Canal Segment Research Articles

Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning

IntroductionThis ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs. MethodsMesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT. ResultsA substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05). ConclusionWhen used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria.

Dens invaginatus Type II in an Immature Lateral Incisor With Apical Periodontitis Treated With Regenerative and Strategic Antimicrobial Procedures: A Case Report

Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.

Deformation Monitoring Based on SBAS-InSAR and Leveling Measurement: A Case Study of the Jing-Mi Diversion Canal in China.

The Jing-Mi Diversion Canal is a large-scale water diversion project in Beijing. Routine monitoring is crucial for the reliability and stability of urban water supply. Compared with traditional monitoring methods, interferometric synthetic aperture radar (InSAR) has the advantages of large scale and high accuracy. Based on the small baseline subset InSAR, 187 ascending and 102 descending SAR images obtained from Sentinel-1 were used to detect the deformation along the diversion canal from 2017 to 2023. The results show that there was a sinking trend along the diversion canal. The subsidence was serious in the first half of the canal, and continued to sink from 2019 to 2020. The subsidence was alleviated in 2023. Combined with leveling measurements, the InSAR deformation monitoring results of important pumping station buildings were verified. The measurement accuracy of InSAR can reach the millimeter level. We extracted the groundwater level time series and subsidence for risky canal segments. Through pixel-by-pixel comparison, it was found that fluctuations in groundwater level would have some impact on surface deformation. Severe local subsidence or uplift deformation occasionally occurred. To ensure the safety of water diversion, the monitoring and maintenance of relevant pump station buildings in risky areas should be increased in the future.

Reduced Fascicle Area Demonstrated in Ilioinguinal Nerves Resected from Primary Inguinal Herniorrhaphy Patients as Evidence of Compression Neuropathy.

30 male patients with primary inguinal hernias undergoing primary inguinal herniorrhaphy were prospectively recruited for ilioinguinal nerve resection and evaluation. Three samples of the resected ilioinguinal nerve (proximal, canal, and distal) were evaluated using Masson's trichrome stain to measure fascicle and total nerve cross-sectional area and detect changes in collagen. The fascicle cross-sectional area in the canal segment was significantly decreased compared to the proximal control with a large effect size observed (p = 0.016, η2 = 0.16). There was no significant difference in the nerve cross-sectional area between locations, but there was a moderate to large effect size observed between locations (p = 0.165, η2 = 0.105). There was no significant difference in collagen content nor effect size observed between locations (p = 0.99, η2 = 1.503 × 10-4). Interpretation. The decrease in the fascicle cross-sectional area within the inguinal canal further suggests that there is chronic pressure applied by hernia tissue consistent with axon degeneration. Collagen content is uniformly distributed along the length of the nerve. Further studies with larger samples are needed to confirm the observed effect of nerve location on the total nerve cross-sectional area and axon loss.

Analysis of clinical manifestations and imaging features of facial nerve schwannomas

Objective:To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas. Methods:Retrospectively analyze the data of 23 patients with facial nerve schwannomas confirmed by surgery and pathology in the Department of Otorhinolaryngology of the First Affiliated Hospital of the Air Force Military Medical University from September 2020 to September 2022, including 8 males and 15 females, aged 18-66 years old. Summarize and analyze their clinical symptoms, specialized examinations, and imaging findings. Results:The clinical manifestations were facial nerve paralysis in 15 cases（2 cases of HB Ⅳ, 6 cases of HB Ⅴ, 7 cases of HB Ⅵ）, hearing loss in 14 cases（5 cases of conductive deafness, 2 cases of mixed deafness, and 7 cases of severe sensorineural hearing loss）, 8 cases tinnitus, 7 cases ear pain, 4 cases dizziness, 4 cases headache, 2 cases ear pus, and parotid gland tumors in 6 cases presenting as local masses. Endoscopic examination revealed 8 cases of external ear canal tumors and 3 cases of intratympanic tumors. Combining temporal bone HRCT, MRI enhanced scanning, and CPR imaging techniques, 1 case involved the internal auditory canal segment, 2 cases in the tympanic segment, 6 cases in the parotid gland area. A total of 14 cases involved two or more segments of the internal auditory canal segment, the labyrinthine segment, geniculate ganglion, the tympanic segment, and the mastoid segment. When the tumors were large, adjacent structures were involved. It was found that 8 cases invaded the external auditory canal and tympanic cavity, ossicles were displaced or bony destruction; 3 cases invaded the jugular foramen area, and 1 case grew to the middle cranial fossa region with temporal lobe brain parenchymal compression. Conclusion:The clinical manifestations of facial nerve schwannomas are diverse. The combination of various imaging techniques will be conducive to topical and qualitative diagnosis and provide an important basis for treatment strategies.

Deformation mechanism and treatment effect of deeply excavated expansive soil slopes with high groundwater level: Case study of MR-SNWTP, China

Taking a 4 km long deeply excavated expansive soil canal segment of the South–North Water Transfer Project Middle Route (MR-SNWTP) in China as an example, a comprehensive investigation of the deformation mechanism and effect of treatment work on the slope with high groundwater level was carried out. First, the project background and initial behaviour were introduced. Second, a series of site investigation, including visual inspection, exploration pit, and geological penetrating radar, was employed to identify the deformation characteristics, appearance damage, and groundwater distribution. Third, the environmental factors were analyzed, and the spatio-temporal deformation characteristics were identified. Then the zoned numerical model was built to analyze the slope stability. Finally, the deformation mechanism and effect of treatment work were discussed. The results show that although the slope surface was replaced with a cement-treated weak expansive soil layer, the water vapor exchange between the undisturbed expansive soils and atmosphere is not completely isolated. The perched groundwater is also still replenished by precipitation infiltration. Groundwater, perched groundwater, long-large fissure and dense fissure zone induce the lateral creep deformation of the slope, and result in significant trend changes. The stability of the deformed body is in a critical state. The critical sliding surface is a broken line consisting of a gentle dip angle at the leading edge and a steep dip angle at the trailing edge. The depth of the potential sliding surface varies due to the geological condition and arrangement of anti-slide piles. Drainage wells can discharge deeper groundwater, thus can lower groundwater level and discharge perched groundwater. Supporting and unloading measures should also be taken to improve the slope stability.

A statistical shape analysis for the assessment of the main geometrical features of the distal femoral medullary canal.

Statistical Shape Models (SSMs) are widely used in orthopedics to extract the main shape features from bone regions (e.g., femur). This study aims to develop an SSM of the femoral medullary canal, investigate its anatomical variability, and assess variations depending on canal length. The canals were isolated from 72 CT femur scans, through a threshold-based segmentation. A region of interest (ROI) was selected; sixteen segments were extracted from the ROI, ranging from 25% of the full length down to the most distal segment. An SSM was developed to identify the main modes of variation for each segment. The number of Principal Components (PCs) needed to explain at least 90% of the shape variance were three/four based on the length of the canal segment. The study examined the relationship between the identified PCs and geometric parameters like length, radius of curvature, ellipticity, mean diameter, and conicity, reporting range and percentage variation of these parameters for each segment. The SSMs provide insights into the anatomical variability of the femoral canal, emphasizing the importance of considering different segments to capture shape variations at various canal length. These findings can contribute for the design of personalized orthopedic implants involving the distal femur.

Ship Speed Optimization Method in Canal Environments Considering Waiting Times for Crossing Locks

The shipping industry faces a pressing challenge with carbon emissions, prompting a focus on speed optimization for energy conservation and emission reduction. While much research has centered on optimizing speeds in oceans and rivers, canals have received less attention, despite their unique challenges of narrow waterways and busy locks. This study fills this gap by establishing a fuel consumption prediction model integrating key environmental factors such as water depth, width, and flow velocity. Drawing upon established methodologies in speed optimization, this study augments these models with waiting time limits for each canal segment. To validate the efficacy of the model, three representative ships are selected as case studies. The findings reveal a high predictive capability of the fuel consumption model, as evidenced by R2 values exceeding 0.97 across all cases. Notably, the optimization approach yields a fuel consumption reduction ranging from 4% to 5% for short waiting times. Furthermore, compared to conventional methods, the proposed optimization strategy achieves an 8.19% enhancement in fuel consumption and carbon emission reduction for long waiting times, culminating in an overall optimization rate of 11.54%. These results underscore the significance of employing the proposed speed optimization methodology, particularly during peak periods of canal congestion.

Multi-scale failure mechanisms of hydraulic engineering exposed to seasonally frozen salinization environment: Integrating SBAS-InSAR and mechanical experiments

Constructing hydraulic engineering ensures agricultural development and improves salinization environments. However, in seasonally frozen salinization regions, hydraulic engineering is prone to deformation failure. Leakage from canal raises the regional groundwater level, triggering secondary salinization environmental issues. Exploring the instability mechanisms is thus necessary for hydraulic engineering. Traditional deformation monitoring techniques and soil experiments are constrained by observation scale and timeliness. In this study, Sentinel-1B data from November 2017 to August 2019 were acquired. The small baseline subset (SBAS) InSAR approach was employed to interpret the seasonal deformation characteristics in both the vertical and slope directions of a damaged canal segment in Songyuan, Northeast China. The mechanical properties of saline-alkali soil under varying water contents were quantified by integrating unconfined compression experiment (UCE). In May, as the soil thawed downward, a frozen lenses with poor permeability formed at a depth of approximately 100 cm, causing the accumulation of meltwater and infiltrated precipitation between the frozen layer and the melting layer in the canal. The soil water content at a depth of 80 to 140 cm exceeded 22 %, reaching a threshold for rapid reduction in unconfined compression strength (UCS). Consequently, in spring, the low soil strength between the frozen layer and the melting layer resulted in interface sliding, with a displacement of −133.88 mm in the canal slope direction. Furthermore, the differential projection of freeze-thaw deformation in the slope direction caused continuous creep of the canal towards the free face, with a value of −23.27 mm, exacerbating the formation of the late spring landslide. Integrating InSAR and engineering geological analysis is beneficial for addressing deformation issues in hydraulic engineering. Ensuring the sustainable operation of hydraulic engineering holds important implications for mitigating the salinization process.

Integration of Sentinel–1 and Landsat–8 data for identifying deformation risk of hydraulic engineering in seasonally frozen salinization regions

Hydraulic engineering has positive effects on agricultural production and soil desalination. However, freeze–thaw cycles can cause instability in canal slopes, emphasizing the need for effective deformation monitoring. Using Sentinel-1B data acquired from November 2017 to August 2019 and applying the small baseline subset (SBAS) InSAR method, two unstable canal segments with vertical deformation rates exceeding –40 mm/year were identified in Songyuan, Northeast China. The canal slopes uplifted in winter and experienced accelerated subsidence in spring, with the shady slope experiencing a deformation rate approximately 10 mm/year faster than the sunny slope. Further investigation, integrating Landsat–8 data collected from November 2017 to August 2019, revealed that the shady slope received less thermal radiation than the sunny slope, with an average annual temperature difference on the land surface of approximately 1 ℃. In winter, the saline–alkali soil particles formed a thick unfrozen water film, which, driven by temperature and soil–water gradients, migrated towards the freezing front, froze, and caused soil frost heave. The shady slope experienced longer freezing periods and deeper frozen depths, up to 240 cm, causing more unfrozen water migration and greater uplift deformation than the sunny slope. In spring, as temperature rose, the soil thawed from the surface downward. Notably, the shady slope thawed at a slower rate than the sunny slope, forming a frozen lens near a depth of 100 cm. Frozen lens acted as a barrier for meltwater infiltration, impeding the dissipation of pore water pressure, making the shady slope prone to surface landslides. The integration of multiple data sources is beneficial for identifying deformation risk in hydraulic engineering.

A novel prediction model construction and result interpretation method for slope deformation of deep excavated expansive soil canals

Several giant water diversion projects go through large expansive soil areas in China. It is challenging to ensure the slope stability of the deep excavated expansive soil canal segments due to its undesirable geologic, and physical and mechanical properties. This study develops a novel deformation prediction method for deep excavated expansive soil canal slopes based on the eXtreme Gradient Boosting (XGBoost) algorithm, and provides a result interpretation using SHAP (SHapley Additive exPlanations). Firstly, the main factors influencing the slope deformation of deep excavated expansive soil canal segments are discussed. Subsequently, the integrated XGBoost-SHAP method is proposed for the prediction model construction of slope deformation and its result interpretation, the related the methodologies including the variational mode decomposition (VMD), XGBoost, and SHAP are also presented. The ten-fold cross-validation is employed to find the hyperparameter combination for the deformation prediction models, and the model performances are compared with common validation measurements. The effectiveness of the explanatory deformation prediction method is verified through one typical deep excavated expansive canal segment of the mid-route of the South-to-North Water Diversion Project in China. The case study shows that the VMD algorithm can well decompose the trend, periodic and fluctuating displacements. Compared with random forest and least squares-support vector machines, the XGBoost-algorithm based model achieves the better prediction performance. SHAP provides prediction result interpretations at both global and local levels. Time dependent effect and groundwater have a significant impact on the slope deformation of deep excavated expansive soil canal segments. The integrated SHAP-XGBoost method can provide a reference for predicting slope deformation of the similar projects. It can also quantify the contribution and mechanism of influencing factors on slope deformation at both global and local levels, which is conducive to implement reinforcement measures.

Influence of brushing motions on the shaping of oval canals by rotary and reciprocating instruments.

The effects of brushing on shaping with three different instruments were assessed in oval canals. Mandibular incisors were assigned to 6 groups (n = 12/group) according to the system, each one with or without brushing: Reciproc Blue, VDW.Rotate, and Race EVO. Micro-computed tomography was performed before and after preparation. Brushing strokes caused no increase in canal volume, surface area, and structure model index independently of the system (p > 0.05), except for RaCe EVO in the full canal surface area (p < 0.05). Brushing did not increase the prepared areas (p > 0.05), except for Reciproc in the apical canal (p < 0.05). Reciproc with no brushing exhibited less pericervical dentin than with brushing (p < 0.05), while RaCe EVO with brushing resulted in less remaining dentin (p < 0.05). The brushing motion had no effects on the overall shaping performance of the 3 instruments tested. An exception was the increase in prepared surface area in the apical canal segment when the Reciproc instrument was used with brushing strokes.

Application of two kinds of electrophysiological monitoring techniques for the prediction of facial nerve outcomes after vestibular Schwannoma surgery

Objective: To investigate the application of transcranial facial nerve motor evoked potential (FNMEP) and direct nerve electrical stimulation (DNES) for the prediction of facial nerve function after vestibular schwannoma surgery. Methods: The clinical data of 106 patients who underwent vestibular schwannoma surgery under electrophysiological monitoring of facial nerve between 2017 and 2021 were retrospectively examined, and there were 57 males and 49 females, with a mean age of (51±11) years. Neuroelectrophysiological monitoring was performed in all patients during the operation. After the tumor was removed, FNMEP and DNES were used for electrophysiological evaluation of facial nerve function. The amplitude ratios of FNMEP to baseline (M1) and the brainstem segment to the internal auditory canal segment of DNES (M2) were recorded after the tumor was removed, respectively. The correlation between these two ratios and facial nerve function at 1 day, 1 month and 3 months after the operation were compared. According to the House-Brackmann (HB) scale, Grade Ⅰ-Ⅱ refers to good facial nerve function, and grade Ⅲ-Ⅵ refers to moderate and severe facial nerve dysfunction. Non-parameter Spearman correlation coefficient was used to evaluate the correlation between M1 and M2 and facial nerve function at 1 day, 1 month and 3 months after operation, and the receiver operating characteristic (ROC) curves were plotted to verify the diagnostic efficacy of M1 and M2 for predicting the prognosis of postoperative facial nerve function. Results: Among 106 patients, 102 cases (96.3%) underwent total tumor resection, 4 patients (3.7%) underwent subtotal resection, 104 patients (98.1%) had anatomical preservation of facial nerves, and there were no deaths reported. All patients could evoke reliable FNMEP and 2 patients could not evoke DNES in the brainstem segment of the facial nerve. There were 81 (76.4%), 99 (93.4%) and 103 patients (97.2%) with satisfactory function of facial nerve at 1 day, 1 month and 3 months after surgery, respectively. M1 had large absolute values of Spearman correlation coefficient at 1 day (ρ=|-0.648|) and 1 month (ρ=|-0.552|) after surgery (both P<0.001), while M2 showed a greater absolute value of Spearman correlation coefficient at 3 months (ρ=|-0.395|) than that of M1 (ρ=|-0.378|) (P<0.001). Cut-off value of M1 was 0.58 (sensitivity=0.92, specificity=0.64), and that of M2 was 0.36 (sensitivity=0.64, specificity=1.00). Meanwhile, M1<0.58 or M2<0.36 suggested moderate and severe impairment of facial nerve function. Conclusions: Both FNMEP and DNES during vestibular schwannoma surgery can effectively evaluate the postoperative facial nerve function. FNMEP is better than DNES in predicting the early postoperative facial nerve function, but DNES is better for predicting the long-term postoperative facial nerve function.

Retreatment of XP-endo Shaper and R-Endo files in curved root canals

ObjectivesTo compare the retreatment efficiency of XP-endo Shaper and R-Endo files in curved root canals using ImageJ software.MethodsForty extracted mandibular first molars with curved mesial canals (25°–35°) were chosen. Access cavities, preparation and obturation of root canals were performed. Roots were randomly distributed into two groups corresponding to the retreatment files used. Group 1 retreated with XP-endo Shaper file, and group 2 retreated with R-Endo files. Each root was sectioned and photographed. ImageJ software was used to estimate the percentage of residual filling material that existed on the three root canal segments. Mann–Whitney U and the Kruskal–Wallis tests were used to compare the percentages of residual filling material between the teeth segments (P < .05).ResultsThe R-Endo group showed a significantly higher median percentage of residual filling material than the XP-endo Shaper group. In both groups, the coronal segments had the highest median of the residual filling material, followed by the middle and apical segments.ConclusionXP-endo Shaper is significantly more effective than R-Endo in removing root canal filling materials in the coronal, middle, and apical segments.

Liquefaction potential evaluation on reconstruction project of irrigation canal in the Jono Oge and Lolu Village

In Indonesia's liquefaction history, the province of Central Sulawesi was severely affected in several locations when a 7.5 Mw earthquake occurred in September 2018. This study aims to evaluate the liquefaction potential and generate the liquefaction hazard map in the reconstruction project of the Gumbasa Irrigation Canals passed through Jono Oge Village and Lolu Village, closely related to the liquefaction event in the Sigi Regency area. Using the simplified procedure method by Idriss and Boulanger, the Liquefaction Factor of Safety (FOS) was calculated for each layer of soil from thirteen (13) locations of soil investigation test at the end of 2021 by the Ministry of Public Works and Housing. Furthermore, it was followed by calculating the Liquefaction Potential Index (LPI) and Liquefaction Severity Index (LSI). The analysis results show that the construction work area has the liquefaction potential with the observed groundwater level. It is mapped on irrigation canals along the Jono Oge Village and Lolu Village to know the critical segment of the irrigation project. Hereafter, an irrigation canal segment named BGKN-45 to BGKN-46 in Jono Oge required a specific mitigation plan to prevent damage from liquefaction in the future.

Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol.

Background Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect. Objective This article evaluates outcomes of patients treated with SRS versus resection + SRS. Method We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection + SRS. The primary study outcome was unfavorable combined endpoint, defined as worsening or new clinical symptoms, and/or tumor radiological progression. SRS (38.81 ± 5.3) and resection + SRS (67.14 ± 11.8) groups had similar clinical follow-ups. Results At the time of SRS, the tumor volumes of SRS (mean ± standard error; 1.83 ± 0.35 mL) and resection + SRS (2.51 ± 0.75 mL) groups were similar. SRS (12.15 ± 0.08 Gy) and resection + SRS (12.16 ± 0.14 Gy) groups received similar radiation doses. SRS group (42/43, 98%) had better local tumor control than the resection + SRS group (10/12, 83%, p = 0.04). Most of SRS (32/43, 74%) and resection + SRS (10/12, 83%) group patients reached a favorable combined endpoint following SRS ( p = 0.52). Considering surgical associated side effects, only 2/10 patients of the resection + SRS group reached a favorable endpoint ( p < 0.001). Patients of SRS group, who are > 34 years old ( p = 0.02), have larger tumors (> 4 mL, 0.04), internal auditory canal (IAC) segment tumor involvement ( p = 0.01) were more likely to reach an unfavorable endpoint. Resection + SRS group patients did not show such a difference. Conclusion While resection is still needed for larger tumors, SRS offers better clinical and radiological outcomes compared to resection followed by SRS for facial schwannomas. Younger age, smaller tumors, and non-IAC situated tumors are factors that portend a favorable outcome.

Comparison of sealer penetration of sonic activation versus conventional needle irrigation: a systematic review and meta-analysis of randomized controlled trials

BackgroundMost existing studies comparing the efficiency of sonic irrigation (SI) and conventional needle irrigation (CNI) in increasing the penetration of sealers into dentine tubules are controversial; and this study aimed to determine whether the use of SI can lead to greater sealing ability than CNI, during the root canal treatment.MethodsThe EMBASE, PubMed, and Cochrane Library databases were used to find confocal laser scanning microscopy studies evaluating percentage and maximum depth of sealer penetration following the use of SI or CNI in mature permanent teeth until October 2022. The critical estimative checklist of randomized controlled trials of the standardized Joanna Briggs Institute was adopted to independently score the quality of each study. The random-effect model for meta-analysis was used to analyse for each canal segment (apical, middle, coronal). The results are shown in the forest plots as weighted mean differences (WMDs) with 95% confidence intervals (95% CIs).ResultsNinety-seven articles were included in the preliminary screening, and nine of them were included in this study. Eight studies were included in the meta-analysis.The meta-analysis exhibited great increases in the coronal (WMD: 8.09, 95% CI 2.78–13.40/WMD: 165.32, 95% CI 128.85–201.80), and middle segments (WMD: 8.81, 95% CI 5.76–11.87/WMD: 132.98, 95% CI 68.71–197.25) for the percentage and maximum depth of sealer penetration, respectively. The percentage of sealer penetration in the apical thirds region was nonsignificant (WMD: 4.73, 95% CI − 2.34–11.80). However, the maximum depth of sealer penetration in the apical thirds region was significant (WMD: 121.46, 95% CI 86.55–156.38). Chi-squared analysis revealed heterogeneity scores of 0.0–70.0% and 44.0–90.0% for the percentage and maximum depth of sealer penetration, respectively.DiscussionThis review verified that SI significantly improves tubular dentin sealer penetration in most areas of the root canal; thus, SI may lead to better filling efficiency and anti-reinfection effects than CNI during and after the root canal therapy. Nevertheless, a large heterogeneity in the current data comparing the irrigation efficiency of SI versus CNI in the apical third of the root canal was found, implying the necessity to standardize root canal irrigation procedures and obtain more accurate results in this area.Trial Registration: INPLASY database (INPLASY202270116).

Numerical simulation to the effect of applying rationing system on the stability of the Earth canal: Birmana canal in Iraq as a case study

Abstract Extreme conditions will cause the water level of high fill canal segment to change suddenly, which will affect the velocity and pore pressure of the slope. A 9 km irrigation earth canal in the city of Alsyahy, 15 km away from Al-Hilla city, and branching off from the left side of Shatt Al-Hilla at 57 km, was studied. The aim of this work is to study and analyze the effect of rationing system on the Birmana earthen canal during rapid drawdown case. Finite element modeling with Geo-Studio software was used in the present study to analyze the combined seepage and slope stability for three cycles. The resulting minimum safety factor obtained from the analysis using the saturated and unsaturated soil model was found to be 1.161, 1.142, 1.159, and 1.2 from the Janbu, Bishop, Morgenstern-Price, and Spencer methods, respectively. The factor of safety (FOS) values in three cycles are less than the required value. Finally, the FOC decreased by 66% from its value before the rationing system was applied, the area of canal and slip surface increased by 77 and 14%, respectively, due to the applied rationing system. These changes led to an irregular water distribution along the canal, in addition to a reduction in road width.

Enhancement of cranial nerves in Lyme neuroborreliosis: incidence and correlation with clinical symptoms and prognosis

PurposeSymptoms of cranial neuritis are a common presentation of Lyme neuroborreliosis (LNB). Imaging studies are scarce and report contradictory low prevalence of enhancement compared to clinical studies of cranial neuropathy. We hypothesized that MRI enhancement of cranial nerves in LNB is underreported, and aimed to assess the prevalence and clinical impact of cranial nerve enhancement in early LNB.MethodsIn this prospective, longitudinal cohort study, 69 patients with acute LNB were examined with MRI of the brain. Enhancement of cranial nerves III–XII was rated. MRI enhancement was correlated to clinical findings of neuropathy in the acute phase and after 6 months.ResultsThirty-nine of 69 patients (57%) had pathological cranial nerve enhancement. Facial and oculomotor nerves were most frequently affected. There was a strong correlation between enhancement in the distal internal auditory canal and parotid segments of the facial nerve and degree of facial palsy (gamma = 0.95, p < .01, and gamma = 0.93, p < .01), despite that 19/37 nerves with mild-moderate enhancement in the distal internal auditory canal segment showed no clinically evident palsy. Oculomotor and abducens nerve enhancement did not correlate with eye movement palsy (gamma = 1.00 and 0.97, p = .31 for both). Sixteen of 17 patients with oculomotor and/or abducens nerve enhancement had no evident eye movement palsy.ConclusionsMRI cranial nerve enhancement is common in LNB patients, but it can be clinically occult. Facial and oculomotor nerves are most often affected. Enhancement of the facial nerve distal internal auditory canal and parotid segments correlate with degree of facial palsy.

Delayed return of urinary continence following the removal of neglected sacral shrapnel

BackgroundGlobalisation of terrorism has led to an increase in the number of injuries from the explosion of improvised explosive devices, with complications resulting from the retained shrapnel. It had been found that a third of those who sustained penetrating spinal cord injuries are from explosions. Retained foreign body in the sacral canal segment is rare, especially shrapnel presenting with urinary incontinence. Moreover, the one who had a dramatic recovery of urinary continence following removal of neglected sacral canal shrapnel. We report a case of a delayed improvement (recovery) in urinary continence following removal of neglected sacral canal shrapnel remotely aided by a pelvic floor exercise.Case presentationOur patient was a 14-year-old male who presented with a 3-year history of trauma to the lower back from an Improvised Explosive Device. He was initially associated with difficulty in walking that improved over eight months. However, the urinary incontinence persisted. He was found to be preserved with no neurological deficit in the lower limb. There was a lower back, midline wound, discharging pus. Lumbosacral imaging revealed a sacral (S2) canal Shrapnel. As a case of urinary incontinence from sacral shrapnel, he had the removal of the shrapnel, did well postoperatively, commenced on pelvic floor exercise. He became continence of urine over time.ConclusionsRetained foreign bodies in the spinal canal are associated with complications that include neurological deficit. Neglected (long-standing) sacral shrapnel with urinary incontinence is rare; moreover, the recovery of the continence with the removal of the shrapnel is aided by the commencement of pelvic floor exercise.