Usual Technique Research Articles

An Analgesic Technique for Orogastric Tube Insertion in Newborns: DOLATSONG, a Randomized Multicentric Controlled Trial.

Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure. Objective: To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure. Prospective, controlled, randomized, multicentered and open label study. Three neonatal intensive care units in France (2 level 3 units and 1 level 2B). Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique ( n = 36) and experimental technique ( n = 35). Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN- Douleur Aiguë du Nouveau-né ; APN-Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models. All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group ( P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015). This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.

Vascular loops mimicking herniated lumbar discs: fair warning.

The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.

Comparison of Fibrin Glue With Conventional Suturing in Peripheral Nerve Repairs: A Study of Sensory and Motor Outcomes.

Nerve injuries have traditionally been repaired with sutures, and this method is considered the gold standard technique in the management of nerve injuries. However, fibrin glue has recently become a promising tool for repairing nerve injuries and has advantages including ease of usability, atraumatic application technique, and decreased co-optation time of the nerves. This study aims to clinically evaluate the efficacy of nerve repair with fibrin glue compared with the usual suture technique in terms of sensory and motor outcomes. A total of 80 patients were included in the study; 50 patients underwent primary nerve repair, and 30 patients underwent Oberlin's repair. These subsets were randomly divided into two groups in which the nerves were repaired with microsutures in one group and fibrin glue in the other group. In the comparison of fibrin glue with microsutures, there were no significant differences between the two groups in the 2-point discrimination (2PD) test, Semmes-Weinstein test, motor function, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. However, the co-optation times were significantly shorter with fibrin glue than with microsutures. Based on our findings, nerve repair with fibrin glue is as effective as microsutures in terms of sensory and motor recovery and has added advantages of ease of usability and shorter repair times. Therefore, fibrin glue may be an effective alternative to sutures in nerve repair.

Meticulous Closure of Mesenteric Defects Effectively Reduces the Incidence of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass.

Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH. Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8years of follow-up. A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001). Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB.

#2294 Muscle ultrasound as a tool for morphofunctional assessment in patients with chronic kidney disease

Abstract Background and Aims The measurement of the rectus femoris of the quadriceps by ultrasound is used as a measure correlated with muscle mass, strength and functionality, being able to determine diameters and muscle area. Aims To assess the usefulness of ultrasound parameters of muscle mass and correlate it with age, gender, dynamometry, exercise, biochemistry and body composition by BIVA Method We evaluated 78 patients with ACKD stages 3,4,5(87.2%) and peritoneal dialysis (22.8%) with ultrasound with an echography device (Echographe Sonosite) measuring: transverse(A) and longitudinal(B) axes, ratio B/A and circumference and muscle area of the rectus femoris of the quadriceps according the usual technique. Likewise, we evaluate Hand-grip strength (HOGS), calf circumference and body-composition by BIA. Results We evaluated 78 patients with CKD: age 71.54 ± 11.76 years, 59% men and 48.7% DM. Dynapenia/presarcopenia =20.8% with lower muscle-ultrasound parameters, with significant direct correlation p0.01 with A, B, C and muscle mass area transverse diameter (A) = 0.99 ± 0.43, B (longitudinal diameter) = 2.63 ± 0.77, muscle circumference (C) = 6.33 ± 1.83, muscular area = 2.23 ± 1,23.(healthy-population A = 1.31 ± 1.2 cm, B = 3.21 ± 3.4 cm), ratio B/A = 2.97 ± 0.94. Right HGS = 27.22 ± 8.26 kg. Having exercised shows better sig parameters: A1.08 ± 0.45 vs 0.84 ± 0.35 p &amp;lt; 0.01, area 2.50 ± 1.27 vs 1.80 ± 1.02 p0.01 (B and C not sig) as well as age ≤75 vs &amp;gt;75 sig. better in all eco-muscular parameters. We found significant differences between men and women in all parameters as well as dynamometry, perimeter-calf and muscle mass by BIA, not in albumin, Hb or CRP. Overall normal vs low hand-grip-strength (HGS) showed better not significant echo-muscle values. CKD vs PD showed higher values in CKD but not significant. Global significant direct correlations of muscle area p &amp;lt; 0.01) with: HGS r0.324, calf-perimeter r0.30, MM r0.40, Phase-Angle r0.35, Cell mass (BCM) r0.39, and intracellular water (AIC) r0.38. Inverse sig p &amp;lt; 0.01 with B/A ratio. Conclusions

A Method of Reducing Errors Due to Sampling in the Measurement of Electric Power

Although data acquisition is a very usual technique, several aspects are not always considered, such as the synchronization of the acquired measures and the evaluation of the resulting errors. This paper aims to highlight this fact by the mathematical determination of the necessary correction and the implementation of software meant to evaluate the performances of acquisition systems. As an example, a three-phased acquisition system was developed in order to monitor the currents and voltages on the three phases. Also, other measures were performed, such as of power and phase. The components on each phase did not have to be fully identified because a whole system calibration could be performed in the first stage. The calibration consisted in finding the weighting coefficients for each measured quantity. The implemented solution for three-phased measure acquisition started from the hypothesis of a sampling frequency that respected the Shannon theorem. The distance between two samples was small enough to consider a linear evolution between two moments for the same measure. Errors that affected the above-mentioned measures, due to the fact that the samples were examined in different moments, were analyzed and brought to the minimum value. Finding a solution to reduce the sampling errors is closely related to reducing the costs.

Rapid determination of hippuric acid as an exposure biomarker of toluene using a colorimetric assay and comparison with high-performance liquid chromatography

Occupational exposure to toluene is associated with health risks that require reliable monitoring methods. Hippuric acid (HA), a urinary metabolite of toluene, serves as a valuable biomarker for such exposure. Colorimetric methods for the quantitative determination of HA have gained prominence due to their simplicity, cost-effectiveness, and suitability for field application. In the present study, a simple colorimetric technique was optimized for the determination of HA in the urine sample, and compared with a usual HPLC technique. The central composite design (CCD) was applied to examine the effective parameters on the colorimetric determination of HA. The calibration curve for HA was established within the concentration range of 6 to 100 mg L−1 with R2 = 0.97. The detection limit (LOD) and quantification limit (LOQ) were determined to be 1.8 mg L−1 and 6 mg L−1 respectively. The relative standard deviation (RSD%) was less than 5%, and the recovery% (R%) was 90.5–100.1. The overall results showed good agreement between the colorimetric and HPLC results. There was a significant relationship between the results obtained from HPLC and colorimetric methods especially for higher concentration levels of HA (≥ 500 mg/g creatinine). In conclusion, our optimized colorimetric method is a simple, cost-effective, and rapid method for determination of HA in occupational exposure, which is comparable with the HPLC technique.

A Penalized Criterion for Selecting the Number of Clusters for K-Medians

Clustering is a usual unsupervised machine learning technique for grouping the data points into groups based upon similar features. We focus here on unsupervised clustering for contaminated data, that is in the case where K-medians algorithm should be preferred to K-means because of its robustness. More precisely, we concentrate on a common question in clustering: how to chose the number of clusters? The answer proposed here is to consider the choice of the optimal number of clusters as the minimization of a penalized criterion. In this article, we obtain a suitable penalty shape for our criterion and derive an associated oracle-type inequality. Finally, the performance of this approach with different types of K-medians algorithms is compared on a simulation study with other popular techniques. All studied algorithms are available in the R package Kmedians on CRAN.

ARIA II: a randomized controlled trial of near-infrared Angiography during RectosIgmoid resection and Anastomosis in women with ovarian cancer

BackgroundOvarian cancer with extensive metastatic disease involving pelvic structures often requires rectosigmoid resection for complete gross resection; however, it is associated with increased surgical morbidity. There are limited data, and...

Hints of neutrino dark matter scattering in the CMB? Constraints from the marginalized and profile distributions

We study scatterlike interactions between neutrinos and dark matter in light of different combinations of temperature, polarization and lensing data released by three independent CMB experiments—the Planck satellite, the Atacama Cosmology Telescope (ACT), and the South Pole Telescope (SPT)—in conjunction with baryon acoustic oscillation (BAO) measurements. We apply two different statistical methodologies. Alongside the usual marginalization technique, we cross-check all the results through a profile likelihood analysis. As a first step, working under the assumption of massless neutrinos, we perform a comprehensive (re)analysis aimed at assessing the validity of some recent results hinting at a mild preference for nonvanishing interactions from small-scale CMB data. We find compelling resilience in the results already documented in the literature, confirming that interactions with a strength uνDM∼10−5–10−4 appear to be globally favored by ACT (both alone and in combination with Planck). This result is corroborated by the inclusion of additional data, such as the recent ACT-DR6 lensing likelihood, as well as by the profile likelihood analysis. Interestingly, a fully consistent preference for interactions emerges from SPT, as well, although it is weaker than the one obtained from ACT. As a second step, we repeat the same analysis considering neutrinos as massive particles. Despite the larger parameter space, all the hints pointing towards interactions are confirmed also in this more realistic case. In addition, we report a very mild preference for interactions in Planck+BAO alone (not found in the massless case) which aligns with small-scale data. While this latter result is not fully confirmed by the profile likelihood analysis, the profile distribution does confirm that interactions are not disfavored by Planck. Published by the American Physical Society 2024

Gastrostomy tube dislodgement into the peritoneal cavity after its manual insertion

Gastrostomy tube dislodgement into the peritoneal cavity after its manual insertion

CardioRetinaNet Joint Analysis of Retinal Images for Cardiovascular Disease Diagnosis and Age Estimation using Convolutional Neural Network

In recent years, despite the consistent progress in the field of medicine, a rapid growth of patients with cardiovascular disease has been a problem globally. Cardiovascular disease, a general term for disorders of the heart or blood vessels, require high-speed and precise detection to control and avoid hostile consequences. Traditionally, computerized tomography scans, utilizing images retrieved from CT-scans, to calculate coronary artery calcium score were the dominant method for the diagnosis of cardiovascular diseases. This usual technique is problematic because of its lengthy procedure and the difficulty of getting the diagnosis due to the expensive cost. To address this problem, I propose a convolutional neural network-based cardiovascular disease diagnosis system using retinal images which are notably more cost-effective than computerized tomography scans. The proposed system takes retinal images as input and generates a categorical assessment of the severity of cardiovascular disease as output. Additionally, it provides a predicted age of the patient, contributing to an enhanced performance in cardiovascular disease classification. By incorporating these features, the proposed system aims to advance the accuracy of cardiovascular disease diagnosis. The experimental results clearly demonstrate that the proposed system attains a state-of-the-art performance in diagnosing cardiovascular disease. I expect that the proposed system will make a significant contribution to the utilization of retinal images as a biomarker for diagnosis of cardiovascular disease.

Optimized reamer geometry for controlled reaming of the proximal femur

Preparation of the femoral proximal medullary cavity by reaming is essential for intramedullary nail osteosynthesis and hip revision arthroplasty. The use of reamers sometimes exerts high torsional forces on the bone. Design and direction of rotation of the reamer are potential influencing factors. The aim of this biomechanical study is to evaluate the best combination of a right- or left-cutting reamer with a clockwise- or counterclockwise-rotating insert in terms of preparation and safety. Right- and left-cutting reamers with conical design were each introduced into five synthetic femurs in both clockwise and counterclockwise rotation with constant feed force. A specially constructed test system was used for this series of tests, with which the respective intramedullary channel were reamed step by step. This was then used to determine the required torque. In addition, the feed rate measurement was analyzed using a modified digital caliper. The feed rates of the reamers with rotation in the same direction as the cutting direction were significantly increased compared to rotation in the opposite cutting direction (CCRLC vs. CCRRC 76.8 ± 9.0 mm/s vs. 25.2 ± 8.3 mm/s and CRRC vs. CRLC 54.3 ± 12.3 mm/s vs. 19.3 ± 0.6 mm/s; p < 0.01). In contrast, the mean torque during the reaming process was identical in all four groups. When preparing the proximal femoral medullary cavity, especially in cases with fragile bone structure, the available reamers should be introduced in opposite rotation to the cutting direction to achieve a more controllable feed of the reamer. Left-cutting reamers represent an alternative, using them in the usual clockwise-rotating technique to reduce the risk of complications during reaming.

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves.

The main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius. We evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography. In all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle. Physical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.

Structural evolution of versatile Bi2O3-B2O3-Cr2O3: ZrO2 glass ceramics monitored by Raman and EPR spectroscopy

A series of BBCZr glass ceramics were synthesized by the usual melt-quenching technique and subsequent two-step heat treatment with the composition (in mol.%): 30Bi2O3-70B2O3 (pure sample) and (29-x)Bi2O3-70B2O3-1Cr2O3:xZrO2 (0 ≤ x ≤ 2). Morphological, physical, thermal, structural, and magnetic characteristics of BBCZr glass ceramics have been investigated with the various concentrations of zirconium oxide nanoparticles (≈45 nm) in the composition. XRD and SEM studies have confirmed the existence of induced heterogeneous crystal phases in the glass ceramics. The Raman spectra have revealed the Boson peak at low frequencies (≈62–72 cm−1), various functional groups of primary glass forming units like [BO4], [BiO3], [CrO4]2− and [ZrO4] units, and other glass modifying units/crystallite units viz., [BO3], [BiO6], [CrO6], BOB chains, etc. The Boson peak maximum has exhibited an anomalous dip at x = 1 mol.%, at which the glass ceramic sample exhibits more heterogeneous crystal phases. The paramagnetic isolated Cr3+ ions plus Cr3+-Cr3+ ion pairs were detected by EPR studies. The BBCZr glass ceramics may be useful for potential applications such as optical elements, paramagnetic sensing elements, etc.

Double mesh in special cases of laparoscopic inguinal hernia repair: case series study

Recurrence of laparoscopic inguinal hernia repair decreases if the technique is systematized and the recommendations are followed. However, there are special cases in which the usual technique may require modifications to avoid it. The use of two polypropylene meshes has been suggested since the early years of laparoscopic hernia repair with good results. However, for almost two decades, there have been no reports in this regard. The objective of this work, is to describe our technique using double mesh, and report a series of complex cases in which this technique was used to reinforce the inguinal wall with good results comparing it with the techniques described in other series.

Enhancing soil resilience in Iranian Haploxeralfs: A study on the impact of two organic matters on aggregate stability and mechanical resistance

In arid regions around the world, erosion is a frequent occurrence due to low annual rainfall weakening plants, which in turn affects the concentration of soil organic matter (SOM). When the soil is exposed, sudden and heavy rainfall can lead to soil degradation, particularly in soil with high sodicity where unstable aggregates are easily ruptured, initiating the first phase of soil erosion. To investigate this phenomenon, soil samples were collected from an erosion‐prone area near Maharloo Salt Lake, specifically Chah‐angiri (soil 1) and Kamal-abad (soil 2), which are loam and silty clay loam soils with low SOM.&lt;strong&gt; &lt;/strong&gt;To evaluate the effect of organic matter sources on soil stability, cow manure (animal source) and wheat straw (plant source) were applied to both soil samples at four different rates (0.0, 10.0, 20.0, and 40.0 g kg&lt;sup&gt;−1&lt;/sup&gt;) and incubated for four months. The soil’s aggregate stability and mechanical resistance were then assessed using two different methods: mechanical resistance, which was measured as the module of rupture and penetration resistance, and aggregate stability, which was evaluated using the conventional and Le Bissonnais methods.&lt;strong&gt; &lt;/strong&gt;The application of organic matter resulted in a linear increase in aggregate stability in both soils, with the increase in Chah‐angiri (with lower sodicity) being greater than Kamal‐abad (with higher ESP). Both linear and exponential equations showed that organic matter treatment reduced soil mechanical resistance exponentially, with wheat straw proving more effective than cow dung at stabilizing aggregates against slaking and lowering soil mechanical resistance in both soils.&lt;strong&gt; &lt;/strong&gt;Furthermore, the stability of aggregates changed by mechanical breakdown (MWD&lt;sub&gt;stir&lt;/sub&gt;) was found to have the strongest relationship among three Le Bissonnais treatments (MWD&lt;sub&gt;slow&lt;/sub&gt;, MWD&lt;sub&gt;fast&lt;/sub&gt;, and MWD&lt;sub&gt;stir&lt;/sub&gt;) and the aggregate stability test using the usual technique (Kemper and Rosenau). The organic matter rate had a significant effect (&lt;em&gt;P &lt;/em&gt;&amp;lt; 0.001) on MWD&lt;sub&gt;stir&lt;/sub&gt;, which increased with rate in a linear relationship (&lt;em&gt;r&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.957, &lt;em&gt;P &lt;/em&gt;= 0.022). Finally, the stability of soil aggregates in water was also investigated.

Three new, UV spectrum filtration protocols for the synchronous quantification of ciprofloxacin HCl and ornidazole in the existence of ciprofloxacin-induced degradation compound

Three new spectrum filtration protocols have been developed and adapted to overcome some difficulties in dealing with highly overlapping triple drug mixtures by proposing new smart mathematical techniques that facilitate the resolution of the ternary mixture and the recovery of a filtrated zero-order spectrum (D0 spectrum) of each component without any overlapping from the accompanying components. The three established spectrophotometric protocols were conducted on the combination of ciprofloxacin hydrochloride and ornidazole as a green alternative to the usual chromatographic technique: the first protocol is ratio difference-isosbestic points coupled with ratio difference-areas under the curve (RD-ISO/RD-AUC); the second protocol is ratio difference-isosbestic points coupled with dual-wavelength equation (RD-ISO/DWE); and the third protocol is signal retrieval by zero-crossing point (SRZ). All three developed protocols have the power to recover a filtrated zero-order spectrum of each ornidazole and ciprofloxacin hydrochloride without any involvement from the ciprofloxacin-induced degradation substance through processing their spectral data either in the zero-order spectrum, ratio spectrum, or derivative spectrum. The correctness of the spectral filtration process for each protocol was checked by involving the spectral print recognition index to ensure the drug's purity and freeness from impurities or degradation products. The validation process was performed as per the directions of ICH, which confirmed the effectiveness of the elaborated protocols and their usability as daily analysis methods with a linearity range of (3.5–15 μg/ml) for ciprofloxacin in (RD-ISO/RD-AUC) and (RD-AUC/DWE) protocols and (1.5–15 μg/ml) in (SRZ) protocol; and a linearity range of (3–20 μg/ml) for ornidazole in (RD-ISO/RD-AUC) and (SRZ) protocols and (3–15 μg/ml) in (RD-ISO/DWE) protocol. A statistical comparison and greenness evaluation utilizing NEMI, AGREE, GAPI, and CALIFICAMET-HEXAGON tools were made with the reference approach, confirming no statistical variations and a better greenness profile for the newly established protocols.

Transseptal puncture using electroanatomical mapping: a safe and cost-effective technique

Abstract Background The usual technique of transseptal puncture (TSP) uses fluoroscopy or intracardiac echocardiography. New techniques for oval fossa (OF) identification by electroanatomical mapping (EAM) have been described. However, the technique of direct visualization of the TSP needle added to the OF location by impedance mapping has not been investigated yet. Purpose To evaluate feasibility and safety of the TSP technique guided by the interatrial septum (IAS) impedance mapping and the TSP needle visualization using EAM system. Methods Consecutive patients who underwent ablation using TSP in July and August 2022 in our institute were included. The standard material for the procedure was used in addition to a temporary pacemaker (PM) connection cable. In all cases, the EAM system was CARTO 3 version 7 (Biosense Webster and a bipolar voltage map of right atrium and a impedance map of the IAS were constructed. The OF location was estimated based on the septal region with the lowest impedance and on traditional anatomical landmarks. Using a temporary PM cable connected to the proximal part of the TSP needle stylet, it was possible to visualize its distal portion on the 3D map used to guide the TSP. The entire process was simultaneously monitored under fluoroscopic visualization by an experienced professional. Results A total of 25 patients were included; mean age of 56 +/- 15 years, 16 (64%) were male. The most frequent procedure was atrial fibrillation ablation (86%); left atrium mean size of 40,26 +/- 5,2 mm. 9 patients (36%) were already submetted to a previous procedure using TSP. None of the patients had congenital heart disease. In all cases, the TSP was successfully performed and a correlation between the anatomical references and the lowest impedance region on the map was observed. There were no complications. Conclusion The technique of visualization of the TSP needle using EAM system added to IAS impedance mapping and use of anatomical markers seems to be a safe and cost-effective alternative for performing TSP. This technique could reduce ionizing radiation without need for additional materials.Impedance map and bipolar voltage mapLA (bipolar voltage map) and TSP orifice

Procedure time and filling quality for bulk-fill base and conventional incremental composite techniques—A randomised controlled in vitro trial

ObjectivesThe aims of this randomised controlled laboratory trial were to determine the procedure time and immediate quality (surface porosity and marginal gaps) of fillings placed using the bulk-fill base technique and the conventional incremental technique in simulated clinical settings. MethodsForty-two dentists and dental students were randomly allocated to use either the bulk-fill base technique or the conventional incremental technique to fill an identical class II disto-occlusal cavity in a maxillary left first molar typodont tooth. We recorded the time the participants used to fill the cavity and evaluated the surface porosity and marginal gaps on the approximal surfaces of the fillings using a stereomicroscope and specific probes according to the FDI criteria for restoration evaluation. Data were analysed using the Mann–Whitney U, Kruskal–Wallis, and chi-square tests. ResultsThe median time ± interquartile range was 186 ± 80 s for the bulk-fill base technique and 463 ± 156 s for the conventional incremental technique (p < 0.001). The quality of the fillings was better for the bulk-fill base technique than for the conventional incremental technique (X2 = 9.5, p = 0.002). Neither operator experience nor the usual technique of choice were associated with the procedure time or the quality of the fillings. ConclusionsCompared to the conventional incremental technique, the use of the bulk-fill base technique shortened the time to fill a cavity by 59.8 % or 4 min and 36 s, and it improved the immediate surface and marginal quality of the fillings, regardless of the operator's experience or technique preference. Clinical significanceThe use of the bulk-fill base technique instead of the conventional incremental technique leads to significant time-savings when placing large class II composite fillings. Additionally, the use of the bulk-fill base technique instead of the conventional incremental technique improves the immediate quality of large class II composite fillings.