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Measuring severe stroke : a scoping review of RCTs
No full textBackground: Stroke severity affects length of hospital stay and functional recovery in rehabilitation. Therefore, establishing baseline data of stroke severity is a crucial step. In 2017, neurorehabilitation researchers met at the Stroke Recovery and Rehabilitation Roundtable (SRRR) to build a consensus on new standards for stroke recovery research. Core outcomes for measurement in stroke trials resulted in the recommendation that severe stroke should be assessed using the NIHSS. This scoping review aims to provide an overview of the variety of measurements used in clinical research to assess severe stroke.
Methods: RCTs and CCTs were identified by searching PubMed, CENTRAL, SSCI, and ICTRP, covering articles published between January 2018 and September 2024. Peer-reviewed articles in English focusing on rehabilitative interventions and patients aged 18 years or older who have been classified with a severe stroke. The articles included were analyzed according to used measurements and cut-off scores.
Results: The initial search yielded 1,004 publications, of which 35 (3.6%) studies were deemed eligible. In total, 11 different measures were used to assess severe stroke. Most studies used the NIHSS (n = 14), followed by mRS (n = 6), the FMA upper extremity (n = 4), the original FMA (n = 4) and the (modified) BI (n = 3). Seven different cut-off scores for the NIHSS were identified, with the scale being most frequently used in clinical settings.
Conclusion: This review indicates substantial variability in measurements and a diverse range of cut-off scores. Consequently, comparability of patients’ baseline stroke severity across studies is limited. Given the fact that the NIHSS is only partially used, future efforts should focus on barriers and challenges using the NIHSS
Preoperative mechanical ventilation prior to surgical repair for type A aortic dissection : incidence, risk, and outcomes
No full textObjectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multicenter European registry. Methods: Data from 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were the subject of this analysis. Bootstrapped Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was performed for variable selection to identify key predictors of hospital death. In the second step, a multilevel multivariable logistic regression (MMLR) was carried out, given the clustered structure of the data. Results: A total of 346 (9.3%) out of 3735 patients required preoperative IMV. Compared to the non-IMV patients, patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, p < 0.001) and a higher proportion of tears in the aortic root (p = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p < 0.001), without a difference in post-discharge survival (p = 0.84). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared to the remaining patients. IMV yielded the second highest odds in the prediction model for in-hospital mortality (OR 2.13, CI 1.60 to 2.85, p < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p < 0.001, OR 2.98). In multivariable analysis, preoperative IMV was independently associated with increased odds of in-hospital mortality. Conclusions: The need for invasive mechanical ventilation before surgical repair for type A aortic dissection is not infrequent. In this subpopulation, the in-hospital mortality rate was twofold compared to patients who did not require IMV. The awareness of the preoperative risk profile and outcomes of this subset of patients should urge surgeons to tailor the surgical strategy more appropriately to improve the immediate postoperative results
MLUH-E-302_1, Hieraaetus pennatus (Gmelin, JF, 1788), eggshell
No full textInventory No.: MLUH-E-302_1, Object: eggshell, Species: Hieraaetus pennatus (Gmelin, JF, 1788), Preservation: slight damage, Locality_loc.: Algerien, Locality today: Algeria, Country: AlgeriaCollection_coll.: M. Schönwetter, published in Handbuch der Oologie, Schönwetter, Max: Vol. I, p. 171, Identification by: M. Schönwetter, Aquisition: 1920, Aquired from: R. Tancré, ex Collection: ex. Coll. R. Tancr
MLUH-E-120_1, Pandion haliaetus carolinensis (Gmelin, JF, 1788), eggshell
No full textInventory No.: MLUH-E-120_1, Object: eggshell, Species: Pandion haliaetus carolinensis (Gmelin, JF, 1788), Preservation: complete preservation, Locality_loc.: Virginia, Locality today: Virginia, Country: USADate: 26/04/1894, Collection_coll.: M. Schönwetter, published in Handbuch der Oologie, Schönwetter, Max: Vol. I, p. 178, Identification by: M. Schönwetter, Aquisition: 1905, Aquired from: H. Rolle, ex Collection: ex. Coll. H. Roll
MLUH-E-222_3, Buteo buteo (Linnaeus, 1758), eggshell
No full textInventory No.: MLUH-E-222_3, Object: eggshell, Species: Buteo buteo (Linnaeus, 1758), Preservation: slight damage, Locality_loc.: Neustadt a.d. Dosse, Locality today: Neustadt (Dosse), Country: GermanyCollector_leg.: G. Schulz, Date: 17/05/1914, Collection_coll.: M. Schönwetter, published in Handbuch der Oologie, Schönwetter, Max: Vol. I, p. 166, Identification by: M. Schönwetter, ex Collection: ex. Coll. G. Schul
Nuclear magnetic resonance- and electron paramagnetic resonance spectroscopic characterization of S4N4 and (SN)x dissolved in [EMIm][OAc]
Get PDFThis work focuses on the reaction mechanism of poly(sulfur nitride) ((SN)x, (S15N)x), with the ionic liquid (IL) 1-ethyl-3-methylimidazolium acetate [EMIm][OAc]. We compare this with the reaction of the IL with S4N4 or its 15N-labeled form S415N4, a precursor for the synthesis of (SN)x and (S15N)x. After purification of the S4N4–IL- and S415N4–IL systems via column chromatography, we characterized the reaction products with 1H, 13C, and 15N nuclear magnetic resonance spectroscopy and with electron spray ionization time-of-flight mass spectrometry. Furthermore, time-resolved electron paramagnetic resonance spectroscopy and time-resolved ultraviolet–visible spectroscopy were carried out. Thus, radical intermediates were detected, which were consumed with reaction time. Finally, we postulate a reaction mechanism for the S4N4–IL- and S415N4–IL systems and compare this with the respective data for the (SN)x −IL- and (S15N)x–IL-systems
Auditory learning in the mongolian gerbil (Meriones unguiculatus) investigated with auditory functional magnetic resonance imaging
Get PDFLearning auditory cues and distinguishing between them is imperative for our daily social
interactions and essential for our perception of the external world. Disorders in the hearing
system and in auditory learning can lead to social isolation and create a wide variety of health
risks. Auditory research aims to understand mechanisms of auditory learning, e.g. learning-
induced brain plasticity changes to enable treatment of such disorders. In humans, the extent of
this research is limited in its invasiveness due to ethical restrictions. Mongolian gerbils (Meriones
unguiculatus) are rodents with hearing thresholds similar to humans. Their ability to perform
complex auditory tasks makes gerbils a popular animal model for invasive auditory learning
experiments that cannot be performed on human participants. Auditory functional magnetic
resonance imaging (fMRI) would be a suitable non-invasive method to improve translatability
from auditory research implemented in gerbils to ongoing human research. But so far this method
has not been implemented in gerbils.
To facilitate direct comparison of gerbil and human auditory research, I established auditory
fMRI in Mongolian gerbils. While doing so, an appropriate anaesthesia protocol was found, fMRI
sequences optimized for the rodent model, and an auditory stimulation setup, intended for human
auditory fMRI, refined for usage in small animals. With optimization of the auditory fMRI
measurement setup, acquired auditory activation patterns feature bilateral activation in auditory
cortex, auditory thalamus and auditory midbrain.
In a second project, the newly established auditory fMRI was evaluated with cerebral blood flow
SPECT imaging. More precisely, the effects of medetomidine anaesthesia and the substantial fMRI
background noise on auditory activation patterns were investigated. In this study, only minor
effects of medetomidine anaesthesia were found. The fMRI background noise showed more
impact on the obtained auditory activation patterns, in the form of lowered subcortical activation
to auditory stimulation and increased activation in higher order auditory cortex areas.
Finally, auditory fMRI was utilized to investigate auditory learning in Mongolian gerbils in a
standard tone discrimination task in a shuttle box. The task was implemented in two alternative
designs, one adding punishment for “False Alarms” to the aversive avoidance paradigm. With
repeated application of auditory fMRI, we were able to distinguish activation changes and
consolidation processes in various brain structures with a clear and significant performance
dependency. The addition of punishment in the training led to higher correlation of the animals’
learning score to the activation levels of multiple neuromodulatory and associative brain regions.
These observed activation changes attest to the usefulness of auditory fMRI in Mongolian gerbils
for auditory research and its potential in bridging the gap to human research.Literaturverzeichnis: Seite 111-12
Minimally invasive approaches for implant-supported overdentures in the atrophied mandible
Get PDFObjectives: The study compares three minimally invasive approaches for the retention of implant supported mandibular complete dentures, particularly focusing on patient satisfaction. Background: The McGill Consensus Statement recommends restoration of the edentulous mandible with an overdenture retained on two implants. Alternatively, less invasive treatment concepts with shorter treatment times have been developed for critical cases. Material and Methods: Thirty-nine patients (with a total of 78 implants) with advanced mandibular bone atrophy were randomly assigned to three groups: “single standard implant-retained overdentures” (SSO) and “mini-implant-retained overdentures” (MO), which was further subdivided into “two mini-implant-retained overdentures” (TMO) and “four mini-implant-retained overdentures” (FMO). The technical and biological parameters and oral health-related quality of life were evaluated over a 10-year period. Data were analysed for group comparisons and longitudinal trend analysis. Results: Sixteen patients (42%) dropped out during the study period. At the time of follow-up, 98.4% of the implants were in situ. The first need for technical intervention occurred after 3.8 ± 1.1, 4.2 ± 0.9, and 4.6 ± 1.3 years in the TMO, SSO, and FMO groups, respectively. Attachment exchange (39%) was the most frequently performed intervention in all groups. Healthy peri-implant and mucosal conditions were observed in 74% and 40% of patients after 1 and 10 years, respectively. The OHIP-G14 score was 22.6 before implantation, 7.6 at 1 year (effect size [ES]: 1.1), and 5.4 at 10 years (ES: 2.3). Conclusion: Irrespective of the minimal concept selected, complete mandibular dentures retained on implants improved the subjective perception of the quality of life. Application of these alternative minimal concepts may be practical in clinical practice
Untersuchung der Perspektive verschiedener Akteure in der Hilfe der Begleiteten Elternschaft
Get PDFDie vorliegende Bachelorarbeit befasst sich mit den Perspektiven verschiedener Akteur:innen im Kontext der Begleiteten Elternschaft – einem Unterstützungsangebot für Eltern mit Lernschwierigkeiten. Auf Grundlage eines relational-konstruktivistischen Ansatzes wird untersucht, wie sich Spannungsfelder zwischen Eltern und Fachkräften innerhalb professioneller Hilfesettings darstellen und kommunizieren lassen. Im Zentrum stehen vier Dichotomien: Hilfe vs. Kontrolle, Nähe vs. Distanz, Ermutigung vs. Bevormundung sowie Angst vs. Sicherheit. Die empirische Analyse basiert auf der Sekundärauswertung zweier Studien und wird erkenntniskritisch eingeordnet. Die Arbeit zeigt, dass Eltern mit Lernschwierigkeiten in institutionellen Zusammenhängen häufig als besonders kontrollbedürftig gelten und dadurch normierende Vorstellungen von Elternschaft reproduziert werden. Gleichzeitig wird das Spannungsfeld zwischen professioneller Unterstützung und elterlicher Selbstbestimmung beleuchtet. Ziel der Arbeit ist es, durch die theoretische Fundierung und kritische Reflexion institutioneller Machtverhältnisse Impulse für eine dialogischere, selbstbestimmungsorientierte Gestaltung sozialpädagogischer Unterstützungsprozesse zu geben.Literaturverzeichnis: Seite 38-3
The interactive effect of tree mycorrhizal type, mycorrhizal type mixture and tree diversity shapes rooting zone soil fungal communities in temperate forest ecosystems
Get PDFThe underlying processes of plant-microbe associations particularly their interactions with their mycorrhizal fungal partners have been extensively studied. However, considerably less is known about the consequences of tree-tree interactions on rooting zone soil microbiota when tree species of different mycorrhizal type (myco-type) grow together as mono and mixed myco-type mixtures along a tree diversity gradient.
Using the MyDiv tree diversity experiment, where arbuscular mycorrhizal (AM) and ectomycorrhizal (EcM) trees and their mixtures were planted in monocultures, two-species and four-species mixture plots, we investigated the interplay of target tree myco-type, myco-type mixture, tree diversity and rooting zone compartment (target tree dominated and its interaction zones with neighbour trees) on the rooting zone soil mycobiota employing meta-barcoding of the ITS2 rDNA fragment of the fungal internal transcribed spacer (ITS).
Our results revealed significant individual and interaction effects of tree myco-type, myco-type mixture and tree diversity but not rooting zone compartment on the fungal taxonomic and functional alpha and beta diversity. This implies intermingling of roots of target and neighbouring tree species there by reducing the target tree species effect in its rooting zone. As tree diversity increases, we found convergence of the fungal community in general, where the fungal community dissimilarity varies depending on the co-existing tree species myco-type and tree species diversity. Furthermore, the fungal community composition in the two and four species mixtures were consistently influenced by soil pH, whereas in the mixed multi-species stands basal respiration, N, PO4−, NO3− were found to be equally important unlike in AM and EcM multi-species stands. Comparative analysis of the fungal taxa specialisation between mono and mixed myco-type multi-species stands revealed that the mixed myco-type plots shared 23.5% (AM) and 19.7% (EcM) of the generalist fungal communities However, the percentage of specialised fungal community in mixed myco-type plots (13.2%) was significantly higher as compared to EcM (9.5%), and significantly lower (9%) as compared to AM (11.7%) plots, resulting in myco-type and myco-type mixture specific fungal communities and functional guild patterns
Our results provide novel insights on the significance of tree species and its co-existing trees preferred mycorrhizal association in shaping the target tree rooting zone soil mycobiome along a tree diversity gradient. Furthermore, it highlights the significance of generalist and specialist fungal communities in mono and mixed myco-type stands in modulating tree-tree interaction, tree species co-existence and regulating soil properties and ecosystem functions