scholarly journals Perfusion Changes in Acute Stroke Treated with Theophylline as an Add-on to Thrombolysis

2021 ◽  
Author(s):  
Boris Modrau ◽  
Anthony Winder ◽  
Niels Hjort ◽  
Martin Nygård Johansen ◽  
Grethe Andersen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cerebral Blood Volume ◽  
Neuroprotective Effect ◽  
Mean Transit Time ◽  
Control Group ◽  
Infarct Core ◽  
Treatment Groups ◽  
Stroke Models ◽  
Magnetic Resonance Imaging Mri

Abstract Purpose Theophylline has been suggested to have a neuroprotective effect in ischemic stroke; however, results from animal stroke models and clinical trials in humans are controversial. The aim of this study was to assess the effect of theophylline on the cerebral perfusion with multiparametric magnetic resonance imaging (MRI). Methods The relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) in the infarct core, penumbra, and unaffected tissue were measured using multi-parametric MRI at baseline and 3‑h follow-up in patients treated with theophylline or placebo as an add-on to thrombolytic therapy. Results No significant differences in mean rCBF, rCBV, and rMTT was found in the penumbra and unaffected tissue between the theophylline group and the control group between baseline and 3‑h follow-up. In the infarct core, mean rCBV increased on average by 0.05 in the theophylline group and decreased by 0.14 in the control group (p < 0.04). Mean rCBF and mean rMTT in the infarct core were similar between the two treatment groups. Conclusion The results indicate that theophylline does not change the perfusion in potentially salvageable penumbral tissue but only affects the rCBV in the infarct core. In contrast to the penumbra, the infarct core is unlikely to be salvageable, which might explain why theophylline failed in clinical trials.

scholarly journals Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

2014 ◽  
Vol 35 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Sebastian E Beyer ◽  
Louisa von Baumgarten ◽  
Kolja M Thierfelder ◽  
Marietta Rottenkolber ◽  
Hendrik Janssen ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Intravenous Thrombolysis ◽  
Lesion Size ◽  
Small Lesion ◽  
Time Resolved ◽  
Time To Peak ◽  
Magnetic Resonance Imaging Mri

The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion ( P<0.001) and a large relative mismatch ( P<0.001) on initial CTP, of a small follow-up lesion ( P<0.001), and of a small difference between initial CBV and follow-up lesion size ( P=0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade ( P=0.001), lack of an additional ICA occlusion ( P=0.009), and intravenous thrombolysis ( P=0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial

2021 ◽  
pp. 112070002110057
Author(s):  
Niels H Bech ◽  
Inger N Sierevelt ◽  
Sheryl de Waard ◽  
Boudijn S H Joling ◽  
Gino M M J Kerkhoffs ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Controlled Trial ◽  
Poor Quality ◽  
Control Group ◽  
Treatment Groups ◽  
Significant Difference ◽  
Randomised Controlled

Background: Hip capsular management after hip arthroscopy remains a topic of debate. Most available current literature is of poor quality and are retrospective or cohort studies. As of today, no clear consensus exists on capsular management after hip arthroscopy. Purpose: To evaluate the effect of routine capsular closure versus unrepaired capsulotomy after interportal capsulotomy measured with NRS pain and the Copenhagen Hip and Groin Outcome Score (HAGOS). Materials and methods: All eligible patients with femoroacetabular impingement who opt for hip arthroscopy ( n = 116) were randomly assigned to one of both treatment groups and were operated by a single surgeon. Postoperative pain was measured with the NRS score weekly the first 12 weeks after surgery. The HAGOS questionnaire was measured at 12 and 52 weeks postoperatively. Results: Baseline characteristics and operation details were comparable between treatment groups. Regarding the NRS pain no significant difference was found between groups at any point the first 12 weeks after surgery ( p = 0.67). Both groups significantly improved after surgery ( p < 0.001). After 3 months follow-up there were no differences between groups for the HAGOS questionnaire except for the domain sport ( p = 0.02) in favour of the control group. After 12 months follow-up there were no differences between both treatment groups on all HAGOS domains ( p  > 0.05). Conclusions: The results of this randomised controlled trial show highest possible evidence that there is no reason for routinely capsular closure after interportal capsulotomy at the end of hip arthroscopy. Trial Registration: This trial was registered at the CCMO Dutch Trial Register: NL55669.048.15.

Prevention of Progression to Severe Obesity in a Group of Obese Schoolchildren Treated With Family Therapy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 880-884
Author(s):  
Carl-Erik Flodmark ◽  
Torsten Ohlsson ◽  
Olof Rydén ◽  
Tomas Sveger
Keyword(s):  
Family Therapy ◽  
Conventional Treatment ◽  
Severe Obesity ◽  
Therapy Group ◽  
Control Group ◽  
Obese Children ◽  
Treatment Groups ◽  
Conventional Treatment Group ◽  
The Family

Study objective. To evaluate the effect of family therapy on childhood obesity. Design. Clinical trial. One year follow-up. Setting. Referral from school after screening. Participants. Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age. Intervention. Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy. Results. At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P &lt; .05), and the family therapy group also had fewer children with BMI &gt; 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P &lt; .05). Conclusions. Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.

scholarly journals The Effects of Mycophenolate on the Formation of Granulation Tissue Post-operatively in Canine Tracheal Stent Patients (2014–2020)

2021 ◽  
Vol 8 ◽  
Author(s):  
Kevin F. Barber ◽  
Catherine A. Loughin ◽  
Dominic J. Marino ◽  
Martin Lesser
Keyword(s):  
Mycophenolate Mofetil ◽  
Granulation Tissue ◽  
Control Group ◽  
Tracheal Lumen ◽  
Loss To Follow Up ◽  
Treatment Groups ◽  
Tracheal Stent ◽  
Significant Difference ◽  
Tracheal Collapse

Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients.Study design: Randomized clinical trial.Animals: 111 dogs from the hospital population.Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, &lt;25%, &gt;25–50%, and &gt;50%).Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410).Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.

Autonomous Mode of Systematic Dilemma Counseling

1981 ◽  
Vol 48 (1) ◽  
pp. 231-246 ◽  
Author(s):  
Morton Wagman
Keyword(s):  
Group Treatment ◽  
Previous Experiment ◽  
Complete System ◽  
Future Research ◽  
Control Group ◽  
Treatment Groups ◽  
Autonomous Mode ◽  
Contact Control ◽  
And Control

The autonomous dilemma counseling system is described and evaluated. The Dilemma Counseling Module teaches the dilemma problem-solving method. Solution components contain 75 representative life-choice problems and over 400 specific and general solutions. The Dilemma Therapeuter Component provides, on cassettes, supportive commentary from a counselor. 75 students with troublesome psychological dilemmas were randomly assigned to treatment groups or to a no-contact control group. One treatment condition consisted of the complete system while the other condition omitted the Dilemma Therapeuter. Treatment and control subjects responded to measures of problem improvement at a 1-wk. follow-up session. Each treatment group improved significantly more than the control group. Treatment groups did not differ. Findings are compared with those of a previous experiment in which the same design and dependent measures were used but in which treatment was given counselors using either the Dilemma Counseling ( n = 20) or an eclectic method ( n = 20). A combined analysis indicated no difference between the autonomous and counselors' treatments. It was concluded that the system can be independently applied. Future research is discussed.

scholarly journals Immunohistochemical Analysis of the Spinal Cord Ischemia– Effect of Remote Ischemic Preconditioning in a Porcine Model

2018 ◽  
Vol 21 (3) ◽  
pp. 209 ◽  
Author(s):  
Henri Johannes Haapanen ◽  
Johanna Herajärvi ◽  
Hannu-Pekka Honkanen ◽  
Caius Mustonen ◽  
Hannu Tuominen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Ischemic Preconditioning ◽  
Neuroprotective Effect ◽  
Spinal Cord Ischemia ◽  
Immunohistochemical Analysis ◽  
Limb Ischemia ◽  
Remote Ischemic Preconditioning ◽  
Control Group ◽  
Segmental Artery

Background: In experimental settings, remote ischemic preconditioning (RIPC) has shown a positive effect regarding spinal cord protection after local ischemia. In this study, we conducted spinal cord immunohistochemistry to demonstrate the protective effect of RIPC after 24 hours of the regional ischemia. Methods: Twenty piglets were randomized into an RIPC group (n = 10) and a control group (n = 10). The RIPC group underwent transient left hind limb ischemia before systematic left subclavian artery and segmental artery occlusion at the level of the diaphragm. Twenty-four hours later, the thoracic and lumbar spinal cords were harvested, and the oxidative stress markers were immunohistochemically analysed. Results: A total of 18 animals survived the 4-hour follow up (10 in the RIPC group, 8 in the control group) and 14 animals survived the 24-hour follow up (7 in each group). In the single sections of the spinal cord, the antioxidant pathway activation was seen in the RIPC group, as OGG1 and DJ-1/PARK7 activation was higher (P = .038 and P = .047, respectively). Conclusions: The results indicate that the neuroprotective effect of RIPC on the spinal cord after local ischemic insult remains controversial.

scholarly journals Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up

Cartilage ◽  
2020 ◽  
pp. 194760352094124
Author(s):  
Florian Schmaranzer ◽  
Pascal C. Haefeli ◽  
Emanuel F. Liechti ◽  
Markus S. Hanke ◽  
Moritz Tannast ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Mr Arthrography ◽  
Additional Treatment ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Study Group ◽  
Acetabular Cartilage ◽  
Significant Difference ◽  
Magnetic Resonance Imaging Mri

Objective To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. Design Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. Results No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores ( r = −0.727, P < 0.001) was observed. Conclusions Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.

Validation of MAF biomarker for response prediction to adjuvant bisphosphonates in 2 clinical trials: AZURE and NSABP-B34.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 513-513
Author(s):  
Alexander H. G. Paterson ◽  
Stewart J. Anderson ◽  
Roger Gomis ◽  
Joel [email protected] ◽  
Juan-Carlos Tercero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Clinical Trials ◽  
Disease Free Survival ◽  
Collaborative Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Free Survival ◽  
Disease Free

513 Background: An Early Breast Cancer Trialists' Collaborative Group (EBCTCG) meta-analysis indicates that adjuvant bisphosphonates increase time to bone recurrence and survival in postmenopausal breast cancer patients, but results of individual trials have been inconclusive. Retrospective analyses of AZURE, a trial of adjuvant zoledronic acid, showed MAF (a transcription factor of the AP-1 family) amplification status predicted bisphosphonate benefit independently of menopause for invasive disease-free survival (IDFS) and overall survival (OS). Validation of MAF amplification status as a potential companion diagnostic for adjuvant bisphosphonates was confirmed using NSABP-B34 specimens. Methods: The randomized, placebo-controlled NSABP B-34 study of women with stage 1-3 breast cancer were assigned to adjuvant systemic therapy plus oral clodronate 1600 mg daily or placebo for 3 years. The primary endpoint was disease-free survival (DFS) with overall survival (OS) as a secondary outcome. MAF amplification was assessed by fluorescence in-situ hybridization on anonymized sections of breast tumor tissue in all patients with tumor samples and performed in a laboratory blind to treatment assignment. Protocol and analysis plans were pre-specified. Disease outcomes were analysed using intention to treat principles. Results: 2496 B-34 patients contributed tumor samples (from 2001-2004), of whom 1883 (75%) were evaluable (947 placebo and 936 clodronate). 1515 (80%) tumors were MAF negative (766 placebo and 749 clodronate) and 368 were MAF positive. At median follow-up of 108 months, MAF was prognostic for DFS, OS and bone-metastasis-free survival in the control group (MAF-positive vs MAF-negative: HRDFS=1·39, 95%CI 1·01-1·92; p=0.045; HROS=1·59, 95%CI 1·08-2·33; p=0.018; HRBM=2·03, 95%CI 1·13-3·68; p=0.016). In patients with MAF-negative tumors, clodronate gave higher DFS and OS than controls at 60 months (HRDFS=0·70, 95%CI 0·51-0·94; p=0.020 and HROS=0·59, 95%CI 0·37-0·93; p=0.024), the latter maintained through follow-up (HROS=0·74, 95%CI 0·54-1.00; p=0.047), but not in patients with MAF-positive tumors - consistent with previous AZURE results. Conclusions: MAF benefit prediction from adjuvant bisphosphonates was confirmed using specimens from 2 randomized clinical trials (AZURE and NSABP-B-34) conducted and analyzed in similar manner using the same validated tests and clinical endpoints. These results are evidence towards introducing MAF testing into clinical practice.

scholarly journals Perfusion reduction in the absence of structural differences in cognitively impaired versus unimpaired RRMS patients

2016 ◽  
Vol 22 (13) ◽  
pp. 1685-1694 ◽  
Author(s):  
Seyed-Parsa Hojjat ◽  
Charles Grady Cantrell ◽  
Timothy J Carroll ◽  
Rita Vitorino ◽  
Anthony Feinstein ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Depression Scale ◽  
Cognitive Testing ◽  
Cognitively Impaired ◽  
Lesion Volume ◽  
Structural Differences ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Background: Cognitive impairment affects 40%–68% of relapsing-remitting multiple sclerosis (RRMS) patients. Gray matter (GM) demyelination is complicit in cognitive impairment, yet cortical lesions are challenging to image clinically. We wanted to determine whether cortical cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) differences exist between cognitively impaired (CI) and unimpaired (NI) RRMS. Methods: Prospective study of healthy controls ( n = 19), CI ( n = 20), and NI ( n = 19) undergoing magnetic resonance imaging (MRI) and cognitive testing <1 week apart. White matter (WM) T2 hyperintense lesions and T1 black holes were traced. General linear regression assessed the relationship between lobar WM volume and cortical and WM CBF, CBV, and MTT. Relationship between global and lobar cortical CBF, CBV, and MTT and cognitive impairment was tested using a generalized linear model. Adjusted Bonferroni p < 0.005 was considered significant. Results: No significant differences for age, gender, disease duration, and any fractional brain or lesion volume were demonstrated for RRMS subgroups. Expanded Disability Status Scale (EDSS) and Hospital Anxiety and Depression Scale–Depression (HADS-D) were higher in CI. Lobar cortical CBF and CBV were associated with cognitive impairment ( p < 0.0001) after controlling for confounders. Cortical CBV accounted for 7.2% of cognitive impairment increasing to 8.7% with cortical CBF ( p = 0.06), while WM and cortical CBF accounted for 8.2% of variance ( p = 0.04). Conclusion: Significant cortical CBF and CBV reduction was present in CI compared to NI in the absence of structural differences.

Longitudinal Effects of Early Literacy Concepts on Reading Achievement: A Kindergarten Intervention and Five-Year Follow-up

1996 ◽  
Vol 28 (1) ◽  
pp. 173-195 ◽  
Author(s):  
Linda M. Phillips ◽  
Stephen P. Norris ◽  
Jana M. Mason
Keyword(s):  
Reading Achievement ◽  
Early Literacy ◽  
Literacy Intervention ◽  
Control Group ◽  
Control Group Design ◽  
Language Program ◽  
Treatment Groups ◽  
Longitudinal Effects ◽  
At Home

The effects of a literacy intervention in kindergarten were measured using a control-group design. Three treatment groups were taught using beginning-reading booklets to complement the authorized language program. One group used the booklets at home; the second, both in school and at home; and the third, in school only. Data were gathered at the beginning of kindergarten and at the end of kindergarten, first, second, third, and fourth grades. Results indicated that children's knowledge of early literacy concepts increased during kindergarten, and that this improved students' reading achievement for the next 4 years. Effects were strongest and longest lasting for the in-school group.

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