Search Results (7,669)

Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions. Full article

Background: Severe damage to one side of the brain often leads to adverse consequences and can also cause widespread changes throughout the brain, especially in the contralateral area. Studying molecular changes in the contralateral cerebral hemisphere, especially with regard to genetic regulation, can help discover potential treatment strategies to promote recovery after severe brain trauma on one side. Methods: In our study, the right motor cortex was surgically removed to simulate severe unilateral brain injury, and changes in glial cells and synaptic structure in the contralateral cortex were subsequently assessed through immunohistological, morphological, and Western blot analyses. We conducted transcriptomic studies to explore changes in gene expression levels associated with the inflammatory response. Results: Seven days after corticotomy, levels of reactive astrocytes and hypertrophic microglia increased significantly in the experimental group, while synapsin-1 and PSD-95 levels in the contralateral motor cortex increased. These molecular changes are associated with structural changes, including destruction of dendritic structures and the encapsulation of astrocytes by synapses. Genome-wide transcriptome analysis showed a significant increase in gene pathways involved in inflammatory responses, synaptic activity, and nerve fiber regeneration in the contralateral cortex after corticorectomy. Key transcription factors such as NF-κB1, Rela, STAT3 and Jun were identified as potential regulators of these contralateral changes. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) confirmed that the mRNA expression levels of Cacna1c, Tgfb1 and Slc2a1 genes related to STAT3, JUN, and NF-κB regulation significantly increased in the contralateral cortex of the experimental group. Conclusions: After unilateral brain damage occurs, changes in the contralateral cerebral hemisphere are closely related to processes involving inflammation and synaptic function. Full article

Background/Objectives: Direct oral anticoagulants (DOACs) are now the guideline-recommended alternative to vitamin K antagonists (VKAs) for long-term anticoagulation in patients with non-valvular atrial fibrillation. However, accurately assessing their impact on ischemic stroke outcomes remains challenging, primarily due to uncertainty regarding anticoagulation status at the time of hospital admission. This preliminary study addresses this gap by using point-of-care testing (POCT) to confirm DOAC activity at bedside, allowing for a more accurate comparison of 90-day functional outcomes between anticoagulated and non-anticoagulated stroke patients. Methods: We conducted a retrospective cohort study of 786 ischemic stroke patients admitted to the University of Pécs between February 2023 and February 2025. Active DOAC therapy was confirmed using the ClotPro^® viscoelastic testing platform, with ecarin Clotting Time (ECT) employed for thrombin inhibitors and Russell’s Viper Venom (RVV) assays for factor Xa inhibitors. Patients were categorized as non-anticoagulated (n = 767) or DOAC-treated with confirmed activity (n = 19). Mahalanobis distance-based matching was applied to account for confounding variables including age, sex, pre-stroke modified Rankin Scale (mRS), and National Institutes of Health Stroke Scale (NIHSS) scores at admission and 72 h post-stroke. The primary outcome was the change in mRS from baseline to 90 days. Statistical analysis included ordinary least squares (OLS) regression and principal component analysis (PCA). Results: After matching, 90-day functional outcomes were comparable between groups (mean mRS-shift: 2.00 in DOAC-treated vs. 1.78 in non-anticoagulated; p = 0.745). OLS regression showed no significant association between DOAC status and recovery (p = 0.599). In contrast, NIHSS score at 72 h (p = 0.004) and age (p = 0.015) were significant predictors of outcome. PCA supported these findings, identifying stroke severity as the primary driver of outcome. Conclusions: This preliminary analysis suggests that ischemic stroke patients with confirmed active DOAC therapy at admission may achieve 90-day functional outcomes comparable to those of non-anticoagulated patients. The integration of bedside POCT enhances the reliability of anticoagulation assessment and underscores its clinical value for real-time management in acute stroke care. Larger prospective studies are needed to validate these findings and to further refine treatment strategies. Full article

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background: Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective cardioprotection to be instituted and tailored to reverse cardiac dysfunction and prevent the discontinuation of essential cancer treatments. Objectives: The PRoactive Evaluation of Function to Evade Cardio Toxicity (PREFECT) study sought to evaluate the ability of fast-strain-encoded (F-SENC) cardiac magnetic resonance imaging (CMR) and 2D echocardiography (2D Echo) to stratify patients at risk of CTX prior to initiating cancer treatment, detect early signs of cardiac dysfunction, including subclinical CTX (sub-CTX) and CTX, and monitor for recovery (REC) during cardioprotective therapy. Methods: Fifty-nine patients with breast cancer or lymphoma were prospectively monitored for CTX with F-SENC CMR and 2D Echo over at least 1 year for evidence of cardiac dysfunction during anthracycline based chemotherapy. F-SENC CMR also monitored myocardial deformation in 37 left ventricular (LV) segments to obtain a MyoHealth risk score based on both longitudinal and circumferential strain. Sub-CTX and CTX were classified based on pre-specified cardiotoxicity definitions. Results: CTX was observed in 9/59 (15%) and sub-CTX in 24/59 (41%) patients undergoing chemotherapy. F-SENC CMR parameters at baseline predicted CTX with a lower LVEF (57 ± 5% vs. 61 ± 5% for all, p = 0.05), as well as a lower MyoHealth (70 ± 9 vs. 79 ± 11 for all, p = 0.004) and a worse global circumferential strain (GCS) (−18 ± 1 vs. −20 ± 1 for all, p < 0.001). Pre-chemotherapy MyoHealth had a higher accuracy in predicting the development of CTX compared to CMR LVEF and 2D Echo LVEF (AUC = 0.85, 0.69, and 0.57, respectively). The 2D Echo parameters on baseline imaging did not stratify CTX risk. F-SENC CMR obtained good or excellent images in 320/322 (99.4%) scans. During cancer treatment, MyoHealth had a high accuracy of detecting sub-CTX or CTX (AUC = 0.950), and the highest log likelihood ratio (indicating a higher probability of detecting CTX) followed by F-SENC GLS and F-SENC GCS. CMR LVEF and CMR LV stroke volume index (LVSVI) also significantly worsened in patients developing CTX during cancer treatment. Conclusions: F-SENC CMR provided a reliable and accurate assessment of myocardial function during anthracycline-based chemotherapy, and demonstrated accurate early detection of CTX. In addition, MyoHealth allows for the robust identification of patients at risk for CTX prior to treatment with higher accuracy than LVEF. Full article

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulatory tool for language rehabilitation in chronic aphasia. However, the effects of bi-hemispheric, multisite stimulation remain largely unexplored, especially in people with chronic and treatment-resistant language impairments. The goal of this study is to look at the effects on behavior and brain activity of an individualized language training program that combines bi-hemispheric multisite anodal tDCS with personalized language training for Albert, a patient with long-standing, treatment-resistant non-fluent aphasia. Methods: Albert, a right-handed retired physician, had transcortical motor aphasia (TCMA) subsequent to a left-hemispheric ischemic stroke occurring more than six years before the operation. Even after years of traditional treatment, his expressive and receptive language deficits remained severe and persistent despite multiple rounds of traditional therapy. He had 15 sessions of bi-hemispheric multisite anodal tDCS aimed at bilateral dorsal language streams, administered simultaneously with language training customized to address his particular phonological and syntactic deficiencies. Psycholinguistic evaluations were performed at baseline, immediately following the intervention, and at 1, 2, 3, and 6 months post-intervention. Resting-state fMRI was conducted at baseline and following the intervention to evaluate alterations in functional connectivity (FC). Results: We noted statistically significant enhancements in auditory sentence comprehension and oral reading, particularly at the 1- and 3-month follow-ups. Neuroimaging showed decreased functional connectivity (FC) in the left inferior frontal and precentral regions (dorsal stream) and in maladaptive right superior temporal regions, alongside increased FC in left superior temporal areas (ventral stream). This pattern suggests that language networks may be reorganizing in a more efficient way. There was no significant improvement in phonological processing, which may indicate reduced connectivity in the left inferior frontal areas. Conclusions: This case underscores the potential of combining individualized, network-targeted language training with bi-hemispheric multisite tDCS to enhance recovery in chronic, treatment-resistant aphasia. The convergence of behavioral gains and neuroplasticity highlights the importance of precision neuromodulation approaches. However, findings are preliminary and warrant further validation through controlled studies to establish broader efficacy and sustainability of outcomes. Full article

This study proposes a new air treatment system that integrates dehumidification, cooling, and water recovery using a Horizontal Air–Ground Heat Exchanger (HAGHE) combined with Peltier cells. The airflow generated by a fan flows through an HAGHE until it meets a septum on which Peltier cells are placed, and then separates into two distinct streams that lap the two surfaces of the Peltier cells: one stream passes through the cold surfaces, undergoing both sensible and latent cooling with dehumidification; the other stream passes through the hot surfaces, increasing its temperature. The two treated air streams may then pass through a mixing chamber, where they are combined in the appropriate proportions to achieve the desired air supply conditions and ensure thermal comfort in the indoor environment. A Computational Fluid Dynamics (CFD) analysis was carried out to simulate the thermal interaction between the HAGHE and the surrounding soil. The simulation focused on a system installed under the subtropical climate conditions of Nairobi, Africa. The simulation results demonstrate that the HAGHE system is capable of reducing the air temperature by several degrees under typical summer conditions, with enhanced performance observed when the soil is moist. Condensation phenomena were triggered when the relative humidity of the inlet air exceeded 60%, contributing additional cooling through latent heat extraction. The proposed HAGHE–Peltier system can be easily powered by renewable energy sources and configured for stand-alone operation, making it particularly suitable for off-grid applications. Full article

Background/Objectives: This study aimed to determine whether postpartum mothers exhibit a uniform trajectory of postpartum emotional status (PES) changes or if distinct subgroups with differing trajectories of PES exist. Additionally, it investigated whether intensified tactile stimulation of the infant through Shantala massage influences maternal PES. Method: A quasi-experimental design with a matched control group was employed. Eighty women following their first physiological delivery volunteered to participate. The intervention involved applying intensified tactile stimulation to the infant via Shantala massage over a 12-week postpartum period. Maternal PES, divided into negative and positive emotional domains, was assessed using four standardized questionnaires. Results: Two opposing trajectories of PES change were identified: adverse and favorable. Intensified tactile stimulation was associated with improvement in maternal emotional status along both trajectories. Conclusions: PES changes do not follow a uniform course across all women; notably, those with a favorable trajectory often begin with more severe symptoms. Overlooking this distinction in diagnosis, prevention, and treatment may result in suboptimal care. The factors influencing PES trajectories remain unidentified but may affect clinical intervention outcomes. The Shantala massage intervention appears to slow the progression of emotional disorders in women with adverse PES changes and accelerate recovery in those with favorable changes. Implementation of this approach in clinical settings is recommended. Full article

The treatment of chronic wounds is one of the most complex therapeutic problems of modern medicine. It leads to patients’ protracted recovery, generating high treatment costs. Herbal products may be useful in the treatment of chronic wounds via a wide range of pharmacological properties and multidirectional effects on the wound healing phases. The study aims to determine the ability of selected plant extracts to modulate the processes involved in wound healing. The antimicrobial (MIC, MBC, MFC) and antioxidant (ABTS, DPPH) activities, cytotoxicity (MTT test), scratch wound test, and collagen assay were tested. R. canina (MBC 0.39 mg/mL) and V. venifera (MBC 3.13 mg/mL) extracts had bactericidal activities against P. aeruginosa and S. aureus, respectively. The V. vinifera extract showed the highest antioxidant activity in both ABTS (EC50 0.078 mg/mL) and DPPH (EC50 0.005 mg/mL) methods. The percentage of wound closure observed for C. cardunculus, R. rosea, and R. canina extracts with HaCaT, and V. vinifera extract with Hs27 cells was set as 100%. V. vinifera extract (50 μg/mL) stimulated collagen synthesis 5.16 times more strongly than ascorbic acid. Our preliminary study showed that some plant extracts may be promising modulators of the wound healing process, although further in-depth studies are necessary to determine their effectiveness in the in vivo model. Full article

The use of Botulinum Neurotoxin A (BoNT/A) to treat peripheral neuropathic pain from nerve injury has garnered interest for its long-lasting effects and safety. This study examined the effects of IncobotulinumtoxinA (Inco/A), a BoNT/A variant without accessory proteins, on nerve regeneration in rats using the chronic constriction injury (CCI) model. Inco/A was administered perineurally at two time points: on days 0 and 21 post CCI. Functional and histological assessments were conducted to evaluate the effect of Inco/A on nerve regeneration. Sciatic Functional Index (SFI) measurements and Compound Muscle Action Potential (CMAP) recordings were conducted at different time points following CCI. Inco/A-treated animals exhibited a 65% improved SFI and 22% reduction in CMAP onset latencies compared to the vehicle-treated group, suggesting accelerated functional nerve recovery. Tissue analysis revealed enhanced remyelination in Inco/A-treated animals and 60% reduction in CGRP and double S100β signal expression compared to controls. Strikingly, 30% reduced immune cell influx into the injury site was observed following Inco/A treatment, suggesting that its anti-inflammatory effect contributes to nerve regeneration. These findings show that two injections of Inco/A promote functional recovery by enhancing neuroregeneration and modulating inflammatory processes, supporting the hypothesis that Inco/A has a neuroprotective and restorative role in nerve injury conditions. Full article

Elaeocarpus sylvestris (Lour.) Poir. var. ellipticus (Thunb.) H.Hara, an evergreen tree species native to Jeju Island, South Korea, has experienced a progressive decline associated with phytoplasma infection. This study aimed to evaluate the efficacy of oxytetracycline-based tree injection for suppressing phytoplasma and improving tree vitality. Two formulations—oxytetracycline hydrochloride (4.3%) and oxytetracycline calcium alkyltrimethyl ammonium (17%)—were administered to 40 infected individuals across two sites using a gravity-fed injection system. Treatment efficacy was evaluated based on chlorophyll content as an indicator of physiological recovery, while phytoplasma presence was assessed by PCR at 150 days after injection. The oxytetracycline hydrochloride group showed the highest suppression, with a 70% phytoplasma non-detection rate as determined by PCR analysis. Treated trees exhibited significantly higher chlorophyll content compared to untreated infected controls. These findings suggest that minimally invasive tree injection using oxytetracycline can provide temporary suppression of phytoplasma and support physiological recovery in E. sylvestris. Full article

The 1.9 billion metric tons of steel globally manufactured in 2023 justify the steel industry’s pivotal role in modern society’s growth. Considering the rapid development of countries that have not fully taken part in the global market, such as Africa, steel production is expected to increase in the next decade. However, the environmental burden associated with steel manufacturing must be mitigated to achieve sustainable production, which would align with the European Green Deal pathway. Such a burden is associated both with the GHG emissions and with the solid residues arising from steel manufacturing, considering both the integrated and electrical routes. The valorisation of the main steel residues from the electrical steelmaking is the central theme of this work, referring to the steel electric manufacturing in the Dalmine case study. The investigation was carried out from two different points of view, comprising the action of a plasma electric reactor and a RecoDust unit to optimize the recovery of iron and zinc, respectively, being the two main technologies envisioned in the EU-funded research project ReMFra. This work focuses on those preliminary steps required to detect the optimal recipes to consider for such industrial units, such as thermodynamic modelling, testing the mechanical properties of the briquettes produced, and the smelting trials carried out at pilot scale. However, tests for the usability of the dusty feedstock for RecoDust are carried out, and, with the results, some recommendations for pretreatment can be made. The outcomes show the high potential of these streams for metal and mineral recovery. Full article

The effects of long-term adjustments in body weight on the lipid balance in patients with severe obesity are not well understood. This study aimed to evaluate a non-invasive lipidomic approach to identifying biomarkers that could help predict which patients may require additional therapies before and after weight loss. Using mass spectrometry, 275 lipid species were analysed in non-obese controls, patients with severe obesity, and patients one year after bariatric surgery. The results showed that severe obesity disrupts lipid pathways, contributing to lipotoxicity, inflammation, mitochondrial stress, and abnormal lipid metabolism. Although weight loss improved these disturbances, surgery did not fully normalise the lipid profiles of all patients. Outcomes varied depending on their baseline liver health and genetic differences. Persistent alterations in cholesterol handling, membrane composition, and mitochondrial function were observed in partial responders. Elevated levels of sterol lipids, glycerophospholipids, and sphingolipids emerged as markers of complete metabolic recovery, identifying candidates for targeted post-surgical interventions. These findings support the use of lipidomics to personalise obesity treatment and follow-up. Full article

This paper presents a comprehensive review of the environmentally friendly management and reutilization of electronic waste (e-waste) plastics in flexible pavement construction. The discussion begins with an overview of e-waste management challenges and outlines key recycling approaches for converting plastic waste into asphalt-compatible materials. This review then discusses the types of e-waste plastics used for asphalt modification, their incorporation methods, and compatibility challenges. Physical and chemical treatment techniques, including the use of free radical initiators, are then explored for improving dispersion and performance. Additionally, in situations where advanced pretreatment methods are not applicable due to cost, safety, or technical constraints, the application of alternative approaches, such as the use of low-cost complementary additives, is discussed as a practical solution to enhance compatibility and performance. Finally, the influence of e-waste plastics on the conventional and rheological properties of asphalt binders, as well as the performance of asphalt mixtures, is also evaluated. Findings indicate that e-waste plastics, when combined with appropriate pretreatment methods and complementary additives, can enhance workability, cold-weather cracking resistance, high-temperature anti-rutting performance, and resistance against moisture-induced damage while also offering environmental and economic benefits. This review highlights the potential of e-waste plastics as sustainable asphalt modifiers and provides insights across the full utilization pathway, from recovery to in-field performance. Full article

Functional recovery after traumatic brain injury (TBI) is hindered by progressive neurodegeneration resulting from neuroinflammation and other secondary injury processes. Dexamethasone (DX), a synthetic glucocorticoid, has been shown to reduce inflammation, but its systemic administration can cause a myriad of other medical issues. We aim to provide a local, sustained treatment of DX for TBI. Previously, we demonstrated that PEG-bis-AA/HA-DXM hydrogels composed of polyethyleneglycol-bis-(acryloyloxy acetate) (PEG-bis-AA) and dexamethasone-conjugated hyaluronic acid (HA-DXM) reduced secondary injury and improved motor functional recovery at 7 days post-injury (DPI) in a rat moderate controlled cortical impact (CCI) TBI model. In this study, we evaluated the effect of PEG-bis-AA/HA-DXM hydrogel on cognitive function and secondary injury at 14 DPI. Immediately after injury, hydrogel disks were placed on the surface of the injured cortex. Cognitive function was evaluated using the Morris Water Maze test, and secondary injury was evaluated by histological analysis. The hydrogel treatment group demonstrated significantly shorter latency to target, decreased distance to find the hidden target, increased number of target crossings, increased number of entries to the platform zone, and decreased latency to first entry of target zone compared to untreated TBI rats for probe test. We also observed reduced lesion volume, inflammatory response, and apoptosis in the hydrogel treatment group compared to the untreated TBI group. Full article