Imaging findings of traumatic injuries in survivors of the 6 February 2023 earthquake in Turkey.

In the southeastern part of Turkey, two earthquakes measuring 7.7 and 7.8 on the Richter scale occurred within 9 h on 6 February 2023, causing 120,000 injuries and over 50,000 deaths. Evacuees were transferred to various secondary and tertiary hospitals as the health system and hospitals in the affected region were affected by the earthquake. Injuries were mostly caused by blunt trauma and/or prolonged bruising under rubble. The severity and pattern of traumatic injuries in earthquake victims differed from other trauma patients who were not affected by an earthquake. In addition to traumatic injuries that affected multiple body regions and systems, patients who were trapped under debris for long periods of time were also frequently found to have crush syndrome. Pulmonary thromboembolism and hypoxic-ischaemic brain injury were observed in some patients. In this review, we present the imaging findings of traumatic injuries in earthquake victims, emphasising the earthquake-related distinct injury types.

The efficiency of different irrigation solutions and techniques for the removal of triple antibiotic paste from simulated immature root canals.

INTRODUCTION: The purpose of this study was to evaluate the efficiencies of different irrigation protocols in the removal of triple antibiotic paste (TAP) from root canals. MATERIALS AND METHODS: A total of 127 extracted human maxillary incisor teeth were prepared. Then, root-end resection of 3 mm was accomplished to simulate immature apex model. The root canals were filled with TAP, after 21 days, randomly divided into nine groups according to irrigation systems and solutions (n = 13). Conventional irrigation (CI) groups - Group 1: Root canal irrigation was performed with CI by Peracetic acid (PAA) solution, Group 2: Root canal irrigation was performed with CI by etidronic acid 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) + sodium hypochlorite (NaOCl) solution, Group 3: Root canal irrigation was performed with CI by ethylenediaminetetraacetic acid (EDTA)/NaOCl solutions. Vibringe system groups - Group 4: Root canal irrigation was performed with Vibringe system by PAA solution, Group 5: Root canal irrigation was performed with Vibringe system by HEBP + NaOCl solution, Group 6: Root canal irrigation was performed with Vibringe system by EDTA/NaOCl solution. EndoVac system groups - Group 7: Root canal irrigation was performed with EndoVac system by PAA solution, Group 8: Root canal irrigation was performed with EndoVac system by HEBP + NaOCl solution, Group 9: Root canal irrigation was performed with EndoVac system by EDTA/NaOCl solution. Control Group: (n = 0). Samples were sectioned vertically, and the amount of remaining medicament was scored for each root half and data were statistically analyzed. RESULTS: Among the irrigation systems, CI groups showed the highest scores at both apical and coronal parts (P < 0.05). In comparisons among the solutions, at the apical part, PAA groups showed the highest scores (P < 0.05). At the coronal part, EDTA + NaOCl groups showed the lowest score values (P < 0.05). CONCLUSION: The use of irrigation systems improved the removal of TAP from the simulated immature root canals. Also, as an irrigation solution EDTA gives more promising results than PAA and HEBP solutions.

Resistance to cyclic fatigue of PathFile, ScoutRaCe and ProGlider glide path files in an S-shaped canal.

AIM: To compare the cyclic fatigue resistance (CFR) of PathFile, ProGlider and ScoutRaCe nickel-titanium (NiTi) rotary instruments used in an S-shaped artificial canal. METHODOLOGY: A total of 90 instruments were tested in an S-shaped artificial canal (n = 30 for each group: PathFile (size 16, 2% constant taper), ProGlider (size 16, variable taper between 2% and 8% along the shaft) and ScoutRaCe (size 15, 2% constant taper). All files were rotated until fracture. The number of cycles to failure was counted to determine CFR. The length of each fractured fragment was measured in millimetres. The CFR was analysed statistically with the Kruskal-Wallis test. The fragment length was analysed using one-way analysis of variance and Tukey's post hoc tests. RESULTS: The ProGlider instruments were associated with significantly greater CFR than the PathFile and ScoutRaCe files in the apical curvature (P < 0.05). There was no significant difference between the CFR of the PathFile and ScoutRaCe files in the apical curvature (P > 0.05). ProGlider, PathFile and ScoutRaCe instruments exhibited similar CFR in the coronal curvature (P > 0.05). CONCLUSIONS: The ProGlider files had greater cyclic fatigue resistance than the PathFile and ScoutRaCe files in the apical curvature of an artificial S-shaped canal.

Laboratory comparison of cyclic fatigue resistance of WaveOne Gold, Reciproc and WaveOne files in canals with a double curvature.

AIM: To compare the resistance to cyclic fatigue of WaveOne Gold (WOG), Reciproc and WaveOne (WO) nickel-titanium files in an artificial root canal with a double (S-shaped) curvature. METHODOLOGY: A total of 120 new WOG primary, Reciproc R25 and WO primary files were tested in an artificial, stainless steel canal with an S-shape (diameter, 1.4 mm and length, 18 mm). Forty files from each system were rotated until fracture to calculate the number of cycles to failure (NCF). The length of each fractured fragment was recorded. Data were analysed using one-way analysis of variance and Tukey's post hoc tests. RESULTS: The WOG primary (apical curvature: 928.87 ± 293.69; coronal curvature 1102.32 ±397.39 NCF) had higher cyclic fatigue resistance than Reciproc R25 and WO primary in the apical and coronal curvatures (P < 0.05). The Reciproc R25 file (745.63 ± 253.49 NCF) had significantly greater cyclic fatigue resistance than the WO primary (583.89 ± 183.38 NCF) in the apical curvature (P < 0.05). There was no significant difference in the cyclic fatigue resistance of the Reciproc R25 and WO files in the coronal curvature (883.63 ± 282.56 and 916.53 ± 268.21 NCF, respectively) (P > 0.05). There was no difference in fractured fragment lengths of the WOG primary, Reciproc R25, and WO primary files in either the apical or coronal curvature (P > 0.05). CONCLUSIONS: WaveOne Gold primary files exhibited greater cyclic fatigue resistance than Reciproc R25 and WO primary in an artificial canal with an S-shape.

Apically extruded debris during root canal preparation using Vortex Blue, K3XF, ProTaper Next and Reciproc instruments.

AIM: To assess the amount of debris extruded apically during root canal preparation using various nickel-titanium instrumentation systems. METHODOLOGY: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to four groups (n = 15 teeth for each group). The canals were then instrumented with the following instrument systems: Vortex Blue (VB; Dentsply Tulsa Dental, Tulsa, OK, USA), K3XF (SybronEndo, Orange, CA, USA), Reciproc (VDW, Munich, Germany) and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland). Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. The data were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. RESULTS: Vortex Blue and PTN files were associated with significantly less apically extruded debris than the K3XF and Reciproc files (P < 0.05), but there was no significant difference between the VB and PTN files or between the K3XF and Reciproc files (P > 0.05). CONCLUSIONS: All instruments were associated with apical extrusion of debris. VB and PTN files were associated with less debris extrusion compared to the other systems.

Influence of a glide path on apical extrusion of debris during canal preparation using single-file systems in curved canals.

AIM: To evaluate the effect of a glide path on the amount of apically extruded debris during canal preparation using single-file systems in curved canals. METHODOLOGY: Ninety extracted mandibular molar teeth were randomly assigned to six groups (n = 15 for each group) for canal instrumentation. Endodontic access cavities were prepared in each tooth. In three of the six groups, a glide path was not created whereas a glide path was created using PathFile instruments on the mesial canals of all teeth in the remaining three groups. The mesial canals of the teeth were then instrumented with the following single-file instrument systems: WaveOne, Reciproc and OneShape. Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. The data obtained were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. RESULTS: The OneShape file was associated with less debris extrusion than the Reciproc and WaveOne files when canal instrumentation was performed without a glide path (P < 0.05). However, no significant difference was found between the Reciproc and WaveOne files (P > 0.05). There was no significant difference amongst the OneShape, Reciproc and WaveOne files when a glide path was created before canal preparation in curved root canals (P > 0.05). All systems extruded significantly less debris in groups with a glide path than in groups without a glide path (P < 0.05). CONCLUSIONS: All instruments were associated with apical extrusion of debris. Creating a glide path prior to canal instrumentation reduced the amount of apically extruded debris in curved canals.

Evaluation of apically extruded debris associated with several Ni-Ti systems.

AIM: To evaluate the apical extrusion of debris associated with several root canal preparation systems in vitro. METHODOLOGY: Forty-five extracted human mandibular premolars with single canals and similar lengths were used. The root canals were instrumented using ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), Twisted File (SybronEndo, Orange, CA, USA) or WaveOne (Dentsply Maillefer, Ballaigues, Switzerland). Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for 5 days. The Eppendorf tubes were weighed to obtain the final weight of the Eppendorf tubes plus extruded debris. Three consecutive weights were obtained for each tube. The groups were compared using the Kruskal-Wallis one-way analysis of variance on Ranks and Tukey's test. RESULTS: The ProTaper Next group produced the highest mean extrusion value whilst WaveOne produced less debris compared with all the other instruments (P > 0.05). There was a significant difference between the ProTaper Next and WaveOne group (P < 0.05). CONCLUSIONS: Apically extruded debris was associated with all instrumentation techniques. The WaveOne system extruded less debris compared with the Twisted File and ProTaper Next.

The effect of reciprocation versus rotational movement on the incidence of root defects during retreatment procedures.

AIM: To compare the incidence of dentinal defects caused by reciprocating and rotary techniques during retreatment procedures. METHODOLOGY: One hundred and twenty extracted mandibular premolars with single canals were selected. Twenty teeth were left unprepared. The root canals in the remaining 100 teeth were prepared with K-files up to size 35 and filled with Gutta-percha and AH Plus sealer using a passive cold lateral compaction technique. Twenty canals were filled and received no further treatment. Eighty teeth were divided into four groups (n = 20 in each) to undergo the removal of the root filling. In groups 1 and 2, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were not refilled. In groups 3 and 4, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were then refilled using a conventional cold lateral compaction technique. The roots were sectioned horizontally at 3, 6 and 9 mm from the root apex and observed under a stereomicroscope at 20× magnification. Defects were categorized as no defect, incomplete defect and fracture. The differences between the groups were analysed using the chi-square exact test (P = 0.05). RESULTS: No defects were observed in the unprepared and filled groups, in contrast to the experimental groups. In the coronal thirds, groups 2 and 4 had more dentinal defects than groups 1 and 3 (P < 0.05). In the middle thirds, group 4 had more defects than group 1 (P < 0.05). In the apical thirds, group 2 had fewer defects than did group 3 and group 4. Also, group 3 had more defects than group 1 (P < 0.05). When comparing the experimental groups, there were no significant differences with regard to fracture (P > 0.05). CONCLUSIONS: Both nickel-titanium systems were associated with dentinal defects during retreatment procedures in extracted premolar teeth.

Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity.

AIM: To evaluate the efficacy of six irrigation techniques to remove calcium hydroxide (CH) from a simulated internal root resorption cavity. METHODOLOGY: The root canals of 100 single-rooted teeth were prepared using the ProTaper system to size F5. The roots were split longitudinally, and standardized simulated internal root resorption cavities were prepared in the two root halves. The root halves were reassembled, and CH was placed into the root canals, with the exception of five teeth that served as the negative control group. Another five teeth (the positive control group) were not subjected to the CH removal procedure. Ninety teeth were randomly divided into six experimental groups (n = 15), according to the final irrigation techniques used: conventional syringe irrigation (CSI), CanalBrush (CB), passive ultrasonic irrigation (PUI), self-adjusting file (SAF) system, EndoActivator (EA), and apical negative pressure irrigation (EndoVac system). Five millilitres of 3% NaOCl and 17% EDTA were used in all experimental groups during the CH removal procedure. The amount of remaining CH was evaluated under a stereomicroscope at 20 ×magnification, using a 4-grade scoring system. The data were statistically compared using the Kruskal-Wallis and Mann-Whitney U-tests (P < 0.05). RESULTS: Remnants of CH in simulated internal root resorption cavities were found in all experimental groups. SAF and PUI were superior to the other groups (P < 0.05); however, there was no significant difference between the SAF and PUI (P > 0.05). There were also no significant differences between the CSI, CB, EA and EndoVac groups (P > 0.05). CONCLUSIONS: None of the irrigation techniques was able to completely remove CH from a simulated internal root resorption cavity.

Application of levofloxacine in the second phase of sequential therapy regimen for Helicobacter pylori eradication: is it a good choice?

AIM: The aim of this study was to evaluate whether modified sequential therapy regimen that consists of an initial phase, including a PPI plus amoxicillin for 5 days followed by a PPI plus only levofloxacin instead of 2 antibiotics for the remaining 5 days increase the eradication rate via decreasing the number and doses of antibiotics, and increasing patient compliance. METHODS: This study included 40 patients who were admitted to Gastroenterology Outpatient Clinic with H. pylori-positive non-ulcer dyspepsia. All patients received lansoprazole 30 mg BID plus amoxicillin 1,000 mg BID for the first five days followed by lansoprazole 30 mg BID plus levofloxacine 500 mg BID for the remaining five days. Eradication rates were calculated using both intention-to-treat (ITT) and per-protocol (PP) analysis. RESULTS: In all, 40 patients (21 females, 19 males) were analyzed with ITT analysis and 38 patients completed the study. H.pylori eradication was achieved in 27 (67.5%) of the 40 patients included in the ITT analysis and in 27 (71%) of the 38 patients included in the PP analysis. Mild adverse effects were reported by 8 patients (8.4%). The most frequent side effects were nausea and a metallic taste in the mouth. Any adverse effect that might lead patients to take less than 80% of the prescribed drugs was not reported. CONCLUSION: This levoflaxin-based sequential therapy regimen was not superior over standard sequential therapy regimen in the eradication of H.pylori. However, it yields better eradication rate than standard triple therapy regimen.

Nitroderm TTS band application for pain after hemorrhoidectomy.

PURPOSE: Anal sphincter spasm is believed to play an important role in pain after hemorrhoidectomy. We tested a different form of nitroglycerin: the Nitroderm TTS band. We investigated its efficacy on posthemorrhoidectomy pain and the relation between pain and anal resting pressure measured preoperatively and postoperatively. METHODS: Thirty-eight hemorrhoid patients were divided into two groups: those with high anal resting pressure were classified as group A (n = 24) and those with low anal resting pressure were classified as group B (n = 14). After hemorrhoidectomy, Nitroderm TTS bands were placed into the anal canal in half of the patients in groups A and B (groups A-1 and B-1) and not in the remaining half (groups A-2 and B-2). Anal resting pressure measurement was repeated at the first day and third month postoperatively. Postoperative pain was assessed by linear analog scale, and analgesic consumption was recorded. RESULTS: Preoperative anal resting pressure was 112.0 (range, 95-140) cm H2O in group A-1 and 110.6 (range, 96-138) cm H2O in group A-2. The difference was insignificant. However, on the first postoperative day, anal resting pressures were 88.7 (range, 75-115) and 110.9 (range, 92-135) cm H2O (P = 0.0001), and at the third month, they were 76.5 (range, 70-100) and 78.0 (range, 70-105) cm H2O, respectively (P = 0.690). Postoperative pain scores were significantly lower in group A-1 than group A-2 (P = 0.0001). In the low-pressure groups (B-1 and B-2), anal resting pressures before surgery, on the first postoperative day, and at the third month postoperatively were 70.4 (range, 56-76), 67.4 (range, 50-75), and 67.2 (range, 55-74) cm H2O in group B-1 and 69.8 (range, 58-76), 70.2 (range, 60-76), and 68.4 (range, 60-74) cm H2O in group B-2. The differences were insignificant (P > or = 0.660). The differences between pain scores in these groups were also insignificant (P > or = 0.160). CONCLUSION: Nitroderm TTS bands effectively reduced anal resting pressure and relieved pain in patients with high preoperative anal resting pressure.

Experimental sodium phosphate and polyethylene glycol induce colonic tissue damage and oxidative stress.

BACKGROUND: Bowel washout solutions may damage colonic mucosa and cause shallow ulceration, which may result in diagnostic errors and complications. The effects of polyethylene glycol (PEG) and sodium phosphate on rat colon were investigated histologically and by measurement of indicators of oxidative stress. METHODS: Thirty Wistar albino rats were divided into three groups and received PEG, sodium phosphate or tap water alone (control). After 8 h, histological changes in colonic mucosa were evaluated. The tissue concentration of malonyldialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in colon homogenates was also measured. RESULTS: Animals in the sodium phosphate and PEG groups had significantly more colonic mucosal damage than controls, the damage induced by sodium phosphate being worse than that caused by PEG. MDA levels were significantly higher in the sodium phosphate and PEG groups than in controls and were higher in the sodium phosphate group than in the PEG group, whereas differences in SOD and GSH-Px activities were significant only between control and both sodium phosphate and PEG groups. CONCLUSION: Sodium phosphate and PEG cause histological damage and trigger oxidative stress on colonic mucosa. The tissue damage and oxidative stress induced by sodium phosphate is more profound than that produced by PEG.

Modified technique for correction of gynaecomastia.

OBJECTIVE: To test a modification of the circumareolar incision for correction of a gynaecomastia from the points of view of complications and appearance of the scar. DESIGN: Clinical study. SETTING: Military and university hospitals, Turkey. SUBJECTS: 32 patients with gynaecomastia operated on between 1992 and 2000. INTERVENTIONS: Simon I patients were treated with an inferior semicircular periareolar incision (n = 12). Half of the Simon II patients had the same incision and the others were treated with a modified extended incision (n = 10 in each group). MAIN OUTCOME MEASURES: Haematoma, skin necrosis, nipple inversion, low-seated nipple, asymmetry, hypoaesthesia and hypertrophic scar. RESULTS: Simon II patients treated with the unmodified incision had more haematomas and seromas than Simon I patients and worse cosmesis (p = 0.009 and p = 0.02). However, the complication rates did not differ significantly compared with the Simon II patients who had the modified incision. CONCLUSION: A modified extended circumareolar incision results in fewer complication and better cosmesis in grade II gynaecomastia than the standard incision.

Endothelial cell response to different mechanical forces.

PURPOSE: Endothelial cells (ECs) are subjected to the physical forces induced by blood flow. The aim of this study was to directly compare the EC signaling pathway in response to cyclic strain and shear stress in cultured bovine aortic ECs. MATERIALS AND METHODS: The ECs were seeded on flexible collagen I-coated silicone membranes to examine the effect of cyclic strain. The membranes were deformed with a 150-mm Hg vacuum at a rate of 60 cycle/min for up to 120 minutes. For a comparison of the effect of shear stress, ECs from the same batch as used in the strain experiments were seeded on collagen I-coated silicone sheets. The ECs were then subjected to 10 dyne/cm(2) shear with the use of a parallel flow chamber for up to 120 minutes. Activation of the mitogen- activated protein kinases was assessed by determining phosphorylation of extracellular signal-regulated kinase (ERK), c-jun N-terminal kinase (JNK), and p38 with immunoblotting. RESULTS: ERK, JNK, and p38 were activated by both cyclic strain and shear stress. Both cyclic strain and shear stress activated JNK with a similar temporal pattern and magnitude and a peak at 30 minutes. However, shear stress induced a more robust and rapid activation of ERK and p38, compared with cyclic strain. CONCLUSIONS: Our results indicate that different mechanical forces induced differential activation of mitogen-activated protein kinases. This suggests that there may be different mechanoreceptors in ECs to detect the different forces or alternative coupling pathways from a single receptor.

Mitogen-activated protein phosphorylation in endothelial cells exposed to hyperosmolar conditions.

The effect of hyperosmolarity on the induction of the mitogen-activated protein kinases (MAPK) was studied in bovine aortic endothelial cell (EC). Different types of agents were used to differentiate the effects of osmolarity from other variables. Hypertonic treatment with physiologically relevant levels of NaCl (350 mOsm/kg H(2)O) significantly increased the level of expression of p38 within 2 min, and ERK-1/2 and JNK after 10 min. The inductions peaked between 30 and 60 min and returned to baseline levels within 2 h. A similar pattern of induction occurred with ionic contrast agent. p38 induction by glucose and mannitol showed a similar pattern, although the level of ERK-1/2 phosphorylation was not as robust, and JNK was not induced by glucose. Urea did not affect the level of induction of the MAPK isoforms. It is concluded that MAPK plays an important role in hyperosmolality-induced signal transduction. Different osmotic agents induce MAPK expression differently. No MAPK induction with urea implies that cell shrinkage may be an important component of hyperosmolality-induced MAPK phosphorylation.

Incidence and aetiological factors in pilonidal sinus among Turkish soldiers.

OBJECTIVE: To study the incidence and causes of pilonidal sinus in Turkish soldiers. DESIGN: Open study by questionnaire. SETTING: Military and University hospitals, Turkey. SUBJECTS: 1000 soldiers who presented for their first medical examination. MAIN OUTCOME MEASURES: Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus. RESULTS: 88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001). CONCLUSIONS: Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if the aetiological factors are understood.