Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county

Background.  Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood.
Aim.  The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents.
Design.  From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3–19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records.
Results.  The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered.
Conclusions.  Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.     

Outcomes of Patients with Coronary Artery Perforation Complicating Percutaneous Coronary Intervention and Correlations with the Type of Adjunctive Antithrombotic Therapy: Pooled Analysis from REPLACE-2, ACUITY, and HORIZONS-AMI Trials

Background: The lack of a specific counteragent to bivalirudin may complicate the management of patients with coronary artery (CA) perforation during percutaneous coronary intervention (PCI).
Aim: Assess outcomes of patients with CA perforation from three PCI trials comparing intravenous bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition versus unfractionated heparin (UFH) plus GP IIb/IIIa.
Methods: A pooled analysis of patients treated with PCI in three randomized trials including REPLACE-2, ACUITY, and HORIZONS-AMI.
Results: Among a total of 12,921 patients, CA perforation occurred in 35 patients (0.27%). By multivariable analysis, baseline creatinine clearance was the only independent predictor of CA perforation (per 10 mL/min decrease, odds ratio [95% confidence interval]= 1.28 [1.11, 1.47], P = 0.0007). At 30 days, patients with versus without CA perforation had significantly (all P values ≤0.001) higher rates of 30-day mortality (11.4% vs. 1.0%), myocardial infarction (MI) [Q wave: 22.9% vs. 5.7%; non-Q wave: 17.1% vs. 4.9%], target vessel revascularization (TVR) [20.1% vs. 1.8%], and composite end-point of death/MI/TVR (31.4% vs. 7.8%). Patients assigned to bivalirudin versus UFH plus a GP IIb/IIIa inhibitor had nonsignificantly lower rates of death (0% vs. 18.8%, P = 0.08), similar rates of MI (26.7% vs. 25.0%, P = 0.92), significantly lower rates of TVR (6.7% vs. 37.5%, P = 0.04), and similar rates of the composite end-point of death/MI/TVR (35.5% vs. 26.7%, P = 0.54).
Conclusion: In three PCI trials, treatment of patients experiencing CA perforation with adjunctive antithrombotic therapy of bivalirudin monotherapy was not associated with worse outcomes compared to treatment with UFH plus GP IIb/IIIa inhibitors.     

Impact of Scheduled Angiographic Follow‐Up in Patients Treated With Primary Percutaneous Coronary Intervention for ST‐Segment Elevation Myocardial Infarction

Routine scheduled angiographic follow‐up (SAF) after percutaneous coronary intervention (PCI) has been associated with a higher rate of target vessel revascularization (TVR). Its benefits are not known. SAF at 13 months after ST‐segment elevation myocardial infarction (STEMI) was planned in the first 1,800 successfully stented patients enrolled in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS‐AMI) trial. We compared the outcomes of patients with and without SAF at 1 year (before SAF) and at 3 years (after SAF). There were 1,197 patients (66.5% of expected) with and 2,207 patients without SAF. Prior to SAF, the 1‐year composite rate of death or myocardial infarction (MI) was not significantly different between the 2 groups (2.7% vs. 3.9%, respectively, P = 0.06), although the rate of death was lower (0.1% vs. 2.2%, P < 0.0001), nor were there differences in the 1‐year rates of TVR, stent thrombosis or major adverse cardiac and cerebral events). At 3 years, death or MI rates were again similar between the groups (8.3% vs. 9.5%, P = 0.22), but TVR was more common in the SAF group (17.0% vs. 8.6%, P < 0.0001), due to an increase in TVR at time of SAF. In the SAF group, patients in whom TVR was performed before or after the 13‐month SAF window had markedly higher 3‐year rates of MI and stent thrombosis than patients in whom TVR was performed during SAF or not at all. In conclusion, SAF after primary PCI in STEMI is associated with doubling of the rate of revascularization without an improvement in death or MI, and therefore cannot be recommended.

     

The ontogeny and site of intestinal lipid and lipoprotein synthesis

The developmental aspects of characteristic intestinal lipoprotein synthesis, chlomicrons (CM), very low density lipoproteins (VLDL) and high density lipoproteins (HDL), are unknown. Our objective was to determine the ontogeny of intestinal lipid and lipoprotein synthesis in both the jejunum and the ileum. Explants of the jejunum and the ileum from fetal (F) (18-19 days of gestation), suckling (S) (5 days old) and weaning (W) (23 days old) rats were cultured in the presence of [14C]-oleic acid to examine lipid synthesis. The results indicate the following. (1) The incorporation of oleic acid is higher for the fetal explants. However, the efficiency of esterification of free fatty acids (FFA) into triglycerides (TG) in the jejunum increases with age (33% F, 37% S, 48% W) (P less than 0.05, by ANOVA). (2) The same profile is found at the ideal site for the incorporation of oleic acid. However, the capacity for the synthesis of TG is more intense at the suckling period (34% F, 54% S, 42% W) (P less than 0.05, by ANOVA). (3) The relative content of TG in CM changes with age: F, 90-93%; S, 80-84%; W, 33-40%. (4) A low percentage of TG content is found in CM at the weaning period while high levels are detectable in VLDL (40-42%). (5) A most significant difference is noted between the jejunum and the ileum in TG synthesis at the suckling period. The ileum synthesizes 53% more TG than the jejunum (P less than 0.025). (6) HDL particles contain substantial amounts of FFA. Nevertheless, they were also found to be able to transport TG mainly in the suckling rat. Thus, this study demonstrates that with growth the rat is able to synthesize CM, VLDL and HDL. Our findings indicate changes in the synthesis of intestinal lipids and lipoproteins, depending on both the development and the site, which suggests an ontogeny. These modifications can be attributed to dietary and hormonal influences present during the period of development.     

Impact of Thienopyridine Administration Prior to Primary Stenting in Acute Myocardial Infarction

The impact of thienopyridine administration prior to primary stenting in acute myocardial infarction (AMI) has not been well studied. We therefore examined the database from the prospective, multicenter, controlled CADILLAC trial in which 1,036 patients were randomized to bare metal stenting with or without abciximab to determine whether patients who received a thienopyridine prior to bare metal stenting in AMI had superior clinical outcomes. Per operator discretion, 659 patients (63.6%; Th+) received either a 500 mg ticlopidine loading dose (n = 623) or a 300 mg clopidogrel loading dose (n = 40), while 377 patients (36.4%; Th-) received no thienopyridine prior to stent implantation. Baseline and procedural characteristics of the two groups, including abciximab use (52.5% vs 52.8%, P = 0.93) were well matched. Th+ compared to Th- patients had lower rates of core lab assessed TIMI 0/1 flow postprocedure (0.8% vs 2.7%, P = 0.01). Th+ compared to Th- patients also had significantly reduced in-hospital and 30-day rates of ischemic target vessel revascularization (TVR) (1.1% vs 3.2%, P = 0.01 and 1.5% vs 3.8%, P = 0.02, respectively) and major adverse cardiovascular events (MACE) (2.7% vs 5.8%, P = 0.01 and 4.0% vs 6.9%, P = 0.03, respectively), results that remained significant after covariate adjustment. In conclusion, in this large prospective, controlled trial, patients receiving a thienopyridine prior to primary stenting in AMI were less likely to have TIMI 0/1 flow postprocedure and experienced reduced in-hospital and 30-day rates of ischemic TVR and MACE compared to those not administered a thienopyridine prior to stent implantation.     

Effectiveness of orientation tour on children's anxiety before elective surgeries

Aim: The purpose of this study was to investigate the effectiveness of an orientated tour in reduction of children's anxiety before elective surgeries. Anxiety is a common emotional reaction following surgical experience among children that can result in increasing postoperative pain, increasing analgesic use. Methods: The study was a blinded clinical trial; 70 children were randomized into two groups (intervention and control). All children received standard preoperative care, while those in the intervention group also received an orientated tour with their mother of the operation room the night before the surgery was carried out. The children's anxiety was assessed by the “Child Drawing: Hospital” instrument and vital signs measured before and after intervention in both groups. Data were analyzed with SPSS ver. 11.5 software. Results: Anxiety decreased in the intervention group following implementation of the orientated tour (P = 0.024). Following the orientated tour in the intervention group, respiration rate (P < 0.000) and blood pressure (P < 0.001 systolic and diastolic) were significantly reduced, while heart rate and body temperature were not significantly different to pre‐intervention. Comparison changes of vital signs following the orientated tour between the two groups was not significant. Conclusion: Implementation of an orientated tour of the preoperative room can decrease anxiety levels in children before elective surgeries, but it has no clinical effect on vital signs.     

Serial Intravascular Ultrasound Analysis of the Impact of Myocardial Bridge on Neointimal Proliferation After Coronary Stenting in Patients with Acute Myocardial Infarction

Background: Mechanisms underlying the association between myocardial bridge (MB)‐stenting and in‐stent restenosis (ISR) are still unclear. Objective: To assess the impact of MB on ISR using intravascular ultrasound (IVUS). Methods: In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS‐AMI) trial, 100 left anterior descending artery (LAD) culprit lesions (79 treated with paclitaxel‐eluting stents [PES] and 21 treated with bare metal stents) were imaged with serial IVUS immediately postprocedure and at 13 months. Results: At baseline the LAD stent extended into the MB segment beyond the culprit lesion in seven patients (MB‐stent group). In the remaining 93 patients the LAD stent was implanted only in the culprit lesion without extending into the MB segment (non‐MB‐stent group). In PES‐treated lesions intimal hyperplasia (IH) was greater in MB‐stent group than in non‐MB‐stent group (1.0 [0.9, 1.3] mm² vs. 0.4 [0.2, 0.7] mm², P = 0.007). When comparing the MB‐stent segment with the non‐MB‐stent segment in the MB‐stent group treated with PES, a significant reduction in lumen area was observed in only the MB‐stent segment, owing to an augmented IH within the MB‐stent segment (1.56 [1.40, 1.91] mm² vs. 0.77 [0.55, 1.23] mm² for non‐MB‐stent segment, P = 0.08), not significant stent recoil (Δstent area). At follow‐up, the minimum lumen area was smaller in the MB‐stent group than in the non‐MB‐stent group (2.9 [2.5, 4.2] mm² vs. 5.2 [4.1, 6.7] mm², P = 0.02). Conclusions: Increased incidence of ISR associated with MB‐stenting may be attributable to enhanced IH, specific to stented MB segment, not to chronic stent recoil. (J Interven Cardiol 2010;23:114‐122)