Neurological Deficiency Research Articles

Role of Serum Ferritin and Prediction of Neurological Outcome in Acute Ischemic Stroke Patients

Background: Stroke, also known as cerebrovascular accident (CVA), is an abrupt onset of neurological deficiency caused by a specific vascular aetiology. Aim: This study aimed to assess the role of serum ferritin in acute ischaemic stroke patients to correlate serum ferritin and neurological scales on the day of admission and during follow-up and to predict neurological outcomes. Methods: This prospective observational study included 100 patients who presented with acute ischaemic stroke clinically and with radiological imaging in the General Medicine and Neurology departments of Saveetha Medical College and Hospital for 18 months. Functional disability was assessed for all patients after 3 months based on the correlation of serum ferritin levels with the neurological scales, and the outcome was estimated. Results: The mean age of the patients was 59.45 ± 14.39. The serum ferritin level and Canadian Stroke Scale score during admission on day 7th and day 30th, were significantly different (p < 0.01). Serum ferritin levels were positively associated with the Glasgow Coma Scale score at admission and on the 7th and 30th days after admission. Ferritin levels were significantly higher in the moderate category under all circumstances (p < 0.01). Patients with mRS scores of 2, 3, and 4 were compared with serum ferritin levels and found to be significantly associated with serum ferritin levels. Conclusion: This study found that patients with higher serum ferritin levels experienced increased stroke severity and lower GCS and mRS scores, which correlated with increased morbidity.

Outcome of Surgery in a Patient with Blindness and Inter- Hemispheric Cyst: A Case Report

Interhemispheric cysts are rare congenital condition which is also associated with corpus callosum agenesis. Most patients present at neonatal age or early childhood with some neurological deficiency. Some patients may present at older age. Here we present a patient with acute blindness of the right eye and dimness of vision of the left eye. He had no mental retardation or other neurological deficit. His fundus showed bilateral papilloedema. His MRI showed an interhemispheric cyst with agenesis of the corpus callosum. He was urgently operated in this hospital. The cyst was approached through interhemispheric fissure. It was excised and communicated with the third ventricle. His post-operative period was uneventful. Immediately after surgery he had improvement of his vision over a period of two week. He could return to normal life following discharge. Therefore, prompt surgical intervention is important for saving vision of these patients. Bang. J Neurosurgery 2024; 13(2): 165-169

Ascorbic acid-containing compound efficacy in ischemic brain damage

Introduction: Ischemic brain injury remains one of the main causes of disability and mortality worldwide. Protection of cellular population, depriving from oxygen supply and nutrients, is of extreme importance for further both clinical and health outcomes of timely implemented intravascular intervention. The aim: to assess anti-ischemic activity of 3-hydroxypyridine ascorbate in the in vitro and in vivo models of brain cell and tissue response to ischemia and reoxygenation. Materials and Methods: 3-hydroxypyridine ascorbate (laboratory code 3-EA) was assessed as chemical substance (purity 99.8%) diluted in sterile phosphate-buffered saline. Intracellular Ca2+ response to glutamate excitotoxicity (GluTox), ischemia and reoxygenation as well as cellular viability was evaluated on NMRI murine fresh cortical neuro-glial cell culture incubated with 2-EA by registering intracellular Fura-2 and propidium iodide fluorescence respectively. Expression of apoptosis regulating genes BCL-2, STAT3, SOCS3, inflammation regulating genes TRAIL, MLKL, Cas-1, Cas-3, IL-1β и TNFα, and genes MAO-A and MAO-B was determined by real-time PCR. The substance neuroprotection was studied in male Sprague-Dawley rats with intraluminal middle cerebral artery (MCA) occlusion/reperfusion treated with 18 mg/kg of 2-EA along with neurological deficiency evaluation and morphological assessment of brain sections. Results: Preincubation of cortical cells with 10-100 μM of 3-EA leads to inhibition of [Ca2+]i in cytosol of neurons and astrocytes under GluTox and oxygen-glucose deprivation (OGD) conditions. Reducing [Ca2+]i inhibits necrotic cell death in an acute experiment. Incubation of cerebral cortex cells with 3-EA leads to an overexpression of anti-apoptotic genes BCL-2, STAT3, SOCS3, along with downregulation of genes TRAIL, MLKL, Cas-1, Cas-3, IL-1β and TNFα. Intraperitoneal administration of 3-EA reduces the volume of necrotic areas, perinecrotic edema, cell damage, and neurological deficits in rats with MCA occlusion. Conclusion: 3-EA dose-dependently suppresses the death of cerebral cortex cells under the excitotoxic effects of glutamate and ischemia/reoxygenation. Cell-protective effect of 3-EA involves changes in the basal and ischemia/reoxygenation-induced expression of genes encoding anti-apoptotic proteins and oxidative status proteins, which leads to inhibition of the late irreversible stages of apoptosis. A course administration of 3-hydroxypyridine ascorbate at a dose of 18 mg/kg per day reduces the severity of damage both by preserving the population of neurons in the penumbra zone and by limiting the local stress response.

Modern Experience of Pharmacotherapeutic Use and Effectiveness of Endolumbal Administration of Glucocorticoids in Progressive Types of Course for Multiple Sclerosis

Effective pharmacotherapy of low-bondly progredient forms of the multiple sclerosis is a difficult task that requires the search for new and improving existing methods of treatment. The author set the task to the optimize the treatment of progredient forms of multiple sclerosis using the method of endolumbal introduction of glucocorticoids and to evaluate its efficiency. The results of treatment of 76 patients with poor curable progresses of multiple sclerosis by intratracal introduction of glucocorticoids (dexamethasone) are presented in the study. The advantages of method, methodic of introduction, the patient`s selection parameters were given. The efficiency criterions of intration of glucocorticoids were defined, including the neurological deficiency regress, stabilization and the delay of multiple sclerosis progressing. Integral assessment of efficiency was made as 4 gradations: “good rate”, “low” and “absence of effect”. The positive dynamics of neurological state was registered predominantly on spastic-paretic syndrome with presence of several active foci with contrast enhancement. The sphincter infringements and brain stem symptomatic were observed as rarely reversible, extremely rarely - cerebellar symptom complex. As the results of the treatment (the term of the observation – 6 months and more) 80.2% of multiple sclerosis patrols marked the efficiency as "good" and "moderate". The obtained data indicated the reasonability of the proposed method of treatment for patrols with saversive counses of multiple sclerosis, occurring inly with spinal symptomatic.

Zinc for GNAO1 encephalopathy: Preclinical profiling and a clinical case

De novo pathogenic variants in GNAO1-the gene encoding the major neuronal G protein Gαo-cause pediatric encephalopathies and other neurological deficiencies largely refractory to available therapies. Zn2+ emerged to restore guanosine triphosphate hydrolysis and cellular interactions of pathogenic Gαo; dietary zinc salt supplementation improves lifespan and motoric function in a Drosophila disease model. Using biochemical, animal, and first-in-human studies, we provide support for the patient stratification and application of zinc acetate in GNAO1-associated disorders. We show that 16 different pathogenic missense variants cluster in three distinct groups in their responsiveness to Zn2+, and we provide the safety study in a mouse disease model. We further describe treatment of a 3-year-old patient with the common pathogenic GNAO1 variant c607G>A, p.Gly203Arg with oral 50mg zinc (in the form of zinc acetate) daily, as applied in Wilson's disease. During 11months of treatment, the patient shows cessation of daily dyskinetic crises, improved Burke-Fahn Marsden Dystonia Rating Scale movement score, reduction in epileptic seizures, and an excellent safety profile. Our findings warrant a large-scale clinical trial and might set the new standard of care for GNAO1-related disorders. This work was funded by the Russian Science Foundation (grant #21-15-00138) and GNAO1 España.

Oligomerization and a distinct tRNA-binding loop are important regulators of human arginyl-transferase function

The arginyl-transferase ATE1 is a tRNA-dependent enzyme that covalently attaches an arginine molecule to a protein substrate. Conserved from yeast to humans, ATE1 deficiency in mice correlates with defects in cardiovascular development and angiogenesis and results in embryonic lethality, while conditional knockouts exhibit reproductive, developmental, and neurological deficiencies. Despite the recent revelation of the tRNA binding mechanism and the catalytic cycle of yeast ATE1, the structure-function relationship of ATE1 in higher organisms is not well understood. In this study, we present the three-dimensional structure of human ATE1 in an apo-state and in complex with its tRNA cofactor and a peptide substrate. In contrast to its yeast counterpart, human ATE1 forms a symmetric homodimer, which dissociates upon binding of a substrate. Furthermore, human ATE1 includes a unique and extended loop that wraps around tRNAArg, creating extensive contacts with the T-arm of the tRNA cofactor. Substituting key residues identified in the substrate binding site of ATE1 abolishes enzymatic activity and results in the accumulation of ATE1 substrates in cells.

Assessment of Stroke Patients' Muscle Strength Following a Combination of Mirror Therapy and ROM (Range of Motion) Exercises Based on Self-Care Theory

Background: When blood flow problems kill off some brain cells, the result is a neurological deficiency known as a stroke. There have been 507 reported cases of stroke in East Java, while the overall stroke prevalence in Indonesia has jumped from 7% to 10.9% (Riskesdas, 2020). The researchers at RSI Darus Syifa's Surabaya set out to determine how much of an impact self-care theory-based mirror therapy and range-of-motion exercises had on the muscular strength of stroke patients admitted to the inpatient unit. Methods: A true experimental with a pretest-posttest control group design was utilised in this type of research. One hundred and ten stroke patients made up the study's population. There were a total of 34 participants in this study, with 17 serving as control subjects and 17 as interventionists. Sampling was based on probability sampling using simple random sampling. The Medical Research Council (MRC) scale was utilised by the device to measure muscular strength. Mann-Whitney and the Wilcoxon Signet Rank Test were used to examine the collected data. Results: In the inpatient ward of the Darus Syifa Surabaya Hospital, stroke patients who undergo a combination of mirror therapy and range of motion exercises based on self-care theory show a significant improvement in muscle strength, according to the Mann-Whitney test (p < 0.05). Conclusion: The study found that stroke patients' muscle strength improved with a combination of mirror therapy and range of motion exercises grounded in self-care theory.

The impact of shoes versus ankle-restricted orthoses on sit-to-stand kinematics and centre of mass trajectories in adults with myelomeningocele

BackgroundIndividuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. Research questionHow are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? MethodsTwenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. ResultsThe AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle). SignificanceThe differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.

Role of Mri in Characterization of Congenital Malformations of Brain in A Tertiary Care Centre-A Retrospective Study

Background: Congenital brain anomalies are rare among the congenital anomalies of various organ systems. It is crucial to recognise these disorders as soon as possible because of the extensive neurological deficiency and negative consequences they can cause. Neuroimaging is a reliable way to accurately diagnose the majority of congenital brain abnormalities. There aren't enough statistics available in developing countries like India about the frequency and types of brain abnormalities. The purpose of this study is to examine the prevalence and range of frequently occurring congenital brain abnormalities. Objective: To study the whole spectrum of all substantial and frequently occurring congenital abnormalities as well as the proportional distribution of the various brain malformations in a tertiary care centre. Methods and materials: The study was conducted at Department of Radio-Diagnosis, Medical College Kolkata from 1st September 2022 to 31st August 2023. All MRI brain examinations at our hospital over a period of one year were retrospectively reviewed and analysed by sex, age at presentation, type of congenital cerebral malformation, and other associated congenital cerebral malformations. Results: This study included 24 patients. The total number of brain malformations identified in these patients was 33. The age of patients at first MRI imaging ranged from 5 days to 16 years. There were 14 males and 10 females. The most common malformations were corpus callosum dysgenesis (24%), Heterotropia (15%) and Lissencephaly (12%). Seven patients (29.1%) had more than one congenital brain malformation. Conclusion: The variety and complexity of congenital brain abnormalities is remarkable. The correct diagnosis is essential for the best care of these unfortunate conditions, and MRI plays a significant role in this process. Identification of distinctive neuroimaging findings of various congenital brain anomalies are immensely helpful in diagnosing the anomalies and further management.

Literature review of non-pharmacological treatment for patients with axial spondyloarthritis.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder affecting the sacroiliac joints and axial spine. Along with pharmacotherapy, non-pharmacological interventions for axSpA are crucial and constitute the cornerstone of treatment. Here, we review the evidence for non-pharmacological treatment of axSpA as a basis for the 2023 Korean treatment recommendations for patients with axSpA. The effectiveness of the core non-pharmacological approaches, such as education, smoking cessation, and exercise, has been reaffirmed. High-quality research on surgical treatment is limited. However, total hip replacement is advised in patients with ongoing pain or disability and visible structural damage to the hip on imaging. Urgent spinal intervention should be considered in cases of acute spinal pain with neurological deficiency or concurrent unstable fractures. Evidence for complementary therapies, including spas and acupuncture, remains insufficient.

Acute ischemic stroke with a diagnosis of Marfan syndrome: A report of 3 cases in multifaceted settings.

Marfan syndrome (MFS), which is a dominantly inherited connective tissue disease resulting from a mutation in the FBN1 gene, exhibits variable manifestations affecting the cardiovascular, musculoskeletal, ophthalmologic, and pulmonary systems. Notably, neurologic deficiency, which involves ischemic or hemorrhagic stroke, is a rare but severe manifestation. The safety of rt-PA treatment for ischemic stroke caused by MFS is still under discussion. In the current report, we discuss 3 atypical MFS cases presented as acute ischemic stroke, compared to those exhibiting cardiovascular and musculoskeletal abnormalities. Three patients were diagnosed with acute ischemic stroke accompanied by MFS based on clinical manifestations, imaging examinations, and genetic testings. The first case underwent intravenous thrombolytic therapy with rt-PA, the second case received antiplatelet therapy, and the third case received anticoagulant therapy and perfusion therapy. The neurologic deficiency of all three patients showed improvement upon discharge, and there were no symptoms of recurrence observed during the follow-up period. MFS is a rare etiology in young people with embolic stroke of undetermined source. Physicians should take MFS into consideration when they observe the characteristic symptoms during a consultation. The potential pathogenesis of ischemic stroke secondary to MFS may include cardio-embolism, arterial dissection, and hypoperfusion. Although intravenous thrombolysis is a promising therapy to treat acute ischemic stroke, further examinations should be conducted to rule out contraindications in patients with a suspicion of MFS.

Understanding the Relationship Between Vascular Smooth Muscle Cell Function and the Efficacy of Acupuncture in Treating Cerebral Ischemic Stroke: A Preclinical Meta-Analysis and Systematic Review.

Cerebral blood flow and vascular structures serve as the fundamental components of brain metabolism and circulation. Acupuncture, an alternative and complementary medical approach, has demonstrated efficacy in treating cerebral ischemic stroke (CIS). Nevertheless, the mechanisms underlying the impact of acupuncture on vascular smooth muscle cell (VSMC) function remain uncertain. The objective of this systematic review and meta-analysis is to assess the alterations in VSMC function following acupuncture stimulation in CIS models. The databases PubMed, Web of Science, SCOPUS, and EMBASE were queried until November 2022 using a predetermined search strategy. The FORMAT BY SYRCLE guidelines were adhered to, and the risk of bias of the included studies was evaluated using the Risk of Bias tool developed by the Systematic Review Centre for Laboratory Animal Experimentation. The random-effects model was employed to estimate the standardized mean difference (SMD). Eighteen articles are included in this review. Acupuncture showed significant positive effects on the region cerebral blood flow (SMD=8.15 [95% CI, 4.52 to 11.78]) and neurological deficiency (SMD=-3.75 [95% CI, -5.54 to -1.97]). Descriptive analysis showed a probable mechanism of acupuncture stimulation in CIS rats related to VSMC function. Limitations and publication bias were presented in the studies. In this systematic review and meta-analysis, our findings indicate that acupuncture stimulation has the potential to improve regional cerebral blood flow and alleviate neurological deficits, possibly by regulating VSMC function. However, it is important to exercise caution when interpreting these results due to the limitations of animal experimental design and methodological quality.

Identifying risk factors for cerebral venous thrombosis in an intensive care unit: Interest in early anticoagulant treatment

Thrombosis of the dural venous sinus or cerebral veins (CVT) of particular anatomical location of venous thrombosis with a complete or partial occlusion. Treatment of CVT with Heparin followed by VKA is recommended by current guidelines. Material and methods: We conducted a descriptive cohort study, of CVT recorded at the University Hospital Centre Lamine Debaghine Bab El Oued (Algeria) from April 2020 to December 2023. Results: We reported 16 cases of cerebral venous thrombosis (CVT) that were admitted to the intensive care ward from April 2020 to December 2023. It represents 7.4% of neurologic deficiency consultation in the emergency department in the studied period. The mean age of our population is 37.38. we found a preponderance in the female population. The aim of our study is to highlight the importance of early anticoagulation. Discussion: We found that early administration of anticoagulant therapy within the first 24 hours reduced mortality and outcomes in the study population. Our results were consistent with most studies reported in the literature. Conclusion: the introduction of the precocial anticoagulation impacts the mortality and outcomes in CVT however, more studies on the exact timing of introduction are required to define the right timing.

Neurological sphincter deficiency: is there a place for artificial urinary sphincter?

PurposeNeurogenic stress urinary incontinence (N-SUI) is a condition with serious impact on the quality of life. There are several treatment modalities of which the artificial urinary sphincter (AUS) stands out as the most suitable technique for addressing sphincter insufficiency. In this article, the purpose is to describe practical considerations, outcomes, and complications of the artificial urinary sphincter in neurological sphincter deficiency in both males and females.MethodsA narrative review of the current literature.ResultsThe outcomes of AUS are reasonably good in patients with NLUTD, the surgical technique is discussed as well as the limitations and special considerations in this complex and heterogeneous patient population.ConclusionThe available evidence suggests that its efficacy and functional durability may be lower in patients with neurogenic lower urinary tract dysfunction (NLUTD) compared to those without neurological deficits. However, studies have shown that AUS can still provide effective and safe continence outcomes in both male and female patients, with long-term device survival rates ranging from several years to over a decade.

Sevoflurane postconditioning alleviates hypoxic-ischemic brain damage in rats by inhibiting the endoplasmic reticulum stress PERK/ATF4/CHOP pathway

Hypoxic-ischemic brain damage (HIBD) frequently induces cognitive impairments. Investigating the role of sevoflurane postconditioning (SPC) in HIBD, we conducted experiments involving HIBD modeling, SPC treatment, and interventions with the PERK inhibitor GSK2656157 or the PERK activator CCT020312, administered 30minutes before modeling, followed by SPC treatment. Behavioral testing using the Morris water maze test and Neurological Deficiency Scale (NDS) was conducted. Additionally, Nissl staining assessed hippocampal CA1 area neuronal density, TUNEL staining evaluated hippocampal CA1 area neuronal apoptosis, and Western blot determined hippocampal CA1 area protein levels, including Bax, Bcl-2, p-PERK/PERK, p-eIF2/eIF2, ATF4, CHOP, GRP78, Bax, and Bcl-2 protein levels. Following SPC treatment, HIBD rats exhibited improved spatial learning and memory abilities, reduced neuronal apoptosis, increased neuronal density in the hippocampal CA1 area, elevated Bcl-2 protein level, decreased Bax protein levels, and decreased levels of endoplasmic reticulum stress pathway related proteins (p-PERK/PERK, p-eIF2/eIF2, ATF4, CHOP and GRP78). Pre-modeling treatment with the PERK inhibitor treatment improved outcomes in HIBD rats. However, pre-modeling treatment with the PERK activator CCT020312 counteracted the protective effects of SPC against HIBD in rats. In conclusion, SPC alleviates neuronal apoptosis in the hippocampus CA1 area of HIBD rats by inhibiting the endoplasmic reticulum stress pathway PERK/ATF4/CHOP, thereby mitigating HIBD in rats.

Application of Range of Motion (ROM) to Increase Muscle Strength in Meeting Activity Needs in Stroke Patients

Stroke is a neurological disease caused by oclusion or hyperfusion in the blood vessels of the brain that causes neurological deficiencies and causes defects or death. The purpose of the case study is to find out a picture of nursing orphanage to meet the needs of physical mobility disorder activity by applying the Range of Motion for stroke patients starting from the achievement assessment to the evaluation. The methods used are descriptive case studies, with data collection techniques including interviews, physical examinations, observations and documentation. The results of the study showed that patients had weakness in the right extremity with the strength of the upper extremity muscle value 0 and the lower extremity value 2. The primary nursing diagnosis of physical mobility disorders is associated with a decrease in muscle strength. Planning to [treatment is to improve physical mobility in stroke patients. Implementation was done with increased physical mobility based on (SOP) Range of Motion performed in the morning, each movement for 10 counts for 30 minutes. Evaluation carried out after 4 days of implementation obtained data there was an increase in muscle strength of the upper extremity to 1 and the lower extremities to 3. Based on the explanation above, there was an increase in muscle strength between before and after the action. It is expected to be able to implement ROM therapy as an intervention to address the problem of physical mobility disorders in stroke patients.

Metabotropic glutamate receptor 5 promotes blood-brain barrier recovery after traumatic brain injury

Blood-brain barrier (BBB) impairment and glutamate release are two pathophysiological features of traumatic brain injury (TBI), contributing to secondary brain damage and neuroinflammation. However, our knowledge of BBB integrity damage and dysfunction are still limited due to the diverse and fluctuating expression of glutamate receptors after trauma. Here, we confirmed the downregulation of metabotropic glutamate receptor 5 (mGluR5) on microvascular endothelial cell within the acute phase of TBI, and the recovered mGluR5 levels on BBB was positively associated with blood perfusion and neurological recovery. In whole body mGluR5-knockout mice, BBB dysfunction and neurological deficiency were exacerbated after TBI compared with wild type mice. In terms of mechanism, the amino acid sequence 201–259 of cytoskeletal protein Alpha-actinin-1 (ACTN1) interacted with mGluR5, facilitating mGluR5 translocation from cytoplasmic compartment to plasma membrane in endothelial cells. Activation of plasma membrane mGluR5 triggers the PLC/PKCμ/c-Jun signaling pathway, leading to increased expression of the tight junction-actin cytoskeleton connecting protein zonula occludens-1 (ZO-1). Our findings uncover a novel mechanism mediated by membrane and cytoplasmic mGluR5 in endothelial cell integrity maintenance and repair, providing the potential therapeutic target for TBI treatment targeting at mGluR5 and mGluR5/ACTN1 complex in BBB.

The management of post-stroke pain

Stroke is a metabolic illness that causes significant impairment in the working-age population. Disability develops due to the consequences of neurological deficiencies and the failure of the medical rehabilitation process. Post-stroke pain is one of the causes of this failure. In a post-stroke patient, pain is an unpleasant physical and emotional experience. In contrast, range of motion barriers might cause the medical rehabilitation procedure to fail. This paper aims to review the various methods of post-stroke pain management that can be used as an alternative therapy that helps post-stroke patients' rehabilitation. The PubMed database was used to search for different kinds of literature. The study includes clinical studies, pilot studies, and randomized control trials published between January 2015 and June 2023. The authors omit several publications to ensure that the final selection of papers includes only the most relevant and reputable sources of information on post-stroke pain, post-stroke pain management, and pain as a measure of outcome. There are 28 publications to be reviewed. The most prevalent cause of post-stroke pain was hemiplegic shoulder pain in numerous studies that have an impact on the post-stroke recovery process. In conclusion, the options for post-stroke therapy range from conservative rehabilitation to interventional therapy. Several innovative experimental rehabilitation treatment approaches have been studied. However, the findings do not outperform conventional rehabilitation treatment.

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients
 
 Abstract
 Objectives: Cervical disk herniation (CDH) is a common disease that usually develops as a result of intervertebral disk degeneration (IVDD) or trauma, which can cause pain or neurological deficiency by nevre root or spinal cord compression. Paraoxonase 1 (PON1) has antioxidant qualities, and its function may vary based on genetic variations and ethnic background. This study aims to compare PON1 activity and phenotype distribution in CDH patients and individuals without the condition.
 Materials and Methods: This study involved 70 CDH patients and 70 individuals in good health. Spectrophotometric tests were conducted to measure the serum PON1 and arylesterase (ARE) activities. The PON1 ratio, which indicates the salt-stimulated PON/ARE level, showed a three-peak distribution. This ratio was utilized to determine the various phenotypes; QQ, QR, and RR for each participant.
 Results: The PON1 activity was lower in CDH patients compared to the healthy individuals (p < 0.05). CDH patients exhibited a statistically significant QQ phenotype in comparison to the healthy participants (p < 0.05).
 Conclusion: Patients with CDH exhibited significantly reduced PON1 activity, indicating that low PON1 activity and the PON1 QQ phenotype could potentially be a risk factor for the development of CDH.
 Keywords: Cervical disk herniation, Paraoxonase, Phenotype, PON1

Efficacy of Citicoline Delivered via Brain Extracellular Space against Experimental Acute Ischemic Stroke in Rats.

Objective: Citicoline can be used to reduce acute ischemic stroke injury via venous infusion, however, its protective effects in the brain extracellular space remain largely unknown. Herein, we investigated the brain protective effects of citicoline administered via the brain extracellular space and sought precise effective dosage range that can protect against ischemic injury after experimental ischemic stroke in rats. Methods: Fifty-six Sprague-Dawley rats were randomly divided into control, intraperitoneal (IP), caudate-putamen (CPu)-25, CPu-40, CPu-50, CPu-60 and CPu-75 groups based on the infusion site and concentration of citicoline. Two hours after the administration of citicoline, the rats were subjected to a permanent middle cerebral artery occlusion to mimic acute ischemic stroke. Then, the brain infarct volume in rats after stroke was measured and their neurological deficiency was evaluated to explain the protective effects and effective dosage range of citicoline. Results: Compared to the control and IP groups, brain infarct volume of rats in CPu-40, CPu-50, and CPu-60 groups is significant smaller. Furthermore, the brain infarct volume of rats in CPu-50 is the least. Conclusions: Here, we showed that citicoline can decrease the brain infarct volume, thus protecting the brain from acute ischemic stroke injury. We also found that the appropriate effective citicoline dose delivered via the brain extracellular space is 50 mM. Our study provides novel insights into the precise treatment of acute ischemic stroke by citicoline via the brain extracellular space, further guiding the treatment of brain disease.