Association between serum transthyretin and intracranial atherosclerosis in patients with acute ischemic stroke

So you described something, what the hell are we supposed to do with this information?  Since you had no objective for your research your mentors and senior researchers need to be fired.

Association between serum transthyretin and intracranial atherosclerosis in patients with acute ischemic stroke

Jinfeng He^1†, Jiamin Zhu^2†, Wenyuan Zhang^2,3, Zhenxiang Zhan², Fangwang Fu² and Qiongqiong Bao^3*

• ¹Department of Neurology, Taizhou Municipal Hospital, Taizhou, China
• ²Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
• ³Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China

Background: Intracranial atherosclerotic stenosis (ICAS) is a primary cause of ischemic stroke. In addition to dyslipidemia, inflammation has been recognized as a potential pathogenesis of atherosclerosis. It remains unknown whether there is a link between transthyretin and ICAS as an inflammatory index.

Methods: Consecutive patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Wenzhou Medical University between January 2019 and June 2020 were retrospectively analyzed. Blood samples were collected from all patients within 24 h of admission to detect their serum transthyretin levels. ICAS was defined as at least one intracranial artery stenosis on vascular examination with a degree of stenosis ≥50%. Multivariable logistic regression analysis was used to identify independent factors associated with ICAS. Restricted cubic spline models were used to depict patterns in the association between serum transthyretin levels and ICAS.

Results: In total, 637 patients with acute ischemic stroke were included in this study, of whom 267 (41.9%) had ICAS. Compared with the patients without ICAS, serum transthyretin levels in patients with ICAS were significantly lower (226.3 ± 56.5 vs. 251.0 ± 54.9 mg/L; p < 0.001). After adjusting for potential confounders, patients in the lowest tertile showed a significant increase in ICAS compared to those in the highest tertile (odds ratio, 1.85; 95% confidence interval, 1.12–3.05; p = 0.016). This negative linear association is also observed in the restricted cubic spline model. However, this association may only be observed in men. Age, National Institutes of Health Stroke Scale score, hemoglobin A1c level, and low-density lipoprotein cholesterol level were independently associated with ICAS.

Conclusions: Decreased serum transthyretin levels are associated with a more severe ICAS burden in patients with acute ischemic stroke. Our findings suggest that transthyretin may play a role in the pathogenesis of ICAS and provide insight into the control of inflammation for the treatment of ICAS.

Introduction

Acute ischemic stroke (AIS) is gradually becoming a major disease threatening the global population's health, particularly in China (1). As the dominant cause of stroke, large artery atherosclerosis is closely related to poor prognoses and high recurrence rates in patients with AIS (2–4). Due to differences in antioxidant content and susceptibility to hemodynamic pressure between the intracranial and extracranial arteries, their responses to different risk factors are inconsistent (5). Compared with Western individuals, intracranial atherosclerotic stenosis (ICAS) affects a larger proportion of Chinese patients than extracranial atherosclerotic stenosis (ECAS) (5). Currently, ICAS is the main cause of the high stroke burden in the Chinese population (6). Recent evidence suggests that inflammation plays a significant role in atherosclerotic disease and is expected to become a therapeutic target (7).

Transthyretin is mainly synthesized in the human liver and plays a role in transporting thyroxine and retinol (8). As a serum protein with a short half-life (approximately 2 days), transthyretin is an ideal index for assessing nutritional status (9). In addition, serum transthyretin concentration decreases in the acute phase of inflammation, malignant tumors, and trauma (8) and is thus a potent inflammatory marker. There is evidence that decreased serum transthyretin levels are associated with poor prognoses in stroke patients, even when stroke severity and vascular risk factors are considered (10–12). In patients with acute coronary syndrome, there is an independent negative relationship between transthyretin levels and coronary stenosis (13).

Consequently, it is speculated that transthyretin is associated with ICAS, although the pathogeneses of ICAS and ECAS are not identical. To our knowledge, no studies have investigated the relationship between transthyretin and ICAS. We aimed to determine whether low serum transthyretin levels are associated with ICAS in patients with AIS.

More at link.

Effects of Transcranial Direct Current Stimulation (tDCS) Combined with Wrist Robot-assisted Rehabilitation on Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

There seems to be no objective diagnosis of damage so this will never be repeatable and usable in creating a stroke rehab protocol. 

The Fugl-Meyer upper extremity scale has no objective distinction for changes in ability and thus would be useless as a measurement tool.

The Modified Ashworth Scale is way too subjective to be of any use in knowing if improvements are occurring.  

 

Effects of Transcranial Direct Current Stimulation (tDCS) Combined with Wrist Robot-assisted Rehabilitation on Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Mazzoleni S, Tran VD, Dario P, Posteraro F.

Abstract

Both transcranial direct current stimulation (tDCS) and wrist robot-assisted training have demonstrated to be promising approaches for stroke rehabilitation. However, the effects of the combination of the two treatments in subacute stroke patients are not yet clear. To investigate the effectiveness of combining tDCS and wrist robot-assisted rehabilitation in subacute stroke patients in comparison with the wrist robotic training only, a single-blind, randomized, sham-controlled trial was performed with 40 subacute stroke patients (25 ± 7 days from stroke onset time). Patients were randomly assigned to experimental group (EG, n = 20) where patients receive real tDCS (2mA, 20 minutes, the anodal electrode on the primary motor cortex -M1 -area of the affected hemisphere(C3/C4 in the 10-20 EEG system and the cathodal electrode on the contralateral orbit bone) or control group (CG, n = 20) where patients receive sham tDCS (5 seconds) during wrist robotic rehabilitation training. The effects of the treatment were evaluated by means of the upper extremity, shoulder-elbow and wrist subsections of the Fugl-Meyer Assessment Scale, Modified Ashworth Scale, Motricity Index and Box & Block test together with kinematic parameters. One out of 20 patients in the CG did not complete the treatment. All the clinical outcome measures except the Modified Ashworth Scale showed a significant increase after the treatment in both groups. However, no significant difference in the average changes after treatment between groups was observed. The movement velocity and smoothness showed significant increases after the training, even though no significant difference between groups was observed. The combination of wrist robot-assisted training and tDCS did not show additional effects in comparison with wrist robot-assisted training only in subacute stroke patients. The negative results found in this study are specific for the specific intervention. The timing of delivering the tDCS and the robot-assisted therapy has to be deeply investigated to enhance the effectiveness of the training.

PMID:

31170077

DOI:

10.1109/TNSRE.2019.2920576

An accelerometry and observational study to quantify upper limb use after stroke during inpatient rehabilitation

If your doctor and therapists aren't doing this they have no objective idea of the movements you are doing. With NO objective diagnosis of your disability they will never be able to map protocols to recovery.   Accelerometers and motion sensors have been written about forever. If your therapists don't use them, they have nothing objective to base their therapy upon or recognize gains.  That is a fireable offense for the stroke department head and the stroke hospital president.

• accelerometers (27 posts to June 2013)
• accelerometry (4 posts to February 2012)
• motion sensors (11 posts to August 2012) 

An accelerometry and observational study to quantify upper limb use after stroke during inpatient rehabilitation

Lay Fong Chin

Kathryn S. Hayward

Aloysius Jun An Soh

Chin Mei Tan

Cheryl Jing Ru Wong

Jia Wei Loh

Genevieve Jia Hui Loke

Sandra Brauer

First published: 16 May 2019

https://doi.org/10.1002/pri.1784

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Abstract

Objectives

The objectives of the study are to characterize paretic upper limb (UL) use in people with different levels of impairment 4 weeks poststroke and to compare accelerometry and direct observational approaches.

Methods

Twelve stroke inpatients (five mild, three moderate, and four severe UL impairment) were recruited from a rehabilitation hospital. UL use was measured using accelerometry (24 hr) and direct observation (12 hr of behavioural mapping). Accelerometry variables included duration of use, use ratio, magnitude ratio, bilateral magnitude, and variation ratio. Direct observation recorded the duration of use and type of UL movement (e.g., functional vs. non‐functional).

Results

From accelerometry data, people with mild, moderate, and severe UL impairments used their paretic UL 59%, 45%, and 22% of a 24 hr‐day, respectively. People with severe UL impairment had the lowest paretic UL use duration (median 1.49 hr/day), magnitude ratio, and variation ratio compared with people with mild and moderate UL impairment. From 12 hr of observational data, people with mild impairment were using their UL for 37.8% of the observed time, whereas the people with moderate and severe impairment were using their UL 15.8% and 4.9%, respectively. UL movements for the mild cohort were mainly functional, whereas UL movements of the moderate and severe cohorts were mainly non‐functional. UL movements were predominantly active for the mild and moderate cohorts but passive for the severe cohort. Duration of paretic UL use from accelerometry and observation data were highly correlated (ICC > 0.8), but the absolute percentage error between methods ranged from 34.2% to 42.7%.

Conclusions

Paretic UL use within the first 4 weeks poststroke differs across levels of impairment in this exploratory study. Accelerometry and observation findings of paretic UL use were correlated and may be needed in different situations as they capture different information.

Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke

Whatever the hell self-efficacy is? I understood nothing here.  Being lazy and cherry picking subjects again, mild impairment. Mild has no objective definition, so this research was completely useless and never repeatable. No objective starting point, no objective measurements.

Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke

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Jill Campbell Stewart, PhD, Rebecca Lewthwaite, PhD, Janelle Rocktashel, MS, ...

First Published March 18, 2019 Research Article

https://doi.org/10.1177/1545968319836231

Article information

Abstract

Background: Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE).
Objective: To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance.
Methods: A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 (not very confident) to 10 (very confident). Results: Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets (R² = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets (R² = 0.291).  
Conclusions: SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.

Keywords stroke, self-efficacy, confidence, arm, kinematics

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Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study

Well shit, without an objective analysis of gait defects we will NEVER be able to correlate interventions to results. You have been in an unregulated clinical trial as a guinea pig by your therapists and doctors since the beginning.  With no protocols everyone trying to treat you is flailing in the dark. Hope you don't mind the inaccuracy and the lack of recovery.  I got the 'Walk this way' from my PT, totally useless.

Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study

• Sarah A. MooreEmail authorView ORCID ID profile,
• Aodhan Hickey,
• Sue Lord,
• Silvia Del Din,
• Alan Godfrey and
• Lynn Rochester

Journal of NeuroEngineering and Rehabilitation201714:130

https://doi.org/10.1186/s12984-017-0341-z

©  The Author(s). 2017

Received: 8 August 2017

Accepted: 13 December 2017

Published: 29 December 2017

Abstract

Background

Application of objective measurement of stroke gait with accelerometer-based wearable technology and associated algorithms is increasing, despite reports questioning the accuracy of this technique in quantifying specific stroke-related gait impairments. The aim of this study is to determine the feasibility, validity and reliability of a low-cost open-source system incorporating algorithms and a single tri-axial accelerometer-based wearable to quantify gait characteristics in the laboratory and community post-stroke.

Methods

Twenty-five participants with stroke wore the wearable (AX3, Axivity) on the lower back during a laboratory 2 minute continuous walk (preferred pace) on two occasions a week apart and continuously in the community for two consecutive 7 day periods. Video, instrumented walkway (GaitRite) and an OPAL accelerometer-based wearable were used as laboratory references.

Results

Feasibility of the proposed system was good. The system was valid for measuring step count (ICC 0.899). Inherent differences in gait quantification between algorithm and GaitRite resulted in difficulties comparing agreement between the different systems. Agreement was moderate-excellent (ICC 0.503–0.936) for mean and variability gait characteristics vs. OPAL. Agreement was moderate-poor between the system and OPAL for asymmetry characteristics. Moderate-excellent reliability (ICC 0.534–0.857) was demonstrated for 11/14 laboratory measured gait characteristics. Community test-retest reliability was good-excellent (ICC 0.867–0.983) for all except one (ICC 0.699) of the 19 gait characteristics.

Conclusion

The proposed system is a low-cost, reliable tool for quantifying gait post-stroke with multiple potential applications. Further refinement to optimise gait quantification algorithms for certain gait characteristics including gait asymmetry is required.