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Blends of aqueous polymer dispersions used for pellet coating: importance of the particle size.

Blends of aqueous dispersions of a water-insoluble and an enteric polymer, namely ethyl cellulose:hydroxypropyl methylcellulose acetate succinate (EC:HPMCAS) and ethyl cellulose:methacrylic acid ethyl acrylate copolymer (EC:Eudragit L), were used as coating materials to control theophylline release from matrix pellets. Varying the polymer blend ratio, broad ranges of drug release patterns were obtained at low as well as at high pH. Interestingly, the resulting release profiles were rather similar for both types of blends in 0.1 M HCl, whereas significant differences were observed in phosphate buffer pH 7.4. Surprisingly, drug release at high pH was much slower for EC:HPMCAS blends compared to EC:Eudragit L blends, although HPMCAS leached out more rapidly (and to a higher extent) from the film coatings than Eudragit L. To explain these phenomena and to better understand the underlying drug release mechanisms, thin polymeric films of identical composition as the pellet coatings were prepared and physicochemically characterized before and upon exposure to the release media. Importantly, the polymer particle size was identified to be a very crucial formulation parameter, determining the resulting film coating structure and properties. The Eudragit L particles are much smaller than the HPMCAS particles (nano- vs. micrometer size range) and, thus, more effectively hinder the formation of a continuous and mechanically stable EC network. Consequently, the EC structures remaining after enteric polymer leaching at high pH are mechanically much weaker in the case of Eudragit L. Upon exposure to phosphate buffer, water-filled cracks are formed, through which the drug rapidly diffuses out. In contrast, the EC structures remaining upon HPMCAS leaching are mechanically stronger and drug release is controlled by diffusion through the polymeric remnants.

Cellulose↗

Bond strength of a dentin bonding system using two techniques of polymerization: visible-light and argon laser.

OBJECTIVE: The aim of this work was to study one dentin-bonding system associated with posterior teeth restorative composite resin by means of tensile bond strength tests varying the technique of polymerization: visible light and argon laser. BACKGROUND DATA: Previous studies have demonstrated the ability of the argon laser to polymerize light-activated materials. METHODS: Sixty specimens were prepared by grinding the labial surface of bovine teeth embedded in acrylic resin. The dentin bonding system used was Single Bond (3M), which has a poliacenoic acid copolimer, associated with a posterior teeth restorative composite resin (Filtek P60, 3M). The bonding sites were treated according to the instruction of the manufacturers. The 60 teeth, duly embedded and ground, were assigned to four groups with 15 teeth each: group 1, the adhesive was light cured during 10 sec with visible light (Curing Light, 3M) with power density of 410 mW/cm2 and the composite resin was light cured during 20 sec with visible light; group 2, the adhesive and the composite resin were cured during 10 seconds with argon laser with 150 mW of power; group 3, the adhesive and the composite resin were cured during 10 sec with argon laser with 200 mW of power; and group 4, the adhesive and the composite resin were cured during 10 sec with argon laser with 250 mW of power. The composite resin was light cured in layers of 1 mm of thickness until the model of teflon with 3 mm in height was completely filled. RESULTS: The tensile bond strength test was performed in a Mini-Instron (model 4442) and the results for group 1 were 19.75 MPa (+/-4.65), group 2 were 16.09 MPa (+/-7.27), group 3 were 11.56 MPa (+/-4.50), and group 4 were 11.90 MPa (+/-5.78). CONCLUSIONS: One can conclude that the tensile bond strength promoted by the polymerization with visible light presented greater tensile bond strength than the polymerization with argon laser with 200 mW and 250 mW, but there was no significant difference between visible light and argon laser with 150 mW. There was no significant difference between argon laser with 150 mW and argon laser with 200 mW or 250 mW.

Animals↗

A pH-dependent colon targeted oral drug delivery system using methacrylic acid copolymers. I. Manipulation Of drug release using Eudragit L100-55 and Eudragit S100 combinations.

Lactose-based placebo tablets were coated using various combinations of two methacrylic acid copolymers, Eudragit L100-55 and Eudragit S100, by spraying from aqueous systems. The Eudragit L100-55-Eudragit S100 combinations (w/w) studied were 1:0, 4:1, 3:2, 1:1, 2:3, 1:4, 1:5 and 0:1. The coated tablets were tested in vitro for their suitability for pH dependent colon targeted oral drug delivery. The same coating formulations were then applied on tablets containing mesalazine as a model drug and evaluated for in vitro dissolution rates under various conditions. The disintegration data obtained from the placebo tablets demonstrate that disintegration rate of the studied tablets is dependent on: (i) the polymer combination used to coat the tablets, (ii) pH of the disintegration media, and (iii) the coating level of the tablets. Dissolution studies performed on the mesalazine tablets further confirmed that the release profiles of the drug could be manipulated by changing the Eudragit L100-55 and Eudragit S100 ratios within the pH range of 5.5 to 7.0 in which the individual polymers are soluble respectively, and a coating formulation consisting of a combination of the two copolymers can overcome the issue of high gastrointestinal (GI) pH variability among individuals. The results also demonstrated that a combination of Eudragit L100-55 and Eudragit S100 can be successfully used from aqueous system to coat tablets for colon targeted delivery of drugs and the formulation can be adjusted to deliver drug at any other desirable site of the intestinal region of the GI tract on the basis of pH-variability. For colon targeted delivery of drugs the proposed combination system is superior to tablets coated with either Eudragit L100-55 or Eudragit S100 alone.

Acrylic Resins↗

Eighteen-month clinical evaluation of two dentin adhesives applied on dry vs moist dentin.

PURPOSE: To evaluate the influence of substrate moisture on the clinical behavior of two dentin adhesives after 18 months. The null hypothesis tested was that drying dentin with air upon rinsing off the acid would not influence the clinical performance of two dentin adhesives as compared to leaving the preparation visibly moist. MATERIALS AND METHODS: Thirty-five patients were enrolled in this study. One hundred twenty-eight restorations divided into 4 groups were inserted and evaluated at baseline: (1) NT/Moist - Prime & Bond NT, an acetone-based adhesive, applied on moist dentin; (2) NT/Dried - Prime & Bond NT applied on dentin dried with air for 3 to 4 s; (3) SB/Moist - Single Bond, an ethanol- and water-based adhesive, applied on moist dentin; (4) SB/Dried - Single Bond applied on dentin dried with air for 3 to 4 s. A microfilled composite resin was used for all restorations. Patients were recalled at 6 and 18 months. RESULTS: At 18 months after initial placement, 110 restorations (86% recall rate) were re-evaluated. Retention rates at 18 months were 92% for NT/Moist, 93% for NT/Dried, 100% for SB/Moist, and 89% for SB/Dried. No statistically significant differences were found among groups for retention rate. Both NT/Moist and SB/Moist resulted in a significant decrease in sensitivity to air from baseline to 18 months. When data were pooled for the variable "substrate moisture", SB resulted in an overall retention rate of 95%, while NT resulted in a retention rate of 92% (statistically similar). The marginal adaptation with SB was significantly worse at 18 months than at baseline. CONCLUSION: The moisture level of the dentin substrate in noncarious cervical lesions does not influence retention of composite restorations, but moist conditions caused less sensitivity to air. When applied as per manufacturers' instructions (moist dentin), both adhesives resulted in Class V retention rates exceeding the ADA 18-month full acceptance guidelines.

Acrylic Resins↗

Effect of biological contamination on dentine bond strength of adhesive resins.

The purpose of this in vitro study was to determine the effect of saliva (S) and blood (B) contamination on the dentine bond strength of two single-component dentine bonding systems. The occlusal thirds of 120 recently extracted, human molars were removed with a low speed saw and subsequently embedded in Bencor rings by means of self-curing, acrylic resin. The occlusal surfaces were ground wet on 600-grit silicone carbide paper in a polishing machine to expose superficial dentine and to create a smear layer. The teeth were randomly divided into 12 groups (n = 10). All the dentine surfaces were etched with 34% phosphoric acid for 15 seconds rinsed with water, air-dried for 3 seconds, leaving the surfaces visibly moist. For the control groups (C) the etched dentine surfaces were treated with either, Scotchbond 1 (SB1, 3M) or Prime & Bond NT (PBNT, Dentsply) according to the manufacturer's instructions. In the contaminated groups, the saliva or blood was applied by means of a disposable brush, left undisturbed for 1 minute, and the excess then thinned by air spray. The dentine bonding systems were then applied, also according to manufacturer's instructions. Composite (Z250 and TPH) and Compomer (F2000 and Dyract AP (D-AP)) stubs were packed and cured incrementally to the corresponding pretreated dentine surfaces. All specimens were stored for 24 hours under water at 37 degrees C. The bonds were then stressed to failure with a Zwick testing machine, operating at a crosshead speed of 0.5 mm/min. Fractured samples were examined in a Scanning Electron Microscope. The data were statistically analysed (Student-t test). The mean SBS (MPa) were. SB1 with Z250: C = 19.1 +/- 4.4; S = 17.3 +/- 3.5; B = 2.6 +/- 0.9; SB1 with F2000: C = 11.8 +/- 3.3; S = 9.7 +/- 1.8; B = 4.7 +/- 1.6. PBNT with TPH: C = 9.2 +/- 3.2; S = 6.5 +/- 3.0; B = 4.3 +/- 1.5; PBNT with D-AP: C = 10.2 +/- 3.6; S = 9.3 +/- 2.9 and B = 7.3 +/- 2.5. There was no statistical significant difference in shear bond strengths between the control and the saliva-contaminated samples for both systems. There was, however, a significant difference in bond strengths between the control and the blood-contaminated samples. Blood contamination negatively influenced bond strength of bonding systems to dentine.

Blood↗

Effect of high-powered LED polymerization on the shear bond strength of a light-polymerized resin luting agent to ceramic and dentin.

STATEMENT OF PROBLEM: A newly introduced high-powered light-emitting diode (LED) light-polymerization unit with various polymerization modes is purported to polymerize dental resins more quickly than standard units. However, there is insufficient information about the effects of this type of light source and its polymerization modes on resin luting agents (RLAs). PURPOSE: This in vitro study evaluated the effects of different modes of a high-powered LED polymerization unit on the shear bond strength of a light-polymerized RLA to ceramic and dentin. MATERIAL AND METHODS: Sixty ceramic cylinders (3 x 3 mm) were fabricated from a heat-pressed ceramic (IPS Empress 2). Specimen surfaces were abraded using 600-grit silicon carbide paper and airborne-particle abraded with 50-mum desiccant alumina particles, cleaned ultrasonically, etched using hydrofluoric acid, and treated with a silane coupling agent (Ceramic primer). Sixty noncarious, freshly extracted, permanent human molar teeth were embedded in autopolymerizing acrylic resin, and their dentin surfaces were wet-ground using a grinding and polishing machine fitted with 180-grit abrasive disks. The ground dentin surfaces were then etched with 37% phosphoric acid gel, and an adhesive agent (Single Bond) was applied. Ceramic specimens (n = 15) were bonded to dentin surfaces with a dual-initiated RLA (Rely-X ARC) and individually polymerized by 1 of 4 different modes, as follows: Halogen standard mode (Control) (600 mW/cm2 for 40 seconds); high-powered LED fast mode (1100 mW/cm2 for 10 seconds); high-powered LED pulse mode (1100 mW/cm2 for 10 seconds); and high-powered LED exponential mode (1100 mW/cm2 for 20 seconds). Cemented specimens were subjected to shear loading until fracture using a universal testing machine. A stereomicroscope (x25) was used to identify the mode of fracture. Bond strength (MPa) data were analyzed using 1-way analysis of variance and the Tukey HSD test (alpha = .05). RESULTS: Specimens polymerized using halogen standard mode (23.9 +/- 1.3 MPa) and LED exponential mode (23.0 +/- 1.1 MPa) had significantly higher ( P < .001) mean shear bond strengths compared with both LED fast (15.1 +/- 1.3 MPa) and pulse (14.6 +/- 1.3 MPa) modes. The Tukey HSD tests showed no significant differences in shear bond strength between specimens polymerized using high-powered LED exponential mode and halogen standard mode. Most failures were adhesive failures at the dentin-RLA interface or the RLA-ceramic interface in specimens polymerized using high-powered LED fast or pulse modes. CONCLUSION: Within the limitations of this study, the shear bond strength of an RLA to ceramic and dentin was found to be similar when polymerized using halogen light in standard mode and high-powered LED light in exponential mode, whereas shear bond strength was significantly lower when polymerized using LED in fast or pulse mode.

Analysis of Variance↗

A preliminary study of experimental polyacid-modified composite resins ('compomers') containing vinyl phosphonic acid.

OBJECTIVES: The aim of this investigation was to determine the properties of two novel compomers formulated with the monomer vinyl phosphonic acid (VPA). The setting properties, mechanical strength, wear characteristics and fluoride release of two experimental unshaded compomers containing VPA were determined, and compared with the commercial compomer Dyract A (shade C3). METHODS: Two novel compomers were prepared, containing, respectively, 0.24% (A) and 2.31% (B) by mass of VPA, and an appropriate amount of reactive glass filler. Their properties were compared with those of Dyract AP (shade A3). Depth of cure was determined according to the method of ISO 4049. Polymerization of model mixtures of bisGMA, TEGDMA and VPA was studied using FT Raman spectroscopy, by comparing the absorption at 1608cm(-1) (aromatic C-C bond) with that at 1313cm(-1) (CC aliphatic). Compressive and biaxial flexure strengths were determined for sets of 6 specimens stored either wet or dry. Wear was determined using a toothbrushing machine and an abrasive slurry, and fluoride release was determined following up to 6 weeks storage in aqueous media, using a fluoride-selective electrode. RESULTS: Of the model monomer mixtures, the one with the greater quantities of VPA showed lowest degrees of polymerization after irradiation for 40s. Compomer A had an acceptable depth of cure, and similar properties to Dyract AP in terms of compressive and biaxial flexure strength, and also fluoride release. Resistance to toothbrush abrasion of both of the experimental compomers was superior to that of Dyract AP. SIGNIFICANCE: These studies demonstrate that VPA can be used as the active monomer in experimental compomers, and is capable of yielding materials with properties equivalent to a commercial material, but with improved resistance to toothpaste abrasion. The level of VPA in the formulation is critical, because this monomer inhibits addition polymerization, hence must be used only in small amounts.

Analysis of Variance↗

Evaluation of microleakage in cervical margins of various posterior restorative systems.

PURPOSE: The purpose of this in vitro study was to evaluate the microleakage and dye penetration patterns of various restorative systems in the cervical margins of Class II cavities using the dye penetration technique. MATERIALS AND METHODS: Ninety bovine incisors were selected and part of the crown was sectioned producing a standardized occlusogingival margin of 4 mm. Standardized Class II box cavities were designed on the mesial (MO) and distal (OD) surfaces with the gingival margin in dentin. The cavities were randomly divided into six groups (n = 30): group 1 (control), Etch & Prime 3.0 (Degussa AG) + Definite (Degussa AG); group 2, Prime & Bond NT (Dentsply De Trey) + Definite; group 3, Etch & Prime 3.0 + flowable composite resin Wave (SDI) + Definite; group 4 (control), Prime & Bond NT + TPH Spectrum (Denstply De Trey); group 5, Etch & Prime 3.0 + TPH Spectrum; group 6, Prime & Bond NT + Wave + TPH Spectrum. After they were finished and polished, the specimens were subjected to 1500 thermal cycles in baths of 5 degrees+/-2 degrees C and 55 degrees+/-2 degrees C with 60 seconds of dwell time for each bath. After the thermocycling, the specimens were sealed with acid-resistant varnish, leaving a 1-mm window around the cervical margin interface, and immersed in 2% methylene blue buffered solution for 4 hours. Then the specimens were sectioned longitudinally in half and qualitatively evaluated under stereomicroscopy at 45 times magnification, using ranked scores for the dentin cervical margin (0-4). The dye penetration pattern (adhesive or dentinal) was also evaluated. The data were subjected to a reproducibility kappa test, and the mean of the three examiners' scores was analyzed by the Kruskal-Wallis nonparametric test and a multiple comparison nonparametric test. Fisher's exact test was used to evaluate the dye penetration pattern. RESULTS: The rank sums of the groups were expressed in decreasing order: group 4, 67.23a; group 3, 72.58ab; group 6, 78.43ab; group 5, 93.19bc; group 2, 112.97c; group 1, 113.52c. (Statistically significant differences are expressed by different superscript letters.) The results indicate that none of the systems used in this study was able to impede microleakage, and that the use of a flowable resin decreases the values of leakage only for Definite composite resin. The dye penetration pattern for the groups that used Prime & Bond NT was predominantly dentinal, whereas the pattern for Etch & Prime 3.0 groups was adhesive. CLINICAL SIGNIFICANCE: An ormocer-based resin that was developed to improve the physical properties of composite resin and a self-etching primer adhesive system obtained higher values of microleakage compared with a one-bottle adhesive system and a microhybrid composite resin. The flowable composite resin decreased the values of microleakage only for the ormocer-based resin.

Animals↗

Technology to obtain sustained release characteristics of drugs after delivered to the colon.

To determine the necessary technology by which sustained drug release is obtained after drug is delivered to the colon, two kinds of microcapsules were prepared and were filled in a pressure-controlled colon delivery capsule (PCDC). As a model drug 5-aminosalicylic acid (5-ASA) was used, because the target site of 5-ASA is the entire large intestine. 5-ASA was microencapsulated using a water-insoluble polymer, ethylcellulose (EC) or with pH-sensitive polymers, Eudragit L-100 or S-100 and encased in PCDC. The particle size of these microcapsules was around 800 microns and the loading efficiencies of 5-ASA were approximately 90%. In vitro dissolution tests were performed with the prepared microcapsules. The release rate of 5-ASA from the microcapsules was significantly prolonged as compared to 5-ASA powder, although there were no significant differences in the release rates between these microcapsules. By incorporating the 5-ASA microcapsules into PCDC, sustained release PCDCs for colon delivery were prepared and in vivo evaluation was performed using beagle dogs. As a fast release colon delivery system, PCDCs were prepared with 5-ASA powder suspended in suppository base. After oral administration of the test preparations to beagle dogs, plasma 5-ASA concentrations were measured and sustained release characteristics of 5-ASA from the test preparations were evaluated from the plasma 5-ASA concentration-time profiles. The first appearance time of 5-ASA into the systemic circulation after oral administration were 3 h for all the colon delivery preparations and it was thought that these test preparations were delivered to the colon. Both EC microcapsules and Eudragit S-100/RS-100 microcapsules in PCDC showed longer the mean residence time MRT, 8.2 +/- 0.6 h and 8.7 +/- 0.9 h, than Eudragit L-100/RS-100 microcapsules in PCDC where the MRT was 6.6 +/- 0.2 h. Since PCDCs containing 5-ASA powder exhibited a MRT of 7.0 +/- 1.0 h, these two types of preparations have suggested sustained release characteristics.

Algorithms↗

Single-bottle adhesives behave as permeable membranes after polymerization. I. In vivo evidence.

OBJECTIVES: This study tested the hypothesis that single-bottle total-etch adhesives are effective in reducing dentine permeability under in vivo conditions. METHODS: Crown preparations on vital human teeth were performed under local analgesia as part of the treatment plan for prosthetic rehabilitation. Four single-bottle adhesives (Single Bond, 3M ESPE; Excite DSC, Ivoclar Vivadent; Prime and Bond NT Dual-Cure, Dentsply DeTrey and One-Step, Bisco Inc.) were applied to the cut dentine after acid-etching. Polyvinyl siloxane impressions were taken, using an ultra-low viscosity impression material, of the smear layer-covered dentine before applying the adhesives to deep vital dentine, and after adhesive placement. Additional impressions were taken of the adhesive-sealed dentine following the removal of the provisional prostheses after a 7-10 day period. Epoxy resin replicas of the crown preparations were examined with scanning electron microscopy to evaluate the extent of dentinal fluid transudation during pre-bonded, immediately bonded and post-bonded periods. RESULTS: Dentinal fluid transudation from localised areas that were close to the dental pulp was universally observed from all epoxy resin replicas, irrespective of the adhesive employed. The transudation of dentinal fluid from the control smear layer-covered dentine of each crown preparation was comparatively mild when compared to the extent that was observed after total-etching and application of the single-bottle adhesive. Dentinal fluid droplets were specifically located over the surface of the adhesive layer. Continuous transudation of dentinal fluid occurred even after the removal of the provisional prostheses, and was considerably more profuse in subjects who opted for the fitting of the permanent prostheses without the use of a local anaesthetic solution. CONCLUSION: Single-bottle adhesives, because of their lack of a comparatively more hydrophobic bonding resin layer, behave as permeable membranes after polymerisation. They permit the continuous transudation of dentinal fluid and do not provide a hermetic seal in vital deep dentine. Although the relatively slow rate of diffusion of dentinal fluid is unlikely to result in post-operative cold sensitivity, it may interfere with the optimal polymerisation of dual-cured or auto-cured composites or resin cements in both direct and indirect restorations.

Adhesives↗

Improvement in site-specific intestinal absorption of furosemide by Eudragit L100-55.

Furosemide (frusemide) is a weakly acidic diuretic drug. Its absorption is poor and variable, in part due to its restricted sites of absorption, mainly the stomach. The narrow absorption window of this drug can be explained by pH partition theory. The purpose of this study was to investigate the feasibility of widening the absorption window of furosemide by controlling the pH in distal portions of the gastrointestinal tract with officially used additives. Methacrylate copolymer (Eudragit L100-55), hydroxypropylmethylcellulose phthalate (HP-55) and hydroxypropylmethylcellulose acetate succinate (AS-MF) were selected as additives. The pH of suspensions of these additives was about 4, and the pH was adjusted to about 6-7 by the addition of NaOH. The Eudragit L100-55 suspension was found to be the most resistant to NaOH titration. When Eudragit L100-55 was used in an in-situ ileal loop experiment in rats, the pH of the intestinal contents was significantly reduced, from 7.9+/-0.1 to 5.7+/-0.1, and the plasma concentration of furosemide 15 min after administration was about 3 times higher than that in controls, 1.81+/- 0.42microg mL(-1) vs 0.63+/-0.08 microg mL(-1). However, the plasma concentration of [14C] mannitol was not changed by the co-administration of Eudragit L100-55. Furthermore, the AUC of furosemide was significantly increased by a factor of about 1.6 relative to that in controls by the co-administration of Eudragit L100-55, to 21.4+/-4.0 microg h mL(-1) from 13.3+/- 3.9 microg h mL(-1), and the gastrointestinal pH in the midgut and ileum was significantly reduced, with most of the furosemide remaining in these segments at 2 h following the oral administration of furosemide with Eudragit L100-55 to rats. These findings clearly demonstrate that the addition of Eudragit L100-55 can increase the absorption of furosemide in distal portions of the gastrointestinal tract. In conclusion, it is feasible to widen the absorption window of furosemide by controlling the pH in distal portions of the gastrointestinal tract by the co-administration of Eudragit L100-55.

Animals↗

Effects of differing nicotine-replacement doses on weight gain after smoking cessation.

OBJECTIVE: To prospectively assess effects of doses of a nicotine-replacement agent on weight gain in men and women after smoking cessation. DESIGN: Four-week, randomized, double-blind clinical trial. SETTING: Outpatient medical clinic. STUDY PARTICIPANTS: Healthy volunteers who smoked at least 10 cigarettes per day. INTERVENTION: Pharmacologic: Random assignment to 0, 2, or 4 mg of nicotine polacrilex on a fixed-dose schedule (one piece per hour while awake). Behavioral: Brief, medical/behavioral counseling regarding smoking cessation. MAIN OUTCOME MEASURE: Weight change as a function of dose and gender only in participants abstinent for all 4 week. (Self-reported abstinence verified by breath carbon monoxide levels). RESULTS: Weight change in women abstinent for 4 weeks (n = 16) was +1.69, +0.33, and -0.26 kg in the placebo, 2-mg, and 4-mg groups, respectively, compared with +1.60, +1.45, and +1.18 kg for the men who were abstinent for 4 weeks (n = 19). Medication use did not differ as a function of dose or gender. CONCLUSIONS: Nicotine polacrilex suppressed, in a dose-related fashion, weight gain after smoking cessation in successfully treated women. Weight gain was not shown to be suppressed in men, possibly because of small sample size.

Adult↗

Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler.

BACKGROUND: There are several nicotine replacement products on the market, and physicians are likely to be asked with increasing frequency about which of these products their patients should use. OBJECTIVE: To provide a basis for rational advice by comparing nicotine polacrilex (gum), a transdermal patch, nasal spray, and an inhaler. DESIGN: Randomized trial with assessments at the quit date and 1, 4, and 12 weeks later. SETTING: Hospital smokers' clinic. PATIENTS: Male and female community volunteers (N = 504) smoking 10 or more cigarettes per day and seeking help to stop smoking. INTERVENTIONS: Patients were given brief advice, and purchased their nicotine replacement treatment at approximately half the regular retail price. MAIN OUTCOME MEASURES: Nicotine replacement treatment use, ratings of withdrawal symptoms, ratings of product characteristics and helpfulness, and biochemically validated continuous lapse-free abstinence. RESULTS: The products did not differ in their effects on withdrawal discomfort, urges to smoke, or rates of abstinence. The continuous validated 12-week abstinence rates were 20%, 21%, 24%, and 24% in the gum, patch, spray, and inhaler groups, respectively. Compliance with recommended nicotine replacement treatment use was high for the patch, low for gum, and very low for the spray and the inhaler. The spray was underused because of adverse effects more often than the other products. In the subjects using the spray, the level of use among abstainers at week 1 predicted outcome at week 12. The inhaler was rated as more embarrassing to use than the other products, but provided at least as much nicotine as the gum. CONCLUSION: When asked about nicotine replacement treatment products available, physicians should note that, despite low compliance with the recommended dose of the spray and inhaler and differences in product ratings, overall, there are no notable differences between the products in their effects on withdrawal discomfort, perceived helpfulness, or general efficacy.

Administration, Cutaneous↗

The efficacy of computer-tailored smoking cessation material as a supplement to nicotine polacrilex gum therapy.

BACKGROUND: Standard, generic self-help materials have been largely ineffective as behavioral treatments for smoking cessation. In contrast, self-help programs tailored to the needs of specific smokers have shown promise in facilitating quitting. OBJECTIVE: To evaluate the incremental efficacy of the Committed Quitters Program (CQP), a set of computer-tailored materials offered to purchasers of nicotine polacrilex gum, compared with a briefuntailored user's guide and audiotape, both as supplements to nicotine replacement therapy. METHODS: We conducted a randomized, open-label trial with 3 parallel arms. Subjects were smokers who purchased 2- or 4-mg nicotine polacrilex gum and called the CQP toll-free enrollment line. Three thousand six hundred twenty-seven subjects consented to participate in 1 of 3 study arms: (1) those receiving the CQP materials (CQP group, n= 1,217), (2) those receiving CQP materials and an outbound telephone call (CQP + C group, n= 1,207); and (3) those receiving no supplemental intervention beyond the user's guide and audiotape that were prepackaged with the nicotine polacrilex gum (UG group, n= 1,203). Twenty-eight-day continuous abstinence rates were assessed by telephone interviews at 6 weeks and 10-week continuous rates at 12 weeks into treatment. RESULTS: Abstinence rates among respondents at the 6- and 12-week assessments were significantly higher for the CQP (36.2% and 27.6%) and CQP + C (35.5% and 27.3%) groups compared with the UG group (24.7% and 17.7%) at both intervals. The quit rates for the CQP and CQP + C groups were almost identical. CONCLUSIONS: The CQP proved to be an effective behavioral treatment, enhancing quit rates over and above nicotine replacement therapy and a brief untailored written guide and audiotape.

Adult↗

Efficacy of a nicotine lozenge for smoking cessation.

BACKGROUND: Since nicotine gum was introduced in the 1980s, nicotine replacement therapy has become the most widely used pharmacological smoking cessation treatment. Some smokers prefer acute oral forms, but many smokers reject chewing gum. We tested the safety and efficacy of a new nicotine polacrilex lozenge for smoking cessation. METHODS: Double-blind, placebo-controlled, randomized clinical trial with parallel arms testing 2- and 4-mg nicotine lozenges. Smokers (n = 1818) were assigned to a lozenge dose on the basis of nicotine dependence, assessed by time to the first cigarette of the day. Low-dependence smokers were randomized to receive the 2-mg nicotine (n = 459) or placebo (n = 458) lozenge; high-dependence smokers, the 4-mg nicotine (n = 450) or placebo (n = 451) lozenge. We assessed abstinence at 6, 12, 24, and 52 weeks and analyzed craving and withdrawal symptoms. RESULTS: Treatment with the nicotine lozenge resulted in significantly greater 28-day abstinence at 6 weeks, for the 2-mg (46.0% vs. 29.7%; odds ratio [OR], 2.10; 95% confidence interval [CI], 1.59-2.79; P<.001) and the 4-mg (48.7% vs. 20.8%; OR, 3.69; 95% CI, 2.74-4.96; P<.001) lozenges, compared with placebo. Significant treatment effects were maintained for a full year. Smokers who used more lozenges achieved significantly better treatment effects. Use of the active lozenge also resulted in reduced craving and withdrawal. Most adverse events were moderate and resembled those seen with nicotine gum. CONCLUSION: The nicotine lozenge is a safe and effective new treatment for smoking cessation in low- and high-dependence smokers.

Adult↗

Controlled trial of nicotine polacrilex gum with supportive measures.

In a placebo-controlled, double-blind, 2-year prospective study, 182 smokers were given either nicotine polacrilex gum containing 4 mg of nicotine (n = 92) or a placebo (n = 90). The number of participants abstinent at 2-year follow-up was 41 (44.6%) of 92 in the nicotine group vs 28 (31.1%) of 90 in the placebo group. Abstinence rates for daily nicotine gum users (n = 64) at 12 months and again at 24 months remained 48.4%, as compared with 26.1% and 31.9% for the daily placebo gum users (n = 69). Of participants with a high nicotine-dependence score, those allotted to the nicotine group rather than to the placebo group were 13 times more likely to be abstaining at the 2-year follow-up. Use of nicotine polacrilex gum, therefore, can substantially aid in stopping smoking, particularly among highly dependent smokers.

Adult↗

Methylmethacrylate monomer in intraocular lenses of polymethylmethacrylate. Cellular toxicity.

Tissue cultures of secondary rabbit kidney cells were grown in maintenance medium containing varying concentrations of methylmethacrylate monomer from 5% to 0.05%. No pathologic changes were observed in those tissue cultures containing 0.1% or less monomer as compared to controls. Data from previous studies on the rate of elution of monomer from polymethylmethacrylate and from published studies of aqueous humor dynamics indicate that the monomer level in intraocular lenses will be less than the concentration toxic to living cells in tissue culture.

Animals↗