Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

<div><p>Background</p><p>While oral anticoagulants (OACs) are highly effective for ischemic stroke prevention in atrial fibrillation, intracerebral hemorrhage (ICH) remains the most feared complication of OAC. Clinical controversy remains regarding OAC resumption and its timing for ICH survivors with atrial fibrillation because the balance between risks and benefits has not been investigated in randomized trials.</p><p>Aims/Hypothesis</p><p>To survey the practice of stroke neurologists, thrombosis experts and neurosurgeons on OAC re-initiation following OAC-associated ICH.</p><p>Methods</p><p>An online survey was distributed to members of the International Society for Thrombosis and Haemostasis, Canadian Stroke Consortium, NAVIGATE-ESUS trial investigators (Clinicatrials.gov identifier NCT02313909) and American Association of Neurological Surgeons. Demographic factors and 11 clinical scenarios were included.</p><p>Results</p><p>Two hundred twenty-eight participants from 38 countries completed the survey. Majority of participants were affiliated with academic centers, and >20% managed more than 15 OAC-associated ICH patients/year. Proportion of respondents suggesting OAC anticoagulant resumption varied from 30% (for cerebral amyloid angiopathy) to 98% (for traumatic ICH). Within this group, there was wide distribution in response for timing of resumption: 21.4% preferred to re-start OACs after 1–3 weeks of incident ICH, while 25.3% opted to start after 1–3 months. Neurosurgery respondents preferred earlier OAC resumption compared to stroke neurologists or thrombosis experts in 5 scenarios (p<0.05 by Kendall’s tau).</p><p>Conclusions</p><p>Wide variations in current practice exist among management of OAC-associated ICH, with decisions influenced by patient- and provider-related factors. As these variations likely reflect the lack of high quality evidence, randomized trials are direly needed in this population.</p></div

Photodynamic Therapy (PDT) in Prosthodontics: Disinfection of Human Teeth Exposed to <i>Streptococcus mutans</i> and the Effect on the Adhesion of Full Ceramic Veneers, Crowns, and Inlays: An In Vitro Study

The use of PDT in prosthodontics as a disinfection protocol can eradicate bacteria from tooth surfaces by causing the death of the microorganisms to which the photosensitizer binds, absorbing the energy of laser light during irradiation. The aim of the study was to investigate the capacity of PDT to increase the bond strength of full ceramic restorations. In this study, 45 extracted human teeth were prepared for veneers, crowns, and inlays and contaminated with Streptococcus mutans. Tooth surfaces decontamination was performed using a diode laser and methylene blue as a photosensitizer. The disinfection effect and the impact on tensile bond strength were evaluated by scanning electron microscopy (SEM) and pull-out tests of the cemented ceramic prosthesis. Results show that the number of bacteria was reduced from colonized prepared tooth surfaces, and the bond strength was increased when PDT was used. In conclusion, the present study indicates that using PDT as a protocol before the final adhesive cementation of ceramic restorations could be a promising approach, with outstanding advantages over conventional methods

Comparative In Vitro Studies on the Effect of Bleaching Agents on Dental Structures in Healthy and Predialysis Patients

(1) Background: What is the effect of 16% and 40% concentration bleaching agents on dental structures in healthy patients compared to predialysis patients? (2) Methods: Forty teeth were included in the study (20 from healthy patients and 20 from predialysis patients). Each group was randomly divided into another two subgroups (n-10), depending on the bleaching agent concentration (16% and 40% gels). Color parameters were registered before and after the whitening process using a spectrophotometer. To determine enamel ultramicroscopic modifications, SEM and AFM analysis were performed before and after bleaching. (3) Results: An increasing trend was identified in the average values of ∆E and ∆L within the groups of predialysis teeth between teeth whitened with 40% concentration gel and those whitened with 16% concentration gel, while for the enamel samples from healthy patients the trend was reversed. The average values for roughness in the case of the two bleaching agents in healthy and predialysis teeth presented statistically significant differences (p &lt; 0.05). (4) Conclusions: The effects of bleaching agents are less significant on teeth from predialysis compared to healthy patients. A direct link exists in terms of the clinical effect between the concentration of the whitening gel and color modifications

Physico-Antibacterial Feature and SEM Morphology of Bio-Hydraulic Lime Mortars Incorporating Nano-Graphene Oxide and Binary Combination of Nano-Graphene Oxide with Nano Silver, Fly Ash, Zinc, and Titanium Powders

The study evaluated the impact of graphene powders used as additives in the recipe of the experimental lime mortar to a mixture ratio of 1:2.5 of NHL3.5 hydraulic lime:fine sand. The content of binder, aggregate and water was kept constant, varying only the amount and the type of the added additives in relation to the amount of natural hydraulic lime NHL3.5. The following five types of experimental mortars were prepared as follows: reference mortar (without additive); mortars containing 1 wt.% GO and 5 wt.% GO powder; mortar with the following GO powders mixture: GO powder functionalized with silver nanoparticles and with fly ash (GO-Ag + GO-fly ash); mortar with the following GO powders mixture: GO with zinc oxide and with titanium oxide (GO-ZnO + GO-TiO2). The influence of the GO-based additive addition on the porosity, surface microstructure, and water sorption coefficient of the mortar samples was evaluated. The antibacterial effect of the mortar samples against three bacterial strains was also investigated. The best results were obtained for the experimental mortar containing GO-ZnO -TiO2, which showed improved experimental properties that potentially allow its use for the rehabilitation of heritage buildings

Choice of anticoagulant for re-initiation across thrombosis experts, stroke neurologists and neurosurgeons.

<p>Choice of anticoagulant for re-initiation across thrombosis experts, stroke neurologists and neurosurgeons.</p

Demographic characteristics of survey respondents.

<p>Demographic characteristics of survey respondents.</p

Rates of neuro-imaging utilization for risk stratification among patients with anticoagulant-associated ICH across specialties.

<p>Intracranial vessel imaging includes CT angiography, MR angiography or Digital Subtraction Angiography.</p

Specialty-specific variation in oral anticoagulant re-initiation following intracranial hemorrhage.

<p>Specialty-specific variation in oral anticoagulant re-initiation following intracranial hemorrhage.</p