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, October 21, 2016

Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study

By focusing on blaming the patient these researchers are giving the ok to not even try to solve ANY of the fucking problems in stroke. 'You caused your own stroke, live with the consequences', not a direct quote but implied.
Prof Denis Xavier, MD
Prof Lisheng Liu, MD
Prof Hongye Zhang, MD
Prof Prem Pais, MD
Prof Matthew J McQueen, MBChB
Prof Graeme J Hankey, FRACP
Prof Antonio L Dans, MD
Prof Khalid Yusoff, FRCP
Prof Ralph L Sacco, MD
Prof Xingyu Wang, PhD
Prof Salim Yusuf, DPhil
, on behalf of the INTERSTROKE investigators
Members listed at end of paper
This article can be found in the following collections: Cerebrovascular disease



The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction.


We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days of symptoms onset and 72 h of hospital admission). Controls had no history of stroke, and were matched with cases for age and sex. All participants completed a structured questionnaire and a physical examination, and most provided blood and urine samples. We calculated odds ratios (ORs) and population-attributable risks (PARs) for the association of all stroke, ischaemic stroke, and intracerebral haemorrhagic stroke with selected risk factors.


In the first 3000 cases (n=2337, 78%, with ischaemic stroke; n=663, 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all stroke were: history of hypertension (OR 2·64, 99% CI 2·26–3·08; PAR 34·6%, 99% CI 30·4–39·1); current smoking (2·09, 1·75–2·51; 18·9%, 15·3–23·1); waist-to-hip ratio (1·65, 1·36–1·99 for highest vs lowest tertile; 26·5%, 18·8–36·0); diet risk score (1·35, 1·11–1·64 for highest vs lowest tertile; 18·8%, 11·2–29·7); regular physical activity (0·69, 0·53–0·90; 28·5%, 14·5–48·5); diabetes mellitus (1·36, 1·10–1·68; 5·0%, 2·6–9·5); alcohol intake (1·51, 1·18–1·92 for more than 30 drinks per month or binge drinking; 3·8%, 0·9–14·4); psychosocial stress (1·30, 1·06–1·60; 4·6%, 2·1–9·6) and depression (1·35, 1·10–1·66; 5·2%, 2·7–9·8); cardiac causes (2·38, 1·77–3·20; 6·7%, 4·8–9·1); and ratio of apolipoproteins B to A1 (1·89, 1·49–2·40 for highest vs lowest tertile; 24·9%, 15·7–37·1). Collectively, these risk factors accounted for 88·1% (99% CI 82·3–92·2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90·3% (85·3–93·7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke.


Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke.


Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, and Boehringer Ingelheim.

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Wednesday, October 19, 2016

Cryptogenic stroke

Unknown origin of the stroke. As a computer programmer my manager never let me get away with saying the problem could not be explained or solved. If I continued to make excuses I would have been fired.  Your neurologist should never be let off the hook and not explain the origin of the stroke. I don't care how fucking long it takes, I have spent 3-6 months at a time solving some of my most difficult challenges.

Hospital saw three adult ADHD patients with ischemic stroke in one week

UCLA-led study shows treatment can provide benefits up to 7.3 hours after onset of stroke

Yet your doctors are doing fucking nothing in the first week to stop the neuronal cascade of death by these 5 causes. 

Time is of the essence when getting people stricken with acute ischemic strokes to treatment. And the use of stent retrievers — devices that remove the blood clot like pulling a cork out of a wine bottle — has proven to be a breakthrough for removing the life-threatening blockage of blood flow to the brain.
Current professional guidelines recommend that the procedure be performed within six hours for people to benefit. But researchers on a UCLA-led study published today in the Journal of the American Medical Association have found that the procedure has benefits for people up to 7.3 hours following the onset of a stroke.
"Extending the time window for therapy will let us help more patients, including patients who were not able to get to a hospital right away because the stroke started while they were asleep or made them unable to call for help," said Dr. Jeffrey Saver, director of the UCLA Comprehensive Stroke Center and the study's lead author.
The researchers also found that for each six-minute delay, there is a 1 percent increase in the proportion of people who end up disabled, underscoring the need for people to seek treatment as quickly as possible when they experience symptoms of a stroke. The study examined the relationship between the onset of the stroke, the amount of time until the blockage was treated and patient outcomes.
The first coil-shaped clot retriever was invented at UCLA and cleared for use in 2004. For this study, researchers primarily used a newer generation of stent retrievers, which were cleared for use in 2012. First, doctors insert the small mesh tubes through an artery in the leg to the blockage in the artery that takes blood to the brain. Next, they open the mesh tubes in the middle of the clot and then extract the stent and the clot to restore blood flow to the brain.
The current study combines data from five clinical trials involving a total of 1,287 people, including the SWIFT PRIME trial led by Saver, that show these devices improved outcomes for people with acute ischemic strokes due to large vessel blockage. The researchers analyzed the relationship between time from onset of the blockage to treatment and outcome among these patients.
The researchers found that people treated earlier with the retrievers plus standard medical therapy were less likely to be disabled three months after surgery than people who only received medical therapy. Outcomes were the best if the procedure was done within the first two hours of a stroke, but those treated up to 7.3 hours after a stroke continued to show a lesser benefit.
Earlier treatment is better than later treatment to restore blood flow and prevent or limit damage to the brain, Saver noted.
"It is important for the public to know the critically important relationship between time to treatment and outcome, so they know to activate the 911 system as soon as possible when they detect stroke symptoms in themselves or friends, family and co-workers," he said. "And it is important to reorganize regional systems of stroke care to ensure that ambulances transport appropriate patients to hospitals that perform this procedure quickly and safely."
The people in these trials were seen at mostly academic medical centers, so the question remains as to whether these same results can be achieved at non-academically affiliated medical centers. Other elements that could skew the results include differences in trial entry criteria and patient characteristics, and that these results may not apply to people who did not qualify for the trials.
In future studies, the researchers plan to use brain imaging techniques to determine if it is possible to identify a specific, smaller group of people who can benefit from the clot retrieval therapy seven to 24 hours after stroke onset, said Dr. Reza Jahan, professor of radiology and neurosurgery at UCLA, and a co-author of the study.
University of California, Los Angeles (UCLA), Health Sciences

Review highlights urgent demand for tool to identify stroke survivors with visual impairments

You mean to tell me that in the whole world there is no tool/protocol to identify visual problems? What a fucking show of incompetence. Led by incompetent ASA, NSA and WSO.
A University of Liverpool led review of the methods available to screen for post-stroke visual impairments has found there is an urgent demand for the development of a tool.
Currently, over 65% of stroke survivors will suffer from a visual impairment while 45% of stroke units do not assess vision.
Visual impairment significantly reduces the quality of life of stroke survivors with many being unable to return to work or drive and in some cases results in depression. The impairments can also have an impact on other people when it is not diagnosed or sufficiently communicated to patients.
Quality of life
Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.
The review, led by postgraduate researcher Kerry Hanna from the University's Institute of Psychology, Health and Society, examined the available literature about current screening methods to accurately identify stroke survivors with visual impairments.
This included reviews of randomised controlled trials, controlled trials, cohort studies, observational studies, systematic reviews and retrospective medical note reviews.
The review, published in 'The Journal of Disability and Rehabilitation' today, found that there is currently no standardised visual screening tool which can accurately assess all potential post stroke visual impairments.
Visual defects missed
Kerry Hanna, said: "The current tools screen for only a number of potential stroke-related impairments meaning many visual defects may be missed.
"The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms.
"Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed."
University of Liverpool

American Academy of Physical Medicine and Rehabilitation (AAPMR) 2016 Annual Assembly

If this gathering of physiatrists is focused on outcomes then there should a presentation on the disasterous results of stroke rehabilitation of only 10% full recovery.
A study on the surgical treatment of scoliosis in patients with Duchenne muscular dystrophy is just one of the presentations that will underscore the specialty's increasing emphasis on evidence-based outcomes, according to organizers here at the American Academy of Physical Medicine and Rehabilitation (AAPMR) 2016 Annual Assembly.
The research, led by David Berbrayer, MD, from the University of Toronto Sunnybrook Health Sciences Centre, casts doubts on the overall benefits of surgery in this patient population.
This is a "really good example of the need for evidence-based medicine," said Joseph Hornyak, MD, PhD, from the C.S. Mott Children's Hospital at the University of Michigan in Ann Arbor, who is chair of the AAMPR evidence committee.
"It doesn't give a definitive answer, but it raises concerns," he told Medscape Medical News.
Other leading presentations cover a diverse array of topics, such as the impact of vitamin D on mood in patients with spinal cord injury, factors associated with patient discharge after acute stroke rehabilitation, and concussion symptom reporting in high-school athletes.
The concussion study, led by Nathan Cook, PhD, from the Massachusetts General Hospital and Harvard Medical School in Boston, examines the reporting of concussion symptoms by high-school students with attention deficit hyperactivity disorder (ADHD), a condition that can make it challenging to differentiate pre-existing symptoms from concussion symptoms.
Dr Joseph Hornyak
Teenagers with ADHD probably have an increased risk for concussion, Dr Hornyak said.
"This is a huge study, with 37,000 high-school athletes, comparing a control group with an ADHD group on medication. It will be very interesting to see the symptom complex between these different populations," he added.
Concussion will also be the subject of a plenary session that features Bennet Omalu, MD, the renowned forensic pathologist who inspired the film Concussion about chronic traumatic encephalopathy.
Dr Thiru Annaswamy
"We're focusing on outcomes a lot more these days," said Thiru Annaswamy, MD, from the University of Texas Southwestern Medical Center, the VA North Texas Health Care System, and the Dallas VA Medical Center, who is chair of the AAPMR evidence, quality, and performance committee.
"The stroke rehabilitation abstract is a great example of an examination of predictors of good outcomes. Focusing on outcomes helps us establish and prove the value of rehabilitation in several conditions, which is increasingly necessary with healthcare reform," he explained.
Dr Annaswamy said he is excited about an analysis being presented on two types of wheelchair propulsion to determine which pattern results in more arm fatigue. The study is "very pertinent for our paraplegics and others who use wheelchairs to get around," he said. "It's very impactful, and there's good science behind it."
Just as appealing as the research presentations, Dr Annaswamy pointed out, is the diverse offering of clinical sessions and hands-on workshops, which will cover topics such as regenerative medicine, ultrasound, cancer rehabilitation, medicolegal work, and opioid prescribing.

We're focusing on outcomes a lot more these days
"These sessions are probably the most widely attended for educational content," he said. "Typically hundreds attend, and sometimes it is into the thousands."
Also on the agenda are political pundits James Carville and Mary Matalin — one of America's most influential political couples — who will make an appearance at the plenary sessions discussing the impact of the current political climate on healthcare.
"In today's political climate, any discussion about healthcare could be very interesting, and they're a good couple to present both sides," Dr Hornyak told Medscape Medical News.
Offbeat conference features include a wheelchair basketball tournament, which will give physiatrists greater insight into adaptive sports. And once again, the AAPMR is hosting its annual movement competition. Attendees can track the distance they travel each day with a pedometer or mobile app, and top scorers will be recognized.

Tuesday, October 18, 2016

2017 Minnesota Cardiovascular Emergencies Conference

I'm going to put in a topic, 'Stroke: The Way Forward; How to solve the intractable problems in stroke!' I'm sure it will be rejected but the conference organizers will wonder who the hell this non-medical stroke survivor thinks he is that he has something important to say to us learned stroke medical people. Well, select me and you'll find out what a barn burner speech it will be. I will not be following Dale Carnegie, 'How to Win Friends and Influence People'.

We are pleased to announce that the Call for Presentation Proposals is now open for the 2017 Minnesota Cardiovascular Emergencies Conference to be held in June of 2017 in the St. Paul-Minneapolis metropolitan area.
We are seeking dynamic and engaging oral presenters on one or more of the following topics related to stroke, STEMI, sudden cardiac arrest and other cardiovascular conditions:
  • Quality
  • Reducing readmissions/transitions of care
  • Patient/public education and engagement
  • Research and technologies in stroke and STEMI care
  • EMS and pre-hospital care
  • Acute hospital care
  • Hemorrhagic stroke
  • Rehabilitation
  • Pharmacy
The deadline for completing the Presentation Proposal Submission Form is November 14, 2016. You will find the form on the 2017 Minnesota Cardiovascular Emergencies Conference webpage.

A Strange Cure for Lack of Sleep

I could have used this in the hospital. I might have fully recovered in the 5 weeks I spent there.
Just believing that you’ve slept better than you really have is enough to boost cognitive performance the next day, a recent study finds.
The research, published in the Journal of Experimental Psychology: Learning, Memory and Cognition, divided 164 people into two groups (Draganich & Erdal, 2014).
Both were given a lecture on the importance of sleep quality and dangers of lack of sleep.
They were also told that the average amount of REM (Rapid Eye Movement) sleep that people get each night is 20%.
Their ‘brainwave frequency’ was then measured and they were shown formulas and spreadsheets.
All these measurements were a sham.
Despite this:
  • One group was told they’d got ‘above average’ sleep quality, spending 28.7% in REM sleep.
  • The other group was told they’d got ‘below average’ sleep, spending just 16.2% in REM sleep.
These numbers had no relationship to any lack of sleep or the REM phase of sleep and were just made up to try and convince one group they’d slept better than the other.
Afterwards, all the participants were given a battery of cognitive tests.
Those told they’d slept better scored higher on tests of attention and memory than those told they’d slept poorly.
Interestingly, the researchers also collected self-reported data on how people thought they had slept the previous night.

Injectable Wires for Fixing the Brain

Measuring the behavior of neurons next to this mesh should be able to identify exactly what occurs during neuroplasticity. What signals are sent to neighboring neurons to cause the next door neighbor to discard existing functions and take on new ones?  But this will never occur because we have shit for brains in stroke leadership. Hell I could design laying down new functionality in a new area to replace dead brain functions.I'd be glad to lose toe movement to restore fingers. This BHAG(Big Hairy Audacious Goal)  is doable, let me at it.
In a basement laboratory at Harvard University, a few strands of thin wire mesh are undulating at the bottom of a cup of water, as if in a minuscule ribbon dance. The meshes—about the length of a pen cap—are able to do something unprecedented: once injected into the brain of a living mouse, they can safely stimulate individual neurons and measure the cells’ behavior for more than a year.
Electronic brain interfaces like these could someday be crucial for people with neurological diseases such as Parkinson’s. The disease causes a group of neurons in one area of the brain to begin dying off, triggering uncontrollable tremors and shakes. Sending targeted electrical jolts to this area can help whip the living neurons back into shape and stop Parkinson’s symptoms.
Today people can undergo an electrical treatment called deep brain stimulation. But it has big limitations. It involves implanting rigid, dense electrodes in the brain. That’s far from ideal in such a soft organ: after about four weeks, scar tissue begins to build up. The only way to get the electrodes to work through this tissue is to keep upping the voltage used to excite the neurons. That can be dangerous, and sometimes another surgery is required to replace the implant.
Pictures at link. Can be injected thru a needle

How your BMI might affect your brain function

Since I'm at a BMI of 29 - overweight - I will need to find ways to reduce inflammation on my own since I'm 100% sure there are no protocols to follow to do that. I'm not sure I have enough brainpower or time to tackle this problem also.
There are plenty of reasons it's important to maintain a healthy weight, and now you can add one more to the list: It may be good for your brain.
Researchers from the University of Arizona have found that having a higher body mass index, or BMI, can negatively impact cognitive functioning in older adults.
How? They say inflammation is to blame.
"The higher your BMI, the more your inflammation goes up," said Kyle Bourassa, lead author of the study, which is published in the journal Brain, Behavior and Immunity. "Prior research has found that inflammation—particularly in the brain—can negatively impact brain function and cognition."
Previous studies also have linked higher BMI—an index of body fat based on height and weight—to lower . But how and why the two are connected was far less clear.
"We saw this effect, but it's a black box. What goes in between?" said Bourassa, a UA psychology doctoral student. "Establishing what biologically plausible mechanisms explain this association is important to be able to intervene later."
Bourassa and his co-author, UA psychology professor David Sbarra, analyzed data from the English Longitudinal Study of Aging, which includes over 12 years' worth of information on the health, well-being and social and economic circumstances of the English population age 50 and older.
Using two separate samples from the study—one of about 9,000 people and one of about 12,500—researchers looked at aging adults over a six-year period. They had information on study participants' BMI, inflammation and cognition, and they found the same outcome in both samples.
"The higher participants' body mass at the first time point in the study," Bourassa said, "the greater the change in their CRP levels over the next four years. CRP stands for C-reactive protein, which is a marker in the blood of systemic inflammation in your body. Change in CRP over four years then predicted change in cognition six years after the start of the study. The body mass of these people predicted their cognitive decline through their levels of systemic inflammation."
The findings support existing literature linking inflammation to cognitive decline and take it a step further by illuminating the important role of body mass in the equation.
Sbarra added a word of caution in trying to understand the findings.
"The findings provide a clear and integrative account of how BMI is associated with through , but we need to remember that these are only correlational findings," he said. "Of course, correlation does not equal causation. The findings suggest a mechanistic pathway, but we cannot confirm causality until we reduce body mass experimentally, then examine the downstream effects on inflammation and cognition."
"Experimental studies finding whether reducing inflammation also improves cognition would be the gold standard to establish that this is a causal effect," Bourassa added.
Cognitive decline is a normal part of aging, even in healthy adults, and can have a significant impact on quality of life. The current research may provide valuable insights for possible interventions and new research directions in that area.
"If you have high inflammation, in the future we may suggest using anti-inflammatories not just to bring down your inflammation but to hopefully also help with your cognition," Bourassa said.
Of course, maintaining a is also good for overall health, he added.
"Having a lower is just good for you, period. It's good for your health and good for your brain," Bourassa said.
More information: Kyle Bourassa et al, Body mass and cognitive decline are indirectly associated via inflammation among aging adults, Brain, Behavior, and Immunity (2016). DOI: 10.1016/j.bbi.2016.09.023

Journal reference: Brain, Behavior, and Immunity search and more info website
Provided by: University of Arizona search and more info website

Pharma CEO: We’re in Business of Shareholder Profit, Not Helping the Sick

Don't ever expect companies like this to find drugs to help stroke survivors. Finding and approving a drug is way too expensive with an uncertain chance of working. This is precisely why we need a great stroke association running clinical trials and creating drugs, getting the money from foundations who want to be associated with successful interventions that help reduce the impact of stroke. This is a no-brainer but with never occur with the fucking failures of stroke associations we have today.
Last month, Martin Shkreli became a household name. The CEO of Turing Pharmaceuticals is now infamous for raising the price of a newly-acquired drug to $750 a pill. He also explained in an interview that his company was not alone in acquiring drugs currently on the market to raise their price and, in turn, rapidly drive up their stock price.
Enter J. Michael Pearson,  The current CEO of Valeant Pharmaceuticals who recently said that his company’s responsibility is to its shareholders, while making no mention of his customers who rely on his drugs to live.
“If products are sort of mispriced and there’s an opportunity, we will act appropriately in terms of doing what I assume our shareholders would like us to do.”
Already this year, Valeant has increased the price of 56 of the drugs in its portfolio an average of 66 percent, highlighted by their recent acquisition, Zegerid, which they promptly raised 550 percent. Not only does this have the unfortunate side effect of placing the price of life-saving drugs out of reach for even moderately-insured people, but it has now begun to call into question the sustainability of this rapidly-spreading business model.
In an interview with CNBC, Pearson defended his business practice of acquiring drugs instead of investing in research and development.
“My primary responsibility is to Valeant shareholders. We can do anything we want to do. We will continue to make acquisitions, we will continue to move forward.”
Since being named CEO in 2008, Valeant has acquired more than 100 drugs and seen their stock price rise more than 1,000 percent with Pearson at the helm. But it appears that all of the public backlash over price gouging of prescription drugs, which has included both Hillary Clinton and Bernie Sanders taking a stance against the practice as a platform in their respective presidential campaigns, has placed the practice under tremendous scrutiny.
The House Committee on Oversight and Government Reform is planning to issue a subpoena for information on recent price increases from both Pearson and Shkreli.
And that pending investigation has sent Valeant’s stock price tumbling more than 27 percent in the last month, which may have shareholders concerned enough to wonder if Pearson pushed too hard for too long.

“Stroke clearly is a brain disease”

Why it is not even a disease at all, you just stabilize them and push them out to home care, similar to colds. Reading between the lines of ASA, NSA and WSO pronouncements; stroke is perfectly taken care of with F.A.S.T. Nothing to fix there at all. Sarcasm notifications needed in my posts.
International experts concerned about WHO moves in classification process
“The medical rationale for stroke being a disease of the brain is overwhelming.” This is the key message of an urgent appeal launched by leading neurology experts in The Lancet.1 The authors are making public their concern about the classification of stroke in the draft revision of the “International Statistical Classification of Diseases and Related Health Problems” (ICD) after an unexpected and uncoordinated change in the classification scheme made by WHO staff.
The ICD-10 currently in place is based on outdated medical knowledge and concepts from the 1980s. The new ICD-11, which has been under discussion since 2009, is aimed at reflecting the changes in science and practice.
“There are very good reasons that we agreed five years ago, in a transparent process and after extensive debate in the WHO Neuroscience Topic Advisory Group and with WHO representatives, that all types of stroke should form a single block in the new classification that should be part of the nervous system disease chapter”, explained Prof Raad Shakir, head of the advisory body and President of the World Federation of Neurology. “All manifestations of cerebrovascular disease are related to brain dysfunction. The relationship with dementia and particularly Alzheimer’s disease is becoming clearer.”
According to Prof Shakir, the unilateral decision by WHO staff to move the newly created cerebrovascular thematic block from neurology to circulatory disease is not only incomprehensible, but also “did not follow the expected transparency of WHO decision-making.”
“The main purpose of any enduring classification should be to serve the interests of patients, which is not the case unless stroke is acknowledged as being a brain disease”, the authors of the comment cautioned. “The latest classification decision with respect to stroke needs to be reversed in order to safeguard patient care and provide correct figures and funding for health care provision.”
1 Revising the ICD: stroke is a brain disease. Raad Shakir, Steve Davis, Bo Norrving, Wolfgang Grisold, William M Carroll, Valery Feigin, Vladimir Hachinski; The Lancet, published online 13 October 2016: journals/lancet/article/ PIIS0140-6736(16)31850-5/ fulltext?rss=yes

Fluoride combined with even trace amounts of aluminum in water can cause major brain damage

Your choice on what to believe.
The reporter who seems to have done no fact-checking:

Monday, October 17, 2016

Glyburide Promising for Treatment of Acute Ischemic Stroke

First written about in Jan. 2012. I bet it will take another dozen years before it possibly gets to clinical treatment. With some actual stroke leadership we could get this done much faster, but hey, it is only stroke survivors being impacted, not anyone from the stroke medical world. And this is only a small percent so no big deal.

Exciting Data from Remedy Pharmaceutical-Sponsored Stroke Drug Trial to Be Presented at the 2012 International Stroke Conference in New Orleans

 The latest here:

 Glyburide Promising for Treatment of Acute Ischemic Stroke

Data from the Safety and Efficacy of Intravenous Glyburide on Brain Swelling after Large Hemispheric Infarction (GAMES-RP) trial was recently published in Lancet Neurology, with analysis on a new targeted therapy for malignant cerebral edema in stroke patients.
As a follow up to a pilot feasibility trial published in 2014,1 the GAMES-RP study is the next step exploring the clinical relevance of the inducible sulfonylurea receptor 1 (SUR1)-transient receptor potential melastatin 4 (TRPM4) channel blockade in reducing cerebral edema in acute ischemic stroke in hopes of reducing morbidity and mortality.2,3
In the current study, 86 patients with large (82-300 cc) anterior circulation stroke were randomized to intravenous glyburide or placebo. The primary outcome was the proportion of patients who achieved a modified Rankin scale (mRS) of greater than 4 at 90 days without undergoing decompressive craniectomy. Secondary outcomes examined markers that were believed to be surrogates for efficacy of glyburide and included proportion of patients who required decompressive hemicraniectomy and changes in measures of swelling.
Although the study did not demonstrate efficacy of glyburide in terms of the primary endpoint, differences were seen in the amount midline shift at 3-4 days, showing some insight into the mechanisms of cerebral edema in acute ischemic stroke. It is also important to note that the study was stopped early due to lack of funding, leading to an underpowered analysis in regards to primary outcome.
In an accompanying editorial,4 Professor Graeme Hankey, MD, pointed out the promise and the pitfalls of GAMES-RP. The results are consistent with the pilot study, furthering the notion that SUR1 plays an important role in the pathogenesis of subsequent cerebral edema and is a viable target for therapy. The consequences of an unfortunate lapse in funding and the variability of decompressive hemicraniectomy certainly affect the outcome data, as well as the “generous” mean interval of 9 hours from stroke onset to treatment.
Currently, the only approved pharmacologic treatment in acute ischemic stroke is alteplase (tPA).5 For patients who are not candidates for tPA or thrombectomy, therapeutic options are limited. Patients with large ischemic strokes are at risk for complications related to subsequent cerebral edema. Currently these complications can be treated with hyperosmolar therapy and in some cases hemicraniectomy. SUR1 is a novel target aimed at reducing cerebral edema, an important cause of mortality and morbidity in acute ischemic stroke.
In current practice, many patients who are older than 60 and present to an ICU with a large hemispheric stroke would be deemed poor candidates for decompressive hemicraniectomy due to higher mortality and odds of poorer outcomes6–8 with surgery. In this patient population in particular, options are limited and often ends with withdrawal of care. Novel targets aimed at pathology that causes increased morbidity and mortality are sorely lacking.
It is for these patients in particular that SUR1 antagonism may play a key role in improving outcome. Despite being a negative trial, intravenous glyburide was proven to be a safe treatment with enough promise for a phase 3 efficacy trial. Shortcomings from GAMES-RP has proven useful to inform the design for the CIRARA in large Hemispheric infarction Analyzed for modified Rankin scale and Mortality (CHARM) trial, which will seek to answer the question of whether targeted therapy with glyburide can improve the outcome of high risk patients with large acute strokes.


  1. Sheth KN, Kimberly WT, Elm JJ, et al. Pilot Study of Intravenous Glyburide in Patients With a Large Ischemic Stroke. Stroke. 2013;45(1).
  2. Simard JM, Sheth KN, Kimberly WT, et al. Glibenclamide in Cerebral Ischemia and Stroke. Neurocrit Care. 2014;20(2):319-333.
  3. Simard JM, Chen M, Tarasov K V, et al. NIH Public Access. 2009;12(4):433-440. doi:10.1038/nm1390.
  4. Hankey GJ, Righetti E, Celani M, et al. Glyburide for cerebral oedema: could an old dog have a new trick? Lancet Neurol. 2016;15(11):1109-1111.
  5. Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
  6. Dasenbrock HH, Robertson FC, Aziz-Sultan MA, et al. Patient Age and the Outcomes after Decompressive Hemicraniectomy for Stroke: A Nationwide Inpatient Sample Analysis. Neurocrit Care. 2016;1-13.
  7. Huttner HB, Schwab S. Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol. 2009;8(10):949-958.
  8. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6(3):215-222.

Playing cards are just the trick to help stroke victims improve their motor skills

What a joke. Any finger/hand exercises will bring back functionality if those control areas are in the penumbra.  Come up with a solution when that area is dead and I will be impressed. But this was totally useless research, the outline of this type of recovery has been known for decades. And it would not have been repeated if we have a publicly available database of stroke protocols. And since this was for recent survivors you can't distinguish between spontaneous recovery and these interventions.
My mum and dad used to play card games endlessly as they got older, and they were both alive and kicking into their late 80s. Now we may know why – it was playing cards.
Playing these, especially ones like snap, can even help stroke patients recover. Canadian researchers have found they improve patients’ motor skills because of the need for coordinated movement, mobility and dexterity.
Playing Jenga, bingo or a games console such as a Nintendo Wii works just as well. It seems the actual task might be less important than how long, how intensively and how often it’s repeated to get hands and arms moving.
The study was designed to test whether virtual reality gaming, which is increasingly being used as rehab therapy for stroke patients, is any better than more traditional games for preserving movement skills in the upper limbs.

After recruiting 141 patients who’d recently suffered a stroke, and now had impaired movement in one or both of their hands and arms, half the patients were allocated to Wii rehab, while the rest did other recreational activities, such as playing cards.
All the patients continued to receive the usual stroke rehabilitation care and support on top of the 10, one-hour sessions of gaming or card playing for a fortnight. Both groups showed ­significant improvement in their motor skills at the end of two weeks and then four weeks. The researchers were impressed that both groups did equally well.
While it’s not clear from this study how much of the improvement was from the regular stroke care the participants received, other research suggests adding in more therapy is beneficial. Investigator Dr Gustavo Saposnik, from St Michael’s Hospital in Toronto, Canada, said: “We all like technology and have the tendency to think new technology is better than old-fashioned strategies, but ­sometimes that’s not the case. In this study, we found that simple recreational activities that can be implemented anywhere may be as effective as technology.”
Alexis Wieroniey, of the UK’s Stroke Association, said the findings were ­particularly encouraging because they suggest that inexpensive, easily ­accessible activities can help some stroke survivors in their recovery.
“Thousands of stroke survivors are left with mobility problems and this can lead to a devastating loss of independence,” she added.
If you have a relative or friend who’s had a stroke, suggest getting out the cards or dominoes. Both of these are good because they require not only fine movements of the arms, hands and fingers, but clear thinking.

Could Ultrasound Slow Brain Aging? - In mice

Will never be tested in stroke survivors.

Summary: Scanning ultrasound appears to slow down aging in healthy brains, a new study reports.
Source: University of Queensland.
Treatment with scanning ultrasound has already been proven to reverse Alzheimer’s disease in mice, and now it appears it could also slow down ageing in healthy brains, according to University of Queensland research.
The research is the latest work from Professor Jürgen Götz’s lab in the Clem Jones Centre for Ageing Dementia Research at the Queensland Brain Institute.
It showed that scanning ultrasound prevented degeneration of cells in the brains of healthy mice.
Researcher Dr Robert Hatch said the work was originally designed as a safety study, but soon revealed a broader role for ultrasound in maintaining brain health.
“We found that, far from causing any damage to the healthy brain, ultrasound treatments may in fact have potential beneficial effects for healthy ageing brains,” Dr Hatch said.
“In a normal brain the structure of neuronal cells in the hippocampus, a brain area extremely important for learning and memory, is reduced with age.
“What we found is that treating mice with scanning ultrasound prevents this reduction in structure, which suggests that by using this approach we can keep the structure of the brain younger as we get older.
“We are currently conducting experiments to see if this preservation of the brain cell structure will ameliorate reductions in learning and memory that occur with ageing.”
The mice were treated with either one or six scanning ultrasound treatments over six weeks. Their brain cell structure and function were reviewed two hours, one day, one week, and three months after receiving the treatment.
In the next stage of research, the team will test the effect of ultrasound on the brain structure and function of older mice.
Professor Götz’s lab has previously shown that non-invasive ultrasound technology can reverse Alzheimer’s disease in mice.

The approach is able to temporarily open the blood-brain barrier, activating mechanisms that clear toxic protein clumps and restore memory functions.
“Collectively, this research is fundamentally changing our understanding of not only how to treat Alzheimer’s but to maintain general brain health,” Dr Hatch said.
“This is a pressing health issue in an ageing society and it’s clear that scanning ultrasound technology has a major role to play.”
Alzheimer’s affects more than two thirds of dementia patients, and about a quarter of a million Australians.
The total number of dementia cases in Australia is expected to rise to 900,000 by 2050.
About this Alzheimer’s disease research article
Funding: The research, published in PloS One, was funded by the estate of Dr Clem Jones and by grants from the Australian Research Council (ARC), the National Health and Medical Research Council, and the ARC Linkage Infrastructure, Equipment and Facilities scheme.
Source: Kirsten MacGregor – University of Queensland
Image Source: image is credited to Hatch et al./PLOS ONE.
Original Research: Full open access research for “Scanning Ultrasound (SUS) Causes No Changes to Neuronal Excitability and Prevents Age-Related Reductions in Hippocampal CA1 Dendritic Structure in Wild-Type Mice” by Robert John Hatch, Gerhard Leinenga, and Jürgen Götz in PLOS ONE. Published online October 11 2016 doi:10.1371/journal.pone.0164278
Cite This Article
University of Queensland “Could Ultrasound Slow Brain Aging?.” NeuroscienceNews. NeuroscienceNews, 12 October 2016.

New study links protein in wheat to the inflammation of chronic health conditions

One key word in here that should trigger followup research in our fucking failures of stroke associations. But that will never occur. Inflammation in the brain does not sound good, what is your doctor doing to fix that? Maybe a diet stroke protocol?
Scientists have discovered that a protein in wheat triggers the inflammation of chronic health conditions, such as multiple sclerosis, asthma and rheumatoid arthritis, and also contributes towards the development of non-coeliac gluten sensitivity.
With past studies commonly focusing on gluten and its impact on digestive health, this new research, presented at UEG Week 2016, turns the spotlight onto a different family of proteins found in wheat called amylase-trypsin inhibitors (ATIs). The study shows that the consumption of ATIs can lead to the development of inflammation in tissues beyond the gut, including the , kidneys, spleen and brain. Evidence suggests that ATIs can worsen the symptoms of , , , lupus and non-alcoholic fatty liver disease, as well as .
ATIs make up no more than 4% of wheat proteins, but can trigger powerful immune reactions in the gut that can spread to other tissues in the body. Lead researcher, Professor Detlef Schuppan from the Johannes Gutenberg University, Germany, explains, "As well as contributing to the development of bowel-related inflammatory conditions, we believe that ATIs can promote inflammation of other immune-related chronic conditions outside of the bowel. The type of gut inflammation seen in non-coeliac gluten sensitivity differs from that caused by coeliac disease, and we do not believe that this is triggered by gluten proteins. Instead, we demonstrated that ATIs from wheat, that are also contaminating commercial gluten, activate specific types of immune cells in the gut and other tissues, thereby potentially worsening the symptoms of pre-existing inflammatory illnesses".
Clinical studies are now due to commence to explore the role that ATIs play on in more detail. "We are hoping that this research can lead us towards being able to recommend an ATI-free diet to help treat a variety of potentially serious immunological disorders" adds Professor Schuppan.
ATIs and Non-Coeliac Gluten Sensitivity
Further to inflaming chronic health conditions outside of the bowel, ATIs may contribute to the development on non-coeliac gluten sensitivity. This condition is now an accepted medical diagnosis for people who do not have coeliac disease but benefit from a gluten free diet. Intestinal symptoms, such as abdominal pain and irregular bowel movements, are frequently reported, which can make it difficult to distinguish from IBS. However, extraintestinal symptoms can assist with diagnosis, which include headaches, joint pain and eczema. These symptoms typically appear after the consumption of gluten-containing food and improve rapidly on a gluten-free diet. Yet, gluten does not appear to cause the condition.
Professor Schuppan hopes that the research will also help to redefine non-coeliac gluten sensitivity to a more appropriate term. He explains, "Rather than non-coeliac gluten sensitivity, which implies that gluten solitarily causes the , a more precise name for the disease should be considered."
More information:
  • Zevallos V, Weinmann-Menke J, Meineck M et al. Alpha-amylase/trypsin inhibitors (ATIs) accelerate murine systemic lupus erythematosus. Poster presentation at the 16th International Coeliac Disease Symposium, 21–24 June 2015, Prague, Czech Republic. Poster P168.
  • Zevallos V, Yogev N, Nikolaev A et al. Consumption of wheat alpha-amylase/trypsin inhibitors (ATIs) enhances experimental autoimmune encephalomyelitis in mice. Oral presentation at the 16th International Coeliac Disease Symposium, 21–24 June 2015, Prague, Czech Republic.
  • Junker Y, Zeissig S, Kim S-J et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 2012;209(13):2395-408.
  • Fasano A, Sapone A, Zevallos V et al. Nonceliac gluten and wheat sensitivity. Gastroenterology 2015;148(6):1195-204.
  • Schuppan D, Pickert G, Ashfaq-Khan M et al. Non-celiac wheat sensitivity: Differential diagnosis, triggers and implications. Best Pract Res Clin Gastroenterol 2015;29(3):469–76.

Provided by: United European Gastroenterology

Medicare unveils far-reaching overhaul of doctors' pay

This can only help stroke survivors get results. Since only 10% of stroke survivors fully recover and zero percent of that is from your doctors intervention. Stroke hospitals will have zero income until they create protocols with efficacy ratings and stop the causes of disability, namely the neuronal cascade of death by these 5 causes in the first week Or create repeatable neuroplasticity and neurogenesis interventions.
Medicare on Friday unveiled a far-reaching overhaul of how it compensates doctors and other clinicians. The goal is to reward quality, cost-effective care instead of just paying piecemeal for services.
The complex regulation is nearly 2,400 pages long and will take years to fully implement. It’s meant to carry out bipartisan legislation that was passed by Congress and signed by President Barack Obama last year.
Whether it succeeds or fails, it’s one of the biggest changes in Medicare’s 50-year history.
While the concept of paying for quality has broad support, the details have been a source of trepidation for some clinicians, who worry that the new system will force small practices and old-fashioned solo doctors to join big groups. Patients may soon start hearing about the changes from their physicians, but it’s still too early to discern the impacts.
The Obama administration sought to calm concerns Friday. “Transforming something of this size is something we have focused on with great care,” said Andy Slavitt, head of the federal Centers for Medicare and Medicaid Services.
Officials said they considered more than 4,000 formal comments and held meetings around the country attended by more than 100,000 people before issuing the final rule. The administration will continue to accept comments, and Slavitt signaled openness to fine tuning.
MACRA, the Medicare Access and CHIP Reauthorization Act, creates two new payment systems, or tracks, for clinicians. The majority of medical professionals who bill Medicare - some 600,000 doctors, nurse practitioners, physician assistants and therapists - are affected. Medical practices must decide next year what track they will take.
Starting in 2019, clinicians can earn higher reimbursements if they learn new ways of doing business, joining a leading-edge track that’s called Alternative Payment Models. That involves being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records.
About 100,000 clinicians are expected to initially take that track, which is more challenging. Officials are hoping that number will quickly grow.
Another 400,000 to 500,000 are expected to join a second track called the Merit-Based Incentive Payment System. It features more modest financial incentives, and accountability for quality, efficiency, use of electronic medical records, and self-improvement.
Finally, about 380,000 clinicians are expected to be exempt from the new systems because they don’t see enough Medicare patients, or their billings do not reach a given threshold.
“This law and this regulation are going to need to evolve as medicine evolves,” Slavitt said.
Advocates say the new system will improve quality and help check costs. But critics say the complicated requirements could prove overwhelming. The administration says some doctors will be pleasantly surprised to find out that reporting requirements have actually been streamlined to make them easier to meet.
With 57 million beneficiaries, Medicare is the government’s premier health insurance program. The Obama administration has pushed to overhaul payment not only for doctors, but also for hospitals and private insurance plans that serve many beneficiaries. The unifying theme is a new emphasis on rewarding quality over volume.
While some quality improvements have already been noted, it’s likely to take years to see whether the new approach can lead to major savings that help keep Medicare sustainable over the long run.
Medicare’s previous congressionally mandated system for paying doctors proved unworkable. It called for automatic cuts when spending surpassed certain levels, and lawmakers routinely waived those reductions. MACRA was intended by lawmakers as a new beginning.