Siponimod signifikantně snižuje riziko potvrzené progrese disability, zhoršení kognitivního výkonu, snižuje riziko relapsů a příznivě ovlivňuje parametry magnetické rezonance hodnocené pomocí atrofie mozku či zánětlivých ložisek u pacientů se sekundárně progresivní roztroušenou sklerózou. Data z pětileté extenze studie EXPAND podporují význam časné detekce sekundárně progresivní roztroušené sklerózy a tedy včasného zahájení léčby siponimodem.
Siponimod significantly reduced the risk of confirmed disability progression, worsening in cognitive processing speed, relapses, and magnetic resonance imaging measures of brain atrophy and inflammation in secondary progressive multiple sclerosis patients. Data from the 5-year extension of the EXPAND study support the importance of early detection of secondary progressive multiple sclerosis and thus early initiation of siponimod treatment.
- Klíčová slova
- siponimod,
- MeSH
- časná diagnóza MeSH
- Kaplanův-Meierův odhad MeSH
- lidé MeSH
- modulátory receptorů sfingosin-1-fosfátu * aplikace a dávkování ekonomika farmakologie MeSH
- mozek účinky léků MeSH
- numbers needed to treat MeSH
- progrese nemoci MeSH
- roztroušená skleróza * farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
The aim of this systematic review is to undertake a critical appraisal of the evidence in the published literature concerning the conversion factors between kerma-area product (PKA) and effective/organ dose (DCED_PKA, DCHT_PKA) for cardiac interventional fluoroscopy procedures performed in adults and paediatric patients and to propose reference conversion factors to help standardize dose calculations. A search strategy utilizing MeSH headings in three databases identified 59 (adult) and 37 (paediatric) papers deemed eligible for the review. Exclusion criteria were adopted to select data only from publications which established DCED_PKAin patients using the ICRP 103 tissue weighting factors. A time restriction from January 2007 was introduced in the search to capture the evolving trends of utilization of fluoroscopy-guided intervention technologies only in recent years. The suggested DCED_PKAand DCHT_PKAwere synthesized by calculating the weighted averages of the values reported by the authors with weights corresponding to the study sample size. Eighteen studies for both adult (9) and paediatric (9) patients matching the search terms fulfilled the inclusion criteria. The suggested value for DCED_PKAin adult patients amounts to 0.24 mSv Gy-1cm-2. The suggested values for DCHT_PKAranged from a minimum of 0.15 mSv Gy-1cm-2for the female breast to a maximum of 0.97 mSv Gy-1cm-2for the lungs. The suggested values for DCED_PKAin paediatric patients ranged from 3.45 mSv Gy-1cm-2for the new-born to 0.49 mSv Gy-1cm-2in the 15 years age class. The suggested values for DCHT_PKAranged from a minimum of 0.33 mSv Gy-1cm-2for bone marrow in the 15 years age class to a maximum of 11.49 mSv Gy-1cm-2for the heart in the new-born. To conclude, values of DCED_PKA/DCHT_PKAwere provided for calculating effective/organ doses in cardiac interventional procedures. They can be useful for standardizing dose calculations, hence for comparison of the radiation detriment from different imaging procedures and in the framework of epidemiologic studies.
- MeSH
- databáze faktografické MeSH
- dítě MeSH
- dospělí MeSH
- fluoroskopie MeSH
- lidé MeSH
- srdce * diagnostické zobrazování MeSH
- technologie * MeSH
- velikost vzorku MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
The complexity of Neolithic population movements and their interpretation through material culture have been the subject of archaeological research for decades. One of the dominant narratives proposes that groups from the Starčevo-Körös-Criş complex spread from the central towards the northern Balkans in the Early Neolithic and eventually brought the Neolithic lifestyle into present-day Hungary. Broad geographical migrations were considered to shape the continuous expansion of Neolithic groups and individuals. However, recent archaeological research, aDNA, and isotope analyses challenged the synchronous appearance of specific material culture distributions and human movement dynamics through emphasizing communication networks and socio-cultural transformation processes. This paper seeks to retrace the complexity of Neolithic mobility patterns across Hungary by means of strontium and oxygen stable isotope analyses, which were performed on a total of 718 human dental enamel samples from 55 Neolithic sites spanning the period from the Starčevo to the Balaton-Lasinja culture in Transdanubia and from the Körös to the Tiszapolgár cultural groups on the Great Hungarian Plain (Alföld). This study presents the largest strontium and oxygen isotope sample size for the Neolithic Carpathian Basin and discusses human mobility patterns on various geographical scales and throughout archaeological cultures, chronological periods, and sex and gender categories in a multiproxy analysis. Based on our results, we discuss the main stages of the Neolithisation processes and particularly trace individual movement behaviour such as exogamy patterns within extensive social networks. Furthermore, this paper presents an innovative differentiation between mobility patterns on small, micro-regional, and supra-regional scales, which provides new insights into the complex organisation of Neolithic communities.
- MeSH
- časové faktory MeSH
- izotopové značení * MeSH
- izotopy kyslíku analýza MeSH
- lidé MeSH
- stroncium analýza MeSH
- velikost vzorku MeSH
- zeměpis MeSH
- zubní sklovina chemie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Maďarsko MeSH
BACKGROUND: Less than 500 participants have been included in randomized trials comparing hypothermia with regular care for out-of-hospital cardiac arrest patients, and many of these trials were small and at a high risk of bias. Consequently, the accrued data on this potentially beneficial intervention resembles that of a drug following small phase II trials. A large confirmatory trial is therefore warranted. METHODS: The TTM2-trial is an international, multicenter, parallel group, investigator-initiated, randomized, superiority trial in which a target temperature of 33°C after cardiac arrest will be compared with a strategy to maintain normothermia and early treatment of fever (≥37.8°C). Participants will be randomized within 3 hours of return of spontaneous circulation with the intervention period lasting 40 hours in both groups. Sedation will be mandatory for all patients throughout the intervention period. The clinical team involved with direct patient care will not be blinded to allocation group due to the inherent difficulty in blinding the intervention. Prognosticators, outcome-assessors, the steering group, the trial coordinating team, and trial statistician will be blinded. The primary outcome will be all-cause mortality at 180 days after randomization. We estimate a 55% mortality in the control group. To detect an absolute risk reduction of 7.5% with an alpha of 0.05 and 90% power, 1900 participants will be enrolled. The main secondary neurological outcome will be poor functional outcome (modified Rankin Scale 4-6) at 180 days after arrest. DISCUSSION: The TTM2-trial will compare hypothermia to 33°C with normothermia and early treatment of fever (≥37.8°C) after out-of-hospital cardiac arrest.
- MeSH
- časové faktory MeSH
- hodnocení ekvivalence jako téma * MeSH
- hodnocení výsledků zdravotní péče MeSH
- horečka terapie MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- příčina smrti MeSH
- randomizované kontrolované studie jako téma * MeSH
- tělesná teplota * MeSH
- terapeutická hypotermie metody MeSH
- velikost vzorku MeSH
- zástava srdce mimo nemocnici mortalita terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
Importance: Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). Objective: To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. Design, Setting, and Participants: The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Interventions: Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. Main Outcomes and Measures: The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Results: Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P < .001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, -2.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P = .25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, -3.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P = .44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups. Conclusions and Relevance: Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. Trial Registration: ClinicalTrials.gov Identifier: NCT01400373.
- MeSH
- čas zasáhnout při rozvinutí nemoci MeSH
- epistaxe etiologie MeSH
- jednoduchá slepá metoda MeSH
- kardiopulmonální resuscitace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- mozek patofyziologie MeSH
- poranění mozku etiologie prevence a kontrola MeSH
- senioři MeSH
- terapeutická hypotermie škodlivé účinky přístrojové vybavení metody MeSH
- urgentní zdravotnické služby * MeSH
- velikost vzorku MeSH
- výsledek terapie MeSH
- zástava srdce mimo nemocnici komplikace mortalita terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Human decision making involving many alternatives is encumbered with inconsistent prioritization. Although inconsistency is assumed to grow with the number of comparisons, it is shown to be reduced by conscious awareness under certain conditions. This study experimentally investigated the effect of repeating a criteria ranking task on inconsistency scores as measured by four different inconsistency coefficients. A total of 107 participants were engaged in a selection task that comprised of ranking from 3 to 10 criteria and was repeated in three trials. Upon completing the first trial, the participants were informed about the inconsistency issues and could improve their ranking in another two trials. The inconsistency score was computed for each set of comparisons and the effect of repeating the selection task on inconsistency concerning the number of criteria was analyzed using the repeated measures ANOVA. The results reveal a significant change in the inconsistency as the task was repeated but the difference depended on the number of criteria. There exists a borderline in the problem size under which the rankings are associated with significantly lower inconsistency, while the rankings with the larger number of criteria were found to have significantly higher inconsistency.
- MeSH
- lidé MeSH
- reprodukovatelnost výsledků * MeSH
- rozhodování * MeSH
- velikost vzorku MeSH
- výzkumný projekt MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
It is often claimed that pair bonds preferentially form between individuals that resemble one another. Such assortative mating appears to be widespread throughout the animal kingdom. Yet it is unclear whether the apparent ubiquity of assortative mating arises primarily from mate choice ("like attracts like"), which can be constrained by same-sex competition for mates; from spatial or temporal separation; or from observer, reporting, publication, or search bias. Here, based on a conventional literature search, we find compelling meta-analytical evidence for size-assortative mating in birds (r = 0.178, 95% CI 0.142-0.215, 83 species, 35,591 pairs). However, our analyses reveal that this effect vanishes gradually with increased control of confounding factors. Specifically, the effect size decreased by 42% when we used previously unpublished data from nine long-term field studies, i.e., data free of reporting and publication bias (r = 0.103, 95% CI 0.074-0.132, eight species, 16,611 pairs). Moreover, in those data, assortative mating effectively disappeared when both partners were measured by independent observers or separately in space and time (mean r = 0.018, 95% CI -0.016-0.057). Likewise, we also found no evidence for assortative mating in a direct experimental test for mutual mate choice in captive populations of Zebra finches (r = -0.020, 95% CI -0.148-0.107, 1,414 pairs). These results highlight the importance of unpublished data in generating unbiased meta-analytical conclusions and suggest that the apparent ubiquity of assortative mating reported in the literature is overestimated and may not be driven by mate choice or mating competition for preferred mates.
- MeSH
- fenotyp MeSH
- odchylka pozorovatele MeSH
- párová vazba MeSH
- pěnkavovití fyziologie MeSH
- sexuální výběr u zvířat fyziologie MeSH
- velikost těla * MeSH
- velikost vzorku MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
Former authors claimed that, due to parasites' aggregated distribution, small samples underestimate the true population mean abundance. Here we show that this claim is false or true, depending on what is meant by 'underestimate' or, mathematically speaking, how we define 'bias'. The 'how often' and 'on average' views lead to different conclusions because sample mean abundance itself exhibits an aggregated distribution: most often it falls slightly below the true population mean, while sometimes greatly exceeds it. Since the several small negative deviations are compensated by a few greater positive ones, the average of sample means approximates the true population mean.
- MeSH
- lidé MeSH
- parazitární nemoci parazitologie MeSH
- paraziti růst a vývoj MeSH
- parazitologie metody MeSH
- velikost vzorku MeSH
- zkreslení výsledků (epidemiologie) MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
