Twice-Weekly and Thrice-Weekly Hemodialysis have Comparative Survival Outcomes: Study

Researchers have found in a new study that Patients undergoing twice-weekly hemodialysis demonstrated comparable overall survival at two years when compared to those on a thrice-weekly schedule. While a twice-weekly regimen may serve as a viable option during the initial year of dialysis—particularly in resource-limited settings—it poses potential risks that require vigilant monitoring beyond the first year.

The optimal frequency of maintenance hemodialysis remains a subject of debate. In many countries, twice-weekly hemodialysis is still commonly practiced. This trial aimed to compare the outcomes of patients undergoing twice-weekly versus thrice-weekly hemodialysis.

This prospective, multicenter, nonrandomized trial included incident adult patients, with chronic kidney disease stage 5, initiating hemodialysis between January 2018 and August 2021. Patients were allocated to either a twice-weekly or thrice-weekly regimen, and monitored at 1, 3, 6, 12 and 24 months. This trial was terminated before reaching the required sample size due to the COVID-19 pandemic and economic factors. Recruitment achieved 25% of the projected number. Missing baseline factors were imputed using multiple imputation algorithms, then entered in a logistic regression model to estimate propensity scores. The primary outcome was two-year survival analyzed using a Cox regression survival model adjusted for propensity scores and baseline residual urine output. Secondary outcomes included hospitalization rates, uncontrolled hypertension and cumulative erythropoietin dose at two years, analyzed using regression models adjusted for propensity scores and baseline residual urine output. All analyses were conducted on an intention-to-treat basis. Results: A total of 132 patients on thrice-weekly hemodialysis and 71 on twice-weekly hemodialysis were included. The mean age was 67 ± 15 years and the median eGFR at dialysis initiation was 6 (4,8) mL/min/1.73 m2. At one year, patients in the twice-weekly group had greater residual urine output. At two years, there was no significant difference in survival (HR = 0.84; 95% CI: 0.37, 1.90), hospitalization rates (P = 0.515) or uncontrolled hypertension (P = 0.442). The twice-weekly group showed a trend toward higher erythropoietin requirements (P = 0.08). Serum potassium levels and the number of antihypertensive medications were greater in the twice-weekly group. Patients on twice-weekly hemodialysis showed comparable overall survival at two years to those on thrice-weekly hemodialysis. While a twice-weekly regimen may be a viable option during the first year of dialysis, especially in low-resource settings, it carries potential risks that necessitate careful monitoring after the first year.

Reference:

Aoun, M., Finianos, S., Beaini, C. et al. Twice against thrice-weekly hemodialysis (TATH): a multicenter nonrandomized trial. BMC Nephrol 26, 176 (2025). https://doi.org/10.1186/s12882-025-04105-3

Keywords:

Twice-Weekly, Thrice-Weekly, Hemodialysis, Survival, Outcomes, Study, Aoun, M., Finianos, S., Beaini, C, Hemodialysis, Mortality, Frequency, Twice-weekly Thrice-weekly, Residual diuresis, Residual urine output, Antihypertensive drugs, Erythropoietin, Serum potassium

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In Pediatric Cardiac Surgery video Laryngoscopy for TEE Probe Insertion safe with higher first attempt success rate: Study

Recent randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

Patient Randomization and Procedures

Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury. The results showed that the incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001). In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

Conclusion and Recommendations

The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Key Points

1. This randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery.

2. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

3. Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury.

4. The incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001).

5. In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

6. The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Reference –

Guriqbal Singh et al. (2025). A Randomised Controlled Trial Comparing Video Laryngoscopy Versus Conventional Blind Technique For Transoesophageal Echocardiography Probe Insertion In Paediatric Patients Undergoing Cardiac Surgery: A Pilot Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_975_24

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Persistent organic pollutants are associated with higher BP in teenagers after weight loss surgery: Study

Researchers from the Keck School of Medicine of USC have found that persistent organic pollutants (POPs)-synthetic toxic chemicals often found in food sources and stored in body fat-are associated with long term higher blood pressure in adolescents who have undergone bariatric surgery, a weight-loss intervention.

The study, funded by the National Institutes of Health and published in the ACS journal Environmental Science & Technology, suggested that POPs diminished the beneficial effect of bariatric surgery on improved blood pressure due to disruptions in lipid metabolism, which is how the body processes fat. The researchers also identified a plausible biological pathway explaining the relationship between POPs and changes in blood pressure.

These findings could eventually lead to treatments to reduce adverse health effects of exposure to these environmental chemicals on individuals with obesity, particularly for those pursuing weight-loss interventions such as bariatric surgery.

“While bariatric surgery is an effective treatment used to address severe obesity and improve cardiometabolic health, it also releases POPs stored in fat into the bloodstream,” says Shudi Pan, the study’s first author and a fourth year PhD candidate in the Department of Population and Public Health Sciences at Keck School of Medicine of USC.

Although their toxicity led many countries to start restricting the use of POPS more than 20 years ago, they remain a global health challenge since they persist for long periods in the environment. They have been detected at concerning levels worldwide even in regions where these chemicals were never manufactured or used.

“POPs are considered an emerging risk factor for hypertension and our study provided us a unique opportunity to evaluate the relationship between POPs exposure and blood pressure. Until now, few studies have examined how POPs exposures in adipose tissue affect blood pressure,” says Pan. “Similarly, the mechanisms underlying the relationship between POP mixtures and blood pressure have been unclear.”

The study included data from 57 adolescents from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) consortium, who underwent bariatric surgery.

“We measured the level of POPs stored in adipose tissue before surgery. After, we assessed whether it affected blood pressure in the short term—at 6 months, and then five years after surgery,” says Pan.

Pan’s research found that POPs mixtures were linked to higher systolic blood pressure five years after bariatric surgery. Additionally, the researchers incorporated metabolomics to understand the underlying mechanisms of POP mixtures in adipose tissue on changes in blood pressure. Metabolomics refers to the study of metabolites which are small molecules or substances made when the body breaks down food, chemicals, or its own tissue—in this case the breakdown of body fat after bariatric surgery.

“Through a technique called high-resolution mass spectrometry, we assessed these metabolites, thousands at a time, to determine what complex biological changes were occurring that led to changes in blood pressure,” says Pan.

The researchers’ analysis revealed that one particular pathway involved in the production of prostaglandin was key in influencing blood pressure changes in the long-term, making this one of the first studies to identify a plausible rationale. Prostaglandin has long been proved to be involved in blood pressure regulation, and this study found that POPs modified prostaglandin pathways, contributing to disruptions in blood pressure regulations.

“While our study had a small sample size, we think the prostaglandin pathway is a key player in understanding the biological mechanism between POPs and the development of high blood pressure in this demographic and more research is needed to further understand this particular pathway linking POP exposures to blood pressure regulation,” says Pan.

High blood pressure in adolescence is associated with an increased risk of cardiovascular disease and cardiovascular diseases mortality in adulthood. Interventions that can address early life hypertension can help reduce the risk of cardiovascular disease, which remains a leading cause of death worldwide. 

Reference:

Shudi PanZhenjiang Li*Douglas I. WalkerBrittney O. BaumertHongxu WangJesse A. Goodrich, Metabolic Signatures in Adipose Tissue Linking Lipophilic Persistent Organic Pollutant Mixtures to Blood Pressure Five Years After Bariatric Surgery Among Adolescents, Environmental Science & Technology, DOI:10.1021/acs.est.4c13902. 

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Almost half of children with complicated appendicitis can recover from surgery at home: Study

Almost half of children who require surgery for complicated appendicitis can safely complete their recovery at home, according to a new study.

The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Pediatric Surgery, found more than 40 per cent who received care in the home following a complex appendectomy recovered faster and had fewer complications.

More than 300 patients present with appendicitis to The Royal Children’s Hospital (RCH) every year, with about one in three experiencing a burst appendix or severe infection.

The study involved 83 children, aged five to 18 years, admitted to the RCH for a complicated appendicectomy, with 35 suitable for the Hospital in the Home (HITH) program. All patients needed at least five days of intravenous antibiotics (IV) post-surgery. Under the program, a nurse visited the child’s home daily to administer the antibiotics and record clinical observations.

MCRI Associate Professor Penelope Bryant said under this model, patients at home recovered more quickly and didn’t require readmission to hospital.

“Acute post-operative care at home is rare, but we found it’s possible for children to spend 35 per cent less time in hospital after complicated surgery,” she said. This could be done safely and without prolonging IV courses or broadening antibiotic use.

“These findings will help clinicians to identify which children are suitable for HITH care following surgery for complicated appendicitis.”

MCRI Associate Professor Warwick Teague said the HITH program, used heavily during the COVID-19 pandemic, had the added benefits of reduced hospital and family costs, improved quality of life, less time taken from work and prevention of hospital-acquired infections.

“The pandemic presented us with the need and opportunity to deliver care to children in their home,” he said. This study showed even children who had severe appendicitis can be well cared for at home after surgery, freeing up hospital beds for other sick children and those needing surgery.

“Traditionally after surgery for severe appendicitis, surgeons have insisted on daily reviews in hospital by the surgical team. However, in this study we learnt that optimal postoperative care be delivered at home, by well-trained non-surgical clinicians working as a team with surgeons.”

“For complicated appendicitis, the HITH program also saved over $1,400 per day for the hospital and $300 daily for families, reducing cost-of-living pressures with longer-term benefits for healthcare sustainability.”

Reference:

Ling Chen, Sebastian K. King, Misel Trajanovska, Lynda M. Gaynor, Veronica Cerratti, Rosemary Burgess, Gregory J.G. Nolan, Warwick J. Teague, Penelope A. Bryant, Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis, Journal of Pediatric Surgery Open, 2025,https://doi.org/10.1016/j.yjpso.2025.100196.

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Bubbly idea: Ultrafine bubble showers suppress atopic dermatitis

Bubble baths might be soothing soaks, but bubble showers could be the next thing in keeping the skin clean.

An Osaka Metropolitan University-led medical research team found that ultrafine bubble showers might help prevent atopic dermatitis.

Graduate School of Medicine student Ayaki Matsumoto and Associate Professor Hisayoshi Imanishi led the study into using ultrafine bubbles, often used to clean medical equipment, on mice with atopic dermatitis.

The scientists found that in mice with atopic dermatitis due to external factors, inflammation was markedly suppressed when the affected skin was showered with ultrafine bubbles, while normal showers also showed some positive results. Additionally, the ultrafine bubble showers improved the levels of proteins in the skin that act as a protective barrier. For mice with atopic dermatitis caused by genetic factors, however, there were no significant differences even compared to mice who were not showered.

“The results of this study suggest that ultrafine bubble shower treatment might be a new treatment for allergen-induced atopic dermatitis for humans, but this study was conducted on mice and the shower treatment period was short, only a week or two,” stated graduate student Matsumoto.

“From now on,” Professor Imanishi added, “it will be necessary to conduct ultrafine bubble shower therapy for several months on human patients to examine the effects.”

Reference:

Ayaki Matsumoto, Beneficial effects of ultrafine bubble shower on a mouse model of atopic dermatitis, Frontiers in Immunology, https://doi.org/10.3389/fimmu.2024.1483000.

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Subarachnoid spinal anesthesia Safe and Effective Anesthesia Option for High-Risk Obstetric Cases: Study

Recent study discusses the challenges of managing parturients with cardiovascular disease (CVD) during anesthesia, highlighting the increased perioperative morbidity and mortality due to the heightened demands of pregnancy. The preference for regional anesthesia in obstetrics is established, with general anesthesia (GA) and conventional spinal posing risks of hemodynamic instability in CVD patients. The introduction of segmental spinal anesthesia (SSA) has shown promise in providing better hemodynamic stability by confining anesthesia to specific dermatomes, enhancing safety for high-risk patients.

Case Studies of Parturients with Pre-Existing Cardiovascular Disease

The research presented five cases of parturients with significant pre-existing CVD (severe mitral stenosis, aortic stenosis, hypertrophic obstructive cardiomyopathy, and peripartum cardiomyopathy) who successfully underwent cesarean section under SSA at a particular institute from September 2023 to January 2024. The implementation of thorough preoperative evaluation and optimization was emphasized, with a multidisciplinary approach for planning combined epidural and SSA, invasive monitoring, and postoperative intensive care unit (ICU) management. Informed consent and meticulous monitoring were highlighted throughout the procedures.

Anesthetic Technique Employed for Parturients with CVD

The anesthetic technique employed included segmental spinal administration at specific vertebra levels using a combination of bupivacaine and fentanyl to achieve effective blockade and hemodynamic stability. Close monitoring and prompt management of hypotensive episodes with phenylephrine boluses were reported. Postoperative care included ongoing vigilance, epidural analgesia, cardiac function reassessment, and uneventful recovery for all cases.

Discussion on Anesthesia Options for CVD Patients

Different options for anesthesia were discussed, including graded epidural, combined spinal-epidural, and continuous spinal anesthesia, with a preference for SSA due to its muscle relaxation, reduced anesthetic requirement, and stable hemodynamics. The study emphasized the potential risks of GA in CVD patients, suggesting carefully managed GA might be necessary in specific scenarios to ensure patient safety. The findings advocate for SSA as an effective, safe, and viable alternative anesthesia technique for high-risk obstetric cases involving parturients with underlying CVD. The research exhibited successful outcomes, underlining the importance of individualized approaches and meticulous perioperative management to enhance safety and optimize recovery in such complex clinical scenarios.

Key Points

– Regional anesthesia, especially segmental spinal anesthesia (SSA), is preferred over general anesthesia (GA) in managing parturients with cardiovascular disease (CVD) due to the risks of hemodynamic instability associated with GA and conventional spinal anesthesia.

– Five cases of parturients with significant pre-existing CVD successfully underwent cesarean section under SSA, emphasizing the importance of thorough preoperative evaluation, multidisciplinary planning, invasive monitoring, and postoperative intensive care unit (ICU) management to ensure patient safety.

– The anesthetic technique employed involved segmental spinal administration at specific vertebra levels using a combination of medications to achieve effective blockade and stable hemodynamics, with close monitoring and prompt management of hypotensive episodes.

– Different anesthesia options, including graded epidural, combined spinal-epidural, and continuous spinal anesthesia, were discussed, with a preference for SSA due to its muscle relaxation, reduced anesthetic requirement, and stable hemodynamics, highlighting the potential risks of GA in CVD patients.

– The study advocates for SSA as an effective, safe, and viable alternative anesthesia technique for high-risk obstetric cases involving parturients with underlying CVD, stressing the importance of individualized approaches and meticulous perioperative management to enhance safety and optimize recovery in complex clinical scenarios.

– Successful outcomes were achieved with the use of SSA, underscoring the significance of personalized care and detailed perioperative management in improving safety and recovery for parturients with CVD undergoing anesthesia for cesarean sections.

Reference –

Ajit Kumar et al. (2025). Enhancing Recovery In Cervical Spine Surgery With Erector Spinae Plane (ESP) Block- A Case Series. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_690_24.

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Osteoporosis cases on the rise but risk differs across demographics, reveals study

While increased average life expectancy is a testament to modern medicine and public health efforts, an aging population comes with an increased presence of chronic diseases such as osteoporosis. Research published in Osteoporosis International by Hong Xue  and graduate students Christopher Naso, Ge Song, and Kenny Lin supplies evidence that some groups are at greater risk for osteoporosis and less likely to receive an official diagnosis:

• From 2005 to 2018, there has been a significant increase in the overall number of individuals who have osteoporosis in the U.S.

• Osteoporosis has increased across all age groups, except those 80 years and older.

• Non-Hispanic White women were shown to have the highest prevalence of diagnosed osteoporosis.

• Nearly 70% of individuals with osteoporosis have gone undiagnosed, primarily men, Mexican Americans, and individuals aged 50-59.

This study is the first to assess undiagnosed osteoporosis trends over time across by gender, ethnicity/race, age group, and both gender and ethnicity/race. Findings indicate there is greater need for proactive care for bone health.

Reference:

Naso, C.M., Lin, SY., Song, G. et al. Time trend analysis of osteoporosis prevalence among adults 50 years of age and older in the USA, 2005–2018. Osteoporos Int 36, 547–554 (2025). https://doi.org/10.1007/s00198-025-07395-3

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Weight training protects older people’s brains against dementia, study suggests

The benefits of weight training are many: it promotes gains in strength and muscle mass, reduces body fat, and contributes to well-being and mental health. And now a study carried out at the State University of Campinas (UNICAMP), in the state of São Paulo, Brazil, has demonstrated another important effect: it protects the brains of older people against dementia. The results were published in the journal GeroScience.

The study involved 44 people with mild cognitive impairment – an intermediate clinical condition between normal aging and Alzheimer’s disease in which cognitive decline is greater than expected for age, indicating a higher risk of dementia. The results showed that strength training not only improved memory performance but also altered brain anatomy.

After six months of twice-weekly weight training, the participants showed protection against atrophy in the hippocampus and precuneus – brain areas associated with Alzheimer’s disease-as well as improvements in parameters that reflect the health of neurons (white matter integrity).

“We already knew that there would be physical improvement. Cognitive improvement was also imagined, but we wanted to see the effect of weight training on the brains of older people with mild cognitive impairment. The study showed that, fortunately, weight training is a strong ally against dementia, even for people who are already at high risk of developing it,” says Isadora Ribeiro, a FAPESP doctoral fellowship recipient at UNICAMP’s School of Medical Sciences (FCM) and first author of the article.

The work was carried out within the framework of the Brazilian Institute for Neuroscience and Neurotechnology (BRAINN) – a FAPESP Research, Innovation and Dissemination Center (RIDC)-and is the first to demonstrate what happens to the integrity of the white matter of individuals with mild cognitive impairment after weight training.

“As well as neuropsychological tests, we also performed MRI scans at the beginning and end of the study. These results are very important because they indicate the need to include more physical educators in the public health system at the primary health care level since increased muscle strength is associated with a reduced risk of dementia. It’s a less complex and cheaper treatment that can protect people from serious diseases,” comments Marcio Balthazar, BRAINN researcher and study supervisor.

“For example, the new anti-amyloid drugs approved in the United States indicated for the treatment of dementia and for people with mild cognitive impairment, cost around USD 30,000 a year. That’s a very high cost. These non-pharmacological measures, as we’ve shown is the case with weight training, are effective, not only in preventing dementia but also in improving mild cognitive impairment,” the researcher adds.

Protocol

The research participants were divided into two groups: half underwent a resistance exercise program with weight training sessions twice a week, at moderate to high intensity and with progressive loads; the other half did not exercise during the study period and were part of the so-called control group.

In the analyses carried out at the end of the intervention, the volunteers who practiced weight training had better performance in verbal episodic memory, improved integrity of neurons and areas related to Alzheimer’s disease protected from atrophy, while the control group showed a worsening of brain parameters.

“A characteristic of people with mild cognitive impairment is that they have volume loss in some brain regions associated with the development of Alzheimer’s. But in the group that did strength training, the right side of the hippocampus and precuneus were protected from atrophy. This result justifies the importance of regular weight training, especially for older people,” Ribeiro highlights.

The researcher believes that a longer period of training could lead to even more positive results than those reported in the study. “All the individuals in the bodybuilding group showed improvements in memory and brain anatomy. However, five of them reached the end of the study without a clinical diagnosis of mild cognitive impairment, such was their improvement. This leads us to imagine that longer training sessions, lasting three years, for example, could reverse this diagnosis or delay any kind of dementia progression. It’s certainly something to be hopeful about and something that needs to be studied in the future,” Ribeiro argues.

According to the researchers, weight training can protect the brain against dementia on two fronts: by stimulating the production of neural growth factor (an important protein for the growth, maintenance and survival of neurons) and by promoting global disinflammation in the body.

“Any physical exercise, whether weight training or aerobic activity, is known to increase levels of a chemical involved in brain cell growth. It can also mobilize anti-inflammatory T-cells. This is key. After all, the more pro-inflammatory protein that is released in the body, the greater the chance of developing dementia, accelerating the neurodegenerative process and forming dysfunctional proteins that eventually kill neurons,” Balthazar explains.

To assess these issues, the volunteers’ levels of irisin and BDNF (brain-derived neurotrophic factor) – substances whose synthesis is stimulated by muscle contraction and which are associated with neural protection and synaptic plasticity-were measured. The results are currently being analyzed.

“It’s a continuation of this study in which we’ll try to better understand how these factors are related to changes in brain anatomy. We believe that it’s a set of anti-inflammatory and neuroprotective factors that lead to these changes,” Ribeiro predicts.

Reference:

Ribeiro, I.C., Teixeira, C.V.L., de Resende, T.J.R. et al. Resistance training protects the hippocampus and precuneus against atrophy and benefits white matter integrity in older adults with mild cognitive impairment. GeroScience (2025). https://doi.org/10.1007/s11357-024-01483-8

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Pretreatment with chlorhexidine and benzalkonium chloride fails to impact Long-Term Bonding in immediate dentin sealing: Study

Researchers have found in a new study that pretreatment with chlorhexidine and benzalkonium chloride does not improve long-term bonding in immediate dentin sealing when using a universal adhesive. However, All Bond Universal adhesive applied in the etch-and-rinse mode demonstrated better long-term bonding performance compared to its self-etch mode when antibacterial agents were used. Effective and durable bonding in immediate dentin sealing is a crucial factor in the success of adhesive-bonded restorations. This study aimed to examine the effects of chlorhexidine and benzalkonium chloride pretreatments on the initial and long-term bond strength of a universal adhesive applied in two different etching modes. The research involved preparing flat dentin surfaces from extracted molars, which were divided into six groups based on pretreatment type and etching mode. The adhesive was used in either etch-and-rinse or self-etch mode, followed by the application of a hydrophobic resin layer. After the provisional stage and final cementation with resin, bond strength was evaluated both immediately after application and again after one year of storage.The results indicated that pretreatment with chlorhexidine did not have a significant effect on bond strength, while pretreatment with benzalkonium chloride led to weaker immediate bonding performance when used in self-etch mode. However, in the etch-and-rinse mode, there were no substantial differences in bond strength among the pretreatment groups immediately after bonding or after one year. Over time, the bond strength in the self-etch mode declined across all groups, with the chlorhexidine group showing the weakest long-term bonding. In contrast, the etch-and-rinse mode showed stable or slightly improved bond strength over time, with the benzalkonium chloride group achieving the highest values after one year. Overall, neither chlorhexidine nor benzalkonium chloride pretreatment provided additional benefits in improving long-term bonding performance in immediate dentin sealing when using the universal adhesive in this study. However, when incorporating antibacterial agents, the etch-and-rinse mode of All Bond Universal adhesive demonstrated superior long-term bonding compared to its self-etch mode. These findings suggest that the choice of etching mode plays a critical role in maintaining durable adhesive restorations.

Reference:

Shafiei, F., Jowkar, Z., Eslamipanah, S. et al. Comparative evaluation of chlorhexidine and benzalkonium chloride pretreatments on bond strength durability of immediate dentin sealing with universal adhesive: an in vitro study. BMC Oral Health 25, 390 (2025). https://doi.org/10.1186/s12903-025-05745-5

Keywords:

Pretreatment, chlorhexidine, benzalkonium, chloride, fails, impact, Long-Term Bonding, immediate dentin sealing, Study, Shafiei, F., Jowkar, Z., Eslamipanah, S

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Norepinephrine as initial vasoactive agent has lower mortality rates in Pediatric Septic Shock compared to Epinephrine: JAMA

Researchers have found in a new study that Children without known cardiac dysfunction who were treated with norepinephrine as the initial vasoactive agent for septic shock showed lower mortality rates compared to those treated with epinephrine, though both groups had similar rates of major adverse kidney events within 30 days (MAKE30). Further prospective studies are required to confirm whether norepinephrine should be the preferred first-line agent in such cases.

There is no consensus and wide practice variation in the choice of initial vasoactive agent in children with septic shock. A study was done to determine whether receipt of epinephrine compared with norepinephrine as the first vasoactive medication administered is associated with improved outcomes among children with septic shock without known cardiac dysfunction. This single-center, retrospective cohort study used propensity score matching to examine encounters in which a patient was diagnosed with septic shock and required a vasoactive infusion within 24 hours of ED arrival at a freestanding quaternary care children’s hospital. Participants included patients aged 1 month to 18 years who presented to the ED and were diagnosed with septic shock without known cardiac dysfunction and began an epinephrine or norepinephrine infusion within 24 hours of ED arrival between June 1, 2017, and December 31, 2023. Data were analyzed from March 1 to December 31, 2024. The primary outcome was major adverse kidney events by 30 days (MAKE30). Secondary outcomes were 30-day in-hospital mortality, 3-day mortality, need for kidney replacement therapy or persistent kidney dysfunction, endotracheal intubation, mechanical ventilation days, extracorporeal membrane oxygenation, and hospital and intensive care unit length of stay. Primary and secondary outcomes were assessed with the χ2 test of proportions for binary variables and Wilcoxon rank sum test for continuous variables. Results Among 231 included encounters, the median (IQR) age was 11.4 (5.6-15.4) years, 126 were female (54.6%), and 142 had a medical history that predisposed them to sepsis (61.5%). Most (147 [63.6%]) initially received an epinephrine infusion and 84 (36.4%) received norepinephrine. In the epinephrine group, 9 of 147 (6.1%) met the outcome of MAKE30 and 6 of 147 (4.1%) died within 30 days. In the norepinephrine group, 3 of 84 (3.6%) met MAKE30 and there were no deaths. After inverse probability of treatment weighting, there were no significant differences in the primary outcome, MAKE30. With 2:1 propensity matching, epinephrine was associated with greater 30-day mortality compared with norepinephrine (3.7% vs 0%; risk difference: 3.7%; 95% CI, 0.2%-7.2%). In this study, those receiving epinephrine had greater 30-day mortality but no difference in MAKE30. Prospective, confirmatory studies are needed to determine if norepinephrine should be the first-line vasoactive agent in pediatric septic shock.

Reference:

Eisenberg MA, Georgette N, Baker AH, Priebe GP, Monuteaux MC. Epinephrine vs Norepinephrine as Initial Treatment in Children With Septic Shock. JAMA Netw Open. 2025;8(4):e254720. doi:10.1001/jamanetworkopen.2025.4720

Keywords:

Norepinephrine, initial, vasoactive, agent, lower , mortality rates, Pediatric, Septic Shock, compared, Epinephrine, JAMA , Eisenberg MA, Georgette N, Baker AH, Priebe GP, Monuteaux MC. Epinephrine

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