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Kamran S, Akhtar N, Alboudi A, Kamran K, Ahmad A, Inshasi J, Salam A, Shuaib A, Qidwai U. Prediction of infarction volume and infarction growth rate in acute ischemic stroke. Sci Rep 2017; 7:7565. [PMID: 28790400 PMCID: PMC5548812 DOI: 10.1038/s41598-017-08044-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/28/2017] [Indexed: 12/01/2022] Open
Abstract
The prediction of infarction volume after stroke onset depends on the shape of the growth dynamics of the infarction. To understand growth patterns that predict lesion volume changes, we studied currently available models described in literature and compared the models with Adaptive Neuro-Fuzzy Inference System [ANFIS], a method previously unused in the prediction of infarction growth and infarction volume (IV). We included 67 patients with malignant middle cerebral artery [MMCA] stroke who underwent decompressive hemicraniectomy. All patients had at least three cranial CT scans prior to the surgery. The rate of growth and volume of infarction measured on the third CT was predicted with ANFIS without statistically significant difference compared to the ground truth [P = 0.489]. This was not possible with linear, logarithmic or exponential methods. ANFIS was able to predict infarction volume [IV3] over a wide range of volume [163.7–600 cm3] and time [22–110 hours]. The cross correlation [CRR] indicated similarity between the ANFIS-predicted IV3 and original data of 82% for ANFIS, followed by logarithmic 70%, exponential 63% and linear 48% respectively. Our study shows that ANFIS is superior to previously defined methods in the prediction of infarction growth rate (IGR) with reasonable accuracy, over wide time and volume range.
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Affiliation(s)
- Saadat Kamran
- The Neuroscience Institute (Stroke Center of Excellence), Hamad General Hospital, Medical Corporation, Doha, Qatar. .,Weill Cornell School of Medicine, Doha, Qatar.
| | - Naveed Akhtar
- The Neuroscience Institute (Stroke Center of Excellence), Hamad General Hospital, Medical Corporation, Doha, Qatar.,Weill Cornell School of Medicine, Doha, Qatar
| | | | - Kainat Kamran
- School of Liberal Arts, University of Illinois, Chicago, USA
| | | | | | - Abdul Salam
- The Neuroscience Institute (Stroke Center of Excellence), Hamad General Hospital, Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- The Neuroscience Institute (Stroke Center of Excellence), Hamad General Hospital, Medical Corporation, Doha, Qatar.,Stroke Program, Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Uvais Qidwai
- KINDI Center for Computing Research, Qatar University, Doha, Qatar
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Zhuang Z, Luo J, Ou C, Chen B, Liu B. The clinical and CT features of rapid spontaneous resolution of traumatic acute subdural hematoma: A retrospective study of 14 cases. Brain Inj 2015; 29:1239-1245. [PMID: 26083053 DOI: 10.3109/02699052.2015.1035327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Resolution of a traumatic acute subdural haematoma (ASDH) requires weeks or months. However, cases of rapid spontaneous resolution of ASDH within 72 hours after trauma have been reported. The purpose of this study was to obtain a better understanding of the clinical and CT features of cases of rapid resolution following traumatic ASDH. METHOD Between 2011-2014, the authors retrospectively collected data from 14 patients with rapid resolution of traumatic ASDH. The clinical data and CT findings of these cases were collected and analysed. RESULTS In 13 of the 14 patients, there was a rapid spontaneous resolution of the ASDH within 48 hours. The mean haematoma width of the second CT was significantly smaller than the width of the initial CT. A significantly marked resolution of the midline shift was observed in the second CT in all patients. The outcome was good in the majority of patients. CONCLUSIONS The acute fluctuation of ICP may drive the spontaneous rapid resolution and redistribution of ASDH. Patients with abnormal coagulant function may be more likely to experience rapid resolution of ASDH. A band of low density in the initial CT image may be a useful sign for rapid resolution of ASDH.
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Affiliation(s)
- Zerui Zhuang
- a Department of Neurosurgery , Second Affiliated Hospital, Shantou University Medical College , Shantou , Guangdong , PR China
| | - Jianming Luo
- a Department of Neurosurgery , Second Affiliated Hospital, Shantou University Medical College , Shantou , Guangdong , PR China
| | - Chugeng Ou
- a Department of Neurosurgery , Second Affiliated Hospital, Shantou University Medical College , Shantou , Guangdong , PR China
| | - Bin Chen
- a Department of Neurosurgery , Second Affiliated Hospital, Shantou University Medical College , Shantou , Guangdong , PR China
| | - Bin Liu
- a Department of Neurosurgery , Second Affiliated Hospital, Shantou University Medical College , Shantou , Guangdong , PR China
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Liu B, Zhuang Z. The cause and consequence of rapid spontaneous redistribution of acute subdural hematoma. Clin Neurol Neurosurg 2013; 115:2310-1. [PMID: 23891142 DOI: 10.1016/j.clineuro.2013.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 05/30/2013] [Accepted: 06/09/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Bin Liu
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, China.
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Liu B, Zhuang Z, Luo J. Fluctuation of intra-parenchymal cerebral pressure may drive the rapid spontaneous resolution of acute subdural hematoma. Med Hypotheses 2013; 81:159-62. [PMID: 23769000 DOI: 10.1016/j.mehy.2013.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/19/2013] [Indexed: 02/05/2023]
Abstract
Acute subdural hematoma (ASDH) is a severe insult with a high mortality rate, and emergent surgical evacuation is recommended in the vast majority of such cases. Generally, resolution of the hemorrhage requires weeks and months in patients treated conservatively. However, numerous cases of rapid spontaneous resolution of ASDH, occurring within 72h after the trauma, have been reported to date in the literature. Several possible hypotheses have been suggested, primarily involving redistribution and dilution, or washing out the ASDH. In this study, we present the relevant images of such a case, review the mechanisms of the rapid spontaneous resolution in the literature, and also propose a new hypothesis to explain the occurrence of the rapid spontaneous resolution of ASDH. We indicate that the fluctuation of intra-parenchymal cerebral pressure that drives the rapid spontaneous resolution of ASDH.
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Affiliation(s)
- Bin Liu
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, China.
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Godil SS, Shamim MS, Enam SA, Qidwai U. Fuzzy logic: A "simple" solution for complexities in neurosciences? Surg Neurol Int 2011; 2:24. [PMID: 21541006 PMCID: PMC3050069 DOI: 10.4103/2152-7806.77177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/03/2011] [Indexed: 11/24/2022] Open
Abstract
Background: Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum. Methods: This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology. Results: The applicability of fuzzy logic is not limited to research related to neuroanatomy, imaging nerve fibers and understanding neurophysiology, but it is also a sensitive and specific tool for interpretation of EEGs, EMGs and MRIs and an effective controller device in intensive care units. It has been used for risk stratification of stroke, diagnosis of different psychiatric illnesses and even planning neurosurgical procedures. Conclusions: In the future, fuzzy logic has the potential of becoming the basis of all clinical decision making and our understanding of neurosciences.
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Affiliation(s)
- Saniya Siraj Godil
- Faculty of Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
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Shamim MS, Enam SA, Qidwai U. Fuzzy Logic in neurosurgery: predicting poor outcomes after lumbar disk surgery in 501 consecutive patients. ACTA ACUST UNITED AC 2009; 72:565-72; discussion 572. [DOI: 10.1016/j.surneu.2009.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 07/02/2009] [Indexed: 01/04/2023]
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Hazelzet JA. Can fuzzy logic make things more clear? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:116. [PMID: 19291252 PMCID: PMC2688115 DOI: 10.1186/cc7692] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Intensive care is a complex environment involving many signals, data and observations. Clinical decision support and artificial intelligence using fuzzy logic and closed loop techniques are methods that might help us to handle this complexity in a safe, effective and efficient way. Merouani and colleagues have performed a study using fuzzy logic and closed loop techniques to more effectively wean patients with sepsis from norepinephrine infusion.
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Affiliation(s)
- Jan A Hazelzet
- Pediatric ICU, Erasmus MC, Sophia, Rotterdam, The Netherlands.
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Shieh JS, Abbod MF, Hsu CY, Huang SJ, Han YY, Fan SZ. Monitoring and Control of Anesthesia Using Multivariable Self-Organizing Fuzzy Logic Structure. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-3-540-89968-6_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Merouani M, Guignard B, Vincent F, Borron SW, Karoubi P, Fosse JP, Cohen Y, Clec'h C, Vicaut E, Marbeuf-Gueye C, Lapostolle F, Adnet F. Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:R155. [PMID: 19068113 PMCID: PMC2646320 DOI: 10.1186/cc7149] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/30/2008] [Accepted: 12/09/2008] [Indexed: 01/04/2023]
Abstract
Introduction The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock. Methods Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation. Results Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] μg/kg versus 1.4 [0.6 to 2.7] μg/kg; P < 0.01). Conclusions Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion. Trial registration Trial registration: Clinicaltrials.gov NCT00763906.
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Affiliation(s)
- Mehdi Merouani
- Samu 93 - EA 3409, Université Paris 13, Hôpital Avicenne, Rue de Stalingrad, 93000 Bobigny, France.
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