1
|
Binder NF, El Amki M, Glück C, Middleham W, Reuss AM, Bertolo A, Thurner P, Deffieux T, Lambride C, Epp R, Handelsmann HL, Baumgartner P, Orset C, Bethge P, Kulcsar Z, Aguzzi A, Tanter M, Schmid F, Vivien D, Wyss MT, Luft A, Weller M, Weber B, Wegener S. Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization. Neuron 2024; 112:1456-1472.e6. [PMID: 38412858 DOI: 10.1016/j.neuron.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/18/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Recanalization is the mainstay of ischemic stroke treatment. However, even with timely clot removal, many stroke patients recover poorly. Leptomeningeal collaterals (LMCs) are pial anastomotic vessels with yet-unknown functions. We applied laser speckle imaging, ultrafast ultrasound, and two-photon microscopy in a thrombin-based mouse model of stroke and fibrinolytic treatment to show that LMCs maintain cerebral autoregulation and allow for gradual reperfusion, resulting in small infarcts. In mice with poor LMCs, distal arterial segments collapse, and deleterious hyperemia causes hemorrhage and mortality after recanalization. In silico analyses confirm the relevance of LMCs for preserving perfusion in the ischemic region. Accordingly, in stroke patients with poor collaterals undergoing thrombectomy, rapid reperfusion resulted in hemorrhagic transformation and unfavorable recovery. Thus, we identify LMCs as key components regulating reperfusion and preventing futile recanalization after stroke. Future therapeutic interventions should aim to enhance collateral function, allowing for beneficial reperfusion after stroke.
Collapse
Affiliation(s)
- Nadine Felizitas Binder
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Mohamad El Amki
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Chaim Glück
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - William Middleham
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Anna Maria Reuss
- Institute of Neuropathology, University Hospital Zurich, University of Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Adrien Bertolo
- Iconeus, 6 rue Jean Calvin, Paris, France; Physics for Medicine, INSERM U1273, ESPCI Paris, CNRS UMR 8063, PSL Research University, 17 rue Moreau, Paris, France
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital and University of Zurich, Zürich, France
| | - Thomas Deffieux
- Physics for Medicine, INSERM U1273, ESPCI Paris, CNRS UMR 8063, PSL Research University, 17 rue Moreau, Paris, France
| | - Chryso Lambride
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Robert Epp
- Institute of Fluid Dynamics, ETH Zurich, Zurich, Switzerland
| | - Hannah-Lea Handelsmann
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | - Philipp Baumgartner
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | - Cyrille Orset
- Normandie University, UNICAEN, INSERM, Unité Mixte de Recherche-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen Normandie, GIP Cyceron, Caen, France
| | - Philipp Bethge
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital and University of Zurich, Zürich, France
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital Zurich, University of Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Mickael Tanter
- Physics for Medicine, INSERM U1273, ESPCI Paris, CNRS UMR 8063, PSL Research University, 17 rue Moreau, Paris, France
| | - Franca Schmid
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Denis Vivien
- Normandie University, UNICAEN, INSERM, Unité Mixte de Recherche-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen Normandie, GIP Cyceron, Caen, France; Department of Clinical Research, Caen Normandie University Hospital, Caen, France
| | - Matthias Tasso Wyss
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Andreas Luft
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Bruno Weber
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland.
| |
Collapse
|
2
|
Doheny EP, Renerts K, Braun A, Werth E, Baumann C, Baumgartner P, Morgan-Jones P, Busse M, Lowery MM, Jung HH. Assessment of Fitbit Charge 4 for sleep stage and heart rate monitoring against polysomnography and during home monitoring in Huntington's disease. J Clin Sleep Med 2024. [PMID: 38450553 DOI: 10.5664/jcsm.11098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
STUDY OBJECTIVES Wearable devices, monitoring sleep stages and heart rate (HR), bring the potential for longitudinal sleep monitoring in patients with neurodegenerative diseases. Sleep quality reduces with disease progression in Huntington's disease (HD). However, the involuntary movements characteristic of HD may affect the accuracy of wrist-worn devices. This study compares sleep stage and heart rate data from the Fitbit Charge 4 (FB) against polysomnography (PSG) in participants with HD. METHODS Ten participants with manifest HD wore a FB during overnight hospital-based PSG, and for nine of these participants continued to wear the FB for seven nights at home. Sleep stages (30s epochs) and minute-by-minute HR were extracted and compared against PSG data. RESULTS FB-estimated total sleep and wake times, and sleep stage times were in good agreement with PSG, with intra-class correlations 0.79-0.96. However, poor agreement was observed for Wake After Sleep Onset, and the number of awakenings. FB detected wake with 68.6±15.5% sensitivity and 93.7±2.5% specificity, rapid eye movement (REM) sleep with high sensitivity and specificity (78.7±31.9%, 95.6±2.3%), and deep sleep with lower sensitivity but high specificity (56.4±28.8%, 95.0±4.8%). FB HR was strongly correlated with PSG, and the mean absolute error between FB and PSG HR data was 1.16 ± 0.42 bpm. At home, longer sleep and shorter wake times were observed compared to hospital data, while percentage sleep stage times were consistent with hospital data. CONCLUSIONS Results suggest the potential for long-term monitoring of sleep patterns using wrist-worn wearable devices as part of symptom management in HD.
Collapse
Affiliation(s)
- Emer P Doheny
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Klavs Renerts
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Andreas Braun
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christian Baumann
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp Baumgartner
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Philippa Morgan-Jones
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Madeleine M Lowery
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Hans H Jung
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Baumgartner P, Kook L, Altersberger VL, Gensicke H, Ardila-Jurado E, Kägi G, Salerno A, Michel P, Gopisingh KM, Nederkoorn PJ, Scheitz JF, Nolte CH, Heldner MR, Arnold M, Cordonnier C, Della Schiava L, Hametner C, Ringleb PA, Leker RR, Jubran H, Luft AR, Engelter ST, Wegener S. Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study. Eur Stroke J 2023; 8:966-973. [PMID: 37421135 PMCID: PMC10683723 DOI: 10.1177/23969873231185895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. RESULTS We screened 200 patients with acute RAO and included 47 IVT and 34 non-IVT patients with complete information about recovery of vision. Visual Acuity at follow up significantly improved compared to baseline in IVT patients (∆VA 0.5 ± 0.8, p < 0.001) and non-IVT patients (∆VA 0.40 ± 1.1, p < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. CONCLUSION Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO.
Collapse
Affiliation(s)
- Philipp Baumgartner
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lucas Kook
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | | | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexander Salerno
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Kiran M Gopisingh
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan F Scheitz
- Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Lucie Della Schiava
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | | | - Peter A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hamza Jubran
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
4
|
Polymeris AA, Karwacki GM, Siepen BM, Schaedelin S, Tsakiris DA, Stippich C, Guzman R, Nickel CH, Sprigg N, Kägi G, Vehoff J, Barinka F, Thilemann S, Maurer M, Wagner B, Traenka C, Gensicke H, De Marchis GM, Bonati LH, Fischer U, Z’Graggen WJ, Nedeltchev K, Wegener S, Baumgartner P, Engelter ST, Seiffge DJ, Peters N, Lyrer PA. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial. Stroke 2023; 54:2223-2234. [PMID: 37466000 PMCID: PMC10453353 DOI: 10.1161/strokeaha.123.042866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH. METHODS We performed a double-blind, randomized, placebo-controlled trial at 6 Swiss stroke centers. Patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake were randomized (1:1) to receive either intravenous TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo in addition to standard medical care via a centralized Web-based procedure with minimization on key prognostic factors. All participants and investigators were masked to treatment allocation. Primary outcome was hematoma expansion, defined as ≥33% relative or ≥6 mL absolute volume increase at 24 hours and analyzed using logistic regression adjusted for baseline hematoma volume on an intention-to-treat basis. RESULTS Between December 12, 2016, and September 30, 2021, we randomized 63 patients (median age, 82 years [interquartile range, 76-86]; 40% women; median hematoma volume, 11.5 [4.8-27.4] mL) of the 109 intended sample size before premature trial discontinuation due to exhausted funding. The primary outcome did not differ between TXA (n=32) and placebo (n=31) arms (12 [38%] versus 14 [45%]; adjusted odds ratio, 0.63 [95% CI, 0.22-1.82]; P=0.40). There was a signal for interaction with onset-to-treatment time (Pinteraction=0.024), favoring TXA when administered within 6 hours of symptom onset. Between the TXA and placebo arms, the proportion of participants who died (15 [47%] versus 13 [42%]; adjusted odds ratio, 1.07 [0.37-3.04]; P=0.91) or had major thromboembolic complications within 90 days (4 [13%] versus 2 [6%]; odds ratio, 1.86 [0.37-9.50]; P=0.45) did not differ. All thromboembolic events occurred at least 2 weeks after study treatment, exclusively in participants not restarted on oral anticoagulation. CONCLUSIONS In a smaller-than-intended NOAC-ICH patient sample, we found no evidence that TXA prevents hematoma expansion, but there were no major safety concerns. Larger trials on hemostatic treatments targeting an early treatment window are needed for NOAC-ICH. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02866838.
Collapse
Affiliation(s)
- Alexandros A. Polymeris
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Grzegorz M. Karwacki
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Switzerland (G.M.K.)
| | - Bernhard M. Siepen
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
- Graduate School of Health Sciences, University of Bern, Switzerland (B.M.S.)
| | - Sabine Schaedelin
- Department of Clinical Research (S.S.), University Hospital Basel and University of Basel, Switzerland
| | | | - Christoph Stippich
- Department of Neuroradiology and Radiology, Kliniken Schmieder, Allensbach, Germany (C.S.)
| | - Raphael Guzman
- Department of Neurosurgery (R.G.), University Hospital Basel and University of Basel, Switzerland
| | - Christian H. Nickel
- Department of Emergency Medicine (C.H.N.), University Hospital Basel and University of Basel, Switzerland
| | - Nikola Sprigg
- Nottingham Stroke Trials Unit, University of Nottingham, United Kingdom (N.S.)
- Stroke Center, Klinik Hirslanden Zurich, Switzerland (F.B., N.P.)
| | - Georg Kägi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, Switzerland (G.K., J.V.)
| | - Jochen Vehoff
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, Switzerland (G.K., J.V.)
| | - Filip Barinka
- Stroke Center, Klinik Hirslanden Zurich, Switzerland (F.B., N.P.)
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Marina Maurer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Henrik Gensicke
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Reha Rheinfelden, Switzerland (L.H.B.)
| | - Urs Fischer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Werner J. Z’Graggen
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Krassen Nedeltchev
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Switzerland (K.N.)
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Switzerland (S.W., P.B.)
| | - Philipp Baumgartner
- Department of Neurology, University Hospital and University of Zurich, Switzerland (S.W., P.B.)
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - David J. Seiffge
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Nils Peters
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| |
Collapse
|
5
|
Baumgartner P, Reiner MF, Wiencierz A, Coslovsky M, Bonetti NR, Filipovic MG, Aeschbacher S, Kühne M, Zuern CS, Rodondi N, Oberle J, Moschovitis G, Lüscher TF, Camici GG, Osswald S, Conen D, Beer JH. Omega-3 Fatty Acids and Heart Rhythm, Rate, and Variability in Atrial Fibrillation. J Am Heart Assoc 2023:e027646. [PMID: 37259986 PMCID: PMC10381984 DOI: 10.1161/jaha.122.027646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Previous randomized control trials showed mixed results concerning the effect of omega-3 fatty acids (n-3 FAs) on atrial fibrillation (AF). The associations of n-3 FA blood levels with heart rhythm in patients with established AF are unknown. The goal of this study was to assess the associations of total and individual n-3 FA blood levels with AF type (paroxysmal versus nonparoxysmal), heart rate (HR), and HR variability in patients with AF. Methods and Results Total n-3 FAs, eicosapentaenoic acid, docosahexaenoic acid, docosapentaenoic acid, and alpha-linolenic acid blood levels were determined in 1969 patients with known AF from the SWISS-AF (Swiss Atrial Fibrillation cohort). Individual and total n-3 FAs were correlated with type of AF, HR, and HR variability using standard logistic and linear regression, adjusted for potential confounders. Only a mild association with nonparoxysmal AF was found with total n-3 FA (odds ratio [OR], 0.97 [95% CI, 0.89-1.05]) and docosahexaenoic acid (OR, 0.93 [95% CI, 0.82-1.06]), whereas other individual n-3 FAs showed no association with nonparoxysmal AF. Higher total n-3 FAs (estimate 0.99 [95% CI, 0.98-1.00]) and higher docosahexaenoic acid (0.99 [95% CI, 0.97-1.00]) tended to be associated with slower HR in multivariate analysis. Docosapentaenoic acid was associated with a lower HR variability triangular index (0.94 [95% CI, 0.89-0.99]). Conclusions We found no strong evidence for an association of n-3 FA blood levels with AF type, but higher total n-3 FA levels and docosahexaenoic acid might correlate with lower HR, and docosapentaenoic acid with a lower HR variability triangular index.
Collapse
Affiliation(s)
- Philipp Baumgartner
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
| | - Martin F Reiner
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, University Hospital of Basel Basel Switzerland
| | - Michael Coslovsky
- Clinical Trial Unit, University Hospital of Basel Basel Switzerland
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Nicole R Bonetti
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
- Center for Molecular Cardiology, Laboratory for Platelet Research University of Zurich Schlieren Switzerland
| | - Mark G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital Bern University Hospital, University of Bern Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Michael Kühne
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Christine S Zuern
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine Bern University Hospital, University of Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Jolanda Oberle
- Department of General Internal Medicine Bern University Hospital, University of Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ende Ospedaliero Cantonale (EOC) Ospedale Regionale di Lugano Lugano Switzerland
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals London UK
- National Heart and Lung Institute Imperial College London UK
- Center for Molecular Cardiology University of Zurich Schlieren Switzerland
| | - Giovanni G Camici
- Center for Molecular Cardiology University of Zurich Schlieren Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - David Conen
- Population Health Research Institute McMaster University Hamilton Canada
| | - Jürg H Beer
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
- Center for Molecular Cardiology, Laboratory for Platelet Research University of Zurich Schlieren Switzerland
| |
Collapse
|
6
|
Traenka C, Lorscheider J, Hametner C, Baumgartner P, Gralla J, Magoni M, Martinez-Majander N, Casolla B, Feil K, Pascarella R, Papanagiotou P, Nordanstig A, Padjen V, Cereda CW, Psychogios M, Nolte CH, Zini A, Michel P, Béjot Y, Kastrup A, Zedde M, Kägi G, Kellert L, Henon H, Curtze S, Pezzini A, Arnold M, Wegener S, Ringleb P, Tatlisumak T, Nederkoorn PJ, Engelter ST, Gensicke H. Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration. J Stroke 2023; 25:272-281. [PMID: 37282374 DOI: 10.5853/jos.2022.03370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/27/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD). METHODS This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015-2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0-2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching. RESULTS Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10-19] vs. 4 [2-7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24-1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28-18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group. CONCLUSION We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.
Collapse
Affiliation(s)
- Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Baumgartner
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mauro Magoni
- ASST Spedali Civili, Neurologia Vascolare, Brescia, Italy
| | | | - Barbara Casolla
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Stroke Unit, UR2CA-URRIS Neurology, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
| | - Katharina Feil
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Annika Nordanstig
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Visnja Padjen
- University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carlo W Cereda
- Stroke Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Marios Psychogios
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Christian H Nolte
- Klinik für Neurologie mit experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Patrik Michel
- Stroke Service, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Yannick Béjot
- Department of Neurology, University Hospital Dijon, Dijon, France
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Wegener
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
Collapse
Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Filioglo A, Simaan N, Honig A, Heldner M, Pezzini A, Martinez-Majander N, Padjen V, Baumgartner P, Papanagiotou P, Salerno A, Nolte C, Nordanstig A, Engelter S, Zini A, Zedde M, Marto JP, Arnold M, Magoni M, Gensicke H, Cohen J, Leker R. Tandem occlusions involving the internal carotid and anterior cerebral arteries-A rare form of stroke: Results from the multicenter EVATRISP collaboration study. Front Neurol 2022; 13:1024891. [PMID: 36570467 PMCID: PMC9780389 DOI: 10.3389/fneur.2022.1024891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background Patients with stroke secondary to isolated anterior cerebral artery (ACA) occlusions have poor outcomes. Whether tandem occlusions (TO) of the extracranial internal carotid (ICA) and the ACA carry even worse outcomes that remain unknown. Methods Patients with TO involving ICA and ACA occlusions were identified from 14 participating centers from the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) project which is a multicenter, observational, cohort study with prospective accrual of data followed by retrospective data analysis. Patients with isolated ACA stroke served as controls. Results Included were 92 patients with isolated ACA and 16 patients with ICA-ACA TO stroke. On univariate analyses, patients with TO had more severe strokes on admission [median NIHSS (IQR) 13.5 (9-21) vs. 8 (5-12), p = 0.003] and were more often treated with thrombectomy (81 vs. 40%, p = 0.002). Mortality rates were higher among TO patients (31 vs. 11%, p = 0.03). Rates of favorable functional outcomes were numerically lower among TO patients (38 vs. 60%) but the difference was not statistically significant (p = 0.09). On multivariate analyses, the presence of TO did not modify the chances for favorable outcomes. Conclusion TO stroke with ICA and isolated ACA involvement is rare and results in more severe initial neurological deficits and higher mortality compared to those seen in patients with isolated ACA stroke.
Collapse
Affiliation(s)
- Andrei Filioglo
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naaem Simaan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mirjam Heldner
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Visnja Padjen
- Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Alexander Salerno
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christian Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research, Berlin Institute of Health, Berlin, Germany
| | - Annika Nordanstig
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Engelter
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Mauro Magoni
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Henrik Gensicke
- Department of Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Jose Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel,*Correspondence: Ronen Leker
| |
Collapse
|
9
|
Filioglo A, Simaan N, Honig A, Heldner MR, von Rennenberg R, Pezzini A, Padjen V, Rentzos A, Altersberger VL, Baumgartner P, Zini A, Grisendi I, Aladdin S, Gomori JM, Pilgram-Pastor SM, Scheitz JF, Magoni M, Berisavac I, Nordanstig A, Psychogios M, Luft A, Gentile M, Assenza F, Arnold M, Nolte CH, Gamba M, Ercegovac M, Jood K, Engelter ST, Wegener S, Forlivesi S, Zedde M, Gensicke H, Tatlisumak T, Cohen JE, Leker RR. Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration. J Neurol Sci 2022; 432:120081. [PMID: 34920158 DOI: 10.1016/j.jns.2021.120081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.
Collapse
Affiliation(s)
- A Filioglo
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Simaan
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - M R Heldner
- Department of Neurology, University Hospital Bern, Switzerland
| | - R von Rennenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - V Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Rentzos
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - V L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - P Baumgartner
- University Hospital Zurich and University of Zurich, Switzerland
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - I Grisendi
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Aladdin
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J M Gomori
- Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Pilgram-Pastor
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Magoni
- U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy
| | - I Berisavac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Nordanstig
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland
| | - A Luft
- University Hospital Zurich and University of Zurich, Switzerland
| | - M Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - F Assenza
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Arnold
- Department of Neurology, University Hospital Bern, Switzerland
| | - C H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Gamba
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Ercegovac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Jood
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - S Wegener
- University Hospital Zurich and University of Zurich, Switzerland
| | - S Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - T Tatlisumak
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J E Cohen
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| |
Collapse
|
10
|
Altersberger VL, Stolze LJ, Heldner MR, Henon H, Martinez-Majander N, Hametner C, Nordanstig A, Zini A, Nannoni S, Gonçalves B, Nolte CH, Baumgartner P, Kastrup A, Papanagiotou P, Kägi G, Leker RR, Zedde M, Padovani A, Pezzini A, Padjen V, Cereda CW, Ntaios G, Bonati LH, Rinkel LA, Fischer U, Scheitz JF, Wegener S, Turc G, Michel P, Gentile M, Rentzos A, Ringleb PA, Curtze S, Cordonnier C, Arnold M, Nederkoorn PJ, Engelter ST, Gensicke H. Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown. Stroke 2021; 52:1693-1701. [PMID: 33793320 PMCID: PMC8078117 DOI: 10.1161/strokeaha.120.032176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.
Collapse
Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.)
| | - Lotte J Stolze
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Hilde Henon
- University Lille, Inserm, CHU Lille, U1172- F-59000, France (H.H., C.C.)
| | | | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.A.R.)
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg (A.N., A.R.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.N., A.R.)
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z., M.G.)
| | - Stefania Nannoni
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland (S.N., P.M.)
| | - Bruno Gonçalves
- Department of Neurology, Sainte-Anne Hospital, Paris, France Université Paris Descartes, France (B.G., G.T.).,Niteroi D'Or Hospital, Niteroi, Brazil (B.G.)
| | - Christian H Nolte
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.)
| | - Philipp Baumgartner
- Zurich Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (P.B., S.W.)
| | - Andreas Kastrup
- Departments of Neurology and Neuroradiology, Klinikum Bremen-Mitte, Germany (A.K., P.P.)
| | | | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (M.Z.)
| | - Alessandro Padovani
- Neurology Section, Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit, ASST Spedali Civili, Italy (A. Padovani, A. Pezzini)
| | - Alessandro Pezzini
- Neurology Section, Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit, ASST Spedali Civili, Italy (A. Padovani, A. Pezzini)
| | - Visnja Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia (V.P.)
| | - Carlo W Cereda
- University Lille, Inserm, CHU Lille, U1172- F-59000, France (H.H., C.C.).,Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Georges Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.)
| | - Leon A Rinkel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Jan F Scheitz
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.)
| | - Susanne Wegener
- Zurich Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (P.B., S.W.)
| | - Guillaume Turc
- Department of Neurology, Sainte-Anne Hospital, Paris, France Université Paris Descartes, France (B.G., G.T.)
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland (S.N., P.M.)
| | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z., M.G.)
| | - Alexandros Rentzos
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg (A.N., A.R.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.N., A.R.)
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.A.R.).,Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Sweden (A.R.)
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.C.)
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.).,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (S.T.E., H.G.)
| | - Henrik Gensicke
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (S.T.E., H.G.)
| | | |
Collapse
|
11
|
Brühlmann F, Baumgartner P, Wallner G, Kriglstein S, Mekler ED. Motivational Profiling of League of Legends Players. Front Psychol 2020; 11:1307. [PMID: 32793019 PMCID: PMC7387664 DOI: 10.3389/fpsyg.2020.01307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Player motivation is a key research area within games research, with the aim of understanding how the motivation of players is related to their experience and behavior in the game. We present the results of a cross-sectional study with data from 750 players of League of Legends, a popular Multiplayer Online Battle Arena game. Based on the motivational regulations posited by Self-Determination Theory and Latent Profile Analysis, we identify four distinct motivational profiles, which differ with regards to player experience and, to a lesser extent, in-game behavior. While the more self-determined profiles “Intrinsic” and “Autonomous” report mainly positive experience-related outcomes, a considerable part of the player base does not. Players of the “Amotivated” and “External” profile derive less enjoyment, experience more negative affect and tension, and score lower on vitality, indicating game engagement that is potentially detrimental to players' well-being. With regards to game metrics, minor differences in the rate of assists in unranked matches and performance indicators were observed between profiles. This strengthens the notion that differences in experiences are not necessarily reflected in differences in behavioral game metrics. Our findings provide insights into the interplay of player motivation, experience, and in-game behavior, contributing to a more nuanced understanding of player-computer interaction.
Collapse
Affiliation(s)
- Florian Brühlmann
- Human-Computer Interaction Research Group, Department of Psychology, Center for General Psychology and Methodology, University of Basel, Basel, Switzerland
| | - Philipp Baumgartner
- Human-Computer Interaction Research Group, Department of Psychology, Center for General Psychology and Methodology, University of Basel, Basel, Switzerland
| | - Günter Wallner
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands.,Faculty of Business and IT, Ontario Tech University, Oshawa, ON, Canada.,Institute of Art and Technology, University of Applied Arts Vienna, Vienna, Austria
| | - Simone Kriglstein
- AIT Austrian Institute of Technology GmbH, Vienna, Austria.,Faculty of Computer Science, University of Vienna, Vienna, Austria
| | - Elisa D Mekler
- Department of Computer Science, Aalto University, Espoo, Finland
| |
Collapse
|
12
|
Conen D, Rodondi N, Müller A, Beer JH, Ammann P, Moschovitis G, Auricchio A, Hayoz D, Kobza R, Shah D, Novak J, Schläpfer J, Di Valentino M, Aeschbacher S, Blum S, Meyre P, Sticherling C, Bonati LH, Ehret G, Moutzouri E, Fischer U, Monsch AU, Stippich C, Wuerfel J, Sinnecker T, Coslovsky M, Schwenkglenks M, Kühne M, Osswald S, Berger S, Bernasconi R, Fröhlich L, Göldi T, Gugganig R, Kofler T, Krisai P, Mongiat M, Pudenz C, Repilado JR, Schweizer A, Springer A, Stempfel S, Szucs T, van der Stouwe J, Voellmin G, Zwimpfer L, Aujesky D, Fuhrer J, Roten L, Jung S, Mattle H, Adam L, Aubert CE, Feller M, Schneider C, Loewe A, Flückiger T, Groen C, Schwab N, Beynon C, Dillier R, Eberli F, Fontana S, Franzini C, Juchli I, Liedtke C, Nadler J, Obst T, Schneider X, Studerus K, Weishaupt D, Kuest S, Scheuch K, Hischier D, Bonetti N, Bello C, Isberg H, Grau A, Villinger J, Papaux MM, Baumgartner P, Filipovic M, Frick M, Anesini A, Camporini C, Conte G, Caputo ML, Regoli F, Moccetti T, Brenner R, Altmann D, Forrer M, Gemperle M, Firmann M, Foucras S, Berte B, Kaeppeli A, Mehmann B, Pfeiffer M, Russi I, Schmidt K, Weberndoerfer V, Young M, Zbinden M, Vicari L, Frangi J, Terrot T, Gallet H, Guillermet E, Lazeyras F, Lovblad KO, Perret P, Teres C, Lauriers N, Méan M, Salzmann S, Arenja N, Grêt A, Vitelli S, Frangi J, Gallino A, Schoenenberger-Berzins R, Witassek F, Radue EW, Benkert P, Fabbro T, Simon P, Schmid R. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 73:989-999. [DOI: 10.1016/j.jacc.2018.12.039] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 01/06/2023]
|
13
|
Rousseau C, Le Thiec M, Ferrer L, Rusu D, Rauscher A, Maucherat B, Frindel M, Baumgartner P, Fleury V, Denis A, Debeaupuis E, Campion L, Kraeber-Bodéré F. Résultats préliminaires d’une étude prospective tep/tdm 68ga-psma chez des patients atteints de récidive occulte d’un cancer de la prostate : performances diagnostiques et impact sur la prise en charge thérapeutique. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Baumgartner P, El Amki M, Bracko O, Luft AR, Wegener S. Sensorimotor stroke alters hippocampo-thalamic network activity. Sci Rep 2018; 8:15770. [PMID: 30361495 PMCID: PMC6202365 DOI: 10.1038/s41598-018-34002-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/10/2018] [Indexed: 01/06/2023] Open
Abstract
Many stroke survivors experience persisting episodic memory disturbances. Since hippocampal and para-hippocampal areas are usually spared from the infarcted area, alterations of memory processing networks remote from the ischemic brain region might be responsible for the observed clinical symptoms. To pinpoint changes in activity of hippocampal connections and their role in post-stroke cognitive impairment, we induced ischemic stroke by occlusion of the middle cerebral artery (MCAO) in adult rats and analyzed the functional and structural consequences using activity-dependent manganese (Mn2+) enhanced MRI (MEMRI) along with behavioral and histopathological analysis. MCAO caused stroke lesions of variable extent along with sensorimotor and cognitive deficits. Direct hippocampal injury occurred in some rats, but was no prerequisite for cognitive impairment. In healthy rats, injection of Mn2+ into the entorhinal cortex resulted in distribution of the tracer within the hippocampal subfields into the lateral septal nuclei. In MCAO rats, Mn2+ accumulated in the ipsilateral thalamus. Histopathological analysis revealed secondary thalamic degeneration 28 days after stroke. Our findings provide in vivo evidence that remote sensorimotor stroke modifies the activity of hippocampal-thalamic networks. In addition to potentially reversible alterations in signaling of these connections, structural damage of the thalamus likely reinforces dysfunction of hippocampal-thalamic circuitries.
Collapse
Affiliation(s)
- Philipp Baumgartner
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Mohamad El Amki
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Oliver Bracko
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY14853, United States
| | - Andreas R Luft
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland.
| |
Collapse
|
15
|
Navarro Rodrigo B, Bobisse S, Viganò S, Baumgartner P, Nguyen-Ngoc T, Gannon P, Genolet R, Stevenson B, Sempoux C, Sauvain MO, Hubner M, Hahnloser D, Demartines N, Montemurro M, Kandalaft L, Rusakiewicz S, Harari A, Coukos G. Exploring personalized immunotherapy opportunities in colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
El Amki M, Baumgartner P, Bracko O, Luft AR, Wegener S. Task-Specific Motor Rehabilitation Therapy After Stroke Improves Performance in a Different Motor Task: Translational Evidence. Transl Stroke Res 2017; 8:347-350. [PMID: 28091936 PMCID: PMC5493722 DOI: 10.1007/s12975-016-0519-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/13/2016] [Accepted: 12/27/2016] [Indexed: 01/25/2023]
Abstract
While the stroke survivor with a motor deficit strives for recovery of all aspects of daily life movements, neurorehabilitation training is often task specific and does not generalize to movements other than the ones trained. In rodent models of post-stroke recovery, this problem is poorly investigated as the training task is often the same as the one that measures motor function. The present study investigated whether motor training by pellet reaching translates into enhancement of different motor functions in rats after stroke. Adult rats were subjected to 60-min middle cerebral artery occlusion (MCAO). Five days after stroke, animals received either training consisting of 7 days of pellet reaching with the affected forelimb (n = 18) or no training (n = 18). Sensorimotor deficits were assessed using the sticky tape test and a composite neuroscore. Infarct volumes were measured by T2-weighted MRI on day 28. Both groups of rats showed similar lesion volume and forelimb impairment after stroke. Trained animals improved in the sticky tape test after day 7 post-stroke reaching peak performance on day 14. More reaching attempts during rehabilitation were associated with a better performance in the sticky tape removal time. Task-oriented motor training generalizes to other motor functions after experimental stroke. Training intensity correlates with recovery.
Collapse
Affiliation(s)
- M El Amki
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - P Baumgartner
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - O Bracko
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - A R Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - S Wegener
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| |
Collapse
|
17
|
Rodrigo BN, Viganò S, Gannon P, Baumgartner P, Maisonneuve C, Sempoux C, Sauvain MO, Hahnloser D, Hubner M, Demartines N, Kandalaft L, Montemurro M, Harari A, Coukos G. Comprehensive assessment of the feasibility of adoptive cell therapy in colorectal carcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Affiliation(s)
- P Baumgartner
- Anaesthetics, Joondalup Health Campus, Joondalup, WA
| |
Collapse
|
19
|
Soleman J, Baumgartner P, Perrig Wolfgang Nicola W, Fathi AR. Outcome and Complications in Patients Undergoing Non-Instrumented Extradural Spine Surgery Treated with Low-dose Acetylsalicylic Acid: A Comparative Study. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
20
|
Baumgartner P. Rocuronium and sugammadex in myotonic dystrophy. Anaesth Intensive Care 2010; 38:959-960. [PMID: 20865895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
21
|
Ferguson E, Baumgartner P, Hamilton M. Accidental transection of radial [correction of radical] artery cannula. Anaesth Intensive Care 2005; 33:142-3. [PMID: 15957707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
|
22
|
Baumgartner P, Paioni R, Jenny W. Höhere, kondensierte Ringsysteme. 6. Mitteilung [1]. NBS-Dehydrierungen an 9,10-Dihydrophenanthrensystemen Synthese von [23] (2,7) Phenanthrenophan-trien. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19710540122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
23
|
|
24
|
|
25
|
Baumgartner P. Penicillin kills. Anaesthesia 2002; 57:942-3. [PMID: 12240619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
26
|
Stoeckelhuber M, Dobner P, Baumgartner P, Ehlert J, Brandt E, Mentele R, Adam D, Engelmann B. Stimulation of cellular sphingomyelin import by the chemokine connective tissue-activating peptide III. J Biol Chem 2000; 275:37365-72. [PMID: 10956644 DOI: 10.1074/jbc.m003709200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The selective import of phospholipids into cells could be mediated by proteins secreted from the cells into the extracellular compartment. We observed that the supernatants obtained from suspensions of thrombin-activated platelets stimulated the exchange of pyrene (py)-labeled sphingomyelin between lipid vesicles in vitro. The proteins with sphingomyelin transfer activity were purified and identified as the chemokine connective tissue-activating peptide III (CTAP-III) and platelet basic protein. Isolated CTAP-III stimulated the exchange of py-sphingomyelin between lipid vesicles but did not affect the translocations of py-labeled phosphatidylcholine and phosphatidylethanolamine. CTAP-III rapidly increased the transfer of py-sphingomyelin from low density lipoproteins into peripheral blood lymphocytes, other immune cells, and fibroblasts. In the presence of heparin, CTAP-III was unable to insert sphingomyelin into the peripheral blood lymphocytes. The activation energy of the py-sphingomyelin transfer suggested that the translocation proceeded entirely in a hydrophobic environment. [(3)H]Sphingomyelin transferred to the cells by CTAP-III was hydrolyzed to [(3)H]ceramide and [(3)H]sphingosine after activation with tumor necrosis factor alpha. The generation of the [(3)H]sphingolipid messengers was catalyzed by acid sphingomyelinase. Our results identify CTAP-III as the first mediator of the selective (endocytosis-independent) cellular import of sphingomyelin allowing the paracrine modulation of the sphingolipid signaling.
Collapse
Affiliation(s)
- M Stoeckelhuber
- Physiologisches Institut der Universität München, Schillerstrasse 44, 80336 München, Germany
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Heim K, Christensen ND, Hoepfl R, Wartusch B, Pinzger G, Zeimet A, Baumgartner P, Kreider JW, Dapunt O. Serum IgG, IgM, and IgA reactivity to human papillomavirus types 11 and 6 virus-like particles in different gynecologic patient groups. J Infect Dis 1995; 172:395-402. [PMID: 7542685 DOI: 10.1093/infdis/172.2.395] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Serum samples from several groups of patients attending a gynecology clinic were analyzed by ELISA for specific antibodies recognizing surface epitopes on intact human papillomavirus (HPV) types 6 and 11 L1 virus-like particles (VLPs) that were synthesized in vitro. In these samples, positive IgG and IgM reactivities to HPV-11 L1 VLPs were, respectively, 12% and 6% for 87 controls, 46% and 67% for 79 condyloma patients, 30% and 64% for 72 cervical intraepithelial neoplasia patients, 16% and 19% for 63 pregnant women at time of delivery, and 5% and 0 in their 63 newborns. IgA reactivities were low and not significantly different. The prevalence of IgG-positivity in HPV-6/11 DNA-positive patients increased from 46% with HPV-11 L1 VLPs to 76% when the sera were additionally screened with HPV-6 L1 VLPs. These data show that HPV-6 and -11 L1 VLPs are effective antigens for serologic studies and they detect type-specific antibodies.
Collapse
Affiliation(s)
- K Heim
- Department of Obstetrics and Gynecology, University Clinic Innsbruck, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Carlier E, Revillon A, Guyot A, Baumgartner P. Functional silica supported polymers IV. Synthesis and catalytic activity of silica-grafted sulfonated polyphenylsilsesquioxane. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/0923-1137(93)90050-p] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Abstract
The goal of this study was to compare expressions of pride and mastery in samples of preschool autistic, mentally retarded and normal children. A paradigm was used in which children completed developmentally appropriate puzzles, both with and without praise. Results indicated that compared to the other children, as many autistic children smiled upon completion of the task, but many fewer looked up to share their pleasure with the parent or experimenter or drew attention to the task. Moreover, significantly more autistic children showed avoidant responses, particularly in response to praise. These findings are discussed in terms of theoretical issues regarding the development of pride and mastery in children with significant social deficiencies.
Collapse
Affiliation(s)
- C Kasari
- Graduate School of Education, University of California, Los Angeles 90024
| | | | | | | |
Collapse
|
30
|
Baumgartner P, Wartusch B, Pinzger G, Zeimet A, Müller-Holzner E, Weiss D, Heim K. [Detection of HPV before and after CO2 laser therapy of the uterine cervix]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:285-6. [PMID: 8118318 DOI: 10.1159/000272267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
31
|
Pinzger G, Müller-Holzner E, Wartusch B, Baumgartner P, Zeimet A, Weiss D, Ruth NR, Marth C, Kirchler H, Heim K. [Combination therapy of Buschke-Löwenstein tumor with CO2 laser and interferon-alpha]. Gynakol Geburtshilfliche Rundsch 1992; 32 Suppl 1:33-4. [PMID: 1337494 DOI: 10.1159/000271929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- G Pinzger
- Univers.-Klinik f. Frauenheilk, Innsbruck
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Zeimet AG, Marth C, Abfalter E, Müller-Holzner E, Heim K, Pinzger G, Baumgartner P, Daxenbichler G, Dapunt O. [The value of tumor markers in vulvar cancer]. Gynakol Geburtshilfliche Rundsch 1992; 32 Suppl 1:28-30. [PMID: 1286338 DOI: 10.1159/000271927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A G Zeimet
- Univers.-Klinik f. Frauenheilk, Innsbruck
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Heim K, Pinzger G, Wartusch B, Müller-Holzner E, Holböck E, Zeimet A, Baumgartner P, Höpfl R, Weiss D, Ruth NR. [HPV infection in the area of the vulva]. Gynakol Geburtshilfliche Rundsch 1992; 32 Suppl 1:21-5. [PMID: 1337492 DOI: 10.1159/000271925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- K Heim
- Univers.-Klinik f. Frauenheilk, Innsbruck
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Oberholzer M, Haber S, Zeller P, Baumgartner P, Lips B, Christen H, Mihatsch M, Heitz PU. [Possibilities for the use of administrative electronic data processing in clinical pathology]. Pathologe 1990; 11:229-35. [PMID: 2399216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M Oberholzer
- Institut für Pathologie, Universität Basel, Schweiz
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Pawelec G, Baumgartner P, Rehbein A, Reusch U, Schaudt K. Cytokine regulation of the balance between alloindifferent and allospecific suppressor induction in mixed lymphocyte cultures. Transplantation 1990; 49:615-9. [PMID: 1690473 DOI: 10.1097/00007890-199003000-00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of exogenous cytokines on the generation of alloindifferent, MHC-unrestricted suppressive activity early on in mixed lymphocyte culture interactions have been investigated. Interleukin 4 strongly blocked the generation of suppression, whereas IL-1, IL-2, and IL-6 enhanced it to some extent. Tumor necrosis factor-alpha, interferons-alpha and -gamma, granulocyte/macrophage colony-stimulating factor, granulocyte CSF, IL-3 and IL-5, and a number of combinations of these factors were without effect in this system. Insofar as the alloindifferent suppression studied here also inhibited the development of allospecific, MHC restricted suppressive activity later in MLC, reduction by IL-4 of its development may have relevance for the use of this cytokine to facilitate the induction of specific suppressor cell-mediated transplantation tolerance in vivo.
Collapse
Affiliation(s)
- G Pawelec
- Immunology Laboratory, Medizinische Klinik, Tübingen, Federal Republic of Germany
| | | | | | | | | |
Collapse
|
36
|
Königsberger K, Faber K, Marschner C, Penn G, Baumgartner P, Griengl H. Enzymatic resolution of endo-bicyclo[2.2.1]hept-2-yl butybates and related compounds: steric requirements in the bridge-region. Tetrahedron 1989. [DOI: 10.1016/0040-4020(89)80096-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
37
|
Abstract
The structure of the Drosophila melanogaster Antennapedia (Antp) gene has been investigated by the isolation and sequencing of different cDNAs and genomic clones. Northern analysis, S1 mapping and primer extension experiments reveal a complex and unusual gene structure. The gene is composed of two promoters, eight exons spanning >100 kb, and two termination processing regions. Four major polyadenylated transcripts were found, two of them starting at a second internal promoter in front of exon 3. All four transcripts have extremely long untranslated leader and trailer sequences in the range of 1-2 kb. Despite the complex transcriptional organization, the open reading frame is the same in all transcripts, and starts in exon 5 giving rise to a protein of mol. wt. 42 800. The putative protein is rich in glutamine (18%) and proline (10%). The homeobox, a region which previously has been shown to be highly conserved among homeotic genes, is contained in the open reading frame and located in the last exon. Functional implications of the complex structure with respect to development and its relation to the mutant phenotypes are discussed.
Collapse
Affiliation(s)
- S Schneuwly
- Department of Cell Biology, Biozentrum, University of Basel, Klingelbergstr. 70, CH-4056 Basel, Switzerland
| | | | | | | |
Collapse
|
38
|
Herrmann WM, Baumgartner P. Combined pharmaco-EEG and pharmacopsychological study to estimate CNS effects of ketanserin in hypertensive patients. Neuropsychobiology 1986; 16:47-56. [PMID: 3574641 DOI: 10.1159/000118296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
When developing a new compound, potential side effects on the central nervous system (CNS) should be systematically investigated to determine the drug's safety, e.g., in respect of operating machinery or driving a car. The present study investigated CNS effects of ketanserin, a newly developed S2-serotonergic antagonist, in hypertensive patients. A multidimensional research strategy was used combining pharmaco-EEG and pharmacopsychological methods. The investigation consisted of two separate double-blind, randomized, and placebo-controlled studies, which were, however, planned together and in part included the same patients. The first study was carried out in 2 X 24 patients receiving chronic treatment with 2 X 20 mg ketanserin for 2 weeks, followed by 2 X 40 mg for a further 3 weeks. The second study was performed in 2 X 20 patients after subacute administration of 20 mg twice daily for six days. A multidimensional research strategy was employed to investigate CNS effects on functional and performance measures. Vigilance-related parameters, such as the alpha slow wave index and the absolute delta power, were assessed with pharmaco electroencephalography. Critical flicker-fusion frequency served as a measure of central sedation. Psychomotor performance and concentration tests were used to detect CNS effects which might impair car-driving ability. In addition, subjective well-being and adverse drug reactions were recorded. Ketanserin proved to be a safe drug to lower blood pressure. Only after chronic treatment were there slight indications that ketanserin could have a sedating and inhibiting action on the CNS. However, the differences between placebo and the ketanserin group, and the alterations within each group, were so minimal that they were not considered clinically relevant. A negative effect of ketanserin on car-driving ability is not very likely. The results show that the model was sensitive enough to detect CNS effects with sufficient certainty.
Collapse
|
39
|
Kuroiwa A, Kloter U, Baumgartner P, Gehring WJ. Cloning of the homeotic Sex combs reduced
gene in Drosophila
and in situ
localization of its transcripts. EMBO J 1985; 4:3757-64. [PMID: 16453653 PMCID: PMC554728 DOI: 10.1002/j.1460-2075.1985.tb04145.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have extended our ;chromosomal walk' in the Antennapedia-complex (ANT-C) by isolating overlapping DNA sequences spanning the chromosomal segment between Antennapedia (Antp) and Deformed (Dfd). The transcription units, homeoboxes and M-repeats were mapped within this region. Four transcription units Antp, fushi tarazu (ftz), Sex combs reduced (Scr) and Dfd contain both a homeobox and an M repeat, whereas at least two additional transcription units, x and z, were found to lack these elements. The Scr locus was identified by deletion mapping. It consists of at least two exonic regions separated by a large intron. The homeobox is located in the 3' exon and is 82% homologous to the one in Antp. Scr encodes a major 3.9-kb RNA. A corresponding cDNA clone was used as a probe for in situ hybridization to sections of various embryonic stages. At gastrula stages Scr transcripts accumulate in the posterior head and the anterior thoracic region of the germ band. At later stages a strong accumulation of transcripts is observed in the suboesophageal and the prothoracic ganglion of the ventral nervous system.
Collapse
Affiliation(s)
- A Kuroiwa
- Department of Cell Biology, Biozentrum, University of Basel, Klingelbergstrasse 70, CH-4056 Basel, Switzerland
| | | | | | | |
Collapse
|
40
|
Baumgartner P. [Experiments with Traumanase in postoperative hematomas]. Schweiz Rundsch Med Prax 1970; 59:217-219. [PMID: 5519010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
41
|
Baumgartner P. [Gerontology and climatic thermalism in Europe and Africa]. Maroc Med 1968; 48:370-1. [PMID: 5738967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
42
|
Baumgartner P. [On the therapy of nose fractures]. Wien Med Wochenschr 1967; 117:549-53. [PMID: 6078460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
43
|
Baumgartner P, Maeglin B. [Primary and secondary osteoplasty in surgery of cleft palate]. Schweiz Med Wochenschr 1966; 96:883-7. [PMID: 4865179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
44
|
|
45
|
Forestier J, Baumgartner P, Françon J, Forestier F, Deslous-Paoli P, Schneider P. [Dry physical therapy during thermal cures in rheumatology]. Presse Therm Clim 1965; 102:210-220. [PMID: 5898501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
46
|
Baumgartner P. Zur operativen Korrektur sekundärer Spaltdeformitäten des harten und weichen Gaumens. ORL J Otorhinolaryngol Relat Spec 1965. [DOI: 10.1159/000274625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
47
|
|
48
|
Baumgartner P, Souplet P. [Muscular senescence and locomotor senescence]. Rhumatologie 1959; 11:121-9. [PMID: 13675671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
49
|
Baumgartner P. Zur Korrektur der vorderen Septumdeviation. ORL J Otorhinolaryngol Relat Spec 1959. [DOI: 10.1159/000274241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Baumgartner P. [Gerontology]. Gaz Med Fr 1958; 65:951-2 passim. [PMID: 13548375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|