Evaluation of bone repair with platelet-rich fibrin following the extraction of impacted third molars - randomized clinical trial.

BACKGROUND: The aim of the present study was to evaluate postoperative effects of platelet-rich fibrin (PRF) in wound and bone healing, pain, swelling and periodontal complications outcomes after impacted third molars extraction. MATERIAL AND METHODS: A prospective, randomized, split-mouth, double-blind clinical trial was conducted. PRF was placed within sockets following tooth removal and before suturing mucoperiosteal flap while no treatment was performed on control group's sockets. Patients were evaluated considering bone volume which was obtained in the 90-day postoperative period. Other variables included trabecular thickness, trabecular distance and grey values, pain, swelling, and wound healing. A Wilcoxon test and a t-Student test were used at a 5% significance level and a Friedman test was used to multiple comparisons. RESULTS: Forty-four surgeries were performed in the present study. The patients' mean age was 22.41 (± 2.75 years) and 72.73% were women. PRF was associated to increased trabecular thickness and bone volume means (p < 0.001). The experimental group had significantly lower pain scores at 4h, 6h, 8h, 16h, 24h, and 72h (p ˂ 0.05). Mean swelling was lower on the experimental group (p < 0.001). The PRF group showed significant higher wound healing (p ˂ 0.001). CONCLUSIONS: Alveolar filling with PRF improves wound and bone healing after extractions while also decreasing pain and swelling in the postoperative period.

Better Selection Criteria With Prognostic Factors for Liver Transplantation.

BACKGROUND: Liver transplantation has evolved significantly in recent years, with each advancement part of the effort toward increasing patient and graft survival as well as quality of life. The objective of this study was to evaluate the prognostic factors and selection criteria for liver transplantation. METHODS: Our study was a statistical analysis, logistic regression, and survival evaluation of a total of 80 liver transplants that were performed between June 1, 2016 and September 24, 2016. Recipient factors evaluated included age, retransplantation, hemodialysis, cardiac risk, portal vein thrombosis, hospitalization, fulminant hepatitis, previous surgery, renal failure, and Model for End-stage Liver Disease (MELD) score. Donor factors included age, cardiac arrest, acidosis, days in the intensive care unit, steatosis, and vasoactive drug use. RESULTS: Of the 80 patients transplanted, 65 deceased donor liver transplants (DDLTs) and 15 living donor liver transplants (LDLTs) were performed. LDLT overall 1-year patient survival was 77.5% and graft survival 75%, and DDLT overall patient survival was 89.23% and graft survival was 86.15%. On evaluated score criteria analyzed we observed a significant score on recipient (P = .01) and not significant on donor (P =.45). Isolated factors evaluated included recipient age (relative risk [RR] 3.15, 95% confidence interval [CI] 0.89 to 11.09; P = .074), retransplant (RR 4.22, 95% CI 1.36 to 13.1; P = .013), and hemodialysis (RR 4.23, 95% CI 1.45 to 12.31, P = .008). On donor evaluation, we observed moderate and severe steatosis (RR 3.8, 95% CI 0.86 to 16.62; P = .06). CONCLUSION: In conclusion, we demonstrate a relevant model of criteria selection of liver transplant patients that is able to make a better match between the donor and recipient allocation for a better graft and patient survival.

Ten years' evaluation of potential pancreas donors in São Paulo, Brazil.

BACKGROUND: Pancreas transplantation is a treatment for advanced type 1 diabetes and offers significant improvement in quality of life. Recent advances in surgical techniques and immunosuppression regimes lead to good outcomes. However, despite significant higher rates of multiorgan donors in Brazil, pancreas transplantation seems to have remained stable. This study aimed to investigate the acceptance rate of potential pancreas donors in the past 10 years in São Paulo State. METHODS: We retrospectively evaluated potential pancreas donors characteristics and its acceptance rate in São Paulo State in the past 10 years. We divided this period into 2 eras: 1st era from January 2003 to January 2008; and 2nd era from January 2008 to January 2013. Data were obtained from São Paulo's government official website. RESULTS: During the whole period, 5,005 deceased donors of all ages were available for pancreas transplantation. According to eras, we had 1,588 donors in the 1st and 3,417 in the 2nd era. In the 2nd era, donors >49 years old were significantly more common (P < .001). Blood test abnormalities, donor comorbidities, and high dosage of vasopressors also were significantly higher in the 2nd era. Rate of graft acceptance had a significant decrease in the 2nd era, from 46.4% to 25% (P < .05). CONCLUSIONS: Despite greater organ availability, pancreas transplantations performed in São Paulo State remained stable. Rate of graft acceptance is dramatically lower in more recent years.