Acute Ischemic Stroke: Overcoming Barriers by Improving Systems of Care - CME

What a joke, nothing on stopping the neuronal cascade of death.

Overview

Author(s)/Faculty: Edward C. Jauch, MD, MS, FAHA, FACEP; Andy S. Jagoda, MD, FACEP; Philip B. Gorelick, MD, MPH, FACP; Lee H. Schwamm, MD, FAHA
Source: Healio - Cardiology Education Lab
Type: Multimedia	Articles/Items: 6
Release Date: 12/11/2015	Expiration Date: 12/11/2016
Credit Type: CME	Number of Credits: 1.5
Cost: Free	Provider:
According to the American Heart Association, strokes are experienced by approximately 795,000 Americans each year and remain the leading cause of disability in North America. It is important for emergency room physicians to identify and treat patients with acute ischemic stroke (AIS) quickly in order to best retain patients’ quality of life. Treatment of AIS is time sensitive, and with the recent updates to the use of endovascular procedures and thrombolytic therapy, physicians need to be prepared for a shift in the treatment paradigm without compromising patient safety. In this activity, leading neurologists and emergency medicine physicians discuss the latest evidence and recommendations on stroke management, including updates to guidelines on thrombolytic use, new data concerning endovascular procedures, and information on how the use of telemedicine and collaboration between stroke systems of care can improve processes and patient outcomes. Test Yourself »

CME Information

Provider Statement: This continuing medical education activity is provided by .
Support Statement: This activity is supported by an educational grant from Genentech, Inc.
Target Audience: The intended audience for the activity is emergency department physicians, nurses, and other health care professionals involved in the treatment of patients with acute ischemic stroke (AIS).
Learning Objective: Upon successful completion of the activities, participants should be better able to:

• Utilize evidence-based inclusion and exclusion criteria to determine candidates for thrombolytic therapy in AIS.
• Incorporate strategies that decrease delays in door-to-needle time in patients with AIS.
• Integrate established guidelines, recommendations, and clinical study findings to enable the safe and effective use of thrombolysis in patients who present with AIS.
• Compare the safety and efficacy of the various reperfusion strategies.
• Evaluate the current use of telemedicine within stroke systems of care and the importance of coordinating care within the transferring facilities to improve patient outcomes.

Activity Chair:
Edward C. Jauch, MD, MS, FAHA, FACEP
Division Director and Professor
Department of Medicine, Division of Emergency Medicine
Professor, Department of Neurosciences
Associate Vice Chair, Research, Department of Medicine
Medical University of South Carolina
Charleston, SC
Faculty:
Andy S. Jagoda, MD, FACEP
Professor and System Chair
Department of Emergency Medicine
Icahn School of Medicine at Mount Sinai
New York, NY
Philip B. Gorelick, MD, MPH, FACP
Professor
Translational Science and Molecular Medicine
Michigan State University
Medical Director
Mercy Health Hauenstein Neurosciences
Mercy Health Physician Partners
Grand Rapids, MI
Lee H. Schwamm, MD, FAHA
Vice Chairman, Department of Neurology
C. Miller Fisher Endowed Chair
Director
MGH Stroke Services
Massachusetts General Hospital
Professor of Neurology
Harvard Medical School
Cambridge, MA
Peer Reviewer:
Kama Z. Guluma, M.D.
Accreditation:
Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation:
Vindico Medical Education designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Approved by the American College of Emergency Physicians for a maximum of 1.50 hour(s) of ACEP Category I credit.
For the purpose of recertifying with American Nurses Credentialing Center (ANCC), AMA PRA Category 1 Credit(s)™ from organizations accredited by ACCME can be used.
This enduring material is approved for 1 year from the date of original release, December 11, 2015 through December 11, 2016.
How To Participate in this Activity and Obtain CME Credit:
To participate in this CME activity, you must watch the presentation, and complete the CME posttest and evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 3 out of 4 of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ Certificate.
Disclosures:
In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.
The authors disclose that they do have significant financial interests in any products or class of products discussed directly or indirectly in this activity, including research support.
Activity Chair and Faculty Members report the following relationship(s):
Edward C. Jauch, MD, MS, FAHA, FACEP
Executive Committee: Covidien Ltd., Genentech, Inc., Penumbra, Inc., Stryker
Andy S. Jagoda, MD, FACEP
Served as an advisor or consultant for: Banyan Biomarkers, Janssen, Pfizer, Teva
Executive board: Ferne
Philip B. Gorelick, MD, MPH, FACP
Served as an advisor or consultant for (paid to institution): Novartis
Served as a speaker or a member of a speakers bureau for (paid to institution): Boehringer Ingelheim, Pfizer
Lee H. Schwamm, MD, FAHA
Received grants for clinical research from: Genentech, National Institute of Neurological Disorders and Stroke
Target: Stroke Working Group, Chair Stroke Clinical Work Group
Steering & Science Committee: American Heart Association
Steering Committee: Lundbeck, Medtronic
Data Safety and Monitoring Board: Penumbra
Peer Reviewer reports the following relationship(s):
Kama Z. Guluma, M.D.
No relevant financial relationships to disclose.
Vindico Medical Education staff report the following relationship(s):
No relevant financial relationships to disclose.
Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.
Unlabeled and Investigational Usage:
The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non-FDA approved or investigational use of products/devices.
Copyright Statement:
Created and published by Vindico Medical Education, 6900 Grove Road, Building 100, Thorofare, NJ 08086-9447. Telephone: 856-994-9400; Fax: 856-384-6680. Printed in the USA. Copyright © 2015 Vindico Medical Education. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of Vindico Medical Education continuing medical education activities does not necessarily reflect the views and opinions of Vindico Medical Education. Neither Vindico Medical Education nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.
CME Questions?
Contact us at CME@VindicoCME.com

US House of Representatives passed the 21st Century Cures Act, supported by the NSA

You can compare NSA support to the blistering negative review by Elizabeth Warren. With the NSA not being able to create a stroke strategy I don't trust their ability to analyze a bill like this. And with no references to why the bill should be supported, the NSA support is worthless to me.

Having trouble? View this message on our website. Dear dean, Late Wednesday evening, the US House of Representatives passed the 21st Century Cures Act by an overwhelming and bipartisan vote of 392 to 26. During the 24-hours prior to the house vote, over 300 SAN advocates sent nearly 1,000 emails to elected officials across the country! Your voices were critical to ensure passage of this bill through the House of Representatives. But we're not done yet! We expect the Senate to vote on the 21st Century Cures Act sometime early next week. We'll update you as soon as that vote is schedule. In the meantime, if you haven't taken action on this bill yet, please take action here: http://advocate.stroke.org/B09yh8S. If you have already taken action, thank you and stay tuned! Sincerely, Mitchell Ronningen, J.D. Manager, Government Affairs Unsubscribe | Forward to a Friend | Visit Our Website 9707 E. Easter Lane, Suite B, Centennial, CO 80112 1-800-STROKES (787-6537) National Stroke Association © 2016 All rights reserved.

The Breathing Technique That Helps Fight Major Depression

Why not the Kundalini Breath of Fire? That also produces nitric oxide.

The Breathing Technique That Helps Fight Major Depression

Breathing technique can reduce the stress hormones in the central nervous system.

Controlled yogic breathing helps alleviate severe depression, new research finds.

People in the study had depression that had not responded to antidepressant medication.
Dr Anup Sharma, the lead author of this study, said:

“With such a large portion of patients who do not fully respond to antidepressants, it’s important we find new avenues that work best for each person to beat their depression.
Here, we have a promising, lower-cost therapy that could potentially serve as an effective, non-drug approach for patients battling this disease.”

The study compared the effects of learning the breathing technique over two months with a control group.
The results showed that those in the yoga group had lower depression and anxiety.
The control group showed no improvement.

Yoga breathing technique

The breathing technique was practised in groups and at home.
The technique involves a series of rhythmic breathing exercises designed to put people in a calm and meditative state.
Slow and calm breaths are alternated with fast and stimulating breaths.
The video below gives you an idea of what is involved in “Sudarshan Kriya yoga”, the breathing technique used in the study.
Along with learning this breathing technique, people practised yoga postures, sitting meditation and received stress education.
Dr Sharma said:

“Sudarshan Kriya yoga gives people an active method to experience a deep meditative state that’s easy to learn and incorporate in diverse settings.”

Sudarshan Kriya yoga has already been linked to benefits in milder forms of depression.
These studies suggest that yoga reduces levels of stress hormones in the central nervous system.
Dr Sharma said:

“The next step in this research is to conduct a larger study evaluating how this intervention impacts brain structure and function in patients who have major depression.”

The study was published in the Journal of Clinical Psychiatry (Sharma et al., 2106).

Novel Clot Buster Flops Again

So what is the next step  to solve this? Not doing anything is not okay, but that is what will happen since we have NO stroke leadership.
http://www.medpagetoday.com/cardiology/strokes/51760

Desmoteplase didn't help late-presenting strokes, the DIAS-3 trial shows.

• by Crystal Phend
  Senior Staff Writer, MedPage Today May 26, 2015
• This article is a collaboration between MedPage Today® and:
  

The investigational thrombolytic desmoteplase didn't improve reperfusion or outcomes compared with placebo in ischemic strokes treated 3 to 9 hours after onset, the DIAS-3 trial showed.
A good functionally independent outcome, marked by a modified Rankin Scale score of 0 to 2, at 90 days occurred in 51% of desmoteplase-treated patients compared with 50% given placebo (P=0.40), Gregory W. Albers, MD, of the Stanford School of Medicine in Stanford, Calif., and colleagues found.
Recanalization at 24 hours, monitored with noninvasive imaging, likewise came out similar between treatment groups (49% and 42%, respectively), they reported in the June issue of Lancet Neurology.
"This factor is key in the neutral results and raises questions about the thrombolytic efficiency of desmoteplase in late time windows," Michael D. Hill, MD, and Bijoy K. Menon, MD, both of the University of Calgary Stroke Program in Alberta, wrote in an accompanying editorial.

The prior phase III DIAS-2 trial with the drug, which is based on the saliva of the vampire bat, had also turned out negative using a different imaging-based selection scheme for enrollment.

DIAS-3 used a "simpler imaging selection paradigm: small core (less than a third of the middle cerebral artery [MCA] or less than a half of the anterior cerebral artery [ACA] or posterior cerebral artery [PCA] territories), plus evidence of a target intracranial arterial occlusion," Hill and Menon noted.
However, imaging protocol violations were common in the trial, with imaging discrepancies in 21% of the 292 acute ischemic stroke patients with occlusion or high-grade stenosis in major cerebral arteries treated at a median 7 hours after onset.
Although serious adverse events, including intracerebral hemorrhage and symptomatic cerebral edema, were similar between groups, another phase III trial, DIAS-4, was stopped based on early indications of futility in DIAS-3.
The researchers pointed to a possible benefit of desmoteplase in small ischemic lesions selected by MRI that might be worth further study.
While that group might have been less prone to imaging measurement error, "this finding would have been more meaningful if increased recanalization early after administration of the thrombolytic agent was also shown in the small core group," the editorialists cautioned.
It may be that late-presenting, small core strokes are just not a good population to target, they suggested.
"We speculate that patients who arrive late without having a large, established core of infarction shown in imaging are more likely to have preserved penumbral tissue because of good intracranial collateral circulation," Hill and Menon wrote. "Such patients could stand to benefit less from thrombolysis, even with reperfusion.
"Further, with time, thrombi mature and fibrin cross-links, resulting in resistance to thrombolysis. Patients who present in later time windows might simply be less amenable to chemical thrombolysis."

How fast you move can predict how healthy you'll be - If you are a roundworm

We'll never know if this applies to stroke survivors.
https://www.mdlinx.com/endocrinology/medical-news-article/2015/11/24/6428485?

Institute for Basic Science News, 11/23/2015

As humans have begun to live longer it has become clear that the quality of our lives is equally as important as the duration. In the lab, a dramatic extension of lifespan isn’t difficult to achieve. In previous experiments using several types of mutated Caenorhabditis elegans roundworms (C. elegans), researchers were able to significantly extend the worm’s lifespan. The lengthened life that the worms experienced was not necessarily a good one, as many of the mutated varieties were less healthy than wild–type worms, especially during the segment of life that was extended beyond normal. Instead of focusing on drawing out the length of life, South Korea’s IBS Center for Plant Aging Research and the research group led by Coleen Murphy, a professor at Princeton University have created a tool that can be used for accurately predicting lifespan as well as assessing the current health state, and discovered the regulatory mechanism that extends “healthspan”, the time in which an organism is at its optimal health. The researchers concluded that maximum velocity (MV) of wild–type worms at day 9 of adulthood is a reliable predictor of longevity. Another factor they observed was the state of C. elegans mitochondria. Elderly humans have weaker muscles and less strength resulted from mitochondrial defects which occur later in life. C. elegans with lower MV exhibit similar defects by midlife but there are far fewer defects in worms with higher MV at the same age. These observations indicate that MV correlates with mitochondrial health expression, suggesting that MV can be a reliable indicator of the actual physical state. The findings show that MV of C. elegans is a reliable indicator of age–related physical decline, accurately reports movement ability and if measured in mid–adulthood, is predictive of future longevity. According to Hong Gil Nam, “our analysis takes into account the length of time an individual can expect to live, and how healthy that individual can expect to be with age.” Many parts of the insulin/IGF–1 signaling (IIS) pathway that enable these functions have been identified, and many of these genes and the underlying mechanisms are conserved in mammals, which mean that the extended abilities that insulin/IGF–1 signaling (IIS) exhibits could offer therapeutic target possibilities for humans in the future. The IBS Center isn’t just looking at push the limits for long life; instead they are unraveling the mechanisms in our cells to maximize our health as we age.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

This Personality Trait Related To Higher Quality Of Life - optimism

But what about the research that says that pessimists live longer?
http://www.spring.org.uk/2016/12/personality-trait-related-higher-quality-life.php?omhide=true

Better mental and physical functioning among people high in this personality trait.

Optimists report higher levels of mental and physical functioning than pessimists, research reveals.

Not only that, but optimists also live longer.
Dr Toshihiko Maruta, the study’s first author, said:

“The wellness of being is not just physical, but attitudinal.
How you perceive what goes on around you and how you interpret it may have an impact on your longevity, and it could affect the quality of your later years.”

Researchers studied 447 people who were followed over 30 years.
Their personality was assessed, along with their physical and mental functioning.
It turned out that pessimists had a lower quality of life, on average.
Dr Maruta said:

“Our study provides documentation for beliefs commonly held by patients and health care practitioners about the importance of optimistic and pessimistic attitudes.
However, questions remain about the practical significance of these findings for health care practitioners.”

Naturally, though, the study cannot tell us if optimism causes these benefits or is a result of it.
Dr Maruta said:

“Explanatory style may have implications for prevention, intervention, health care utilization and compliance with treatment regimens.
Well formulated studies are essential to warrant the extra time, effort and costs associated with efforts to intervene in a patient’s explanatory style or to personalize the care specific to explanatory style.”

Previous research has also revealed that both extroverts and optimists are more likely to live longer than introverts and pessimists.
As I wrote previously:

“Optimists have healthier hearts than pessimists, a new study of over 51,000 adults finds.
Optimists also had healthier body mass indexes, were more physically active and less likely to smoke.
Researchers found that the more optimistic people were, the greater their overall physical health.
The most optimistic people were 76% more likely to have health scores that were in the ideal range.”

The study was published in the journal Mayo Clinic Proceedings (Maruta et al., 2012).

Music modulates the perceived creaminess, sweetness, and bitterness of chocolate

And since dark chocolate is so good for you your doctor should be prescribing the correct music to go with that. You get two for one; music therapy and cocoa benefits. Bet your doctor never does this. Don't do this on your own, dangerous combination, chocolate and music.
https://www.mdlinx.com/internal-medicine/medical-news-article/2016/12/02/taste-sound-music-chocolate-crossmodal-correspondences/6944375/?newsdt=120216&subspec_id=0&utm_source=DailyNL&utm_medium=newsletter&utm_content=general-article&

Appetite, 12/02/2016 Carvalho FR, et al.

Interestingly, and in contrast with previous similar studies, these outcomes show that in certain cases, sounds can have a perceptual effect on gustatory food attributes without essentially changing the hedonic experience.

• There has been a recent growth of interest for figuring out if sound (specifically music and soundscapes) can improve not only the basic taste attributes connected with food and beverage items (for example, sweetness, bitterness, sourness, etc.), additionally other vital components of the tasting experience, such as, for instance, crunchiness, creaminess, and/or carbonation.
• In the present study, participants assessed the perceived creaminess of chocolate.
• Two contrasting soundtracks were produced with such texture–correspondences in mind, and validated by means of a pre–test.
• The participants tasted the similar chocolate twice (without knowing that the chocolates were identical), each time listening to one of the soundtracks.
• The ‘creamy’ soundtrack enhanced the perceived creaminess and sweetness of the chocolates, as compared to the ratings given while listening to the ‘rough’ soundtrack.
• Moreover, while the participants preferred the creamy soundtrack, this difference did not seem to influence their overall enjoyment of the chocolates.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

6 Potential Brain Benefits Of Bilingual Education

They missed this benefit;

Stroke Rounds: Bilingual Brains Sustain Less Stroke Damage

 

6 Potential Brain Benefits Of Bilingual Education

Department of Health and Human Services National Institutes of Health National Institute of Neurological Disorders and Stroke 2017 Fiscal Year Budget Congressional Justification

Because we have NO stroke strategy we can't look at anything here and identify research that will help stroke survivors. Our fucking failures of stroke associations don't have any strategy and won't be doing anything to make sure fundings goes to helpful research. Nothing will get fixed until we destroy the existing associations and replace them with survivor led ones. The main takeaway from this is to ignore the NINDS and get funding from foundations and individual donors. Federal funding can't be counted on.

NINDS 2017 Congressional Justification

Hemorrhagic stroke after consumption of energy drink

Be careful out there.
http://www.news-medical.net/news/20161122/UAB-case-study-details-patient-experiencing-hemorrhagic-stroke-after-consumption-of-energy-drink.aspx

Investigators at the University of Alabama at Birmingham have presented the first case study of a patient experiencing a hemorrhagic stroke — a brain bleed — following consumption of an energy drink.
In an article in press in the American Journal of Emergency Medicine, the UAB physicians detail the case of a 57-year-old man who developed an intracranial hemorrhage within 15 minutes of drinking a popular energy drink.
The patient presented at a local emergency department and was transferred to the stroke unit at UAB with symptoms of sensory changes (tingling and numbness) in the right arm and leg, along with ataxia (shaky gait and movement). A CT scan revealed a small hemorrhage near the left thalamus.
"The man reported that his symptoms began about 15 minutes after drinking an energy drink, the first time he had consumed this particular product, as he was about to do yardwork," said Anand Venkatraman, M.D., a fourth-year resident in the Department of Neurology at UAB and the lead author of the study.
Venkatraman says the drink contains a high level of caffeine, along with a variety of other ingredients, many of which are associated with increases in blood pressure.
"This particular drink contains several supplements for which we have little understanding of their potential interactions with each other or with caffeine," Venkatraman said. "One is structurally similar to amphetamines, and several are known to stimulate the sympathetic nervous system."
The sympathetic nervous system regulates what is known as the "flight or fight" response. When faced with an urgent, potentially dangerous situation, the body gears up to either take extraordinary action (fight) or run away (flight).
"The body begins to marshal all of its resources to respond to the situation at hand — boosting strength and alertness, for example — in part by raising blood pressure to increase blood flow," Venkatraman said. "For a patient who may be at risk for vascular disease, this increase in blood pressure could be potentially dangerous, as a rise in blood pressure can affect an already weakened blood vessel to the point that it ruptures."

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Ingredients in the drinks that are suspected to influence the sympathetic nervous system include β-phenylethylamine hydrochloride, yohimbine and green tea extract.
"These ingredients are supplements and, as such, are not regulated by the government to the same degree that medications are," Venkatraman said. "We don't have good information on dosing for some of these supplements. We don't know how much is too much, for example, especially in populations with varying degrees of risk."
Another issue is serving size. The manufacturer's label says the bottle contains two servings, but the patient reported that he drank the full 8 oz. bottle at one time, a behavior that Venkatraman believes is common.
"The warning here is that we do not fully understand how some of these ingredients interact with other compounds," Venkatraman said. "Nor do we have enough information on maximum dosages, especially for individuals with underlying health issues. Consumers need to be aware of the ingredients in the drinks if they choose to use them, and check with their physician if they have questions. They should also follow the manufacturer's recommendations."
In this case, the patient had a history of elevated blood pressure and was at increased risk for vascular disease. Several months after the incident, the patient reported that he still had some residual effects from the incident.
"I am not anti-energy drink," Venkatraman said. "In fact, I use them myself on occasion. But I strongly urge consumers to read the label and be informed. Don't take unnecessary risks with your health. There is potential for a serious outcome."

Source:

University of Alabama at Birmingham

China’s Former Richest Man Turns His Mind to Neuroscience

After reading the article several times I still don't know who the person is. We should be able to use the seven degrees of separation to contact him and suggest working on stroke problems. 
https://international.thenewslens.com/article/55417
Humankind has made huge scientific progress in the last decade, and China’s tech giants can no longer achieve success by enjoying access to a gigantic market and emulating existing innovative firms. Competition in the science and technology industry has reached a stage where speed decides who succeeds and who fails. Indeed, the nature of the Internet means game-changing innovations become ubiquitous almost as soon as they appear.
To me, the science of the human brain is the ultimate scientific frontier. It is now also one of the most fiercely competitive sectors in the tech industry. The last 10 years have even witnessed several governments entering the neuroscience arena, including the Obama administration’s BRAIN Initiative, the EU’s Human Brain Project, and the China Brain Project.
Crucially, there is now an industry-wide consensus that the time is ripe for a breakthrough in neuroscience. In computing, image processing, and other brain-related technologies, we have progressed to a point where we can start applying what we have learned in real life. We may, within the next 20 years, even possess the technology to bioengineer a real-life human avatar.
The key innovation needed for this to take place is an interface between humans and machines allowing them to transmit signals to each other. For example, such an interface would need to have the ability to send scent information from a robot’s “nose” to a human’s olfactory receptors — those responsible for detecting smell — or to send visual information to the human optic nerve. Shanda Group will soon announce the establishment of a research institute aimed at developing these technologies.

The technology involved should also enable us to modify the human brain. Understanding optical input into the brain, for example, would eventually allow us to replace our eyes with video cameras with direct access to the optic nerves. Potentially, we would then be able to see just about everything, from distant craters on the moon to tiny bacteria.
Israeli Professor Yuval Noah Harari, a renowned historian and author of the bestseller “Sapiens: A Brief History of Humankind,” has said that the 21st century may well be the most unequal era in history. Human modification and enhancement will be achieved, but not for all, and this will create class divisions.
I believe people’s fears about artificial intelligence (AI) to be premature. The current tendency when discussing AI is to differentiate between its so-called weak and strong forms. Actually, the former is what we know as AI, whereas the latter is called AGI — or “artificial general intelligence.” Machines need to develop consciousness to achieve AGI.
As an example, there are currently several computer programs capable of beating a human at chess. These are all forms of AI. However, if a computer were to stop the game halfway through and type out a message saying, “You’re awful at this; I’m going to play against someone else,” it would have gained the self-awareness to qualify as AGI. Only at this stage could artificial intelligence pose a potential threat to humanity, and this is why I believe current technology will help and not hinder us.
There are huge prospects for the future of neurology. For this reason, Shanda Group is investing US$1 billion into establishing a neuroscience program to support research projects in China. There are many Chinese neurologists around the world conducting fantastic research. They are excited by China as a rapidly developing market, and they have abundant faith in China’s research capabilities and resources. But they are reluctant to move their families back to China and carry on their research here out of concerns for their children’s education and for environmental pollution. They are also equally keen to maintain close ties with the United States, which is the world leader in their field.
Realizing this, Shanda and several Chinese universities have put forward a solution. Their proposal is to seek out the top Chinese neuroscientists worldwide and have them conduct their research at a lab, perhaps in Silicon Valley or Boston, built specifically with neuroscience in mind. They would then make regular trips back home to China to give lectures and classes, and the findings of their research, along with any patents, would belong to the university with which they were affiliated. Indeed, this initiative is already in the process of being rolled out.
I will feel an immense sense of accomplishment if Shanda Group can contribute to unlocking the secrets of the human mind and am eager for us to play a leading role by investing in academic institutions and commercial enterprises. We already make frequent charitable donations to universities and have established a scheme to provide long-term funding for Chinese postdoctoral researchers and assistant professors in the field of neurology. The scheme currently supports several hundred researchers around the globe.
One of our most interesting commercial partners is ElMindA, an Israeli firm that assesses cognition quantitatively by monitoring and analyzing brain activity. For example, if a doctor asks you how much something hurts, you are basically limited to saying it hurts “a lot,” “a little,” “sort of,” and so on. Even if you try to rate the degree of pain from 1 to 10, the best you can give is a rough estimate. Nobody truly knows how to quantify the sensation of pain in their mind. ElMindA is the only firm on the planet with approval from the American Food and Drug Administration that is exploring the brain from the perspective of quantifying sentience and cognition.
Virtual reality (VR) and augmented reality (AR) are also keys to the future of neuroscience. VR and AR equipment are currently very heavy, and only offer a restricted field of view to the user. If the firms we have invested in can successfully miniaturize this technology, the implications of their research would be revolutionary.
Of course, as a commercial enterprise, we are not excluding the possibility that a genuine business opportunity might emerge from our outside interests. If we discover a way to write memories directly into the brain, for example, it would transform the world of education. If we can create a VR or AR universe on the scale of “The Matrix,” the entertainment industry as we know it would cease to exist. Neuroscience is so seductive partially because it has the potential to turn a firm into the next Google — or perhaps something even larger. Yet if we approach neuroscience with a desire to tear down existing corporations, we will make an ordeal out of a wondrous journey of discovery.
After becoming the richest person in China at 30 years old, is there any value in striving to achieve this ambition all over again at age 40 or 60? As far as I am concerned, there is none whatsoever. What is more valuable is the potential variety of human experience, all of which is a product of the brain. Naturally, this includes both happiness and pain; right now, I would prefer to set my brain to “happiness mode,” and enjoy contemplating the future of neuroscience.

(The News Lens has been authorized to repost this article. The piece was first published on Sixth Tone here. Sixth Tone covers trending topics, in-depth features, and illuminating commentary from the perspectives of those most intimately involved in the issues affecting China today. It belongs to the state-funded Shanghai United Media Group.)
 

Experts come together to develop plan for managing and sharing neuroscience data

Is your doctor, hospital and stroke association involved in this? I bet not one single person represents stroke in here. A massive failure on on stroke medical professionals.
http://www.news-medical.net/news/20161124/Experts-come-together-to-develop-plan-for-managing-and-sharing-neuroscience-data.aspx

Three years ago the White House launched the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative to accelerate the development and application of novel technologies that will give us a better understanding about how brains work.
Since then, dozens of technology firms, academic institutions, scientists and other have been developing new tools to give researchers unprecedented opportunities to explore how the brain processes, utilizes, stores and retrieves information. But without a coherent strategy to analyze, manage and understand the data generated by these new technologies, advancements in the field will be limited.
This is precisely why Lawrence Berkeley National Laboratory (Berkeley Lab) Computational Neuroscientist Kristofer Bouchard assembled an international team of interdisciplinary researchers--including mathematicians, computer scientists, physicists and experimental and computational neuroscientists--to develop a plan for managing, analyzing and sharing neuroscience data. Their recommendations were published in a recent issue of Neuron.
"The U.S. BRAIN Initiative is just one of many national and private neuroscience initiatives globally that are working toward accelerating our understanding of brains," says Bouchard. "Many of these efforts have given a lot of attention to the technological challenges of measuring and manipulating neural activity, while significantly less attention has been paid to the computing challenges associated with the vast amounts of data that these technologies are generating."
To maximize the return on investments in global neuroscience initiatives, Bouchard and his colleagues argue that the international neuroscience community should have an integrated strategy for data management and analysis. This coordination would facilitate the reproducibility of workflows, which then allows researchers to build on each other's work.
For a first step, the authors recommend that researchers from all facets of neuroscience agree on standard descriptions and file formats for products derived from data analysis and simulations. After that, the researchers should work with computer scientists to develop hardware and software ecosystems for archiving and sharing data.
The authors suggest an ecosystem similar to the one used by the physics community to share data collected by experiments like the Large Hadron Collider (LHC). In this case, each research group has their own local repository of physiological or simulation data that they've collected or generated. But eventually, all of this information should also be included in "meta-repositories" that are accessible to the greater neuroscience community. Files in the "meta-repositories" should be in a common format, and the repositories would ideally be hosted by an open-science supercomputing facility like the Department of Energy's (DOE's) National Energy Research Scientific Computing Center (NERSC), located at Berkeley Lab.

Because novel technologies are producing unprecedented amounts of data, Bouchard and his colleagues also propose that neuroscientists collaborate with mathematicians to develop new approaches for data analysis and modify existing analysis tools to run on supercomputers. To maximize these collaborations, the analysis tools should be open-source and should integrate with brain-scale simulations, they emphasize.
"These are the early days for neuroscience and big data, but we can see the challenges coming. This is not the first research community to face big data challenges; climate and high energy physics have been there and overcome many of the same issues," says Prabhat, who leads NERSC's Data & Analytics Services Group.
Berkeley Lab is well positioned to help neuroscientists address these challenges because of its long tradition of interdisciplinary science, Prabhat adds. DOE facilities like NERSC and the Energy Sciences Network (ESnet) have worked closely with Lab computer scientists to help a range of science communities--from astronomy to battery research--collaborate and manage and archive their data. Berkeley Lab mathematicians have also helped researchers in various scientific disciplines develop new tools and methods for data analysis on supercomputers.
"Harnessing the power of HPC resources will require neuroscientists to work closely with computer scientists and will take time, so we recommend rapid and sustained investment in this endeavor now," says Bouchard. "The insights generated from this effort will have high-payoff outcomes. They will support neuroscience efforts to reveal both the universal design features of a species' brain and help us understand what makes each individual unique."

Source:

DOE/Lawrence Berkeley National Laboratory

The Type of Smile That Helps Start New Relationships

With all the relationships that survivors will lose your doctor and psychologist should be providing you with new ways to make friends.
http://www.spring.org.uk/2015/05/the-type-of-smile-that-helps-start-new-relationships.php

People feel emotionally close to others displaying this type of smile.

A ‘Duchenne smile’ is a powerful way of striking up a new relationship, a new study finds.

People are highly tuned to the Duchenne smile, which involves upturned lips and crinkly eyes.
And they can easily spot a fake smile, which tends to involve only the mouth and not the eyes.
The research tested how much people are aware of each other’s emotions, whether negative or positive.
It found that people were more aware of positive emotions in other people than negative.
It also found that a genuine smile was a strong sign of cooperation and affiliation.
People felt emotionally closer to strangers who showed positive emotions.
The positive emotion that was particularly attractive was awe.
Dr Belinda Campos, who led the research, said:

“Our findings provide new evidence of the significance of positive emotions in social settings and highlight the role that positive emotions display in the development of new social connections.
People are highly attuned to the positive emotions of others and can be more attuned to others’ positive emotions than negative emotions.”

The study was published in the journal Motivation and Emotion (Campos et al., 2015).

Comparing Gait Parameters Can Predict Decline in Memory, Thinking

I had a significant decline in gait post-stroke. Does that predict my decline in memory and thinking? My gait is still off 10 years later. The same study should have included abnormal participants like stroke and TBI survivors, like the real world contains rather than these cherry picked participants.
http://dgnews.docguide.com/comparing-gait-parameters-can-predict-decline-memory-thinking?
A study published in the Journal of Alzheimer's Disease found that problems associated with gait can predict a significant decline in memory and thinking.
Using the Rochester Epidemiology Project, researchers from the Mayo Clinic, Rochester, Minnesota, examined medical records of residents from Olmsted County, Minnesota, who were aged between 70 and 89 as of October 1, 2004.
The analysis included 3,426 cognitively normal participants enrolled in the Mayo Clinic Study of Aging who had a complete gait and neuropsychological assessment.
At baseline and every 15 months (mean follow-up, 1.93 years), participants had a study coordinator evaluation, neurological examination, and a neuropsychological assessment using 9 tests that covered 4 domains. Gait parameters were assessed with the GAITRite instrument.
Spatial (stride length), temporal (ambulatory time, gait speed, step count, cadence, double support time), and spatiotemporal (cadence) gait parameters, and greater intraindividual variability in stride length, swing time, and stance time were associated with a significant decline in global cognition and in specific domains including memory, executive function, visuospatial, and language.
The results of the study also support the role of computerised analysis because the computer tool detected modifications before impairment was detected with a standard neuropsychological test.
“The presence of gait disturbances increases with advancing age and affects the independence of daily living, especially in the elderly,” said lead author Rodolfo Savica, MD, Mayo Clinic. “Computerised gait analysis is a simple, noninvasive test that potentially could be used to identify patients at high risk for cognitive decline and to target appropriate therapies.”
SOURCE: Mayo Clinic

A Go on NOGO: Promising Therapy for CNS Disease and Injury

So has anything here been put into clinical practice after 15 years studying this? We need axonal regeneration. Is this a piece of the stroke strategy? WHOM is making sure this gets translated into viable clinical interventions?

A Go on NOGO: Promising Therapy for CNS Disease and Injury

Cecilia Reyes and Yaroslav Voronin
Department of Biology
Lake Forest College
Lake Forest, Illinois 60045

Abstract

Mammals  have  evolved  with  a  limited  capacity  to  regenerate  neurons  in  the  CNS.  Damage  to  the  CNS  by  traumatic  injury,  stroke and neurodegenerative disorders can result in permanent loss of  sensory,  motor,  and  cognitive  functions.    Fifteen  years  ago,  my lab began studying the inhibitory mechanisms in damaged CNS.  We have identified the myelin-associated protein Nogo-A as a key player in  sprouting  inhibition.  Nogo-A,  as  well  as  two  other  inhibitory  proteins, MAG and OMgp, bind to the nogo-66 receptor (NgR) to inhibit axonal regeneration in the CNS.  We identified two mechanisms with neurons  that  promote  Nogo-based  CNS  inhibition:  the  rho-ROCK  kinase  pathway  that  is  selectively  activated  by  NgR,  and  the  integrin-actin pathway that is activated by a 66-amino-acid residue on Nogo-A.  While genetic and chemical disruption of NgR ligands (nogo-A, MAG and OMgp) has resulted in poor regeneration after injury, manipulation of NgR has shown promising therapeutic value in both in vivo and in vitro. Therapeutic administration of NgR(310)ecto-Fc protein, an NgR antagonist, in tissue and mouse models can neutralize the inhibitory effects of the three NgR ligands and has proven beneficial in
promoting motor function after spinal cord injury and stroke. Finally, we have found that inhibiting Nogo-A in ALS and Alzheimer’s disease models reduces pathological characteristics, indicating that manipulating Nogo-NgR based inhibition holds great promise for CNS injury
and neurodegenerative disease. 

Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

Nothing here helps anyone because the standardised measurements are never mentioned.
http://www.forskningsdatabasen.dk/en/catalog/2348956661

Authors:

Maribo, Thomas³; Nielsen, Claus Vinther⁴

Affiliations:

¹ Department of Public Health, Health, Aarhus University

---

² Department of Public Health - Klinisk Socialmedicin og Rehabilitering, Department of Public Health, Health, Aarhus University

---

³ Department of Public Health, Health, Aarhus University

---

⁴ Department of Public Health - Klinisk Socialmedicin og Rehabilitering, Department of Public Health, Health, Aarhus University

Abstract:

Relevance: Stroke is one of the major chronic diseases leading to long-term disability. Stroke treatment has improved and in-hospital stays have been reduced, leading to increasing emphasis on home-based rehabilitation. The transition from hospital to home-based rehabilitation is critical, as vital information can be lost as the rehabilitation teams change. Using relevant instruments to describe functioning is a way of ensuring continuity in the transition. Clinical guidelines recommend use of reliable and valid instruments in the transition, but recommendations on which outcome measures to use are vague. Purpose: The purpose was to examine the use of outcome measures used in clinical practice in the transition from hospital to home-based rehabilitation. Methods/Analysis: A questionnaire were sent to the heads of 26 hospitals discharging patients with stroke and 52 municipalities' health services treating stroke patients at home in three regions in Denmark. The three regions have a total population of three million. The survey was targeted at health care professionals that typically take part in municipal health service: nurses, physiotherapists, occupational therapists, speech-language pathologists, nursing assistants and neuropsychologists. The questionnaire had one open-ended question: “Which instruments, outcome measures or tests are commonly used to describe functioning in persons with stroke?”. The questionnaire underlined that only instruments routinely used to assess functioning were to be reported. Data were subjected to descriptive analysis. Instruments were separated into standardised (published) and “others”. Results: 85% of the hospitals and 90% of the municipalities returned the questionnaire. 95% of the hospitals and 96% of the municipalities used standardised instruments. The hospitals reported 61 standardised instruments and 45 “other”. The municipalities reported 60 standardised instruments and 53 “other”. A total of 89 standardised instruments were used to describe functioning in stroke patients. No instrument was used in every hospital or municipality, and a majority of the instruments were used in just one or two places. The different health professionals reported diverse use of standardised instruments, with occupational therapists at hospitals being the most frequent users and nurses reporting the least use of standardised instruments. In 79% of the hospitals and 89% of the municipalities, PTs used standardised instruments. Discussion and conclusions: Health professionals are encouraged to use evidence-based practice, including the use of valid and reliable instruments in health care transitions, but there are no recommendations on which instruments to use. This survey of more than half the Danish health care sector shows that the vast majority of services use standardised instruments, but there is absolutely no consensus in the selection of instruments. Impact and Implications: There is a strong need for recommendations on which outcome measures should be used in stroke rehabilitation, especially in the transition between hospital and home-based rehabilitation. A nationwide, interprofessional and intersectional group is currently discussing recommendations for the use of outcome measures in stroke rehabilitation. Results from this group will be presented at the conference. Funding Acknowledgement: The study was supported by Central Denmark Region and Aarhus University.

Type:

Conference poster

Language:

English

Main Research Area:

Medical science

Review type:

Peer Review

Conference:

The European Region of the World Confederation for Physical Therapy, 2016

Submission year:

2016

Scientific Level:

Scientific

ID:

2348956661

Habitual cocoa intake reduces arterial stiffness in postmenopausal women regardless of intake frequency: A randomized parallel-group study

Sounds like a good thing, but I bet your doctor will never get this into a diet protocol. Don't do this dangerous thing on your own. 

Habitual cocoa intake reduces arterial stiffness in postmenopausal women regardless of intake frequency: A randomized parallel-group study

Clinical Interventions in Aging, 12/02/2016 Okamoto T, et al.

For this study, researchers examine the impacts of cocoa consumption frequency on arterial stiffness in postmenopausal women. In spite of the fact that this study did not include a sedentary control group, these outcomes recommend that regardless of frequency, habitual cocoa consumption decreases central and peripheral arterial stiffness in postmenopausal women.

• 64±12 years was the mean age ± standard deviation of the participant.
• A sum of 26 postmenopausal women were haphazardly assigned to two groups with different cocoa–intake frequencies: one group ingested 17 g of cocoa once daily except on Sundays (every–day group, n=13), and the other ingested 17 g of cocoa twice daily every other day (every–other–day group, n=13).
• These consumption regimens were kept up in both groups for 12 weeks.
• Carotid–femoral pulse–wave velocity and femoral–ankle pulse–wave velocity were measured in both groups at baseline and again at the end of the 12–week study period.
• Contrasted with baseline, both pulse–wave velocities had altogether diminished after the 12–week study period in both groups (P<0.05).
• However, no significant difference in degree of change was observed between the two groups.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

RCP stroke guidance recommends 45 minutes of therapy daily

What a fucking piece of shit guideline. You should be doing hours upon hours of therapy daily including action observation, mirror therapy, meditation, PROM, music listening and virtual realty game playing.  You will never recover much if you listen to this stupid bullshit.  Until the stroke medical world starts writing protocols instead of guidelines they really are useless.
http://www.csp.org.uk/news/2016/11/30/rcp-stroke-guidance-recommends-45-minutes-therapy-daily
People with stroke should receive at least 45 minutes of each appropriate therapy a day, guidance from the Royal College of Physicians (RCP) recommends.
Rehabilitation is central to the document, which says the frequency of therapy must enable stroke patients to meet their rehabilitation goals.(That goal is 100% recovery, nothing less) And, very importantly, therapy should continue as long as patients are willing and capable of participating and showing measurable benefit from treatment.
The RCP’s Key Recommendations for Stroke 2016 offers a concise guide to better stroke care. Its 30 recommendations are based on the RCP’s detailed 151-page National Clinical Guideline for Stroke, with more than 400 recommendations covering almost every aspect of stroke management.(Pretty much useless since these are guidelines not protocols)
A stroke unit must be capable of providing rehabilitation to all its patients, it tells commissioners. In addition, it calls on them to provide a specialist early supported discharge service, so stroke patients can continue their rehabilitation at home.
Commissioners are recommended to look for specialist rehabilitation services which meet the specific health, social and vocational needs of people with stroke of all ages. And they should commission services capable of delivering specialist rehabilitation in out-patient and community settings, in liaison with inpatient services.
Daily mobilisation
Early mobilisation is key, the document says. Patients who are medically stable but have difficulty moving soon after a stroke should be offered frequent, short, daily mobilisations by appropriately trained staff. Typically this should begin between 24 and 48 hours after a stroke.
Inpatient stroke units should be staffed by a multidisciplinary team that meets at least once each week to exchange information about patients.
Nicola Hancock, lecturer in physiotherapy at the University of East Anglia, contributed to the guidance. She said physiotherapists would find the concise guidance highly accessible and hoped it would be used, along with the full guidelines, to inform, support and improve acute and rehabilitation services.
'The new National Clinical Guideline for Stroke is the most comprehensive, evidence-based tool available to guide practice all the way through the stroke pathway, from the earliest stages to long-term management of this important condition,’ she said.
‘The guidelines were developed using a highly-rigorous process of searching, appraising and compiling the evidence. The concise guide brings together a number of guidelines from the main document that are particularly relevant to physiotherapy practice.’

Website links

Key Recommendations for Stroke 2016

National Clinical Guideline for Stroke, fifth edition

Benefits of daily aspirin outweigh risk to stomach

For your discussion with your doctor. Ask her/him about the 81mg vs. 300 mg in Britain and 325 mg (or 5 grains) in the United States and if the size made any difference.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=170515&CultureCode=en
Stomach bleeds caused by aspirin are considerably less serious than the spontaneous bleeds that can occur in people not taking the drug, concludes a study led by Cardiff University.
Published in the journal Public Library of Science, the extensive study of literature on aspirin reveals that while regular use of the drug increases the risk of stomach bleeds by about a half, there is no valid evidence that any of these bleeds are fatal.
Professor Peter Elwood from Cardiff University’s School of Medicine said: “Although many people use aspirin daily to reduce the risk of health problems such as cancer and heart disease, the wider use of the drug is severely limited because of the side effect of bleeding from the stomach. With our study showing that there is no increased risk of death from stomach bleeding in people who take regular aspirin, we hope there will be better confidence in the drug and wider use of it by older people, leading to important reductions in deaths and disablement from heart disease and cancer across the community.”
Heart disease and cancer are the leading causes of death and disability across the world, and research has shown that a small daily dose of aspirin can reduce the occurrence of both diseases by around 20-30%.
Recent research has also shown that low-doses of aspirin given to patients with cancer, alongside chemotherapy and/or radiotherapy, is an effective additional treatment, reducing the deaths of patients with bowel, and possibly other cancers, by a further 15%.
The study ‘Systematic review and meta-analysis of randomised trials to ascertain fatal gastrointestinal bleeding events attributable to preventive low-dose aspirin: No evidence of increased risk’ can be found in Public Library of Science.
This study was a systematic review and meta-analysis of randomised trials. This type of research provides the strongest evidence for drawing causal conclusions because it draws together all of the best evidence.
Full bibliographic informationSystematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

Peter C. Elwood , Gareth Morgan , Julieta Galante , John W. K. Chia , Sunil Dolwani , J. Michael Graziano , Mark Kelson , Angel Lanas , Marcus Longley , Ceri J. Phillips , Janet Pickering , Stephen E. Roberts , Swee S. Soon , [ ... ], Alison L. Weightman

Published: November 15, 2016

http://dx.doi.org/10.1371/journal.pone.016616

Microbubbles and Ultrasound Open the Blood-Brain Barrier to Administer Drugs

For when we actually get drugs that can help improve neuroplasticity and neurogenesis.  I wonder what researcher is working on kickstarting neuroplasticity and neurogenesis? A great stroke association would know exactly what stroke research is going on, who funded it, status, and what part of the stroke strategy it is addressing. That is what these employees should be doing instead of writing press releases and setting up awareness crap like marathon teams. 

Microbubbles and Ultrasound Open the Blood-Brain Barrier to Administer Drugs

Summary: Researchers have developed a new method that could allow for the delivery of drugs across the blood-brain barrier.
Source: FECYT.
The impassable blood-brain barrier prevents microorganisms from entering our brain, however it also blocks medicines that could help treat Parkinson’s, Alzheimer’s and other neurodegenerative diseases. Now, a Spanish physicist and other researchers at the University of Columbia (USA) have succeeded in embedding these substances in tiny lipid bubbles, in such a way that ultrasound can be used to release them into the specific area of the brain where they are needed.
A defence mechanism as sophisticated as the blood-brain barrier, which protects our brains from viruses, bacteria and fungi that filter into our blood, can become our worst enemy when it comes to treating certain illnesses. This “wall” is an impassable obstacle for 98% of drugs, which it treats as pathogens and blocks from passing from patients’ bloodstream into their brain.
Scientists have for years been trying to break through this natural barrier, but almost none of the techniques developed to date (such as intracranial injections, gene therapy and the chemical modification of the medicine) have been able to transport the drug to where it is needed, without it affecting the rest of the body and with the action being reversible (where the barrier opens and closes very rapidly).
The only method that has been capable of overcoming all these conditions is based on the use of ultrasound (sound whose frequency is higher than the range of human hearing) after drugs are administered with an independent intravenous injection of lipid-coated gas microbubbles (which are completely innocuous).
Like a laser, the ultrasound is focused on a specific region of the brain, where the microbubbles begin to oscillate and increase in size due to their interaction with the acoustic waves. When these tiny bubbles reach the critical size of 8 microns, the blood-brain barrier near to them opens, allowing the medicine circulating in the blood to pass through.
This technique has been used successfully for over ten years, but it does have a disadvantage: the drugs move through the entire circulatory system and reach organs where they are not needed, causing adverse effects. However, it appears that scientists at the Ultrasound Elasticity Imaging Laboratory (UEIL) at New York’s Columbia University have found the solution.
“We’ve made a step forward by incorporating the substance we’re interested in into the lipid coating of the microbubbles. This makes the substance stay adhered to the microbubbles and prevents it circulating freely through the body,” SINC was told by the physicist Carlos Sierra, a UEIL researcher who receives a grant from A Coruña’s Berrié Foundation and the lead author of the paper on this new advance, published in the Journal of Cerebral Blood Flow and Metabolism.
With this technique, the microbubbles flow through the entire body with the potential drug adhered to them, but only release it in the area of the brain where it is required, where the effect of the ultrasound causes them to rupture and open the blood-brain barrier. “It does all this, while being non-invasive, reversible and completely safe,” Sierra stresses.
From experiments on mice to human trials
So far, the researchers have proven the efficacy of their technique on mice. They chose a fluorescent molecule called 5-dodecanoylaminofluorescein and confirmed that it was reaching the brain without affecting other parts of the animal. At the same time, they identified the acoustic pressure thresholds from which the substance is guaranteed to reach its target in vivo.

Microbubbles with the fluorescent substance in their lipid coating, from which the effect of the ultrasound causes them to be released into the desired area of the brain.

“Defining these parameters means we can think about how to transfer the technique to human patients, although it has to be tested on monkeys first,” the researcher explains, adding that “it could be applied to diseases like Parkinson’s, Alzheimer’s, Huntington’s diseases, brain tumours, strokes, multiple sclerosis and amyotrophic lateral sclerosis, where we expect to see a very significant rise in the efficacy of treatment and a considerable reduction in side-effects.”
The team has now started administering potentially therapeutic compounds for treating Parkinson’s disease “with promising initial findings,” Sierra points out, concluding that “the success of this technique in mice, and even in monkeys, can’t guarantee it will be effective in people, but if we continue to get satisfactory results then pre-clinical trials on humans would begin.”

About this neurology research article

Source: FECYT
Image Source: This NeuroscienceNews.com image is credited to UEIL, C. Sierra et al..
Original Research: Abstract for “Lipid microbubbles as a vehicle for targeted drug delivery using focused ultrasound-induced blood–brain barrier opening” by Carlos Sierra, Camilo Acosta, Cherry Chen, Shih-Ying Wu, Maria E Karakatsani, Manuel Bernal, and Elisa E Konofagou in Journal of Cerebral Blood Flow and Metabolism. Published online June 8 2016 doi:10.1177/0271678X16652630

At long last - stroke patients can be monitored at home, using a sensor suit

Your stroke hospital should be waiting with baited breath for this to become available. Finally survivors can get objective measurements of where their muscles are working incorrectly. From that you therapist can pick the correct stroke protocol to resolve those deficits. I know this is pie in the sky thinking but it is what should be occurring to get all stroke survivors to 100% recovery. If that is not your stroke hospitals goal then you need to completely remove all the personnel and start over again with people who believe in total recovery and can plan a way to get there. The current crop of stroke medical professionals has accepted failure so readily I don't think they can be retrained.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=170493&CultureCode=en
From now on it will be possible to accurately monitor and analyse how stroke patients move during everyday life. This involves the use of a new suit fitted with 41 sensors, plus the infrastructure needed to transmit, store and process all of the data collected. This technology and information will make it possible to improve the rehabilitation process and cut healthcare costs. Bart Klaassen developed the system together with an international team of engineers and healthcare professionals. He will defend his thesis (which is based on this research) on 30 November, at the University of Twente. “The technology is finally ready.”
As many as 33 million people(Really!, the standard number bandied about is always 15 million) throughout the world suffered strokes in 2010. With our aging population, it seems logical to expect a further increase in these numbers in the upcoming years. Stroke survivors often have to cope with physical limitations. They generally take part in rehabilitation programmes, which are intended to help patients function as effectively as possible in their everyday lives. In practice, however, rehabilitation mainly takes place in rehabilitation clinics. Not enough is known about how, after completing such programmes, patients cope with their limitations in a daily life setting. Yet it is known that a better understanding of how these people function in everyday life could lead to more effective rehabilitation, at a lower cost. In the context of a European FP7 research project, Bart Klaassen (a PhD student at the University of Twente) and a large team of researchers developed a system for accurately measuring and modelling these patients’ movement quality, and for transmitting the relevant information to the therapist. This project is a world first. Never before have researchers used systems like this to analyse these patients’ every movement in a daily life setting. “There has long been a great need for systems like this, but the technology simply was not ready”, says Klaassen. “That is now changing rapidly, thanks to rapid developments in the fields of battery technology, wearables, smart e-textiles and big data analysis.”
41 sensors
Together with a large consortium of engineers and healthcare professionals, Bart Klaassen developed the INTERACTION System. This consists of a suit that study subjects had to wear under their clothing for three months, as well as the entire technical infrastructure needed to transmit, store and process the data collected. The suit contains no less than 41 sensors, including sensors on a large number of body segments, sensors that measure muscle strength, stretch sensors on the back and the hands, and force sensors in the soles of the shoes. In addition, the suit is equipped with a portable transmitter that can transmit all of the information gathered through the internet to data processing servers at the University of Twente.
In the course of his PhD research, Klaassen showed that the system works well in practice. “We have been able to demonstrate that all the information is transmitted successfully, that this process is very efficient, and much more besides. We have succeeded in modelling all of the relevant movements, and in cleaning up the data that is relevant for the therapist by filtering out the rest.Our project has delivered new techniques and methods that can be used to monitor patients at home for extended periods of time, and to identify any differences with structured clinical measurements. We are currently engaged in further research to obtain final verification that these methods are indeed an ideal way of supervising rehabilitation.”
When developing this system, Bart Klaassen and the team adopted a user-centred design approach. This enabled them to continually incorporate feedback from the patients involved into the development of the system. Other relevant parties – such as insurance companies and healthcare professionals – were also involved in the design and research work at an early stage.
PhD defence
As part of his PhD research, Klaassen worked closely with what he calls ‘world leaders in the field of rehabilitation technology’. These included Cereneo A.G. (a Swiss rehabilitation centre), the Department of Neurology at the University Hospital of Zurich in Switzerland and Roessingh Research and Development BV. Bart Klaassen conducted his research at the Biomedical Signals and Systems Department in the University of Twente’s MIRA research institute. Klaassen will defend his PhD thesis in the Prof. G. van Berkhoff hall, in the Waaier Building on the University of Twente campus at 16:30 on Wednesday 30 November. Bart Klaassen is currently working as a coordinator at the University of Twente’s tech4People BMS lab.

UAB case study details patient experiencing hemorrhagic stroke after consumption of energy drink

Be careful out there.
This line from this article points out that this is not the first stroke reported after an energy drink, back in Nov. 2012.

More Deaths, Illness Linked to Energy Drinks

Disability from irregular heartbeat or stroke linked to Rockstar Energy drink

 

UAB case study details patient experiencing hemorrhagic stroke after consumption of energy drink

Investigators at the University of Alabama at Birmingham have presented the first case study of a patient experiencing a hemorrhagic stroke — a brain bleed — following consumption of an energy drink.
In an article in press in the American Journal of Emergency Medicine, the UAB physicians detail the case of a 57-year-old man who developed an intracranial hemorrhage within 15 minutes of drinking a popular energy drink.
The patient presented at a local emergency department and was transferred to the stroke unit at UAB with symptoms of sensory changes (tingling and numbness) in the right arm and leg, along with ataxia (shaky gait and movement). A CT scan revealed a small hemorrhage near the left thalamus.
"The man reported that his symptoms began about 15 minutes after drinking an energy drink, the first time he had consumed this particular product, as he was about to do yardwork," said Anand Venkatraman, M.D., a fourth-year resident in the Department of Neurology at UAB and the lead author of the study.
Venkatraman says the drink contains a high level of caffeine, along with a variety of other ingredients, many of which are associated with increases in blood pressure.
"This particular drink contains several supplements for which we have little understanding of their potential interactions with each other or with caffeine," Venkatraman said. "One is structurally similar to amphetamines, and several are known to stimulate the sympathetic nervous system."
The sympathetic nervous system regulates what is known as the "flight or fight" response. When faced with an urgent, potentially dangerous situation, the body gears up to either take extraordinary action (fight) or run away (flight).
"The body begins to marshal all of its resources to respond to the situation at hand — boosting strength and alertness, for example — in part by raising blood pressure to increase blood flow," Venkatraman said. "For a patient who may be at risk for vascular disease, this increase in blood pressure could be potentially dangerous, as a rise in blood pressure can affect an already weakened blood vessel to the point that it ruptures."

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Ingredients in the drinks that are suspected to influence the sympathetic nervous system include β-phenylethylamine hydrochloride, yohimbine and green tea extract.
"These ingredients are supplements and, as such, are not regulated by the government to the same degree that medications are," Venkatraman said. "We don't have good information on dosing for some of these supplements. We don't know how much is too much, for example, especially in populations with varying degrees of risk."
Another issue is serving size. The manufacturer's label says the bottle contains two servings, but the patient reported that he drank the full 8 oz. bottle at one time, a behavior that Venkatraman believes is common.
"The warning here is that we do not fully understand how some of these ingredients interact with other compounds," Venkatraman said. "Nor do we have enough information on maximum dosages, especially for individuals with underlying health issues. Consumers need to be aware of the ingredients in the drinks if they choose to use them, and check with their physician if they have questions. They should also follow the manufacturer's recommendations."
In this case, the patient had a history of elevated blood pressure and was at increased risk for vascular disease. Several months after the incident, the patient reported that he still had some residual effects from the incident.
"I am not anti-energy drink," Venkatraman said. "In fact, I use them myself on occasion. But I strongly urge consumers to read the label and be informed. Don't take unnecessary risks with your health. There is potential for a serious outcome."

Source:

University of Alabama at Birmingham

Standing up in patients with Parkinson's disease exacerbates cognitive deficits, study shows

Would this same problem occur in stroke. When I stand up it requires tons of mental energy just to get upright and then even more to stop the swaying and finally take a first step. I'm sure my mental abilities have gone to hell during those minutes.
http://www.news-medical.net/news/20161130/Upright-posture-in-patients-with-Parkinsons-disease-exacerbates-cognitive-deficits-study-shows.aspx

In a new study published online today in the journal Neurology, a research team led by neurologists at Beth Israel Deaconess Medical Center (BIDMC) and neuropsychologists at Boston University has shown that when patients with Parkinson's disease experience a drop in blood pressure upon standing up - a condition known as orthostatic hypotension (OH) - they exhibit significant cognitive deficits. These deficits reverse when they lie down and their blood pressure returns to normal.
These cognitive impairments may go unnoticed by physicians assessing patients with Parkinson's who are lying down or seated, and could lead to difficulty in daily activities performed while standing and walking, such as tracking conversations, counting change and interpreting traffic signals.
"Cognitive impairment is a common symptom of Parkinson's disease," said co-senior author Roy Freeman, MD, director of the Center for Autonomic and Peripheral Nerve Disorders at BIDMC and a professor of neurology at Harvard Medical School (HMS). "In this study, we demonstrated that the upright posture in patients with Parkinson's disease exacerbated cognitive deficits, and that this effect is transient and reversible. Based on these results, we encourage clinicians to include cognitive testing in a variety of postures in their assessments of patients."
Marked by characteristic tremor, rigidity and slowness of movement, Parkinson's disease (PD) is a progressive degeneration of parts of the nervous system. It affects many aspects of movement and can cause a masklike, expressionless face, rigid limbs, and problems with walking and posture. PD is also associated with cognitive defects attributed to breakdowns in connectivity between regions of the brain. Up to 50 percent of people with Parkinson's disease may also have orthostatic hypotension.
In a previous study, Freeman and colleagues demonstrated that orthostatic hypotension is linked to reversible cognitive impairment in patients with a rare neurological disorder called autoimmune autonomic ganglionopathy. In this new study of the far more prevalent Parkinson's disease, the researchers investigated whether OH is linked to reversible cognitive deficits in patients with PD as well.
Freeman and colleagues including lead author Justin Centi and co-senior author Alice Cronin-Golomb, PhD, director of the Vision and Cognition Laboratory and Center for Clinical Biopsychology and a professor of psychological and brain sciences at Boston University, divided 55 volunteers into three study groups: 18 patients with both PD and OH, 19 patients with PD but without OH, and 18 control participants with neither PD nor OH. All participants were given a series of cognitive tests, with the tests administered while supine and again while tilted to 60 degrees. Researchers measured and recorded the participants' blood pressure before and during each round of cognitive testing to ensure that participants were never at risk for fainting.
"As we suspected, people with both Parkinson's disease and orthostatic hypotension showed posture-related impairments when upright relative to supine on nearly all measures of cognition," said Centi, who noted that study participants with Parkinson's disease without orthostatic hypotension demonstrated deficits on only two cognitive tests. There was no difference between upright and supine scores for the control group.
When the three groups' relative performances were compared to each other, postural changes had no significant impact on participants with PD but without OH, compared to the control group. However, Participants with PD and OH were far more susceptible to posture-related impairment on several tests, including those that measured math skills, the ability to produce words easily, keeping information in mind while working on it, paying sufficient attention so that later memory is efficient and searching for items quickly and accurately.
"Essentially all neuropsychological tests are given to patients in the seated position in the clinic as well as during most research studies - with the exception of imaging studies in which the patient is lying down," said Cronin-Golomb. "The cognitive performance that we see in those patients with Parkinson's disease who are tested when seated or lying down in fact may underestimate their cognitive problems in real life, when they are standing up and going about their business of daily activities. Also, the patterns of brain activity that we see on imaging when they are lying down may not be the patterns that the brain produces during normal upright activity."
Cognitive deficits in PD result, at least in part, from neurodegeneration, the authors explained. But transient blood pressure changes when upright may indeed play a contributing role. Clinical providers might miss an important target for intervention when not considering OH as a contributor to cognitive impairment.

Source:

Beth Israel Deaconess Medical Center