4,052 research outputs found

    Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

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    Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH. Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study. Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5). Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment

    Effectiveness of massage chair and classic massage in recovery from physical exertion: a pilot study

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    Quick and cost-effective recovery is foundational to high-quality training and good competition results in today’s sports. The aim of the research was to elucidate the effects of hand and massage chair massage on the biomechanical parameters of muscles of lower limbs and back, indicators of Pain Pressure Thresholds (PPT) and subjectively perceived fatigue. A total of 32 female recreational athletes (18 – 50 years old) were assigned to a hand massage, massage chair, or lying down the group. They were measured for muscle biomechanical properties (MyotonPro), PPT (Wagner Instruments) and subjectively perceived fatigue (VAS scale) before and after fatigue tests and treatment. The recovery procedure and subjective satisfaction with treatment were rated on a Likert scale. Changes in the median value of m. rectus femoris and m. gastrocnemius stiffness with treatment showed that hand massage could be more effective in reducing stiffness, as compared to chair massage. Hand massage may have benefits for recovery from physical exertion, but due to the individuality of subjects, detailed methodological studies are needed to evaluate the effects of massage chair vs. hand massage

    Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

    No full text
    Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH. Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study. Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5). Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment

    Kroonilise neeruhaiguse levimus Eesti e-tervise andmete alusel

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    Taust. Kroonilise neeruhaiguse (KNH) levimus Eestis ei ole teada. Kuna KNH keskmine levimus maailmas on 9,1%, peaks KNH-patsientide arv Eestis olema umbes 118 300. Samas on 2017. aasta üleilmse aruande kohaselt KNH patsientide arv Eestis 258 859, mis on tõenäoliselt ülehinnatud.Eesti e-tervis on alustalaks tervishoiuandmete registreerimisele ja kogumisele. Samas on andmete analüüs tihti tüsilik, sest väljunddokumendid on erinevas formaadis, ja see raskendab oluliselt analüüsi. Lisaks pole haiguslugudes sageli märgitud diagnoosikoode ja/või KNH raskuskategooriat.Eesmärk. Töö eesmärk oli selgitada KNH levimust ja käsitlust Eestis, hinnates e-tervise infosüsteemi andmete põhjal retrospektiivselt täiskasvanud KNH-patsientide hulka ja jaotust vastavalt KNH riskiprofiilile, kasutades esimest korda ka tehisintellekti abi.Meetodid. Uuringu alusandmestiku moodustas Eesti elanikkonna 10% juhuvalimi raviarvete, digiretsepti ja tervise infosüsteemi andmete (e-tervise andmed) ühendväljavõte (sh eriarstiabi, perearstiabi, ostetud ravimid, laboratoorsed andmed). Uuringupopulatsioon määratleti kui kõik vähemalt 18aastased patsiendid, kellel oli ajavahemikul 2016–2019 diagnoositud vähemalt üks haigus, mis on KNH riskitegur, ja/ või kellel oli 2019. aasta jooksul vähemalt ühel korral registreeritud hinnangulise glomerulaarfiltratsiooni kiiruse (eGFR) ja/või uriinis albumiini-kreatiniini suhte (U-Alb/U-Crea, UACR) väärtus. Analüüsiti ka patsientide väljaostetud ravimeid, haiglaravi ja/või erakorralise meditsiini osakonna (EMO) juhtude arvu. Erinevas formaadis väljunddokumentide analüüsimiseks kasutati tehisintellekti abi, mille käigus transformeeriti epikriisi tekstifailis olev info analüüsis kasutatavale kujule.Tulemused. E-tervise andmete alusel tuvastati 5%-l elanikkonnast juba olemasolev KNH diagnoos ja lisaks 2,4%-l potentsiaalne KNH raskusastmega G3–G5. Nende andmete kohaselt võib Eestis kokku olla 83 710 KNH-patsienti ja KNH levimus täiskasvanud elanikkonnas on 7,4%. eGFR-i väärtused olid uuringus kättesaadavad 52%-l riskipatsientidest, UARC väärtused aga vaid 12%-l. Hulgihaigestumise hindamisel leiti, et KNH-patsientidel esineb kaasnevalt kõige sagedamini hüpertensioon (79%), südame-veresoonkonnahaigus (SVH) (63%) ja diabeet (28%). Ligi pooled KNH-patsientidest olid ühe aasta jooksul hospitaliseeritud või pöördunud EMOsse. Selle peamiseks põhjuseks oli olnud SVH (11%). KNH diagnoosiga patsiendid eristuvad KNH riskirühma kuuluvatest patsientidest (diabeet, hüpertensioon, SVH) suurema hospitaliseerimismäära ja erakorralise abi vajaduse poolest.Järeldused. KNH levimus Eestis täiskasvanud elanikkonnas on e-tervise andmetel 7,4%. Hoolimata riikliku KNH ravijuhendi olemasolust ning KNH sõeluuringu süsteemist diabeedi ja hüpertensiooni korral esineb lünki patsientide skriinimises, neeruhaiguse progresseerumise riski hindamises ja patsientide tõenduspõhises ravis. KNH tekkeriski ja progresseerumise tuvastamiseks ja asjakohase ravi tagamiseks on KNH riskirühmade seas vaja järgida ravijuhendit UARC väärtuse määramisel ning täpsustada alati ka KNH raskusaste koos albuminuuria kategooriaga. KNH-patsientide haiguskoormus on suur ning nende patsientide käsitlus nõuab tihedat koostööd esmatasandi tervishoiu ja eriarstide vahel. Seetõttu on KNH progresseerumise ennetamiseks tarvis enam ressursse

    Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

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    Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH. Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study. Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5). Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment

    Taphonomy of early life (2.1 Ga) in the francevillian basin (Gabon): Role of organic mineral interactions

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    The taphonomy of early soft-bodied organisms in Palaeoproterozoic sediments is not yet clearly understood, even though some locations where these fossils are found present all the conditions for exceptional fossil preservation. Indeed, the degree of fossil preservation has received attention, but better knowledge of the environmental conditions and associated taphonomic processes is also essential. In the Gabonese Francevillian Basin, the discovery of macrofossils (2.1 Ga) of multicellular organisms in black shales is an outstanding example of this degree of preservation. Indeed, the biological diversity, as a wide variety of fossil morphologies are observed, is associated with two major taphonomic processes – moulding (lenticular-shaped forms) or early pyritization, while the fossil host rocks were not deeply buried and were affected only by weak to moderate diagenesis. However, usually, the mechanisms of this preservation remain difficult to assess, as the original taphonomic processes are impacted by diagenesis and still misunderstood. In this way, by closely observing fossil mineralization in four morphotypes of macrofossils and associated host rocks from mineralogical and textural points of view, this work aims to provide some keys to a taphonomic comprehension of soft-bodied organism preservation. After the deposition of dead organisms on the clayey sediment, an illitization process, which depends on the availability of dissolved K driven by bacterial activity, started from the first stages of preservation by moulding the lenticular-shaped forms and proceeded in the pores of the other macrofossils after their pyritization. At the fossil level, the intensity of illitization is controlled by the mode of preservation and the evolution of the associated permeability. In the nonpyritized lenticular-shaped specimens, illitization was not achieved, preserving I-S mixed-layer minerals, while in the pyritized forms, the illitization degree was more extensive. In comparison, I-S mixed-layer minerals are almost absent in pyritized abiotic concretions. A second process, which occurred later, consists of general chloritization from fluid circulation. Our detailed results show that each specimen behaved like a microsystem with its own physico-chemical and mineralogical evolution during preservation/diagenesis. This finding allows us to propose a conceptual model of the taphonomic history, describing the fossilization stages for each type of specimen

    Fractionation of trace and platinum-group elements during metamorphism of komatiitic chromites from the early Archean Gorumahishani greenstone belt, Singhbhum Craton (eastern India)

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    International audienceIt is well established that the major and minor element contents of chromites are subject to change during greenschist to amphibolite facies metamorphism. During upper amphibolite facies metamorphism, chromite can be completely converted to chrome magnetite. However, not all elements are affected to the same degree, the concentrations of +2 ions (e.g. Zn, Co, Mn) being particularly vulnerable to modification. The degree to which trace elements, particularly the platinum-group elements (PGE), are affected has not been closely examined. The compositions and textures of chromites from komatiites of the Gorumahishani greenstone belt of the Singhbhum Craton (India) have experienced a range of metamorphic conditions from greenschist to amphibolite facies, providing the opportunity to study the changes of trace and platinum-group element composition with metamorphic grade. Five types of altered chromites are identified from the komatiitic suite of rocks in the ~120-km-long greenstone belt. The type-I chromites are non-porous and characterized by the least modified cores. These chromites are mostly present in the northern Maharajgunj-Tua Dungri section where rocks show metamorphism from greenschist to greenschist-amphibolite transition facies. The type-II and type-III chromites are porous and mostly found in the southern Kapili section of the greenstone belt where rocks show metamorphism up to the mid-amphibolite facies. Type-IV and type-V chromites are completely modified to ferritchromit and chrome magnetite, respectively, and are present in the komatiitic rocks from the entire greenstone belt. The central cores of the type-I and type-II grains have relatively higher concentrations of mobile trace elements (e.g. Zn, Co, and Mn) with higher Mg# [Mg/(Mg + Fe2+)], lower Cr# [Cr/(Cr + Al)], and lower Fe3+/R3+ (R3+ = Fe3+ + Cr3+ + Al3+) ratios than their respective rims. Significantly higher concentrations of the immobile trace elements (e.g. Ti and V) in the cores of the type-II grains relative to their chrome magnetite rims from the Kapili section and to the type-I varieties from other sections might be due to the metamorphism of the komatiitic rocks under higher-grade conditions (amphibolite facies). In situ LA-ICPMS analysis for PGE reveals a relatively higher concentration of Ru and Rh in the rims of the type-I chromites than in the cores which is due to the diffusion of these elements from the normal spinel structure of the cores towards the bivalent octahedral sites of the inverse spinel structure of the chrome magnetite rims during metamorphic processes. The lower concentrations of Os, Ir, Ru, and Rh in the cores of the type-II chromites from the Kapili section might be related to the metamorphism of the rocks under higher-grade conditions that facilitated the diffusion of these elements to associated sulphide or platinum-group mineral or alloy phases. The calculated partition coefficients of Sc, Ti, V, Mn, Ni, Ga, Os, Ir, Ru, and Rh from the least altered chromite cores assuming equilibrium with the parental komatiitic melt also suggest the variable effects of metamorphism when compared with global experimental and empirical values of the natural sample
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