To Study The Efficacy Of Reciprocating Single File System And Multifile Rotary Systems In Elimination Of Root Canal Bacteria And Endotoxins

AIM: To study the efficacy of reciprocating single file system and multifile rotary systems in elimination of root canal bacteria and endotoxins. MATERIAL AND METHOD: Forty permanent single rooted mandibular premolars with straight canals inoculated with Escherichia Coli suspension for 21 days were selected for the study. Teeth were randomly divided into four groups (n=10) according to instrumentation system: Grp. A–Reciproc (VDW); Grp. B–WaveOne (Dentsply Maillefer); Grp. C–MTwo (VDW); and Grp. D–K3( Sybron Endo); Bacterial and endotoxin samples were collected with a sterile paper point before instrumentation and after instrumentation. Culture methods estimated the colony-forming units (CFU) and the Limulus Amebocyte Lysate test was used for quantification of endotoxins. Results so obtained were calculated and statistically analysed. RESULT: Results at S1 concluded that bacteria and endotoxins were found in all of the investigated root canals. After instrumentation all systems were associated with the significant reduction of the bacterial load and endotoxins respectively: Grp. A– Reciproc (88.25% and 89.10%); Grp. B– WaveOne (83.53% and 80.59%); Grp. C– MTwo(79.41% and 75.84%) and Grp. D– K3 (67% and 74.4%). Statistically no difference was found amongst the instrumentation systems regarding bacteria and endotoxin elimination (P <0.05). CONCLUSION: The reciprocating single file, Reciproc and WaveOne were as effective as the multifile rotary systems for the eradication of bacteria and endotoxins from root canals.

Efficacy and Safety of a Novel Adsorber for LPS-Selective Hemosorption (Experimental Study)

The purpose of the study is to evaluate the in vitro and ex vivo effectiveness and safety of a new device for extracorporeal blood purification.Materials and methods. The sorption properties and safety of hemoperfusion using the LPS sorption column that employs hypercrosslinked styrene-divinylbenzene copolymer.were studied using three different models:1) Escherichia coli endotoxin solution in aqueous 0.9% NaCl solution with an assessment of the efficacy of endotoxin elimination,2) donor erythrocyte suspension with assessment of the hemoperfusion column safety for blood cells,3) whole donor blood with assessment of hemosorption efficacy and hemoperfusion safety of the new column. Results. There was a 18.5-fold decrease in the endotoxin concentration in 0.9% sodium chloride solution over2 hours of perfusion vs. the baseline, while maintaining the residual sorption capacity of the column. Perfusion of RBC suspension and freshly prepared donor blood through the new LPS column did not demonstrate the emergence and growth of cytolytic markers; on the contrary, a two-fold decrease in the concentration of free hemoglobin containing in the RBC suspension was observed. There was a two-fold decrease in the vitamin B12 concentration, a 3.54-fold decrease in β2-microglobulin and a 2.5-fold decrease in creatinine levels. The atomic force microscopy did not find critical impairment of the morphology of erythrocyte membranes.Conclusion. In vitro and ex vivo tests demonstrated reliable experimental data on the effectiveness and safety of the device that employs a hypercrosslinked styrene-divinylbenzene copolymer for LPS-selective hemosorption, which was not inferior to one of analogues for hemosorption currently employed in clinical practice.

The importance of early detection of endotoxemia

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.

Immunomodulation in Sepsis: The Role of Endotoxin Removal by Polymyxin B-Immobilized Cartridge

Severe sepsis results in high morbidity and mortality. Immunomodulation strategies could be an adjunctive therapy to treat sepsis. Endotoxin is a component of gram-negative bacteria and plays an important role in the pathogenesis of septic shock when it is recognized by immune cells. Removal of endotoxin could be an effective adjunctive approach to the management of sepsis. Devices to adsorb endotoxin or inflammatory cytokines have been designed as a strategy to treat severe sepsis, especially sepsis caused by gram-negative bacteria. Polymyxin B-immobilized cartridge has been successfully used to treat patients with sepsis of abdominal origin. Although this cartridge was conceived to adsorb endotoxin, several other immunological mechanisms have been elucidated, and this device has also yielded promising results in patients with nonseptic respiratory failure. In this paper, we summarize the immune modulation actions of Polymyxin B-immobilized cartridge to explore its potential usefulness beyond endotoxin elimination.