Different Types Of Stroke Research Articles

Association between abnormal body weight and stroke outcome: A meta-analysis and systematic review.

To test the hypothesis that "obesity paradox" exists in stroke patients, we conducted a meta-analysis and systematic review on the association between abnormal body weight (obesity, overweight, or underweight) and the outcome of different types of stroke. This meta-analysis and systematic review was performed in conformity to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines in Appendix S2. Studies investigating the association between abnormal body weight and the outcome of different types of stroke were searched for in the PubMed and Embase databases from their inception to 20 March 2021. Thirty-three articles including 84,660 patients were included in this study. Obesity and overweight were associated with longer survival in mixed-stroke patients (acute ischemic stroke [AIS] combined with one or more other stroke subtypes) than was normal weight, whereas underweight was related to shorter survival; the pooled hazard ratios (HRs) of mortality were 0.77 (95% confidence interval [CI] = 0.71-0.83) for obesity, 0.76 (95% CI = 0.72-0.80) for overweight, and 1.71 (95% CI = 1.56-1.87) for underweight. However, only obesity was associated with longer survival in AIS patients compared with normal weight, and underweight was related to shorter survival; the pooled HR of mortality was 0.75 (95% CI = 0.64-0.88) for obesity and 1.53 (95% CI = 1.27-1.85) for underweight. After merging mixed-stroke and AIS patients, we obtained similar results as in mixed-stroke patients. Our results suggested that in patients with mixed stroke or AIS, obesity was associated with a longer survival time than normal weight, whereas underweight was associated with a shorter survival time.

Flexible Electromagnetic Cap for Three-Dimensional Electromagnetic Head Imaging.

The timely treatment is the crucial element for the survival of patients with brain stroke. Thus, a fast, cost-effective, and portable device is needed for the early and on-the-spot diagnosis of stroke patients. A 3D electromagnetic head imaging system for rapid brain stroke diagnosis with a wearable and lightweight platform is presented. The platform comprises a custom-built flexible cap with a 24-element planar antenna array, and a flexible matching medium layer. The custom-built cap is made out of an engineered polymer-ceramic composite substrate of RTV silicone rubber and aluminum oxide (Al2O3) for enhanced dielectric properties and mechanical flexibility and robustness. The array is arranged into two elliptical rings that are entirely incorporated into the flexible cap. The employed antenna elements within the system are compact with low SAR values over the utilized frequency range of 0.9-2.5 GHz. Moreover, a flexible matching medium layer is introduced on the front of the apertures of the antenna array to enhance the impedance matching with the skin. The detection capability of the system is experimentally verified on 3D realistic head phantoms at multiple imaging scenarios and different types of strokes. The reconstructed 3D and 2D multi-slice images using the beamforming and polar sensitivity encoding (PSE) image processing algorithms indicate the applicability and potential of the system for onsite brain imaging.

Electocardiographic changes in acute cerebrovascular accidents-a tertiary centre experience in South India

Cerebrovascular accident plays an important role in the morbidity and mortality of adults posing serious medical, socio-economic and rehabilitation problems. Electrocardiographic abnormalities have been known to occur in the context of neurological disease. The current study is an observational study aimed at elucidating the relation between cerebrovascular accident and ECG. To determine the frequency of ECG changes in cerebrovascular accident and to determine the variations in ECG manifestations and mortality in different types of stroke. 100 patients of acute stroke were considered. ECG was recorded in these patients within 24 hours of admission. Follow up of admitted patients was done to know the prognosis. ECG abnormalities noted among cerebral ischemic patients were presence of T Wave inversion (34.48%) and ST segment depression (32.76%) followed by QTc Prolongation (29.31%) and presence of U waves (27.59%). In cases of haemorrhagic Stroke, T wave inversion (33.33%) and arrhythmias (33.33%) were followed by U waves (30.95%) and ST segment depression (23.81%). Mortality was higher in patients with ST-T changes in ischemic group (66.66%) and in patients with positive U waves (60%) in haemorrhagic group. Studying ECG changes will provide insight in prognosis and management of stroke patients and may alter their management in coming future. ECG changes occurred very commonly in acute stroke. The changes are thought to be independent of the nature of stroke. It was noted that ST and T inversion being common in ischemic while T inversions and arrhythmias common in haemorrhagic CVA. It was also noted that the mortality was higher in patients with abnormal ECG following an acute Cerebrovascular event.

Hospitalization Expenditures and Out-Of-Pocket Expenses in Patients With Stroke in Northeast China, 2015-2017: A Pooled Cross-Sectional Study.

Background: Stroke is the second most common cause of mortality worldwide and the leading cause of death in China. It imposes a heavy financial burden on patients, especially for some social groups that are vulnerable to economic risks. Objective: This study aimed to comprehensively assess the magnitude of hospital and out-of-pocket (OOP) costs associated with stroke in Northeast China. Methods: Patients were selected via a multistage stratified cluster random sampling approach. We reviewed all patients’ records from 39 hospitals across six cities in Liaoning Province between 2015 and 2017. Cost characteristics of four major stroke types were analyzed. Multivariate linear regression analyses were employed to examine the determinants of hospitalization costs and OOP expenses. Results: A total of 138,757 patients were assessed for the medical costs. The mean hospitalization costs were $1,627, while the mean OOP expenses were $691, accounting for 42.5% of the total expenditures. Medication expenses were the largest contributor to hospitalization costs. The regression analysis suggested that age, length of stay (LOS), social identity, type of stroke, surgery, intensive care unit (ICU) admission, hospital level and hospital type were significantly correlated with hospitalization costs and OOP expenses. Conclusion: Stroke imposes a heavy financial burden on both patients and society in Liaoning Province, Northeast China. Results showed that there are some differences in the individual and social economic burden among different types of stroke. In addition, stroke patients share a high proportion of costs through OOP expenses, especially for poor social-economic status patients. Targeted intervention measures and specific policies are needed to reduce the individual and social economic burden of stroke as well as improve equity in health care among different social groups.

Acute Stroke Biomarkers: Are We There Yet?

Background: Distinguishing between stroke subtypes and knowing the time of stroke onset are critical in clinical practice. Thrombolysis and thrombectomy are very effective treatments in selected patients with acute ischemic stroke. Neuroimaging helps decide who should be treated and how they should be treated but is expensive, not always available and can have contraindications. These limitations contribute to the under use of these reperfusion therapies.Aim: An alternative approach in acute stroke diagnosis is to identify blood biomarkers which reflect the body's response to the damage caused by the different types of stroke. Specific blood biomarkers capable of differentiating ischemic from hemorrhagic stroke and mimics, identifying large vessel occlusion and capable of predicting stroke onset time would expedite diagnosis and increase eligibility for reperfusion therapies.Summary of Review: To date, measurements of candidate biomarkers have usually occurred beyond the time window for thrombolysis. Nevertheless, some candidate markers of brain tissue damage, particularly the highly abundant glial structural proteins like GFAP and S100β and the matrix protein MMP-9 offer promising results. Grouping of biomarkers in panels can offer additional specificity and sensitivity for ischemic stroke diagnosis. Unbiased “omics” approaches have great potential for biomarker identification because of greater gene, protein, and metabolite coverage but seem unlikely to be the detection methodology of choice because of their inherent cost.Conclusion: To date, despite the evolution of the techniques used in their evaluation, no individual candidate or multimarker panel has proven to have adequate performance for use in an acute clinical setting where decisions about an individual patient are being made. Timing of biomarker measurement, particularly early when decision making is most important, requires urgent and systematic study.

A time series analysis of the relationship between ambient temperature and ischaemic stroke in the Ljubljana area: immediate, delayed and cumulative effects

BackgroundStroke is a major health problem around the world. Several studies have examine the influence of ambient temperature on incidence of stoke, but they reported different results for different types of stroke and different geographical regions. Hence, effect of ambient temperature is still much of interest, when focusing on ischemic stroke (IS) in regions that have not been examined yet. The aim of our study is to analyse association between IS incidences and short, delayed and cumulative effect of average daily ambient temperature, humidity and pressure in central Europe. To the best of our knowledge, this is the first IS study conducted between 45° and 50° latitude where large part of Central European population resides.MethodsWe linked daily hospitals’ admission data for whole population and separately for two specific age groups with ambient temperature data. We considered patients coming from Ljubljana basin and its immediate surrounding. Data were gathered daily from January 2012 to December 2017. To measure the effect of average ambient temperature, humidity and pressure we used generalized linear model with a log-link-function and a Poisson distribution.ResultsThe results of our study show a statistically significant immediate, delayed and cumulative effects of ambient temperatures on IS incidence for the whole population and the population older than 65 years. Specifically, 1 °C reduction in ambient temperature on a given day (Lag 0) increases the IS risk for approximately 5‰ (all population) or 6‰ (population older than 65 years). Similar effects were found for lags from 1 to 6. Analysis of time windows from 0 to 1 days up to 0–28 days also show statistically significant cumulative effect for the same two age groups. IS incidence was not found to be significantly related to pressure or humidity in any group.ConclusionThe findings of this study may help healthcare authorities in central Europe improve existing stroke prevention measures and raise public awareness.

Association of Ambient PM <sub>1</sub> with Hospital Admission and Recurrence of Stroke: Evidence from 292 Chinese Cities

Background: China suffers from both severe air pollution and stroke burden, but the association of PM1(particles with aerodynamic diameter ≤ 1·0μm) with stroke remains unclear. We estimated the associations of short-term exposure to PM1 with hospital admission and recurrence of stroke in 292 Chinese cities. Methods: Data of 989,591 stroke cases were derived from the Chinese Stroke Center Alliance (CASA) program. Daily air pollution and meteorological data in each selected city were collected to estimate the daily PM1 concentration using a generalized additive model (GAM). A time-stratified case-crossover study design was applied to estimate the associations of short-term exposure to PM1 with hospital admission of stroke. Findings: Each 10μg/m3 increase in PM1(lag06) was associated with a 0·53% (95%CI: 0·39%, 0·67%) increment in hospital admission for all types of stroke, and greater associations were found with ischemic stroke than intracerebral hemorrhage. The associations between PM1 and stroke were statistically significant in Northeast (0·94%, 95 %CI: 0·51%, 1·38 %), North (0·47%, 95%CI: 0·20%, 0·75%), Central (0·57%, 95%CI: 0·30%, 0·85%), and East China (0·63%, 95%CI: 0·27%, 1·00%). The attributable fraction (AF) of hospital admission for stroke caused by PM1 was 2·4% (95%CI: 1·7%, 3·0%). Each 10μg/m3 increase in PM1 was associated with a 1·64% (95%CI: 1·28%, 2·01%) increment in the risk of recurrent stroke. Interpretation: Short-term exposure to PM1 might increase the risk of incidence and recurrence of stroke in China, and the associations varied across different types of stroke and regions. Funding Statement: National Key Research and Development Program of China. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: All participating hospitals in the CSCA were approved to collect data without requiring individual patient informed consent under the common rule or a waiver of authorization and exemption from their institutional review board.

Prediction of Brain Stroke Severity Using Machine Learning

In recent years strokes are one of the leading causes of death by affecting the central nervous system. Among different types of strokes, ischemic and hemorrhagic majorly damages the central nervous system. According to the World Health Organization (WHO), globally 3% of the population are affected by subarachnoid hemorrhage, 10% with intracerebral hemorrhage, and the majority of 87% with ischemic stroke. In this research work, Machine Learning techniques are applied in identifying, classifying, and predicting the stroke from medical information. The existing research is limited in predicting risk factors pertained to various types of strokes. To address this limitation a Stroke Prediction (SPN) algorithm is proposed by using the improvised random forest in analyzing the levels of risks obtained within the strokes. This research of the Stroke Predictor (SPR) model using machine learning techniques improved the prediction accuracy to 96.97% when compared with the existing models.

Gut Microbiotic Features Aiding the Diagnosis of Acute Ischemic Stroke.

Increasing evidence suggests that features of the gut microbiota correlate with ischemic stroke. However, the specific characteristics of the gut microbiota in patients suffering different types of ischemic stroke, or recovering from such strokes, have rarely been studied, and potential microbiotic predictors of different types of stroke have seldom been analyzed. We subjected fecal specimens from patients with lacunar or non-lacunar acute ischemic infarctions, and those recovering from such strokes, to bacterial 16S rRNA sequencing and compared the results to those of healthy volunteers. We identified microbial markers of different types of ischemic stroke and verified that these were of diagnostic utility. Patients with two types of ischemic stroke, and those recovering from ischemic stroke, exhibited significant shifts in microbiotic diversities compared to healthy subjects. Cluster of Orthologous Groups of Proteins (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed reduced metabolic and transport-related pathway activities in ischemic stroke patients. We performed fivefold cross-validation using a Random Forest model to identify two optimal bacterial species (operational taxonomic units; OTUs) serving as markers of lacunar infarction; these were Lachnospiraceae (OTU_45) and Bacteroides (OTU_4), and the areas under the receiver operating characteristic curves (AUCs under the ROCs) were 0.881 and 0.872 respectively. In terms of non-lacunar acute ischemic infarction detection, the two optimal species were Bilophila (OTU_330) and Lachnospiraceae (OTU_338); the AUCs under the ROCs were 0.985 and 0.929 respectively. In post-ischemic stroke patients, the three optimal species were Pseudomonas (OTU_35), Sphingomonadaceae (OTU_303), and Akkermansia (OTU_9); the AUCs under the ROCs were 1, 0.897, and 0.846 respectively. Notably, the gut microbial markers were of considerable value for utility when diagnosing lacunar infarction, non-lacunar acute ischemic infarction, and post-ischemic stroke. This study is the first to characterize the gut microbiotic profiles of patients with lacunar or non-lacunar, acute ischemic strokes, and those recovering from stroke, and to identify microbiotic predictors of such strokes.

Analysis of Incidence Risk for Different Types of Stroke among the Mayak Worker Cohort

The incidence risk estimates for different types of strokes among the cohort of 22 377 Mayak workers occupationally exposed to prolonged radiation and followed up until the end of 2013 are presented. Information about the work histories and estimates of the liver absorbed doses from external and internal radiations were obtained from the “Mayak Worker Dosimetry System—2013” database; medical data and lifestyle factors were obtained from the “Clinic” medical and dosimetry database. Over the entire follow-up period, 221 cases of intracerebral hemorrhage (ICH), 1463 cases of brain cerebral infarction (BI), and 342 cases of nonspecified stroke (NS) were registered in the study cohort. It was shown that the ICH, BI, and NS incidence risks in the study cohort were significantly associated with nonradiation factors such as gender, age, calendar period, duration of employment at the main plants, smoking, alcohol assumption, body mass index, and comorbidities (arterial hypertension and diabetes), which agreed with the literature data. Analyses did not reveal an effect of external γ-ray exposure on the ICH and BI incidence. However, NS relative risk (RR) was statistically significantly below the one in the groups of workers exposed to external γ-rays at the total absorbed liver doses above 0.20 Gy as compared with workers exposed at doses below 0.10 Gy. BI incidence RR was statistically significantly above the one in the groups of workers exposed to internal α-radiation at the total absorbed liver dose above 0.10 Gy as compared with workers exposed at lower doses. There was no effect of internal exposure on the ICH and NS incidence. These findings agreed with the results obtained earlier for the Mayak worker cohort.

Characterization of a novel model of global forebrain ischaemia\u2013reperfusion injury in mice and comparison with focal ischaemic and haemorrhagic stroke

Stroke is caused by obstructed blood flow (ischaemia) or unrestricted bleeding in the brain (haemorrhage). Global brain ischaemia occurs after restricted cerebral blood flow e.g. during cardiac arrest. Following ischaemic injury, restoration of blood flow causes ischaemia–reperfusion (I/R) injury which worsens outcome. Secondary injury mechanisms after any stroke are similar, and encompass inflammation, endothelial dysfunction, blood–brain barrier (BBB) damage and apoptosis. We developed a new model of transient global forebrain I/R injury (dual carotid artery ligation; DCAL) and compared the manifestations of this injury with those in a conventional I/R injury model (middle-cerebral artery occlusion; MCAo) and with intracerebral haemorrhage (ICH; collagenase model). MRI revealed that DCAL produced smaller bilateral lesions predominantly localised to the striatum, whereas MCAo produced larger focal corticostriatal lesions. After global forebrain ischaemia mice had worse overall neurological scores, although quantitative locomotor assessment showed MCAo and ICH had significantly worsened mobility. BBB breakdown was highest in the DCAL model while apoptotic activity was highest after ICH. VCAM-1 upregulation was specific to ischaemic models only. Differential transcriptional upregulation of pro-inflammatory chemokines and cytokines and TLRs was seen in the three models. Our findings offer a unique insight into the similarities and differences in how biological processes are regulated after different types of stroke. They also establish a platform for analysis of therapies such as endothelial protective and anti-inflammatory agents that can be applied to all types of stroke.

Creation of a Dataset of MSCT-Images and Clinical Data for Acute Cerebrovascular Events

Background The use of neuroimaging methods is an integral part of the process of assisting patients with acute cerebrovascular events (ACVE), and computed tomography (CT) is the «gold standard» for examining this category of patients. The capabilities of the analysis of CT images may be significantly expanded with modern methods of machine learning including the application of the principles of radiomics. However, since the use of these methods requires large arrays of DICOM (Digital Imaging and Communications in Medicine)-images, their implementation into clinical practice is limited by the lack of representative sample sets. Inaddition, at present, collections (datasets) of CT images of stroke patients, that are suitable for machine learning, are practically not available in the public domain.Aim of study Regarding the aforesaid, the aim of this work was to create a DICOM images dataset of native CT and CT-angiography of patients with different types of stroke. Material and meth ods The collection was based on the medical cases of patients hospitalized in the Regional Vascular Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine. We used a previously developed specialized platform to enter clinical data on the stroke cases, to attach CT DICOMimages to each case, to contour 3D areas of interest, and to tag (label) them. A dictionary was developed for tagging, where elements describe the type of lesion, location, and vascular territory.Results A dataset of clinical cases and images was formed in the course of the work. It included anonymous information about 220 patients, 130 of them with ischemic stroke, 40 with hemorrhagic stroke, and 50 patients without cerebrovascular disorders. Clinical data included information about type of stroke, presence of concomitant diseases and complications, length of hospital stay, methods of treatment, and outcome. The results of 370 studies of native CT and 102 studies of CT-angiography were entered for all patients. The areas of interest corresponding to direct and indirect signs of stroke were contoured and tagged by radiologists on each series of images.Conclusion The resulting collection of images will enable the use of various methods of data analysis and machine learning in solving the most important practical problems including diagnosis of the stroke type, assessment of lesion volume, and prediction of the degree of neurological deficit.

Dynamic Cerebral Autoregulation in Embolic Stroke of Undetermined Source.

Background and PurposeDynamic cerebral autoregulation (dCA) in acute ischemic stroke is probably compromised. Although the characteristics of dCA in different types of stroke have been largely investigated, dCA in embolic stroke of undetermined source (ESUS) remains poorly understood. In this group, we aimed to elucidate the characteristics of dCA and their relevance to clinical outcomes.MethodsThe study enrolled 77 ESUS patients and 50 controls. Bilateral cerebral blood flow velocities (CBFV) of middle cerebral arteries and arterial blood pressure were simultaneously recorded using a transcranial Doppler combined with a servo-controlled finger plethysmograph. Transfer function analysis was used to obtain dCA parameters including phase, gain, coherence at very low frequency (VLF) and low frequency (LF), and the rate of recovery (RoRc) of CBFV. A multivariable logistic regression model was established to explore the relationship between dCA and clinical outcomes.ResultsGain at VLF and LF, phase at LF, and RoRc of CBFV in bilateral hemispheres of the ESUS group were consistently worse than those of the control group (all P < 0.001). Bilateral RoRc of CBFV was significantly higher in patients with favorable outcomes than in those with unfavorable outcomes (stroke hemisphere: P < 0.001; non-stroke hemisphere, P = 0.029). Rate of recovery of CBFV in stroke hemisphere >13.3%/s was an independent predictor of favorable clinical outcomes (adjusted odds ratio = 30.95, 95% CI: 5.33–179.81, P < 0.001).ConclusionsDynamic cerebral autoregulation was relatively impaired in both stroke and non-stroke hemispheres in ESUS patients, and functioning dCA after ESUS may indicate favorable clinical outcomes.

Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden.

Stroke and fine particulate matter (PM2.5) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM2.5 on the acute incidence and national acute health burdens of stroke attributed to PM2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10μg/m3 increase in the PM2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and-0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM2.5 exposure across China in 2015. This study provided robust estimates of PM2.5-induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution.

Post-stroke epilepsy and mortality: an observational study on healthcare administrative database

Abstract Background Post-stroke epilepsy (PSE) has been associated with hospitalization and increased mortality risk. So far, evidence on PSE and mortality risk is lacking. Therefore, this study aimed to evaluate the association between PSE and mortality in different type of stroke. Methods A retrospective observational study was conducted using healthcare administrative databases of Lombardy, a northern Italian region (16.4% of the Italian population). Patients aged 40 years or older admitted to the hospital between 1/1/2004 and 31/12/2008 with diagnosis of hemorrhagic (HS)- or ischemic (IS)- stroke were included. Diagnosis of seizure/epilepsy was identified by using discharge ICD9-CM codes, exemption code or use of antiepileptic drugs. This date was considered the index date. For each stroke cohort case of PSE was matched with 2 non post-stroke epileptic (PNS) individuals. Demographic and clinical characteristics were compared between PSE and PSN among the stroke cohorts. Cox proportional regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (95%CI) of mortality. Results In the observed period, 13,749 of patients (4,583 PSE Vs 9,166 PSN) had IS and 4,875 (1,625 PSE Vs 3,250 PNS) had HS. Individuals were ≥75-year-old with no difference among cohorts (p value &amp;gt;0.9). Similarly, no differences were observed for gender (p = 1.00) and Charlson'comorbidity index (p = 1.00). Early seizure occurred in 15% of ischemic cohort and 20% of hemorrhagic one. Differences in antithrombotic drug use were observed among PSE and PSN in IS (p = 0.009) and HS cohort (p = 0.03). In ischemic cohort PSE was positively associated with increased mortality risk (HRadj: 1.67; 95%CI: 1.57-1.79), whereas no significant result was observed in hemorrhagic cohort (1.06; 0.94-1.20). Conclusions This study demonstrated a twofold increased risk of mortality in IS cohort. Further studies need to deeply characterize possible association between PSE and mortality in HS individuals. Key messages Occurrence of seizure/epilepsy in ischemic post-stroke patients represents a risk factor for morality. New studies need to clarify the contrasting result observed for hemorrhagic PSE patients.

Feasibility of Storing Lightning Energy Being Discharged t hrough a Lightning Arrester by a Capacitor

Lightning phenomenon over the years has been subject of debate of scientists as well as that of people. For some, it is the manifestation of their deities, and, for others it is nothing but a simple display of colors along with fearsome sounds with a destructive power. We know by the work of scientists like Benjamin Franklin (18th century) that it was not what we used to think, and, has some explanations. We now, have understood how the clouds get charged, and how they, in turn, induce charges on the surface of the earth below them. The different types of strokes were also better understood along the way. With the grasp of the real phenomenon, scientists worked out its multiple threats to transmission lines, and therefore, came up with some protective devices to avoid the total catastrophe that could occur should these strokes be left without any preventive measures. Hence, many protective devices came to life with special applications; one of which the lightning arrester. The latter one helps a lot, especially nearby substations by grounding lightning induced energy. We also know that scientists have been discussing the possibility of capturing lightning energy, and, use it to compensate the deficit in energy demand from the world needs in terms of energy. We are using here a capacitor-lightning arrester combination to try and store the lightning-induced energy in transmission lines. We shall carry out this work by making use of the ability of the capacitor while subjected to a surge, and then, find out about the energy it can store by getting charged up. we shall also make use of SmartDraw software for our designs and models. The aim here is to target how we could possibly break the grounds in the mastering of the ever-lost lightning energy to ground.

Simplified Prehospital Prediction Rule to Estimate the Likelihood of 4 Types of Stroke: The 7-Item Japan Urgent Stroke Triage (JUST-7) Score

Objective Prehospital prediction models to estimate the likelihood of several types of stroke (large vessel occlusion [LVO], intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH], and other types of stroke) should be useful to transfer those with suspected stroke to appropriate facilities. We recently reported Japan Urgent Stroke Triage (JUST) score with 21 items had excellent predictive abilities, and we further tried to simplify the score with parsimonious items and comparable predictive abilities. Methods We conducted historical and prospective multicenter cohort studies at 8 centers from June 2015 to March 2018. We developed the prediction rules with select variables from JUST score for LVO, ICH, SAH and other types of stroke in 2236 patients with suspected stroke in historical derivation cohort. We validated the developed prediction rules in 964 patients in prospective validation cohort. Results There were 1150 stroke, including 235 LVO, 352 ICH, 107 SAH and 456 other types of stroke in the derivation cohort. We developed the scores with 7 items (high blood pressure, arrhythmia, conjugate deviation, headache, dysarthria, disturbance of consciousness, paralysis of upper limbs) and the developed scores had area under the receiver-operating curve (AUC) of 0.84 for any type of stroke, 0.89 for LVO, 0.79 for ICH, and 0.90 for SAH in the derivation cohort. There were 490 stroke, including 102 LVO, 138 ICH, 28 SAH and 222 other types of stroke in the validation cohort. The scores well discriminated these strokes in the validation cohort (AUC of 0.76 for any type of stroke; 0.81 for LVO, 0.73 for ICH, and 0.85 for SAH). Conclusions The simplified 7-item JUST (JUST-7) score had good predictive ability and can help healthcare providers to estimate the likelihood of different types of stroke and decide the referral hospital.

Increased risk of ischemic stroke in patients with Bell's palsy: A longitudinal follow-up study using a national sample cohort

ObjectiveTo investigate the association between Bell's palsy and stroke according to the different types of stroke, using a sample cohort based on the national Korean population. MethodsIndividuals aged ≥ 20 years were collected from the Korean National Health Insurance Service National Sample Cohort between 2002 and 2013. We extracted the data for Bell's palsy patients (n = 3658) and 1:4 matched controls (n = 14,632) and analyzed the occurrence of hemorrhagic or ischemic stroke in both groups. Matching was performed on the basis of age, gender, income, and region of residence. For Bell's palsy, we included only participants who received the diagnosis (ICD-10 code, G510) 2 or more times via ambulatory visits for the same episode with steroid treatment. Patient admission histories were used to identify occurrences of hemorrhagic stroke (I60, I61 and I62) and ischemic stroke (I63). Adjusted hazard ratios were calculated using stratified Cox proportional hazard models for the Charlson comorbidity index and 95% confidence intervals (CIs). For the subgroup analyses, we divided the participants by age, sex, and each time period after the onset of Bell's palsy (≤1 year, 1 to 2 years, 2 to 3years, > 3years). ResultsThe risk of ischemic stroke was significantly increased in Bell's palsy patients compared to that in the controls (adjusted HR = 1.74, 95% CI = 1.38–2.19, P < 0.001). In the subgroup analyses, a significant association between two clinical disorders was observed in patients aged ≥ 50 years old, regardless of gender. The risk of ischemic stroke was significantly increased, especially within 2 years after Bell's palsy. In contrast, the risk of hemorrhagic stroke was not significantly increased. ConclusionThere is an association of Bell's palsy with ischemic stroke but not with hemorrhagic stroke.

Analysis of association between FGB, MTHFR, MTR and MTRR genes polymorphisms and ischemic and hemorrhagic stroke

The genetic component is a leading factor of stroke manifestation. Contribution of single nucleotide polymorphisms or combined genotypes to disease development has population differences. Special attention should be paid to genetic features in different types of strokes among the Ukrainian population. The aim of the study was to estimate the association of polymorphisms between FGB, MTHFR, MTR, MTRR genes or gene-gene interaction and a risk of atherotrombotic ischemic stroke and intracranial hemorrhagic stroke among Ukrainians. Materials and methods. 102 patients with atherotrombotic ischemic stroke, 56 patients with intracranial hemorrhagic stroke and 102 healthy control subjects were included in the study. The control group comprised peoples without cardiovascular diseases, family history of stroke and with normal lipid profile values. The mean age was 53.4 ± 9.1 years for stroke patients and 54.5 ± 8.2 years for the control group. Single nucleotide polymorphisms С677T (rs1801133) MTHFR gene, A66G (rs1801394) MTRR gene, A2756G (rs 1805087) MTR gene, C-148T (rs 1800787) FGB gene were detected by polymerase chain reaction (PCR) followed by restriction of amplificated fragments and polymorphism A1298C (rs1801131) MTHFR gene was determined by allele specific PCR method. Results . The association between 1298СС genotype MTHFR gene (OR = 3.457, 95 % CI:1.053–11.357) and -148СТ genotype FGB gene (OR = 2.276, 95 % CI: 1.248–4.152) and a risk of atherotrombotic ischemic stroke was revealed. A risk of intracranial hemorrhagic stroke was associated with 66AG (OR = 2.643, 95 % CI: 1.059–6.593) and 66GG (OR = 4.826, 95 % CI: 1.858–12.535) genotypes of MTRR gene. Synergistic effect was shown for polymorphic loci of FGB/С-148Т and MTRR / A66G in atherotrombotic ischemic stroke development as well as independent effect of MTRR/A66G for intracranial hemorrhagic stroke. Conclusions. There are some differences in the genetic components of different types of acute stroke in Ukrainians that should be taken into account when initiating therapy or preventative measures.

Stroke and Alzheimer's Disease: A Mendelian Randomization Study.

Stroke and Alzheimer’s disease (AD) are common neurological diseases. Several exiting studies indicated that late onset-AD and ischemic stroke have shared genetic links. Different kinds of stroke have different mechanisms. However, it remains unclear whether there is a causal relationship between different types of strokes, including any stroke (AS), any ischemic stroke (AIS), large-artery atherosclerotic stroke (LAS), and cardio-embolic stroke (CES), and AD. Herein, we conducted several Mendelian randomization (MR) studies to explore genetically causal link of different kinds of strokes and AD. The results for inverse-variance weighted (IVW) meta-analysis (β = −0.039, OR = 0.9618, and P-value = 0.750) and weighted median regression (WMR) (β = −0.156, OR = 0.8556, and P-value = 0.274) demonstrated that AS is not causally associated with AD risk. The result of MR-Egger regression (β = −1.312, P-value = 0.098) and intercept term (P-value = 0.105) illustrated no pleiotropy in this MR study. According to the results for IVW (P-value = 0.305, β = −0.103, and OR = 0.9021) and WMR (P-value = 0.487, β = −0.092, and OR = 0.9121) in the MR study between AIS and AD, there is no causal association between AIS and AD risk. In addition, the MR-Egger regression (P-value = 0.290 and β = −0.512) and intercept term (P-value = 0.387) showed no potential pleiotropy. LAS is not causally associated with AD risk according to the MR results (IVW: P-value = 0.568, β = 0.037, and OR = 1.0377; WMR: P-value = 0.793, β = −0.022, and OR = 0.9782). Additionally, the results of MR-Egger regression (P-value = 0.122 and β = −1.220) and intercept term (P-value = 0.110) showed no potential pleiotropy. Our results [IVW: P-value = 0.245, β = −0.064, and OR = 0.938; WMR: P-value = 0.331, β = −0.057, and OR = 0.9446; MR-Egger: P-value = 0.673 and β = −0.062, and intercept term (P-value = 0.985)] further demonstrated there is no causal link between CES and AD and no pleiotropy in this MR study. In conclusion, different types of stroke, including AS, AIS, LAS, and CES, would not be causally associated with AD risk.