Bond strength of resin cements to leucite-reinforced ceramics: part 2 – after one-year aging in water

The aim of this study was to compare the shear bond strength (SBS) of two resin cements bonded to four leucite-reinforced ceramics after one week and one year of aging. Material and methods: Forty ceramic blocks (4 mm wide, 14 mm length, and 2 mm thick) were used (1 week) and reused at the back side (1 year). The blocks were abraded with aluminum oxide (90 µm) and randomly divided into eight groups for each time. Two dual resin cements (RelyX ARC and RelyX U200 self-adhesive, 3M ESPE) were bonded to ceramics Creapress (CRE – Creation / Klema), Finesse All-Ceramic (FIN – Dentsply / Ceramco), IPS Empress Esthetic (IEE – Ivoclar Vivadent) and Vita PM9 (PM9-Vita). For each resin, time, and ceramic block, after applications of the 10% hydrofluoric acid (for 1 min) and silane, 3 Tygon cut tubes were positioned over each block and filled in with the resin cements (light-cured for 40 s). The tubing molds were removed to expose the bond specimens as cylinders (area=0.38 mm2) stored in relative humidity at 24±2°C for one week and at 37±2°C for one year. All bonds were tested in an Instron in shear (applied of the base cylinder with a thin wire - 0.25 mm) at speed of 0.5 mm/min, until failure. Results: The results were analyzed by ANOVA (resin cements, ceramic systems, and time) and Tukey test (p<0.05) for rank ordering of SBS. The FIN and IEE ceramics did not show significant SBS decreasing on aging with U200. The mean SBS decreasing for all the ceramics was 36% with ARC and 14% with U200 cement. Conclusion: The SBS of ARC cement were significantly lower for all ceramics with aging than that of U200 cement. The SBS of ARC cement was also weakened by aging. FIN ceramic + U200 cement proved to be the most stable and strongest bond strength, and PM9+ARC cement proved to be the weakest bond strength with low stability.The aim of this study was to compare the shear bond strength (SBS) of two resin cements bonded to four leucite-reinforced ceramics after one week and one year of aging. Material and methods: Forty ceramic blocks (4 mm wide, 14 mm length, and 2 mm thick) were used (1 week) and reused at the back side (1 year). The blocks were abraded with aluminum oxide (90 µm) and randomly divided into eight groups for each time. Two dual resin cements (RelyX ARC and RelyX U200 self-adhesive, 3M ESPE) were bonded to ceramics Creapress (CRE – Creation / Klema), Finesse All-Ceramic (FIN – Dentsply / Ceramco), IPS Empress Esthetic (IEE – Ivoclar Vivadent) and Vita PM9 (PM9-Vita). For each resin, time, and ceramic block, after applications of the 10% hydrofluoric acid (for 1 min) and silane, 3 Tygon cut tubes were positioned over each block and filled in with the resin cements (light-cured for 40 s). The tubing molds were removed to expose the bond specimens as cylinders (area=0.38 mm2) stored in relative humidity at 24±2°C for one week and at 37±2°C for one year. All bonds were tested in an Instron in shear (applied of the base cylinder with a thin wire - 0.25 mm) at speed of 0.5 mm/min, until failure. Results: The results were analyzed by ANOVA (resin cements, ceramic systems, and time) and Tukey test (p<0.05) for rank ordering of SBS. The FIN and IEE ceramics did not show significant SBS decreasing on aging with U200. The mean SBS decreasing for all the ceramics was 36% with ARC and 14% with U200 cement. Conclusion: The SBS of ARC cement were significantly lower for all ceramics with aging than that of U200 cement. The SBS of ARC cement was also weakened by aging. FIN ceramic + U200 cement proved to be the most stable and strongest bond strength, and PM9+ARC cement proved to be the weakest bond strength with low stability

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Mapping the human genetic architecture of COVID-19

The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3–7. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease

Effects of fetal antiepileptic drug exposure Outcomes at age 4.5 years

OBJECTIVE: To examine outcomes at age 4.5 years and compare to earlier ages in children with fetal antiepileptic drug (AED) exposure. METHODS: The NEAD Study is an ongoing prospective observational multicenter study, which enrolled pregnant women with epilepsy on AED monotherapy (1999–2004) to determine if differential long-term neurodevelopmental effects exist across 4 commonly used AEDs (carbamazepine, lamotrigine, phenytoin, or valproate). The primary outcome is IQ at 6 years of age. Planned analyses were conducted using Bayley Scales of Infant Development (BSID at age 2) and Differential Ability Scale (IQ at ages 3 and 4.5). RESULTS: Multivariate intent-to-treat (n = 310) and completer (n = 209) analyses of age 4.5 IQ revealed significant effects for AED group. IQ for children exposed to valproate was lower than each other AED. Adjusted means (95% confidence intervals) were carbamazepine 106 (102–109), lamotrigine 106 (102–109), phenytoin 105 (102–109), valproate 96 (91–100). IQ was negatively associated with valproate dose, but not other AEDs. Maternal IQ correlated with child IQ for children exposed to the other AEDs, but not valproate. Age 4.5 IQ correlated with age 2 BSID and age 3 IQ. Frequency of marked intellectual impairment diminished with age except for valproate (10% with IQ <70 at 4.5 years). Verbal abilities were impaired for all 4 AED groups compared to nonverbal skills. CONCLUSIONS: Adverse cognitive effects of fetal valproate exposure persist to 4.5 years and are related to performances at earlier ages. Verbal abilities may be impaired by commonly used AEDs. Additional research is needed