Regenerative Endodontic Procedures of Immature Permanent Premolars with Periapical Lesions: A Report of Two Cases Using Two Different Materials, 18-Month Follow-Up.

Regenerative endodontic procedure is an emerging alternative to traditional therapies for immature teeth with necrotic pulp with or without periapical lesions. This innovative approach, also known as revitalization procedures, is aimed at enhancing canal wall thickness, stimulating root lengthening, and promoting apical closure. The regenerative endodontic procedures involve minimally invasive cleaning to preserve stem cells, stimulation of bleeding and clot formation within the canal, and the use of biomaterials to stimulate differentiation. This method is the first choice in biologically based treatments for immature permanent teeth. We present two successful clinical cases in which regenerative endodontic procedures were performed on permanent premolars with necrotic pulp with symptomatic apical periodontitis and chronic apical abscess due to dens evaginatus. The same procedure was employed for both cases, utilizing two differential materials: ProRoot MTA (Dentsply Tulsa Dental Specialities, USA) and Biodentine™ (Septodont, Saint-Maur-des-Fossés, France). Both cases exhibited positive clinical and radiographic outcomes after an 18-month follow-up period including periapical healing, increased dentin thickness, root lengthening, and apical closure.

Surface-enhanced Raman scattering (SERS) from low-cost silver nanoparticle-decorated cicada wing substrates for rapid detection of difenoconazole in potato.

Potato is one of the most important food crops worldwide in terms of human consumption. However, potato farmers employ a variety of pesticides to protect crops from harmful insects and illnesses, and difenoconazole is a commonly used one that has severe effects on human health and the environment. Therefore, detecting difenoconazole quickly and correctly is critical. In this work, we fabricated AgNPs/cicada wing substrates using natural cicada segments, decorated with silver nanoparticles for surface-enhanced Raman scattering (SERS) measurements to detect trace amounts of difenoconazole in potatoes. Results indicated that a linear relationship with the coefficient of detection (R2) of 0.987 and the detection limit (LOD) of 0.016 ppm was observed by targeting a distinctive peak at 808 cm-1 and logarithmic difenoconazole concentrations of 0.1 to 100 ppm. In addition, difenoconazole LODs in potatoes were 63 µg/kg, lower than those specified by the EU (0.1 mg/kg) and Vietnam (4 mg/kg) utilizing this new technique. Therefore, this proposed SERS method could be used to detect difenoconazole in potatoes at trace levels.

Clinical consequences of gestational diabetes mellitus and maternal obesity as defined by asian BMI thresholds in Viet Nam: a prospective, hospital-based, cohort study.

BACKGROUND: Gestational Diabetes Mellitus (GDM) is common in South East Asia, occurring at relatively lean Body Mass Index (BMI). Outside pregnancy, cardiometabolic risks increase at lower BMI in Asian populations, justifying Asian-specific thresholds for overweight and obesity. We aimed to explore the effects of GDM and obesity on perinatal outcomes using a WHO expert consultation-recommended Asian-specific definition of obesity. METHODS: This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19+ 0-22+ 6 weeks gestation and followed until delivery. GDM screening occurred between 24 and 28 weeks using WHO criteria. Obesity was defined as BMI ≥ 27.5 kg/m2, based on weight and height at recruitment. We assessed associations between GDM (singly, and in combination with obesity) and perinatal outcomes. Participants were categorised into four groups: no GDM/non-obese (reference group), GDM/non-obese, no GDM/obese and GDM/obese. Outcomes included primary caesarean section, hypertensive disorders of pregnancy (HDP), large-for-gestational-age (LGA), birth weight, preterm birth, and composite adverse neonatal outcome. Logistic and linear regressions were performed with adjustment for differences in baseline characteristics. RESULTS: Among 4,970 participants, 908 (18%) developed GDM. Compared to women without GDM, GDM increased risks for preterm birth (OR: 1.40, 95% CI: 1.09-1.78), higher birthweight (birthweight z-score 0.16 versus 0.09, p = 0.027), and LGA (OR 1.14, 0.89-1.46). GDM without obesity was associated with an increased risk of preterm birth (OR 1.35, 1.04-1.74). Obese women without GDM were more likely to deliver by caesarean section and have an LGA baby (1.80, 1.33-2.44 and 2.75, 1.88-4.03). The highest risks were observed amongst women with both GDM and obesity: caesarean Sect. (2.43, 1.49-3.96), LGA (3.36, 1.94-5.80) and preterm birth (2.42, 1.32-4.44). CONCLUSIONS: GDM was associated with an increased risk of preterm birth and larger newborn size. Using an Asian-specific definition of obesity, we demonstrate obese women with GDM are at the highest risk of adverse outcomes. Using a BMI threshold in pregnancy of 27.5 kg/m2 (between 19 and 22 weeks gestation) for Asian women can identify women who will benefit from intensified diabetes, nutritional, and obstetric care. This has relevance for obstetric service delivery within Asia, and other health systems providing pregnancy care for Asian expatriate women.

Clarification on the Reactivity of Diaryl Diselenides toward Hexacyclohexyldilead under Light.

In this study, the reactivity of organochalcogen compounds toward a representative alkyl-lead bond compound under light was investigated in detail. Under light irradiation, the Cy-Pb bond of Cy6Pb2 (Cy = cyclohexyl) undergoes homolytic cleavage to generate a cyclohexyl radical (Cy•). This radical can be successfully captured by diphenyl diselenide, which exhibits excellent carbon-radical-capturing ability. In the case of (PhS)2 and (PhTe)2, the yields of the corresponding cyclohexyl sulfides and tellurides were lower than that of (PhSe)2. This probably occurred due to the low carbon-radical-capturing ability of (PhS)2 and the high photosensitivity of the cyclohexyl-tellurium bond.

Toxic Clostridioides (formerly Clostridium) difficile colitis: No longer a diarrhea associated infection.

BACKGROUND: Clostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea. METHODS: We report a case series of 9 surgical patients from a single institution who developed CDI without preceding diarrhea. RESULT: All 9 patients had CDI with positive laboratory testing for C. difficile toxin. They, however, presented with a lack of or minimal bowel movements. Six patients had rapid development of abdominal distention, 1 patient had a single episode of watery stool in 3 days, while the other 2 patients presented with constipation. Seven patients received stool softeners, suppositories and/or enemas for presumed constipation. Four patients had a mild course of infection and were successfully treated medically. The other 5 patients developed toxic megacolon, and eventually required total abdominal colectomy. Out of the 5 patients that required total colectomy, 2 expired. CONCLUSION: CDI must be suspected in patients who rapidly develop abdominal distention, vague abdominal complaints or change in bowel function even in the absence of diarrhea, especially if coupled with multi-system organ failure.

Suture techniques and patch materials using an in-vitro model for watertight closure of in-utero spina bifida repair.

PURPOSE: Despite proven benefits of in-utero spina bifida (SB) repair, ≥30% of children at birth have Chiari II malformation or cerebrospinal fluid (CSF) leakage from the repair site. Our study's purpose was to determine CSF pressures in the myelomeningocele sac during mid-gestation in order to design an in-vitro model for evaluating different surgical methods used for watertight closure during in-utero SB repair. METHODS: CSF pressures were measured during in-utero SB repair at mid-gestation. An in-vitro chicken thigh model, simulating fetal tissue, tested watertight closure when attached to the base of a water column. Primary closure methods were evaluated using defect sizes of 20 × 3 mm for minimal traction or 20 × 8 mm for moderate traction. Additionally, 3 common in-utero repair patches were compared using 15 × 15 mm defects. RESULTS: Using 6-12.5 cm pre-determined CSF pressures, 165 in-vitro experiments were performed. Regardless of methodology we found that in 66 primary-based closures that minimal versus moderate wound edge traction provided better seals. The locking method was superior to the non-locking technique for watertight closure in 99 patch-based closures. CONCLUSIONS: Minimal wound edge traction was best for primary closures, and locking sutures ideal for patch-based closures, however surgical techniques should be individualized to improve upon clinical outcomes.

A Spectral Approach to Model-Based Noninvasive Intracranial Pressure Estimation.

BACKGROUND: Intracranial pressure (ICP) normally ranges from 5 to 15 mmHg. Elevation in ICP is an important clinical indicator of neurological injury, and ICP is therefore monitored routinely in several neurological conditions to guide diagnosis and treatment decisions. Current measurement modalities for ICP monitoring are highly invasive, largely limiting the measurement to critically ill patients. An accurate noninvasive method to estimate ICP would dramatically expand the pool of patients that could benefit from this cranial vital sign. METHODS: This article presents a spectral approach to model-based ICP estimation from arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) measurements. The model captures the relationship between the ABP, CBFV, and ICP waveforms and utilizes a second-order model of the cerebral vasculature to estimate ICP. RESULTS: The estimation approach was validated on two separate clinical datasets, one recorded from thirteen pediatric patients with a total duration of around seven hours, and the other recorded from five adult patients, one hour and 48 minutes in total duration. The algorithm was shown to have an accuracy (mean error) of 0.4 mmHg and -1.5 mmHg, and a precision (standard deviation of the error) of 5.1 mmHg and 4.3 mmHg, in estimating mean ICP (range of 1.3 mmHg to 24.8 mmHg) on the pediatric and adult data, respectively. These results are comparable to previous results and within the clinically relevant range. Additionally, the accuracy and precision in estimating the pulse pressure of ICP on a beat-by-beat basis were found to be 1.3 mmHg and 2.9 mmHg respectively. CONCLUSION: These contributions take a step towards realizing the goal of implementing a real-time noninvasive ICP estimation modality in a clinical setting, to enable accurate clinical-decision making while overcoming the drawbacks of the invasive ICP modalities.

Epidemiological characterization of pityriasis versicolor and distribution of Malassezia species among students in Hai Phong city, Vietnam.

BACKGROUND AND PURPOSE: Pityriasis versicolor (PV) is a common fungal skin infection caused by Malassezia species. Previous studies have shown that the prevalence of PV is influenced by geographic factors. The aim of the current study was to find the epidemiological characteristics of PV and distribution of Malassezia species in the secondary school students living in Hai Phong city, Vietnam. MATERIALS AND METHODS: This study was conducted on 1357 students within the age range of 10 - 16 years selected from four secondary schools in Hai Phong city. The students were screened for PV skin lesions from August 2016 to December 2017. The isolates of Malassezia from PV patients were analyzed by performing direct microscopy and culturing on modified Dixon agar plates, containing gentamicin, at 32oC for 7 days. In the next stage, the fungal strains obtained from patients with positive fungal cultures were identified using the CHROMagarTM Malassezia medium, polymerase chain reaction-restriction fragment length polymorphism techniques, and D1/D2 rDNA genome sequencing. RESULTS: Pityriasis versicolor was diagnosed in 305 (22.48%) students and confirmed by clinical appearance and direct examination. A total of 293 (96.07%) samples grew on modified Dixon agar. With regard to demographic characteristics, 50.49% of the PV cases were female, and 57.38% of cases resided in urban areas. Furthermore, 88.52% of the subjects had the illness duration of more than 6 months. Hypopigmented and erythematous skin lesions were also observed in the research participants, with hypopigmentation being the most frequent condition (97.05%). Most of the Malassezia fungal strains were isolated from the back (39.56%), face (23.99%), and chest (16.51%). Malassezia furfur and M. japonica accounted for PV in 96.25% and 3.75% of the cases, respectively. Furthermore, Malassezia furfur was distributed in both rural and urban areas, while M. japonica was found only in the urban areas. CONCLUSION: The findings of the present study were indicative of the high prevalence of Malassezia yeasts, mostly M. furfur, among the students in Hai Phong city, Vietnam.

The utility of impedance cardiography in hemodynamic monitoring of patients with sepsis.

BACKGROUND: Commonly used biochemical indicators and hemodynamic and physiologic parameters of sepsis vary with regard to their sensitivity and specificity to the diagnosis. The aim of this preliminary study was to evaluate non-invasive impedance cardiography as a monitoring tool of the hemodynamic status of patients with sepsis throughout their initial volume resuscitation to explore the possibility of identifying additional measurements to be used in the future treatment of sepsis. METHODS: Nine patients who presented to the emergency room and received a surgical consultation during a 3-month period in 2016, meeting the clinical criteria of sepsis defined by systemic inflammatory response syndrome in the 2012 Surviving Sepsis Campaign Guidelines, were included in this study. We applied cardiac impedance monitors to each patient's anterior chest and neck and obtained baseline recordings. Measurements were taken at activation of the sepsis alert and 1 hour after fluid resuscitation with 2 L of intravenous crystalloid solution. RESULTS: Nine patients met the inclusion criteria. The mean age was 60±17 years and two were female; eight were febrile, five were hypotensive, four were tachycardic, seven were treated for infection, and six had positive blood cultures. Hemodynamic parameters at presentation and 1 hour after fluid resuscitation were heart rate (beats per minute) (97±13 and 93±18; p=0.23), mean arterial pressure (mm Hg) (81±13 and 85±14; p=0.55), systemic vascular resistance (dyne-s/cm- 5) (861±162 and 1087±272; p=0.04), afterload measured as systemic vascular resistance index (dyne-s/cm- 5/m2) (1813±278 and 2283±497; p=0.04), and left cardiac work index (kg*m/m2) (3.6±1.4 and 3.3±1.3; p=0.69). DISCUSSION: Through measuring a patient's systemic vascular resistance and systemic vascular resistance index (afterload), statistical significance is achieved after intervention with a 2 L crystalloid bolus. This suggests that, along with clinical presentation and biochemical markers, impedance cardiography may show utility in providing supporting hemodynamic data to trend resuscitative efforts in patients with sepsis. LEVEL OF EVIDENCE: Level IV.

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism.

BACKGROUND: Thrombectomy is recommended to treat for an acute ischemic stroke (AIS) patient with anterior large vessel occlusion. However, there were neither detailed guidelines nor systematic reviews of acute ischemic stroke patients having multiple times or re-occluded arteries. CASE REPORT: In our case report, we struggled a multiple (4-times) AIS patient underwent by one intravenous r-tpA and 3 remaining of endovascular treatment of thrombectomy. Especially, the finding of both pulmonary embolism and cerebral arteries occlusion in this patient made us difficult to decide the appropriate treatment plan. The patient was considered having multiple cardiac thrombi pumping out to the brain and pulmonary vessels even in treatment with NOAC (New Oral Anticoagulant). Our priority, normally, was to recanalize the brain vessels compared to the pulmonary arteries. CONCLUSION: In conclusion, based on this noticed case study, we want to share our experiences on the diagnosis of ischemic stroke, the strategy in treatment and prevention with anticoagulant therapy.

Radicular cyst in a primary molar following pulp therapy with gutta percha: A case report and literature review.

A radicular cyst (RC) in deciduous dentition is relatively rare. This clinical report presents a case of RC that condition derived from a primary molar undergone an endodontic treatment with gutta-percha approximately one year ago. In addition, we also considered whether intracanal medicaments and gutta-percha filling material related to the formation and development of the cyst or not. Key words:Primary tooth, radicular cyst, pulp therapy, gutta-percha filling material, intracanal medicament.

A Frequency-domain Approach to Noninvasive Intracranial Pressure Estimation.

Intracranial pressure (ICP) is a cranial vital sign, crucial in the monitoring and treatment of several neurological injuries. The clinically accepted measurement modalities of ICP are highly invasive, carrying risks of infection and limiting the benefits of ICP measurement to a small subset of critically ill patients. This work aims to take a step towards developing an accurate noninvasive means of estimating ICP, by utilizing a model-based frequency-domain approach. The mean ICP and pulse pressures of ICP are estimated from arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) waveforms, and the estimates are validated on an adult population, comprising of around two hours of data from five patients. The algorithm was shown to have an accuracy (mean error) of -1.5 mmHg and a precision (standard deviation of the error) of 4.3 mmHg in estimating the mean ICP. These results are comparable to the previously reported errors among the currently accepted invasive measurement methods, and well within the clinically relevant range.

Correction of Upper Incisor Proclination by Applying Lingual Crown Torque with Pre adjusted Lingual Brackets in a Skeletal-Class III Patient - Case Report.

BACKGROUND: After levelling and alignment in skeletal Class III patients with upper anterior crowding, the upper incisors usually have excessive proclination. In these cases, the upper incisors' axial proclination need to be reduced to improve esthetics. CASE REPORT: This case report presents an invisible orthodontic treatment of a 24-year-old adult female patient with skeletal Class III relationship, anterior crossbite, proclined upper incisors, and reduced incisor showing. Patients denied extraction and interproximal reduction. With multi-slotted lingual brackets and straight archwires, we applied lingual crown torque to upper anterior teeth to reduce axial proclination. The resulting uprighted position of upper incisors led to increased incisor showing. A good smile and stable occlusion were obtained after 15 months of active treatment. CONCLUSION: The use of lingual brackets to apply lingual crown torque helps to reduce axial proclination and increasing upper incisor showing without interproximal reduction nor extraction in skeletal Class III patients with upper anterior crowding.

Perforator Mapping of the Superficial and Deep Inferior Epigastric Artery in the Abdominal Region of the Vietnamese.

BACKGROUND: Previous studies worldwide have investigated the anatomy of the perforators of the deep inferior epigastric arteries to figure out the navigation patterns of the perforators on the abdominal wall. This has been inconsistent amongst the researchers about how to select the perforator to increase the blood supply area for the flap. AIM: To explore the blood supply area of the perforators of the superficial and deep inferior epigastric artery in the abdominal region of the Vietnamese by dissection and 64-slice multislice computed tomography (64-slice MSCT). METHODS: A descriptive cross-sectional study Center from September 2014 to September 2016 on two groups including 30 cadavers fixed by formalin 10% in Anatomy Department of UPNT, and 37 patients getting the 64-slice MSCT abdominal arteries angiogram. RESULTS: The superficial epigastric arteries at the level of the inguinal ligament were located in the middle region, with 96% (right) and 88.5% (left). The anterior superior iliac spine level was in the middle, and lateral regions of 68% and 32% respectively. The level of the umbilical cord was in the lateral region with 66.7% and 85.7%, respectively. There were about 6 perforators of the deep inferior epigastric arteries located in the navel area. These perforators were 70% in the medial region and 30% in the middle region. CONCLUSION: Mapping the blood supply based on the fourth space in the abdominal region in which the superfical inferior epigastric arteries supplied the lateral area. The middle and the internal ones were the perforators of the deep inferior epigastric arteries.

Have outcomes improved in trauma patients age 90 years and older over the past decade: Experience at a level II trauma center.

INTRODUCTION: Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades. METHODS: Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD). RESULTS: A total of 1697 patients were recorded, 551 (ED) and 1146 (LD). The mean age was 92.92 ±â€¯8(90-108)[ED] and 92.9 ±â€¯2.7(90-105)[LD] years. The most common mechanism and type of injury was falls and extremity trauma. Hospital length of stay (LOS) was shorter in the LD. There was no significant difference in in-hospital mortality or ICU LOS. CONCLUSION: Trauma admission has increased in the last decade. However, in-hospital mortality remains low. It is important for multidisciplinary teams to allocate resources to treat this elderly population.

Two concurrent appendiceal neoplasms in an elderly patient: A case report.

INTRODUCTION: Acute appendicitis, one of the commonest surgical diagnoses, is rare and more complex presentation in the elderly. Physicians must consider atypical causes appendicitis in this population, which could affect the management of the patient. PRESENTATION OF CASE: An elderly female presented with a two-day history of lower abdominal pain, associated with low-grade fevers and chills. Studies showed leukocytosis and computed tomography (CT) findings consistent with appendicitis. She underwent laparoscopic appendectomy. Intra-operatively, the Appendix had an unusual appearance, so a frozen-section was obtained, suggestive of a mucinous neoplasm with grossly clear margins. Despite the possibility that she may require a more extensive cancer operation pending the final Pathology results, the decision was made to complete the operation at this stage, and return at a later date if needed, after completing the patient's work-up with a colonoscopy to rule out any synchronous colonic lesions that could alter her surgical management. Final Pathology revealed both a low-grade appendiceal mucinous neoplasm, as well as a tip carcinoid tumor, both of which were adequately treated with appendectomy alone. DISCUSSION: Physicians treating elderly patients with appendicitis should suspect an atypical etiology, such as appendiceal cancer. Early identification and appropriate pre-operative counseling may alter the surgical management. CONCLUSION: The role and timing of right hemicolectomy in treating appendiceal cancers remain controversial, and should be evaluated on a case by case basis.

There is no functional small-fibre neuropathy in prurigo nodularis despite neuroanatomical alterations.

Prurigo nodularis (PN) is a pruritic condition with altered epidermal neuroanatomy as demonstrated previously. Here we elucidated neuroimmunological mechanisms by combining functional, morphological and gene expression experiments in twelve subjects with PN and eight healthy controls. Subjects with PN showed a reduced intra-epidermal nerve fibre density (IENFD) in lesional skin. Quantitative sensory testing indicated maintenance of somatosensory function compared to controls. None of the tested molecular markers including the neuron-distracting SEMA3A and neuron-attracting NGF were altered in lesional vs non-lesional skin in PN subjects. Accordingly, we speculate that scratching may contribute to reduced IENFD rather than an authentic endogenous neuropathy.

Initial hematocrit in trauma: a paradigm shift?

BACKGROUND: After severe trauma and hemorrhage, it is generally assumed that the rate of fluid shift from the interstitial space into the vasculature is relatively slow and that initial hematocrit (Hct) does not reflect estimated blood loss. This study challenges that idea and tests the hypothesis that initial Hct correlates with signs of shock and hemorrhage in trauma patients. METHODS: Data were retrospectively reviewed from 198 trauma patients requiring emergency surgery at a Level I center from July 2009 to April 2010. Patients were divided into quartiles based on the initial Hct measured within 10 minutes of arrival. Categorical data were compared using χ(2) test or Fisher's exact test, as appropriate. Normally distributed data were compared using Student's t test or analysis of variance. Nonparametric data were compared with a Mann-Whitney U test or Kruskal-Wallis test. Post hoc analysis was conducted using the Bonferroni correction or paired Mann-Whitney U tests. RESULTS: The study population was 83% male, aged 35 ± 1 years (mean ± SE), with 71% penetrating injuries. Lower initial Hct correlated with hypotension (p < 0.001), acidosis (p = 0.003), altered mental status (p < 0.001), Injury Severity Score (p < 0.001), Revised Trauma Score (p < 0.001), estimated blood loss (p < 0.001), and usage of packed red blood cells (p < 0.001), fresh frozen plasma (p = 0.003), crystalloid (p = 0.021), and vasopressors (p < 0.001). CONCLUSION: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.

Operating room or angiography suite for hemodynamically unstable pelvic fractures?

BACKGROUND: Few patients require angiography and therapeutic embolization for bleeding pelvic fractures, but they are risk for significant morbidity and mortality. In hemodynamically unstable trauma patients with pelvic fractures, the decision to proceed to the operating room (OR) to address intraabdominal bleeding, or angiography to address pelvic bleeding (ANGIO), is rarely straightforward. This study tested the hypothesis that outcomes are similar regardless if the sequence was OR-ANGIO or ANGIO-OR. METHODS: All pelvic fractures between 1999 and 2011 were retrospectively reviewed and stratified by initial management with ANGIO or OR. RESULTS: Of 2,922 patients with pelvic fractures, only 183 (6%) required angiography for suspected bleeding. For OR-ANGIO (n = 49) versus ANGIO (n = 134), injury severity score was similar (40 ± 15 vs. 35 ± 16), but systolic blood pressure (97 ± 28 vs. 108 ± 32 mmHg, p = 0.038) and base excess were both lower (-9 ± 5 vs. -5 ± 5 mEq/L, p < 0.001). During initial resuscitation and in the first 24 hours, crystalloid, blood product usage and total fluid requirements were all increased 50% to 100% (all p < 0.001). Despite these differences, lengths of stay (32 ± 32 vs. 26 ± 28 days) and mortality (33% vs. 31%) were similar. The same trends in fluid requirements remained in the subset of patients with unstable pelvic fractures, with an increased mortality (67% vs. 20%, p = 0.011) in those requiring ANGIO-OR versus OR-ANGIO. CONCLUSION: These data support current management algorithms. In hemodynamically unstable trauma patients with pelvic fractures, those who proceeded immediately to the OR to address intraabdominal bleeding tended to be sicker but had outcomes that were the same or better compared with those who received angiography to address pelvic bleeding. LEVEL OF EVIDENCE: III, retrospective review.