Clinical Validation of a Novel High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction.

BACKGROUND: Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate the Siemens-hs-cTnI-Centaur assay and develop 0/1-h and 0/2-h algorithms. METHODS: We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis); second, using hs-cTnI (Abbott-Architect, secondary analysis) measurements in addition to the clinically applied (hs)-cTn. Siemens-hs-cTnI-Centaur was measured at presentation, 1 h, and 2 h. The primary objective was a direct comparison of diagnostic accuracy, quantified by the area under the ROC curve (AUC), of Siemens-hs-cTnI-Centaur vs the 2 established hs-cTn assays (Roche-hs-cTnT-Elecsys, Abbott-hs-cTnI-Architect). Secondary objectives included the development of Siemens-hs-cTnI-Centaur-specific 0/1-h and 0/2-h algorithms. RESULTS: AMI was the final diagnosis in 318 of 1755 (18%) patients (using Roche-hs-cTnT-Elecsys for adjudication). The AUC at presentation for Siemens-hs-cTnI-Centaur was 0.94 (95% CI, 0.92-0.96) and comparable with 0.95 (95% CI, 0.93-0.97) for Roche-hs-cTnT-Elecsys and 0.93 (95% CI, 0.90-0.96) for Abbott-hs-cTnI-Architect. Applying the derived Siemens-hs-cTnI-Centaur 0/1-h algorithm to the validation cohort, 46% of patients were ruled out (sensitivity, 99.1%; 95% CI, 95.3-100), and 18% of patients were ruled in (specificity, 94.1%; 95% CI, 91.8-95.9). The Siemens-hs-cTnI-Centaur 0/2-h algorithm ruled out 55% of patients (sensitivity, 100%; 95% CI, 94.1-100), and ruled in 18% of patients (specificity, 96.0%; 95% CI, 93.1-97.9). Findings were confirmed in the secondary analyses using serial measurements of Abbott-hs-cTnI-Architect for adjudication. CONCLUSIONS: Diagnostic accuracy and clinical utility of the novel Siemens-hs-cTnI-Centaur assay are high and comparable with the established hs-cTn assays. ClinicalTrials.gov Identifier: NCT00470587.

Sequential piezocision: a novel approach to accelerated orthodontic treatment.

Piezocision-assisted orthodontic treatment is an innovative, minimally invasive surgical technique designed to help achieve rapid orthodontic tooth movement. Microsurgical interproximal openings are made in the buccal gingivae to let the piezoelectric knife create the bone injury that will lead to transient demineralization and subsequent accelerated tooth movement. When this procedure was first described, cuts were made simultaneously at the maxilla and the mandible. In recent years, the technique has evolved to a more staged approach, with selected areas or segments of the arch demineralized at different times during orthodontic treatment to help achieve specific results. The purpose of this article was to report the use of sequential piezocision in the correction of a Class III malocclusion, in a total treatment time of 8 months.

Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon.

BACKGROUND: Techniques to accelerate tooth movement have been a topic of interest in orthodontics over the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increased decalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment time in orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in accelerated tooth movement has been the increased interest in adult orthodontics. REVIEW: This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. It also describes the advantages and limitations of these techniques, including guidance for future investigations. CONCLUSIONS: Optimization of the described techniques is still required, but some of the techniques appear to offer the potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.

Piezocision-assisted Invisalign treatment.

In today's fast-paced, esthetic-conscious society, the orthodontic treatment of the adult patient can sometimes be a challenge. Considerable time spent in treatment as well as the use of brackets often deter patients from seeking treatment. The authors illustrate how piezocision combined with Invisalign can be used in selected cases to successfully treat adults who would otherwise not pursue orthodontic treatment.

Facial asymmetry case with multiple missing teeth treated by molar autotransplantation and orthognathic surgery.

Autotransplantation is an alternative treatment in cases of missing teeth. Autotransplantation of teeth can lead to significantly shorter treatment time and an improved treatment result in certain cases of tooth loss, wherever a suitable tooth is available and the anatomic circumstances permit it. The presented case report, treated successfully with molar autotransplantation and orthognathic surgery, had a number of missing teeth and facial asymmetry.