Regular pulse checks for patients with non-cardioembolic stroke in rehabilitation hospitals to improve recognition and detection of atrial fibrillation (the ESCORT study): protocol for a prospective multicenter observational study.

Background: Cryptogenic stroke (CS) are heterogeneous in origin; however, most CS are embolic mechanism. Paroxysmal atrial fibrillation (AF) is suspected to be a major type of CS that leads to severe cerebral infarction without anticoagulant use. Therefore, the identification of AF is vital in patients with CS. However, patients are often unaware of AF because they have no symptoms, and AF may not be detected on an electrocardiogram (ECG) or Holter ECG on admission. After patients with stroke are treated in the acute phase, they are promptly transferred to a rehabilitation hospital for functional recovery. Once the patient is transferred to a hospital, a few attempts are made to detect AF. In addition, rehabilitation therapists are considered to have insufficient awareness of the possibility of undiagnosed AF. Objective: This study aimed to increase the understanding of the importance of AF detection in patients with ischemic stroke among therapists in rehabilitation hospitals and to investigate whether regular pulse screening can aid in the detection of AF. If AF was detected, we determined the rate and timing of AF detection and identified the patient characteristics. Methods: This multicenter prospective observational study aimed to detect AF in patients with non-cardiac stroke at rehabilitation hospitals. Therapists performed pulse checks before, during, and after rehabilitation. If arrhythmia or tachycardia was detected, an ECG was performed, and the physician checked for AF. If the patient complained of chest symptoms, electrocardiography (ECG) was performed to check for AF. We investigated the characteristics, laboratory data, cognitive status, complications, such as stroke recurrence, and functional outcomes of patients with AF. Results: The study is in the enrollment phase. Recruitment began in September 2022 and will end in August 2023. Patients have provided written informed consent. The main results have been submitted for publication in your journal. Conclusion: The findings of this study will help identify patients with AF in rehabilitation hospitals and improve awareness among therapists.

Recovery process of vertical perception and activities of daily living in stroke patients: A retrospective cohort study.

INTRODUCTION: Clarifications regarding the recovery process of the subjective postural vertical (SPV) and activities of daily living in stroke patients are required to help clinicians determine treatment plans. Therefore, we aimed to investigate the characteristics of the longitudinal recovery process of SPV and activities of daily living after stroke. METHODS: Overall, 109 patients with stroke were enrolled. Clinical assessments included the SPV and total functional independence measure (FIM), initially and after 1 month. The mean and standard deviation of SPV indicated the directional and variability errors, respectively. Participants were categorized as follows: nondeviation group comprised directional and variability errors within the standard values, deviation of variability errors group comprised directional errors within the standard value and variability errors greater than the standard value, and deviation of both directional and variability errors group comprised directional and variability errors greater than the standard values. In addition, a two-way analysis of variance was performed for initial pre- and post-SPV, and pre- and posttotal FIM scores (p < .05). RESULTS: The deviation of variability errors group, and deviation of both directional and variability errors group, had larger SPV variability errors than did the nondeviation group. Furthermore, the deviation of variability errors group showed a significant improvement in variability errors after 1 month. There was a correlation between the initial SPV with eyes opened variability error and total FIM after 1 month in Pusher patients with unilateral spatial neglect in the deviation of both directional and variability errors group. CONCLUSIONS: SPV with eyes opened variability errors and initial FIM score may influence the independence of activities of daily living after 1 month in the recovery of patients with stroke with Pusher and unilateral spatial neglect.

Efficacy of sitting balance training with delayed visual feedback among patients with stroke: a randomized crossover clinical trial.

[Purpose] This study aimed to determine the effect of delayed visual feedback on the center of pressure and sitting balance in patients with stroke. [Participants and Methods] This was a single-blinded, randomized crossover trial. The duration of each intervention in real-time visual feedback and delayed visual feedback conditions while sitting on the platform was five days. We measured the center of pressure, function in sitting test, and functional independence measure for physiotherapy assessment. [Results] Twenty patients with stroke were included in this study. The delayed visual feedback condition improved the center of pressure for lateral distance, function in sitting test, and functional independence measure. The lateral center of pressure deviation increased significantly after 500 ms of intervention. The function in sitting test evaluated the interaction between pre- and post-training, and these conditions revealed that timing and condition factors contributed to the improvement. Sitting balance training affected the functional independence measure. [Conclusion] Sensory-motor and cognitive learning was facilitated through balance training with delayed visual feedback, and the internal model was updated with the efference copy of error correction. Sensory-motor feedback to visual stimulation can improve postural control, balance, and activities of daily living.

Efficacy of lateral truncal tilt training with a wedge on postural vertical and activities of daily living in recovery phase after stroke: A randomized crossover trial.

BACKGROUND: The subjective postural vertical (SPV) is affected by training that requires participants to maintain balance; training to achieve sitting balance may also help SPV recovery and activities of daily living (ADLs). OBJECTIVE: This study aimed to assess the medium-term effects of balance training on the postural vertical (PV) and ADLs in patients with stroke. METHODS: Thirty-three patients with stroke were enrolled in this randomized crossover trial. The outcomes were SPV, SPV with eyes opened (SPV-EO), and the Functional Independent Measure (FIM) after the 14-day intervention of experimental or control training. Experimental training consisted of a maximum lateral truncal tilt to the paretic side at 0.25 Hz with or without a 10° wedge, repeated 60 times. Repeated-measures two-way analysis of variance was performed with two factors: intervention and the intervention period. RESULTS: There was no interaction between the control condition and the PV, but there was interaction between the intervention period and using a wedge for SPV variability errors. FIM showed an interaction between the intervention period and the use of a wedge. CONCLUSIONS: Balance training while sitting with a wedge significantly improved the SPV and FIM. This improved cognition and perception, which facilitate difficult dynamic tasks in ADLs.

[Effectiveness of Kampo medicine Gorei-San for chronic subdural hematoma].

Chronic subdural hematomas (CSDHs) are basically treated by surgery. In some cases with no or minimum symptoms, however, they may be treated conservatively. In the present study, we evaluated the therapeutic effect of a Kampo medicine (Japanese traditional herbal medicine), Gorei-san, in the treatment of those CSDHs. Gorei-san 7.5 g t.i.d. was orally administered for 4 weeks in 22 patients with 27 CSDHs. Maximum thickness of the hematoma was followed up on CT scan for 4 to 29 weeks after administration of Gorei-san. In 7 of 22 patients, tranexamic acid and/or carbazochrome sodium sulfonate were also administrated. Gorei-san was effective in 23 of 27 CSDHs. In 12 of them, the hematoma was completely disappeared within 14 weeks after administration. In the other 11 CSDHs, the thickness was decreased. In those effective cases, thickness began to decrease 3 to 4 weeks after administration of Gorei-san. It was more effective in CSDHs with iso-/high or mixed density than with low density on CT. It was not effective in 4 out of 27 CSDHs. No apparent adverse effect was noted in the present series of patients. The present study suggests that a Kampo medicine, Gorei-san, is a useful option in the conservative treatment of CSDHs with no or minimum symptoms.

Angiogenesis of glioma: evaluation of ultrastructural characteristics of microvessels and tubular bodies (Weibel-Palade) in endothelial cells and immunohistochemical findings with VEGF and p53 protein.

Capillary endothelial proliferation is often a prominent feature of malignant gliomas. The understanding of structural and functional characteristics of the vascular microenvironment in gliomas is essential for the design of future therapeutic strategies against this tumor. Electron microscopic analysis of the capillary endothelial proliferation in malignant gliomas indicated that the complex vascular structures within the tumor were composed essentially of immature capillaries. Immature capillaries had a narrow slitlike lumen composed of endothelial cells with their high nuclear : cytoplasmic ratio and the relative paucity of organelles. They resembled capillary buds seen in normal repair tissue. Immature microvessels caused by angiogenesis were found more frequently in marginal zone of the tumors with increased microvessels. The tubular body was an organelle observed in vascular endothelial cells and was used frequently as a marker of the endothelial cell. Tubular bodies were evaluated by quantitative measurement of the mean percent (%) ratio of the number of endothelial cells with tubular bodies to all endothelial cells in microvessels of tumors. In glioblastomas it yielded a value of 32.4% in the margin, about two times as high as that in the center of the tumors. However, it was lower in all locations of astrocytomas. Tubular bodies in endothelial cells could be increased in proportion to neovascularization, and they might serve as a marker for increasing microvessels in astrocytic tumors. Tumor angiogenesis may be regulated by growth factors with angiogenic activities that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) may play a critical role in the regulation of vascular endothelial proliferation. We found that 86% of 29 glioblastomas and 79% of 14 anaplastic astrocytomas demonstrated immunoreactivity for VEGF in their tumor cells. There tended to be a correlation between VEGF and vascularity. A correlation existed between the grade of immunoreactivity for VEGF and the grade of p53 protein expression in the malignant gliomas. However, the MIB-1 indices did not increase in correlation with increase in the extent of immunoreactivity for VEGF.

Long-term prognosis of hemangioblastomas of the central nervous system: clinical and immunohistochemical study in relation to recurrence.

The long-term prognosis and immunohistochemical findings for the expression of VEGF (vascular endothelial growth factor), p53 protein, and proliferative potential with MIB-1 were evaluated in six patients with VHL (von Hippel-Lindau) disease and seven patients with sporadic hemangioblastomas in relation to recurrent or new central nervous system (CNS) hemangioblastomas following treatment. Sporadic CNS hemangioblastomas were treated by total removal, and they demonstrated a good long-term prognosis without neurological deficits and no recurrence. However, even if total removal of the CNS hemangioblastomas in patients with VHL disease was performed initially, new lesions, consisting of small multiple hemangioblastomas, recurred in areas remote from the primary region in three of four patients during long-term follow-up. Such newly developed hemangioblastomas in patients with VHL disease could reflect the biological multipotentiality of CNS hemangioblastomas that were not detected during the initial operation. All of the hemangioblastomas displayed extensive overexpression of VEGF protein. The immunohistochemical findings for VEGF protein, p53 protein, and MIB-1 did not differ significantly between the sporadic and VHL disease-associated hemangioblastomas. In conclusion, since patients with VHL disease are at risk of developing new lesions, the management of hemangioblastomas in patients with VHL disease represents a more prolonged and difficult task.

[Improvement of host-immunity by adjuvant therapy with juzen-taiho-to for patients with brain tumors].

T cell subset, natural killer (NK) cell activity and tumor necrosis factor alpha (TNF-alpha) productivity of lymphocytes in the peripheral blood were investigated in order to study host-immunity before and after administration of Juzentaiho-to (TJ-48) with or without Interferon-beta (INF-beta) for 29 patients with brain tumors (15 cases of gliomas and 14 cases of non-glial tumors). "A" group was given TJ-48 (7.5 g/day, p.o.) with INF-beta 300 million IU/1-2 weeks after initial treatment, and "B" group was treated by only TJ-48. % values of helper T cells (CD4+, CD45RA-), cytotoxic T cells (CD8+, 11b-), suppressor T cells (CD8+ +. 11b+) and NK activity were calculated with two color flowcytometry before and at 1 month, 2 months and 3 months after the administration of TJ-48. TNF-alpha productivity of lymphocytes was examined by the ELISA method at the same time. Suppressor T cells decreased significantly after 2 months following administration of JT-48 in 16 of 17 cases in both A and B group. After administration of TJ-48, helper T cells tended to increase slightly, but cytotoxic T cells and NK activity did not change. TNF-alpha productivity was measured in 8 cases of gliomas and increased to levels higher than they were before administration of TJ-48 in all of the cases which were examined more than 2 months after treatment. Adjuvant therapy with TJ-48 in both A and B group improved the host-immunity of the patients with brain tumors. It was concluded that it was useful as an assistant treatment for brain tumors.

An ultrastructural and immunohistochemical study of olfactory neuroepithelioma with rhabdomyoblasts.

A rare case of olfactory neuroepithelioma with rhabdomyoblasts in a 61-year-old man was investigated using electron microscopic and immunohistochemical methods. A large tumor enhanced by gadolinium-diethylenetriamine pentaacetic acid (DTPA) was demonstrated on magnetic resonance imaging (MRI), located within the anterior cranial fossa without bone destruction. The tumor mostly consisted of small cells with scant cytoplasm. Tubular rosettes were often found. Immunoreactivity for cytokeratin and epithelial membrane antigen (EMA) was strongly positive. Most of the tumor cells were shown to be positive for neuron-specific enolase (NSE) and vimentin and weakly positive for synaptophysin and S-100. Rhabdomyoblasts, which showed oval cells with abundant eosinophilic cytoplasm and a nucleus sometimes displaced toward the periphery of the cell body, were frequently intermingled with the tumor cells. The immunoreactivity for myoglobin was frequently positive in these oval cells. The MIB-1 index showed high values, of 20%-40%. About 10% of the tumor cells revealed positivity for p53 protein and vascular endothelial growth factor (VEGF). Ultra-structurally, numerous junctional complexes were observed between cell bodies and processes. The cell processes frequently contained numerous microtubules. There were sometimes numerous filaments with small aggregates of Z-band material and thick filament-ribosomal complexes in the oval cells. They were concluded to be consistent with rhabdomyoblasts on light microscopic and immunohistochemical findings.