ESO Announces Strategic Plan 2018-2020 - a total failure

What a pile of shit for objectives. NOTHING on solving all the problems in stroke, or creating a database of stroke protocols.  It is not even for stroke survivors. 
https://eso-stroke.org/eso/eso-announces-strategic-plan-2018-2020/

Strategic Plan Summary

Introduction

Across Europe, stroke accounts for over 1 million deaths each year. The risk of death due to stroke varies substantially between countries, and is more than three times higher in central and eastern Europe than in northern, southern and western Europe.

The vision of the European Stroke Organisation (ESO) is to serve as the voice of stroke in Europe, harmonising stroke management across the whole of Europe, and taking action to reduce the burden of stroke regionally and globally. (Nothing for helping survivors recover)

The society has developed rapidly in recent years, including:

• The launch and steady growth of the European Stroke Organisation Conference (ESOC) to over 4,000 participants
• Exceptional membership growth, from 700 to over 7,000 professionals represented in the society in the period 2014 – 2017
• Geographic expansion and outreach through ESO EAST (Enhancing and Accelerating Stroke Treatment)
• The launch of ESO’s own journal – European Stroke Journal (ESJ)
• Establishing the ESO Stroke Unit and Stroke Centre Certification programme
• Recognition by European institutions of ESO’s leadership in stroke science

In this context, in 2017, ESO leadership undertook a strategic planning exercise to maintain and further develop ESO, and to guide the investment of ESO resources over the next 3 years.

Key Objectives

The principal strategic objectives for ESO in the next 3 years are about ensuring sustainable success, including:

• Maintaining an exceptional level of quality output across ESO
• Continuing to attract the top talent in the field, whether as members, leaders or contributors to ESO projects
• Creating an organisational structure to encourage and facilitate further growth
• Providing reliable and consistently good services to members, customers and partners
• Further growth in individual membership, as well as via national societies and related associations.

Highlighted Projects

To support achieving its mission, ESO runs a wide range of projects in multiple areas, including:

Novel Stent Retriever Is Quick to Restore Flow

Once again lazy endpoints were chosen for the trial. Time to reperfusion rather than the correct endpoint of 100% recovery. So what if it is fast? The outcome is still a failure. Not getting to 100% recovery, that is the only goal.  Partial goals are not good enough, keep working.
https://www.medpagetoday.com/meetingcoverage/isc/70778?
More than half of recipients saw substantial reperfusion on first pass

• by Crystal Phend, Senior Associate Editor, MedPage Today January 26, 2018
• This article is a collaboration between MedPage Today® and:

LOS ANGELES -- A novel stent retriever device achieved high rates of rapid, substantial reperfusion for large vessel ischemic strokes without significant safety concerns, the pivotal ARISE II study showed.

With the EmboTrap device, 80% of recipients reached the primary endpoint of more than 50% flow restored (modified TICI 2b, 2c, or 3 flow) within three passes without aspiration or other rescue therapy, including 65% with near-complete or full flow.

Notably, 51.5% of those treated had this substantial flow restored on the first pass, Osama Zaidat, MD, of St. Vincent Mercy Hospital in Toledo, Ohio, reported here at the International Stroke Conference.

While the final rate of mTICI 2b-3 flow was 93%, on par with other mechanical thrombectomy trials, Zaidat noted that the high early-pass revascularization rate was a "remarkable" advance.

"That's what the trial is, it's pushing the limit," he said at a press conference. "The physicians are taking the right patients and they are taking them fast. And I think that's why I think we achieved one of the highest mRS 0-2 at 67%" compared with other studies.

The proportion of participants with a good functional outcome (modified Rankin Scale score 0-2) was 67.3% at 90 days.

J Mocco, MD, of Mount Sinai Hospital in New York City, who presented another trial at the same session reporting mRS 0-2 achieved in 52% of patients treated with an aspiration-first approach and 49% with a stentriever-first strategy, agreed that this is an important evolving area.

"Sooner and fewer is always better," he told MedPage Today at the press briefing, "although I think that more important right now is to focus on the time component to getting at least TICI 2b or greater. If you can do that with one pass, obviously that will be faster. If it's two passes and it's still very quick, that's just as important. We need to focus on the quality of reperfusion ... we need to move our conversation to 2c and 3, we need to be talking about 90% of the brain getting blood flow or more, not 52%."

"For one pass efficacy, that is something that seems to be clear but does not have clear proof," he added. "However, for achieving 2c or 3 versus TICI 2b, has overwhelming proof" of impact on clinical outcomes.

"The first pass is a nuance, I think," agreed Ralph Sacco, MD, of the University of Miami, and president of the American Academy of Neurology. "It may be a predictor of how fast you can then subsequently open up the vessel, I think that's the data they need to show."

The trial included 227 patients treated with the EmboTrap device for large vessel occlusions within 8 hours of last time known well before onset of symptoms. Median time from onset to puncture was 214 minutes; median time from puncture to revascularization was 35 minutes.

The primary safety endpoint of symptomatic intracranial hemorrhage within 24 hours of treatment or other serious adverse events occurred in 5.3%. No patients died related to the procedure in the first week, although 9.0% died from any cause by day 90.

Device developer Cerenovus has applied for FDA clearance of EmboTrap based on ARISE II.

ARISE II was sponsored by Neuravi (since acquired by Cerenovus, a Johnson & Johnson company).

Zaidat disclosed being a consultant for the company.

• Primary Source

  International Stroke Conference

  Source Reference: Zaidat O, et al "ARISE II trial result" ISC 2018; Abstract LB5.

Stent Retrievers and Aspiration On Par for Initial Thrombectomy Strategy

Once again lazy endpoints were chosen for the trial. Time to reperfusion rather than the correct endpoint of 100% recovery. So what if both parts were the same? the outcome is still a failure. Not getting to 100% recovery, that is the only goal.
https://www.medpagetoday.com/meetingcoverage/isc/70755?
Stroke functional outcomes don't differ in head-to-head trial

• by Crystal Phend, Senior Associate Editor, MedPage Today January 25, 2018
• This article is a collaboration between MedPage Today® and:
  

LOS ANGELES -- Which mechanical thrombectomy tool clinicians reach for first in large vessel ischemic strokes may not make much difference in outcomes, the COMPASS trial showed.

Aspiration as the initial strategy was noninferior to initial stent retriever use for good functional outcomes at 90 days (52% versus 49% modified Rankin Scale score 0-2, Nor was there any differential shift in the overall Rankin scores, J Mocco, MD, of Mount Sinai Hospital in New York City, and colleagues reported here at the International Stroke Conference.

Time to substantial reperfusion and the quality of the reperfusion, in terms of proportion of blood flow restored, were statistically comparable between groups, although initial aspiration held consistent numerical advantages.

Safety was nearly identical between the two strategies for 90-day all-cause mortality and intracranial hemorrhage, both overall and symptomatic.

"Now we have level I evidence that stent retrievers and primary aspiration have equivalent clinical outcomes in large vessel occlusion," Mocco concluded at a press briefing for the late-breaking clinical trial session.

Ralph Sacco, MD, of the University of Miami and president of the American Academy of Neurology, said he wasn't so sure that the evidence has risen to what guidelines committees would consider class Ia.

He cautioned that noninferiority designs don't always prove equivalence. "I think it's grade A evidence. Is it level I? It's getting pretty close."

"The important thing is all of these tools are helpful, the question is what do you start with," he added. "What COMPASS unequivocally shows is you don't have to open the stent retriever. If you go up with the catheter, do aspiration, and that works ... then you're done. If it doesn't work, then you use that same catheter that is already up by the clot to put [in] the stent retriever and grab the clot."

The COMPASS "data are a bit more robust for aspiration compared to the previously, technically-driven trial, ASTER," he added. That French trial had shown closer similarity across endpoints than COMPASS, which Mocco suggested might be accounted for by newer devices and catheters in the latter.

While formal cost analysis of the trial has not yet been completed, press conference moderator Bruce Ovbiagle, MD, of the Medical University of South Carolina in Charleston, noted that this will be a factor in clinical choice as well.

The aspiration technique has been suggested as a less expensive approach, by eliminating need for a roughly $6,000 stent retriever device. In the aspiration-first arm of COMPASS, only 20.9% of patients received stent retriever treatment as a second device due to failure or in attempt to improve flow.

The proportion achieving at least substantial reperfusion (TICI 2b flow) with the primary modality was similar between groups (83.2% aspiration versus 81.3% stent retriever, P=0.75).

The investigator-initiated head-to-head trial included 270 patients randomized to the two treatment strategies at 15 centers, which were balanced between those doing mostly aspiration-first thrombectomy and those doing most cases stent-retriever first as well as a few with no clear preference.

Mocco cautioned that the data should be considered preliminary, as small changes may be made if one patient must be excluded due to consent problems that were just discovered and are under investigation by the group.

COMPASS was funded by Penumbra, although it played no role in the trial execution, data collection, or analysis.

Mocco disclosed relationships with Blockade Medical, Cardinal, Endostream, Rebound Medical, Apama, Viseon, 3Rivers Medical, Serenity, Synchron, Cerebrotech, and the Stroke Project.

Primary Source

International Stroke Conference

Source Reference: Mocco J, et al "A comparison of direct aspiration vs. stent retriever as a first approach ('COMPASS'): A randomized trial" ISC 2018; Abstract LB4.

Long-term consumption of sunflower and fish oils damages the liver

You need to know details on this immediately, there have been numerous beneficial reports on fish oil(Omega-3s) consumption although fish is better.  Ask your doctor the amounts to avoid.
https://medicalxpress.com/news/2018-01-long-term-consumption-sunflower-fish-oils.html

An international group of scientists led by the University of Granada (UGR) has demonstrated that the long-term intake of sunflower or fish oils damages the liver and can give rise to non-alcoholic steatohepatitis (NASH).

NASH, which causes inflammation of the liver that is not caused by alcohol abuse, is a very serious condition and can act as a catalyst for the onset of other diseases such as cirrhosis and liver cancer. Its prevalence in the general population increases with age. It affects 1 percent to 3 percent of children, 5 percent of teenagers, 18 percent of those aged between 20 and 40, 39 percent of those aged between 40 and 50, and more than 40 percent of those over 70.
The research, recently published in the Journal of Nutritional Biochemistry, analysed how the long-term consumption of dietary fat sources such as olive, sunflower and fish oil affects the livers of rats. UGR researchers conducted a series of comprehensive analyses, including studies of pathological anatomy, ultrastructural analyses using electron microscopes, sophisticated bioenergy techniques, telomere length measurements, and oxidative stress. Most importantly, they conducted a comprehensive study of the liver genome in order to establish how it evolved in line with the consumption of the different oils.
As José Luis Quiles Morales, Full Professor of Physiology at the UGR explains: "[the research] demonstrates that fat accumulates in the liver with age, but the most striking finding is that the type of fat accumulated differs depending on the oils consumed, which means that regardless of this accumulation, some livers age in a healthier way than others, and with a greater or lesser predisposition to certain diseases."
Three dietary fats (virgin olive oil, sunflower oil and fish oils) were studied, and virgin olive oil was shown to the best of the three for preserving the liver throughout life. The research also revealed that sunflower oil induced fibrosis, ultrastructural alterations, gene expression blockades and high oxidation. Meanwhile, fish oil intensified oxidation associated with aging, lowered mitochondrial electron transport chain activity and altered relative telomere length. Telomeres are the ends of chromosomes, the shortening of which can cause cell ageing and the lengthening of which can cause cancer.
"The alterations caused by the long-term consumption of sunflower and fish oils make the liver susceptible to non-alcoholic steatohepatitis, a very serious disease that may act as a catalyst for other liver diseases such as cirrhosis and liver cancer," Prof. Quiles notes. In light of the results, he also says, "Virgin olive oil is the healthiest option, which has already been proven in relation to diverse aspects of health."
According to Prof. Quiles, the most innovative aspect of this study is "how it reveals the mechanisms by which virgin olive oil provides these benefits and why the over-consumption of other dietary fats is dangerous. We believe that this study will be very useful in preventing and treating diverse liver diseases."

Explore further: Emerging drug could help treat a common liver disease

More information: Alfonso Varela-Lopez et al. Gene pathways associated with mitochondrial function, oxidative stress and telomere length are differentially expressed in the liver of rats fed lifelong on virgin olive, sunflower or fish oils, The Journal of Nutritional Biochemistry (2017). DOI: 10.1016/j.jnutbio.2017.09.007

Journal reference: Journal of Nutritional Biochemistry
Provided by: University of Granada

Memory and Brain Amyloid and Tau Effects of a Bioavailable Form of Curcumin in Non-Demented Adults: A Double-Blind, Placebo-Controlled 18-Month Trial

How many times does curcumin and tumeric have to be reported on as beneficial before your doctor gets off his/her ass and gets a diet protocol written up? NEVER I BET. Notice the word bioavailable, probably means your doctor will need to prescribe.
25 posts on curcumin back to March 2011.  Your doctors incompetency in action.
14 posts on tumeric back to March 2011.
https://www.sciencedirect.com/science/article/pii/S1064748117305110?via%3Dihub

Author links open overlay panelGary W.SmallM.D.

PrabhaSiddarthPh.D.ZhaopingLiM.D., Ph.D.Karen J.MillerPh.D.LindaErcoliPh.D.Natacha D.EmersonM.A.JacquelineMartinezM.B.A., M.S.Koon-PongWongPh.D.JieLiuPh.D.David A.MerrillM.D., Ph.D.Stephen T.ChenM.D.Susanne M.HenningPh.D., R.D.NagichettiarSatyamurthyPh.D.Sung-ChengHuangD.Sc.DavidHeberM.D., Ph.D.Jorge R.BarrioPh.D.

https://doi.org/10.1016/j.jagp.2017.10.010Get rights and content

Under a Creative Commons license

open access

Highlights

•

This is the first long-term (18 months) double-blind, placebo controlled trial of a bioavailable

form of curcumin (Theracurmin® containing 90 mg of curcumin twice daily) in non-demented adults.

•

We found that daily oral Theracurmin led to significant memory and attention benefits.

•

FDDNP-PET scans performed pre- and post-treatment suggested that behavioral and cognitive benefits are associated with decreases in plaque and tangle accumulation in brain regions modulating mood and memory.

•

Curcumin's cognitive benefits may stem from its anti-inflammatory and/or anti-amyloid brain effects.

Objective

Because curcumin's anti-inflammatory properties may protect the brain from neurodegeneration, we studied its effect on memory in non-demented adults and explored its impact on brain amyloid and tau accumulation using 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile positron emission tomography (FDDNP-PET).

Methods

Forty subjects (age 51–84 years) were randomized to a bioavailable form of curcumin (Theracurmin® containing 90 mg of curcumin twice daily [N = 21]) or placebo (N = 19) for 18 months. Primary outcomes were verbal (Buschke Selective Reminding Test [SRT]) and visual (Brief Visual Memory Test-Revised [BVMT-R]) memory, and attention (Trail Making A) was a secondary outcome. FDDNP-PET signals (15 curcumin, 15 placebo) were determined in amygdala, hypothalamus, medial and lateral temporal, posterior cingulate, parietal, frontal, and motor (reference) regions. Mixed effects general linear models controlling for age and education, and effect sizes (ES; Cohen's d) were estimated.

Results

SRT Consistent Long-Term Retrieval improved with curcumin (ES = 0.63, p = 0.002) but not with placebo (ES = 0.06, p = 0.8; between-group: ES = 0.68, p = 0.05). Curcumin also improved SRT Total (ES = 0.53, p = 0.002), visual memory (BVMT-R Recall: ES = 0.50, p = 0.01; BVMT-R Delay: ES = 0.51, p = 0.006), and attention (ES = 0.96, p < 0.0001) compared with placebo (ES = 0.28, p = 0.1; between-group: ES = 0.67, p = 0.04). FDDNP binding decreased significantly in the amygdala with curcumin (ES = −0.41, p = 0.04) compared with placebo (ES = 0.08, p = 0.6; between-group: ES = 0.48, p = 0.07). In the hypothalamus, FDDNP binding did not change with curcumin (ES = −0.30, p = 0.2), but increased with placebo (ES = 0.26, p = 0.05; between-group: ES = 0.55, p = 0.02).

Conclusions

Daily oral Theracurmin may lead to improved memory and attention in non-demented adults. The FDDNP-PET findings suggest that symptom benefits are associated with decreases in amyloid and tau accumulation in brain regions modulating mood and memory.

Ohio State researchers find pacemaker-like device reduces Alzheimer’s effects

You will need this.

Your chances of getting dementia.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

Ohio State researchers find pacemaker-like device reduces Alzheimer’s effects

 esearchers at Ohio State University say deep brain stimulation (DBS) from a device similar to a cardiac pacemaker can slow the decline of problem-solving and decision-making skills in Alzheimer’s patients.

In a study published in the Journal of Alzheimer’s Disease, the researchers said they implanted thin electrical wires into the frontal lobes of patients with Alzheimer’s disease to see if using a brain pacemaker could improve cognitive, behavioral and functional abilities in patients with this form of dementia.
They found that using DBS to target the frontal brain regions can reduce the overall performance decline typically seen in people with mild or early-stage Alzheimer’s. The disease affects more than 5 million people in the U.S. That number is expected to rise to as many as 16 million by 2050, according to the Alzheimer’s Association.
“The frontal lobes are responsible for our abilities to solve problems, organize and plan, and utilize good judgments,” Douglas Scharre, M.D., co-author of the study and director of the Division of Cognitive Neurology at Ohio State’s Wexner Medical Center’s Neurological Institute, told the Ohio State News. “By stimulating this region of the brain, the Alzheimer’s subjects’ cognitive and daily functional abilities as a whole declined more slowly than Alzheimer’s patients’ in a matched comparison group not being treated with DBS.”
The researchers said they will next look at nonsurgical methods to stimulate the frontal lobe, which would be a less invasive treatment option to slow down the symptoms of Alzheimer’s disease.

Advances in brain imaging can help identify more eligible patients for stroke treatment

You expect your hospital to actually implement this? What imaginary world do you live in? Or are you in another multiverse?
https://www.news-medical.net/news/20180125/Advances-in-brain-imaging-can-help-identify-more-eligible-patients-for-stroke-treatment.aspx

• Download PDF Copy

January 25, 2018

Advances in brain imaging can identify a greater number of stroke patients who can receive therapy later than previously believed, according to a new study. The results of the Endovascular Therapy Following Imaging Evaluation for the Ischemic Stroke (DEFUSE 3) trial, presented at the International Stroke Conference 2018 in Los Angeles and published on Jan. 24 in the New England Journal of Medicine, demonstrated that physically removing brain clots up to 16 hours after symptom onset in selected patients led to improved outcomes compared to standard medical therapy. The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
"These striking results will have an immediate impact and save people from life-long disability or death," said Walter Koroshetz, M.D., director NINDS. "I really cannot overstate the size of this effect. The study shows that one out of three stroke patients who present with at-risk brain tissue on their scans improve and some may walk out of the hospital saved from what would otherwise have been a devastating brain injury."
DEFUSE 3 was a large, multi-site study supported by NINDS' StrokeNet, which is a network of hospitals providing research infrastructure for multi-site clinical trials. This study was conducted at 38 centers across the United States and was led by Gregory W. Albers, M.D., professor of neurology and neurological sciences at Stanford University School of Medicine, in California, and director of the Stanford Stroke Center. The study was ended early by the NIH on recommendation of the independent Data and Safety and Monitoring Board because of overwhelming evidence of benefit from the clot removal procedure.
Ischemic stroke occurs when a cerebral blood vessel becomes blocked, cutting off the delivery of oxygen and nutrients to brain tissue. Brain tissue in the immediate area of the blockage, known as the core, cannot typically be saved from dying, and it can enlarge over time. However, it has long been thought that the area surrounding the core (known as the ischemic penumbra) has the potential to be saved based on how quickly the blood flow can be restored. Over the past two decades, scientists have been working to develop brain scanning methods, called perfusion imaging, that could identify patients with brain tissue that can still be salvaged by removing the blockage. In perfusion imaging, a standard dye is injected and scanned for a few minutes as it passes through the brain.

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Using an automated software known as RAPID to analyze perfusion MRI or CT scans, the DEFUSE 3 researchers identified patients thought to have salvageable tissue up to 16 hours after stroke onset. The participants were randomized to either receive endovascular thrombectomy plus standard medical therapy or medical therapy alone.
Endovascular thrombectomy, or the physical removal of the blockage, is currently approved for use up to six hours following onset of stroke symptoms. Dr. Albers and the DEFUSE 3 researchers discovered that this intervention can be effective up to 16 hours after symptoms begin in this select group of patients. The findings showed that patients in the thrombectomy group had substantially better outcomes 90 days after treatment compared to those in the control group. For example, 45 percent of the patients treated with the clot removal procedure achieved functional independence compared to 17 percent in the control group. In addition, thrombectomy was associated with improved survival. According to the results 14 percent of the treated group had died within 90 days of the study, compared to 26 percent in the control group.
"Although stroke is a medical emergency that should be treated as soon as possible, DEFUSE 3 opens the door to treatment even for some patients who wake up with a stroke or arrive at the hospital many hours after their initial symptoms," said Dr. Albers.
DEFUSE 3 builds on results from the two earlier DEFUSE studies as well as the industry-sponsored DAWN trial, which used perfusion imaging technology to identify patients most likely to benefit from interventions such as thrombectomy. Those studies suggested that the advanced brain imaging could identify which patients could benefit from restoring blood flow in an extended treatment window.

Source:

https://www.ninds.nih.gov/News-Events/News-and-Press-Releases/Press-Releases/Brain-scan-guided-emergency-stroke-treatment-can

New Findings Could Save Lives of More Stroke Patients

And you expect your hospital to implement this? Without you telling them about it? When they have ignored dozens to thousands of other research articles that might have helped stroke survivors?
https://www.nytimes.com/2018/01/24/health/stroke-clots-brain.html?rref=collection%2Fsectioncollection%2Fhealth

Many more stroke victims than previously thought can be saved from disability or death if doctors remove blood clots that are choking off circulation to the brain, a new study has shown.

“These striking results will have an immediate impact and save people from lifelong disability or death,” Dr. Walter J. Koroshetz, director of the National Institute of Neurological Disorders and Stroke, said in a statement. “I really cannot overstate the size of this effect.”

The key finding is that there is often more time than doctors realized in which brain cells can still be rescued by a procedure to remove the clot. Traditional guidelines have set a limit of six hours after stroke symptoms begin, and said after that it would be too late to help.

The study showed that the time window could be expanded to 16 hours. However, the findings do not apply to every stroke victim. The researchers used a special type of brain imaging to identify the patients who still had live brain tissue that could be saved if the blood supply was restored. Only about half the patients who were screened qualified for treatment, known as thrombectomy, which uses a mechanical device to pull clots out of a blood vessel.

The study, involving 182 patients at 38 hospitals in the United States, was stopped early because patients who had clots removed fared so much better than those who did not.

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Ninety days after treatment, 45 percent of the thrombectomy patients were well enough to be “functionally independent,” as opposed to 17 percent of those who did not have the procedure. The death rates were 14 percent in the thrombectomy group, and 26 percent in those whose clots were not removed.

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The results were published on Wednesday in The New England Journal of Medicine. The study was paid for by the National Institutes of Health, and led by researchers from Stanford University. The Stanford team said it expected the study would lead the American Heart Association to change the guidelines for stroke treatment, extending the time window for thrombectomy.

It is not uncommon for strokes to begin during sleep, and some of those patients miss out on treatment because it is not clear what time the stroke began. Medical practice has been to set the beginning of the time window as the last moment they were known to be well, and if they have slept most of the night the six-hour window may be over by the time they wake up. New guidelines may allow such patients to be treated.

About 750,000 people a year suffer strokes in the United States, and 85 percent of those are caused by clots — the same type treated in this study. Symptoms include speech difficulty, arm weakness and facial drooping. Experts urge patients or their families to call 911 immediately so that treatment can be started as soon as possible.

A version of this article appears in print on January 25, 2018, on Page A13 of the New York edition with the headline: Study Widens Time Frame In Treatment For Strokes. Order Reprints| Today's Paper|Subscribe