Seed functional ecology in Brazilian rock outcrop vegetation: an integrative synthesis.

BACKGROUND AND AIMS: Rock outcrop vegetation is distributed worldwide and hosts a diverse and unique flora that evolved under harsh environmental conditions. Unfortunately, seed ecology in such ecosystems has received little attention, especially regarding seed traits, germination responses to abiotic factors and the potential role of phylogenetic relatedness on such features Here, we provide the first quantitative and phylogenetically-informed synthesis of the seed functional ecology of Brazilian rock outcrop vegetation, with a particular focus on quartzitic and ironstone campo rupestre. METHODS: Using a database of functional trait data, we calculated the phylogenetic signal of seven seed traits for 371 taxa and tested whether they varied among growth forms, geographic distribution, and microhabitats. We also conducted meta-analyses that included 4,252 germination records for 102 taxa to assess the effects of light, temperature, and fire-related cues on the germination of campo rupestre species and explored how the aforementioned ecological groups and seed traits modulate germination responses. KEY RESULTS: All traits and germination responses showed a moderate-to-strong phylogenetic signal. Campo rupestre species responded positively to light and had maximum germination between 20-25 ºC. The effect of temperatures beyond this range was moderated by growth form, species geographic distribution, and microhabitat. Seeds exposed to heat shocks above 80 °C lost viability, but smoke accelerated germination. We found a moderating effect of seed mass for in responses to light and heat shocks, with larger, dormant seeds tolerating heat better but less sensitive to light. Species from xeric habitats evolved phenological strategies to synchronise germination during periods of increased soil water availability. CONCLUSIONS: Phylogenetic relatedness plays a major role in shaping seed ecology of Brazilian rock outcrop vegetation. Nevertheless, seed traits and germination responses varied significantly between growth forms, species geographic distribution and microhabitats, providing support to the regeneration niche hypothesis and the role of functional traits in shaping germination in these ecosystems.

Food insecurity in children with heart disease.

PURPOSE OF REVIEW: This review discusses the epidemiology of food insecurity (FI) and its consequences in children with congenital heart disease. We aimed to highlight current interventions to screen and address food insecurity in the context of pediatric cardiology and to offer strategies for providers to engage in this meaningful work. RECENT FINDINGS: Food insecurity is consistently associated with poor health outcomes in children. In the United States, 17.3% of households with children experience FI. Nonwhite and single-parent families are disproportionately affected. Interestingly, because of a low-quality diet, FI is associated with childhood obesity, putting affected children at increased risk for cardiovascular morbidity and mortality over time. Children with congenital heart disease are susceptible to poor outcomes due to unique altered metabolic demands, increased risk for growth impairment, frequent need for specialized feeding regimens, and additional morbidity associated with heart surgery in underweight children. SUMMARY: Today, the burden of screening for FI is most commonly placed on general pediatricians. Considering the importance of nutrition to cardiovascular health and general wellbeing, and the ease with which screening can be performed, pediatric cardiologists and other subspecialists should take a more active role in FI screening.

The effects of age, mature oocyte number, and cycle number on cumulative live birth rates after planned oocyte cryopreservation.

PURPOSE: To examine the effects of age, mature oocyte number, and cycle number on cumulative live birth rates after planned oocyte cryopreservation (OC), with the goal of developing a patient counselling tool. METHODS: We performed a retrospective cohort study of all patients with ≥ 1 autologous oocyte thaw at our university-affiliated fertility center before 12/31/2023. Patients were included if they (1) had a live birth or ongoing pregnancy > 12 weeks from OC, or (2) used all oocytes and euploid/untested embryos from OC. Primary outcome was cumulative live birth / ongoing pregnancy rate (CLBR). RESULTS: 527 patients with 1 OC cycle, 149 patients with 2 OC cycles, and 55 patients with ≥ 3 OC cycles were included. Overall CLBR was 43%. CLBR was > 70% among patients who thawed ≥ 20 mature oocytes that were cryopreserved at age < 38 years. Multiple logistic regression showed that age at first OC and total number of mature oocytes thawed independently predicted CLBR, but number of OC cycles did not. CONCLUSION: Patients must be counselled that younger age at OC and more mature oocytes improve CLBR. However, additional OC cycles do not independently improve CLBR. Our results can help patients decide whether to pursue additional OC cycles to obtain more oocytes.

Baricitinib or imatinib in hospitalized COVID-19 patients: Results from COVINIB, an exploratory randomized clinical trial.

Baricitinib and imatinib are considered therapies for coronavirus disease 2019 (COVID-19), but their ultimate clinical impact remains to be elucidated, so our objective is to determine whether these kinase inhibitors provide benefit when added to standard care in hospitalized COVID-19 patients. Phase-2, open-label, randomized trial with a pick-the-winner design conducted from September 2020 to June 2021 in a single Spanish center. Hospitalized adults with COVID-19 pneumonia and a symptom duration ≤10 days were assigned to 3 arms: imatinib (400 mg qd, 7 days) plus standard-care, baricitinib (4 mg qd, 7 days) plus standard-care, or standard-care alone. Primary outcome was time to clinical improvement (discharge alive or a reduction of 2 points in an ordinal scale of clinical status) compared on a day-by-day basis to identify differences ≥15% between the most and least favorable groups. Secondary outcomes included oxygenation and ventilatory support requirements, additional therapies administered, all-cause mortality, and safety. One hundred and sixty-five patients analyzed. Predefined criteria for selection of the most advantageous arm were met for baricitinib, but not for imatinib. However, no statistically significant differences were observed in formal analysis, but a trend toward better results in patients receiving baricitinib was found compared to standard care alone (hazard ratio [HR] for clinical improvement: 1.41, 95% confidence intervals [CI]: 0.96-2.06; HR for discontinuing oxygen: 1.46, 95% CI: 0.94-2.28). No differences were found regarding additional therapies administered or safety. Baricitinib plus standard care showed better results for hospitalized COVID-19 patients, being the most advantageous therapeutic strategy among those proposed in this exploratory clinical trial.

Patient Insight With Collagenase Treatment for Dupuytren: A Prospective Study.

PURPOSE: There appears to be controversy regarding differing patient and physician perceptions of adverse effects (AEs) in the treatment of Dupuytren disease with collagenase clostridium histolyticum (CCH). The aim of this study was to compare the number, type, and severity of AEs perceived and reported by patients and by their physician METHODS: To assess AEs following CCH injection in a standardized way, patients were given a list of predefined complications and asked to rate their severity on a 4-point Likert scale ranging from 1 (serious) to 4 (insignificant). RESULTS: Eighty-five patients were included. Patients reported fewer AEs than their physician (mean, 1.48 vs 2.18). There was no agreement between physician- and patient-reported AEs except for skin lacerations, which showed fair agreement (κ = 0.257). CONCLUSIONS: Patients and physicians differ in their evaluation of AEs due to CCH treatment in Dupuytren disease. A fair level of agreement was observed for skin lacerations. CLINICAL RELEVANCE: Greater consensus is needed when defining AEs associated with CCH in the treatment of Dupuytren disease.

Importance of the gender and preoperative knee sagittal alignment to avoid unnecessary tibial resection in TKR.

BACKGROUND: Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS: Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth ≤ 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS: A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was ≤ 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION: A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.

A data mining based clinical decision support system for survival in lung cancer.

BACKGROUND: A clinical decision support system (CDSS ) has been designed to predict the outcome (overall survival) by extracting and analyzing information from routine clinical activity as a complement to clinical guidelines in lung cancer patients. MATERIALS AND METHODS: Prospective multicenter data from 543 consecutive (2013-2017) lung cancer patients with 1167 variables were used for development of the CDSS. Data Mining analyses were based on the XGBoost and Generalized Linear Models algorithms. The predictions from guidelines and the CDSS proposed were compared. RESULTS: Overall, the highest (> 0.90) areas under the receiver-operating characteristics curve AUCs for predicting survival were obtained for small cell lung cancer patients. The AUCs for predicting survival using basic items included in the guidelines were mostly below 0.70 while those obtained using the CDSS were mostly above 0.70. The vast majority of comparisons between the guideline and CDSS AUCs were statistically significant (p < 0.05). For instance, using the guidelines, the AUC for predicting survival was 0.60 while the predictive power of the CDSS enhanced the AUC up to 0.84 (p = 0.0009). In terms of histology, there was only a statistically significant difference when comparing the AUCs of small cell lung cancer patients (0.96) and all lung cancer patients with longer (≥ 18 months) follow up (0.80; p < 0.001). CONCLUSIONS: The CDSS successfully showed potential for enhancing prediction of survival. The CDSS could assist physicians in formulating evidence-based management advice in patients with lung cancer, guiding an individualized discussion according to prognosis.

Complications of computer-assisted navigation in total knee replacement: retrospective cohort of eight hundred and seventy eight consecutive knees.

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

High-rate algal pond for removal of pharmaceutical compounds from urban domestic wastewater under tropical conditions. Case study: Santiago de Cali, Colombia.

This study evaluated the capacity of a pilot-scale high-rate algal pond (HRAP) to remove pharmaceutical compounds (PCs) from domestic wastewater in the city of Santiago de Cali, Colombia. The compounds analyzed included antiepileptics, hypolipidemic drugs, tranquilizers and analgesics, and anti-inflammatory drugs. The HRAP operated under a continuous water flow of 0.2 m3d-1 and a 3-day hydraulic retention time (HRT). Removal efficiencies were high (>70%) for fenofibric acid, ibuprofen, and paracetamol; medium (30-70%) for gabapentin, lamotrigine, fenofibrate, gemfibrozil, diclofenac, ketoprofen, naproxen, and pentoxifylline; and low (<30%) for carbamazepine and its metabolite 10,11-Dihidro-10,11-dihidroxicarbamazepine (CBZ-Diol). The findings herein are similar to other studies, but were obtained with a shorter HRT. These results show that tropical environmental conditions favor photodegradation and contribute to the development of microalgae and the biodegradation process. Twenty microalgae species were identified, with the phylum Chlorophyta as the most abundant, particularly due to its natural introduction. The removal of the PCs also reflected a percentage reduction (>50%) in the ecological hazard posed by most of the compounds, although it is important to note that the hazard from gemfibrozil and ibuprofen remained high even after treatment, indicating the need for complementary treatment.

Differences in breast cancer outcomes amongst Black US-born and Caribbean-born immigrants.

BACKGROUND: There are few studies that directly investigate disparities in outcome within the African diaspora in the US. We investigated the association between nativity of Black women diagnosed with breast cancer (Caribbean or USA place of birth) and ethnicity, age at diagnosis, treatment, tumor characteristics and outcome. METHODS: The data were obtained from the University of Miami Health System, and Jackson Health System. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (Caribbean Blacks, CB) or in the USA (US Black, USB) using Cox proportional hazards regression analysis for overall survival. RESULTS: The cohort contains data from 624 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006 and 2017. Compared to CB patients, USB patients had more Estrogen Receptor negative (31.4% vs. 39.1%, P = 0.018) and triple negative breast cancers (19.6% vs. 27.9%, P = 0.003). CB women presented at more advanced stages III/IV (44.2% vs. 35.2%; P = 0.016). CB patients showed a better overall survival (hazard ratio, HR = 0.75; 95% CI 0.59-0.96; P = 0.024). Overall Black Hispanic patients had a better overall survival (HR = 0.51; 95% CI 0.28-0.93; P = 0.028) compared to non-Hispanic Black patients. CONCLUSION: In conclusion the study found that CB immigrants diagnosed with breast cancer have an improved overall survival when compared with USB patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to worse outcomes in African Americans.

Study of the occurrence and ecosystem danger of selected endocrine disruptors in the urban water cycle of the city of Bogotá, Colombia.

Endocrine disruptors have been studied for their high occurrence in different environments including aquatic; however, in the context of developing countries, their occurrence, magnitude and potential threat have little information. This study involved the analysis of various components of the urban water cycle in the city of Bogotá, Colombia. As a result, it was found that the compounds with the highest occurrence are plasticizers such as phthalates and bisphenol A, whereas among the drugs, carbamazepine presented the highest concentrations (0.68-31.45 µg L-1); the analysis of the threat coefficient (HQ) showed the importance of bis(2-ethylhexyl) phthalate (BEHP) and estrone (E1) that can reach surface waters from domestic and industrial discharges.

Cementless modular neck stems: are they a safe option in primary total hip arthroplasty?

PURPOSE: The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck. METHODS: Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41-84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted. RESULTS: The mean follow-up was 6.1 (range, 2-8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening. CONCLUSIONS: The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.

Transcultural adaptation and validation of the Mexican version of the kidney disease questionnaire KDQOL-SF36 version 1.3.

PURPOSE: To translate the Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) v1.3 questionnaire into the Spanish language, adapt it culturally, and validate it in the Mexican population. METHODS: The translation and transcultural adaptation were performed according to the recommendations of RAND Health (translation/pilot test/back-translation). We used coefficient alpha to determine the internal consistency, intra- and interobserver intraclass correlation coefficients (ICCs) to determine the test-retest reliability, and Pearson correlation coefficients to confirm the construct validity. RESULTS: The questionnaires were applied to 194 Mexican on haemodialysis. In total, 37.6 % lived in the northern region of Mexico, 28.9 % lived in the southern region, and 33.5 % lived in the central region. The average age was 54 ± 16 years, and 54.6 % were male. The intra- and interobserver ICCs were ≥0.7 for most dimensions evaluated (range 0.5-0.9). The internal consistency was acceptable, with coefficient alpha values ≥0.7 for 12 of the 18 dimensions (range 0.4-0.9). The construct validity was acceptable, especially in the generic component SF36, with correlation coefficients >0.5 for most dimensions. CONCLUSIONS: Psychometric testing indicated that the Mexican version of the KDQOL-SF36 provided valid and reliable scores that were similar to the results obtained with the original English version.

[Clinical features of major depressive disorders treated in secondary health care facilities in Chile]. / Características clínicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención.

BACKGROUND: Depression is considered the second leading cause of disability worldwide. AIM: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE). MATERIAL AND METHODS: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied. RESULTS: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features. CONCLUSIONS: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.

[Predictors of remission from major depressive disorder in secondary care]. / Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención.

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Clinical, Dialytic, and Laboratory Factors Associated With Poor Health-Related Quality of Life in Mexican Patients on Hemodialysis.

BACKGROUND: End-stage renal disease and its treatment have a negative impact on the quality of life of patients. OBJECTIVE: To determine the clinical, dialytic, and laboratory factors associated with poor health-related quality of life in Mexican patients on hemodialysis. METHODS: A multicenter, cross-sectional study. The KDQOL-SF36 v1.3 questionnaire was applied to patients with end-stage renal disease on hemodialysis in different regions of Mexico. Patients were classified according to their overall score on the questionnaire: poor health-related quality of life (overall score below the median) or good health-related quality of life (overall score above the median). Clinical, dialytic, and laboratory variables associated with poor health-related quality of life were analyzed using linear correlation and multivariate logistic regression. RESULTS: We included 194 adult patients with a median age of 55 (45-64) years. The diagnosis of poor health-related quality of life was present in 47.4% of patients. A poor correlation was found between the clinical, dialytic, and biochemical parameters and the health-related quality of life score (range of correlations r = -0.4 to 0.2). Serum albumin level showed the highest number of weak, statistically significant correlations. Factors associated with poor health-related quality of life in the multivariate analysis were: time spent on hemodialysis (OR = 1.02; 95% CI; 1.00-1.04; p = 0.02), use of a venous catheter (OR = 3.2; 95% CI: 1.36-7.75; p = 0.01), and serum albumin < 4 g/dl (OR = 3.55; 95% CI: 1.44-8.74; p < 0.01). CONCLUSIONS: Poor health-related quality of life was common in Mexican patients undergoing hemodialysis. No strong correlation was found between the clinical, dialytic, or laboratory factors with health-related quality of life. Factors associated with poor health-related quality of life were: time on hemodialysis, use of a venous catheter, and serum albumin level < 4 g/dl.

Performance of a system with full- and pilot-scale sludge drying reed bed units treating septic tank sludge in Brazil.

This study investigated the performance of sludge drying reed beds (SDRB) at full- and pilot-scale treating sludge from septic tanks in the city of Belo Horizonte, Brazil. The treatment units, planted with Cynodon spp., were based on an adaptation of the first-stage of the French vertical-flow constructed wetland, originally developed for treating sewage. Two different operational phases were investigated; in the first one, the full-scale unit was used together with six pilot-scale columns in order to test different feeding strategies. For the second phase, only the full-scale unit was used, including a recirculation of the filtered effluent (percolate) to one of the units of the French vertical wetland. Sludge application was done once a week emptying a full truck, during 25 weeks. The sludge was predominantly diluted, leading to low solids loading rates (median values of 18 kgTS m(-2) year(-1)). Chemical oxygen demand removal efficiency in the full-scale unit was reasonable (median of 71%), but the total solids removal was only moderate (median of 44%) in the full-scale unit without recirculation. Recirculation did not bring substantial improvements in the overall performance. The other loading conditions implemented in the pilot columns also did not show statistically different performances.

Post-reconstitution Stability of Telavancin with Commonly Used Diluents and Intravenous Infusion Solutions.

OBJECTIVE: The post-reconstitution chemical stability and microbial challenge hold time of nonpreserved telavancin for injection was determined using common reconstitution diluents and intravenous (IV) infusion solutions stored at room temperature with light (ambient) or at 2°C to 8°C without light (refrigeration). METHODS: Telavancin was reconstituted with 5% dextrose, 0.9% normal saline, or sterile water (15 mg/mL). Infusion solutions at 0.6 and 8.0 mg/mL were prepared in ViaFlex (polyvinyl chloride) IV bags (Baxter International Inc, Deerfield, Illinois) using 5% dextrose, 0.9% normal saline, or lactated Ringer's solution. Chemical stability was evaluated for up to 14 days under refrigeration and for up to 3 days under ambient conditions. Telavancin concentration and degradant levels were determined using a stability-indicating HPLC method. Solutions were subjected to microbial-challenge testing for up to 48 hours (ambient) or for up to 6 days (refrigeration). RESULTS: All reconstituted or infused telavancin solutions met the prespecified stability acceptance criteria after 2 days under ambient and minimum 7 days under refrigeration. Following inoculation with gram-positive and gram-negative microorganisms, telavancin infusion solutions stored under ambient conditions reduced or inhibited populations of all organisms up to 48 hours, except for Serratia marcescens, which exhibited growth of >0.5 log10 after 12 hours. All refrigerated samples inhibited or reduced bacterial populations up to 6 days. CONCLUSIONS: These results are supportive of a total hold time for reconstituted telavancin in vials plus the time in IV infusion solutions in polyvinyl chloride bags to not exceed 12 hours under ambient conditions and 7 days under refrigeration.

Quantitative longitudinal evaluation of diaschisis-related cerebellar perfusion and diffusion parameters in patients with supratentorial hemispheric high-grade gliomas after surgery.

Decreased cerebral blood volume (CBV) in contralateral cerebellar gray matter (cGM) in conjunction with cerebellar white matter (cWM) damage, consistent with crossed cerebro-cerebellar diaschisis (cCCD) develop following supratentorial hemispheric stroke. In this study, we investigated the longitudinal evolution of diaschisis-related cerebellar perfusion and diffusion tensor-imaging (DTI) changes in patients after surgery for supratentorial brain tumors. Eight patients (M:F 5:3, age 8-22 years) who received surgery for supratentorial high-grade gliomas were evaluated. Initial MRI studies were performed 19-54 days postoperatively, with follow-ups at 2- to 3-month intervals. For each study, parametric maps of the cerebellum were generated and coregistered to T1-weighted images that had been previously segmented for cGM and cWM. Aggregate mean values of CBV, cerebral blood flow (CBF), and fractional anisotropy (FA) were obtained separately for cGM and cWM, and asymmetry indices (AIs) were calculated. Hemodynamic changes were more robust in cGM than in cWM. Seven patients showed decreased perfusion within cGM contralateral to the supratentorial lesion on the first postoperative study, and asymmetry was significant for both CBV (p = 0.008) and CBF (p < 0.01). For CBV, follow-up studies showed a significant trend towards recovery (p < 0.02). DTI changes were more pronounced in cWM. FA values suggested a "paradoxical" increase at initial follow-up, but steadily declined thereafter (p = 0.0003), without evidence of subsequent recovery. Diaschisis-related hemodynamic alterations within cGM appear on early postoperative studies, but CBV recovers over time. Conversely, cWM DTI changes are delayed and progressive. Although the clinical correlates of cCCD are yet to be elucidated, better understanding of longitudinal structural and hemodynamic changes within brain remote from the area of primary insult could have implications in research and clinical rehabilitative strategies.

Oral health in older patients with oropharyngeal dysphagia.

BACKGROUND: oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). AIM: to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. PATIENTS AND METHODS: fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S); (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis); and (iii) the presence of dental caries. RESULTS: 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent; 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. CONCLUSIONS: older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.