Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, May 23, 2017

Chocolate intake and risk of clinically apparent atrial fibrillation: the Danish Diet, Cancer, and Health Study

You'll have to ask your doctor to find out what a serving is and the type of chocolate and cocoa percentage. Then your doctor will do nothing to update a diet stroke protocol.
http://heart.bmj.com/content/early/2017/05/01/heartjnl-2016-310357

PDF
Original article
Chocolate intake and risk of clinically apparent atrial fibrillation: the Danish Diet, Cancer, and Health Study
Free
  1. Elizabeth Mostofsky1,2,
  2. Martin Berg Johansen3,4,
  3. Anne Tjønneland5,
  4. Harpreet S Chahal6,
  5. Murray A Mittleman1,2,
  6. Kim Overvad3,7

Author affiliations

Abstract

Objective To evaluate the association between chocolate intake and incident clinically apparent atrial fibrillation or flutter (AF).
Methods The Danish Diet, Cancer, and Health Study is a large population-based prospective cohort study. The present study is based on 55 502 participants (26 400 men and 29 102 women) aged 50–64 years who had provided information on chocolate intake at baseline. Incident cases of AF were ascertained by linkage with nationwide registries.
Results During a median of 13.5 years there were 3346 cases of AF. Compared with chocolate intake less than once per month, the rate of AF was lower for people consuming 1–3 servings/month (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.82 to 0.98), 1 serving/week (HR 0.83, 95% CI 0.74 to 0.92), 2–6 servings/week (HR 0.80, 95% CI 0.71 to 0.91) and ≥1 servings/day (HR 0.84, 95% CI 0.65 to 1.09; p-linear trend <0.0001), with similar results for men and women.
Conclusions Accumulating evidence indicates that moderate chocolate intake may be inversely associated with AF risk, although residual confounding cannot be ruled out.

Effect of a Coconut Oil Supplement (2g/d) on Total Cholesterol to HDL Cholesterol Ratio in Healthy Adults

Oh well, I'm still doing coconut oil for reasons in these 38 posts. Don't listen to me I have no medical training. 
http://search.proquest.com/openview/4172252bc6194b82998c2b1f4fe55da4/1?pq-origsite=gscholar&cbl=18750&diss=y
ABSTRACT
There are limited studies exploring the direct relationship between coconut oil and cholesterol concentrations. Research in animals and a few intervention trials suggest that coconut oil increases the good cholesterol (high density lipoprotein, HDL) and thus reduces the risk of cardiovascular disease. Preliminary research at Arizona State University(ASU) has found similar results using coconut oil as a placebo, positive changes in HDL cholesterol
concentrations were observed.
The goal of this randomized, double blind, parallel two arm study, was to further examine the beneficial effects of a 2g supplement of coconut oil taken each day for 8 weeks on cholesterol concentrations, specifically the total cholesterol to HDL cholesterol ratio, compared to placebo.
Forty-two healthy adults between 18-40 years of age, exercising less than 150
minutes each week, non smoking, BMI between 22-35 and not taking any medications that could effect blood lipids were recruited from the ListServs at ASU. Participants were randomized to receive either a placebo capsule of flour or a coconut oil capsule (Puritan’s Pride brand, coconut oil softgels, 2g each) and instructed to take the capsules for 8 weeks.
Results indicated no significant change in total cholesterol to HDL ratio between baseline and 8 weeks in the coconut oil and placebo groups (p=0.369), no significant change in HDL (p=0.648), no change in LDL (p=0.247), no change in total cholesterol (p=0.216), and no change in triglycerides (p=0.369). Blood lipid concentrations were not significantly altered by a 2g/day dosage of coconut oil over the course of 8 weeks in healthy adults, and specifically the total cholesterol to HDL ratio did not change or improve.

Lesion location associated with balance recovery and gait velocity change after rehabilitation in stroke patients

Well DUH, smaller lesions and locations outside of the walking control areas lead to better recovery. The brainpower to come up with that could never have occurred in stroke-addled survivors like me.
http://link.springer.com/article/10.1007/s00234-017-1840-0
  • Hyun Im Moon
  • Hyo Jeong Lee
  • Seo Yeon Yoon
  • Hyun Im Moon
    • 1
  • Hyo Jeong Lee
    • 1
  • Seo Yeon Yoon
    • 1
  1. 1.Department of Rehabilitation MedicineBundang Jesaeng General HospitalSeoungnam-siRepublic of Korea
Functional Neuroradiology
DOI: 10.1007/s00234-017-1840-0
Cite this article as:
Moon, H.I., Lee, H.J. & Yoon, S.Y. Neuroradiology (2017). doi:10.1007/s00234-017-1840-0

Abstract

Purpose

Impaired gait function after stroke contributes strongly to overall patient disability. However, the response to rehabilitation varies between individuals. The aims of this study were to identify predictors of gait velocity change and to elucidate lesion location associated with change of balance and gait function.

Methods

We reviewed 102 stroke patients. The patients were divided into two groups according to gait ability post-rehabilitation, and we analyzed differences in their characteristics, such as demographic information, lesion factors, and initial balance function. Multivariate regression analyses were performed to examine the predictors of rehabilitation response. Lesion location and volume were measured on brain magnetic resonance images. We generated statistical maps of the lesions related to functional gains in gait and balance using voxel-based lesion symptom mapping (VLSM).

Results

The group of patients who regained independent ambulation function showed a smaller lesion size, a shorter duration from stroke onset, and higher initial balance function. In the regression model, gait velocity changes were predicted with the initial Berg balance scale (BBS) and duration post-onset. Absolute BBS changes were also correlated with the duration post-onset and initial BBS, and relative BBS changes were predicted by the baseline BBS. Using VLSM, lesion locations associated with gait velocity changes and balance adjusting for other factors were the insula, internal capsule, and adjacent white matter.

Conclusion

Initial balance function as well as the interval between stroke onset and the initiation of therapy might influence balance recovery and gait velocity changes. Damage to the insula and internal capsule also affected gait velocity change after rehabilitation.

Feasibility of Integrating Post Stroke Rehabilitation and Recovery Assessments in Stroke Clinic (P5.295)

The assessments should have come up with mapping deficits to protocols that correct those deficits. But NO, this was fucking useless research for getting patients closer to 100% recovery.
http://www.neurology.org/content/88/16_Supplement/P5.295.short
  1. Amre Nouh1
  1. Neurology vol. 88 no. 16 Supplement P5.295

Abstract

Objective: To assess the feasibility of integrating post-stroke rehabilitation and recovery guideline assessment during the outpatient post-stroke follow-up visit.
Background: While a large focus of post-stroke follow-up is secondary prevention, many patients experience fatigue, depression, cognitive and rehabilitation challenges requiring attention. In May 2016, the AHA/ASA issued guidelines(not protocols) on adult stroke rehabilitation and recovery integrating objective assessments and treatment recommendations. Ensuring these aspects of care(not results) are adequately addressed by the provider during follow-up can be challenging, particularly in mild stroke patients.
Design/Methods: After IRB approval, a prospective collection of rehabilitation and recovery parameters for all patients seen in the stroke clinic after hospital discharge was performed using a structured questionnaire format completed by trained research personnel. Metrics including clinical parameters, stroke severity, modified Rankin Scale, Patient Health Questionnaire 9, Fatigue Assessment Scale, Montreal Cognitive Assessment, and rehabilitation status including ability to drive, return to work, and sexual dysfunction were collected.
Results: Thus far, 37 patients were surveyed with each assessment averaging 15 minutes. Patients were 60% male with mean age of 65+/− 14.4 years. Despite low mean NIHSS (1 +/−2) and MoCA score of 25 (+/−3), approximately 16% had clinical depression, 10% had mildly depressive symptoms, and 38% complained of post stroke fatigue. Furthermore, 41% could not return to driving. Roughly 64% of patients were assessed within 3 months of stroke and 36% >3 months. All but 4 patients required assistance in completing the survey.
Conclusions: Significant post stroke fatigue, depression and rehabilitative challenges are prevalent, even in patients with mild stroke. Utilizing a structured assessment tool with dedicated personnel is a feasible and sensitive method in evaluating post stroke patients and guiding management, particularly those with mild disability.
Disclosure: Dr. Taboada has nothing to disclose. Dr. Taboada has nothing to disclose. Dr. Nouh has nothing to disclose.

Predicting brain atrophy from resting-state functional connectivity and structural connectivity in ischemic stroke (P5.297)

Who gives a shit about prediction you blithering idiots? What are you doing to prevent brain atrophy post stroke? What protocol is there for that?
http://www.neurology.org/content/88/16_Supplement/P5.297.short

  • April 27, 2017
    • Poster Session V
      • Stroke Recovery and Rehabilitation


  1. Michael D. Fox1
  1. Neurology vol. 88 no. 16 Supplement P5.297

Abstract

Objective: To investigate whether resting-state functional connectivity MRI (rs-fcMRI) can predict brain atrophy caused by ischemic stroke, and whether this prediction is independent of structural connectivity from diffusion MRI (dMRI).
Background: A stroke in one location can have effects on remote but connected brain regions, including focal atrophy. dMRI has previously been shown to predict regional atrophy of connected brain regions. Improving the prediction of these remote effects may improve symptom localization, prognosis, and allow for individualized neurorehabilitation.
Design/Methods: 26 patients with acute ischemic stroke received anatomical MRI scans shortly after their stroke and then again at a later date (10.7±7.5 months). The change in volume (atrophy) of 116 automated anatomical labeling (AAL) regions was computed. Connectivity of each AAL region to the lesion location was assessed using rs-fcMRI from a large cohort of normal subjects (N = 98). For dMRI, connectivity was the percentage of tracks from the AAL region that passed through the lesion mask, as used in prior work. The lesioned areas themselves were excluded from analyses. Mixed-effects regression analyses of atrophy as outcome, with rs-fcMRI and/or dMRI values as fixed effects and individual patients as random effect were conducted.
Results: Rs-fcMRI with the lesion location was a significant predictor of remote atrophy (z = 4.03, p = 5.6e-05), whereas dMRI fell just short of significance (z = 1.70, p = .089). Regression analysis of atrophy including both rs-fcMRI and dMRI as predictors found a significant effect of rs-fcMRI (z = 3.78, p = 0.0002) but not dMRI (z = 0.98, p = 0.33).
Conclusions: Resting-state functional connectivity with the lesion location can predict atrophy of remote brain regions after ischemic stroke, independent of structural white-matter connectivity.
Study Supported by: M.D.F. was supported by the National Institutes of Health (R21 MH099196, K23 NS083741), Dystonia Medical Research Foundation, National Parkinson’s Foundation, and NFL Players Association. A.J. was supported by a Postdoctoral Fellowship from the Natural Sciences and Engineering Research Council of Canada (NSERC PDF 454617). A.D.B. was supported by 4K12HD027748-24.
Disclosure: Dr. Jannati has nothing to disclose. Dr. Boes has nothing to disclose. Dr. Horn has nothing to disclose. Dr. Pascual-Leone has received personal compensation for activities with Magstim, Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, Axilum Robotics, and Neosync as a member of scientific advisory boards. Dr. Pascual-Leone has received personal compensation in an editorial capacity for the Annals of Neurology and the European Journal of Neuroscience. Dr. Kuceyeski has nothing to disclose. Dr. Fox has nothing to disclose.

Strokes: Know the symptoms and save a life

My god, the excellent laziness as evidenced by all the employees and board of directors of the National Stroke Association. This is precisely why I call them FUCKING FAILURES.

http://www.dailyitem.com/news/lifestyles/strokes-know-the-symptoms-and-save-a-life/article_c9de821e-3702-5149-8891-93b4e634d5a6.html
SUNBURY — According to the National Stroke Association, stroke is our nation’s number three killer and the leading cause of adult disability. In the United States, someone has a stroke every 45 seconds. May is National Stroke Awareness Month, and Manor Care Sunbury is honoring the occasion by raising awareness of the symptoms and risk factors of stroke.
Stroke can happen to anyone of any age, gender or race, though women are uniquely affected. Many of the risk factors are manageable, such as high blood pressure and cholesterol, weight, cigarette smoking and heart disease. However, risk factors such as increasing age, heredity and a prior history of strokes cannot be controlled. The good news is that 80 percent of strokes can be prevented by lifestyle changes such as exercising, drinking alcohol in moderation and eating a healthy diet low in sodium and fat.
Strokes occur when the blood supply to the brain is interrupted by blood clots or a hemorrhage. Denied of a blood supply, brain cells begin to die off. Unlike other cells in the body, brain cells do not replace themselves, and damage to the body and mind can be permanent. Victims of stroke may be paralyzed, unable to speak or comprehend what others are saying, suffer memory loss or be confused.
According to the National Stroke Association, recognizing the symptoms of a stroke and Acting F.A.S.T. to seek lifesaving treatment is the key to saving lives. Remembering the acronym F.A.S.T. (Face, Arm, Speech, Time) will help a person to recognize if someone is suffering from a stroke. The National Stroke Association says to:
F-ace Ask the person to smile. Does one side of the face droop?
A-rm Ask the person to raise both arms. Does one arm drift downward?
S-peech Ask the person to repeat a simple phrase. Does the speech sounds slurred or strange?
T-ime If you observe any of these signs, it’s time to call 9-1-1.


My reply:
 Are you also aware that only 10% of stroke survivors fully recover or that tPA fails to get you fully recovered 88% of the time? That there are no publicly available stroke rehab protocols with efficacy percentages? No cures for spasticity? No cures for fatigue? There are many problems in stroke not being addressed except for lazy awareness campaigns.

Capsaicin-loaded nanolipoidal carriers for topical application: design, characterization, and in vitro/in vivo evaluation

I would think that Capsaicin applied to the skin would be great for environmental enrichment and following Margaret Yekutiel in the book, 'Sensory Re-Education of the Hand After Stroke' in 2001 and lead to better recovery? Cheap, easy to do, what is not to like about it except that your doctors have never done ANYTHING that smacked of innovation or thinking outside the box?  You, your children and your grandchildren will continue to be screwed from stroke as long as the existing stroke medical 'professionals' stay in charge. 
 https://www.dovepress.com/articles.php?article_id=32956
Authors Wang XR, Gao SQ, Niu XQ, Li LJ, Ying XY, Hu ZJ, Gao JQ
Received 7 January 2017
Accepted for publication 28 March 2017
Published 22 May 2017 Volume 2017:12 Pages 3881—3898
DOI https://doi.org/10.2147/IJN.S131901
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Thiruganesh Ramasamy
Peer reviewer comments 2
Editor who approved publication: Dr Lei Yang
Xia-Rong Wang,1 Si-Qian Gao,1 Xiao-Qian Niu,1 Long-Jian Li,2 Xiao-Ying Ying,1 Zhong-Jie Hu,2 Jian-Qing Gao1,3

1Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 2Zhejiang Provincial Corps Hospital of Chinese People’s Armed Police Forces, Jiaxing, Zhejiang, 3Jiangsu Engineering Research Center for New-Type External and Transdermal Preparations, Jiangsu, People’s Republic of China


Abstract: Capsaicin has been used in clinical applications for the treatment of pain disorders and inflammatory diseases. Given the strong pungency and high oil/water partition coefficient of capsaicin, capsaicin-loaded nanolipoidal carriers (NLCs) were designed to increase permeation and achieve the analgesic, anti-inflammatory effect with lower skin irritation. Capsaicin-loaded NLCs were prepared and later optimized by the Box–Behnken design. The physicochemical characterizations, morphology, and encapsulation of the capsaicin-loaded NLCs were subsequently confirmed. Capsaicin-loaded NLCs and capsaicin-loaded NLCs gel exhibited sustained release and no cytotoxicity properties. Also, they could significantly enhance the penetration amount, permeation flux, and skin retention amounts of capsaicin due to the application of NLCs. To study the topical permeation mechanism of capsaicin, 3,3'-dioctadecyloxacarbocyanine perchlorate (Dio) was used as a fluorescent dye. Dio-loaded NLCs and Dio-loaded NLCs gel could effectively deliver Dio up to a skin depth of 260 and 210 µm, respectively, primarily through the appendage route on the basis of version skin sections compared with Dio solution, which only delivered Dio up to 150 µm. In vivo therapeutic experiments demonstrated that capsaicin-loaded NLCs and capsaicin-loaded NLCs gel could improve the pain threshold in a dose-dependent manner and inhibit inflammation, primarily by reducing the prostaglandin E2 levels in the tissue compared with capsaicin cream and capsaicin solution. Meanwhile, skin irritation was reduced, indicating that application of NLCs could decrease the irritation caused by capsaicin. Overall, NLCs may be a potential carrier for topical delivery of capsaicin for useful pain and inflammation therapy.

Keywords: capsaicin-loaded NLCs, prescription optimization, analgesic, anti-inflammation, hot-plate test, carrageenan-induced paw edema
Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
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Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

Who gives a shit about inter-rater reliability you blithering idiots? We want to know the efficacy and results of recovering using this. My god, the stupidity out there is appalling. How well would environmental enrichment and following Margaret Yekutiel in the book, 'Sensory Re-Education of the Hand After Stroke' in 2001 lead to better recovery?

Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

  • Jennifer A. SemrauEmail author,
  • Troy M. Herter,
  • Stephen H. Scott and
  • Sean P. Dukelow
Journal of NeuroEngineering and Rehabilitation201714:42
DOI: 10.1186/s12984-017-0260-z
Received: 3 August 2016
Accepted: 16 May 2017
Published: 22 May 2017



Abstract

Background

Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task.

Methods

Twenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task.

Results

We evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]).

Conclusions

The robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying kinesthesia after stroke.

Federal budget proposal would deal ‘devastating blow’ to medical research

If this doesn't change our fucking failures of stroke associations approach to funding stroke research then we truly have no one helping us get to 100% recovery.
With a defined stroke strategy getting foundation grants and individual donors to step up and fund such research would be damned easy.  Asking for general funding for stupid stroke association press release funding is complete insanity. Asking for funding to solve glutamate poisoning in the neuronal cascade of death would be a concrete proposal people and foundations could get behind. I.E, 'I helped solve the glutamate poisoning piece of stroke neuron death'. You could send out certificates of appreciation suitable to being framed. This is so fucking easy to solve the funding problem but will require destroying our fucking failures of stroke associations and replacing them with a great stroke association. 

Federal budget proposal would deal ‘devastating blow’ to medical research


Researchers suggest dual gait testing as early predictor of dementia

Maybe your doctor wants to test for this to establish a baseline for your likely descent into dementia.
1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.


 Researchers suggest dual gait testing as early predictor of dementia


In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.

Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph's Health Care London, and associate professor in the Division of Geriatric Medicine at Western University's Schulich School of Medicine & Dentistry, is leading the "Gait and Brain Study." His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.

"Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease," says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.

"While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation," says Dr. Montero-Odasso. "We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function."

The "gait cost," or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.

"Our results reveal a 'motor signature' of cognitive impairment that can be used to predict dementia," adds Dr. Montero-Odasso. "It is conceivable that we will be able to diagnose Alzheimer's disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia."

The study, "Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment", was published in the journal, Jama Neurology.

Explore further: Challenges of mobility aids and dementia explored

More information: Manuel M. Montero-Odasso et al. Association of Dual-Task Gait With Incident Dementia in Mild Cognitive Impairment, JAMA Neurology (2017). DOI: 10.1001/jamaneurol.2017.0643

Journal reference: Archives of Neurology search and more info website

Provided by: Lawson Health Research Institute search and more info website


Read more at: https://medicalxpress.com/news/2017-05-dual-gait-early-predictor-dementia.html#jCp

Researchers develop new biomedical polymer to treat atherosclerosis

I would rather do this which addresses the real cause of atherosclerosis rather than the secondary approach of reducing cholesterol.
http://www.news-medical.net/news/20170522/Researchers-develop-new-biomedical-polymer-to-treat-atherosclerosis.aspx

Researchers at Ben-Gurion University (BGU) and the Sheba Medical Center have developed a new therapy to treat atherosclerosis and prevent heart failure with a new biomedical polymer that reduces arterial plaque and inflammation in the cardiovascular system.
Atherosclerotic cardiovascular disease causes 56 million deaths annually worldwide, according to the 2015 Lancet Global Burden of Disease Report. Arteries are lined by a thin layer of cells called the "endothelium" which keep them toned and smooth and maintain blood flow. Atherosclerosis begins with damage to the endothelium and is caused by high blood pressure, smoking or high cholesterol. The resulting damage leads to plaque formation.
When endothelial cells experience inflammation, they produce a molecule called "E-selectin," which brings white blood cells (monocytes) to the area and causes plaque accumulation in the arteries.
"Our E-selectin-targeting polymer reduces existing plaque and prevents further plaque progression and inflammation, preventing arterial thrombosis, ischemia, myocardial infarction, and stroke," says Prof. Ayelet David of the BGU Department of Clinical Biochemistry and Pharmacology.
This innovative nano-polymer has several advantages. First, it targets only damaged tissue and does not harm healthy tissue. At present, there are several available treatment options for atherosclerosis, but no other therapy reverses arterial damage and improves the heart muscle. Lastly, the polymer has no side effects, unlike statins, which are currently the leading medication used for treating atherosclerosis.
Patented and in preclinical stage, the new polymer has been tested on mice with positive results. In a study that has been submitted for publication, the researchers treated atherosclerotic mice with four injections of the new biomedical polymer and tested the change in their arteries after four weeks. "We were stunned by the results," says Prof. David. "The myocardial function of the treated mice was greatly improved, there was less inflammation and a significant decrease in the thickness of the arteries."
Prof. David and collaborator Prof. Jonathan Leor, director of the Cardiovascular Research Institute of the Sheba Medical Center and professor of cardiology at Tel Aviv University, suggest that this polymer-based therapy can also be helpful to people with diabetes, hypertension and other age-related conditions. "As such, the new polymeric therapy may have life-changing benefits for millions of people," the researchers say.
"This is unprecedented," says Prof. Leor. "We achieved an adherence level similar to that of an antibody, which may explain the strong beneficial effect we observed."
"We are now seeking a pharmaceutical company to bring our polymer therapy through the next stages of drug development and ultimately to market," says Dr. Ora Horovitz, senior vice president of business development at BGN Technologies (BGN). BGU's technology transfer and commercialization company. "We believe that this therapy has the potential to help a great number of people."

Forgot aspirin, replaced with Guinness on this trip.

I managed to not pack my aspirin bottle for this week. So rather than walk one block to Walgreens I am using the Guinness replacement. Don't do this or listen to me, I have no medical training. And since I'm on the 325 one rather than low-dose I assume I need 2-3 pints a day.

Guinness could really be good for you

A pint of the black stuff a day may work as well as a low dose aspirin to prevent heart clots that raise the risk of heart attacks.

Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable (SRRR)

This should have been one of the goals and objectives of our fucking failures of stroke associations. A publicly available database of all relevant stroke research and protocols. 
http://eprints.nottingham.ac.uk/42706/
Walker, Marion F. and Hoffmann, Tammy C. and Brady, Marian C. and Dean, Catherine M. and Eng, Janice J. and Farrin, Amanda J. and Felix, Cynthia and Forster, Anne and Langhorne, Peter and Lynch, Elizabeth A. and Radford, Kathryn A. and Sunnerhagen, Katharina and Watkins, Caroline L. (2017) Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable (SRRR). International Journal of Stroke . ISSN 1747-4949 (In Press)
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      Abstract

      Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable.

      An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made.

      To validate the need for the recommendations the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention calls into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless the majority of reporting recommendations were still not adequately described.

      To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence based clinical care we urge the research community to endorse and adopt our recommendations.
      Item Type: Article
      Keywords: stroke, rehabilitation, intervention development, reporting, fidelity
      Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
      Depositing User: Eprints, Support
      Date Deposited: 10 May 2017 11:33
      Last Modified: 19 May 2017 16:25
      URI: http://eprints.nottingham.ac.uk/id/eprint/42706

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      Virtual reality stroke rehab platform gets FDA clearance

      I bet it will take decades before this gets to your hospital. Your hospital probably has NO person or group whose sole function is to identify research that should be implemented into common practice to help stroke survivors get to 100% recovery. If that goal isn't for your doctor and stroke hospital, you have complete fucking incompetency there.
      https://pharmaphorum.com/news/vr-stroke-rehab-fda-clearance/
      MindMaze, a Swiss neurogaming company, has received FDA clearance for its virtual reality rehab platform for stroke and traumatic injury patients.
      The MindMotion Pro platform features both motion capture technology and virtual 3D environments to help stroke patients regain the use of affected upper-body limbs.
      Patients are presented with a scenario that challenges them to perform simple functions such as pointing, reaching or grasping using a virtual representation of their non-functional limb.
      This virtual limb is controlled using the functional limb, for example, a patient who has lost the use of their left arm will use their right arm to complete each scenario. This method can kickstart the recovery of the non-functional limb’s capabilities.
      The platform is given to stroke patients as a rehabilitation programme as early as one to six weeks post-stroke.
      According to the company, beginning the therapy early can dramatically improve a patient’s recovery time as well as reduce losses in economic activity resulting from the condition – a number that currently sits at around $65 billion based on the approximately 800,000 US citizens that experience a stroke every year.
      “Our work at the forefront of neuroscience and virtual reality allows patients to recover faster and return more fully to the life they lived before injury,” explained Dr. Tej Tadi, CEO and founder of MindMaze. “Over the last decade, we’ve honed this therapy to be cost-effective for both patients and healthcare providers.”
      Alongside its newly FDA-cleared MindMotion Pro, the company has also completed 261 patient trials for its MindMotion Go.
      MindMotion Go is designed as a portable version of MindMotion Pro, acting as either an outpatient equivalent or a continuation of the same rehabilitation care at home.
      Results from a total patient population of 250 from therapy centre trials across the UK, Italy, Germany and Switzerland, MindMotion Go led to an increased patient engagement and adherence to therapy.
      MindMotion Go is yet to receive FDA clearance.
      Since its founding in 2012, MindMaze has accrued $108.5 million in funding, $100 million of which it obtained in February.

      Haptoglobin Hp2 Variant Promotes Premature Cardiovascular Death in Stroke Survivors

      You might want to know about this so your doctor can prevent this from happening.
      http://stroke.ahajournals.org/content/48/6/1463?etoc=
      Petra Ijäs, Susanna Melkas, Jani Saksi, Antti Jula, Matti Jauhiainen, Niku Oksala, Tarja Pohjasvaara, Markku Kaste, Pekka J. Karhunen, Perttu Lindsberg, Timo Erkinjuntti
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      Abstract

      Background and Purpose—Haptoglobin (Hp) is an acute phase plasma protein protecting tissues from oxidative damage. It exists in 2 variant alleles (hp1/hp2) giving rise to 3 protein isoforms with different biochemical properties and efficiency to limit oxidative stress. We previously found that hp2 variant is associated with stroke risk in the patients with carotid stenosis and the risk of ischemic cardiovascular events in a general population cohort. This study examined the hypothesis that Hp genotype is associated with general cardiovascular risk in patients with stroke.
      Methods—Hp was genotyped in SAM study (Helsinki Stroke Aging Memory, n=378). A total of 1426 individuals ascertained from a nationally representative cross-sectional health survey served as population controls.
      Results—Hp genotype frequencies were 15.6% (hp1-1), 44.2% (hp1-2), and 40.2% (hp2-2) in patients with stroke. During a mean of 7.5-year follow-up after first-ever stroke, hp2 carriers had a substantially higher rate of cardiac deaths (24.5% versus 8.5%; P=0.006) and a trend toward more fatal strokes (23.5% versus 13.6%; P=0.122). The combined risk of ischemic cardiovascular deaths was 2.4-fold higher among hp2 carriers (95% confidence interval, 1.28–4.43) after adjustment for major cardiovascular risk factors.
      Conclusions—Hp2 allele is associated with premature ischemic cardiovascular deaths after first-ever ischemic stroke.
      • Received October 14, 2016.
      • Revision received February 13, 2017.
      • Accepted March 8, 2017.
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      Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke

      BDNF is good for our recovery. What the hell is your doctors' protocol to ensure your levels are good and you are getting enough?


      Won Hyuk Chang, Eunhee Park, Jungsoo Lee, Ahee Lee, Yun-Hee Kim
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      Abstract

      Background and Purpose—The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke.
      Methods—A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor.
      Results—The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of Met alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke.
      Conclusions—Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement.
      • Received August 26, 2016.
      • Revision received March 24, 2017.
      • Accepted April 10, 2017.
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      Have Stroke Neurologists Entered the Arena of Stroke-Related Cognitive Dysfunctions?

      Only evaluation and assessment NOT stroke protocols to correct such problems. Pretty much useless research. 
      http://stroke.ahajournals.org/content/48/6/1441?etoc=

      Not Yet, but They Should!

      Leonardo Pantoni

      See related article, p 1539
      In this issue of Stroke, Zamboni et al1 reported the results of a study that explored whether early cognitive impairment was associated with the volume of white matter hyperintensities and with white matter damage on diffusion-weighted magnetic resonance imaging in patients with transient ischemic attack (TIA) or minor stroke. Cognitive evaluation was performed with the 2 currently most widely used screening tools, the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination. Scores on both tests, 1 month after the event, were significantly correlated with volume of white matter hyperintensities and fractional anisotropy. However, only the MoCA was independently correlated with white matter hyperintensity volumes, average fractional anisotropy values, and reduced fractional anisotropy in anterior tracts after controlling for the Mini Mental State Examination.
      This study reinforces the idea that the MoCA is better suited than the Mini Mental State Examination for the assessment of patients with cerebrovascular diseases.2 These data are also in agreement with previous studies showing that the MoCA is more specifically associated with microstructural damage in white matter than the Mini Mental State Examination.3
      Some issues, such as the appropriate normality cutoffs for these tests, remain open, but these studies, however, have the great merit of raising a series of relevant points concerning the cognitive costs of cerebrovascular diseases.

      Cognition After Stroke: Magnitude of the Problem

      Cognitive dysfunction is among the most common and severe consequence of stroke. For patients and their caregivers, cognition and related disturbances are among the top 10 priorities related to life after stroke.4
      In hospital series, poststroke dementia prevalence can be as high as 40% depending on inclusion of recurrent strokes, time of evaluation after stroke, dementia criteria, and exclusion of aphasic patients.5 The magnitude of the problem is even larger considering that many stroke patients develop cognitive deficits that do not meet criteria for dementia (ie, mild cognitive impairment)6; this percentage can be as high as 80%.7 Finally, >90% of stroke survivors complain of subjective cognitive impairment.8 These complaints may benefit from objective testing.9
      The presence of cognitive deficits has several consequences after stroke. Importantly, it may heavily affect rehabilitation strategies.10 Early poststroke cognitive dysfunction, together with stroke severity and prestroke functionality, is a significant and independent predictor of long-term functional poststroke outcome.11
      In this era where a great focus and vast efforts are placed on acute stroke and on the treatments available in this phase, it is interesting to compare the above-mentioned data with the figures of stroke patients subjected to thrombolysis. Estimates of alteplase treatment range from 3% to 5%,12 with eligibility estimates approaching 10%. Optimistically, patients eligible for endovascular thrombectomy could be 7%,13 but current performance rates are significantly lower. Remarkably, all stroke patients can clearly benefit from admission to a dedicated stroke unit.
      It is obvious that although the acute-phase therapies(Where are they?) are cornerstones of our care of stroke patients and, on an individual patient basis, they may change dramatically the outcome, the bulk of stroke problems remain in the chronic phase.

      Stroke Neurologist Are Called to Assess Cognition

      Despite the impressive data on the frequency of the stroke cognitive consequences, this topic has received scarce attention to date. One systematic review of published stroke trials pointed out that, out of almost 9000 studies, <5% included a cognitive measure.14
      The evaluation of the patient’s cognitive abilities has always been part of the neurological examination, and neurologists had been skilled in this for years. However, this part of the neurological examination is complex, requires experience, and takes time. Today, we are frequently called to quickly visit stroke patients especially in specific settings such as in the acute phase when time-dependent decisions need to be made. Brief and time-convenient neurological scales have, therefore, been developed, the best example being the National Institute of Health Stroke Scale. The National Institute of Health Stroke Scale has great advantages such as the implementation of a standardized scoring measure and use of a common language among centers. These scales are so widely used in the stroke setting that there is a tendency for them to entirely replace the full neurological examination. There are clear hazards in such oversimplification. One is that these scales are heavily weighted on more easily evaluable deficits such as motor, whereas cognitive evaluation, besides language items, is minimalized.

      Tools for the Evaluation of Cognition After Stroke

      Thus, the evaluation of cognition should clearly become part of the neurological assessment of all stroke patients. Some of the open issues in this regard concern the time of the evaluation and the tools for it. A thorough cognitive assessment requires time as cognitive domains are various (language, memory, attention, executive function, visuospatial, etc).
      Many cognitive instruments have been proposed for the evaluation of stroke patients.15 These tools should be selected according to the different intervals of assessment after stroke and the availability of time and personnel. In any case, we need tools to systematically assess cognition in stroke patients and instruments that are usable from the early phases.
      The MoCA could be one of such tools.16 Its use for the assessment of cerebrovascular disease patients has been advocated because it evaluates many of the cognitive domains affected in these patients.17 The MoCA has been tested in several studies in the acute stroke setting where it is applicable and predictive of long-term outcome. The MoCA has advantages and limitations as does any other cognitive tool2 under investigation for use in acute stroke. More important than the issue of the finding of the best tool (likely to be an impossible task) is attention to the evaluation of cognition in stroke patients.

      Is It a TIA or a Cognitive Stroke?

      One last interesting issue raised by the study by Zamboni et al1 is the fact that some cognitive impairment was found in TIA patients 1 month after the event. TIA symptoms by definition must last <24 hours, so finding a clinical deficit at a time distant from onset could challenge the concept of TIAs being transient.
      There are at least 2 possible explanations for such findings. The first is that the vascular event clinically diagnosed as TIA induces a cerebral damage that is transient in its noncognitive expression but that is sustained for cognition. Indeed, it is well documented that some TIAs are associated with permanent brain lesions.18 This damage might also happen at a microstructural level and be invisible on conventional neuroimaging. Alternatively, one may hypothesize that, in TIA patients, brain microstructural damage and functional dysfunction are present before the event. White matter damage as shown in the study by Zamboni et al could be one of the correlates of this cognitive decline. The answer to this question can come from longitudinal imaging studies, cognitively assessing subjects before the cerebrovascular event and then afterward. However, these are not easy to conduct.
      Ten years after the call for vascular neurologists to enter the arena of poststroke cognition to fight the hard problem in daily life after a stroke,19 the consideration given to this aspect remains limited. We urge stroke clinicians to increase their attention toward the cognitive and long-term consequences of stroke.