26 research outputs found
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations
Aus Buchwerkstatt und Bibliothek. Manuskriptkulturen des Mittelalters in Orient und Okzident
Handschriften, seien sie Produkte des europĂ€ischen Mittelalters oder des vormodernen islamischen Orients, bergen eine FĂŒlle von Informationen ĂŒber grundlegende kulturelle Praktiken der Alten Welt, die aber auch entschlĂŒsselt sein wollen. In den FĂ€chern, die sich am Zentrum fĂŒr Mittelalterstudien der UniversitĂ€t Bamberg beteiligen, hat die BeschĂ€ftigung mit Manuskripten ihren festen Platz. Unter dem Titel âManuskriptkulturen des Mittelaltersâ wurden im Rahmen der Ringvorlesung des Zentrums fĂŒr Mittelalterstudien an der UniversitĂ€t Bamberg im Sommersemester 2011 zehn VortrĂ€ge gehalten, die sich ganz verschiedenen Aspekten des Themas widmeten. Chronologisch umspannten die BeitrĂ€ge etwa ein Jahrtausend, geographisch sind sie zwischen dem Atlantik und dem Indischen Ozean angesiedelt. Die in den VortrĂ€gen behandelten Handschriften reprĂ€sentieren die verschiedensten Inhalte und literarischen Formen â vom Epos bis zur juristisch-religiösen Traditionssammlung. Dennoch zeigen sich ĂŒbergreifende Aspekte von Manuskriptkulturen, die sich im spezifischen Umgang mit den Texten und ihren Illustrationen, in den Anforderungen eines Layouts und grafischer Gestaltung niederschlagen. Diese wirkten sich bis weit in die Geschichte des gedruckten Buches aus. Der vorliegende Band enthĂ€lt sieben VortrĂ€ge der Ringvorlesung, die zum Teil wesentlich ĂŒberarbeitet wurden, sowie einen weiteren Beitrag, der aus einer Abschlussarbeit im Fach Iranistik hervorging
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations
Purpose: The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity. Methods: This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA. Results: 845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (p = 0.008). Conclusion: The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results
RA-MAP, molecular immunological landscapes in early rheumatoid arthritis and healthy vaccine recipients
Rheumatoid arthritis (RA) is a chronic inflammatory disorder with poorly defined aetiology characterised by synovial inflammation with variable disease severity and drug responsiveness. To investigate the peripheral blood immune cell landscape of early, drug naive RA, we performed comprehensive clinical and molecular profiling of 267 RA patients and 52 healthy vaccine recipients for up to 18 months to establish a high quality sample biobank including plasma, serum, peripheral blood cells, urine, genomic DNA, RNA from whole blood, lymphocyte and monocyte subsets. We have performed extensive multi-omic immune phenotyping, including genomic, metabolomic, proteomic, transcriptomic and autoantibody profiling. We anticipate that these detailed clinical and molecular data will serve as a fundamental resource offering insights into immune-mediated disease pathogenesis, progression and therapeutic response, ultimately contributing to the development and application of targeted therapies for RA.</p
Herpesvirus saimiriâtransformed macaque T cells are tolerated and do not cause lymphoma after autologous reinfusion
Characterising flow regime and interrelation between surface-water and ground-water in the Fuente de Piedra salt lake basin by means of stable isotopes, hydrogeochemical and hydraulic data
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations.
PURPOSE
The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) atâ>â24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity.
METHODS
This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recordedâ>â24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA.
RESULTS
845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP atâ>â24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (pâ=â0.008).
CONCLUSION
The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results
Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management
INTRODUCTION: A multimodal approach to prognostication of outcome after cardiac arrest (CA) is recommended. Evidence for combinations of methods is low. In this post-hoc analysis we described findings on head computed tomography (CT) after CA. We also examined whether generalised oedema on CT alone or together with the biomarker Neuron-specific enolase (NSE) could predict poor outcome.METHODS: Patients participating in the Target Temperature Management after out-of-hospital-cardiac-arrest-trial underwent CT based on clinical indications. Findings were divided into pre-specified categories according to local radiologists descriptions. Generalised oedema alone and in combination with peak NSE at either 48h or 72h was correlated with poor outcome at 6 months follow-up using the Cerebral Performance Category (CPC 3-5).RESULTS: 356/939 (37.9%) of patients underwent head CT. Initial CTâ€24h after CA was normal in 174/218 (79.8%), whilst generalised oedema was diagnosed in 21/218 (9.6%). Between days 1-7, generalised oedema was seen in 65/143 (45.5%), acute/subacute infarction in 27/143 (18.9%) and bleeding in 9/143 (6.3%). Overall, generalised oedema predicted poor outcome with 33.6% sensitivity (95%CI:28.1-39.5) and 98.4% specificity (95%CI:94.3-99.6), whilst peak NSE demonstrated sensitivities of 61.5-64.8% and specificity 95.7% (95%CI:89.5-98.4). The combination of peak NSE>38ng/l and generalised oedema on CT predicted poor outcome with 46.0% sensitivity (95%CI:36.5-55.8) with no false positives. NSE was significantly higher in patients with generalised oedema.CONCLUSION: In this study, generalised oedema was more common >24hâ€7d after CA. The combination of CT and NSE improved sensitivity and specificity compared to CT alone, with no false positives in this limited population