Objective: To evaluate the expression of an activator of nuclear factor-kappa (RANK), osteoprotegerin (OPG), osteopontin (OPN), and transforming growth factor ß1 (TGF-ß1) in gingival crevicular fluid (GCF) of teeth subjected to orthodontic forces. Materials and Methods: A randomized, pilot clinical trial including 10 healthy volunteers was conducted using a split-mouth design. Orthodontic elastic separators were placed between the second premolar and first molar, with the contralateral quadrant serving as a control. The GCF samples were collected from the tension and compression sites at baseline, 24 hours, and 7 days after the placement of separators. The GCF sample volumes were measured using a Periotron 8000, and total protein concentrations were determined. Levels of RANK, OPG, OPN, and TGF-ß1 were also analyzed using a multiplex enzyme-linked immunosorbent assay. Results: The control sites remained unchanged throughout the study. In contrast, the concentration of OPG significantly decreased at the compression site by 24 hours, and the amount and concentration of RANK differed significantly between the control, compression, and tension sites after 7 days. A significant increase in absolute TGF-ß1 levels was also detected at the compression site versus the control and tension sites after 7 days. Conclusion: Bone metabolism is affected by application of force to the teeth by elastic separators. Both increased expression of bone resorptive mediators (eg, RANK and TGF-ß1) and decreased expression of a bone-forming mediator (eg, OPG) on the compression side were detected. (Angle

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Background Goal-directed haemodynamic therapy (GDHT) has been shown to reduce morbidity and mortality in high-risk surgical patients. However, there is little evidence of its efficacy in patients undergoing hip fracture surgery. This study aims to evaluate the effect of GDHT guided by non-invasive haemodynamic monitoring on perioperative complications in patients undergoing hip fracture surgery. Methods Patients > 64 years undergoing hip fracture surgery within an enhanced recovery pathway (ERP) were enrolled in this single-centre, non-randomized, intervention study with a historical control group and 12-month follow-up. Exclusion criteria were patients with pathological fractures, traffic-related fractures and refractures. Control group (CG) patients received standard care treatment. Intervention group (IG) patients received a GDHT protocol based on achieving an optimal stroke volume, in addition to a systolic blood pressure > 90 mmHg and an individualized cardiac index. No changes were made between groups in the ERP during the study period. Primary outcome was percentage of patients who developed intraoperative haemodynamic instability. Secondary outcomes were intraoperative arrhythmias, postoperative complications (cardiovascular, respiratory, infectious and renal complications), administered fluids, vasopressor requirements, perioperative transfusion, length of hospital stay, readmission and 1-year survival. Results In total, 551 patients (CG=272; IG=279) were included. Intraoperative haemodynamic instability was lower in the IG (37.5% vs 28.0%; p=0.017). GDHT patients had fewer postoperative cardiovascular (18.8% vs 7.2%; p < 0.001), respiratory (15.1% vs 3.6%; p<0.001) and infectious complications (21% vs 3.9%; p<0.001) but not renal (12.1% vs 33.7%; p<0.001). IG patients had less vasopressor requirements (25.5% vs 39.7%; p<0.001) and received less fluids [2.600 ml (IQR 1700 to 2700) vs 850 ml (IQR 750 to 1050); p=0.001] than control group. Fewer patients required transfusion in GDHT group (73.5% vs 44.4%; p<0.001). For IG patients, median length of hospital stay was shorter [11 days (IQR 8 to 16) vs 8 days; (IQR 6 to 11) p < 0.001] and 1-year survival higher [73.4% (95%CI 67.7 to 78.3 vs 83.8% (95%CI 78.8 to 87.7) p<0.003]. Conclusions The use of GDHT decreases intraoperative complications and postoperative cardiovascular, respiratory and infectious but not postoperative renal complications. This strategy was associated with a shorter hospital stay and increased 1-year survival. Trial registration ClinicalTrials.gov NCT02479321.

Objective: the aim of this study was to test two buffer solutions in order to attain a reliable and reproducible analysis of inflammatory cytokines (IL-1β, IL-6, TNF-α, OPG, OPN and OC), in gingival crevicular fluid (GCF) by flow cytometry. Material and Methods: GCF samples from healthy volunteers were collected with perio-paper strips and diluted either in phosphate buffered saline (PBS) or Tris-HCl buffer, with and without protease inhibitors (PI). Cytokine immunoassays were carried out by flow cytometry (Luminex Xmap 200) generating standard curves. Results: standards curves generated with the use of phosphate-buffered saline (PBS) demonstrated best adjustment for cytokines IL-1ß, IL-6 and TNF- α levels, when using Tris-HCl (p<0.05). Conclusions: The use of PBS buffer with the addition of PI provided reliable measurements of inflammatory biomarkers in GCF samples of healthy volunteers. Key words:Curve fitting, flow cytometer, immunoassay buffer, crevicular fluid, cytokines.

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Rat liver mitochondria accumulate calcium from the incubation medium both in the presence of ATP and of succinate with rotenone. Lowering free calcium concentration by means of EGTA leads to a reduction of maximum transport capacity to less than 25% of the total added calcium. Under these conditions addition of oxaloacetate inhibits calcium uptake, an effect which is blocked by equimolar concentrations of beta-hydroxybutyrate. Oxaloacetate and acetoacetate induce an efflux of previously accumulated mitochondrial calcium. These effects appear to be independent of free calcium concentration and of whether the mitochondria were obtained from fed rats or rats fasted for 16 h or 4 days.

Background: Goal-Directed Hemodynamic Therapy (GDHT) has been shown to reduce morbidity and mortality in high-risk surgical patients. However, there is little evidence of its efficacy in patients undergoing hip fracture surgery. This study aims to evaluate the effect of GDHT guided by non-invasive haemodynamic monitoring on perioperative complications in patients undergoing hip fracture surgery.Methods: Patients > 64 years undergoing hip fracture surgery within an Enhanced Recovery Pathway were enrolled in this single-center, non-randomized, intervention study with a historical control group and 12-months follow-up. Exclusion criteria were patients with pathological fractures, traffic-related fractures and refractures. Control group patients received the standard care given at our hospital. Intervention group patients received an individualized management strategy aimed at achieving an optimal stroke volume by fluid administration, in addition to a systolic blood pressure > 90 mmHg and an optimal cardiac index according to the patient's age and baseline metabolic equivalents. No changes were made between groups in the enhanced recovery protocols, nor in the composition of the multidisciplinary team during the study period. Primary combined outcome was perioperative complications. Intraoperatively: haemodynamic instability, sustained cardiac arrhythmias. Postoperative complications: cardiovascular, respiratory, infectious and renal complications. Secondary outcomes were administered fluids, vasopressor requirements, perioperative transfusion, length of hospital stay, readmission and one-year survival.Results: 551 patients (Control group=272; Intervention group=279). Intraoperative haemodynamic instability was lower in the intervention group (37.5% vs 28.0%; p=0.017). GDHT patients had fewer postoperative cardiovascular (18.8% vs 7.2%; p < 0.001), respiratory (15.1% vs 3.6%; p<0.001) and infectious complications (21% vs 3.9%; p<0.001) but not renal (12.1% vs 33.7%; p<0.001). Intervention group patients had less vasopressors requirements (p<0.001) and received less fluids (p=0.001) than control group. Fewer patients required transfusion in GDHT group (p<0.001). For intervention group patients, median length of hospital stay was shorter (p < 0.001) and one-year survival higher (p<0.003).Conclusions: The use of GDHT decreases intraoperative complications and postoperative cardiovascular, respiratory and infectious but not postoperative renal complications. This strategy was associated with a shorter hospital stay and increased one-year survival.Trial registration: Clinicaltrials.gov: NCT02479321