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:

Friday, May 25, 2018

Study examines the rise of plaque in arteries

Maybe we could finally address the root cause of atherosclerosis rather than taking statins to lower cholesterol levels. But statins are a cash cow for Big Pharma, they won't go lightly even with overwhelming evidence.  Probably won't occur in my lifetime.
The accumulation of cholesterol plaques in artery walls can lead to atherosclerosis, or the hardening of arteries that contributes to heart attacks and strokes. In a new study, Yale researchers investigate how plaque cells develop at the molecular level, and their findings could help produce targeted treatments for the disease.
Smooth muscle , the dominant type of cell found in , are known to be involved in plaque build-up, but it has not been clear how this occurs. The research team, led by senior study author Daniel Greif, used mice models and primary human cells to study smooth muscle cells and their contribution to atherosclerotic plaques.
They discovered that a single smooth muscle cell gives rise, through a process of clonal expansion, to the majority of cells found in the plaque. Additionally, they learned that a gene known as integrin beta3 regulates the migration of a single smooth muscle cell progenitor from the artery wall into plaque. Once inside the plaque, the progenitor cell reproduces and changes into other cell types. Further, the researchers determined that the gene's role in development occurs in as well as in bone marrow-derived cells.   
Together, the findings shed light on the complex mechanisms behind the progression of atherosclerosis, and suggests potential targets for future therapies, the researchers note.
The study is published in Nature Communications.

Blood from umbilical cord may help fix your brain after a stroke

You'll have to ask your doctor to find the research that reported this.
By Alice Klein
A healing balm for the brain? Infusions of umbilical cord blood seem to help people recover better after a stroke.
Strokes occur when blood can’t reach brain cells because of a blocked or burst blood vessel, causing them to rapidly starve and die. Joanne Kurtzberg at Duke University, North Carolina, and her colleagues wondered if young blood might help heal brains that have been damaged in this way.
Blood from babies and teenagers has previously been shown to reverse brain ageing in older mice, and there are …

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Moderate ultraviolet light exposure boosts the brainpower of mice thanks to increased production of the neurotransmitter glutamate

Is this too fucking hard for your doctors and stroke hospitals to do followup clinical research for this on humans?
The sun’s ultraviolet (UV) radiation is a major cause of skin cancer, but it offers some health benefits too, such as boosting production of essential vitamin D and improving mood. Today (May 17), a report in Cell adds enhanced learning and memory to UV’s unexpected benefits.
Researchers have discovered that, in mice, exposure to UV light activates a molecular pathway that increases production of the brain chemical glutamate, heightening the animals’ ability to learn and remember.
“The subject is of strong interest, because it provides additional support for the recently proposed theory of ultraviolet light’s regulation of the brain and central neuroendocrine system,” dermatologist Andrzej Slominski of the University of Alabama who was not involved in the research writes in an email to The Scientist.
“It’s an interesting and timely paper investigating the skin-brain connection,” notes skin scientist Martin Steinhoff of University College Dublin’s Center for Biomedical Engineering who also did not participate in the research. “The authors make an interesting observation linking moderate UV exposure to . . . [production of] the molecule urocanic acid. They hypothesize that this molecule enters the brain, activates glutaminergic neurons through glutamate release, and that memory and learning are increased.”
While the work is “fascinating, very meticulous, and extremely detailed,” says dermatologist David Fisher of Massachusetts General Hospital and Harvard Medical School, “it does not imply that UV is actually good for you. . . . Across the board, for humanity, UV really is dangerous.”
Wei Xiong of the University of Science and Technology of China who led the research did not set out to investigate the effects of UV light on the brain or the skin-brain connection. He stumbled upon his initial finding “almost accidentally,” he explains in an email to The Scientist. Xiong and his colleagues were using a mass spectrometry technique they had recently developed for analyzing the molecular contents of single neurons, when their results revealed the unexpected presence of urocanic acid—a little-known molecule produced in the skin in response to UV light.
“It was a surprise because we checked through all the literature and found no reports of the existence of this small molecule in the central nervous system,” writes Xiong.
With little information to go on, Xiong and his colleagues decided to see whether UV light could also boost levels of urocanic acid in the brain. They exposed shaved mice to a low-dose of UVB—responsible for sunburn in humans—for 2 hours, then performed mass spectrometry on the animals’ individual brain cells. Sure enough, levels of urocanic acid increased in neurons of the animals exposed to the light, but not in those of control animals.
Urocanic acid can absorb UV rays and, as a result, may be able to protect skin against the sun’s harmful effects. But in the liver and other peripheral tissues, the acid is also known to be an intermediate molecule generated in the metabolic pathway that converts histidine to glutamate. Given glutamate’s role in the brain as an excitatory neurotransmitter, Xiong and his colleagues were interested to test whether the observed UV-dependent increase in urocanic acid in neurons might be coupled with increased glutamate production. It was.
Next, the team showed that UV light enhanced electrical transmission between glutaminergic neurons in brain slices taken from animals exposed to UV, but not in those from control animals. This UV-induced effect was prevented when the researchers inhibited activity of the enzyme urocanase, which converts urocanic acid to glutamate, indicating that the acid was indeed the mediator of the UV-induced boost in glutaminergic activity.
Lastly, the team showed that mice exposed to UV performed better in motor learning and recognition memory tasks than their unexposed counterparts. And, as before, treating the animals with a urocanase inhibitor prevented the UV-induced improvements in learning and memory. Administering urocanic acid directly to animals not exposed to ultraviolet light also spurred similar learning and memory improvements to those achieved with UV exposure.
Whether the results obtained in mice, which are nocturnal and rarely see the sun, will hold true in humans is yet to be determined. But, Fisher says, if the results do hold, the finding that urocanic acid alone can enhance learning and memory might suggest “a way to utilize this information to benefit people without exposing them to the damaging effects of UV.”
H. Zhu et al., “Moderate UV exposure enhances learning and memory by promoting a novel glutamate biosynthetic pathway in the brain,” Cell, doi: 10.1016/j.cell.2018.04.014, 2018.

Telehealth Holds Its Own in Helping Stroke Victims Recover Mobility

So just because you fail at 100% recovery with telehealth; that's ok because you also fail with hospital services. "War is Peace, Ignorance is Strength, Freedom is Slavery."
You'll grab at anything to declare success in stroke. Do we not have anyone in the stroke medical world that actually thinks?

Telehealth Holds Its Own in Helping Stroke Victims Recover Mobility 

- Stroke patients who use telehealth to recover at home do just as well as those who undergo physical rehabilitation at a clinic.
That’s the take-away from a study conducted by Dr. Steven C. Cramer at the University of California at Irvine. Presenting at the 2018 European Stroke Organization Conference in Gothenburg, Sweden, he said patients using telemedicine at home gain as much mobility – if not more – as those traveling to receive in-person rehab.
“Motor deficits are a major contributor to post-stroke disability, and we know that occupational and physical therapy improve patient outcomes in a supervised rehabilitation program,” Cramer, a neurologist and professor of neurology in the UCI School of Medicine, said in a news release issued by UCI. “Since many patients receive suboptimal therapy for reasons that include cost, availability and difficulty with travel, we wanted to determine whether a comprehensive in-home telehealth therapy program could be as effective as in-clinic rehabilitation.”
The six-week study, involving 124 stroke victims at 11 US sites, adds to the body of literature supporting physical therapy services delivered through telehealth and telemedicine not just for stroke, but a wide range of conditions, including post-operative care, chronic conditions and workmen’s comp cases.
Physical therapists and trainers have long sought to develop accepted exercise and rehab programs that allow them to oversee patients in their own homes. In some cases, group homes, assisted care facilities and senior living centers are using the platform to help individual residents or conduct guided group programs.
The movement toward telehealth-aided therapy is expected to gain momentum later this year when the Physical Therapy Licensure Compact goes live, giving physical therapists an expedited path to receiving licenses to practice in member states.
In his study, Cramer split the group of stroke victims - averaging 61 years old, 4.5 months post-stroke, with moderate arm motor deficits at study entry – into two groups, with half undergoing intensive arm therapy through a virtual platform and half undergoing in-person therapy. Those using telehealth were overseen by a licensed occupational/physical therapist.
When examined 30 days after the end of the therapy program, those using telehealth saw an improvement of 8.4 points on the Fugi-Meyer scale, which measures arm function on a scale of 0 to 66; those using in-person therapy saw an improvement of 7.9 points.
“The current findings support the utility of a computer-based system in the home, used under the supervision of a licensed therapist, to provide clinically meaningful rehab therapy,” Said Cramer, whose study was supported by the National Institutes of Health. “Future applications might examine longer-term treatment, pair home-based telerehab with long-term dosing of a restorative drug, treat other neurological domains affected by stroke (such as language, memory, or gait), or expand the home treatment system to build out a smart home for stroke recovery.”
“Getting patients to remain engaged and comply with therapy is a key measure of success of any rehabilitation program,” he added. “Greater gains are associated with therapy that is challenging, motivating, accompanied by appropriate feedback, interesting and relevant. Telerehab achieves this because therapy is provided through games, provides user feedback, can be adjusted based on individual needs, is easy to use – and is fun.”


Prediction of Tissue Outcome and Assessment of Treatment Effect in Acute Ischemic Stroke Using Deep Learning

Oh fuck, another prediction tool. Survivors don't care about prediction you blithering idiots. They want 100% recovery. GET THERE! Have you ever talked to survivors?
Anne Nielsen, Mikkel Bo Hansen, Anna Tietze, Kim Mouridsen
Stroke. 2018;49:1394-1401
Originally published May 2, 2018

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Background and Purpose—Treatment options for patients with acute ischemic stroke depend on the volume of salvageable tissue. This volume assessment is currently based on fixed thresholds and single imagine modalities, limiting accuracy. We wish to develop and validate a predictive model capable of automatically identifying and combining acute imaging features to accurately predict final lesion volume.
Methods—Using acute magnetic resonance imaging, we developed and trained a deep convolutional neural network (CNNdeep) to predict final imaging outcome. A total of 222 patients were included, of which 187 were treated with rtPA (recombinant tissue-type plasminogen activator). The performance of CNNdeep was compared with a shallow CNN based on the perfusion-weighted imaging biomarker Tmax (CNNTmax), a shallow CNN based on a combination of 9 different biomarkers (CNNshallow), a generalized linear model, and thresholding of the diffusion-weighted imaging biomarker apparent diffusion coefficient (ADC) at 600×10−6 mm2/s (ADCthres). To assess whether CNNdeep is capable of differentiating outcomes of ±intravenous rtPA, patients not receiving intravenous rtPA were included to train CNNdeep, −rtpa to access a treatment effect. The networks’ performances were evaluated using visual inspection, area under the receiver operating characteristic curve (AUC), and contrast.
Results—CNNdeep yields significantly better performance in predicting final outcome (AUC=0.88±0.12) than generalized linear model (AUC=0.78±0.12; Tmax
(AUC=0.72±0.14; thres (AUC=0.66±0.13; P<0.0001) and a substantially better performance than CNNshallow (AUC=0.85±0.11; P=0.063). Measured by contrast, CNNdeep improves the predictions significantly, showing superiority to all other methods (P≤0.003). CNNdeep also seems to be able to differentiate outcomes based on treatment strategy with the volume of final infarct being significantly different (P=0.048).
Conclusions—The considerable prediction improvement accuracy over current state of the art increases the potential for automated decision support in providing recommendations for personalized treatment plans.

Population-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke

You'll have to bring this to your doctors attention if you are in this cohort; seizures occur in about 10% of stroke patients. 
Or maybe you want this:

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them?

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

Population-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke  

Alexander E. Merkler, Gino Gialdini, Michael P. Lerario, Neal S. Parikh, Nicholas A. Morris, Benjamin Kummer, Lauren Dunn, Michael E. Reznik, Santosh B. Murthy, Babak B. Navi, Zachary M. Grinspan, Costantino Iadecola, Hooman Kamel
Stroke. 2018;49:1319-1324
Originally published April 25, 2018
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Background and Purpose—We sought to determine the long-term risk of seizures after stroke according to age, sex, race, and stroke subtype.
Methods—We performed a retrospective cohort study using administrative claims from 2 complementary patient data sets. First, we analyzed data from all emergency department visits and hospitalizations in California, Florida, and New York from 2005 to 2013. Second, we evaluated inpatient and outpatient claims from a nationally representative 5% random sample of Medicare beneficiaries. Our cohort consisted of all adults at the time of acute stroke hospitalization without a prior history of seizures. Our outcome was seizure occurring after hospital discharge for stroke. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR).
Results—Among 777 276 patients in the multistate cohort, the annual incidence of seizures was 1.68% (95% confidence interval [CI], 1.67%–1.70%) after stroke versus 0.15% (95% CI, 0.15%–0.15%) among the general population (IRR, 7.3; 95% CI, 7.3–7.4). By 8 years, the cumulative rate of any emergency department visit or hospitalization for seizure was 9.27% (95% CI, 9.16%–9.38%) after stroke versus 1.21% (95% CI, 1.21%–1.22%) in the general population. Stroke was more strongly associated with a subsequent seizure among patients <65 years of age (IRR, 12.0; 95% CI, 11.9–12.2) than in patients ≥65 years of age (IRR, 5.5; 95% CI, 5.4–5.5) and in the multistate analysis, the association between stroke and seizure was stronger among nonwhite patients (IRR, 11.0; 95% CI, 10.8–11.2) than among white patients (IRR, 7.3; 95% CI, 7.2–7.4). Risks were especially elevated after intracerebral hemorrhage (IRR, 13.3; 95% CI, 13.0–13.6) and subarachnoid hemorrhage (IRR, 13.2; 95% CI, 12.8–13.7). Our study of Medicare beneficiaries confirmed these findings.
Conclusions—Almost 10% of patients with stroke will develop seizures within a decade. Hemorrhagic stroke, nonwhite race, and younger age seem to confer the greatest risk of developing seizures.

An ingestible bacterial-electronic system to monitor gastrointestinal health

With any brains at all amongst our stroke medical professionals we could use this to determine the exact diet needed for optimum brain health using the gut-brain axis. But that won't occur because we have fucking failures of stroke associations.
23 posts on gut bacteria.
5 posts on gut microbes.
7 posts on gut microbiome.
3 posts on gut microbiota.
Even with all this information on gut-brain axis nothing will be done by your stroke medical professionals.
See allHide authors and affiliations
Science  25 May 2018:
Vol. 360, Issue 6391, pp. 915-918
DOI: 10.1126/science.aas9315
You are currently viewing the abstract.
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Biomolecular monitoring in the gastrointestinal tract could offer rapid, precise disease detection and management but is impeded by access to the remote and complex environment. Here, we present an ingestible micro-bio-electronic device (IMBED) for in situ biomolecular detection based on environmentally resilient biosensor bacteria and miniaturized luminescence readout electronics that wirelessly communicate with an external device. As a proof of concept, we engineer heme-sensitive probiotic biosensors and demonstrate accurate diagnosis of gastrointestinal bleeding in swine. Additionally, we integrate alternative biosensors to demonstrate modularity and extensibility of the detection platform. IMBEDs enable new opportunities for gastrointestinal biomarker discovery and could transform the management and diagnosis of gastrointestinal disease.
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New Parts of the Brain Become Active After Students Learn Physics - Study

Would learning physics be more important than learning a new musical instrument for dementia prevention and recovery from your stroke? Informed stroke survivors want to know. I'd suggest 'The Physics of Superheroes' by James Kakalios, who is a professor in the School of Physics and Astronomy at the University of Minnesota.
12 posts on music training back to June 2014.

New Parts of the Brain Become Active After Students Learn Physics - Study 

May 24, 2018

A person looking at a brain image on a monitor while someone else is helped into an MRI in the background.
Scanning using fMRI determined that physics learning activated new parts of the brain. Photo courtesy of Florida International University.

Parts of the brain not traditionally associated with learning science become active when people are confronted with solving physics problems, a new study shows.

The researchers, led by Eric Brewe, PhD, an associate professor in Drexel University’s College of Arts and Sciences, say this shows that the brain’s activity can be modified by different forms of instruction.

Using fMRI (functional magnetic resonance imaging) to measure blood flow in the brain, the researchers looked to map what areas become active when completing a physics reasoning task, both before a course on the concepts and after.

“The neurobiological processes that underpin learning are complex and not always directly connected to what we think it means to learn,” Brewe said of the findings, which were published in Frontiers in ICT.

More than 50 volunteer students took part in the study in which they were taught a physics course that utilized “Modeling Instruction,” a style of teaching which encourages students to be active participants in their learning. 

Before they participated in the class, the students answered questions from an abridged version of the Force Concept Inventory while undergoing fMRI. The Force Concept Inventory is a test that assesses knowledge of physics concepts commonly taught in early college physics classes. 

After the volunteer students completed their physics course, they again took the Force Concept Inventory, once more monitored by fMRI.

In the pre-instruction scans, parts of the brain associated with attention, working memory and problem solving — the lateral prefrontal cortex and parietal cortex, sometimes called the brain’s “central executive network” — showed activity.

“One of the keys seemed to be an area of the brain, the dorsal lateral prefrontal cortex, that generates mental simulations,” Brewe said. “This suggests that learning physics is an imaginative process, which is not typically how people think of it.”

A person looking up at a mirror in an MRI machine
A person during fMRI scanning on their brain as a part of the study. Photo courtesy of Florida International University.

After the subjects had completed their class, comparison of the pre- and post-learning scans revealed increased activity in the frontal poles, which was to be expected since they’ve been linked to learning. But there was another area that also became active: the posterior cingulate cortex, which is linked to episodic memory and self-referential thought.

“These changes in brain activity may be related to more complex behavioral changes in how students reason through physics questions post- relative to pre-instruction,” Brewe and his co-authors wrote about the study. “These might include shifts in strategy or an increased access to physics knowledge and problem-solving resources.”

One of the aims of the study was to further explore how the form of teaching used, Modeling Instruction, encourages students to use their own mental models to understand new concepts. 

“The idea of mental models is something that people who research learning love to talk about, but have no evidence of what is happening inside brains other than what people say or do,” Brewe said. “We are actually looking for evidence from inside the brain.”

As such, Brewe and his fellow researchers think their study provides a good look at what might be typical when these “mental models” take hold.

But why physics? What makes this the ideal subject to study mental modeling in the brain?

Brewe said that there has been some research on the brain networks associated with learning math and reading. But mental modeling especially lends itself to physics, which has not gotten as much attention.

“Physics is a really good place to understand learning for two reasons,” Brewe said. “First, it deals with things that people have direct experience with, making formal classroom learning and informal understanding both relevant and sometimes aligned — and sometimes contrasted.”

“Second, physics is based in laws, so there are absolutes that govern the way the body works,” Brewe finished.

Moving forward, Brewe is excited by what this study opens up in his quest to improve physics learning in the United States and beyond.

“I would like to follow up on the question of mental simulations in physics, to see where that shows up at different levels of physics learning and with different populations,” he said. “But this whole study opens up many new areas of investigations and I’m pretty excited about how it will play out.”