RESUMO
Biological invasions are increasingly recognised as a major global change that erodes ecosystems, societal well-being, and economies. However, comprehensive analyses of their economic ramifications are missing for most national economies, despite rapidly escalating costs globally. Türkiye is highly vulnerable to biological invasions owing to its extensive transport network and trade connections as well as its unique transcontinental position at the interface of Europe and Asia. This study presents the first analysis of the reported economic costs caused by biological invasions in Türkiye. The InvaCost database which compiles invasive non-native species' monetary costs was used, complemented with cost searches specific to Türkiye, to describe the spatial and taxonomic attributes of costly invasive non-native species, the types of costs, and their temporal trends. The total economic cost attributed to invasive non-native species in Türkiye (from 202 cost reporting documents) amounted to US$ 4.1 billion from 1960 to 2022. However, cost data were only available for 87 out of 872 (10%) non-native species known for Türkiye. Costs were biased towards a few hyper-costly non-native taxa, such as jellyfish, stink bugs, and locusts. Among impacted sectors, agriculture bore the highest total cost, reaching US$ 2.85 billion, followed by the fishery sector with a total cost of US$ 1.20 billion. Management (i.e., control and eradication) costs were, against expectations, substantially higher than reported damage costs (US$ 2.89 billion vs. US$ 28.4 million). Yearly costs incurred by non-native species rose exponentially over time, reaching US$ 504 million per year in 2020-2022 and are predicted to increase further in the next 10 years. A large deficit of cost records compared to other countries was also shown, suggesting a larger monetary underestimate than is typically observed. These findings underscore the need for improved cost recording as well as preventative management strategies to reduce future post-invasion management costs and help inform decisions to manage the economic burdens posed by invasive non-native species. These insights further emphasise the crucial role of standardised data in accurately estimating the costs associated with invasive non-native species for prioritisation and communication purposes.
Assuntos
Espécies Introduzidas , Ecossistema , Conservação dos Recursos Naturais/economia , Agricultura/economia , Animais , Pesqueiros/economiaRESUMO
BACKGROUND: Surface tension and contact angle properties, which play a crucial role in determining the effectiveness of irrigation solutions in penetrating dentin surfaces and dentin tubules, are highly important for the development of new irrigation solutions and their preferences. The aim of the current study was to compare the surface tension and contact angle properties of different irrigation solutions used in endodontics, both on the dentin surface and within dentin tubules. METHODS: In this study, the contact angles and surface tensions of 5.25% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), 5% boric acid (BA), 0.02% hypochlorous acid (HOCl), 0.2% chlorine dioxide (ClO2), Biopure MTAD, QMix solutions, and distilled water (control group) were measured. Measurements were conducted using a goniometer device (Attension Theta Lite Tensiometer, Biolin Scientific, USA), employing the sessile drop method for contact angle measurements on pre-prepared dentin surfaces, and the pendant drop method for surface tension. RESULTS: Contact angle measurements revealed no statistically significant differences between the contact angle values of MTAD, ClO2, and CHX or between NaOCl, QMix, BA, and HOCl (p > 0.05). However, EDTA exhibited a significantly greater contact angle than did MTAD, ClO2, CHX, NaOCl, QMix, BA, and HOCl (p < 0.05). Furthermore, the contact angle of dentin with distilled water was greater than that with all other solutions tested (p < 0.05). Surface tension measurements revealed that the surface tension values of QMix and MTAD were statistically similar (p > 0.05). CHX exhibited lower surface tension than distilled water and HOCl (p < 0.05), and it also had lower surface tension than ClO2, NaOCl, and BA (p < 0.05). Additionally, the surface tension of the samples treated with EDTA was greater than that of all other solutions tested (p < 0.05). CONCLUSION: The direct linear relationship between the surface tension of liquids and contact angles on different surfaces may not always hold true, and these values should be considered independently for each solution on various surfaces. Considering the contact angles and surface tension properties of irrigation solutions with root canal dentin, it can be suggested for clinical use that ClO2 could be recommended over NaOCl, and similarly, BA could be recommended over EDTA.
Assuntos
Dentina , Irrigantes do Canal Radicular , Tensão Superficial , Dentina/efeitos dos fármacos , Humanos , Hipoclorito de Sódio/farmacologia , Ácido Edético , Ácido Hipocloroso , Propriedades de SuperfícieRESUMO
BACKGROUND: Pulmonary embolism (PE) is a common complication of deep vein thrombosis that causes high mortality and morbidity. This study aimed to determine the relationship between clinical risk scoring for early mortality and fractional exhaled nitric oxide (FeNO) in PE patients. METHODS: The study included a total of 98 subjects, 68 patients diagnosed with PE in the emergency department, and 30 healthy controls. Patients with PE were grouped according to clinical scoring of early mortality risk as low (n = 20), moderate-low (n = 24), and moderate-high (n = 24) risk. FeNO levels were measured after diagnosis. RESULTS: FeNO levels were significantly higher in patients with moderate-high risk PE compared to the other three groups and in those with moderate-low risk PE compared to the control group (p < 0.001 for all). Moderate to strong positive correlations were observed between FeNO level and mean pulmonary artery pressure (r = 0.818, p = 0.01), troponin-I (r = 0.67, p = 0.01), pro-BNP (r = 0.762, p = 0.01), and D-dimer levels (r = 0.652, p = 0.01). A FeNO cutoff value of 7.5 ppb had 84% sensitivity and 78% specificity in differentiating moderate-high risk PE from moderate-low risk PE. CONCLUSIONS: FeNO may be as reliable, noninvasive, and easily accessible as cardiac biomarkers in clinical risk scoring for early mortality in PE patients.
Assuntos
Teste da Fração de Óxido Nítrico Exalado , Embolia Pulmonar , Humanos , Óxido Nítrico , Testes Respiratórios , Embolia Pulmonar/diagnóstico , Medição de Risco , BiomarcadoresRESUMO
PURPOSE: This study aimed to investigate the effect of surface treatment and type of composite resin material on the color stability and surface roughness of different denture characterizing composites. MATERIALS AND METHODS: Two nanohybrids [Gradia Plus Gum, (GP) and SR Nexco Paste Gingiva, (SR)] and one microhybrid gingiva-colored composite resin [Amaris Gingiva, (AG)] were investigated. A total of 120 disk-shaped samples were prepared, 40 of each material. Samples were divided into two groups (n = 20) for each material according to the surface treatment applied: conventional polishing (control) and coated with a sealant in addition to the surface polishing. All groups were thermocycled. The surface roughness (Ra) was measured using a profilometer after thermal cycling. The samples were then divided into 2 subgroups (n = 10) and stored for 7 days in distilled water or coffee solution. Color differences (ΔE00 ) were calculated with a spectrophotometer. Results were evaluated with Kruskal-Wallis and Mann-Whitney U statistical analysis. RESULTS: The type of denture characterizing composite material and surface treatment method revealed statistically significant differences for the ΔE00 (after immersion both in coffee and distilled water) and the Ra values of denture characterizing composite (p < 0.001 for both). All sealed groups showed significantly higher Ra than the all polished groups. Both in the polished groups and the sealant applied groups, the GP had the highest mean Ra values (0.29 ±0.05 µm and 0.47 ±0.09 µm, respectively). It was followed by SR (0.23 ±0.06 µm and 0.41 ±0.10 µm, respectively), and AG groups (0.20 ±0.06 µm and 0.39 ±0.09 µm, respectively). According to the mean ΔE00 results, all composite groups showed significantly higher ΔE00 values immersed in coffee solutions compared to distilled water. In coffee solutions, the highest ΔE00 was observed in the polished GP (1.90 ±0.40), and the lowest ΔE00 was observed in the polished SR (0.97 ±0.36). The sealed groups showed higher ΔE00 than the polished groups, except for GP. CONCLUSIONS: The surface roughness value of sealant applied groups were significantly higher than those of the polished groups. The surface sealant application significantly increased the staining of all composite groups compared to conventional polishing, except for GP.
Assuntos
Café , Resinas Compostas , Materiais Dentários , Dentaduras , Água , Propriedades de Superfície , Teste de Materiais , Cor , Polimento Dentário/métodosRESUMO
OBJECTIVE: The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients. METHODS: The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects. RESULTS: The carotid intima-media thickness was determined as 0.47⯱â¯0.05â¯mm in the patient group and 0.44⯱â¯0.04â¯mm in the control group (pâ¯=â¯0.028). The carotid intima-media thickness was measured as 0.45⯱â¯0.05â¯mm in patients with epilepsy taking monotherapy and 0.49⯱â¯0.04â¯mm in those taking polytherapy (pâ¯=â¯0.003). The epicardial adipose tissue thickness was determined as 3.42⯱â¯0.09â¯mm in the patient group and 1.72⯱â¯0.90â¯mm in the control group (pâ¯=â¯0.000). The epicardial adipose tissue thickness was measured as 3.16⯱â¯0.87â¯mm in patients with epilepsy taking monotherapy and 3.77⯱â¯0.83â¯mm in those taking polytherapy (pâ¯=â¯0.041). CONCLUSIONS: It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Anticonvulsivantes/uso terapêutico , Espessura Intima-Media Carotídea , Epilepsia/diagnóstico por imagem , Epilepsia/tratamento farmacológico , Pericárdio/diagnóstico por imagem , Tecido Adiposo/efeitos dos fármacos , Adolescente , Anticonvulsivantes/efeitos adversos , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/efeitos dos fármacos , Criança , Pré-Escolar , Epilepsia/sangue , Feminino , Seguimentos , Cardiopatias/sangue , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Pericárdio/efeitos dos fármacos , Fatores de RiscoRESUMO
BACKGROUND: Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke. METHODS: We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%). CONCLUSIONS: In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.
Assuntos
Isquemia Encefálica , Doenças de Pequenos Vasos Cerebrais , Hipertensão , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Artérias , Hipertensão/complicações , Hipertensão/epidemiologia , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Imageamento por Ressonância MagnéticaRESUMO
Introduction: The gold standard treatment for obstructive sleep apnea syndrome (OSAS) is positive airway pressure therapy (PAP) treatments. PAP treatments reduce complications by reducing apnea and hypopnea attacks by creating airflow at a determined pressure. In our study, we aimed to examine the effect of treatment compliance on kidney and liver functions, apneahypopnea (AHI) index, and lipid profile of patients diagnosed with OSAS and started PAP treatment. Materials and Methods: Patients who were admitted to the sleep laboratory of our hospital between September 2022 and September 2023 and started PAP treatment after PSG were included in our study. Patients who were called for follow-up six months after the initiation of PAP treatment were divided into two groups according to their compliance with PAP treatment. Patients who used the device for at least four hours per night and more than 70% at night were grouped as PAP-compliant patients, while the other patients were grouped as non-PAP-compliant patients. Result: It was observed that uric acid, BUN, triglyceride, total cholesterol, ALT, GGT, ALP, and AHI levels of the patients who started PAP treatment decreased after six months (p= 0.001, 0.006, <0.001, 0.006, 0.01, <0.001, <0.001, <0.001 with). It was observed that HDL cholesterol levels increased (p≤ 0.001). It was observed that the change in uric acid, AHI, total cholesterol, and GGT levels in group 1 (n= 36) patients who were compliant with PAP treatment was statistically higher than in group 2 (n= 30) patients (p< 0.001, <0.03, <0.001, 0.008, respectively). Conclusions: Uric acid, total cholesterol and GGT are biomarkers that may increase in OSAS due to intermittent hypoxia with the involvement of other systems. Since a decrease in these biomarkers can be observed in the early period depending on treatment compliance, these biomarkers can be used practically in the follow-up of treatment compliance and treatment efficacy.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Cooperação do Paciente , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/sangue , Feminino , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Seguimentos , Adulto , Polissonografia , Lipídeos/sangueRESUMO
BACKGROUND: Adverse non-motor outcomes are common after acute stroke and likely to substantially affect quality of life, yet few studies have comprehensively assessed their prevalence, patterns, and predictors across multiple health domains. AIMS: We aimed to identify the prevalence, patterns, and the factors associated with non-motor outcomes 30 days after stroke. METHODS: This prospective observational hospital cohort study-Stroke Investigation in North and Central London (SIGNAL)-identified patients with acute ischemic stroke or intracerebral hemorrhage (ICH) admitted to the Hyperacute Stroke Unit (HASU) at University College Hospital (UCH), London, between August 1, 2018 and August 31, 2019. We assessed non-motor outcomes (anxiety, depression, fatigue, sleep, participation in social roles and activities, pain, bowel function, and bladder function) at 30-day follow-up using the Patient-Reported Outcome Measurement Information System-Version 29 (PROMIS-29) scale and Barthel Index scale. RESULTS: We obtained follow-up data for 605/719 (84.1%) eligible patients (mean age 72.0 years; 48.3% female; 521 with ischemic stroke, 84 with ICH). Anxiety (57.0%), fatigue (52.7%), bladder dysfunction (50.2%), reduced social participation (49.2%), and pain (47.9%) were the commonest adverse non-motor outcomes. The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2 and ⩾ 3 domains were 89%, 66.3%, and 45.8%, respectively; in adjusted analyses, stroke due to ICH (compared to ischemic stroke) and admission stroke severity were the strongest and most consistent predictors. There were significant correlations between bowel dysfunction and bladder dysfunction (κ = 0.908); reduced social participation and bladder dysfunction (κ = 0.844); and anxiety and fatigue (κ = 0.613). We did not identify correlations for other pairs of non-motor domains. CONCLUSION: Adverse non-motor outcomes were very common at 30 days after stroke, affecting nearly 90% of evaluated patients in at least one health domain, about two-thirds in two or more domains, and almost 50% in three or more domains. Stroke due to ICH and admission stroke severity were the strongest and most consistent predictors. Adverse outcomes occurred in pairs of domains, such as with anxiety and fatigue. Our findings emphasize the importance of a multi-domain approach to effectively identify adverse non-motor outcomes after stroke to inform the development of more holistic patient care pathways after stroke.
Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Feminino , Idoso , Masculino , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/complicações , Estudos de Coortes , AVC Isquêmico/complicações , Qualidade de Vida , Prevalência , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/complicações , Hospitais , Medidas de Resultados Relatados pelo Paciente , Dor , Fadiga/epidemiologia , Fadiga/complicaçõesRESUMO
BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) may be associated with the pathogenesis and phenotype of cerebral small vessel disease (SVD), which is the commonest cause of intracerebral hemorrhage (ICH). The purpose of this study was to investigate the associations of CKD with ICH neuroimaging phenotype, volume, and location, total burden of small vessel disease, and its individual components. METHODS: In 2 cohorts of consecutive patients with ICH evaluated with MRI, we investigated the frequency and severity of CKD based on established Kidney Disease Improving Global Outcomes criteria, requiring estimated glomerular filtration rate (eGFR) measurements <60 mL/min/1.732 ≥ 3 months apart to define CKD. MRI scans were rated for ICH neuroimaging phenotype (arteriolosclerosis, cerebral amyloid angiopathy, mixed location SVD, or cryptogenic ICH) and the presence of markers of SVD (white matter hyperintensities [WMHs], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces, defined according to the STandards for ReportIng Vascular changes on nEuroimaging criteria). We used multinomial, binomial logistic, and ordinal logistic regression models adjusted for age, sex, hypertension, and diabetes to account for possible confounding caused by shared risk factors of CKD and SVD. RESULTS: Of 875 patients (mean age 66 years, 42% female), 146 (16.7%) had CKD. After adjusting for age, sex, and comorbidities, patients with CKD had higher rates of mixed SVD than those with eGFR >60 (relative risk ratio 2.39, 95% CI 1.16-4.94, p = 0.019). Severe WMHs, deep microbleeds, and lacunes were more frequent in patients with CKD, as was a higher overall SVD burden score (odds ratio 1.83 for each point on the ordinal scale, 95% CI 1.31-2.56, p < 0.001). Patients with eGFR ≤30 had more CMBs (median 7 [interquartile range 1-23] vs 2 [0-8] for those with eGFR >30, p = 0.007). DISCUSSION: In patients with ICH, CKD was associated with SVD burden, a mixed SVD phenotype, and markers of arteriolosclerosis. Our findings indicate that CKD might independently contribute to the pathogenesis of arteriolosclerosis and mixed SVD, although we could not definitively account for the severity of shared risk factors. Longitudinal and experimental studies are, therefore, needed to investigate causal associations. Nevertheless, stroke clinicians should be aware of CKD as a potentially independent and modifiable risk factor of SVD.
Assuntos
Hemorragia Cerebral , Doenças de Pequenos Vasos Cerebrais , Imageamento por Ressonância Magnética , Insuficiência Renal Crônica , Humanos , Masculino , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/complicações , Feminino , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/complicações , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Estudos Transversais , Pessoa de Meia-Idade , Taxa de Filtração Glomerular , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Cerebral small vessel disease (CSVD) causes between 25% and 30% of all ischaemic strokes. In acute lacunar ischaemic stroke, despite often mild initial symptoms, early neurological deterioration (END) occurs in approximately 15-20% of patients and is associated with poor functional outcome, yet its mechanisms are not well understood. AIMS: In this review we systematically evaluated data on: (1) definitions and incidence of END; (2) mechanisms of small vessel occlusion; (3) predictors and mechanisms of END; and (4) prospects for the prevention or treatment of patients with END. SUMMARY OF REVIEW: We identified 67 reports (including 13407 participants) describing the incidence of END in acute lacunar ischaemic stroke. The specified timescale for END varied from <24h to 3 weeks. The rate of END ranged between 2.3% and 47.5 with a pooled incidence of 23.54% (95% CI 21.02-26.05%) but heterogeneity was high (I2=90.29%). The rates of END defined by NIHSS decreases of ≥1, ≥2, ≥3, and 4 points were: 24.17 (21.19-27.16)%; 22.98 (20.48-25.30)%; 23.33 (16.23-30.42)%; and 10.79 (2.09-23.13)%, respectively, with lowest heterogeneity and greatest precision for a cut-off of ≥2 points. Of the 20/67 studies (30%) reporting associations of END with clinical outcome, 19/20 (95%) reported worse outcomes (usually measured using the modified Rankin score at 90 days or at hospital discharge) in patients with END. In a meta-regression analysis female sex, hypertension, diabetes, and smoking, were associated with END. CONCLUSIONS: Early neurological deterioration occurs in over 20% of patients with acute lacunar ischaemic stroke and might provide a novel target for clinical trials. A definition of an NIHSS ≥2 decrease is most used and provides the best between-study homogeneity. END is consistently associated with poor functional outcome. Further research is needed to better identify patients at risk of END, to understand the underlying mechanisms and to carry out new trials to test potential interventions.
RESUMO
OBJECTIVES: Cerebral amyloid angiopathy (CAA)-associated lobar intracerebral hemorrhage (ICH) has a high risk of recurrence, but the underlying mechanisms remain uncertain. We, therefore, aimed to characterize patterns of recurrent ICH. METHODS: We investigated early recurrent ICH (≥1 recurrent ICH event within 90 days of the index event) and ICH clusters (≥2 ICH events within 90 days at any time point) in 2 large cohorts of consecutive patients with first-ever ICH and available MRI. RESULTS: In 682 included patients (median age 68 years, 40.3% female, median follow-up time 4.1 years), 18 (2.6%) had an early recurrent ICH, which was associated with higher age and CAA. In patients with probable CAA, the risk of early recurrent ICH was increased 5-fold within the first 3 months compared with during months 4-12 (hazard ratio 5.41, 95% CI 2.18-13.4) while no significant difference was observed in patients without CAA. In patients with an ICH cluster, we observed spatial clustering (recurrent ICH within close proximity of index ICH in 63.0%) and a tendency for multiple sequential hemorrhages (≥3 ICH foci within 3 months in 44.4%). DISCUSSION: Our data provide evidence of both temporal and spatial clustering of ICH in CAA, suggesting a transient and localized active bleeding-prone process.
Assuntos
Angiopatia Amiloide Cerebral , Hemorragia Cerebral , Imageamento por Ressonância Magnética , Recidiva , Humanos , Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/epidemiologia , Feminino , Masculino , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Estudos de Coortes , Seguimentos , Fatores de Tempo , Análise por ConglomeradosRESUMO
BACKGROUND AND OBJECTIVES: Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS: We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS: The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION: CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.
Assuntos
Angiopatia Amiloide Cerebral , Acidente Vascular Cerebral , Humanos , Idoso , Reprodutibilidade dos Testes , Estudos Retrospectivos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Angiopatia Amiloide Cerebral/diagnóstico por imagemRESUMO
Aim: This study compared exhaled carbon monoxide (CO) levels in patients hospitalized for bacterial and COVID-19-related viral community-acquired pneumonia. Materials & methods: The study included a total of 150 patients: 50 patients hospitalized for COVID-19 between February 2021 and March 2022, 50 patients with bacterial community-acquired pneumonia and 50 healthy controls. Results: In comparisons of exhaled CO levels among the groups, there was no significant difference between patients with bacterial pneumonia and controls, whereas patients with COVID-19 pneumonia had significantly higher exhaled CO levels compared with both the bacterial pneumonia and control groups (p < 0.001). Conclusion: Viral agents can directly affect the heme oxygenase system of the lower respiratory tract, leading to greater increases in ferritin and exhaled CO levels compared with bacterial pneumonia.
Infections in the lung tissue cause stress in the body. Several mechanisms are activated in the body to balance this stress. The heme oxygenase system plays a role in suppressing inflammation, and its overactivation can cause an increase in the amount of carbon monoxide (CO) we exhale. This study examined exhaled CO levels in patients with bacterial lung infection and COVID-19 viral lung infection in comparison with the healthy population. We found that patients with COVID-19 lung infection had higher levels of CO in their breath than patients with bacterial lung infection and healthy control subjects. These findings suggest that measurements of exhaled CO levels in people with signs and symptoms of lung infection might be used to differentiate patients with viral and bacterial lung infections.
Assuntos
COVID-19 , Pneumonia Bacteriana , Humanos , Monóxido de Carbono , Heme Oxigenase (Desciclizante) , Expiração , Pneumonia Bacteriana/diagnóstico , Testes RespiratóriosRESUMO
BACKGROUND: Cerebral amyloid angiopathy (CAA), a common cause of intracerebral hemorrhage (ICH), is diagnosed using the Boston criteria including magnetic resonance imaging (MRI) biomarkers (cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS). The simplified Edinburgh criteria include computed tomography (CT) biomarkers (subarachnoid extension (SAE) and finger-like projections (FLPs)). The underlying mechanisms and diagnostic accuracy of CT compared to MRI biomarkers of CAA are unknown. METHODS: We included 140 survivors of spontaneous lobar supratentorial ICH with both acute CT and MRI. We assessed associations between MRI and CT biomarkers and the diagnostic accuracy of CT- compared to MRI-based criteria. RESULTS: FLPs were more common in patients with strictly lobar CMB (44.7% vs 23.5%; p = 0.014) and SAE was more common in patients with cSS (61.3% vs 31.2%; p = 0.002). The high probability of the CAA category of the simplified Edinburgh criteria showed 87.2% (95% confidence interval (CI): 78.3-93.4) specificity, 29.6% (95% CI: 18.0-43.6) sensitivity, 59.3% (95% CI: 38.8-77.6) positive predictive value, and 66.4% (95%: CI 56.9-75.0) negative predictive value, 2.3 (95% CI: 1.2-4.6) positive likelihood ratio and 0.8 (95% CI 0.7-1.0) negative likelihood ratio for probable CAA (vs non-probable CAA), defined by the modified Boston criteria; the area under the receiver operating characteristic curve (AUROC) was 0.62 (95% CI: 0.54-0.71). CONCLUSION: In lobar ICH survivors, we found associations between putative biomarkers of parenchymal CAA (FLP and strictly lobar CMBs) and putative biomarkers of leptomeningeal CAA (SAE and cSS). In a hospital population, CT biomarkers might help rule-in probable CAA (diagnosed using the Boston criteria), but their absence is probably not as useful to rule it out, suggesting an important continued role for MRI in ICH survivors with suspected CAA.
Assuntos
Angiopatia Amiloide Cerebral , Acidente Vascular Cerebral , Humanos , Hemorragia Cerebral/epidemiologia , Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , BiomarcadoresRESUMO
INTRODUCTION: Pulmonary embolism (PE) often occurs secondary to deep vein thrombosis and is an important cause of mortality and morbidity. This study aimed to evaluate the relationship between YKL-40 level and clinical risk score in patients with PE. METHODS: The study included a total of 100 patients, 80 patients diagnosed with PE in the emergency department and 20 healthy controls. Patients with PE were divided into four groups: high-risk patients (n = 20), high-intermediate-risk patients (n = 20), low-intermediate-risk patients (n = 20), and low-risk patients (n = 20). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Pulmonary artery obstruction index (PAOI) was calculated from computed tomography angiography images. RESULTS: PAOI increased in correlation with PE risk and differed significantly between all patient groups (p < 0.001). Troponin-I levels were significantly higher in the high-risk and high-intermediate-risk groups compared to the other groups (p < 0.001), but did not differ significantly between high-risk and high-intermediate-risk patients (p = 0.09). YKL-40 level was significantly higher in the high-risk PE group than the high-intermediate-risk group (p < 0.001). In receiving operator characteristic curve analysis assessing the discriminatory value of YKL-40 for high-risk PE patients, a cut-off value of 227.2 ng/mL had sensitivity of 85 % and specificity of 70 %. DISCUSSION: YKL-40 may be an important biomarker in decisions regarding early thrombolytic treatment in patients with high-intermediate-risk PE. In addition, medical treatments targeting YKL-40 may also reduce thrombotic tendency in high-risk patient groups.
Assuntos
Arteriopatias Oclusivas , Embolia Pulmonar , Doença Aguda , Biomarcadores , Proteína 1 Semelhante à Quitinase-3 , Humanos , Embolia Pulmonar/diagnóstico , Fatores de Risco , Troponina IRESUMO
BACKGROUND AND PURPOSE: The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. METHODS: This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March-16th May 2018 (pre-COVID-19 pandemic); and 16th March-16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System-29 (PROMIS-29 version 2.0) at 30 days after stroke. RESULTS: We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (ß = 28.0, p < 0.001), fatigue (ß = 9.3, p < 0.001), depression (ß = 4.5, p = 0.002), sleep disturbance (ß = 2.3, p = 0.018), pain interference (ß = 10.8, p < 0.001); and reduced physical function (ß = 5.2, p < 0.001) and participation in social roles and activities (ß = 6.9, p < 0.001). CONCLUSION: Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.
Assuntos
COVID-19 , Acidente Vascular Cerebral , Adulto , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Reino Unido/epidemiologiaRESUMO
Objective: The aim of this in vitro study was to investigate the possible interactions between photon-induced photoacoustic streaming (PIPS™)-activated oxidizing agents and 2% chlorhexidine digluconate. Background data: There is no information about the safety of laser-activated oxidizing agents in combination usage with chlorhexidine gluconate. Materials and methods: Groups were designed as follows G1: 98% para-chloroaniline (PCA); G2: 2% chlorhexidine (CHX); G3: 5.25% sodium hypochlorite (NaOCl) +2% CHX; G4: 5.25% NaOCl (30 sec PIPS activated) +2% CHX; G5: 5.25% NaOCl (60 sec PIPS activated) +2% CHX; G6: 3.5% chlorine dioxide (ClO2) + 2% CHX; G7: 3.5% (ClO2) (30 sec PIPS activated) +2% CHX; G8: 3.5% (ClO2) (60 sec PIPS activated) +2% CHX. The laser-irrigation protocol was performed with an erbium:yttrium-aluminum-garnet laser with a wavelength of 2940 nm equipped with a 140 mm long endodontic fiber tip (PIPS) using 10 mJ at 15 Hz (0.15 W), per pulse operating outputs. Groups were analyzed with proton nuclear magnetic resonance spectroscopy, using PCA as an internal standard. Results: No free PCA was formed in any groups of mixtures or after PIPS activation. Conclusions: Mixing of 3.5% ClO2 and 2% CHX does not form bulky precipitates, unlike the mixture NaOCl + CHX. PIPS activation does not cause changes in reactions of oxidizing agents.
Assuntos
Anti-Infecciosos Locais/efeitos da radiação , Clorexidina/análogos & derivados , Terapia com Luz de Baixa Intensidade , Oxidantes/efeitos da radiação , Técnicas Fotoacústicas , Irrigantes do Canal Radicular/efeitos da radiação , Compostos de Anilina/efeitos da radiação , Clorexidina/efeitos da radiação , Lasers de Estado Sólido , Espectroscopia de Prótons por Ressonância Magnética , Preparo de Canal Radicular , Hipoclorito de Sódio/efeitos da radiaçãoRESUMO
OBJECTIVES: This study assessed the antibacterial activity of both separate and combined uses of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% ethylenediaminetetraacetic acid (EDTA), 3% hydrogen peroxide (H2O2), MTAD, SmearClear (SC) and 13.8% chlorine dioxide (ClO2) irrigation solutions against Enterococcus faecalis. MATERIALS AND METHODS: Two hundred eighty single rooted human premolars were randomly grouped into 26 test and 2 control (negative and positive) groups and were incubated for 24 h with E. faecalis, except for the negative control group. The tested solutions were as follow: NaOCl; CHX; ClO2; MTAD; SC; EDTA; H2O2; NaOCl + CHX; NaOCl + MTAD; SC + NaOCl; EDTA + NaOCl; H2O2 + NaOCl; ClO2 + CHX; CHX + MTAD; SC + CHX; EDTA + CHX; CHX + H2O2; ClO2 + MTAD; SC + ClO2; EDTA + ClO2; ClO2 + H2O2; SC+MTAD; EDTA+MTAD; MTAD + H2O2; SC + H2O2; and EDTA + H2O2. Optic density values were recorded at 0, 6, 12, 18, 24, 30, 36, 42 and 48 h and bacterial growth curve created for each solution. RESULTS: The CHX, MTAD and ClO2 showed a high potential for the elimination of E. faecalis, both alone and in all combinations. The EDTA, H2O2, H2O2+ EDTA, H2O2 + NaOCl and SC + NaOCl groups showed less antibacterial activity than the other groups. The SC + CHX group showed the best antibacterial effect against E. faecalis. CONCLUSION: The SC + CHX combination can be recommended as the most effective irrigation regimen against E. faecalis in persistent endodontic infections.
RESUMO
AIM: This study compared the fracture resistance of endodontically-treated mandibular molars with mesio-occluso-distal (MOD) cavities restored using different restoration techniques. METHODOLOGY: Sixty sound extracted mandibular molars were randomly assigned to six groups (n=10). Group 1 did not receive any preparation. The teeth in Groups 2-6 received root canal treatment and a MOD cavity preparation. The teeth in Group 2 were kept unrestored. Group 3 was restored conventionally with amalgam. Group 4 was restored with a dentin bonding system (DBS, Clearfil SE Bond) and resin composite (CR) (Clearfil Photoposterior). Group 5 was restored with indirect hybrid ceramic inlay material (Estenia). In Group 6, polyethylene ribbon fiber (Ribbond) was inserted into cavities in a buccal-to-lingual direction and the teeth were then restored with DBS and CR. After finishing and polishing, the specimens, except for Group 2, were loaded to failure by a chewing simulation device (60,000 cycles x 50 N load, 1.3 Hz frequency) in an artificial environment at 37 degrees C. Each tooth was subjected to compressive loading perpendicular to the occlusal surface at a crosshead speed of 1 mm/minute. The mean loads necessary to fracture were recorded in Newtons and the results were statistically analyzed. RESULTS: The mean fracture values were as follows: Group 1: 2485.3 +/- 193.98a, Group 2: 533.9 +/- 59.4a, Group 3: 1705.8 +/- 135.7a, Group 4: 2033.3 +/- 137.6cd, Group 5: 2121.3 +/- 156.5d, Group 6: 1908.9 +/- 132.2cd. There were statistically significant differences between the groups annotated with different letters. Thus, Group 1 (intact teeth) had the greatest fracture resistance and Group 2 (non-restored teeth) the poorest. No statistically significant differences were found between Groups 3 (amalgam), 4 (resin composite) and 6 (polyethylene ribbon fiber reinforced composite) (p > 0.05). Group 5 (indirect hybrid ceramic inlay) had greater fracture resistance than Group 3 (p < 0.05). CONCLUSIONS: Within the limitations of this study, although all of the restoration groups were stronger than the prepared-only group, none of the restoration techniques tested was able to completely restore the fracture resistance lost from MOD cavity preparation. However, use of indirect hybrid inlay restorations in these teeth may be recommended, because this restoration technique indicated more favorable fracture failure modes than other restoration techniques used in this study and particularly greater fracture strength than amalgam restorations. The promising result of indirect hybrid inlay restorations may need to be confirmed by long-term clinical studies.
Assuntos
Materiais Dentários/química , Restauração Dentária Permanente/métodos , Dente Molar/patologia , Fraturas dos Dentes/fisiopatologia , Dente não Vital/terapia , Força de Mordida , Resinas Compostas/química , Amálgama Dentário/química , Preparo da Cavidade Dentária/classificação , Polimento Dentário , Porcelana Dentária/química , Restauração Dentária Permanente/classificação , Adesivos Dentinários/química , Humanos , Restaurações Intracoronárias , Teste de Materiais , Polietilenos/química , Cimentos de Resina/química , Tratamento do Canal Radicular , Estresse Mecânico , TemperaturaRESUMO
The organic tissue dissolution properties of irrigating solutions are important for the success of endodontic treatment. Chlorine dioxide (ClO2) has been recently proposed as an irrigation solution in endodontics. The organic tissue dissolution property of sodium hypochlorite (NaOCl) is well-known and extensively investigated, but apparently no data have been published on tissue-dissolving properties of ClO2. The aim of this in vitro study was to compare organic tissue dissolution capacity of NaOCl and ClO2. In this study, 5.25% NaOCl, 13.8% ClO2, and, as a control, isotonic saline solutions (0.9% NaCl) were used. Thirty bovine pulp specimens were previously weighed and immersed for 20 minutes in each test solution (changing the solution every 2 minutes). The pulp specimens were then blotted dry and weighed again. The percentage of weight loss was calculated and statistically analyzed by using one-way analysis of variance and post hoc Tukey honestly significant difference tests. Saline solution did not dissolve the organic tissue. Both 5.25% NaOCl and 13.8% ClO2 dissolved the tissue pieces more effectively than saline control (P < .05). No statistically significant difference was found between the tissue-dissolving properties of 5.25% NaOCl and those of 13.8% ClO2 (P > .05). Within the limitations of this in vitro study, it was concluded that ClO2 and NaOCl are equally efficient for dissolving organic tissue.