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1.
Zhongguo Zhen Jiu ; 44(5): 565-8, 2024 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-38764107

RESUMO

The clinical experience of Shao's needling technique for post-stroke depression is introduced. Professor SHAO Jingming proposes that the main pathogenesis of this condition lies in the "imbalance of body and spirit," with its onset closely related to the heart, liver, spleen, and kidney. In clinical practice, based on the principle of "treating both the body and spirit", "three acupoints for treating the spirit" including Dazhui (GV 14), Fengchi (GB 20), and Baihui (GV 20) are selected, combined with back-shu points such as Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20), and Shenshu (BL 23). The nu-needle manipulation method is applied. The treatment focuses on both physical and mental aspects, achieving remarkable therapeutic effects.


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura , Depressão , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Terapia por Acupuntura/métodos , Depressão/terapia , Depressão/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso
3.
N Engl J Med ; 390(18): 1677-1689, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38718358

RESUMO

BACKGROUND: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied. METHODS: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group). The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). The primary safety outcome was death from any cause at 90 days, and an ancillary safety outcome was symptomatic intracerebral hemorrhage. RESULTS: A total of 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients); 9 were excluded from the analysis because of consent withdrawal or legal reasons. The trial was stopped early because results of similar trials favored thrombectomy. Approximately 35% of the patients received thrombolysis therapy. The median modified Rankin scale score at 90 days was 4 in the thrombectomy group and 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001). Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group and in 55.5% of those in the control group (adjusted relative risk, 0.65; 95% CI, 0.50 to 0.84), and the percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (adjusted relative risk, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group. CONCLUSIONS: In patients with acute stroke and a large infarct of unrestricted size, thrombectomy plus medical care resulted in better functional outcomes and lower mortality than medical care alone but led to a higher incidence of symptomatic intracerebral hemorrhage. (Funded by Montpellier University Hospital; LASTE ClinicalTrials.gov number, NCT03811769.).


Assuntos
Infarto da Artéria Cerebral Anterior , Acidente Vascular Cerebral , Trombectomia , Terapia Trombolítica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Hemorragia Cerebral/etiologia , Terapia Combinada , Procedimentos Endovasculares , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Infarto Encefálico/terapia , Doença Aguda , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Doenças Arteriais Cerebrais/complicações , Doenças Arteriais Cerebrais/diagnóstico por imagem , Doenças Arteriais Cerebrais/patologia , Doenças Arteriais Cerebrais/cirurgia , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/patologia , Infarto da Artéria Cerebral Anterior/cirurgia
4.
Sensors (Basel) ; 24(10)2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38793907

RESUMO

(1) Background: This study evaluates the effectiveness of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in improving gait in post-stroke hemiplegic patients, using wearable sensor technology for objective gait analysis. (2) Methods: A total of 72 stroke patients were randomized into control, sham stimulation, and LF-rTMS groups, with all receiving standard medical treatment. The LF-rTMS group underwent stimulation on the unaffected hemisphere for 6 weeks. Key metrics including the Fugl-Meyer Assessment Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and gait parameters were measured before and after treatment. (3) Results: The LF-rTMS group showed significant improvements in the FMA-LE, BBS, MBI, and various gait parameters compared to the control and sham groups (p < 0.05). Specifically, the FMA-LE scores improved by an average of 5 points (from 15 ± 3 to 20 ± 2), the BBS scores increased by 8 points (from 35 ± 5 to 43 ± 4), the MBI scores rose by 10 points (from 50 ± 8 to 60 ± 7), and notable enhancements in gait parameters were observed: the gait cycle time was reduced from 2.05 ± 0.51 s to 1.02 ± 0.11 s, the stride length increased from 0.56 ± 0.04 m to 0.97 ± 0.08 m, and the walking speed improved from 35.95 ± 7.14 cm/s to 75.03 ± 11.36 cm/s (all p < 0.001). No adverse events were reported. The control and sham groups exhibited improvements but were not as significant. (4) Conclusions: LF-rTMS on the unaffected hemisphere significantly enhances lower-limb function, balance, and daily living activities in subacute stroke patients, with the gait parameters showing a notable improvement. Wearable sensor technology proves effective in providing detailed, objective gait analysis, offering valuable insights for clinical applications in stroke rehabilitation.


Assuntos
Marcha , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Magnética Transcraniana , Dispositivos Eletrônicos Vestíveis , Humanos , Masculino , Feminino , Estimulação Magnética Transcraniana/métodos , Estimulação Magnética Transcraniana/instrumentação , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Marcha/fisiologia , Idoso , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Análise da Marcha/métodos
5.
Patient Educ Couns ; 125: 108308, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38705023

RESUMO

PURPOSE: To synthesize the available evidence on factors associated with self-management behavior in young stroke patients. METHODS: The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research. RESULTS: Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support). CONCLUSION: Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management). PRACTICE IMPLICATIONS: Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.


Assuntos
Autogestão , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral , Autocuidado , Autoeficácia , Adulto , Apoio Social , Adulto Jovem , Qualidade de Vida , Feminino , Masculino
6.
Stroke ; 55(6): 1689-1698, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38738376

RESUMO

The Get With The Guidelines-Stroke program which, began 20 years ago, is one of the largest and most important nationally representative disease registries in the United States. Its importance to the stroke community can be gauged by its sustained growth and widespread dissemination of findings that demonstrate sustained increases in both the quality of care and patient outcomes over time. The objectives of this narrative review are to provide a brief history of Get With The Guidelines-Stroke, summarize its major successes and impact, and highlight lessons learned. Looking to the next 20 years, we discuss potential challenges and opportunities for the program.


Assuntos
Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Estados Unidos , Guias de Prática Clínica como Assunto/normas , Sistema de Registros , História do Século XXI , História do Século XX
7.
Int J Mol Sci ; 25(10)2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38791605

RESUMO

MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate gene expression by binding to target messenger RNAs (mRNAs). miRNAs have been implicated in a variety of cardiovascular and neurological diseases, such as myocardial infarction, cardiomyopathies of various geneses, rhythmological diseases, neurodegenerative illnesses and strokes. Numerous studies have focused on the expression of miRNA patterns with respect to atrial fibrillation (AF) or acute ischemic stroke (AIS) However, only a few studies have addressed the expression pattern of miRNAs in patients with AF and AIS in order to provide not only preventive information but also to identify therapeutic potentials. Therefore, the aim of this review is to summarize 18 existing manuscripts that have dealt with this combined topic of AF and associated AIS in detail and to shed light on the most frequently mentioned miRNAs-1, -19, -21, -145 and -146 with regard to their molecular mechanisms and targets on both the heart and the brain. From this, possible diagnostic and therapeutic consequences for the future could be derived.


Assuntos
Fibrilação Atrial , Biomarcadores , MicroRNAs , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/genética , Fibrilação Atrial/terapia , Fibrilação Atrial/metabolismo , MicroRNAs/genética , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/terapia , Regulação da Expressão Gênica , Animais
8.
Stroke ; 55(6): 1507-1516, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38787926

RESUMO

BACKGROUND: Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability. METHODS: We studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0. RESULTS: Of 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1: 60 minutes, Q3: 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https://harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]). CONCLUSIONS: This map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times.


Assuntos
Serviços Médicos de Emergência , Sistema de Registros , Tempo para o Tratamento , Humanos , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/epidemiologia , AVC Isquêmico/terapia , AVC Isquêmico/epidemiologia , Estados Unidos/epidemiologia
9.
Stroke ; 55(6): 1489-1497, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38787927

RESUMO

BACKGROUND: Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions. METHODS: This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0-2) and excellent (mRS score, 0-1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality. RESULTS: A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95-1.64]; P=0.110), rates of good (mRS score, 0-2; aOR, 1.32 [95% CI, 0.97-1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94-1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78-1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21-1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24-0.85]; P=0.013) in the EVT group. CONCLUSIONS: This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.


Assuntos
Procedimentos Endovasculares , Humanos , Masculino , Feminino , Procedimentos Endovasculares/métodos , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Idoso de 80 Anos ou mais , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/cirurgia , Terapia Trombolítica/métodos , Infarto da Artéria Cerebral Média/cirurgia , AVC Isquêmico/cirurgia , AVC Isquêmico/terapia
11.
Stroke ; 55(6): 1467, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38787928
12.
BMC Med ; 22(1): 198, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750449

RESUMO

BACKGROUND: In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit. MAIN TEXT: Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement. CONCLUSIONS: The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.


Assuntos
Sistema de Aprendizagem em Saúde , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Austrália , Medicina Baseada em Evidências , Prática Clínica Baseada em Evidências/métodos
13.
Cardiovasc Diabetol ; 23(1): 170, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750553

RESUMO

OBJECTIVE: Although the TyG index is a reliable predictor of insulin resistance (IR) and cardiovascular disease, its effectiveness in predicting major adverse cardiac events in hospitalized acute coronary syndrome (ACS) patients has not been validated in large-scale studies. In this study, we aimed to explore the association between the TyG index and the occurrence of MACEs during hospitalization. METHODS: We recruited ACS patients from the CCC-ACS (Improving Cardiovascular Care in China-ACS) database and calculated the TyG index using the formula ln(fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). These patients were classified into four groups based on quartiles of the TyG index. The primary endpoint was the occurrence of MACEs during hospitalization, encompassing all-cause mortality, cardiac arrest, myocardial infarction (MI), and stroke. We performed Cox proportional hazards regression analysis to clarify the correlation between the TyG index and the risk of in-hospital MACEs among patients diagnosed with ACS. Additionally, we explored this relationship across various subgroups. RESULTS: A total of 101,113 patients were ultimately included, and 2759 in-hospital MACEs were recorded, with 1554 (49.1%) cases of all-cause mortality, 601 (21.8%) cases of cardiac arrest, 251 (9.1%) cases of MI, and 353 (12.8%) cases of stroke. After adjusting for confounders, patients in TyG index quartile groups 3 and 4 showed increased risks of in-hospital MACEs compared to those in quartile group 1 [HR = 1.253, 95% CI 1.121-1.400 and HR = 1.604, 95% CI 1.437-1.791, respectively; p value for trend < 0.001], especially in patients with STEMI or renal insufficiency. Moreover, we found interactions between the TyG index and age, sex, diabetes status, renal insufficiency status, and previous PCI (all p values for interactions < 0.05). CONCLUSIONS: In patients with ACS, the TyG index was an independent predictor of in-hospital MACEs. Special vigilance should be exercised in females, elderly individuals, and patients with renal insufficiency.


Assuntos
Síndrome Coronariana Aguda , Biomarcadores , Glicemia , Bases de Dados Factuais , Valor Preditivo dos Testes , Triglicerídeos , Humanos , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , China/epidemiologia , Glicemia/metabolismo , Triglicerídeos/sangue , Biomarcadores/sangue , Medição de Risco , Fatores de Risco , Fatores de Tempo , Prognóstico , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Parada Cardíaca/sangue , Parada Cardíaca/mortalidade , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Parada Cardíaca/epidemiologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Hospitalização , Mortalidade Hospitalar
14.
J Pak Med Assoc ; 74(5): 848-851, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783428

RESUMO

OBJECTIVE: To compare the effects of core muscle strengthening exercises with and without routine physical therapy on trunk balance in chronic stroke patients. METHODS: The randomised controlled trial was conducted at Mubarak Medical Complex, Sargodha, Pakistan, from October 28, 2021, to April 28, 2022, and comprised patients of either gender with chronic stroke aged 40-60 years. The subjects were randomised using the lottery method into group A that was managed with routine physical therapy, and group B which was further managed with core strengthening exercises. The intervention comprised 4 sessions per week for 8 weeks. Outcome was measured using Trunk Impairment Scale and Time Up and Go test. Data was collected at baseline, week 4 and post-intervention. Data was analysed using SPSS 23. RESULTS: Of the 80 individuals screened, 74(92.5%) were included. There were 37(50%) patients in group A; 30(81%) males and 7(19%) females with mean age 56.73±2.37 years. The remaining 37(50%) patients were in group B; 27(73%) males and 10(27%) females with mean age 55.65±2.88 years. Trunk balance and functional mobility improved significantly post-intervention in both groups (p<0.05), but group B values were significantly better compared to group A values (p<0.05). CONCLUSIONS: Core muscle strengthening exercises combined with routine physical therapy were found to be more effective compared to routine physical therapy alone in chronic stroke patients for improving trunk balance and functional mobility. Registration Number: IRCT20211116053070N1.


Assuntos
Força Muscular , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral/métodos , Equilíbrio Postural/fisiologia , Força Muscular/fisiologia , Adulto , Treinamento Resistido/métodos , Terapia por Exercício/métodos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Modalidades de Fisioterapia , Paquistão , Tronco/fisiopatologia
15.
Cell Mol Life Sci ; 81(1): 224, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769196

RESUMO

Synaptic loss is an early event in the penumbra area after an ischemic stroke. Promoting synaptic preservation in this area would likely improve functional neurological recovery. We aimed to detect proteins involved in endogenous protection mechanisms of synapses in the penumbra after stroke and to analyse potential beneficial effects of these candidates for a prospective stroke treatment. For this, we performed Liquid Chromatography coupled to Mass Spectrometry (LC-MS)-based proteomics of synaptosomes isolated from the ipsilateral hemispheres of mice subjected to experimental stroke at different time points (24 h, 4 and 7 days) and compared them to sham-operated mice. Proteomic analyses indicated that, among the differentially expressed proteins between the two groups, cystatin C (CysC) was significantly increased at 24 h and 4 days following stroke, before returning to steady-state levels at 7 days, thus indicating a potential transient and intrinsic rescue mechanism attempt of neurons. When CysC was applied to primary neuronal cultures subjected to an in vitro model of ischemic damage, this treatment significantly improved the preservation of synaptic structures. Notably, similar effects were observed when CysC was loaded into brain-derived extracellular vesicles (BDEVs). Finally, when CysC contained in BDEVs was administered intracerebroventricularly to stroked mice, it significantly increased the expression of synaptic markers such as SNAP25, Homer-1, and NCAM in the penumbra area compared to the group supplied with empty BDEVs. Thus, we show that CysC-loaded BDEVs promote synaptic protection after ischemic damage in vitro and in vivo, opening the possibility of a therapeutic use in stroke patients.


Assuntos
Isquemia Encefálica , Encéfalo , Cistatina C , Vesículas Extracelulares , Camundongos Endogâmicos C57BL , Sinapses , Animais , Vesículas Extracelulares/metabolismo , Vesículas Extracelulares/transplante , Cistatina C/metabolismo , Sinapses/metabolismo , Camundongos , Masculino , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patologia , Encéfalo/metabolismo , Encéfalo/patologia , Proteômica/métodos , Sinaptossomos/metabolismo , Neurônios/metabolismo , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/terapia , Células Cultivadas , Modelos Animais de Doenças
16.
Int J Mol Sci ; 25(10)2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38791292

RESUMO

Acute ischemic stroke (AIS) is a challenging disease, which needs urgent comprehensive management. Endovascular thrombectomy (EVT), alone or combined with iv thrombolysis, is currently the most effective therapy for patients with acute ischemic stroke (AIS). However, only a limited number of patients are eligible for this time-sensitive treatment. Even though there is still significant room for improvement in the management of this group of patients, up until now there have been no alternative therapies approved for use in clinical practice. However, there is still hope, as clinical research with novel emerging therapies is now generating promising results. These drugs happen to stop or palliate some of the underlying molecular mechanisms involved in cerebral ischemia and secondary brain damage. The aim of this review is to provide a deep understanding of these mechanisms and the pathogenesis of AIS. Later, we will discuss the potential therapies that have already demonstrated, in preclinical or clinical studies, to improve the outcomes of patients with AIS.


Assuntos
Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , AVC Isquêmico/terapia , Animais , Trombectomia/métodos , Gerenciamento Clínico , Isquemia Encefálica/terapia , Terapia Trombolítica/métodos
17.
Sci Rep ; 14(1): 11971, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796610

RESUMO

Transcranial direct current stimulation (tDCS) exerts beneficial effects on motor recovery after stroke, presumably by enhancement of adaptive neural plasticity. However, patients with extensive damage may experience null or deleterious effects with the predominant application mode of anodal (excitatory) stimulation of the damaged hemisphere. In such cases, excitatory stimulation of the non-damaged hemisphere might be considered. Here we asked whether tDCS exerts a measurable effect on movement quality of the hemiparetic upper limb, following just a single treatment session. Such effect may inform on the hemisphere that should be excited. Using a single-blinded crossover experimental design, stroke patients and healthy control subjects were assessed before and after anodal, cathodal and sham tDCS, each provided during a single session of reaching training (repeated point-to-point hand movement on an electronic tablet). Group comparisons of endpoint kinematics at baseline-number of peaks in the speed profile (NoP; smoothness), hand-path deviations from the straight line (SLD; accuracy) and movement time (MT; speed)-disclosed greater NoP, larger SLD and longer MT in the stroke group. NoP and MT revealed an advantage for anodal compared to sham stimulation of the lesioned hemisphere. NoP and MT improvements under anodal stimulation of the non-lesioned hemisphere correlated positively with the severity of hemiparesis. Damage to specific cortical regions and white-matter tracts was associated with lower kinematic gains from tDCS. The study shows that simple descriptors of movement kinematics of the hemiparetic upper limb are sensitive enough to demonstrate gain from neuromodulation by tDCS, following just a single session of reaching training. Moreover, the results show that tDCS-related gain is affected by the severity of baseline motor impairment, and by lesion topography.


Assuntos
Braço , Movimento , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Humanos , Estimulação Transcraniana por Corrente Contínua/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fenômenos Biomecânicos , Idoso , Braço/fisiopatologia , Movimento/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Método Simples-Cego , Estudos Cross-Over
18.
Rev Esc Enferm USP ; 58: e20230339, 2024.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38801780

RESUMO

OBJECTIVE: To map home-based educational interventions for family caregivers of older adults after stroke. METHOD: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used. RESULTS: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers. CONCLUSION: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.


Assuntos
Cuidadores , Autocuidado , Acidente Vascular Cerebral , Cuidadores/educação , Humanos , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/terapia , Idoso , Autocuidado/métodos , Serviços de Assistência Domiciliar , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Ensaios Clínicos Controlados Aleatórios como Assunto , Educação em Saúde/métodos
19.
J Pak Med Assoc ; 74(4): 832-835, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38751295

RESUMO

OBJECTIVE: To assess the economic burden of acute stroke, and to determine the average cost of acute stroke care for a single hospital stay in a public tertiary care hospital. METHODS: The cross-sectional study was conducted at the Medical Teaching Institute, Bacha Khan Medical Complex, Swabi, Pakistan, from May 16 to September 19, 2022, and comprised patients of either gender who were hospitalised with an acute stroke for the first time. All costs incurred during the care of the patients were measured using the micro-costing methodology, and the association of the cost with other variables was evaluated. Data was analysed using SPSS 24. RESULTS: Of the 34 patients, 24(70.6%) were males and 10(29.4%) were females. The overall mean age was 66+/-13.00 years. The mean length of hospital stay was 4+/-3.00 days. The mean total cost was 18,156+/-9,068 Pakistani rupees, which was the equivalent of 76.89+/-38.4 United States dollars. The cost of the first day of admission was the highest, declining per day as the stay progressed, and imaging/laboratory investigations formed the highest component of the overall cost (p<0.001). CONCLUSIONS: The cost of acute stroke care was found to be high even in a public hospital. The length of hospital stay was the most important determinant of the overall cost.


Assuntos
Tempo de Internação , Acidente Vascular Cerebral , Centros de Atenção Terciária , Humanos , Feminino , Paquistão , Masculino , Centros de Atenção Terciária/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Estudos Transversais , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Custos Hospitalares/estatística & dados numéricos
20.
Stud Health Technol Inform ; 314: 58-62, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38785004

RESUMO

Stroke remains a significant global health burden, with substantial costs and morbidity associated with its occurrence. To address this challenge, STROKE 5.0 proposes a comprehensive approach to stroke care management, integrating advanced digital technologies and clinical expertise. This paper presents the rationale, design, and potential impact of the STROKE 5.0 platform, which aims to optimize stroke care delivery from pre-hospital assessment through acute hospitalization. The platform facilitates early symptom recognition, efficient emergency response, and streamlined hospital management through intelligent decision support systems. By leveraging predictive analytics and personalized care pathways, STROKE 5.0 seeks to enhance clinical outcomes while providing a platform capable of optimizing the efficiency of service delivery. This innovative model represents a proactive shift towards evidence-based, patient-centered stroke care, with implications for healthcare quality improvement and resource allocation in the digital health domain.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Prestação Integrada de Cuidados de Saúde
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