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Alteplase is an approved treatment for acute ischemic stroke. Tenecteplase is a genetically modified form of alteplase, with lower cost and a more favourable pharmacokinetic profile allowing bolus injection. The aim of this study was to compare both drugs in adult patients with acute ischemic stroke undergoing thrombolysis.

PubMed and CENTRAL were searched for observational and experimental studies comparing both drugs in the population of interest. Additional studies were sought in clinical trial registries and by means of reference check. The efficacy outcomes of interest were functional status at 3months, recanalization and early neurological improvement (ENI). The safety outcomes of interest were cerebral haemorrhage (ICH), symptomatic ICH and mortality. The effect measure of interest was the absolute risk difference (ARD). Effect measures for each outcome were pooled across studies using random effect models.

Eight studies were included, involving 2031 patients. Overall, there were no differences in terms of good or excellent functional outcome (ARR=0.07 and 0.03 respectively, p>0.05 for both comparisons) but tenecteplase patients showed higher rates of recanalization (ARD=0.11, 95% CI [0.01;0.20]) and ENI (ARD=0.10, 95% CI [0.02;0.17]). There were no differences between groups in terms of ICH (ARD=-0.02, 95% CI [-0.06;0.01]), symptomatic ICH (ARD=0.00, 95% CI [-0.01;0.02]) or death (ARD=0.00, 95% CI [-0.03;0.03]).

Tenecteplase is an alternative to alteplase for stroke thrombolysis, with lower cost and a more favourable pharmacokinetic profile.

Tenecteplase is an alternative to alteplase for stroke thrombolysis, with lower cost and a more favourable pharmacokinetic profile.

The aim of this in vitro study was to analyze the failure of occlusal veneers made of three different restorative CAD/CAM materials under lateral static loading.

Sixty standardized semi-anatomical occlusal veneers were fabricated on natural lower molars from three different CAD/CAM materials hybrid ceramic (Vita Enamic), lithium disilicate (IPS e. max CAD) and translucent zirconia (Bruxzir). The specimens were mechanically loaded by a custom-made device attached to a universal testing machine (MTS 858 Mini Bionix II, MN, USA). Static lateral loading was applied on the buccal cusp of the occlusal veneer until failure. Failure loads were recorded, and the types of failure noted for each group. 3D finite element (FE) models simulating the actual test set-up were further employed to evaluate the stresses within the tooth-restoration complex to help interpret the experimental results.

Occlusal veneers made from zirconia recorded a significantly higher mean failure load (843.1±141.5N) than specimens of the otting on teeth has been described. – The study highlights the harm of excursive contacts on ceramic restorations.

– A novel device was used for testing occlusal veneers under lateral static loading. – 3D-FE analysis explained and corroborated the experimental results. – The relationship between vertical and horizontal forces acting on teeth has been described. – The study highlights the harm of excursive contacts on ceramic restorations.

Family history (FH) of substance use disorders (SUDs) is known to elevate SUD risk in offspring. However, the influence of FH SUDs has been confounded by the effect of externalizing psychopathologies in the addiction risk neuroimaging literature. Thus, the current study aimed to assess the association between parental SUDs and offspring functional connectivity in samples matched for psychopathology and demographics.

Ninety 11-12-year-old participants with externalizing disorders were included in the study (48 FH+, 42 FH-). We conducted independent component analyses (ICA) and seed-based analyses (orbitofrontal cortex; OFC, nucleus accumbens (NAcc), dorsolateral prefrontal cortex) with resting state data.

FH+ adolescents showed stronger functional connectivity between the right lateral OFC seed and anterior cingulate cortex compared to FH- adolescents (p < 0.05, corrected). Compared to FH-, FH+ adolescents showed stronger negative functional connectivity between the left lateral OFC seed and right pos and regions associated with sensory input (e.g., postcentral gyrus, occipital regions). We speculate that families densely loaded for SUD may confer risk by altered neurocircuitry that is associated with emotion regulation and valuation of external stimuli beyond what would be explained by externalizing psychopathology alone.

Cardiac transplant is an effective long-term management option for several severe cardiac diseases. These cardiac transplant patients may present to the emergency department with a range of issues involving the cardiac transplantation, including complications due to their transplant as well as altered presentations of disease resulting from their transplant.

This narrative review provides a focused guide to the evaluation and management of patients with cardiac transplantation and its complications.

Cardiac transplant is an effective therapy for end-stage heart failure. A transplanted heart varies both anatomically and physiologically from a native heart. Ruboxistaurin Several significant complications may occur. Graft failure, rejection, and infection are common causes of morbidity and mortality within the first year of transplant. As these patients are on significant immunosuppressive medication regimens, they are at risk of infection, but inadequate immunosuppression increases the risk of acute rejection. A variety of dysrhythmias such as atrial fibrillation and ventricular dysrhythmias may occur. These patients are also at risk of acute coronary syndrome, cardiac allograft vasculopathy, and medication adverse events. Importantly, patients with acute coronary syndrome can have an altered presentation with the so-called “painless” myocardial infarction. Consultation with the transplant physician is recommended, if available, for these patients to assist in evaluation and management.

An understanding of the presentations and various complications that may affect patients with cardiac transplant will assist emergency clinicians in the care of these patients.

An understanding of the presentations and various complications that may affect patients with cardiac transplant will assist emergency clinicians in the care of these patients.