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When does life end? New organ donation strategy fuels debate
On a chilly holiday Monday in January 2020, a medical milestone passed largely unnoticed. In a New York City operating room, surgeons gently removed the heart from a 43-year-old man who had died and shuttled it steps away to a patient in desperate need of a new one. More than 3500 people in the United States receive a new heart each year. But this case was different—the first of its kind in the country. “It took us 6 months to prepare,” says Nader Moazami, surgical head of heart transplantation at New York University (NYU) Langone Health, where the operation took place. The run-up included oversight from an ethi...
Source: ScienceNOW - May 11, 2023 Category: Science Source Type: news

Estimated pulse-wave velocity predicts survival in patients requiring extracorporeal membrane oxygenation
CONCLUSIONS: ePWV is a promising marker for risk-stratification in ECMO patients. Further investigation is required to better delineate the role of arterial health assessment in disease trajectory and strengthen the validity of AS as a marker of interest in medical and surgical management.PMID:36419384 | DOI:10.1177/02676591221141963
Source: Perfusion - November 24, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Mohsyn I Malik Dave Nagpal Source Type: research

Early Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study
Conclusions: A high proportion of aSAH patients presented at the coiling procedure with dehydration and a low cardiac output state; these derangements were more likely to be corrected if the GDT algorithm was used. Compared with standard therapy, use of the GDT algorithm resulted in earlier recognition and more consistent treatment of dehydration and hemodynamic derangement during endovascular coiling.
Source: Journal of Neurosurgical Anesthesiology - December 13, 2021 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Automated CT Perfusion Imaging to Aid in the Selection of Patients With Acute Ischemic Stroke for Mechanical Thrombectomy: A Health Technology Assessment.
Conclusions: Automated CT perfusion imaging has an acceptable sensitivity and specificity for detecting brain areas that have been affected by stroke. In patients selected for mechanical thrombectomy using automated CT perfusion imaging, there was significant improvement in functional independence. Mechanical thrombectomy informed by automated CT perfusion imaging is likely to be cost-effective. We estimate that publicly funding automated CT perfusion imaging in Ontario would result in additional costs of $1.3 million in year 1 and $0.9 million per year thereafter. PMID: 33240454 [PubMed - in process]
Source: Ontario Health Technology Assessment Series - November 27, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Functional MRI of Letter Cancellation Task Performance in Older Adults
Conclusion The present work is the first to identify neural correlates of the LCT using fMRI and tablet technology in a healthy aging population. Across all ages, the activation was found to be bilateral, including in the cerebellum, superior temporal lobe, precentral gyrus, frontal gyrus, and various occipital and parietal areas. With increasing age, performance generally decreased and brain activity was reduced in the supplementary motor area, middle and inferior frontal gyrus, middle occipital gyrus, putamen and cerebellum. Better LCT performance was correlated with increased activity in the middle frontal gyrus, and r...
Source: Frontiers in Human Neuroscience - April 15, 2019 Category: Neuroscience Source Type: research

Decompressive Craniectomy for Traumatic Brain Injury: Postoperative Cerebral Hemodynamic Evaluation
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

An Evaluation of Personal Cooling Systems for Reducing Thermal Strain Whilst Working in Chemical/Biological Protective Clothing
Conclusion: The IV, PCM, and SLIV produced lower heart rate, mean skin, rectal and mean body temperatures in addition to improved work times compared to control. The WS did not improve work times possibly as a result of the cooling capacity of the suit abating, and magnifying thermal insulation. Considering the added time and resources required to implement combination cooling in the form of ice slurry and ice vest (SLIV), there was no significant additive effect for perception, cardiovascular strain, rectal temperature and total trial time relative to the phase change vest or ice vest alone. This may be a product of a &#x...
Source: Frontiers in Physiology - April 11, 2019 Category: Physiology Source Type: research

Characterizing the Penumbras of White Matter Hyperintensities and Their Associations With Cognitive Function in Patients With Subcortical Vascular Mild Cognitive Impairment
Conclusion In this study, reduced CBF and FA and increased MD in the inner NAWM layers for both PVWMH and DWMH suggested extensive WM alterations beyond the visible WM lesions commonly observed on clinical MRI of svMCI subjects. CBF penumbras cover more extensive WM at risk than DTI penumbras, suggesting the likelihood that compromised CBF precedes white matter integrity changes, and CBF penumbras may be a potential target for the prevention of further microstructural white matter damage. The imaging parameters investigated, however, did not correlate to cognition. Author Contributions YZ, QX, and XG conceived and desig...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

The 2018 ter Brugge Lecture: Problems with the Introduction of Innovations in Neurovascular Care.
Abstract Most endovascular innovations have been introduced into clinical care by showing good outcomes in small enthusiastic case series of selected patients. Randomized clinical trials (RCTs) have rarely been performed, except for acute ischemic stroke, but even then most trial designs were too explanatory to inform clinical decisions. In this article, we review 2 × 2 tables and forest plots that summarize RCT results to examine methodological issues in the design and interpretation of clinical studies. Research results can apply in practice when RCTs are all-inclusive, pragmatic trials. Common problems inclu...
Source: The Canadian Journal of Neurological Sciences - February 21, 2019 Category: Neurology Authors: Raymond J, Fahed R, Roy D, Darsaut TE Tags: Can J Neurol Sci Source Type: research

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