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Background and objectives: Limited research has looked into the precise connection between lung function, arterial blood gases, and cerebral stroke. This study was focused on examining the correlation between pulmonary function and carotid intima-media thickness (CIMT) in patients with and without cerebral stroke who do not have chronic pulmonary disease. Methods: A case–control study included 125 cerebral stroke patients and 125 non-stroke controls selected from the outpatient clinics of the Neurology and Rheumatology & Rehabilitation departments at Zagazig University Hospital, Sharkia Governorate, Egypt. The assessment of lung function passed through measuring forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ratio, and maximum voluntary ventilation (MVV). Arterial blood gases were measured, and CIMT was evaluated using high-resolution ultrasonography by the radiology author. Results: The research findings suggested that patients exhibiting elevated carotid intima-media thickness (CIMT) faced a heightened risk of suffering from a cerebral stroke in comparison to those with normal CIMT levels. Additionally, the study revealed a negative relationship between lung function, as measured by FEV1, FVC, the ratio (FEV1/FVC), and MVV, and arterial blood gases, as indicated by the partial pressure of oxygen (PaO2), in relation to CIMT. Reduced FEV1, FVC, FEV1/FVC, MVV, and PaO2 were found to be associated with elevated CIMT. The stepwise multivariable regression model further showed that CIMT was positively correlated with age, while it displayed negative correlations with FEV1, FVC, FEV1/FVC, MVV, and PaO2. Conclusion: Patients who have an elevated carotid intima-media thickness (CIMT) are at a greater risk of experiencing a cerebral stroke. In addition, reduced forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, maximal voluntary ventilation (MVV), and arterial partial pressure of oxygen (PaO2) are all linked with increased CIMT levels. Patients with elevated CIMT have a higher risk of cerebral stroke. These findings suggest that lung function tests in individuals without respiratory conditions could be beneficial for identifying those who may be at a heightened risk for experiencing a cerebrovascular stroke. [ABSTRACT FROM AUTHOR]

Transient receptor potential vanilloid subfamily member 1 (TRPV1) has been strongly implicated in the pathophysiology of cerebral stroke. However, the exact role and mechanism remain elusive. TPRV1 channels are exclusively present in the neurovascular system and involve many neuronal processes. Numerous experimental investigations have demonstrated that TRPV1 channel blockers or the lack of TRPV1 channels may prevent harmful inflammatory responses during ischemia–reperfusion injury, hence conferring neuroprotection. However, TRPV1 agonists such as capsaicin and some other non-specific TRPV1 activators may induce transient/slight degree of TRPV1 channel activation to confer neuroprotection through a variety of mechanisms, including hypothermia induction, improving vascular functions, inducing autophagy, preventing neuronal death, improving memory deficits, and inhibiting inflammation. Another factor in capsaicin-mediated neuroprotection could be the desensitization of TRPV1 channels. Based on the summarized evidence, it may be plausible to suggest that TPRV1 channels have a dual role in ischemia–reperfusion-induced cerebral injury, and thus, both agonists and antagonists may produce neuroprotection depending upon the dose and duration. The current review summarizes the dual function of TRPV1 in ischemia–reperfusion-induced cerebral injury models, explains its mechanism, and predicts the future. [ABSTRACT FROM AUTHOR]

Biofeedback (BFB) is a rehabilitation method, which, among other things, is used for the restitution of motor and gait function. As of now, it has become technically feasible to use BFB training based on target gait parameters to improve the gait function in stroke patients. The walking patterns of stroke patients are generally characterized by significant gait phase asymmetries, mostly of the stance phase and the single stance phase. The aim of the study was to investigate the restoration of gait function using BFB training with gait phases as feedback targets. The study included two patient groups, each of 20 hemiparetic patients in the subacute stage of stroke and a control group of 20 healthy subjects. Each patient group received BFB training with either stance phase or single stance phase as the feedback target, respectively. The patients received a total of 8 to 11 training sessions. Assessments based on clinical scales and gait analysis data (spatiotemporal, kinematic, and EMG parameters) were performed before and after the training course. The score-based clinical assessments showed a significant improvement in both patient groups. According to the assessments of gait biomechanics, the subjects in the Single Stance Phase group had significantly more severe dysfunctions. In both patient groups, the unaffected limb responded to the BFB training, while the stance phase significantly changed after training in the unaffected limb only. The other patient group, trained using the single stance phase as the feedback target, showed no changes in the target parameter either in the affected or in the contralateral limb. The clinical and instrumental assessments showed different, non-equivalent sensitivity. The results of the study demonstrated the possibility to use targeted BFB training to improve walking function. However, a significant effect of such training was only observed with stance phase as the target parameter. A response to training was observed predominantly in the unaffected limb and facilitated the desired increase in the functional ability of the paretic limb. Training based on stance phase as the target parameter is probably preferable for the patient population under study. [ABSTRACT FROM AUTHOR]

Abstract Background and objectives Limited research has looked into the precise connection between lung function, arterial blood gases, and cerebral stroke. This study was focused on examining the correlation between pulmonary function and carotid intima-media thickness (CIMT) in patients with and without cerebral stroke who do not have chronic pulmonary disease. Methods A case–control study included 125 cerebral stroke patients and 125 non-stroke controls selected from the outpatient clinics of the Neurology and Rheumatology & Rehabilitation departments at Zagazig University Hospital, Sharkia Governorate, Egypt. The assessment of lung function passed through measuring forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ratio, and maximum voluntary ventilation (MVV). Arterial blood gases were measured, and CIMT was evaluated using high-resolution ultrasonography by the radiology author. Results The research findings suggested that patients exhibiting elevated carotid intima-media thickness (CIMT) faced a heightened risk of suffering from a cerebral stroke in comparison to those with normal CIMT levels. Additionally, the study revealed a negative relationship between lung function, as measured by FEV1, FVC, the ratio (FEV1/FVC), and MVV, and arterial blood gases, as indicated by the partial pressure of oxygen (PaO2), in relation to CIMT. Reduced FEV1, FVC, FEV1/FVC, MVV, and PaO2 were found to be associated with elevated CIMT. The stepwise multivariable regression model further showed that CIMT was positively correlated with age, while it displayed negative correlations with FEV1, FVC, FEV1/FVC, MVV, and PaO2. Conclusion Patients who have an elevated carotid intima-media thickness (CIMT) are at a greater risk of experiencing a cerebral stroke. In addition, reduced forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, maximal voluntary ventilation (MVV), and arterial partial pressure of oxygen (PaO2) are all linked with increased CIMT levels. Patients with elevated CIMT have a higher risk of cerebral stroke. These findings suggest that lung function tests in individuals without respiratory conditions could be beneficial for identifying those who may be at a heightened risk for experiencing a cerebrovascular stroke.

Cerebral stroke consequence assessment in patients with residual schizophrenia is a complex clinical scenario questioning both diagnostic and therapeutic strategies. Aim. To assess the structure of neurocognitive dysfunctions in patients with residual schizophrenia with pronounced negative symptoms depending on a history of cerebral stroke. Materials and methods. In the period of 2020–2023, a clinical examination of 47 patients of Zaporizhzhia Regional Clinical Psychiatric Hospital and Veselovsky Psychoneurological Boarding School with a diagnosis of residual schizophrenia (ICD-10: F20.5) was carried out. Study groups were formed: G1 – 9 patients with residual schizophrenia and the history of cerebral stroke; G2 – 36 patients with residual schizophrenia without the history of cerebral stroke. Results. The DSM-5 neurocognitive functioning assessment system was used in the study, based on which a protocol for rapid testing of neurocognitive functions adapted for patients with residual schizophrenia was developed. The group of patients with the history of cerebral stroke has demonstrated lower results in attention allocation (p ≤ 0.05). This group has also shown relatively poor results in planning (p ≤ 0.05), error correction (p ≤ 0.05), inhibition (p ≤ 0.05) and flexibility (p ≤ 0.05). As concerning verbal ability, worse results of expressive speech (p ≤ 0.05), grammar and syntax (p ≤ 0.05) have been revealed in the group of patients with the history of cerebral stroke. In terms of perceptual-motor functions, the gnosis task has been performed worse (p ≤ 0.05) by the group of patients with the history of cerebral stroke. Differences in emotion recognition and theory of mind were insignificant between groups. Conclusions. An original neurocognitive function assessment protocol adapted for the Ukrainian-speaking patient population with residual schizophrenia has been developed. The patient population with residual schizophrenia and the history of cerebral stroke or without it has been examined with the use of the developed protocol for the assessment of neurocognitive functions. According to the obtained results, patients with residual schizophrenia and the history of cerebral stroke have demonstrated worse cognitive performance compared to those without the history of stroke.

Objective: This study aimed to explore and evaluate the efficacy of non-invasive brain stimulation (NIBS) as a standalone or coupled intervention and understand its mechanisms to produce positive alterations in neuroplasticity and behavioral outcomes after acquired brain injury (ABI). Data sources: Cochrane Library, Web of Science, PubMed, and Google Scholar databases were searched from January 2013 to January 2024. Study selection: Using the PICO framework, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) randomized controlled trials (RCTs), retrospective, pilot, open-label, and observational large group and single-participant case studies were included. Two authors reviewed articles according to pre-established inclusion criteria. Data extraction: Data related to participant and intervention characteristics, mechanisms of change, methods, and outcomes were extracted by two authors. The two authors performed quality assessments using SORT. Results: Twenty-two studies involving 657 participants diagnosed with ABIs were included. Two studies reported that NIBS was ineffective in producing positive alterations or behavioral outcomes. Twenty studies reported at least one, or a combination of, positively altered neuroplasticity and improved neuropsychological, neuropsychiatric, motor, or somatic symptoms. Twentyeight current articles between 2020 and 2024 have been studied to elucidate potential mechanisms of change related to NIBS and other mediating or confounding variables. Discussion: tDCS and TMS may be efficacious as standalone interventions or coupled with neurorehabilitation therapies to positively alter maladaptive brain physiology and improve behavioral symptomology resulting from ABI. Based on postintervention and follow-up results, evidence suggests NIBS may offer a direct or mediatory contribution to improving behavioral outcomes post-ABI. Conclusion: More research is needed to better understand the extent of rTMS and tDCS application in affecting changes in symptoms after ABI. [ABSTRACT FROM AUTHOR]

Cerebral stroke consequence assessment in patients with residual schizophrenia is a complex clinical scenario questioning both diagnostic and therapeutic strategies. Aim. To assess the structure of neurocognitive dysfunctions in patients with residual schizophrenia with pronounced negative symptoms depending on a history of cerebral stroke. Materials and methods. In the period of 2020-2023, a clinical examination of 47 patients of Zaporizhzhia Regional Clinical Psychiatric Hospital and Veselovsky Psychoneurological Boarding School with a diagnosis of residual schizophrenia (ICD-10: F20.5) was carried out. Study groups were formed: G1 - 9 patients with residual schizophrenia and the history of cerebral stroke; G2 - 36 patients with residual schizophrenia without the history of cerebral stroke. Results. The DSM-5 neurocognitive functioning assessment system was used in the study, based on which a protocol for rapid testing of neurocognitive functions adapted for patients with residual schizophrenia was developed. The group of patients with the history of cerebral stroke has demonstrated lower results in attention allocation (p ≤ 0.05). This group has also shown relatively poor results in planning (p ≤ 0.05), error correction (p ≤ 0.05), inhibition (p ≤ 0.05) and flexibility (p ≤ 0.05). As concerning verbal ability, worse results of expressive speech (p ≤ 0.05), grammar and syntax (p ≤ 0.05) have been revealed in the group of patients with the history of cerebral stroke. In terms of perceptual-motor functions, the gnosis task has been performed worse (p ≤ 0.05) by the group of patients with the history of cerebral stroke. Differences in emotion recognition and theory of mind were insignificant between groups. Conclusions. An original neurocognitive function assessment protocol adapted for the Ukrainian-speaking patient population with residual schizophrenia has been developed. The patient population with residual schizophrenia and the history of cerebral stroke or without it has been examined with the use of the developed protocol for the assessment of neurocognitive functions. According to the obtained results, patients with residual schizophrenia and the history of cerebral stroke have demonstrated worse cognitive performance compared to those without the history of stroke. [ABSTRACT FROM AUTHOR]

Rapid and reliable diagnosis of cerebral stroke is a vital necessity, and among them, ischemic stroke is the most difficult to recognize on MRI images. Increasing the efficiency of stroke diagnosis is associated with the transition to increasingly "heavy" AI tools working in 3D mode, processing MRI images not pixel-by-pixel, but voxel-by-voxel and using complex multifactor information processing algorithms. The implementation of such products requires large computing resources, which are often unavailable outside large medical centers. In addition, existing explainable AI tools identify the affected area very roughly and generally, which reduces the doctor's confidence in the diagnostic result. On the other hand, one can use AI models operating in 2D mode - weaker, but faster and less demanding on computing resources. The article uses a Siamese neural network as a base model. To improve classification efficiency, a model pretrain on "light" synthetic data based on Perlin noise is proposed. To objectify the choice of mode, the article uses the apparatus of topological data analysis, namely, changes in persistent entropy and Renyi entropy of data embeddings on fully connected layers of a neural network. It is experimentally confirmed that using a 2D model, when trained on slices with maximum lesion visibility, produces ROC-AUC values no worse than using a full-scale 3D SOTA models, while allowing the clinician to selectively evaluate the individual slices he or she selects. It is experimentally confirmed that simple model that contains only locally useful features can support neural network training to a level comparable to much more complex and resource-intensive generative model. [ABSTRACT FROM AUTHOR]

Background: Cerebral air embolism (CAE) is an uncommon medical emergency with a potentially fatal course. We have retrospectively analyzed a set of patients treated with CAE at our comprehensive stroke center and a hyperbaric medicine center. An overview of the pathophysiology, causes, diagnosis, and treatment of CAE is provided. Results: We retrospectively identified 11 patients with cerebral venous and arterial air emboli that highlight the diversity in etiologies, manifestations, and disease courses encountered clinically. Acute-onset stroke syndrome and a progressive impairment of consciousness were the two most common presentations in four patients each (36%). Two patients (18%) suffered from an acute-onset coma, and one (9%) was asymptomatic. Four patients (36%) were treated with hyperbaric oxygen therapy (HBTO), high-flow oxygen therapy without HBOT was started in two patients (18%), two patients (18%) were in critical care at the time of diagnosis and three (27%) received no additional treatment. CAE was fatal in five cases (46%), caused severe disability in two (18%), mild disability in three (27%), and a single patient had no lasting deficit (9%). Conclusion: Cerebral air embolism is a dangerous condition that necessitates high clinical vigilance. Due to its diverse presentation, the diagnosis can be missed or delayed in critically ill patients and result in long-lasting or fatal neurological complications. Preventative measures and a proper diagnostic and treatment approach reduce CAE's incidence and impact. [ABSTRACT FROM AUTHOR]

Molecular pathways involved in cerebral stroke are diverse. The major pathophysiological events that are observed in stroke comprises of excitotoxicity, oxidative stress, mitochondrial damage, endoplasmic reticulum stress, cellular acidosis, blood–brain barrier disruption, neuronal swelling and neuronal network mutilation. Various biomolecules are involved in these pathways and several major proteins are upregulated and/or suppressed following stroke. Different types of receptors, ion channels and transporters are activated. Fluctuations in levels of various ions and neurotransmitters have been observed. Cells involved in immune responses and various mediators involved in neuro-inflammation get upregulated progressing the pathogenesis of the disease. Despite of enormity of the problem, there is not a single therapy that can limit infarction and neurological disability due to stroke. This is because of poor understanding of the complex interplay between these pathophysiological processes. This review focuses upon the past to present research on pathophysiological events that are involved in stroke and various factors that are leading to neuronal death following cerebral stroke. This will pave a way to researchers for developing new potent therapeutics that can aid in the treatment of cerebral stroke. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to explore and evaluate the efficacy of non-invasive brain stimulation (NIBS) as a standalone or coupled intervention and understand its mechanisms to produce positive alterations in neuroplasticity and behavioral outcomes after acquired brain injury (ABI).Data sourcesCochrane Library, Web of Science, PubMed, and Google Scholar databases were searched from January 2013 to January 2024.Study selectionUsing the PICO framework, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) randomized controlled trials (RCTs), retrospective, pilot, open-label, and observational large group and single-participant case studies were included. Two authors reviewed articles according to pre-established inclusion criteria.Data extractionData related to participant and intervention characteristics, mechanisms of change, methods, and outcomes were extracted by two authors. The two authors performed quality assessments using SORT.ResultsTwenty-two studies involving 657 participants diagnosed with ABIs were included. Two studies reported that NIBS was ineffective in producing positive alterations or behavioral outcomes. Twenty studies reported at least one, or a combination of, positively altered neuroplasticity and improved neuropsychological, neuropsychiatric, motor, or somatic symptoms. Twenty-eight current articles between 2020 and 2024 have been studied to elucidate potential mechanisms of change related to NIBS and other mediating or confounding variables.DiscussiontDCS and TMS may be efficacious as standalone interventions or coupled with neurorehabilitation therapies to positively alter maladaptive brain physiology and improve behavioral symptomology resulting from ABI. Based on postintervention and follow-up results, evidence suggests NIBS may offer a direct or mediatory contribution to improving behavioral outcomes post-ABI.ConclusionMore research is needed to better understand the extent of rTMS and tDCS application in affecting changes in symptoms after ABI.

The review analyzed literature data on the epidemio­logy, risk factors, and mechanisms of acute cerebrovascular accident (ACVA) in patients with diabetes mellitus. The role of insulin resistance and the effectiveness of therapeutic approaches to its correction in cerebral stroke are considered. Diabetes mellitus is recognized as an independent modifiable risk factor for ACVA. In people with diabetes of different age, the risk of stroke is increased by 2–6 times, and the indicators are especially high in patients of young working age. The presence of diabetes mellitus is associated with more severe symptoms, increased risk of complications, longer hospitalization, and higher mortality. Research results show that insulin resistance is one of the main triggers for the development of ischemic stroke due to embolism caused by oxidative stress, endothelial dysfunction and platelet hyperactivation, as well as due to atherosclerotic changes caused by inflammation, proliferation of smooth muscle cells of the vascular wall, dyslipidemia and hypertension on the background of hyperglycemia and hyperinsulinemia. It has been proven that insulin resistance not only provokes ACVA, but also negatively affects their prognosis. Metformin is a key drug for improving insulin sensitivity and is recognized as one of the most important first-line therapeutic agents to achieve and maintain treatment goals in patients with type 2 diabetes. The results of expe­rimental and clinical studies proved that this agent has a whole range of neuroprotective properties, which generally prevent the development of cerebral ischemia and reduce the negative consequences in case of its occurrence. Animals with experimental acute cerebral ischemia who have been treated with metformin had a better overall neurological score, significantly smaller infarct size, better coordination scores, and higher numbers of neurons and microglia. The neuroprotective effect of metformin in stroke is realized through the AMPK (5’AMP-activated protein kinase) signaling pathway with reduction of oxidative stress, neuroinflammation, stimulation of angiogenesis and neurogenesis, autophagy, and inhibition of apoptosis. According to data from cohort and randomized clinical trials, the use of metformin is associated with a significantly lower risk of developing ACVA. Long-term use of this drug in type 2 diabetes contributes to a milder course of stroke, is associated with better functional recovery, and a decrease in disability and mortality rates.

Purpose: To assess the incidence of various neuro-ophthalmological symptoms in patients with chronic cerebrovascular disease (CVD). Material and Methods: This study was conducted at the clinical departments of the Petro Mohyla Black Sea National University (Mykolaiv) in 2018-2022. Two hundred and sixteen patients with CVD were involved in the study. Mean patient age was 62.3 ± 1.2 years and most patients (133 or 60.2%) were males. A neuroophthalmological examination included visual acuity testing, intraocular pressure measurement, perimetry, type of vision and heterophoria assessment, evaluation of ocular motility, convergence, and strabismus in the cardinal positions of gaze, and ophthalmoscopy. In addition, patients had optical coherence tomography with Оptovue Avanti XR apparatus, if indicated. Results: Of 216 patients, 45 (20.8%) had cerebral small-vessel disease, 157 (72.7%), a prior history of transient ischemic attack (TIA), and 118 (46.1%), a prior history of acute cerebrovascular events (ACVE). All patients exhibited signs of hypertensive angiopathy. Of 216 patients, 22 (10.2%) had grade 3, and 6 (2.8%), grade 4 hypertensive angiopathy. There was evidence of posterior ischemic optic neuropathy in the presence of cerebral small-vessel disease in 27 patients (12.5%). Retinal microvascular changes were seen in 133 patients (61.6%). In addition, 10 patients (4.6%) exhibited isolated retinal hemorrhages, 16 (7.4%), hard exudates, and 1 (6.3%) cotton-wool exudates. Moderate retinal and optic disc edema was seen in 23 patients (10.6%). Isolated homonymous visual field defects were found in 13 patients (6.0%); all these patients had a prior history of ACVE. Conclusion: In patients with CVD, we found fundus changes which were mostly ischemic and more severe in the presence of cerebral small-vessel disease. There is a need for an integrated multispecialty/interdisciplinary approach to further research on the neuroophthalmological aspect of CVD.

Biofeedback (BFB) is a rehabilitation method, which, among other things, is used for the restitution of motor and gait function. As of now, it has become technically feasible to use BFB training based on target gait parameters to improve the gait function in stroke patients. The walking patterns of stroke patients are generally characterized by significant gait phase asymmetries, mostly of the stance phase and the single stance phase. The aim of the study was to investigate the restoration of gait function using BFB training with gait phases as feedback targets. The study included two patient groups, each of 20 hemiparetic patients in the subacute stage of stroke and a control group of 20 healthy subjects. Each patient group received BFB training with either stance phase or single stance phase as the feedback target, respectively. The patients received a total of 8 to 11 training sessions. Assessments based on clinical scales and gait analysis data (spatiotemporal, kinematic, and EMG parameters) were performed before and after the training course. The score-based clinical assessments showed a significant improvement in both patient groups. According to the assessments of gait biomechanics, the subjects in the Single Stance Phase group had significantly more severe dysfunctions. In both patient groups, the unaffected limb responded to the BFB training, while the stance phase significantly changed after training in the unaffected limb only. The other patient group, trained using the single stance phase as the feedback target, showed no changes in the target parameter either in the affected or in the contralateral limb. The clinical and instrumental assessments showed different, non-equivalent sensitivity. The results of the study demonstrated the possibility to use targeted BFB training to improve walking function. However, a significant effect of such training was only observed with stance phase as the target parameter. A response to training was observed predominantly in the unaffected limb and facilitated the desired increase in the functional ability of the paretic limb. Training based on stance phase as the target parameter is probably preferable for the patient population under study.

Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99–73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99–31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition. [ABSTRACT FROM AUTHOR]

Cerebral strokes, the abrupt cessation of blood flow to the brain, lead to a cascade of events, resulting in cellular damage due to oxygen and nutrient deprivation. Contemporary lifestyle factors, including high glucose levels, heart disease, obesity, and diabetes, heighten the risk of stroke. This research investigates the application of robust machine learning (ML) algorithms, including logistic regression (LR), random forest (RF), and K-nearest neighbor (KNN), to the prediction of cerebral strokes. Stroke data is collected from Harvard Dataverse Repository. The data includes—clinical, physiological, behavioral, demographic, and historical data. The Synthetic Minority Oversampling Technique (SMOTE), adaptive synthetic sampling (ADASYN), and the Random Oversampling Technique (ROSE) are used to address class imbalances to improve the accuracy of minority classes. To address the challenge of forecasting strokes from partial and imbalanced physiological data, this study introduces a novel hybrid ML approach by combining a machine learning method with an oversampling technique called ADASYN_RF. ADASYN is an oversampling technique used to resample the imbalanced dataset then RF is implemented on the resampled dataset. Also, other oversampling techniques and ML models are implemented to compare the results. Notably, the RF algorithm paired with ADASYN achieves an exceptional performance of 99% detection accuracy, exhibiting its dominance in stroke prediction. The proposed approach enables cost-effective, precise stroke prediction, providing a valuable tool for clinical diagnosis. [ABSTRACT FROM AUTHOR]

BackgroundCerebral air embolism (CAE) is an uncommon medical emergency with a potentially fatal course. We have retrospectively analyzed a set of patients treated with CAE at our comprehensive stroke center and a hyperbaric medicine center. An overview of the pathophysiology, causes, diagnosis, and treatment of CAE is provided.ResultsWe retrospectively identified 11 patients with cerebral venous and arterial air emboli that highlight the diversity in etiologies, manifestations, and disease courses encountered clinically. Acute-onset stroke syndrome and a progressive impairment of consciousness were the two most common presentations in four patients each (36%). Two patients (18%) suffered from an acute-onset coma, and one (9%) was asymptomatic. Four patients (36%) were treated with hyperbaric oxygen therapy (HBTO), high-flow oxygen therapy without HBOT was started in two patients (18%), two patients (18%) were in critical care at the time of diagnosis and three (27%) received no additional treatment. CAE was fatal in five cases (46%), caused severe disability in two (18%), mild disability in three (27%), and a single patient had no lasting deficit (9%).ConclusionCerebral air embolism is a dangerous condition that necessitates high clinical vigilance. Due to its diverse presentation, the diagnosis can be missed or delayed in critically ill patients and result in long-lasting or fatal neurological complications. Preventative measures and a proper diagnostic and treatment approach reduce CAE’s incidence and impact.

After water, tea is the most popular drink in the world, and its relationship with heart diseases, stroke, and cancer has been always considered by researchers. The aim of the present study is to assess the relationship between green tea or black tea consumption and stroke risk using systematic review and meta-analysis methods. To assess the required resources, PubMed, Scopus, Web of science, Cochrane electronic databases, and the Google Scholar search engine were searched. To assess the study heterogeneity, I2 indexes was used. Data were analyzed using STATA 14 software. P

Abstract Background Cerebral stroke (CS) is the leading cause of death in China, and a complex disease caused by both alterable risk factors and genetic factors. This study intended to investigate the association of MMP3, MMP14, and MMP25 single nucleotide polymorphisms (SNPs) with CS risk in a Chinese Han population. Methods A total of 1,348 Han Chinese were recruited in this case-control study. Four candidate loci including rs520540 A/G and rs679620 T/C of MMP3, rs2236302 G/C of MMP14, and rs10431961 T/C of MMP25 were successfully screened. The correlation between the four SNPs and CS risk was assessed by logistic regression analysis. The results were analyzed by false-positive report probability (FPRP) for chance or significance. The interactions between four SNPs associated with CS risk were assessed by multifactor dimensionality reduction (MDR). Results rs520540 A/G and rs679620 C/T SNP in MMP3 were associated with risk of CS in allele, codominant, dominant and log-additive models. Ischemic stroke risk were significantly lower in carriers with rs520540-A allele and rs679620-T allele than those with G/G or C/C genotypes. However, rs520540-A allele and rs679620-T allele were associated with higher risk of hemorrhagic stroke. Stratified analysis showed that these two SNPs were associated with reduced risk of CS in aged

Objective: To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. Design: A cross-sectional exploratory study. Subjects: 87 working stroke survivors. Methods: This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. Results: Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. Conclusion: Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

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Objective: To observe the curative effect of fire needle combined with rehabilitation training on spastic hemiplegia after stroke (SHAS). Methods: A total of 130 SHAS patients admitted to the People’s Hospital of Funan County from January 2020 to November 2021 were selected. The selected patients were randomly divided into 2 groups according to a random number table method, as the control group and the study group. There were 65 cases in the control group, and they were given conventional drugs combined with rehabilitation training. There were 65 cases in the study group, and they were given fire needle on the basis of the control group. The curative effect, modified Ashworth grade, motor function, Fugl-Meyer assessment (FMA) score and modified Barthel index (MBI) score were compared. Results: After treatment, the total effective rate of the study group (91.80%) was significantly higher than that of the control group (78.69%), and the difference was statistically significant (P < 0.05). After treatment, the modified Ashworth grade of both study group and control group was better than that before treatment (P < 0.05). Moreover, the modified Ashworth grade of the study group was significantly better than that of the control group (P < 0.05) after treatment. After treatment, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of study group and control group were higher than those before treatment (P < 0.05). Moreover, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of the study group increased more significantly than those of the control group (P < 0.05) after treatment. Conclusion: The curative effect of fire needle combined with rehabilitation training on SHAS is certain, which can improve limb spasm, motor function and activities of daily living. [ABSTRACT FROM AUTHOR]

Background: Cerebral stroke (CS) is the leading cause of death in China, and a complex disease caused by both alterable risk factors and genetic factors. This study intended to investigate the association of MMP3, MMP14, and MMP25 single nucleotide polymorphisms (SNPs) with CS risk in a Chinese Han population. Methods: A total of 1,348 Han Chinese were recruited in this case-control study. Four candidate loci including rs520540 A/G and rs679620 T/C of MMP3, rs2236302 G/C of MMP14, and rs10431961 T/C of MMP25 were successfully screened. The correlation between the four SNPs and CS risk was assessed by logistic regression analysis. The results were analyzed by false-positive report probability (FPRP) for chance or significance. The interactions between four SNPs associated with CS risk were assessed by multifactor dimensionality reduction (MDR). Results: rs520540 A/G and rs679620 C/T SNP in MMP3 were associated with risk of CS in allele, codominant, dominant and log-additive models. Ischemic stroke risk were significantly lower in carriers with rs520540-A allele and rs679620-T allele than those with G/G or C/C genotypes. However, rs520540-A allele and rs679620-T allele were associated with higher risk of hemorrhagic stroke. Stratified analysis showed that these two SNPs were associated with reduced risk of CS in aged < 55 years, non-smoking and non-drinking participants, and rs679620 SNP also reduced CS risk in male participants. The levels of uric acid, high-density lipoprotein cholesterol, and eosinophil were different among patients with different genotypes of rs520540 and rs679620. No statistically significant association was found between MMP14 rs2236302 G/C or MMP25 rs10431961 T/C with CS even after stratification by stroke subtypes, age, gender as well as smoking and drinking conditions in all the genetic models. Conclusion: MMP3 rs520540 A/G and rs679620 C/T polymorphisms were associated with CS risk in the Chinese Han population, which provides useful information for the prevention and diagnosis of CS. [ABSTRACT FROM AUTHOR]

Background: Cerebral stroke is a leading cause of death and disability worldwide. Ligusticum Chuanxiong Hort. (LCH), a well-known Chinese herb, is widely used for the treatment of cerebral stroke. This study aimed to investigate the underlying mechanisms of LCH in cerebral stroke and develop a diagnostic model. Methods: We employed network pharmacology analyses to identify the active compounds, targets, and underlying mechanisms of LCH for treating cerebral stroke. Molecular docking was performed to visualize the binding site between the core active compounds and hub targets. Furthermore, a diagnostic model for cerebral stroke was constructed based on transcriptomic analysis. Results: Our findings revealed that LCH contains multiple active ingredients, including oleic acid and caffeic acid. Protein-protein interaction network analysis identified IL1B, CCL2, MAPK3, PTGS2, JUN, MMP9, TLR4, HIF1A, PPARA, FOS, PTEN, NFE2L2, TLR2, TIMP1, and SOD2 as the top 15 hub genes. Kyoto Encyclopedia of Genes and Genomes pathway analysis highlighted the enrichment of TNF and IL-17 signaling pathways. Molecular docking analysis demonstrated binding sites between oleic acid, caffeic acid, and MMP9, PPARP, PTEN, and TIMP1. The diagnostic model indicated that FOS, MMP9, PPARA, PTEN, TIMP1, and TLR2 serve as blood biomarkers for cerebral stroke. Conclusions: This study demonstrates that LCH alleviates the symptoms following cerebral stroke through interactions with the TNF and IL-17 signaling pathways. The findings contribute to a better understanding of the therapeutic mechanisms of LCH and offer insights into the development of a diagnostic model for cerebral stroke. [ABSTRACT FROM AUTHOR]

Objectives. Stroke is an acute cerebrovascular disease with high morbidity and mortality rate. Many stroke management strategies can improve prognosis and quality of life, but only to a certain extent. Phosphodiesterase inhibitor-5 (PDE-5i) has shown benefits in numerous preclinical studies, but human studies have been inconclusive. Material and Methods. For this narrative review, we conducted a systematic search following the PRISMA statement guideline from inception until November 2022. The search was conducted in PubMed, ScienceDirect, EBSCOhost, and ProQuest. We included all human and animal studies on this topic, including preclinical studies, randomized clinical trials, and case studies. All the excluded studies are reviews or non-English studies. Review. Many PDE-5i have shown benefits in anatomical and functional outcomes in preclinical acute experimental stroke models. PF-03049423 was safe and well tolerated in humans but had no significant impact on neurological or functional outcomes. Sildenafil on acute/subacute was deemed safe to use and demonstrated improvement over baseline, but power remains unknown due to the lack of a control group. Tadalafil use resulted in a reduction in regional cerebral blood flow in subjects with a history of stroke. Conclusions. Despite promising results in preclinical studies, current evidence shows that PDE-5i does not affect clinical or functional recovery in people with acute stroke. The disparity in the intricacy of stroke pathophysiology between human and animal models was crucial. Further research in a larger population with more consistent stroke onset, medicines, and doses is required for a more conclusive result.

Inflammatory responses and oxidative stress contribute to the pathogenesis of brain ischemia/reperfusion (IR) injury. Naturally occurring bioflavonoids possess antioxidant and anti-inflammatory properties. The phytochemicals of Juniperus sabina L., known as “Abhal” in Saudi Arabia, have been studied and cupressuflavone (CUP) has been isolated as the major bioflavonoid. This study aimed to investigate the neuroprotective potential of CUP in reducing brain IR damage in rats and to understand probable mechanisms. After 60 min of inducing cerebral ischemia by closing the left common carotid artery (CCA), blood flow was restored to allow reperfusion. The same surgical procedure was performed on sham-operated control rats, excluding cerebral IR. CUP or vehicle was given orally to rats for 3 days prior to ischemia induction and for a further 3 days following reperfusion. Based on the findings of this study, compared to the IR control group, CUP-administered group demonstrated reduced neurological deficits, improved motor coordination, balance, and locomotor activity. Additionally, brain homogenates of IR rats showed a decrease in malondialdehyde (MDA) level, an increase in reduced glutathione (GSH) content, and an increase in catalase (CAT) enzyme activity following CUP treatment. CUP suppressed neuro-inflammation via reducing serum inflammatory cytokine levels, particularly those of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) and enhancing the inflammatory cytokine levels, such as Nuclear factor kappa- B (NF-κB), TANK-binding kinase-1 (TBK1), and interferon beta (IFN-β) in brain tissues. Furthermore, CUP ameliorated the histological alterations in the brain tissues of IR rats. CUP significantly suppressed caspase-3 expression and downregulated the Toll-like receptor 4 (TLR4)/NF-κB signaling pathway as a result of suppressing High mobility group box 1 (HMGB1). To our knowledge, this is the first study to document the neuroprotective properties of CUP. Thus, the study findings revealed that CUP ameliorates IR–induced cerebral injury possibly by enhancing brain antioxidant contents, reducing serum inflammatory cytokine levels, potentiating the brain contents of TBK1 and IFN-β and suppressing the HMGB1/TLR-4 signaling pathway. Hence, CUP may serve as a potential preventive and therapeutic alternative for cerebral stroke.

Stroke is a multiphasic process, and the initial ischemic phase of neuronal damage is followed by secondary innate and adaptive responses that unfold over days after stroke, offer a longer time frame of intervention, and represent a novel therapeutic target. Therefore, revealing the distinct functions of immune cells in both brain and periphery is important for identification of immunotherapeutic targets for stroke to extend the treatment time window. In this paper an examination of the cellular dynamics of the immune response in the central nervous system (CNS) and periphery provoked by cerebral ischemia is provided. New data is presented for the number of immune cells in brain and spleen of mice during the 7 days following middle cerebral artery occlusion (MCAO). A novel analysis of the correlation among various cell types in the brain and spleen following stroke is presented. It is found that the infiltrated macrophages in the ischemic hemisphere positively correlate with neutrophils which implies their synergic effect in migrating into the brain after stroke onset. It is noted that during infiltration of adaptive immune cells, the number of neutrophils correlate positively with T cells, which suggests neutrophils contribute to T cell infiltration in the stroked brain. Furthermore, the correlation among neurological deficit and various immune cells suggests that microglia and splenic adaptive immune cells (T and B cells) are protective while infiltrating peripheral myeloid cells (macrophage and neutrophils) worsen stroke outcome. Comprehension of such immune responses post cerebral ischemia is crucial for differentiating the drivers of outcomes and also predicting the stroke outcome.

Purpose: Description of the behavioural therapy of a patient after a subarachnoid haemorrhage from a ruptured aneurysm of the anterior communicating artery with an intracerebral haemorrhage, after aneurysm embolisation and left craniotomy, and after an ischemic cerebral stroke. Case description: The author presents behavioural therapy techniques used in patient rehabilitation in all areas requiring improvement in the daily functioning of a disabled person. The course of selected therapeutic interventions is analysed and the effects of the interventions are assessed. The presented case is an example of successful behavioural therapeutic intervention that led to changes compared to the initial functional state of the organism. Thanks to the use of behavioural techniques, independent multiprofile patient functioning was achieved. Given the limited availability of health services, the focus on the therapy on evidence-based teaching makes them intrinsic to the patient's success. Comment: The presented phases of therapy fully reflect the effective modification of behaviour patterns in a person after a subarachnoid haemorrhage from a ruptured aneurysm in the anterior communicating artery with an intracerebral haemorrhage, after aneurysm embolisation and left craniotomy, and after an ischemic cerebral stroke. The outcome of the applied behaviour approach seems to be significant enough to encourage the further development of the therapy for stroke patients regardless of the type of neurological disorders, functional difficulties, and age. [ABSTRACT FROM AUTHOR]

Background: Cerebral stroke (stroke) is an acute cerebrovascular disease with high incidence and mortality. This study aimed to explore the association between single nucleotide polymorphisms (SNPs) of CYP4A22 and stroke risk in the Chinese Han population. Methods: A total of 550 stroke patients and 545 healthy people were recruited. Four candidate SNPs (rs76011927 T/C, rs12564525 C/T, rs2056900 A/G and rs4926581 T/G) of CYP4A22 were screened. The association between CYP4A22 SNPs and stroke risk was assessed using genetic models and the relationship between SNPs and clinical biochemical indicators was analyzed by one‐way analysis of variance (one‐way ANOVA). Results: The overall analysis showed that rs12564525 could significantly reduce stroke risk only under the recessive model (OR = 0.72, 95% CI 0.53–0.99), but rs2056900 and rs4926581 were significantly associated with increased stroke risk under the homozygote (OR = 1.49, 95% CI 1.06–2.09; OR = 1.49, 95% CI 1.06–2.10), heterozygote (OR = 1.49, 95% CI 1.11–2.00; OR = 1.48, 95% CI 1.11–1.99), additive (OR = 1.22, 95% CI 1.03–1.45; OR = 1.22, 95% CI 1.03–1.45) and dominant (OR = 1.49, 95% CI 1.13–1.97; OR = 1.49, 95% CI 1.13–1.96) models (all p < 0.05). Subgroup analyses further indicated that rs2056900 and rs4926581 could significantly increase stroke risk in participants aged >63 years and females. In addition, high‐density lipoprotein cholesterol (HDL‐C) levels differed considerably among different genotypes of rs12564525, rs2056900 and rs4926581. Conclusions: This study revealed that CYP4A22 SNPs are associated with stroke risk in the Chinese Han population, and in particular, rs2056900 and rs4126581 have a significant correlation with increased stroke risk. [ABSTRACT FROM AUTHOR]

To evaluate the clinical outcomes of patients with malignant middle cerebral artery (MCA) infarction who underwent wide decompressive hemicraniectomy. Fifty-two patients with large MCA infarcts were retrospectively evaluated, and 12 patients who underwent extensive decompressive hemicraniectomy and duraplasty with a bone flap extending beyond the infarct borders were included in the study. The degree of stroke (stroke volume), preoperative and postoperative midline shift of the craniectomy area and improvement in midline shift were calculated on computed tomography. Preoperative and postoperative neurologic examination scores were determined using the modified Rankin Scale. The mean age was 63 (min: 41, max: 79) years. There was left MCA infarction in one patient and right MCA infarction in 11 patients. The postoperative follow-up period of the operated patients ranged from 14 to 90 days. The neurological examination of seven patients (58.3%) showed significant improvement. Eight (66.6%) patients survived. Postoperatively, the mean midline deviation value of 12 patients decreased from 11.04 to 4.8. It is considered that wide decompressive craniectomy performed in young patients in the early period with strict radiological and clinical follow-up can increase survival and functional recovery. [Med-Science 2023; 12(1.000): 286-90]

Abstract Background Patients with Down syndrome are at a higher risk of developing autoimmune disorders such as thyroiditis, diabetes, and celiac disease compared with the general population. Although some diseases are well known to be associated with Down syndrome, others such as idiopathic pulmonary hemosiderosis and ischemic stroke due to protein C deficiency remain rare. Case presentation We report a case of a 2.5-year-old Tunisian girl with Down syndrome and hypothyroiditis admitted with dyspnea, anemia, and hemiplegia. Chest X-ray showed diffuse alveolar infiltrates. Laboratory tests showed severe anemia with hemoglobin of 4.2 g/dl without hemolysis. A diagnosis of idiopathic pulmonary hemosiderosis was confirmed by bronchoalveolar lavage showing numerous hemosiderin-laden macrophages, with a Golde score of 285 confirming the diagnosis of pulmonary hemosiderosis. Concerning hemiplegia, computed tomography showed multiple cerebral hypodensities suggestive of cerebral stroke. The etiology of these lesions was related to protein C deficiency. Conclusion Idiopathic pulmonary hemosiderosis remains a severe disease, which is rarely associated with Down syndrome. The management of this disease in Down syndrome patients is difficult, especially when associated with an ischemic stroke secondary to protein C deficiency.

Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU). Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed. Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.

ObjectiveTo observe the effect of five elements music concrete hypnosis technique on depressive mood state, somatic motor function and activities of daily living of patients with subthreshold depression after stroke.MethodsA total of 78 patients with subthreshold depression after stroke in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group and observation group, with 39 cases in each group. During the treatment,a total of 3, 1 case fell off/stopped in the control group and the observation group respectively. Finally, a total of 36,38 cases were included in the control group and the observation group respectively. The control group received individualized emotional support from medical staff with no professional psychological training an conventional treatment. The observation group received five elements music concrete hypnosis technique intervention on the basis of conventional treatment. The hypnotic relaxation and movement guidance language in the background of Jue tune of five element music were recorded by professional psychological technicians, and the patients received motor imagination training in the music background under the guidance of therapists. Both groups were treated for 30 minutes a time, once a day, six times a week, lasting for four weeks. Before treatment and four weeks after treatment, the Hamilton depression scale 17 (HAMD-17) and the center for epidemiologic studies depression scale (CES-D) were used to evaluate the depressive mood state of patients; the Fugl-Meyer assessment (FMA) was used to evaluate somatic motor function; the modified Barthel index (MBI) scale was used to evaluate the ability of activities of daily living. In addition, 12 patients in the observation group underwent resting-state functional magnetic resonance imaging (rs-fMRI) to observe the activation range of brain regions.ResultsCompared with those before treatment, the scores of HAMD-17 and CES-D of both groups decreased significantly after treatment, and the scores of FMA and MBI increased significantly (PP

Cerebral stroke remains the leading cause of death and disability worldwide as well as in Ukraine. After a cerebral stroke, there is an increased risk of a new cerebral stroke (9‒15 % within 1 year), and about a quarter of all cerebral stroke are recurrent. Up to 80 % of recurrent cerebral stroke can be avoided through lifestyle modifications (healthy diet, sufficient amount of physical activity, normalization of body weight, cessation of smoking and alcohol abuse) and control of chronic diseases such as hypertension, diabetes, hyperlipidemia and atrial fibrillation. The key to effective secondary prevention is determining the etiology of cerebral stroke, which requires a primary examination in all cases and a number of additional tests as needed. The most common causes of ischemic cerebral stroke are cardiogenic embolism, atherosclerosis of the large cerebral arteries (macroangiopathy), and brain small vessels disease (microangiopathy), but approximately 1/3 of cerebral stroke have other, rear, determined cause or the cause remains unknown despite the appropriate workup (cryptogenic cerebral stroke). In the review, we discuss modern approaches to ischemic cerebral stroke classification and determination of their etiology, from the most prevalent to the rarest causes. A careful search for the cause of cerebral stroke is particularly important in young patients (aged 18 to 50 years) with a high life expectancy. We have reviewed in detail the possibilities of screening for subclinical atrial fibrillation by long-term cardiac monitoring with implantable devices and the diagnosis of monogenetic causes of cerebral stroke, with a particular focus on Fabry disease, for which there is an effective treatment.

In Ukraine, the problem of stroke, like other cardiovascular diseases, is extremely acute: it leads to 67 % of all deaths. The Ministry of Health of Ukraine notes that more than 140,000 of our compatriots are diagnosed with stroke every year; 30–40 % of patients die in the first 3 days and up to 50 % — within a year; 20–40 % of survivors become dependent on external assistance (12.5 % of primary disability). All over the world, measures that can prevent the occurrence of a stroke, and methods for rehabilitation of people who have already developed it are of great importance in terms of solving the problem of vascular disasters. This article provides scientifically based etiopathogenetic mechanisms of cerebral stroke (ischemic, hemorrhagic), its diagnosis (clinical, instrumental, laboratory), diagnostic criteria for early detection and early emergency (urgent) medical care. Examples of providing care in the pre-hospital period, inpatient (stroke centers) stage — primary, secondary and tertiary care are given. The importance of early rehabilitation and preventive measures is emphasized. It is indicated that it is important to act urgently and to focus efforts where the greatest effectiveness in stroke prevention can be achieved.

Background: In patients with stroke, alongside diminished level of consciousness, impaired swallowing and aspiration pneumonia are also common. In some studies, angiotensin-converting enzyme inhibitors (ACEIs) have caused improved swallowing and reduced incidence of aspiration pneumonia in some patients. This study has examined the effects of captopril on reducing the extent of aspiration pneumonia in stroke patients. Methods: A total of 68 patients with brain stroke and diminished level of consciousness hospitalized in Ayatollah Rouhani Hospital, Babol were chosen and randomly assigned into captopril and placebo groups. In the captopril group, in case of blood pressure above 100/70 mmHg, captopril was prescribed with a dose of 6.25 mg three times per day. In the placebo group, vitamin C was given, and in both groups in the case of hypertension, an antihypertensive drug other than ACEI was used. Age, gender, blood pressure, potassium level, and primary underlying diseases were recorded. The two groups were compared with each other daily for 14 days in terms of severity of incidence of pneumonia as well as hemodynamic changes in potassium. Results: A total of 68 patients with brain stroke were included in the study in two equal 34-subject groups. The two groups had no difference in terms of age, gender, systolic and diastolic blood pressure, initial potassium level, and underlying diseases. In the captopril group, 1 (2.9%) and in the placebo group 6 (17.6%) suffered pneumonia (P < 0.046). The two groups had no significant difference in terms of systolic and diastolic blood pressure, heart rate, and serum potassium. Conclusion: The results of this study indicated that captopril is effective in reducing the extent of incidence of aspiration pneumonia in brain stroke patients. [ABSTRACT FROM AUTHOR]

Brain–computer interfaces (BCI) are actively used in neurorehabilitation. Recent years have seen the accumulation of an extensive database of results from clinical studies conducted around the world demonstrating the efficacy of BCI in restoring motor function after stroke. The use of BCI in post-stroke cognitive impairment continues to expand. This article discusses the potential and prospects for the use of BCI in the treatment of cognitive disorders and experience of its use, presents results from clinical studies in stroke patients, evaluates the possibilities of using this technology, and describes its prospects and new areas of work addressing its effects. [ABSTRACT FROM AUTHOR]

Objectives: Regulation of microglia polarisation may be a new way to treat ischaemic stroke based on its effects on brain injury. Isoliquiritigenin (ILG) is a flavonoid with neuroprotective function. The study investigated whether ILG regulated microglial polarisation and affects brain injury. Methods: Here, a transient middle cerebral artery occlusion (tMCAO) model in vivo and lipopolysaccharide (LPS)-induced BV2 cells in vitro were established. Brain damage was assessed using a 2,3,5-triphenyl-tetrazolium-chloride staining assay. Microglial polarisation was analysed using enzyme linked immunosorbent assay, quantitative real-time polymerase chain reaction, and immunofluorescence assay. The levels of p38/MAPK pathway-related factors were measured by western blot. Key findings: ILG suppressed infarct volume and neurological function of tMCAO rats. Moreover, ILG facilitated M2 microglia polarisation and suppressed M1 polarisation in the tMCAO model and LPS-induced BV2 cells. Moreover, ILG reduced the phosphorylation of p38, MAPK activated protein kinase 2, and heat shock protein 27 induced by LPS. Rescue study showed that activating the p38/MAPK pathway reversed the microglia polarisation induced by ILG and inactivating the p38/MAPK pathway enchanced the microglia polarisation. Conclusion: ILG promoted microglia M2 polarisation by inactivating the p38/MAPK pathway, suggesting that ILG has the potential for the treatment of ischaemic stroke. [ABSTRACT FROM AUTHOR]

Aim. To study the long-term survival of patients with cerebrovascular accident, depending on sex and age.Material and methods. The outpatient part of the REGION-M registry (patients with cerebrovascular accident, hospitalized in a Moscow hospital) included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke, which were divided into 5 age groups: group 1 — ≤50 years, n=72 (10,5%), group 2 — 51-60 years old, n=122 (17,8%), group 3 — 61-70 years old, n=156 (22,8%), group 4 — 71-80 years old, n=185 (27,0%) and group 5 — ≥81 years old, n=149 (21,8%). The survival of patients was assessed at the 2nd and 3rd stages after 4,2 (2,4-5,6) and 5,5 (2,4-7,0) years.Results. The mortality of patients in the long-term follow-up period significantly increased with age. There were following mortality rate for stages 2 and 3 stages: 18-50 years old — 8,3 and 22,2%, 51-60 years old — 18 and 36,9%, 61-70 years old — 41 and 56,4%, 71-80 years old — 54,1 and 73%, >81 years — 76,5 and 87,9% (p

Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack.Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p

Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99–73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99–31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition.

A cerebral stroke is a medical problem that occurs when the blood flowing to a section of the brain is suddenly cut off, causing damage to the brain. Brain cells gradually die because of interruptions in blood supply and other nutrients to the brain, resulting in disabilities, depending on the affected region. Early recognition and detection of symptoms can aid in the rapid treatment of strokes and result in better health by reducing the severity of a stroke episode. In this paper, the Random Forest (RF), Extreme Gradient Boosting (XGBoost), and light gradient-boosting machine (LightGBM) were used as machine learning (ML) algorithms for predicting the likelihood of a cerebral stroke by applying an open-access stroke prediction dataset. The stroke prediction dataset was pre-processed by handling missing values using the KNN imputer technique, eliminating outliers, applying the one-hot encoding method, and normalizing the features with different ranges of values. After data splitting, synthetic minority oversampling (SMO) was applied to balance the stroke samples and no-stroke classes. Furthermore, to fine-tune the hyper-parameters of the ML algorithm, we employed a random search technique that could achieve the best parameter values. After applying the tuning process, we stacked the parameters to a tuning ensemble RXLM that was analyzed and compared with traditional classifiers. The performance metrics after tuning the hyper-parameters achieved promising results with all ML algorithms. [ABSTRACT FROM AUTHOR]

The preferred surgical method for treating adults with moyamoya disease (MMD) remains controversial. The purpose of this study was to compare the efficacy of different surgical methods in the treatment of adults with ischaemic-type MMD. We retrospectively analyzed the data of patients with ischaemic-type MMD who underwent indirect bypass (IB), direct bypass (DB), or combined bypass (CB) at the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2019. Postoperative complications, improvements in neurological function, haemodynamics, recurrent stroke and neovascularization were compared. A total of 310 adults (371 hemispheres) with ischaemic-type MMD were included in our study. Ninety, 127, and 154 hemispheres underwent IB, DB and CB, respectively. A total of 24 (6.5%) ischaemic events and 8 (2.8%) symptomatic hyperperfusion events occurred after the operations. There was no significant difference in postoperative complications among the three types of surgery (p = 0.300). During the follow-up period, there were 21 cases (5.7%) of recurrent ischaemia and 12 cases (3.2%) of recurrent haemorrhage. Kaplan-Meier survival analysis showed that the ischaemia-free survival of the CB group was significantly longer than that of the IB group (p = 0.047), but there was no significant difference in haemorrhage-free survival among the three groups (p = 0.660). Six months after the operation, DB and CB were superior to IB in improving cerebral blood flow and neovascularization (p = 0.002), but there was no significant difference in the improvement of neurological function among the three groups at the last follow-up (p = 0.784). The three surgical methods achieved satisfactory results in the treatment of ischaemic-type MMD. DB and CB can significantly improve haemodynamics and reduce recurrent stroke. In terms of improving neurological function, the curative effect of the three surgical methods remains to be further explored. [ABSTRACT FROM AUTHOR]

Objectives. Stroke is an acute cerebrovascular disease with high morbidity and mortality rate. Many stroke management strategies can improve prognosis and quality of life, but only to a certain extent. Phosphodiesterase inhibitor-5 (PDE-5i) has shown benefi ts in numerous preclinical studies, but human studies have been inconclusive. Material and Methods. For this narrative review, we conducted a systematic search following the PRISMA statement guideline from inception until November 2022. The search was conducted in PubMed, ScienceDirect, EBSCOhost, and ProQuest. We included all human and animal studies on this topic, including preclinical studies, randomized clinical trials, and case studies. All the excluded studies are reviews or non-English studies. Review. Many PDE-5i have shown benefi ts in anatomical and functional outcomes in preclinical acute experimental stroke models. PF-03049423 was safe and well tolerated in humans but had no significant impact on neurological or functional outcomes. Sildenafi l on acute/subacute was deemed safe to use and demonstrated improvement over baseline, but power remains unknown due to the lack of a control group. Tadalafi l use resulted in a reduction in regional cerebral blood flow in subjects with a history of stroke. Conclusions. Despite promising results in preclinical studies, current evidence shows that PDE-5i does not aff ect clinical or functional recovery in people with acute stroke. The disparity in the intricacy of stroke pathophysiology between human and animal models was crucial. Further research in a larger population with more consistent stroke onset, medicines, and doses is required for a more conclusive result. [ABSTRACT FROM AUTHOR]

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Background: Patients with Down syndrome are at a higher risk of developing autoimmune disorders such as thyroiditis, diabetes, and celiac disease compared with the general population. Although some diseases are well known to be associated with Down syndrome, others such as idiopathic pulmonary hemosiderosis and ischemic stroke due to protein C deficiency remain rare. Case presentation: We report a case of a 2.5-year-old Tunisian girl with Down syndrome and hypothyroiditis admitted with dyspnea, anemia, and hemiplegia. Chest X-ray showed diffuse alveolar infiltrates. Laboratory tests showed severe anemia with hemoglobin of 4.2 g/dl without hemolysis. A diagnosis of idiopathic pulmonary hemosiderosis was confirmed by bronchoalveolar lavage showing numerous hemosiderin-laden macrophages, with a Golde score of 285 confirming the diagnosis of pulmonary hemosiderosis. Concerning hemiplegia, computed tomography showed multiple cerebral hypodensities suggestive of cerebral stroke. The etiology of these lesions was related to protein C deficiency. Conclusion: Idiopathic pulmonary hemosiderosis remains a severe disease, which is rarely associated with Down syndrome. The management of this disease in Down syndrome patients is difficult, especially when associated with an ischemic stroke secondary to protein C deficiency. [ABSTRACT FROM AUTHOR]

Objective: To discuss the therapeutic effect of the back-shu and front-mu point combinations acupuncture method combined with Qi-Boosting and Phlegm-Dissolving Formula in the treatment of stroke associated pneumonia. Methods: A total of 82 cases of stroke associated pneumonia patients admitted to the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2017 to October 2019 were selected. The patients were randomly divided into two groups as the control group and the study group according to a random number table. Patients in the control group were treated with routine treatment of the modern medicine, including antihypertensive, lipid-lowering, anti-infection, anticoagulation, expectorant and nutritional support treatment. Patients in the study group were treated with the back-shu and front-mu point combinations acupuncture method combined with Qi-Boosting and Phlegm-Dissolving Formula treatment on the base of routine treatment in the control group. After treatment, the clinical curative effect was compared between the two groups. The recovery time of body temperature and white blood cells, full absorption time of lesion and hospital stay of the two groups were compared. The pneumonia severity index (PSI) was used to evaluate the severity of pneumonia. The levels of c-reactive protein (CRP), soluble triggering receptor of myeloid cells-1 (sTREM-1) and neutrophil/lymphocyte ratio (NLR) of patients in the two groups were measured before and after treatment. Results: After treatment, curative effect of the study group was 95.00%, and the control group was 77.50%. Curative effect of the study group was higher than that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the recovery time of body temperature and white blood cells, full absorption time of lesion and hospital stay in the study group were less than those in the control group, and the differences were statistically significant (P < 0.05). After treatment, the PSI of the two groups obviously decreased compared with that before treatment, and the difference was statistically significant (P < 0.05). Moreover, decreased degree in the study group was more obvious than that in the control group, and the difference was statistically significant (P < 0.05). After treatment, the CRP, sTREM-1 and NLR of the two groups obviously decreased compared with those before treatment, and differences were statistically significant (P < 0.05). Moreover, the decreased degrees of the study group were lower than those of the control group, and differences were statistically significant (P < 0.05). Conclusions: The back-shu and front-mu point combinations acupuncture method combined with Qi-Boosting and Phlegm-Dissolving Formula treatment can increase the curative effect of stroke associated pneumonia. Moreover, the therapeutic method can further alleviate the clinical symptoms and signs, control development of disease condition and decrease level of inflammatory factors. [ABSTRACT FROM AUTHOR]

To evaluate the clinical outcomes of patients with malignant middle cerebral artery (MCA) infarction who underwent wide decompressive hemicraniectomy. Fiftytwo patients with large MCA infarcts were retrospectively evaluated, and 12 patients who underwent extensive decompressive hemicraniectomy and duraplasty with a bone flap extending beyond the infarct borders were included in the study. The degree of stroke (stroke volume), preoperative and postoperative midline shift of the craniectomy area and improvement in midline shift were calculated on computed tomography. Preoperative and postoperative neurologic examination scores were determined using the modified Rankin Scale. The mean age was 63 (min: 41, max: 79) years. There was left MCA infarction in one patient and right MCA infarction in 11 patients. The postoperative follow-up period of the operated patients ranged from 14 to 90 days. The neurological examination of seven patients (58.3%) showed significant improvement. Eight (66.6%) patients survived. Postoperatively, the mean midline deviation value of 12 patients decreased from 11.04 to 4.8. It is considered that wide decompressive craniectomy performed in young patients in the early period with strict radiological and clinical follow-up can increase survival and functional recovery. [ABSTRACT FROM AUTHOR]