Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study

Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).

Left Atrial Appendage Closure Yields Favorable Cardio- and Cerebrovascular Outcomes in Patients With Non-valvular Atrial Fibrillation and Prior Stroke

Introduction: Patients with non-valvular atrial fibrillation (NVAF) and previous stroke are at significantly higher risk of stroke recurrence. Data on the efficacy of left atrial appendage closure (LAAC) on these patients is limited. The aim of this study was to investigate the differences of LAAC efficacy on long-term cardio- and cerebrovascular outcomes in NVAF patients with vs. without prior stroke.Methods: Three hundred and seventy consecutive NVAF patients who underwent LAAC were enrolled and divided into stroke and non-stroke groups based on history of previous stroke. Endpoints, such as thromboembolism, major bleeding, and mortality post-LAAC, were followed up among groups.Results: Patients in the stroke group had higher mean CHA2DS2-VASc and HAS-BLED scores compared to the non-stroke group (5.1 vs. 3.6 and 4.1 vs. 3.4, both P &lt; 0.001, respectively). Over a median follow-up of 2.2 years, there were no significant differences in incidence rates of thromboembolism, device-related thrombus (DRT), major bleeding, and combined efficacy endpoints between the two groups. In both stroke and non-stroke groups, LAAC decreased the risk of thromboembolism [relative risk reduction (RRR) 87.5%, P = 0.034, and 74.6%, P = 0.004, respectively] and major bleeding (RRR 68.8%, P = 0.034, and 68.6%, P = 0.007, respectively) compared with predicted risk. The RRR in thromboembolism was greater in patients with vs. without prior stroke (OR 2.45, 95% CI: 1.20–5.12, P = 0.016). The incidence rates of all-cause mortality and non-cardiovascular death were similar between the two groups, but the risks of cardiovascular death post-LAAC both before (1.4% vs. 8.1%, respectively, P = 0.038) and after adjustment for confounding factors (P = 0.048) were significantly decreased in the stroke group.Conclusions: Patients with vs. without prior stroke did not exhibit a worse clinical prognosis after LAAC. LAAC may provide an increased benefit in cardio-cerebrovascular outcomes in patients with previous stroke compared to those without previous stroke. Further research is necessary to evaluate the efficacy of LAAC in this field.

COMPARISON OF COGNITIVE FUNCTION BETWEEN FIRST ISCHEMIC STROKE AND RECURRENT ISCHEMIC STROKE PATIENTS

Background: Cognitive impairment is a common condition that may affect up to 50% of stroke patients. Post stroke cognitive impairment is associated with reduced quality of life, which may increase the number of dependency. Recurrent stroke may happen in approximately 25% patients and they have higher rates of cognitive impairment. Objective: The aim of this study is to examine the comparison of cognitive function between first ischemic stroke and recurrent ischemic stroke patients in Hasan Sadikin Hospital, Bandung. Methods: This study is a retrospective, cross-sectional study using the data recruited between the year 2012 - 2016 at the Department of Neurology at the Hasan Sadikin Hospital Bandung. The data collected in this study were demographic data, including age, level of education, and residence, and the clinical data as well. Cognitive function was assessed using Mini-Mental State Examination (MMSE). The comparison between the cognitive function between both groups were analyzed using the Mann-Whitney U test. Results: There were 428 subjects eligible for this study, with 207 subjects categorized as first ischemic stroke group and 221 subjects categorized as recurrent ischemic stroke group. There was a statistically significant difference in MMSE scores between the first ischemic stroke patients (24.90 ± 4.64) and recurrent ischemic stroke patients (22.85 ± 4.64 ) with a p value of 0.002. Conclusion: Recurrent ischemic stroke patients had lower MMSE scores than the first ischemic stroke patients. Clinicians should be more aware in detecting early cognitive impairment in stroke patients and in preventing the incidence of recurrent stroke.

Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients with and without Prior Stroke

Background. Combined atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. Data of the combined procedure in selected patients with prior stroke are limited. The aim of this study is to compare the safety and efficacy of combined catheter ablation and LAAC between AF patients with and without prior stroke. Methods and Results. This retrospective study enrolled 296 patients who underwent combined procedures of AF ablation and LAAC. Patients were divided into two groups: 81 patients with prior stroke (Stroke group) and 215 patients without prior stroke (Control group). Combined procedures were successfully performed in all the patients. Patients in the Stroke group had higher CHA2DS2-VASc scores (4.9 ± 1.2 vs. 3.2 ± 1.0, P < 0.001 ) and higher HAS-BLED scores (3.5 ± 1.1 vs. 3.0 ± 1.0, P < 0.001 ) compared with those in the Control group. Procedure-related complications in the Stroke group included two pericardial effusions and two groin hematomas, which did not differ significantly fromthe Control group (4.9% vs. 4.2%, P = 0.778 ). After a mean follow-up of 20 months, the AF-free rate of the Stroke group was comparable with that of the Control group (64.2% vs. 68.4%, P = 0.495 ). The relative risk reductions in stroke and bleeding (observed rate compared to that predicted from the CHA2DS2-VASc and HAS-BLED scores) were 80% and 79%, respectively, in the Stroke group, and 62% and 62%, respectively, in the Control group. Conclusions. The combination of catheter ablation and LAAC is safe and efficient in selected AF patients with prior stroke. It was observed that patients with prior stroke may benefit more from risk reductions of stroke and bleeding following the combined procedure.

The Effectiveness of Computer-Assisted Cognitive Rehabilitation and the Degree of Recovery in Patients with Traumatic Brain Injury and Stroke

Objectives: To determine the effectiveness of computer-assisted cognitive rehabilitation and compare the patterns of cognitive function recovery occurring in both traumatic brain injury (TBI) and stroke. Methods: A total of 62 patients were finally enrolled, consisting of 30 with TBI and 32 with stroke. The patients received 30 sessions of computer-assisted cognitive rehabilitation (Comcog) five times per week. Each session lasted for 30 min. Before and immediately after cognitive rehabilitation, all patients were evaluated by computerized neuropsychological test (CNT), Mini-Mental State Examination (MMSE), and modified Barthel index (MBI). Results: We analyzed the differences between pre- and post-cognitive rehabilitation in each TBI and stroke group. Significant differences were observed in MMSE, MBI, and some CNT contents, including digit span forward, verbal learning, verbal learning delayed recall, visual span forward, visual span backward, visual learning, trail making test A and B, and intelligence quotient (IQ) in the TBI group (p < 0.05). In the stroke group, in addition to significant differences that appeared in the TBI group, additional significant differences in the digit span backward, visual learning delayed recall, auditory continuous performance test (CPT), visual CPT, and card sorting test. We compared the difference values at pre- and post-cognitive rehabilitation for cognitive recovery between the TBI and stroke groups. All contents, except the digital span forward, visual learning, word-color test, and MMSE, had greater mean values in the stroke group; and thus, statistically significant higher values were observed in the visual span forward and card sorting test (p < 0.05). Conclusion: Most evaluation results showed improvement and the evaluation between the TBI and stroke groups also showed significant differences in cognitive functions in addition to more CNT contents, which significantly change in the stroke group. The stroke group showed a high difference value in most CNT contents. Therefore, those with stroke in the focal brain region tend to have better cognitive function recovery after a computer-assisted cognitive rehabilitation than those with TBI, which could cause diffuse brain damage and post-injury inflammation.

10th Anniversary of Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia Pacific

The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and reliability across the Asia Pacific and beyond. The 10 year journey will be reviewed in the background of many internal and external developments including changes in Asia Pacific stroke epidemiology, stroke care systems, stroke service developments as well as major research studies in the Asia Pacific.

Investigating Relationships between Balance Confidence and Balance Ability in Older Adults

Increasing balance confidence in older individuals is important towards improving their quality of life and reducing activity avoidance. Here, we investigated if balance confidence (perceived ability) and balance performance (ability) in older adults were related to one another and would improve after balance training. The relationship of balance confidence in conjunction with balance performance for varied conditions (such as limiting vision, modifying somatosensory cues, and also base of support) was explored. We sought to determine if balance confidence and ability, as well as their relationship, could change after several weeks of training. Twenty-seven healthy participants were trained for several weeks during standing and walking exercises. In addition, seven participants with a higher risk of imbalance leading to falls (survivors of stroke) were also trained. Prior to and after training, balance ability and confidence were assessed via the Balance Error Scoring System (BESS) and Activities Specific Balance Confidence (ABC) Scale, respectively. Both groups showed improvements in balance abilities (i.e., BESS errors significantly decreased after training). Balance confidence was significantly higher in the healthy group than in the stroke group; however, ABC results reflected that balance confidence did not significantly increase after training for each. The correlations between balance ability and balance confidence were explored. Encouragingly, healthy participants displayed a negative correlation between BESS errors and ABC (i.e., enhancements in balance confidence (increases in ABC Scale results) were related to improvements in balance ability (decreases in BESS errors)). For the stroke participants, despite improvements in balance ability, our results showed that there was no relation to balance confidence (i.e., no correlation between BESS errors and ABC) in this group.

Altered neurogenic pathways in experimental rat models of ischemic cerebral stroke: A transcriptome based meta-analysis

Objectives: Promoting neurogenesis mediated recovery is one of the most sought after strategies in recovery after cerebral stroke. In this paper we elucidate how neurogenesis related genes are altered in the early stroke environment, to hint at potential pathways for therapeutic recovery. Materials and Methods: Around 97 microarray datasets derived from stroke affected rat brains were collected from NCBI-GEO. Datasets were normalized and subjected to a meta-analysis in Network Analyst to identify differentially expressed genes. Gene enrichment analyses were carried out using GSEA, and WebGestalt and results were visualized using Cytoscape Enrichment mapping. Results: Nearly 939 differentially expressing genes were identified in the cerebral stroke group. Among them, 30 neurogenesis related genes were identified through enrichment mapping analysis, and 35 genes through Protein-Protein Interaction analysis. Highest upregulated neurogenesis genes were found to be TSPO, GFAP, VIM, and TGFB1. The Highest Downregulated neurogenesis genes were found to be THY1, NR1D1, CDK5, STX1B, and NOG. Conclusions: Through this study, we have identified that during the acute time frame after stroke, the majority of the neurogenesis genes related to neural proliferation and neural differentiation are downregulated, while the majority of the genes related to neuronal migration were upregulated. A single or combined therapeutic approach against the identified dysregulated genes could greatly aid neural restoration and functional recovery during the postischemic stage.

Risk Factors of Restroke in Patients with Lacunar Cerebral Infarction Using Magnetic Resonance Imaging Image Features under Deep Learning Algorithm

This study was aimed to explore the magnetic resonance imaging (MRI) image features based on the fuzzy local information C-means clustering (FLICM) image segmentation method to analyze the risk factors of restroke in patients with lacunar infarction. In this study, based on the FLICM algorithm, the Canny edge detection algorithm and the Fourier shape descriptor were introduced to optimize the algorithm. The difference of Jaccard coefficient, Dice coefficient, peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), running time, and segmentation accuracy of the optimized FLICM algorithm and other algorithms when the brain tissue MRI images were segmented was studied. 36 patients with lacunar infarction were selected as the research objects, and they were divided into a control group (no restroke, 20 cases) and a stroke group (restroke, 16 cases) according to whether the patients had restroke. The differences in MRI imaging characteristics of the two groups of patients were compared, and the risk factors for restroke in lacunar infarction were analyzed by logistic multivariate regression. The results showed that the Jaccard coefficient, Dice coefficient, PSNR value, and SSIM value of the optimized FLICM algorithm for segmenting brain tissue were all higher than those of other algorithms. The shortest running time was 26 s, and the highest accuracy rate was 97.86%. The proportion of patients with a history of hypertension, the proportion of patients with paraventricular white matter lesion (WML) score greater than 2 in the stroke group, the proportion of patients with a deep WML score of 2, and the average age of patients in the stroke group were much higher than those in the control group ( P < 0.05 ). Logistic multivariate regression showed that age and history of hypertension were risk factors for restroke after lacunar infarction ( P < 0.05 ). It showed that the optimized FLICM algorithm can effectively segment brain MRI images, and the risk factors for restroke in patients with lacunar infarction were age and hypertension history. This study could provide a reference for the diagnosis and prognosis of lacunar infarction.

Neurofilament Light Chain Protein Is a Predictive Biomarker for Stroke After Surgical Repair for Acute Type A Aortic Dissection

Background: Although great progress has been made in surgery and perioperative care, stroke is still a fatal complication of acute type A aortic dissection (ATAAD). Serum biomarkers may help assess brain damage and predict patient's prognosis.Methods: From March, 2019 to January, 2020, a total of 88 patients underwent surgical treatment at the Department of Cardiovascular Surgery of Beijing Anzhen Hospital, China, and were enrolled in this study. Patients were divided into two groups according to whether they had suffered a stroke after the operation. Blood samples were collected at 8 time points within 3 days after surgery to determine the level of S100β, neuron-specific enolase (NSE) and neurofilament light chain protein (NFL). Receiver operating characteristic curves (ROC) were established to explore the biomarker predictive value in stroke. The area under the curve (AUC) was used to quantify the ROC curve.Results: The patient average age was 48.1 ± 11.0 years old and 70 (79.6%) patients were male. Fifteen (17.0%) patients suffered stroke after surgery. The NFL levels of patients in the stroke group at 12 and 24 h after surgery were significantly higher than those in the non-stroke group (all P &lt; 0.001). However, the NSE and S100β levels did not differ significantly at any time point between the two groups. The predictive value of NFL was the highest at 12 and 24 h after surgery, and the AUC was 0.834 (95% CI, 0.723–0.951, P &lt; 0.001) and 0.748 (95% CI, 0.603–0.894, P = 0.004), respectively. Its sensitivity and specificity at 12 h were 86.7 and 71.6%, respectively. The NFL cutoff value for the diagnosis of stroke at 12 h after surgery was 16.042 ng/ml.Conclusions: This study suggests that NFL is an early and sensitive serum marker for predicting post-operative neurological prognosis of ATAAD patients. Further studies, including large-scale prospective clinical trials, are necessary to test whether the NFL can be used as a biomarker for clinical decision-making.