Stroke and Emerging Blood Biomarkers: A Clinical Prospective.

Stroke constitutes the primary source of adult functional disability, exhibiting a paramount socioeconomic burden. Thus, it is of great importance that the prediction of stroke outcome be both prompt and accurate. Although modern neuroimaging and neurophysiological techniques are accessible, easily available blood biomarkers reflecting underlying stroke-related pathophysiological processes, including glial and/or neuronal death, neuroendocrine responses, inflammation, increased oxidative stress, blood-brain barrier disruption, endothelial dysfunction, and hemostasis, are required in order to facilitate stroke prognosis. A literature search of two databases (MEDLINE and Science Direct) was conducted in order to trace all relevant studies published between 1 January 2010 and 31 December 2021 that focused on the clinical utility of brain natriuretic peptide, glial fibrillary acidic protein, the red cell distribution width, the neutrophil-to-lymphocyte ratio, matrix metalloproteinase-9, and aquaporin-4 as prognostic tools in stroke survivors. Only full-text articles published in English were included. Twenty-eight articles were identified and are included in this review. All studied blood-derived biomarkers proved to be valuable prognostic tools poststroke, the clinical implementation of which may accurately predict the survivors' functional outcomes, thus significantly enhancing the rehabilitation efficiency of stroke patients. Along with already utilized clinical, neurophysiological, and neuroimaging biomarkers, a blood-derived multi-biomarker panel is proposed as a reasonable approach to enhance the predictive power of stroke prognostic models.

Transcranial Direct Current Stimulation in Conjunction with Mirror Therapy for Upper Extremity Rehabilitation in Chronic Stroke Patients.

Objective: Stroke represents a major cause of upper limb motor impairment among stroke survivors, resulting in functional disability and affecting negatively their quality of life. Thus, it is imperative that stroke rehabilitation be efficient. Up to the present, several intervention methods have been proposed in an attempt to improve recovery potential poststroke, transcranial direct current stimulation (tDCS) and mirror therapy (MT) being among them. The aim of this review is to investigate the utility of tDCS administration in conjunction with MT on chronic stroke population. Methods: A literature research of two databases (MEDLINE and Scopus) was conducted in order to identify all relevant studies published between January 1st 2010 and September 30th 2021 that focused on the efficacy of the combined application of tDCS and MT on upper limb rehabilitation among chronic stroke patients. Results: Three studies fulfilled the selection criteria and were included in the present review. Transcranial direct current stimulation application along with MT exhibited statistically significant increases in Box and block test, grip strength, Action research arm test score and Nottingham extended activities of daily living score within the experimental group compared to controls. The timing-dependent interaction effects seem to be of key importance, as sequentially delivered tDCS prior to MT is considered to be more advantageous and time-efficient compared to the concurrent application of tDCS and MT. Conclusions: Application of tDCS in parallel with MT represents a promising neurorehabilitation tool for post-stroke patients regarding upper limb motor performance, movement efficiency and daily function. Future studies are needed in order to clarify whether sequential or concurrent tDCS and MT application is more beneficial.

Gross total resection with fluorescence could lead to improved overall survival rates: a systematic review and meta-analysis.

INTRODUCTION: Glioblastoma cases are often treated with aggressive resection. Recent studies have suggested that extended surgical resection could improve survival. Improved extent of resection could be afforded by the use of fluorescence during surgery. We aimed to examine the effect of fluorescence on the results of gross total resection (GTR) and its impact on the overall survival (OS) and progression-free survival (PFS) rates. METHODS: We performed a literature search of studies published between 2000 and 2021. The study followed the PRISMA guidelines and focused on newly-diagnosed glioblastoma cases. The collected data were divided into two groups according to the fluorescence use: Group A (standard white-light use) and Group B (fluorescent-light use). RESULTS: The results showed a superiority of the fluorescence use during surgery for newly diagnosed glioblastoma cases concerning the procurement of GTR. Additionally, we highlighted the importance of GTR on the OS but not on the PFS rate. We found that the use of 5-aminolevulinic acid resulted in better OS rates compared to fluorescein sodium. CONCLUSION: GTR is a significant factor leading to improved OS; nevertheless, it was an apparently unrelated factor for estimating the PFS rate. Fluorescence use during surgery could lead to higher rates of complete resection and better OS rates.

Which is the Prognostic Value of the Mini Mental State Examination Test in Surgical Oncology?

INTRODUCTION: Cancer patients are usually subjected to numerous surgeries during their course of treatment. Recent studies suggest that anesthetic drugs such as propofol, benzodiazepines, and opioids are linked to cognitive impairment. AIM: The aim of the study was to show and compare the cognitive function of oncology patients who have undergone surgery and have been sedated with propofol, fentanyl and benzodiazepines. MATERIALS AND METHODS: In order to determine whether the cognition of oncological patients is being impaired, a mini-mental state examination (MMSE) test was obtained 6 to 24 hours pre- and postoperatively for the duration of one month from 8 eligible oncological patients and 7 non-oncological ones. Afterwards, the data were statistically processed with SPSS version 25.0 (Chicago, Ill. the USA). RESULTS: The analysis shows that there is statistically significant difference in the preoperative MMSE scores between oncological and non-oncological patients. CONCLUSIONS: Oncological patients compound a sensitive group for cognitive dysfunction, and indeed, MMSE test could be useful for cognitive evaluation. The present sample, however, is small, and the results could not be generalized. Therefore a more extensive study is needed.