| 211. |
|
|
| 212. |
|
|
| 213. |
- Sundgren, PC, et al.
(författare)
-
Carotid artery stenosis: contrast-enhanced MR angiography with two different scan times compared with digital subtraction angiography
- 2002
-
Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 44:7, s. 592-599
-
Tidskriftsartikel (refereegranskat)abstract
- Contrast enhanced magnetic resonance angiography (CE MRA) is a non-invasive alternative to conventional digital subtraction angiography (DSA). CE MRA is increasingly used as a complement to Duplex in the preoperative assessment of carotid artery stenosis. The purpose of this study was to determine if CE MRA could replace preoperative DSA. CE MRA with a scan time of 10 or 28 s was performed in 24 consecutive patients who were scheduled for preoperative DSA because of Duplex-verified severe carotid artery stenosis. Two neuroradiologists measured the degree of stenosis with three different methods, and the image quality was evaluated. DSA was used as the gold standard. For detection of severe stenosis (N. American symptomatic carotid endarterectomy trial (NASCET) greater than or equal to70%; European symptomatic carotid endarterectomy trial (ECST) greater than or equal to80%; common carotid artery method (CCAM) greater than or equal to80%), the sensitivity of CE MRA maximum intensity projection (MIP) compared with DSA was 82%-100%, the specificity was 74%-93% and the accuracy was 77%-90%. The inter-observer agreement was higher, the image quality was better and the intracranial main arteries were better visualized with the 28 s than with the 10 s scan time. The enhancement of the jugular veins seen in 17% of the 10 s scans and in 58% of the patients with the 28 s scans did not interfere with the evaluation of the carotid arteries. CE MRA, preferably with a scan time of 28 s, can replace DSA in the preoperative assessment of most patients with carotid artery stenosis.
|
|
| 214. |
- Svensson, Johanna, et al.
(författare)
-
Societal Value of Stem Cell Therapy in Stroke - A Modeling Study.
- 2012
-
Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 33:6, s. 532-539
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke is one of the major causes of disability in the adult population and represents a heavy social and economic burden. Currently available therapeutic tools to support the recovery of impaired brain functions are quite limited. Animal studies have demonstrated that neuronal replacement and partial reconstruction of neural circuitry or modulation of the recovery process is possible with cell transplantation in the damaged adult brain. Stem cell therapy (SCT) may promote functional recovery also in stroke patients, thereby improving quality of life and reducing costs. Our aim was to estimate the potential societal value of SCT in stroke patients. Methods: We created a decision-analytic model in Microsoft Excel 2010 to assess life-long costs and quality-adjusted life years (QALYs) of SCT versus standard care for stroke patients from a societal perspective. The model structure consisted of 7 health states in accordance with the modified Rankin Scale (mRS). We modeled for age (55, 65, and 75 years), functional status at discharge (mRS 2, 3, and 4), effectiveness of SCT (50 and 25% increase in the probability to improve 1 mRS grade), mode of stem cell administration, risk of recurrent stroke, complications of intervention, and use of immunosuppressive drugs. The difference between an assumed societal willingness to pay for a QALY gain in Sweden (110,400 USD) and the cost per QALY gain resulting from the model was interpreted as the value of SCT. Results: Increased survival (1.06 life years) and improved functional status gave rise to an estimated gain of 1.34 QALY in a cohort of patients aged 55 with mRS 2 at hospital discharge. Although the SCT intervention increased costs by 64,014 USD (excluding cost of stem cells), the costs of intervention were offset mainly by decreased productivity losses. In total, the intervention saved 19,055 USD, i.e., at a price of 19,055 USD for stem cells, the SCT would be cost neutral. The societal value of SCT was 166,500 USD. Conclusions: The application of the health-economic model to Sweden shows that in younger stroke patients with moderate disability, the societal value of SCT given a zero price of stem cells is 166,500 USD. Although the transplantation itself is more costly, SCT offers potential for cost offset and cost savings in a long-term perspective by reducing the disability after stroke. The therapy appeared cost effective under a wide range of assumptions. Hence, further research and development in stem cells suitable for stroke therapy could potentially produce great value to society.
|
|
| 215. |
- Söderholm, M, et al.
(författare)
-
Exome array analysis of ischaemic stroke : results from a southern Swedish study
- 2016
-
Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 23:12, s. 1722-1728
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Genome-wide association (GWA) studies have identified a few risk loci for ischaemic stroke, but these variants explain only a small part of the genetic contribution to the disease. Coding variants associated with amino acid substitutions or premature termination of protein synthesis could have a large effect on disease risk. We performed an exome array analysis for ischaemic stroke.METHODS: Patients with ischaemic stroke (n = 2385) and control subjects (n = 6077) from three Swedish studies were genotyped with the Illumina HumanOmniExpressExome BeadChip. Single-variant association analysis and gene-based tests were performed of exome variants with minor allele frequency of < 5%. A separate GWA analysis was also performed, based on 700 000 genotyped common markers and subsequent imputation.RESULTS: No exome variant or gene was significantly associated with all ischaemic stroke after Bonferroni correction (all P > 1.8 × 10(-6) for single-variant and >4.15 × 10(-6) for gene-based analysis). The strongest association in single-variant analysis was found for a missense variant in the DNAH11 gene (rs143362381; P = 5.01 × 10(-6) ). In gene-based tests, the strongest association was for the ZBTB20 gene (P = 7.9 × 10(-5) ). The GWA analysis showed that the sample was homogenous (median genomic inflation factor = 1.006). No genome-wide significant association with overall ischaemic stroke risk was found. However, previously reported associations for the PITX2 and ZFHX3 gene loci with cardioembolic stroke subtype were replicated (P = 7 × 10(-15) and 6 × 10(-3) ).CONCLUSIONS: This exome array analysis did not identify any single variants or genes reaching the pre-defined significance level for association with ischaemic stroke. Further studies on exome variants should be performed in even larger, well-defined and subtyped samples.
|
|
| 216. |
- Söderholm, Martin, et al.
(författare)
-
Genome-wide association meta-analysis of functional outcome after ischemic stroke
- 2019
-
Ingår i: Neurology. - 1526-632X. ; 92:12, s. 1271-1283
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To discover common genetic variants associated with poststroke outcomes using a genome-wide association (GWA) study. METHODS: The study comprised 6,165 patients with ischemic stroke from 12 studies in Europe, the United States, and Australia included in the GISCOME (Genetics of Ischaemic Stroke Functional Outcome) network. The primary outcome was modified Rankin Scale score after 60 to 190 days, evaluated as 2 dichotomous variables (0-2 vs 3-6 and 0-1 vs 2-6) and subsequently as an ordinal variable. GWA analyses were performed in each study independently and results were meta-analyzed. Analyses were adjusted for age, sex, stroke severity (baseline NIH Stroke Scale score), and ancestry. The significance level was p < 5 × 10-8. RESULTS: We identified one genetic variant associated with functional outcome with genome-wide significance (modified Rankin Scale scores 0-2 vs 3-6, p = 5.3 × 10-9). This intronic variant (rs1842681) in the LOC105372028 gene is a previously reported trans-expression quantitative trait locus for PPP1R21, which encodes a regulatory subunit of protein phosphatase 1. This ubiquitous phosphatase is implicated in brain functions such as brain plasticity. Several variants detected in this study demonstrated suggestive association with outcome (p < 10-5), some of which are within or near genes with experimental evidence of influence on ischemic stroke volume and/or brain recovery (e.g., NTN4, TEK, and PTCH1). CONCLUSIONS: In this large GWA study on functional outcome after ischemic stroke, we report one significant variant and several variants with suggestive association to outcome 3 months after stroke onset with plausible mechanistic links to poststroke recovery. Future replication studies and exploration of potential functional mechanisms for identified genetic variants are warranted.
|
|
| 217. |
|
|
| 218. |
- Thorlin, Thorleif, et al.
(författare)
-
[Neurological issues common during internship. A questionnaire study as a basis for continuous development of neurology teaching].
- 2011
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:4, s. 152-155
-
Tidskriftsartikel (refereegranskat)abstract
- To obtain knowledge if basic medical education satisfies the demands the medical graduates face during internship is a basis for the design and evaluation of teaching.The aim of the study was to evaluate the physicians’ satisfaction with the teaching of neurology at universities in Sweden subsequent to having tested the obtained skills in the 21 months internship needed for Swedish physician licence.A questionnaire with 23 questions was sent in 2007 to 1628 newly licensed doctors who received their cards between 2005-01-01 and 2007-10-09, after completing Swedish internship.Onethousand-fiftyone physicians (65%) answered the questionnaire. Most felt that the quality of the theoretical and practical education in neurology obtained at the university was good or very good. Physicians with less coherent university neurology teaching time indicated to a greater degree that teaching time at the undergraduate level was too short. The physicians indicated that neurological issues are common during the internship. A majority indicated that that they had received too little training in neurology during their internship. The results give a good feedback for further development of neurology teaching. Similar studies could be carried out also for other areas of graduate medical education.
|
|
| 219. |
- Thorlin, Thorleif, et al.
(författare)
-
Neurologiska frågeställningar vanliga under AT-tiden
- 2011
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:4, s. 152-155
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Kunskap om hur grundutbildningen på läkarprogrammet tillfredsställer de krav som en utexaminerad läkare ställs inför under AT-tjänstgöringen är grundläggande för utformning och utvärdering av kursprogrammet. Syftet med vår studie var att utvärdera AT-läkares tillfredsställelse med neurologiundervisningen på läkarprogrammet vid samtliga universitetsorter i Sverige, efter att ha prövat sina kunskaper i kliniskt arbete. En enkät skickades till 1 628 nylegitimerade läkare som fått sin legitimation mellan 1 januari 2005 och 9 oktober 2007. 65 procent besvarade enkäten. Merparten ansåg att kvaliteten på den teoretiska och praktiska undervisningen under grundutbildningen i neurologi var bra eller mycket bra. Läkare med kortare sammanhållen grundutbildningstid i neurologi angav i högre grad att undervisningstiden varit för kort. Neurologiska frågeställningar angavs vara vanliga under AT. En majoritet angav att mängden neurologisk undervisning under AT varit för liten. Resultaten ger god återkoppling för fortsatt utveckling av neurologiundervisningen. Liknande studier bör kunna genomföras även för andra områden inom läkarutbildningen.
|
|
| 220. |
- Thorlin, Thorleif, et al.
(författare)
-
Neurologiska frågeställningar vanliga under AT-tiden : Enkätstudie lägger grund för fortsatt utveckling av neurologiundervisningen
- 2011
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:4, s. 152-155
-
Tidskriftsartikel (refereegranskat)abstract
- Kunskap om hur grundutbildningen på läkarprogrammet tillfredsställer de krav som en utexaminerad läkare ställs inför under AT-tjänstgöringen är grundläggande för utformning och utvärdering av kursprogrammet. Syftet med vår studie var att utvärdera AT-läkares tillfredsställelse med neurologiundervisningen på läkarprogrammet vid samtliga universitetsorter i Sverige, efter att ha prövat sina kunskaper i kliniskt arbete. En enkät skickades till 1 628 nylegitimerade läkare som fått sin legitimation mellan 1 januari 2005 och 9 oktober 2007. 65 procent besvarade enkäten. Merparten ansåg att kvaliteten på den teoretiska och praktiska undervisningen under grundutbildningen i neurologi var bra eller mycket bra. Läkare med kortare sammanhållen grundutbildningstid i neurologi angav i högre grad att undervisningstiden varit för kort. Neurologiska frågeställningar angavs vara vanliga under AT. En majoritet angav att mängden neurologisk undervisning under AT varit för liten. Resultaten ger god återkoppling för fortsatt utveckling av neurologiundervisningen. Liknande studier bör kunna genomföras även för andra områden inom läkarutbildningen.
|
|
