Search Results (1,853)

Individuals post-stroke commonly experience impairments in upper extremity function that limit participation in valued activities. Task repetitive practice is an effective intervention strategy, but accurately monitoring adherence and movement quality in home programs remains a challenge. This pilot study investigates the reliability and validity of raw accelerometer data captured by a commercially available, wrist-worn activity monitor to assess upper extremity movement in healthy adults during task repetitive practice. Measures of duration, angular velocity, and acceleration were obtained from activity monitors worn by 25 healthy adults performing four functional tasks under varying conditions. Preliminary results indicate moderate to excellent within-session reliability in these three measures when compared across repeated trials of the same task, with one exception. Across all tasks, the duration measure consistently detected differences in exercise time between sets of 5, 10, and 20 repetitions at a comfortable pace. All three measures differentiated between 10 comfortable repetitions and 10 fast repetitions on three out of four tasks. These findings provide initial psychometric properties in a healthy population and further research is required to determine whether these properties remain robust in the presence of motor impairment. This work represents an early step towards developing approaches for monitoring home exercise programs that support stroke recovery. Full article

Background: Ischemic stroke (IS) remains a leading global cause of mortality, recurrence, and long-term disability, with survivors also at risk of post-stroke dementia (PSD) and cognitive impairment (PSCI). The precise impact of statin therapy across different IS populations, including those with cardioembolic/atrial fibrillation (CE/AF) strokes and patients with low-baseline low-density lipoprotein (LDL) cholesterol, remains unclear, as does the influence of statin timing, intensity, type, and solubility. Methods: We conducted the Impact of Statin Therapy on the Risk of Stroke Recurrence, Mortality, and Dementia After Ischemic Stroke (ISMARDD) meta-analysis, synthesizing evidence from 51 studies (n = 521,126), to evaluate the association between post-stroke statin therapy and key outcomes: all-cause mortality, stroke recurrence, cognition, and C-reactive protein (CRP). PSD was defined as new, persistent cognitive decline meeting standard diagnostic criteria, and PSCI as measurable but sub-threshold cognitive deficits. Random-effects models were used, and certainty was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: Statin therapy significantly reduced all-cause mortality within 3 months (OR 0.32), at 1 year (OR 0.35), and beyond 1 year (OR 0.56). Stroke recurrence was modestly reduced both within 1 year (OR 0.77) and after 1 year (OR 0.76). Statin use was associated with a lower risk of PSD (OR 0.74) but not PSCI overall. Benefits extended to CE/AF-related strokes and patients with low-baseline LDL cholesterol, both showing significantly lower mortality with statin use. Early initiation (<24 h) was linked with reduced recurrence, though effects of statin intensity, type, and solubility were inconsistent. Statins also significantly reduced CRP levels, underscoring anti-inflammatory and pleiotropic mechanisms. Conclusions: The ISMARDD study demonstrates that statins confer survival benefit and selective cognitive protection (notably reduced PSD risk) after ischemic stroke, with modest recurrence benefit, supporting their broad use in secondary prevention. These findings highlight the need for precision-guided approaches tailored to stroke subtype, pharmacogenomics, and treatment timing to optimize therapeutic outcomes. Full article

In this study, we propose a 2.5-dimensional (2.5-D) structure approach for insect-mimetic flapping-wing air vehicles (FWAVs). The proposed approach includes design and fabrication methods. To our best knowledge, this study is the first one that develops a flapping system for FWAVs without any post-assembly of structural components. The proposed structure consists of a transmission, a supporting frame, and elastic wings. The transmission transforms the small translational displacement produced by a piezoelectric bimorph into a large rotational displacement of the wings. The size is reduced using the proposed design method. Then, the 2.5-D structure is fabricated using the proposed polymer MEMS micromachining method. The presented micro flapping system flaps the wing with a stroke angle and flapping frequency comparable to those of actual small insects using resonance. The results confirm that the proposed approach can miniaturize FWAVs. Full article

Background: Stroke represents a leading cause of disability worldwide and is frequently associated with cognitive impairment, anxiety, and post-stroke depression (PSD), all of which can hinder rehabilitation and reduce quality of life. This study aimed to evaluate the correlations between cognitive function, depression, and anxiety in stroke survivors. Methods: A total of 71 patients (41 female, 30 male; mean age 68.1 years, range 42–88) were assessed during rehabilitation using the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), and the Patient Health Questionnaire-9 (PHQ-9). Stroke type and comorbidities, including hypertension, chronic ischemic heart disease, atrial fibrillation, and type II diabetes, were also recorded. Results: As expected, most patients experienced ischemic strokes (73.1%), while 16.9% had hemorrhagic strokes. Comorbidities were highly prevalent, particularly hypertension (63 patients) and chronic ischemic heart disease (60 patients). Cognitive impairment (MMSE < 24) was observed in 28.2% of participants. Emotional assessment showed a mean HADS score of 11.55, with 36.6% of patients classified as having moderate to severe depression (PHQ-9 ≥ 10). Hemorrhagic stroke patients reported slightly higher PHQ-9 scores (8.4 compared to 8.2), while ischemic patients had higher HADS scores (11.8 compared to 9.8). A strong correlation was found between PHQ-9 and HADS (r = 0.90), while MMSE scores showed weak associations with emotional outcomes. Conclusions: Cognitive and affective disturbances are common during stroke rehabilitation, with depression and anxiety strongly interrelated but only weakly linked to cognitive decline. These findings emphasize the need for integrated screening and mental health support in rehabilitation programs. Future studies may explore technology-assisted tools, including virtual reality, to enhance patient engagement and recovery. Full article

Background: CT perfusion (CTP) is increasingly used in the evaluation of acute ischemic stroke (AIS) and may complement non-contrast CT (NCCT) and CT angiography (CTA). This review aimed to assess the role of CTP in patient selection for reperfusion therapy, its prognostic value, and the influence of technical factors, collateral assessment, and post-processing software. Methods: A literature search of PubMed, DOAJ, and Google Scholar (2014–2025) identified 119 articles; after screening, 39 met inclusion criteria. Only studies on adult AIS patients investigated with CTP were included. Data were synthesized across eight thematic categories: core/penumbra estimation, prognosis, treatment selection, collateral assessment, software validation, technical parameters, reliability, and safety. Results: CTP improved identification of infarct core, penumbra, and collateral status, aiding patient selection for endovascular therapy, particularly beyond 6 h. Limitations included variability in tissue thresholds, “ghost infarct core,” and differences across software. Technical advances, such as “one-stop-shop” protocols and low-kV acquisition, reduced treatment delays and radiation. Reliability studies showed CTP to be less accurate than diffusion-weighted MRI, while safety analyses confirmed a low risk of contrast-induced nephropathy. Conclusions: CTP enhances patient stratification and outcome prediction, supporting individualized treatment strategies. Standardization of protocols and validation of software remain necessary before CTP can serve as a reliable alternative to MRI-DWI. Full article

Background: Emotionally salient music may enhance attention-focused rehabilitation, yet concurrent music plus virtual-reality programs in chronic stroke are largely untested. We assessed whether personalized emotional music stimulation (EMS) layered onto a standardized virtual reality rehabilitation system (VRRS) augments cognitive, affective, physiological, and functional outcomes. Methods: In a quasi-randomized outpatient trial, 20 adults ≥ 6 months post-ischemic stroke were allocated by order of recruitment to VRRS alone (control, n = 10) or VRRS+EMS (experimental, n = 10). Both groups performed 45 min of active VRRS cognitive training (3×/week, 8 weeks), while the EMS group received approximately 60 min sessions including setup and feedback phases. Primary outcomes were cognition and global function; secondary outcomes were intrinsic motivation, depression, anxiety, and heart rate. Non-parametric tests with effect sizes and Δ-scores were used. Results: The experimental group improved across all domains: cognition (median +4.5 points), motivation (median +54 points), depression (median −3.5 points), anxiety (median −4.0 points), heart rate (median −6.35 beats per minute), and disability (median one-grade improvement), each with large effects. The control group showed smaller gains in cognition and motivation and a modest heart-rate reduction, without significant changes in mood or disability. At post-treatment, the music group outperformed controls on cognition, motivation, and disability. Change-score analyses favored the music group for every endpoint. Larger heart-rate reductions correlated with greater improvements in depression (ρ = 0.73, p < 0.001) and anxiety (ρ = 0.58, p = 0.007). Conclusions: Adding personalized emotional music to virtual-reality attention training produced coherent, clinically relevant gains in cognition, mood, motivation, autonomic regulation, and independence compared with virtual reality alone. Full article

Background and Objectives: The endothelial glycocalyx (EG) maintains vascular barrier and homeostasis, but is vulnerable to perioperative stress and ischemia/reperfusion. We evaluated whether central venous pressure (CVP) strategy—low (LCVP, <5 mmHg) versus normal (NCVP, 5–12 mmHg)—and hepatic ischemia/reperfusion during hepatectomy influence perioperative EG shedding in hepatic or pancreatic resections. Materials and Methods: A total of 37 adults, out of 40 screened, (18–80 years) scheduled for elective hepatic or pancreatic resection under propofol–remifentanil anesthesia with invasive hemodynamic monitoring, were allocated by initial CVP to LCVP or NCVP protocols and further stratified by ischemia versus no ischemia. Plasma syndecan-1 and heparan sulfate were quantified by ELISA at predefined timepoints (baseline after induction; intraoperative and 2 h post-op). Statistical analyses included nonparametric tests, Friedman with Bonferroni, and ANCOVA adjusted for baseline; p < 0.05 significant. Results: Thirty-six patients completed analysis (NCVP n = 23; LCVP n = 13). In procedures without ischemia (n = 24; NCVP 16, LCVP 8), heparan sulfate increased over time in both groups; between-group differences in absolute/percentage change were not significant. Syndecan-1 was similar between groups except at 2 h post-op (T3), where LCVP was higher than NCVP (median 9 [11.5] vs. 1.4 [4.5]; p = 0.027). In procedures with ischemia (n = 12; NCVP 7, LCVP 5), neither biomarker differed between CVP groups at any timepoint. A weak negative CVP–stroke volume variation (SVV) correlation was seen at one timepoint (T1: r = −0.363; p = 0.030). Conclusions: Major hepatic/pancreatic surgery is associated with measurable EG shedding. Overall, shedding appeared largely independent of CVP strategy and ischemia/reperfusion status, with a late postoperative rise in syndecan-1 under LCVP in non-ischemia cases suggesting potential endothelial cost of aggressive fluid restriction/vasopressor use. These findings highlight the need to refine hemodynamic targets that balance minimizing bleeding with preserving endothelial integrity and suggest that perioperative fluid and vasopressor management may directly influence glycocalyx preservation. Full article

Background/Objectives: Stroke is a leading cause of disability, and post-stroke spasticity frequently impairs ankle mobility, strength, and gait. The gastrocnemius medialis (GM) is central to these deficits, yet the relationship between its ultrasound characteristics, functional outcomes, and spasticity severity remains unclear. This study aimed to compare structural and textural ultrasound features of the GM between individuals with chronic stroke presenting ankle spasticity and healthy controls, and to examine their associations with functional performance and spasticity severity. Methods: This case–control study included 26 individuals with stroke and 26 matched controls. Ultrasound assessments were performed using B-mode imaging to obtain parameters such as muscle thickness, pennation angle, and textural features (first-, second-, and higher-order). Functional measures included mobility (Timed Up and Go), walking speed (10-Meter Walk Test), ankle strength (dynamometry), and range of motion (goniometry). Spasticity was evaluated separately using the Modified Ashworth Scale. Results: No significant differences in GM ultrasound parameters were observed between groups or limbs (p > 0.05). Participants with stroke showed significantly reduced dorsiflexion mobility and lower strength for both plantarflexors and dorsalflexors. Correlations between ultrasound parameters and functional measures were not statistically significant; however, the effect size was consistently small. Spasticity severity did not significantly influence ultrasound findings. Conclusions: GM ultrasound parameters did not distinguish participants with stroke from controls or meaningfully correlate with function or spasticity. Functional impairments may stem primarily from neural mechanisms and compensatory motor strategies rather than muscle alterations detectable by ultrasound. Full article

Background: Although both rhythmic auditory stimulation (RAS) and vibrotactile feedback have been shown to yield beneficial effects in stroke rehabilitation, evidence regarding their combined application remains limited. This study investigates the effects of RAS gait training alone (RG) versus RAS combined with vibrotactile feedback (RAS-V) on balance and gait in individuals post-stroke. Methods: Twenty-two people with stroke were randomly assigned to either an RAS-V or an RG group. The RAS-V group performed RAS gait training combined with vibrotactile feedback while the RG group performed RAS gait training. Both groups participated in 30-min gait training sessions, 5 times a week for 4 weeks. Balance ability was assessed using the Berg Balance Scale (BBS) and Timed Up and Go test (TUG). Gait ability was evaluated using the G-Walk gait analyzer and the 10-m Walk Test (10 mWT), including gait cadence, velocity, and stride length. Results: Within-group comparisons showed significant improvements in BBS (p < 0.001) and TUG scores (p < 0.05) in both groups. The RAS-V group demonstrated significant post-intervention improvements in gait velocity, 10 mWT (p < 0.05), and gait cadence (p < 0.001). Between-group comparisons revealed that the RAS-V group achieved significantly greater improvements than the RG group in TUG, gait cadence, gait velocity, and 10 mWT (p < 0.05). Conclusions: RAS gait training with vibrotactile feedback enhances balance and gait ability more effectively than RAS gait training alone, suggesting additional benefits of incorporating vibrotactile feedback. Full article

Background: Despite percutaneous coronary intervention (PCI) for revascularization, patients with acute coronary syndrome (ACS) still face residual risks of adverse outcomes. Insulin resistance (IR) and renal impairment are independent predictors of poor prognosis in these patients, yet their interaction and underlying mechanisms linked to post-PCI outcomes remain incompletely elucidated. Methods: A retrospective cohort study was conducted involving patients with ACS who underwent PCI at the Third People’s Hospital of Chengdu from July 2018 to December 2020. Insulin resistance (IR) was quantified using the triglyceride–glucose (TyG) index, and renal function was evaluated via the estimated glomerular filtration rate (eGFR). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization. Multivariable Cox proportional hazards regression and mediation analyses were applied to explore the associations of TyG index and eGFR with patient prognosis, and to quantify the mediating effect of eGFR on the relationship between TyG index and prognosis. Results: A total of 1340 patients with ACS were included in the final analysis. Over a median follow-up duration of 31.02 (interquartile range [IQR]: 27.34–35.03) months, 124 patients (9.25%) experienced MACEs. After adjusting for potential confounders, both the TyG index and eGFR were identified as significant independent predictors of MACEs in the overall population and across predefined subgroups. Specifically, each one-unit increase in the TyG index was associated with a 73.8% higher risk of MACEs (HR 1.738; 95% CI 1.273–2.372), whereas each ten-unit decrease in eGFR was linked to a 12.7% increased MACEs risk (HR 1.127; 95% CI 1.032–1.232). Importantly, after further adjustment for confounders, eGFR significantly mediated 9.63% of the total effect of the TyG index on MACEs risk. Conclusions: Renal impairment partially mediates the association between IR and adverse cardiovascular outcomes in ACS patients undergoing PCI. This finding underscores the clinical importance of the metabolic–cardiorenal axis in this population, suggesting that a comprehensive assessment targeting both IR and renal function-related pathways may enhance risk-stratification accuracy and optimize therapeutic strategies for ACS patients. Full article

Critically ill patients are predisposed to developing cognitive dysfunction, excessive daytime sleepiness (EDS), and fatigue during their stay in the intensive care unit (ICU). Modafinil, a wakefulness-promoting agent, has demonstrated potential benefits in enhancing alertness, cognitive performance, and activity levels in various clinical populations. The present narrative review aims to systematically evaluate the existing literature regarding the administration of modafinil for the treatment of EDS and fatigue in the ICU context. A comprehensive literature search was performed using the Embase, MEDLINE, Web of Science, and Google Scholar databases, covering publications up to 20 June 2025. Studies investigating the use of modafinil to improve wakefulness in ICU patients were identified. A total of nine relevant studies were included, comprising two randomized controlled trials (RCTs), two case series, and five retrospective cohort studies (n = 950 patients). Four of these studies focused on patients with traumatic brain injury or post-stroke conditions, whereas the remaining studies addressed heterogeneous ICU populations. Preliminary evidence indicates that modafinil may enhance wakefulness in selected critically ill patients and potentially facilitate their participation in rehabilitative interventions, such as physical therapy. Nonetheless, robust conclusions regarding efficacy and safety remain limited by the small sample sizes and methodological constraints of the available studies. Consequently, further large-scale RCTs are warranted to elucidate the therapeutic role of modafinil in the management of EDS and hypoactivity among ICU patients. Full article

Background/Objectives: Guibi-tang (GBT) and its variant Kami-guibi-tang (KGBT) are traditional East Asian multi-herb formulas prescribed for memory loss, insomnia, and fatigue. Preclinical data suggest multimodal neuroprotective actions, including cholinergic signaling modulation and activation of the cAMP response element-binding protein (CREB)/extracellular signal-regulated kinase (ERK) pathway; however, clinical evidence for cognitive disorders remains scattered. This scoping review aimed to map the breadth, design characteristics, efficacy signals, and safety profile of GBT and KGBT across the full spectrum of cognitive impairment. Methods: Following the Arksey–O’Malley framework and PRISMA-ScR guidelines, seven databases were searched (MEDLINE, Embase, Cochrane Library, China National Knowledge Infrastructure, ScienceON, Scopus, Citation Information by the National Institute of Informatics) from inception to 31 January 2025, for human studies evaluating GBT or KGBT in subjective cognitive decline, mild cognitive impairment (MCI), dementia, or post-stroke cognitive impairment (PSCI). Two reviewers independently screened, extracted, and charted data on study design, participants, interventions, outcomes, and adverse events. Results: Fifteen studies met the inclusion criteria—nine randomized controlled trials, one crossover trial, and five observational reports—enrolling 555 participants (age range, 59–87 years). All were conducted in the Republic of Korea, Japan, or China. GBT or KGBT, given as monotherapy or adjunctive therapy for 4 weeks to 9 months, produced modest but consistent improvements in global cognition (Mini-Mental State Examination/Montreal Cognitive Assessment), memory domains, activities of daily living, and neuropsychiatric symptoms across MCI, Alzheimer’s disease, and PSCI cohorts. Reported adverse event rates were comparable to or lower than those of placebo, usual care, or conventional drugs, and no serious treatment-related toxicity was identified. Conclusions: Current evidence—although limited by small sample sizes, heterogeneous formulations, short follow-up durations, and regional concentration—indicates that GBT and KGBT are well tolerated and confer clinically meaningful cognitive and functional benefits. Standardized, multicenter, placebo-controlled trials with biomarker end points are warranted to confirm long-term efficacy, clarify mechanisms, and guide integrative clinical use. Full article

Background: Hemorrhagic transformation (HT) is a major complication of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Objectives: To investigate the factors as sociated with HT in patients with successful recanalization and examine the impact of collateral status (CS) on ischemic progression and outcomes. Methods: We retrospectively analyzed patients with AIS with successful recanalization (modified treatment in cerebral infarction (mTICI) 2B-3) who underwent dual-energy CT (DECT) within 24 h and MRI within 10 days post-EVT. Patients with posterior circulation stroke, missing multiphase CT angiography (CTA) collateral scores, or missing 3-month modified ranking scale scores were excluded from the study. Results: Among the 86 patients, those with HT had a significantly lower proportion of 3-month excellent outcomes and worse imaging scores, including non-contrast CT (NCCT)-Alberta Stroke Program Early CT Score (ASPECTS), virtual non-contrast (VNC)-ASPECTS, and diffusion-weighted imaging (DWI)-ASPECTS. Patients with HT with poor CS had a significantly lower proportion of 3-month excellent outcomes, poorer post-EVT National Institutes of Health Stroke Scale (NIHSS) score, worse imaging scores, including VNC-ASPECTS, and DWI-ASPECTS. In the predictive factor analysis, post-EVT NIHSS and VNC-ASPECTS scores were significantly associated with 3-month excellent functional outcomes (modified Rankin Scale (mRS) 0-1). Conclusions: In patients with successfully recanalized AIS, HT with poor CS was associated with poorer functional outcomes and worse imaging scores, and a 24 h combined measure (post-EVT NIHSS and DECT VNC-ASPECT) show promise for early risk stratification; prospective external validation is warranted before routine use. Full article

Patent foramen ovale (PFO) is implicated in cryptogenic stroke and other clinical syndromes, with transcatheter closure demonstrating superiority over medical therapy in selected patients. Most closure devices are composed of nitinol, a nickel–titanium alloy, raising concerns in individuals with nickel hypersensitivity, one of the most prevalent contact allergies worldwide. Although typically manifesting as localized dermatitis, nickel allergy has been associated with systemic reactions after device implantation, including chest pain, palpitations, migraines, dyspnea, and cutaneous eruptions. Recent evidence indicates that nickel-sensitive patients experience a significantly higher incidence of post-procedural device-related symptoms. Nevertheless, severe reactions remain rare, and the benefits of PFO closure generally outweigh the risks. The predictive value of pre-implantation patch testing remains uncertain, and the lack of nickel-free alternatives constrains device selection. Management strategies are empirical, relying on symptomatic treatment with corticosteroids, antihistamines, or device explantation in refractory cases. Future research should focus on elucidating the pathophysiology of nickel-induced hypersensitivity in cardiovascular implants, improving diagnostic algorithms, and developing biocompatible, nickel-free devices. A multidisciplinary approach involving cardiologists, dermatologists, and allergists is essential to optimize outcomes in this complex subset of patients. Full article

Background: Atrial fibrillation (AF) may be detected at the time of ischemic stroke or newly detected after stroke. While AF detected after stroke (AFDAS) is associated with poor outcomes compared to sinus rhythm, its prognostic implications relative to known-AF are inconsistent. High-sensitivity cardiac troponin (hs-cTn) is a biomarker of myocardial injury, but its role in predicting AFDAS in stroke patients is unclear. We aimed to evaluate hs-cTn as a predictor for AFDAS and to compare all-cause death, readmission for heart failure (HF) and readmission for stroke among patients with non-AF, AFDAS, and known-AF in the post-ischemic stroke period. Methods: From August 2014 to July 2017, 1506 patients with acute ischemic stroke were consecutively enrolled in a retrospective single-center registry. Out of these, 1019 patients were selected for analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, HF-caused readmission, or stroke-caused readmission during follow-up. Results: Out of 1019 ischemic stroke patients, 121 (13.8%) developed AFDAS over a median of 22.5 months; 135 had known-AF and 763 were maintained sinus rhythm during follow-up. Elevated hs-TnI (≥99th percentile), age > 75, and left atrial volume index >34 mL/m² independently predicted AFDAS. Both AFDAS and known-AF groups had a significantly increased risk of MACCE compared to the non-AF group (adjusted hazard ratio (HR) 1.85 and 1.76, respectively; p < 0.05 for both). The known-AF group also had a higher risk of all-cause mortality (adjusted HR 2.05, p = 0.02). The risks for MACCE and all-cause death did not differ significantly between the AFDAS and known-AF groups. Conclusions: An elevated hs-TnI level is independently associated with development of AFDAS and may serve as a valuable marker for stratifying the risk of future cerebrocardiovascular events following ischemic stroke. Full article