Antimicrobial Efficacy of the Use of Mouthwash with Cetylpiridinium Chloride for Aerosol Producing Procedures. A Systematic Review / Eficacia antimicrobiana del uso del enjuague bucal con cloruro de cetilpiridinio en procedimientos que generan aerosoles. Revisión sistemática

Abstract The present research aims to determine the antimicrobial efficacy of the mouthwashes based on cetylpyridinium chloride (CPC), before aerosol producing dental procedures. A data search was performed during August 2021 in five databases MEDLINE (PubMed), SCOPUS, SCIELO, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. Randomized clinical trials (RCTs) were included based on the PICO question, comparing the efficacy of the mouthwashes based on cetylpyridinium chloride (CPC), versus other mouthwashes and water, before aerosol producing dental procedures, papers in English, Spanish and Portuguese were included without time limits. The risk of the included studies was evaluated with the tool RoB 2.0. Number of registration PROSPERO N° CRD42021275982. 120 papers were obtained in the preliminary search, discarding those that didn't comply with the selection criteria, leaving only 3 studies. These papers reported the use of cetylpyridinium chloride (CPC) was effective for the reduction of bacteria during the ultrasonic prophylactic procedure. The use of CPC mouthwashes previous to the dental treatment with ultrasonic prophylaxis showed only antibacterial capacity.

Resumen El presente trabajo de investigación tiene como objetivo determinar la eficacia antimicrobiana de los colutorios a base de cloruro de Cetilpiridinio (CPC), previo a tratamientos dentales que generen aerosol. Se realizó una búsqueda bibliográfica hasta agosto del 2021 en cinco bases de datos: MEDLINE (vía PubMed), SCOPUS, SCIELO, Cochrane Central Register of Controlled Trials (CENTRAL) y Google Scholar. Se incluyeron ensayos clínicos aleatorizados (ECAs), basándose en la pregunta PICOS, que compare la eficacia del colutorio a base de cloruro de Cetilpiridinio (CPC) con otro colutorio, placebo o agua, previo a un tratamiento dental que genere aerosol, en los idiomas español, inglés o portugués y sin límite de tiempo. El riesgo de los estudios incluidos se evaluó con la herramienta RoB 2.0. Número de registro PROSPERO N° CRD42021275982. Se obtuvo un total de 120 artículos en la búsqueda preliminar, descartando aquellos que no cumplían con los criterios de selección, quedando sólo 3articulos. Estos artículos informaron que el uso de CPC es efectivo para la reducción de bacterias durante el procedimiento de profilaxis con ultrasonido. El uso de los enjuagues bucales a base de CPC previo al tratamiento dental de profilaxis con ultrasonido sólo tiene eficacia antibacteriana.

[Flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resin composites: in vitro study.] / Resistencia flexural de las resinas fluida convencional, fluida bulk fill y fluida de alta carga: estudio in vitro.

Objective: To evaluate and compare the flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resins. Materials and methods: Thirty 2mm x 2mm x 25mm specimens of Tetric N-Flow (TNF), Filtek Bulk Fill Flowable Restorative (FBF) and Beautifil Flow Plus F00 (BFP) flowable resins were made up; they were distributed into three groups according to brand (n=10) and stored in distilled water for 24 hours at 37ºC. The 3-point bending test according to ISO 4049 was performed on a universal testing machine at a speed of 0.5 mm/min until fracture. The results were evaluated with Anova and Tukey tests. P<0.05. Results: Statistically significant differences were found between the groups with a value of p=0.011. According to the statistical analysis, the groups that showed statistically significant differences were the BFP and TNF groups (p=0.015) and the BFP and FBF groups (p=0.035), while no statistically significant difference was found in the TNF and FBF groups. Conclusion: The high-filled flowable resin presents better flexural strength compared to the conventional flowable and bulk fill flowable resins, while the conventional and bulk fill flowable resins have no statistically significant difference.

Microshear bond strength of dual-cure resin cement in zirconia after different cleaning techniques: an in vitro study.

PURPOSE: This study aimed to compare the microshear bond strength (µSBS) of dual-cure resin cement in CAD-CAM zirconia after different cleaning techniques. MATERIALS AND METHODS: Fifty discs of zirconia-based ceramic from Ivoclar Vivadent were embedded in acrylic resin. The discs were divided into five groups according to the cleaning methods used: Group 1: drying with spraying + sandblasting with Al2O3; Group 2: washed with water and dried with spraying + sandblasting with Al2O3; Group 3: washed with distilled water and dried with spraying + sandblasting with Al2O3 + zirconium oxide (Ivoclean); Group 4: washed with distilled water and dried with spraying + sandblasting with Al2O3 + potassium hydroxide (Zirclean); and Group 5: washed with distilled water and dried with spraying + sandblasting with Al2O3 + 1% NaClO. All of the groups were contaminated with artificial saliva for 1 minute and then cleaned. Statistical analyses were performed using ANOVA and Tukey's tests. RESULTS: There were statistically significant differences among all groups for µSBS (P < .05). The group treated with zirconium oxide (Group 3) showed the highest µSBS (18.75 ± 0.23 MPa). CONCLUSION: When applied to zirconia, the cleaning methods affected the bonding with resin cement differently.

Tratamiento multidisciplinario mínimamente invasivo de la sonrisa gingival / Minimally invasive multidisciplinary treatment of the gummy smile

El aumento en la demanda de tratamientos de odontología estética ha conducido al desarrollo de una comunicación multidisciplinaria entre las diferentes especialidades para lograr el éxito. La sonrisa gingival es un problema estético frecuente que consiste en una exposición excesiva de la encía durante la sonrisa y cuyas modalidades de tratamiento van desde una gingivectomía hasta el levantamiento de un colgajo para la remoción de hueso excedente. Las restauraciones con carillas directas de resinas compuestas son adecuadas para la conservación y la mejora estética del sector anterior, con óptima estética y durabilidad, además de ser consideradas un tratamiento mínimamente invasivo debido a sus conceptos conservadores de preservar la estructura dentaria.El presente caso clínico describe el tratamiento de un paciente joven con sonrisa gingival y alteración en forma y color de los dientes anteriores, mediante procedimientos mínimamente invasivos tales como la gingivectomía y la rehabilitación con carillas directas de resinas compuestas, con el objetivo máximo de preservar la estructura dentaria y una mayor predictibilidad estético-funcional. (AU)

The increasing demand of patients for esthetics dentistry treatments has led to the development of multidisciplinary communication between approaches among different specialties to achieve treatment success. The gummy smile is a frequent esthetic problem, which consists of excessive exposure of the gum when smiling. Treatment modalities range from gingivectomy to flap lift for the removal of excess bone. Restoration with direct veneers of composite resins is suitable for the preservation and esthetic improvement of the anterior sector, with optimal aesthetics and durability. In addition, minimally invasive treatment can be considered due to its conservative concepts of preserving the dental structure.The present case describes the treatment of a young patient with gummy smile and alteration in shape and color of the anterior teeth, through minimally invasive procedures such as gingivectomy and rehabilitation with direct veneers of composite resins with the objective of preserving the dental structure and greater esthetic - functional predictability. The present case report describes the treatment of a young patient with gummy smile. The shape and color of the anterior teeth were altered by minimally invasive procedures including gingivectomy and rehabilitation with direct veneers of composite resins with the objective of preserving the dental structure and providing greater esthetic - functional predictability. (AU)

Rehabilitación bioaditiva con resinas compuestas en desgaste severo: reporte de caso / Bioaditive rehabilitation with composite resins in severe wear: case report

El desgate dental es la pérdida de tejido duro de etiología múltiple y puede deberse a factores funcionales o parafuncionales. Dependiendo de esto, se debe elegir un tratamiento restaurador según la gravedad del desgaste, ya que puede resultar en la pérdida de dimensión vertical de la oclusión (DVO), sensibilidad dental y disminución de la calidad de vida. En estos casos, la elección de la estrategia de restauración debe seguir protocolos de tratamiento basados en la evidencia, que incluyan técnicas de restauración directas e indirectas, así como tratamientos mínimamente invasivos a partir de resinas compuestas que surgen como una alternativa a las restauraciones convencionales de cerámica. El presente caso clínico describe el tratamiento de un paciente con desgaste dental severo mediante la rehabilitación oral con resinas compuestas a través de técnicas directas e indirectas, con el objetivo de preservar al máximo la estructura dentaria y tener una mayor predictibilidad estético-funcional. (AU)

Dental wear inolves the loss of hard tissue of multiple etiology and may be due to functional or parafunctional factors. Accordingly, restorative treatment should be chosen considering the severity of the wear, since it can result in the loss of vertical dimension of the occlusion (DVO), dental sensitivity and a reduction in the quality of life. The choice of a restoration strategy should follow evidence-based treatment protocols, including direct and indirect restoration techniques such as minimally invasive treatments based on composite resins which are being increasingly used as an alternative to conventional ceramic restorations. The present clinical case describes the treatment of a patient with severe dental wear who underwent oral rehabilitation with composite resins using direct and indirect techniques with the aim of preserving tooth structure and greater aesthetic - functional predictability. (AU)

Microfiltración en restauraciones parciales indirectas cementadas con cementos resinosos duales autoadhesivos / MicroIeakage in indirect partial restorations cemented with self-adhesive dual resin cements

El objetivo de este estudio es comparar in vitro el grado de microfiltración marginal en incrustaciones de cerámica inyectada realizadas con dos cementos resinosos duales autoadhesivos seT PP (SDI) y RelyX U200 (3M ESPE). Se evaluaron 40 premolares superiores e inferiores extraídos por motivos ortodónticos y se dividieron en dos grupos según cemento asignado (n = 20). Luego, se realizó la preparación de cavidades tipo clase II, de aproximadamente 3 mm de ancho en la caja oclusal y proximal; y 2 mm de espesor en el piso gingival y la pared oclusal. Se restauraron de manera indirecta con restauraciones inyectadas de cerámica IPS e.max Press (Ivoclar Vivadent), se cementaron con los cementos estudiados según las especificaciones del fabricante. Los especímenes fueron guardados en un frasco y llevados a termociclado; luego, se realizaron cortes transversales a las coronas y se evaluó el grado de microfiltración por medio de un estereoscopio. Al comparar la microfiltración entre el cemento seT PP y RelyX U200, se concluyó que no existe una asociación estadísticamente significativa entre el grado de microfiltración y el tipo de cemento (prueba de Chi-cuadrado de Pearson; p > 0,05) y al observar el grado de microfiltración del seT PP y el RelyX U200 en la cementación de incrustaciones cerámicas inyectadas IPS e.max Press. En conclusión, no se hallaron diferencias significativas entre los dos cementos resinosos autoadhesivos. En ambos prevaleció la no microfiltración; sin embargo, para seT PP, la microfiltración fue del 17,5% en 1/3 de la pared cervical. (AU)

Objective: To compare in vitro the degree of marginal microleakage in injected embedded ceramics cemented with two self-adhesive dual resin cements: seT PP (SDI) and RelyX U200 (3M ESPE). Materials and methods: 40 upper and lower premolars extracted for orthodontic reasons were evaluated and divided into two groups according to the cement assigned (n = 20). The preparation of class II cavities was approximately 3 mm wide in occlusal and proximal boxes and 2 mm thick on the gingival floor and the occlusal wall. They were indirectly restored with restorations injected with IPS e.max Press ceramic (Ivoclar Vivadent), cemented with one of the study cements following the manufacturer's specifications. The samples were stored in a bottle and thermocycled. Cross sections of the crowns were then made, and the degree of microleakage was evaluated by stereoscopy. Results: There was no statistically significant association between the degree of microleakage and the type of cement used (Pearson's Chisquare Test; p> 0.05) or the degree of microfiltration of seT PP and RelyX U200 in IPS e.max Press-injected ceramic cementation. No microleakage prevailed with both cements; however, seT PP showed 17.5% microleakage in 1/3 of the cervical wall. Conclusions: No significant differences were observed between the two self-adhesive resinous cements in relation to microleakage. (AU)

Consideraciones actuales sobre el uso de férulas oclusales en rehabilitación oral: una revisión crítica / Current considerations about the use of occlusal splints in oral rehabilitation: a critical review

El uso de las férulas oclusales en la actualidad, en el vasto campo de la odontología, es de gran importancia para el tratamiento de trastornos témporo mandibulares (TTM), así como en el tratamiento de otras para funciones relacionadas con la articulación témporo mandibular (ATM). Actualmente, existe variedad en cuanto al diseño de férulas oclusales, hechas con diferentes materiales, con diferentes resistencias y utilizadas para cada tipo de disfunción temporomandibular que se presente, así como para las parafunciones existentes. Dentro de esta variedad son solo cinco tipos de férulas las que se conocen ampliamente, según la evidencia científica. Cada una de ellas tiende a considerar diversas características en la forma de fabricación y sus indicaciones; así mismo, el clínico debe ejecutar una buena elección, un plan de control adecuado para cada caso, con un diagnóstico acertado que llevará al éxito de los resultados. Se debaten diferentes aspectos en cuanto el uso de las férulas en el tratamiento de rehabilitación oral, incluyendo su uso para desprogramar la ATM, correcciones en la relación cóndilo fosa, eliminación de desarmonías oclusales para aliviar el dolor en la ATM, su influencia en la eficiencia muscular y su efecto en la carga muscular. Se debe diseñar un tipo de férula para cada tras-torno en específico y evaluar su verdadero valor terapéutico. En esta revisión crítica, se busca describir y analizar el uso de las férulas oclusales, sus principales funciones y aplicaciones en pacientes con diferentes trastornos. (AU)

At present, the use of the occlusal splints in the vast field of dentistry is of great importance for the treatment of temporo mandibular disorders (TMD) as well as in the treatment of other functions related to the temporo-mandibular joint (ATM). The design of occlusal splints varies, involving different materials, different resistances and according to the type of temporomandibular dysfunction as well as existing parafunctions. To date 5 types of splints have been described, each of which considers different characteristics related to manufacturing and their indications. Likewise, to ensure adequate results, clinicians must select the splint to be used according to the characteristics of each patient. We discuss different aspects such as the use of splints in the treatment of oral rehabilitation, including their use to deprogram TMD, corrections in the condyle fossa relationship, elimination of occlusal disharmony to relieve TMJ pain, the influence of splints on muscle efficiency and their effect on muscle load. Splints must be designed individually to assess their real therapeutic value, taking into account the specific conditions of each patient. This critical review, seeks to describe and analyze the use of occlusal splints and their main functions and applications in patients with different oral disorders. (AU)

Microfiltración marginal de carillas oclusales de cerómero con diferentes terminaciones. Un estudio in vitro / Marginal microleakage ossclusal ceromer veneers with different finish lines. An in vitro study

Objetivo: Comparar la microfiltración marginal de carillas oclusales de cerómero con diferentes terminaciones: hombro, chámfer y un grupo control sin preparación. Materiales y métodos: Se utilizaron 33 dientes premolares humanos, sanos, extraídos por indicación de ortodoncia. Se dividieron en tres grupos de once por aleatorización. Una vez cementadas las carillas oclusales, las muestras fueron sometidas a un termociclado manual de 1000 ciclos, con el fin de simular el ambiente de la cavidad bucal. Después, fueron puestas en inmersión pasiva con azul de metileno al 2% por un periodo de 24 horas. Una vez culminado el tiempo, se procedió al corte de las muestras a nivel del surco central de cada pieza, con el fin de observar la microfiltración alcanzada. La microfiltración se observó con un microscopio óptico estereoscópico con aumento de lupa de 10x y se calificó según la penetración del colorante y la escala de Cassin y Pearsons modificada. Resultados: La terminación que obtuvo la mayor microfiltración fue la de hombro, con un 45% de filtración en pared axial (escala 4). El grupo con la menor filtración fue sin línea de terminación, en la cual el 72,7% se ubicó en la escala 1. La prueba de asociación de Chi cuadrado fue significativa y se obtuvo un resultado de p < 0,001. Conclusión: Existe asociación entre el aumento de microfiltración y la línea de terminación tipo hombro. Esta relación debe tenerse en cuenta al momento de la planificación de tratamiento protésico. (AU)

Objective: To compare the marginal microleakage of occlusal ceromer veneers with different finish lines; shoulder, chamfer and a group without preparation. Materials and methods:33 sound human premolars under orthodontic extraction were used. They were divided into 3 groups of 11 each. Once the occlusal veneers were bonded, they were manually thermocycled for 1000 cycles with the aim of simulating the oral cavity. They were then immersed in 2% blue methylene for 24 hours, after which cross section samples of the central groove were taken for micro-leakage observation. The microleakage was observed with an optical stereos-copic microscope with 10x magnification power and classified according to the Cassin and Pearson's modified scale. Results: The finish line with the most microleakage was the shoulder, with 45% of axial wall microleakage (scale 4). The least microleakage was observed in the group without finish line, with 72.7% (scale 1). Conclusion: The association between greater microleakage and the shoulder finish line was determined. (AU)

Evaluación de la microdureza superficial de discos de resinas para reconstrucción de muñones. Estudio in vitro / Evaluation of the surface micro-hardness of resin discs for core build-up. In vitro study

Objetivo: Comparar, a las 48 horas, la microdureza superficial de las resinas para reconstrucción de muñones Luxa- core DMG America, Absolute Dentin Parkell y Z350 XT 3M. Materiales y métodos: El grupo de estudio estuvo conformado por 33 discos de resina, distribuidos en tres subgrupos: dos experimentales cada uno conformado por (n = 11), y uno control (n = 11). Los dos primeros grupos son resinas de foto activación y el tercero, una resina de activación dual. Estos fueron sometidos al instrumento microdurómetro Vickers, marca LG, en el laboratorio de ensayos mecánicos. Se aplicó una carga de 200 gramos fuerza por 10 segundos para cada indentación. El análisis estadístico se realizó con ayuda del programa SPSS versión 24 y se realizó la prueba de Anova y la prueba de comparación múltiple de Tukey. Resultados: Luego del ensayo de microdureza Vickers (VHN), los resul- tados fueron: para G1, el valor promedio para la variable microdureza fue 55,24 ± 1,7 VHN; el G2 arrojó un valor promedio de 54,34 ± 3,82 VHN, y para G3 fue de 75.66 ± 4.4 VHN. Conclusión: Las resinas compuestas foto activadas, como material de reconstrucción de muñones sometidos a la prueba de microdureza superficial, mostraron propiedades mecánicas mejoradas en comparación con las resinas duales evaluadas. (AU)

Objective: Compare the superficial microhardness at 48 hours of the core build-up resins Luxacore DMG America, Absolute Dentin PARKELL and Z350 XT 3M. Materials and methods: The study group consisted of 33 resin discs, distrib-uted in three sub-groups: two experi-mental groups (n = 11) and one control group (n = 11). The first two groups were photo activation resins and the third group was a dual activation resin, subjected to the Micro-Vickers Hardness Tester - LG Brand in the mechanical testing labo-ratory. A test force of 200 grams was applied for 10 seconds for each indenta-tion. Statistical analysis was conducted with the help of the SPSS version 24 program and the Anova test and Tukey multiple comparison test were performed. Results: Following the Vickers micro-hardness test (vhn), the mean results for the indentations are shown in Table 1 in vhn values. f or g1 the average microhardness variable was 55.24 ± 1.7 vhn. g2 exhibited an average value of 54.34 ± 3.82 vhn. the average micro-hardness value for G3 was 75.66 ± 4.4 vhn.Conclusions: Composite photo activated resins as a core build-up mate-rial subjected to surface microhardness testing displayed improved mechanical properties compared to the dual resins evaluated. (AU)

Distribución de la tensión compresiva en segundas premolares superiores en coronas individuales mediante el análisis de elementos finitos / Distribution of compressive tension in second higher premolars in individual crowns through the finite element analysis

Objetivo: Evaluar la tensión compresiva en segundas premolares superiores rehabilitadas con coronas de disilicato de litio (D.L) y de Silicato de litio reforzado con zirconio (S.L) mediante el método de elementos finitos. Metodología: Se construyeron dos modelos virtuales usando el programa Solidworks 2014 para la construcción de modelos. En el primer modelo se representó la dentina remanente, cofia de disilicato de litio, cemento relyx U 200 y porcelana cerámica feldespática IPS e.Max (Ivoclar Vivadent) (MEF 1). En el segundo modelo se representó la dentina remanente, cofia de vita suprinity, cemento relyx U 200 y porcelana (MEF 2). Ambos modelos fueron sometidos a una carga de 200 N. Resultados: El valor de máxima tensión en la corona de disilicato de litio (MEF 1) fue de 166.98 Mpa, mientras que en la corona de Silicato de litio (MEF 2) fue de 177.6 Mpa. El valor de máxima tensión compresiva en dentina en el (MEF 1) fue 0.27 Mpa y en el (MEF 2) la máxima tensión en la dentina fue 0.26 Mpa. El valor de máxima tensión compresiva en cervical del (MEF 1) fue de 3.93 Mpa y en el (MEF 2) en cervical fue de 3.90 Mpa. Conclusiones: La corona de silicato de litio mostró la mayor tensión compresiva en el área oclusomesial. En dentina y en el área cervical la tensión compresiva tuvieron resultados similares. (AU)

Objective:To evaluate compressive stress between the disilicate (D.L) and Zirconium reinforced lithium silicate (S.L) crowns using finite element analysis.Material and Methods:Two virtual models were constructed using the Solidworks 2014 software for building models. In the first model was designed the remaining dentin, lithium disilicate cap, RelyX U200 cement and porcelain feldspathic ceramics IPS e.Max (Ivoclar Vivadent). In the second model was designed dentin remaining, silicate cup, RelyX U 200 cement and porcelain. Both models were applied to load of 200 N.Results:The value of maximum tension in the lithium disilicate crown (FEM 1) was obtained was 166.98 Mpa, while in the Zirconium reinforced lithium silicate crown (FEM 2) the maximum tension was 177.6 Mpa. The value of maximum tension on dentin (FEM 1) is 0.27 Mpa and the maximum value (FEM 2) dentin was 0.26 Mpa. The value of maximum tension (FEM 1) on the cervical was 3.93 and (FEM 2) on the cervical was 3.90.Conclusions:The (S.L) crown showed the highest compressive tension in the occlusal and mesial area. In dentin and in the cervical area the compressive tension had similar results. (AU)

An Update on Human Stem Cell-Based Therapy in Parkinson's Disease.

CDATA[Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease and it is characterized by the progressive loss of dopaminergic neurons of the substantia nigra pars compacta (SNpc). Current pharmacological treatments for PD are only symptomatic and unfortunately there is still no cure for this disorder. Stem cell technology has become an attractive option to investigate and treat PD. Indeed, transplantation of fetal ventral mesencephalic cells into PD brains have provided proof of concept that cell replacement therapy can be beneficial for some patients, greatly improving their motor symptoms. However, ethical and practical aspects of tissue availability limit its widespread clinical use. Hence, the need of alternative cell sources are based on the use of different types of stem cells. Stem cell-based therapies can be beneficial by acting through several mechanisms such as cell replacement, trophic actions and modulation of inflammation. Here we review recent and current remarkable clinical studies involving stem cell-based therapy for PD and provide an overview of the different types of stem cells available nowadays, their main properties and how they are developing as a possible therapy for PD treatment.

Therapy with stem cells in inflammatory bowel disease.

Inflammatory bowel disease (IBD) affects a part of the young population and has a strong impact upon quality of life. The underlying etiology is not known, and the existing treatments are not curative. Furthermore, a significant percentage of patients are refractory to therapy. In recent years there have been great advances in our knowledge of stem cells and their therapeutic applications. In this context, autologous hematopoietic stem cell transplantation (HSCT) has been used in application to severe refractory Crohn's disease (CD), with encouraging results. Allogenic HSCT would correct the genetic defects of the immune system, but is currently not accepted for the treatment of IBD because of its considerable risks. Mesenchymal stem cells (MSCs) have immune regulatory and regenerative properties, and low immunogenicity (both autologous and allogenic MSCs). Based on these properties, MSCs have been used via the systemic route in IBD with promising results, though it is still too soon to draw firm conclusions. Their local administration in perianal CD is the field where most progress has been made in recent years, with encouraging results. The next few years will be decisive for defining the role of such therapy in the management of IBD.

Optimal Anticoagulant Therapy in ST Elevation Myocardial Infarction Interventions.

Bivalirudin is a direct thrombin inhibitor. It is a new recommendation for the treatment of patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Bivalirudin combined with aspirin and P2Y12 inhibitors has proved to be an effective and safe choice for the management of thrombus in coronary artery disease. The use of bivalirudin compared with the combination of heparin plus glycoprotein IIb/IIIa inhibitors as anticoagulant therapy is associated with reduced severe bleeding and inpatient mortality, as well as diminished costs. There is only a slight increase of late stent thrombosis, which may be controlled with the use of thienopyridines.

Global Acute Myocardial Infarction Perspectives: Beyond Door-to-Balloon Interventions.

The goal in ST-elevation myocardial infarction (STEMI) intervention is achieving a door-to-balloon time of less than 90 minutes. Challenges in North America and Europe include patient education and implementing legislative mandates for STEMI guidelines. Globally, hurdles for primary percutaneous coronary intervention include limitations of access and financial constraints to providing STEMI care to vast populations. Adherence to North American and European guidelines globally remains an unrealistic goal given the unique cultural, demographic, and fiscal dynamics in poorer countries. The authors propose a four-phased population-based strategy for global acute myocardial infarction development and a pharmacoinvasive approach to STEMI care based on socioeconomic characteristics.

Compulsive Thrombus Management in STEMI Interventions.

Thrombus is a fundamental concept in the pathophysiology of ST-elevated myocardial infarction (STEMI). Distal embolization and no reflow are associated with less angiographic success, reduced myocardial blush, less ST resolution after primary percutaneous coronary intervention, larger enzymatic infarct size, lower left ventricular ejection fraction at discharge, and higher long-term mortality. We believe that with the use of thrombectomy devices, these shortcomings can be minimized. Based on our experience from the Single Individual Community Experience Registry (SINCERE) database, we formulated a selective thrombus burden management strategy (the Mehta classification) for thrombus management.

Door-to-Balloon ST-Elevation Myocardial Infarction Interventions: Illustrated Cases.

ST-elevation myocardial infarction (STEMI) intervention comprises 2 components, the STEMI procedure and the STEMI process, which have unique aspects that can be modified and improved, ultimately affecting patient outcome. The 15 illustrated cases in this article highlight suggested improvements mainly in the STEMI procedure, with some references as to how the authors practically improved the STEMI process for the described procedure. The illustrated procedures have been meticulously selected from more than 1000 short door-to-balloon STEMI interventions recorded in the Single Individual Community Experience Registry (SINCERE) database, and are aimed at educating the reader about unique STEMI skills.

STEMI interventions--a review of relevant clinical trials.

Major advances have been made in primary reperfusion and adjunctive therapies for STEMI. Mechanical reperfusion therapy has become the preferred reperfusion strategy for patients with STEMI. Outcomes have improved with the use of stents, platelet inhibitors, and with increased experience, and there is a promise that outcomes can become even better with new methods to enhance myocardial reperfusion and reduce reperfusion injury and with new anticoagulants and drug-eluting stents. Recent trends from the NRMI have shown that the frequency of use of primary PCI has increased and has surpassed lytic therapy, but primary PCI is used to treat only a minority of patients with STEMI. The major challenge for clinicians in the next decade will be to find new ways to make mechanical reperfusion more available, improve outcomes through the use of optimal adjuvant therapies and improved systems of care to speed primary PCI. The nation-wide effort to reduce door-to-balloon times has been launched by American Heart Association, with goal of making primary PCI more available to patients with STEMI.

In vivo effect of an luteinizing hormone-releasing hormone analog on vascular endothelial growth factor and epidermal growth factor receptor expression in mammary tumors.

BACKGROUND: The hypothalamic luteinizing hormone-releasing hormone (LHRH) is well known for its role in the control of pituitary gonadotropin secretion and it has demonstrated a direct antiproliferative effect on some cancer cell lines of LHRH and its synthetic analogs. The study was designed to assess whether administration of the LHRH analog (goserelin) has any effect on the expression of the vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR) in rats with N-nitroso-N-methylurea (NMU)-induced-mammary tumors " in vivo". MATERIALS AND METHODS: The animals with tumors were assessed after acute or chronic treatment with goserelin, and in all the animals VEGF and EGFR expression was examined both in plasma and tumor homogenates by enzyme immunoassay. RESULTS: The basal plasma values of VEGF were lower in the healthy control group than in rats with NMU-induced tumors ( P = 0.025). Following acute treatment with goserelin, VEGF expression in plasma increased above basal levels after 60 min ( P = 0.05) and dropped during chronic treatment. Likewise, in the tumor homogenate the mean VEGF expression was higher at 60 min post-goserelin administration than the basal levels, although VEGF expression then diminished at 90 min. Plasma EGFR expression was higher in rats with NMU-induced tumors than in healthy controls ( P Conclusions: The results allow us to conclude that goserelin may exert a short-term stimulatory effect on the release of VEGF, as well as a long-term inhibitory effect on VEGF but not EGFR expression.