Mode and timing of treatment failure (recurrent ischemic events) after hospital admission for non-ST segment elevation acute coronary syndromes

Background Clarification of the specific clinical course of non-ST-segment elevation acute coronary syndromes (NSTEMI ACS), including recurrent ischemic events and need for coronary revascularization, is important given the increasing economic pressure to shorten the length of hospitalization and therefore the duration of acute therapy. To examine the mode and timing of subsequent cardiac events, we analyzed pooled data from the ESSENCE and TIMI 11B studies of antithrombotic therapy in NSTEMI ACS. Methods The daily event rates (with confidence intervals) during the first 43 days and the monthly average event rates during the first year were tabulated for 7081 patients. Results The median antithrombotic treatment duration was 3.2 days, whereas the highest absolute frequency of recurrent angina prompting urgent revascularization, myocardial infarction, or death after hospital admission occurred on day 2, day 3, and day 8, respectively. Coronary revascularization was performed in 32% of patients, with the greatest number occurring on day 4. Only 12% of the end point events were adjudicated as being periprocedural. The median length of hospital stay was 7 days. Conclusions Despite aggressive antithrombotic therapy, a significant proportion of patients with NSTEMI ACS have recurrent ischemia precipitating urgent revascularization or infarction within the first few days, whereas the highest risk of death occurs later, after the first week. (Am Heart J 2002;143:63-9.)     

An in vitro evaluation of a metal reinforced orthodontic ceramic bracket

The objectives of the present study were to measure and compare the bond strength and failure sites of a currently available ceramic bracket (Transcend 3M-Unitek) with the new metal reinforced ceramic bracket (Clarity 3M-Unitek) and to evaluate the amount of composite left on the tooth using the Adhesive Remnant Index in the teeth that were debonded with pliers recommended for this purpose. In addition, the presence or absence of enamel damage after debonding was also assessed. One hundred and twenty extracted premolar teeth were divided into 4 groups of 30 each. Two groups of 30 teeth had Transcend 6000 brackets bonded, and the other 2 groups had Clarity brackets bonded. Shear bond strength was carried out on 30 Transcend 6000 brackets and 30 Clarity brackets, whereas the other 2 groups of 30 teeth bonded with Transcend 6000 and Clarity brackets were debonded with debonding pliers recommended by the manufacturer of both ceramic brackets. The mean shear bond strength of the Clarity brackets was 13.27 MPa, whereas that of the Transcend 6000 was 21.19 MPa. Both brackets failed mostly at the bracket-adhesive interface (75%), indicating a possible reduction of the chances of enamel damage. Six of the premolars, bonded with Transcend 6000 brackets and debonded with the plier, showed an increase in the number or length of enamel cracks as evaluated by an optical microscope (Micro-Vu); one premolar, bonded with Clarity brackets and debonded with the pliers, showed an increased enamel crack length. Gross enamel damage, assessed by enamel dislodgment, was not evident in any specimen. Results of this study suggest that the new metal reinforced ceramic bracket (Clarity) may be recommended for clinical use because of its acceptable shear bond strength and possible reduced chances of enamel damage during bracket removal.     

Effect of a self-etch primer/adhesive on the shear bond strength of orthodontic brackets

Conventional adhesive systems use 3 different agents (an enamel conditioner, a primer solution, and an adhesive resin) during the bonding of orthodontic brackets to enamel. A unique characteristic of some new bonding systems in operative dentistry is that they combine the conditioning and priming agents into a single product. Combining conditioning and priming saves time and should be more cost-effective to the clinician and, indirectly, to the patient. The purpose of this study was to determine the effects of the use of a self-etch primer on the shear bond strength of orthodontic brackets and on the bracket/adhesive failure mode. Brackets were bonded to extracted human teeth according to 1 of 2 protocols. In the control group, teeth were etched with 37% phosphoric acid. After the sealant was applied, the brackets were bonded with Transbond XT (3M Unitek, Monrovia, Calif) and light cured for 20 seconds. In the experimental group, a self-etch acidic primer (ESPE Dental AG, Seefeld, Germany) was placed on the enamel for 15 seconds and gently evaporated with air, as suggested by the manufacturer. The brackets were then bonded with Transbond XT as in the first group. The present in vitro findings indicate that the use of a self-etch primer to bond orthodontic brackets to the enamel surface resulted in a significantly (P = .004) lower, but clinically acceptable, shear bond force (mean, 7.1 +/- 4.4 MPa) as compared with the control group (mean, 10.4 +/- 2.8 MPa). The comparison of the adhesive remnant index scores indicated that there was significantly (P = .006) more residual adhesive remaining on the teeth that were treated with the new self-etch primer than on those teeth that were bonded with the use of the conventional adhesive system.     

Fabrication of conventional complete dentures for a left segmental mandibulectomy patient: A clinical report

Without preprosthetic reconstructive surgery, denture fabrication for mandibulectomy patients becomes extremely difficult. Implant-assisted overdentures may improve denture retention and stability, but some patients cannot afford this treatment. For the segmental mandibulectomy patient described in this report, properly fabricated conventional complete dentures provided comfort and sufficient function.     

Specific immune response against Gardnerella vaginalis hemolysin in patients with bacterial vaginosis

OBJECTIVE: Our goal was to study the mucosal host response in bacterial vaginosis by evaluating the presence of a specific immune response elicited against the Gardnerella vaginalis hemolysin in vaginal fluids of patients and by verifying its correlation with usual criteria adopted to diagnose bacterial vaginosis. STUDY DESIGN: A total of 123 white women attending the gynecologic care unit for urogenital complaints or for screening of uterine malignancies (Papanicolaou test) aged from 20 to 60 years, nonmenstruating, were enrolled. Bacterial vaginosis was diagnosed by clinical criteria and a Gram stain score >6. RESULTS: We performed the determination of the antibody response in vaginal fluid against the hemolysin produced by G. vaginalis, a common agent present in bacterial vaginosis. The purified G. vaginalis toxin was a suitable antigen for detecting the presence of an immune response in the vaginal fluids of patients with bacterial vaginosis regardless of the strain of G. vaginalis present. A specific immunoglobulin A response was detected in 60% of women with overt bacterial vaginosis (Gram stain score >6) and in 18.5% of women with intermediate vaginal flora (Gram stain score 4 to 6). The specificity of the test was 91%. CONCLUSIONS: We found a correlation between the specific local immune response to G. vaginalis toxin and bacterial vaginosis. The highly purified form of the toxin is able to discriminate disorders from the opportunistic colonization by G. vaginalis. (Am J Obstet Gynecol 1996;175:1601-5.)     

Comparison of inhaled salmeterol and oral zafirlukast in patients with asthma

BACKGROUND: Salmeterol, a long-acting beta2 -agonist, and zafirlukast, a leukotriene receptor antagonist, are both indicated for the treatment of asthma in adolescent and adult patients. OBJECTIVE: We sought to compare the effect of 4 weeks of treatment with inhaled salmeterol xinafoate versus oral zafirlukast in the treatment of persistent asthma. METHODS: This was a randomized, double-blind, double-dummy, parallel-group, multicenter clinical trial. Patients, over 80% of whom were on a concurrent inhaled corticosteroid regimen, were treated for 4 weeks with either inhaled salmeterol xinafoate 42 microgram twice daily administered by means of a metered-dose inhaler or oral zafirlukast 20 mg twice daily. The primary efficacy measure was morning peak expiratory flow (PEF); secondary efficacy measures included evening PEF, asthma symptom scores, supplemental albuterol use, nighttime awakenings, sleep symptoms, asthma exacerbations, and FEV1. RESULTS: Both inhaled salmeterol and oral zafirlukast resulted in within-group improvements from baseline in measures of pulmonary function, asthma symptoms, and supplemental albuterol use. Salmeterol treatment resulted in significantly greater improvements from baseline compared with zafirlukast for most efficacy measurements, including morning PEF (29.6 vs 13.0 L/min; P 相似文献   

Low-dose inhaled fluticasone propionate versus oral zafirlukast in the treatment of persistent asthma

Background: Few studies have compared the efficacy of inhaled corticosteroids and leukotriene modifiers for the treatment of persistent asthma. Objective: Our purpose was to compare the efficacy of a low dose of inhaled fluticasone propionate (FP) with that of oral zafirlukast in the treatment of persistent asthma previously treated with short-acting β₂-agonists alone. Methods: A 12-week, randomized, double-blind, double-dummy, multicenter study was conducted in 451 patients aged 12 years and older with asthma who were symptomatic on short-acting β₂-agonists alone. After an 8- to 14-day run-in period, patients were randomized to treatment with FP 88 μg twice daily or zafirlukast 20 mg twice daily. Results: Treatment with FP was more effective than treatment with zafirlukast in increasing morning FEV₁ (by 0.42 L vs 0.20 L over baseline, P < .001), morning peak expiratory flow (by 49.94 L/min vs 11.68 L/min over baseline, P < .001), and evening PEF (by 38.91 L/min vs 10.50 L/min over baseline, P < .001). Statistically significant differences between the two treatments in FEV₁ were noted after the first observation (week 4) and in morning and evening peak expiratory flow by week 2. Mean change in percentage of symptom-free days was greater with FP than with zafirlukast (28.5% of days vs 15.6% of days, P < .001) and FP significantly increased the percentage of rescue-free days by 40.4% of days compared with 24.2% of days with zafirlukast (P < .001). Treatment with FP significantly reduced albuterol use by 2.39 puffs per day compared with 1.45 puffs per day (P < .001) and increased the percentage of nights with no awakenings by 21.2% of nights compared with 8.0% of nights with zafirlukast (P < .001). Conclusion: The clinical effectiveness of a low dose of FP as first-line therapy in patients with persistent asthma who are symptomatic on β₂-agonists alone is superior to that of zafirlukast. (J Allergy Clin Immunol 2000;105:1123-9.)