Removal Of Tissue Research Articles

INDIRECT REVASCULARIZATION OF THE DISTAL PARTS OF THE LOWER LIMB AT THE TERMINAL STAGES OF OCCLUSIVE-STENOTIC LESIONS OF ITS ARTERIES

Background. The terminal stages of occlusive-stenotic lesions of the limb arteries, especially in the distal areas, are characterized by critical ischemia, the development of gangrenous lesions of parts of the limb, and despite the use of a number of medical and surgical methods, there is a threat of limb loss. An effective remedy in this situation is the removal of dead tissue, reliable closure of the defect with revascularization of ischemic tissue.
 Aim: to improve the results of treatment of patients with distal occlusive lesions of the lower extremity arteries by combined revascularization using free soft tissue flaps.
 Materials and methods. We studied 45 patients with terminal stages of occlusive-stenotic lesions of the distal lower extremities (lower legs and feet). Preliminary graft sizes were established after clinical and instrumental assessment of the volume of tissue deficiency in the recipient area. The expected size of the flap tissue transformation, which occurred in the long term after surgery, was also taken into account.
 Results. The effectiveness of the method was studied in the transplantation of 48 flaps in 45 patients with terminal limb arterial lesions. The used method ensures 90.5% of limb survival after 3 years; 81.0% of good results - walking with a cane.
 Conclusion. 1. The used method of treatment of limbs with terminal stages of occlusive-stenotic arterial lesions by indirect revascularization with a thoraco-dorsal flap is effective, provides 90.5% survival of the limb after 3 years. Preliminary graft sizes should be established after clinical and instrumental assessment of the volume of tissue deficiency in the recipient area, taking into account the size of tissue transformation. Combined revascularization of the lower extremities significantly improves the hemodynamics of the ischemic limb.

COMPARISON OF VARIOUS MACERATION TECHNIQUES FOR COLLECTION OF HUMAN BONES IN ANATOMY DEPARTMENT

Objectives: To compare diff erent maceration processes in terms of efficacy, efficiency, and destructiveness. Materials and Methods: Four techniques were used to clean the bones, following dissection the samples were buried for a period of two years in the department's burial area. Following the excavation, the bones were cleaned; the dismembered portions were manually de-fleshed. The bones were released from the joints. In the first technique, the bones were immersed in detergent for 24 hours following excavation. The second approach involved dipping bones into a liquid lime solution. In the third technique hydrogen peroxide was used to chemically cure the bones. In the fourth technique 30% hydrogen peroxide and baking soda were combined to create a paste. Applying this, bones were coated for 24 hours. All the four techniques were compared. Results: The procedure utilizing 30% H2O2 was the best in terms of maceration duration, ease of soft tissue removal, and successful procurement with little damage. The new technique, which involved application of paste was made of baking soda and H2O2 was effective and efficient for smaller specimens. It didn't take very long and with almost no damage to the bones. Conclusion: Excellent results were obtained with maceration using 30% H2O2. The newly developed approach worked well for small specimens and save time. The removal of soft tissue was simple and caused no or little bone damage.

Possibilities of Using Laser Radiation in Vitreoretinal Surgery

Currently, laser technologies are widely used in the treatment of diseases of the eye and its accessory apparatus. Basically, they are used in oculoplastic surgery during operations on the accessory apparatus of the eye, in refractive and corneal surgery, laser support for ultrasound cataract surgery, laser treatment of glaucoma, laser coagulation of the retina, thermotherapy of choroidal formations. In the 21st century, Nd: YAG laser treatment of floating opacities in the vitreous body began to be actively popularized with mixed results. In vitreoretinal surgery, which is improving every decade, laser technology remains at the level of the 20th century. In endovitreal surgery, the laser is still used only for endolaser coagulation of the retina, despite the fact that there is a huge potential for using lasers as a “laser scalpel” for removing the vitreous, precision removal of a retinal tear, epiretinal fibrosis, precision retinotomy, and choroidotomy. In this regard, it is necessary to search for the most suitable laser radiation, which will make it possible to carry out thin cuts on the retina and choroid with high accuracy, minimal damage to the surrounding tissues, and a sufficient degree of coagulation to prevent hemorrhages. This laser will allow for surgical interventions in the posterior eye segment with a lower risk of intra- and postoperative complications, as well as better anatomical and functional results. With further development, this new approach to laser ablation may become an alternative to mechanical instruments for surgical dissection and removal of pathological tissue from the surface of the retina.

Дослідження розподілу напружень під впливом згинаючого навантаження в моделях різних варіантів остеосинтезу кісток гомілки з переломами в середній третині при їх уродженому псевдоартрозі в дітей з незавершеним ростом

Congenital pseudoarthrosis of the bones of the lower leg is a rare disease characterized by the presence of non-union (pseudoarthrosis) of the bones of the lower leg, which does not grow independently. The majority of surgical techniques involve the removal of pathological soft tissues in the zone of pseudarthrosis followed by bone autoplasty and fixation of tibial bone fragments in external fixation devices or with the help of intramedullary fixators. Purpose - to investigate the stress-deformed state of models of the leg in the presence of pseudarthrosis in the middle third under the influence of bending load and their osteosynthesis using intramedullary rods of various designs in children with incomplete growth. Materials and methods. Mathematical modeling of 3 variants of osteosynthesis of lower leg bones with congenital pseudarthrosis in the middle third was performed: 1 - rod without rotational stability; 2 - rod with rotational stability; 3 - rod with rotational stability and blocked movement during compression. The stress-strain state of the models under the influence of a bending load of 300 N was studied. Results. When using a rotationally unstable «growing» rod, maximum stress levels of 18.5 MPa and 23.1 MPa are determined at the proximal and distal ends of the tibia, respectively. In the fracture zone, the stress level is minimal and does not exceed 0.2 MPa. In the diaphyseal part, stresses are determined at the level of 0.3 MPa and 0.4 MPa above and below the fracture zone, respectively. In the zone of the fracture of the fibula, the stress level is also not significant - 0.7 MPa and 0.8 MPa in the proximal and distal fragments. The use of a rod with rotational stability does not lead to any significant changes in the stress-strain state of the model compared to tibial osteosynthesis with a rotationally unstable rod. The use of an intramedullary rod with blocked movement during compression allows to reduce the values of stresses at the proximal and distal ends of the tibia - up to 16.9 MPa and 21.2 MPa, respectively. In all control points of the diaphyseal part of the tibia, the stresses are minimal and equal to 0.2 MPa. It should be noted that in this case the stresses in the area of the fracture of the fibula, where they do not exceed the mark of 0.1 MPa, are almost negligible. Conclusions. Under bending loads, all types of intramedullary rods provide a minimum level of stress in the tibial fracture zone. Additional rotational and longitudinal stability of the rods allow to slightly reduce the level of stress in the proximal and distal ends of the tibia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties.

To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties. An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied. The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques. Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found. Identify dentist's knowledge about MI.

Outpatient hysteroscopic removal of retained products of conception: evaluation of effectiveness, safety and patient satisfaction

ObjectiveTo assess effectiveness, safety and patient satisfaction of hysteroscopic removal of retained products of conception using a tissue removal system in the outpatient setting. Study designA prospective observational study was carried out in a tertiary care hospital over a 10-month period. Fifty-two women who underwent an outpatient hysteroscopy for removal of retained products of conception were included. Effectiveness was evaluated as complete removal of retained products of conception in a one-time procedure. Safety was determined based on the rate of complications using the Clavien–Dindo classification system. Patient satisfaction and pain were assessed using a visual analogue scale survey completed by patients after the procedure. ResultsComplete removal of retained products of conception in a one-time procedure was achieved in 98.1% of cases. The mean morcellation time was 6.0 min. The complication rate recorded in this study was 9.6%; most complications were mild, but there was one case of uterine perforation. A global satisfaction ratio of 8.9 out of 10 was reported by patients. The study did not find any significant differences in complete removal of retained products of conception based on type of hysteroscope, presence of symptoms or Gutenberg classification. Although not significant, a linear relationship was observed between a higher volume of retained products of conception and a higher Gutenberg classification (p=0.229). ConclusionOutpatient management of retained products of conception using a tissue removal system is effective and safe, and has a high level of patient satisfaction. The results of this study have the potential to alter the standard approach to the management of retained products of conception.

Postoperative inflammatory response in colorectal cancer surgery: a meta-analysis.

Surgical removal of the cancerous tissue remains the cornerstone of curative treatment for colorectal cancer and results in an inflammatory response. An exaggerated inflammatory response has been implicated in the promotion of tumor proliferation and has shown associations with postoperative complications. Literature on the preferred surgical technique to minimize inflammatory response is inconclusive. Therefore, the aim of this study was to assess the inflammatory response and postoperative incidence of infectious complications following surgery for colorectal cancer. Embase, PubMed, and Cochrane databases were searched for RCTs that reported inflammatory parameters as a function of surgical modality only. Data related to CRP or IL-6 levels on postoperative days 1 and 3 and data related to postoperative infections were subject to a pairwise meta-analysis to compare open versus laparoscopic techniques. The literature search and screening process yielded 4151 studies. Ten studies met criteria, including 568 patients. Only studies on laparoscopic and open surgery were found. Pooled analyses found lower Il-6 and CRP levels on postoperative day 1 and lower CRP levels on postoperative day 3 for laparoscopic surgery compared to open surgery. However, there was no difference in incidence of postoperative infectious complications. The findings of this study indicate a superior inflammatory profile for laparoscopic surgery compared to an open approach for colorectal cancer surgery. For future research, it would be worthwhile to conduct a randomized controlled trial to compare the postoperative inflammatory response and related clinical outcomes between minimally invasive surgical approaches, including laparoscopic and robot-assisted surgery.

AI in Surgical Curriculum Design and Unintended Outcomes for Technical Competencies in Simulation Training

To better elucidate the role of artificial intelligence (AI) in surgical skills training requires investigations in the potential existence of a hidden curriculum. To assess the pedagogical value of AI-selected technical competencies and their extended effects in surgical simulation training. This cohort study was a follow-up of a randomized clinical trial conducted at the Neurosurgical Simulation and Artificial Intelligence Learning Centre at the Montreal Neurological Institute, McGill University, Montreal, Canada. Surgical performance metrics of medical students exposed to an AI-enhanced training curriculum were compared with a control group of participants who received no feedback and with expert benchmarks. Cross-sectional data were collected from January to April 2021 from medical students and from March 2015 to May 2016 from experts. This follow-up secondary analysis was conducted from June to September 2022. Participants included medical students (undergraduate year 0-2) in the intervention cohorts and neurosurgeons to establish expertise benchmarks. Performance assessment and personalized feedback by an intelligent tutor on 4 AI-selected learning objectives during simulation training. Outcomes of interest were unintended performance outcomes, measured by significant within-participant difference from baseline in 270 performance metrics in the intervention cohort that was not observed in the control cohort. A total of 46 medical students (median [range] age, 22 [18-27] years; 27 [59%] women) and 14 surgeons (median [range] age, 45 [35-59] years; 14 [100%] men) were included in this study, and no participant was lost to follow-up. Feedback on 4 AI-selected technical competencies was associated with additional performance change in 32 metrics over the entire procedure and 20 metrics during tumor removal that was not observed in the control group. Participants exposed to the AI-enhanced curriculum demonstrated significant improvement in safety metrics, such as reducing the rate of healthy tissue removal (mean difference, -7.05 × 10-5 [95% CI, -1.09 × 10-4 to -3.14 × 10-5] mm3 per 20 ms; P < .001) and maintaining a focused bimanual control of the operative field (mean difference in maximum instrument divergence, -4.99 [95% CI, -8.48 to -1.49] mm, P = .006) compared with the control group. However, negative unintended effects were also observed. These included a significantly lower velocity and acceleration in the dominant hand (velocity: mean difference, -0.13 [95% CI, -0.17 to -0.09] mm per 20 ms; P < .001; acceleration: mean difference, -2.25 × 10-2 [95% CI, -3.20 × 10-2 to -1.31 × 10-2] mm per 20 ms2; P < .001) and a significant reduction in the rate of tumor removal (mean difference, -4.85 × 10-5 [95% CI, -7.22 × 10-5 to -2.48 × 10-5] mm3 per 20 ms; P < .001) compared with control. These unintended outcomes diverged students' movement and efficiency performance metrics away from the expertise benchmarks. In this cohort study of medical students, an AI-enhanced curriculum for bimanual surgical skills resulted in unintended changes that improved performance in safety but negatively affected some efficiency metrics. Incorporating AI in course design requires ongoing assessment to maintain transparency and foster evidence-based learning objectives.

Liver Inclusion Appears to Be Protective Against Graft Loss-Due-to Chronic But Not Acute Rejection Following Intestinal Transplantation.

In intestinal transplantation, while other centers have shown that liver-including allografts have significantly more favorable graft survival and graft loss-due-to chronic rejection (CHR) rates, our center has consistently shown that modified multivisceral (MMV) and full multivisceral (MV) allografts have significantly more favorable acute cellular rejection (ACR) and severe ACR rates compared with isolated intestine (I) and liver-intestine (LI) allografts. In the attempt to resolve this apparent discrepancy, we performed stepwise Cox multivariable analyses of the hazard rates of developing graft loss-due-to acute rejection (AR) vs. CHR among 350 consecutive intestinal transplants at our center with long-term follow-up (median: 13.5years post-transplant). Observed percentages developing graft loss-due-to AR and CHR were 14.3% (50/350) and 6.6% (23/350), respectively. Only one baseline variable was selected into the Cox model indicating a significantly lower hazard rate of developing graft loss-due-to AR: Transplant Type MMV or MV (p < 0.000001). Conversely, two baseline variables were selected into the Cox model indicating a significantly lower hazard rate of developing graft loss-due-to CHR: Received Donor Liver (LI or MV) (p = 0.002) and Received Induction (p = 0.007). In summary, while MMV/MV transplants (who receive extensive native lymphoid tissue removal) offered protection against graft loss-due-to AR, liver-containing grafts appeared to offer protection against graft loss-due-to CHR, supporting the results of other studies.

Clinical Management of External Cervical Resorption: ASystematic Review.

This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified by an electronic search, 60 clinical case reports and six case series were included. No randomised clinical trials were found. Risk of bias was assessed using Joanna Briggs Institute's tools. External surgical intervention was the preferred method of accessing the lesions. Removal of resorptive tissue was most often achieved mechanically. Bioactive endodontic cements were the preferred materials for restoring teeth. The outcome measures were based on clinical and radiographic parameters. Of the cases included in the review, no specific treatment approach had a superior outcome in relation to Heithersay's classification. Furthermore, due to the absence of randomised clinical trials, and the low level of evidence associated with case reports/case series, it was not possible to define the optimum clinical treatment for external cervical resorption.

Incidental parathyroidectomy during total thyroidectomy and functional parathyroid preservation: a retrospective cohort study

BackgroundThe published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP.MethodsThis retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups.ResultsAvoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p < 0.001 and OR 1.72, 95% CI 1.02–2.82, p = 0.038).ConclusionsPatients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.

Development of a high‐power blue diode laser for precision vaporization of prostate tissue for the surgical management of benign prostatic hyperplasia

AbstractThis paper explores the advancement and application of high‐power blue diode lasers in treating benign prostatic hyperplasia (BPH). Addressing the challenges posed by existing techniques, the study focuses on optimizing tissue removal methods. Energy platform for BPH should balance a range of factors, such as operative time, patient conditions, urinary functions, complications, durability, accessibility, and cost, all while prioritizing patient care. Blueray Medical's innovation of high‐power blue diode laser systems for BPH surgery is explored, with emphasis on achieving a balance among these considerations. By illustrating the biomedical effects of lasers and their interaction with soft tissues, particularly emphasizing the role of photon absorption by biomolecules and proteins in tissue behavior, this study outlines the advantages of the high‐power blue diode laser system. The initial laboratory experiments and clinical results consistently align with our theoretical predictions, especially in terms of tissue vaporization efficiency, tissue coagulation, and bleeding control. In conclusion, blue diode lasers hold potential to enhance surgical outcomes for BPH. Their unique properties offer benefits like improved tissue removal rate and reduced thermal damages. Integrating blue laser technology into BPH protocols could lead to shorter hospital stays, cost savings, and expanded patient eligibility, although rigorous clinical studies are needed to fully understand their benefits and limitations.

Prognostic significance of the immunohistochemical status of the endometrium as markers of therapy for endometrial hyperplasia

BACKGROUND: In patients of reproductive age with endometrial hyperplasia without atypia, hormonal treatment, and prognosis of response remain relevant issues.&#x0D; AIM: To increase the effectiveness of hormonal therapy for endometrial hyperplasia in patients of reproductive age with abnormal uterine bleeding, considering the receptivity, and proliferative activity of the endometrium.&#x0D; MATERIALS AND METHODS: A total of 179 patients of reproductive age with abnormal uterine bleeding and endometrial hyperplasia were examined. After the removal of the endometrial tissue, hormonal therapy was performed for 6 months: 101 patients received dydrogesterone 20 mg/day, and 78 patients received norethisterone acetate 10 mg/day. The expression levels of estrogen receptor- (Er), progesterone receptor (PR), and Ki67 in the endometrial tissue were determined by immunohistochemistry at baseline and 3 months after the treatment. The comparison group consisted of 18 women without gynecological pathology. Variation statistics methods were used to process the data, the differences between the indicators groups of patients were considered significant at p 0.05.&#x0D; RESULTS: Before treatment, the expression levels of ER, PR in both compartments, and Ki-67 in the glands were lower (p 0.05) in the endometrial hyperplasia group than in the control group. Remission was achieved in 77 (76.24%) (dydrogesterone) and 62 (79.49%) (norethisterone acetate) patients. Initially, the expression level of ER in the glands and stroma of endometrial hyperplasia was lower (p 0.05) than that in the comparison group; the resistant group had a lower (p 0.05) response to treatment. The expression of PR in the resistant group was lower (p 0.05) than that in the comparison group and remission group. The expression level of Ki67 in the response group was lower than that in the comparison group (p 0.05), and the expression in the stroma was lower than that in the resistant group (p 0.05). After treatment in both compartments, the expression levels of ER and PR were lower in the resistant group than in the comparison group and response group (p 0.05). A logistic regression equation was obtained with a set of predictors: ER (glands) + PR (glands and stroma) + Ki-67 (stroma) with a potential response to therapy of 93%.&#x0D; CONCLUSIONS: The specified predictive model is promising. The therapy was effective in 93% of cases.

Cryolipolysis for fat reduction using Cooltech® Define technology: A large-sample retrospective clinical study.

Cryolipolysis is a noninvasive technique for localized fat reduction, which induces selective apoptosis of the adipocytes using controlled exposure to intense cold. During the past 10 years, this technique has been shown to be safe and effective and its application has significantly increased. In this context, Cooltech® devices have been widely used around the world. The purpose of this retrospective study was to evaluate the efficacy and safety of the removal of localized fatty tissue in different body areas using the new Cooltech® Define controlled cooling system. This single-center study was carried out on 287 patients, both female and male, treated with Cooltech® Define on different body areas for a total of 1118 procedures. Follow-up evaluations were conducted to estimate efficacy and safety. Efficacy was evaluated through plicometry and photographs. Side effects were also reported. Fold thickness showed a significant reduction (-69.91 ± 12.55%) after cryolipolysis treatment (fold thickness before: 35.33 ± 8.41 mm; fold thickness after: 10.69 ± 5.27 mm). Few side effects were reported, they included posttreatment pain (1.70%) and one case of paradoxical adipose hyperplasia (0.09%). The Cooltech® Define cryolipolysis device is a safe, effective, and well-tolerated nonsurgical procedure for reducing localized fat.

Technical Evaluation of a New Medical Device Based on Rigenase in the Treatment of Chronic Skin Lesions.

Chronic wound is characterized by slow healing time, persistence, and abnormal healing progress. Therefore, serious complications can lead at worst to the tissue removal. In this scenario, there is an urgent need for an ideal dressing capable of high absorbency, moisture retention and antimicrobial properties. Herein we investigate the technical properties of a novel advanced non-woven triple layer gauze imbibed with a cream containing Rigenase, an aqueous extract of Triticum vulgare used for the treatment of skin injuries. To assess the applicability of this system we analyzed the dressing properties by wettability, dehydration, absorbency, Water Vapor Transmission Rate (WVTR), lateral diffusion and microbiological tests. The dressing showed an exudate absorption up to 50%. It created a most environment allowing a proper gaseous exchange as attested by the WVTR and a controlled dehydration rate. The results candidate the new dressing as an ideal medical device for the treatment of the chronic wound repairing process. It acts as a mechanical barrier providing a good management of the bacterial load and proper absorption of abundant wound exudate. Finally, its vertical transmission minimizes horizontal diffusion and side effects on perilesional skin as maceration and bacterial infection.

Evaluation of the Efficiency of Enzyme-Based Chemomechanical Method in Atraumatic Restorative Treatment of Primary Molars

Aim: To compare clinical and radiographic successes and pain dimensions this chemomechanical agent and traditional Atraumatic Restorative Treatment (ART) method. Material and Methods: Children aged 3-8 years who applied clinic with their parents were included our study (n=38). Teeth included study; Traditional ART method with excavator, enamel chisel and probe and chemomechanical carious tissue removal method with Brix 3000 material were applied. After caries removal methods, restorations were completed with high viscosity glass ionomer cement (YVCIS). After restoration applications, evaluation was made according the Wong Baker Pain Scale. The clinical success restorations was followed up 3, 6 and 12 months according the modified USPHS criteria. Radiographic evaluation was performed 6 and 12 months. In whole study, error value was 5% and load was accepted maintaining the p&lt;0.05 value. Results: 3 and 6 months, there was difference marginal compliance criteria between chemomechanical caries removal and YVCIS restorations applied after traditional ART methods, under surveillance (3rd month p=0.040; 6th month p=0.047). YVCIS restorations applied after chemomechanical caries removal method had Charlie score 2.8% in secondary caries criterion 6th month follow-up. In evaluation made with Wong Baker Pain Scale, facial expression representing no pain expression was preferred most both groups. When all results were evaluated between the two groups, no difference was found when removed (p=0.536). Conclusion: Our study; The chemomechanical caries removal method used non-surgical and acceptable caries removal technique similar the conventional ART method.

Intraoperative Ultrasound-Guided Conserving Surgery for Breast Cancer: No More Time for Blind Surgery.

Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time visualization during all resection phases. This was a prospective observational cohort study conducted at the Veneto Institute of Oncology between January 2021 and June 2022. Patients with ductal carcinoma in situ, T1-2 invasive cancer, or post-neoadjuvant tumors, suitable for BCS, were recruited. All breast cancer lesion types were included, i.e. solid palpable, solid non-palpable, non-solid non-palpable, and post-neoadjuvant treatment residual lesions. Eligible participants were randomly assigned to either IOUS or traditional surgery (TS) in a 1:1 ratio. The main outcomes were surgical margin involvement, reoperation rate, closest margin width, main specimen and cavity shaving margin volumes, excess healthy tissue removal, and calculated resection ratio (CRR). Overall, 160 patients were enrolled: 80 patients were allocated to the TS group and 80 to the IOUS group. IOUS significantly reduced specimen volumes (16.8 cm3 [10.5-28.9] vs. 24.3 cm3 [15.0-41.3]; p=0.015), with wider closest resection margin width (2.0 mm [1.0-4.0] vs. 1.0 mm [0.5-2.0] after TS; p<0.001). Tumor volume to specimen volume ratio was significantly higher after IOUS (4.7% [2.5-9.1] vs. 2.9% [0.8-5.2]; p<0.001). IOUS yielded significantly better CRR (84.5% [46-120.8] vs. 114% [81.8-193.2] after TS; p<0.001), lower involved margin rate (2.5 vs. 15%; p=0.009) and reduced re-excision rate (2.5 vs. 12.5%; p=0.032). IOUS allows real-time resection margin visualization and continuous control during BCS. It showed clear superiority over TS in both oncological and surgical outcomes for all breast cancer lesion types. These results disfavor the paradigm of blind breast surgery.

Automated fracture detection in the ulna and radius using deep learning on upper extremity radiographs.

This study aimed to detect single or multiple fractures in the ulna or radius using deep learning techniques fed on upper-extremity radiographs. The data set used in the retrospective study consisted of different types of upper extremity radiographs obtained from an open-source dataset, with 4,480 images with fractures and 4,383 images without fractures. All fractures involved the ulna or radius. The proposed method comprises two distinct stages. The initial phase, referred to as preprocessing, involved the removal of radiographic backgrounds, followed by the elimination of nonbone tissue. In the second phase, images consisting only of bone tissue were processed using deep learning models, such as RegNetX006, EfficientNet B0, and InceptionResNetV2. Thus, whether one or more fractures of the ulna or the radius are present was determined. To measure the performance of the proposed method, raw images, images generated by background deletion, and bone tissue removal were classified separately using RegNetX006, EfficientNet B0, and InceptionResNetV2 models. Performance was assessed by accuracy, F1 score, Matthew's correlation coefficient, receiver operating characteristic area under the curve, sensitivity, specificity, and precision using 10-fold cross-validation, which is a widely accepted technique in statistical analysis. The best classification performance was obtained with the proposed preprocessing and RegNetX006 architecture. The values obtained for various metrics were as follows: accuracy (0.9921), F1 score (0.9918), Matthew's correlation coefficient (0.9842), area under the curve (0.9918), sensitivity (0.9974), specificity (0.9863), and precision (0.9923). The proposed preprocessing method is able to detect fractures of the ulna and radius by artificial intelligence.

Knowledge of Oral Biopsy Procedure among Dental Interns at a Tertiary Hospital in Eastern Nepal

Introduction: Various diagnostic procedures are available to reach a diagnosis in case of oral lesions. Biopsy is one of the important tools for confirmatory diagnosis. It becomes imperative not only for dentists but future dentists to have adequate knowledge regarding oral biopsy procedures.&#x0D; Objective: To assess the knowledge of oral biopsy procedure among dental interns.&#x0D; Methodology: A web-based cross-sectional study was conducted among interns at College of Dental Surgery, B.P. Koirala Institute of Health Sciences. A questionnaire was prepared and Google Form link was shared with the signed-up participants via messaging apps; Viber and WhatsApp. The descriptive statistics were calculated using Microsoft Excel 2016.&#x0D; Results: Out of 54 participants, 53 (98.15%) and 50 (92.5%) of the interns knew about incisional and excisional biopsy respectively. Only 27 (50%) of them responded that every lesion should be sent for histopathological examination. Only 25 (46.3%) of the interns were aware that the removal of tissue by laser or electrosurgery can introduce artefacts or tissue distortion and 27 (50%) responded that punch biopsy generally produces few artefacts within the biopsied sample. Seventy seven percent of the interns responded that volume of the fixative should be two times the volume of the biopsy specimen, while 15 (27.78%) responded that normal saline could be used as a fixative.&#x0D; Conclusion: The present study revealed, dental interns had a good understanding regarding oral biopsy and also highlighted the need for further training and modifications in curriculum.

The efficacy of a novel SWEEPS laser-activated irrigation compared to ultrasonic activation in the removal of pulp tissue from an isthmus area in the apical third of the root canal.

This study aimed to evaluate the efficacy of Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS) in the removal of remaining pulp tissue from the root canal isthmus area in lower molars and compare it with ultrasonically activated irrigation (UAI) and conventional needle irrigation (NI). Forty-one lower molars with isthmuses between mesial canals were included in the study. The teeth were randomly distributed into experimental groups (n = 12/each) based on the final irrigation protocol (SWEEPS, UAI, or NI) and a control group (C) (n = 5). The traditional access cavity of the mesial part of each tooth was made in all samples. The mesial root canals in the experimental groups were instrumented with a Wave One Gold Primary (25/.07) file using 3% sodium hypochlorite (NaOCl) while the distal canal served as a control for the presence of pulp tissue. No treatment was performed in the C group. Sections from the isthmus region were processed for histopathology to measure the remaining pulp tissue (RPT). The results were analyzed using analysis of variance and the Kruskal-Wallis test (α = 0.05). There were no significant differences in the relative surface area of root canals and isthmus among the groups (p > 0.05). Samples in the SWEEPS group had significantly less RPT than UAI, NI, and C (p = 0.003, 0.014, 0.003, respectively). There were no significant differences between the UAI and NI (p = 0.583). SWEEPS was the most efficient in debridement of the root canal isthmus area. UAI and NI showed similar but lower efficiency.