New blood test for strokes could help tackle a $2 trillion problem, researchers say

 Will your competent hospital put this protocol into their emergency room doctor handbook with all these other fast diagnosis options? Or don't you have a functioning stroke hospital with protocols to follow as stroke patients come in?

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

Smart Brain-Wave Cap Recognises Stroke Before the Patient Reaches the Hospital

 October 2023

And then this to rule out a bleeder.

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

The latest here:

New blood test for strokes could help tackle a $2 trillion problem, researchers say

By Eleanor Laise

Test can accelerate treatment for severe stroke patients, when minutes matter

A new blood test can quickly detect a particularly severe type of stroke, according to new research released Friday, dramatically improving patients' odds of getting lifesaving treatment before it's too late.

The test identified large-vessel occlusion strokes - which occur when a major artery in the brain is blocked - with a high level of accuracy, according to the study led by researchers at Brigham and Women's Hospital in Boston and published in the peer-reviewed journal Stroke: Vascular and Interventional Neurology.

Every minute matters when treating these strokes, because brain cells can die quickly when blood supply is disrupted. Traditionally, the strokes have been diagnosed with the help of computed tomography or magnetic resonance imaging procedures - and it can take hours to complete those procedures, interpret the results and get the patient to a hospital capable of providing the right treatment, Joshua Bernstock, clinical fellow at Brigham and Women's Hospital and senior author of the study, told MarketWatch.

The new blood test can detect a large-vessel occlusion stroke within 10 to 15 minutes, Bernstock said. "We have developed a game-changing, accessible tool that could help ensure that more people suffering from stroke are in the right place at the right time to receive critical, life-restoring care," Bernstock said in a statement.

Every year, nearly 800,000 people in the U.S. have a stroke, according to the Centers for Disease Control and Prevention. Stroke is also the second-leading cause of death globally, even though it is highly preventable and treatable, according to a report last year from the World Stroke Organization-Lancet Neurology Commission. If current trends continue, stroke deaths could increase 47% by 2050, the report found.

Worldwide, total macroeconomic losses linked with strokes totaled more than $2 trillion in 2019, or about 1.7% of global gross domestic product, according to a study published last year in the journal Stroke.

Large-vessel occlusion strokes require quick treatment with mechanical thrombectomy, a surgical procedure to remove the blockage. The earlier that procedure can start, "the better the patient's outcome is going to be," Bernstock said in a statement. The new test, he added, "has the potential to allow more people globally to get this treatment faster."

The test, Bernstock told MarketWatch, could potentially allow patients to bypass the time-consuming imaging procedures altogether and move directly to treatment.

The study also found that the combination of blood-based biomarkers and a clinical score could identify the severe strokes while ruling out other conditions such as bleeding in the brain, which can cause similar symptoms but requires different treatment.

The researchers are also conducting a trial to assess the test's performance when used in an ambulance. The team plans to start the U.S. regulatory approval process for the test later this year, Bernstock said.

The test could have a particularly significant impact, Bernstock said, by improving patients' access to thrombectomy in lower- and middle-income countries that don't have widespread imaging capabilities. "By democratizing access to this transformative therapy, I hope it will touch the lives of millions of people," he said.

-Eleanor Laise

This content was created by MarketWatch, which is operated by Dow Jones & Co. MarketWatch is published independently from Dow Jones Newswires and The Wall Street Journal.

Implications for driving based on the risk of seizures after ischaemic stroke

Totally wrong research; SOLVE THE FUCKING PROBLEM! What is the EXACT PROTOCOL to prevent seizures?  Doesn't anyone in stroke have two functioning neurons to rub together for a spark of intelligence? You've known of seizures post stroke for years, why haven't you solved the problem?

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind?  Survivors would like to know why you are being so fucking incompetent!

 

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (7 posts to December 2016)

The latest crapola here:

 Implications for driving based on the risk of seizures after ischaemic stroke

1. http://orcid.org/0000-0003-1438-7544Kai Michael Schubert1,
2. Giulio Bicciato1,
3. Lucia Sinka1,2,
4. Laura Abraira3,
5. http://orcid.org/0000-0003-1915-0335Estevo Santamarina3,
6. José Álvarez-Sabín3,
7. Carolina Ferreira-Atuesta4,5,
8. Mira Katan1,6,
9. Natalie Scherrer1,
10. Robert Terziev1,
11. Nico Döhler7,8,
12. Barbara Erdélyi-Canavese7,
13. Ansgar Felbecker7,
14. Philip Siebel7,
15. Michael Winklehner9,
16. Tim J von Oertzen9,
17. http://orcid.org/0000-0002-0776-6821Judith N Wagner9,10,
18. Gian Luigi Gigli11,
19. Annacarmen Nilo11,
20. Francesco Janes11,
21. Giovanni Merlino11,
22. Mariarosaria Valente11,
23. María Paula Zafra-Sierra12,
24. Luis Carlos Mayor-Romero12,
25. Julian Conrad13,14,
26. S Evers13,15,
27. Piergiorgio Lochner16,
28. Frauke Roell16,
29. http://orcid.org/0000-0003-0928-1577Francesco Brigo17,
30. http://orcid.org/0000-0003-2399-7678Carla Bentes18,
31. Rita Peralta18,
32. Teresa Pinho e Melo18,
33. Mark R Keezer19,20,
34. http://orcid.org/0000-0002-1373-0681John Sidney Duncan4,
35. http://orcid.org/0000-0001-6041-9661Josemir W Sander4,19,21,
36. Barbara Tettenborn7,
37. Matthias Koepp4,
38. http://orcid.org/0000-0002-2307-071XMarian Galovic1,4

1. Correspondence to Dr Marian Galovic, Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, 8091, Switzerland; marian.galovic@usz.ch

Abstract

Background In addition to other stroke-related deficits, the risk of seizures may impact driving ability after stroke.

Methods 

 

We analysed data from a multicentre international cohort, including 4452 adults with acute ischaemic stroke and no prior seizures. We calculated the Chance of Occurrence of Seizure in the next Year (COSY) according to the SeLECT_2.0 prognostic model. We considered COSY<20% safe for private and <2% for professional driving, aligning with commonly used cut-offs.

Results 

Seizure risks in the next year were mainly influenced by the baseline risk-stratified according to the SeLECT_2.0 score and, to a lesser extent, by the poststroke seizure-free interval (SFI). Those without acute symptomatic seizures (SeLECT_2.0 0–6 points) had low COSY (0.7%–11%) immediately after stroke, not requiring an SFI. In stroke survivors with acute symptomatic seizures (SeLECT_2.0 3–13 points), COSY after a 3-month SFI ranged from 2% to 92%, showing substantial interindividual variability. Stroke survivors with acute symptomatic status epilepticus (SeLECT_2.0 7–13 points) had the highest risk (14%–92%).

Conclusions 

Personalised prognostic models, such as SeLECT_2.0, may offer better guidance for poststroke driving decisions than generic SFIs. Our findings provide practical tools, including a smartphone-based or web-based application, to assess seizure risks and determine appropriate SFIs for safe driving.

Data availability statement

Data are available on reasonable request. Who can access the data: Data will be shared on a reasonable request by a qualified investigator, provided consent to share is given by the individual cohorts. Types of analyses: For any purpose on reasonable request by a qualified investigator. Mechanisms of data availability: With investigator support.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

UK Stroke Research Workshop 2024

 You can obviously see that nothing here is about getting survivors 100% recovered or even remotely close! USELESS! I expect stroke researchers to do research that directly gets survivors recovered! None of this useless crapola of predicting failure to recover or biomarkers.  Solve the problems that stroke survivors have.

Every single stroke research should layout where in the stroke strategy they fit and create and distribute protocols worldwide.

Our fucking failures of stroke associations  have garbage goals of prevention and F.A.S.T. press releases.

 

UK Stroke Research Workshop 2024

Interactive Workshops:
Designing and Implementing a Stroke Research Study

Sessions:
Stroke in the Young
​New Developments in Stroke Rehabilitation
Mechanisms in Vascular Dementia
Biomarkers in Stroke
Controversies in Acute Stroke
 
Abstracts:
Oral Presentations
Two Guided Poster Tours

Short-chain fatty acids: Important components of the gut-brain axis against AD

 You'll have to ask your competent? doctor for the EXACT PROTOCOL that will deliver Alzheimer's prevention. THINK YOUR DOCTOR CAN DO THAT?

Short-chain fatty acids: Important components of the gut-brain axis against AD

Yan Huang, Yi Feng Wang, Jing Miao, Rui Fang Zheng, Jin Yao Li,

^a

School of Pharmaceutical Sciences and Institute of Materia Medica, Xinjiang University, Urumqi 830017, China

^b

Xinjiang Key Laboratory of Uygur Medical Research, Xinjiang Institute of Materia Medica, Urumqi 830004, China

^c

College of Life Science and Technology, Xinjiang University, Urumqi 830000, China

^d

Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, Xinjiang University, Urumqi 830004, China

https://doi.org/10.1016/j.biopha.2024.116601Get rights and content

Under a Creative Commons license

open access

Abstract

Alzheimer's disease (AD) comprises a group of neurodegenerative disorders with some changes in the brain, which could lead to the deposition of certain proteins and result in the degeneration and death of brain cells. Patients with AD manifest primarily as cognitive decline, psychiatric symptoms, and behavioural disorders. Short-chain fatty acids (SCFAs) are a class of saturated fatty acids (SFAs) produced by gut microorganisms through the fermentation of dietary fibre ingested. SCFAs, as a significant mediator of signalling, can have diverse physiological and pathological roles in the brain through the gut-brain axis, and play a positive effect on AD via multiple pathways. Firstly, differences in SCFAs and microbial changes have been stated in AD cases of humans and mice in this paper. And then, mechanisms of three main SCFAs in treating with AD have been summarized, as well as differences of gut bacteria. Finally, functions of SCFAs played in regulating intestinal flora homeostasis, modulating the immune system, and the metabolic system, which were considered to be beneficial for the treatment of AD, have been elucidated, and the key roles of gut bacteria and SCFAs were pointed out. All in all, this paper provides an overview of SCFAs and gut bacteria in AD, and can help people to understand the importance of gut-brain axis in AD.

More at link.

NBT stroke service reconfiguration leads to improved patient outcomes across the region

 If you were to genuinely ask survivors if they were  'improved' enough; they would reply; 'Hell no, I didn't get 100% recovered!'. So this stroke service is normalizing failure. You as stroke survivors will need to take it over; right now it's a complete failure!

NBT stroke service reconfiguration leads to improved patient outcomes across the region

North Bristol NHS Trust’s stroke team has undergone dramatic transformation and expansion over the past ten years. It is currently the largest service of its kind in the UK, and one of the largest in Europe. 

The biggest changes have been the expansion of the mechanical thrombectomy service in December 2022 to run 24/7, and the centralisation of urgent stroke services in Bristol, North Somerset and South Gloucestershire to create the hyper acute and acute stroke units  at Southmead Hospital’s comprehensive stroke centre in May 2023. The changes mean that Southmead is now the main provider of emergency stroke care(NOT RECOVERY!) for patients in the region via the Hyper Acute Stroke Unit (HASU), with the Acute Stroke Unit (ASU) providing specialist follow-up care(NOT RECOVERY!) before patients move onto rehab closer to their homes, or are discharged home with support. 

In the first year of offering the 24/7 service, the team treated 200 more patients than the previous year with more than 400 thrombectomies performed in 2023.  

Dr James Dodd, Clinical Lead for Stroke at NBT, says it’s been “incredible” to see how advances in care(NOT RECOVERY!) and treatment have improved patient outcomes in the six years he has been practising as a doctor.  

“We know from research and evidence that getting people to a specialist centre earlier improves stroke outcomes. Prior to reconfiguration, a lot of stroke outcomes depended on when and where you had the stroke. And we were aware that there was an inequality of outcomes across the wider region. 

“It has been incredible to see this service grow considerably and how many people have been in receipt of our care(NOT RECOVERY!) and treatment. 

“I think we're very lucky to work in a hospital like Southmead where it's a very beautiful building, it's light and airy, and I think the workforce and indeed the patients and relatives, they often comment on how nice it is, and I think that really does help with the patient experience.” 

Use of Robotic Assisted Mirror Therapy for Hand Rehabilitation in Post-stroke Patients: A Narrative Review of Literature

 With no picture of the soft robotic glove it is impossible to tell if spastic hands/fingers could ever get the glove on.

Use of Robotic Assisted Mirror Therapy for Hand Rehabilitation in Post-stroke Patients: A Narrative Review of Literature

Hemanshi N. Vekariya1, Vivek H. Ramanandi2, Rumana Khatun A. Pathan 3,
Roshni G. Kachhadiya 4
1,3,4Post graduate Student, SPB Physiotherapy College, Veer Narmad South Gujarat University, Surat, India.
2Associate Professor, SPB Physiotherapy College, Veer Narmad South Gujarat University, Surat, India.
Corresponding Author: Dr. Vivek H. Ramanandi
DOI: https://doi.org/10.52403/ijhsr.20240523

ABSTRACT

Background: 

 

Recovery of hand function is very important for the independence of patients
with stroke. Standard mirror therapy is a well-established therapy regime for severe arm
paresis after acquired brain injury. Soft robotic glove along with mirror therapy (i.e., robotic
assisted mirror therapy) have been employed recently to assist the recovery of hand function
during activities of daily living (ADLs) in stroke patients. This study aims to review available
literature related to use of robotic assisted mirror therapy for hand rehabilitation in post stroke
patients.
 

Methodology: 

 

Full texts of scientific literature published in English language between 2011
to 2022 were searched on various online databases. Total 3 publications related to use of
robotic assisted mirror therapy for hand rehabilitation were found. Based upon the selection
criteria, 2 full texts were included for review. Randomized control trials (RCTs), pre-
test/post-test, pilot & non-RCTs were included.
 

Result: 

 

Both articles reported that combining effect of mirror therapy with robotic glove
therapy was more beneficial when compared to the conventional mirror therapy alone to
improve glove functions.
 

Conclusion: 

 

It can be concluded that clinically combination of mirror therapy with robotic
glove will be promoted for better outcomes related to hand rehabilitation in post-stroke
patients.

CURCUMIN MITIGATES STRESS INDUCED DEPRESSION AND HIPPOCAMPAL DAMAGE THROUGH UPREGULATION OF BDNF EXPRESSION AND ADULT NEUROGENESIS

Since you probably have major depression issues because your competent? doctor doesn't know anything about getting you 100% recovered, maybe s/he can compensate with a curcumin prescription. But your doctor won't even know about this, so you're screwed.

All this earlier research your doctor doesn't know about, why are you seeing them?

• curcumin (40 posts to March 2011)

• tumeric (21 posts to March 2011)

Do you prefer your  doctor  incompetence NOT KNOWING? OR NOT DOING?

Yeah in rats but competent doctors would ensure human testing gets done.

 CURCUMIN MITIGATES STRESS INDUCED DEPRESSION AND HIPPOCAMPAL DAMAGE THROUGH UPREGULATION OF BDNF EXPRESSION AND ADULT NEUROGENESIS

399
Scientia Africana, Vol. 23 (No. 2), April, 2024. Pp389-402
© Faculty of Science, University of Port Harcourt, Printed in Nigeria ISSN 1118 – 1931
CURCUMIN MITIGATES STRESS INDUCED DEPRESSION AND HIPPOCAMPAL
DAMAGE THROUGH UPREGULATION OF BDNF EXPRESSION AND ADULT
NEUROGENESIS.
¹Wogu, E. U., and ¹Edibamode, E. I.
¹Anatomy Department, University of Port Harcourt, Rivers State, Nigeria.
Received: 03-04-2024
Accepted: 24-04-2024

ABSTRACT

Chronic stress, recognized as a major precipitant of depression, has been linked to various neural alterations, including cell death, neuronal atrophy, and compromised hippocampal neurogenesis and plasticity. This study aim to scrutinize curcumin's influence on glucocorticoid hormone secretion and its subsequent effects on the structural integrity and neurogenesis of the hippocampal neurons. A total of 30 adult albino Wistar rats, each weighing between 200-250 g, were utilized for the study. The rats, excluding those in the control group, underwent a 42-day regimen of modified Chronic Unpredictable Stress (CUS) to induce depressive-like states. After inducing CUS, these rats were categorized into six groups, each receiving different oral treatments for two weeks. The treatments included 30 mg/kg body weight of curcumin, 20 mg/kg body weight of fluoxetine, or a combination of both, along with a control group that received distilled water and an olive oil treated group. The rats were tested for behavioural despair using the forced swim test and their blood samples were obtained for serum corticosterone test. Afterwards, the rats were anesthetized, transcardially perfused and the hippocampus dissected and prepared for histopathological study.
The study's multi-faceted approach encompassed behavioral, biochemical, and histological
evaluations. Behavioral despair, gauged through the forced swimming test, displayed a marked
reduction in the curcumin-treated rats compared to controls (p<0.05). Additionally, curcumin
significantly lowered serum corticosterone levels, aligning them closely with the control levels.
Histomorphological analysis of the hippocampus showed that the curcumin-treated rats exhibited
substantially less neurodegeneration, as evidenced by fewer cytoplasmic vacuolations and more
intact neuronal structures. Increased cell proliferation and BDNF level were also observed in
curcumin treated rats. This study has illuminated a multifaceted approach through which curcumin mitigates hippocampal neurodegeneration, thus showing possible therapeutic potential of curcumin in ameliorating depressive symptoms.

 

More at link.

Prehospital Hypertension Control No Help in Unselected Acute Stroke

 So our stroke medical 'professionals' still have NO FUCKING CLUE on how to address blood pressure management at any point during a stroke.  Incompetence in full display. Leaders would solve such problems! There are NO leaders anywhere in stroke! 

• blood pressure management (82 posts to June 2017)

 

It would seem a great solution to determine ischemic vs. hemorrhagic stroke very fast by these methods:

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

Smart Brain-Wave Cap Recognises Stroke Before the Patient Reaches the Hospital

 October 2023

And then this to rule out a bleeder.

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

 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind?  Survivors would like to know why you haven't solved the blood pressure management problems. NO excuses allowed; just your factual statement why it hasn't been solved. You do realize you'll want this solved before you are the 1 in 4 per WHO that has a stroke?  

Leaders solve problems, why aren't you a leader?

 

The latest here:

Prehospital Hypertension Control No Help in Unselected Acute Stroke

Chinese trial suggests benefit for one stroke subtype but may need replication

by Crystal Phend , Contributing Editor, MedPage Today May 16, 2024

Bringing blood pressure under control in the ambulance didn't improve stroke outcomes in an unselected population, the China-based INTERACT 4 trial showed.

Functional outcome measured by the modified Rankin Scale was no better with that early systolic blood pressure reduction to 130-140 mm Hg compared with usual care en route to the hospital (common OR 1.00, 95% CI 0.87-1.15), reported Gang Li, MD, PhD, of Shanghai East Hospital at Tongji University in Shanghai, and colleagues.

The prehospital intervention appeared safe overall, with serious adverse events occurring in 27.5% and 28.7% of patients, respectively, they noted in the New England Journal of Medicine. The findings were also presented at the European Stroke Organisation meeting in Basel, Switzerland.

Of note, for the roughly half of patients who were diagnosed at the hospital with ischemic stroke, prehospital blood pressure control significantly increased the odds of a poor functional outcome (common OR 1.30, 95% CI 1.06-1.60).(Probably because by lowering the blood pressure you are vastly reducing the amount of blood providing oxygen to the penumbra, thus increasing the speed at which neurons die in the penumbra.) I'm not medically trained so nothing here will be listened to.

However, for those with hemorrhagic stroke, the opposite was true, with a significant 25% relative reduction in risk of poor functional outcome.

"These results are perhaps predictable," wrote Jonathan A. Edlow, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, in an accompanying editorial.

A similar overall neutral finding with possible harm was seen in the RIGHT-2 trial of nitroglycerin patches administered in the hospital to rapidly reduce blood pressure for suspected acute stroke patients.

Blood pressure targets diverge for intracerebral hemorrhage versus acute ischemic stroke and whether thrombolysis or mechanical thrombectomy is planned.

"Antihypertensive therapy in patients with intracerebral hemorrhage is meant to limit hematoma growth," Edlow noted, whereas less restrictive targets are used in acute ischemic stroke "with the presumption that autoregulated blood pressure improves blood flow to, and results in increased salvage of, ischemic penumbral tissue."(This, which I explained above.)

A number of issues in INTERACT 4, though, indicate that the results should be viewed as hypothesis generating rather than conclusive, he argued, calling for validation of the trial results in other settings.

"First, nearly all the patients were treated with urapidil, an α1 receptor blocker that is unavailable in the United States," and were of Han Chinese ethnicity, Edlow pointed out.

More importantly, he added, "the roughly even split between patients with intracerebral hemorrhage and those with acute ischemic stroke is unusual, even in a Chinese population. Aggressive reduction of blood pressure in a typical North American or European community-based stroke population, in which the ratio of patients with intracerebral hemorrhage to those with acute ischemic stroke is approximately 20:80, could result in net harm if the subgroup analysis estimates are valid."

And, oddly, "more than two thirds of patients with acute ischemic stroke in this trial had visible signs of ischemia or infarction on the initial CT scans, which were obtained within 3 hours after stroke onset; however, most CT scans obtained within this time frame are normal in patients with acute ischemic stroke," Edlow pointed out. "Potential explanations for the high sensitivity of CT in the current trial include the presence of unusually large strokes in the trial cohort, erroneously determined stroke onset times, or improvements in CT technology, all of which are unlikely."

The trial included 2,404 patients (mean age 70) in China with motor deficits from a suspected acute stroke assessed in the ambulance within 2 hours after onset of symptoms or time last known well, who had a systolic blood pressure of at least 150 mm Hg.

They were randomized 1:1 to immediate treatment in the ambulance with antihypertensive medication to bring their systolic blood pressure to 130-140 mm Hg or to a usual management approach with antihypertensives given only if their systolic pressure reached 220 mm Hg or higher or if their diastolic pressure reached at least 110 mm Hg. Nearly all of the intervention group patients (98.5%) received antihypertensive medication as randomized in the ambulance compared with 9.7% of the usual care group.

Median time from symptom onset to randomization was 61 minutes. Systolic blood pressure declined from a median of 178 mm Hg at randomization to 158 mm Hg in the intervention group, compared with 170 mm Hg in the usual care group at hospital arrival.

Stroke was subsequently confirmed by imaging in 2,240 patients, of whom 46.5% had a hemorrhagic stroke.

The researchers cautioned that the subgroup analysis for the primary outcome measure of modified Rankin Scale by stroke type was not part of a hierarchical statistical plan, thus "causal inferences about these associations cannot be drawn."

Other study limitations included that emergency services involved in the trial involved trained doctors, which might limit generalizability to paramedic-run ambulance services like those more common in the U.S.; potentially limited relevance to patients presenting with possible stroke that has caused a minor neurologic deficit; and the open-label design.

• 

  Crystal Phend is a contributing editor at MedPage Today. Follow

Disclosures

The trial was supported by the National Health and Medical Research Council of Australia, the George Institute for Global Health, Shanghai East Hospital of Tongji University, other institutional and governmental funds, and Takeda Pharmaceuticals China.

Li disclosed no relevant relationships with industry.

Edlow disclosed relationships with UpToDate.

Primary Source

New England Journal of Medicine

Source Reference: Li G, et al "Intensive ambulance-delivered blood-pressure reduction in hyperacute stroke" N Engl J Med 2024; DOI: 10.1056/NEJMoa2314741.

Secondary Source

New England Journal of Medicine

Source Reference: Edlow JA "Lowering blood pressure in stroke patients in the ambulance -- A bridge too close?" N Engl J Med 2024; DOI: 10.1056/NEJMe2402356.

Research validates anti-inflammatory properties of wine using urinary tartaric acid as biomarker

 But this is absolutely impossible! This proves the impossibility! I'm going to be a Super-ager, only 68, going strong, Mom at 95 still living alone.

Safest level of alcohol consumption is none, worldwide study shows

But this!  

SuperAgers indulge. They also indulged in an occasional glass of alcohol; people who drink moderately were 23% less likely to develop Alzheimer’s disease or signs of memory problems than those who don’t drink alcohol. The key here is moderation.

Research validates anti-inflammatory properties of wine using urinary tartaric acid as biomarker

By Vijay Kumar MalesuMay 13 2024Reviewed by Lily Ramsey, LLM

In a recent study published in The Journal of nutrition, health and aging, a group of researchers investigated the anti-inflammatory effects of wine by analyzing the relationship between urinary tartaric acid concentrations and changes in serum inflammatory biomarkers in PREvención con Dieta MEDiterránea (PREDIMED) trial participants.

Study: Moderate wine consumption measured using the biomarker urinary tartaric acid concentration decreases inflammatory mediators related to atherosclerosis. Image Credit: CandyRetriever/Shutterstock.com

Background 

Inflammation is crucial for health, acting protectively in acute scenarios and detrimentally when chronic, leading to diseases like arthritis and diabetes.

The Mediterranean diet (MedDiet), rich in plant-based foods, healthy fats, and moderate wine intake, effectively reduces inflammatory markers in those at high cardiovascular risk.

This diet's polyphenols and omega-3 fatty acids help combat inflammation linked to chronic diseases. Despite ongoing debates, many studies confirm red wine's anti-inflammatory benefits attributed to polyphenols.

Urinary tartaric acid offers a more objective measure of wine consumption than food frequency questionnaires. Further research is essential to understand wine's impact on inflammation and validate this biomarker across different groups.

About the study 

The present cohort analysis was conducted using baseline and one-year data from the PREDIMED study, a large, parallel-group, multicenter, randomized, controlled trial.

It was conducted in Spain from October 2003 to December 2010. It assessed the impact of the MedDiet enriched with olive oil or nuts on cardiovascular disease (CVD) incidence, involving 7,447 participants at high cardiovascular risk.

This analysis specifically included a subsample of 217 participants from the Hospital Clinic of Barcelona and Navarra recruitment centers, examining their inflammatory biomarkers and urinary tartaric acid levels.

The Institutional Review Board (IRB) of the Hospital Clinic in Barcelona approved the study protocol, and all participants provided written informed consent.

SLAS EU - Highlights from 2022 eBook Check out the key interviews from SLAS Europe 2023 Download the latest edition

Dietary intake was assessed with a validated food frequency questionnaire, and physical activity was measured using a Spanish version of the Minnesota physical activity questionnaire.

Inflammatory biomarkers were analyzed using eXtensible MicroArray Profiling (xMAP) technology, and tartaric acid concentration was measured in urine samples using high-performance liquid chromatography coupled with mass spectrometry (LC–ESI–MS/MS).

The statistical analysis included dividing participants into tertiles based on the one-year changes in urinary tartaric acid concentration, and multivariable-adjusted linear regression models were used to explore associations between changes in tartaric acid and inflammatory biomarkers. 

Study results

The present study analyzed the baseline characteristics of participants from the PREDIMED trial, focusing on their demographic and health profiles as related to changes in urinary tartaric acid concentrations over one year.

The average age of the participants was 68.8 years, with a slight majority being female (52.1%). The participants were similarly distributed across the three tertiles regarding sex, age, and physical activity levels.

Most participants were classified as overweight, and a high prevalence of cardiovascular risk factors was observed: 54.8% had diabetes, 63.6% had dyslipidemia, and 78.8% had hypertension. The majority were non-smokers (85.7%) and had a low educational level (75.1%), with these characteristics evenly distributed among the tertiles.

Adherence to the MedDiet was generally consistent across groups, though slightly lower in the first tertile, and wine consumption was notably lower in the second tertile.

The study also reviewed changes in dietary intake over the year, finding that food and nutrient consumption remained well-balanced across the tertiles.

The relationship between wine consumption and urinary tartaric acid excretion was analyzed, adjusting for various potential confounders such as age, sex, smoking habits, educational level, body mass index (BMI), physical activity, intervention group, analysis time, energy intake, and consumption of grapes and raisins.

The results indicated a clear correlation: higher wine consumption led to increased tartaric acid excretion, with an adjusted increase of 0.39 μg/mg creatinine per standard deviation, highly significant at p < 0.001.

The reliability of urinary tartaric acid as a biomarker for wine consumption was supported by a Receiver Operating Characteristic (ROC) curve analysis, demonstrating good predictive ability with an Area Under the Curve (AUC) of 0.818.

Furthermore, the impact of urinary tartaric acid on inflammatory markers was assessed. Higher increases in tartaric acid were associated with significant reductions in soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations, adjusting for potential confounders (−0.20 ng/mL per standard deviation increase, p = 0.031).

However, no significant associations were observed when changes in tartaric acid were considered continuously.

The study found an inverse relationship between increases in tartaric acid and changes in plasma sVCAM-1 and intercellular adhesion molecule-1 (sICAM-1) when analyzed by tertiles.

Participants in the second and third tertiles showed significantly lower concentrations of sICAM-1 compared to the first tertile, and similar patterns were observed for sVCAM-1, especially in the third tertile. 

Conclusion

In conclusion, the study successfully establishes urinary tartaric acid as a credible biomarker for wine consumption, providing clear evidence that moderate wine intake, particularly red wine rich in polyphenols, is associated with significant reductions in key inflammatory markers.

These findings not only reinforce the potential health benefits of moderate wine consumption in reducing cardiovascular risk but also highlight the importance of including such bioactive compounds in the diet for their anti-inflammatory properties.

Further research may explore the long-term health impacts of sustained wine consumption and its role in chronic disease prevention, thereby enriching our understanding of dietary influences on health outcomes.

Journal references:

• Inés Domínguez López, Camila Arancibia-Riveros, Rosa Casas, et al. (2024) Moderate wine consumption measured using the biomarker urinary tartaric acid concentration decreases inflammatory mediators related to atherosclerosis, The Journal of nutrition, health and aging.doi:https://doi.org/10.1016/j.jnha.2023.100003.https://www.sciencedirect.com/science/article/pii/S1279770723000866
  

Olive oil – 7 grams per day may keep the dementia away!

 Finally something specific instead of the vagueness of the Mediterranean diet. So 1.5 teaspoons seems about right, but to verify, ask your doctor!

Weight in Grams:	Volume in Teaspoons of:
	Water	Granulated Sugar
7 g	1.4202 tsp	1.68 tsp
8 g	1.6231 tsp	1.92 tsp
9 g	1.826 tsp	2.16 tsp

Olive oil – 7 grams per day may keep the dementia away!

In a recent study published in the journal JAMA Network Open, researchers used a large prospective cohort study to investigate the long-term associations between olive oil consumption and dementia mortality risk. Their cohort comprising 92,383 American adults revealed that consuming seven or more grams of olive oil per day was associated with a 28% reduction in dementia-related death compared to participants devoid of olive oil consumption. This study highlights the importance of diet in age-associated cognitive decline and mortality. It suggests that olive oil intake may present an efficient strategy to combat dementia mortality risk among Americans.

Study: Consumption of Olive Oil and Diet Quality and Risk of Dementia-Related Death. Image Credit: ifong / Shutterstock

Food may affect age-associated cognitive decline

Dementia, the umbrella term for a spectrum of diseases affecting one’s ability to recall details and events, process data, or make rational decisions, affects more than 55 million individuals and accounts for more than 33% of all adult deaths globally. While recent advances in medicine have resulted in overall decreases in cardiovascular disease (CVD)-related mortality (strokes and heart disease), trends in dementia prevalence and dementia-associated mortality are alarmingly on the rise, with more than 10 million new cases reported every year.

Extensive research, especially during and immediately following the Coronavirus disease of 2019 (COVID-19) pandemic, has revealed the complex yet undeniable association between good health behaviors (particularly sleep, physical activity, and diet) and chronic disease outcomes, with dietary interventions increasingly being investigated for their beneficial impacts on cardiovascular and age-associated cognitive outcomes. The Mediterranean dietary pattern and its derivatives (e.g., DASH – Dietary Approaches to Stop Hypertension), inspired by the traditional eating habits of citizens of southern Spain, southern Italy, and Crete, has been gaining global traction given its observed anti-inflammatory and neuroprotective benefits.

Olive oil is a fundamental part of the Mediterranean diet and is the primary source of oil and fat in that diet. This oil is known to be rich in monounsaturated fatty acids, vitamin E, and polyphenols, compounds rich in antioxidants, which in turn have been observed to delay dementia onset and reduce Alzheimer’s disease risk. Previous studies on olive oil consumption have revealed that its regular intake, when combined with a healthy diet high in fresh fruits and vegetables and low in processed fats and meats, can effectively improve cognitive outcomes compared to its sporadic or non-intake. Unfortunately, most studies investigating the potential benefits of olive oils have been conducted in Mediterranean countries, with a dearth of evidence from other countries.

About the study

In the present study, researchers investigated the long-term effects of olive oil consumption on a large American cohort to elucidate any potential improvements in dementia-associated mortality outcomes within this population. They further examine how these outcomes change based on diet quality (healthy diet adherence) in tandem with regular olive oil consumption. Their prospective study enrolled participants (N = 92,383) from two preexisting long-term association studies - the Nurses’ Health Study I (NHS; the female participant cohort) and the Health Professionals Follow-Up Study (HPFS; the male participant cohort).

Data for the study was collated over a 33-year-long period between 1990 and 2023 and consisted of biennial assessments of participants’ lifestyle habits and medical histories. NHS and HPFS enrollees with a clinical history of CVD, cancer, implausible daily calorific intakes, or incomplete olive oil consumption data were excluded from the subsequent analysis. The questionnaire (‘Food frequency questionnaire’ [FFQ]) was validated by experts in a smaller test cohort and included more than 130 items. A modified version of the Alternative Mediterranean Index (AMED) score was used for diet quality assessments.

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“Participants were asked how frequently they consumed specific foods, including types of fats and oils used for cooking or added to meals in the past 12 months. Total olive oil intake was determined by summing up answers to 3 questions related to olive oil consumption (ie, olive oil used for salad dressings, olive oil added to food or bread, and olive oil used for baking and frying at home).”

Since the apolipoprotein E ε4 (APOE ε4) allele has been almost ubiquitously implicated in increased dementia risk, especially for homozygous carriers, blood (or buccal) samples from a subset of participants (N = 27,296) were collected for APOE genotyping. Deaths and covariates (smoking status, body weight, physical activity levels, menopausal status, medicine, and dietary supplement use) were obtained from the National Death Index and the biennial questionnaires, respectively. Age-stratified Cox proportional hazard models were used for statistical validation to compute the relationship between olive oil intake and dementia-associated mortality.

Study findings and conclusions

Of the 92,383 participants (65.6% women) included in the study, 4,751 dementia-associated deaths were reported over the 33-year follow-up period. Mean olive oil intake across cohorts was found to be 1.3 g//d, with Mediterranean diet adherence estimated at 4.5 and 4.2 points for the NHS and HPFS cohorts, respectively.

“Olive oil intake was inversely associated with dementia-related mortality in age-stratified and multivariable-adjusted models. Compared with participants with the lowest olive oil intake, the pooled HR for dementia-related death among participants with the highest olive oil intake (>7 g/d) was 0.72 (95% CI, 0.64-0.81), after adjusting for sociodemographic and lifestyle factors.”

This study’s highlight is revealing that consistent olive oil intake, when consumed as a part of a healthy balanced diet (herein, the Mediterranean diet), can substantially reduce the risk of age-associated dementia-related mortality in Americans, particularly women. Surprisingly, consuming more than 7.0 g/d of olive oil was found to lower dementia risk even in the absence of the Mediterranean diet, suggesting its independent ability to delay the progression of cognitive decline.

Journal reference:

• Tessier, A.-J., Cortese, M., Yuan, C., Bjornevik, K., Ascherio, A., Wang, D. D., Chavarro, J. E., Stampfer, M. J., Hu, F. B., Willett, W. C., & Guasch-Ferré, M. (2024). Consumption of Olive Oil and Diet Quality and Risk of Dementia-Related Death. In JAMA Network Open (Vol. 7, Issue 5, p. e2410021). American Medical Association (AMA), DOI – 10.1001/jamanetworkopen.2024.10021, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818362 
  

Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial

 But all this proves is that an extra 40 minutes daily walking rehab gets you better outcome. Not necessarily proving your intervention was the reason. Does anyone in stroke have two functioning neurons to rub together for a spark of intelligence?

Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial

• Satoshi Hirano,
• Eiichi Saitoh,
• Daisuke Imoto,
• Takuma Ii,
• Tetsuya Tsunoda &
• Yohei Otaka 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 76 (2024) Cite this article

• Metrics details

Abstract

Background

Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.

Methods

An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.

Results

A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914–18.995], p = 0.065, HR 4.443 [95%CI 0.973–20.279], p = 0.054, respectively).

Conclusions

The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.

Trial registration

This study was registered with the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCT 042180078) on March 3, 2019.

Background

Gait disorders remain a major health challenge that affects individuals with stroke. More than 12 million individuals suffer from stroke each year [1] and approximately 30% require assistance with walking [2]. Individuals with gait impairments have a decreased quality of life and activities of daily living (ADLs) [3, 4] and a higher risk of secondary impairments due to falls [5]. Therefore, the improvement of gait disorders in individuals with stroke is an important issue, and gait training has been provided in clinical practice [6, 7].

Recently, various types of gait robots have been used to assist individuals with hemiparesis during gait training. Robot-assisted gait training (RAGT) can provide intensive, repetitive, and task-oriented training for individuals with hemiparetic stroke who have difficulty walking independently, by partially or fully supporting their body weight and movements using a robot control mechanism [8]. A systematic review showed that a higher percentage of individuals with hemiparetic stroke within 3 months of stroke onset achieved gait independence by combining RAGT with conventional training [9]. Hence, its use is currently recommended in several treatment guidelines [10].

However, most gait robots for individuals with difficulty walking have been designed to assist both legs [11, 12]. These robots assist the patient in achieving a symmetrical gait, which can be problematic when used in patients with hemiparetic stroke. If the patient has severe motor paralysis and requires compensatory movements to walk, the gait achieved will not be symmetrical. Therefore, training a symmetrical gait may have low task transferability to the target gait. Therefore, we developed a simpler, one-leg assisted gait robot, called Welwalk WW-1000 (Welwalk, Toyota Motor Corporation, Aichi, Japan) [13]. Previous studies on the effectiveness of RAGT using the Welwalk in individuals with subacute hemiparetic stroke have reported higher gait independence than conventional gait training [14, 15]. These were single-center studies with small sample sizes, and a large multicenter randomized controlled trial is needed to validate the effectiveness of RAGT using this device on gait independence. Therefore, we designed a multicenter, prospective, open-blind endpoint randomized controlled trial with blinded assessors. This study aimed to verify the effects of RAGT on gait independence in individuals with subacute hemiparetic stroke.

More at link.