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Background
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region.
Methods
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals.
Results
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period.
Conclusion
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
We report on the synthesis of N‐heterocyclic tetrylenes ligated by the NON‐donor framework 4,5‐bis(2,6‐diisopropylphenyl‐amino)‐2,7‐di‐tert‐butyl‐9,9‐dimethylxanthene. The molecular structures of the germylene (3), stannylene (4) and plumbylene (5) where determined by X‐ray diffraction studies. Furthermore, we present quantum chemical studies on the σ‐donor and π‐acceptor properties of 3–5. Additionally, we report on the reactivity of the tetrylenes towards the transition metal carbonyls [Rh(CO)\(_{2}\)Cl]\(_{2}\), [W(CO)\(_{6}\)] and [Ni(CO)\(_{4}\)]. The isolated complexes (6 and 7) show the differing reactivity of NHTs compared to NHCs. Instead of just forming the anticipated complex [(NON)Sn−Rh(CO)\(_{2}\)Cl], 4 inserts into the Rh−Cl bond to afford [(NON)Sn(Cl)Rh(CO)(C\(_{6}\)H\(_{6}\))] (6, additional CO/C6H6 exchange) and [(NON)Sn(Cl)Rh\(_{2}\)(CO)\(_{4}\)Cl] (7). By avoiding halogenated transition metal precursors in order to prevent insertion reactions, germylene 3 shows “classical” coordination chemistry towards {Ni(CO)3} forming the complex [(NON)Ge−Ni(CO)\(_{3}\)] (8).
Recovery of upper limb (UL) impairment after stroke is limited in stroke survivors. Since stroke can be considered as a network disorder, neuromodulation may be an approach to improve UL motor dysfunction. Here, we evaluated the effect of high-frequency stimulation (HFS) of the subthalamic nucleus (STN) in rats on forelimb grasping using the single-pellet reaching (SPR) test after stroke and determined costimulated brain regions during STN-HFS using 2-[\(^{18}\)F]Fluoro-2-deoxyglucose-([\(^{18}\)F]FDG)-positron emission tomography (PET). After a 4-week training of SPR, photothrombotic stroke was induced in the sensorimotor cortex of the dominant hemisphere. Thereafter, an electrode was implanted in the STN ipsilateral to the infarction, followed by a continuous STN-HFS or sham stimulation for 7 days. On postinterventional day 2 and 7, an SPR test was performed during STN-HFS. Success rate of grasping was compared between these two time points. [\(^{18}\)F]FDG-PET was conducted on day 2 and 3 after stroke, without and with STN-HFS, respectively. STN-HFS resulted in a significant improvement of SPR compared to sham stimulation. During STN-HFS, a significantly higher [\(^{18}\)F]FDG-uptake was observed in the corticosubthalamic/pallidosubthalamic circuit, particularly ipsilateral to the stimulated side. Additionally, STN-HFS led to an increased glucose metabolism within the brainstem. These data demonstrate that STN-HFS supports rehabilitation of skilled forelimb movements, probably by retuning dysfunctional motor centers within the cerebral network.