Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy.

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. METHODS: We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. RESULTS: A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI. CONCLUSION: Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.

Numerical simulations of pyrite oxidation and acid mine drainage in unsaturated waste rock piles.

Numerical simulations of layered, sulphide-bearing unsaturated waste rock piles are presented to illustrate the effect of coupled processes on the generation of acid mine drainage (AMD). The conceptual 2D systems were simulated using the HYDRUS model for flow and the POLYMIN model for reactive transport. The simulations generated low-pH AMD which was buffered by sequential mineral dissolution and precipitation. Sulphide oxidation rates throughout the pile varied by about two orders of magnitude (0.004-0.4 kg m-3 year-1) due to small changes in moisture content and grain size. In the fine-grained layers, the high reactive surface area induced high oxidation rates, even though capillary forces kept the local moisture content relatively high. In waste rock piles with horizontal layers, most of the acidity discharged through vertical preferential flow channels while with inclined fine grained layers, capillary diversion channeled the AMD to the outer slope boundary, keeping the pile interior relatively dry. The simulation approach will be useful for helping evaluate design strategies for controlling AMD from waste rock.

Home care of the elderly. Oral cancer patient.

Elderly patients with oral cancer present many challenges in the home healthcare setting. Timely detection of disease, appropriate and timely referrals, and the adverse effects of therapies, nutrition, and depression are discussed in this article. Using a case study, the author offers suggestions on the coordination of services of dental, medical, and nursing professionals and management of adverse dental effects.

Oral cancer screening in the elderly: the home healthcare nurse's role.

Screening for oral cancer is an often overlooked element of annual medical examinations and physical assessments in the elderly. As the elderly population increases, more emphasis will be placed on caring for clients in the home, and oral cancer screening will be provided by nurses. This article outlines the most common types of oral cancer and provides step-by-step instructions of performing an oral cancer screening examination.

Dental hygiene screening reveals childhood neck mass.

A benign neck mass was discovered in a young child which, based on presentation, was diagnosed as a thyroglossal duct cyst. Thyroglossal duct cysts normally appear in childhood and are usually asymptomatic. They are a congenital neoplasm resulting from incomplete resorption of the thyroglossal duct following the embryonic descent of the thyroid gland and are often found attached to the hyoid bone. They may or may not have exterior fistulae and are slow growing. Other types of neck masses should be included in a complete differential diagnosis, as this case verified. Masses such as the dermoid cyst may be misdiagnosed as TGDC. While also slow growing, and presenting similarly to the TGDC, dermoid cysts may enlarge and compromise airways and interfere with eating and swallowing. Treatment of choice for these neck masses is excision including ductal remnants. Care must be taken not to remove ectopic thyroid tissue if that is the entire extent of the patient's thyroid gland. This case presentation exemplifies the role of the dental hygienist in identifying lesions of the head and neck and seeking appropriate referral when indicated. The dental hygienist if ideally suited to perform complete extraoral and intraoral examinations by virtue of education and training. Routine examinations must extend beyond the intraoral structures to include the head and neck regions. One must not assume that pathology exists only in the older population.

The role of dentistry in palliative care of the head and neck cancer patient.

Although palliative care for the terminally ill is based on a multidimensional philosophy to provide whole-person comfort care while maintaining optimal function, it does not usually include dentistry in its team approach. Dentists can have a significant role in the care of these patients by providing total, active comfort care of the oral cavity. The function of the oral cavity is essential to the patient's ability to thrive. Therefore, alleviation of pain and prevention of infection in the oral cavity should be a priority in providing total, active comfort for the patient. The oral problems experienced by the hospice head and neck patient clearly affect the quality of his or her remaining life. Through routine assessments and interventions by a dentist on the palliative care team (Figure 4), comfort care for the patient may be improved by the maintenance of oral hygiene and procedures to hydrate the oral mucosa. In addition, routine dental assessments may identify dental disease and facilitate dental interventions for caries, periodontal disease, oral mucosal problems or prosthetic needs. Attention to such detail may reduce not only the microbial load of the mouth but the risk for pain and oral infection as well. This multidisciplinary approach to palliative care, including a dentist, may reduce the oral debilities that influence the patient's ability to speak, eat or swallow. Not only does maintenance of oral health have impact on the quality of life, which is already challenged by the disease, but it also aids in the ability of patients to thrive for whatever precious time is left to them.