Sex-Specific Patterns of Cerebral Atrophy and Enlarged Perivascular Spaces in Patients with Cerebral Amyloid Angiopathy and Dementia.

BACKGROUND AND PURPOSE: Cerebral amyloid angiopathy is characterized by amyloid ß deposition in leptomeningeal and superficial cortical vessels. Cognitive impairment is common and may occur independent of concomitant Alzheimer disease neuropathology. It is still unknown which neuroimaging findings are associated with dementia in cerebral amyloid angiopathy and whether they are modulated by sex. This study compared MR imaging markers in patients with cerebral amyloid angiopathy with dementia or mild cognitive impairment or who are cognitively unimpaired and explored sex-specific differences. MATERIALS AND METHODS: We studied 58 patients with cerebral amyloid angiopathy selected from the cerebrovascular and memory outpatient clinics. Clinical characteristics were collected from clinical records. Cerebral amyloid angiopathy was diagnosed on MR imaging on the basis of the Boston criteria. Visual rating scores for atrophy and other imaging features were independently assessed by 2 senior neuroradiologists. RESULTS: Medial temporal lobe atrophy was higher for those with cerebral amyloid angiopathy with dementia versus those cognitively unimpaired (P = .015), but not for those with mild cognitive impairment. This effect was mainly driven by higher atrophy in men with dementia, compared with women with and without dementia (P = .034, P = .012; respectively) and with men without dementia (P = .012). Enlarged perivascular spaces in the centrum semiovale were more frequent in women with dementia versus men with and without dementia (P = .021, P = .011; respectively) and women without dementia (P = .011). CONCLUSIONS: Medial temporal lobe atrophy was more prominent in men with dementia, whereas women showed a higher number of enlarged perivascular spaces in the centrum semiovale. Overall, this finding suggests differential pathophysiologic mechanisms with sex-specific neuroimaging patterns in cerebral amyloid angiopathy.

Causes of Death in Endovascularly Treated Patients with Acute Stroke.

BACKGROUND AND PURPOSE: Because stroke therapy has changed with the introduction of endovascular stroke treatment as a standard approach, studies on intrahospital causes of death from stroke are no longer up-to-date. The purpose of this observational study was to present the causes of death during hospitalization of patients with ischemic stroke who received endovascular stroke treatment, with the focus on a differentiation of curative and secondary palliative treatment. MATERIALS AND METHODS: We studied a total cohort of 1342 patients who received endovascular stroke treatment in a tertiary stroke center (Aachen, Germany) between 2010 and 2020 and analyzed the causes of death in all 326 consecutive deceased patients. We distinguished between curative treatment and a secondary palliative approach and analyzed causes of death and treatment numbers across the years. RESULTS: In the entire cohort of 326 deceased patients, the most common cause of death was of a cerebrovascular nature (51.5%), followed by pneumonia and sepsis (25.8%) and cardiovascular causes (8.3%). Neurovascular causes constituted 75.8% of reasons for palliation. In the group with a secondary palliative approach, causes of death were neurovascular in 54.0% of patients and pneumonia and sepsis in 26.0% of patients. CONCLUSIONS: Cerebrovascular causes in patients with stroke play a major role in the intrahospital causes of death and reasons for palliation. Considering the large proportion of secondarily palliative-treated patients, reasons for palliation should be considered instead of causes of death to avoid concealment by, for example, life-terminating measures.

Toxicity of three rare earth elements, and their combinations to algae, microcrustaceans, and fungi.

Rare earth elements (REEs) are naturally distributed in the environment, and are increasingly being used in agriculture and high technology materials worldwide, thereby increasing anthropogenic contamination and environmental risks. There exists scarce and contradictory toxicity information about REEs; hence, more studies are required, especially on their mixtures. Thus, this study aimed to assess the toxicities of La3+, Nd3+, Sm3+, and the combinations of these elements (binary 1:1 and ternary 1:1:1), to organisms from different trophic levels: producers (the microalgae Chlorella vulgaris and Raphidocelis subcapitata), primary consumers (the microcrustaceans Daphnia similis and Artemia salina), and decomposers (the fungi Penicillium simplicissimum and Aspergillus japonicus). Ecotoxicological bioassays were performed, and toxic concentrations were determined. Thereafter, toxicities of single and mixture REEs were classified as slightly to highly toxic according to their toxic units. Finally, a concentration addition (CA) model was used to estimate how REEs interact upon combining. Nd3+ was the most toxic element for all organisms, especially D. similis (48 h LC50 9.41 mg.L-1), and was therefore classified as highly toxic. Sm3+ promoted cell agglomeration in Chlorella vulgaris and was the most toxic of the tested elements for this organism (72 h IC50 25.78 mg.L-1). The CA model revealed synergistic responses for most of the combinations, principally Nd3+ + Sm3+, which was the most toxic combination for the tested organisms. Both fungi were the most resistant organisms, and A. japonicus produced exudate and sclerotia, which help in the detoxification of chemicals. Owing not only to the fact that fungi displayed a higher resistance to REEs, but also due to the absence of regulations for REEs released from the agricultural or industrial sector, and the lack of methods to treat effluents or to dispose of technological items containing REEs, these organisms should be considered as a model for the biosorption or bioremediation of REEs. Finally, the toxic effects of REEs, particularly Nd3+, on the biota and human health should be the focus of future studies due to their increased use in technology.

Improving operational management of wastewater systems. A case study.

Wastewater treatment facilities collecting wastewater from longstanding sewer networks of five municipalities in the Ave River basin (located in NW Portugal) are especially vulnerable to water inflows since they have considerable extensions of sewers installed in stream and riverbeds. TRATAVE, the company responsible for operating the system, designed and implemented a monitoring network to measure discharges along the entire drainage network and treatment facilities in order to reduce those water inflows. Several flow measurement devices were installed at strategic locations within the sewer network and integrated with a SCADA system responsible for its operation. A decision support system (DSS) is being implemented using the Delft-FEWS platform, integrating monitoring data and models. Based on monitored data and model results, an estimation of infiltration volumes during wet periods is presented. Moreover, the capabilities of the DSS are illustrated in: (i) location of manholes losses along sewer networks during wet periods; (ii) identification and location of unknown connections to the sewer network using wastewater balances; and (iii) design of a PID controller for a pumping station using on-line tank water level measurement. Acquired knowledge resulting from the DSS greatly improved the utility performance both in terms of economic revenue and environmental protection.

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke.

BACKGROUND AND PURPOSE: Post-stroke dysphagia occurs in up to three quarters of patients with acute stroke and is associated with a higher risk of respiratory infections and poor outcome. Systematic screening of dysphagia in the acute stroke unit is essential to identify patients at risk of aspiration and to provide dietary recommendations. Our study aimed to assess the impact of the systematic application of the Gugging Swallowing Screen (GUSS) in patients with acute ischaemic stroke. METHODS: This was a retrospective study of consecutive patients with acute ischaemic stroke admitted to an acute stroke unit in two time periods: pre-GUSS (February 2014-July 2015), when the 10-mL water-swallowing test was systematically administered, and GUSS (August 2015-October 2016), when the GUSS test was systematically administered. Groups were compared with regard to baseline and stroke characteristics, and the occurrence of stroke-associated pneumonia (SAP), in-hospital death and 3-month outcome. RESULTS: Of the 344 patients who were included in the study (median age 71 years), 51.7% were male with a median National Institutes of Health Stroke Scale score of 11. A total of 204 patients were included during the pre-GUSS period and 140 during the GUSS period. Patients in the GUSS period more frequently had diabetes and partial anterior circulation syndromes, and were more frequently treated with thrombectomy. There was no difference in the occurrence of SAP between the two groups (pre-GUSS, 12.5%; GUSS, 15.1%; P = 0.490) and no differences were found concerning in-hospital mortality (P = 0.996), 3-month functional independence (P = 0.647) or 3-month mortality (P = 0.598). CONCLUSIONS: The systematic administration of GUSS in a population of patients with acute ischaemic stroke did not reduce the occurrence of SAP, mortality or 3-month functional dependence when compared with the systematic administration of the 10-mL water-swallowing test.

Assessment of postural control after sleep deprivation with a low-cost portable force plate.

It is well-known that acute sleep deprivation affects negatively postural control. The analysis of sleep quality during long periods and its impact on motor control and learning performance are crucial aspects of human health. Nevertheless, there is conflicting evidence regarding which postural control variables are more prone to change due to sleep deprivation. Moreover, very few clinicians have at their disposal expensive force plates to measure such variables, so the use of a low-cost portable device could be very interesting. Therefore, we aimed to identify which posture control variables, obtained from a low-cost plate, are more sensitive to sleep deprivation. In order to do so, we have performed a set of experiments with volunteers before and after a night without sleep. Eight participants took part of the study and had their balance measured by a Wii Balance Board before and after one night of sleep deprivation. They were asked to keep a quiet stance on top of the plate with their eyes open and closed, in a balanced design. The main results showed that, regardless the visual information, sleep deprivation has deepest impact on the anterior-posterior center of pressure displacement. Sleep deprivation without visual information had a more pronounced (large effect size) impact on the mean sway in the anterior-posterior direction and its distribution variation. The information that sleep deprivation has a more meaningful impact on anterior-posterior center of pressure excursion may help clinicians and healthcare professionals to better deal with its implications.

Daytime sleepiness affects gait auditory synchronization ability.

Sleep disturbances in modern life lead to cognitive and motor performance impairments in everyday tasks such as gait. The most common symptom of these disturbances is daytime sleepiness, which can be assessed by questionnaires such as the Epworth Sleep Scale (ESS). The ESS evaluates sleep health and daytime dysfunction. The goal of this study is to assess the influence of sleepiness on a motorauditory synchrony task, rhythmed gait. High and low sleepiness clusters were formed based on the participants ESS scores. Walking on a treadmill, two different rhythmic auditory stimulus conditions were set with a metronome: isochronous and non-isochronous. Reflective markers on both heels with seven infrared cameras were used to assess the difference between footfall and metronome beep, what is named synchronization error (SE). There was a tendency to anticipate the beep in the HS group when compared to the LS group only in the non-isochronous stimulus condition that was statistically significant. Sleep disturbances that generate daytime sleepiness may bring detrimental effects on brain areas that could be responsible for the real-time adjustment of gait and sustained attention. These impairments may be responsible for the larger synchronization error with larger relative phase of the group with high sleepiness. More studies are necessary involving other parameters of sleep and gait to identify sleep disturbances through gait analysis.

Serological and molecular markers of hepatitis E virus infection in HIV-infected patients in Brazil.

In Brazil, the circulation of hepatitis E virus (HEV) has been demonstrated in distinct groups of individuals and some animals, but its prevalence among individuals with human immunodeficiency virus (HIV) infection is unknown. This study aimed to assess the frequency of serological and molecular HEV markers in individuals infected with HIV from São Paulo, Brazil. Serum and plasma samples of 354 HIV-infected patients collected between 2007 and 2013 were included. All samples were tested for anti-HEV IgG and IgM antibodies and HEV RNA. Anti-HEV IgG and IgM antibodies were detected in 10.7% (38/354) and 1.4% (5/354) of the samples, respectively. Both antibodies were detected simultaneously in only two samples. HEV RNA was not detected in any sample. There was no significant correlation of anti-HEV serological status (positivity to anti-HEV IgG and/or IgM) with sex, age, CD4+ T cell count, HIV viral load, antiretroviral therapy, liver enzyme levels, or coinfection with hepatitis B virus and/or hepatitis C virus. Our study provides serological evidence of past and recent HEV infections in HIV-infected patients from São Paulo, Brazil. However, the occurrence of ongoing HEV infection appears be a rare event in this population.

Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device.

Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11.1±5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index>2/h). Mean SB index was 5.12±3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7±9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R=0.755, p=0.019 and R=0.737, p=0.023 respectively, Pearson correlation). Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R=-0.632 and R=-0.611, p>0.05, Pearson correlation). This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting.

Diagnosis of the strongyloid nematode Strongyloides venezuelensis in experimentally infected rats.

Strongyloides venezuelensis is an intestinal nematode of rats, frequently used as a model for studying human and animal strongyloidiasis. In the present study, we evaluated parasitological, serological and molecular methods for the diagnosis of experimental S. venezuelensis in rats, Rattus norvegicus. Blood and faecal samples were collected and analysed up to 60 days post infection (pi) with adult worm recovery occurring from 5 to 45 days pi. Using an enzyme-linked immunosorbent assay (ELISA), serum levels of IgG antibodies increased up to 28 days pi, thereafter decreasing by day 60 pi. Polymerase chain reaction (PCR) assays detected S. venezuelensis DNA in faecal samples of rats from 5 to 21 days pi. The present study therefore represents the first step towards improving the diagnosis of experimental strongyloidiasis.

Presence of Mycobacterium leprae DNA and PGL-1 antigen in household contacts of leprosy patients from a hyperendemic area in Brazil.

Leprosy is a highly infectious disease endemic to underdeveloped countries. In Maranhão State, Northeastern Brazil, the hyperendemic rate of 56.11 cases/100,000 inhabitants increased the necessity of better understanding the epidemiological profile of this population, particularly regarding efficient methods for evaluating individuals residing with diagnosed patients to understand disease transmission and the risk of infection. In this study, we examined the percentage of contacts with positive indices for Mycobacterium leprae DNA and phenol-glycolipid-1 antigen (PGL-1). PGL-1 was analyzed by an enzyme-linked immunosorbent assay, the ML-Flow test, and polymerase chain reaction of oral and nasal secretions of 808 leprosy contacts from Maranhão. PGL-1 was detected in 14.0% of patients and differed by operational classification of the index case (P < 0.05). Seropositive results of ML-Flow were 15.0% and identified individuals with and without Bacillus Calmette-Guérin vaccine scars. Molecular diagnosis detected M. leprae DNA in 5.6% of oral samples and 4.6% of nasal tissues, and 87% of subjects resided with high bacillary load patients. This study reinforces the efficacy of combining molecular and serological techniques to identify potential bacillus carriers in the asymptomatic stage of infection, such as in household contacts, highlighting the importance of these meth-ods for monitoring hyperendemic populations.

Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder.

Temporomandibular disorders (TMD) consist of a group of pathologies that affect the masticatory muscles, temporomandibular joints (TMJ), and/or related structures. String instrumentalists, like many orchestra musicians, can spend hours with head postures that may influence the biomechanical behavior of the TMJ and the muscles of the craniocervicomandibular complex (CCMC). The adoption of abnormal postures acquired during performance by musicians can lead to muscular hyperactivity of the head and cervical muscles, with the possible appearance of TMD. Medical infrared thermography is a non-invasive procedure that can monitor the changes in the superficial tissue related to blood circulation and may serve as a complement to the clinical examination. The objective of this study was to use infrared thermography to evaluate, in one subject, the cutaneous thermal changes adjacent to the CCMC that occur before, during, and after playing a string instrument.

Comparative study of the accuracy of different technique for the laboratory diagnosis of schistosomiasis mansoni in areas of low endemicity in Barra Mansa City, Rio de Janeiro State, Brazil

Schistosomiasis constitutes a major public health problem, with an estimated 200 million people infected worldwide. Many areas of Brazil show low endemicity of schistosomiasis, and the current standard parasitological techniques are not sufficiently sensitive to detect the low-level helminth infections common in areas of low endemicity (ALEs). This study compared the Kato-Katz (KK); Hoffman, Pons, and Janer (HH); enzyme-linked immunosorbent assay- (ELISA-) IgG and ELISA-IgM; indirect immunofluorescence technique (IFT-IgM); and qPCR techniques for schistosomiasis detection in serum and fecal samples, using the circumoval precipitin test (COPT) as reference. An epidemiological survey was conducted in a randomized sample of residents from five neighborhoods of Barra Mansa, RJ, with 610 fecal and 612 serum samples. ELISA-IgM (21.4%) showed the highest positivity and HH and KK techniques were the least sensitive (0.8%). All techniques except qPCR-serum showed high accuracy (82­95.5%), differed significantly from COPT in positivity , and showed poor agreement with COPT. Medium agreement was seen with ELISA-IgG (Kappa = 0.377) and IFA (Kappa = 0.347). Parasitological techniques showed much lower positivity rates than those by other techniques. We suggest the possibility of using a combination of laboratory tools for the diagnosis of schistosomiasis in ALEs.

Conventional PCR for molecular diagnosis of human strongyloidiasis.

Strongyloidiasis is frequently asymptomatic and diagnosis of latent infection is difficult due to limitations of current parasitological and serological methods. This study aimed to verify the use of conventional polymerase chain reaction (PCR) assay for molecular diagnosis of Strongyloides stercoralis infection. Fresh stool samples were obtained from 103 individuals: 33 S. stercoralis positive, 30 positive for other parasites and 40 negative for parasitological methods. These samples were examined by the Lutz, Rugai and agar plate culture methods and conventional PCR assay. Two sets of primers (S. stercoralis species-specific and genus-specific sets), located in the 18S ribosomal RNA gene, were used for PCR. Of the 33 samples positive for S. stercoralis by parasitological methods, 28 (84.8%) were also detected by PCR assay using species-specific primers and 26 (78.8%) using genus-specific primers. Among the stool samples negative by parasitological methods, seven (17.5%) were positive by PCR using species-specific primers and two (5.0%) using genus-specific primers. In conclusion, the conventional PCR assay described in this study using a species-specific primer pair provided a molecular method for S. stercoralis diagnosis in human stool samples.

Birds' nesting parameters in four forest types in the Pantanal wetland.

We tested the heterogeneity/productivity hypothesis with respect to the abundance and richness of birds and the vegetation density hypothesis with respect to birds' nest predation rates, and determined the relative importance of forested vegetation formations for the conservation of birds in the Pantanal. We estimated the apparent nesting success, and the abundance and richness of nesting birds' in four forest types, by monitoring nests during two reproductive seasons in four forested physiognomies (two high productivity/heterogeneity evergreen forests = Cambará and Landi; two low productivity/heterogeneity dry forests = Cordilheira and Carvoeiro) in the Pantanal wetland in Poconé, State of Mato Grosso, Brazil. We found 381 nests of 46 species (35 Passeriformes and 11 non-Passeriformes) in the four forest types. Of these, we monitored 220 active nests belonging to 44 species, 101 during the reproductive season of 2001 and 119 in 2002. We supported the productivity/heterogeneity hypothesis since the two evergreen forests had higher nest abundance and one of them (Cambará) had higher nesting species richness than the dry forests. The number of nests found in each habitat differed with most nests monitored in the Cambará forest (82%), followed by Landi (9%), Cordilheira (6%) and Carvoeiro (3%) forests. The total number of nests monitored was significantly higher in evergreen forests than in dry forests. Also, more species nested in evergreen (37 species) than in dry (16 species) forests. A Correspondence Analysis revealed that only Carvoeiros had a different nesting bird community. The overall apparent nesting success of 220 nests was 26.8%. We did not support the vegetation density hypothesis since nest predation rates were similar between evergreen (73.5%) and dry (70%) forests, and were higher in the Landi (85%) than in the other three forests (69.2 to 72.2%). Our data indicate that Cambará forests seem to be a key nesting habitat for many bird species of the Pantanal. If this local pattern also occurs in other regions of the Pantanal, the use and management of Cambará forests might prove to be important for the conservation of forest birds of this biome. However, conflicting results with other taxonomic groups show that conservation measures for these forests and land use policies should be based on a more complete biodiversity evaluation of the region.

Placa ateromatosa calcificada en radiografía panorámica: aspectos radiográficos y diagnósticos diferenciales / Calcified atheromatous plaque in panoramic radiography: radiographic aspects and differential diagnosis

Las placas de ateroma son conformadas por depósitos de lípidos en las camadas más profundas de las arterias y que siendo estructuras calcificadas pueden ser vistas en radiografías panorámicas. Su aspecto radiográfico debe ser diferenciado de las imágenes que pertenecen a diversas estructuras anatómicas y patológicas radiopacas, puesto que en dicho examen es posible observar asimismo otros hallazgos radiográficos en región cervical. Calcificaciones más a menudo descriptas en la literatura y que consisten en diagnóstico diferencial para las placas ateromatosas son el hueso hioides, cartílago tritícea, el cuerno superior de calcificación del cartílago tiroides calcificada, la epiglotis, los ganglios linfáticos calcificados, los flebolitos, los submaxilares de glándulas salivales y los tonsiolitos. Este estudio tiene como objetivo realizar una revisión de la literatura relativa a las placas ateromatosas y su diferencial diagnóstico con el fin de orientar mejor al dentista en la interpretación de estas imágenes. De esta manera, permite el reenvío de la paciente a un tratamiento preventivo, contribuyendo al desarrollo de la salud pública...

The atheromatous plaques consist of deposits of fat in the inner layers of the arteries and as they are calcified, can be detected on panoramic radiographs. Its radiographic appearance should be differentiated from others anatomical and pathological radiopaque structures, since this examination can also detect other radiographic findings in the neck. The calcifications most frequently described in the literature between anatomical and pathological conditions, and which constitute the differential diagnosis for atheromatous plaques are the hyoid bone, cartilage triticeous, the superior horn of the calcified thyroid cartilage, epiglottis, calcified lymph nodes, the phleboliths, submandibular salivary gland sialoliths and tonsilloliths. This study aims to conduct a review of literature related to atheromatous plaques and their differential diagnoses in order to provide better guidance to the dentist in the interpretation of those images. Thus, the patient can properly receive an early treatment, contributing to the development of public health...