BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

• Klíčová slova
• Dehydration, Geriatrics, Guideline, Malnutrition, Nutritional care, Recommendations,
• MeSH
• dehydratace terapie   MeSH
• enterální výživa MeSH
• geriatrie metody   MeSH
• lidé MeSH
• nadváha terapie   MeSH
• parenterální výživa MeSH
• podvýživa terapie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVE: Whether intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. METHODS: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. RESULTS: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67-1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = -2.83, 95% CI = -5.28 to -0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30-0.84), and smaller baseline hematoma volume (linear regression coefficient = -0.24, 95% CI = -0.47 to -0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81-1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63-1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49-1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57-1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75-1.43). INTERPRETATION: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702-712.

• MeSH
• antikoagulancia aplikace a dávkování   škodlivé účinky   MeSH
• aplikace orální MeSH
• cerebrální krvácení chemicky indukované   mortalita   patologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurozobrazování MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vitamin K antagonisté a inhibitory   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• Názvy látek
• antikoagulancia MeSH
• vitamin K MeSH

Different strategies have been developed using Independent Component Analysis (ICA) to automatically de-noise fMRI data, either focusing on removing only certain components (e.g. motion-ICA-AROMA, Pruim et al., 2015a) or using more complex classifiers to remove multiple types of noise components (e.g. FIX, Salimi-Khorshidi et al., 2014 Griffanti et al., 2014). However, denoising data obtained in an acute setting might prove challenging: the presence of multiple noise sources may not allow focused strategies to clean the data enough and the heterogeneity in the data may be so great to critically undermine complex approaches. The purpose of this study was to explore what automated ICA based approach would better cope with these limitations when cleaning fMRI data obtained from acute stroke patients. The performance of a focused classifier (ICA-AROMA) and a complex classifier (FIX) approaches were compared using data obtained from twenty consecutive acute lacunar stroke patients using metrics determining RSN identification, RSN reproducibility, changes in the BOLD variance, differences in the estimation of functional connectivity and loss of temporal degrees of freedom. The use of generic-trained FIX resulted in misclassification of components and significant loss of signal (< 80%), and was not explored further. Both ICA-AROMA and patient-trained FIX based denoising approaches resulted in significantly improved RSN reproducibility (p < 0.001), localized reduction in BOLD variance consistent with noise removal, and significant changes in functional connectivity (p < 0.001). Patient-trained FIX resulted in higher RSN identifiability (p < 0.001) and wider changes both in the BOLD variance and in functional connectivity compared to ICA-AROMA. The success of ICA-AROMA suggests that by focusing on selected components the full automation can deliver meaningful data for analysis even in population with multiple sources of noise. However, the time invested to train FIX with appropriate patient data proved valuable, particularly in improving the signal-to-noise ratio.

• Klíčová slova
• Acute stroke, BOLD, Denoising, Independent component analysis, Resting state, fMRI,
• MeSH
• analýza hlavních komponent * MeSH
• cévní mozková příhoda diagnostické zobrazování   MeSH
• kyslík krev   MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• nervové dráhy diagnostické zobrazování   MeSH
• počítačové zpracování obrazu * MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kyslík MeSH

BACKGROUND AND PURPOSE: Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. METHODS: We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. RESULTS: In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001; 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01; 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37; CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3; CI, 0.8-2.24; P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). CONCLUSIONS: In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.

• Klíčová slova
• carotid stenosis, ischemic attack, transient, statin,
• MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnostické zobrazování   patofyziologie   prevence a kontrola   MeSH
• difuzní magnetická rezonance metody   MeSH
• ischemie mozku diagnostické zobrazování   farmakoterapie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• radiografie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statiny aplikace a dávkování   MeSH
• stenóza arteria carotis diagnostické zobrazování   farmakoterapie   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• statiny MeSH