Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients

BackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome.ObjectiveThe aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed.MethodsForty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1–20 and 21–40 for the learning curve effect.ResultsThe trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1–20 and 21–40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1–20 and 21–40.ConclusionThe final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter)

A Novel Statistical Model for Predicting the Efficacy of Vagal Nerve Stimulation in Patients With Epilepsy (Pre-X-Stim) Is Applicable to Different EEG Systems

Background: Identifying patients with intractable epilepsy who would benefit from therapeutic chronic vagal nerve stimulation (VNS) preoperatively remains a major clinical challenge. We have developed a statistical model for predicting VNS efficacy using only routine preimplantation electroencephalogram (EEG) recorded with the TruScan EEG device (Brazdil et al., 2019). It remains to be seen, however, if this model can be applied in different clinical settings. Objective: To validate our model using EEG data acquired with a different recording system. Methods: We identified a validation cohort of eight patients implanted with VNS, whose preimplantation EEG was recorded on the BrainScope device and who underwent the EEG recording according to the protocol. The classifier developed in our earlier work, named Pre-X-Stim, was then employed to classify these patients as predicted responders or non-responders based on the dynamics in EEG power spectra. Predicted and real-world outcomes were compared to establish the applicability of this classifier. In total, two validation experiments were performed using two different validation approaches (single classifier or classifier voting). Results: The classifier achieved 75% accuracy, 67% sensitivity, and 100% specificity. Only two patients, both real-life responders, were classified incorrectly in both validation experiments. Conclusion: We have validated the Pre-X-Stim model on EEGs from a different recording system, which indicates its application under different technical conditions. Our approach, based on preoperative EEG, is easily applied and financially undemanding and presents great potential for real-world clinical use

Issues of accounting and control at nursery schools

This work deals with accounting nursery schools and the subsequent scrutiny. Also focuses on the importance and status of nursery schools in the network of schools and school facilities. Monitors who may be the founder and the resulting funding opportunities for nursery schools. Lists the various forms in which the nursery school set up in more detail and is concerned with the school legal entity. In the field of accounting is to focus mainly on property and its accounting procedures that are outlined in several examples. More detail is the work focuses on the cash and equity funds. To their accounting methods and the possibility of their use. Whereas the kindergarten are financed mainly from public funds, includes the work of a few details on how monitoring is carried out and who has the opportunity and obligation to carry out such checks

Issues of accounting and control at nursery schools

This work deals with accounting nursery schools and the subsequent scrutiny. Also focuses on the importance and status of nursery schools in the network of schools and school facilities. Monitors who may be the founder and the resulting funding opportunities for nursery schools. Lists the various forms in which the nursery school set up in more detail and is concerned with the school legal entity. In the field of accounting is to focus mainly on property and its accounting procedures that are outlined in several examples. More detail is the work focuses on the cash and equity funds. To their accounting methods and the possibility of their use. Whereas the kindergarten are financed mainly from public funds, includes the work of a few details on how monitoring is carried out and who has the opportunity and obligation to carry out such checks.Tato práce se zabývá účetnictvím mateřských škol a jeho následnou kontrolou. Zaměřuje se také na význam a postavení mateřských škol v soustavě škol a školských zařízení. Sleduje kdo může být zřizovatelem a z toho vyplývající možnosti financování mateřských škol. Uvádí jednotlivé formy v jakých se mateřské školy zřizují a podrobněji se zabývá především školskou právnickou osobou. V oblasti účetnictví je pozornost soustředěna převážně na majetek a postupy jeho účtování jež jsou uvedeny v několika příkladech. Podrobněji se pak práce zaměřuje na peněžní a majetkové fondy. Na způsoby jejich účtování a možnosti jejich využití. Vzhledem k tomu, že mateřské školy jsou financovány převážně z veřejných zdrojů, obsahuje práce i několik informací o tom, jakým způsobem kontrola probíhá a kdo má možnost či povinnost tuto kontrolu provádět

Secondary malignancies and survival of FCR‐treated patients with chronic lymphocytic leukemia in Central Europe

Abstract This is the first large‐scale cross‐country analysis of patients with chronic lymphocytic leukemia (CLL) aimed to evaluate the incidence, types, and key prognostic factors of secondary malignancies, and to assess the impact on overall survival based on retrospective claims data from three Central European countries. We analyzed 25,814 newly diagnosed CLL patients from Czechia, Hungary, and Poland; 10,312 (39.9%) patients were treated for CLL in study periods between 2004 and 2016. Out of the treated patients, 1986 (19.3%) received the FCR therapy in the first line and 779 (7.6%) received FCR in subsequent lines. We observed that 33.7% of treated patients developed secondary malignancies during the study. Based on country estimates, the probability to develop a secondary malignancy within 4 years since starting the first‐line FCR therapy ranged between 28.0% and 36.8%. We found the age at diagnosis, male gender, any malignancy prior to the CLL diagnosis, and the CLL treatment to be the key risk factors for developing secondary malignancies. Specifically, the FCR therapy was a statistically significant (p < 0.001) prognostic factor for risk increase with the hazard ratio between 1.46 and 1.60. Across the three Central European countries, we observed consistent results indicating FCR increased the risk of secondary malignancies in CLL patients. We conclude that secondary malignancies are clearly an undervalued burden for CLL patients, caregivers, and the healthcare system. When evaluating new therapies in regulatory and reimbursement decision making, the factor of secondary malignancies deserves deeper considerations