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In present-day dentistry, the photo-cured composite materials are widely used for aesthetic dental restorations. There is a wide choice of photo-cured composite materials, which differ significantly in physical and working properties, as well as the technique of their application. Most of the modern photo-cured composite materials contain the light-sensitive catalyst camphorquinone, but lucerin and 1-phenyl-1,2-propanedione are also used as photoinitiators. The important condition for photocured composite materials polymerization is that it begins and is prolonged when the intensity of the light flux is acceptable to maintain the excited state of the photoinitiator. The polymerization process is accompanied by stress, which results in polymerization shrinkage. The various approaches are used to prevent the negative consequences, namely, directed polymerization, the effect of the light flux according to the soft start, pulsating and honeycomb polymerization. The lifetime of dental restorations is directly associated with the technical characteristics of photo-cured composite materials, among which there are halogen, LED, laser and plasma ones. The main features of halogen photopolymerizers include the wide range of rays, which creates the ability to polymerize composites with photoinitiator, different to camphorquinone, with significant amount of heat, and high power consumption. However, after the thermal exposure, the mechanical characteristics of photo-cured composites, in particular, plasticity and strength deteriorate significantly; the uneven polymerization of the material occurs, which leads to the local internal stresses and deformations. Halogen photopolymerizers are rarely used recently. In LED photopolymerizers, light is generated in a semiconductor crystal due to the energy of excited electrons. In the spectrum of the luminous flux of the LED photopolymerizer the thermal and ultraviolet components are absent, all the energy is in the range of blue light, which prevents the possibility of significant overheating of hard tissues and dental pulp. The disadvantages of LED photopolymerizers include the possibility of their application only for photo-cured composite materials polymerization, where only camphorquinone appears to be the photoinitiator as well as the high degree of emitted luminous flux dispersion. The important advantage is the stability of the light flux in time and the possibility of wireless structures application. LED photopolymerizers are used in clinical practice more often. In laser photopolymerization devices light is generated by transition of electrons in gas environment of argon from the unstable to stable state. The short exposure time of photo-cured composite material portion (2-3 sec) is the important property of laser photopolymerizers, but it is also the negative factor for the occurrence of polymerization stress in material, the high energy flux turns into a high level of stress in material without providing the corresponding mechanical characteristics and significant degree of conversion. Laser photopolymerizers also emit a significant amount of heat. The widespread clinical application of these devices is limited. Plasma photopolymerizers generate a rather bright light flux due to the high-voltage arc located between two electrodes in a medium of highly rarefied ionized gas. The source of bright light flux is xenon or argon lamp. Their advantages include the possibility of application with photo-cured composite materials containing various photoinitiators, but plasma photopolymerizers are bulky and uncomfortable in use, they have large thermal radiation, they are short-lived. Thus, there is a wide choice of restorative photo-cured composite materials and significant number of photopolymerization agents used for hardening of these materials during the dental restorations. It became possible due to significant advances in dental materials technology and engineering as well as restoration technologies. However, the application of certain materials and devices with definite characteristics in a particular clinical case requires numerous laboratory investigations and long-term clinical studies.

An international geopark "The Park of Ice Age" located near Starunia village in Bohorodchany district of Ivano-Frankivsk region is world-famous for being a paleontological site of Pleistocene fauna of the woolly rhinoceroses and mammoth (the Eemian interglacial period - 46000-10000 years ago according to radiocarbon dating C14) and for its mud volcano which is unique in the Carpathian region. This is a geological nature monument with an area of 60 hectares where abandoned ozokerite mine and oil and gas exploratory boreholes are situated. The detailed investigations carried out in 2004-2009 by Ukrainian-Polish expeditions were focused on discovering the possible new sites of fauna fossils and human remains of European early modern humans (EEMH). The future discoveries at the paleontological site of Starunia are extremely important. They intend to carry out ecological assessment of soil, surface and spring waters, atmospheric air, snow, ashes of meadow grasses, radiological screening, and geo-radar sensing to find new locations of extinct mammals. The Starunia area meets all the requirements of a geopark according to UNESCO standards and concepts. The first research findings (1907) included the remains of woolly rhinoceros, mammoth, horse, roe deer and other Pleistocene mammals which were found in the ozokerite mine at the depth of 12 m near Starunia (Bohorodchany district, Ivano-Frankivsk region). In 1914 the scientists from Lviv (Ukraine) and Krakow (Poland) fully appreciated these discoveries and published a set of articles and a monograph. In 1929 the members of the expedition of Skill Academy (Krakow, Poland) found the remains of three more woolly rhinoceroses in the ozokerite mine at the depth of 17 m. Numerous bones of vertebrates (rodents), remains of mussels, a lot of species of insects, beetles, parasitic worms, fleas, butterflies, spiders, snails, vascular plants, mosses, seeds and branches of dwarf birch (Betula Nana), alder (Alnus glutinosa), and other fossil of tundra flora were also discovered. Polish scientists organized detailed investigations of flora and fauna around Starunia, their results were published in the articles, but World War II suspended this process. The investigations around Starunia intensified the comprehensive study of stratigraphy, paleontology, paleogeography, geochronology and other aspects of the Quaternary Period. In 1932 the International Geological Congress (the International Union of Quaternary Study) was established in Leningrad by INQUA. The main methodological principles of this study dealt with the investigations around Starunia. [ABSTRACT FROM AUTHOR]

Purpose: Transduodenal surgical ampullectomy (tAMP) with papillary reimplantation is a valid alternative to pancreaticoduodenectomy for lesions of the periampullary region not amenable to endoscopic resection. As tAMP is burdened by high rates of biliopancreatic-enteric anastomotic leak, we tested preventive endoluminal vacuum therapy (eVAC) combined with post-operative continuous perianastomotic irrigation (CPI) to reduce such anastomotic leak., Methods: Between 10/2013 and 09/2023, 37 patients undergoing laparotomic tAMP (with or without jejunal transposition) and papillary reimplantation at Hirslanden Klinik Zurich were retrospectively analysed; of these, 16 received prophylactic eVAC combined with CPI, while the remaining represented the historical cohort., Results: The eVAC-CPI-group and the historical-cohort were homogeneous in demographic characteristics. Surgery in the prophylactic eVAC-CPI-group lasted about 30 min longer due to eVAC application (p = 0.008). The biliopancreatico-enteric anastomotic leak rates were 6.2% in the eVAC-CIP-group vs. 19.0% in the historical-cohort (p = 0.266). Along, a strong trend of less severe post-operative complications in general (p = 0.073), and borderline-significantly less cases of acute pancreatitis (p = 0.057) and tAMP-related re-operations or re-interventions (p = 0.057) in particular, were observed in the eVAC-CPI-group. The only anastomotic leak in the eVAC-CPI-group was successfully managed through repeated cycles of eVAC. The device was well tolerated by all patients; no vacuum/irrigation-related complications or malfunctioning occurred., Conclusion: Our study is the first to provide some technical insights demonstrating the safety and feasibility of a prophylactic approach with eVAC and perianastomotic irrigation to reduce anastomotic leak after tAMP. Increasing the number of subjects will confirm the benefit of our promising results., (© 2024. The Author(s).)

Background: Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies., Methods: We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options., Results: In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years., Conclusions: Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain., Competing Interests: The authors declares no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Lung transplantation is a well-established treatment for children facing advanced lung disease and pulmonary vascular disorders. However, organ shortage remains highest in children. For fitting the small chest of children, transplantation of downsized adult lungs, lobes, or even segments were successfully established. The worldwide median survival after pediatric lung transplantation is currently 5.7 years, while under consideration of age, underlying disease, and peri- and posttransplant center experience, median survival of more than 10 years is reported. Timing of referral for transplantation, ischemia-reperfusion injury, primary graft dysfunction, and acute and chronic rejection after transplantation remain the main challenges., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Cardiovascular Surgery.)

In the last decade, endoluminal vacuum therapy (eVAC) has emerged as an effective treatment for anastomotic leak (AL); however, little is known regarding its prophylactic use. In this systematic review we evaluated overall outcomes in patients undergoing major gastrointestinal surgery and treated with prophylactic eVAC. A systematic review of English articles on four electronic databases was performed according to the PRISMA statement up until January 2022. References of selected articles were manually screened to identify relevant missing papers. Primary endpoints were AL and mortality rates estimates. Secondary endpoints included analysis of eVAC-associated morbidity, treatment duration, long-term complications, and general indications for the eVAC management in the perioperative period. A total of 11 studies (5 case reports, 5 retrospective case series and a retrospective, case-control study) were included in the analysis. AL ranged from 0 to 25%. No major eVAC-associated complications were observed, except for sponge dislocation or obstruction. Overall mortality ranged between 0 and 12.5%; however, these fatalities were neither related to the use of eVAC, nor to AL-associated complications. The most frequent long-term complication was anastomotic stenosis responsive to endoscopic dilatation in most cases. The operating negative pressure ranged from -25 to -125 mmHg among different papers. In all studies but two, prophylactic eVAC was applied to anastomoses at high risk of dehiscence based on the subjective evaluation of the leading surgeon. In conclusion, prophylactic eVAC is safe and it could lead to potential benefit for prevention of AL, especially in high-risk anastomoses., (© 2022. Italian Society of Surgery (SIC).)

Objective: To assess whether prophylactic irrigation and passive drainage of pancreatico-jejunal anastomosis could reduce leak and mortality rates after high-risk pancreaticoduodenectomies., Background: Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreaticoduodenectomy. Several risk factors have been proposed likewise potential mitigation strategies. Regarding the latter, surgical drain policy remains a "hot topic." We propose an innovative approach to mitigate POPF and POPF-related mortality following high-risk pancreaticoduodenectomies., Methods: One hundred fifty-seven patients undergoing pancreaticoduodenectomy between January 2012 and November 2021 were included in the study. Subjects with main pancreatic duct ≤ 3 mm and soft parenchyma were classified as high-risk for POPF development. Since August 2015, high-risk patients received prophylactic irrigation and drainage of the perianastomotic area. These patients were compared with risk-matched historical controls., Results: We identified 73 high-risk patients. Of these, the 47 subjects receiving prophylactic perianastomotic irrigation showed significantly lower POPF rates (12.7% vs 69.2%, P < 0.001). Multivariate regression analysis confirmed the significant association between irrigation drainages and POPF (odds ratio 0.014, P = 0.01). Although not significant, mortality was lower in the irrigation group (4.2% vs 13.0%, P = 0.340). However, none of the fatalities in the irrigation-drainage group were POPF-related. No significant difference in length of hospital stay was observed between the 2 groups (18.0 vs 21.0 days, P = 0.091)., Conclusions: Irrigation and drainage of the perianastomotic area represents a powerful approach to reduce POPF and, potentially, mortality after high-risk pancreaticoduodenectomies., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Postoperative pancreatic fistula (POPF) represents the most common form of morbidity after distal pancreatectomy (DP). The aim of this study was to illustrate an innovative technique of irrigation and passive drainage to reduce clinically relevant POPF (CR-POPF) incidence in high-risk patients undergoing DP., Material and Methods: Twelve consecutive high-risk patients received irrigation and passive drainage of the pancreatic stump with a Salem sump drainage after DP. The Salem sump was irrigated with 100 ml/h of Ringer solution for 2 postoperative days (POD). In the case of low-drain amylase and lipase levels on POD 3, the irrigation was reduced to 50 ml/h. Persistence of low-drain pancreatic enzymes on POD 4 allowed for interruption of irrigation and subsequent removal of drainage from POD 7 onward in the absence of evidence of any pancreatic fistula., Results: Overall, 16.6% of the patients experienced a grade 3 or higher surgical complication. We experienced only one case of POPF: the fistula was classified as grade B and it was managed with radiologic drainage of the fluid collection. We did not experience any case of re-operation nor in-hospital mortality., Conclusions: Irrigation with passive drainage of the pancreatic stump after DP is an interesting approach for CR-POPF prevention in high-risk patients.

Background: Transplantation of kidneys from donation after cardiocirculatory death (DCD) donors is becoming an ever-increasing reality. So far, biopsy histologic assessment is the main parameter for evaluation of graft suitability, but it has several drawbacks and has poor reliability. The aim of this study is to verify if real-time renal resistance (RR) measurement during hypothermic machine perfusion (HMP) can be used as a reliable parameter to evaluate the quality of grafts from DCD and extracorporeal membrane oxygenation (ECMO) donors., Methods: From January 2015 to September 2018, HMP has been systematically applied to all organs from DCD and ECMO donors. All grafts underwent preimplantation biopsy histologic assessment with Karpinski's score. Single kidney transplants (SKTs) or double kidney transplants (DKTs) were performed according to biopsy score results. Kidneys were considered suitable for transplant if RR reached ≤ 1.0 within 3 hours of perfusion. RR trend and postoperative outcome were analyzed considering biopsy score and donor type., Results: A total of 30 kidneys (15 from DCD and 15 from ECMO donors) were used to perform 26 transplants (22 SKTs and 4 DKTs). Considering RR trend, all grafts were considered suitable for transplant within 1 hour of perfusion. Biopsy confirmed this result in all cases, and median score was 3 (range, 0-7). SKT score kidneys had lower starting RR than DKT ones (1.88 vs 2.88; P = .04) but identical final RR (0.58 vs 0.57; P = .76). DKT recipients had faster postoperative creatinine reduction than SKT recipients but similar postoperative day 30 value (1.42 vs 1.15 mg/dL; P = .20). No differences were found between DCD and ECMO grafts in terms of RR trend and postoperative outcome., Conclusions: HMP can be an alternative to histologic biopsy assessment for evaluation of transplant suitability of DCD and ECMO kidneys. If acceptability threshold is reached, SKT can be performed in all cases. ECMO donors should be considered like DCD donors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Hypothermic machine perfusion (HPM) grants a better postoperative outcome in transplantation of organs procured from extended criteria donors (ECDs) and donors after cardiac death (DCD). So far, the only available parameter for outcome prediction concerning those organs is pretransplant biopsy score. The aim of this study is to evaluate whether renal resistance (RR) trend during HPM may be used as a predictive marker for post-transplantation outcome. From December 2015 to present, HMP has been systematically applied to all organs from ECDs and DCD. All grafts underwent pretransplantation biopsy evaluation using Karpinski's histological score. Only organs that reached RR value ≤1.0 within 3 hours of perfusion were transplanted. Single kidney transplantation (SKT) or double kidney transplantation (DKT) were performed according to biopsy score results. Sixty-five HMPs were performed (58 from ECDs and 7 from DCD/ECMO donors). Fifteen kidneys were insufficiently reconditioned (RR > 1) and were therefore discarded. Forty-nine kidneys were transplanted, divided between 21 SKT and 14 DKT. Overall primary nonfunction (PNF) and delayed graft function (DGF) rate were 2.9 and 17.1%, respectively. DGF were more common in kidneys from DCD (67 vs. 7%; P = 0.004). Biopsy score did not correlate with PNF/DGF rate (P = 0.870) and postoperative creatinine trend (P = 0.796). Recipients of kidneys that reached RR ≤ 1.0 within 1 hour of HMP had a lower PNF/DGF rate (11 vs. 44%; P = 0.033) and faster serum creatinine decrease (POD10 creatinine: 1.79 mg/dL vs. 4.33 mg/dL; P = 0.019). RR trend is more predictive of post-transplantation outcome than biopsy score. Hence, RR trend should be taken into account in the pretransplantation evaluation of the organs., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Endoscopic Zenker diverticulum (ZD) treatment has become quite common because of the low complication rates, reduced procedure time, and shorter hospital stay. Many endoscopic treatments are available including the endoscopic stapled esophago-diverticulostomy (ESD). Many data regarding ESD are available on the short-term outcomes, but few on the long-term ones., Materials and Methods: From March 1998 to July 2016, 126 patients with ZD were candidate for ESD. Since 2009, 2 stay sutures were routinely positioned at the lateral edges of the septum using Medtronic Endostitch 10 mm suturing device. Demographic and perioperative data, symptoms, and surgical outcomes were recorded. Long-term ESD results were analyzed. An extra-analysis on the surgical outcome was performed comparing patients treated with or without stay sutures., Results: In total, 117 patients successfully underwent ESD. The mean age was 69.9 years with a male predominance. Intraoperative complications occurred in 6.8% of cases. Only 2.6% of the patients reported postoperative complications. For the long-term analysis, we were able to contact 92 patients for a mean period follow-up of 65.3 months. At 6-month outpatient visit 77.68% of patients were completely asymptomatic. In total, 22.3% of the patients needed an extratreatment due to incomplete section of the septum, reaching a success rate of 95.5%. The long-term resolution rate remained high (91.3%). The use of stay sutures did not statistically influence the operative time (22.8 vs. 26.7 min, P=0.070), nor intraoperative and postoperative complication rate, but a statistically significant higher complete resolution rate of symptoms with a single session of ESD was observed respect those treated without (87.3% vs. 65.3%, respectively)., Conclusions: ESD is a safe and effective treatment of ZD and it can control symptoms even in a long-term follow-up. In our experience, the use of stay sutures placed with Endostitch increases short and long-term results reducing the need for further treatments.