[Undesired side effects of tapentadol in comparison to oxycodone. A meta-analysis of randomized controlled comparative studies]. / Unerwünschte Nebenwirkungen von Tapentadol im Vergleich zu Oxycodon. Eine Metaanalyse randomisierter, kontrollierter Vergleichsstudien.

OBJECTIVE: Tapentadol is a new centrally acting analgesic with a dual mode of action as an agonist of the µ-opioid receptor and as a norepinephrine reuptake inhibitor. The aim of the present study was to evaluate the results from randomized controlled trials investigating the relative amount of adverse effects using tapentadol or oxycodone for the treatment of pain. METHODS: A quantitative systematic review was carried out according to the PRISMA recommendations on randomized controlled trials comparing tapentadol and oxycodone in pain treatment. The incidences of typical adverse side effects of opioid-based analgesic therapy (e.g. nausea, vomiting, obstipation or pruritus) were extracted and the pooled relative risks (RR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS: A total of 9 trials involving 7,948 patients were included and of these 2,810 patients were treated with oxycodone and 5,138 were treated with tapentadol in equivalent analgesic dosages as documented by an equivalent analgesic effect. The risk of typical opioid-based adverse effects, such as nausea (RR 0.61; 95% CI 0.57-0.66), vomiting (RR 0.50, 95% CI: 0.41-0.60), obstipation (RR 0.47, 95%-CI 0.40-0.56), dizziness (RR 0.86, 95% CI 0.78-0.95), somnolence (RR 0.76, 95% CI 0.67-0.86) and pruritus (RR 0.46, 95% CI 0.37-0.58) was reduced when tapentadol was used for analgesic treatment. These adverse effects were investigated in all nine trials. The risk for dryness of the mouth (6 trials, 6,218 patients, RR 1.79, 95% CI 1.40-2.29) and dyspepsia (1 trial, 646 patients, RR 2.75, 95% CI 1.09-6.94) was increased when tapentadol was used instead of oxycodone. There were no significant differences in the relative risk for any other investigated adverse effect such as dysentery, headache or fatigue. CONCLUSION: The results show that using tapentadol significantly reduces the risk of the typical opioid-based adverse effects compared with oxycodone while providing equivalent analgesic treatment.

Distribution of extracellular matrix components in normal and degenerated canine tricuspid valve leaflets.

The aim of the present study was to investigate the composition and distribution of various extracellular matrix (ECM) components in normal canine tricuspid valves (TVs) and in TVs affected by chronic valvular disease (CVD). The parietal (pTV) and septal (sTV) leaflets of the TVs from 27 dogs were investigated immunohistochemically for expression of collagen types I, III, IV and VI, elastin, laminin, fibronectin and heparan sulphate. Normal pTV consisted mainly of elastin and collagen VI in the atrialis, fibronectin in the thin spongiosa and mixed collagens in the fibrosa. The layered structure was less distinct in sTV, with numerous adipocytes and proteoglycans in the spongiosa and collagen III predominating in the fibrosa. The earliest stages of CVD affecting the pTV were recognized in the spongiosa and progression to advanced disease was characterized by nodular accumulation of proteoglycans within the free edge of the leaflet. These nodular lesions of the pTV contained more fibronectin, elastin and collagens I and VI than those affecting the sTV. These findings contrast with those reported in CVD affecting the mitral valve (MV) in which the early lesions affect the atrialis and advanced disease involves the entire leaflet. The pathogenesis of CVD in TV may involve initial alterations of the tricuspid annulus that lead to early lesions within the spongiosa, resulting in further shear stress and proteoglycan accumulation at the free edge of the pTV.

Expression of genes encoding matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in normal and diseased canine mitral valves.

The pathogenesis of canine chronic valvular disease (CVD) is not fully characterized. The present study investigates the expression of genes encoding matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in normal and diseased mitral valves (MVs). Samples from normal (n=15) or diseased (n=10) canine MVs were subject to real-time polymerase chain reaction (PCR) for quantification of mRNA encoding MMP-1, -2, -9 and -14 and TIMP-2, -3 and -4. In normal valves there was low expression of mRNA encoding MMP-2, -9 and -14 and TIMP-3. In the valves from dogs with CVD there was significantly increased transcription of mRNA encoding MMP-1 and -14 and TIMP-2, -3 and -4, but no elevation in mRNA encoding MMP-2 and -9. MMPs and TIMPs are therefore likely to be involved in extracellular matrix metabolism in normal canine MVs and there are significant alterations in the expression of genes encoding these molecules during CVD.

Elimination of drugs by the new polyamide hemofilter FH77H during various in vitro conditions.

BACKGROUND/AIMS: Multiple organ failure alters the dosage of drugs during hemofiltration. To separate factors, we utilized in vitro hemofiltration to investigate different blood flows, protein concentrations and intracellular drug partition with the FH77H polyamide membrane. METHODS: One liter of warm heparinized fresh human blood was hemofiltrated in two series: (1) with digoxin, netilmycin, phenobarbital, ceftriaxone and teicoplanin, and (2) with amikacin, theophylline, ceftazidim, phenytoin and vancomycin and, in addition, with cell-free fresh frozen plasma. RESULTS: The increased volumes of distribution of aminoglycosides and theophylline were a combined result of partition into cells and adsorption into the filter membrane. The deviations of drug sieving from predicted values were due to different affinities of the drugs on whole blood binding sites. CONCLUSION: The in vitro composition of drugs and blood improved the detection of factors that influence drug elimination during hemofiltration. The FH77H polyamide hemofilter facilitates more precise predictions of drug dosages by low adsorption rates to the membrane.

[The effect of various ultrasonic tooth cleaning devices on dental filling materials]. / Die Auswirkung verschiedener Ultraschall-Zahnreinigungs-geräte auf zahnärztliche Füllungsmaterialien.

The influence of various ultrasonic devices for cleaning teeth on the surfaces of different filling materials was studied in 300 extracted teeth. Special attention was directed to the cavity edge and the area immediately surrounding it. Alterations in surface roughness were determined and compared with an electromechanical stylus. The inflicted damage depends much more on the type of filling material than on the device. Distinct quantitative differences due to the devices however were observable.