Short-Term Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke: A Meta-Analysis of 5 Randomized Trials.

Tenecteplase (TNK) has been shown to be noninferior to Alteplase (ALT) for long term efficacy and safety outcomes. Whether this also applies to short term efficacy outcomes such as early clinical improvement and recanalization is unknown. To compare TNK and ALT regarding the short term efficacy outcomes: early neurological improvement and recanalization. The PRISMA was used to conduct a meta analysis, adapted to noninferiority analysis. The primary outcome was early (24-72 h) neurological improvement, defined as either NIHSS score 0 or reduction of at least 8 points compared to baseline. Recanalization was a secondary outcome. The noninferiority margin was set at 6.5%. Search strategy yielded 5 randomized clinical trials (1585 patients: 828 TNK, 757 ALT). Mean age was 70.8, 58.8% were men, mean baseline NIHSS was 7, and mean onset to treatment time was 148 min. Patients in intervention group received TNK at doses of 0.1 mg/kg (6.8%), 0.25 mg/kg (24.6%), and 0.4 mg/kg (68.6%), while all ALT patients received 0.9 mg/kg. In random effects meta analysis, TNK was noninferior to ALT for the primary outcome, early major neurological improvement (risk difference 8% in favor of TNK, 95% CI 1%-15%). Recanalization was also noninferior for the TNK compared to the ALT group (risk difference 9% in favor of TNK, 95% CI 6% to 23%). Fixed effects models yielded similarly noninferior results and signaled for a possible TNK superiority for both early neurological improvement and recanalization. TNK is noninferior to ALT at the short term efficacy outcomes: early neurological improvement and recanalization.

Calibration and validation of the Pneumonia Shock Score in critically ill patients with SARS-CoV-2 infection, a multicenter prospective cohort study.

Background: Prognostic tools developed to stratify critically ill patients in Intensive Care Units (ICUs), are critical to predict those with higher risk of mortality in the first hours of admission. This study aims to evaluate the performance of the pShock score in critically ill patients admitted to the ICU with SARS-CoV-2 infection. Methods: Prospective observational analytical cohort study conducted between January 2020 and March 2021 in four general ICUs in Salvador, Brazil. Descriptive statistics were used to characterize the cohort and a logistic regression, followed by cross-validation, were performed to calibrate the score. A ROC curve analysis was used to assess accuracy of the models analyzed. Results: Six hundred five adult ICU patients were included in the study. The median age was 63 (IQR: 49-74) years with a mortality rate of 33.2% (201 patients). The calibrated pShock-CoV score performed well in prediction of ICU mortality (AUC of 0.80 [95% Confidence Interval (CI): 0.77-0.83; p-value < 0.0001]). Conclusions: The pShock-CoV score demonstrated robust discriminatory capacity and may assist in targeting scarce ICU resources during the COVID-19 pandemic to those critically ill patients most likely to benefit.

Evaluation of the roughness of composite resins submitted to different surface treatments.

The aim of this study was to evaluate the surface roughness of restorative composite resins after polishing with aluminum oxide discs and applying an adhesive layer The following composite resins were used: Filtek Z250 (hybrid, 3MESPE, A2) and Filtek Supreme XT (nanofilled, 3M ESPE, A2E). Thirty specimens of each composite were made using a condensation silicone mold (5.0 x 2.0 mm) into which the composites were inserted and submitted to light pressure. After polymerization using the halogen light source Curing Light 2500 (3M) for 40 seconds, the specimens were assigned to the following groups: G1-Z250/CO- control, did not receive any treatment; G2-Z250/SL--the specimens underwent finishing and polishing with Sof-Lex discs; G3-Z250/ADE, application of an adhesive layer on the top of the specimen and light curing for 20 seconds. Groups G4, G5 and G6 followed the same treatment sequence, but using Filtek Supreme XT The specimens were stored in deionized water at 37 degrees C for 24 h. Three readings of surface roughness were made for each specimen. The results were submitted to variance analysis by Two-Way ANOVA Test and Tukey HSD Test. The mean values obtained were: G3 (0.2325 +/- 0.1484 microm) and G6 (0.2266 +/- 0.0463 microm), which were higher than the other groups and did not differ statistically from each other. Groups G1 (0.1023 +/- 0.0464 microm), G4 (0.1083 +/- 0.0241 microm), G5 (0.1160 +/- 0.0252 microm) and G2 (0.1360 +/- 0.0131 microm) had the lowest average roughness and did not differ statistically among each other. It was concluded that the Sof-Lex discs performed better for the surface treatment of the composites resins tested, producing similar values of surface roughness for both composites. Covering with dentin adhesive increased the surface roughness in both composites.

Evaluation of the roughness of composite resins submitted to different surface treatments / Evaluación de la rugosidad de resinas compuestas después de diferentes tratamientos de superficie

El propósito del presente estudio fue evaluar la rugosidad superficial de resinas compuestas después de ser pulidas con discos de óxido de aluminio y de aplicar una capa de adhesivo. Se utilizó resina Filtek Z250 y Filtek Supreme XT. Se fabricaron treinta especímenes de cada resina utilizando una matriz de silicona (5,0 x 2,0 mm). Después de su polimerización por 40 segundos, se formaron los siguientes grupos: G1-Z250/CO – control, que no recibió ningún tratamiento; G2-Z250/SL – los especímenes fueronacabados y pulidos con discos Sof-Lex; G3-Z250/ADE – se aplicó una capa de adhesivo en la parte superficial de los especímenes polimerizada por 20 segundos. Los grupos G4, G5 y G6 siguieron el mismo patrón, utilizando resina Filtek Supreme XT. Tres lecturasde rugosidad superficial fueron hechas en cada especímen. Se evaluaron mediante la pruebas de ANOVA Two-Way y Tukey HDS (p = 0,05), obteniendo los siguientes valores: G3 (0.2325 ± 0.1484 μm) y G6 (0.2266 ± 0.0463 μm) obtuvieron valores superiores a los otros grupos sin diferencia estadística. G1 (0.1023 ± 0.0464 μm), G4 (0.1083 ± 0.0241 μm), G5 (0.1160 ± 0.0252 μm) y G2(0.1360 ± 0.0131 μm) obtuvieron los menores valores de rugosidadsuperficial sin diferencia estadística. Se concluyó que los discos Sof-Lex presentaron un mejor desempeño para el tratamiento superficial de las resinas compuestas, siendo capaces de producirvalores similares de rugosidad de la superficie de ambos compuestos.La aplicación de una capa hidrofóbica de monómeros en las resinas produjo una elevada rugosidad superficial.

Evaluation of the roughness of composite resins submitted to different surface treatments / Evaluación de la rugosidad de resinas compuestas después de diferentes tratamientos de superficie

El propósito del presente estudio fue evaluar la rugosidad superficial de resinas compuestas después de ser pulidas con discos de óxido de aluminio y de aplicar una capa de adhesivo. Se utilizó resina Filtek Z250 y Filtek Supreme XT. Se fabricaron treinta especímenes de cada resina utilizando una matriz de silicona (5,0 x 2,0 mm). Después de su polimerización por 40 segundos, se formaron los siguientes grupos: G1-Z250/CO û control, que no recibió ningún tratamiento; G2-Z250/SL û los especímenes fueronacabados y pulidos con discos Sof-Lex; G3-Z250/ADE û se aplicó una capa de adhesivo en la parte superficial de los especímenes polimerizada por 20 segundos. Los grupos G4, G5 y G6 siguieron el mismo patrón, utilizando resina Filtek Supreme XT. Tres lecturasde rugosidad superficial fueron hechas en cada especímen. Se evaluaron mediante la pruebas de ANOVA Two-Way y Tukey HDS (p = 0,05), obteniendo los siguientes valores: G3 (0.2325 ± 0.1484 μm) y G6 (0.2266 ± 0.0463 μm) obtuvieron valores superiores a los otros grupos sin diferencia estadística. G1 (0.1023 ± 0.0464 μm), G4 (0.1083 ± 0.0241 μm), G5 (0.1160 ± 0.0252 μm) y G2(0.1360 ± 0.0131 μm) obtuvieron los menores valores de rugosidadsuperficial sin diferencia estadística. Se concluyó que los discos Sof-Lex presentaron un mejor desempeño para el tratamiento superficial de las resinas compuestas, siendo capaces de producirvalores similares de rugosidad de la superficie de ambos compuestos.La aplicación de una capa hidrofóbica de monómeros en las resinas produjo una elevada rugosidad superficial.(AU)