| 1. |
- van de Munckhof, A., et al.
(författare)
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Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase
- 2022
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Ingår i: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 53:10, s. 3206-3210
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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| 2. |
- Scutelnic, A., et al.
(författare)
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Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19
- 2023
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Ingår i: European Stroke Journal. - 2396-9873. ; 8:4, s. 1001-1010
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x10(9)/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
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| 3. |
- van de Munckhof, A., et al.
(författare)
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Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries
- 2023
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Ingår i: International Journal of Stroke. - 1747-4930. ; 18:9, s. 1112-1120
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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| 4. |
- Rahmati, O., et al.
(författare)
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Development of novel hybridized models for urban flood susceptibility mapping
- 2020
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Ingår i: Scientific Reports. - : Nature Research. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Floods in urban environments often result in loss of life and destruction of property, with many negative socio-economic effects. However, the application of most flood prediction models still remains challenging due to data scarcity. This creates a need to develop novel hybridized models based on historical urban flood events, using, e.g., metaheuristic optimization algorithms and wavelet analysis. The hybridized models examined in this study (Wavelet-SVR-Bat and Wavelet-SVR-GWO), designed as intelligent systems, consist of a support vector regression (SVR), integrated with a combination of wavelet transform and metaheuristic optimization algorithms, including the grey wolf optimizer (GWO), and the bat optimizer (Bat). The efficiency of the novel hybridized and standalone SVR models for spatial modeling of urban flood inundation was evaluated using different cutoff-dependent and cutoff-independent evaluation criteria, including area under the receiver operating characteristic curve (AUC), Accuracy (A), Matthews Correlation Coefficient (MCC), Misclassification Rate (MR), and F-score. The results demonstrated that both hybridized models had very high performance (Wavelet-SVR-GWO: AUC = 0.981, A = 0.92, MCC = 0.86, MR = 0.07; Wavelet-SVR-Bat: AUC = 0.972, A = 0.88, MCC = 0.76, MR = 0.11) compared with the standalone SVR (AUC = 0.917, A = 0.85, MCC = 0.7, MR = 0.15). Therefore, these hybridized models are a promising, cost-effective method for spatial modeling of urban flood susceptibility and for providing in-depth insights to guide flood preparedness and emergency response services.
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| 5. |
- Callander, Margarita, 1964-, et al.
(författare)
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Multiple sclerosis immunopathic trait and HLA-DR(2)15 as independent risk factors in multiple sclerosis
- 2007
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Ingår i: Multiple Sclerosis Journal. - : SAGE Publications. - 1352-4585 .- 1477-0970. ; 13:4, s. 441-445
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Tidskriftsartikel (refereegranskat)abstract
- We analysed HLA haplotypes in pairs of 78 sporadic multiple sclerosis (MS) patients and 78 healthy siblings. The presence of 2 oligoclonal IgG bands, detected by immunoblotting of the cerebrospinal fluid in healthy siblings, has previously been defined as MS immunopathic trait (MSIT), based on a cut-off derived from healthy unrelated volunteers. The frequency of MSIT was 17.9% (n=14/78 siblings). The HLA-DR(15)2 allelle was present in 21.4% (n=3/14) of the siblings with MSIT, in 40.6% (n =26/64) of the siblings without MSIT, and in 59% (n =46/78) of the patients with clinically-definite (CD) MS. The distribution of zero, one or two HLA-DR(2)15 alleles was significantly skewed towards a lower allelle count in the siblings with MSIT compared with the group of unrelated siblings with MS (P=0.002), and also lower than their related siblings with MS (P=0.1). These results suggest that the MS susceptibility gene, HLA-DR(2)15 type, does not induce MSIT, and conceivably these are two separate risk factors in the development of MS. The effect of HLA-DR(2)15 and MSIT in sporadic MS appears to be synergistic.
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| 6. |
- Krzywicka, Katarzyna, et al.
(författare)
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Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.
- 2023
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Ingår i: European journal of neurology. - : Wiley. - 1468-1331 .- 1351-5101. ; 30:5, s. 1335-1345
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored.Data from an ongoing international registry of patients who developed CVST within 28days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included.Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p<0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p<0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p=0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6months, 8/10 of surgical CVST-VITT who survived admission were functionally independent.Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
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| 7. |
- Mattsson, Niklas, 1979, et al.
(författare)
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Reduced cerebrospinal fluid BACE1 activity in multiple sclerosis.
- 2009
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Ingår i: Multiple sclerosis (Houndmills, Basingstoke, England). - : SAGE Publications. - 1352-4585 .- 1477-0970. ; 15:4, s. 448-54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cell and animal experiments have shown that beta-site APP-cleaving enzyme 1 (BACE1) may be involved in myelination. OBJECTIVE: Here, we assess the association of cerebrospinal fluid (CSF) BACE1 activity with multiple sclerosis (MS). METHODS: BACE1 activity and levels of secreted amyloid precursor protein (APP) and amyloid-beta (Abeta) isoforms were analyzed in CSF from 100 patients with MS and 114 neurologically healthy controls. Patients with systemic lupus erythematosus (SLE), 26 with and 41 without cerebral engagement, were also included to enable comparisons with regards to another autoimmune disease. A subset of patients with MS and controls underwent a second lumbar puncture after 10 years. RESULTS: MS patients had lower CSF BACE1 activity than controls (P = 0.03) and patients with cerebral SLE (P < 0.001). Patients with cerebral SLE had higher BACE1 activity than any other group (P < 0.05 for all comparisons). BACE1 activity correlated with the different amyloid markers in all study groups. BACE1 activity decreased over 10 years in the MS group (P = 0.039) and correlated weakly with clinical disease severity scores in an inverse manner. CONCLUSIONS: These results suggest an involvement of BACE1 in the MS disease process.
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| 8. |
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| 9. |
- Bitaraf Haghighi, Ehsan, et al.
(författare)
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Cooling performance of nanofluids in a small diameter tube
- 2013
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Ingår i: Experimental Thermal and Fluid Science. - : Elsevier. - 0894-1777 .- 1879-2286. ; 49, s. 114-122
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Tidskriftsartikel (refereegranskat)abstract
- This article reports convective single-phase heat transfer performance in laminar flow for some selected nanofluids (NFs) in an open small diameter test section. A 0.50 mm inner diameter, 30 cm long stainless steel test section was used for screening single phase laminar convective heat transfer with water and five different water based NFs. Tested NFs were; Al2O3 (two types), TiO2 (two types) and CeO2 (one type), all 9 wt.% particle concentration. The effective thermal conductivity of the NFs were measured with Transient Plane Source (TPS) method and viscosity were measured with a rotating coaxial cylindrical viscometer. The obtained experimental results for thermal conductivity were in good agreement with the predicted values from Maxwell equation. The local Shah correlation, which is conventionally used for predicting convective heat transfer in laminar flow in Newtonian fluids with constant heat flux boundary condition, was shown to be valid for NFs. Moreover, the Darcy correlation was used to predict the friction factor for the NFs as well as for water. Enhancement in heat transfer for NFs was observed, when compared at equal Reynolds number, as a result of higher velocity or mass flow rate of the NFs at any given Reynolds number due to higher viscosity for NFs. However, when compared at equal pumping power no or only minor enhancement was observed.
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| 10. |
- Bitaraf Haghighi, Ehsan, et al.
(författare)
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Shelf stability of nanofluids and its effect on thermal conductivity and viscosity
- 2013
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Ingår i: Measurement science and technology. - : IOP Publishing. - 0957-0233 .- 1361-6501. ; 24:10, s. 105301-
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Tidskriftsartikel (refereegranskat)abstract
- This study proposes a method and apparatus to estimate shelf stability of nanofluids. Nanofluids are fabricated by dispersion of solid nanoparticles in base fluids, and shelf stability is a key issue for many practical applications of these fluids. In this study, shelf stability is evaluated by measuring the weight of settled solid particles on a suspended tray in a colloid versus time and correlated with the performance change of some nanofluid systems. The effects of solid particle concentration and bath sonication time were investigated for selected nanofluids. The results show the applicability of this simple method and the apparatus to evaluate nanofluid shelf stability. Furthermore, it shows that Stokes' law is not valid for determining the settling time of the tested nanoparticles probably due to their complicated shape and presence of surface modifiers. The effect of shelf stability on thermal conductivity and viscosity was illustrated for some nanofluids. Experimental results show that water-based Al2O3 nanofluids have quite good shelf stability and can be good candidates for industrial applications.
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