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Exercise-based interventions can be a safe alternative to improve and maintain physical and mental health during the aging process. The aim of the present study was to evaluate the effects of a 12-week training program with Dance Exergames on the mood and functional fitness profile of elderly women. The sample (n = 22) was divided into Exergames (EG, n = 9, 70.6 ± 1.6 years) and Control Groups (CG, n = 13, 73.6 ± 2.2 years). Evaluations were carried out before and after the interventions. Each participant played, in pairs, the electronic game Dance Central 3, with the XBOX 360 Kinect console (Slim, Microsoft, USA). The EG trained for 12 weeks (24 sessions), with two weekly sessions of 50 min and the CG performed manual activities workshops. In functional fitness, both exercise training with exergame (EG) and the intervention model for the CG did not produce significant effects regarding interaction (group*time). Mood state presented significant effect of time intervention regarding tension (p = <0.001), depression (p = 0.001), anger (p = 0.030), fatigue (p = 0.001), and mental confusion (p = 0.004). Twelve weeks of training with a dance exergame (for, EG) and manual activities (for, CG) is enough to promote improvements in the mood state of healthy elderly women. This is an interesting result, as it shows that social interaction is as important a component as improving functional capacity. [ABSTRACT FROM AUTHOR]

• Apolipoprotein E gene polymorphism ε4 is associated with lobar intracranial hemorrhages. • Apolipoprotein E gene polymorphism ε2 also predisposes to changes in the blood vessels and white matter changes. • We found no association between APOE polymorphisms and hemorrhagic transformation following thrombolysis. APOE ε4 is independently associated with lobar intracranial hemorrhages (ICH). Although the ε4 allele enhances amyloid deposition in blood vessels, the ε2 allele predisposes to vasculopathic changes leading to rupture of amyloid laden vessels. Thus, ε4 and ε2 carriers might have increased susceptibility to ICH. We aimed to study the impact of the apolipoprotein E alleles in the development of symptomatic ICH (sICH). We included 384 consecutive ischemic anterior circulation stroke patients submitted to thrombolysis between January 2014 and March 2016. Admission CT-scans were reviewed to calculate the ASPECTS. Patients were followed for up to at least 6 months post-stroke or until death. Outcome was development of sICH, defined according to the ECASS III. Considering APOE genotyping, three patients had ε2/ε2, four had ε2/ε4, 38 had ε2/ε3, 284 had ε3/ε3, 51 had ε3/ε4 and four had ε4/ε4. sICH was associated with sex and diabetes. In multivariate analysis, sICH was not associated with carrying one or more ε4 alleles (OR: 0.483, 95%CI = [0.059, 3.939], p = 0.497) nor with carrying one or more ε2 alleles (OR: 1.369, 95%CI = [0.278, 6.734], p = 0.699). No association was found between APOE genotype and the development of symptomatic intracranial hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the leading causes of disability worldwide. Early prediction of poststroke disability using clinical models is of great interest, especially in the rehabilitation field. Although some biomarkers and neuroimaging techniques have shown potential predictive value, there are still insufficient data to support their clinical utility in predicting poststroke functional recovery. We aimed to assess the value of serum biomarkers (C-reactive protein [CRP], D-dimer, fibrinogen, and S100β protein) in predicting medium-term (12 weeks) functional outcome in patients with acute ischemic stroke.Methods: This is an observational, prospective study in a sample of patients hospitalized for ischemic stroke (N = 131). Peripheral blood levels of biomarkers of interest were determined at admission (CRP, D-dimer, and fibrinogen) or at 48 hours poststroke (S100β protein). Functional status was accessed at 48 hours and 12 weeks poststroke using the modified Rankin Scale (mRS).Results: S100β protein levels measured at 48 hours were significantly associated with mRS scores at 12 weeks (odds ratio = 1.005, 95% confidence interval [CI] [1.005-1.007]; P <.001). This association was not seen for the remaining biomarkers of interest. The S100β cutoff for poor functionality at 12 weeks was 140.5 ng/L or more (sensibility 83.8%; specificity 71.4%; area under the curve = .80, 95% CI [.722, .879]).Conclusions: S100β levels in peripheral blood at 48 hours poststroke reflect acute stroke severity and predict functional outcome at 12 weeks with a cutoff value of 140.5 ng/dL. The value of S100β as predictor of functional recovery after stroke should be emphasized in further clinical research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cardioembolism has tendency to recur and cause lesions in distinct cerebrovascular territories. Using the imaging characteristics of cerebral lesions to determine dissemination in time and space (DTS) is a concept already used in other neurologic conditions; however, it has never been applied as a diagnostic tool in ischemic stroke etiology.Aim: This study aimed to assess DTS as a diagnostic marker of cardioembolism.Methods: We enrolled consecutive patients with acute ischemic stroke of various etiologies admitted in a cerebrovascular disease nursery from a university hospital in a retrospective cohort study. We excluded patients with coexisting etiologies, incomplete study, or without an acute vascular lesion on computed tomography scan. Lacunar infarctions were not considered. Cerebrovascular territory was divided into right anterior, left anterior, and posterior. Localization of the acute vascular lesion(s), existence of previous vascular lesions, and their respective areas were analyzed. The presence of dissemination in time, space, or DTS was determined.Results: We included 661 patients (mean age: 74.05 years (SD: 13.01)). Cardioembolism was the etiology with most DTS (30.47% of cardioembolic strokes); DT occurred more frequently within the atherosclerotic subtype (9.88%); DS was more prevalent within the arterial dissection group (3.33%). There was a statistically significant difference in stroke etiology between patients with DTS and patients without dissemination (P < .001). DTS had 81.67% specificity, 30.47% sensitivity, 66.67% positive predictive value, and 49.40% negative predictive value for the identification of cardioembolism.Conclusion: DTS is a specific diagnostic predictor of cardioembolic stroke and may be helpful in guiding etiologic investigation. [ABSTRACT FROM AUTHOR]

Objetives: Time is relative in large-vessel occlusion acute ischemic stroke (LVO-AIS). We aimed to evaluate the rate of inter-hospital ASPECTS decay in patients transferred from a primary (PSC) to a comprehensive stroke center (CSC); and to identify patients that should repeat computed tomography (CT) before thrombectomy.Materials and Methods: This was a retrospective cohort study of consecutive anterior circulation LVO-AIS transferred patients. The rate of ASPECTS decay was defined as (PSC-ASPECTS - CSC-ASPECTS)/hours elapsed between scans. Single-phase CT angiography (CTA) at the PSC was used to classify the collateral score. We compared patients with futile versus useful CT scan re-evaluation.Results: We included 663 patients, of whom 245 (37.0%) repeated CT at a CSC. The median rate of ASPECTS decay was 0.4/h (0.0-0.9). Patients excluded from thrombectomy after a CT scan repeat (n=64) had a median ASPECTS decay rate of 1.18/h (0.83-1.61). Patients with absent collateral circulation had a median rate of 1.51(0.65-2.19). The collateral score was an independent predictor of the ASPECTS decay rate (aβ = -0.35; 95%CI -0.45 - -0.19, p<0.001). Age (aOR: 1.04 95% CI 1.02-1.07, p<0.001), NIHSS (aOR: 1.11 95% CI 1.06-1.15, p<0.001), PSC ASPECTS (aOR: 0.74 95% CI 0.60-0.91, p=0.006) and the CTA collateral score (aOR: 0.14 95% CI 0.08-0.22, p<0.001) were independent predictors of the usefulness of a CT scan repeat.Conclusions: The rate of ASPECTS decay can be predicted by the CTA collateral score, helping in the selection of patients that would benefit from repeating a CT assessment on arrival at the CSC. [ABSTRACT FROM AUTHOR]

BIM methodology has gained great importance in the construction industry. This methodology introduces noteworthy changes in the way as building design, construction and maintenance are traditionally managed. This paper explores and evaluates the advantages and disadvantages of BIM methodology application on the preparation, revision and coordination of designs, as well as the analysis of the computational tools available. Using the Revit software a building (laundry of a hospital) was modeled in BIM based in the design drawings carried out by using the traditional methods in CAD 2D. [ABSTRACT FROM AUTHOR]

Background Intracranial atherosclerotic disease is a common cause of stroke; its incidence and prevalence vary widely by ethnicity. The aim of our study was to analyze the recurrence rate of cerebrovascular events in patients with symptomatic and asymptomatic intracranial stenosis (IS). Methods We conducted a historical cohort study including all patients admitted in our hospital for stroke or transient ischemic attack (TIA) during 2011 and 2012 with information on intracranial circulation (ultrasonography and/or computed tomography angiography). We identified patients with symptomatic and asymptomatic IS and studied the recurrence of cerebrovascular events (TIA or ischemic stroke within the territory of the stenosis) for a minimum follow-up period of 6 months after the diagnosis of IS. For the recurrence rate estimation, patients with other potentially embolic diseases (in cervical arteries or heart) were excluded. We calculated the rate of recurrence of cerebrovascular events and performed Kaplan–Meier survival curves for symptomatic and asymptomatic IS. Results We investigated 1302 patients, mean age was 72.41 years (standard deviation 12.75). We identified 218 IS in 158 patients, 77 were symptomatic and 141 were asymptomatic. The recurrence rate of cerebrovascular events was 12.32 per 100 patient-years, with a mean time to recurrence of 1.73 months for symptomatic intracranial stenosis (SIS) and .88 per 100 patient-years for asymptomatic IS ( P < .001). Conclusions These results indicate a high risk of early recurrence of stroke in the territory of a SIS, highlighting the importance of its early diagnosis and aggressive treatment. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: It is estimated that approximately 20–30% of patients diagnosed with epilepsy have been misdiagnosed, and neurocardiogenic syncope (NCS) might frequently be the real cause of transient loss of consciousness (TLOC) episodes. We assessed the role of the head-up tilt test (HUTT) in patients previously diagnosed with refractory epilepsy to evaluate the ability of this test to correctly diagnose patients with NCS. Method: We retrospectively analysed the clinical records of 107 consecutive patients with a previous diagnosis of refractory epilepsy that were taking antiepileptic drugs and who were referred for HUTT between January 2000 and December 2010. During the subsequent follow-up, we recorded the treatments performed and the recurrence of symptoms. Results: Complete follow-up data were available for 94 (88%) patients, and the mean follow-up period was 80±36 months. The HUTT was positive in 54% of patients. Thirty-one (33%) patients were misdiagnosed with epilepsy, and 20 (21%) patients had a dual diagnosis of NCS and epilepsy. The recurrence of TLOC was reported in 55% of the patients, but it was significantly lower in the misdiagnosed group (42% versus 64%; P =0.039). Conclusion: NCS is an important cause of epilepsy misdiagnosis. The HUTT is often critical for making an accurate diagnosis and subsequently selecting the appropriate treatment for patients presenting with TLOC. The diagnostic overlap between epilepsy and NCS is not uncommon, suggesting that electroencephalographic monitoring during a HUTT may play an important role in diagnosing patients with recurrent, undiagnosed TLOC episodes. [Copyright &y& Elsevier]

Background and Objectives: Intravenous thrombolysis (IV-rtPA) has been suggested as a potential cause of myocardial infarction (MI) after acute ischemic stroke (AIS), with randomized clinical trials showing a higher number of cardiac events within the thrombolysis group. We assessed the prevalence and MI mechanisms after IV-rtPA for AIS.Methods: Retrospective review of consecutive AIS patients admitted to six stroke units and systematic literature review searching for AIS patients who suffered a MI less than 24 h after IV-rtPA. In those with available coronary angiography, MI etiology was defined as atherosclerotic or embolic. Patients' characteristics were compared between groups.Results: Fifty-two patients were included. Thirty-two patients (61.5%) derived from hospital cases, after reviewing 6958 patients treated with IV-rtPA [0.5% (95% CI 0.38-0.54) of total hospital cases]. After coronary angiography (n = 25, 48.1%), 14 (54%) patients were considered to have an atherosclerotic MI, and 11 (46%) due to coronary embolism. Patients with an embolic MI more frequently had a cardioembolic AIS (72.7% vs 28.6%; p-value = 0.047) and an intracardiac thrombus (27.3% vs 0.0%; p-value = 0.044). Although not statistically significant, patients with an embolic MI had apparent lower time intervals between starting IV-rtPA infusion and MI occurrence [2 h (0.2-3.0) vs 3 h (1.0-15.0); p-value = 0.134].Conclusions: MI within the first 24 h after IV-rtPA for AIS is an infrequent event, and more frequently non-embolic. However, the prevalence of embolic MI was superior to what is found in the general population with MI. There was an association between the pathophysiology of AIS and MI. The low number of events and publication bias may have limited our conclusions. [ABSTRACT FROM AUTHOR]

Abstract: Despite the high level of effectiveness of natalizumab (NTZ) in the treatment of patients with multiple sclerosis (MS), concerns about its high direct cost and its safety have restricted its use. Our aim was to identify and quantify the clinical factors that predict an optimal response to NTZ. Patients with MS undergoing treatment with NTZ for at least 12months were classified as optimal responders if, during treatment, they sustained a reduction in their Kurtzke Expanded Disability Status Scale (EDSS) score of 1 point or more or experienced a reduction in annualised relapse rate (ARR) of more than 1. The remaining patients were classified as suboptimal responders and non-responders. Our subject pool included 48 patients. The variables associated with optimal response included: ARR in the previous year of at least 2, an age at first administration of 37.5years or less, a baseline EDSS score of 4.5 points or less, a disease duration of 9.5years or less and, in patients with secondary-progressive MS, a progressive-phase duration of 4.5years or less. The characteristics of the disease at its onset did not affect responsiveness, indicating that patients with highly active disease and low disability are the ideal candidates for NTZ treatment, regardless of previous clinical characteristics. [Copyright &y& Elsevier]

Summary: Neurovascular coupling (NVC), analysed by a control system approach, was shown to be unaffected by orthostatic challenge, but data is lacking regarding the mechanism of this interplay and the behaviour of other cerebrovascular reactivity parameters. We investigated the changes in different pressure–velocity models during functional transcranial Doppler (TCD), under different orthostatic conditions. Thirteen healthy volunteers performed a reading test stimulation task in sitting, supine and head-up tilt (HUT) positions. CBF velocity was monitored with TCD in the posterior cerebral artery, and blood pressure was monitored with Finapres. Cerebrovascular resistance index (CVRi) was compared to a two-parameter model including resistance-area product (RAP) and critical closing pressure (CrCP), in the maximal and in the stable phases of flow response to visual stimulation. All cerebrovascular resistance parameters decreased with visual stimulation but the magnitude of their variation in each orthostatic condition was not similar. From supine to HUT, CrCP variation decreased (both maximal and stable phase p =0.001). CVRi variation increased from sitting to HUT positions (maximal p =0.039; stable phase p =0.033). RAP variation to visual stimulation did not change between the three positions (maximal p =0.077; stable phase p =0.188). A 2-parameter model of vascular resistance provided better discrimination for the effects of posture on NVC as shown by the adaptive changes in CrCP with orthostatic challenge, in comparison with the classical use of CVRi. These findings suggest that although NVC seemed unaffected by orthostatic challenge, more complex vasoregulative mechanisms are activated in different orthostatic conditions that could potentially be of diagnostic or prognostic value. [ABSTRACT FROM AUTHOR]

Summary: Background: Osteoma is a benign often asymptomatic neoplasm, consisting of well-differentiated mature bone. This paper reports a case of peripheral osteoma located in the anterior mandibular region and provides a review of the literature about this lesion in the jaws. Patient and methods: A 43-year-old white woman presented with a swelling in the left mandible of 7 years duration. The English literature was reviewed over the past 76 years and data about location, histopathology and number of the peripheral osteomas, sex, and age of the patients were evaluated. Results: Data analysis showed 69 well-documented cases of peripheral osteoma. Peripheral osteomas are more frequent in the mandible than the maxilla and the cancellous type was most frequent; males and females are equally affected in the mandible; the age range was 9–85 years. Conclusion: The peripheral type of osteoma is most common in the lower jaws, occurs at the surface of the cortical bone and is sessile or pedicled. [Copyright &y& Elsevier]

In early September 2019, dense crude oil began to wash the beaches of Brazil's tropical coast. Four months after the first report, the oil has already been found along >3000 km of the Brazilian coastline on >980 beaches and was recently observed along the Amazon coast, making this oil spill the most extensive and severe environmental disaster ever recorded in Brazilian history, in the South Atlantic basin, and in tropical coastal regions worldwide. Four features of this oil-spill disaster make it unique: 1) the characteristics of the oil spill; 2) the characteristics of the affected region in tropical Brazil; 3) the significant number of protected areas (>55) and tropical ecosystems affected by the oil; and 4) the absence of measures and/or flaws in the measures taken by the federal government to address this environmental and social emergency. The affected species and poor human communities in Brazil should receive focused attention in the coming decades owing to the long-term impacts of the oil contamination. Environmental monitoring and response measures must be implemented to minimize the ecological, economic, and social effects of the spill. Biodiversity and climate regulation losses considering blue carbon environments should drive discussions regarding mining accidents and global consequences related to pre-salt oil exploitation, new spill events, and their global impacts. These measures are particularly relevant in areas with high tropical biodiversity and high social inequality, as in the present case, which represents one of the worst-case scenarios of an environmental and governmental disaster. Image 1 • This oil spill disaster is unique owing to four main features. • The affected Brazilian tropical region is unique considering coral endemism. • The significant number of protected areas and tropical ecosystems affected by the oil. • The characteristics of the oil spill itself. • The absence of and/or flaws in the measures taken by the federal governmental to address this emergency. [ABSTRACT FROM AUTHOR]

Purpose: Better understanding of clinical predictors of aphasia outcome is of the utmost importance, in patients' rehabilitation planning, expectation management, and further physiopathology understanding. We aimed to identify clinical predictors of long-term poststroke aphasia's outcome.Methods: We conducted a prospective longitudinal observation study of patients with left-Middle Cerebral Artery stroke with aphasia. Patients were evaluated at baseline, day 7 and 6 months with National Institutes of Health Stroke Scale (NIHSS) and Aphasia Rapid Test Other demographic variables and vascular risk factors were collected. A linear regression was performed to identify best predictors of aphasia at 6 months.Findings: We included 113 patients with a left hemisphere stroke, with 81 reaching the final evaluation. Aphasia Handicap Score at 6 months was predicted by baseline total NIHSS (β = .077, 95%CI = [.026, .127]. P = .004), infarct volume on CT-scan (β = .009, 95%CI = [.003, .015]. P = .003), single word repetition at baseline (β = .188, 95%CI = [.040, .335]. P = .013), and infection during hospitalization (β = .759, 95%CI = [.263, 1.255]. P = .003).Conclusions: Aphasia's outcome in patients with stroke is predicted by a single word repetition task at baseline. Infection during hospitalization has a negative impact on aphasia's outcome at 6 months. [ABSTRACT FROM AUTHOR]

Summary: Purpose: Osseous choristoma is a rare, benign lesion of the oral cavity and is usually found in the tongue. It presents as a tumour-like mass of normal bony structure with mature cells in an abnormal position. The object of this paper is to report one case of osseous choristoma. Patient: A 32-year-old male presented with a lesion in the submandibular region, which was treated by excision. After 28 months of follow-up there was no recurrence. Conclusion: Upon reviewing the English literature, no previous case of an osseous choristoma located in the submandibular region has been found. Extended clinical and radiographic follow-up is necessary after surgical excision of an osseous choristoma, despite its benign nature. [Copyright &y& Elsevier]

Abstract: It is shown that the relationship between the alkyl chain length of 3-alkyl-3′,4′,5,7 tetrahydroxyflavones (FnH) bearing alkyl chains of n =1, 4, 6, 10 carbons and their capacity to counter oxidative damage varies markedly with the nature of the biological system. In Cu2+-induced lipid peroxidation of low-density lipoprotein (LDL), the less hydrophobic short-chain F1H and F4H are probably located in the outer layer of LDL and parallel the reference flavonoid antioxidant, quercetin (Q) as effective inhibitors of lipid peroxidation. A marked inhibition of haemolysis induced in red blood cells (RBC) suspensions by the membrane-permeant oxidant, tert-butylhydroperoxide (t-BuOOH), is observed with F4H and F6H present at concentration in the micromolar range. However, F10H the most hydrophobic FnH is even more effective than Q against both haemolysis and lipid peroxidation as measured by malondialdehyde (MDA) equivalents. In oxidation of RBC by H2O2, at least 50 times more F6H and F10H than by t-BuOOH are required to only partly inhibit haemolysis and MDA production. The F1H, F4H and Q are found rather inactive under these conditions. At concentrations in the micromolar range, a marked protection against the cytotoxic effects of the t-BuOOH-induced oxidative stress in human skin NCTC 2544 keratinocytes is also exhibited by the four FnH antioxidants and is comparable to that of Q. Thus, the four FnH species under study may be considered as potent antioxidants which manifest complementary anti-oxidative actions in biological systems of markedly different complexity. [Copyright &y& Elsevier]

Four polyhydroxylated 2-styrylchromones, structurally related to flavones and cinnamic acid, have been studied. An SC derivative with OH groups only at positions 3′ and 4′ on the styryl moiety and another SC bearing an additional OH group at position 5 on the benzopyrone ring were more potent inhibitors of the Cu2+-induced peroxidation of LDL than the flavonoid quercetin. Fluorescence and absorption spectroscopies suggested that one LDL particle may bind 40 SC molecules. A pulse radiolysis study in pH 7 buffered micellar solutions of neutral TX100 and positively charged CTAB demonstrated that one-electron oxidation by ⋅Br2-, ⋅O2- and tryptophan radicals (⋅Trp) depends strongly on the micellar microenvironment. All SCs were readily oxidized by ⋅O2- in CTAB micelles (rate constants: 6–18×106 M-1 s-1). In TX100 micelles only the SC derivative with OH groups in position 3′ and 4′ reacted with ⋅O2- (rate constant: 1.1×106 M-1 s-1). In CTAB, electron transfer to ⋅Trp radicals was observed for all SCs with rate constants ≥3.2×107 M-1 s-1. In TX100 micelles, this reaction occurred solely with the derivative bearing OH groups only at positions 3′ and 4′. [Copyright &y& Elsevier]

Neutral tryptophan (•Trp) and tyrosine (TyrO•) radicals are repaired by certain flavonoids in buffer, in micelles and in human serum albumin (HSA) with corresponding formation of semioxidized flavonoid radicals. In deaerated buffer, •Trp but not TyrO• radicals react with catechin. In micelles, quercetin and rutin repair both •Trp and TyrO• radicals. In addition to amino acid reactivity, microenvironmental factors and nature of the flavonoids govern this repair. Electron transfer efficiencies from quercetin to negatively charged •Trp radicals are 100% in the micellar pseudophases of positively charged cetyltrimethylammonium bromide, (CTAB), and neutral Triton X100 (TX100), but 55% in negatively charged sodium dodecyl sulfate (SDS). In oxygen-saturated CTAB micelles, quercetin also reacts with the superoxide radical anion. When bound to domain IIA of HSA, quercetin repairs, by intra- or intermolecular encounter, less than 20% of oxidative damage to HSA. Quercetin can also repair freely circulating oxidized molecules with repair efficiencies falling to 7% for oxidized Trp, Tyr and α-MSH and to less than 2% for urate radical. This limited effectiveness is attributed both to the inaccessibility of bound quercetin and rutin toward radicals of circulating molecules and to the diffusion-controlled recombination of these radicals. [Copyright &y& Elsevier]