Prevalence and Causes of Paralysis—United States, 2013

Armour, Brian S.; Courtney-Long, Elizabeth A.; Fox, Michael H.; Fredine, Heidi; Cahill, Anthony

doi:10.2105/ajph.2016.303270

Cited by 161 publications

(92 citation statements)

References 8 publications

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“…The emotional and financial burdens for the patient, the patient's family, and the healthcare system are enormous and have lifelong implications. 9 This metaanalysis examined the current evidence regarding mortality and neurologic complications, with special focus on SCI, associated with the use of the FET (Video 1).…”

Section: Perspectivementioning

confidence: 99%

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

181

136

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Objective: The frozen elephant trunk technique's safety regarding spinal cord ischemia has been questioned. We used a meta-analysis to determine the rates of adverse neurologic events and mortality. Methods:We searched PubMed/Medline, Embase, Scopus, and Cochrane databases (inception to April 2018) to identify studies of neurologic events after the frozen elephant trunk procedure. Separate meta-analyses were conducted with random-effects models to assess frozen elephant trunk associations with spinal cord ischemia, stroke, operative mortality, and all adverse events combined. Subgroup analyses compared outcomes in patients with acute versus nonacute type A dissection and aneurysm and with different extents of coverage.Results: Thirty-five studies (total N ¼ 3154) met inclusion criteria. The pooled rates of the outcomes of interest were 4.7% (95% confidence interval, 3.5-6.2) for spinal cord ischemia, 7.6% (95% confidence interval, 5.0-11.5) for stroke, and 8.8% (95% confidence interval, 7.0-10.9) for operative mortality. The spinal cord ischemia event rate was higher with stent length 15 cm or greater or coverage to T8 or beyond than with stent length of 10 cm (11.6% vs 2.5%, P<.001). Adverse event rates in patients with acute type A aortic dissection versus nonacute dissection or aneurysm were as follows: mortality 9.2% versus 7.6% (P ¼ .46), stroke 9.3% versus 6.6% (P ¼ .51), and overall adverse events 22.0% versus 16.5% (P ¼ .41). Conclusions:As the frozen elephant trunk procedure becomes more popular, accurate data regarding outcomes are vital. We associated the frozen elephant trunk technique with (nonsignificantly) more adverse events overall in acute type A dissection cases. Stent length of 10 cm was associated with significantly less risk of spinal cord ischemia. Using a stent 15 cm or greater or coverage extending to T8 or farther should be avoided. (J Thorac Cardiovasc Surg 2020;160:20-33) 35 Studies 3154 Patients 4.7% SCI 7.6% Stroke 8.8% Mortality Extent of SC Coverage Dissection (Type A or DeBakey Type I) / Aneurysm, Nondissection Overall Adverse Event (Mortality / Stroke / SCI) ≥ 15 cm stent length / Coverage at or distal to T8 (6 studies / 201 patients)From the

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Section: Perspectivementioning

confidence: 99%

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

181

136

View full text Add to dashboard Cite

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“…They are at risk for serious burn injuries, from being unable to 20 detect noxious heat, and suffer the emotional consequences of being unable to receive reassuring touch. SCIs are estimated to affect over 1 million people in the US, and cost ~$40 billion annually in health care (Abraira et al, 2017;Armour et al, 2016). SCI patients have significantly lower life expectancy than uninjured individuals, regardless of injury severity; their average life expectancy has not improved since the 1980s.…”

Section: Looking Ahead: What Does Knowledge Of These Manipulatiomentioning

confidence: 99%

New perspectives on the mechanisms establishing the dorsal-ventral axis of the spinal cord

Andrews

Kong

Novitch

et al. 2019

Current Topics in Developmental Biology

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Distinct classes of neurons arise at different positions along the dorsal-ventral axis of the spinal cord leading to spinal neurons being segregated along this axis according to their physiological properties and functions. Thus, the neurons associated with motor control are generally located in, or adjacent to, the ventral horn whereas the interneurons (INs) that mediate sensory activities are present within the dorsal horn. Here, we review classic and recent studies examining the developmental mechanisms that establish the dorsal-ventral axis in the embryonic spinal cord. Intriguingly, while the cellular organization of the dorsal and ventral halves of the spinal cord look superficially similar during early development, the underlying molecular mechanisms that establish dorsal vs. ventral patterning are markedly distinct. For example, the ventral spinal cord is patterned by the actions of a single growth factor, sonic hedgehog (Shh) acting as a morphogen, i.e. concentration-dependent signal. Recent studies have shed light on the mechanisms by which the spatial and temporal gradient of Shh is transduced by cells to elicit the generation of different classes of ventral INs, and motor neurons (MNs). In contrast, the dorsal spinal cord is patterned by the action of multiple factors, most notably by members of the bone morphogenetic protein (BMP) and Wnt families. While less is known about dorsal patterning, recent studies have suggested that the BMPs do not act as morphogens to specify dorsal IN identities as previously proposed, rather each BMP has signal specific activities. Finally, we consider the promise that elucidation of these mechanisms holds for neural repair.

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“…With as many as 1 in 50 people suffering from paralysis worldwide [1], Intra-cortical Brain Machine Interfaces (iBMIs) have a great potential in restoring semblance of a normal life for these embattled souls. iBMIs literally transform thought into action.…”

Section: Introductionmentioning

confidence: 99%

Towards Autonomous Intra-cortical Brain Machine Interfaces: Applying Bandit Algorithms for Online Reinforcement Learning

Shaikh

Sibindi

et al. 2020

Preprint

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This paper presents application of Banditron -an online reinforcement learning algorithm (RL) in a discrete state intra-cortical Brain Machine Interface (iBMI) setting. We have analyzed two datasets from non-human primates (NHPs) -NHP A and NHP B each performing a 4-option discrete control task over a total of 8 days. Results show average improvements of ≈ 15%, 6% in NHP A and 15%, 21% in NHP B over state of the art algorithms -Hebbian Reinforcement Learning (HRL) and Attention Gated Reinforcement Learning (AGREL) respectively. Apart from yielding a superior decoding performance, Banditron is also the most computationally friendly as it requires two orders of magnitude less multiply-and-accumulate operations than HRL and AGREL. Furthermore, Banditron provides average improvements of at least 40%, 15% in NHPs A, B respectively compared to popularly employed supervised methods -LDA, SVM across test days. These results pave the way towards an alternate paradigm of temporally robust hardware friendly reinforcement learning based iBMIs.

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Prevalence and Causes of Paralysis—United States, 2013

Cited by 161 publications

References 8 publications

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

New perspectives on the mechanisms establishing the dorsal-ventral axis of the spinal cord

Towards Autonomous Intra-cortical Brain Machine Interfaces: Applying Bandit Algorithms for Online Reinforcement Learning

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