633 research outputs found
Vagus Nerve Stimulation in Refractory Epilepsy: Effects on Pro- and Anti-Inflammatory Cytokines in Peripheral Blood
Objective: The vagus nerve has important immunological functions that may be relevant for its anticonvulsive action. We postulate that this anticonvulsive action is activated by a shift in the immune system resulting in a reduction of neurotoxic and an increase of neuroprotective tryptophan metabolites. Methods: Eleven patients with refractory epilepsy and 11 controls matched for age and gender were included in this study. The primary outcome measure was a 50% seizure reduction. Other variables were pro-inflammatory cytokines IL-6 and TNF-alpha, anti-inflammatory cytokine IL-10, cortisol, and the tryptophan metabolites 3-hydroxykynurenine (3-OH-KYN), kynurenic acid (KYNA), kynurenine, serotonin (5-HT) and 5-hydroxyindol acetic acid (5-HIAA). Blood samples were scheduled during baseline, and in week 28 of add-on treatment. Results: IL-6 levels were higher in the responders than in the control group, and decreased after vagus nerve stimulation (VNS), whereas IL-10 was low and increased after VNS. In nonresponders, VNS resulted in an increase of IL-6 plasma levels and in a decrease of IL-10. Cortisol concentrations are higher in the epilepsy group than in the control group. After VNS, these concentrations decreased. The concentrations of the tryptophan metabolites were lower in the epilepsy group than in the control group. The KYNA ratios are defined as the ratio of neuroprotective KYNA versus neurotoxic 3-OH-KYN and KYNA versus neurotoxic kynurenine: these ratios were lower in epilepsy patients than in controls, and they both moderately increased after VNS. Conclusion: The outcome of this preliminary study indicates that VNS causes a rebalancing of the immune system. This results in: (1) a reduction of neurotoxic and an increase of neuroprotective kynurenine metabolites and (2) in the normalization of cortisol levels. Copyright (C) 2010 S. Karger AG, Base
How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: data extraction, risk of bias, and transferability (part 3/3)
Introduction: This article is part of the series βHow to Prepare a Systematic Review (SR) of Economic Evaluations (EE) for Informing Evidence-based Healthcare Decisionsβ in which a five-step-approach for conducting a SR of EE is proposed. Areas covered: This paper explains the data extraction process, the risk of bias assessment and the transferability of EEs by means of a narrative review and expert opinion. SRs play a critical role in determining the comparative cost-effectiveness of healthcare interventions. It is important to determine the risk of bias and the transferability of an EE. Expert commentary: Over the past decade, several criteria lists have been developed. This article aims to provide recommendations on these criteria lists based on the thoroughness of development, feasibility, overall quality, recommendations of leading organizations, and widespread use
Prediction of final infarct volume from native CT perfusion and treatment parameters using deep learning
CT Perfusion (CTP) imaging has gained importance in the diagnosis of acute
stroke. Conventional perfusion analysis performs a deconvolution of the
measurements and thresholds the perfusion parameters to determine the tissue
status. We pursue a data-driven and deconvolution-free approach, where a deep
neural network learns to predict the final infarct volume directly from the
native CTP images and metadata such as the time parameters and treatment. This
would allow clinicians to simulate various treatments and gain insight into
predicted tissue status over time. We demonstrate on a multicenter dataset that
our approach is able to predict the final infarct and effectively uses the
metadata. An ablation study shows that using the native CTP measurements
instead of the deconvolved measurements improves the prediction.Comment: Accepted for publication in Medical Image Analysi
n- ΠΈΡΡΠΈΡΠ»Π΅Π½ΠΈΠ΅ β ΡΠ΅Π°Π»ΠΈΡΡΠΈΡΠ½Π°Ρ ΡΠΎΡΠΌΠ°Π»ΠΈΠ·Π°ΡΠΈΡ ΠΊΠ»Π°ΡΡΠ° ΠΏΠ΅ΡΠ΅ΠΏΠΈΡΡΠ²Π°ΡΡΠΈΡ ΡΠΈΡΡΠ΅ΠΌ
ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ Π½ΠΎΠ²ΡΠΉ ΡΠΎΡΠΌΠ°Π»ΠΈΠ·ΠΌ ΡΠΈΠΏΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Ξ·-ΠΈΡΡΠΈΡΠ»Π΅Π½ΠΈΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠ΅ΠΎΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΡΠ½ΠΎΠ²Ρ Π΄Π»Ρ ΠΏΠΎ-ΡΡΡΠΎΠ΅Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΊΠ»Π°ΡΡΠΎΠ² ΡΠΈΡΡΠ΅ΠΌ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΠ΅ΡΠ΅ΠΏΠΈΡΡΠ²Π°ΡΡΠΈΡ
ΠΏΡΠ°Π²ΠΈΠ». Π€ΠΎΡΠΌΠ°-Π»ΠΈΠ·ΠΌ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅Ρ ΡΠΏΠΎΡΡΠ΄ΠΎΡΠ΅Π½Π½ΡΠ΅ Π½Π΅ΠΊΠΎΠ½ΡΠ»ΡΡΠ½ΡΠ½ΡΠ΅ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π° ΠΏΡΠ°Π²ΠΈΠ» ΠΏΠ΅ΡΠ΅ΠΏΠΈΡΡΠ²Π°Π½ΠΈΡ ΠΈ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ Ρ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΡΠΌ ΠΎΠΊΡΡΠΆΠ΅Π½ΠΈΠ΅ΠΌ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ°ΡΡΠΈΡΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠΉ
Dordt College 2003-2004 Catalog
Academic Catalog for 2003-04https://digitalcollections.dordt.edu/academic_catalogs/1012/thumbnail.jp
Peripheral Artery Disease in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy; Results From the MR CLEAN Registry
Background and Purpose: Though peripheral artery disease (PAD) is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD. This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow. The aim of this study is to compare outcomes after endovascular thrombectomy (EVT) in acute stroke patients with and without PAD and to assess the relation between PAD and collateral grades. Methods: We analyzed acute ischemic stroke patients treated with EVT for an anterior circulation large artery occlusion, included in the Dutch, prospective, multicenter MR CLEAN Registry between March 2014 and November 2017. Collaterals were scored on CT angiography, using a 4-point collateral score. We used logistic regression analysis to estimate the association of PAD with collateral grades and functional outcome, assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included mortality at 90 days, symptomatic intracranial hemorrhage, and stroke progression. Results: We included 2,765 patients for analysis, of whom 254 (9.2%) had PAD. After adjustment for potential confounders, multivariable regression analysis showed no association of PAD with functional outcome [mRS cOR 0.90 (95% CI, 0.7-1.2)], collateral grades (cOR 0.85, 95% CI 0.7-1.1), or safety outcomes. Conclusion: In the absence of an association between the presence of PAD and collateral scores or outcomes after EVT, it may be questioned whether PAD leads to RIPC in patients with acute ischemic stroke due to large vessel occlusion
Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke:A MR CLEAN Registry Substudy
Background and Purpose - If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion. Methods - For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. The association of stroke etiology with the hyperdense artery sign, clot burden score, and thrombus location was estimated with univariable and multivariable binary and ordinal logistic regression. Additionally, for 367 patients with available thin-section imaging, we assessed the association of stroke etiology with absolute and relative thrombus attenuation, distance from internal carotid artery-terminus to thrombus, thrombus length, and thrombus attenuation increase with univariable and multivariable linear regression. Results - Compared with cardioembolic strokes, noncardioembolic strokes were associated with presence of hyperdense artery sign (odds ratio, 2.2 [95% CI, 1.6-3.0]), lower clot burden score (common odds ratio, 0.4 [95% CI, 0.3-0.6]), shift towards a more proximal thrombus location (common odds ratio, 0.2 [95% CI, 0.2-0.3]), higher absolute thrombus attenuation (Ξ², 3.6 [95% CI, 0.9-6.4]), decrease in distance from the ICA-terminus (Ξ², -5.7 [95% CI, -8.3 to -3.0]), and longer thrombi (Ξ², 8.6 [95% CI, 6.5-10.7]), based on univariable analysis. Thrombus characteristics of strokes with undetermined cause were similar to those of cardioembolic strokes. Conclusions - Thrombus computed tomography characteristics of cardioembolic stroke are distinct from those of noncardioembolic stroke. Additionally, our study supports the general hypothesis that many cryptogenic strokes have a cardioembolic cause. Further research should focus on the use of thrombus computed tomography characteristics as a diagnostic tool for stroke cause in clinical practice
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