Search Results (283)

Coronary artery disease (CAD) constitutes a major contributor to morbidity, mortality and healthcare burden worldwide. Recent innovations in imaging modalities, pharmaceuticals and interventional techniques have revolutionized diagnostic and treatment options, necessitating the reevaluation of established drug protocols or the consideration of newer alternatives. The utilization of beta blockers (BBs) in the setting of acute myocardial infarction (AMI), shifting from the pre-reperfusion to the thrombolytic and finally the primary percutaneous coronary intervention (pPCI) era, has become increasingly more selective and contentious. Nonetheless, the extent of myocardial necrosis remains a key predictor of outcomes in this patient population, with large trials establishing the beneficial use of beta blockers. Computed tomography coronary angiography (CTCA) has emerged as a highly effective diagnostic tool for delineating the coronary anatomy and atheromatous plaque characteristics, with the added capability of MESH-3D model generation. Induction and preservation of a low heart rate (HR), regardless of the underlying sequence, is of critical importance for high-quality results. Landiolol is an intravenous beta blocker with an ultra-short duration of action (t1/2 = 4 min) and remarkable β1-receptor specificity (β1/β2 = 255) and pharmacokinetics that support its potential for systematic integration into clinical practice. It has been increasingly recognized for its importance in both acute (primarily studied in STEMI and, to a lesser extent, NSTEMI pPCI) and chronic (mainly studied in elective PCI) CAD settings. Given the limited literature focusing specifically on landiolol, the aim of this narrative review is to examine its pharmacological properties and evaluate its current and future role in enhancing both diagnostic imaging quality and therapeutic outcomes in patients with CAD. Full article

The objective of this study was to evaluate the serum biomarkers implicated in the interaction of platelets and endothelium, as well as the efficacy of antiplatelet therapy in patients with aortic stenosis (AS) and coronary artery disease (CAD). A total of 78 adult patients with CAD on aspirin therapy participated in this study, including 49 consecutive patients with AS and 29 control subjects. The analysis included the following serum biomarkers: thrombomodulin (TM), platelet factor 4 (PF4), P-selectin, and CD40L. The efficacy of antiplatelet treatment was evaluated using the VerifyNow Aspirin test (ASPI test) and P2Y12 assay test (ADP test). Patients with AS exhibited increased serum levels of TM (7.64 ± 3.5 ng/mL vs. 6.28 ± 2.1 ng/mL, p = 0.011) and PF4 (25.16; Q1: 8.3; Q3: 29.6 μg/mL vs. 12.85; Q1: 5.7; Q3: 14.5 μg/mL, p = 0.021) compared to the control group. P-selectin and CD40L levels did not differ between groups. There were no significant differences in platelet aggregation in the ASPI (474.04 ± 66.7 ARU vs. 471.31 ± 56.2 ARU; p = 0.822) or ADP (224.88 ± 46.4 PRU vs. 216.62 ± 29.6 PRU; p = 0.394) tests. Bleeding incidence did not differ significantly between groups. The coexistence of AS in patients with CAD is associated with elevated levels of the aforementioned biomarkers, which are indicative of endothelial damage and platelet activation. However, the efficacy of antiplatelet treatment was independent of the presence of AS. Full article

Background/Objectives: The introduction of composite attachments has greatly improved orthodontic aligner therapy, through better force delivery, more predictable movements, and enhanced retention. This in vitro study aims to present and investigate an innovative digital protocol for aligner attachment fabrication incorporating the latest 3D technology used in dentistry. Methods: A virtual attachment measuring 2.5 × 2 × 2 mm was designed using computer-aided design (CAD) software (Meshmixer, Autodesk Inc., San Francisco, CA, USA) and exported as an individual STL file. The attachments were fabricated using a digital light processing (DLP) 3D printer (model: Elegoo 4 DLP, Shenzhen, China) and a dental-grade biocompatible resin. A custom 3D-printed placement guide was used to ensure precise positioning of the attachments on the printed maxillary dental models. A flowable resin was applied to secure the attachments in place. Following attachment placement, the models were scanned using a laboratory desktop scanner (Optical 3D Smart Big, Open Technologies, Milano, Italy) and three intraoral scanners: iTero Element (Align Technology, Tempe, AZ, USA), Aoral 2, and Aoral 3 (Shining 3D, Hangzhou, China). Results: Upon comparison, the scans revealed that the iTero Element exhibited the highest precision, particularly in the attachment, with an RMSE of 0.022 mm and 95.04% of measurements falling within a ±100 µm tolerance. The Aoral 2 scanner showed greater variability, with the highest RMSE (0.041 mm) in the incisor area and wider deviation margins. Despite this, all scanners produced results within clinically acceptable limits. Conclusions: In the future, custom attachments made by 3D printing could be a valid alternative to the traditional composite attachments when it comes to improving aligner attachment production. While these preliminary findings support the potential applicability of such workflows, further in vivo research is necessary to confirm clinical usability. Full article

(1) Background: Our aim was to evaluate the diagnostic performance of combined coronary computed tomography angiography (CCTA) and dynamic CT myocardial perfusion imaging (CT-MPI) for detecting hemodynamically significant coronary artery disease (CAD) in patients with intermediate pretest probability. (2) Methods: Patients with an intermediate pretest probability of CAD were retrospectively enrolled. All patients underwent CCTA and dynamic CT-MPI using a third-generation dual-source CT scanner prior to invasive coronary angiography (ICA). Anatomically significant stenosis was defined as ≥50% luminal narrowing on both CCTA and ICA. Fractional flow reserve (FFR) was performed during ICA in selected cases. Hemodynamically significant CAD was defined per vessel as FFR ≤ 0.80, angiographic stenosis ≥70%, or having undergone revascularization. The diagnostic performance of CCTA alone and CCTA combined with CT-MPI was compared against this reference standard. (3) Results: Seventy-four patients (mean age, 66.8 ± 11.1 years; 59 men) were included. The median coronary calcium score was 508.5 Agatston units (interquartile range: 147–1173). ICA and CCTA detected anatomically significant stenoses in 137 (61.7%) and 146 (65.8%) coronary vessels, respectively, and in 62 (83.8%) and 71 (95.9%) patients, respectively. Hemodynamically significant stenosis was present in 56 patients (76%) and 99 vessels (45%). On a per-vessel basis, CCTA alone yielded a sensitivity of 96.7%, specificity of 60.3%, positive predictive value (PPV) of 64.4%, and negative predictive value (NPV) of 96.1%. Combined CCTA and CT-MPI demonstrated a sensitivity of 90.1%, specificity of 84.3%, PPV of 82.7%, and NPV of 91.1%. The area under the receiver operating characteristic curve improved from 0.787 (95% confidence interval: 0.73–0.84) for CCTA to 0.872 (95% confidence interval: 0.82–0.91) for the combined approach (p < 0.05). The median total radiation dose for both CCTA and CT-MPI was 8.05 mSv (interquartile range: 6.71–11.0). (4) Conclusions: In patients with intermediate pretest probability of CAD, combining CCTA with dynamic CT-MPI significantly enhances the diagnostic performance for identifying hemodynamically significant coronary stenosis compared to CCTA alone. Full article

The objective of this study was to evaluate the effect of morpholine on saliva-contaminated resin-based composite (RBC)-CAD/CAM material repaired with resin composite. Fifty RBC-CAD/CAM materials were fabricated and assigned to five groups and surface-treated with saliva, phosphoric acid (PHR), morpholine (MRL), and a universal adhesive agent (Scotchbond universal plus, SCP) based on the following techniques: group 1, saliva; group 2, SCP; group 3, saliva + SCP; group 4, saliva + PHR + SCP; and group 5, saliva + MRL + SCP. An ultradent model was placed on the specimen center, and then the resin composite was pressed and light-cured for 20 s. A mechanical testing device was used to evaluate the samples’ shear bond strength (SBS) scores. The debonded specimen areas were inspected under a stereomicroscope to identify the failure mechanisms. The data were analyzed using one-way ANOVA, and the significance level (p < 0.05) was set with Tukey’s test. The highest SBS values were in groups 2, 4 and 5, with values of 21.43 ± 1.93, 20.93 ± 1.46, and 22.02 ± 1.77 MPa, respectively. However, they were not statistically different (p > 0.05). Group 1 had the lowest SBS value by a significant amount (1.88 ± 1.01 MPa). All specimens in group 1 showed adhesive failures. Moreover, groups 2–5 found cohesive and mixed failures. In conclusion, morpholine and phosphoric acid effectively enhance bond strength. These results indicate that alternative surface modifications with morpholine for saliva-contaminated RBC-CAD/CAM materials can significantly improve the outcome. Full article

The aim was to assess the blending effect of universal-shade resin-based composites (RBCs) (Omnichroma—OC; Clearfil Majesty Universal–CM; Venus Pearl—V; Transcend—T) used for repair for lithium disilicate blocks. Fifteen parallelepiped-shaped (10.5 × 10.5 × 3 mm) specimens with four cavities (3 mm in diameter and 2 mm in depth) were designed from lithium disilicate CAD/CAM blocks (CEREC Tessera HT A3) and milled. Specimens were then randomly divided into five groups based on the five resin composite materials for cavity restoration (n = 12): Group 1, control group (F); Group 2 (T); Group 3 (OC); Group 4 (V); and Group 5 (CM). After surface conditioning, composite resins were applied to the ceramic surface. Color measurements were taken with a colorimeter in the center of the resin restoration and on the CAD/CAM block. Tristimulus values were converted to CIELab color coordinates and color differences were expressed in ΔE₀₀ units using the CIEDE-2000 formula. F showed significantly better color matching (ΔE₀₀ = 2.51 ± 0.64) in comparison to single-shade RBCs except T (ΔE₀₀ = 2.55 ± 0.64). All groups exceeded perceptibility and acceptability thresholds. The control group presented higher color matching than the single shade universal composites except for Transcend. Full article

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time. Full article

Background/Objectives: Recently, a novel magnetic attachment system was introduced to improve performance. Using the same technology, a new ultra-thin magnetic attachment (UTMA) was possible to produce. This study aimed to evaluate the feasibility of a magnet-retained telescopic partial denture (MTPD) utilizing the new UTMA. Methods: This in vitro study was performed using a titanium master model representing prepared lower first-premolar and second-molar abutment teeth. The inner crowns (ICs) (h: 4 mm, 4° taper) and four-unit MTPDs were fabricated via computer-aided design/computer-aided manufacturing (CAD/CAM) using zirconia. A Ø4 mm UTMA system (magnet assembly and keeper thickness: 0.6 mm and 0.4 mm, respectively) was cemented into the MTPD and the ICs using dual-cure resin cement. A load of 100 N was applied along with 10,000 insertion–removal cycles. The MTPD retentive force was measured before and after every set of 1000 cycles. Stability tests and surface morphology evaluations were conducted before and after cycling. A paired t-test (α = 0.05) was used to observe statistical differences. Results: The average retentive force of the MTPD was 6.86 ± 0.63 N and did not change significantly (p > 0.05) following the load cycles (6.66 ± 0.79 N). The MTPD demonstrated adequate stability under the occlusal load. Minimal deformations were observed on the magnet assemblies, keepers, ICs, and MTPD surfaces after the load tests. Conclusions: Considering the limitations of this study, an MTPD utilizing novel UTMAs fabricated through a digital workflow demonstrated adequate retentive force, stability, and durability for clinical use. Full article

Aging of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) under wet conditions is known as low-temperature degradation (LTD), which is associated with phase change and decreasing mechanical strength. Herein, we studied the effects of different surface treatments on the LTD of three different commercial Y-TZP blocks utilizing CAD/CAM technology, namely, Cercon^®, e.max^® ZirCAD, and Vita In-ceram^® YZ. The blocks were immersed in 4% acetic acid at 80 °C for 0, 7, 14, and 28 days. The effects of surface treatments such as sandblasting and polishing were also examined. The results showed that the monoclinic phase increased with immersion time in all three brands. In Cercon^® blocks, a minimal amount of phase transformation was observed, with the smallest amount of degradation after immersion. Sandblasting and polishing both suppressed phase transformation. After immersion, the mechanical strength exhibited a small decrease with time. Accelerating the evaluation of the LTD of zirconia may effectively help with clinical applications. Full article

Background/Objectives: This in vitro study investigated the retention of three different geometrical designs of short titanium base (Ti-base) abutments used in implant-supported zirconia crowns. The advent of digital technology has facilitated the integration of Ti-base abutments into implant dentistry by improving time efficiency, precision, and patient comfort. Methods: Three types of short Ti-base abutments were evaluated: Geo SRN multibase^® (Group A), Herilink^® (Group B), and TS Link^® (Group C), each with a height of 4 mm and gingival height of 1 mm (n = 20 per group). Zirconia crowns (LUXEN^® Smile S2, DentalMax, Republic of Korea) were modified for the testing setup and fabricated using CAD/CAM technology, then bonded to the abutments with RelyX^® Luting 2 resin-modified glass ionomer cement. Pull-out tests were conducted at a crosshead speed of 1 mm/min to assess retention. Results: One-way ANOVA and post hoc Tukey tests revealed significant differences in retention values among the different abutment shapes (p < 0.05). The mean retention forces were 194.65 N for Group A, 241.33 N for Group C, and 360.20 N for Group B. Conclusions: The geometrical design of Ti-base short abutments significantly affects the retention of CAD/CAM zirconia crowns, with hexagonal shapes (Group B) demonstrating superior retention. Clinically, selecting an abutment design with enhanced mechanical retention may improve the long-term success of implant-supported restorations. Full article

Background: Chronic kidney disease (CKD) significantly affects health-related quality of life (HRQoL), impacting physical and mental well-being. This study aimed to identify the key determinants influencing HRQoL among patients with CKD. Methods: A cross-sectional observational study was conducted from July 2022 to March 2023 at the Rajiv Gandhi Cooperative Multi-Specialty Hospital, Palakkad, Kerala, South India, including 154 patients diagnosed with CKD stages 3 to 5. Eligible participants were required to be at least 18 years of age and have a confirmed diagnosis of CKD, specifically stages 3 to 5, with prior treatment. CKD stages were defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines, based on estimated glomerular filtration rate (eGFR) thresholds as follows: Stage 3 (eGFR 30–59 mL/min/1.73 m²), Stage 4 (eGFR 15–29 mL/min/1.73 m²), and Stage 5 (eGFR < 15 mL/min/1.73 m²). Participants were classified into stages based on their most recent stable eGFR value at the time of recruitment. HRQoL was assessed using the European Quality of Life-5 Dimensions-3 Levels (EQ-5D-3L) questionnaire. Chi-square, ANOVA, and multivariate regression were used to analyze associations with EQ-5D-3L domains. Results: Out of 154 participants, 68.8% were male, 91.6% were aged over 50 years, and 63.6% were from rural areas. Most had primary education (55.2%) and were unemployed, retired, or housewives (66.2%). As CKD progressed, comorbidities, particularly diabetes mellitus and coronary artery disease (CAD), increased, with Stage 5 showing the highest prevalence. Clinical markers showed significant declines in the glomerular filtration rate (GFR) (Stage 3: 49.16 ± 7.59, Stage 4: 22.37 ± 3.88, Stage 5: 8.79 ± 1.68) and hemoglobin (Stage 3: 10.45 ± 0.84, Stage 4: 8.88 ± 0.60, Stage 5: 7.12 ± 0.53) and an increase in serum creatinine (Stage 3: 1.72 ± 0.40, Stage 4: 3.21 ± 0.44, Stage 5: 7.05 ± 1.46). HRQoL assessments showed significant declines in mobility, self-care, usual activities, pain, and anxiety/depression with advancing CKD. Mobility issues increased from 61.2% in Stage 3 to 62.0% in Stage 5, with greater difficulties in self-care and usual activities at Stage 5. Pain and anxiety/depression worsened across stages. Multivariate analysis identified female gender, older age (≥50 years), lower education, unemployment, multiple comorbidities, smoking, lack of social support, and advanced CKD stages as significant factors linked to impaired HRQoL. CKD stage 5 (GFR < 29 mL/min/1.73 m²) and high serum creatinine (>1.2 mg/dL) were associated with significantly higher odds of impairment in all HRQoL domains. Conclusions: This study highlights that factors such as female gender, older age, lower education, unemployment, multiple comorbidities, smoking, advanced CKD stages, and high serum creatinine levels are associated with reduced quality of life in CKD patients. Conversely, social support acts as a protective factor. The findings emphasize the need for targeted interventions that address both medical care and psychosocial aspects, including lifestyle changes, patient education, mental health support, and community involvement, to improve CKD patients’ well-being. Full article

Background: Sepsis survivors are at risk of developing myocardial infarction and heart failure. It remains unclear whether coronary artery disease (CAD) is a major contributor to the development of these complications. This study sought to characterize the burden and distribution of significant CAD in sepsis survivors. Methods: Sepsis survivors who underwent computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA) in a UK tertiary cardiac center for suspected ischemic heart disease were retrospectively studied. Results: Of the 30 sepsis survivors (age 57 ± 12 years; 50% males), 21 patients underwent CTCA and 9 patients underwent ICA a median 39 days [IQR 12–152] from the sepsis episode. Eight patients (~27%) had angiographically significant CAD (n = 6 severe [>70%] stenosis; n = 2 moderate [50–70%] stenosis). The CT coronary calcium score was higher in patients with significant CAD compared to patients without significant CAD (638 [368–1015] vs. 4 [1–72]; p < 0.001). Of the 8 patients with significant CAD, 3 patients had LV systolic dysfunction (38%) on echocardiography and 8/21 (38%) patients without significant CAD had LV systolic dysfunction (p = 1.00). Long-term adverse complications (all-cause mortality and/or heart failure hospitalization) occurred 3/8 (38%) patients with significant CAD and 4/22 (18%) patients without significant CAD (p = 0.345). Conclusions: A minority of sepsis survivors have significant CAD. The presence of significant CAD cannot fully explain the occurrence of post-sepsis LV systolic dysfunction and adverse outcomes. The ischemic and non-ischemic mechanisms underlying post-sepsis cardiovascular disease require further investigation. Full article

Background/Objective: Diagnostic trial restorations play a crucial role in restorative dentistry by allowing clinicians to evaluate aesthetics, function, and phonetics before finalizing definitive restorations. These restorations facilitate communication between patients, clinicians, and dental technicians, ensuring treatment alignment and predictable outcomes. The accuracy of transferring diagnostic trial restorations to the oral cavity is essential to maintain the integrity of the planned design. Various fabrication techniques, including conventional silicone matrices and computer-aided design/computer-aided manufacturing (CAD-CAM)-based methods, have been developed to improve transfer precision. However, there is limited evidence directly comparing their dimensional accuracy. This randomized in vivo study aimed to evaluate and compare the accuracy of four commonly used techniques—condensation silicone, addition PVS silicone, transparent PVS silicone, and CAD-CAM combination matrices—by assessing their linear and volumetric discrepancies. Methods: Twenty patients requiring aesthetic rehabilitation of their anterior maxillary teeth participated. The sequence of matrix usage was determined through randomization. Four techniques for transferring diagnostic trial restorations were evaluated: (1) condensation silicone matrix, (2) addition polyvinyl siloxane (PVS) silicone matrix, (3) transparent PVS silicone matrix, and (4) CAD-CAM combination matrix. Dimensional accuracy was assessed by comparing intraoral scans (IOSs) of the transferred restorations to the original diagnostic wax-up. Linear discrepancies were measured at four buccal landmarks (cervical, medial, lower medial, and incisal), and volumetric deviation was evaluated using reverse engineering alignment software. Results: Significant differences were observed among the groups in both linear and volumetric discrepancies (p < 0.05). The CAD-CAM combination matrix showed superior volumetric accuracy, with minimal deviations from the diagnostic wax-up. The addition PVS silicone matrix demonstrated consistent linear accuracy, particularly at the cervical and medial landmarks. The condensation silicone matrix exhibited moderate performance across both linear and volumetric accuracy. The transparent PVS silicone matrix showed the highest variability, with greater volumetric deviations. Conclusions: The study highlights that the choice of matrix material and technique significantly impacts the dimensional accuracy of diagnostic trial restoration transfers. The CAD-CAM combination matrix and the addition PVS silicone matrix demonstrated superior advantages compared to the other techniques. Clinicians should consider the specific requirements of each case, including accuracy and ease of use, when selecting a transfer technique for aesthetic rehabilitations. Full article

Introduction: High-performance fiber-reinforced technopolymers for computer-aided design/computer-aided manufacturing (CAD/CAM) of dental restorations offer superior durability and strength. However, exposure to acidic solutions may adversely affect these mechanical properties. Objective: This study aimed to evaluate the flexural properties of a high-strength commercially available CAD/CAM fiber-reinforced dental material in response to water, cola, and artificial gastric acid solutions. Method: Forty bar-shaped specimens (1 × 4 × 13 mm) were fabricated from a pre-polymerized glass fiber-reinforced composite (Trilor disks, Bioloren, Saronno, Italy). Ten specimens were randomly selected for baseline testing. The remaining specimens were subdivided into three groups based on the storage media (n = 10): artificial gastric acid solution, Coca-Cola, and deionized water (37 °C, 48 h). Mean flexural strengths and moduli were statistically compared at a significance level of p < 0.05. Results: No statistically significant change in flexural strength was observed after immersion in the different media. However, there was a statistically significant decrease in the flexural modulus after storage for 48 h, regardless of pH. Conclusion: Fiber-reinforced CAD/CAM technopolymers show promising strength stability in response to varying pH conditions. However, further studies are needed to investigate the material’s long-term strength stability. Full article

This investigation analyzes the design integrity from a mechanical engineering perspective of a single-cylinder high-pressure steam engine with a Corliss valve gear designed by Arnold Throp. This concerns a double-acting steam engine that incorporates a steam distribution system using a Corliss valve gear, whose blueprints were published in the Model Engineer magazine in 1982. This is a complex historical invention given the high number of components (120) that constitute it, and for which no information exists regarding its operating conditions. Once the 3D CAD model of the same was obtained, and given that no physical model exists to subject to testing, a linear static analysis was performed at two critical positions (top dead center and bottom dead center), determining the maximum gauge pressure at the steam inlet (working pressure), such that the minimum safety factor is within an optimal range with values between 2 and 4. Said linear static analysis was performed using the stress analysis module of Autodesk Inventor Professional 2024, applying the finite element method. The results obtained confirm that the optimal range of working pressures is between 4.1 and 7.8 MPa. Full article