Search

To evaluate the extent to which Generative Pre-trained Transformer 4 (GPT-4) can educate patients by generating easily understandable information about the most common interventional radiology (IR) procedures. We reviewed 10 IR procedures and prepared prompts for GPT-4 to provide patient educational instructions about each procedure in layman's terms. The instructions were then evaluated by four clinical physicians and nine nonclinical assessors to determine their clinical appropriateness, understandability, and clarity using a survey. A grade-level readability assessment was performed using validated metrics to evaluate accessibility to a wide patient population. The same procedures were also evaluated from the patient instructions available at radiologyinfo.org and compared with GPT-generated instructions utilizing a paired t test. Evaluation by four clinical physicians shows that nine GPT-generated instructions were fully appropriate, whereas arterial embolization instructions was somewhat appropriate. Evaluation by nine nonclinical assessors shows that paracentesis, dialysis catheter placement, thrombectomy, ultrasound-guided biopsy, and nephrostomy-tube instructions were rated excellent by 57% and good by 43%. The arterial embolization and biliary-drain instructions were rated excellent by 28.6% and good by 71.4%. In contrast, thoracentesis, port placement, and CT-guided biopsy instructions received 43% excellent, 43% good, and 14% fair. The readability assessment across all procedural instructions showed a better Flesch-Kincaid mean grade of GPT-4 instructions compared with radiologyinfo.org (7.8 ± 0.87 versus 9.6 ± 0.83; P =.007) indicating excellent readability at 7th- to 8th-grade level compared with 9th to 10th grade. Additionally there was a lower Gunning Fog mean index (10.4 ± 1.2 versus 12.7 ± 0.93; P =.006), and higher Flesch Reading Ease mean score (69.4 ± 4.8 versus 51.3±3.9; P =.0001) indicating better readability. IR procedural instructions generated by GPT-4 can aid in improving health literacy and patient-centered care in IR by generating easily understandable explanations. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the outcomes of 2 types of drains for severe odontogenic infection management. Thirty-eight patients with severe odontogenic infections underwent drainage performed under general anesthesia. According to the type of drain used, they were randomized and separated into 2 groups: irrigating (n = 19) and non-irrigating drain (n = 19). Data such as age, ethnicity, sex, number of teeth, and fascial spaces were collected on admission through anamnesis. The clinical and laboratory parameters were checked every 24 hours until discharge. Symptom evolution was monitored daily using a visual analog scale. The Mann-Whitney U test was used for the primary outcome, and a P value < 0.05 was considered to indicate statistical significance. No statistically significant difference in the overall length of stay was observed. Statistically significant differences in parameters such as pain, odynophagia, and leukocyte and segmented neutrophil counts were observed. Non-irrigating drains may be as effective as irrigating drains in treating severe odontogenic infections. [ABSTRACT FROM AUTHOR]

Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial. A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions. Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events. LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs. [ABSTRACT FROM AUTHOR]

The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily. The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women. Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated. First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care. The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery. [ABSTRACT FROM AUTHOR]

The airway develops from the primitive foregut at 4 weeks' gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults, with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight-bladed laryngoscope are usually used for intubation. Neonates are also obligate nasal breathers and simultaneously suckle and breath. Minute volume is rate dependent and the highly compliant chest easily displays sternal and intercostal recession during respiratory distress, and early onset of fatigue. From the neonatal period onwards the anatomy gradually begins to resemble that of adults. The cricoid descends caudally, the epiglottis becomes firmer and shorter, and the relatively large occiput recedes. The conventional wisdom of the cricoid ring being the narrowest part of the paediatric airway is not supported by contemporary investigation. The consequence of these findings on endotracheal tube selection and the rationale for increasing use of cuffed endotracheal tubes in children is discussed. [ABSTRACT FROM AUTHOR]

To evaluate the interference of artifacts from metal dental restorations with superimposed DICOM and STL files with automatic segmentation using CBCT planning software and compare this interference with image acquisition in occlusion and non-occlusion. CBCT scan files in DICOM format were acquired following intraoral scans performed in 97 patients. The DICOM files were selected and superimposed on their corresponding STL file based on four fixed anatomical positions in the 3D arches to standardize the superposition. The overall results showed a mean of 0.489 mm, with a maximum standard deviation of ±1,353 mm. The analysis of variance showed a significant influence regarding the number of metal restorations on the deviations of models in the horizontal/anterior position (p=0.009). Group 1 showed a statistically significant difference from group 2. Group 0 did not statistically significantly differ from groups 1 and 2. When comparing occlusion and non-occlusion, VP and VA positions showed a statistically significant difference. Whether the patient is in occlusion or not, metal artifacts did not interfere with CBCT planning software for superimposed images in vertical analyses. However, horizontally, there was an inferred discrepancy in the adjustments to DICOM-STL segmentation. [ABSTRACT FROM AUTHOR]

To describe the epidemiological, clinical, and pathological profile of cases diagnosed as oral epithelial dysplasia in a reference center for oral lesions. This is a descriptive study, based on secondary data from clinical records and histopathological reports, from 2010 to 2019. Data were analyzed descriptively. 88 cases of oral epithelial dysplasia were diagnosed, most of them in females (51.1%), over 45 years of age (83.3%), non-white race/color (74.2%), with education at elementary school (42.4%), and smokers (59.7%). Leukoplasia (45.8%) was the most frequent clinical lesion, with the lower lip (23.2%) being the anatomical site with the greatest involvement. Regarding the histopathological diagnosis, there was a predominance of cases of moderate dysplasia (38.6%). There was an even distribution between the degrees of dysplasia, with a slight predominance of moderate dysplasia. The knowledge of the clinical epidemiological profile of individuals diagnosed with oral epithelial dysplasia should enable the early diagnosis of oral cavity cancer and the establishment of more adequate protection measures and treatment protocols for these lesions. [ABSTRACT FROM AUTHOR]

We report a case of a patient with a complete vaccination schedule, and subsequent exacerbation of herpes zoster (HZ) symptoms jointly with orocutaneous eruptions after a second infection by SARS-CoV2. In December 2022, a 52-year-old female presented to the clinic with symptoms of cough, runny nose, and fatigue. She was monitored under at-home quarantine for 10 days, having her oxygen saturation measured daily, under antiallergic and corticosteroid therapy. Posteriorly, the RT‐ PCR result confirmed the diagnosis of COVID-19. The patient's medical history showed a past report of fibromyalgia, total thyroidectomy, and herpes zoster (HZ) infection. The association between SARS-CoV-2 and herpesviruses has been observed in several patients, although the pathophysiological mechanisms involved in the process of herpes zoster (HZ) lytic reactivation remain poorly understood. [ABSTRACT FROM AUTHOR]

A metastatic giant cell-rich osteosarcoma (GCRO) to the jaws is an exceedingly rare neoplasm. To date, fewer than 10 cases have been reported in the English language literature. In this article, we describe an additional case of a metastatic GCRO that presented the diagnostic challenge of a painless mass in the posterior mandible of a 19-year-old girl who exhibited rapid and aggressive local growth. The lesion was confirmed radiologically as an ill-defined expansive osteolytic mass showing cortical perforation. Microscopically, the presence of osteoclast-like giant cells permeated with atypical oval and rounded mesenchymal cells in a fibrovascular stroma, cellular atypia, and scarce osteoid formation were observed. Immunohistochemistry revealed the Ki-67 proliferative index in 50% of positive cells, positivity for vimentin and CD68, as well as scarce positivity for CDK4. The patient's medical history involved a GCRO in the proximal ulna. This report highlights the aggressive behavior of GCRO and its high capacity for metastasis to different parts of the body. Clinicians, pathologists, and surgeons should be aware of the giant cell-rich variant of osteosarcoma of the jaws, an imminent "wolf in a sheep's skin", because its indolent but unrelenting growth and dissemination, with radiographic and histologic characteristics that may represent a diagnostic pitfall regarding aggressive central giant cell lesions of the jaws. [ABSTRACT FROM AUTHOR]

Heart failure (HF) and atrial fibrillation (AF) are 2 cardiac conditions that are increasing in prevalence and incidence. The 2 conditions frequently coexist, and are associated with increased morbidity and mortality. Catheter ablation of AF has been successfully performed in patients with HF, with an improvement in HF and AF, when compared to amiodarone, but further data is required to compare this to rate control. OBJECTIVES: The primary objective is to determine whether AF treated by catheter ablation, with or without antiarrhythmic drugs reduces all-cause mortality and hospitalizations for HF as compared with rate control in patients with HF and a high burden AF. METHODS: This is a multi-center prospective randomized open blinded endpoint (PROBE) study. Patients with NYHA class II-III HF (HF with reduced ejection fraction (<35%) or HF with preserved ejection fraction), and high burden AF are included in the trial. Patients are randomized to either rate control or catheter ablation-based AF rhythm control in a 1:1 ratio. Patients in the rate control group receive optimal HF therapy and rate control measures to achieve a resting hazard ratio (HR) < 80 bpm and 6-minute walk HR < 110 bpm. Patients randomized to catheter ablation-based AF rhythm control group receive optimal HF therapy and one or more aggressive catheter ablation, which include PV antral ablation and LA substrate ablation with or without adjunctive antiarrhythmic drug. The primary outcome is a composite of all-cause mortality and hospitalization for heart failure defined as an admission to a health care facility. The sample size is 600. Enrolment has been completed. [ABSTRACT FROM AUTHOR]

Introduction: Surgically assisted rapid maxillary expansion is a widely used surgical procedure for resolving transverse maxillary occlusal changes in patients with bone maturity. However, few studies about the postoperative morphologic alterations in the nasal cavity in its inferior portion and the nasal septum positioning exist.Methods: The linear nasal septum measurements of 26 adult patients treated with surgically assisted rapid maxillary expansion from 2009 to 2013 were assessed through a retrospective analysis of cone-beam computed tomographies, in Digital Imaging and Communications in Medicine files, through the Dolphin Imaging program (Dolphin Imaging and Management Solutions, Chatsworth, Calif), aimed to identify significant changes during 3 time periods of the treatment: preoperative, immediately after the palatal expansion device locking (immediate postoperative), and 6-months postoperative (late postoperative). The analyses were performed in the inferior third of the nasal septum, from 4 equidistant points in anteroposterior position and height, using fixed cranial references for lateral measures of displacement.Results: No significant difference was found between preoperative, immediate postoperative, and late postoperative measurements in the 4 fixed nasal septum measurements, applying the analysis of variance test with a significance level of 5%. Comparing the surgical times alone, we found no statistically significant difference between the right and left sides applying the Student t test, which also showed symmetry in the nasal septum.Conclusions: The measurements of the nasal septum did not change in the different surgical times throughout their inferior extension, and they remained symmetrical throughout patients' follow-up period. [ABSTRACT FROM AUTHOR]

Pneumonia is the most prevalent healthcare-associated infection after coronary artery bypass grafting (CABG), but the relative effectiveness of strategies to reduce its incidence remains unclear. We evaluated the relationship between healthcare-associated infection recommendations and risk of pneumonia after CABG. Pneumonia prevention practice recommendations were developed based on literature review and analysis of semistructured interviews with key health care personnel across centers with low (<5.9%), medium (5.9%-6.1%), and high (>6.1%) rates of pneumonia. These practices were implemented among 2482 patients undergoing CABG from 2016 to 2017 across 18 centers. The independent effect of each practice in reducing pneumonia was assessed using multivariable logistic regression, adjusting for baseline risk and center. A composite (bundle) score was calculated as the number of practices (0 to 4) each patient received. Recommended pneumonia prevention practices included lung protective ventilation management, early extubation, progressive ambulation, and avoidance of postoperative bronchodilator therapy. Pneumonia occurred in 2.4% of patients. Lung protective ventilation (adjusted odds ratio [OR adj ], 0.45; 95% confidence interval [CI], 0.22-0.92), ambulation (OR adj , 0.08; 95% CI, 0.04-0.17), and postoperative ventilation of less than 6 hours (OR adj , 0.47; 95% CI, 0.26-0.87) were significantly associated with lower odds of pneumonia. Postoperative bronchodilator therapy (OR adj , 4.83; 95% CI, 2.20-10.7) was significantly associated with higher odds. Risk-adjusted rates of pneumonia, operative mortality, and intensive care unit length of stay were lower in patients with higher bundle scores (all P -trend <.01). These pneumonia prevention recommendations may serve as effective targets for avoiding postoperative healthcare-associated infections. [ABSTRACT FROM AUTHOR]

Intra-operative haemodynamic instability during carotid endarterectomy (CEA) has been associated with an increased risk of procedural stroke. Diffusion weighted imaging (DWI) lesions have been proposed as a surrogate marker for peri-operative silent cerebral ischaemia. This study aimed to investigate the relationship between peri-operative blood pressure (BP) and presence of post-operative DWI lesions in patients undergoing CEA. A retrospective analysis was performed based on patients with symptomatic CEA included in the MRI substudy of the International Carotid Stenting Study. Relative intra-operative hypotension was defined as a decrease of intra-operative systolic BP ≥ 20% compared with pre-operative ('baseline') BP, absolute hypotension was defined as a drop in systolic BP < 80 mmHg. The primary endpoint was the presence of any new DWI lesions on post-operative MRI (DWI positive). The occurrence and duration of intra-operative hypotension was compared between DWI positive and DWI negative patients as was the magnitude of the difference between pre- and intra-operative BP. Fifty-five patients with symptomatic CEA were included, of whom eight were DWI positive. DWI positive patients had a significantly higher baseline systolic (186 ± 31 vs. 158 ± 27 mmHg, p =.011) and diastolic BP (95 ± 15 vs. 84 ± 13 mmHg, p =.046) compared with DWI negative patients. Other pre-operative characteristics did not differ. Relative intra-operative hypotension compared with baseline occurred in 53/55 patients (median duration 34 min; range 0–174). Duration of hypotension did not differ significantly between the groups (p =.088). Mean systolic intra-operative BP compared with baseline revealed a larger drop in BP (−37 ± 29 mmHg) in DWI positive compared with DWI negative patients (−14 ± 26 mmHg, p =. 024). Absolute intra-operative systolic BP values did not differ between the groups. In this exploratory study, high pre-operative BP and a larger drop of intra-operative BP were associated with peri-procedural cerebral ischaemia as documented with DWI. These results call for confirmation in an adequately sized prospective study, as they suggest important consequences for peri-operative haemodynamic management in carotid revascularisation. [ABSTRACT FROM AUTHOR]

Intraosseous schwannomas or neurilemomas are rare benign neoplasms. Total resection of the intraosseous schwannoma is considered risky in immunocompromised patients, thus minimally invasive vertebroplasty was conducted in this study. In this case, we presented A 40-year-old male presented with intermittent back pain for the last two years. Imaging and histopathological examination conclude the diagnosis of intraosseous schwannoma. Vertebroplasty was conducted without the resection of the tumor. Excellent pain improvement and functional outcome were reported on one-year follow-up. Minimally invasive surgery could decrease post-operative pain and morbidity such as atelectasis and venous thrombosis, earlier hospital discharge, and improved cosmetics. We considered the use of minimally invasive vertebroplasty due to HIV infection comorbidities in the subject. Extensive tumor resection in this population could increase the risks of infection significantly thus affecting the outcome of the surgery. The aim of percutaneous vertebroplasty is to increase the stability of the collapsed vertebra and improve the symptoms, especially with severe back pain. Intraosseous schwannoma of the vertebrae could be treated effectively with vertebroplasty with excellent pain improvement and functional outcome. • The case report presents a rare occurrence of an ancient schwannoma • 40-year-old male presented with intermittent back pain diagnosed with intraosseous schwannoma. • Minimally invasive vertebroplasty was performed without tumor resection. • The patient showed excellent pain improvement and functional outcome [ABSTRACT FROM AUTHOR]

Myocardial Infarction (MI) is a rare but potentially fatal complication after non-cardiac surgery (1-2). Strategies to detect myocardial ischemia by troponin surveillance have been recommended (3-4). The 2017 Canadian Cardiovascular Society (CCS) guideline on perioperative cardiac risk assessment recommends measuring Brain Natriuretic Peptide (BNP) or N-terminal pro-BNP (NT-proBNP) preoperatively in patients 65 years or older, or 45-64 years old with significant cardiovascular disease (CVD), or who have at least one Revised Cardiac Risk Index factor. Postoperative troponin surveillance is recommended when BNP or NT-proBNP is elevated, or in all these patients when these results are not available (4). We aimed to evaluate the effect of the 2017 CCS guideline on troponin surveillance and outcomes after non-cardiac surgery. After approval from the institutional Research Ethics Board we conducted a single center (UHN) retrospective observational study. Patients aged 40 years or older undergoing intermediate- to high-risk elective non-cardiac surgery between 2016 and 2021 were included. We first compared the number and percentage of troponin tests ordered before and after the guideline was published and compared patient characteristics, specifically cardiovascular comorbidity, using Odds Ratio's (OR) with 95% Confidence Intervals (CI). Second, the occurrence of myocardial injury, MI, and in-hospital mortality before and after guideline publication were compared. The cohort included 36,386 patients. Median age was 63 years. According to the guideline, troponin surveillance was recommended in 20,807 (57%) patients, was actually ordered in 4,859 (13%) and elevated in 1,031 (2.8%). Between 2016-2018 troponin surveillance was done in 2,461 (13%) of the 19,046 patients, compared to 2,398 (14%) of the 17,340 patients who had surgery between 2019-2021 (OR 1.1, 95% CI: 1.0-1.2). Patients undergoing surgery in the second period had less CVD. Adding troponin surveillance according to the guideline to a regression model predicting MI did not have added value. Adding actual troponin ordering, however, was significantly associated with MI (OR 19, 95% CI: 11-34) and mortality (OR 5.7, 95% CI: 4.1-7.8). Publication of the CCS guidelines did not impact the number of troponin tests ordered. Surveillance according to the CCS guideline would have resulted in monitoring more than half of the population, without a significant increase in outcome detection rates. In conclusion, the CCS guidelines are not consistently applied in daily practice and detection of myocardial injury, MI and mortality did not change after publication. It seems best to perform postoperative troponin surveillance based on CVD, the interpretation of its severity, and perioperative context (5). [ABSTRACT FROM AUTHOR]

A pre-operative marker for identification of patients at risk of peri-operative adverse events and 30 day mortality might be the percentage of young, reticulated platelets (pRP). This study aimed to determine the predictive value of pre-operative pRP on post-operative myocardial injury (PMI) and 30 day mortality, in patients aged ≥ 60 years undergoing moderate to high risk non-cardiac surgery. The incidence of PMI (troponin I > 0.06 μg/L) and 30 day mortality was compared for patients with normal and high pRP (≥2.82%) obtained from The Utrecht Patient Orientated Database. The predictive pRP value was assessed using logistic regression. A prediction model for PMI or 30 day mortality with known risk factors was compared with a model including increased pRP using the area under the receiving operator characteristics curve (AUROC). In total, 26.5% (607/2289) patients showed pre-operative increased pRP. Increased pRP was associated with more PMI and 30 day mortality compared with normal pRP (36.1% vs. 28.3%, p <.001 and 8.6% vs. 3.6%, p <.001). The median pRP was higher in patients suffering PMI and 30 day mortality compared with not (2.21 [IQR: 1.57–3.11] vs. 2.07 [IQR: 1.52–1.78], p =.002, and 2.63 [IQR: 1.76–4.15] vs. 2.09 [IQR: 1.52–3.98], p <.001). pRP was independently related to PMI (OR: 1.28 [95% CI: 1.04–1.59], p =.02) and 30 day mortality (OR: 2.35 [95% CI: 1.56–3.55], p <.001). Adding increased pRP to the predictive model of PMI or 30 day mortality did not increase the AUROC 0.71 vs. 0.72, and 0.80 vs. 0.81. In patients undergoing major non-cardiac surgery, increased pre-operative pRP is related to 30 day mortality and PMI. [ABSTRACT FROM AUTHOR]

Background: The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies.Methods: BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup.Results: A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively).Conclusions: In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In Brazil, glanders remains a serious problem, with the obligatory sacrifice of disease-positive animals without compensation. Each year, glanders cases are reported in several regions of the country, causing severe economic losses and trade restrictions. The present study describes and discusses the occurrence of glanders foci in Brazil during a 12-year period from 2005 to 2016. The highest frequency of reported affected holdings during the study period was in the northeast region. Moreover, during this period, the disease incidence in Brazil showed an overall increasing tendency. The number of affected holdings significantly increased during the last four years of the period, and more cases were noted during the months of May and June. Spatiotemporally, there are four high-risk glanders clusters: (1) cluster A (relative risk [RR = 6.51, P <.0001) involved the northeast region from March 2008 to February 2014; (2) cluster B (RR = 17.37, P <.0001) involved a southeast region state from March 2013 to June 2015; (3) cluster C (RR = 6.92, P <.0001) involved the states in the midwest, southeast, and south regions of Brazil from March 2015 to May 2016; and (4) cluster D (RR = 19.07, P <.0001) involved a north region state from October 2015 to April 2016. Only two states of the north region (Acre and Amapá) did not experience glanders during the study period. • Glanders remains a serious problem, with the obligatory sacrifice of disease-positive animals without compensation. • The present study describes and discusses the occurrence of glanders foci in Brazil in a 12-year period, 2005–2016. • The frequency of reported foci during the study period was highest in states of the Nordeste region. • There have been four spatiotemporal high-risk clusters. • These results show the worsening of the epidemiological situation for glanders in Brazil. [ABSTRACT FROM AUTHOR]

Heme is an iron-coordinated tetrapyrrole molecule that plays an indispensable role in various biological processes such as respiration, oxygen metabolism, oxygen transfer, photosynthetic electron transportation and oxidative stress responses. Heme is also the primary source of functional, bioavailable iron in the human body. Iron deficiency results in a range of acute and chronic human health consequences. Iron deficiency anemia affects approximately 25 % of the global human population. New sources of bioavailable heme are required to help combat this ubiquitous mineral deficiency. Microalgae do biosynthesize heme but our knowledge of the regulation of those pathways, what the actual yields of heme may be, and how heme yields may be improved is restricted to a few model species. In this review we explore the potential of microalgae as an alternative source of bioavailable heme, suggest some strategies that may be pursued, and highlight some of the challenges that still need to be overcome. Developing heme enriched microalgae could transform our access to bioavailable iron through direct use as a dietary supplement and/or incorporation into functional foods. • Critical analysis of heme biosynthetic pathway in microalgae • Analysis of abiotic triggers of heme biosynthesis in microalgae • Identification of potential molecular targets to increase heme synthesis • Critical appraisal of microalgae as a source of bioavailable heme • Reflection on upscaling production to tackle global nutritional iron deficiency [ABSTRACT FROM AUTHOR]

Objectives Endovascular aortic repair (EVAR) is associated with an increased risk of pulmonary embolism, which is often clinically silent and therefore difficult to recognise. The aim was to investigate the incidence of pulmonary embolism after EVAR using routinely performed pre- and post-operative aortic computed tomography angiography (CTA), and the association between pulmonary embolism and mortality. Methods This single centre retrospective cohort study included adult patients who underwent EVAR in the University Medical Centre Utrecht between January 2010 and July 2015 and who had a total aortic, thoracic aortic, or pulmonary CTA within one month post-operatively. Baseline and mortality data were obtained by reviewing hospital and general practitioner records. The primary outcome was pulmonary embolism within one month after surgery. Secondary outcomes were 30 day and six month mortality. Results During the study period, 526 EVARs were performed. Seventy-four of these procedures were included in the analysis of which there were 40 thoracic and 34 abdominal EVARs. In nine patients (12%, 95% CI 7–22) pulmonary embolism was observed of which one was central, two were segmental, and six were subsegmental. Seven were clinically silent and two were present on the pre-operative CTA. Thirty day mortality was significantly higher in patients with pulmonary embolism (relative risk 14.4, 95% CI 1.4–143, p =.037) though none of the deaths seemed directly attributable to it. Conclusions This study, although preliminary, suggests that silent pulmonary embolism after EVAR occurs in approximately one in 10 patients, despite routine thrombo-embolism prophylaxis. Pulmonary embolism was associated with a higher 30 day mortality risk yet it was not the cause of death in any of these patients. [ABSTRACT FROM AUTHOR]

Abstract The airway develops from the primitive foregut at 4 weeks' gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults, with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight bladed laryngoscope are usually used for intubation. Neonates are also obligate nasal breathers and simultaneously suckle and breath. Minute volume is rate dependent and the highly compliant chest easily displays sternal and intercostal recession during respiratory distress, and early onset of fatigue. From the neonatal period onwards the anatomy gradually begins to resemble that of adults. The cricoid descends caudally, the epiglottis becomes firmer and shorter, and the relatively large occiput recedes. The conventional wisdom of the cricoid ring being the narrowest part of the paediatric airway is not supported by contemporary investigation. The consequence of these findings on endotracheal tube selection and the rationale for increasing use of cuffed endotracheal tubes in children is discussed. [ABSTRACT FROM AUTHOR]

Background: Passiflora cincinnata Mast. is described as a native species from the Caatinga biome, and used by traditional medicine for several pharmacological purposes, such as inflammatory disorders. However, studies that prove its biological activities are scarce.Hypothesis/purpose: This paper aims to evaluate the antinociceptive and anti-inflammatory activities of the aerial parts of Passiflora cincinnata (Pc-EtOH) in mice.Methods: The chemical composition of Pc-EtOH was assessed by high-performance liquid chromatography coupled to diode array detector (HPLC-DAD). The antinociceptive profile of the extract (given orally: 100, 200 and 400 mg/kg) was established using the in vivo chemical models (acetic acid-induced abdominal constriction and formalin-induced paw licking test) and thermal (hot plate test) of nociception. The role of opioid, potassium channels, TRPV-1, muscarinic, serotoninergic (5-HT3) receptors and the participation of the nitric oxide pathway also was determined. The rota-rod test was used to verify the possible interference of the extract treatment in motor performance. Paw edema induced by carrageenan or histamine, and leukocyte migration, determination of total protein and nitric oxide to the peritoneal cavity were used for anti-inflammatory profile.Results: The presence of flavonoids in the extract was confirmed using HPLC-DAD. At all doses tested the Pc-EtOH significantly reduced the number of writhing and decreased the paw licking time in both phases of the formalin test (p < 0.05). In the hot plate test, the extract increased the reaction time, reducing painful behavior. The antinociceptive mechanism probably involves central and peripheral pathways, involving the pathway of opioid and muscarinic receptors with influence of potassium channels and the nitric oxide pathway. However, the motor coordination test indicated that in the time of 120 min the extract decreases the stay time of the animal in the rota-rod. Pc-EtOH inhibited significantly (p < 0.05) the increase of the edema volume after administration of carrageenan and histamine. In the peritonitis test, acute pre-treatment with Pc-EtOH inhibited leukocyte migration, with a reduction in the number of neutrophils and concentration of total proteins and nitric oxide.Conclusion: The present study suggests that Pc-EtOH possesses peripheral and central antinociceptive action, and showed potential in inhibition of release of mediators of the inflammatory process. [ABSTRACT FROM AUTHOR]

Background: Recovery of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is not universal and is difficult to predict. Fragmented QRS (fQRS) complexes are thought to be markers of myocardial scar. We hypothesized that fQRS complexes on 12‑lead surface ECGs during the initial post-MI period would be associated with adverse LV remodeling over the following year.Methods: Change in LVEF between the early (0-2 month) and later (2-12 month) post-MI periods was assessed in two independent cohorts of post-MI patients with initial LV dysfunction. A decline or no recovery in LVEF (ΔLVEF ≤0%) was used as a primary outcome. fQRS complexes were measured on 12‑lead ECGs within a week of acute MI. A subset of patients underwent cardiac magnetic resonance imaging (CMR) for scar quantification.Results: Of 705 patients in the combined cohort, 27% experienced the primary outcome (average ΔLVEF of -4%). fQRS complexes were associated with a two-fold higher risk of no LVEF recovery, independent of prior MI or CABG, baseline LVEF, MI location and QRS duration or axis. Of 113 patients undergoing CMR, fQRS was associated with increased peri-infarct zone late gadolinium enhancement (13 ± 5% vs 11 ± 4%, p = 0.02), but not core infarct.Conclusions: Despite contemporary post-MI therapy, >1 in 4 patients will show a decline in LVEF during follow-up. Fragmented QRS complexes on 12‑lead surface ECG early post-MI may be a valuable marker of unfavorable LV remodeling and correlate to increased peri-infarct scar on CMR imaging. [ABSTRACT FROM AUTHOR]

Background: Few therapies are available for the safe and effective treatment of atrial fibrillation (AF) in patients with heart failure. Bucindolol is a non-selective beta-blocker with mild vasodilator activity previously found to have accentuated antiarrhythmic effects and increased efficacy for preventing heart failure events in patients homozygous for the major allele of the ADRB1 Arg389Gly polymorphism (ADRB1 Arg389Arg genotype). The safety and efficacy of bucindolol for the prevention of AF or atrial flutter (AFL) in these patients has not been proven in randomized trials.Methods/design: The Genotype-Directed Comparative Effectiveness Trial of Bucindolol and Metoprolol Succinate for Prevention of Symptomatic Atrial Fibrillation/Atrial Flutter in Patients with Heart Failure (GENETIC-AF) trial is a multicenter, randomized, double-blinded "seamless" phase 2B/3 trial of bucindolol hydrochloride versus metoprolol succinate, for the prevention of symptomatic AF/AFL in patients with reduced ejection fraction heart failure (HFrEF). Patients with pre-existing HFrEF and recent history of symptomatic AF are eligible for enrollment and genotype screening, and if they are ADRB1 Arg389Arg, eligible for randomization. A total of approximately 200 patients will comprise the phase 2B component and if pre-trial assumptions are met, 620 patients will be randomized at approximately 135 sites to form the Phase 3 population. The primary endpoint is the time to recurrence of symptomatic AF/AFL or mortality over a 24-week follow-up period, and the trial will continue until 330 primary endpoints have occurred.Conclusions: GENETIC-AF is the first randomized trial of pharmacogenetic guided rhythm control, and will test the safety and efficacy of bucindolol compared with metoprolol succinate for the prevention of recurrent symptomatic AF/AFL in patients with HFrEF and an ADRB1 Arg389Arg genotype. (ClinicalTrials.govNCT01970501). [ABSTRACT FROM AUTHOR]

Background: Left ventricular (LV) dysfunction may be sustained or aggravated during the convalescent months following an acute myocardial infarction (MI) and is difficult to predict. We sought to determine current practice patterns of LV ejection fraction (LVEF) reassessment during the months following MI and evaluate the predictors and clinical significance of LVEF change in a prospective post-MI patient cohort.Methods: Patients with an acute MI between June 2010 and August 2014 were identified using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry. Patients with initial LV dysfunction (LVEF <40% with first MI or <45% with multiple MI events) underwent a protocol-driven repeat LVEF assessment in follow-up if routine LVEF reassessment was not performed.Results: Of 5,964 MI patients, follow-up LVEF assessments were attained for 442 of the 695 patients who had significant LV dysfunction. A sizable proportion (25%) had either no increase or a decline in LVEF. Adverse remodeling was associated with an anterior MI location, a greater peak serum troponin T, and a higher baseline LVEF at time of MI. Adverse LV remodeling conferred a 3-fold risk of death (hazard ratio 3.0, 95% CI 1.6-5.7, P=.001) adjusted for baseline LVEF, anterior MI location, and medication use.Conclusions: Current practice of LVEF reassessment during the convalescent months post-MI is suboptimal despite a sizeable proportion of patients that undergo adverse LV remodeling. Targeting processes affecting low rates of LVEF reassessment may reduce missed care opportunities and ensure that patients consistently receive appropriate evidence-based and guideline-recommended care. [ABSTRACT FROM AUTHOR]

Objectives The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography. Background LV hypertrophy is associated with adverse cardiovascular outcomes in healthy subjects. However, its influence in those with known or suspected coronary artery disease is poorly understood. Methods A total of 3,754 patients (mean age 59.3 ± 13.1 years) undergoing invasive coronary angiography and cardiac magnetic resonance (CMR) (mean interval 1.0 ± 1.5 months) were studied. LV mass and volumes were determined from cine images and indexed to body surface area. Analyses were adjusted for CMR variables, medical comorbidities, and severity of coronary artery disease (Duke Jeopardy Score) and were stratified to LV function. Results At a median of 44.9 months, 315 patients (8.4%) died and 168 patients (4.5%) underwent revascularization. Multivariable analysis showed that each 10 g/m 2 increase in LV mass index was associated with a 6% greater risk of mortality (hazard ratio: 1.06; 95% confidence interval [CI]: 1.01 to 1.11; p = 0.02) and a 10% greater need for revascularization (hazard ratio: 1.10; 95% CI: 1.04 to 1.17; p < 0.01). According to pre-defined thresholds, moderate to severe hypertrophy was associated with a 1.7-fold risk of mortality (95% CI: 1.2 to 2.3) and 1.8-fold need for revascularization (95% CI: 1.18 to 2.67). These findings were predominantly observed in those with a left ventricular ejection fraction >35% with respective hazard ratios of 2.93 (95% CI: 1.92 to 4.47) and 2.20 (95% CI: 1.21 to 3.98). Conclusions LV mass index is an independent predictor of all-cause mortality and need for revascularization. This finding establishes relevance for LV mass measurements in clinical decision-making surrounding both the need and timing of revascularization in this population. [ABSTRACT FROM AUTHOR]

develop and validate a formula, through a discriminant analysis of sex estimation, evaluating maxillary sinus in cone beam computed tomography scans in a Brazilian population, comparing this formula with two other existing ones. 190 cone beam CT scans of Brazilian adults were retrospectively evaluated by an independent examiner. Measurements were performed in the right and left MS region: height, width, length, distance between the breasts, distance between infraorbital foramina, and volume in the ITK software. The sample was divided into female and male. T test, ANOVA, Tukey test and the ROC Curve was performed (p > 0,05). statistically significant differences were found in relation to the maximum height of the MS both right (p = 0,001) and left (p = 0,026) between sexes and the maximum length in the right MS (p = 0,01). Regarding the comparison of MS volume according to the different analysis methods, statistically significant differences were found between sexes for the right MS when using the method by Bangi et al. (p = 0,012) and the volume of the left MS in females (p < 0,001). Comparing the three classification models, statistically significant differences were found between the proposed method and the classification by Bangi et al. (p < 0.007). The ROC curve showed greater accuracy in the classification proposed in this work. the new proposed formula obtained better predictions of sexual dimorphism, when compared to classifications already described in the literature. • Individual's identification is of fundamental importance in forensic medicine. • Maxillary sinus can be one of the structures that will help in identifying the body. • Software of imaging analysis help and achieve greater accuracy in predicting the sex. • Sex determination in different ethnic groups is influenced by anthropometric indices. [ABSTRACT FROM AUTHOR]

Various treatment modalities for clot clearance are available to the clinician for management of acute deep vein thrombosis (DVT). These include catheter directed thrombolysis (CDT), percutaneous pharmacomechanical thrombectomy, and mechanical thrombectomy. The use of thrombolytic therapy carries a risk of major bleeding during the infusion period. It also requires greater hospital and human resources, requiring a higher level of nursing care, length of stay for the duration of the infusion as well as repeat visits to the interventional radiography suite for assessment of thrombus clearance. This was an epidemiological study assessing trends of treatment of acute DVT in a tertiary referral centre. A retrospective analyses of a prospective collated database was performed to assess for trends in the treatment modality of management of acute DVT. Patients treated for an acute DVT between 2014 and 2022 were included in the study. A total of 101 patients were treated for an acute DVT between 2014 and 2022 with varying modalities as presented below. Trends of venous clot clearance modality over time for the treatment of acute DVT Year Thrombolysis Pharmacomechanical thrombectomy ± CDT Mechanical Thrombectomy 2014 1 0 0 2015 0 2 0 2016 8 4 0 2017 5 1 0 2018 5 3 0 2019 2 8 0 2020 7 9 0 2021 4 1 12 2022 0 0 13 In the past 18 months, this centre has weaned off the use of thrombolysis. This has decreased the resources needed to proceed with intervention and decreased patient exposure to potential life threatening complications. [ABSTRACT FROM AUTHOR]

Frailty increases risk for morbidity and mortality after cardiac surgery. Its influence on functional outcome is largely unknown. We studied the association of frailty with health-related quality of life and disability after cardiac surgery. A prospective 2-center observational cohort of 555 patients aged 70 years or more undergoing cardiac surgery. A comprehensive frailty assessment was performed before surgery based on 11 individual assessments in physical, mental, and social domains. Frailty was defined as at least 1 positive test in each domain. The primary outcome was health-related quality of life over 1 year, and the secondary outcomes were severe in-hospital complications and disability over 1 year. Adverse functional outcome was defined as the composite of a decreased health-related quality of life and disability. Physical frailty was most common (91%) compared with mental (39%) or social frailty (42%). Adverse functional outcome occurred in 257 patients (46%) and consisted of decreased physical health-related quality of life in 134 (24%), decreased mental health-related quality of life in 141 (25%), and disability in 120 (22%). Frailty was more common in patients with adverse functional outcome (29%) compared with patients without adverse functional outcome (16%, P <.001). Poor mobility, malnutrition, and polypharmacy were associated with a decreased health-related quality of life over time, whereas impaired physical functioning and higher self-rated health were related to increased health-related quality of life. Disability after cardiac surgery was associated with poor mobility, polypharmacy, dependent living, living alone, and lower self-rated mental health before surgery. Mobility, nutrition, medication use, physical functioning, and self-rated health before surgery are associated with health-related quality of life in elderly patients 1 year after cardiac surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

A 26-year-old female patient was referred to the stomatology clinic with a complaint of "lump in the gums." Physical examination revealed a discrete swelling laterally to the upper lip on the left side. On intraoral examination, a dome-shaped swelling that was sessile, normochromic, with an intact surface, painless and firm in the alveolar mucosa, above the crowns of teeth 23 and 24, and with a year of evolution was noted. Periapical and panoramic radiographic revealed a single radiolucent image with sclerotic borders limited by the adjacent bone and displacement of the premolar roots. Excisional biopsy was performed during the surgery, and upon detaching the buccal mucosa, it was noted that the lesion was located peripherally and that the cortical bone was intact, showing only an erosion where the lesion was lodged. The diagnostic hypotheses were odontogenic lesions with peripheral variant and other reactive lesions. Histopathologic analysis was conclusive to adenomatoid odontogenic tumor. The patient is being followed up with no recurrence. [ABSTRACT FROM AUTHOR]

Liver resection remains the cornerstone of curative treatment for hepatocellular carcinoma and colorectal cancer liver metastases. Its success is dependent upon the extent of resection achieved. To this end, intra-operative imaging techniques have been experimented with to aid the surgeon. Fluorescence guided surgery (FGS) utilises the properties of near infrared light emitting molecules to identify malignant tissue, enabling the surgeon to maximise resection of diseased tissue and minimise collateral damage. Data from early trials showed increased superficial lesion detection when using fluorescence to guide liver resection. However, with far greater tissue penetration, intra-operative ultrasound (IOUS) remains the gold-standard intra-operative imaging modality. Subsequent trials have shown that the concomitant use of both FGS and IOUS may increase tumour detection rates intra-operatively. This review provides a comprehensive analysis of the most compelling evidence regarding fluorescence in hepatobiliary surgery and addresses the challenges faced introducing it into common practice. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB). Design Retrospective analysis. Setting Tertiary-care hospital. Participants Patients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014. Interventions None. Measurements and Main Results IOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI. Conclusions In the authors’ study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI. [ABSTRACT FROM AUTHOR]

Ameloblastoma is considered the most common odontogenic tumor. It normally shows a slow and persistent growth, and is considered a locally aggressive neoplasm, affecting the posterior area of the mandible in most cases. This study aimed to report a case of unicystic ameloblastoma. A 21-year-old female patient reported a volume growing on the right size of her face, without other symptoms. Oral clinical examination showed an increase in the mandibular alveolar ridge region, covering the region of the right 1st and 2nd molars. An incisional biopsy was conducted and the anatomopathological analysis revealed a unicystic amelobastoma. A lesion decompression device was implanted. Two months after removing the decompression device, enucleation of the lesion and bone reconstruction with autogenous and xenogenous grafts were performed. Six months later, the patient began rehabilitation with implants, followed by the installation of prosthetic crowns. [ABSTRACT FROM AUTHOR]

Background: The report from the 2nd Consensus Committee on BrS suggests that all patients with syncope without a "clear extracardiac cause" should have an implantable cardioverter-defibrillator (ICD). However, a clear extracardiac cause for syncope may be difficult to prove.Objective: The purpose of this study was to characterize syncope in patients with Brugada syndrome (BrS).Methods: All patients diagnosed with BrS at our institution between 1999 and 2010 were enrolled in a prospective registry. Patients with suspected arrhythmic syncope (group 1) were compared to patients with nonarrhythmic syncope (group 2) and to patients with syncope of doubtful origin (group 3).Results: Of 203 patients with BrS, 57 (28%; 44 male, age 46 ± 12 years) experienced at least 1 syncope. Group 1 consisted of 23 patients, all of whom received an ICD. In group 2 (17 patients), 3 received an ICD because of a positive electrophysiologic study. In group 3 (17 patients), 6 received an implantable loop recorder and 6 received an ICD. After mean follow-up of 65 ± 42 months, 14 patients in group 1 remained asymptomatic, 4 had recurrent syncope, and 6 had appropriate ICD therapy. In group 2, 9 patients remained asymptomatic and 7 had recurrent neurocardiogenic syncope. In group 3, 7 remained asymptomatic and 9 had recurrent syncope. One patient from each group died from a noncardiac cause.Conclusion: In the present study, syncope occurred in 28% of patients with BrS. The ventricular arrhythmia rate was 5.5% per year in group 1. In 30%, the etiology of the syncope was questionable. No sudden cardiac death occurred in groups 2 and 3. [ABSTRACT FROM AUTHOR]

Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in secondary prevention of AF. However, a comprehensive summary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases from inception to October 2021 for both randomized controlled trials (RCT) and observational studies comparing multifactorial risk factor interventions to usual care in patients with AF. Fifteen studies (10 RCT, 5 observational) with 3786 patients were included (mean age 63.8 years, 64.0% males). Follow-up ranged from 3 to 42 months. We found no significant effects of multifactorial risk factor interventions on AF recurrence [pooled relative risk (RR): 0.93, 95% CI: 0.74-1.16, P = 0.51, I 2 = 54%], AF-related rehospitalization at 12 months (RR: 0.69, 95% CI: 0.43-1.11, P = 0.13, I 2 = 0%), cardiovascular rehospitalization at 12 months (RR: 0.76, 95% CI: 0.53-1.09, P = 0.13, I 2 = 53%), or AF-related adverse events at 12 and 15 months. However, multifactorial interventions were associated with reduced AF-related symptoms and improved health-related quality of life (HRQoL) at all studied time points. Current evidence does not support consistent associations between multifactorial risk factor interventions and AF recurrence after rhythm control therapy or AF-related or cardiovascular hospitalization in patients with AF. However, these interventions are associated with clinically relevant improvement in AF-related symptoms and HRQoL. Additional randomized studies are required to evaluate the impact of multifactorial risk factor interventions on patient-centered health outcomes. [ABSTRACT FROM AUTHOR]

Statement of problem Different instruments have been developed to improve crown finish lines after conventional preparation with diamond rotary instruments. However, more evidence on the effectiveness of these instruments is required. Purpose of study The purpose of this in vitro study was to assess the effectiveness of 4 different instruments used for cervical margin finishing in regard to the external line angle (ELA). Material and methods Forty-eight freshly extracted third molar teeth with similar dimensions were conventionally prepared for crowns and randomly allocated into 4 groups (n=12) according to the finishing instrument: hand trimmer (HT), tungsten carbide bur (TCB), ultrasonic instrument (UI), and diamond rotary instrument (DRI) mounted in a contra angle handpiece with reduced speed. Photomicrographs from the margin profiles of each tooth were obtained with scanning electron microscopy (×40) before and after finishing procedures. The images were qualitatively analyzed (scores 1-4) by 9 experienced dental professionals. Average results were assessed with the paired t test and repeated measures ANOVA followed by Tukey HSD test (α=.05). Results HT, TCB, and UI demonstrated no significant differences between unfinished and finished mean ELA scores. DRI was the only group to demonstrate a significantly improved ELA ( P <.001). Except for HT in relation to TCB ( P =.989), all the other groups demonstrated statistically significant different ELA scores. Conclusion DRI mounted in a contra angle handpiece was the only finishing instrument capable of significantly improving the ELA, while TCB and UI produced nonsignificant improvement, and HT was detrimental to the ELA. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the conversion of waste kina shells ( Evechinus chloroticus ) into hydroxyapatite (HA, Ca 10 (PO 4 ) 6 (OH) 2 ), while preserving its porous and interconnected structure. The shells were subjected to a pyrolysis process followed by a chemical synthesis step at ambient pressure and at a low temperature of 100 °C under alkaline condition. The obtained HA had a porous structure with large pores ranged 300–500 µm and small pores of 10–20 µm, which is considered beneficial for bone repair materials to ensure blood and nutrient circulation required for bone regeneration. The samples also had high concentrations of magnesium (3.44%) which is an important component of HA used in bone grafting. X-Ray Diffractometer results indicated that a HA layer was formed on the surface of the calcium carbonate structure of the shells. The synthesized HA had no toxicity to the osteoblast cells and the porous and interconnected microstructure of the shells was preserved during an incubation period of 3 days. The obtained HA may have potential applications in bone tissue enegineering. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described.Methods: We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728).Results: Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, P<.001) and more likely to be female (37.2% vs 32.1%, P<.001) and have a prior myocardial infarction (14.3% vs 11.5%, P<.001) compared with patients admitted to a CCU. Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7days, P=.29) and fewer cardiac procedures (40.3% vs 48.5%, P<.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio [aOR] 1.57, 95% CI 0.98-2.52), cardiac arrest (0.7% vs 0.9%, aOR 1.37, 95% CI 0.94-2.00), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50, 95% CI 0.82-2.75), or 30-day all-cause postdischarge readmission (10.6% vs 10.8%, aOR 1.07, 95% CI 0.90-1.28) between cardiology telemetry ward and CCU patients. Results were similar across low-, intermediate-, and high-risk Duke Jeopardy Scores, and in patients with non-ST-segment myocardial infarction or unstable angina.Conclusions: There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. [ABSTRACT FROM AUTHOR]

The airway develops from the primitive foregut at four weeks' gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight bladed laryngoscope are usually used for intubation. Neonates are also obligate nasal breathers and simultaneously suckle and breathe. Minute volume is rate-dependent and the highly compliant chest easily displays sternal and intercostal recession during respiratory distress, and early onset of fatigue. From the neonatal period onwards the anatomy gradually begins to resemble that of adults. The cricoid descends caudally, the epiglottis becomes firmer and shorter, and the relatively large occiput recedes. The conventional wisdom of the cricoid ring being the narrowest part of the paediatric airway is not supported by contemporary investigation. The consequence of these findings on endotracheal tube selection and the rationale for increasing use of cuffed endotracheal tubes in children is discussed. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the frequency of Neospora spp. infection, as well as its associated risk factors, in horses in the state of Alagoas, Brazil. In total, 427 samples from 36 properties in 23 districts, covering three mesoregions, were studied. An immunofluorescence assay was used to quantify anti- Neospora caninum immunoglobulin G antibodies, and risk factors were assessed through investigative questionnaires that focused on the productive, reproductive, and sanitary management of herds. Data from the questionnaires were evaluated by two statistical analyses. The total frequency of anti- Neospora spp. antibodies found was 18% (95% confidence interval [95% CI]: 14.4–22.1). At least one seropositive horse was found in 72.2% of the farms evaluated (26 of 36). The following risk factors were associated with infection: the access of other species to the horses' water source ( P = .017; odds ratio [OR] = 1.84; 95% CI: 1.11–3.04); no to consume hay ( P = .000; OR = 3.33; 95% CI: 1.87–5.94); the informal purchase of animals ( P = .000; OR = 8.43; 95% CI: 3.06–23.16); and an absence of quarantine management ( P = .000; OR = 8.70; 95% CI: 3.10–24.39). The results of the present study show that horses in the state of Alagoas are at risk for Neospora spp. infection, and care should be implemented based on identified risk factors to prevent infection in horses. [ABSTRACT FROM AUTHOR]

Surface sediments collected in the intertidal zone of Paraguaçu estuary in July, 2013, were analyzed for organic matter, nitrogen, phosphorus, grain size fractions and partial concentrations of 16 metals. The USEPA 3051A method and ICP-OES and CV-AAS techniques were chosen to metal analysis. Pollution indices (EF, I geo and PI N ) and a comparison with sediment quality guidelines (UET, ERL, ERM, TEL and PEL of NOAA) were conducted in order to evaluate the potential metal impacts over the area. Principal Component Analysis (PCA) and Pearson correlation results showed the importance of organic matter content and the fine-grained fraction of sediments on the control of the bioavailable metals distribution. The Paraguaçu estuary already has anthropogenic enrichment relative to the background level, especially for Mn, whose values exceeded almost 30 times the background at one site (Mn: 1197.30 mg kg −1 ). However, metal levels are still below the reference values with the exception of Hg at one site (Hg: 0.25 mg kg −1 , exceeded TEL and ERL). [ABSTRACT FROM AUTHOR]