Predictors and indicators of disability and quality of life 4 years after a severe traumatic brain injury. A Structural Equation Modelling analysis from the PariS-TBI study

ObjectiveTo assess the predictors and indicators of disability and quality of life four years after a severe traumatic brain injury (TBI), using a Structural Equation Modelling (SEM). SEM is a multivariate approach permitting to take into account the complex inter-relationships between individual predictors, in order to disentangle factors which have a direct or indirect relationship with the dependant variable.MethodsThe Paris-TBI study is a longitudinal inception cohort study of 504 patients with severe TBI in the Parisian area [1]. Among 245 survivors, 147 patients were assessed four years post-injury. Two outcome measures were analysed separately using SEM: the Glasgow Outcome Scale-extended (GOS-E) [2], which is a global measure of disability after TBI, and the QOLIBRI, a disease-specific measure of quality of life after TBI [3]. Four groups of variable were entered in the model: demographics; injury severity; psychological and cognitive impairments; somatic impairments.ResultsThe GOS-E was directly significantly related to all four groups of variables (age, gender, severity of injury, psycho-cognitive and somatic impairments). Education duration had an indirect effect, mediated by psycho-cognitive impairments. In contrast, the QOLIBRI was only directly predicted by psycho-cognitive impairments. Age and somatic impairments had an indirect influence on the QOLIBRI, via psycho-cognitive impairments.Discussion/ConclusionDisability and quality of life were directly influenced by different factors. While disability appeared to result from an interaction of a wide range of factors, including demographics, injury severity, psycho-cognitive and somatic deficiencies, quality of life was solely directly related to psycho-cognitive factors. Other factors, such as age and somatic impairments only had an indirect effect

Botulinum toxin and refractory non-neurogenic overactive detrusor

AbstractPurposeTo study the value and efficacy of botulinum toxin for treatment of cases of non-neurogenic detrusor overactivity (NNDO) that are refractory to anticholinergic drugs.Materials and methodsA systematic review of the literature, based on a keyword search of the Medline database. Selection of articles in French and English (meta-analyses, reviews, case studies and randomized, controlled clinical trials) on intradetrusor botulinum toxin injection in the management of refractory NNDO.ResultsNineteen publications (including three randomized, controlled trials) were selected. Intradetrusor injection of botulinum toxin in patients with refractory NNDO has produced promising results, with a significant improvement in physical symptoms, urodynamic parameters and quality of life. The rare side effects consist primarily of dose-dependent urine retention.ConclusionOn the basis of preliminary data, botulinum toxin appears to be a valuable therapeutic option and fills the gap between anticholinergics and surgery in the treatment of NNDO that is refractory to anticholinergic agents. Botulinum toxin has a promising future in urology but requires further scientific evaluation

SoK: Consensus in the Age of Blockchains

The core technical component of blockchains is consensus: how to reach agreement among a distributed network of nodes. A plethora of blockchain consensus protocols have been proposed---ranging from new designs, to novel modifications and extensions of consensus protocols from the classical distributed systems literature. The inherent complexity of consensus protocols and their rapid and dramatic evolution makes it hard to contextualize the design landscape. We address this challenge by conducting a systematization of knowledge of blockchain consensus protocols. After first discussing key themes in classical consensus protocols, we describe: (i) protocols based on proof-of-work; (ii) proof-of-X protocols that replace proof-of-work with more energy-efficient alternatives; and (iii) hybrid protocols that are compositions or variations of classical consensus protocols. This survey is guided by a systematization framework we develop, to highlight the various building blocks of blockchain consensus design, along with a discussion on their security and performance properties. We identify research gaps and insights for the community to consider in future research endeavours

Physical and rehabilitation medicine (PRM) care pathways: Adults with severe traumatic brain injury

AbstractThis document is part of a series of guidelines documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These reference documents focus on a particular pathology (here patients with severe TBI). They describe for each given pathology patients’ clinical and social needs, PRM care objectives and necessary human and material resources of the pathology-dedicated pathway. ‘Care pathways in PRM’ is therefore a short document designed to enable readers (physician, decision-maker, administrator, lawyer, finance manager) to have a global understanding of available therapeutic care structures, organization and economic needs for patients’ optimal care and follow-up. After a severe traumatic brain injury, patients might be divided into three categories according to impairment's severity, to early outcomes in the intensive care unit and to functional prognosis. Each category is considered in line with six identical parameters used in the International Classification of Functioning, Disability and Health (World Health Organization), focusing thereafter on personal and environmental factors liable to affect the patients’ needs

Pharmacological therapies in post stroke recovery: Recommendations for future clinical trials

Stroke is a leading cause of serious long-term disability in adults and is the second leading cause of death worldwide. Early reperfusion and neuroprotection techniques have been the focus of much effort with the aim of very acute treatment of the stroke. Targeting different mechanisms, pharmacological therapies have the potential to reduce disability in a large fraction of patients who survive the acute stroke. The brain's capacity to reorganize after stroke through plasticity mechanisms can be modulated by pharmacological agents. A number of therapeutic interventions are under study, including small molecules, growth factors, and monoclonal antibodies. Recently it has been shown that the SSRI fluoxetine improved motor deficit in patients with ischaemic stroke and hemiplegia which appeared to be independent of the presence of depression. In this context, it is of major importance to support innovative research in order to promote the emergence of new pharmacological treatments targeting neurological recovery after stroke, as opposed to acute de-occlusion and neuroprotection. This paper is the work of a group of 14 scientists with aim of (1) addressing key areas of the basic and clinical aspects of human brain plasticity after stroke and potential pharmacological targets for recovery, (2) asking questions about the most appropriate characteristics of clinical trials testing drugs in post stroke recovery and (3) proposing recommendations for future clinical trials. © 2013 Springer-Verlag Berlin Heidelberg

Visual neglect in posterior cortical atrophy

In posterior cortical atrophy (PCA), there is a progressive impairment of high-level visual functions and parietal damage, which might predict the occurrence of visual neglect. However, neglect may pass undetected if not assessed with specific tests, and might therefore be underestimated in PCA. In this prospective study, we aimed at establishing the side, the frequency and the severity of visual neglect, visual extinction, and primary visual field defects in an unselected sample of PCA patients