1
|
Xie L, Zi Y. Application of Psychotherapy Based on Five-Element Theory in Traditional Chinese Medicine in Improving the Mental States of Patients with Post-Stroke Depression. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:542-548. [PMID: 39129679 PMCID: PMC11319754 DOI: 10.62641/aep.v52i4.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND This study aims to explore the clinical effect of psychotherapy based on five-element theory in traditional Chinese medicine (TCM) in improving the mental states of patients with post-stroke depression (PSD), to provide reference and guidance for clinical treatment. METHODS A retrospective study was conducted on 163 PSD cases treated in The Second Affiliated Hospital, Hengyang Medical School, University of South China from January 2022 to January 2023. The patients treated with conventional treatment were included in the control group (n = 84), and patients receiving psychotherapy based on five-element theory in TCM and conventional treatment were classified as the observation group (n = 79). The anxiety levels, depression levels, TCM syndrome scores and sleep quality were compared in both groups. The enumeration data were tested by χ2 test. Kolmogorov-Smirnov method tested whether the measurement data met normal distribution, and those did not meet normal distribution were tested by Mann-Whitney method. The difference was statistically significant at p < 0.05. RESULTS After 4-week and 8-week treatments, the observation group had significantly lower scores of Hamilton Anxiety Scale (z = -4.562, -6.765; p < 0.001), Hamilton Depression Scale (z = -7.588, -8.023; p < 0.001), TCM syndrome (z = -7.138, -10.946; p < 0.001), and Pittsburgh sleep quality index (z = -6.819, -8.240; p < 0.001) than the control group. CONCLUSION Psychotherapy based on five-element theory in TCM is beneficial to patients with PSD and can bring a certain clinical reference value.
Collapse
Affiliation(s)
- Lixia Xie
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| | - Yaling Zi
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| |
Collapse
|
2
|
Ma Z, He W, Zhou Y, Mai L, Xu L, Li C, Li M. Global burden of stroke in adolescents and young adults (aged 15-39 years) from 1990 to 2019: a comprehensive trend analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:2042. [PMID: 39080669 PMCID: PMC11289945 DOI: 10.1186/s12889-024-19551-1] [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: 08/28/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION The incidence of stroke is rising among individuals aged 15-39. Insufficient research targeting this age group hampers the development of effective strategies. This study analyzes data from the Global Burden of Disease Study 2019 (GBD 2019) to examine trends from 1990 to 2019 and propose future interventions. METHODS Data on ischemic strokes, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019 was collected from the Global Health Data Exchange (GHDx) platform. We used the Annual Average Percentage Change (AAPC) to assess global trends in incidence, prevalence, Disability-Adjusted Life Years (DALYs), and mortality rates across various stroke categories. Joinpoint models identified significant years of trend inflection. Trend analyses were segmented by age, gender, and Sociodemographic Index (SDI). FINDINGS From 1990 to 2019, the global incidence of ischemic stroke within the adolescents and young adults (AYAs) cohort declined from 1990 to 1999, further decreased from 2000 to 2009, and then increased from 2010 to 2019. The overall AAPC p-value showed no significant difference. Mortality rates for ischemic strokes were consistently reduced during this period. The overall incidence rate of intracerebral hemorrhage has exhibited a downward trend. Meanwhile, the incidence rate of subarachnoid hemorrhage decreased from 1990 to 2009, yet saw a resurgence from 2010 to 2019. Male ischemic stroke incidence grew more than female incidence, but both absolute incidence and rates were higher for females. Differences in SDI levels were observed, with the fastest increase in incidence occurring in low-middle SDI regions, followed by high SDI regions, and the smallest increase in low SDI regions. Conversely, the most rapid decline was noted in high-middle SDI regions, with no significant change observed in middle SDI regions. CONCLUSION A concerning trend of increasing ischemic stroke incidence, DALYs, and prevalence rates has emerged in the global 15-39 age group, especially among those aged 30-39. This increase is evident across regions with varying SDI classifications. To combat this alarming trend among adolescents and young adults, enhancing preventive efforts, promoting healthier lifestyles, strengthening the healthcare system's responsiveness, and maintaining vigilant epidemiological monitoring is essential.
Collapse
Affiliation(s)
- Zixuan Ma
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Wenkai He
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanxin Zhou
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Li Mai
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lifeng Xu
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyan Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Berkovich R, Sokolov AY, Totolyan NA, Verbitskaya EV, Yakupova AA, Eskenazi J. Cross-prevalence of multiple sclerosis and stroke evaluated on cohorts of four independent specialty medical centers. Mult Scler Relat Disord 2024; 90:105772. [PMID: 39137567 DOI: 10.1016/j.msard.2024.105772] [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: 05/12/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Numerous sources reported the increased risk of cerebrovascular accidents (CVA) in individuals with multiple sclerosis (MS), without a single study thus far challenging the conclusion. Before addressing hypothesis on potential cause-effect relationships, a question whether there are indeed frequent comorbidities between MS and CVA needed to be answered. METHODS Authors designed a study to evaluate substantial populations of four independent neurology centers with the purpose to assess the prevalence of CVA diagnosis in patients with MS, and vice versa. Data of subjects meeting enrollment criteria were entered into a single database. Authors compared obtained data with the MS and CVA prevalences in the populations of specific countries. RESULTS Of the 1881 subjects' records, the main diagnosis was MS for 51.5% and CVA for 48.5%. The CVA prevalence as a secondary diagnosis among MS subjects was 1.47% in USA cohort and 1.65% in combined USA+ Russian Federation (RF) cohorts, which is lower than known prevalence of stroke in adult population of these regions. The prevalence of MS as a secondary diagnosis among subjects with stroke in USA cohort was 0.4% and in combined USA+RF cohorts was 0.33%, which is higher, but not statistically different from calculated MS prevalence in both USA and RF populations combined. CONCLUSION Thus, authors found that prevalence of CVA in cohorts with MS of 2 independent centers was at least not higher, than that in general population, which differs from previously published data.
Collapse
Affiliation(s)
| | - Alexey Y Sokolov
- Pavlov First Saint Petersburg State Medical University, Russian Federation; Pavlov Institute of Physiology of the Russian Academy of Sciences, Russian Federation
| | - Natalia A Totolyan
- Pavlov First Saint Petersburg State Medical University, Russian Federation
| | | | - Aida A Yakupova
- Kazan State Medical University, Tatarstan, Russian Federation
| | | |
Collapse
|
4
|
Guo D, Hu L, Xie P, Sun P, Yu W. Seipin is involved in oxygen-glucose deprivation/reoxygenation induced neuroinflammation by regulating the TLR3/TRAF3/NF-κB pathway. Int Immunopharmacol 2024; 134:112182. [PMID: 38703568 DOI: 10.1016/j.intimp.2024.112182] [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: 02/25/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
Seipin plays a crucial role in lipid metabolism and is involved in neurological disorders. However, the function and mechanism of action of seipin in acute ischemic stroke have not yet been elucidated. Here, we aimed to investigate the effect of seipin on neuroinflammation induced by oxygen-glucose deprivation/reoxygenation (OGD/R) and further explore the molecular mechanism by functional experiments. Our results revealed a significant decrease in seipin mRNA levels, accompanied by enhanced expression of TNF-α in patients with AIS, and a significant negative correlation between seipin and TNF-α was observed. Additionally, there was a negative correlation between seipin levels and the National Institutes of Health Stroke Scale (NIHSS) score. Furthermore, seipin levels were also decreased in middle cerebral artery occlusion/reperfusion (MCAO/R) mice and OGD/R-treated BV2 cells. RNA sequencing analysis showed that seipin knockdown altered the Toll-like receptor 3 (TLR3) signaling pathway. It was further confirmed in vitro that seipin knockdown caused significantly increased secretion of inflammatory factors including TNF-α, interleukin (IL)-1β, and interferon (IFN)-β. Meanwhile, seipin knockdown activated the Tlr3 signal pathway while this effect could be reversed by Tlr3 inhibitor in OGD/R treated BV2 cells. Furthermore, neuroinflammation induced by OGD/R was significantly reduced by seipin overexpression. Overall, our study demonstrate that seipin deficiency aggravates neuroinflammation by activating the TLR3/TRAF3/NF-κB signaling pathway after OGD/R stimuli, and suggest that seipin may be a potential therapeutic target for AIS.
Collapse
Affiliation(s)
- Dongfen Guo
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China
| | - Lele Hu
- Department of Neurology, The Second People's Hospital of Guiyang, Guiyang 550023, Guizhou, China
| | - Peng Xie
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China
| | - Ping Sun
- Department of Neurology, The Second People's Hospital of Guiyang, Guiyang 550023, Guizhou, China.
| | - Wenfeng Yu
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China; Key Laboratory of Human Brain Bank for Functions and Diseases of Department of Education of Guizhou Province, Guizhou Medical University, Guiyang 550025, Guizhou, China.
| |
Collapse
|
5
|
Han L, Lan K, Kou D, Meng Z, Feng J, Maitland E, Nicholas S, Wang J. Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula. HEALTH ECONOMICS REVIEW 2024; 14:37. [PMID: 38836982 PMCID: PMC11154974 DOI: 10.1186/s13561-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. METHOD We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. RESULTS EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. CONCLUSIONS EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.
Collapse
Affiliation(s)
- Lu Han
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Kuixu Lan
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dejian Kou
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Zehua Meng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jin Feng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, England, United Kingdom
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, NSW, Australia
| | - Jian Wang
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, Wuhan, China.
| |
Collapse
|
6
|
Winardi W, Moi SH, Winardi T, Cheng YW, Chen PY, Lin CK. Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:939. [PMID: 38929556 PMCID: PMC11205390 DOI: 10.3390/medicina60060939] [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: 05/12/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Although statins are recommended for secondary prevention of acute ischemic stroke, some population-based studies and clinical evidence suggest that they might be used with an increased risk of intracranial hemorrhage. In this nested case-control study, we used Taiwan's nationwide universal health insurance database to investigate the possible association between statin therapy prescribed to acute ischemic stroke patients and their risk of subsequent intracerebral hemorrhage and all-cause mortality in Taiwan. Materials and Methods: All data were retrospectively obtained from Taiwan's National Health Insurance Research Database. Acute ischemic stroke patients were divided into a cohort receiving statin pharmacotherapy and a control cohort not receiving statin pharmacotherapy. A 1:1 matching for age, gender, and index day, and propensity score matching was conducted, producing 39,366 cases and 39,366 controls. The primary outcomes were long-term subsequent intracerebral hemorrhage and all-cause mortality. The competing risk between subsequent intracerebral hemorrhage and all-cause mortality was estimated using the Fine and Gray regression hazards model. Results: Patients receiving statin pharmacotherapy after an acute ischemic stroke had a significantly lower risk of subsequent intracerebral hemorrhage (p < 0.0001) and lower all-cause mortality rates (p < 0.0001). Low, moderate, and high dosages of statin were associated with significantly decreased risks for subsequent intracerebral hemorrhage (adjusted sHRs 0.82, 0.74, 0.53) and all-cause mortality (adjusted sHRs 0.75, 0.74, 0.74), respectively. Conclusions: Statin pharmacotherapy was found to safely and effectively reduce the risk of subsequent intracerebral hemorrhage and all-cause mortality in acute ischemic stroke patients in Taiwan.
Collapse
Affiliation(s)
- William Winardi
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Sin-Hua Moi
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medical Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | | | - Yu-Wen Cheng
- Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Po-Yuan Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Cheng-Kai Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| |
Collapse
|
7
|
Kang T, Zhu L, Xue Y, Yang Q, Lei Q, Wang Q. Overexpression of olfactory receptor 78 ameliorates brain injury in cerebral ischaemia-reperfusion rats by activating Prkaca-mediated cAMP/PKA-MAPK pathway. J Cell Mol Med 2024; 28:e18366. [PMID: 38856956 PMCID: PMC11163950 DOI: 10.1111/jcmm.18366] [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: 11/28/2023] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 06/11/2024] Open
Abstract
Ischemic stroke is one of the main causes of disability and death. However, recanalization of occluded cerebral arteries is effective only within a very narrow time window. Therefore, it is particularly important to find neuroprotective biological targets for cerebral artery recanalization. Here, gene expression profiles of datasets GSE160500 and GSE97537 were downloaded from the GEO database, which were related to ischemic stroke in rats. Olfactory receptor 78 (Olfr78) was screened, and which highly associated with Calcium signalling pathway and MAPK pathway. Interacting protein of Olfr78, Prkaca, was predicted by STRING, and their interaction was validated by Co-IP analysis. Then, a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) and a neuronal cell model stimulated by oxygen-glucose deprivation/reoxygenation (OGD/R) were constructed, and the results showed that expression of Olfr78 and Prkaca was downregulated in MCAO rats and OGD/R-stimulated neurons. Overexpression of Olfr78 or Prkaca inhibited the secretion of inflammatory factors, Ca2+ overload, and OGD/R-induced neuronal apoptosis. Moreover, Overexpression of Prkaca increased protein levels of cAMP, PKA and phosphorylated p38 in OGD/R-stimulated neurons, while SB203580, a p38 inhibitor, treatment inhibited activation of the cAMP/PKA-MAPK pathway and counteracted the effect of Olfr78 overexpression on improvement of neuronal functions. Meanwhile, overexpression of Olfr78 or Prkaca markedly inhibited neuronal apoptosis and improved brain injury in MCAO/R rats. In conclusion, overexpression of Olfr78 inhibited Ca2+ overload and reduced neuronal apoptosis in MCAO/R rats by promoting Prkaca-mediated activation of the cAMP/PKA-MAPK pathway, thereby improving brain injury in cerebral ischaemia-reperfusion.
Collapse
Affiliation(s)
- Tao Kang
- Department of NeurologyShaanxi Provincial People's HospitalXi'anChina
| | - Lijuan Zhu
- Department of AnesthesiaShaanxi Provincial People's HospitalXi'anChina
| | - Yanli Xue
- Department of NeurologyShaanxi Provincial People's HospitalXi'anChina
| | - Qian Yang
- Department of NeurologyShaanxi Provincial People's HospitalXi'anChina
| | - Qi Lei
- Department of NeurologyShaanxi Provincial People's HospitalXi'anChina
| | - Qianqian Wang
- Department of Traditional Chinese MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| |
Collapse
|
8
|
Libruder C, Yaari R, Fluss R, Hershkovitz Y, Ram A, Tanne D, Huppert A, Zucker I. Age-dependent seasonality in the incidence of stroke: A 21-year population-based study. Eur Stroke J 2024; 9:460-467. [PMID: 38174544 PMCID: PMC11318438 DOI: 10.1177/23969873231223031] [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: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Seasonality in the incidence of stroke has been examined in numerous studies, yet data on whether it differs with age are limited. To fill this gap, we utilized a largescale dataset from Israel. PATIENTS AND METHODS We retrieved data of all hospitalizations for ischemic stroke (IS), transient ischemic attack (TIA) and intra cerebral hemorrhage (ICH) from 2000 to 2020. We maintained separate datasets for IS/TIA and ICH, divided into five age groups: 18-49, 50-59, 60-69, 70-79, and 80+. We modeled the monthly incidence using a generalized additive model. The seasonal effect was defined by the rate ratio (RR) of each month compared to the annual mean. RESULTS The analysis included 317,586 and 23,789 events of IS/TIA and ICH respectively. We found an interaction between age and seasonality, accounting for a phase shift with age in the seasonal pattern of IS/TIA incidence. For cases under 70 years, the peak was during summertime and the RRs increased with decreasing age, reaching 1.11 (95% CI 1.09-1.13) at the youngest age group. In contrast, among the elderly, a winter peak was observed and the RRs increased with age to 1.07 (95% CI 1.06-1.08) at the oldest age group. For ICH, a winter/autumn peak was identified and the RRs increased with age to 1.20 (95% CI 1.16-1.24). CONCLUSIONS Our finding of age-dependent seasonal patterns in the occurrence of stroke, suggests closer monitoring of cardiovascular risk factors during wintertime among elderly individuals. The mechanism governing the seasonal phase shift with age in IS/TIA incidence, requires further investigation.
Collapse
Affiliation(s)
- Carmit Libruder
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Tel Hashomer, Israel
| | - Rami Yaari
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ronen Fluss
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Hershkovitz
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Tel Hashomer, Israel
| | - Amit Ram
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Tel Hashomer, Israel
| | - David Tanne
- Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Amit Huppert
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Inbar Zucker
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| |
Collapse
|
9
|
Esze R, Balkay L, Barna S, Egeresi LS, Emri M, Páll D, Paragh G, Rajnai L, Somodi S, Képes Z, Garai I, Káplár M. Impact of Fat Distribution and Metabolic Diseases on Cerebral Microcirculation: A Multimodal Study on Type 2 Diabetic and Obese Patients. J Clin Med 2024; 13:2900. [PMID: 38792441 PMCID: PMC11122647 DOI: 10.3390/jcm13102900] [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: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Since metabolic diseases and atherosclerotic vascular events are firmly associated, herein we investigate changes in central microcirculation and atherosclerosis-related body fat distribution in patients with type 2 diabetes mellitus and obesity. Methods: Resting brain perfusion single-photon emission computed tomography (SPECT) imaging with Technetium-99m hexamethylpropylene amine oxime ([99mTc]Tc-HMPAO SPECT) was performed, and the breath-holding index (BHI) and carotid intima-media thickness (cIMT) were measured to characterise central microcirculation. Besides CT-based abdominal fat tissue segmentation, C-peptide level, glycaemic and anthropometric parameters were registered to search for correlations with cerebral blood flow and vasoreactivity. Results: Although no significant difference was found between the resting cerebral perfusion of the two patient cohorts, a greater blood flow increase was experienced in the obese after the breath-holding test than in the diabetics (p < 0.05). A significant positive correlation was encountered between resting and provocation-triggered brain perfusion and C-peptide levels (p < 0.005). BMI and cIMT were negatively correlated (rho = -0.27 and -0.23 for maximum and mean cIMT, respectively), while BMI and BHI showed a positive association (rho = 0.31 and rho = 0.29 for maximum and mean BHI, respectively), which could be explained by BMI-dependent changes in fat tissue distribution. cIMT demonstrated a disproportional relationship with increasing age, and higher cIMT values were observed for the men. Conclusions: Overall, C-peptide levels and circulatory parameters seem to be strong applicants to predict brain microvascular alterations and related cognitive decline in such patient populations.
Collapse
Affiliation(s)
- Regina Esze
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
- Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - László Balkay
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (L.B.); (S.B.); (M.E.); (Z.K.); (I.G.)
| | - Sándor Barna
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (L.B.); (S.B.); (M.E.); (Z.K.); (I.G.)
| | - Lilla Szatmáriné Egeresi
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary;
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (L.B.); (S.B.); (M.E.); (Z.K.); (I.G.)
| | - Dénes Páll
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
- Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - György Paragh
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
| | - Liliána Rajnai
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
| | - Sándor Somodi
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
| | - Zita Képes
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (L.B.); (S.B.); (M.E.); (Z.K.); (I.G.)
| | - Ildikó Garai
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (L.B.); (S.B.); (M.E.); (Z.K.); (I.G.)
- ScanoMed Ltd., Nuclear Medicine Centers, Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - Miklós Káplár
- Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary; (D.P.); (G.P.); (L.R.); (S.S.); (M.K.)
| |
Collapse
|
10
|
Fernández-Solana J, Álvarez-Pardo S, Moreno-Villanueva A, Santamaría-Peláez M, González-Bernal JJ, Vélez-Santamaría R, González-Santos J. Efficacy of a Rehabilitation Program Using Mirror Therapy and Cognitive Therapeutic Exercise on Upper Limb Functionality in Patients with Acute Stroke. Healthcare (Basel) 2024; 12:569. [PMID: 38470680 PMCID: PMC10931296 DOI: 10.3390/healthcare12050569] [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: 12/13/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Applying evidence-based therapies in stroke rehabilitation plays a crucial role in this process, as they are supported by studies and results that demonstrate their effectiveness in improving functionality, such as mirror therapy (MT), cognitive therapeutic exercise (CTE), and task-oriented training. The aim of this study was to assess the effectiveness of MT and CTE combined with task-oriented training on the functionality, sensitivity, range, and pain of the affected upper limb in patients with acute stroke. A longitudinal multicenter study recruited a sample of 120 patients with acute stroke randomly and consecutively, meeting specific inclusion and exclusion criteria. They were randomly allocated into three groups: a control group only for task-oriented training (TOT) and two groups undergoing either MT or CTE, both combined with TOT. The overall functionality of the affected upper limb, specific functionality, sensitivity, range of motion, and pain were assessed using the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale validated for the Spanish population. An initial assessment was conducted before the intervention, a second assessment after completing the 20 sessions, and another three months later. ANCOVA analysis revealed statistically significant differences between the assessments and the experimental groups compared to the control group, indicating significant improvement in the overall functionality of the upper limb in these patients. However, no significant differences were observed between the two experimental groups. The conclusion drawn was that both therapeutic techniques are equally effective in treating functionality, sensitivity, range of motion, and pain in the upper limb following a stroke.
Collapse
Affiliation(s)
- Jessica Fernández-Solana
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | | | - Adrián Moreno-Villanueva
- Faculty of Health Science, University Isabel I, 09003 Burgos, Spain;
- BioVetMed & SportSci Research Group, Department of Physical activity and Sport, Faculty of Sport Sciences, University of Murcia, San Javier, 30720 Murcia, Spain
| | - Mirian Santamaría-Peláez
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Jerónimo J. González-Bernal
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Rodrigo Vélez-Santamaría
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Josefa González-Santos
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| |
Collapse
|
11
|
Pinosanu LR, Wolff N, Olaru DG, Popa-Wagner A. Stem Cell Treatments in Preclinical Relevant Stroke Models. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:487-494. [PMID: 38559835 PMCID: PMC10976206 DOI: 10.12865/chsj.49.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/11/2023] [Indexed: 04/04/2024]
Abstract
Since stroke has limited treatment options, an active search for new therapeutic approaches is required. Initial excitement of using cell-based therapies to stimulate recovery processes in the ischemic brain turned into a more measured perspective, acknowledging obstacles related to the unfavorable environments associated in part with aging. Given the predominance of stroke in older populations, evaluating the effectiveness of cell therapies in aged brain environments is essential and clinically relevant. Despite a common perception of the aged brain being resistant to regeneration, recent research with neural precursor cells and bone marrow-derived mesenchymal stem cells indicates that cell-based therapy can promote plasticity and remodeling in the aged rat brain. However, significant differences in the aged brain compared to the young brain, such as expedited progression of ischemic injury to brain infarction, decreased rate of endogenous neurogenesis, and delayed onset of neurological recovery, must be noted. The effectiveness of cell-based therapies may further be connected to age-related comorbidities such as diabetes or hyperlipidemia, potentially leading to maladaptive or impaired brain remodeling. These age-related factors need careful consideration in the clinical application of restorative therapies for stroke.
Collapse
Affiliation(s)
- Leonard Radu Pinosanu
- Experimental Research Center for Normal and Pathological Aging (ARES), University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Nora Wolff
- University of Crete, School of Sciences, Faculty of Medicine, Heraklion, Crete, Greece
| | - Denissa Greta Olaru
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, Romania
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging (ARES), University of Medicine and Pharmacy of Craiova, Craiova, Romania
| |
Collapse
|
12
|
McBenedict B, Hauwanga WN, Elamin A, Eshete FD, El Husseini N, El Ghazzawi AA, Patel VK, Pessôa BL, Tolentino J, Mesquita ET. Cerebrovascular Disease Mortality Trends in Brazil: An In-Depth Joinpoint Analysis. Cureus 2023; 15:e45845. [PMID: 37881379 PMCID: PMC10594394 DOI: 10.7759/cureus.45845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
Background Cerebrovascular disease is the second leading cause of death and the third leading cause of disability following heart disease. In 2019, there were over 101 million people living with a stroke and 12.2 million incidents of stroke globally. For the past three decades, stroke has remained the leading cause of death in Brazil, causing over 100,000 fatalities annually, along with numerous functional impairments among those who survive. The Brazilian healthcare system has witnessed notable advancements in the last decade, including the establishment of additional hospitals and a rise in the count of healthcare professionals specializing in cardiovascular and neurological surgery. However, there exists a gap in the research landscape for continuous comprehensive studies aimed at exploring the evolving mortality rates related to cerebrovascular diseases, of which the last one included data up to 2019. This study aimed to address this gap by meticulously analyzing the trends in cerebrovascular disease mortality in Brazil from 2000 to 2021, for the variables age, sex, state of residence, and geographic region. Methods This is a descriptive, ecological, and time series study. Nationwide data for annual cerebrovascular mortality from Brazil were used for the period 2000-2021. Age-adjusted mortality rates (AAMRs) by direct standardization, encompassing people above 20 years of age, were calculated and expressed per 100,000 persons. Mortality trends were assessed using joinpoint regression analysis by calculating the annual percentage change (APC) and its corresponding 95% confidence interval (CI) across categories of age, sex, and state and region of residence. Results The mortality rates decreased for the sex categories over the analyzed years. The AAMR for the categories decreased as follows: males and females (95 deaths/100,000 to 52 deaths/100,000 inhabitants), males (108 deaths/100,000 to 63 deaths/100,000 inhabitants), and females (83 deaths/100,000 to 44 deaths/100,000 inhabitants). The most substantial reduction in AAMR for males occurred in the 30-39-year age group (APC: -4.10), while the smallest decline was observed in the 20-29-year age group (APC: -1.44). All five macro-regions demonstrated statistically significant and downward AAPC values in mortality rates. The south and midwest regions decreased at a stable rate, as denoted by the same APC and AAPC values (-4.05 and -3.11, respectively). The north and northeast regions exhibited an increase in AAMR, followed by a decrease (APC: 0.68 to -1.42 and 2.63 to -2.35, respectively). Conclusions Our comprehensive analysis revealed a downward trend in cerebrovascular disease mortality rates across diverse demographic groups and macro-regions. Females experienced a more substantial reduction compared to males. Despite higher mortality rates among individuals aged 50 and above, all age groups displayed a marked decrease. The continuous decline can be attributed to policy interventions aimed at enhancing healthcare delivery, increased awareness, and healthier diets and lifestyles. With regard to the macro-regions, the regions in the southern zone demonstrated a more significant decrease as compared to the northern part. In Brazil, a more significant decline in cerebrovascular disease mortality rates could be achieved through increased focus on prevention measures and efforts toward mitigating disparities and inequalities between macro-regions.
Collapse
Affiliation(s)
- Billy McBenedict
- General and Specialized Surgery, Universidade Federal Fluminense, Niteroi, BRA
| | - Wilhelmina N Hauwanga
- General and Specialized Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | | | | | | | | | | | - Bruno L Pessôa
- General and Specialized Surgery, Universidade Federal Fluminense, Niteroi, BRA
| | - Julio Tolentino
- General and Specialized Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | | |
Collapse
|