Acute Stage Of Stroke Research Articles

Analysis of Clinical Characteristics of Cognitive Impairment in Patients with Acute Hemorrhagic Stroke

To study the clinical characteristics of cognitive impairment in patients with hemorrhagic stroke, Birmingham cognitive screen test, mini-mental state examination, Montreal cognitive assessment was used to evaluate the cognitive function of acute hemorrhagic stroke and the incidence and clinical characteristics of cognitive impairment was evaluated. Seventy acute hemorrhagic stroke patients were enrolled in the study and the abnormal rates of Birmingham cognitive screen test, mini-mental state examination and Montreal cognitive assessment were 81.42, 33.34 and 41.5 %, respectively. Birmingham cognitive screen test showed that patients with acute hypertensive intracerebral hemorrhage have cognitive impairment in many aspects, especially in language function, memory, attention, executive function, number and application ability and the damage rate was more than 30 %. Different degrees of cognitive impairment involving multiple cognitive domains could occur in the acute stage of hemorrhagic stroke, among which language ability, memory, execution and application ability were the most common. Compared to minimental state examination and Montreal cognitive assessment, Birmingham cognitive screen test has a higher detection rate of cognitive impairment after hypertensive hemorrhage and a more comprehensive evaluation of cognitive function.

MicroRNA-126-3p/-5p Overexpression Attenuates Blood-Brain Barrier Disruption in a Mouse Model of Middle Cerebral Artery Occlusion.

Background and Purpose- Blood-brain barrier (BBB) disruption is a critical pathological feature after stroke. MicroRNA-126 (miR-126) maintains BBB integrity by regulating endothelial cell function during development. However, the role of miR-126-3p and -5p in BBB integrity after stroke is unclear. Here, we investigated whether miR-126-3p and -5p overexpression regulates BBB integrity after cerebral ischemia. Methods- A lentivirus carrying genes encoding miR-126-3p or -5p was stereotactically injected into adult male Institute of Cancer Research mouse brains (n=36). Permanent middle cerebral artery occlusion was performed 2 weeks after virus injection. Brain infarct volume, edema volume, and modified neurological severity score were assessed at 1 and 3 days after ischemia. Immunostaining of ZO-1 (zonula occludens-1) and occludin was used to evaluate BBB integrity. IL-1β (interleukin-1β), TNF-α (tumor necrosis factor-α), VCAM-1 (vascular cell adhesion molecule-1), and E-selectin expression levels were determined by real-time polymerase chain reaction and Western blot analysis. Results- The expression of miR-126-3p and -5p decreased at 1 and 3 days after ischemia (P<0.05). Injection of lentiviral miR-126-3p or -5p reduced brain infarct volume and edema volume (P<0.05) and attenuated the decrease in ZO-1/occludin protein levels and IgG leakage at 3 days after stroke (P<0.05). Injection of lentiviral miR-126-5p improved behavioral outcomes at 3 days after stroke (P<0.05). miR-126-3p and -5p overexpression downregulated the expression of proinflammatory cytokines IL-1β and TNF-α and adhesion molecules VCAM-1 and E-selectin, as well as decreased MPO+ (myeloperoxidase positive) cell numbers at 3 days after ischemia (P<0.05). Conclusions- miR-126-3p and -5p overexpression reduced the expression of proinflammatory cytokines and adhesion molecules, and attenuated BBB disruption after ischemic stroke, suggesting that miR-126-3p and -5p are new therapeutic targets in the acute stage of stroke.

A practical protocol for shortening reconstruction time of volumetric data and imaging bilateral middle cerebral arteries for thrombectomy in acute ischemic stroke using an 80-row computed tomography scanner.

Time-consuming reconstruction of volumetric data by area-detector-computed tomography (ADCT) scanning and narrow coverage of small-row ADCT may hinder volumetric scanning in acute stroke stage. To design a practical protocol of volumetric scanning for thrombectomy using an 80-row ADCT. An imaging protocol that focuses on the middle cerebral arteries by tilting the gantry of an 80-row ADCT with 0.5-mm-thick detectors can shorten the reconstruction time by 1.0-mm thickness scanning without subtraction. The reconstruction time of small volumetric data was 69 second. This practical protocol is applicable before thrombectomy in different stroke centres with narrow-coverage ADCT scanners.

Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study

BackgroundTranscranial Direct Current Stimulation has been increasing in popularity in the last few years. Despite vast amounts of articles on the use of tDCS on stroke patients, very little has been done during the acute phase. ObjectivesMeasure the effects of tDCS on functional and sensory outcomes throughout the first year post onset of stroke. Methods50 acute stroke patients were randomized and placed into either the treatment or sham group. Anodal tDCS was applied (2 mA, 20 min) 5 times a week during the first month post stroke. Patients were evaluated with the Wolf Motor Function Test, the Semmes Weinstein Monofilament Test, the Upper Extremity section (UEFM), the Lower Extremity section (LEFM) and the Somatosensory section of the Fugl Meyer Test, the Tardieu Spasticity Scale, the Stroke Impact Scale (SIS), the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index. Evaluations were held at 48 h post stroke, week 1, 2, 3, 4, 3 months, 6 months and 1 year. ResultsThere were statistically and clinically significant improvements after tDCS in all functional motor outcomes, and somatosensory functions. Differences between both groups for the main outcome (WMFT time) were 51% (p = 0.04) at one month, and 57% (p = 0.02) at one year. ConclusiontDCS seems to be an effective adjuvant to conventional rehabilitation techniques. If applied in the acute stages of stroke, functional recovery is not only accelerated, but improved, and results are maintained up to one-year post stroke.

Prior antithrombotic use is significantly associated with decreased blood viscosity within 24 hours of symptom onset in patients with acute ischemic stroke

Background Blood viscosity (BV) is the intrinsic resistance of blood to flow and is a measure of blood stickiness. Several clinical and epidemiologic studies have demonstrated an association between BV and the occurrence of major thromboembolic events. Although BV is significantly higher in cases of lacunar or cardioembolic strokes, its relationship with demographic and laboratory parameters during the acute stage of ischemic stroke is unknown. We investigated the relationship between baseline characteristics of acute ischemic stroke and BV within 24 hours of symptom onset in patients with acute ischemic stroke. Methods We enrolled patients aged 40 years or older with documented histories of ischemic stroke or transient ischemic attack within 24 hours of symptom onset. A scanning capillary-tube viscometer was used to assess whole BV. Results The mean age was 69.6±12.03 years and 44.4% of the patients were female. Of 189 patients, 68.3% had a history of hypertension; 27%, diabetes; 42.9%, hypercholesterolemia; 3.7%, coronary artery disease; and 18%, stroke. Additionally, 40.7% were current smokers. Sixty-one patients (32.3%) were regularly taking antithrombotics. Multiple linear regression analysis revealed that hematocrit was positively corelated with increased BV and prior antithrombotic use was corelated with decreased BV. Hematocrit-adjusted partial correlation demonstrated that prior antithrombotic use was significantly associated with decreased BV. Conclusion Prior antithrombotic use is significantly associated with decreased BV within 24 hours of symptom onset in patients with acute ischemic stroke. Our findings indicate that antithrombotic medications may change the hemorheological profile in these patients. Key Words: Aspirin; Blood viscosity; Hematocrit; Blood platelets; Stroke

Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes.

Background:Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.Objective:We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.Methods:This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.Results:The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (, and , respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.Conclusion:Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

Stroke during pregnancy and puerperium among Japanese women: a single-center registry

Background Stroke is one of the major causes of maternal death. This study aimed to analyze the maternal and fetal outcomes of stroke occurred during pregnancy and puerperium. Methods We conducted a retrospective analysis of patients admitted to our perinatology center between 1982 and 2012 with a diagnosis of acute cerebral stroke during pregnancy or within 6 weeks postpartum. Results Thirty-four patients were registered and all the patients had never been diagnosed as stroke nor detected cerebrovascular abnormalities before the current pregnancies. They were divided into 8 ischemic strokes (ISs) and 26 intracranial hemorrhage group. In the hemorrhage group, there was a spontaneous abortion and two patients chose artificial abortions to avoid rehemorrhage, and there were another three intrauterine fetal deaths (IUFDs) in the acute stage of maternal stroke. More patients in hemorrhage group delivered in preterm than in IS group for the treatment of stroke, 10/23 (43%) versus 0/8 (0%), p < .05. More patients in hemorrhage group had low Glasgow Coma Scale (GCS) (3–8) than in IS group at the onset of the stroke, 12/26 (46%) versus 0/8 (0%), p < .05. There were three maternal deaths and 6/23 (26%) were neurologically dependent in hemorrhage group in the chronic stage, whereas 87% were independent in IS group, p < .05. Conclusions Hemorrhagic stroke was more common etiology of stroke related to pregnancy than IS in this study. Intensive and multidisciplinary care was needed especially in hemorrhagic stroke related to pregnancy as in the hemorrhagic stroke the fetal survival rate was lower, and maternal conscious levels at the onset of the stroke and neurological outcomes in the chronic stage were worse than IS.

QM-FOrMS: A portable and cost-effective upper extremity rehabilitation system

Abstract Long-term rehabilitation opportunities are critical for millions of individuals with chronic upper limb motor deficits striving to improve their motor performance. While formal rehabilitation is well organized in the acute stages of stroke, there is minimal professional support of rehabilitation across the lifespan. In this paper, we introduce an upper extremity rehabilitation system, the Quality of Movement Feedback-Oriented Measurement System (QM-FOrMS), by integrating cost-effective portable sensors and clinically verified motion quality analysis towards individuals with upper limb motor deficits. Specifically, QM-FOrMS is comprised of an eTextile pressure sensitive mat, named Smart Mat, a sensory can, named Smart Can, and a mobile device. A personalizable and adaptive upper limb rehabilitation program is developed, including both unilateral and bilateral functional activities which can be selected from a list or custom designed to further tailor the program to the individual.

Effect of Nebivolol and Olmesartan on 24-Hour Brachial and Aortic Blood Pressure in the Acute Stage of Ischemic Stroke.

Background Elevated blood pressure (BP) in the acute phase of ischemic stroke is associated with heightened risk of early disability and death. However, whether BP-lowering in this setting is beneficial and the exact levels at which BP should be targeted remain unclear. This study aimed to evaluate the effect of nebivolol, olmesartan, and no-treatment on 24-hour BP in patients with hypertension during the acute poststroke period. Methods In a single-blind fashion, 60 patients with acute ischemic stroke and clinic systolic BP (SBP) 160–220 mmHg were randomized to nebivolol (5 mg/day), olmesartan (20 mg/day), or no-treatment between Day 4 and Day 7 of stroke onset. BP-lowering efficacy was assessed through 24-hour BP monitoring using the Mobil-O-Graph device (IEM, Germany). Results Between baseline and Day 7, significant reductions in 24-hour brachial SBP were noted with nebivolol and olmesartan, but not with no-treatment. Change from baseline (CFB) in 24-hour brachial SBP was not different between nebivolol and olmesartan groups (between-group difference: −3.4 mmHg; 95% confidence interval (CI): −11.2, 4.3), whereas nebivolol was superior to no-treatment in lowering 24-hour brachial SBP (between-group difference: −7.8 mmHg; 95% CI: −7.8 mmHg; 95% CI: −15.6, −0.1). Similarly, nebivolol and olmesartan equally lowered 24-hour aortic SBP (between-group difference: −1.9 mmHg; 95% CI: −10.1, 6.2). Nebivolol and olmesartan provoked similar reductions in 24-hour heart rate-adjusted augmentation index and pulse wave velocity. Conclusion This study suggests that during the acute phase of ischemic stroke, nebivolol is equally effective with olmesartan in improving 24-hour aortic pressure and arterial stiffness indices. ClinicalTrials.gov identifier number: NCT03655964.

Features of the cytotoxic effect of lymphocytes with cardiolipin in patients with ischemic stroke in low mountain area

Sensitization to phospholipids can act not only as an immediate cause of development of the ischemic stroke (IS) itself, but as its complications also, which, in combination with other factors may aggravate the course of the disease. One of the rarely used methods that reflect the state of lymphocyte sensitization and tendency to thrombus formation is the study of the reaction of the cytotoxic effect of lymphocytes to cardiolipin (CESL) Recognition of the concept of pathogenetic heterogeneity of ischemic cerebral blood circulation is of great practical importance, since only upon revealing the cause and pathogenetic mechanism of the development of an acute cerebrovascular episode, it becomes possible to conduct adequate therapy and secondary prevention We examined 36 patients with diagnosis of IS on 1st and 10th day since onset of the disease. The average age 64.50±10.88.The diagnosis was verified by clinical examinations, including hemostasiological screening studies. CESL was determined by the standard method. The higher rates of CESL in the examined patients were observed on the background of hypercoagulable changes in the blood. Since sensitization to cardiolipin contributes to an increased tendency to thrombus formation, our data can reflect this process in severe acute and acute stage of ischemic stroke. In patients with ischemic stroke, autoimmune reactions of lymphocytes to cardiolipin are detected. The apparency of cytotoxic reactions of lymphocytes to cardiolipin depends on the severity of the process. The CESL for cardiolipin may serve as an additional criterion for the presence of hemostasiological disorders in patients with cerebral infarctions.

Category specific recall in acute stroke: a case with letter speech

ABSTRACTCategory selective recall in spontaneous speech after stroke has been reported only rarely. We recently described three cases demonstrating transient number speech in the acute stage of left hemispheric stroke and hypothesized a link with multilingualism and mathematical proficiency. In this report, we describe a similar case with a transient episode of utterances of randomly selected letters. Like in the three previous cases, this episode was preceded by a brief stage of mutism and ultimately evolved to Wernicke’s aphasia over a period of days. This phenomenon is reviewed with reference to linguistic models and neuroanatomic and neurophysiological correlates.

The relationship between social cognitive difficulties in the acute stages of stroke and later functional outcomes

ABSTRACTAlthough social cognitive difficulties are common following stroke, the extent to which such difficulties observed in the acute phase are related to long-term socioemotional outcomes remains poorly understood. To address this question empirically, 53 stroke patients completed a measure of Theory of Mind (The Reading the Mind in the Eyes Test) and a cognitive flexibility measure that has been related to social cognitive processes (a Reversal Learning Task) at hospital bedside. These participants then completed measures of socioemotional functioning at a 6-month follow-up. Baseline difficulties on the two measures were found to predict distinct types of socioemotional difficulties. The RMET uniquely predicted self-reported depression and loneliness whereas the Reversal Learning task uniquely predicted peer-reported social behavior, specifically social inappropriateness and stereotyping and prejudice. Importantly, a measure of general cognitive function did not explain variance in these outcome measures, suggesting that social cognitive difficulties are linked to poor socioemotional outcomes. By showing for the first time that social cognitive deficits observed acutely post-stroke are related to longer term functional outcomes, these findings reinforce the importance of including brief social cognitive measures as part of routine post-stroke clinical assessment.

Impact of Collateral Status on Neuroprotective Effect of Cyclosporine A in Acute Ischemic Stroke

Neuroprotection for acute ischemic stroke remains an elusive goal. Intracranial collaterals may favor neuroprotective drugs delivery at the acute stage of ischemic stroke. A recent phase 2 study showed that cyclosporine A (CsA) reduced ischemic damage in patients with a proximal occlusion who experienced effective recanalization. Collateral flow may improve this benefit. Collateral supply was assessed using dynamic susceptibility contrast MRI in 47 patients among the 110 patients from the original study and were graded in two groups: good collaterals and poor collaterals. Patients with good collaterals had significantly smaller initial infarct in both CsA group (p = 0.003) and controls (p = 0.016). Similarly, the final lesion volume was significantly lower in patients with good collaterals in both groups. In patients with either good or poor collaterals CsA showed no additional benefit on ischemic lesion progression and final infarct size at day 30. We failed to demonstrate any significant additional benefit of CsA in patients with good collateral circulation.

Factors affecting the occurrence of gastrointestinal bleeding in acute ischemic stroke patients.

Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine:(1) the risk factors of GIB in acute cerebral infarction patients;(2) association between GIB and 1-year mortality in patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. A 1:1 matched case-control method and conditional logistic regression models for single and multiple factors were used to assess the risk factors of GIB in acute cerebral infarction patients.Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR = 1.030, P = .009), low Glasgow Coma Scale (GSC) score (OR = 0.850, P = .014), infection (OR = 4.693, P < .001), high NIHSS score (OR = 1.114, P = .001), and posterior circulation infarction (OR = 4.981, P = .010). The case-control study ultimately included 136 case-control pairs. Stepwise conditional regression analyses revealed that the independent risk factors for GIB in patients with acute cerebral infarction were low Glasgow Coma Scale (GSC) score (RR = 0.645, P = .011), infection (RR = 15.326, P = .001), and posterior circulation infarction (RR = 6.129, P = .045). The group with GIB had a higher rate of mortality and disability level (mRS grade ≥ 4) than the group without GIB (P < .001) within 1 year after stroke. In addition, independent risk factors of death within 1 year after stroke in patients were GIB (OR = 6.096, P < .001), infection (OR = 4.493, P < .001), mRS grade ≥ 4 (OR = 4.129, P < .001), and coronary heart disease (OR = 3.718, P = .001).GIB is a common complication after ischemic stroke. These identified factors may help clinicians identify risks of GIB before it develops. GIB is associated with increased risk of 1-year mortality and poor functional outcome in acute cerebral infarction patients.

Immunomodulatory Therapeutic Strategies in Stroke.

The role of immunity in all stages of stroke is increasingly being recognized, from the pathogenesis of risk factors to tissue repair, leading to the investigation of a range of immunomodulatory therapies. In the acute phase of stroke, proposed therapies include drugs targeting pro-inflammatory cytokines, matrix metalloproteinases, and leukocyte infiltration, with a key objective to reduce initial brain cell toxicity. Systemically, the early stages of stroke are also characterized by stroke-induced immunosuppression, where downregulation of host defences predisposes patients to infection. Therefore, strategies to modulate innate immunity post-stroke have garnered greater attention. A complementary objective is to reduce longer-term sequelae by focusing on adaptive immunity. Following stroke onset, the integrity of the blood–brain barrier is compromised, exposing central nervous system (CNS) antigens to systemic adaptive immune recognition, potentially inducing autoimmunity. Some pre-clinical efforts have been made to tolerize the immune system to CNS antigens pre-stroke. Separately, immune cell populations that exhibit a regulatory phenotype (T- and B- regulatory cells) have been shown to ameliorate post-stroke inflammation and contribute to tissue repair. Cell-based therapies, established in oncology and transplantation, could become a strategy to treat the acute and chronic stages of stroke. Furthermore, a role for the gut microbiota in ischaemic injury has received attention. Finally, the immune system may play a role in remote ischaemic preconditioning-mediated neuroprotection against stroke. The development of stroke therapies involving organs distant to the infarct site, therefore, should not be overlooked. This review will discuss the immune mechanisms of various therapeutic strategies, surveying published data and discussing more theoretical mechanisms of action that have yet to be exploited.

Absolute blood eosinophil count could be a potential biomarker for predicting haemorrhagic transformation after intravenous thrombolysis for acute ischaemic stroke

BackgroundImmune cells are involved in all stages of acute ischaemic stroke (AIS) and possess both neuroprotective and neurodamaging properties. It has been suggested that immune system activation after stroke may be associated with the development of haemorrhagic transformation (HT), which is the main complication limiting the clinical use of intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) for AIS. The purpose of our study was to analyse the association between absolute eosinophil count (AEC) at admission and the occurrence of HT after intravenous rtPA therapy for AIS.MethodsIn this retrospective study we enrolled AIS patients who were treated with rtPA within 4.5 h of symptom onset. Baseline stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS). Patients underwent head computed tomography scans at admission which were repeated 24 h after treatment with rtPA or promptly in case of clinical deterioration. HT was defined as blood at any site in the brain on follow-up head computed tomography scans. Spearman’s rank correlation test was used to analyse the correlation between AEC and NIHSS scores. The optimal AEC cut-off value for predicting HT was calculated using the area under the receiver operating characteristic curve. Multiple logistic regression was used to determine the association between AEC included as a binary variable and the incidence of HT.ResultsThe data of 201 patients was analysed (59.7% females; median age 77 years); 23 (11.4%) of them developed HT. The median of AEC was 62.5% greater in the non-HT group compared to the HT group (0.13 × 109/l and 0.08 × 109/l, respectively, p = 0.026). No correlation was found between AEC and baseline NIHSS scores (r = 0.061, p = 0.393). AEC ≥ 0.11 × 109/l predicted the occurrence of HT with 69.6% sensitivity and 60.7% specificity. AEC ≥ 0.11 × 109/l was independently associated with a 78% reduction in the odds of developing HT (adjusted odds ratio = 0.223, 95% confidence interval = 0.069–0.723, p = 0.012).ConclusionHigher values of AEC were associated with lower odds of developing HT, thus, AEC at admission could be considered an independent predictive marker of HT after treatment with rtPA for AIS.

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

ObjectivesStroke 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. MethodsIschemic 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. ResultsIschemic 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. ConclusionsIschemic 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 SourcesThe study was funded by the National Institute of Health and University of Georgia (Faculty Research Grant).

The role of GFAP and vimentin in learning and memory.

Intermediate filaments (also termed nanofilaments) are involved in many cellular functions and play important roles in cellular responses to stress. The upregulation of glial fibrillary acidic protein (GFAP) and vimentin (Vim), intermediate filament proteins of astrocytes, is the hallmark of astrocyte activation and reactive gliosis in response to injury, ischemia or neurodegeneration. Reactive gliosis is essential for the protective role of astrocytes at acute stages of neurotrauma or ischemic stroke. However, GFAP and Vim were also linked to neural plasticity and regenerative responses in healthy and injured brain. Mice deficient for GFAP and vimentin (GFAP-/-Vim-/-) exhibit increased post-traumatic synaptic plasticity and increased basal and post-traumatic hippocampal neurogenesis. Here we assessed the locomotor and exploratory behavior of GFAP-/-Vim-/- mice, their learning, memory and memory extinction, by using the open field, object recognition and Morris water maze tests, trace fear conditioning, and by recording reversal learning in IntelliCages. While the locomotion, exploratory behavior and learning of GFAP-/-Vim-/- mice, as assessed by object recognition, the Morris water maze, and trace fear conditioning tests, were comparable to wildtype mice, GFAP-/-Vim-/- mice showed more pronounced memory extinction when tested in IntelliCages, a finding compatible with the scenario of an increased rate of reorganization of the hippocampal circuitry.

"The ipsilesional attention bias in right-hemisphere stroke patients as revealed by a realistic visual search task: Neuroanatomical correlates and functional relevance": Correction to Machner et al. (2018).

A realistic visual search task is introduced, in which eye movements are recorded while the patient searches for paperclips among different everyday objects on a computer display. The "desk task" performance of 34 acute right-hemisphere stroke patients was compared to established paper-pencil tests for neglect and the Posner reaction time task, and finally correlated to structural brain lesions. Most of the patients, even those without clinical neglect signs and with normal paper-pencil test performance, exhibited a clear ipsilesional attention bias in the desk task. This bias was highly correlated to the left-right asymmetry in the Posner task and to neglect-related functional impairment scores. Lesion-symptom mapping revealed task-specific differences: deficits in the desk task were associated with lesions of the superior temporal gyrus, contralesional unawareness in the Posner task with ventral frontal cortex lesions and paper-pencil cancellation bias with damage to the inferior parietal lobe. Neglect behavior was further associated with distinct frontoparietal white matter tract disconnections (inferior longitudinal fasciculus, superior longitudinal fasciculus, arcuate). Results from the novel desk task indicate a functional relevance of spatial attention deficits in right-hemisphere stroke patients, even if they are "subclinical." This should be considered especially in patients without obvious clinical neglect signs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Knowledge of Nurses about Evidence-based Guideline in Patients with Acute Ischemic Stroke

Introduction: Stroke is the most common cerebrovascular disease and the third most common cause of disability in the world. The study aimed to assess the knowledge of nurses in emergency departments based on evidence-based care guidelines in the acute phase of ischemic stroke.&#x0D; Methods: This cross-sectional analytical study was performed on 129 nurses working in emergency departments of 16 hospitals of Guilan University of Medical Sciences in 2017. Samples were selected randomly. The study tool was a questionnaire with 10 multiple choice questions about the care of acute phase of ischemic stroke patients. Data were analyzed by SPSS software ver. 21 using descriptive tests, ANOVA, T-test, Chi-square.&#x0D; Results: The mean of the participants’ knowledge about acute phase of ischemic stroke care was 40.07 ± 16.46. The highest response rate was related to the symptoms of stroke (85.27%). There was a significant relationship between the number of beds in the hospitals and the nurses' knowledge about beginning treatment of Tissue Plasminogen Activator (tPA) (P&lt;0.005), optimal level of blood pressure prior to administering intravenous tPA (P&lt;0.001), and recommended dosage of tPA (P&lt;0.001) .Also, a significant relationship was reported between the number of beds in the emergency departments and the nurses' knowledge about optimal level of blood pressure prior to administering intravenous tPA (P&lt;0.001), and recommended dosage of tPA (P&lt;0.001).&#x0D; Conclusion: The nurses' knowledge was not satisfactory about the guideline of the acute stage of ischemic stroke. Therefore, provision of evidence-based continuing education courses and mandatory attendance of emergency nurses in these courses is recommended.