Small-world characteristics of EEG patterns in post-anoxic encephalopathy

Post-anoxic encephalopathy (PAE) has a heterogenous outcome which is difficult to predict. At present, it is possible to predict poor outcome using somatosensory evoked potentials in only a minority of the patients at an early stage. In addition, it remains difficult to predict good outcome at an early stage. Network architecture, as can be quantified with continuous electroencephalography (cEEG), may serve as a candidate measure for predicting neurological outcome. Here, we explore whether cEEG monitoring can be used to detect the integrity of neural network architecture in patients with PAE after cardiac arrest. From 56 patients with PAE treated with mild therapeutic hypothermia, 19-channel cEEG data were recorded starting as soon as possible after cardiac arrest. Adjacency matrices of shared frequencies between 1 and 25Hz of the EEG channels were obtained using Fourier transformations. Number of network nodes and connections, clustering coefficient (C), average path length (L), and small-world index (SWI) were derived. Outcome was quantified by the best cerebral performance category (CPC)-score within 6months. Compared to non-survivors, survivors showed significantly more nodes and connections. L was significantly higher and C and SWI were significantly lower in the survivor group than in the non-survivor group. The number of nodes, connections, and the L were negatively correlated with the CPC-score. C and SWI correlated positively with the CPC-score. The combination of number of nodes, connections, C, and L showed the most significant difference and correlation between survivors and non-survivors and CPC-score. Our data might implicate that non-survivors have insufficient distribution and differentiation of neural activity for regaining normal brain function. These network differences, already present during hypothermia, might be further developed as early prognostic markers. The predictive values are however still inferior to current practice parameters. Keywords: small-world network, continuous EEG, post-anoxic encephalopathy, prognosis, resuscitatio

COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD

BACKGROUND: We developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score. METHODS: In our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed. RESULTS: Eighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach's apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001). CONCLUSIONS: c-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD. TRIAL REGISTRATION NUMBER: NCT01232140

Clinical Trial Strategies to Compare Protons With Photons

The favorable beam properties of protons can be translated into clinical benefits by target dose escalation to improve local control without enhancing unacceptable radiation toxicity or to spare normal tissues to prevent radiation-induced side effects without jeopardizing local tumor control. For the clinical validation of the added value of protons to improve local control, randomized controlled trials are required. For the clinical validation of the added value of protons to prevent side effects, both model-based validation or randomized controlled trials can be used. Model-based patient selection for proton therapy is crucial, independent of the validation approach. Combining these approaches in rapid learning health care systems is expected to yield the most efficient and scientifically sound way to continuously improve patient selection and the therapeutic window, eventually leading to more cancer survivors with better quality of life. (C) 2018 The Authors. Published by Elsevier Inc

National Protocol for Model-Based Selection for Proton Therapy in Head and Neck Cancer

In the Netherlands, the model-based approach is used to identify patients with head and neck cancer who may benefit most from proton therapy in terms of prevention of late radiation-induced side effects in comparison with photon therapy. To this purpose, a National Indication Protocol Proton therapy for Head and Neck Cancer patients (NIPP-HNC) was developed, which has been approved by the health care authorities. When patients qualify according to the guidelines of the NIPP-HNC, proton therapy is fully reimbursed. This article describes the procedures that were followed to develop this NIPP-HNC and provides all necessary information to introduce model-based selection for patients with head and neck cancer into routine clinical practice.</p

Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial

Aims: Our objectives were to compare effectiveness and long-term prognosis after epicardial thoracoscopic atrial fibrillation (AF) ablation vs. endocardial catheter ablation, in patients with prior failed catheter ablation or high risk of failure. Methods and results: Patients were randomized to thoracoscopic or catheter ablation, consisting of pulmonary vein isolation with optional additional lines (2007–2010). Patients were reassessed in 2016/2017, and those without documented AF recurrence underwent 7-day ambulatory electrocardiography. The primary rhythm outcome was recurrence of any atrial arrhythmia lasting >30 s. The primary clinical endpoint was a composite of death, myocardial infarction, or cerebrovascular event, analysed with adjusted Cox proportional hazard ratios (HRs). One hundred and 24 patients were randomized with 34% persistent AF and mean age 56 years. Arrhythmia recurrence was common at mean follow-up of 7.0 years, but substantially lower with thoracoscopic ablation: 34/61 (56%) compared with 55/63 (87%) with catheter ablation [adjusted HR 0.40, 95% confidence interval (CI) 0.25–0.64; P < 0.001]. Additional ablation procedures were performed in 8 patients (13%) compared with 31 (49%), respectively (P < 0.001). Eleven patients (19%) were on anti-arrhythmic drugs at end of follow-up with thoracoscopy vs. 24 (39%) with catheter ablation (P = 0.012). There was no difference in the composite clinical outcome: 9 patients (15%) in the thoracoscopy arm vs. 10 patients (16%) with catheter ablation (HR 1.11, 95% CI 0.40–3.10; P = 0.84). Pacemaker implantation was required in 6 patients (10%) undergoing thoracoscopy and 3 (5%) in the catheter group (P = 0.27). Conclusion: Thoracoscopic AF ablation demonstrated more consistent maintenance of sinus rhythm than catheter ablation, with similar long-term clinical event rates

Navigieren

Prof. Dr. Jens Schröter, Christoph Borbach, Max Kanderske und Prof. Dr. Benjamin Beil sind Herausgeber der Reihe. Die Herausgeber*innen der einzelnen Hefte sind renommierte Wissenschaftler*innen aus dem In- und Ausland.Navigieren ist längst kein Unikum professionalisierter Seefahrer:innen mehr, sondern als Smartphone- und Browser-Praktik fester Bestandteil des vernetzten digitalen Alltags. Da Wegfindungen durch On- und Offline-Räume navigationsspezifische Formen von Medienkompetenz voraussetzen und hervorbringen, fordern sie die Intensivierung der medienkulturwissenschaftlichen Beschäftigung mit den situierten und technisierten Medienpraktiken der Navigation geradezu heraus. Die Ausgabe nimmt diesen Befund zum Anlass, polyperspektivische Zugänge zum »Navigieren« vorzustellen. Die körper-, kultur- und medientechnischen Facetten des Navigierens stehen dabei ebenso im Fokus wie ihre historischen Ausgestaltungen, die Arbeit am und im Datenmaterial von Navigationsmedien und die Theoretisierung postdigitaler Sensor-Medien-Kulturen, die dem Umstand Rechnung trägt, dass es nicht allein Daten, Dinge und Körper sind, die es zu navigieren gilt, sondern zunehmend nicht-menschliche Akteure selbst zielgerichtete Raumdurchquerungen praktizieren. Fehlte es in der (deutschsprachigen) Medienkulturwissenschaft bislang an einer Bündelung heterogener navigationsspezifischer Forschungsarbeiten, gibt diese Ausgabe einen Überblick über das Feld, seine Forscher:innen und Fragestellungen. Denn trotz des Spatial Turns in den Humanities und der gegenwärtigen Konjunktur geomedialer Arbeiten, scheint die synthetisierende Fokussierung auf Medien und Praktiken des Navigierens in historischer, ethnografischer, technischer und theoretischer Perspektive bislang ein Desiderat darzustellen.Navigation is no longer unique to the context of professional seafaring, but has become an integral part of networked digital everyday life enabled through smartphones and web browsers. Indeed, finding one’s way through online and offline spaces increasingly presupposes and produces specific forms of media competence one could call »navigational«. In this, a ›media cultural studies‹ perspective on the situated and ›technologized‹ media practices of navigation becomes imperative to understanding the contemporary media landscape. Issue 1/22 of Navigationen answers this call by presenting polyperspectival approaches to »navigating«. The contributions discuss the bodily, cultural, and media-technical facets of navigation, as well as its historical forms, the work on and in the data produced by and with navigational media, and the theorization of post-digital ›sensor media cultures‹. In doing so, the issue acknowledges that not only do data, things, and bodies need to be ›navigated‹ in the context of logistics, but that the increasingly autonomous wayfinding processes of non-human actors change the notion of navigation itself. As (German language) media cultural studies has so far lacked a convincing compilation of heterogeneous approaches to studying navigation, this issue provides an overview of the field, its researchers and questions. Despite the spatial turn in the humanities and a recent surge in geomedia studies, an approach towards the media and practices of navigation that combines historical, ethnographic, technical and theoretical perspectives, has remained a desideratum until now. The issue fills this gap