Safety and efficacy of regional citrate anticoagulation in continuous blood purification treatment of patients with multiple organ dysfunction syndrome

The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.

Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin

Abstract This study aimed to evaluate the effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Sixty root canals from mandibular incisors were instrumented and randomly divided into six groups (n = 10) according to the irrigant used: QMiX, 17% EDTA, 10% citric acid (CA), 1% peracetic acid (PA), 2.5% NaOCl (solution control), and distilled water (negative control). The chelating solutions were used to irrigate the canal followed by 2.5% NaOCl as a final flush. After the irrigation protocols, all specimens were rinsed with 10 mL of distilled water to remove any residue of the chemical solutions. Before and after the final irrigation protocols, dentin microhardness was measured with a Knoop indenter. Three indentations were made at 100 µm and 500 µm from the root canal lumen. Afterwards, the specimens were prepared for scanning electron microscopic analysis and the amount of dentin erosion was examined. Wilcoxon and Kruskal-Wallis tests were used to analyze the results with a significance level set at 5%. At 100 µm, all protocols significantly reduced dentin microhardness (p < .05), while at 500 µm, this effect was detected only in the EDTA and QMiX groups (p < .05). CA was the irrigant that caused more extensive erosion in dentinal tubules, followed by PA and EDTA. QMiX opened dentinal tubules, but did not cause dentin erosion. Results suggest that QMiX and 17% EDTA reduced dentin microhardness at a greater depth. Additionally, QMiX did not cause dentin erosion.

Efetividade de soluções endodônticas na redução da viabilidade de Enterococcus faecalis cultivados em forma séssil e planctônica / Effectiveness of endodontic solutions to reduce the viability of sessile and planktonic Enterococcus faecalis

Este estudo teve como objetivo avaliar a sensibilidade dos biofilmes de E. faecalis a NaOCl, CHX e PAA após uma exposição de ácido cítrico 2,5%. O biofilme de E. faecalis foi formado em lamínulas de vidro circular de 13 mm Ø em placas de cultura de 24 poços. Os biofilmes foram tratados ou não durante 5 minutos com ácido cítrico, posteriormente, exposto a diferentes concentrações de NaOCl, CHX e PAA. A atividade antimicrobiana foi avaliada por meio da contagem de unidade formadora de colônias (UFCs). Ao analisar o percentual de redução bacteriana na forma planctônica em função do tempo e da solução/concentração, o teste de Anova demonstrou não haver diferença estatística entre CHX e NaOCl (p>0,05). Contudo a CHX, quando utilizada sozinha, apresentou menor efetividade que NaOCl (p<0,05) sobre o biofilme. O pré-tratamento do biofilme com ácido cítrico tornou as bactérias na forma séssil mais sensível ao NaOCl e ao PAA. Baseado nos resultados obtidos foi possível concluir que o tratamento com ácido cítrico aumentou a sensibilidade do biofilme de E. faecalis a irrigante utilizado em procedimento endodôntico e orienta o início do tratamento com irrigação prévia com o ácido cítrico.

The present study aimed to evaluate the sensitivity of E. faecalis biofilms to NaOCl, CHX and PAA after exposure to 2.5% citric acid. The E. faecalis biofilm was formed in 13-mm diameter circular glass microslides in 24-well culture plates. The biofilms were treated or not for 5 minutes with citric acid, and subsequently exposed to different concentrations of NaOCl, CHX and PAA. The antimicrobial activity was assessed by colony-forming unit (CFU) count. When analyzing the bacterial reduction percentage in planktonic form according to the time and solution/concentration, the Anova test demonstrated no statistical difference between CHX and NaOCl (p>0.05). However, CHX, when utilized alone, presented less effectiveness than NaOCl (p<0.05) on the biofilm. The citric acid pretreatment of the biofilm made the bacteria in the sessile form more sensitive to NaOCl and PAA. Based on the obtained results, it was possible to conclude that citric acid treatment increased the sensitivity of the E. faecalis biofilm to irrigants employed in endodontic procedures, guiding the beginning of treatment with prior citric acid irrigation.

effect of four commonly used root conditioner agents in different time periods applied on periodontally diseased and healthy teeth

Statement of Problem: Root surface contamination or infection can potentially change the consequences of regenerative periodontal therapies and therefore the modification and disinfection of the contaminated root surfaces are necessary

Objectives: This study aimed to compare the surface characteristics of the extracted human teeth after exposure to four root conditioners in different time periods

Materials and Methods: The study samples were prepared from 40 freshly extracted teeth including 20 affected teeth with periodontal diseases and 20 healthy teeth. After performing root planning, 240 dentinal block samples were prepared and each affected and healthy sample was randomly allocated to receive one of the following root conditioners; Ethylenediaminetetraaceti acid [EDTA], citric acid, doxycycline, and tetracycline or rinsed with normal saline as the control agent. The prepared specimens were evaluated using scanning electron microscope and the inter-group differences and changes in study indices; dentin [%], tubular spaces [%], and diameter of dentinal tubules [micro m[2]] were compared using one-way ANOVA test

Results: In the control group receiving normal saline, the changes in the indicators of dentin, tubular spaces, and diameter of dentinal tubules remained insignificant in all time periods. EDTA, citric acid, and tetracycline had chelating effects on the study indices; however, doxycycline led to gradual decrease of the tubular space and diameter as well as increase in dentin percentage

Conclusions: In different time intervals and when considering healthy or affected tooth surfaces, the effect of conditioning agents could be different. Amongst the four agents used, EDTA and tetracycline consistently increased the diameter of tubules and percentage of patent tubules in both healthy and diseased teeth

Efeito da desmineralização óssea sobre parâmetros de superfície e sobre o comportamento de pré-osteoblastos em cultura: estudo em microscopia eletrônica de varredura e confocal / Effect of bone demineralization on surface parameters and on behavior of pre-osteoblasts in culture: study in scanning electron microscopy and confocal microscopy

A desmineralização óssea superficial tem se demonstrado favorável à consolidação de enxertos e ao comportamento celular, entretanto os mecanismos envolvidos ainda não estão esclarecidos. Os subsídios para o embasamento biológico da desmineralização, proporcionado por publicações anteriores, sugeriram que modificações na superfície óssea teriam influenciado o comportamento de pré-osteoblastos em cultura. Assim, este estudo objetivou comparar o efeito de duas concentrações de ácido cítrico na desmineralização de superfícies ósseas onde foram cultivadas células pré-osteoblásticas (MC3T3-E1), e analisar parâmetros de superfície comparando superfícies desmineralizadas a não desmineralizadas. Setenta amostras ósseas bicorticais foram removidas das calvárias de 35 ratos e divididas em grupos para as análises: 1) Microscopia Eletrônica de Varredura (MEV) para avaliação da área de recobrimento e espessura da camada de células sobre as amostras (n = 15) durante 24, 48 e 72 horas: Grupo AC.10 – amostras desmineralizadas por 30 segundos com ácido cítrico 10 %; Grupo AC.50 –amostras desmineralizadas por 30 segundos com ácido cítrico 50 %; e Grupo C (controle) – amostras não desmineralizadas; 2) Microscopia Confocal para análise da área de expressão e intensidade de fluorescência das BMP-2, -4 e -7: AC.10 – seis amostras desmineralizadas conforme item 1); AC.50 – seis amostras desmineralizadas conforme item 1); C – três amostras não desmineralizadas; 3) Microscopia Confocal para análise da rugosidade superficial média (Ra e Sa): Grupos AC.10 e AC.50 com cinco amostras cada, desmineralizadas conforme o item 1), sendo cada amostra seu próprio controle (análises antes e depois da desmineralização). Também foram avaliadas as distâncias entre picos (P-P) e entre picos e vales (P-V) antes e depois da desmineralização; 4) Microscopia Eletrônica de Varredura / Espectroscopia de Energia Dispersiva (MEV / EDS) para análise da composição superficial: mesmas...

The superficial bone demineralization has proved to be a favorable procedure for bone grafts consolidation and cell behavior, however the underlying mechanisms have not been clarified yet. Therefore, this study aimed to compare the effect of two concentrations of citric acid on demineralization of bone surfaces where pre-osteoblastic cells (MC3T3-E1) were cultivated, and analyze surface parameters comparing demineralized bone surfaces with non-demineralized surfaces. Seventy bicortical bone samples were harvested from the calvaria of 35 rats and divided into groups as follows: 1) Scanning Electron Microscopy (SEM) to evaluate the coating area and thickness of cells layers cultured on the samples (n = 15) for 24, 48, and 72 hours: Group CA.10 – samples demineralized for 30 seconds with 10 % citric acid; Group CA.50 – samples demineralized for 30 seconds with 50 % citric acid, and Group C (control) – non-demineralized samples; 2) Confocal Microscopy for analysis of expression area and intensity of fluorescence of BMP-2, -4, and -7: CA.10 – six samples demineralized as item 1); CA.50 – six samples demineralized as item 1); Group C – three non-demineralized samples; 3) Confocal Microscopy for surface mean roughness analysis (Ra and Sa): Groups CA.10 and CA.50 made up of five samples each and demineralized according to item 1), each sample was its own control (analysis before and after demineralization). The distances between peaks (P-P) and between peaks and valleys (P-V) were also evaluated before and after demineralization; 4) Scanning Electron Microscopy / Energy Dispersive Spectroscopy (SEM / EDS) to analyze the surface composition: the same samples of item 3) were evaluated before and after demineralization for atomic percentage (%A) of carbon, oxygen, magnesium, phosphorus, sulfur and calcium. Statistical test was made by adopting the 95 % significance level. Demineralized samples showed cells with morphology in the later stages of differentiation...

Efeito da desmineralização óssea sobre parâmetros de superfície e sobre o comportamento de pré-osteoblastos em cultura: estudo em microscopia eletrônica de varredura e confocal / Effect of bone demineralization on surface parameters and on behavior of pre-osteoblasts in culture: study in scanning electron microscopy and confocal microscopy

A desmineralização óssea superficial tem se demonstrado favorável à consolidação de enxertos e ao comportamento celular, entretanto os mecanismos envolvidos ainda não estão esclarecidos. Os subsídios para o embasamento biológico da desmineralização, proporcionado por publicações anteriores, sugeriram que modificações na superfície óssea teriam influenciado o comportamento de pré-osteoblastos em cultura. Assim, este estudo objetivou comparar o efeito de duas concentrações de ácido cítrico na desmineralização de superfícies ósseas onde foram cultivadas células pré-osteoblásticas (MC3T3-E1), e analisar parâmetros de superfície comparando superfícies desmineralizadas a não desmineralizadas. Setenta amostras ósseas bicorticais foram removidas das calvárias de 35 ratos e divididas em grupos para as análises: 1) Microscopia Eletrônica de Varredura (MEV) para avaliação da área de recobrimento e espessura da camada de células sobre as amostras (n = 15) durante 24, 48 e 72 horas: Grupo AC.10 – amostras desmineralizadas por 30 segundos com ácido cítrico 10 %; Grupo AC.50 –amostras desmineralizadas por 30 segundos com ácido cítrico 50 %; e Grupo C (controle) – amostras não desmineralizadas; 2) Microscopia Confocal para análise da área de expressão e intensidade de fluorescência das BMP-2, -4 e -7: AC.10 – seis amostras desmineralizadas conforme item 1); AC.50 – seis amostras desmineralizadas conforme item 1); C – três amostras não desmineralizadas; 3) Microscopia Confocal para análise da rugosidade superficial média (Ra e Sa): Grupos AC.10 e AC.50 com cinco amostras cada, desmineralizadas conforme o item 1), sendo cada amostra seu próprio controle (análises antes e depois da desmineralização). Também foram avaliadas as distâncias entre picos (P-P) e entre picos e vales (P-V) antes e depois da desmineralização; 4) Microscopia Eletrônica de Varredura / Espectroscopia de Energia Dispersiva (MEV / EDS) para análise da composição superficial: mesmas...

The superficial bone demineralization has proved to be a favorable procedure for bone grafts consolidation and cell behavior, however the underlying mechanisms have not been clarified yet. Therefore, this study aimed to compare the effect of two concentrations of citric acid on demineralization of bone surfaces where pre-osteoblastic cells (MC3T3-E1) were cultivated, and analyze surface parameters comparing demineralized bone surfaces with non-demineralized surfaces. Seventy bicortical bone samples were harvested from the calvaria of 35 rats and divided into groups as follows: 1) Scanning Electron Microscopy (SEM) to evaluate the coating area and thickness of cells layers cultured on the samples (n = 15) for 24, 48, and 72 hours: Group CA.10 – samples demineralized for 30 seconds with 10 % citric acid; Group CA.50 – samples demineralized for 30 seconds with 50 % citric acid, and Group C (control) – non-demineralized samples; 2) Confocal Microscopy for analysis of expression area and intensity of fluorescence of BMP-2, -4, and -7: CA.10 – six samples demineralized as item 1); CA.50 – six samples demineralized as item 1); Group C – three non-demineralized samples; 3) Confocal Microscopy for surface mean roughness analysis (Ra and Sa): Groups CA.10 and CA.50 made up of five samples each and demineralized according to item 1), each sample was its own control (analysis before and after demineralization). The distances between peaks (P-P) and between peaks and valleys (P-V) were also evaluated before and after demineralization; 4) Scanning Electron Microscopy / Energy Dispersive Spectroscopy (SEM / EDS) to analyze the surface composition: the same samples of item 3) were evaluated before and after demineralization for atomic percentage (%A) of carbon, oxygen, magnesium, phosphorus, sulfur and calcium. Statistical test was made by adopting the 95 % significance level. Demineralized samples showed cells with morphology in the later stages of differentiation...

Medicinas tradicionales andinas y su despenalización: entrevista con Walter Álvarez Quispe / Decriminalizing traditional Andean medicine: an interview with Walter Álvarez Quispe

Walter Álvarez Quispe, terapeuta kallawaya y biomédico especializado en cirugía general y ginecología, presenta la lucha de los terapeutas tradicionales y alternativos por la depenalización de estos sistemas médicos andinos realizada entre 1960 y 1990. Bolivia se torna el primer país en América Latina y el Caribe en despenalizar la medicina tradicional antes de los planteamientos de la Conferencia Internacional sobre Atención Primaria de Salud (Alma-Ata, 1978). Los datos aportados por el entrevistado aseguran que los logros alcanzados, principalmente por los kallawayas, responden a un proyecto propio y autónomo. Estas conquistas no se deben a las políticas oficiales de interculturalidad en salud, aunque busquen atribuirse para sí los logros alcanzados.

Walter Álvarez Quispe, a Kallawaya healer and biomedical practitioner specializing in general surgery and gynecology, presents the struggle of traditional and alternative healers to get their Andean medical systems depenalized between 1960 and 1990. Bolivia was the first country in Latin America and the Caribbean to decriminalize traditional medicine before the proposals of the International Conference on Primary Health Care (Alma-Ata, 1978). The data provided by the interviewee show that the successes achieved, mainly by the Kallawayas, stem from their own independent initiative. These victories are not the result of official policies of interculturality in healthcare, although the successes achieved tend to be ascribed to them.

In vitro regeneration and ploidy level analysis of Eulophia ochreata Lindl.

Various parameters including explant-type, medium compositions, use of phytohormones and additives were optimized for direct and indirect regeneration of E. ochreata, a medicinal orchid under threat. Protocorm-like-bodies (PLBs) proved to be the best explants for shoot initiation, proliferation and callus induction. Murashige and Skoog’s (MS) medium containing 2.5 mg L-1 6-benzylaminopurine (BAP), 1.0 mg L-1 kinetin (Kin) and additives (adenine sulfate, arginine, citric acid, 30 mg L-1 each and 50 mg L-1 ascorbic acid) was optimal for shoot multiplication (12.1 shoots and 7.1 PLBs per explant with synchronized growth), which also produced callus. Shoot number was further increased with three successive subcultures on same media and ~40 shoots per explant were achieved after 3 cycles of 30 days each. Additives and casein hydrolysate (CH) showed advantageous effects on indirect shoot regeneration via protocorm-derived callus. Optimum indirect regeneration was achieved on MS containing additives, 500 mg L-1 CH, 2.5 mg L-1 BAP and 1.0 mg L-1 Kin with 30 PLBs and 6 shoots per callus mass (~5 mm size). The shoots were rooted (70% frequency) on one by fourth-MS medium containing 2.0 mg L-1 indole-3-butyric acid, 200 mg L-1 activated charcoal and additives. The rooted plantlets were hardened and transferred to greenhouse with 63% survival rate. Flow-cytometry based DNA content analysis revealed that the ploidy levels were maintained in in vitro regenerated plants. This is the first report for in vitro plant regeneration in E. ochreata.

Etidronate from Medicine to Endodontics: effects of different irrigation regimes on root dentin roughness

An increase in dentin roughness, associated with surface composition, contributes to bacterial adherence in recontaminations. Surface roughness is also important for micromechanical interlocking of dental materials to dentin, and understanding the characteristics of the surface is essential to obtain the adhesion of root canal sealers that have different physico-chemical characteristics. OBJECTIVES: To evaluate the effects of sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), etidronic (HEBP), and citric acid (CA) associated with different irrigation regimens on root dentin roughness. MATERIAL AND METHODS: Forty-five root halves of anterior teeth were used. The root parts were sectioned in thirds, embedded in acrylic resin and polished to a standard surface roughness. Initially, the samples of each third were randomly assigned into 3 groups and treated as follows: G1 - saline solution (control); G2 - 5% NaOCl+18% HEBP mixed in equal parts; and G3 - 2.5% NaOCl. After initial measuments, the G3 samples were distributed into subgroups G4, G5 and G6, which were subjected to 17% EDTA, 10% CA and 9% HEBP, respectively. Following the new measuments, these groups received a final flush with 2.5% NaOCl, producing G7, G8 and G9. The dentin surface roughness (Ra) was determined before and after treatments using a profilometer. The Wilcoxon test (α<0.05) was used to compare the values before and after treatments, and the Friedman test (α<0.05) to detect any differences among root thirds. RESULTS: (i) NaOCl did not affect the surface roughness; (ii) there was a significant increase in roughness after the use of chelating agents (P<0.01); and (iii) only the G3 group showed a difference in surface roughness between apical third and other thirds of the teeth (P<0.0043). CONCLUSION: Only the irrigation regimens that used chelating agents altered the roughness of root dentin. .

Efeito da desmineralização ácida da interface enxerto-leito na consolidação de enxertos ósseos autógenos em bloco / Influence of acid demineralization of contacting osseous surfaces on the consolidation of autogenous onlay bone grafts

Para testar a hipótese de que a desmineralização in situ das superfícies de contato enxerto-leito, e a forma como o enxerto é estabilizado ao leito, podem influenciar os mecanismos envolvidos na consolidação do enxerto, fragmentos ósseos de 10 mm de diâmetro foram removidos das metáfises proximais tibiais de 36 coelhos (Oryctolagus Cuniculus) e transplantados para uma área adjacente. Na tíbia esquerda dos animais, as superfícies de contato do enxerto e do leito hospedeiro foram desmineralizadas com ácido cítrico pH 1,0 por 3 minutos antes dos enxertos serem fixados ao leito. Na tíbia direita, o transplante do bloco ósseo não foi precedido de desmineralização. Metade dos enxertos foi imobilizada sobre o leito pela superposição de uma membrana não reabsorvível de politetrafluoretileno colada com cianoacrilato ao leito à distância da interface enxerto-leito. A outra metade dos enxertos foi fixada por um parafuso de titânio no centro do enxerto. Assim, foram formados 4 grupos de estudo: membrana (M), membrana + ácido (MA), parafuso (P) e parafuso + ácido (PA). Três animais de cada grupo forneceram espécimes para análise microscópica quantitativa e qualitativa aos 15, 30 e 45 dias de pós-operatório. A análise qualitativa demonstrou que não houve formação óssea na interface em nenhum espécime aos 15 dias e que nos demais períodos, em todos os grupos, a quantidade de tecido ósseo neoformado na interface e seu estágio de maturação aumentaram com o tempo. Ambos os métodos de fixação empregados foram eficientes em manter os enxertos em posição, porém a membrana promoveu menor reabsorção da estrutura do enxerto. A análise quantitativa computadorizada revelou que, aos 30 dias, os grupos MA e PA apresentaram maior área de formação óssea na interface (71,34 ± 12,03%; 56,74 ± 2,15% respectivamente) em relação aos grupos M e P (51,75 ± 11,02%; 43,95 ± 4,05% respectivamente) e superfícies de consolidação óssea mais extensas (93,41 ± 5,95%; 93,73 ± 4,96%...

In order to test the hypothesis that the demineralization "in situ" of contacting surfaces of bone graft/bone bed and the fixation method used for graft stabilization can influence the mechanisms involved in the consolidation of the graft, bone fragments of 10 mm in diameter were removed from the proximal tibial metaphysis of thirty-six male rabbits (Oryctolagus Cuniculus) and transplanted to an adjacent area. In the left tibia of the animals, the contacting surfaces of the graft and host bed were demineralized with citric acid pH 1.0 for 3 minutes before the grafts were fixed to the receptor bed. In the right tibia, the bone block transplantation was not preceded by demineralization. Half of the grafts were immobilized on the bone bed by a nonresorbable polytetrafluoroethylene membrane glued with cyanoacrylate adhesive to the host bed distant from the bone graft-bone bed interface. The other half of the grafts were fixed by a titanium screw in the center of the graft. Thus, four groups were formed: membrane (M), membrane + acid (MA), screw (P) and screw + acid (PA). Three animals from each group provided specimens for quantitative and qualitative microscopic analysis at 15, 30 and 45 days postoperatively. Qualitative analysis showed no significant bone formation at the interface in any specimen of the groups at 15 days and on the other periods in all groups, the amount of newly formed bone at the interface as well as the stage of bone maturation increased with time. Both fixation methods were effective in maintaining the graft in position, but the membrane resulted in less resorption of the graft. Quantitative analysis, performed by means of a computer program for image analysis, showed that at day 30, groups MA and PA, showed greater area of bone formation at the interface (71.34 ± 12.03%; 56.74 ± 2 15%) than groups M and P (51.75 ± 11.02%, 43.95 ± 4.05%) and more osseointegrated bone surfaces (93.41 ± 5.95%, 93.73 ± 4.96%) than those...

Efeito da desmineralização ácida da interface enxerto-leito na consolidação de enxertos ósseos autógenos em bloco / Influence of acid demineralization of contacting osseous surfaces on the consolidation of autogenous onlay bone grafts

Para testar a hipótese de que a desmineralização in situ das superfícies de contato enxerto-leito, e a forma como o enxerto é estabilizado ao leito, podem influenciar os mecanismos envolvidos na consolidação do enxerto, fragmentos ósseos de 10 mm de diâmetro foram removidos das metáfises proximais tibiais de 36 coelhos (Oryctolagus Cuniculus) e transplantados para uma área adjacente. Na tíbia esquerda dos animais, as superfícies de contato do enxerto e do leito hospedeiro foram desmineralizadas com ácido cítrico pH 1,0 por 3 minutos antes dos enxertos serem fixados ao leito. Na tíbia direita, o transplante do bloco ósseo não foi precedido de desmineralização. Metade dos enxertos foi imobilizada sobre o leito pela superposição de uma membrana não reabsorvível de politetrafluoretileno colada com cianoacrilato ao leito à distância da interface enxerto-leito. A outra metade dos enxertos foi fixada por um parafuso de titânio no centro do enxerto. Assim, foram formados 4 grupos de estudo: membrana (M), membrana + ácido (MA), parafuso (P) e parafuso + ácido (PA). Três animais de cada grupo forneceram espécimes para análise microscópica quantitativa e qualitativa aos 15, 30 e 45 dias de pós-operatório. A análise qualitativa demonstrou que não houve formação óssea na interface em nenhum espécime aos 15 dias e que nos demais períodos, em todos os grupos, a quantidade de tecido ósseo neoformado na interface e seu estágio de maturação aumentaram com o tempo. Ambos os métodos de fixação empregados foram eficientes em manter os enxertos em posição, porém a membrana promoveu menor reabsorção da estrutura do enxerto. A análise quantitativa computadorizada revelou que, aos 30 dias, os grupos MA e PA apresentaram maior área de formação óssea na interface (71,34 ± 12,03%; 56,74 ± 2,15% respectivamente) em relação aos grupos M e P (51,75 ± 11,02%; 43,95 ± 4,05% respectivamente) e superfícies de consolidação óssea mais extensas (93,41 ± 5,95%; 93,73 ± 4,96%...

In order to test the hypothesis that the demineralization "in situ" of contacting surfaces of bone graft/bone bed and the fixation method used for graft stabilization can influence the mechanisms involved in the consolidation of the graft, bone fragments of 10 mm in diameter were removed from the proximal tibial metaphysis of thirty-six male rabbits (Oryctolagus Cuniculus) and transplanted to an adjacent area. In the left tibia of the animals, the contacting surfaces of the graft and host bed were demineralized with citric acid pH 1.0 for 3 minutes before the grafts were fixed to the receptor bed. In the right tibia, the bone block transplantation was not preceded by demineralization. Half of the grafts were immobilized on the bone bed by a nonresorbable polytetrafluoroethylene membrane glued with cyanoacrylate adhesive to the host bed distant from the bone graft-bone bed interface. The other half of the grafts were fixed by a titanium screw in the center of the graft. Thus, four groups were formed: membrane (M), membrane + acid (MA), screw (P) and screw + acid (PA). Three animals from each group provided specimens for quantitative and qualitative microscopic analysis at 15, 30 and 45 days postoperatively. Qualitative analysis showed no significant bone formation at the interface in any specimen of the groups at 15 days and on the other periods in all groups, the amount of newly formed bone at the interface as well as the stage of bone maturation increased with time. Both fixation methods were effective in maintaining the graft in position, but the membrane resulted in less resorption of the graft. Quantitative analysis, performed by means of a computer program for image analysis, showed that at day 30, groups MA and PA, showed greater area of bone formation at the interface (71.34 ± 12.03%; 56.74 ± 2 15%) than groups M and P (51.75 ± 11.02%, 43.95 ± 4.05%) and more osseointegrated bone surfaces (93.41 ± 5.95%, 93.73 ± 4.96%) than those...

Chitosan: effect of a new chelating agent on the microhardness of root dentin

The effect of solutions of 0.2% chitosan, 15% EDTA and 10% citric acid on the microhardness of root dentin was evaluated comparatively in this study. Thirteen sound human maxillary central incisors were selected and decoronated at the cementoenamel junction. Ten roots were set into rapid polymerization acrylic resin and the root/resin block was fitted to the cutting machine to obtain slices from the cervical third. The first slice was discarded and the second slice was divided into four quadrants. Each quadrant was used to construct a sample, so that 4 specimens were obtained from each root slice, being one for each chelating solution to be tested: 15% EDTA, 10% citric acid, 0.2% chitosan and distilled water (control). The specimens were exposed to 50 μL of the solution for 5 min, and then washed in distilled water. A microhardness tester (Knoop hardness) with a 10 g load was used for 15 s. Data were analyzed statistically by one-way ANOVA and Tukey-Kramer test (α=0.05). The other 3 roots had the canals instrumented and irrigated at the end of the biomechanical preparation with the test solutions, and then examined by scanning electron microscopy (SEM) for qualitative analysis. All solutions reduced the microhardness of root dentin in a way that was statistically similar to each other (p>0.05) but significantly different from the control (p>0.05). The SEM micrographs showed that the three solutions removed smear layer from the middle third of the root canal. In conclusion, 0.2% chitosan, 15% EDTA and 10% citric acid showed similar effects in reducing dentin microhardness.

Avaliou-se o efeito das soluções de quitosana 0,2%, EDTA 15% e ácido cítrico 10% sobre a microdureza da dentina radicular. Foram utilizados 13 incisivos centrais superiores humanos, os quais tiveram suas coroas seccionadas transversalmente e desprezadas. Dez raízes foram incluídas em resina acrílica de rápida polimerização e o bloco formado raiz/resina adaptado à maquina de corte. Desprezou-se o primeiro corte transversal da porção cervical e dividiu-se o segundo, em 4 quadrantes. Cada quarto foi destinado à confecção do corpo-de-prova obtendo-se 4 espécimes para cada raiz, um para cada solução (n=10): EDTA a 15%, ácido cítrico a 10%, quitosana a 0,2% e água destilada (controle). Os espécimes receberam 50 μ L da solução por 5 min, sendo em seguida, lavados com água destilada. Utilizou-se um microdurômetro (dureza Knoop) com carga de 10 g durante 15 s. Os dados foram avaliados por meio do teste ANOVA e Tukey-Kramer (α=0,05). Três incisivos centrais superiores foram instrumentados e irrigados, ao final da biomecânica, com uma das soluções estudadas. Os espécimes foram levados para MEV e posterior análise qualitativa. Todas as soluções avaliadas reduziram a microdureza da dentina radicular de forma semelhante entre si (p>0,05) e estatisticamente diferente do controle (p<0,01). As fotomicrografias mostraram que as 3 soluções removeram a smear layer do terço médio do canal radicular. Concluiu-se que as soluções de quitosana 0,2%, EDTA 15% e ácido cítrico 10% apresentam efeito semelhante na redução da microdureza dentinária.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37 percent phosphoric acid for 3 min; 5) Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100 percent of the specimens from the groups PA and control; in 80 percent from EDTA group; in 33.3 percent from TC-HCl group and 0 percent from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17 percent; TC-HCl=0.08±0.06 percent; PA=0.03±0.05 percent; EDTA=0.01±0.01 percent and Control=0±0 percent. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Development of an orange juice surrogate for the study of dental erosion

The aim of this study was to create a synthetic juice (SJ) to be used as a surrogate for natural orange juices in erosion studies, verifying its erosive potential. The SJ was formulated based on the chemical composition of orange juices from different locations. Forty enamel and 40 root dentin specimens were randomly assigned into 4 experimental groups (n=10): SJ; 1% Citric Acid (CA); Minute Maid Original® (MM) and Florida Natural Original® (FN). The specimens were immersed in their respective solutions for 5 min, 6x/day for 5 days, in an erosion-remineralization cycling model. Enamel specimens were analyzed by surface Knoop microhardness and optical profilometry and dentin specimens only by optical profilometry. Outcomes were analyzed statistically by ANOVA followed by Tukey’s test considering a significance level of 5%. For enamel, the surface loss and microhardness changes found for MM and SJ groups were similar (p>0.05) and significantly lower (p<0.01) than those found in the CA group. For dentin, CA promoted significantly greater (p<0.01) surface loss compared with all the other groups. No significant difference (p>0.05) was observed in dentin surface loss between MM and SJ. In conclusion, CA was the most erosive solution, and SJ had a similar erosive potential to that of MM natural orange juice.

O objetivo deste estudo foi criar um suco sintético (SJ) para ser usado como substituto do suco de laranja natural em estudos de erosão dental, verificando o seu potencial erosivo. O SJ foi formulado com base na composição química de sucos de laranja de diferentes locais. Quarenta espécimes de esmalte e 40 de dentina radicular foram aleatoriamente alocados em 4 grupos experimentais (n=10): SJ; 1% Citric acid (CA); Minute Maid Original® (MM) e Florida Natural Original® (FN). Os espécimes foram imersos nas suas respectivas soluções por 5 min, 6x/dia por 5 dias, em um modelo de ciclagem de erosão-remineralização. Os espécimes de esmalte foram analisados por microdureza de superfície Knoop e perfilometria ótica, enquanto que os espécimes de dentina foram analisados somente por perfilometria. Os resultados foram analisados estatisticamente com o teste de ANOVA, seguido pelo teste de Tukey, considerando um nível de significância de 5%. Para o esmalte, a perda superficial e as alterações de microdureza encontradas para os grupos MM e SJ foram similares (p>0,05) e significantemente menores (p<0,01) do que as encontradas para o grupo CA. Para dentina, CA promoveu significantemente (p<0,01) a maior perda de superfície quando comparada aos outros grupos. Não foram encontradas diferenças significantes (p>0,05) entre a perda de superfície de dentina dos grupos MM e SJ. Concluiu-se que CA foi a solução mais erosiva e SJ apresentou um potencial erosivo semelhante ao do suco de laranja natural MM.

Effect of iron gel on dentin permeability

This study evaluated in vitro the effect of an experimental gel containing iron on the reduction of hydraulic conductance of dentin. Thirty-six 1-mm-thick dentin discs obtained from extracted human third molars were divided into 3 groups of 10 specimens each. The groups corresponded to the following experimental materials: 1.23 percent acidulated phosphate fluoride gel, pH 4.1; 3 percent potassium oxalate gel, pH 4.1 (Oxa-Gel®); and iron sulfate gel (10 mmol/L FeSO4), pH 4.1. The gels were applied to dentin under the following conditions: after 37 percent phosphoric acid and before 6 percent citric acid. Data were analyzed statistically by ANOVA and Tukey's test at 5 percent significance level. There was no significant differences (p<0.05) among the groups in any of the conditions for hydraulic conductance reduction, except for smear layer presence. The active agents reduced dentin permeability, but they produced significantly lower (p<0.05) reduction in hydraulic conductance when compared to presence of smear layer. The effectiveness in reducing dentin permeability was not significantly different (p>0.05) among the gels. This study suggests that the iron gel promoted reduction in dentin permeability comparable to that of the other agents and thus may be considered a good clinical alternative for the treatment of dentin hypersensitivity.

Este estudo objetivou avaliar in vitro o efeito do gel experimental contendo ferro na redução da condutividade hidráulica na dentina. Trinta e seis discos de dentina humana de 1 mm de espessura, foram obtidos de terceiros molares extraídos divididos em 3 grupos de 10 espécimes cada. Os grupos foram divididos nos seguintes grupos experimentais: F- flúor gel a 1,23 por cento, pH 4,1; O- gel de oxalato de potássio a 3 por cento, pH 4,1; I- gel de sulfato ferroso FeSO4 a 10 mmol/L, pH 4,1. Os géis foram aplicados na dentina sob as diferentes condições: após o ácido fosfórico a 37 por cento a antes do ácido cítrico a 6 por cento. Os resultados foram analisados por ANOVA e teste de Tukey, com nível de significância de 5 por cento. Todos os grupos (gel de flúor, oxalato de potássio e gel de ferro) não apresentaram diferenças significativas entre si para todas as condições testadas, exceto na presença da smear layer (p<0,05). Os produtos utilizados reduziram a permeabilidade dentinária, entretanto apresentaram baixa redução quando comparados à smear layer (p<0,05). Não houve diferença significativa na efetividade dos géis testados para reduzir a permeabilidade dentinária (p<0,05). Este estudo sugere que o gel de ferro promoveu redução na permeabilidade dentinária comparável à dos outros agentes e, portanto, pode ser considerada uma boa alternativa clínica para o tratamento da hipersensibilidade dentinária.

Regional Anticoagulation with Citrate is Superior to Systemic Anticoagulation with Heparin in Critically Ill Patients Undergoing Continuous Venovenous Hemodiafiltration

BACKGROUND/AIMS: Short hemofilter survival and anticoagulation-related life-threatening complications are major problems in systemic anticoagulation with heparin (SAH) for continuous renal replacement therapy (CRRT). The present study examined if regional anticoagulation with citrate (RAC) using commercially available solutions can overcome the associated problems of SAH to produce economical benefits. METHODS: Forty-six patients were assigned to receive SAH or RAC. We assessed the coagulation state, clinical outcomes, and adverse events. A Kaplan-Meier analysis was used to estimate hemofilter life span. The economical benefit related to the prolonged hemofilter survival was examined on the basis of the average daily cost. RESULTS: The mean age of patients was 66.5 +/- 13.8 years and the majority were male (60.9%). While elective discontinuation was most common cause of early CRRT interruption in the RAC group (34.3%, p < 0.01), hemofilter clotting was most prevalent in the SAH group (82.2%, p < 0.01). The patient metabolic and electrolyte control and survival rate were not different between the two groups. When compared with the RAC group, the anticoagulation-associated bleeding was a major complication in the SAH group (15.0% vs. 61.5%, p < 0.01). Regional anticoagulated hemofilters displayed a significantly longer survival time than systemic anticoagulated hemofilters (59.5 +/- 3.8 hr vs. 15.6 +/- 1.3 hr, p < 0.01). Accordingly, the mean daily continuous venovenous hemodiafiltration costs in the RAC and SAH groups were $575 +/- 268 and $1,209 +/- 517, respectively (p < 0.01). CONCLUSIONS: RAC prolonged hemofilter survival, displaying an economical benefit without severe adverse effects. The present study therefore demonstrates that RAC, using commercially available solutions, may be advantageous over SAH as a cost-effective treatment in CRRT.

Inhibitory activity of root canal irrigants against Candida albicans, Enterococcus faecalis and Staphylococcus aureus

The present study evaluated the antimicrobial activity of three root canal irrigants against Enterococcus faecalis, Candida albicans, and Staphylococcus aureus. These microorganisms were incubated in the presence of citric acid (6 and 10 percent), EDTA (17 percent), and NaOCl (0.5, 1.0, 2.5, and 5.25 percent). Agar diffusion tests were performed and redox indicator resazurin was used to evaluate the inhibitory effect of the irrigants on the metabolic activity of these microorganisms. The mean diameters of the inhibition zones for the C. albicans cultures were 11.6 mm (17 percent EDTA), 5.5 mm (0.5 percent NaOCl), 12.9 mm (1 percent NaOCl), 22.1 mm (2.5 percent NaOCl), and 28.5 mm (5.25 percent NaOCl). The mean diameters of the inhibition zones for E. faecalis were 2.8 mm (1 percent NaOCl), 5.4 mm (2.5 percent NaOCl), and 8.3 mm (5.25 percent NaOCl). For S. aureus, the mean values were 8.0 mm (17 percent EDTA), 3.0 mm (1 percent NaOCl), 8.8 mm (2.5 percent NaOCl), and 10.0 mm (5.25 percent NaOCl). Most of the irrigant solutions presented effective antimicrobial activity against C. albicans. A high inhibitory effect on the metabolic activity of E. faecalis was detected when the microorganisms were incubated with 17 percent EDTA. The same result was reached when S. aureus was incubated in the presence of > 2.5 percent NaOCl. Altogether, these results indicate that 2.5 percent and 5.25 percent NaOCl are microbicides against S. aureus while 0.5 percent and 1 percent NaOCl are only microbiostatic against the tested bacteria. The 6 percent and 10 percent citric acid as well as 17 percent EDTA did not affect the viability of any of the assayed microorganisms.

Antimicrobial effect of MTAD, Tetraclean, Cloreximid, and sodium hypochlorite on three common endodontic pathogens.

Objectives: The aim of this in vitro study was to evaluate the antimicrobial action of BioPure MTAD (Dentsply Tulsa Dental, Johnson City, TN), Tetraclean, Cloreximid (a mixture of Chlorhexidine (CHX) digluconate and Cetrimide), and 5.25% NaOCl (Ogna Laboratori Farmaceutici, Milano, Italy) against selected endodontic pathogens (Enterococcus faecalis, Porphyromonas gingivalis, and Prevotella intermedia). Materials and Methods: The agar plate diffusion procedure was used to observe the antimibrobial activity of irrigants. Results: Statistical analysis revealed significant effects of the different irrigants on the bacteria colonies. Treatment with 5.25% NaOCl induced a larger zone of microbial inhibition in Prevotella intermedia and Porphyromonas gingivalis (Tukey HSD post-test, P = 0.0001) when compare to MTAD, Tetraclean and CHX. Anyway, MTAD and Tetraclean were more effective to inhibit bacterial growth compared to CHX (P < 0.0001, Tukey HSD post-test). Furthermore, post hoc analysis revealed that MTAD and Tetraclean induced the largest zone of microbial inhibition of Enterococcus faecalis cultured under both aerobic and anaerobic conditions, when compared with 2% CHX and NaOCl (P < 0.0001, Tukey HSD post-test). The control group showed no microbial inhibition. Conclusion: 5.25% NaOCl showed a high antimicrobial activity against anaerobic bacteria. MTAD and Tetraclean showed a high action against both, strictly anaerobic and facultative anaerobic bacteria. Chlorexidine + Cetrimide (Cloreximid) showed the lowest antibacterial activity against both, facultative and strictly anaerobic bacteria tested.

In vitro evaluation of the antimicrobial activity of different antiseptics on contaminated gutta-percha cones / Estudo in vitro da atividade antimicrobiana de direferentes soluções antissépticas em cones de guta-percha contaminados

OBJECTIVES: The purpose of this in vitro study was to evaluate the effectiveness of different antisepticsfor decontamination of gutta-percha cones. MATERIALS AND METHODS: Thirty-six cones werecontaminated with standardized pure cultures of six different microorganisms: Staphylococcus aureus,Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae and Candida albicans. The cones were treated forfive minutes with different antiseptic solutions: 2% iodine alcohol, 3% sodium hypochlorite, 0.2%chlorohexidine and 5% citric acid. RESULTS: Iodine alcohol was the most effective for all themicroorganisms, except for Candida albicans. For this microorganism, the best results were obtainedwith 3% sodium hypochlorite and 5% citric acid; these two solutions showed moderate activity onother microorganisms. Chlorohexidine was not effective on any of the microorganisms.

OBJETIVOS: Neste trabalho avaliou-se a atividade antimicrobiana in vitro de diferentessoluções antissépticas na desinfecção de cones de guta-percha. MATERIAIS E MÉTODOS:Trinta e seis cones de guta-percha foram contaminados com culturas puras de diferentesmicrorganismos: Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiellapneumoniae e Candida albicans. Os cones foram imersos em diferentes soluções antissépticas:álcool iodado a 2%, hipoclorito de sódio a 3%, clorhexidina a 0,2% e ácido cítrico a 5%,durante 5 minutos. RESULTADOS: Os resultados indicam que o álcool iodado é o maiseficaz sobre todos os microrganismos, exceto sobre a C. albicans. Sobre esta, o mais eficazfoi o hipoclorito de sódio a 3 %, mostrando moderada eficácia sobre os restantesmicrorganismos, tal como o ácido cítrico. A clorhexidina não mostrou eficácia sobre qualquerdos microrganismos, nestas condições experimentais.

In vitro evaluation of the effect of natural orange juices on dentin morphology

The patient's diet has been considered an important etiological factor of dentin hypersensitivity. The frequent ingestion of acidic substances can promote the loss of dental structure or remove the smear layer. The purpose of this study was to evaluate the degree of smear layer removal and dentinal tubules exposure by different natural orange juices. Extracted human teeth were submitted to manual scaling in order to develop the smear layer. Seventy dentin samples were obtained and distributed into the following groups: Control, lime orange, lime, valência orange, navel orange, mandarin, and tangerine. Each group included 2 methods of application: Topical and topical + friction. After preparation for SEM analysis, photomicrographs were assessed by a blind calibrated examiner using an index system. The Kruskal-Wallis test indicated a significant influence of the orange juices on smear layer removal. Significant difference was observed between navel orange, valência orange, mandarin and the control group (p < 0.05). These orange juices resulted in greater removal of the smear layer and greater opening of dentinal tubules. The comparison between the application methods for each group using the Mann-Whitney test showed that friction increased smear layer removal significantly only for lime orange and lime. The data suggest that certain natural orange juices are more effective in terms of smear layer removal and dentinal tubules exposure than others.