von Jürgen Beck ; Christian Fung ; Daniel Strbian ; Lukas Bütikofer ; Werner J. Z'Graggen ; Matthias F. Lang ; Seraina Beyeler ; Jan Gralla ; Florian Ringel ; Karl Schaller ; Nikolaus Plesnila ; Marcel Arnold ; Werner Hacke ; Peter Jüni ; Alexander David Mendelow ; Christian Stapf ; Rustam Al-Shahi Salman ; Jenny Bressan ; Stefanie Lerch ; Arsany Hakim ; Nicolas Martinez-Majander ; Anna Piippo-Karjalainen ; Peter Vajkoczy ; Stefan Wolf ; Gerrit A. Schubert ; Anke Höllig ; Michael Veldeman ; Roland Rölz ; Andreas Gruber ; Philip Rauch ; Dorothee Wachter ; Veit Rohde ; Thomas Kerz ; Eberhard Uhl ; Enea Thanasi ; Hagen B. Huttner ; Bernd Kallmünzer ; L. Jaap Kappelle ; Wolfgang Deinsberger ; Christian Roth ; Robin Lemmens ; Jan Leppert ; Jose L. Sanmillan ; Jonathan M. Coutinho ; Katharina Hackenberg ; Gernot Reimann ; Mikael Mazighi ; Claudio L. A. Bassetti ; Heinrich P. Mattle ; Andreas Raabe ; Urs Fischer ; Renán Sánchez-Porras
BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone. METHODS: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone. The primary outcome was a score of 5-6 on the modified Rankin Scale (mRS) at 180 days, analysed in the intention-to-treat population. This trial is registered with ClincalTrials.gov, NCT02258919, and is completed. FINDINGS: SWITCH had to be stopped early due to lack of funding. Between Oct 6, 2014, and April 4, 2023, 201 individuals were randomly assigned and 197 gave delayed informed consent (96 decompressive craniectomy plus best medical treatment, 101 best medical treatment). 63 (32%) were women and 134 (68%) men, the median age was 61 years (IQR 51-68), and the median haematoma volume 57 mL (IQR 44-74). 42 (44%) of 95 participants assigned to decompressive craniectomy plus best medical treatment and 55 (58%) assigned to best medical treatment alone had an mRS of 5-6 at 180 days (adjusted risk ratio [aRR] 0·77, 95% CI 0·59 to 1·01, adjusted risk difference [aRD] -13%, 95% CI -26 to 0, p=0·057). In the per-protocol analysis, 36 (47%) of 77 participants in the decompressive craniectomy plus best medical treatment group and 44 (60%) of 73 in the best medical treatment alone group had an mRS of 5-6 (aRR 0·76, 95% CI 0·58 to 1·00, aRD -15%, 95% CI -28 to 0). Severe adverse events occurred in 42 (41%) of 103 participants receiving decompressive craniectomy plus best medical treatment and 41 (44%) of 94 receiving best medical treatment. INTERPRETATION: SWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups. FUNDING: Swiss National Science Foundation, Swiss Heart Foundation, Inselspital Stiftung, and Boehringer Ingelheim.
The lancet London [u.a.] : Elsevier, 1823 403(2024), 10442 vom: Juni, Seite 2395-2404 Online-Ressource
von Rick J. G. Vreeburg ; Ranjit D. Singh ; Inge A. M. van Erp ; Tommi K. Korhonen ; John K. Yue ; Harry Mee ; Ivan Timofeev ; Angelos Kolias ; Adel Helmy ; Bart Depreitere ; Wouter A. Moojen ; Alexander Younsi ; Peter J. Hutchinson ; Geoffrey T. Manley ; Ewout W. Steyerberg ; Godard C. W. de Ruiter ; Andrew I. Maas ; Wilco C. Peul ; Jeroen T. J. M. van Dijck ; Hugo F. den Boogert ; Jussi P. Posti ; Thomas van Essen ; Renán Sánchez-Porras
CENTER-TBI participants and investigators: Cecilia Åkerlund, Julia Mattern, Oliver Sakowitz, Andreas Unterberg, Alexander Younsi und zahlreiche weitere ; Gesehen am 20.08.2025
Journal of neurosurgery Charlottesville, Va. : American Assoc. of Neurological Surgeons, 1944 141(2024), 4 vom: Okt., Seite 895-907 Online-Ressource
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this causal depression network (CDN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis Principal Component Analysis (PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CDN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CDN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes (t = −2.35, p = 0.019). This evidence further supports that treatment interventions converge on a CDN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
von Yi Zhong ; Yanguang Liu ; Hu Yang ; Qiuzhen Yin ; David J. Wilson ; Zhengyao Lu ; Samuel L. Jaccard ; Torben Struve ; P. D. Clift ; Stefanie Kaboth-Bahr ; Juan C. Larrasoaña ; André Bahr ; Xun Gong ; Debo Zhao ; Yanan Zhang ; Wenyue Xia ; Qingsong Liu
Airborne mineral dust is sensitive to climatic changes, but its response to orbital forcing is still not fully understood. Here, we present a reconstruction of dust input to the Subarctic Pacific Ocean covering the past 190 kyr. The dust composition record is indicative of source moisture conditions, which were dominated by precessional variations. In contrast, the dust flux record is dominated by obliquity variations and displays an out-of-phase relationship with a dust record from the mid-latitude North Pacific Ocean. Climate model simulations suggest precession likely drove changes in the aridity and extent of dust source regions. Additionally, the obliquity variations in dust flux can be explained by meridional shifts in the North Pacific westerly jet, driven by changes in the meridional atmospheric temperature gradient. Overall, our findings suggest that North Pacific dust input was primarily modulated by orbital-controlled source aridity and the strength and position of the westerly winds.
Geophysical research letters Hoboken, NJ : Wiley, 1974 51(2024), 4, Artikel-ID e2023GL106631, Seite 2023GL106631-1-e2023GL106631-14 Online-Ressource
von Martin Benedikt ; Eckard Böde ; Andreas Bossert ; Jens Braband ; Tino Brade ; Niklas Braun ; Tobias Braun ; Simon Burton ; Thomas Dallmann ; Werner Damm ; Tobias Düser ; Lukas Elster ; Tim Fingscheidt ; Marco Fistler ; Marzena Franek ; Martin Fränzle ; Jonas Freyer ; Roland Galbas ; Roman Gansch ; Dirk Geyer ; Lukas Haas ; Arsalan Haider ; Peter Heidl ; Matthias Hein ; Andreas Heyl ; Johannes Hiller ; Hardi Hungar ; Dieter Hutter ; Rolf Jung ; Cornel Klein ; Jörg Krüger ; Thomas Kuhn ; Jacob Langner ; Markus Maurer ; Kerstin Mayr ; André Meyer-Vitali ; Eike Möhlmann ; Adam Molin ; Björn Möller ; Jürgen Niehaus ; Bastian Nolte ; Marcus Nolte ; Stefan Otten ; Jan Peleska ; Steven Peters ; Tim Poguntke ; Florian Poprawa ; Jan Reich ; Philipp Rosenberger ; Nayel Fabian Salem ; Bernhard Schick ; Daniel Schneider ; Stefan-Alexander Schneider ; Christian Schyr ; Carsten Thomas ; Mario Trapp ; Florence Wagner ; Nicolas Wagener ; Timo Woopen ; Thomas Zeh
von Victor Schulze-Zachau ; Nikki Rommers ; Nikos Ntoulias ; Alex Brehm ; Nadja Krug ; Ioannis Tsogkas ; Matthias Anthony Mutke ; Thilo Rusche ; Amedeo Cervo ; Claudia Rollo ; Markus Alfred Möhlenbruch ; Jessica Jesser ; Kornelia Kreiser ; Katharina Althaus ; Manuel Requena ; Marc Rodrigo-Gisbert ; Tomas Dobrocky ; Bettina L. Serrallach ; Christian H. Nolte ; Christoph Paul Riegler ; Jawed Nawabi ; Errikos Maslias ; Patrik Michel ; Guillaume Saliou ; Nathan Manning ; Alexander McQuinn ; Alon Taylor ; Christoph J. Maurer ; Ansgar Berlis ; Daniel Kaiser ; Ani Cuberi ; Manuel Moreu ; Alfonso López-Frías ; Carlos Pérez-García ; Riitta Rautio ; Ylikotila Pauli ; Nicola Limbucci ; Leonardo Renieri ; Isabel Fragata ; Tania Rodriguez-Ares ; Jan Kirschke ; Julian Schwarting ; Sami Al Kasab ; Alejandro M. Spiotta ; Ahmad Abu Qdais ; Adam A. Dmytriw ; Robert W. Regenhardt ; Aman B. Patel ; Vitor Mendes Pereira ; Nicole M. Cancelliere ; Carsten Schmeel ; Franziska Dorn ; Malte Sauer ; Grzegorz Marek Karwacki ; Jane Khalife ; Ajith Thomas ; Hamza A. Shaikh ; Christian Commodaro ; Marco Pileggi ; Roland Schwab ; Flavio Bellante ; Anne Dusart ; Jeremy Hofmeister ; Paolo Machi ; Edgar A. Samaniego ; Diego J. Ojeda ; Robert M. Starke ; Ahmed Abdelsalam ; Frans van den Bergh ; Sylvie De Raedt ; Maxim Bester ; Fabian Flottmann ; Daniel Arvid Weiß ; Marius Kaschner ; Peter T. Kan ; Gautam Edhayan ; Michael R. Levitt ; Spencer L. Raub ; Mira Katan ; Urs Fischer ; Marios-Nikos Psychogios
Introduction: Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes. - Patients and methods: In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models. - Results: 459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p < 0.001). - Discussion and conclusion: Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.
European stroke journal London : Sage Publishing, 2016 10(2025), 1, Seite 63-73 Online-Ressource
von Yi Zhong ; Ning Tan ; Jordan T. Abell ; Chijun Sun ; Stefanie Kaboth-Bahr ; Heather L. Ford ; Timothy D. Herbert ; Alex Pullen ; Keiji Horikawa ; Jimin Yu ; Torben Struve ; Michael E. Weber ; P. D. Clift ; Juan C. Larrasoaña ; Zhengyao Lu ; Hu Yang ; André Bahr ; Tianyu Chen ; Jingyu Zhang ; Cao Wei ; Wenyue Xia ; Sheng Yang ; Qingsong Liu
The Transformation of Consumer Law and Policy in Europe 1st ed [Erscheinungsort nicht ermittelbar] : Hart Publishing, 2023 (2023), Seite 261-280 1 Online-Ressource (376 pages)
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