Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

<p>Abstract</p> <p>Introduction</p> <p>Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern.</p> <p>Case presentation</p> <p>We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction.</p> <p>Conclusion</p> <p>Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.</p

High platelet reactivity in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Randomised controlled trial comparing prasugrel and clopidogrel

Background: Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. Objectives: To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome (ACS). Patients: Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer, i.e. “poor responders” were randomised to prasugrel (60 mg loading and 10 mg maintenance dose) or clopidogrel (600 mg reloading and 150 mg maintenance dose). The primary outcome measure was proportion of patients with platelet reactivity <40 AUC 4 hours after loading with study medication, and also at one hour (secondary outcome). 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors. Results: At 4 hours after study medication 100% of patients treated with prasugrel compared to 91% of those treated with clopidogrel had platelet reactivity <40 AUC (p = 0.49), while at 1 hour the proportions were 95% and 64% respectively (p = 0.02). Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 (p = 0.005) and 19 versus 34 (p = 0.01) respectively. Conclusions: Routine platelet function testing identifies patients with high residual platelet reactivity (“poor responders”) on clopidogrel. A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity. Future trials need to identify if this translates into clinical benefit

Interaction of enamel matrix proteins with human periodontal ligament cells

Dorothy Hodgkin Postgraduate Award for research studies (jointly funded by the Engineering and Physical Sciences Research Council, UK, and by Institut Straumann) and the Research Discretionary Funds of the Periodontology Unit, UCL Eastman Dental Institute. Financial support was also provided by the NIHR Comprehensive Biomedical Research Centre and by the WCU Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. R31-10069)

Cariostatic effect of fluoride-containing restorative materials associated with fluoride gels on root dentin

Secondary caries is still the main cause of restoration replacement, especially on the root surface OBJECTIVE: This in vitro study evaluated the cariostatic effects of fluoride-containing restorative materials associated with fluoride gels, on root dentin. MATERIALS AND METHODS: A randomized complete block design was used to test the effects of the restorative systems, fluoride regimes and the interactions among them at different distances from restoration margins. Standardized cavities were prepared on 240 bovine root specimens and randomly assigned to 15 groups of treatments (n=16). Cavities were filled with the following restorative materials: Ketac-Fil (3M-ESPE); Vitremer (3M-ESPE); Dyract/Prime & Bond NT (Dentsply); Charisma/Gluma One Bond (Heraeus Kulzer) and the control, Z250/Single Bond (3M-ESPE). The specimens were subjected to a pH-cycling model designed to simulate high-caries activity. During the cycles, 1.23% acidulated phosphate fluoride, 2.0% neutral sodium fluoride or deionized/distilled water (control) was applied to the specimens for 4 min. The surface Knoop microhardness test was performed before (KHNi) and after (KHNf) the pH cycles at 100, 200 and 300 mm from the margins. Dentin microhardness loss was represented by the difference in initial and final values (KHNi - KHNf). Data were analyzed by Friedman's and Wilcoxon's tests, ANOVA and Tukey's test (&#945;=5%). RESULTS: The interaction of restorative systems and topical treatments was not significant (p=0.102). Dentin microhardness loss was lowest closer to the restoration. Ketac-fil presented the highest cariostatic effect. Vitremer presented a moderate effect, while Dyract and Charisma did not differ from the control, Z250. The effects of neutral and acidulated fluoride gels were similar to each other and higher than the control. CONCLUSION: Conventional and resin-modified glass ionomer cements as well as neutral and acidulated fluoride gels inhibit the progression of artificial caries adjacent to restorations. The associated effect of fluoride-containing restorative materials and gels could not be demonstrated