scholarly journals Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

2021 ◽  
Vol 10 (15) ◽  
pp. 3344
Author(s):  
Ali M. Alawieh ◽  
Nicholas Au Yong ◽  
Nicholas M. Boulis
Keyword(s):  
Ischemic Stroke ◽  
Large Scale ◽  
Surgical Intervention ◽  
Nerve Transfer ◽  
The United States ◽  
Chronic Stroke ◽  
Stroke Recovery ◽  
Current Evidence ◽  
Treatment Protocols ◽  
Stroke Research

Ischemic stroke remains a major cause of disability in the United States and worldwide. Following the large-scale implementation of stroke thrombectomy and the optimization of treatment protocols for acute stroke, the reduction in stroke-associated mortality has resulted in an increased proportion of stroke survivors, many of whom have moderate to severe disability. To date, the treatment of subacute and chronic stroke has remained a challenge. Several approaches, involving pharmacological interventions to promote neuroplasticity, brain stimulation strategies and rehabilitative interventions, are currently being explored at different stages of the translational spectrum, yet level 1 evidence is still limited. In a recent landmark study, surgical intervention using contralateral C7 nerve transfer, an approach used to treat brachial plexus injury, was implemented in patients with chronic stroke, demonstrating an added benefit to standard rehabilitation strategies, leading to improved motor performance and reduced spasticity. The procedure involved the transfer of the C7 nerve root and middle trunk from the uninjured extremity to the injured extremity using a short conduit that allows for faster regeneration and innervation of the injured upper extremity via the ipsilateral (contralesional) hemisphere. In this work, we review the rationale for using contralateral C7 nerve transfer in stroke, describe the surgical intervention with associated variations and limitations, and discuss the current evidence for the efficacy of this technique in ischemic stroke research.

scholarly journals Longitudinal Effects of Lesions on Functional Networks after Stroke

2013 ◽  
Vol 33 (8) ◽  
pp. 1279-1285 ◽  
Author(s):  
Smadar Ovadia-Caro ◽  
Kersten Villringer ◽  
Jochen Fiebach ◽  
Gerhard Jan Jungehulsing ◽  
Elke van der Meer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Resting State ◽  
Large Scale ◽  
Clinical Symptoms ◽  
Resting State Fmri ◽  
Functional Change ◽  
Stroke Recovery ◽  
Focal Lesion ◽  
Supporting Evidence ◽  
Post Stroke

While ischemic stroke reflects focal damage determined by the affected vascular territory, clinical symptoms are often more complex and may be better explained by additional indirect effects of the focal lesion. Assumed to be structurally underpinned by anatomical connections, supporting evidence has been found using alterations in the functional connectivity of resting-state functional magnetic resonance imaging (fMRI) data in both sensorimotor and attention networks. To assess the generalizability of this phenomenon in a stroke population with heterogeneous lesions, we investigated the distal effects of lesions on a global level. Longitudinal resting-state fMRI scans were acquired at three consecutive time points, beginning during the acute phase (days 1, 7, and 90 post-stroke) in 12 patients after ischemic stroke. We found a preferential functional change in affected networks (i.e., networks containing lesions changed more during recovery when compared with unaffected networks). This change in connectivity was significantly correlated with clinical changes assessed with the National Institute of Health Stroke Scale. Our results provide evidence that the functional architecture of large-scale networks is critical to understanding the clinical effect and trajectory of post-stroke recovery.

scholarly journals The Impact of Neurofeedback on Effective Connectivity Networks in Chronic Stroke Patients

2020 ◽  
Author(s):  
Lioi Giulia ◽  
Veliz Adolfo ◽  
Coloigner Julie ◽  
Duché Quentin ◽  
Butet Simon ◽  
...  
Keyword(s):  
Neural Plasticity ◽  
Large Scale ◽  
Scale Effects ◽  
Self Regulation ◽  
Chronic Stroke ◽  
Causal Modeling ◽  
Stroke Recovery ◽  
Functional Improvement ◽  
Stroke Patients ◽  
The Impact

AbstractStroke is a complex motor disease that not only affects perilesional areas but also global brain networks in both hemispheres. Neurofeedback (NF) is a promising technique to enhance neural plasticity and support functional improvement after stroke by means of brain self-regulation. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on motor outcomes and successful activation of targeted cortical regions. However, given the crucial role of large-scale networks reorganization for stroke recovery, it is now believed that assessment of brain connectivity is central to predict treatment response and to individualize rehabilitation therapies. In this study, we assessed the impact of EEG-fMRI NF training on connectivity strength and direction using a Dynamic Causal Modeling approach. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas. Our results in nine chronic stroke patients indicate that NF upregulation of targeted areas (ipsilesional SMA and M1) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task. To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.

scholarly journals The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after stroke

2020 ◽  
Author(s):  
Sook-Lei Liew ◽  
Artemis Zavaliangos-Petropulu ◽  
Neda Jahanshad ◽  
Catherine E. Lang ◽  
Kathryn S. Hayward ◽  
...  
Keyword(s):  
Big Data ◽  
Working Group ◽  
Large Scale ◽  
Meta Analysis ◽  
Brain Magnetic Resonance Imaging ◽  
Stroke Recovery ◽  
Data Harmonization ◽  
Stroke Research ◽  
Brain And Behavior ◽  
Data Collaboration

The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 1,800 stroke patients collected across 32 research sites and 10 countries around the world, comprising the largest multi-site retrospective stroke data collaboration to date. This paper outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multi-site stroke brain magnetic resonance imaging (MRI), behavioral and demographics data. Specifically, the processes for scalable data intake and pre-processing, multi-site data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.

scholarly journals Dynamic Changes of Gut Microbiome and Immune Response During the Acute Stage of Stroke in a Pig Model (P14-012-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Julie Jeon ◽  
Jeferson Lourenco ◽  
Erin Kaiser ◽  
Elizabeth Waters ◽  
Kelly Scheulin ◽  
...  
Keyword(s):  
Immune Response ◽  
Ischemic Stroke ◽  
Gut Microbiome ◽  
Critical Role ◽  
The United States ◽  
Acute Stage ◽  
Pig Model ◽  
Stroke Recovery ◽  
Microbiome Composition ◽  
Α Diversity

Abstract Objectives Stroke is a leading cause of mortality and disability in the United States. Secondary injuries induced by inflammation plays a critical role in stroke recovery. This study investigates gut microbiome changes during the acute stage of ischemic stroke to better understand the role of gut microbiome in inflammation in an ischemic stroke pig model. Methods Ischemic stroke was induced by middle cerebral artery occlusion in pigs (n = 7). Fecal samples were collected at pre-stoke (PRE), 1 (1DPS), 3 (3DPS), and 5 days post-stroke (5DPS) to measure gut microbiome composition. Blood samples were collected at 1DPS for white blood cell analysis. Results Ischemic stroke was confirmed by magnetic resonance imaging at 1DPS. The dominant pre-stroke fecal bacterial phyla (>1% relative abundance) were Firmicutes (89.2%), Bacteroidetes (3.7%), Actinobacteria (2.0%) and Proteobacteria (1.3%). This composition significantly (P < 0.05) differed at 3DPS with a decreased Firmicutes (68.1%) and increased Actinobacteria (3.70%) and Proteobacteria (19.0%), and a trending (P = 0.06) increase among Bacteroidetes (7.6%). At 5DPS, Bacteroidetes (7.6%) remained elevated, but Firmicutes (86.6%), Actinobacteria (2.0%) and Proteobacteria (0.7%) returned to levels similar to PRE. At 1DPS, the α-diversity measured by Shannon index and species evenness were both decreased (P < 0.05), suggesting that overall bacterial diversity decreased immediately after the stroke. β-diversity analysis showed a trend for overall differences over time (P = 0.07), but no differences between specific days were found. Elevated inflammation and neutrophil-to-lymphocyte ratio (NLR) following stroke event have been related to negative functional outcome in stroke patients. At 1DPS, a significant increase in NLR was observed in the stroke pigs compared to those at PRE (P < 0.05), suggesting initiation of inflammatory response following stroke. Conclusions Ischemic stroke altered the gut microbiome composition, reduced microbiome diversity and increased immune response in pigs. Future studies are warranted to investigate systemic and neural inflammation mediated by the alteration of the gut microbiome following ischemic stroke. Funding Sources The study was funded by the National Institute of Health and University of Georgia (Faculty Research Grant).

Spatiotemporal electrophysiology of cerebral ischemia observed using chronic electrode array in auditory cortex

2008 ◽  
Vol 2 (1) ◽  
Author(s):  
M.T. Huberty ◽  
P. Tek ◽  
P.J. Rousche
Keyword(s):  
Auditory Cortex ◽  
Time Course ◽  
Electrode Array ◽  
The United States ◽  
Stroke Recovery ◽  
Sprague Dawley ◽  
Stroke Research ◽  
Sprague Dawley Rats ◽  
The Mean

Stroke research is of considerable societal value in an age in which the scourge is a leading cause of disability and the third-leading cause of death in the United States. While previous studies investigate the electrophysiology of stroke, none examine the long-term time-course of stroke recovery in the auditory cortex, the objective of this study. An electrode was implanted in the auditory cortex of two anesthetized Sprague-Dawley rats, stroke was induced in one of the subjects using photothrombosis, and daily electrical recordings were made while each subject was presented with a click stimulus every 500 ms. Peri-stimulus time histograms reveal that in the control subject, the second stimulus-evoked bursts peak decreased the day following implantation (Day 1) but returned almost to its Day 0 (day of surgery) value by Day 5, representing recovery from implantation trauma. The mean firing rate decreased logarithmically from its Day 0 value of 90 Hz to 10 Hz by Day 8, revealing decreasing electrode viability. In the stroke subject, the second stimulus-evoked bursts peak was undetected Day 1, but was detected again on Day 4, elucidating that the rat auditory cortex regains function as stroke recovery progresses.

Abstract WMP49: Temporal Trends in the Burden of Atrial Fibrillation in Acute Ischemic Stroke and Transient Ischemic Attack in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Seemant Chaturvedi ◽  
Jose G Romano ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Large Scale ◽  
Temporal Trends ◽  
The United States ◽  
Hospital Size ◽  
Ischemic Attack

Background: Large scale data on atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) is sparse since approval of dabigatran for non-valvular AF in 2010. We studied recent trends in prevalence of AF in AIS and transient ischemic attack (TIA) in the United States (US) and association of AF with in-hospital mortality, cost and length of stay (LOS) in AIS. Methods: Adults admitted to US hospitals from 2007-2012 with diagnosis of AIS (n=3,427,806) and TIA (n=502,820) were identified from the Nationwide Inpatient Sample. Weighted prevalence of AF in AIS and TIA by demographics and region was computed. Multivariate logistic regression was used to evaluate association of AF with other clinical factors and mortality in AIS. Association of AF with LOS and cost was assessed using generalized linear models. Results: AF prevalence increased by 11.5% in AIS (22%-24.5%, p<0.001) and by 29% in TIA (13.5%-17.4%, p<0.001) from 2007-2012. AF prevalence varied by age (AIS: 7% in 50-59yo vs 38% in >80yo; TIA: 5% in 50-59yo vs 27% in >80yo), sex (AIS: 20% in M vs 25% in F); TIA: 16% in M vs 15% in F), race (AIS: whites 26% vs blacks 12%) and region (AIS: Northeast 25% vs South 21%). AF prevalence increased in all subgroups over time (p<0.001) except AIS <40yo and TIA<50yo (Figure 1). Advancing age, female sex, white race, high income, Medicare insurance, CHA 2 DS 2 -VASc score and large hospital size were associated with increased odds of AF in AIS. AF was positively associated with death (OR=1.60, 95%CI 1.56-1.64) but mortality in AIS with AF decreased from 13.2% in 2007 to 10.7% in 2012 (p<0.001). AF was associated with increased cost of $2,631 and LOS 1.1 days in AIS. Conclusion: Prevalence of AF in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality, LOS and hospital cost in AIS but mortality in AIS with AF is decreasing. More AIS preventive efforts are needed in AF patients especially in the elderly.

scholarly journals Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study

10.2196/27419 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e27419
Author(s):  
Junjiang Li ◽  
Philippe Giabbanelli
Keyword(s):  
United States ◽  
Large Scale ◽  
Vaccination Campaign ◽  
Vaccination Strategy ◽  
The United States ◽  
Current Evidence ◽  
Logistic Growth ◽  
Agent Based ◽  
Current Availability ◽  
Nonpharmaceutical Interventions

Background In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. Objective We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. Methods We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. Results For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. Conclusions Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections.

scholarly journals Sex-specific lesion topographies explain outcomes after acute ischemic stroke

2020 ◽  
Author(s):  
Anna K. Bonkhoff ◽  
Markus D. Schirmer ◽  
Martin Bretzner ◽  
Sungmin Hong ◽  
Robert W. Regenhardt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Large Scale ◽  
Stroke Severity ◽  
Men And Women ◽  
Language Functions ◽  
Stroke Research ◽  
Modelling Framework ◽  
Lesion Pattern

AbstractAcute ischemic stroke affects men and women differently in many ways. In particular, women are oftentimes reported to experience a higher acute stroke severity than men. Here, we derived a low-dimensional representation of anatomical stroke lesions and designed a sex-aware Bayesian hierarchical modelling framework for a large-scale, well phenotyped stroke cohort. This framework was tailored to carefully estimate possible sex differences in lesion patterns explaining acute stroke severity (NIHSS) in 1,058 patients (39% female). Anatomical regions known to subserve motor and language functions emerged as relevant regions for both men and women. Female patients, however, presented a more widespread pattern of stroke severity-relevant lesions than male patients. Furthermore, particularly lesions in the posterior circulation of the left hemisphere underlay a higher stroke severity exclusively in women. These sex-sensitive lesion pattern effects could be discovered and subsequently robustly replicated in two large independent, multisite lesion datasets. The constellation of findings has several important conceptual and clinical implications: 1) suggesting sex-specific functional cerebral asymmetries, and 2) motivating a sex-stratified approach to management of acute ischemic stroke. To go beyond sex-averaged stroke research, future studies should explicitly test whether acute therapies administered on the basis of sex-specific cutoff volumes of salvageable tissue will lead to improved outcomes in women after acute ischemic stroke.

Quality Control of Data in a Large-Scale Cancer Register Program

1966 ◽  
Vol 05 (02) ◽  
pp. 67-74 ◽  
Author(s):  
W. I. Lourie ◽  
W. Haenszeland
Keyword(s):  
United States ◽  
Quality Control ◽  
Cancer Patients ◽  
Large Scale ◽  
The United States ◽  
Newly Diagnosed ◽  
Related Data ◽  
Cancer Register ◽  
Independent Review ◽  
End Results

Quality control of data collected in the United States by the Cancer End Results Program utilizing punchcards prepared by participating registries in accordance with a Uniform Punchcard Code is discussed. Existing arrangements decentralize responsibility for editing and related data processing to the local registries with centralization of tabulating and statistical services in the End Results Section, National Cancer Institute. The most recent deck of punchcards represented over 600,000 cancer patients; approximately 50,000 newly diagnosed cases are added annually.Mechanical editing and inspection of punchcards and field audits are the principal tools for quality control. Mechanical editing of the punchcards includes testing for blank entries and detection of in-admissable or inconsistent codes. Highly improbable codes are subjected to special scrutiny. Field audits include the drawing of a 1-10 percent random sample of punchcards submitted by a registry; the charts are .then reabstracted and recoded by a NCI staff member and differences between the punchcard and the results of independent review are noted.

Assessment of quality of life in patients with the effects of transient ischemic stroke

2016 ◽  
pp. 37-39
Author(s):  
A. Babirad
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Large Scale ◽  
Cerebrovascular Diseases ◽  
Control Measures ◽  
Sociological Research ◽  
Cerebrovascular Events ◽  
Sf 36 ◽  
Angioplasty And Stenting

Cerebrovascular diseases are a problem of the world today, and according to the forecast, the problem of the near future arises. The main risk factors for the development of ischemic disorders of the cerebral circulation include oblique and aging, arterial hypertension, smoking, diabetes mellitus and heart disease. An effective strategy for the prevention of cerebrovascular events is based on the implementation of large-scale risk control measures, including the use of antiagregant and anticoagulant therapy, invasive interventions such as atheromectomy, angioplasty and stenting. In this connection, the efforts of neurologists, cardiologists, angiosurgery, endocrinologists and other specialists are the basis for achieving an acceptable clinical outcome. A review of the SF-36 method for assessing the quality of life in patients with the effects of transient ischemic stroke is presented. The assessment of quality of life is recognized in world medical practice and research, an indicator that is also used to assess the quality of the health system and in general sociological research.

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