المؤلفون: Steffen Haupeltshofer, Stine Mencl, Rebecca D. Szepanowski, Christina Hansmann, Ana I. Casas, Hanna Abberger, Wiebke Hansen, Alina Blusch, Cornelius Deuschl, Michael Forsting, Dirk M. Hermann, Friederike Langhauser, Christoph Kleinschnitz

المصدر: Journal of Neuroinflammation, Vol 21, Iss 1, Pp 1-12 (2024)

مصطلحات موضوعية: Thrombo-inflammation, Thrombosis, Ischemic stroke, Recovery, Subacute, Plasma kallikrein, Neurology. Diseases of the nervous system, RC346-429

الوصف: Abstract Activation of the kallikrein-kinin system promotes vascular leakage, inflammation, and neurodegeneration in ischemic stroke. Inhibition of plasma kallikrein (PK) – a key component of the KKS – in the acute phase of ischemic stroke has been reported to reduce thrombosis, inflammation, and damage to the blood-brain barrier. However, the role of PK during the recovery phase after cerebral ischemia is unknown. To this end, we evaluated the effect of subacute PK inhibition starting from day 3 on the recovery process after transient middle artery occlusion (tMCAO). Our study demonstrated a protective effect of PK inhibition by reducing infarct volume and improving functional outcome at day 7 after tMCAO. In addition, we observed reduced thrombus formation in cerebral microvessels, fewer infiltrated immune cells, and an improvement in blood-brain barrier integrity. This protective effect was facilitated by promoting tight junction reintegration, reducing detrimental matrix metalloproteinases, and upregulating regenerative angiogenic markers. Our findings suggest that PK inhibition in the subacute phase might be a promising approach to accelerate the post-stroke recovery process.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1742-2094Test

الوصول الحر: https://doaj.org/article/47314db5edc8456c8ff87473e47850e1Test

المؤلفون: Denise Bos, Aydin Demircioğlu, Julia Neuhoff, Johannes Haubold, Sebastian Zensen, Marcel K. Opitz, Marcel A. Drews, Yan Li, Hanna Styczen, Michael Forsting, Kai Nassenstein

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-10 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract In this retrospective study, we aimed to assess the objective and subjective image quality of different reconstruction techniques and a deep learning-based software on non-contrast head computed tomography (CT) images. In total, 152 adult head CT scans (77 female, 75 male; mean age 69.4 ± 18.3 years) obtained from three different CT scanners using different protocols between March and April 2021 were included. CT images were reconstructed using filtered-back projection (FBP), iterative reconstruction (IR), and post-processed using a deep learning-based algorithm (PS). Post-processing significantly reduced noise in FBP-reconstructed images (up to 15.4% reduction) depending on the protocol, leading to improvements in signal-to-noise ratio of up to 19.7%. However, when deep learning-based post-processing was applied to FBP images compared to IR alone, the differences were inconsistent and partly non-significant, which appeared to be protocol or site specific. Subjective assessments showed no significant overall improvement in image quality for all reconstructions and post-processing. Inter-rater reliability was low and preferences varied. Deep learning-based denoising software improved objective image quality compared to FBP in routine head CT. A significant difference compared to IR was observed for only one protocol. Subjective assessments did not indicate a significant clinical impact in terms of improved subjective image quality, likely due to the low noise levels in full-dose images.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/ee83d3ee26bf46f1bbc8d5fe19deb44eTest

المؤلفون: Dirk Westhölter, Johannes Haubold, Matthias Welsner, Luca Salhöfer, Johannes Wienker, Sivagurunathan Sutharsan, Svenja Straßburg, Christian Taube, Lale Umutlu, Benedikt M. Schaarschmidt, Sven Koitka, Sebastian Zensen, Michael Forsting, Felix Nensa, René Hosch, Marcel Opitz

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-11 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract A poor nutritional status is associated with worse pulmonary function and survival in people with cystic fibrosis (pwCF). CF transmembrane conductance regulator modulators can improve pulmonary function and body weight, but more data is needed to evaluate its effects on body composition. In this retrospective study, a pre-trained deep-learning network was used to perform a fully automated body composition analysis on chest CTs from 66 adult pwCF before and after receiving elexacaftor/tezacaftor/ivacaftor (ETI) therapy. Muscle and adipose tissues were quantified and divided by bone volume to obtain body size-adjusted ratios. After receiving ETI therapy, marked increases were observed in all adipose tissue ratios among pwCF, including the total adipose tissue ratio (+ 46.21%, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/f083b010ca674e2bb98c97dac99faa1aTest

المؤلفون: Johannes Wienker, Kaid Darwiche, Nele Rüsche, Erik Büscher, Rüdiger Karpf-Wissel, Jane Winantea, Filiz Özkan, Dirk Westhölter, Christian Taube, David Kersting, Hubertus Hautzel, Luca Salhöfer, René Hosch, Felix Nensa, Michael Forsting, Benedikt M. Schaarschmidt, Sebastian Zensen, Jens Theysohn, Lale Umutlu, Johannes Haubold, Marcel Opitz

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-13 (2024)

مصطلحات موضوعية: Chronic obstructive pulmonary disease, Emphysema, Bronchoscopic lung volume reduction, Valves, Body composition, Computed tomography, Medicine, Science

الوصف: Abstract Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation, with individual body composition influencing disease severity. Severe emphysema worsens symptoms through hyperinflation, which can be relieved by bronchoscopic lung volume reduction (BLVR). To investigate how body composition, assessed through CT scans, impacts outcomes in emphysema patients undergoing BLVR. Fully automated CT-based body composition analysis (BCA) was performed in patients with end-stage emphysema receiving BLVR with valves. Post-interventional muscle and adipose tissues were quantified, body size-adjusted, and compared to baseline parameters. Between January 2015 and December 2022, 300 patients with severe emphysema underwent endobronchial valve treatment. Significant improvements were seen in outcome parameters, which were defined as changes in pulmonary function, physical performance, and quality of life (QoL) post-treatment. Muscle volume remained stable (1.632 vs. 1.635 for muscle bone adjusted ratio (BAR) at baseline and after 6 months respectively), while bone adjusted adipose tissue volumes, especially total and pericardial adipose tissue, showed significant increase (2.86 vs. 3.00 and 0.16 vs. 0.17, respectively). Moderate to strong correlations between bone adjusted muscle volume and weaker correlations between adipose tissue volumes and outcome parameters (pulmonary function, QoL and physical performance) were observed. Particularly after 6-month, bone adjusted muscle volume changes positively corresponded to improved outcomes (ΔForced expiratory volume in 1 s [FEV1], r = 0.440; ΔInspiratory vital capacity [IVC], r = 0.397; Δ6Minute walking distance [6MWD], r = 0.509 and ΔCOPD assessment test [CAT], r = −0.324; all p 10, respectively). BCA results among patients divided by the minimal clinically important difference for forced expiratory volume of the first second (FEV1) showed significant differences in bone-adjusted muscle and intramuscular adipose tissue (IMAT) volumes and their respective changes after 6 months (ΔMuscle, BAR% −5 vs. 3.4 and ΔIMAT, BAR% −0.62 vs. 0.60 for groups with ΔFEV1 ≤ 100 mL vs > 100 mL). Altered body composition, especially increased muscle volume, is associated with functional improvements in BLVR-treated patients.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/f618991bf2f9403ca680a549299e1f20Test

المؤلفون: Ali Khanafer, Hans Henkes, Philipp Bücke, Florian Hennersdorf, Hansjörg Bäzner, Michael Forsting, Philipp von Gottberg

المصدر: BMC Neurology, Vol 24, Iss 1, Pp 1-8 (2024)

مصطلحات موضوعية: Stroke, Carotid artery stenting, Endovascular thrombectomy, In-Stent restenosis, Anti-platelet therapy, Neurology. Diseases of the nervous system, RC346-429

الوصف: Abstract Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. Methods Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. Results 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. Conclusion In our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2377Test

الوصول الحر: https://doaj.org/article/0963334f82af4c82a82272ca99a1ae07Test

المؤلفون: Cornelius Deuschl, Lukas Goertz, Christoph Kabbasch, Martin Köhrmann, Christoph Kleinschnitz, Ansgar Berlis, Christoph Johannes Maurer, Iris Mühlen, Bernd Kallmünzer, Matthias Gawlitza, Daniel P. O. Kaiser, Joachim Klisch, Donald Lobsien, Daniel Behme, Maximilian Thormann, Fabian Flottmann, Laurens Winkelmeier, Elke Ruth Gizewski, Lukas Mayer‐Suess, Markus Holtmannspoetter, Christoph Moenninghoff, Martin Schlunz‐Hendann, Dominik Grieb, Christophe T. Arendt, Ferdinand O. Bohmann, Jens Altenbernd, Yan Li, Ulrich Sure, Ruben Mühl‐Benninghaus, Thomas Rodt, Kai Kallenberg, Alexandru Durutya, Mohamed Elsharkawy, Christian‐Paul Stracke, Mathias Gerhard Schumann, Alexander Bock, Omid Nikoubashman, Martin Wiesmann, Hans Henkes, Sebastian Dolff, Aydin Demircioglu, Michael Forsting, Hanna Styczen

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 13, Iss 9 (2024)

مصطلحات موضوعية: acute ischemic stroke, COVID‐19, COVID‐19 vaccination, mechanical thrombectomy, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Data on impact of COVID‐19 vaccination and outcomes of patients with COVID‐19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. Methods and Results This was a retrospective analysis of patients with COVID‐19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID‐19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P=0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group (P=0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome (P=0.957). However, acute COVID‐19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007–1.417]; P=0.041). Conclusions Our study demonstrated no impact of COVID‐19 vaccination on angiographic or clinical outcome of COVID‐19–positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID‐19 was confirmed.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2047-9980Test

الوصول الحر: https://doaj.org/article/d0046009810d45d98d301d4705a4c496Test

المؤلفون: Luca Salhöfer, Johannes Haubold, Maurice Gutt, René Hosch, Lale Umutlu, Mathias Meetschen, Maximilian Schuessler, Michael Forsting, Felix Nensa, Benedikt Michael Schaarschmidt

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract A novel software, DiffTool, was developed in-house to keep track of changes made by board-certified radiologists to preliminary reports created by residents and evaluate its impact on radiological hands-on training. Before (t0) and after (t2−4) the deployment of the software, 18 residents (median age: 29 years; 33% female) completed a standardized questionnaire on professional training. At t2−4 the participants were also requested to respond to three additional questions to evaluate the software. Responses were recorded via a six-point Likert scale ranging from 1 (“strongly agree”) to 6 (“strongly disagree”). Prior to the release of the software, 39% (7/18) of the residents strongly agreed with the statement that they manually tracked changes made by board-certified radiologists to each of their radiological reports while 61% were less inclined to agree with that statement. At t2−4, 61% (11/18) stated that they used DiffTool to track differences. Furthermore, we observed an increase from 33% (6/18) to 44% (8/18) of residents who agreed to the statement “I profit from every corrected report”. The DiffTool was well accepted among residents with a regular user base of 72% (13/18), while 78% (14/18) considered it a relevant improvement to their training. The results of this study demonstrate the importance of providing a time-efficient way to analyze changes made to preliminary reports as an additive for professional training.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/61ef5624b4a04c56bf67a9cabe1a4edcTest

المؤلفون: Christopher Schuppert, Susanne Rospleszcz, Jochen G. Hirsch, Daniel C. Hoinkiss, Alexander Köhn, Ricarda von Krüchten, Maximilian F. Russe, Thomas Keil, Lilian Krist, Börge Schmidt, Karin B. Michels, Sabine Schipf, Hermann Brenner, Thomas J. Kröncke, Tobias Pischon, Thoralf Niendorf, Jeanette Schulz-Menger, Michael Forsting, Henry Völzke, Norbert Hosten, Robin Bülow, Maxim Zaitsev, Hans-Ulrich Kauczor, Fabian Bamberg, Matthias Günther, Christopher L. Schlett

المصدر: Scientific Reports, Vol 13, Iss 1, Pp 1-14 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract In magnetic resonance imaging (MRI), the perception of substandard image quality may prompt repetition of the respective image acquisition protocol. Subsequently selecting the preferred high-quality image data from a series of acquisitions can be challenging. An automated workflow may facilitate and improve this selection. We therefore aimed to investigate the applicability of an automated image quality assessment for the prediction of the subjectively preferred image acquisition. Our analysis included data from 11,347 participants with whole-body MRI examinations performed as part of the ongoing prospective multi-center German National Cohort (NAKO) study. Trained radiologic technologists repeated any of the twelve examination protocols due to induced setup errors and/or subjectively unsatisfactory image quality and chose a preferred acquisition from the resultant series. Up to 11 quantitative image quality parameters were automatically derived from all acquisitions. Regularized regression and standard estimates of diagnostic accuracy were calculated. Controlling for setup variations in 2342 series of two or more acquisitions, technologists preferred the repetition over the initial acquisition in 1116 of 1396 series in which the initial setup was retained (79.9%, range across protocols: 73–100%). Image quality parameters then commonly showed statistically significant differences between chosen and discarded acquisitions. In regularized regression across all protocols, ‘structured noise maximum’ was the strongest predictor for the technologists’ choice, followed by ‘N/2 ghosting average’. Combinations of the automatically derived parameters provided an area under the ROC curve between 0.51 and 0.74 for the prediction of the technologists’ choice. It is concluded that automated image quality assessment can, despite considerable performance differences between protocols and anatomical regions, contribute substantially to identifying the subjective preference in a series of MRI acquisitions and thus provide effective decision support to readers.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/e2b22445b4b648cdb751618f06f3afe7Test

المؤلفون: Aydin Demircioğlu, Anton S. Quinsten, Lale Umutlu, Michael Forsting, Kai Nassenstein, Denise Bos

المصدر: Scientific Reports, Vol 13, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract In this retrospective study, we aimed to predict the body height and weight of pediatric patients using CT localizers, which are overview scans performed before the acquisition of the CT. We trained three commonly used networks (EfficientNetV2-S, ResNet-18, and ResNet-34) on a cohort of 1009 and 1111 CT localizers of pediatric patients with recorded body height and weight (between January 2013 and December 2019) and validated them in an additional cohort of 116 and 127 localizers (acquired in 2020). The best-performing model was then tested in an independent cohort of 203 and 225 CT localizers (acquired between January 2021 and March 2023). In addition, a cohort of 1401 and 1590 localizers from younger adults (acquired between January 2013 and December 2013) was added to the training set to determine if it could improve the overall accuracy. The EfficientNetV2-S using the additional adult cohort performed best with a mean absolute error of 5.58 ± 4.26 cm for height and 4.25 ± 4.28 kg for weight. The relative error was 4.12 ± 4.05% for height and 11.28 ± 12.05% for weight. Our study demonstrated that automated estimation of height and weight in pediatric patients from CT localizers can be performed.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/61087b62a0ca4cd2a44939578ad1b3e7Test

المؤلفون: Ali Khanafer, Hans Henkes, Jose Cohen, Pablo Albiña-Palmarola, John Moshe Gomori, Michael Forsting, Philipp von Gottberg

المصدر: Frontiers in Neurology, Vol 15 (2024)

مصطلحات موضوعية: flow diversion, aneuryms, ACA, pericallosal aneurysm, endovascular treatment, Neurology. Diseases of the nervous system, RC346-429

الوصف: PurposeFlow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data.MethodsData for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded.ResultsForty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits.ConclusionFDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fneur.2024.1368612/fullTest; https://doaj.org/toc/1664-2295Test

الوصول الحر: https://doaj.org/article/b23dc6b47c3644519a73a67ab84852eeTest