Coronary bifurcation lesions treated with simple approach (from the Cordoba & Las Palmas [CORPAL] Kiss Trial)

The present report compared the incidence of 1-year clinical events in patients with bifurcation lesions that had been treated with a simple approach who were randomized to either a simultaneous final kissing balloon (KB) or an isolated side-branch (SB) balloon post-dilation. From February 2007 to December 2008, 293 patients with all types of Medina bifurcation lesions were enrolled in a prospective study. All patients underwent implantation of a sirolimus- or everolimus-eluting stent across the bifurcation and provisional SB stenting. Patients with no SB ostial compromise or those needing a second stent were excluded from the present study (n = 49). The eligible patients were randomly assigned to treatment with final KB inflation (n = 124, KB group) or isolated balloon after dilation (n = 120, non-KB group). No significant differences were found between the patients from the KB and non-KB groups in terms of age, risk factors, clinical status, or location of the bifurcation lesions. The angiographic data and immediate results were also similar in both groups. Four patients experienced a non-Q-wave acute myocardial infarction in the hospital: three (2%) from the KB group and one (1%) from the non-KB group. Two in-hospital deaths occurred in the non-KB group. Target lesion revascularization was required in 7 patients (3%): 5 from the KB group and 2 from the non-KB group. Late mortality occurred in 3 patients from the KB group and 2 patients from the non-KB group. The incidence of major events at 1 year (death, target lesion revascularization, or acute myocardial infarction) was similar in both groups: 11 (9%) from the KB group and 7 (6%) from the non-KB group (p = NS). In conclusion, no differences in the clinical outcome at 1 year of follow-up were observed between the patients with bifurcation lesions treated with a simple approach and either a simultaneous final KB or an isolated SB balloon post-dilation.     

Abdominal Surgery in Nonagenarians: Short-Term Results

PURPOSE: To determine the short-term results of abdominal surgery in nonagenarians. METHODS: Retrospective analyses of 193 patients aged 90 and older operated on for abdominal complaints during a 15-year period (1990-2004) in a 500-bed tertiary care institutional hospital and 100-bed rural institutional hospital in Spain. The factors analyzed included the following: perioperative risk, diagnosis, operative procedures, timing of operation (elective or emergency), morbidity, mortality, and length of hospital stay. RESULTS: The most common diagnoses were hernia in 69 cases, colorectal cancer in 39, and biliary lithiasis in 24. One hundred and thirty-seven patients (71%) were operated on on an emergency basis. Forty-seven patients died (24%), with mortality rates of 9% (5/56) and 31% (42/137) respectively, for elective and emergency surgery. None of the 15 patients classified as grade I according to the criteria of the American Society of Anesthesiologists (ASA) died and only 3 out of 63 (5%) died who were ASA grade II. Eighty patients (41%) had postoperative complications. Local morbidity was 16% (n = 30), and systemic morbidity was 30% (n = 58). CONCLUSIONS: Our results support the notion that elective and acute abdominal surgery in nonagenarians can be performed with acceptable rates of mortality and morbidity. Mortality for surgery in nonagenarians is strongly related to the perianesthetic risk (ASA grade), emergency operation, and seriousness of the disease in question.     

Differential effect of in vitro degradation on resin-dentin bonds produced by self-etch versus total-etch adhesives

OBJECTIVE: To evaluate the effect of an in vitro challenge (NaOCl immersion) on microtensile bond strength (MTBS) of five adhesive systems to dentin. METHODS: Flat dentin surfaces from 40 molars were bonded with three total-etch adhesives (Single Bond, Prime&Bond NT and the experimental Prime&Bond XP), and two self-etching agents (Clearfil SE Bond and Etch&Prime 3.0). Composite build-ups were constructed with Tetric Ceram. Teeth were then sectioned into beams of 1.0 mm2 cross-sectional area. Half of the beams were immersed in 10% NaOCl aqueous solution for 5 h. Each beam was tested in tension in an Instron machine at 0.5 mm/min. Data were analyzed by 2-way ANOVA and multiple comparisons tests (p < 0.05). RESULTS: Clearfil SE Bond and Single Bond attained higher MTBS than the other three adhesives. Prime&Bond NT and Prime&Bond XP performed equally, and Etch&Prime resulted in the lowest MTBS. After NaOCl immersion, MTBS decreased in all groups. The highest MTBS values were obtained for Clearfil SE Bond and Prime&Bond XP. Scaning electron microscopy observation of debonded sticks evidenced dissolution and microstructural alterations of intertubular dentin, except when Clearfil SE Bond was used. CONCLUSIONS: Resin-dentin bonds are prone to chemical degradation. The extent of the resin degradation is adhesive system specific. Chemical degradation of the nonresin infiltrated collagen fibers does also exist in total-etch adhesives. Both processes may reduce long-term resin-dentin bond strength.     

Effects of adhesive systems and luting agents on bonding of fiber posts to root canal dentin

The study evaluated the influence of different luting materials on the microtensile bond strength of glass fiber posts to root canal dentin. Thirty extracted maxillary premolars were endodontically treated, and the roots were prepared for post cementation using the FRC Postec system (Vivadent). Two luting materials (Multilink, Vivadent and Clearfil Photo Core, Kuraray) were used in combination with three adhesive: Multilink Primer (Vivadent), Clearfil Photo Bond, and Clearfil New Bond (Kuraray). A composite build-up was performed around the root to provide adequate gripping during testing. Specimens were cut to obtain beams with the post in the center and with the radicular dentin overlaid by the composite build-up on each side. Microtensile testing was performed with a universal testing machine at a cross-head speed of 0.5 mm/min. The failure mode was classified under a stereomicroscope and four representative beams of each group were selected for SEM analysis. Bond strength data that were analyzed with two-way ANOVA and Student-Newman-Keuls multiple comparisons tests revealed that adhesive systems, luting materials, and the interaction between these two factors significantly influenced the bond strength results (p < 0.01). Multilink applied with its own adhesive system obtained the best results, while the lowest bond strength was achieved with clearfil photo core in combination with multilink primer.     

Sorption and solubility testing of orthodontic bonding cements in different solutions

To evaluate and compare the solubility and sorption of orthodontic bonding cements after immersion in different solutions, five different cements were used: a fluoride-containing resin composite, a light-cured glass ionomer cement, a light-cured resin composite, a paste-paste chemically cured resin composite, and a liquid-paste chemically cured resin composite. Five different solutions were employed: distilled water, artificial saliva, an alcohol-free mouthrinse solution (Orthokin), a 5% alcohol mouthrinse solution (Perioaid), and a 75% ethanol/water solution. Five disc specimens (15 mm x 0.85 mm) were used for each experimental condition. Materials were handled following manufacturers' instructions and were ground wet with silicon carbide paper. Solubility and sorption of the materials were calculated by means of weighing the samples before and after immersion and desiccation. Data were analyzed by two-way ANOVA and Student-Newman-Keuls test (p < 0.05). The light-cured glass ionomer cement showed the lowest solubility and the highest sorption values. When using alcohol-containing solutions as storage media, solubility of the paste-paste chemically cured resin composite increased, and sorption values for the tested chemically cured resin composites were also increased. The use of alcohol-free mouthrinses does not affect sorption and solubility of orthodontic cements. The chemically cured (paste-paste) composite resin cement, requiring a mixing procedure, was the most affected by immersion in alcohol-containing solutions.     

Polymeric systems containing dual biologically active ions

This paper reports the synthesis and characterization of dual functional polymerizable salts containing quaternary ammonium cations ionically linked to non steroidal anti-inflammatory drugs (NSAIDs), and their polymers and copolymeric systems obtained with acrylic monomers of different hydrophilicity, e.g. methyl methacrylate and 2-hydroxyethyl methacrylate. NSAIDs used were meclofenamic acid, ketoprofen and ibuprofen. Sustained release of the NSAID from polymeric and copolymeric samples was observed over a period of 10 days and the hydrophobic/hydrophilic character of both the polymeric system and the drug played a role in the release behaviour. The antimicrobial activity of dual functional monomeric and polymeric derivatives was confirmed against Gram-positive and Gram-negative bacteria and polymeric compounds presented higher bactericidal action than the precursory monomers. The extracts of copolymeric samples had anti-inflammatory activity in a nitric oxide inhibitory assay on RAW 264.7 cells and they produced a NO inhibition around 80% within the first seven days.     

Estudio de la hiperfrecuentación en un distrito de atención primaria

Objective

To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain).

Emergency Department Companions of Stroke Patients: Implications on Quality of Care

Acute care of stroke victims largely relies on the rapid identification and timely clinical and radiological assessment. We evaluated the effect of the number of patient companions on the efficiency of the diagnostic process in the emergency department (ED).Consecutive stroke patients admitted to the ED between August 2011 and October 2012 were evaluated. Clinical, epidemiological, and timeline data (symptoms onset, ED arrival, computed tomography [CT] scanning, and recombinant tissue plasminogen activator infusion), as well as the number of accompanying persons in the ED were prospectively recorded. We used multivariate Poisson log linear models to analyze the association of number of companions adjusted and door-to-CT times and logistic regression for the analysis of the successful identification of stroke patient by ED triage nurse.Out of a total of 724 stroke patients admitted, data regarding number of ED companions were available for 610 (84.3%) patients. Number of companions was associated with higher National Institute of Health Stroke Scale and speech disturbances. It was found to be independently associated with shorter time to CT scanning adjusted for the stroke severity, sex, and speech disturbances (no companions as a reference group, relative risks 0.82, 0.73, and 0.70 for 1, 2, and ≥3 companions, respectively, all P < 0.001). Similarly, number of companions was associated with higher rates of stroke recognition by the triage nurse adjusted for covariates (odds ratios 2.11, 2.62, and 4.11, respectively, all P < 0.05).Our findings suggest that the family members and other companions could serve as facilitators of faster and more effective ED management of stroke patients, possibly improving their outcome.     

Preliminary results of immune modulating antibody MDV9300 (pidilizumab) treatment in children with diffuse intrinsic pontine glioma

Journal of Neuro-Oncology - Diffuse intrinsic pontine glioma (DIPG) is an incurable disease with a median overall survival of 10&nbsp;months. Immune modulating antibodies have recently emerged...