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

Tuesday, January 31, 2017

Cleveland Clinic Performs Nation’s First Deep Brain Stimulation for Stroke Recovery

Have your doctor follow this research, sounds promising. This is still after all the damage has been done. It would make much more fucking sense to prevent a lot of that damage by stopping the neuronal cascade of death by these 5 causes in the first week. Does no one understand cause and effect?
https://newsroom.clevelandclinic.org/2017/01/04/cleveland-clinic-performs-nations-first-deep-brain-stimulation-stroke-recovery/

First-in-human trial of deep brain stimulation for stroke recovery has begun


Cleveland Clinic has performed the first deep brain stimulation (DBS) surgery for stroke recovery, as part of an ongoing clinical trial assessing the procedure’s potential to improve movement in patients recovering from stroke.
Stroke is the leading cause of long-term disabilities in the United States. Despite rehabilitative efforts, one-third of stroke patients maintain long-term motor deficits severe enough to be disabling.
A team led by Andre Machado, M.D., Ph.D., chairman of Cleveland Clinic’s Neurological Institute, performed the DBS surgery Dec. 19, 2016. During the 6 hour procedure, electrodes were implanted in a part of the patient’s brain called cerebellum, which has extensive connections with the cerebral cortex. Connected to a pace-maker device, DBS electrodes provide small electric pulses as a way to help people recover control of their movements.
Andre Machado, M.D., Ph.D., chairman of Cleveland Clinic’s Neurological Institute
Andre Machado, M.D., Ph.D., chairman of Cleveland Clinic’s Neurological Institute
“If this research succeeds, it is a new hope for patients that have suffered a stroke and have remained paralyzed after a stroke. It is an opportunity to allow our patients to rehabilitate and gain function and therefore gain independence,” Dr. Machado said. “Our knowledge to date shows that deep brain stimulation can help the brain reorganize, can help the brain adapt, beyond what physical therapy alone can do. The goal of our study is to boost rehabilitation outcomes beyond what physical therapy alone could achieve.”
Over the next few weeks, the patient – who has been discharged home feeling well and in stable condition – will continue to heal and recover from brain surgery, followed by physical therapy. After a few weeks of rehabilitation, the DBS device will be turned on as the patient continues physical therapy. The patient will be monitored and evaluated regularly to determine how DBS can boost the effects of physical therapy.
“In addition to characterizing the effect of treatment on motor recovery, we will examine directly how stimulation affects brain activity using a combination of non-invasive imaging and electrophysiological techniques,” said Kenneth Baker, Ph.D., of Cleveland Clinic’s Department of Neurosciences and co-primary investigator on the research grant.  “Through these studies, we hope to gain further insight into its therapeutic mechanisms and, perhaps more importantly, how best to optimize delivery of the therapy as we move forward.”
Dr. Machado’s previous research has shown that DBS targeting the same brain pathway in a laboratory model promotes the brain’s plasticity, the ability to form new neural connections, during recovery from stroke. This clinical trial expands on that work and for the first time translates it to humans. This is currently an experimental approach and, as for any surgical procedure, has risks. Potential risks include hemorrhage, infection and neurological complications. Additional information about the trial can be found at https://clinicaltrials.gov/ct2/show/NCT02835443.
This first-in-human trial is co-funded by an NIH BRAIN Initiative Grant: Brain Research through Advancing Innovative Neurotechnologies and this is among one of many projects exploring human brain activity.
Dr. Machado patented the DBS method in stroke recovery. Boston Scientific owns a license to those patents and provided the Vercise DBS systems used in the trial. In 2010, Cleveland Clinic Innovations established a for-profit spin-off company, Enspire DBS Therapy to fund the clinical trial and commercialize the method; Dr. Machado holds stock options and equity ownership rights with Enspire and serves as the chief scientific officer. Boston Scientific recently invested $2.5 million into Enspire DBS.
Editor’s Note: Photos, videos and an animation are available for download below. An interview with Dr. Macahado and surgery video are available at the following links:
  • Download Dr. Machado sound bites here
  • Download DBS surgery b-roll here

Sleep Apnea Device Improves Breathing, But Maybe Not Heart Risk - No benefit for endothelial function, blood pressure

So you can have your doctor decipher between these two.

Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke


Sleep Apnea Device Improves Breathing, But Maybe Not Heart Risk - No benefit for endothelial function, blood pressure

  • by
    Contributing Writer
  • This article is a collaboration between MedPage Today® and:
    Medpage Today

Action Points

  • Jaw repositioning with mandibular advancement therapy significantly improved sleep scores and symptoms, but the treatment did not improve key measures of heart disease risk among CPAP-intolerant patients with severe sleep apnea.
  • Note that these findings from a sham-controlled, randomized trial thus cast doubt on the belief that successful treatment of sleep apnea will reduce the cardiovascular risk associated with the condition.
Jaw repositioning with mandibular advancement therapy significantly improved sleep scores and symptoms, but the treatment did not improve key measures of heart disease risk among CPAP-intolerant patients with severe sleep apnea in a newly reported study.
Use of a mandibular advancement device (MAD) was associated with improvements in apnea-hypopnea index (AHI) scores, micro-arousal index scores and snoring, daytime fatigue and sleepiness in the study, but the treatment did not appear to improve endothelial function or lower blood pressure.
These findings from a sham-controlled, randomized trial thus cast doubt on the belief that successful treatment of sleep apnea will reduce the cardiovascular risk associated with the condition.
The multicenter study is among the first to examine the impact of MAD therapy on cardiovascular risk factors in patients with obstructive sleep apnea (OSA), wrote study leader Frederic Gagnadoux, MD, of the University Hospital of Angers in France, and colleagues.
Their research was published online Friday in the American Journal of Respiratory and Critical Care Medicine.
Endothelial dysfunction, which is a major predictor of atherosclerosis, as well as myocardial infarction (MI) and stroke risk, can be caused or exacerbated by OSA. Untreated sleep apnea is an independent risk factor for MI and stroke, and evidence has suggested that successful treatment of OSA could lower this risk.
Continuous positive airway pressure (CPAP) is considered the front-line treatment for OSA, but patient compliance remains a challenge. Studies suggest that 29% to 84% of patients on CPAP are nonadherent, meaning they use their CPAP device for 4 hours or less each night.
Mandibular advancement therapy has emerged as the main alternative to CPAP. The oral devices open the airways by moving the lower jaw forward.
In the newly reported study, Gagnadoux and colleagues assessed the impact of MAD therapy on key measures of sleep and cardiovascular risk in patients with severe sleep apnea and no known cardiovascular disease.
A total of 150 patients with severe sleep apnea (mean apnea-hypopnea index [AHI] score of 41), but only moderate daytime sleepiness, were randomized to either MAD therapy (n=75) or sham device therapy (n=75) for 2 months.
In the effective MAD group, mean mandibular advancement was 7.9 (1.5) mm, corresponding to an average of 106% of maximum voluntary advancement. Eleven effective MAD patients and 10 sham treatment patients dropped out of the study.
The primary study outcome was change in the reactive hyperemia index (RHI), which is a validated measurement of endothelial function.
Among the main findings:
  • In the intention-to-treat analysis, RHI decreased by 0.03 points in the effective MAD group (P=0.95) and by 0.13 points (P=0.13) in the sham device group.
  • After adjustment for baseline values, age, gender, BMI, AHI, and smoking habits, the difference in RHI outcome between effective MAD and sham device groups was not statistically significant (adjusted intergroup difference 0.15, 95% CI -0.08 to 0.38; P=0.20).
  • In the overall population, change in RHI from baseline to follow-up was not correlated with either change in AHI (r=-0.08; P=0.41) or change in 3% oxygen desaturation index.
  • In a post-hoc analysis in which the median value of baseline RHI was used to classify patients into low and high RHI groups, a significant improvement in RHI was observed in the low RHI group with both effective MAD and sham device, with no significant adjusted intergroup difference between the two treatments.
The mean objective compliance with effective MAD was 6.7 hours per night, which corresponded to approximately 90% of reported sleep duration.
"Interestingly, we found that reported and objective compliance were highly correlated in the effective MAD group but not in the sham device group, which emphasizes the importance of objective compliance measurement in sham-controlled trials of MAD therapy," the researchers wrote.
They further noted that several recent studies have shown little or no improvement in cardiovascular outcomes associated with treatment for OSA. Research published last year in the New England Journal of Medicine showed no evidence of a reduction in such outcomes among patients with moderate to severe OSA treated with CPAP.
The researchers added that the exclusion of patients with cardiovascular disease may have been a limitation of their study.
"Although our post hoc analysis showed no intergroup differences in RHI outcome in patients with low baseline RHI, further studies are required to determine whether MAD therapy for OSA can improve endothelial function in patients with overt cardiovascular disease and metabolic disorders who exhibit more severe endothelial dysfunction at baseline," they wrote.
Funding for this research was provided by the French Ministry of Health.
  • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
last updated

Meal planning, timing may affect CHD risk, related risk factors

I bet your doctor will do NOTHING with this until  SOMEONE ELSE SOLVES THE PROBLEM.
Yes this is not fully proven yet but is your doctor willing to try stuff that might help you? Not to be done on your own. Way too dangerous. 

Meal planning, timing may affect CHD risk, related risk factors

Meal frequency and timing have an effect on CHD and related risk factors, according to a new American Heart Association scientific statement.
Marie-Pierre St-Onge, PhD, associate professor of nutritional medicine at Columbia University and chair of the group that wrote the statement, and colleagues provided a summary of the current scientific evidence on when and how often people eat and the effects of eating patterns on risk for MI, obesity, diabetes and other factors.
Meal timing may affect health due to its impact on the body’s internal clock,” St-Onge said in a press release. “In animal studies, it appears that when animals receive food while in an inactive phase, such as when they are sleeping, their internal clocks are reset in a way that can alter nutrient metabolism, resulting in greater weight gain, insulin resistance and inflammation. However, more research would need to be done in humans before that could be stated as a fact.
Breakfast skipping
Skipping breakfast was associated with poorer cardiometabolic health across several studies.
According to one study, 74% of people who skipped breakfast did not meet two-thirds of the recommended dietary allowance for vitamins and minerals vs. 41% of those who ate breakfast. The study also showed that young adults who skipped breakfast were more likely to have a greater total energy intake from added sugars vs. those who ate breakfast.
Skipping breakfast also is associated with higher BMI globally, St-Onge and colleagues wrote. For example, a meta-analysis of 19 studies (n = 19,108) in the Asian and Pacific regions showed the group with the lowest frequency of breakfast consumption had greater prevalence of overweight or obesity vs. the group with the highest frequency of breakfast consumption (OR = 1.75; 95% CI, 1.57-1.95).
Studies also have shown that breakfast skipping is associated with impaired glucose metabolism, greater risk for diagnosed type 2 diabetes and higher risk for CHD and CVD, according to the researchers.
Individuals who ate breakfast daily were less likely to have elevated serum LDL, low serum HDL and elevated BP, St-Onge and colleagues wrote.
“On the basis of the combined epidemiological and clinical intervention data, daily breakfast consumption among U.S. adults may decrease the risk of adverse effects related to glucose and insulin metabolism,” the researchers wrote. “In addition, comprehensive dietary counseling that supports daily breakfast consumption may be helpful in promoting healthy dietary habits throughout the day.”
Meal timing and frequency
Studies also have shown that greater frequency of eating is associated with lower risk for obesity. In one study, participants who ate at least four times a day had an OR for obesity of 0.55 (95% CI, 0.33-0.91) vs. participants who ate three or fewer times per day, after adjustments for age, sex, physical activity and total energy intake.
Related studies also have shown that greater frequency of eating is associated with lower mean total cholesterol and LDL, according to the researchers.
Late-night eating has been associated with a greater risk for poor cardiometabolic health, St-Onge and colleagues wrote. For example, a Swedish study found that late-night eaters were more likely to be obese (OR = 1.62; 95% CI, 1.1-2.39) vs. non-late-night eaters.
“The impact of meal timing, particularly related to the evening meal, deserves further study,” the researchers wrote. “Epidemiological findings suggest a potential detrimental effect of late meals on cardiometabolic health, but clinical intervention studies, which would address causality, have been limited in scope and too diverse to draw definitive conclusions and make recommendations.”
Recommendations for further study
Because of the wide variation between definitions of meals and snacks across the studies, the researchers made recommendations to maintain consistency.
“On the basis of the current information, we propose that eating occasions be defined as any eating/drinking episode providing at least 210 kJ and that 15 minutes should be the minimum amount of time elapsed between separate occasions,” the researchers wrote. “Distinguishing between meals and snacks should be left to the participant’s discretion. This will provide a definition that accommodates different social norms and cultural behaviors.”
The researchers also made recommendations about what interventions may be beneficial.
“Although more direct translational research is still needed, these data suggest that intervening on meal timing and frequency may be beneficial,” the researchers wrote. “By focusing on meal frequency and timing as an intervention target, patients may directly address poor dietary quality without the need to deal with calorie restriction to promote weight loss.”
More data are needed to understand how intermittent fasting and eating speed may have an effect on weight and CHD risk factors, St-Onge and colleagues wrote. Additionally, special populations were underrepresented in the available data. The researchers recommended studies include considerations for racial/ethnic disparities in obesity and incidence of CVD, as well as children, adolescents and the elderly.
“We suggest eating mindfully, by paying attention to planning both what you eat and when you eat meals and snacks, to combat emotional eating,” St-Onge said in the release. “Many people find that emotions can trigger eating episodes when they are not hungry, which often leads to eating too many calories from foods that have low nutritional value.” – by Cassie Homer

Ankle strengthening walking

In order to get in my 10,000 steps a day I have to hit the trails from 5pm til 6:30 when it is already dark. With a couple of inches of snow on the ground I have no idea what the footing is like as I step. It could be a frozen lump of snow, a branch, or just leaves. This requires you to instantly determine how to adjust you foot, ankle and legs to stay upright. On the last couple hundred yards I'm walking on a trail that slopes to the left. This requires my left ankle to be strong enough not to roll and become sprained.  Last night I saw two deer and a turkey running down the trail. You might be able to see turkey prints in the snow. I got in 8,000 steps in 1.5 hours.
Don't do this on your own.

Routine blood test that measures kidney function can predict short-term outcomes for stroke patients

Well, what can your doctor do about this problem?. Don't just describe a problem and run away, suggest a solution. Does no one in stroke have any brains at all?  Well no wonder, it was led by a neurologist.
http://www.news-medical.net/news/20170131/Routine-blood-test-that-measures-kidney-function-can-predict-short-term-outcomes-for-stroke-patients.aspx
A routine blood test that measures kidney function can be a valuable predictor of short-term outcomes for stroke patients, according to a study led by a neurologist at Wake Forest Baptist Medical Center.
The study team analyzed data on more than 232,000 ischemic stroke patients age 65 and older who were admitted to 1,581 U.S. hospitals over a three-year period. The researchers found that those patients with renal dysfunction upon admission, as indicated by the estimated glomerular filtration rate (eGFR) calculated from a blood creatinine test and basic demographic information such as age, race and sex, were significantly more likely to die while hospitalized and far less likely to be discharged home.
The study is published in the February issue of the journal Stroke.
"Kidney disease is frequently a comorbidity in patients with acute ischemic stroke," said the study's principal investigator, Nada El Husseini, M.D., assistant professor of neurology at Wake Forest School of Medicine, a part of Wake Forest Baptist. "This one test done on admission to measure kidney function can be used to better inform patients with ischemic stroke and their families about what to expect."
The eGFR is measured on a scale from 0 to 120, with scores 15 and under indicative of kidney failure and scores 60 and above considered normal. In their study the researchers found that in-hospital mortality was most common (29.2 percent) among the stroke patients with eGFR scores 15 and under without dialysis and least common (9.1 percent) among those with scores 60 and above.
The data also revealed that discharge home was most common (42.8 percent) among the stroke patients with eGFR scores 60 and above and least common (23.5 percent) among those with scores 15 and under without dialysis. The findings regarding those with eGFR scores between 16 and 59 followed similar trends in short-term outcomes, with higher scores correlating to lesser risk of in-hospital mortality and greater odds of being discharged home.
"Any renal dysfunction was associated with increased risk of inpatient mortality and any eGFR less than 30 with lower likelihood of being discharged home," El Husseini said. "Kidney function is clearly an important factor in stroke patients."
Because the study was limited to Medicare patients 65 and over who were admitted to facilities participating in a voluntary nationwide quality-improvement program, the research results may not be directly applicable to other populations, El Husseini said.
But future research in this area, she said, might "determine if specific interventions could further influence short-term outcomes following stroke in those with kidney disease."

Robotic wrist training after stroke: Adaptive modulation of assistance in pediatric rehabilitation

So send your doctor after the protocol and equipment used. Each individual doctor wouldn't have to do this if we had a great stroke association keeping track of all research and protocols in a publicly available database.
http://www.sciencedirect.com/science/article/pii/S0921889016303268
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Highlights

Pediatric stroke leads to limb hemiparesis, sensory impairments, and spasticity.
A 14-year old stroke patient completed in a 3-month wrist robotic training program.
The robot provided online adaptive modulation of assistance instantaneously during each trial.
Robot therapy led to positive changes in upper limb motor coordination and function.
In addition, the patient needed less robot assistance to complete each trial.

Abstract

In this paper we present a case study in which a 14-year-old, right-handed stroke patient with severe weakness, spasticity, and motor dysfunction of the left upper extremity participated in a three-month distal robotic training program. The robotic device was compliant to the patients’ movements and was able to modulate the level of assistance continuously throughout the trial (i.e., online adaptive modulation). Standard clinical and robotic evaluations of upper extremity motor performance were conducted before and after robotic training. There were improvements in upper extremity spasticity and motor functions. In addition, robotic training lead to positive changes in wrist active range of motion and kinematics: movements were smoother and there was a noticeable decrease in the level of robotic intervention required to complete each trial. In sum, results of the present case study demonstrate that distal upper extremity robotic rehabilitation that features the proposed adaptive control algorithm promoted positive changes in upper limb motor coordination and function after pediatric stroke.

Prediction of quality of life after stroke rehabilitation

Who gives a fuck about prediction? Make recovery happen by creating interventions that get survivors to 100% recovery. Do something useful instead of this prediction crapola.
http://www.openaccessjournals.com/peer-review/prediction-of-quality-of-life-after-stroke-rehabilitation.html
*Corresponding Author:
Fu-Han Hsieh
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences,
College of Medicine, Chang Gung University, Tao-Yuan, 333, Taiwan
Telephone: +886-3-2118800 ext: 3355, 5761
Email: fuhan@mail.cgu.edu.tw
 
Ching-Yi Wu
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences,
College of Medicine, Chang Gung University, Tao-Yuan, 333, Taiwan
Telephone: +886-3-2118800 ext: 3355, 5761
Email: cywu@mail.cgu.edu.tw

Abstract

Introduction:
The purpose of this study was to develop a computational method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.
Methods:
Five classifiers were trained by five personal factors and nine functional outcome measures by 10-fold cross-validation. The classifier with the highest cross-validated accuracy was considered to be the optimal classifier for QOL prediction.
Results:
Particle Swarm-Optimized Support Vector Machine (PSO-SVM) showed highest accuracy in predicting QOL in stroke patients and was adopted as the optimal classifier. Potential predictors were assessed by PSO-SVM with feature selection. The early outcomes of Quality of Movement scale of the Motor Activity Log (MAL_QOM) and the Stroke Impact Scale (SIS) were identified to be the most predictive outcome predictors for QOL.
Conclusion:
The approach provides the medical team another possibility to improve the accuracy in predicting QOL in stroke patients. Therapists could determine the therapies for stroke patients more accurately and efficiently to enhance the quality of life after stroke.

Keywords

Stroke, Quality of life, Outcome prediction, Classifier

Introduction

Stroke remains a leading cause of death and disability in the developed world [1]. After stroke, the effects of stroke and post stroke rehabilitation are usually assessed by health professional ratings and performance tests [2-4]. However, real life of stroke survivors is affected in multiple ways and may not be described completely by only health and functional status. It is possible that a treatment succeeds in enhancing physical function recovery however induces psychosocial problems [5,6]. In this case, quality of life (QOL) may actually be degraded after poststroke rehabilitation. The WHO suggests that a comprehensive view of quality of life includes not only physical health, but also psychological health, social relationships, and environmental quality [4]. Therefore, to obtain a comprehensive view of the effects after stroke, life quality should also be considered when assessing a person’s health and functioning.
In recent years, assessment of QOL in stroke has become increasingly common. Many recent rehabilitation therapies have been reported to be effective in restoring upper limb motor function after stroke but showed varied effects in QOL [7-10]. Different rehabilitation therapies may benefit different subgroups of the stroke population and cause different effects to QOL. Identifying key predictors of QOL may assist therapists to determine an optimal therapy, which can not only improve physical function but also maximize QOL for a specific subgroup of stroke survivors. Decision making of rehabilitation strategies may be more efficient and complete with identifying predominant predictors of QOL.
Only three studies examined predictors of QOL [5,11,12]. In these three studies, the predictive ability of multiple factors was examined, including demographic factors, vascular risk factors, clinical scales and neuropsychological assessment, and lesion characteristics. However, general predictors of outcomes of QOL were hard to determine because of the heterogeneity among these studies. Both physical and psychological factors were reported to be important in predicting QOL after stroke [5,11,12]. Although stroke rehabilitation gains in QOL are important, the question of which patients may benefit most in QOL from specific therapies has not been widely addressed, and statistical approaches to reveal such associations and predictors may not be optimal [13,14]. However, possible predictors related to QOL performance outcome after rehabilitation remained less discussed. More studies are needed to clarify the predictive ability of diverse QOL predictors in stroke patients.
Practical implementation of outcome predictors in clinical use was also constrained by the complexity of the algorithms. Developing prognostic algorithm based on existing and simple algorithms may reduce the complexity in clinical implementation, increase the use of prognostic model, and further improve the efficiency of rehabilitation therapy. Traditionally, studies examined outcome predictors used regression analysis to discriminate the most predictive factors from others [15-18]. However, the results of regression analysis can only explained the variance of the outcome in percentage. Computational methods can provide another aspect of outcome prediction. The results of regression statistical method showed that the factors were predictors for the outcome measure model, and the model only explained how percentage of the variance in the outcome measure scores. However, the results of computational classifier methods can provide accuracy and more application related to the predictors.
It has been applied in predicting clinical outcome in cancer patients and showed high accuracy and efficiency [19,20]. Using classifiers could improve the accuracy in predicting QOL. Hopefully, predominant predictors could also be better identified. That’s why we try to utilize a computational classifier method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.

Top Ten Medical Research Issues and Trends to Watch in 2017

 I expect our fucking failures of stroke associations will do nothing with this.  No direct relation but we fit under 4, 5,6 and 8.
http://www.huf, fingtonpost.com/margaret-anderson/top-ten-medical-research_b_13975834.html
2016 will go down as a year that taught us to question our assumptions. The election of Donald Trump, an outcome almost no one predicted, left many with a sense of uncertainty about what 2017 will bring in the biomedical and health-care space. To bring clarity to these unsure times, FasterCures has compiled a list of issues critical to the future of medical innovation that we’ll be tracking over the coming year. While some issues will be closely linked with the people and policies of the new presidential administration, we think all will be important to continuing the progress toward faster cures and treatments.
1. FDA: What is the roadmap going forward?

2. What size would you like: small, medium or big science?

3. Clinical trial innovation and reform: It’s a big job but somebody’s gotta do it.

4. Doing science in the real world.

5. Patient-centricity: What’s the ROI?

6. Move over direct-to-consumer ads - it’s time for direct-to-patient R&D.

7. Digitization of disease, and health.

8. Data sharing: Where there’s a will, there needs to be a way.

9. Evolution of value frameworks.

10. Blockchain could be good for your health.


Monday, January 30, 2017

Scientists describe lab technique with potential to change medicine and research

If any good at all our fucking failures of stroke associations would be contacting stroke researchers to see how this could be used to create various neurons to help recovery. But that will never occur since we have NO stroke leadership and NO stroke strategy.  You are on your own to solve your own stroke problems, your doctors are worthless.
https://www.mdlinx.com/pharma-news/top-medical-news/article/2017/01/30/7?
 
Georgetown University Medical Center News
Researchers who developed and tested a revolutionary laboratory technique that allows for the endless growth of normal and diseased cells in a laboratory are publicly sharing how the technique works.

The Georgetown University Medical Center (GUMC) researchers hope that by doing so, scientists around the world can realize the many of possibilities of “conditional reprogramming,” which includes living biobanks, personalized and regenerative medicine, and novel cancer research.

Published in the journal Nature Protocols, investigators demonstrate how conditional reprogramming (CR) works, and why it may be able to fill a number of clinical care and research voids.

CR is the only known system that can indefinitely grow healthy as well as cancer cells “as if they were just extracted from a patient, and expand them — a million new cells can be grown in a week — as long as needed,” says the co–lead author Xuefeng Liu, MD, associate professor of pathology and a director in the Center for Cell Reprogramming at Georgetown University Medical Center.

No genetic modification is needed to coax the cells to grow — all that is used are special “feeder” cells and a chemical inhibitor.

As one example, the researchers demonstrate they are able to use CR to produce new and healthy pancreatic beta islet cells that secrete insulin — suggesting a promising avenue for type I diabetes research.

“A true cure for this kind of diabetes could be achieved by replacing the lost beta cells with new functional insulin producing cells,” says Liu.

The researchers have also grown healthy and cancerous cells from airway tissues, retinas, prostates, breasts, and intestines, which replicate for extended periods with conditional reprogramming.

Since CR was developed and described by Liu, Richard Schlegel, MD, PhD, director of the Center for Cell Reprogramming, and their colleagues at Georgetown in 2011, scientists have been testing the ability of the cells to perform a number of advanced goals. The CR method has spread worldwide, for example, the National Cancer Institute cited the CR method in Precision Medicine Initiatives for oncology and drug discovery programs. Georgetown researchers have trained more than 100 scientists in the technique.

In the newly published protocol, the Georgetown researchers describe many other possibilities that CR offers: among them, living biobanks, personalized and regenerative medicine, and novel cancer research.

Additionally, biobanking normal cells from a patient allows the possibility of using those cells in the future to infuse healthy cells into a damaged organ. “We can grow cells, freeze them, thaw them,” Liu says. “Think about use of such cells for skin replacement, for organ patching, and cancer studies.”

CR cancer cells also could allow oncologists to test and select a therapy based on an expanded laboratory population of a patient’s individual cancer cells — a procedure already conducted at Georgetown and published in the New England Journal of Medicine. An independent research study at Massachusetts General Hospital Cancer Center, published in Science, demonstrated that the CR method identified a combination of therapies for resistant lung cancer patients.

Several institutes have used CR platform for discovery of anti–cancer drug or new targets.

It may also be possible to fix damaged cells, using gene editing techniques, and then grow new, repaired cells to fix a wide variety of diseases, Liu says. “It is not unimaginable that we could take a tiny nose biopsy from a person with cystic fibrosis, correct the defect that causes the disease, then regrow the healthy cells to infuse back into the lung. Because the cells were derived from the patient, they would not be rejected.”

Telling patient stories to teach new medical students

Every medical school should have stroke survivors describe the fucking failure of their recovery to new medical students. If you are asked, don't hold back and just say you are glad you are alive thanks to the ER doctors. Say how fucking mad you are at the PMR docs and neurologists for not getting you to 100% recovery.
http://scopeblog.stanford.edu/2017/01/30/telling-patient-stories-to-teach-new-medical-students/

Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial

So ask your doctor for the protocol and when it will be installed in their department. Anything longer than a month is grounds for calling the president to ask why the stroke department has no sense of urgency. A year later and has your doctor done one damn thing with this information? Not even knowing about this is grounds for firing. We need to clear out all the dead wood in stroke.
http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0125-x
  • Joon-Ho ShinEmail author,
  • Mi-Young Kim,
  • Ji-Yeong Lee,
  • Yu-Jin Jeon,
  • Suyoung Kim,
  • Soobin Lee,
  • Beomjoo Seo and
  • Younggeun Choi
Journal of NeuroEngineering and Rehabilitation201613:17
DOI: 10.1186/s12984-016-0125-x
Received: 26 October 2015
Accepted: 12 February 2016
Published: 24 February 2016

Abstract

Background

Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.

Methods

The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl–Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen–Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention.

Results

The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group.

Conclusions

VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL.

Trial registration

This study is registered under the title “Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke” and can be located in https://clinicaltrials.gov with the study identifier NCT02029651.

Healthy Diet May Be Linked to Lower Risk of Memory and Thinking Decline

Useless information, no amounts to eat per body size or age. But it is good for their conscious laundering, making them feel like they are doing good. Only 1.7 years old, has your doctor done one damn thing with this information?
https://www.aan.com/PressRoom/home/pressrelease/1383
MINNEAPOLIS – People who eat a healthy diet with lots of fruits and vegetables, nuts, fish, moderate alcohol use and not much red meat may be less likely to experience declines in their memory and thinking skills, according to a new study published in the May 6, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology. “Adoption of a healthy diet probably begins early in life, and a healthy diet might also go along with adoption of other healthy behaviors,” said study author Andrew Smyth, MMedSc, of McMaster University in Hamilton, Ontario, Canada, and the National University of Ireland in Galway. For the study, 27,860 people in 40 countries were followed for an average of about five years. All participants were 55 or older and had diabetes or a history of heart disease, stroke or peripheral artery disease. People who had experienced a recent stroke, congestive heart failure and other serious conditions were not included in the study. (So they cherry picked healthier people, making this not generalizable to us)  Participants’ thinking and memory skills were tested at the start of the study, after two years and after about five years. Participants were asked at the beginning of the study how often they ate certain types of foods, including fruits and vegetables, nuts and soy proteins, whole grains, deep fried foods and drank alcohol, as well as the ratio of fish to meat and eggs in their diet. The study participants were followed until they experienced a heart attack, stroke, hospitalization for congestive heart failure or death from cardiovascular disease or until the end of the study. The thinking and memory tests yielded total scores with a maximum of 30 points. Participants were considered to have declined in their skills if their scores dropped by three or more points during the study. A total of 4,699 people had a decline in their thinking and memory skills. People with the healthiest diets were 24 percent less likely to have cognitive decline than people with the least healthy diets. Among the 5,687 people with the healthiest diet, 782, or about 14 percent, had cognitive decline, compared to 987, or about 18 percent, of the 5,459 people with the least healthy diets. The results were the same when researchers accounted for other factors that could affect the results, such as physical activity, high blood pressure and history of cancer. The study was supported by Boehringer Ingelheim. To learn more about brain health, please visit www.aan.com/patients.
The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with 30,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, LinkedIn and YouTube.

What are YOUR goals and expectations for stroke recovery?

YOUR GOALS, not what the low expectation goals your therapists and doctors set for you. If your goal is 100% recovery, tell your doctor that and don't back down when they say it is not possible. Ask when it will be possible and what EXACTLY they are doing to get to that point for all their patients. If they spout 'All strokes are different, all stroke recoveries are different' tell them to fuck off and read some research. A path exists to get to 100% recovery. It will take a bunch of research and time but it is doable for anyone with drive and persistence. Tell them the status quo is a failure and to find the successes needed for stroke recovery. They are doctors, they are supposed to help people, not provide excuses on why you can't be helped.

Tomato and lycopene supplementation and cardiovascular risk factors: A systematic review and meta-analysis

Why the fuck was a meta-analysis needed? What was needed was exact amounts to consume to provide benefits. This stupidity is because we have NO stroke strategy to solve problems rather than just describe them. This is totally fucking useless.
https://www.mdlinx.com/internal-medicine/medical-news-article/2017/01/19/tomato-lycopene-intervention-cardiovascular-risk-factors/7012407/?
Atherosclerosis, 01/19/2017
Cheng HM, et al. – This study suggests a positive influence of tomato products and lycopene supplementation on blood lipids, blood pressure and endothelial function. These outcomes support the development of promising individualised nutritional strategies involving tomatoes to tackle cardiovascular diseases (CVD).

Methods

  • Researchers searched 3 databases including Medline, Web of science, and Scopus from inception to August 2016.
  • Inclusion criteria were: intervention randomised controlled trials reporting effects of tomato products and lycopene supplementation on CV risk factors among adult subjects >18 years of age.
  • The outcomes of interest included blood lipids (total-, HDL-, LDL-cholesterol, triglycerides, oxidised-LDL), endothelial function (flow-mediated dilation (FMD), pulse wave velocity (PWV)) and blood pressure (BP) inflammatory factors (CRP, IL-6) and adhesion molecules (ICAM-1).
  • They used random-effects models to determine the pooled effect sizes.

Results

  • Data showed that out of 1189 publications identified, 21 fulfilled inclusion criteria and were meta-analysed.
  • Overall, findings demonstrated that interventions supplementing tomato were associated with significant reductions in LDL-cholesterol (-0.22 mmol/L; p = 0.006), IL-6 (standardised mean difference -0.25; p = 0.03), and improvements in FMD (2.53%; p = 0.01); while lycopene supplementation reduced Systolic-BP (-5.66 mmHg; p = 0.002).
  • Additionally, it was noted that no other outcome was significantly affected by these interventions.
Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Fish consumption in relation to myocardial infarction, stroke and mortality among women and men with type 2 diabetes: A prospective cohort study

You will have to ask your doctor if the full article refutes this earlier research from Oct. 2012. Or is diabetes the reason for the difference? Your doctor should know the answer to this.

Adding just two servings of fish to the diet each week could be an important way to cut your risk of stroke, finds a new study. The newest research found fish oil supplements don’t seem to provide the same benefit.     Oct. 2012

https://www.mdlinx.com/internal-medicine/medical-news-article/2017/01/30/type-2-diabetes-fish-consumption-prospective/7036380/?
Clinical Nutrition, 01/30/2017
Among individuals with type 2 diabetes, fish consumption was associated with lower myocardial infarction (MI) incidence, while no association was seen with stroke. The data additionally showed an association with lower mortality, especially for coronary heart disease (CHD)–related deaths. Researchers bolster the current general advice on regular fish consumption also in the high–risk group of type 2 diabetes patients.

Methods

  • From 1998 through 2012, the researchers followed women and men with diagnosed type 2 diabetes (n=2225; aged 45-84 years) within 2 population-based cohorts (the Swedish Mammography Cohort and the Cohort of Swedish Men).
  • They used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

  • During follow-up of up to 15 years, the researchers identified 333 incident MI events, 321 incident stroke events and 771 deaths (154 with coronary heart disease [CHD] as underlying cause).
  • In this study, the multivariable HRs comparing >3 servings/week with ≤3 servings/month were 0.60 (95% CI, 0.39-0.92) for MI and 1.04 (95% CI, 0.66-1.64) for stroke.
  • For total mortality, HRs were lowest for moderate fish consumption of 1- <2 servings/week (0.82; 95% CI, 0.64-1.04) and 2-3 servings/week (0.79; 95% CI, 0.61-1.01) compared with ≤3 servings/month.
  • For CHD-related mortality, the corresponding HRs were 0.53; 95% CI, 0.32-0.90 and 0.75; 95% CI, 0.45-1.27.
Go to Abstract Print Article Summary Cat 2 CME Report

Um, Excuse Me, Why Did You Stop My Post-Op Anticoagulant?

You probably need to ask your doctor for the evidence-based reason for your changes in anti-coagulation, from rat poison to aspirin, etc.
http://www.medpagetoday.com/Cardiology/CardioBrief/62803?
Cardiology writer learns firsthand about real-world practice

Sunday, January 29, 2017

The type, not just the amount, of sugar consumption matters in risk of health problems

Is your doctor stuck in the past and still focusing on salt?

Paper Raises More Questions About Salt Restriction In Heart Failure

 

Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.

 

The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease


https://www.mdlinx.com/internal-medicine/top-medical-news/article/2017/01/27/6

American Physiological Society News
Long–term fructose consumption impairs vascular and liver function in rats.
The type of sugar you eat – and not just calorie count – may determine your risk for chronic disease. A new study is the first of its kind to compare the effects of two types of sugar on metabolic and vascular function. The paper was published ahead of print in the American Journal of Physiology–Heart and Circulatory Physiology.

Female rats were given a liquid solution of either glucose or fructose in addition to their normal diet of solid food. The rats received the sweetened solutions for eight weeks, roughly equivalent to a person eating large amounts of sugar for six years. The sugar–fed rats were compared with a control group that received plain drinking water in addition to their food supply.

Researchers found that although both sugar–fed groups consumed more calories than the control group, the total calorie intake of the glucose–fed rats was higher than the rats that were given fructose. Another surprising observation was that “despite this difference, only the fructose group exhibited a significant increase in final body weight,” wrote the research team.

In addition to higher weight gain, the fructose group showed more markers of vascular disease and liver damage than the glucose group. These included high triglycerides, increased liver weight, decreased fat burning in the liver and impaired relaxation of the aorta, which can affect blood pressure.

These findings suggest that an increase in the amount of calories consumed due to sweeteners is not the only factor involved in long–term health risks. The type of sugar may also play a role in increasing risk factors for heart disease, diabetes and other chronic diseases.

The article is titled “Type of Supplemented Simple Sugar, Not Merely Calorie Intake, Determines Adverse Effects on Metabolism and Aortic Function in Female Rats.”

Depression confers risk for CVD in similar magnitude to obesity, high cholesterol in men

Does your doctor know about the correct way to treat your stroke depression? Maybe by not having you so fucking disabled because you are being treated for the  5 causes of neuronal cascade of death in the first week. Thus leaving you much less disabled and possibly getting to 100% recovery. Treat the cause of the depression not the depression itself. But if your doctor knows nothing about cascade of death prevention I guess you will have to go down the second best route.

Common antidepressant can help stroke patients improve movement and coordination Sept. 2015 

Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013 

Not talk therapy.

Depression confers risk for CVD in similar magnitude to obesity, high cholesterol in men 

According to new data, depressed mood and exhaustion pose as great a CVD risk in men as high cholesterol and obesity.
“There is little doubt that depression is a risk factor for [CVDs],” Karl-Heinz Ladwig, MD, group leader at the Institute of Epidemiology II at the Helmholtz Zentrum München, Neuherberg, Germany, professor of psychosomatic medicine at Technische Universität München’s Klinikum recths der Isar and scientist at Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich, said in a press release. “The question now is: What is the relationship between depression and other risk factors like tobacco smoke, high cholesterol levels, obesity or hypertension — how big a role does each factor play?”
The researchers analyzed 3,428 patients aged 45 to 74 years who participated in one of three MONICA/KORA Augsburg surveys, conducted between 1984 and 1995, to investigate the comparison of the link between traditional somatic risk factors and depressed mood on all-cause mortality prediction and fatal CVD endpoints in an identical-source population.
In 10 years of follow-up covering 31,791 patient-years, 269 fatal CVD events and 557 cases of all-cause mortality were observed.
At baseline, 34% (n = 1,164) of participants experienced depressed mood and exhaustion.
Per 1,000 person-years, the absolute mortality risk for depressed mood and exhaustion was 23.1 cases for all-cause mortality and 11.2 cases for CVD mortality, Ladwig and colleagues wrote.
Depressed mood and exhaustion conferred elevated risk for all-cause and CVD mortality (HR = 1.52; P < .01 for both) at a magnitude higher than hypercholesterolemia and obesity but lower than hypertension, smoking and diabetes, according to the researchers.
Improvement in all-cause and CVD mortality risk prediction from depressed mood and exhaustion was similar to that from hypercholesterolemia and obesity, but substantially lower than that from hypertension, smoking and diabetes, Ladwig and colleagues wrote.
Depressed mood and exhaustion accounted for roughly 15% of the population-attributable risk for all-cause and CVD mortality, placing it around the middle among the classical risk factors, according to the researchers.
“Our data show that depression has a medium effect size within the range of major, non-congenital risk factors for [CVDs],” Ladwig said in the release. “In high-risk patients, the diagnostic investigation of comorbid depression should be standard. This could be registered with simple means.” – by Dave Quaile

Use of spent coffee grounds as food ingredient in bakery products

For your doctor and nutritionist to evaluate. Do you get the same benefits from this as from drinking coffee? Or has all the goodness leached into the coffee water? Do not let them get away with non-answers until they have explained exactly what researchers they are contacting to followup this simple question. Because we have never demanded followup from our doctors is why 100% full recovery has not been achieved.  Pay it forward for your children and grandchildren. No one else is going to do this. Our fucking failures of stroke associations will do nothing.
119 posts on coffee if your doctor is not up-to-date on research.
http://www.sciencedirect.com/science/article/pii/S0308814616312067
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Highlights

Spent coffee grounds are natural source of antioxidant dietary fibre.
Coffee antioxidant dietary fibre is a food ingredient for use at high temperature.
A food grade ingredient has been obtained from spent coffee grounds.
Safety of spent coffee grounds can be easily controlled.
Spent coffee grounds can be used in bakery products and other foodstuffs.

Abstract

The present research aimed to evaluate the use of spent coffee grounds (SCG) from instant coffee as a food ingredient and its application in bakery products. Data on physicochemical characterization, thermal stability and food safety of SCG were acquired. Evaluation of feasibility as dietary fibre was also determined. Results showed SCG are natural source of antioxidant insoluble fibre, essential amino acids, low glycaemic sugars, resistant to thermal food processing and digestion process, and totally safe. In the present work, SCG were incorporated in biscuit formulations for the first time. Low-calorie sweeteners and oligofructose were also included in the food formulations. Nutritional quality, chemical (acrylamide, hydroxymethylfurfural and advanced glycation end products) and microbiological safety and sensory tests of the biscuits were carried out. Innovative biscuits were obtained according to consumers’ preferences with high nutritional and sensorial quality and potential to reduce the risk of chronic diseases such as obesity and diabetes.