RESUMO
BACKGROUND: As the life expectancy of elderly people has drastically increased, the incidence of cardiovascular and cerebrovascular diseases in this population has proportionally grown. Vascular cognitive impairment (VCI) refers to all forms of cognitive disorder associated with cerebrovascular disease. Homocysteine has recently been recognized as a contributor to the pathomechanisms involved in cognitive impairment. B vitamins, such as folic acid, are known to be effective in lowering homocysteine levels. AIM OF THE STUDY: To evaluate the efficacy of folic acid in patients with VCI. METHODS: We conducted a systematic review and meta-analysis of research on folic acid treatments for VCI. Only randomized controlled trials studies that compared the efficacy of folic acid to placebo or other interventions were considered, irrespective of publication status, year of publication, and languages. Two independent reviewers searched the Medline via Ovid, EMBASE and Cochrane Central Register of Controlled Trials (Central) journal databases up to July 2021 and independently appraised the included studies. We used mean difference outcome with 95% confidence intervals (CI) to calculate the change of Mini-Mental State Examination (MMSE), cognitive function domain, and concentration of homocysteine. RESULTS: We found three studies comparing folic acid with placebo and one study comparing folic acid with other interventions. There is only slight evidence that the MMSE score in patients who received Folic Acid increased 0.3 point higher compared to the placebo group after 24 months (95% CI:-0.12-0.37; p=0.31). There is very strong evidence that the concentration of Homocysteine in the Folic Acid group became 6.16 µmol/L lower compared to the placebo group after 6 months (95% CI:2.32-8.21 lower; p<0.001). CONCLUSIONS: Our review shows the effectiveness of folic acid in lowering plasma homocysteine concentration after 6 months period compared to placebo. However, this effect is not accompanied by improvement in cognitive function.
RESUMO
Underwater concrete is a cohesive self-consolidated concrete used for concreting underwater structures such as bridge piers. Conventional concrete used anti-washout admixture (AWA) to form a high-viscosity underwater concrete to minimise the dispersion of concrete material into the surrounding water. The reduction of quality for conventional concrete is mainly due to the washing out of cement and fine particles upon casting in the water. This research focused on the detailed investigations into the setting time, washout effect, compressive strength, and chemical composition analysis of alkali-activated fly ash (AAFA) paste through underwater placement in seawater and freshwater. Class C fly ash as source materials, sodium silicate, and sodium hydroxide solution as alkaline activator were used for this study. Specimens produced through underwater placement in seawater showed impressive performance with strength 71.10 MPa on 28 days. According to the Standard of the Japan Society of Civil Engineers (JSCE), the strength of specimens for underwater placement must not be lower than 80% of the specimen's strength prepared in dry conditions. As result, the AAFA specimens only showed 12.11% reduction in strength compared to the specimen prepared in dry conditions, thus proving that AAFA paste has high potential to be applied in seawater and freshwater applications.