting. Future research studies should address what works for which individual child, and when, including children with and without additional needs. Future research into any interventions for childhood CFC should take into account relevant evidence relating to the development and evaluation of complex interventions. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.

This study aimed to assess the amount of erosion during activated endodontic irrigation with either HEDP or EDTA via high-resolution micro-computed tomography. Two root canals of twenty premolars were prepared with ProTaper Next and irrigated with sodium hypochlorite. Palatal canals, which served as control groups, were sealed, while buccal canals were further irrigated with either EDTA (n = 10) or HEDP (n = 10), which served as test groups. Micro-CT was performed to measure erosion depth. For 2D and 3D measurements, non-parametric repeated ANOVA measurements and post hoc tests were performed. 2D analysis showed highly significant differences between the case groups at each position of the root (p ≤ 0.01). The cervical and apical positions showed significant differences in the EDTA group (p = 0.03). The 3D analysis also showed significant differences between both chelating agents (p < 0.01) and the case and control groups (p = 0.01). The mean erosion depths in the cervical, middle, and apical thirds of the EDTA group were 45.75, 41.79, and 32.25 µm, and for the HEDP group were 20.25, 16.40, and 15.96 µm, respectively. HEDP seems to have a significantly less erosive effect. Different irrigation protocols with harsher conditions, as might be the case during endodontic retreatment, could be assessed with micro-CT. [ABSTRACT FROM AUTHOR]

BackgroundSurgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital.MethodsWe queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model.Results475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied.ConclusionsA protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures.Level of evidenceLevel II.

Objective To investigate the clinical efficacy of eyelid margin deep cleaning combined with intense pulsed light (IPL) in the treatment of patients with demodex blepharitis. Methods A total of 60 patients (120 eyes) who were diagnosed with demodex blepharitis in Shenzhen Eye Hospital from July 2021 to March 2022 were enrolled, and according to the treatment modality, they were divided into eyelid margin deep cleaning group (group A with 60 eyes) and eyelid margin deep cleaning+IPL group (group B with 60 eyes). The two groups were compared in terms of Ocular Surface Disease Index (OSDI) score, eyelid inflammation score, meibomian gland opening score, meibomian gland secretion score, meibomian gland loss score, and demodex mite count before treatment and after 2 months of treatment, as well as the changes in these indices after treatment. Results After 2 months of treatment, both groups had significant reductions in OSDI score, eyelid inflammation score, meibomian gland opening score, meibomian gland secretion score, and demodex mite count (t=6.880-15.959,P0.05). There were significant differences between the two groups in the changes in OSDI score, eyelid inflammation score, meibomian gland opening score, meibomian gland secretion score, and demodex mite count after treatment (t=2.047-5.685,P0.05). Conclusion Eyelid margin deep cleaning combined with IPL exerts a marked therapeutic effect on demodex blepharitis by alleviating eye discomfort, improving meibomian gland secretion, and reducing the number of demodex mites.

PurposeHigh intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy.Materials and methodsTwenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule.ResultsThe mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement.ConclusionsPressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.

Aim: The aim of this study was to measure the amount of material extruded in the periapical area using three irrigation needles (Max-I-Probe, NaviTip Fx and IrriFlex flexible needle). Materials and Methods: Mandibular premolars were selected for this study and glass vials were used to gather the extruded debris and they were preweighed. The samples were divided into two groups: Group A (1 mm penetration of needle from working length), which was subdivided into three subgroups: Subgroup A1: Irrigation was made by Max-I-Probe. Subgroup A2: Irrigation was made by NaviTip Fx. Subgroup A3: Irrigation was made by IrriFlex flexible needle. Group B (3 mm penetration of needle), which was subdivided into three subgroups: Subgroup B1: Irrigation was made by Max-I-Probe. Subgroup B2: Irrigation was made by NaviTip Fx. Subgroup B3: Irrigation was made by IrriFlex flexible needle. XP-endo Shaper was used for chemomechanical preparation. After removal from vials, the teeth were incubated and then removed from the incubator and weighed again three times. The average of the readings was taken. Analysis of variance (ANOVA) and least significance difference tests were applied to analyse data. Results: All of the needles caused debris extrusion. There was a significant difference between groups (P = 0.001) according to the depth of penetration. The lowest value for debris was observed in subgroup B3 while subgroup A2 had shown the highest mean. Conclusion: Results revealed that the design and depth of needles significantly affected the debris extrusion. Using more flexible needles and shorter penetration depth for irrigation so that we don't need to push the needles so far apically. [ABSTRACT FROM AUTHOR]

Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11-2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00-1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.

PURPOSE:Stomal stenosis has been reported to occur in 12% to 45% of patients following Malone antegrade continence enema and Mitrofanoff appendicostomy. The standard stoma technique entails excision of the distal appendix. We evaluated a novel technique with preservation of the appendiceal tip and vessels, and opening the lumen in a more proximal and vascular area to determine whether the incidence of stenosis would be decreased. MATERIALS AND METHODS:Medical records of patients who underwent appendicostomy for Malone antegrade continence enema or urinary diversion were retrospectively evaluated. We included cases with a minimum of 1 year of followup and those in which the distal portion of a complete appendix was oriented for use as the stomal end in the umbilicus. Variables such as age, gender, body mass index, antegrade continence enema or urinary diversion, open or laparoscopic approach, cecal and appendiceal adhesions, retrocecal position, cecal imbrication, technique and stenosis were recorded. Cox proportional hazards analyses were performed to determine association of covariates. RESULTS:A total of 123 patients met inclusion criteria. The incidence of stenosis following standard stoma technique was 13% (12 of 93 patients) with a median followup of 9.4 years. Of these cases 75% occurred within 1 year of surgery. Stomal stenosis did not occur after the new stoma technique in 30 patients with a median followup of 3.3 years. Only technique cohort (standard vs new) was associated with stenosis (p=0.04). CONCLUSIONS:Stomal stenosis of appendicostomy may be lessened by preservation of the distal appendiceal vasculature and tip, and opening the lumen in a more proximal location.

INTRODUCTION:Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-flow relationships, and fluid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system. MATERIALS AND METHODS:An in vitro ureteroscopy model was used for testing, consisting of a short semirigid ureteroscope (6/7, 5F, 31cm Wolf 425612) connected to a continuous digital pressure transducer (Meriam m1550). Each system pressure output and flow-rate, via 100mL beaker filling time, was measured using multiple trials at pressure settings between 30 and 300mmHg. Output fluid temperature was monitored using a digital thermometer (Omega DP25-TH). RESULTS:The pressure output of both systems exceeded the desired setting across the entire tested range, a difference of 15.7±2.4mmHg for the TFS compared to 5.2±1.5mmHg for the CRF (p < 0.0001). Related to this finding, the TFS also had slightly higher flow rates across all trials (7±2mL/min). Temperature testing revealed a similar maximum temperature of 34.0⁰C with both systems, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test, while the CRF took over 18 minutes to reach a similar peak. CONCLUSIONS:Our in vitro ureteroscopy testing found that the CRF system had better pressure accuracy than the TFS system but with noticeably slower fluid heating capabilities. Each system provided steady irrigation at safe pressures within their expected operating parameters with small differences in performance that should not limit their ability to provide steady irrigation at safe pressures.

Introduction: The objective of this study was to determine if use of an automated irrigation pump (AIP) during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) affects circulating nurse labor, irrigation-related issues, and surgeon and nurse satisfaction when compared to manual hand pump (HP) irrigation. Methods: Eighty consecutive adult patients undergoing unilateral URS or PCNL were prospectively randomized to irrigation with the HP or AIP. Preoperative pump setup time, intraoperative pump maintenance time, total pump time (setup+maintenance), and the number of irrigation-related concerns verbalized by the surgeon intraoperatively were recorded; postoperatively, surgeons and nurses rated their satisfaction with the irrigation system (1 = highly dissatisfied to 10 = highly satisfied). Results: Eighty patients were enrolled (39 AIP and 41 HP); 51 patients underwent URS and 29 patients underwent PCNL. On univariate analysis, the AIP resulted in a significantly reduced total pump time for URS (2.9 vs 5.9 minutes) and PCNL (4.6 vs 33.9 minutes; p

Clostridium difficile infection remains a common nosocomial illness with a significant impact on health care delivery. As molecular phenotyping of this organism has changed our understanding of its transmission and virulence, so too have diagnostic methods and treatment strategies evolved in recent years. The burden of this infection falls predominantly on elderly patients with comorbidities who have recently received antibiotics. Oral or enteral vancomycin is now preferred for first-line antimicrobial treatment across the disease spectrum, including mild-moderate initial cases. Fidaxomicin (a novel macrolide antibiotic), bezlotoxumab (a monoclonal antibody against toxin TcdB), and fecal microbiota transplantation expand the therapeutic armamentarium, particularly for recurrent infection. Operative treatment should be reserved for patients with fulminant infection, and early identification of patients who would benefit from an operation remains a challenge. Less invasive surgical options-such as laparoscopic diverting ileostomy with colonic irrigation-may improve survival and other outcomes relative to total abdominal colectomy and represent an attractive alternative particularly for frail patients.

Background:The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market. The aim of this study was to compare the mechanical properties of different models of latex and silicone three-way catheters in an in vitro setting that resembles clinical use. Methods:Three different three-way catheters were evaluated: Gold Silicone-Coated Rusch® (Model A), 100% Silicone Rusch® (Model B) and X-Flow Coloplast® (Model C). Irrigation channel, drainage channel, and overall cross-sectional areas were all digitally measured. Irrigation and drainage channel flow rates were measured and correlated with their corresponding catheter cross-sectional area values. Results:Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff port diameters. The Model C IUC internal irrigation port diameter is significantly larger than models A and B. When flows were evaluated, we found that in the same model, the increase in caliber of the IUC was related to an increased drainage flow, but not to an increased irrigation flow. Conclusion:Precise measurements of the internal architecture of the three-way catheter, rather than relying on the caliber itself, could assist surgeons in choosing the best product for each specific patient, while minimizing complications.

Mass spectrometry (MS) offers high levels of specificity and sensitivity in clinical applications, and we have previously been able to demonstrate that matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS is capable of distinguishing two-component cell mixtures at low limits of detection. Ovarian cancer is notoriously difficult to detect due to the lack of diagnostic techniques available to the medical community. By sampling a local microenvironment, such as the vaginal canal and cervix, a MS based method is presented for monitoring disease progression from proximal samples to the diseased tissue. A murine xenograft model of high grade serous ovarian carcinoma (HGSOC) was used for this study, and vaginal lavages were obtained from mice on a weekly basis throughout disease progression and subjected to our MALDI-TOF MS workflow followed by statistical analyses. Proteins in the 4-20 kDa region of the mass spectrum yielded a fingerprint that we could consistently measure over time that correlated with disease progression. These fingerprints were found to be largely stable across all mice, with the protein fingerprint converging toward the end point of the study. MALDI-TOF MS serves as a unique analytical technique for measuring a sampled vaginal microenvironment in a specific and sensitive manner for the detection of HGSOC in a murine model.

IntroductionOpen fractures are associated with a high risk of infection. The prevention of infection is the single most important goal, influencing perioperative care of patients with open fractures. Using data from 2,500 participants with open fracture wounds enrolled in the Fluid Lavage of Open Wounds trial, we conducted a multivariable analysis to determine the factors that are associated with infections 12 months postfracture.MethodsEighteen predictor variables were identified for infection a priori from baseline data, fracture characteristics, and surgical data from the Fluid Lavage of Open Wounds trial. Twelve predictor variables were identified for deep infection, which included both surgically and nonoperatively managed infections. We used multivariable Cox proportional hazards regression analyses to identify the factors associated with infection. Irrigation solution and pressure were included as variables in the analysis. The results were reported as adjusted hazard ratios (HRs), 95% confidence intervals (CIs), and associated P values. All tests were two tailed with alpha = 0.05.ResultsFactors associated with any infection were fracture location (tibia: HR 5.13 versus upper extremity, 95% CI 3.28 to 8.02; other lower extremity: HR 3.63 versus upper extremity, 95% CI 2.38 to 5.55; overall P < 0.001), low energy injury (HR 1.64, 95% CI 1.08 to 2.46; P = 0.019), degree of wound contamination (severe: HR 2.12 versus mild, 95% CI 1.35 to 3.32; moderate: HR 1.08 versus mild, 95% CI 0.78 to 1.49; overall P = 0.004), and need for flap coverage (HR 1.82, 95% CI 1.11 to 2.99; P = 0.017).DiscussionThe results of this study provide a better understanding of which factors are associated with a greater risk of infection in open fractures. In addition, it can allow for surgeons to better counsel patients regarding prognosis, helping patients to understand their individual risk of infection.

Aim: The aim of this study was to measure the amount of material extruded in the periapical area using three irrigation needles (Max-I-Probe, NaviTip Fx and IrriFlex flexible needle). Materials and Methods: Mandibular premolars were selected for this study and glass vials were used to gather the extruded debris and they were preweighed. The samples were divided into two groups: Group A (1 mm penetration of needle from working length), which was subdivided into three subgroups: Subgroup A1: Irrigation was made by Max-I-Probe. Subgroup A2: Irrigation was made by NaviTip Fx. Subgroup A3: Irrigation was made by IrriFlex flexible needle. Group B (3 mm penetration of needle), which was subdivided into three subgroups: Subgroup B1: Irrigation was made by Max-I-Probe. Subgroup B2: Irrigation was made by NaviTip Fx. Subgroup B3: Irrigation was made by IrriFlex flexible needle. XP-endo Shaper was used for chemomechanical preparation. After removal from vials, the teeth were incubated and then removed from the incubator and weighed again three times. The average of the readings was taken. Analysis of variance (ANOVA) and least significance difference tests were applied to analyse data. Results: All of the needles caused debris extrusion. There was a significant difference between groups (P ≤ 0.001) according to the depth of penetration. The lowest value for debris was observed in subgroup B3 while subgroup A2 had shown the highest mean. Conclusion: Results revealed that the design and depth of needles significantly affected the debris extrusion. Using more flexible needles and shorter penetration depth for irrigation so that we don't need to push the needles so far apically.

Background and Objective: Bromelain, extracted from pineapple, is one of the best-known plant proteases. It has been shown to inhibit the growth of Porphyromonas gingivalis in vitro. The study's objective was to evaluate and compare the antimicrobial effect of subgingival irrigation with 0.2% chlorhexidine and 4.8% bromelain extract on P. gingivalis levels in the periodontal pockets. Methodology: A randomized controlled clinical trial with a parallel-group design was conducted involving 24 adults with a periodontal pocket of 5 mm or more depth, who were randomly allocated to the two interventional groups. In each individual, the pocket of the selected tooth was irrigated with 3 ml of interventional irrigants (0.2% chlorhexidine and 4.8% bromelain extract) once, 24 h after supragingival scaling. The baseline subgingival sample was collected using paper points before irrigation, and the second sample was collected on the 7th day after irrigation. Real-time polymerase chain reaction quantitative microbial analysis was done. The Mann–Whitney U-test and Wilcoxon signed-rank test were employed for statistical analysis. Results: There was a significant postirrigation reduction in the level of P. gingivalis counts within Group A (P = 0.002) and Group B (P = 0.002). On intergroup comparison, a statistically significant (P = 0.05) higher reduction in the level of P. gingivalis counts was observed in the chlorhexidine group (35.40 × 105 ± 34.71 × 105 CFU) compared to the bromelain group (36.20 × 105 ± 29.75 × 105 CFU). Conclusion: Periodontal pocket irrigation with 4.8% bromelain resulted in a clinically significant reduction of P. gingivalis counts.

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0–100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6–7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: −10.23 mm (95% confidence interval −17.86; −2.60); pain at rest: − 8.39 mm (95% confidence interval −13.70; −3.08)), while mandibular function remained similar in the two groups (MFIQ −2.41 (95% confidence interval −8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis were conducted to evaluate the effect of endodontic irrigation on the mineral content of root canal dentine. A systematic search was performed in the following databases: PubMed, Web of Science, Scopus, Cochrane, ProQuest, and Wiley. The quality assessment of the articles was performed. The meta-analysis was carried out using the random effects model in the Stata 16 software (p<0.05). The results showed that Er:YAG Laser had a significant effect on the removal of the phosphorus content of dentine (Hedges' g=-0.49; 95% CI: -0.85, -0.13; I2=0.0%). In addition, the EDTA 5Min had a lower removal effect compared to the control group on the magnesium content of dentine (Hedges' g=0.58; 95% CI: 0.00, 1.16; I2=0.0%). Other irrigations had no significant effect on other on the mineral content of root canal dentine. Evidence was found to support that most root canal irrigation protocols did not have a significantly affected in terms of the mineral content of root dentine. [ABSTRACT FROM AUTHOR]

Background and Objective: Bromelain, extracted from pineapple, is one of the best-known plant proteases. It has been shown to inhibit the growth of Porphyromonas gingivalis in vitro. The study's objective was to evaluate and compare the antimicrobial effect of subgingival irrigation with 0.2% chlorhexidine and 4.8% bromelain extract on P. gingivalis levels in the periodontal pockets. Methodology: A randomized controlled clinical trial with a parallel-group design was conducted involving 24 adults with a periodontal pocket of 5 mm or more depth, who were randomly allocated to the two interventional groups. In each individual, the pocket of the selected tooth was irrigated with 3 ml of interventional irrigants (0.2% chlorhexidine and 4.8% bromelain extract) once, 24 h after supragingival scaling. The baseline subgingival sample was collected using paper points before irrigation, and the second sample was collected on the 7th day after irrigation. Real-time polymerase chain reaction quantitative microbial analysis was done. The Mann--Whitney U-test and Wilcoxon signed-rank test were employed for statistical analysis. Results: There was a significant postirrigation reduction in the level of P. gingivalis counts within Group A (P = 0.002) and Group B (P = 0.002). On intergroup comparison, a statistically significant (P = 0.05) higher reduction in the level of P. gingivalis counts was observed in the chlorhexidine group (35.40 x 105 ± 34.71 x 105 CFU) compared to the bromelain group (36.20 x 105 ± 29.75 x 105 CFU). Conclusion: Periodontal pocket irrigation with 4.8% bromelain resulted in a clinically significant reduction of P. gingivalis counts. [ABSTRACT FROM AUTHOR]

Aims: To date, there is no distinct principle determining whether to use irrigation under negative-pressure wound therapy (NPWT). We developed a new economical device to manage difficult wounds, employing 1 of 2 techniques depending on the wound condition. Methods: This case series study was conducted in 12 patients with difficult wound, from 2017 to 2018. Four patients were treated with Type A bidirectional irrigation system (wound irrigation), while 8 patients were treated with Type B bidirectional irrigation system (wound irrigation combined with NPWT). Results: In the Type A device group, inflammatory profiles in case I, case IV, and case VIII were not monitored due to the stability of their wound. The mean recovery period was 3.75 weeks (2-8 weeks), with decreases in 100% healing rate. In the Type B device group, we noted an average of 71% reduction in inflammatory profiles. All patients' infections were resolved or were healing, and 7 patients recovered satisfactorily. The recovery period ranged from 4 to 17 weeks, with a median value of 7 weeks. Conclusion: Bidirectional irrigation system decreases secondary infections and complications, and increases the healing rate in patients with difficult wound. [ABSTRACT FROM AUTHOR]

There is no consensus on the use of prophylactic intraoperative wound irrigation (pIOWI) for reducing surgical-site infections (SSIs), particularly surgical incisional wounds, and opinions are divided on whether an antibiotic should be mixed with the solution used for incisional wound irrigation. No large, reliable cohort studies or meta-analyses of pIOWI for surgical incisional wounds were found in PubMed or Embase. We searched the PubMed, Embase, Cochrane Library, Insight, Scopus, and Web of Science databases for primary research articles investigating the relevance of pIOWI with antibiotics for SSIs. The initial search was limited to human studies published before January 2022, which were indexed as randomized controlled trials (RCTs); clinical trials; or observational, cross-sectional, or cohort studies. We used R statistical software version 4.1.2 for this meta-analysis. The odds ratio of the random-effects model was 0.519 [95% confidence interval (CI); 0.311, 0.864, P-value < 0.0117], indicating that the intervention had a statistically significant effect on surgical complications. To examine the heterogeneity of the entire study, we performed statistical analysis (τ2 (tau square) = 0.4175 [0.0732; 2.8178]; τ (tau) = 0.6461 [0.2706; 1.6786]; Higgins' I2 = 64.0% [34.8%; 80.1%]; and H = 1.67 [1.24; 2.24]). Many studies have shown that inclusion of antibiotics in the irrigation solution significantly lowers the rate of soft-tissue-related SSIs, but those studies contain both heterogeneity and many biases. Further large, prospective RCTs only limited to incisional SSIs and excluding other variables and biases in the field of plastic surgery are needed. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem 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.)

This study aimed to assess the amount of erosion during activated endodontic irrigation with either HEDP or EDTA via high-resolution micro-computed tomography. Two root canals of twenty premolars were prepared with ProTaper Next and irrigated with sodium hypochlorite. Palatal canals, which served as control groups, were sealed, while buccal canals were further irrigated with either EDTA (n = 10) or HEDP (n = 10), which served as test groups. Micro-CT was performed to measure erosion depth. For 2D and 3D measurements, non-parametric repeated ANOVA measurements and post hoc tests were performed. 2D analysis showed highly significant differences between the case groups at each position of the root (p ≤ 0.01). The cervical and apical positions showed significant differences in the EDTA group (p = 0.03). The 3D analysis also showed significant differences between both chelating agents (p < 0.01) and the case and control groups (p = 0.01). The mean erosion depths in the cervical, middle, and apical thirds of the EDTA group were 45.75, 41.79, and 32.25 µm, and for the HEDP group were 20.25, 16.40, and 15.96 µm, respectively. HEDP seems to have a significantly less erosive effect. Different irrigation protocols with harsher conditions, as might be the case during endodontic retreatment, could be assessed with micro-CT.

Introduction: Chronic rhinosinusitis is an inflammatory condition of the nasal cavity and the paranasal sinuses that requires multifactorial treatment. Xylitol can be employed with nasal irrigation and can provide better control of the disease. Objective: To evaluate the association between the effects of nasal lavage with saline solution compared to nasal lavage with a xylitol solution. Methods: Fifty-two patients, divided into two groups (n = 26 in the “Xylitol” group and n = 26 in the “Saline solution” group) answered questionnaires validated in Portuguese (NOSE and SNOT-22) about their nasal symptoms and general symptoms, before and after endonasal endoscopic surgery and after a period of 30 days of nasal irrigation. Results: The “Xylitol” group showed significant improvement in pain relief and nasal symptom reduction after surgery and nasal irrigation with xylitol solution (p

BackgroundIntravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT.MethodsWe retrospectively reviewed records of patients with NMIBC at our institution in 2012-2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed.Results205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28-6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20-0.59) and MMC (HR 0.43, 95% CI: 0.25-0.75) were associated with decreased risk.ConclusionsPostoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone.

ObjectivesRectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT).MethodsFrom 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson's χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted.ResultsOf 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p

BACKGROUND Scaling and root planing (SRP) is a conventional treatment for chronic periodontitis; however, it has limitations in treating deep pockets. To enhance its efficacy, Chlorhexidine (CHX) is proposed as adjunctive therapy with SRP due to its broad antimicrobial spectrum, low systemic toxic activity in humans, absence of oral microorganism resistance, and lack of teratogenic effects. This study aimed to know the efficacy of the adjunctive therapy of CHX. METHODS A literature search was conducted using various databases including PubMed, LIVIVO, EBSCOhost, and Google Scholar, following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines within the last 10 years (2011-2021). Clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), and clinical attachment level (CAL) were recorded. The risk of bias in the selected studies was assessed using Cochrane Collaboration's Handbook version 5.2.0. RESULTS Of 368 studies, 10 met the inclusion criteria, with 8 of them having a higher quality. Higher reduction of PI, GI, BI, PD, and CAL were observed in SRP with CHX irrigation compared with SRP alone. CONCLUSIONS Overall, adding CHX to SRP appeared to have additional clinical benefits compared with SRP alone in the treatment of chronic periodontitis. [ABSTRACT FROM AUTHOR]

Washout of knee joint contents, whether by arthrotomy, arthroscopy, or percutaneous methods, can remove phlogistic material contributing to the problem at hand. Observations dating from the turn of the last century coupled with multiple trials suggest such that an intervention can be useful in the management of osteoarthritis, inflammatory arthropathies, crystal arthritis, and septic arthritis. We suggest that this intervention-applicable at the bedside with minimal cost, preparation, or expertise-be reconsidered as an adjunct in management of these disorders. [ABSTRACT FROM AUTHOR]

Chemical burns can cause deep injury and subsequently significant scarring to the skin. The mechanism and pathophysiology of chemical burns is distinct to thermal burns, and recommended first aid approaches are consequently different. Twenty minutes of cool running water is an effective first aid measure to improve outcomes after thermal burn. For chemical burns to the skin, the recommendations are immediate water lavage for 60 min, removal of contaminated clothing if not stuck to the skin and then covering the wound with a sterile dressing. This review assesses the peer-reviewed literature to find the evidence behind the efficacy of cutaneous chemical burn first aid on short term outcomes such as length of hospital stay, depth of burn and longer-term outcomes such as scarring; in particular, the effect of immediate or early water lavage, and the effect of the duration of water lavage. Ocular chemical burns were not included in this review. The review suggests some evidence to support that the early application of cool water irrigation may reduce length of hospital stay and the extent of scarring. Community education should emphasize that water irrigation is recommended and that the earlier this happens, the better. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes. [ABSTRACT FROM AUTHOR]

This systematic review aimed to evaluate the efficacy of arthrocentesis compared to conservative treatments for symptomatic temporomandibular joint disorders. A systematic search for randomized, prospective and retrospective controlled trials was undertaken in five electronic databases. Various patient outcomes and economic evaluations were analysed for short-term (<6 months), intermediate-term (6 months to 5 years) and long-term (≥5 years) follow-up periods. Primary meta-analyses were performed for randomized controlled trials using random-effects models. Arthrocentesis was superior to conservative treatments regarding pain reduction at short-term (MD 14.5 (95% CI 9.7; 19.4), k= 9 RCTs, n= 545 patients, I 2 = 48%, high quality of evidence) and intermediate-term follow-up (MD 14.2 (95% CI 7.3; 21.1), k=9 RCTs, n= 547 patients, I 2 = 81%, moderate quality of evidence). Furthermore, arthrocentesis was superior to conservative treatment regarding maximum mouth opening improvement at short-term (MD 2.4 mm (95% CI 0.8; 4.1), k= 8 RCTs, n= 472 patients, I 2 = 80%, moderate quality of evidence) and intermediate-term follow-up (MD 2.2 mm (95% CI 0.5; 3.9), k= 8 RCTs, n= 468 patients, I 2 = 75%, moderate quality of evidence). Trial sequential analysis supported the conclusions of all primary meta-analyses. Results were clinically relevant for pain improvement, but not for maximum mouth opening improvement. Results at long-term follow-up and for other study outcomes were either lacking or too heterogenous for meta-analysis, highlighting the need for more standardized, high-quality research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty. In chronic PJI, a biofilm envelops the surface of implants, which contains microbiota within an extra-microbial polymeric matrix (EMPM). Microbial identification is paramount for effective treatment. In this study, we use a multi-modal, EMPM disrupting, neoadjuvant irrigant and compare the microbiota detected pre-lavage to post-lavage by two techniques: culture and Next Generation Sequencing (NGS). We suspect more organisms to be identified after applying an EMPM disrupting irrigant., Methods: A multicenter, prospective study was conducted on 38 patients with known Total Knee Arthroplasty PJI. At initial arthrotomy, synovial fluid was obtained and analyzed for quantitative cultures and microbial NGS. Joint was then irrigated with Bactisure Lavage followed by Normal Saline. Post-lavage samples were similarly obtained and analyzed., Results: In pre-lavage samples for cultures, 55.3% of samples were positive, identifying 11 unique organisms. In post-lavage samples for cultures, 13.2% of samples were positive, identifying 5 unique organisms. In pre-lavage samples for NGS, 79% were DNA signal positive, identifying 126 unique organisms. In post-lavage samples for NGS, 74% of samples were DNA signal positive, identifying 177 unique organisms. Moreover, 135/177 of these organisms were not identified pre-lavage., Conclusion: In this pre-to-post irrigant study, culture showed a decrease in the number of identifiable organisms post-lavage. In contrast NGS revealed an increase in the number of identifiable organisms post-lavage. Furthermore, NGS identified 135 additional organisms, not detected pre-lavage. This suggests an increased diversity of microbes may exist within EMPM, which are not cultivable., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Surgical site infection (SSI) after foot and ankle surgery has serious negative effects on patient health and quality of life. While previous studies have looked at predisposing factors for SSI, to our knowledge, no study has proposed a risk severity score., Questions/purposes: Can a risk severity score, based on patient demographic characteristics and surgical variables, be developed for preoperative use in patients undergoing foot and ankle surgery that will calculate the risk of an irrigation and debridement (I&D) procedure within 90 days of surgery utilizing data from previous surgeries?, Methods: A retrospective chart study was performed on patients undergoing foot and ankle surgery. Data on demographic characteristics including age, sex, and BMI were recorded. Data on patient factors including diabetes and smoking history were also recorded. Surgical details including length of surgery, procedure type, surgeon, antibiotic delivery time, antibiotic type, and antibiotic dose were analyzed. Of 2979 procedures, 1% (36) of I&Ds were performed within 90 days. The mean age at surgery was 49 ± 17 years, and 57% (1702) of patients were female. The mean BMI was 28 ± 6 kg/m 2 . The primary outcome was I&D within 90 days postoperatively. Descriptive statistics of differences in patient characteristics between those who underwent I&D and those who did not were examined using chi-square tests and t-tests (p < 0.05 was taken as significant). Significant variables from a simple regression analysis were included in a multiple logistic regression model with a forward stepwise procedure for variable selection. We required all data in the model to be categorical; thus, continuous variables such as time were dichotomized. We factored odds ratios determined by multiple regression for significant variables into the final risk severity score, and an easy-to-use tool based on this risk severity score was created in Excel (Microsoft)., Results: Current tobacco use, diabetes, and longer operative times were the only factors associated with I&D within 90 days postoperatively. A risk severity score was developed using current tobacco use, diabetes, and length of surgery greater than 60 minutes as factors. A patient with a severity score of 0 (no risk factors) had a 0.6% chance of I&D within 90 days, while a severity score of 1 indicated a 1.1% chance, a score of 2 indicated a 2.1% chance, a score of 3 indicated a 4.0% chance, and a score of 4 (all risk factors) indicated a 7.5% chance of I&D within 90 days. A spreadsheet that can be used at the point of care was created based on these findings., Conclusion: Our risk severity score may help inform preoperative patient guidance and operative planning. Calculating the score in the office setting during preoperative visits can also improve communication between physician and patient. Future research should focus on validation of this risk severity score at multiple institutions., Level of Evidence: Level III, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

In their recent publication, the authors explored the preventive effect of gentamicin in the irrigating solution on endophthalmitis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) after phacoemulsification with intraocular lens (IOL) implantation in rabbits. This letter commends the authors for their innovative approach and discusses the potential of chitosan-based intraocular lenses as a future solution for reducing the incidence of endophthalmitis. Chitosan's natural antibacterial properties, coupled with its capacity for sustained drug release and surface modification, make it a promising material for IOLs. This letter highlights recent advancements and suggests areas for further research to fully realize the potential of chitosan-based IOLs in ocular surgery.

Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone-iodine (PI) and hydrogen peroxide (H 2 O 2 ) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone-implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H 2 O 2 , or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull-out testing. No wound complications were observed. MicroCT scans revealed no differences in peri-implant trabecular bone parameters. Biomechanical pull-out testing showed no differences in the bone-implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri-implant osteocalcin, osterix, or endomucin-positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity. CLINICAL RELEVANCE: Dilute 0.3% povidone-iodine and a 1:1 combination of 10% povidone-iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications., (© 2024 Orthopaedic Research Society.)

Purpose: Endometriosis has a strong impact on women's quality of life (QoL). Pain is the main symptom of the disease, but bowel dysfunctions such as fecal incontinence, constipation and voiding difficulties are also reported. Patients could suffer from a Low Anterior Resection Syndrome (LARS)-like syndrome. Transanal irrigation (TAI), known to alleviate LARS-related symptoms, has been suggested to aid bowel dysfunction in endometriosis patients, potentially facilitating pelvic floor rehabilitation., Methods: We retrospectively collected data from 60 patients with endometriosis and bowel dysfunction who had been prescribed with the Peristeen ® Plus TAI system. Patient satisfaction, pain, QoL and LARS score were evaluated before (baseline) and after TAI treatment (follow-up of approximately 12 months)., Results: Of the 60 patients meeting the inclusion criteria, 12 patients did not complete the questionnaires at follow-up and 16 patients discontinued treatment. Data analysis performed on 32 patients showed a mean increase of 3.6 points in patient satisfaction after TAI treatment and a mean pain reduction of 1.8 points (both, p-value < 0.001). LARS score decreased from a mean of 21.9 at baseline to a mean of 12.7 (p-value < 0.001). Accordingly, there was a notable improvement in patients' QoL., Conclusion: TAI is a useful treatment for bowel dysfunctions in patients with endometriosis. When offered to these patients, TAI seems to represent a valuable strategy to reduce pelvic floor stress. This study confirms that TAI was associated to a significantly higher patients' satisfaction, as well as to a reduction of pain and LARS-like symptoms., Competing Interests: Declarations Ethics approval The protocol of this study was approved by the Ethics Committee of the IRCCS Sacro Cuore Don Calabria (Negrar di Valpolicella, Verona, Italy). The study was conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice for clinical investigations of medical devices in humans. Patient consent Written informed consent was obtained from all individual participants included in the study. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Endometrial cancer (EC) rates are continuing to rise and it remains the most common gynecologic cancer in the US. Existing diagnostic methods are invasive and can cause pain and anxiety. Hence, there is a need for less invasive diagnostics for early EC detection. The study objective was to evaluate the utility of growth factors collected through minimally invasive cervicovaginal lavage (CVL) sampling as diagnostic and prognostic biomarkers for EC. CVL samples from 192 individuals undergoing hysterectomy for benign or malignant conditions were collected and used to quantify the concentrations of 19 growth and angiogenic factors using multiplex immunoassays. Patients were categorized based on disease groups: benign conditions (n = 108), endometrial hyperplasia (n = 18), and EC (n = 66). EC group was stratified into grade 1/2 endometrial endometrioid cancer (n = 53) and other EC subtypes (n = 13). Statistical associations were assessed using receiver operating characteristics, Spearman correlations and hierarchical clustering. Growth and angiogenic factors: angiopoietin-2, endoglin, fibroblast activation protein (FAP), melanoma inhibitory activity, and vascular endothelial growth factor-A (VEGF-A) were significantly (p < 0.0001) elevated in EC patients. A multivariate model combining 11 proteins with patient age and body mass index exhibited excellent discriminatory potential (area under curve = 0.918) for EC, with a specificity of 90.7% and a sensitivity of 87.8%. Moreover, angiopoietin-2, FAP and VEGF-A significantly (p < 0.05-0.001) associated with tumor grade, size, myometrial invasion, and mismatch repair status. Our results highlight the innovative use of growth and angiogenic factors collected through CVL sampling for the detecting endometrial cancer, showcasing not only their diagnostic potential but also their prognostic value., (© 2024. The Author(s).)

Introduction: The long-term efficacy of renal denervation (RDN) has not been extensively documented., Aim: To describe the long-term follow-up of patients after RDN., Methods: We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated., Results: The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m 2 (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m 2 (p = 0.034), and the uACR did not significantly change from baseline to follow-up., Conclusions: In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time., (© 2024. The Author(s).)

Anastomotic leakage and subsequent pelvic sepsis are serious complications after surgery for pelvic malignancies, particularly challenging due to the large pelvic cavity dead space post-exenteration. We report a 47-year-old man treated for a severely infected pelvic hematoma and sepsis following anastomotic leakage after anterior pelvic exenteration. Post robot-assisted exenteration for locally advanced sigmoid colon cancer treated with neoadjuvant chemotherapy, a pelvic abscess from anastomotic dehiscence was identified. Initial CT-guided drainage and subsequent laparoscopic drainage were performed. On postoperative day 22, a bleeding left internal iliac pseudoaneurysm required embolization. Despite these efforts, the sepsis worsened due to an enlarged, infected hematoma. Endoscopic lavage, in collaboration with skilled endoscopists, successfully removed the hematoma, leading to an improved inflammatory response, and the patient was discharged. Endoscopic lavage proved to be the safest and most effective treatment for pelvic sepsis with an infected hematoma after various attempted interventions., (© 2024 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

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., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background and Objective: Eliminating intracanal Enterococcus faecalis ( E. faecalis ) is challenging because of its ability to penetrate deep dentinal tubules and its high resistance to many chemicals. This study evaluated the effectiveness of conventional needle irrigation and three different irrigant activation methods in reducing E. faecalis . Methods: The root canals of extracted teeth were shaped, contaminated with E. faecalis , and incubated for three weeks. They were randomly allocated to four experimental groups of 15 teeth each according to the final irrigation method: group 1, conventional needle irrigation; group 2, passive ultrasonic (PU) irrigation; group 3, XP-endo Finisher (XPF); and group 4, laser-activated (LA) irrigation. Bacterial samples were taken and cultured before and after these final irrigation procedures. The colony-forming units were counted, and the bacterial reduction percentages of each group were calculated. The Kruskal-Wallis and Dunnet tests were used for statistical analysis. Results: All irrigant activation methods were significantly more effective than conventional needle irrigation. Although the LA group generated more negative samples than PU, there was no statistically significant difference between the LA and PU groups. LA was significantly more effective than the XPF, whereas PU and XPF were statistically similar. Conclusions: Within the limitations of this study, the final irrigation with LA and PU showed the best reductive effect on E. faecalis colonies. Considering that the LA group had more negative samples, it may be chosen as an alternative to enhance root canal disinfection, especially in difficult cases.