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All fiber-based illumination system for multi-exposure speckle imaging.

Monitoring blood flow is critical to treatment efficacy in many surgical settings. Laser speckle contrast imaging (LSCI) is a simple, real-time, label-free optical technique for monitoring blood flow that has emerged as a promising technique but lacks the ability to make repeatable quantitative measurements. Multi-exposure speckle imaging (MESI) is an extension of LSCI that requires increased complexity of instrumentation, which has limited its adoption. In this paper, we design and fabricate a compact, fiber-coupled MESI illumination system (FCMESI) that is substantially smaller and less complex than previous systems. Using microfluidics flow phantoms, we demonstrate that the FCMESI system measures flow with an accuracy and repeatability equivalent to traditional free space MESI illumination systems. With an

Targeted photothrombotic subcortical small vessel occlusion using in vivo real-time fiber bundle endomicroscopy in mice.

The development of an accurate subcortical small vessel occlusion model for pathophysiological studies of subcortical ischemic stroke is still insignificant. In this study, in vivo real-time fiber bundle endomicroscopy (FBEµ) was applied to develop subcortical photothrombotic small vessel occlusion model in mice with minimal invasiveness. Our FBFµ system made it possible to precisely target specific blood vessels in deep brain and simultaneously observe the clot formation and blood flow blockage inside the target blood vessel during photochemical reactions. A fiber bundle probe was directly inserted into the anterior pretectal nucleus of the thalamus in brain of live mice to induce a targeted occlusion in small vessels. Then, targeted photothrombosis was performed using a patterned laser, observing the process through the dual-color fluorescence imaging. On day one post occlusion, infarct lesions are measured using TTC staining and post hoc histology. The results show that FBEµ applied to targeted photothrombosis can successfully generate a subcortical small vessel occlusion model for lacunar stroke.

Cardiometabolic Multimorbidity Associated with Moderate and Severe Disabilities Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana and South Africa.

Integrated management of cardiometabolic diseases is crucial in improving the quality of life of older persons. The objective of the study was to identify clusters of cardiometabolic multimorbidity associated with moderate and severe disabilities in Ghana and South Africa. Data were from the World Health Organization (WHO) study on global AGEing and adult health (SAGE) Wave-2 (2015) conducted in Ghana and South Africa. We analysed the clustering of cardiometabolic diseases including angina, stroke, diabetes, obesity, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataracts, and depression. The WHO Disability Assessment Instrument version 2.0 was used to assess functional disability. We used latent class analysis to calculate the multimorbidity classes and disability severity levels. Ordinal logistic regression was used to identify the clusters of multimorbidity associated with moderate and severe disabilities. Data from 4,190 adults aged over 50 years were analysed. The prevalence of moderate and severe disabilities was 27.0% and 8.9% respectively. Four latent classes of multimorbidity were identified. These included a relatively healthy group with minimal cardiometabolic multimorbidity (63.5%), general and abdominal obesity (20.5%), hypertension, abdominal obesity, diabetes, cataracts, and arthritis (10.0%), and angina, chronic lung disease, asthma, and depression (6.0%). Compared to the participants with minimal cardiometabolic multimorbidity, the odds of moderate and severe disabilities were higher among participants with multimorbidity comprising hypertension, abdominal obesity, diabetes, cataract and arthritis aOR 3.0 95% CI 1.6 to 5.6, and those with angina, chronic lung disease, asthma and depression aOR 2.7 95% CI 1.6 to 4.5. Cardiometabolic diseases among older persons in Ghana and South Africa cluster in distinct multimorbidity patterns that are significant predictors of functional disabilities. This evidence may be useful for defining disability prevention strategies and long-term care for older persons living with or at risk of cardiometabolic multimorbidity in sub-Saharan Africa.

The expression profiling of serum miR-92a, miR-134 and miR-375 in acute ischemic stroke.

To investigate the expression profile and diagnostic potentials of serum miR-92a, 134, and 375 in acute ischemic stroke (AIS) patients. Serum miRs-92a, 134, and 375 expression profiles were estimated by qRT-PCR for 70 AIS patients, age-matched with 25 control subjects. Their diagnostic potential was estimated by ROC analysis. Down-expression of miR-92a and miR-375 was found (56 96.5% -1.86 ± 1.36 and 53 91.4% -1.63 ± 1.38, respectively), while miR-134 showed a predominant upregulation (46 79.3% 0.853 ± 1.34). The diagnostic accuracy was the highest for miR-92a and miR-375 (area under the curve 0.9183 and 0.898, respectively), with greater specificity for miR-375 (Sp 96%). Serum miR-92a and miR-375 could be promising early detective biomarkers of AIS. This study aimed to examine how miR-92a, 134, and 375 in acute ischemic stroke (AIS) patients were expressed and if they could be used to diagnose the disease. Hence, their expression profiles were assessed in the serum of 70 AIS patients and 25 controls. Results showed that miR-92a and miR-375 were downregulated, while miR-134 was mostly upregulated. miR-92a and miR-375 had the best diagnostic accuracy, but miR-375 was more specific. Therefore, miR-92a and miR-375 show promise as potential early AIS biomarkers.

Cerebral Fat Embolism Syndrome in a Patient With an Aortic Dissection and Orthopedic Injuries A Case Report.

Traumatic brain injury is a significant cause of morbidity and mortality in adults and can be associated with severe secondary complications, including post-traumatic cerebral infarction. One potential cause of post-traumatic cerebral infarction is cerebral fat embolism syndrome (FES). We present a case in which a male in his twenties was involved in a motorcycle collision with a truck. He sustained numerous injuries, including bilateral femur fractures, left acetabular, open left tibial and fibular fractures, and a type A aortic dissection. Before orthopedic fixation, his Glasgow Coma Score (GCS) was 10. Following open reduction and internal fixation, his GCS was noted to be 4, with a stable computed tomography scan of the head. The differential included embolic strokes related to his dissection, an unrecognized cervical spine injury, and cerebral FES. Stat magnetic resonance imaging of the head demonstrated a starfield pattern of restricted diffusion consistent with cerebral FES. An intracranial pressure (ICP) monitor was placed, and his ICP acutely spiked to over 100 mmHg despite maximal medical management. This case highlights several key learning points, namely, that cerebral FES should remain in the mind of any physician treating high-energy multisystem traumas. While it is a rare syndrome, its effects can lead to significant morbidity and mortality as treatment is controversial and can conflict with the treatment of other systemic injuries. Further research into prevention and treatment is warranted to continue optimizing outcomes following cerebral FES.

Prevalence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Graft Surgery in Elderly Patients.

Background Atrial fibrillation (AF) is one of the frequent complications following coronary artery bypass surgery. Postoperative atrial fibrillation (POAF) can lead to thromboembolic events and prolong hospital stays. We aimed to determine the prevalence of POAF following off-pump coronary artery bypass surgery (OPCAB) in the elderly population. Materials and Methods This cross-sectional study was carried out between May 2018 to April 2020. Elderly patients (age ≥65 years) admitted for isolated elective OPCAB were eligible for the study. A total of 60 elderly patients were evaluated based on the preoperative and intraoperative risk factors and postoperative outcomes during the hospital stay. Results The mean age was 67.83±4.06 years, and the prevalence of POAF in elderly adults was 48.3%. The mean number of grafts was 3.20±0.73, and ICU stays at 3.43±1.61 days. The mean duration of the hospital stays was 10.03±2.12 days. Although stroke developed in 1.7% of post-CABG patients, no mortality was observed postoperatively. Conclusion

Open-source statistical and data processing tools for wide-field optical imaging data in mice.

Wide-field optical imaging (WOI) can produce concurrent hemodynamic and cell-specific calcium recordings across the entire cerebral cortex in animal models. There have been multiple studies using WOI to image mouse models with various environmental or genetic manipulations to understand various diseases. Despite the utility of pursuing mouse WOI alongside human functional magnetic resonance imaging (fMRI), and the multitude of analysis toolboxes in the fMRI literature, there is not an available open-source, user-friendly data processing and statistical analysis toolbox for WOI data. To assemble a MATLAB toolbox for processing WOI data, as described and adapted to combine techniques from multiple WOI groups and fMRI. We outline our MATLAB toolbox on GitHub with multiple data analysis packages and translate a commonly used statistical approach from the fMRI literature to the WOI data. To illustrate the utility of our MATLAB toolbox, we demonstrate the ability of the processing and analysis framework to detect a well-established deficit in a mouse model of stroke and plot activation areas during an electrical paw stimulus experiment. Our processing toolbox and statistical methods isolate a somatosensory-based deficit 3 days following photothrombotic stroke and cleanly localize sensory stimulus activations. The toolbox presented here details an open-source, user-friendly compilation of WOI processing tools with statistical methods to apply to any biological question investigated with WOI techniques.

Light-sheet laser speckle imaging for cilia motility assessment.

Mucociliary clearance is an important innate defense mechanism predominantly mediated by ciliated cells in the upper respiratory tract. Ciliary motility on the respiratory epithelium surface and mucus pathogen trapping assist in maintaining healthy airways. Optical imaging methods have been used to obtain several indicators for assessing ciliary movement. Light-sheet laser speckle imaging (LSH-LSI) is a label-free and non-invasive optical technique for three-dimensional and quantitative mapping of velocities of microscopic scatterers. Here, we propose to use an inverted LSH-LSI platform to study cilia motility. We have experimentally confirmed that LSH-LSI can reliably measure the ciliary beating frequency and has the potential to provide many additional quantitative indicators for characterizing the ciliary beating pattern without labeling. For example, the asymmetry between the power stroke and the recovery stroke is apparent in the local velocity waveform. PIV (particle imaging velocimetry) analysis of laser speckle data could determine the cilia motion directions in different phases.

Extreme lipoprotein(a) in clinical practice A cross sectional study.

Measurement of lipoprotein(a) Lp(a) is recommended once in a lifetime to identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to analyze the clinical features of patients with extreme Lp(a). Cross-sectional, case-control study of a single healthcare organization between 2015 and 2021. Individuals with extreme Lp(a) > 430 nmolL (53 of 3900 tested patients) were compared to age- and sex-matched controls with normal range Lp(a). Mean patient age was 58 ± 14 years (49% women). Myocardial infarction (47.2% vs. 18.9%), coronary artery disease (CAD) (62.3% vs. 28.3%), and peripheral artery disease (PAD) or stroke (22.6% vs. 11.3%) were more prevalent in patients with extreme than normal range Lp(a). The adjusted odds ratio 95% confidence interval (CI) associated with extreme compared to normal range Lp(a) was 2.50 (1.20-5.21) for myocardial infarction, 2.20 (1.20-4.05) for CAD, and 2.75 (0.88-8.64) for PAD or stroke. A high-intensity statin plus ezetimibe combination was issued by 33% and 20% of CAD patients with extreme and normal range Lp(a), respectively. In patients with CAD, low density lipoprotein cholesterol (LDL-C) <55 mgdL was achieved in 36% of those with extreme Lp(a) and 47% of those with normal range Lp(a). Extremely elevated Lp(a) levels are associated with an approximately 2.5-fold increased risk of ASCVD compared with normal range Lp(a) levels. Although lipid-lowering treatment is more intense in CAD patients with extreme Lp(a), combination therapies are underused, and attainment rates of LDL-C goals are suboptimal.

The impact of rehabilitation on the community life of stroke survivors in Accra, Ghana.

Return to pre-stroke life is of great importance to stroke survivors, their families and communities as stroke affects their ability to perform activities of daily living. It is therefore important to understand the impact of stroke rehabilitation on the community life of stroke survivors in Ghana as there are limited data. Our study aimed to explore and describe the views of stroke survivors on the impact of stroke rehabilitation on their community life. A descriptive qualitative study was conducted among 15 stroke survivors recruited from three selected hospitals in the Greater Accra Region of Ghana. Individual in-depth interviews were conducted using a semi-structured interview guide. Interview transcripts were analysed using thematic analysis and this gave rise to several themes. The authors found that stroke left most of the survivors with functional limitations and they required various degrees of assistance to perform their activities of daily living. As the stroke survivors received rehabilitation, most of them mentioned improvements in function. However, most participants were still unable to return to work and enjoy social or leisure activities. Our study shows that attention needs to be given to the occupational and social management in rehabilitation as much as it is given to the physical management, to improve community integration post-stroke. Our study highlights the need to take into consideration the occupational and social aspects of life as part of the rehabilitation process for stroke survivors.

Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke.

Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Twenty-eight trials ( Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. A high dosage of aerobic exercise, duration ≥ 120 minweek intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.

Neutrophil extracellular traps in central nervous system pathologies A mini review.

Neutrophils are the first cells to be recruited to sites of acute inflammation and contribute to host defense through phagocytosis, degranulation and neutrophil extracellular traps (NETs). Neutrophils are rarely found in the brain because of the highly selective blood-brain barrier (BBB). However, several diseases disrupt the BBB and cause neuroinflammation. In this regard, neutrophils and NETs have been visualized in the brain after various insults, including traumatic (traumatic brain injury and spinal cord injury), infectious (bacterial meningitis), vascular (ischemic stroke), autoimmune (systemic lupus erythematosus), neurodegenerative (multiple sclerosis and Alzheimers disease), and neoplastic (glioma) causes. Significantly, preventing neutrophil trafficking into the central nervous system or NET production in these diseases alleviates brain pathology and improves neurocognitive outcomes. This review summarizes the major studies on the contribution of NETs to central nervous system (CNS) disorders.

Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic.

Patients with disabilities and those from diverse equity-deserving backgrounds have been disproportionately affected by the SARS COV-2 (COVID-19) pandemic. To describe the significant needs and social determinants of health that affected a group of uninsured patients (from equity-deserving groups) with rehabilitation diagnoses during the early months of the COVID-19 pandemic. Retrospective cohort study utilizing a telephone-based needs assessment from April to October, 2020. Free interdisciplinary rehabilitation clinic serving patients with physical disabilities from equity-deserving minority backgrounds. 51 uninsured, diverse patients with spinal cord injuries, brain injuries, amputations, strokes, and other diagnoses requiring interdisciplinary rehabilitation care. Using a non-structured approach, telephone-based needs assessments were collected monthly. Reported needs were summarized into themes and the frequencies of each theme were recorded. From the total number of concerns, medical issues were reported with the highest frequency (46%), followed by equipment needs (30%) and mental health concerns (30%). Other frequently mentioned needs centered around themes of rent, employment, and supplies. Rent and employment were more frequently cited in earlier months, and equipment problems were more frequently cited in later months. A minority of patients reported they had no needs, some of whom had acquired insurance. Our objective was to describe the needs of a racially and ethnically diverse set of uninsured individuals with physical disabilities seen at a specialized interdisciplinary rehabilitation pro bono clinic during the early months of COVID-19. Medical issues, equipment needs, and mental health concerns were the top three needs. To optimally serve them, care providers must be aware of current and future needs for their underserved patients, especially if future lockdowns occur.

Joint effect of highly-sensitive cardiac troponin T and ankle-brachial index on incident cardiovascular events The MESA and CHS.

Elevated highly-sensitive cardiac troponin-T (hs-cTnT≥14 ngL) and low ankle-brachial index (ABI<0.9) are risk factors for atherosclerotic cardiovascular diseases (ASCVD) but their joint effect on the risk of ASCVD events is unknown. We used data from the two population-based cohort studies, the Multi-Ethnic study of Atherosclerosis (MESA) and Cardiovascular Heart Study (CHS) among 10,897 participants free of CVD events at baseline (mean age 66.3 years, 44.7% males). Incident ASCVD was defined as CHD (fatalnon-fatal MI or revascularization), transient ischemic attack, or stroke,. Hazard ratio (HR) and 95% CI was calculated from a Cox regression model. Interaction on the additive scale was assessed using relative excess risk due to interaction (RERI) and interaction on the multiplicative scale was assessed by Likelihood ratio (LR) test. At baseline (2000-2002 for MESA and 1989-1990 for CHS), 10.2% of participants had elevated hs-cTnT and 7.5% had low ABI. During a median follow-up of 13.6 years (interquartile range, 7.5-14.7 years), there were 2590 incident ASCVD and 1542 incident CHD events. The hazard of CHD and ASCVD was higher in participants with both elevated hs-cTnT and low ABI HR(95% CI) CHD 2.04 (1.45, 2.88), ASCVD 2.05 (1.58, 2.66) than those with only elevated hs-cTnT CHD 1.65 (1.37, 1.99), ASCVD 1.67 (1.44, 1.99) or only low ABI CHD 1.87 (1.52, 2.31), ASCVD 1.67 (1.42, 1.97). Antagonistic multiplicative interaction was observed for CHD (LR test The observed joint effect of elevated cTnT and low ABI on ASCVD risk was smaller (i.e., antagonistic interaction) than that expected by the combined independent effects of each risk factor.

A Systematic Review and Meta-Analysis of Influences of Chronic Kidney Disease on Patients after Percutaneous Coronary Intervention for Chronic Total Occlusions.

Chronic kidney disease (CKD) is a clinical collective term for kidney disease with glomerular filtration rate (GFR) < 60 mLmin for more than three months due to various factors and is usually associated with coronary heart disease and is also an independent risk factor for coronary heart disease. This study is aimed at systematically reviewing the influence of CKD on the outcomes of patients after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). The Cochrane Library, PubMed, Embase, China biomedical literature database (SinoMed), China National Knowledge Infrastructure, and Wanfang database were searched for case-control studies on the influence of CKD on outcomes after PCI for CTOs. After screening the literature, extracting data, and evaluating the quality of literature, RevMan 5.3 software was used for meta-analysis. There were 11 articles with a total of 558,440 patients included. Meta-analysis results indicated that left ventricular ejection fraction (LVEF) level, diabetes, smoking, hypertension, coronary artery bypass grafting, angiotensin converting enzyme inhibitor (ACEI)angiotensin receptor blocker (ARB), LVEF level, diabetes, smoking, hypertension, coronary artery bypass grafting, ACEIARB,

Enriched environment promotes post-stroke angiogenesis through astrocytic interleukin-17A.

Our previous studies have revealed that the protective effect of an enriched environment (EE) may be linked with astrocyte proliferation and angiogenesis. However, the relationship between astrocytes and angiogenesis under EE conditions still requires further study. The current research examined the neuroprotective effects of EE on angiogenesis in an astrocytic interleukin-17A (IL-17A)-dependent manner following cerebral ischemiareperfusion (IR) injury. A rat model of ischemic stroke based on middle cerebral artery occlusion (MCAO) for 120 min followed by reperfusion was established, after which rats were housed in either EE or standard conditions. A set of behavior tests were conducted, including the modified neurological severity scores (mNSS) and the rotarod test. The infarct volume was evaluated by means of 2,3,5-Triphenyl tetrazolium chloride (TTC) staining. To evaluate the levels of angiogenesis, the protein levels of CD34 were examined by means of immunofluorescence and western blotting, while the protein and mRNA levels of IL-17A, vascular endothelial growth factor (VEGF), and the angiogenesis-associated factors interleukin-6 (IL-6), JAK2, and STAT3 were detected by western blotting and real-time quantitative PCR (RT-qPCR). We found that EE promoted functional recovery, reduced infarct volume, and enhanced angiogenesis compared to rats in standard conditions. IL-17A expression in astrocytes was also increased in EE rats. EE treatment increased the levels of microvascular density (MVD) and promoted the expression of CD34, VEGF, IL-6, JAK2, and STAT3 in the penumbra, while the intracerebroventricular injection of the IL-17A-neutralizing antibody in EE rats attenuated EE-mediated functional recovery and angiogenesis. Our findings revealed a possible neuroprotective mechanism of astrocytic IL-17A in EE-mediated angiogenesis and functional recovery after IR injury, which might provide the theoretical basis for EE in clinical practise for stroke patients and open up new ideas for the research on the neural repair mechanism mediated by IL-17A in the recovery phase of stroke.

Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI.

High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration. The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT. Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulams-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction TIMI major or minor) endpoints at 1 year. Regardless of HBR (n 1,893 31.6%) and complex PCI (n 999 16.7%), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14% non-HBR, 1.90% vs 2.02% The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 STOPDAPT-2, NCT02619760 Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS STOPDAPT-2 ACS, NCT03462498).

Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure A Population-Based Cohort Study.

Heart failure (HF) may increase the risk of dementia via shared risk factors. The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. The previously territory-wide database was interrogated to identify eligible patients with HF (N 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Coxcompeting risk regression models where appropriate. Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 IQR 1.2-10.2 years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimers disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included older age (≥75 years, subdistribution hazard ratio SHR 2.22), female sex (SHR 1.31), Parkinsons disease (SHR 1.28), peripheral vascular disease (SHR 1.46), stroke (SHR 1.24), anemia (SHR 1.11), and hypertension (SHR 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR 4.51 New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.

Effect of Sex Differences in Atrial Fibrillation After the Combined Procedure Predisposed or Impartial

Figure see text

Impact of Complete or Incomplete Revascularization for Left Main Coronary Disease The Extended PRECOMBAT Study.

Whether complete revascularization (CR) or incomplete revascularization (IR) may affect long-term outcomes after PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease is unclear. The authors sought to assess the impact of CR or IR on 10-year outcomes after PCI or CABG for LMCA disease. In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) 10-year extended study, the authors evaluated the effect of PCI and CABG on long-term outcomes according to completeness of revascularization. The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCE) (composite of mortality from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization). Among 600 randomized patients (PCI, n 300 and CABG, n 300), 416 patients (69.3%) had CR and 184 (30.7%) had IR 68.3% of PCI patients and 70.3% of CABG patients underwent CR, respectively. The 10-year MACCE rates were not significantly different between PCI and CABG among patients with CR (27.8% vs 25.1%, respectively adjusted HR 1.19 95% CI 0.81-1.73) and among those with IR (31.6% vs 21.3%, respectively adjusted HR 1.64 95% CI 0.92-2.92) ( In this 10-year follow-up of PRECOMBAT, the authors found no significant difference between PCI and CABG in the rates of MACCE and all-cause mortality according to CR or IR status. (Ten-Year Outcomes of PRE-COMBAT Trial PRECOMBAT, NCT03871127 PREmier of Randomized COMparison of Bypass Surgery Versus AngioplasTy Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease PRECOMBAT, NCT00422968).

Prasugrel-Based De-Escalation in Patients With Acute Coronary Syndrome According to Renal Function.

Patients with coronary artery disease and impaired renal function are at higher risk for both bleeding and ischemic adverse events after percutaneous coronary intervention (PCI). This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function. We conducted a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS study. Patients with available estimated glomerular filtration rate (eGFR) (n 2,311) were categorized into 3 groups. (high eGFR >90 mLmin intermediate eGFR 60 to 90 mLmin and low eGFR <60 mLmin). The end points were bleeding outcomes (Bleeding Academic Research Consortium type 2 or higher), ischemic outcomes (cardiovascular death, myocardial infarction, stent thrombosis, repeated revascularization, and ischemic stroke), and net adverse clinical event (including any clinical event) at 1-year follow-up. Prasugrel de-escalation was beneficial regardless of baseline renal function ( In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.

Sex Differences in the Combined Ablation and Left Atrial Appendage Closure Results From LAACablation Registry.

More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China. This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures. Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes. Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation LAACablation NCT03788941).

Ventriculoperitoneal Shunt Failure 3-year after Shunt Surgery Caused by Migration of Detached Ventricular Catheter into the Cranium A Case Study of Idiopathic Normal-pressure Hydrocephalus.

Idiopathic normal-pressure hydrocephalus (iNPH) is a neurological disorder that typically presents with gait disturbance, cognitive impairment, and urinary incontinence. Although most patients respond to cerebrospinal-fluid shunting, some do not react well because of shunt failure. A 77-year-old female with iNPH underwent ventriculoperitoneal shunt implantation, and her gait impairment, cognitive dysfunction, and urge urinary incontinence improved. However, 3 years after shunting (at the age of 80), her symptoms gradually recurred for 3 months and she did not respond to shunt valve adjustment. Imaging studies revealed that the ventricular catheter detached from the shunt valve and migrated into the cranium. With immediate revision of the ventriculoperitoneal shunt, her gait disturbance, cognitive dysfunction, and urinary incontinence improved. When a patient whose symptoms have been relieved by cerebrospinal-fluid shunting experiences an exacerbation, it is important to suspect shunt failure, even if many years have passed since the surgery. Identifying the position of the catheter is crucial to determine the cause of shunt failure. Prompt shunt surgery for iNPH can be beneficial, even in elderly patients.

Evolution of a circulatory support system with full implantability personal perspectives on a long journey.

Implantable mechanical circulatory support systems have evolved dramatically over the last 50 years. The objective has been to replace or support the failing left ventricle with a device that pumps six litres of blood each minute, a massive 8,640 litres per day. Noisy cumbersome pulsatile devices have been replaced by smaller silent rotary blood pumps that are much more patient friendly. Nonetheless, the tethering to external components, together with the risks of power line infection, pump thrombosis and stroke, must be addressed before widespread acceptance. Infection predisposes to thromboembolism, so elimination of the percutaneous electric cable has the capacity to transform outcomes, reduce costs and improve quality of life. Developed in the UK, the Calon miniVAD is powered by an innovative coplanar energy transfer system. As such, we consider it can achieve those ambitious objectives.

Commercial device-based hand rehabilitation systems for stroke patients State of the art and future prospects.

Various hand rehabilitation systems have recently been developed for stroke patients, particularly commercial devices. Articles from 10 electronic databases from 2010 to 2022 were extracted to conduct a systematic review to explore the existing commercial training systems (hardware and software) and evaluate their clinical effectiveness. This review divided the rehabilitation equipment into contact and non-contact types. Game-based training protocols were further classified into two types immersion and non-immersion. The results of the review indicated that the majority of the devices included were effective in improving hand function. Users who underwent rehabilitation training with these devices reported improvements in their hand function. Game-based training protocols were particularly appealing as they helped reduce boredom during rehabilitation training sessions. However, the review also identified some common technical drawbacks in the devices, particularly in non-contact devices, such as their vulnerability to the effects of light. Additionally, it was found that currently, there is no commercially available game-based training protocol that specifically targets hand rehabilitation. Given the ongoing COVID-19 pandemic, there is a need to develop safer non-contact rehabilitation equipment and more engaging training protocols for community and home-based rehabilitation. Additionally, the review suggests the need for revisions or the development of new clinical scales for hand rehabilitation evaluation that consider the current scenario, where in-person interactions might be limited.

Advances in the clinical application of orthotic devices for stroke and spinal cord injury since 2013.

Stroke and spinal cord injury are common neurological disorders that can cause various dysfunctions. Motor dysfunction is a common dysfunction that easily leads to complications such as joint stiffness and muscle contracture and markedly impairs the daily living activities and long-term prognosis of patients. Orthotic devices can prevent or compensate for motor dysfunctions. Using orthotic devices early can help prevent and correct deformities and treat muscle and joint problems. An orthotic device is also an effective rehabilitation tool for improving motor function and compensatory abilities. In this study, we reviewed the epidemiological characteristics of stroke and spinal cord injury, provided the therapeutic effect and recent advances in the application of conventional and new types of orthotic devices used in stroke and spinal cord injury in different joints of the upper and lower limbs, identified the shortcomings with these orthotics, and suggested directions for future research.

Prognostic role of dynamic neutrophil-to-lymphocyte ratio in acute ischemic stroke after reperfusion therapy A meta-analysis.

The prognostic role of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, in acute ischemic stroke (AIS) after reperfusion therapy remains controversial. Therefore, this meta-analysis sought to assess the correlation between the dynamic NLR and the clinical outcomes of patients with AIS after reperfusion therapy. PubMed, Web of Science, and Embase databases were searched to identify relevant literature from their inception to 27 October 2022. The clinical outcomes of interest included poor functional outcome (PFO) at 3 months, symptomatic intracerebral hemorrhage (sICH), and 3-month mortality. The NLR on admission (pre-treatment) and post-treatment was collected. The PFO was defined as a modified Rankin scale (mRS) of >2. A total of 17,232 patients in 52 studies were included in the meta-analysis. The admission NLR was higher in the 3-month PFO (standardized mean difference SMD 0.46, 95% confidence interval CI 0.35-0.57), sICH (SMD 0.57, 95% CI 0.30-0.85), and mortality at 3 months (SMD 0.60, 95% CI 0.34-0.87). An elevated admission NLR was associated with an increased risk of 3-month PFO (odds ratio OR 1.13, 95% CI 1.09-1.17), sICH (OR 1.11, 95% CI 1.06-1.16), and mortality at 3 months (OR 1.13, 95% CI 1.07-1.20). The post-treatment NLR was significantly higher in the 3-month PFO (SMD 0.80, 95% CI 0.62-0.99), sICH (SMD 1.54, 95% CI 0.97-2.10), and mortality at 3 months (SMD 1.00, 95% CI 0.31-1.69). An elevated post-treatment NLR was significantly associated with an increased risk of 3-month PFO (OR 1.25, 95% CI 1.16-1.35), sICH (OR 1.14, 95% CI 1.01-1.29), and mortality at 3 months (OR 1.28, 95% CI 1.09-1.50). The admission and post-treatment NLR can be used as cost-effective and easily available biomarkers to predict the 3-month PFO, sICH, and mortality at 3 months in patients with AIS treated with reperfusion therapy. The post-treatment NLR provides better predictive power than the admission NLR. httpswww.crd.york.ac.ukPROSPERO, identifier CRD42022366394.

Stroke profile and care during the COVID-19 pandemic What changed and what did not A prospective cohort from Joinville, Brazil.

The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. The profiles of TIAstroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8% The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemics negative effects, even with scarce resources.

Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years.

The subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for improving drainage. We aim to analyze the effectiveness of SEPS with subdural thrombolysis in patients older than 80 years. Consecutive patients aged ≥80 years old who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021 were retrospectively studied. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and 3 months. In total, 52 patients with CSDH in 57 hemispheres were operated on, with a mean age of 83.9 ± 3.3 years, and 40 (76.9%) patients were men. The preexisting medical comorbidities were observed in 39 patients (75.0%). Postoperative complications occurred in nine patients (17.3%), with two having significant complications (3.8%). The complications observed included pneumonia (11.5%), acute epidural hematoma (3.8%), and ischemic stroke (3.8%). One patient experienced contralateral malignant middle cerebral artery infarction and died of subsequent severe herniation, contributing to a perioperative mortality rate of 1.9%. Discharge and 3 months of favorable outcomes (mRS score 0-3) were achieved in 86.5% and 92.3% of patients, respectively. CSDH recurrence was observed in five patients (9.6%), and repeat SEPS was performed. As an exhaustive drainage strategy, SEPS followed by thrombolysis is safe and effective with excellent outcomes among elderly patients. It is a technically easy and less invasive procedure with similar complications, mortality, and recurrence rates compared with burr-hole drainage in the literature.

Selective intraarterial hypothermia combined with mechanical thrombectomy for acute cerebral infarction based on microcatheter technology A single-center, randomized, single-blind controlled study.

To investigate the safety and efficacy of selective intraarterial hypothermia combined with mechanical thrombectomy in the treatment of acute cerebral infarction based on microcatheter technology. A total of 142 patients with anterior circulation large vessel occlusion were randomly assigned to the hypothermic treatment group (test group) and the conventional treatment group (control group). National Institutes of Health Stroke Scale (NIHSS) scores, postoperative infarct volume, the 90-day good prognosis rate (modified Rankin Scale (mRS) score ≤ 2 points), and the mortality rate of the two groups were compared and analyzed. Blood specimens were collected from patients before and after treatment. Serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6), IL-10, and RNA-binding motif protein 3 (RBM3) were measured. The 7-day postoperative cerebral infarct volume (63.7 ± 22.1) ml vs. (88.5 ± 20.8) ml and NIHSS scores at postoperative Days 1, 7, and 14 (6.8 ± 3.8) points vs. (8.2 ± 3.5) points (2.6 ± 1.6) points vs. (4.0 ± 1.8) points (2.0 ± 1.2) points vs. (3.5 ± 2.1) points in the test group were significantly lower than those in the control group. The good prognosis rate at 90 days postoperatively (54.9 vs. 35.2%, Mechanical thrombectomy combined with intraarterial cold saline perfusion is a safe and effective measure for the treatment of acute cerebral infarction. Postoperative NIHSS scores and infarct volumes were significantly improved with this strategy compared with simple mechanical thrombectomy, and the 90-day good prognosis rate was improved. The mechanism by which this treatment exerts its cerebral protective effect may be by inhibiting the transformation of the ischaemic penumbra of the infarct core area, scavenging some oxygen free radicals, reducing inflammatory injury to cells after acute infarction and ischaemia-reperfusion, and promoting RBM3 production in cells.

Exaggerated postural sway improves orthostatic cardiovascular and cerebrovascular control.

Healthy individuals with poor cardiovascular control, but who do not experience syncope (fainting), adopt an innate strategy of increased leg movement in the form of postural sway that is thought to counter orthostatic (gravitational) stress on the cardiovascular system. However, the direct effect of sway on cardiovascular hemodynamics and cerebral perfusion is unknown. If sway produces meaningful cardiovascular responses, it could be exploited clinically to prevent an imminent faint. Twenty healthy adults were instrumented with cardiovascular (finger plethysmography, echocardiography, electrocardiogram) and cerebrovascular (transcranial Doppler) monitoring. Following supine rest, participants performed a baseline stand (BL) on a force platform, followed by three trials of exaggerated sway (anterior-posterior, AP mediolateral, ML square, SQ) in a randomized order. All exaggerated postural sway conditions improved systolic arterial pressure (SAP, Exaggerated sway improves cardiovascular and cerebrovascular control and may supplement cardiovascular reflex responses to orthostatic stress. This movement provides a simple means to boost orthostatic cardiovascular control for individuals with syncope, or those with occupations that require prolonged motionless standing.

Prolonged dual antiplatelet therapy for Chinese ACS patients undergoing emergency PCI with drug-eluting stents Benefits and risks.

In patients with acute coronary syndrome (ACS), prolonged dual antiplatelet therapy (DAPT) may reduce ischemic events and increase the risks of bleeding events differently in different ethnic groups. However, whether prolonged DAPT in Chinese patients with ACS following emergency percutaneous coronary intervention (PCI) with drug-eluting stents (DES) will be beneficial or dangerous remains unclear. This study aimed to examine the potential benefits and risks of prolonged DAPT in Chinese patients with ACS who have undergone emergency PCI with DES. This study included 2,249 patients with ACS who underwent emergency PCI. If DAPT was continued for 12 or 12-24 months, it was classified as the standard ( After a median period of 47 months of follow-up 47 (40, 54), the rate of composite bleeding events was 13.2% ( The prolonged DAPT group had a considerably greater incidence of composite bleeding events than the standard DAPT group. No statistically significant difference was observed in the incidence of MACCEs between the two groups.

Burden and trend of cardiovascular diseases among people under 20 years in China, Western Pacific region, and the world An analysis of the global burden of disease study in 2019.

Cardiovascular disease (CVD) is a global public health concern, but its disease burden and trend have been poorly studied in people younger than 20 years. This study aimed to fill this gap by evaluating the CVD burden and trend in China, Western Pacific Region, and the world from 1990 to 2019. We applied the 2019 Global Burden of Diseases (GBD) analytical tools to compare the incidence, mortality, and prevalence of CVD, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) among people younger than 20 years from 1990 to 2019 in China, the Western Pacific Region, and the world. The trends of disease burden between 1990 and 2019 evaluated using the average annual percent change (AAPC) and the 95% uncertainty interval (UI) were reported. Globally, in 2019, there were 2.37 (95% UI 1.82 to 3.05) million incidence of CVD, 16.85 (95% UI 12.56 to 22.03) million prevalence of CVD, and 74386.73 (95% UI 64543.82 to 86310.24) deaths due to CVD among people under 20 years of age. The trends for DALYs decreased among children and adolescents in China, Western Pacific Region, and the world (AAPC -4.29, 95% CI -4.38% to -4.20% AAPC -3.37, 95% CI -3.48% to -3.26% AAPC -2.17, 95% CI -2.24% to -2.09% Our study shows a decline in the burden and trend of CVD among people younger than 20 years, which reflects the success in reducing disability, premature death, and the early incidence of CVD. More effective and targeted preventive policies and interventions aimed at mitigating preventable CVD burden and addressing risk factors from childhood are urgently needed.

Safety and feasibility of left atrial appendage inversion in swine A proof-of-concept study for potential therapy to prevent embolic stroke.

Diagnostic yield of an insertable cardiac monitor in a large patient population.

Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy. The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications. Patients from 2 prospective clinical studies were included to determine the diagnostic yield of the ICM. The primary endpoint was time to clinical diagnosis per implant indication or to the first change in atrial fibrillation (AF) therapy. A total of 632 patients were included with a mean follow-up of 233 ± 168 days. Of 384 patients with (pre)syncope, 34.2% had a diagnosis at 1 year. The most frequent therapy was permanent pacemaker implantation. Of 133 patients with cryptogenic stroke, 16.6% had an AF diagnosis at 1 year, resulting in oral anticoagulation. Of 49 patients with an indication for AF monitoring, 41.0% had a relevant change in AF therapy based on ICM data at 1 year. Of 66 patients with other indications, 35.4% received a rhythm diagnosis at 1 year. Moreover, 6.5% of the cohort had additional diagnoses 26 of 384 patients with syncope, 8 of 133 patients with cryptogenic stroke, and 7 of 49 patients with AF monitoring. In a large unselected patient population with heterogeneous ICM indications, the primary endpoint of rhythm diagnosis was achieved in ∼1 in 4, and additional clinically relevant findings was achieved in 6.5% of patients at short-term follow-up.

Cost-effectiveness of atrial fibrillation screening in Canadian community practice.

Contemporary guidelines recommend opportunistic screening for atrial fibrillation (AF). The objective of this study was to assess the cost-effectiveness of single time point opportunistic AF screening for patients 65 years and older by using the single-lead electrocardiogram. An established Markov cohort model was adapted by updating the background mortality estimates, epidemiology, screening efficacy, treatment patterns, resource use, and cost inputs to reflect a Canadian health care setting. Inputs were derived from a contemporary prospective screening study performed in Canadian primary care settings (screening efficacy and epidemiology) and the published literature (unit costs, epidemiology, mortality, utility, and treatment efficacy). The impact of screening and oral anticoagulant treatment on the cost and clinical outcomes was analyzed. A Canadian payer perspective over lifetime was used for analysis, with costs expressed in 2019 Canadian dollars. Among the estimated screening-eligible population of 2,929,301 patients, the screening cohort identified an additional 127,670 AF cases compared with the usual care cohort. The model estimated avoidance of 12,236 strokes and incremental quality-adjusted life-years of 59,577 (0.02 per patient) over lifetime in the screening cohort. Cost savings were substantial because of improved health outcomes, reflecting screening being the dominant strategy (affordable and effective). Model results were robust across sensitivity and scenario analyses. Single time point opportunistic screening of AF using a single-lead electrocardiogram device in Canadian patients 65 years and older without known AF may provide improved health outcomes with cost savings from the perspective of a single payer health care environment.

Honokiol alleviated neurodegeneration by reducing oxidative stress and improving mitochondrial function in mutant SOD1 cellular and mouse models of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper and lower motor neurons (MNs) with large unmet medical needs. Multiple pathological mechanisms are considered to contribute to the progression of ALS, including neuronal oxidative stress and mitochondrial dysfunction. Honokiol (HNK) has been reported to exert therapeutic effects in several neurologic disease models including ischemia stroke, Alzheimers disease and Parkinsons disease. Here we found that honokiol also exhibited protective effects in ALS disease models both

Bilateral gradual cortical blindness due to hemodynamic stroke A case report.

Cortical blindness refers to the loss of vision caused by a lesion affecting the geniculate calcarine visual pathway. Bilateral occipital lobe infarctions in the vascular territory of the posterior cerebral arteries are the most common cause of cortical blindness. However, bilateral cortical blindness gradual is rarely reported. Gradual bilateral blindness usually occurs in lesions other than stroke, such as tumors. We report a case of a patient with gradual cortical blindness caused by a nonocclusive stroke caused by hemodynamic compromise. A 54-year-old man diagnosed with bilateral cerebral ischemia after complaining of bilateral gradual vision loss and headache for 1 month. Initially, he only complained of blurred vision with >260 vision. However, his visual acuity worsened until he could only see hand movements and only light perception later on (with visual acuity of 1∼). A computed tomography scan of the head revealed a bilateral occipital infarction, and cerebral angiography revealed multiple stenoses and near-total occlusion of the left vertebral artery ostium, underwent angioplasty and stenting. He has received dual antiplatelet and antihypertensive treatment. He got visual improvement with visual acuity 2300 after 3 months of the treatment and procedure. Gradual cortical blindness caused by hemodynamic stroke is rare. The most common cause of posterior cerebral arteries infarction is embolism from the heart or vertebrobasilar circulation. With proper management and focusing on treating the etiology of these patients, vision improvements can be obtained in these patients.

Cardioembolic stroke with hemorrhagic transformation in atrial fibrillation patients on anticoagulant therapy A case report.

Cardioembolic stroke is the second leading cause of mortality and the leading cause of long-term morbidity. Embolisms of cardiac origin, such as atrial fibrillation, represent about one-fifth of all ischemic strokes. Patients with acute atrial fibrillation frequently require anticoagulation, which increases the risk of hemorrhagic transformation. A 67-year-old woman was brought to the Emergency Department with decreased consciousness, weakness on the left side, facial expression, and slurred speech. The patient had a history of atrial fibrillation and was taking regular medications acarbose, warfarin, candesartan and bisoprolol. She has had an ischemic stroke about a year ago. Left hemiparesis, hyperreflexias, pathologic reflexes, and central type of facial nerve palsy were found. The CT-Scan results revealed hyperacute to acute thromboembolic cerebral infraction in the frontotemporoparietal lobe to the right basal ganglia accompanied by hemorrhagic transformation. Massive cerebral infarction, history of previous stroke, and use of anticoagulants are among the greatest risk factors for hemorrhagic transformation in these patients. The use of warfarin should be of particular concern to the clinician, because hemorrhagic transformation is associated with poorer functional outcome and morbidity and mortality.

The Detection of Hypercoagulability in Patients with Acute Cerebral Infarction Using a Clot Waveform Analysis.

A few studies concerning hypercoagulable states have sufficiently been reported in patients with acute cerebral infarction (ACI), as ACI is generally considered to be caused by platelet activation. Clot waveform analyses (CWA) for activated partial thromboplastin time (APTT) and small amount of tissue factor FIX activation assay (sTFFIXa) were examined in 108 patients with ACI, 61 patients without ACI, and 20 healthy volunteers. CWA-APTT and CWA-sTFFIXa showed that the peak heights were significantly higher in ACI patients without anticoagulant therapy than in healthy volunteers. Absorbance exceeding 78.1 mm on the 1

Development of an in-vitro model based on patient vessel geometry for simulated use testing in neurointerventional surgery.

Neurointerventionalists use in-vitro vascular models to train for worst-case scenarios and test new devices in a simulated use environment to predict clinical performance. According to the Food and Drug Administration (FDA), any neurovascular navigation device should be able to successfully navigate two 360-degree turns and two 180-degree turns at the distal portion of the anatomical model. Here, we present a device benchmarking vascular model that complies with FDA recommendations. Our vascular model was assembled from quantitative characterization of 49 patients who underwent CT angiography either for acute ischemic stroke caused by large vessel occlusion or for aneurysm treatment. Following complete characterization of these data, the vascular segments were 3D reconstructed from CT angiograms of 6 selected patients that presented with challenging anatomy. The curvature and total rotational angle were calculated for each segment and the anatomical parts that complied with FDA recommendations were fused together into a single in-vitro model. The model was constructed containing two common carotid branches arising from a type two aortic arch and the dimensions of the overall model exceeded the recommendations of the FDA. Two experienced neurointerventionalists tested the model for navigation difficulty using several devices on an in-vitro perfusion system and concluded that the model provided a realistic, challenging scenario. This model provides a first prototype designed according to FDA recommendations of cumulative angle while also integrating an aggregation of actual patient-specific anatomy. The availability of this clinically relevant benchmark model presents a potential standardized approach for neurovascular device testing.

Functional outcomes of ischaemic stroke patients with known Atrial Fibrillation not on therapeutic anticoagulation.

Anticoagulation significantly reduces the risk of ischaemic stroke in patients with atrial fibrillation (AF). There are a proportion of patients with known AF who remain off anticoagulation. This study aims to retrospectively compare the baseline characteristics, treatments and functional outcomes between patients with ischaemic stroke and known atrial fibrillation based on their anticoagulation status. A single centre, retrospective review of consecutive patients with an ischaemic stroke and a known history of AF was conducted RESULTS 204 patients with an ischaemic stroke had documented AF prior to the index admission, of which 126 were anticoagulated. Median admission NIHSS score was lower for anticoagulated patients, though not statistically significant (5.1 vs 7.0 p 0.09). Median baseline mRS did not significantly differ. Non-anticoagulated patients were more likely to have large vessel occlusions (37.2% vs 23.8%, p0.04) and more likely to receive intravenous thrombolysis (15.4% versus 1.6%, p<0.01). There was no difference in rates of endovascular clot retrieval between groups (p>0.05). Unfavourable functional outcome at 90 days (mRS > 3) did not significantly differ between groups (p0.51). 38.5% of non-anticoagulated patients had no documented reason for this. Of the patients who survived the index admission 81.5% of patients who were not anticoagulated on admission received anticoagulation. Baseline anticoagulation was associated with milder stroke severity patients with known AF and an ischaemic stroke. There was no significant difference in functional outcomes at 90 days between groups. Larger observational studies are required to further assess this cohort. This article is protected by copyright. All rights reserved.

Reduced Range of Gait Speed A Parkinsons Disease-Specific Symptom

Reduced range of gait speed (RGS) may lead to decreased environmental adaptability in persons with Parkinsons disease (PwPD). Therefore, lab-measured gait speed, step time, and step length during slow, preferred, and fast walking were assessed in 24 PwPD, 19 stroke patients, and 19 older adults and compared with 31 young adults. Only PwPD, but not the other groups, showed significantly reduced RGS compared to young adults, driven by step time in the low and step length in the high gait speed range. These results suggest that reduced RGS may occur as a PD-specific symptom, and different gait components seem to contribute.

Consistency of left ventricular ejection fraction measurements in the early time course of STEMI.

Early after ST-segment elevation myocardial infarction (STEMI), initial LV reshaping and hypokinesia may affect analysis of LV function. Concomitant microvascular dysfunction may affect LV function. To perform a comparative evaluation of left ventricular ejection fraction (LVEF) and stroke volume (SV) by different imaging modalities to assess LV function early after STEMI. LVEF and SV were assessed using serial imaging within 24 h and 5 days after STEMI using cineventriculography (CVG), 2-dimensional echocardiography (2DE), 2D3D cardiovascular magnetic resonance (CMR) (2D3D) in 82 patients. 2D analyses of LVEF using CVG, 2DE and 2D CMR yielded uniform results within 24 h and 5 days of STEMI. SV assessment between CVG and 2DE was comparable, whereas values for SV were higher using 2D CMR (p < 0.01 all). This was due to higher LVEDV measurements. LVEF by 2D versus 3D CMR was comparable, 3D CMR yielded higher volumetric values. This was not influenced by infarct location or infarct size. 2D analysis of LVEF yielded robust results across all imaging techniques implying that CVG, 2DE, and 2D CMR can be used interchangeably early after STEMI. SV measurements differed substantially between imaging techniques due to higher intermodality-differences of absolute volumetric measurements.

CircSEC11A knockdown alleviates oxidative stress and apoptosis and promotes cell proliferation and angiogenesis by regulating miR-29a-3pSEMA3A axis in OGD-induced human brain microvascular endothelial cells (HBMECs).

Circular RNA (circRNA) has been found to play an important role in the progression of many diseases, including ischemic stroke. However, the regulatory mechanism of circSEC11A in ischemic stroke progression need to further investigation. Human brain microvascular endothelial cells (HBMECs) were stimulated by oxygen glucose deprivation (OGD). CircSEC11A, SEC11A mRNA and miR (microRNA)-29a-3p were quantified by quantitative real-time PCR (qRT-PCR). SEMA3A, BAX and BCL2 protein level was quantified by western blot. Oxidative stress, cell proliferation, angiogenesis and apoptosis abilities were gauged by oxidative stress assay kit, 5-Ethynyl-2-Deoxyuridine (EdU) staining, tube formation assay and flow cytometry assays, respectively. Direct relationship between miR-29a-3p and circSEC11A or SEMA3A was validated by dual-luciferase reporter assay, RIP assay and RNA pull-down assay. CircSEC11A was upregulated in OGD-induced HBMECs. OGD promoted the oxidative stress and apoptosis and inhibited cell proliferation and angiogenesis, while circSEC11A knockdown relieved the effects. CircSEC11A functioned as the sponge for miR-29a-3p, and miR-29a-3p inhibitor reversed the effects of si-circSEC11A on OGD-induced HBMECs oxidative injuries. Moreover, SEMA3A served as the target gene of miR-29a-3p. MiR-29a-3p inhibition ameliorated OGD-induced HBMECs oxidative injuries, while SEMA3A overexpression rescued the impacts of miR-29a-3p mimic. CircSEC11A promoted the malignant progression in OGD-induced HBMECs through the mediation of miR-29a-3pSEMA3A axis. This study has provided the new insight into the underlying application of circSEC11A in cell model of ischemic stroke.

Ethnic differences in stroke outcomes in Aotearoa New Zealand A national linkage study.

Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke sub-types, but evidence is mixed. This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017-October 2018 were included (N6,879). Post-stroke unfavourable outcome was defined as being dead, change in residence, or unemployed if working pre-stroke. In total, 5,394 NZ Europeans, 762 Māori, 369 Pacific Peoples and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavourable outcome at all three time-points (OR1.6 (95%CI1.3-1.9) 1.4 (1.2-1.7) 1.4 (1.2-1.7), respectively). Māori also had increased odds of death at all time-points (1.7 (1.3-2.1) 1.5 (1.2-1.9) 1.7 (1.3-2.1)) and unemployment at twelve months (2.5 (1.2-5.2). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. We found ethnic disparities in care and outcomes following stroke, independent of traditional risk factors raising concern for potential unconscious bias and institutional racism in stroke services.

Exertional Heat Illness Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators.

Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. Cross-sectional. Level 4. A total of 466 AAs (82.4% male age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch Of the AAs surveyed, 77.9% (n 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR 1,7), with only 5.6% (n 26) of AAs reporting adoption of all policy components. AAs who had access to an AT ( Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.

2000 Years of Clinical Trials The Evolution of Evidence-Based Practice.

Although the first documented clinical trial as described in the biblical book of Daniel dates to 606 BC, the prophet Daniels nutrition study is contemporary in both approach and topic and could be considered the first comparative effectiveness research (CER) trial. This article summarizes the historical evolution of clinical trials and associated regulatory legislation. Ethical considerations foundational to nursing and evidence-based practice (EBP) in the 21st century are examined. Distinguishing features of CER, various study designs and checklists, and EBP are detailed. Biblical foundations for research and the Bibles relevance to modern research methods are discussed.

A Real-World Exploration into Clinical Outcomes of Direct Oral Anticoagulant Dosing Regimens in Morbidly Obese Patients Using Data-Driven Approaches.

The clinical outcomes of direct oral anticoagulant (DOAC) dosage regimens in morbid obesity are uncertain due to limited clinical evidence. This study seeks to bridge this evidence gap by identifying the factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients. A data-driven observational study was carried out using supervised machine learning (ML) models with a dataset extracted from electronic health records and preprocessed. Following 70%30% partitioning of the overall dataset via stratified sampling, the selected ML classifiers (e.g., random forest, decision trees, bootstrap aggregation) were applied to the training dataset (70%). The outcomes of the models were evaluated against the test dataset (30%). Multivariate regression analysis explored the association between DOAC regimens and clinical outcomes. A sample of 4,275 morbidly obese patients was extracted and analysed. The decision trees, random forest, and bootstrap aggregation classifiers achieved acceptable (excellent) values of precision, recall, and F1 scores in terms of their contribution to clinical outcomes. The length of stay, treatment days, and age were ranked highest for relevance to mortality and stroke. Among DOAC regimens, apixaban 2.5 mg twice daily ranked highest for its association with mortality, increasing the mortality risk by 43% (odds ratio OR 1.430, 95% confidence interval CI 1.181-1.732, p 0.001). On the other hand, apixaban 5 mg twice daily reduced the odds of mortality by 25% (OR 0.751, 95% CI 0.632-0.905, p 0.003) but increased the odds of stroke events. No clinically relevant non-major bleeding events occurred in this group. Data-driven approaches can identify key factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients. This will help design further studies to explore well tolerated and effective DOAC doses for morbidly obese patients.

Effective constituents of essential oil from Gleditsiae Fructus Abnormalis and anti-cerebral ischemiareperfusion injury mechanism based on GC-MS, network pharmacology, and experimental verification.

Based on GC-MS and network pharmacology, the active constituents, potential targets, and mechanism of essential oil from Gleditsiae Fructus Abnormalis(EOGFA) against cerebral ischemiareperfusion(IR) injury were explored, and the effective constituents were verified by experiment. To be specific, GC-MS was used identify the constituents of the volatile oil. Secondly, the targets of the constituents and disease were predicted by network pharmacology, and the drug-constituent-target network was constructed, followed by Gene Ontology(GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment of the core targets. Molecular docking was performed to investigate the binding affinity between the active constituents and the targets. Finally, SD rats were used for experimental verification. The IR injury model was established, and the neurological behavior score, infarct volume, and pathological morphology of brain tissue were measured in each group. The content of interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-α) was determined by enzyme-linked immunosorbent assay(ELISA), and the protein expression of vascular endothelial growth factor(VEGF) by Western blot. A total of 22 active constituents and 17 core targets were screened out. The core targets were involved in 56 GO terms and the major KEGG pathways of TNF signaling pathway, VEGF signaling pathway, and sphingolipid signaling pathway. Molecular docking showed that the active constituents had high affinity to the targets. The results of animal experiment suggested that EOGFA can alleviate the neurological impairment, decrease the cerebral infarct volume and the content of IL-1β, IL-6 and TNF-α, and down-regulate the expression of VEGF. The experiment verified the part results of network pharmacology. This study reflects the multi-component, multi-target, and multi-pathway characteristics of EOGFA. The mechanism of its active constituents is related to TNF and VEGF pathways, which provides a new direction for in-depth research on and secondary development of Gleditsiae Fructus Abnormalis.

Regulation of ischemic stroke by circadian rhythm and intervention by traditional Chinese medicine.

Circadian rhythm is an internal regulatory mechanism formed in organisms in response to the circadian periodicity in the environment, which modulates the pathophysiological events, occurrence and development of diseases, and the response to treatment in mammals. It significantly influences the susceptibility, injury, and recovery of ischemic stroke, and the response to therapy. Accumulating evidence indicates that circadian rhythms not only regulate the important physiological factors of ischemic stroke events, such as blood pressure and coagulation-fibrinolysis system, but also participate in the immuno-inflammatory reaction mediated by glial cells and peripheral immune cells after ischemic injury and the regulation of neurovascular unit(NVU). This article aims to link molecular, cellular, and physiological pathways in circadian biology to the clinical consequences of ischemic stroke and to illustrate the impact of circadian rhythms on ischemic stroke pathogenesis, the regulation of NVU, and the immuno-inflammatory responses. The regulation of circadian rhythm by traditional Chinese medicine is reviewed, and the research progress of traditional Chinese medicine intervention in circadian rhythm is summarized to provide a reasonable and valuable reference for the follow-up traditional Chinese medicine research and molecular mechanism research of circadian rhythm.

The association between obesity and postoperative outcomes in a broad surgical population A 7-year American College of Surgeons National Surgical Quality Improvement analysis.

The number of obese surgical patients continues to grow, and yet obesitys association with surgical outcomes is not totally clear. This study examined the association between obesity and surgical outcomes across a broad surgical population using a very large sample size. This was an analysis of the 2012 to 2018 American College of Surgeons National Surgical Quality Improvement database, including all patients from 9 surgical specialties (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, and vascular). Preoperative characteristics and postoperative outcomes were compared by body mass index class (normal weight 18.5-24.9 kgm A total of 5,572,019 patients were included 44.6% were obese. Median operative times were marginally higher for obese patients (89 vs 83 minutes, P < .001). Compared to normal weight patients, overweight and obese patients in classes I, II, and III all had higher adjusted odds of developing infection, venous thromboembolism, and renal complications, but they did not exhibit elevated odds of other postoperative complications (mortality, overall morbidity, pulmonary, urinary tract infection, cardiac, bleeding, stroke, unplanned readmission, or discharge not home (except for class III patients). Obesity was associated with increased odds of postoperative infection, venous thromboembolism, and renal but not the other American College of Surgeons National Surgical Quality Improvement complications. Obese patients need to be carefully managed for these complications.

Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus Real-World Data Analysis.

Little is known about the adverse events (AEs) associated with coronavirus disease 2019 (COVID-19) vaccination in patients with type 2 diabetes mellitus (T2DM). This study used vaccine AE reporting system data to investigate severe AEs among vaccinated patients with T2DM. A natural language processing algorithm was applied to identify people with and without diabetes. After 13 matching, we collected data for 6,829 patients with T2DM and 20,487 healthy controls. Multiple logistic regression analysis was used to calculate the odds ratio for severe AEs. After COVID-19 vaccination, patients with T2DM were more likely to experience eight severe AEs than controls cerebral venous sinus thrombosis, encephalitis myelitis encephalomyelitis, Bells palsy, lymphadenopathy, ischemic stroke, deep vein thrombosis (DVT), thrombocytopenia (TP), and pulmonary embolism (PE). Moreover, patients with T2DM vaccinated with BNT162b2 and mRNA-1273 were more vulnerable to DVT and TP than those vaccinated with JNJ-78436735. Among patients with T2DM administered mRNA vaccines, mRNA-1273 was safer than BNT162b2 in terms of the risk of DVT and PE. Careful monitoring of severe AEs in patients with T2DM may be necessary, especially for those related to thrombotic events and neurological dysfunctions after COVID-19 vaccination.

Perioperative Management of the Acute Stroke Patient From Door to Needle to NeuroICU.

Acute ischemic stroke is a neurologic emergency that requires precise care due to high likelihood of morbidity and mortality. Current guidelines recommend thrombolytic therapy with alteplase within the first 3 to 4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16 to 24 hours. Anesthesiologists may be involved in the care of these patients perioperatively and in the intensive care unit. Although the optimal anesthetic for these procedures remains under investigation, this article will review how to best optimize and treat these patients to achieve the best outcomes.

Perioperative Fluid Management and Volume Assessment.

Fluid therapy is an integral component of perioperative care and helps maintain or restore effective circulating blood volume. The principal goal of fluid management is to optimize cardiac preload, maximize stroke volume, and maintain adequate organ perfusion. Accurate assessment of volume status and volume responsiveness is necessary for appropriate and judicious utilization of fluid therapy. To accomplish this, static and dynamic indicators of fluid responsiveness have been widely studied. This review discusses the overarching goals of perioperative fluid management, reviews the physiology and parameters used to assess fluid responsiveness, and provides evidence-based recommendations on intraoperative fluid management.

Association between ambient temperature and cause-specific cardiovascular disease admissions in Japan A nationwide study.

Substantial evidence suggests that non-optimal temperatures can increase the risk of cardiovascular disease (CVD) mortality and morbidity however, limited studies have reported inconsistent results regarding hospital admissions depending on study locations, which also lack national-level investigations on cause-specific CVDs. We performed a two-stage meta-regression analysis to examine the short-term associations between temperature and acute CVD hospital admissions by specific categories i.e., ischemic heart disease (IHD), heart failure (HF), and stroke in 47 prefectures of Japan from 2011 to 2018. First, we estimated the prefecture-specific associations using a time-stratified case-crossover design with a distributed lag nonlinear model. We then used a multivariate meta-regression model to obtain national average associations. During the study period, a total of 4,611,984 CVD admissions were reported. We found cold temperatures significantly increased the risk of total CVD admissions and cause-specific categories. Compared with the minimum hospitalization temperature (MHT) at the 98 This study indicated that cold and heat exposure could increase the risk of hospital admissions for CVD, varying depending on the cause-specific categories, which may provide new evidence to reduce the burden of CVD.

Long Term Mortality in Patients Treated with Carotid Endarterectomy.

Carotid endarterectomy (CEA) is an effective surgical method for stroke prevention in selected patients with carotid stenosis. Few contemporary studies report on long term mortality in CEA treated patients, despite continuous changes in medication, diagnostics, and patient selection. Here, the long term mortality is described in a well characterised cohort of asymptomatic and symptomatic CEA patients, sex differences evaluated, and mortality ratio compared with the general population. This was a two centre, non-randomised, observational study evaluating all cause, long term mortality in CEA patients from Stockholm, Sweden between 1998 and 2017. Death and comorbidities were extracted from national registries and medical records. Cox regression was adapted to analyse associations between clinical characteristics and outcome. Sex differences and standardised mortality ratio (SMR, age and sex matched) were studied. A total of 1 033 patients were followed for 6.6 ± 4.8 years. Of those, 349 patients died during follow up where overall mortality was similar in asymptomatic and symptomatic patients (34.2% vs. 33.7%, p .89). Symptomatic disease did not influence the mortality risk (adjusted HR 1.14, 95% CI 0.81 - 1.62). Women had lower crude mortality than men in the first 10 years (20.8% vs. 27.6%, p .019). In women, cardiac disease was associated with increased mortality (adjusted HR 3.55, 95% CI 2.18 - 5.79), while in men, lipid lowering medication was protective (adjusted HR 0.61, 95% CI 0.39 - 0.96). Within the first five years after surgery, SMR was increased for all patients (men 1.50, 95% CI 1.21 - 1.86 women 2.41, 95% CI 1.74 - 3.35), as well as in patients < 80 years (SMR 1.46, 95% CI 1.23 - 1.73). Symptomatic and asymptomatic carotid patients show similar long term mortality after CEA, but men had worse outcome than women. Sex, age, and time after surgery were shown to influence SMR. These results highlight the need for targeted secondary prevention, to alter the long term adverse effects in CEA patients.

Early Surgery for Moyamoya Is Not Associated with Worse Outcomes Analysis of a North American Adult Cohort.

Patients with symptomatic moyamoya disease (MMD) or moyamoya syndrome (MMS) are at high risk for recurrent stroke. Surgical revascularization with either direct or indirect superficial temporal artery to the middle cerebral artery (STA-MCA) bypass is a well-accepted treatment. The optimal timing and surgical technique for adult patients with MMD or MMS remains unknown. We performed a retrospective chart review of patients who underwent STA-MCA bypass for MMD or MMS from January 1, 2017, to January 1, 2022. Data collected included demographics, comorbidities, complications, and angiographicclinical outcomes. Early surgery occurred within two weeks of the last stroke delayed after two weeks. Statistical analysis compared early vs. delayed surgery and direct vs. indirect bypass. Nineteen patients underwent bypass surgery on 24 hemispheres. There were 10 early and 14 delayed bypasses. Seventeen were direct, and seven were indirect. There was no statistical difference in total complications in the early (310, 30%) vs. the delayed groups (314, 21%) (P 0.67). There were five total complications in the direct group (517, 29%) and one in the indirect group (17, 14%) (P0.63). There were no mortalities related to surgery. Angiographic follow-up showed more extensive revascularization with early direct bypass than delayed indirect bypass. In this population of North American adults undergoing surgical revascularization for MMD or MMS, early surgery within two weeks of the last stroke did not differ from delayed surgery in terms of complications or outcomes. Early direct bypass showed more revascularization on angiography than delayed indirect surgery.

Immune regulation in neurovascular units after traumatic brain injury.

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Survivors may experience movement disorders, memory loss, and cognitive deficits. However, there is a lack of understanding of the pathophysiology of TBI-mediated neuroinflammation and neurodegeneration. The immune regulation process of TBI involves changes in the peripheral and central nervous system (CNS) immunity, and intracranial blood vessels are essential communication centers. The neurovascular unit (NVU) is responsible for coupling blood flow with brain activity, and comprises endothelial cells, pericytes, astrocyte end-feet, and vast regulatory nerve terminals. A stable NVU is the basis for normal brain function. The concept of the NVU emphasizes that cell-cell interactions between different types of cells are essential for maintaining brain homeostasis. Previous studies have explored the effects of immune system changes after TBI. The NVU can help us further understand the immune regulation process. Herein, we enumerate the paradoxes of primary immune activation and chronic immunosuppression. We describe the changes in immune cells, cytokineschemokines, and neuroinflammation after TBI. The post-immunomodulatory changes in NVU components are discussed, and research exploring immune changes in the NVU pattern is also described. Finally, we summarize immune regulation therapies and drugs after TBI. Therapies and drugs that focus on immune regulation have shown great potential for neuroprotection. These findings will help us further understand the pathological processes after TBI.

The effect of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke.

This study was conducted to examine the effects of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. 35 individuals between the ages of 21 and 78 who were diagnosed with stroke were included in the study. The body awareness of the individuals participating in the study was determined with the Body Awareness Questionnaire (BAQ), trunk control with Trunk Impairment Scale (TIS), the affected upper extremity functions with Motor Activity Log-28 (MAL,-28), and Fugl-Meyer Upper Extremity Assessment (FMUEA), balance with Berg Balance Scale (BBS), fear of falling with Tinetti Falls Efficacy Scale (TFES), functional level with Barthel Activities of Daily Living Index (BI) and level of independence with Functional Independence Measures (FIM). For patients participating in the study, 26% were female, 74% were male and 43% showed left, 57% showed right hemisphere involvement. In simple linear regression analysis, BAQ measurement had a statistically significant effect on TIS (F 25.439 In conclusion, body awareness was found to be one of the factors affecting trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. It was thought that there was a need for assessment of body awareness and include bodyawareness in rehabilitation programs in patients with stroke.

Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP) an open-label, blinded-endpoint, cluster-randomised trial.

Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease has not been established. We aimed to test the effectiveness of such an intervention compared with usual care on risk of cardiovascular disease and all-cause death among individuals with hypertension. In this open-label, blinded-endpoint, cluster-randomised trial, we recruited individuals aged at least 40 years with an untreated systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg (≥130 mm Hg and ≥80 mm Hg for those at high risk for cardiovascular disease or if currently taking antihypertensive medication). We randomly assigned (11) 326 villages to a non-physician community health-care provider-led intervention or usual care, stratified by provinces, counties, and townships. In the intervention group, trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic blood pressure goal of less than 130 mm Hg and diastolic blood pressure goal of less than 80 mm Hg with supervision from primary care physicians. They also delivered discounted or free antihypertensive medications and health coaching for patients. The primary effectiveness outcome was a composite outcome of myocardial infarction, stroke, heart failure requiring hospitalisation, and cardiovascular disease death during the 36-month follow-up in the study participants. Safety was assessed every 6 months. This trial is registered with ClinicalTrials.gov, NCT03527719. Between May 8 and Nov 28, 2018, we enrolled 163 villages per group with 33 995 participants. Over 36 months, the net group difference in systolic blood pressure reduction was -23·1 mm Hg (95% CI -24·4 to -21·9 p<0·0001) and in diastolic blood pressure reduction, it was -9·9 mm Hg (-10·6 to -9·3 p<0·0001). Fewer patients in the intervention group than the usual care group had a primary outcome (1·62% vs 2·40% per year hazard ratio HR 0·67, 95% CI 0·61-0·73 p<0·0001). Secondary outcomes were also reduced in the intervention group myocardial infarction (HR 0·77, 95% CI 0·60-0·98 p0·037), stroke (0·66, 0·60-0·73 p<0·0001), heart failure (0·58, 0·42-0·81 p0·0016), cardiovascular disease death (0·70, 0·58-0·83 p<0·0001), and all-cause death (0·85, 0·76-0·95 p0·0037). The risk reduction of the primary outcome was consistent across subgroups of age, sex, education, antihypertensive medication use, and baseline cardiovascular disease risk. Hypotension was higher in the intervention than in the usual care group (1·75% vs 0·89% p<0·0001). The non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. The Ministry of Science and Technology of China and the Science and Technology Program of Liaoning Province, China.

Vertebrobasilar dolichoectasia and other arterial abnormalities leading to abducens nerve palsy.

Dolichoectatic vessels can cause cranial nerve dysfunction by either direct compression or ischemia. Abducens nerve palsy due to neurovascular compression by elongated, enlarged, tortuous or dilated arteries is an uncommon but important cause. To highlight neurovascular compression as a cause of abducens nerve palsy and discuss various diagnostic techniques. Manuscripts were identified using the National Institutes of Health PubMed literature search system. Search terms included abducens nerve palsy, neurovascular compression, dolichoectasia and arterial compression. Inclusion criteria required that the articles were written in English. The literature search identified 21 case reports where abducens nerve palsy was due to vascular compression. Out of these 18 patients were male and the mean age was 54 years. Eight patients had unilateral right abducens nerve involvement eleven patients had unilateral left nerve involvement and two patients had bilateral involvement. The arteries causing the compression were basilar, vertebral and anterior inferior cerebellar arteries. A compressed abducens nerve is not usually clearly detected on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging). MRA (Magnetic Resonance Angiography), Heavy T2- WI (weighted imaging), CISS (constructive interference in steady state) and FIESTA (Fast Imaging Employing Steady-state Acquisition) are essential to demonstrate vascular compression of the abducens nerve. The various treatment options included controlling hypertension, glasses with prisms, muscle resection and microvascular decompression.

Elevated HMGB1 and sRAGE levels in cerebrospinal fluid of aneurysmal subarachnoid hemorrhage patients.

Neuroinflammation after aneurysmal subarachnoid hemorrhage (aSAH) leads to poor outcome of patients. High mobility group box 1 (HMGB1) contributes to inflammation through binding to receptors for advanced glycation end-products (RAGE) in various diseases. We aimed to determine the production of these two factors after aSAH and their relationship with clinical features. HMGB1 and soluble RAGE (sRAGE) levels in cerebrospinal fluid (CSF) of aSAH patients and controls were measured, and their temporal courses were observed. The correlation between early concentrations (days 1-3) and clinical symptoms assessed by disease severity scores, neuroinflammation estimated by CSF IL-6 levels, as well as prognosis evidenced by delayed cerebral ischemia (DCI) and 6-month adverse outcome was investigated. Finally, combined analysis of early levels for predicting prognosis was confirmed. CSF HMGB1 and sRAGE levels were higher in aSAH patients than in controls (P < 0.05), and the levels decreased from higher early to lower over time. Their early concentrations were positively associated with disease severity scores, IL-6 levels, DCI and 6-month poor outcome (P < 0.05). HMGB1 ≥ 6045.5 pgml (OR 14.291, P 0.046) and sRAGE ≥ 572.0 pgml (OR 13.988, P 0.043) emerged as independent predictors for DCI, while HMGB1 ≥ 5163.2 pgml (OR 7.483, P 0.043) and sRAGE ≥ 537.3 pgml (OR 12.653, P 0.042) were predictors for 6-month poor outcome. Combined analysis of them improved predictive values of adverse prognosis. CSF HMGB1 and sRAGE levels of aSAH patients were increased early and then varied dynamically, which might act as potential biomarkers for poor outcome, especially when co-analyzed.

Cerebral oxygen extraction fraction declines with ventricular enlargement in patients with normal pressure hydrocephalus.

Normal pressure hydrocephalus (NPH) is a neurodegenerative disease that is potentially reversible by shunt surgery in approximately 60% of patients. Imaging may provide a means to investigate brain tissue viability and oxygen metabolism in NPH patients. Oxygen extraction fraction (OEF) mapping was generated from 3D multi-echo gradient echo MRI (mGRE) data using QQ-CCTV algorithm and cerebral blood flow (CBF) using 3D arterial spin labeling (ASL) MRI data, thereby calculating the cerebral metabolic rate of oxygen (CMRO OEF showed significant negative correlations with normalized brain ventricular volumes in the whole brain (p 0.004, q 0.01), cortical gray matter (p 0.004, q 0.01), caudate (p 0.02, q 0.04), and pallidum (p 0.03, q 0.04), but no significant correlation with CSF stroke volume (q > 0.05). There was no significant finding with CBF or CMRO In NPH patients, low OEF in several regions was significantly correlated with large ventricular volumes, indicating decreased tissue oxygen metabolism with increased NPH severity. OEF mapping may provide a functional understanding of neurodegeneration in NPH and may improve monitoring of disease course and treatment outcomes.

Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction The RAPID-HF Randomized Clinical Trial.

Reduced heart rate during exercise is common and associated with impaired aerobic capacity in heart failure with preserved ejection fraction (HFpEF), but it remains unknown if restoring exertional heart rate through atrial pacing would be beneficial. To determine if implanting and programming a pacemaker for rate-adaptive atrial pacing would improve exercise performance in patients with HFpEF and chronotropic incompetence. Single-center, double-blind, randomized, crossover trial testing the effects of rate-adaptive atrial pacing in patients with symptomatic HFpEF and chronotropic incompetence at a tertiary referral center (Mayo Clinic) in Rochester, Minnesota. Patients were recruited between 2014 and 2022 with 16-week follow-up (last date of follow-up, May 9, 2022). Cardiac output during exercise was measured by the acetylene rebreathe technique. A total of 32 patients were recruited of these, 29 underwent pacemaker implantation and were randomized to atrial rate responsive pacing or no pacing first for 4 weeks, followed by a 4-week washout period and then crossover for an additional 4 weeks. The primary end point was oxygen consumption (V̇o2) at anaerobic threshold (V̇o2,AT) secondary end points were peak V̇o2, ventilatory efficiency (V̇eV̇co2 slope), patient-reported health status by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Of the 29 patients randomized, the mean age was 66 years (SD, 9.7) and 13 (45%) were women. In the absence of pacing, peak V̇o2 and V̇o2 at anaerobic threshold (V̇o2,AT) were both correlated with peak exercise heart rate (r 0.46-0.51, P < .02 for both). Pacing increased heart rate during low-level and peak exercise (16min 95% CI, 10 to 23, P < .001 14min 95% CI, 7 to 21, P < .001), but there was no significant change in V̇o2,AT (pacing off, 10.4 SD, 2.9 mLkgmin pacing on, 10.7 SD, 2.6 mLkgmin absolute difference, 0.3 95% CI, -0.5 to 1.0 mLkgmin P .46), peak V̇o2, minute ventilation (V̇e)carbon dioxide production (V̇co2) slope, KCCQ-OSS, or NT-proBNP level. Despite the increase in heart rate, atrial pacing had no significant effect on cardiac output with exercise, owing to a decrease in stroke volume (-24 mL 95% CI, -43 to -5 mL P .02). Adverse events judged to be related to the pacemaker device were observed in 6 of 29 participants (21%). In patients with HFpEF and chronotropic incompetence, implantation of a pacemaker to enhance exercise heart rate did not result in an improvement in exercise capacity and was associated with increased adverse events. ClinicalTrials.gov Identifier NCT02145351.

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes syndrome a case report.

A biopsy of gastrocnemius muscle from a patient with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome was studied histologically in semithin sections stained by hematoxylin-and-eosin (HE) and toluidine blue, and ultrathin sections by transmission electron microscopy (TEM). HE stain demonstrated typical ragged-red fibers (RRFs) and affected fibers in fascicles. Toluidine-blue stain showed an irregular meshwork in the center of RRFs. TEM demonstrated damaged myofibrils and variations in mitochondrial structure in RRFs and affected fibers. Dense mitochondria were compacted with cristae and pleomorphic electron-dense inclusions. Lucent mitochondria included paracrystalline inclusions with a parking lot appearance. At high magnification, the paracrystalline inclusions were composed of plates that paralleled and connected with mitochondrial cristae. These observations indicated that electron-dense granular and paracrystalline inclusions resulted from cristal degeneration and overlapping in mitochondria in MELAS syndrome.

Eliminating Medication Copayments for Low-income Older Adults at High Cardiovascular Risk A Randomized Controlled Trial.

Self-management Support Using Advertising Principles for Older Low Income Adults at High Cardiovascular Risk a Randomized Controlled Trial.

Smartphone videos of the sit-to-stand test predict osteoarthritis and health outcomes in a nationwide study.

Physical function decline due to aging or disease can be assessed with quantitative motion analysis, but this currently requires expensive laboratory equipment. We introduce a self-guided quantitative motion analysis of the widely used five-repetition sit-to-stand test using a smartphone. Across 35 US states, 405 participants recorded a video performing the test in their homes. We found that the quantitative movement parameters extracted from the smartphone videos were related to a diagnosis of osteoarthritis, physical and mental health, body mass index, age, and ethnicity and race. Our findings demonstrate that at-home movement analysis goes beyond established clinical metrics to provide objective and inexpensive digital outcome metrics for nationwide studies.

Correlation between frailty and cardiac structure and function in echocardiography in elderly patients with normal ejection fraction.

This study aims to accurately evaluate the cardiac structure and function of the frail population in elderly patients with normal ejection fraction (EF) using the 3D volume quantification and speckle tracking of echocardiography, to explore the correlation between frailty and cardiac structure and function. A total of 350 elderly aged 65 and above in-patients, excluding those with congenital heart disease, cardiomyopathy, and severe valvular heart disease, were included in the study. Patients were divided into non-frail, pre-frail, and frail group. Echocardiography techniques including speckle tracking and 3D volume quantification, were used to analyze the cardiac structure and function of the study subjects. Comparative analysis was statistically significant if P < 0.05. The cardiac structure of the frail group was different compared with non-frail patients, the frail group demonstrated increased left ventricular myocardial mass index (LVMI), but decreased stroke volume. Cardiac function was also impaired in the frail group reservoir strain and conduit strain of left atrium, strain of right ventricular (RV) free wall, strain of RV septum, 3D EF of RV, and global longitudinal strain of LV were significantly decreased. Frailty was significantly and independently associated with LV hypertrophy (OR 1.889 95% CI 1.240,2.880 P 0.003), LV diastolic dysfunction (OR 1.496 95% CI 1.016,2.203 P 0.041), left ventricular global longitudinal strain (LVGLS) reduction (OR 1.697 95% CI 1.192, 2.416 P 0.003), and reduced RV systolic function (OR 2.200 95% CI 1.017, 4.759 P 0.045). Frailty is closely associated with several heart structural and functional alterations, which not only manifested as LV hypertrophy and reduced LV systolic function, but also decreased LV diastolic function, RV systolic function, and left atrial systolic function. Frailty is an independent risk factor for LV hypertrophy, LV diastolic dysfunction, LVGLS reduction, and reduced RV systolic function. ChiCTR2000033419. Date of registration May 31, 2020.

The IPDGCGP2 Hackathon - an open science event for training in data science, genomics, and collaboration using Parkinsons disease data.

Open science and collaboration are necessary to facilitate the advancement of Parkinsons disease (PD) research. Hackathons are collaborative events that bring together people with different skill sets and backgrounds to generate resources and creative solutions to problems. These events can be used as training and networking opportunities, thus we coordinated a virtual 3-day hackathon event, during which 49 early-career scientists from 12 countries built tools and pipelines with a focus on PD. Resources were created with the goal of helping scientists accelerate their own research by having access to the necessary code and tools. Each team was allocated one of nine different projects, each with a different goal. These included developing post-genome-wide association studies (GWAS) analysis pipelines, downstream analysis of genetic variation pipelines, and various visualization tools. Hackathons are a valuable approach to inspire creative thinking, supplement training in data science, and foster collaborative scientific relationships, which are foundational practices for early-career researchers. The resources generated can be used to accelerate research on the genetics of PD.

Always Look on the Bright Side Associations of Optimism With Functional Outcomes After Stroke.

Background Psychological health is as an important contributor to recovery after cardiovascular disease, but the roles of both optimism and depression in stroke recovery are not well characterized. Methods and Results A total of 879 participants in the SRUP (Stroke Recovery in Underserved Populations) 2005 to 2006 Study, aged ≥50 years, with incident stroke admitted to a rehabilitation facility were included. Optimism was assessed by the question Are you optimistic about the future Depression was defined by Center for Epidemiologic Studies Depression scale score >16. Participants were categorized into 4 groups optimisticwithout depression (n581), optimisticwith depression (n197), nonoptimisticwithout depression (n36), and nonoptimisticwith depression (n65). Functional Independence Measure scores were used to assess stroke outcomes at discharge, 3 months after discharge, and 1 year after discharge with adjusted linear mixed models to estimate score trajectories. Participants were a mean age of 68 years (SD, 13 years), 52% were women, and 74% were White race. The optimisticwithout depression group experienced the most recovery of total Functional Independence Measure scores in the first 3 months, 24.0 (95% CI, 22.5-25.4), followed by no change in the following 9 months, -0.3 (95% CI, -2.3 to 1.7), similar to the optimisticwith depression group with rapid recovery in 0 to 3 months, 21.1 (95% CI, 18.6-23.6) followed by minimal change in 3 to 12 months, 0.7 (95% CI, -2.8 to 4.1). The nonoptimistic groups demonstrated slow but continued recovery throughout the 12-month period, with overall change, 25.4 (95% CI, 17.6-33.2) in the nonoptimisticwithout depression group and 17.6 (95% CI, 12.0-23.1) in the nonoptimisticwith depression group. There was robust effect modification between optimism and depression (

Epicardial adipose tissue density is a better predictor of cardiometabolic risk in HFpEF patients a prospective cohort study.

Epicardial adipose tissue (EAT) accumulation is associated with multiple cardiometabolic risk factors and prognosis of heart failure with preserved ejection fraction (HFpEF). The correlation between EAT density and cardiometabolic risk and the effect of EAT density on clinical outcome in HFpEF remain unclear. We evaluated the relationship between EAT density and cardiometabolic risk factors, also the prognostic value of EAT density in patients with HFpEF. We included 154 HFpEF patients who underwent noncontrast cardiac computed tomography (CT) and all patients received follow-up. EAT density and volume were quantified semi-automatically. The associations of EAT density and volume with cardiometabolic risk factors, metabolic syndrome and the prognostic impact of EAT density were analyzed. Lower EAT density was associated with adverse changes in cardiometabolic risk factors. Each 1 HU increase in fat density, BMI was 0.14 kgm EAT density was an independent impact factor of cardiometabolic risk in HFpEF. EAT density might have better predictive value than EAT volume for metabolic syndrome and it might have prognostic value in patients with HFpEF.

Antithrombotic Treatment, Prehospital Blood Pressure, and Outcomes in Spontaneous Intracerebral Hemorrhage.

Background In acute intracerebral hemorrhage, both elevated blood pressure (BP) and antithrombotic treatment are associated with poor outcome. Our aim was to explore interactions between antithrombotic treatment and prehospital BP. Methods and Results This observational, retrospective study included adult patients with spontaneous intracerebral hemorrhage diagnosed by computed tomography within 24 hours, admitted to a primary stroke center during 2012 to 2019. The first recorded prehospitalambulance systolic and diastolic BP were analyzed per 5 mm Hg increment. Clinical outcomes were in-hospital mortality, shift on the modified Rankin Scale at discharge, and mortality at 90 days. Radiological outcomes were initial hematoma volume and hematoma expansion. Antithrombotic (antiplatelet andor anticoagulant) treatment was analyzed both together and separately. Modification of associations between prehospital BP and outcomes by antithrombotic treatment was explored by multivariable regression with interaction terms. The study included 200 women and 220 men, median age 76 (interquartile range, 68-85) years. Antithrombotic drugs were used by 252 of 420 (60%) patients. Compared with patients without, patients with antithrombotic treatment had significantly stronger associations between high prehospital systolic BP and in-hospital mortality (odds ratio OR, 1.14 versus 0.99,

Exosomal Mir-3613-3p derived from oxygen-glucose deprivation-treated brain microvascular endothelial cell promotes microglial M1 polarization.

Brain microvascular endothelial cell (BMEC) injury can affect neuronal survival by modulating immune responses through the microenvironment. Exosomes are important vehicles of transport between cells. However, the regulation of the subtypes of microglia by BMECs through the exosome transport of microRNAs (miRNAs) has not been established. In this study, exosomes from normal and oxygen-glucose deprivation (OGD)-cultured BMECs were collected, and differentially expressed miRNAs were analyzed. BMEC proliferation, migration, and tube formation were analyzed using MTS, transwell, and tube formation assays. M1 and M2 microglia and apoptosis were analyzed using flow cytometry. miRNA expression was analyzed using real-time polymerase chain reaction (RT-qPCR), and IL-1β, iNOS, IL-6, IL-10, and RC3H1 protein concentrations were analyzed using western blotting. We found that miR-3613-3p was enriched in BMEC exosome by miRNA GeneChip assay and RT-qPCR analysis. miR-3613-3p knockdown enhanced cell survival, migration, and angiogenesis in the OGD-treated BMECs. In addition, BMECs secrete miR-3613-3p to transfer into microglia via exosomes, and miR-3613-3p binds to the RC3H1 3 untranslated region (UTR) to reduce RC3H1 protein levels in microglia. Exosomal miR-3613-3p promotes microglial M1 polarization by inhibiting RC3H1 protein levels. BMEC exosomal miR-3613-3p reduces neuronal survival by regulating microglial M1 polarization. miR-3613-3p knockdown enhances BMEC functions under OGD conditions. Interfering with miR-3613-3p expression in BMSCs reduced the enrichment of miR-3613-3p in exosomes and enhanced M2 polarization of microglia, which contributed to reduced neuronal apoptosis.

Associations of Modified Healthy Aging Index With Major Adverse Cardiac Events, Major Coronary Events, and Ischemic Heart Disease.

Background The Healthy Aging Index (HAI) has been regarded as useful in capturing the health status of multiple organ systems. However, to what extent the HAI is associated with major cardiovascular events remains largely unknown. The authors constructed a modified HAI (mHAI) to quantify the association of physiological aging with major vascular events and explored how the effects of a healthy lifestyle can modify this association. Methods and Results The participants with either missing values of any individual mHAI component or major illnesses such as heart attack, angina and stroke, and self-reported cancer at baseline were excluded. The mHAI components include systolic blood pressure, reaction time, forced vital capacity, serum cystatin c, and serum glucose. The authors used Cox proportional hazard models to quantify the association of mHAI with major adverse cardiac events, major coronary events, and ischemic heart disease. Cumulative incidence at 5 and 10 years was estimated, and joint analyses were stratified by age group and 4 mHAI categories. The mHAI was significantly correlated with major cardiovascular events, which is a better reflection of the aging level of the body than chronological age. An mHAI was calculated in 338 044 participants aged 38 to 73 years in the UK Biobank. Each point increase in the mHAI was associated with a 44% higher risk of major adverse cardiac events (adjusted hazard ratio aHR, 1.44 95% CI, 1.40-1.49), 44% higher risk of major coronary events (aHR, 1.44 95% CI, 1.40-1.48), and 36% higher risk of ischemic heart disease (aHR, 1.36 95% CI, 1.33-1.39). The percentage of population-attribution risk was 51% (95% CI, 47-55) for major adverse cardiac events, 49% (95% CI, 45-53) for major coronary events, and 47% (95% CI, 44-50) for ischemic heart disease, which means that a substantial portion of these events could be prevented. Systolic blood pressure was the factor most significantly associated with major adverse cardiac events (aHR, 1.94 95% CI, 1.82-2.08 percentage of population-attribution risk, 36%), major coronary events (aHR, 2.01 95% CI, 1.85-2.17 percentage of population-attribution risk, 38%), and ischemic heart disease (aHR, 1.80 95% CI, 1.71-1.89 percentage of population-attribution risk, 32%). A healthy lifestyle significantly attenuated mHAI associations with incidence of vascular events. Conclusions Our findings indicate that higher mHAI is associated with increased major vascular events. A healthy lifestyle may attenuate these associations.

The Rationalisation of Intra-Operative Imaging During Cardiac Surgery A Systematic Review.

One critical complication of cardiac surgery is cerebrovascular accidents (CVAs). Ascending aorta atherosclerosis poses a significant risk of embolisation to distal vessels and to cerebral arteries. Epi-aortic ultrasonography (EUS) is thought to offer a safe, high-quality accurate visualisation of the diseased aorta to guide the surgeon on the best surgical approach to the planned procedure and potentially improve neurological outcomes post-cardiac surgery. The authors conducted a comprehensive search of PubMed, Scopus and Embase. Studies that reported on epi-aortic ultrasound use in cardiac surgery were included. Major exclusion criteria were (1) abstracts, conference presentations, editorials, literature reviews (2) case series with <5 participants (3) epi-aortic ultrasound in trauma or other surgeries. A total of 59 studies and 48,255 patients were included in this review. Out of the studies that reported patient co-morbidities prior to cardiac surgery, 31.6% had diabetes, 59.5% had hyperlipidaemia and 66.1% had a diagnosis of hypertension. Of those that reported significant ascending aorta atherosclerosis found on EUS, this ranged from 8.3% of patients to 95.2% with a mean percentage of 37.8%. Hospital mortality ranged from 7% to 13% four studies reported zero deaths. Long-term mortality and stroke rate varied significantly with hospital duration. Current data have shown EUS to have superiority over manual palpation and transoesophageal echocardiography in the prevention of CVAs following cardiac surgery. Yet, EUS has not been implemented as a routine standard of care. Extensive adoption of EUS in clinical practice is warranted to aid large, randomised trials before making prospective conclusions on the efficacy of this screening method.

Association of pneumococcal vaccination with cardiovascular diseases in older adults The vaccine effectiveness, networking, and universal safety (VENUS) study.

The protective effect of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against cardiovascular disease has been investigated in the United States and Europe however, its effect has not been fully established. This study aimed to investigate the protective effect of PPSV23 on cardiovascular events in adults aged ≥ 65 years. This population-based nested case-control study was conducted using the claims data and vaccine records between April 2015 and March 2020 from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study. PPSV23 vaccination was identified using vaccination records in each municipality. The primary outcome was acute myocardial infarction (AMI) or stroke. The adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for PPSV23 vaccination were calculated using conditional logistic regression. Among 383,781 individuals aged ≥ 65 years, 5,356 and 25,730 individuals with AMI or stroke were matched with 26,753 and 128,397 event-free controls, respectively. Individuals who were PPSV23 vaccinated, compared with the unvaccinated individuals, had significantly lower odds of AMI or stroke events (aOR, 0.70 95% CI, 0.62-0.80 and aOR, 0.81 95% CI, 0.77-0.86, respectively). More recent PPSV23 vaccination was associated with lower odds ratios (AMI, aOR 0.55 95% CI, 0.42-0.72 for 1-180 days and aOR 1.11 95% CI, 0.84-1.47 for 720 days or longer stroke, aOR 0.83 95% CI, 0.74-0.93 for 1-180 days and aOR 0.90 95% CI, 0.78-1.03 for 720 days or longer). Among Japanese older adults, individuals who were PPSV23 vaccinated, compared with unvaccinated individuals, had significantly lower odds of AMI or stroke events.

ASOC Osuntokun Award Lecture 2022 Partnership for stroke prevention and treatment in Africa Qualitative research processes and findings.

Africa has one of the highest rates of stroke and stroke deaths in the world. The burden of stroke is increasing with a 3-year mortality rate of up to 84%. Stroke disproportionately affects the young and middle-aged population contributing to morbidity and mortality affecting families, communities, health systems, and economic progress. My objectives of the 2022 Osuntokun Award Lecture at the African Stroke Organization Conference were to explore our qualitative research findings from our communities and to propose future qualitative methods for improving stroke outcomes in Africa. Qualitative research processes and findings related to stroke prevention, treatmentongoing care, recovery, and knowledge and attitudes influencing ethical, legal and social implications related to stroke neuro-biobanking were explored. For each qualitative study, methods were developed by the research team including (1) plans to implement aims and ethics review (2) guides and detailed steps for implementation (3) training for team (4) pilot testing, data collection, transport, transcription, storage (5) data analysis and manuscript development. The research focused on genetics, genomics and phenomics of stroke and more recently on exploring the ethical, legal, and social implications of stroke neuro-biobanking. All included a qualitative component to obtain input and guidance from the community. As in quantitative research, questions were developed by the research team, reviewed for clarity by a small group of community members, and 1,289 community members (ages 22-85) participated in the focus groups and key informant interviews from 2014 through 2022. Answers to questions were diverse with some knowledgeable about the science of stroke prevention and treatment, but many had ideas about prevention and causes of stroke that were not supported by science and many reported using traditional healers for treatment and religious beliefs preventing brain biobanking. In addition to our current qualitative research related to stroke in Africa and beyond, we must form research partnerships with communities that not only answer researchers and community members questions but identify and implement ways to prevent stroke and improve stroke outcomes.

Presbyphagia and swallowing disorders.

Swallowing disorders, which are frequent in geriatrics, are linked to multiple pathologies cancer, stroke, neurocognitive disorders, acute confusion, vigilance disorders, etc. They can have serious consequences and therefore require special care. From the identification of the disorders by the doctor, the nurse, the caregiver, to the speech therapy assessment, through the adaptation of the diet by the dietician, the management of swallowing disorders concerns all the medical and paramedical staff. The aim of this article is to present the main existing recommendations to promote the patients feeding despite the presence of these disorders.

Utility of Cerebral Embolic Protection Devices in Transcatheter Procedures A Systematic Review and Meta-Analysis.

With the emergence of the largest randomized control trial to date - the Stroke Protection With Sentinel During Transcatheter Aortic Valve Replacement (PROTECTED TAVR) study- we sought to conduct an updated meta-analyses to evaluate the utility of CEP devices on both clinical outcomes and neuroimaging parameters. Electronic databases were queried through November 2022 for clinical trials comparing the utility of Cerebral Embolic Protection (CEP) devices in Transcatheter Aortic Valve Replacement (TAVR) with non-CEP TAVR procedures. Meta-analyses were performed using the generic inverse variance technique, and a random-effects model, and results are presented as weighted mean differences (WMD) for continuous outcomes, and hazard ratios (HR) for dichotomous outcomes. Outcomes of interest included stroke, disabling stroke, non-disabling stroke, bleeding, mortality, vascular complications, new ischemic lesions, acute kidney injury (AKI) and total lesion volume. 13 studies (8 RCTs, 5 observational studies) consisting of 128,471 patients were included in the analysis. Results from our meta-analyses showed a significant reduction in stroke (OR 0.84 0.74 - 0.95 P < 0.01 I The results suggest that CEP device use was associated with a lower risk of disabling stroke and bleeding events in patients undergoing TAVR.

Young Patients Undergoing Carotid Endarterectomy Have Increased Rates of Recurrent Disease and Late Neurologic Events.

There is a paucity of data regarding outcomes of patients with premature cerebrovascular disease (age ≤ 55 years) who undergo carotid endarterectomy (CEA). The objective of this study was to analyze the demographics, presentation, perioperative and later outcomes of younger patients undergoing CEA. The Society for Vascular Surgery Vascular Quality Initiative was queried for CEA cases between 2012-2022. Patients were stratified based on age ≤ 55 or age > 55 years. Primary endpoints were periprocedural stroke, death, myocardial infarction and composite outcomes. Secondary endpoints included restenosis (≥80%) or occlusion, late neurologic events and re-intervention. Of 120,549 patients undergoing CEA, 7,009 (5.5%) were ≤ 55 years old (mean age of 51.3 years). Younger patients were more likely to be African American (7.7% vs 4.5%, p < .001), female (45.2% vs 38.9%, p < .001) and active smokers (57.3% vs 24.1%, p < .001). They were less likely than older patients to have hypertension (82.5% vs 89.7%, p < .001), coronary artery disease (25% vs 27.3%, p < .001) and CHF (7.8% vs 11.4%, p<.001). Younger patients were significantly less likely than older patients to be on aspirin, anti-coagulation, statins, or beta-blockers but were more likely to be taking P2Y12 inhibitors (37.2 vs 33.7%, p <.001). Younger patients were more likely to present with symptomatic disease (35.1% vs 27.6%, p<.001) and were more likely to undergo non-elective CEA (19.2% vs 12.8% P < .001). Younger and older patients had similar rates of perioperative strokedeath (2% vs 2%, p NS) and post-operative neurologic events (1.9% vs 1.8%, p NS). However, younger patients had lower rates of overall postoperative complications compared to their older counterparts (3.7% vs 4.7%, p<.001). 72.6% of patients had recorded follow-up (mean 13 months). During follow-up, younger patients were significantly more likely than older patients to experience a late failure, defined as significant (≥80%) restenosis or complete occlusion of the operated artery (2.4% vs 1.5%, p <.001) and were more likely to experience any neurologic event (3.1% vs 2.3%, p<.001). Re-intervention rates did not significantly differ between the two cohorts. After controlling for co-variates using a logistic regression model, age ≤ 55 years was independently associated with increased odds of late re-stenosisocclusion (OR 1.591, 95% CI 1.221-2.073, p<.001) as well as late neurologic events (OR 1.304, 95% CI 1.079-1.576, p 0.006). Young patients undergoing CEA are more likely to be African American, female, and active smokers. They are more likely to present symptomatically and undergo non-elective CEA. Although perioperative outcomes are similar, younger patients are more likely to experience carotid occlusion or restenosis as well as subsequent neurological events, during relatively short follow-up. These data suggest that younger CEA patients may require more diligent follow-up, and a continued aggressive approach to medical management of atherosclerosis to prevent future events related to the operated artery, given the particularly aggressive nature of premature atherosclerosis.

Hydroxyurea with dose escalation for primary stroke risk reduction in children with sickle cell anaemia in Tanzania (SPHERE) an open-label, phase 2 trial.

Transcranial Doppler screening with chronic transfusions reduces stroke risk in children with sickle cell anaemia but is not feasible in low-resource settings. Hydroxyurea is an alternative treatment to decrease stroke risk. We aimed to estimate stroke risk in children with sickle cell anaemia in Tanzania and to determine the efficacy of hydroxyurea to decrease and prevent stroke. We did an open-label, phase 2 trial (SPHERE) at Bugando Medical Centre, Mwanza, Tanzania. Children aged 2-16 years with a diagnosis of sickle cell anaemia confirmed by haemoglobin electrophoresis were eligible for enrolment. Participants had transcranial Doppler ultrasound screening by a local examiner. Participants with elevated Doppler velocities, either conditional (170-199 cms) or abnormal (≥200 cms), received oral hydroxyurea starting at 20 mgkg once daily and escalated every 8 weeks by 5 mgkg per day to the maximum tolerated dose. Participants with normal Doppler velocities (<170 cms) received usual care from the sickle cell anaemia clinic and were rescreened after 12 months to determine whether they qualified for treatment on trial. The primary endpoint was change in transcranial Doppler velocity from the baseline visit to after 12 months of hydroxyurea treatment, analysed in all patients who had paired baseline and follow-up measurements collected after 12 months of treatment. Safety was analysed in the per-protocol population (all participants who received study treatment). This study is registered with ClinicalTrials.gov, NCT03948867. Between April 24, 2019, and April 9, 2020, 202 children were enrolled and had transcranial Doppler screening. Sickle cell anaemia was confirmed by DNA-based testing in 196 participants (mean age 6·8 years SD 3·5, 103 53% were female, and 93 47% were male). At the baseline screening, 47 (24%) of 196 participants had elevated transcranial Doppler velocities (43 22% conditional, four 2% abnormal) 45 initiated hydroxyurea at a mean dose of 20·2 mgkg per day (SD 1·4) with escalation to a mean dose of 27·4 mgkg per day (5·1) after 12 months. Treatment response was analysed after 12 months (± 1 month median 11 months, IQR 11-12) and 24 months (±3 months median 22 months, 22-22). Transcranial Doppler velocities decreased to a mean of 149 cms (SD 27) compared with 182 cms (12) at baseline, which was significantly lower than baseline (p<0·0001), with an average decline of 35 cms (SD 23) after 12 months of treatment in 42 participants with paired results available at baseline and 12 months. No clinical strokes occurred, and 35 (83%) of 42 participants reverted to normal transcranial Doppler velocities. Clinical adverse events were mild, and dose-limiting toxicities were uncommon. The most common grade 3 adverse events were malaria (12 29% episodes in 45 patients) and sepsis (13 32% episodes). There were three serious adverse events, none of which were treatment-related, and no treatment-related deaths occurred. Children with sickle cell anaemia in Tanzania have a high baseline stroke risk. Hydroxyurea at the maximum tolerated dose significantly lowers transcranial Doppler velocities and reduces primary stroke risk. Transcranial Doppler screening plus hydroxyurea at the maximum tolerated dose is an effective stroke prevention strategy, supporting wider hydroxyurea access for patients with sickle cell anaemia across sub-Saharan Africa. American Society of Hematology, National Institutes of Health, Cincinnati Childrens Research Foundation.

Neutrophil extracellular traps as a unique target in the treatment of chemotherapy-induced peripheral neuropathy.

Chemotherapy-induced peripheral neuropathy (CIPN) is a severe dose-limiting side effect of chemotherapy and remains a huge clinical challenge. Here, we explore the role of microcirculation hypoxia induced by neutrophil extracellular traps (NETs) in the development of CIPN and look for potential treatment. The expression of NETs in plasma and dorsal root ganglion (DRG) are examined by ELISA, IHC, IF and Western blotting. IVIS Spectrum imaging and Laser Doppler Flow Metry are applied to explore the microcirculation hypoxia induced by NETs in the development of CIPN. Stroke Homing peptide (SHp)-guided deoxyribonuclease 1 (DNase1) is used to degrade NETs. The level of NETs in patients received chemotherapy increases significantly. And NETs accumulate in the DRG and limbs in CIPN mice. It leads to disturbed microcirculation and ischemic status in limbs and sciatic nerves treated with oxaliplatin (L-OHP). Furthermore, targeting NETs with DNase1 significantly reduces the chemotherapy-induced mechanical hyperalgesia. The pharmacological or genetic inhibition on myeloperoxidase (MPO) or peptidyl arginine deiminase-4 (PAD4) dramatically improves microcirculation disturbance caused by L-OHP and prevents the development of CIPN in mice. In addition to uncovering the role of NETs as a key element in the development of CIPN, our finding provides a potential therapeutic strategy that targeted degradation of NETs by SHp-guided DNase1 could be an effective treatment for CIPN. This study was funded by the National Natural Science Foundation of China81870870, 81971047, 81773798, 82271252 Natural Science Foundation of Jiangsu ProvinceBK20191253 Major Project of Science and Technology Innovation Fund of Nanjing Medical University2017NJMUCX004 Key RD Program (Social Development) Project of Jiangsu ProvinceBE2019732 Nanjing Special Fund for Health Science and Technology DevelopmentYKK19170.

The role of the autonomic nervous system in cerebral blood flow regulation in stroke A review.

Stroke is a pathophysiological condition which results in alterations in cerebral blood flow (CBF). The mechanism by which the brain maintains adequate CBF in presence of fluctuating cerebral perfusion pressure (CPP) is known as cerebral autoregulation (CA). Disturbances in CA may be influenced by a number of physiological pathways including the autonomic nervous system (ANS). The cerebrovascular system is innervated by adrenergic and cholinergic nerve fibers. The role of the ANS in regulating CBF is widely disputed owing to several factors including the complexity of the ANS and cerebrovascular interactions, limitations to measurements, variation in methods to assess the ANS in relation to CBF as well as experimental approaches that can or cannot provide insight into the sympathetic control of CBF. CA is known to be impaired in stroke however the number of studies investigating the mechanisms by which this occurs are limited. This literature review will focus on highlighting the assessment of the ANS and CBF via indices derived from the analyses of heart rate variability (HRV), and baroreflex sensitivity (BRS), and providing a summary of both clinical and animal model studies investigating the role of the ANS in influencing CA in stroke. Understanding the mechanisms by which the ANS influences CBF in stroke patients may provide the foundation for novel therapeutic approaches to improve functional outcomes in stroke patients.

Mechanoelectric effects in healthy cardiac function and under Left Bundle Branch Block pathology.

Mechanoelectric feedback (MEF) in the heart operates through several mechanisms which serve to regulate cardiac function. Stretch activated channels (SACs) in the myocyte membrane open in response to cell lengthening, while tension generation depends on stretch, shortening velocity, and calcium concentration. How all of these mechanisms interact and their effect on cardiac output is still not fully understood. We sought to gauge the acute importance of the different MEF mechanisms on heart function. An electromechanical computer model of a dog heart was constructed, using a biventricular geometry of 500K tetrahedral elements. To describe cellular behavior, we used a detailed ionic model to which a SAC model and an active tension model, dependent on stretch and shortening velocity and with calcium sensitivity, were added. Ventricular inflow and outflow were connected to the CircAdapt model of cardiovascular circulation. Pressure-volume loops and activation times were used for model validation. Simulations showed that SACs did not affect acute mechanical response, although if their trigger level was decreased sufficiently, they could cause premature excitations. The stretch dependence of tension had a modest effect in reducing the maximum stretch, and stroke volume, while shortening velocity had a much bigger effect on both. MEF served to reduce the heterogeneity in stretch while increasing tension heterogeneity. In the context of left bundle branch block, a decreased SAC trigger level could restore cardiac output by reducing the maximal stretch when compared to cardiac resynchronization therapy. MEF is an important aspect of cardiac function and could potentially mitigate activation problems.

Evaluation of cholesterol crystals in carotid plaque by dual energy computed tomography.

Cholesterol crystals (CCs) in carotid plaques might be an indicator of vulnerability, although they have not been fully investigated and non-invasive methods of assessment have not been established. This study examines the validity of assessing CCs using dual-energy computed tomography (DECT) that uses X-rays with different tube voltages for imaging, allowing material discrimination. We retrospectively evaluated patients who had undergone preoperative cervical computed tomography angiography and carotid endarterectomy between December 2019 and July 2020. We developed CC-based material decomposition images (MDIs) by scanning CCs crystallized in the laboratory using DECT. We compared the percentage of CCs in stained slides defined by cholesterol clefts with the percentage of CCs displayed by CC-based MDIs. Thirty-seven pathological sections were obtained from 12 patients. Thirty-two sections had CCs of these, 30 had CCs on CC-based MDIs. CC-based MDIs and pathological specimens showed a strong correlation. Thus, DECT allows the evaluation of CCs in carotid artery plaques.

Psychological impact of COVID-19 containment on CADASIL patients.

COVID-19 restrictive containment was responsible for major psychological distress and alteration of quality of life (QoL) in the general population. Their impact in a group of patients having cerebral small vessel disease (SVD) and at high risk of stroke and disability was unknown. We aimed to determine the potential psychological impact of strict containment during the COVID-19 pandemic in a sample of CADASIL patients, a rare SVD caused by NOTCH3 gene mutations. Interviews of 135 CADASIL patients were obtained just after the end of the strict containment in France. Depression, QoL and negative subjective experience of the containment were analysed, as well as predictors of posttraumatic and stressor-related manifestations, defined as an Impact Event Scale-Revised score ≥ 24, using multivariable logistic analysis. Only 9% of patients showed a depressive episode. A similar proportion had significant posttraumatic and stressor-related disorder manifestations independently associated only with socio-environment factors, rather than clinical ones living alone outside a couple (OR 7.86 (1.87-38.32), unemployment (OR 4.73 (1.17-18.70)) and the presence of 2 or more children at home (OR 6.34 (1.35-38.34). Psychological impact of the containment was limited in CADASIL patients and did not appear related to the disease status. About 9% of patients presented with significant posttraumatic and stressor-related disorder manifestations which were predicted by living alone, unemployment, or exhaustion related to parental burden.

Not surgical technique, but etiology, contralateral MRI, prior surgery, and side of surgery determine seizure outcome after pediatric hemispherotomy.

We aimed to assess determinants of seizure outcome following pediatric hemispherotomy in a contemporary cohort. We retrospectively analyzed the seizure outcomes of 457 children who underwent hemispheric surgery in five European epilepsy centers between 2000 and 2016. We identified variables related to seizure outcome through multivariable regression modeling with missing data imputation and optimal group matching and further investigated the role of surgical technique by Bayes factor (BF) analysis. 177 (39%) children underwent vertical and 280 (61%) lateral hemispherotomy. 344 (75%) children achieved seizure freedom at a mean follow-up of 5.1 years (range 1 to 17.1). We identified acquired etiology other than stroke (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.1-18.0), hemimegalencephaly (OR 2.8, CI 1.1-7.3), contralateral MRI findings (5.5, CI 2.7-11.1), prior resective surgery (OR 5.0, CI 1.8-14.0), and left hemispherotomy (OR 2.3, CI 1.3-3.9), as significant determinants of seizure recurrence. We found no evidence for an impact of the hemispherotomy technique on seizure outcome (the Bayes factor for a model including the hemispherotomy technique over the null model was 1.1), with comparable overall major complication rates for different approaches. Knowledge about independent determinants of seizure outcome following pediatric hemispherotomy will improve the counseling of patients and families. In contrast to previous reports, we found no statistically-relevant difference in seizure-freedom rates between the vertical and horizontal hemispherotomy techniques when accounting for different clinical features between groups.

Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease. Two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC) and European Association of Preventive Cardiology (EAPC).

To appraise all available antithrombotic treatments within or after 12 months following coronary revascularization andor acute coronary syndrome in two network meta-analyses (NMA). Forty-three (N 189 261) trials within 12 months and 19 (N 139 086 patients) trials beyond 12 months were included for efficacysafety endpoints appraisal.Within 12 months, ticagrelor 90 mg bis in die (b.i.d.) (hazard ratio HR 0.66 95% confidence interval CI 0.49-0.88), aspirin and ticagrelor 90 mg (HR 0.85 95%CI 0.76-0.95), or aspirin, clopidogrel and rivaroxaban 2.5 mg b.i.d. (HR 0.66 95%CI 0.51-0.86) were the only treatments associated with lower cardiovascular mortality, compared with aspirin and clopidogrel, without or with greater bleeding risk for the first and the other treatment options, respectively.Beyond 12 months, no strategy lowered mortality compared with aspirin the greatest reductions of myocardial infarction (MI) were found with aspirin and clopidogrel (HR 0.68 95%CI, 0.55-0.85) or P2Y12 inhibitor monotherapy (HR 0.76 95%CI, 0.61-0.95), especially ticagrelor 90 mg (HR 0.54 95%CI, 0.32-0.92), and of stroke with VKA (HR, 0.56 95%CI, 0.44-0.76) or aspirin and rivaroxaban 2.5 mg (HR, 0.58 95%CI, 0.44-0.76). All treatments increased bleeding except P2Y12 monotherapy, compared with aspirin. Within 12 months, ticagrelor 90 mg monotherapy was the only treatment associated with lower mortality, without bleeding risk trade-off compared with aspirin and clopidogrel. Beyond 12 months, P2Y12 monotherapy, especially ticagrelor 90 mg, was associated with lower MI without bleeding trade-off aspirin and rivaroxaban 2.5 mg most effectively reduced stroke, with a more acceptable bleeding risk than VKA, compared with aspirin. Registration URL httpswww.crd.york.ac.ukPROSPERO Unique identifiers CRD42021243985 and CRD42021252398.

Platypnoea orthodeoxia syndrome and its association with cryptogenic ischaemic stroke.

Platypnoea orthodeoxia syndrome is a rare condition, which can be present in patients with patent foramen ovale (PFO). In this case, a 72-year-old lady presented to the emergency department with a cryptogenic stroke associated with right thalamic infarct. While in hospital, it was noticed that the patient had desaturations in the upright position, and these improved in the recumbent position, consistent with platypnoea orthodeoxia syndrome. The patient was found to have a PFO, which was then closed, and her saturations returned to normal. This case highlights the importance of patients who present with cryptogenic stroke and features of platypnoea orthodeoxia syndrome need to be considered for underlying PFO or other septal defect.

What is the food like that people choke on A study on food bolus physical properties under different in vitro oral capacities.

People with oral impairments, such as poor denture status, poor muscle strength, and poor salivary secretion, have more difficulties performing oral processes, which results in the risk of choking. In this study, we aimed to understand, in vitro, how different oral impairments can affect the oral processing of food reported as a choking hazard. Six foods that frequently cause choking were selected and studied, varying three in vitro factors at two levels-saliva incorporation amount, cutting activity, and compression action. The median particle size (a50) and the particle size heterogeneity (a7525) of the food fragmentation, the hardness, and adhesiveness of the bolus formation, and the final cohesiveness of the bolus were studied. The results showed that all the parameters studied varied depending on the food product. High compression reduced a50 (except in mochi that increased) and a7525 (except in eggs and fish) but increased bolus adhesion and particle aggregation (except for mochi). Regarding cutting activity, when performing a greater number of strokes, the particle size for sausage and egg, and the hardness of the bolus for mochi and sausage were lower. In contrast, for some food products, the bolus adhesiveness (bread) and particle aggregation (pineapple) were higher at a high number of strokes. The amount of saliva also played an important role in the creation of the bolus. When high amounts of saliva were added, the a50 values (mochi) and hardness (mochi, egg, and fish) decreased and increased the adhesiveness (mochi) and particle aggregation (bread, pineapple, and sausage). When all oral factors are compromised (lack of muscle strength, denture status, and saliva secretion), some food products create a choking hazard as individuals cannot achieve the right particle size, bolus cohesiveness, and mechanical properties of the bolus to be safe to swallow, there is still a need to elaborate a guide, considering all the safety parameters.

Polygenic Parkinsons Disease Genetic Risk Score as Risk Modifier of Parkinsonism in Gaucher Disease.

Biallelic pathogenic variants in GBA1 are the cause of Gaucher disease (GD) type 1 (GD1), a lysosomal storage disorder resulting from deficient glucocerebrosidase. Heterozygous GBA1 variants are also a common genetic risk factor for Parkinsons disease (PD). GD manifests with considerable clinical heterogeneity and is also associated with an increased risk for PD. The objective of this study was to investigate the contribution of PD risk variants to risk for PD in patients with GD1. We studied 225 patients with GD1, including 199 without PD and 26 with PD. All cases were genotyped, and the genetic data were imputed using common pipelines. On average, patients with GD1 with PD have a significantly higher PD genetic risk score than those without PD (P 0.021). Our results indicate that variants included in the PD genetic risk score were more frequent in patients with GD1 who developed PD, suggesting that common risk variants may affect underlying biological pathways. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Development and feasibility of first- and third-person motor imagery for people with stroke living in the community.

Impairment of arm movement occurs in up to 85% of people post-stroke, affecting daily living activities, and quality of life. Mental imagery effectively enhances hand and daily function in people with stroke. Imagery can be performed when people imagine themselves completing the movement or imagine another person doing it. However, there is no report on the specific use of first-person and third-person imagery in stroke rehabilitation. To develop and assess the feasibility of the First-Person Mental Imagery (FPMI) and the Third-Person Mental Imagery (TPMI) programs to address the hand function of people with stroke living in the community. This study comprises phase 1-development of the FPMI and TPMI programs, and phase 2-pilot-testing of the intervention programs. The two programs were developed from existing literature and reviewed by an expert panel. Six participants with stroke, living in the community, participated in the pilot-testing of the FPMI and TPMI programs for 2 weeks. Feedback collected included the suitability of the eligibility criteria, therapists and participants adherence to intervention and instructions, appropriateness of the outcome measures, and completion of the intervention sessions within the specified time. The FPMI and TPMI programs were developed based on previously established programs and included 12 hand tasks. The participants completed four 45-min sessions in 2 weeks. The treating therapist adhered to the program protocol and completed all the steps within the specified time frame. All hand tasks were suitable for adults with stroke. Participants followed the instructions given and engaged in imagery. The outcome measures selected were appropriate for the participants. Both programs showed a positive trend towards improvement in participants upper extremity and hand function and self-perceived performance in activities of daily living. The study provides preliminary evidence that these programs and outcome measures are feasible for implementation with adults with stroke living in the community. This study outlines a realistic plan for future trials in relation to participant recruitment, training of therapists on the intervention delivery, and the use of outcome measures. Title Effectiveness of first-person and third-person motor imagery in relearning daily hand tasks for people with chronic stroke a randomised controlled trial. SLCTR2017031. Date registered 22nd September 2017.

Blunt Cerebrovascular Injury (BCVI) Management Is There a Right Answer

Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid andor vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one traumastroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.

Predictors of Serious Adverse Events and High-Level Cardiorespiratory Support in Patients Undergoing Transcatheter Pulmonary Vein Interventions.

Patients with pulmonary vein stenosis (PVS) often require frequent transcatheter pulmonary vein (PV) interventions for management of restenosis. Predictors of serious adverse events (AEs) and need for high-level cardiorespiratory support (mechanical ventilation, vasoactive support, andor extracorporeal membrane oxygenation) 48 h after transcatheter PV interventions have not been reported. This is a single-center retrospective cohort analysis of patients with PVS who underwent transcatheter PV interventions from 312014 to 12312021. Univariate and multivariable analyses were performed using generalized estimating equations to account for within-patient correlation. 240 patients underwent 841 catheterizations involving PV interventions (median 2 catheterizations per patient 1,3). At least one serious AE was reported in 100 (12%) cases, the most common of which were pulmonary hemorrhage (n 20) and arrhythmia (n 17). There were 14 severecatastrophic AEs (1.7% of cases) including three strokes and one patient death. On multivariable analysis, age less than 6 months, low systemic arterial saturation (< 95% in patients with biventricular BiV physiology, < 78% in single ventricle SV physiology), and severely elevated mean PA pressure (≥ 45 mmHg in BiV, ≥ 17 mmHg in SV) were associated with SAEs. Age less than 1 year, hospitalization prior to catheterization, and moderate-severe RV dysfunction were associated with high-level support after catheterization. Serious AEs during transcatheter PV interventions in patients with PVS are common, although major events such as stroke or death are uncommon. Younger patients and those with abnormal hemodynamics are more likely to experience serious AEs and require high-level cardiorespiratory support after catheterization.

Significance of pulse pressure variability in predicting functional outcome in acute ischemic stroke a retrospective, single-center, observational cohort study.

This study aimed to determine the association between pulse pressure variability (PPV) and short- and long-term outcomes of acute ischemic stroke (AIS) patients. We studied 203 tertiary stroke center patients with AIS. PPV during 72 h after admission was analyzed using different variability parameters including standard deviation (SD). Patients outcome was assessed after 30 and 90 days post-stroke with modified Rankin Scale. The association between PPV and outcome was investigated using logistic regression analysis with adjustment for potential confounders. The predictive significance of PPV parameters was determined using area under the curve (AUC) of receiver operating characteristics. In the unadjusted logistic regression analysis, all PPV indicators were independently associated with unfavorable outcome at 30 days (i.a. Odds ratio (OR) 4.817, 95%CI 2.283-10.162 per 10 mmHg increase in SD, p 0.000) and 90 days (i.a. OR 4.248, 95%CI 2.044-8.831 per 10 mmHg increase in SD, p 0.000). After adjustment for confounders, ORs for all PPV indicators remained statistically significant. On the basis of AUC values, all PPV parameters were found relevant outcome predictors (p < 0.01). In conclusion, elevated PPV during first 72 h after admission due to AIS is associated with unfavorable outcome at 30 and 90 days, independent of mean blood pressure levels.

Long-term outcomes of moyamoya disease versus atherosclerosis-associated moyamoya vasculopathy using high-resolution MR vessel wall imaging.

We aimed to compare the long-term outcomes and surgical benefits between moyamoya disease (MMD) and atherosclerosis-associated moyamoya vasculopathy (AS-MMV) using high-resolution MRI (HRMRI). MMV patients were retrospectively included and divided into the MMD and AS-MMV groups according to vessel wall features on HRMRI. Kaplan-Meier survival and Cox regression were performed to compare the incidence of cerebrovascular events and prognosis of encephaloduroarteriosynangiosis (EDAS) treatment between MMD and AS-MMV. Of the 1173 patients (mean age 42.4±11.0 years male 51.0%) included in the study, 881 were classified into the MMD group and 292 into the AS-MMV group. During the average follow-up of 46.0±24.7 months, the incidence of cerebrovascular events in the MMD group was higher compared with that in the AS-MMV group before (13.7% vs 7.2% HR 1.86 95% CI 1.17 to 2.96 p0.008) and after propensity score matching (6.1% vs 7.3% HR 2.24 95% CI 1.34 to 3.76 p0.002). Additionally, patients treated with EDAS had a lower incidence of events than those not treated with EDAS, regardless of whether they were in the MMD (HR 0.65 95% CI 0.42 to 0.97 p0.043) or AS-MMV group (HR 0.49 95% CI 0.51 to 0.98 p0.048). Patients with MMD had a higher risk of ischaemic stroke than those with AS-MMV, and patients with both MMD and AS-MMV could benefit from EDAS. Our findings suggest that HRMRI could be used to identify those who are at a higher risk of future cerebrovascular events.

Silent brain infarcts after carotid or vertebrobasilar artery stenting.

Stenting is an important treatment for preventing stroke. However, the effect of vertebrobasilar stenting (VBS) might be limited because of relatively high periprocedural risks. Silent brain infarcts (SBIs) are known as a predictor for future stroke. Because of anatomical differences, factors for SBIs might be different between carotid artery stenting (CAS) and VBS. We compared the characteristics of SBIs between VBS and CAS. We included patients who underwent elective VBS or CAS. Diffusion-weighted imaging was performed pre- and post-procedure to detect new SBIs. Clinical variables, occurrence of SBIs, and procedure-related factors were compared between CAS and VBS. Moreover, we investigated predictors of SBIs in each group separately. Ninety-two (34.2%) out of 269 patients had SBIs. SBIs were more frequently observed in VBS (29 56.6% vs. 63 28.9%, p<.001). The risk of SBIs outside the stent-inserted vascular territory was higher in VBS compared to CAS (14 48.3% vs. 8 12.7%, p<.001). Larger-diameter stents (odds ratio 1.28, 95% confidence interval 1.06-1.54, p .012) and prolonged procedure time (1.01, 1.00-1.03, p .026) increased the risk of SBIs in CAS, whereas only age increased the risk of SBIs in VBS (1.08 1.01-1.16, p .036). Compared to CAS, VBS was associated with longer procedure time, more residual stenosis, and more SBIs, especially outside the stent-inserted vascular territory. The risk of SBIs after CAS was associated with stent size and procedural difficulty. Only age was associated with SBIs in VBS. The pathomechanism of SBIs after VBS and CAS may be different.

Whole Body Retrograde Perfusion Combined With Central Aortic Perfusion Strategy in the Repair of Distal Arch Pathology Through a Lateral Thoracotomy.

To compare the results of the hypothermic circulatory arrest (HCA) retrograde whole-body perfusion (RBP) technique with those of deep hypothermic circulatory arrest (DHCA-only) approach. Limited data are available on cerebral protection techniques when distal arch repairs are performed through a lateral thoracotomy. In 2012, the RBP technique was introduced as adjunct to HCA during open distal arch repair via thoracotomy. We reviewed the results of the HCA RBP technique compared with those of the DHCA-only approach. From February 2000 to November 2019, 189 patients (median age, 59 IQR, 46 to 71 years 30.7% female) underwent open distal arch repair via lateral thoracotomy to treat aortic aneurysms. The DHCA technique was used in 117 patients (62%, median age 53 IQR, 41 to 60 years), whereas HCA RBP was used in 72 patients (38%, median age 65 IQR, 51 to 74 years). In HCA RBP patients, cardiopulmonary bypass was interrupted when systemic cooling achieved isoelectric electroencephalogram once the distal arch had been opened, RBP was then initiated via the venous cannula (flow of 700 to 1000 mLmin, central venous pressure <15 to 20 mm Hg). The stroke rate was significantly lower in the HCA RBP group (3%, n2) compared with the DHCA-only (12%, n14) (P.031), despite longer circulatory arrest times in HCA RBP compared with the DHCA-only (31 IQR, 25 to 40 minutes vs 22 IQR, 17 to 30 minutes, respectively P<.001). Operative mortality for patients undergoing HCA RBP was 6.7% (n4), whereas for those undergoing DHCA-only it was 10.4% (n12) (P.410). The 1-, 3-, and 5-year age-adjusted survival rates for the DHCA group are 86%, 81%, and 75%, respectively. The 1-, 3-, and 5-year age-adjusted survival rates for the HCA RBP group are 88%, 88%, and 76%, respectively. The addition of RBP to HCA in the treatment of distal open arch repair via a lateral thoracotomy is safe and provides excellent neurological protection.