Cortical gamma-synchrony measured with magnetoencephalography is a marker of clinical status and predicts clinical outcome in stroke survivors

Background:Quality of life (QoL) is considered an important outcome in the treatment of schizophrenia and is linked with clinical and social recovery. Until recently treatments of schizophrenia have focused mainly on reducing positive symptoms, often leaving patients with numerous residual difficulties. It's been expected that atypical antipsychotics improve QoL equally as they improve clinical outcome of the patients with schizophrenia.Objectives:To compare clinical improvement and QoL of patients treated with risperidone and clozapine two months after the beginning of treatment.Methods:The sample included 40 patients (17 males and 23 females, mean age 33.1) with diagnosis of schizophrenia according to ICD-X. the patients were treated with either risperidone (n=20) or clozapine (n=20). the PANSS and CGI scales for clinical status were applied at the beginning of the treatment and two months later. the QoL was assessed by the WHOQOL-BREF.Results:Analysis of data has shown a significant difference for all four domains (physical, psychological, social relationships and environment) at WHOQOL-BREF scale for both medications after two months, but no difference between the two antipsychotics. the patients treated with clozapine had significantly higher scores on PANSS at the beginning of treatment. PANSS and CGI applied after two months have not shown differences between the medications.Conclusion:Both clozapine and risperidone had equal and statistically significant effect in reducing the symptoms of schizophrenia measured by PANSS and CGI in two months period, as well as in improving the quality of life. However no difference was found between the two medications.

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Treatment of Vertebral Artery Origin Stenosis with a Pharos Stent Device: A Single Center Experience

Interventional Neuroradiology ◽

10.1177/159101991101700306 ◽

2011 ◽

Vol 17 (3) ◽

pp. 316-322 ◽

Cited By ~ 2

Author(s):

E. Broussalis ◽

A.B. Kunz ◽

G. Luthringshausen ◽

S. Klein ◽

M.R. McCoy ◽

...

Keyword(s):

Magnetic Resonance ◽

Clinical Outcome ◽

Vertebral Artery ◽

Clinical Status ◽

Magnetic Resonance Tomography ◽

Clinical Results ◽

Stent Restenosis ◽

Atherosclerotic Stenosis ◽

One Year ◽

In Stent Restenosis

Atherosclerotic stenosis of vertebral artery (VA) origin exceeding 70% severity accounts for one third of all vertebrobasilar strokes. For a period of one year the results of endovascular treatment of VA stenosis with the new Pharos stent device were assessed. Twenty-two patients with symptomatic VA stenosis were treated with the Pharos stent. Clinical status and stenosis grade were documented before treatment and 24 hours, one, three and twelve months after treatment via ultrasound and magnetic resonance tomography. All procedures proved to be technically successful without the occurrence of intra-procedural complications. During the observation period of more than one year, 55% of patients were documented with a mean stenosis degree of 60%: two (10%) of these patients showed a residual stenosis after angioplasty and nine patients (45%) an in-stent restenosis, whereas only two patients were documented with a hemodynamically relevant in-stent restenosis of 80%. These two patients were retreated with balloon dilatation. None of the patients showed neurological deterioration or new abnormalities at magnetic resonance tomography examination. Neither VA occlusion nor restenosis of the contralateral VA negatively affected the clinical outcome. An in-stent restenosis was developed by more female than male patients. VA origin stenting with the Pharos stent device is an effective treatment of stenosis. The good clinical results compared to the high restenosis rates have to be examined in further studies. Pin particular, it has to be determined whether the Pharos stent allows the vessel time for collateralization, whether double antiplatelet treatment prevents recurrent cerebrovascular events or whether merely the low restenosis degree is causative for the clinical outcome.

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Clinical Validation of Kinematic Assessments of Post-Stroke Upper Limb Movements with a Multi-Joint Arm Exoskeleton

10.21203/rs.3.rs-52210/v1 ◽

2020 ◽

Author(s):

Florian Grimm ◽

Jelena Kraugmann ◽

Georgios Naros ◽

Alireza Gharabaghi

Keyword(s):

Clinical Outcome ◽

Upper Limb ◽

Convergent Validity ◽

Degrees Of Freedom ◽

Clinical Status ◽

Multiple Regression Model ◽

Fine Grained ◽

Starting Position ◽

Upper Limb Function ◽

Upper Limb Movements

Abstract Background: Robotic and gravity-balancing exoskeletons, originally designed for the rehabilitation training of neurological patients, are now being increasingly applied in objective and fine-grained sensor-based assessments of upper limb function. However, gravity compensation, inertia and damping properties of the exoskeleton interfere with the natural sensorimotor interaction, proprioceptive and visual feedback during movement execution. This may endanger the validity of the kinematic assessments in relation to the clinical outcome measures that they were supposed to reflect. Here, we appliedMethods: In a proof of concept study involving nineteen severely impaired chronic stroke patients, we assessed sensor-based kinematic data acquired with a multi-joint arm exoskeleton and compared it to the clinical outcome measure Upper Extremity Fugl-Meyer Assessment (UE-FMA) scale. During this assessment, real-time movement feedback of the system’s seven degrees of freedom was provided with a biomorphic 3D virtual representation of the upper limb, including the proximal component of the arm. To align posture and to minimize the exoskeleton-patient interaction, the same position (neutral zero) with a distance of 90 degrees between forearm and upper arm was taken as the starting position for all assessments. Within self-contained tasks, we assessed separately and subsequently the range of motion/spatial posture of four single joints (i.e., joint angles of wrist, elbow, arm, and shoulder movement) and the closing and opening of the hand with a pressure sensor placed in the handle.Results: A strong correlation was observed between wrist and elbow movements within the kinematic parameters (r > 0.7, p<0.003; Bonferroni corrected). A multiple regression model predicted the UE-FMA significantly (F (5, 13) = 12.22, p < 0.0005, adj. R2 = 0.83). Both shoulder rotation and grip pressure added significantly (p < 0.05) to the prediction with the standardized coefficients β of 0.55 and 0.38, respectively.Conclusions: Exoskeleton-based evaluation of single-joint movements and grip force facilitates the assessment of upper limb kinematics after stroke with high structural and convergent validity. Proximal and distal measures may contribute independently to the prediction of the clinical status.

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Detection of Midline Shift from CT Scans to Predict Outcome in Patients with Head Injuries

International Journal of Biomedicine ◽

10.21103/article11(1)_oa3 ◽

2021 ◽

Vol 11 (1) ◽

pp. 18-23

Author(s):

Ikhlas Abdelaziz ◽

Rowa Aljondi ◽

Ali Alhailiy ◽

Mustafa Mahmoud

Keyword(s):

Clinical Outcome ◽

Brain Injuries ◽

Head Injuries ◽

Clinical Status ◽

Ct Scans ◽

Ct Scanner ◽

Midline Shift ◽

Medical Systems ◽

Gcs Score ◽

The Relationship

Background: The present study aimed to detect the degree of midline shift from CT scans and the clinical status of the patient, to evaluate the relationship between the degree of midline shift found by the CT scan and GCS score as a predictor of clinical outcome in head injury patients. Furthermore, we aimed to assess the relationship between midline shift and age, sex, and causes. Methods and Results: The study included 50 subjects (36 males and 14 females). The age range of the patients in this study was 18–95 years old (mean age of 48.34±17.02 years). The inclusion criteria were patients with traumatic brain injury (TBI) or patients evaluated for level of consciousness by a neurosurgeon. Toshiba 16 Slice CT scanner (Toshiba Medical Systems, Nasu, Japan 2003) was used to scan all patients in the supine, head first position. Contiguous 2 mm slices were obtained using the Toshiba 16-slice machine spiral technique (pitch 1.25–1.5, 0.75 s rotation time, 120 KvP, 2 mm reconstruction interval). The results indicated that the degree of midline shift in patients with brain injuries was statistically significant as a determinant of clinical outcome. It appeared that the probability of poor clinical outcome was higher when there was a combination of midline shift and other types of intracranial hemorrhage, clinical factors, such as sex, age, and GCS score, and associated injuries. The worst outcome was seen in patients with midline shift and subdural hematoma, when compared with other lesions in patients with brain injuries. Conclusion: This study suggests that the degree of midline shift may be predictive of clinical outcome in patients with head injuries.

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P3701Short-term decrease of left atrial size predicts clinical outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehz745.0555 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R De Rosa ◽

M.-I Murray ◽

D Schranz ◽

S Mas-Peiro ◽

A Esmaeili ◽

...

Keyword(s):

Aortic Valve ◽

Clinical Outcome ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Nyha Class ◽

Clinical Status ◽

Transcatheter Aortic Valve

Abstract Background Increased left atrium (LA) size is a hallmark of severe aortic stenosis (AS) and is associated with adverse patients' cardiovascular outcome. Whether transcatheter aortic valve replacement (TAVR) may lead to a decrease in LA size is not known. Aim: We investigated whether TAVR results in a short-term decrease in LA size and whether such decrease may predict patients' clinical outcome. Methods 104 consecutive patients with severe symptomatic AS and dilated LA undergoing TAVR were enrolled. LA volume was assessed by echocardiography before and shortly after TAVR (median time: 7 days). Composite rate of death and hospitalization for acutely decompensated heart failure (HF) was recorded and clinical status was assessed through NYHA- class evaluation at 12 months median follow-up. Results After TAVR, 49 patients (47%) demonstrated a decrease in LA volume. Despite a similar baseline NYHA class, patients with decrease in LA size had significant better improvement in clinical status respect to patients with unvaried LA size (NYHA post: 1.2±0.6 vs 1.8±1.1, p=0.001; NYHA reduction: −1.6±0.9 vs −0.9±1.0, p=0.002, respectively). Moreover, these patients had a significantly reduced rate of death or HF-hospitalization (4 vs 29%, p=0.001) and a significantly longer event-free-survival from Kaplan-Meier curves (p=0.003). COX regression analysis showed that, among echocardiographic parameters, decrease in LA-size was an independent predictor of clinical outcome (HR: 0.149, CI: 0.034–0.654, p=0.012). Conclusions The lack of decrease in LA size shortly after TAVR is associated with significantly higher rates of death and HF-hospitalization, as well as with impaired improvement in clinical status during long-term follow-up.

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Rectus Femoris Characteristics in Post Stroke Spasticity: Clinical Implications from Ultrasonographic Evaluation

Toxins ◽

10.3390/toxins12080490 ◽

2020 ◽

Vol 12 (8) ◽

pp. 490

Author(s):

Lucia Cosenza ◽

Alessandro Picelli ◽

Danila Azzolina ◽

Marco Alessandro Minetto ◽

Marco Invernizzi ◽

...

Keyword(s):

Clinical Outcome ◽

Botulinum Toxin Type A ◽

Muscle Thickness ◽

Rectus Femoris ◽

Botulinum Toxin Type ◽

Individual Variability ◽

Muscle Quality ◽

Stroke Survivors ◽

Unaffected Side ◽

Cross Sectional

In stroke survivors, rectus femoris (RF) spasticity is often implicated in gait pattern alterations such as stiff knee gait (SKG). Botulinum toxin type A (BoNT-A) is considered the gold standard for focal spasticity treatment. However—even if the accuracy of injection is crucial for BoNT-A efficacy—instrumented guidance for BoNT-A injection is not routinely applied in clinical settings. In order to investigate the possible implications of an inadequate BoNT-A injection on patients’ clinical outcome, we evaluated the ultrasound-derived RF characteristics (muscle depth, muscle thickness, cross-sectional area and mean echo intensity) in 47 stroke survivors. In our sample, we observed wide variability of RF depth in both hemiparetic and unaffected side of included patients (0.44 and 3.54 cm and between 0.25 and 3.16 cm, respectively). Moreover, our analysis did not show significant differences between treated and non-treated RF in stroke survivors. These results suggest that considering the inter-individual variability in RF muscle depth and thickness, injection guidance should be considered for BoNT-A treatment in order to optimize the clinical outcome of treated patients. In particular, ultrasound guidance may help the clinicians in the long-term follow-up of muscle quality.

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Clinical validation of kinematic assessments of post-stroke upper limb movements with a multi-joint arm exoskeleton

10.21203/rs.3.rs-52210/v2 ◽

2020 ◽

Author(s):

Florian Grimm ◽

Jelena Kraugmann ◽

Georgios Naros ◽

Alireza Gharabaghi

Keyword(s):

Clinical Outcome ◽

Range Of Motion ◽

Upper Limb ◽

Clinical Status ◽

Objective Evaluation ◽

Joint Space ◽

Multiple Regression Model ◽

Stroke Patients ◽

Starting Position ◽

Upper Limb Movements

Abstract BACKGROUND: The clinical evaluation of the upper limb of severely impaired stroke patient is challenging. Sensor-based assessments may allow for an objective evaluation of this patient population. This study investigated the validity of a device-assisted approach in comparison to the clinical outcome that it is supposed to reflect. METHODS: In nineteen severely impaired chronic stroke patients, we applied a gravity-compensating, multi-joint arm exoskeleton (Armeo Spring) and compared this sensor-based assessment with the clinical outcome measure Upper Extremity Fugl-Meyer Assessment (UE-FMA) scale. Specifically, we assessed separately and subsequently the range of motion in joint space for four single joints (i.e., angles of wrist, elbow, arm, and shoulder movement), and the closing and opening of the hand with a pressure sensor placed in the handle. The same position (neutral zero) with a distance of 90 degrees between forearm and upper arm was taken as the starting position for all assessments. RESULTS: Within the kinematic parameters, a strong correlation was observed between wrist and elbow movements (r > 0.7, p<0.003; Bonferroni corrected). The UE-FMA was significantly predicted by a multiple regression model (F (5, 13) = 12.22, p < 0.0005, adj. R2 = 0.83). Both shoulder rotation and grip pressure added significantly (p < 0.05) to the prediction with the standardized coefficients β of 0.55 and 0.38, respectively. CONCLUSIONS: By applying an exoskeleton-based self-contained evaluation of single-joint movements, a clinically valid assessment of the upper limb range of motion in severely impaired stroke patients is feasible. Shoulder rotation contributed most relevantly to the prediction of the clinical status. These findings need to be confirmed in a large, independent patient cohort.

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CLINICAL OUTCOME OF THORACOTOMY, ANTERIOR SPINAL DECOMPRESSION AND FIXATION WITH SCREWS AND RODS FOR DORSAL SPINE TUBERCULOSIS

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2015.5.2.671-676 ◽

1969 ◽

Vol 5 (2) ◽

pp. 671-676

Author(s):

BAKHT ZAR KHAN ◽

MUHAMMAD ISHFAQ ◽

NAEEM UL HAQ ◽

MUMTAZ ALI ◽

RAMZAN HUSSAIN ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Status ◽

Lower Limbs ◽

Dorsal Spine ◽

Spinal Decompression ◽

Transpedicular Approach ◽

Back Ache ◽

Spine Tuberculosis ◽

Age Range ◽

With Screws

BACKGROUND: The posterolateral or transpedicular approach has been used extensively for themanagement of spinal TB. This approach is a viable and importantly a safe surgical option for ventraldecompression in thoracic spine TB when followed by anti tuberculosis treatment for 18 months andimmobilization in an alkathene shell for 3 months.OBJECTIVE: To determine clinical outcome of thoracotomy, anterior spinal decompression andfixation with screws and rods for dorsal spine TB.MATERIAL AND METHODES: This observational prospective study was conducted inNeurosurgery Department Lady Reading Hospital Peshawar from Mar 2013 to March 2014. All patientsadmitted with dorsal spine tuberculosis and undergone thoracotomy, anterior spinal decompression andfixation with screws & rods were included in the study while those having unstable dorsal spine due tothe metabolic, neoplastic, traumatic pathologies & stable dorsal spine tuberculosis cases were excluded.Patients’ age, sex, addresses, level of dorsal spine tuberculosis, pre operative signs & symptoms, per &post op complications and post op variations in clinical status were recorded on a designed proforma.Minimum 6 months follow up was done. Data was analyzed by SPSS version 17 and expressed in theform of tables and charts.RESULTS: Total 24 patients were included in this study in which males and females were equal innumber. The age range was from 15 to 50 years and mean age was 31.5 ±3.8 years. Backward & hillyareas patients 15(62.5%) were on the top. D7,8,9 levels had highest frequency of involvement 45.83%(11) . Lower limbs weakness was present in all cases (100%) followed by back ache in 23 (95.8 %)while power >3/5,3/5 were noted in 22(75.4 %) followed by gibus formation in 29.3 % cases. Postoperative improvement in pain and power was 100%, 62.5 % while complications occurred in 4 (16.7%) cases having no mortalityCONCLUSIONS: Incidence of dorsal spine tuberculosis is more in backward hilly areas of KPKeffecting lower part of dorsal spine and great improvement in power of lower limbs & pain occurs afterthoracotomy, decompression, bone grafting with cage placement and fixation with screws and rods withacceptable mortality and morbidityKEY WORDS: Dorsal spine tuberculosis, Thoracotomy, Anterior spinal decompression & stabilizationwith screws and rods, clinical outcome.

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Significance of Extreme Temperament in Infancy for Clinical Status in Preschool Years

The British Journal of Psychiatry ◽

10.1192/bjp.154.4.535 ◽

1989 ◽

Vol 154 (4) ◽

pp. 535-543 ◽

Cited By ~ 35

Author(s):

Michel Maziade ◽

Robert Côté ◽

Hugues Bernier ◽

Pierrette Boutin ◽

Jacques Thivierge

Keyword(s):

Risk Factors ◽

General Population ◽

Clinical Outcome ◽

Middle Childhood ◽

Parental Attitudes ◽

Clinical Status ◽

Stressful Events ◽

Family Attitudes ◽

Direct Association ◽

The Relationship

The relationship between extreme temperament in infancy and clinical status at 4.7 years of age was studied in temperamentally different groups of infants matched for sex and SES, and subselected from a large birth cohort representative of the general population. The effects of certain dimensions of family functioning and of other risk factors were examined. By itself, extremely difficult temperament in infancy had no strong direct association with clinical outcome at four years of age, whereas temperament assessed at four, family attitudes to discipline, and stressful events did. However, extreme temperament in infancy might indirectly affect outcome through its association with temperament at four. The interplay between adverse temperament and parental attitudes of discipline previously observed in middle childhood might have antecedents in preschool years.

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Six-Month Clinical Status as a Predictor of 24-Month Clinical Outcome in First-Admission Patients with Schizophrenia

Annals of Clinical Psychiatry ◽

10.3109/10401239909147071 ◽

1999 ◽

Vol 11 (4) ◽

pp. 197-203 ◽

Cited By ~ 8

Author(s):

Thomas Craig ◽

Shmuel Fennig ◽

Marsha Tanenberg-Karant ◽

Evelyn Bromet

Keyword(s):

Clinical Outcome ◽

Clinical Status ◽

First Admission

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