Deformation and Fracture of Mtwo Rotary Nickel-Titanium Instruments After Clinical Use

IntroductionIn recent years, a number of rotary nickel titanium (NiTi) systems have been developed to provide better, faster, and easier cleaning and shaping of the root canal system. Although the NiTi instruments are more flexible than the stainless steel files, the main problem with the rotary NiTi instruments is the failure of the instruments. The aim of this study was to evaluate the deformation and fracture rate of Mtwo rotary nickel-titanium instruments (VDW, Munich, Germany) discarded after routine clinical use.MethodsA total of 593 Mtwo rotary NiTi instruments were collected after clinical use from the clinic of endodontics over 12 months. The length of the files was measured using a digital caliper to determine any fracture, and then all the files were evaluated under a stereomicroscope for defects such as unwinding, curving, or bending and fracture. The fracture faces of separated files were also evaluated under a scanning electron microscope. The data were analyzed using a chi-square and z test.ResultsA percentage of all files (25.80%) showed defects, and the major defect was fracture (16.02%). The most frequently fractured file was #10.04 (30.39%). Deformations without fracture were mostly observed on #15.05 files (25.47%).ConclusionsA higher rate of deformation was observed for #10.04 and #15.05 files. Therefore, these files should be considered as single-use instruments. Because cyclic fatigue was the cause of 71.58% of the instrument fractures, it is also important not to exceed the maximum number of usage recommended by the manufacturer and discard the instruments on a regular basis.     

Effect of obesity on postoperative outcomes in patients with left ventricular assist device

Journal of Artificial Organs -     

Short-term effects of high-intensity laser therapy,manual therapy,and Kinesio taping in patients with subacromial impingement syndrome

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n?=?15), KT?+?EX (n?=?20), MT?+?KT?+?EX (n?=?16), and MT?+?KT?+?HILT?+?EX (n?=?19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT?+?KT?+?EX and HILT?+?MT?+?KT?+?EX groups (p?<?0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p?<?0.05). These differences were significant especially between the groups MT?+?KT?+?EX and KT?+?EX (p?<?0.05) and HILT?+?MT?+?KT?+?EX and KT?+?EX (p?<?0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.     

Long-term outcome after total correction of tetralogy of Fallot in adolescent and adult age

Although most patients with tetralogy of Fallot (TOF) undergo radical repair during infancy and childhood, patients remaining undiagnosed and untreated until adulthood can still be treated. These patients have either a previous palliative or natural collateral circulation to the lung or a mild form of right ventricular outflow tract (RVOT) obstruction. The aim of this study is to analyze the perioperative and long-term results of radical corrective procedures in patients who reached adult ages. Two hundred and seven patients with TOF underwent complete correction between 1985-and 2002, 64 (30.9%) of whom were aged 14 years or more. The mean age at corrective repair for this group was 20.6 +/- 7.5 years (range 14 to 49 years). Only two patients had previous modified Blalock-Taussig shunts. In 44 patients (68.7%) besides infundibular resection, a transannular gluteraldehyde-treated pericardial patch was used to reconstruct right ventricular outflow tract (RVOT). Only infundibular patching was used in 15 patients (23.4%) and infundibular muscular resection with primary closure of right ventricle was performed in five patients (7.8%). Hospital mortality was 3.1% with two patients. Four patients (6.2%) underwent reoperation because of recurrent ventricular septal defect (VSD) with/without residual obstruction or pulmonary regurgitation. All survivors were in NYHA class I (42) or II (17). Late mortality was recorded in two patients and 16-year actuarial survival was 89.2%+/- 4.9%. The significant negative predictors of late survival determined by univariate analysis were reoperation <0.018) and associated cardiac anomalies <0.011). Multivariate analysis showed that there was no negative predictor of late-term mortality. Corrective procedures in adult patients with TOF can be performed successfully compared to patients who underwent operation during infancy and childhood.     

Reversed-J inferior versus full median sternotomy: which is better for awake coronary bypass surgery

BACKGROUND: The aim of this study was to ascertain whether the approach with a less invasive reversed-J inferior sternotomy could improve intraoperative patient compliance and postoperative recovery than the standard median sternotomy. METHODS: Seventeen patients underwent elective single coronary artery bypass graft operation under high thoracic epidural anesthesia without endotracheal intubation. The reversed-J sternotomy was performed in 10 patients (Group A) and full sternotomy in 7 patients (Group B). The technical and surgical difficulties, pulmonary functions (by spirometric tests) and hospital stay were assessed. RESULTS: Through the reversed-J sternotomy coronary revascularization was accomplished without any additional technical difficulties and with a good exposure of both the left anterior descending artery and the left internal thoracic artery. No conversion to standard sternotomy and no intubation were observed. Additional doses of local anesthetic at jugular notch was not required in Group A. Pleura was opened more in Group B (57% vs. 20%; p = 0.14). Oxygen saturation was better in Group A during the surgical procedure (98.8 +/- 0.7% vs. 97.1 +/- 2.1%; p = 0.033), however, intraoperative PaCO2 was similar in both the groups. The patients in Group A were discharged from the hospital earlier (3.2 +/- 1.5 vs. 7.3 +/- 3.5 days; p = 0.004). CONCLUSIONS: Less invasive approach to coronary artery bypass graft operations is possible through combination of the high thoracic epidural anesthesia and a reversed-J sternotomy. This technique is less traumatic for patient and provides practical better oxygenation and shorter hospital stay.     

Apolipoprotein A-I positively associated with diabetes in women independently of apolipoprotein E genotype and apolipoprotein B levels

ObjectiveGiven the elevated apolipoprotein (apo) A-I level enhancement of type 2 diabetes among Turks, the interrelation among it, apoB, and apoE genotype with respect to the likelihood of diabetes and metabolic syndrome (MetS), and the role of gender need further investigation.MethodsA random sample of Turkish adults genotyped for apoE with measured serum apoB and apoA-I concentrations was studied cross-sectionally. Apo ?2/?4 genotype was excluded to avoid confounding. MetS was identified by modified criteria of the Adult Treatment Panel III.ResultsAmong 1673 participants, ?3 homozygotes prevailed in 74%, apoE2 (?2/?3, ?2/?2) in 12%, and apoE4 (?3/?4, ?4/?4) in 13%. Low-density lipoprotein cholesterol and apoB levels were significantly lower and apoE concentrations higher in the apoE2 than in the remaining groups. ApoA-I levels in female subjects were significantly higher than in the E4 group. Multivariable analysis for determinants of apoB showed apoE genotype, serum apoE, C-reactive protein, apoA-I, and triacylglycerol levels to be major independent covariates. Logistic regression analyses for MetS, adjusted for potential confounders, revealed that apoB is linked to MetS in men independently of serum triacylglycerols and apoE2 group, whereas that in women in the apoE2 group was associated with MetS by mediation by triacylglycerols or apoB. The independent inverse association of apoA-I with MetS was considered apparent. Multi-adjusted likelihood of diabetes was associated only with triacylglycerol levels and, in women, with apoA-I (odds ratio 1.43, 95% confidence interval 1.10–1.86, per 1 SD increment).ConclusionThe confirmed positive association of serum apoA-I with diabetes in Turkish women is independent of apoE genotype and apoB levels.     

Amniotic membrane covering for facial nerve repair

Amniotic membranes have been widely used in ophthalmology and skin injury repair because of their anti-inflammatory properties. In this study, we measured therapeutic efficacy and determined if amniotic membranes could be used for facial nerve repair. The facial nerves of eight rats were dissected and end-to-end anastomosis was performed. Amniotic membranes were covered on the anastomosis sites in four rats. Electromyography results showed that, at the end of the 3 rd and 8 th weeks after amniotic membrane covering, the latency values of the facial nerves covered by amniotic membranes were significantly shortened and the amplitude values were significantly increased. Compared with simple facial nerve anastomosis, after histopathological examination, facial nerve anastomosed with amniotic membrane showed better continuity, milder inflammatory reactions, and more satisfactory nerve conduction. These findings suggest that amniotic membrane covering has great potential in facial nerve repair.