[Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy].

Objective: To explore the effectiveness of irreducible intertrochanteric femoral fracture in the elderly by treating with folding top technique and right-angle pliers prying and pulling under G-arm X-ray fluoroscopy. Methods: The clinical data of 74 elderly patients with irreducible intertrochanteric femoral fracture admitted between February 2016 and December 2022 and met the selection criteria were retrospectively analyzed. Among them, 38 cases were treated with folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy and intramedullary nailing fixation (study group), and 36 cases were treated with limited open reduction combined with other reduction methods and intramedullary nailing fixation (control group). There was no significant difference in baseline data between the two groups, such as age, gender, cause of injury, affected side and classification of fractures, complicated medical diseases, and time from injury to operation ( P>0.05). The operation time, intraoperative blood loss, hospital stay, fracture reduction time, fracture healing time, and complications of the two groups were recorded and compared. The quality of fracture reduction was evaluated by Baumgaertner et al. and Chang et al. fracture reduction standards. Results: Patients in both groups were followed up 10-14 months, with an average of 12 months. The operation time and intraoperative blood loss in the study group were significantly less than those in the control group ( P<0.05), there was no significant difference in hospital stay between the two groups ( P>0.05). At 2 days after operation, according to the fracture reduction standards of Baumgaertner et al. and CHANG Shimin et al., the quality of fracture reduction in the study group was better than that in the control group, and the fracture reduction time in the study group was shorter than that in the control group, with significant differences ( P<0.05). After operation, the fractures of the two groups all healed, and there was no significant difference in healing time between the two groups ( P>0.05). During the follow-up, there was no complication such as incision infection, internal fixation failure, deep venous thrombosis of lower limbs, intramedullary nail breakage, spiral blade cutting, or hip varus in the two groups, except for 2 cases of coxa vara in the control group. Conclusion: For the irreducible intertrochanteric femoral fracture, using folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy can obviously shorten the operation time, reduce the intraoperative blood loss, and improve the quality of fracture reduction.

Effects of tool grip span, workpiece orientation, moving direction, and working height on two-handed torque strength and subjective measures.

BACKGROUND: Using both hands is regularly needed for force/torque exertions in many activities, especially when using hand tools. OBJECTIVE: To investigate the effects of tool grip span, workpiece orientation, moving direction, and working height on two-handed wrist U/R deviation torque strength, usability, comfort, and discomfort while using locking pliers. METHODS: Participants (n = 22) took part in an experimental study which evaluated the effects of tool grip span (4.5-6.5 cm), workpiece orientation (transverse/sagittal), moving direction (clockwise (CW)/counterclockwise (CCW)), and working height (shoulder/elbow/knuckle) on two-handed wrist U/R deviation torque, (dis)comfort, and usability while using locking pliers. RESULTS: The results showed no significant effect of tool grip span on wrist U/R deviation torque strength, but the locking pliers with 4.5 cm handle grip span led to more comfort and better usability. The two-handed wrist U/R deviation torque strengths were significantly higher in sagittal plane than in transverse plane, and in CW direction than in CCW direction. The highest values of two-handed wrist U/R deviation torque strength in sagittal and transverse planes were exerted in knuckle and elbow heights, respectively. CONCLUSION: The findings can be used to develop guidelines and recommendations with regard to daily and occupational activities which require the use of both hands for force exertion with manual hand tools.

What is the safest method of orthodontic debonding - a systematic review of the literature.

The objective of this study was to review the current knowledge based on in vitro and in vivo studies, that evaluated the enamel damage connected with removal of metal and ceramic orthodontic brackets taking into account different debonding methods. Brackets fracture was also assessed. The protocol for this study was constructed according to the PRISMA statement. The literature review was performed in MEDLINE via PubMed, Cochrane and Scopus databases in May 2021. The searching was repeated in Journal of Stomatology, Orthodontic Forum and grey literature was screened using Google Scholar. Out of eligible studies 207 were screened by title and abstract, 85 subjected to full-text analysis and 30 were qualified for the research. The prevalence of enamel fracture ranged from 0 to 94.4%. The results of our review do not allow to identify the manual method of debonding that minimizes the risk of enamel damage. Thermal method and laser irradiation reduce the risk of enamel fracture.

Influência da pressão dos alicates na rugosidade superficial de fios ortodônticos / Influence of gripping with pliers on the surface rugosity of orthodontic wires

Resumo Proposição: avaliar in vitro a rugosidade superficial de fios ortodônticos antes e após a compressão com pinças ortodônticas. Material E Métodos: 30 fios 0,014" de níckel-titânio termoativados (Neosentalloy, GAC) e 30 fios 0,019 x 0,025" de aço foram usados nos experimentos. Avaliou-se a rugosidade superficial com rugosímetro (NewViewTM 7100, Zygo), antes e após a compressão com alicate Weingart do lado esquerdo e pinça Mathieu do lado direito (Dentaurum). Foram determinados os parâmetros de rugosidade Ra (µm), Rq (µm), PV (µm), Srmax Iso (nm). Testes estat´siticos Wilcoxon foram realizados para analisar a variação dos parâmetros da rugosidade com nível de confiança de 95% e p<0,05. Resultados: Os fios redondos de NiTi apresentaram diferenças significaticas dos parâmetros Ra e Rq antes e após a compressão com pinça Mathieu. O emprego do alicate Weingart não alterou a rugosidade dos fios redondos. Os fios retangulares apresentaram diferenças significativas em todos os parâmetros com uso das duas pinças. As médias das diferenças dos parâmetros entre o alicate Weingart e a pinça Mathieu nos fios redondos, não foram estatisticamente significativos. Os fios retangulares apresentaram maior rugosidade com o emprego do alicate Weingart, com diferenças significativas. Conclusão: O uso do alicate tipo Weingart e da pinça tipo Mathieu aumentam a rugosidade dos fios de NiTi e de aço (AU)

Abstract Proposition: the surface roughness of orthodontic wires was evaluated in vitro before and after gripping with two different orthodontic pliers. Material And Methods: Units were made of 30 round heat-activated Nickel Titanium alloy wires 0,014" (Neosentalloy, GAC), and another group with 30 rectangular steel wires 0,019 x 0,025". The surface roughness was evaluated with a rugosimeter (NewViewTM 7100, Zygo), before and after gripping with Weingart plier on the left side and Mathieu plier on the right side (Dentaurum), in addition to the average difference in roughness between groups of the same types of wires with parameters Ra (µm), Rq (µm), PV (µm), Srmax Iso (nm). The variation of parameters with different clamps was evaluated (Wilcoxon test); different alloys by the same clamp, 95% confidence level and p<0.05. Results: The round wires showed significant differences (Ra and Rq) before and after being gripped with Mathieu plier. The roughness was higher after being gripped. Weingart pliers and round wires obtained the same results, with greater roughness after being clamped. Rectangular wires showed significant differences in all parameters, with both clamps. The means of the differences in the parameters between the Weingart pliers and the Mathieu forceps on the round wires were not statistically significant. In the rectangular wire, the values between the tweezers showed greater roughness with the grip of the Weingart pliers, with significant differences.Conclusion: After securing the orthodontic wires, the Weingart pliers and the Mathieu tweezers increased the roughness parameters (AU)

Safe Debonding of Fixed Appliances: A Comparison of Traditional Techniques and LODI Devices on Different Bracket Types in Terms of Enamel Cracks, Site of Bond Failure, and Bracket Reusability.

The objective of this study was to compare the effects of the debonding of three different bracket types by means of three popular debonding methods. A total of 180 human third molars was divided into six groups, consisting of 20 teeth each. Three bracket types were bonded to the enamel (metal brackets with an integral base and a foil mesh base, and ceramic brackets) and three methods of bracket debonding were employed (bracket removal pliers, Weingart pliers, and Lift-Off Debonding Instrument). The samples were examined with scanning electron microscopy to assess the number of enamel cracks, measure the area of adhesive remaining on the enamel, and calculate the adhesive remnant index (ARI). There were no statistically significant differences between the groups in terms of the number of enamel cracks after bracket debonding. The amount of adhesive remaining on the teeth after the brackets were removed was significantly different between the groups. LODI and Weingart pliers are considered to be the safest methods of debonding brackets with an integral base, while LODI is the best tool for brackets with foil mesh. Bracket removal pliers are considered to be the preferred method for ceramic bracket debonding.

Use of optical coherence tomography in orthodontics.

Optical coherence tomography (OCT) is a modern imaging method with applicability in orthodontics. In recent years, there has been an increasing trend in the use of ceramic brackets. The aim of the present study was to investigate the effects of bonding metallic and ceramic brackets on tooth enamel, using optical coherence tomography. For this purpose, 20 permanent teeth we bonded and were subsequently debonded using a side cutter or anterior bracket removal pliers. Using the OCT technique, the enamel, the amount of adhesive remaining and the bracket fragments remaining on the tooth surface were analyzed following the debonding procedure. It was demonstrated that enamel cracks were present only in the samples bonded with ceramic brackets. At the same time, it was noted that the type of pliers did not affect the incidence and extent of damage to the enamel. The type of debonding technique (using the side cutter or the anterior removal pliers) used did not markedly affect the amount of adhesive remaining on the teeth. Thus, as demonstrated herein, by analyzing the enamel structure through the use of OCT, the quality of the processes and the materials used for manufacturing brackets can be increased.

Desinfección de Alicates de Ortodoncia. Actualización de Recomendaciones en Contexto de COVID- 19. Revisión de la Literatura

RESUMEN: El adecuado conocimiento de definiciones, normas, procedimientos, uso de antisépticos y desinfectantes, permite contar con las herramientas para evitar la diseminación de agentes infecciosos y proporcionar el conocimiento para el uso racional de estos. El objetivo de este trabajo es presentar de manera estructurada y ordenada la información disponible respecto de la desinfección de alicates de ortodoncia y proporcionar una guía para el control óptimo de infecciones. Se realizó una búsqueda mediante PubMed, MEDLINE y Google Scholar, sin importar idioma, desde el año 2000 a abril 2021. Se establecieron los desinfectantes más recomendados para la desinfección de alicates de ortodoncia y las consideraciones en su uso. Además, se determinaron los riesgos de corrosión y recomendaciones para evitarlas. Es importante contar con información actualizada que se pueda utilizar para desarrollar un programa óptimo de asepsia, sobre todo en el contexto actual de pandemía.

ABSTRACT: Adequate knowledge of definitions, norms, procedures, use of antiseptics and disinfectants, allows to avoid the spread of infectious agents and provides knowledge for proper use of these aides. The objective of this study is to present the information available regarding the disinfection of orthodontic pliers in a structured and organized manner, and to provide a guide for optimal infection control. A search was carried out using PubMed, MEDLINE and Google Scholar, regardless of language, from the year 2000 to April 2021. The most recommended disinfectants for the disinfection of orthodontic pliers and the considerations in their use were established. In addition, risks of corrosion and recommendations to avoid them were determined. It is important to have up-to-date information that can be used to develop an optimal asepsis program, especially in the present context of a pandemic.

The application of prenatal ultrasound in the diagnosis of congenital duodenal obstruction.

BACKGROUND: The purpose of this research is to summarize the prenatal ultrasound characteristics of congenital duodenal obstruction (CDO), especially in the diagnosis of duodenal diaphragm and annular pancreas. At present, few researchers have summarized the specific ultrasound features of duodenal diaphragm and annular pancreas. METHODS: In this study, a retrospective analysis of 40 patients diagnosed with CDO between January 2016 and December 2019 was carried out. Data on the diagnosis, ultrasound images and outcomes of the patients were gathered, and the features of the patients were analyzed. RESULTS: The results showed that there were 17 patients (42.5%) of congenital duodenal diaphragm, all with a 'rat tail' sign on the ultrasound images. Moreover, there were 4 patients (10.0%) of CDO caused by annular pancreas, all with a 'pliers' sign on the ultrasound images. We summarized the imaging features of the 'rat tail' sign and the 'pliers' sign. CONCLUSION: The main conclusion of this study was that the 'rat tail' sign could be used as an indirect ultrasound feature to diagnose duodenal diaphragm. The 'pliers' sign could be used as a direct ultrasound feature in the diagnosis of annular pancreas in CDO.

Orthodontic instrument sterilization with microwave irradiation.

OBJECTIVE: This study was designed to evaluate the efficiency of microwave sterilization of orthodontic instruments and molar bands immersed in plain distilled water with and without oral rinse, and to ascertain the minimum time of exposure required to sterilize. MATERIALS AND METHODS: The orthodontic instruments (hinged and nonhinged), molar bands and mouth mirrorsused in the patient 's mouth were selected for the study. The instruments were divided into two groups - Group I with oral rinse-set A (0.01% chlorhexidine gluconate) and set B (0.025% betadine) and Group II (included sets C and D without oral rinse). The instruments of set A, B and C were microwaved at 2,450 MHz, 800 W for 5 min, whereas, set D was microwaved for 10 min at the same above mentioned specifications. The efficacy of sterilization was assessed by stab inoculation of the instruments onto trypticase soya agar plates. The plates were checked for bacterial growth following incubation at 37 °C for 24 h. For sterility control,Geobacillus stearothermophilus (MTCC 1518) was included. RESULTS: No growth was observed in the plates that were inoculated with the microwaved orthodontic instruments of sets A, B and D, whereas scanty bacterial growth was observed in the plates inoculatedwith the microwaved set C instruments. CONCLUSION: Effective sterilization was achieved when the orthodontic instruments and molar bands were immersed in distilled water without oral rinse and microwaved for 10 min as also for those that were immersed in distilled water with oral rinse and microwaved for 5 min.

Optimization of a statistical algorithm for objective comparison of toolmarks.

Due to historical legal challenges, there is a driving force for the development of objective methods of forensic toolmark identification. This study utilizes an algorithm to separate matching and nonmatching shear cut toolmarks created using fifty sequentially manufactured pliers. Unlike previously analyzed striated screwdriver marks, shear cut marks contain discontinuous groups of striations, posing a more difficult test of algorithm applicability. The algorithm compares correlation between optical 3D toolmark topography data, producing a Wilcoxon rank sum test statistic. Relative magnitude of this metric separates the matching and nonmatching toolmarks. Results show a high degree of statistical separation between matching and nonmatching distributions. Further separation is achieved with optimized input parameters and implementation of a "leash" preventing a previous source of outliers--however complete statistical separation was not achieved. This paper represents further development of objective methods of toolmark identification and further validation of the assumption that toolmarks are identifiably unique.

Comparison of the Debonding Characteristics of Conventional and New Debonding Instrument used for Ceramic, Composite and Metallic Brackets - An Invitro Study.

BACKGROUND: Debonding procedure is time consuming and damaging to the enamel if performed with improper technique. Various debonding methods include: the conventional methods that use pliers or wrenches, an ultrasonic method, electrothermal devices, air pressure impulse devices, diamond burs to grind the brackets off the tooth surface and lasers. Among all these methods, using debonding pliers is most convenient and effective method but has been reported to cause damage to the teeth. Recently, a New Debonding Instrument designed specifically for ceramic and composite brackets has been introduced. As this is a new instrument, little information is available on efficacy of this instrument. The purpose of this study was to evaluate the debonding characteristics of both "the conventional debonding Pliers" and "the New debonding instrument" when removing ceramic, composite and metallic brackets. MATERIALS AND METHODS: One Hundred Thirty eight extracted maxillary premolar teeth were collected and divided into two Groups: Group A and Group B (n = 69) respectively. They were further divided into 3 subGroups (n = 23) each according to the types of brackets to be bonded. In subGroups A1 and B1{stainless steel};A2 and B2{ceramic};A3 and B3{composite}adhesive precoated maxillary premolar brackets were used. Among them {ceramic and composite} adhesive pre-coated maxillary premolar brackets were bonded. All the teeth were etched using 37% phosphoric acid for 15 seconds and the brackets were bonded using Transbond XT primer. Brackets were debonded using Conventional Debonding Plier and New Debonding Instrument (Group B). After debonding, the enamel surface of each tooth was examined under stereo microscope (10X magnifications). Amodifiedadhesive remnant index (ARI) was used to quantify the amount of remaining adhesive on each tooth. RESULTS: The observations demonstrate that the results of New Debonding Instrument for debonding of metal, ceramic and composite brackets were statistically significantly different (p = 0.04) and superior from the results of conventional debonding Pliers. CONCLUSION: The debonding efficiency of New Debonding Instrument is better than the debonding efficiency of Conventional Debonding Pliers for use of metal, ceramic and composite brackets respectively.

Design options for improving protective gloves for industrial assembly work.

The study investigated the effects of wearing two new designs of cotton glove on several hand performance capabilities and compared them against the effects of barehanded, single-layered and double cotton glove conditions when working with hand tools (screwdriver and pliers). The new glove designs were based on the findings of subjective hand discomfort assessments for this type of work and aimed to match the glove thickness to the localised pressure and sensitivity in different areas of the hand as well as to provide adequate dexterity for fine manipulative tasks. The results showed that the first prototype glove and the barehanded condition were comparable and provided better dexterity and higher handgrip strength than double thickness gloves. The results support the hypothesis that selective thickness in different areas of the hand could be applied by glove manufacturers to improve the glove design, so that it can protect the hands from the environment and at the same time allow optimal hand performance capabilities.

Evaluation of disinfection methods of orthodontic pliers / Avaliação dos métodos de desinfecção de alicates ortodônticos

INTRODUCTION: In recent years, a strong behavior change regarding the control of cross infection during dental treatment was perceived, except among some orthodontists who insist in the misconception that Orthodontics is a specialty of low risk in the transmission of infectious and contagious diseases. OBJECTIVE: The objective of this study was to evaluate the methods used by orthodontists for disinfection of pliers in their daily practice. METHODS: The bacteria Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus salivarius were inoculated in vitro in 30 orthodontic pliers. The pliers were divided into 3 groups (n = 10) and disinfected in different ways. Group 1: Brush, soap and water; Group 2: Cotton soaked in ethyl alcohol 70%; Group 3: Immersion in a solution of 2% glutaraldehyde for 30 minutes and then rinsed with water. RESULTS: The results showed that the ethyl alcohol 70% (Group 2) kept 20% of the pliers infected, being more efficient than the soap and water (Group 1), which maintained 60% of contaminated pliers. Only immersion in 2% glutaraldehyde was able to decontaminate all pliers and was statistically superior to the aforementioned methods (p = 0.030). CONCLUSION: Based on these results, we concluded that among the tested methods, disinfection of orthodontic pliers with 2% glutaraldehyde is the only efficient method.

INTRODUÇÃO: nos últimos anos, constatou-se uma forte mudança de comportamento no que diz respeito ao controle de infecção cruzada durante atendimento odontológico, exceto dentre alguns ortodontistas, que ainda persistem na ideia equivocada de que a Ortodontia é uma especialidade de baixo risco na transmissão de doenças infectocontagiosas. OBJETIVO: objetivo desse trabalho foi avaliar os métodos mais usados pelos ortodontistas para desinfecção de alicates na sua clínica diária. MÉTODOS: as bactérias Pseudomonas aeruginosa, Streptococcus salivarius e Staphylococcus aureus foram inoculadas in vitro em 30 alicates ortodônticos. Os alicates foram divididos em 3 grupos (n=10) e desinfectados de formas diferentes: grupo 1, escova, água e sabão; grupo 2, algodão embebido em álcool etílico a 70%; grupo 3, imersão em solução de glutaraldeído a 2% durante 30 minutos sendo, em seguida, enxaguados com água corrente. RESULTADOS: os resultados demonstraram que o álcool etílico 70% (grupo 2) manteve 20% dos alicates infectados, sendo mais eficiente que a água e sabão (grupo 1), que mantiveram 60% dos alicates contaminados. Apenas a imersão em glutaraldeído 2% foi capaz de descontaminar todos os alicates, sendo estatisticamente superior aos outros métodos (p =0,030). CONCLUSÃO: com base nesses resultados, concluiu-se que, dentre os métodos testados, a desinfecção de alicates ortodônticos com glutaraldeído 2% é o único método eficiente.

Remoção de braquetes cerâmicos com alicate de How associado à broca diamantada: avaliação da topografia do esmalte / Removal of ceramic brackets with How-type pliers in association with diamond drill: a topographic evaluation of the enamel

OBJETIVO: avaliar a topografia do esmalte dentário após a descolagem de braquetes cerâmicos Allure (GAC/Dentsply) através de dois diferentes métodos. METODOLOGIA: foram utilizados 20 incisivos inferiores permanentes bovinos divididos em dois grupos (n = 10). Em ambos os grupos foram feitas colagens de braquetes cerâmicos Allure utilizando-se Concise (3M Unitek) seguindo as recomendações do fabricante. Após a colagem, os espécimes foram mantidos em estufa, a 37ºC por 24 horas, para completa polimerização do compósito. Após isso foi realizada a remoção dos braquetes, sendo que no grupo A foi utilizado alicate de corte de amarrilho e no grupo B alicate tipo How em braquete previamente fragilizado com broca diamantada. Em ambos os grupos o remanescente de compósito foi removido com broca de carboneto de tungstênio. Após descolagem, os espécimes foram preparados para análise em microscopia eletrônica de varredura, para posterior análise da superfície do esmalte. RESULTADOS E CONCLUSÕES: os resultados mostraram maior quantidade de arranhões nos dentes do grupo A, esses resultados foram estatisticamente superiores ao grupo B com p < 0,05. Dessa maneira, verificou-se que o uso do alicate tipo How em braquete previamente fragilizado produziu menores arranhões à superfície de esmalte, indicando-o para uso clínico.

OBJECTIVE: to evaluate the topography of the tooth enamel after debonding Allure ceramic brackets using two different methods. METHODS: Twenty bovine permanent lower incisors were divided into two groups (n = 10). In groups A and B Allure ceramic brackets were bonded to the teeth using Concise composite according to manufacture's recommendations. After the bonding procedures, the samples were kept in stove at 37ºC for 24 hours for complete composite polymerization. Next, the brackets of group A were removed by using wire pliers, whereas the brackets of group B, which had been previously weakened with diamond drill, were debonded by using How-type pliers. In both groups the composite remnant was removed by using a tungsten carbide-tipped drill. Following the debonding procedures, the samples were prepared for scanning electronic microscopy so that their enamel surfaces could be analyzed. RESULTS AND COCLUSION: showing more scratch marks on the surfaces of the group A teeth were statistically superior to those found in group B (p < 0.05). Therefore, it was observed that the use of How-type pliers for debonding pre-weakened brackets caused less scratches on the enamel surface, which supports their clinical use.

Burns from orthodontic pliers.

A case of burn injury from orthodontic pliers resulting in a partial-thickness burn is presented. A brief description of the injury, a review of the pertinent literature, and general guidelines for out-patient management of such burns are also presented.

The application of internal anastomotic appliance of pouch pliers in the 65 cases retention of anus operation of mesal,low rectal carcinoma / 中国基层医药

Objective To investigate the application of a new type internal anastomotic appliance of pouch pliers in the retention of anus operation of mesal,low rectal carcinoma.Methods The data of 65 patients with mesal,low rectal carcinoma with the technique of the anal retention using KYGW type anastomotic appliance of pouch pliers were reviewed and analyzed retrospectively.Results 65 patients were coincided success only one time. Anastomotic fistula occurred after operation in 1 case,being cured and discharged at last,no anastomotic stricture. Conclusion The internal anastomotic appliance of pouch pliers in the anal retention of mesal-low rectal carcinoma is an efficient method with better cost-effectiveness and fewer complications,which is easy to manipulate and popular- ize.

Percutaneous lumbar diskectomy using rotating pliers system / 介入放射学杂志

Objective To explore the feasibility of using rotating pliers system for treating lumbar disc herniation with concomitant prolapse.Methods Ex vivo incision experiment was performed on 8 lumbar discs of 2 pigs using rotating pliers. Clinical application included 12 patients of lumbar disc herniation shown by CT or MRI. 40% herniations excerted enough pressure on dural sac with concomitant prolapse of different degrees. The symptoms and image findings were concordant. The herniated nucleus pulposus were resected using rotaing pliers system, MacNab standard was applied for the clinical evaluation. Results The ex vivo experiments and clinical application were successful. Clinical application showed CR in 4 patients (33.3%), PR in 5 patients (41.7%) and NR in 3 patients (25.0%). CT demonstrated the herniated disk tissue retraction of different degrees in CR and PR patients, together with decrease in CT attenuation number, ranging from 8 30 HU, 18?5HU in average but no changes in NR patients.Conclusions Percutaneous lumbar diskectomy is safe and effective to treat lumbar disc herniation with concomitant prolapse by using rotating pliers systems and thus extending the PLD application.