Campbell, B. C.V. et al. (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data.ABSTRACT Background: CT-perfusion (CTP) and MRI may assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of ischaemic core and penumbra volumes were associated with functional outcomes and treatment effect.
This article addresses the problem of managing Moving Objects Databases (MODs) which capture the inherent imprecision of the information about the moving object's location at a given time. We deal systematically with the issues of constructing and representing the
trajectories
of moving objects and querying the MOD. We propose to model an uncertain trajectory as a three-dimensional (3D) cylindrical body and we introduce a set of novel but natural spatio-temporal
operators
which capture the
uncertainty
and are used to express spatio-temporal range queries. We devise and analyze algorithms for processing the operators and demonstrate that the model incorporates the uncertainty in a manner which enables efficient querying, thus striking a balance between the modeling power and computational efficiency. We address some implementation aspects which we experienced in our DOMINO project, as a part of which the operators that we introduce have been implemented. We also report on some experimental observations of a practical relevance.
Campbell, B. C. V. et al. (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurology, 17(1), pp. 47-53. (doi:10.1016/S1474-4422(17)30407-6) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/149670/ variables. An alternative approach using propensity-score stratification was also used. To account for between-trial variance we used mixed-effects modeling with a random effect for trial incorporated in all models. Bias was assessed using the Cochrane tool.Findings: Of 1764 patients in 7 trials, 871 were allocated to endovascular thrombectomy. After exclusion of 74 patients (72 who did not undergo the procedure and 2 with missing data on anaesthetic strategy), 236/797 (30%) of endovascular patients were treated under GA. At baseline, GA patients were younger and had shorter time to randomisation but similar pre-treatment clinical severity compared to non-GA. Endovascular thrombectomy improved functional outcome at 3 months versus standard care in both GA (adjusted common odds ratio (cOR) 1·52, 95%CI 1·09-2·11, p=0·014) and non-GA (adjusted cOR 2·33, 95%CI 1·75-3·10, p<0·001) patients. However, outcomes were significantly better for those treated under non-GA versus GA (covariate-adjusted cOR 1·53, 95%CI 1·14-2·04, p=0·004; propensitystratified cOR 1·44 95%CI 1·08-1·92, p=0·012). The risk of bias and variability among studies was assessed to be low.Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons.
Funding:The HERMES collaboration was funded by an unrestricted grant from Medtronic to the University of Calgary.
Research in contextEvidence before this study between abolition of the thrombectomy treatment effect in MR CLEAN and no effect in THRACE. Three single-centre randomised trials of general anaesthesia versus conscious sedation found either no difference in functional outcome between groups or a slight benefit of general anaesthesia.
Added value of this studyThese data from contemporary, high quality randomised trials form the largest study to date of the association between general anesthesia and the benefit of endovascular thrombectomy versus standard care. We used two different approaches to adjust for baseline imbalances (multivariable logistic regression and propensity-score stratification). We found that GA for endovascular thrombectomy, as practiced in contemporary clinical care across a wide range of expert centres during the rand...
We propose a method for rendering volumetric data sets at interactive frame rates while supporting dynamic ambient occlusion as well as an approximation to color bleeding. In contrast to ambient occlusion approaches for polygonal data, techniques for volumetric data sets have to face additional challenges, since by changing rendering parameters, such as the transfer function or the thresholding, the structure of the data set and thus the light interactions may vary drastically. Therefore, during a preprocessing step which is independent of the rendering parameters we capture light interactions for all combinations of structures extractable from a volumetric data set. In order to compute the light interactions between the different structures, we combine this preprocessed information during rendering based on the rendering parameters defined interactively by the user. Thus our method supports interactive exploration of a volumetric data set but still gives the user control over the most important rendering parameters. For instance, if the user alters the transfer function to extract different structures from a volumetric data set the light interactions between the extracted structures are captured in the rendering while still allowing interactive frame rates. Compared to known local illumination models for volume rendering our method does not introduce any substantial rendering overhead and can be integrated easily into existing volume rendering applications. In this paper we will explain our approach, discuss the implications for interactive volume rendering and present the achieved results.
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