Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion

The aim of this study was to verify the occurrence of hemolysis after infusion of packed red blood cells (PRBCs) in 12 peripherally inserted central catheters (PICCs) with a proximal valve, according to size and infusion rate. This was an experimental in vitro study performed under laboratory-controlled conditions, and the sample was composed of 12 PICCs with proximal valves (3F and 4F catheter). Twelve type A+ aliquots from 10 PRBCs were analyzed preinfusion and postinfusion according to PICC size and infusion rate. Hemolysis markers, total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L), and rate of hemolysis (%) were studied. Data were analyzed using analysis of variance and Bonferroni multiple comparison tests. After the infusions in 3F PICCs, an increase was seen in rate of hemolysis (P =.003) and free hemoglobin (P =.014), in addition to a reduction in total hemoglobin (P =.002), with significant influence of minimum and maximum flow rates on the rate of hemolysis. The study finding indicated that the smaller catheter size and the infusion rate influenced variations in some hemolysis markers, but the alterations observed in the hemolysis markers would not contraindicate the infusion of PRBCs by 3F and 4F PICCs with proximal valves.No Full Tex

Effects of Adjacent Tooth Type and Occlusal Fatigue on Proximal Contact Force of Posterior Bulk Fill and Incremental Resin Composite Restoration

SUMMARY Objectives To measure the proximal contact force in newtons (N) between incremental and bulk fill class II resin composite restorations and implant molar teeth or adjacent premolar teeth with simulated periodontal ligament. Methods The model used was created with a typodont first molar tooth with two bilateral occlusal-proximal class II cavities, an adjacent tooth simulating an implanted molar tooth (Titamax CM, Neodent, Curtiba, PR, Brazil) and a premolar with simulated periodontal ligament. Two resin composite restorative techniques were used: Inc-Z350XT, (Filtek Z350, 3M Oral Care, St. Paul, MN, USA) inserted incrementally and Bulk-OPUS, (Opus Bulk Fill APS, FGM, Joinville, SC, Brazil) high viscosity bulk fill resin composite (n=10). As a control, a typodont having intact teeth without restorations was used. After the restorative procedure, each specimen was radiographed using a digital system (Dürr Dental, Bietigheim-Bissingen, Germany). The proximal contact force (N) was measured using dental floss with a microtensile machine (Microtensile ODEME, Luzerna, SC, Brazil). The specimens were then subjected to mechanical fatigue cycling to simulate 5 years of aging. All the parameters were measured after aging. The X-rays were blindly qualitatively analyzed by two operators to identify the loss of proximal contact. One-way ANOVA was used for comparing the initial contact force between restored and intact teeth. Two-way ANOVA followed by Tukey testing was performed for contact area data and for the contact force/contact area ratio. The proximal contact force data were analyzed using one-way repeated measurement ANOVA followed by Tukey testing (α=0.05). The X-ray proximal contact analyses were described by the frequency. Results The initial proximal contact force was similar for intact and restored teeth. The contact force and contact area with the molar were significantly higher than with the premolar; however the contact force/contact area ratio was similar for all tested groups. The bulk fill technique showed a contact force similar to the incremental filling technique. Fatigue resulted in a significant reduction in the proximal contact force (p&amp;lt;0.001), irrespective of the region analyzed or restorative material used. The digital X-rays detected no alteration in the proximal contact after occlusal fatigue. Conclusions Larger contact area resulted in higher proximal contact force. Proximal contact force decreased with 5 years of simulated occlusal fatigue. The bulk fill technique showed a proximal contact force similar to that of the incremental filling technique. </jats:sec