Stroke: a global response is needed

A review: From old drugs to new solutions: The role of repositioning in alzheimer's disease treatment

Drug repositioning or drug reprofiling, involves identifying novel indications for approved and previously abandoned drugs in the treatment of other diseases. The traditional drug discovery process is tedious, time-consuming, risky, and challenging. Fortunately, the inception of the drug repositioning concept has expedited the process by using compounds with established safety profiles in humans, and thereby significantly reducing costs. Alzheimer's disease (AD) is a severe neurological disorder characterized by progressive degeneration of the brain with limited and less effective therapeutic interventions. Researchers have attempted to identify potential treatment of AD from existing drug however, the success of drug repositioning strategy in AD remains uncertain. This article briefly discusses the importance and effectiveness of drug repositioning strategies, the major obstacles in the development of drugs for AD, approaches to address these challenges, and the role of machine learning in identifying early markers of AD for improved management.

Nontyphoidal salmonellosis is associated with an increased risk of stroke: Insights from multinational real-world data

BACKGROUND

Stroke is a significant cause of morbidity and mortality worldwide, contributing substantially to the global burden of disease. In low- and middle-income countries, stroke tends to occur at younger ages, with infection being one of the notable contributing factors. Previous studies have explored the impact of nontyphoidal Salmonella (NTS) on vascular and blood-related diseases, with animal experiments confirming related mechanisms. This study aims to investigate the association between NTS and cerebrovascular diseases (CVDs), with a focus on identifying specific patient populations more susceptible to stroke due to infection.

METHODS

This retrospective cohort study utilized the TriNetX database, including 4708 patients infected with NTS compared with a healthy population, with disease risk tracked over 6 months, 1 year, and lifelong periods. The primary outcome was CVDs (ICD-10-CM: I60-I69), while secondary outcomes examined hemorrhagic stroke (ICD-10-CM: I60-I62) and ischemic stroke (ICD-10-CM: I63). Subgroup analyses were conducted based on gender and age at index, with sensitivity analysis performed by comparing hospitalized patients, utilizing different databases, and evaluating the specificity of the NTS-CVD association by examining patients with a higher risk of acute myocardial infarction (AMI).

RESULTS

The lifelong hazard ratios (HRs) for cerebrovascular diseases (CVD), hemorrhagic stroke, and ischemic stroke following NTS infection were 1.606 (95% confidence interval (CI), 1.410-1.830), 1.866 (95% CI, 1.304-2.669), and 1.717 (95% CI, 1.385-2.130), respectively. A significant increase in the risk of hemorrhagic stroke was observed in the short term and mid-term, with HRs of 3.345 (95% CI, 1.091-10.259) and 2.816 (95% CI, 1.184-6.699), respectively. Subgroup analyses indicated statistically significant associations with the primary outcomes across all age groups. Males demonstrated a higher risk of hemorrhagic stroke, with an HR of 1.891 (95% CI, 1.142-3.310), whereas females exhibited a stronger association with ischemic stroke, with an HR of 1.592 (95% CI, 1.189-2.132). These associations remained significant among hospitalized patients, while no significant relationship was observed between NTS infection and AMI. The findings of this study were reproducible in a US-based database.

CONCLUSION

There is a significant association between NTS and CVD, with a particularly important impact on the occurrence of stroke in younger populations, especially regarding the elevated risk of hemorrhagic stroke.

Enhanced neuroplasticity and gait recovery in stroke patients: a comparative analysis of active and passive robotic training modes

BACKGROUND

Stroke is a leading cause of long-term disability, with lower limb dysfunction being a common sequela that significantly impacts patients' mobility and quality of life. Robotic-assisted training has emerged as a promising intervention for gait rehabilitation post-stroke. This study aims to compare the effects of active and passive lower limb robotic training on gait recovery in stroke patients.

METHODS

This randomized controlled trial included 45 stroke patients who were divided into three groups: active mode group, passive mode group, and control group. All participants received standard rehabilitation therapy, while the intervention groups additionally received 20 min of robotic training (active or passive mode) daily for 10 sessions over two weeks. Outcome measures included the Fugl-Meyer Assessment (FMA) for motor function, motor evoked potentials (MEP) for neurophysiological assessment, and functional near-infrared spectroscopy (fNIRS) for brain imaging.

RESULTS

Both active and passive groups showed significant improvements in FMA scores and MEP measures compared to pre-treatment baselines (P < 0.01). The active group exhibited significantly greater FMA score improvements (P = 0.02) and MEP amplitudes (P < 0.01) than the passive group. Additionally, fNIRS results indicated significantly enhanced brain activation in the affected motor cortex in the active group post-treatment (F = 5.82, P = 0.026), a change not observed in the passive group. These findings underscore the clinical superiority of active robotic training in enhancing motor recovery post-stroke.

CONCLUSION

Active mode robotic training is more effective than passive mode training in improving motor function and neurophysiological outcomes in stroke patients. These findings support the preferential use of active mode robotic training in clinical rehabilitation settings for enhancing gait recovery post-stroke. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these results and explore long-term benefits.

Evaluating the Neuroprotective Effects of the Novel Kv2.1 Blocker Zj7923 against Ischemic Stroke In Vitro and In Vivo

The voltage-dependent potassium channel Kv2.1 correlates closely to the regulation of neuronal excitability and cellular apoptosis. Ischemia or oxidative treatment were known to stimulate the surge of Kv2.1-mediated current to activate neuronal apoptosis pathways, while inhibiting excessive Kv2.1 K+ current efflux could reduce neuronal apoptosis and exhibit neuroprotective effects. Here, we found a novel Kv2.1 selective blocker Zj7923 and investigated whether it produces neuroprotective function after ischemic stroke animal model. We demonstrate that Zj7923 potently inhibits Kv2.1 current with an IC50 of 0.12 μM. Zj7923 had no obvious effect on the activation process of Kv2.1 channels, but could significantly accelerate the inactivation process of Kv2.1 channels. The mutations at Y380 and K356 in the outer vestibule of Kv2.1 channels weakened the inhibitory effect of Zj7923, and the IC50 value of Zj7923 on the mutation channels increased to 3.66 μM and 3.20 μM, respectively, indicating that the compound may act on the above two positions. Zj7923 could increase the spontaneous firing rate of normal hippocampal pyramidal neurons and ameliorate OGD-induced impairment of neuronal excitability. Kv2.1 channel inhibition by Zj7923 provides protection against DTDP-induced apoptosis and its mechanism might be related to the modulation of the expression of apoptosis-related proteins, such as Bcl-2, Bax and cleaved caspase-3 proteins. In vivo pharmacodynamics evaluation, intravenous administration of Zj7923 in rats following transient middle cerebral artery occlusion significantly reduced infarct volume and improved neurological deficits. Our results indicate that Zj7923 exerts a neuronal protection from cerebral ischemia in vitro and in vivo by inhibiting Kv2.1 current and validate the potential value of developing drugs targeting Kv2.1 for ischemic stroke.

Role and Relationship Between Homocysteine and H2S in Ischemic Stroke

Homocysteine (Hcy), a sulfur-containing amino acid, is an important intermediate product of methionine metabolism. Hcy can be either metabolized to cysteine, a precursor for glutathione synthesis and hydrogen sulfide (H2S) production, or regenerated back to methionine. Besides, the Hcy metabolism is central to supply methyl groups, which are essential for DNA methylation. In the transsulfuration pathway of Hcy metabolism, Hcy is metabolized to form cysteine and H2S by catalytic enzymes, containing cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE). Hcy metabolism-related enzymes and coenzymes, such as vitamin B6, vitamin B12, and folic acid, are closely related to hyperhomocysteinemia (HHcy), which is frequently accompanied by reduced H2S content. An accumulating study has revealed that HHcy is a risk factor for ischemic stroke, while H2S, served as a gaseous mediator at the physiological level, has protective effects against ischemic stroke. This review outlined the literature data from recent research related to Hcy metabolism and H2S production and described the roles and relationship among Hcy metabolism and H2S in ischemic stroke.

The relationship between fibrous cap status or plaque surface morphology and intraplaque hemorrhage volume over time: The PARISK Study

BACKGROUND

Carotid intraplaque hemorrhage (IPH) is a strong predictor of stroke, but factors contributing to IPH development are incompletely understood. Therefore, we investigate the longitudinal relationship between a thin/ruptured fibrous cap (TRFC)/disrupted plaque surface and IPH volume.

METHODS

116 ischemic TIA/stroke patients with ipsilateral carotid plaques underwent baseline and two-year follow-up MRI. IPH and fibrous cap status (thick versus TRFC) on MRI and disruption of the plaque surface (smooth versus fissure/ulceration) on CTA were assessed.

RESULTS

In the TRFC and disrupted plaque surface groups, the median IPH volume (tended) to decrease during follow-up (baseline: 97.3 IQR: [3.2-193.3] mm3 versus follow-up: 29.7 [0.0-115.1] mm3, p = 0.09, and baseline: 25.1 [0.0-166.2] mm3 versus follow-up: 11.2 [0.0-68.3] mm3, p = 0.04, respectively). In the group with a thick fibrous cap/smooth plaque surface, the median IPH volumes were zero at baseline and follow-up. The risk of IPH progression was higher in the TRFC/disrupted plaque groups (risk ratio (RR): 2.9 and 2.0, respectively) than in patients with a thick fibrous cap/smooth plaque surface.

CONCLUSION

TIA/stroke patients with a TRFC/disrupted plaque showed a net decrease in IPH volume over time, indicating plaque healing in some patients, but patients with a TRFC/disrupted plaque are still at increased risk for IPH progression.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01208025.

Stroke incidence, trends, and geographic disparities in Ghana: An analysis of nationwide health facility records

OBJECTIVES

Despite the increasing burden of stroke and its effects in sub-Saharan Africa, there is a paucity of empirical studies on the burden of stroke and its risk factors to help guide targeted interventions in the region. This study examines the incidence, trends and some factors associated with stroke cases in Ghana.

STUDY DESIGN

Retrospective analysis of observational routinely collected data.

METHODS

Empirical data of confirmed stroke cases from all government-affiliated healthcare facilities were extracted from the District Health Information Management Systems of the Ghana Health Service spanning 2016-2021. Variables include stroke case counts by sex, age group and location. Cartographic geospatial mapping of stroke case density and negative binomial regressions were employed to assess trends and factors associated with stroke.

RESULTS

Stroke cases increased by more than two-fold in just six years (from 10,732 to 23,009). The rates for people 35-59years (IRR = 5.06, 95% CI: 4.04-6.63) and those above 60 years (IRR = 6.29, 95% CI: 5.01-7.88) were 5 and 6 times higher compared with 0-35year old. The rate of stroke in the year 2021 was 61 % higher than in 2016 (IRR = 1.61, 95% CI: 1.18-2.21). People in the northern savannah ecological zone had 77 % lower rate of stroke compared with those in the coastal zone of Ghana (IRR = 0.23, 95% CI: 0.18-0.30).

CONCLUSIONS

The incidence of stroke in Ghana is rising across all age groups, sexes and locations with a trajectory of early onset within the life course. There is an urgent need for the implementation of public health interventions for early detection, prevention and management of stroke cases in the country.

Time-series atlases of the rat brain after middle cerebral artery occlusion using FDG-PET images

The middle cerebral artery occlusion (MCAO) procedure is widely used in ischemic stroke research. When using functional 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) images to study ischemic stroke, the difficulty in determining the region of interest (ROI) comes from two aspects: the large variations due to differences in uptake and reaction time and the consistency of different intensity normalization methods among subjects. Using the rat as a model animal, we propose time-series atlases of ischemic stroke after MCAO based on the PET images to annotate changes in ROIs. Concretely, we spatially align serial scans with a built PET template, use histograms of orientated gradient (HOG) features to detect lesion boundaries, and combine them with results from an intensity-based detection method to construct probability maps at different time points with the Bernoulli mixture model (BMM). Simulated PET images with known ground truth and triphenyl tetrazolium chloride (TTC) staining slices validate the correctness of the time-series atlases. We demonstrate that these atlases could provide references when tracking the spatial-temporal dynamic development of lesions in rat brains.

Determining the Prioritization of Behavior Change Techniques for Long-Term Stroke Rehabilitation: Delphi Survey Study

Background

Stroke results in both physical disability and psychological distress. The impact can be minimized through rehabilitation, but it is a long-term process, making it difficult for patients to adhere to treatment. Thus, a better understanding of long-term behavior change interventions for patients with stroke is needed as well as how such interventions can support not only rehabilitation of motoric functions but also mental well-being.

Objective

The aim of this study is to understand both the most important behavior change technique (BCT) clusters for long-term stroke rehabilitation in general as well as which are most relevant for each aspect of stroke rehabilitation: behavioral, cognitive, and emotional.

Methods

We applied the 16 BCT clusters. The study used a 2-round Delphi survey, as reliable consensus was obtained among a group of 12 international experts. Experts represented three main backgrounds involved in behavioral intervention in the health context: (1) specialists in behavioral science (n=4), (2) behavioral designers (n=4), and (3) expert health care professionals (n=4). Experts were brought together in this way for the first time. In the first round, web-based questionnaires were used to collect data from the experts. This was followed by a personalized second round. Consensus was determined by statistically aggregating the responses and evaluating IQR and percentage consensus. BCT clusters reaching consensus (IQR ≤1 and percentage ≥50%) were then ranked.

Results

In total, 12 of 16 BCT clusters reached consensus for general importance in stroke rehabilitation, with 11, 9, and 6 BCT clusters achieving consensus for, respectively, the behavioral, cognitive, and emotional aspects of rehabilitation. The overall most relevant BCT clusters were repetition and substitution, social support, feedback and monitoring, and self-belief, with similar outcomes for behavioral and cognitive rehabilitation. For emotional rehabilitation, social support and identity were emphasized. The least relevant BCT clusters were natural consequences, covert learning, and comparison of behavior.

Conclusions

This expert panel study using a 2-round Delphi survey ranked the importance of BCT clusters for long-term stroke rehabilitation. The process yielded a number of novel insights highlighting differences in importance between general rehabilitation and that specifically focused on the behavioral, cognitive, and emotional aspects of stroke recovery. This provides a first but important step toward unlocking the prioritization of BCT clusters for long-term intervention contexts such as stroke rehabilitation and enables effective intervention mapping addressing long-term behavior change and treatment adherence.

Large vessel occlusion identification network with vessel guidance and asymmetry learning on CT angiography of acute ischemic stroke patients

Identifying large vessel occlusion (LVO) is of significant importance for the treatment and prognosis of acute ischemic stroke (AIS) patients. CT Angiography (CTA) is commonly used in LVO identification due to its visibility of vessels and short acquisition time. It is challenging to make LVO identification methods focus on vascular regions without vessel segmentation while accurate vessel segmentation is difficult and takes more time. Meanwhile, most existing methods fail to effectively integrate clinical prior knowledge. In this work, we propose VANet, a novel LVO identification network which utilizes coarse-grained vessel feature for feature enhancement and learns asymmetry of two brain hemispheres on CTA of AIS patients. Firstly, we reconstruct 3D CTA scans into 2D based on maximum intensity projection (MIP) to reduce computational complexity and highlight vessel information. Secondly, we design a coarse-grained vessel aware module based on simple edge detection and morphological operations to acquire coarse-grained vessel feature without precise vessel segmentation. Thirdly, we design a vessel-guided feature enhancement that directs the model's attention to vessel areas in the images by utilizing coarse-grained vessel feature. Finally, inspired by the clinical knowledge that LVO can lead to asymmetry in brain, we design an asymmetry learning module utilizing deep asymmetry supervision to keep the patients' inherent asymmetry invariant and using asymmetry computing to acquire effective asymmetry features. We validate the proposed VANet on our private internal and external AIS-LVO datasets which contain 366 and 81 AIS patients, respectively. The results indicate that our proposed VANet achieves an accuracy of 94.54% and an AUC of 0.9685 on the internal dataset, outperforms 11 state-of-the-art methods (including general classification methods and LVO-specific methods). Besides, our method also achieves the best accuracy of 88.89% and AUC of 0.9111 when compared to 11 methods on the external test dataset, implying its good generalization ability. Interpretability analysis shows that the proposed VANet can effectively focus on vascular regions and learn asymmetry features.

Experiences of Non-Family Paid Helpers Providing Palliative Care to Stroke Patients: The Toll of Professional Informal Caregiving in a Job Lacking Recognition

Background: Employing non-family paid helpers has become a prevalent practice across North America, Europe, and Asia, which families adopt to alleviate the stroke care burden, allowing family to take a break from their obligations and perform other social activities. However, paid helpers' experiences of providing palliative care to stroke patients are under-explored. This study aimed to explore the caregiving experiences of non-family paid helpers providing palliative care to stroke patients. Method: A qualitative descriptive study was undertaken using purposive sampling and semi-structured individual in-depth interviews. Thematic analysis was used for data analysis. Results: Seventeen participants (mean age: 51.23 years) were included, predominantly being female (88%), and their caregiving experiences with patients ranged from four to 26 years. Participants shared that monetary compensation offset the exhaustion, familial and health sacrifices of palliative caregiving. They emphasized emotional self-management through accepting and coping or avoiding and distancing, and appreciated rewarding appraisals from stroke patients and family members. They also expressed a lack of recognition from the public, being invisible to the healthcare system/professionals, and insecurity in employment rights. Conclusions: Findings support the need for governmental initiatives to subsidize families in employing helpers to provide palliative care. Helpers perceived monetary compensation and a reciprocal caregiving relationship as the primary motives for providing care. Public recognition of this role as a helper in caregiving, contractual employment rights, and being recognized by the healthcare system and healthcare professionals are considerations in promoting quality care and alleviating a health care burden. The findings may contribute to further understanding of the experiences of non-family paid helpers in a job lacking recognition when delivering palliative care in a hospital for stroke patients. Evidence-based interventions that enhance reciprocity and recognition should be considered as part of the global initiatives to support paid helpers in palliative care.

Single-Cell Transcriptomes of Immune Cells from Multiple Compartments Redefine the Ontology of Myeloid Subtypes Post-Stroke

The activation and infiltration of immune cells are hallmarks of ischemic stroke. However, the precise origins and the molecular alterations of these infiltrating cells post-stroke remain poorly characterized. Here, a murine model of stroke (permanent middle cerebral artery occlusion [p-MCAO]) is utilized to profile single-cell transcriptomes of immune cells in the brain and their potential origins, including the calvarial bone marrow (CBM), femur bone marrow (FBM), and peripheral blood mononuclear cells (PBMCs). This analysis reveals transcriptomically distinct populations of cerebral myeloid cells and brain-resident immune cells after stroke. These include a novel CD14+ neutrophil subpopulation that transcriptomically resembles CBM neutrophils. Moreover, the sequential activation of transcription factor regulatory networks in neutrophils during stroke progression is delineated, many of which are unique to the CD14+ population and underlie their acquisition of chemotaxis and granule release capacities. Two distinct origins of post-stroke disease-related immune cell subtypes are also identified: disease inflammatory macrophages, likely deriving from circulating monocytes in the skull, and transcriptionally immature disease-associated microglia, possibly arising from pre-existing homeostatic microglia. Together, a comprehensive molecular survey of post-stroke immune responses is performed, encompassing both local and distant bone marrow sites and peripheral blood.

Motor Cortex Activation Patterns in Both Hemispheres Induced by Motor Imagery in Patients With Right- and Left-Sided Cerebral Infarction: An fNIRS Study

This study aimed to explore the neuroimaging basis of motor imagery (MI) in stroke rehabilitation, particularly focusing on the brain activation patterns during MI tasks. Additionally, this study may provide insights into clinical rehabilitation strategies. A total of 40 right-handed stroke patients from Zhejiang Rehabilitation Medical Center were assigned to either the right-sided or left-sided cerebral infarction group. They were right-handed and recruited from Zhejiang Rehabilitation Medical Center. A portable near-infrared brain function imaging system was used to detect changes in oxyhemoglobin concentration in the bilateral sensorimotor cortex, premotor cortex, and supplementary motor area during the MI task. Activated channels and intensity changes in brain regions under the MI state were observed and analyzed. In patients with right-sided cerebral infarction, brain activation was left-lateralized during both left- and right-limb MI. Patients with left-sided cerebral infarction exhibited left lateralization during right-limb MI and right lateralization during left-limb MI. Functional near-infrared spectroscopy was utilized to investigate the activation of motor-related brain regions during MI after stroke. These regions of interest were associated with hand motor tasks and were successfully activated during the MI task. Following infarction, the activation of the MI cortex was asymmetric. When imagining movements on the dominant-hand side, MI becomes more vivid and activates bilateral motor cortex areas.

Systematic Review of Upper Extremity Outcome Measures Assessed in Randomized Controlled Trials of Poststroke Upper Extremity Rehabilitation in Low-to-Middle-Income and High-Income Countries

OBJECTIVE

To systematically review randomized controlled trials (RCTs) of poststroke upper extremity (UE) motor rehabilitation interventions to identify the outcome measures used in studies in low-to-middle-income countries (LMICs) and high-income countries (HICs) and describe the differences in the context of the International Classification of Functioning, Disability and Health.

DATA SOURCES

Five databases "Embase, PubMed, CINAHL, Scopus, and Web of Science" were searched from 1960 to April 1, 2021.

STUDY SELECTION

Studies were included if they were (1) RCTs or RCT crossovers in English; (2) with ≥50% participants affected by ischemic/hemorrhagic stroke; (3) participants aged ≥18 years; and (4) used an intervention for the hemiparetic UE as the primary objective of the study.

DATA EXTRACTION

Title and abstract screening and full-text studies were reviewed, and data for included studies were extracted by two independent investigators. The study quality was assessed using the Physiotherapy Evidence Database scale. Data analyses were performed using SPSS (V29.0).

DATA SYNTHESIS

Of 5408 records, 1276 RCTs were eligible, 298 RCTs were conducted in LMICs and 978 in HICs. A higher percentage of RCTs in LMICs employed body structure and function outcome measures for central nervous system (eg, Fugl-Meyer Assessment) and tone and range of motion (eg, modified Ashworth Scale) as well as activity outcome measures for general activities of daily living (eg, Barthel Index). In HICs, a higher percentage of RCTs used body structure and function outcome measures assessing strength (eg, Motricity Index), activity outcome measures examining motor specific activity (eg, Action Research Arm Test and Wolf Motor Function Test) and dexterity (eg, Box and Block Test), as well as participation outcome measures (eg, Stroke Impact Scale).

CONCLUSIONS

There were significant differences in the outcome measures chosen for assessing poststroke UE rehabilitation interventions by researchers in LMICs and HICs. This suggests that there might be potential resource and expertise as well as timing constraints that influences the choice of outcome measures in RCTs between HICs and LMICs and highlights the need for investigating the availability of resources, infrastructure, and expertise and their effect on the feasibility and practicality of employing different outcome measures in different countries.

Signal Characteristics, Motor Cortex Engagement, and Classification Performance of Combined Action Observation, Motor Imagery and SSMVEP (CAMS) BCI

Motor imagery (MI)-based Brain-Computer Interfaces (BCIs) have shown promise in engaging the motor cortex for recovery. However, individual responses to MI-based BCIs are highly variable and relatively weak. Conversely, combined action observation (AO) and motor imagery (MI) paradigms have demonstrated stronger responses compared to AO or MI alone, along with enhanced cortical excitability. In this study, a novel BCI called Combined AO, MI, and Steady-State Motion Visual Evoked Potential (SSMVEP) (CAMS) was proposed. CAMS was designed based on gait observation and imagination. Twenty-five healthy volunteers participated in the study with CAMS serving as the intervention and SSMVEP checkerboard as the control condition. We hypothesized the CAMS intervention can induce observable increases in the negativity of the movement-related cortical potential (MRCP) associated with ankle dorsiflexion. MRCP components, including Bereitschaftspotential, were measured pre- and post-intervention. Additionally, the signal characteristics of the visual and motor responses were quantified. Finally, a two-class visual BCI classification performance was assessed. A consistent increase in negativity was observed across all MRCP components in signals over the primary motor cortex, compared to the control condition. CAMS visual BCI achieved a median accuracy of 83.8%. These findings demonstrate the ability of CAMS BCI to enhance cortical excitability in relation to movement preparation and execution. The CAMS stimulus not only evokes SSMVEP-like activity and sensorimotor rhythm but also enhances the MRCP. These findings contribute to the understanding of CAMS paradigm in enhancing cortical excitability, consistent and reliable classification performance holding promise for motor rehabilitation outcomes and future BCI design considerations.

Efficacy and safety of brain-computer interface for stroke rehabilitation: an overview of systematic review

Background

Stroke is a major global health challenge that significantly influences public health. In stroke rehabilitation, brain-computer interfaces (BCI) offer distinct advantages over traditional training programs, including improved motor recovery and greater neuroplasticity. Here, we provide a first re-evaluation of systematic reviews and meta-analyses to further explore the safety and clinical efficacy of BCI in stroke rehabilitation.

Methods

A standardized search was conducted in major databases up to October 2024. We assessed the quality of the literature based on the following aspects: AMSTAR-2, PRISMA, publication year, study design, homogeneity, and publication bias. The data were subsequently visualized as radar plots, enabling a comprehensive and rigorous evaluation of the literature.

Results

We initially identified 908 articles and, after removing duplicates, we screened titles and abstracts of 407 articles. A total of 18 studies satisfied inclusion criteria were included. The re-evaluation showed that the quality of systematic reviews and meta-analyses concerning stroke BCI training is moderate, which can provide relatively good evidence.

Conclusion

It has been proven that BCI-combined treatment can improve upper limb motor function and the quality of daily life for stroke patients, especially those in the subacute phase, demonstrating good safety. However, its effects on improving speech function, lower limb motor function, and long-term outcomes require further evidence. Multicenter, long-term follow-up studies are needed to increase the reliability of the results.

Clinical Trial Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024562114, CRD42023407720.

Safety and Efficacy of Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery

PURPOSE

Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is less established than for large vessel occlusions. This study evaluates the safety and efficacy of MT in DMVOs, comparing it with M1-segment occlusions.

MATERIALS AND METHODS

This retrospective study analyzed 218 patients who underwent MT for isolated M1 (n=123) or distal M2+M3 (n=35) occlusions between January 2020 and August 2023. Outcomes included procedural complications, hemorrhagic events, reperfusion rates, and clinical severity and disability at admission and discharge. Multivariate logistic regression identified predictors of favorable outcomes (modified Rankin Scale≤2) at discharge.

RESULTS

Median admission National Institutes of Health Stroke Scale (NIHSS) scores were higher in the M1 group (13, interquartile range [IQR]: 8) compared to the distal M2+M3 group (8, IQR: 7; P<0.001), with significant improvements at discharge in both groups (6 [IQR: 8] for M1 and 2.5 [IQR: 5] for M2+M3; P=0.025). Favorable outcomes were more frequent in the M2+M3 group (50.0%) compared to M1 (28.1%; P=0.023). Recanalization rates (modified Thrombolysis in Cerebral Infarction≥2b) were excellent (>90% in both groups; P=0.300). Procedural complications were rare, with vessel perforations occurring infrequently (M1: 1.6%; M2+M3: 2.9%; P=0.531). Symptomatic intracranial hemorrhage rates were similarly low (2.4% vs. 2.9%; P=0.889). Multivariate analysis identified younger age (P=0.045) and lower NIHSS (P=0.061) as predictors of favorable outcomes in distal occlusions.

CONCLUSION

MT is safe and effective for DMVOs of the MCA, demonstrating significant improvements in clinical outcomes and comparable complication rates to MT for M1-segment occlusions. Given the typically less severe presentations in DMVO and similar risk profiles, careful patient selection and individualized treatment remain critical.

Self-rehabilitation strategy for rural community-dwelling stroke survivors in a lower-middle income country: a modified Delphi study

BACKGROUND

More than half of stroke survivors in lower-middle income countries lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising for addressing stroke rehabilitation inadequacies in lower-middle income countries. Self-rehabilitation interventions are more readily acceptable to community-dwelling stroke survivors, and therefore, have the potential to boost the successful realization of the Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus-building process that sought to identify which task trainings are relevant to include in a task-specific self-rehabilitation strategy for rural community-dwelling stroke survivors.

METHODS

An iterative two-stage mixed-method consensus-building approach was used: (1) focus group discussions (n =  5) with rural community-dwelling chronic stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to develop a list of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability of survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items given a rating of 3 (quite relevant) or 4 (highly relevant) by expert panellists is ≥  0.8. Kendall's coefficient of concordance (W) was used to assess the level of agreement among the expert panellists.

RESULTS

A list of 74 task trainings was generated from the results of the focus group discussions involving 29 chronic stroke survivors. The tasks were classified as follows: training for the upper extremity (37); lower extremity training (21); trunk training (7); and balance training (9). A panel of 13 stroke rehabilitation experts reviewed these task trainings using the Delphi method and consensus was reached on keeping 28 task trainings in the first round (Kendall's W =  0.252, p <  0.001) and an additional 7 in the second round (Kendall's W =  0.409, p <  0.001). In the study team's analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 task trainings (66% of 74) on which there was consensus (the mean proportion of items given a rating of 3 or 4 by panellists was 0.93; Kendall's W =  0.291, p <  0.001) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) as well as warm up exercises (10).

CONCLUSION

The study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among rural community-dwelling stroke survivors, especially in sub-Saharan Africa.

Virtual Reality Enhanced Exercise Training in Upper Limb Function of Patients With Stroke: Meta-Analytic Study

BACKGROUND

Recovery of upper limb function after stroke secondary to ischemia or hemorrhage is crucial for patients' independence in daily living and quality of life. Virtual reality (VR) is a promising computer-based technology designed to enhance the effects of rehabilitation; however, the results of VR-based interventions remain equivocal.

OBJECTIVE

This study aims to review the plausible factors that may have influenced VR's therapeutic effects on improving upper limb function in patients with stroke, with the goal of synthesizing an optimal VR intervention protocol.

METHODS

The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published from May 2022 onward. Two reviewers independently extracted data from the included papers, and discrepancies in their findings were resolved through consensus during joint meetings. The risk of bias was assessed using the Physiotherapy Evidence Database Scale and the Methodological Index for Non-Randomized Studies. Outcome variables included the Action Research Arm Test, Box-Block Test, Functional Independence Measure, Upper Extremity Fugl-Meyer Assessment, and Wolf Motor Function Test. The plausible factors examined were age, total dosage (hours), trial length (weeks), session duration (hours/session), frequency (sessions/week), and VR content design. The Bonferroni adjustment was applied to P values to prevent data from being incorrectly deemed statistically significant.

RESULTS

The final sample included 15 articles with a total of 1243 participants (age range 48.6-75.59 years). Participants in the VR therapy (VRT) group (n=455) demonstrated significantly greater improvements in upper limb function and independence in activities of daily living compared with those in the conventional therapy group (n=301). Significant factors contributing to improved outcomes in upper limb function were younger age (mean difference [MD] 5.34, 95% CI 2.18-8.5, P<.001; I2=0%), interventions lasting more than 15 hours (MD 9.67, 95% CI 4.19-15.15, P<.001; I2=0%), trial lengths exceeding 4 weeks (MD 4.02, 95% CI 1.39-6.65, P=.003; I2=15%), and more than 4 sessions per week (MD 3.48, 95% CI 0.87-6.09, P=.009; I2=0%). However, the design of the VR content, including factors such as the number of features (eg, offering exercise and functional tasks; individualized goals; activity quantification; consideration of comorbidities and baseline activity level; addressing patient needs; aligning with patient background such as education level; patient-directed goals and interests; goal setting; progressive difficulty levels; and promoting self-efficacy), did not demonstrate significant effects (MD 3.89, 95% CI -6.40 to 1.09; effect Z=1.36, P=.16).

CONCLUSIONS

Greater VR effects on improving upper limb function in patients with stroke were associated with higher training doses (exceeding 15 hours) delivered over 4-6 weeks, with shorter sessions (approximately 1 hour) scheduled 4 or more times per week. Additionally, younger patients appeared to benefit more from the VR protocol compared with older patients.

Progress in the application of motor imagery therapy in upper limb motor function rehabilitation of stroke patients with hemiplegia

Stroke is the leading cause of disability in Chinese adults. Upper limb motor dysfunction is a common manifestation of neurological dysfunction after stroke and can exert significant effects on a patient's daily living ability and quality-of-life. Therefore, it is crucial to provide appropriate rehabilitation treatment for upper limb motor function in stroke patients with hemiplegia. Currently, rehabilitation treatment for upper limb motor function in hemiplegic stroke patients in China includes motor therapy, neuro-promoting technology, occupational therapy, physical factor intervention, speech therapy, and swallowing therapy. Motor imagery therapy has also been shown to effectively promote the rehabilitation of upper limb function in stroke patients. Here, we review the concept, classification, mechanism of action, application, and effect of motor imagery therapy for the rehabilitation of upper limb motor function in stroke patients with hemiplegia in China. We summarize the available evidence, arising from Chinese experience, to support the implementation of this method in medical and rehabilitation institutions.

Acceptability of Telerehabilitation Among Stroke Survivors in Nigeria

BackgroundThe Covid-19 pandemic has accelerated the adoption of telerehabilitation as a tool to overcome geographical barriers, scarcity of care providers, and improve access to rehabilitation services. However, limited studies exist on its acceptability among care recipients particularly in low-and-middle-income countries.ObjectiveThis mixed-methods study explored the perception and acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria.MethodsA convenient sample of 44 stroke survivors was surveyed, and six participated in a focus group discussion (FGD). Quantitative data was analyzed using inferential statistics at p < 0.05. Qualitative data was thematically analysed.ResultsParticipants (61.4% males) were aged 60.93 ± 13.10 years. 19(43.3%) of them were favorably disposed to receiving treatment via telerehabilitation. Acceptability differed significantly across marital status, level of education, and socioeconomic status (p < 0.05). Qualitative findings indicated positive perceptions, although participants preferred telerehabilitation as an adjunct to face-to-face physiotherapy. Barriers included unstable internet connectivity, high costs of data, and lack of personal contact with physiotherapists. Facilitators included using telerehabilitation for additional or missed sessions, and the provision of necessary equipment and data by the government.ConclusionOur findings revealed limited acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria. This underscores the need to address the identified concerns and barriers, to enhance acceptability. A contextualized and multifaceted approach can help create awareness about the effectiveness of telerehabilitation and improve its acceptability.

A Data-Informed Mathematical Model of Microglial Cell Dynamics During Ischemic Stroke in the Middle Cerebral Artery

Neuroinflammation immediately follows the onset of ischemic stroke in the middle cerebral artery. During this process, microglial cells are activated in and recruited to the penumbra. Microglial cells can be activated into two different phenotypes: M1, which can worsen brain injury; or M2, which can aid in long-term recovery. In this study, we contribute a summary of experimental data on microglial cell counts in the penumbra following ischemic stroke induced by middle cerebral artery occlusion (MCAO) in mice and compile available data sets into a single set suitable for time series analysis. Further, we formulate a mathematical model of microglial cells in the penumbra during ischemic stroke due to MCAO. Through use of global sensitivity analysis and Markov Chain Monte Carlo (MCMC)-based parameter estimation, we analyze the effects of the model parameters on the number of M1 and M2 cells in the penumbra and fit identifiable parameters to the compiled experimental data set. We utilize results from MCMC parameter estimation to ascertain uncertainty bounds and forward predictions for the number of M1 and M2 microglial cells over time. Results demonstrate the significance of parameters related to M1 and M2 activation on the number of M1 and M2 microglial cells. Simulations further suggest that potential outliers in the observed data may be omitted and forecast predictions suggest a lingering inflammatory response.

A review of the Bovis Calculus's intervention mechanism and clinical application in ischemic stroke

Background

Bovis Calculus (BC), also named Niuhuang in Chinese, is utilized as a resuscitation drug in Traditional Chinese Medicine (TCM) for the treatment of neurological disorders. Ischemic stroke (IS) is a significant global public health issue that currently lacks safe and effective therapeutic drugs. Ongoing efforts are focused on identifying effective treatment strategies from Traditional, Complementary, and Integrative Medicine. Noticeably, BC has been used in TCM for thousands of years to prevent or treat IS-related diseases.

Methods

The historical origins of BC in the treatment of IS were investigated through the examination of ancient Chinese medical texts. Furthermore, the chemical components of BC were analyzed, and its mechanisms of action against IS were summarized using literature sourced from databases such as Web of Science, PubMed, and China National Knowledge Infrastructure. Information on Chinese medicine preparations and clinical reports was also integrated to provide an overview of modern applications and safety considerations.

Results

BC mainly includes chemical components such as bile pigments, bile acids, cholesterol, proteins amino acids, and trace elements. Additionally, the efficacy of BC in treating cerebral ischemia/reperfusion injury (CI/RI) is certain, particularly due to the components of bile pigments, bile acids, and amino acids that can interfere with the enzymatic cascade reaction of CI/RI through multiple components, targets, and pathways. The active components of BC exert neuroprotective effects by reducing microcirculation disturbance, excitatory amino acid toxicity, and oxidative stress injury in the acute stage; inhibiting inflammatory injury, apoptosis, and blood-brain barrier (BBB) disruption in the subacute stage; and promoting angiogenesis and neurogenesis in the restoration stage. Furthermore, as a crude drug, BC appears in many Chinese patent medicine (CPM) preparations for the treatment of IS, and clinical and preclinical studies have proved its safety.

Conclusion

The use of BC in the treatment of IS has a long history, proven efficacy, and widespread application. Future efforts should focus on elucidating its mechanisms of action and exploring its applications.

Application of metagenomic next-generation sequencing in the diagnosis of post-stroke infections: a case series study using multiple sample types

Background

Metagenomic high-throughput sequencing (mNGS) represents a powerful tool for detecting nucleic acids from various pathogens, such as bacteria, fungi, viruses and parasites, in clinical samples. Despite its extensively employed in the pathogen diagnosis for various infectious diseases, its application in diagnosing stroke-related infection, and its potential impact on clinical decision-making, anti-infection treatment, clinical intervention, and patient prognosis remain insufficiently explored. Additionally, while mNGS offers promising potential, it facts limitations related to sensitivity, specificity, cost, and standardization, which could influence its integration into routine clinical practice.

Methods

We retrospectively analyzed 18 stroke patients admitted to the First Affiliated Hospital of Medical College of Shantou University from January to February 2023, comparing culture-based methods with mNGS detection, and assessing its significance in etiological diagnosis. Additionally, we evaluated the performance differences among various sequencing platforms.

Results

Among the 18 stroke patients enrolled, pulmonary infections were identified in 7 cases, urinary tract infections in 1 case, central nervous system infections in 10 cases, and combined pulmonary and central nervous system infections in 2 cases, with 2 cases yielding negative results. mNGS detected pathogens in 13 cases, aligning with clinical diagnoses (75% concordance), whereas culture-based methods yielded positive results in only 6 cases (22% concordance). Importantly, for 9 of the 18 patients, adjustments to anti-infective treatment regimens based on mNGS results led to improved symptomatic relief and infection control. This suggests that mNGS can contribute to more timely and precise treatment modifications, particularly for infections with low pathogen loads, potentially enhancing clinical outcomes.

Conclusion

Our findings highlights the utility of mNGS in diagnosing stroke-associated infections by providing a more comprehensive etiological diagnosis compared to traditional method. While mNGS shows promise in enhancing diagnostic accuracy and guiding clinical treatment, it high cost and technical challenges need addressing before widespread clinical adoption. Future research should focus on optimizing mNGS protocols, integration it with convertional diagnostic tools, and evaluating its cost-effectiveness and clinical impact through larger, multicentric studies.

The mitochondria as a potential therapeutic target in cerebral I/R injury

Ischemic stroke is a major cause of mortality and disability worldwide. Among patients with ischemic stroke, the primary treatment goal is to reduce acute cerebral ischemic injury and limit the infarct size in a timely manner by ensuring effective cerebral reperfusion through the administration of either intravenous thrombolysis or endovascular therapy. However, reperfusion can induce neuronal death, known as cerebral reperfusion injury, for which effective therapies are lacking. Accumulating data supports a paradigm whereby cerebral ischemia/reperfusion (I/R) injury is coupled with impaired mitochondrial function, contributing to the pathogenesis of ischemic stroke. Herein, we review recent evidence demonstrating a heterogeneous mitochondrial response following cerebral I/R injury, placing a specific focus on mitochondrial protein modifications, reactive oxygen species, calcium (Ca2+), inflammation, and quality control under experimental conditions using animal models.

Perceptions of Patients With Stroke Regarding an Immersive Virtual Reality-Based Exercise System for Upper Limb Rehabilitation: Questionnaire and Interview Study

BACKGROUND

With substantial resources allocated to develop virtual reality (VR)-based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence.

OBJECTIVE

This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises.

METHODS

A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns.

RESULTS

The questionnaire results revealed that the patients' perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony.

CONCLUSIONS

Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology's success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology.

Evaluating the Clinical Impact of a Polyphenol-Rich Extract from Salicornia ramosissima on Patients with Transient Ischemic Attack and Minor Stroke

Transient ischemic attack (TIA) is a well-established risk factor for future strokes, making interventions that target recovery and vascular risk crucial. This study aimed to assess the safety and clinical effects of a polyphenol-rich Salicornia ramosissima extract in post-TIA patients. A randomized, triple-blind, placebo-controlled trial was conducted with participants who had a history of TIA or minor stroke and who received 1 g of Salicornia extract or placebo over 11 months. Biochemical analyses, neuropsychological assessments (MOCA test), and gait and aerobic performance tests were conducted at the beginning and the end of the study. A total of 118 individuals were screened, with 80 finally included. Importantly, no significant adverse events were reported throughout the study. A neurological analysis showed an improvement in MOCA scores in patients treated with the Salicornia extract for 11 months. The treatment did not affect spatiotemporal gait parameters, but it significantly reduced blood pressure at baseline and after the aerobic performance test. Biochemically, both groups exhibited mild hyperhomocysteinemia at baseline; however, Salicornia treatment significantly lowered homocysteine levels, bringing them within the normal range. These findings highlight the safety of the Salicornia extract in patients at a high cerebrovascular risk and suggest it as a potential therapeutic option for managing vascular risk factors, such as hyperhomocysteinemia and hypertension. However, further studies are required to confirm the underlying mechanisms and explore broader clinical applications.

Text mining of hypertension researches in the west Asia region: a 12-year trend analysis

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.

Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care

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.

Numerical investigation of unruptured middle cerebral artery bifurcation aneurysms: influence of aspect ratio

An aneurysm is a disease condition, which is due to the pathological weakening of an arterial wall. These aneurysms are often found in various branch points and bifurcations of an artery in the cerebral circulation. Most aneurysms come to medical attention, either due to brain hemorrhages caused by rupture or found unruptured. To consider surgically invasive treatment modalities, clinicians need scientific methods such as, hemodynamic analysis to assess rupture risk. The arterial wall loses its structural integrity when wall shear stress (WSS) and other hemodynamic parameters exceed a certain threshold. In the present study, numerical simulations are carried out for unruptured middle cerebral artery (MCA) aneurysms. Three distinct representative sizes are chosen from a larger patient pool of 26 MCA aneurysms. Logically, these aneurysms represent three growth stages of any patient with similar anatomical structure. Simulations are performed to compare the three growth phases (with different aspect ratios) of an aneurysm and correlate their hemodynamic parameters. Simulations with patient specific boundary conditions reveal that, aneurysms with a higher aspect ratio (AR) correspond to an attendant decrease in both time-averaged wall shear stress (TAWSS) and spatial wall shear stress gradients (WSSG). Smaller MCAs were observed to have higher positive wall shear stress divergence (WSSD), exemplifying the tensile nature of arterial wall stretching. Present study identifies positive wall shear stress divergence (PWSSD) to be a potential biomarker for evaluating the growth of an aneurysm.

Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990-2019

Background

High body mass index (BMI) is a significant risk factor for non-communicable diseases; however, its impact on disease burden in China remains understudied. This study aimed to analyze trends in the burden of type 2 diabetes mellitus (T2DM), stroke, and hypertensive heart disease (HHD) attributable to high BMI in China from 1990 to 2019.

Methods

We utilized data from the Global Burden of Disease 2019 study, quantifying disease burden through years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs). Joinpoint regression analysis was employed to determine temporal trends.

Results

The study revealed distinct gender-specific temporal trends. Men exhibited a consistent increase in disease burden across all three conditions. Women showed more nuanced patterns: a gradual rise in T2DM burden, an inverted U-shaped trend for stroke, and a U-shaped trend for HHD in terms of age-standardized DALYs. Age-specific analysis demonstrated that the burden of T2DM and stroke peaked in the 70-74-year age group, whereas HHD-related DALYs continued to increase with advancing age.

Conclusions

Our findings underscore the need for tailored obesity prevention and management strategies in Chinese healthcare settings, emphasizing early screening and intervention for high BMI, particularly in middle-aged and older adults.

G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities Using Guitar): A Randomized Controlled Trial Using Guitar Lessons for Restoring Hand Function among Patients with Unilateral Hand Impairment

Objective

To determine the effects of guitar lessons (intervention group) in comparison to conventional occupational therapy (OT) sessions (control group) on hand function of chronic stroke patients with unilateral hand impairment.

Methods

This randomized controlled trial enrolled 34 chronic stroke patients with unilateral hand impairment. Participants were grouped randomly into intervention (guitar lessons) and control (conventional occupational therapy) groups. Each group participant underwent a total of eight consecutive therapy sessions, twice weekly for an hour each session, at the designated treatment rooms in the Department of Rehabilitation Medicine of the Philippine General Hospital. Pre- and post-treatment evaluations were done to assess range of motion, grip and pinch strength, and hand functions. Satisfaction surveys were answered at the end of the 8-therapy session.

Results

Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and post-treatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength.In evaluating the satisfaction of participants in both groups, higher mean scores were observed in the control group. No statistically significant difference in most of the questions in the satisfaction survey in both groups.All participants in both groups displayed 100% compliance in attending onsite treatments. Despite not showing statistically significant difference between groups (p = 0.721), an 11.8% tendency for better compliance is found in the intervention group.

Conclusion

The specific guitar lesson created and performed in this study as used by 17 participants of the intervention group have brought about improvement in hand function that is comparable with those who underwent traditional occupational therapy. This may be most helpful in areas with limited access to rehabilitation facilities and occupational therapy services. This may also be used as a continuing activity of chronic stroke patients at home to help improve hand function.

Improved Transfer Learning for Detecting Upper-Limb Movement Intention Using Mechanical Sensors in an Exoskeletal Rehabilitation System

The objective of this study was to propose a novel strategy for detecting upper-limb motion intentions from mechanical sensor signals using deep and heterogeneous transfer learning techniques. Three sensor types, surface electromyography (sEMG), force-sensitive resistors (FSRs), and inertial measurement units (IMUs), were combined to capture biometric signals during arm-up, hold, and arm-down movements. To distinguish motion intentions, deep learning models were constructed using the CIFAR-ResNet18 and CIFAR-MobileNetV2 architectures. The input features of the source models were sEMG, FSR, and IMU signals. The target model was trained using only FSR and IMU sensor signals. Optimization techniques determined appropriate layer structures and learning rates of each layer for effective transfer learning. The source model on CIFAR-ResNet18 exhibited the highest performance, achieving an accuracy of 95% and an F-1 score of 0.95. The target model with optimization strategies performed comparably to the source model, achieving an accuracy of 93% and an F-1 score of 0.93. The results show that mechanical sensors alone can achieve performance comparable to models including sEMG. The proposed approach can serve as a convenient and precise algorithm for human-robot collaboration in rehabilitation assistant robots.

Applications of Near Infrared Spectroscopy and Mirror Therapy for Upper Limb Rehabilitation in Post-Stroke Patients: A Brain Plasticity Pilot Study

Objectives: The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. Methods: A box containing a mirror was placed between the arms of the patients to create the illusion of normal motion in the affected limb by reflecting the image of the unaffected limb in motion. We measured the cerebral hemodynamic response using near-infrared spectroscopy (NIRS). We enrolled ten right-handed stroke patients. They observed healthy hand movements in the mirror (MT condition) while performing various tasks (MT condition), and then repeated the same tasks with the mirror covered (N-MT condition). Results: Significant activation of some brain areas was observed in the right and left hemiparesis groups for the MT condition, while lower levels of activation were observed for the N-MT condition. The results showed significant differences in hemodynamic response based on oxygenated (HbO) concentrations between MT and N-MT conditions across all tasks in sensorimotor areas. These neural circuits were activated despite the motor areas being affected by the brain injury, indicating that the reflection of movement in the mirror helped to activate them. Conclusions: These results suggest that MT promotes cortical activations of sensory motor areas in affected and non-affected brain sides in subacute post-stroke patients, and it encourages the use of these tools in clinical practice.

Validation of Siriraj Stroke Scoring System in the Clinical Differentiation of Stroke Sub-types in a resource-limited Setting

Background

Stroke remains one of the major non-communicable public health disease conditions with resultant high morbidity and mortality. Neuroimaging in the form of Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) is adjudged to be the most reliable and efficient method of accurately diagnosing stroke and ruling out differentials. However, in view of cost implication and non-availability, a clinical scoring system known as the Siriraj Stroke Score (SSS) was developed to clinically differentiate stroke types, especially in resource-limited settings. This study sought to validate and determine the role of Siriraj stroke score in the clinical evaluation of patients presenting with acute stroke.

Methodology

This is a descriptive prospective study that was conducted over a one-year period. The study populations were adult patients presenting with acute stroke in a tertiary health facility in North-Western Nigeria. Clinical details with neuroimaging in the form of a CT scan were obtained. Data obtained was analyzed using Stata 15.

Results

Fifty-four percent (54%) of patients enrolled were males and ischaemic stroke is the commonest stroke subtype present in 69% of patients studied. Altered levels of consciousness, headache and vomiting are important discriminatory variables of the scoring system. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Siriraj Stroke Score for haemorrhagic stroke is 92%, 72%, 62%, 95% and 62% respectively.

Conclusion

Siriraj Stroke Score with sensitivity greater than 90% is reliable in differentiating the stroke sub-types; the patients in the 'grey zone' will however require neuroimaging.

Exploring Education Interventions for Stroke Prevention Among Adults and Older Individuals: A Scoping Review

Background and Aims

This investigation aims to conduct a comprehensive review of educational interventions targeting stroke prevention to provide effective preventive measures and optimize resource utilization in adults and the elderly populations.

Methods

A comprehensive literature search was conducted on PubMed, SCOPUS, and Embase for articles published online or in print until February 22, 2022. Inclusion criteria for studies were limited to the studies that examined stroke education or training interventions aimed at improving knowledge among adults aged 30 years and above, with a particular focus on older adults.

Results

A review of 97,848 papers was conducted, resulting in the inclusion of 19 papers. Of these, six were randomized controlled trials (RCTs), six were non-randomized studies, five were campaign studies, one was a cross-sectional study, one was a pilot study, and one was a prospective study. The provided information describes various interventions and educational programs related to stroke awareness, prevention, and management. The intervention subjects were categorized as awareness of warning signs and symptoms of stroke (n = 14), comprehensive awareness campaigns (n = 5), multilevel strategies for stroke education (n = 4), community-based nursing education and rehabilitation program (n = 5), multimedia campaign for 9-1-1 awareness (n = 3), and self-management interventions (n = 1).

Conclusion

The categorized interventions, addressing awareness of warning signs and symptoms, comprehensive awareness campaigns, multilevel strategies, community-based nursing education and rehabilitation programs, multimedia campaigns for 9-1-1 awareness, and self-management interventions, collectively enrich our understanding of the multifaceted approaches to stroke education.

Are Optometrists Prepared to Be Involved in Post-Stroke Rehabilitation?

BACKGROUND/OBJECTIVES

Stroke survivors often experience various visual consequences that impact their daily life and may benefit from visual interventions. However, some of these usually go unaddressed as optometrists are rarely included in the post-stroke care pathway. Yet, optometrists are interested in contributing to the care of these patients. This survey evaluated the readiness of optometrists in diagnosing and managing visual disorders specific to stroke survivors.

METHODS

A questionnaire was developed by the researchers, pilot tested by 5 research optometrists and 15 community optometrists, and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, the US, Hong Kong, India, and the UK.

RESULTS

Most respondents displayed strong knowledge, but 61.6% indicated that enhancing their knowledge would be helpful. The majority (87%) agreed that stroke is related to an increased incidence of falls. Participants' knowledge regarding the natural history of post-stroke visual disorders was poorer. There were also inconsistencies regarding what optometrists considered ideal interventions and what they undertook in practice. More than 50% of respondents reported that the quality of published evidence on post-stroke visual consequences was low or nonexistent.

CONCLUSIONS

Overall, survey respondents displayed sufficient knowledge. However, there are areas of uncertainty in their knowledge, which in many cases correspond to real gaps in the available evidence. There is a need to identify and remediate these gaps to enable optometrists to deliver quality optometric care as collaborative members of the post-stroke professional team, which would eventually improve the rehabilitation of stroke survivors.

Recent advances in the prevention of secondary ischemic stroke: A narrative review

Stroke remains a significant contributor to global morbidity and mortality, with acute ischemic stroke comprising the majority of cases. Secondary stroke, the recurrent stroke, is often more severe and linked to worse functional outcomes and increased mortality. The secondary prevention of ischemic stroke is crucial for reducing the risk of recurrent events. Significant advancements have been made in secondary prevention strategies in recent years. These include the refinement of antithrombotic regimens, the use of direct oral anticoagulants in managing atrial fibrillation, and the implementation of more aggressive targets for blood pressure, lipid management, and glucose management. Furthermore, emerging therapeutic approaches, such as remote ischemic conditioning and anti-inflammatory agents such as colchicine, have shown promise in reducing stroke recurrence through nontraditional mechanisms. This review summarizes the latest advancements in the secondary prevention of ischemic stroke over the past 5 years, highlighting the key clinical trials and novel interventions. The optimization of traditional risk factor management and the emergence of novel therapeutic methods have provided more options for clinical practice. Future research should focus on identifying the optimal treatment strategies for specific patient subgroups and the clinical translation and application of new therapeutic methods.

Novel therapeutic targets for reperfusion injury in ischemic stroke: Understanding the role of mitochondria, excitotoxicity and ferroptosis

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.

Nature-based rehabilitation-experiences from patients with acquired brain injury: an explorative qualitative study

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.

ScRNAs reveals high-frequency rTMS-induced pericyte differentiation: Potential implications for vascular regeneration and blood-brain barrier stability in stroke

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.

Antiaggregation Versus Anticoagulation for Stroke, Bleeding, and Mortality in Patients With Blunt Carotid Injury: A Systematic Review and Meta-Analysis

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.

Oral Microbiome Dysbiosis as a Risk Factor for Stroke: A Comprehensive Review

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.

The State of Stroke Research in Malawi: Results from a Mapping Review Study

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.

How does combining physical therapy with transcranial direct stimulation improve upper-limb motor functions in patients with stroke? A theory perspective

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.

The Transcriptional Landscape of Pericytes in Acute Ischemic Stroke

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.

Individual patient data meta-analysis of the effects of fluoxetine on functional outcomes after acute stroke

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.

Gray-Scale Median in Patients with Symptomatic and Asymptomatic Carotid Atherosclerosis-Risk Factors and Diagnostic Potential

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.

Application of interpretable machine learning algorithms to predict acute kidney injury in patients with cerebral infarction in ICU

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.