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Introduction: The focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke. Methods: Systematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3-12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline. Perspectives: This living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments. [ABSTRACT FROM AUTHOR]

Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively. Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort. Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs. Results: 1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0–2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred <48 h (80.0%) and had a small vessel occlusion etiology (100%), affecting more often the internal capsule (60.0%). Dual antiplatelet therapy (DAPT) versus single antiplatelet therapy was associated with lower 3-month cumulative stroke incidence (12.5% vs. 57.1%; p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0–1; p = 0.323). Conclusions: CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS. [ABSTRACT FROM AUTHOR]

IntroductionThe focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke.MethodsSystematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3–12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline.PerspectivesThis living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments.

Background: COVID-19 may be a new risk factor for stroke. Stroke in COVID-19 varies from 1.1 to 8.1%. Various pathophysiological pathways predispose SARS-CoV-2 infected patients to stroke. Aim: To describe COVID-19 patients with acute stroke in one Colombian Center. Methods: From March 6 2020 and March 6 2021 records of patients with acute stroke and in-hospital positive PCR (Polymerase Chain Reaction) test for Sars-CoV-2 infection were reviewed. Demographic, stroke and COVID-19 characteristics were extracted. Continuous variables were reported in means and ranges. Categorical variables were presented in frequencies and percentage. A descriptive narrative was performed. Results: Of 328 acute stroke patients 14 (4.2%) tested positive for PCR SARS-CoV-2. Mean age 56.4 years with 57% males. Five were (35.7%) without vascular risk factors but 9 (64.3%) overweight. Brain infarct diagnosed in 11 (78.5%), 53% with anterior circulation syndromes. Mean NIHSS score 11.8 and 7 (63%) received intravenous thrombolysis. Acute inflammatory blood biomarkers (D-dimer, ferritin, LDH elevated) were positive in all. 11 (78.5%) had symptomatic COVID-19 before stroke with a mean latency of 7 days. 12 (85.7%) had severe COVID-19 and 6 (42.8%) required mechanical ventilation. Outcome was unfavorable in 9 (64.3%) (The Modified Rankin Scale (mRS) >2), mean hospital stay was 21.8 days and in-hospital case fatality rate was 14.2%. Conclusion: In susceptible individuals COVID-19 predisposes to stroke. Hypercoagulation and immune thrombosis may be at the culprit for this state. In Colombia, COVID-19 patients with stroke have similar characteristics to the described worldwide.

Background: Echocardiography is highly relevant in patients with ischemic stroke or TIA. Utilization of routine echocardiographic examinations [transthoracic (TTE) or transesophageal (TEE)] on stroke units remains however unknown. To representatively examine echocardiographic rates on stroke units in Germany and to evaluate structural factors that may influence the decision to conduct echocardiography. Methods: A nationwide analysis was performed by using certification audit data of all primary and comprehensive stroke centers (pSC and cSC) in Germany. Results: Structural and organizational requirements of 310 departments (cSCs: 42.6%) were extracted. Median TTE rate was 63.3% (IQR 39.3–80.8), median TEE rate 21.3% (IQR 16.4–29.5). A cardiological department on site was present in 74.2%, and they were associated with higher TEE rates. TTE rates decreased with increasing numbers of patients (p = 0.026). Likewise, TEE rates decreased with increasing numbers of patients (p = 0.006), mediated by departments with cSCs (p = 0.008 for cSCs vs p = 0.230 for pSCs). TTE rates were far more inhomogeneously distributed than TEE rates and higher in pSCs (p = 0.011). Overall, 12.9% of centers did not perform any echocardiographic examination in at least 50% of all stroke patients. Conclusion: More detailed recommendations regarding echocardiography should be included in future guidelines. Moreover, evaluating the impact of echocardiographic examinations on long-term prognosis in stroke patients should be focus of further evaluations. [ABSTRACT FROM AUTHOR]

In the last 10 years, the use of dual antiplatelet therapy (DAPT) in the neurological ambit has been explored in patients with non-cardioembolic ischemic stroke, transient ischemic attack (TIA), and intracranial atherosclerotic disease. Two clinical trials (CHANCE and POINT) showed that in patients with minor non-cardioembolic ischemic stroke or high-risk TIA, the addition of clopidogrel to aspirin reduces the risk of stroke recurrence. Another trial (THALES) evaluated the association of ticagrelor and aspirin in mild-to-moderate non-cardioembolic ischemic stroke or high-risk TIA, showing a reduced risk of subsequent stroke compared to aspirin alone. Finally, the use of DAPT has been assessed in the treatment of stroke associated with atherosclerotic intracranial stenosis in the SAMMPRIS trial, showing a favorable profile compared to percutaneous angioplasty and stenting. The aim of this article is, after a review the major trials evaluating DAPT in patients with ischemic cerebrovascular events and the ways they have been implemented in Italian, European, and USA guidelines, to provide a practical algorithm to help clinicians in their everyday clinical practice and to outline possible caveats in the practical implementation of guidelines. Possible limitations and gaps in knowledge regarding specific conditions (e.g., the use of DAPT after acute phase therapies) are also underlined. [ABSTRACT FROM AUTHOR]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain. Aims: We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke. Methods: Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis. Results: Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (−12.44/15.99 vs −13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion. Conclusion: There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics. [ABSTRACT FROM AUTHOR]

By understanding stroke as a chronic disease, aftercare becomes increasingly important. For developing aftercare programs, the patients' perspective regarding, for example, stroke-related symptoms and interactions with the healthcare system is necessary. Records from a local stroke pilot program were used to extract relevant topics from the patients' perspective, as mentioned during a phone call two months after hospital discharge. Data from 157 patients with ischemic stroke or transient ischemic attack (TIA) were included. "Rehabilitation" was mentioned by 67.5% of patients, followed by "specialist physician", "symptoms", and "medication". Compared with severely disabled patients, those with no relevant disability at hospital discharge mentioned "symptoms" significantly more often. Regarding rehabilitation, "outpatient care" was mentioned more often by patients in an inpatient setting, and 11.8% without rehabilitation mentioned "depression". Patients in single-compared to multi-person households differed, for example, in the frequency of mentioning "specialist physicians" and gradually "outpatient care". A multivariate model yielded associations between the disability at discharge and the probability of mentioning relevant topics afterward. This study provided insights into the patients' perspective and identified topics that need attention while accompanying stroke and TIA patients after discharge. Further, the degree of disability at discharge might be helpful for planning individual aftercare. [ABSTRACT FROM AUTHOR]

Background: The detection of paroxysmal atrial fibrillation (AF) is of importance in stroke care. The method used is continuous electrocardiogram (ECG)-monitoring or multiple short ECG-recordings during an extended period. Their relative efficiency is a matter of discussion. In a retrospective cohort study on 994 patients with an ischemic stroke or transient ischemic attack (TIA), we have compared continuous 7-day monitoring to intermittent recording 60 sec three times daily with a handheld device during 3 weeks. We related the result to subsequent occurrence of AF as detected in 12-lead ECG recordings. Methods: The patients were identified in the local database of cardiovascular investigations. Their clinical profile and vital status during the follow-up were obtained from the Swedish Stroke Register and the Swedish general population registry. For comparison, we used an age- and sex-matched population with no known cerebrovascular event and a population with a cerebrovascular event that was not screened. Results: AF was detected in 7.1% by continuous screening and in 5.1% by intermittent screening (P = 0.3). During follow-up of 32 months, AF in 12-lead ECG was found in 7.0%. In the subgroup with positive screening, 46.3% had AF compared with 6.7% in the subgroup with negative screening (P < 0.0001). Conclusions: The two screening approaches had a similar yield of arrhythmia, in spite of the group with intermittent monitoring having a more favorable clinical profile. A positive screening was highly predictive of AF in ECG during the follow-up.

Transient ischemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. In this type of ischemic event, there are no data about a possible cardiac injury tested with troponin. After a stroke, it is well established the cardiac involvement due to a neuro-inflammatory response (recently defined as Stroke Heart Syndrome). The aim of this study is to compare the troponin elevation after a stroke with the troponin elevation after a TIA. This is a retrospective, single center study on 565 patients (73 TIAs, 492 stroke). We collected demographic characteristics, cardiovascular risk factors, cardiac data such as troponin, NT-proBNP, left atrial dilatation, etiology of the ischemic event (TOAST classification). We compare IS and TIA for each TOAST subtype. In all groups no substantial differences were found in demographic and past medical history (p > 0.05). However, the maximum troponin level reached were significantly lower in TIAs than IS (p < 0.05), except in lacunar etiology were troponin elevation was low also in IS group. We found a trend in favor to IS in the rise and fall troponin elevation over 30% in all the TOAST subgroups, but only in the cryptogenic etiology the difference was significant. About the others cardiac markers of injury, a significant higher rate of elevated NT-proBNP was found in the IS cohort. Troponin level after TIAs is significantly lower than after IS. Troponin elevation after an ischemic event may be more relevant in patients with higher NT-proBNP levels and older age. More studies are needed to better understand the pathophysiology of this phenomenon after an ischemic event. [ABSTRACT FROM AUTHOR]

Abstract Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke, in particular residual problems such as anxiety/fatigue (‘Knowledge’). Identification and management of needs was largely influenced by HCPs’ perceived role, professional training (‘Social professional role and identity’) and time constraints (‘Environmental context and resources’). Follow-up was often passive – with onerous on patients to seek support – and predominantly focused on acute medical management (‘Intentions’/‘Goal’). Conclusions Follow-up care post-TIA/minor stroke is currently sub-optimal. Through identifying factors which influence follow-up, we can inform guidelines and practical strategies to improve holistic healthcare.

Information regarding the profile of reticulated platelets (RP) in ischemic cerebrovascular disease (CVD) patients is limited. Data from two prospective, observational, case-control studies were combined to compare the %RP using whole blood flow cytometry in patients ≤ 4 weeks of TIA/stroke onset (baseline, N = 210), and 14 ±7 days (14d, N = 182) and ≥ 90 days (90d, N = 145) after starting or changing antiplatelet therapy with healthy controls (N = 34). There were no differences in median %RP between the overall CVD patient population at baseline or 14d vs. controls (P ≥ 0.2). However, the median %RP was significantly higher in CVD patients overall at 90d (P = .036), and in the subgroup of patients with “lacunar” TIA/ischemic stroke at baseline (P = .04) and at 90d (P = .01), but not at 14d (P = .06) vs. controls. There were no significant differences in the median %RP between other TIA/stroke subgroups and controls (P ≥ 0.05). Elevated circulating reticulated platelets, as a marker of increased platelet production/turnover, may occur following an ischemic event in a well-phenotyped TIA/ischemic stroke population overall, but may precede symptom onset at least in the subgroup with small vessel occlusion. These data improve our understanding of the profile of reticulated platelets in CVD patients.

Background and Purpose: To investigate the association of different phenotypes, count, and locations of chronic covert brain infarctions (CBI) with long‐term mortality in patients with first‐ever manifest acute ischemic stroke (AIS) or transient ischemic attack (TIA). Additionally, to analyze their potential interaction with white matter hyperintensities (WMH) and predictive value in addition to established mortality scores. Methods: Single‐center cohort study including consecutive patients with first‐ever AIS or TIA with available MRI imaging from January 2015 to December 2017. Blinded raters adjudicated CBI phenotypes and WMH (age‐related white matter changes score) according to established definitions. We compared Cox regression models including prespecified established predictors of mortality using Harrell's C and likelihood ratio tests. Results: A total of 2236 patients (median [interquartile range] age: 71 [59‐80] years, 43% female, National Institutes of Health Stroke Scale: 2 [1‐6], median follow‐up: 1436 days, 21% death during follow‐up) were included. Increasing WMH (per point adjusted Hazard Ratio [aHR] = 1.29 [1.14‐1.45]), but not CBI (aHR = 1.21 [0.99‐1.49]), were independently associated with mortality. Neither CBI phenotype, count, nor location was associated with mortality and there was no multiplicative interaction between CBI and WMH (p >.1). As compared to patients without CBI or WMH, patients with moderate or severe WMH and additional CBI had the highest hazards of death (aHR = 1.62 [1.23‐2.13]). The Cox regression model including CBI and WMH had a small but significant increment in Harrell's C when compared to the model including 14 clinical variables (0.831 vs. 0.827, p <.001). Discussion: WMH represent a strong surrogate biomarker of long‐term mortality in first‐ever manifest AIS or TIA patients. CBI phenotypes, count, and location seem less relevant. Incorporation of CBI and WMH slightly improves predictive capacity of established risk scores. [ABSTRACT FROM AUTHOR]

Spontaneous spinal epidural hematoma (SSEH), a disease with exact etiology unknown, is characterized by acute onset of neck or back pain and rapidly progressive nerve root or spinal cord compression. It is rare in clinical practices, with a prevalence of approximately one in a million. Due to the lack of population-based epidemiological survey data for SSEH, clinicians have a serious lack of understanding of the disease and are prone to miss the best time for treatment, leaving patients with neurological dysfunction which is difficult to recover. In this paper, we report a case of SSEH with rare clinical manifestations, to improve clinicians' understanding of SSEH. The patient was mainly characterized by episodic left lower limb weakness and had been misdiagnosed as TIA. [ABSTRACT FROM AUTHOR]

Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient's risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity. Material and Methods: Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups—group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies. Results: Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores. Conclusions: We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI. [ABSTRACT FROM AUTHOR]

Background and purpose: To explore the relationship between baseline levels of matrix metalloproteinase 9 (MMP9) in peripheral blood and the outcomes in patients with acute minor stroke and transient ischemic attack (TIA). Methods: We assessed data from patients with acute minor ischemic stroke or TIA who were included in the CHANCE (Clopidogrel in High‐Risk Patients with Acute Nondisabling Cerebrovascular Events) trial. Baseline level of MMP9 in peripheral blood is classified into five quintiles. We assessed the relationship between the baseline MMP9 and outcomes of stroke recurrence, composite vascular events, and poor functional outcomes within 90 days after stroke onset. Results: Of the 3014 patients included, 295 (9.79%) had recurrent stroke, 289 (9.59%) had recurrent ischemic stroke, 297 (9.85%) had combined vascular events, and 199 (6.64%) had poor functional outcomes within 90 days. We used MMP9 concentrations near hazard ratio (HR) = 1 (Q3) in restricted cubic splines as the reference. The result showed that, compared to patients in the Q3 group, patients in the highest quintile (Q5 group) had an increased risk of poor functional outcomes at 90 days after adjusting the risk factors and confounders (p = 0.030), which may be associated with an increased risk of combined vascular events (p = 0.052). Using Cox regression models or logistic regression models with restricted cubic spline, we also observed that higher MMP9 ratios were associated with an increased risk of stroke recurrence, combined events, and poor functional outcomes at a range of concentrations. Conclusions: For patients with acute minor stroke or TIA, higher baseline MMP9 level was associated with an increased risk of poor functional outcomes, which might be related to stroke recurrence and combined vascular events. [ABSTRACT FROM AUTHOR]

Aims To elucidate the frequency and clinical impact of left atrial appendage thrombus (LAAT) in patients set for transcatheter aortic valve implantation (TAVI). Methods and results All patients undergoing TAVI between January 2014 and June 2020 with analysable multislice computed tomography (MSCT) for LAAT were included. Baseline and procedural characteristics were collected, pre-procedural MSCT's were retrospectively analysed for LAAT presence. The primary endpoint was defined as the cumulative incidence of any cerebrovascular event (stroke or transient ischaemic attack) within the first year after TAVI. A Cox proportional hazards model was used to identify predictors. A total of 1050 cases had analysable MSCT. Median age was 80 [interquartile range (IQR) 74–84], median Society of Thoracic Surgeons' Predicted Risk Of Mortality (STS-PROM) was 3.4% (IQR 2.3–5.5). Thirty-six percent were on oral anticoagulant therapy for atrial fibrillation (AF). LAAT was present in 48 (4.6%) of cases. Patients with LAAT were at higher operative risk [STS-PROM: 4.9% (2.9–7.1) vs. 3.4% (2.3–5.5), P  = 0.01], had worse systolic left ventricular function [EF 52% (35–60) vs. 55% (45–65), P  = 0.01] and more permanent pacemakers at baseline (35% vs. 10%, P  < 0.01). All patients with LAAT had a history of AF and patients with LAAT were more often on vitamin K antagonist-treatment than patients without LAAT [43/47 (91%) vs. 232/329 (71%), P  < 0.01]. LAAT [hazard ratio (HR) 2.94 (1.39–6.22), P  < 0.01] and the implantation of more than one valve [HR 4.52 (1.79–11.25), P  < 0.01] were independent predictors for cerebrovascular events. Conclusion Patients with MSCT-identified LAAT were at higher risk for cerebrovascular events during the first year after TAVI. [ABSTRACT FROM AUTHOR]

Background: Cerebral blood flow (CBF) can be related to the risk of occurrence of neurological symptoms. Well-developed collateral circulation is a good prognostic factor in patients with cerebrovascular disease. Understanding the mechanisms of collateral circulation may be important in the diagnosis, treatment, and monitoring in this group of patients. The aim of this study covered the assessment of CBF in patients with 70–99% Internal carotid artery (ICA) stenosis, focusing on the circulation pathways and flow volume in extracranial arteries. Materials and methods: 53 patients with 70–99% ICA stenosis (mean age 73.4 ± 7 years old; 17 female, mean age 73.9 ± 7.5 years old; 36 male, mean age 73.2 ± 6.8 years old) were included in the study. In all patients a Doppler ultrasound (DUS) examination, measuring blood flow volume in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), was performed. The cerebral blood flow (CBF) was compared to the previously reported CBF values in the healthy population > 65 years old. Results: Among the study groups three subgroups with flow differences were identified: patients with elevated CBF (significant volumetric flow compensation—26/53, 49%), patients with CBF similar to (mild compensation—17/53, 32%), and patients with CBF lower than (no compensation—10/53, 19%) the healthy, equally aged population. The percentage of patients with significant volumetric flow compensation was the highest in age groups 65–69 years old (62.5%) and >80 years old (60%). In the oldest age group (>80 years old) no patients without flow compensation (0%) were observed. The level of compensation depends on the number of the arteries with compensatory increased flow. In patients with significant volumetric flow compensation, the compensatory increased flow was observed, on average, in 3.31 arteries, in the mild compensation group—in 2.18 arteries, and in the no compensation group only in 1 artery. ICA plays the most important role in the volumetric flow compensation—the increase in the flow volume, in comparison to the reference values, was between 116.7 mL/min and 251.9 mL/min (in the ECA 57.6 mL/min–110.4 mL/min; in the VA 73.9 mL/min–104.9 mL/min). The relative flow increase was highest in the VA: 215–246%, then in the ECA: 163–206%, and finally in the ICA: 148.6–192%. The increased flow was most commonly observed in the VA—57 arteries, in second place in the ECA—42 arteries, and ICA—31 arteries. In patients with unilateral ICA stenosis, the volumetric flow increase was stated more frequently in the ipsilateral ECAs then in the contralateral ones (23 vs. 14). In the VA the opposite tendency was observed (29 contralateral vs. 23 ipsilateral). The ability of volumetric flow compensation decreased significantly with increasing age. Conclusions: Understanding the mechanisms of collateral circulation and their assessment in Doppler ultrasonography may provide a novel and easily accessible tool of identifying and monitoring patients with cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The radiological pattern of stroke patients with thrombophilia is unknown. Our aim is to compare the MRI radiological pattern of silent and acute lesions in cryptogenic stroke/TIA patients under 60 years of age with and without thrombophilia., Methods: Cryptogenic stroke/TIA patients under 60 years of age hospitalized at our Stroke Unit during four years were consecutively included. Thrombophilia screening was performed at 3 months after stroke and verified 12 weeks later. The follow-up was performed at 3, 12 and 24 months. Radiological pattern was assessed with the Fazekas and van Swieten scales., Results: During four years, 185 cryptogenic stroke/TIA patients under 60 years of age were included; mean age was 51 years, 61% were female, with a follow-up of 22±3.2 months. Thrombophilia was detected in 20% of patients. We detected a significant increase of previous vascular events (29.7% vs 7.5%, p=.01) as well as lower hypercholesterolemia (27% vs 62.5% p=.003) in the thrombophilia group, without significant differences in other vascular risk factors or vascular recurrence during follow-up. Regarding the acute lesion, we did not detect significant differences between groups. The radiological pattern of silent lesions showed that the thrombophilia group presented more large confluent lesions (39.1% vs 19.2%, p=.02) with greater sparing of the anterior territory (0% vs 30%, p=.01)., Conclusions: Our data suggest a characteristic radiological pattern of silent lesions in cryptogenic stroke/TIA patients with thrombophilia, with more confluent lesions and less involvement of the anterior territory., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: General anesthesia poses a significant risk for patients with MMA, yet its risk in the setting of nonrevascularization procedures remains unclear. Data regarding the risk of general anesthesia for nonrevascularization procedures are scarce. We therefore aimed to assess the incidence of neurological adverse events (NAEs) among pediatric patients with MMA undergoing general anesthesia for nonrevascularization procedures., Methods: We conducted a retrospective cohort study at a tertiary referral pediatric center of patients with MMA aged ≤18 years, who underwent general anesthesia for nonrevascularization procedures between January 2014 and July 2023. Postanesthesia NAEs were defined as occurrence of transient ischemic attacks, seizures, altered mental status, severe headache, or evidence of arterial ischemic stroke (AIS) in the 30 days postprocedure., Results: Among 149 procedures on 38 patients (median age [interquartile range]: 8.3 [5.0, 12.7] years; 57% female), 124 (83.2%) procedures were imaging studies and angiographies and 25 (16.8%) were surgical procedures. Preprocedural hyperhydration treatment was administered before most (111, 74.5%) procedures per our institutional protocol. The incidence of postanesthesia NAEs was 0.67% (one of 149), as a result of acute AIS following a ventriculoperitoneal shunt revision surgery, in a patient with postradiation MMA, panhypopituitarism, and uncontrolled diabetes insipidus, despite preprocedural hyperhydration treatment. There were no NAEs after imaging studies performed under general anesthesia., Conclusions: Our results suggest that general anesthesia for nonrevascularization procedures in pediatric patients with MMA prepared with hyperhydration is safe. As neuroradiological follow-up is central in children with MMA, this information can be valuable for reassuring patients and their families., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Multiple sclerosis (MS) is an auto-immune mediated neurological disorder that affects the central nervous system and leads to myelin sheath destruction. The pathogenesis of MS involves T helper cells causing inflammation and eventual death of the oligodendrocytes. Etiologies for the development of MS include a combination of genetic, environmental, and immune factors. Vaccines have been proposed to increase the immune response and have reportedly activated some autoimmune disorders. Although certain vaccines such as hepatitis B have been associated with MS, studies have refuted these cases. We present a rare case of a 32-year-old patient who presented with symptoms and suggestive of MS a few days after receiving the COVID vaccine. Laboratory and imaging findings confirmed the diagnosis of MS, and she was started on steroids and discharged in a stable condition a few days after.

Background: There has been a decline in the stroke incidence across high income countries but such knowledge exists at Country or State rather than areal unit level such local government area (LGA). In this disease mapping study, we evaluate if there are local hot spots or temporal trends in TIA rate. Such knowledge will be of help in planning healthcare service delivery across regions. Methods: Linked hospital discharge data (Victorian Admitted Episodes Dataset or VAED) was used to collect TIA (defined by ICD-10-AM codes G450-G459) cases from 2001 to 2011. The State of Victoria is the second most populous state in Australia, with a population of 6.7 million and can be divided into 79 administrative units or LGA. The data is anonymized and contains residence of the patient in terms of LGA but not exact location. The date of the TIA event when the patient is admitted to hospital is provided in the dataset. The number of TIAs per year was aggregated for each LGA. Standardized TIA ratios were calculated by dividing actual over expected cases for each LGA per year. We used Integrated Nested Laplace Approximation (INLA) to perform spatial and spatiotemporal regression, adjusting for hypertension, sex and population, age (≥60), and socio-economic status (SES) decile within the LGA. The final model was chosen based on the lowest the Deviance Information Criterion (DIC) and Watanabe-Akaike information criteria (WAIC). Results: Choropleth maps showed a higher standardized TIA ratios in North-West rural region. Compared to the baselinemodel (DIC 13,159, WAIC 13,261), adding in a spatial random effect significantly improved the model (DIC 6,463, WAIC 6,667). However, adding a temporal component did not lead to a significant improvement (DIC 6,483, WAIC 6,707). Conclusion: Our finding suggests a statically significant spatial component to TIA rate over regional areas but no temporal changes or yearly trends. We propose that such exploratory method should be followed by evaluation of reasons for regional variations and which in turn can identify opportunities in primary prevention of stroke, and stroke care. [ABSTRACT FROM AUTHOR]

Background and purpose: To investigate the association of different status of cerebral small vessel disease (CSVD) and infarction number with recurrence after acute minor stroke and transient ischaemic attack (TIA). Methods: This study was a post hoc analysis of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, and includes 886 patients with acute minor stroke and TIA. The status of CSVD and infarction number was recorded for each individual. Infarction number were classified as multiple acute infarctions (MAIs≥2), single acute infarction (SAI =1), and non-acute infarction (NAI =0). The CSVD burden were grouped into non-CSVD (0 score) and CSVD (1–4 score). The primary outcome was a recurrent stroke at the 1-year follow-up. The secondary outcomes were recurrent ischaemic stroke, composite vascular event (CVE), and TIA. We analyzed the relationships between different status of CSVD burden and infarction pattern with the risk of outcomes using multivariable Cox regression models. Results: Among all 886 patients included in present analysis, recurrent stroke was occurred in 93 (10.5%) patients during 1-year follow-up. After adjusted for all potential covariates, compared with patients with non-CSVD and NAI, patients with CSVD and MAIs were associated with approximately 9.5-fold increased risk of recurrent stroke at 1 year (HR 9.560, 95% CI 1.273–71.787, p=0.028). Similar results observed in ischaemic stroke and CVE. Conclusion: The status of CSVD and infarction number predicted recurrent stroke in patients with acute minor stroke and TIA, especially for those with coexistent CSVD and MAIs. [ABSTRACT FROM AUTHOR]

Purpose: Imaging guidelines for transient ischemic attack (TIA) recommend that patients undergo urgent brain and neurovascular imaging within 48 hours of symptom onset. Prior research suggests that most patients with TIA discharged from the emergency department (ED) do not complete recommended TIA imaging workup during their ED encounters. The purpose of this study was to determine the nationwide percentage of patients with TIA discharged from EDs with incomplete imaging workup who complete recommended imaging after discharge.Methods: Patients discharged from EDs with the diagnosis of TIA were identified from the Medicare 5% sample for 2017 and 2018 using International Classification of Diseases, tenth rev, Clinical Modification codes. Imaging performed was identified using Current Procedural Terminology codes. Incomplete imaging workup was defined as a TIA encounter without cross-sectional brain, brain-vascular, and neck-vascular imaging performed within the subsequent 30 days of the initial ED encounter. Patient- and hospital-level factors associated with incomplete TIA imaging were analyzed in a multivariable logistic regression.Results: In total, 6,346 consecutive TIA encounters were analyzed; 3,804 patients (59.9%) had complete TIA imaging workup during their ED encounters. Of the 2,542 patients discharged from EDs with incomplete imaging, 761 (29.9%) completed imaging during the subsequent 30 days after ED discharge. Among patients with TIA imaging workup completed after ED discharge, the median time to completion was 5 days. For patients discharged from EDs with incomplete imaging, the odds of incomplete TIA imaging at 30 days after discharge were highest for black (odds ratio, 1.84; 95% confidence interval, 1.27-2.66) and older (≥85 years of age; odds ratio, 2.41; 95% confidence interval, 1.78-3.26) patients. Reference values were age cohort 65 to 69 years; male gender; white race; no co-occurring diagnoses of hypertension, hyperlipidemia, or diabetes mellitus; household income > $63,029; hospital in the Northeast region; urban hospital location; hospital size > 400 beds; academically affiliated hospital; and facility with access to MRI.Conclusions: Most patients discharged from EDs with incomplete TIA imaging workup do not complete recommended imaging within 30 days after discharge. [ABSTRACT FROM AUTHOR]

Background and Purpose: Regular, sustained moderate-to-vigorous physical activity (MVPA) is a recommended strategy to reduce the risk of recurrent stroke for people who have had transient ischemic attack (TIA) or mild stroke. This study aimed to explore attitudes toward, and experience of engaging in physical activity by adults following a TIA or mild stroke. Methods: Constructivist grounded theory methodology informed data collection and analysis. Interviews from 33 adults with TIA or mild stroke (mean age 65 [SD 10] years, 48% female, 40% TIA) were collected. Results: Business as usual characterized physical activity engagement post-TIA or mild stroke. Most participants returned to prestroke habits, as either regular exerciser or nonexerciser , with only a small number making changes. Influencing factors for physical activity participation included information, challenges, strategies , and support. Business as usual was associated with a perceived lack of information to suggest a need to change behaviors. Nonexercisers and those who decreased physical activity emphasized challenges to physical activity, while regular exercisers and those who increased physical activity focused on strategies and support that enabled participation despite challenges. Discussion and Conclusion: Information about the necessity to engage in recommended physical activity levels requires tailoring to the needs of the people with TIA or mild stroke. Helpful information in combination with support and strategies may guide how to navigate factors preventing engagement and might influence the low level of physical activity prevalent in this population. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A376). [ABSTRACT FROM AUTHOR]

An active feedback network‐based bandwidth extension technique for CMOS differential transimpedance amplifier (TIA) is proposed in 0.18 µm CMOS process technology. The design consists of three stages in differential mode. The first stage is a common‐source amplifier that minimizes noise. A common collector stage is used for level shifting and buffering in the second stage. The third stage is a differential amplifier that provides additional gain. In addition to these three stages, an active CMOS negative feedback circuit is used for extending the bandwidth. The proposed design achieves a gain of 45.2 dBΩ with a 3 dB bandwidth of 21.23 GHz. The active feedback circuit provides an additional bandwidth of 7.3 GHz. The TIA achieves a data rate of 30 Gb/s with input‐referred noise current density of 63.1 pA/Hz $\sqrt{\mathrm{Hz}}$ and jitter of 9.07 ps. The TIA consumes a power of 10.3 mW with a supply voltage of 1.8 V. [ABSTRACT FROM AUTHOR]

Background and purpose: Stroke is the most common and the most deadly neurological disease that is accompanied with many complications. The aim of this study was to compare the diagnostic value of hs-CRP and ABCD2 criteria in predicting the future incidence of acute cerebrovascular events during follow-up in patients with transient ischemic attack (TIA). Materials and methods: This cohort study was performed in TIA patients during the first 24 hours of onset of symptoms. Blood samples were taken and demographic information was obtained, then hs-CRP was measured in all patients. History of hypertension, atherosclerosis, and ABCD2 scores were also recorded. Results: The patients (n= 135) included 69 (51.11%) male and 66 (48.88%) female cases. Eight subjects had a stroke within three months. There was no significant relationship between hs-CRP level and stroke incidence (P= 0.303), but ABCD2 cut-off scores of >1.5 had the most sensitivity (87.5%) and specificity (81.9) that could significantly predict the occurrence of stroke (P= 0.011). Systolic blood pressure (OR=1.04) and ABCD2 score (OR=2.43) could predict the occurrence of stroke (P

Introduction. Transient ischemic attacks can be a predictor of a more severe cardiovascular event, the risk of which depends on many factors that requires a personalized approach. Neuropsychological disorders (cognitive, emotional) have a significant impact on quality of life and social activity and are often underestimated in patients with TIA. Comprehensive medical rehabilitation with the inclusion of antithrombotic therapy and psychocorrection measures may reduce the risk of recurrent cardiovascular events in patients with TIA.Purpose of the study: to substantiate the efficiency of complex medical and non-pharmacological rehabilitation in patients who underwent TIA by analyzing the characteristics of the main and leading concomitant diseases.Materials and methods. The morbidity of 351 TIA patients was studied and analyzed. The average age of the examined patients was 58.6 ± 2.2 years, there were 64.9% of women and 35.1% of men. All patients received an individualized medical rehabilitation program for 12 months with correction of identified neuropsychological disorders. Depending on background and concomitant diseases the antiplatelet or anticoagulants therapy was differently administrated.Results and dicussion. Psychological, cognitive, and physical disorders (based on subjective complaints) are common in patients with TIA. The prevalence of mental disorders in patients with TIA was 138.2 cases per 100 patients. The correction of cognitive impairment, depressive symptoms is associated with improved quality of life (p < 0.05). Repeated acute cerebrovascular events (TIA, ischemic stroke) were recorded during the first 6 months after TIA in 29 patients (10.4%) with severe stenosis of the brachiocephalic arteries, severe arterial hypertension and paroxysmal atrial fibrillation.Conclusion. The importance of comprehensive medical and social rehabilitation of patients with TIA is determined. The participation of a psychotherapist as a member of a multidisciplinary team is necessary. A significant role of the secondary prevention of acute cerebrovascular events is assigned to rational antithrombotic therapy.

Abstract Background Cardio- and cerebrovascular events such as myocardial infarction (MI), stroke and transient ischemic attack (TIA) are leading causes of death and disability and have also been associated with poor mental outcomes. In addition, cardio- and cerebrovascular events may pose the risk of experiencing a sudden traumatic occurrence of symptoms during ictus and thus contribute to high rates of PTSD as well as high rates of subsequent depression and anxiety. Moreover, MI, TIA and stroke survivors with PTSD, depressive and anxiety symptoms may have poorer health-related quality of life (HRQoL) and poorer disease prognosis than patients who do not develop psychiatric symptoms after ictus. However, data on the prevalence of PTSD, anxiety and depression, as well as the HRQoL, coping strategies and potential risk factors for development of PTSD in these patients, are rare. Methods In an exploratory, descriptive study we interviewed 112 patients (54 MI, 18 TIA, 40 stroke; mean age: 69.5 years, 55.4% males) from three general physician practices and used psychometric self-assessment tools to determine the occurrence of PTSD and psychosomatic comorbidity, anxiety and depression and to assess HRQoL and coping strategies. We evaluated disease severity and compared the patient groups to each other. Moreover, we assessed psychological outcome differences between patients with or without PTSD after ictus. Results The prevalence of PTSD after MI, TIA and stroke was 23.2%. The patients who developed PTSD had higher rates of depression, anxiety and maladaptive coping as well as reduced HRQoL. Adaptive coping was positively related to better mental HRQoL and negatively related to anxiety and depression. Disease severity of MI, TIA and stroke was not related to PTSD, depression, anxiety or physical HRQoL. Conclusions Experiencing MI, TIA or stroke means confronting a life-threatening event for those affected and, therefore, these can be regarded as traumatic events. Cerebral and cardiovascular events increase the risk of developing chronic PTSD with subsequent increased depression and anxiety and reduced HRQoL. These findings emphasize the need for early screening and diagnosis of PTSD in somatically ill patients, which should be followed by specialized treatment, as PTSD hampers overall (somatic) disease prognosis. Trial registration German Clinical Trials Register, DRKS00021730, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730 , registered 05/19/2020 - Retrospectively registered.

BackgroundThere has been a decline in the stroke incidence across high income countries but such knowledge exists at Country or State rather than areal unit level such local government area (LGA). In this disease mapping study, we evaluate if there are local hot spots or temporal trends in TIA rate. Such knowledge will be of help in planning healthcare service delivery across regions.MethodsLinked hospital discharge data (Victorian Admitted Episodes Dataset or VAED) was used to collect TIA (defined by ICD-10-AM codes G450-G459) cases from 2001 to 2011. The State of Victoria is the second most populous state in Australia, with a population of 6.7 million and can be divided into 79 administrative units or LGA. The data is anonymized and contains residence of the patient in terms of LGA but not exact location. The date of the TIA event when the patient is admitted to hospital is provided in the dataset. The number of TIAs per year was aggregated for each LGA. Standardized TIA ratios were calculated by dividing actual over expected cases for each LGA per year. We used Integrated Nested Laplace Approximation (INLA) to perform spatial and spatiotemporal regression, adjusting for hypertension, sex and population, age (≥60), and socio-economic status (SES) decile within the LGA. The final model was chosen based on the lowest the Deviance Information Criterion (DIC) and Watanabe-Akaike information criteria (WAIC).ResultsChoropleth maps showed a higher standardized TIA ratios in North-West rural region. Compared to the baseline model (DIC 13,159, WAIC 13,261), adding in a spatial random effect significantly improved the model (DIC 6,463, WAIC 6,667). However, adding a temporal component did not lead to a significant improvement (DIC 6,483, WAIC 6,707).ConclusionOur finding suggests a statically significant spatial component to TIA rate over regional areas but no temporal changes or yearly trends. We propose that such exploratory method should be followed by evaluation of reasons for regional variations and which in turn can identify opportunities in primary prevention of stroke, and stroke care.

Background The aim of this study was to investigate the association between hsCRP (high‐sensitivity C‐reactive protein) and prognosis over time after stroke onset. Methods and Results In this prespecified prospective substudy of the Third China National Stroke Registry, a total of 9438 patients with acute ischemic stroke or transient ischemic attack and measured hsCRP were included. Patients were categorized into 3 groups according to the sampling time after index onset (

Background: Empiric strategies for secondary prevention in cryptogenic stroke and cryptogenic TIA are lacking. The best therapy to prevent recurrence depends on the cause of stroke. Attempting a correct diagnosis is therefore the fundamental goal of stroke treatment. Further investigation into the source of embolism if suspected, and determination of the etiology, even if demanding, is the needed prerequisite for optimal secondary prevention and risk reduction. Aims: This paper discusses evaluation and treatment of cryptogenic stroke in light of recent years' clinical trials results and developments in cardiology and neuroradiology. No ethical approval was needed for this work. Results: Cardioembolism due to paroxysmal atrial fibrillation, patent foramen ovale, or cardiomyopathy; occult atherosclerosis from unstable plaques and hypercoagulable conditions seem to be the most common underlying causes to be revealed by further investigations. Treatment of these conditions can reduce the stroke recurrence significantly. Conclusions: An individual approach and targeted diagnostics using advanced medical technologies in selected patients, who may benefit from a tailored treatment regimen, can help reveal a probable cause in the majority of strokes and TIAs previously classified as cryptogenic. [ABSTRACT FROM AUTHOR]

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This study presents a Ka-band direct-conversion receiver using a 28-nm CMOS (Complimentary Metal Oxide Semiconductor) process for radar applications. The designed receiver includes a LNA (Low-Noise Amplifier), Mixer, and Baseband amplifier. The LNA adopts a two-stage cascode amplifier structure. Then, the mixer is a single-balanced passive mixer with low flicker noise. At the end, the baseband amplifier is a transimpedance amplifier with fat FET (Field-Effect-transistor) for low flicker noise and current-mode operation of the mixer. The LO (Local Oscillator) signal for driving the mixer is supplied externally. The performance of the receiver is tested using on-wafer probing and an air test is performed by integrating a microstrip antenna. The total conversion gain, noise figure, and 3 dB bandwidth are 28 dB, 6.1 dB, and 6 GHz, respectively. The chip size is 0.320 mm². [ABSTRACT FROM AUTHOR]

The objective of this work was to design a versatile readout circuit for patch-type wearable devices consisting of a Transimpedance Amplifier (TIA). The TIA performs Current to Voltage (I–V) conversion, the most widely used technique for amperometry and impedance measurement for various types of electrochemical sensors. The proposed readout circuit employs a digitally controllable feedback resistor ( R f ) technique in the TIA to improve accuracy, which can be utilized in a variety of electrochemical sensors within a current range of 0.1 µA–100 µA. It is designed to accommodate multiple sensors simultaneously to track multiple target analytes for high accuracy and versatile usage. The readout circuit consists of low power operational amplifier (op–amp) and digital circuit blocks, is designed and fabricated with Magna 0.18 µm Complementary Metal Oxide Semiconductor (CMOS) technology, which provides low power consumption and a high degree of integration. The design has a small size of 0.282 mm 2 and low power consumption of 0.38 mW with a 3.3 V power supply, which are desirable factors in wearable device applications. [ABSTRACT FROM AUTHOR]

Background: TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician's attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations. Data on recurrence and secondary prevention of Fabry's stroke are scanty. Methods: The study had a prospective observational design involving 33 Italian neurological Stroke Units. Considering the incidence of TIA/stroke in the European population aged < 60 years and the frequency of Fabry disease in this category (as foreseen by a pilot study held at the Careggi University-Hospital, Florence), we planned to screen for Fabry disease a total of 1740 < 60-year-old individuals hospitalized for TIA, ischemic, or hemorrhagic stroke. We investigated TIA and stroke pathogenesis through internationally validated scales and we gathered information on possible early signs of Fabry disease among all cerebrovascular patients. Every patient was tested for Fabry disease through dried blood spot analysis. Patients who received Fabry disease diagnosis underwent a 12-month follow-up to monitor stroke recurrence and multi-system progression after the cerebrovascular event. Discussion: The potential implications of this study are as follows: (i) to add information about the yield of systematic screening for Fabry disease in a prospective large cohort of acute cerebrovascular patients; (ii) to deepen knowledge of clinical, pathophysiological, and prognostic characteristics of Fabry-related stroke. [ABSTRACT FROM AUTHOR]

Introduction: The majority of stroke survivors suffer from physical and mental disabilities. This causes social and economic burdens, and it is regarded as a major source of morbidity and the second leading cause of death worldwide. This study aims to quantify the incidence of cerebrovascular stroke in the Taif region, identify risk factors for CVA, and raise awareness about modifiable risk factors. Methods: Over 17 months period (February 2020 to June 2021), all firststroke patients admitted to Alhada military hospital and King Faisal hospital in Taif region were included. Stroke patients from outside the Taif region were excluded from participating in the study. Age, gender, domicile, employment, history of hypertension, diabetes, cardiac diseases, smoking, previous history of stroke or transient ischemic episodes were all obtained from the patient's files. Also, a history of medications, particularly anticoagulants and contraceptive tablets if a female in childbearing age. Results: Overall, the study included 404 patients, 40.6% of whom were females and 59.4% of whom were males, with a mean age of 64.0 ± 14.9 years. The most common type of CVA was ischemic stroke (78.5%), followed by TIA (11.9%), and hemorrhagic stroke (7.2%). Slurred speech was the most commonly reported chief symptom among stroke survivors (23%), followed by dizziness (13.6%), left-sided weakness (10.9%), and right-sided weakness (10.9%). The incidence of stroke is increasing in patients who had chronic diseases like hypertension which is 62.6% survival had, and the second most common lead to stroke and decreased elasticity of vessels is diabetes mellitus 60.4% followed by ischemic heart disease 9.4% and smoking 5.4%. Conclusions: Finally, using a prospective clinical study, the incidence of first time CVA in Taif was higher in males (about 59.4%) than in females (40.6%). That indicates a strong relation between Diabetes which represents 60.4%, Hypertension was 62.6% and age 18--55. We suggest running campaigns that target people with these risk factors to reduce the possibility of CVA occurrence. [ABSTRACT FROM AUTHOR]

Ning Li,1 Jinxin Li,1 Ting Gao,1 Dandan Wang,1,2 Yang Du,1,2 Xingquan Zhao1,2 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of ChinaCorrespondence: Xingquan ZhaoBeijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of ChinaTel +86-13501031486Email zxq@vip.163.comPurpose: Transient ischemic attack (TIA) and minor stroke had a high recurrence rate, resulting in potential neurological impairment. Only a few previous studies focused on gait and balance disorder in TIA and minor stroke. This study aimed to explore the relationship between gait and balance disorder and TIA/minor stroke.Patients and Methods: Eighty-two patients with TIA/minor stroke and fifty-two healthy control participants were recruited. The gait and balance function of the two groups was tested with six measurements (Four Square Step, Tandem, Functional Reach, Gait and Pivot Turn, Timed “Up and Go”, and Single Leg Balance tests). The associations between these measures and TIA/minor stroke were determined through linear and logistic regression analyses.Results: There were no significant group differences in age, gender, body mass index, vision, and cognitive function. People with TIA/minor stroke had poorer performance in all six gait and balance measures (all p< 0.05). Logistic regression analysis showed TIA/minor stroke was strongly associated with gait and balance disorder (Four Square Step Test [OR, 24.07; 95% CI 5.90– 98.13; p< 0.001], Tandem Test [OR, 5.50; 95% CI 1.64– 18.40; p=0.006], Functional Reach Test [OR, 4.25; 95% CI 1.04– 17.33; p=0.044], Gait and Pivot Turn Test [OR, 3.78; 95% CI 1.22– 11.31; p=0.021], Timed“Up and Go”Test [OR, 15.79; 95% CI 2.32– 107.48; p=0.005], and Single Leg Balance Test [OR, 8.96; 95% CI 2.34– 34.01; p=0.001]). TIA/minor stroke patients with older age, cognitive dysfunction, high K-CRP level, and severe atherosclerosis in lower limbs were more likely to have gait and balance disorder.Conclusion: Our findings highlight the significant relationship between gait and balance disorder and TIA/minor stroke. It seems that people with TIA/minor stroke had a higher possibility to get gait and balance disorder. Gait and balance disorder following a minor stroke or TIA may be attributed to cognitive function in these patients.Keywords: TIA, minor stroke, mobility function, intervention, cognition