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Clinicians should be aware of SDCT as a useful tool in the assessment of focal airway lesions. Spectral detector dual-energy computed tomography (SDCT) is a relatively novel imaging technology which has been utilized to aid in the diagnosis of many cardiothoracic conditions. Specifically, the availability of generated iodine density maps, virtual monoenergetic images, and effective atomic number maps allow for better evaluation of thoracic lesions compared to conventional CT. SDCT has previously been shown to be useful in the differentiation of benign vs malignant pulmonary nodules, pleural lesions, and lymph nodes. We describe 3 cases in which a patient presents with an indeterminate tracheal or bronchial lesion on conventional CT and subsequent SDCT reconstructions provided additional information which helped guide diagnosis or management of the patient. The goal is to help clinicians understand the benefit of SDCT in the detection and workup of airway lesions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the effect of nanoparticles on the mechanical properties of acrylic denture repairs. The review was designed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Database search was conducted involving articles published from 2000 to 2020 using the following keywords: PMMA/nanoparticles, denture repair/nanoparticles, and repair strength/nanoparticles. PubMed/MEDLINE, Embase, Google Scholar, Scopus, and EBSCOhost were used to find only those studies used repair resin reinforced with nanoparticles for denture repairs. Due to variations between nanoparticles types, sizes, and testing properties, the quantitative statistical meta-analysis couldn't be conducted. Therefore, a descriptive data analysis was applied. Out of 379 articles, 8 articles were included; three nanoparticles, zirconium oxide (nano-ZrO 2 ), silicon oxide (nano-SiO 2 ), and aluminum oxide (nano-Al 2 O 3 ) nanoparticles were used as reinforcements to repair resin. Seven studies investigated the effects of 0.25-7.5 wt.% nano-ZrO 2 on the mechanical properties of repaired denture bases and reported positive effects with high concentrations. Two studies study investigated 0.25-0.75 wt% nano-SiO 2 and found that low % nano-SiO 2 concentrations improved repair strength while, one study showed that 1 and 1.5 wt.% nano-Al 2 O 3 increased the flexural strength. Although nanoparticles offer positive effects on the properties of denture repair, inadequate studies exist. Therefore, further investigations are required. Scientific field of dental Science: Prosthodontics., (© 2021 The Authors.)

Background: This study aimed to determine whether people living in the Eastern Region of Saudi Arabia would prefer to continue the practice of physical distancing after the coronavirus disease 2019 (COVID-19) pandemic or to return to their previous way of life. Methods: This cross-sectional study was conducted from August 2020 to October 2020 in the Eastern Region of Saudi Arabia. A pre-tested questionnaire was sent electronically through social media. Data on participants' demographics and their perspectives regarding post-pandemic physical distancing were collected. The calculated sample size was 1,066; however, the total number of responses included in the analysis was 989. Results: The average age of the participants was 31.15±11.93 years. There were 435 men and 554 women in the study. Participants showed significantly high levels of disagreement with statements indicating that they were willing to use public transportation (61%), attend social gatherings (36%), and hug relatives or colleagues (40%) after the pandemic ( p <0.001); however, 43% agreed that they would spend time with family or friends ( p <0.001). The level of education was also found to be significantly related to the responses, and the level of disagreement increased as the level of education increased ( p <0.001). Conclusions: One-third of the study participants planned to continue engaging in physical distancing even after the current pandemic and if the COVID-19 related restriction will remain in place for longer, there is chance to increase in this proportion. However, it cannot be concluded whether or not this behavior will prevail in the long run, after the ease in restrictions. If so, it may greatly affect some businesses and perhaps some social norms and values as well., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Khan SQ et al.)

Background: Acute coronary syndrome (ACS) is affected by several weather conditions. Studies from different geographical locations have yielded mixed results regarding the outcomes of patients presenting with ACS during snowy days, and we aim to report the Cleveland Clinic experience., Methods: Patients who presented with an ACS and underwent percutaneous coronary intervention (PCI) from July 1, 2009 to September 30, 2017 were divided into ST-segment elevation myocardial infarction (STEMI), and non-ST segment elevation ACS (NSTE-ACS). According to snowy day arrival, we compared in-hospital mortality, culprit lesion anatomy, and door-to-balloon (DTB) time (in STEMI patients). Findings were confirmed in propensity-score matched cohorts., Results: A total of 6878 patients were included: 1608 patients with STEMI (139 snowy-day vs 1469 non-snowy day PCIs) and 5270 NSTE-ACS (419 snowy-day vs 4851 non-snowy day PCIs). Right coronary artery territories accounted for most of the stented culprit lesions in all STEMI and NSTE-ACS snowy-day PCIs. While left anterior descending artery lesions were predominant in NSTE-ACS non-snowy day PCIs. There was no difference in in-hospital mortality between the snowy-day vs non-snowy day groups (4.3% vs 4.5% in the STEMI group [P=.92] and 1.2% vs 1.7% in the NSTE-ACS group [P=41]). In STEMI patients, mean DTB times were similar (43 ± 55.1 minutes vs 46.7 ± 59.6 minutes; P=.61), which remained true after hours, during weekends and holidays. Outcomes were similar in propensity-score matched cohorts., Conclusion: At our institution, snowy days do not seem to affect in-patient mortality. In STEMI patients, DTB times were similar in those who underwent PCI regardless of the snowfall.

Background Well-conducted meta-analyses are considered to be at the top of the evidence-based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine-related meta-analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine-related systematic reviews and meta-analyses published in The New England Journal of Medicine, The Lancet, Journal of the American Medical Association, The British Medical Journal, Annals of Internal Medicine, Circulation, European Heart Journal, and Journal of American College of Cardiology between January 1, 2012 and December 31, 2018. Among 6406 original investigations published during the study period, meta-analyses represented 422 (6.6%) articles, with an annual decline in the proportion of published meta-analyses (8.7% in 2012 versus 4.6% in 2018, P trend =0.002). A substantial number of studies failed to incorporate elements of Preferred Reporting Items for Systematic Reviews and Meta-Analyses or Meta-Analysis of Observational Studies in Epidemiology guidelines (51.9%) and only a minority of studies (10.4%) were registered in PROSPERO (International Prospective Register of Systematic Reviews). Fewer manuscripts failed to incorporate the Preferred Reporting Items for Systematic Reviews and Meta-Analyses or Meta-Analysis of Observational Studies in Epidemiology elements over time (60.2% in 2012 versus 40.0% in 2018, P trend <0.001) whereas the number of meta-analyses registered at PROSPERO has increased (2.4% in 2013 versus 17.5% in 2018, P trend <0.001). Conclusions The proportion of cardiovascular medicine-related meta-analyses published in the highest impact journals has declined over time. Although there is an increasing trend in compliance with quality-based guidelines, the overall compliance remains low.

Introduction: Because of the improved colorectal cancer (CRC) survival in the U.S., patients may live long enough after CRC diagnosis to the point where non-cancer-related comorbidities may considerably impact their overall survival. In this study, we perform a long-term analysis of causes of death (CODs) following nonmetastatic CRC with respect to different demographic and tumor-related criteria., Materials and Methods: We gained access to the Surveillance, Epidemiology, and End Results data to review patients diagnosed with nonmetastatic CRC during 2000-2015. We calculated standardized mortality ratios (SMRs) for each COD following CRC. SMRs represented the change of risk of a specific COD following CRC diagnoses when compared with the risk in the general U.S., Results: We reviewed 302,345 patients, of whom 112,008 died during the study period. More deaths (68.3%) occurred within 5 years following nonmetastatic CRC diagnosis, with 76,486 deaths. CRC was the most common COD (51.4%) within 5 years of diagnosis followed by heart disease (15.2%) and other cancers (8.4%). As time passed after diagnosis, the number of CRC deaths decreased, and other noncancer causes increased to the point that after 10 years only 10.4% of deaths were attributed to CRC, 15.3% were attributed to other cancers, and 34.2% were secondary to heart disease., Conclusion: Following nonmetastatic CRC diagnosis, most deaths remain secondary to CRC. Other causes, including other cancers and cardiovascular disease, represent a significant number of deaths, especially in the 5 years following initial CRC diagnosis. Our findings help guide counseling patients with CRC regarding future health risks., Implications for Practice: Most common causes of death following nonmetastatic colorectal cancer (CRC) are heart diseases, other cancers, chronic obstructive pulmonary disease, and cerebrovascular diseases. Physicians should counsel patients regarding survivorship with cancer screening and focus on prevention of noncancer deaths. These findings should be considered by physicians who give care for survivors of nonmetastatic CRC., (© 2021 AlphaMed Press.)

Purpose: This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO 2 ) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses., Materials and Methods: Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO 2 concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey's post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions., Results: Groups with 0% nano-ZrO 2 showed no significant difference in the flexural strength as thickness decreased ( P = .153). The addition of nano-zirconia significantly increased the flexural strength ( P < .001). The highest value was with 5% nano-ZrO 2 and 2 mm-thickness (125.4 ± 18.3 MPa), followed by 5% nano-ZrO 2 and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness ( P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant ( P = .10)., Conclusion: Reinforcement of denture base material with nano-ZrO 2 significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO 2 was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMA/nano-ZrO 2 could be used with minimum acceptable thickness of 1.5 mm., (© 2021 The Korean Academy of Prosthodontics.)

Objective: To investigate the trend and outcomes of acute pulmonary embolism (PE) during pregnancy and puerperium using a large national database., Patients and Methods: The National Inpatient Sample was queried to identify pregnancy-related hospitalizations in the United States from January 1, 2007, through September 30, 2015. Temporal trends in the rates of acute PE and in-hospital mortality rates were extracted., Results: Among 37,524,314 hospitalizations, 6,333 patients (0.02%) had acute PE. The prevalence of comorbidities and risk factors such as hypertension, obesity, and smoking increased, but rates of acute PE did not change significantly (18.01 in 2007 vs 19.36 in 2015, per 100,000 hospitalizations, P trends =.21). Advanced therapies were used in a small number of women (systemic thrombolysis: 2.4%, surgical pulmonary embolectomy: 0.5%, and inferior vena cava filter in 8.3%). Rates of in-hospital mortality were almost 200-fold higher among those who had acute PE (29.3 vs 0.13, per 1000 pregnancy-related, P<.001). The rate of in-hospital mortality did not change among women with acute PE (2.6% in 2007 vs 2.5% in 2015, P trends =.74)., Conclusion: In this contemporary analysis of pregnancy-related hospitalizations, acute PE was uncommon, but rates have not decreased over the past decade. Acute PE during pregnancy and puerperium was associated with high maternal mortality, and the rates of in-hospital mortality have not improved. Future studies to improve prevention and management of acute PE during pregnancy and puerperium are warranted., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To evaluate the antimicrobial effects of different concentrations of zirconium dioxide nanoparticles (nano-ZrO 2 ) reinforcement of poly(methyl) methacrylate (PMMA) on surface roughness and C. albicans biofilm., Methods: 20 heat-polymerized acrylic resin discs were conventionally made and divided into 4 groups ( n  = 5) according to nano-ZrO 2 concentration: control (0% filler) and 3 experimental groups (2.5% (Z2.5), 5.0% (Z5.0), and 7.5% (Z7.5)). An optical profilometer was used for surface roughness evaluation, followed by Candida adherence assay. Specimens were sterilized, then immersed in cultured yeast ( C. albicans ), and incubated at 37°C for 48 hours. After that, discs were rinsed before extracting the clustered pellets of Candida. The attached C. albicans was counted using the direct method after spreading on agar media and incubating for 48 hours. Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test at α  = 0.05., Results: Surface roughness was significantly increased with all modified groups compared with control ( P < 0.01), which showed the lowest roughness value (0.027 ± 0.004  μ m). There was no significant difference in the roughness value among reinforced groups (2.5, 5.0, and 7.5%) ( P > 0.05), with Z7.5 showing the highest roughness value (0.042 ± 0.004  μ m). Candida count was reduced as the nano-ZrO 2 increased but not significantly ( P =0.15)., Conclusions: The addition of different concentrations of nano-ZrO 2 particles to PMMA increased the surface roughness compared with control; in contrast, insignificant reduction of C. albicans biofilm was detected., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Reem Abualsaud et al.)

The aim of this study was to assess the translucency of denture base acrylic resin reinforced with zirconium dioxide (ZrO 2 NPs), silicon dioxide (SiO 2 NPs), and diamond (DNPs) nanoparticles. A total of 130 heat-polymerized acrylic discs (15×2.5 mm) were fabricated conventionally and divided into control and experimental groups according to nanoparticle type and concentration (0.5, 1, 1.5, and 2.5 wt%). Unmodified acrylic resin specimens served as control. All specimens were thermocycled (5,000 cycles). Translucency was measured using a spectrophotometer. ANOVA and post-hoc Turkeys' test were used for data analysis at α=0.05. The translucency of modified PMMA was significantly lower than control (p<0.05) except 0.5% ZrO 2 NPs and SiO 2 NPs (p>0.05) which exhibited the highest translucency values among modified groups. As the NPs concentration increased, the translucency decreased and the lowest value was seen with 2.5% DNPs (1.18±0.10). The addition of ZrO 2 NPs, SiO 2 NPs, and DNPs into denture base resin decreased the translucency.

Purpose: To evaluate the effect of the addition of low concentration of silicon-dioxide nanoparticles (nano-SiO 2 ) to poly(methylmethacrylate) (PMMA) denture base material on Candida albicans adhesion, surface roughness, contact angle, hardness, and translucency., Materials and Methods: A total of 150 acrylic disks were fabricated from heat-polymerized acrylic resin and specimens were divided into 3 groups of 50 per test. They were further subdivided into 5 subgroups (n = 10) according to the concentration of nano-SiO 2 : control (no addition) and four tested groups modified with 0.05, 0.25, 0.5, and 1.0 wt% nano-SiO 2 of acrylic powder. Slide count and direct culture methods were used to measure C. albicans count (CFU/mL). The surface roughness values (R a ; μm) were determined using a profilometer. The contact angle ( o ) measurement was performed by a goniometer using the sessile drop method. Vickers hardness was used to analyze surface hardness. Translucency was measured using a spectrophotometer. Data analysis was conducted through analysis of variance and Tukey's post hoc tests (α = 0.05)., Results: Compared to the control group, direct culture and slide count methods illustrated a significant decrease in C. albicans count (p ˂ 0.001) with the addition of nano-SiO 2 , and this decrease was correlated with the concentration of nano-SiO 2 . The addition of nano-SiO 2 significantly decreased the contact angle (p ˂ 0.001), whereas hardness and surface roughness significantly increased (p ˂ 0.001). The addition of nano-SiO 2 significantly decreased translucency (p ˂ 0.001), and this decrease was concentration dependent., Conclusion: Addition of low concentration of nano-SiO 2 decreased C. albicans adhesion to PMMA denture base resin. Also, low additions of nano-SiO 2 have positive effects on contact angle and hardness, whereas surface roughness and translucency were adversely affected at high concentrations., (© 2020 by the American College of Prosthodontists.)

Background: The number of patients seeking orthodontic treatment has been consistently increasing. During orthodontic treatment, it is recommended to place the provisional restoration and to delay the final restoration until completion of orthodontic treatment. Recurrent bracket debonding necessitates orthodontists to prepare the bonding area with special measures., Objective: This study aimed to evaluate the effect of different grit sizes of diamond burs and sandblasting surface treatment on the shear bond strength of orthodontic brackets to provisional crowns., Materials and Methods: A total of 75 discs were fabricated from a bisacrylic composite and divided into 5 groups ( n  = 15) according to surface treatment by black, blue, and green diamond burs and sandblasting in addition to a control group. Metal orthodontic brackets were bonded to discs in a standardized conventional manner. All specimens were subjected to thermocycling with 5000 cycles of alternating 5°C and 55°C waterbaths. The shear bond strength test was performed using a universal testing machine. A scanning electron microscope (SEM) was used to analyze the surface treatment effect and features of debonded surfaces. The amount of composite resin left on the specimen surfaces was analyzed and classified with the adhesive remnant index. One-way ANOVA was performed at α  = 0.05., Results: The shear bond strength of specimens treated with sandblasting was significantly higher than that of the control group under thermal aging conditions ( p =0.022), as well as blue burs ( p =0.001), while no significant differences were found between different grit diamond burs and the controls ( p > 0.05)., Conclusion: Under thermocycling conditions, sandblasting of provisional crowns increases the bond strength of orthodontic brackets., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Suliman Y Shahin et al.)

Aim and Objective: The present study assessed the influence of Azadirachta indica (AI) powder on the mechanical, surface, and optical properties of heat-polymerized polymethyl methacrylate (PMMA) denture base material., Materials and Methods: A total of 300 heat-polymerized PMMA acrylic resin specimens were fabricated with dimensions of 65 × 10 × 3.3 ± 0.01 mm for flexural strength, 50 × 6 × 4 ± 0.01 mm for impact strength testing, and 15 × 2 ± 0.01 mm for surface roughness, hardness, and translucency testing. The specimens were distributed into six groups ( n = 10) based on AI powder concentration: An unmodified control group and AI powder-modified groups with 0.5, 1, 1.5, 2, and 2.5 wt% of acrylic resin powder. Universal testing machine was used to measure flexural strength and Charpy's impact tester for impact strength. Surface roughness, hardness, and translucency were assessed using a profilometer, Vicker hardness tester, and spectrophotometer, respectively. One-way analysis of variance (ANOVA) and posthoc Scheffe's test were utilized; p ≤ 0.05 was considered a statistically significant difference., Results: ANOVA showed no significant differences in terms of impact strength ( p = 0.175) and surface roughness ( p = 0.371), while significant differences were detected in terms of flexural strength, hardness, and translucency ( p = 0.001). According to post hoc Scheffe's test, there was a significant decrease in flexural strength for AI groups ( p < 0.001 ) except 0.5% AI group ( p = 0.66), while impact strength had no significant difference between AI groups ( p = 0.175). Hardness had an insignificant difference between control and modified groups ( p >0.05), with exception of 2.5% AI group ( p = 0.001). For translucency, a significant difference was found between control and all modified groups ( p <0.05)., Conclusion: Incorporating AI powder into heat-polymerized denture base material did not significantly alter impact strength, surface roughness, or hardness, except at 2.5% AI concentration, where hardness decreased. On the contrary, flexural strength and translucency were significantly affected., Clinical Significance: This study contributes to establishing a new approach for denture stomatitis disease treatment and prevention with the lowest adverse effect on denture properties.

The antifungal effect of zirconium dioxide nanoparticles (ZrO 2 NPs) incorporated into denture base material has been inadequately investigated; additionally, to the authors' knowledge, no studies have assessed the influence of artificial aging on the antifungal activity of these particles. Methodology . Heat-polymerized acrylic resin disks were fabricated and divided into four groups (0%, 1%, 2.5%, and 5% ZrO 2 NPs by weight). Antifungal activity was assessed using the direct culture and disk diffusion methods. Surface roughness and contact angles were measured using a profilometer and a goniometer, respectively. The artificial aging procedure was performed by repeating all tests at 7, 14, and 30 days following 2 rounds of thermocycling. Data were analyzed using ANOVA and Tukey's post-hoc test ( p < 0.05). Results . The addition of ZrO 2 NPs significantly decreased the adhesion of Candida albicans with and without artificial aging procedures ( p < 0.001), while the disk diffusion methods did not reveal inhibition zones. ZrO 2 NP-modified specimens displayed significantly higher surface roughness compared to specimens in the control group ( p < 0.05) and showed the same behaviors with artificial aging procedures. The contact angle was significantly decreased in all modified groups in comparison to the control group ( p < 0.05). Conclusion . The addition of ZrO 2 NPs to polymethylmethacrylate denture base material reduced the adhesion of Candida albicans with a long-term antifungal effect. With the addition of ZrO 2 NPs, contact angles were decreased and surface roughness was increased; 1% was the most appropriate concentration. Clinical significance. The addition of ZrO 2 NPs to denture base material confers a long-term antifungal effect and could be used as a possible method for preventing and treating denture stomatitis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Shorouq Khalid Hamid et al.)

Purpose: This in-vitro study evaluated and compared the effect of white henna (WH) and natural henna (NH) addition on Candida albicans adhesion and physical properties of the denture base material., Materials and Methods: A total of 243 acrylic resin specimens (9 per group) were divided as follows: 81 for flexural strength, 81 for Candida albicans adherence test, and 81 for surface roughness, translucency, and hardness. Heat-polymerized acrylic resin specimens were prepared by adding 0.5, 1.0, 1.5, or 2.0 wt% of WH or NH. Candida albicans adhesion was determined using direct culture and slide count methods. Flexural strength, surface roughness, hardness, and translucency were measured using the three-point bending test, profilometer, Vickers hardness test, and spectrophotometer, respectively. ANOVA and post hoc Tukey's tests were performed for data analysis., Results: Addition of 0.5% WH, 1% WH, and 0.5% NH to denture base resin significantly decreased Candida albicans adhesion (p<0.05). WH and NH significantly decreased the flexural strength and translucency, except 0.5% WH, and significantly increased surface roughness, except 0.5% WH and 0.5% NH. WH addition showed nonsignificant differences in the hardness, while NH addition significantly decreased hardness (p<0.05)., Conclusion: Addition of WH and NH decreased C. albicans adhesion to PMMA denture base resin. However, flexural strength, translucency, and surface roughness were adversely affected, particularly at higher concentrations. Hardness was reduced with NH only., (Copyright © 2021 European Oral Research.)

Several studies designed to augment high density lipoprotein (HDL) levels have so far been unsuccessful in reducing rates of major adverse cardiovascular and cerebrovascular events (MACCE). In this study, we report the effect of HDL-C levels on overall survival outcomes and rates of MACCE following percutaneous coronary intervention (PCI). We reviewed patients who underwent PCI at the Cleveland Clinic from 2005 to 2017 and followed them through the end of 2018. Restricted cubic splines incorporated into Cox proportional hazard regression models were used to assess the outcomes. The HDL-C level associated with the lowest mortality was used as a reference value.15,633 patients underwent PCI during the study period, of which 70% were male, 81% were white, and 73% were on statins. The mean age at the time of procedure was 65.8 ± 11.8 years. After adjusting for demographics, co-morbidities, lipid profile, statin use, and date of procedure, our model demonstrated a U-shaped association between HDL-C and overall mortality, with HDL-C levels of 30-50 mg/dl associated with the most favorable outcomes, and HDL-C levels < 30 mg/dl or > 50 mg/dl associated with worse outcomes. A sensitivity analysis in men yielded a similar U-shaped association. In conclusion, our study shows that both low and high levels of HDL-C are associated with worse overall survival, with no effect on rates of MACCE in PCI patients. Further studies are required to understand the mechanism of this association between elevated HDL-C levels with increased overall mortality in patients with atherosclerotic cardiovascular disease (ASCVD)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: This study sought to determine the impact of baseline chronic kidney disease (CKD) on in-hospital outcomes of transcatheter mitral valve repair with MitraClip (MC)., Background: MC is now an established treatment in high surgical risk patients. However, limited data are available on outcomes of MC in patients with baseline renal dysfunction., Methods: The authors used data from January 2014 to December 2017 National Readmission Database to identify all patients ≥18 years of age who underwent MC. International classification of diseases (ICD)-9 and ICD-10 codes were used to identify patients with no-CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes., Results: Of 13,563 patients undergoing MC, 8,935 (65.8%) had no-CKD, 4,152 (30.6%) had CKD, and 476 (3.5%) had ESRD. ESRD patients compared to CKD and no-CKD had significantly higher mortality (7.2% vs. 2.5% vs. 2.0%; p < .001), higher incidence of bleeding, blood transfusions, and 30 day all cause readmission. CKD patients compared to no-CKD had significantly higher mortality (odds ratio-1.29; CI 1.01-1.65; p = .04), acute kidney injury (odds ratio-3.0; CI 2.69-3.34; p < .001), new in-hospital hemodialysis (odds ratio- 2.70; CI 1.57-4.62; p < .001), blood transfusions, 30 day all cause and congestive heart failure (CHF) readmissions. In-hospital stroke and cardiac tamponade did not differ between the three groups. Patients with baseline kidney disease undergoing MC had higher mortality at high volume centers compared to low volume centers. CHF was the most common cause of readmission postMC in patients with or without preprocedural kidney disease., Conclusion: Patients with baseline kidney disease have worse outcomes after MC with higher readmission rates requiring careful patient selection and follow up in this population., (© 2020 Wiley Periodicals LLC.)

Objectives: Despite the rising use of MC, the impact of preexisting AF, a common comorbidity, on short-term postprocedural outcomes is poorly defined. We sought to assess outcomes between patients with and without atrial fibrillation (AF) who underwent percutaneous mitral valve repair with MitraClip (MC)., Methods: In this retrospective cohort study, the Nationwide Readmissions Database was queried for patients who underwent MC between 2014-2017. Groups were stratified based on the presence of AF. Multivariable logistic regression analyses were performed to identify the association between AF and in-hospital stroke and mortality., Results: Of the 15,570 patients who underwent MC, 7,740 (49.7%) had AF. AF patients were older (82 vs. 79 years, p < .001) and more comorbid. Patients with AF relative to without AF demonstrated increased rates of in-hospital ischemic (1.3% vs .0.7%, p < .001) and hemorrhagic stroke (0.3% vs. 0.1%, p = .007), longer duration of hospitalization (median 3 vs. 2 days, p < .001), and similar in-hospital mortality (2.8% vs. 2.6%, p = .52). After adjusting for comorbidities, age, sex, hospital procedural volume, and CHA2DS2-VASc, the presence of AF was associated with higher in-hospital stroke (OR = 2.096, 95%CI[1.503-2.921], p < .001) but not in-hospital mortality (OR = 1.012, 95%CI[0.828-1.238], p = .904). AF patients were more likely to be readmitted (16.8% vs.14.1%, p < .001) and die (1.5% vs. 0.9%, p = .005) within 30 days of discharge despite similar incidences of stroke (0.7% vs. 0.6%, p = .53)., Conclusions: The increased risk of in-hospital stroke, 30-day mortality, and longer hospitalization suggest the need for increased preprocedural optimization by means of stroke prevention strategies in those with AF undergoing MC., (© 2020 Wiley Periodicals LLC.)

Objectives: This study aimed to evaluate denture cleanser effects on color stability, surface roughness, and hardness of PMMA denture base resin reinforced with nano-ZrO 2 ., Materials and Methods: A total of 420 specimens were fabricated of unreinforced and nano-ZrO 2 reinforced acrylic resin at 2.5% and 5%, resulting in 3 main groups. These groups were further subdivided ( n  = 10) according to immersion solution (distilled water, Corega, sodium hypochlorite, and Renew) and immersion duration. Surface roughness, hardness, and color were measured at baseline (2 days- T 0 ) in distilled water and then after 180 and 365 days of immersion ( T 1 & T 2 ) in water or denture cleansing solutions. Data was collected and analyzed using two-way ANOVA followed by Bonferroni post hoc test ( α  = 0.05)., Results: Surface roughness increased significantly after denture cleanser immersion of unmodified and nano-ZrO 2 -modified PMMA materials while hardness decreased ( P < 0.001). The denture cleansers significantly affected the color of both PMMA denture bases ( P < 0.001). The immersion time in denture cleansers significantly affected all tested properties ( P < 0.001). Within denture cleansers, NaOCl showed the highest adverse effects ( P < 0.05) while Renew showed the least adverse effects., Conclusion: Denture cleansers can significantly result in color change and alter the surface roughness and hardness of denture base resin even with ZrO 2 nanoparticles addition. Therefore, they should be carefully used., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Mohammed M. Gad et al.)

Objectives: This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR)., Background: AFMR remains poorly defined clinically., Methods: Consecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. We excluded patients with endocarditis, any form of cardiomyopathy, or prior mitral intervention. The absence of leaflet pathology defined AFMR. Outcomes included death and heart failure hospitalizations., Results: A total of 283 patients were included (AFMR = 14%, PMR = 86%). Compared to PMR, patients with AFMR had more comorbidities, including hypertension (94.9% vs. 76.2%; p = 0.015), diabetes mellitus (46.2% vs. 18.4%; p < 0.001), long-standing atrial fibrillation (28.2% vs. 13.1%; p = 0.015), prior nonmitral cardiac surgery (25.6% vs. 9.8%; p = 0.004), and pacemaker placement (33.3% vs. 13.5%; p = 0.002). They also had higher average E/e' (median [interquartile range]:16.04 [13.1 to 22.46] vs. 14.1 [10.89 to 19]; p = 0.036) and worse longitudinal left atrial strain peak positive value (16.86 ± 12.15% vs. 23.67 ± 14.09%; p = 0.002) compared to PMR. During follow-up (median: 22 months), patients with AFMR had worse survival (log-rank p = 0.009) and more heart failure hospitalizations (log-rank p = 0.002). They were also less likely to undergo mitral valve intervention (59.0% vs. 83.6%; p = 0.001), although surgery was associated with improved survival (log-rank p = 0.021). On multivariable regression analysis, AFMR was independently associated with mortality [adjusted odds ratio: 2.61, 95% confidence interval: 1.17 to 5.83; p = 0.02]., Conclusions: AFMR constitutes an under-recognized high-risk group, with significant comorbidities, limited therapeutic options, and poor outcomes., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Kidney transplant recipients (KTRs) are considered high-risk patients for surgical interventions. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) at high operative risk. However, the outcomes of TAVI compared with SAVR KTRs have not been well-studied in nationally representative data. Patients with prior history of functioning kidney transplant who were hospitalized for TAVI and SAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database. Our study included 762 TAVI and 1,278 SAVR KTRs. Compared with SAVR, TAVI patients generally had higher rates of co-morbidities with lower risk of in-hospital mortality (3.1% vs 6.3, p = 0.002), blood transfusion (11.5% vs 38.6%, p <0.001), acute myocardial infarction (3.9% vs 6.5%, p = 0.16), acute kidney injury (24.5% vs 42.1%, p <0.001), sepsis (3.9% vs 9.5%, p <0.001) and discharge with disability (42.6% vs 68.4%, p <0.001). However, the rate of permanent pacemaker implantation was significantly higher in TAVI group (11.4% vs 3.9%, p <0.001). Of note, in-hospital stroke and 30-day readmission were comparable between both groups. These findings were confirmed after adjusting for other co-morbidities. TAVI is growing as a valid and safe alternative for KTRs with severe AS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The additions of zirconium oxide nanoparticles (nano-ZrO 2 ) to denture base materials have produced nanocomposites with satisfactory properties, although there is a lack of research investigating the effects of denture cleansers on these materials. This study aimed to evaluate the effect of denture cleansers on the flexural strength of denture base materials modified with nano-ZrO 2 ., Materials and Methods: A total of 270 specimens were fabricated from pure and nano-ZrO 2 reinforced acrylic resins at 2.5% and 5%, resulting in 3 main groups. The groups were further divided into subgroups (n = 10) according to immersion solution (distilled water, Corega, sodium hypochlorite, and Renew) and immersion duration. Flexural strength was measured at baseline (T 0 ) in distilled water and after 180 and 365 days of immersion (T 1 and T 2 ) in denture cleansers. Data were collected and analyzed using repeated measure ANOVA and Bonferroni post hoc tests (α = 0.05)., Results: The flexural strength of the nano-ZrO 2 modified denture base material decreased significantly after immersion in different denture cleansers at different immersion durations in comparison to baseline (T 0 ) (p < 0.001). Sodium hypochlorite showed the highest reduction in flexural strength followed by Corega, while Renew cleansing solution resulted in the least change., Conclusion: Denture cleansers can significantly affect the flexural strength of nano-ZrO 2 modified denture base materials and thus should be used cautiously., (© 2020 by the American College of Prosthodontists.)

Data on the impact of economic status on Transcatheter aortic valve implantation (TAVI) and MitraClip (MC) is lacking. Patients who underwent TAVI and/or MC during 2012 to 2017 were identified in the Nationwide Readmission Database and divided by zip code estimated income quartile into 4 groups (Q1 to Q4). The utilization of TAVI and/or MC was defined as the number of TAVIs and/or MCs over all admissions with an aortic and/or mitral valve disease (AVD and/or MVD) and represented per 1,000 admissions. A total of 168,853 patients underwent TAVI; 20.6% in Q1, 26.3% in Q2, 27.3% in Q3, and 25.8% in Q4, while 15,387 patients underwent MC; 22% in Q1, 26.2% in Q2, 26.3% in Q3, and 25.5% in Q4. The annual utilization of TAVIs and/or MCs increased over the study period and was generally lower with lower income. In 2012, TAVI was performed for 8.2, 8.8, 10.8, and 11.3 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, TAVI was performed for 54.1, 65.1, 68.6, and 71 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2014, MC was performed for 1.6, 2.1, 1.8, and 1.9 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, MC was performed for 5.6, 6.5, 8, and 8 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In-hospital mortality, stroke, and 30-day readmissions were generally comparable across groups. Lower-income patients may be underrepresented among patients undergoing TAVI and MC despite comparable outcomes. Further studies are needed to examine the etiologies behind these disparities and identify targeted strategies for its mitigation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The use of transcatheter aortic valve replacement (TAVR) has expanded to patient populations of varying surgical risk in light of recent clinical trials, yet its role in patients with aortic stenosis and coexisting thoracic aortic aneurysm (TAA) is not well-delineated. We aimed to evaluate whether risk factors and in-hospital outcomes vary between TAVR patients with and without an unruptured TAA., Methods: The Nationwide Readmissions Database was queried for patients hospitalized between January 2012 and December 2017 who underwent TAVR with and without an unruptured TAA. In-hospital outcomes were compared between cohorts after adjusting for sex, comorbidities, and TAVR approach, and in a subgroup analysis that excluded those with bicuspid aortic valves., Results: Among 171,011 TAVR patients, 1,677 (1%) presented with TAA. Patients with TAA were younger (median age 80 vs. 82 years, p < .001) and more likely to have bicuspid aortic valves (9.3% vs. 0.9%, p < .001). Among patients with aneurysm, 2.6% died, 2.2% developed stroke, 1% developed aortic dissection, and 1.4% experienced cardiac tamponade while hospitalized. After adjusting for age, sex, bicuspid aortic valve, and all comorbidities, TAA was associated with significantly higher risk of post-TAVR aortic dissection (OR = 2.117, 95% CI [1.304-3.435], p = .002) and cardiac tamponade (OR = 1.682, 95% CI [1.1-2.572], p = .02)., Conclusions: While the overall incidence of post-TAVR complications is low, patients with an unruptured TAA should be carefully considered by the Heart Team in weighing the additional risks of aortic dissection and cardiac tamponade after TAVR with those associated with surgery., (© 2020 Wiley Periodicals LLC.)

Objective: We aimed to compare short-term outcomes between transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (AR) and TAVR for aortic stenosis (AS)., Background: In patients with severe pure AR for whom surgical valve replacement is infeasible, TAVR is sometimes used off-label., Methods: Using the Nationwide Readmissions Database 2016-2017, we retrospectively identified patients without prior valve surgery who underwent endovascular TAVR. We compared in-hospital and 30-day outcomes according to the type of aortic valve disease., Results: A total of 81,542 eligible patients were divided into the pure AR (n = 1,222, 1.50%), pure AS (n = 72,690, 89.1%), and AS + AR (n = 7,630, 9.36%) groups. In unadjusted analyses, the pure AR group, compared with the pure AS and AS + AR groups, showed a higher incidence of acute kidney injury (16.8% vs. 9.8% vs. 12.1%, respectively; p < .001) and need of surgical bailout (1.4% vs. 0.4% vs. 0.6%; p < .01). The pure AR group also showed higher in-hospital mortality than the pure AS group (2.4% vs. 1.4%; p = .005). After multivariable adjustment, TAVR for pure AR was significantly associated with a higher risk of acute kidney injury (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.33-2.02; p < .001), cardiac tamponade (OR = 1.98, 95% CI = 1.00-3.92; p = .0498), and prolonged hospital stay (OR = 1.59, 95% CI = 1.29-1.95; p < .001) compared with TAVR for pure AS, whereas it was not significantly associated with in-hospital mortality (OR = 1.55, 95% CI = 0.99-2.45; p = .058) and other outcomes., Conclusions: TAVR may be a reasonable treatment option for selected patients with pure AR with regard to short-term outcomes. However, additional techniques or devices may be necessary to reduce periprocedural risk., (© 2020 Wiley Periodicals LLC.)

As the use of transcatheter aortic valve implantation (TAVI) expands to varying patient populations, impacting the landscape of surgical aortic valve replacement (SAVR), this study sought to assess volume and performance trends of aortic valve replacement (AVR) in the United States during 2012-2017. The Nationwide Readmissions Database was queried for patients who underwent endovascular/transapical TAVI, isolated SAVR, or complex aortic valve surgery between 2012 and 2017. Temporal trends in annual case volume, admission costs, in-hospital outcomes, and 30-day readmission were evaluated. Of 624,303 patients (median age 72 years) who received AVR, 387,011 (62%) were men. Among these patients, 170,521 (27%) underwent TAVI and 453,782 (73%) underwent SAVR with 299,398 isolated and 154,384 complex aortic valve surgery. TAVI patients were significantly older and higher risk compared with SAVR patients. From 2012 to 2017, the annual number of TAVI increased from 8,295 to 55,168 whereas SAVR volume remained remarkably stable. Patients who underwent AVR demonstrated significant improvements in mortality, stroke, duration of hospitalization, and 30-day readmission. In conclusion, this large contemporary analysis reports the considerable growth of AVR in the United States. It remains unequivocal that the treatment of aortic stenosis is improving overall with reduced mortality following AVR, highlighting the effectiveness of various process improvements such as newer valves, enhanced patient selection, and the interdisciplinary Heart Team approach., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the flexural strength, elastic modulus, microhardness, and surface roughness of monolithic zirconia, lithium disilicate ceramics, and feldspathic ceramics after being exposed to different acidic solutions., Materials and Methods: Rectangular specimens (n = 180) were prepared from three different ceramic materials: lithium disilicate, monolithic zirconia, and feldspathic porcelain. Initial Surface roughness of ninety specimens (n = 30/material) was evaluated using an optical noncontact profilometer. Thirty specimens of each material were immersed in one of the following solutions (n = 10/group): citric acid; acidic beverage; and artificial saliva, which served as the control. Post immersion surface roughness, flexural strength, and elastic modulus were determined using an optical noncontact profilometer and three-point bending test. Another thirty specimens of each material were immersed in the aqueous solutions (n = 10/group) following the same protocol and subjected to microhardness test using a Vickers diamond microhardness tester. A scanning electron microscope (SEM) was used to examine the surface characteristics changes. ANOVA and Post-hoc Tukey's Kramer tests were used for data analysis (α = 0.05)., Results: Immersion in different solutions did not affect the flexural strength and elastic modulus of lithium disilicate or zirconia. Microhardness and surface roughness were significantly affected in all groups (p < 0.05). For feldspathic porcelain groups, the flexural strength and elastic modulus were significantly decreased in the citric acid group (p = 0.045 and p = 0.019). Also, there were significant differences among all feldspathic porcelain groups (p = 0.001) in terms of microhardness and surface roughness values., Conclusions: The tested acidic agents significantly affected the flexural strength, elastic modulus, surface roughness, and microhardness of feldspathic porcelain. However, the flexural strength and elastic modulus of evaluated lithium disilicate and zirconia did not change significantly., (© 2020 by the American College of Prosthodontists.)

Objectives: This study sought to investigate the incidence and outcomes of surgical bailout (SB) after transcatheter mitral valve repair (TMVr) with MitraClip., Background: TMVr poses a risk of serious procedural complications, possibly requiring urgent open surgery for SB. However, little is known about the risk of SB cases after TMVr., Methods: We retrospectively identified patients who underwent TMVr using the Nationwide Readmissions Database 2014-2017. SB was defined as open thoracotomy for heart and aorta during the same hospitalization. Annual hospital volume was defined as the annual number of TMVr cases in each hospital in each year., Results: Among 15,032 eligible patients, SB was required in 214 (1.42%), of whom 134 (62.6%) underwent mitral valve surgery (113 replacements; 21 repairs). The incidence of SB was decreasing significantly over the 4 years (5.26% in 2014; 0.43% in 2017; p trend  < .001). There was a significant nonlinear, inverse association of annual hospital volume with the incidence of SB. In-hospital death (15.0 vs. 2.1%; p < .001) and other in-hospital adverse events were significantly more frequent in patients with than without SB, whereas the 30-day readmission rate was similar (13.2 vs. 15.1%; p = .572). After adjustment for patient and hospital characteristics, SB was significantly associated with higher in-hospital mortality (odds ratio = 6.67, 95% confidence interval = 4.35, 10.23, p < .001)., Conclusions: This study suggests that although the incidence of SB after TMVr is decreasing, SB is required more frequently in lower-volume hospitals and carries high in-hospital mortality. Further efforts are needed to understand the reasons for SB and improve outcomes in patients needing SB., (© 2020 Wiley Periodicals LLC.)

Background The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited. Methods and Results Pregnant and post-partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in-hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in-hospital outcomes. Among 46 700 637 pregnancy-related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 065 (19.1%) were Hispanic. The trends of mortality and stroke declined significantly in Black women, but however, were mostly unchanged among White women. The incidence of mortality and cardiovascular morbidity was highest among Black women followed by White women, then Hispanic women. The majority of Blacks (62.3%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of Black women were below-median income (71.2%) while over half of the White patients were above the median income (52.7%). Compared with White women, Black women had the highest mortality with adjusted odds ratio (aOR) of 1.45, 95% CI (1.21-1.73); myocardial infarction with aOR of 1.23, 95% CI (1.06-1.42); stroke with aOR of 1.57, 95% CI (1.41-1.74); pulmonary embolism with aOR of 1.42, 95% CI (1.30-1.56); and peripartum cardiomyopathy with aOR of 1.71, 95 % CI (1.66-1.76). Conclusions Significant racial disparities exist in major cardiovascular events among pregnant and post-partum women. Further efforts are needed to minimize these differences.

Objectives: This study sought to evaluate and assess the extent of serial coronary artery calcification in response to oral calcium supplementation., Background: Oral calcium supplements are frequently used despite their cardiovascular safety remaining controversial. Their effects on serial coronary calcification are not well established., Methods: In a post hoc patient-level analysis of 9 prospective randomized trials using serial coronary intravascular ultrasound, changes in serial percentage of atheroma volume (PAV) and calcium indices (CaI) were compared in matched segments of patients coronary artery disease who were receiving concomitant calcium supplements (n = 447) and in those who did not receive supplements (n = 4,700) during an 18- to 24-month trial period., Results: Patients (mean age 58 ± 9 years; 73% were men; 43% received concomitant high-intensity statins) demonstrated overall annualized changes in PAV and CaI with a mean of -0.02 ± 1.9% (p = 0.44) and a median of 0.02 (interquartile range: 0.00 to 0.06) (p < 0.001) from baseline, respectively. Following propensity-weighted mixed modeling adjusting for treatment and a range of demographic, clinical, ultrasonic, and laboratory parameters (including but not limited to sex, race, baseline, and annualized change in PAV, baseline CaI, concomitant high-intensity statins, diabetes mellitus, renal function), there were no significant between-group differences in annualized changes in PAV (least-squares mean: 0.09; 95% confidence interval [CI]: -0.20 to 0.37 vs. 0.01; 95% CI: -0.27 to 0.29; p = 0.092) according to calcium supplement intake. Per a multivariable logistic regression model accounting for the range of covariates described, calcium supplementation independently associated with an increase in annualized CaI (odds ratio: 1.15; 95% CI: 1.05 to 1.26; p = 0.004)., Conclusions: Oral calcium supplementation may increase calcium deposition in the coronary vasculature independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes requires further investigation., Competing Interests: Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Detachment of acrylic teeth from denture base material is a common complication in dentistry which accounts for 26-30% of repair cases. This study aimed to evaluate the effect of alumina-blasting, silane coupling agent, and thermal cycling on the shear bond strength of repaired teeth to denture base., Materials and Methods: Specimens (140) of repaired teeth to denture bases were fabricated and divided into 14 groups: 7 groups before thermal cycling and 7 groups after thermal cycling ( n  = 10). The groups were divided according to surface treatment into no treatment (control), treatment of the base (B), the tooth (T), or both (BT). Each group was further subdivided according to the surface treatment method into alumina-blasting or alumina-blasting and silane coupling agent. After treatment, acrylic discs and teeth were fixed in a jig, and the repair procedure was done. Half the specimens were thermally cycled. Shear bond strength was measured using a universal testing machine. ANOVA and Tukey HSD tests were performed at α  = 0.05., Results: Surface treatment significantly improved the bond strength compared to the control group ( P < 0.001). Comparing surface treatments, alumina-blasting with silane coupling agent treatment resulted in significantly higher strength compared to alumina-blasting alone ( P < 0.001). The BT group treated with alumina-blasting and silane coupling agent showed the highest significant shear bond strength (23.91 ± 0.96 MPa) ( P < 0.001). Significant drop in strength value was observed in all groups after thermal cycling ( P < 0.004) except the BT group treated with alumina-blasting ( P =0.096)., Conclusion: Surface treatment using alumina-blasting with silane coupling agent for denture base and tooth increased repair strength., Competing Interests: All authors declare no conflicts of interest regarding the preparation and publication of this manuscript., (Copyright © 2020 Zahra A. AlZaher et al.)

Background: Incidence and outcomes of acute coronary syndrome (ACS) immediately following transcatheter aortic valve replacement (TAVR) remain largely unknown., Objectives: This study sought to assess the incidence, clinical characteristics, and outcomes of ACS following TAVR., Methods: We queried the National Readmission Database from January 2012 to September 2015 for TAVR admissions with and without ACS, creating a propensity-matched cohort to compare outcomes., Results: A total of 48,454 patients underwent TAVR, with 1,332 (2.75%) developing ACS. TAVR patients with ACS compared to those without ACS had a significantly higher incidence of acute kidney injury (24.7 vs. 19.2%; p = .001), ischemic stroke (3.7 vs. 2.3%; p = .04), vascular complications (8.6 vs. 5.8%; p = .008), cardiogenic shock (9.8 vs. 1.9%; p < .001), cardiac arrest (5.1 vs. 2.8%; p = .002), mechanical circulatory support (8.1 vs. 1.5%; p < .001), and in-hospital mortality (9.6 vs. 3.4%; p < .001). Additionally, TAVR with ACS had longer lengths of stay (median 10 days vs. 6 days; p < .001) and hospital charges (median $23,200 vs. $19,000; p < .001). Positive predictors of ACS were history of PCI (odds ratio, 1.43; 95% CI: 1.25-1.63), hyperlipidemia (odds ratio, 1.20; 95% CI: 1.07-1.34), chronic blood loss anemia (odds ratio, 2.16; 95% CI: 1.54-3.03), chronic kidney disease (odds ratio, 1.17; 95% CI: 1.04-1.31), fluid and electrolyte disorders (odds ratio, 1.65; 95% CI: 1.47-1.85), and weight loss (odds ratio, 1.53; 95% CI: 1.22-1.91). Heart failure (34%) was the most common reason for readmission in the ACS cohort., Conclusion: ACS after TAVR is uncommon but is associated with worse clinical outcomes and increased healthcare resource utilization., (© 2019 Wiley Periodicals, Inc.)

Background: Cholangiocarcinoma is an aggressive malignancy with few available studies assessing incidence and mortality. In this study, we aim to investigate trends of incidence and mortality in a large nation-wide epidemiologic study., Methods: We used SEER 18 database to study cholangiocarcinoma cases in the US during 2000-2015. Incidence and mortality rates of cholangiocarcinoma were calculated by race and were expressed by 1,000,000 person-years. Annual percent change (APC) was calculated using joinpoint regression software., Results: We reviewed 16,189 patients with cholangiocarcinoma, of which 64.4% were intrahepatic. Most patients were whites (78.4%), males (51.3%), and older than 65 years (63%). A total of 13,121 patients died of cholangiocarcinoma during the study period. Cholangiocarcinoma incidence and mortality were 11.977 and 10.295 and were both higher among Asians, males, and individuals older than 65 years. Incidence rates have significantly increased over the study period (APC=5.063%, P<.001), while mortality increased significantly over the study period (APC=5.964%, P<.001), but decreased after 2013 (APC=-25.029, P<.001)., Conclusion: The incidence and mortality of cholangiocarcinoma were increasing in the study period with significant observed disparities based on race and gender., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Desmoid tumors are a manifestation of familial adenomatous polyposis (FAP), associated with mutation of the APC gene. Although considered benign tumors, desmoids can be aggressive and cause considerable morbidity. Known risk factors for desmoid tumor growth include location of mutations within the APC gene, family history of desmoid tumors, previous surgery, female gender, and pregnancy. Desmoids occur at diverse sites, commonly within the abdomen or at sites of previous surgery; thoracic desmoids are relatively uncommon. Reported here is a highly desmoid tumor-prone FAP family with a truncating mutation in the APC gene at codon 1550 (c.4648G>T) in which female siblings developed remarkably similar thoracic desmoids with highly aggressive tumor behavior during the onset of puberty, throughout adolescence, and in one sibling during and following pregnancy. Both siblings had a fatal outcome. This case underscores the potential for aggressive behavior of desmoids during adolescence and the need for close vigilance during the adolescent and young adult (AYA) age range in desmoid-prone FAP kindreds.

Aims: The aim of this meta-analysis was to evaluate the evidence regarding the rates of procedural success and the incidence of adverse outcomes following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in patients with failed bioprosthetic aortic valves., Methods and Results: A systematic search of major electronic databases was conducted for studies relevant to patients with failed bioprosthetic aortic valves undergoing VIV-TAVR. The primary outcome was procedural success. A total of 5,553 patients from 24 studies were included. The mean Society of Thoracic Surgeons (STS) score was 7.84±5.14. The procedural success rate was high (97%, 95% confidence interval [CI]: 94-98%). At 30 days, all-cause mortality was 5% (95% CI: 3-6%), stroke 2% (95% CI: 1-2%), myocardial infarction 1% (95% CI: 1-2%), permanent pacemaker placement 6% (95% CI: 5-8%), and aortic regurgitation 7% (95% CI: 5-10%). At one year, the incidence of all-cause mortality was 12% (95% CI: 10-14%), stroke 3% (95% CI: 2-4%), myocardial infarction 1% (95% CI: 0-2%), and permanent pacemaker placement 7% (95% CI: 5-11%). At three years, the incidence of all-cause mortality was 29% (95% CI: 25-34%) and stroke 6% (95% CI: 5-9%)., Conclusions: VIV-TAVR appears to be associated with high procedural success rates and low adverse outcomes during the short-term and midterm follow-up period.