scholarly journals Evaluation and Prediction of Post-stroke Cerebral Edema Based on Neuroimaging

2022 ◽  
Vol 12 ◽  
Author(s):  
Xiaocheng Zhang ◽  
Peiyu Huang ◽  
Ruiting Zhang
Keyword(s):  
Cerebral Edema ◽  
Early Identification ◽  
Functional Outcomes ◽  
Evidence Based ◽  
Common Complication ◽  
Midline Shift ◽  
Negative Effects ◽  
Intensive Monitoring ◽  
Underlying Mechanisms ◽  
Review Current

Cerebral edema is a common complication of acute ischemic stroke that leads to poorer functional outcomes and substantially increases the mortality rate. Given that its negative effects can be reduced by more intensive monitoring and evidence-based interventions, the early identification of patients with a high risk of severe edema is crucial. Neuroimaging is essential for the assessment and prediction of edema. Simple markers, such as midline shift and hypodensity volume on computed tomography, have been used to evaluate edema in clinical trials; however, advanced techniques can be applied to examine the underlying mechanisms. In this study, we aimed to review current imaging tools in the assessment and prediction of cerebral edema to provide guidance for using these methods in clinical practice.

scholarly journals Biomarkers for sepsis: past, present and future

2016 ◽  
Vol 10 (4) ◽  
pp. 301 ◽  
Author(s):  
Giuseppe Chesi ◽  
Natale Vazzana ◽  
Claudio Giumelli
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Supportive Care ◽  
Early Identification ◽  
Antibiotic Stewardship ◽  
Treatment Strategies ◽  
Severe Infection ◽  
Antibiotic Use ◽  
Evidence Based ◽  
Drug Resistant

Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients.

Can Complexity Move UK Policy beyond ‘Evidence-Based Policy Making’ and the ‘Audit Culture’? Applying a ‘Complexity Cascade’ to Education and Health Policy

2011 ◽  
Vol 60 (1) ◽  
pp. 20-43 ◽  
Author(s):  
Robert Geyer
Keyword(s):  
Health Policy ◽  
Policy Making ◽  
Policy Response ◽  
Evidence Based ◽  
Visual Metaphor ◽  
Negative Effects ◽  
Audit Culture ◽  
Education And Health ◽  
Evidence Based Policy ◽  
The Uk

For much of the twentieth century UK public policy has been based on a strong centralist, rationalist and managerialist framework. This orientation was significantly amplified by New Labour in the 1990s and 2000s, leading to the development of ‘evidence-based policy making’ (EBPM) and the ‘audit culture’ – a trend that looks set to continue under the current government. Substantial criticisms have been raised against the targeting/audit strategies of the audit culture and other forms of EBPM, particularly in complex policy areas. This article accepts these criticisms and argues that in order to move beyond these problems one must not only look at the basic foundation of policy strategies, but also develop practical alternatives to those strategies. To that end, the article examines one of the most basic and common tools of the targeting/audit culture, the aggregate linear X-Y graph, and shows that when it has been applied to UK education policy, it leads to: (1) an extrapolation tendency; (2) a fluctuating ‘crisis–success' policy response process; and (3) an intensifying targeting/auditing trend. To move beyond these problems, one needs a visual metaphor which combines an ability to see the direction of policy travel with an aspect of continual openness that undermines the extrapolation tendency, crisis–success policy response and targeting/auditing trend. Using a general complexity approach, and building on the work of Geyer and Rihani, this article will attempt to show that a ‘complexity cascade’ tool can be used to overcome these weaknesses and avoid their negative effects in both education and health policy in the UK.

scholarly journals Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Paul Hoogervorst ◽  
Tess van Dam ◽  
Nico Verdonschot ◽  
Gerjon Hannink
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Intramedullary Fixation ◽  
Common Complication ◽  
Fixation Device ◽  
Operative Strategy ◽  
Fixation Devices ◽  
Clavicle Fractures

Abstract Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures (DMCF) using plate osteosynthesis, is internal fixation by means of intramedullary fixation devices. These devices differ considerably in their specifications and characteristics. The aim of this systematic review is to generate an overview of functional outcomes and complications in the management of DMCF per available intramedullary device.Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group.Results Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively (GRADE High). The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are most common (GRADE Moderate). For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35) (GRADE Low). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases (GRADE Very low). Conclusion Although most studies were of low quality, good functional results and union rates irrespective of the type of device are found. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

Early Detection of Learning Problems: Questions, Cautions, and Guidelines

1973 ◽  
Vol 40 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Barbara K. Keogh ◽  
Laurence D. Becker
Keyword(s):  
At Risk ◽  
Early Detection ◽  
Young Children ◽  
Early Identification ◽  
Research Literature ◽  
Learning Problems ◽  
Negative Effects ◽  
Short Term ◽  
Screening Techniques ◽  
Functional Aspects

Assumptions underlying programs of early identification of young children viewed as educationally “at risk” are reviewed in terms of the research literature relevant to questions of validity of identifying or screening techniques, implications of recognition for remediation, and possible compounding negative effects of early identification. Guidelines for development and implementation of programs of early detection are proposed. Recommendations include emphasis upon techniques which are short term and educationally oriented and which are based on functional aspects of children's behavior in classroom settings.

Before the Mining Begins

2010 ◽  
pp. 1-20
Author(s):  
Dries Verlet ◽  
Carl Devos
Keyword(s):  
Data Mining ◽  
Public Sector ◽  
Policy Evaluation ◽  
Reliable Data ◽  
Solid Base ◽  
Evidence Based ◽  
Negative Effects ◽  
The Public ◽  
Measurement Systems ◽  
The Right

Although policy evaluation has always been important, today there is a rising attention for policy evaluation in the public sector. In order to provide a solid base for the so-called evidence-based policy, valid en reliable data are needed to depict the performance of organisations within the public sector. Without a solid empirical base, one needs to be very careful with data mining in the public sector. When measuring performance, several unintended and negative effects can occur. In this chapter, the authors focus on a few common pitfalls that occur when measuring performance in the public sector. They also discuss possible strategies to prevent them by setting up and adjusting the right measurement systems for performance in the public sector. Data mining is about knowledge discovery. The question is: what do we want to know? What are the consequences of asking that question?

scholarly journals Gut Microbial Metabolites and Biochemical Pathways Involved in Irritable Bowel Syndrome: Effects of Diet and Nutrition on the Microbiome

2019 ◽  
Vol 150 (5) ◽  
pp. 1012-1021 ◽  
Author(s):  
Shanalee C James ◽  
Karl Fraser ◽  
Wayne Young ◽  
Warren C McNabb ◽  
Nicole C Roy
Keyword(s):  
Irritable Bowel Syndrome ◽  
Metabolic Pathways ◽  
Critical Discussion ◽  
Microbial Metabolites ◽  
Dietary Interventions ◽  
Negative Effects ◽  
Gut Function ◽  
Underlying Mechanisms ◽  
Irritable Bowel ◽  
The Impact

ABSTRACT The food we consume and its interactions with the host and their gut microbiota affect normal gut function and health. Functional gut disorders (FGDs), including irritable bowel syndrome (IBS), can result from negative effects of these interactions, leading to a reduced quality of life. Certain foods exacerbate or reduce the severity and prevalence of FGD symptoms. IBS can be used as a model of perturbation from normal gut function with which to study the impact of foods and diets on the severity and symptoms of FGDs and understand how critical processes and biochemical mechanisms contribute to this impact. Analyzing the complex interactions between food, host, and microbial metabolites gives insights into the pathways and processes occurring in the gut which contribute to FGDs. The following review is a critical discussion of the literature regarding metabolic pathways and dietary interventions relevant to FGDs. Many metabolites, for example bile acids, SCFAs, vitamins, amino acids, and neurotransmitters, can be altered by dietary intake, and could be valuable for identifying perturbations in metabolic pathways that distinguish a “normal, healthy” gut from a “dysfunctional, unhealthy” gut. Dietary interventions for reducing symptoms of FGDs are becoming more prevalent, but studies investigating the underlying mechanisms linked to host, microbiome, and metabolite interactions are less common. Therefore, we aim to evaluate the recent literature to assist with further progression of research in this field.

scholarly journals Bexarotene normalizes chemotherapy-induced myelin decompaction and reverses cognitive and sensorimotor deficits in mice

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Angie C. A. Chiang ◽  
Alexandre V. Seua ◽  
Pooja Singhmar ◽  
Luis D. Arroyo ◽  
Rajasekaran Mahalingam ◽  
...  
Keyword(s):  
Sensorimotor Cortex ◽  
Ultrastructural Level ◽  
Term Treatment ◽  
Synaptic Function ◽  
Axonal Guidance ◽  
Sensorimotor Function ◽  
Negative Effects ◽  
Short Term Treatment ◽  
Canonical Pathways ◽  
Underlying Mechanisms

AbstractFrequently reported neurotoxic sequelae of cancer treatment include cognitive deficits and sensorimotor abnormalities that have long-lasting negative effects on the quality of life of an increasing number of cancer survivors. The underlying mechanisms are not fully understood and there is no effective treatment. We show here that cisplatin treatment of mice not only caused cognitive dysfunction but also impaired sensorimotor function. These functional deficits are associated with reduced myelin density and complexity in the cingulate and sensorimotor cortex. At the ultrastructural level, myelin abnormalities were characterized by decompaction. We used this model to examine the effect of bexarotene, an agonist of the RXR-family of nuclear receptors. Administration of only five daily doses of bexarotene after completion of cisplatin treatment was sufficient to normalize myelin density and fiber coherency and to restore myelin compaction in cingulate and sensorimotor cortex. Functionally, bexarotene normalized performance of cisplatin-treated mice in tests for cognitive and sensorimotor function. RNAseq analysis identified the TR/RXR pathway as one of the top canonical pathways activated by administration of bexarotene to cisplatin-treated mice. Bexarotene also activated neuregulin and netrin pathways that are implicated in myelin formation/maintenance, synaptic function and axonal guidance. In conclusion, short term treatment with bexarotene is sufficient to reverse the adverse effects of cisplatin on white matter structure, cognitive function, and sensorimotor performance. These encouraging findings warrant further studies into potential clinical translation and the underlying mechanisms of bexarotene for chemobrain.

scholarly journals Neural Stem Cell Extracellular Vesicles Disrupt Midline Shift Predictive Outcomes in Porcine Ischemic Stroke Model

2019 ◽  
Vol 11 (4) ◽  
pp. 776-788 ◽  
Author(s):  
Samantha E. Spellicy ◽  
Erin E. Kaiser ◽  
Michael M. Bowler ◽  
Brian J. Jurgielewicz ◽  
Robin L. Webb ◽  
...  
Keyword(s):  
Stem Cell ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Neural Stem Cell ◽  
Functional Outcomes ◽  
Extracellular Vesicle ◽  
Stroke Model ◽  
Midline Shift ◽  
Post Stroke ◽  
Non Invasive

AbstractMagnetic resonance imaging (MRI) is a clinically relevant non-invasive imaging tool commonly utilized to assess stroke progression in real time. This study investigated the utility of MRI as a predictive measure of clinical and functional outcomes when a stroke intervention is withheld or provided, in order to identify biomarkers for stroke functional outcome under these conditions. Fifteen MRI and ninety functional parameters were measured in a middle cerebral artery occlusion (MCAO) porcine ischemic stroke model. Multiparametric analysis of correlations between MRI measurements and functional outcome was conducted. Acute axial and coronal midline shift (MLS) at 24 h post-stroke were associated with decreased survival and recovery measured by modified Rankin scale (mRS) and were significantly correlated with 52 measured acute (day 1 post) and chronic (day 84 post) gait and behavior impairments in non-treated stroked animals. These results suggest that MLS may be an important non-invasive biomarker that can be used to predict patient outcomes and prognosis as well as guide therapeutic intervention and rehabilitation in non-treated animals and potentially human patients that do not receive interventional treatments. Neural stem cell–derived extracellular vesicle (NSC EV) was a disruptive therapy because NSC EV administration post-stroke disrupted MLS correlations observed in non-treated stroked animals. MLS was not associated with survival and functional outcomes in NSC EV–treated animals. In contrast to untreated animals, NSC EVs improved stroked animal outcomes regardless of MLS severity.

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