The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients

Background The incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK. Methods DSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2 %] Indian Asian, 2219 [41.6 %] European white and 434 [8.1 %] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality. Results There were 849 (15.9 %) NFCE and 1365 (25.6 %) deaths over a median follow-up period of 4.6 years. In total 1174 (22 %) patients had inducible myocardial ischaemia during DSE, 859 (16.1 %) had fixed wall motion abnormalities and 3645 (68.4 %) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups. Conclusions DSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

The Effect of Various Finishing and Polishing Systems on the Surface Roughness of Four Composite Resin Materials –An in Vitro Study

ABSTRACTAim: To compare the effect of three finishing and polishing systems having different abrasives and clinical steps on surface roughness of four types of composite resins i.e. microfilled composite, hybrid composite, packable composite and nanofilled composite resins.Materials and methods:    The composite resins examined in this study include Microfilled composite Heliomolar® (Ivoclar Vivadent, Schaan,  Liechtenstein), Hybrid composite Filtek™Z250 (3M ESPE, St Paul, MN, USA), Packable composite Filtek™P60  (3M ESPE, St Paul, MN, USA), Nanofilled composite  Filtek™Z350 XT (3M ESPE, St Paul, MN, USA). Specimens (N=80 , Twenty for each composite material) measuring 10 mm in diameter x 5 mm in thickness were fabricated in split metal mould covered with a Mylar strip using four composite resins. A control group of five specimens of each material received no polishing after being cured under the Mylar strip. Fifteen specimens for each composite were randomly divided among three finishing and polishing systems (n=5) Sof- Lex™(3M ESPE, St Paul, MN, USA) OptraPol ( Ivoclar Vivadent , Schaan,  Liechtenstein) Enhance®PoGo™ Complete kit ( Dentsply Caulk, Milford, DE, USA).The average surface roughness (Ra, μm) was measured with Profilometer Surfcom–130A Surface Roughness Tester (Carl Zeiss). Results were statistically analyzed by One-way analysis of variance (ANOVA) and the post-hoc Tukey’s Multiple comparison test at a p<0.05 significance level.Results: Significant differences were found for the surface roughness. The ranking order of surface roughness on the basis of the type of composite was as follows:  Packable composite > Hybrid composite > Microfilled composite > Nanofilled composite; and the ranking for the finishing and polishing systems: Enhance/PoGo < Mylar strip< Sof-Lex < OptraPol. There were no statistically significant differences created between Enhance/PoGo, Mylar strip, Sof-lex, however smoother surfaces were obtained with Enhance/PoGo system Conclusion: Nanofilled Composites showed excellent polishability. Enhance/PoGo polisher produced smoothest surfaces Considering the reduced steps, application time and achievement of Mylar strip like surfaces two-step Enhance/PoGo polisher might be the preferred system for polishing composites

Comparison of the regenerative potential of an allograft used alone and that in conjunction with an immunosuppressive drug in the treatment of human periodontal infrabony defects: A clinical and radiological study

Background: Experimentation confirmed the conclusion that bone allografts, like other tissue and organ allografts, are immunogenic. These immune responses cause resorption of allograft, thus lowering the bone formation capacity of the graft. An attempt has been made in this study to prevent immune reactions and achieve enhanced regeneration of allograft-demineralized freeze-dried bone matrix by incorporating it with an immunosuppressive drug Cyclosporine-A (CsA) in the treatment of human periodontal infrabony defects. Materials and Methods: Fifteen patients showing clinical evidence of almost bilateral infrabony defects requiring bone grafting procedures were selected. In each patient, the infrabony defect of one side of the arch was designated as Group A (control site) and the infrabony defect of the contralateral side of the same arch was designated as Group B (test site). Results: On comparative evaluation of the two groups (by Student t-test), the mean values of reduction in probing depth (P=0.81 NS ) and gain in clinical attachment level (P=1.00 NS ) of Group B were found to be greater than that of Group-A, but the differences were statistically non-significant. The mean linear bone fill (P=0.010 FNx08 ) of Group B was also detected to be higher than that of Group A, and the difference was found to be statistically significant. Conclusion: Increase in linear bone fill in Group B signifies the role of CsA in augmenting the regenerative potential of allograft by eliminating immune reactions

Comparative Evaluation of Apical Debris Extrusion from the Root Canal using Hand Files, Continuous Rotary Files and Reciprocating File System: An In-vitro Study

Introduction: Root canal preparation is an important step of endodontic therapy. For successful endodontic therapy apical extrusion of debris through the apical foramen into the periradicular region should be minimal to avoid postoperative complication such as flare-ups. Aim: To evaluate in-vitro, extrusion of apical debris from the root canal using continuous rotary files (using multiple files system and single rotary file system), reciprocating file system and hand files. Materials and Methods: This in-vitro research was carried out in the Department of Conservative Dentistry and Endodontics, MM college of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2017 to January 2018. A total of 120 human mandibular premolar teeth that were caries free and single-rooted were split into four groups (each group with n=30) Group I: Hand ProTaper, Group II: Protaper Universal, Group III: F360 and Group IV: WaveOne Gold file system. The root canal was instrumented according to manufacturer’s Instructions; and standardised irrigation with distilled water was performed. The Myers and Montgomery’s Model was employed to gather irrigant and debris that had been apically ejected. The analysis of data obtained was done using Post-hoc Bonferroni test, Oneway Analysis of Variance (ANOVA) and paired t-test. Results: The findings indicate that all instrumentation techniques produced significant amount of extruded debris and irrigant. The mean apical debris extrusion using the One-way ANOVA test showed significant difference (p-value<0.001). WaveOne Gold file group showed least (0.0005±0.0001 mg) and Hand ProTaper file showed maximum (0.0017±0.0002) apical debris and irrigant extrusion. Conclusion: Less apical extrusion of irrigant and debris was observed in the engine-driven nickel-titanium systems than manual technique. Reciprocating file system when compared with hand and continuous rotary file system showed less debris extrusion

Effect of ultrasonic agitation on the penetration depth of different root canal sealers: An in vitro study

Aim: The present in vitro study was taken to compare penetration depth of five different root canal sealers to radicular dentin by confocal laser scanning microscope. Materials and Methods: 100 extracted intact single- rooted human teeth were collected. Teeth were decoronated, shaping and cleaning was done with rotary file system till #25 number file with 0.06% taper. Half of the samples (n=50) were irrigated without ultrasonic agitation while other half (n=50) samples were irrigated with ultrasonically agitation. Teeth were obturated and divided into five groups on the basis of five different sealer used (Group A: Zinc oxide eugenol sealer (control group), Group B: Apexit Plus, Group C: AH Plus, Group D: MTA Fillapex, Group E: Bio-C sealer). Samples were sectioned horizontally at 2mm, 4mm and 6mm from the apical region and penetration depth was observed under confocal laser scanning microscope. Data obtained was statistically analysed using Independent t test and Tukey Test. Results: Among the groups, Bio- C sealer (Group E) revealed greatest penetration depth at 2mm and 4mm while zinc oxide eugenol (Group A) had the least penetration depth. Among the subgroups, samples irrigated with ultrasonic agitation showed rise in penetration depth of the sealers.&nbsp