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13 06, 2024

Immediate multivessel revascularization after myocardial infarction: change of strategy?

2024-06-13T10:48:57+00:00

Eur Heart J Suppl. 2024 Apr 17;26(Suppl 1):i39-i43. doi: 10.1093/eurheartjsupp/suae015. eCollection 2024 Apr.

ABSTRACT

Multivessel coronary artery disease (MVD) is a frequently encountered condition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit vessel. Several studies have demonstrated the benefit of complete coronary revascularization compared with the treatment of the culprit lesion only in patients with STEMI. Based on this evidence, the current European guidelines recommend that in haemodynamically stable patients with STEMI and MVD, routine complete revascularization should be achieved either during the same procedure in concomitance with the treatment of the culprit lesion (immediate multivessel PCI) or with a subsequent intervention within 45 days from the index PCI of the culprit lesion (deferred multivessel PCI). However, the guidelines do not express a preference for immediate vs. delayed multivessel PCI. Therefore, the optimal timing of the treatment of non-culprit lesions in patients with STEMI and haemodynamic stability is still debated and has been evaluated in recent studies that showed the non-inferiority of immediate vs. delayed multivessel PCI. The article discusses the results and clinical implications of these studies on the timing of complete revascularization of non-culprit lesions in haemodynamically stable patients with STEMI.

PMID:38867855 | PMC:PMC11167991 | DOI:10.1093/eurheartjsupp/suae015

Immediate multivessel revascularization after myocardial infarction: change of strategy?2024-06-13T10:48:57+00:00
19 05, 2024

Soft-tissue profile changes in adult patients treated with premolar extractions

2024-05-19T16:52:45+00:00

Am J Orthod Dentofacial Orthop. 2024 May 18:S0889-5406(24)00149-5. doi: 10.1016/j.ajodo.2024.04.011. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to identify the soft-tissue profile changes and the potential pretreatment cephalometric parameters that clinicians could use to predict the lip response after premolar extraction treatment in adult patients.

METHODS: Pretreatment and posttreatment lateral cephalograms of 75 white patients treated with premolar extractions were analyzed. The following initial cephalometric measurements were recorded: upper and lower lip to E-plane, vermilion thickness, lip length, maxillary and mandibular incisor inclination, and mentolabial and nasolabial angle. Pretreatment and posttreatment radiographs were superimposed using the Björk structural method to record lip retraction and incisor/lip retraction ratio. Pearson correlation and Kruskal-Wallis tests were used to compare lip retraction and incisor/lip retraction ratio with the cephalometric variables. The sample was divided according to different extraction patterns.

RESULTS: The mean upper and lower lip retraction values were 1.4 mm and 1.7 mm, respectively. Vermilion thickness showed a negative and statistically significant correlation (P <0.05) with lip retraction and incisor/lip retraction ratio. In addition, the mean incisor/lip retraction ratio was 61% and 98% for the upper and lower thin lip, respectively, whereas the mean incisor/lip retraction ratio was 17% and 44% for the upper and lower thick lip, respectively. The comparison among extraction patterns did not highlight any noticeable difference.

CONCLUSIONS: The choice of a specific extraction pattern did not impact lip response. The vermilion thickness was the key factor influencing lip retraction: an increase in this parameter was related to a decrease in lip retraction and vice versa.

PMID:38762811 | DOI:10.1016/j.ajodo.2024.04.011

Soft-tissue profile changes in adult patients treated with premolar extractions2024-05-19T16:52:45+00:00
9 05, 2024

Nonsurgical treatment of an adult patient with severe transversal skeletal discrepancy: Tooth bone-borne tandem expander and hybrid aligner approach

2024-05-09T04:46:58+00:00

J World Fed Orthod. 2024 May 7:S2212-4438(24)00021-3. doi: 10.1016/j.ejwf.2024.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: Although they have proven effective in the resolution of mild to moderate malocclusions, aligners demonstrate substantial limitations. More complex malocclusions therefore require a combination of auxiliaries, or a hybrid approach involving both aligners and fixed appliances, such as miniscrew-supported appliances or sectionals. This case report presents a 25-year-old female patient with a severe transversal discrepancy associated with an anterior open-bite tendency effectively treated with a tooth bone-borne palatal expander characterized by two expansion screws (tandem expander) and a hybrid treatment with aligners.

METHODS: After accurate matching between the pretreatment cone-beam computed tomography scan and digital models, four self-drilling miniscrews were inserted palatally using a computer- aided design and computer-aided manufacturing surgical template to guide their correct and safe placement, and a tooth bone-borne appliance was fitted. After this first phase, the hybrid clear aligner approach was used to obtain alignment, leveling, and arch coordination, with the use of a partial lingual fixed appliance.

RESULTS: Transverse maxillary deficiency was corrected, crowding has been resolved, Class I molar and canine relationship were obtained, and marginal ridges has been aligned.

CONCLUSIONS: Double jackscrew of the tandem expander enabled effective expansion of both the posterior segments as required to correct the skeletal discrepancy and the anterior region, thus relieving the dental crowding. Lingual sectional appliances have been shown to increase the effectiveness of clear aligners which, on the other hand, have been shown to be effective in closing the anterior bite by retroclination of the maxillary and mandibular incisors and, only minimally, by extrusion movements.

PMID:38719759 | DOI:10.1016/j.ejwf.2024.03.008

Nonsurgical treatment of an adult patient with severe transversal skeletal discrepancy: Tooth bone-borne tandem expander and hybrid aligner approach2024-05-09T04:46:58+00:00
28 03, 2024

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients

2024-03-28T10:46:56+00:00

Sleep Sci. 2024 Feb 20;17(1):e55-e63. doi: 10.1055/s-0043-1776752. eCollection 2024 Mar.

ABSTRACT

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

PMID:38545244 | PMC:PMC10965295 | DOI:10.1055/s-0043-1776752

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients2024-03-28T10:46:56+00:00
22 02, 2024

Monotherapy with P2Y12-inhibitors after dual antiplatelet therapy: Filling gaps in evidence

2024-02-22T06:49:29+00:00

Int J Cardiol. 2024 Feb 19:131893. doi: 10.1016/j.ijcard.2024.131893. Online ahead of print.

ABSTRACT

BACKGROUND: Whether P2Y12 inhibitor monotherapy (P2Y12-I) is superior to aspirin following DAPT discontinuation post-PCI remains to be established.

METHODS: We updated our prior network meta-analysis where P2Y12-I and aspirin had been compared with DAPT or directly with each other. The focus is specifically on the available direct evidence, now consisting of the three head-to-head comparisons of P2Y12-I and aspirin in event-free PCI patients after DAPT. We include a Trial Sequential Analysis of the direct evidence based on meta-analytical literature.

RESULTS: The main finding reveals a 39% significantly lower risk of myocardial infarction with P2Y12-I (RR 0.61, 95% CI 0.47-0.78, p = 0.0001, I2 = 0%) with no difference in bleeding. Trial Sequential Analysis demonstrates clinically meaningful evidence for a reduction in the incidence of myocardial infarction with P2Y12-I that is also supported by statistical significance.

CONCLUSIONS: Accruing data highlight that P2Y12-I following DAPT discontinuation after PCI is associated with lower risk for MI and a similar risk for bleeding as compared with ASA. In light of potential limitations to the widespread adoption of life-long P2Y12-I treatment, clinicians should consider identifying selected patients who are expected to derive the highest benefit.

PMID:38382856 | DOI:10.1016/j.ijcard.2024.131893

Monotherapy with P2Y12-inhibitors after dual antiplatelet therapy: Filling gaps in evidence2024-02-22T06:49:29+00:00
21 02, 2024

Non-compliance treatment in a young adult full-step class II division 2 malocclusion with preadjusted lingual appliance and upper first molars extractions

2024-02-21T16:53:23+00:00

Int Orthod. 2024 Feb 19;22(2):100848. doi: 10.1016/j.ortho.2024.100848. Online ahead of print.

ABSTRACT

This case report describes a complex full-step class II case in a young adult patient treated with lingual straight-wire appliance and upper first molar extraction. As the patient refused a surgical treatment, she was offered the best possible camouflage with the double aim of obtaining an ideal occlusal relationship and maintaining the profile; appropriate biomechanical strategies, including extraction choice and anchorage control during space closure, were needed to achieve the planned results. This case report demonstrates the possibility of successfully resolving severe sagittal discrepancies in an adult patient without surgical treatment by means of a completely invisible non-compliance technique, with the extraction of the most compromised teeth. This report also underlines the need for careful planning during both diagnostic and treatment phases, in order to obtain the best results.

PMID:38377831 | DOI:10.1016/j.ortho.2024.100848

Non-compliance treatment in a young adult full-step class II division 2 malocclusion with preadjusted lingual appliance and upper first molars extractions2024-02-21T16:53:23+00:00