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Background
Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke.
Methods
We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602.
Findings
Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19–2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20–1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82–3·29) for intracranial haemorrhage and 1·23 (1·08–1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08–6·72] for intracranial haemorrhage vs 1·47 [1·19–1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36–9·05] vs 1·43 [1·07–1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69–15·81] vs 1·86 [1·23–2·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48–84] per 1000 patient-years vs 27 intracranial haemorrhages [17–41] per 1000 patient-years; and for ≥20 cerebral microbleeds, 73 ischaemic strokes [46–108] per 1000 patient-years vs 39 intracranial haemorrhages [21–67] per 1000 patient-years).
Interpretation
In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden.
Background
Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure.
Methods
Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients.
Results
Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings.
Conclusions
Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.
"
Laser spectroscopic gas sensing has been applied for decades for several applications
as atmospheric monitoring, industrial combustion gas analysis or fundamental research.
The availability of new laser sources in the mid-infrared opens the spectral fingerprint
range to the technology where multiple molecules possess their fundamental ro-vibrational
absorption features that allow very sensitive detection and accurate discrimination of
the species. The increasing maturity of quantum cascade lasers that cover this highly
interesting spectral range motivated this research to gain fundamental knowledge about
the spectra of hydrocarbon gases in pure composition and in complex mixtures as they
occur in the petro-chemical industry. The long-term target of developing accurate and fast
hydrocarbon gas analyzers, capable of real-time operation while enabling feedback-loops,
would lead to a paradigm change in this industry.
This thesis aims to contribute to a higher accuracy and more comprehensive understanding
of the sensing of hydrocarbon gas mixtures. This includes the acquisition of yet
unavailable high resolution and high accuracy reference spectra of the respective gases,
the investigation of their spectral behavior in mixtures due to collisional broadening of
their transitions and the verification of the feasibility to quantitatively discriminate the
spectra when several overlapping species are simultaneously measured in gas mixtures.
To achieve this knowledge a new laboratory environment was planned and built up to
allow for the supply of the individual gases and their arbitrary mixing. The main element
was the development of a broadly tunable external-cavity quantum cascade laser based
spectrometer to record the required spectra. This also included the development of a new
measurement method to obtain highly resolved and nearly gap-less spectral coverage as
well as a sophisticated signal post-processing that was crucial to achieve the high accuracy
of the measurements. The spectroscopic setup was used for a thorough investigation of
the spectra of the first seven alkanes as of their mixtures. Measurements were realized
that achieved a spectral resolution of 0.001 cm-1 in the range of 6-11 µm while ensuring an
accuracy of 0.001 cm-1 of the spectra and attaining a transmission sensitivity of 2.5 x 10-4
for long-time averaging of the acquired spectra.
These spectral measurements accomplish a quality that compares to state-of-the art
spectral databases and revealed so far undocumented details of several of the investigated
gases that have not been measured with this high resolution before at the chosen measurement
conditions. The results demonstrate the first laser spectroscopic discrimination of a
seven component gas mixture with absolute accuracies below 0.5 vol.% in the mid-infrared
provided that a sufficiently broad spectral range is covered in the measurements. Remaining
challenges for obtaining improved spectral models of the gases and limitations of the
measurement accuracy and technology are discussed.