Search Results (203)

Background/Objectives: Delayed cerebral ischemia (DCI) after an aneurysmal subarachnoid hemorrhage (aSAH) often presents with bilateral vasospasm and cortical spreading depolarizations. Computer tomography perfusion (CTP) is the prevailing screening method for detecting early changes in the cerebral blood flow. Commonly used CTP thresholds include an rCBF < 30% for the core volume and a Tmax > 6 s for hypoperfused tissue detection in acute ischemic stroke. These stroke algorithm computing thresholds compared to the contralateral hemisphere may or may not apply to detect tissue at risk of DCI. We aimed to quantify the volumetric agreement of three different stroke algorithms compared to the final infarct volumes as the standard. Methods: Furthermore, 123 CTP datasets of 75 patients with aSAH suspicious of DCI were processed using Intellispace Portal (ISP), Cercare Threshold, and Cercare Artificial Intelligence (AI) to calculate the tissue-at-risk (hypoperfused) and non-viable tissue (core) volumes. CT infarct volumes in plain CTs were segmented in the follow-up study by using a 3D slicer. Results: The calculated core volumes corresponded best to the final infarct volumes if DCI-related treatment was performed subsequently. Additional postprocessing improved the calculation of core volumes but overestimated the tissue at risk of hypoperfusion in DCI. Whereas the accuracy of tissue-at-risk prediction accelerated without treatment, underlining the importance of intra-arterial spasmolysis and induced hypertension in the prevention of DCI. Conclusions: Cercare AI and ISP revealed a sensitivity of 100% each, with a serious low specificity of <5% that was independent of treatment. Overall, the Cercare Threshold, applying the commonly used stroke thresholds, performed the best in predicting tissue at risk of hypoperfusion in DCI. Full article

Motor impairments significantly affect individuals’ ability to perform activities of daily living, reducing autonomy and quality of life. In response to this, robot-assisted rehabilitation has emerged as an effective and practical solution, enabling controlled limb movements and supporting functional recovery. This study presents the development of an upper-limb exoskeleton designed to assist rehabilitation by integrating neurophysiological signal processing and real-time control strategies. The system incorporates a proportional–derivative (PD) controller to execute cyclic flexion and extension movements based on a sinusoidal reference signal, providing repeatability and precision in motion. The exoskeleton integrates a brain–computer interface (BCI) that utilizes electroencephalographic signals for therapy selection and engagement enabling user-driven interaction. The EEG data extraction was possible by using the UltraCortex Mark IV headset, with electrodes positioned according to the international 10–20 system, targeting alpha-band activity in channels O1, O2, P3, P4, Fp1, and Fp2. These channels correspond to occipital (O1, O2), parietal (P3, P4), and frontal pole (Fp1, Fp2) regions, associated with visual processing, sensorimotor integration, and attention-related activity, respectively. This approach enables a more adaptive and personalized rehabilitation experience by allowing the user to influence therapy mode selection through real-time feedback. Experimental evaluation across five subjects showed an overall mean accuracy of 86.25% in alpha wave detection for EEG-based therapy selection. The PD control strategy achieved smooth trajectory tracking with a mean angular error of approximately 1.70°, confirming both the reliability of intention detection and the mechanical precision of the exoskeleton. Also, our core contributions in this research are compared with similar studies inspired by the rehabilitation needs of stroke patients. In this research, the proposed system demonstrates the potential of integrating robotic systems, control theory, and EEG data processing to improve rehabilitation outcomes for individuals with upper-limb motor deficits, particularly post-stroke patients. By focusing the exoskeleton on a single degree of freedom and employing low-cost manufacturing through 3D printing, the system remains affordable across a wide range of economic contexts. This design choice enables deployment in diverse clinical settings, both public and private. Full article

Background/Objectives: This systematic review aimed to investigate the causes of dysphagia after stroke through diffusion tensor tractography (DTT) studies. Methods: This review used databases such as Google Scholar, PubMed, and ScienceDirect. Keywords related to stroke, dysphagia, and diffusion tensor tractography were utilized. Seven studies were selected and analyzed. Results: The analysis identified that damage to the corticobulbar tract (CBT) was the most frequently reported cause of dysphagia. Additionally, some studies suggested that damage to the vestibulospinal tract (VST) and the core vestibular pathway (CVP) contributed to dysphagia. Moreover, a significant negative correlation was found between dysphagia severity and key DTT-derived metrics, such as lower fractional anisotropy (FA) and tract volume (TV), indicating that reduced FA and TV values are associated with more severe dysphagia symptoms. Conclusions: DTT provides valuable insights into the neural mechanisms underlying dysphagia after stroke. Identifying the affected tracts can help diagnose dysphagia more accurately and develop targeted rehabilitation strategies. Full article

Artesunate (AS) and tetramethylpyrazine (TMP) have been proven to have therapeutic potential in ischemic stroke. Nevertheless, their synergistic treatment mechanisms and effectiveness remain unclear. A rat MCAO model was induced, and AS, combined with TMP, was administered intranasally to rats once a day for 3 days. The neurological severity scores, TTC staining, and H&E staining were implemented to analyze tissue injuries. Evans blue staining and immunohistochemistry of ZO-1, occludin, MMP-9, and TIMP-1 were implemented to evaluate the integrity of the blood–brain barrier (BBB). ELISA was used to detect the expression levels of inflammatory factors TNF-α and IL-10. TUNEL staining and the protein expression of Bax and Bcl-2 were used to evaluate the apoptosis of brain tissue cells. The core targets were predicted by network pharmacology and verified by the OGD/R cell model and siRNA in vitro. Results showed that nasal administration of AS and TMP significantly ameliorated ischemic-stroke-induced neurological dysfunction, BBB disruption, and cortical neuronal apoptosis. The protective mechanisms mainly included adjusting the expression and ratio of tight junction proteins TIMP-1 and MMP-9 in brain tissue, regulating the HIF-1α-VEGF pathway, and anti-inflammatory effects. This study provides experimental support for the further development and application of AS and TMP nasal combinations and provides the foundation for expanding the practical-application value of artemisinin and its derivatives. Full article

Moyamoya disease (MMD) is a cerebrovascular condition characterized by progressive stenosis of intracranial arteries, leading to stroke. While MMD was long considered a genetic disorder, emerging evidence suggests autoimmune mechanisms may contribute to its pathogenesis. The role of non-coding RNAs (ncRNAs) in the pathogenesis of MMD is under heated discussion, and a competitive endogenous RNA (ceRNA) network involving MMD-related ncRNAs has not been constructed. In this study, we integrated multiple bioinformatic analyses on transcriptomic data from the middle cerebral arteries of MMD patients and controls. Our analysis revealed a significant enrichment of innate immune system pathways, including antigen processing and macrophage activation, in MMD tissue. We constructed a robust ceRNA network centered on the long non-coding RNA MALAT1, identifying 15 core mRNA targets. A classifier built from these MALAT1-related genes accurately distinguished MMD patients from controls, with an area under the curve of 0.869 in independent validation. Furthermore, immune deconvolution analysis showed a marked increase in microvascular endothelial cells and a decrease in CD4⁺ memory T cells and regulatory T cells in MMD arteries. The expression of the MALAT1 network genes strongly correlated with these shifts in cellular composition, positively with endothelial cells and negatively with T cells. Our findings uncover a MALAT1-driven ceRNA network that links immune dysregulation to vascular changes in MMD, highlighting MALAT1 as a potential biomarker and therapeutic target. Full article

To address the critical challenge of ensuring bottom water-inrush stability during the excavation of ultra-deep foundation pits for riverside suspension-bridge anchorages under complex geological conditions involving high-pressure confined groundwater, we investigate the application of D-RJP high-pressure rotary jet grouting pile technology for ground improvement. Its effectiveness is systematically validated through a case study of the South Anchorage Foundation Pit for the North Channel Bridge of the Zhangjinggao Yangtze River Bridge. The D-RJP method led to the successful construction of a composite foundation within the soft soil that satisfies the permeability coefficient, interface friction coefficient, bearing capacity, and shear strength requirements, significantly improving the geotechnical performance of the anchorage foundation. A series of field experiments were conducted to optimize the critical construction parameters, including the lifting speed, water–cement ratio, and stroke spacing. Core sampling and laboratory testing revealed the grout columns to have good structural integrity. The unconfined compressive strength of the high-pressure jet grout columns reached 5.45 MPa in silty clay layers and 8.21 MPa in silty sand layers. The average permeability coefficient ranged from 1.67 × 10⁻⁷ to 2.52 × 10⁻⁷ cm/s. The average density of the columns was 1.66 g/cm³ in the silty clay layer and 2.08 g/cm³ in the silty sand layer. The cement content in the return slurry varied between 18% and 27%, with no significant soil squeezing effect observed. The foundation interface friction coefficient ranged from 0.44 to 0.52. After excavation, the composite foundation formed by D-RJP columns was subjected to static load and direct shear testing. The results showed a characteristic bearing capacity value of 1200 kPa, the internal friction angle exceeded 24.23°, and the cohesion exceeded 180 kPa. This study successfully verifies the feasibility of applying D-RJP technology to construct high-performance artificial composite foundations in complex strata characterized by deep soft soils and high-pressure confined groundwater, providing valuable technical references and practical insights for similar ultra-deep foundation pit projects involving suspension bridge anchorages. Full article

Isoliquiritigenin (ISL) is a type of chalcone that widely exists in medicinal plants of the Leguminosae family and exhibits a remarkable anti-ischemic stroke (IS) effect. However, the anti-IS mechanisms of ISL remain to be systematically elucidated. In this study, network pharmacology was used to predict potential targets related to the anti-IS effect of ISL. The binding ability of ISL to potential core targets was further analyzed by molecular docking and molecular dynamics (MD) simulations. By establishing an oxygen–glucose deprivation/reoxygenation (OGD/R)-induced HT22 cell model, the anti-IS mechanisms of ISL were investigated via RT-qPCR and Western Blot (WB). As a result, network pharmacology analysis revealed that APP, ESR1, MAO-A, PTGS2, and EGFR may be potential core targets of ISL for anti-IS treatment. Molecular docking and molecular dynamics simulation results revealed that ISL can stably bind to the five potential core targets and form stable complex systems with them. The results of the cell experiments revealed a significant anti-IS effect of ISL. Additionally, mRNA and protein expression levels of APP, MAO-A and PTGS2 or ESR1 in the ISL treatment group were significantly lower or higher than those in the OGD/R group In conclusion, ISL may improve IS by regulating the protein expression levels of APP, ESR1, MAO-A, and PTGS2. Full article

Chinese Optical Character Recognition (OCR) technology is essential for digital transformation in Chinese regions, enabling automated document processing across various applications. However, Chinese OCR systems struggle with visually similar characters, where subtle stroke differences lead to systematic recognition errors that limit practical deployment accuracy. This study develops FLIP (Feedback Learning-based Intelligent Plugin), a lightweight post-processing plugin designed to improve Chinese OCR accuracy across different systems without external dependencies. The plugin operates through three core components as follows: UTF-8 encoding-based output parsing that converts OCR results into mathematical representations, error correction using information entropy and weighted similarity measures to identify and fix character-level errors, and adaptive feedback learning that optimizes parameters through user interactions. The approach functions entirely through mathematical calculations at the character encoding level, ensuring universal compatibility with existing OCR systems while effectively handling complex Chinese character similarities. The plugin’s modular design enables seamless integration without requiring modifications to existing OCR algorithms, while its feedback mechanism adapts to domain-specific terminology and user preferences. Experimental evaluation on 10,000 Chinese document images using four state-of-the-art OCR models demonstrates consistent improvements across all tested systems, with precision gains ranging from 1.17% to 10.37% and overall Chinese character recognition accuracy exceeding 98%. The best performing model achieved 99.42% precision, with ablation studies confirming that feedback learning contributes additional improvements from 0.45% to 4.66% across different OCR architectures. Full article

Ships play a crucial role in modern society, serving purposes such as marine transportation, tourism, and exploration. Malfunctions or defects in the main engine, which is a core component of ship operations, can disrupt normal functionality and result in substantial financial losses. Consequently, early fault diagnosis of abnormal engine conditions is critical for effective maintenance. In this paper, we propose a deep hybrid model for fault diagnosis of ship main engines, utilizing exhaust gas temperature data. The proposed model utilizes both time-domain features (TDFs) and time-series raw data. In order to effectively extract features from each type of data, two distinct feature extraction networks and an attention module-based classifier are designed. The model performance is evaluated using real-world cylinder exhaust gas temperature data collected from the large ship low-speed two-stroke main engine. The experimental results demonstrate that the proposed method outperforms conventional methods in fault diagnosis accuracy. The experimental results demonstrate that the proposed method improves fault diagnosis accuracy by 6.146% compared to the best conventional method. Furthermore, the proposed method maintains superior performanceeven in noisy environments under realistic industrial conditions. This study demonstrates the potential of using exhaust gas temperature using a single sensor signal for data-driven fault detection and provides a scalable foundation for future multi-sensor diagnostic systems. Full article

Intracerebral hemorrhage (ICH), a severe stroke subtype common in the elderly, often results in high morbidity and mortality, with limited treatment options for long-term recovery. While glial scar formation is increasingly recognized as key to central nervous system (CNS) repair, its role and characteristics in the aging brain post-ICH remain unclear. This study investigated glial scar formation after ICH (100 μL autologous blood injected into the right basal ganglia model) in aged Fischer 344 rats and assessed the effects of deferoxamine (DFX) treatment. Histological and immunohistochemical analyses were conducted on days 7, 28, and 60 post-ICH using cell-specific and iron-related markers, with DFX administered at 100 mg/kg daily for 14 days in separate groups. Over time, the lesion core showed increased hemosiderin accumulation and astrogliosis. By day 60, the area of astrogliosis corresponded to an area with persistent neuronal loss (DARPP-32-negative). Glial composition shifted from microglia dominance on day 28 to astrocyte predominance by day 60. DFX treatment reduced iron deposition, astrogliosis, and DARPP-32-negative regions while enhancing oligodendrocyte presence. Iron-related markers (HO-1, ferritin, Perls’ staining) and PDGFRβ-positive fibrotic cells were concentrated in the scar core. These findings provide novel insights into scar formation after ICH in aged rats and suggest DFX as a potential therapy to improve outcomes in elderly stroke patients. Full article

Carotid stenosis is a common pathology in clinical practice and unfortunately carries a high risk of serious cerebrovascular events. The early recognition of carotid plaque and, consequently, a careful analysis by means of multimodal imaging are the necessary steps to undertake a correct management pathway, aimed at preventing or, if not possible, reducing the risk of atherogenic phenomena responsible for cerebral infarction. In particular, the presence or absence of clinical symptoms, understood as the occurrence of events such as TIAs in the last 6 months, non-disabling strokes or repeated episodes of amaurosis fugax, and the degree of carotid stenosis, are certainly the most studied parameters, and as reported by several international guidelines, can lead to the best therapeutic strategy: whether to rely on conservative medical therapy or to resort to mechanical revascularization of the carotid stenosis. According to the recommendations of the European Society of Vascular Surgery, mechanical revascularization is recommended for stenosis > 50% in symptomatic patients and stenosis > 60% in asymptomatic patients. In contrast, the latest findings on plaque vulnerability have focused attention on individual patient characteristics and clinical comorbidities that may be responsible for plaque inflammation and should therefore be taken into consideration to decide if revascularization treatment is needed even in those subjects who present stenosis with less degree than reported as critical value. Moreover, further radiological investigations are fundamental to finding the presence of entities such as plaque ulceration, plaque neo-vascularization, fibrous caps, and intraplaque lipid core that are responsible for increased vulnerability. Medical therapy involves interventions aimed at eliminating cardiovascular risk factors by administering drugs that control the comorbidities responsible for worsening carotid stenosis. Recent studies are also evaluating the effectiveness of new plaque-modifying drugs or targeted anti-inflammatory agents in reducing the risk of plaque development and complications. Revascularization therapies, on the other hand, include surgery (CEA), the endovascular technique (CAS), and a new hybrid technique (TCAR): they are all valid alternatives for the treatment of carotid stenosis, each with specific technical difficulties, but on the whole with comparable safety profiles and risk rates of postoperative complications, although some recent emergencies have focused attention on possible short- and long-term gender-dependent outcome differences. The aim of this manuscript is to present the state of the art in the management of patients with carotid stenosis and to take a closer look at revascularization options. In our opinion, the choice of one strategy over another should therefore depend on gender, anatomical features of the patient, preoperative comorbidities, and last but not least, the experience of the center and the multidisciplinary team involved in the management of the patient. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent but frequently underdiagnosed comorbidity in patients undergoing cardiac surgery, including coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve repair or replacement (MVR). This systematic review and meta-analytic synthesis investigates the relationship between OSA and postoperative morbidity and mortality, with particular attention to the predictive utility of established screening instruments. Methods: A systematic search of the PubMed database was conducted (April 2025), identifying 724 articles published in the last ten years. Seventeen primary studies met the inclusion criteria for qualitative synthesis, and four additional studies were included in the meta-analyses. Outcomes assessed included atrial fibrillation, major adverse cardiac and cerebrovascular events (MACCE), acute kidney injury (AKI), respiratory complications, pneumonia, hospital length of stay (LOS), and mortality. Risk of bias was assessed qualitatively based on study design and reporting limitations. This review was registered in the PROSPERO database under registration number CRD420251049574. Results: Meta-analyses demonstrated significantly elevated odds of atrial fibrillation (OR = 2.44, 95% CI: 1.46–4.07), major adverse cardiac and cerebrovascular events (OR = 2.06, 95% CI: 1.61–2.63), acute kidney injury (OR = 2.24, 95% CI: 1.67–3.01), and respiratory complications (OR = 1.15, 95% CI: 1.05–1.25) among patients with OSA. Additionally, OSA was associated with a significantly prolonged hospital length of stay (standardized mean difference [SMD] = 0.62, 95% CI: 0.46–0.78) and a marginal increase in pneumonia risk (OR = 1.07, 95% CI: 1.00–1.15). Evidence regarding stroke, intensive care unit (ICU) stay, and mortality was inconsistent or underpowered. Conclusions: Across core outcomes, findings were consistent across multiple studies involving a large patient population. Obstructive sleep apnea is a clinically consequential risk factor in cardiac surgery, associated with increased perioperative complications and prolonged hospitalization. These findings support the integration of routine OSA screening into preoperative risk assessment protocols. Further prospective, multicenter trials are warranted to assess the efficacy of perioperative management strategies, including continuous positive airway pressure (CPAP) therapy, in improving surgical outcomes. Full article

Aim of the study: Traditional Chinese herbs have a unique therapeutic effect on stroke and numerous successful clinical cases. However, these clinical cases are highly dispersed, creating challenges for translational research. This study employs a new paradigm to identify treatment patterns and the active compound interactions contained within these clinical cases, with experimental validation after target screening. Methods and Materials: Stroke-related targets were identified through GEO, DisGeNET, and Genecards. Active ingredients were extracted from BATMAN-TCM 2.0. All herbs and diseases were confirmed by the Pharmacopoeia of the People’s Republic of China (2020 edition) and Medical Subject Heading (MeSH). All networks in this study were constructed by Cytoscape, and data analysis was done by Python. All formulations and herbs were retrieved from the literature review. For the molecular docking process, Autodock was applied as the docking platform, and all the protein structures were downloaded from PDB. For experimental validation after target screening, HT22 cells were incubated with glucose-free DMEM and placed in an anaerobic chamber for 2 h. Subsequently, HT22 cells were reoxygenated for 24 h. Estrogen Receptor 1 (ESR1) protein levels were measured in vitro. Results: seven materials, including Angelicae Sinensis Radix, Pheretima, Chuanxiong Rhizoma, Persicae Semen, Astragali Radix, Carthami Flos, and Radix Paeoniae Rubra, were identified as the core herbs for the treatment of stroke. The targets of the stroke mechanism were screened, and the herbs-compound-target network was constructed. Among them, paeoniflorin (PF) was identified as the core active compound, and its interaction with ESR1 was verified by molecular docking as the key interaction for the treatment of stroke. In vitro experiments showed that PF inhibited cell apoptosis under hypoxia by increasing the expression of ESR1 compared with the oxygen-glucose deprivation-reperfusion (OGD/R) model group. Western showed that PF (100 μM, 200 μM) can significantly increase the decreased ESR1 protein level caused by the OGD/R model. Conclusions: seven key herbs were screened. Further bioinformatics and network pharmacology studies suggested that PF is expected to become a new active compound for the treatment of stroke. In vitro validation further demonstrated that PF enhanced neuronal survival and ESR1 expression under ischemic conditions, supporting its therapeutic candidacy. Full article

Background and Objectives: Military capability may be reduced in hot environments with individuals at risk of exertional heat stroke (EHS). Heat tolerance testing (HTT) can be used to indicate readiness to return to duty following EHS. HTT traditionally relies on rectal core temperature (T_re) assessment via a rectal probe. This study investigated the use of gastrointestinal core temperature (T_gi) as an alternative to T_re during HTT. A secondary aim was to compare physiological factors between heat-tolerant and heat-intolerant trials. Materials and Methods: Australian Defence Force personnel undergoing HTT following known or suspected heat stroke volunteered (n = 23 cases participating in 26 trials) along with 14 controls with no known heat illness history. Confusion matrices enabled comparison of HTT outcome based on T_gi and T_re. The validity of T_gi compared to T_re during HTT was assessed using correlation and bias. Comparisons between heat-tolerant and intolerant trials were performed using non-parametric tests. Results: Although T_gi correlated closely with T_re (Spearman’s rank correlation $\rho$ = 0.893; median bias 0.2 °C) there was no consistent pattern in the differences between measures. Importantly, the two measures only agreed on heat tolerance outcome in 80% of trials with T_gi failing to detect heat intolerance identified by T_re in 6 of 8 trials. If T_gi was relied upon for diagnostic outcome, return to duty may occur before full recovery. None of the assessed covariates were related to the difference between T_re and T_gi. In addition, resting heart rate and systolic blood pressure were significantly lower and body surface area to mass ratio significantly higher in heat-tolerant compared to intolerant trials. Conclusions: It is not recommended to rely on T_gi instead of T_re during HTT. Resting heart rate and systolic blood pressure findings point to the importance of aerobic exercise in conveying heat tolerance along with body composition. Full article

Brain endothelial cells (BECs) constitute the core component of the blood–brain barrier (BBB), regulating substance exchange between blood and the brain parenchyma to maintain central nervous system homeostasis. In pathological states, the BBB exhibits the disruption of tight junctions, endothelial cell (EC) damage, and increased permeability, accompanied by neuroinflammation, oxidative stress, and abnormal molecular signaling pathways, leading to neurotoxic effects in the brain parenchyma and exacerbating neurodegeneration and disease progression. This review systematically summarizes the developmental origin, structural characteristics, and pathological mechanisms of BECs in diseases such as Alzheimer’s disease, multiple sclerosis, stroke, and glioblastoma with a particular focus on the regulatory mechanisms of the Wnt/β-catenin and VEGF signaling pathways. By integrating the latest research advances, this review aims to provide a comprehensive perspective for understanding the role of BECs in physiological and pathological states and to provide a theoretical basis for the development of BBB-based therapeutic approaches for neurological diseases. Full article