Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: TREAT Trial

BackgroundThe efficacy of ticagrelor in the long-term post–ST-segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy remains uncertain.ObjectivesThe purpose of this study was to evaluate the efficacy of ticagrelor when compared with clopidogrel in STEMI patients treated with fibrinolytic therapy.MethodsThis international, multicenter, randomized, open-label with blinded endpoint adjudication trial enrolled 3,799 patients (age <75 years) with STEMI receiving fibrinolytic therapy. Patients were randomized to ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300- to 600-mg loading dose, 75 mg daily thereafter). The key outcomes were cardiovascular mortality, myocardial infarction, or stroke, and the same composite outcome with the addition of severe recurrent ischemia, transient ischemic attack, or other arterial thrombotic events at 12 months.ResultsThe combined outcome of cardiovascular mortality, myocardial infarction, or stroke occurred in 129 of 1,913 patients (6.7%) receiving ticagrelor and in 137 of 1,886 patients (7.3%) receiving clopidogrel (hazard ratio: 0.93; 95% confidence interval: 0.73 to 1.18; p = 0.53). The composite of cardiovascular mortality, myocardial infarction, stroke, severe recurrent ischemia, transient ischemic attack, or other arterial thrombotic events occurred in 153 of 1,913 patients (8.0%) treated with ticagrelor and in 171 of 1,886 patients (9.1%) receiving clopidogrel (hazard ratio: 0.88; 95% confidence interval: 0.71 to 1.09; p = 0.25). The rates of major, fatal, and intracranial bleeding were similar between the ticagrelor and clopidogrel groups.ConclusionAmong patients age <75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events when compared with clopidogrel. (Ticagrelor in Patients With ST Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis [TREAT]; NCT02298088)     

Polymerization shrinkage of densely-filled resin composites

A new group of restorative materials called "packable" composites has recently been introduced. These products are essentially highly-filled or densely-filled hybrid resin composites. One of the many claims made about these materials is that they undergo less polymerization shrinkage than their conventional counterparts. This in vitro investigation compared the amount of linear shrinkage that occurs within a variety of densely filled resin composites (DFC) and conventional hybrid resin composites when cured with a visible halogen light. Six DFC resins (Alert, Ariston, P60, Prodigy, Solitaire and Surefil) and two hybrids (TPH-Spectrum, Z100) were used in this study. Dimensional change was measured in a linear direction using a calibrated light microscope. Eighty samples of resin composite were tested, resulting in eight groups of 10 samples (N=10) each. The one-way ANOVA with Student-Newman-Keuls post-hoc test was used to compare the shrinkage between groups, and Pearson's Correlation was used to test the relationship between filler characteristics and shrinkage. Alert and P-60 had significantly less shrinkage than Solitaire, Ariston, Prodigy, Z-100 and TPH-S. Thus, the shrinkage values of some DFC resins were significantly less and others were no different from conventional hybrid resins. There is a moderate association between filler volume and shrinkage. Filler size and resin chemistry are other factors that may also effect shrinkage.     

A 12-year retrospective audit study of tooth loss in a general dental practice

OBJECTIVES: To determine the incidence of periodontal disease in a general dental practice, and to evaluate the effectiveness of treatment in preventing tooth loss over a period of 12 years. DESIGN: This was a single centre retrospective analysis. SETTING: A general dental practice in Bournemouth. SUBJECTS AND METHODS: Over a 6-month period from February 1997 to August 1997 records were made of all patients attending at the practice who had presented for dental examination between September 1985 and September 1986. A database was constructed to record the number of teeth present at the beginning of the study, those which at their initial exam had probing depths of between 5 and 6 mm, and those with 7 mm and greater. If teeth were lost, the date of the extraction was recorded. INTERVENTIONS: All patients were treated by conventional dental therapy. MAIN OUTCOME MEASURES: Tooth loss was chosen as the end-point. RESULTS: 13% of the patients presenting initially had periodontal problems, and conventional treatment resulted in very few teeth being lost over the study period. CONCLUSIONS: Periodontal disease affected only a small number of the patients in the general dental practice. Those patients affected responded well to conventional therapy, resulting in very few teeth being lost during the period of study.     

Aetiological factors for oral manifestations of HIV

OBJECTIVES: Describe the oral diseases in HIV-infected individuals in London, UK and identify social and medical factors related to the presence of specific oral diseases.
DESIGN: Cross-sectional analytic study.
SETTING: Dental clinics.
SUBJECTS: Consecutive sample of 456 patients with HIV infection.
METHODS: Social and medical history and clinical examinations. Univariate and logistic regression analysis.
OUTCOMES: Presence of HIV-associated oral disease.
RESULTS: 80% of patients with AIDS and 50% of patients with HIV had a specific oral disease. The most common diseases were hairy leukoplakia (30%), erythematous candidiasis (24%), pseudomembranous candidiasis (14%), angular chielitis (6%), necrotising periodontal disease (8%) and non-recurrent ulceration (6%).
CONCLUSIONS: The presence of erythematous candidiasis was not related to advanced HIV disease. Pseudomembranous candidiasis, hairy leukoplakia and mucosal ulceration were significantly associated with advanced HIV disease. Smoking was also identified as a strong aetiological factor in oral diseases. Longitudinal studies are required to further explore the prognostic significance of oral diseases in HIV infection.     

Load fatigue of compromised teeth: a comparison of 3 luting cements

PURPOSE: This study compared the number of cycles to failure of central incisors restored with full cast crowns and then cemented with 3 different luting cements. MATERIALS AND METHODS: Fifteen human maxillary central incisors received cast post-and-core restorations. These were cemented with zinc phosphate. The teeth were then divided into 3 groups of 5 samples each. Each tooth had a ferrule length of 1.0 mm and was prepared for a full crown. A waxing jig was used to standardize the load application point on all waxed crowns. Complete cast crowns were cemented to the compromised teeth using 3 different luting cements: a zinc phosphate cement (control group), a resin-modified glass-ionomer cement, and a resin cement with a dentin bonding agent. A fatigue load of 1.5 kg was applied at a rate of 72 cycles per minute until failure of the cement layer occurred between the crown and the tooth (preliminary failure). The independent variable was the number of load cycles required to create preliminary failure. An electrical resistance strain gauge was used to provide evidence of preliminary failure. RESULTS AND CONCLUSION: The resin cement samples had a significantly higher number of load cycles to preliminary failure than both the zinc phosphate and the resin-modified glass ionomer (P < or = 0.05). There was no significant difference between the zinc phosphate and the resin-modified glass-ionomer cements.     

Development of a robotic walker for individuals with cerebral palsy

Abstract

Objective: This study describes the first use of a robotic walker in youth and young adults with cerebral palsy (CP) Gross Motor Function Classification (GMFCS) IV.

Methods: Semi-structured interviews were conducted before and after each robotic walker trial. Interviews were recorded, then transcribed and subjected to thematic analysis.

Results: Five participants (4 male, 13–22?years of age) with quadriplegia secondary to CP were recruited. Four individuals with mixed tone quadriplegia GMFCS IV were able to independently walk with the device. One individual with significant dyskinesia was unable to utilize the device. The assessment team included two physiotherapists, an occupational therapist, a physiatrist and three engineers. Major themes related to physical and social impacts were identified. Some physical advantages include the ability to walk hands-free and promotion of physical fitness. Examples of physical barriers include limited harness design and large device size. Social advantages include increased independence and peer engagement. Finally, a social disadvantage identified was limited use on uneven terrains.

Discussion: Suggestions for modifications for identified challenges and disadvantages include decreasing the size of the robotic walker, more harness designs, decreasing the force required to take an initial step, adding a joy stick for user control and creating a more versatile base that can be used on different terrains such as ice or baseball fields.

Conclusion: Robotics holds great hope for individuals with CP where mobility options are limited. Physical and social advantages are evident. Recommendations for future improvement and studies of use in exercise and participation are provided.

• IMPLICATIONS FOR REHABILITATION

• As youth and young adults with cerebral palsy age, options for mobilization can become limited with challenges in placing them in a walking device due to size and numerous other physical limitations.

• A robotic walker with a built-in mechanical lift is available for individuals with cerebral palsy.

• This study was able to gather important information and recommendations to tailor a new robotic walker prototype specifically for individuals with cerebral palsy.

     

Surgical delivery of drug releasing poly(lactic-co-glycolic acid)/poly(ethylene glycol) paste with in vivo effects against glioblastoma

Introduction

The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.

Methods

Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.

Results

Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.

Conclusions

Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models.