Sandwich Technique Research Articles

Native nephrectomy in patients with autosomal dominant polycystic kidney disease in kidney transplant program: long-term single-center experience.

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to end-stage renal disease. In this study, we examine the indications, procedures, and outcomes of native nephrectomy (NN) in ADPKD patients at our transplant center. Drawing on 25 years of clinical practice, we aim to provide insights into the surgical management of ADPKD, focusing on the specific factors influencing NN. A retrospective study was conducted involving ADPKD patients who underwent KT and NN between 1999 and 2023. Collected data encompassed demographics and surgery parameters, such as duration, hospital stay length, blood loss, and complications. Patients were classified based on the urgency (acute/planned) of the NN and its type (unilateral/bilateral), followed by an analysis of the outcomes per group. Out of 152 patients post-KT for ADPKD, 89 (58.6%) underwent NN. The procedures were predominantly unilateral (71; 64%), with bilateral NN accounting for 40 (36%) cases. NN timing relative to KT was 31 (27.9%) pretransplant, 9 (8.1%) concomitant, 51 (45.9%) posttransplant, and 10 (9%) patients undergoing the sandwich technique. Acute NN were performed in 42 cases, while 69 were planned. Acute NNs were associated with longer surgeries, greater blood loss, and a higher incidence of perioperative complications compared to planned NNs. Specifically, unilateral acute NN had a 23.8% complication rate compared to 2.9% in planned cases; bilateral acute NN showed a 28.6% complication rate versus 4.3% in planned cases. This investigation accentuates the significance of planning and selection in NN for ADPKD, factoring in the heightened risk of complications. Acute NN are linked to worse outcomes, including higher rates of complications. The data emphasize the necessity of tailored surgical approaches based on individual patient circumstances.

B-071 Unraveling Histamine Intolerance: Exploring DAO Quantity, Elimination Ratios and Cofactor Influences

Abstract Background Non-allergic reactions to food, often triggered by biogenic amines like histamine, result in symptoms such as headache, rhinitis, respiratory issues, digestive complaints, and eczema. The symptomatic overlap between histamine intolerance (HIT) and allergies may contribute to potential underdiagnosis. Limited data impedes precise incidence determination, but estimates suggest 1-3% of the population is affected, with increasing cases anticipated as knowledge and diagnostic tools for HIT advance. Despite histamine's physiological importance, elevated levels pose health risks. HIT arises when ingested or internally released histamine surpasses rapid breakdown capacity. Studies link HIT to DAO deficiency and/or impaired DAO activity, often in subgroups with genetic, pathological, or pharmacological factors. DAO cofactor deficiencies like copper, zinc, vitamin C or vitamin B6 may exacerbate DAO impairment. The trial aimed to explore the relationship of histamine elimination, DAO quantity, and essential cofactors for DAO activity. Methods Serum samples from 40 patients underwent analysis for DAO quantity and histamine elimination ratio using Immundiagnostik AG test kits. ELISA quantification employed a sandwich technique with polyclonal antibodies against recombinant DAO. Low DAO levels (< 3 U/ml) indicated histamine intolerance, moderate levels (3 - 10 U/ml) suggested probability, and high levels (< 10 U/ml) initially ruled out intolerance. Histamine elimination efficiency was assessed by comparing spiked sample levels at 0 and 24 hours after incubation, gauging histamine breakdown mechanisms without directly measuring enzyme quantity. Histamine elimination > 40% indicated unlikely intolerance, 25 - 40% (moderate) suggested probability, and < 25% (poor) indicated likelihood. Additionally, vitamin B6 influence was explored using Immundiagnostik AG's microbiological ID-VIT Test system, spiking samples with DAO for supplementation. Six samples with varying B6 levels underwent investigation. Results The investigation revealed that DAO quantity and histamine elimination highlight the enzyme's pivotal role. Distinctions emerged in histamine intolerance classification, with more than 25% of the population showing reduced elimination in samples with moderate DAO levels (3-10 U/mL), and more than 10% showing reduced elimination in samples with high DAO levels (>10 U/mL), suggesting potential DAO inhibition contributing to impaired histamine breakdown. Analyses based on functional vitamin B6 levels demonstrated varying responses to DAO supplementation. Samples with high functional B6 levels (>20 µg/l) showed a 20% increase in elimination with DAO supplementation of 3 U/mL. In contrast, samples with lower B6 levels (<7 µg/l) exhibited minimal to no additional elimination, despite supplemental DAO at 6 U/mL. These findings underscore the nuanced interplay among DAO levels, histamine elimination, and the influence of vitamin B6, providing insights into factors impacting histamine metabolism across diverse patient profiles. Conclusions The data unveil a high potential for differential diagnosis, particularly in the realm of moderate to high DAO quantity, where the dependence on DAO inhibition yields a different classification of HIT probability. Analyzing DAO cofactors, such as vitamin B6, emerges as a valuable complementary tool for the diagnosis and treatment of HIT. These findings underscore the importance of considering DAO levels, their inhibition, and cofactors in a comprehensive approach to enhance the accuracy of HIT assessment and guide effective therapeutic interventions.

Detection of Salmonella by competitive ELISA of lipopolysaccharide secreted into the culture medium

Detection of Salmonella in food is topical due to known cases of salmonellosis epidemics. Immunochemical methods including ELISA are widely used for Salmonella detection. Traditionally, commercial ELISA kits are based on sandwich technique and detect lipopolysaccharide (LPS), which is considered to be the component of the outer membrane of Gram-negative bacteria. Our aim was elaboration of competitive ELISA test for Salmonella detection in food with improved parameters. It was shown that in the Salmonella culture after the standard sample preparation procedure LPS is present mainly outside cells as a component of outer membrane vesicles. Improved sample preparation procedure includes separation of bacteria from the medium and analysis of the medium, which increases analytical sensitivity. Immobilization of the bovine serum albumin (BSA)-LPS conjugate in microplate wells allows to obtain a more homogeneous coating than immobilization of LPS itself. Thus, we have developed test system for Salmonella detection in food by competitive ELISA of LPS secreted into the culture medium with the immobilized BSA-LPS conjugate and monoclonal antibodies (mAb) to LPS core in the liquid phase. New competitive ELISA test is high sensitive, give reproducible results, allows the detection of any Salmonella serotype and is important for the protection of human health.

Neurofilaments light chains as a diagnostic and predictive biomarker for Tunisian Multiple Sclerosis patients

BackgroundMultiple Sclerosis (MS) course was shown to be more severe among North Africans compared to Caucasians. Validation of prognostic biomarkers of disease activity and severity is a priority in our practice. ObjectiveWe aimed to investigate the association between baseline cerebrospinal fluid (CSF) and serum NfL (sNFL) levels and disease activity and disability accrual in a cohort of Tunisian patients with MS. MethodsA cross-sectional study was conducted, in the department of Neurology of Razi Hospital, including patients diagnosed with MS. Patient's data were retrieved from our local MS database. Blood and CSF sampling were performed at the first visit. sNFL levels were measured using the Enzyme-Linked Immuno-Sorbent Assay (ELISA) sandwich technique. ResultsThree hundred MS patients were enrolled (sex-ratio= 3.05; mean age at MS onset=28.83 years+9.55, mean MS course = 10.21 years+8.96). MS phenotype was predominately relapsing (73%). CSF NfL levels were significantly correlated to the serum ones. NfL concentrations were significantly associated with MS activity (p = 0.012), disease progression (p = 0.001), and higher Multiple Sclerosis Severity Scores (MSSS) (p = 0.0017, r = 0.28). ConclusionsThese results support the value of NfL as a sensitive and clinically meaningful CSF and blood biomarker to evaluate MS activity and outcomes among Tunisian MS patients.

Improving clay-geogrid interaction: Enhancing pullout resistance with recycled concrete aggregate encapsulation

In this study, Recycled Concrete Aggregate (RCA) was employed as a sandwich technique around the geogrid to enhance the pullout resistance of the geogrid in clayey backfills. Large-scale pullout tests were conducted on three configurations: geogrid-reinforced clay, geogrid-reinforced RCA, and geogrid sandwiched between layers of RCA, aimed at investigating pullout resistance and deformation. The experiments encompassed two different geogrid types (designated as G1 and G2), varying normal pressures ranging from 10 to 50 kPa, and RCA layers with thicknesses of 40, 80, 160, and 320 mm. Results from the experiments revealed that the inclusion of RCA layers around the geogrid substantially enhanced pullout resistance, with improvements ranging from 1.5 to 3 times compared to clay specimens. Optimal RCA thicknesses were determined in order to enhance soil-geogrid bonding and pullout resistance. For G1 geogrid, a thickness of 160 mm (equivalent to replacing 25% of clay volume with RCA) was identified as optimal, while for G2 geogrid, an 80 mm thickness (equivalent to replacing 15% of clay volume with RCA) was found to be sufficient. These thicknesses were established to achieve over 80% of the pullout force compared to full RCA specimens.

Treatment of conjunctival palpebral lesions using ruthenium plaque brachytherapy "Sandwich Technique"

ObjectiveTreatment of palpebral conjunctival lesions is problematic due to late diagnosis, difficult surgical approach, and the need to preserve eyelid integrity. We describe our treatment experience using plaque brachytherapy in the "sandwich technique.” DesignA retrospective study. ParticipantsWe reviewed the medical records of patients treated by plaque brachytherapy for conjunctival lesions at the Hadassah Medical Center between January 1, 2013, and January 1, 2024, and included in the analysis patients treated for palpebral conjunctival lesions. MethodsRuthenium plaque was sutured to the palpebral conjunctiva. The matching nonradioactive “dummy” plaque was sutured to the external eyelid to flip the tarsal's curvature. ResultsThe study cohort included 5 patients, 2 men (40%) and 3 women (60%) at a median age of 68.11 years (range: 47-79.7 years). Three patients had conjunctival melanoma (60%), 1 had sebaceous carcinoma (20%), and 1 had extensive carcinoma in situ (20%). All lesions were in the left upper eyelid. Median follow-up was 37.6 months (range: 18.7-110.6 months). Four patients demonstrated a complete response (80%), while one had a partial response (20%). There was local recurrence in 1 patient (20%), and 1 patient had new foci elsewhere (20%). All patients had full local control after adding local treatments. One patient developed metastatic disease and died (20%). All patients had manageable madarosis and conjunctival scars. ConclusionsTreatment of palpebral conjunctival lesions using “sandwich” plaque brachytherapy is safe and effective. To the best of our knowledge, this treatment was never described before, and we believe it should be added to our armamentarium.

The sandwich technique used for correction of pectus carinatum combined with Harrison sulcus

We aimed to investigate the feasibility of the sandwich technique to treat pectus carinatum combined with Harrison sulcus. We retrospectively analysed the clinical data of 38 paediatric patients with pectus carinatum combined with Harrison sulcus treated from June 2015 to October 2022. All the patients underwent surgery using the sandwich technique. The surgical conditions and postoperative outcomes of the patients and the satisfaction score of family members were analysed. Overall, the patients had a mean duration of surgery of 179.05 ± 36.01 min, intraoperative blood loss of 10.03 ± 2.77 mL, postoperative hospital stay of 6.89 ± 0.73 days, and postoperative satisfaction score of 89.4 ± 4.6. The incidence of surgical complications was 7.89%. The internal fixation stents were removed in 22 patients, and there was no recurrence during a follow-up 371.4 ± 6.3 days post-stent removal. These results were satisfactory. The use of the sandwich technique to treat this condition does not reduce the volume of the thorax after the procedure and results in an aesthetically pleasing incision, less complications, and fast postoperative recovery. Thus, it is a safe and effective method that is worthy of being promoted for clinical application.

The Burden of Chronic Obstructive Pulmonary Disease COPD in Stable Patients and its Association with Inflammatory Biomarkers and Body Mass Index

Background: Chronic obstructive pulmonary disease (COPD) is a progressive airflow limitation that is preventable but not curable. It is associated with persistent symptoms that cause a considerable burden on individual productivity at work, and daily activities, and reduced quality of life, also burdening the healthcare system and society. Objectives: The study aims to measure the burden of COPD on patients in terms of daily activities and work productivity. It also seeks to investigate some inflammatory biomarkers' levels and their correlation with selected outcomes. Patients and Methods: A cross-sectional study on 120 stable COPD patients who were diagnosed and treated according to the GOLD guidelines at Kirkuk General Hospital's chest and Internal Medicine consultation clinics, and in private internist clinics in Kirkuk City, Iraq between January and April 2023. The Work Productivity and Activity Impairment Questionnaire (WPAI-COPD) measured the Burden of COPD. The symptom burden was assessed by the COPD assessment test (CAT). The level of IL-6 monoclonal antibodies was measured via a Roche Cobas 6000 analyzer and TNF-α using the ELISA sandwich technique. All these devices and machines were authorized by the Ministry of Health, Iraq. Results: The mean age was (54.1 ± 8.12) years, 62.5% being males and 37.5% being females; 41.7% were public sector employees, and 39.2% were self-employed. Due to COPD, the overall work loss was (45.9±18.91) days, the mean percentage of absenteeism was (10.9% ± 12.31%), activity impairment was (47.5% ±17.79%) among all patients, presenteeism was (40.8 ± 15.05%,) and COPD-related retirees were 14.2% of the study group. The mean CAT score (19.3±5.63) was high and the most troubling symptom among patients was chest tightness. WPAI-COPD scores were higher in older age and longer disease duration. The levels of biomarkers were above the reference ranges, the mean IL-6 level was (69.4 ± 35.29) pg/ml, and the mean TNF-α was (72.3 ± 22.45) pg/ ml. Conclusions: COPD patients exhibit a disease burden in terms of productivity loss at work and activity impairment that increases with aging and disease duration. COPD patients with low BMI are more prone to a decline in lung functions and to worse symptoms.

Embolization of a splenic artery aneurysm: a case report

Splenic artery aneurysm (SAA) is the most common aneurysm of the visceral arteries. SAA can be silent and asymptomatic; rupture is a rare but serious complication that can manifest as acute diffuse abdominal pain and hypovolemic shock with a high risk of mortality. Surgery is the traditional treatment, but has the disadvantage of severe surgical injuries, a high risk of complications and a high mortality rate. We present the case of a 58-year-old woman with a saccular aneurysm of the middle segment of the splenic artery; she was treated by coiling embolization using the sandwich technique. Contrast-enhanced computed tomography (CECT) controls at one month, four months and one year showed progressive reduction and complete devascularization of the aneurysmal sac. Embolization of the splenic artery aneurysm is an effective and safe treatment.

Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms.

The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.

Comparative evaluation of different surface pretreatment methods on the depth of penetration of adhesive resin in sandwich technique: A confocal laser scanning microscopy study.

The aim of the study was to evaluate and compare the depth of penetration of adhesive resin in resin-modified glass ionomer cement (RMGIC) after different surface pretreatment methods using a confocal laser scanning microscope (CLSM). Class I cavity preparation was done in 45 freshly extracted premolars and divided into three groups, according to the surface pretreatment of RMGIC which was placed in a thickness of 1 mm in the cavity. In the control group, no pretreatment was done, and other two groups were pretreated with acid etching and air abrasion (AA). The fifth-generation dentin bonding agent mixed with rhodamine B dye 0.1% was applied on RMGIC in all the samples and cured for 15 s. Samples were restored using composite resin and sectioned longitudinally. The depth of penetration of adhesive resin was evaluated using CLSM. Depth of penetration of adhesive resin was highest with AA (153.70 ± 10.23), followed by acid etching (122.71 ± 12.25) and control group (77.12 ± 6.37). Based on the findings of this research, AA enhances the depth of penetration of adhesive resin in the RMGIC surface. Thus, AA before placement of composite resin on the RMGIC can be effective in a clinical scenario.

СИСТЕМАТИЧЕСКИЙ ОБЗОР МЕТОДОВ ВОССТАНОВЛЕНИЯ ПРОКСИМАЛЬНЫХ ПОЛОСТЕЙ ЖЕВАТЕЛЬНЫХ ЗУБОВ: СОВРЕМЕННОЕ СОСТОЯНИЕ И ПЕРСПЕКТИВНЫЕ ТЕХНОЛОГИЧЕСКИЕ ДОСТИЖЕНИЯ

Relevance. To maintain dental health and maintain the normal structure of the dental system, a deep understanding of methods for restoring lost dental tissue is necessary. When restoring class II carious lesions, open and closed sandwich techniques were used, as well as various methods of manipulating composite materials. Systematization of existing research will allow the dentist to better navigate the available techniques and provide better treatment to his patients. Aim: To conduct a systematic review of the effectiveness of the method for restoring proximal contacts of posterior teeth. Materials and methods. As part of the study, a systematic analysis of the technique for restoring contact points of teeth was carried out, in compliance with established criteria. Initial data were obtained by searching the Google Scholar, ScienceDirect, PubMed, ResearchGate, CyberLeninka and eLIBRARY.RU databases using the following key terms: «recovery methods», «contact point», «open sandwich», «closed sandwich», «filling technique», «point of contact», «closed centripetal», «open centripetal». Results. To conduct a systematic review, 7 articles were reviewed on the seal quality of restorations made using the open sandwich, closed sandwich, and total bonding methods. In 85% of cases, the open sandwich method was indicated by the authors as the most appropriate for creating sealed class 2 restorations. Conclusions. The best tightness of restorations in in vitro studies in 85% of cases was achieved using the technique of filling an open sandwich. The tightness of the restoration not only affects the choice of material, but also prevents its application. Further comparative in vivo studies on the survival of class 2 restorations made using the open sandwich or total bonding method are needed.

Human and camel cystic echinococcosis – a polyclonal antibody-based sandwich ELISA for its serodiagnosis with molecular identification

Cystic echinococcosis (CE) is an emergent neglected disease affecting human and animals in Egypt with a wide distribution and incidence. This study aimed to evaluate the use of a polyclonal antibody-based sandwich ELISA in the detection of Echinococcus granulosus antigen in human and camel sera. Hydatid cyst protoscoleces antigen (PsAg) was isolated from hydatid cysts collected from naturally infected camel livers and lungs. PsAg was used for immunization of rabbits to raise IgG polyclonal antibodies (IgG PsAb). IgG PsAb were then precipitated, purified using Protein-A Sepharose gel and labeled with horseradish peroxidase enzyme. We assayed the purity of the IgG PsAb, and the two prepared E. granulosus antigens CPsAg from camel cysts and HPsAg from human cysts by Sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The resulted protein bands of the prepared CPsAg appeared at different molecular weights: 180, 90, 68, 54, 42 and 22 kDa while, HPsAg shared with it in 4 common bands at 68, 54, 42, and 22 kDa. The purified IgG PsAb had been resolved at two bands at 52 kDa and at 32 kDa. Sandwich ELISA were performed for the detection of circulating E. granulosus antigens in sera of human (n = 183) and camels (n = 190). The purified IgG PsAb showed strong reactivity against E. granulosus infected human and camel samples and no cross reactivity neither with free-healthy negative sera nor with others parasitic diseases (Schistosomiasis, Fascioliasis, Toxoplasmosis, Ancylostomiasis for human samples and Fascioliasis, ticks’ infestation, Eimeriosis, Cryptosporidiosis, Nasal myiasis, Toxoplasmosis for camel samples). The sensitivity of the assay was 98.25% (56/57) and 96.9% (31/32) against human and camel samples, respectively. Specificity was 100% in both human and camel samples. Sandwich ELISA detected CE in 33.3% (24/72) and 55.6% (50/90) random human and camel samples, respectively. Indirect ELISA, using CPsAg, was used for detection of antibodies in positive human and camels’ sera and detected 96.5% (55/57) and 93.8% (30/32) of human and camel samples, respectively. In our study, Genomic DNA was extracted from protoscoleces fluid of human liver hydatid cysts to identify the Echinococcus sp. isolate based on NADH dehydrogenase subunit 1 (NAD1) gene by Polymerase Chain Reaction (PCR) and the isolate (GenBank: OP785689.1) were identified as E. granulosus sensu lato genotype. In conclusion, Sandwich ELISA technique was found to be a potent and sensitive assay for detection of hydatid antigen in both human and camel samples.

INVASIVE CERVICAL RESORPTION OF UNCOMMON ORIGIN: A CASE REPORT WITH 14-YEAR FOLLOW-UP

Background: Invasive cervical resorption (ICR) is a complex, relatively uncommon, and insidious phenomenon. Its occurrence is associated mainly with local predisposing factors, but systemic risk factors may be involved as well. An ICR lesion that develops in the absence of an identifiable cause is termed 'idiopathic'. Case report: This study presents the surgical management and very long-term follow-up results of an "idiopathic" Class 3 ICR lesion in the maxillary central incisor. The case provides a unique insight into an uncommon ICR lesion that exhibited an unusual appearance and features. For the repair material, a sandwich technique was applied using mineral trioxide aggregate (MTA) covered with glass ionomer cement (GIC). At the 14-year follow-up, the tooth was symptom-free and functional; however, the disadvantages of both materials were clearly demonstrated. From that perspective, the study highlighted the discoloration potential of the white form of MTA-Angelus and the lack of regenerative properties of the GIC used. Remarkably, 12 years after the surgery, the patient was diagnosed with Familial Mediterranean fever, a rare systemic disease. However, the connection between this genetic disease and the initiation of ICR remains an open question for now. Conclusion: The clinician should be alert for the occurrence of ICR lesions, especially in patients with concomitant systemic disorders. The right choice of appropriate repair material is a key factor for the healing outcome of ICR lesions in the anterior zone.

Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series

Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an “eye of the tiger” configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

Early Results of the Sandwich Technique Using Cyanoacrylate Glue and Polidocanol Foam Sclerotherapy for the Treatment of Varicose Veins

Background: This is a retrospective analysis of the results of treatment for varicose veins using the sandwich technique with cyanoacrylate glue and foam sclerotherapy. This novel method allows for a substantial reduction in the amount of glue needed for vein closure, and minimizes the risk of granuloma formation and allergic reaction related to the epifascial administration of cyanoacrylate. Methods: This technique was used in 60 patients, 77 intrafascial veins were managed. Vein closures were performed with Venex cyanoacrylate glue and 1–3% polidocanol foam. All procedures were performed under ultrasonographic control, through direct percutaneous punctures of target veins. Follow-ups were scheduled 1–3 weeks after the procedure. If revealed, unclosed segments of the target veins were obliterated at these follow-up visits, with glue and/or sclerotherapy. Results: There were no serious adverse events intra- or postprocedurally. The technical success rate was 100%. The primary success rate at 1–3 weeks follow-up was 84.4%. The primary assisted success rate, after additional closures, was 100%. Conclusions: We demonstrated that the treatment for varicose veins, using a sandwich technique, which combines cyanoacrylate glue and foam sclerotherapy, can be safe and efficient.

Shear bond strength between conventional composite resin and alkasite-based restoration used in sandwich technique: An in vitro study.

The success of layered restorations necessitates the utilization of an improved restorative material compatible with composite restorations. Therefore, in this line of research, the strength of adhesion of conventional resin-based dental composite to different filling materials was tested. Conventional composite resin was bonded to four restorative materials (Group I: conventional glass ionomer cement (GIC), Group II: resin-modified glass ionomer cement, Group III: flowable composite, and Group IV: Cention-N) received no surface treatment (Subgroup A: control), sandblasting using 50-µm aluminum oxide particles (Subgroup B), sandblasting and resin adhesive (Subgroup C), acid etch and resin adhesive (Subgroup D), or self-etch resin adhesive (Subgroup E). After 24 h, the strength of adhesion between the conventional composite resin and the other tested filling materials was estimated by using a universal testing machine and compared using one-factor analysis of variance and Tukey's method. The conventional GIC had the minimum values of adhesion strength while the flowable composite and Cention-N had the maximum values of adhesion strength (P < 0.05). The treatment of the used restorative materials with sandblasting and resin adhesive boosted the adhesion strength (P < 0.05). The surface treatment of GIC-based materials with either acid etch and resin bonding agent or self-etch resin bonding agent boosted the adhesion strength (P < 0.05). Cention-N sandblasted and coated with resin adhesive before the application of conventional composite resin in layered restorations is a potential alternative to GIC-based restorations and flowable composite.

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes.

Incidental dural tears (IDTs) are sometimes observed asan intraoperative complication associated withlumbar spine surgery. Commonly, this complication is recognized and repaired during surgery, but if it is undiagnosed or inadequately treated, a variety of consequences may occur. Many techniques have been developed to treat cerebrospinal fluid (CSF) leakage, and each has its limitations. Objectives: To assess the prevalence of incidental dural tears in lumbar spine surgeries and evaluate the outcomes of the sandwich technique in the management of this complication. A total of 92 patients who underwent lumbar spine surgery at the Royal Rehabilitation Center in Amman from January 2018 to December 2021 were retrospectively reviewed. Patients were divided into two groups: group A (patients without IDT) and group B (patients with IDT), where group B was repaired using the sandwich technique. The follow-up period was six months. Further, the sandwich technique involves repairing the dural defect with interlocking sutures, painting medical glue around the dural incision, covering this with gelatin sponge, and finally covering the gelatin sponge with medical glue again. The overall prevalence of IDT in the study group was 14.1%. IDT was more common among elderly patients above the age of 60 (17.2%), females (16.7%), patients with multiple lumbar levels treated (66.7%), open approaches (21%), and those who had previous spinal surgery (72.7%). Most IDTs were diagnosed and managed intraoperatively (84.6%). Among those patients, only one complained of a surgical site infection. Patients in group B had a significantly higher postoperative length of hospital stay, amount of drainage, and operative time compared to group A (P<0.001). Regarding postoperative pain, patients in group B had significantly higher pain on the Numerical Pain Scale at day three post-operation compared to patients in group A (P<0.001). Based on our results, the sandwich technique was effective in the management and prevention of CSF leakage. Further prospective studies with long-term follow-up are needed to confirm our findings.

LYMPHOCYTIC CHORIOMENINGITIS VIRUS INFECTION

Background: Lymphocytic choriomeningitis virus (LHMV) infection is a neglected rodent-borne zoonotic infection but it is found all over the world because of the cosmopolitan distribution of its reservoirs. The diagnostic of this disease is not widely applied that is why it has been underreported. The aim of this study is to investigate infection with LCMV in hospitalized patients in 2015-2022 in Bulgaria and to analyse the data compared to the worldwide data available in this field of research. Materials/methods: A total of 66 serum samples and 25 cerebrospinal fluid (CSF) samples from 73 patients with suspected LCMV infection from different hospitals in Bulgaria were collected. All samples were tested with a commercial enzyme-linked immunosorbent assay (Human LCMV-Ab ELISA, SSBT, China), based on the principle of double-antibody sandwich technique to detect Human LCMV-Antibody. Results: A total of 11/91 (12.09%) positive samples were found in 5 males and 6 females throughout the study period. The positive samples were from patients from the cities: Sofia, Stara Zagora, Montana. A total of 3/25 (12%) positive samples were from CSF samples and 8/66 positive samples (12.12%) were from serum samples. Conclusions: It’s found that this infection occurs in our country and should not be underestimated, due to the possible severe neurological course and the danger of fetal damage in pregnant women. The diagnosis of LCMV infection is based on previous experience, placed in the light of the continuous introduction of new more sensitive and specific approaches.

Serum Level Alteration of IL-6, IL-1β, and IFN-γ in Groups of Healthy Adults with Oxidative DNA Damage in Najaf Governorate.

Najaf governorate was recorded as one of the most polluted Iraqi governorates with increased cancer, autoimmune, and abortion cases. Study Groups. A total of 88 adult volunteers from three test groups were divided based on their inhabitance in different geographical regions in Najaf governorate. Group 1 (G1; n, 29) inhabitants of Al-Ansar, Al-Abbaseyeh, and Al-Manathera districts, Group 2 (G2; n, 27) inhabitants of 22 different scattered districts of the governorate, Group 3 (G3; n, 32) inhabitants of Kufa city and center districts in the old Najaf city. According to previous authors' findings, all participants had uranium contamination in their urine and blood samples, and also, they had DNA damage according to the level of urinary 8-OHdG compound. The control group 4 (G4; n, 25) were adult healthy Iraqi volunteers who were residents of the Sulaimaniyah governorate, which has low-level uranium pollution. The present study aims to determine the effect of uranium pollution and DNA damage on the immune system function in terms of estimating the levels of serum interleukin (IL)-6, interferon-gamma (IFN-γ), and IL-1 beta (β). Enzyme-linked immunosorbent assay (ELISA) (Sandwich method technique) was used for estimating the serum cytokines levels in test and control groups. A significant elevation of cytokines levels was reported as compared with the control groups (p ≤ 0.01). The level of IL-6 was 764.64 ± 24.12 pg/ml, 768.87 ± 19.64 pg/ml, and 735.62 ± 18.47 in G1, G2, and G3, respectively. The level of IFN-γ was 264.55 ± 19.17 pg/ml, 259 ± 18.76 pg/ml, and 261.20 ± 12.99 pg/ml for G1, G2, and G3, respectively. The level of IL-1β was 99.85 ± 10.81 pg/ml, 116.8 ± 10.71 pg/ml, and 83 ± 19.24 pg/ml in G1, G2, and G3, respectively. The levels of IL-6, IFN-γ, and IL-1β were 86.5 ± 22.9 pg/ml, 19.4 ± 2.8 pg/ml, and 16.1 ± 3.2 pg/ml in the sera of control (G4). The results showed significant statistical elevation with the corresponding p value cut-off p ≤ 0.01 in IL-6, IFN-γ, and IL-1β in the sera of three test groups as compared with the results of the control group. The change in the proinflammatory cytokines (IL-6, IFN-γ, and IL-1β) levels indicates a persistent inflammatory response in the participants and may reflect immune system impairment as a consequence of exposure to long-term low-dose ionizing radiation.