Evaluation of peri-implant soft and hard tissues behavior in screw-retained crowns by the biologically oriented preparation technique (BOPT) : ambispective longitudinal analytical study

Clinical and radiographic evaluation of soft and hard tissues around convergent collar implants and shoulderless abutments. Material and Methods: Ambispective longitudinal analytical study with a sample size of 32 implants in 21 patients t

Soft tissue thickness evaluation in screw-retained crowns by the biologically oriented preparation technique (BOPT)

Intraoral scanner evaluation (3Shape, TRIOS®) of soft tissue thickness around convergent collar implants and shoulderless abutments. Ambispective longitudinal analytical study with a sample size of 26 implants in 17 patients treated in a private denta

Nanocellular Polymers with a Gradient Cellular Structure Based on Poly(methyl methacrylate)/Thermoplastic Polyurethane Blends Produced by Gas Dissolution Foaming

Graded structures and nanocellular polymers are two examples of advanced cellular morphologies. In this work, a methodology to obtain low-density graded nanocellular polymers based on poly(methyl methacrylate) (PMMA)/ thermoplastic polyurethane (TPU) blends produced by gas dissolution foaming is reported. A systematic study of the effect of the processing condition is presented. Results show that the melt-blending results in a solid nanostructured material formed by nanometric TPU domains. The PMMA/ TPU foamed samples show a gradient cellular structure, with a homogeneous nanocellular core. In the core, the TPU domains act as nucleating sites, enhancing nucleation compared to pure PMMA and allowing the change from a microcellular to a nanocellular structure. Nonetheless, the outer region shows a gradient of cell sizes from nano- to micron-sized cells. This gradient structure is attributed to a non-constant pressure profile in the samples due to gas desorption before foaming. The nucleation in the PMMA/ TPU increases as the saturation pressure increases. Regarding the effect of the foaming conditions, it is proved that it is necessary to have a fine control to avoid degeneration of the cellular materials. Graded nanocellular polymers with relative densities of 0.16–0.30 and cell sizes ranging 310–480 nm (in the nanocellular core) are obtained

Understanding the role of MAM molecular weight in the production of PMMA/MAM nanocellular polymers

Nanostructured polymer blends with CO2-philic domains can be used to produce nanocellular materials with controlled nucleation. It is well known that this nanostructuration can be induced by the addition of a block copolymer poly(methyl methacrylate)-poly(butyl acrylate)-poly(methyl methacrylate) (MAM) to a poly(methyl methacrylate) (PMMA) matrix. However, the effect of the block copolymer molecular weight on the production of nanocellular materials is still unknown. In this work, this effect is analysed by using three types of MAM triblock copolymers with different molecular weights, and a fixed blend ratio of 90 wt% PMMA and 10 wt% of MAM. Blends were produced by extrusion. As a result of the extrusion process, a non-equilibrium nanostructuration takes place in the blends, and the micelle density increases as MAM molecular weight increases. Micelle formation is proposed to occur as result of two mechanisms: dispersion, controlled by the extrusion parameters and the relative viscosities of the polymers, and self-assembly of MAM molecules in the dispersed domains. On the other hand, in the nanocellular materials produced with these blends, cell size decreases from 200 to 120 nm as MAM molecular weight increases. Cell growth is suggested to be controlled by the intermicelle distance and limited by the cell wall thickness. Furthermore, a theoretical explanation of the mechanisms underlying the limited expansion of PMMA/MAM systems is proposed and discussed

PMMA-sepiolite nanocomposites as new promising materials for the production of nanocellular polymers

In this work, a new system based on poly(methyl methacrylate) (PMMA) sepiolite nanocomposites that allow producing nanocellular polymers by using the gas dissolution foaming technique is described. Nanocomposites with different nanoparticle types and contents have been produced by extrusion. From these blends, cellular materials have been fabricated using the so-called gas dissolution foaming method. An extensive study of the effect of the processing parameters (saturation pressure and foaming temperature) on the cellular materials produced has been performed. Results showed that among the three sepiolites used, only those modified with a quaternary ammonium salt are suitable for being used as nucleating agents in PMMA. With these nanoparticles bimodal cellular polymers, with micro and nanometric cells, have been produced. Cell sizes in the range of 300–500 nm and cell densities of the order of 1013–1014 nuclei/cm3 have been obtained in the nanocellular region. A foaming temperature of 80 °C and a wide range of saturation pressures (between 10 and 30 MPa) and low particle contents (between 0.5 and 1.5 wt%) allow obtaining these materials. Furthermore, it has been found that cell size in the nanometric population can be controlled by means of the particles content; a reduction in the cell size is obtained when the particles content increases. Finally, results indicate that an increase in the foaming temperature leads to cellular nanocomposites with lower relative densities (below 0.21) and larger cell sizes (above 450 nm).Financial support from FPU grant FPU14/02050 (V. Bernardo) from the Spanish Ministry of Education and Junta of Castile and Leon grant Q4718001C (J. Martín-de León) is gratefully acknowledged. Financial assistance from MINECO, FEDER, UE (MAT2015- 69234-R) and the Junta de Castile and Leon (VA011U16) are gratefully acknowledged. We would also like to thank the company Tolsa (Madrid, Spain) for supplying the sepiolites of this stud

Toxoplasma gondii Seropositivity Interacts with Catechol-O-methyltransferase Val105/158Met Variation Increasing the Risk of Schizophrenia

Schizophrenia is a heterogeneous and severe psychotic disorder. Epidemiological findings have suggested that the exposure to infectious agents such as Toxoplasma gondii (T. gondii) is associated with an increased risk for schizophrenia. On the other hand, there is evidence involving the catechol- O-methyltransferase (COMT) Val105/158Met polymorphism in the aetiology of schizophrenia since it alters the dopamine metabolism. A case–control study of 141 patients and 142 controls was conducted to analyse the polymorphism, the prevalence of anti-T. gondii IgG, and their interaction on the risk for schizophrenia. IgG were detected by ELISA, and genotyping was performed with TaqMan Real- Time PCR. Although no association was found between any COMT genotype and schizophrenia, we found a significant association between T. gondii seropositivity and the disorder ( 2 = 11.71; p-value < 0.001). Furthermore, the risk for schizophrenia conferred by T. gondii was modified by the COMT genotype, with those who had been exposed to the infection showing a different risk compared to that of nonexposed ones depending on the COMT genotype ( 2 for the interaction = 7.28, p-value = 0.007). This study provides evidence that the COMT genotype modifies the risk for schizophrenia conferred by T. gondii infection, with it being higher in those individuals with the Met/Met phenotype, intermediate in heterozygous, and lower in those with the Val/Val phenotype.Junta de Andalucia P06-CTS-01686Spanish Ministry of Health via the Instituto de Salud Carlos III FIS PS09/01671 PI13/01967 PI18/00467Programa Operativo FEDER B-CTS-361-UGR1

Interleukin-6 Could Be a Potential Prognostic Factor in Ambulatory Elderly Patients with Stable Heart Failure: Results from a Pilot Study

Introduction: Inflammation is a fundamental phenomenon in heart failure, but the prognostic or therapeutic role of markers such as interleukin-6 (IL-6) has not yet been clarified. The objective of this study is to describe the clinical profile of patients with elevated IL-6 and determine if they have worse clinical outcomes. Methods: A retrospective c.ohort observational study including 78 patients with heart failure followed up at the Heart Failure Outpatient Clinic of the Internal Medicine Department. IL-6 was determined in all patients, who were then assigned into two groups according to IL-6 level (normal or high). Clinical and prognostic data were collected to determine the differences in both groups. Results: The average age was 79 years, 60% female. A total of 53.8% of the patients had elevated IL-6 (group 2). Patients with elevated IL-6 presented more frequently with anemia mellitus (64.3% vs. 41.7%; p = 0.046), atrial fibrillation (83.3% vs. 61.9% p = 0.036), dyslipidemia (76.2% vs. 58.2%; p = 0.03), higher creatinine levels (1.35 mg/dL vs. 1.08 mg/dL; p = 0.024), lower glomerular filtration rate (43.6 mL/min/m2 vs. 59.9 mL/min/m2; p = 0.007), and anemia 25% vs. 52.4% p = 0.014. The factors independently associated with the increase in IL-6 were anemia 3.513 (1.163–10.607) and renal failure 0.963 (0.936–0.991), p < 0.05. Mortality was higher in the group with elevated IL-6 levels (16% vs. 2%; p = 0.044) with a log-rank p = 0.027 in the Kaplan–Meier curve. Conclusion: Patients with heart failure and elevated IL-6 most often have atrial fibrillation, diabetes mellitus, dyslipidemia, anemia, and renal failure. In addition, mortality was higher and a tendency of higher hospital admission was observed in stable HF patients with elevated IL-6

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality