Baseline Results of an Acute Ischemic Stroke Registry Including Acute Multimodal Imaging (ASTRAL)

Background: The DEFUSE (n_74) and EPITHET (n_101) studies have in common that a baseline MRI was obtained prior to treatment (tPA in DEFUSE; tPA or placebo in EPITHET) in the 3-6 hour time-window. There were however important methodological differences between the studies. A standardized reanalysis of pooled data was undertaken to determine the effect of these differences on baseline characteristics and study outcomes. Methods: To standardize the studies 1) the DWI and PWI source images were reprocessed and segmented using automated image processing software (RAPID); 2) patients were categorized according to their baseline MRI profile as either Target Mismatch (PWITmax_6/DWI ratio_ 1.8 and an absolute mismatch _15mL), Malignant (DWI or PWITmax_10 lesion _ 100 mL), or No Mismatch. 3) favorable clinical response was defined as NIHSS score of 0-1 or a _8 points improvement on the NIHSSS at day 90. Results: Prior to standardization there was no difference in the proportion of Target Mismatch patients between EPITHET and DEFUSE (54% vs 49%, p_0.6), but the EPITHET study had more patients with the Malignant profile than DEFUSE (35% vs 9%, p_0.01) and fewer patients that had No Mismatch (11% vs 42%, p_0.01). These differences in baseline MRI profiles between EPITHET and DEFUSE were largely eliminated by standardized processing of PWI and DWI images with RAPID software (Target Mismatch 49% vs 48%; Malignant 15% vs 8%; No Mismatch 36% vs 25%; p_NS for all comparisons) Reperfusion was strongly associated with a favorable clinical response in mismatch patients (figure). This relationship was not affected by the standardization procedures (pooled odds ratio of 8.8 based on original data and 6.6 based on standardized data). Conclusion: Standardization of image analyses procedures in acute stroke is important as non-standardized techniques introduce significant variability in DWI and PWI imaging characteristics. Despite methodological differences, the DEFUSE and EPITHET studies show a consistent and robust association between reperfusion and favorable clinical response in Target Mismatch patients regardless of standardization. These data support an RCT of iv tPA in the 3-6 hour time-window for Target Mismatch patients identified using RAPID.

Théâtre de la ville de Paris / Michel de La Rochemaillet ; introduction et notes, par l'abbé Valentin Dufour

Collection : Collection des anciennes descriptions de Paris ; IV

Gestió dels recursos docents en el marc de l'EEES

L'Espai Europeu d'Educació Superior comporta un canvi de paradigma molt important, com ésl'adopció d'un procés d'aprenentatge basat en l'adquisició i desenvolupament de competències mitjançant activitats, relegant els continguts a un segon terme. El propi concepte d'activitat inclou i combina elements molt diversos que involucren recursos docents de tota mena, tot abastant un ventall més ampli del que s'entén estrictament per contingut en el sentit tradicional. És necessari, doncs, plantejar-se una gestió dels recursos docents orientada a facilitar la creació d'itineraris formatius que permetin als estudiants assolir les competències desitjades, així com complementar la seva formació. En lloc de proporcionar els continguts directament als estudiants, l'objectiu és aconseguir un procés d'aprenentatge centrat en l'usuari mitjançant la formació que els permeti ser autònoms en la localització, l'ús i fins i tot la generació de continguts necessaris en cada activitat.