Therapeutic Hypothermia in Stroke and Traumatic Brain Injury

Therapeutic hypothermia (TH) is considered to improve survival with favorable neurological outcome in the case of global cerebral ischemia after cardiac arrest and perinatal asphyxia. The efficacy of hypothermia in acute ischemic stroke (AIS) and traumatic brain injury (TBI), however, is not well studied. Induction of TH typically requires a multimodal approach, including the use of both pharmacological agents and physical techniques. To date, clinical outcomes for patients with either AIS or TBI who received TH have yielded conflicting results; thus, no adequate therapeutic consensus has been reached. Nevertheless, it seems that by determining optimal TH parameters and also appropriate applications, cooling therapy still has the potential to become a valuable neuroprotective intervention. Among the various methods for hypothermia induction, intravascular cooling (IVC) may have the most promise in the awake patient in terms of clinical outcomes. Currently, the IVC method has the capability of more rapid target temperature attainment and more precise control of temperature. However, this technique requires expertise in endovascular surgery that can preclude its application in the field and/or in most emergency settings. It is very likely that combining neuroprotective strategies will yield better outcomes than utilizing a single approach

Designing an Avatar-based Translator System from Persian into Persian Sign Language (PSL)

Background and Objectives: Sign Language is a visual language that uses hand shapes, facial expression gestures, and body language for communication. Linguistic studies have shown that Sign Languages, like spoken languages, are natural and meet the communication needs of their speakers. Sign Language is not a single language that can be universal, nor every country has a Sign Language equivalent to its own spoken language. There are many Sign Languages ​​in the world including the American, English, Japanese, Italian, Turkish, and Persian Sign Language. The Persian Sign Language is the natural language of the deaf in Iran. The ability to communicate effectively is an important step in establishing relationships and participation for the deaf in the community. Lack of support from the hearing community leads deaf people to isolation and other social problems. In order to overcome the obstacles that exist between hearing and hearing impaired people, a translator system is needed to translate messages into the Sign Language in accordance with their spoken language. A Sign Language translation system can be used by the deaf, the family and friends of such people, the blind-deaf people, the people who have lost their ability to speak due to some factors, the professors and teachers, the medical staff and also people who are interested in learning this language. This article, by providing an automatic translator system for translating from the Persian Language into the Persian Sign Language, aims to help the deaf in Iran to communicate better. Methods: The proposed translator system requires the use of an architecture in order to convert the Persian text into the Persian Sign Language. Due to the nature of the Persian language as the input language of the translator system and also the problems inherent in the Persian Sign Language as the output language of the translator system, the architecture of the translation systems presented in other languages ​​cannot be presented and developed regarding the Persian language. One of the most important issues in the Persian Sign Language is lack of equivalent signs for some words in the Persian language. In order to overcome these problems, an architecture appropriate to the Persian language and the Persian Sign Language was presented. By using the proposed architecture, the proposed system, receives the Persian text as an input in the form of word or sentence from the user, and after performing the initial processing and by using the lexical transfer module, the system translates the text into the Persian Sign Language. Finally, by using an avatar, the Sign Language form corresponding the input of a word, phrase, or sentence can be represented. For this purpose, transfering the translated words into HamNoSys notation, turning the HamNoSys notation to SiGML language and then animating the 3D character with the help of this language are used. Findings: To evaluate the translation system of the Persian language to the Persian Sign Language, a set of test sentences were used. After evaluating the system, it was found that the proposed system has acceptable efficiency, storage space and speed. Conclusion: Research in interdisciplinary sciences is only effective and influential when research in all of the sciences involved is done equally and each science solves the challenges of its own field of study. For example, the most important challenge in completing the Persian Sign Language translation system is lack of linguistic research on Persian Sign Language. The proposed translation system is a combination of linguistic, social, and engineering sciences. Focusing on each of these areas and upgrading them will considerably improve the proposed system. However, the proposed system can improve the relationship between the hearing and the hearing impaired people to a great extent. One can focus on any of the proposed architecture modules and upgrade and improve each of them. It is also possible to integrate the section of emotions and facial expressions with the animated character so that the facial expressions of this avatar can change according to the conditions.  ===================================================================================== COPYRIGHTS  ©2021 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original authors and source are cited. No permission is required from the authors or the publishers.  ====================================================================================

Intracranial Aneurysms: Review of Current Treatment Options and Outcomes

Intracranial aneurysms are present in roughly 5% of the population, yet most are often asymptomatic and never detected. Development of an aneurysm typically occurs during adulthood, while formation and growth are associated with risk factors such as age, hypertension, pre-existing familial conditions, and smoking. Subarachnoid hemorrhage, the most common presentation due to aneurysm rupture, represents a serious medical condition often leading to severe neurological deficit or death. Recent technological advances in imaging modalities, along with increased understanding of natural history and prevalence of aneurysms, have increased detection of asymptomatic unruptured intracranial aneurysms (UIA). Studies reporting on the risk of rupture and outcomes have provided much insight, but the debate remains of how and when unruptured aneurysms should be managed. Treatment methods include two major intervention options: clipping of the aneurysm and endovascular methods such as coiling, stent-assisted coiling, and flow diversion stents. The studies reviewed here support the generalized notion that endovascular treatment of UIA provides a safe and effective alternative to surgical treatment. The risks associated with endovascular repair are lower and incur shorter hospital stays for appropriately selected patients. The endovascular treatment option should be considered based on factors such as aneurysm size, location, patient medical history, and operator experience

The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection

Purpose of Review: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health challenge. This review aims to summarize the incidence, risk factors, possible pathophysiology, and proposed management of neurological manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC) or neuro-PASC based on the published literature. Recent Findings: The National Institutes of Health has noted that PASC is a multi-organ disorder ranging from mild symptoms to an incapacitating state that can last for weeks or longer following recovery from initial infection with SARS-CoV-2. Various pathophysiological mechanisms have been proposed as the culprit for the development of PASC. These include, but are not limited to, direct or indirect invasion of the virus into the brain, immune dysregulation, hormonal disturbances, elevated cytokine levels due to immune reaction leading to chronic inflammation, direct tissue damage to other organs, and persistent low-grade infection. A multidisciplinary approach for the treatment of neuro-PASC will be required to diagnose and address these symptoms. Tailored rehabilitation and novel cognitive therapy protocols are as important as pharmacological treatments to treat neuro-PASC effectively. Summary: With recognizing the growing numbers of COVID-19 patients suffering from neuro-PASC, there is an urgent need to identify affected individuals early to provide the most appropriate and efficient treatments. Awareness among the general population and health care professionals about PASC is rising, and more efforts are needed to understand and treat this new emerging challenge. In this review, we summarize the relevant scientific literature about neuro-PASC

Functional and Safety Outcomes of Carotid Artery Stenting and Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke With Tandem Lesions

Arteria carótida; Trombectomía mecánica; Accidente cerebrovascular isquémicoArtèria caròtida; Trombectomia mecànica; Accident cerebrovascular isquèmicCarotid artery; Mechanical thrombectomy; Ischemic strokeImportance Approximately 10% to 20% of large vessel occlusion (LVO) strokes involve tandem lesions (TLs), defined as concomitant intracranial LVO and stenosis or occlusion of the cervical internal carotid artery. Mechanical thrombectomy (MT) may benefit patients with TLs; however, optimal management and procedural strategy of the cervical lesion remain unclear. Objective To evaluate the association of carotid artery stenting (CAS) vs no stenting and medical management with functional and safety outcomes among patients with TL-LVOs. Design, Setting, and Participants This cross-sectional study included consecutive patients with acute anterior circulation TLs admitted across 17 stroke centers in the US and Spain between January 1, 2015, and December 31, 2020. Data analysis was performed from August 2021 to February 2022. Inclusion criteria were age of 18 years or older, endovascular therapy for intracranial occlusion, and presence of extracranial internal carotid artery stenosis (>50%) demonstrated on pre-MT computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Exposures Patients with TLs were divided into CAS vs nonstenting groups. Main Outcomes and Measures Primary clinical and safety outcomes were 90-day functional independence measured by a modified Rankin Scale (mRS) score of 0 to 2 and symptomatic intracranial hemorrhage (sICH), respectively. Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), discharge mRS score, ordinal mRS score, and mortality at 90 days. Results Of 685 patients, 623 (mean [SD] age, 67 [12.2] years; 406 [65.2%] male) were included in the analysis, of whom 363 (58.4%) were in the CAS group and 260 (41.6%) were in the nonstenting group. The CAS group had a lower proportion of patients with atrial fibrillation (38 [10.6%] vs 49 [19.2%], P = .002), a higher proportion of preprocedural degree of cervical stenosis on digital subtraction angiography (90%-99%: 107 [32.2%] vs 42 [20.5%], P < .001) and atherosclerotic disease (296 [82.0%] vs 194 [74.6%], P = .003), a lower median (IQR) National Institutes of Health Stroke Scale score (15 [10-19] vs 17 [13-21], P < .001), and similar rates of intravenous thrombolysis and stroke time metrics when compared with the nonstenting group. After adjustment for confounders, the odds of favorable functional outcome (adjusted odds ratio [aOR], 1.67; 95% CI, 1.20-2.40; P = .007), favorable shift in mRS scores (aOR, 1.46; 95% CI, 1.02-2.10; P = .04), and successful reperfusion (aOR, 1.70; 95% CI, 1.02-3.60; P = .002) were significantly higher for the CAS group compared with the nonstenting group. Both groups had similar odds of sICH (aOR, 0.90; 95% CI, 0.46-2.40; P = .87) and 90-day mortality (aOR, 0.78; 95% CI, 0.50-1.20; P = .27). No heterogeneity was noted for 90-day functional outcome and sICH in prespecified subgroups. Conclusions and Relevance In this multicenter, international cross-sectional study, CAS of the cervical lesion during MT was associated with improvement in functional outcomes and reperfusion rates without an increased risk of sICH and mortality in patients with TLs

Seropositivity to syphilis in blood samples from four regions (136 sections) of Ribeirão Preto - SP

Avaliou-se a demanda de solicitação sorológica para sífilis (VDRL e FTA Abs), considerando-se a idade e sexo dos pacientes e freqüência de soropositividade de acordo com a Área Distrital de Saúde (ADS), responsável pelo atendimento médico. Um total de 16127 amostras, oriundas de 4 ADS (136 bairros de Ribeirão Preto) foram submetidas ao VDRL, confirmando-se o resultado com o FTA-Abs. O percentual de VDRL falsos positivos foi de 9,0% . Considerando os resultados do FTA-Abs, concluiu-se que as freqüências de amostras positivas para sífilis foi de 9,5%. A ADS que apresentou a maior freqüência de positividade foi a Central, provavelmente por ser uma região onde há maior concentração de profissionais do sexo. Notou-se, também, um elevado número de resultados falsos positivos entre as amostras oriundas da ADS Sumarezinho, levantando questões epidemiológicas e laboratoriais de realce. Houve nítido aumento de solicitações das reações sorológicas para diagnóstico de sífilis, considerando o quadriênio 1989-1992. Apesar do aumento no número de diagnósticos, o percentual de soropositividade para sífilis reduziu, consideravelmente, de 1989 para 1992. Aventa-se que essa redução possa refletir o empenho multidisciplinar nas campanhas de educação em saúde.The serological solicitation for syphilis (VDRL and FTA-Abs) was evaluated, considering the age, sex of patients and the seropositivity frequences according to the Districtal Health Section (DHS) responsible for the medical care. A total of 16,127 samples that came from 4 DHS (136 sections of Ribeirão Preto) of blood, that came from 4 DHS (136 sections of Ribeirão Preto) were analysed throught VDRL and the results were&nbsp;confirmed by FTA-Abs. The percentual of false positive VDRL was equal to 9.0%. By considering the results of FTA-Abs, we concluded that the frequency of positive samples to syphilis was 9.5%. The DHS that had the highest taxes of seropositivity was the Central. It was probably due to the fact that this region reunites a big concentration of sex professionals. It was also observed a big number of false-positive results among the samples from Sumarezinho DHS, what motivated important epidemiological and laboratorial questions. There was a notable increasing of solicitations of serological reactions for syphilis, considering the four-year period 1989-1992. Besides the increasing in the number of diagnosis, the percentual of seropositivity to syphilis reduced considerably from 1989 to 1992. Such reduction may also probably be the result of the multidisciplinary efforts during campaigns of health education

Monomeric C-reactive protein and cerebral hemorrhage: From bench to bedside

© 2018 Di Napoli, Slevin, Popa-Wagner, Singh, Lattanzi and Divani. C-reactive protein (CRP) is an important mediator and a hallmark of the acute-phase response to inflammation. High-sensitivity assays that accurately measure levels of CRP have been recommended for use in risk assessment in ischemic stroke patients. Elevation of CRP during the acute-phase response in intracerebral hemorrhage (ICH) is also associated with the outcomes such as death and vascular complications. However, no association has been found with the increased risk of ICH. The aim of this review is to synthesize the published literature on the associations of CRP with acute ICH both as a risk biomarker and predictor of short- and long-term outcomes as well as its role as a pathogenic determinant. We believe before any clinical utility, a critical appraisal of the strengths and deficiencies of the accumulated evidence is required both to evaluate the current state of knowledge and to improve the design of future clinical studies