Udruženost višestrukih moždanih aneurizma i moždane arteriovenske malformacije: prikaz slučaja i pregled literature

The incidence of aneurysmal subarachnoid hemorrhage is about 10-11 cases per 100,000 inhabitants. The true incidence of multiple aneurysms is not known, however, according to previous studies it may vary between 20% and 30%. The association of arteriovenous malformation and cerebral aneurysm is well documented and varies between 20% and 30%. A case is described of a 47-year-old female presenting with massive acute subarachnoid hemorrhage. Computed tomography and cerebral panangiography revealed seven saccular aneurysms (five along the left anterior cerebral artery and its branches, one at the left M1/2 junction, and one in the anterior communicating artery), and an arteriovenous malformation involving the left frontal and parietal lobe fed mostly by the left anterior cerebral artery. Neurosurgeons clipped all seven aneurysms and then the arteriovenous malformation was extirpated.Incidencija aneurizmatskog subarahnoidnog krvarenja iznosi oko 10-11 slučajeva na 100.000 stanovnika. Stvarna incidencija višestrukih aneurizma nije poznata, no prema prethodnim ispitivanjima ona bi se mogla kretati između 20% i 30%. Udruženost arteriovenske malformacije i moždane aneurizme dobro je dokumentirana i kreće se između 20% i 30%. Autori izvješćuju o slučaju 47-godišnje žene koja je dola s opsežnim akutnim subarahnoidnim krvarenjem. Kompjutorizirana tomografija i cerebralna panangiografija otkrile su sedam sakularnih aneurizma (pet duž lijeve prednje moždane arterije i njezinih ogranaka, jednu na lijevom spoju M1/2 i jednu u prednjoj komunikacijskoj arteriji) i arteriovensku malformaciju koja je zahvaćala lijevi frontalni i parijetalni režanj koji se uglavnom opskrbljuje putem lijeve prednje moždane arterije. Neurokirurzi su štipaljkama učvrstili svih sedam aneurizama, nakon čega je uklonjena arteriovenska malformacija

Peak systolic velocity ratio for evaluation of internal carotid artery stenosis correlated with plaque morphology: substudy results of the ANTIQUE study

BackgroundAccurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA.MethodsConsecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman’s correlation and Kendall’s rank correlation were used to evaluate the results.ResultsA total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman’s correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (r = 0.238), whereas EDV showed a higher correlation (r = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (r = 0.677), while the PSVICA/ICA ratio showed the highest correlation in stenoses with irregular (r = 0.373) or ulcerated (r = 0.382) surfaces, as well as lipid (r = 0.406), fibrous (r = 0.461), and mixed (r = 0.403; p < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (p > 0.05 in all cases).ConclusionPSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy

Short‐term fully closed‐loop insulin delivery using faster insulin aspart compared to standard insulin aspart in type 2 diabetes

We evaluated the efficacy and safety of short‐term fully closed‐loop insulin delivery using faster versus standard insulin aspart in type 2 diabetes. Fifteen adults with insulin‐treated type 2 diabetes underwent 22 hours of closed‐loop insulin delivery with either faster or standard insulin aspart in a double‐blind randomised crossover design. Basal‐bolus regimen was replaced by model predictive control algorithm‐directed insulin delivery based on sensor glucose levels. The primary outcome was time with plasma glucose in target range (5.6‐10.0mmol/l) and did not differ between treatments (mean difference [95%CI] ‐3.3% [8.2;1.7], p=0.17). Mean glucose and glucose variability were comparable, as was time spent below and above target range. Hypoglycaemia (<3.5mmol/l) occurred once with faster insulin aspart and twice with standard insulin aspart. Mean total insulin dose was higher with faster insulin aspart (mean difference [95%CI] 3.7U [0.7;6.8], p=0.021). No episodes of severe hypoglycaemia or other serious adverse events occurred. In conclusion, short‐term fully closed‐loop in type 2 diabetes may require higher dose of faster insulin aspart compared to standard insulin aspart to achieve comparable glucose control.Swiss National Science Foundation (P1BEP3_165297), UDEM Scientific Fund, Cambridge Biomedical Research Centre - NIHR

WSMO-Lite and hRESTS: lightweight semantic annotations for Web services and RESTful APIs

Service-oriented computing has brought special attention to service description, especially in connection with semantic technologies. The expected proliferation of publicly accessible services can benefit greatly from tool support and automation, both of which are the focus of Semantic Web Service (SWS) frameworks that especially address service discovery, composition and execution. As the first SWS standard, in 2007 the World Wide Web Consortium produced a lightweight bottom-up specification called SAWSDL for adding semantic annotations to WSDL service descriptions. Building on SAWSDL, this article presents WSMO-Lite, a lightweight ontology of Web service semantics that distinguishes four semantic aspects of services: function, behavior, information model, and nonfunctional properties, which together form a basis for semantic automation. With the WSMO-Lite ontology, SAWSDL descriptions enable semantic automation beyond simple input/output matchmaking that is supported by SAWSDL itself. Further, to broaden the reach of WSMO-Lite and SAWSDL tools to the increasingly common RESTful services, the article adds hRESTS and MicroWSMO, two HTML microformats that mirror WSDL and SAWSDL in the documentation of RESTful services, enabling combining RESTful services with WSDL-based ones in a single semantic framework. To demonstrate the feasibility and versatility of this approach, the article presents common algorithms for Web service discovery and composition adapted to WSMO-Lite

همبستگی عزت نفس با پیشرفت تحصیلی در دانشجویان دانشکده‌ی پرستاری و مامایی زنجان 1388

زمینه و هدف: یکی از بزرگترین معضلات آموزشی، افت تحصیلی دانشجویان است. بنابراین توجه به بهداشت روانی و پیشرفت تحصیلی این گروه اهمیت به‌سزایی دارد. پاره‌ای از مطالعات بیانگر ارتباط مستقیم بین عزت نفس و پیشرفت تحصیلی است، لیکن بعضی از صاحب نظران رابطه‌ی مستقیم این دو را مورد تردید قرار داده‌اند. این پژوهش با هدف تعیین همبستگی عزت نفس با پیشرفت تحصیلی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان انجام شده است. روش بررسی: این پژوهش یک مطالعه‌ی همبستگی بود، کلیه‌ی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان که حداقل دو نیم‌سال سابقه‌ی تحصیلی داشتند، (182 نفر) در مطالعه شرکت کردند. ابزار جمع‌آوری اطلاعات پرسش‌نامه بود. پرسش‌نامه از دو بخش شامل: ویژگی‌های فردی و تحصیلی واحدهای پژوهش و آزمون 58 سوالی عزت نفس کوپراسمیت تشکیل شده بود. یافته‌ها: ضریب همبستگی پیرسون رابطه‌ی معنی‌داری بین عزت نفس و پیشرفت تحصیلی دانشجویان نشان داد (31/0= r ). ولی عزت نفس با سن و جنسیت ارتباط آماری معنی‌داری نداشت (05/0 P ). نتیجه‌گیری: با توجه به وجود همبستگی مثبت بین عزت نفس و پیشرفت تحصیلی دانشجویان، به نظر می‌رسد استفاده از روش‌های تقویت عزت نفس می‌تواند در جلوگیری از افت تحصیلی دانشجویان نقش داشته باشد

Mechanical recanalization in ischemic anterior circulation stroke within an 8-hour time window: a real-world experience

PURPOSE:We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6–8 h/unknown onset time, as only limited data are available for a time window beyond 6 h.METHODS:Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time. All patients underwent unenhanced computed tomography (CT) of the brain, CT angiography of the cervical and intracranial arteries and digital subtraction angiography. Perfusion CT was performed in patients beyond a 6-hour time window/with unknown onset time. We collected the following data: baseline characteristics, presence of risk factors, neurologic deficit at the time of treatment, time to therapy, recanalization rate, and 3-month clinical outcome. Successful recanalization was defined as Thrombolysis in Cerebral Infarction score of 2b/3 and good clinical outcome as modified Rankin scale value of 0–2 points.RESULTS:Successful recanalization was achieved in 82 patients (74.5%): in 61 patients treated within 6 h (73.5%), 7 patients treated within 6–8 h (63.6%), and 13 patients with unknown onset time (81.3%). Good 3-month clinical outcome was achieved in 61 patients (55.5%): in 46 patients treated within 6 h (55.4%), 5 patients treated within 6–8 h (45.5%), and 10 patients with unknown onset time (62.5%). Recanalization success or clinical outcome were not significantly different between patients treated at different time windows.CONCLUSION:Our data confirms the safety and effectiveness of mechanical recanalization performed in carefully selected patients with ischemic stroke in the anterior circulation within 8 h of stroke onset or with unknown onset time in everyday practice

Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomized crossover trial

Funder: CB was supported by a grant from The Novo Nordisk UK Research FoundationFunder: LB was supported by a grant of the Swiss Society for Endocrinology and a grant of the Diabetes and Swiss Kidney Foundation.Funder: Supported by National Institute for Health Research Cambridge Biomedical Research Centre.Abstract: We evaluated the safety and efficacy of fully closed-loop insulin therapy compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis. In an open-label, multinational, two-center, randomized crossover trial, 26 adults with type 2 diabetes requiring dialysis (17 men, 9 women, average age 68 ± 11 years (mean ± s.d.), diabetes duration of 20 ± 10 years) underwent two 20-day periods of unrestricted living, comparing the Cambridge fully closed-loop system using faster insulin aspart (‘closed-loop’) with standard insulin therapy and a masked continuous glucose monitor (‘control’) in random order. The primary endpoint was time in target glucose range (5.6–10.0 mmol l−1). Thirteen participants received closed-loop first and thirteen received control therapy first. The proportion of time in target glucose range (5.6–10.0 mmol l−1; primary endpoint) was 52.8 ± 12.5% with closed-loop versus 37.7 ± 20.5% with control; mean difference, 15.1 percentage points (95% CI 8.0–22.2; P < 0.001). Mean glucose was lower with closed-loop than control (10.1 ± 1.3 versus 11.6 ± 2.8 mmol l−1; P = 0.003). Time in hypoglycemia (<3.9 mmol l−1) was reduced with closed-loop versus control (median (IQR) 0.1 (0.0–0.4%) versus 0.2 (0.0–0.9%); P = 0.040). No severe hypoglycemia events occurred during the control period, whereas one severe hypoglycemic event occurred during the closed-loop period, but not during closed-loop operation. Fully closed-loop improved glucose control and reduced hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis. The trial registration number is NCT04025775

Day‐to‐day variability of insulin requirements in the inpatient setting: Observations during fully closed‐loop insulin delivery

Funder: and the Swiss Diabetes FoundationAbstract: The aim of this study was to characterize the variability of exogenous insulin requirements during fully closed‐loop insulin delivery in hospitalized patients with type 2 diabetes or new‐onset hyperglycaemia, and to determine patient‐related characteristics associated with higher variability of insulin requirements. We retrospectively analysed data from two fully closed‐loop inpatient studies involving adults with type 2 diabetes or new‐onset hyperglycaemia requiring insulin therapy. The coefficient of variation quantified day‐to‐day variability of exogenous insulin requirements during up to 15 days using fully automated closed‐loop insulin delivery. Data from 535 days in 67 participants were analysed. The coefficient of variation of day‐to‐day exogenous insulin requirements was 30% ± 16%, and was higher between nights than between any daytime period (56% ± 29% overnight [11:00 pm to 4:59 am] compared with 41% ± 21% in the morning [5:00 am to 10:59 am], 39% ± 15% in the afternoon [11:00 am to 4:59 pm] and 45% ± 19% during the evening [5:00 pm to 10:59 pm]; all P < 0.01). There is high day‐to‐day variability of exogenous insulin requirements in inpatients, particularly overnight, and diabetes management approaches should account for this variability

Fully closed-loop insulin delivery in inpatients receiving nutritional support: a two-centre, open-label, randomised controlled trial.

BACKGROUND: Glucose management is challenging in patients who require nutritional support in hospital. We aimed to assess whether fully closed-loop insulin delivery would improve glycaemic control compared with conventional subcutaneous insulin therapy in inpatients receiving enteral or parenteral nutrition or both. METHODS: We did a two-centre (UK and Switzerland), open-label, randomised controlled trial in adult inpatients receiving enteral or parenteral nutrition (or both) who required subcutaneous insulin therapy. Patients recruited from non-critical care surgical and medical wards were randomly assigned (1:1) using a computer-generated minimisation schedule (stratified by type of nutritional support [parenteral nutrition on or off] and pre-study total daily insulin dose [<50 or ≥50 units]) to receive fully closed-loop insulin delivery with faster-acting insulin aspart (closed-loop group) or conventional subcutaneous insulin therapy (control group) given in accordance with local clinical practice. Continuous glucose monitoring in the control group was masked to patients, ward staff, and investigators. Patients were followed up for a maximum of 15 days or until hospital discharge. The primary endpoint was the proportion of time that sensor glucose concentration was in target range (5·6-10·0 mmol/L), assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01774565. FINDINGS: Between Feb 8, 2018, and Sept 21, 2018, 90 patients were assessed for eligibility, of whom 43 were enrolled and randomly assigned to the closed-loop group (n=21) or the control group (n=22). The proportion of time that sensor glucose was in the target range was 68·4% [SD 15·5] in the closed-loop group and 36·4% [26·6] in the control group (difference 32·0 percentage points [95% CI 18·5-45·5; p<0·0001]). One serious adverse event occurred in each group (one cardiac arrest in the control group and one episode of acute respiratory failure in the closed-loop group), both of which were unrelated to study interventions. There were no adverse events related to study interventions in either group. No episodes of severe hypoglycaemia or hyperglycaemia with ketonaemia occurred in either study group. INTERPRETATION: Closed-loop insulin delivery is an effective treatment option to improve glycaemic control in patients receiving nutritional support in hospital. FUNDING: Diabetes UK, Swiss National Science Foundation, National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust, and European Foundation for the Study of Diabetes

Hybrid closed‐loop glucose control with faster insulin aspart compared with standard insulin aspart in adults with type 1 diabetes: A double‐blind, multicentre, multinational, randomized, crossover study

Abstract: Aim: To evaluate the use of hybrid closed‐loop glucose control with faster‐acting insulin aspart (Fiasp) in adults with type 1 diabetes (T1D). Research Design and Methods: In a double‐blind, multinational, randomized, crossover study, 25 adults with T1D using insulin pump therapy (mean ± SD, age 38 ± 9 years, HbA1c 7.4% ± 0.8% [57 ± 8 mmol/mol]) underwent two 8‐week periods of unrestricted living comparing hybrid closed‐loop with Fiasp and hybrid closed‐loop with standard insulin aspart in random order. During both interventions the CamAPS FX closed‐loop system incorporating the Cambridge model predictive control algorithm was used. Results: In an intention‐to‐treat analysis, the proportion of time sensor glucose was in the target range (3.9–10.0 mmol/L; primary endpoint) was not different between interventions (75% ± 8% vs. 75% ± 8% for hybrid closed‐loop with Fiasp vs. hybrid closed‐loop with standard insulin aspart; mean‐adjusted difference −0.6% [95% CI −1.8% to 0.7%]; p < .001 for non‐inferiority [non‐inferiority margin 5%]). The proportion of time with sensor glucose less than 3.9 mmol/L (median [IQR] 2.4% [1.2%–3.2%] vs. 2.9% [1.7%–4.0%]; p = .01) and less than 3.0 mmol/L (median [IQR] 0.4% [0.2%–0.7%] vs. 0.7% [0.2%–0.9%]; p = .03) was reduced with Fiasp versus standard insulin aspart. There was no difference in mean glucose (8.1 ± 0.8 vs. 8.0 ± 0.8 mmol/L; p = .13) or glucose variability (SD of sensor glucose 2.9 ± 0.5 vs. 2.9 ± 0.5 mmol/L; p = .90). Total daily insulin requirements did not differ (49 ± 15 vs. 49 ± 15 units/day; p = .45). No severe hypoglycaemia or ketoacidosis occurred. Conclusions: The use of Fiasp in the CamAPS FX closed‐loop system may reduce hypoglycaemia without compromising glucose control compared with standard insulin aspart in adults with T1D