Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.

Importance: The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. Objective: To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. Interventions: Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. Main Outcomes and Measures: The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. Results: Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. Conclusions and Relevance: Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use of loading doses of atorvastatin among unselected patients with ACS and intended invasive management. Trial Registration: clinicaltrials.gov Identifier: NCT01448642.

Microwave disinfection of complete dentures contaminated in vitro with selected bacteria.

PURPOSE: This study evaluated the effectiveness of microwave irradiation for disinfection of simulated complete dentures. MATERIALS AND METHODS: Seventy dentures were fabricated in a standardized procedure, subjected to ethylene oxide sterilization, individually inoculated (10(7) cfu/mL) with Staphylococcus aureus (n = 20), Pseudomona aeruginosa (n = 20), and Bacillus subtilis (n = 30) and incubated for 24 hours at 37 degrees C. After that, 40 dentures were selected for microwaving. For each microorganism, 10 dentures were submitted to microwave irradiation at 650 W for 3 minutes. In addition, 10 dentures contaminated with B. subtilis were irradiated for 5 minutes. Thirty non-microwaved dentures (n = 10 for each bacteria) were used as positive controls. Replicate aliquots (25 microL) of suspensions were plated at dilutions of 10(-3) to 10(-6) on plates of selective media appropriate for each organism. After incubation (37 degrees C for 48 hours), colonies were counted (cfu/mL). TSB beakers with the microwaved dentures were incubated at 37 degrees C for a further 7 days to verify long-term disinfection. The data were statistically analyzed by the Kruskal-Wallis test (alpha= 0.05). RESULTS: No evidence of growth was observed at 48 hours for S. aureus and P. aeruginosa on plates, and no turbidity was visible in the TSB beakers of these specimens after 7 days of incubation. Dentures contaminated with B. subtilis and irradiated for 3 minutes produced microbial growth on six plates and turbidity on all TSB beakers. Microwaving for 5 minutes resulted in survival of B. subtilis in two plates and two beakers. CONCLUSION: Microwave irradiation for 3 minutes at 650 W produced sterilization of complete dentures contaminated with S. aureus and P. aeruginosa. Dentures contaminated with B. subtilis were disinfected by microwave irradiation after 3 and 5 minutes at 650 W.

Metabolic syndrome signs in Wistar rats submitted to different high-fructose ingestion protocols.

In search of an adequate model for the human metabolic syndrome, the metabolic characteristics of Wistar rats were analysed after being submitted to different protocols of high fructose ingestion. First, two adult rat groups (aged 90 d) were studied: a control group (C1; n 6) received regular rodent chow (Labina, Purina) and a fructose group (F1; n 6) was fed on regular rodent chow. Fructose was administered as a 10 % solution in drinking water. Second, two adult rat groups (aged 90 d) were evaluated: a control group (C2; n 6) was fed on a balanced diet (AIN-93G) and a fructose group (F2; n 6) was fed on a purified 60 % fructose diet. Finally, two young rat groups (aged 28 d) were analysed: a control group (C3; n 6) was fed on the AIN-93G diet and a fructose group (F3; n 6) was fed on a 60 % fructose diet. After 4-8 weeks, the animals were evaluated. Glucose tolerance, peripheral insulin sensitivity, blood lipid profile and body fat were analysed. In the fructose groups F2 and F3 glucose tolerance and insulin sensitivity were lower, while triacylglycerolaemia was higher than the respective controls C2 and C3 (P < 0.05). Blood total cholesterol, HDL and LDL as well as body fat showed change only in the second protocol. In conclusion, high fructose intake is more effective at producing the signs of the metabolic syndrome in adult than in young Wistar rats. Additionally, diet seems to be a more effective way of fructose administration than drinking water.