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1.
Bragança; s.n; 20210000. tab, ilus.
Tese em Português | BDENF - Enfermagem | ID: biblio-1281601

RESUMO

A desnutrição associada à doença é um grave problema que pode influenciar o prognóstico, aumentar os tempos de internamento, os custos e os resultados em saúde. No doente vítima de AVC, onde são frequentes as alterações do estado de consciência, a presença de disfagia orofaríngea e outras comorbidades, as consequências clínicas da desnutrição poderão afetar os processos de reabilitação e a funcionalidade. Objetivos: O presente estudo teve como objetivo principal avaliar o o risco nutricional em doentes com AVC, aquando da admissão no internamento e aos três meses após a alta hospitalar, e procurar associações entre o estado nutricional e outras variáveis referentes ao estado funcional. Métodos: Foram avaliados 70 doentes ingressados consecutivamente numa Unidade de AVC, na admissão, alta e 3 meses após a alta. Do formulário faziam parte variáveis sociodemográficas e clínicas. Nos 3 momentos de avaliação foi aplicada a Mini Avaliação Nutricional (MNA) para aferir o estado nutricional e a Escala de Rankin Modificada (ERM) e Índice de Barthel (IB) para avaliação da funcionalidade. Resultados: Dos doentes avaliados (76,1±11,2 anos) (80%) apresentavam AVC isquémico e 20% AVC hemorrágico. Os dados relativos ao estado funcional (ERM, IB) e ao estado nutricional (MNA) variaram significativamente de acordo com os vários momentos de avaliação (p<0,05). Observou-se uma correlação entre o estado nutricional e a funcionalidade em todos os momentos de avaliação (p< 0,05). Conclusão: Pela análise estatística realizada conclui-se que um bom estado nutricional prognostica uma melhor funcionalidade, analisando esta última variável quer através da ERM quer através do IB.


Malnutrition associated with the disease is a serious problem that can influence the prognosis, increase hospitalization times, costs and health outcomes. In a stroke victim, where changes in the state of consciousness are frequent, the presence of oropharyngeal dysphagia and other comorbidities, the clinical consequences of malnutrition may affect the rehabilitation processes and functionality. Aim: The main objective of this study was to assess the nutritional risk in stroke patients, upon admission to hospital and three months after hospital discharge, and to look for associations between nutritional status and other variables related to functional status. Methods: Seventy patients admitted consecutively to a stroke unit were evaluated on admission, discharge and 3 months after discharge. The form included sociodemographic and clinical variables. In the 3 assessment moments, the Mini Nutritional Assessment (MNA) was applied to assess the nutritional status and the Modified Rankin Scale (mRS) and Barthel Index (BI) to assess functionality. Results: Of the patients evaluated (76.1 ± 11.2 years) 80% had ischemic stroke and 20% hemorrhagic stroke. The data related to functional status (mRS, BI) and nutritional status (MNA) varied significantly according to the various moments of assessment (p <0.05). There was a correlation between nutritional status and functionality at all times of assessment (p <0.05). Conclusion: From the statistical analysis performed, we concluded that a good nutritional status predicts a better functionality, analyzing this last variable either through the mRS or through the BI.


Assuntos
Humanos , Idoso , Repertório de Barthel , Acidente Vascular Cerebral , AVC Isquêmico , AVC Hemorrágico , Deficiência de Proteína , Atividades Cotidianas
2.
Artigo em Russo | MEDLINE | ID: mdl-34223749

RESUMO

Ischemic stroke (IS) is a serious medical and social problem due to the widespread prevalence, profound and long-term disability of patients. The effectiveness of pharmaceutical neuroprotection in IS remains low which necessitates the investigation of new therapeutic methods in post-stroke patients. OBJECTIVE: The rationale for the use of infrared (IR) radiation with terahertz (THz) modulation in the complex treatment of patients in the acute period of IS. MATERIAL AND METHODS: The results of transcranial application of IR radiation with THz modulation in 112 patients in the acute period of IS are presented. In the main group (38 patients) the infrared radiation with THz modulation was used on the projection of the IS focus in addition to basic drug therapy; in the control group (37 patients) - basic drug therapy; in the placebo group (37 patients) the physiotherapy was mimicked. The data of neurological status and neuro-functional indicators were assessed using the NIHSS, MMSE, Rankin, and Rivermid scales. Cerebral blood flow was examined using duplex scanning of brachiocephalic vessels. RESULTS: The inclusion in the complex treatment of IR radiation with THz modulation on the projection of the IS focus in the acute period contributed to a significant regression of neurological deficit, a complete recovery of cognitive functions and an increase in daily activity due to the restoration of adequate blood supply on the side of the affected hemisphere. CONCLUSION: A pathogenesis justified method of treating acute IS is proposed which can increase the effectiveness of early neurorehabilitation measures. An early improvement in cerebral hemoperfusion led to the creation of optimal conditions for the survival of neural structures and the preservation of their functional activity that demonstrated the neuroprotective feasibility of early inclusion of IR radiation with THz modulation in the complex treatment of patients in the acute period of IS.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Atividades Cotidianas , Cognição , Humanos
3.
Zhonghua Yi Xue Za Zhi ; 101(25): 1968-1972, 2021 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-34225417

RESUMO

Objective: To investigate the impact of ultrasound-guided lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks on the outcomes of elderly acute cerebral infarction patients with femoral neck fracture who underwent hip replacement. Methods: The clinical data of 114 elderly acute cerebral infarction patients with femoral neck fracture and underwent artificial hip replacement surgery from May 2013 to September 2018 in Renmin Hospital of Wuhan University were retrospectively analyzed. The patients were divided into two groups based on the different anesthetic methods they received: general anesthesia (G group, n=48), lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks (N group, n=66). The operation time, anesthesia time, blood loss, urine volume, norepinephrine dose, length of intensive care unit (ICU) stay, hospital mortality and postoperative 6-month mortality were observed and compared between the two groups. The mini-mental state examination (MMSE) scores and the national institute of health stroke scale (NIHSS) scores were evaluated, respectively. Meanwhile, plasma D-Dimer and S100ß levels were measured 1 d before surgery, 3 d and 7 d after surgery. Results: There were no significant differences in the baseline characteristics, operation time, anesthesia time, blood loss and length of ICU stay between the two groups (all P>0.05). Compared with group G, the dosage of norepinephrine [(86±23) µg vs (184±28) µg], hospital mortality [7.6% (5/66) vs 25.0% (12/48)] and postoperative 6-month mortality [12.1% (8/66) vs 31.3% (15/48)] were significantly decreased in group N, while the urine volume [(265±58) ml vs (160±55) ml] was significantly increased (all P<0.01). The MMSE scores (9.9±3.0 vs 14.6±2.4) in group N were significantly higher than those in the group G 3 d after surgery, while the NIHSS scores (15.3±3.2 vs 9.9±3.5), plasma D-Dimer [(10.8±2.5) mg/L vs (7.3±2.2) mg/L] and S100ß levels [(326±35) ng/L vs (276±29) ng/L] were significantly lower than those in group G (all P<0.01). Conclusion: Combined nerve blocks can reduce the mortality of acute cerebral infarction patients undergoing hip replacement surgery, and improve the brain function and prognosis of the patients.


Assuntos
Artroplastia de Quadril , Bloqueio Nervoso , Acidente Vascular Cerebral , Idoso , Infarto Cerebral , Humanos , Estudos Retrospectivos
4.
Medicina (Kaunas) ; 57(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207100

RESUMO

Background and Objectives: A hospital-based stroke registry is a useful tool for systematic analyses of the epidemiology, clinical characteristics, and natural course of stroke. Analyses of stroke registry data can provide information that can be used by health services to improve the quality of care for patients with this disease. Materials and Methods: Data were collected from the Riga East University Hospital (REUH) Stroke Registry in order to evaluate the etiology, risk factors, clinical manifestations, treatment, functional outcomes, and other relevant data for acute stroke during the period 2016-2020. Results: During a five-year period, 4915 patients (3039 females and 1876 males) with acute stroke were registered in the REUH Stroke Registry. The causative factors of stroke were cardioembolism (45.7%), atherosclerosis (29.9%), lacunar stroke (5.3%), stroke of undetermined etiology (1.2%), and stroke of other determined causes (1.2%). The most frequent localizations of intracerebral hemorrhage were subcortical (40.0%), lobar (18.9%), and brainstem (9.3%). The most prevalent risk factors for stroke were hypertension (88.8%), congestive heart failure (71.2%), dyslipidemia (46.7%), and atrial fibrillation (44.2%). In addition, 1018 (20.7%) patients were receiving antiplatelet drugs, 574 (11.7%) were taking statins, and 382 (7.7%) were taking anticoagulants. At discharge, 35.5% of the patients were completely independent (mRS (modified Rankin Scale) score: 0-2), while 49.5% required some form of assistance (mRS score: 3-5). The intrahospital mortality rate was 13.7%, although it was higher in the hemorrhage group (30.9%). Conclusions: Our stroke registry data are comparable to those of other major registries. Analysis of stroke registry data is important for improving stroke care and obtaining additional information for stroke studies.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Hemorragia Cerebral/epidemiologia , Feminino , Hospitais , Humanos , Masculino , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
5.
Molecules ; 26(13)2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34203368

RESUMO

CD47 is a receptor belonging to the immunoglobulin (Ig) superfamily and broadly expressed on cell membranes. Through interactions with ligands such as SIRPα, TSP-1, integrins, and SH2-domain bearing protein tyrosine phosphatase substrate-1 (SHPS-1), CD47 regulates numerous functions like cell adhesion, proliferation, apoptosis, migration, homeostasis, and the immune system. In this aspect, previous research has shown that CD47 modulates phagocytosis via macrophages, the transmigration of neutrophils, and the activation of T-cells, dendritic cells, and B-cells. Moreover, several studies have reported the increased expression of the CD47 receptor in a variety of diseases, including acute lymphoblastic leukemia (ALL), chronic myeloid leukemia, non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), bladder cancer, acute myeloid leukemia (AML), Gaucher disease, Multiple Sclerosis and stroke among others. The ubiquitous expression of the CD47 cell receptor on most resident cells of the CNS has previously been established through different methodologies. However, there is little information concerning its precise functions in the development of different neurodegenerative pathologies in the CNS. Consequently, further research pertaining to the specific functions and roles of CD47 and SIRP is required prior to its exploitation as a druggable approach for the targeting of various neurodegenerative diseases that affect the human population. The present review attempts to summarize the role of both CD47 and SIRP and their therapeutic potential in neurodegenerative disorders.


Assuntos
Encéfalo/metabolismo , Antígeno CD47/metabolismo , Doença de Gaucher/metabolismo , Esclerose Múltipla/metabolismo , Acidente Vascular Cerebral/metabolismo , Animais , Humanos , Inflamação/metabolismo
6.
Am J Case Rep ; 22: e931109, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34252070

RESUMO

BACKGROUND Embolic stroke of undetermined source (ESUS) represents 20-30% of ischemic strokes, with a high risk of recurrence. It usually requires an extensive diagnostic evaluation to address the potential etiologies. Coronary artery anomaly (CAA) of the left anterior descending artery (LAD) is uncommon, and it is known to be linked to myocardial complications. The association of this anomaly with ischemic strokes has not been reported yet. Here, we report on a rare case of a young patient with hypoplastic LAD complicated by an impaired ventricular function that resulted in left ventricular (LV) thrombus formation as a source of recurrent ischemic strokes. CASE REPORT A 36-year-old man had a 4-year history of recurrent strokes despite maintaining antiplatelet treatment. He had no pre-existing vascular risk factors or relevant family history. The initial stroke etiology work-up was inconclusive. A transesophageal echocardiogram showed moderate ventricular hypokinesia. A coronary angiogram was initiated, and a hypoplastic (LAD) artery anomaly was found. At first, the antiplatelet therapy was maintained. Later on, he presented with transient focal neurological symptoms indicative of a transient ischemic attack. Repeated echocardiograms detected left ventricular thrombus. Apixaban was started, with successful thrombus resolution in a one-month follow-up echocardiogram. He has not had a further recurrent ischemic event for 18 months. CONCLUSIONS This case suggests that CAAs might be considered as an associated etiology of ESUS in a young patient with recurrent cerebral events. In a clinical setting, we encourage early use of advanced cerebral and cardiac imaging modalities to accurately determine the stroke etiology, target the appropriate treatment, and prevent a further neurological sequel.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Isquemia Encefálica/etiologia , Vasos Coronários , Ecocardiografia , Humanos , Masculino , Acidente Vascular Cerebral/etiologia
7.
Biochemistry (Mosc) ; 86(6): 657-666, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34225589

RESUMO

Ischemic brain injuries are accompanied by the long-term changes in gene expression in the hippocampus, the limbic system structure, involved in the regulation of key aspects of the higher nervous activity, such as cognitive functions and emotions. The altered expression of genes and proteins encoded by them may be related to the development of post-ischemic psycho-emotional and cognitive disturbances. Activation of neuroinflammation following stroke in the hippocampus has been suggested to play an essential role in induction of long-lasting consequences. Identification of changes in the gene expression patterns after ischemia and investigation of the dynamics of these changes in the hippocampus are the necessary first steps toward understanding molecular pathways responsible for the development of post-stroke cognitive impairments and mental pathologies.


Assuntos
Isquemia Encefálica/genética , Transtornos Cognitivos/etiologia , Hipocampo/metabolismo , Transtornos Mentais/etiologia , Acidente Vascular Cerebral/genética , Animais , Lesões Encefálicas , Isquemia Encefálica/complicações , Isquemia Encefálica/metabolismo , Cognição , Depressão/etiologia , Regulação da Expressão Gênica , Humanos , Inflamação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/metabolismo
9.
Mayo Clin Proc ; 96(7): 1845-1860, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218859

RESUMO

OBJECTIVE: To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). PATIENTS AND METHODS: Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. RESULTS: A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. CONCLUSION: Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias , Implantação de Prótese/instrumentação , Acidente Vascular Cerebral , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Regras de Decisão Clínica , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Risco Ajustado/métodos , Medição de Risco/métodos , Dispositivo para Oclusão Septal , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
10.
Trials ; 22(1): 463, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281611

RESUMO

BACKGROUND: Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance. OBJECTIVE: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. METHODS: The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups. RESULTS: Data collection is currently on-going and results are expected in 2021. DISCUSSION: LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities. TRIAL REGISTRATION: www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Terapia por Exercício , Marcha , Humanos , Extremidade Inferior , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
11.
Artigo em Russo | MEDLINE | ID: mdl-34283527

RESUMO

OBJECTIVE: To develop a method for early (24 hrs after intervention) prognosis of functional outcome at discharge in patients after endovascular thrombectomy (EVT) in anterior cerebral circulation based on NIHSS. MATERIAL AND METHODS: A retrospective analysis of endovascular treatment in 362 acute stroke patients (189 men, 173 women, median age 69 years) with anterior circulation large vessel occlusion was performed in the regional vascular centers of St. Petersburg. RESULTS: The original scale (S10-10) developed for prognosis of functional outcome at discharge is based on total scores on 3 patterns: NIHSS 24 hrs after EVT (10 and less - 1, greater than 10 - 2), NIHSS improvement 24 hrs (greater than 10 - 0, 1-10 - 1, 0 and less - 2), older than 78 yr - 1. According to the total score, 5 grades are determined: 1 (good, mRs 0-2 75%, mRs 3-5 25%, mRs 6 0%), 2 (favorable, mRs 0-2 66%, mRs 3-5 26%, mRs 6 8%), 3 (unfavorable, mRs 0-2 14%, mRs 3-5 68%, mRs 6 18%), 4 (unfavorable with high mortality, mRs 0-2 1%, mRs 3-5 52%, mRs 6 47%), 5 (highly negative, mRs 0-2 0%, mRs 3-5 16%, mRs 6 84%). S10-10 greater than 2 indicates unfavorable prognosis. The scale allows accurate prognosis of functional outcome at discharge (AUC 0.89; AUC 0.84 in a validation cohort) and length of in-patient staying and time to death for S10-10 greater than 2. CONCLUSION: Accurate prognosis of functional outcome at discharge can be done 24 hrs after EVT in anterior cerebral circulation based on the widely used neurological scale (NIHSS) taking into account patient age.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Artéria Carótida Primitiva , Feminino , Humanos , Masculino , Alta do Paciente , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
12.
Curr Protoc ; 1(7): e197, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34286918

RESUMO

Studying and quantifying the mechanics of blood clots is essential to better diagnosis and prognosis of, as well as therapy for, thromboembolic pathologies such as strokes, heart attacks, and pulmonary embolisms. Unfortunately, mechanically testing blood clots is complicated by their softness and fragility, thus making the use of classic mounting techniques, such as clamping, challenging. This is particularly true for mechanical testing under large deformation. Here, we describe protocols for creating in vitro blood clots and securely mounting these samples on mechanical test equipment. To this end, we line 3D-printed molds with a hook-and-loop fabric that, after coagulation, provides a secure interface between the sample and device mount. In summary, our molding and mounting protocols are ideal for performing large-deformation mechanical testing, with samples that can withstand substantial deformation without delaminating from the apparatus. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Cube-shaped blood clot preparation Basic Protocol 2: Sheet-shaped blood clot preparation.


Assuntos
Acidente Vascular Cerebral , Tromboembolia , Trombose , Coagulação Sanguínea , Humanos , Testes Mecânicos , Trombose/diagnóstico
13.
Artigo em Inglês | MEDLINE | ID: mdl-34205457

RESUMO

BACKGROUND: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Terapia por Exercício , Marcha , Humanos , Estudos Multicêntricos como Assunto , Equilíbrio Postural , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Postura Sentada , Resultado do Tratamento
14.
Int J Mol Sci ; 22(13)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206635

RESUMO

White matter tract (WMT) degeneration has been reported to occur following a stroke, and it is associated with post-stroke functional disturbances. White matter pathology has been suggested to be an independent predictor of post-stroke recovery. However, the factors that influence WMT remodeling are poorly understood. Cortisol is a steroid hormone released in response to prolonged stress, and elevated levels of cortisol have been reported to interfere with brain recovery. The objective of this study was to investigate the influence of corticosterone (CORT; the rodent equivalent of cortisol) on WMT structure post-stroke. Photothrombotic stroke (or sham surgery) was induced in 8-week-old male C57BL/6 mice. At 72 h, mice were exposed to standard drinking water ± CORT (100 µg/mL). After two weeks of CORT administration, mice were euthanised and brain tissue collected for histological and biochemical analysis of WMT (particularly the corpus callosum and corticospinal tract). CORT administration was associated with increased tissue loss within the ipsilateral hemisphere, and modest and inconsistent WMT reorganization. Further, a structural and molecular analysis of the WMT components suggested that CORT exerted effects over axons and glial cells. Our findings highlight that CORT at stress-like levels can moderately influence the reorganization and microstructure of WMT post-stroke.


Assuntos
Corticosterona/administração & dosagem , Gliose/metabolismo , Gliose/patologia , Vias Neurais/efeitos dos fármacos , Acidente Vascular Cerebral/metabolismo , Substância Branca/efeitos dos fármacos , Substância Branca/fisiologia , Animais , Axônios/metabolismo , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/metabolismo , Corpo Caloso/patologia , Modelos Animais de Doenças , Progressão da Doença , Suscetibilidade a Doenças , Gliose/tratamento farmacológico , Gliose/etiologia , Imuno-Histoquímica , Masculino , Camundongos , Bainha de Mielina/efeitos dos fármacos , Bainha de Mielina/metabolismo , Oligodendroglia/efeitos dos fármacos , Oligodendroglia/metabolismo , Estresse Fisiológico/efeitos dos fármacos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34208689

RESUMO

Ischemic stroke is a leading cause of motor impairment and psychosocial disability. Although free fatty acids (FFA) have been proven to affect the risk of stroke and potentially dementia, the evidence of their impact on cognitive functions in stroke patients is lacking. We aimed to establish such potential relationships. Seventy-two ischemic stroke patients were prospectively analysed. Their cognitive functions were assessed seven days post-stroke and six months later as follow-up (n = 41). Seven days post-stroke analysis of serum FFAs levels showed direct correlations between Cognitive Verbal Learning Test (CVLT) and the following FFAs: C20:4n6 arachidonic acid and C20:5n3 eicosapentaenoic acid, while negative correlations were observed for C18:3n3 linolenic acid (ALA), C18:4 n3 stearidonic acid and C23:0 tricosanoic acid. Follow-up examination with CVLT revealed positive correlations with C15:0 pentadecanoid acid, C18:3n6 gamma linoleic acid, SDA, C23:0 tricosanoic acid and negative correlations with C14:0 myristic acid and C14:1 myristolenic acids. Several tests (Trail Making Test, Stroop Dots Trail, Digit Span Test and Verbal Fluency Test) were directly correlated mainly with C14:0 myristic acid and C14:1 myristolenic acid, while corresponding negatively with C18:1 vaccinic acid, C20:3n3 cis-11-eicosatrienoic acid, C22:1/C20:1 cis11- eicosanic acid and C20:2 cis-11-eicodienoic acid. No correlations between Montreal Cognitive Assessment (MOCA) test performed on seventh day, and FFAs levels were found. Saturated fatty acids play a negative role in long-term cognitive outcomes in stroke patients. The metabolic cascade of polyunsaturated fatty acids (n3 PUFA) and the synthesis of (AA) can be involved in pathogenesis of stroke-related cognitive impairment.


Assuntos
Ácidos Graxos não Esterificados , Acidente Vascular Cerebral , Cognição , Ácidos Graxos , Humanos , Sobreviventes
16.
BMJ Case Rep ; 14(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210690

RESUMO

A 76-year-old Korean woman presented with intermittent episodes of exertional hypoxia at the rehabilitation facility after a recent admission for ischaemic stroke. Clinical and diagnostic investigation confirmed the presence of platypnea-orthodeoxia syndrome (POS). Transoesophageal echocardiogram revealed a patent foramen ovale and hyperdynamic interatrial septum with right-to-left intracardiac shunt. Further diagnostic workup did not reveal right atrial hypertension, cirrhosis, pulmonary hypertension or any other extracardiac causes of right-to-left shunt. Positional preferential blood flow from inferior vena cava to the left atrium due to counterclockwise displacement of interatrial septum with age and posture was postulated to explain the atrial right-to-left shunt and the resultant POS. Closure was performed using a cribriform amplatzer occluder which improved her symptoms.


Assuntos
Isquemia Encefálica , Forame Oval Patente , Aneurisma Cardíaco , Comunicação Interatrial , Acidente Vascular Cerebral , Idoso , Pressão Atrial , Dispneia/etiologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Hipóxia/etiologia
17.
BMJ Case Rep ; 14(7)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230048

RESUMO

Central pain after stroke due to brainstem infarction is very rare. Treatment is difficult and specific guidelines are lacking. This is the report of a 61-year-old female patient who, after a posterolateral left medulla oblongata insult with incomplete Wallenberg syndrome, subsequently developed a burning and tingling pain in the contralateral leg and a burning and shooting pain in the ipsilateral face in trigeminal branches 1 and 2. More than 3 years of therapy with amitriptyline, gabapentin, pregabalin and various grade II and III opioids was ineffective or showed intolerable side effects. The administration of tetrahydrocannabinol and cannabidiol as an oromucosal spray in a 1:1 ratio improved the pain situation and quality of life quickly and permanently. The encouraging results in the present case may suggest that treatment with medical cannabis should be considered in similar cases when standard therapies are insufficient.


Assuntos
Canabidiol , Neuralgia , Acidente Vascular Cerebral , Dronabinol , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico
18.
Sensors (Basel) ; 21(13)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34202142

RESUMO

Wrist-worn accelerometers are often applied to measure arm use after stroke. They measure arm movements during all activities, including whole-body movements, such as walking. Whole-body movements may influence clinimetric properties of arm use measurements-however, this has not yet been examined. This study investigates to what extent arm use measurements with wrist-worn accelerometers are affected by whole-body movements. Assuming that arm movements during whole-body movements are non-functional, we quantify the effect of whole-body movements by comparing two methods: Arm use measured with wrist-worn accelerometers during all whole-body postures and movements (P&M method), and during sitting/standing only (sit/stand method). We have performed a longitudinal observational cohort study with measurements in 33 stroke patients during weeks 3, 12, and 26 poststroke. The P&M method shows higher daily paretic arm use outcomes than the sit/stand method (p < 0.001), the mean difference increased from 31% at week three to 41% at week 26 (p < 0.001). Differences in daily paretic arm use between methods are strongly related to daily walking time (r = 0.83-0.92). Changes in the difference between methods are strongly related to changes in daily walking time (r = 0.89). We show that not correcting arm use measurements for whole-body movements substantially increases arm use outcomes, thereby threatening the validity of arm use outcomes and measured arm use changes.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Acelerometria , Braço , Humanos , Extremidade Superior , Punho , Articulação do Punho
19.
Sensors (Basel) ; 21(13)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206540

RESUMO

The emergence of an aging society is inevitable due to the continued increases in life expectancy and decreases in birth rate. These social changes require new smart healthcare services for use in daily life, and COVID-19 has also led to a contactless trend necessitating more non-face-to-face health services. Due to the improvements that have been achieved in healthcare technologies, an increasing number of studies have attempted to predict and analyze certain diseases in advance. Research on stroke diseases is actively underway, particularly with the aging population. Stroke, which is fatal to the elderly, is a disease that requires continuous medical observation and monitoring, as its recurrence rate and mortality rate are very high. Most studies examining stroke disease to date have used MRI or CT images for simple classification. This clinical approach (imaging) is expensive and time-consuming while requiring bulky equipment. Recently, there has been increasing interest in using non-invasive measurable EEGs to compensate for these shortcomings. However, the prediction algorithms and processing procedures are both time-consuming because the raw data needs to be separated before the specific attributes can be obtained. Therefore, in this paper, we propose a new methodology that allows for the immediate application of deep learning models on raw EEG data without using the frequency properties of EEG. This proposed deep learning-based stroke disease prediction model was developed and trained with data collected from real-time EEG sensors. We implemented and compared different deep-learning models (LSTM, Bidirectional LSTM, CNN-LSTM, and CNN-Bidirectional LSTM) that are specialized in time series data classification and prediction. The experimental results confirmed that the raw EEG data, when wielded by the CNN-bidirectional LSTM model, can predict stroke with 94.0% accuracy with low FPR (6.0%) and FNR (5.7%), thus showing high confidence in our system. These experimental results demonstrate the feasibility of non-invasive methods that can easily measure brain waves alone to predict and monitor stroke diseases in real time during daily life. These findings are expected to lead to significant improvements for early stroke detection with reduced cost and discomfort compared to other measuring techniques.


Assuntos
COVID-19 , Aprendizado Profundo , Acidente Vascular Cerebral , Idoso , Humanos , Redes Neurais de Computação , SARS-CoV-2
20.
Sensors (Basel) ; 21(13)2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34208996

RESUMO

A large number of stroke survivors suffer from a significant decrease in upper extremity (UE) function, requiring rehabilitation therapy to boost recovery of UE motion. Assessing the efficacy of treatment strategies is a challenging problem in this context, and is typically accomplished by observing the performance of patients during their execution of daily activities. A more detailed assessment of UE impairment can be undertaken with a clinical bedside test, the UE Fugl-Meyer Assessment, but it fails to examine compensatory movements of functioning body segments that are used to bypass impairment. In this work, we use a graph learning method to build a visualization tool tailored to support the analysis of stroke patients. Called NE-Motion, or Network Environment for Motion Capture Data Analysis, the proposed analytic tool handles a set of time series captured by motion sensors worn by patients so as to enable visual analytic resources to identify abnormalities in movement patterns. Developed in close collaboration with domain experts, NE-Motion is capable of uncovering important phenomena, such as compensation while revealing differences between stroke patients and healthy individuals. The effectiveness of NE-Motion is shown in two case studies designed to analyze particular patients and to compare groups of subjects.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Movimento , Recuperação de Função Fisiológica , Extremidade Superior
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