Neurological Factors Research Articles

SURG-07. QUANTIFYING THE RISK OF SHORT TERM SEIZURES FOLLOWING LASER INTERSTITIAL THERMAL THERAPY

Abstract BACKGROUND Tumor-related epilepsy is a common sequela of both primary and metastatic brain tumors, as well as radiation necrosis (RN). Laser interstitial thermal therapy (LITT) is an effective option for lesional cytoreduction but induces transient peritumoral edema that typically resolves within 3 months of the procedure. Accordingly, we quantified the risk of seizure development early post-LITT in patients with tumors or RN of diverse histologies. METHODS Patients treated with LITT for brain tumors or radiation necrosis at a high-volume center from 2015 – 2021 with at least 3 months of clinical follow-up were evaluated for seizure risk and time to discontinuation of anti-epileptic drugs (AEDs) for at least 4 weeks, with censoring at death or last follow-up. RESULTS One-hundred and seventeen patients met inclusion criteria, and 22 (19%) experienced a post-LITT seizure within 3 months of surgery. Those with pre-LITT seizures (P = 0.03), prior whole-brain radiation (WBRT) (P = 0.0099), or lower pre-operative KPS (P = 0.04) were more likely to have a post-LITT seizure. Frontal lobe tumors appeared to be more frequently associated with seizures (68% vs 45%, P = 0.06). Prior WBRT, odds ratio (OR) 4.27 (95% CI 1.01 – 18.55), P = 0.047 and pre-LITT seizure, OR 5.39 (95% CI 1.87 – 16.31), P = 0.002 remained predictive on multivariate analyses. Successful AED weaning occurred at a median of 1.68 months (no seizure within 3-months group) versus undefined for patients experiencing seizures (P = 0.015). Post-LITT seizures within 3 months were associated with worsened post-LITT overall survival, 5.95 vs 17.2 months, P < 0.0001. DISCUSSION Prior seizure history or previous WBRT pose a risk of breakthrough seizures following laser ablation. Neurosurgeons should consider extended AED treatment or referral for management of tumor-related epilepsy in patients with these neurologic risk factors.

Polymer nanotherapeutics: A promising approach toward microglial inhibition in neurodegenerative diseases.

Nanoparticles (NPs) that target multiple transport mechanisms facilitate targeted delivery of active therapeutic agents to the central nervous system (CNS) and improve therapeutic transport and efficacy across the blood-brain barrier (BBB). CNS nanotherapeutics mostly target neurons and endothelial cells, however, microglial immune cells are the first line of defense against neuronal damage and brain infections. Through triggering release of inflammatory cytokines, chemokines and proteases, microglia can however precipitate neurological damage-a significant factor in neurodegenerative diseases. Thus, microglial inhibitory agents are attracting much attention among those researching and developing novel treatments for neurodegenerative disorders. The most established inhibitors of microglia investigated to date are resveratrol, curcumin, quercetin, and minocycline. Thus, there is great interest in developing novel agents that can bypass or easily cross the BBB. One such approach is the use of modified-nanocarriers as, or for, delivery of, therapeutic agents to the brain and wider CNS. For microglial inhibition, polymeric NPs are the preferred vehicles for choice. Here, we summarize the immunologic and neuroinflammatory role of microglia, established microglia inhibitor agents, challenges of CNS drug delivery, and the nanotherapeutics explored for microglia inhibition to date. We also discuss applications of the currently considered "most useful" polymeric NPs for microglial-inhibitor drug delivery in CNS-related diseases.

Signs of life as a favorable predictor for non-shockable cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation post non-shockable cardiac arrest

BackgroundWhen the initial rhythm of cardiac arrest is non-shockable, resuscitation outcomes tend to be unfavorable. However, signs of life (gasping, pupillary light reaction, or any form of body movement) have been suggested as favorable prognostic factors for patients with refractory cardiac arrest who are undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This study determined whether signs of life are favorable neurological prognostic factors for patients undergoing ECPR post non-shockable cardiac arrest. Methods and resultsThis single-center retrospective study included 227 refractory out-of-hospital cardiac-arrest patients who had undergone ECPR, divided into four groups according to shockability of initial cardiac rhythms and presence of signs of life. Initial cardiac rhythms were shockable in 154 patients (67.8 %) and non-shockable in 73 (32.2). Favorable neurological outcomes were observed in 4.1 %, 48.2 %, 0.0 %, and 38.7 % of patients with shockable rhythm without signs of life, shockable rhythm with signs of life, non-shockable rhythm without signs of life, and non-shockable rhythm with signs of life, respectively, with significant differences. Multivariate logistic regression analysis showed an independent association of signs of life during resuscitation with favorable neurological outcomes. The adjusted odds ratios for patients with shockable and non-shockable rhythm with signs of life were 34.33 and 96.51, respectively, compared with those without signs of life. ConclusionsSigns of life during resuscitation were favorable prognostic factors in patients with refractory cardiac arrest and non-shockable rhythm. When these patients are considered for ECPR, the status of signs of life during resuscitation may facilitate the decision to perform ECPR.

NSE and S100β as serum alarmins in predicting neurological outcomes after cardiac arrest

Cardiac arrest (CA) is a serious health concern that often results in mortality or severe neurological dysfunction in the case of survival. Our aim was to explore the neurological prognostic factors in patients with CA. This retrospective observational study included adult patients with CA. We investigated serum neuron-specific enolase (NSE), S100 calcium-binding protein β (S100β), and indices and parameters at 1, 3, 5, 7 and intensive care unit (ICU) discharge days after CA. The primary study endpoint was the Cerebral Performance Category (CPC) scale score at ICU discharge, which was dichotomized as good neurological outcome (CPC 1–2: full recovery or moderate disability) and poor neurological outcome (CPC 3–5: severe disability, vegetative state, or death). Of the 191 adult patients with CA, 42 (22%) had good neurological outcomes, and 149 (78%) had poor neurological outcomes. NSE at 1,3,5,7 and ICU discharge days showed excellent predictive accuracy for neurological outcomes (area under the curve [AUC]: 0.666, 0.716, 0.870, 0.739, and 0.901, respectively). However, S100β exhibited general predictive power (AUC: 0.666, 0.573, 0.607, 0.594, 0.727). Finally, the early warning model, which combined day 1 NSE, day 1 S100β, cardiac arrest time, SOFA scores, APACHE II scores, and age, was used to screen CA patients with poor neurological prognosis at early stages and had an AUC of 0.792. Serum concentrations of NSE and S100β were significantly elevated in CA patients and could be prognostic biomarkers to predict neurological outcomes. Day 1 NSE and S100β combined with multiple indicators could be a decent early warning model for poor neurological prognosis in patients with CA.

Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium.

In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection. The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022. Incidence of neurological complications was estimated as number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and risk factors were assessed using multivariable Poisson regression. 713 patients were included. Median age = 56years (interquartile range (IQR) = 45-65). Neurological complications reported in 61/480 patients (12.7%) with the majority being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). Multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR) = 6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. Extracorporeal membrane oxygenation (IRR = 5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR = 4.70, 1.62-13.7), and age >55 (IRR = 3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR = 3.43, 1.11-10.6), LMIC vs HIC (IRR = 8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR = 0.17, 0.04-0.69) and age >55 (IRR = 4.05, 1.15-14.3) were independent risk factors for seizure. Decision-making should incorporate salient risk factors to inform management of SARS-CoV2 infection and avoid neurological complications.

Promoting auditory accessibility for the Autism Spectrum Disorder (ASD) on the public transport system

The Autism Spectrum Disorder (ASD) is mainly characterized by a difficulty with neurotypical social interactions, a need for orderliness and routine, and a hypersensibility to stimuli. From all sensory stimuli, sound is proven to be most disturbing to autistic individuals. Most autistics experience severe anxiety and stress having to navigate a world that was not built for them. Therefore, this study aims to understand (quantify and qualify) the atypical response to sound - especially on ASD persons - and the neurological factors behind it. The next step on this research is reviewing literature regarding architectural design strategies for ASD. Later on, using a subway station from the city of São Paulo as study object, this paper will propose a guideline for architectural design for ASD focused on the metro system. This study will contribute to the better understanding of the Autistic Community´s sensory diversity and to a more inclusive architectural designing process.

Exploring the Role of Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) and Kynurenine Pathway Dysregulation in Migraine Pathophysiology Among Women With Polycystic Ovary Syndrome (PCOS).

A narrative review was undertaken to explore the current understanding of the relationship between polycystic ovary syndrome and migraine headaches, with a focus on the potential roles of pituitary adenylate cyclase-activating polypeptide and the kynurenine pathway in the shared pathophysiology of these conditions. Emerging evidence suggests that pituitary adenylate cyclase-activating polypeptide may be a key player in the development of migraine headaches, with potential implications for the higher incidence of migraine observed in women with polycystic ovary syndrome. Additionally, dysregulation of the kynurenine pathway and altered levels of kynurenine metabolites have been linked to both migraine and polycystic ovary syndrome, indicating a complex interplay between hormonal, metabolic, and neurological factors in the comorbid presentation of these disorders. Further research is needed to elucidate the specific mechanisms underlying these associations and to develop targeted therapeutic approaches for managing migraine in the context of polycystic ovary syndrome.

Epilepsy trends in Kazakhstan: A retrospective longitudinal study using data from unified national electronic health system 2014–2020

ObjectiveThis study is designed to estimate the epidemiology of epilepsy in Kazakhstan, using a large-scale administrative health database during 2014–2020. MethodsUsing the Unified National Electronic Health System of Kazakhstan over a seven-year span, we explored incidence and prevalence rates, disability-adjusted life years (DALY), and all-cause mortality. Regression models using Cox proportional hazards were used to analyze the sociodemographic, mental, behavioral, and neurological factors affecting survival. Overall analyses were performed using STATA (V.16). ResultsThe total cohort comprised of 82,907 patients, with a significant increase in the incidence of epilepsy from 26.15 in 2014 to 88.80 in 2020 per 100,000 people. Similar trends were observed in the prevalence rates, which tripled from 26.06 in 2014 to 73.10 in 2020. While mortality rates fluctuated, the elderly and children had the greatest rates of 9.97 and 2.98 per 1000 person-years respectively. DALYs revealed a substantial disease burden, with 153,532 DALYs (824.5 per 100,000) being lost during the study period. A few comorbidities, such as cerebral palsy (adjusted hazard ratio (aHR) 2.23) and central nervous system atrophy (aHR, 27.79), markedly elevated all-cause mortality. Furthermore, extrapyramidal and movement disorders (aHR 2.16, p = 0.06) and demyelinating diseases of the central nervous system (aHR 6.36, p = 0.06) showed a trend toward increased mortality risk. ConclusionTo the best of our knowledge, this is the first study from Central Asia exploring a large epilepsy cohort. The findings highlight the need for targeted interventions to address the growing burden of epilepsy, particularly among children, male sex, and those with neurological comorbities.

The correlation of muscle morphology with variations of 10-repetition maximum bench press strength in resistance-trained subjects

The relationship between muscle mass and strength is complex as it can be influenced by several neurological factors. Variations in the type of training and its mechanisms involved, such as strength- or hypertrophy-oriented training, may influence this relationship in different ways (Carvalho et al., 2022). In addition, the relationship between muscle stiffness and strength remains unclear (Akagi et al., 2016; Mannarino et al., 2019). Thus, this research aimed to investigate the potential correlation between the strength levels, measured by the 10-repetition maximum (10RM), across different ranges of motion (ROM) in the barbell bench press exercise (BP) to the cross-sectional area (CSA) and shear modulus (= indication for stiffness) of the muscles primarily engaged in the exercise. Twenty-one resistance-trained participants (age 27.1 ± 3.4 years) volunteered in this study. The CSA and muscle shear modulus were assessed in a resting position with ultrasound imaging using an ultrasound system (Supersonic Imaging, Aix-en-Provence, France). CSA ultrasound images were captured with panoramic mode for the pectoralis major and the triceps brachii long head. Muscle shear modulus was measured for the pectoralis major, the anterior deltoid, and the triceps brachii long head using shear wave elastography (SWE). Additionally, participants were assessed for their 10RMs of the three types of BP variations, a full ROM and two partial ROMs, the upper half and lower half of the full movement. Data analyses revealed significant correlations between all BP variations and the medial and lateral CSA of the pectoralis major with correlations ranging from r = 0.775 to r = 0.832 (p = 0.001). Significant correlations were also found for the proximal CSA of the triceps brachii long head with the strength values of all tested BP variations with correlations ranging from ρ = 0.492 to ρ = 0.494 (p = 0.028 to p = 0.027). The distal CSA of the triceps brachii did only correlate significantly with the lower ROM BP (r = 0.484, p = 0.026). No significant correlations were found between the SWE of the measured muscles and the bench press variations tested. Additionally, no differences were observed in the correlations between the BP variations. Correlations between 10RM strength levels and the CSA of the pectoralis, and to a lesser extent, the triceps muscle, show the significance of muscle mass for strength in resistance-trained individuals. This finding aligns with a previous training study that examined the hypertrophic effects of bench press exercises on various muscles (Ogasawara et al., 2012). The study revealed that although both the pectoralis and triceps muscles increased in size, the triceps tended to plateau earlier. This suggests that the pectoralis muscle has a greater capacity for muscle volume growth and, consequently, a higher potential for force production. Finally, SWE measurements revealed no significant correlation with BP variations, implying that muscle stiffness may not play as critical a role in 10RM performance as muscle CSA does. This conclusion aligns with other studies that could not find significant changes in muscle stiffness using SWE following resistance training interventions (Dankel & Razzano, 2020). References Akagi, R., Shikiba, T., Tanaka, J., & Takahashi, H. (2016). A six-week resistance training program does not change shear modulus of the triceps brachii. Journal of Applied Biomechanics, 32(4), 373–378. https://doi.org/10.1123/jab.2015-0290 Carvalho, L., Junior, R. M., Barreira, J., Schoenfeld, B. J., Orazem, J., & Barroso, R. (2022). Muscle hypertrophy and strength gains after resistance training with different volume-matched loads: A systematic review and meta-analysis. Applied Physiology, Nutrition, and Metabolism, 47(4), 357–368. https://doi.org/10.1139/apnm-2021-0515 Dankel, S. J., & Razzano, B. M. (2020). The impact of acute and chronic resistance exercise on muscle stiffness: A systematic review and meta-analysis. Journal of Ultrasound, 23(4), 473–480. https://doi.org/10.1007/s40477-020-00486-3 Mannarino, P., Matta, T. T. D., & Oliveira, L. F. D. (2019). An 8-week resistance training protocol is effective in adapting quadriceps but not patellar tendon shear modulus measured by Shear Wave Elastography. PLoS ONE, 14(4), Article e0205782. https://doi.org/10.1371/journal.pone.0205782 Ogasawara, R., Thiebaud, R. S., Loenneke, J. P., Loftin, M., & Abe, T. (2012). Time course for arm and chest muscle thickness changes following bench press training. Interventional Medicine and Applied Science, 4(4), 217–220. https://doi.org/10.1556/imas.4.2012.4.7

From Hair-Pulling to Trichobezoars and Rapunzel Syndrome: A Comprehensive Review of Trichotillomania

Introduction: Trichotillomania (TTM) is an obsessive-compulsive disorder characterized by the uncontrollable pulling of hair from various parts of the body, most commonly from the scalp, eyebrows, and eyelashes. Clinical manifestations of TTM include patchy alopecia, uneven hair shaft growth, and characteristic changes visible in trichoscopy, such as the presence of black dots, twisted hairs, split ends, and hairs shaped like exclamation marks. The etiology of TTM is complex and involves genetic, neurological, and psychological factors. In some patients, TTM co-occurs with trichophagia, leading to the formation of trichobezoars in the gastrointestinal tract. In extreme cases, such as Rapunzel Syndrome, bezoars can lead to intestinal obstruction. Treatment for TTM is multifaceted and includes both psychotherapeutic and pharmacological interventions. Objective: The objective of this study is to provide a comprehensive review of trichotillomania (TTM), with a particular focus on its clinical symptoms, etiology, diagnostics, and treatment methods. The aim is to understand this obsessive-compulsive disorder, its impact on patients' lives, and its connections to serious complications such as trichobezoars and Rapunzel Syndrome. Materials and Methods: The study utilized analyses of scientific research, review articles, and reports concerning trichotillomania (TTM), trichobezoars, trichophagia, and Rapunzel Syndrome. It is primarily based on data from PubMed, Google Scholar, Cochrane Library, and studies published between 2000 and 2024, focusing on the diagnostics, etiology, and treatment of TTM and related disorders. Conclusions: The purpose of this study is to provide a comprehensive review of the current knowledge on trichotillomania, including its clinical symptoms, etiology, diagnostics, and treatment methods, while considering serious complications such as trichobezoars and Rapunzel Syndrome.

Relationship of myofascial trigger points with related disability, anxiety, and depression in patients with migraine headaches

BackgroundMigraine affects one in ten individuals worldwide and is the second leading cause of disability. Studies have shown an association between migraine and the musculoskeletal system, and myofascial trigger points (MTrPs) play an essential role. Additionally, those with myofascial pain have been proven to experience higher levels of depression and anxiety. Understanding the association between MTrPs and migraine is crucial for developing targeted treatment strategies. Additionally, recognizing the link between MTrPs and migraine-related depression and anxiety underscores the importance of a holistic approach to migraine management. By addressing both musculoskeletal and neurological factors, healthcare providers can provide more effective and personalized care for migraine patients. This study aims to determine the association between MTrPs with migraine-related disability, anxiety, depression, and migraine characteristics.MethodsThis cross-sectional study included 68 migraine patients from an outpatient neurology clinic. The number of MTrPs was determined through examination by an experienced neurologist during a migraine-free period using the recommended international criteria. We evaluated anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and disability with the Migraine Disability Assessment Scale (MIDAS).ResultsWe enrolled 68 patients (22 males) with a mean age of 36.23 ± 9.63 years. The mean number of MTrPs was 2.75 ± 2.934. MTrPs were positively correlated with severity (CC: 0.576, P-value < 0.001). There was no association between MTrPs and HADS-D or MIDAS, but migraine patients with abnormal HADS-A scores had more MTrPs than patients with normal HADS-A scores (0.6 ± 0.84 vs 3.56 ± 3.11, P-value:0.013).ConclusionsThe number of MTrPs is associated with higher anxiety levels and headache intensity. Further research could investigate the impact of MTrP-based therapies on anxiety among individuals suffering from migraines.

Clinical characteristics and management of functional neurological disorders (FND) mimicking stroke in emergency settings: a functional stroke mimic cases.

FNDs mimicking a stroke represent a growing challenge in the emergency department (ED). A comprehensive diagnostic approach involving clinical evaluation and neuroimaging is essential to differentiate stroke from mimics. The safety profile of thrombolysis justifies its use where FNDs cannot be ruled out. This approach highlights the need for more precise diagnostic tools and protocols to improve patient care and reduce unnecessary treatments. Distinguishing FNDs from actual cerebrovascular events is critical yet difficult, particularly under time constraints. Given the urgency and potential severity of strokes, intravenous thrombolysis is frequently administered even when FNDs cannot be definitively excluded. This retrospective study analyzed data of participants admitted to the Trieste University Hospital Stroke Unit between January 2018 and December 2022, focusing on those presenting with sudden-onset focal neurological deficits mimicking a stroke, with some presenting within the reperfusion treatment window (<4.5 h from symptoms onset). We obtained detailed clinical evaluations and neuroimaging, and administered thrombolytic therapy in selected cases. We included 84 participants presenting with stroke mimics (average age of 45 yo) predominantly female (65.5%). Most common presentations: hemiparesis or hemisensory loss (75%), speech disorder (10.7%), vertigo/gait disorders (4.8%). History of psychiatric disorders was found in 32.1% of cases, and 48.8% had prior neurological disease or stroke risk factors. Advanced neuroimaging was performed in 43 cases yielding normal or non-specific results. Thrombolysis was safely administered in 31%. Patients mostly recovered within the first 24 h from admission (44.7%). We compared this FND's sample with 291 patients with mild ischemic stroke (NIHSS ≤7).

Clinico-epidemiological profile & outcome of patients presenting with cerebral venous thrombosis to emergency department

ObjectivesTo better understand the clinical and radiological characteristics of Cerebral Venous Thrombosis (CVT), we conducted a study focusing on the assessment of neurological outcomes and factors associated with poor prognosis in patients with CVT. MethodsThis prospective, observational study took place over two years (July 2020 to June 2022) in a tertiary care teaching hospital in South India, encompassing adults aged 18 years and over. Key data points included demographic information, symptomatology, physical and neurological examinations, neuroimaging findings, hospital interventions, and neurological outcomes at discharge and at a six-week telephonic follow-up. ResultsA total of 140 patients with CVT, median age 34 years, were studied. 61.4 % were males. The most common symptoms and signs were headaches (70.7 %) and papilledema (60.7 %). Hemorrhagic infarct was the most prevalent finding on the non-contrast computed tomography (NCCT) of the brain, involving 39.4 % of patients. The most commonly affected sinus was the superior sagittal sinus. Risk factors most often observed were alcoholism (45 %), smoking (21.4 %), anemia (27.1 %), oral contraceptive pill usage (12.1 %), and hypertension (12.1 %). Deep vein thrombosis or pulmonary embolism was present in 5 % of the patients. The mean hospital stay was 13.9 days, with 6.4 % of patients requiring endotracheal intubation at presentation and 22.9 % during their stay. The observed in-hospital mortality rate was 17.9 %, increasing to 22.4 % at the six-week follow-up. Morbidity (mRS 3–5) was 24.3 % at discharge, decreasing to 8.2 % at six-week follow-up. Favorable outcomes were reported in 57.9 % of cases at discharge, rising to 69.4 % at six weeks. ConclusionsOur study underscores the importance of recognizing cardinal symptoms and diverse risk factors of CVT, including alcoholism and anemia. Majority of CVT occurrences were observed in males aged 18–29. Critical determinants of heightened morbidity and mortality were identified, including lower GCS scores and the necessity for advanced interventions. Notably, majority of patients presented favorable neurological outcomes at six-week follow-up.

Effects of Hypogonadism and Testosterone Therapy on Diabetic Foot Complications.

Results of recent studies suggest that high levels of endogenous testosterone decrease the risk of diabetes. Testosterone therapy may delay the transition from prediabetes to diabetes and accelerate healing of diabetic foot ulcers in hypogonadal men. We investigated whether testosterone therapy in this population decreases the occurrence of diabetic foot complications within 1 and 5 years of diabetes diagnosis. Optum's deidentified Clinformatics Data Mart database was searched for male patients with diabetes. Associations between testosterone therapy and the occurrence of ulceration or the use of wound care were explored in the entire population and in those with and without hypogonadism using both bivariate and multivariate analyses. Contrary to the hypotheses, testosterone therapy seems to confer increased risk of diabetic foot complications. In hypogonadal men with at least 1 year of follow-up after diabetes diagnosis, any use of testosterone therapy increased the odds of wound care utilization by a factor of 1.10 (95% confidence interval, 1.03-1.17), and the odds of ulceration by a factor of 1.13 (95% confidence interval, 1.03-1.24). Similar results are seen in all men, both with and without hypogonadism. Further exploration reveals that hypogonadism also increases the risk of wounds among people with diabetes with care utilization in the entire population. Further research is needed to elucidate the mechanisms by which hypogonadism and testosterone therapy impact diabetic foot complications, and whether these mechanisms are mediated by vascular or neurologic factors.

Association of Age and Neurological Severity at Intensive Care Unit Admission With Driving Resumption Within 30 Days of Stroke: A Single-Center Historical Cohort Study.

Objectives Guidelines in several countries recommend against driving soon after a stroke; however, some patients resume driving within one month after onset. This study aimed to examine the relationship between neurological and social background factors at intensive care unit (ICU) admission and resumption of motor vehicle driving within 30 days of the first acute stroke/cerebral hemorrhage. Materials and methods Data were extracted from medical records of a single center linked to the National Cerebral and Cardiovascular Center Administration Office for Stroke Data Bank in Japan. The data included age, sex, Japan Coma Scale (JCS), National Institutes of Health Stroke Scale (NIHSS), employment status, family situation, and outcomes of driving resumption in patients with a valid driving license transported to the ICU within 24 hours of stroke onset. Time-to-event analysis was used to explore the associations between these factors and driving resumption, with data censored 30 days from onset. Results In total, 239 patients had complete medical records, of whom 66 resumed driving. A multivariate Cox proportional hazards analysis showed that fewer patients aged ≥65 years resumed driving than those aged <65 years (hazard ratio 0.46; 95% confidence interval: 0.25-0.84; p=0.009). Patients with NIHSS scores ≥5 and JCS scores ≥1 were also less likely to resume driving compared with those with scores <5 (0.22; 0.08-0.56; p=0.008) and 0 (0.13; 0.04-0.37; p<0.001), respectively. Conclusions Age, NIHSS score, and JCS score at ICU admission are independently associated with the likelihood of resuming driving within 30 days of stroke onset. These findings may aid with the provision of support and education to facilitate the efficient resumption of driving after an acute event.

Efficacy and mechanism of Xiaoshuan enteric-coated capsule as an adjunctive treatment for ischemic stroke: A randomized clinical trial

ObjectiveTo explore the clinical efficacy of Xiaoshuan enteric-coated capsule (XSECC) in treating cerebral infarction and its potential mechanism of action. MethodsPatients with acute ischemic stroke (AIS) of the qi deficiency and blood stasis type were randomly assigned to the control and observation groups. They were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL), Hachinskilnchemic Scale (HIS), Barthel Index (BI), clinical efficacy scores, and TCM syndrome scores on days 0, 14, 30, and 90. Furthermore, VEGF and BDNF levels were measured on days 30 and 90. Finally, we analyzed the changes in each scale score and vascular neurological factor in both groups. ResultsAfter 14 days of treatment, the difference values in NIHSS, ADL, and BI were higher, and TCM syndrome and clinical efficacy scores were increased in the observation group compared with those of the control group (all P < .05). After 30 days, the NIHSS, ADL, HIS, and TCM syndrome scores were decreased compared with those of the control group, while BI and clinical efficacy scores were increased (all P < .05). After 90 days, the difference value in ADL was higher, and TCM syndrome score was increased in the observation group compared with that of the control group (P = .047, P = .005, respectively). The levels of VEGF and BDNF were higher in the observation group than in the control group on days 14, 30, and 90 (all P < .05). VEGF and BDNF levels on day 0 were associated with prognosis of patients with AIS; therefore, they have a predictive value for the prognosis of acute cerebral infarction. ConclusionsXSECC therapy can improve clinical outcomes in patients with acute and recurrent cerebral infarctions. Its mechanism of action may be associated with the secretion of VEGF and BDNF.

Relationship between the effect of panic attack and physiological parameters in some patients and animals lab

The effects of a panic attack were studied in some patients who do not have hereditary diseases "sudden onset" as well as using laboratory animal "rats" to examine the types of effects on some physiological parameters. compared with control. These attacks affect daily life and result from a complex interaction between environmental, neurological, and psychological factors. Venous blood samples were collected from people suffering from non-genetic diseases. Blood samples were also collected from experimental animals exposed to fear at intervals of 0, 3, 7, and 28 days to detect the relationship between environmental factors and some physiological factors. Statistical analysis was performed using the SPSS program. The results indicated an increase in the level of cholesterol, glucose, and C-reactive protein in people with non-genetic diseases compared to their decrease in the control group, in addition to an increase in the level of cholesterol and glucose and no effect on C-reactive protein in rats exposed to the impact of fear and low body weight. The results also show a significant increase in heart and breathing rates and a significant decrease in oxygen levels.

Spectrofluorometric determination of ascorbic acid in the plasma matrix: Exploring correlation with autism spectrum disorder

Ascorbic acid (Vitamin C) is crucial for bodily functions, including collagen synthesis, immune system support and antioxidant defense. Despite autism spectrum disorder's multifactorial nature involving genetic, environmental and neurological factors, robust evidence exploring the association between ascorbic acid and this disorder is notably lacking. This study introduces an innovative spectrofluorometric method to quantify ascorbic acid in the plasma of healthy children and those with autism spectrum disorder. The method relies on the interaction of ascorbic acid with the fluorescent dye propidium iodide. In acidic conditions, propidium iodide undergoes protonation and selectively binds to the negatively charged ascorbic acid forming an ion-pair complex. This complex alters the molecular structure of propidium iodide inducing chemical fluorescence quenching, that can be utilized for ascorbic acid quantification. The developed method undergoes rigorous validation following ICH guidelines, demonstrating a linear relationship within a concentration range of 4–40 μg/mL, with high precision and accuracy metrics. Analysis of real plasma samples from autistic and healthy children reveals clinically and statistically elevated levels of ascorbic acid in those with autism spectrum disorder.

Changes in protein fluxes and gene expression in non-injured muscle tissue distant from an acute myotoxic injury in male mice.

The response to acute myotoxic injury requires stimulation of local repair mechanisms in the damaged tissue. However, satellite cells in muscle distant from acute injury have been reported to enter a functional state between quiescence and active proliferation. Here, we asked whether protein flux rates are altered in muscle distant from acute local myotoxic injury and how they compare to changes in gene expression from the same tissue. Broad and significant alterations in protein turnover were observed across the proteome in the limb contralateral to injury during the first 10days after. Interestingly, mRNA changes had almost no correlation with directly measured protein turnover rates. In summary, we show consistent and striking changes in protein flux rates in muscle tissue contralateral to myotoxic injury, with no correlation between changes in mRNA levels and protein synthesis rates. This work motivates further investigation of the mechanisms, including potential neurological factors, responsible for this distant effect. KEY POINTS: Previous literature demonstrates that stem cells of uninjured muscle respond to local necrotic muscle tissue damage and regeneration. We show that muscle tissue that was distant from a model of local necrotic damage had functional changes at both the gene expression and the protein turnover level. However, these changes in distant tissue were more pronounced during the earlier stages of tissue regeneration and did not correlate well with each other. The results suggest communication between directly injured tissue and non-affected tissues that are distant from injury, which warrants further investigation into the potential of this mechanism as a proactive measure for tissue regeneration from damage.

Deciphering Mechanisms, Prevention Strategies, Management Plans, Medications, and Research Techniques for Strokes in Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic condition characterized by an unpredictable course and a wide spectrum of manifestations varying in severity. Individuals with SLE are at an increased risk of cerebrovascular events, particularly strokes. These strokes manifest with a diverse range of symptoms that cannot be solely attributed to conventional risk factors, underscoring their significance among the atypical risk factors in the context of SLE. This complexity complicates the identification of optimal management plans and the selection of medication combinations for individual patients. This susceptibility is further complicated by the nuances of neuropsychiatric SLE, which reveals a diverse array of neurological symptoms, particularly those associated with ischemic and hemorrhagic strokes. Given the broad range of clinical presentations and associated risks linking strokes to SLE, ongoing research and comprehensive care strategies are essential. These efforts are critical for improving patient outcomes by optimizing management strategies and discovering new medications. This review aims to elucidate the pathological connection between SLE and strokes by examining neurological manifestations, risk factors, mechanisms, prediction and prevention strategies, management plans, and available research tools and animal models. It seeks to explore this medical correlation and discover new medication options that can be tailored to individual SLE patients at risk of stroke.