Friday, July 5, 2024

Brain responses to intermittent fasting and the healthy living diet in older adults

 FYI. Your doctor should know about this.

Brain responses to intermittent fasting and the healthy living diet in older adults


Highlights

  • 8 weeks of 5:2 intermittent fasting caused more weight loss than healthy living diet
  • Both diets reduced neuronal insulin resistance and the pace of brain aging
  • Both diets improved memory and executive function, with 5:2 intermittent fasting more so
  • Biomarkers of Alzheimer’s disease did not change with either diet

Summary

Diet may promote brain health in metabolically impaired older individuals. In an 8-week randomized clinical trial involving 40 cognitively intact older adults with insulin resistance, we examined the effects of 5:2 intermittent fasting and the healthy living diet on brain health. Although intermittent fasting induced greater weight loss, the two diets had comparable effects in improving insulin signaling biomarkers in neuron-derived extracellular vesicles, decreasing the brain-age-gap estimate (reflecting the pace of biological aging of the brain) on magnetic resonance imaging, reducing brain glucose on magnetic resonance spectroscopy, and improving blood biomarkers of carbohydrate and lipid metabolism, with minimal changes in cerebrospinal fluid biomarkers for Alzheimer’s disease. Intermittent fasting and healthy living improved executive function and memory, with intermittent fasting benefiting more certain cognitive measures. In exploratory analyses, sex, body mass index, and apolipoprotein E and SLC16A7 genotypes modulated diet effects. The study provides a blueprint for assessing brain effects of dietary interventions and motivates further research on intermittent fasting and continuous diets for brain health optimization. For further information, please see ClinicalTrials.gov registration: NCT02460783.

Graphical abstract

Review finds no proven clinical benefit to strict salt restriction for patients with heart failure

 Ask your doctor about salt intake for hypertension and don't accept research from China on it.

Review finds no proven clinical benefit to strict salt restriction for patients with heart failure

For decades, it's been thought that people with heart failure should drastically reduce their dietary salt intake, but some studies have suggested that salt restriction could be harmful for these patients. A recent review in the European Journal of Clinical Investigation that assessed all relevant studies published between 2000 and 2023 has concluded that there is no proven clinical benefit to this strategy for patients with heart failure.

Most relevant randomized trials were small, and a single large, randomized clinical trial was stopped early due to futility. Although moderate to strict salt restriction was linked with better quality of life and functional status, it did not affect mortality and hospitalization rates among patients with heart failure.

Doctors often resist making changes to age-old tenets that have no true scientific basis; however, when new good evidence surfaces, we should make an effort to embrace it."

Paolo Raggi MD, PhD, author of the University of Alberta

Source:
Journal reference:

Raggi, P., (2024) Salt versus no salt restriction in heart failure a review. European Journal of Clinical Investigationdoi.org/10.1111/eci.14265.

Neuroplasticity and Rehabilitation: Harnessing Brain Plasticity for Stroke Recovery and Functional Improvement

Still nothing on EXACTLY how to get neuroplasticity working. 

Neuroplasticity is often mentioned as to how survivors will recover, that's a useless statement because no one has identified the signals occurring between neurons that tell a neighboring neuron to drop its' current function and take up a neighboring neurons function. Until that is identified neuroplasticity will never be repeatable on demand. 

 Neuroplasticity and Rehabilitation: Harnessing Brain Plasticity for Stroke
Recovery and Functional Improvement

Dr. Shailendra Singh*
Psychiatrist at National Institute of Mental
Health and Neurosciences (NIMHANS),
Chennai
DOI: https://doi.org/10.36676/urr.v11.i3.1287
Accepted: 10/05/2024 Published: 30/06/2024 * Corresponding author

Abstract: 

 
This paper provides a comprehensive review of the current understanding of
neuroplasticity and its application in stroke rehabilitation. Stroke remains a leading cause of
disability worldwide, often resulting in motor, sensory, and cognitive impairments.
Neuroplasticity, the brain's ability to reorganize and adapt in response to experience and
injury, offers promising avenues for recovery. This review discusses key principles of
neuroplasticity and explores various rehabilitation strategies aimed at harnessing its potential
for stroke recovery. Topics covered include early intervention, task-specific training, intensity
and repetition, constraint-induced movement therapy, multimodal approaches, environmental
enrichment, and neurostimulation techniques. Additionally, the paper discusses emerging
research directions and challenges in optimizing neuroplasticity-based rehabilitation
approaches. Understanding the role of neuroplasticity in stroke recovery can inform the
development of more effective rehabilitation interventions and improve outcomes for
individuals affected by stroke.
Keywords: neuroplasticity, stroke rehabilitation, motor recovery, sensory recovery, cognitive
rehabilitation
Introduction
Stroke remains one of the leading causes of disability globally, presenting significant
challenges to individuals, families, and healthcare systems. Every year, millions of people
worldwide experience stroke, resulting in a wide range of physical, cognitive, and emotional
impairments. While advancements in acute stroke care have improved survival rates, the need
for effective rehabilitation strategies to promote recovery and improve functional outcomes is
paramount. Central to the quest for enhanced stroke rehabilitation is the concept of
neuroplasticity. Neuroplasticity refers to the brain's remarkable ability to reorganize its
structure and function in response to experiences, learning, and injury. This phenomenon
underlies the brain's capacity to adapt following stroke, offering hope for recovery even in the
face of significant neurological damage.
Understanding the mechanisms and principles of neuroplasticity is crucial for developing and
optimizing rehabilitation interventions aimed at facilitating stroke recovery. By harnessing the
SHODH SAGAR®
Universal Research Reports
ISSN: 2348-5612 | Vol. 11 No. 3 (2024): Special Issue: Advances in Medical Research | June 2024
51
© 2024 Published by Shodh Sagar. This is a Gold Open Access arƟcle distributed under the terms of the CreaƟve Commons License
[CC BY NC 4.0] and is available on hƩps://urr.shodhsagar.com
brain's inherent plasticity, rehabilitation strategies can promote neural rewiring, functional
reorganization, and ultimately, improved outcomes for individuals affected by stroke.
Neuroplasticity: Foundations and Mechanisms
Neuroplasticity, the brain's remarkable ability to reorganize and adapt in response to
experience, injury, or environmental changes, lies at the heart of stroke rehabilitation.
Understanding the foundational principles and underlying mechanisms of neuroplasticity is
essential for designing effective rehabilitation strategies aimed at promoting recovery
following stroke. Neuroplasticity encompasses a broad spectrum of adaptive changes in the
brain, ranging from synaptic modifications at the cellular level to large-scale reorganization of
neural circuits. It reflects the brain's intrinsic capacity for structural and functional remodelling
throughout life. The mechanisms underlying neuroplasticity involve complex interactions
between neurons, glial cells, neurotransmitters, and molecular signalling pathways. At the
cellular level, synaptic plasticity plays a central role in encoding and consolidating learning
and memory. Long-term potentiation (LTP) and long-term depression (LTD) are two well-
studied forms of synaptic plasticity that contribute to experience-dependent changes in neural
connectivity. On a macroscopic scale, cortical remapping refers to the reorganization of cortical
representations in response to sensory or motor input. Following stroke, cortical areas adjacent
to the lesion may undergo functional reorganization to compensate for lost functions, a
phenomenon known as diaschisis. Additionally, axonal sprouting and dendritic remodelling
can facilitate the formation of new connections and neural pathways, contributing to functional
recovery. In the context of stroke recovery, several forms of neuroplasticity are particularly
relevant, including reactive plasticity, compensatory plasticity, restorative plasticity, and
experience-dependent plasticity. Understanding the interplay between these different forms of
neuroplasticity is critical for tailoring rehabilitation interventions to individual patients' needs
and optimizing outcomes following stroke.

Reteplase Bests Alteplase for Early Reperfusion in Acute Ischaemic Stroke

 Can't tell if this is good enough from what's being reported in this abstract.

Reteplase Bests Alteplase for Early Reperfusion in Acute Ischaemic Stroke

By Gabrielle Mostello

Reteplase is more likely than alteplase to result in an excellent functional outcome in patients with acute ischaemic stroke(Excellent is 100% recovery, did it do that?), according to a study published in The New England Journal of Medicine.

Alteplase is currently the standard agent used in early reperfusion therapy; however, since demand has increased significantly, alternative thrombolytic agents are needed.

For the current study, Shuya Li, MD, Beijing Tiantan Hospital, Beijing, China, and colleagues randomised patients with ischaemic stroke within 4.5 hours after symptom onset 1:1 to receive a bolus of intravenous reteplase 18 mg followed 30 minutes later by a second bolus of 18 mg (n = 707) or intravenous alteplase at 0.9 mg/kg of body weight up to a maximum dose of 90 mg (n = 705).

The researchers found that 79.5% of patients who received reteplase had an excellent functional outcome(Excellent is 100% recovery, did it do that?) compared with 70.4% of those who received alteplase (risk ratio [RR] = 1.13; 95% confidence interval [CI], 1.05-1.21; P < .001 for noninferiority and P = .002 for superiority).

Within 36 hours of disease onset, the incidence of symptomatic intracranial haemorrhage was similar between the 2 groups, occurring in 2.4% of patients in the reteplase group and 2% of those in the alteplase group (RR = 1.21; 95% CI, 0.54-2.75).

At 90 days, the incidence of any intracranial haemorrhage was higher with reteplase than with alteplase (7.7% vs 4.9%; RR = 1.59; 95% CI, 1.00-2.51), as was the incidence of adverse events (91.6% vs 82.4%; RR = 1.11; 95% CI, 1.03-1.20).

The researchers acknowledged several limitations to the study, including its open-label design, enrollment limited to Chinese adults, and under-representation of women. Furthermore, patients aged ≥80 years and patients eligible for thrombectomy were excluded.

“In patients with acute ischaemic stroke who were eligible for intravenous thrombolysis within 4.5 hours after the onset of symptoms, reteplase [is] more likely to result in an excellent functional outcome than alteplase,” the researchers concluded.

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2400314

SOURCE: The New England Journal of Medicine

Movement-dependent stroke recovery: A systematic review and meta-analysis of TMS and fMRI evidence

 This tells me nothing, what about those, like me, with dead motor and pre-motor cortexes? Where are the dead brain rehab protocols I need?

Movement-dependent stroke recovery: A systematic review and meta-analysis of TMS and fMRI evidence

2008, Neuropsychologia
Lorie G. Richards 1,2 , Kim C. Stewart 4 , Michelle L. Woodbury 1,2 , Claudia Senesac 1,3 , and James H. Cauraugh 1,4 1 North Florida/South Georgia Veterans Health System 2 Occupational Therapy 3 Physical Therapy 4 Applied Physiology and Kinesiology, University of Florida  
 

Abstract  

 
Evidence indicates that experience-dependent cortical plasticity underlies post-stroke motor recovery of the impaired upper extremity. Motor skill learning in neurologically intact individuals is thought to involve the primary motor cortex, and the majority of studies in the animal literature have studied changes in the primary sensorimotor cortex with motor rehabilitation. Whether changes in engagement in the sensorimotor cortex occur in humans after stroke currently is an area of much interest. The present study conducted a meta-analysis on stroke studies examining changes in neural representations following therapy specifically targeting the upper extremity to determine if rehabilitation-related motor recovery is associated with neural plasticity in the sensorimotor cortex of the lesioned hemisphere. Twenty-eight studies investigating upper extremity neural representations (e.g., TMS, fMRI, PET, or SPECT) were identified, and 13 met inclusion criteria as upper extremity intervention training studies. Common outcome variables representing changes in the primary motor and sensorimotor cortices were used in calculating standardized effect sizes for each study. The primary fixed effects model meta-analysis revealed a large overall effect size (E.S. = 0.84, S.D. = 0.15, 95% C.I. = 0.76 – 0.93). Moreover, a fail-safe analysis indicated that 42 null effect studies would be necessary to lower the overall effect size to an insignificant level. These results indicate that neural changes in the sensorimotor cortex of the lesioned hemisphere accompany functional paretic upper extremity motor gains achieved with targeted rehabilitation interventions.

Cheyenne Regional Medical Center Celebrates Three-Year CARF Accreditation for Acute Rehab Unit and Stroke Rehab Specialty Program

 So what? Celebrating processes rather than recovery is not what survivors want. Tell us how many of your patients 100% recovered and then we might decide you are a decent hospital. Until then, NOTHING DOING! Anyone who touts 'care' is not worth going to!

Cheyenne Regional Medical Center Celebrates Three-Year CARF Accreditation for Acute Rehab Unit and Stroke Rehab Specialty Program

Cheyenne Regional Medical Center (CRMC) is delighted to announce the three-year accreditation achieved by its Acute Rehab Unit (ARU) and Stroke Rehab Specialty Programs following the recent CARF (Commission on Accreditation of Rehabilitation Facilities) survey. CRMC’s ARU is the only CARF accredited inpatient rehabilitation facility in the State of Wyoming. This recognition underscores the dedication and commitment of CRMC to delivering exceptional care(NOT RECOVERY!) and services to the local community.
 
This milestone signifies the first time CRMC autonomously managed the survey, highlighting the proficiency and dedication to upholding the highest standards of quality care(NOT RECOVERY!). This success would not have been possible without the invaluable contributions of all staff who generously offered their time, effort and support throughout the survey period.
 
ARU Program Director, Rebecca Carey shared, “The ARU leadership and staff have worked diligently to maintain the highest standards of care that CARF requires in order to achieve this level of certification. We remain committed to providing continued quality care(NOT RECOVERY!) for our patients to enable their successful achievement in meeting their rehab goals.”(Well, your leadership is a piece of shit if you're celebrating this!)

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? I need an explanation of your thought processes on 'care'(NOT RECOVERY!)

 
 
CRMC eagerly anticipates the continued opportunities to provide top-tier care(NOT RECOVERY!) and achieve optimal outcomes, bolstering its reputation as a trusted provider of rehabilitation services. As we celebrate this achievement, we look forward to further successes and advancements in our ongoing mission to excel in patient care(NOT RECOVERY!).

How Healthy Is Watermelon?

 Didn't your competent? doctor start prescribing watermelon juice a long time ago? NO? So you don't have a functioning stroke doctor, do you? You'll want the benefits of lycopene and nitric oxide even if your doctor KNOWS NOTHING! Over a decade for your competent? doctor to have protocols on these. But I bet you don't have a functioning stroke doctor, do you?

 

Watermelon juice reverses hardening of the arteries  Nov. 2011 

The latest here:

Application of Novel Wearable Self-Balancing Exoskeleton Robot Capable for Complete Self-Support in Post-stroke Rehabilitation: A Case Study

 Well, useless, you don't tell us what this wearable self-balancing exoskeleton robot is so we can direct our doctors to get it. How fucking stupid are you?

Application of Novel Wearable Self-Balancing Exoskeleton Robot Capable for Complete Self-Support in Post-stroke Rehabilitation: A Case Study

Yanzheng ZhangZhanhe LiYuanyuan ZhangYefan CaoLei LiHewei Wang

Published: July 04, 2024

DOI: 10.7759/cureus.63831 

  Peer-Reviewed

Cite this article as: Zhang Y, Li Z, Zhang Y, et al. (July 04, 2024) Application of Novel Wearable Self-Balancing Exoskeleton Robot Capable for Complete Self-Support in Post-stroke Rehabilitation: A Case Study. Cureus 16(7): e63831. doi:10.7759/cureus.63831

Abstract

Early weight-bearing and trunk control training are essential components for promoting lower limb motor recovery in individuals with stroke. In this case study, we presented the successful implementation of a three-week wearable self-balancing exoskeleton robot training program for a 57-year-old male patient who had suffered from a stroke. After carefully reviewing the patient's previous medical records, conducting a thorough assessment, and excluding other potential contraindications, we introduced wearable self-balancing exoskeleton robot training to complement conventional rehabilitation in managing balance and lower limb function. The training program included early initiation of weight bearing and trunk control training following an ischemic stroke, aimed at promoting motor recovery and improving functional independence. The findings indicated that training with a wearable self-balancing exoskeleton robot enhanced the balance and motor function of the hemiplegic patient, with commendable adherence. Furthermore, the participants consistently reported increased satisfaction and confidence during the training sessions. This case report not only provided preliminary evidence of the effectiveness of the wearable self-balancing exoskeleton robot in promoting functional recovery following a stroke but also outlined a comprehensive training program that may hold value for future clinical application.

Introduction

Walking problems occur in up to 80% of persons post-stroke, and it is reported that 70% of individuals with stroke are at risk for falling [1]. Enhancing the quality of life and promoting psychological well-being for stroke survivors relies on achieving safe, independent, effective, and efficient real-world mobility. This not only improves functional independence but also fosters self-reliance [2].

The 2016 American Heart Association/American Stroke Association Guideline recommends robot-assisted movement training to improve motor function after stroke as class IIb-level A evidence [3], and it is also endorsed as level A evidence by the 2019 Canadian Stroke Best Practice Recommendations [4]. One meta-analysis shows that patients with severe lower limb impairment post-stroke demonstrate better outcomes in terms of walking movements and daily activities when they receive robot-assisted rehabilitation [5]. With the assistance of a robot, many recommended training, such as early initiation of weight-bearing, integration of trunk and limb activities, controllable balance training, and attainment of a symmetrical gait pattern, can be feasibly implemented with high dosage and prolonged duration [6]. The use of robot training conserves significant therapist resources and reduces the time for participants to commence recovery, potentially enabling individuals with latent capabilities to achieve their maximum potential for rehabilitation.

The self-balancing exoskeleton robot is an innovative technology that enables participants’ weight-bearing training even in the stage of paralysis. It can also elicit protective reactions to maintain balance when shifting the center of gravity, thereby promoting the restoration of trunk balance control function. Furthermore, with this technology, therapists can now focus on therapeutic intervention while minimizing falling risks. A user satisfaction study recruited a group of seven individuals with physical disabilities and found that the self-balancing exoskeleton robot demonstrated superior ease of transfer compared to other robotic devices [7], thus offering significant rehabilitation opportunities for persons with severely impaired locomotor function. 

Currently, while the effectiveness of robots in lower limb stroke rehabilitation has been recognized; however, the actual application modalities in clinical practice vary, and there is a lack of training programs with sufficient details. Therefore, this case study aims to demonstrate the utilization of wearable self-balancing exoskeleton robots in the balance and lower limb function rehabilitation of stroke patients, with a specific focus on its clinical application methods and clinical efficacy. This case report adheres to the CAse REport (CARE) guidelines.

Case Presentation

Patient information

A 57-year-old male was admitted to the rehabilitation hospital due to left-sided weakness, balance disorder, and slurred speech one month ago on September 26, 2023. After being diagnosed with an ischemic stroke (infarction in the right centrum semiovale and genu of corpus callosum, as well as bilateral subcortical lacunar infarctions), he received drug treatment in the hospital, including clopidogrel bisulfate tablets, atorvastatin calcium tablets, and other medications to improve and circulation and restore cerebral perfusion. Although his condition stabilized after the acute phase of stroke treatment, the movement disorder still significantly impacted his daily life. The patient was capable of sitting independently but required assistance for standing, walking, and performing basic self-care tasks, which caused significant distress. The patient had a 20-year history of diabetes but achieved acceptable blood glucose control with subcutaneous insulin and oral metformin. He does not have any significant family medical history or orthopedic conditions, joint diseases, or other complications. Moreover, the patient demonstrated clear consciousness without any cognitive impairment and exhibited the ability to comprehend and successfully execute medical staff instructions. He received conventional physical therapy, speech therapy, and occupational therapy subsequently. The patient was informed by the rehabilitation therapist about the availability of a wearable self-balancing exoskeleton robot that could provide a stable standing support platform to promote the recovery of balance and lower limb function. Recognizing the potential benefits, the patient proactively chose this treatment method on October 27, 2023, driven by a strong desire for prompt recovery (Figure 1). 

Clinical findings

The Brunnstrom recovery stage assessment showed that the patient's left upper limb, hand, and lower limb were classified as stage III, stage III, and stage II, respectively. The hemiplegic limbs did not show spasticity, and the Modified Ashworth Scale (MAS) score was 0. The simplified three-level balance assessment method revealed that the patient exhibited a level 2 sitting balance (capable of sustaining dynamic balance for over three seconds, accompanied by upper limb movement) and a level 0 standing balance (incapable of maintaining static self-balance for more than three seconds). In daily life, the patient heavily relied on wheelchairs for his activities. The patient reported no pain during daily activities and rehabilitation treatment. The patient exhibited hyporeflexia and positive pathological reflexes or hyper-reflexia in the affected lower limb (Table 1). The patients had normal body size, with 168 cm height and 66 kg weight. The assessment results of the active and passive range of motion in the upper and lower limbs were presented in Table 2, indicating that the patient fulfilled the fundamental criteria for undergoing robotic training.

More at link, maybe you can guess from the pictures there.

Thursday, July 4, 2024

Embedding Patient and Health Care Professional Voices in Clinical Trials

 Get me involved in stroke research and I would probably reject almost all stroke research for not actually solving stroke recovery.  Because we have NO leadership and NO strategy to solve stroke!

Embedding Patient and Health Care Professional Voices in Clinical Trials

JAMA. Published online July 1, 2024. doi:10.1001/jama.2024.6314

There is growing evidence that a substantial proportion of trials do not generate informative results due to suboptimal design or underrecruitment.1 For every funded study that is uninformative due to poor design, the opportunity is lost to fund an alternative study. This leads to fiscal waste but, more importantly, it represents an ethical issue: every uninformative study has put undue burden on patients who willingly contributed for zero benefits, leading to a negative benefit-risk ratio.


Mediation Analysis of Acute Carotid Stenting in Tandem Lesions

I would never do carotid stenting, way too many possible complications.

Stents were never the permanent solution, they do nothing to address the inflammation in your arteries that creates plaque. And why would you want to put inflexible stents in flexible arteries?  I still don't understand why you would medically need to stent a carotid artery at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.

Here is why your doctor needs to guarantee NO complications from stenting!

 

 

Restenosis is a gradual re-narrowing of the stented segment that occurs mostly between 3 to 12 months after stent placement

So by not solving the inflammation problem you get this! Stents don't solve the underlying problem, why the fuck is your doctor prescribing them? Money?

Mediation Analysis of Acute Carotid Stenting in Tandem Lesions


  • Abstract

    Background and Objectives

    Current evidence suggests that acute carotid artery stenting (CAS) for cervical lesions is associated with better functional outcomes in patients with acute stroke with tandem lesions (TLs) treated with endovascular therapy (EVT). However, the underlying causal pathophysiologic mechanism of this relationship compared with a non-CAS strategy remains unclear. We aimed to determine whether, and to what degree, reperfusion mediates the relationship between acute CAS and functional outcome in patients with TLs.

    Methods

    This subanalysis stems from a multicenter retrospective cohort study across 16 stroke centers from January 2015 to December 2020. Patients with anterior circulation TLs who underwent EVT were included. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction scale ≥2B by the local team at each participating center. Mediation analysis was conducted to examine the potential causal pathway in which the relationship between acute CAS and functional outcome (90-day modified Rankin Scale) is mediated by successful reperfusion.

    Results

    A total of 570 patients were included, with a median age (interquartile range) of 68 (59–76), among whom 180 (31.6%) were female. Among these patients, 354 (62.1%) underwent acute CAS and 244 (47.4%) had a favorable functional outcome. The remaining 216 (37.9%) patients were in the non-CAS group. The CAS group had significantly higher rates of successful reperfusion (91.2% vs 85.1%; p = 0.025) and favorable functional outcomes (52% vs 29%; p = 0.003) compared with the non-CAS group. Successful reperfusion was a strong predictor of functional outcome (adjusted common odds ratio [acOR] 4.88; 95% CI 2.91–8.17; p < 0.001). Successful reperfusion partially mediated the relationship between acute CAS and functional outcome, as acute CAS remained significantly associated with functional outcome after adjustment for successful reperfusion (acOR 1.89; 95% CI 1.27–2.83; p = 0.002). Successful reperfusion explained 25% (95% CI 3%–67%) of the relationship between acute CAS and functional outcome.

    Discussion

    In patients with TL undergoing EVT, successful reperfusion predicted favorable functional outcomes when CAS was performed compared with non-CAS. A considerable proportion (25%) of the treatment effect of acute CAS on functional outcome was found to be mediated by improvement of successful reperfusion rates.

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    Absolute failure of getting yougurt cup into left hand

     My doctor and therapists completely failed at doing ANYTHING AT ALL to cure my spasticity of my left hand. 

    As you can see the resting state of the fingers are curled. The yogurt cup is already deformed, luckily it didn't sploosh all over. It is totally impossible to get the fingers open with the right hand AND at the same time insert the yogurt cup! So I can never get the cup cleaned with my spoon. What a waste!



    Rapeseed diacylglycerol oil may combat obesity by enhancing lipid metabolism

     Hopefully your competent? doctor instructs the dietician to incorporate Diacylglycerol (DAG) in your hospital diet and then create EXACT DIET PROTOCOLS using it. Do you have a competent doctor or not?

    Rapeseed diacylglycerol oil may combat obesity by enhancing lipid metabolism

    Rapeseed oil is a widely used vegetable oil; however, excess consumption of this oil may contribute to obesity. A recent study published in the journal Nutrients examines how rapeseed diacylglycerol oil (RDG) used as a functional fat may impact fat accumulation and metabolism in a mouse model.

    Study: The lipid-metabolism-associated anti-obesity properties of rapeseed diacylglycerol oil. Image Credit: LN team / Shutterstock.com

    Obesity

    Obesity refers to excessive adiposity due to abnormal fat accumulation and arises following the chronic and excessive intake of energy relative to energy expenditure. Obesity is associated with various health conditions, including type 2 diabetes, hypertension, cardiovascular disease, and several types of cancer.   

    With the prevalence of obesity continuing to rise, researchers estimate that about four billion people may be obese by 2035. Thus, obesity prevention is an important research area for public health.

    There are three different types of adipose tissue: white adipose tissue (WAT), brown adipose tissue (BAT), and beige adipose tissue. WAT is a crucial source of triacylglycerol (TAG), the end-product of fat digestion following excessive energy intake.

    BAT and beige adipose tissue are metabolically active and allow energy to escape as heat. This heat production arises due to non-oxidative uncoupling, which subsequently leads to higher glucose uptake by fat cells and increased lipid metabolism. Thus, activating these forms of adipose tissue could be important for alleviating the metabolic imbalance of obesity.

    Decreasing the amount of WAT and increasing the amount of BAT is crucial to accelerating lipid metabolism and preventing obesity.”

    Oils in the human diet

    Oils are important sources of essential fatty acids, vitamins, and other fat-soluble nutrients. However, excessive oil intake in food increases the risk of obesity.

    Diacylglycerol (DAG) is found in small proportions in natural oils. It has been proposed as a healthy replacement for TAG-rich oil because DAG does not convert to TAG or TAG chylomicrons, which are associated with obesity.

    TAG is converted into chylomicrons in the small intestine, these being stored in fatty tissue. Comparatively, DAG supplies energy and regulates fat metabolism, thereby improving insulin sensitivity, regulating blood lipid levels, and reducing visceral fat.

    DAG may also reduce abnormal blood clots and certain cardiovascular disease risk factors such as high glucose and lipid levels. Additionally, DAG enhances fat digestion by promoting fatty acid release into the intestines.

    Rapeseed oil is the major vegetable oil in China and consists of unsaturated fatty acids. RDG is thus poised to replace conventional vegetable oils, including rapeseed oil, in oil-rich modern foods. This motivated the current study that compared the effectiveness of RDG with rapeseed triacylglycerol oil (RTG) on obesity-related parameters and clinical syndromes in obese mice

    About the study

    The current study compares serum glucose levels in obese mice in a high-fat dietary trial. In the RDGM group, mice were fed a high-fat diet (HFD) for eight weeks followed by 12 weeks of RDG, with 45% of the total energy from RDG oil.

    Graphical Abstract

    Graphical Abstract

    For the RTGM group, which included mice fed an HFD for eight weeks followed by 12 weeks of RTG, the RTG oil. A control group provided a control diet for 20 weeks, a 20-week high-fat dietary group (HFD), and an RDG group given an RDG diet for 20 weeks were also included in the analysis.

    All groups except controls obtained 45% of their energy from oil. At eight weeks, all groups exhibited a mean increase of 20% in body weight as compared to controls, thus indicating obesity had been achieved.

    RDG benefits in obese mice

    RDGM-obese mice had lower fasting blood glucose levels than the RTGM group. Blood ketone levels also declined, indicating a reduced metabolic burden. Serum triglyceride levels in the RDGM group were also 26% lower than those in the RTGM group.

    The RDGM group exhibited significantly slower weight gain than the RTGM group. RDGM and RDG mice also exhibited reduced WAT index and became thinner than RTGM mice.

    Liver size in RDG mice resembled that of controls, whereas RTGM mice had the largest livers, followed by RDGM mice. The liver structure exhibited beneficial changes following RDGM intervention as compared to RTGM, thus indicating improved lipid metabolism in both the intestines and the liver. Triglyceride levels were reduced in RDGM mice as compared to the RTGM group; however, high-density lipoprotein (HDL) and total cholesterol levels were similar.

    Transcriptional effects were also observed in the RDGM group. Reduced expression of peroxisome proliferator-activated receptor γ (PPAR-γ) and diglyceride acyltransferase (DGAT) genes, both of which are related to fat accumulation, was observed in the intestines and liver. More specifically, PPAR-γ expression in the liver and intestines was reduced by 22% and 7%, respectively, compared to nearly 40% and 47% for DGAT, respectively.

    Fat breakdown in BAT was unchanged, with little alteration in lipolytic gene expression. This observation suggests RDG-associated alterations in the expression of adipogenic genes in fatty tissue, liver, and intestine, which leads to reduced white fat deposits with smaller fat cell size.

    RDG consumption was associated with greater gut microbial diversity. The changes in various species could enhance lipid metabolism, thereby producing beneficial effects.

    Conclusions

    The RDGM dietary intervention in obese mice was associated with beneficial effects, including improved body type, reduced obesity-related indices, a more diverse gut microbiome, restricted adipogenesis, and improved lipid metabolism in multiple key tissues.

    Given that RDG has the potential to decrease liver damage and regulate cholesterol metabolism, this relationship suggests that RDG intake can regulate lipid metabolism.”

    Journal reference:
    • Mao, Y., Zheng, D., He, L., et al. (2024). The lipid-metabolism-associated anti-obesity properties of rapeseed diacylglycerol oil. Nutrients. doi:10.3390/nu16132003, https://www.mdpi.com/2072-6643/16/13/2003

    Midlife Cognition Tied to Inflammation Years Earlier

     Well, what is your doctor doing to counteract this midlife cognition problem? NOTHING LIKE USUAL? I expect doctors to have EXACT answers to these questions if they are competent at all!

    Midlife Cognition Tied to Inflammation Years Earlier

    Consistently high CRP levels over 18 years raised the risk of poor cognitive function

     A computer rendering of electrical activity between neurons.

    Key Takeaways

    • Chronic inflammation in early adulthood was associated with midlife cognitive outcomes.
    • Links emerged between inflammation trajectories and subsequent processing speed and executive function scores.
    • There was no association between inflammation trajectories and memory, fluency, or global cognition impairment.

    Inflammation in young adulthood was associated with midlife cognitive outcomes, data from the CARDIA study showed.

    Compared with lower stable levels of C-reactive protein (CRP), consistently higher CRP levels over 18 years led to higher odds of poor processing speed scores in midlife (adjusted OR 1.67, 95% CI 1.23-2.26), as did moderately/increasing CRP levels (adjusted OR 2.04, 95% CI 1.40-2.96), reported Amber Bahorik, PhD, of the University of California San Francisco (UCSF), and co-authors.

    Consistently higher CRP was also linked with poor executive function scores in midlife (adjusted OR 1.36, 95% CI 1.00-1.88), the researchers reported in Neurology.

    Higher levels of inflammation are associated with obesity, physical inactivity, chronic illness, stress, and smoking. Inflammation levels tend to vary over the life course, and this variation over time may help predict cognitive aging, the researchers suggested.

    "There is likely a direct and indirect effect of inflammation on cognition," co-author Kristine Yaffe, MD, also of UCSF, said in a statement. "Fortunately, there are ways to reduce inflammation -- such as by increasing physical activity and quitting smoking -- that might be promising paths for prevention."

    Late-life inflammation has been tied to dementia risk and cognitive decline, Yaffe noted. In a recent U.K. Biobank analysis, high levels of CRP emerged as one of several risk factors for young-onset dementia.

    The CARDIA research "underscores the importance of considering earlier time points when exploring the determinants of cognitive decline and the relevance of monitoring inflammation in this context," noted Eleanor Conole, PhD, of the University of Oxford in England, in an accompanying editoria.

    "Approaches that consider multiple immune markers in deeply phenotyped populations are strongly encouraged, and advances in our ability to measure immune function at low cost and at scale may aid in clarifying these relationships," she added.

    But whether CRP is the best marker to assess baseline inflammation in a population study like this isn't clear, Conole pointed out. "CRP is an acute phase protein produced in the liver and, true to its name, is acute, phasic, and reactive," she wrote.

    Clinically, changes in CRP levels are indicators of deterioration or recovery; rising levels can signal a flare-up and decreasing levels can indicate effective treatment. "However, this phasic nature of CRP poses problems for capturing baseline inflammation in population studies, a limitation acknowledged by the authors," Conole observed.

    Bahorik and colleagues followed 2,364 adults in the ongoing CARDIA study, a longitudinal cohort study that started in 1985 to evaluate determinants of cardiovascular disease and their risk factors. About half the participants were female; a little under half were Black, and the rest were white. Participants with elevated levels of inflammation (CRP of 10 mg/L or more) were excluded from the study.

    CRP was measured at four time points over 18 years when people were from ages 24 to 58 years. Inflammation trajectories that reflected overall patterns showed that 39% of participants had consistently higher CRP, 16% had moderate/increasing CRP, and 45% had lower stable CRP.

    Five years after the last CRP measurement, the researchers administered a battery of six cognitive tests to assess verbal memory, processing speed, executive function, verbal and category fluency, and global cognition. Participants were ages 47 to 63 when they were tested. Poor cognitive performance was defined as a decline of one or more standard deviations less than the mean on each domain.

    Patterns of consistently higher and moderate/increasing inflammation were associated with slower processing speed and worse executive function after controlling for demographics, lifestyle risk factors, and APOE4. "Participants with a pattern of consistently higher inflammation were most likely to have higher odds of poor cognitive function," Bahorik and colleagues noted. "There was no association of inflammation trajectory and impairment in memory, fluency, or global cognition."

    Limitations of the research included possible selection bias due to loss of follow-up and the study's reliance on CRP as the only inflammatory marker, they acknowledged.

    • Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

    Disclosures

    The CARDIA study is supported by the NIH.

    Yaffe reported relationships with Eli Lilly, Alpha Cognition, Alector, the Dominantly Inherited Alzheimer Network Trials Unit, the Beeson Scientific Advisory Board, and the Global Council on Brain Health. Bahorik and other authors reported no disclosures.

    Conole reported no relevant disclosures.

    Primary Source

    Neurology

    Source Reference: Bahorik AL, et al "Association of changes in C-reactive protein level trajectories through early adulthood with cognitive function at midlife: the CARDIA study" Neurology 2024; DOI: 10.1212/WNL.0000000000209526.

    Secondary Source

    Neurology

    Source Reference: Conole ELS "Chronic inflammation and brain health: the case for early monitoring" Neurology 2024; DOI: 10.1212/WNL.0000000000209613.

    Wednesday, July 3, 2024

    Researchers call for enhanced research into common post-stroke condition

     Name the leader you are tasking with getting this done! EXACT NAMES ONLY! Since there is NO leadership in stroke, nothing will get done.

    Researchers call for enhanced research into common post-stroke condition

    Lateropulsion, a clinical condition that results in the body leaning to one side, affects about half of all stroke survivors.

    Edith Cowan University (ECU) Ph.D. graduate Dr. Jessica Nolan said while the problem is common, lateropulsion is still severely under recognized and under assessed around the world.

     

    "A person with lateropulsion uses the limbs on their stronger side, to push themselves over toward their weaker side. Often those with lateropulsion resist correction back towards their stronger side or the mid-line, and this can cause problems with sitting, standing, walking and looking after themselves. It is also associated with a higher risk of falling, reduced recovery and a reduced likelihood of discharge after in-patient rehabilitation," Dr. Nolan said.

    "The treatment of lateropulsion in stroke survivors is a critical aspect of rehabilitation; however, the issue requires better understanding and more research."

    It is estimated that in 2020, there were some 39,500 stroke events in Australia, averaging more than 100 a day. In that same year, it was estimated that more than 445,087 Australians were living with the side effects of stroke. Stroke is one of Australia's biggest killers, with the event killing more women than breast cancer and more men than prostate cancer.

    Despite the prevalence of lateropulsion following a stroke event, a lack of agreement on terminology and the defining features of the condition present obstacles to understanding its prevalence, accurately comparing research results, and agreeing on a consistent approach to rehabilitation.

    "People affected after a stroke may be at a disadvantage, because of the inconsistent approaches to rehabilitation and the failure of health policy to accommodate their rehabilitation needs," Dr. Nolan said.

    "Improved understanding of the condition could lead to improved management, which will enhance patient outcomes after stroke and increase efficiency of health care resource use."

    Dr. Nolan has previously led a Delphi consensus process, partnering with 21 international experts to reach a consensus on the terminology used to describe the condition and on the rehabilitation requirements for people living with severe lateropulsion, as well as recommendations for rehabilitation.

    While a consensus regarding terminology was not reached, the panel achieved some agreement that lateropulsion was the preferred term to describe the phenomenon. More than 100 consensus-based recommendations were also provided to guide rehabilitation of lateropulsion.

    In her latest research, Dr. Nolan found that lateropulsion could continue to resolve up to one-year post-stroke, far beyond the period of in-patient rehabilitation. Average in-patient length of stay following a stroke varies, but for those patients presenting with lateropulsion, in-patient stay was about three to four weeks longer compared to those without. The research is published in the journal Topics in Stroke Rehabilitation.

    "This study was the first to investigate functional recovery up to 12 months post-stroke, and to compare outcomes among people with and without lateropulsion. This study supports findings from previous work that lateropulsion severity was a predictor of long-term functional outcomes."

    "Lateropulsion after stroke can resolve, but it is dependent on access to ongoing rehabilitation.

    "People who do not have access to long-term rehabilitation following a stroke did not show the same extent of lateropulsion resolution or functional recovery."

    More information: Jessica Nolan et al, Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study, Topics in Stroke Rehabilitation (2024). DOI: 10.1080/10749357.2024.2333186

    Provided by Edith Cowan University

     

     

     


    our @WorldStrokeEd podcast series – where knowledge meets action in the fight against stroke:

     You can check them out. Since it's from the World Stroke Organization don't expect anything useful, they've proven not to have anything for survivors.

     our@WorldStrokeEd  podcast series – where knowledge meets action in the fight against stroke:

    Highlights of the 2024 European Stroke Organization Conference

     Look at that! NOTHING ON GETTING SURVIVORS RECOVERED! You would think with stroke in the name, it would be about helping stroke survivors! 22 minute podcast, I'm not listening.

    Highlights of the 2024 European Stroke Organization Conference

    Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about recent trials presented at the European Stroke Organization Conference.

    Show references: 

    Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy 

    Rationale and Design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III)

    Colchicine for Prevention of Vascular Inflammation in Non-CardioEmbolic Stroke (CONVINCE)

    Intensive Ambulance-Delivered Blood- Pressure Reduction in Hyperacute Stroke

    This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

    Disclosures can be found at Neurology.org.

    Andrew M. Southerland, MD, MSc, FAHA, FAAN

    Editorial Board, Neurology® Education

    Andrew M. Southerland is a Harrison Distinguished Teaching Professor of Neurology and Public Health Sciences at the University of Virginia. He received his M.D. as a Brody Scholar from the Brody School of Medicine at East Carolina University, and completed his Neurology Residency and Vascular Neurology Fellowship at the University of Virginia. He currently serves as Residency Program Director and Executive Vice Chair in the UVA Department of Neurology. Dr. Southerland also serves on the AAN Education Committee and the Editorial Board for Neurology: Education.

    Seemant Chaturvedi, MD, FAAN, FAHA

    Editorial Board, Neurology®