Current approach to acute stroke management

lncRNA six3os1 diagnoses acute stroke, predicts disease severity, and predicts post-stroke cognitive impairment

BACKGROUND

Stroke is the main cause of death and disability. Post-stroke cognitive impairment (PSCI) is one of the most severe complications of stroke, which lacks effective biomarkers for its early detection.

OBJECTIVE

This study evaluated the significance of lncRNA SIX3OS1 in acute stroke and PSCI aiming to identify a novel biomarker.

PATIENTS AND METHODS

The study enrolled 138 patients with acute stroke and 80 healthy individuals. By comparing the serum SIX3OS1 in acute stroke and healthy individuals, the significance of SIX3OS1 in diagnosing acute stroke, assessing disease severity, and predicting the risk of PSCI was revealed.

RESULTS

Significant upregulation of SIX3OS1 in acute stroke was observed, which discriminated patients with acute stroke from healthy individuals and indicated severe disease conditions of patients. There were 72 acute stroke patients who had PSCI accounting for 52.17% that showed a higher serum SIX3OS1 level than post-stroke cognitive normal patients. The increasing serum SIX3OS1 level was also identified as a risk factor for PSCI and could distinguish PSCI patients. Additionally, SIX3OS1 showed a negative correlation with the MoCA score of PSCI patients.

CONCLUSION

Serum SIX3OS1 level can be considered a biomarker for screening acute stroke and a predictor for PSCI.

A systematic review and meta-analysis show a decreasing prevalence of post-stroke infections

BACKGROUND

Infection is a common complication in the acute phase after stroke; a systematic review in 2011 reported a post-stroke infection prevalence of 30%. Despite the plethora of primary data on post-stroke infections in recent times, a systematic review that synthesizes the data to provide comprehensive information to guide preventive, control, and management efforts is yet to be undertaken. This systematic review, therefore, aimed at bridging this gap by describing the epidemiology of post-stroke infections including the global prevalence and the associated mortality rates.

METHODOLOGY

A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science resulting in 2210 studies, of which 73 studies covering 32,109,574 stoke patients were included in the systematic review. Prevalence data on defined post-stroke infections were extracted for analysis in RStudio version 4.3.3.

RESULTS

The pooled prevalence of post-stroke infections and mortality rates were 9.14% and 15.91% respectively. The prevalence of post-stroke infections was highest for pneumonia (12.4%), followed by urinary tract infection (8.31%). Geographically, the prevalence of post-stroke infections for the various continents were Europe (10.41%), Africa (10.22%), South America (8.83%), North America (8.15%), Asia (8.09%), and Australia (7.88%). Common etiological agents of post-stroke infections included multidrug-resistant organisms particularly, Carbapenem-resistant Klebsiella pneumoniae (15.4-31.8%), Methicillin-resistant Staphylococcus aureus (9.8-15.4%), and Carbapenem-resistant Acinetobacter baumannii (38.5%).

CONCLUSION

This systematic review indicates about a 3-fold decline in the global prevalence of post-stroke infections in the last decade. Pneumonia is the most common post-stroke infection. Europe and Africa have the highest prevalence of post-stroke infections.

The healthcare experience of young stroke survivors: an interpretative phenomenological study

PURPOSE

While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people.

MATERIALS AND METHODS

Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18-49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis.

RESULTS

Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges.

CONCLUSIONS

The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.

A Review of Post-Stroke Cognitive Impairment and the Potential Benefits of Stingless Bee Honey Supplementation

Post-stroke cognitive impairment (PSCI) is a common decline in cognitive abilities that occurs within 3 months after a stroke. During recovery, stroke survivors often experience varying degrees of cognitive decline, with some patients experiencing permanent cognitive deficits. Thus, it is crucial to prioritise recovery and rehabilitation after a stroke to promote optimal protection of and improvement in cognitive function. Honey derived from stingless bees has been linked to various therapeutic properties, including neuroprotective effects. However, scientific evidence for the mechanisms through which these honey supplements enhance cognitive function remains limited. This narrative review aims to provide an overview of the causes of PSCI, current treatments, the biomarkers influencing cognition in post-stroke patients and the potential of stingless bee honey (SBH) as a neuroprotective agent against the progression of PSCI.

Analysis of ischemic stroke burden in Asia from 1990 to 2019: based on the global burden of disease 2019 data

Background

Ischemic stroke has the characteristics of high morbidity, mortality, and recurrence rate. This study aimed to describe and assess the burden of ischemic stroke in Asia based on the global burden of disease (GBD) 2019 data and provide a crucial scientific foundation for the prevention and control of this life-threatening disease.

Method

This study used the GBD 2019 data to assess the burden of ischemic stroke. The indicators used in this study were derived from the following methods: (i) the incidence of ischemic stroke was estimated using the disability model for the global burden of disease study-mixed effects regression (DisMod-MR), a Bayesian meta-regression disease modeling tool; (ii) the non-specific codes of all available data on mortality were corrected and used to estimate mortality rates for ischemic stroke and the cause of death ensemble model was used to estimate mortality rates; and (iii) the disability-adjusted life years (DALYs) is the sum of years lived with disability (YLD) and the years of life lost (YLL), which quantifies the health loss due to specific diseases and injuries. In addition, the joinpoint regression model was adopted to analyze the temporal trend of ischemic stroke from 1990 to 2019 in Asia.

Result

This study found an increase in the burden of ischemic stroke in 2019 compared to 1990. Moreover, the age-standardized incidence rate (ASIR) of ischemic stroke showed a gradual upward trend over the specific period. The age-standardized mortality rate (ASMR) showed a downward trend in Asia from 1990 to 2019. The burden of ischemic stroke was more concentrated on older age groups, particularly those older than 65 years. East Asia had the highest burden of ischemic stroke compared to other regions in Asia. Particularly, China, India, Indonesia, and Japan had the highest burdens of ischemic stroke among the Asian countries and regions. However, the population with the highest burden of ischemic stroke was still the elderly group.

Conclusion

Based on our study, it is evident that the burden of ischemic stroke exists substantially and exhibits variations in the aspects of age, gender, and geographical region in Asia. Without targeted implementation of population-wide primary strategies for prevention and control, the burden of ischemic stroke is likely to worsen significantly in the future.

Stroke analysis and recognition in functional near-infrared spectroscopy signals using machine learning methods

Stroke is a high-incidence disease with high disability and mortality rates. It is a serious public health problem worldwide. Shortened onset-to-image time is very important for the diagnosis and treatment of stroke. Functional near-infrared spectroscopy (fNIRS) is a noninvasive monitoring tool with real-time, noninvasive, and convenient features. In this study, we propose an automatic classification framework based on cerebral oxygen saturation signals to identify patients with hemorrhagic stroke, patients with ischemic stroke, and normal subjects. The reflected fNIRS signals were used to detect the cerebral oxygen saturation and the relative value of oxygen and deoxyhemoglobin concentrations of the left and right frontal lobes. The wavelet time-frequency analysis-based features from these signals were extracted. Such features were used to analyze the differences in cerebral oxygen saturation signals among different types of stroke patients and healthy humans and were selected to train the machine learning models. Furthermore, an important analysis of the features was performed. The accuracy of the models trained was greater than 85%, and the accuracy of the models after data augmentation was greater than 90%, which is of great significance in distinguishing patients with hemorrhagic stroke or ischemic stroke. This framework has the potential to shorten the onset-to-diagnosis time of stroke.

Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy

Introduction

For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors.

Methods

A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible.

Results

Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation).

Discussion

These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

Choroid plexus epithelium and its role in neurological diseases

Choroid plexus epithelial cells can secrete cerebrospinal fluid into the ventricles, serving as the major structural basis of the selective barrier between the neurological system and blood in the brain. In fact, choroid plexus epithelial cells release the majority of cerebrospinal fluid, which is connected with particular ion channels in choroid plexus epithelial cells. Choroid plexus epithelial cells also produce and secrete a number of essential growth factors and peptides that help the injured cerebrovascular system heal. The pathophysiology of major neurodegenerative disorders like Alzheimer's disease, Parkinson's disease, as well as minor brain damage diseases like hydrocephalus and stroke is still unknown. Few studies have previously connected choroid plexus epithelial cells to the etiology of these serious brain disorders. Therefore, in the hopes of discovering novel treatment options for linked conditions, this review extensively analyzes the association between choroid plexus epithelial cells and the etiology of neurological diseases such as Alzheimer's disease and hydrocephalus. Finally, we review CPE based immunotherapy, choroid plexus cauterization, choroid plexus transplantation, and gene therapy.

The Effect of Action Observation Combined with Motor Imagery Training on Upper Extremity Function and Corticospinal Excitability in Stroke Patients: A Randomized Controlled Trial

This study aimed to investigate the effect of motor imagery (MI) intervention with action observation (AO) on upper extremity function and corticospinal activation in stroke patients. MI and AO are two forms of motion simulation that activate the motor system without physical activity. There are many studies that show the effect of AO and MI alone, but there are few studies in parallel. This study was conducted on 45 patients who were divided into an experimental group (n = 22) and a control group (n = 23) using a computer randomization program. The experimental group conducted AO with MI, and the control group only AO. All participants received interventions for twenty-five minutes per session, five times a week, for eight weeks. For the pre- and post-evaluation of all participants, motor evoked potential (MEP) amplitude was measured to compare corticospinal activation, and Fugl-Meyer Assessment Upper Extremity (FMA UE), Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL) were evaluated for changes in upper extremity function. In comparing the amount of change before and after the intervention, a significant change was observed in the experimental group's MEP amplitude. In the comparison between groups after the intervention and the amount of change before and after the intervention, the experimental group showed significant changes in FMA UE and MAL Amount of Use (MAL AOU) items. As a result of this study, AO with MI is effective in enhancing upper extremity function and increasing cortical spinal cord activation in patients with severe stroke with limited movement.

Timing theory continuous nursing, resistance training: Rehabilitation and mental health of caregivers and stroke patients with traumatic fractures

BACKGROUND

Stroke is the leading cause of adult lifelong disability worldwide. A stroke is an acute cerebrovascular disease with a variety of causes and corresponding clinical symptoms. Around 75% of surviving stroke patients experience impaired nerve function, and some suffer from traumatic fractures, which can lead to special care needs.

AIM

To determine the effect of timing theory continuous care, with resistance training, on the rehabilitation and mental health of caregivers and stroke patients with traumatic fractures.

METHODS

Between January 2017 to March 2021, we selected 100 hospital admissions with post-stroke hemiplegia complicated with a traumatic fracture. Two participant groups were created: (1) Control group: given resistance training; and (2) Observation group: given timing theory continuous care combined with resistance training. The degree of satisfaction and differences in bone and phosphorus metabolism indexes between the two groups were compared. The self-perceived burden scale (SPBS) and caregiver burden questionnaire were used to evaluate the psychological health of patients and caregivers. The Harris hip function score, ability of daily living (ADL) scale, and global quality of life questionnaire (GQOL-74) were used to evaluate hip function, ability of daily living, and quality of life.

RESULTS

Data were collected prior to and after intervention. Alkaline phosphatase (ALP), osteocalcin, and vitamin D3 in the observation group and control group increased after intervention (P < 0.05), and carboxy-terminal peptide of type I collagen β Special sequence (β-CTX) decreased (P < 0.05). ALP and osteocalcin in the observation group were higher than in the control group (P < 0.05). There was no significant difference in β-CTX and vitamin D3 between the two groups (P > 0.05). The SPBS score of the observation group was lower and the ADL score was higher than the control group. The burden score was lower and the Harris hip function and GQOL-74 scores were higher than that of the control group (P < 0.05). The observation group’s satisfaction rating was 94.00%, which was higher than the rating from the control group (P < 0.05).

CONCLUSION

Timing theory continuous nursing with resistance training can reduce hip dysfunction in stroke patients with a traumatic fracture and enhance quality of life and mental health of patients and caregivers.

Global, Regional, and National Burden of Ischemic Stroke, 1990-2019

BACKGROUND AND OBJECTIVES

To our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. To examine ischemic stroke burdens at global, regional and national levels in terms of sex, age and social development index (SDI).

METHODS

Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and disability-adjusted life-years (DALY) trends of ischemic stroke. Measures were stratified by sex, region, country, age and SDI.

RESULTS

The global age-standardized incidence rate (ASIR) of ischemic stroke decreased from 1990 to 2019, with an EAPC of -0.43 [95% confidence interval (CI), -0.54 to -0.32]. High-middle and middle SDI regions had much higher ASIR, ASDR and age-standardized DALY rates due to ischemic stroke than other SDI regions. Regionally, East Asia had the highest ASIR of ischemic stroke in 2019 and the largest increase in the ASIR from 1990 to 2019. Nationally, Egypt (EAPC, 1.40; 95% CI, 1.27 to 1.52) and China (EAPC, 1.10; 95% CI, 1.00 to 1.20) had the most pronounced increases in the ASIR of ischemic stroke. Globally, there was an increase in ischemic stroke incidence with increasing age, especially in females aged 50-69 years or older. The global age-standardized death rate (ASDR) decreased from 1990 to 2019, with an EAPC of -1.63 (95% CI, -1.72 to -1.53). The ASDR and age-standardized DALY rates increased most in Southern sub-Saharan Africa, Eastern sub-Saharan Africa and Southeast Asia.

CONCLUSIONS

The ASIR, ASDR and the age-standardized DALY rates remained high in high-middle and middle SDI regions. East Asia, Southern sub-Saharan Africa, Eastern sub-Saharan Africa, and Southeast Asia had the greatest burden of ischemic stroke. Globally, females had a greater burden of ischemic stroke than males, especially those aged 50-69 years or older.