Quitter!

I'm seriously thinking of pulling back from my stroke blog for a while. It has completely consumed my life for the past 5 years and I'm not seeing much effect yet. Everything is pretty much laid out on how to fix the stroke medical system. Every single stroke hospital in the world should be doing  the exact same thing I'm doing, analyzing stroke research and seeing where it applies in the stroke protocols or setting up research to answer the question of how to get translational effects out of the research. I'm superfluous  There is no real intellectual challenge anymore in this. It is a management challenge and I've already proven in an earlier career that I hit the Peter Principle really hard when I was promoted to manager. Part of this is because I'm tired and I want to recover a couple hours for myself each night, maybe I'll finally catch up on sleep.
I will still post but probably put them up in a draft status until the weekend when I can blast them all out.
 There is still lots to do:
1. I have 20-30 ebooks to write yet on stroke
2. I have to create content for the various URLs I own.
    AFTERYOURSTROKE.COM   
    AFTERYOURSTROKE.INFO
    AFTERYOURSTROKE.NET
    AFTERYOURSTROKE.ORG
    DEANREINKE.COM
    DEANREINKE.INFO
    DEANREINKE.NET
    DEANREINKE.ORG
    DEANSSTROKEMUSINGS.COM
    STROKERESEARCHINSTITUTE.COM
    STROKERESEARCHINSTITUTE.INFO
    STROKERESEARCHINSTITUTE.NET
    STROKERESEARCHINSTITUTE.ORG
    STROKESURVIVORINSTITUTE.COM
    STROKETRIBEBLOGS.COM


3. I have to start up a stroke research foundation.
4. I have to recover enough to start running again.
5. I have to start a stroke blog farm.
Part of this is because I want to start another blog:
Deans' Michigan musings - Michigan is in a world of hurt from all the disastrous policies that have been implemented. And I happen to think that if I apply myself I could solve these problems. Hopefully leading to another career in public policy.
http://www.jamesaltucher.com/2015/06/quitter/?

A Cost-Effectiveness Study of Home-Based Stroke Rehabilitation

I don't give a flying fuck about cost-effectiveness. The only study that should be done is:

A Result-Effectiveness Study of Home-Based Stroke Rehabilitation. Her advisor should really know better than have her do research like this that does nothing useful.

A Cost-Effectiveness Study of Home-Based Stroke Rehabilitation

Development of a Questionnaire to Investigate Study Design Factors Influencing Participation in Gait Rehabilitation Research by People with Stroke: A Brief Report

So instead of actually doing something useful like solving the problems in stroke, they developed a fucking questionnaire. The mentors of these researchers need to be publicly chastised. Matt Lopez and Dr. Mariel Jessup please do the honors.
http://www.utpjournals.press/doi/abs/10.3138/ptc.2014-12
Kara K. Patterson, PT, PhD Nicole Gallant, MPT Tracey Ormiston, MPT Chad Patience, MPT Mandy Whitechurch, MPT Avril Mansfield, PhD Janet Brown, PT, MEd

ABSTRACT

Purpose: The main objective of this study was to evaluate the feasibility of a newly developed questionnaire to assess the influence of study design on participation in gait rehabilitation research in a pilot test with individuals with stroke. A secondary objective was to investigate the relationship between participation in gait rehabilitation research and social and clinical factors of interest after stroke.
Methods: A questionnaire was developed with expert opinion and guidance from related previous research. The questionnaire was pilot tested in a group of 21 people with stroke, and social and clinical factors (including gait function) were collected. Gait function was assessed using a pressure-sensitive mat; social and clinical characteristics were extracted from patient charts. Correlations were performed to investigate relationships between questionnaire responses and gait function, motor impairment, and chronicity; t-tests were used to examine response differences between people with a caregiver at home and those without.
Results: A total of 21 people with stroke completed the questionnaire without difficulty; mean completion time was 7.2 (SD 3.5) minutes, with a range of responses across participants. Borderline significant associations were found between gait function and the number of studies in which a person would participate and between stroke chronicity and the location of studies in which a person would participate.
Conclusions: A questionnaire to investigate the influence of study design factors on participation in rehabilitation research is feasible for administration in the post-stroke population and has potential to inform the design of future studies.

Recovery of post stroke proximal arm function, driven by complex neuroplastic bilateral brain activation patterns and predicted by baseline motor dysfunction severity

Once again, no clue. The researchers don't even know what they are measuring. We have no definition of what chronic means.
http://journal.frontiersin.org/article/10.3389/fnhum.2015.00394/abstract
Svetlana Pundik^{1, 2*}, Jessica McCabe⁴, Ken Hrovat⁴, Alice E. Fredrickson¹, Curtis Tatsuoka², I Jung Feng³ and Janis J. Daly^{5, 6}

• ¹Neurology, Cleveland Department of Veterans Affairs Medical Center, USA
• ²Neurology, Case Western Reserve University School of Medicine, USA
• ³Biostatistics, Case Western Reserve Univeristy, USA
• ⁴Research, Cleveland Department of Veterans Affairs Medical Center, USA
• ⁵Brain Rehabilitation Research Center of Excellence, MR Gainesville Department of Veterans Affairs Medical Center, USA
• ⁶Neurology, University of Florida, College of Medicine, USA

Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stoke have been poorly understood.(This may not be neuroplasticity, this could still be spontaneous recovery, depending on the time since the stroke) The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors.
Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI) for the shoulder/elbow components of reach and a skilled motor function test (Arm Motor Abilities Test (AMAT)), collected before and after treatment.
Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was an linear relationship between greater functional gain (AMAT) and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke.
Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e. increase or decrease in task-related brain recruitment) for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases or different strategies of neuroplasticity that drive functional recovery.

4C.08: AORTIC STIFFNESS IS AN INDEPENDENT BIOMARKER OF SUBCLINICAL BRAIN DAMAGE IN ACUTE ISCHEMIC STROKE

I have absolutely no clue what they are trying to say, it's not written in understandable English.  These people would not get another research grant from any stroke organization I controlled until they learn to write.
http://www.ncbi.nlm.nih.gov/pubmed/26102864

Gasecki D¹, Kwarciany M, Kowalczyk K, Rojek A, Nowicki T, Skrzypek-Czerko M, Szurowska E, Boutouyrie P, Laurent S, Narkiewicz K.

Author information

Abstract

OBJECTIVE:

Ischemic stroke may be the first manifestation of cerebrovascular disease. However, subclinical organ complications of underlying arterial stiffness and hypertension may coexist and stratify outcome. The study aimed to examine measures of arterial stiffness and blood pressure (BP) on subclinical brain damage in acute ischemic stroke patients.

DESIGN AND METHOD:

In a prospective study, we enrolled 132 (68,6% males) patients with acute ischemic stroke, AIS (age 62.2 ± 12.2 years, admission National Institutes of Health Stroke Scale score 7.1 ± 6.5, mean ± SD). Carotid-femoral pulse wave velocity (CF-PWV), central augmentation index (cAIx), as well as central and peripheral BPs were measured (SphygmoCor, Omron, respectively) one week after stroke onset. The presence of brain subclinical lesions was graded on admission computed tomography scans using van Swieten criteria with any relevant cerebral small vessel disease considered as brain microvascular damage.

RESULTS:

In univariate analysis, high carotid-femoral PWV (p = 0.00005), and high cAIx (p = 0.02) were significantly associated with brain microvascular damage. Age, presence of hypertension, diabetes mellitus, previous ischemic stroke, but not BP values, also predicted brain outcome. In multivariate analysis, the predictive value of carotid-femoral PWV remained significant (OR, 1.30; 95% CI, 1.04-1.62; p = 0.02). By contrast, cAIx had no significant predictive value after adjustment.

CONCLUSIONS:

Increased aortic stiffness is associated with brain microvascular disease in patients with acute ischemic stroke, beyond and above classical risk factors. PWV provides a useful new tool for identification of subclinical brain damage in AIS.

Adding Brain Stimulation Enhances Stroke Rehab

This is probably going to be hard to figure out how to do this yourself, but ask your therapist and doctor how. I do wonder how useful this is for those that have extensive dead areas in the motor cortex like me? I bet the researchers have no idea on what exact damage their subjects had to even figure out which patients will do better with this. There is nothing mentioned here that would leave me to believe that this is anything other than some patients had less damage and so looked like they recovered better.  The presidents of the ASA and NSA should be verifying research results to see if they even make sense. I don't know who made up surrogate markers but I don't think they should be used.
http://www.medscape.com/viewarticle/847174
Combining brain stimulation with a challenging motor training task may improve poststroke rehabilitation, according to a new randomized, double-blind, crossover study.
The study showed that compared with sham stimulation, a single session of dual transcranial direct-current stimulation (dual-tDCS) enhanced skill retention and produced lasting increases in resting-state functional MRI functional connectivity (FC) in the somatomotor network of stroke patients.
Because FC is considered a potential surrogate marker of poststroke recovery, the study findings are promising for neuro-rehabilitation, lead author Professor Yves Vandermeeren, MD, PhD, Neurology Department, Université catholique de Louvain, Brussels, Belgium, told Medscape Medical News.
"It's possible that within the next 5 or 10 years, every rehabilitation session will start with the placement of some electrodes to focus brain function, with the aim of enhancing the effect of training."
But Dr Vandermeeren stressed that brain stimulation won't work if the exercise that stroke patients are performing is "just repetitive training" and that the task needs to be "complex" and "challenging" to patients.
The research was presented here at the first Congress of the European Academy of Neurology (EAN).
Disrupted Connectivity
Research on resting-state fMRI has shown that FC is disrupted in stroke patients. This connectivity, said Dr. Vandermeeren, correlates with recovery. Motor learning, too, plays a key role in poststroke neuro-rehabilitation. With repeated training, movements become faster and more accurate, he added.
The new study included 22 patients with chronic hemiparetic stroke (18 men and 4 women). They ranged in age from 45 to 82 years.
Fifteen patients had sustained a subcortical stroke, while the rest had had a cortical stroke. All had some difficulty with hand function.
Their modified Rankin Scale score ranged from 1 to 4. Their National Institutes of Health Stroke Scale score was 0 to 12.
After completing a baseline resting-state fMRI session, patients entered the randomized, double-blind, placebo-controlled, crossover phase of the study. In each of the two parts of the study, patients received real or sham dual tDCS, applied over 30 minutes, while they completed the motor skill learning task.
Designed by the researchers, the task involves moving a mouse across a circuit as fast and as accurately as possible. For some patients, their paretic hand had to be taped to the computer to carry out the task, said Dr Vandermeeren.
Sixteen of the patients performed the task in a supine position, and the other 6 did so in front of a computer.
A week later, the patients returned for the "retention" session. A run of resting-state fMRI was carried out at the beginning of the retention session in each of the two study sections.

Researchers quantified FC with whole-brain independent component analysis.
The study found that compared with sham treatment, dual-tDCS enhanced motor skill retention (8% vs 64% for sham; P = .0004).
From the ICA, there were no changes between baseline and sham sessions in the somatomotor network, whereas FC was increased 1 week after dual-tDCS compared with baseline (qFDR < 0.05; t(63)  = 4.15).
Dr. Vandermeeren emphasized that the task has to be challenging.
"It's not just repetitive movements, but training that requires the subject to be focused, with increasing difficulty, raising the attention of the subject, and providing feedback and rewards."
He predicted that within about a decade, noninvasive brain stimulation might be added to poststroke exercises to enhance the rehabilitation effects. "Maybe patients can recover faster; maybe they can recover better, and maybe for a longer time," he told the session audience. As a quip, he added "It's a little bit like aspirin; it's good for everything…so far."
In responding to a query from a delegate about whether the data were sufficiently strong to suggest that a single brain stimulation could produce lasting results, Dr Vandermeeren said this was the first time that researchers were able to observe such a long-term effect with a single session of dual tDCS. Most effects from previous research with a single stimulation bout have been short-term.
Encouraging Findings
Commenting on the findings for Medscape Medical News, Gereon Fink, MD, PhD, director, Department of Neurology, University Hospital Cologne, Germany, who co-chaired the session on neurotraumatology and rehabilitation, said that the study is encouraging to those in the field.
"Given the importance of promoting brain plasticity to ameliorate neurological deficits, the results are very promising but nevertheless need to be replicated before one can really judge whether or not the approach used here may represent the future of post-stroke rehab."
It's important to keep in mind, said Dr Fink, that despite multiple studies reporting positive neuromodulatory effects of transcranial magnetic stimulation (TMS) or TDCS, many studies failed to find significant effects.
"Thus, at present, current evidence does not support the routine use of rTMS [repetitive TMS] or TDCS for the treatment of stroke. Further trials with larger sample sizes are needed to determine suitable rTMS or TDCS protocols and the long-term functional outcome."
Dr Vandermeeren and Dr Fink have disclosed no relevant financial relationships.
Congress of the European Academy of Neurology (EAN). Abstract 01124 Presented June 20, 2015.

garden suport

Mom places these plush toys  in her garden to keep the rabbits away. She works at a thrift store to get these.

Rental car

I flew back to Minnesota for a wedding this past weekend and had to rent a car. Got a Ford C Max hybrid.  It had the keyless start. The first problem was getting the car out of the rental lot. I'd push the start button and since this is a hybrid you don't hear any sound of an engine running.  I put the transmission in gear and nothing would happen. Finally figured out that the seat belt needed to be buckled. Very poor user design with no error messages or notifications on why the car won't get going. I don't expect to have to open the owners manual just to get the car moving, it should be intuitive. I'm driving my parents to the wedding so we hop in the rental because it has USB ports to plug in the smartphone to keep it charged while the GPS is used. Once again the car will not engage any gear. No messages except for my swearing which I never do in front of my parents. Finally dawned on me to unplug the USB. That allowed the car to be drivable. Complete stupidity on lack of user testing on Fords' part.

On the way back from the wedding Dad was complaining of being too cool from the fan pushing AC air. So we looked for the fan speed control, did not find it, pushed some buttons which managed to put the fan speed up to high, which elicted a bunch more swearing on my part.

It is so godamned simple to control, a knob or lever that controls cool/heat, a similar knob/lever that controls fan speed. Complete failure on the designers part. I was finally able to see the universal electronic on/off button
and pushed that to turn off the complete air system. My parents with no electronic experience would never have been able to figure that out.

Discovered: How The Brain Repairs Itself After a Stroke

A PSYBLOG writeup on this; readable even for your doctor.
http://www.spring.org.uk/2014/10/discovered-how-the-brain-repairs-itself-after-a-stroke.php

The actual research on this: 
A latent neurogenic program in astrocytes regulated by Notch signaling in the mouse

Discovery of Quantum Vibrations Inside Brain Neurons Supports Controversial Theory of Consciousness

Quantum anything basically is not understandable by me. So pass this onto whatever genius you know to see where it leads to in stroke recovery.
Regular discussion of it here:
http://www.spring.org.uk/2014/01/discovery-of-quantum-vibrations-inside-brain-neurons-supports-controversial-theory-of-consciousness.php?

The research it comes from here: 

Consciousness in the universe: A review of the ‘Orch OR’ theory

Scientists build fully functional neuron using organic bioelectronics

How will your doctor use this for your recovery?
http://www.news-medical.net/news/20150624/Scientists-build-fully-functional-neuron-using-organic-bioelectronics.aspx

Scientists at Sweden's Karolinska Institutet have managed to build a fully functional neuron by using organic bioelectronics. This artificial neuron contain no "living" parts, but is capable of mimicking the function of a human nerve cell and communicate in the same way as our own neurons do.
Neurons are isolated from each other and communicate with the help of chemical signals, commonly called neurotransmitters or signal substances. Inside a neuron, these chemical signals are converted to an electrical action potential, which travels along the axon of the neuron until it reaches the end. Here at the synapse, the electrical signal is converted to the release of chemical signals, which via diffusion can relay the signal to the next nerve cell.
To date, the primary technique for neuronal stimulation in human cells is based on electrical stimulation. However, scientists at the Swedish Medical Nanoscience Centre (SMNC) at Karolinska Institutet in collaboration with collegues at Linkoping University, have now created an organic bioelectronic device that is capable of receiving chemical signals, which it can then relay to human cells.

"Our artificial neuron is made of conductive polymers and it functions like a human neuron," says lead investigator Agneta Richter-Dahlfors, professor of cellular microbiology. "The sensing component of the artificial neuron senses a change in chemical signals in one dish, and translates this into an electrical signal. This electrical signal is next translated into the release of the neurotransmitter acetylcholine in a second dish, whose effect on living human cells can be monitored."
The research team hope that their innovation, presented in the journal Biosensors & Bioelectronics, will improve treatments for neurologial disorders which currently rely on traditional electrical stimulation. The new technique makes it possible to stimulate neurons based on specific chemical signals received from different parts of the body. In the future, this may help physicians to bypass damaged nerve cells and restore neural function.
"Next, we would like to miniaturize this device to enable implantation into the human body," says Richer-Dahlfors. "We foresee that in the future, by adding the concept of wireless communication, the biosensor could be placed in one part of the body, and trigger release of neurotransmitters at distant locations. Using such auto-regulated sensing and delivery, or possibly a remote control, new and exciting opportunities for future research and treatment of neurological disorders can be envisaged."

Source:

Karolinska Institutet

Effectiveness of body weight-supported treadmill training compared to overground training on functional outcomes in patients with hemiparesis

I hated treadmills because they were not realistic and I couldn't see it really helping regular walking. But I'm not normal. I would think by now there would be stroke protocols with efficacy ratings for how to recover walking.
http://dspace.unm.edu/handle/1928/27704

Author(s)

Jaramillo, Elizabeth

Subject(s)

hemiparesis
gait training
overground training
body weight supported treadmill training
stroke

Abstract

Abstract Background: Cerebral Vascular Accident (CVA) or stroke, is among the most common diagnoses seen in an inpatient rehabilitation facility as more than 790,000 Americans suffer new or recurrent strokes each year. Of these, approximately two thirds of survivors experience significant limitations in walking leading to increased risk for falls and fractures, decreased mobility, limited community access, depression and decreased quality of life. For this reason, gait training becomes a major focus of a rehabilitation program. Several common gait training methods may be implemented which have proven to be effective for improving gait speed and walking endurance in patients with hemiparesis (weakness on one side of the body). These may include overground training, treadmill training with or without body weight support, robotic-assisted locomotor training and functional electrical stimulation. Of these methods, overground gait training and treadmill training are among the most commonly used. Purpose: The purpose of this literature review is to examine overground training and body weight supported treadmill training and evaluate which method of gait training is more effective in improving functional outcomes in individuals following stroke. Case Description: This patient is a 35 year old male who suffered a right hemorrhagic cerebral vascular accident and seizures for which he underwent a right craniotomy. Patient presents with left hemiparesis, flaccid left upper and lower extremities, right lateral gaze and dysphagia. Upon initial evaluation, the patient required maximal two person assistance for bed positioning and mobility and maximal two person assistance for all transfers. Patient was only able to walk approximately 25 feet using an Arjo® Walker (hydraulic lift) at maximal assist with a dorsiflexion Ace wrap applied to the left lower extremity and assistance with foot clearance and limb advancement during ambulation. Outcomes: Over an eight week period the patient made significant gains. Patient required moderate assistance with all bed mobility skills and basic transfers. Both gait training methods were utilized in the rehabilitation program with an improvement demonstrated in ambulation with the patient able to ambulate 150 feet using a narrow based quad cane with moderate assistance and a dorsiflexion wrap to the left lower extremity. Neither method of gait training was proven to be superior to the other in improving walking speed and endurance. Discussion: Evidence shows that both overground gait training and body weight supported gait training are effective methods for increasing walking capacity, speed and endurance. No conclusive evidence exists that suggests that either method is more effective in promoting functional outcomes. Therefore, selection of intervention must be determined by the physical therapist based on functional status and limitations, along with the patient's values, goals, and expectations.

URI

http://hdl.handle.net/1928/27704

From Time is brain to Physiology is brain: a case for reflection in acute stroke treatment decisions

I'm sure your doctor subscribes to this and already has changed your stroke protocols because of this.
It's only 5 days old.
http://brain.oxfordjournals.org/content/138/7/1768

Smriti Agarwal , Elizabeth A. Warburton , Jean-Claude Baron

DOI: http://dx.doi.org/10.1093/brain/awv120 1768-1770 First published online: 23 June 2015

• Article
• Figures & data
• Information
• Explore
• PDF

This scientific commentary refers to ‘Perfusion computed tomography to assist decision making for stroke thrombolysis’, by Bivard et al. (doi:10.1093/brain/awv071).

The ischaemic penumbra, defined as severely hypoperfused, functionally impaired yet salvageable tissue, has been established as the key target for acute stroke therapy for more than three decades (Muir et al., 2006). However, the penumbra has a limited lifespan and, unless reperfused early, it progresses to become part of the irreversibly damaged tissue referred to as the ‘core’. The core therefore grows over time, incorporating first the most hypoperfused portions of the penumbra, and then progressively less hypoperfused portions, until none remains. How fast this process occurs varies greatly from subject to subject, mainly because of variable pial collaterals and the occurrence of spontaneous reperfusion (Fig. 1). On a mechanistic basis, reperfusion therapy—such as with intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA)—would be expected to be of no benefit, and potentially harmful, in cases with large core or no penumbra (Marchal et al., 1993).

Figure 1

The three main pathophysiological profiles used by Bivard et al. to categorize acute stroke patients, as originally defined using PET with ¹⁵oxygen-labelled compounds to generate quantitative maps of cerebral blood flow (CBF, left column) and the cerebral oxygen metabolic rate (CMRO₂, right). Validated tissue compartments including penumbra (reduced cerebral blood flow but relatively preserved CMRO₂) and core (markedly reduced CMRO₂) were used to characterize the three profiles of ‘target mismatch', ‘large core' and ‘no mismatch' (Muir et al., 2006). Consistent with the strikingly distinct spontaneous outcomes associated with these profiles (Marchal et al., 1993), Bivard et al. provide evidence from their cohort that the target mismatch group, i.e. patients with significant penumbral tissue and a small core, benefit the most from intravenous …

Key protein may affect risk of stroke

While this is good news, this just proves that no one seems to be willing to tackle solving the incredibly difficult problems in stroke. Leaders create strategies and tackle the difficult problems. They don't just sit back and continue down the failed status quo path. I need to quit getting mad about this before I blow an artery. But hell this is so fucking simple and obvious what needs to be done that I can't believe the thousands of highly educated stroke medical people don't have enough brains to see the way forward. And yes, this is not the way; 'How to Win friends and Influence People'.  But I don't care.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=154135&CultureCode=en
Studies on mice reveal that a special protein in the brain’s tiniest blood vessels may affect the risk of stroke. Peter Carlsson, professor in genetics at the University of Gothenburg, and his research team are publishing new research findings in the journal Developmental Cell about how the blood-brain barrier develops and what makes the capillaries in the brain different from small blood vessels in other organs.
The brain’s smallest blood vessels differ from those in other organs in that the capillary walls are much more compact. The nerve cells in the brain get the nutrients they need by molecules actively being transported from the blood, instead of passively leaking out from the blood vessels.
This blood-brain barrier is vital, because it enables strict control over the substances with which the brain’s nerve cells come into contact. It has a protective function that if it fails, increases the risk of stroke and other complications.
Special cell type essential to development
The smallest blood vessels, the capillaries, have a type of cell called pericytes. These are essential to the development of the blood-brain barrier. Pericytes are also found in other organs, and researchers have previously been unable to find out what gives the brain’s pericytes this unique ability.
The Gothenburg research team has found that the brain’s pericytes contain a protein, FoxF2, which is not present in the pericytes of other organs, and which coordinates the changes that make the blood vessels compact. FoxF2 is needed in order for the blood-brain barrier to form during foetal development.
“Mice that have too little or too much FoxF2 develop various types of defects in the brain’s blood vessels,” explains Peter Carlsson, professor at the University of Gothenburg’s Department of Chemistry and Molecular Biology.
One gene may play a critical role
In humans, researchers have noted that major changes in a region of chromosome 6 have been associated with an increased risk of stroke, but it has not been known which of the genes in the area are responsible for this risk.
“The FoxF2 gene is an extremely interesting candidate, as it is located right in the middle of this region, and research is under way now in collaboration with clinical geneticists to investigate the extent to which variations in the FoxF2 gene affect people’s risk of suffering a stroke,” says Peter Carlsson.
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http://www.gu.se/english/about_the_university/news-calendar/News_detail//key-protein-may-affect-risk-of-stroke.cid1310761

Peconic Bay Medical Center Receives Prestigious American Heart Association/American Stroke Association Honor - Long Island, NY

I wish they would just stop doing this, This is fucking useless because without a focus on results we are never going to make progress in stroke.
These are NOT result awards so they don't tell you anything about how good the program is. Call that hospital president( Andy Mitchell) and demand to know what the RESULTS are; 30 day deaths, 100% recovery.
There is absolutely nothing in here that tells me that the RESULTS are better in this hospital than other hospitals. I don't give a crap about how well you do processes.
Big f*cking whoopee.
Guidelines here: You can see how this is nothing to be impressed about. This is all indirect action, not results.
http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStrokeResus/GetWithTheGuidelinesStrokeHomePage/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp

But the puffery article here; 
https://www.longislandexchange.com/press-releases/peconic-bay-medical-center-receives-prestigious-american-heart-associationamerican-stroke-association-honor/

Letters of Support for H.R. 6, the 21st Century Cures Act

Fucking hey! Our stroke associations can't even be bothered to show support for this legislation. It would seem to be right up their alley. Getting someone else to do the hard work of solving all the problems in stroke. But I should just calm down and accept that they will never do anything useful for survivors. I bet they don't even know about this legislation.
http://energycommerce.house.gov/letter/letters-support-hr-6-21st-century-cures-act

Do Plaques Rapidly Progress Prior to Myocardial Infarction?

And if we had anything even approaching a decent stroke association and some competent doctors this would become a similar research project for stroke. But once again no one will follow up this and determine how this information could solve stroke problems.
http://circres.ahajournals.org/content/117/1/99.abstract

The Interplay Between Plaque Vulnerability and Progression

1. Amir Ahmadi,
2. Jonathon Leipsic,
3. Ron Blankstein,
4. Carolyn Taylor,
5. Harvey Hecht,
6. Gregg W. Stone,
7. Jagat Narula

+ Author Affiliations

1. From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.).

1. Correspondence to Jagat Narula, MD, PhD, Professor Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029. E-mail jagat.narula@mountsinai.org

Abstract

There is a common misperception in the cardiology community that most acute coronary events arise from ruptures of mildly stenotic plaques. This notion has emanated from multiple studies that had measured the degree of angiographic luminal narrowing in culprit plaques months to years before myocardial infarction. However, angiographic studies within 3 months before myocardial infarction, immediately after myocardial infarction with thrombus aspiration or fibrinolytic therapy, and postmortem pathological observations have all shown that culprit plaques in acute myocardial infarction are severely stenotic. Serial angiographic studies also have demonstrated a sudden rapid lesion progression before most cases of acute coronary syndromes. The possible mechanisms for such rapid plaque progression and consequent luminal obstruction include recurrent plaque rupture and healing and intraplaque neovascularization and hemorrhage with deposition of erythrocyte-derived free cholesterol. Moreover, recent intravascular and noninvasive imaging studies have demonstrated that plaques which result in coronary events have larger plaque volume and necrotic core size with greater positive vessel remodeling compared with plaques, which remain asymptomatic during several years follow-up, although these large atheromatous vulnerable plaques may angiographically seem mild. As such, it is these vulnerable plaques which are more prone to rapid plaque progression or are those in which plaque progression is more likely to become clinically evident. Therefore, in addition to characterizing plaque morphology, inflammatory activity, and severity, detection of the rate of plaque progression might identify vulnerable plaques with an increased potential for adverse outcomes.

Conquer the whole world with one hand behind my back

I will conquer the world even if no one else is holding my hand. 23 versions on the web so I can't tell where this originated. 

This  leads directly into this blog post;

world domination vs. stroke rehab protocols 

Conquering the world with one hand is vastly easier than trying to get the stroke medical world to actually solve the problems in stroke.

Chiropractic and Stroke: The question is not answered

More analysis of this. I will never get my neck adjusted, but then I'm stroke-addled and no one should ever listen to me.
https://www.sciencebasedmedicine.org/chiropractic-and-stroke-the-question-is-not-answered/

What Is The Lucky Number Hidden In Your Name?

Not that I believe any of this stuff. ME!, lack of confidence?
http://appso.me/node/567/result/558d901a21f6b

One month later on July 20 my fortune changed;