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Resume L’objectif de cette etude etait de determiner quelles asymetries du sourire, dentaires ou gingivales etaient percues comme etant les moins esthetiques. Materiel et methodes Des non-professionnels (297), des omnipraticiens (223), des dentistes prothesistes (50) et des orthodontistes (49) ont evalue l’esthetique d’images numeriquement modifiees a partir de la meme photographie intraorale de face, en utilisant les memes levres et en simulant une deviation du milieu maxillaire superieur, une inclinaison du plan occlusal, une asymetrie du bord incisif et une migration gingivale asymetrique. Ulterieurement, les images ont ete presentees par paires de 3 groupes. Resultats Les seules images jugees esthetiques etaient : le bord incisif asymetrique de l’incisive centrale, plus courte de 0,5 mm et la migration gingivale asymetrique de 2 mm d’une incisive centrale superieure. Parmi les images appariees, la deviation du milieu du maxillaire superieur versus la migration gingivale asymetrique, celle-ci a ete jugee la moins esthetique alors que, entre le bord incisif asymetrique et la migration gingivale asymetrique, celle-ci a ete consideree comme la moins esthetique. Conclusion Les non-professionnels et les omnipraticiens ont attribue les scores plus favorables. Les seules images jugees esthetiques etaient le bord incisif asymetrique d’une incisive centrale plus courte de 0,5 mm et la migration gingivale asymetrique de 2 mm d’une incisive centrale superieure. Sur le plan horizontal (deviation du milieu maxillaire versus inclinaison du plan occlusal), les asymetries dentaires etaient jugees moins esthetiques que les asymetries gingivales. Cependant, sur le plan vertical (bord incisif asymetrique versus migration gingivale asymetrique) la situation inverse s’est produite.

Highly reactive lipid peroxidation-derived carbonyls (oxoLPP) modify protein nucleophiles via Michael addition or Schiff base formation. Once formed, Michael adducts can be further stabilized via cyclic hemiacetals with or without loss of water. Depending on the mechanism of their formation, peptide–oxoLPP can carry aldehyde or keto groups and thus be a part of the total protein carbonylation level. If a carbonyl function is lost during consecutive reactions, the oxoLPP–peptide adducts will not be detected using the common carbonyl labeling protocols. Because of the differences in adduct stabilities, it is possible to address the heterogeneity of peptide/protein–oxoLPP adducts by careful evaluation of tandem mass spectra of modified peptides. Here, we used hydrophilic interaction liquid chromatography–tandem mass spectrometry analysis of lysine, cysteine and histidine containing model peptides co-incubated with oxidized 1-palmitoyl-2-linoleoyl-sn-glycerophosphatidylcholine to characterize the collision-induced dissociation behavior of peptide–carbonyl adducts. Numerous modifications were detected based on the analysis of tandem mass spectra, including Schiff bases on lysine (two), Michael adducts on lysine (six), cysteine (eleven) and histidine (two), as well as 4-hydroxy-2-aldehydes derived dehydrated cyclic hemiacetals on cysteine (five) and histidine (one). Additionally, cysteine and histidine side chains were modified by lipid-bound aldehydes as Michael adducts and dehydrated hemiacetals. The tandem mass spectra revealed collision-induced dissociation characteristics specific for each class of oxoLPP–peptide adducts. Copyright © 2015 John Wiley & Sons, Ltd.

© 2018 American Heart Association, Inc., Background and Purpose—Some patients with ischemic strokes that are currently classified as having an undetermined cause may have structural or functional changes of the left atrium (LA) and left atrial appendage, which increase their risk of thromboembolism. We compared the LA and left atrial appendage of patients with different ischemic stroke causes using cardiac magnetic resonance imaging. Methods—We prospectively included a consecutive sample of ischemic stroke patients. Patients with structural changes on echocardiography currently considered as causal for stroke in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3-T cardiac magnetic resonance imaging was performed. Results—One hundred and eleven patients were evaluated. Patients with an undetermined cause had a higher percentage of LA fibrosis (P=0.03) than patients with other stroke causes and lower, although not statistically significant, values of LA ejection fraction. Patients with atrial fibrillation and undetermined stroke cause showed a similar value of atrial fibrosis. Conclusions—The LA phenotype that was found in patients with undetermined cause supports the hypothesis that an atrial disease may be associated with stroke., This study is funded by “Fundo de Investigação para a Saúde”(FIS-2015-01CCV)

Introduction: The stomatognathic system is a set of structures that are interconnected to perform vital functions. Changes in any of the parts may lead to a general postural imbalance. Purpose: To verify if there is a relation between breathing pattern and swallowing with posture, dental occlusion and harmful oral habits of the sample under study. Materials and methods: The final sample of n=50 consisted of 34 children/ adolescents males and 16 females. The evaluation consisted of a questionnaire about signs and symptoms of mouth breathing, a clinical evaluation and a photogrammetric postural assessment, performed through software for Postural Assessment (SAPO®). Data analysis using descriptive and inferential statistics were obtained using the SPSS-21.0 software, and it was used a α=0.05 significance level. Results: There was a predominance of head tilt to the left, right shoulder elevation and tendency to tilt the head forward in mouth breathers. Regarding the occlusion there was a predominance of Angle Class II malocclusion and the presence of a greater number of children with open bite that also presented oral breathing and atypical swallowing patterns. The study of the deleterious oral habits allowed to determine a relationship between the pattern of mouth breathing and atypical swallowing with digital sucking habits and pacifier use. Conclusion: Statistically significant associations were established between the breathing pattern and the horizontal alignment of acromions, as well as the horizontal and vertical alignment of the head; between the pattern of breathing and swallowing with occlusal relationship anteroposterior and occlusal relationship vertical and also between breathing pattern and swallowing with digital sucking habits and pacifier use.

Introduction and Aims: Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions and elasticity and to find predictors of aortic dilatation. Methods: A total of 126 adults were prospectively included after TOF repair and compared to 63 gender- and age-matched controls. Transthoracic echocardiography was used to assess aortic diameters at the level of the sinuses of Valsalva and ascending aorta and aortic dilatation was defined as z-score >+2. M-mode parameters of the ascending aorta were used to calculate strain, distensibility and stiffness index. Results: TOF patients (mean age 30±9 years; 52% male) had a complete repair at a median age of five (2-49) years; mean follow-up time since repair was 23±7 years. The prevalence of aortic dilatation at the sinuses of Valsalva and ascending aorta was 29% and 24%, respectively. Compared to controls, TOF patients had a higher ascending aorta z-score, lower strain (6.4% [0.0-61.5] vs. 15.2% [0.0-45.0], p +2. Parâmetros modo M da aorta ascendente foram usados para calcular strain, distensibilidade e índice de rigidez. Resultados: Doentes com tetralogia de Fallot (idade média 30 ± 9 anos; 52% homens) foram operados com uma idade mediana de 5 (2-49) anos; tempo médio de seguimento desde a cirurgia 23 ± 7 anos. A prevalência de dilatação dos seios de Valsalva e da aorta ascendente foi 29% e 24%, respetivamente. Comparado aos controlos, os doentes com tetralogia de Fallot apresentaram maior z-score da aorta ascendente, menor strain (6,4 [0,0-61,5] versus 15,2 [0,0-45,0]%; p < 0,01) e maior índice de rigidez (7,3 [0,8-23,6] versus 3,1 [0,9-14,1]; p < 0,01). Na análise multivariada o sexo masculino associou-se significativamente à dilatação dos seios de Valsalva (odds ratio 6,3, intervalo de confiança de 95% 1,5-26,3; p = 0,01). Conclusões: Na tetralogia de Fallot operada há uma prevalência significativa de dilatação tardia da aorta, com a aorta ascendente maior e mais rígida. O sexo masculino parece influenciar a dilatação da raiz da aorta. Esta aortopatia requer um seguimento cuidadoso para evitar complicações futuras. Keywords: Aortic dilatation, Aortic elasticity, Tetralogy of Fallot, Transthoracic echocardiography, Palavras-chave: Dilatação aórtica, Elasticidade aórtica, Tetralogia de Fallot, Ecocardiografia transtorácica

OBJECTIVES: Language recovery following acute stroke is difficult to predict due to several evaluation factors and time constraints. We aimed to investigate the predictors of aphasia recovery and to identify the National Institute of Health and Stroke Scale (NIHSS) items that best reflect linguistic performance, 1 week after thrombolysis. MATERIALS AND METHODS: We retrieved data from a prospective registry of patients with aphasia secondary to left middle cerebral artery (MCA) stroke treated with intravenous thrombolysis. Complete recovery at day 7 (D7) was measured in a composite verbal score (CVS) (Σ Language+Questions+Commands NIHSS scores). Lesion size was categorized by the Alberta Stroke Program Early CT score (ASPECTS) and vascular patency by ultrasound. CVS was correlated with standardized aphasia testing if both were performed within a two-day interval. RESULTS: Of 228 patients included (age average 67.32 years, 131 men), 72% presented some language improvement that was complete in 31%. Total recovery was predicted by ASPECTS (OR=1.65; 95% CI, 1.295-2.108; P < 0.00) and baseline aphasia severity (OR=0.439; 95% CI, 0.242-0.796; P < 0.007). CVS correlated better with standardized aphasia measures (aphasia quotient, severity, comprehension) than NIHSS_Language item. CONCLUSIONS: Lesion size and initial aphasia severity are the main predictors of aphasia recovery one week after thrombolysis. A NIHSS composite verbal score seems to capture the global linguistic performance better than the language item alone. info:eu-repo/semantics/publishedVersion

Background and Purpose— Pregnancy is associated with increased risk of venous thrombotic events, including cerebral venous thrombosis. We aimed to study the complications and outcome of subsequent pregnancies in women with previous cerebral venous thrombosis. Methods— Follow-up study of women with acute cerebral venous thrombosis at childbearing age included in a previously described cohort (International Study of Cerebral Vein and Dural Sinus Thrombosis). Patients were interviewed by local neurologists to assess rate of venous thrombotic events, pregnancy outcomes, and antithrombotic prophylaxis during subsequent pregnancies. Results— A total of 119 women were included, with a median follow-up of 14 years. Eighty-two new pregnancies occurred in 47 women. In 83% (68 of 82), some form of antithrombotic prophylaxis was given during at least 1 trimester of pregnancy or puerperium. Venous thrombotic events occurred in 3 pregnancies, including 1 recurrent cerebral venous thrombosis. Two of the 3 women were on prophylactic low-molecular-weight heparin at the time of the event. Outcomes of pregnancies were 51 full-term newborns, 9 preterm births, 2 stillbirths, and 20 abortions (14 spontaneous). Conclusions— In women with prior cerebral venous thrombosis, recurrent venous thrombotic events during subsequent pregnancies are infrequent.

© 2017 S. Karger AG, Basel, Background: In 2010, changes were made to the shift pattern of neurology residents for cover in the Emergency Department at a university hospital. This resulted in a decrease in the number of emergency hours worked by neurology specialists and allowed for a natural quasi-experiment. Aim: We aimed to evaluate if changes to the number of emergency hours worked by neurology residents and specialist neurologists, (intervention) altered the number or pattern of admitted stroke mimics (SMs). Methods: Observational retrospective study from January 2007 to December 2013. Time of intervention was set as August 2010. We used a segmented linear regression – ARIMA – to evaluate changes in the temporal pattern of admitted SMs. A statistical correlation between the number of emergency hours worked by neurology residents and the number of admitted SMs was calculated using the Pearson Correlation Coefficient. Results: Of the 2,552 patients admitted to the stroke unit, 290 were SMs (11.4%). After August 2010, there was an increase in the number of admitted SMs ( p = 0.003). After 2010, the most frequent SM diagnosis changed from a psychiatric condition to peripheral vertigo. A positive correlation was found between the number of hours worked primarily by neurology residents and the number of admitted SMs (Pearson correlation coefficient = 0.94; p = 0.002). Conclusions: Changes in the pattern of Emergency Department shifts were associated with an increase in the rate of admitted SMs and with a higher number of mimics with a final diagnosis of peripheral vertigo.

© 2017 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial, and no modifications or adaptations are made., Objective: Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity. Methods: A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (, This work was supported by the 2012 Research Grant in Cerebrovascular Diseases (C.B.; scientific promoter: Sociedade Portuguesa do AVC; sponsor: Tecnifar).

final draft, peerReviewed

Summary Open bite is related to various etiological factors and, in many cases, is difficult to diagnose. The present study is aimed at evaluating, through cephalometric analysis, the dimensions of the upper airways and dentoalveolar heights in open bite (OB) patients versus normal overbite patients. The relationship between the width of the upper airways and the lack of overbite is also studied, in order to differentiate between dental open bite (DOB) and skeletal open bite (SOB). Materials and methods Eighty X-rays were selected from files of orthodontic patients to form the control sample (n = 40) and open bite sample (n = 40). Dimensions of the upper airways and dentoalveolar heights were measured in both samples, using 16 linear measurements, two angle values and one ratio. Results In OB patients, anteroposterior narrowing of the upper airways, mainly in the nasopharynx and oropharynx, was observed, together with forward displacement of the hyoid bone and increased maxillary and mandibular dentoalveolar heights, and anterior facial height. In SOB, the overbite was more negative and facial growth was more clockwise-oriented than in DOB. Greater narrowing of the airways in the anteroposterior orientation was also noted. In DOB, there was evidence of muscular adaptation, as shown by increased values of the hyoid bone displacement to a more anterior and lower position, and increased values of the vertical dimensions of the airways. An increase in posterior facial height was also observed allowing anterior rotation of the mandible. Conclusion The results suggest that the airway's dimensions reflect a tendency to open bite. The variable vertical airway length (Val) and the position of the hyoid bone allow the adaptive potential of these individuals to be determined and make the treatment of open bites more predictable.

Resume Les beances sont associees a divers facteurs etiologiques et, dans de nombreux cas, sont difficiles a diagnostiquer. L’objectif de cette etude est d’evaluer, par analyse cephalometrique, les dimensions des voies aeriennes superieures et les hauteurs dentoalveolaires chez les patients presentant une beance compares a des patients avec une supraclusion normale. La relation entre la largeur des voies aeriennes superieures et l’absence de beance est egalement examinee afin de differencier les beances dentaires (BD) et les beances squelettiques (BS). Materiaux et methodes Quatre-vingts radiographies ont ete selectionnees parmi les dossiers de patients orthodontiques afin de constituer l’echantillon temoin ( n = 40) et un echantillon « beance » ( n = 40). Les dimensions des voies aeriennes superieures et les hauteurs dentoalveolaires ont ete mesurees pour les deux echantillons a l’aide de 16 mesures lineaires, de deux valeurs angulaires et d’un ratio. Resultats Chez les patients avec beance, il a ete observe un retrecissement anteroposterieur des voies superieures, surtout au niveau du rhinopharynx et de l’oropharynx, ainsi qu’un deplacement anterieur de l’os hyoidien et une augmentation des hauteurs dentoalveolaires maxillaire et mandibulaire et de la hauteur faciale anterieure. Chez les sujets BS, la supraclusion etait plus negative et la croissance faciale etait davantage caracterisee par une rotation posterieure que chez les sujets BD. Il a ete releve aussi un retrecissement plus important des voies aeriennes dans le sens anteroposterieur. Dans l’echantillon BD, nous avons note des signes d’une adaptation musculaire, indiquee par les valeurs augmentees du deplacement de l’os hyoidien dans le sens antero-inferieur, et des valeurs plus importantes des dimensions verticales des voies aeriennes. Une augmentation de la hauteur faciale posterieure a egalement ete observee permettant une rotation anterieure de la mandibule. Conclusion Les resultats suggerent que les dimensions des voies aeriennes refletent une tendance a la beance. La variable longueur verticale des voies aeriennes (Val) et la position de l’os hyoidien permettent de determiner le potentiel d’adaptation chez les sujets presentant une beance et de rendre plus previsible le traitement de ces patients.

The reactivity of nitrosoalkenes toward dipyrromethanes, pyrrole, and 2,5-dimethylpyrrole is described. 1-(p-Bromophenyl)nitrosoethylene shows a different chemical behavior with these heterocycles than the previously reported reactions of ethyl nitrosoacrylate, which proceeds via a Diels-Alder reaction. 1-(p-Bromophenyl)nitrosoethylene reacts with dipyrromethanes and pyrrole to afford two isomeric oximes via conjugate addition followed by rearomatization of the pyrrole unit. On the other hand, this nitrosoalkene reacts with 2,5-dimethylpyrrole through an initial conjugate addition followed by intramolecular O- and N-nucleophilic addition with the formation of the corresponding bicyclic oxazine and five-membered cyclic nitrone, respectively. Quantum chemical calculations, at the DFT level of theory, indicate that the barriers associated with the Diels-Alder reactions of ethyl nitrosoacrylate are over 30 kJ/mol lower than those that would be required for the cycloadditions of 1-(p-bromophenyl)nitrosoethylene. Thus, calculations predict that the Diels-Alder reaction is privileged in the case of ethyl nitrosoacrylate and point to a different reaction pathway for 1-(p-bromophenyl)nitrosoethylene, corroborating the experimental findings.

Purpose: The aim of this study was to determine the dental esthetic perception of the smile of patients with maxillary lateral incisor agenesis (MLIA); the perceptions were examined pre- and post-treatment. Esthetic determinations were made with regard to the gingival exposure in the patients’ smile by orthodontists, general dentists, and laypersons. Materials and Methods: Three hundred eighty one people (80 orthodontists, 181 general dentists, 120 laypersons) rated the attractiveness of the smile in four cases before and after treatment, comprising two cases with unilateral MLIA and contralateral microdontia and two with bilateral MLIA. For each case, the buccal photograph was adjusted using a computer to apply standard lips to create high, medium, and low smiles. A numeric scale was used to measure the esthetic rating perceived by the judges. The resulting arithmetic means were compared using an ANOVA test, a linear trend, and a Student’s t-test, applying a significance level of p < 0.05. The predictive capability of the variables, unilateral, or bilateral MLIA, symmetry of the treatment, gingival exposure of the smile, group, and gender were assessed using a multivariable linear regression model. Results: In the pre- and post-treatment cases, medium smile photographs received higher scores than the same cases with high or low smiles, with significant differences between them. In all cases, orthodontists were the least-tolerant evaluation group (assigninglowestscores),followedbygeneraldentists.Inapredictivelinearregression model, bilateral MLIA was the more predictive variable in pretreatment cases. The gingival exposure of the smile was a predictive variable in post-treatment cases only. Conclusion: The medium-height smile was considered to be more attractive. In all cases, orthodontists gave the lowest scores, followed by general dentists. Laypersons and male evaluators gave the highest scores. Symmetrical treatments scored higher than asymmetrical treatments. The gingival exposure had a significant influence on the esthetic perception of smiles in post-treatment cases. Among the Portuguese population, prevalence of maxillary lateral incisor agenesis (MLIA) has been estimated at 1.3%, with aslightlyhigherfrequencyinfemales. 1 Unilateralagenesiswas found to be associated with dysmorphia or microdontia of the corresponding contralateral tooth, 2 which suggested that microdontia of maxillary lateral incisors was part of the same phenotype. 3

Brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences and correlative apparent diffusion coefficient (ADC) maps is a very sensitive way to detect acute ischemic stroke. Cases of negative MRI-DWI on acute phase of ischemic stroke are uncommon, and most of them are reported in single small-sized lesions, which in most cases are below the technical spatial resolution and in patients imaged shortly after the symptoms start. The few published cases of territorial ischemic stroke with negative DWI affect exclusively one vascular territory. We report the case of an ischemic stroke involving 2 different arteries of the posterior circulation, with a negative DWI/ADC brain MRI 18 hours after time-last-seen-well. We also suggest a possible explanation regarding the mechanism of false-negative diffusion MRI on ischemic stroke.

Resume L’objectif de cette etude etait de determiner la perception esthetique de certaines composantes du sourire telles que l’exposition gingivale, la longueur coronaire, la mediane maxillaire et les diastemes interincisifs par des profanes, des etudiants en dentaire et des dentistes. Materiaux et methodes Six cent trente-quatre sujets portugais (292 profanes, 241 etudiants en dentaire et 101 dentistes) ont evalue l’esthetique de 13 images modifiees du meme sourire presentees de facon randomisee. Les composantes modifiees (exposition gingivale, niveau des collets gingivaux, longueur coronaire, ligne mediane maxillaire et diastemes interincisifs) ont ete manipulees a l’aide du logiciel Adobe Photoshop® CS6. La classification des images a ete effectuee au moyen de l’echelle visuelle analogique (EVA) avec des scores de 1 a 10. Les reponses ont ete ensuite analysees et traitees par le SPSS® version 21.0 en utilisant des tests d’egalite de moyennes et de correlation. Resultats Le sourire moyen etait le sourire le plus apprecie alors que le sourire gingival et les sourires avec diasteme ont ete consideres les moins esthetiques. Parmi tous les parametres, le changement de la ligne mediane a ete le moins perceptible. La preference en faveur de l’asymetrie en rapport avec le collet gingival des incisives laterales maxillaires (ILM) et de la symetrie de la longueur coronaire des incisives centrales maxillaires (ICM) temoigne de l’importance accordee aux ICM au niveau du sourire. Le sexe des evaluateurs n’a pas influe sur les scores attribues, sauf en ce qui concerne le sourire gingival. Ce sont les participants jeunes qui ont donne les scores les plus eleves. Concernant la formation universitaire ou professionnelle, il y avait une concordance intragroupe des opinions ; les profanes avaient tendance a donner des scores plus eleves et les professionnels les scores les plus bas sans aucune correlation entre les variables. Le fait que les profanes aient recu, ou non, un traitement orthodontique n’a pas eu d’impact sur leurs opinions. Conclusion Lors d’une evaluation de divers elements d’un sourire modifie, les profanes, les etudiants en dentaire et les praticiens avaient des perceptions differentes de leur attractivite, a l’exception des sourires avec diasteme ; il n’y avait pourtant pas de differences significatives entre les groupes. On a observe une correlation entre le sexe des evaluateurs et les sourires tres gingivaux. Il n’y avait pas de correlation entre leur âge et leurs opinions. Il n’y avait aucune difference entre les perceptions des profanes, qu’ils aient recu, ou non, un traitement orthodontique.

Background and Purpose— Recanalization status after intravenous thrombolysis (IVT) in patients with ischemic stroke is a reference point to proceed with a rescue reperfusion intervention, although early neurological improvement (NI) may preclude endovascular procedures. We aimed to evaluate the importance of restoration of blood flow at the arterial occlusion site in subgroups of patients with stroke stratified by early NI after IVT. Methods— The following patients were recruited from the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register: (1) with baseline vessel occlusion documented by computed tomographic (CT) or magnetic resonance (MR) angiography and follow-up angioimaging between 22 and 36 hours after IVT available; and (2) with dense cerebral artery sign on admission CT scan and results of follow-up CT reported. Recanalization at 24 hours was defined as absence of vessel occlusion or as resolution of dense cerebral artery sign on follow-up 22- to 36-hour imaging. NI was assessed at 2 hours and 24 hours after IVT and was defined as improvement by 20% from baseline National Institute of Health Stroke scale score. Primary outcome measure was independence, defined as modified Rankin scale score 0 to 2 after 3 months. Results— Of 28136 cases registered between December 2003 and November 2009, 5324 cases (19%) met the inclusion criteria. Patients with both NI at 2 hours post-treatment and vessel recanalization had the best chances to achieve independence at 3 months (adjusted odds ratio, 15.8; 95% confidence interval, 12.5–20.0), followed by those who had NI despite persistent occlusion (adjusted odds ratio, 4.7; 95% confidence interval, 3.6–6.1); and those without NI despite recanalization (adjusted odds ratio, 2.7; 95% confidence interval, 2.2–3.3). Conclusions— Recanalization of an occluded artery in acute stroke is associated with favorable functional outcome both in patients with and without NI after IVT. In future evaluations of mechanical thrombectomy and other additional strategies, recanalization should be considered in patients with persisting occlusion after IVT even after significant NI.

Background Diagnosing paroxysmal atrial fibrillation in patients with stroke can be difficult. We aimed to determine if N-terminal pro-brain natriuretic peptide can help identify paroxysmal atrial fibrillation in cryptogenic stroke. Methods and results Among 264 ischemic stroke patients, serum levels of N-terminal pro-brain natriuretic peptide were measured within 72 h of stroke onset. In cryptogenic stroke patients, 24-h Holter monitoring was used to look for paroxysmal atrial fibrillation within the first week and also three-and six-months after admission. First, patients with a defined etiology were used to construct a receiver operating characteristic curve for the diagnosis of atrial fibrillation. From this curve, the sensitivity and specificity of preestablished cutoff points for the diagnosis of atrial fibrillation were calculated. A logistic regression was performed to assess the independent relationship of the logarithm of N-terminal pro-brain natriuretic peptide levels with atrial fibrillation. The cutoff points were then evaluated in patients with cryptogenic stroke. Results One hundred eighty-four patients had a specific stroke etiology. Fifty-five patients had atrial fibrillation. Using multivariate analysis, the logarithm of N-terminal pro-brain natriuretic peptide levels was independently associated with atrial fibrillation. The area under the receiver operating characteristic curve of N-terminal pro-brain natriuretic peptide for the diagnosis of atrial fibrillation was 0·91 (95% confidence interval 0·87–0·95). The cutoff point of 265·5 pg/ml had a sensitivity of 100% and specificity of 70·5% for the diagnosis of atrial fibrillation. The cutoff point of 912 pg/ml had a sensitivity of 81·8% and a specificity of 87·5%. Eighty patients had a cryptogenic stroke. In 17, paroxysmal atrial fibrillation was found during follow-up. In these patients, the area under the curve for the diagnosis of paroxysmal atrial fibrillation was 0·83. The cutoff point of 265·5 had a sensitivity of 88·2% and a specificity of 61·9%. The cutoff point of 912 pg/ml had a sensitivity of 47·1% and a specificity of 88·9%. Conclusion N-terminal pro-brain natriuretic peptide has good accuracy in predicting the presence of paroxysmal atrial fibrillation in patients with cryptogenic stroke and can help to identify these patients.

Introduction and Aims: We describe the clinical characteristics, management and outcomes of patients hospitalized with acute heart failure in a south-west European cardiology department. We sought to identify the determinants of length of stay and heart failure rehospitalization or death during a 12-month follow-up period. Methods and Results: This was a retrospective cohort study including all patients admitted during 2010 with a primary or secondary diagnosis of acute heart failure. Death and readmission were followed through 2011.Of the 924 patients admitted, 201 (21%) had acute heart failure, 107 (53%) of whom had new-onset acute heart failure. The main precipitating factors were acute coronary syndrome (63%) and arrhythmia (14%). The most frequent clinical presentations were heart failure after acute coronary syndrome (63%), chronic decompensated heart failure (47%) and acute pulmonary edema (21%). On admission 73% had left ventricular ejection fraction

Resume Objectif Le but de cette etude etait d’evaluer, chez un echantillon portugais, la prevalence et la distribution des agenesies, des dents surnumeraires, des dents incluses et des transpositions dentaires, aussi bien que la relation entre ces differentes anomalies. Materiaux et methodes L’echantillon comprenait 2888 patients, observes entre 2005 et 2009 a la clinique de dentisterie de l’Instituto Superior de Ciencias da Saude-Norte (ISCSN, Portugal). L’etude comprenait l’evaluation des parametres suivants : agenesie de toutes les dents, dents surnumeraires, dents permanentes incluses et transpositions de dents. L’âge des sujets s’echelonnait de sept a 21 ans. Pour l’etude portant sur l’absence de la troisieme molaire, les sujets âges de moins de 14 ans ont ete exclus. L’analyse statistique a ete realisee a l’aide de SPSS ® . Resultats En excluant les troisiemes molaires, la prevalence de l’agenesie dentaire, des dents surnumeraires, des dents incluses et des transpositions etait, respectivement, de 6,1 %, 0,8 %, 1,8 % et 0,2 % dans cet echantillon de la population portugaise. La prevalence de dents surnumeraires etait significativement plus elevee chez les hommes que chez les femmes ( p p Conclusions L’agenesie est l’anomalie dentaire la plus frequente. Il n’existe pas de differences entre les sexes, a l’exception des dents surnumeraires, que l’on observe plus frequemment chez les hommes. Une relation entre l’agenesie de la troisieme molaire et les canines incluses a ete observee.

Introduction: Transthoracic echocardiography is an important tool after tetralogy of Fallot repair, of which aortic root dilatation is a recognized complication. In this study we aimed to assess its prevalence and potential predictors. Methods: We consecutively assessed adult patients by transthoracic echocardiography after tetralogy of Fallot repair, and divided them into two groups based on the maximum internal aortic diameter at the sinuses of Valsalva in parasternal long-axis view: group 1 with aortic root dilatation (≥38 mm) and group 2 without dilatation (

Resumo: Introdução: O ecocardiograma transtorácico é fundamental na avaliação de doentes operados a tetralogia de Fallot. A dilatação da raiz da aorta é uma complicação descrita. Neste estudo, avaliámos a sua prevalência e potenciais preditores. População e métodos: Estudo consecutivo de adultos operados a tetralogia de Fallot. O diâmetro interno máximo da aorta ao nível dos seios de Valsalva (DAo) foi avaliado por ecocardiograma transtorácico, em paraesternal eixo longo. Definimos dois grupos: grupo 1 com dilatação da raiz da aorta (DAo ≥ 38 mm) e grupo 2 sem dilatação (DAo

The aim of this study was to evaluate the prevalence and pattern of agenesis, supernumerary teeth, impacted teeth and transpositions, as well as the relation between them, in a Portuguese sample.The study sample consisted of 2888 patients, observed between 2005 and 2009 at the Dentistry Clinic of the Instituto Superior de Ciências da Saúde-Norte (ISCSN, Portugal). The study included evaluation of the following parameters: agenesis of all teeth, supernumerary teeth, impacted permanent teeth and tooth transposition. The age range varied from 7 to 21 years. In order to study the absence of the third molar, subjects aged below 14 years were excluded. Statistical analysis was performed using SPSS(®).Excluding third molars, the prevalence of tooth agenesis, supernumerary teeth, impacted teeth and transpositions was 6.1%, 0.8%, 1.8% and 0.2%, respectively, for this Portuguese population. There was a significantly higher prevalence of supernumerary teeth in males than in females (P0.05). The mesiodens was the most frequent supernumerary tooth, the upper canine was the most frequent impacted tooth, and the upper canine and upper lateral were the two most frequently transposed teeth. There was a significantly higher prevalence of missing third molars in the impacted canine group than in the non-impacted canine group (P0.05).Agenesis is the most frequent dental anomaly. There are no differences between genders, except for supernumerary teeth, which are found more frequently in men. A relation between third molar agenesis and impacted canines was found.

Background Studies suggest that N-terminal-pro-brain natriuretic peptide (NT-proBNP) can be a biomarker of cardioembolic stroke. However, the best time to measure it after stroke is unknown. We studied the time course of NT-proBNP in patients with ischemic stroke. Methods Consecutive acute ischemic stroke patients were admitted over 10 months to a Stroke Unit. Stroke type was classified according to TOAST. Blood samples were drawn within 24, 48, and 72 hours after stroke. Friedman test was used to compare NT-proBNP values across the 3 times in all, cardioembolic and non-cardioembolic stroke patients. Post hoc analysis with Wilcoxon signed-rank tests was conducted with a Bonferroni correction. Mann–Whitney test was used to compare median values of NT-proBNP between cardioembolic and non-cardioembolic stroke patients. ROC curves were drawn to determine NT-proBNP accuracy to diagnose cardioembolic stroke at 24, 48, and 72 hours after stroke onset. Results One hundred and one patients were included (29 cardioembolic) with a mean age of 64.5±12.3 years. NT-proBNP values for cardioembolic stroke were significantly higher (P

Introduction: Post-stroke apathy is a disturbance of motivation evidenced by low initiative, difficulties in starting, sustaining or finishing any goal-directed activity, low self-activation or self-initiated behavior and emotional indifference. Apathy is a common behavioral disturbance in stroke survivors. We aimed to analyze the relationship between post-stroke apathy at 1 year after stroke and (1) apathy in acute phase; (2) demographic, pre-stroke predisposing conditions (previous mild cognitive impairment, alcohol abuse, mood/anxiety disorder) and clinical features (stroke type and location, neurological symptoms); (3) post-stroke depression and post-stroke cognitive impairment, and (4) post-stroke functional outcome, quality of life and the perception of health. Methods: Consecutive stroke (infarct/intracerebral hemorrhage) patients without aphasia or consciousness disturbances were included in the acute phase of stroke and assessed at 1 year after stroke. We assessed apathy with the clinically rated version of the Apathy Evaluation Scale. We also assessed post-stroke depression (Montgomery Asberg Depression Rating Scale) and post-stroke cognitive impairment (attention, mental flexibility, verbal, motor and graphomotor initiative, and non-verbal and verbal abstract reasoning, and Mini-Mental State Examination), functional outcome (Barthel Index), quality of life and perception of health (EuroQol). Data were analyzed using bivariate associations (χ2 and t test) and stepwise multivariate analysis. Results: We included 76 stroke patients [32.9% women, mean age 62.9 years (SD = 10.9) and a mean of 6.9 (SD = 4.3) years of education]. Apathy was present in 17 patients in the acute phase and in 18 (23.7%) patients at 1 year after stroke. At 1 year after stroke, 41% of the acute apathetic patients remained apathetic. Sixty-one percent of new cases of post-stroke apathy were detected. Post-stroke apathy was associated only with previous cognitive impairment, apathy in acute stroke, post-stroke cognitive impairment, verbal abstract reasoning and with worse Barthel Index scale scores. In the multivariate logistic regression model, verbal abstract reasoning (odds ratio, OR = 7.03) and apathy in acute stroke (OR = 3.8) were identified as independent factors for post-stroke apathy at 1 year. Apathetic patients did not report worse quality of life or health. Conclusion: Apathy in acute stroke phase was a reliable indicator of post-stroke apathy. Apathy should be assessed in both phases. Verbal abstract reasoning impairment was also an independent factor for post-stroke apathy impairing patients' ability to reason about goal-directed activity. Even though apathetic patients had worse post-stroke functional outcome, they did not report losing quality of life or having worse health.

A 49-year-old woman, with no relevant family history, was admitted in 1996 for arrhythmic storm with polymorphic ventricular tachycardia (torsade de pointes) which degenerated into ventricular fibrillation. Iatrogenic causes were excluded, the electrocardiogram (ECG) was normal and there was no structural heart disease. She refused cardioverter-defibrillator implantation. Treatment was begun with amiodarone, which she took irregularly.She remained asymptomatic until 2014 when she was admitted for a new arrhythmic storm with torsade de pointes, refractory to antiarrhythmic therapy and aggravated by ventricular pacing (65 defibrillations). She had frequent ventricular extrasystoles (with short-coupled period

Right ventricular infarction is uncommon in isolation but can be observed in 50% of cases of inferior wall myocardial infarction. Diagnosis is difficult and suspicion of this condition should always be borne in mind. Progression to cardiogenic shock is not uncommon, when the outcome is similar to left ventricular infarction; mortality can reach 60%. We present the case of a 64-year-old woman with known coronary disease who was admitted to our coronary care unit after an anterior myocardial infarction. Cardiac catheterization showed diffuse stenosis of the left descending and 70% stenosis of the posterior descending arteries. She was surgically revascularized with a favorable evolution, but was later readmitted for acute decompensated heart failure with cardiogenic shock. She was refractory to medical therapy, with biventricular dysfunction on echocardiographic examination. Cardiac magnetic resonance imaging confirmed the diagnosis of right ventricular infarction. Resumo: O enfarte do miocárdio isolado do ventrículo direito é uma entidade patológica incomum; no entanto, pode estar associada a até 50% dos enfartes agudos do miocárdio da parede inferior. A realização deste diagnóstico pressupõe um elevado grau de suspeição clínica. A evolução para choque cardiogénico pode ocorrer num número considerável de casos e o outcome descrito é semelhante ao enfarte miocárdico do ventrículo esquerdo, com uma mortalidade que pode atingir os 60%. Os autores apresentam o caso clínico de uma doente de 64 anos, com história prévia de doença coronária, admitida após enfarte agudo do miocárdio da parede anterior. O cateterismo cardíaco mostrou estenose difusa da artéria coronária descendente anterior e estenose de 70% da artéria coronária descendente posterior. Foi submetida a cirurgia de revascularização miocárdica. Cerca de um mês após este evento, foi readmitida em contexto de insuficiência cardíaca aguda, em choque cardiogénico, com disfunção sistólica biventricular. Apresentava eletrocardiograma semelhante ao prévio, bem como cateterismo cardíaco, que mostrava a patência da pontagem realizada. Após estabilização clínica, foi submetida a RMN cardíaca, que evidenciou a presença de realce tardio na parede livre do ventrículo direito, confirmando a hipótese de enfarte miocárdio do ventrículo direito. Keywords: Right ventricular infarction, Cardiogenic shock, Magnetic resonance imaging, Palavras-chave: Enfarte ventrículo direito, Choque cardiogénico, Ressonância magnética cardíaca

This article describes the complex dental treatment of an adult patient with missing upper posterior teeth, malocclusion with a severe curve of Spee and generalized moderate chronic periodontitis. A skeletal Class II due to a retruded mandible with high overjet and overbite and labial inclination of the maxillary incisors were also present. Based on the loss of supporting periodontal tissue, missing upper posterior teeth and extrusion of the antagonist teeth, with consequent loss of space for rehabilitation, the orthodontic treatment consisted of a mini-screw anchorage on the posterior maxilla. A multiloop edgewise arch wire was applied in the lower arch in order to correct the severity of the curve of Spee, intruding posterior teeth and incisors. When the occlusal plane was established and a normal interocclusal space was obtained at the posterior teeth a prosthodontic treatment with implants was done to replace the missing teeth. In spite of the high skeletal Class II at the end of the treatment, the overall treatment improved periodontal attachments and a Class I dental relationship was achieved with a slight mandibular anterior repositioning. Furthermore, improved aesthetics of the patient was obtained by upper incisor retraction without increasing vertical dimensions.

This article describes the complex dental treatment of an adult patient with multiple missing teeth, mild chronic periodontitis, and a malocclusion with a cant of the occlusal plane. After periodontal treatment, titanium implants and a miniscrew were placed to correct the occlusal plane canting with orthodontic treatment. Prosthodontic treatment was completed by using osseointegrated implants to replace the missing teeth.

Takotsubo cardiomyopathy is a reversible form of left ventricular dysfunction with an apparently benign natural history after left ventricular recovery. Rarely there are complications such as arrhythmias and apical thrombus. We describe a case of takotsubo cardiomyopathy complicated with apical thrombus and persistent complete atrioventricular block after improvement of left ventricular wall motion. Resumo: A miocardiopatia de takotsubo constitui uma forma transitória e aparentemente benigna de disfunção ventricular esquerda. Raramente cursa com complicações como arritmias e trombos apicais. Descrevemos um caso de miocardiopatia de takotsubo complicada com trombo apical e bloqueio aurículo-ventricular completo persistente após a normalização da contractilidade do ventrículo esquerdo. Keywords: Takotsubo cardiomyopathy, Complete heart block, Apical thrombus, Palavras-chave: Miocardiopatia de takotsubo, Bloqueio aurículo-ventricular completo, Trombo apical

This article presents an adult patient with scissor bite in the posterior region, lateral open bite with a missing first molar and a second premolar on the lower left side. The scissor bite was difficult to correct due to severe occlusal difficulties in the lower left arch with a highly titled and extruded third molar. After third molar extractions (except left mandibular molar), the first step was to upright the lower second molar with a helical loop, replaced in a second step by a multiloop edgewise archwire including the third molar in order to correct the occlusal plane, uprighting and intruding the posterior teeth (second and third molar) and extruding the lateral teeth (canine and first premolar). In a third step, after the occlusal space was obtained on the teeth with previous scissor bite, the upper second molar buccal inclination was also improved with a helical loop followed by a multiloop edgewise archwire technique.

Resume Objectif Cette etude a cherche a evaluer la prevalence et la distribution de l’hypodontie dans la dentition permanente, avec et sans les troisiemes molaires, dans un echantillon de population portugaise. Patients et methodes Le groupe d’etude comprenait 2888 patients, suivis entre 2005 et 2009 a la clinique dentaire de l’Instituto Superior de Ciencias de Saude-Norte (ISCSN, Portugal). Les patients ont ete examines pour l’hypodontie, et pour la presence ou l’absence de dents temporaires chez ceux qui presentaient une agenesie. L’âge des sujets s’etalait de sept a 21 ans. Pour l’etude sur l’absence de troisiemes molaires, nous avons exclu les patients de moins de 14 ans. L’analyse statistique a ete realisee en utilisant SPSS®. Resultats Sans tenir compte des troisiemes molaires, la prevalence d’agenesie dentaire etait de 6,1 % pour cette population. L’agenesie dentaire a ete observee plus frequemment chez les femmes que chez les hommes, quoique cette difference ne fut pas statistiquement significative (p > 0,05). L’absence de dent la plus frequente etait la deuxieme premolaire mandibulaire, suivie de l’incisive laterale maxillaire et de la deuxieme premolaire maxillaire. Nous avons releve une prevalence significativement plus elevee de troisiemes molaires absentes dans le groupe avec agenesie que dans le groupe sans agenesie. Il y avait une correlation entre l’agenesie des deuxiemes premolaires et des incisives laterales superieures avec la presence des dents temporaires correspondantes. Conclusions La prevalence de l’agenesie dentaire a ete retrouvee chez 6,1 % de cette population portugaise ainsi qu’une correlation entre l’agenesie et la presence de dents temporaires, et entre l’agenesie et l’absence de troisiemes molaires.

Resumo: O diagnóstico diferencial entre o aneurisma e o pseudoaneurisma ventricular, embora difícil, é fundamental face às implicações terapêutica e prognóstica. O presente caso clínico realça o papel fulcral das técnicas de imagem não invasivas no diagnóstico diferencial destas entidades, possibilitando uma correta orientação dos doentes. Abstract: Distinguishing between ventricular aneurysm and pseudoaneurysm, although difficult, is of major importance due to the therapeutic and prognostic implications. The present case highlights the pivotal role of non-invasive imaging modalities for differential diagnosis between these entities in order to ensure appropriate management of these patients. Palavras-chave: Pseudoaneurisma, Ventrículo esquerdo, Ecocardiografia, Ressonância magnética cardíaca, Cirurgia de reconstrução ventricular, Keywords: Pseudoaneurym, Left ventricle, Echocardiography, Cardiac magnetic resonance, Left ventricular reconstructive surgery

Distinguishing between zventricular aneurysm and pseudoaneurysm, although difficult, is of major importance due to the therapeutic and prognostic implications. The present case highlights the pivotal role of non-invasive imaging modalities for differential diagnosis between these entities in order to ensure appropriate management of these patients. Resumo: O diagnóstico diferencial entre o aneurisma e o pseudoaneurisma ventricular, embora difícil, é fundamental face às implicações terapêutica e prognóstica. O presente caso clínico realça o papel fulcral das técnicas de imagem não invasivas no diagnóstico diferencial destas entidades, possibilitando uma correta orientação dos doentes. Keywords: Pseudoaneurysm, Left ventricle, Echocardiography, Cardiac magnetic resonance, Left ventricular reconstructive surgery, Palavras-chave: Pseudoaneurisma, Ventrículo esquerdo, Ecocardiografia, Ressonância magnética cardíaca, Cirurgia de reconstrução ventricular

Left ventricular noncompaction is an unusual but increasingly recognized cardiomyopathy, the etiology of which is still not definitely established. Clinical presentation includes a wide spectrum of scenarios, including heart failure, thromboembolism and malignant arrhythmias, with half of deaths occurring suddenly. Early detection of LVNC is therefore essential to prevent sudden cardiac death. To our knowledge, this is the first report of the presence of cardiac sympathetic nervous dysfunction, assessed by 123iodine-metaiodobenzylguanidine myocardial scintigraphy, in a patient with LVNC, preserved left ventricular systolic function and exercise-induced nonsustained ventricular tachycardia. This finding may be related to the increased arrhythmic risk observed in this cardiomyopathy, giving a new insight into the pathophysiology of LVNC. Resumo: O miocárdio não-compactado (MNC) é uma miocardiopatia que, embora rara, tem sido gradualmente mais descrita. O espectro de apresentação clínica é variável, incluindo insuficiência cardíaca, fenómenos tromboembólicos e arritmias, sendo que metade das mortes ocorre subitamente (MSC). Por conseguinte, o diagnóstico precoce e correto do MNC é fundamental para a prevenção da MSC. O presente artigo ilustra pela primeira vez a presença de disfunção neuronal simpática, avaliada por cintigrafia cardíaca com 123I-metaiodobenzilguinadina, num doente com MNC, função sistólica ventricular esquerda preservada e taquicardia não sustentada induzida pelo esforço. A presença de alterações na actividade adrenérgica cardíaca pode estar relacionada com o maior risco arrítmico característico desta miocardiopatia, podendo contribuir para o melhor esclarecimento da sua patofisiologia. Keywords: Cardiac 123I-MIBG scintigraphy, Left ventricular noncompaction, Arrhythmias, Palavras-chave: Cintigrafia cardíaca com 123I-MIBG, Miocárdio não-compactado, Arritmias

A previously healthy 22-year-old woman was admitted with three weeks evolution of sharp and pleuritic chest pain, under ibuprofen 600 mg every 8 hours. The physical examination, 12- lead ECG and ch...

Resume Objectif Evaluer l’impact de l’agenesie des incisives laterales maxillaires (AILM) sur la morphogenese du visage. Methodes Evaluation des dimensions squelettiques du maxillaire et du segment des incisives superieures. L’analyse a ete realisee aupres de trois groupes : individus avec une AILM, leurs parents proches et la population normale. Dans ces groupes, une comparaison a ete faite entre les adultes et les individus en pleine croissance. Resultats L’AILM peut influer sur la longueur du maxillaire et sur la hauteur anterosuperieure de la face, ce qui peut avoir un impact negatif sur sa croissance potentielle. Il n’y a aucune correlation entre l’AILM et les modifications de l’inclinaison du plan palatin, la hauteur du maxillaire, l’evolution des dimensions de l’epine nasale anterieure ou de l’epine nasale posterieure par rapport au plan de Francfort pendant la phase de croissance observee. L’inclinaison coronopalatine des incisives chez les enfants avec une agenesie bilaterale des incisives laterales semble se modifier pendant la vie d’adulte. Conclusions L’AILM est associee a un raccourcissement du maxillaire et semble avoir un impact significatif sur la hauteur anterieure du visage en reduisant ses dimensions potentielles.

Summary Objectives Assessment of the influence of maxillary lateral incisor agenesis (MLIA) on the facial morphogenesis. Methods Evaluation of the skeletal dimensions of the upper maxilla and its incisor region. Analysis was performed among three groups: individuals with MLIA, its relatives and the normal population. Among these a comparison between adults and growing individuals was performed. Results MLIA may interfere with the maxillary length and the anterosuperior facial height, negatively conditioning on its potential growth. MLIA was not correlated with changes of the palatine plane inclination, maxillary height nor with adjustment of the anterior nasal spine dimensions related to the Frankfurt plan or to the posterior nasal spine–Frankfurt plan during the observed development stage; the backward angle of the incisors in children with bilateral agenesis of lateral incisors appear to have been corrected in adulthood. Conclusions MLIA is associated with an upper maxilla shortening, and appear to interfere significantly with the anterior facial height, reducing its potential size.

This case report describes the treatment of a patient with a horizontally impacted maxillary central incisor, a canine in the same quadrant, and an inclusion tendency. Due to severe crowing in the maxilla and the Class II molar relationship on the impaction side, a 2-stage treatment plan was developed. In the first stage, the right first premolar and deciduous canine were extracted; this allowed enough space for the eruption of the maxillary right permanent canine. The second stage included surgical exposure and traction of the impacted central incisor with a fixed orthodontic appliance. An excisional uncovering technique was needed to expose the impacted incisor. After it erupted, an apically positioned partial-thickness flap was used to add keratinized attached gingiva in the area surrounding the crown, initially located in an area of unattached gingiva. The patient finished treatment with a normal and stable occlusion between the maxillary and mandibular arches and an adequate width of attached gingiva.