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Rezapour M, Yazdinejad M, Rajabi Kouchi F, Habibi Baghi M, Khorrami Z, Khavanin Zadeh M, Pourbaghi E, Rezapour H. Text mining of hypertension researches in the west Asia region: a 12-year trend analysis. Ren Fail 2024; 46:2337285. [PMID: 38616180 PMCID: PMC11018045 DOI: 10.1080/0886022x.2024.2337285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
More than half of the world population lives in Asia and hypertension (HTN) is the most prevalent risk factor found in Asia. There are numerous articles published about HTN in Eastern Mediterranean Region (EMRO) and artificial intelligence (AI) methods can analyze articles and extract top trends in each country. Present analysis uses Latent Dirichlet allocation (LDA) as an algorithm of topic modeling (TM) in text mining, to obtain subjective topic-word distribution from the 2790 studies over the EMRO. The period of checked studied is last 12 years and results of LDA analyses show that HTN researches published in EMRO discuss on changes in BP and the factors affecting it. Among the countries in the region, most of these articles are related to I.R Iran and Egypt, which have an increasing trend from 2017 to 2018 and reached the highest level in 2021. Meanwhile, Iraq and Lebanon have been conducting research since 2010. The EMRO word cloud illustrates 'BMI', 'mortality', 'age', and 'meal', which represent important indicators, dangerous outcomes of high BP, and gender of HTN patients in EMRO, respectively.
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Affiliation(s)
- Mohammad Rezapour
- Faculty Member of the Iranian Ministry of Science, Research and Technology, Tehran, Iran
| | | | - Faezeh Rajabi Kouchi
- Department of Computer Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | | | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Khavanin Zadeh
- Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elmira Pourbaghi
- Faculty of Advanced Sciences and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hassan Rezapour
- Department of Transportation and Urban Infrastructure Studies, Morgan State University, Baltimore, MD, USA
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Awasthi VA, Dhankar V, Singh S. Novel therapeutic targets for reperfusion injury in ischemic stroke: Understanding the role of mitochondria, excitotoxicity and ferroptosis. Vascul Pharmacol 2024; 156:107413. [PMID: 39059676 DOI: 10.1016/j.vph.2024.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024]
Abstract
Ischemic reperfusion injury (IRI) remains a significant challenge in various clinical settings, including stroke. Despite advances in reperfusion strategies, the restoration of blood flow to ischemic tissues often exacerbates tissue damage through a complex cascade of cellular and molecular events. In recent years, there has been growing interest in identifying novel therapeutic targets to ameliorate the detrimental effects of IRI and improve patient outcomes. This review critically evaluates emerging therapeutic targets and strategies for IRI management, such as R-spondin 3, neurolysin, glial cell gene therapy and inter alpha inhibitors. Diverse pathophysiology involved in IRI stroke such as oxidative stress, inflammation, mitochondrial dysfunction, and ferroptosis are also closely discussed. Additionally, we explored the intricate interplay between inflammation and IRI, focusing on cell-mediated gene therapy approaches and anti-inflammatory agents that hold promise for attenuating tissue damage. Moreover, we delve into novel strategies aimed at preserving endothelial function, promoting tissue repair, and enhancing cellular resilience to ischemic insults. Finally, we discuss challenges, future directions, and translational opportunities for the development of effective therapies targeting ischemic reperfusion injury.
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Affiliation(s)
- Vidhi Anupam Awasthi
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Punjab, India
| | - Vaibhav Dhankar
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Punjab, India
| | - Shamsher Singh
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Punjab, India.
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Vibholm AP, Pallesen H, Christensen JR, Varning Poulsen D. Nature-based rehabilitation-experiences from patients with acquired brain injury: an explorative qualitative study. Disabil Rehabil 2024; 46:4384-4393. [PMID: 37950396 DOI: 10.1080/09638288.2023.2274874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Nature has been found to improve and promote health and prevent disease. Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation is a developing approach. Yet to date the research is sparse. Following an acquired brain injury (ABI), people often experience impairments that cause limitations in activity and participation in daily life, which can impact the quality of life long-term. NBR delivered in neurorehabilitation has previously been explored from the perspective of occupational therapists and physiotherapists, however, to date patients' experiences are yet to be explored. This study aims to explore patients' experiences and perspectives of NBR delivered as part of standard neurorehabilitation. METHODS This qualitative study had a constructivist and phenomenological design. Semi-structured focus group interviews were carried out across three healthcare settings in Denmark with 17 participants. Data was analysed using content analysis. RESULTS The analysis generated three categories: 1. Outdoor versus indoor environment, 2. The natural environment as a co-therapist, and 3. Interrelatedness. CONCLUSION The study provides insight into participants' experiences of NBR. They reported that interacting with the natural environment as part of neurorehabilitation enhanced activity. Moreover, being in nature increased their self-efficacy, sense of autonomy, community spirit, cooperation, and joy, and led to a feeling of peace.
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Affiliation(s)
- Anne Pernille Vibholm
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Hospital Unit Viborg, Silkeborg, Hammel and Skive, University of Aarhus, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Hospital Unit Viborg, Silkeborg, Hammel and Skive, University of Aarhus, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus, Denmark
- DRIVEN, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorthe Varning Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Denmark
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Zhang J, Hong J, Chen J, Zhao F, Ye Q, Shan Y, Li C, Wen H. ScRNAs reveals high-frequency rTMS-induced pericyte differentiation: Potential implications for vascular regeneration and blood-brain barrier stability in stroke. Heliyon 2024; 10:e35339. [PMID: 39229501 PMCID: PMC11369456 DOI: 10.1016/j.heliyon.2024.e35339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 09/05/2024] Open
Abstract
Stroke is a major cause of adult disability worldwide, often involving disruption of the blood-brain barrier (BBB). Repairing the BBB is crucial for stroke recovery, and pericytes, essential components of the BBB, are potential intervention targets. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a treatment for functional impairments after stroke, with potential effects on BBB integrity. However, the underlying mechanisms remain unclear. In this study using a transient middle cerebral artery occlusion (tMCAO) rat model, we investigated the impact of rTMS on post-stroke BBB. Through single-cell sequencing (ScRNAs), we observed developmental relationships among pericytes, endothelial cells, and vascular smooth muscle cells, suggesting the differentiation potential of pericytes. A distinct subcluster of pericytes emerged as a potential therapeutic target for stroke. Additionally, our results revealed enhanced cellular communication among these cell types, enriching signaling pathways such as IGF, TNF, NOTCH, and ICAM. Analysis of differentially expressed genes highlighted processes related to stress, differentiation, and development. Notably, rTMS intervention upregulated Reck in vascular smooth muscle cells, implicating its role in the classical Wnt signaling pathway. Overall, our bioinformatics findings suggest that rTMS may modulate BBB permeability and promote vascular regeneration following stroke. This might happen through 20 Hz rTMS promoting pericyte differentiation into vascular smooth muscle cells, upregulating Reck, then activating the classical Wnt signaling pathway, and facilitating vascular regeneration and BBB stability.
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Affiliation(s)
| | | | - Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Fei Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Qiuping Ye
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yilong Shan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
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Sanjuan J, Cuellar Bahamón AM, Marmolejo MDM, Sendoya JE, Yamid Quintero Y, García-Perdomo HA. Antiaggregation Versus Anticoagulation for Stroke, Bleeding, and Mortality in Patients With Blunt Carotid Injury: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00316. [PMID: 39180474 DOI: 10.1097/crd.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
To assess the effectiveness and safety of antiplatelet therapy compared with anticoagulation therapy in preventing stroke occurrence following blunt carotid injuries. A comprehensive search was conducted on Medline, Central, and Embase using mesh criteria, yielding 1236 articles. Additionally, 3 studies met the inclusion criteria. Two review authors independently extracted data from randomized controlled trials, controlled clinical trials, and nonrandomized studies comparing anticoagulant and antiplatelet therapies for carotid blunt trauma. Primary outcomes included stroke, transient ischemic attack, and mortality, with secondary outcomes encompassing major extracranial bleeding events. Drug dosage, treatment duration, and follow-up data were extracted and analyzed. Only 1 randomized trial was identified, and 3 studies met all exclusion and inclusion criteria (comprising 796 patients). The odds of stroke [1.13, 95% confidence interval (CI), 0.30-4.24], transient ischemic attack (1.01, 95% CI, 0.14-6.59), and major bleeding (0.94, 95% CI, 0.02-2.77) resulted in no significant differences between the 2 interventions. Nevertheless, additional studies with robust designs and strong evidence are required to assess antiplatelet and anticoagulation drugs, dosing, timing, and outcomes in patients with carotid blunt trauma, ultimately enabling the formulation of recommendations.
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Affiliation(s)
- Juan Sanjuan
- From the Department of Surgery, Fundación Santa Fe de Bogotá, Bogotá, Hospital Serena del Mar, Cartagena de Indias, Colombia
| | | | | | - Jesús E Sendoya
- Department of Surgery, Southcolombian University, Neiva, Colombia
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Leonov G, Salikhova D, Starodubova A, Vasilyev A, Makhnach O, Fatkhudinov T, Goldshtein D. Oral Microbiome Dysbiosis as a Risk Factor for Stroke: A Comprehensive Review. Microorganisms 2024; 12:1732. [PMID: 39203574 PMCID: PMC11357103 DOI: 10.3390/microorganisms12081732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
Stroke represents a significant global health burden, with a substantial impact on mortality, morbidity, and long-term disability. The examination of stroke biomarkers, particularly the oral microbiome, offers a promising avenue for advancing our understanding of the factors that contribute to stroke risk and for developing strategies to mitigate that risk. This review highlights the significant correlations between oral diseases, such as periodontitis and caries, and the onset of stroke. Periodontal pathogens within the oral microbiome have been identified as a contributing factor in the exacerbation of risk factors for stroke, including obesity, dyslipidemia, atherosclerosis, hypertension, and endothelial dysfunction. The alteration of the oral microbiome may contribute to these conditions, emphasizing the vital role of oral health in the prevention of cardiovascular disease. The integration of dental and medical health practices represents a promising avenue for enhancing stroke prevention efforts and improving patient outcomes.
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Affiliation(s)
- Georgy Leonov
- Federal Research Center of Nutrition, Biotechnology and Food Safety, 109240 Moscow, Russia;
| | - Diana Salikhova
- Institute of Molecular and Cellular Medicine, RUDN University, 117198 Moscow, Russia; (D.S.); (A.V.); (T.F.)
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (O.M.); (D.G.)
| | - Antonina Starodubova
- Federal Research Center of Nutrition, Biotechnology and Food Safety, 109240 Moscow, Russia;
- Therapy Faculty, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Andrey Vasilyev
- Institute of Molecular and Cellular Medicine, RUDN University, 117198 Moscow, Russia; (D.S.); (A.V.); (T.F.)
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (O.M.); (D.G.)
- E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
- Central Research Institute of Dental and Maxillofacial Surgery, 119021 Moscow, Russia
| | - Oleg Makhnach
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (O.M.); (D.G.)
| | - Timur Fatkhudinov
- Institute of Molecular and Cellular Medicine, RUDN University, 117198 Moscow, Russia; (D.S.); (A.V.); (T.F.)
| | - Dmitry Goldshtein
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (O.M.); (D.G.)
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Mtambo ML, Masangwi DD, Soko AO, Kaledzera T, Bickton FM, Chipeta MC. The State of Stroke Research in Malawi: Results from a Mapping Review Study. J Multidiscip Healthc 2024; 17:4023-4041. [PMID: 39175495 PMCID: PMC11339346 DOI: 10.2147/jmdh.s476012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Stroke is one of the leading causes of death and disability globally, and low-income countries such as Malawi bear a heavy burden. Tailored, high-quality research is essential for bridging existing gaps and improving the healthcare provided in low-resource settings while maximizing available resources. Aim This mapping study aimed to synthesize the current state of stroke research in Malawi. Methods Six databases were thoroughly searched: CINAHL complete, Ovid MEDLINE and EMBASE, Web of Science Core Collection, PubMed, and Google Scholar. Results The search retrieved 598 references and identified 20 studies published between 2005 and 2023. Of these, 70% were conducted at Queen Elizabeth Central Hospital only; open-access journals published 95% of the studies. Cross-sectional studies were the most common (50%), followed by case-control studies (20%). The Malawi-Liverpool-Wellcome Trust Clinical Research Program authors contributed the most articles as main authors (25%). The number of citations per article ranged from 0 to 168 on Google Scholar, and the number of authors per article ranged from 1 to 15. Authors from thirty-five different institutions from 11 other countries partnered with Malawi on stroke articles, and England contributed 45.7% of the institutions. Most articles focused on pathophysiology (30%), followed by diagnosis (20%) and stroke management (15%). The highest number of participants included in the analysis was 739 and the highest number of stroke participants was 222. The identified challenges included the need for more infrastructure and under-utilization of available services. The Wellcome Trust has emerged as the primary funding agency for stroke research in Malawi. Conclusion The study found limited collaboration among local institutions in Malawi, with most research focused in Blantyre District. There is a critical need for increased interdisciplinary teamwork to boost nationwide research.
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Affiliation(s)
- Memory Lucy Mtambo
- Department of Clinical Sciences, Malawi University of Science and Technology, Blantyre, Malawi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Kuala Lumpur, Selangor, Malaysia
| | - Didjier Danger Masangwi
- Department of Applied Sciences, Malawi University of Science and Technology, Blantyre, Malawi
| | - Alpha Omega Soko
- Department of Basic Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Thom Kaledzera
- Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Fanuel Meckson Bickton
- Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Lung Health Research Group, Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
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Albishi AM. How does combining physical therapy with transcranial direct stimulation improve upper-limb motor functions in patients with stroke? A theory perspective. Ann Med Surg (Lond) 2024; 86:4601-4607. [PMID: 39118708 PMCID: PMC11305811 DOI: 10.1097/ms9.0000000000002287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/06/2024] [Indexed: 08/10/2024] Open
Abstract
More than half of stroke survivors suffer from upper-limb dysfunction that persists years after stroke, negatively impacting patients' independence and, therefore, affecting their quality of life. Intense motor rehabilitation is required after a stroke to facilitate motor recovery. More importantly, finding new ways to maximize patients' motor recovery is a core goal of stroke rehabilitation. Thus, researchers have explored the potential benefits of combining the effects of non-invasive brain stimulation with physical therapy rehabilitation. Specifically, combining transcranial direct stimulation (tDCS) with neurorehabilitation interventions can boost the brain's responses to interventions and maximize the effects of rehabilitation to improve upper-limb recovery post-stroke. However, it is still unclear which modes of tDCS are optimal for upper-limb motor recovery in patients with stroke when combined with physical therapy interventions. Here, the authors review the existing literature suggesting combining physical therapy rehabilitation with tDCS can maximize patients' motor recovery using the Interhemispheric Competition Model in Stroke. The authors focus on two main rehabilitation paradigms, which are constraint-induced movement therapy (CIMT) and Mirror therapy with and without tDCS. The authors also discuss potential studies to elucidate further the benefit of using tDCS adjunct with these upper-limb rehabilitation paradigms and its effectiveness in patients with stroke, with the ultimate goal of maximizing patients' motor recovery.
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Affiliation(s)
- Alaa. M. Albishi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Buizza C, Enström A, Carlsson R, Paul G. The Transcriptional Landscape of Pericytes in Acute Ischemic Stroke. Transl Stroke Res 2024; 15:714-728. [PMID: 37378751 PMCID: PMC11226519 DOI: 10.1007/s12975-023-01169-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
The current treatment options for ischemic stroke aim to achieve reperfusion but are time critical. Novel therapeutic approaches that can be given beyond the limited time window of 3-4.5 h are still an unmet need to be addressed to improve stroke outcomes. The lack of oxygen and glucose in the area of ischemic injury initiates a pathological cascade leading to blood-brain barrier (BBB) breakdown, inflammation, and neuronal cell death, a process that may be intercepted to limit stroke progression. Pericytes located at the blood/brain interface are one of the first responders to hypoxia in stroke and therefore a potential target cell for early stroke interventions. Using single-cell RNA sequencing in a mouse model of permanent middle cerebral artery occlusion, we investigated the temporal differences in transcriptomic signatures in pericytes at 1, 12, and 24 h after stroke. Our results reveal a stroke-specific subcluster of pericytes that is present at 12 and 24 h and characterized by the upregulation of genes mainly related to cytokine signaling and immune response. This study identifies temporal transcriptional changes in the acute phase of ischemic stroke that reflect the early response of pericytes to the ischemic insult and its secondary consequences and may constitute potential future therapeutic targets.
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Affiliation(s)
- Carolina Buizza
- Translational Neurology Group, Department of Clinical Science, Lund University, 22184, Lund, Sweden
| | - Andreas Enström
- Translational Neurology Group, Department of Clinical Science, Lund University, 22184, Lund, Sweden
| | - Robert Carlsson
- Translational Neurology Group, Department of Clinical Science, Lund University, 22184, Lund, Sweden
| | - Gesine Paul
- Translational Neurology Group, Department of Clinical Science, Lund University, 22184, Lund, Sweden.
- Department of Neurology, Scania University Hospital, 22185, Lund, Sweden.
- Wallenberg Centre for Molecular Medicine, Lund University, 22184, Lund, Sweden.
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Mead G, Graham C, Lundström E, Hankey GJ, Hackett ML, Billot L, Näsman P, Forbes J, Dennis M. Individual patient data meta-analysis of the effects of fluoxetine on functional outcomes after acute stroke. Int J Stroke 2024; 19:798-808. [PMID: 38497332 PMCID: PMC11298115 DOI: 10.1177/17474930241242628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Three large randomized controlled trials of fluoxetine for stroke recovery have been performed. We performed an individual patient data meta-analysis (IPDM) on the combined data. METHODS Fixed effects meta-analyses were performed on the combined data set, for the primary outcome (modified Rankin scale (mRS) at 6 months), and secondary outcomes common to the individual trials. As a sensitivity analysis, summary statistics from each trial were created and combined. FINDINGS The three trials recruited a combined total of 5907 people (mean age 69.5 years (SD 12.3), 2256 (38%) females, 2-15 days post-stroke) from Australia, New Zealand, United Kingdom, Sweden, and Vietnam; and randomized them to fluoxetine 20 mg daily or matching placebo for 6 months. Data on 5833 (98.75%) were available at 6 months. The adjusted ordinal comparison of mRS was similar in the two groups (common OR 0.96, 95% CI 0.87 to 1.05, p = 0.37). There were no statistically significant interactions between the minimization variables (baseline probability of being alive and independent at 6 months, time to treatment, motor deficit, or aphasia) and pre-specified subgroups (including age, pathological type, inability to assess mood, proxy or patient consent, baseline depression, country). Fluoxetine increased seizure risk (2.64% vs 1.8%, p = 0.03), falls with injury (6.26% vs 4.51%, p = 0.03), fractures (3.15% vs 1.39%, p < 0.0001) and hyponatremia (1.22% vs 0.61%, p = 0.01) but reduced new depression (10.05% vs 13.42%, p < 0.0001). At 12 months, there was no difference in adjusted mRS (n = 5760; common OR 0.98, 95% CI 0.89 to 1.07). Sensitivity analyses gave the same results. INTERPRETATION Fluoxetine 20 mg daily for 6 months did not improve functional recovery. It increased seizures, falls with injury, and bone fractures but reduced depression frequency at 6 months.
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Affiliation(s)
- Gillian Mead
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Catriona Graham
- Wellcome Trust Clinical Research Facility at the Western General Hospital, Edinburgh, UK
| | - Erik Lundström
- Neurology, Department of Medical Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Graeme J Hankey
- Centre for Neuromuscular and Neurological Disorders, UWA Medical School, The University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Maree L Hackett
- The George Institute for Global Health, Barangaroo, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- University of Central Lancashire, Preston, UK
| | - Laurent Billot
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Per Näsman
- KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Martin Dennis
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Płoński A, Pawlak D, Płoński AF, Głowiński J, Madycki G, Pawlak K. Gray-Scale Median in Patients with Symptomatic and Asymptomatic Carotid Atherosclerosis-Risk Factors and Diagnostic Potential. Biomedicines 2024; 12:1594. [PMID: 39062167 PMCID: PMC11274489 DOI: 10.3390/biomedicines12071594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The identification of clinical factors affecting the gray-scale median (GSM) and determination of GSM diagnostic utility for differentiating between symptomatic and asymptomatic internal carotid artery (ICA) stenosis. METHODS This study included 45 patients with asymptomatic and 40 patients with symptomatic ICA stenosis undergoing carotid endarterectomy (CEA). Echolucency of carotid plaque was determined using computerized techniques for the GSM analysis. Study groups were compared in terms of clinical risk factors, coexisting comorbidities, and used pharmacotherapy. RESULTS Mean GSM values in the symptomatic group were significantly lower than in the asymptomatic group (p < 0.001). Both in the univariate as well as in the multiple regression analysis, GSM was significantly correlated with D-dimers and fasting plasma glucose levels and tended to correlate with β-adrenoceptor antagonist use in the symptomatic group. In asymptomatic patients, GSM was associated with the presence of grade 2 and grade 3 hypertension, and tended to correlate with the use of metformin, sulfonylureas, and statin. Independent factors for GSM in this group remained as grade 3 hypertension and statin's therapy. The receiver operating characteristic (ROC) analysis revealed that GSM differentiated symptomatic from asymptomatic ICA stenosis with sensitivity and specificity of 73% and 80%, respectively. CONCLUSION The completely diverse clinical parameters may affect GSM in symptomatic and asymptomatic patients undergoing CEA, whose clinical characteristics were similar in terms of most of the compared parameters. GSM may be a clinically useful parameter for differentiating between symptomatic and asymptomatic ICA stenosis.
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Affiliation(s)
- Adam Płoński
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.P.); (A.F.P.); (J.G.)
| | - Dariusz Pawlak
- Department of Pharmacodynamics, Medical University of Bialystok, 15-222 Bialystok, Poland;
| | - Adam F. Płoński
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.P.); (A.F.P.); (J.G.)
| | - Jerzy Głowiński
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.P.); (A.F.P.); (J.G.)
| | - Grzegorz Madycki
- Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Bielanski Hospital, 01-809 Warsaw, Poland;
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, 15-222 Bialystok, Poland
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Lu X, Chen Y, Zhang G, Zeng X, Lai L, Qu C. Application of interpretable machine learning algorithms to predict acute kidney injury in patients with cerebral infarction in ICU. J Stroke Cerebrovasc Dis 2024; 33:107729. [PMID: 38657830 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is not only a complication but also a serious threat to patients with cerebral infarction (CI). This study aimed to explore the application of interpretable machine learning algorithms in predicting AKI in patients with cerebral infarction. METHODS The study included 3920 patients with CI admitted to the Intensive Care Unit and Emergency Medicine of the Central Hospital of Lishui City, Zhejiang Province. Nine machine learning techniques, including XGBoost, logistics, LightGBM, random forest (RF), AdaBoost, GaussianNB (GNB), Multi-Layer Perceptron (MLP), support vector machine (SVM), and k-nearest neighbors (KNN) classification, were used to develop a predictive model for AKI in these patients. SHapley Additive exPlanations (SHAP) analysis provided visual explanations for each patient. Finally, model effectiveness was assessed using metrics such as average precision (AP), sensitivity, specificity, accuracy, F1 score, precision-recall (PR) curve, calibration plot, and decision curve analysis (DCA). RESULTS The XGBoost model performed better in the internal validation set and the external validation set, with an AUC of 0.940 and 0.887, respectively. The five most important variables in the model were, in order, glomerular filtration rate, low-density lipoprotein, total cholesterol, hemiplegia and serum kalium. CONCLUSION This study demonstrates the potential of interpretable machine learning algorithms in predicting CI patients with AKI.
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Affiliation(s)
- Xiaochi Lu
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Yi Chen
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Gongping Zhang
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Xu Zeng
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Linjie Lai
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Chaojun Qu
- Department of Intensive care unit, Lishui Municipal Central Hospital, Lishui, 323000, PR China.
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13
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Antoniadis Y, Khan SA, Nallamotu S, Ranganatha A, Ferrer JES, Gautam G, Todras L, Campbell R, Chelluri S, Parvathaneni NM. The Role of Neurosurgical Techniques in Management of Acute and Chronic Stroke: A Comprehensive Literature Review. Cureus 2024; 16:e65671. [PMID: 39211723 PMCID: PMC11357835 DOI: 10.7759/cureus.65671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Stroke is a medical condition that results from a decreased or completely diminished supply of blood to the brain, and it is considered one of the major causes of morbidity and mortality globally. Stroke is categorized as ischemic and hemorrhagic stroke, both of which demand prompt and particular timely intervention. This extensive review is done to investigate the precise management of acute and chronic manifestations of stroke in relation to neurosurgical interventions, ultimately providing a thorough analysis regarding indications, procedures, outcomes, and complications that are associated with it. In this regard, a pervasive review of literature was carried out, which was primarily sourced from literature databases such as PubMed. This paper particularly outlines a sound relative analysis of anticipating the competence of each neurosurgical technique in use. Endovascular clot retrieval (ECR) has been particularly highlighted, as its effectiveness has been profoundly observed when selected as a treatment option within a time period of 6-24 hours following an ischemic stroke. In less than a time frame of 48 hours, decompressive hemicraniectomy (DH) is usually considered the most suitable treatment for cases of intracranial hypertension resulting from middle cerebral artery (MCA) infarction. Hemorrhages that occur due to ruptured aneurysms are most commonly dealt with clipping and neuroendovascular techniques. Additionally, considering that revascularization surgery is time-sensitive, the results can ultimately vary. Competent results have been linked with stereotactic surgery, which includes deep brain stimulation (DBS) and focused ultrasound ablation (FUSA), which are also famous for being minimally invasive in nature. However, the broader application of these techniques is hindered by the absence of established protocols. This review highlights the importance of timely interventions, advanced equipment, and precise medical protocols to optimize treatment outcomes.
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Affiliation(s)
- Yiorgos Antoniadis
- Department of Medicine, St. George's University School of Medicine, Saint George, GRD
| | - Sana A Khan
- Department of Surgery, Liaquat College of Medicine and Dentistry, Karachi, PAK
| | - Sandhya Nallamotu
- Department of Surgery, Kasturba Medical College of Manipal, Manipal, IND
- Department of General Surgery, Murrieta Valley Surgery Associates, Wildomar, USA
| | - Akash Ranganatha
- Department of Surgery, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | | | - Gargi Gautam
- Department of Internal Medicine, Georgian National University SEU, Tbilisi, GEO
| | - Lillian Todras
- Department of Biology, Suffolk County Community College, New York, USA
| | - Renée Campbell
- Department of Internal Medicine, St. George's University, Saint George, GRD
| | - Suresh Chelluri
- Department of Surgery, Rajiv Gandhi Institute of Medical Sciences, Telangana, IND
| | - Naga M Parvathaneni
- Department of Surgery, International Higher School of Medicine, Bishkek, KGZ
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14
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Gu L, Chen H, Sun M, Chen Y, Shi Q, Chang J, Wei J, Ma W, Bao X, Wang R. Unraveling dynamic immunological landscapes in intracerebral hemorrhage: insights from single-cell and spatial transcriptomic profiling. MedComm (Beijing) 2024; 5:e635. [PMID: 38988493 PMCID: PMC11233862 DOI: 10.1002/mco2.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024] Open
Abstract
Intracerebral hemorrhage (ICH) poses a formidable challenge in stroke management, with limited therapeutic options, particularly in the realm of immune-targeted interventions. Clinical trials targeting immune responses post-ICH have encountered setbacks, potentially attributable to the substantial cellular heterogeneity and intricate intercellular networks within the brain. Here, we present a pioneering investigation utilizing single-cell RNA sequencing and spatial transcriptome profiling at hyperacute (1 h), acute (24 h), and subacute (7 days) intervals post-ICH, aimed at unraveling the dynamic immunological landscape and spatial distributions within the cerebral tissue. Our comprehensive analysis revealed distinct cell differentiation patterns among myeloid and lymphocyte populations, along with delineated spatial distributions across various brain regions. Notably, we identified a subset of lymphocytes characterized by the expression of Spp1 and Lyz2, termed macrophage-associated lymphocytes, which exhibited close interactions with myeloid cells. Specifically, we observed prominent interactions between Lgmn+Macro-T cells and microglia through the spp1-cd44 pathway during the acute phase post-ICH in the choroid plexus. These findings represent a significant advancement in our understanding of immune cell dynamics at single-cell resolution across distinct post-ICH time points, thereby laying the groundwork for exploring critical temporal windows and informing the development of targeted therapeutic strategies.
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Affiliation(s)
- Lingui Gu
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hualin Chen
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mingjiang Sun
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yihao Chen
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qinglei Shi
- Research Institute of Big Data, Chinese University of Hong Kong (Shenzhen) School of MedicineShenzhenChina
| | - Jianbo Chang
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Junji Wei
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenbin Ma
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xinjie Bao
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Common Mechanism Research for Major DiseasesBeijingChina
| | - Renzhi Wang
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- School of MedicineThe Chinese University of Hong KongShenzhenGuangdongChina
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15
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Uroose W, Ikram M, Ikram M, Shaki Ur Rehman S, Asif M, Javed HR. Urdu translation and cross-cultural validation of the stroke self-efficacy questionnaire. BMC Neurol 2024; 24:225. [PMID: 38951800 PMCID: PMC11218183 DOI: 10.1186/s12883-024-03704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale with 13 items that assess self-efficacy after a stroke in several functional domains. OBJECTIVE The purpose was to translate the Stroke Self-Efficacy Questionnaire into Urdu Language and to find out the validity and reliability of Urdu SSEQ among stroke patients. METHODS The cross-cultural validation study design was used. Following COSMIN guidelines, forward and backward translation protocols were adopted. After pilot testing on 10 stroke patients, the final Urdu version was drafted. A sample of 110 stroke patients was used to evaluate the validity and reliability of the SSEQ-U. Content and Concurrent validity were determined. The intraclass correlation coefficient and Cronbach's alpha were used to measure internal consistency and test-retest reliability. Data analysis was performed using SPSS 25. RESULTS The final version was drafted after application on 10 stroke patients. Content validity was analyzed by a content validity index ranging from 0.87 to 1. The internal consistency was calculated by Cronbach's alpha (α > 0.80). Test-retest reliability was determined by the Intra-class correlation coefficient (ICC2,1=0.956). Concurrent validity was determined by correlations with other scales by using the Spearman correlation coefficient; moderate to strong correlations (positive and negative) were found with the Functional Independence Measure (r = 0.76), Beck Depression Inventory (r=-0.54), Short Form of 12-item Scale (r = 0.68) and Fall Efficacy Scale (r = 0.82) with p < 0.05. CONCLUSION The Urdu version was linguistically acceptable and accurate for stroke survivors for determining self-efficacy. It showed good content and concurrent validity, internal consistency and test-retest reliability.
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Affiliation(s)
- Waffa Uroose
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Mehwish Ikram
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan.
| | - Maryam Ikram
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Syed Shaki Ur Rehman
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Marvi Asif
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Hafiza Rabia Javed
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
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16
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Kolangarakath A, Chalil Madathil K, Hegde S, Agrawal S, Bian M, Simmons L, Molloseau G, Holmstedt C, LeBlanc D, Harvey J, McGeorge T, Spampinato M, Roberts D. Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care. ERGONOMICS 2024:1-20. [PMID: 38916114 DOI: 10.1080/00140139.2024.2367157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.
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Affiliation(s)
- Arvind Kolangarakath
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Kapil Chalil Madathil
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Sudeep Hegde
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Shubham Agrawal
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Mary Bian
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Lauren Simmons
- Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina, USA
| | - Gabby Molloseau
- College of Medicine, Medical University of South Carolina, Clemson, South Carolina, USA
| | - Christine Holmstedt
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dustin LeBlanc
- Department of Emergency Medicine, Medical University of South Carolina,Charleston, South Carolina, USA
| | - Jillian Harvey
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Todd McGeorge
- Charleston County Emergency Medical Services, Charleston, South Carolina, USA
| | - Maria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donna Roberts
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
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17
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Wang X, Ding Q, Groleau RR, Wu L, Mao Y, Che F, Kotova O, Scanlan EM, Lewis SE, Li P, Tang B, James TD, Gunnlaugsson T. Fluorescent Probes for Disease Diagnosis. Chem Rev 2024; 124:7106-7164. [PMID: 38760012 PMCID: PMC11177268 DOI: 10.1021/acs.chemrev.3c00776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/19/2024]
Abstract
The identification and detection of disease-related biomarkers is essential for early clinical diagnosis, evaluating disease progression, and for the development of therapeutics. Possessing the advantages of high sensitivity and selectivity, fluorescent probes have become effective tools for monitoring disease-related active molecules at the cellular level and in vivo. In this review, we describe current fluorescent probes designed for the detection and quantification of key bioactive molecules associated with common diseases, such as organ damage, inflammation, cancers, cardiovascular diseases, and brain disorders. We emphasize the strategies behind the design of fluorescent probes capable of disease biomarker detection and diagnosis and cover some aspects of combined diagnostic/therapeutic strategies based on regulating disease-related molecules. This review concludes with a discussion of the challenges and outlook for fluorescent probes, highlighting future avenues of research that should enable these probes to achieve accurate detection and identification of disease-related biomarkers for biomedical research and clinical applications.
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Affiliation(s)
- Xin Wang
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Qi Ding
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | | | - Luling Wu
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
| | - Yuantao Mao
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Feida Che
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Oxana Kotova
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Advanced
Materials and BioEngineering Research (AMBER) Centre, Trinity College
Dublin, The University of Dublin, Dublin 2 D02 W9K7, Ireland
| | - Eoin M. Scanlan
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Synthesis
and Solid-State Pharmaceutical Centre (SSPC), School of Chemistry, Trinity College Dublin, The University of Dublin, Dublin 2 , Ireland
| | - Simon E. Lewis
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
| | - Ping Li
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Bo Tang
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
- Laoshan
Laboratory, 168 Wenhai
Middle Road, Aoshanwei Jimo, Qingdao 266237, Shandong, People’s Republic of China
| | - Tony D. James
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
- School
of Chemistry and Chemical Engineering, Henan
Normal University, Xinxiang 453007, People’s
Republic of China
| | - Thorfinnur Gunnlaugsson
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Advanced
Materials and BioEngineering Research (AMBER) Centre, Trinity College
Dublin, The University of Dublin, Dublin 2 D02 W9K7, Ireland
- Synthesis
and Solid-State Pharmaceutical Centre (SSPC), School of Chemistry, Trinity College Dublin, The University of Dublin, Dublin 2 , Ireland
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18
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Zhou Z, Li W, Ni L, Wang T, Huang Y, Yu Y, Hu M, Liu Y, Wang J, Huang X, Wang Y. Icariin improves oxidative stress injury during ischemic stroke via inhibiting mPTP opening. Mol Med 2024; 30:77. [PMID: 38840035 PMCID: PMC11155182 DOI: 10.1186/s10020-024-00847-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Ischemic stroke presents a significant threat to human health due to its high disability rate and mortality. Currently, the clinical treatment drug, rt-PA, has a narrow therapeutic window and carries a high risk of bleeding. There is an urgent need to find new effective therapeutic drugs for ischemic stroke. Icariin (ICA), a key ingredient in the traditional Chinese medicine Epimedium, undergoes metabolism in vivo to produce Icaritin (ICT). While ICA has been reported to inhibit neuronal apoptosis after cerebral ischemia-reperfusion (I/R), yet its underlying mechanism remains unclear. METHODS PC-12 cells were treated with 200 µM H2O2 for 8 h to establish a vitro model of oxidative damage. After administration of ICT, cell viability was detected by Thiazolyl blue tetrazolium Bromide (MTT) assay, reactive oxygen species (ROS) and apoptosis level, mPTP status and mitochondrial membrane potential (MMP) were detected by flow cytometry and immunofluorescence. Apoptosis and mitochondrial permeability transition pore (mPTP) related proteins were assessed by Western blotting. Middle cerebral artery occlusion (MCAO) model was used to establish I/R injury in vivo. After the treatment of ICA, the neurological function was scored by ZeaLonga socres; the infarct volume was observed by 2,3,5-Triphenyltetrazolium chloride (TTC) staining; HE and Nissl staining were used to detect the pathological state of the ischemic cortex; the expression changes of mPTP and apoptosis related proteins were detected by Western blotting. RESULTS In vitro: ICT effectively improved H2O2-induced oxidative injury through decreasing the ROS level, inhibiting mPTP opening and apoptosis. In addition, the protective effects of ICT were not enhanced when it was co-treated with mPTP inhibitor Cyclosporin A (CsA), but reversed when combined with mPTP activator Lonidamine (LND). In vivo: Rats after MCAO shown cortical infarct volume of 32-40%, severe neurological impairment, while mPTP opening and apoptosis were obviously increased. Those damage caused was improved by the administration of ICA and CsA. CONCLUSIONS ICA improves cerebral ischemia-reperfusion injury by inhibiting mPTP opening, making it a potential candidate drug for the treatment of ischemic stroke.
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Affiliation(s)
- Zhiyong Zhou
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Weili Li
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Lu Ni
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Tianlun Wang
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Yan Huang
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Yuanqi Yu
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Mingxin Hu
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Yinling Liu
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Jin'e Wang
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China
- College of Basic Medical Sciences, China Three Gorges University, Yichang, 443002, P. R. China
| | - Xiaofei Huang
- Third-grade Pharmacological Laboratory on Traditional Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Yichang, 443002, P. R. China.
- College of Medicine and Health Sciences, China Three Gorges University, Yichang, 443002, P. R. China.
| | - Yanyan Wang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, P. R. China.
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19
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Kokorelias KM, Cameron JI, Salbach NM, Colquhoun H, Munce SEP, Nelson MLA, Martyniuk J, Steele Gray C, Tang T, Hitzig SL, Lindsay MP, Bayley MT, Wang RH, Kaur N, Singh H. Exploring the Poststroke Experiences and Needs of South Asian Communities Living in High-Income Countries: Findings from a Scoping Review. J Racial Ethn Health Disparities 2024; 11:1345-1373. [PMID: 37382872 DOI: 10.1007/s40615-023-01613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 06/30/2023]
Abstract
Despite the high prevalence of stroke among South Asian communities in high-income countries, a comprehensive understanding of their unique experiences and needs after stroke is lacking. This study aimed to synthesize the literature examining the experiences and needs of South Asian community members impacted by stroke and their family caregivers residing in high-income countries. A scoping review methodology was utilized. Data for this review were identified from seven databases and hand-searching reference lists of included studies. Study characteristics, purpose, methods, participant characteristics, results, limitations, recommendations, and conclusions were extracted. Data were analyzed using descriptive qualitative analysis. In addition, a consultative focus group exercise with six South Asian community members who had experienced a stroke and a program facilitator was conducted to inform the review interpretations. A total of 26 articles met the inclusion criteria and were analyzed. Qualitative analysis identified four descriptive categories: (1) rationale for studying the South Asian stroke population (e.g., increasing South Asian population and stroke prevalence), (2) stroke-related experiences (e.g., managing community support versus stigma and caregiving expectations), (3) stroke service challenges (e.g., language barriers), and (4) stroke service recommendations to address stroke service needs (e.g., continuity of care). Several cultural factors impacted participant experiences, including cultural beliefs about illness and caregiving. Focus group participants from our consultation activity agreed with our review findings. The clinical and research recommendations identified in this review support the need for culturally appropriate services for South Asian communities across the stroke care continuum; however, more research is necessary to inform the design and structure of culturally appropriate stroke service delivery models.
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Affiliation(s)
- Kristina M Kokorelias
- Department of Medicine, Geriatrics Program, Sinai Health System, University Health Network, Toronto, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nancy M Salbach
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah E P Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michelle L A Nelson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Carolyn Steele Gray
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
| | - Sander L Hitzig
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Mark T Bayley
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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20
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Liu C, Chong MC, Lee WL, Zhang HY, Zhang JH. Perceptions and self-management of a healthy diet among middle-aged adults with risk of stroke in North China: a qualitative exploration. BMJ Open 2024; 14:e081840. [PMID: 38772896 PMCID: PMC11110585 DOI: 10.1136/bmjopen-2023-081840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE Although stroke is prevalent among older people, there is a rising incidence among the younger subpopulations, particularly middle-aged adults. A healthy diet is one of the key modifiable factors to primary prevention of stroke among these subpopulations, yet there is limited understanding of the dietary habits among middle agers who have the risk factor(s) but no occurrence of stroke. This study aims to explore the views on perceptions and the self-management of middle-aged adults at risk of stroke on a healthy diet and to identify the enablers and barriers that could inform the future development of dietary interventions. DESIGN This study used an interpretive descriptive qualitative design, employing semistructured purposive sampling for focus group discussions. Thematic analysis was conducted on the transcribed interviews and field notes, facilitated by NVivo 12.0 Plus software. SETTING Community settings in Zhengzhou City, Henan Province. PARTICIPANTS Middle-aged adults (aged 45-59) were identified as at risk of stroke due to the presence of one or more modifiable risk factors. RESULT A total of seven focus group discussions were audio recorded. Four main themes emerged, which were: (1) cognitive understanding of a healthy diet; (2) dietary practices; (3) knowledge acquisition and (4) barriers to dietary adherence. CONCLUSIONS The middle-aged adults at risk of stroke were generally aware of the risk and attempted to practise healthy eating. The existing educational programmes on following a healthy diet in the prevention of disease need to be made more comprehensible, accessible and equitable, especially for those from socioeconomically disadvantaged communities.
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Affiliation(s)
- Cui Liu
- Department of Nursing Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Ling Lee
- Department of Nursing Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hai Yan Zhang
- Faculty of Nursing, Xinxiang Medical University, Xinxiang City, China
| | - Jin Hua Zhang
- Faculty of Nursing, Xinxiang Medical University, Xinxiang City, China
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21
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Ding J, Tang Z, Chen Q, Liu Y, Feng C, Li Y, Ding X. Abnormal degree centrality as a potential imaging biomarker for ischemic stroke: A resting-state functional magnetic resonance imaging study. Neurosci Lett 2024; 831:137790. [PMID: 38670522 DOI: 10.1016/j.neulet.2024.137790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/09/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To explore degree centrality (DC) abnormalities in ischemic stroke patients and determine whether these abnormalities have potential value in understanding the pathological mechanisms of ischemic stroke patients. METHODS Sixteen ischemic stroke patients and 22 healthy controls (HCs) underwent resting state functional magnetic resonance imaging (rs-fMRI) scanning, and the resulting data were subjected to DC analysis. Then we conducted a correlation analysis between DC values and neuropsychological test scores, including Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Finally, extracted the abnormal DC values of brain regions and defined them as features for support vector machine (SVM) analysis. RESULTS Compared with HCs, ischemic stroke patients showed increased DC in the bilateral supplementary motor area, and median cingulate and paracingulate gyri and decreased DC in the left postcentral gyrus, right calcarine fissure and surrounding cortex, lingual gyrus, and orbital parts of the right superior frontal gyrus and bilateral cuneus. Correlation analyses revealed that DC values in the right lingual gyrus, calcarine fissure and surrounding cortex, and orbital parts of the right superior frontal gyrus were positively correlated with the MMSE scores. The SVM classification of the DC values achieved an area under the curve (AUC) of 0.93, an accuracy of 89.47%. CONCLUSION Our research results indicate that ischemic stroke patients exhibit abnormalities in the global connectivity mechanisms and patterns of the brain network. These abnormal changes may provide neuroimaging evidence for stroke-related motor, visual, and cognitive impairments, contribute to a deeper comprehension of the underlying pathophysiological mechanisms implicated in ischemic stroke.
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Affiliation(s)
- Jurong Ding
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China.
| | - Zhiling Tang
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China
| | - Qiang Chen
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China
| | - Yihong Liu
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China
| | - Chenyu Feng
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China
| | - Yuan Li
- School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, PR China; Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & Engineering, Zigong, PR China
| | - Xin Ding
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, PR China
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22
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Gomez MG, Arynchyna-Smith A, Ghotme KA, Garcia R, Johnson WD, Boop FA, Park KB, Caceres A, Pardo Vargas RA, Ayala R, Ibbotson G, Sheneman N, Peterson DB, Öcal E, Nyalundja AD, La Fuente J, Khan T, Hobart-Porter L, Moser RP, Ahmed YS, El Abbadi N, Woodrow S, Sundell K, Osendarp SJM, Martinez H, Blount JP, Rosseau GL. Global Neurosurgery at the 76th World Health Assembly (2023): First Neurosurgery-Driven Resolution Calls for Micronutrient Fortification to Prevent Spina Bifida. World Neurosurg 2024; 185:135-140. [PMID: 38266995 DOI: 10.1016/j.wneu.2024.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
Since 2018, a neurosurgery delegation has been actively engaged and consistently present at the World Health Assembly. Recognizing the growing impact of neurosurgical diseases, the neurosurgery delegation participated in the 76th World Health Assembly in May 2023, advocating for timely, safe, and affordable global neurosurgical care. The delegation focused on forging new collaborations, strengthening the World Health Organization-World Federation of Neurosurgical Societies official relations, and actively supporting resolutions that impact the neurosurgical patients. However, there is a long advocacy journey ahead to address unmet neurosurgical needs. Patient-centered advocacy is an inherent task of our profession and the essence of the Global Neurosurgery Bogota Declaration of 2016. The highlight of the 76th World Health Assembly was the adoption of the first neurosurgery-driven resolution calling for micronutrient fortification to prevent spina bifida and other micronutrient deficiencies. For the last 4 years, the Global Alliance for Prevention of Spina Bifida, a group spearheaded by neurosurgeons, advocated for spina bifida prevention. This Alliance collaborated with many stakeholders, notably, the Colombian government to promote the resolution: "Accelerating efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification." This is a proud milestone for the neurosurgical profession. There are many strategies available for neurosurgeons, when working together with elected leaders, other stakeholders, and allied professionals, to implement initiatives that can prevent future cases of spina bifida and other neurological disorders and reduce the burden of neurosurgical disease.
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Affiliation(s)
- Martina Gonzalez Gomez
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anastasia Arynchyna-Smith
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia; Department of Neurosurgery, Pediatric Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia.
| | - Roxanna Garcia
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Walter D Johnson
- Department of Surgery and Neurosurgery, Department of Global Health, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Frederick A Boop
- Department of Neurosurgery, St Jude Global Program, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Caceres
- Department of Pediatric Neurosurgery, Children's National Hospital, San Jose, Costa Rica
| | - Rosa A Pardo Vargas
- Genetics Section and Neonatology Unit, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Ruben Ayala
- Operation Smile Inc., Virginia Beach, Virginia, USA
| | | | - Natalie Sheneman
- Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (The G4 Alliance), Chicago, Illinois, USA
| | - Daniel B Peterson
- Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (The G4 Alliance), Chicago, Illinois, USA
| | - Eylem Öcal
- Department of Neurosurgery, University of Arkansas for Medical Sciences Medical Center, Little Rock, Arkansas, USA
| | - Arsene Daniel Nyalundja
- Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu, South-Kivu, Democratic Republic of Congo; Research Department, Université Catholique de Bukavu, South-Kivu, Democratic Republic of Congo; Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | - Jesus La Fuente
- Department of Neurosurgery, Sacred Heart Hospital, Barcelona, Spain
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Pakistan
| | - Laura Hobart-Porter
- Pediatric Physical Medicine and Rehabilitation, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Richard P Moser
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Najia El Abbadi
- Department of Neurosurgery, Hospital Ibn Sina, Rabat, Morroco
| | - Sarah Woodrow
- Department of Neurological Surgery, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Kristin Sundell
- Global Alliance for Improved Nutrition, Washington DC, Northwest Washington, USA
| | | | - Homero Martinez
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gail L Rosseau
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA; Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia; Department of Neurosurgery, Pediatric Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
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23
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Xu S, Li C, Wei C, Kang X, Shu S, Liu G, Xu Z, Han M, Luo J, Tang W. Closed-Loop Wearable Device Network of Intrinsically-Controlled, Bilateral Coordinated Functional Electrical Stimulation for Stroke. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304763. [PMID: 38429890 PMCID: PMC11077660 DOI: 10.1002/advs.202304763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/28/2024] [Indexed: 03/03/2024]
Abstract
Innovative functional electrical stimulation has demonstrated effectiveness in enhancing daily walking and rehabilitating stroke patients with foot drop. However, its lack of precision in stimulating timing, individual adaptivity, and bilateral symmetry, resulted in diminished clinical efficacy. Therefore, a closed-loop wearable device network of intrinsically controlled functional electrical stimulation (CI-FES) system is proposed, which utilizes the personal surface myoelectricity, derived from the intrinsic neuro signal, as the switch to activate/deactivate the stimulation on the affected side. Simultaneously, it decodes the myoelectricity signal of the patient's healthy side to adjust the stimulation intensity, forming an intrinsically controlled loop with the inertial measurement units. With CI-FES assistance, patients' walking ability significantly improved, evidenced by the shift in ankle joint angle mean and variance from 105.53° and 28.84 to 102.81° and 17.71, and the oxyhemoglobin concentration tested by the functional near-infrared spectroscopy. In long-term CI-FES-assisted clinical testing, the discriminability in machine learning classification between patients and healthy individuals gradually decreased from 100% to 92.5%, suggesting a remarkable recovery tendency, further substantiated by performance on the functional movement scales. The developed CI-FES system is crucial for contralateral-hemiplegic stroke recovery, paving the way for future closed-loop stimulation systems in stroke rehabilitation is anticipated.
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Affiliation(s)
- Shuxing Xu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- Center on Nanoenergy ResearchSchool of Physical Science & TechnologyGuangxi UniversityNanning530004China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Chengyu Li
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Conghui Wei
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Xinfang Kang
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Sheng Shu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Guanlin Liu
- Center on Nanoenergy ResearchSchool of Physical Science & TechnologyGuangxi UniversityNanning530004China
| | - Zijie Xu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Mengdi Han
- Department of Biomedical EngineeringCollege of Future TechnologyPeking UniversityBeijing100871China
| | - Jun Luo
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Wei Tang
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
- Institute of Applied NanotechnologyJiaxingZhejiang314031China
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24
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Posawang P, Vatcharavongvan P. Development of health literacy assessment scale for Thai stroke patients. Top Stroke Rehabil 2024; 31:336-344. [PMID: 37880193 DOI: 10.1080/10749357.2023.2275091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND One important factor influencing the treatment and rehabilitation results for stroke patients is their level of health literacy. In order to acquire comprehensive information for appropriate treatment and rehabilitation programs that will promote the optimal possible health outcomes, health literacy assessment should be done in stroke patients from the earliest stages of stroke onset. OBJECTIVES This research aimed to develop a health literacy assessment scale for Thai stroke patients and to evaluate the HL levels of those patients using that assessment scale. METHODS A draft version of the scale has been developed based on the literature review and focus group discussions. After tryout, content validity, corrected item-total correlation and internal consistency were examined. A confirmatory factor analysis (CFA) was conducted in 400 patients with stroke to test the construct validity. RESULTS The Health Literacy Assessment Scale for Thai Stroke Patients was successfully developed. The complete version featured 50 health literacy-related questions, along with seven demographic-related questions. This tool demonstrated good psychometric properties, including content validity (Item-objective congruence; IOC > 0.50), internal consistency (Cronbach's alpha = 0.951 to 0.955, overall = 0.94). Confirmatory factor analysis (CFA) also revealed good construct validity. CONCLUSIONS The Health Literacy Assessment Scale for Thai Stroke Patients (HLS-Th) is measuring five components cover all health literacy aspects necessary for Thai stroke patient. This novel measurement scale is an accurate psychometric tool for assessing the level of health literacy among Thai stroke survivors.
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Affiliation(s)
- Pornsawan Posawang
- Department of Community and Family Medicine, Faculty of Medicine, Thammasat University, Klong Nueng, Thailand
- Sirindhorn National Medical Rehabilitation Institute, Soi Bamrasnaradura, Nonthaburi, Thailand
| | - Pasitpon Vatcharavongvan
- Department of Community and Family Medicine, Faculty of Medicine, Thammasat University, Klong Nueng, Thailand
- Research Unit in Physical Anthropology and Health Sciences, Faculty of Medicine, Thammasat University, Klong Nueng, Thailand
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25
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Ashraf F, Mustafa MS, Shafique MA, Haseeb A, Mussarat A, Noorani A, Sohail Rangwala B, Kashif Rasool F, Siddiq MA, Iqbal J. Association between depression and stroke risk in adults: a systematic review and meta-analysis. Front Neurol 2024; 15:1331300. [PMID: 38725648 PMCID: PMC11079212 DOI: 10.3389/fneur.2024.1331300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Stroke is a significant global health concern, and numerous studies have established a link between depression and an increased risk of stroke. While many investigations explore this link, some overlook its long-term effects. Depression may elevate stroke risk through physiological pathways involving nervous system changes and inflammation. This systematic review and meta-analysis aimed to assess the association between depression and stroke. Methodology We conducted a comprehensive search of electronic databases (PubMed, Embase, Scopus, and PsycINFO) from inception to 9 April 2023, following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We included all articles assessing the association between different stroke types and depression, excluding post-stroke depression. Two investigators independently extracted data and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, utilizing a random-effects model for data synthesis. The primary outcome was the association of depression with stroke, with a secondary focus on the association of antidepressants with stroke. Results The initial search yielded 10,091 articles, and 44 studies were included in the meta-analysis. The pooled analysis revealed a significant association between depression and stroke risk, with an overall hazard ratio of 1.41 (95% CI 1.32, 1.50; p < 0.00001), indicating a moderately positive effect size. Subgroup analyses showed consistent associations with ischemic stroke (HR = 1.30, 95% CI 1.13, 1.50; p = 0.007), fatal stroke (HR = 1.39, 95% CI 1.24, 1.55; p < 0.000001), and hemorrhagic stroke (HR = 1.33, 95% CI 1.01, 1.76; p = 0.04). The use of antidepressants was associated with an elevated risk of stroke (HR = 1.28, 95% CI 1.05, 1.55; p = 0.01). Conclusion and relevance This meta-analysis indicates that depression moderately raises the risk of stroke. Given the severe consequences of stroke in individuals with depression, early detection and intervention should be prioritized to prevent it. Systematic review registration Prospero (CRD42023472136).
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Affiliation(s)
- Farheen Ashraf
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Amber Noorani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | | | - Javed Iqbal
- Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
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Han L, Song Y, Xiang W, Wang Z, Wang Y, Zhou X, Zhu DS, Guan Y. Fibrinogen deposition promotes neuroinflammation and fibrin-derived γ 377-395 peptide ameliorates neurological deficits after ischemic stroke. Int Immunopharmacol 2024; 131:111831. [PMID: 38489969 DOI: 10.1016/j.intimp.2024.111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Fibrin(ogen) deposition in the central nervous system (CNS) contributes to neuropathological injury; however, its role in ischemic stroke is unknown. In this study, we identified fibrinogen as a novel proinflammatory regulator of post-stroke neuroinflammation and revealed the neuro-protection effect of fibrin-derived γ377-395peptide in stroke. METHODS Fibrinogen depletion and fibrinogen-derived γ377-395peptide treatment were performed 2 h after establishing a permanent middle cerebral artery occlusion (pMCAO) model. The infarction volume, neurological score, fibrin(ogen) deposition, and inflammatory response were evaluated 24 h after occlusion. Both in vivo and in vitro studies were conducted to assess the therapeutic potential of the γ377-395peptide in blocking the interactions between fibrin(ogen) and neutrophils. RESULTS Fibrin(ogen) deposited in the infarct core promoted post-stroke inflammation and exacerbated neurological deficits in the acute phase after stroke onset. Reducing fibrinogen deposition resulted in a decrease in infarction volume, improved neurological scores, and reduced inflammation in the brain. Additionally, the presence of neutrophil accumulation near fibrin(ogen) deposits was observed in ischemic lesions, and the engagement of fibrin(ogen) by integrin receptor αMβ2 promoted neutrophil activation and post-stroke inflammation. Finally, inhibiting fibrin(ogen)-mediated neutrophil activation using a fibrinogen-derived γ377-395peptide significantly attenuated neurological deficits. CONCLUSIONS Fibrin(ogen) is a crucial regulator of post-stroke inflammation and contributes to secondary brain injury. The inflammation induced by fibrin(ogen) is primarily driven by neutrophils during acute ischemic stroke and can be ameliorated using the fibrin-derived γ377-395peptide. Targeting the fibrin(ogen)-mediated neuropathological process represents a promising approach for neuroprotective therapy after stroke while preserving its beneficial coagulation function.
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Affiliation(s)
- Lu Han
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yaying Song
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Weiwei Xiang
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ze Wang
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yishu Wang
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Xiajun Zhou
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - De-Sheng Zhu
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Department of Neurology, Baoshan Branch, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200444, China.
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
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Vanoglio F, Comini L, Gaiani M, Bonometti GP, Luisa A, Bernocchi P. A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2574. [PMID: 38676190 PMCID: PMC11054364 DOI: 10.3390/s24082574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.
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Affiliation(s)
- Fabio Vanoglio
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Laura Comini
- Scientific Direction of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy;
| | - Marta Gaiani
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Gian Pietro Bonometti
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Alberto Luisa
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Palmira Bernocchi
- Continuity of Care Service of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy
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Habibzadeh A, Rahimlou M, Ravankhah M, Vahid F, Tabrizi R. Association between dietary total antioxidant capacity and the risk of stroke: a nested case-control study. BMC Nutr 2024; 10:56. [PMID: 38622676 PMCID: PMC11017524 DOI: 10.1186/s40795-024-00867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Oxidative stress after ischemic stroke contribute to neuronal cell injury. Unhealthy and unbalanced dietary patterns can increase the risk of several diseases, including stroke and cardiometabolic ones. However, the association between dietary total antioxidant capacity (DTAC) of antioxidant and stroke is controversial. Our study aimed to establish a correlation between DTAC and its impact on the occurrence of stroke. METHODS This nested case-control study included 79 stroke cases and 158 healthy controls. We used data from the Fasa Adults Cohort Study (FACS) comprising 10,035 individuals at baseline. To assess the nutritional status of each individual, a 125-item food frequency questionnaire (FFQ) has been used to evaluate their dietary habits and intakes over the past year. DTAC was calculated using the ferric-reducing antioxidant power (FRAP) international databases. The stroke was confirmed by an experienced neurologist using standard imaging methods. Conditional logistic regression analyses were performed to evaluate the association between DTAC and stroke. RESULTS The assessment of DTAC revealed that there was no statistically significant distinction between cases (mean ± SD: 5.31 ± 2.65) and controls (5.16 ± 2.80) with a p-value of 0.95. Even after adjusting for the potentially important confounding factors such as age, sex, event time, energy intake, smoking, hypertension, and diabetes, the association remains non-significant (adjusted odds ratio (OR) = 1.06, 95% CI: 0.94, 1.20, p-value = 0.33). CONCLUSIONS Our results did not confirm a significant link between DTAC and stroke risk. These findings emphasize the intricate interplay of factors influencing stroke risk and highlight the need for further research to unravel these relationships more comprehensively.
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Affiliation(s)
- Adrina Habibzadeh
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- USERN Office, Fasa University of Medical Sciences, Fasa, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Mahdi Ravankhah
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Vahid
- Nutrition & Health Research Group, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Reza Tabrizi
- Noncommunicable Diseases Research Center, Fasa University of Medical Science, Fasa, Iran.
- Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran.
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Chen X, Zeng Q, Tao L, Yuan J, Hang J, Lu G, Shao J, Li Y, Yu H. Machine Learning-Based Clinical Prediction Models for Acute Ischemic Stroke Based on Serum Xanthine Oxidase Levels. World Neurosurg 2024; 184:e695-e707. [PMID: 38340801 DOI: 10.1016/j.wneu.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Early prediction of the onset, progression and prognosis of acute ischemic stroke (AIS) is helpful for treatment decision-making and proactive management. Although several biomarkers have been found to predict the progression and prognosis of AIS, these biomarkers have not been widely used in routine clinical practice. Xanthine oxidase (XO) is a form of xanthine oxidoreductase (XOR), which is widespread in various organs of the human body and plays an important role in redox reactions and ischemia‒reperfusion injury. Our previous studies have shown that serum XO levels on admission have certain clinical predictive value for AIS. The purpose of this study was to utilize serum XO levels and clinical data to establish machine learning models for predicting the onset, progression, and prognosis of AIS. METHODS We enrolled 328 consecutive patients with AIS and 107 healthy controls from October 2020 to September 2021. Serum XO levels and stroke-related clinical data were collected. We established 5 machine learning models-the logistic regression (LR), support vector machine (SVM), decision tree, random forest, and K-nearest neighbor (KNN) models-to predict the onset, progression, and prognosis of AIS. The area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, negative predictive value, and positive predictive value were used to evaluate the predictive performance of each model. RESULTS Among the 5 machine learning models predicting AIS onset, the AUROC values of 4 prediction models were over 0.7, while that of the KNN model was lower (AUROC = 0.6708, 95% CI 0.576-0.765). The LR model showed the best AUROC value (AUROC = 0.9586, 95% CI 0.927-0.991). Although the 5 machine learning models showed relatively poor predictive value for the progression of AIS (all AUROCs <0.7), the LR model still showed the highest AUROC value (AUROC = 0.6543, 95% CI 0.453-0.856). We compared the value of 5 machine learning models in predicting the prognosis of AIS, and the LR model showed the best predictive value (AUROC = 0.8124, 95% CI 0.715-0.910). CONCLUSIONS The tested machine learning models based on serum levels of XO could predict the onset and prognosis of AIS. Among the 5 machine learning models, we found that the LR model showed the best predictive performance. Machine learning algorithms improve accuracy in the early diagnosis of AIS and can be used to make treatment decisions.
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Affiliation(s)
- Xin Chen
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Qingping Zeng
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Luhang Tao
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jing Yuan
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Echocardiography, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jing Hang
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jun Shao
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Cardiac Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuping Li
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China; Institute of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hailong Yu
- Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China.
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Liu XY, Zhang LY, Wang XY, Li SC, Hu YY, Zhang JG, Xian XH, Li WB, Zhang M. STAT4-Mediated Klotho Up-Regulation Contributes to the Brain Ischemic Tolerance by Cerebral Ischemic Preconditioning via Inhibiting Neuronal Pyroptosis. Mol Neurobiol 2024; 61:2336-2356. [PMID: 37875707 DOI: 10.1007/s12035-023-03703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
Our previous study has proved that the Klotho up-regulation participated in cerebral ischemic preconditioning (CIP)-induced brain ischemic tolerance. However, the exact neuroprotective mechanism of Klotho in CIP remains unclear. We explored the hypothesis that STAT4-mediated Klotho up-regulation contributes to the CIP-induced brain ischemic tolerance via inhibiting neuronal pyroptosis. Firstly, the expressions of pyroptosis-associated proteins (i.e., NLRP3, GSDMD, pro-caspase-1, and cleaved caspase-1) in hippocampal CA1 region were determined during the process of brain ischemic tolerance. We found the expression of pyroptosis-associated proteins was significantly up-regulated in the ischemic insult (II) group, and showed no significant changes in the CIP group. The expression level of each pyroptosis-associated proteins was lower in the CIP + II group than that in the II group. Inhibition of Klotho expression increased the expression of pyroptosis-associated proteins in the CIP + II group and blocked the CIP-induced brain ischemic tolerance. Injection of Klotho protein decreased the expression of pyroptosis-associated proteins in the II group, and protected neurons from ischemic injury. Secondly, the transcription factor STAT4 of Klotho was identified by bioinformatic analysis. Double luciferase reporter gene assay and chromatin immunoprecipitation assay showed STAT4 can bind to the site between nt - 881 and - 868 on the Klotho promoter region and positively regulates Klotho expression. Moreover, we found CIP significantly enhanced the expression of STAT4. Knockdown STAT4 suppressed Klotho up-regulation after CIP and blocked the CIP-induced brain ischemic tolerance. Collectively, it can be concluded that STAT4-mediated the up-regulation of Klotho contributed to the brain ischemic tolerance induced by CIP via inhibiting pyroptosis.
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Affiliation(s)
- Xi-Yun Liu
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
| | - Ling-Yan Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China
| | - Xiao-Yu Wang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
| | - Shi-Chao Li
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
| | - Yu-Yan Hu
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China
| | - Jing-Ge Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China
| | - Xiao-Hui Xian
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China
| | - Wen-Bin Li
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China
| | - Min Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050017, People's Republic of China.
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, People's Republic of China.
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Zhang LY, Hu YY, Liu XY, Wang XY, Li SC, Zhang JG, Xian XH, Li WB, Zhang M. The Role of Astrocytic Mitochondria in the Pathogenesis of Brain Ischemia. Mol Neurobiol 2024; 61:2270-2282. [PMID: 37870679 DOI: 10.1007/s12035-023-03714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
The morbidity rate of ischemic stroke is increasing annually with the growing aging population in China. Astrocytes are ubiquitous glial cells in the brain and play a crucial role in supporting neuronal function and metabolism. Increasing evidence shows that the impairment or loss of astrocytes contributes to neuronal dysfunction during cerebral ischemic injury. The mitochondrion is increasingly recognized as a key player in regulating astrocyte function. Changes in astrocytic mitochondrial function appear to be closely linked to the homeostasis imbalance defects in glutamate metabolism, Ca2+ regulation, fatty acid metabolism, reactive oxygen species, inflammation, and copper regulation. Here, we discuss the role of astrocytic mitochondria in the pathogenesis of brain ischemic injury and their potential as a therapeutic target.
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Affiliation(s)
- Ling-Yan Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China
| | - Yu-Yan Hu
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China
| | - Xi-Yun Liu
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Xiao-Yu Wang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Shi-Chao Li
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Jing-Ge Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China
| | - Xiao-Hui Xian
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China
| | - Wen-Bin Li
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China
| | - Min Zhang
- Department of Pathophysiology, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017, Hebei, People's Republic of China.
- Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, 050017, People's Republic of China.
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Niering M, Seifert J. The effects of visual skills training on cognitive and executive functions in stroke patients: a systematic review with meta-analysis. J Neuroeng Rehabil 2024; 21:41. [PMID: 38532485 PMCID: PMC10967170 DOI: 10.1186/s12984-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
The visual system and associated skills are of particular importance in stroke rehabilitation. The process of neuroplasticity involved in restoring cognitive function during this period is mainly based on anatomical and physiological mechanisms. However, there is little evidence-based knowledge about the effects of visual skills training that could be used to improve therapeutic outcomes in cognitive rehabilitation. A computerized systematic literature search was conducted in the PubMed, Medline, and Web of Science databases from 1 January 1960 to 11 Febuary 2024. 1,787 articles were identified, of which 24 articles were used for the calculation of weighted standardized mean differences (SMD) after screening and eligibility verification. The findings revealed moderate effects for global cognitive function (SMD = 0.62) and activities of daily living (SMD = 0.55) as well as small effects for executive function (SMD = 0.20) - all in favor of the intervention group. The analyses indicate that the results may not be entirely robust, and should therefore be treated with caution when applied in practice. Visual skills training shows positive effects in improving cognitive and executive functions, especially in combination with high cognitive load and in an early phase of rehabilitation. An improvement in activities of daily living can also be observed with this type of intervention. The high heterogeneity of the studies and different treatment conditions require the identification of a relationship between certain visual skills and executive functions in future research.
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Affiliation(s)
- Marc Niering
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany
| | - Johanna Seifert
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany.
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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Lin HP, Xu Y, Zhang X, Woolley D, Zhao L, Liang W, Huang M, Cheng HJ, Zhang L, Wenderoth N. A usability study on mobile EMG-guided wrist extension training in subacute stroke patients-MyoGuide. J Neuroeng Rehabil 2024; 21:39. [PMID: 38515192 PMCID: PMC10956308 DOI: 10.1186/s12984-024-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Effective stroke rehabilitation requires high-dose, repetitive-task training, especially during the early recovery phase. However, the usability of upper-limb rehabilitation technology in acute and subacute stroke survivors remains relatively unexplored. In this study, we introduce subacute stroke survivors to MyoGuide, a mobile training platform that employs surface electromyography (sEMG)-guided neurofeedback training that specifically targets wrist extension. Notably, the study emphasizes evaluating the platform's usability within clinical contexts. METHODS Seven subacute post-stroke patients (1 female, mean age 53.7 years, mean time post-stroke 58.9 days, mean duration per training session 48.9 min) and three therapists (one for eligibility screening, two for conducting training) participated in the study. Participants underwent ten days of supervised one-on-one wrist extension training with MyoGuide, which encompassed calibration, stability assessment, and dynamic tasks. All training records including the Level of Difficulty (LoD) and Stability Assessment Scores were recorded within the application. Usability was assessed through the System Usability Scale (SUS) and participants' willingness to continue home-based training was gauged through a self-developed survey post-training. Therapists also documented the daily performance of participants and the extent of support required. RESULTS The usability analysis yielded positive results, with a median SUS score of 82.5. Compared to the first session, participants significantly improved their performance at the final session as indicated by both the Stability Assessment Scores (p = 0.010, mean = 229.43, CI = [25.74-433.11]) and the LoD (p < 0.001; mean: 45.43, CI: [25.56-65.29]). The rate of progression differed based on the initial impairment levels of the patient. After training, participants expressed a keen interest in continuing home-based training. However, they also acknowledged challenges related to independently using the Myo armband and software. CONCLUSIONS This study introduces the MyoGuide training platform and demonstrates its usability in a clinical setting for stroke rehabilitation, with the assistance of a therapist. The findings support the potential of MyoGuide for wrist extension training in patients across a wide range of impairment levels. However, certain usability challenges, such as donning/doffing the armband and navigating the application, need to be addressed to enable independent MyoGuide training requiring only minimal supervision by a therapist.
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Affiliation(s)
- Hao-Ping Lin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Yang Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Xue Zhang
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Daniel Woolley
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Lina Zhao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Weidi Liang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Mengdi Huang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore.
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland.
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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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Marquez-Romero JM, Romo-Martínez J, Hernández-Curiel B, Ruiz-Franco A, Krishnamurthi R, Feigin V. Assessing the individual risk of stroke in caregivers of patients with stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-5. [PMID: 38467391 PMCID: PMC10927366 DOI: 10.1055/s-0044-1779691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/29/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Genetic factors influence the risk of developing stroke. Still, it is unclear whether this risk is intrinsically high in certain people or if nongenetic factors explain it entirely. OBJECTIVE To compare the risk of stroke in kin and nonkin caregivers. METHODS In a cross-sectional study using the Stroke Riskometer app (AUT Ventures Limited, Auckland, AUK, New Zealand), we determined the 5- and 10-year stroke risk (SR) among caregivers of stroke inpatients. The degree of kinship was rated with a score ranging from 0 to 50 points. RESULTS We studied 278 caregivers (69.4% of them female) with a mean age of 47.5 ± 14.2 years. Kin caregivers represented 70.1% of the sample, and 49.6% of them were offspring. The median SR at 5 years was of 2.1 (range: 0.35-17.3) versus 1.73 (range: 0.04-29.9), and of 4.0 (range: 0.45-38.6) versus 2.94 (range: 0.05-59.35) at 10 years for the nonkin and kin caregivers respectively. In linear logistic regression controlled for the age of the caregivers, adding the kinship score did not increase the overall variability of the model for the risk at 5 years (R2 = 0.271; p = 0.858) nor the risk at 10 years (R2 = 0.376; p = 0.78). CONCLUSION Caregivers of stroke patients carry a high SR regardless of their degree of kinship.
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Affiliation(s)
- Juan Manuel Marquez-Romero
- Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada, Hospital General de Zona #2, Departamento de Neurología, Aguascalientes AGS, Mexico.
| | - Jessica Romo-Martínez
- Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada, Centro Médico de Occidente, Departamento de Radiología, Guadalajara JAL, Mexico.
| | | | - Angélica Ruiz-Franco
- Hospital Juárez de México, Departamento de Neurología, Ciudad México CDMX, Mexico.
| | - Rita Krishnamurthi
- National Institute for Stroke & Applied Neurosciences, School of Clinical Sciences, Auckland AUK, New Zealand.
| | - Valery Feigin
- National Institute for Stroke & Applied Neurosciences, School of Clinical Sciences, Auckland AUK, New Zealand.
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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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Usatova VS, Mishina NM, Berestovoy MA, Ivanenko AV, Jappy D, Krut' VG, Sokolov RA, Moshchenko AA, Rozov A, Shevchenko EK, Belousov VV. Hydrogen peroxide is not generated intracellularly in human neural spheroids during ischemia-reperfusion. Free Radic Biol Med 2024; 212:234-240. [PMID: 38158053 DOI: 10.1016/j.freeradbiomed.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Reactive oxygen species (ROS) are considered a primary source of damage during ischemic stroke. However, the precise timing of ROS production (during hypoxia or reperfusion) remains unclear. Cellular 3D spheroids are often proposed as an optimal alternative to both 2D cell cultures and animal models in modeling disease conditions. Here we report live imaging of hydrogen peroxide dynamics during the acute phase of hypoxia and reperfusion in human iPSC-derived neural spheroids, stably expressing fluorescent biosensor HyPer7. Contrary to previous reports, we did not observe a hydrogen peroxide production burst neither during hypoxia nor in course of reperfusion. Our data suggest either lack of oxidative stress during ischemia-reperfusion in spheroids or existence of different mechanisms of oxidative damage.
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Affiliation(s)
- Veronika S Usatova
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia
| | - Natalie M Mishina
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia; Laboratory of Synthetic Neurotechnologies, Pirogov Russian National Research Medical University, 117997, Moscow, Russia
| | - Mikhail A Berestovoy
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia
| | - Alexander V Ivanenko
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, 117997, Moscow, Russia; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia
| | - David Jappy
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia; Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, 603022, Nizhny Novgorod, Russia
| | - Viktoriya G Krut'
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia; Laboratory of Synthetic Neurotechnologies, Pirogov Russian National Research Medical University, 117997, Moscow, Russia
| | - Rostislav A Sokolov
- Laboratory of Synthetic Neurotechnologies, Pirogov Russian National Research Medical University, 117997, Moscow, Russia; Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, 603022, Nizhny Novgorod, Russia
| | - Aleksandr A Moshchenko
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia
| | - Andrei Rozov
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia; Laboratory of Neurobiology, Kazan Federal University, 420008, Kazan, Russia
| | - Evgeny K Shevchenko
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia
| | - Vsevolod V Belousov
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, 117997, Moscow, Russia; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia; Laboratory of Synthetic Neurotechnologies, Pirogov Russian National Research Medical University, 117997, Moscow, Russia; Life Improvement by Future Technologies (LIFT) Center, 121205, Moscow, Russia.
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Lee H, Culpepper J, Porter E. Analysis of electrode arrangements for brain stroke diagnosis via electrical impedance tomography through numerical computational models. Physiol Meas 2024; 45:025006. [PMID: 38306666 DOI: 10.1088/1361-6579/ad252c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024]
Abstract
Objective.Rapid stroke-type classification is crucial for improved prognosis. However, current methods for classification are time-consuming, require expensive equipment, and can only be used in the hospital. One method that has demonstrated promise in a rapid, low-cost, non-invasive approach to stroke diagnosis is electrical impedance tomography (EIT). While EIT for stroke diagnosis has been the topic of several studies in recent years, to date, the impact of electrode placements and arrangements has rarely been analyzed or tested and only in limited scenarios. Optimizing the location and choice of electrodes can have the potential to improve performance and reduce hardware cost and complexity and, most importantly, diagnosis time.Approach.In this study, we analyzed the impact of electrodes in realistic numerical models by (1) investigating the effect of individual electrodes on the resulting simulated EIT boundary measurements and (2) testing the performance of different electrode arrangements using a machine learning classification model.Main results.We found that, as expected, the electrodes deemed most significant in detecting stroke depend on the location of the electrode relative to the stroke lesion, as well as the role of the electrode. Despite this dependence, there are notable electrodes used in the models that are consistently considered to be the most significant across the various stroke lesion locations and various head models. Moreover, we demonstrate that a reduction in the number of electrodes used for the EIT measurements is possible, given that the electrodes are approximately evenly distributed.Significance.In this way, electrode arrangement and location are important variables to consider when improving stroke diagnosis methods using EIT.
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Affiliation(s)
- Hannah Lee
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jared Culpepper
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas, United States of America
| | - Emily Porter
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas, United States of America
- Department of Biomedical Engineering, McGill University, Montreal, Canada
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Rizk HI, Magdy R, Emam K, Mohammed MS, Aboulfotooh AM. Substance use disorder in young adults with stroke: clinical characteristics and outcome. Acta Neurol Belg 2024; 124:65-72. [PMID: 37454034 PMCID: PMC10874343 DOI: 10.1007/s13760-023-02317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults. METHODS Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month. RESULTS The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each). CONCLUSION Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.
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Affiliation(s)
- Hoda Ibrahim Rizk
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Khadiga Emam
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Soliman Mohammed
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Nascimento H, Almeida B. Psychotic Disorder after Left Posterior Cerebral Artery Stroke-An Atypical Event. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:60-65. [PMID: 38454893 PMCID: PMC10926015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Stroke survivors usually present physical and neuropsychiatric complications. Post-stroke psychosis (PSPsy) is a particularly neglected sequel despite its disruptive nature. OBJECTIVES To present a case of early emerging neuropsychiatric symptoms following a left posterior cerebral artery (PCA) stroke. To review and discuss PSPsy clinical manifestations, pathophysiology, and clinical outcomes. CLINICAL CASE A previously autonomous 68-year-old woman with vascular risk factors and depressive disorder presented to the emergency department with a 5-day history of disorientation, motor aphasia, and right hypoesthesia. Computer tomography revealed a left PCA stroke. She was started on acetylsalicylic acid and rosuvastatin and discharged the next day. Afterward, the patient developed a depressive mood, emotional lability, periods of confusion, delusions of persecution, guilt and unworthiness, auditory hallucinations, and suicide ideation. She was admitted to a psychiatric hospital and started on risperidone with a good response, being discharged after 15 days with the resolution of psychiatric symptoms. CONCLUSIONS PSPsy is more common after right hemisphere lesions and usually develops after some months. Nevertheless, our patient presented PSPsy following an ischemic event of the left PCA, with neuropsychiatric symptomatology dominating the clinic since the beginning. The involvement of the retrosplenial cortex or its connections was likely important for this atypical presentation. Due to the lack of guidelines on approaching PSPsy, most patients are treated with the same strategies used for non-stroke patients. A better comprehension of the anatomical basis underlining the symptomatology in these patients could deepen the understanding of psychosis and psychotic disorders.
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Affiliation(s)
- Henrique Nascimento
- Neurology Department, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal
| | - Bárbara Almeida
- Psychiatry Inpatient Unit, Hospital de Magalhães Lemos, 4149-003 Porto, Portugal
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Nainani SA, Raghuveer R, Nathani HR, Khan AF. The Impact of Constraint-Induced Movement Therapy on Motor Recovery in Middle Cerebral Artery Infarction Having Cardiomegaly in an Intensive Care Unit. Cureus 2024; 16:e54384. [PMID: 38505431 PMCID: PMC10948960 DOI: 10.7759/cureus.54384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
Stroke can be characterized by rapidly emerging neurological manifestations of global or focal impairment of neurological functionality, with consequences lasting a day or more or giving rise to mortality, with no significant etiology other than vascular origin. A middle cerebral artery (MCA) infarct is a form of stroke that develops when the MCA, one of the primary arteries providing blood to the brain, becomes blocked or obstructed. Constraint-induced movement therapy (CIMT) is an emerging method that has mainly been utilized to rehabilitate stroke patients, especially upper extremities. According to recent advances, CIMT can also be applied to the lower limbs to increase insufficient limb balance, thereby facilitating gait. This case report is based on a 65-year-old female who had weakness in the left side of the body and slurring of speech and was diagnosed with an MCA infarct. She was managed with CIMT in the ICU along with conventional physiotherapy. The outcomes showed that CIMT is a beneficial approach for patients with stroke.
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Affiliation(s)
- Shweta A Nainani
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Raghumahanti Raghuveer
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Harsh R Nathani
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Arasha F Khan
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Baena-Caldas GP, Li J, Pedraza L, Ghosh S, Kalmes A, Barone FC, Moreno H, Hernández AI. Neuroprotective effect of the RNS60 in a mouse model of transient focal cerebral ischemia. PLoS One 2024; 19:e0295504. [PMID: 38166102 PMCID: PMC10760892 DOI: 10.1371/journal.pone.0295504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/22/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Stroke is a major cause of death, disability, and public health problems. Its intervention is limited to early treatment with thrombolytics and/or endovascular clot removal with mechanical thrombectomy without any available subacute or chronic neuroprotective treatments. RNS60 has reduced neuroinflammation and increased neuronal survival in several animal models of neurodegeneration and trauma. The aim here was to evaluate whether RNS60 protects the brain and cognitive function in a mouse stroke model. METHODS Male C57BL/6J mice were subjected to sham or ischemic stroke surgery using 60-minute transient middle cerebral artery occlusion (tMCAo). In each group, mice received blinded daily administrations of RNS60 or control fluids (PNS60 or normal saline [NS]), beginning 2 hours after surgery over 13 days. Multiple neurobehavioral tests were conducted (Neurological Severity Score [mNSS], Novel Object Recognition [NOR], Active Place Avoidance [APA], and the Conflict Variant of APA [APAc]). On day 14, cortical microvascular perfusion (MVP) was measured, then brains were removed and infarct volume, immunofluorescence of amyloid beta (Aβ), neuronal density, microglial activation, and white matter damage/myelination were measured. SPSS was used for analysis (e.g., ANOVA for parametric data; Kruskal Wallis for non-parametric data; with post-hoc analysis). RESULTS Thirteen days of treatment with RNS60 reduced brain infarction, amyloid pathology, neuronal death, microglial activation, white matter damage, and increased MVP. RNS60 reduced brain pathology and resulted in behavioral improvements in stroke compared to sham surgery mice (increased memory-learning in NOR and APA, improved cognitive flexibility in APAc). CONCLUSION RNS60-treated mice exhibit significant protection of brain tissue and improved neurobehavioral functioning after tMCAo-stroke. Additional work is required to determine mechanisms, time-window of dosing, and multiple dosing volumes durations to support clinical stroke research.
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Affiliation(s)
- Gloria Patricia Baena-Caldas
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- Health Sciences Division, Department of Morphology, School of Biomedical Sciences, Universidad del Valle, Cali, Colombia
| | - Jie Li
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Lina Pedraza
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Supurna Ghosh
- Revalesio Corporation, Tacoma, WA, United States of America
| | - Andreas Kalmes
- Revalesio Corporation, Tacoma, WA, United States of America
| | - Frank C. Barone
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
| | - Herman Moreno
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
| | - A. Iván Hernández
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
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Zafar F, Wadhwa A, Kumar K, Ahmed M, Khokhar AS, Sajjad S, Oliveira Souza Lima SR, Baluch SK, Srour AK, Al-Deir SS, Shehryar A, Rehman A, Abubakar M. Smoke Signals: Unraveling the Paradoxical Impact of Smoking on Stroke Prognosis and Treatment Efficacy. Cureus 2024; 16:e52346. [PMID: 38361733 PMCID: PMC10867546 DOI: 10.7759/cureus.52346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Smoking is a well-established risk factor for stroke, yet its impact on stroke prognosis remains complex and multifaceted. This systematic review aims to elucidate the relationship between smoking and various stroke outcomes, including response to treatment and long-term recovery. We conducted a comprehensive analysis of four fundamental studies that examined the prognosis of stroke in smokers, focusing on clinical outcomes post-endovascular treatment, response to antiplatelet therapy, incidence of post-stroke delirium, and the effectiveness of thrombolysis treatment. The studies varied in design, including observational, retrospective, and post hoc trial analyses. The review reveals that smoking may paradoxically predict better clinical outcomes in specific treatment scenarios, such as post-endovascular treatment and when using clopidogrel. However, smokers also demonstrated higher rates of ischemic stroke and post-stroke delirium. Notably, the smoker's paradox in thrombolysis treatment was not supported. These findings highlight the need for personalized treatment approaches based on smoking status. Smoking has a complex and significant impact on stroke prognosis. While some benefits in specific treatment contexts were observed, the overall evidence strongly advises against smoking due to its adverse health consequences. This review underscores the importance of personalized stroke management in smokers and the integration of smoking cessation programs in post-stroke care. Future research should focus on larger, longitudinal studies to explore these associations further.
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Affiliation(s)
| | - Anesh Wadhwa
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Kabeer Kumar
- Medicine and Surgery, Chandka Medical College, Larkana, PAK
| | - Muhammad Ahmed
- Psychiatry and Behavioral Sciences, Dow University of Health Sciences, Karachi, PAK
| | | | | | | | - Shariq K Baluch
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Abeer K Srour
- Internal Medicine, Palestine Medical Complex, Ramallah, PSE
| | - Shadi S Al-Deir
- Internal Medicine, Misr University for Science and Technology, Amman, JOR
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Luo S, Mao R, Li Y. Mendelian Randomization Highlights Gut Microbiota of Short-chain Fatty Acids' Producer as Protective Factor of Cerebrovascular Disease. Curr Neurovasc Res 2024; 21:32-40. [PMID: 38551043 DOI: 10.2174/0115672026299307240321090030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Recent research advancements have indicated a potential association between gut microbiota and cerebrovascular diseases, although the precise causative pathways and the directionality of this association remain to be fully elucidated. OBJECTIVE This study utilized a bidirectional two-sample Mendelian Randomization (MR) methodology to explore the causal impact of gut microbiota compositions on the risk of cerebrovascular disease. METHODS Genome-wide Association Study (GWAS) data pertaining to gut microbiota were obtained from the MiBioGen consortium. For Ischemic Stroke (IS), Transient Ischemic Attack (TIA), Vascular Dementia (VD), and Subarachnoid Hemorrhage (SAH), GWAS summary data were sourced from the FinnGen consortium, the IEU Open GWAS project, and the GWAS catalog, respectively. RESULTS Our MR analyses identified that specific bacterial strains, notably those involved in the production of Short-chain Fatty Acids (SCFAs), including Barnesiella, Ruminococcus torques group, and Coprobacter, serve as protective factors against IS, TIA, and SAH. Linkage Disequilibrium Score Regression (LDSC) analysis corroborated a significant genetic correlation between these gut microbiota strains and various forms of cerebrovascular disease. In contrast, reverse MR analysis failed to establish a bidirectional causal relationship between genetically inferred gut microbiota profiles and these cerebrovascular conditions. CONCLUSION This investigation has pinpointed particular strains of gut microbiota that play protective or detrimental roles in cerebrovascular disease pathogenesis. These findings offer valuable insights that could be pivotal for the clinical management, prevention, and treatment of cerebrovascular diseases.
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Affiliation(s)
- Shihang Luo
- Department of Neurology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Rui Mao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Li
- Department of Radiology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, Sichuan Province, China
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Kang B, Ma J, Jeong I, Yoon S, Kim JI, Heo SJ, Oh SS. Behavioral marker-based predictive modeling of functional status for older adults with subjective cognitive decline and mild cognitive impairment: Study protocol. Digit Health 2024; 10:20552076241269555. [PMID: 39193313 PMCID: PMC11348489 DOI: 10.1177/20552076241269555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/25/2024] [Indexed: 08/29/2024] Open
Abstract
Objective This study describes a research protocol for a behavioral marker-based predictive model that examines the functional status of older adults with subjective cognitive decline and mild cognitive impairment. Methods A total of 130 older adults aged ≥65 years with subjective cognitive decline or mild cognitive impairment will be recruited from the Dementia Relief Centers or the Community Service Centers. Data on behavioral and psychosocial markers (e.g. physical activity, mobility, sleep/wake patterns, social interaction, and mild behavioral impairment) will be collected using passive wearable actigraphy, in-person questionnaires, and smartphone-based ecological momentary assessments. Two follow-up assessments will be performed at 12 and 24 months after baseline. Mixed-effect machine learning models: MErf, MEgbm, MEmod, and MEctree, and standard machine learning models without random effects [random forest, gradient boosting machine] will be employed in our analyses to predict functional status over time. Results The results of this study will be fundamental for developing tailored digital interventions that apply deep learning techniques to behavioral data to predict, identify, and aid in the management of functional decline in older adults with subjective cognitive decline and mild cognitive impairment. These older adults are considered the optimal target population for preventive interventions and will benefit from such tailored strategies. Conclusions Our study will contribute to the development of self-care interventions that utilize behavioral data and machine learning techniques to provide automated analyses of the functional decline of older adults who are at risk for dementia.
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Affiliation(s)
- Bada Kang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Jinkyoung Ma
- Department of Nursing, Yong-In Arts and Science University, Yongin, Republic of Korea
| | - Innhee Jeong
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
- Navy Headquarter, Gyeryong, Republic of Korea
| | - Seolah Yoon
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 Four Project, Yonsei University, Seoul, Republic of Korea
| | - Jennifer Ivy Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Seok-jae Heo
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Soyeon Oh
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
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Naz F, Hussain D, Ali H, Raza Q, Siddique F. Effectiveness of functional electrical stimulation machine in managing neurological diseases - A retrospective study. Pak J Med Sci 2024; 40:S53-S57. [PMID: 38328644 PMCID: PMC10844914 DOI: 10.12669/pjms.40.2(icon).8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/18/2023] [Accepted: 11/16/2023] [Indexed: 02/09/2024] Open
Abstract
Background & Objective Cerebrovascular Accident (CVA) or stroke, Spinal Cord injury can lead to neurological diseases resulting in major loss in motor function causing hemiplegia or tetraplegia. In 2019, according to The Global Burden of Diseases (GBD) CVA/Stroke is the second leading cause of death and the third leading cause of death and disability combined, globally. Its prevalence vary drastically among South Asian countries. The objective of this study was to determine the effectiveness of Functional Electrical Stimulation (FES) machine on neurologically impaired patients at the Physical Therapy department at IHHN, Karachi, Pakistan. Method In this retrospective study data was extracted from August 2016 to February 2022 on patients with neurological symptoms i.e. hemiplegia or paraplegia with muscle power of two or less on Manual Muscle Testing (MMT). The parameters for evaluating patients progress pre and post treatment were MMT results and their mobility status. The number of sessions ranged between 40 to 100 sessions of Functional Electrical Stimulation (FES) provided on alternate days according to the patient's need. Result Data of 51 patients who had completed their treatment were extracted and analyzed. The mean age of patients who completed treatment was 49.62 ± 17.26 years. Out of 51(100%), 30 (58.8%) were male and 21 (41.2%) were female. Pre- and post-treatment median (IQR) showed remarkable improvement in MMT of upper limb muscle (from 1.0 to 4.0) and lower limb muscle (from 2.0 to 4.0). Conclusion FES cycling is an effective treatment for patients with neurological impairments, as it resulted in improvement in both upper and lower limb muscle strength, along with mobility status.
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Affiliation(s)
- Farah Naz
- Farah Naz, Department of Physical Therapy, Indus Hospital and Health Network, Karachi, Pakistan
| | - Danish Hussain
- Danish Hussain, Department of Physical Therapy, Indus Hospital and Health Network, Karachi, Pakistan
| | - Hussain Ali
- Hussain Ali, Department of Physical Therapy, Indus Hospital and Health Network, Karachi, Pakistan
| | - Qasim Raza
- Qasim Raza, Department of Physical Therapy, Indus Hospital and Health Network, Karachi, Pakistan
| | - Farrukh Siddique
- Farrukh Siddique, Department of Physical Therapy, Indus Hospital and Health Network, Karachi, Pakistan
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Ouyang H, Jiang H, Huang J, Liu Z. COVID-19 Pandemic Brings Challenges to the Management of Stroke-The Differences Between Stroke Cases Admitted to a Tertiary Hospital Before and During COVID-19 Pandemic in China. Risk Manag Healthc Policy 2023; 16:2893-2905. [PMID: 38155847 PMCID: PMC10752818 DOI: 10.2147/rmhp.s435094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
Background An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic. Methods This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020). Results When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006). Conclusion The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.
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Affiliation(s)
- Hui Ouyang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hong Jiang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jin Huang
- Department of Emergency, Yiyang Central Hospital, Yiyang, Hunan, People’s Republic of China
| | - Zunjing Liu
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
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Dobe J, Gustafsson L, Walder K, Bower K, Lachman R. Co-creation of self-management support during inpatient stroke rehabilitation. PEC INNOVATION 2023; 3:100191. [PMID: 37521957 PMCID: PMC10371841 DOI: 10.1016/j.pecinn.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/04/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
Objective This study aimed to identify priority self-management skills and behaviours in partnership with stroke survivors, and to co-create approaches to support self-management during inpatient stroke rehabilitation. Methods Three stroke survivors and two communication partners participated in the three-stage Participatory Action Research project with embedded co-design processes after undertaking inpatient rehabilitation at a metropolitan tertiary hospital. Results Participants identified key factors influencing self-management during inpatient rehabilitation including motivation, emotional well-being, and fatigue. Three approaches to support people to self-manage post-stroke were co-created. (1) A health professional concierge and early family meeting. (2) A peer support person. (3) Adapting the hospital environment. Conclusion Findings suggest post-stroke self-management support should commence during inpatient rehabilitation to optimise its research-informed benefits. This support should focus on empowering stroke survivors and their key support people through active involvement in decision-making, and provision of multi-modal individualised education. The impact of hospital environments on emotional-wellbeing and self-management post-stroke also requires further investigation. Innovation The identification of a health professional concierge as a co-designed solution to the current challenges with self-management support is an innovative recommendation for practice. The findings support changes to the traditional processes of rehabilitation towards a consumer and family-led practices.
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Affiliation(s)
- Joshua Dobe
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Queensland, Australia
| | - Kim Walder
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Kylie Bower
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
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Suryadi T, Kulsum K. Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration. F1000Res 2023; 10:1303. [PMID: 38144172 PMCID: PMC10739180 DOI: 10.12688/f1000research.75630.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanwhile, at the same time, the patient could also be infected with coronavirus disease 2019 (COVID-19), one of treatment is the administration of anticoagulants. Methods A case report. A 46-year-old male patient was admitted to hospital with a loss of consciousness and was diagnosed with intracerebral hemorrhage due to a hemorrhagic stroke and was confirmed positive for COVID-19. Giving anticoagulants to patients is considered counterproductive so, an ethical dilemma arises. For this reason, a joint conference was held to obtain the best ethical and medicolegal solutions for the patient. Results By using several methods of resolving ethical dilemmas such as basic ethical principles, supporting ethical principles, and medicolegal considerations, it was decided that the patient was not to be given anticoagulants. Conclusions Giving anticoagulants to hemorrhagic stroke patients is dangerous even though it is beneficial for COVID-19 patients, so here the principle of risk-benefit balance is applied to patients who prioritize risk prevention rather than providing benefits. This is also supported by the prima facie principle by prioritizing the principle of non-maleficence rather than beneficence, the minus malum principle by seeking the lowest risk, and the double effect principle by making the best decision even in a slightly less favorable way as well as the medicolegal aspect by assessing patient safety and risk management.
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Affiliation(s)
- Taufik Suryadi
- Ethics and Medicolegal Consultant, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Forensic Medicine and Medicolegal, Faculty of Medicine, Universitas Syiah Kuala, Aceh, 23111, Indonesia
- Department of Forensic Medicine and Medicolegal, Dr.Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
| | - Kulsum Kulsum
- Neuro-anesthesia and Critical Care Consultant, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Anesthesiology and Intensive Therapy, Dr.Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
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Lone AW, Aydin N. Wavelet Scattering Transform based Doppler signal classification. Comput Biol Med 2023; 167:107611. [PMID: 37913613 DOI: 10.1016/j.compbiomed.2023.107611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
Normal blood supply to the human brain may be marred by the presence of a clot inside the blood vessels. This clot structure called emboli inhibits normal blood flow to the brain. It is considered as one of the main sources of stroke. Presence of emboli in human's can be determined by the analysis of transcranial Doppler signal. Different signal processing and machine learning algorithms have been used for classifying the detected signal as an emboli, Doppler speckle, and an artifact. In this paper, we sought to make use of the wavelet transform based algorithm called Wavelet Scattering Transform, which is translation invariant and stable to deformations for classifying different Doppler signals. With its architectural resemblance to Convolutional Neural Network, Wavelet Scattering Transform works well on small datasets and subsequently was trained on a dataset consisting of 300 Doppler signals. To check the effectiveness of extracted Scattering transform based features for Doppler signal classification, learning algorithms that included multi-class Support vector machine, k-nearest neighbor and Naive Bayes algorithms were trained. Comparative analysis was done with respect to the handcrafted Continuous wavelet transform features extracted from samples and Wavelet scattering with Support vector machine achieved an accuracy of 98.89%. Also, with set of extracted scattering coefficients, Gaussian process regression was performed and a regression model was trained on three different sets of scattering coefficients with zero order scattering coefficients providing least prediction loss of 34.95%.
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Affiliation(s)
- Ab Waheed Lone
- Department of Computer Engineering, Yildiz Technical University, Istanbul, Turkey.
| | - Nizamettin Aydin
- Department of Computer Engineering, Yildiz Technical University, Istanbul, Turkey.
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