Doppler sonography in the diagnosis of extracranial vascular changes

On account of cerebrovascular insufficiencies or asymptomatic vascular noises which had taken place 45 patients were examined by means of Doppler sonography and after this by means of angiography. The judgement of the common carotid artery, the internal and external carotid arteries, the vertebral artery, the subclavian artery and the supratrochlear artery were involved into the ultrasound investigation. The sensitivity of the supratrochlear compression test was 50% in the diagnosis of high-degree stenoses and occlusions of the internal carotid artery, whereas the sensitivity of the complete ultrasound investigation way about 80%. The advantages and disadvantages of the ultrasound Doppler sonography investigation are discussed.     

„Sprung ins kalte Wasser“

Background

With high-fidelity simulators in a modern blended learning setting, students are able to acquire knowledge and practical skills in acute medicine in realistic scenarios. However, it has not yet been clarified if the sequence of linking between knowledge and simulator-based training of practical skills plays an important role for increasing knowledge, for the self-concept and learning emotions of trainees.

Aim

In a pilot study the influence of the type of knowledge acquisition under two independent conditions was investigated in which the order of presenting the learning material (firstly theory and then simulation vs. simulation elements before the theory) was reversed. In addition the influence of individual attributes of personality on the construction of situated knowledge was correlated with these conditions in two groups.

Material and methods

To investigate the outcome of simulator-based learning 20 students were randomly allocated to one of the two conditions and undertook two scenarios (anaphylactic shock and myocardial infarction), whereby the theoretical lessons were given either before or after the scenarios. Using standardized questionnaires and problem-centered semi-standardized interviews, the following variables of the participants were assessed: personality traits, current positive and negative feelings, professional self-concept, general self-efficacy and coping strategies for stress. Theoretical knowledge and practical skills were assessed using a knowledge test and standardized assessment questionnaires which also focused on performance and patient safety.

Results

All together the results showed a slight advantage for the condition of theory before simulation which was not determined by the acquisition of knowledge but by a better performance of trainees as assessed by the trainers. Regarding knowledge acquisition, no statistically significant differences could be shown. Significant differences (p?<?0.05) were found for negative feelings (very intense negative emotional state) and for the professional self-concept (perception of own professional skills) in favor of the theory then simulation condition. More extrovert participants showed poorer results which could not be attributed to one of the conditions. However, the participants always assessed the allocated learning condition as the best premise for effective learning outcome. Reaction to stress has been described as “jumping in at the deep end” as well as the lasting effect on learning from errors.

Conclusion

In the context of simulation-based teaching, the learning outcome not only depends on knowledge, practical skills and motivational variables but also on the presence of negative feelings, ability self-concepts and various personality traits. There was a trend which showed that simulation in the field of anesthesiology and emergency medicine should be set up with the theoretical basis first in order to avoid negative feelings.     

The Subarachnoid Hemorrhage International Trialists (SAHIT) Repository: Advancing Clinical Research in Subarachnoid Hemorrhage

Researchers and other stakeholders continue to express concern about the failure of randomized clinical trials (RCT) in subarachnoid hemorrhage (SAH) to show efficacy of new treatments. Pooled data may be particularly useful to generate hypotheses about causes of poor outcomes and reasons for failure of RCT in SAH, and strategies to improve them. Investigators conducting SAH research collaborated to share data with the intent to develop a large repository of pooled individual patient data for exploratory analysis and testing of new hypotheses relevant to improved trial design and analysis in SAH. This repository currently contains information on 11,443 SAH patients from 14 clinical databases, of which 9 are datasets of recent RCTs and 5 are datasets of prospective observational studies and hospital registries. Most patients were managed in the last 15 years. Data validation and quality checks have been conducted and are satisfactory. Data is available on demographic, clinical, neuroimaging, and laboratory results and various outcome measures. We have compiled the largest known dataset of patients with SAH. The SAHIT repository may be an important resource for advancing clinical research in SAH and will benefit from contributions of additional datasets.     

Scale‐free functional brain dynamics during recovery from sport‐related concussion

Studies using blood‐oxygenation‐level‐dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The literature to date, however, has largely focused on measuring changes in the spatial organization of functional brain networks. In the present study, changes in the temporal dynamics of BOLD signals are examined throughout concussion recovery using scaling (or fractal) analysis. Imaging data were collected for 228 university‐level athletes, 61 with concussion and 167 athletic controls. Concussed athletes were scanned at the acute phase of injury (1–7 days postinjury), the subacute phase (8–14 days postinjury), medical clearance to return to sport (RTS), 1 month post‐RTS and 1 year post‐RTS. The wavelet leader multifractal approach was used to assess scaling ( c₁ ) and multifractal ( c₂ ) behavior. Significant longitudinal changes were identified for c₁ , which was lowest at acute injury, became significantly elevated at RTS, and returned near control levels by 1 year post‐RTS. No longitudinal changes were identified for c₂ . Secondary analyses showed that clinical measures of acute symptom severity and time to RTP were related to longitudinal changes in c₁ . Athletes with both higher symptoms and prolonged recovery had elevated c₁ values at RTS, while athletes with higher symptoms but rapid recovery had reduced c₁ at acute injury. This study provides the first evidence for long‐term recovery of BOLD scale‐free brain dynamics after a concussion.     

Predicting survival in anaplastic astrocytoma patients in a single-center cohort of 108 patients

Purpose

Stereotactic radiation therapy (SRT) and immune checkpoint inhibitors (ICI) may act synergistically to improve treatment outcomes but may also increase the risk of symptomatic radiation necrosis (RN). The objective of this study was to compare outcomes for patients undergoing SRT with and without concurrent ICI.

Methods and materials

Patients treated for BMs with single or multi-fraction SRT were retrospectively reviewed. Concurrent ICI with SRT (SRT-ICI) was defined as administration within 3 months of SRT. Local control (LC), radiation necrosis (RN) risk and distant brain failure (DBF) were estimated by the Kaplan-Meier method and compared between groups using the log-rank test. Wilcoxon rank sum and Chi-square tests were used to compare covariates. Multivariate cox regression analysis (MVA) was performed.

Results

One hundred seventy-nine patients treated with SRT for 385 brain lesions were included; 36 patients with 99 lesions received SRT-ICI. Median follow up was 10.3 months (SRT alone) and 7.7 months (SRT- ICI) (p = 0.08). Lesions treated with SRT-ICI were more commonly squamous histology (17% vs 8%) melanoma (20% vs 2%) or renal cell carcinoma (8% vs 6%), (p < 0.001). Non-small cell lung cancer (NSCLC) compromised 60% of patients receiving ICI (n = 59). Lesions treated with SRT-ICI had significantly improved 1-year local control compared to SRT alone (98 and 89.5%, respectively (p = 0.0078). On subset analysis of NSCLC patients alone, ICI was also associated with improved 1 year local control (100% vs. 90.1%) (p = 0.018). On MVA, only tumor size ≤2 cm was significantly associated with LC (HR 0.38, p = 0.02), whereas the HR for concurrent ICI with SRS was 0.26 (p = 0.08). One year DBF (41% vs. 53%; p = 0.21), OS (58% vs. 56%; p = 0.79) and RN incidence (7% vs. 4%; p = 0.25) were similar for SRT alone versus SRT-ICI, for the population as a whole and those patients with NSCLC.

Conclusion

These results suggest SRT-ICI may improve local control of brain metastases and is not associated with an increased risk of symptomatic radiation necrosis in a cohort of predominantly NSCLC patients. Larger, prospective studies are necessary to validate these findings and better elucidate the impact of SRT-ICI on other disease outcomes.

     

Pioglitazone, a specific ligand of peroxisome proliferator-activated receptor-gamma, protects pancreas against acute cerulein-induced pancreatitis

ABM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ(PPARγ) ligand, on the development of acute pancreatitis (AP) and on the expression of heat shock protein 70 (HSP70) in the pancreas. METHODS: AP was induced in rats by subcutaneous infusion of cerulein for 5 h. Pancreatic blood flow was measured by laser Doppler flowmetry. Plasma lipase activity, interleukin-1β (IL-1β) and IL-10 were determined, Pancreatic weight and histology were evaluated and pancreatic DNA synthesis and blood flow as well as pancreatic mRNA for IL-1β and HSP70 were assessed in rats treated with pioglitazone alone or in combination with cerulein. RESULTS: Pioglitazone administered (10-100 mg/kg i.g.) 30 min before cerulein, attenuated dose-dependently the pancreatic tissue damage in cerulein-induced pancreatitis (CIP) as demonstrated by the improvement of pancreatic histology, reduction in plasma lipase activity, plasma concentration of pro-inflammatory IL-1β and its gene expression in the pancreas and attenuation of the pancreatitis-evoked fall in pancreatic blood flow. CIP increased pancreatic HSP70 mRNA and protein expression in the pancreas and this effect was enhanced by pioglitazone treatment. CONCLUSION: Pioglitazone attenuates CIP and the beneficial effect of this pioglitazone is multifactorial probably due to its anti-inflammatory activities, to the suppression of IL-1β and to the over-expression of HSP70. PPARγ ligands could represent a new therapeutic option in the treatment of AP.     

The diurnal variations of serum prolactin levels before and during pregnancy in normal and hyperprolactinemic patients

Although it seems likely that some patients with unexplained repeated abortions have early or subclinical autoimmune disease, there are no reports on the incidence of autoimmune serologic abnormalities in such patients by use of a series of tests. This diagnosis would suggest a treatable etiology for reproductive loss. We performed 11 serologic autoimmune tests in sera from 14 patients with three or more unexplained abortions (group II) and compared these results to those of 16 control patients with an established diagnosis for repeated abortions (group I). The groups were similar in age, gravidity, number of spontaneous abortions and live births, and in the interval from last abortion to serum sampling. A positive antinuclear antibody test plus at least one other positive test was found in four of 14 (29%) patients in group II (p less than 0.05). The tests that identified all these patients included levels of antinuclear antibody, antibodies to DNA or extractable nuclear antigen, and low levels of complement 3.