Features of the dynamics of inflammation and apoptosis markers in patients with different acute post-stroke period

The purpose of this was to study the dynamics of markers of inflammation and apoptosis in the serum of patients with ischemic stroke in the early post-stroke period. Materials and methods. The study involved 22 patients (mean age 60 ± 5.5 years) with different dynamics of neurological symptoms in the acute post-stroke period. Patients were examined twice: on the 1st and 10th day of observation. Quantitative assessment of the severity of neurological deficit using ESS and NIHSS scales was carried. Enzymatic activity of leukocyte elastase, functional activity of a1-proteinase inhibitor, level of autoantibodies to MBP (inflammatory markers), as well as the content of p53 and Bcl-2 proteins (markers of apoptosis) were determined in serum. The control group consisted of 35 somatically healthy people of the appropriate age and sex. Results. Identified the different features of the spectrum of the analyzed markers of inflammation and apoptosis in patients with positive and negative dynamics of neurological symptoms in the acute period of ischemic stroke assessed according to the ESS and NIHSS scales. The observed clinical and biological relationships reflect the features of the course of the early post-stroke period and can be considered as possible predictors of the development trajectory of acute brain ischemia.

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Cognitive effect of cilostazol in post stroke cognitive impairment: a prospective study

10.21203/rs.2.9552/v1 ◽

2019 ◽

Author(s):

Ling-Chun Huang ◽

Sun-Wung Hsieh ◽

Chun-Hung Chen ◽

Yuan-Han Yang

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Randomized Clinical Trials ◽

Multiple Logistic Regression Analysis ◽

Antiplatelet Agent ◽

Cognitive Change ◽

Control Group ◽

Cognitive Changes ◽

Post Stroke ◽

Significant Difference

Abstract Background Whether antiplatelet agents have a preventive effect on cognitive function after ischemic stroke remains unknown. This study examined the potential effect of cilostazol, an antiplatelet agent and cyclic adenosine monophosphate phosphodiesterase 3 inhibitor, on cognitive impairment after stroke in an Asian population. Methods A total of 45 patients using cilostazol (100 mg) twice per day were enrolled as the study group and 45 patients using aspirin (100 mg) or clopidogrel (75 mg) daily were enrolled as the control group. Mini-mental state examination and Cognitive Assessment Screening Instrument were administered at the start of the study and after 6 months. Multiple logistic regression analysis was used to estimate the association between the cognitive change and cilostazol use. Results Overall, 60-70% of the patients improved their cognition after 6 months follow up. No significant differences were observed in the cognitive change between the cilostazol and control groups. However, the cilostazol group appeared to perform better in the fluency, language and judgment subdomains. Conclusions In the current study, the clinical course of post stroke cognitive changes was described. Although cilostazol did not make a significant difference in cognitive change after ischemic stroke, it may improve fluency, language and judgment subdomains. These findings should be examined further in randomized clinical trials.

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Abstract TP224: Interleukin-37 Level is Elevated in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp224 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Saif Bushnaq ◽

Atif Zafar ◽

Kempuraj Duraisamy ◽

Nudrat Tasneem ◽

Mohammad M Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Inflammatory Responses ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Delayed Presentation ◽

Stroke Patients ◽

Post Stroke ◽

Urine And Serum ◽

Serum And Urine

Background: Interleukin-37 (IL-37) is a new member of IL-1 cytokine family with a defined role as a negative feedback inhibitor of pro-inflammatory responses. IL-37 has yet to be evaluated in non-immune neurological diseases like ischemic or hemorrhagic stroke. This study aimed to measure the urine and serum IL-37 levels in patients with acute ischemic stroke. Method: Twelve patients consented for the study. Two sets of serum and urine samples were obtained and analyzed; one upon admission to the hospital, and the second the next morning after overnight fasting. The trends in serum level of IL-37 in 5 stroke patients, while trends in urine level of 6 patients were available, measured by real-time polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Prior studies with healthy volunteers as control group have consistently showed IL-37 plasma level around or less than 65 pg/ml with maximum normal levels on ELISA approximated at 130 pg/ml. Results: IL-37 level in urine in stroke patients ranged from 297 - 4467. IL-37 levels were in the range of 300s to 1000s in patients with ischemic stroke compared with reported healthy controls in literature where the level was always less than 90. Three of these 10 patients presented within 3 hours of stroke onset with IL-37 serum levels being 2655 pg/ml, 3517 pg/ml and 5235 pg/ml. In all others, it ranged much less than that, with the trend of delayed presentation giving less IL-37 levels, both in urine and serum. There were no clear differences found in patients with or without tPA, diabetes, hyperlipidemia and high blood pressure in our small study. Conclusion: The study shows a rather stable elevation of IL-37 levels post-ischemic stroke, which if compared to available data from other studies, is 3-10 times elevated after acute ischemic stroke with an uptrend in the first few days. IL-37 plays some role in mediating post-stroke inflammation with significant rise in serum and urine IL-37 levels suggesting a key role of this novel cytokine in post-stroke pathology. This is the first ever reported study measuring and trending IL-37 levels in human plasma after an acute ischemic stroke.

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Abstract TP150: Effects of Pre-existing Psychotropic Medication Use on a Cohort of Patients With Ischemic Stroke Outcome

Stroke ◽

10.1161/str.51.suppl_1.tp150 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dilip Jayaraman ◽

Nils Henninger ◽

Brian Silver ◽

Majaz Moonis ◽

Anthony Rothschild ◽

...

Keyword(s):

Ischemic Stroke ◽

Psychotropic Medication ◽

Medication Use ◽

Female Gender ◽

Control Group ◽

Stroke Outcome ◽

Stroke Registry ◽

Post Stroke ◽

Significant Difference

Background: Although SSRI use for ischemic stroke related motor recovery has been studied with mixed results, the effects of the pre-existing psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke outcome is unknown. Objective: We sought to determine the prevalence of PPMU, and the clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods: We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke that were included in an institutional stroke registry between January 2015 and December 2017. Baseline characteristics, functional outcome measured by mRS, cardiovascular complications and death within 90 days and 365 days were recorded. The control was defined as a group of ischemic stroke patients that were not on psychotropic medications pre- and/or post-ischemic stroke. Results: The prevalence of PPMU in the studied cohort was 21.4% (69/323). The prevalence of female gender in PPMU was higher compared to the control and post stroke-psychotropic medication use groups (P<0.001), and the patients with PPMU had similar vascular risk factors compared to the control (NS), except for an increased presence of hyperlipidemia (68.1% vs. 57.5%, p<0.05). Among the patients with an available 90-day follow-up (n=175) and 365-day follow-up (n=246), there was no statistically significant difference in outcome events of MI, stroke, death, and dementia. The mRS was higher on PPMU and poststroke-psychotropic medication use groups compared to the control group within the 365-day follow-up (P=0.013). Conclusion: The prevalence of PPMU is common in ischemic stroke, and it is not associated with worsened post-stroke complications within 1 year.

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Abstract TP319: Risk Factors of Post-stroke Epilepsy

Stroke ◽

10.1161/str.51.suppl_1.tp319 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Tatyana Danilova ◽

Dina Khasanova

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Neuroimaging ◽

Cerebral Arteries ◽

Transcranial Doppler Sonography ◽

Epileptic Seizures ◽

Brain Lesions ◽

Control Group ◽

Ischemic Brain ◽

Post Stroke

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, <0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, <0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p<0.001) compared to controls (71.6%). CVR < 10% was registered in 33.8% patients with seizures versus 13.4% controls (p<0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p<0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (> 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, <0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

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The Effect of “SELF-HELP Packages” on Post Stroke Depression among Ischemic Stroke Survivors

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v10i3.31014 ◽

2020 ◽

Vol 10 (3) ◽

pp. 361-375

Author(s):

Fitria Handayani ◽

Setyowati Setyowati ◽

Dwi Pudjonarko ◽

Dian Ratna Sawitri

Keyword(s):

Social Support ◽

Ischemic Stroke ◽

Intervention Group ◽

Nursing Intervention ◽

Control Group ◽

Stroke Survivors ◽

Post Stroke ◽

Self Help ◽

Confounding Variables ◽

Post Stroke Depression

Background: There are several factors that contribute to Post Stroke Depression (PSD). Since a single intervention is proven ineffective to deal with PSD, an intervention which includes biological, psychological, social, and spiritual aspects (“SELF-HELP Packages”), therefore, needs to be established.Purpose: The purpose of the study was to investigate the effect of “SELF HELP Packages” intervention on PSD among ischemic stroke survivors after three months from onset and its effect after confounding variables were controlled.Methods: This study was a pre and post quasi-experiment with a control group involving 34 ischemic stroke survivors each group. The inclusion criteria were survivors after three months from ischemic stroke, no aphasia, having a good hearing, and having Mini Mental Status Examination (MMSE) score of ≥ 22. GRID-HAMD 17, Multidimensional Scale of Perceived Social Support (MSPSS), and Barthel-Index were used to measure PSD, social support, and functional status respectively. “SELF-HELP Packages” intervention was delivered in three sessions, namely information delivery, discussion and activity. Statistical analyses were conducted using McNemar test, Chi-square and logistic regression.Results: The result showed that “SELF-HELP Packages” considerably decreased PSD in the intervention group (p=0.004). There were also significant differences in PSD after the intervention between two groups (p=0.008). Logistic regression showed that ‘SELF-HELP Package” had no effect on PSD when other confounding variables were controlled (p=0.075, OR=0.288, 95% CI 0.073 – 1.135).Conclusion: SELF-HELP Packages” should be applied in providing the nursing intervention among stroke ischemic survivors in clinical setting. A longer period of time for the intervention is also recommended for the next study in order to obtain a more robust result.

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Abstract TP107: Midline Shift Predicts Functional Outcomes in Porcine Ischemic Stroke Model

Stroke ◽

10.1161/str.51.suppl_1.tp107 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Samantha Spellicy ◽

Erin Kaiser ◽

Michael Bowler ◽

Brian Jurgielewicz ◽

Robin Webb ◽

...

Keyword(s):

Animal Model ◽

Ischemic Stroke ◽

Functional Outcomes ◽

Randomized Study ◽

Large Animal Model ◽

Control Group ◽

Large Animal ◽

Midline Shift ◽

Post Stroke ◽

Significant Difference

In this study, we sought to identify acute MRI parameters which are predictive of long-term functional outcomes as well as assess the effects of a neural stem cell extracellular vesicle (NSC EV) therapeutic in a large animal model of ischemic stroke. In this randomized study, stroke was induced through a permanent right-sided middle cerebral artery occlusion (MCAO) on 16 male landrace pigs, which were divided into either treatment or control group. NSC EVs or PBS was administered at 2, 14, and 24 hours, and MRI was conducted at day 1 and 84 post-stroke. Data on 65 gait and 25 behavior parameters were collected pre-stroke and at multiple timepoints over 84 days following MCAO. Of all 15 measured MRI parameters, axial and coronal midline shift (MLS), at day 1 post stroke, had the highest total number of significant correlations (52 parameters at p<0.05) to acute and chronic functional measurements in control animals such as step time in the left front limb (p=0.0322) and cycle time in the right hind limb (p=0.0011) respectively. This suggests MLS is the best overall predictor of specific functional deficits at both acute and chronic timepoints, which to our knowledge has never been shown in an animal model. Additionally, the parameters found to be correlated to MLS in control animals were not correlated in NSC EV-treated animals, suggesting NSC EV treatment disrupts this natural correlation between degree of MLS and functional outcomes. NSC EVs and control pigs were binned into either high or low MLS groups and their survival and recovery was assessed by the modified Rankin Scale (mRS). While there was a significant difference in mRS scores of control animals with high and low MLS at day 6 post-MCAO (p=0.0008), there was not in NSC EV-treated animals (p=0.6754). Further, there was a significant difference in survival of control animals with high and low axial MLS (p=0.0401), but not in the NSC EV group (p=0.4142). Additionally, mRNA expression of GFAP was significantly correlated with increasing MLS in non-treated but not NSC EV-treated animals. These findings show although NSC EV treatment does not significantly alter the degree of MLS 1-day post-MCAO, it does alter gene expression, increase survival, and improve functional recovery following large MLS alterations.

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Anemia Is a Risk Factor for the Development of Ischemic Stroke and Post-Stroke Mortality

Journal of Clinical Medicine ◽

10.3390/jcm10122556 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2556

Author(s):

Jayoon Heo ◽

Tae-Mi Youk ◽

Kwon-Duk Seo

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Health Insurance ◽

Control Group ◽

Stroke Mortality ◽

Health Insurance Data ◽

Post Stroke ◽

Risk Of Death ◽

Anemia Group

Background: anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk of ischemic stroke and the risk of death after ischemic stroke. Methods: The study included patients from National Health Insurance Service cohort, from January 2005 to December 2015. Anemia patients were defined as those with confirmed diagnostic codes and related medications in the sample cohort, and patients under the age of 18 were excluded. To perform a comparative analysis with the control group, twice as many patients were extracted by propensity score matching. The effects of anemia on the development of ischemic stroke were analyzed. Results: A total of 58,699 patients were newly diagnosed with anemia during the study period. In anemia group, the rate of ischemic stroke occurring within 1 year was 0.550%, and the rate was 0.272% in the control group. The odds ratio of anemia related to ischemic stroke was 1.602 (95% confidence intervals (CI) 1.363–1.883). During the follow-up period, 175 out of 309 (56.6%) died in anemia group, and 130 out of 314 (41.4%) died in control group. The anemia group showed a higher risk of death than the control group (Hazard ratio 1.509, 95% CI 1.197–1.902). Conclusion: Analysis of the nationwide health insurance data revealed that anemia is one of the risk factors for the development of ischemic stroke, and also an independent prognostic factor affecting post-stroke mortality.

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Using Fractional Amplitude of Low-Frequency Fluctuations and Functional Connectivity in Patients With Post-stroke Cognitive Impairment for a Simulated Stimulation Program

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.724267 ◽

2021 ◽

Vol 13 ◽

Author(s):

Sirui Wang ◽

Bo Rao ◽

Linglong Chen ◽

Zhuo Chen ◽

Pinyan Fang ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Functional Connectivity ◽

Pearson Correlation ◽

Low Frequency ◽

Cingulate Cortex ◽

Anterior Cingulate ◽

Control Group ◽

Post Stroke ◽

Frequency Fluctuations

Stroke causes alterations in local spontaneous neuronal activity and related networks functional connectivity. We hypothesized that these changes occur in patients with post-stroke cognitive impairment (PSCI). Fractional amplitude of low-frequency fluctuations (fALFF) was calculated in 36 patients with cognitive impairment, including 16 patients with hemorrhagic stroke (hPSCI group), 20 patients with ischemic stroke (iPSCI group). Twenty healthy volunteers closely matched to the patient groups with respect to age and gender were selected as the healthy control group (HC group). Regions with significant alteration were regarded as regions of interest (ROIs) using the one-way analysis of variance, and then the seed-based functional connectivity (FC) with other regions in the brain was analyzed. Pearson correlation analyses were performed to investigate the correlation between functional indexes and cognitive performance in patients with PSCI. Our results showed that fALFF values of bilateral posterior cingulate cortex (PCC)/precuneus and bilateral anterior cingulate cortex in the hPSCI group were lower than those in the HC group. Compared with the HC group, fALFF values were lower in the superior frontal gyrus and basal ganglia in the iPSCI group. Correlation analysis showed that the fALFF value of left PCC was positively correlated with MMSE scores and MoCA scores in hPSCI. Besides, the reduction of seed-based FC values was reported, especially in regions of the default-mode network (DMN) and the salience network (SN). Abnormalities of spontaneous brain activity and functional connectivity are observed in PSCI patients. The decreased fALFF and FC values in DMN of patients with hemorrhagic and SN of patients with ischemic stroke may be the pathological mechanism of cognitive impairment. Besides, we showed how to use fALFF values and functional connectivity maps to specify a target map on the cortical surface for repetitive transcranial magnetic stimulation (rTMS).

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AGE AND GENDER PREDILECTION OF PLASMA C-REACTIVE PROTEIN LEVELS ON MORTALITY IN FIRST EVER ACUTE ISCHEMIC STROKE

10.36106/ijsr/4611138 ◽

2021 ◽

pp. 1-4

Author(s):

Bharat L. Konin ◽

Shiney Aggarwal ◽

Swaraj S. Waddankeri

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Control Group ◽

C Reactive Protein ◽

Stroke Patients ◽

Age And Gender ◽

Protein Levels ◽

Reactive Protein ◽

Markers Of Inflammation ◽

And Gender

Background and Purpose: The measurement of markers of inflammation or thrombosis has been proposed as a method to improve the prediction of risk in patients with vascular disease. The role of C-reactive protein (CRP) as a novel plasma marker of atherothrombotic disease is currently under investigation. We related age and gender predilection of plasma CRP levels to first ever ischemic stroke and its role on mortality. Methods: Sixty patients with either hypertension or diabetes or both or none without thrombolysis with first ever acute ischemic stroke patients were examined. CT scan of brain was done after 24 hours of onset of symptoms to confirm the diagnosis. Plasma CRP level was determined after 12 - 72 hours range after the onset of symptoms in all CT confirmed ischemic stroke patients. This clinical study was done during June 2018 to January 2020. CRP was randomly measured in 60 age and sex matched individuals admitted in other wards of the hospital matched in all possible criteria expect the disease under study as a control group. Results: The CRP concentration in ischemic strokes is independent of infarction site, the value was more between 51-70 years of age group and almost equal in both gender. 54 of the 60 ischemic strokes studied had CRP value >6 mg/l and only 6 patients had <6 mg/l (p<0.001), chi square test value is ²=73.65 which is statistically significant. Only 7 of the 60 control group had CRP >6 mg/l. Conclusion: In this study mean C-Reactive protein levels were significantly higher in patients with ischemic stroke when compared to controls. C-reactive protein level increases as age advances. C-reactive protein is a better prognostic marker with no gender predilection and not a mortality predictor.

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Alleviation of Neuronal Cell Death and Memory Deficit with Chungkookjang Made with Bacillus amyloliquefaciens and Bacillus subtilis Potentially through Promoting Gut–Brain Axis in Artery-Occluded Gerbils

Foods ◽

10.3390/foods10112697 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2697

Author(s):

Ting Zhang ◽

Myeong-Seon Ryu ◽

Xuangao Wu ◽

Hee-Jong Yang ◽

Su Ji Jeong ◽

...

Keyword(s):

Blood Flow ◽

Cell Death ◽

Ischemic Stroke ◽

Normal Control ◽

Neuronal Cell Death ◽

Neuronal Cell ◽

Artery Occlusion ◽

Control Group ◽

Β Cell ◽

Post Stroke

Short-term fermented soybeans (chungkookjang) with specific Bacillus (B.) spp. have anti-obesity, antidiabetic, and anti-stroke functions. We examined the hypothesis that the long-term consumption of B. amyloliquefaciens SCGB 1 fermented (CKJ1) and B. subtilis SCDB 291 (CKJ291) chungkookjang can alleviate clinical symptoms and hyperglycemia after ischemic stroke by promoting the gut microbiota–brain axis. We examined this hypothesis in Mongolian male gerbils with stroke symptoms induced by carotid artery occlusion. The artery-occluded gerbils were divided into five groups: no supplementation (Control, Normal-control), 4% cooked soybeans (CSB), CKJ1, or CKJ291 in a high-fat diet for 3 weeks. The carotid arteries of gerbils in the Control, CSB, CKJ1, and CKJ291 groups were occluded for 8 min and they then continued on their assigned diets for an additional 3 weeks. Normal-control gerbils had no artery occlusion. The diets in all groups contained an identical macronutrient composition using starch, casein, soybean oil, and dietary fiber. The CSB, CKJ1, and CKJ291 groups exhibited less neuronal cell death than the Control group, while the CKJ1 group produced the most significant reduction among all groups, as much as 85% of the Normal-control group. CKJ1 and CKJ291 increased the blood flow and removal of blood clots, as determined by Doppler, more than the Control. They also showed more improvement in neurological disorders from ischemic stroke. Their improvement showed a similar tendency as neuronal cell death. CKJ1 treatment improved memory impairment, measured with Y maze and passive avoidance tests, similar to the Normal-control. The gerbils in the Control group had post-stroke hyperglycemia due to decreased insulin sensitivity and β-cell function and mass; the CKJ291, CSB, and CKJ1 treatments protected against glucose disturbance after artery occlusion and were similar to the Normal-control. CKJ1 and CKJ291 also reduced serum tumor necrosis factor-α concentrations and hippocampal interleukin-1β expression levels, compared to the Control. CKJ1 and CKJ291 increased the contents of Lactobacillus, Bacillus, and Akkermansia in the cecum feces, similar to the Normal-control. Picrust2 analysis showed that CKJ1 and CKJ291 increased the propionate and butyrate metabolism and the starch and glucose metabolism but reduced the lipopolysaccharide biosynthesis and fatty acid metabolism compared to the Control. In conclusion, daily CKJ1 and CKJ291 intake prevented neuronal cell death and memory dysfunction from the artery occlusion by increasing blood flow and β-cell survival and reducing post-stroke-hyperglycemia through modulating the gut microbiome composition and metabolites to influence the host metabolism, especially inflammation and insulin resistance, protecting against neuronal cell death and brain dysfunction. CKJ1 had better effects than CKJ291.

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