Article
A Possible Sensory Interpretation of Alternate Motor Fibers Relating to Structural Reserve during Stroke Recovery
Recovery after stroke relates tightly to the white matter integrity. Currently, the main methodology for non-invasive white matter integrity assessment is diffusion-weighted magnetic resonance imaging (DW-MRI), a state-of-the-art approach which is, however, prone to multiple limitations. Using DW-MRI, it was demonstrated that many pathways including corticospinal tract (CST) and corpus callosum contribute to structural brain reserve after stroke, but only a few of these tracts were found to be useful in the clinical practice. The most widely known measure is an asymmetry of the fractional anisotropy (FA) in CST at the level of the internal capsule, which could be used for predicting motor recovery in acute stroke. Recently, a new complementary motor component of the structural reserve, the so-called alternate motor fibers (AMFs), was proposed for motor recovery prognosis in stroke patients, and it was even reported to correlate with the effect of the transcranial direct current stimulation in chronic stroke. Here, we would like to point out a possible additional sensory interpretation of the AMF that appears plausible after taking into account technical limitations of DW-MRI approach, which may potentially give rise to different interpretations of the same results.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
Background: Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality rates were greater in men. However, sex differences in various metrics of stroke burden on a global scale have not been a subject of comprehensive and comparable assessment for most regions of the world, nor have sex differences in stroke burden been examined for trends over time. Methods: Stroke incidence, prevalence, mortality, disability-adjusted life years (DALYs) and healthy years lost due to disability were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Data inputs included all available information on stroke incidence, prevalence and death and case fatality rates. Analysis was performed separately by sex and 5-year age categories for 188 countries. Statistical models were employed to produce globally comprehensive results over time. All rates were age-standardized to a global population and 95% uncertainty intervals (UIs) were computed. Findings: In 2013, global ischemic stroke (IS) and hemorrhagic stroke (HS) incidence (per 100,000) in men (IS 132.77 (95% UI 125.34-142.77); HS 64.89 (95% UI 59.82-68.85)) exceeded those of women (IS 98.85 (95% UI 92.11-106.62); HS 45.48 (95% UI 42.43-48.53)). IS incidence rates were lower in 2013 compared with 1990 rates for both sexes (1990 male IS incidence 147.40 (95% UI 137.87-157.66); 1990 female IS incidence 113.31 (95% UI 103.52-123.40)), but the only significant change in IS incidence was among women. Changes in global HS incidence were not statistically significant for males (1990 = 65.31 (95% UI 61.63-69.0), 2013 = 64.89 (95% UI 59.82-68.85)), but was significant for females (1990 = 64.892 (95% UI 59.82-68.85), 2013 = 45.48 (95% UI 42.427-48.53)). The number of DALYs related to IS rose from 1990 (male = 16.62 (95% UI 13.27-19.62), female = 17.53 (95% UI 14.08-20.33)) to 2013 (male = 25.22 (95% UI 20.57-29.13), female = 22.21 (95% UI 17.71-25.50)). The number of DALYs associated with HS also rose steadily and was higher than DALYs for IS at each time point (male 1990 = 29.91 (95% UI 25.66-34.54), male 2013 = 37.27 (95% UI 32.29-45.12); female 1990 = 26.05 (95% UI 21.70-30.90), female 2013 = 28.18 (95% UI 23.68-33.80)). Interpretation: Globally, men continue to have a higher incidence of IS than women while significant sex differences in the incidence of HS were not observed. The total health loss due to stroke as measured by DALYs was similar for men and women for both stroke subtypes in 2013, with HS higher than IS. Both IS and HS DALYs show an increasing trend for both men and women since 1990, which is statistically significant only for IS among men. Ongoing monitoring of sex differences in the burden of stroke will be needed to determine if disease rates among men and women continue to diverge. Sex disparities related to stroke will have important clinical and policy implications that can guide funding and resource allocation for national, regional and global health programs.
Interrelations of product perishability and supply chain resilience are studied. The major distinguishing features in a supply chain with perishable products that may affect the resilience are the risks of goods write-off. Constraints on product perishability typically result in safety stock reductions and transportation frequency increase. Consideration of the production capacity disruption risks may lead to safety stock increase. The developed simulation model was run with data of a fast moving consumer goods company and revealed novel managerial insights and practical recommendations on inventory, on-time delivery and service level control. More specifically, the evidence for adjustment of production and inventory control policies during the disruption time is provided. Otherwise the delayed and backlog orders are accumulated over the disruption time. They transit as residues into the post-disruption period and do not allow full performance and operation dynamics stabilization even after full capacity recovery. An example of such a contingency production-inventory control policy is presented.
Background and Purpose Despite the continuing efforts in multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the corticospinal tract (CST) integrity and the role of the contralesional hemisphere are still missing. The aim of this work was to find the best combination of the motor system parameters, allowing classification of patients into three predefined groups of upper limb motor recovery.
Methods 35 chronic ischemic stroke patients (47 [26–66] y.o., 29 [6–58] months post-stroke) with only supratentorial lesion and unilateral upper extremity weakness were enrolled. Patients were divided into three groups depending on the upper limb motor recovery. Non-parametric statistical tests and regression analysis were used to investigate the relationships among structural and functional motor system parameters, probed by diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS). In addition, stratification rules were tested, using a decision tree classifier to identify parameters explaining motor recovery.
Results Fractional anisotropy (FA) ratio in the internal capsule (IC) and absence/presence of motor evoked potentials (MEPs), were equally discriminative of the worst motor outcome group (96% accuracy). MEP presence diverged for two investigated hand muscles. Concurrently, for the three recovery groups’ classification, the best parameter combination was: IC FA ratio and Fréchet distance between the contralesional and ipsilesional CST FA profiles (91% accuracy). No other metrics had any additional value for patients’ classification.
Conclusions This study demonstrates that IC FA ratio and MEPs absence are equally important markers for poor recovery. Importantly, we found that MEPs should be controlled in more than one hand muscle. Finally, we show that better separation between different motor recovery groups may be achieved when considering the whole CST FA profile.
The collection contains materials of the international scientific-practical conference, revealing the actual problems in the process of introducing fitness of physical education in modern conditions of its modernization and the transition to a multi-level education, defines the role fittnesa and its ability to rehabilitate the population of Russia.
Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year)1. Minor cervical traumas, infection, migraine and hypertension are putative risk factors1, 2, 3, and inverse associations with obesity and hypercholesterolemia are described3, 4. No confirmed genetic susceptibility factors have been identified using candidate gene approaches5. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69–0.82; P = 4.46 × 10−10), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10−3; combined P = 1.00 × 10−11). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction6, 7, 8, 9. Deciphering the mechanisms underlying this pleiotropy might provide important information on the biological underpinnings of these disabling conditions.
Using changes in consumption as a proxy for ‘vulnerability’ we identify the characteristics associated with vulnerability around the time of the 1998 Russian financial crisis. In addition, we examine the role of formal and informal safety nets in preserving individual well being. We apply quantile regression techniques in order to identify the characteristics associated with vulnerability across the two periods. Amongst those most vulnerable during the crisis were, less educated individuals living in urban areas, in households containing greater numbers of pensioners. Furthermore, we found that increases in home production and help from relatives acted to decrease vulnerability, especially amongst those suffering the largest changes in consumption. Following the crisis, amongst the least vulnerable were, better educated individuals, resident in urban areas, able to increase home production, and in receipt of improved pension payments and child benefits.
Data management and analysis is one of the fastest growing and most challenging areas of research and development in both academia and industry. Numerous types of applications and services have been studied and re-examined in this field resulting in this edited volume which includes chapters on effective approaches for dealing with the inherent complexity within data management and analysis. This edited volume contains practical case studies, and will appeal to students, researchers and professionals working in data management and analysis in the business, education, healthcare, and bioinformatics areas.
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.