Long-Term Effect of Mechanical Thrombectomy in Stroke Patients According to Advanced Imaging Characteristics.

PURPOSE Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters. METHODS We performed a single-centre retrospective cohort study of stroke patients receiving MT between January 1, 2010 and December 31, 2018. We assessed baseline imaging to determine core and mismatch volumes and hypoperfusion intensity ratio (with low ratio reflecting good collateral status) using RAPID automated post-processing software. Main outcomes were cross-sectional long-term mortality, functional outcome and quality of life by May 2020. Analysis were stratified by the final reperfusion status. RESULTS In total 519 patients were included of whom 288 (55.5%) have deceased at follow-up (median follow-up time 28 months, interquartile range 1-55). Successful reperfusion was associated with lower long-term mortality in patients with ischemic core volumes ≥ 70 ml (adjusted hazard ratio (aHR) 0.20; 95% confidence interval (95% CI) 0.10-0.44) and ≥ 100 ml (aHR 0.26; 95% CI 0.08-0.87). The effect of successful reperfusion on long-term mortality was significant only in the presence of relevant mismatch (aHR 0.17; 95% CI 0.01-0.44). Increasing reperfusion grade was associated with a higher rate of favorable outcomes (mRS 0-3) also in patients with ischemic core volume ≥ 70 ml (aOR 3.58, 95% CI 1.64-7.83). CONCLUSION Our study demonstrated a sustainable benefit of better reperfusion status in patients with large ischemic core volumes. Our results suggest that patient deselection based on large ischemic cores alone is not advisable

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Background and aimIdentification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.MethodsSVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.ResultsOf the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45–6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73–13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54–2.11).ConclusionThe absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care

Interdisciplinary and transdisciplinary research: Finding the common ground of multi-faceted concepts

Inter- and transdisciplinarity are increasingly relevant concepts and practices within academia. While various definitions exist, a clear distinction between inter- and transdisciplinarity remains difficult. Although there is a wide consensus about the need to define and apply these approaches, there is no agreement over definitions. Building on data collected during the first year of the COST Action TD1408 “Interdisciplinarity in research programming and funding cycles” (INTREPID), this paper describes both tensions and common ground about the characteristics and building blocks of interand trans-disciplinarity. Drawing on empirical data from participatory workshops involving INTREPID network members coming from 27 different countries, the paper shows that diverse definitions of inter and trans-disciplinarity coexist within scientific literature and in the mind of researchers and practitioners. The understanding about the involvement of actors outside of academia also differs widely across scientific communities irrespective of disciplinary training or the research subjects. The focus should be on the knowledge that is required to deal with a specific problem, rather than discussing “if” and “how” to integrate actors outside the academia, and collaboration should start with joint problem framing. This diversity is, however, not an absolute obstacle to practice, since the latter is made possible through building blocks such as knowledge domains, problem- and solution- oriented approaches, common goals, as well as target knowledge. In order to move towards more effective inter- and transdisciplinary research, we identify the need for trained interdisciplinarity facilitators and ‘accompanying research’ (derived from the Danish term ‘følgeforskning’). These two roles can be essential to inter- and transdisciplinarity practices including the promotion of reflexivity

Actor Analysis in Case Studies for (regional) Sustainable Development

V záležitostech (udržitelného) rozvoje je třeba věnovat zvláštní pozornost situaci a jevům na místní úrovni. Řešení problémů, jež zde vznikají v sociálně-environmentálních systémech, je tak třeba hledat a zkoumat v místních souvislostech. A pokud jsou právě na této úrovni snahy o studium a hledání řešení problémů v rovnováze, může to mít významný dopad na rozhodovací procesy a jejich výsledek pro místní komunity.Do procesů regionálního (udržitelného) rozvoje vstupují sociální aktéři, a jsou to oni, kdo mezi sebou interagují a nakonec též rozhodují. Procesy vzájemné interakce mohou být zkoumány z praktického hlediska, takže výsledek potom přispívá k udržitelným řešením, a vede například k pochopení toho, jak by měly být řízeny rozvojové procesy, jak nakládat s existujícími konflikty, nebo jak sdílet informace nezbytné pro tvorbu strategií.V tomto článku je představena metoda analýzy aktérů, a na případové studii z oblasti Krušných hor jsou pro ilustraci ukázány možnosti, jak ji využít v praxi. Kroky této metody, popsané v textu, mohou sloužit jako vodítko pro její uplatnění v praxi, ale uvedené případy též uvádějí spektrum možných sociálních interakcí, jimiž se lze zabývat, a představují způsoby, jimiž lze generovat nápady nebo praktická řešení.Specific local situations or phenomena pose specific challenges for regional (sustainable) development. These challenges require mostly local or regional solution paths for existing social-environmental systems that have to be investigated. Here the balance between studying and developing solution options can have a high impact on decision making and community choices.Processes of regional (sustainable) development are controlled by social players and these are the ones who finally decide and interact. These processes can be investigated with practical relevance in order to contribute (information) for sustainable solutions, for examples how to steer regional development processes, how to solve existing conflicts and to deliver information for strategy development.In this article, the method actor analysis is introduced and different options for implementation in practice are provided by using a case study conducted in the Ore Mountains as illustration. The described steps of an actor analysis can be read as guideline for implementing an analysis, but also the examples given are intended to show the potential and different options which aspects of social interactions could be in focus of investigation and how ideas or solutions with practical relevance can be generated

Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage

OBJECT Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs as part of the WFNS Grade V definition. The authors therefore reevaluated the WFNS scale by using "positive" clinical signs and the logic of the Glasgow Coma Scale as a progressive herniation score. METHODS The authors performed a retrospective analysis of 182 patients with SAH who had poor grades on the WFNS scale. Patients were graded according to the original WFNS scale and additionally according to a modified classification, the WFNS herniation (hWFNS) scale (Grade IV, no clinical signs of herniation; Grade V, clinical signs of herniation). The prediction of poor outcome was compared between these two grading systems. RESULTS The positive predictive values of Grade V for poor outcome were 74.3% (OR 3.79, 95% CI 1.94-7.54) for WFNS Grade V and 85.7% (OR 8.27, 95% CI 3.78-19.47) for hWFNS Grade V. With respect to mortality, the positive predictive values were 68.3% (OR 3.9, 95% CI 2.01-7.69) for WFNS Grade V and 77.9% (OR 6.22, 95% CI 3.07-13.14) for hWFNS Grade V. CONCLUSIONS Limiting WFNS Grade V to the positive clinical signs of the Glasgow Coma Scale such as flexion, extension, and pupillary abnormalities instead of including "no motor response" increases the prediction of mortality and poor outcome in patients with severe SAH

Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage.

OBJECT Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs as part of the WFNS Grade V definition. The authors therefore reevaluated the WFNS scale by using "positive" clinical signs and the logic of the Glasgow Coma Scale as a progressive herniation score. METHODS The authors performed a retrospective analysis of 182 patients with SAH who had poor grades on the WFNS scale. Patients were graded according to the original WFNS scale and additionally according to a modified classification, the WFNS herniation (hWFNS) scale (Grade IV, no clinical signs of herniation; Grade V, clinical signs of herniation). The prediction of poor outcome was compared between these two grading systems. RESULTS The positive predictive values of Grade V for poor outcome were 74.3% (OR 3.79, 95% CI 1.94-7.54) for WFNS Grade V and 85.7% (OR 8.27, 95% CI 3.78-19.47) for hWFNS Grade V. With respect to mortality, the positive predictive values were 68.3% (OR 3.9, 95% CI 2.01-7.69) for WFNS Grade V and 77.9% (OR 6.22, 95% CI 3.07-13.14) for hWFNS Grade V. CONCLUSIONS Limiting WFNS Grade V to the positive clinical signs of the Glasgow Coma Scale such as flexion, extension, and pupillary abnormalities instead of including "no motor response" increases the prediction of mortality and poor outcome in patients with severe SAH

Nuclear accidents call for transdisciplinary nuclear energy research

The consequences of nuclear accidents touch many aspects of society, and thus lead to challenges for multiple actors across spatial and temporal scales. Here, we highlight unused potential of communication, collaboration and knowledge co-production for response after nuclear accidents. This potential can be harnessed by a transdisciplinary research approach including all relevant actors on a regional scale such as nuclear industry, government officials, civil society and scientific researchers. Transdisciplinary research approaches on regional scale could enhance implementation of proper mid- and long-term remediation measures and build capacity to cope up with the impacts after nuclear accidents

Data_Sheet_1_Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke.docx

Background and aimIdentification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.MethodsSVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.ResultsOf the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45–6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73–13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54–2.11).ConclusionThe absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.</p