1.
Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis
Tang Q, Jin H, Lin S, Ma L, Tian T, Qin X
BMC oral health. 2022;22(1):589
Abstract
BACKGROUND The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. METHODS We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. RESULTS Of the 1272 screened studies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. CONCLUSIONS Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.
2.
The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial
Yu L, Sun H, Jin H, Tan H
BMC surgery. 2020;20(1):25
Abstract
BACKGROUND This prospective randomized controlled study was designed to evaluate the effect of fluid restriction alone versus fluid restriction + low central venous pressure (CVP) on hepatic surgical field bleeding, intraoperative blood loss, and the serum lactate concentration in patients undergoing partial hepatectomy. METHODS One hundred forty patients undergoing partial hepatectomy with intraoperative portal triad clamping were randomized into a fluid restriction group (Group F) or fluid restriction + low CVP group (Group L). Both groups received limited fluid infusion before the liver lesions were removed. Ephedrine was administered if the systolic blood pressure (SBP) decreased to <90 mmHg for 1 min. When the urine output was <20 ml/h or the SBP was <90 mmHg for 1 min more than three times, an additional 200 ml of crystalline solution was quickly infused within 10 min. In addition to fluid restriction, patients in Group L received continuous nitroglycerin and esmolol infusion to maintain a low CVP. The duration of portal triad clamping, frequency of additional fluid infusion, frequency of ephedrine administration, intraoperative blood loss, extent of liver resection, and bleeding score of the hepatic surgical field were recorded. Arterial blood gas analysis was performed before anesthesia (T1), after liver dissection and immediately before liver resection (T2), 10 min after removal of the liver lesion (T3), and before the patient was discharged from the postanesthesia care unit (T4). RESULTS Being in the fluid restriction Group (Group F) (odds ratio = 5.04) and cirrhosis (odds ratio = 3.28) were risk factors for hepatic surgical field bleeding. Factors contributing to intraoperative blood loss were the operation time, duration of portal triad clamping, and extent of resection. No significant between-group difference was observed for blood loss or blood transfusion. The serum lactate concentration peaked at T3 in both groups. CONCLUSIONS Maintaining a lower CVP during hepatectomy provides an optimal surgical field but has no significant effect on intraoperative blood loss. Moreover, lower CVP does not increase the serum lactate concentration. TRIAL REGISTRATION "A comparative study of the effect fluid restriction and low CVP pressure on the oozing of blood in liver wounds and blood lactate in patients undergoing partial hepatectomy" was prospectively registered as a trial (registration number: ChiCTR-INR-17014172, date of registration: 27 December 2017).