Factores asociados al fracaso de las terapias neuroprotectoras en fase clínica en modelos animales con isquemia cerebral / Factors associated with the failure of the neuroprotector therapies in the clinical phase of animal models with cerebral ischemia

Los accidentes cerebrovasculares se han mantenido, a nivel mundial, como la tercera causa de muerte y la primera de discapacidad. Para disminuir la incidencia de casos de isquemia o hemorragia cerebral, así como sus consecuencias, se deben poseer los conocimientos sobre dichas entidades clínicas, los factores de riesgo asociados y las alternativas preventivas y terapéuticas como estrategias neuroprotectoras. Muchas de las intervenciones médicas realizadas hasta la fecha en modelos animales han resultado insatisfactorias en la fase clínica. Por ello, se realizó una revisión de las publicaciones más recientes donde se abordan los modelos experimentales para la isquemia cerebral más utilizados en las evaluaciones de las terapias neuroprotectoras, y se pudo concluir que si se analizan los protocolos empleados en la fase preclínica podrán optimizarse las investigaciones para lograr resultados más acertados en este campo.

The strokes have been considered, worldwide, as the third cause of death and the first cause of disability. To diminish the incidence of ischemia cases or cerebral hemorrhage, as well as their consequences, one should have the knowledge on this clinical entities, the associated risk factors and preventive and therapeutic alternatives as neuroprotector strategies. Many of the medical interventions carried out so far in animal models have been unsatisfactory in the clinical phase. Reason why, a review of the most recent publications was carried out, where the most used experimental models for the cerebral ischemia in the evaluations of the neuroprotector therapies are approached, and it was concluded that if protocols used in the preclinic phase are analyzed, the investigations could be optimize to achieve more relevant results in this field.

Análisis de la calidad de ejecución técnica de los golpeos de mano alta, en atletas de bádminton categoría escolar / Análise da qualidade da execução técnica dos golpes de mão alta, na categoria escolar badminton atletas / Analysis of the quality of technical execution of high hand strokes in school category badminton athletes

Resumen La práctica del bádminton, desde sus inicios, en el alto rendimiento en la provincia Pinar del Río, ha logrado mantener un trabajo sistemático y con resultados que avalan la estancia de atletas pinareños en la élite nacional, fundamentalmente en la modalidad de doble y doble mixto, sin embargo, en la evaluación de los resultados de los test pedagógicos-técnicos y evaluaciones de los objetivos pedagógicos a nivel nacional, actualmente están evaluados de Mal. Con el objetivo de conocer tal comportamiento, se realizó un minucioso estudio de las particularidades de la ejecución técnica de los golpeos de mano alta, la cual resulta ser la técnica más afectada según observaciones realizadas a sesiones de entrenamientos y desarrollo de competencias. La investigación se desarrolló en los siete atletas de la categoría escolar de la EIDE "Ormani Arenado Llorch" de Pinar del Río. A través de la entrevista y la observación como métodos científicos, se pudo constatar el nivel de ejecución técnico de los golpeos de mano alta en los atletas de bádminton categoría escolar, detectándose insuficiencias que atentan con la obtención de resultados competitivos superiores.

Resumo A prática do badminton, desde o seu início, no alto desempenho na província de Pinar del Río, conseguiu manter um trabalho sistemático e com resultados que garantem a permanência dos atletas de Pinar del Río na elite nacional, principalmente na modalidade dupla e mista, no entanto, na avaliação dos resultados dos testes pedagógico-técnicos e avaliações dos objetivos pedagógicos a nível nacional, são atualmente avaliados por Mal. A fim de compreender este comportamento, foi realizado um estudo detalhado sobre as particularidades da execução técnica dos golpes de mão alta, que é a técnica mais afetada de acordo com as observações feitas durante as sessões de formação e o desenvolvimento de competências. A investigação foi desenvolvida nos sete atletas da categoria escolar do EIDE "Ormani Arenado Llorch" em Pinar del Río. Através da entrevista e da observação como métodos científicos, foi possível verificar o nível de execução técnica dos golpes de mão alta nos atletas de Badminton da categoria escolar, detectando deficiências que tentam com a obtenção de resultados competitivos superiores.

Abstract The practice of badminton since its beginnings in the high performance in the province of Pinar del Río, has managed to maintain a systematic work and with results that guarantee the stay of Pinar del Río athletes in the national elite, mainly in the double and mixed modality, however in the evaluation of the results of the pedagogic-technical tests and evaluations of the pedagogic objectives at national level are currently evaluated from Mal. With the objective of knowing such behavior, a meticulous study was made of the particularities of the technical execution of high hand strikes, which turns out to be the technique most affected according to observations made in training sessions and development of competencies. The research was developed in the seven athletes of the school category of the EIDE "Ormani Arenado Llorch" from Pinar del Río. Through the interview and the observation as scientific methods, it was possible to verify the level of technical execution of high hand strokes in the badminton athletes of school category, detecting deficiencies that attempt to obtain superior competitive results.

Trombosis venosa cerebral: lo que hay que saber / Venous cerebral thrombosis: What you need to know

Resumen La trombosis venosa cerebral representa 0.5% del evento vascular cerebral en el mundo. Sin embargo, la expresión fenotípica de la enfermedad en los países en desarrollo como México muchas veces es subestimada por múltiples factores, entre ellos la falta de sospecha de la enfermedad, la carencia de estudios diagnósticos y el patrón subclínico de la enfermedad. Desde hace más de 30 años se ha considerado a la población mexicana con un factor de riesgo de la aparición de fenómenos protrombóticos en sitios tradicionales; sin embargo, en la última década la prevalencia de trombosis venosa en sitios atípicos, como el sistema venoso cerebral, se ha incrementado. Por lo anterior, es importante para el médico no neurólogo el conocimiento de esta enfermedad, aparentemente no común, en nuestra población.

Abstract Cerebral venous thrombosis represents 0.5% of all strokes in the world. However, the phenotypic expression of the disease in developing countries such as Mexico is often underestimated by multiple factors, including low suspicion of the disease, lack of diagnostic studies and subclinical pattern of the disease. Since more than 30 years, Mexican population has been considered with a risk factor for the development of prothrombotic phenomena in traditional sites; however, in the last decade prevalence of venous thrombosis in atypical sites, such as the cerebral venous system, has increased dramatically, thus, it is mandatory for the non-neurologist physician to know about the disease, apparently uncommon in our population.

Cerebellar infarction complicated with acute hydrocephalus

Acute hydrocephalus is a rare manifestation of posterior circulation strokes. Clinical worsening and coma may occur in addition to these symptoms of cerebellar dysfunction. Timely and careful approach will certainly prove to be life saving when deciding for a shunt procedure in a patient developing obstructive hydrocephalus following cerebellar infarct. The case presented here is a reminder for both this rare complication, and the treatment approach. We present a patient with cerebellar infarct and secondary obstructive hydrocephalus. Forty three year old male patient was brought to the emergency room in our hospital with unconsciousness, before that patient with suddenly developing dizziness, loss of balance and vomiting. His neurological examination showed that he was coma. The patient's brain computed tomography scan showed severe third and lateral ventricular dilation suggestive of obstructive hydrocephalus. Following shunt placement and suboccipital decompression, the patient recovered and was able to walk without assistance. Cerebellar infarcts may cause death as a result of pressure increase in the posterior fossa and pressure on the brain stem due to edema. Moreover, the aquaductus or the fourth ventricle may close because of edema and cause obstructive hydrocephalus and acute intracranial pressure increase. Temporary external ventricular drainage or permanent shunt systems and surgical decompression of the posterior fossa may be considered to prevent progressive neurologic worsening. In conclusion, we wished to point out that a timely surgical procedure in a cerebellar infarct case where acute hydrocephalus developed could be life saving.

Etiologic Pattern of Stroke in Young Patients in a Tertiary Care Hospital

Introduction: Strokes in young is important for a society, for anation where most of the risk factors are avoidable andmodifiable.Objective: In this study our main goal is to identify the etiologyof stroke in young age.Method: This cross sectional type of descriptive studywasconducted among the patients reporting to our patientsdepartment and patients admitted into Neuromedicine andMedicine Units of Rajshahi Medical College Hospital from 2012January 1 to 2013 December 31. During the study data wascollected by face to face interview, physical examination andinvestigations in a data collection sheet also evaluated andanalyzed by SPSS.Results: The experiment wheremost of the stroke patientswere female gender and hypertension was most common riskfactor 76%. Also contraceptive user female with strokes where32.1% were haemorrhagic and 36.8% were ischemic.Conclusion: After much analysis we can conclude thatrheumatic heart diseases were important factors for femalestrokes and hypertension were for both male and femalestrokes. Further community based large sample studies arerequired to have better outcome.

Neuroprotective effect of Sanqi Tongshuan Tablets on sequelae post-stroke in rats / 中草药·英文版

Objective: To identify the therapeutic effect and possible mechanisms of Chinese medicine Sanqi Tongshuan Tablets (SQTS) on sequelae post-stroke in rats. Methods: The rat cerebral ischemia sequelae post-stroke models were successfully induced by blocking the middle cerebral artery with electric coagulator after the seventh week and balance beam test ≤ 4. The rats were then received with SQTS (0.5, 1, and 2 g/kg) and Naodesheng (NDS, 1.24 g/kg), Vinpocetine (VP, 1.55 mg/kg) for 30 d. The beam-walking test and shuttle test were performed before and after 10, 20, and 30 d of administration. In addition, histopathology changes and GAP-43, GFAP were measured by H&E staining and immunohistochemisty. Results: The model displayed signs of brain damage on motor function, learning and memory function and histopathology. After 30 d of treatment, SQTS at different doses (0.5, 1.0, and 2.0 g/kg) restored the beam-walking scores by 21.7% (P > 0.05), 30.4% (P > 0.05), and 39.1% (P 0.05), 50.0% (P > 0.05), and 75.0% (P < 0.05), respectively. On the other hand, the histological changes were less severe and the GAP-43 expression increased in hippocampal CA1 and cortical region. Conclusion: SQTS showed therapeutic benefits on sequelae post-stroke in rats, which might be through the pathway of regeneration or neuroplasticity.

Clinical profiles, electrolytes status in acute strokes and their outcome

Background: Intracerebral hemorrhage (ICH) and Ischemic strokes (ISCHS) can occurs along with many metabolic abnormalities in acute stage. Electrolyte disturbances can occurs in acute stage of strokes due to many causes. The aim of the present study is to observe the clinical profiles, electrolytes status in acute stage of strokes and their outcome.Methods: One hundred stroke patients diagnosed clinically and confirmed by CT or MRI within 24 hours of onset were consecutively selected for the study after fulfillment of inclusion criteria in the indoor department of medicine, VSSIMSAR, Burla, Odisha (India), from Nov 2015 to Nov 2017. Baseline Glasgow Coma Scale (GCS), serum electrolytes were estimated along with other biochemical tests as needed. Glasgow Outcome Scale (GOS) was determined after 5th day of strokes. Data were collected and analyzed. Results: Hyponatraemia present in 13 (36.11%) of ICH and 6 (2.38%) ISCHS. Hypokalaemia was present in 7 (9.44%) of ICH and 11(17.19%) ISCHS. Hypocalcaemia was present in 3 (8.33%) of ICH and 18(28.12%) ISCHS. (P 0.0001). Hypomagnesaemia in 2(5.56%) ICH and 21 (32.81%) ISCHS. (P 0.0001). Minor GCS in 38 (62.29%), moderate 15 (24.59%) and severe 8(13.12%) patients with dyselectrolytemia versus 31 (79.48%), 5 (12.82%) and 3 (7.7%) with normal electrolytes respectively. GOS was good in 30 (49.18%), poor 18 (29.51%) and GOS 1 (Deaths) 13 (21.31%) versus 32(82.05%), 5(12.82%) and 1(1.3%) in patients with normal electrolytes status. (P 0.03).Conclusions: E Hyponatraemia and hypoklaemia was very often present in ICH and hypocalcaemia and hypomagnesaemia in ISCHS, Higher rates of morbidity and mortalities was associated with dyselectrolytemia.

Comparison of Outcomes after Device Closure and Medication Alone in Patients with Patent Foramen Ovale and Cryptogenic Stroke in Korean Population

PURPOSE: To compare the effectiveness of device closure and medical therapy in prevention of recurrent embolic event in the Korean population with cryptogenic stroke and patent foramen ovale (PFO). MATERIALS AND METHODS: Consecutive 164 patients (men: 126 patients, mean age: 48.1 years, closure group: 72 patients, medical group: 92 patients) were enrolled. The primary end point was a composite of death, stroke, transient ischemic attack (TIA), or peripheral embolism. RESULTS: Baseline characteristics were similar in the two groups, except age, which was higher in the medical group (45.3±9.8 vs. 50.2±6.1, p<0.0001), and risk of paradoxical embolism score, which was higher in the closure group (6.2±1.6 vs. 5.7±1.3, p=0.026). On echocardiography, large right-to-left shunt (81.9% vs. 63.0%, p=0.009) and shunt at rest/septal hypermobility (61.1% vs. 23.9%, p<0.0001) were more common in the closure group. The device was successfully implanted in 71 (98.6%) patients. The primary end point occurred in 2 patients (2 TIA, 2.8%) in the closure group and in 2 (1 death, 1 stroke, 2.2%) in the medical group. Event-free survival rate did not differ between the two groups. CONCLUSION: Compared to medical therapy, device closure of PFO in patients with cryptogenic stroke did not show difference in reduction of recurrent embolic events in the real world's setting. However, considering high risk of echocardiographic findings in the closure group, further investigation of the role of PFO closure in the Asian population is needed.

Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active movements. Therefore, cerebrovascular lesions of the cerebellum or its pathways can cause diverse movement disorders, such as action tremor, Holmes' tremor, palatal tremor, asterixis, and dystonia. The pathophysiology of abnormal movements after stroke remains poorly understood. However, due to the current advances in functional neuroimaging, it has recently been described as changes in functional brain networks. This review describes the clinical features and pathophysiological mechanisms in different types of movement disorders following cerebrovascular lesions in the cerebellar circuits.

Systematic review: hereditary thrombophilia associated to pediatric strokes and cerebral palsy / Revisão sistemática: trombofilias hereditárias associadas aos acidentes vasculares cerebrais pediátricos e a paralisia cerebral

OBJECTIVES: This review aimed to organize and consolidate the latest knowledge about mutations and genetic polymorphisms related to hereditary thrombophilia and their potential association with pediatric stroke and cerebral palsy (CP). SOURCES: Scientific articles published from 1993 to 2013, written in Portuguese, English, French, and Spanish, were selected and reviewed. The publications were searched in electronic databases, and also in the collections of local libraries. The terms "hereditary thrombophilia", "polymorphisms", "mutation", "pediatric strokes", and "cerebral palsy" were used for the research. SUMMARY OF THE FINDINGS: The search in databases and in the bibliographic references retrieved 75 articles for inclusion in this review. Studies that investigated hereditary thrombophilias and their associations to CP and arterial and venous pediatric stroke presented contradictory results. The meta-analysis and case-control studies that showed positive results for this association described only slightly increased relative risks and sometimes had questionable conclusions. The association of two or more hereditary thrombophilias, or the association between thrombophilia and other specific clinical risk factors, suggest a higher risk of CP and pediatric stroke than isolated hereditary thrombophilia. CONCLUSIONS: Larger, multicenter studies should be developed in order to elucidate the role of mutations leading to hereditary thrombophilia and the development of CP and pediatric stroke. The complex and multifactorial etiology of CP and stroke makes this an arduous and difficult task; however, the benefits generated by these studies are immeasurable. .

OBJETIVO: Sistematizar e integrar os últimos conhecimentos sobre mutações e polimorfismos genéticos relacionados às trombofilias hereditárias e suas potenciais associações com acidentes vasculares cerebrais pediátricos (AVC) e paralisia cerebral (PC). MATERIAL: Artigos científicos publicados de 1993 a 2013, escritos em português, inglês, francês e espanhol foram selecionados e revisados. As publicações foram pesquisadas nas bases de dados eletrônicas, como também nos acervos das bibliotecas locais. Os termos mutação, polimorfismos, trombofilias hereditárias, acidentes vasculares cerebrais pediátricos e paralisia cerebral foram usados para a pesquisa. RESULTADOS: A pesquisa nas bases de dados e nas referências bibliográficas identificou 75 artigos para inclusão nesta revisão. Os estudos que investigaram as trombofilias hereditárias e suas associações à PC e aos AVC pediátricos arteriais e venosos apresentaram resultados contraditórios. As metanálises e os estudos caso-controle que demonstraram resultados positivos para essa associação descreveram riscos relativos discretamente aumentados e, algumas vezes, questionáveis. A associação de duas ou mais trombofilias hereditárias, ou a junção de trombofilias específicas com demais fatores de riscos clínicos, sugerem maior risco no aparecimento da PC e do AVC pediátrico do que as trombofilias hereditárias isoladas. CONCLUSÃO: Estudos multicêntricos de grande porte devem ser conduzidos para elucidar o papel real das mutações que levam às trombofilias hereditárias e ao aparecimento da PC e AVC pediátricos. A etiologia multifatorial e complexa da PC e dos AVC torna essa tarefa árdua e difícil, porém, os benefícios gerados por esses estudos são incalculáveis. .

Minor strokes: clinical characteristics, methods of diagnostics, and principles of prevention of its complications into major stroke / Монголын Анагаах Ухаан

BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.

A research about testing the stroke impact scale / 中国实用护理杂志

0.5.8 factors can explain the 80% of the whole variable. There were significant differences in the aspects of emotion,ADL/IADL,moving ability,participating and the total score(P

Effect of Ultraviolet Blood Irradiation and Oxygenation(UBIO)on Ischemic Strokes / 中国康复理论与实践

@#The paper was a study on the effect of UBIO on ischemic strokes. 80 Cases with acute ischemic strokes were randomly divided into two groups:UBIO group and control group. Clinic effectiveness,hemorheology and in vitro infarction were studied before and after 14 days treatment. Clinical results showed that the excellent,effetive rate of UBIO group was respectively better than that of control group (P<0.05). The results of hemorheology and in vitro infarction showed UBIO has a faster effectiveness than control group. The results indicate that UBIO therapy is a hopeful assistant method for the treatment of acute ischemic strokes.