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A growing body of research supports an association between periapical inflammation and an increased risk of developing systemic diseases. There is currently no scientific evidence to support a causal effect of inflammation on the onset of insulin resistance (IR) in patients with apical periodontitis (AP). The aim of this in vitro study was to evaluate any association between AP and levels of serum inflammatory factors potentially associated with the onset of IR, and to investigate the effect of root canal treatment (RCT) on these systemic inflammation markers and on the response in vitro to insulin. A total of 27 control subjects and 27 patients with AP were enrolled. Patients with AP underwent RCT and were followed-up 6 and 12 months post-treatment. Enzyme-linked immunosorbent assays were used to evaluate serum levels of proinflammatory cytokines interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF)-α. The response in vitro to insulin was assessed by measuring glucose consumption in a human pancreatic epithelioid carcinoma cell line treated with sera from healthy and AP subjects. At baseline AP was associated with significant higher levels of IL-1, IL-6, and IL-8 in the serum of untreated (AP) patients vs controls (P <.001). Glucose consumption decreased in pancreatic cells incubated with baseline serum from patients with AP, in a manner proportional to total cytokines amount. Notably, endodontic treatment was associated with reduced levels of cytokines (P <.001) and improved response to insulin in AP group (P <.001). Our findings suggest that AP may promote inflammatory-driven IR in an in vitro model, and that RCT may ameliorate inflammatory mediators in vivo and the cellular response to insulin in vitro. [ABSTRACT FROM AUTHOR]

Assessment of risk factors is crucial for lowering complication rates and costs of hip and knee arthroplasty. The objective of this study was to assess if members of the Argentinian Hip and Knee Association (ACARO) are influenced by such risk factors when planning surgery. In 2022, a survey was distributed as an electronically based questionnaire to 370 members of the ACARO. A descriptive analysis was performed on 166 proper answers (44.9%). There were 68% of the respondents who were specialists in joint arthroplasty and 32% practiced general orthopedics. A large number had large volumes at private hospitals without service/residents and 48.2% had been in practice for more than 15 years. Of the responding surgeons, 99% routinely performed a preoperative reversible risk factors evaluation that considered diabetes, malnutrition, weight, and smoking, and 95% canceled/postponed the surgery for abnormalities. Malnutrition was important for 79% of the polled with blood albumin being used by 69.3%. Fall risk assessment was performed by 60.2% of the surgeons. Only 44% of the surgeons felt free to choose the implant for the arthroplasty, possibly because 69.9% work for a capitated system. Important delays for surgery were reported by 63.9 and 84.3% had waiting lists. 74.7% of the polled noted physical or psychological deterioration during such delays. Socioeconomic factors firmly impact on the accessibility to arthroplasty in Argentina. Despite these barriers, the qualitative analysis of this poll let us demonstrate greater awareness of preoperative risk factors, especially diabetes as the most reported comorbidity. [ABSTRACT FROM AUTHOR]

To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at −80 °C until assay. In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = −0.43, −0.47, 0.75, 0.84, −0.47, - 0.58, −0.41, respectively) Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects. • The coexistence of endometrial cancer with obesity is common. • Omentectomy changed blood levels of adipokines. • Adipokines have a critical role on the metabolism of glucose or lipid [ABSTRACT FROM AUTHOR]

Background: Abiotrophia, Granulicatella, and Gemella are gastrointestinal microbiota, gram-positive cocci that behave like viridans group streptococci. Despite the low incidence of bacteremia from these organisms, they can lead to infective endocarditis (IE) and other clinical syndromes. Due to scant data, we aim to describe detailed clinical features, management, and outcomes of patients with bacteremia from these organisms.Methods: We reviewed all adult patients who developed Abiotrophia, Granulicatella, or Gemella bacteremia from 2011 to 2020, at Mayo Clinic.Results: We identified 238 patients with positive blood culture for these organisms. Of those, 161 (67.6%) patients were deemed to have bacteremia of clinical significance; 62 (38.5%) were neutropenic, - none of whom were diagnosed with IE. The primary source of bacteremia for the neutropenic group was the gastrointestinal tract. Among 161 patients, echocardiography was obtained in 88 (54.7%) patients, especially those with unknown sources of bacteremia. A total of 19 cases had IE: 5 (26.3%) Abiotrophia, 11 (57.9%) Granulicatella, and 3 (15.8%) Gemella. Based on known IE scoring systems, the negative predictive value at established cutoffs for these scores, performed with our cohort were 95.9%, 100% and 97.9% for NOVA, HANDOC and DENOVA scores, respectively. We also found that the penicillin-non-susceptible rate was high in Abiotrophia (66.7%) and Granulicatella (53.7%).Conclusions: We described unique characteristics of Abiotrophia, Granulicatella, and Gemella bacteremia at our institution. Clinical significance, clinical syndrome, their proclivity of endocarditis, and susceptibility pattern should be thoroughly reviewed when encountering these organisms. [ABSTRACT FROM AUTHOR]

Background: The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplasty (THA) remains unclear. This randomized controlled trial compared postoperative pain and tramadol requirement in patients undergoing unilateral primary THA who received one versus two perioperative doses of dexamethasone.Methods: Patients consented to undergo blinded, simple randomization to either one (at anesthetic induction [1D-group]: 54 patients) or two (with an additional dose 8 hours after surgery [2D-group]: 61 patients) perioperative doses of 8-mg intravenous dexamethasone. Pain was evaluated with visual analog scale at 8, 16, and 24 hours postoperatively and with tramadol requirement. The secondary outcomes included postoperative nausea and vomiting, time to ambulation, and length of stay.Results: Age (mean, 66 ± 13 years), body mass index (mean, 29 ± 5), gender (60% female), and history of diabetes were similar between groups (P >.05). Pain was higher at 16 (4 [interquartile range {IQR} 3-5] vs 2 [IQR 1-3]; P <.001) and 24 (2.5 [IQR 2-3] vs 1 [IQR 0-1] P <.001) hours postoperatively in the 1D-group patients. 1D-group patients had significantly more tramadol consumption (50 [IQR 50-100] vs 0 [IQR 0-50]; P = .01), as well as postoperative nausea and vomiting (18 [33.3%] vs 5 [8.2%]; P = .001). Fifty-five (90%) patients in the 2D-group and 32 (59%) in the 1D-group ambulated on postoperative day 0 (P = .0002). Fifty-eight (95%) patients in the 2D-group and 37 (68%) in the 1D-group were discharged on postoperative day 1 (P = .0002).Conclusion: An additional dose of dexamethasone at 8 hours postoperatively significantly reduced pain, tramadol consumption, time to ambulation, and length of stay after primary THA. [ABSTRACT FROM AUTHOR]

The aim of the present laboratory study was to three-dimensionally evaluate the interfacial adaptation of flowable materials with different flowability in a simulated deep-margin elevation scenario, before and after cyclic fatigue. The null hypothesis tested was that the substrate of the cervical margin, enamel or dentin, the material employed, and the simulated ageing did not influence the quality of the marginal sealing in terms of gap presence. 50 extracted premolars were selected, and two class II cavities were prepared: one mesial, with the cervical margin 1 mm above CEJ (enamel margin) and one distal, with the cervical margin 1 mm below CEJ (dentin margin). After performing adhesive procedures using a self-etch adhesive system with enamel selective etching, specimens were divided into 5 groups (n=10) according to the materials employed for horizontal margin relocation. G1: nanohybrid composite (Clearfil ES2,Kuraray); G2: medium viscosity flowable composite (Majesty ES2 Low-Flow, Kuraray); G3:low viscosity flowable composite (Majesty ES2 Superlow-Flow, Kuraray); G4: conventional viscosity flowable composite (Tetric Flow, Ivoclar); G5: CAD/CAM inlay (Katana Avencia, Kuraray). All restorations, except for G5 were finalized using an oblique layering with a nanohybrid composite. To reveal interfacial gap progression specimens were scanned with a micro-CT (SkyScan 1172), before and after 500000 cycles of thermomechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growth: only the external gap of the relocation (2 mm) was considered in the analysis. Obtained STL optimal quality masks were imported into Geomagic software for noise removal and volume calculation. Interfacial gap progression, expressed in mm3, was collected and statistically analyzed with ANOVA test (α<0.05). The mean external gap augmentation was tri-dimensionally measured as volume. Three-way ANOVA showed significant differences in the data obtained for the variable substrate, material and ageing. Enamel performed better than dentin in all groups, ageing affected the gap presence over time and flowable materials reduced gap presence in comparison to nanohybrid composite. However, no differences were found between the different tested flowable composites. The initial null hypothesis was rejected since tested flowable resin composites, independently from their viscosity, showed less gap formation than nanohybrid composites at the enamel and dentin margin in deep second class. In addition, enamel guaranteed a better performance of the restorative materials both before and after ageing. Artificial ageing significantly affects the presence of volumetric gap at the interface. [ABSTRACT FROM AUTHOR]

Different materials and cements have been proposed for overlay restorations in the last decade. The present study aimed to better understand the mechanical behavior of an overlay interface under load through finite element analysis (FEA). A lower molar was endodontically treated, restored with an overlay restoration after build-up and then scanned with micro-CT (Skyscan 1172, Bruker) and segmented (Mimics 24.0) in the following volumes: enamel, dentin, restorative material, cement, build-up material. The volumes were optimized for FEA and exported in a simulation software (LS Dyna). Three different restorative materials were tested: Lithium Disilicate (DL), Cubic Zirconia (CZ), Reinforced Composite (RC). Two cements were tested for each restorative material: dual-cure resin cement (DR) and flowable composite (FC). After simulating shrinkage stress of resin materials, accordingly to manufacturer data, the model was loaded axially and horizontally with a sphere. Shear and tensile stresses were recorded, and color-maps were created to better understand stress distribution at the adhesive interface. All tested scenarios showed similar shear and tensile stress distribution at the cement interface. However, RC showed a significantly better distribution (lower peak stresses) compared to other materials. This might be due to the mechanical properties similar to the ones of tested cements, that create a homogeneous force distribution. The greatest shear stresses were located at the interproximal boxes of the preparation, above all when ceramic materials were tested. No significant differences were observed between DR and FC. Having a homogeneous combination of materials might significantly improve the tooth-restoration complex mechanical resistance to loads, above all at the adhesive interface, with subsequent better clinical prognosis. Further studies are necessary to confirm the obtained results when cyclic fatigue is simulated. [ABSTRACT FROM AUTHOR]

To show dissection of sentinel lymph nodes. A step-by-step demonstration of the technique with narration. Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator) + bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5 × 1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC. [ABSTRACT FROM AUTHOR]

• The possibility to use an ethanol-based cross-linker as a primer seems to be a promising option in terms of bond strength. • N,N'-dicyclohexylcarbodiimide (DCC) pre-treatment efficiently preserves bond strength over time. • Matrix-metalloproteinases activity seems to be influenced by the application mode of a universal adhesive. To evaluate the effects of N,N'-dicyclohexylcarbodiimide (DCC), an ethanol-based dentin cross-linker, on the immediate and long-term microtensile bond strength (μTBS) and nanoleakage expression of a universal adhesive employed in self-etch mode (SE) or etch-and-rinse mode (ER). The effect of DCC on the dentinal MMP activity was also investigated by means of in-situ zymography. Eighty freshly extracted human molars were sectioned to expose mid-coronal dentin surfaces. The teeth were assigned to one of the following groups, according to the dentin surface priming/adhesive approach: (G1): DCC pre-treatment and Scotchbond Universal (SBU) in ER mode; (G2): SBU in ER mode; (G3): DCC pretreatment and SBU in SE mode; (G4): SBU in SE mode. μTBS test was performed immediately (T 0) or after 1-year aging (T 12) in artificial saliva. Ten additional teeth per group were prepared for nanoleakage evaluation (N = 5) and for in-situ zymography (N = 5). Three-factor analysis of variance revealed significant difference for the variables DCC pretreatment, application mode and aging (p < 0.05) for both microtensile bond strength testing and in-situ zymography. Nanoleakage analysis revealed reduced marginal infiltration of DCC experimental groups both at T 0 and T 12. The use of an ethanol-based primer containing DCC appears to be promising in preserving the stability of the adhesive interface of a universal adhesive, especially in the SE mode. [ABSTRACT FROM AUTHOR]