Comparative evaluation of pH and Ca + ion release from MTA on interaction with platelet-rich fibrin and blood clot: an in vitro study.

Background: 'Regenerative endodontics' using host-derived scaffolds and biomaterials (MTA) is popular in the management of teeth with open apex. Alkaline pH and bioactivity contribute to tissue healing and remineralization. We assessed the influence of PRF and Blood Clot on the pH and Ca + ion release from MTA. Methods: A total of 15 single-rooted human extracted teeth were sectioned at the level of the cementoenamel junction. Based on the type of scaffolds used, samples were divided into three groups. Group 1 (MTA+ PRF), Group 2 (MTA + Blood Clot), Group 3 (control MTA). The prepared specimens were transferred to a fresh falcon tube containing 10mL of distilled water and the collected solutions were analysed for pH and Ca + ion release at 3h, seventh day and 14 th day. Results: It was observed that the mean pH and Ca + ion release were significantly lower in the experimental groups as compared to the control group. Though there was an increase in the pH recorded in Group 1 and 2 at all time periods, the difference was not significant. Ca + ion release peaked at Day 7 (Group3 > Group2 > Group1) and reduced significantly on the 14 th day for all groups. Conclusions: Within the limitations of the study, it can be concluded that PRF and blood clot influence the pH and Ca + ion release from MTA.

Prehabilitation Before Gastrointestinal Cancer Surgery: Protocol for an Implementation Study.

BACKGROUND: Surgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being are associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and psychological interventions. Yet, how it transitions from a trial setting to being integrated into a real-world health setting is unknown. OBJECTIVE: The primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. The secondary aim is to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes. METHODS: This is an implementation study that will investigate a multimodal prehabilitation intervention, in a nonblinded, nonrandomized, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital, with ≥14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The study will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Evaluation Framework. RESULTS: The protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee (reference number 2019/PID13679). Recruitment commenced in January 2020. In response to the COVID-19 pandemic, recruitment was paused in March 2020 and reopened in August 2020 with remote or telehealth intervention adaptations. Recruitment ended on December 31, 2021. Over the 16-month recruitment period, a total of 77 participants were recruited. CONCLUSIONS: Prehabilitation represents an opportunity to maximize functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of health care delivery including telehealth. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTR 12620000409976; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378974&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/41101.

Short-term multimodal prehabilitation improves functional capacity for colorectal cancer patients prior to surgery.

AIM: Evaluate feasibility and outcomes of a multimodal prehabiliation program in patients with stage I-III colorectal cancer (CRC) awaiting surgery. METHODS: Patients scheduled for elective CRC resection at Concord Repatriation General Hospital were recruited from pre-admission clinic between January and November 2018. Participants received a 2-4 week prehabilitation program consisting of supervised exercise sessions, nurse-led phone support, and written nutritional information. Participants were assessed at baseline, pre-surgery, and 4 weeks post-surgery. RESULTS: Twenty-two patients participated in the program: 55% male; median age 73 (56-86) years. Six (28%) required an interpreter. At baseline, 19 of 22 (86%) had at least one comorbidity. Median intervention length was 11.5 days (range 7-29). Participants attended 79% of scheduled exercise sessions (range 33-100%, mean 3.5 sessions) and 66% of nurse support calls (range 0-100%, mean 2.6 sessions). Between baseline and pre-surgery, participants reported increasing mean unsupervised moderate-intensity aerobic exercise from 17 (range 0-210) to 73 minutes/week (range 0-276) and mean vigorous-intensity aerobic exercise from 0 to 24 minutes/week (range 0-300). Resistance exercise sessions increased from 0.6 to 2.6 times/week. Mean 6-minute walk test distance increased by 48 meters (435-483 m) and 30-second "sit to stand" by 1.6 repetitions. Small improvements were seen in global quality of life and fatigue. Nutritional status and body composition remained unchanged. All participants were satisfied/strongly satisfied with the program and would recommend it to others. CONCLUSION: Our multimodal prehabilitation program was feasible in CRC patients inclusive of those from non-English speaking backgrounds, with improvement in functional capacity before CRC surgery.

Marking time: the temporal experience of gastrointestinal cancer.

This study uses Heideggerian Phenomenology to explore the lived experience of gastrointestinal cancer and treatment with a curative intent. Eighteen patients and carers engaged in in-depth, conversational style interviews. Four recurring themes that spoke of the temporal significance of the cancer diagnosis included a recall of intricate details around significant dates; waiting; a changing pace of perceived time and being-towards-death. Fear and anxiety around cancer progression and recurrence underlie these themes. The meaning of time altered so that it was experienced as a precious commodity to be consciously managed in the context of their changed present and future. Being-towards-death was constituted of fear, but allowed the person to redefine meaning and purpose in their life. These insights will better prepare health professionals to guide discussions and provide perspective for the concerns of patients and families, particularly in relation to waiting times for tests and cancer interventions.