Development of Organic/Inorganic Hybrid Materials for Fully Degradable Reactive Oxygen Species-Releasing Stents for Antirestenosis.

Despite innovative advances in stent technology, restenosis remains a crucial issue for the clinical implantation of stents. Reactive oxygen species (ROS) are known to potentially accelerate re-endothelialization and lower the risk of restenosis by selectively controlling endothelial cells and smooth muscle cells. Recently, several studies have been conducted to develop biodegradable polymeric stents. As biodegradable polymers are not electrically conductive, double metallic layers are required to constitute a galvanic couple for ROS generation. Here, we report a new biodegradable hybrid material composed of a biodegradable polymer substrate and double anodic/cathodic metallic layers for enhancing re-endothelialization and suppressing restenosis. Pure Zn and Mg films (3 µm thick) were deposited onto poly-l-lactic acid (PLLA) substrates by DC magnetron sputtering, and a long-term immersion test using biodegradable hybrid materials was performed in phosphate-buffered solution (PBS) for 2 weeks. The concentrations of superoxide anions and hydrogen peroxide generated by the corrosion of biodegradable metallic films were monitored every 1 or 2 days. Both superoxide anions and hydrogen peroxide were seamlessly generated even after the complete consumption of the anodic Mg layer. It was confirmed that the superoxide anions and hydrogen peroxide were formed not only by the galvanic corrosion between the anode and cathode layers but also by the corrosion of a single Mg or Zn layer. The corrosion products of the Mg and Zn films in PBS were phosphate, oxide, or chloride of the biodegradable metals. Thus, it is concluded that ROS generation by the corrosion of PLLA-based hybrid materials can be sustained until the exhaustion of the cathode metal layer.

Are Biodegradable Plates Applicable in Endoscope-Assisted Open Reduction and Internal Fixation of Mandibular Subcondyle Fractures?

PURPOSE: To investigate whether biodegradable plates are applicable in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondyle fractures. MATERIALS AND METHODS: This retrospective case-series study included patients with mandibular subcondyle fractures treated with EAORIF using an unsintered hydroxyapatite particles/poly-l-lactide biodegradable plate system, with at least 6 months of clinical follow-up data available. The outcome variables were fracture healing with postoperative stability and postoperative complications. Other variables included age, gender, fracture site, cause of injury, accompanying mandibular fracture, total follow-up period, fracture classification, extent of displacement, preoperative status of occlusion, preoperative mandibular movements, fixation materials in accompanying mandibular fracture, location and number of fixation plates, periods of intermaxillary fixation/elastic bands, and postoperative mandibular movements. Fracture healing in these patients was assessed by comparing the immediate postoperative cone-beam computed tomography (CBCT) images with those obtained at least 3 months after surgery. RESULTS: A total of 11 patients, 9 male and 2 female, with a mean ± standard deviation age of 35.3 ± 15.9 years, were included. The mean follow-up period was 18.8 ± 7.8 months. Four patients had an accompanying mandibular fracture. Two 4-hole, 2.0-mm biodegradable plates were fixed with 6-mm screws along the posterior border of the mandibular ramus and near the sigmoid notch. Complete bone formation around the fracture lines or fading of the fracture lines, with no change in the position of the fractured segments, was observed on the postoperative CBCT images at 3 months. With the exception of 2 patients, no patient complained of plate palpability, deviation in occlusion, or discomfort during the postoperative follow-up period. CONCLUSIONS: EAORIF using biodegradable plates for mandible subcondylar fractures is a stable and reliable method, with considerable advantages compared with titanium plates.

Facile synthesis of Cu NPs@Fe3O4-lignosulfonate: Study of catalytic and antibacterial/antioxidant activities.

Environmental pollution is one of the important concerns for human health. There are different types of pollutants and techniques to eliminate them from the environment. We hereby report an efficient method for the remediation of environmental contaminants through the catalytic reduction of the selected pollutants. A green method has been developed for the immobilization of copper nanoparticles on magnetic lignosulfonate (Cu NPs@Fe3O4-LS) using the aqueous extract of Filago arvensis L. as a non-toxic reducing and stabilizing agent. The characterization of the prepared Cu NPs@Fe3O4-LS was achieved by vibrating sample magnetometer (VSM), Fourier-transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), high resolution TEM (HRTEM), X-ray diffraction (XRD), scanning TEM (STEM), thermogravimetry-differential thermal analysis (TG/DTA), fast Fourier transform (FFT), energy-dispersive X-ray spectroscopy (EDS), and X-ray photoelectron (XPS) analyses. The synthesized Cu NPs@Fe3O4-LS was applied as a magnetic and green catalyst in the reduction of congo red (CR), 4-nitrophenol (4-NP), and methylene blue (MB). The progress of the reduction reactions was monitored by UV-Vis spectroscopy. Finally, the biological properties of Cu NPs@Fe3O4-LS were investigated. The prepared catalyst demonstrated excellent catalytic efficiency in the reduction of CR, 4-NP, and MB in the presence of sodium borohydride (NaBH4) as the reducing agent. The appropriate magnetism of Cu NPs@Fe3O4-LS made its recovery very simple. The advantages of this process include a simple reaction set-up, high and catalytic antibacterial/antioxidant activities, short reaction time, environmentally friendliness, high stability, and easy separation of the catalyst. In addition, the prepared Cu NPs@Fe3O4-LS could be reused for four cycles with no significant decline in performance.

Management of multiple odontogenic keratocysts associated with nevoid basal cell carcinoma syndrome: a case report of 11-year follow-up.

Multiple odontogenic keratocysts (OKC) are a distinguishing feature of nevoid basal cell carcinoma syndrome (NBCCS). Owing to the high recurrence rate of syndromes associated OKCs, complete surgical resection is generally recommended as a definitive treatment. Herein, we report the management of multiple OKCs with marsupialization followed by excision with peripheral ostectomy in an NBCCS patient. We then discuss lesion progression over 11 years of annual follow-ups.

Photoswitchable Microgels for Dynamic Macrophage Modulation.

Dynamic manipulation of supramolecular self-assembled structures is achieved irreversibly or under non-physiological conditions, thereby limiting their biomedical, environmental, and catalysis applicability. In this study, microgels composed of azobenzene derivatives stacked via π-cation and π-π interactions are developed that are electrostatically stabilized with Arg-Gly-Asp (RGD)-bearing anionic polymers. Lateral swelling of RGD-bearing microgels occurs via cis-azobenzene formation mediated by near-infrared-light-upconverted ultraviolet light, which disrupts intermolecular interactions on the visible-light-absorbing upconversion-nanoparticle-coated materials. Real-time imaging and molecular dynamics simulations demonstrate the deswelling of RGD-bearing microgels via visible-light-mediated trans-azobenzene formation. Near-infrared light can induce in situ swelling of RGD-bearing microgels to increase RGD availability and trigger release of loaded interleukin-4, which facilitates the adhesion structure assembly linked with pro-regenerative polarization of host macrophages. In contrast, visible light can induce deswelling of RGD-bearing microgels to decrease RGD availability that suppresses macrophage adhesion that yields pro-inflammatory polarization. These microgels exhibit high stability and non-toxicity. Versatile use of ligands and protein delivery can offer cytocompatible and photoswitchable manipulability of diverse host cells.

Finite Element Analysis of Dental Implants with Zirconia Crown Restorations: Conventional Cement-Retained vs. Cementless Screw-Retained.

The present study was designed to compare the stress distributions in two restoration types of implants and the surrounding bone. The first restoration type was a conventional cement-retained zirconia crown, and the second was a novel cementless screw-retained zirconia crown with a base abutment. A three-dimensional finite element method was used to model the implants, restorations, and supporting bone. A comparative study of the two implants was performed under two masticatory loads: a vertical load of 100 N and a 30-degree oblique load of 100 N. Under both loading conditions, the maximum von Mises stress and strain values in the implant and supporting bone were higher in the conventional cement-retained restoration model than in the cementless screw-retained model. In terms of stress distribution, the cementless screw-retained zirconia crown with base abutment may be considered a superior restoration option compared to the conventional cement-retained zirconia crown.

A screen printed electrode modified with Fe3O4@polypyrrole-Pt core-shell nanoparticles for electrochemical detection of 6-mercaptopurine and 6-thioguanine.

In this paper, Fe3O4@ppy-Pt core-shell nanoparticles (NPs) could be produced and utilized for the development of a novel electrochemical sensor to detect 6-mercaptopurine (6-MP). 6-MP determination was examined by cyclic voltammetry (CV), chronoamperometry (CHA), linear sweep voltammetry (LSV), and differential pulse voltammetry (DPV) at Fe3O4@ppy-Pt core-shell NPs modified screen printed electrode (Fe3O4@ppy-Pt/SPE) in phosphate buffered solution (PBS). The outcomes obtained from DPV demonstrated that the Fe3O4@ppy-Pt/SPE proved a linear concentration range among 0.04 and 330.0 µM having a detection limit of 10.0 nM for 6-MP. Also, modified electrode was satisfactorily utilized to detect 6-MP in the presence of 6-thioguanine (6-TG). This sensor showed two separate oxidative peaks at 530 mV for 6-MP and at 730 mV for 6-TG with a peak potential separation of 200 mV which was large enough for simultaneous detection of the two anticancer drugs. In addition, the proposed sensor presented long-term stability, good repeatability, and excellent reproducibility. Finally, the modified electrode demonstrated satisfactory outcomes while used in real samples, proposing the appropriate potential of Fe3O4@ppy-Pt/SPE in the case of clinical diagnosis, biological samples and pharmaceutical compounds analysis.

Human Dental Pulp-Derived Mesenchymal Stem Cell Potential to Differentiate into Smooth Muscle-Like Cells In Vitro.

Previous studies have shown that mesenchymal stem cells (MSCs) derived from various tissue sources can be differentiated into smooth muscle-like cells (SMLCs) in vitro. In this paper, dental pulp-derived mesenchymal stem cells (DPSCs) were evaluated for their differentiation ability towards smooth muscle-like cells (SMLCs) under the effect of widely used cytokines (TGF-ß1 and PDGF-BB) with special focus on different culturing environments. For this purpose, both the commercially used culturing plates (Norm-c) and 0.1% gelatin-precoated (Gel-c) plates were used. Isolated cells displayed plastic adherence, pluripotency and cell surface marker profiling, and adipogenic and osteogenic differentiation potential with lineage specific marker expression. Differentiated cells induced under different culturing plates showed successful differentiation into SMLCs by positively expressing smooth muscle cell (SMC) specific markers both at the mRNA and protein levels. Gelatin coating could substantially enhance DPSC differentiation potential than Norm-c-induced cells. However, the absence of mature marker MHY-11 by immunostaining results from all treatment groups further indicated the development of immature and synthetic SMLCs. Finally, it was concluded that DPSC differentiation ability into SMLCs can be enhanced under cytokine treatment as well as by altering the cellular niche by precoating the culturing plates with suitable substrates. However, to get fully functional, contractile, and mature SMLCs, still many different cytokine cocktail combinations and more suitable coating substrates will be needed.

Choice of graft material in relation to maxillary sinus width in internal sinus floor augmentation.

PURPOSE: When grafts with solely osteoinductive or osteoconductive effects are used in the maxillary sinus, the medial wall of the sinus membrane should be reflected to receive the vascular supply and the osteoconductive effect. Because the internal sinus floor augmentation is a blind technique, it is impossible to directly verify whether the medial sinus wall is reflected in the operation. The purpose of this study is to describe the modality of choice among the grafting materials and techniques in relation to the width of the maxillary sinus through preoperative planning and measuring in computed tomography (CT) images. PATIENTS AND METHODS: In a total of 57 patients, 100 implants were placed by 3 different sinus floor augmentation techniques. Postoperative cone-beam CT (CBCT) scans were performed and the arrival distance of grafts from lateral wall to medial wall at the apical end level of the implant in the maxillary sinus was measured. RESULTS: Buccolingual arrival distances of grafts were measured to be a mean of 12.1 mm +/- 2.0 in postoperative CT images. In 23 of 77 cases (29.9%) in which distances were greater than 12.1 mm, the grafts made contact with the medial wall. However, in 22 of 23 cases (95.7%) in which distances were less than 12.1 mm, the grafts made complete contact with the medial wall. CONCLUSIONS: The buccolingual width of the maxillary sinus should be measured at the apical end level of the implant that will be placed in preoperative CT. In the internal sinus floor augmentation, grafting materials with solely osteoconductive potential are to be used for narrow sinuses. For large sinuses, autogenous bone with osteogenic potential should be used; alternatively, the reflection of the medial wall by the lateral window technique is recommended.

Clinical outcome of implants placed in grafted maxillary sinus via lateral approach: A 10-year follow-up study.

BACKGROUND/PURPOSE: The maxillary sinus floor augmentation (MSFA) technique is frequently used for the preparation of implant sites in the maxillary region. The aim of this study was to investigate the 10-year outcome of dental implants placed in a grafted maxillary sinus, and identify possible risk factors for implant failure. MATERIALS AND METHODS: We retrospectively analyzed 202 implants after MSFA in 97 patients from January 2008 to April 2009. The outcome variables were 1) 10-year cumulative survival rate of the implant, 2) risk factors for implant failure, and 3) correlation between preoperative residual bone height (RBH) and graft materials in terms of implant survival. Graft materials used were divided into five different groups: autogenic, allogenic, xenogenic, combination of allogenic and xenogenic, or combination of autogenic and xenogenic graft. RESULTS: The cumulative 10-year survival rate for the implants was 96.04%. In regions with a residual bone height of 5.0 mm and less, greater RBH was preferable for long-term implant survival (odds ratio = 3.475; p = 0.035). Implant survival was not significantly different with different graft materials, even when RBH was unfavorable. CONCLUSION: The placement of dental implants with MSFA is a reliable procedure. Further, RBH is an important predictor of long-term implant survival.

Measurement of mandibular lingula location using cone-beam computed tomography and internal oblique ridge-guided inferior alveolar nerve block.

OBJECTIVES: Inferior alveolar nerve block (IANB) is the most frequently used treatment for mandibular molars. Successful IANB requires insertion of the dental needle near the mandibular foramen. In this study, we aimed to analyze the anatomic location of the mandibular lingula and evaluate the effects of internal oblique ridge (IOR)-guided IANB. MATERIALS AND METHODS: The location of the mandibular lingula was measured using cone-beam computed tomography images of the mandibles obtained from 125 patients. We measured the distances from the occlusal plane to the lingula and from the IOR to the lingula in 250 mandibular rami. Based on the mean of these distances, alternative anesthesia was carried out on 300 patients, and the success rate of the technique was evaluated. RESULTS: The mean vertical distance was 8.85±2.59 mm, and the mean horizontal distance was 14.68±1.44 mm. The vertical (P<0.001) and the horizontal (P<0.05) distances showed significant differences between the sex groups. The success rate of the IOR-guided technique was 97.3%. CONCLUSION: IANB-based location of mandibular lingula showed a high success rate. From this study, we concluded that analysis of the anatomic locations for mandibular lingula and IOR-guided IANB are useful for restorative and surgical dental procedures of the mandibular molars.

Developing a thermal grafting process for zwitterionic polymers on cross-linked polyethylene with geometry-independent grafting thickness.

To overcome the drawbacks of the UV grafting method, an alternative, thermal grafting process is suggested. The uniform and geometry-independent grafting of zwitterionic polymers on curved cross-linked polyethylene (CLPE), which is used in artificial hip joints, surface was successfully achieved. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) and poly(2-(methacryloyloxy)ethyl)dimethyl(3-sulfopropyl)ammonium hydroxide) (PMEDSAH) were grafted on the CLPE by two methods: a UV-based process and a thermal process. The thermal method yielded zwitterionic surfaces with similar hydrophilicities and graft layer thicknesses to those prepared via the UV grafting method. The X-ray photoelectron spectra and surface zeta potential results showed that the PMPC and PMEDSAH layers were successfully grafted onto the CLPE surface. In addition, 3-D confocal microscopy, as well as friction and wear volume tests, confirmed that there was a significant decrease in the friction coefficient and wear, which indicates that the thermal grafting method can successfully substitute the UV grafting method. The thermally grafted polymer showed uniform graft layer thickness on the curved CLPE surface, whereas the UV-grafted polymer showed a geometry-dependent heterogeneous graft layer thickness. Thus, we confirmed that the thermal grafting method is advantageous for the preparation of uniform grafting layers on artificial joint surfaces with complicated shapes. STATEMENT OF SIGNIFICANCE: Formation of uniform grafting thickness of the zwitterionic polymers on the implant materials is a very important issue in the field of biomaterials. In this study, a thermal grafting process was developed for the formation of the uniform grafting thickness of the zwitterionic polymers on the curved cross-linked polyethylene (CLPE) surface used in artificial hip-joint. This method yielded zwitterionized CLPE surfaces with similar hydrophilicities and friction coefficient to those prepared via the UV grafting method which has been widely used process to modify the implant surfaces. Furthermore, the thermally grafted CLPE surface showed geometry-independent uniform grafting thickness on the curved CLPE surface while UV-grafted one showed uneven grafting thickness. This grafting method could help the development of complex, personalized, and biocompatible artificial liner surfaces.

Bioprinting of three-dimensional dentin-pulp complex with local differentiation of human dental pulp stem cells.

Numerous approaches have been introduced to regenerate artificial dental tissues. However, conventional approaches are limited when producing a construct with three-dimensional patient-specific shapes and compositions of heterogeneous dental tissue. In this research, bioprinting technology was applied to produce a three-dimensional dentin-pulp complex with patient-specific shapes by inducing localized differentiation of human dental pulp stem cells within a single structure. A fibrin-based bio-ink was designed for bioprinting with the human dental pulp stem cells. The effects of fibrinogen concentration within the bio-ink were investigated in terms of printability, human dental pulp stem cell compatibility, and differentiation. The results show that micro-patterns with human dental pulp stem cells could be achieved with more than 88% viability. Its odontogenic differentiation was also regulated according to the fibrinogen concentration. Based on these results, a dentin-pulp complex having patient-specific shape was produced by co-printing the human dental pulp stem cell-laden bio-inks with polycaprolactone, which is a bio-thermoplastic used for producing the overall shape. After culturing with differentiation medium for 15 days, localized differentiation of human dental pulp stem cells in the outer region of the three-dimensional cellular construct was successfully achieved with localized mineralization. This result demonstrates the possibility to produce patient-specific composite tissues for tooth tissue engineering using three-dimensional bioprinting technology.

Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures.

PURPOSE: To compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures. MATERIALS AND METHODS: This retrospective cohort study included patients with mandibular subcondylar fractures treated with EAORIF using bioabsorbable unsintered hydroxyapatite/poly l-lactide composite plates or titanium miniplate systems. The outcome variables included preoperative fracture conditions, postoperative stability during fracture healing, and complications during the follow-up period. Other variables included clinical characteristics (age, sex, fracture site, and total follow-up duration) and intra- and postoperative data (surgical duration, duration of intermaxillary fixation/elastic band guidance). Variables were evaluated using descriptive statistics and compared between groups using the Mann-Whitney test and the chi-square test or Fisher's exact test, as appropriate. RESULTS: In total, 28 patients were analyzed, including 13 who underwent EAORIF using bioabsorbable plates and 15 who underwent EAORIF using titanium miniplates. With the exception of second surgery for plate removal, none of the assessed variables showed significant differences between the two groups (p < 0.05). CONCLUSIONS: Our results suggest that EAORIF using biodegradable plates is a stable and reliable method for the management of mandibular subcondylar fractures and eliminates the need for secondary surgery for plate removal.

Predictors and Long-Term Clinical Outcome of Longitudinal Stent Deformation: Insights From Pooled Analysis of Korean Multicenter Drug-Eluting Stent Cohort.

BACKGROUND: There are limited data on the frequency of and factors associated with quantitative coronary angiography (QCA)-defined longitudinal stent deformation (LSD) in various contemporary drug-eluting stents platforms. This study sought to evaluate the predictors of LSD and its long-term clinical implication. METHODS AND RESULTS: A patient-level pooled analysis was performed with 7350 lesions in 5871 patients treated with platinum-chromium-based everolimus-eluting stent (Promus Element), cobalt-chromium-based everolimus-eluting stent (Promus/Xience V), or cobalt-chromium-based zotarolimus-eluting stent (Endeavor Resolute). QCA was performed to analyze differences of stent length between immediate post-deployment and final post-procedure. Independent factors associated with LSD were identified. Clinical outcomes at 3 years were compared between those with and without QCA-based LSD. The frequency of QCA-based LSD was 1.12% (82 cases). Nine of these cases were angiographically overt. Left main or ostial lesion, bifurcation treatment with provisional side branch stenting or ballooning, additional downstream intervention of a distal lesion, intravascular ultrasound use, and adjunctive post-dilatation were independently associated with QCA-based LSD. The type of stent was not associated with QCA-based LSD. Rates of target lesion failure were nominally higher in lesions with QCA-based LSD than in those without (8.97% versus 5.88%; hazard ratio, 1.415; 95% confidence interval, 0.631-3.175; P=0.399). CONCLUSIONS: LSD is uncommon with contemporary drug-eluting stents, regardless of the type of stent platform. LSD is mainly associated with procedural factors, especially with additional downstream procedures which require the passage of devices through the stent. Careful manipulation of poststent imaging or procedural devices is required to prevent LSD. More data are needed to clarify the impact of LSD on clinical events.

Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI.

OBJECTIVE: Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. MATERIAL AND METHODS: Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks "a souk" and "a geese" were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. RESULTS: The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. CONCLUSION: The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.

Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial.

BACKGROUND: The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. METHODS/DESIGN: The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. DISCUSSION: The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. TRIAL REGISTRATION: National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495 ), registration date: May 8, 2012.

Two-Year Safety and Efficacy of Biodegradable Polymer Drug-Eluting Stent Versus Second-Generation Durable Polymer Drug-Eluting Stent in Patients With Acute Myocardial Infarction: Data from the Korea Acute Myocardial Infarction Registry (KAMIR).

BACKGROUND: Despite improved long-term safety of biodegradable polymer (BP) drug-eluting stents (DES) compared to first-generation durable polymer (DP) DES, data on the safety and efficacy of BP-DES compared with second-generation (2G) DP-DES in patients with acute myocardial infarction (AMI) are limited. HYPOTHESIS: To evaluate the safety and efficacy of BP-DES compared with 2G-DP-DES in the higher stent thrombosis (ST) risk setting of AMI. METHODS: A total of 3359 AMI patients who received either BP-DES (n = 261) or 2G-DP-DES (n = 3098) were included from the Korea Acute Myocardial Infarction Registry (KAMIR). Differences in baseline clinical and angiographic characteristics were adjusted using a 1:5 propensity score matching analysis (n = 261 for BP-DES and n = 1305 for 2G-DP-DES). The primary outcome was the incidence of major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction (re-MI), and target vessel revascularization (TVR). The rate of definite or probable ST was also investigated. RESULTS: In adjusted analysis, there was no significant difference between the 2 groups in baseline clinical and angiographic characteristics; 2-year MACE (10.7% and 9.9% in the BP-DES group and 2G-DP-DES group, respectively, P = 0.679); ST incidence (0.8% vs 0.9%, respectively, P = 1.0), and rates of all-cause death, re-MI, and TVR. By multivariate analysis, old age, diabetes mellitus, renal dysfunction, and left ventricular dysfunction were the independent predictors of MACE after BP-DES or 2G-DP-DES implantation. CONCLUSIONS: BP-DES and 2G-DP-DES appear to have comparable 2-year safety and efficacy for the treatment of AMI. However, longer-term follow-up is needed.

Objective Tinnitus Concomitant with Eye Blinking: A Case Report.

Tinnitus is a common auditory phenomenon associated with many otological diseases, and is usually subjective. Objective tinnitus can be generated by para-auditory structures, usually derived from vascular or myogenic sources, or the eustachian tube. We present a rare case of intermittent unilateral tinnitus associated with eye blinking. Otoendoscopic examination showed that the external auditory canals and tympanic membranes were normal; however, rhythmic movements of both tympanic membranes, concomitant with the tinnitus, were evident whenever the patient blinked. The tympanometry and stapedial reflexes measured via impedance audiometry exhibited saw-tooth patterns; movement of the tympanic membrane was associated with eyelid blinking. The patient was managed conservatively, with reassurance and medication, and the condition became well-controlled. Here, we present this educational case and review the literature.