scholarly journals The Cortical Response Evoked by Robotic Wrist Perturbations Reflects Level of Proprioceptive Impairment After Stroke

2021 ◽  
Vol 15 ◽  
Author(s):  
Joost van Kordelaar ◽  
Mark van de Ruit ◽  
Teodoro Solis-Escalante ◽  
Leo A. M. Aerden ◽  
Carel G. M. Meskers ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Predictive Value ◽  
Signal To Noise Ratio ◽  
Cortical Response ◽  
Predictive Values ◽  
Clinical Assessments ◽  
Significant Difference ◽  
Cortical Responses ◽  
Robotic Wrist

Background: Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalography (EEG) may be an objective method to support current clinical assessments of proprioception.Objective: To establish whether evoked cortical responses reflect proprioceptive deficits as assessed by clinical scales and whether they predict upper extremity motor function at 26 weeks after stroke.Methods: Thirty-one patients with stroke were included. In week 1, 3, 5, 12, and 26 after stroke, the upper extremity sections of the Erasmus modified Nottingham Sensory Assessment (EmNSA-UE) and the Fugl-Meyer Motor Assessment (FM-UE) and the EEG responses (64 channels) to robotic wrist perturbations were measured. The extent to which proprioceptive input was conveyed to the affected hemisphere was estimated by the signal-to-noise ratio (SNR) of the evoked response. The relationships between SNR and EmNSA-UE as well as SNR and time after stroke were investigated using linear regression. Receiver-operating-characteristic curves were used to compare the predictive values of SNR and EmNSA-UE for predicting whether patients regained some selective motor control (FM-UE > 22) or whether they could only move their paretic upper extremity within basic limb synergies (FM-UE ≤ 22) at 26 weeks after stroke.Results: Patients (N = 7) with impaired proprioception (EmNSA-UE proprioception score < 8) had significantly smaller SNR than patients with unimpaired proprioception (N = 24) [EmNSA-UE proprioception score = 8, t(29) = 2.36, p = 0.03]. No significant effect of time after stroke on SNR was observed. Furthermore, there was no significant difference in the predictive value between EmNSA-UE and SNR for predicting motor function at 26 weeks after stroke.Conclusion: The SNR of the evoked cortical response does not significantly change as a function of time after stroke and differs between patients with clinically assessed impaired and unimpaired proprioception, suggesting that SNR reflects persistent damage to proprioceptive pathways. A similar predictive value with respect to EmNSA-UE suggests that SNR may be used as an objective predictor next to clinical sensory assessments for predicting motor function at 26 weeks after stroke.

Predictive value of time-variant color-coded multiphase CT angiography (mCTA) regarding clinical outcome of acute ischemic stroke: in comparison with conventional mCTA and CT perfusion

2020 ◽  
pp. 028418512098177
Author(s):  
Yu Lin ◽  
Nannan Kang ◽  
Jianghe Kang ◽  
Shaomao Lv ◽  
Jinan Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Multivariate Logistic Regression Model ◽  
Infarct Core ◽  
Predictive Values ◽  
Significant Difference ◽  
Core Volume

Background Color-coded multiphase computed tomography angiography (mCTA) can provide time-variant blood flow information of collateral circulation for acute ischemic stroke (AIS). Purpose To compare the predictive values of color-coded mCTA, conventional mCTA, and CT perfusion (CTP) for the clinical outcomes of patients with AIS. Material and Methods Consecutive patients with anterior circulation AIS were retrospectively reviewed at our center. Baseline collateral scores of color-coded mCTA and conventional mCTA were assessed by a 6-point scale. The reliabilities between junior and senior observers were assessed by weighted Kappa coefficients. Receiver operating characteristic (ROC) curves and multivariate logistic regression model were applied to evaluate the predictive capabilities of color-coded mCTA and conventional mCTA scores, and CTP parameters (hypoperfusion and infarct core volume) for a favorable outcome of AIS. Results A total of 138 patients (including 70 cases of good outcomes) were included in our study. Patients with favorable prognoses were correlated with better collateral circulations on both color-coded and conventional mCTA, and smaller hypoperfusion and infarct core volume (all P < 0.05) on CTP. ROC curves revealed no significant difference between the predictive capability of color-coded and conventional mCTA ( P = 0.427). The predictive value of CTP parameters tended to be inferior to that of color-coded mCTA score (all P < 0.001). Both junior and senior observers had consistently excellent performances (κ = 0.89) when analyzing color-coded mCTA maps. Conclusion Color-coded mCTA provides prognostic information of patients with AIS equivalent to or better than that of conventional mCTA and CTP. Junior radiologists can reach high diagnostic accuracy when interpreting color-coded mCTA images.

The Forced Active Buckling Sign: A New Clinical Test for the Diagnosis of ACL Insufficiency

2018 ◽  
Vol 33 (01) ◽  
pp. 042-047
Author(s):  
Fabian Blanke ◽  
Maximilian Haenle ◽  
Andreas Feitenhansl ◽  
Stephan Vogt ◽  
Carlo Camathias
Keyword(s):  
Predictive Value ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Sign Test ◽  
Pivot Shift Test ◽  
Clinical Test ◽  
Diagnostic Study ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Significant Difference

AbstractAlthough insufficiency of the anterior cruciate ligament (ACL) is a frequent result of an injury, validated tests are associated with unsatisfying validity. Moreover, some of these tests are not easy to perform and patient's muscular resistance often limits their reliability. Therefore, with this study, we want to design an accurate test to diagnose an ACL insufficiency, which is independent of the assessor's skills and overcome any muscular resistance. Fifty patients with an isolated ACL rupture (group A; age 26.4 years ± 14.9 standard deviation [SD]; female, n = 15) and additional 50 patients with an intact ACL but meniscal lesions (group B; age 45.4 years ± 12.9 SD; female, n = 23) were consecutively included in this study. The integrity of the ACL and the menisci were evaluated by magnetic resonance imaging and verified arthroscopically. Two orthopaedic surgeons performed a pivot shift test, a Lachman's test, and our new “forced active buckling” (FAB)-sign test in all patients. The surgeons were blinded for the pathology of the knee and we randomized the tests for each patient and examiner. The sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios with confidence intervals were calculated and compared. With a prevalence of 0.5, the FAB-sign test revealed the best overall sensitivity of 0.78 compared with the Lachman's and pivot shift tests of 0.74 and 0.46, respectively. Also, the overall specificity of the FAB-sign test of 0.95 was higher than the Lachman's test of 0.83, however, comparable to the pivot shift test of 0.96. The FAB-sign test demonstrated the best positive and negative predictive values of 0.94 and 0.81. There was no significant difference between the two examiners concerning the accuracy of results in each test (p = 0.83). This study shows that the introduced FAB-sign test can detect an ACL insufficiency more sensitive and more specific compared to the pivot shift and Lachman's tests in the subacute phase. This is a randomized controlled diagnostic study, level 1b.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke

2020 ◽  
pp. 1-9
Author(s):  
Humera Ambreen ◽  
Hina Tariq ◽  
Imran Amjad
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Recovery Of Function ◽  
Hand Function ◽  
Group Analysis ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Beneficial Effects ◽  
Significant Difference ◽  
Bilateral Arm Training

Abstract Objective: This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. Methods: Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. Results: Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). Conclusion: Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement. Key Words: Stroke, Upper extremity, Recovery of function, Bilateral arm training. Continuous...

scholarly journals Screening Tests for Predicting Difficult Intubation. A Clinical Assessment in Turkish Patients

1998 ◽  
Vol 26 (4) ◽  
pp. 382-386 ◽  
Author(s):  
H. Bilgin ◽  
G. Özyurt
Keyword(s):  
Positive Predictive Value ◽  
Difficult Intubation ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Screening Tests ◽  
Sensitive Test ◽  
Predictive Values ◽  
Significant Difference ◽  
Turkish Patients

Three methods of predicting difficult intubation were compared prospectively. Mallampati test, Wilson risk-sum and thyromental distance were determined preoperatively and laryngeal views were graded in 500 patients. The sensitivities, specificities, positive and negative predictive values of each test were calculated. The incidence of difficult intubation was found to be 8%. The sensitivities of the Mallampati test, the Wilson risk-sum and the thyromental distance were 43%, 58% and 35% respectively, and the specificities were 93%, 91% and 95% respectively. Significant differences were seen between the sensitivities of the Mallampati test and the Wilson risk-sum (P<0.001), the Wilson risk-sum and the thyromental distance (P<0.001), the Mallampati test and the thyromental distance (P<0.05). Among the different specificities, the only significant difference was observed between the Wilson risk-sum and the thyromental distance (P<0.05). There were no significant differences between the positive and negative predictive values of the three screening tests (P>0.05). In conclusion, the Wilson risk-sum was the most sensitive test and the thyromental distance has the highest positive predictive value for difficult intubation.

scholarly journals Low serum apolipoprotein A 1 is an indicator of severity in patients with coronavirus disease 2019

2020 ◽  
Author(s):  
Yayun Yang ◽  
Zhe Zhu ◽  
Lingyan Fan ◽  
Shuyuan Ye ◽  
Kehong Lou ◽  
...  
Keyword(s):  
Predictive Value ◽  
Risk Model ◽  
Laboratory Data ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
Apolipoprotein A1 ◽  
Lipoprotein Cholesterol ◽  
Predictive Values ◽  
Significant Difference ◽  
Severe Group

Abstract Background: Recently, dyslipidaemia was observed in patients with coronavirus disease 2019 (COVID-19), especially in severe cases. This study aimed to explore the predictive value of blood lipid levels for COVID-19 severity.Methods: All patients with COVID-19 admitted to HwaMei Hospital, University of Chinese Academy of Sciences, from January 23 to April 20, 2020, were included in this retrospective study. General clinical characteristics and laboratory data (including blood lipid parameters) were obtained, and their predictive values for the severity were analysed.Results: In total, 142 consecutive patients with COVID-19 were included. The non-severe group included 125 cases, and 17 cases were included in the severe group. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein A1 (ApoA1) at baseline were significantly lower in the severe group. ApoA1 and interleukin-6 (IL-6) were recognized as independent risk factors for COVID-19 severity. ApoA1 had the highest area under the receiver operator characteristic curve (AUC) among all the single markers (AUC: 0.896, 95% CI: 0.834-0.941). Moreover, the risk model established using ApoA1 and IL-6 enhanced the predictive value (AUC: 0.977, 95% CI: 0.932-0.995). On the other hand, ApoA1 levels were elevated in the severe group during treatment, and there was no significant difference between the severe and non-severe groups during the recovery stage of the disease.Conclusion: The blood lipid profile in severe COVID-19 patients is quite different from that in non-severe cases. Serum ApoA1 could severe as a good indictor to reflect the severity of COVID-19.

scholarly journals Predictive value of hepatic transaminases during febrile phase as a predictor of a severe form of Dengue: analysis of adult Dengue patients from a tertiary care setting of Sri Lanka

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dickowita Kankanamge Dilani Priyangika ◽  
Gayani Premawansa ◽  
Madura Adikari ◽  
Sharmila Thillainathan ◽  
Sunil Premawansa ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Predictive Value ◽  
Large Scale ◽  
Severe Disease ◽  
Tertiary Care ◽  
Roc Curves ◽  
Severe Form ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Significant Difference

Abstract Objectives Dengue viral infection is an ongoing epidemic in Sri Lanka, causing significant mortality and morbidity. A descriptive-analytical study was carried out using serologically confirmed Dengue patients during a 6 month period. The relationship between the elevation of hepatic enzymes and severity of Dengue was assessed after stratifying recorded maximum AST/ALT (SGOT/SGPT) values 2–15 times elevated and by the phases of the illness. Sensitivity, specificity, predictive values, and ROC curves were assessed using maximum values for AST and ALT. Results Out of 255 patients, 107(42%) were females. The majority (52.9%) were in the 20–39 year age group. Only 19.6% had DHF. No statistically significant difference was noticed in the values of maximum transaminases during the febrile phase among DF and DHF patients. Higher sensitivity and low specificity with the 1–5 times elevation range was noticed, and a higher cut-off level of more than 5 times elevation showed low sensitivity and higher specificity. The combination of both transaminases cut-offs with age and sex also does not show clinically significant predictability of severe disease. The AST and ALT elevations are not showing discriminatory predictive value on dengue severity. As different serotypes cause different epidemics, it is important to carry out large-scale specific studies considering the serotypes.

Predictive Value of Decreasing Antithrombin III in Deep-Vein Thrombosis

1980 ◽  
Vol 44 (03) ◽  
pp. 135-137 ◽  
Author(s):  
Thorkild Lund Andreasen
Keyword(s):  
Deep Vein Thrombosis ◽  
Predictive Value ◽  
Coronary Care Unit ◽  
Antithrombin Iii ◽  
Predictive Values ◽  
Vein Thrombosis ◽  
At Iii ◽  
Coronary Care ◽  
Time Of Admission ◽  
Deep Vein

SummaryAntithrombin III (At-III) was measured at the time of admission and two days later in 131 patients laid up in a coronary care unit. The patients were examined for deep-vein thrombosis (DVT) clinically and by means of 125I-fibrinogen scanning. 19 patients developed DVT. In 11 subjects with and 25 without DVT At-III decreased more than 10%. And in 7 with and 17 without DVT At-III decreased more than 15%. One person with DVT had subnormal At-III. By using decrease of At-III or subnormal initial At-III to predict DVT the following predictive value (PV) were found. Decrease ≤ 10%, PV pos.= 0.32 and PV neg. = 0.93. Decrease ≤ 15%, PV pos. = 0.32 and PV neg. = 0.90. The positive predictive values obtained were too low to let decreasing At-III give occasion for prophylactic anticoagulant treatment.

Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping

2020 ◽  
Vol 132 (4) ◽  
pp. 1188-1196 ◽  
Author(s):  
Tobias Greve ◽  
Veit M. Stoecklein ◽  
Franziska Dorn ◽  
Sophia Laskowski ◽  
Niklas Thon ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Predictive Value ◽  
Neurological Outcome ◽  
Positive Impact ◽  
Case Series ◽  
Intraoperative Neuromonitoring ◽  
Neurosurgical Procedures ◽  
Long Term Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

OBJECTIVEIntraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure.METHODSThe dates of inclusion in the study were 2007–2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007–2010) and after introduction of IOM (n = 138, IOM-group; 2011–2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification.RESULTSThere was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%.CONCLUSIONSThe assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.

Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Receiver Operating Curve ◽  
Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

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