Anatomical Diameter Research Articles

ANATOMICAL MODELING OF THE SUPERFICIAL MUSCLES OF NECK IN PERINATAL PERIOD OF ONTOGENESIS

The analysis of the literature indicates the high interest of not only domestic, but also foreign scientists in the anatomy and topography of the neck muscles at various stages of ontogenesis for adequate surgical correction of abnormalities in newborns and young children. The study was performed on 63 objects of human fetuses aged from 4 to 10 months and 7 newborns (in particular, 5 isolated organ complexes). For create anatomical models of the surface muscles of the neck, muscle parameters and commonly known neck sizes were determined in all age groups. The length of the muscles was determined from the place of its beginning to the place of attachment, the width – at the level of its widest part, that is, at the level of the anatomical diameter. Statistical analysis of the obtained data was performed using the licensed program RStudio. For the morphometric parameters of the sternocleidomastoid and scapulohyoid muscles during the perinatal period of development, periods of accelerated development are characteristic, for the length of the sternocleidomastoid muscle – from the 5th to the 9th month, for the length scapular- hyoid muscle – from the 4th to the 6th month of intrauterine development. For width of the right and left sternocleidomastoid muscle has two periods of the most intense increase: during 5-6 and 8-10 months of development, while the width of the right and left scapulohyoid muscle increases gradually during this period of development. The created anatomical model based on the morphometric parameters of the surface muscles of the neck is a template for all age groups during the perinatal period of ontogenesis with the aim of establishing typical and variant anatomy with the subsequent prediction of developmental abnormalities or congenital pathology. The established correlation relationships between the morphometric parameters of the sternoclavicular mastoid and scapular- hyoid muscles during the perinatal period of development testify to their synchronous and harmonious development.

Abstract TP81: Retrospective Gender Disparity Study Evaluating Arterial Size and Post Stroke Outcomes

Introduction: Mechanical thrombectomy is now the standard of care for eligible large vessel occlusion (LVO) patients, but women are less likely to be independent at 90-days and have worse functional outcomes compared to men (Modified Rankin Scale (mRS) > 2). The factors that contribute to this disparity, including arterial size, have not been thoroughly explored and these factors are critical to understand for developing new thrombectomy technologies and techniques. Methods: Retrospective data from Barrow Neurological Institute was analyzed to determine the correlation between arterial diameters and the clinical outcome at 90-days of six patient groups (males vs. females: ages 18-40, 41-65, and 65+) after mechanical thrombectomy. Patients were adults who underwent aspiration thrombectomy for LVO within the past 3 years (verified with documented and calibrated computerized tomography (CT) and angiography) and had a documented 90-day mRS score. Vessel diameters were measured from calibrated patient CT scans and conventional angiograms. After adjusting for critical factors (such as demographics, pre-stroke mRS, and use of rTPA), a multiple logistic regression analysis was implemented to determine the correlation between arterial diameter and the 90-day clinical outcome. Results: The data suggests a correlation between arterial diameters and the efficacy of currently available thrombectomy systems. With cerebral vessel anatomical diameters documented as statistically smaller in women versus men, these results play a role in the worse outcomes seen in women. Conclusion: Currently available mechanical thrombectomy systems may not be optimized for patients with smaller arterial sizes as compared to patients with larger arterial sizes. Future devices with improved navigation and patient-specific size-adaptive capabilities may lead to improved patient outcomes.

Clinical determination of anatomical diameter in different dental groups correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis: an observational clinical study

The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.

Ex Vivo Evaluation of the Efficacy of Photodynamic Therapy in Eliminating Enterococcus faecalis from Dentinal Tubules by Confocal Laser Scanning Microscopy

IntroductionThe aim of the present study was to investigate ex vivo by confocal laser scanning microscopy the antibacterial effect of photodynamic therapy (PDT) on dentinal tubules in the apical 5 mm of human mandibular premolars contaminated with Enterococcus faecalis. MethodsThirty-four teeth were standardized to 20 mm and foraminal anatomic diameters using a #20 K-file (Dentsply Maillefer). Samples were contaminated for 21 days and divided into the following 3 experimental groups (n = 10): the PDT group (instrumented canals and PDT), the passive ultrasonic irrigation (PUI) group (instrumented canals and PUI), and the PUI-PDT group (instrumented canals, PUI, and PDT), along with a control group (n = 4) (noninstrumented canals). The canals in the experimental groups were instrumented with ProTaper Next (Dentsply Maillefer) up to X3 and rinsed with EDTA and sodium hypochlorite. The photosensitizer used was 0.01% methylene blue with a preirradiation time of 5 minutes and a diode laser with 4 J energy and a 660-nm wavelength. Cross sections were made 5 mm from the apex of all samples, which were analyzed using confocal laser scanning microscopy. The results were analyzed using the Shapiro-Wilk and Kruskal-Wallis (Dunn) tests. ResultsThere was a lower percentage of live bacteria in the PUI-PDT group, with a statistical difference compared with the control and PDT groups (P < .05). There was no statistical difference in the percentage of live bacteria between PUI-PDT and PUI (P > .05). ConclusionsIt was concluded that the PUI-PDT association was most effective in disinfecting root canals compared with the control group and PDT.

Innovatív genomikai és élettani kutatások az angol telivér állomány versenyteljesítményének fokozása érdekében

Összefoglalás. Célkitűzés: Miosztatin (MSTN) genotípusok összefüggés-vizsgálata izomfejlődéssel és cardiovascularis paraméterekkel angol telivérekben. Módszer: Három, MSTN-genotipizált csoportban echokardiográfiát és izomultrahangot végeztünk. Adatainkat SPSS 15.0 szoftverrel elemeztük. Eredmények: A C/C csoport mért izomvastagságai 22,08 (p = 0,004) és 12,24 (p &amp;lt; 0,001) %-kal; a cardiovascularis rendszeré 6,33 (p = 0,015), 6,03 (p = 0,011) és 6,72 (p = 0,014) %-kal magasabb volt, mint a T/T genotípusnál. Pearson-féle R: anconeus pólyahossz r = 0,460; triceps r = 0,590; aorta Valsalva-öböl diasztolé r = 0,423, szisztolé r = 0,450, billentyűk síkjában szisztolé r = 0,462. Következtetések: Az eredmények hozzájárulnak a galopplovak hatékony tréningmódszereinek kidolgozásához, így jelentősen befolyásolható eredményességük. Summary. Background: The myostatin gene (MSTN; g.66493737) C/T polymorphism has great influence on the development of the muscles and the rates between the types of muscle fibers as well as cardiovascular performance in thoroughbred horses. Consequently MSTN gene decisively determines the optimal race distance and racing ability in thoroughbreds through the muscle development regulation. A more detailed understanding of these genetic attributions and their associations leads us to be able to maximise the athletic potential of thoroughbreds. Objective: In this paper the relationships were investigated between the MSTN genotypes and muscle development or the main cardiovascular parameters which affect or define the cardiac performance of thoroughbreds. Methods: Ultrasonography and echocardiography was performed on each individual selected for our study. Sixty-six thoroughbreds were applied in each measurement (22 of each genotype, C/C, C/T and T/T). All of them participated at different races or were trained at the same time in Hungary. A portable MyLab™ ultrasound system (Alfa-Vet, Animal Healthcare Ltd.) was used for the measurements. To investigate the development of the candidate muscles the size of the anconaeous and triceps brachii muscles were used as indicators. The length of the mentioned muscles was given by the size of the total length of the muscle fascia (m. fasciae anconeus and m. fasciae triceps brachii). Thickness was measured at the largest anatomical diameter of the muscles. To characterize the cardiovascular system, the diameter of the Valsalva sinus of the aorta was measured at the end of diastole and systole, respectively, as well as the diameter of the aorta in the plane of the semilunar valves. The data were analyzed with the SPSS 15.0 for Windows software. Homogeneity of variance between groups was checked with Levene’s test and multivariate analysis of variance was used to determine the correlations between the measured variables and the myostatin genotypes. Results According to our measurements relationship was detected between individual myostatin genotypes, muscular development and cardiovascular parameters of the thoroughbreds. The muscle thickness and fascicle length of group C/C of MSTN showed significant differences compared to group T/T. Aortic diameter at the sinus of Valsalva (end-diastole and end-systole) and aortic diameter at the valve (end-systole) also indicated significant differences between C/C and T/T genotypes too. The thickness of the two muscles (anconaeous and triceps brachii) in the group C/C was 2.08 (p=0.004) and 12.24 (p&amp;lt;0.001) % higher; and of the parameters of cardiovascular system were 6.33 (p=0.015), 6.03 (p=0.011) and 6.72 (p=0.014) % greater, respectively, than in the T/T genotypes. Conclusions: The results contribute to a better understanding of the effects of MSTN genetic variations on phenotypes, which help to develop new, effective training methods for racehorses in order to prepare them for their best race distance according to their genotypes. Thus, the competitive performance and racing ability of thoroughbreds can be improved significantly.

Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge

Abstract Funding Acknowledgements Type of funding sources: None. Background Anatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). Electrographic flow (EGF) mapping is a novel method used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. The EGF technology offers a revolutionary mapping possibility for AF, however, it is not commercially available yet. Purpose This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by EGF in patients with persistent AF. Methods We collected cardiac computed tomography (CT) and EGF data from patients who underwent radiofrequency catheter ablation (CA) for persistent AF. EGF mapping creates a spatial and temporal reconstruction of electric potentials derived from endocardial unipolar electrograms. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA. Patients with individual stable sources with a source activity above threshold (leading source present in more than &amp;gt; 26% of the time) were classified as having an S-Type EGF signature with source-dependent AF. Patients with no stable active source pattern and no leading source with a source activity above threshold were characterized as having a C-Type EGF signature consistent with source-independent AF. We assessed LA anatomical characteristics including size, LAA length, LAA ostial diameter, trajectory of the left superior pulmonary vein (LSPV) and its relation to the LAA on cardiac CT scans. Abutting LAA-LSPV was defined as cases when the LSPV touched the posterior aspect of LAA, and the maximal distance between the two structures was less than 2 mm. Those cases where the distance between LAA and LSPV was more than 2 mm were defined as non-abutting LAA-LSPV. Results Thirty patients were included in this study (mean age 62.4±6.8 years):23 patients had an S-Type EGF signature (77%), and 7 patients had a C-Type EGF signature (23%). We identified 10 patients with AF sources near the LA ridge, while twenty patients had no leading source near the LA ridge. LA anatomical characteristics, LAA length and ostial diameter showed no correlation with the presence of a leading source near the ridge. We described 19 patients with abutting LAA-LSPV, and 11 patients with non-abutting LAA-LSPV. Three out of 19 patients presented with a leading source near ridge in the abutting LAA-LSPV group, while 7 out of 11 patients presented with a leading source near ridge in the non-abutting LAA-LSPV group (p=0.01). Conclusion Our data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.

Surgical procedure in restoration interventions for tubal obstructions

The practical advantages of restorative surgery in tubal sterility versus in vitro fertilization (IVF) – especially the avoidance of ovarian stimulation and the risks of multiple pregnancy, the possibility of natural conception and the lower costs – have led the search for new surgical procedures. Performing the tubal isthmic incision as an initial step in solving the tubal pathological processes, both isthmic and ampullary or pavilion, aims to insert the catheter, both in the uterine cavity, facilitating its extraction at the optimum time and along the entire lumen of the restored tube, thus preventing restenosis or tubal obstruction secondary to the intervention. The use of the 0.85 mm catheter, close to the isthmic and interstitial intraluminal tubal anatomical diameter (with ɸ = 0.9 mm), avoids the destruction of the epithelial ciliated cells and non-ciliated endoluminal cells, and enables the postsurgical maintenance of physiological intraluminal diameter of the isthmic incised area. The accuracy of the surgical technique in the case of tubal repermeabilization after tubal ligation ensures a high success rate compared to IVF. In this paper, we approach a staged practical presentation of this pathology in which we highlight the advantages of the described surgical procedure.

Revision Anterior Cruciate Ligament Reconstruction: Tibial Tunnel-First Graft-Sizing Technique

Revision anterior cruciate ligament reconstruction (R-ACLR) has become more common as the number of failed primary ACLRs increase. Although increasingly common, R-ACLR has a greater failure rate than a primary reconstruction. Technical errors, particularly in tunnel placement, account for a large proportion of graft failure in R-ACLR as well as re-revision cases. Tunnel placement and trajectory is particularly important in R-ACLR and becomes more challenging with each additional revision attempt. This is in part because any tunnels created for revision may converge with formerly drilled tunnels or face interference hardware creating, complicating proper graft fixation. While there are many approaches to revision ACL surgery, our technique describes a simple, tibial tunnel-first graft-sizing method initially reaming tunnels with very small diameters and sequentially working your way up to more anatomic diameters.

Duplication of superficial femoral artery: imaging findings and literature review

BackgroundDuplication of the superficial femoral artery (SFA) is an extremely rare anatomic variation, with few case studies reported. We report one case of the duplicated SFA, discovered by both ultrasonography (US) and computed tomography angiography (CTA). We also reviewed literatures concerning 6 cases of the duplicated SFA (including our present case), and summarized the clinical and imaging features of the anatomic variation.Case presentationA 55-year-old woman presented to our hospital with an intermittent cramp in the lateral aspect of the right leg. The patient underwent Doppler US examination on bilateral lower extremity arteries and veins to examine potential vascular abnormality. Incidentally, US discovered the duplicated left SFA and CTA of bilateral lower extremities revealed the anatomic orientation, course, length, diameter and distance of the duplicated left SFA. It was revealed to be divided into two trunks with similar luminal diameter and courses parallel. They reunited at distal thigh level. The findings of US and CTA examination did not correspond with the symptom of the patient, and the patient was discharged.ConclusionWe report a rare case of the duplicated SFA diagnosed with the combinations of US and CTA examination, which served as valuable imaging methods to detect and diagnose the vascular anatomic variation in lower extremities.

Structural Integrity of Vascular System in Branching Units of Coniferous Shoot

In conifers with spiral phyllotaxis, two numbers: one of the vascular sympodia and the second of cortical resin canals, define the shoot anatomic diameter. This in turn reflects the size and vigor of the apical meristem. Both numbers belong to the mathematical series, associated with the shoot phyllotactic pattern. The number of canals is one step lower in a series than the number of sympodia. The first one, easier to determine, automatically defines the second. Using this protocol and screening the large number of branching shoots of selected conifers, we have discovered strong correlation between orientation of vascular sympodia in the lateral and supporting branches. There was no such correlation with regard to the chiral configurations of phyllotaxis. This finding reveals the presence of special phyllotactic compensation in the case of differences in anatomic diameter of the parental and lateral shoot under the imperative of maintaining the sympodia orientation within one branching unit. Phyllotaxis of the axillary apex is evidently not established at random but adapted to the condition of the subtending axis. The monopodial, regularly branching shoot of conifers is an attractive example of biological system, which is not a sum of independent, iteratively formed units. Rather, it appears to be an entity organized on hierarchically higher level, which emerges from coordination of developmental processes in a population of the units.

A Postural Approach to the Pelvic Diameters of Obstetrics: The Dynamic External Pelvimetry Test.

In recent years, there has been a renewed interest in internal and external pelvimetry, in relation to the diagnosis of dystocia from a "contracted pelvis." Dystocia is still one of the causes of maternal-fetal morbidity and mortality in the world. The main cause is the fetal-pelvic disproportion, of which mechanical dystocia and contracted pelvis are most probably involved. Clinical pelvimetry was the diagnostic method of "contracted pelvis" and still seems to have its place in the clinical obstetric routine. Studies have been conducted in order to measure anatomical diameters and correlate them with operative or vaginal delivery. Some studies have been published regarding the diameters' variation with the shifting of the patient's posture. The positions used in the research for the analysis of changes in pelvis measurements are the same as those used for centuries to assist and promote childbirth.This technical report is to define a method of measuring changes in classical pelvimetric external diameters in relation to the postural change of the subjects, taking into consideration the needs of the operators, the postural difficulties of pregnant women and the evidence acquired from instrumental research. It aims to propose a dynamic postural method suited to daily practice, according to the directives and principles of the classical external obstetric pelvimetry.

Repairing massive soft tissue defects of shank and foot with combined flaps with the help of 3D-CTA technique

Objective To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 patients with massive soft tissue defects (defect area: 21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps (ALTP) combined with local transferred sural neurocutaneous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thoraco-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-umbilical flap in 1 case. Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-operatively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment: 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb function and shorten the course of treatment. Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the operation time and improve the accuracy rate of vascular anastomosis. Key words: 3D-CTA; Combined flaps; Anterolateral thigh perforater flaps; Shank injury; Foot injury; Repair

Matching the Dimensions of Currently Available Instruments with the Apical Diameters of Mandibular Molar Mesial Root Canals Obtained by Micro–computed Tomography

IntroductionThis micro–computed tomographic study investigated the original anatomic diameters of the apical portion of mandibular molar mesial canals and matched them to the dimensions of instruments that are currently available and commonly used for apical preparation. MethodsOne hundred eight mandibular molar mesial roots with Vertucci type IV configuration were scanned by micro–computed tomographic imaging, and the largest anatomic diameter of both mesial canals at 1, 2, 3, and 4 mm short of the apical foramen was measured. Canal diameters were compared with the dimensions of 10 endodontic instruments for simulation of preparation 1 mm short of the apical foramen. Accordingly, the instruments with a diameter larger than the largest canal diameter were regarded as having the potential to prepare 100% of the canal walls at each specific point or over the 4-mm apical segment. ResultsAt 1 and 2 mm short of the apical foramen, a 45/.02 instrument had a larger diameter than the mesiobuccal canal diameter in 73% and 55% of the teeth, respectively. Corresponding figures for the mesiolingual canal were 65% and 55%. When the entire 4-mm apical segment was considered, a 40/.06 instrument had better results, being larger than the apical canal in about 20% of the specimens. Overall, 78% of the apical canals would not be completely prepared by any instrument. Based on the mean (median) anatomic diameters, the adequate instrument dimensions would be 40/.10 (40/.08) for mesiobuccal canals and 45/.08 (40/.09) for mesiolingual canals. ConclusionsThe dimensions of the available instruments are not compatible with complete apical preparation in the majority of cases. The ideal instrument size/taper to include all the canal walls in apical preparation is too large and may not be safe for clinical use.

Numerical investigation of the effect of vessel size and distance on the cryosurgery of an adjacent tumor

Cryosurgery is an efficient cancer treatment which can be used for non-invasive ablation of some internal tumors such as liver and prostate. Tumors are usually located near the large blood vessels and the heat convection may affect the progression of the ice ball. Hence it is necessary to predict the surgery procedure and its consequences earlier. In spite of the recent studies it is still unclear that which arteries will significantly affect the freezing treatment of tumors and which can be ignored. Therefore a numerical model of a spherical 3 cm diameter liver tumor, subjected to cryosurgery was developed. The specific thermophysical properties were applied to the tumor and healthy tissues in frozen and unfrozen states. A simplified Hepatic artery with different anatomical diameters was placed in different positions relative to the tumor and energy and momentum equations were solved. The temperature distribution and the shape of the resultant ice ball were discussed. The results showed that a 4 mm diameter artery in the vicinity of a tumor will increase the minimum temperature achieved at the tumor boundary by 12.5 °C and therefore significantly affects the cryosurgery outcome. This may cause insufficient freezing which leads to incomplete death of tumor cells, failure of the surgery and tumor regenesis. Eventually it was shown that injection of gold and Fe3O4 nanoparticles to the surrounding tissue of the artery can enhance the heat transfer and progression of the ice ball, making temperature distribution similar to the no vessel state. Development of computational models can provide the physicians an applicable tool which helps them recognize how efficient a treatment method will be for a specific case and design a suitable cryosurgery plan.

The Superficial Femoral Artery Flap: A 3-Dimensional Anatomical Study.

The superficial femoral artery perforator (SFAP) flap offers advantages for pedicled transfer including consistent perforators and vascular territory, well-hidden donor site scar, and hairless flap skin. This article provides a historical overview of the SFAP flap and describes the vascular anatomy of the SFAP by 3-dimensional analysis and angiography. Ten fresh cadavers were injected using the lead oxide technique through the femoral artery. Spiral computed tomographic scanning and 3-dimensional evaluation were used to describe the SFAP number, diameter, length, type, and location. A total of 288 perforators in 15 cadaver limbs were identified; 19 ± 8 perforators per thigh ≥0.5 mm in diameter, with an average diameter of 0.8 ± 0.3 mm and a range of 0.5 to 2.1 mm; the mean length of each perforator was 68 ± 31 mm; 45% were septocutaneous and 55% were musculocutaneous. The medial thigh region was divided into 6 areas (anterior and posterior halves, then the proximal third, middle third, and distal third of each). The majority of the perforators were located in the middle and distal thirds of the anteromedial thigh (33% each). Using 3-dimensional vascular anatomical analysis, the number, location, length, type, and diameter of the SFAP were documented. In the literature, relatively few reports of the use of the SFAP flap are available, however, this is a valid donor site with consistent cutaneous perforators suitable for harvest as a local or regional flap transfer. This is the first 3-dimensional vascular anatomical study to comprehensively document the vascular anatomy of the SFAP flap.

Comparison of Apically Extruded Debris during Retreatment Procedure by Two Types of Endodontic Instruments

Abstract Introduction: During root canal treatment, canal debris is inadvertently extruded through the apex during shaping and cleaning. This happens not only during the routine endodontic cases, but also during the retreatment cases. Objective: This study analyzed in vitro the amount of debris extruded through the foramen using two instrumentation techniques during endodontic retreatment. Materials and methods: Sixty roots of mandibular first premolars were selected, instrumented with anatomical diameter up to size number 40 International Organization for Standardization (ISO) file, and then obturated with gutta-percha and zinc-oxide eugenol sealer by lateral condensation. They were then divided into two groups of 30 each. The first group was instrumented with ISO K-files for gutta-percha removal and the second group was instrumented with Protaper retreatment files and gutta-percha was removed. All teeth were irrigated with distilled water. The debris extruded through the foramen were collected and weighed by an analytical balance. Results: Group II had the lowest average for material extrusion through the foramen followed by group I. When Tukey test for statistical analysis was applied, significant differences among groups were found (p = 0.02). Conclusion: It can be concluded that Protaper retreatment files produce significantly less debris as compared with K-files.

Application of transesophageal echocardiography in left atrial appendage closer with Amplatzer Cardiac Plug

Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP). Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE. Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum, minimum values, and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation. The outcomes of LAA occlusion were analyzed. Results Among 32 patients, 27 cases achieved successful LAA occlusion, including 2 cases with peripheral leakage ≤5 mm, and 5 cases failed occlusion.Among 5 failed closed patients, 3 cases with LAA AAD≥ 30 mm, 1 case with LAA of short depth, and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA. LAA AAD maximum, minimum and LAA depth were (25.9±4.9)mm, (20.0±3.8)mm, (31.0±5.6)mm, respectively, and LAA AOD maximum, minimum diameters were (26.2±6.2)mm, (19.4±4.3)mm, respectively. Among 10 cases with LAA AAD≥30 mm, 7 cases achieved successful LAA occlusion, but 3 cases failed. The implanted device diameter was (26.4±3.8)mm, and device compression rate was (7.6±5.5)%. The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717, respectively. There was no complication but 1 case with pericardial effusion. Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder. The AAD of 2D TEE has the good correlation with ACP occluder′s size, the AADs are important factors which affect the success of LAA occlusion. Key words: Echocardiography, transesophageal; Left atrial appendage; Occlusion; Amplatzer Cardiac Plug

Diode lasers for pediatric endodontics: State-of-the-art!

Introduction: Conventional chemomechanical debridement (CMD) of deciduous root canals can significantly reduce the intracanal bacterial load but cannot assure predictable disinfection due to the inherent anatomical complexities. Newer methods are thus being employed to enhance the efficacy of pediatric endodontic disinfection, and the use of laser technology is at the forefront of this endeavor. Aim: The aim is to assess the efficacy of diode laser-assisted disinfection in comparison to conventional sodium hypochlorite (NaOCl) based CMD in deciduous root canals. Materials and Methods: A total of 12 patients aged 5–8 years of both genders were selected. Local anesthesia was administered and rubber dam isolation achieved. Access opening was done and the roof of the pulp chamber was removed. A sterile paper point compatible with the anatomic diameter of the canal was introduced and left in place for 30 s ( first sample) which was then transferred into an Eppendorf tube containing reduced transport fluid medium. CMD was performed up to 25 number K-file with intermittent 3% NaOCl irrigation. Post-CMD, sterile number 25 paper points were introduced as above (second sample). Thereafter, an 810 nm diode laser (1W, CW) with a specific endodontic E-200 tip was introduced into the root canals 2 mm short of the radiographic apex and was gently withdrawn in a helical zigzag motion. Another sample was then taken using a sterile No. 25 paper point (third sample) and transported to the microbiological laboratory for culture. Results: The mean reduction in colony forming units postdiode laser application was seen to be 100% when compared to 98.46% reduction after CMD with 3% NaOCl. Conclusion: An 810 nm diode laser can be used as an effective adjunct to conventional methods of deciduous root canal disinfection.

Correlation analysis between left atrial appendage transesophageal echocardiography measurements and Watchman left atrial appendage occluder size

Objective To evaluate the correlation between left atrial appendage (LAA) transesophageal echocardiography (TEE) measurements and Watchman LAA occluder size. Methods Consecutive 59 atrial fibrillation (AF) patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion under the guidance of TEE between October, 2014 and February, 2016. Measurements of the LAA anchoring area diameter and anatomical LAA orifice diameter including maximum, minimum and average values, and LAA depth on behalf of LAA size on 2D TEE, and anchoring area diameter including maximum, minimum and average values on 3D TEE were done before closer device implanation. The correlational analysis between TEE LAA diameter and Watchman LAA occluder size was conducted. Results Fifty-nine patients included 53 cases with successful LAA occlusion (peripheral leakage ≤5 mm), 3 cases with incomplete occlusion (peripheral leakage >5 mm ), and 3 cases with failed occlusion. Among 56 patients with device implanation, 43 had 3D TEE data. Maximum, minimum and average diameters of LAA anchoring area and LAA depth were (22.6±3.4)mm, (17.7±2.8)mm, (20.3±2.9)mm, (28.2±5.3)mm, respectively, and their coefficient of correlation r were 0.669, 0.564, 0.696, and 0.530, respectively ( all P=0.000) with Watchman device diameter. Maximum, minimum and average diameters of LAA anatomical orifice were (23.5±4.2)mm, (18.3±3.6)mm, (20.9±3.7)mm, respectively, and their coefficient of correlation r were 0.576, 0.610, 0.643 separately ( all P=0.000) with Watchman device diameter. Maximum, minimum and average diameters of LAA anchoring area were (22.2±4.3)mm, (18.2±3.9)mm, (20.2±3.7)mm, respectively with 3D TEE of 43 patients, and their coefficient of correlation r were 0.650, 0.655, 0.727, respectively ( all P=0.000) with Watchman device diameter. Conclusions Both 2D TEE and 3D TEE measurements of LAA have clinical guiding significance in the selection of proper size of Watchamn LAA occluder. The average diameter of 2D TEE and 3D TEE LAA anchoring area have the best correlation with Watchman device size, and have the most potency for the predicting the proper size of device. Key words: Echocardiography, transesophageal; Left atrial appendage; Occlusion; Watchman occluder

Manual and Rotary Instrumentation Ability to Reduce Enterococcus faecalis Associated with Photodynamic Therapy in Deciduous Molars

This aim of this study was to assess the ability of manual or rotary instrumentation associated with photodynamic therapy (PDT) to reduce Enterococcus faecalis using three combinations of light/photosensitizers: toluidine blue O/laser, fuchsin/halogen light and fuchsin/LED. Twenty deciduous molars were selected and contaminated with Enterococcus faecalis (McFarland 0.5 scale). Working length determination was performed by visual method. The teeth were randomly divided into two groups: G1 (n=10): manual instrumentation (Kerr-type files) and G2 (n=10): rotary instrumentation (ProTaper system). The bacteria were collected three times using sterile paper cones compatible with the anatomic diameter of the root canal for 30 s before and after instrumentation and after PDT. The samples were diluted in peptone water, seeded on blood agar plates and incubated in an oven at 37 °C for colony-forming units counting. The decrease of E. faecalis counts after instrumentation and after PDT was compared using the Wilcoxon test, t-test and Kruskal Wallis test. A significant reduction of E. faecalis occurred after manual and rotary instrumentation and after PDT using the three combinations of light/photosensitizer (p<0.05). It may be concluded that both rotary and manual instrumentation reduced E. faecalis. Fuchsin with halogen light or LED irradiation and toluidine blue O with laser irradiation can be used to reduce E. faecalis in root canals of primary molars. PDT can be used as an adjuvant to conventional endodontic treatment.