Coordination between the hands may be key to better stroke outcomes

 REALLY? You determined that higher functioning survivors with less damage recover better? Good to know how useless research is applied.

Coordination between the hands may be key to better stroke outcomes

by Stroke Foundation

Credit: Pixabay/CC0 Public Domain

We use our hands together for most of our daily tasks, but very little is known about how stroke affects the coordination of our hands. Now, new research has found that stroke affects some bimanual tasks more than others.

The University of Auckland researchers behind the study say more detailed studies of bimanual coordination could improve independence in daily activities after stroke.

The study, called "Recovery of Bimanual Coordination after Stroke," has been led by Ph.D. student Harry Jordan and is being presented at the 31st Annual Scientific Meeting of the Stroke Society of Australasia 2022.

The annual Australasian conference is this year being held at Christchurch's Te Pae Convention Center and has attracted stroke experts from around the world.

Stroke most often affects one side of the body, and the weaker hand and arm can become the focus of rehabilitation therapies.

Mr. Jordan's study developed a new way to assess how well the hands and arm works together to perform different types of bimanual tasks. The team observed 56 patients beginning one week after their stroke, until six months afterwards.

The study found that tasks involving asymmetric hand movements were more impaired by stroke than those involving symmetric hand movements. It also found that most recovery of coordination happens in first three months after stroke, but improvements continued to be seen at six months in some tasks.

Mr. Jordan says his study may offer encouragement for survivors of stroke undergoing rehabilitation in future.

"Most tasks we perform in our lives involve coordinating both hands together, but a lot of therapy after stroke focuses on one-handed tasks. A better understanding of how people recover the ability to coordinate their hands could lead to therapies that more effectively improve independence in daily activities."

Stroke is a leading cause of disability in both New Zealand and Australia, impacting almost 40,000 people across the two countries each year.

Aging, testosterone, and neuroplasticity: friend or foe?

 Ask your doctor what the full article says about using testosterone for neuroplasticity.

All this other stuff for your doctor to know about;

Well your doctor has a lot of studying to do. 

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Testosterone increases neurotoxicity of glutamate in vitro and ischemia-reperfusion injury in an animal model

 

Thinking with your gonads: testosterone and cognition

 

Effect of testosterone on functional recovery in a castrate male rat stroke model

 

Lower Testosterone Levels Predict Incident Stroke and Transient Ischemic Attack in Older Men

 

Could androgens maintain specific domains of mental health in aging men by preserving hippocampal neurogenesis?

Single-Dose Testosterone Administration Impairs Cognitive Reflection in Men

The latest here:

Aging, testosterone, and neuroplasticity: friend or foe?

Kiarash Saleki , Mohammad Banazadeh , Amene Saghazadeh and Nima Rezaei

From the journal Reviews in the Neurosciences

https://doi.org/10.1515/revneuro-2022-0033

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Abstract

Neuroplasticity or neural plasticity implicates the adaptive potential of the brain in response to extrinsic and intrinsic stimuli. The concept has been utilized in different contexts such as injury and neurological disease. Neuroplasticity mechanisms have been classified into neuroregenerative and function-restoring processes. In the context of injury, neuroplasticity has been defined in three post-injury epochs. Testosterone plays a key yet double-edged role in the regulation of several neuroplasticity alterations. Research has shown that testosterone levels are affected by numerous factors such as age, stress, surgical procedures on gonads, and pharmacological treatments. There is an ongoing debate for testosterone replacement therapy (TRT) in aging men; however, TRT is more useful in young individuals with testosterone deficit and more specific subgroups with cognitive dysfunction. Therefore, it is important to pay early attention to testosterone profile and precisely uncover its harms and benefits. In the present review, we discuss the influence of environmental factors, aging, and gender on testosterone-associated alterations in neuroplasticity, as well as the two-sided actions of testosterone in the nervous system. Finally, we provide practical insights for further study of pharmacological treatments for hormonal disorders focusing on restoring neuroplasticity.

Keywords: aging; central nervous system; neuroendocrine disorders; neuroplasticity; testosterone

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Corresponding author: Nima Rezaei, Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, 14197 33151 Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, 14176 13151 Tehran, Iran; and Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), 14197 33151 Tehran, Iran, E-mail: rezaei_nima@tums.ac.ir

Kiarash Saleki and Mohammad Banazadeh contributed equally to this work.

Home-based is as effective as centre-based rehabilitation for improving upper limb motor recovery and activity limitations after stroke: A systematic review with meta-analysis

 So it is just as ineffective in getting to 100% recovery? Survivors don't want 'improvement' they want 100% recovery! GET THERE!

Home-based is as effective as centre-based rehabilitation for improving upper limb motor recovery and activity limitations after stroke: A systematic review with meta-analysis

Show all authors

Lucas R Nascimento, Lívia Fornaciari Gaviorno, Milena de Souza Brunelli, ...

First Published August 25, 2022 Research Article 

https://doi.org/10.1177/02692155221121015

Article information

Abstract

Objective

This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke.

Data sources

AMED, MEDLINE, EMBASE CINAHL, Cochrane, PsycINFO, and PEDro databases.

Review methods

Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre-based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results

Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3–43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI −0.9 to 3.8), dexterity (MD −0.01 pegs/s; 95% CI −0.04 to 0.05), upper limb activity performance (SMD −0.04; 95% CI −0.25 to 0.18), and quality of movement (0.1 points; 95% CI −0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation.

Conclusion

Effects of home-based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke.

Keywords

Stroke, activities of daily living, meta-analysis, exercise therapy, rehabilitation

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Prediction of balance function for stroke based on EEG and fNIRS features during ankle dorsiflexion

In what multiverse do you live where predictions of failure to 100% recovery do any good at all for survivor recovery? Create protocols to solve the balance problems post stroke instead of this useless shit. 

Prediction of balance function for stroke based on EEG and fNIRS features during ankle dorsiflexion

Jun Liang^1,2†, Yanxin Song^3†, Abdelkader Nasreddine Belkacem^4*, Fengmin Li¹, Shizhong Liu¹, Xiaona Chen¹, Xinrui Wang¹, Yueyun Wang¹ and Chunxiao Wan^1*

• ¹Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China
• ²Laboratory of Neural Engineering and Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
• ³Tianjin Tianshi College, Tianjin, China
• ⁴Department of Computer and Network Engineering, College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates

Balance rehabilitation is exceedingly crucial during stroke rehabilitation and is highly related to the stroke patients’ secondary injuries (caused by falling). Stroke patients focus on walking ability rehabilitation during the early stage. Ankle dorsiflexion can activate the brain areas of stroke patients, similar to walking. The combination of electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) was a new method, providing more beneficial information. We extracted the event-related desynchronization (ERD), oxygenated hemoglobin (HBO), and Phase Synchronization Index (PSI) features during ankle dorsiflexion from EEG and fNIRS. Moreover, we established a linear regression model to predict Berg Balance Scale (BBS) values and used an eightfold cross validation to test the model. The results showed that ERD, HBO, PSI, and age were critical biomarkers in predicting BBS. ERD and HBO during ankle dorsiflexion and age were promising biomarkers for stroke motor recovery.

Introduction

Stroke is a disease affecting the arteries within the brain, resulting in motor impairment in about 80% of survivors (Langhorne et al., 2009). Among many stroke survivors, most patients were left with sequelae of motor dysfunction, and 30% of patients completely lost the ability to work and became highly disabled (Langhorne et al., 2009; Benjamin et al., 2017). Motor dysfunction causes patients to lose part of their living ability, rendering them unable to complete some daily living activities (Basteris et al., 2014). Therefore, motor recovery always focuses on stroke rehabilitation (Hatem et al., 2016). Balance recovery is essential to motor recovery, as the imbalance-leading falling substantially affects regular training and rehabilitation. In clinical practice, the Berg Balance Scale (BBS) is often used to evaluate the balance function of patients with cerebrovascular and brain injury (Sapmaz and Mujdeci, 2021). However, the scale’s accuracy depends on the experience and subjective judgment of the physical therapists. A biomarker that can illustrate the balance recovery process is necessary to organize the rehabilitation strategy better and improve balance recovery. Developed imaging techniques have given valuable information for diagnostic and functional prognosis. Nevertheless, they may have limitations, such as the special requirements for patients and low temporal resolution (Mukherjee et al., 2008; Buchbinder, 2016). Therefore, more and more studies have concentrated on more convenient methods with electroencephalography (EEG) (Wu et al., 2016; Sebastian-Romagosa et al., 2020).

The EEG acquisition device is simple and portable and has a high temporal resolution. It is highly sensitive to detecting EEG activities and allows subjects to perform some complex limb movement tasks while observing them non-invasively and dynamically in real-time. The neurons’ activity in the brain has been broadly used to monitor the stroke survivors’ brain states (Cillessen et al., 1994; Foreman and Claassen, 2012; Xin et al., 2017). The EEG’s beta band power patterns differed according to the location of the lesion (Park et al., 2016), and event-related desynchronization (ERD) magnitude correlated with residual motor function in the paretic arm (Bartur et al., 2019). However, one challenge of using EEG is its low spatial resolution problem, i.e., the ERD may be contaminated and weakened by the neural activities in the nearby areas. One alternative solution is to use functional near-infrared spectroscopy (fNIRS) as a supplement (Li et al., 2020). In a study using fNIRS to assess the correlation between cortical activation and external postural disturbances, the correlation became stronger with an increase in position-related oxygenated hemoglobin signal and an increase in balance function as measured by the BBS balance scale supplementary motor area (SMA) (Fujimoto et al., 2014). The fNIRS alone has been applied to assess the stroke’s progressive brain plasticity (Delorme et al., 2019). It has also been used with EEG to estimate the effect of different training strategies (Wang et al., 2019). Therefore, combining fNIRS and EEG may give new sight to stroke rehabilitation assessment.

The stroke rehabilitation assessment with EEG or fNIRS was usually undertaken during resting tasks (Nicolo et al., 2015; Sebastian-Romagosa et al., 2020). However, motor recovery should be reflected better during motor or motor imagery tasks (Wang et al., 2019; Li et al., 2020) when the corresponding brain area is activated. Walking ability is an urgent need for stroke patients in the early stage. The assessment should be taken during walking to assess the walking ability of stroke patients precisely. Bipedal locomotion is a complex task requiring maintaining specific motion frequencies, balance and load-bearing, visual integration, and multi-joint coordination (Petersen et al., 2012). However, most stroke survivors during the early stage cannot walk, or they may fall off during walking.

Additionally, ankle dorsiflexion is critical for walking as it occurs throughout the swing phase and at the initiation of the stance phase of gait (Dobkin et al., 2004). How the stroke survivors complete the ankle dorsiflexion affects their walking ability. Therefore, ankle dorsiflexion may be a promising task for stroke rehabilitation assessment (Gennaro and De Bruin, 2020).

This paper aims to evaluate the combination of EEG and fNIRS features during ankle dorsiflexion in rehabilitation assessment. We collected data from stroke survivors during ankle dorsiflexion and built a linear regression model with age, ERD, and oxygenated hemoglobin (HBO) as the predictors and BBS as the response. Our results verified the feasibility of EEG and fNIRS combination in predicting stroke balance state.

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Editorial: Long term disability in neurological disease: A rehabilitation perspective

You've identified a lot of the problems in stroke.  What the fuck is the  strategy of the stroke world to solve them? I'm guessing head in the sand because this meme from World Stroke Day a few years ago tells us stroke is solved already. 

 

What a lying piece of shit.

 

 

 

 

Editorial: Long term disability in neurological disease: A rehabilitation perspective

Alessio Baricich^1,2*, Grazia F. Spitoni^3,4 and Giovanni Morone⁵

• ¹Physical and Rehabilitative Medicine, Department of Health Sciences, Scuola di Medicina, Università degli Studi del Piemonte Orientale, Novara, Italy
• ²Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
• ³Department of Dynamic, Clinical Psychology and Health, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
• ⁴Santa Lucia Foundation (IRCCS), Rome, Italy
• ⁵Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy

Editorial on the Research Topic
Long term disability in neurological disease: A rehabilitation perspective

Neurological diseases are often associated with a significant burden of disability, which can severely affect different aspects of patients' autonomy, notably motor and cognitive impairments. These impairments can arise in a progressive and long-term manner, as expected in neurodegenerative diseases and after acute conditions such as strokes, traumatic brain injuries, or spinal cord injuries. The clinical and social impact of these conditions is critical.

As outlined in the recent guidelines, stroke represents the second cause of mortality worldwide, drawing attention to improving the acute care of disease successfully, leading to a significant reduction in mortality (1).

However, due to this central focus, the long-term effects have been under-explored, leaving strokes a significant cause of disability. Even if strokes are generally considered and managed as a transient condition, most stroke survivors suffer from persistent critical limitations in the activities of daily living. 50% of stroke survivors report unmet needs such as incontinence, emotional problems, mobility, pain, and speaking problems. However, most of them do not receive a rehabilitative follow-up or other therapeutic approaches (2).

It is known that recovery is a complex process, which probably implies a combination of spontaneous and learning-dependent processes and adaptive behavior. Current evidence suggests that several mechanisms are involved, including restoring the functionality of damaged neural tissue (e.g., restitution), reorganization of spared neural pathways (e.g., substitution), improvement of impaired skills in the activities of daily living (e.g., compensation) (3) and last but not least, the recovery of cognitive skills.

Considering these aspects, there is cumulative evidence that interdisciplinary rehabilitation treatment improves the outcomes of stroke survivors when applied in acute and subacute phases after the event (4, 5). Indeed, the “formal” post-stroke motor rehabilitation usually ends 3–4 months after the event, based on the fact that motor and functional recovery reaches a debated plateau 3–6 months after stroke (6). However, current evidence supports the hypothesis that cognitive (Wang et al.; Rohrbach et al.) and motor skills may improve at any time after stroke, as well as in other pathologies such as other conditions that might critically affect the central nervous system (Cammisuli et al.; Elena et al.; Calafiore et al.) or muscular inherited muscular diseases (Alvarez et al.).

Brain plasticity phenomena are also widely involved in the chronic phase, albeit to a lesser extent than in the subacute phase. They lead to a modification of the cortical network, which can, in some cases, lead to clinically significant functional improvements. We know that rehabilitation may promote favorable neural plasticity (7, 8); notably, these processes may be reinforced by the use of innovative techniques and devices (Bressi et al.; Li et al.; Caimmi et al.; Peng et al.). In addition, the use of innovative orthoses and prostheses can reduce the impact that loss of function or organ damage has on the patient's abilities, improving their emotional state and consequently increasing social engagement (Pundik et al.).

However, future studies should focus on the development of a theoretical model to better understand the neurophysiological aspects of CNS recovery, as suggested by an interesting study protocol proposed by Simis et al.

In chronic stroke, modifications and possible modulations are linked not only to the brain and brain plasticity but also to the peripheral skeletal muscle in an interdependent way. Azzollini et al. discuss this topic in their review.

In addition, long-term unmet needs are observed in many domains, including social reintegration, health-related quality of life, maintenance of activity, and self-efficacy. From this point of view, stroke should be considered a chronic disease, and rehabilitation processes should be designed considering also these aspects. In this regard, rehabilitation services must have proper patient management in the form of a dedicated clinical pathway considering each individual's many different factors, including clinical, social, and economic aspects. In this line, identifying the target patient subgroup is the new challenge of translational medicine and, in particular, the rehabilitation that has high costs and is resource consuming. Studies that aim to identify prognostic factors, not only for conventional therapy but even for technologically assisted training, are essential to plan future effective rehabilitation plans (Wu et al.; Lee and Shin) or to identify subjects unable to return to work after a CNS lesion (Iosa et al.).

Additionally, some recent technology innovations may help patients' follow-up adherence. These aspects should be considered where the patient is unable to reach rehabilitation facilities or in low-income countries where outcomes are less favorable, as suggested by Contrada et al..

Technology is not the only answer to meeting patients' needs in a long-term perspective.

Current literature suggests the positive impact of peer support programs (9), and Baumgartner-Dupuits et al. proposed a study protocol to clarify these aspects.

In another intriguing study, Grimm et al. explored the potential impact of biographical music and biographical language on physiological responses and the endocrine system of people with disorders of consciousness.

From what has been briefly set out, a picture emerges in which an initial acute phase must necessarily be followed by a phase involving long-term interventions. In this phase, patient care must include an intervention in which the various professional figures together with territorial medical services must tune in and integrate to allow the patient the best possible quality of life.

Limb heaviness as a sensorimotor disorder alters rehabilitation adherence after a stroke

Limb heaviness IS NOT  a sensorimotor disorder, it is simply spasticity! And your mentors and senior researchers did not know that?  

You're just as wrong as this one:

Limb Heaviness A Perceptual Phenomenon Associated With Poststroke Fatigue?

The latest here:

Limb heaviness as a sensorimotor disorder alters rehabilitation adherence after a stroke

Yuanyuan Chen^†, Hongyan Yang^†, Yanqin Chen, Hui Wei and Meijuan Lan^*

• Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

Introduction: To the best of our knowledge, it is still unknown how perceived limb heaviness affects rehabilitation adherence. As rehabilitation adherence is very important for the functional recovery of patients with stroke, it is important to explore the relationship between perceived limb heaviness and rehabilitation adherence.

Methods: We retrospectively reviewed the data of patients with consecutive stroke recruited in the CIRCLE study. The influence of age, gender, time from onset to enrollment, educational background, hypertension, diabetes, Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS) on rehabilitation adherence was analyzed. Multiple linear regression analysis was used to examine the association between perceived limb heaviness and rehabilitation adherence changes.

Results: A total of 108 participants completed the study. About 40 (37.0%) participants felt limb heaviness. The mean scores on the Medical Research Council (MRC) scale for the upper affected limb strength were 3.05 ± 1.7, and the mean score on the exercise adherence questionnaire (EAQ) was 34.27 ± 8.9. Univariate analysis showed that rehabilitation adherence levels differed in upper limb muscle strength and whether they perceived limb heaviness. After adjustment for independent predictors, we found that perceived limb heaviness was associated with rehabilitation adherence (B = −9.681 ± 1.494, p < 0.05) and R² was 0.332 and 0.074 if the muscle strength of the upper limb and perceived limb heaviness were included in the model and the model was without perceived limb heaviness, respectively.

Conclusion: By identifying patients with stroke with limb heaviness, it led to lower levels of motor functional rehabilitation adherence. We must pay more attention to limb heaviness and provide effective interventions to improve rehabilitation adherence and promote patient recovery.

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A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

 What will you do with those patients you determine are futile? Leave them to rot? Figure out how to recover on their own with no help from medical 'professionals'?

A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

ShiTeng Lin^1,2†, XinPing Lin^1,2†, Juan Zhang^3†, Meng Wan^2,4, Chen Chen^2,4, Qiong Jie^2,4, YueZhang Wu^2,4, RunZe Qiu^2,4, XiaoLi Cui³, ChunLian Jiang^5*, JianJun Zou^2,4* and ZhiHong Zhao^6*

• ¹School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
• ²Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ³Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ⁴Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
• ⁵Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ⁶Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan), Hunan Normal University, Changsha, China

Background and purpose: Futile recanalization occurs in a significant proportion of patients with basilar artery occlusion (BAO) after endovascular thrombectomy (EVT). Therefore, our goal was to develop a visualized nomogram model to early identify patients with BAO who would be at high risk of futile recanalization, more importantly, to aid neurologists in selecting the most appropriate candidates for EVT.

Methods: Patients with BAO with EVT and the Thrombolysis in Cerebral Infarction score of ≥2b were included in the National Advanced Stroke Center of Nanjing First Hospital (China) from October 2016 to June 2021. The exclusion criteria were lacking the 3-month Modified Rankin Scale (mRS), age <18 years, the premorbid mRS score >2, and unavailable baseline CT imaging. Potential predictors were selected for the construction of the nomogram model and the predictive and calibration capabilities of the model were assessed.

Results: A total of 84 patients with BAO were finally enrolled in this study, and patients with futile recanalization accounted for 50.0% (42). The area under the curve (AUC) of the nomogram model was 0.866 (95% CI, 0.786–0.946). The mean squared error, an indicator of the calibration ability of our prediction model, was 0.025. A web-based nomogram model for broader and easier access by clinicians is available online at https://trend.shinyapps.io/DynNomapp/.

Conclusion: We constructed a visualized nomogram model to accurately and online predict the risk of futile recanalization for patients with BAO, as well as assist in the selection of appropriate candidates for EVT.

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High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China

So you're predicting cognitive impairment but giving us NOTHING on how to prevent it. Useless. Do we have no one in the world that wants to solve stroke? I'd have you all fired.

High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China

Tianling Shang¹, Bo Ma², Yanxin Shen¹, Chunxiao Wei¹, Zicheng Wang¹, Weijie Zhai¹, Mingxi Li¹, Yongchun Wang¹ and Li Sun^1*

• ¹Department of Neurology, The First Hospital of Jilin University, Changchun, China
• ²Department of Hepatology, The First Hospital of Jilin University, Changchun, China

Background and aims: Recently, various hemocyte and blood cell ratios have garnered researchers' attention, as a low-cost, widely prevalent, and easy-to-measure index for diagnosing and predicting disease. Therefore, we sought to investigate the effect and predictive value of the peripheral blood neutrophil percentage and neutrophil-lymphocyte ratio (NLR) in the acute phase of ischemic stroke (AIS) in post-stroke cognitive impairment (PSCI).

Methods: We selected 454 patients with mild AIS and acquired general clinical data. The patients were divided into PSCI and post-stroke no cognitive impairment (PSNCI) groups according to their Montreal Cognitive Assessment (MOCA) scores. We assessed whether there were differences in clinical data, peripheral blood neutrophil percentage, and NLR values between the different groups. We also analyzed the independent influences on the occurrence of PSCI using a binary logistic regression. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the above inflammatory indicators and models containing different inflammatory indicators for PSCI.

Results: In total, 454 patients were included, of whom 253 (55.7%) patients were in the PSCI group, with a mean age of 62.15 ± 7.34 years and median neutrophil percentage and NLR of 0.64 (0.32–0.95) and 2.39 (0.71–54.46), respectively. Both neutrophil percentage (adjusted OR = 1.025; 95% confidence interval: 1.005–1.406) and NLR as a categorical variable (Q5, adjusted OR = 2.167; 95% CI: 1.127–4.166) were independent risk factors for PSCI, and the Q5 group (NLR ≥ 4.05) had significantly worse overall cognition and executive function.

Conclusions: Neutrophil percentage and NLR in the acute phase of AIS were independently associated with PSCI, and a high NLR was strongly associated with executive function. In addition, neutrophil percentage and NLR have diagnostic values for PSCI.

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Association between serum netrin-1 levels and early neurological deterioration after acute ischemic stroke

So you're predicting early neurological deterioration but giving us NOTHING on how to prevent it. Useless. Do we have no one in the world that wants to solve stroke? I'd have you all fired.

Association between serum netrin-1 levels and early neurological deterioration after acute ischemic stroke

Zhuo Chen¹, Tianli Cao¹, Xingju Zhong¹, Yong Wu¹, Wei Fu¹, Chaoli Fan¹, Yu Jiang¹, Qi Zhou¹, Jie Peng¹, Jieyu Liao¹, Zhike You¹, Xin Yi¹ and Jingyu Tan^2*

• ¹Department of Neurology, Mianzhu People's Hospital, Mianzhu, China
• ²Department of Endocrinology, Mianzhu People's Hospital, Mianzhu, China

Background and purposes: Experimental studies demonstrated that netrin-1 (NT-1) has anti-inflammatory, tissue regeneration, and immune modulation properties. We aimed to discern the utility of NT-1 as a biomarker for assessing the risk of early neurological deterioration (END) after ischemic stroke.

Methods: This was a prospective study enrolling ischemic stroke patients with symptoms onset <24 h. Serum NT-1 concentrations were measured at admission. The National Institutes of Health Stroke Scale increased by ≥2 points and ≥4 points during the first 72 h after admission and was defined as END2 and END4, respectively.

Results: The study included 268 patients (146 men and 122 women) with a mean age of 63.0 ± 9.6 years. The median NT-1 concentrations were 466.4 pg/ml (interquartile range, 341.4–589.2 pg/ml). During the initial 72 h after admission, END2 was found in 83 (31.0%) patients, and END4 was observed in 48 (17.9%) subjects. After adjusted for potential confounders, multivariate analysis indicated that decreased NT-1 levels is an independent predictor for END2 [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.46–0.84, p < 0.001) and END4 (OR 0.53, 95% CI 0.36–0.76, p < 0.001). Similar results were found when the NT-1 levels were analyzed as a categorical variable. Furthermore, restricted cubic spline analysis showed a linear association between NT-1 concentrations and the risk of END (END2, p = 0.006 for linearity; END4, p < 0.001 for linearity).

Conclusions: Our results suggest that decreased NT-1 levels were significantly associated with a higher risk of END after ischemic stroke.

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