Kajian Konsep Lund dan Konsep Rosner untuk Tatalaksana Cedera Otak Traumatik Berat

Tatalaksana pasien dengan cedera otak traumatik (COT) berat mengalami perubahan berkesinambungan selama 30 tahun terakhir. Tatalaksana yang diarahkan di unit perawatan intensif (intensive care unit/ICU) mengacu pada tatalaksana klinis sebagai titik akhir terapi utama, bertujuan untuk mempertahankan variabel fisiologis tertentu secara ketat dalam rentang target yang telah ditentukan. Satu alternatif terhadap terapi konvensional ini adalah konsep Lund yang mengutamakan penurunan tekanan mikrovaskular. Konsep Lund termasuk suatu strategi target volume untuk mengendalikan tekanan intrakranial, berasal dari Universitas Lund Swedia, lebih dari 27 tahun yang lalu dan tetap masih kontroversi sampai saat ini. Sejak tahun 1996, American Brain Trauma Foundation dan European Brain Injury Consortium, yang mengacu pada konsep Rosner, telah menerbitkan dan memperbarui panduan untuk tatalaksana cedera otak traumatik. Para ahli sangat menyadari adanya patologi intrakranial multifaktorial yang terlihat pada pasien COT berat dan kompleksitas mekanisme cedera otak sekunder setelah trauma primer, akan menemukan bahwa revisi ini sulit untuk dipahami. Hubungan antara peningkatan tekanan intrakranial (TIK) dan hasil luaran klinis yang lebih buruk sudah terbukti. Menyederhanakan fisiologi otak setelah COT berat ke strategi tatalaksana pasien bedasarkan ambang batas adalah berkaitan erat dengan hubungan interaksi komplek antara: peningkatan TIK, aliran darah otak, dan metabolisme otak. Review of Lund Concept and Rosner Concept for Therapy of Severe Traumatic Brain InjuryAbstractThe management of patients with severe traumatic brain injury (TBI) has undergone continuous changes over the past 30 years. Management directed at the intensive care unit (ICU) refers to clinical management as the main end point of therapy, aiming to maintain certain physiological variables strictly within a predetermined target range. One alternative to this conventional therapy is the Lund concept which prioritizes the reduction of microvascular pressure. The concept of Lund includes a volume target strategy for controlling intracranial pressure, from Lund University in Sweden, more than 27 years ago and remains controversial to date. Since 1996, the American Brain Trauma Foundation and the European Brain Injury Consortium, which refers to the Rosner concept, have published and updated guidelines for the management of traumatic brain injury. Experts are well aware of the multifactorial intracranial pathology seen in severe TBI patients and the complexity of the mechanism of secondary brain injury after primary trauma will find that this revision is difficult to understand. The relationship between increased intracranial pressure (ICP) and worse clinical outcome has been proven. Simplifying the physiology of the brain after severe TBI to the patient's management strategy based on the threshold is closely related to the relationship between complex interactions: increased ICP, cerebral blood flow (CBF), and brain metabolism.

COVID-19 will worsen southern European ‘brain drain’

The economic shock of COVID-19 on southern Europe will drive many more skilled people abroad in search of opportunity

Mind and the World in Modern European Sociology

This is a chapter that comprises an analysis of modern Western sociology and philosophy. It opens with a discussion of systems of knowledge as rulers of the world as opposed to systems of politics or religion and goes on to discuss modern ways of knowledge as they are institutionalized in the university, the structure of knowledge that emerged from the modern positivist dualism of the Enlightenment; the shared dualisms of fact and value, theory and practice, ends and means; the hierarchy of the sciences, the opposed sides of the European brain, empiricism, rationalism and dialectics in modern Western thought. There is extensive discussion of the three main streams of modern Western sociology as represented by Marx, Weber and Durkheim.

Working with others, the lesson of the European Brain Council

In neurological advocacy it has often been forgotten that we share interests with related specialties and basic science, as well as with patient organizations and industry. We are all working with the same organ, the brain, and its extensions in the spinal cord and the peripheral nervous system. When it comes to influencing at the highest level the European Union or the National Institutes of Health, it is important that all players work together to promote brain research and brain health. That was the aim of the European Brain Council, which successfully united everybody in Europe and managed to greatly improve the attention to brain research and brain diseases at the European level. While cancer and heart diseases have always worked closely together as major players, this was the first time that concerted action on behalf of the brain and its disorders took place and it was highly successful.

Occurrence of non-western magic in the European brain

ABSTRACTTimecourses that exhibit identical behaviour at distinct measurement occasions are reliable. Voodoo connectivity occurs when connectivity among brain regions exceeds within subject timecourse reliability. Thus, timecourse reliability limits the true detectable connectivity. We reproduced a working memory related connectome consisting of 561 paths obtained from 67 individuals. We tested >100000 fc-MRI pipelines and show that Savitzky Golay (SG) filters maximize true connectivity while conserving cognitively relevant changes of signals. This is noteworthy for approaches that focus on rapidly changing aspects of connectomes. Furthermore, SG filters detect zombie activity. These “resting state oscillations” are not under human control and contaminate working state signals. SPM pipelines exhibit more voodoo connectivity than SG pipelines. With the SPM pipeline, we observed a connectivity of r=0.44 and a poor true connectivity of r=0.23, but with the SG pipeline we observed a connectivity of r=0.59 and a fair true connectivity of r=0.43. The number of paths detected with fair true connectivity (r >0.4) was 4 for the SPM pipeline but 352 for the SG based pipeline. However, superior statistical properties of SG pipelines may not reflect neural reality. Hence, causal external validation of fc-MRI pipelines is crucial. Without such studies, different pipelines produce at best “alternative maps”.