Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Avalia??o da for?a de uni?o de diferentes t?cnicas de soldagem para uso em ortodontia

Submitted by Caroline Xavier ([email protected]) on 2017-06-30T18:49:20Z No. of bitstreams: 1 DIS_FERNANDA_DE_SOUZA_HENKIN_PARCIAL.pdf: 153660 bytes, checksum: cc61f5fcacec40f72a7ba7bfb17c4045 (MD5)Approved for entry into archive by Caroline Xavier ([email protected]) on 2017-06-30T18:49:25Z (GMT) No. of bitstreams: 1 DIS_FERNANDA_DE_SOUZA_HENKIN_PARCIAL.pdf: 153660 bytes, checksum: cc61f5fcacec40f72a7ba7bfb17c4045 (MD5)Made available in DSpace on 2017-06-30T18:49:32Z (GMT). No. of bitstreams: 1 DIS_FERNANDA_DE_SOUZA_HENKIN_PARCIAL.pdf: 153660 bytes, checksum: cc61f5fcacec40f72a7ba7bfb17c4045 (MD5) Previous issue date: 2017-01-19Introduction: During orthodontic treatment, the use of appliances and devices that require welding procedures is often needed. Besides conventional silver soldering, different joining methods ? with potentially higher biocompatibility ? can be used. The mechanical strength of the welded areas is critical for their success, and must be evaluated. Objective: To review the joining methods for orthodontic purpose and evaluate the strength ? by tensile strength measurements ? of Silver Soldering, Spot, laser and TIG welding. Materials and Methods: 40 stainless steel wire segments with 0.8 mm diameter (Morelli, Sorocaba/SP, Brasil) were joined by means of silver soldering, spot, laser and TIG welding. For each joining method, 10 specimens were produced. Tensile strength test was performed 24 hours after welding by means of a universal testing machine (Instron Corporation, Canton, USA) using a cell load of 1000 N with a crosshead speed of 10 mm/minute. Results: The highest tensile strenght mean values was obtained by silver soldering (532.1N), followed by laser (419.8N), spot (301.1N) and TIG (216,3N) welding. Statistically significant diferences were observed between the groups, and the Dunn post-hoc test revealed difference between laser and spot welding (p=0046), laser and tig (p=0.016), spot and silver (p=2.5e-05) and silver and TIG (p=4.6e-06). Conclusions: The strenght of the laser joints are comparable to the Silver soldering joints, and represent a favorable alternative for orthodontic use. The spot and TIG welding methods presented comparable and significantly lower strenghts in relation do laser and silver soldering methods.Introdu??o: Durante o tratamento ortod?ntico, frequentemente s?o utilizados dispositivos e aparelhos auxiliares que requerem soldagem para a sua confec??o. Al?m do processo de soldagem convencional ? prata, diferentes m?todos ? potencialmente mais biocompat?veis - podem ser utilizados. A resist?ncia mec?nica destas soldas ? fundamental para seu sucesso e deve ser avaliada. Objetivo: Revisar os m?todos de soldagem dispon?veis para uso em Ortodontia e avaliar a for?a de uni?o das soldas ? tra??o em soldas ponto, prata, laser e TIG. Materiais e M?todos: 40 segmentos de fio de a?o inoxid?vel de 0,8mm (Morelli, Sorocaba/SP, Brasil) foram soldados entre si atrav?s das t?cnicas de soldagem el?trica, ? prata, a laser e TIG, sendo realizadas 10 soldagens para cada t?cnica. Foi realizado ensaio de tra??o por meio de uma m?quina de ensaios universal (Emic DL- 2000), utilizando c?lula de carga de 1000 N e velocidade de 10 mm/min. Resultados: O grupo de soldagem ? prata apresentou a maior m?dia de resist?ncia ? tra??o (532,1N), seguido pelos grupos laser (419,8N), ponto (301,1N) e TIG (216,3N) respectivamente. Houve diferen?a significativa entre os grupos, e partir do teste post-hoc de Dunn identificou-se que esta diferen?a ocorreu entre os grupos laser e ponto (p=0,046), laser e TIG (p=0,016), ponto e prata (p=2,5e-05) e prata e tig (p=4,6e-06). Conclus?es: A for?a de uni?o de soldagens a laser pode ser compar?vel com ? de soldagens ? prata e apresenta-se como boa alternativa para uso em Ortodontia. As t?cnicas de soldagem a ponto e a TIG apresentaram for?a de uni?o compar?veis e significativamente inferiores aos das soldagens a laser e ? prata

Análise in vitro da resistência adesiva e do índice de adesivo remanescente em diferentes tipos de braquetes metálicos

Introduction: There is a great variety of orthodontic brackets in the Brazilian market, and constantly evaluating them is critical for professionals to know their properties, so as to be able to choose which product best suits their clinical practice. Objectives: To evaluate the bond strength and the adhesive remnant index (ARI) of different brands of metal brackets. Material and Methods: A total of 105 bovine incisors were used, and brackets of different brands were bonded to teeth. Seven different bracket brands were tested (MorelliTM, American OrthodonticsTM, TP OrthodonticsTM, Abzil-3MTM, OrthometricTM, TecnidentTM and UNIDENTM). Twenty-four hours after bonding, shear bond strength test was performed; and after debonding, the ARI was determined by using an optical microscope at a 10-fold increase. Results: Mean shear bond strength values ranged from 3.845 ± 3.997 (MorelliTM) to 9.871 ± 5.106 MPa (TecnidentTM). The majority of the ARI index scores was 0 and 1. Conclusion: Among the evaluated brackets, the one with the lowest mean shear bond strength values was MorelliTM. General evaluation of groups indicated that a greater number of bond failure occurred at the enamel/adhesive interface.Introdução: atualmente, há uma grande diversidade de braquetes ortodônticos no mercado brasileiro, e a avaliação desses é fundamental para que os profissionais conheçam suas propriedades e possam qualificar a sua escolha. Objetivo: avaliar o desempenho de diferentes braquetes metálicos — com diferentes características de base —, por meio da resistência de união e do Índice de Adesivo Remanescente (IAR). Material e Métodos: braquetes de sete marcas distintas foram testados (Morelli®, American Orthodontics®, TP Orthodontics®, Abzil-3M®, Orthometric®, Tecnident® e UNIDEN®). Os braquetes foram colados em incisivos bovinos totalizando 105 corpos de prova. O teste de resistência ao cisalhamento foi realizado 24h após a colagem e, em seguida, foi avaliado o IAR, por meio do uso de um microscópio óptico, em aumento de 10 vezes. Resultados: a média dos valores de resistência de união variou entre 3,845 ± 3,997MPa (Morelli®) e 9,871 ± 5,106MPa (Tecnident®). A maioria dos escores do IAR foi de 0 e 1. Conclusão: entre os braquetes avaliados, o que obteve a menor média de resistência de união foi o Morelli®. A avaliação geral dos grupos indicou maior número de falhas de colagem na interface esmalte/adesivo

Análise in vitro da resistência adesiva e do índice de adesivo remanescente em diferentes tipos de braquetes metálicos

Introduction: There is a great variety of orthodontic brackets in the Brazilian market, and constantly evaluating them is critical for professionals to know their properties, so as to be able to choose which product best suits their clinical practice. Objectives: To evaluate the bond strength and the adhesive remnant index (ARI) of different brands of metal brackets. Material and Methods: A total of 105 bovine incisors were used, and brackets of different brands were bonded to teeth. Seven different bracket brands were tested (MorelliTM, American OrthodonticsTM, TP OrthodonticsTM, Abzil-3MTM, OrthometricTM, TecnidentTM and UNIDENTM). Twenty-four hours after bonding, shear bond strength test was performed; and after debonding, the ARI was determined by using an optical microscope at a 10-fold increase. Results: Mean shear bond strength values ranged from 3.845 ± 3.997 (MorelliTM) to 9.871 ± 5.106 MPa (TecnidentTM). The majority of the ARI index scores was 0 and 1. Conclusion: Among the evaluated brackets, the one with the lowest mean shear bond strength values was MorelliTM. General evaluation of groups indicated that a greater number of bond failure occurred at the enamel/adhesive interface.Introdução: atualmente, há uma grande diversidade de braquetes ortodônticos no mercado brasileiro, e a avaliação desses é fundamental para que os profissionais conheçam suas propriedades e possam qualificar a sua escolha. Objetivo: avaliar o desempenho de diferentes braquetes metálicos — com diferentes características de base —, por meio da resistência de união e do Índice de Adesivo Remanescente (IAR). Material e Métodos: braquetes de sete marcas distintas foram testados (Morelli®, American Orthodontics®, TP Orthodontics®, Abzil-3M®, Orthometric®, Tecnident® e UNIDEN®). Os braquetes foram colados em incisivos bovinos totalizando 105 corpos de prova. O teste de resistência ao cisalhamento foi realizado 24h após a colagem e, em seguida, foi avaliado o IAR, por meio do uso de um microscópio óptico, em aumento de 10 vezes. Resultados: a média dos valores de resistência de união variou entre 3,845 ± 3,997MPa (Morelli®) e 9,871 ± 5,106MPa (Tecnident®). A maioria dos escores do IAR foi de 0 e 1. Conclusão: entre os braquetes avaliados, o que obteve a menor média de resistência de união foi o Morelli®. A avaliação geral dos grupos indicou maior número de falhas de colagem na interface esmalte/adesivo

In vitro analysis of shear bond strength and adhesive remnant index of different metal brackets

ABSTRACT Introduction: There is a great variety of orthodontic brackets in the Brazilian market, and constantly evaluating them is critical for professionals to know their properties, so as to be able to choose which product best suits their clinical practice. Objectives: To evaluate the bond strength and the adhesive remnant index (ARI) of different brands of metal brackets. Material and Methods: A total of 105 bovine incisors were used, and brackets of different brands were bonded to teeth. Seven different bracket brands were tested (MorelliTM, American OrthodonticsTM, TP OrthodonticsTM, Abzil-3MTM, OrthometricTM, TecnidentTM and UNIDENTM). Twenty-four hours after bonding, shear bond strength test was performed; and after debonding, the ARI was determined by using an optical microscope at a 10-fold increase. Results: Mean shear bond strength values ranged from 3.845 ± 3.997 (MorelliTM) to 9.871 ± 5.106 MPa (TecnidentTM). The majority of the ARI index scores was 0 and 1. Conclusion: Among the evaluated brackets, the one with the lowest mean shear bond strength values was MorelliTM. General evaluation of groups indicated that a greater number of bond failure occurred at the enamel/adhesive interface