63 research outputs found
Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement
Robotic-guided and percutaneous pedicle screw placement are emerging technologies. We here report a retrospective cohort analysis comparing conventional open to open robotic-guided and percutaneous robotic-guided pedicle screw placement. 112 patient records and CT scans were analyzed concerning the intraoperative and perioperative course. 35 patients underwent percutaneous, 20 open robotic-guided and 57 open conventional pedicle screw placement. 94.5% of robot-assisted and 91.4% of conventionally placed screws were found to be accurate. Percutaneous robotic and open robotic-guided subgroups did not differ obviously. Average X-ray exposure per screw was 34 s in robotic-guided compared to 77 s in conventional cases. Subgroup analysis indicates that percutaneously operated patients required less opioids, had a shorter hospitalization and lower rate of adverse events in the perioperative period. The use of robotic guidance significantly increased accuracy of screw positioning while reducing the X-ray exposure. Patients seem to have a better perioperative course following percutaneous procedures
Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review
Objectives This systematic review aims to evaluate the
evidence of non-pharmacological
strategies to improve
blood pressure (BP) control in patients with hypertension
from African countries.
Design We performed a systematic review and searched
Medline, Central, CINAHL and study registers until June
2020 for randomised studies on interventions to decrease
BP of patients with hypertension in African countries.
We assessed the study quality using the Cochrane risk
of bias tool and narratively synthesised studies on non-pharmacological
hypertension interventions.
Setting We included studies conducted in African
countries.
Participants Adult African patients with a hypertension
diagnosis.
Interventions Studies on non-pharmacological
interventions aiming to improve BP control and treatment
adherence.
Outcomes Main outcomes were BP and treatment
adherence.
Results We identified 5564 references, included 23 with
altogether 18 153 participants from six African countries.
The studies investigated educational strategies to improve
adherence (11 studies) and treatment by healthcare
professionals (5 studies), individualised treatment
strategies (2 studies), strategies on lifestyle including
physical activity (4 studies) and modified nutrition (1
study). Nearly all studies on educational strategies stated
improved adherence, but only three studies showed a
clinically relevant improvement of BP control. All studies
on individualised strategies and lifestyle changes resulted
in clinically relevant effects on BP. Due to the type of
interventions studied, risk of bias in domain blinding of
staff/participants was frequent (83%). Though incomplete
outcome data in 61% of the studies are critical, the
general study quality was reasonable.
Conclusions The identified studies offer diverse
low-cost
interventions including educative and task-shifting
strategies, individualised treatment and lifestyle
modifications to improve BP control. Especially trialled
physical activity interventions show clinically relevant BP
changes. All strategies were trialled in African countries
and may be used for recommendations in evidence-based
guidelines on hypertension in African settings
Automated grading of cerebral vasospasm to standardize computed tomography angiography examinations after subarachnoid hemorrhage
Background: Computed tomography angiography (CTA) is frequently used with computed tomography perfusion imaging (CTP) to evaluate whether endovascular vasospasm treatment is indicated for subarachnoid hemorrhage patients with delayed cerebral ischemia. However, objective parameters for CTA evaluation are lacking. In this study, we used an automated, investigator-independent, digital method to detect vasospasm, and we evaluated whether the method could predict the need for subsequent endovascular vasospasm treatment.Methods: We retrospectively reviewed the charts and analyzed imaging data for 40 consecutive patients with subarachnoid hemorrhages. The cerebrovascular trees were digitally reconstructed from CTA data, and vessel volume and the length of the arteries of the circle of Willis and their peripheral branches were determined. Receiver operating characteristic curve analysis based on a comparison with digital subtraction angiographies was used to determine volumetric thresholds that indicated severe vasospasm for each vessel segment.
Results: The automated threshold-based volumetric evaluation of CTA data was able to detect severe vasospasm with high sensitivity and negative predictive value for predicting cerebral hypoperfusion on CTP, although the specificity and positive predictive value were low. Combining the automated detection of vasospasm on CTA and cerebral hypoperfusion on CTP was superior to CTP or CTA alone in predicting endovascular vasospasm treatment within 24 h after the examination.
Conclusions: This digital volumetric analysis of the cerebrovascular tree allowed the objective, investigator-independent detection and quantification of vasospasms. This method could be used to standardize diagnostics and the selection of subarachnoid hemorrhage patients with delayed cerebral ischemia for endovascular diagnostics and possible interventions
Breathing during REM and non-REM sleep: correlated versus uncorrelated behaviour
Abstract Healthy sleep can be characterized by several stages: deep sleep, light sleep, and REM sleep. Here we show that these sleep stages lead to di erent autonomic regulation of breathing. Using the detrended uctuation analysis up to the fourth order we ÿnd that breath-to-breath intervals and breath volumes separated by several breaths are long-range correlated during the REM stages and during wake states. In contrast, in the non-REM stages (deep sleep and light sleep), long-range correlations are absent. This behaviour is very similar to the correlation behaviour of the heart rate during the night and may be related to the phase synchronization between heartbeat and breathing found recently. We speculate that the di erences are caused by di erent cortically in uenced control of the autonomic nervous system
Concurrent Activation of Both Survival-Promoting and Death-Inducing Signaling by Chloroquine in Glioblastoma Stem Cells : Implications for Potential Risks and Benefits of Using Chloroquine as Radiosensitizer
Lysosomotropic agent chloroquine was shown to sensitize non-stem glioblastoma cells to
radiation in vitro with p53-dependent apoptosis implicated as one of the underlying mechanisms.
The in vivo outcomes of chloroquine or its effects on glioblastoma stem cells have not been previously
addressed. This study undertakes a combinatorial approach encompassing in vitro, in vivo and in
silico investigations to address the relationship between chloroquine-mediated radiosensitization
and p53 status in glioblastoma stem cells. Our findings reveal that chloroquine elicits antagonistic
impacts on signaling pathways involved in the regulation of cell fate via both transcription-dependent
and transcription-independent mechanisms. Evidence is provided that transcriptional impacts of
chloroquine are primarily determined by p53 with chloroquine-mediated activation of pro-survival
mevalonate and p21-DREAM pathways being the dominant response in the background of wild
type p53. Non-transcriptional effects of chloroquine are conserved and converge on key cell fate
regulators ATM, HIPK2 and AKT in glioblastoma stem cells irrespective of their p53 status. Our
findings indicate that pro-survival responses elicited by chloroquine predominate in the context of
wild type p53 and are diminished in cells with transcriptionally impaired p53. We conclude that p53 is
an important determinant of the balance between pro-survival and pro-death impacts of chloroquine
and propose that p53 functional status should be taken into consideration when evaluating the
efficacy of glioblastoma radiosensitization by chloroquine
Diversity of Clinically Relevant Outcomes Resulting from Hypofractionated Radiation in Human Glioma Stem Cells Mirrors Distinct Patterns of Transcriptomic Changes
Hypofractionated radiotherapy is the mainstay of the current treatment for glioblastoma.
However, the efficacy of radiotherapy is hindered by the high degree of radioresistance associated
with glioma stem cells comprising a heterogeneous compartment of cell lineages differing in
their phenotypic characteristics, molecular signatures, and biological responses to external signals.
Reconstruction of radiation responses in glioma stem cells is necessary for understanding the
biological and molecular determinants of glioblastoma radioresistance. To date, there is a paucity
of information on the longitudinal outcomes of hypofractionated radiation in glioma stem cells.
This study addresses long-term outcomes of hypofractionated radiation in human glioma stem cells
by using a combinatorial approach integrating parallel assessments of the tumor-propagating capacity,
stemness-associated properties, and array-based profiling of gene expression. The study reveals a
broad spectrum of changes in the tumor-propagating capacity of glioma stem cells after radiation and
finds association with proliferative changes at the onset of differentiation. Evidence is provided that
parallel transcriptomic patterns and a cumulative impact of pathways involved in the regulation of
apoptosis, neural differentiation, and cell proliferation underly similarities in tumorigenicity changes
after radiation
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