Orifice Enlargement Research Articles

Reactions of Diaminonaphthalenes with a Cage‐Opened C60 Derivative

AbstractThe reactions of cage‐opened C60 derivatives with aromatic diamines are known to cause an orifice‐enlargement in association with incorporating extended π‐systems. The present work focuses on 1,2‐, 2,3‐, and 1,8‐diaminonaphthalenes for the synthesis of a series of naphthalene‐fused fullerene derivatives. For the former two, orifice enlargement proceeded by cleaving two C=C bonds to afford an opening with a ring‐atom count of 20, in which the naphthalene moiety was fused by a pyrazine ring. For the reaction with 1,8‐diaminonaphthalene, only one C=C bond was cleaved to give a 17‐membered‐ring opening where the diaminonaphthalene moiety was fused by a pyrimidine ring.

Difference in left atrial appendage remodeling between diabetic and nondiabetic patients with atrial fibrillation.

BackgroundDiabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib.HypothesisIn this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib.MethodsThis retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real‐time 3‐dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the “Yosefy rotational 3DTEE method.”ResultsThe RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1‐lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2‐width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3‐depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2, P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008).ConclusionsAdverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.

Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study

IntroductionThis report includes outcomes for a group of patients with significant periapical lesions who were treated and evaluated in two single-arm, multicenter, prospective, nonsignificant risk clinical studies. MethodsForty-five teeth were from 45 patients who met the inclusion criteria and consented for the clinical studies and were diagnosed with periapical lesions with periapical index score ≥3. Patients were treated with a standardized treatment protocol including instrumentation to an apical diameter of #20 without orifice enlargement, the GentleWave Procedure, and warm vertical obturation. Clinical signs and radiographic assessments were evaluated at 12 months to assess healing. Success was classified as healing or healed and accounted for the cumulative success rate of healing. Statistical analyses were performed by using Fisher exact test, Pearson correlation, and multivariate logistic regression analyses. ResultsAt 12 months, 44 of 45 teeth (97.8%) were evaluated. The cumulative success rate for the GentleWave Procedure was 97.7%. Forty-three of 44 teeth were completely functional; all teeth had complete resolution for measured indices of mobility, soft tissue lesions, sinus tract, and furcation involvement. No patients experienced moderate or severe pain at 2, 7, and 14 days after procedure. Although only 1 patient was unsuccessful and the presence of clinical symptoms and type of periradicular diagnosis at 12 months were correlated with an unsuccessful outcome, the analyses were limited by the sample size. ConclusionsIn this case series analysis, treatment of sizable periapical lesions with the GentleWave Procedure resulted in a success rate of 97.7% at 12-month re-evaluation.

Incidentally Discovered Foley Catheter Placement Into a Transplanted Kidney

Although unusual, placement of a Foley catheter into the renal pelvis or ureter has been reported. Proposed predisposing factors for errant placement include pre-existing hydronephrosis or congenital ureteral orifice enlargement. We report a case where aberrant placement of a Foley catheter into the renal pelvis of a transplanted kidney was detected by ultrasound in a patient being evaluated for acute kidney injury. The Foley had been in place for 2 weeks. This is the only reported case we are aware of involving accidental catheterization of a transplant's renal pelvis.

Ahmed valve implantation: intraoperative and early postoperative complications

Purpose. To analyze the causes of intraoperative and early postoperative complications and to develop a plan to improve the surgical technique. Methods. An Ahmed valve implantation by a standard method with obligatory posterior sclerectomy was performed in 238 patients aged from 18 to 88 years. Results. There were 7 cases of corneal perforation during the preparatory stage in excessively deep bridle suture; 3 cases of conjunctival and scleral perforation; 4 cases of inadvertent orifice enlargement in needle perforation of limbal scar tissue with consequent excessive filtration; in 37 patients, there was a hemorrhage from new vessels situated in the anterior chamber angle and the iris; 59 cases of serous cilio-choroidal effusion; 12 cases of hemorrhagic detachment. Conclusions. It is mandatory to follow the main principles of surgical technique and to take into consideration associated diseases.

Impact of Increased Orifice Size and Decreased Flow Velocity of Left Atrial Appendage on Stroke in Nonvalvular Atrial Fibrillation

The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm(2), p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA2DS2-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm(2)) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm(2) (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.

Root Canal Debridement: An Online Study Guide

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will present root canal debridement including subdivisions on canal access, canal debridement, orifice enlargement and preflaring, crown-down technique, balanced force, nickel titanium and other shape memory alloys, rotary engine-driven techniques, endodontic instruments, irrigation, electronic apex locators, sonics/ultrasonics, smear layer, and intracanal medicaments.

The effect of instrument type and preflaring on apical file size determination.

The aim of this study was to investigate the effect of instrument type (K-files and Lightspeed (LS) instruments) and the impact of preflaring on the first file size that binds at working length (WL) in a range of canal types of varying sizes and curvatures. One hundred and twenty-one canals from 60 extracted intact human maxillary and mandibular premolars and molars were utilized. After standard access cavities, a size 6 K-file was inserted into each canal until the tip of the file was visible outside the apical foramen. WL were set 0.5 mm short of these measurements. Each canal was sized using consecutively larger K-files and hand-held LS instruments until one bound at WL. The file sizes were recorded. The same procedures were repeated after coronal and middle third flaring using Profile rotary instruments. Statistical analysis (univariate analysis of variance: ANOVA) showed that overall, the estimate of mean apical diameter with the LS instrument was larger than with the K-file by 9.4 x 10(-2) mm (P < 0.001; 95% confidence interval: 8.7 x 10(-2), 10.2 x 10(-2)), i.e. almost 2 ISO file sizes larger. Flaring of the cervical and middle thirds of the canal had an impact on apical sizing by both types of instruments, with an average increase of 5.3 x 10(-2) mm (P < 0.001; 95% confidence interval: 4.5 x 10(-2), 6.0 x 10(-2)), i.e. approximately 1 ISO file size larger. Preflaring and use of hand-held LS instruments resulted in an increase in the instrument size that bound at WL. If an operator wishes to determine an accurate master apical file size, canal orifice enlargement should be performed first before the placement of the assessment file.

Comparison of the performance of four files with rounded tips during shaping of simulated root canals

A total of 160 simulated canals of various angles and positions of curvature were prepared by hand using either Mani Flexile Files, Mani SEC-O Files, Maillefer Flexofiles, or Zipperer Flexicut Files. After orifice enlargement, each file type was used to prepare 40 canals employing a balanced force motion and a modified double-flared technique. Pre- and postoperative images of the canals were taken with a videocamera, and stored and manipulated in a computer with image analysis software. The presence of canal aberrations and the amount of material removed as a result of preparation were determined from composite images of superimposed pre- and postoperative views. Significant differences (p < 0.001) in preparation time were observed, with Flexile Files being quickest and SEC-O Files being slowest. Overall, Flexofiles and Flexicut Files deformed significantly more (p < 0.001) than Flexile and SEC-O Files. The incidence of canal blockage was not influenced by instrument type, but the incidence of apical extrusion was significantly greater (p < 0.001) with SEC-O Files. SEC-O Files created significantly fewer (p < 0.001) and significantly narrower (p < 0.001) zips, with significantly less (p < 0.001) removal of material from the outer aspect of the curve and thus significantly less (p < 0.001) transportation. Flexicut Files created the widest canals apically, with the greatest removal of material from the outer aspect of the curve and the most transportation. Flexofiles created significantly more (p < 0.001) perforations. Under the conditions of this study, obvious differences between instruments were highlighted with SEC-O Files preparing canals more safely and with least destruction. The unique rounded tip of the SEC-O Files may have had an influence on the outcome.

Comparison of two stainless steel files to shape simulated root canals

The aim of this study was to compare the shaping ability of two stainless steel files using simulated canals. A total of 80 simulated canals of various angles and positions of curvature were prepared by hand using either Mani K-Files or Micro Mega K-Files. Following orifice enlargement each file type was used to prepare 40 canals employing a linear filing motion and an anticurvature stepback technique. Pre- and post-operative longitudinal images of the canals were taken with a video camera and stored and manipulated in a computer with image analysis software. The presence of canal aberrations and the amount of material removed as a result of preparation were determined from composite images of superimposed pre- and post-operative views. Overall, canal preparation with Mani K-Files was significantly quicker (P < 0.005) and was associated with fewer instrument failures. Zips and elbows were observed in 70% of specimens with significantly more (P < 0.05) occurring following preparation with Micro Mega K-Files. Mani K-Files created significantly more (P < 0.01) danger zones. Micro Mega K-Files created significantly wider (P < 0.001) zips with significantly more (P < 0.01) resin removed from the outer aspect of the curves and, thus, significantly more (P < 0.01) transportation. Canal shape had a significant influence on preparation time (P < 0.001), the incidence of zips (P < 0.05) and danger zones (P < 0.005), the width of zips (P < 0.001) and transportation at the zips (P < 0.001). Under the conditions of this study, Mani K-Files were more effective than Micro Mega K-Files and produced canals with better shapes. Original canal shape had a substantial influence on the outcome of shaping procedures.

Computed Tomography During Experimental Balloon Dilatation For Calcific Aortic Stenosis. A Look into the Mechanism of Valvuloplasty

Thin‐slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12‐mm trefoil‐shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12‐mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm2 to 2.36 (range 0.95–3.14) cm2. The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon‐leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interven Cardiol 1988:1:2)

Functional morphology of the balanomorph barnacles Tesseropora rosea (Krauss) and Tetraclitella purpurascens (Wood) (Tetraclitidae)

Tesseropora rosea of eastern Australia inhabits exposed, wave-washed rocks, is an extension feeder in fast currents, and has monometric growth, with orifice enlargement by erosion. It has a deep, mobile operculum. Tergal depressor muscles are large, scutal depressors moderately large. The opercular valves play an active part in respiratory pumping beat. Tergal depressors effect opercular withdrawal. Rostral scutal depressors assist in pumping beat. Lateral scutal depressors assist in opercular opening. Cim IV-VI of T. rosea unfurl rapidly in response to fast water currents and are captorial, either singly or in concert. The antenniform third maxillipeds (cirrus 111) turn back laterally in the extended position but fold over and hold down the captorial cirri in the curled position. Tetraclitella purpurascens of southern Australia inhabits crevices and overhangs on rocky shores, is an extension feeder in moderate currents, and has diametric growth, with orifice enlargement by circumferential growth of radii and parietes. It has a shallow operculum with only slight mobility. Tergal depressors are large, scutal depressors small. Valve action is mainly hinge-like and slow, with little apicobasal movement. The small scutal depressors assist the large tergal depressors in opercular withdrawal and have only a very minor role in pumping beat. Cirri IV-VI of T. purpurascens are held erect for long periods in moderate water currents. Captorial movements are similar to but slower than those of T. rosea. The third maxillipeds have short rami involved in forward food transfer. Setation correlates with function on the cirri of both species. The oral cone of T. rosea is broader and the mouthparts relatively larger than those of T. purpurascens, possibly mediating a more powerful triturating mechanism. A comparison of structure and function shows that T. purpurascens retains many primitive balanomorph features, whereas T. rosea has a more advanced functional configuration. In the evolution of tetraclitids, it seems likely that the tetraclitellines diverged early, before the austrobalanines gave rise to the tetraclitines. The four-plated wall may have evolved independently in tetraclitellines and austrobalanines.

Canal orifice enlargement as related to biomechanical preparation

Extracted human maxillary and mandibular molars displaying curved roots and closed apices were used to determine the effect of orifice enlargement prior to biomechanical canal preparation. When this was accomplished, files could be passed more easily to the apex, indicating the elimination of interferences cervical to the apical constriction. The Peezo reamer was a more effective instrument for orifice enlargement than the Gates-Glidden drill.

Functional anatomy and volume-pressure characteristics of immature lungs

The mechanical behavior of immature rabbit fetal lungs in situ was assessed by air and saline volume-pressure diagrams. All lungs were in their natural fetal state, i.e., filled with fetal pulmonary fluid, prior to inflation. Anatomic correlates were determined by continuous stereomicroscopic monitoring of the lungs. We found the following to be characteristic of immature lungs: (1) Tissue retractive forces are similar to adults. (2) Fetal lungs are not ‘plastic’ above functional residual capacity. (3) Initial aeration is by ‘axial filling’ in which airways are distended several times their resting size. (4) Invariably, peripheral rather than central saccules are the first to be aerated and saccules are recruited by both pressure- and time-dependent processes. (5) Pressure-dependence is related to surface forces and terminal orifice size, while time-dependent processes include orifice enlargement, liquid flow through terminal conduits, and the formation of very short-lived, labile bubbles. (6) ‘Opening pressure’ inflection in the VP diagram is not coincidental with, but follows the onset of saccular aeration. (7) Negative compliance at the onset of deflation is due to saccular enlargement and recruitment. (8) Hysteresis is due to tissue conformational characteristics at high pressures and air entrapment at low pressures. (9) Surface tension cannot be measured reliable from the saline and air VP diagrams.