Infarct recurrence in intracranial atherosclerosis: Results from the MyRIAD study

 You better hope by the time you have your stroke that a way is found to prevent this problem because I see nothing to suggest that they are working on prevention. Problems like this should be delivered to that great stroke association  to get it added to the stroke strategy and then create research to solve the problem. But no, we have fucking failures of stroke associations doing nothing for survivors. 

Infarct recurrence in intracranial atherosclerosis: Results from the MyRIAD study

• Jose G. Romano, MD
• Shyam Prabhakaran, MD, MS
• Azhar Nizam, MS
• 
  
• Marc I. Chimowitz, MD
• David S. Liebeskind, MD
• on behalf ofMyRIAD Investigators
  ¹1
• Show all authors
• Show footnotes

Published:December 01, 2020DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105504

Abstract

Background

Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke with a high risk of clinical stroke recurrence. Multiple mechanisms may underlie cerebral ischemia in this condition. The study's objective is to discern the mechanisms of recurrent ischemia in ICAD through imaging biomarkers of impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, and artery-to-artery embolism.

Methods

This prospective multicenter observational study enrolled patients with recent (≤21 days) ischemic stroke or transient ischemic attack (TIA) caused by ICAD with 50-99% stenosis treated medically. We obtained baseline quantitative MRA (QMRA), perfusion MRI (PWI), transcranial Doppler vasoreactivity (VMR), and emboli detection studies (EDS). The primary outcome was ischemic stroke in the territory of the stenotic artery within 1 year of follow-up; secondary outcomes were TIA at 1 year and new infarcts in the territory on MRI at 6-8 weeks.

Results

Amongst 102 of 105 participants with clinical follow-up (mean 253±131 days), the primary outcome occurred in 8.8% (12.7/100 patient-years), while 5.9% (8.5/100 patient-years) had a TIA. A new infarct in the territory of the symptomatic artery was noted in 24.7% at 6-8 weeks. A low flow state on QMRA was noted in 25.5%, poor distal perfusion on PWI in 43.5%, impaired vasoreactivity on VMR in 67.5%, and microemboli on EDS in 39.0%. No significant association was identified between these imaging biomarkers and primary or secondary outcomes.

Conclusions

Despite intensive medical management in ICAD, there is a high risk of clinical cerebrovascular events at 1 year and an even higher risk of new imaging-evident infarcts in the subacute period after index stroke. Hemodynamic and plaque instability biomarkers did not identify a higher risk group. Further work is needed to identify mechanisms of ischemic stroke and infarct recurrence and their consequence on long-term physical and cognitive outcomes.

Trial Registration

ClinicalTrials.gov: NCT02121028.

 

The Role of Antioxidant Treatment in Acute Ischemic Stroke: Past, Present and Future

Maybe our stroke leaders can use this to figure out next steps in the strategy to solve stroke. Or much more likely they will do absolutely nothing. Only 7 pages. 

The Role of Antioxidant Treatment in Acute Ischemic Stroke: Past, Present and Future

We’re looking for a Director of Stroke Support to provide strategic direction to our work in England.

YOU have to get involved in this. Otherwise the strategy created and followed will not include 100% recovery. Conquering stroke is nothing less than 100% recovery. Hold their feet to the fire to accomplish that goal. Otherwise they will allow the tyranny of low expectations creep in. Ideally this should be a stroke survivor, I don't trust currently abled people to have the drive and passion to complete that 100% goal, they haven't in the past.

We’re looking for a Director of Stroke Support to provide strategic direction to our work in England. 

Region: 

Nationwide

Salary: 

Competitive

Closing date: 

Sunday, 24 February, 2019

Job type: 

Full time

Ref:S495 | National (Office or home-based) | 35 hours per week

We’re looking for an exceptional individual to provide strategic direction to our work in England. You’ll develop partnerships to ensure all affected by stroke get the help they need to live the best life they can. Leading and inspiring your team of staff and volunteers, you’ll ensure we deliver excellence in all we do. And you’ll be passionate about ensuring all affected by stroke have a strong and influential voice.
Reporting to the UK Executive Director of Stroke Support, you’ll be joining the UK senior leadership team at a really exciting time as we take forward our new strategy. With proven influencing and negotiation skills, you will actively develop positive, credible relationships with all stakeholders to grow our work. You’ll be innovative in contributing to support and policy development and skilled in driving change.
Significant senior management or executive level experience in the third, social or health sectors is required, to help us make stroke the priority it needs to be and grow access to our support offerings.
It is optional for this role to be homebased, please see our homeworking agreement for full details.
This is an exciting time to join the Stroke Association. Join us and together we can conquer stroke.

Applying

We want to make the process of applying for this role as straightforward as possible. To this end, we ask that your application consist of the following three documents:

• A supporting statement, no more than two pages in length, which addresses and provides evidence against the criteria set out in the Person Specification in the Role Profile section below. The covering letter provides you with the opportunity to explain your motivation for applying, as well as highlighting how your experience and achievements fit with the requirements of the role. As such, it is an important part of the application process.
• A comprehensive CV.
• Your completed Equal Opportunities Form - The information you provide in this form will not be shown to the Selection Panel and will play no part in the assessment of your application. The Stroke Association is an equal opportunities employer, to fulfil our responsibilities please email it to equalops@stroke.org.uk which is managed by our HR team.

For more information on how we use the information you have provided and the legal basis upon which we rely to process the personal information you have provided in this form, please see our job applicant privacy notice which can be viewed by clicking here
Email the completed supporting statement and CV to recruitment@stroke.org.uk by the closing date 24 February 2019. 1 stage interview to be held on 6 March 2019, London. 2 stage interview to be confirmed.
If you have any queries please email the HR team at recruitment@stroke.org.uk
If you’re still unsure about applying for a role with us or just want to get an idea of the benefits of doing so please visit the benefits page or see what we do.

Role profile

Download the role profile for the Director of Stroke Support England role.

About Us

We are the UK’s leading charity dedicated to conquering stroke.
There are over 1.2 million stroke survivors in the UK. Almost two thirds have a disability and one third rely on others for help, making stroke one of the biggest causes of disability.
We are continually working to improve the lives of stroke survivors and their families who deserve the very best treatment and care. We deliver amazing, life-changing support to over 60,000 stroke survivors and their families each year. We also fund research to find better treatments, campaign for better stroke care and help people understand how to spot and prevent stroke. This work is made possible by more than 4,000 talented volunteers and staff, our fantastic supporters and our strong relationships with the stroke clinical and research community.
We work with integrity, demonstrating our values as one combined passionate, innovative, respectful and professional team.
Together we can conquer stroke.

UK Stroke Association Project Grants

YOU have to infiltrate this to make sure that there is a stroke strategy being followed that will solve all the problems in stroke.   

Then that ALL research results in stroke rehab protocols.

And only research that can be mapped to the stroke strategy is funded. 

I see nothing here that suggests a strategy is being followed. Survivors need to be in charge, this is way too fucking important to leave to non-survivors. They have NO understanding of what needs to be done.  

UK Stroke Association Project Grants

Will doctors be replaced by algorithms?

Well, in stroke rehabs case, NO, since there are no rehab protocols to load up into a computer or even an objective diagnosis of the damage that needs to be solved. All because of the laziness of the stroke medical world relying on this fucking stupid statement, 'All strokes are different, all stroke recoveries are different'. If you believe that you haven't thought about stroke recovery at all.  The real replacement will be in stroke researchers because the algorithm will specify exactly what needs to be solved next in the stroke strategy. I can't wait for that day to get here.

Will doctors be replaced by algorithms?

In-hospital mortality due to acute stroke continues to decline

What specifically is being done to continue this? Or was this just blind dumb luck? Any hope of stopping the 5 causes of the neuronal cascade of death in the first week? Was there a strategy behind this? 

In-hospital mortality due to acute stroke continues to decline

The rate of mortality among patients hospitalized with acute stroke continues to decrease nationwide, according to a study presented at the American Academy of Neurology annual meeting.

“Previously, a downward trend in stroke-related in-hospital mortality was noted from 1996 to 2006, reflecting advancements in acute stroke care,” , professor and chair of the Texas Tech University Health Sciences Center El Paso’s department of neurology, and colleagues wrote.

Cruz-Flores and colleagues sought to determine nationwide trends in in-hospital mortality due to acute stroke between 2007 and 2014 using a nationally representative sample of all hospital discharges in the United States.

The researchers found that during the study period, there was an in increase in overall stroke hospitalizations from 1,017,414 in 2007-2008 to 1,114,960 in 2013-2014. In-hospital deaths related to stroke decreased from 8.98% in 2007-2008 to 7.34% in 2013-2014.

The odds of mortality declined among all stroke types assessed, including ischemic stroke (OR = 0.798; 95% CI, 0.762-0.835), subarachnoid hemorrhage (OR = 0.885; 95% CI, 0.810-0.968) and intracerebral hemorrhage (OR = 0.865, 95% CI, 0.824-0.908), and remained significant after adjustments for age, gender, race, medical comorbidities, in-hospital complications, insurance status and APR-DRG Severity scale.

“The decreasing mortality in patients hospitalized for stroke suggests an improved in-hospital care of stroke patients, which may be a reflection of better and standardized care across all hospitals, from better management of medical problems, such as hypertension and diabetes, to prevention of complications, to better multidisciplinary care during the hospital stay, to the higher utilization of specific treatments for stroke, such as tissue plasminogen activator or mechanical thrombectomy,” Cruz-Flores told Healio Internal Medicine.

“If indeed, the decreasing mortality is a reflection of better care, it behooves the medical community to adopt the protocols of care and guidelines for stroke care to continue to make an impact in outcome,” he added.

“Since the study is based on an administrative database, it lacks specificity as to specific conditions that are not reported in the dataset and that may impact outcome,” he said. – by Alaina Tedesco

Reference:

Afzal MR, et al. Continued nationwide decline in stroke related in-hospital mortality in United States. Presented at: American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.

Johns Hopkins receives $50M gift to transform stroke diagnosis, treatment, rehabilitation

Unless they can articulate a strategy and exactly which problems in stroke they are trying to solve, this will be a total waste of money and time.
https://hub.jhu.edu/2018/02/01/johns-hopkins-stroke-institute-uae-gift/

Sheikh Khalifa Stroke Institute, funded by gift from the United Arab Emirates, will bring together experts in neurology, rehabilitation, biomedical engineering, and patient safety to address a significant global health challenge

Video: Hopkins Medicine

By Hub staff report
/ Published 2 hours ago

Johns Hopkins and the United Arab Emirates Embassy in Washington, D.C., today announced a new institute for stroke research and clinical care funded by a $50 million gift from the UAE.
The Sheikh Khalifa Stroke Institute will enable top clinician-scientists at Johns Hopkins to build on their pioneering work in neurology and neurosurgery, leveraging advances in biomedical engineering, artificial intelligence, and precision medicine to better diagnose, treat, and restore function to stroke patients.

About one-third of people who have strokes die each year, accounting for 5.5 million people worldwide. Of the survivors, two-thirds leave the hospital with a disability.

The gift, believed to be the largest ever for a stroke-specific initiative, was announced this afternoon at an event in New York City, where speakers included Johns Hopkins University President Ronald J. Daniels; Paul Rothman, dean of JHU's medical faculty and CEO of Johns Hopkins Medicine; philanthropist, Johns Hopkins alumnus, and former New York City Mayor Michael R. Bloomberg; and Yousef Al Otaiba, UAE Ambassador to the U.S.
"We are grateful for the UAE's gift, which enables us to leverage our considerable strengths in neurology, physical medicine, and rehabilitation—in combination with our expertise in biomedical engineering and patient safety—to develop new tools for stroke diagnosis, treatment, and recovery," Rothman says. "These efforts will improve the health of millions of people in Baltimore, the UAE, and around the world."
The new institute, with locations in Baltimore and Abu Dhabi, builds upon Johns Hopkins' leadership in the treatment of stroke and other neurological conditions. It will house two centers of excellence around which new research and patient care efforts will be designed:

• The center of excellence in stroke detection and diagnosis will focus on both analyzing the genetic underpinnings of stroke and developing new interventions that might include digital neurological exams or automated bedside diagnosis, or using imaging in new ways to better understand stroke.
• The center of excellence in stroke treatment, recovery, and rehabilitation will focus on developing new approaches to get blood vessels to regrow, delivering drugs and medications past the blood-brain barrier, and stimulating the brain to coax it to relearn movement post-stroke.

About one-third of people who have strokes die each year, accounting for 5.5 million people worldwide, according to the World Health Organization. Of the survivors, two-thirds leave the hospital with a disability, the U.K. Stroke Association reports.
"This new institute will not only generate better outcomes for stroke patients in the UAE and the U.S. but will also strengthen opportunities for collaboration between UAE and U.S. scientists and researchers," Otaiba says. "We are grateful to Johns Hopkins for their continued leadership in patient-centered medicine and are proud of our longstanding partnership."
The Sheikh Khalifa Stroke Institute will be directed by Justin McArthur, professor and director of neurology at Johns Hopkins.
"Standard clinical approaches to stroke do not leverage new knowledge about brain repair, neural plasticity, or learning, and treatment options for stroke patients are extremely limited," McArthur says. "But with this support from the UAE, we will be able to really bring stroke research and patient care to a new level."
Added Pablo Celnik, an expert in brain injury rehabilitation who directs the Johns Hopkins Department of Physical Medicine and Rehabilitation: "We are particularly excited to innovate how we care for patients with stroke, initiating recovery and novel rehabilitation strategies from the very onset of the disease."
Johns Hopkins and the UAE have a longstanding partnership dating back several decades. Johns Hopkins has provided specialized care to thousands of Emiratis since the 1970s and has helped build and improve overall health care delivery in the UAE by assisting with management and oversight of three of the UAE's major hospitals: Tawam, Al Rahba, and Corniche. In 2012, The Johns Hopkins Hospital and the UAE dedicated the Sheikh Zayed Tower, a state-of-the-art center for adult care at Johns Hopkins made possible through a gift from His Highness Sheikh Khalifa bin Zayed Al Nahyan, president of the UAE.

Posted in Health
Tagged stroke, philanthropy, interdisciplinary research

$100,000 Hearst Health Prize for Excellence in Population Health

Our great stroke association would apply for this after setting up and executing a strategy to get all stroke patients to 100% recovery. 
http://www.jefferson.edu/university/population-health/population-health-innovation/hearst-health-prize.html

Population health is essential to transforming from an illness-centered healthcare system to one focused on protecting and improving health. We created this prize to help identify and promote promising ideas in the field that help to improve health outcomes, and thus proliferate best practices more rapidly. Our goal is to discover, support and showcase the work of an individual, group, organization or institution that has successfully implemented a population health program or intervention that has made a measurable difference. The results of successful programs are expressed in terms of actual improvements in health outcomes and/or health behaviors, not just financial measures, clinical process measures, or measures of participation.

The Winner will receive a $100,000 cash prize, and up to two Finalists will each receive a $25,000  cash prize, in recognition of outstanding achievement in managing or improving population health. This is not a grant program.

Surprise: A virus-like protein is important for cognition and memory

That great stroke association would assemble a group of experts and determine what strategy needs to be followed to see if this could help stroke survivors. But since we have fucking failures of stroke associations nothing will be done.  Damn, give me money and researchers and I could solve stroke. I don't shy away from BHAGs(Big Hairy Audacious Goals). No stroke survivor shies away from work.
https://medicalxpress.com/news/2018-01-virus-like-protein-important-cognition-memory.html



January 11, 2018, University of Utah

A protein involved in cognition and long-term memory, called Arc, acts like a protein from viruses. Arc can encapsulate and deliver its own genetic material to brain cells (neurons) similar to the way viruses infect host cells. This picture …more

The prospect that virus-like proteins could be the basis for a novel form of cell-to-cell communication in the brain could change our understanding of how memories are made, according to Jason Shepherd, Ph.D., a neuroscientist at University of Utah Health and senior author of the study publishing in Cell on Jan. 11.

Shepherd first suspected that something was different about Arc when his colleagues captured an image of the protein showing that Arc was assembling into large structures. With a shape that resembles a capsule from a lunar lander, these structures looked a lot like the retrovirus, HIV.

"At the time, we didn't know much about the molecular function or evolutionary history of Arc," says Shepherd who has researched the protein for 15 years. "I had almost lost interest in the protein, to be honest. After seeing the capsids, we knew we were onto something interesting."

The gap in research was not for want of an interesting subject. Prior work had shown that mice lacking Arc forgot things they had learned a mere 24 hours earlier. Further, their brains lacked plasticity. There is a window of time early in life when the brain is like a sponge, easily soaking up new knowledge and skills. Without Arc, the window never opens.

Scientists had never considered that mechanisms responsible for acquiring knowledge could stem from foreign origins. Now, the work by Shepherd and his team has raised this intriguing possibility.

A protein important for cognition and memory named Arc can encapsulates genetic material (polyhedron enveloping the ribbon-like strands) and delivers it to brain cells in a manner similar to the way in which viruses infect host cells. Credit: Chris Manfre

Everything Old is New Again

Seeing Arc's unusual propensity to form virus-like structures prompted Shepherd to scrutinize the protein sequence with a new set of eyes. He found that regions of the code were similar to that from viral capsids. An essential tool for viral infection, capsids carry virus' genetic information and deliver it from cell to cell in its victim.

Given that Arc looks like a viral protein, Shepherd and his colleagues designed a set of experiments to test whether it also acts like one. They first determined that several copies of Arc self-assemble into hollow virus-like capsids and stash its own genetic material, in this case mRNA, inside them. When the scientists added the capsids to mouse brain cells, or neurons, growing in a dish, Arc transferred its genetic cargo into the cells.

After viruses invade host cells, they emerge ready to infect once again. It appears that Arc works in a similar way. The scientists gathered Arc that had been released from mouse neurons and determined that the proteins and their cargo could be taken up by another set of neurons. Unlike for viruses, activating neurons mobilizes Arc, triggering the release of capsids.

"We went into this line of research knowing that Arc was special in many ways, but when we discovered that Arc was able to mediate cell-to-cell transport of RNA, we were floored," says the study's lead author, postdoctoral fellow Elissa Pastuzyn, Ph.D. "No other non-viral protein that we know of acts in this way."

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A protein involved in cognition and storing long-term memories looks and acts like a protein from viruses, according to research by scientists at University of Utah Health. The protein, called Arc, has properties similar to those that viruses use …more

When Lightning Strikes Twice

The story of Arc's origin is relayed through the genomes of animals throughout evolutionary time. 350-400 million years ago, a chance occurrence struck four-limbed creatures that roamed the earth. An ancestor to retroviruses, called retrotransposons, inserted its genetic material into the animals' DNA. The event led to the mammalian Arc that we know today.

The significance of such an event is hinted at by the fact that it happened more than once. An accompanying paper in the same issue of Cell shows that a version of Arc found in flies also looks and acts like a viral capsid. Vivian Budnik's lab at the University of Massachusetts shows that fly Arc transports RNA from neurons to muscles to control movement. Even though mammalian and fly Arc evolved from the same class of retrotransposons, the event in flies occurred about 150 million years later.

"As an evolutionary biologist this is what is the most exciting to me," says co-author Cédric Feschotte, Ph.D. a professor at Cornell University. "The fact that it happened at least twice makes us think that it happened even more."

Shepherd believes this could mean that it is advantageous to have this viral-inspired system in place, and it may represent a novel form of intercellular communication. This hypothesis remains to be tested in mammals. "Knowing what cargo Arc vesicles transport in living animals will be critical to understanding the function of this pathway," he says.

Remember the unusual viral-like protein that you just learned about? It could be controlling your memory.

Explore further: Scientists find the invisibility cloak that shields HIV-1 from the immune system

More information: Cell (2018). DOI: 10.1016/j.cell.2017.12.024 , http://www.cell.com/cell/fulltext/S0092-8674(17)31504-0

Journal reference: Cell

Provided by: University of Utah