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Evaluation of Nanobubble Water Irrigation For Removing Biofilm-Mimicking Hydrogel in Premolars With Type II Canal Systems
(2026-06) Johnson, Cole; Govindool, Sharaschandra; Ehrlich, Ygal; Namli, Halide
Objective: The purpose of this in vitro study was to evaluate the efficacy of nanobubble water (NBW) irrigation for removal of a biofilm-mimicking hydrogel from premolars with Vertucci Type II canal systems and to compare its performance across different irrigant activation techniques.
Materials and Methods: Extracted human premolars (n = 70) with confirmed Vertucci Type II canal configurations were instrumented using a standardized rotary protocol. A fluorescently labeled biofilm-mimicking hydrogel was introduced into the root canal system and allowed to stabilize prior to irrigation activation techniques. Specimens were randomly assigned to experimental groups based on irrigant type, nanobubble water or deionized water, and activation method, including sonic activation, passive ultrasonic irrigation, and laser-activated irrigation. A non-irrigated control group was also included. Following completion of the assigned irrigation or control protocol, each specimen was placed into a black 5 mL vial containing 2 mL of deionized water. Each specimen was then instrumented with an XP Shaper file for 30 seconds to help dislodge residual hydrogel from the canal walls, followed by vortexing to disperse the released fluorescent hydrogel into solution. A 200µL aliquot was then pipetted from each vial and analyzed using fluorescence spectroscopy to measure relative fluorescence units (RFUs). Lower RFU values indicated less residual hydrogel and therefore greater hydrogel removal. Duplicate fluorescence readings were averaged for each specimen prior to statistical analysis. Data were analyzed at α = 0.05. Normality was assessed using the Shapiro–Wilk test, and group differences were evaluated using Welch’s one-way ANOVA with Welch-compatible post hoc comparisons.
Results: Residual hydrogel fluorescence differed significantly among the seven irrigation protocols. Shapiro–Wilk testing demonstrated that all groups satisfied the assumption of normality except DIW + SA, which showed a significant deviation from normality (W = 0.7702, p = 0.0063). Therefore, fluorescence values were compared using Welch’s one-way ANOVA, which demonstrated a statistically significant difference in mean fluorescence across groups (p < 0.0001). Post hoc Welch-compatible pairwise comparisons showed that NBW + Laser exhibited significantly lower fluorescence values than Control, NBW + PUI, NBW + SA, DIW + PUI, DIW + SA, and DIW + Laser (p < 0.05 to p < 0.0001). Additionally, DIW + Laser demonstrated significantly lower fluorescence than DIW + SA (p < 0.01).
Conclusions: Within the limitations of this in vitro study, irrigation protocol significantly influenced removal of biofilm-mimicking hydrogel from premolars with Vertucci Type II canal systems. The NBW + Laser group demonstrated the lowest residual fluorescence values, indicating the greatest hydrogel removal among the tested protocols. The finding that DIW + Laser also produced significantly lower fluorescence than DIW + SA suggests that laser activation enhanced hydrogel removal even when deionized water was used as the irrigant. Overall, these findings support continued investigation of nanobubble water, particularly when combined with laser activation, as a potential strategy for improving physical debridement within anatomically complex root canal systems.
Pien Tze Huang plus entecavir improves hepatic fibrosis in Chinese patients with chronic hepatitis B
(Elsevier, 2025-07-01) Zhang, Xin; Zhang, Liwen; Ji, Longshan; Liangpunsakul, Suthat; Zhang, Jinghao; Hong, Fei; Lyu, Hua; Hwang, Seonghwan; Gou, Chunyan; Jiang, Yuyong; Chen, Xiaorong; Li, Qin; Tong, Guangdong; Zhang, Anna; Wang, Jing; Li, Xiaodong; Zhang, Mingxin; Sun, Xuehua; Li, Man; Gao, Yueqiu; Anatomy, School of Medicine
BACKGROUND: Pien Tze Huang (PTH), a well-established traditional Chinese medicine compound, has exhibited anti-hepatic fibrosis properties both in vitro and in vivo animal models, but the randomized clinical trials to evaluate anti-hepatic fibrosis efficacy of PTH are deficient. Chronic hepatitis B (CHB) is a leading cause of hepatic fibrosis in China. Although antiviral therapies have demonstrated significant effectiveness in arresting the progression of fibrotic disease, complete regression of established fibrosis is limited to only a subset of treated patients.
PURPOSE: To assess the efficacy of PTH in improving hepatic fibrosis in CHB patients.
STUDY DESIGN: We conducted a randomized, double-blind, placebo-controlled clinical trial involving 144 CHB patients with hepatic fibrosis. This study was carried out from September 2020 to April 2023. (Clinical Trials Registration: ChiCTR2000035128) METHODS: CHB patients with an Ishak score of 2-5 points were recruited from ten hospitals across China. Participants were randomized in 1:1 ratio to receive either oral PTH (0.6 g per dose, three times/day) or placebo for 48 weeks, in addition to the standard treatment of entecavir (0.5 mg/day). The primary endpoint was the change in Ishak score. Secondary outcomes included changes in Knodell HAI score, liver stiffness measurement, AST- to -platelet ratio index, Fibrosis-4 index and hepatic function indices.
RESULTS: Of the 144 randomized patients, 142 patients (71 in the PTH group and 71 in the placebo group) were included in the primary analysis. The PTH group exhibited lower Ishak score compared to the control group (2.37 ± 0.94 vs. 2.87 ± 1.04, F = 6.072, p = 0.015). Notably, in treatment-naive patients, the PTH group showed significant improvement in Ishak score post-treatment compared with the control group (2.13 ± 0.72 vs. 2.74 ± 1.07, F = 6.336, p = 0.014). However, no significant changes were observed in these parameters among patients already receiving antiviral therapy.
CONCLUSIONS: The combination of PTH and entecavir demonstrates significant improvement in hepatic fibrosis among CHB patients, especially those who are treatment-naive patients.
Huangjia Ruangan granules with entecavir for fibrosis regression in Chroinc Hepatitis B: A multicenter, randomized, double-blind, phase II trial
(Elsevier, 2025-11-25) Zhu, Xiaojun; Zhang, Jinghao; Zhou, Zhijia; Liangpunsakul, Suthat; Wang, Jing; Ge, Guohong; Tan, Shanzhong; An, Xuan; Sun, Kewei; Wu, Gang; Zhu, Liying; Tang, Jinmo; Song, Xinwen; Zhang, Anna; Lv, Hui; Jiang, Yongfang; Gou, Chunyan; Li, Man; Sun, Xuehua; Gao, Yueqiu
BACKGROUND: Huangjia Ruangan Granules (HRG) has shown promising therapeutic effects in treating hepatic fibrosis in China. This study aimed to assess its specific efficacy.
METHODS: This 48-week phase II study was a multicenter, randomized, double-blind, placebo-controlled trial conducted at 14 centers in China (No. ChiCTR2400086796). patients with chronic hepatitis B (CHB) and an Ishak fibrosis score between 2 to 5 were eligible for inclusion. Patients were randomly assigned to three groups (1:1:1 ratio): ETV (0.5 mg/day) + HRG-10g (10g/day, once daily), ETV (0.5 mg/day) + HRG-20g (10 g, twice daily), and ETV (0.5 mg/day) + placebo. The primary outcome was the change in fibrosis stage according to the Ishak scale. Safety assessments were conducted throughout the trial.
RESULTS: A total of 240 participants were randomly allocated to three treatment groups: ETV+HRG-10g (n=80), ETV+HRG-20g (n=79), or ETV+placebo (n=80). After 48 weeks, the ETV+HRG-20g group showed a significantly higher fibrosis regression rate (≥1 stage improvement in histopathology) was in the compared to both the ETV+HRG-10g group (67.09 % vs. 36.25 %; 95 % CI, 15.81-45.6) and the ETV+placebo group (67.09 % vs. 26.25 %; difference, 40.69 %; 95 % CI, 26.55-54.83).
CONCLUSIONS: Combining a 20g dose of the TCM formula HRG with ETV significantly enhances liver fibrosis regression in CHB patients.
The association of steatotic liver disease with cardiometabolic criteria and cardiovascular disease risk in a large cohort of people living with human immunodeficiency virus
(Elsevier, 2025-12-01) Sterling, Richard K.; Sternberg, Alice L.; Lake, Jordan E.; Naggie, Susanna; Heath, Sonya; Price, Jennifer C.; Wilson, Laura; Crandall, Holly; Gawrieh, Samer; Chalasani, Naga; Loomba, Rohit; Sulkowski, Mark; Network, HIV NASH Clinical Research; Anatomy, School of Medicine
Background & Aims: Steatotic liver disease (SLD), both metabolic dysfunction-associated liver disease (MASLD) without or with alcohol-associated liver disease (MetALD), is common in people with HIV (PWH) and associated with increased risk of cardiovascular disease (CVD).
Methods: Clinical and laboratory data were collected prospectively. MASLD was defined as SLD with ≥1 cardiometabolic risk factors (CMRF) and non-significant alcohol use. CVD risk was assessed by five 10-year risk scores (Framingham CVD score, 2013 ASCVD score, and PREVENT scores for total CVD, ASCVD, and heart failure) and one 5-year CVD score (D:A:D). Those without SLD were compared to MASLD and MetALD.
Results: Among 991 PWH without history of CVD, MASLD was present in 40% and MetALD in 9%. At least 4 CMRF were present in 55% of those with MASLD, 61% MetALD compared to 29% without SLD. Those with MASLD had higher PREVENT total CVD score than those without SLD and similarly for mean PREVENT ASCVD and heart failure scores. Those with MASLD also had higher mean risk than those without SLD by Framingham CVD score, 2013 ASCVD score, and D:A:D score. Conversely, those with MetALD and those without SLD had similar CVD risk scores. 10-year CVD risk level by PREVENT score was generally least.
Conclusions: CMRF are very common in PWH, with MASLD or MetALD frequently having multiple CMRF. The PREVENT scores showed higher 10-year CVD, ASCVD, and heart failure risk in those with MASLD versus those without SLD.
Barriers and facilitators to implementing a brief tobacco cessation intervention during vaccine administration in community pharmacies: A mixed-methods study
(Elsevier, 2025-09-01) Kampman, Haleigh; Elkhadragy, Nervana; Randall, David; King, Hannah; Corelli, Robin L.; Hudmon, Karen Suchanek; Hilts, Katy Ellis; Health Policy and Management, Richard M. Fairbanks School of Public Health
OBJECTIVE: This study describes the implementation of a brief tobacco cessation intervention (Ask, Advise, Refer: AAR) into routine vaccination workflows.
METHODS: Using a convergent mixed methods approach, data were collected from 10 community pharmacies in (independent, hospital outpatient, and chain locations) via electronic documentation during vaccine administration and semi-structured interviews with pharmacy staff. The Consolidated Framework for Implementation Research served as a framework to guide qualitative interview coding and analyses, and quantitative data were analyzed descriptively. Findings were triangulated following the analyses.
RESULTS: Pharmacy staff members (14 pharmacists, 3 pharmacy technicians) participated in interviews and electronic intervention documentation was submitted by 8 of the 10 pharmacies. Participants found the AAR intervention to be appropriate, feasible, and compatible with existing vaccination workflows. Seven of the 10 pharmacies included a question about tobacco use on their vaccine intake forms, capturing the tobacco use status in 987 patients (73%). However, staff noted that individuals receiving for vaccines tended to be more health-conscious, limiting the reach of the intervention to individuals who use tobacco. Quantitative data confirmed this, with 6% of screened patients reporting tobacco use. Asking about tobacco use on both the intake form and verbally appeared to be the most effective method of identifying individuals who use tobacco. Other facilitators noted during interviews included having a designated vaccination room and strategic placement of materials to enhance reach. Factors identified to support continued delivery included additional staffing during busy times and leveraging other appointment-based services in the pharmacy.
CONCLUSION: Despite a limited reach, pharmacy personnel reported that that it was feasible and acceptable to integrate AAR into routine vaccine workflows. Future work should examine other workflow points to expand reach in community pharmacies.