Assessment of the anti-inflammatory and biological properties of Bioroot Flow: A novel bioceramic sealer.

INTRODUCTION: BioRoot Flow (BRF) is a novel premixed bioceramic sealer indicated for endodontic treatments, but the biological and immunomodulatory effects of this endodontic sealer on human periodontal ligament stem cells (hPDLSCs) have not been elucidated. METHODS: To ascertain the biological impact of BRF, TotalFill BC Sealer (TFbc), and AH Plus (AHP) on human Periodontal Ligament Stem Cells (hPDLSCs), assessments were conducted to evaluate the cytocompatibility, cellular proliferation, migratory capacity, osteo/cementogenic differentiation potential, the ability to form mineralized nodules, and the immunomodulatory characteristics of hPDLSCs following treatment with these endodontic sealers. RESULTS: Biological assays showed adequate cell metabolic activity and cell migration in BRF, while SEM assay evidenced that TFbc and BRF groups demonstrated a superior cell adhesion process, including substrate adhesion, cytoskeleton development, and spreading on the niche-like structures of the cement as compared to the AHP group. TFbc and BRF-treated groups exhibited a significantly lower IL6 and IL8 production than AHP (* p <.05). The bioceramic sealers stimulated heightened expression of BSP, CEMP-1, and CAP genes within a 7-14 day period. Notably, BRF and TFbc demonstrated a significant enhancement in the mineralization of hPDLSCs when compared to the negative control. Among these, cells treated with BRF showed a more substantial accumulation of calcium (*** p < .001). CONCLUSIONS: Taken together, these findings indicate that BRF can potentially enhance cell differentiation by promoting the expression of essential genes related to bone and cement formation. In addition, BRF and TFbc displayed anti-inflammatory effects.

Comparative bioactivity and immunomodulatory potential of the new Bioroot Flow and AH Plus Bioceramic sealer: An in vitro study on hPDLSCs.

OBJECTIVES: To evaluate the cytocompatibility, bioactivity, and anti-inflammatory potential of the new pre-mixed calcium silicate cement-based sealers Bioroot Flow (BrF) and AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared to the epoxy resin-based sealer AH Plus (AHP). MATERIALS AND METHODS: Standardized discs and 1:1, 1:2, and 1:4 eluates of BrF, AHPbcs and AHP after setting were prepared. The following assays were performed: cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound-healing assay, cytoskeleton organization via immunofluorescence staining; cytokine release via ELISA; osteo/cemento/odontogenic marker expression via RT-qPCR, and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars from healthy patients. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < 0.05. RESULTS: Both BrF and AHPbcs showed significantly positive results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group, while AHP showed significant negative results. BrF exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. BrF showed a significantly higher calcified nodule formation than AHPbcs, the negative and positive control groups, while AHPbcs was higher than the negative control group. Both were also significantly higher than AHP group. CONCLUSION: BrF and AHPbcs exhibit adequate and comparable cytocompatibility on hPDLSCs. BrF also promoted the osteo/cementogenic differentiation of hPDLSCs. Both calcium silicate-based sealers favored the downregulation of the inflammatory cytokine IL-6 and the calcified nodule formation from hPDLSCs. BrF exerted a significantly higher influence on cell mineralization than AHPbcs. CLINICAL RELEVANCE: This is the first study to elucidate the biological properties and immunomodulatory potential of Bioroot Flow and AH Plus Bioceramic Sealer. The results act as supporting evidence for their use in root canal treatment.

Premixed calcium silicate-based ceramic sealers promote osteogenic/cementogenic differentiation of human periodontal ligament stem cells: A microscopy study.

To evaluate the effects of premixed calcium silicate based ceramic sealers on the viability and osteogenic/cementogenic differentiation of human periodontal ligament stem cells (hPDLSCs). The materials evaluated were TotalFill BC Sealer (TFbc), AH Plus Bioceramic Sealer (AHPbc), and Neosealer Flo (Neo). Standardized discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following in vitro experiments were carried out: ion release, cell metabolic activity 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell migration, immunofluorescence experiment, cell attachment, gene expression, and mineralization assay. Statistical analyses were performed using one-way ANOVA followed by Tukey's post hoc test (p < .05). Increased Ca2+ release was detected in TFbc compared to AHPbc and Neo (*p < .05). Biological assays showed a discrete cell metabolic activity and cell migration in Neo-treated cell, whereas scanning electronic microscopy assay exhibited that TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc (***p < .001). All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells (***p < .001). Our results suggested that TFbc promotes cell differentiation, both by increasing the expression of key osteo/odontogenic genes and by promoting mineralization of the extracellular matrix, whereas this phenomenon was less evident in Neo and AHPbc. RESEARCH HIGHLIGHTS: TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc. All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells.

Clinical Profile and Prognosis of Patients with Left-Sided Infective Endocarditis with Surgical Indication Who Are Not Operated.

Approximately a quarter of patients with infective endocarditis (IE) who have surgical indication only receive antibiotic treatment. Their short-term prognosis is dismal. We aimed to describe the characteristics of this group of patients to evaluate the mortality according to the cause of rejection and type of surgical indication and to analyze their prognostic factors of mortality. From 2005 to 2022, 1105 patients with definite left-sided IE were consecutively attended in three tertiary hospitals. Of them, 912 (82.5%) had formal surgical indication according to the most recent European Guidelines available in each period of the study and 303 (33%) only received medical treatment. These were older, had more comorbidities and higher in-hospital (46% vs. 24%; p < 0.001) and one year mortality (57.1% vs. 27.6%; p < 0.001) than operated patients. The main reason for surgical rejection was high surgical risk (57.1%) and the highest mortality when the cause were severe neurological conditions (76%). When the endocarditis team took the decision not to operate (25.5% of the patients), in-hospital (7%) and one-year mortality (17%) were low. In-hospital mortality associated with each surgical indication was 67% in heart failure, 53% in uncontrolled infection and 45% in prevention of embolisms (p < 0.001). Heart failure (OR: 2.26 CI95%: 1.29-3.96; p = 0.005), Staphylococcus aureus (OR: 3.17; CI95%: 1.72-5.86; p < 0.001) and persistent infection (OR: 5.07 CI95%: 2.85-9.03) are the independent risk factors of in-hospital mortality. One third of the patients with left-sided IE and formal surgical indication are rejected for surgery. In-hospital mortality is very high, especially when heart failure is the indication for surgery and when severe neurological conditions the reason for rejection. Short term prognosis of patients rejected by a specialized endocarditis team is favorable.

Evaluating the Cooling Efficiency of Polymer Injection Molds by Computer Simulation Using Conformal Channels.

Injection molds are production tools that require detailed analysis based on the quality of the resulting part, the impact on cycle times, and the expected production volume. Cooling channels also play a critical role in mold performance and product quality as they largely determine cycle time. Designs that incorporate conformal cooling channel (CCC) geometries that conform to or align with the part contour are currently being explored as an alternative to conventional cooling channel designs in injection molds. In this study, a simulation of CCC geometries was performed and their effects on mold temperatures and warpage were investigated. Two cross-sectional geometries, circular and square, were selected for a three-factor level design of experiments (DOE) analysis. The response variables used were mold temperatures and part warpage. A cup-shaped part with upper and lower diameters of 54 and 48 mm, respectively, a height of 23 mm and a thickness of 3 mm was used for the injection molded part. A comparison was also made between two materials for the injection mold, steel and polycarbonate. The DOE results showed that the distance between the CCC and the injected part and the diameter or side of the square have significant effects on the response variables for both systems (steel and polycarbonate molds). In addition, a comparison between conventional and conformal cooling channels was analyzed using a cup-shaped part and a less rigid part geometry. The finite element simulation results show a 9.26% reduction in final warpage in the cup-shaped part using CCCs compared with the conventional cooling methods in steel. When using parts with lower geometry stiffness, the use of CCCs reduced final part warpage by 32.4% in metal molds and by 59.8% in polymer molds.

Contemporary Clinical Profile of Left-Sided Native Valve Infective Endocarditis: Influence of the Causative Microorganism.

Studies focused on the clinical profile of native valve endocarditis are scarce and outdated. In addition, none of them analyzed differences depending on the causative microorganism. Our objectives are to describe the clinical profile at admission of patients with left-sided native valve infective endocarditis in a contemporary wide series of patients and to compare them among the most frequent etiologies. To do so, we conducted a prospective, observational cohort study including 569 patients with native left-sided endocarditis enrolled from 2006 to 2019. We describe the modes of presentation and the symptoms and signs at admission of these patients and compare them among the five more frequent microbiological etiologies. Coagulase-negative Staphylococci and Enterococci endocarditis patients were the oldest (71 ± 11 years), and episodes caused by Streptococci viridans were less frequently nosocomial (4%). The neurologic, cutaneous or renal modes of presentation were more typical in Staphylococcus aureus endocarditis (28%, p = 0.002), the wasting syndrome of Streptococcus viridans (49%, p < 0.001), and the cardiac in Coagulase-negative Staphylococci, Enterococci and unidentified microorganism endocarditis (45%, 49% and 56%, p < 0.001). The clinical signs agreed with the mode of presentation. In conclusion, the modes of presentation and the clinical picture at admission were tightly associated with the causative microorganism in patients with left-sided native valve endocarditis.

Biological properties of Ceraputty as a retrograde filling material: an in vitro study on hPDLSCs.

OBJECTIVES: To assess the cytocompatibility and bioactive potential of the new calcium silicate-based cement Ceraputty on human periodontal ligament stem cells (hPDLSCs) compared to Biodentine and Endosequence BC root repair material (ERRM). MATERIALS AND METHODS: hPDLSCs were isolated from extracted third molars from healthy donors. Standardized sample discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following assays were performed: surface element distribution via SEM-EDX, cell attachment and morphology via SEM, cell viability via a MTT assay, osteo/cemento/odontogenic marker expression via RT-qPCR, and cell calcified nodule formation via Alizarin Red S staining. hPDLSCs cultured in unconditioned or osteogenic media were used as negative and positive control groups, respectively. Statistical analysis was performed using one-way ANOVA or two-way ANOVA and Tukey's post hoc test. Statistical significance was established at p < 0.05. RESULTS: The highest Ca2+ peak was detected from Biodentine samples, followed by ERRM and Ceraputty. hPDLSC viability was significantly reduced in Ceraputty samples (p < 0.001), while 1:2 and 1:4 Biodentine and ERRM samples similar results to that of the negative control (p > 0.05). Biodentine and ERRM exhibited an upregulation of at least one cemento/odonto/osteogenic marker compared to the negative and positive control groups. Cells cultured with Biodentine produced a significantly higher calcified nodule formation than ERRM and Ceraputty (p < 0.001), which were also higher than the control groups (p < 0.001). CONCLUSION: Ceraputty evidenced a reduced cytocompatibility towards hPDLSCs on its lowest dilutions compared to the other tested cements and the control group. Biodentine and ERRM promoted a significantly higher mineralization and osteo/cementogenic marker expression on hPDLSCs compared with Ceraputty. Further studies are necessary to verify the biological properties of this new material and its adequacy as a retrograde filling material. CLINICAL RELEVANCE: This is the first study to elucidate the adequate biological properties of Ceraputty for its use as a retrograde filling material.

Development, Simulation of Temperatures, and Experimentation in Injection Molds Obtained through Additive Manufacturing with Photocurable Polymeric Resins.

Additive manufacturing (AM) is a relatively new option in mold manufacturing for rapid tooling (RT) in injection processes. This paper presents the results of experiments with mold inserts and specimens obtained by stereolithography (SLA), which is a kind of AM. A mold insert obtained by AM and a mold produced by traditional subtractive manufacturing were compared to evaluate the performance of the injected parts. In particular, mechanical tests (in accordance with ASTM D638) and temperature distribution performance tests were carried out. The tensile test results of specimens obtained in a 3D printed mold insert were better (almost 15%) than those produced in the duralumin mold. The simulated temperature distribution closely matched its experimental counterpart-the difference in average temperatures was merely 5.36 °C. These findings support the use of AM in injection molding and RT as an excellent alternative for small and medium-sized production runs in the global injection industry.

Diameter and taper variability of gutta-percha cones adapted to TruNatomyTM and RotateTM rotary file systems.

Background: Evaluate the discrepancy in diameter and taper between adapted gutta-percha cones for TruNatomyTM 26.04 (TRU04), RotateTM 25.04 (ROT04) and 25.06 (ROT06) systems and their reference files. Material and Methods: A sample of 60 gutta-percha cones and 15 rotary files was selected and divided into three groups (TRU04, ROT04, ROT06). Each group consisted of 20 cones and 5 corresponding files. They were observed under an optical microscope at x20 magnification and images of all observations were obtained. Diameters were measured with a digital ruler calibrated at 3 levels: D1, D3, D16 (mm from tip). The taper of each system of cones and files was calculated, The percentage of discrepancy between the taper of each file system and its corresponding gutta-percha cone was calculated. Results: The percentage of discrepancy between the diameter of the tested gutta-percha cones and their corresponding files varied from -7% to 21%. The smallest dimensional discrepancy between gutta-percha cone and corresponding file was found at D16 in TRU04 group. The tapers of the gutta-percha cones vs their respective files were: 2% vs 3% (TRU04), 4% vs 5% (ROT04), and 6% vs 5% (ROT06). The highest discrepancy was observed at D16 in ROT06 group. The global taper discrepancy between gutta-percha cone and its corresponding file was negative in TRU04 and ROT04 groups. Conclusions: The taper and the diameter at D1, D3, and D16 differed between all of the tested gutta-percha cones and their corresponding files. TruNatomy 26.04 files and its adapted gutta-percha cones exhibited the least discrepancy. Key words:Corresponding gutta-percha, rotary file, taper, TruNatomy, Rotate, standardization.

Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study.

OBJECTIVES: The aim of the present in vitro study is to determine the cytocompatibility of the recently introduced NeoPutty in contact with human dental pulp cells compared with its precursor NeoMTA Plus and the classic gold standard MTA Angelus. MATERIALS AND METHODS: Sample disks were obtained for each of the tested materials (5 mm diameter; 2 mm thickness; n = 30), along with 1:1, 1:2, and 1:4 material eluents. HDPCs were extracted and cultured with the tested materials (test groups) or in unconditioned medium (control group), and the following biocompatibility assays were performed: MTT assay, scratch wound assay, cell cytoskeleton staining assays, and cell attachment assessment via SEM. Additionally, material ion release and surface element composition were evaluated via ICP-MS and SEM-EDX, respectively. Each experimental condition was carried out three times and assessed in three independent experiments. Statistical significance was established at p < 0.05. RESULTS: 1:2 dilutions of all the tested materials exhibited a comparable cell viability to that of the control group at 48 and 72 h of culture (p < 0.05). The same was observed for 1:4 dilutions of the tested materials at 24, 48, and 72 h of culture (p > 0.05). All the tested materials exhibited adequate cytocompatibility in the remaining biocompatibility assays. MTA exhibited a significantly higher calcium ion release compared to NeoPutty and NeoMTA Plus (p < 0.05). CONCLUSION: The results from the present work elucidate the adequate cytocompatibility of NeoPutty, NeoMTA Plus, and MTA Angelus towards human dental pulp cells. CLINICAL RELEVANCE: Within the limitations of the present in vitro study, our results may act as preliminary evidence for its use in vital pulp therapy as a pulp capper. However, results need to be interpreted with caution until further clinical supporting evidence is reported.

Dentin Sealing of Calcium Silicate-Based Sealers in Root Canal Retreatment: A Confocal Laser Microscopy Study.

The aim of the present in vitro study was to evaluate the intratubular penetration of three bioceramic sealers in root canal retreatment. Here, 30 single-rooted human teeth were instrumented with the Protaper Universal system and filled with gutta-percha and the epoxy-resin-based sealer AH Plus mixed with rhodamine B. After two weeks in a humid environment, they were re-instrumented with Reciproc Blue and divided into three groups according to the endodontic sealer to be used in the re-filling (n = 10): G1: CeraSeal, G2: TotalFill BC Sealer, G3: TotalFill BC Sealer HiFlow. For the filling, a single cone technique was used, and the respective sealers were mixed with fluorescein. The roots were then sectioned at 2, 5, and 8 mm (apical, medial, and coronal measurement points, respectively) from the apex, and the dentinal tubule penetration depth and percentage of penetration around the canal perimeter were evaluated by means of confocal laser scanning microscopy (CLSM). Penetration between groups was compared using the Kruskal−Wallis test, and within each group using the Wilcoxon test. Statistical significance was established at p < 0.05. A non-significant reduction was found in the penetration depths and in a percentage of penetration around the canal perimeter between AH Plus and the tested calcium-silicate-based sealers (p > 0.05). Consequently, this reduction may not affect the three-dimensional seal of the root canal system in a negative manner. The penetration depth and percentage of penetration around the canal perimeter at both the root canal treatment and retreatment were significantly reduced from the coronal to apical points in all groups (p < 0.05).

Cytocompatibility and bioactive potential of AH Plus Bioceramic Sealer: An in vitro study.

AIM: To assess the cytocompatibility and bioactive potential of the new calcium silicate cement-based sealer AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared with the epoxy resin-based sealer AH Plus (AHP) and the calcium silicate cement-based sealer Endosequence BC Sealer (ESbcs). METHODOLOGY: Standardized sample discs and 1:1, 1:2 and 1:4 eluates of the tested materials were prepared. The following assays were performed: surface element distribution via SEM-EDX, cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound-healing assay, osteo/cemento/odontogenic marker expression via RT-qPCR and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < .05. RESULTS: A higher peak of Ca2 + was detected from ESbcs compared with AHPbcs and AHP in SEM-EDX. Both AHPbcs and ESbcs showed significantly positive results in the cytocompatibility assays (cell viability, migration/proliferation, attachment and morphology) compared with a negative control group, whilst AHP showed significant negative results. Both AHPbcs and ESbcs exhibited an upregulation of at least one osteo/odonto/cementogenic marker compared with the negative and positive control groups. Both ESbcs and AHPbcs showed a significantly higher calcified nodule formation than the negative and positive control groups, indicative of their biomineralization potential and were also significantly higher than AHP group. CONCLUSION: AH Plus Bioceramic Sealer exhibited a significantly higher cytocompatibility and bioactive potential than AH Plus and a similar cytocompatibility to that of Endosequence BC Sealer. Endosequence BC Sealer exhibited a significantly higher mineralization potential than the other tested sealers. The results from this in vitro study act as supporting evidence for the use of AH Plus Bioceramic Sealer in root canal treatment.

Scientific production on silicate-based endodontic materials: evolution and current state: a bibliometric analysis.

OBJECTIVES: To perform a bibliometric analysis on silicate-based biomaterials in endodontics; to elucidate the evolution and distribution of scientific production regarding research on these biomaterials, the authors and institutions involved, and the most used descriptors/keywords in this field. MATERIALS AND METHODS: A general advanced broad search was performed in Web of Science Core Collection, using the terms "Silicate" and "Endod*." By means of the "Analyze Results" and "Citation Analysis" tools from Web of Science, bibliometric data were extracted. Bibliometric networks on co-authorship and keyword co-occurrence were illustrated using VOSviewer software tool. RESULTS: Research in the field of silicate-based endodontic materials in endodontics has followed an exponential crescent tendency over the period between 1995 and 2020. Two major co-authorship networks lead the research production in the field, headed by Gandolfi MG and Prati C, and Rodríguez-Lozano FJ and Forner L; respectively. "Mineral trioxide aggregate," "MTA", "Biocompatibility," "Biodentine," and "In vitro" were the terms with the highest occurrence. The modal study type in this research area are laboratory studies, representing 77.7% of the total number of records. The relationship between keywords illustrates the recent tendency to assess biological properties of MTA and Biodentine, which could be extrapolated to other silicate-based materials. CONCLUSIONS: The results from the present study highlight the exponential increase and distribution of scientific production on silicate-based materials in endodontics, along with the modal keywords used as descriptors and the major authorship networks involved. The predominance of laboratory studies in this research field reinforces the need for clinical studies, to extrapolate the reported performance and characteristics of silicate-based materials into the clinical setting. CLINICAL RELEVANCE: The present study may aid the clinician's continuing education and evidence-based practice by providing knowledge and facilitating the literature search on the field of silicate-based biomaterials in endodontics.

Analysis and Advances in Additive Manufacturing as a New Technology to Make Polymer Injection Molds for World-Class Production Systems.

The currently growing demand for metallic and polymeric products has undoubtedly changed the rules of manufacturing, enabling customers to more functionally define their products based on their needs. Nowadays, a new technique for rapid tooling, Additive Manufacturing (AM), can create customized products with more complex geometries and short life cycles (flexibility) in order to keep up with the new variables imposed by the manufacturing environment. In the last two decades, the migration from subtractive manufacturing to AM has materialized such products with reduced costs and cycle times. AM has been recently promoted to develop polymer molds for product manufacturing. This paper reviews the main findings in the literature concerning polymer molds created by AM compared to conventional (metal) molds obtained by subtractive manufacturing. Information about specific topics is scarce or nonexistent, for example, about the characterization of the most commonly injected materials and molds used in this type of technology, their mechanical properties (part and mold), designs for all types of geometries, and costs. These aspects are addressed in this literature review, highlighting the advantages of this alternative manufacturing process, which is considered a desirable technology worldwide.

Concordance between tomographic and surgical AAST injury grades in liver, spleen, and kidney due to blunt abdominal trauma / Concordancia entre los grados de lesión AAST tomográficos y quirúrgicos en hígado, bazo y riñón por trauma cerrado de abdomen

OBJETIVO: Determinar la concordancia entre los grados de lesión de la escala AAST (American Association for the Surgery of Trauma) tomográficos y quirúrgicos en lesiones hepáticas, esplénicas y renales por trauma abdominal cerrado. Método: Estudio prospectivo, unicéntrico, observacional, comparativo y transversal, en pacientes mayores de 15 años con lesión hepática, esplénica o renal por trauma abdominal cerrado, sometidos a tomografía abdominal y posterior laparotomía exploradora, en quienes se determinó la concordancia de los grados de lesión AAST tomográficos y quirúrgicos de estos órganos, de marzo de 2017 a diciembre de 2020, en el Hospital Civil de Culiacán, Sinaloa, México. RESULTADOS: Se incluyeron 48 pacientes, con una edad promedio de 27.9 ± 10.9 años; de ellos, 41 eran hombres (85%). La lesión esplénica fue la más frecuente, en 30 pacientes (63%), seguida de la hepática en 20 (42%) y la renal en 15 (31%). La concordancia del grado de lesión AAST entre la tomografía y la cirugía fue baja o moderada, con valores kappa de 0.234 (p < 0.001), 0.419 (p < 0.001) y 0.415 (p < 0.001) para las lesiones hepáticas, esplénicas y renales, respectivamente. CONCLUSIONES: Los grados de lesión AAST tomográficos y quirúrgicos en el hígado, el bazo y los riñones por trauma abdominal cerrado tienen baja y moderada concordancia, y los grados tomográficos son menores que los quirúrgicos.

Risk factors associated to intestinal anastomotic leakage in elective surgery.

BACKGROUND: The intestinal anastomotic leakage is the most feared surgical complication of a digestive surgery and is associated with a significant increase of morbidity, mortality and hospital stay. OBJECTIVE: Analyze the risk factors to the intestinal anastomotic leakage in elective surgery. METHOD: Observational and retrospective study in which we include patients with intestinal anastomosis, in elective surgery at the second level hospital from January 2007 to January 2017. RESULTS: 64 patients were included in the study, in which 7 presented anastomotic leakage. The statistically significant risk factors associated with anastomotic leakage were, cocaine use (p = 0.030), neoplasia as a primary pathology (p = 0.008), neoadjuvant treatment for neoplasia (p = 0.003), and end-to-end anastomosis (p = 0.037). Patients with a leakage had a longer hospital stay and a mortality of 14.3%. CONCLUSIONS: The risk factors associated with the presence of anastomotic leakage found in this study are consistent with the reported worldwide literature. However, in our results, it is worth highlighting the use of cocaine as a risk factor, with statistical significance.

ANTECEDENTES: La fuga de una anastomosis intestinal es la complicación quirúrgica más temida de la cirugía digestiva y se asocia con un aumento significativo de la morbimortalidad y de la estancia hospitalaria. OBJETIVO: Analizar los factores de riesgo asociados a la fuga de anastomosis intestinal en cirugía electiva. MÉTODO: Estudio observacional y retrospectivo en el que se recabaron los expedientes de los pacientes operados de anastomosis intestinal en forma electiva en un hospital de segundo nivel de enero de 2007 a enero de 2017. RESULTADOS: Se incluyeron 64 pacientes, de los cuales siete presentaron fuga de la anastomosis. Los factores de riesgo asociados a fuga anastomótica estadísticamente significativos fueron consumo de cocaína (p = 0.030), neoplasia como patología primaria (p = 0.008), tratamiento con neoadyuvantes para neoplasia (p = 0.003) y anastomosis término-terminal (p = 0.037). Los pacientes con fuga tuvieron una estancia intrahospitalaria más prolongada y una mortalidad del 14.3%. CONCLUSIONES: Los factores de riesgo asociados con la presencia de fuga anastomótica encontrados en este estudio son consistentes con los reportados en la literatura mundial. Sin embargo, en nuestros resultados cabe destacar el uso de cocaína como factor de riesgo, con significancia estadística.

Análisis clínico-tomográfico en obstrucción de intestino delgado por adherencias según el sitio de obstrucción en la tomografía / Clinical-tomographic analysis in adhesive small bowel obstruction according to obstruction site in the tomography

Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias. Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel. Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal. Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.

Introduction. Postoperative adhesions are the most common cause of small bowel obstruction. The clinical presentation suggests the diagnosis, but imprecisely the cause and the site of the obstruction. Contrast computed tomography is the optimal study and allows the timely identification of patients requiring surgical intervention. The objective of this study was to analyze the correlation between the symptoms and the obstruction site detected in the abdominal contrasted computed tomography in patients with suspected diagnosis of small bowel obstruction due to adhesions. Methods. Prospective, cross-sectional and analytical study of patients with clinical suspicion of small bowel obstruction due to adhesions and surgical history, and its correlation with the obstruction site detected in the abdominal contrasted computed tomography, during March 2016 to February 2019 in a secondary level hospital. Results. Forty-one patients were included, the mean age was 59 years and the male gender was the most frequent (68.3%, n=28); the absence of evacuations was present in 97.5% (p=0.026). Contrast computed tomography showed the obstruction site in 73% of the patients. The most prevalent location of the obstruction was in the distal ileum (31.7%, n=13). It was associated with leukocytosis (p=0.041) and more intense pain (p=0.049), without presenting peritoneal irritation. Conclusion. The obstruction located in the distal ileum was characterized by more pain and a higher white blood cell count, without correlation as a risk factor for requiring surgical treatment

Comparative Biological Properties and Mineralization Potential of 3 Endodontic Materials for Vital Pulp Therapy: Theracal PT, Theracal LC, and Biodentine on Human Dental Pulp Stem Cells.

INTRODUCTION: The aim of this study was to assess the biological properties and mineralization potential of the new Theracal PT (Bisco Inc, Schaumburg, IL) compared with its predecessor Theracal LC (Bisco Inc) and the hydraulic silicate-based cement Biodentine (Septodont, Saint-Maur-des-Fossés, France) on human dental pulp stem cells (hDPSCs) in vitro. METHODS: Standardized sample discs were obtained for each material (n = 30) together with 1:1, 1:2, and 1:4 material eluates. Previously characterized hDPSCs were cultured with the different materials in standardized conditions, and the following assays were performed: a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, a wound healing assay, Annexin-V-FITC and 7-AAD staining (BD Biosciences, San Jose, CA), reactive oxygen species production analysis, cell adhesion and morphology evaluation via scanning electron microscopy and immunofluorescence, quantification of the expression of osteo/odontogenic markers via real-time quantitative reverse-transcriptase polymerase chain reaction, and alizarin red S staining. Statistical significance was established at P < .05. RESULTS: All of the tested dilutions of Theracal LC exhibited a significantly higher cytotoxicity and reactive oxygen species production (P < .001) and a lower cell migration rate than the control group (hDPSCs cultured in growth medium without material extracts) at all of the measured time points (P < .001). Both 1:4 Theracal PT and Biodentine-treated hDPSCs exhibited similar levels of cytocompatibility to that of the control group, a significant up-regulation of at least 1 odontogenic marker (Biodentine: dentin sialophosphoprotein (P < .05); Theracal PT: osteonectin and runt-related transcription factor 2 [P < .001]), and a significantly higher mineralized nodule formation (P < .001). CONCLUSIONS: The newly introduced TheraCal PT offers an improved in vitro cytocompatibility and mineralization potential on hDPSCs compared with its predecessor, TheraCal LC, and comparable biological properties to Biodentine.