Comatose With Basilar Artery Occlusion : Still Odds of Favorable Outcome With Recanalization Therapy

Background: Around 30-60% of patients with basilar artery occlusion (BAO) present with coma, which is often considered as a hallmark of poor prognosis. Aim: To examine factors that will help predict outcomes in patients with BAO comatose on admission. Methods: A total of 312 patients with angiography-proven BAO were analyzed. Comas were assessed as Glasgow Coma Scale (GCS) of Results: In total, 103/259 (39.8%) of BAO patients were comatose on admission. Factors associated with acute coma were higher age, coronary artery disease, convulsions, extent of early ischemia by posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) < 8, absence of patent posterior collateral vasculature, and occlusion over multiple segments of BA. A total of 21/103 (20.4%) of comatose patients had a favorable outcome (mRS 0-3), and 12/103 (11.7%) had a good outcome (mRS 0-2). Factors associated with a favorable outcome in comatose BAO patients were younger age (p = 0.010), less extensive baseline ischemia (p = 0.027), recanalization (p = 0.013), and avoiding symptomatic intracranial hemorrhage (sICH) (p = 0.038). Factors associated with the poorest outcome or death (mRS 5-6) were older age (p = 0.001), diabetes (p = 0.022), atrial fibrillation (p = 0.016), lower median GCS [4 (IQR 3.6) vs. 6 (5-8); p = 0.006], pc-ASPECTS < 8 (p = 0.003), unsuccessful recanalization (p = 0.006), and sICH (p = 0.010). Futile recanalization (mRS 4-6) was significantly more common in comatose patients (49.4 vs. 18.5%, p < 0.001). Conclusions: One in five BAO patients with acute coma had a favorable outcome. Older patients with cardiovascular comorbidities and already existing ischemic lesions before reperfusion therapies tended to have a poor prognosis, especially if no recanalization is achieved and sICH occurred.Peer reviewe

Ultra-Early Differential Diagnosis of Acute Cerebral Ischemia and Hemorrhagic Stroke by Measuring the Prehospital Release Rate of GFAP

BACKGROUND: Plasma glial fibrillary acidic protein (GFAP) and tau are promising markers for differentiating acute cerebral ischemia (ACI) and hemorrhagic stroke (HS), but their prehospital dynamics and usefulness are unknown. METHODS: We performed ultra-sensitivite single-molecule array (Simoa((R))) measurements of plasma GFAP and total tau in a stroke code patient cohort with cardinal stroke symptoms [National Institutes of Health Stroke Scale (NIHSS) >= 3]. Sequential sampling included 2 ultra-early samples, and a follow-up sample on the next morning. RESULTS: We included 272 cases (203 ACI, 60 HS, and 9 stroke mimics). Median (IQR) last-known-well to sampling time was 53 (35-90) minutes for initial prehospital samples, 90 (67-130) minutes for secondary acute samples, and 21 (16-24) hours for next morning samples. Plasma GFAP was significantly higher in patients with HS than ACI (P410pg/mL, or prehospital GFAP 90-410pg/mL together with GFAP release >0.6pg/mL/minute) enabled ruling out HS with high certainty (NPV 98.4%) in 68% of patients with ACI (sensitivity for HS 96.6%, specificity 68%, PPV 50%). CONCLUSIONS: In comparison to single-point measurement, monitoring the prehospital GFAP release rate improves ultra-early differentiation of stroke subtypes. With serial measurement GFAP has potential to improve future prehospital stroke diagnostics.Peer reviewe

Biomedical Diagnostics Enabled by Integrated Organic and Printed Electronics

© 2017 American Chemical Society. Organic and printed electronics integration has the potential to revolutionize many technologies, including biomedical diagnostics. This work demonstrates the successful integration of multiple printed electronic functionalities into a single device capable of the measurement of hydrogen peroxide and total cholesterol. The single-use device employed printed electrochemical sensors for hydrogen peroxide electroreduction integrated with printed electrochromic display and battery. The system was driven by a conventional electronic circuit designed to illustrate the complete integration of silicon integrated circuits via pick and place or using organic electronic circuits. The device was capable of measuring 8 μL samples of both hydrogen peroxide (0-5 mM, 2.72 × 10 -6 A·mM -1 ) and total cholesterol in serum from 0 to 9 mM (1.34 × 10 -8 A·mM -1 , r 2 = 0.99, RSD < 10%, n = 3), and the result was output on a semiquantitative linear bar display. The device could operate for 10 min via a printed battery, and display the result for many hours or days. A mobile phone "app" was also capable of reading the test result and transmitting this to a remote health care provider. Such a technology could allow improved management of conditions such as hypercholesterolemia

Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

Background and purpose Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO. Methods This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers. Results In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P = 125. Conclusions The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.Peer reviewe

Novel Insights into Pituitary Tumorigenesis: Genetic and Epigenetic Mechanisms.

Substantial advances have been made recently in the pathobiology of pituitary tumors. Similar to many other endocrine tumors, over the last few years we have recognized the role of germline and somatic mutations in a number of syndromic or nonsyndromic conditions with pituitary tumor predisposition. These include the identification of novel germline variants in patients with familial or simplex pituitary tumors and establishment of novel somatic variants identified through next generation sequencing. Advanced techniques have allowed the exploration of epigenetic mechanisms mediated through DNA methylation, histone modifications and noncoding RNAs, such as microRNA, long noncoding RNAs and circular RNAs. These mechanisms can influence tumor formation, growth, and invasion. While genetic and epigenetic mechanisms often disrupt similar pathways, such as cell cycle regulation, in pituitary tumors there is little overlap between genes altered by germline, somatic, and epigenetic mechanisms. The interplay between these complex mechanisms driving tumorigenesis are best studied in the emerging multiomics studies. Here, we summarize insights from the recent developments in the regulation of pituitary tumorigenesis

Vaikuttavuusmittarin laatiminen CorusCardio - sydänkuntoutukselle

Tämän opinnäytetyön tarkoituksena oli kehittää PDL – palvelut Oy / DiaVire:n CorusCardio – sydänkuntoutuksen käyttöön subjektiivisen vaikuttavuuden mittari. Tulevaisuudessa vaikuttavuusmittarin avulla saadaan tutkittua miten kuntoutus on vaikuttanut kuntoutujien fyysiseen, psyykkiseen ja sosiaaliseen hyvinvointiin. Vaikuttavuusmittari kehitettiin pilotoinnin, teorian sekä DiaViren:n Ulla Joopin haastattelun perusteella. Ensimmäinen versio vaikuttavuusmittarista pilotoitiin kuuden (6) hengen ryhmälle, joka koostui kolmesta (3) naisesta ja kolmesta (3) miehestä. Aerobisen kapasiteetin on todettu parantuvan merkittävästi 12 viikon säännöllisen harjoittelujakson aikana. Tästä syystä pilotointiin valittiin ne henkilöt, jotka olivat käyneet kuntoutuksessa vähintään 3 kuukauden ajan. Lopullinen versio kyselylomakkeesta muodostui pilotoinnin kautta saatujen palautteiden perusteella sekä muokkaamalla ulkoasua selkeämmäksi. Tulevaisuudessa opinnäytetyöstä tullaan tekemään jatkoopinnäytetyö, jolla pyritään kyselylomaketta käyttämällä selvittämään kuntoutuksen vaikuttavuutta.The purpose of this thesis was to develop subjective effectiveness scale for CorusCardio heart rehabilitation. In Pori CorusCardio is provided by PDL – palvelut Oy / DiaVire. In future the effectiveness scale will help to research if rehabilitation has had an effect to patient´s physical, mental and social well-being. Effectiveness scale was based on a pilot, theory and interview of Ulla Joopi from DiaVire. First version of the effectiveness scale was piloted by a group of six persons comprised of three women and three men. It has shown that aerobic capacity improves significantly after 12 weeks of training. Therefore those who had participated in rehabilitation for at least three months were selected in piloting. The final version of the effectiveness scale was formed with the help of feedback from the piloting and revising the layout more clear. In future this thesis will be continued with another study where the effectiveness scale will be applied to find out the effectiveness of rehabilitation

Positiivisuutta Tanhualan arkeen

Opinnäytetyömme aiheena oli positiivinen pedagogiikka. Tavoitteena oli lisätä positiivista pedagogiikkaa osaksi Päiväkoti Tanhualan arkea ja tukea sen toteuttamista. Lisäksi tavoitteenamme oli lisätä henkilökunnan ja vanhempien tietoisuutta eri luonteenvahvuuksista ja opettaa heitä käyttämään vahvuuksia hyödyksi. Opinnäytetyömme oli toiminnallinen, ja toteutimme sen neljän erilaisen intervention avulla, joiden aiheina olivat luonteen vahvuudet, ystävällisyys sekä kiitollisuus. Opinnäytetyömme teoriassa käsiteltiin varhaiskasvatusta, positiivista psykologiaa sekä positiivista pedagogiikkaa. Osallistimme päiväkodin henkilöstön sekä huoltajat mukaan opinnäytetyöhömme. Interventiot toteutimme syksyllä 2021. Interventioissa oli mukana 15 lasta, jotka olivat iältään 1–5-vuotiaita. Opinnäytetyömme pohjautuu PERMA-teoriaan. PERMA-teoria muodostuu englanninkielisistä sanoista, jotka ovat suomennettuna: myönteiset tunteet, toimintaan sitoutuminen, ihmissuhteet, merkityksellisyyden kokemukset sekä saavuttaminen. Nämä ovat viisi supervoimaa, jotka tukevat lasten hyvinvointia. Nämä viisi elementtiä antavat positiivisen pedagogiikan toimintaan ja toteuttamiseen riittävästi volyymia. On tärkeää vahvistaa monia eri PERMA-teorian osa-alueita samaan aikaan.The topic of this thesis was positive pedagogy. The aim was to add positive pedagogy to the daily life of the kindergarten Tanhuala and to support its implementation. In addition, the aim of the thesis was to increase the awareness of staff and parents about the character strengths and to teach them to take advantage of them. This thesis was functional, and it was implemented with four different interventions. The themes of the interventions were character strengths, kindness, and gratitude. The theoretical part of this thesis dealt with early childhood education, positive psychology, and positive pedagogy. Kindergarten staff and guardians were included in this thesis. The interventions were conducted in the autumn of 2021. The interventions were attended by 15 children aged 1–5 years. This thesis is based on the PERMA theory. The PERMA theory consists of the words: positive emotions, engagement, relationships, meaning, and accomplishment. These are the five great forces that support the well-being of children. The PERMA theory gives strength to the implementation of positive pedagogy. It is important to reinforce all the aspects of PERMA theory simultaneously