Review of Dental Impression Materials

Major advances in impression materials and their application have occurred during the last decade, with greater emphasis being placed on rubber impression materials than on dental compound, zinc oxide-eugenol, and agar and alginate. Of particular interest has been the effect of disinfection solutions on the qualities of impressions and the biocompatibility of impression materials. The principal advance in hydrocolloids has been the introduction of the agar/alginate impression technique, which has simplified the procedure and improved the quality of gypsum dies compared with those prepared in alginate impressions. The tear strength of some alginates has been improved, and some have been formulated so that the powder is dustless, thus reducing the health hazard as a result of patient inhalation of dust during the dispensing process. Polyether and silicone impression materials have been modified so that the working time, viscosity, and flexibility of the polyethers have been improved and, with the introduction of addition silicones, their accuracy has become exceptional. Although the early addition silicones liberated hydrogen after setting, thus delaying the pouring of models and dies, most addition silicones have been improved so that no hydrogen is released and dies can be poured immediately. The introduction of automatic mixing systems for addition silicones has simplified their manipulation, has reduced the number of voids in impressions, and has reduced the amount of material wasted. The incorporation of surfactants into addition silicones has made them hydrophilic, with wetting properties similar to those of polyethers, and has made pouring bubble-free gypsum dies easier. This review is confined to published and unpublished information of the past decade. It will also suggest trends that should be anticipated in the near future based on this information. The review will not present information developed before 1975, which is available in several textbooks on dental materials by Craig (1985a), Phillips (1982), and Williams and Cunningham (1979).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66604/2/10.1177_08959374880020012001.pd

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None

Le rapport P/alpha dans les vins doux naturels

L'importance du rapport P/alpha (P/α) n'est plus à démontrer. Il est le seul critère permettant de vérifier la bonne élaboration d'un vin doux naturel telle que la loi l'exige. En outre, ce critère permet de rechercher certaines fraudes

An antibiotic produced by an insect-pathogenic bacterium suppresses host defenses through phenoloxidase inhibition

Photorhabdus is a virulent pathogen that kills its insect host by overcoming immune responses. The bacterium also secretes a range of antibiotics to suppress the growth of other invading microorganisms. Here we show that Photorhabdus produces a small-molecule antibiotic (E)-1,3-dihydroxy-2-(isopropyl)-5-(2-phenylethenyl)benzene (ST) that also acts as an inhibitor of phenoloxidase (PO) in the insect host Manduca sexta. The Photorhabdus gene stlA encodes an enzyme that produces cinnamic acid, a key precursor for production of ST, and a mutation in stlA results in loss of ST production and PO inhibitory activity, which are both restored by genetic complementation of the mutant and also by supplying cinnamic acid. ST is produced both in vitro and in vivo in sufficient quantities to account for PO inhibition and is the only detectable solvent-extractable inhibitor. A Photorhabdus stlA− mutant is significantly less virulent, proliferates slower within the host, and provokes the formation of significantly more melanotic nodules than wild-type bacteria. Virulence of the stlA− mutant is also rescued by supplying cinnamic acid. The proximate cause of the virulence effect, however, is the inhibition of PO, because the effect of the stlA− mutation on virulence is abolished in insects in which PO has been knocked down by RNA interference (RNAi). Thus, ST has a dual function both as a PO inhibitor to counter host immune reactions and also as an antibiotic to exclude microbial competitors from the insect cadaver