Detection of Visually Imperceptible Blood Contamination in the Surgical Area Using Luminol Among Different Oral Surgical Procedures: An Observational Study.

Introduction Oral surgeons often encounter a significant occupational risk of exposure to potentially harmful infectious diseases during minor oral surgical procedures. These diseases can be transmitted through direct contact with body fluids and aerosolized splatters that may not be visibly detectable. The likelihood of transmission is heightened for clinicians, healthcare workers, and patients alike. The reported prevalence of exposure to blood-borne infections in this field is as high as 90%, with half of these exposures being visually imperceptible. Aim The aim was to detect visually imperceptible blood contamination on personal protective equipment (PPE) and clinical surfaces using the chemiluminescence agent luminol during oral surgical procedures. Materials and methods Thirty minor oral surgical procedures were performed in the Oral and Maxillofacial Surgery Department after obtaining approval from the Institutional Ethics Committee (IEC), Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation, Salem, India. The surgeon, assistant, patient, and clinical surfaces (comprising 15 subsites within the surgical field) wore PPE. The PPE was scrutinized for traces of visually imperceptible blood contamination using luminol. The results of blood splatter on PPE and clinical surfaces in different oral surgical procedures between the non-aerosol and aerosol groups of different durations were analyzed statistically using the chi-square test with p < 0.05 considered significant. Results We observed that visually imperceptible blood contamination in non-aerosol procedures was detected on the assistant PPE kit (46.7%, n = 14), assistant face shield (40%, n = 12), suction apparatus (50%, n = 15), wall (30%, n = 9), and floor (56.7%, n = 17), in both aerosol and non-aerosol procedures. The p-value has been considered statistically significant at p < 0.05 between both the groups (aerosol and non-aerosol). Conclusion Our study results confirmed the presence of undetected blood spillage during aerosol procedures of 30 minutes and non-aerosol surgical procedures of more than 30 minutes over an area of 3.1 feet horizontally and 4.8 feet vertically. So, we strongly emphasize that PPE kits and face shields are mandatory for both surgeon and assistant while performing oral surgical procedures in order to prevent the risk of cross infections, proper infection prevention control protocol for the clinical surfaces also needs to be followed as a standard protocol in all operations.

The Effect of Different Decontamination Methods on the Micro-Tensile Bond Strength of CAD/CAM Resin-Based Blocks to Resin Cement.

INTRODUCTION: This study evaluates the impact of decontamination methods on Microtensile bond strength (µTBS) between resin cement and resin blocks. METHODS: Twenty CAD/CAM resin blocks from two manufacturers were wet-polished, sandblasted, and ultrasonically cleaned. After blood and saliva contamination, blocks were divided into subgroups: control, water rinsing, acid etching, alkaline cleaning paste, or 10-MDP containing cleaner. Resin-based cement was then applied. After 24 hours, the blocks were sectioned to obtain bars for testing. Half of the specimens were tested immediately for µTBS, and the other half underwent artificial aging. The surfaces of the blocks were inspected with a scanning electron microscope (SEM). Three-way ANOVA was performed for µTBS values (α=0.05). RESULTS: In one of the substrates, the positive control subgroup obtained the highest value (56,01 MPa, SD:6,96) followed by 10-MDP cleaner and universal cleaning paste, when immediately tested, with significant differences respect to the water rinsing (p⟨0.041) and acid etching (p⟨0.048) groups. After thermocycling, higher values were found in the 10-MDP cleaner (47,57 MPa, SD:8,15), but differences were not significant. In the other substrate group, the 10-MDP cleaner subgroup showed highest bond strengths (64,46 MPa SD: 10,92) at the initial test. After thermocycling, 10-MDP cleaner (58,66 MPa, SD: 9,93) gave the highest µTBS value. Significant differences between water rinsing group and the rest of subgroups (p⟨0.001), and between 10-MDP cleaner and the positive control group (p⟨0.006) were observed. CONCLUSION: Cleaning after contamination improves bonding. 10-MDP containing cleaner can help to restore initial µTBS value and maintain it in the long-term.

Comparative evaluation of the effect of two natural collagen cross-linkers on microtensile bond strength of self-etch adhesive system to dentin after contamination with blood and hemostatic agent: An in vitro study.

Background: Cavity preparation often causes gingival bleeding which can be controlled by hemostatic agents (HAs). These along with blood act as contaminants and hamper the bonding mechanism. Collagen cross-linkers (CCLs) are agents known to increase the bond strength (BS) to dentin. Hence, the purpose of this in vitro study was to determine the effect of two different CCLs, proanthocyanidin (grape seed extract [GSE]) and hesperidin on the microtensile BS (µTBS) of a self-etch adhesive (SEA) system to dentin which was contaminated with blood and a HA. Materials and Methods: Thirty-six extracted human molars were collected, and their occlusal surfaces were sectioned to expose the dentin. The teeth were randomly divided into four groups: Group I - Control, Group II - Contamination with blood and HA, Group III - Application of GSE after contamination, and Group IV - Application of hesperidin extract after contamination. The SEA was applied, followed by the use of a nanocomposite. Dentin-composite rods were obtained from each group, and µTBS testing was done. The fracture pattern was visually classified as an adhesive failure at the interface, cohesive failure in composite, or dentin. The scanning electron microscope (SEM) analysis was done for two samples from each group. Statistical analysis was done using the Student's unpaired "t" and ANOVA test. Results: Group II showed a statistically significant reduction in µTBS in comparison to Group I. This was overcome in Groups III and IV. Hesperidin showed marginally better results than GSE. Conclusions: The use of GSE and hesperidin increases the µTBS of composite resin to dentin postcontamination with blood and ViscoStat Clear with Single Bond Universal Adhesive.

Alzheimer's disease biomarkers in cerebrospinal fluid are stable with the Elecsys immunoassay to most pre-analytical influencing factors except freezing at -80 °C.

BACKGROUND: Alzheimer´s disease is considered a neurodegenerative disease and is diagnosed by exclusion, while the detection of specific cerebrospinal fluid (CSF) biomarkers, namely amyloid-beta (Aß) peptides Aß1-42 (Aß42), phospho-tau (181P; P-tau), and total-tau (T-tau), has been shown to improve diagnostic accuracy. Recently, a new generation of sample tubes (Sarstedt false-bottom tubes) for the Elecsys CSF immunoassay for the determination of Alzheimer´s disease biomarkers in CSF was introduced, promising better measurability. However, the pre-analytic influencing factors have not yet been sufficiently investigated. METHODS: In 29 patients without Alzheimer's disease diagnosis, CSF concentrations of Aß42, P-tau and T-tau were examined in native CSF and after different influencing interventions using the Elecsys immunoassay test method. The following influencing factors were analyzed: contamination with blood (10,000 and 20,000 erythrocytes/µl CSF), 14-day storage at 4 °C, blood contamination of CSF and 14-day storage at 4 °C, 14-day freezing at -80 °C in Sarstedt tubes or glass vials, 3-month intermediate storage at -80 °C in glass vials. RESULTS: Both storage at -80 °C for 14 days in Sarstedt false-bottom tubes and in glass vials and storage at -80 °C for 3 months in glass vials resulted in significant decreases in Aß42 (13% after 14 days in Sarstedt and 22% in glass vials, 42% after 3 months in glass vials), P-tau (9% after 14 days in Sarstedt and 13% in glass vials, 12% after 3 months in glass vials) and T-tau (12% after 14 days in Sarstedt and 19% in glass vials, 20% after 3 months in glass vials) concentrations in CSF. No significant differences were found for the other pre-analytical influencing factors. CONCLUSIONS: Measurements of the concentrations of Aß42, P-tau, and T-tau in CSF with use of the Elecsys immunoassay are robust to the pre-analytical influencing factors of blood contamination and duration of storage. Freezing at -80 °C results in significant reduction of biomarker concentrations regardless of the storage tube and must be considered in retrospective analysis.

Impact of low- and high-risk operators handling irinotecan on the blood contamination of health care workers in oncology day care units.

INTRODUCTION: Health care workers handling antineoplastic drugs (ADs) are at risk of mutagenicity and adverse reproductive effects. Despite protective equipment and AD handling guidelines, AD levels are still detected in caregivers in oncology units. This study attempted to assess blood contamination by irinotecan and its metabolites in all health care workers in oncology day hospital units according to activities specific to each employment category. METHODS: The study was performed at two different hospitals: a university hospital and a comprehensive cancer centre. Forty-four participants were categorized according to their daily activity as a high-risk operator (29 nurses/ward aides and 5 cleaning staff) and a low-risk operator (7 doctors and 3 secretaries). The collected blood samples were subjected to UHPLC-MS/MS. The plasma and red blood cell (RBC) levels of irinotecan and its metabolites (SN-38; APC) were determined using a validated analytical method detection test. RESULTS: Two hundred sixty-four assay results were collected (132 plasma results and 132 RBC results). The comparison between low- and high-risk operator-contaminated workers was not significant (18.33% positive results in low-risk operators vs. 25.98% positive results in high-risk operators; P = 0.22). This homogeneity showed overall contamination within the unit. Positive results were obtained in 21.43% of physicians, 11.11% of secretaries, 25.86% of nurses/ward aides and 26.67% of cleaning staff. These results could be explained by the lack or failure of personal and collective protective equipment. A lack of protection and inadequate decontamination procedures can result in surface contamination. CONCLUSIONS: This study evaluated blood contamination with irinotecan and its metabolites in health care workers from day hospital care units. Among the 24.24% of contaminations observed in care units, the difference between low- and high-risk operator contamination was not significant (P = 0.22). The impact on blood contamination found is the same between low- and high-risk caregivers. This implies that the protective precautions associated with the handling of anticancer drugs must therefore be followed by all staff, including those believed to be at low risk of exposure.

Blood and saliva contamination on protective eyewear during dental treatment.

OBJECTIVES: Dental treatments are inherently associated with the appearance of potentially infective aerosols, blood and saliva splashes. The aim of the present study was to investigate the quantitative contamination of protective eyewear during different dental treatments and the efficacy of the subsequent disinfection. MATERIALS AND METHODS: Fifty-three standardized protective eyewear shields worn by students, dentists and dental assistants during different aerosol-producing dental treatment modalities (supragingival cleaning, subgingival periodontal instrumentation, trepanation and root canal treatment and carious cavity preparation; within all treatments, dental evacuation systems were used) were analysed, using common forensic techniques. For detection of blood contamination, luminol solution was applied onto the surface of safety shields. A special forensic test paper was used to visualize saliva contamination. Further analysis was conducted after standardized disinfection using the same techniques. Statistical analysis was performed using SPSS. RESULTS: Macroscopically detectable contamination was found on 60.4% of protective eyewear surfaces. A contamination with blood (median 330 pixels, equivalent to 0.3% of the total surface) was detected on all shields after dental treatment. Between various dental treatments, the contamination with blood tend to be statistically significant (p = 0.054). Highest amount of blood was observed after professional tooth cleaning (median 1,087 pixels). Significant differences of saliva contamination were detected between the different measurements (p < 0.001) with contamination only after dental treatment. Due to the low variance and right-skewed distribution for saliva contamination, no statistical analysis between different treatments could be performed. After disinfection, 0.02% blood contamination and no saliva contamination were detected. CONCLUSIONS: Disinfection is effective against blood and saliva contamination. Macroscopically, clean protective eyewear contains up to 12% surface contamination with blood. Based on the results, it may be concluded that protective eyewear is essential for each dental practitioner. CLINICAL RELEVANCE: As standard for infection prevention in the dental practice, disinfection of protective eyewear after each patient is necessary.

Push-out bond strength of the calcium silicate-based endodontic cements in the presence of blood: A systematic review and meta-analysis of in vitro studies.

OBJECTIVES: The push-out bond strength (POBS) of calcium silicate-based cements (CSCs) to the dentinal wall is considered one of the essential physical properties for clinical success. The presence of blood in the treatment area affects the POBS of these types of cement. This study aimed to evaluate the impact of blood contamination on the bond strength of CSCs and dentinal walls. MATERIAL AND METHODS: This systematic review was performed by searching electronic databases (MEDLINE-PubMed, Scopus, and EMBASE) to include relevant in vitro studies published between 1992 and April 2020. Two reviewers independently evaluated the selected studies and extracted data on the type of studied CSCs, evaluated area of the teeth, sample size, the dimension of a prepared area, slice thickness, storage duration, the setting of the universal testing machine (UTM), effects of blood contamination on POBS of CSCs and their failure modes. The bond strength of evaluated CSCs in studies was used for network meta-analysis. RESULTS: Initial searches identified 292 articles, while only 13 articles met the inclusion criteria. Full texts of these articles were evaluated, and data extraction was performed. The effect of blood contamination on bond strength to the dentinal wall was assessed in various CSCs such as PMTA, Biodentine, and AMTA. The network meta-analysis results showed that the bond strength of Biodentine was significantly higher than other types of cement in blood presence (p < .05). CONCLUSIONS: Based on the current systematic review, despite controversies among the result of the different articles and the lack of data for some CSCs like bioaggregate, it could be concluded that the bond strength of Biodentine to the dentinal wall is better than other evaluated CSCs in the presence of blood.

A comparative study of data-dependent acquisition and data-independent acquisition in proteomics analysis of clinical lung cancer tissues constrained by blood contamination.

Proteomics analysis is often troubled by high-abundance proteins in samples such as plasma. However, many surgical tissue samples inevitably have got contaminated with blood before cryopreservation. Selection of an appropriate method to minimize the effect of high-abundance proteins is important for proteomics analysis of blood contaminated tissues. Here, we investigated and compared the abilities of data-independent acquisition (DIA) and data-dependent acquisition (DDA) strategies for the proteomics analysis of blood contaminated clinical tissue samples. Twelve pairs of carcinoma and para-carcinoma tissue samples from lung cancer patients were used for proteomics assays separately by DIA and DDA, and the blood contamination level in samples was evaluated by contamination index (CI). Compared with the DDA strategy, DIA in whole exhibited much better analytical capabilities in proteomics analysis of these samples with more identified protein groups and a higher discovery of differential proteins. With CI value increasing, whether DIA or DDA showed decreasing analysis ability. However, for samples with high CI values, the DIA strategy still shows acceptable analytical capability and indicates better blood pollution resistance than the DDA strategy. Our results implied that for clinical tissue samples, particularly for those contaminated with blood, DIA strategy should be a preferred method in proteomics studies.

Blood contamination of the pharmaceutical staff by irinotecan and its two major metabolites inside and outside a compounding unit.

BACKGROUND: Caregivers in healthcare settings are exposed to a risk of antineoplastic drug contamination which can lead to adverse health effects. Biological monitoring is necessary to estimate the actual level of exposure of these workers. This study was conducted with the aim of assessing blood contamination levels by irinotecan and its metabolites of pharmaceutical staff operating inside and outside a compounding unit. METHODS: The study took place within the pharmaceutical unit of a French comprehensive cancer centre. Blood samples were collected from the pharmacy workers operating inside and outside the compounding unit, and analysed by UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN-38; APC) were determined with a validated analytical method detection test. RESULTS: A total of 17/78 (21.8%) plasma and red blood cell-based assays were found to be contaminated among staff. Overall, the total number of positive assays was significantly higher for staff members working outside the compounding unit than for workers working inside it (P = 0.022), with respectively 5/42 (11.9%) and 12/36 (33.3%) positive assays. For plasma dosages, the "outside" group had a significantly higher number of positive assays (P = 0.014). For red blood cell-based assays, no significant difference was found (P = 0.309). CONCLUSIONS: This study reveals that pharmaceutical staff serving in health care settings are exposed to a risk of antineoplastic drug contamination, not only inside the compounding room but also in adjacent rooms. The results would help to raise awareness and potentially establish protective measures for caregivers working in areas close to the compounding room as well.

Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study.

OBJECTIVES: To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. MATERIALS AND METHODS: Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro-Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). RESULTS: Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. CONCLUSIONS: Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. CLINICAL RELEVANCE: APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.

Stenotrophomonas maltophilia Bacteremia: From Diagnosis to Treatment.

Objective: There are many difficulties in diagnosing and treating Stenotrophomonas maltophilia bacteremia. In this study, we aimed to evaluate "true" and "false-positive bacteremia" and assess mortality risk factors and the impact of different treatment regimens. Materials and Methods: Hospitalized adult patients with S. maltophilia-positive blood cultures were assessed by a two-stage analysis. First, the clinical significance of blood cultures was assessed, and patients were divided into "true" and "false-positive bacteremia" groups. Then, excluding false positives, we analyzed the antimicrobial regimens and the factors associated with 28-day mortality in true bacteremia cases performing univariate and multivariate analyses. Results: The study included 127 out of 138 patients with S. maltophilia bacteremia. True bacteremia was identified in 51.2% and false-positive bacteremia in 48.8% of patients. In the true bacteremia group, hypotension, nosocomial bacteremia, concomitant infections, a source of bacteremia, two positive blood culture sets, and 28-day mortality were more common. The 28-day mortality was 50.7% among true bacteremia cases. In multivariate analysis, age and solid tumor were the independent predictors of 28-day mortality. Early effective antimicrobial therapy and different antimicrobial regimens, including trimethoprim-sulfamethoxazole (SXT), fluoroquinolones (FQs), and tigecycline (TGC), did not have any significant impact on survival. Conclusion: Patients with S. maltophilia bacteremia should first be assessed regarding clinical significance. Clinical findings, the presence of multiple positive blood culture sets and the primary sources of bacteremia are useful parameters while discriminating true from false-positive bacteremia. Patients with advanced age and solid tumors should be followed carefully in terms of mortality. Antimicrobial regimens, including SXT, FQs, or TGC, can be preferred in patients with S. maltophilia bacteremia considering antimicrobial resistance and adverse effects or toxicity.

Is the blood of a surgeon performing HIPEC contaminated by irinotecan, its major metabolites and platinum compounds?

OBJECTIVES: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a beneficial surgical technique for patients, but the surgeons are being exposed to cytotoxic drugs. Few biomonitoring studies were led on blood samples in the context of HIPEC. This study aimed to evaluate the surgeon's plasmatic and red blood cell (RBC) contamination by irinotecan, two of its major metabolites and platinum compounds. METHODS: HIPEC procedures performed using the coliseum techniques were observed between September 2015 and April 2018 in a French comprehensive cancer center. Irinotecan and its metabolites SN-38 and APC were dosed by UHPLC with a limit of quantification determined at 50 pg/mL. Platinum compounds were dosed by inductively coupled plasma mass spectrometry with a limit of quantification determined at 16 pg/mL. RESULTS: Despite collective and personal protective equipment, 80% of plasma samples were contaminated by irinotecan and 33% by platinum compounds out of 21. The results showed that the surgeon was contaminated after HIPEC and even after a period of HIPEC inactivity. Nineteen percent of plasmatic samples and 45% of RBC samples were contaminated by SN-38, the active metabolite of irinotecan. APC was only found in some RBC samples (33%). CONCLUSIONS: Even if this study shows blood contamination by irinotecan, two of its major metabolites (including active SN-38) and platinum compounds both in the plasma and RBC of a surgeon performing the HIPEC procedures, further studies should be performed to confirm these results. Additional studies should be carried out to further investigate the contamination in the context of HIPEC and more broadly in the hospital.

Cerebrospinal fluid hemoglobin levels as markers of blood contamination: relevance for α-synuclein measurement.

OBJECTIVES: Cerebrospinal fluid α-synuclein (CSF α-syn) represents a possible biomarker in Parkinson's disease (PD) diagnosis. CSF blood contamination can introduce a bias in α-syn measurement. To date, CSF samples with a red blood cells (RBC) count >50 RBC × 106/L or haemoglobin (Hb) concentration >200 µg/L are excluded from biomarker studies. However, investigations for defining reliable cut-off values are missing. METHODS: We evaluated the effect of blood contamination on CSF α-syn measurement by a systematic approach in a cohort of 42 patients with different neurological conditions who underwent lumbar puncture (LP) for diagnostic reasons. CSF samples were spiked with whole blood and serially diluted to 800, 400, 200, 100, 75, 50, 25, 5, 0 RBC × 106/L. CSF α-syn and Hb levels were measured by ELISA. RESULTS: In neat CSF, the average concentration of α-syn was 1,936 ± 636 ng/L. This value increased gradually in spiked CSF samples, up to 4,817 ± 1,456 ng/L (+149% α-syn variation) in samples with 800 RBC × 106/L. We established different cut-offs for discriminating samples with α-syn level above 5, 10, and 20% variation, corresponding to a Hb (RBC) concentration of 1,569 µg/L (37 RBC × 106/L), 2,082 µg/L (62 RBC × 106/L), and 3,118 µg/L (87 RBC × 106/L), respectively. CONCLUSIONS: Our data show the high impact of CSF blood contamination on CSF α-syn levels, highlighting the measurement of Hb concentration as mandatory when assessing CSF α-syn. The thresholds we calculated are useful to classify CSF samples for blood contamination, considering as reliable only those showing a Hb concentration <1,569 µg/L.

Kappa Free Light Chains in the Context of Blood Contamination, and Other IgA- and IgM-Related Cerebrospinal Fluid Disease Pattern.

In this retrospective, monocentric cohort study, we tested if an intrathecal free light chain kappa (FLC-k) synthesis reflects not only an IgG but also IgA and IgM synthesis. We also analysed if FLC-k can help to distinguish between an inflammatory process and a blood contamination of cerebrospinal fluid (CSF). A total of 296 patient samples were identified and acquired from patients of the department of Neurology, University Medicine Greifswald (Germany). FLC-k were analysed in paired CSF and serum samples using the Siemens FLC-k kit. To determine an intrathecal FLC-k and immunoglobulin (Ig) A/-M-synthesis we analysed CSF/serum quotients in quotient diagrams, according to Reiber et al. Patient samples were grouped into three cohorts: cohort I (n = 41), intrathecal IgA and/or IgM synthesis; cohort II (n = 16), artificial blood contamination; and the control group (n = 239), no intrathecal immunoglobulin synthesis. None of the samples had intrathecal IgG synthesis, as evaluated with quotient diagrams or oligoclonal band analysis. In cohort I, 98% of patient samples presented an intrathecal synthesis of FLC-k. In cohort II, all patients lacked intrathecal FLC-k synthesis. In the control group, 6.5% presented an intrathecal synthesis of FLC-k. The data support the concept that an intrathecal FLC-k synthesis is independent of the antibody class produced. In patients with an artificial intrathecal Ig synthesis due to blood contamination, FLC-k synthesis is lacking. Thus, additional determination of FLC-k in quotient diagrams helps to discriminate an inflammatory process from a blood contamination of CSF.

Effectiveness of double-gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta-analysis.

AIMS: To determine the effectiveness of the double-gloving method on preventing surgical glove perforation and blood contamination compared with single gloving. DESIGN: Systematic review. DATA SOURCES: Seven electronic databases were searched including: Embase, CINAHL, OVID, Medline, Pubmed, Web of Science, and Foreign Medical Literature Retrieval Service in March 2020. REVIEW METHOD: Our systematic review and meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Risk of bias of Cochrane Handbook (Version 5.1.0) was applied to evaluate the study quality. Revman 5.3 was used to calculate the effect size of odds ratio (OR) with 95% confidence interval (CI). Meta-analysis with forest plot and funnel plot was performed to compare the rate of surgical glove perforation and to determine the published bias, respectively. This review has been registered with ID: CRD42020189694 on the web site of PROSPERO. RESULTS: Seven randomized controlled trials regarding the efficacy of double gloving on reducing surgical glove perforation were identified and a total of 7090 gloves were tested. After analyzing the pooled data, we identified that the rate of surgical glove perforation in the double-gloving group was lower than that of single gloving with statistical significance (OR = 0.75, 95% CI: 0.64-0.89, p < .05). It was statistically significant that surgical glove perforation was lower in the double-inner gloves as well as matched outer-inner perforated gloves compared with that of single glove (OR = 0.05, 95% CI: 0.03-0.07, p < .05). CONCLUSION: Findings of this systematic review demonstrate that double gloving could reduce the rate of surgical-glove perforation. Meanwhile, the risk of being contaminated by a blood-borne pathogen during surgery could be reduced by wearing double gloves. We strongly suggest that surgical team members when operating should wear double gloves to protect themselves and reduce the risk of occupational blood exposure. IMPACT: The necessity of double gloving for preventing blood contamination was demonstrated. The rate of surgical glove perforation is statistically significant in double-gloving group compared to single gloving. Double gloving could reduce the risk of being contaminated during surgery by blood-borne pathogen. Evidence is provided for surgical team and decision makers that double gloving could reduce occupational exposure.

Influence of blood contamination on the bond strength and biointeractivity of Biodentine used as root-end filling.

AIM: To evaluate the influence of blood contamination on the bond strength and apatite forming ability of Biodentine used as root-end filling material. METHODOLOGY: Eighty (n = 80) extracted single-rooted, sound human maxillary anterior teeth were prepared and obturated. Then, the roots were resected, retrograde cavities were prepared and Biodentine was inserted as the root-end filling material. Teeth were then randomly divided into 2 equal groups (n = 40) according to the setting environment of Biodentine i.e., group A where setting took place in human blood and group B where setting took place in deionized water (control group). Teeth were incubated at 37  °C for 45 min to ensure complete setting. Root discs with the filling material in their core were prepared. Push-out bond strength test was performed using a universal testing machine and failure mode was examined. Both groups were aged in HBSS for 30 days. Apatite nucleation was evaluated at one-day, 7-days, and 30-days interval using SEM for morphological analysis and EDX for elemental analysis. Calculation of the Ca/P ratios was performed in addition to XRD for crystal phase analysis. RESULTS: Blood contamination (group A) resulted in significant reduction of bond strength values. It also affected the amount of apatite deposition on the material surface and interfacial spaces with higher Ca/P ratios than that of the normal stoichiometric hydroxyapatite. CONCLUSIONS: Blood contamination during setting of Biodentine had a detrimental effect on the bond strength and reduced the nucleation of apatite in comparison to non-contaminated group.

Effects of blood contamination and hemostatic agents on bond strength in primary teeth dentin.

BACKGROUND: Contamination is a common problem in pediatric restorative dentistry and there are a few studies that investigate blood contamination, hemostatic agents, and tooth dentin. AIM: The purpose of this study was to evaluate the effects of blood contamination and hemostatic agents on the bond strength of two different bonding systems with the dentin of primary teeth. MATERIALS AND METHODS: Buccal and lingual dentin surfaces of 40 primary second molar teeth were used for this study. Specimens were divided into 4 groups according to the contamination and hemostatic agents (Blood-B, Ankaferd Blood Stopper-A, ViscoStat-V, Control-C) and then every group was further divided into two subgroups according to the bonding systems (Clearfil SE Bond-I, All Bond Universal-II, n = 10 per group). A bulk-fill composite resin was built-up on the surfaces. The specimens were tested in the micro shear mode at a crosshead speed of 1 mm/min on a universal test machine. Statistical analysis was performed with ANOVA and Tukey's tests at P < 0.05. RESULTS: Significant differences have been detected in the micro shear bond strengths only between the Ankaferd Blood Stopper (ABS) (AI = 13.72 ± 4.47 and AII = 9.12 ± 4.4) and control groups (CI = 22.78 ± 10.86 and CII = 16.49 ± 6.55) without regards to the bonding systems. The highest scores were obtained in the control groups. Clearfil SE Bond showed better performance than All Bond Universal in all groups. CONCLUSION: It was determined that only the ABS contamination groups showed statistically significant decreases in the bond strengths when compared with control groups.

Thirty years of translational research in Mobility Medicine: Collection of abstracts of the 2020 Padua Muscle Days.

More than half a century of skeletal muscle research is continuing at Padua University (Italy) under the auspices of the Interdepartmental Research Centre of Myology (CIR-Myo), the European Journal of Translational Myology (EJTM) and recently also with the support of the A&CM-C Foundation for Translational Myology, Padova, Italy. The Volume 30(1), 2020 of the EJTM opens with the collection of abstracts for the conference "2020 Padua Muscle Days: Mobility Medicine 30 years of Translational Research". This is an international conference that will be held between March 18-21, 2020 in Euganei Hills and Padova in Italy. The abstracts are excellent examples of translational research and of the multidimensional approaches that are needed to classify and manage (in both the acute and chronic phases) diseases of Mobility that span from neurologic, metabolic and traumatic syndromes to the biological process of aging. One of the typical aim of Physical Medicine and Rehabilitation is indeed to reduce pain and increase mobility enough to enable impaired persons to walk freely, garden, and drive again. The excellent contents of this Collection of Abstracts reflect the high scientific caliber of researchers and clinicians who are eager to present their results at the PaduaMuscleDays. A series of EJTM Communications will also add to this preliminary evidence.

Blood Contamination in CSF and Its Impact on Quantitative Analysis of Alpha-Synuclein.

Analysis of cerebrospinal fluid (CSF) is important for diagnosis of neurological diseases. Especially for neurodegenerative diseases, abnormal protein abundance in CSF is an important biomarker. However, the quality of CSF is a key factor for the analytic outcome. Any external contamination has tremendous impact on the analysis and the reliability of the results. In this study, we evaluated the effect of blood contamination in CSF with respect to protein biomarker identification. We compared three distinct measures: Combur10-Test® strips, a specific hemoglobin ELISA, and bottom-up mass spectrometry (MS)-based proteomics for the determination of the general blood contamination level. In parallel, we studied the impact of blood contamination on the detectability of alpha-synuclein (aSyn), a highly abundant protein in blood/erythrocytes and a potential biomarker for Parkinson's disease. Comparable results were achieved, with all three approaches enabling detection of blood levels in CSF down to 0.001%. We found higher aSyn levels with increasing blood contamination, highlighting the difficulty of authentic quantification of this protein in CSF. Based on our results, we identified other markers for blood contamination beyond hemoglobin and defined a grading system for blood levels in CSF samples, including a lower limit of tolerable blood contamination for MS-based biomarker studies.

Does equipment change impact blood contamination with irinotecan and its two major metabolites in a centralized cytotoxic pharmacy unit?

BACKGROUND: Antineoplastic drugs exposure is a major problem for caregivers' health. The aim of this study is to assess blood contamination with irinotecan and its two metabolites in a centralized pharmacy unit for cytotoxic drug preparations workers before and after protective equipment changes. METHODS: The study took place in a university hospital centralized pharmacy unit for cytotoxic drug and was performed in two parts, before (Round 1: R1) and after equipment changes (Round 2: R2). Collection of pharmacy staff blood samples was performed in UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN38; APC) were determined with a validated analytical method detection test. RESULTS: A total of 15/36 (41.6%) assays were positive in R1 and 16/72 (22.2%) in R2 with a significant decrease between periods (P = 0.035). For plasma dosages, no difference between the two periods was found (P = 0.71); respectively 4/18 (22.2%) assays were positive in R1 and 6/36 (16.6%) in R2. For red blood cells dosages, a significant decrease between periods was found (P = 0.01); respectively 11/18 (61%) were positive in R1 and 10/36 (27.8%) in R2. CONCLUSIONS: These dosages make it possible to have the very first evaluation for plasma and red blood cell contamination with irinotecan and its metabolites in the context of equipment changes, both at individual and collective levels. This work would help to protect health workers from the potential risks represented by these molecules, especially by revealing a contamination of workers in order to objectify the results of exposure.