This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, ...retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval CI, 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.
Abstract
Background
The prevalence of severe aortic valve stenosis is increasing due to the prolonged life expectancy. Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment ...for severe aortic stenosis that is particularly attractive for elderly patients. However, there are limited data evaluating clinical outcomes in patients older than 90 years of age undergoing TAVI.
Purpose
The aim of this study was to compare in-hospital clinical outcomes between nonagenarians undergoing TAVI versus patients younger than 90 years of age and to evaluate 2-year clinical outcomes of all-cause death, stroke, and hospitalization for heart failure among nonagenarians.
Methods and results
A total of 57 nonagenarians (12%) and 418 patients younger than 90 years of age (mean 82.5 years of age) undergoing TAVI from February 2014 to February 2023 in our institution were included. Among nonagenarians, 83.7% had hypertension, 8.9% had diabetes mellitus, 17.9% had atrial fibrillation, and 10.5% had malignant diseases. Self-expanding valves were more often implanted in nonagenarians (43.9% vs. 29.0%, p=0.02) and nonagenarians were likely to undergo transfemoral TAVI (89.5% vs. 84.0%, p=0.28) Mean hospitalization days after TAVI was almost similar between nonagenarians and patients younger than 90 years of age (12.5 days vs. 12.8 days, p=0.90). Rates of in-hospital disabling stroke (3.6% vs. 1.8%, p = 0.38) and need for permanent pacemaker implantation (8.8% vs. 5.7%, p = 0.37) tended to be higher in nonagenarians. The rate of major vascular complication was almost similar between two groups (3.5% vs. 4.8%, p=0.66). The 2-year survival rates of all-cause death, stroke and hospitalization for heart failure, composites of all-cause death and stroke and composites of all-cause death, stroke and hospitalization for heart failure among nonagenarians were 86.3%, 87.5%, 88.9%, 80.6% and 74.0%, respectively. During an average 1.6-year follow-up period, nine deaths occurred among nonagenarians. Of those, seven patients died from non-cardiovascular causes.
Conclusion
In this single center analysis, clinical outcomes in nonagenarians undergoing TAVI were acceptable compared with patients younger than 90 years of age.
This retrospective study sought voluntary participation from leading cleft centres from Europe and Brazil regarding core outcome measures. The results of this study would inform the debate on core ...outcome consensus pertaining to the European Reference Network for rare diseases (ERN CRANIO) and achieve a core outcome set for cleft care providers worldwide.
Five orofacial cleft (OFC) disciplines were identified, within which all of the International Consortium of Health Outcomes Measurement (ICHOM) outcomes fall. One questionnaire was designed for each discipline and comprised 1. the relevant ICHOM's outcomes within that discipline, and 2. a series of questions targeted to clinicians. What core outcomes are currently measured and when, did these align with the ICHOM minimum, if not how did they differ, and would they recommend modified or additional outcomes?.
For some disciplines participants agreed with the ICHOM minimums but urged for earlier and more frequent intervention. Some clinicians felt that some of the ICHOM standards were compatible but that different ages were preferred and for others the ICHOM standards were acceptable but developmental stages should be preferred to absolute time points.
Core outcomes for OFC were supported in principle but there are differences between the ICHOM recommendations and the 2002 WHO global consensus. The latter are established in many centres with historical archives of OFC outcome data, and it was concluded that with some modifications ICHOM could be moulded into useful core outcomes data for inter-centre comparisons worldwide.
A resorbable collagen matrix with recombinant human bone morphogenetic protein (rhBMP-2) was compared with traditional iliac crest bone graft for the closure of alveolar defects during secondary ...dental eruption.
Sixteen patients with unilateral cleft lip and palate, aged 8 to 12 years, were selected and randomly assigned to group 1 (rhBMP-2) or group 2 (iliac crest bone graft). Computed tomography was performed to assess both groups preoperatively and at months 6 and 12 postoperatively. Bone height and defect volume were calculated through Osirix Dicom Viewer (Pixmeo, Apple Inc.). Overall morbidity was recorded.
Preoperative and follow-up examinations revealed progressive alveolar bone union in all patients. For group 1, final completion of the defect with a 65.0% mean bone height was detected 12 months postoperatively. For group 2, final completion of the defect with an 83.8% mean bone height was detected 6 months postoperatively. Dental eruption routinely occurred in both groups. Clinical complications included significant swelling in three group 1 patients (37.5%) and significant donor-site pain in seven group 2 patients (87.5%).
For this select group of patients with immature skeleton, rhBMP-2 therapy resulted in satisfactory bone healing and reduced morbidity compared with traditional iliac crest bone grafting.
This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review and, based on panoramic ...radiographs, retrospectively and longitudinally analyze the behavior of permanent canines after completion of secondary bone grafting in 50 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. Twelve patients with unilateral cleft lip and alveolus and 38 patients with complete unilateral cleft lip and palate (n = 50) had undergone bone grafts to repair their residual alveolar clefts before the eruption of their permanent canines. These patients were observed over an average period of 3 years. In 94% of the sample (47 patients), the permanent canines presented intra-alveolar movement toward the oral cavity. In 72% of those 47 patients (36 patients), the permanent canines spontaneously erupted through the grafted area. In 6% of the 47 patients (3 patients), the permanent canines required orthodontic traction.
Objective
To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental ...development.
Participants
Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise.
Statistics
The interexaminer reliability was calculated using weighted kappa statistics.
Results
The interrater weighted kappa scores were between .74 and .92, which is in the “good” to “very good” categories.
Conclusions
Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds’ yardstick), one for early mixed dentition (9-year-olds’ yardstick), and one for early permanent dentition (12-year-olds’ yardstick).
The intracellular acid phosphatase II (ACPase II) produced by Aspergillus niger KU-8 preferentially dephosphorylates C-6 phosphate groups rather than C-3 phosphate groups of phosphoryl ...oligosaccharides. In this study, the kinetic parameters of ACPase II were measured. 3
2
-phosphoryl maltotriose and 6
2
-phosphoryl maltotriose, which differ only in the binding position of the phosphate group, were prepared and used as the substrates. The K
m
for both substrates were similar. However, the k
cat
value for the 6
2
-phosphoryl maltotriose was about three-fold of that for the 3
2
-phosphoryl maltotriose.
OBJECTIVETo compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and ...palate (BCLP).DESIGNRetrospective longitudinal intercenter outcome study.PATIENTSDental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers.SETTINGThree cleft palate centers with different treatment protocols.MAIN OUTCOME MEASURESDental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models.RESULTSThere were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p=.027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p=.041) and 12.9% (p=.009), respectively.CONCLUSIONSDespite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.
Effects of Mao-Bushi-Saishin-to (MBS) on anti-inflammatory activities were examined in mice and rats. MBS significantly inhibited the increase in vascular permeability induced by acetic acid, the ear ...edema induced by arachidonic acid and phorbol ester, and the cutaneous extravasation induced by bradykinin and histamine. MBS, however, was not effective against the serotonin-induced cutaneous permeability increase in mice. MBS significantly inhibited carrageenin-induced hind foot edema and cotton pellet-induced granulation tissue growth in rats. These results show that MBS may exert anti-inflammatory effects through the underlying mechanism(s) of preventing mediator release from mast cells and macrophages.
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