Purpose of ReviewThe older patient population is at increased risk of postoperative neurologic complications. With an ever-increasing proportion of older adults requiring advanced surgical ...interventions, surgeons should be knowledgeable in contemporary diagnostic and management paradigms. In this review, we detail neurologic complications common encountered in elderly populations, reviewing relevant literature and practices.Recent FindingsCommon postoperative neurologic complications in the elderly include delirium, cerebrovascular accidents, and seizures. The mainstay of treatment of postoperative delirium is non-pharmacologic management. Postoperative cerebrovascular disorders require prompt diagnosis and evaluation for revascularization (if ischemic) or decompressive (if hemorrhagic) therapies, recognizing certain recent updates have changed guidelines. Preoperative anti-epileptic drug optimization is the most important approach to preventing postoperative seizures in epileptic patients.SummaryA standardized and systematic approach in managing postoperative neurologic complications is paramount, particularly in the older adult. This includes a comprehensive history (including review of preexisting medications and drug use), physical exam, chemical analysis (glucose, electrolytes, infectious evaluation, blood gas), and axial neurologic imaging, lumbar puncture, or electroencephalogram when indicated. Early expert consultation with a neurologist or neurosurgeon is often warranted.
Purpose of Review
The older patient population is at increased risk of postoperative neurologic complications. With an ever-increasing proportion of older adults requiring advanced surgical ...interventions, surgeons should be knowledgeable in contemporary diagnostic and management paradigms. In this review, we detail neurologic complications common encountered in elderly populations, reviewing relevant literature and practices.
Recent Findings
Common postoperative neurologic complications in the elderly include delirium, cerebrovascular accidents, and seizures. The mainstay of treatment of postoperative delirium is non-pharmacologic management. Postoperative cerebrovascular disorders require prompt diagnosis and evaluation for revascularization (if ischemic) or decompressive (if hemorrhagic) therapies, recognizing certain recent updates have changed guidelines. Preoperative anti-epileptic drug optimization is the most important approach to preventing postoperative seizures in epileptic patients.
Summary
A standardized and systematic approach in managing postoperative neurologic complications is paramount, particularly in the older adult. This includes a comprehensive history (including review of preexisting medications and drug use), physical exam, chemical analysis (glucose, electrolytes, infectious evaluation, blood gas), and axial neurologic imaging, lumbar puncture, or electroencephalogram when indicated. Early expert consultation with a neurologist or neurosurgeon is often warranted.
Public health measures were instituted to reduce COVID-19 spread. A decrease in total emergency department volume followed, but the impact on injury is unknown. With lockdown and social distancing ...potentially increasing domicile discord, we hypothesized that intentional injury increased during COVID-19, driven primarily by an increase in penetrating trauma.
A retrospective review of acute adult patient care in an urban Level I trauma center assessed injury patterns. Presenting patient characteristics and diagnoses from 6 weeks pre to 10 weeks post statewide stay-at-home orders (March 16, 2020) were compared, as well as with 2015-2019. Subsets were defined by intentionality (intentional vs nonintentional) and mechanism of injury (blunt vs penetrating). Fisher exact and Wilcoxon tests were used to compare proportions and means.
There were 357 trauma patients that presented pre stay-at-home order and 480 that presented post stay-at-home order. Pre and post groups demonstrated differences in sex (35.6% vs 27.9% female; p = 0.02), age (47.4 ± 22.1 years vs 42 ± 20.3 years; p = 0.009), and race (1.4% vs 2.3% Asian; 63.3% vs 68.3% Black; 30.5% vs 22.3% White; and 4.8% vs 7.1% other; p = 0.03). Post stay-at-home order mechanism of injury revealed more intentional injury (p = 0.0008). Decreases in nonintentional trauma after adoption of social isolation paralleled declines in daily emergency department visits. Compared with earlier years, 2020 demonstrated a significantly greater proportion of intentional violent injury during the peripandemic months, especially from firearms.
Unprecedented social isolation policies to address COVID-19 were associated with increased intentional injury, especially gun violence. Meanwhile, emergency department and nonintentional trauma visits decreased. Pandemic-related public health measures should embrace intentional injury prevention and management strategies.
Display omitted
Expanding the previously known family of ‐onium (ammonium, phosphonium, and sulfonium) organic structure‐directing agents (OSDAs) for the synthesis of zeolite MFI, a new member, the arsonium cation, ...is used for the first time. The new group of tetraalkylarsonium cations has allowed the synthesis of the zeolite ZSM‐5 with several different chemical compositions, opening a route for the synthesis of zeolites with a new series of OSDA. Moreover, the use of As replacing N in the OSDA allows the introduction of probe atoms that facilitate the study of these molecules by powder X‐ray diffraction (PXRD), solid‐state nuclear magnetic resonance (MAS NMR), and X‐ray absorption spectroscopy (XAS). Finally, the influence of trivalent elements such as B, Al, or Ga isomorphically replacing Si atoms in the framework structure and its interaction with the As species has been studied. The suitability of the tetraalkylarsonium cation for carrying out the crystallization of zeolites is demonstrated along with the benefit of the presence of As atoms in the occluded OSDA, which allows its advanced characterization as well as the study of its evolution during OSDA removal by thermal treatments.
As organic structure‐directing agents: Tetraalkylarsonium cations, a novel member of the ‐onium (ammonium, phosphonium, and sulfonium) family of organic structure‐directing agents for the synthesis of zeolites, are presented for the first time. These cations permit the synthesis of the zeolite ZSM‐5 as well as serving as probes for the study of the zeolite and the occluded cation by several techniques, as powder XRD, solid‐state NMR spectroscopy, and XAS.
The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the ...association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population.
This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles.
51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92.
In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Pathological tremor in patients with essential tremor and Parkinsons disease is typically treated using medication or neurosurgical interventions. There is a widely recognized need for new treatments ...that avoid the side effects of current medications and do not carry the risks of surgical interventions. Building on decades of research and engineering development, non-invasive electrical stimulation of peripheral nerves has emerged as a safe and effective strategy for reducing pathologic tremor in essential tremor. This review surveys the peripheral electrical stimulation (PES) literature and summarizes effectiveness, safety, clinical translatability, and hypothesized tremor-reduction mechanisms of various PES approaches. The review also proposes guidelines for assessing tremor in the context of evaluating new therapies that combine the strengths of clinician assessments, patient evaluations, and novel motion sensing technology. The review concludes with a summary of future directions for PES, including expanding clinical access for patients with Parkinson's disease and leveraging large, at-home datasets to learn more about tremor physiology and treatment effect that will better characterize the state of tremor management and accelerate discovery of new therapies. Growing evidence suggests that non-invasive electrical stimulation of afferent neural pathways provides a viable new option for management of pathological tremor, with one specific PES therapy cleared for prescription and home use, suggesting that PES be considered along with medication and neurosurgical interventions for treatment of tremor.
This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
•Peripheral electrical stimulation is an available treatment to reduce tremor.•Deeper understanding of tremor mechanisms is crucial to optimize current therapies.•Stimulation of afferent pathways is a promising effective neuromodulation therapy.•Wearable technology will allow development of personalized tremor treatments.
Neurotrauma Niziolek, Grace; Sandsmark, Danielle K; Pascual, Jose L
Current opinion in critical care,
12/2022, Letnik:
28, Številka:
6
Journal Article
This review will highlight the latest research relevant to the clinical care of traumatic brain injury (TBI) patients over the last 2 years while underscoring the implications of these advances in ...the understanding of diagnosis, treatment, and prognosis of TBI.
Brain tissue oxygenation monitoring can identify hypoperfusion as an adjunct to intracerebral pressure monitoring. Multiple biomarker assays are now available to help clinicians screen for mild TBI and biomarker elevations correlate with the size of intracranial injury. Beta-blocker exposure following TBI has demonstrated a survival benefit in those with TBI though the mechanism for this remains unknown. The optimal timing for venous thromboembolism prophylaxis for TBI patients is still uncertain.
The current characterization of TBI as mild, moderate, or severe fails to capture the complexity of the disease process and helps little with prognostication. Molecular biomarkers and invasive monitoring devices including brain tissue oxygenation and measures of cerebral autoregulation are being utilized more commonly and can help guide therapy. Extracranial complications following TBI are common and include infection, respiratory failure, coagulopathy, hypercoagulability, and paroxysmal sympathetic hyperactivity.
In preparation for new-generation imaging spectrometer missions and the accompanying unprecedented inflow of hyperspectral data, optimized models are needed to generate vegetation traits routinely. ...Hybrid models, combining radiative transfer models with machine learning algorithms, are preferred, however, dealing with spectral collinearity imposes an additional challenge. In this study, we analyzed two spectral dimensionality reduction methods: principal component analysis (PCA) and band ranking (BR), embedded in a hybrid workflow for the retrieval of specific leaf area (SLA), leaf area index (LAI), canopy water content (CWC), canopy chlorophyll content (CCC), the fraction of absorbed photosynthetic active radiation (FAPAR), and fractional vegetation cover (FVC). The SCOPE model was used to simulate training data sets, which were optimized with active learning. Gaussian process regression (GPR) algorithms were trained over the simulations to obtain trait-specific models. The inclusion of PCA and BR with 20 features led to the so-called GPR-20PCA and GPR-20BR models. The 20PCA models encompassed over 99.95% cumulative variance of the full spectral data, while the GPR-20BR models were based on the 20 most sensitive bands. Validation against in situ data obtained moderate to optimal results with normalized root mean squared error (NRMSE) from 13.9% (CWC) to 22.3% (CCC) for GPR-20PCA models, and NRMSE from 19.6% (CWC) to 29.1% (SLA) for GPR-20BR models. Overall, the GPR-20PCA slightly outperformed the GPR-20BR models for all six variables. To demonstrate mapping capabilities, both models were tested on a PRecursore IperSpettrale della Missione Applicativa (PRISMA) scene, spectrally resampled to Copernicus Hyperspectral Imaging Mission for the Environment (CHIME), over an agricultural test site (Jolanda di Savoia, Italy). The two strategies obtained plausible spatial patterns, and consistency between the two models was highest for FVC and LAI (R2=0.91, R2=0.86) and lowest for SLA mapping (R2=0.53). From these findings, we recommend implementing GPR-20PCA models as the most efficient strategy for the retrieval of multiple crop traits from hyperspectral data streams. Hence, this workflow will support and facilitate the preparations of traits retrieval models from the next-generation operational CHIME.
Recent work on the Jurassic-Cretaceous transition of the Iberian Range (Spain) has opened a new window onto the interpretation of the trackmakers of some medium-sized tridactyl tracks. The ichnotaxon ...Therangospodus oncalensis has been described in the Huérteles Formation (Berriasian) and is one of the classical tracks from the area assigned to medium-sized theropods.
A review of the type locality of Therangospodus oncalensis (Fuentesalvo tracksite) and other tracksites from the Huérteles Formation (Berriasian) has yielded new information on the morphology, gait and trackmaker identity of the aforementioned ichnospecies. The new data suggest that the trackmaker is an ornithopod rather than a theropod on the basis of the length/width ratio, the anterior triangle length-width ratio, the short steps, the round to quadrangular heel pad impression and the probable manus impressions.
T. oncalensis shows similarities with various tracks from the Berriasian of Europe assigned to Iguanodontipus. The ichnotaxonomical status of this ichnospecies is here considered as Iguanodontipus? oncalensis due to the current state of knowledge of the ichnotaxonomy of medium-sized ornithopod tracks. This reassessment of I? oncalensis also has two significant implications for the palaeoecology of the faunas during the deposition of the Huérteles Formation: 1- the high number and percentage of theropod tracks would be lower than previous papers have suggested. 2- the gregarious behaviour described in the type locality (Fuentesalvo) would be among ornithopods instead of theropods.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The continuous monitoring of the terrestrial Earth system by a growing number of optical satellite missions provides valuable insights into vegetation and cropland characteristics. Satellite missions ...typically provide different levels of data, such as level 1 top-of-atmosphere (TOA) radiance and level 2 bottom-of-atmosphere (BOA) reflectance products. Exploiting TOA radiance data directly offers the advantage of bypassing the complex atmospheric correction step, where errors can propagate and compromise the subsequent retrieval process. Therefore, the objective of our study was to develop models capable of retrieving vegetation traits directly from TOA radiance data from imaging spectroscopy satellite missions. To achieve this, we constructed hybrid models based on radiative transfer model (RTM) simulated data, thereby employing the vegetation SCOPE RTM coupled with the atmosphere LibRadtran RTM in conjunction with Gaussian process regression (GPR). The retrieval evaluation focused on vegetation canopy traits, including the leaf area index (LAI), canopy chlorophyll content (CCC), canopy water content (CWC), the fraction of absorbed photosynthetically active radiation (FAPAR), and the fraction of vegetation cover (FVC). Employing band settings from the upcoming Copernicus Hyperspectral Imaging Mission (CHIME), two types of hybrid GPR models were assessed: (1) one trained at level 1 (L1) using TOA radiance data and (2) one trained at level 2 (L2) using BOA reflectance data. Both the TOA- and BOA-based GPR models were validated against in situ data with corresponding hyperspectral data obtained from field campaigns. The TOA-based hybrid GPR models revealed a range of performance from moderate to optimal results, thus reaching R2 = 0.92 (LAI), R2 = 0.72 (CCC) and 0.68 (CWC), R2 = 0.94 (FAPAR), and R2 = 0.95 (FVC). To demonstrate the models’ applicability, the TOA- and BOA-based GPR models were subsequently applied to imagery from the scientific precursor missions PRISMA and EnMAP. The resulting trait maps showed sufficient consistency between the TOA- and BOA-based models, with relative errors between 4% and 16% (R2 between 0.68 and 0.97). Altogether, these findings illuminate the path for the development and enhancement of machine learning hybrid models for the estimation of vegetation traits directly tailored at the TOA level.
PDF
