Enlargement Technique Research Articles

Outcome of Nonsurgical Root Canal Retreatment of Teeth with Persistent Apical Periodontitis Treated with Foraminal Enlargement and 2% Chlorhexidine Gel: A Retrospective Cohort Study

IntroductionNonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature. MethodsThis retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed. ResultsThe average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome. ConclusionsNS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings.

Aortic Root Enlargement by “Y” Technique – Our Experience

Aortic valve replacement is the commonest valvular surgery done around the world. In Asian population the aortic valve annulus size is smaller. So there is always a chance of patient prosthesis mismatch. There a number of techniques of aortic root enlargement during aortic valve replacement. We have used ‘Y incision technique’ in six of our patients in this case series. This technique is feasible and perioperative outcomes are promising. But it needs more mid and long - term results. Cardiovasc j 2024; 16(2): 98-101

Computational fluid dynamics (CFD), virtual rhinomanometry, and virtual surgery for neonatal congenital nasal pyriform aperture stenosis

ObjectivesInvestigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention. MethodsCT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared. ResultsIn the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery. ConclusionCFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.

Aortic root anatomy: insights into annular and root enlargement techniques.

The introduction of the Y(ang)-technique for aortic root enlargement has sparked a renewed interest in annular and root enlargement procedures world-wide. In order to execute these procedures proficiently however, it's important to understand the complex three-dimensional structure of the aortic root and left ventricular outflow tract, and also be familiar with the different enlargement techniques. Herein, we are providing a description of the aortic root anatomy and the most commonly utilized root enlargement procedures. This should facilitate clinical decision making and guidance of patients towards the most appropriate procedure, which should not only treat the patients' acute symptoms, but should also set the patient up for potentially needed future procedures and respective life-time management of aortic valve disease.

Comparison of the short-term outcomes between Y-incision aortic annular enlargement and traditional aortic annular enlargement techniques.

The short-term efficacy and safety of the Y-incision technique of aortic annular enlargement (AAE) has been established. We aimed to determine how the short-term outcomes of the Y-incision technique compared to traditional AAE techniques. From February 2011 to June 2022, 380 patients at the University of Michigan Hospital underwent aortic valve replacement (AVR) with AAE using either traditional annular enlargement techniques (Traditional group, n=270), including Nicks [63% (171/270)], Manouguian [34% (91/270)], and others [3% (8/270)], or the Y-incision technique (Y-incision group, n=110). Propensity score matching was performed by controlling for age, sex, body surface area (BSA), hypertension, diabetes, dialysis, chronic lung disease, stroke, prior cardiac surgery, primary indication, operative status, concomitant procedures, and prosthesis type, to generate a balanced cohort of 103 pairs. There were no differences in demographics, comorbidities, primary indications of the operations, or concomitant procedures between the matched groups. The median native aortic annulus diameter, measured in the operating room, was 21 mm for both groups. Median prosthesis size was 23 in the Traditional group, and 27 in the Y-incision group (P<0.001). There were no differences in perioperative complications/outcomes between the matched groups, including operative mortality, which was 3.9% (8/206) overall. Short-term survival was similar between the groups on Kaplan-Meier analysis; one-year survival was 95% in the Traditional group, and 97% in the Y-incision group (P=0.54). The Y-incision group had significantly lower mean aortic valve gradients (7 vs. 10 mmHg, P<0.001), larger aortic valve areas (2.2 vs. 1.8 cm2, P=0.007), and less moderate/severe patient-prosthesis mismatch (PPM) (5.5% vs. 23%, P=0.039) on one-year follow-up echocardiography. The Y-incision technique was as safe and more effective in enlarging the aortic annulus and upsizing the prosthetic valve than the traditional techniques of AAE in AVR for small aortic annuli.

Changes in aortic root dimensions post aortic root enlargement with Y-incision and modified aortotomy.

Lifetime management in aortic stenosis (AS) can be facilitated by aortic root enlargement (ARE) to improve anatomy for future valve-in-valve (ViV) procedures. A mitral valve-sparing ARE technique ("Y-incision") and sinotubular junction (STJ) enlargement ("roof" patch aortotomy) allow upsizing by 3-4 valve sizes, but quantitative analysis of changes in root anatomy is lacking. Among 78 patients who underwent ARE by Y-incision technique (± roof aortotomy closure) we identified 45 patients with high-quality pre- and post-operative computed tomography angiography (CTA) scans to allow analysis of change in aortic root dimensions. Detailed measurements of the annulus/basilar ring and sinuses were performed by an expert imager on both pre- and post-operative CTAs. The basal ring was defined as the functional annulus when a bioprosthetic valve was present. Average age was 65±11 years, the majority were female (29, 64%), and 9 (20%) had undergone prior aortic valve replacement (AVR). Valve upsizing was ≥3 sizes in 41 (91%). Post-operative mean basal ring diameter was larger compared to the native annular diameter (26.3 vs. 25.3 mm, P<0.01) and substantially larger than prior prosthetic valve in redo AVR (25.6 vs. 19.3 mm, P<0.001). Diameters of the sinuses at pre-operative computed tomography (CT) increased by +7.7±2.8 [right sinuses of Valsalva (R SVS)], +6.7±3.0 [left sinuses of Valsalva (L SVS)], and +6.6±2.9 mm [non-coronary sinuses of Valsalva (N SVS)]. Mean diameter of the STJ increased to 38.3±3.7 post-operative (+8.1±3.2 mm). Left main (LM) and right coronary artery (RCA) heights decreased by -6.3±3.3 and -3.7±3.4 mm respectively due to the supra-annular position of the valve, however, the post-operative valve-to-coronary (VTC) artery distances were 6.6±2.3 and 4.9±2.0 mm, respectively. The Y-incision root enlargement technique significantly enlarges the sinus and STJ diameters by 6-7 mm while preserving VTC distances despite upsizing by 3-4 valve sizes, resulting in post-operative anatomy that is favorable for future transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV).

A New Technique for Aortic Annular and Outflow Enlargement: Combined Y-incision and Nicks Procedures

A New Technique for Aortic Annular and Outflow Enlargement: Combined Y-incision and Nicks Procedures

Treatment Strategies for Hypertrophic Cardiomyopathy: Surgical

Septal myectomy is a well-established procedure for septal reduction in patients with obstructive hypertrophic cardiomyopathy (HCM) who have not responded to medical treatment. The surgical approach is tailored to the unique pathophysiology and septal morphology of the patient. Extended transaortic myectomy is the standard procedure for patients with isolated subaortic obstruction, the most common type of HCM. However, transapical myectomy is a useful adjunct for patients with long or midventricular obstruction and is our preferred technique for ventricular enlargement in patients with severe symptomatic diastolic heart failure because of extensive apical hypertrophy. Septal myectomy provides excellent postoperative outcomes as regards symptom relief and functional improvement, and operative morbidity and mortality rates are low in experienced centers. This article summarizes our current surgical management of patients with HCM and details operative methods and outcomes.

BLUE SWIMMING CRAB ENLARGEMENT TECHNIQUE: INSIGHT FROM SMALL-SCALE FISHERY IN THE SOUTH COAST OF PAMEKASAN, MADURA ISLAND

Pagagan Village, Pademawu District, and especially members of the "Berkah Capit Biru" fishermen, had the potential to carry out the sustainability of blue swimming crab because of the abundant crab fisheries. The purpose of this research was to encourage fishermen to not always carry out crab fishing activities in nature so nature remained sustainable and to increase the potential of natural and human resources who were enthusiastic about crab enlargement in Pagagan village. This research was conducted from January to May 2022. The crab breeding location measured 8x10 meters, had a substrate of muddy sand, and was in a coastal area bordering a mangrove ecosystem. Wooden stakes woven with bamboo with a netting around them were set higher than the wave. This enlargement technique did not use aeration in the form of wheels but only utilized tidal conditions so that periodic water changes occurred at the site. The stages in the crab enlargement technique are 1) site selection, 2) construction, 3) spreading seeds, 4) feeding, 5) controlling, and 6) harvesting. This enlargement technique is a solution for crab fishermen to meet market stocks. &#x0D; Keywords: blue swimming crab, enlargement technique, small-scale fishery

The Optimal Consumption, Investment and Life Insurance for Wage Earners under Inside Information and Inflation

This paper studies the dynamically optimal consumption, investment and life-insurance strategies for a wage earners under inside information and inflation. Assume that the wage earner can invest in a risk-free asset, a risky asset and an inflation-indexed bond and that the wage earner can obtain some additional information on the risky asset from the financial market. By maximizing the expected utility of the wage earner’s consumption, inheritance and terminal wealth, we obtain the dynamically optimal consumption, investment and life-insurance strategies for the wage earner. The method of this paper is mainly based on (dynamical) stochastic control theory and the technique of enlargement of filtrations. Moreover, sensitivity analysis is carried out, which reveals that a wage earner with inside information tends to increase his/her consumption and investment, while reducing his/her purchase of life insurance.

Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement.

Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.

Y Incision and Roof Technique for Aortic Root Enlargement: A Minimally Invasive Approach

Y Incision and Roof Technique for Aortic Root Enlargement: A Minimally Invasive Approach

Aortic valve surgery in the pediatric population: pathophysiology, clinical features and management.

There are several conditions where the function of the aortic valve can be compromised in the pediatric population. The aortic valve is composed of three leaflets which are thin and mobile and are attached to the aortic sinuses. Each leaflet is made up of connective tissue, forming a highly ordered network of extracellular matrix components. Together, this enables the aortic valve to open and close more than 100,000 times throughout the day. However, there are conditions where the structure of the aortic valve can be compromised resulting in its function being affected. Conditions such as congenital valvular aortic stenosis and abnormal valve morphology including bicuspid valves often necessitate intervention to improve symptoms and quality of life in children. Other conditions which result in requiring surgical intervention include infective endocarditis and trauma. In this article, we present the common forms of aortic valve disease in the pediatric population and the clinical presentation and pathophysiology of these. We also discuss the range of management options including medical management and percutaneous intervention. Surgical interventions such as Aortic annular enlargement techniques, the Ross procedure and the Ozaki procedure will also be discussed. The effectiveness, complications and long-term outcomes associated with these methods will be explored.

The Yang procedure: Renaming the recently described “Y” incision/rectangular patch aortic annulus enlargement technique

The Yang procedure: Renaming the recently described “Y” incision/rectangular patch aortic annulus enlargement technique

Healing of peri-apical lesions with calcium hydroxide medicament following apical enlargement: a case study

With public health orders restricting movement and changes to routine endodontic practice during the COVID-19 pandemic, many patients chose to wait, in the range of 12-18 months, before returning to complete their root canal treatment. This report describes several cases of non-vital and infected teeth that showed positive healing responses from having endodontic treatment using calcium hydroxide paste as an intracanal medicament and an apical enlargement technique to further reduce bacterial numbers. This indicates healing of peri-apical lesions may occur with a longer observation period. CPD/Clinical Relevance: Endodontic treatment for peri-apical infection may allow a patient time to decide upon treatment options.

Pengaruh Teknik Pembesaran pada Kandang Close house Berbasis IoT Terhadap Bobot dan Karkas Ayam Broiler

The success of broiler production is expressed in the performance of broiler chickens. The appearance of broiler chickens is influenced by management. Fight management factors have an important role as a determinant of the success of broiler chicken farming. The purpose of this study was to analyze the effect of the enlargement technique using IoT-based Close house cages on bobo and broiler chicken carcasses. This research was conducted in Jumo Village, Kedungjati District, Grobogan Regency. The materials used in this study were: DOC broiler 2500, water, disinfectant, commercial ration feed, vaccine, vitachick, plastic curtain. The tools used are: IoT-based Close house cages, drinking bowls, feed bins, buckets, thermometers, digital scales. The research was carried out in a quantitative descriptive manner, namely the effect of using IoT in cages seen from the weight and carcass of the broiler chickens produced. The maintenance process in the research was carried out for 4 weeks. The results of the qualitative descriptive test obtained an average body weight of broiler chickens at 4 weeks, namely 1732.8 grams, including normal body weight. While the average serving of broiler chicken carcass is 70.3%, which is included in the normal carcass percentage.

Classification Model for Diabetes Mellitus Diagnosis based on K-Means Clustering Algorithm Optimized with Bat Algorithm

Diabetes mellitus is a disease characterized by abnormal glucose homeostasis resulting in an increase in blood sugar. According to data from the International Diabetes Federation (IDF), Indonesia ranks 7th out of 10 countries with the highest number of diabetes mellitus patients in the world. The prevalence of patients with diabetes mellitus in Indonesia reaches 11.3 percent or there are 10.7 million sufferers in 2019. Prevention, risk analysis and early diagnosis of diabetes mellitus are necessary to reduce the impact of diabetes mellitus and its complications. The clustering algorithm is one of methods that can be used to diagnose and analyze the risk of diabetes mellitus. The K-mean Clustering Algorithm is the most commonly used clustering algorithm because it is easy to implement and run, computation time is fast and easy to adapt. However, this method often gets to be stuck at the local optima. The problem of the K-means Clustering Algorithm can be solved by combining the K-means Clustering algorithm with the global optimization algorithm. This algorithm has the ability to find the global optimum from many local optimums, does not require derivatives, is robust, easy to implement. The Bat Algorithm (BA) is one of global optimization methods in swarm intelligence class. BA uses automated enlargement techniques into a solution and it’s accompanied by a shift from exploration mode to local intensive exploitation. Based on the background that has been explained, this article proposes the development of a classification model for diagnosing diabetes mellitus based on the K-means clustering algorithm optimized with BA. The experimental results show that the K-means clustering optimized by BA has better performance than K-means clustering in all metrics evaluations, but the computational time of the K-means clustering optimized by BA is higher than K-means clustering.

Outcomes Post-Nick's Aortic Root Enlargement Technique: Single-Center Experience.

Different techniques for aortic root enlargement (ARE) have been reported in the literature. Each technique comes with its own advantages and disadvantages. We report our outcomes of Nick's technique for ARE. A single-center retrospective data analysis of 31 patients was performed. Patients were operated between May 2015 and November 2017 at Assuit University Heart Hospital, Assuit, Egypt. The median cardiopulmonary bypass time was 125 minutes (range: 90.0-160.0 minutes), with 90 minutes of cross-clamp (range: 60.0-110.0 minutes). Altogether 59% of the patients had mixed aortic valve diseases. Median intensive care unit and total hospital stay were 2 and 5 days, respectively. Patient-prosthesis mismatch was reported in one patient only (3.25%). Two patients died within 30 days. Median pressure gradient across the aortic valve was 20 mm Hg at 3 years of follow-up. The benefits of Nick's technique for ARE can be demonstrated in populations with younger patients and complicated pathology. Further research is required in larger patient populations.

Yang technique for aortic annular enlargement and the "lemon on a stick".

First, we would like to congratulate the author on his simple and reproducible technique that facilitates the placement of a larger aortic prosthesis.1 However, we do not feel at ease when the technique is being described as an aortic annular enlargement (AAE) and is being compared with and considered superior to other well-established true annular enlargement techniques, such as those of Nicks,2 Manouguian,3 and Konno-Rastan.4

Reply from authors: Not lemon on a stick, but crown (valve) on a head (left ventricular outflow tract).

Since our Y-incision/rectangular patch technique was presented and published in 2021, concern has been raised that our aortic annular enlargement (AAE) technique does not enlarge the “true” aortic annulus and left ventricular outflow tract (LVOT). Is this the case, and should we be concerned?