Risk factors analysis according to regional distribution of white matter hyperintensities in a stroke cohort.

OBJECTIVES: The spectrum of distribution of white matter hyperintensities (WMH) may reflect different functional, histopathological, and etiological features. We examined the relationships between cerebrovascular risk factors (CVRF) and different patterns of WMH in MRI using a qualitative visual scale in ischemic stroke (IS) patients. METHODS: We assembled clinical data and imaging findings from patients of two independent cohorts with recent IS. MRI scans were evaluated using a modified visual scale from Fazekas, Wahlund, and Van Swieten. WMH distributions were analyzed separately in periventricular (PV-WMH) and deep (D-WMH) white matter, basal ganglia (BG-WMH), and brainstem (B-WMH). Presence of confluence of PV-WMH and D-WMH and anterior-versus-posterior WMH predominance were also evaluated. Statistical analysis was performed with SPSS software. RESULTS: We included 618 patients, with a mean age of 72 years (standard deviation [SD] 11 years). The most frequent WMH pattern was D-WMH (73%). In a multivariable analysis, hypertension was associated with PV-WMH (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.29-2.50, p = 0.001) and BG-WMH (OR 2.13, 95% CI 1.19-3.83, p = 0.012). Diabetes mellitus was significantly related to PV-WMH (OR 1.69, 95% CI 1.24-2.30, p = 0.001), D-WMH (OR 1.46, 95% CI 1.07-1.49, p = 0.017), and confluence patterns of D-WMH and PV-WMH (OR 1.62, 95% CI 1.07-2.47, p = 0.024). Hyperlipidemia was found to be independently related to brainstem distribution (OR 1.70, 95% CI 1.08-2.69, p = 0.022). CONCLUSIONS: Different CVRF profiles were significantly related to specific WMH spatial distribution patterns in a large IS cohort. KEY POINTS: • An observational study of WMH in a large IS cohort was assessed by a modified visual evaluation. • Different CVRF profiles were significantly related to specific WMH spatial distribution patterns. • Distinct WMH anatomical patterns could be related to different pathophysiological mechanisms.

Measurement properties of the Brazilian version of the Stroke Upper Limb Capacity Scale (SULCS-Brazil).

BACKGROUND: The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. OBJECTIVES: To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. METHODS: The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test-retest reliability. Test-retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. RESULTS: High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96-0.99) and 80% of the individual items had almost perfect agreement (k= 0.81-1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. CONCLUSIONS: The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke.

Toxicological assessment of pristine and degraded forms of graphene functionalized with MnOx nanoparticles using human in vitro models representing different exposure routes.

The development of novel advanced nanomaterials (NMs) with outstanding characteristics for their use in distinct applications needs to be accompanied by the generation of knowledge on their potential toxicological impact, in particular, that derived from different occupational risk exposure routes, such as inhalation, ingestion, and skin contact. The harmful effects of novel graphene-metal oxide composites on human health are not well understood, many toxicological properties have not been investigated yet. The present study has evaluated several toxicological effects associated with graphene decorated with manganese oxide nanoparticles (GNA15), in a comparative assessment with those induced by simple graphene (G2), on human models representing inhalation (A549 cell line), ingestion (HT29 cell line) and dermal routes (3D reconstructed skin). Pristine and degraded forms of these NMs were included in the study, showing to have different physicochemical and toxicological properties. The degraded version of GNA15 (GNA15d) and G2 (G2d) exhibited clear structural differences with their pristine counterparts, as well as a higher release of metal ions. The viability of respiratory and gastrointestinal models was reduced in a dose-dependent manner in the presence of both GNA15 and G2 pristine and degraded forms. Besides this, all NMs induced the production of reactive oxygen species (ROS) in both models. However, the degraded forms showed to induce a higher cytotoxicity effect. In addition, we found that none of the materials produced irritant effects on 3D reconstructed skin when present in aqueous suspensions. These results provide novel insights into the potentially harmful effects of novel multicomponent NMs in a comprehensive manner. Furthermore, the integrity of the NMs can play a role in their toxicity, which can vary depending on their composition and the exposure route.

Toxicology assessment of manganese oxide nanomaterials with enhanced electrochemical properties using human in vitro models representing different exposure routes.

In the present study, a comparative human toxicity assessment between newly developed Mn3O4 nanoparticles with enhanced electrochemical properties (GNA35) and their precursor material (Mn3O4) was performed, employing different in vitro cellular models representing main exposure routes (inhalation, intestinal and dermal contact), namely the human alveolar carcinoma epithelial cell line (A549), the human colorectal adenocarcinoma cell line (HT29), and the reconstructed 3D human epidermal model EpiDerm. The obtained results showed that Mn3O4 and GNA35 harbour similar morphological characteristics, whereas differences were observed in relation to their surface area and electrochemical properties. In regard to their toxicological properties, both nanomaterials induced ROS in the A549 and HT29 cell lines, while cell viability reduction was only observed in the A549 cells. Concerning their skin irritation potential, the studied nanomaterials did not cause a reduction of the skin tissue viability in the test conditions nor interleukin 1 alpha (IL- 1 α) release. Therefore, they can be considered as not irritant nanomaterials according to EU and Globally Harmonized System of Classification and Labelling Chemicals. Our findings provide new insights about the potential harmful effects of Mn3O4 nanomaterials with different properties, demonstrating that the hazard assessment using different human in vitro models is a critical aspect to increase the knowledge on their potential impact upon different exposure routes.

Saluteca oral con enfoque familiar: hacia una nuevaorientación en educación de la salud bucal / A family-focused oral-health toy library: towards a new direction in oral health education

Introducción: descubrir estrategias con las que se propicie el fomento de la motivación de las habilidades personales, debe ser una tarea permanente del área de la salud bucal. El propósito de este programa fue crear un espacio en la ludoteca, dedicado alrefuerzo de hábitos saludables bucales, con la guía de personas capacitadas como ludotecarias y odontólogos, que desarrollaron estrategias lúdicas de enseñanza y refuerzo de conocimientos sobre temas de la salud bucal con los niños y sus familias. Métodos: se hizo un estudio preexperimental de intervención comunitaria, se evaluaron 99 niños entre los cuatro y doce años. Se hicieron encuestas de conocimientos a los escolares, padres y acudientes antes y después de la interacción con el material lúdico y se aplicaron los índices de caries dental y placa blanda. Resultados: las capacitaciones contribuyeron en la mejoría del nivel de conocimientos de padres y niños del 21 y 29%respectivamente. El porcentaje promedio de placa blanda fue de 38,2 ± 18,9 mostrándose diferencia de 18,3% con respecto al primer examen. Entre las superficies con historia de caries predominaron las obturadas (1,5 ± 2,6). El análisis cualitativo de los niños frente a la percepción de los juegos, reflejó ideas positivas, agradables, divertidas y educativas. Conclusión: el establecimiento de una saluteca oral,vista como un ambiente favorable que involucra estrategias innovadoras para la educación en salud, posibilitó en la población beneficiada la socialización y el fomento de hábitos bucales saludables que refuerzan el autocuidado.

Introduction: discovering strategies to promote motivation of personal skills must be a permanent task of oral healthprofessionals. The purpose of this program was to create a place, within the toy library, devoted to strengthening oral health habits, with the guidance of trained personnel such as toy librarians and dentists, who developed ludic strategies for teaching and reinforcing oral health knowledge among children and their families Methods: this was a pre-experimental community intervention program, which evaluated99 children between 4 and 12 years of age. Surveys were conducted in order to assess the students’, parents’, and guardians’ knowledge before and after their interaction with the ludic material; also, caries and dental plaque indexes were measured. Results: this trainingprogram allowed improving the knowledge level among parents and children by 21 and 29% respectively. The average percentage of dentalplaque was 38.2 ± 18.9 showing a difference of 18.3% with respect to the initial exam. Among the surfaces with caries history, those which had been restored were predominant (1.5 ± 2.6). The qualitative analysis of the children’s perception of the games revealed that they found them positive, nice, fun, and educational. Conclusions: establishing an oral health toy library, as a constructive environment that involvesinnovative strategies aimed at health education, allowed socialization of the studied population as well as promotion of healthy oral habits and reinforcement of self-care among this population.

Evolución quirúrgica de la derivación versus reparación primaria en una población de pacientes lesionados del cólon / Surgical evolution of the derivation versus primary reparation in a population of patients with colonïs lesions

Se realizó un estudio prospectivo en 18 pacientes con lesiones de cólon con el propósito de evaluar los resultados del tratamiento de las lesiones de cólon utilizando la derivación versus reparación primaria en diferentes centros de salud, Santiago y Santo Domingo, República Dominicana, durante el período marzo 1991-marzo 1993. El 88//eran del sexo masculino y el 11//femenino. El rango de edad osciló de 20-45 años. Todos los pacientes recibieron antibioticoterapia prequirúrgico. Todos fueron laparotomizados. Al 50//se le realizó derivación y colostomia, al 50//restante reparación primaria