Understanding the impact of ischemic stroke on peripheral immune responses

Abstract

The study is about analysing the impacts of ischemic stroke on peripheral immune responses. The T cells are affected after the ischemic stroke and the immune response is there as it affects the spleen and splenetic cells. Through the study, it is possible to analyse the splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke in order to improve immune response so that the individual is able to fight against infection. The objective of the study includes evaluating the causes and symptoms of ischemic stroke, evaluating the splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke and recommending future treatment for restoring the immune functions so that the wellbeing of the individuals can be improved after stroke. The literature review of the research is effective for develop in depth understanding and knowledge related to the research topic, especially in the field of biomedical dissertation help.

The causes and complications after stroke are evaluated efficiently in the literature review along with the immune response and cell damage in the brain after stroke. As per the research methodology, the researcher selects the interpretivism research philosophy and deductive approach to conduct the qualitative study efficiently. The secondary data collection method is being chosen through reviewing the secondary sources of information inclusion, books, journals, articles, and health care reports, so that it would be possible to collect authentic information. As per the findings, there are critical impacts of ischemic stroke on the peripheral immune response, in order to damaging the T cells and secretion of protein enzymes. A distinct reticular fibre network exists within the spleen, but ischemic stroke where stroke induced impairment is increasing which affects the peripheral immune responses. The ECM and fibre network remodelling are required as it has direct correlation with the B and T cells for improving the immune response, which is crucial for fighting against infection and other health disease.

Acknowledgement

This research has been the greatest learning opportunity for me throughout the entire course; and it would have been difficult without the supportive team members, and guidance provided by my lecturer. I wish to thank my fellow members and colleagues for making each and every day a challenge, as well as their support and encouragement during this study are also fruitful for me to get motivation and also I am blessed with supportive family members. His/her commitment and passion to teach further inspired me at a time, when I felt lack of confidence. I feel confident to complete my course with effective support and advice from my peers. I would like to thank many people for their contribution to this research project. I also get cooperation and support from my peer and senior team, who help me to gain in depth understanding about the research topic and access the health and social care journals for evaluating the research topic. Without their cooperation and response, it would not be possible for me to collect relevant and valid information related to ischemic stroke and its impacts, as well as progress in the study by proposing good treatment and care through splenic extracellular matrix (ECM) and reticular fibre network remodelling.

Chapter 1: Introduction

1.1 Introduction

The research is related to the Ischemic stroke, which is increasing among the individuals year by year. Every year, more than 795,000 people in the USA have a stroke and about 87% of all strokes are Ischemic stroke, which deteriorate the immune power of the individuals (Boese et al., 2018). It is a serious issue among the people, where they are not able to fight against stroke and related effects after stroke, due to deterioration of the immune system. The study will be beneficial to understand the symptoms and causes of Ischemic stroke as well as exploring the splenic extracellular matrix (ECM) and reticular fibre network remodelling that have direct link with suppression effect observed after stroke. For the individual having stroked, it is mandatory to have good immunity power for fighting against infection and other related disease; however the ischemic stroke affects the peripheral immune responses negatively (Jiang et al., 2018). Through this study, it is possible to demonstrate the peripheral immune responses effects after stroke by evaluating the splenic extracellular matrix (ECM) and reticular fibre network remodelling.

1.2 Background of the study

Stroke-associated infection (SAI) is a very common and there are serious complications that affect one- third of stroke survivors and correlates with poor outcome and 20% of the deaths (Boshuizen and Steinberg, 2018). There is numbers of evidence that, SAI has a strong correlation with stroke-induced impairments in the peripheral immune response, which is required to fight against infection (Venkat, Chen and Chopp, 2018). The spleen is a key organ in immune defence that is significantly affected after a stroke, with general shrinkage and loss in cellularity being reported clinically and in experimental animal models (Bennett and Molofsky, 2019). Within the spleen, a distinct reticular fibre network exists in each of the compartments, which play a key role in the regulated movement of cells and blood-borne molecules between different splenic regions as well as solenocytes development and haemostasis (Al Mamun et al., 2021).

Ischemic stroke is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. It keeps the blood from flowing to the brain and within minutes, the brain cells start to die. Another major cause of Ischemic stroke is stenosis or narrowing of the artery. The effects of ischemic stroke on splenic extracellular matrix (ECM) and reticular fibre network remodelling is lacking which could have a direct link to the immunosuppression effect observed after stroke such the loss of lymphocytes and innate-like MZ B cells (Chavda, Madhwani and Chaurasia, 2021). Therefore, in this project, the main focus is related to a comprehensive analysis of ECM remodelling of splenic tissues at different time points after experimental stroke model in mice using microarray data provided by the collaborators from the University of Edinburgh. This will be followed by network analysis to identify the interaction between those (Saand et al., 2019). ECM components with significant differential expression identified will be validated with PCR, immune system followed by confocal imaging of splenic tissues. Since ECM components has a critical role in immune cells survival and function, data generated from this project is expected to inform future treatment approaches to restore peripheral immune function after stroke to prevent post-stroke infections (Xu et al., 2020).

1.3 Research aim and objectives

The aim of the research is to analyse the impacts of ischemic stroke on peripheral immune responses, where through this research, the researcher would be able to identify the effects of Ischemic stroke on the immune system which is required for overcoming the critical health issues. It important for the researcher to analyse the splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke so that it would be possible to develop future treatment for restoring the immune functions after stroke.

The objectives of the study are,

To understand the causes and effects of Ischemic stroke

To analyse the splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke

To recommend future treatment for restoring the immune functions so that the wellbeing of the individuals can be improved after stroke

1.4 Questions of the study

The major questions of the study are such as,

What are the causes and effects of Ischemic Stroke?

What are the concept of splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke?

What would be the future suggested treatment for restoring the immune functions so that the wellbeing of the individuals can be improved after stroke?

1.5 Rationale of the research

What is the issue?

In the recent years, the numbers of individual affected by ischemic stroke is increasing over the period of time, and it has serious impacts on the health, mainly the immune system of the human being (Qiu et al., 2021). It becomes a major concern of the doctors and health care workers to treat the individuals after stroke, as their immunity power is being deteriorated after stroke. 87% of stroke is ischemic stroke, and there are critical impacts on the immune response and health of the individuals. Study found that, 30% patients did not survive beyond the first month after Ischemic stroke and about 70% of patients suffering from an ischemic stroke survived one year (Ritzel et al., 2018). It is rare cases, where the patients are surviving last 3 to 5 years as the ischemic stroke deteriorates the immune response along with other health issues (Li et al., 2018). Moreover, lack of splenic extracellular matrix (ECM) and reticular fibre network remodelling raise the issues related to immunosuppression effect after stroke (Pawluk et al., 2020).

Why is it an issue?

The Ischemic stroke is the most common stroke among the individual, which is mainly caused by a blood clot that blocks or plugs a blood vessel in the brain (Shi et al., 2018). A blood clot often forms in arteries damaged by the build-up of plaques and narrowing an artery leading to the brain is also another cause of Ischemic stroke (Iadecola, Buckwalter and Anrather, 2020). The death rate due to Ischemic stroke is also increasing over the period of time, which becomes a serious concern for the health and social care providers to support the individuals after stroke and provide them the best quality treatment in order to maximise their wellbeing (Wang et al., 2018). It is a major issue now, as the Ischemic stroke affects the immunity system of the individual, where the fighting power against infection deteriorated among the individual during the period of time (Ao et al., 2018). Hereby, it is high time for the doctors and other social care workers to review after stroke impacts on the peripheral immune response by evaluating the splenic extracellular matrix (ECM) and reticular fibre network remodelling (Enzmann, Kargaran and Engelhardt, 2018).

Why is it an issue now?

In the recent yours, it becomes a serious concern to have effective immune response to fight against infection, as the infectious disease is increasing recently. According to the National Stroke Association, 10% of the people recover almost completely after stroke, however, 25% people recover with minor impairments and 40% individuals experience moderate to severe impairments that require health and social care (Amantea et al., 2018). It is a serious issue now, as immunosuppression effect observed after stroke such the loss of lymphocytes and innate-like MZ B cells (Wang et al., 2019). There is also serious effects of Ischemic stroke on the splenic extracellular matrix (ECM) and reticular fibre network remodelling for which, the immunity power of the individual is being deteriorated over the time and also the individuals cannot fight against infection and other health issues (Li et al., 2018).

How does the research shed light on the topic under consideration?

The research topic is critical which sheds light on the in depth analysis of Ischemic stroke that reduces the immune response of the individual along with other health issues. There are critical symptoms of Ischemic stroke such as weakness, analysis and problems of balancing and coordination (Selvaraj and Stowe, 2017). Additionally, the individuals are suffering from pain, numbness, burning and tingling sensation. These are the major symptoms after ischemic stroke. The study is hereby beneficial to analyse the impacts of the ischemic stroke among the individuals that is linked with the peripheral immune system (Jones et al., 2018). Through this study, it would be possible to recommend some treatment through which the immune response of the individual can be improved by reviewing the splenic extracellular matrix (ECM) and reticular fibre network remodelling that is interlinked with the immunosuppression effect (Stamova et al., 2019). This becomes a serious topic, where the number of individual suffering from ischemic stroke is increasing over the period of time, and there are serious impacts such as deterioration of immune response, other health issues and impairment, where the individuals face difficulties to survive and lead a normal life (Kolosowska et al., 2019). The study is beneficial to analyse the splenic extracellular matrix (ECM) and reticular fibre network remodelling for developing good treatment and care for the Ischemic stroke patients and guide them efficiently for improving their wellbeing and immune power so that they would be able to fight against infection and other health issues.

1.6 Significance of the study

The study is helpful to explore the causes and symptoms of Ischemic stroke among the individuals, where the researcher will focus on evaluating the splenic extracellular matrix (ECM) and reticular fibre network remodelling which is associated directly with the immune response of the individuals. This study sheds light on the in-depth analysis of the immune system of the individuals after stroke. Through this paper, it is also possible for the researcher to evaluate the splenic extracellular matrix (ECM) and reticular fibre network remodelling system among the individuals so that there would be best treatment for improving immune response of the individual, so that they can fight against infection and other health issues. Hence, the study is beneficial to develop in depth understanding on Ischemic stroke that has serious impacts on the peripheral immune response of the individuals.

1.7 Structure of the dissertation

The research is related to analysing the effects of Ischemic stroke on the peripheral immune response of the individuals where there is increasing numbers of individuals having Ischemic stroke and their immunity power has been deteriorated over the period of time due to infection and other health issues. There are six chapters in the researcher, which are introduction, literature review, research methodology, data findings, discussion as well as conclusion and recommendations. The first chapter introduction includes the background of the research, rationale of the study as well as aim and objectives that are effective to create good base of the research and identify the research questions to progress in the study in a systematic way. The second chapter is literature review which helps to review the existing literatures on ischemic stroke and its symptoms as well as the splenic extracellular matrix (ECM) and reticular fibre network remodelling for proposing treatment to improve wellbeing of the individuals. The Reviewing theories and concepts of the research topic will help the researcher to gain in depth understanding and analyse the gathered information critically to meet the above mentioned research aim and objectives. The research methodology is the next chapter that is effective for the researcher to select the right method for collecting and analysing the gathered information critically. Appropriate methodology of the study as well as the ethical consideration of this research are helpful to progress in this paper ethically and collect authentic data and information for meeting the research objectives. The fourth chapter will represent the data and findings as well as the fifth chapter will be the discussion, in which the researcher will analyse the gathered data critically to understand the impact of ischemic stroke on peripheral immune responses. Conclusion and recommendation is the last chapter of the research which provides a scope to the researcher to draw conclusion after data analysis and evaluation as well as recommend some suitable suggestions for the individual treatment and improving the immune response among the individuals so that they can fight against the health issues and maximise their wellbeing.

Chapter 2: Literature review

2.1 Introduction

Stroke become very common cause of death and it is serious concern for the health and social care workers to support the individual after stroke, as there are critical symptoms on health condition including, pain, uneasiness, mental issue and impairment. The study is effective to analyse the impacts of ischemic stroke on the peripheral immune response, where 87% stroke are ischemic stroke, and there is high death rate due to ischemic stroke across the globe. The literature review chapter is effective for the researcher to review the existing literatures, secondary sources of information in order to improve in depth understanding related to the above mention research topic. Through the literature review, it is possible to understand the ischemic stroke, its causes and symptoms, as well as the treatment facilities for the people who are suffering from ischemic stroke. The literature review also provides a scope to understand the splenic extracellular matrix (ECM) and reticular fibre network remodelling which are important for improving the immune system of the individuals, so that they can fight against infection and other disease. Hereby, the literature review is beneficial for the researcher to gain understanding and utilise the theories and practice for further in depth analysis and critical evaluation.

2.2 Ischemic stroke and its causes

As opined by Enzmann, Kargaran and Engelhardt (2018), ischemic stroke is one of the serous strokes referred to brain ischemia and cerebral ischemia. It is mainly caused by the blockage in an artery that sullies blood to the brain and the blockage reduces the blood flow and oxygen to the brain, for which the people are suffering from this ischemic stroke. Blockage leads to damage it death of brain cells and if circulation is not restored quickly brain damage can be armament. Approximately 87% of all strokes are ischemic stroke where the people are suffering from serious health issues, partial and armament impairment. As stated by Bennett and Molofsky (2019), circulatory condition is the main risk factors for ischemic stroke, where it increases clots or fatty deposits. The conditions are high blood pressure, high cholesterol, atherosclerosis, atrial fibrillation, prior to heart attack and sickle cell anaemia, clotting disorders and congenital defects. The other risk factors are diabetes, smoking, heavy alcohol misuse, use of certain drugs such as cocaine and being overweight especially abdominal fat. As opined by Wang et al. (2018), ischemic stroke is also more common in people who have a family history of stroke or who have experienced past stroke. Men are more likely than women to have ischemic stroke where the blacks have higher risk than the other races or ethnic group. As stated by Ao et al. (2018), risks related to ischemic stroke is increasing with age. Hereby, the major cause is related to blood supply cut off to the part of the brain by a blood clot it narrowing of the arteries.

According to Li et al. (2018), there are two main causes of stroke, which are a blocked artery and leaking or bursting of a blood vessel. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack or TIA that does not cause lasting symptoms. Ischemic stroke is the most common type that happen when the brains blood vessels become narrowed or blocked, causing severely reduced blood flow. As stated by Bennett and Molofsky (2019), the Blocked or narrowed blood vessels are caused by fatty deposits which further build up in blood vessels or by blood clots or other debris that travel through the bloodstream and lodge in the blood vessel, uncontrolled high blood pressure as well as overtreatment with blood thinners, traumas such as car accidents and protein deposited in blood vessel walls are the common causes that leads to ischemic stroke. According to Amantea et al. (2018), there are increasing numbers of people, experiencing ischemic stroke. In this context, as stated by Bennett and Molofsky (2019), blood clots may be caused by an irregular heartbeat such as arrhythmias, problems with heart valve, infection of the heart muscle, hardening of the arteries, and blood clotting disorders, heart attack and inflammation of the blood vessel. A less common cause of such stroke occurs when blood pressure becomes too low that is also known as hypertension, reducing blood flow to the brain. This usually occurs with narrowed or disease arteries. Low blood pressure can result from a heart attack, large loss of blood or severe infection. As opined by Stamova et al. (2019), each of these conditions affects the flow of blood through the heart and blood vessels that further increases the risk of stroke. Among the people younger than fifty years, the more common cause of stroke includes migraine, consumption of energy drinks or herbal supplements, artery dissections and drug abuse. According to Kolosowska et al. (2019), artery dissection occurs when a small tear forms in the innermost lining of the artery wall allowing blood to leak into the space between the inner and outer layers of the vessel. In this context, uncontrolled blood pressure, diabetes, coronary artery disease and high blood cholesterol are all the risk factors for such ischemic stroke.

2.3 Complications of Ischemic stroke

As opined by Boshuizen and Steinberg (2018), the major symptoms of an ischemic stroke depend on what region of the brain is affected and certain symptoms are common such as vision problem, blindness in one eye or double vision, weakness or analysis in the limbs which may be one side or both, depending on the affected artery. Additionally, dizziness, vertigo, confusion, loss of coordination and face on one side are also the common symptoms of ischemic stroke. As stated by Jones et al. (2018), the isthmic stokes is caused temporary or garment disabilities, depending on the way brain lacks blood flow and which part of the brain was affected. As stated by Bennett and Molofsky (2019), the complications are such as analysis or loss of muscle movement, difficulties in talking or swallowing, memory loss or thinking difficulties, emotional problems and pain as well as changes in behaviour and self-care ability. Paralysis or loss of muscle movement is the main complications that the people are suffering after stroke. One option or whole body may become paralysed where the people lose their control of certain muscles, such as one side of the body, face or one arm. As opined by Venkat, Chen and Chopp (2018), it is the main complications, where the people cannot move and lost their movement due to analysis, difficulty in talking or swallowing are also serious complications of ischemic stroke, where the stroke might affect control of the muscles in mouth, throat, making difficult for the people to talk clearly, swallow or eat. As opined by Wang et al. (2019), there are difficulties in language including understanding speech, reading and writing. Emotional problems are increasing over the period of time after ischemic stroke, where the individuals may have more difficulties in controlling their emotions and they may develop stress and depression. Anxiety disorders, eating disorders and depression are common symptoms among the individuals after they have had ischemic stroke.

In addition to this, memory loss or thinking difficulties are other issues where the people face problems in memorising the past activities as well as they have difficulty in thinking, reasoning, making judgements and understanding the concepts. According to Li et al. (2018), the quality of life of the individual having ischemic stroke hereby deteriorated over the period of time due to such critical complications. The people are also suffering from severe pain and numbness or other unusual sensation that may occur in the oats of the body affected by the stroke. For example, stroke causes to lose feeling in the left or right arm that may develop an uncomfortable tingling sensation in that arm. As stated by Selvaraj and Stowe (2017), changes in the behavioural activities and self-care ability have been seen after ischemic stroke, where the people become more withdrawn from the activities in daily lives. Hereby, there are serious impacts of ischemic stroke, where the people are suffering from body movement, paralysis and sever pain. As opined by Venkat, Chen and Chopp (2018), it becomes difficult for them to live a normal life, and there needs lots of time to recover the condition and improve their wellbeing. After stroke, some people become mentally traumatised and they are suffering from mental health illness along with physical issues. The immune response of the body is being affected for this stroke, for which the individuals fail to fight against disease and other physical issues. As opined by Selvaraj and Stowe (2017), without proper immunity power among the individuals after stroke, it becomes difficult for the people to fight against infection, virus and other health issues. Hence, ischemic stroke have serious impacts on the wellbeing of the individuals along with the physical and mental illness.

2.4 Splenic extracellular matrix (ECM)

As stated by Pawluk et al. (2020), the splenic extracellular matrix (ECM) is a highly dynamic structure that is resent in all the tissue and continuously undergoes controlled remodelling. The process involves quantitative and qualitative changes in EM, mediated by specific enzymes that are responsible for ECM degradation such as metalloproteinase. According to Al Mamun et al. (2021), it is mainly a remodelling process referring to a series of quantitative and qualitative changes in ECM during neoplastic transformation facilitating tumour growth and metastasis. The ECM directs repair tissue by regulating the behaviour of the wide variety of cell type that are mobilised to the damaged area in order to rebuild the tissue. As opined by Venkat, Chen and Chopp (2018), the ischemic stroke affect spleen negatively which is a key organ on the immune defence that is significantly affected after stroke, for which the immune power of the people has been deteriorated after stroke. A distinct reticular fibre network exists in each compartment, which plays a key role in the regulated movement of cells and blood-borne molecules between different splenic regions as well as solenocytes development and haemostasis. Here, According to Jiang et al. (2018), there is great influence of ECM for remodelling the cells and improve immune response of the individuals affected by ischemic stroke. Loss of lymphocytes and innate-like MZ B cells are very common symptoms after ischemic stroke, and ECM is effective for protecting cells and developing ECM remodelling of splenic tissues at different time points after experimental stroke. It is hereby considered as a potential therapeutic target to treat the people having ischemic stroke that affects spleen tissue. As stated by Boese et al. (2018), the enzymes mainly remodel it and receptors transduce their signals offers promising therapeutic opportunities for many diseases. As opined by Venkat, Chen and Chopp (2018), injecting ECM scaffolds derived from decellularised porcine myocardial tissue into porcine models of myocardial infarction can improve cardiac function and hence, for overcoming the difficulties among the individuals experiencing ischemic stroke, it would be beneficial to intervene with ECM remodelling for developing the spleen tissue and improve cardiac condition of the human being. ECM is also helpful for acute stroke by promoting the secretion of vascular endothelial growth factor and angiogenesis, which ultimately promotes motor function recovery in rodent models. According to Jiang et al. (2018), the strategies to increase growth factor affinity to the ECM may improve the repair of chronic wounds and bone defects, and thus adopting ECM remodelling process would be beneficial for the individuals to improve their cardiac functions and rebuild cells for improving immune response.

In addition to this, ECM stiffness can influence responses to anticancer agents by regulating access to chemotherapy and potentially forming a physical barrier to promote resistance. According to Qiu et al. (2021), lung cancer cells that express high level of fibronectim, platinic and collagen IV are also protected against chemotherapy induced apoptosis. Hereby, ECM is also effective strategy to improve tumour responses to systematic and radiation therapy. The major components of ECM are an extensive molecule network composed of three major components which are protein, glycosaminoglycan, and glycoconjugate. According to Al Mamun et al. (2021), ECM directs rearing the tissue by regulating the behaviour of the wide variety of cell type that are mobilised to the damaged area in order to rebuild the tissue. Its manipulation, induction, and impairment in regulation of its composition can play a role in several diseases and for example, the diseases are such as spinal cord injury, progression and metastasis of breast, splenic tissue repair, chronic obstructive pulmonary disease and pancreatic ductal adenocarcinoma. As stated by Boese et al. (2018), it is hereby beneficial for the treatment of the people who have experience of ischemic stroke, as their immune response has been affected by the stroke. The health and social care workers can utilise ECM for remodelling the tissue and develop strategies to fight against other health disease and infection.

2.5 Immune Cells in Brain after Ischemic Stroke

As stated by Boese et al. (2018), after acute stroke, there are multiple immune cells that can enter into the brain parenchyma in an orderly manner, where Microglia increased in the early stage along with the peripheral immune cells after stroke including myeloid dendritic cells, monocytes/macrophages, and neutrophils. According to Qiu et al. (2021), neutrophils are the first leukocytes subset to appear after ischemic stroke and there is small increase of T and B lymphocytes. These neutrophils remain in the cerebral micro vessels and it damages BBB by releasing ROS and protein enzymes. According to Iadecola, Buckwalter and Anrather (2020), neutrophils penetrate the CNS parenchyma which is considered to be more damaging of the BBB, resulting in destruction of adjacent blood vessels, severe endothelial damage and also in some cases haemorrhagic transformation. Peripheral monocytes can be recruited after BBB damaged. T lymphocytes influx is into the brain within hours after tMCAO and aggregate around the border of infected region. Hence, as opined by Xu et al. (2020), there is increasing evidence that the immune cells are involved in neuroinflammatory processes and also it is mandatory to maintain CNS homeostasis. Cerebral ischemic stroke leads to the release of danger-associated molecular patterns (DAMPs) from dying neurons that affects the immune cells in brain after ischemic stroke. Injured brain cells are exposed to inflammatory mediators, such as platelet activating factor. According to Iadecola, Buckwalter and Anrather (2020), T cells preferentially migrate to the edge of the lesion, and the number of cells increases several days after ischemia, where T cells are important group of immune cells involved in the pathogens of certain neurological diseases by innate and adaptive immune response. According to Ritzel et al. (2018), when neuroinflammatory responses occur in the acute stage of cerebral ischemia, the internal T cells act on neurons indirectly by the interaction with the innate immune system. Hence, the immune system is being affected by the ischemic stroke, and it is important for the doctors to diagnose the internal functions and support brain cells for boosting immune response.

2.6 Treatment of Ischemic stroke

According to Ritzel et al. (2018), the doctors and health care workers try to support and guide the patients for better quality of life through adopting healthy lifestyle so that the immune system can be improved and the people can fight against other health disease and infection. According to Saand et al. (2019), healthy life style changes with proper time to time medications are required to stay fit and health and control blood pressure as controlling blood pressure is mandatory for the individual to stay stable. As stated by Chavda, Madhwani and Chaurasia (2021), lowering the amount of cholesterol and saturated fat in the diet is also another strategy that the doctors prescribe to the patients. Eating less cholesterol and fat, especially the saturated fat and Trans fats, may reduce the build-up in your arteries. As opined by Xu et al. (2020), in case of serious condition, cholesterol lowering medications are also prescribed in such cases. Quitting tobacco use is mandatory as smoking raises the risk of stroke for both smokers and non-smokers exposed to second-hand smoke. As stated by Chavda, Madhwani and Chaurasia (2021), quitting tobacco and following the healthy lifestyle are hereby beneficial to recover the condition and improve the standard of living. Managing diabetes through healthy eating and medications, diet and exercise so that the blood sugar level of the individuals after stroke can be under control. According to Iadecola, Buckwalter and Anrather (2020), overweight contributes in stroke risk factors along with high blood pressure, diabetes and cholesterol, and thus it is mandatory for the people to maintain weight and live a healthy life style. The doctor usually utilise physical exam and family history to diagnose the ischemic stroke patients, and also review the symptoms for understanding the issues of the individuals. According to Iadecola, Buckwalter and Anrather (2020), a cranial CT scan is important to distinguish between ischemic strokes from other issue that cause brain tissue death such as brain tumour to haemorrhage. As stated by Chavda, Madhwani and Chaurasia (2021), MRI is also the best way to determine when the ischemic stroke started and there are other tests to diagnose the patients that includes ECG or EKG to test for abnormal heart rhythms, blood test for cholesterol and clotting problems, echocardiography t5o check heart for clots or nay other abnormalities as well as an angiography for reviewing which arteries are blocked and how severe the blockage is.

As opined by Shi et al. (2018), the first goal of treatment is to restore breathing, heart rate and blood pressure of the individual to normal. If necessary, the doctors try to reduce the pressure in the brain with medication. The main treatment of ischemic stroke is intravenous tissue plasminogen activator which breaks up the internal clots. 2018 guidelines from the American Heart Association (AHA) and the American Stroke Association (ASA) state that, tPA is most effective treatment for the people who have experienced ischemic stroke. As stated by Chavda, Madhwani and Chaurasia (2021), the long term treatment includes aspirin or an anticoagulant to prevent further clots. The doctors also recommend stent to open an artery narrowed by plaque or statins to lower blood pressure. After Ischemic stroke, continuous observation is mandatory and if stroke caused paralysis or severe weakness, it is necessary to strategies rehabilitation afterward to regain the body functions. Rehabilitation and also therapeutic intervention are required to regain the body functions, motor skills and coordination. According to Saand et al. (2019), occupational, physical, and speech therapy might also be useful to help regain other lost function where the younger people start recovering quickly. Hence, correct treatment and continuous observation is essential in case if ischemic stroke, where the individuals can overcome the situation and regain the functions of their body. In this context, the ischemic stroke damages the spleen tissue, which is mandatory for immune system of the individuals. Hereby, as opined by Shi et al. (2018), the people having ischemic stroke are suffering through weakens, numbs and low immunity power to fight against the health disease and infection. The doctors and nurses aims to have ECM for developing splenetic tissue in order to improve immunity power among the individuals.

2.7 Summary

The literature review is hereby effective for the researcher to develop in depth understanding about the symptoms and treatment of ischemic stroke, to protect and support the patients and guide them to improve the quality of life. The literature review includes the causes and symptoms of ischemic stroke as well as its impacts on the immunity system of the human being. Through this literature review, it is possible for the researcher to understand the effects of ischemic stroke, and the symptoms that the individuals are suffering from. Hence, through literature review, it is possible to understand the context of the research and improve knowledge for further critical analysis and evaluation. The study mainly focuses on analysing the impacts of ischemic stroke on the peripheral immune system and it becomes a serious issue for the doctors as immunity power among the individuals start deteriorating after stroke, where the patients cannot cope up with the health issues, serious disease and infection. The theories of immune cells in brain after ischemic stroke and splenic extracellular matrix for remodelling the treatment are effective for this study to improve understanding and progress in the research through critical evaluation.

Chapter 3: Research methodology

3.1 Research method

The research methodology is the third chapter that is crucial for the researcher to select the right method of conducting the research efficiently. The research is about analysing the effects of ischemic stroke on the peripheral immune system of the individuals. Through choosing the right data collection and data analysis method, the researcher would be able to gather authentic data sources and information which further helps to analyse the above mentioned research topic efficiently and progress in the paper successfully in a systematic process.

3.2 Research philosophy

The research philosophy refers to the way in which data about a phenomenon should be gathered efficiently and it is also possible for the researcher to evaluate and utilise the gathered data and information critically in order to complete the study successfully (Snyder, 2019). The three types of research philosophy are interpretivism, realism and positivism. Interpretivism philosophy is beneficial for the researcher to interpret the gathered data and influence the information with the social existence and theories (Abutabenjeh and Jaradat, 2018). Realism research method refers to the reality and it is independent of human thoughts and beliefs (Zangirolami-Raimundo, Echeimberg and Leone, 2018). On the other hand, the positivism philosophy is related to analysing the collected information and data related to the research topic by effective inclusion of the human being, where the respondents can share their feedback and provide opinion about the research topic. For the secondary study, it is beneficial for the researcher to select interpretivism research philosophy, as it provides a scope to interpret the findings and develop critical discussion on the research topic (Zangirolami-Raimundo, Echeimberg and Leone, 2018). Under the interpretivism research philosophy, the point of research is to gain in depth insight into the lives of respondents and emphatic understanding about the real life activities. The study is about the impacts of ischemic stroke, where the secondary data and authentic information are mandatory to be included in this study and through interpreting the information, it would be possible to progress in the study and meet the above mentioned research topic. The interpretivism research philosophy is mainly chosen for the qualitative research method, where the researcher aims at interpreting the gather data and information related to Ischemic stroke and its impacts on immune system of the human being efficiently for further in-depth analysis.

3.3 Research approaches

Research approach is the planning and procedure including the steps of assumptions with detailed methods of data collection and analysis for completing the study efficiently. Deductive and inductive are the two types of research approach, where the researcher needs to choose the best method for progressing in the study (Zangirolami-Raimundo, Echeimberg and Leone, 2018). Under the deductive approach, the theories and concepts related to the research are gathered in the study and after that the researcher will be able to create observation and gather the authentic data and information (Abutabenjeh and Jaradat, 2018). The data and information will be analysed to draw ultimate conclusion and meet the research objectives. On the other hand, the inductive approach refers to the practice where the researcher collects and analyses the data and information efficiently in order to develop appropriate theory and concepts for successful completion of the project. In this particular study, the researcher will select the deductive research approach, in order to review the secondary information and theories related to the ischemic stroke and its symptoms and effects on the human being for further in depth analysis and evaluation. The deductive approach will be beneficial for reviewing the theories and develop critical analysis related to the above mentioned research topic for drawing ultimate conclusion with in depth evaluation.

3.4 Data collection

The data collection method provides a scope to the researcher for choosing the sources of data collection and the best way of gathering the authentic and relevant data and information for the study (Snyder, 2019). There are two types of data collection method, which are primary and secondary data collection (Abutabenjeh and Jaradat, 2018). The primary data collection method is related to gathering the data from the first hand sources like questionnaire, survey, case study analysis and interview and in this context the strategies of collecting primary data are such as survey questionnaires, interview session, and case study review (Basias and Pollalis, 2018). On the other hand, the secondary data collection method is to collect the information from the secondary sources such as books, journals, articles and online published articles, which are considered the authentic secondary sources for relevant information gathering to progress in the study (Brannen, 2017). The researcher in this particular study selects the secondary data collection method, for better analysis and evaluation after improving own knowledge and understanding related to the above mentioned research topic. The research topic is related to the ischemic stroke and its effects on peripheral immune system and in this context, choosing the secondary data collection method would be beneficial for the researcher to review the data and information related to stroke and progress in the study for critical evaluation. In this particular study, the researcher reviews the journals and articles related to ischemic stroke and symptoms, and also review the books and online articles on treatment process for analysing the research topic and meet the objectives of the study.

3.5 Data analysis

There are two types of data analysis methods that includes quantitative and qualitative data analysis and through selecting the right analytical method for conducting the research, the researcher would be able to progress in the study and fulfil the research objectives (Basias and Pollalis, 2018). The quantitative analysis method is related to analysing the gathered data and information through the charts, graphs and statistical tools, where numeric data is being collected by the researcher (Abutabenjeh and Jaradat, 2018). On the other hand, the qualitative data analysis method refers to analysing of the data by critical evaluation and utilising the secondary information and thematic analysis (Brannen, 2017). In this particular study, the researcher will select the qualitative data analysis method, for analysing the gathered information critically. The secondary information is being collected by reviewing case studies and journal papers related to the health and social care, stroke and treatment. These data and information will be analysed through thematic analysis, so that critical evaluation would be developed by creating different themes related to the above mentioned research topic.

3.6 Ethical consideration

Ethical considerations provide a systematic way for conducting the research efficiently and completing it in a systematic approach by following all the ethical practice (Abutabenjeh and Jaradat, 2018). Authenticity of the data and information is maintained by using valid sources of secondary information, where the researcher tries to collect the relevant information and its author’s name in order to maintain validly of the information (Brannen, 2017). There is proper citation with authors name and year for maintaining the validity of the secondary research. For the qualitative study, it is mandatory for the researcher to follow the ethical rules and maintain the data authenticity for improving the quality of the study. Additionally, the researcher tries to maintain authenticity and validity of the gathered data and secondary information which is being kept safely under the Data Protection Act 1998 (Abutabenjeh and Jaradat, 2018). In the recent pandemic situation, it is difficult for the researcher to access library of the university, hence, the online library is being utilised to gather the journal and articles related to the above mentioned research topic. For maintaining data relevancy, the journal information and data are being kept through password protected computerised system, as well as the researcher also ensures that, the data and information will be utilised only for this research purpose. Hereby, the ethical considerations are beneficial for the researcher to follow the rules of conducting the research and complete it without any ethical issues. These ethical considerations are advantageous for the researcher to progress in this research in a systematic approach and complete it successfully through critical evaluation and in-depth analysis. Hereby, maintaining data security, research ethics and authenticity are helpful to follow the research structure and progress in the study for critical analysis to understand the impacts of ischemic stroke on the peripheral immune system among the individuals.

Chapter 4: Data findings and discussion

4.1 Introduction

The data findings and analysis chapter is crucial in this research in order to represent the findings and analyse the data and information critically. The researcher selects the qualitative study for this particular research where the main focus of the study is on analysing the impacts of ischemic stroke on the peripheral immune response. This is mainly a qualitative study with inclusion of the secondary information, where the researcher reviews the secondary sources of information including books, journals, articles and health care journals, where the case study analysis method is being chosen for conducting the research critically. The case studies related to the stroke patients and its effects on peripheral impairment are reviewed efficiently for in depth evaluation.

4.2 Data findings

Inflammation and infections are serious for ischemic stroke, where the individual’s immune response is being affected after stroke. Inflammatory processes have fundamental roles in stroke in both the ethology of ischemic cerebrovascular disease and cerebral ischemia (Kolosowska et al., 2019). Infection and inflammation is hereby trigger factors for stroke among the individuals and there is functional interrelation between traditional risk factors, genetic predisposition and infection or inflammation in stroke pathogenesis (Jiang et al., 2018). Endothelium activity regulates this activity in both health and disease for serving the host functions such as immune surveillance and removal of cell debris. Development of atherosclerotic vascular lesions includes an immune-mediated inflammatory response (Boshuizen and Steinberg, 2018). In an increased proportion of stroke patients, C pneumonia antigen was detected in circulating immune complexes.in animal experience, CMV infection led to an increased injury in the intima despite the absence of the virus in the vascular wall and there is serious role for inflammatory and immune responses. Intracellular pathogens can also lead to a persistent lifelong infection increasing a long term immune response, appearing to be particularly important (Stamova et al., 2019). Atherosclerosis is a developing disease, and recurrent acute infections or intermittent reactivation of latent chronic infection may contribute to the intermittent exacerbations of atherosclerotic vessel disease.

Chronic infection may indirectly influence the risk of atherosclerosis and thrombosis by increased systematic inflammation that damage vascular walls as well as leading to a coagulant state, immune mediated mechanism including molecular mimicry, possibly including a cross reaction of antibodies between human and bacterial structure such as heat shock protein (Amantea et al., 2018). It further influences on risk factors, e.g., alteration of serum lipids toward a more proatherogenic profile. Induction of natural immune tolerance to endogenous inflammatory stimuli is also worth further studies in stroke prevention (Boese et al., 2018). The risk of atherosclerosis and ischemic events may depend not only on the infectious burden, but also the severity and different type of immune response. For example, susceptibility to CMV-related CHD was restricted to women with a humoral immune response and was not present in women with a cellular response. For example, susceptibility to CMV-related CHD was restricted to women with a humoral immune response and was not present in women with a cellular response (Wang et al., 2019). Strong response towards acute and chronic infection may be associated with high risk of stroke. Hence, there is a serious impact of ischemic stroke on the peripheral immune response, which raises the risk factors for the patients to fight against the disease and infection.

Having a stroke damages the immune cells as well as affecting the functions of the brain and as per the findings; the patients have greater risks of catching life threatening infections, such as pneumonia, after having a stroke (Li et al., 2018). The study found that, the patients have reduced levels of protective antibodies in their blood after having stroke, which might explain why they are more susceptible to the infections. Tests with mice revealed that, those which experienced a stroke had fewer numbers of specialised immune cells called marginal zone B cells, which produce antibodies; hence, there is lack of immune response among the individuals after stroke (Selvaraj and Stowe, 2017). The researchers found that, the affected mice were more susceptible to bacterial lung infections. Loss of the B cells is activated during stroke and it was caused by a chemical called noradrenaline produced by nerves. Researchers, led by the University of Edinburgh's Roslin Institute, further found that, they could protect the mice from infections by using a therapy to block the effects of noradrenaline. Noradrenaline is part of the body's fight or fighting response against infectiocious diseased and it further provides a scope to prepare the body for action and has several effects including boosting blood supply (Pawluk et al., 2020). Triggering the released of energy from stores and raising heart rates. Blocking noradrenaline becomes dangerous for the stroke patients and there is requirement for therapeutic intervention that blocks or bypasses the damage to the immune system which would be helpful to cut the risk of infection after ischemic stroke (Jones et al., 2018).

There are highest chances among the patients to develop infection and the doctors try to monitor the stroke patients closely for better observation in order to develop effective treatment and care for maximising their wellbeing and providing them support to live healthy life style, so that their immune response can be improved further (Al Mamun et al., 2021). There are one third of the patients stricken by infection and the chances of making good recovery is reduced among the individuals after ischemic stroke. Treatment with antibodies does not protect the patients from developing infections and new therapies in this regard are required immediately (Ritzel et al., 2018). Hence, infections are major complications of stroke and can lead to a worse outcome for the patients. It is important to provide continuous support and treatment to the patients so that the antibodies can be generated in the body in order to fight against infection.

As per the study, stroke is the leading cause of death worldwide and a leading cause of disability. Most stroke cases are caused by the occlusion of a major cerebral artery and substantial advances that have been made in elucidating the ischemic damage in the brain (Pawluk et al., 2020). There are increasing evidence suggest that, the points to a double-edged role of the immune system in stroke pathophysiology (Xu et al., 2020). In the acute phase, the innate immune cells invade in brain and meninges. It contributes in ischemic damages and in this phase, danger signals released into the circulation by damaged brain cells leading to activation of systematic immunity (Saand et al., 2019). It is followed by profound immunodepression that promotes life-threatening infections. On the other hand, in the chronic phase, the antigen presentation initiates an adaptive immune response targeted to the brain which may underlie neuropsychiatric squeal. In such cases, the pathogenic processes and the potential therapeutic value must be reviewed efficiently for targeting immunity in human stroke (Al Mamun et al., 2021).

4.3 Critical analysis

Theme 1: Relation between ischemic stroke and immune response

The inflammatory and immune responses contribute to the risk of stroke and outcomes in stroke disease, the accumulation of inflammatory cells mainly monocytes/macrophages, within the vascular wall starts early during thermogenesis. Their activation can lead to plaque rupture and thrombus formation, increasing stroke risk (Qiu et al., 2021). The periphery of the immune system as opposed to the central lymphoid organs contains in homogeneously distributed B and T cells and the internal functions are highly divergent. Infections occur commonly after stroke and it is strongly associated with the functional outcome of the patients. Stroke-induced immunosuppression is also increasing and the summarised previous attempts to prevent outstroke infections by using the prophylactic antibiotics (Venkat, Chen and Chopp, 2018). Hence, immediate treatment and therapies are required for the patients to fight against infection and other serious disease, as the patients are not able to fight against infection due to stroke-induced immunosuppression. Stroke impairs the systematic immune responses, as it affects the spleens including the splenetic cells (Chavda, Madhwani and Chaurasia, 2021). It becomes a serious concern where the immune response of the patients start deteriorating where the patients cannot have the power to fight against infection and other critical disease. There are evidences related to a protective role of immunosuppression after stroke. A consequence of immunosuppression has been linked to the increased risk of infection after ischemic stroke onset. The brain derived neurogenic innervations are in the control of the systematic immunity.

In this phase, brain injury-induced activation of neurogenic pathways includes the sympathetic innervation, hypothalamic-pituitary-adrenal (HPA) axis and parasympathetic innervation work together in order to influence the magnitude and intensity of systemic immune response (Iadecola, Buckwalter and Anrather, 2020). Peripheral immunosuppression is a common symptom after ischemic stroke, where stroke suppresses immunity in the ischemic brain. Ischaemic neurons can secrete several neurotransmitters like acetylcholine (Ach), glutamate and serotonin (Shi et al., 2018). It further interacts with the receptors of peripheral infiltrated lymphocytes and modulates their functional status. Ischemic stroke promotes the apoptosis of immune cells and it further leads to a decrease of peripheral immune cells and a bias towards T cell immune response (Enzmann, Kargaran and Engelhardt, 2018). Hence, it can be stated that, there is immunosuppression after ischemic stroke, where the immunity power of the patients become decreased and it is difficult for the patients to fight against infection. The ischemic stroke damages splenetic cells, which is mandatory for immune response (Ao et al., 2018).

Theme 2: Potential therapies to combat stroke-associated infection

Animal experiments demonstrated that, pharmacological blockade of the sympathetic pathway could reduce the stroke induced immune dysfunction and post stroke infection to improve animals’ functional outcome (Bennett and Molofsky, 2019). It is important for the doctors and health care providers to strategize the treatment and care for protecting the patients and helping them to improve their wellbeing. Β-blocker use is associated with less severe stroke at presentation, with lower thrombin, haemoglobin and it is considered to be neuroprotective as the use of β-blockers is associated with the reduced risk of early death. Safety and efficacy of such therapy has positive impacts on stroke outcome and along with this it is also important to provide preventive antibiotic treatment. Boosting peripheral immunity is important as it is considered as another viable approach for countering post stroke infections and avoiding the systemic effects of neurogenic innervations (Li et al., 2018). Hence, post stroke pneumonia could be more refractory to treatment than other types of infections and it can be stated that the stroke treatment is imperative to mitigate immunosuppression that further decreases the risk of infectious complications after stroke. It is important to provide medications to dissolve the clot such as tissue plasminogen (tPA) and it is beneficial for increasing the chances of recovery (Wang et al., 2018).

The surgical procedure known as thrombectomy is also helpful for the stroke patients. Removing blood vessel blockages after a small stroke or transient ischemic attack (TIA) may reduce the risk of future strokes and treating aneurysms or arteriovenous malformations may be recommended (Enzmann, Kargaran and Engelhardt, 2018). The goals of these treatments are to prevent life threatening complications, prevent future strokes, reduce disability and prevent long term complications, so that the patients can live a normal life through rehabilitation (Li et al., 2018). Hence, along with treatment and therapeutic intervention, the rehabilitation care is also mandatory for the patients to improve immune system and fight against infection and other health issues. Hereby, continuous observation and providing effective treatment and care can support the patient to improve immunity power to maximise their wellbeing in long run.

Chapter 5: Conclusion and recommendations

5.1 Conclusion

It can be concluded that, the after stroke symptoms and complications are increasing among the individuals where they are suffering from loss in movement, reducing the immunity power, impairment and analysis. There are also other effects of ischemic stroke including health issues, weakness, mental trauma and depression, lack of self-control and partial or full impairment. The immune system is one of the mandatory factors that are required for the patients to overcome the situation and fight against infection. The ischemic stroke affect the spleen, which is essential for boosting immune system in the human body, and thus there is negative impacts of ischemic stroke on the immunity power of the individuals. The immunity power of the patients starts deteriorating over the period of time after stroke, for which they cannot overcome the situation and face difficulties to cope up with the treatment and guidance of the doctors. Through the study, it is hereby possible to understand that, the doctors and other health care staff must focus on boosting immune system among the individuals after stroke, by ECM and remodeling so that their power to fight against infection and other health disease can be improved.

5.2 Meeting objectives

Through this research, it is possible to analyse the above mention research objectives and evaluate each objectives for meeting the ultimate aim of the study. The study mainly focuses on analysing the impacts of ischemic stroke on the peripheral immune system among the individuals.

To understand the causes and effects of Ischemic stroke

Through this study, it is possible to explore the causes and effects of ischemic stroke, where as per the analysis, the main cause is blood clotting in brain, for which the individuals have experience ischemic stroke and another reason is blockage in artery. Through this study, it is possible to understand the effects of ischemic stroke which includes emotional problems and mental health illnesses, as well as severe pain in body, changes in behaviour and lack of self-care ability, difficulties in talking and swallowing, paralysis, memory loss, loss of muscle movement and thinking difficulties. These are the major complications that the individuals are suffering from and one of the major symptoms of ischemic stroke is loss of immune power among the individuals, for which the people face difficulties to fight against health diseases and infection, as stroke destroy spleen, which is important for immune system.

To analyse the splenic extracellular matrix (ECM) and reticular fibre network remodelling after stroke

This objective is also met through the study, where the ECM method is utilised by the doctors for remodelling the treatment for building immune cells in the human body, as ischemic stroke defects the spleen and splenetic cells for which the immunity system of the individual is being affected negatively. ECM repairs the cells by regulating the behaviour of the wide variety of cell types which are mobilised to the damaged area in order to rebuild the tissue. ECM is a dynamic structure that is resent in the tissue and it undergoes controlled remodelling for restoring the cells and improves immune system. The study is hereby effective to meet the second objective of the study by exploring the practice of ECM by patient diagnosis and developing effective strategies for recovering the splenetic cells in order to boost the immune system of the individuals. Through this study, it has been proved that, the immune system of the individual is deteriorated after ischemic stroke.

To recommend future treatment for restoring the immune functions so that the wellbeing of the individuals can be improved after stroke

Through this study, it has been explored that, it is mandatory for the doctors and health and social care providers to restore the immune system among the individuals, as stroke destroy the splenetic cells in the body, for which the immune system is being deteriorated over time after stroke. The people are suffering through weakness, numbs and paralysis, and they cannot fight against infection and other health and mental illness. There are several treatment and care for the patients, who have experience of ischemic stroke. There are direct impacts of stroke on immunity power of the individuals, for which the individuals are suffering to overcome the situation. The study is helpful to meet the objectives by critical analysis and recommending some suggestions to improve the treatment procedure so that the patients can develop their immune power and fight against infection and other health issues.

5.3 Suggested recommendations

The doctors mainly need to focus on ECM remodeling process in order to develop splenetic cells, so that the immune power of the individual can be improved. Healthy life style and supporting the patients with effective dieting and exercise are also essential for the doctors to treat the patients who have experience of ischemic stroke.

It is important to develop ECM and reticular fiber network remodeling as it has direct link with the immunosuppression. Hence, the doctors and nurses must diagnose the patient and review the ECM for rebuilding the sole enatic cells in order to boost the immunity system of the individuals. ECM components with significant differential expression identified will be validated and ensure immunostaining followed by confocal imaging of splenic tissues.

The stroke associated infection is also very common among the individuals, and it is mandatory for the doctors to develop immediate treatment including Medications delivered directly to the brain, Emergency IV medication and An IV injection of recombinant tissue plasminogen activator (tPA), also called alteplase (Activase), so that it would be possible to stabilise the condition of the patient and improve immunity power over the period of time by medications and healthy lifestyle.

5.4 Limitation of the study

There are some limitations of the study which would be developed by effective strategic planning. Lack of time is one of the main limitations of the study, where the researcher is bound to complete the research within specific time period. Additionally, lack of budget may lead to poor data collection and information gathering practices. Due to lack of budget, the researcher is not able to access the protected library and journal site, which is considered as major limitation of the study. On the other hand, the researcher lacks evidences of in-depth information about ischemic stroke and also lacks understanding and knowledge related to the above mentioned research topic. Due to lack of in depth knowledge and expertise in stroke related issues, cell functions and immune system, the researcher fails to explore more information about the biological functions and after stroke treatment and care for the patients. It is important for the researcher to have in-depth knowledge and understanding about the research, so that it would be possible to evaluate the information and analyse the research topic critically. In this study, lack of understanding and lack of authentic information gathering related to biological functions are the major limitations of the study.

5.5 Future scope

The research sheds light on the ischemic stroke, which is very common among the individuals across the globe. 87% stroke is ischemic stroke, where there are critical symptoms and impacts of ischemic stroke, for which the individuals are suffering a lot. The study would be beneficial for the future researchers to have in-depth knowledge and understanding related to ischemic stroke. The study includes the concept of ischemic stroke and its symptoms, which would be beneficial for the future researchers to have in depth knowledge and progress in further research in future. Hence, the study is beneficial for the researchers to conduct more researches and develop critical understanding or analysing the impacts of ischemic stroke on the immune system. Future researchers can review the journals and articles and also review this study for further analysis on the cell and immune power in the human body after stroke.

Reference list

• Abutabenjeh, S. and Jaradat, R., 2018. Clarification of research design, research methods, and research methodology: A guide for public administration researchers and practitioners. Teaching Public Administration, 36(3), pp.237-258.
• Al Mamun, A., Ngwa, C., Qi, S., Honarpisheh, P., Datar, S., Sharmeen, R., Xu, Y., McCullough, L.D. and Liu, F., 2021. Neuronal CD200 Signaling Is Protective in the Acute Phase of Ischemic Stroke. Stroke, pp.STROKEAHA-120.
• Amantea, D., Greco, R., Micieli, G. and Bagetta, G., 2018. Paradigm shift to neuroimmunomodulation for translational neuroprotection in stroke. Frontiers in neuroscience, 12, p.241.
• Ao, L.Y., Yan, Y.Y., Zhou, L., Li, C.Y., Li, W.T., Fang, W.R. and Li, Y.M., 2018. Immune cells after ischemic stroke onset: roles, migration, and target intervention. Journal of Molecular Neuroscience, 66(3), pp.342-355.
• Basias, N. and Pollalis, Y., 2018. Quantitative and qualitative research in business & technology: Justifying a suitable research methodology. Review of Integrative Business and Economics Research, 7, pp.91-105.
• Bennett, F.C. and Molofsky, A.V., 2019. The immune system and psychiatric disease: a basic science perspective. Clinical & Experimental Immunology, 197(3), pp.294-307.
• Boese, A.C., Le, Q.S.E., Pham, D., Hamblin, M.H. and Lee, J.P., 2018. Neural stem cell therapy for subacute and chronic ischemic stroke. Stem cell research & therapy, 9(1), pp.1-17.
• Boshuizen, M.C. and Steinberg, G.K., 2018. Stem Cell–Based Immunomodulation After Stroke: Effects on Brain Repair Processes. Stroke, 49(6), pp.1563-1570.
• Brannen, J., 2017. Mixing methods: Qualitative and quantitative research. London: Routledge.
• Chavda, V., Madhwani, K. and Chaurasia, B., 2021. Stroke and immunotherapy: Potential mechanisms and its implications as immune‐therapeutics. European Journal of Neuroscience, 54(1), pp.4338-4357.
• Enzmann, G., Kargaran, S. and Engelhardt, B., 2018. Ischemia–reperfusion injury in stroke: impact of the brain barriers and brain immune privilege on neutrophil function. Therapeutic advances in neurological disorders, 11, p.1756286418794184.
• Iadecola, C., Buckwalter, M.S. and Anrather, J., 2020. Immune responses to stroke: mechanisms, modulation, and therapeutic potential. The Journal of clinical investigation, 130(6), pp.2777-2788.
• Jiang, X., Andjelkovic, A.V., Zhu, L., Yang, T., Bennett, M.V., Chen, J., Keep, R.F. and Shi, Y., 2018. Blood-brain barrier dysfunction and recovery after ischemic stroke. Progress in neurobiology, 163, pp.144-171.
• Jones, K.A., Maltby, S., Plank, M.W., Kluge, M., Nilsson, M., Foster, P.S. and Walker, F.R., 2018. Peripheral immune cells infiltrate into sites of secondary neurodegeneration after ischemic stroke. Brain, behavior, and immunity, 67, pp.299-307.
• Kolosowska, N., Keuters, M.H., Wojciechowski, S., Keksa-Goldsteine, V., Laine, M., Malm, T., Goldsteins, G., Koistinaho, J. and Dhungana, H., 2019. Peripheral administration of IL-13 induces anti-inflammatory microglial/macrophage responses and provides neuroprotection in ischemic stroke. Neurotherapeutics, 16(4), pp.1304-1319.
• Li, D., Lang, W., Zhou, C., Wu, C., Zhang, F., Liu, Q., Yang, S. and Hao, J., 2018. Upregulation of microglial ZEB1 ameliorates brain damage after acute ischemic stroke. Cell reports, 22(13), pp.3574-3586.
• Li, Y., Zhu, Z.Y., Huang, T.T., Zhou, Y.X., Wang, X., Yang, L.Q., Chen, Z.A., Yu, W.F. and Li, P.Y., 2018. The peripheral immune response after stroke—a double edge sword for blood‐brain barrier integrity. CNS neuroscience & therapeutics, 24(12), pp.1115-1128.
• Pawluk, H., Woźniak, A., Grześk, G., Kołodziejska, R., Kozakiewicz, M., Kopkowska, E., Grzechowiak, E. and Kozera, G., 2020. The role of selected pro-inflammatory cytokines in pathogenesis of ischemic stroke. Clinical interventions in aging, 15, p.469.
• Qiu, Y.M., Zhang, C.L., Chen, A.Q., Wang, H.L., Zhou, Y.F., Li, Y.N. and Hu, B., 2021. Immune Cells in the BBB disruption after Acute Ischemic Stroke: targets for immune therapy?. Frontiers in Immunology, 12.
• Ritzel, R.M., Lai, Y.J., Crapser, J.D., Patel, A.R., Schrecengost, A., Grenier, J.M., Mancini, N.S., Patrizz, A., Jellison, E.R., Morales-Scheihing, D. and Venna, V.R., 2018. Aging alters the immunological response to ischemic stroke. Acta neuropathologica, 136(1), pp.89-110.
• Saand, A.R., Yu, F., Chen, J. and Chou, S.H., 2019. Systemic inflammation in hemorrhagic strokes–A novel neurological sign and therapeutic target?. Journal of Cerebral Blood Flow & Metabolism, 39(6), pp.959-988.
• Selvaraj, U.M. and Stowe, A.M., 2017. Long-term T cell responses in the brain after an ischemic stroke. Discovery medicine, 24(134), p.323.
• Shi, K., Wood, K., Shi, F.D., Wang, X. and Liu, Q., 2018. Stroke-induced immunosuppression and poststroke infection. Stroke and vascular neurology, 3(1).
• Snyder, H., 2019. Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, pp.333-339.
• Stamova, B., Ander, B.P., Jickling, G., Hamade, F., Durocher, M., Zhan, X., Liu, D.Z., Cheng, X., Hull, H., Yee, A. and Ng, K., 2019. The intracerebral hemorrhage blood transcriptome in humans differs from the ischemic stroke and vascular risk factor control blood transcriptomes. Journal of Cerebral Blood Flow & Metabolism, 39(9), pp.1818-1835.
• Venkat, P., Chen, J. and Chopp, M., 2018. Exosome-mediated amplification of endogenous brain repair mechanisms and brain and systemic organ interaction in modulating neurological outcome after stroke. Journal of Cerebral Blood Flow & Metabolism, 38(12), pp.2165-2178.
• Wang, X., Xuan, W., Zhu, Z.Y., Li, Y., Zhu, H., Zhu, L., Fu, D.Y., Yang, L.Q., Li, P.Y. and Yu, W.F., 2018. The evolving role of neuro‐immune interaction in brain repair after cerebral ischemic stroke. CNS neuroscience & therapeutics, 24(12), pp.1100-1114.
• Wang, Z., He, D., Zeng, Y.Y., Zhu, L., Yang, C., Lu, Y.J., Huang, J.Q., Cheng, X.Y., Huang, X.H. and Tan, X.J., 2019. The spleen may be an important target of stem cell therapy for stroke. Journal of neuroinflammation, 16(1), pp.1-24.
• Xu, S., Lu, J., Shao, A., Zhang, J.H. and Zhang, J., 2020. Glial cells: role of the immune response in ischemic stroke. Frontiers in immunology, 11, p.294.
• Zangirolami-Raimundo, J., Echeimberg, J.D.O. and Leone, C., 2018. Research methodology topics: Cross-sectional studies. Journal of Human Growth and Development, 28(3), pp.356-360.

Dig deeper into Understanding the Global Prevalence and Impact of Ovarian Cancer with our selection of articles.