84 research outputs found
Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany
Study design: Survey study.
Objectives: Spinal cord injury (SCI)-associated pneumonia (SCI-AP) is associated with poor functional recovery and a major cause of death after SCI. Better tackling SCI-AP requires a common understanding on how SCI-AP is defined. This survey examines clinical algorithms relevant for diagnosis and treatment of SCI-AP.
Setting: All departments for SCI-care in Germany.
Methods: The clinical decision-making on SCI-AP and the utility of the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of âclinically defined pneumoniaâ were assessed by means of a standardized questionnaire including eight case vignettes of suspected SCI-AP. The diagnostic decisions based on the case information were analysed using classification and regression trees (CART).
Results: The majority of responding departments were aware of the CDC-criteria (88%). In the clinical vignettes, 38â81% of the departments diagnosed SCI-AP in accordance with the CDC-criteria and 7â41% diagnosed SCI-AP in deviation from the CDC-criteria. The diagnostic agreement was not associated with the availability of standard operating procedures for SCI-AP management in the departments. CART analysis identified radiological findings, fever, and worsened gas exchange as most important for the decision on SCI-AP. Frequently requested supplementary diagnostics were microbiological analyses, C-reactive protein, and procalcitonin. For empirical antibiotic therapy, the departments used (acyl-)aminopenicillins/ÎČ-lactamase inhibitors, cephalosporins, or combinations of (acyl-)aminopenicillins/ÎČ-lactamase inhibitors with fluoroquinolones or carbapenems.
Conclusions: This survey reveals a diagnostic ambiguity regarding SCI-AP despite the awareness of CDC-criteria and established SOPs. Heterogeneous clinical practice is encouraging the development of disease-specific guidelines for diagnosis and management of SCI-AP
Association of age with the timing of acute spine surgeryâeffects on neurological outcome after traumatic spinal cord injury
Purpose: To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI).
Methods: Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression.
Results: The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (>= 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients ( 60 h = 40y 5-20% probability).
Conclusion: Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients
a clinical study protocol
Introduction The approved analgesic and anti-inflammatory drugs ibuprofen and
indometacin block the small GTPase RhoA, a key enzyme that impedes axonal
sprouting after axonal damage. Inhibition of the Rho pathway in a central
nervous system-effective manner requires higher dosages compared with orthodox
cyclooxygenase-blocking effects. Preclinical studies on spinal cord injury
(SCI) imply improved motor recovery after ibuprofen/indometacin-mediated Rho
inhibition. This has been reassessed by a meta-analysis of the underlying
experimental evidence, which indicates an overall effect size of 20.2%
regarding motor outcome achieved after ibuprofen/indometacin treatment
compared with vehicle controls. In addition, ibuprofen/indometacin may also
limit sickness behaviour, non-neurogenic systemic inflammatory response
syndrome (SIRS), neuropathic pain and heterotopic ossifications after SCI.
Consequently, âsmall moleculeâ-mediated Rho inhibition after acute SCI
warrants clinical investigation. Methods and analysis Protocol of an
investigator-initiated clinical open-label pilot trial on high-dose ibuprofen
treatment after acute traumatic, motor-complete SCI. A sample of n=12 patients
will be enrolled in two cohorts treated with 2400â
mg/day ibuprofen for 4 or 12
weeks, respectively. The primary safety end point is an occurrence of serious
adverse events, primarily gastroduodenal bleedings. Secondary end points are
pharmacokinetics, feasibility and preliminary effects on neurological
recovery, neuropathic pain and heterotopic ossifications. The primary safety
analysis is based on the incidence of severe gastrointestinal bleedings.
Additional analyses will be mainly descriptive and casuistic. Ethics and
dissemination The clinical trial protocol was approved by the responsible
German state Ethics Board, and the Federal Institute for Drugs and Medical
Devices. The study complies with the Declaration of Helsinki, the principles
of Good Clinical Practice and all further applicable regulations. This safety
and pharmacokinetics trial informs the planning of a subsequent randomised
controlled trial. Regardless of the result of the primary and secondary
outcome assessments, the clinical trial will be reported as a publication in a
peer-reviewed journal. Trial registration number NCT02096913; Pre-results
protocol of a prospective, longitudinal study
Background Natural killer (NK) cells comprise the main components of
lymphocyte-mediated nonspecific immunity. Through their effector function they
play a crucial role combating bacterial and viral challenges. They are also
thought to be key contributors to the systemic spinal cord injury-induced
immune-deficiency syndrome (SCI-IDS). SCI-IDS increases susceptibility to
infection and extends to the post-acute and chronic phases after SCI. Methods
and design The prospective study of NK cell function after traumatic SCI was
carried out in two centers in Berlin, Germany. SCI patients and control
patients with neurologically silent vertebral fracture also undergoing
surgical stabilization were enrolled. Furthermore healthy controls were
included to provide reference data. The NK cell function was assessed at 7
(5â9) days, 14 days (11â28) days, and 10 (8â12) weeks post-trauma. Clinical
documentation included the American Spinal Injury Association (ASIA)
impairment scale (AIS), neurological level of injury, infection status,
concomitant injury, and medications. The primary endpoint of the study is
CD107a expression by NK cells (cytotoxicity marker) 8â12 weeks following SCI.
Secondary endpoints are the NK cellâs TNF-α and IFN-Îł production by the NK
cells 8â12 weeks following SCI. Discussion The protocol of this study was
developed to investigate the hypotheses whether i) SCI impairs NK cell
function throughout the post-acute and sub-acute phases after SCI and ii) the
degree of impairment relates to lesion height and severity. A deeper
understanding of the SCI-IDS is crucial to enable strategies for prevention of
infections, which are associated with poor neurological outcome and elevated
mortality. Trial registration DRKS00009855
Neuro-cognitive mechanisms of conscious and unconscious visual perception: From a plethora of phenomena to general principles
Psychological and neuroscience approaches have promoted much progress in
elucidating the cognitive and neural mechanisms that underlie phenomenal visual
awareness during the last decades. In this article, we provide an overview of
the latest research investigating important phenomena in conscious and
unconscious vision. We identify general principles to characterize conscious and
unconscious visual perception, which may serve as important building blocks for
a unified model to explain the plethora of findings. We argue that in particular
the integration of principles from both conscious and unconscious vision is
advantageous and provides critical constraints for developing adequate
theoretical models. Based on the principles identified in our review, we outline
essential components of a unified model of conscious and unconscious visual
perception. We propose that awareness refers to consolidated
visual representations, which are accessible to the entire brain and therefore
globally available. However, visual awareness not only depends
on consolidation within the visual system, but is additionally the result of a
post-sensory gating process, which is mediated by higher-level cognitive control
mechanisms. We further propose that amplification of visual representations by
attentional sensitization is not exclusive to the domain of conscious
perception, but also applies to visual stimuli, which remain unconscious.
Conscious and unconscious processing modes are highly interdependent with
influences in both directions. We therefore argue that exactly this
interdependence renders a unified model of conscious and unconscious visual
perception valuable. Computational modeling jointly with focused experimental
research could lead to a better understanding of the plethora of empirical
phenomena in consciousness research
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Motion and pattern cortical potentials in adults with high-functioning autism spectrum disorder
Purpose: Autism spectrum disorder (ASD) is a condition in which visual perception to both static and moving stimuli is altered. The aim of this study was to investigate the early cortical responses of subjects with ASD to simple patterns and moving radial rings using visual evoked potentials (VEPs).
Methods: Male ASD participants (n = 9) and typically developing (TD) individuals (n = 7) were matched for full, performance and verbal IQ (p > 0.263). VEPs were recorded to the pattern reversing checks of 50âČ side length presented with Michelson contrasts of 98 and 10 % and to the onset of motionâeither expansion or contraction of low-contrast concentric rings (33.3 % duty cycle at 10 % contrast).
Results: There were no significant differences between groups in the VEPs elicited by pattern reversal checkerboards of high (98 %) or low (10 %) contrast. The ASD group had a significantly larger N160 peak (1.85 x) amplitude to motion onset VEPs elicited by the expansion of radial rings (p = 0.001). No differences were evident in contraction VEP peak amplitudes nor in the latencies of the motion onset N160 peaks. There was no evidence of a response that could be associated with adaptation to the motion stimulus in the interstimulus interval following an expansion or contraction phase of the rings.
Conclusion: These data support a difference in processing of motion onset stimuli in this adult high-functioning ASD group compared to the TD group
Modulation of Human Time Processing by Subthalamic Deep Brain Stimulation
Timing in the range of seconds referred to as interval timing is crucial for cognitive operations and conscious time processing. According to recent models of interval timing basal ganglia (BG) oscillatory loops are involved in time interval recognition. ParkinsoĆs disease (PD) is a typical disease of the basal ganglia that shows distortions in interval timing. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a powerful treatment of PD which modulates motor and cognitive functions depending on stimulation frequency by affecting subcortical-cortical oscillatory loops. Thus, for the understanding of BG-involvement in interval timing it is of interest whether STN-DBS can modulate timing in a frequency dependent manner by interference with oscillatory time recognition processes. We examined production and reproduction of 5 and 15 second intervals and millisecond timing in a double blind, randomised, within-subject repeated-measures design of 12 PD-patients applying no, 10-Hz- and â„130-Hz-STN-DBS compared to healthy controls. We found under(re-)production of the 15-second interval and a significant enhancement of this under(re-)production by 10-Hz-stimulation compared to no stimulation, â„130-Hz-STN-DBS and controls. Milliseconds timing was not affected. We provide first evidence for a frequency-specific modulatory effect of STN-DBS on interval timing. Our results corroborate the involvement of BG in general and of the STN in particular in the cognitive representation of time intervals in the range of multiple seconds
Auditory DID: ERP signature of target processing
Data from a behavioral study including the factors 'distractor number' (0,1,or n), cue-target SOA (0 va 300 ms), and presentation mode (separated vs superimposed streams).
Data from an ERP experiment including the factors 'cue-alone vs cue+target', 'hit vs miss', and electrode position.
PsychoPy Presentation Code and Stimulus Material
Results of a randomization test (repeated t-tests for randomly selected subsamples, including a control with random assignment of conditions
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