Deans' stroke musings

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

What this blog is for:

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

Friday, May 31, 2013

Magnetic Resonance Imaging Profile of Blood–Brain Barrier Injury in Patients With Acute Intracerebral Hemorrhage

You do expect your doctor to understand and apply this to your recovery?
http://jaha.ahajournals.org/content/2/3/e000161.full

Abstract

Background Spontaneous intracerebral hemorrhage (ICH) is associated with blood–brain barrier (BBB) injury, which is a poorly understood factor in ICH pathogenesis, potentially contributing to edema formation and perihematomal tissue injury. We aimed to assess and quantify BBB permeability following human spontaneous ICH using dynamic contrast‐enhanced magnetic resonance imaging (DCE MRI). We also investigated whether hematoma size or location affected the amount of BBB leakage.
Methods and Results Twenty‐five prospectively enrolled patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were examined using DCE MRI at 1 week after symptom onset. Contrast agent dynamics in the brain tissue and general tracer kinetic modeling were used to estimate the forward leakage rate (Ktrans) in regions of interest (ROI) in and surrounding the hematoma and in contralateral mirror–image locations (control ROI). In all patients BBB permeability was significantly increased in the brain tissue immediately adjacent to the hematoma, that is, the hematoma rim, compared to the contralateral mirror ROI (P<0.0001). Large hematomas (>30 mL) had higher Ktrans values than small hematomas (P<0.005). Ktrans values of lobar hemorrhages were significantly higher than the Ktrans values of deep hemorrhages (P<0.005), independent of hematoma volume. Higher Ktrans values were associated with larger edema volumes.
Conclusions BBB leakage in the brain tissue immediately bordering the hematoma can be measured and quantified by DCE MRI in human ICH. BBB leakage at 1 week is greater in larger hematomas as well as in hematomas in lobar locations and is associated with larger edema volumes.

POLYMERIC MATERIALS FOR NEOVASCULARIZATION

You will need to ask your doctor the difference between angiogenesis and neovascularization. A great dissertation.
https://www.ideals.illinois.edu/bitstream/handle/2142/44267/Ross_Devolder.pdf?sequence=1
Only 122 pages for your doctor.
Revascularization therapies have emerged as a promising strategy to treat various acute and
chronic wounds, cardiovascular diseases, and tissue defects
.
It is common to either administer proangiogenic growth factors, such as vascular endothelial growth factor (VEGF) or transplant cells that
endogenously express multiple proangiogenic factors.
Additionally, these strategies utilize a wide variety
of polymeric systems, including hydrogels and biodegradable plastics, to deliver proangiogenic factors in a sophisticated manner to maintain a sustained proangiogenic environment.
Despite some impressive results in rebuilding vascular networks, it is still
a challenging task to engineer mature and functional neovessels in
target tissues, because of the increasing complexities involved with neovascularization
applications
.
To resolve these challenges, this work aims to design a wide variety of proangiogenic biomaterial systems with tunable properties used for neovascularization therapies.
This thesis describes the design of several biomaterial systems used for the delivery of proangiogenic factors in neovascularization therapies, including: an electrospun/e
lectrosprayed biodegradable plastic patch used for directional blood vessel growth (Chapter 2), an alginate-
g
-
pyrrolehydrogel system that biochemically stimulates cellular endogenous proangiogenic factor expression (Chapter 3), an enzyme catalyzed alginate
-
g
-
pyrrole hydrogel system for VEGF delivery (Chapter 4), an
enzyme activated alginate
-
g
-
pyrrole hydrogel system with systematically controllable electrical and
mechanical properties (Chapter 5), and an alginate
-
g
-
pyrrole hydrogel that enables the decoupled control
of electrical conductivity and mechanical rigidity and is use to electrically stimulate cellular endogenous proangiogenic factor expression (Chapter 6). Overall, the
biomaterial systems developed in this thesis
will be broadly useful for improving the quality of a wide array of molecular and cellular
based revascularization therapies

Thursday, May 30, 2013

Near-Infrared Spectroscopy based Neurofeedback Training increases Specific Motor Imagery Related Cortical Activation compared to Sham Feedback

No clue on this one, your doctor and therapists had better know what this means and use it to help you recover.
http://www.sciencedirect.com/science/article/pii/S0301051113001233

Abstract

In the present study we implemented a real-time feedback system based on multichannel near-infrared spectroscopy (NIRS). Prior studies indicated that NIRS-based neurofeedback can enhance motor imagery related cortical activation. To specify these prior results and to confirm the efficacy of NIRS based neurofeedback training, we examined changes in blood oxygenation level collected in eight NIRS neurofeedback training sessions. The study design differentiated between a feedback group (N = 9) that got real feedback about their own brain activity and a sham feedback group (N = 8) that saw a playback of another person's feedback recording. All participants were instructed to imagine a right hand movement to control the vertical position of a ball displayed on a computer screen. Real neurofeedback induced specific and focused brain activation over left motor areas. This focal brain activation became even more specific over the eight training sessions. In contrast, sham feedback led to diffuse brain activation patterns over the whole cortex. These findings indicate that NIRS-based real-time neurofeedback induces focused activation in specific brain areas which can be useful when training patients with focal brain lesions to increase activity of specific brain areas for rehabilitation purpose.

Leg wraps raise hopes of saved lives after strokes

Would this be any better than leg compressions?  Ask your doctor for a definitive answer and keep asking until an answer is provided. Ask your contact at the Joint Commission how many years before they incorporate it into their guidelines.
Picture from link.
http://www.bbc.co.uk/news/health-22715362
Leg wraps


Cheap inflatable leg wraps may save the lives of patients after a stroke, according to research in Scotland.
The devices regularly squeeze the legs to keep blood flowing and prevent formation of fatal blood clots.
A trial with 2,876 patients, published in the Lancet, showed there were fewer clots with the wraps.
The Stroke Association said the results were "extremely encouraging" and had the potential to save thousands of lives.
Bleeding on brain A clot in the leg, a deep vein thrombosis, is normally associated with long flights, but is a problem for hospital patients unable to move.
Around 60,000 people a year in the UK are immobile when admitted to hospital after a stroke.
Doctors at Western General Hospital and the University of Edinburgh said compression socks did not improve survival and clot-busting drugs led to other problems, including bleeding on the brain.
They tested the devices, which fit around the legs and fill with air every minute. They compress the legs and force the blood back to the heart.
They were worn for a month or until the patient recovered and was able to move again.
'Reduces the risk' In the study, 8.5% of patients using the compression device developed blood clots, compared with 12.1% of patients who were treated normally.
Prof Martin Dennis said: "At last we have a simple, safe and affordable treatment that reduces the risk of deep vein thrombosis and even appears to reduce the risk of dying after a stroke.
"We estimate that this treatment could potentially help about 60,000 stroke patients each year in the UK.
"If this number were treated, we would prevent about 3,000 developing a deep vein thrombosis and perhaps save 1,500 lives."
He said the system should also be tested in other immobile patients, such as those with pneumonia.
'Incorporate into clinical guidelines' Prof Tony Rudd, who chairs the Intercollegiate Stroke Guideline Group at the Royal College of Physicians, said: "This study is a major breakthrough showing how a simple and safe treatment can save lives.
"It is one of the most important research studies to emerge from the field of stroke in recent years."
Dr Dale Webb, of the Stroke Association charity, said: "The results of this research are extremely encouraging and show that using a compression device on the legs of patients at risk of developing blood clots could be a more effective treatment.
"This new device has the potential to save thousands of lives and we would like to see it incorporated into national clinical guidelines."

Acupuncture is a theatrical placebo: the end of a myth - DC's Improbable Science

For those still on the fence, from DC's Improbable Science.
http://www.dcscience.net/?p=6060
These two paragraphs are constructive.

Acupuncture is an interesting case, because it seems to have achieved greater credibility than other forms of alternative medicine, despite its basis being just as bizarre as all the others. As a consequence, a lot more research has been done on acupuncture than on any other form of alternative medicine, and some of it has been of quite high quality. The outcome of all this research is that acupuncture has no effects that are big enough to be of noticeable benefit to patients, and it is, in all probablity, just a theatrical placebo.
After more than 3000 trials, there is no need for yet more. Acupuncture is dead

 

High-Dose NSAIDs Hike Risk of Heart Attack and Stroke

Be careful out there.
http://www.medpagetoday.com/PainManagement/PainManagement/39457?
High doses of some commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) increased the risk of major vascular events by about a third, according to a new meta-analysis of clinical trials.
The increase -- mainly driven by a higher risk of myocardial infarction -- is similar to that seen with selective COX-2 inhibitors, or coxibs, according to Colin Baigent, MD, of the University of Oxford, and colleagues.
But the analysis suggests the size of the risk can be predicted, which could assist doctors and patients in making clinical decisions, the researchers reported online in The Lancet.
High-dose NSAIDs, widely used to manage pain in inflammatory disorders, have been linked previously with an increased risk of gastrointestinal complications.
The coxibs -- a newer generation of NSAIDs -- were developed to reduce gastrointestinal side effects, but were found to increase the risk of heart attacks and death.
But the vascular effects of the traditional NSAIDs -- diclofenac, ibuprofen, and naproxen at respective doses of 150, 2,400, and 1,000 mg daily -- has not been clear.
To help fill the gap, Baigent and colleagues in the Coxib and traditional NSAID Trialists' Collaboration undertook a meta-analysis of 639 trials of coxibs and traditional NSAIDs compared with each other or with placebo. The coxibs under study were mainly mainly celecoxib (Celebrex), rofecoxib (Vioxx), etoricoxib (Arcoxia), and lumiracoxib (Prexige).
The main outcomes were major vascular events, including non-fatal MI, non-fatal stroke, or vascular death, as well as major coronary events, stroke, mortality, heart failure, and upper gastrointestinal complications.
All told, the trials included more than 353,000 participants with patient-level data available for many of the studies.
The analysis showed:
  • Major vascular events were increased by about a third by a coxib, where the rate ratio was 1.37 (95% CI 1.14-1.66, P=0.0009).
  • The same was true for diclofenac: the rate ratio was 1.41 (95% CI 1.12-1.78, P=0.003).
  • The increases were chiefly due to more major coronary events. The rate ratio for such events for coxibs was 1.76 (P=0.0001), while the ratio for diclofenac was 1.70 (P=0.003).
  • Ibuprofen significantly increased major coronary events -- the rate ratio was 2.22 (95% CI 1.10 to 4.48, P=0.0253) -- but not major vascular events.
  • Naproxen did not significantly increase major vascular events or vascular deaths.
Heart failure risk was roughly doubled by all NSAIDs and all NSAID regimens increased upper GI complications, with rate ratios of 1.81 for coxibs, 1.89 for diclofenac, 3.97 for ibuprofen, and 4.22 for naproxen.
Compared with placebo, Baigent and colleagues reported, the effect of coxibs or diclofenac was to slightly increase the risk of vascular events. For every 1,000 patients treated with either, rather than a placebo, there were three extra major vascular events, one of which was fatal.
On the positive side, high-dose naproxen seemed to be associated with less hazard, although it's "unclear" if that's true of the lower doses most commonly used in clinical practice, they reported.
"Whilst NSAIDs increase vascular and gastrointestinal risks to a varying extent," Baigent said in a statement, "our analyses indicate that the effects of different regimens in particular patients can be predicted, which may help physicians choosing between alternative NSAID regimens to weigh up which type of NSAID is safest in different patients."
Indeed, the analysis "offers considerable certainty" about the risks of high doses of commonly used NSAIDS, commented Marie Griffin, MD, of Vanderbilt University Medical Center in Nashville.
But in an accompanying commentary, Griffin argued that the study has some major gaps -- the risks associated with lower doses, longer durations of use, and residual effects after stopping treatment.
Clinical trials are not the whole story, she noted, and information to help fill those gaps might be found in observational studies.
But the bottom line, Griffin wrote, is that "identification of safe and effective strategies for chronic pain is sorely needed."
Until those are worked out, she concluded, "long-term use of high-dose NSAIDs should be reserved for those who receive considerable symptomatic benefit from the treatment and understand the risks."

The World Stroke Organization and Boston Scientific Join Forces to Bolster Awareness and Advocacy Efforts

Big Whoopee. More press releases. Why not tackle the neuronal cascade of death and do something worthwhile?  Lazy, lazy, lazy.
Sorry Dr. Stephen Davis, this is not what an innovative, forward thinking leader would do. This is the sign of a boring status quo leader.
http://world.einnews.com/pr_news/152084116/the-world-stroke-organization-and-boston-scientific-join-forces-to-bolster-awareness-and-advocacy-efforts
The World Stroke Organization will team with global medical technology leader Boston Scientific Corporation (NYSE:BSX), to further raise awareness and take action in the worldwide fight against stroke.
"The WSO aims to reduce the global burden of stroke through prevention, acute treatment and long-term care," said WSO president Prof. Stephen Davis. Joining forces with Boston Scientific and other leading companies involved in the stroke field, to address atrial fibrillation and other stroke-related conditions, directly helps us to achieve that mission."
As the newest member of the World Stroke Campaign, Boston Scientific will join other sponsors to raise awareness about World Stroke Day to take place on October 29, 2013 and will support additional World Stroke Organization efforts to share key messages and important information about stroke prevention and treatments through campaign websites, pamphlets, posters, educational efforts and email messages.
"Boston Scientific is dedicated to improving the health of patients around the world and supporting WSO in efforts to increase awareness of stroke is a natural extension of our mission," said Keith Dawkins, M.D., global chief medical officer, Boston Scientific. "We are committed to developing innovative technologies which may provide alternatives to the current standard of care for stroke, and the WSO efforts to support patient education about stroke, risk factors, prevention and treatment options are highly complementary to our work."
According to the World Health Organization, approximately 15 million people suffer a stroke each year. Stroke is the second leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15 to 59. It also affects children, including newborns. Each year, nearly six million people die from stroke. In fact, stroke is responsible for more deaths annually than those attributed to AIDS, tuberculosis and malaria altogether. Stroke is also the leading cause of long-term disability, irrespective of age, gender, ethnicity or country.
The WSO launched the World Stroke Campaign in 2010 with the theme "1 in 6" to call attention to the fact that one in six people worldwide will have a stroke in their lifetime. Stroke knows no borders and can strike at any age. More information about the campaign can be obtained by visiting http://www.worldstrokecampaign.org
The WSO is calling on its member organizations and partners to share the WSO "1 in 6" challenge by asking them to remind individuals about these important steps in preventing stroke:
  1. Know their personal risk factors: high blood pressure, diabetes, and high blood cholesterol.
  2. Be physically active and exercise regularly. Attain and maintain a healthy body weight.
  3. Maintain a healthy diet high in fruit and vegetable and low in salt, sugar, saturated and trans fats to stay a healthy state and keep blood pressure low.
  4. Limit alcohol consumption.
  5. Avoid cigarette smoke. And, if they smoke, to seek help to stop now.
  6. Learn to recognize the warning signs of a stroke.

About WSO
The World Stroke Organization (WSO) was established in October 2006. WSO's mission is to reduce the global burden of stroke through prevention, treatment and long-term care. As the lead international body for stroke, WSO aims to accomplish its mission by:
  • Fostering the best standards of practice
  • Increasing stroke awareness among the population and among health professionals
  • Preventing subtle cerebrovascular disease leading to gait disorders, imbalance, vascular cognitive impairment and behavioral changes
  • Influencing policies for stroke prevention and improved health services
  • Providing education in collaboration with public and private organizations
  • Facilitating stroke research advocacy for people with stroke
  • Fostering the development of systems and organizations for long-term care and support of stroke survivors and their families.
With individual and organizational members worldwide, including stroke support groups, WSO is the global voice for stroke. WSO is the only international stroke NGO in official relations with the World Health Organization (WHO). Prof. Stephen Davis, MD, FRCP, Edin FRACP, from Melbourne, Australia, is the president of the World Stroke Organization.
http://www.worldstrokecampaign.org

Arthritis painkillers raise stroke, heart attack risk by more than a third, landmark study suggests

So ask your doctor which of these risk reduction ideas will counteract the use of these painkillers. You do expect your doctor to know this, don't you?
http://life.nationalpost.com/2013/05/30/arthritis-painkillers-raise-stroke-heart-attack-risk-by-more-than-a-third-landmark-study-suggests/
Millions of arthritis sufferers could be increasing their risk of a heart attack or stroke by more than a third by taking large doses of drugs such as ibuprofen, according to one of the largest studies into painkillers.
The study of more than 350,000 patients taking prescription doses of such medications found the chance of a heart attack or stroke rose by almost 40%.
The research found that the greater risk of cardiac side-effects from ibuprofen was similar to those of another arthritis drug, Vioxx, which was withdrawn from the market almost a decade ago when research suggested it might double the risk of heart attacks.
The painkillers were also found to double the risk of heart failure and bleeding ulcers when taken in high quantities
The painkillers, which are known as non-steroidal anti-inflammatory drugs (NSAIDs) and taken by millions of arthritis sufferers each day, were also found to double the risk of heart failure and complications such as bleeding ulcers when taken in high quantities.
The authors of the University of Oxford study said that their findings showed that prolonged use of such medicines was “risky”, but added that patients needed to weigh up the benefits against the potential dangers.
More than seven million people in Britain suffer from rheumatoid arthritis and osteoarthritis, and many rely on high doses of NSAIDs, which are also sold in lower quantities over the counter for common ailments.
The study, published in The Lancet, found that for every 1,000 people with a moderate risk of heart disease, about eight would normally have a heart attack or stroke each year.
When similar patients were given a year of treatment with a high dose of ibuprofen (2,400 milligrams daily) or another NSAID called diclofenac (150mg daily), that risk rose, with 11 patients suffering major cardiac events.
One in three of the extra heart attacks was fatal, the study found.
The same dosage, which is the maximum normally prescribed and twice the amount allowed over the counter, more than doubled the risk of heart failure from three cases in 1,000 to seven, and more than doubled the risks of complications such as bleeding ulcers.
If all seven million people with arthritis took the highest dosage of drugs, it would equate to an estimated 21,000 more heart attacks in sufferers, the study suggested.
‘We are trying to say yes, these drugs are risky, but it may be worth it’
Researchers said the study, funded by the Medical Research Council and the British Heart Foundation and led by the council’s unit at Oxford, had looked at the risks from common painkillers in “unprecedented detail.”
The lead author, Colin Baigent from the University of Oxford, said: “The research shows that, when used in high doses, diclofenac and ibuprofen increase the risk of cardiovascular disease, on average causing about three extra heart attacks a year in every 1,000 patients treated, one of which would be fatal.”
He added: “For many people who take these drugs for severe arthritis they make the difference between being able to go about their daily life or not. We are trying to say yes, they are risky, but it may be worth it.”
The findings, from an analysis of 639 randomized trials, found that a third drug, called naproxen, did not increase the risk of heart attacks or strokes when a high dose of 1,000mg a day was taken.
The study found that it was the most likely of the medications to cause bleeding from the stomach, but researchers said such problems were normally less serious.
Researchers said the cardiac risks from ibuprofen and diclofenac were “mainly relevant” to people with arthritis who were prescribed high doses or long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” said Prof Baigent.
Last year almost 17 million prescriptions were written by doctors in England for NSAIDs. About a third were for ibuprofen, a third for diclofenac and about a sixth for naproxen.
Alan Silman, the medical director of Arthritis Research UK, urged arthritis sufferers not to be “unduly concerned,” but said family doctors were turning increasingly to naproxen because of the potential cardiac risks of the other medications. He said: “There is an urgent need to find alternatives that are as effective, but safer.”
Dr. Shannon Amoils, research advisor at the BHF, said: “People should take the lowest effective dose of these drugs for the shortest time necessary.”

Technique Could Identify Patients at High Risk of Stroke or Brain Hemorrhage

For information only.
http://www.newswise.com/articles/technique-could-identify-patients-at-high-risk-of-stroke-or-brain-hemorrhage
Measuring blood flow in the brain may be an easy, noninvasive way to predict stroke or hemorrhage in children receiving cardiac or respiratory support through a machine called ECMO, according to a new study by researchers at Nationwide Children’s Hospital. Early detection would allow physicians to alter treatment and take steps to prevent these complications—the leading cause of death for patients on ECMO.
Short for extracorporeal membrane oxygenation, ECMO is used when a patient is unable to sustain enough oxygen in the blood supply due to heart failure, septic shock, or other life-threatening condition, said Nicole O’Brien, MD, a physician and scientist in critical care medicine at Nationwide Children’s and lead author of the study, which appears in a recent issue of the journal Pediatric Critical Care Medicine. The patient is connected to ECMO with tubes that carry the patient’s blood from a vein through the machine, where it is oxygenated and funneled back to the patient via an artery or vein that then distributes the oxygen-rich blood to vital organs and tissues.
The disease processes that lead someone to need ECMO are different, O’Brien noted, but it is used only after traditional therapies, such as a ventilator, fail. One of the biggest risks of ECMO is bleeding in the brain. Only 36 percent of children who suffer this complication survive, many left with permanent neurologic injury.
“Most of these patients are critically ill before they go on ECMO and often have low oxygen levels, low blood pressure and poor heart function, all of which can certainly lead to strokes,” said O’Brien, also an associate professor of clinical medicine at The Ohio State University College of Medicine. “Still, some patients develop problems and others don’t and we don’t understand why.”
To better understand the cause for these brain bleeds, O’Brien launched a pilot study to monitor cerebral blood flow using a transcranial doplar ultrasound machine, a portable, noninvasive technology that uses sound waves to measure the amount and speed of blood flowing through the brain. All patients on ECMO experience a change in cranial blood flow, but O’Brien wanted to see if those variations offered any hint as to why some patients had complications while others didn’t.
She measured cranial blood flow in 18 ECMO patients, taking the first reading within the patient’s first 24 hours on the machine, then again each day they received the treatment and one more time after ECMO therapy ended.
When she compared these measurements to normal cerebral blood flow rates for children in the same age group, she found significant differences. Thirteen of the children in the study developed no neurologic complications while on ECMO. In these children, cerebral blood flow was 40 percent to 50 percent lower than normal. But in the five patients who had either a stroke or brain hemorrhage while on ECMO, cerebral blood flow was 100 percent higher than normal.
The age of the child, length of time on ECMO or the underlying illness didn’t seem to matter. The only difference was that cerebral blood flow was dramatically increased in patients who ultimately had problems. While O’Brien found that interesting, the most intriguing finding was that the increase in blood flow occurred as long as two to six days before the patient began bleeding in the brain.
“That could give us a lot of lead time to prevent the brain bleeds or hemorrhages,” said O’Brien.
Physicians may decide to try to wean a patient off ECMO a little more quickly or change the dosage of anti-coagulant medication that all ECMO patients take.
Although O’Brien is excited about the results, she is careful to note that the findings are preliminary. She is planning a multi-center trial to see if the outcome will be the same in a larger study population.
“We still need to understand why these kids bleed and why they stroke,” said O’Brien. “This little piece of information is the very tip of the iceberg in terms of why that happens.”

Do you still think of eggs as nutritional no-nos?

I don't and since eggs are the seventh in foods that contain cholesterol. The top six are various types of brains. That should lead you to question, if brains contain so much cholesterol, What is its function and why would you want to reduce cholesterol by taking statins? Don't listen to me, I'm just confusing the brainwashing your doctors are giving you. 
http://www.webmd.com/food-recipes/features/3-ways-cook-eggs
Do you still think of eggs as nutritional no-nos? A growing body of research scrambles the old thinking that eggs raise the risk of heart disease. One egg does contain 186 milligrams cholesterol, but an analysis of two large studies found that healthy people who ate eggs didn't have an increased risk of heart disease or stroke.
"The amount that an egg a day would raise your blood cholesterol levels is actually pretty small," says Walter Willett, MD, DrPH, professor of epidemiology and nutrition at the Harvard School of Public Health. The American Heart Association recommends healthy adults stick to about an egg a day, but that's an average. Two eggs every other day are fine, too, Willett says.
It's eggs-cellent news, given that eggs, at only 70 calories each, are inexpensive, a snap to prepare, popular with kids, and packed with 6 grams of protein. The protein may even make eggs a good choice if you're trying to slim down. In one recent study, participants ate breakfasts of either eggs or wheat cereal with nearly identical calories and protein. The people who ate eggs felt fuller and ate less at lunch.

Made-in-P.E.I. drug aims to ease strokes

Someone who isn't bamboozled the the tPA aura.
http://www.theguardian.pe.ca/News/Local/2013-05-29/article-3264069/Made-in-P.E.I.-drug-aims-to-ease-strokes/1
Stroke victims could some day get help from a made-in-P.E.I. drug as Atlantic Veterinary College researchers move closer to trying it out on human patients.
Professor Tarek Saleh’s lab developed a compound to protect the brain during a stroke and recently signed a memorandum of understanding with Mokwon University in South Korea for further research.
Saleh said he was excited to see other people interested in his lab’s work.
“It’s truly a global collaboration,” he said.
When a blood clot stops the flow of blood to the brain, it causes a stroke and cuts off oxygen to the brain.
There is a drug, called tissue plasminogen activator (TPA), available to break up the clot, but most stroke victims can’t take it because doctors have a small window of opportunity in which to administer it.
Only about five per cent of stroke victims are able to use the clot-busting drug.
The problem, Saleh said, is that free radicals cause damage to the brain when blood flow suddenly returns.
Saleh and his research team created a compound called UPEI-100 that protects the brain from the free radical damage and extends the window of opportunity for doctors to administer TPA, even if the victim doesn’t know when they had the stroke.
The next step is proving the compound’s effectiveness and that’s where research technician Barry Connell comes in.
Connell works in a small lab at the veterinary college where injects up to four rats a day with the compound and anesthetizes them before inducing a stroke in them.
He does that by inserting three nylon threads under an artery in a rat’s brain to cut off the blood flow.
The threads are later removed to allow blood to flow back into the brain to simulate a clot removal.
After Connell removes the threads, he also removes the rat’s brain and colours it with a dye to measure how much damage the stroke causes and to determine how much protection the compound gives once blood starts flowing again.
All of the animal testing is done under stringent controls to ensure the test animals are treated in a responsible and ethical manner.
Saleh said those tests have shown promising results with the compound made up of natural, plant-based products leading to reduced damage after the blood flow returns.
It was that combination of the products that is in pre-clinical trials and got the attention of the lab’s partners in Korea and a bioscience company in Atlanta.
“It’s a hundred-fold more potent if you combine the compounds than if you were
to give them individually,” he said.
Trials have already shown the natural products that make up the compound are safe for humans, but human trials for UPEI-100 as a stroke treatment are still a few years away.
And while they know the compound created in Charlottetown works, Saleh said his lab doesn’t know why and that’s where Mokwon University comes in.
“That’s why we’re doing testing.”
Connell was the lab’s representative in South Korea where he travelled in March for a ceremonial signing of the memorandum of understanding.
When he was there, he was treated like royalty with TV, newspaper and radio outlets all there to cover the signing, Connell said.
“It was more than ... I could ever hope could have come out of the work that we do.”
Connell said he has been working in a lab doing research for 35 years and is finally seeing something he helped develop with potential to lead to more than just a scientific paper.
“It’s incredible,” he said.

New Treatment for Stroke Set to Increase Chances of Recovery - haemorrhage blood pressure lowering

Do you really think your hospital will install this procedure in the next 10 years? Go ahead, demand to know when they are going to be up-to-date.
If you present to the hospital tomorrow with a  haemorrhage, do you think you'll get the latest treatment? Are you 100% sure?
http://www.sciencedaily.com/releases/2013/05/130529111248.htm
University of Leicester researchers have contributed to a landmark study which has revealed a new way to treat strokes caused by bleeding inside the brain.

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The study found that intensive blood pressure lowering in patients with intracerebral haemorrhage, the most serious type of stroke, reduced the risk of major disability and improved chances of recovery by as much as 20 per cent.
The study, which involved more than 2800 patients from 140 hospitals around the world, was announced today at the European Stroke Conference in London, and published in The New England Journal of Medicine.
Professor Thompson Robinson, Deputy Head of the University of Leicester's Department of Cardiovascular Sciences, was the UK co-ordinator for the study and co-authored the paper.
The study was led by the George Institute for Global Health, in Sydney, Australia.
Professor Thompson Robinson said: "Stroke is the third most common cause of death in the UK and the most common adult cause of neurological disability. Approximately 1 million people are living with the consequences of stroke in the United Kingdom, a third with life-changing severe disability. Every year an estimated 152,000 people in the UK have a stroke and intracerebral haemorrhage -- spontaneous bleeding within the brain most often due to hypertension -- accounts for at least 10 per cent of all cases.
"Intracerebral haemorrhage kills about half of those affected within one month and leaves most survivors disabled, and to date there is no specific treatment for this type of stroke.
"The results of the study show that intensively reducing high blood pressure within 6 hours of onset of a bleeding-related stroke is safe, and results in a significant shift from being dead and dependent to being alive and independent after stroke. Because it involves treatment with already available blood pressure-lowering treatments, the results should be easy to implement in all hospitals and be of benefit to patients. It is important to reinforce that stroke is a medical emergency, and individuals who suspect that they may have had a stroke should dial 999 and seek urgent medical attention.
"Leicester has a long-standing interest in acute stroke and blood pressure research, and hosts the NIHR Trent Stroke Local Research Network. There are many opportunities for Leicester patients presenting with stroke to participate in research to improve outcomes for future patients with stroke."
Professor Bruce Neal of The George Institute and The University of Sydney said the study challenges previous thought about blood pressure lowering in intracerebral haemorrhage.
He said: "The study findings will mean significant changes to guidelines for stroke management worldwide. They show that early intensive blood pressure lowering, using widely available therapies, can significantly improve the outcome of this illness.
"We hope to see hospital emergency departments around the world implement the new treatment as soon as possible. By lowering blood pressure, we can slow bleeding in the brain, reduce damage and enhance recovery.
"The study findings are tremendously exciting because they provide a safe and efficient treatment to improve the likelihood of a recovery without serious disability -- a major concern for those who have experienced stroke.
"The only treatment option to date has been risky brain surgery, so this research is a very welcome advance."
The study found patients who suffered an acute intracerebral haemorrhage and received the blood pressure lowering treatment were better off from both a physical and psychological perspective.

Tuesday, May 28, 2013

Tips to prevent a stroke

I know this is from a community newspaper but the answer reads like press release boilerplate. The first thing you do is find out exactly what caused your dads stroke and check with your doctor to see if that is hereditary.
You will notice it doesn't tell about all these  stroke reduction ideas; like marijuana buds, etc.
http://www.mcphersonsentinel.com/article/20130528/LIFESTYLE/130529242?refresh=true
Q: My dad is 54 and just had a stroke! I'm turning 30 and don't want that to happen to me. What exactly causes a stroke and how can I stay healthy? — Kathy P., Little Rock, Ark.
A: You're smart to get in front of this problem. These days, when 20 percent of strokes hit folks younger than 55, everyone needs to get on board with stroke prevention. Fortunately, there's a lot you can do to protect yourself.
Stroke facts: There are three types of strokes. Ischemic stroke accounts for 87 percent of all events; it's caused by a blockage from a clot or plaque in a vessel that supplies blood to the brain. The remaining 13 percent are from hemorrhagic stroke — from a ruptured blood vessel — and transient ischemic attack, also called a ministroke, largely caused by a clot or platelet plug in your carotid artery or a clot in your heart, if you have atrial fibrillation.  
Who's at risk? There are nonmodifiable genetic and age-related factors that increase the risk of stroke.
But you should concentrate on your modifiable risk factors. They include hypertension, smoking or exposure to secondhand smoke, diabetes, atrial fibrillation, elevated LDL and triglyceride levels, poor diet, physical inactivity, obesity (especially belly fat), metabolic syndrome, alcohol and drug abuse and sleep apnea.  
Your Stroke Busters: First, eliminate exposure to tobacco smoke, recreational drugs and excess alcohol (more than one glass of wine a day for women and two for men). Then, through diet and exercise, you can control high blood pressure, high LDL cholesterol, a-fib, diabetes and metabolic syndrome and even sleep apnea.
Start with 60 minutes of brisk walking daily, building up to your goal of 10,000 steps, and practice stress reduction through meditation. Avoid the Five Food Felons — added sugars and sugar syrups, any grain that's not 100 percent whole, most saturated fats and all trans fats — and up your fiber intake from vegetables and fruits. Take blood pressure medication if prescribed (it can cut stroke risk by 32 percent) and, if your doc OKs it, two baby aspirin a day with a half glass of warm water before and after. Start today, and your tomorrows will bring you a brighter future and a younger RealAge!

The Use of Neuroimaging Studies and Neurological Consultation to Evaluate Dizzy Patients in the Emergency Department

And maybe if ER departments had one of these 17 objective testss for stroke this wouldn't be quite such a big concern.
http://nho.sagepub.com/content/3/1/7.full.pdf+html
Abstract
Background and Purpose:
Dizziness is a frequent reason for neuroimaging and neurological consultation, but little is known
about the utility of either practice. We sought to characterize the patterns and yield of neuroimaging and neurological con-
sultation for dizziness in the emergency department (ED).
Methods:
We retrospectively identified consecutive adults presenting
to an academic ED from 2007 to 2009, with a primary complaint of dizziness, vertigo, or imbalance. Neurologists reviewed medical records to determine clinical characteristics, whether a neuroimaging study (head computed tomography [CT] or brain magnetic resonance imaging [MRI]) or neurology consultation was obtained in the ED, and to identify relevant findings on neuroimaging studies. Two neurologists assigned a final diagnosis for the cause of dizziness. Logistic regression was used to evaluate bivariate and multivariate predictors of neuroimaging and consultation.

Results:
Of 907 dizzy patients (mean age 59
years; 58% women), 321 (35%) had a neuroimaging study (28% CT, 11% MRI, and 4% both) and 180 (20%) had neurological consultation. Serious neurological disease was ultimately diagnosed in 13% of patients with neuroimaging and 21% of patients with neurological consultation, compared to 5% of the overall cohort. Headache and focal neurological deficits were associated with both neuroimaging and neurological consultation, while age≥60 years and prior stroke predicted neuroimaging but not consultation, and positional symptoms predicted consultation but not neuroimaging.

Conclusion:
In a tertiary care ED, neuroimaging and neurological consultation were frequently utilized to evaluate dizzy patients, and their diagnostic yield was substantial.
Introduction
Dizziness is one of the most common triage complaints in the
emergency department (ED), accounting for approximately
3%
of visits.
1
Most cases of acute dizziness or vertigo are related to benign causes, such as peripheral vestibular dysfunction.
1-5
However, a small proportion of cases are due to central causes, particularly posterior fossa strokes, which if missed, could lead to severe disability or death.
1,2,6,7
This general concern for uncommon but serious causes of
dizziness often leads to extensive workups for acutely dizzy
patients in the ED that include neuroimaging studies or
neurological consultation.
8,9
However, little is known about the prevalence or utility of either practice, and there are no published data about the clinical factors that are associated with requests for imaging or consultation. A better understanding of the factors associated with these management decisions and the usefulness of these costly and time-
consuming tests is a necessary step toward improving the
overall efficiency and cost-effectiveness of these evaluations

Top 20 Grant-Giving Disease Foundations

You really didn't expect a stroke one to be in here, did you? Well you won't be disappointed, the ASA and NSA are not represented. Unless an organization has a high % in this category will I consider donating. I will not donate to a press release organization.
http://www.genengnews.com/insight-and-intelligence/top-20-grant-giving-disease-foundations/77899817/ 

Mount St. Mary's celebrates stroke achievements - Niagara Falls

I will only focus on the last line, its that mentality that is preventing progress in stroke. What we have today is good enough - NO IT'S NOT.  A 10 % recovery rate is failure by any definition.
http://www.wnypapers.com/news/article/current/2013/05/28/111153/mount-st.-marys-celebrates-stroke-achievements
Congratulations are in order for the team that oversees the stroke care program at Mount St. Mary's for earning the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke Gold Plus Quality Achievement Award and Target Stroke Honor Roll designation.
In a ceremony to celebrate the awards, from left, hospital President and CEO Judy Maness was joined by stroke patient survivor Edgar Hayes of Lewiston, stroke program medical director Dr. Gregory Sambucci, clinical excellence coordinator Rosanne Schavi, and the American Heart and American Stroke Association of Western New York's executive director, Liz Zulawski, and quality improvement director, Roseanne Hemmitt.
Over a 12-month period, at least 50 percent of the hospital's eligible ischemic stroke patients received tissue plasminogen activator, or tPA, within 60 minutes of arriving at the hospital (known as "door-to-needle" time).
A thrombolytic, or clot-busting agent, tPA is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reverse the effects of stroke and reduce permanent disability.
"With a stroke, time lost is brain lost, and the Get With The Guidelines-Stroke Gold Plus Quality Achievement Award and Target Stroke Honor Roll demonstrates Mount St. Mary's commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care," Maness said. "We will continue with our focus on providing evidence-based care, i.e., care that has been shown in scientific literature to quickly and efficiently treat stroke patients with proven protocols."

Monday, May 27, 2013

An Updated Definition of Stroke for the 21st Century

Great, our medical team doesn't even have a definition of stroke. How the hell do we expect them to solve all the problems in stroke rehab, prevention, research?
Written about in 1999;
Stroke is the wrong term to use
The term ‘stroke’ is obscurantist, reductionist, and redundant. It has connotations that are unhelpful to both the general public and the medical profession. Better terms exist that either do not pretend to be a diagnosis (eg, ‘brain attack’), or that have some pathophysiological significance. ‘Stroke’ should be consigned to the dustbin of medical usage.

And 13 years later we might get some definition. We are working with sloths but that would denigrate sloths.
http://stroke.ahajournals.org/content/early/2013/05/07/STR.0b013e318296aeca

Abstract

Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term “stroke” is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease

You'll have to have your doctor get the full article to make sure s/he is up-to-date on your anticoagulation needs.
http://neurology.org/content/80/22/2065

Abstract

Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article.
Methods: Systematic literature review with practice recommendations.
Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients undergoing invasive ocular anesthesia, cataract surgery, dermatologic procedures, transrectal ultrasound–guided prostate biopsy, spinal/epidural procedures, and carpal tunnel surgery should probably continue aspirin (Level B). Some stroke patients undergoing vitreoretinal surgery, EMG, transbronchial lung biopsy, colonoscopic polypectomy, upper endoscopy and biopsy/sphincterotomy, and abdominal ultrasound–guided biopsies should possibly continue aspirin (Level C). Stroke patients requiring warfarin should routinely continue it when undergoing dental procedures (Level A) and probably continue it for dermatologic procedures (Level B). Some patients undergoing EMG, prostate procedures, inguinal herniorrhaphy, and endothermal ablation of the great saphenous vein should possibly continue warfarin (Level C). Whereas neurologists should counsel that warfarin probably does not increase clinically important bleeding with ocular anesthesia (Level B), other ophthalmologic studies lack the statistical precision to make recommendations (Level U). Neurologists should counsel that warfarin might increase bleeding with colonoscopic polypectomy (Level C). There is insufficient evidence to support or refute periprocedural heparin bridging therapy to reduce thromboembolic events in chronically anticoagulated patients (Level U). Neurologists should counsel that bridging therapy is probably associated with increased bleeding risks as compared with warfarin cessation (Level B). The risk difference as compared with continuing warfarin is unknown (Level U).

Clinic helps stroke patients recover balance, avoid future falls

Something like this should be available in every hospital/clinic. Objective evaluation of your walking and falling practice. Remember to ask your therapist to perturb your walking.
http://www.ctvnews.ca/health/clinic-helps-stroke-patients-recover-balance-avoid-future-falls-1.1298336
Janet Raymond leans forward, her upper body supported by a vest-like harness suspended from the ceiling. She's waiting for the apparatus to deliver the jolt she knows is coming, its goal is to test how steady she is on her feet.
There's an abrupt release of tension on the harness and Raymond lurches forward, her face betraying a touch of uneasiness, despite having gone through this manoeuvre many times before.
But she's kept her footing and hasn't fallen -- and that means she's making progress.
About eight months ago, Raymond was about to board a Toronto streetcar after a night out with friends, when her legs suddenly felt too weak to mount the vehicle's stairs.
It turned out she had suffered a mild stroke, which affected her right leg and part of her hand. After a stay in hospital, Raymond was transferred to the stroke unit at Toronto Rehab, where therapists took over her recovery.
"When I first arrived, I couldn't walk at all," says Raymond, 62. "I was in a wheelchair. I was quite upset and I wondered what was going to happen, if I'd be in a wheelchair all my life."
Her goal was to walk again, to go back to work as a delivery driver and to return to everyday activities with her husband.
That's when staff at the Balance, Falls and Mobility clinic at Toronto Rehab kicked into high gear.
The recently created program is designed to assess patients' balance and walking ability using state-of-the-art computerized technology.
"We have developed a clinic where individuals come from the stroke unit or from our brain injury in-patient unit and they get a very sophisticated assessment based on some of the research that we're doing," says Dr. Mark Bayley, medical director of the brain and spinal rehab program.
"And we provide them with a treatment plan based on that assessment."
One of those assessment tools, and indeed recovery tools, involves having patients "fall" or go off balance while wearing a protective harness.
Strapped into the gear, the patient stands on pressure-sensitive force plates that transmit data to a computer, which maps how their footing changes in response to the controlled fall -- a "perturbation" in rehab-speak.
"We look at their reactions to that perturbation and try to improve that through training them," says Bayley.
Another piece of the assessment-training equipment is a pressure-sensitive gait mat, which records a patient's steps as they walk, transferring their footfalls in real time to a computer screen.
"The person walks on the mat and it's able to pick up footfalls and give us a whole bunch of information, quantitative information, about how that person is walking -- how quickly, what their stride length is, how variable they are in their walking," explains clinic leader Liz Inness.
"And again, we might be able to compare how they walk with their cane, without their cane, with or without an orthotic, under different conditions, so we can tailor our therapies."
Inness says using these more technological assessments goes beyond what therapists can glean about a patient's mobility strictly through observation.
Seeing how a patient's feet land can reveal underlying issues that might be affecting balance control or gait, so that therapy can be more specifically targeted.
"Balance and mobility issues are a huge problem after someone has a stroke or a brain injury," she says. "It can affect their risk for falls when they return to the community. It can also affect their day-to-day life.
"When we're out in the community, we are experiencing countless perturbations to our balance just to be able to walk, negotiating crowds, walking on the sidewalk.
"And this allows us to assess underlying issues we need to address in therapies to help people become more mobile and return to the community in a safe and independent way."
Toronto Rehab is also developing portable tools using such game-based devices as Nintendo Wii balance boards, which could be used in clinical settings outside the hospital.
"We're working to see if we can use those to provide the same measurements as in the clinic," says mobility team leader William McIlroy.
"Our bigger plan, our bigger initiative, is to transform not just the Toronto Rehab and not just in southern Ontario, but around the world about how people diagnose and treat balance and mobility challenges."
For Raymond, the program has meant a return to independence.
"You don't feel the same after you have a stroke," she says. "I had to learn how to walk all over again ... Eventually, I couldn't believe it, but I could walk. Every day was better.
"It gave me hope that I'm not going to be stuck in a wheelchair. I'm going to be walking and normal."

Encouraging data from stem cell trial in stroke patients as plans for Phase II progress

I am somewhat concerned that they talk about enrolling stroke patients, all of whom will have suffered a stroke within a few weeks. That means there is no way to split off spontaneous recovery from any boost provided by the stem cells. Bad science.
http://medicalxpress.com/news/2013-05-stem-cell-trial-patients-phase.html
Updated interim data from the PISCES trial, which has seen the brains of ischaemic stroke patients injected with neural stem cells to test the safety and tolerability of the treatment, was presented to the 22nd European Stroke Conference in London today. Professor Keith Muir of the University of Glasgow, who is heading the trial of ReNeuron Group plc's ReN001 stem cell therapy at the Southern General Hospital, Glasgow reported that data from the first nine patients treated has shown no cell-related or immunological adverse affects. He added that most patients had experienced sustained modest reductions in neurological impairment compared to their pre-treatment baseline performance, accompanied by improvement in abilities to undertake day to day tasks. A further two patients have been treated since the data were collated and the trial is now drawing to a close, with full results due to be published next year. Meanwhile, plans are proceeding for a Phase II trial which will examine the efficacy of stem cell treatment in stroke patients and an application is expected to be submitted to the UK regulatory authorities in early July. If approved the Phase II trial is scheduled to commence later this year. The Phase II trial will be a controlled multi-centre trial involving around 20 patients initially, all of whom will have suffered a stroke within a few weeks. Professor Muir said: "We remain pleased and encouraged by the data emerging from the PISCES study. The data to date identify no safety issues with the ReN001 treatment – which is the primary focus of this Phase I trial. "The evidence of functional improvement requires further investigation in a suitably designed Phase II efficacy study and we look forward to being a principal clinical site in that study when it commences." Michael Hunt, Chief Executive Officer of ReNeuron, said: "The PISCES study continues to yield encouraging results. Assuming the remaining required short-term follow up data confirm the good safety profile of the treatment, we will be able to move the ReN001 therapy confidently into Phase II clinical development, as planned, later this year." The Phase II study plan has been adopted by the NHS National Institute for Health Research Stroke Research Network (SRN). This important endorsement will enable ReNeuron to work closely with the SRN to optimise performance against defined targets regarding site set-up, patient recruitment and monitoring activities across the various sites participating in the study. ReNeuron will seek final regulatory and ethical approvals for the Phase II stroke study by submitting a data package including three month follow-up data on the final dose cohort in the PISCES study to the UK regulatory authorities in early July and, assuming approvals are granted, expects to commence recruitment into the Phase II study shortly thereafter. The PISCES study is the world's first fully-regulated clinical trial of a neural stem cell therapy for disabled stroke patients. Stroke is the third largest cause of death and the single largest cause of adult disability in the developed world. The trial is being conducted at the Institute of Neurological Sciences, Southern General Hospital, Greater Glasgow and Clyde NHS Board.

Read more at: http://medicalxpress.com/news/2013-05-stem-cell-trial-patients-phase.html#jCp
Updated interim data from the PISCES trial, which has seen the brains of ischaemic stroke patients injected with neural stem cells to test the safety and tolerability of the treatment, was presented to the 22nd European Stroke Conference in London today. Professor Keith Muir of the University of Glasgow, who is heading the trial of ReNeuron Group plc's ReN001 stem cell therapy at the Southern General Hospital, Glasgow reported that data from the first nine patients treated has shown no cell-related or immunological adverse affects. He added that most patients had experienced sustained modest reductions in neurological impairment compared to their pre-treatment baseline performance, accompanied by improvement in abilities to undertake day to day tasks. A further two patients have been treated since the data were collated and the trial is now drawing to a close, with full results due to be published next year. Meanwhile, plans are proceeding for a Phase II trial which will examine the efficacy of stem cell treatment in stroke patients and an application is expected to be submitted to the UK regulatory authorities in early July. If approved the Phase II trial is scheduled to commence later this year. The Phase II trial will be a controlled multi-centre trial involving around 20 patients initially, all of whom will have suffered a stroke within a few weeks. Professor Muir said: "We remain pleased and encouraged by the data emerging from the PISCES study. The data to date identify no safety issues with the ReN001 treatment – which is the primary focus of this Phase I trial. "The evidence of functional improvement requires further investigation in a suitably designed Phase II efficacy study and we look forward to being a principal clinical site in that study when it commences." Michael Hunt, Chief Executive Officer of ReNeuron, said: "The PISCES study continues to yield encouraging results. Assuming the remaining required short-term follow up data confirm the good safety profile of the treatment, we will be able to move the ReN001 therapy confidently into Phase II clinical development, as planned, later this year." The Phase II study plan has been adopted by the NHS National Institute for Health Research Stroke Research Network (SRN). This important endorsement will enable ReNeuron to work closely with the SRN to optimise performance against defined targets regarding site set-up, patient recruitment and monitoring activities across the various sites participating in the study. ReNeuron will seek final regulatory and ethical approvals for the Phase II stroke study by submitting a data package including three month follow-up data on the final dose cohort in the PISCES study to the UK regulatory authorities in early July and, assuming approvals are granted, expects to commence recruitment into the Phase II study shortly thereafter. The PISCES study is the world's first fully-regulated clinical trial of a neural stem cell therapy for disabled stroke patients. Stroke is the third largest cause of death and the single largest cause of adult disability in the developed world. The trial is being conducted at the Institute of Neurological Sciences, Southern General Hospital, Greater Glasgow and Clyde NHS Board.

Read more at: http://medicalxpress.com/news/2013-05-stem-cell-trial-patients-phase.html#jCp
Updated interim data from the PISCES trial, which has seen the brains of ischaemic stroke patients injected with neural stem cells to test the safety and tolerability of the treatment, was presented to the 22nd European Stroke Conference in London today. Professor Keith Muir of the University of Glasgow, who is heading the trial of ReNeuron Group plc's ReN001 stem cell therapy at the Southern General Hospital, Glasgow reported that data from the first nine patients treated has shown no cell-related or immunological adverse affects. He added that most patients had experienced sustained modest reductions in neurological impairment compared to their pre-treatment baseline performance, accompanied by improvement in abilities to undertake day to day tasks. A further two patients have been treated since the data were collated and the trial is now drawing to a close, with full results due to be published next year. Meanwhile, plans are proceeding for a Phase II trial which will examine the efficacy of stem cell treatment in stroke patients and an application is expected to be submitted to the UK regulatory authorities in early July. If approved the Phase II trial is scheduled to commence later this year. The Phase II trial will be a controlled multi-centre trial involving around 20 patients initially, all of whom will have suffered a stroke within a few weeks. Professor Muir said: "We remain pleased and encouraged by the data emerging from the PISCES study. The data to date identify no safety issues with the ReN001 treatment – which is the primary focus of this Phase I trial. "The evidence of functional improvement requires further investigation in a suitably designed Phase II efficacy study and we look forward to being a principal clinical site in that study when it commences." Michael Hunt, Chief Executive Officer of ReNeuron, said: "The PISCES study continues to yield encouraging results. Assuming the remaining required short-term follow up data confirm the good safety profile of the treatment, we will be able to move the ReN001 therapy confidently into Phase II clinical development, as planned, later this year." The Phase II study plan has been adopted by the NHS National Institute for Health Research Stroke Research Network (SRN). This important endorsement will enable ReNeuron to work closely with the SRN to optimise performance against defined targets regarding site set-up, patient recruitment and monitoring activities across the various sites participating in the study. ReNeuron will seek final regulatory and ethical approvals for the Phase II stroke study by submitting a data package including three month follow-up data on the final dose cohort in the PISCES study to the UK regulatory authorities in early July and, assuming approvals are granted, expects to commence recruitment into the Phase II study shortly thereafter. The PISCES study is the world's first fully-regulated clinical trial of a neural stem cell therapy for disabled stroke patients. Stroke is the third largest cause of death and the single largest cause of adult disability in the developed world. The trial is being conducted at the Institute of Neurological Sciences, Southern General Hospital, Greater Glasgow and Clyde NHS Board.

[Act FAST] Now what? - NSA email

You'll have to see if you believe the statements in here. I don't.
Act Fast for Stroke - Donate Today


Dear dean,
You hear it all the time—do your part, act FAST, spread awareness, know the signs, get to the hospital. But now what? You hope the hospital has the resources necessary to recognize and treat a stroke quickly.
Stroke TeamNational Stroke Association’s Stroke Center Network is a community of hundreds of hospitals, rehabilitation centers and healthcare professionals working together to ensure you or your loved ones are receiving the best stroke care possible.
We provide education to our partners to make sure they stay up to date on the best stroke guidelines and the newest treatment options, and to help train hospital staff. (The problem is the guidelines aren't good enough to save neurons from the neuronal cascade of death, naked emperor and all.)
From community awareness to hospital preparedness to recovery resources and rehabilitation support, we are working every day to improve and save lives. But we can't do it alone and the best hospitals can’t do it alone—we need you.
Your support plays a central role in keeping our network strong and our community reach as wide as it can be, and helps us improve stroke care from recognition to hospital to home.
Please give today to support hospital education and help us make sure you, your family and your friends have access to the best stroke care available. Don't forget this May, three generous sponsors have stepped up and offered $30,000 in matching funds to double your contribution.
One of National Stroke Association’s very first network partners is OSF St. Francis Medical Center in Peoria, Ill.—a model of stroke excellence.
Their stroke team strives for the best care for every stroke patient, every time. Last year, OSF even matched the world record for fastest stroke treatment: nine minutes.
“You need team dedication and passion to make it work, [but] we can’t do what we need to unless people get here! We really promote National Stroke Association’s FAST message and the importance of calling 9-1-1.”—from a recent interview with OSF’s chief stroke nurse coordinator, Jan Jahnel
National Stroke Association is a part of Jan’s team. We make sure they have resources to not only provide support to stroke survivors, but also educate their surrounding community about stroke.
Your donation helps us improve stroke care from the onset of a stroke to the hospital to home.
Reducing the impact and incidence of stroke—that’s our mission. We can’t meet our mission without our stroke team in place—our community, our network and you.
Thank you,
Sharon Januchowski Signature
Sharon Januchowski
Executive Vice President
National Stroke Association
Act Fast for Stroke - Donate Today

Menopausal 'Foggy Brain' Confirmed in Tests

Now is your memory problem from these seven or this latest one? Don't let your doctor use Occams' razor just because your stroke was the  most recent happening. I bet your neurologist is not reading the journal Menopause.
http://news.yahoo.com/menopausal-foggy-brain-confirmed-tests-150941726.html

Memory problems are a common complaint of women going through menopause, and now a new study provides more evidence linking mood and hot flashes to loss of memory abilities during menopause.
Researchers found that women who felt their memory wasn't functioning well scored lower in a series of psychological tests of attention and memory. The women's cognitive performance was still within the normal range, but their ratings of their own memory abilities lined up with how well they performed in the tests.
The study also revealed links between memory abilities and mood, and the severity of menopause symptoms. Women who reported more negative emotions did worse on the tests than women who had felt less negative. Similarly, women who experienced severe hot flashes did worse on the tests, compared to women who had fewer hot flashes.
"The good news for women is that there's proof that their perception about their performance is real," said Dr. Margery Gass, the executive director for The North American Menopause Society and a gynecologist at Cleveland Clinic, who was not involved in the study.

More at link.