Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. 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

Thursday, August 13, 2020

Robot-based hand motor therapy after stroke

 So, in the past 12 years were any protocols written and distributed on this? And did your hospital do ONE DAMN THING WITH THIS EXCEPT IGNORE IT?

Robot-based hand motor therapy after stroke

2008, Brain

 Craig D.Takahashi,

Lucy Der-Yeghiaian,Vu Le, Rehan R. Motiwala and Steven C.Cramer
Department of Neurology and Department of Anatomy & Neurobiology,University of California, Irvine,USA*Present Address: Department of Engineering, Santa Ana College, Santa Ana,CA,USACorrespondence to: Steven C.Cramer, MD,University of California, Irvine Medical Center,101The City Drive South,Building 53 Room 203,Orange,CA 92868-4280,USAE-mail: scramer@uci.edu
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization.Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research ArmTest (34 ± 20 to 38 ±19, P < 0.0005) and arm motor Fugl-Meyer score (45 ± 10 to 52 ±10, P <0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions.The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a nonpracticed task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.Keywords:
 stroke; motor therapy; functional MRI; generalization
Abbreviations:
 IP=interphalangeal; MCP=metacarpophalangeal
Received July13, 2007. Revised November 27, 2007. Accepted November 28, 2007. Advance Access publication December 21, 2007

Lupus Anticoagulant Tied to COVID Thrombosis

 Do we need to wait for this testing to occur or do we just immediately start anticoagulation therapies? I'm not waiting around, I'm having my doctor give me heparin immediately.

Lupus Anticoagulant Tied to COVID Thrombosis

Small study suggests consideration of therapeutic anticoagulation

A blue gloved hand holds a test tube labeled: Lupus anticoagulant (LA) - Test

Prothrombotic autoantibodies were elevated in COVID-19 and linked to development of thrombosis, a small observational study showed.

Lupus anticoagulant (LA) appeared in 44% of COVID-19 patients tested versus 22% of other patients (30 of 68 vs 27 of 119, P=0.002), according to Morayma Reyes Gil, MD, PhD, of Montefiore Medical Center in New York City, and colleagues.

In the COVID-19 group, 63% of the LA-positive patients had documented arterial or venous thrombosis compared with 34% of the LA-negative patients (P=0.03), the group reported in JAMA Network Open.

C-reactive protein (CRP) levels were higher with LA positivity but not linked with thrombosis. On the other hand, LA remained a significant independent predictor of thrombosis after adjusting for CRP, with an odds ratio of 4.39.

"LA-positive individuals have a marked risk of arterial and venous thrombosis, and therapeutic anticoagulation should be considered in these patients," the group concluded.

Prior series of COVID-19 patients have also found high LA-positive prevalence. For example, an observational study that is often referenced in support of inpatient anticoagulation for COVID-19, based on a suggestion of mortality benefit, found 91% LA positive among the 34 patients tested for it, significantly more than seen in historical controls.

LA has also been associated with thrombotic events in systemic lupus erythematosus, but the autoantibodies are not specific to lupus.

Gil and colleagues' retrospective study included 187 patients with LA testing ordered from March 1 to April 30, 2020, at Montefiore Medical Center. The comparator group for the COVID-19 patients was the 119 who were not tested, or were negative by PCR testing, for the SARS-CoV-2 virus.

Mean prothrombin time and partial thromboplastin time (PTT) were more prolonged in LA-positive compared with LA-negative patients, the researchers noted.

LA positivity was determined by the dilute Russell viper venom time, because PTT-based tests are interfered with by the elevated CRP levels seen in most patients with COVID-19.

LA status didn't correlate with gender, race, ethnicity, ventilation, mortality, or anticoagulation at the time of thrombosis.

Study limitations included a small sample size and inability to control time of LA testing from admission to outcome (mortality and thrombosis).

Disclosures

Gil and co-authors disclosed no relevant relationships with industry.

 

Peri-Infarct Hot-Zones Have Higher Susceptibility to Optogenetic Functional Activation-Induced Spreading Depolarizations

What the hell is being done with this knowledge to help survivors recover?

Peri-Infarct Hot-Zones Have Higher Susceptibility to Optogenetic Functional Activation-Induced Spreading Depolarizations

Originally publishedhttps://doi.org/10.1161/STROKEAHA.120.029618Stroke. 2020;51:2526–2535

Background and Purpose:

Spreading depolarizations (SDs) are recurrent and ostensibly spontaneous depolarization waves that may contribute to infarct progression after stroke. Somatosensory activation of the metastable peri-infarct tissue triggers peri-infarct SDs at a high rate.

Methods:

We directly measured the functional activation threshold to trigger SDs in peri-infarct hot zones using optogenetic stimulation after distal middle cerebral artery occlusion in Thy1-ChR2-YFP mice.

Results:

Optogenetic activation of peri-infarct tissue triggered SDs at a strikingly high rate (64%) compared with contralateral homotopic cortex (8%; P=0.004). Laser speckle perfusion imaging identified a residual blood flow of 31±2% of baseline marking the metastable tissue with a propensity to develop SDs.

Conclusions:

Our data reveal a spatially distinct increase in SD susceptibility in peri-infarct tissue where physiological levels of functional activation are capable of triggering SDs. Given the potentially deleterious effects of peri-infarct SDs, the effect of sensory overstimulation in hyperacute stroke should be examined more carefully.

Footnotes

For Sources of Funding and Disclosures, see page 2534.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.120.029618.

Correspondence to: Cenk Ayata, MD, PhD, Massachusetts General Hospital, Harvard Medical School, 149 13th St, 6408, Charlestown, MA 02129. Email

 

Usefulness of stent strut deformity during thrombectomy for predicting the stroke etiology in acute large artery occlusion

 I can see almost zero usefulness in stroke etiology(the cause). Survivors want to know: WHAT THE FUCK ARE YOU DOING TO CURE ME?

Usefulness of stent strut deformity during thrombectomy for predicting the stroke etiology in acute large artery occlusion

Highlights

Underlying intracranial atherosclerotic stenosis can be a cause of refractory occlusion after stent-based thrombectomy.

Defining the stroke etiology is important for the treatment of acute large vessel occlusion.

Full-length stent visibility during thrombectomy can provide information on the stroke etiology or the clot characteristics.

Abstract

Background

Stent retriever thrombectomy has been regarded as the standard treatment for acute intracranial large artery occlusion. As fast recanalization is the most important factor for favorable outcomes in patients with stroke, defining the etiology is important for the treatment of acute large vessel occlusion. We aimed to investigate whether full-length stent visibility during thrombectomy could provide information on the stroke etiology or the clot characteristics using the stent strut deformity during thrombectomy.

Materials and methods

Intra-arterial thrombectomy was performed on 46 patients with Trevo stent as the first endovascular thrombectomy device. Patients were assigned to the full expansion group or the stent deformity group based on the shape of the stent strut during the endovascular procedure. The presence of stent deformity during the procedure, underlying intracranial atherosclerotic stenosis (ICAS), and residual stenosis at the occlusion site on the final conventional angiography, follow-up magnetic resonance angiography, or computed tomography angiography were retrospectively assessed.

Results

Recanalization without underlying arterial stenosis at the occlusion site was observed in 92.9 % (26/28 patients) and 50.0 % (8/16 patients) of the full expansion and stent deformity groups (p = 0.002), respectively. A significantly lower proportion of patients in the full expansion group demonstrated ICAS-related occlusion compared with that in the stent deformity group (3.6 % vs. 43.8 %, respectively; p = 0.002).

Conclusions

The degree of stent expansion during thrombectomy in acute large artery occlusion can be a useful predictor of the stroke etiology and potentially helpful to the operator for endovascular treatment planning.

 

Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke

I'm sure their definition of successful reperfusion is completely using the fucking tyranny of low expectations. Blowing out the clot, NOT 100% RECOVERY. And until we get survivors in charge setting correct stroke goals your children and grandchildren having strokes will be screwed just as you were.

Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke

Originally publishedhttps://doi.org/10.1161/STROKEAHA.120.029892Stroke. ;0

Background and Purpose:

We aim to examine effects of collateral status and post-thrombectomy reperfusion on final infarct distribution and early functional outcome in patients with anterior circulation large vessel occlusion ischemic stroke.

Methods:

Patients with large vessel occlusion who underwent endovascular intervention were included in this study. All patients had baseline computed tomography angiography and follow-up magnetic resonance imaging. Collateral status was graded according to the criteria proposed by Miteff et al and reperfusion was assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) system. We applied a multivariate voxel-wise general linear model to correlate the distribution of final infarction with collateral status and degree of reperfusion. Early favorable outcome was defined as a discharge modified Rankin Scale score ≤2.

Results:

Of the 283 patients included, 129 (46%) had good, 97 (34%) had moderate, and 57 (20%) had poor collateral status. Successful reperfusion (mTICI 2b/3) was achieved in 206 (73%) patients. Poor collateral status was associated with infarction of middle cerebral artery border zones, whereas worse reperfusion (mTICI scores 0–2a) was associated with infarction of middle cerebral artery territory deep white matter tracts and the posterior limb of the internal capsule. In multivariate regression models, both mTICI (P&lt;0.001) and collateral status (P&lt;0.001) were among independent predictors of final infarct volumes. However, mTICI (P&lt;0.001), but not collateral status (P=0.058), predicted favorable outcome at discharge.

Conclusion:

In this cohort of patients with large vessel occlusion stroke, both the collateral status and endovascular reperfusion were strongly associated with middle cerebral artery territory final infarct volumes. Our findings suggesting that baseline collateral status predominantly affected middle cerebral artery border zones infarction, whereas higher mTICI preserved deep white matter and internal capsule from infarction; may explain why reperfusion success—but not collateral status—was among the independent predictors of favorable outcome at discharge. Infarction of the lentiform nuclei was observed regardless of collateral status or reperfusion success.

Footnotes

*Drs Payabvash and Petersen contributed equally.

For Sources of Funding and Disclosures, see page e201.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.120.029892.

Correspondence to: Seyedmehdi Payabvash, MD, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins E 2, 333 Cedar St, New Haven, CT 06520-8042, Email
Nils H. Petersen, MD, Department of Neurology, Divisions of Neurocritical Care and Stroke, Yale School of Medicine, 15 York St, LCI 1003, New Haven, CT 06510, Email

 

Tuesday, August 11, 2020

Region's First Mobile Stroke Unit(University of Cincinnati) Seeks To Speed Up Treatment

 And why would you want to roll out something that slow? Incompetently didn't know about faster options? Not your job to keep up with current stroke research?

Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?

 

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

Region's First Mobile Stroke Unit(University of Cincinnati) Seeks To Speed Up Treatment

Seconds count(How many?) in stroke treatment so beginning Tuesday UC Health will have a new resource to get patients the help they need.

UC is introducing a Mobile Stroke Unit specially designed to evaluate and treat patients who may be having a stroke. It's staffed with a paramedic, an EMT, a critical care registered nurse and a CT technician. A Cincinnati/Northern Kentucky Stroke Team physician will respond via telemedicine.

The average stroke patient doesn't get clot-busting medicine until 45-60 minutes after arriving at a hospital. This is because patients have to first get a CT scan and other assessments.

"Millions of brain cells die every minute that stroke treatment is delayed and research shows that mobile stroke units can provide treatment 20 to 30 minutes faster(How fast does it have to be to get 100% recovered? Why the fuck don't you know that answer?) than in an emergency department," says Joseph Broderick, MD, director of the UC Gardner Neuroscience Institute and Professor of Neurology and Rehabilitation medicine at the UC College of Medicine."

The Mobile Stroke Unit is dispatched along with the local EMS department. It's equipped with advanced diagnostic technology including a mobile CT scanner and the clot-busting medication tPA. (tissue plasminogen activator)

Medical Director of the Mobile Stroke Unit Dr. Christopher Richards says it's the first of its kind in the region. "We are able to bring the emergency department to the curbside in order to diagnose and treat stroke as quickly and safely as possible."

The unit is based at the Springfield Township Fire Department at 9150 Winton Road and will be available between 7 a.m. and 7 p.m. daily, including holidays. It will respond in an area of approximately 15 minutes from the fire station.

 

UAMS(University of Arkansas for Medical Sciences) stroke program receives two awards for excellence of care

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

  1. tPA full recovery? Better than 12%?
  2. 30 day deaths? Better than competitors?
  3. rehab full recovery? Better than 10%?

 

You'll' want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

UAMS(University of Arkansas for Medical Sciences) stroke program receives two awards for excellence of care

LITTLE ROCK — Excellence in treating stroke patients has earned the University of Arkansas for Medical Sciences Stroke Program two national awards.

The American Heart Association/American Stroke Association honored UAMS with the Get with the Guidelines Target: Stroke Honor Roll and Gold Plus Quality Achievement awards in June. The awards recognize the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally-recognized, research-based guidelines based on the latest scientific evidence.

The Target: Stroke Honor Roll recognition acknowledges the program’s compliance with standards for quick and timely treatment of stroke. The Gold Plus status recognizes the program’s continued high performance by those measures for two or more consecutive years after receiving a Gold or Silver award. UAMS has maintained the Gold Plus status for six consecutive years.

“Our staff has worked very hard for many years first to achieve and then to continue to receive this recognition,” said Matthew Mitchell, M.N.Sc., R.N., director of the Stroke Program. “We want our patients to have the very best outcomes, and this recognition speaks to our efforts to follow the guidelines and standards of practice that ensure the best results for them.”

In 2018, UAMS Medical Center became the first health care provider in Arkansas to be certified as a Comprehensive Stroke Center by The Joint Commission. The Joint Commission is an independent, nonprofit organization that evaluates and accredits more than 20,000 health care organizations in the United States.

According to The Joint Commission, the certification is the most demanding accreditation and is designed for those hospitals that have the specific abilities to receive and treat the most complex stroke cases.

According to the American Heart Association/American Stroke Association, stroke is the fifth leading cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

 

Cape Cod Hospital Earns National Awards For Stroke Care

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

  1. tPA full recovery? Better than 12%?
  2. 30 day deaths? Better than competitors?
  3. rehab full recovery? Better than 10%?

 

You'll' want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

Cape Cod Hospital Earns National Awards For Stroke Care

Cape Cod Hospital has been recognized nationally for achievement in stroke care with awards from the Paul Coverdell National Acute Stroke Program, a division of the Centers for Disease Control and Prevention and the American Heart Association/American Stroke Association.

Cape Cod Hospital was awarded the Coverdell Award for achieving "door to CT within 25 mins from arrival for at least 75 percent of stroke patients," as measured by the Coverdell Program and announced by the Massachusetts Department of Public Health.

To earn this recognition, which was offered for the first time in 2020, Cape Cod Hospital met the timing and percentage measures for all patients who were eligible for alteplase treatment and arrived at the hospital via emergency medical services. In addition to the measurements of the award, Cape Cod Hospital also achieved the additional recommendation to engage EMS agencies in quality improvement activities aimed at improving this measure.

To earn the Coverdell System of Care Partnership Award, Cape Cod Hospital established a formal partnership, including a memorandum of understanding, with EMS and post-acute care facilities for quality standards of care.

Cape Cod Hospital also earned the American Heart Association/American Stroke Association's Gold Get With The Guidelines Plus Quality Award, an advanced level of recognition for hospitals who meet quality measures for 24 consecutive months or more including dysphagia screening, stroke education, intensive statin therapy and time to IV thrombolytic therapy.

 

Researcher studies statins for stroke therapy

If we had a complete database of stroke research this problem would be solved in no time. Getting thru the blood brain barrier, maybe one of these?

Overcoming the Blood–Brain Barrier: Successes and Challenges in Developing Nanoparticle-Mediated Drug Delivery Systems for the Treatment of Brain Tumours

May 2020

LIPOSOMES FOR BRAIN DRUG DELIVERY  February 2020 

Exosomes as drug delivery vehicles for therapeutic proteins to the brain February 2019 

Miniaturized system delivers drugs to the brain with pinpoint accuracy February 2018 

Nanowires could be potential drug delivery tools for neurodegenerative diseases

 November 2017

Nose2Brain – Better Therapy for Multiple Sclerosis April 2017 

Novel Alzheimer's treatment uses microscopic droplets of fat to carry drugs into the brain October 2016 

New Technology Shows Promise for Delivery of Therapeutics to the Brain 

 October 2014

Nose-to-Brain Drug Delivery by Nanoparticles in the Treatment of Neurological Disorders July 2014 

Brain Targetting through Intranasal Route November 2013 

exosomes delivering drugs to brain March 2011

 And that is as far as I go back, so there are probably lots more.

 

 The latest here:

Researcher studies statins for stroke therapy

Every year in the United States, about 800,000 people experience a stroke. Many are left with neurological complications such as paralysis on one side of the body, speech and language problems, vision issues, behavioral changes and memory loss. University of Arizona Health Sciences researchers aim to reduce those devastating effects by developing therapeutic treatments for acute stroke using a commonly prescribed class of drugs – cholesterol-reducing statins.

Using a $2.79 million grant from the National Institute of Neurological Disorders and Stroke, a unit of the National Institutes of Health, Patrick T. Ronaldson hopes to solve one of the main challenges when it comes to post-stroke treatments – the effective delivery of neuroprotective drugs, specifically statins, into the brain.

An associate professor in the Department of Pharmacology at the College of Medicine – Tucson, Ronaldson studies ischemic stroke, which occurs when blood supplied to the brain is obstructed by a clot. Current treatments, which focus on removing the blockage, are limited by time and treatment options. Many patients don't arrive at the hospital in time to undergo surgery or receive the one drug that is approved by the U.S. Food and Drug Administration for the treatment of ischemic stroke.

ADVERTISEMENT - SCROLL TO KEEP READING

Research dating back to the mid-2000s offers clinical evidence that statins are effective in providing neuroprotection to stroke patients. When given to patients at high risk for stroke, statins reduce the incidence of stroke. In post-stroke patients, statins decrease risk of recurrent strokes and improve functional outcomes.

"If you can get statins to the brain at effective concentrations, they actually are protective in the setting of stroke," Ronaldson said.

For years, the development of therapeutic drugs to treat ischemic stroke has been stopped, literally, by the blood-brain barrier, which is a network of blood vessels that run through the brain and protect it from toxins. Because the blood-brain barrier plays a major role in preventing things from getting into the brain in the first place, Ronaldson said, it creates a challenge for doctors who need to get therapeutic drugs across the barrier to specific targets in the brain.

"There have been about 2,000 neuroprotective compounds that have been identified in pre-clinical studies over the past 20 years, and none of them have even made it to a phase 3 clinical trial," Ronaldson said. "Most of the research in drug discovery and stroke has focused on trying to identify something that works and then worrying about how to get it into the brain. We're taking something that we know works – statins – and figuring out exactly how to get it into the brain. If you appreciate that from day one, that's going to lead you toward more effective therapies for stroke."(The answers are already out there, just look for them.)

To that end, Ronaldson and his team are studying drug uptake transporters, which are proteins that carry drugs into tissues or organs, such as the brain, liver or kidneys. In prior research published in the journal Molecular Pharmacology, he identified the specific family of transporters – organic anion transporting polypeptides, known as Oatps – that can efficiently carry statins across the blood-brain barrier.

In the new study, Ronaldson's hypothesis is that Oatps can be targeted specifically for the purpose of delivering statins to the brain. He hopes to show that Oatp-mediated transport is the primary reason why statins work as a therapeutic treatment in stroke.

"This is the critical step in determining whether a statin works for stroke therapy," Ronaldson said, adding that some clinicians already give statins to stroke patients based on anecdotal evidence of improved outcomes. "Our research will be able to inform treatment options for stroke so that clinicians can use that knowledge to try to make those treatments and statins more effective."


The research team also will be investigating ways to regulate Oatp transporters by manipulating the signaling pathways that control them. If researchers can control how and when the transporters work, they might be able to extend the narrow window of time that doctors have to effectively administer stroke treatments.

Eventually, Ronaldson would like to formulate statins that could be administered intravenously, which would allow medical professionals to deliver these drugs even earlier. Currently, statins are only sold in tablet form for oral delivery. That can be problematic for stroke patients, many of whom cannot swallow in the 24 hours immediately following a stroke.

"Not only do we want to target a transporter and deliver the drug, but we want to control the playing field," Ronaldson said. "If we can extend that therapeutic window and give first responders or emergency room clinicians a safe and effective tool that can reliably protect the brain, that's one of the best ways that we can make a contribution in terms of improving stroke therapy."

The study is supported by the National Institute of Neurological Disorders and Stroke/National Institutes of Health under Award No. 2R01NS084941-06A1.

A version of this article originally appeared on the UArizona Health Sciences website.

To read more, click here

 

Monday, August 10, 2020

All Scripps(San Diego, CA area) hospitals recognized for excellent stroke care again

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

  1. tPA full recovery? Better than 12%?
  2. 30 day deaths? Better than competitors?
  3. rehab full recovery? Better than 10%?

 

You'll' want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

 All Scripps(San Diego, CA area) hospitals recognized for excellent stroke care again


 

For the third consecutive year, all five Scripps Health hospital campuses – Scripps Mercy San Diego, Scripps Mercy Chula Vista, Scripps Memorial Hospital La Jolla, Scripps Memorial Hospital Encinitas and Scripps Green Hospital – have earned the Stroke Gold Plus Quality Achievement Award for ensuring that stroke patients receive the most appropriate treatment according to nationally recognized guidelines based on the latest scientific evidence, the American Heart Association/American Stroke Association announced recently.

The awards, which are part of the AHA/ASA’s Get With The Guidelines stroke program, recognize hospitals across the United States that consistently comply with patient management quality measures that are embedded in the program.

“Once again, these awards confirm that patients going to any Scripps hospital will receive the best possible stroke care from a highly skilled and integrated team of physicians, nurses, technicians and staff members,” said Mary Kalafut, M.D., a Scripps Health stroke director and vascular neurologist. “They also serve as an important reminder during the coronavirus pandemic that Scripps facilities remain open and safe for patients to seek care for all of their medical needs.”

To win the gold awards, each Scripps hospital consistently achieved a series of AHA/ASA program performance measures for 24 or more consecutive months.

The measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients also receive education on managing health, get a follow-up visit scheduled, as well as other care transition interventions.

Additionally, all four Scripps hospital campuses with emergency rooms – Scripps Memorial La Jolla, Scripps Memorial Encinitas, Scripps Mercy San Diego and Scripps Mercy Chula Vista -- were named to the AHA/ASA’s Target: Stroke Elite Honor Roll, which recognizes hospitals that deliver thrombolytic therapy (a medication called intravenous tissue plasminogen activator) to eligible patients within one hour of hospital arrival at least 75 percent of the time.

A stroke occurs when blood flow to the brain is cut off due to a blocked or ruptured blood vessel, killing brain cells and potentially causing disability or death. Stroke is the fifth leading cause of death in the United States, and about 795,000 people have a stroke each year, according to the Centers for Disease Control and Prevention.

Scripps has long been a leader in the treatment and rehabilitation of patients who suffer a stroke.

Scripps Memorial La Jolla was among the first U.S. hospitals to earn the prestigious Comprehensive Stroke Center designation by The Joint Commission and AHA/ASA in 2012. The designation recognizes the highly specialized stroke care available at the hospital, which includes advanced imaging capabilities, the availability of round-the-clock specialized treatments, and a staff that employs the highest levels of education and skill in the care of complex stroke patients.

Additionally, Scripps Memorial Encinitas, Scripps Mercy San Diego and Scripps Mercy Chula Vista are certified by The Joint Commission and AHA/ASA as Primary Stroke Centers for demonstrating their compliance with the organizations’ stroke-related standards and requirements.

 

Characteristics and management of stroke in Korea: 2014–2018 data from Korean Stroke Registry

 This just shows you how fucking bad stroke is. THEY ARE NOT EVEN MEASURING 100% RECOVERY. No measurements, no possibility of getting better rehab. If you don't know what is wrong you can't fix it.

Characteristics and management of stroke in Korea: 2014–2018 data from Korean Stroke Registry

First Published October 22, 2019 Research Article Find in PubMed 

Lifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population.

We aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time.

This study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis.

A total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060–1.131), p < 0.001).

This study provided analysis of nationwide, hospital-based, quality-controlled data from the Korean Stroke Registry database regarding changes in the characteristics, risk factors, and treatments of strokes in Korea.

 

Parkview(Pueblo, CO) receives national award for stroke care

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

  1. tPA full recovery? Better than 12%?
  2. 30 day deaths? Better than competitors?
  3. rehab full recovery? Better than 10%?

 

You'll' want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

Parkview(Pueblo, CO) receives national award for stroke care

Parkview Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines: Stroke Gold Plus Quality Achievement Award.

The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines built on the latest scientific evidence.

Parkview earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients, at a set level, for a designated period.

These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines: with the goal of speeding recovery and reducing death and disability for stroke patients.

“Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions,” noted Racheal Morris, communications specialist for Parkview.

“We are dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get with the Guidelines-Stroke initiative,” said Leslie Barnes, the hospital’s president and CEO.

“The tools and resources provided help us track and measure our success in meeting evidence-based clinical guidelines developed to improve patient outcomes.”

Additionally, Parkview received the association’s Target: Type 2 Honor Roll award.

To qualify for this recognition, hospitals must meet quality measures developed with more than 90% of compliance for 12 consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States.

On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

In other medical news, Parkview reminds citizens that even during a pandemic, preventative care, including immunizations, remains vital.

“Many families may be nervous to go anywhere right now, let alone a doctor’s office,” noted Dr. Sarah Bryant, a pediatrician practicing at Parkview. “However, preventative care is just as important now as it was before: maybe even more important.”

During a preventative/wellness visit, Bryant said the focus is on a child’s growth and development, safety awareness and “managing chronic conditions to help keep children healthy during this time. The last thing we want right now is for a patient with asthma to have poor control of their symptoms.

“These are the things we can address during your or your child’s regular wellness visits.”

Similarly for adults, preventative care visits can identify problems and allow medical professionals to manage them, “keeping you healthy and out of the emergency room,” Bryant said.

Vaccine awareness is another important aspect of preventative care.

“It is vital during this time to stay up to date with vaccines,” Bryant said. “We know that when children and adults get their regular immunizations and booster shots on time, they are less likely to suffer serious complications such as pneumonia or meningitis.

“Also, they are less likely to be hospitalized or need antibiotics if they get sick.”

Youngsters who are behind on immunizations are more likely to suffer from common illnesses, especially in the early years of life.

“Children receive nearly all of their vaccines against illnesses such as measles, chicken pox, whooping cough, pneumonia, sepsis (blood infections), and meningitis in the first four years of life: because that is when they are most likely to become seriously ill or die of vaccine-preventable illnesses,” Bryant said.

Although the threat of COVID-19 remains prevalent, Bryant said fear should not prevent a visit to a doctor’s office for a wellness check or immunization.

“Primary care offices are working really hard, now more than ever, taking precautions to make sure that patients can continue to receive care without getting exposed to others who might be sick,” she said.

Chieftain reporter Jon Pompia can be reached by email at jpompia@chieftain.com or at twitter.com/jpompia. Help support local journalism by subscribing to the Chieftain at chieftain.com/subscribenow

 

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 Lazy, lazy, lazy. Describes a problem, offers NO solution. These people need to be removed from stroke and if we had ANY STROKE LEADERSHIP AT ALL, that would occur.

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 

A Systematic Review and Meta-Analysis
Originally publishedhttps://doi.org/10.1161/STROKEAHA.119.028899Stroke. ;0

Background and Purpose:

We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both).

Methods:

We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy.

Results:

We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%–8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%–10.2%), 5.9% (95% CI, 4.1%–8.4%), and 5.8 % (95% CI, 3.0%–10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%–11.02%) and that of early PSS was 3.14% (95% CI, 2.05%–4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75–2.05).

Conclusions:

The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.

Footnotes

For Sources of Funding and Disclosures, see page XXX.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.028899.

Correspondence to: Alain Lekoubou, MD, MSc, Department of Neurology, Penn State University, 30 Hope Dr, Hershey, PA, 17033. Email

'Game-changing' drug that could halt Alzheimer’s may be available in the US by March

Interesting that they don't tell you this is intravenous, once a month. From this earlier piece on it here:

Clinicians view new Alzheimer’s drug with guarded optimism

But is this the correct path to go down or should tau proteins be addressed? Is this just cleaning up existing plaque but not addressing new plaque being generated by tau? Cause and effect once again. Ask your doctor to clarify.

The real cause of Alzheimer’s is a dysfunctional ‘tau’ protein, a new study of over 3,600 brains finds.

 

The latest here:

'Game-changing' drug that could halt Alzheimer’s may be available in the US by March

An Alzheimer’s drug that could halt the progression of the disease has been hailed a “game changer”.

The memory-robbing disorder has no cure, with existing treatments working to ease its symptoms.

In severe cases, patients may become aggressive, struggle to move or even hallucinate.

Hopes have been raised after the US Food and Drug Administration (FDA) granted the medication aducanumab fast-track approval.

Read more: Gum disease linked to double the risk of dementia

Trials have demonstrated aducanumab helps to untangle Alzheimer’s tell-tale protein clumps in the brain, potentially reversing the disease.

The FDA has not considered a new treatment for the condition in 17 years, with aducanumab’s fate being decided by 7 March 2021.

If licensed, it would be the first therapy approved to delay Alzheimer’s progression.

Existing Alzheimer's drugs work to ease symptoms. (Getty Images)
Existing Alzheimer's drugs work to ease symptoms. (Getty Images)

‘A new era for Alzheimer’s treatments’

“The FDA’s acceptance of the aducanumab with priority review is an important step in the path to potentially having a treatment that meaningfully changes the course of Alzheimer’s disease,” said Michel Vounatsos, CEO of the manufacturer Biogen, as reported by Global News Wire.

“We believe aducanumab marks the beginning of a new era of potential treatments for Alzheimer’s disease that will inspire even more discovery and innovation to bring hope to those affected by this devastating disease.”

Read more: 'Game changing' Alzheimer's blood test edges closer

More than 5 million people in the US have Alzheimer’s, which is expected to increase to over 13 million by 2050.

In the UK, around 850,000 people have dementia – the umbrella term for conditions that cause a gradual decline in brain function.

Alzheimer’s is the most common type of dementia, affecting between 50% and 75% of patients in the UK.

The disease is thought to be caused by the abnormal build-up of proteins in and around brain cells.

Two of these are amyloid – which forms plaques, and tau – which develops into tangles.

Over time, the chemical messengers that send signals between brain cells decline.

Different areas of the vital organ then shrink, usually starting with those responsible for memories.

Trials have shown aducanumab works to untangle these clumps, slowing memory loss.

The drug was also linked to improvement in a patient’s ability to carry out day-to-day tasks, like household chores and leaving the home alone.

Read more: Elderly who distinctly smell roses 'have half the risk of dementia'

“I am heartened by what this progress may mean for people living with Alzheimer’s disease and their families,” said Dr Christopher van Dyck, from the Yale Alzheimer’s Disease Research Center.

“If aducanumab is determined to be effective in reducing the decline in cognition and activities of daily living resulting from progression of this disease by addressing the underlying disease pathology, it will deliver meaningful benefits to those who most need them.”

Keeps patients ‘in a better place for a longer time’

Aducanumab has had a bumpy road. Studies were scrapped in March 2019 after two late-stage trials suggested it was of no benefit.

Several months later, Biogen looked at a larger amount of data that became available after the trials stopped.

It found the drugs were effective providing they were given early enough and at a sufficient dose.

Experts hope aducanumab will benefit those with early signs of dementia, helping to halt or slow the disease before patients became incapacitated.

The FDA has been set an “action date” of 7 March 2021, but “plans to act early on this application under an expedited review”.

Michael Yee, an analyst at the investment bank Jefferies, expects a verdict in the first quarter of 2021, adding the data demonstrating the drug’s effectiveness is “mixed and still inconclusive”, Fierce Biotech reported.

Nevertheless, the fast-track approval suggests the FDA is “comfortable with the totality of the data, recognises high unmet need and really wants to get an Alzheimer’s drug approved”, he added.

Analyst Brian Abrahams, from RBC Capital Markets, has given aducanumab a 30% chance of approval.

Dr Dennis Selkoe from Harvard told wbur: “I think there’s a reasonable chance that aducanumab, if approved and we don’t know that yet, will be the first disease-modifying agent for Alzheimer’s, and that will be a huge milestone, and patients of mine and others can access the drug.

“Having cared for hundreds of patients with this disease, this would be a game changer.

“At least for some of my patients, if aducanumab is approved, [it would be] something that will slow down their deterioration, that will keep them in a better place for a longer time.”

The FDA only accepts drugs for priority review if they offer major advances in treatments or provide a therapy where none existed.

If approved in the US, experts are confident other health watchdogs around the world will consider doing the same.

In the meantime, Biogen is planning further studies, which will offer high doses to all eligible participants from the earlier trials.

 

Sunday, August 9, 2020

Recumbent tricycle learnings#2

Hand turn signals will never occur, left arm is useless. Not a problem until I start road biking. Will have to see if they make turn signals for bikes.  Looked for some, lots of negative reviews on them breaking off or not working at all.

My left leg is not always is a straight line while pedaling. I should be able to go to any physical therapist in the world and get an accurate diagnosis of why it is doing that AND GET STROKE PROTOCOLS TO CORRECT IT.  If I don't figure this out I'm sure I will destroy the knee because that won't stop me from biking long distances. I can join my friends who have already replaced knees and hips.

The gear shifting on the right handlebar is totally counterintuitive and wrong. You turn it upwards to shift to a lower gear and downwards to get to higher gears.

Will need to look for a battery powered bike pump. The floor pump is good to stay in the car, my current 8 inch long mini pump is impossible without two very strong hands. 

Looked for a mount for my cell phone,lots of negative reviews 

 

A friend is worried about me doing this, so to reassure her I related my two biking accidents on commuting to/from work, I'm a survivor.

 

I biked to work for 27 years prior to my stroke, 4 miles each way 9 months out of the year. Biking to work, I would take it relatively slow so I wouldn't sweat too much, although I did take a wet washcloth to wipe down my pits before changing into work clothes. Biking home I whaled on the bike, seeing how fast I could get home.  I have a loud booming voice so I would yell at drivers cutting me off, they didn't appreciate my comments, especially the one time I told a driver he would run over his own daughter because he didn't know how to drive.

Accident #1:

Leaving work from downtown Minneapolis I ride on 8th street, 4 lanes wide until I turn onto Portland.  I ride hell bent for leather to get out of the car zone as fast as possible. Ahead of me a bus is pulling out and spread across the three right lanes. I instantly decide I'm not going fast enough to pass on the left most lane and cut behind the bus on the right. The reason the bus was across three lanes was because it was getting around a stopped car waiting to make a right hand turn. I had no time to even hit the brakes. I crumpled onto the trunk of a brown Volvo. It was stopped waiting to make a right turn when the pedestrians cleared. The women asked me if this was her fault. 'Nope.' She offered to take me home since the front fork was bent.  So we threw the bike in the trunk. On the way, found out she was a lawyer working for the Dayton-Hudson corporation. My white helmet left a scuff mark on her trunk, but never heard from her again. Had a headache  that night, probably from a concussion.

Accident #2:

Was hurrying home at sunset because we were supposed to be helping out at a whitewater canoeing class that weekend in central Minnesota on the Kettle River, Banning State Park.  I'm heading south on Portland at high speed when a car is trying to cross the street from the left. It pulls directly in front of me, I have maybe 30 feet to get stopped before I hit the car, it is not going fast enough to clear the intersection. I slam on both brakes but the front brake grabs harder and I stand up on my front tire and unceremoniously get thrown over the handlebars slamming into the ground with my left shoulder first, then my face with my glasses breaking and giving me a crescent shaped cut on my cheek. I'm now 15 feet from the car which has stopped, bleeding profusely from the cut. The woman apologizes for not seeing me since she was looking directly into the sun.  Ambulance arrives 15 minutes later, and the attendants load my bike into the ambulance also. At the hospital they lock it up to the fence by the ER entrance.  The nice doctor stitching me up says he is not sure he can fix it so it won't leave a scar. An hour later and I'm discharged, now pitch dark, I find my bike, attach my lights to my legs and bike the 7.5 miles home.  My ex was pissed at me for biking home, I most certainly was not going to take a taxi home when I had a perfectly serviceable bike and was healthy.

With my glassses on the scar is not noticeable and the beard covers my major scar just below my lower lip.
With my glassses on the scar is not noticeable and the beard covers my major scar just below my lower lip from a youthful accident.

As you can see this is me.

Part of my Hunter S. Thompson journey;
“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!”

Day 3 was 8.18 miles in 1:09. Avg. speed; 7.0 mph. Max speed 13.5 mph. Elevation loss; 204.4 feet. Elevation gain; 163.7; Avg. pace 8:30 min/mi.

Day 4 was 8.14 miles in 1:09. Avg. speed; 7.1 mph. Max speed 14.1 mph. Elevation loss; 106.0 feet. Elevation gain; 102.7; Avg. pace 8:28 min/mi.

Right now I'm just doing the same trail to get my legs into shape, I haven't biked for over 14 years

For today I lowered the seat back one notch, my butt bones weren't feeling adequately secure and in danger of sliding out.

Day 5 was 8.16 miles in 1:01. Avg. speed; 8.0 mph. Max speed 15.7 mph. Elevation loss; 127.6 feet. Elevation gain; 125.0; Avg. pace 7:30 min/mi. 

Lowered the seat one more notch, felt pretty good.

Day 6 was 8.16 miles in 0:58:22. Avg. speed; 8.4 mph. Max speed 15.5 mph. Elevation loss; 128.3 feet. Elevation gain; 127.0; Avg. pace 7:09 min/mi. 

Day 7 was 8.15 miles in 0:58:00. Avg. speed; 8.4 mph. Max speed 16.1 mph. Elevation loss; 111.5 feet. Elevation gain; 115.8; Avg. pace 7:06 min/mi.

 

Whatever muscle that is spastic that pulls my left arm in is at least semi calm. I don't have to constantly fight against the steering with my right arm. I can't drink out of my water bottle while moving though.

One of the unregulated road crossings is quite bad, Coleman Rd.

At recumbent level you can't see cars coming at all.

After trimming, much better. Will still need to go back

 

 
Got my brush scythe and went back to the intersection

There are 6 road crossings, two controlled by stoplights which I don't always wait for.

I could probably do this much faster if at the halfway point I didn't have to get off the bike and turn it 180 degrees to go back the way I came.

I start at Towar Ave. on the right side, head north, turn around at State Rd. end up going thru White Memorial Park before returning to Towar Ave.  I live on Biber St. 1/2 mile away