340880 research outputs found
Sort by
Neuromodulating the rhythms of cognition
No full textRhythmic non-invasive brain stimulation (rh-NIBS) allows to modulate neural oscillations and study the functional role of these brain rhythms for cognition. We hope to draw attention to often neglected aspects of this field that limit the interpretations of the findings and their translational potential. We here review current rh-NIBS trends and propose to conceptually differentiate oscillatory synchronization, aimed at enhancing an intrinsic oscillatory amplitude, from frequency-shifting, designed to speed-up or slow-down a given oscillatory rhythm. At the same time, we offer a precise mechanistic account of these two rh-NIBS protocols that accounts for inter-individual differences in stimulation outcomes. Finally, we gap the bridge between entrainment, understood as an online manipulation of neural oscillations via rh-NIBS, versus plasticity, defined as the aftereffects of the TMS offline protocols. Specifically, we bring forward a promising possibility that the aftereffects of rh-NIBS protocols, preferably tuned to the dominant oscillatory frequency, might produce the desired outcome through a successful online oscillatory tuning, understood as a prerequisite for the generation of synaptic plasticity reflecting enduring aftereffects. This conceptual and mechanistic framework aims to provide a deeper theoretical understanding of recommended rh-NIBS best practices for noninvasively studying dynamic oscillation-cognition relationships in cognitive and clinical research
Can we share data? - Kinematic consistency during walking in three different treadmill-based laboratories
No full textBACKGROUND: Three-dimensional gait analysis is crucial for diagnosis and treatment planning. Treadmill-based laboratories efficiently collect 3D gait data over many consecutive steps. Pooling/sharing data across treadmill-based laboratories could enhance clinical utility. However, the inter-laboratory consistency of gait kinematics from treadmill-based systems is unknown. RESEARCH QUESTION: How consistent are lower-limb kinematics of healthy subjects measured in three different treadmill-based gait laboratories? METHODS: Eighteen volunteers (14 women; 27 ± 9 years; BMI 24 ± 3 kg/m ) walked in three treadmill-based laboratories (Motek Medical, The Netherlands) within one week. Per laboratory, participants completed 3-minute walking trials (0.9, 1.1, 1.3 m/s) wearing a non-weight-bearing harness and identical clothes and shoes. The same marker-set (Human-Body Model 2) and virtual reality configurations were used. Statistical Parametric Mapping was used to compare time-normalized kinematic curves of the lower-limb, averaged over 40 steps, between laboratories. Root mean square differences (RMSD) calculated over periods of the gait cycle with statistically significant differences were considered clinically meaningful when > 5°. RESULTS AND SIGNIFICANCE: Kinematics curves from all laboratories followed similar patterns. Only 17 % of all curves displayed clinically relevant differences. These differences included more knee flexion in laboratory 2 compared to the others (RMSD 6.0-8.6°) and less hip flexion in laboratory 3 compared to laboratory 2 (all speeds) and to laboratory 1 (1.3 m/s; RMSD 5.4-6.4°). Reported differences are likely due to varying operator protocols rather than to the measurement system. The findings indicate that inter-laboratory data sharing using such infrastructure is possible but training to align protocols is essential
Event-based optical flow on neuromorphic processor:ANN vs. SNN comparison based on activation sparsification
No full textSpiking neural networks (SNNs) for event-based optical flow are claimed to be computationally more efficient than their artificial neural networks (ANNs) counterparts, but a fair comparison is missing in the literature. In this work, we propose an event-based optical flow solution based on activation sparsification and a neuromorphic processor, SENECA. SENECA has an event-driven processing mechanism that can exploit the sparsity in ANN activations and SNN spikes to accelerate the inference of both types of neural networks. The ANN and the SNN for comparison have similar low activation/spike density (~5%) thanks to our novel sparsification-aware training. In the hardware-in-loop experiments designed to deduce the average time and energy consumption, the SNN consumes 44.9ms and 927.0µJ, which are 62.5% and 75.2% of the ANN's consumption, respectively. We find that SNN's higher efficiency is attributed to its lower pixel-wise spike density (43.5% vs. 66.5%) that requires fewer memory access operations for neuron states
Association of anesthesia strategies with outcomes in endovascular treatment for distal and medium vessel occlusions:A propensity score-matched analysis of the MR CLEAN registry and meta-analysis
No full textBackground: Recent trials did not demonstrate the benefit of endovascular therapy (EVT) for distal or medium vessel occlusions (DMVOs), raising questions about factors influencing outcomes. Anesthesia choice may play a role, yet its impact remains unclear. This study assessed general anesthesia (GA) versus non-GA in EVT for DMVOs, evaluating procedural, functional, and safety outcomes. Patients and methods: Patients undergoing EVT for AIS due to anterior DMVOs in the middle cerebral artery (MCA-M2, M3, M4) and anterior cerebral artery (ACA-A1, A2, A3) from the MR CLEAN registry between March 2014 and December 2018 were included. They were stratified into GA and non-GA groups, with propensity score matching employed to adjust for differences in baseline risk. Primary outcomes included functional outcomes at 90 days, assessed by ordinal regression analysis of modified Rankin Scale (mRS) scores at 90 days, and recanalization rates measured by Thrombolysis in Cerebral Infarction (TICI) scores. Secondary outcomes included dichotomized mRS scores, death at 90 days, and symptomatic intracranial hemorrhage (sICH). A systematic review and meta-analysis of relevant DMVO studies with a random effects model was performed. This study was registered with PROSPERO (CRD42024607294). Results: Among 5193 patients in the registry, 657 were eligible for our study, with 506 in the non-GA group, and 151 in the GA group. The median age was 73 years (IQR 64–81) in the non-GA group and 73 years (IQR 61–80) in the GA group (p = 0.35). The proportion of male patients was 50.2% in the non-GA group and 57.0% in the GA group (p = 0.15). In the matched cohort (n = 170), recanalization rates were higher in the GA group compared to the non-GA group (excellent recanalization rates (TICI2c/3): 61.0% vs 32.1%; OR 3.31, 95% CI (1.74–6.29), p < 0.001). There were no significant differences in the overall distribution of functional outcomes at 90 days (common OR 0.93, 95% CI (0.54–1.56), p = 0.77). Mortality was comparable between groups (34.1% vs 31.8%; OR 1.11, 95% CI (0.59–2.11), p = 0.74), and there was no significant difference in sICH (12.9% vs 5.9%; OR 0.42, 95% CI (0.14–1.27), p = 0.12). The systematic review and meta-analysis included six studies with a total of 3521 patients. The pooled analysis indicated that GA was associated with significantly lower rates of excellent functional outcomes (mRS 0–1: OR 0.74, 95% CI (0.58–0.94), p = 0.01) and higher mortality (OR 1.36, 95% CI (1.07–1.74), p = 0.01) compared to the non-GA at 90 days. Discussion and conclusion: In the MR CLEAN Registry, GA was associated with higher recanalization rates during EVT, but this technical advantage did not translate into improved 90-day functional outcomes. Our meta-analysis further indicated that non-GA strategies were associated with better functional recovery and lower mortality. These associations, however, warrant cautious interpretation given potential unmeasured confounders, including blood pressure management and conversion from non-GA to GA. Broad categorization of anesthesia as GA versus non-GA overlooks critical factors such as agent selection, physiological targets, and intraoperative monitoring, which may substantially impact cerebral perfusion and outcomes. Further prospective randomized studies with detailed anesthetic data and expert input are needed to refine these findings and guide clinical practice.</p
Optimizing Bone Health in Diabetes:Strategies for Fracture Risk Reduction in Public Healthcare
No full textPurpose of reviewIn this review, we explore the under-recognized burden of fractures in diabetes, focusing on resource-constrained healthcare systems. We examine the epidemiology, assessment methodologies, and management approaches to osteoporosis in diabetes and discuss strategies to improve skeletal health outcomes.Recent findingsPublic healthcare strategies for fracture risk reduction in diabetes include educating healthcare providers, empowering patients, and integrating fracture liaison services for secondary prevention. Community-based awareness programs, digital health solutions, and screening tools such as FRAX (R) (with diabetes-specific adjustments) facilitate early identification and management. Policies supporting insurance coverage and cost-effective management strategies are likewise crucial.SummaryDiabetes-related bone fragility, characterized by altered bone quality and increased fracture risk despite relatively preserved bone density, creates a significant yet underrecognized health burden. Fracture prevention in diabetes is both a clinical necessity and an economic imperative. In this expanding cohort, multidisciplinary, policy-supported strategies can reduce morbidity, mortality, and costs associated with fragility fractures
De-escalation strategies with targeted therapies in non-small cell lung cancer
No full textTargeted therapies (TT) for non-small cell lung cancer (NSCLC) with actionable genomic alterations (AGA), particularly EGFR-mutant and ALK-rearranged tumors, have become the standard of care across nearly all stages of the disease. However, the arbitrarily defined dose and treatment duration of TT, as well as the financial cost of these drugs, reduce their availability worldwide. Pharmacokinetic and pharmacodynamic properties of TT suggest that doses of some TT are overestimated as there is limited evidence supporting a direct relationship between therapeutic intensity and outcomes. This can lead to overtreatment of patients, resulting in an increased risk of toxicity without enhanced efficacy. Some academic initiatives have been launched aiming to explore de-escalating strategies with TT, either reducing the dose or the duration of these drugs. These approaches can decrease the risk of adverse events positively impacting patients’ quality of life, without compromising efficacy, while reducing economic impact. In this review, we summarize current data regarding de-escalating strategies with TT, ongoing trials and challenges of this approach
Spectrum of Interstitial Cell of Cajal Deficits in Chronic Gastroduodenal Disorders:Systematic Review and Meta-Analysis
No full textBackground and Aims:Chronic neurogastroduodenal disorders are heterogeneous and thought to lie on a spectrum of disease encompassing both sensory and neuromuscular pathologies. Abnormalities of interstitial cells of Cajal (ICC), a subset of which generate pacemaker signals and subsequently motility, have been implicated in their pathophysiology. We systematically reviewed the literature to pool ICC deficits observed in chronic neurogastroduodenal disorders.Methods:Studies quantifying gastric ICC from the corpus or antrum, in adult patients with gastroparesis, functional dyspepsia (FD) or chronic nausea and vomiting syndromes (CNVS) were analysed (PROSPERO: CRD42024613226). MEDLINE, Embase and CENTRAL databases were searched systematically. Random effects meta-analyses were used to compare ICC counts by disorder group with subgroup analysis by quantification methodology.Results:2158 studies were screened and 22 included. Comparative studies (n=12) showed patients with chronic neurogastroduodenal disorders (n=167 with gastroparesis, n=19 with FD±CNVS) had lower ICC counts than non-diabetic controls (n=130); standardised mean difference -1.58, 95% confidence interval -2.09 to -1.07, p<0.0001, with more severe deficits in gastroparesis compared to FD±CNVS (SMD -0.44, p=0.048). A spectrum of ICC deficits was evident in a subgroup of studies using gold-standard methods with c-KIT antibody and DAPI-stained nuclei confirmation (7 studies, 246 patients: mean ICC counts 2.29 in gastroparesis vs 3.49 in FD±CNVS, and 5.27 in controls; p<0.001 all comparisons). Most studies were at high risk of bias (n=21).Conclusion:Marked depletion of ICC is a consistent finding in neurogastroduodenal disorders. A spectrum of disease is revealed, with greater depletion associated with delayed emptying. Techniques for clinically defining ICC-driven gastric neuromuscular dysfunction should be prioritized.</p
Synthesis of 2,5-Substituted 1,3,4-Oxadiazoles via a Tandem Reaction Involving a Cobalt-Catalyzed Carbene Transfer to N-Isocyaniminotriphenylphosphorane
No full textA cobalt(II)-catalyzed three-component synthesis of 2,5-substituted 1,3,4-oxadiazoles using N-isocyaniminotriphenylphosphorane (NIITP), diazo compounds, and carboxylic acids has been developed. The tandem reaction involves a carbene transfer to NIITP, followed by the addition of the carboxylic acid to the in situ-formed ketenimine and a subsequent intramolecular aza-Wittig reaction. The protocol tolerates a broad range of carboxylic acids and diazoacetates. This includes medicinally relevant carboxylic acids that were successfully converted into their corresponding 1,3,4-oxadiazole bioisosteres. Postfunctionalization extends the applicability of this three-component reaction.</p
Met onderdanigheid bouw je geen Europese defensie
No full textEuropa moet een onafhankelijke defensie durven bouwen die niet onderhevig is aan de Amerikaanse grillen. Zonder strategische assertiviteit dreigt Europa machteloos te zijn in een gevaarlijke wereld
Can the Assessment of Burden of Chronic Conditions (ABCC) Tool contribute to person-centered care?
No full textChronic conditions represent an increasing public health challenge. While concepts like person-centered care, shared decision-making, and self-management are increasingly promoted, their practical realization remains difficult within our disease-centered healthcare system. The Assessment of Burden of Chronic Conditions (ABCC) tool may contribute to a more person-centered approach within the current healthcare system. This tool can support patients and healthcare providers in developing personalized care plans by measuring and visualizing perceived disease burden. Research indicates that the questions within the ABCC tool are valid and reliable for COPD, asthma, type 2 diabetes, chronic heart failure, osteoarthritis, and colorectal cancer. An effectiveness study found that using the tool resulted in significant differences in perceived quality of care and patient activation compared to control. However, outcomes like quality of life and well-being showed no significant differences in this study. Future research should focus on validation for multimorbidity, long-term effects, and implementation strategies