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Frédéric Zubler Andreas Steimer Rebekka Kurmann Mojtaba Bandarabadi Jan Novy Heidemarie Gast Mauro Oddo Kaspar Schindler Andrea O. Rossetti 《Clinical neurophysiology》2017,128(4):635-642
Objective
Outcome prognostication in comatose patients after cardiac arrest (CA) remains a major challenge. Here we investigated the prognostic value of combinations of linear and non-linear bivariate EEG synchronization measures.Methods
94 comatose patients with EEG within 24 h after CA were included. Clinical outcome was assessed at 3 months using the Cerebral Performance Categories (CPC). EEG synchronization between the left and right parasagittal, and between the frontal and parietal brain regions was assessed with 4 different quantitative measures (delta power asymmetry, cross-correlation, mutual information, and transfer entropy). 2/3 of patients were used to assess the predictive power of all possible combinations of these eight features (4 measures × 2 directions) using cross-validation. The predictive power of the best combination was tested on the remaining 1/3 of patients.Results
The best combination for prognostication consisted of 4 of the 8 features, and contained linear and non-linear measures. Predictive power for poor outcome (CPC 3–5), measured with the area under the ROC curve, was 0.84 during cross-validation, and 0.81 on the test set. At specificity of 1.0 the sensitivity was 0.54, and the accuracy 0.81.Conclusion
Combinations of EEG synchronization measures can contribute to early prognostication after CA. In particular, combining linear and non-linear measures is important for good predictive power.Significance
Quantitative methods might increase the prognostic yield of currently used multi-modal approaches. 相似文献44.
Renal vein thrombosis can occur as a complication of nephrotic syndrome. We present the case of a young man with nephrotic syndrome caused by minimal change disease who developed acute inferior vena cava and left renal vein thrombosis. He was treated initially with intravenous heparin. Because of the persistence of severe left flank pain and gross hematuria, local infusion of recombinant tissue plasminogen activator was tried, with resolution of thrombi and subsidence of symptoms. Functional preservation of the involved kidney is good, as indicated by Tc-99m DMSA scan (involved kidney, 47.4%; uninvolved kidney, 52.6%). Anticoagulation is usually recommended as the treatment of choice in renal vein thrombosis. We believe that in cases with critical presentations, such as bilateral involvement, extension into inferior vena cava, acute renal failure, pulmonary embolism or severe flank pain, thrombolytic therapy should be considered as a second-line treatment if good response is not obtained with heparin. 相似文献
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Results of the Biocompatible Osteoconductive Polymer (BOP) as an Intersomatic Graft in Anterior Cervical Surgery 总被引:5,自引:0,他引:5
J. Ibáñez A. Carreño C. Garcìa-Amorena J. Caral F. Gastón E. Ferrer 《Acta neurochirurgica》1998,140(2):126-133
Summary Eighty-two patients operated on in our Department between 1989 and 1995 with an anterior cervical approach for soft and
hard cervical disc herniations and cervical stenosis were included in this study. In 41 cases a heterologous intersomatic
bovine graft (Surgibone?) was used. Another 41 patients underwent surgery with a biocompatible osteoconductive polymer (BOP?) as intervertebral graft. Both groups were retrospectively reviewed and compared with the objectives of evaluating the biodynamic
behaviour of the grafts in the intersomatic space, the complications which appeared (specially those related to the grafts),
the bone fusion rate achieved and the clinical outcome of the patients. The results of our study show that the BOP group presented
a higher tendency to intersomatic space collapse 6 months after discectomy. There were no differences in the general surgical
complications between both groups, but those related directly to the graft were significantly higher in the BOP group. The
vast majority of the graft complications recorded had no clinical correlation. Without a strict radiological follow-up such
complications would never have been discovered. Bone fusion in the BOP group was significantly slower and worse. Finally,
the clinical outcome in both groups did not show any significant difference. 相似文献
46.
Transforming growth factor beta-coated platinum coils for endovascular treatment of aneurysms: an animal study 总被引:5,自引:0,他引:5
de Gast AN Altes TA Marx WF Do HM Helm GA Kallmes DF 《Neurosurgery》2001,49(3):690-4; discussion 694-6
OBJECTIVE: To test the hypothesis that coating platinum coils with transforming growth factor beta (TGFbeta) would improve the cellular proliferation within experimental aneurysms relative to uncoated coils. MATERIALS AND METHODS: Elastase-induced saccular aneurysms were created in 12 New Zealand White rabbits. These aneurysms were embolized with platinum coils, either "control" (unmodified) coils or "test" (coated with TGFbeta) coils. Subjects were killed either 2 weeks (n = 3, control; n = 3, test) or 6 weeks (n = 3, control; n = 3, test) after embolization. Aneurysm tissue was embedded in plastic, sectioned, and stained with hematoxylin and eosin. The thickness of tissue covering the coils at the coil-lumen interface was measured by use of a digital microscope, and was compared between groups by use of the Student's t test (P < or = 0.05). RESULTS: Two-week implantation samples demonstrated mean thickness of tissue overlying TGFbeta-coated coils of 36+/-15 microm and mean thickness of overlying control coils of 3+/-5 microm, indicating significantly thicker tissue growth covering test versus control coils (P = 0.02). Six-week implantation samples demonstrated mean thickness of tissue overlying TGFbeta-coated coils of 86+/-74 microm versus mean thickness overlying control coils of 37+/-6 mu; this difference did not reach statistical significance (P = 0.30). Thickness of tissue covering TGFbeta-coated coils did not change significantly from 2 to 6 weeks (P = 0.31). Tissue thickness over control coils increased significantly between 2 and 6 weeks (P = 0.002). CONCLUSION: TGFbeta-coated platinum coils undergo earlier cellular coverage than standard platinum coils, but differences in coverage between coated and control coils are no longer present at later time points. These data suggest that improvements in intra-aneurysmal cellular proliferation resulting from coil modifications, although significant in the early postembolization phase, may dissipate over time. 相似文献
47.
Stroke causes a transient imbalance of interhemispheric information flow in EEG during non-REM sleep
Frederic Zubler Andrea Seiler Thomas Horvath Corinne Roth Silvia Miano Christian Rummel Heidemarie Gast Lino Nobili Kaspar A. Schindler Claudio L. Bassetti 《Clinical neurophysiology》2018,129(7):1418-1426
Objective
Large-scale connectivity, especially interhemispheric connections, plays a crucial role for recovery after stroke. Here we used methods from information theory to characterize interhemispheric information flow in wake- and sleep-EEG after cerebral ischemia.Methods
34 patients with unilateral ischemic stroke were included. Symbolic Transfer Entropy (STE) was applied between bipolar EEG signals on the left and the right cerebral hemisphere during polysomnographic recordings in the acute phase and 3?months after stroke.Results
In the acute phase, we found a sleep stage-dependent preferred interhemispheric asymmetry: during non-REM sleep the information flow was predominantly directed from the contralesional toward the ipsilesional hemisphere. This effect was greatly reduced in a follow-up recording 3?months after stroke onset.Conclusion
Our findings are consistent with functional imaging studies showing a transient hyperactivity of contralesional areas after stroke. We conclude that STE is a robust method for detecting post-stroke connectivity reorganizations, and that sleep stages have to be taken into account when assessing functional connectivity.Significance
EEG is more widely available than functional MRI. Future studies will have to confirm whether EEG derived STE can be useful in a clinical setting during rehabilitation after stroke. 相似文献48.
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