Rationale and design of the prospective German registry of outcome in patients with severe disorders of consciousness after acute brain injury.

OBJECTIVE: To describe the rationale and design of a new patient registry (Koma Outcome von Patienten der Frührehabilitation-Register [KOPF-R; Registry for Coma Outcome in Patients Undergoing Acute Rehabilitation]) that has the scope to examine determinants of long-term outcome and functioning of patients with severe disorders of consciousness (DOC). DESIGN: Prospective multicenter neurologic rehabilitation registry. SETTING: Five specialized neurologic rehabilitation facilities. PARTICIPANTS: Patients (N=42) with DOC in vegetative state or minimally conscious state (MCS) as defined by the Coma Recovery Scale-Revised (CRS-R) after brain injury. Patients are being continuously enrolled. The data presented here cover the enrollment period from August 2011 to January 2012. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: CRS-R, FIM, and emergence from MCS. RESULTS: The registry was set up in 5 facilities across the state of Bavaria/Germany with a special expertise in the rehabilitation of acquired brain injury. Inclusion of patients started in August 2011. Measures include sociodemographic and clinical characteristics, course of acute therapy, electrophysiologic measures (evoked potentials, electroencephalogram), neuron-specific enolase, current medication, functioning, cognition, participation, quality of life, quantity and characteristics of rehabilitation therapy, caregiver burden, and attitudes toward end-of-life decisions. Main diagnoses were traumatic brain injury (24%), intracerebral or subarachnoid hemorrhage (31%), and anoxic-ischemic encephalopathy (45%). Mean CRS-R score ± SD at admission to rehabilitation was 5.9 ± 3.3, and mean FIM score ± SD at admission was 18 ± 0.4. CONCLUSIONS: The KOPF-R aspires to contribute prospective data on prognosis in severe DOC.

Cobalt-catalyzed 1,4-hydrovinylation of allylsilane and allylboronic esters for the synthesis of hydroxy-functionalized 1,4-dienes.

The cobalt(I)-catalyzed 1,4-hydrovinylation reaction of allyl trimethylsilane and allyl pinacol boronic ester with symmetrical and unsymmetrical 1,3-dienes generates building blocks for the in situ allylboration or the Lewis acid induced allylation reaction utilizing the corresponding allyl silane derivatives. The products of these three-component reactions are hydroxy-functionalized 1,4-dienes which can be used for the synthesis of pyranones. An alternate reaction sequence for the synthesis of the hydroxy-functionalized 1,4-dienes by performing the allylation first followed by the cobalt-catalyzed 1,4-hydrovinylation is also possible. Accordingly, polyfunctionalized complex structures can be generated by both approaches in a convergent fashion.

Coherence in resting-state EEG as a predictor for the recovery from unresponsive wakefulness syndrome.

We investigated differences of EEG coherence within (short-range), and between (long-range) specified brain areas as diagnostic markers for different states in disorders of consciousness (DOC), and their predictive value for recovery from unresponsive wakefulness syndrome (UWS). EEGs of 73 patients and 24 controls were recorded and coma recovery scale- revised (CRS-R) scores were assessed. CRS-R of UWS patients was collected after 12 months and divided into two groups (improved/unimproved). Frontal, parietal, fronto-parietal, fronto-temporal, and fronto-occipital coherence was computed, as well as EEG power over frontal, parietal, occipital, and temporal areas. Minimally conscious patients (MCS) and UWS patients could not be differentiated based on their coherence patterns or on EEG power. Fronto-parietal and parietal coherence could positively predict improvement of UWS patients, i.e. recovery from UWS to MCS. Parietal coherence was significantly higher in delta and theta frequencies in the improved group, as well as the coherence between frontal and parietal regions in delta, theta, alpha, and beta frequencies. High parietal delta and theta, and high fronto-parietal theta and alpha coherence appear to provide strong early evidence for recovery from UWS with high predictive sensitivity and specificity. Short and long-range coherence can have a diagnostic value in the prognosis of recovery from UWS.

Stability of auditory event-related potentials in coma research.

Patients with unresponsive wakefulness syndrome (UWS) or in minimally conscious state (MCS) after brain injury show significant fluctuations in their behavioural abilities over time. As the importance of event-related potentials (ERPs) in the detection of traces of consciousness increases, we investigated the retest reliability of ERPs with repeated tests at four different time points. Twelve healthy controls and 12 inpatients (8 UWS, 4 MCS; 6 traumatic, 6 non-traumatic) were tested twice a day (morning, afternoon) for 2 days with an auditory oddball task. ERPs were recorded with a 256-channel-EEG system, and correlated with behavioural test scores in the Coma Recovery Scale-revised (CRS-R). The number of identifiable P300 responses varied between zero and four in both groups. Reliabilities varied between Krippendorff's α = 0.43 for within-day comparison, and α = 0.25 for between-day comparison in the patient group. Retest reliability was strong for the CRS-R scores for all comparisons (α = 0.83-0.95). The stability of auditory information processing in patients with disorders of consciousness is the basis for other, even more demanding tasks and cognitive potentials. The relatively low ERP-retest reliability suggests that it is necessary to perform repeated tests, especially when probing for consciousness with ERPs. A single negative ERP test result may be mistaken for proof that a UWS patient truly is unresponsive.

Gaining absolute control of the regiochemistry in the cobalt-catalyzed 1,4-hydrovinylation reaction.

The absolute control of the regiochemistry of a cobalt-catalyzed 1,4-hydrovinylation reaction is achieved by alternation of the ligands applied. While the dppe/dppp ligands led to the formation of the branched product, the herein described application of the SchmalzPhos ligand generates the corresponding linear product in both excellent yields and regioselectivities. The catalyst system exhibits a high tolerance toward functional groups, and the very mild reaction conditions allow the synthesis of 1,4-dienes without isomerization into conjugated systems.