During left heart catheterization, cerebral microemboli, especially those which are solid, may damage the brain. Cardiac catheterization may therefore pose a greater risk for the brain than previously acknowledged.
Patients with NSTEMI due to acute coronary occlusions develop larger infarcts and more impaired left ventricular function than patients with NSTEMI without occlusions, regardless of infarct-related territory. Territorial circumferential strain by echocardiography enables very early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent revascularisation.
Measurement of electrical impedance can discriminate between tissues of different electrical properties. A measurement system with adequate spatial resolution focused on a volume around the tip of a needle or other invasive clinical equipment can be used to determine in which type of tissue the tip is positioned. We have measured the sensitivity zone of a needle electrode with an active electrode area of 0.3 mm 2 , and measured impedance spectra in porcine tissue in vivo. Small electrode impedance data will be influenced by electrode polarization impedance (EPI) at low frequencies. To refine existing methods for needle guidance with higher spatial resolution, we have used multivariate analysis and new interpretations of EPI, and tissue data gathered with selected needle electrodes. The focus of this study is on discrimination between muscle and fat/subdermis for drug administration, but our results also indicate that these refinements will facilitate new clinical applications for impedance-based needle guidance in general.
Methods: Seventy patients with a verified ABI and executive dysfunction were randomly allocated to GMT (n = 33) or a psycho-educative active control condition, Brain Health Workshop (BHW) (n = 37). In addition, all participants received external cueing by text messages. Neuropsychological tests and self-reported questionnaires of executive functioning were administered pre-intervention, immediately after intervention, and at 6 months followup. Assessors were blinded to group allocation.Results: Questionnaire measures indicated significant improvement of everyday executive functioning in the GMT group, with effects lasting at least 6 months post-treatment. Both groups improved on the majority of the applied neuropsychological tests. However, improved performance on tests demanding executive attention was most prominent in the GMT group. Conclusions:The results indicate that GMT combined with external cueing is an effective metacognitive strategy training method, ameliorating executive dysfunction in daily life for patients with chronic ABI. The strongest effects were seen on self-report measures of executive functions 6 months post-treatment, suggesting that strategies learned in GMT were applied and consolidated in everyday life after the end of training. Furthermore, these findingsshow that executive dysfunction can be improved years after the ABI. INTRODUCTIONExecutive functions (EF) are required for independent, purposive, self-directed behavior and include processes of initiation, planning, purposive action, volition, inhibition, flexibility, as well as self-monitoring and self-regulation (Lezak, 1995;Stuss, 2011). A division between "cold" and "hot" components of EF has been suggested, with "cold" EF corresponding closely to cognitive and logical processes, and the "hot" aspects of EF involving regulation of emotion and motivation (Chan, Shum, Toulopoulou & Chen, 2008).Thus, EF is an umbrella term for a set of interrelated capacities resulting from activity in anatomically and functionally independent, but interconnected networks subserved by widespread brain regions, the prefrontal cortex playing a central role (Stuss & Alexander, 2007).Executive dysfunction (ED) is common following acquired brain injury (ABI) (Stuss & Levine, 2002;Novakovic-Agopian et al, 2011), and may disrupt the ability to effectively use intact functions or compensatory strategies, undermine efficient self-management (Lewis, Babbage & Leathem, 2011), hamper the rehabilitation process (Robertson & Murre, 1999), and is also associated with long-term negative psychosocial and vocational outcome (Draper & Ponsford, 2008; Ylvisaker & Feeney, 2000). Thus, techniques for reducing ED might significantly impact functional outcome (Manly & Murphy, 2012).Most theories describe EF as top-down controlled processes involved in the control and direction of self-regulatory cognition, emotion and behavior (Cicerone et al., 2006;Stuss, 2011). Current theories of cognitive EF bear close resemblance to dominant models of attention (Norman & Shalli...
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