bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vitro evaluation of a novel endodontic irrigant and its efficacy on smear layer removal
Authors: Selvakumar B Gladson , Abinaya R , Swathika B , Ganesan S , Elavarasu Prem Kumar , Vinodhini V , Kannan K Bharathi , Arockiam Selva 
Published: February 2025

Aim:
The study’s objective was to evaluate the efficacy of simvastatin (SMV) solution in different concentrations as an endodontic irrigant for eliminating the smear layer from intraradicular dentin, utilizing a scanning electron microscope (SEM).

Methods:
In this experimental study, smear layer removal efficacy was evaluated by collecting freshly extracted 50 single-rooted teeth. Teeth were decoronated, and biomechanical preparation was done according to the step-back technique. Roots were then randomly divided into five groups: Group 1: SMV of 1 μM/L concentration, Group 2: SMV of 5 μM/L concentration, Group 3: SMV of 10 μM/L concentration, Group 4: 17% ethylenediaminetetraacetic acid (positive control), Group 5: 0.9% normal Saline (negative control). After irrigation with respective irrigating solutions, all canals were dried and sectioned into two halves and observed under a scanning electron microscope at the apical third level, and the images were scored according to the criteria.

Results:
The study’s findings indicate that SMV at a concentration of 10 µM/L demonstrated superior efficacy in removing the smear layer compared to the other experimental groups, with the exception of the positive control group. Statistical analysis using Chi-square and sample t-test revealed a significant difference among the experimental groups (P < 0.0001).

Conclusion:
The results of this in vitro study have shown that SMV can be used as an effective endodontic irrigant based on its smear layer removal potential.
Effect of gypsum accelerators on properties of mineral trioxide aggregate
Authors: Gopinath Sarath , Karthikeyan Kittappa , Kavitha Sanjeev , Mahalaxmi Sekar 
Published: February 2025

Aim:
Comparative evaluation of the pH, compressive strength, setting time, and cytotoxicity of mineral trioxide aggregate (MTA) with and without the incorporation of four different accelerators.

Methods:
10% CaCl2, 3% Na2SO4, 2% NaCl, and 3% K2SO4 solutions were replaced instead of MTA liquid and mixed with MTA powder (Group B, C, D, and E) and were evaluated for setting time, pH, compressive strength, and cell viability using Gilmore needle, digital pH meter, universal testing machine, and 3-(4,5-dimethylthiazol–2–yl) 2,5-diphenyltetrazolium bromide assay, respectively, and compared with that of MTA (Group A).

Results:
Group A (control) showed significantly less initial and final setting time. Groups D and E showed a significant decrease in the setting time compared to Groups B and C. Significantly no difference was observed in the pH values, immediately and 3 h after mixing in all groups. The mean compressive strength was greater for Group E followed by the control Groups D, C, and B. About 10% CaCl2 group showed a significant reduction in the compressive strength. Both fresh and set groups showed no significant difference in the cell viability at varying concentrations.

Conclusion:
Considering its application, as root-end filling and setting time of MTA incorporated with 3% K2SO4 and 2% NaCl have satisfied the requirements as compared to 10% CaCl2 and 3% Na2SO4.
Comparative evaluation of side-vented needle, air sonic, and ultrasonic irrigation techniques on sodium hypochlorite penetration into tubules of dentin in root canal: An in vitro study
Authors: Meena Anjali , Sharma Nidhi , Sinha Dakshita Joy , Singh Sarita , Dhawan Anu , Verma Neha 
Published: February 2025

Aim:
This study aimed to assess the effectiveness of several irrigation techniques, including side-vented needles, air-sonic, and ultrasonic methods, in penetrating the dentinal tubules of root canals with sodium hypochlorite (NaOCl).

Methods:
“Seventy-five fully developed, permanent premolars on the lower jaw with a single root canal were assigned by simple randomization by chit picking method to three groups: Group A – irrigation with 30-gauge side-vented needles, Group B – air sonic irrigation, and Group C – passive ultrasonic irrigation done with NaOCl, positive control group and negative control group. After 72 h of submerging the root canals in crystal violet, the bleaching impact of NaOCl will be measured under a stereomicroscope.

Results:
Data were analyzed using the Kruskal–Wallis test. One-way analysis of variance test was used to study the differences in NaOCl penetration using conventional needle irrigation and sonic and ultrasonic irrigation in coronal, middle, and apical third. The level of significance and confidence of the interval were set at 5% (P < 0.05) and 95%, respectively. In the coronal section, maximum penetration depth was seen in the conventional needle group and least in the sonic group (P < 0.05). In the middle section and apical sections, the maximum penetration depths were seen in the sonic group which was statistically significantly different from the other two groups.

Conclusion:
“Irrigation methods impact the depth to which NaOCl penetrates dentinal tubules in root canals. The penetration of NaOCl into root canal dentinal tubules can be enhanced using the sonic irrigation approach in the apical third.
Effect of the addition of nanoparticles on setting time and solubility of mineral trioxide aggregate: A systematic review and meta-analysis
Authors: Humnabad Vamshi , Hindlekar Ajit , Mittal Priya , Jadhav Ganesh Ranganath , Shinde Siddharth , Arora Suraj , Patil Rutuja 
Published: February 2025

Aim:
This systematic review and meta-analysis aims to assess and compare the solubility and setting time of mineral trioxide aggregate (MTA) by the addition of nanoparticles.

Methods:
This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The online databases used for searches were PubMed, Directory of Open Access Journals, and Google Scholar. In this review, in vitro studies conducted till May 2024 in the English language were incorporated. The inclusion criteria were entrenched using the PICOS strategy.
a. P (Population): The use of extracted teeth, cylinders, or tubes containing experimental materials
b. I (Intervention): Studies including MTA with the addition of nanoparticles such as silica, silver, titanium, etc.
c. C (Comparison): Studies including comparison MTA with and without nanoparticles
d. O (Outcome): Physical properties, solubility, and setting time of the MTA
e. S (Study Design): in vitro or laboratory studies.

In vitro studies without a valid comparison group or addition of materials other than nanoparticles in MTA or nonavailability of full texts or studies with outcomes not included in the inclusion criteria were excluded from the analysis. The risk of bias assessment used the QUIN tool. The statistical heterogeneity was assessed using χ² and I² values. A random-effects model was used for meta-analysis. RevMan software (5.4 version) was used for meta-analysis.

Results:
After the application of the inclusion and exclusion criteria, seven studies were included in the final analysis. The addition of nanoparticles significantly reduced the setting time (Pooled Odds ratios for setting time and solubility were 2.17 [−14.03, 9.70]) and 1.41 (−0.26, 3.09), respectively. Among the included studies, 5 showed a low risk of bias and 2 showed a medium risk. Information about sample size calculation, sampling technique, randomization, and blinding was not mentioned in any of the included studies.

Conclusion:
The addition of nanoparticles increased the solubility and shortened the setting time.
Biofabrication of periostracum, the outer covering of seashells, mediated silver nano particles as a promising irrigant with antibiofilm efficacy
Authors: Valan Annie Sylvea , Krithikadatta Jogikalmat , Doble Mukesh , Lakshmipathy Muthukrishnan 
Published: February 2025

Aim:
The aim of the present study is to assess the antibiofilm and antibacterial efficacy of periostracum as an irrigant with and without silver nanoparticles (AgNPs).

Methods:
The periostracum was extracted and mixed with silver nitrate solution (at 1:1 ratio). The periostracum was characterized using Fourier-transform infrared spectroscopy, and the antibiofilm efficacy of the irrigant against Enterococcus Faecalis was determined using the crystal violet assay. Confocal laser scanning microscope (CLSM) was used to determine the number of viable and dead bacterial cells after the treatment of sixty extracted mandibular central incisors that were colonized with a biofilm of E. faecalis. The results were compared with standard irrigants that are currently in use.

Results:
Sodium hypochlorite (NaOCl) had the highest antibiofilm efficacy and could inhibit the E. Faecalis biofilm by 93.15%. A higher concentration of periostracum showed 50% inhibition at 0.08–0.09 mg/ml, while periostracum-mediated AgN) irrigant demonstrated 50% inhibition at 0.01–0.02 mg/ml in a concentration-dependent manner. The root samples treated with NaOCl, when studied under CLSM, showed 95% dead cells. This was comparable to the root samples treated with 1 mg/ml of the periostracum-mediated AgNp irrigant, which showed 85% dead cells, while with periostracum alone, 23% viable cells and 77% dead cells were observed.

Conclusion:
Periostracum alone, as well as mediated silver nanoparticles, has a significant anti-biofilm and antimicrobial activity, which could be attributed to their synergistic effect.
Geographic and Hospital Variations in the Use of Red Blood Cells and Tranexamic Acid among Total hip and Total Knee Arthroplasty
Authors: Hsu Ling-I , Chen Jen-Wei , Hou Sheng-Mou 
Published: February 2025

Background:
Hemorrhage is a consideration when performing joint replacement surgeries. The utilization of hemostatic agents, such as tranexamic acid (TXA), has proven effective in reducing blood loss.

Objectives:
We aimed to investigate the trends in red blood cell (RBC) transfusion and TXA usage in unilateral total hip or knee arthroplasty (THA, TKA) and to explore variations among geographic regions and hospital levels.

Materials and Methods:
We obtained data from the National Health Insurance database for patients who underwent THA or TKA 2017–2021. The analysis included the utilization of RBCs and TXA based on hospital levels and geographic regions. The relative risk (RR) associated with these factors was estimated using logistic regression.

Results:
A total of 42,832 and 122,373 cases of THA and TKA were included. The RBC transfusion rates continued to decrease, while TXA usage showed a consistent rise for both surgeries. In 2021, the transfusion rates for THA and TKA were 43.7% and 26.6%, respectively, with TXA utilization rates of 61.8% and 73.5%, respectively. Medical centers exhibited lower transfusion rates (hip: 33.0%, knee: 20.1%) compared to nonmedical centers (hip: 54.4%, knee: 33.5%). Compared to medical centers, nonmedical centers had a higher RR of RBC transfusion for hip: 1.55 (95% confidence interval: 1.50–1.60) and knee: 1.56 (1.52–1.60). After adjusting for institutional surgical volume, the association remained, though much attenuated (THA: RR = 1.07, 1.02–1.11; TKA: 1.27, 1.23–1.31). Regarding geographic differences, RBC transfusion rates for THA and TKA in the Southern and Kao-Ping regions were lower than in other regions.

Conclusions:
These findings identified areas for improvement in peri-operative transfusion practice in joint arthroplasties. To further mitigate the demand for transfusions, priority should be accorded to nonmedical centers, emphasizing the promotion of patient blood management, including the appropriate use of TXA.
Treatment of Type V Acromioclavicular Separation with Minimally Invasive Closed-loop Double-endobutton Technique
Authors: Yang Wei-Hsiang , Lu Yung-Chang , Chang Ting-Kuo , Liu Chung-Ting 
Published: February 2025

Background:
Acromioclavicular (AC) separation is a prevalent shoulder girdle injury, accounting for 50% of all sports-related shoulder injuries. Surgery is recommended for Rockwood Types IV-VI injuries. In such cases, AC joint congruity and coracoclavicular ligament complex integrity are prerequisites for robust scar tissue healing.

Objectives:
This study aimed to describe our indirect reduction procedure using a minimally invasive, closed-loop, double endobutton (Tightrope) technique for Type V AC separation and evaluate short-term outcomes and complications.

Materials and Methods:
A total of 51 patients with Rockwood Type V AC separation underwent surgery using the Tightrope technique between January 2017 and December 2021. Clinical and radiological outcomes were assessed using the Constant–Murley score with documentation of complications.

Results:
Patients were divided into three groups based on the amount of reduction: Good reduction (16, 31.4%), partial reduction loss (25, 49%) and complete reduction loss (10, 19.6%). Notably, no statistically significant differences were observed between the first two groups. However, the complete reduction loss group demonstrated significantly lower Constant–Murley scores.

Conclusions:
The Tightrope technique is a promising approach for Rockwood Type V AC separation, yielding favorable clinical outcomes; however, radiographic findings may not be satisfactory. While partial reduction loss had minimal impact, complete loss was associated with inferior results. Therefore, precise tightrope placement and avoidance of coracoid tip positioning are crucial for optimal outcomes.
Mechanistic Insights on Skin ageing and Dermatologic Interventions to Slow Ageing Process
Authors: Sriram Rajashree , Gopal V 
Published: February 2025

Abstract
The skin which is a robust predictor of age-related diseases, undergoes morphological and physiological alterations, because of synergistic effects of Intrinsic or Chronological (Age-dependent decline of cell function) and Extrinsic (environmental insults) ageing factors. Ageing is a preordained process that can be determined as the collection of various deleterious changes in cells and tissues. Skin that ages as a consequence of the combination effect of intrinsic and extrinsic factors is characterized by coarseness, wrinkling, hyperpigmentation, telangiectasia, burns and skin sagging. Despite the structural and pathophysiological differences, both types of ageing share several molecular similarities, with the emergence of reactive oxygen species and matrix metalloproteinases induction reflecting as the key aspects of skin ageing. This review elucidates the skin ageing mechanism with a focus on the management of dermatologic ageing that includes treatment strategies and trends in the use of invasive procedures, and energy-based devices which are aimed at addressing skin ageing phenotypes.
Effectiveness, Tolerability and Safety of Topical Clobetasol with Oral Hydroxychloroquine versus Topical Clobetasol with NBUVB Phototherapy in Unstable Vitiligo: Investigator Blind, Randomized Controlled Trial
Authors: Tarafdar Dhiman , Sen Indrayudh , Koley Sankha , Ray Biswarup , Sarkar Pinaki , Sil Amrita , Ghosh Arghyaprasun , Das Nilay K. 
Published: February 2025

Abstract

Background:
Vitiligo is an acquired multifactorial depigmentation disorder with dreadful social stigma without any gold standard treatment option. Treatment of unstable vitiligo is, furthermore limited. Hydroxychloroquine has shown promise in a few case reports.

Objectives:
The effectiveness, tolerability and safety of narrow-band ultraviolet B (NBUVB)-plus topical clobetasol (group A) versus oral hydroxychloroquine-plus topical clobetasol (0.05%) (group B) were evaluated.

Methods:
Single-centre, investigator-blind, randomised, active-controlled, parallel-group phase IV trial (CTRI/2019/07/020345) was conducted on unstable vitiligo of either sex. Patients were randomised into two groups (1:1 allocation ratio), and allocation concealment was ensured by the sequentially numbered, sealed, opaque envelope technique. The assessing physician was unaware regarding treatment allocation. Outcome measures were the vitiligo area scoring index (VASI), vitiligo disease activity score (VIDA) and dermatology life quality index (DLQI). The economic burden of therapy was calculated in terms of travel costs and loss of time for availing of the therapy. Routine haematological and biochemical tests and treatment-emergent adverse events were monitored for safety. The calculated sample size was 82 (5% alpha-error, 80% power, 61.1% and 30% percentage improvement in study groups, 10% drop-out).

Results:
Intention-to-treat analysis showed significant improvement in VASI (Friedman’s analysis of variance, P < 0.01) in group A (1048.00 ± 1450.10 reduced to 933.43 ± 1387.79) and group B (415.00 ± 458.47 reduced to 283.85 ± 386.61) at the end-of-treatment visit (24th week). Improvement was noted from 12 weeks onwards in group A and eight weeks onwards in group B (post-hoc Dunn’s test, P < 0.001). Within group comparison showed significantly more improvement in group B than group A from eight weeks onwards (P < 0.05, analysis of covariance test with baseline VASI as covariate). A similar result was obtained with VIDA. DLQI significantly improved only in group B. The monthly cost of travel and loss of time were significantly less (Mann-Whitney’s test, P < 0.5) in group B than group A. No adverse events were noted in either group.

Conclusion:
Both NBUVB and hydroxychloroquine combined with topical clobetasol are safe and effective agents in the treatment of vitiligo, though the improvement is more and faster with hydroxychloroquine. With hydroxychloroquine, there is no infrastructural requirement, less travel cost and less loss of working hours as opposed to NBUVB, which needs infrastructural set-up.
Bone Health in Young Adults with Type 1 Diabetes Mellitus in South India
Authors: Bhandarkar Akhila , Bhavani Nisha , Pavithran Praveen V. , Kumar Harish 
Published: February 2025

Abstract

Introduction:
Patients with type 1 diabetes mellitus (T1DM) have a higher lifetime fracture risk. The rising obesity incidence in T1DM is causing hybrid diabetes. There is scarce data of bone health and body composition in T1DM from India. This South Indian study compared bone health and body composition of patients with T1DM to healthy age- and sex-matched controls.

Methods:
Fifty-one adults with T1DM and 52 healthy controls were enrolled and underwent dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) and body composition. Bone turnover markers—C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N pro-peptide (P1NP), parathormone (PTH) and 25 hydroxy-vitamin D levels were measured in patients.

Results:
The mean age of patients with T1DM was 27 years, the median duration of illness was 15 years and the median glycated haemoglobin (HbA1c) was 8%. BMD at the lumbar spine and hip were similar among patients and healthy controls. Patients with T1DM had decreased levels of CTX compared to controls (cases 0.347 (0.233–0.463) ng/mL, controls 0.440 (0.320–0.684) ng/mL, P = 0.005), whereas both had similar levels of P1NP. One-third of patients with T1DM were obese. Patients with T1DM with disease duration more than 10 years showed higher abdomen fat% (<10 years 20.4% [14–39.5], 10–20 years 37.2% [30.1–41.9], >20 years 41.5% [36.4–42.7] P = 0.013) and trunk fat% (<10 years 22.6% [14.8–37.2], 10–20 years 36.7% [30.1–40.5], >20 years 37.6% [33.55–40.5]).

Conclusion:
Young adults with T1DM have normal BMD and low bone resorption markers compared to healthy controls, whereas truncal obesity increases with a longer duration of illness. This may indicate a change in T1DM bone health and body composition characters, probably due to better glycaemic management.
Trabecular Bone Score in Asian-Indian Post-menopausal Women Across the Spectrum of Hyperglycaemia: Insights from a Cross-Sectional Study
Authors: Aggarwal Tanushi , Shah Ravi , Pal Rimesh , Rastogi Ashu , Singla Veenu , Bhadada Sanjay K. 
Published: February 2025

Abstract

Introduction:
Type 2 diabetes mellitus (T2DM) increases the risk of fragility fractures, despite the fact that areal bone mineral density (aBMD) is either increased or normal compared to healthy non-diabetic subjects. Hence, the trabecular bone score (TBS) is under investigation in this patient cohort as an alternative metric for the assessment of bone health. The present study aimed to determine TBS in post-menopausal women diagnosed with T2DM and in non-diabetic individuals.

Methods:
This cross-sectional study enrolled 101 individuals with T2DM and 101 individuals without overt T2DM (43 individuals with pre-diabetes and 58 normoglycaemic individuals). Participants underwent a comprehensive history and physical examination, biochemical investigations, and a dual-energy X-ray absorptiometry (DXA) scan with TBS measurement.

Results:
Post-menopausal women with T2DM did not exhibit any significant difference in aBMD levels in comparison to those with pre-diabetes or normoglycaemic individuals. Although there was no statistically significant difference in aBMD among the three groups, the mean TBS value was significantly lower in the T2DM group when compared to both comparison groups (P < 0.001). Additionally, glycated haemoglobin (HbA1c) and the duration of diabetes demonstrated a significant negative correlation with TBS.

Conclusion:
TBS may serve as a valuable tool for assessing bone health in individuals with T2DM, particularly when aBMD does not accurately predict the risk of fragility fractures. Both glycaemic control and the duration of diabetes significantly impact TBS values. In individuals with T2DM, incorporating TBS measurements alongside aBMD assessments could offer a more comprehensive evaluation of their bone health.
The role of virtual training workshops based on the ISO 10015 standard in increasing the health and safety students’ knowledge
Authors: Khosravi Zeinab , Mish Mast Mohammadreza , Davoodi Fereshteh , Hosseini Gousheh Seyed Nouredin , Khajehnasiri Farahnaz , Azmoon Mohammad Hossein , Ahangarzadeh Milad , Eshaghzadeh Maliheh , Sahlabadi Ali Salehi , Askari Ali , Poursadeghiyan Mohsen 
Published: February 2025

BACKGROUND:
A basic level of knowledge is obtained through training courses; which leads students to achieve the desired level of preparation of professional knowledge and skills. The purpose of the present study, Evaluating the role of educational workshops organized by scientific-research associations in increasing the level of knowledge and examining its impact on the performance and information of professional health engineering students of Ardabil University of Medical Sciences.

MATERIAL AND METHODS:
This study was semi-experimental with a pre-test-post-test design for the implementation of an educational process, which was conducted by census sampling method in 2021. The research tool was the implementation of educational evaluation models through the implementation of ISO 10015 clauses. The ISO 10015 educational standard includes the step-by-step process of needs assessment, design and planning, implementation, and evaluation of effectiveness. Data analysis was done through SPSS V.22.

RESULTS:
Results show there is a significant difference in the analyzed parameters before and after the courses, including the change in attitude, students’ understanding of the ease and usefulness of the courses, and their overall satisfaction (P value <0.005).

CONCLUSION:
The establishment and implementation of the ISO 10015 educational management, and the increase of scientific workshops and webinars in the field of safety, health, crisis, and disasters can have an effect on the learning process and skills, and the satisfaction with the education quality.