Advanced platelet-rich fibrin as a therapeutic option in the treatment of dry socket: Literature review and case series

Alveolar osteitis (AO) is one of the complications that occur after tooth extraction. The aim of this study has been to evaluate the efficacy of Advanced Platelet-rich Fibrin (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of AO. Consecutive patients who were diagnosed with AO, recruited from patients referred to the Oral Surgery Department of the University of Naples Federico II, were enrolled. After local anesthesia, the dry socket was curetted and irrigated with saline. The Platelet-rich Fibrin (PRF) clot was placed in the socket and then covered with an A-PRF membrane. Clinical parameters, such as the degree of pain and rate of granulation tissue (GT) formation, were measured before treatment and after 1, 3, 7, 14, and 21 days. The Friedman test for dependent samples was used to detect the treatment and time effect. Four patients with established AO were included. On all the examination days, the post-operative recovery was uneventful. The pain scores progressively reduced, from an average of 8.5 before treatment to 0.25 on the third day, and the GT formation improved over time. The use of A-PRF in the treatment of AO significantly reduced the pain level and enhanced the wound-healing process

Trials in "true" dyslipidemic patients are urged to reconsider comprehensive lipid management as a means to reduce residual cardiovascular risk

Randomized cardiovascular trials aimed to reduce the excessive residual risk in high-risk patients through a more aggressive LDL-cholesterol control or targeting triglycerides or HDL-cholesterol levels have shown a null or, at best, limited incremental benefit. In some cases, the treatment produced meaningful effects only in study subgroups. As a consequence, some compounds were withdrawn (e.g. nicotinic acid derivatives and CETP inhibitors), whereas others (fibrates) are utilized with reluctance due to the low level of evidence-based data. By reviewing these trials analytically, we identified a common feature that might explain their meagre results: most of them involved patients generically at high cardiovascular risk with normal or near normal lipid levels and not patients with "true" dyslipidemia, who would receive the treatment if it were part of usual care. These observations may warrant reexamining a central criterion of pragmatism, eligibility, in the outline of forthcoming cardiovascular trials with novel lipid-modifying drugs

Plasma exosome profile in st-elevation myocardial infarction patients with and without out-of-hospital cardiac arrest

The identification of new biomarkers allowing an early and more accurate characterization of patients with ST-segment elevation myocardial infarction (STEMI) is still needed, and exosomes represent an attractive diagnostic tool in this context. However, the characterization of their protein cargo in relation to cardiovascular clinical manifestation is still lacking. To this end, 35 STEMI patients (17 experiencing resuscitated out-of-hospital cardiac arrest (OHCA-STEMI) and 18 uncomplicated) and 32 patients with chronic coronary syndrome (CCS) were enrolled. Plasma exosomes were characterized by the nanoparticle tracking analysis and Western blotting. Exosomes from STEMI patients displayed a higher concentration and size and a greater expression of platelet (GPIIb) and vascular endothelial (VE-cadherin) markers, but a similar amount of cardiac troponin compared to CCS. In addition, a difference in exosome expression of acute-phase proteins (ceruloplasmin, transthyretin and fibronectin) between STEMI and CCS patients was found. GPIIb and brain-associated marker PLP1 accurately discriminated between OHCA and uncomplicated STEMI. In conclusion, the exosome profile of STEMI patients has peculiar features that differentiate it from that of CCS patients, reflecting the pathophysiological mechanisms involved in STEMI. Additionally, the exosome expression of brain-and platelet-specific markers might allow the identification of patients experiencing ischemic brain injury in STEMI

Apoyo a la implantación de unidades de conservación en la Región Centro-Norte Catarinense

A região do litoral centro-norte catarinense precisa despertar para a oportunidade e necessidade de implantação de unidades de conservação, pois poucas unidades foram criadas e a maioria inexistindo delimitação, regularização fundiária e adoção de infraestrutura e de mão de obra adequadas. Ainda, outros locais apresentam potencial e/ou necessidade de proteção, aumentando a quantidade e a qualidade de áreas protegidas. O processo que envolve desde a criação até a efetivação destas unidades é regido pelos Sistemas Nacional e Estadual de Unidades de Conservação. Portanto, exigindo conhecimento técnico-legal e procedimentos político-administrativos, sendo necessária assistência aos atores sociais interessados e envolvidos, entendendo que um adequado embasamento conceitual sobre o assunto, assim como o despertar para a participação dos atores sociais é uma forma de estimular e incentivar a consolidação do processo. Este Projeto atuou por meio da organização de banco de dados, da realização de reuniões e oficinas locais e da elaboração de listagem de problemas e de oportunidades observados em cada processo de atuação. As técnicas e estratégias utilizadas em cada processo variaram de acordo com as características dos mesmos e a fase em que se encontravam. Foram trabalhados oito processos de unidades de conservação, em cinco (5) municípios e tiveram trinta e cinco (35) instituições envolvidas entre órgãos públicos, organizações não governamentais e instituição de ensino, assim como dezoito (18) estudantes participantes, além de representantes da comunidade que participaram em diferentes momentos.The coastal region of the central-north catarinense must awake to the opportunity and need for deploymentof protected areas, because few units were created and most of them were not demarcated, withoutland regularization and adoption of infrastructure and appropriate labour. Still, other places have potentialand/or need for protection, increasing the quantity and quality of protected areas. The process involvingthe creation provided to the effectiveness of these units is governed by the National and State System ofProtected Areas. Therefore, requiring technical-legal knowledge and political-administrative proceduresand becoming necessary assistance to social actors concerned and involved, and an adequate conceptual basement on the subject, the awakening to the participation of actors is a way to stimulate and encouragethe consolidation of the process. This project was served by the organization of a database, holding localmeetings and workshops and preparing lists of problems and opportunities found in each case of action.The techniques and strategies used in each case varied according to the characteristics in the same stagewhere they were. The project worked in eight cases, in five (5) municipalities and had thirty-five (35) institutionsinvolved among public bodies, non-governmental organizations and institutions of education, as wellas eighteen (18) students participating, in addition to representatives of communities, who participated atdifferent times.La región de la costa centro-norte catarinense necesita despertar para las oportunidades y la necesidad dela implantación de unidades de conservación, pues pocas unidades han sido creadas y la mayoría condelimitación inexistente, regularización agraria y adopción de infraestructura y de mano de obra adecuadas.Todavía, otros locales presentan potencial y/o necesidad de protección, aumentando la cantidad y lacalidad de áreas de protección. El proceso que envuelve desde la creación hasta la consolidación de estasunidades es conducido por los Sistemas Nacional y Estadual de Conservación. Por lo tanto, exigiendoconocimiento técnico-legal y procedimientos político-administrativos, siendo necesario auxilio a los agentessociales interesados y envueltos, entendiendo que un embasamiento conceptual adecuado sobre el tema, asícomo el despertar para la participación de los agentes sociales es una forma para estimular y para incentivarla consolidación del proceso. Este proyecto actuó por medio de la organización de la base de datos, de larealización de reuniones y talleres locales y de la elaboración del listado de problemas y de oportunidadesobservados en cada proceso de actuación. Las técnicas y las estrategias usadas en cada proceso varían deacuerdo con las características de cada cual y de la fase donde se encontraban. Ocho procesos de unidadesde la conservación han sido trabajados, en cinco (5) ciudades y tuvieron treinta y cinco (35) institucionesenvueltas entre los órganos públicos, organizaciones no gubernamentales y la institución de educación, asícomo dieciocho (18) estudiantes participantes, además de representantes de la comunidad que participaronen diversos momentos

Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

Vitamin d plasma levels and in-hospital and 1-year outcomes in acute coronary syndromes : a prospective study

Deficiency in 25-hydroxyvitamin D (25[OH]D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH)D deficiency in ACS patients remains poorly defined. The purpose of this prospective study was to assess the association between 25 (OH)D levels, at hospital admission, with in-hospital and 1-year morbidity and mortality in an unselected cohort of ACS patients.We measured 25 (OH)D in 814 ACS patients at hospital presentation. Vitamin D serum levels >30\u200ang/mL were considered as normal; levels between 29 and 21\u200ang/mL were classified as insufficiency, and levels\u200a<\u200a20\u200ang/mL as deficiency. In-hospital and 1-year outcomes were evaluated according to 25 (OH)D level quartiles, using the lowest quartile as a reference.Ninety-three (11%) patients had normal 25 (OH)D levels, whereas 155 (19%) and 566 (70%) had vitamin D insufficiency and deficiency, respectively. The median 25 (OH)D level was similar in ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients (14.1 [IQR 9.0-21.9] ng/mL and 14.05 [IQR 9.1-22.05] ng/mL, respectively; P\u200a=\u200a.88). The lowest quartile of 25 (OH)D was associated with a higher risk for several in-hospital complications, including mortality. At a median follow-up of 366 (IQR 364-379) days, the lowest quartile of 25 (OH)D, after adjustment for the main confounding factors, remained significantly associated to 1-year mortality (P\u200a<\u200a.01). Similar results were obtained when STEMI and NSTEMI patients were considered separately.In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital and 1-year outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated

Contrast medium-induced nephropathy. Aspects on incidence, consequences, risk factors and prevention

Contrast media-induced nephropathy (CIN) is a well-known complication of radiological examinations employing iodine contrast media (I-CM). The rapid development and frequent use of coronary interventions and multi-channel detector computed tomography with concomitant administration of relatively large doses of I-CM has contributed to an increasing number of CIN cases during the last few years. Reduced renal function, especially when caused by diabetic nephropathy or renal arteriosclerosis, in combination with dehydration, congestive heart failure, hypotension, and administration of nephrotoxic drugs are risk factors for the development of CIN. When CM-based examinations cannot be replaced by other techniques in patients at risk of CIN, focus should be directed towards analysis of number and type of risk factors, adequate estimation of GFR, institution of proper preventive measures including hydration and post-procedural observation combined with surveillance of serum creatinine for 1-3 days. For the radiologist, there are several steps to consider in order to minimise the risk for CIN: use of “low-“ or “iso-osmolar” I-CM and dosing the I-CM in relation to GFR and body weight being the most important as well as utilizing radiographic techniques to keep the I-CM dose in gram iodine as low as possible below the numerical value of estimated GFR. There is as yet no pharmacological prevention that has been proven to be effective