ABSTRACT
The recent European Atherosclerosis Society (EAS) guidelines for the management of familial hypercholesterolaemia (FH) succinctly reiterate the under-diagnosis and poor management of this common genetic disorder, which is associated with greatly increased mortality from coronary heart disease (CHD), especially in young people. The prevalence of FH is thought to be between 1/500 and 1/200, and thus in Europe 1.8-4.5 million individuals have FH. In most European countries including the UK, fewer than 15% of cases have been identified to date, amounting to over 100,000 undiagnosed cases in the UK alone. There are a number of issues that have impeded the implementation of FH diagnostic and management guidelines in Europe; here, we briefly review the current situation in the UK, and propose ways to start to break down implementation barriers that may be applicable across Europe. Despite guidelines by the UK National Institute of Health and Clinical Excellence (NICE) published in 2008 that recommend genetic testing of index cases and cascade screening of their family members, and the recent NICE Quality Standards for management of FH (QS41), there has been little action towards systematic diagnosis in England despite implementation of systematic screening programmes in Scotland, Wales, Northern Ireland and in other selected countries in Europe. This is surprising because early treatment with statins provides an effective and cheap treatment that reduces mortality to near that found in the normolipidaemic population. With increasing emphasis on preventive medicine and genetic diagnosis across the medical specialties, FH is a clear example of how new genome technologies can - and should - be deployed now for the benefit of patients.
Subject(s)
Hyperlipoproteinemia Type II/epidemiology , Hyperlipoproteinemia Type II/therapy , Anticholesteremic Agents/therapeutic use , Cholesterol, LDL/blood , Coronary Disease/prevention & control , Cost-Benefit Analysis , Europe , Genetic Predisposition to Disease , Genome, Human , Genomics , Health Policy , Humans , Hyperlipoproteinemia Type II/diagnosis , Hyperlipoproteinemia Type II/genetics , Practice Guidelines as Topic , Prevalence , Risk Factors , United KingdomABSTRACT
AIM: To determine the tangential tensile force loading behavior of mini-implants relative to cortical bone thickness in the porcine mandible. METHODS: Eighteen mini-implants were placed both anteriorly and posteriorly perpendicular to the bone surface in porcine mandibles and subjected to shear tests using a Universal Testing Machine (Instron). Further, cone beam CT was used to measure cortical bone thickness at each mini-implant site. RESULTS: The shear strength differed significantly between the anterior (mean 89.05 ± 35.9 N) and posterior (mean 179.85 ± 29.01 N) sites. The same was true for the cortical bone thickness (anteriorly, mean 3.59 ± 0.49 mm; posteriorly, mean 4.24 ± 0.5 mm). CONCLUSION: The shear forces required to dislodge mini-implants were much higher than forces typically applied for orthodontic purposes. Therefore, mandibular cortical bone supporting monocortical orthodontic mini-implants would most likely withstand immediate loading with tangential shear forces. In addition, it seems that mini-implants loaded tangentially continue to exhibit adequate anchorage for orthodontic forces even after they are displaced.
Subject(s)
Dental Implants , Mandible/anatomy & histology , Orthodontic Anchorage Procedures/instrumentation , Orthodontic Appliance Design , Animals , Biomechanical Phenomena , Cone-Beam Computed Tomography/methods , Dental Arch/anatomy & histology , Dental Stress Analysis/instrumentation , Image Processing, Computer-Assisted/methods , Materials Testing , Miniaturization , Shear Strength , Stress, Mechanical , Swine , Tensile StrengthABSTRACT
The appropriate combination of methacrylate polymers permits the synthesis of a soluble polymer for use in ruthenium(II)-catalyzed asymmetric transfer hydrogenation reactions. Using a 7:3 copolymer of a poly(ethylene glycol) ester and a hydroxyethyl ester, a derived ruthenium(II)/norephedrine complex catalyses reduction of acetophenone in up to 95% yield and 81% ee.
