Mixing with Propylene Glycol Enhances the Bond Strength of Mineral Trioxide Aggregate to Dentin

IntroductionMixing mineral trioxide aggregate (MTA) with different proportions of propylene glycol (PG) improves its handling property. The aim of this study was to evaluate the effect of PG on MTA-dentin push-out bond strength.MethodsSeventy-five 2-mm-thick midroot sections were prepared from single-rooted human extracted teeth. The lumen of each slice was enlarged with Gates-Glidden burs. The slices were randomly divided into 3 groups (n = 25). In each group, 0.3 mL of the liquid was mixed with 1 g MTA (Angelus, Londrina, Brazil). The liquid vehicles used in groups 1–3 were 100% distilled water (DW), 20% PG–80% DW, and 100% PG, respectively. After incubation, the push-out strength of the samples was measured using a universal testing machine. The samples were then cut in halves and examined under a stereomicroscope to determine the failure pattern. One-way analysis of variance followed by the Tukey post hoc test was used to compare the push-out strength among groups.ResultsThere were statistically significant differences between groups (P < .001). The push-out strength in group 1 (DW) was significantly lower than groups 2 and 3 (P < .001 and P = .022, respectively). However, there was no significant difference between groups 2 (DW-PG) and 3 (PG).ConclusionsMixing MTA with PG increased its push-out bond strength to dentin. In the present study, the most suitable ratio was 80% DW–20% PG.     

Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival

Background Liver disease has emerged as an important cause of morbidity and mortality in renal transplant recipients. Liver insufficiency is the cause of death in up to 28% of long-term survivors after renal transplantation. The aim of this work was to evaluate the prevalence and causes of hepatic dysfunction in renal transplant recipients in Egypt, and its impact on both renal graft function and patient survival. Methods This study comprised 447 kidney transplant recipients who received their grafts between January 1999 and December 2003 at Mansoura Urology and Nephrology Center. Among these recipients, 104 patients showed persistent hepatic dysfunction, while the remaining 343 had normal liver function or transient hepatic dysfunction of less than 6 months’ duration. Results We found that the prevalence of persistent hepatic dysfunction in our recipients was 23.3%. Infections such as hepatitis C virus (HCV;, with longer dialysis duration and blood transfusion as risk factors), HBV, and cytomegalovirus (CMV), were the main causes of persistent hepatic dysfunction. Drugs (e.g., the sirolimus and tacrolimus; cyclosporine; and azathioprine) were also associated with hepatic dysfunction. We did not find a significant impact of hepatic dysfunction on either patient or graft survival. Conclusions Viral infections–especially HCV and CMV–were more prevalent in the group of patients with persistent hepatic dysfunction, with duration of dialysis as an important risk factor for HCV infection. Dose-dependent cyclosporine-induced hepatic dysfunction was observed early post-transplant. Neither tacrolimus- nor sirolimus-associated hepatic dysfunction was dose-dependent. Hepatic dysfunction had no significant impact on either patient or graft survival; however, this finding may be due to the relatively short duration of follow up.     

Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: New technique

OBJECTIVES: Radical cystectomy is the standard treatment for patients with invasive bladder carcinoma. Preservation of sexual function and fertility are important for surgery acceptance in young patients with this disease, and part of the prostate is generally preserved for this reason; however, this may compromise the radical nature of the surgery. Herein a novel technique of radical cystectomy with preservation of the vas deferens only is described aimed at preservation of sexual function and better cancer control. METHODS: Between March 2002 and February 2004, four potent male patients with muscle invasive transitional cell carcinoma of the bladder underwent nerve-sparing radical cystectomy with urinary diversion. The bladder, prostate with prostatic urethra, regional lymph nodes and seminal vesicles were removed while the vas deferens was preserved until its terminal end and anastomosed (in the perineum) to the bulbar urethra (end to side). The diversion was ureterocolic in three patients and ileal conduit in one patient. The median age of the patients was 45.0 years (range 35-55). The mean follow-up was 35.5 months (range 23-46 months). RESULTS: There was no mortality. All patients were free of the disease (no local or distant recurrence) at the last follow-up. All patients reported adequate sexual function with normal erections and satisfactory intercourse similar to that reported before surgery. Two patients maintained antegrade ejaculation allowing procreation in one case. CONCLUSION: This technique allows preservation of sexual function in nearly all cases with better oncological outcome than any other techniques of radical cystectomy aimed at preservation of sexual function.     

Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

PURPOSE: We evaluated the influence of prior maximal exhalation on preoxygenation in 15 adult volunteers using tidal volume breathing (TVB) for five minutes and deep breathing (DB) for two minutes with and without prior maximal exhalation. METHODS: Inspired and end-tidal oxygen, nitrogen and carbon dioxide were monitored continuously and recorded during room air breathing and at 30-sec intervals during 100% oxygen TVB or DB (rate of 8 breaths.min(-1)). RESULTS: Tidal volume breathing with prior maximal exhalation resulted in an end-tidal oxygen concentration (ETO(2)) slightly higher (P = 0.028) at 0.5 and 1.0 min as compared with TVB without prior maximal exhalation at the same time periods. Regardless of whether TVB was preceded by maximal exhalation or not, 2.5 min was required to reach a mean ETO(2) value of 90% or higher. With DB, there were no differences in ETO(2) values at any time period and 1.5 min was required to reach an ETO(2) of 90% or greater, with or without prior maximal exhalation. CONCLUSIONS: Maximal exhalation prior to TVB slightly steepens the initial rise in ETO(2) during the first minute, but confers no real benefit if maximal preoxygenation is the goal. Maximal exhalation prior to DB has no added value in enhancing preoxygenation.     

Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws

Lateral mass screw (LMS) fixation for the treatment of subaxial cervical spine instability or deformity has been traditionally associated with few neurovascular complications. However, cervical pedicle screw (CPS) fixation has recently increased in popularity, especially with navigation assistance, because of the higher pullout strength of the pedicle screws. To their knowledge, the authors conducted the first meta-analysis comparing the complication rates during and/or after CPS and LMS placement for different pathologies causing cervical spine instability. A systematic literature search of PubMed and Embase from inception to January 12, 2021 was performed to identify studies reporting CPS and/or LMS-related complications. Complications were categorized into intraoperative and early postoperative (within 30 days of surgery) and late postoperative (after 30 days from surgery) complications. All studies that met the prespecified inclusion criteria were pooled and cumulatively analyzed. A total of 24 studies were conducted during the time frame of the search and comprising 1768 participants and 8636 subaxially placed screws met the inclusion criteria. The CPS group experienced significantly more postoperative C5 palsy (odds ratio [OR]?=?3.48, 95% confidence interval [CI]?=?1.27–9.53, p?<?0.05). Otherwise, there were no significant differences between the LMS and CPS groups. There were no significant differences between the CPS and LMS groups in terms of neurovascular procedure-related complications other than significantly more C5 palsy in the CPS group.