Economic Evaluation of Ticagrelor for Secondary Prevention Following Acute Coronary Syndromes

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.

Vegetative propagation of bauhinia x blakeana, an ornamental sterile tree

Bauhinia x blakeana (B. purpurea x B. variegata) is a natural hybrid that has been cultivated in gardens, streets and parks. Due to its sterility, it must be vegetatively propagated. The objective of this work was to evaluate the viability of cuttings and grafting on its propagation. Semi-woody cuttings were collected during four seasons and treated with 0; 1,000; 2,000; and 3,000 mg L-1 of IBA. The experimental design was entirely randomized and the treatments were arranged in a 4x4 factorial scheme (four collecting times x four IBA concentrations) and five replications with 10 cuttings each, per collecting time and per IBA concentration. Characteristics of roots and shoots were evaluated after 90 days. The data means were compared by the Tukey test and submitted to the polynomial regression analysis. For the grafting experiment, B. variegata and B. variegata var. candida plants of six and 12 months were used as rootstocks and the splice graft and T-budding methods were tested. The experimental design was entirely randomized and the treatments were arranged in a 2x2x2 factorial scheme (two rootstock species x two grafting methods x two rootstock ages) and four replications with five plants each, per rootstock species, per grafting method and per rootstock age. Characteristics of shoots were evaluated after 90 days and the data means were compared by the Tukey test. B. x blakeana can be propagated by semi-woody cuttings collected in spring, without IBA application, or in summer, with the application of 3,000 mg L-1 of IBA. The tested grafting methods were not effective.

Greffage irréversible de polyélectrolytes sur des substrats de silice et de mica et étude des propriétés de surface et de gonflement

Le protocole pour le greffage irréversible du copolymère amphiphile polystyrène-b-poly (acrylate de sodium) PS-b-PANa, sur un substrat de mica et de silice hydrophobe a été développé, en utilisant la méthode de greffage à partir de solution. Les propriétés de surface du bloc chargé ont été évaluées. L’effet de la force ionique sur le gonflement des chaînes a été investigué par ellipsométrie. Les forces d’interaction entre les surfaces recouvertes du copolymère ont été évaluées par la technique SFA. Les profils de force ont démontré être stables et nettement répulsifs en compression et décompression, montrant l’irréversibilité du greffage. Les forces de frottement entre les brosses de PANa sont élevées, mais aucune évidence d’endommagement de la surface n’a été observée. La comparaison entre le comportement à la surface des chaînes de l’acide polyacrylique PAA et celles du PANa, obtenues par deux méthodes de greffage différentes, est également investiguée.

Vegetative propagation of bauhinia x blakeana, an ornamental sterile tree

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação de métodos de enxertia em pepino

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Armazenamento a frio de ramos porta-borbulhas e métodos de enxertia de cultivares de marmeleiro

Visando a aumentar o aproveitamento do material propagativo, ampliar o período de oferta das mudas de marmeleiro e dinamizar o uso da mão-de-obra no viveiro, faz-se necessário o armazenamento dos ramos porta-borbulhas. Sendo assim, o presente trabalho teve por objetivos estudar a viabilidade da manutenção dos ramos porta-borbulhas de diferentes cultivares de marmeleiro, por meio do armazenamento a frio, e diagnosticar o método de enxertia para promover melhor desenvolvimento do enxerto. Ramos dos marmeleiros 'Japonês' (Chaenomeles sinensis), 'Smyrna', 'Portugal', 'Mendoza Inta-37' e 'Provence' (Cydonia oblonga) foram coletados em julho de 2008. Uma parte dos ramos foi utilizada para a realização da enxertia (métodos de borbulhia e garfagem) em mudas de seis meses de idade do porta-enxerto 'Japonês', e a outra parte foi armazenada sob baixa temperatura (estacas envoltas em papel umedecido, embrulhadas em sacos de polietileno colocadas em câmara fria a 4°C), por 30 e 60 dias. Passados 60 dias, foi mensurada a porcentagem de brotação dos enxertos e, ao final de 120 dias da realização das enxertias, foram mensurados o comprimento, o diâmetro e a massa seca média dos enxertos. Concluiu-se que, apesar de as cultivares apresentarem diferença, recomenda-se que os ramos sejam armazenados por até 30 dias, sendo utilizada a enxertia pelo método de garfagem.

Filling of extraction sockets with autogenous bone in cats

OBJETIVO: Avaliar a regeneração óssea de alvéolos dentais de gatos após enxertia. MÉTODOS: Dezoito gatos adultos, distribuídos em três grupos de 6 animais cada, foram submetidos a extração do canino mandibular direito ou esquerdo. No grupo 1, controle, o alvéolo foi deixado vazio. No grupo 2, o alvéolo foi preenchido com osso esponjoso autógeno do osso ilíaco e no grupo 3, com raspa de osso cortical do osso ilíaco. Os animais foram submetidos à eutanásia 6 semanas após a cirurgia. RESULTADOS: Nas radiografias realizadas no pós-operatório imediato na projeção ventrodorsal observou-se uma área de radiolucência correspondente ao local da alveolectomia e extração dentária. Diminuição da radiolucência foi verificada nas radiografias realizadas seis semanas após a cirurgia. Nos cortes histológicos verificou-se a presença de trabéculas ósseas. A porcentagem de tecido ósseo esponjoso presente nos alvéolos dentais foi quantificada por exames histométricos. Não houve diferença estatisticamente significante entre os grupos (Teste de Kruskal-Wallis p > 0.05) (grupo 1: 52,54 ± 15,4; grupo 2: 50,51 ± 5,01; grupo 3: 51,85 ± 9,52). CONCLUSÃO: Os alvéolos dentais de gatos preenchidos com osso esponjoso autógeno ou raspa de osso cortical autógeno apresentaram regeneração óssea similar àquela observada no grupo controle, após um período de observação de seis semanas.

Métodos de enxertia em melão rendilhado e seus efeitos na produtividade em três épocas de cultivo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Enxertia no controle da murcha bacteriana na atividade de enzimas e produção em tomateiro

Pós-graduação em Agronomia (Horticultura) - FCA

Propagação vegetativa e produção de mudas de Bauhinia spp

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Filling of extraction sockets of feline maxillary canine teeth with autogenous bone or bioactive glass

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Manutenção de dois sistemas radiculares em aspectos bioquímicos e fisiológicos durante o desenvolvimento de plantas e desempenho agronômico de Passiflora edulis Sims enxertadas

Pós-graduação em Agronomia (Horticultura) - FCA

Reação de araçazeiros a Meloidogyne enterolobii e enxertia da goiabeira ‘Paluma’ em portaenxertos resistentes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Human Bone Morphogenetic Protein-2 Use for Maxillary Reconstruction in Cleft Lip and Palate Patients

Background: The conventional methods of maxillary alveolar reconstruction in patient with cleft are the periosteoplasty and autologous bone grafting. As an important alternative of bone substitution, there is the recombinant human bone morphogenetic protein-2 (rhBMP-2). This study compares the rhBMP-2 with periosteoplasty and autologous bone grafting. Methods: Patients with cleft and alveolar defect were divided into 3 groups of 6 patients who underwent to autologous iliac crest bone grafting, resorbable collagen sponge with rhBMP2, and periosteoplasty, respectively. The analysis was performed through computed tomographic scan preoperatively and at months 3, 6, and 12 postoperatively. The variables analyzed were the alveolar defect volume, formed bone volume, bone formation rate, maxillary height repair rate, and the formed bone density mean. Results: The formed bone volume was similar comparing the bone graft and BMP groups at 1-year postoperative analysis (P = 0.58). Both of them had the formed bone volume significantly larger than the periosteoplasty group at 3 and 6 months postoperatively. In this last group, the 1-year follow-up was canceled because the bone formation was insufficient. The bone formation rate, the maxillary height repair rate, and the mean of density of the formed bone were similar in the bone graft and BMP groups at 1-year follow-up with P values of 0.93, 0.90, and 0.81, respectively. Conclusions: The amount of formed bone in the periosteoplasty group was insufficient. There was no difference among the bone graft and rhBMP-2 therapy considering the parameters analyzed.

Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial

OBJECTIVE: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting. METHODS: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification). RESULTS: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P = .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P(interaction) = .008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%). CONCLUSION: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.