Podcasts about strokeaha

The controversial KETO-CTA study, tough decisions in subclinical AF, and another potentially huge benefit for GLP-1 agonist drugs are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I The KETO-CTA Study JACC Advances Paper: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686 Meta-analysis https://doi.org/10.1016/j.ajcnut.2024.01.009 II Subclinical AF – Anticoagulate or Not? Anticoagulation in Subclinical AF May Offer Little Benefit https://www.medscape.com/viewarticle/anticoagulation-subclinical-af-may-offer-little-benefit-2025a1000b31 Treat AFib ‘Diagnosed' by Smartwatch https://www.medscape.com/viewarticle/treat-afib-diagnosed-smartwatch-2025a1000avp JAMA NO paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833437 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 McIntyre meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512 Singer et al https://pmc.ncbi.nlm.nih.gov/articles/PMC2777526/ Stroke paper https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.123.045843 American Journal of Medicine paper https://pubmed.ncbi.nlm.nih.gov/38331136/ III GLP1a for Treatment of Fatty Liver Disease ESSENCE trial https://www.nejm.org/doi/10.1056/NEJMoa2413258 Features CABG Still Superior to Stents Despite FAME 3 Endpoint Swap https://www.medscape.com/viewarticle/cabg-still-superior-stents-despite-fame-3-endpoint-swap-2025a1000ao5 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The FDA approval of TAVR for asymptomatic AS, digital health, subcutaneous vs transvenous ICD, and cryptogenic stroke in young adults are discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I  FDA announces approval for TAVR in pts with asymptomatic AS Edwards Press Release https://www.edwards.com/newsroom/news/2025-05-01-edwards-tavr-receives-fda-approval-for-patients-with-asymptomatic-severe-aortic-stenosis Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis (EARLY TAVR) https://www.nejm.org/doi/full/10.1056/NEJMoa2405880 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec Asymptomatic Aortic Stenosis: 'Time to Act' or Not So Fast? https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9 II PPG that Can Distinguish source of Tachycardia Machine-learning guided differentiation between photoplethysmography waveforms of supraventricular and ventricular origin https://doi.org/10.1016/j.cmpb.2025.108798 III PRAETORIAN -XL trial Device-related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-term Follow-up: the PRAETORIAN-XL Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.074576 Subcutaneous or Transvenous Defibrillator Therapy (PRAETORIAN trial) https://www.nejm.org/doi/full/10.1056/NEJMoa1915932 Subcutaneous or Transvenous Defibrillator Therapy Letter to Editor https://www.nejm.org/doi/full/10.1056/NEJMc2034917 The PRAETORIAN Trial: Guarded Approach to Subcutaneous ICD Best https://www.medscape.com/viewarticle/937156 IV Stroke in Young People Burden of Modifiable Risk Factors in Young-Onset Cryptogenic Ischemic Stroke by High-Risk Patent Foramen Ovale https://www.ahajournals.org/doi/10.1161/STROKEAHA.124.049855 Migraine: A Key Factor in Young Adults With Unexplained Stroke https://www.medscape.com/viewarticle/migraine-key-factor-young-adults-unexplained-stroke-2025a10009jj U.S. stroke rate declining in adults 75 and older, yet rising in adults 49 and younger ASA statement https://newsroom.heart.org/news/u-s-stroke-rate-declining-in-adults-75-and-older-yet-rising-in-adults-49-and-younger Increasing stroke in the young https://doi.org/10.1016/j.ajpc.2020.100085 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

En este episodio entrevistamos a Bernat de las Heras, investigador en neurorehabilitación y experto en neuroplasticidad post-ictus. Desde su formación inicial en Ciencias del Deporte hasta su doctorado en la Universidad McGill, Bernat ha explorado cómo el ejercicio cardiovascular —en especial el aeróbico y HIIT— puede modular la neuroplasticidad cerebral tras un ictus. Bernat nos explica los beneficios y limitaciones del entrenamiento interválico de alta intensidad, su percepción por parte de los pacientes, y cómo combinarlo de forma efectiva con otras estrategias terapéuticas. Hablamos también de aprendizaje y localización de la lesión. Una conversación profunda y práctica para entender los límites actuales de la evidencia, y al mismo tiempo, abrir nuevas vías para la rehabilitación neurológica individualizada. Referencias del episodio: 1) Ploughman, M., Attwood, Z., White, N., Doré, J. J., & Corbett, D. (2007). Endurance exercise facilitates relearning of forelimb motor skill after focal ischemia. The European journal of neuroscience, 25(11), 3453–3460. https://doi.org/10.1111/j.1460-9568.2007.05591.x (https://pubmed.ncbi.nlm.nih.gov/17553014/). 2) Jeffers, M. S., & Corbett, D. (2018). Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function. Stroke, 49(6), 1496–1503. https://doi.org/10.1161/STROKEAHA.118.020814 (https://pubmed.ncbi.nlm.nih.gov/29752347/). 3) De Las Heras, B., Rodrigues, L., Cristini, J., Moncion, K., Ploughman, M., Tang, A., Fung, J., & Roig, M. (2024). Measuring Neuroplasticity in Response to Cardiovascular Exercise in People With Stroke: A Critical Perspective. Neurorehabilitation and neural repair, 38(4), 303–321. https://doi.org/10.1177/15459683231223513 (https://pubmed.ncbi.nlm.nih.gov/38291890/). 4) Roig, M., & de Las Heras, B. (2018). Acute cardiovascular exercise does not enhance locomotor learning in people with stroke. The Journal of physiology, 596(10), 1785–1786. https://doi.org/10.1113/JP276172 (https://pubmed.ncbi.nlm.nih.gov/29603752/). 5) Rodrigues, L., Moncion, K., Eng, J. J., Noguchi, K. S., Wiley, E., de Las Heras, B., Sweet, S. N., Fung, J., MacKay-Lyons, M., Nelson, A. J., Medeiros, D., Crozier, J., Thiel, A., Tang, A., & Roig, M. (2022). Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke. Trials, 23(1), 442. https://doi.org/10.1186/s13063-022-06359-w (https://pubmed.ncbi.nlm.nih.gov/35610659/). 6) Cristini, J., Kraft, V. S., De Las Heras, B., Rodrigues, L., Parwanta, Z., Hermsdörfer, J., Steib, S., & Roig, M. (2023). Differential effects of acute cardiovascular exercise on explicit and implicit motor memory: The moderating effects of fitness level. Neurobiology of learning and memory, 205, 107846. https://doi.org/10.1016/j.nlm.2023.107846 (https://pubmed.ncbi.nlm.nih.gov/37865261/). 7) Moncion, K., Rodrigues, L., De Las Heras, B., Noguchi, K. S., Wiley, E., Eng, J. J., MacKay-Lyons, M., Sweet, S. N., Thiel, A., Fung, J., Stratford, P., Richardson, J. A., MacDonald, M. J., Roig, M., & Tang, A. (2024). Cardiorespiratory Fitness Benefits of High-Intensity Interval Training After Stroke: A Randomized Controlled Trial. Stroke, 55(9), 2202–2211. https://doi.org/10.1161/STROKEAHA.124.046564 (https://pubmed.ncbi.nlm.nih.gov/39113181/). 8) De las Heras, B., Rodrigues, L., Cristini, J., Moncion, K., Dancause, N., Thiel, A., Edwards, J. D., Eng, J. J., Tang, A., & Roig, M. (2024). Lesion location changes the association between brain excitability and motor skill acquisition post-stroke. medRxiv. https://doi.org/10.1101/2024.07.30.24311146 (https://www.medrxiv.org/content/10.1101/2024.07.30.24311146v1.article-info). 9) Rodrigues, L., Moncion, K., Angelopoulos, S. A., Heras, B. L., Sweet, S., Eng, J. J., Fung, J., MacKay-Lyons, M., Tang, A., & Roig, M. (2025). Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-stroke?. Archives of physical medicine and rehabilitation, S0003-9993(25)00498-8. Advance online publication. https://doi.org/10.1016/j.apmr.2025.01.468 (https://pubmed.ncbi.nlm.nih.gov/39894292/). 10) de Las Heras, B., Rodrigues, L., Cristini, J., Weiss, M., Prats-Puig, A., & Roig, M. (2022). Does the Brain-Derived Neurotrophic Factor Val66Met Polymorphism Modulate the Effects of Physical Activity and Exercise on Cognition?. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry, 28(1), 69–86. https://doi.org/10.1177/1073858420975712 (https://pubmed.ncbi.nlm.nih.gov/33300425/). 11) MacKay-Lyons, M., Billinger, S. A., Eng, J. J., Dromerick, A., Giacomantonio, N., Hafer-Macko, C., Macko, R., Nguyen, E., Prior, P., Suskin, N., Tang, A., Thornton, M., & Unsworth, K. (2020). Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Physical therapy, 100(1), 149–156. https://doi.org/10.1093/ptj/pzz153 (https://pubmed.ncbi.nlm.nih.gov/31596465/).

Send us a textIn this engaging conversation, Dr. Emin Maltepe shares his journey as a neonatologist and physician scientist, discussing the serendipitous events that shaped his research interests, particularly in hypoxia and drug development for neonatology. He reflects on the importance of mentorship, the challenges of drug development in pediatrics, and the MD-PhD pathway, providing insights into the complexities of balancing clinical practice with research. In this conversation, Emin Maltepe discusses his journey through the MD-PhD program and how it shaped his career in pediatric drug development. He highlights the significant challenges faced in developing therapeutics for pediatric populations, particularly preterm infants, and the lack of attention and funding in this area. Emin shares insights into his innovative approaches to drug and device development, including collaborations with global organizations and the importance of using appropriate animal models. He emphasizes the need for policy advocacy and business knowledge in the field of pediatric therapeutics, while also reflecting on the personal challenges and rewards of balancing family life with a demanding career.Resources mentioned in episode:https://www.ahajournals.org/doi/10.1161/STROKEAHA.124.048264https://journals.lww.com/shockjournal/fulltext/2024/07000/omx__a_novel_oxygen_delivery_biotherapeutic.14.aspxhttps://www.nature.com/articles/s41598-023-36653-9https://www.nature.com/articles/s41587-021-00866-yhttps://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2005924Episode Webpage Link:As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Health and income, high BP in the hospital, and more on subclinical AF and when to use anticoagulants are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic   I. Health and Income  A Cash Giveaway to Improve Health https://www.medscape.com/viewarticle/cash-giveaway-improve-health-2024a1000dhf?form=fpf JAMA RCT https://jamanetwork.com/journals/jama/fullarticle/2821454 NBER RCT https://www.nber.org/papers/w32711 Have We Missed the Hidden Cause of Medical Overuse? https://www.medscape.com/viewarticle/908309 Mar 17, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/989775 Other References  Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120 Rand Link https://www.rand.org/pubs/reports/R3055.html The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/ Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576 Full Coverage for Preventive Medications after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmsa1107913 Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial InfarctionThe ARTEMIS Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2720024 II. Elevated BP in the hospital JAMA-IM https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821364 III. Short-duration Subclinical AF Apixaban Cuts Stroke but Ups Bleeding in Subclinical AF: ARTESIA https://www.medscape.com/viewarticle/998379 ARTESiA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 ARTESiA CHADSVASC Subgroup  https://www.jacc.org/doi/10.1016/j.jacc.2024.05.002 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 EHJ NOAH subanalysis https://doi.org/10.1093/eurheartj/ehae225 Stroke: Prolonged Heart Rhythm Monitoring After Stroke https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.045843 EHRA Analysis https://esc365.escardio.org/EHRA-Congress/sessions/10668   You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington   Questions or feedback, please contact news@medscape.net

Highlights from this episode: - ALAN and Stroke - DST and Mortality - Lamps and Fixtures that Are Not Sponsors - New OrdinancesSponsor:  Evluma  https://evluma.com/dark-sky-friendly-lighting/ Intro and outro music by Doctor Turtle Headlines and Sources:ALAN Increases Risk of Strokehttps://www.ahajournals.org/doi/10.1161/STROKEAHA.123.044904ANSES Recommends Limiting Blue Light Exposurehttps://www.anses.fr/en/content/leds-anses%E2%80%99s-recommendations-limiting-exposure-blue-lightDST Does Affect Mortality Rateshttps://bmjmedicine.bmj.com/content/3/1/e000771Low Income, Racialized Neighborhoods in US South Have More Light Pollutionhttps://www.mdpi.com/2624-5175/6/2/16Red Lights for Research Labshttps://www.arch-products.com/featured/article/33016026/the-case-for-using-narrow-spectrum-non-filtered-red-led-lighting-in-animal-research-facilitiesPanasonic Launches Anti-Glare Anti-Light Pollution LED Flood Lamphttps://re-how.net/699537/Cree Lighting Debuts Street Lighting Products for 'Visual Comfort' https://www.uslightingtrends.com/portfolio/cree-lighting-introduces-guideway-series-street-light-that-delivers-visual-comfort/ Emerson Offers New Industrial LEDs for Low Light Trespasshttps://electricalindustry.ca/product-news/emerson-upgrades-led-industrial-luminaires-to-support-drive-to-lower-energy-requirements-and-minimize-light-pollution/More Brands Are Offering Turtle-Friendly Tape LEDshttps://www.lightnowblog.com/2024/03/growth-in-turtle-friendly-tape-light/UK Gov to Research Headlightshttps://www.iaaf.co.uk/news/govt-plans-to-independently-research-headlamp-glare/#:~:text=Once%20implemented%2C%20these%20tougher%20requirements,identify%20any%20further%20appropriate%20mitigations.UT Governor Signs Dark Sky Month Proclamationhttps://utahnewsdispatch.com/briefs/utah-governor-names-april-dark-sky-month/Summit County and Park City, UT Set Lighting Ordinanceshttps://www.kpcw.org/summit-county/2024-04-04/summit-county-park-city-dark-skies-ordinances-take-full-effect-this-yearBrisbane, CA Begins Work on Lighting Ordinance Compliancehttps://www.cbsnews.com/sanfrancisco/news/brisbane-woman-hopes-to-bring-back-starry-sky-by-reducing-light-pollution/Truckee, CA Launches Rebate Program for Responsible Lightinghttps://www.sierrasun.com/news/town-of-truckee-urging-residents-to-embrace-the-night-launches-dark-skies-rebate-program/Marathon, Fl Amends Lighting Ordinance for Trespass Ruleshttps://keysweekly.com/42/which-lights-are-legal-graphic-illustrates-new-ordinance-in-marathon/ Oak Hill Development Threatens DS Statushttps://www.kxan.com/investigations/will-oak-hill-project-affect-nearby-dark-sky-community/Edison County, NJ Sues Over Billboardshttps://www.yahoo.com/news/edison-looking-crack-down-billboards-085217744.htmlSC Beaches Ready for Turtle Nestinghttps://original.newsbreak.com/@explore-beaufort-sc-1602564/3390301419606-sea-turtle-nesting-season-coming-soon-to-south-carolina-beachesToronto, ON Begins Lights Out Campaignhttps://totimes.ca/city-launches-lights-out-toronto-campaign-to-protect-migratory-birds/NV to Offer 'Dark Sky' License Plateshttps://www.2news.com/news/local/nevadas-new-license-plate-celebrates-dark-skies-conservation/article_755dc4c4-f158-11ee-ad19-1765e6ee14a6.htmlGMU Cancels Cricket Pitch Planshttps://www.gazetteleader.com/fairfax/sports/pullback-on-cricket-field-leaves-university-baseball-team-in-limbo-8528201Connect with Restoring Darkness:Instagram: @restoringdarknessTwitter: restoringdrknssFacebook: restoringdarknessLinkedin: restoring-darknesswww.restoringdarkness.com

Beta-blocker withdrawal in HFpEF, the ARCADIA trial, food as medicine, and bariatric surgery are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. HFpEF and Heart Rate PRESERVE HF Substudy https://jamanetwork.com/journals/jamacardiology/fullarticle/2814596 PRESERVE HF Original https://doi.org/10.1016/j.jacc.2021.08.073 II. ARCADIA trial ARCADIA Main Paper: Apixaban vs ASA https://jamanetwork.com/journals/jama/fullarticle/2814933 KAMEL's AF and Stroke Paper 10.1161/STROKEAHA.115.012004 AVERROES Substudy -- 10.1016/S1474-4422(12)70017-0 III. Food as Medicine Food-As-Medicine Trial results: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812982 NPR Story https://www.npr.org/sections/thesalt/2017/05/08/526952657/fresh-food-by-prescription-this-health-care-firm-is-trimming-costs-and-waistline IV. Bariatric Surgery Weight Loss Surgery Yields Long-Term BP Control in Obesity https://www.medscape.com/viewarticle/weight-loss-surgery-yields-long-term-bp-control-obesity-2024a10002le Gateway RCT https://doi.org/10.1016/j.jacc.2023.11.032 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode of CUBIST, Amanda, and Don discuss the article “Traumatic brain injury and long-term risk of stroke among U.S. military service members," written by Andrea Schneider and her colleagues and published in the journal Stroke in August of 2023. In addition, a senior biostatistician at TBICoE, Mr. Brian Ivins, helps decipher some of the biostatistical issues that were raised by this study. Article Citation: Schneider, A. L. C., Peltz, C. B., Li, Y., Bahorik, A., Gardner, R. C., & Yaffe, K. (2023). Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans. Stroke, 54(8), 2059–2068. https://doi.org/10.1161/STROKEAHA.123.042360 Article LINK: pubmed.ncbi.nlm.nih.gov/37334708/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury most relevant to patient care. For more about TBI, including clinical tools, go to www.health.mil/TBICoE or email us at dha.TBICoEinfo@health.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.

In this episode of CUBIST, Amanda, and Don discuss the article “Traumatic brain injury and long-term risk of stroke among U.S. military service members," written by Andrea Schneider and her colleagues and published in the journal Stroke in August of 2023. In addition, a senior biostatistician at TBICoE, Mr. Brian Ivins, helps decipher some of the biostatistical issues that were raised by this study. Article Citation: Schneider, A. L. C., Peltz, C. B., Li, Y., Bahorik, A., Gardner, R. C., & Yaffe, K. (2023). Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans. Stroke, 54(8), 2059–2068. doi.org/10.1161/STROKEAHA.123.042360 Article LINK: pubmed.ncbi.nlm.nih.gov/37334708/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury most relevant to patient care. For more about TBI, including clinical tools, go to www.health.mil/TBICoE or email us at dha.TBICoEinfo@health.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0

In this episode, guest host and neurointerventional surgeon Dr. Krishna Amuluru interviews triple-boarded neurointerventional surgeon, neurointensivist, and neurologist Dr. Fawaz Al-Mufti about stroke thrombectomy in special populations. --- CHECK OUT OUR SPONSOR MicroVention FRED X https://www.fred-x.com/ --- SHOW NOTES Fawaz serves as an Associate Professor, Director of Neuroendovascular Surgery Fellowship & Neurocritical-Care Unit, Assistant Dean of GME research, and Vice-Chair of Neurology research at New York Medical College, Westchester Medical Center. First, we define the special populations that have been excluded from stroke thrombectomy randomized controlled trials (RCTs). These populations include octogenarian, nonagenarian, pediatric, and pregnant patients. Fawaz then recaps the landmark trials that have shaped the field of neuroendovascular surgery, beginning with the handful that were published in 2015/2016. Approaching mechanical stroke thrombectomy in patients in their 80s and 90s and the lack of existing RCT literature is also discussed. Switching gears, Fawaz then speaks on caring for pediatric patients with large-vessel occlusion (LVO). Krishna and Fawaz cover the relative rarity of pediatric LVOs, significant differences in adult vs. pediatric stroke, and what literature exists to help guide decision-making in this patient population. Krishna then asks Fawaz about mechanical stroke thrombectomy in pregnant patients. They also cover existing literature, etiologies, and their approaches to intervention. To conclude the episode, Fawaz and Krishna speak on the purposes, applications, extrapolations, and limitations of randomized-controlled trials. --- RESOURCES SVIN 2023 Annual Meeting: https://www.svin.org/i4a/pages/index.cfm?pageid=3625 IMS-III Trial 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214300 Mr. Clean Study: https://www.nejm.org/doi/full/10.1056/nejmoa1411587 REVASCAT Study: https://www.nejm.org/doi/full/10.1056/nejmoa1503780 EXTEND-IA Study: https://www.nejm.org/doi/full/10.1056/nejmoa1414792 ESCAPE Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1414905 SWIFT PRIME Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1415061 HERMES Registry: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00351-2/fulltext?rss%3Dyes Thrombolysis in Pediatric Stroke Study (TIPS): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342311/ Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke Study: https://www.ahajournals.org/doi/10.1161/strokeaha.108.519066#:~:text=Analysis%20of%20Delay%20in%20Arterial,and%2020%25%20within%206%20hours. Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke Study: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036361 Recanalization Treatments for Pediatric Acute Ischemic Stroke in France (Kids-Clot): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796278 Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study: https://pubmed.ncbi.nlm.nih.gov/31609380/ Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee: https://jnis.bmj.com/content/14/10/1033 O-039 diameters of large vessels in children and compatibility with adult interventional stroke devices: children are not little adults: https://jnis.bmj.com/content/7/Suppl_1/A21.1 Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke: A Multi-Institutional Experience of Technical and Clinical Outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8660626/#bib28 WEB Device from Microvention TERUMO: https://www.microvention.com/products/web-family

Lege Sjur Even Aunmo er opptatt av å følge med på forskning. I denne episoden forteller han om problemene med å leve av planter. Planter har nemlig forsvarsmekanismer mot å bli spist. De kan dessuten stjele mineraler, trigge immunsystemet, tilføre tungmetall og gi næring til kreft. Selv foretrekker han et kosthold bestående utelukkende av animalske produkter. Han synes det er beklagelig at rådene har blitt politiske gjennom at de har tatt inn klimasaken, fremfor at de er en mest mulig sann fremstilling av hva ulike typer mat gjør med kroppen. Aunmo legger frem forskningsevidens som peker i motsatt retning av kostholdsrådene norske myndigheter har lagt frem nylig. Han har mange suksesshistorier fra pasienter med autoimmune sykdommer, diabetes og andre sykdommer, som har blitt friske etter at de sluttet å spise bestemte typer planter, produkter fra planter eller utelukket dem helt fra kosten.Sjur Even Aunmo: • youtube.com • facebook.comGrønnsaker uten noen kjent form for gluten: • hodekål, blomkål, brokkoli, paprika, rødbeter, bladbete, squash, potet, søtpotet, gulrøtter, gresskar, romano-salat, indisk bladsennep, spinat, grønnkål • Obs: Selv om disse plantene ikke inneholder gluten, finnes det andre stoffer i dem som er uheldige. Paprika, for eksempel, hører til søtvier-familien, sammen med potet og tobakk. De forsvarer seg mot mennesker, dyr og insekter med lektiner og solanin. Spinat inneholder mye oksalat som stjeler kalsium fra kroppen. Det finnes igjen i nyrestener og mistenkes for å stimulere brystkreft. Grønnsaker inneholder druesukker, som er et viktig næringsstoff for kreft. Grønnsaker som vokser over bakken inneholder ofte mindre sukker enn de som vokser under bakken. De minst usunne grønnsakene på listen synes å være hodekål, blomkål og brokkoli, på tross av at disse danner goitrin, et stoff som motvirker dannelsen av stoffskiftehormon.Diverse kilder: • Mindre kjøtt, mer plantebasert: Her kommer De nordiske ernæringsanbefalingene 2023 • Helsedirektoratets kostråd • The Seven Countries Study (søk) • Paleo diet (søk) • Keto diet (søk) • Carnivore diet (søk)› Relaterte AJP-episoder: • AJP 61 | Sjur Even Aunmo – Fikk sparken for å snakke om bivirkningerRelatert forskning:› FETT› https://doi.org/10.1136/bmj.e8707 Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis› https://doi.org/10.1136/bmj.i1246 Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)› https://doi.org/10.3945/ajcn.2009.27725 Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease› https://doi.org/10.1186/s12937-017-0254-5 The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials› https://doi.org/10.1016/j.jacc.2020.05.077 Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review› http://dx.doi.org/10.1136/openhrt-2014-000196 Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis› http://dx.doi.org/10.1136/bmjebm-2019-111180 Fat or fiction: the diet-heart hypothesis› https://www.mn.uio.no/ibv/tjenester/kunnskap/plantefys/leksikon/h/herdet-fett.html› https://doi.org/10.1046/j.1471-4159.1997.68052092.x 4-Hydroxynonenal-Derived Advanced Lipid Peroxidation End Products Are Increased in Alzheimer's Disease› https://doi.org/10.1016/j.freeradbiomed.2006.07.021 Induction of mitochondrial nitrative damage and cardiac dysfunction by chronic provision of dietary ω-6 polyunsaturated fatty acids› https://doi.org/10.1038/s41467-018-05614-6 Dietary stearic acid regulates mitochondria in vivo in humans› http://dx.doi.org/10.17140/AFTNSOJ-1-123 Oxidation of Polyunsaturated Fatty Acids and its Impact on Food Quality and Human Health› https://doi.org/10.1194/jlr.M026179 Dietary oxidized n-3 PUFA induce oxidative stress and inflammation: role of intestinal absorption of 4-HHE and reactivity in intestinal cells› https://doi.org/10.1021/jf049207s Effect of the Type of Frying Culinary Fat on Volatile Compounds Isolated in Fried Pork Loin Chops by Using SPME-GC-MS› STATINER (KOLESTEROLSENKENDE STOFFER)› http://dx.doi.org/10.1136/bmjopen-2018-023085 Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews› http://dx.doi.org/10.1136/bmjopen-2014-007118 The effect of statins on average survival in randomised trials, an analysis of end point postponement› https://doi.org/10.1001/archinternmed.2010.182 Statins and All-Cause Mortality in High-Risk Primary Prevention: A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants› https://www.felleskatalogen.no/medisin/lipitor-upjohn-eesv-pfizer-560999› https://www.felleskatalogen.no/medisin/zocor-organon-565655› https://www.legemiddelhandboka.no/L8.15.1/Statiner› https://www.bmj.com/campaign/statins-open-data Statins - a call for transparent data› https://doi.org/10.1001/archinternmed.2011.625 Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative› https://doi.org/10.1007/s40264-017-0620-4 Amyotrophic Lateral Sclerosis Associated with Statin Use: A Disproportionality Analysis of the FDA's Adverse Event Reporting System› https://doi.org/10.1001/jamainternmed.2020.6084 Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years› https://doi.org/10.1016/j.atherosclerosis.2022.07.003 Statin therapy for the primary prevention of cardiovascular disease: Cons› http://doi.org/10.1161/STROKEAHA.121.034576 Lipid-Lowering Therapy and Hemorrhagic Stroke RiskLipid-Lowering Therapy and Hemorrhagic Stroke Risk› KJØTT› https://www.acpjournals.org/doi/full/10.7326/M19-0622 Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes A Systematic Review of Randomized Trials› https://doi.org/10.3945/ajcn.116.142521 Total red meat intake of ≥0.5 servings/d does not negatively influence cardiovascular disease risk factors: a systemically searched meta-analysis of randomized controlled trials› https://doi.org/10.3945/ajcn.113.062638 Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies› FISK› https://doi.org/10.1093/jn/nxab112 Biomarkers and Fatty Fish Intake: A Randomized Controlled Trial in Norwegian Preschool Children› https://doi.org/10.1007/s12016-013-8363-1 Fish Allergy: In Review› KOLESTEROL› http://dx.doi.org/10.1136/bmjopen-2015-010401 Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review› https://doi.org/10.1016/j.mehy.2018.09.019 Inborn coagulation factors are more important cardiovascular risk factors than high LDL-cholesterol in familial hypercholesterolemia› PMID: 18277343 ApoB/ApoA1 ratio and subclinical atherosclerosis› https://doi.org/10.1016/0021-9150(89)90130-5 Cigarette smoking renders LDL susceptible to peroxidative modification and enhanced metabolism by macrophages› https://doi.org/10.1161/01.CIR.93.7.1346 Cigarette Smoking Potentiates Endothelial Dysfunction of Forearm Resistance Vessels in Patients With Hypercholesterolemia: Role of Oxidized LDL› https://doi.org/10.1161/01.CIR.97.20.2012 Passive Smoking Induces Atherogenic Changes in Low-Density Lipoprotein› https://doi.org/10.1016/j.atherosclerosis.2008.04.046 Smoking and smoking cessation—The relationship between cardiovascular disease and lipoprotein metabolism: A review› https://doi.org/10.1161/ATVBAHA.113.300156 Smoking and Cardiovascular Disease› https://doi.org/10.3402/fnr.v59.29240 LDL biochemical modifications: a link between atherosclerosis and aging› https://doi.org/10.1016/j.cjca.2017.07.015 Association Between Circulating Oxidized LDL and Atherosclerotic Cardiovascular Disease: A Meta-analysis of Observational Studies› https://doi.org/10.1054/plef.2000.0204 Why is glycated LDL more sensitive to oxidation than native LDL? A comparative study.› KARBOHYDRAT› https://www.helsedirektoratet.no/rapporter/anbefalinger-om-kosthold-ernaering-og-fysisk-aktivitet/Anbefalinger%20om%20kosthold%20ern%C3%A6ring%20og%20fysisk%20aktivitet.pdf/_/attachment/inline/2f5d80b2-e0f7-4071-a2e5-3b080f99d37d:2aed64b5b986acd14764b3aa7fba3f3c48547d2d/Anbefalinger%20om%20kosthold%20ern%C3%A6ring%20og%20fysisk%20aktivitet.pdf› FRUKTOSE› https://doi.org/10.1016/j.jhep.2021.02.027 Fructose- and sucrose- but not glucose-sweetened beverages promote hepatic de novo lipogenesis: A randomized controlled trial› https://doi.org/10.1093/ajcn/nqaa332 Effects of fructose restriction on liver steatosis (FRUITLESS); a double-blind randomized controlled trial› https://doi.org/10.5223/pghn.2021.24.5.483 The Relationship between Daily Fructose Consumption and Oxidized Low-Density Lipoprotein and Low-Density Lipoprotein Particle Size in Children with Obesity› KUNSTIG SØTNING› https://doi.org/10.1016/s0378-8741(99)00081-1 Effects of chronic administration of Stevia rebaudiana on fertility in rats› https://doi.org/10.1371/journal.pone.0000698 Intense Sweetness Surpasses Cocaine Reward› https://doi.org/10.1016/j.cell.2022.07.016 Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance› https://doi.org/10.1289/ehp.8711 First Experimental Demonstration of the Multipotential Carcinogenic Effects of Aspartame Administered in the Feed to Sprague-Dawley Rats› https://doi.org/10.1289/ehp.10271 Life-Span Exposure to Low Doses of Aspartame Beginning during Prenatal Life Increases Cancer Effects in Rats› DIABETES› https://doi.org/10.1001/jama.295.6.655 Low-Fat Dietary Pattern and Risk of Cardiovascular DiseaseThe Women's Health Initiative Randomized Controlled Dietary Modification Trial – se side 661, økt hjerte/kar-risk sfa. Lavfett-diett› https://doi.org/10.3945/ajcn.110.010843 Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the Women's Health Initiative (WHI) Dietary Modification trial› https://doi.org/10.1007/s11745-008-3274-2 AOCS Lipids (lavranket journal) Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet› https://doi.org/10.1161/ATVBAHA.114.303284 Small Dense Low-Density Lipoprotein-Cholesterol Concentrations Predict Risk for Coronary Heart Disease- ArtThromVas prospektiv kohort› https://doi.org/10.1097/MOL.0b013e328306a057 Glycation as an atherogenic modification of LDL : Current Opinion in Lipidology› https://doi.org/10.1016/0021-9150(93)90084-8 Glycosylated low density lipoprotein is more sensitive to oxidation: implications for the diabetic patient?› https://doi.org/10.2337/diabetes.55.02.06.db05-1103 Loss of Endothelial Glycocalyx During Acute Hyperglycemia Coincides With Endothelial Dysfunction and Coagulation Activation In Vivo› https://doi.org/10.1016/S0895-7061(00)01260-7 Blood viscosity and blood pressure: role of temperature and hyperglycemia› https://doi.org/10.2337/dc13-1374 Blood Viscosity in Subjects With Normoglycemia and Prediabetes› https://doi.org/10.1007/s00592-017-1004-z Elevated 1-h post-challenge plasma glucose levels in subjects with normal glucose tolerance or impaired glucose tolerance are associated with whole blood viscosity› https://doi.org/10.1080/09674845.2010.11730293 Blood viscosity at different stages of diabetes pathogenesis.› DIABETES-DEMENS› https://doi.org/10.1212/WNL.53.9.1937 Diabetes mellitus and the risk of dementia - The Rotterdam Study› https://doi.org/10.1016/S1474-4422(05)70284-2 Lancet Neurology 2006, sysrew lavere evidensgrad. Risk of dementia in diabetes mellitus: a systematic review› https://doi.org/10.1111/j.1445-5994.2012.02758.x Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies› https://doi.org/10.1016/j.arr.2019.100944 Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies› https://doi.org/10.1177/193229680800200619 Alzheimer's Disease is Type 3 Diabetes—Evidence Reviewed› https://doi.org/10.3390/ijerph120708281 Evaluating the Association between Diabetes, Cognitive Decline and Dementia› https://doi.org/10.3390/ijms21030934 Ketone Bodies Promote Amyloid-β1–40 Clearance in a Human in Vitro Blood–Brain Barrier Model› https://doi.org/10.1038/s41574-018-0048-7 Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications› https://doi.org/10.1038/s41586-020-2247-3 APOE4 leads to blood–brain barrier dysfunction predicting cognitive decline› DIABETES NYRESYKDOM› https://doi.org/10.2337/diacare.27.2007.S79 Nephropathy-in-Diabetes Nephropathy in Diabetes› Diabetic Nephropathy: Diagnosis, Prevention, and Treatment› https://doi.org/10.1016/S0272-6386(96)90538-7 Diabetic nephropathy in type II diabetes› DIABETES ØYESYKDOM› https://doi.org/10.1016/S0140-6736(09)62124-3 Diabetic retinopathy› https://doi.org/10.1016/S2213-8587(18)30128-1 Incidence and progression of diabetic retinopathy: a systematic review› DIABETES HJERTE- OG KAR-SYKDOM› https://doi.org/10.1001/jamacardio.2020.7073 Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women› PLANTE-ANTINÆRINGSSTOFF, VERN OG GIFT› https://doi.org/10.1016/j.foodchem.2008.01.056 Food Chemistry 2008 Bioaccessibility of Ca, Mg, Mn and Cu from whole grain tea-biscuits: Impact of proteins, phytic acid and polyphenols› https://doi.org/10.1002/mnfr.200900099 Phytate in foods and significance for humans: food sources, intake, processing, bioavailability, protective role and analysis.› https://doi.org/10.1046/j.1440-6047.1999.00038.x Oxalate content of foods and its effect on humans› https://doi.org/10.1104/pp.109.2.347 Lectins as plant defense proteins.› https://doi.org/10.1016/j.taap.2009.03.012 Effects of wheat germ agglutinin on human gastrointestinal epithelium: Insights from an experimental model of immune/epithelial cell interaction› https://doi.org/10.1038/s41531-018-0066-0 Ingestion of subthreshold doses of environmental toxins induces ascending Parkinsonism in the rat› https://doi.org/10.1016/S0140-6736(05)79894-9 Identification of intact peanut lectin in peripheral venous blood› https://doi.org/10.1136/bmj.318.7190.1023 Do dietary lectins cause disease?› https://doi.org/10.1016/S0015-0282(16)54596-8 Lectin binding of endometrium in women with unexplained infertility› https://doi.org/10.1016/S0271-5317(88)80133-7 Changes in organs and tissues induced by feeding of purified kidney bean (Phaseolus vulgaris) lectins› https://doi.org/10.3390/molecules20022014 Insecticidal Activity of Plant Lectins and Potential Application in Crop Protection› https://doi.org/10.1210/endo-113-6-1921 Bound Lectins that Mimic Insulin Produce Persistent Insulin-Like Activities› https://doi.org/10.1042/BJ20071137 Contribution of leptin receptor N-linked glycans to leptin binding› https://doi.org/10.1111/j.1365-2249.2007.03368.x Potato lectin activates basophils and mast cells of atopic subjects by its interaction with core chitobiose of cell-bound non-specific immunoglobulin E› https://doi.org/10.1002/(SICI)1521-4141(199903)29:03 Dietary lectins can induce in vitro release of IL-4 and IL-13 from human basophils› https://doi.org/10.1016/j.ekir.2018.07.020 Secondary Oxalate Nephropathy: A Systematic Review› http://dx.doi.org/10.1136/gut.16.3.193 The effect of tea on iron absorption.› PMID: 1862 Disler PB, Lynch SR, Torrance JD, et al. The mechanism of the inhibition of iron absorption by tea. The South African Journal of Medical Sciences. 1975 ;40(4):109-116.› https://doi.org/10.1016/0887-2333(95)00113-1 Effects of saponins and glycoalkaloids on the permeability and viability of mammalian intestinal cells and on the integrity of tissue preparationsin vitro› https://doi.org/10.1079/BJN2002725 The biological action of saponins in animal systems: a review› http://doi.org/10.1093/carcin/bgp082 Lung tumor promotion by curcumin› https://doi.org/10.3945/ajcn.2009.26736M Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford)› https://doi.org/10.3382/ps.0550716 Antithyroid Activity of Goitrin in Chicks› https://doi.org/10.1016/s0278-6915(82)80294-9 Hepatic effects of R-goitrin in in Sprague-Dawley rats› https://doi.org/10.1002/ana.24448 Vagotomy and subsequent risk of Parkinson's disease --> https://doi.org/10.1038/s41531-018-0066-0› Ingestion of subthreshold doses of environmental toxins induces ascending Parkinsonism in the rat› http://doi.org/10.1056/NEJMra2010852 Salicylate Toxicity› https://doi.org/10.1021/jf0113070 Relationship between Cyanogenic Compounds in Kernels, Leaves, and Roots of Sweet and Bitter Kernelled Almonds› https://doi.org/10.1179/146532810X12637745451951Cyanide poisoning caused by ingestion of apricot seeds› https://doi.org/10.3390/toxins11060324 Ricin: An Ancient Story for a Timeless Plant Toxin› https://doi.org/10.1016/j.taap.2009.03.012Effects of wheat germ agglutinin on human gastrointestinal epithelium: Insights from an experimental model of immune/epithelial cell interaction› GLUTEN› https://doi.org/10.1080/00365520500235334 Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines› https://doi.org/10.1053/j.gastro.2008.03.023 Gliadin Induces an Increase in Intestinal Permeability and Zonulin Release by Binding to the Chemokine Receptor CXCR3› https://doi.org/10.1016/j.jprot.2017.03.026 A curated gluten protein sequence database to support development of proteomics methods for determination of gluten in gluten-free foods› https://doi.org/10.1111/jgh.13703 What is gluten?› https://doi.org/10.1186/s41043-015-0032-y The opioid effects of gluten exorphins: asymptomatic celiac disease› https://doi.org/10.1016/j.peptides.2015.07.013 Bioactive peptides derived from natural proteins with respect to diversity of their receptors and physiological effects› SOYA› https://doi.org/10.1271/bbb.70516Soymorphins, novel μ opioid peptides derived from soy β-conglycinin β-subunit, have anxiolytic activities.› TILSETNINGSSTOFFER› https://doi.org/10.3233/NHA-170023 A randomized trial of the effects of the no-carrageenan diet on ulcerative colitis disease activity› https://doi.org/10.1053/j.gastro.2021.11.006 Randomized Controlled-Feeding Study of Dietary Emulsifier Carboxymethylcellulose Reveals Detrimental Impacts on the Gut Microbiota and Metabolome› https://doi.org/10.1002/ijc.21925 Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of Swedish women› KETOGENISITET/KREFT› https://oslo-universitetssykehus.no/behandlinger/pet-undersokelse› https://stanfordhealthcare.org/medical-tests/p/pet-scan/what-to-expect.html› https://www.sciencedirect.com/topics/medicine-and-dentistry/warburg-effect› https://doi.org/10.1016/j.tibs.2015.12.001 The Warburg Effect: How Does it Benefit Cancer Cells?› https://doi.org/10.1080/01635581.2019.1650942 Feasibility, Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study› https://doi.org/10.1093/jnci/djs399 Dietary Glycemic Load and Cancer Recurrence and Survival in Patients with Stage III Colon Cancer: Findings From CALGB 89803› https://doi.org/10.18632/aging.101382 Ketogenic diet in cancer therapy› IATROGENISITET› https://doi.org/10.1111/eci.12834 How to survive the medical misinformation mess› https://doi.org/10.1111/jlme.12068 Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs› https://doi.org/10.1136/bmj.f3830 Why we can't trust clinical guidelines› https://doi.org/10.1016/S0140-6736(15)60696-1 Offline: What is medicine's 5 sigma?› https://apjcn.nhri.org.tw/server/apjcn/procnutsoc/1990-1999/1995/1995%20p1-10.pdfLast ned episodenInnspilt: 2023-07-18Publisert: 2023-07-28Støtte Antijantepodden?Liker du arbeidet vi gjør, og vil bidra til at vi lager flere episoder?Finn ut hvordan du kan gi noe tilbake ved å gå til antijantepodden.com!Meld deg på vårt nyhetsbrev

Carotid stents, the paclitaxel story now closed, inclisiran, DOAC failures, and primary vs secondary prevention are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Carotid Stenting CMS Proposal Expanded Coverage of Carotid Stenting in CMS Draft Proposal https://www.medscape.com/viewarticle/994315 No Added Benefit From Revascularization in Low-Risk CAS https://www.medscape.com/viewarticle/992524 - Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=311 - Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy https://doi.org/10.1016/S0140-6736(21)01910-3 - SPACE-2 https://journals.sagepub.com/doi/10.1177/1747493019833017 - Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial 10.1161/STROKEAHA.120.030730 II. Paclitaxel FDA: No Excess Mortality Risk From Paclitaxel Stents, Balloons for Peripheral Intervention https://www.medscape.com/viewarticle/994253 - FDA Statement https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality?utm_medium=email&utm_source=govdelivery#_FDA_Actions III. Inclisiran FDA Expands Inclisiran Statin-Adjunct Indication to Include Primary Prevention https://www.medscape.com/viewarticle/994185 - ORION 10-11 Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol https://www.nejm.org/doi/10.1056/NEJMoa1912387 - Effect of inclisiran on lipids in primary prevention: the ORION-11 trial https://doi.org/10.1093/eurheartj/ehac615 - Inclisiran and cardiovascular events: a patient-level analysis of phase III trials https://pubmed.ncbi.nlm.nih.gov/36331326/ IV. DOAC Failure Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant https://doi.org/10.1212/WNL.0000000000207422 V. Primary or Secondary Prevention You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Our nursing professors cautioned us about the risk of not using proper technique when removing central lines, their warnings sometimes seeming dramatic and unlikely. That's why this previously released interview with Nurse Marissa is such an important story, because sometimes those rare cases DO happen!In this episode, Marissa tells the story of a patient that was admitted for her mental status, lethargy and hyperkalemia. She seemed to improve but then became unresponsive, and the rapid response team was called. What followed was the surprising discovery of air in her brain, and a probe into how it happened.At the end of Marissa's story, host Sarah Lorenzini shares her research on air embolisms, including how air gets into the bloodstream, what happens when it travels to each part of the body, and the level of risk associated with each scenario.By the end of this episode, you'll know the steps you can take if your patient pulls their central line just like Marissa's patient, what signs to look for, and how to treat a cerebral embolus if it occurs. Tune in now!Topics discussed in this episode:Marissa's journey from Med-Surg nurse to Cardiac ICU to Rapid ResponseHer patient's presentation and patient historyWhat the patient's CT showedHow they treated the patient for air in the brainHow air gets into the bloodstreamThe risk associated with air embolismsWhat to do if your patient pulls their own central lineThings to remember about air embolismsLearn more about the pathophysiology of air embolism in the brain in this article by the American Heart Association, called Accidental Air Embolism: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.119.025340Mentioned in this episode:Rapid Response and Rescue Intro CourseIf you would like to check out Sarah's 1hr, 1 CE course, go to: http://www.rapidresponseandrescue.com To get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST!AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!

A breakdown of what Central Nervous System Vasculitis and what you need to know as a patient as well as insight from patients on life with CNS/PACNS. Here's what you'll find in this episode: What is CNS? What are the symptoms of CNS? What causes CNS? How is CNS Diagnosed? How is CNS treated? Side effects from the medications Life with Vasculitis Patient to Patient Please don't forget to click that subscibe button whereever you listen to the podcast and do me a HUGE favor and leave a review! These two things help others find the podcast, find our community, and feel a little less alone in their journey through life with chronic illness! Join us on Instagram: https://www.instagram.com/teamvasculitis Join the Email List: https://teamvasculitis.com/team-vasculitis-email Sources: https://my.clevelandclinic.org/health/diseases/13205-central-nervous-system-vasculitis https://www.ninds.nih.gov/health-information/disorders/vasculitis-nervous-system https://www.uofmhealth.org/conditions-treatments/brain-neurological-conditions/central-nervous-system-cns-vasculitis https://pn.bmj.com/content/20/2/109 https://www.rheumatologyadvisor.com/ddi/central-nervous-system-cns-vasculitis/ https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021878  

Contributor: Travis Barlock MD Educational Pearls:  Large Vessel Occlusion (LVO) is a condition where a clot blocks one of the major blood vessels in the brain, leading to a stroke. What are the vessels that can experience an LVO? Middle Cerebral artery (MCA) Internal Carotid Artery (ICA) Anterior Cerebral Artery (ACA) Posterior Cerebral Arteries (PCA) Basilar Artery (BA) Vertebral Arteries (VA) What are the locations at which a mechanical thrombectomy can be performed as a treatment for an LVO? Distal ICA, M1 or M2 segments of the MCA, A1 or A2 segments of the ACA, and some evidence for the BA. What are the symptoms of LVO? Use the mnemonic FANG-D to remember a few key symptoms: Field Cut (A person loses vision in a portion of their visual field) Aphasia (Difficulty speaking) Neglect (A person may have difficulty paying attention to or acknowledging stimuli on the affected side of their body or in their environment. For example, a person with neglect may deny that their left hand belongs to them) Gaze Deviation (One or both eyes are turned away from the direction of gaze) Dense Hemiparesis (Paralysis affecting one side of the body) What are the treatment windows for treating an LVO? 24 hours for mechanical thrombectomy 0-4.5 hours for tPA/TNK References 1. Brain embolism, Caplan LR, Manning W (Eds), Informa Healthcare, New York 2006. 2. Berkhemer OA, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi: 10.1056/NEJMoa1411587. Epub 2014 Dec 17. Erratum in: N Engl J Med. 2015 Jan 22;372(4):394. PMID: 25517348. 3. Herpich, Franziska MD1,2; Rincon, Fred MD, MSc, MB.Ethics, FACP, FCCP, FCCM1,2. Management of Acute Ischemic Stroke. Critical Care Medicine 48(11):p 1654-1663, November 2020. 4. Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019 Dec;50(12):3331-3332. doi: 10.1161/STROKEAHA.119.027708. Epub 2019 Oct 30. PMID: 31662117. 5. Hoglund J, Strong D, Rhoten J, Chang B, Karamchandani R, Dunn C, Yang H, Asimos AW. Test characteristics of a 5-element cortical screen for identifying anterior circulation large vessel occlusion ischemic strokes. J Am Coll Emerg Physicians Open. 2020 Jul 24;1(5):908-917. doi: 10.1002/emp2.12188. PMID: 33145539; PMCID: PMC7593424. Summarized by Jeffrey Olson | Edited by Meg Joyce & Jorge Chalit, OMS1  

PODCASTER SENIOR: Silvia Colnaghi; PODCASTER JUNIOR Gaia Fanella; Video: Video 1_Head Impulse.mov - Google DriveVideo 2_Nistagmo.mov - Google DriveVideo 3_Test of Skew.mov - Google Drive;Razionale: La vertigine è un sintomo particolarmente rilevante per la neurologia d'urgenza sia per la sua frequenza sia per la gravità delle malattie delle quali può essere il sintomo. Quanto a frequenza, la vertigine motiva dal 10 al 20% degli accessi in PS e nel 25% di questi casi è il sintomo di un ictus, diagnosi che viene mancata in fase acuta nel 35% dei casi. In particolare, la vertigine è tra i più comuni sintomi di esordio degli ictus del circolo posteriore e solo il 27% di questi pazienti presenta anche dei segni neurologici focali, pertanto stabilire dei criteri per poter valutare se una vertigine acuta, non associata ad altri segni, è ‘centrale' è di grande importanza.Bibliografia: Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008 Jul;83(7):765-75. doi: 10.4065/83.7.765. PMID: 18613993; PMCID: PMC353647 Newman-Toker DE, Peterson SM, Badihian S, Hassoon A, Nassery N, Parizadeh D, Wilson LM, Jia Y, Omron R, Tharmarajah S, Guerin L, Bastani PB, Fracica EA, Kotwal S, Robinson KA. Diagnostic Errors in the Emergency Department: A Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. Report No.: 22(23)-EHC043. PMID: 36574484. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999 Apr;33(4):373-8. doi: 10.1016/s0196-0644(99)70299-4. PMID: 10092713. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke. 2017 Feb;48(2):479-481. doi: 10.1161/STROKEAHA.116.015169. Epub 2017 Jan 12. PMID: 28082668.Saber Tehrani AS, Kattah JC, Mantokoudis G, Pula JH, Nair D, Blitz A, Ying S, Hanley DF, Zee DS, Newman-Toker DE. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014 Jul 8;83(2):169-73. doi: 10.1212/WNL.0000000000000573. Epub 2014 Jun 11. PMID: 24920847; PMCID: PMC4117176. Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015 Aug;33(3):577-99, viii. doi: 10.1016/j.ncl.2015.04.011. PMID: 26231273; PMCID: PMC4522574. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10. doi: 10.1161/STROKEAHA.109.551234. Epub 2009 Sep 17. PMID: 19762709; PMCID: PMC4593511. Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. J Vestib Res. 2022;32(3):205-222. doi: 10.3233/VES-210169. PMID: 35367974; PMCID: PMC9249306. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Kheradmand A, Newman-Toker D. Vestibular migraine: Diagnostic criteria1. J Vestib Res. 2022;32(1):1-6. doi: 10.3233/VES-201644. PMID: 34719447; PMCID: PMC9249276. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis". J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):458-60. doi: 10.1136/jnnp.2007.123596. PMID: 18344397.

As we see more patients who have had Covid-19, we ask psychiatrist, Dr. Imaan Alaidroos, to speak with us about the neuropsychiatric impact of the disease. In this episode, Dr. Alaidroos outlines the treatments that are currently being studied for the neuropsychiatric symptoms of Covid-19. We also chat about the implications of these symptoms for the field of mental health. Hosts: Alan, Toshia Guest: Imaan Alaidroos, MD References: 7. Qureshi, A. I., Baskett, W. I., Huang, W., Shyu, D., Myers, D., Raju, M., Lobanova, I., Suri, M., Naqvi, S. H., French, B. R., Siddiq, F., Gomez, C. R., & Shyu, C. R. (2021). Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients. Stroke, 52(3), 905–912. https://doi.org/10.1161/STROKEAHA.120.031786 8. Helms J, Kremer S, MerdjiH, Clere-JehlR, Schenck M, KummerlenC, et al. Neurologic features in severe SARS-CoV-2 infection. N EnglJ Med. 2020;382:2268–2270. doi: 10.1056/NEJMc2008597. 9. FerrandoSJ, KlepaczL, Lynch S, TavakkoliM, DornbushR, BaharaniR, Smolin Y, Bartell A. COVID-19 psychosis: a potential new neuropsychiatric condition triggered by novel coronavirus infection and the inflammatory response? Psychosomatics. 2020;61:551–555. doi: 10.1016/j.psym.2020.05.012. 10. Parra A, JuanesA, LosadaCP, Álvarez-SesmeroS, Santana VD, Martí I, et al. Psychotic symptoms in COVID-19 patients. A retrospective descriptive study. Psychiatry Res. 2020;291:113254. doi: 10.1016/j.psychres.2020.113254. 11. Farooq, S., Tunmore, J., Wajid Ali, M., & Ayub, M. (2021). Suicide, self-harm and suicidal ideation during COVID-19: A systematic review. Psychiatry research, 306, 114228. https://doi.org/10.1016/j.psychres.2021.114228 12. Stefano, G. B., Büttiker, P., Weissenberger, S., Ptacek, R., Wang, F., Esch, T., Bilfinger, T. V., & Kream, R. M. (2021). Biomedical Perspectives of Acute and Chronic Neurological and Neuropsychiatric Sequelae of COVID-19. Current neuropharmacology, 10.2174/1570159X20666211223130228. Advance online publication. https://doi.org/10.2174/1570159X206662112231 13. de Erausquin, G. A., Snyder, H., Carrillo, M., Hosseini, A. A., Brugha, T. S., Seshadri, S., & CNS SARS-CoV-2 Consortium (2021). The chronic neuropsychiatric sequelae of COVID-19: The need for a prospective study of viral impact on brain functioning. Alzheimer's & dementia : the journal of the Alzheimer's Association, 17(6), 1056–1065. https://doi.org/10.1002/alz.12255 14. PashaeiY. Drug repurposing of selective serotonin reuptake inhibitors: Could these drugs help fight COVID-19 and save lives? J. Clin. Neurosci. 2021;88:163–172. doi: 10.1016/j.jocn.2021.03.010. 15. Dąbrowska, E., Galińska-Skok, B., & Waszkiewicz, N. (2021). Depressive and Neurocognitive Disorders in the Context of the Inflammatory Background of COVID-19. Life (Basel, Switzerland), 11(10), 1056. https://doi.org/10.3390/life11101056 Kępińska AP, Iyegbe CO, Vernon AC, Yolken R, Murray RM, Pollak TA. Schizophrenia and Influenza at the Centenary of the 1918-1919 Spanish Influenza Pandemic: Mechanisms of Psychosis Risk. Front Psychiatry. 2020 Feb 26;11:72. doi: 10.3389/fpsyt.2020.00072. PMID: 32174851; PMCID: PMC7054463.

This week, Syd & Jess will keep you on the edge of your seat with the story of Murder Nurse (and unfortunately, Texas native), William George Davis. We'll cover the story of a man who was recently convicted (Oct 2021) of killing at least 4 patients at a hospital in Tyler, TX, by injecting air into their arterial systems, purposely causing every nurse's worst nightmare - an air embolism.  If you want to help us grow, don't forget to subscribe and leave us a review!Send us an email at: malpracticepodcast@gmail.comFollow us on Instagram, Facebook, and Twitter: @malpracticepodcastSources for this episode:https://people.com/crime/texas-hospital-nurse-serial-killer-murdered-patients-with-ivs/https://www.nytimes.com/2021/10/28/us/texas-nurse-death-penalty.htmlhttps://www.washingtonpost.com/nation/2021/10/20/nurse-convicted-injection-killings/https://nypost.com/2021/10/20/texas-nurse-william-davis-convicted-of-killing-4-patients-with-air-injections/https://www.cbsnews.com/news/william-davis-nurse-death-sentence-killing-four-patients-texas-air-injection/https://tylerpaper.com/news/crime/detective-nurse-accused-of-murder-deflected-police-questioning-gave-indirect-responses-in-interview/article_611dd7b4-2ae1-11ec-87f7-ff74b74d7a85.htmlhttps://www.ahajournals.org/doi/10.1161/STROKEAHA https://www.kltv.com/2021/10/07/murder-trial-day-8-son-alleged-davis-victim-testifies-fathers-surgery-death/ https://www.youtube.com/watch?v=iIPHBAbk4m4 slutcastslut is a derogatory term for a female sex worker. the use of "slut" is an attempt at...Listen on: Apple Podcasts Spotify Smells Like HumansLike spending time with funny friends talking about curious human behavior. Listen on: Apple Podcasts SpotifySupport the show

Guest: Adam Oostema, MD MS FACEP (Associate Professor of EM, Michigan State University College of Human Medicine) Host: Jason Woods MD Select References: National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401. PMID: 7477192. Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke. 2010 Oct;41(10):2381-90. doi: 10.1161/STROKEAHA.110.583807. Epub 2010 Sep 9. PMID: 20829518; PMCID: PMC2949055. Kwiatkowski TG et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999 Jun 10;340(23):1781-7. doi: 10.1056/NEJM199906103402302. PMID: 10362821. Ingall TJ et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004 Oct;35(10):2418-24. doi: 10.1161/01.STR.0000140891.70547.56. Epub 2004 Sep 2. PMID: 15345796. Emberson J et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266. Hacke W et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656. PMID: 18815396. Alper BS et al. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386. Epub 2020 May 19. PMID: 32430395; PMCID: PMC7548536. Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037.

This episode is a preview of the interviews and discussions scheduled EMS on AIR Podcast Season 3.  Below are links to information and references from this episode.  Visit GuardianCME.com for access to free CAPCE accredited EMS CE courses.  Visit https://general-devices.com/ for more info about e-Bridge.Visit 410medical.com for more information about LifeFlow.  Visit CarterKits.org for more info about their sensory bags.  Article:  Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities from the Prehospital Stroke System of Care Consensus Conference. (https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033228)Visit Stroke.org/stroke transportplansPlease keep emailing your questions, comments, feedback, and episode ideas to the EMS on AIR Podcast team by email at Geoff@EMSonAIR.com Visit EMSonAIR.com for the latest information, podcast episodes and other details. Follow us on Instagram @EMSOnAIR.Geoff Lassers, Paramedic I/C, AASHost/Producer, EMS on AIR PodcastFirefighter/Paramedic, West Bloomfield Fire DepartmentEMS System Manager, Oakland County Medical Control AuthorityDirector of Sponsorships, GuardianCME.comGeoff@EMSonAIR.com      Support the show (https://www.patreon.com/emsonair?fan_landing=true)

En el episodio de hoy, vamos a hablar de la cadera post-ictus, un tema que, como dice el título, es una encrucijada, ya que es un lugar donde se cruzan varios caminos, varias explicaciones sobre el movimiento de los pacientes neurológicos. El episodio parte de un introducción, un breve recordatorio anatómico de la cadera, una justificación de por qué hacer episodios como este y después iremos recorriendo algunos estudios que he leído y sintetizado que tienen relación con el fenotipo de la cadera post-ictus. Compensaciones, fatiga, biomecánica...al servicio de la neurociencia. Referencias del episodio: (1) Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010 Feb;40(2):82-94. doi: 10.2519/jospt.2010.3025. PMID: 20118525 (https://pubmed.ncbi.nlm.nih.gov/20118525/). (2) Hyngstrom AS, Onushko T, Heitz RP, Rutkowski A, Hunter SK, Schmit BD. Stroke-related changes in neuromuscular fatigue of the hip flexors and functional implications. Am J Phys Med Rehabil. 2012 Jan;91(1):33-42. doi: 10.1097/PHM.0b013e31823caac0. PMID: 22157434; PMCID: PMC3940208 (https://pubmed.ncbi.nlm.nih.gov/22157434/). (3) Rybar MM, Walker ER, Kuhnen HR, Ouellette DR, Berrios R, Hunter SK, Hyngstrom AS. The stroke-related effects of hip flexion fatigue on over ground walking. Gait Posture. 2014 Apr;39(4):1103-8. doi: 10.1016/j.gaitpost.2014.01.012. Epub 2014 Jan 31. PMID: 24602975; PMCID: PMC4007512 (https://pubmed.ncbi.nlm.nih.gov/24602975/). (4) Lewek MD, Schmit BD, Hornby TG, Dhaher YY. Hip joint position modulates volitional knee extensor muscle activity after stroke. Muscle Nerve. 2006 Dec;34(6):767-74. doi: 10.1002/mus.20663. PMID: 16967491 (https://pubmed.ncbi.nlm.nih.gov/16967491/). (5) Cruz TH, Dhaher YY. Evidence of abnormal lower-limb torque coupling after stroke: an isometric study. Stroke. 2008 Jan;39(1):139-47. doi: 10.1161/STROKEAHA.107.492413. Epub 2007 Dec 6. PMID: 18063824; PMCID: PMC3641752 (https://pubmed.ncbi.nlm.nih.gov/18063824/). (6) Finley JM, Perreault EJ, Dhaher YY. Stretch reflex coupling between the hip and knee: implications for impaired gait following stroke. Exp Brain Res. 2008 Jul;188(4):529-40. doi: 10.1007/s00221-008-1383-z. Epub 2008 Apr 30. PMID: 18446331; PMCID: PMC2881696 (https://pubmed.ncbi.nlm.nih.gov/18446331/). (7) Sulzer JS, Gordon KE, Dhaher YY, Peshkin MA, Patton JL. Preswing knee flexion assistance is coupled with hip abduction in people with stiff-knee gait after stroke. Stroke. 2010 Aug;41(8):1709-14. doi: 10.1161/STROKEAHA.110.586917. Epub 2010 Jun 24. PMID: 20576947; PMCID: PMC3306800 (https://pubmed.ncbi.nlm.nih.gov/20576947/). (8) Matsuda et al. 2016. Analysis of strategies used by hemiplegic stroke patients to achieve toe clearance (https://www.jstage.jst.go.jp/article/jjcrs/7/0/7_111/_article). (9) Awad LN, Bae J, Kudzia P, Long A, Hendron K, Holt KG, OʼDonnell K, Ellis TD, Walsh CJ. Reducing Circumduction and Hip Hiking During Hemiparetic Walking Through Targeted Assistance of the Paretic Limb Using a Soft Robotic Exosuit. Am J Phys Med Rehabil. 2017 Oct;96(10 Suppl 1):S157-S164. doi: 10.1097/PHM.0000000000000800. PMID: 28777105; PMCID: PMC7479995 (https://pubmed.ncbi.nlm.nih.gov/28777105/). (10) Akbas T, Prajapati S, Ziemnicki D, Tamma P, Gross S, Sulzer J. Hip circumduction is not a compensation for reduced knee flexion angle during gait. J Biomech. 2019 Apr 18;87:150-156. doi: 10.1016/j.jbiomech.2019.02.026. Epub 2019 Mar 8. PMID: 30876735 (https://pubmed.ncbi.nlm.nih.gov/30876735/).

Dr. Sabeen Dhand talks with Neurointerventionalist Dr. Ansaar Rai from about his approach to posterior circulation strokes, including patient selection, technique and devices, and pitfalls to avoid. --- CHECK OUT OUR SPONSOR CERENOVUS https://www.jnjmedicaldevices.com/en-US/companies/cerenovus --- SHOW NOTES In this episode, neurointerventional radiologist Dr. Ansaar Rai joins Dr. Sabeen Dhand to discuss posterior circulation stroke, including when to treat with thrombectomy, techniques, and advances in stroke research in recent years. They discuss factors to consider when deciding to treat posterior circulation strokes with thrombectomy. Dr. Rai reports that age is the most important factor, followed by comorbidities and severity of clinical symptoms. He discusses the variability in presentation of basilar artery strokes, ranging from mild ataxia to coma. He treats these aggressively with thrombectomy, especially for young patients. For isolated PCA strokes, he often treats with intra arterial TPA only. Dr. Rai next discusses landmark clinical trials, as well as his own research looking at stroke burden. He found that 2% of all acute ischemic strokes occur in the posterior circulation. Importantly, he postulates that there will never be good posterior circulation trials due to lack of equipoise and difficulty in randomizing to a medical treatment only arm. Dr. Rai uses general anesthesia for posterior circulation strokes. He prefers femoral access, and uses an 8Fr femoral short sheath and a guide catheter (ideally 088), rather than a balloon guide catheter. He then uses an 070 or 072 intermediate aspiration catheter navigated over an 024 microwire (Aristotle) or 027 microcatheter (Duo or XT-27) into the basilar. After trying many techniques, he prefers aspiration using the ADAPT technique. If he has to cross clot, he uses a stent retriever such as Trevo, Embotrap or Solitaire. Due to the delicate vasculature and high risk in posterior circulation thrombectomies, Dr. Rai always uses a J wire, biplane imaging and emphasizes that knowing the anatomy on CT is key to decreasing complications such as dissection or distal embolization. --- RESOURCES ASPECTS score: https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.016745 Route 92 Medical SUMMIT MAX Clinical trial: https://evtoday.com/news/route-92-medicals-monopoint-reperfusion-system-studied-in-pivotal-summit-max-trial#:~:text=According%20to%20Route%2092%20Medical%2C%20SUMMIT%20MAX%20is,sites%20in%20the%20United%20States%20and%20New%20Zealand. The Greater Cincinnati Northern Kentucky Stroke Study: https://www.gcnkss.com MR RESUE trial: https://www.ahajournals.org/doi/full/10.1161/strokeaha.113.001443 IMS3 trial: https://evtoday.com/news/ims-3-substudy-shows-delays-in-stroke-treatment-leads-to-worse-outcomes#:~:text=IMS%203%20was%20a%20multicenter%20international%20trial%20in,received%20tPA%20within%203%20hours%20of%20stroke%20onset. SWIFT PRIME trial: https://evtoday.com/news/covidien-commences-enrollment-for-swift-prime-acute-ischemic-stroke-study#:~:text=The%20SWIFT%20PRIME%20study%20will%20evaluate%20acute%20ischemic,will%20also%20include%20an%20extensive%20health%20economics%20analysis. ADAPT technique trial by Turc: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025753 BEST trial: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30395-3/fulltext#:~:text=The%20BEST%20trial%20was%20a%20multicentre%2C%20prospective%2C%20open-label%2C,the%20institutional%20review%20board%20of%20each%20participating%20site. ATTENTION trial: https://pubmed.ncbi.nlm.nih.gov/35102797/

In this podcast, Dr. Ron Tarrel, a Stroke Neurologist with Allina Health, discusses everything stroke. Dr. Tarrel walks through recognition, evaluation, and management of stroke. He also discusses current guidelines, as well as the future of stroke medicine. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Identify and describe warning signs of stroke and its initial presentation. Assess when initial urgent/emergent evaluation, imaging, coordination of care and decision making needs to occur in regards to stroke. Discuss treatment options and indications in regards to stroke care. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. ADDENDUM TO SHOW NOTES:Please note the Dr. Tarrel refers to TPA as a blood thinner at one point throughout the podcast. He would like the listerner to know that this medication (TPA) is a clot dissolving medication and not a blood thinner. Dr. Tarrel does not wish to confuse the listner on the nomenclature of TPA vs blood thinners (i.e. anticoagulants). SHOW NOTES: FAST The American Heart Association (AHA) put forth an initative for the lay person to recognize signs and symptoms of stroke and that was the FAST assessment which is (Facial asymmetry or weakness, Arm weakness, Speech difficulties, and Time), but now it has moved to the BE-FAST screening test. the BE portion of the FAST exam is assessment of Balance and Eyes to determine if there are posterior circulation findings. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.116.015169 HINTS ExamThe HINTS exam is a bit more specific and sensitve, looking for posterior circulation strokes in the correct patient population. Briefly, HINTS is a Head Impulse test direction-changing Nystagmus in eccentric gaze, or skew deviation. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.551234 Common DeficitsThe majority of strokes are going to occur in the anterior circulation which would be the carotid distribution, then into MCA (M1, M2, M3, M4, M5). Most of the deficits are going to be unilateral weakness, sensory or cognitive symptoms - example: aphasia/ neglect (cortical symptoms). Whereas, posterior circulation (vertebrobasilar) may have more devastating qualities. Symptoms for posterior stroke can include dizziness, nausea and vomiting, nystagmus, coordination, ataxia. However, see the article linked below where posterior cirulation vs anterior crculation infarcts can sometimes be difficult to determine on a clinical exam alone. Therefore, neuroimaging is recommended to accurately determine stroke distribution. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.112.652420 This study indicates that the symptoms/signs considered typical of posterior circulation infarcts occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate posterior circulation infarcts from anterior circulation infarcts. Neuroimaging is vital to ensure acurate localization of cerebral infarction. Hemorrhagic vs Ischemic StrokeWhich one is it? According to Dr. Tarrel, intracranial hemorrhage appears to exhibit more headache symptoms, such as this is the "worst headache of my life" , whereas ischemic stroke appears to be more painless, usually. Blood pressure and loss of consciousness can closely mimic hemorrhagic vs ischemic. Telestroke GuidelinesTelestroke guidelines are generally insitution specific. Refer to the linked article below, on the current guidelines in telestroke medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802246/pdf/tmj.2017.0006.pdf BP / 1st Line AgentFor hemorrhagic strokes, the neurosurgeons and neurologist like the systolic blood pressure to be in the 140-160 range. BP is usually controlled with Nicardipine as a 1st line agent. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.020058 Last Known Well (LKW)Last Known Well (LKW) is extremely important especially since we know that we are working against the closk for the use of lytic therapy (currently 4.5 hour window).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630074/pdf/nihms699406.pdf https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.116.023336 Imaging Imaging modalities for stroke workup can often include an initial non-contrast CT of the head to rule out ICH, but hen what happens? Generally, it is recommended to work in concert with the stroke neurologist to then determine the next line of imaging studies. If it is determined the patient looks to have a high NIHSS and concerns for LVOT (Large Vessel Occulusion) a CTA of the head and neck can be considered. Perfusion studies and advanced MR imaging should be discussed with consulting neurologists. Clinicians should also remember to follow their specific institutional guidelines for imaging studies if the stroke neurologist is unavailable or there is a delay in consultation. LKW along with CTA and CT perfusion of the head in ischemic stroke patients can sometimes give us a picture of the infarct core with surrounding penumbra (ratio). If circumstances are faborable, it may allow the pursuit of a thrombectomy. The current guidelines are for thrombectomy within 6 hours, but consideration upwards of 24 and beyond in the right patient population. Please see the DAWN and DIFFUSE 3 trials. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.027974 ThrombectomyGenerally the neurointerventionalist does not pursue thrombectomy beyond the MCA (M2 region), sometimes depending on anatomy. ASPECT ScoreThe ASPECT Score (Alberta Stroke Program Early CT Score) determines the volume of subcortical and cortical infarct involvement via perfusion study. Generally the score provided is 1-10. Anything less than a 6 portends a poor outcome. More early changes seen on CT suggest poorer outcomes from stroke. Patients with scores >8 have a better chance for an independent outcome. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.016745 IV TPAIV TPA with thrombectomy is safe. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.568451 TNK appears to have the same efficacy as TPA. Single dose IV push over 5 minute infusion. Easier and faster delivery of TNK. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.025080 Institutions may have different absolute and relative contraindications to TPA. Practice should be guided by institutional protocol and consultation with neurology. https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000086 Secondary PreventionSecondary prevention of stroke with the aid of DAPT (Dual Antiplatelet Therapy) - usually Plavix and Aspirin. Patients with cerebra ischemia are at high risk for early recurrent stroke, and use of DAPT for secondary prevention is reflected in current guidelines. Good BP and lipid management is paramount for 2nd stroke prevention. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.028400 Scoring SystemsHAS-BLED score for major bleeding risk. CHA2DS2-VASc Score for artrial fibrillation stroke risk. Anti-thrombotic Therapy & Elderly PatientsChoosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls.https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/484991 Fall risk and anticoagulatoin for atrial fibrillation in the elderly: A delicate balance. https://www.ccjm.org/content/ccjom/84/1/35.full.pdf  

Efectos de diferentes regímenes de Entrenamiento en Intervalos de Alta Intensidad -HIIT- sobre la resistencia y la neuroplasticidad después de derrame cerebral isquemico Caroline Pin-Barre, Nicolas Hugues, Annabelle Constans, Eric Berton, Christophe Pellegrino, Jérôme Laurin Originally published1 Feb 2021https://doi.org/10.1161/STROKEAHA.120.031873 Stroke. 2021;52:1109–1114 Abstracto Traducido del Original Antecedentes y objetivo: El objetivo es comparar los efectos del entrenamiento en intervalos de alta intensidad (HIIT) con intervalos largos versus cortos sobre la resistencia y el rendimiento motor. Su influencia sobre los marcadores de neuroplasticidad se evalúa en la corteza e hipocampo ipsilesional y contralesional ya que su remodelación podría mejorar la recuperación funcional. Métodos: Las ratas realizaron un HIIT4 adaptado al trabajo (intervalos largos: 4 minutos) o HIIT1 (intervalos cortos: 1 minuto) en una cinta rodante durante 2 semanas después de la oclusión transitoria de la arteria cerebral media. La fuerza de agarre de las extremidades anteriores evaluó la función motora, mientras que las pruebas de ejercicio incrementales midieron el rendimiento de resistencia. Los marcadores clave de neuroplasticidad se evaluaron mediante Western blot. Resultados: Ambos regímenes fueron efectivos para mejorar tanto la velocidad asociada con el umbral de lactato como la velocidad máxima en D8 y D15. Los marcadores de neuroplasticidad se regularon positivamente en el hemisferio contralesional después del entrenamiento contrario al lado ipsilesional. La fuerza de agarre se recuperó por completo, pero es más rápida con HIIT4. Conclusiones: El HIIT con intervalos cortos y largos indujo mejoras tempranas en la aptitud aeróbica y la fuerza de agarre. Nuestros hallazgos revelaron que los marcadores de neuroplasticidad se regularon positivamente en la corteza contralesional y el hipocampo para promover la recuperación funcional. Resumen Sujetos En este estudio se incluyeron 42 ratas Sprague-Dawley macho adultas. Los animales se asignaron aleatoriamente a 4 grupos: los animales se sometieron a la cirugía sin isquemia cerebral (n=12); los animales se sometieron a una oclusion transitoria de la arteria cerebral media sin entrenamiento tMCAO (n=10); y dos grupos que después de oclusion arterial realizaron HIIT con intervalos largos HIIT4 (n=10) o cortos HIIT1 (n=10). tMCAO, puntuación neurológica, fuerza de agarre y pruebas de ejercicio incremental Los ratones fueron sometidos a una oclusion arterial derecha por 2 horas. La recuperación funcional se evaluó midiendo primero la fuerza de agarre de cada miembro anterior y de los miembros anteriores combinados antes y en los dias1, 3, 8 y 15 despues de la oclusion. Se les realizaron pruebas de esfuerzo incrementales en los dias 1, 8 y 15 para definir la velocidad asociada al umbral de lactato (SLT) y la velocidad máxima (Smax; rendimiento de resistencia). Se recogió una muestra de sangre de la vena de la cola después de cada nivel de velocidad para medir la concentración de lactato. HIIT4 y HIIT1 emparejados en la cinta de correr HIIT4 (intervalos largos: 4 minutos) y el HIIT1 (intervalos cortos: 1 minuto) incluyeron 10 sesiones desde el dia 2 hasta el dia 13 despues de la oclusion. Segun los autores, estos protocolos de HIIT pueden extrapolarse fácilmente a los pacientes con esquemia cerebral porque: (1) el entrenamiento se basó en parámetros fisiológicos aplicables en pacientes a partir de una prueba de ejercicio incremental, es decir, velocidad asociada al umbral de lactato y velocidad máxima. (2) la velocidad y la duración se individualizaron de una manera emparejada con el trabajo para permitir dosis de ejercicio comparables (3) el HIIT es seguro durante el período crítico de rehabilitación en pacientes médicamente estables, y (4) la velocidad se incrementó progresivamente añadiendo una prueba incremental intermedia para reevaluar la velocidad de las sesiones. Western Blot En el dia 17 se extrajeron las proteínas totales del hipocampo y la corteza ipsilesional y contralesional para detectar GFAP (proteína ácida fibrilar glial), pTrkB (la forma fosforilada del receptor de tropomiosina quinasa B) p75NTR (receptor de neurotrofina p75), FNDC5 (proteína 5 que contiene dominio de fibronectina tipo III), VEGF (factor de crecimiento endotelial vascular) y CytC (citocromo C). Hallazgos importantes Ambos regímenes de HIIT promueven los marcadores de neuroplasticidad en el hemisferio contralateral, además de un aumento sustancial del rendimiento de resistencia y de la fuerza de agarre. Las mejoras funcionales podrían estar asociadas a los cambios en el hemisferio contralesional. El aumento de la pTrkB y del FNDC5 tras el HIIT podría contribuir a los resultados beneficiosos por su papel en la supervivencia neuronal, la neurogénesis del hipocampo, la plasticidad sináptica y la recuperación funcional. La recuperación efectiva de la fuerza de agarre confirma la necesidad de superar la velocidad asociada al umbral de lactato (SLT) para mejorar la función motora. Sin embargo, una mayor velocidad (HIIT1) no induce mayores ganancias porque se observan beneficios similares entre los regímenes. Curiosamente, el HIIT4 mostró una recuperación más rápida que el HIIT1, lo que sugiere que los intervalos largos podrían ser más adecuados. Esto tiene relevancia clínica, ya que los efectos beneficiosos más tempranos se asocian con frecuencia a una mayor recuperación a largo plazo. Ambos regímenes de HIIT generan una cinética similar de dos fuertes indicadores de calidad de vida, el SLT y el Smax. El SLT está poco estudiado en los pacientes, mientras que su aumento sugiere una reducción de la fatiga inducida por el ejercicio a una velocidad determinada. Las mejoras en el Smax, fuertemente correlacionadas con el consumo máximo de oxígeno, sugieren una mejora de las capacidades aeróbicas. En cuanto a las ganancias de fuerza, el aumento temprano del rendimiento de resistencia (en D8) podría ser prometedor para la recuperación a largo plazo. Al garantizar un estímulo fisiológico suficiente durante el período de entrenamiento, la prueba intermedia también permite observar que las velocidades individualizadas pueden aumentar fuertemente durante la segunda semana. Por lo tanto, la aptitud aeróbica sigue mejorando a lo largo del entrenamiento. Por lo tanto, debería considerarse la reevaluación periódica del rendimiento para optimizar la intensidad del entrenamiento. Por último, los pacientes con ictus podrían utilizar ambos regímenes HIIT en función de sus capacidades aeróbicas/motoras y de sus preferencias de ejercicio sin reducir la relevancia del entrenamiento. Mas Episodios

A gente tende a acreditar que passar muito tempo sentado é um mal contemporâneo.Mas será verdade? Ou é mais antigo que imaginamos?Nosso corpo foi feito pra ficar sentado, de pé, deitado?Confira no papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (52min 30s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*PARCERIA: ALURAA Alura tem mais de 1.000 cursos de diversas áreas e é a maior plataforma de cursos online do Brasil -- e você tem acesso a todos com uma única assinatura.E no link especial de Black Friday você tem o maior desconto da história da Alura: 25% de desconto para quem se matricular do dia 22 até o dia 26 de novembro.bit.ly/blackfriday-alura-naruhodoAproveite: é a sua chance de estudar na Alura com um preço incrível!*REFERÊNCIASSitting time and mortality from all causes, cardiovascular disease, and cancerhttps://pubmed.ncbi.nlm.nih.gov/19346988/Give Your Ideas Some Legs: The Positive Effect of Walking on Creative Thinkinghttps://www.apa.org/pubs/journals/releases/xlm-a0036577.pdfAssessment of Physical Activity in Adults Using Wrist Accelerometershttps://academic.oup.com/epirev/advance-article-abstract/doi/10.1093/epirev/mxab004/6313190Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort studyhttps://www.sciencedirect.com/science/article/pii/S0165032718310905?casa_token=hFLbw0ZoU1UAAAAA:VsZcaX2ZKIFQehcgdXLwSND47MBwyTcYiGGNot8KGdz2Nz3yxRAVe9WIamywV5iL-BmV_VJ8RicLack of exercise is a major cause of chronic diseaseshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241367/Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasureshttps://www.tandfonline.com/doi/full/10.1080/17461391.2020.1761076?casa_token=Lf4C5xlNB7UAAAAA%3Ahzbrv2TR22WW5bAa30p4WcWn7McfI0pcEWKHr4q4pUpYwtxF_H7IX_3CyOOgtJr2TbMZbZ7sHclSagSignificant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantinehttps://link.springer.com/article/10.1007/s00415-020-10064-6A systematic review and meta-analysis of the effect of treadmill desks on energy expenditure, sitting time and cardiometabolic health in adultshttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12094-9Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Studyhttps://link.springer.com/article/10.1007/s40121-021-00418-6Efficacy, characteristics, behavioural models and behaviour change strategies, of non-workplace interventions specifically targeting sedentary behaviour; a systematic review and meta-analysis of randomised control trials in healthy ambulatory adultshttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256828Effects of Interrupting Prolonged Sitting with Physical Activity Breakson Blood Glucose, Insulin and Triacylglycerol Measures: A SystematicReview and Meta‑analysishttps://link.springer.com/content/pdf/10.1007/s40279-019-01183-w.pdfTrends in Adherence to the Physical Activity Guidelines for Americans for Aerobic Activity and Time Spent on Sedentary Behavior Among US Adults, 2007 to 2016https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2739044Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation?https://bjsm.bmj.com/content/bjsports/53/16/1013.full.pdfIs the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findingshttps://bjsm.bmj.com/content/bjsports/53/6/377.full.pdfWalk more and sit less: even light exercise is linked to a lower risk of deathhttps://www.bmj.com/content/366/bmj.l5051Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysishttps://www.bmj.com/content/366/bmj.l4570.fullGet Up, Stand Up: The Effects of a Non-Sedentary Workspace on Information Elaboration and Group Performancehttps://journals.sagepub.com/doi/full/10.1177/1948550614538463?casa_token=0rJskI98etMAAAAA%3Au18V12isIlvbF7cnYdhQSIdA9sOyllBIqsdIFczaWCEetr0GkAfmahIJ9WAMgJlVb0TkkCL4D0PMWAWorldwide surveillance of self-reported sitting time: a scoping reviewhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469304/De Morbis Artificum Diatriba [Diseases of Workers]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446785/A Philosophy of Walkinghttps://www.amazon.com/gp/product/1781688370/ref=as_li_qf_asin_il_tl?ie=UTF8&tag=farnamstreet-20&creative=9325&linkCode=as2&creativeASIN=1781688370&linkId=f9888e26f18e71c758bbd1d402cb26d4Sedentary Behaviors and Health Outcomes Among Adultshttps://www.ajpmonline.org/article/S0749-3797(10)00608-2/fulltextDose–response association of screen time-based sedentary behaviour in children and adolescents and depression: a meta-analysis of observational studieshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977203/Sedentary Behavior and Cancer: A Systematic Review of the Literature and Proposed Biological Mechanismshttps://cebp.aacrjournals.org/content/19/11/2691Workplace interventions for reducing sitting at workhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517221/Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activityhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2343229/Biopsychosocial Functions of Human Walking and Adherence to Behaviourally Demanding Belief Systems: A Narrative Reviewhttps://www.frontiersin.org/articles/10.3389/fpsyg.2021.654122/fullMemória de Kant em Kaliningrad / Königsberghttps://www.youtube.com/watch?v=v1gCVjh2RmE&t=164s&ab_channel=Ant%C3%B3nioLu%C3%ADsRoviscoThe physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does https://bjsm.bmj.com/content/52/3/149.abstractAssociation Between Excess Leisure Sedentary Time and Risk of Stroke in Young Individualshttps://www.ahajournals.org/doi/full/10.1161/STROKEAHA.121.034985Naruhodo #284 - Qual o impacto do desemprego em nossa vida?https://www.b9.com.br/shows/naruhodo/naruhodo-284-qual-o-impacto-do-desemprego-em-nossa-vida/Podcasts das #Minas: DAZMINA#MulheresPodcastershttps://open.spotify.com/show/6qeCBTW2uQu4JKWeutm1f6*APOIE O NARUHODO!Você sabia que pode ajudar a manter o Naruhodo no ar?Ao contribuir, você pode ter acesso ao grupo fechado no Telegram, receber conteúdos exclusivos e ter vantagens especiais.Assine o apoio mensal pelo PicPay: https://picpay.me/naruhodopodcast

Fast Takes -Episode 30 In this episode, Dr. Olga Boukrina, Research Scientist in our Center for Stroke Rehabilitation Research talks about her peer reviewed article “Brain Network Dysfunction in Poststroke Delirium and Spatial Neglect: An fMRI Study” published on October 8, 2021 in the journal Stroke. Funding source: American Heart Association grant 17SDG33660442 (Dr Boukrina). In kind support provided by grant R24AG054259 (PI: Inouye) from the National Institute on Aging. Learn more about: Dr. Boukrina at https://kesslerfoundation.org/aboutus/Olga%20Boukrina The peer-reviewed article at https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.121.035733 and podcast host Joan Banks-Smith at https://kesslerfoundation.org/aboutus/Joan%20Banks-Smith Co-authors: Mateusz Kowalczyk, Yury Koush, Yekyung Kong, A.M. Barrett ================================================= Tuned into our podcast series lately? Join our listeners in 90 countries who enjoy learning about the work of Kessler Foundation. Be sure and subscribe to our SoundCloud channel “KesslerFoundation” for more research updates. Follow us on Facebook, Twitter, and Instagram. Listen to us on Apple Podcasts, Spotify, SoundCloud, or wherever you get your podcasts. This podcast was recorded on October 20, 2021 remotely and was edited and produced by Joan Banks-Smith, Creative Producer for Kessler Foundation.

In this episode, we welcome Dr. Christian Martin-Gill, MD, MPH, who is here to provide us with his perspective regarding the development of stroke systems of care in the suburban environment.  Doc is an ED physician with a deep background in a variety of EMS systems.  Specifically, Dr. Martin-Gill serves as Chief of the Division of EMS, the EMS Fellowship Director, and is an Associate Professor of Emergency Medicine at the University of Pittsburgh School of Medicine. He has been a nationally registered paramedic for over 20 years and is also a certified Flight paramedic.   Doc was a co-author of the 2021 Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities from the Prehospital Stroke System of Care Consensus Conference, which is the focus of today's episode.  This landmark consensus provides local and regional EMS agencies and stroke advisory committees with guiding principles and recommendations for how to integrate the elements of a stroke system of care in three key regional settings: urban, suburban, and rural settings.  The consensus seeks to inform or update EMS about new models and systems of acute ischemic stroke care, especially mechanical thrombectomy for large vessel occlusion stroke, and how they affect their stroke systems of care.  To maximize the power of the recommendations, the American Heart Association / American Stroke Association produced a very cool and very useful website full of resources and information directly related to helping EMS develop and or fortify their stroke systems of care.  I highly recommend you visit www.Stroke.org/stroketransportplans and use it to consider evolving the stroke system of care in your community. Dr. Martin-Gill is here to help us appreciate what is at stake for stroke patients, as well as the nuances, advantages, and disadvantages of the suburban environment regarding EMS and stroke.  Finally, Doc provides his recommendations regarding how EMS systems should use the contents of the consensus and the stroke.org/stroketransportplans website resources to improve their Stroke Systems of Care and strengthen their stroke chain of survival. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  Visit EMSonAIR.com for the latest information, podcast episodes and other details.  Follow us on Instagram @EMSOnAIR.Recommended resources referenced in the episode:www.Stroke.org/stroketransportplansRecommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference:  https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033228Contact the episode participants:Geoff Lassers, Paramedic I/C, AASHost, EMS on AIR Podcast EMS System Manager, Oakland County Medical Control Authority (OCMCA)FF/Paramedic, West Bloomfield Fire DepartmentDirector of Education, American CMEQi@ocmca.org Christian Martin-Gill, MD, MPHAssociate Professor of Emergency MedicineUniversity of Pittsburgh School of MedicineChief, Division of EMSProgram Director, EMS Fellowshipmartingillc2@upmc.edu Support the show (https://www.patreon.com/emsonair?fan_landing=true)

Clinical Challenge in Surgery – Carotid Artery Stenosis Carotid endarterectomy is a great option for most patients, but what do you do when the lesion extends high in the neck or the neck has been irradiated? In this episode from the Vascular Surgery team at Behind the Knife, we discuss carotid artery stenosis using a real patient case from the University of Michigan. We touch on diagnosis and imaging as well as medical and surgical management of carotid disease with a special discussion about Transcarotid Artery Revascularization (TCAR), a new technique available for the treatment of carotid lesions. Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran's Affairs Healthcare System. Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan. Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan. Seminal Papers in Carotid Artery Stenosis The MRC European Carotid Surgery Trial (ECST): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS Trial): https://jamanetwork.com/journals/jama/article-abstract/388335 The North American Symptomatic Carotid Endarterectomy Trial (NASCET Trial): https://www.ahajournals.org/doi/epub/10.1161/01.STR.30.9.1751 Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER Trial): https://pubmed.ncbi.nlm.nih.gov/26506270/ ROADSTER 2 Trial: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030550

In this episode, we learn how the incorrect choices we make in the food we eat can affect our brains long term.   This episode is sponsored by WYSK Spark Radio, https://live365.com/station/Spark-Radio-a82219. To keep this podcast going please feel free to donate at https://paypal.me/yopistudio?locale.x=en_US If you would like to read more on this topic or any other previous topics, you can do so by checking out our blog at https://yopistudio.blogspot.com/ Feel free to see what we are up to by following us at:  https://twitter.com/Dauricee https://www.facebook.com/yopistudio/ https://www.facebook.com/LouisianaEntertainmentAssociation/ To listen to the podcast, watch creative videos and skits go to https://www.youtube.com/channel/UCvn6tns6wKUwz9xZw11_vAQ/videos Interested in projects Daurice has worked on in the movie industry you can check it out at www.IMDb.com under Daurice Cummings. For comments or questions, you can reach us at yopi@post.com To read more about today’s topic check out the references below. Previous Episodes of Interest: https://yopistudio.podbean.com/e/can-you-guess-the-worst-ingredient-for-your-body-70/ https://yopistudio.podbean.com/e/the-effects-of-soda-in-your-body-68/ https://yopistudio.podbean.com/e/ep-38-nutty-for-brain-power/ References: Widya RL, Kroft LJM, Altmann-Schneider I, et al. Visceral adipose tissue is associated with microstructural brain tissue damage. Obesity. 2015;23(5):1092-1096. doi:10.1002/ oby.21048 Rippe JM, Angelopoulos TJ. Sucrose, High-Fructose Corn Syrup, and Fructose, Their Metabolism and Potential Health Effects: What Do We Really Know?12. Adv Nutr. 2013;4(2):236-245. doi:10.3945/an.112.002824 Berti V, Murray J, Davies M, et al. Nutrient patterns, and brain biomarkers of Alzheimer’s disease in cognitively normal individuals. J Nutr Health Aging. 2015;19(4):413-423. doi:10.1007/s12603-014-0534-0 Gu Y, Scarmeas N. Dietary Patterns in Alzheimer’s Disease and Cognitive Aging. Curr Alzheimer Res. 2011;8(5):510-519. Molteni R, Barnard RJ, Ying Z, Roberts CK, Gómez-Pinilla F. A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience. 2002;112(4):803-814. doi:10.1016/s0306-4522(02)00123-9 Lennerz BS, Alsop DC, Holsen LM, et al. Effects of dietary glycemic index on brain regions related to reward and craving in men. Am J Clin Nutr. 2013;98(3):641-647. doi:10.3945/ajcn.113.064113 Qiu Q, Lin X, Sun L, et al. Cognitive decline is related to high blood glucose levels in older Chinese adults with the ApoE ε3/ε3 genotype. Transl Neurodegener. 2019;8. doi:10.1186/ s40035-019-0151-2 Beilharz JE, Maniam J, Morris MJ. Short-term exposure to a diet high in fat and sugar, or liquid sugar, selectively impairs hippocampal-dependent memory, with differential impacts on inflammation. Behav Brain Res. 2016;306:1-7. doi:10.1016/j.bbr.2016.03.018 Akiyama H, Barger S, Barnum S, et al. Inflammation and Alzheimer’s disease. Neurobiol Aging. 2000;21(3):383-421 Kiage JN, Merrill PD, Robinson CJ, et al. Intake of trans fat and all-cause mortality in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Am J Clin Nutr. 2013;97(5):1121-1128. doi:10.3945/ajcn.112.049064 Ginter E, Simko V. New data on harmful effects of trans-fatty acids. Bratisl Lek Listy. 2016;117(5):251-253. doi:10.4149/bll_2016_048 Patterson E, Wall R, Fitzgerald GF, Ross RP, Stanton C. Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids. J Nutr Metab. 2012;2012. doi:10.1155/2012/539426 Sánchez-Villegas A, Verberne L, Irala JD, et al. Dietary Fat Intake and the Risk of Depression: The SUN Project. PLOS ONE. 2011;6(1):e16268. doi:10.1371/journal. pone.0016268 Bühler M, Mann K. Alcohol and the Human Brain: A Systematic Review of Different Neuroimaging Methods. Alcohol Clin Exp Res. 2011;35(10):1771-1793. doi:10.1111/j.1530- 0277.2011.01540.x Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539-549. doi:10.1111/acer.12006 Zahr NM, Kaufman KL, Harper CG. Clinical and pathological features of alcohol-related brain damage. Nat Rev Neurol. 2011;7(5):284-294. doi:10.1038/nrneurol.2011.42 Bertelli AAA, Das DK. Grapes, wines, resveratrol, and heart health. J Cardiovasc Pharmacol. 2009;54(6):468-476. doi:10.1097/FJC.0b013e3181bfaff3 Beilharz JE, Maniam J, Morris MJ. Diet-Induced Cognitive Deficits: The Role of Fat and Sugar, Potential Mechanisms and Nutritional Interventions. Nutrients. 2015;7(8):6719- 6738. doi:10.3390/nu7085307 Henderson ST. High carbohydrate diets and Alzheimer’s disease. Med Hypotheses. 2004;62(5):689-700. doi:10.1016/j.mehy.2003.11.028 Oddy WH, Allen KL, Trapp GSA, et al. Dietary patterns, body mass index and inflammation: Pathways to depression and mental health problems in adolescents. Brain Behav Immun. 2018;69:428-439. doi:10.1016/j.bbi.2018.01.002 Lenoir M, Serre F, Cantin L, Ahmed SH. Intense Sweetness Surpasses Cocaine Reward. PLoS ONE. 2007;2(8). doi:10.1371/journal.pone.0000698 Humphries P, Pretorius E, Naudé H. Direct and indirect cellular effects of aspartame on the brain. Eur J Clin Nutr. 2008;62(4):451-462. doi:10.1038/sj.ejcn.1602866 Lindseth GN, Coolahan SE, Petros TV, Lindseth PD. Neurobehavioral effects of aspartame consumption. Res Nurs Health. 2014;37(3):185-193. doi:10.1002/nur.21595 Pase MP, Himali JJ, Beiser AS, et al. Sugar- and artificially sweetened beverages and the risks of incident stroke and dementia: A prospective cohort study. Stroke. 2017;48(5):1139-1146. doi:10.1161/STROKEAHA.116.016027 de la Monte SM, Neusner A, Chu J, Lawton M. Epidemiological Trends Strongly Suggest Exposures as Etiologic Agents in the Pathogenesis of Sporadic Alzheimer’s Disease, Diabetes Mellitus, and Non-Alcoholic Steatohepatitis. J Alzheimers Dis JAD. 2009;17(3):519-529. doi:10.3233/JAD-2009-1070 Khambadkone SG, Cordner ZA, Dickerson F, et al. Nitrated meat products are associated with mania in humans and altered behavior and brain gene expression in rats. Mol Psychiatry. 2020;25(3):560-571. doi:10.1038/s41380-018-0105-6 Tong M, Neusner A, Longato L, Lawton M, Wands JR, de la Monte SM. Nitrosamine Exposure Causes Insulin Resistance Diseases: Relevance to Type 2 Diabetes Mellitus, NonAlcoholic Steatohepatitis, and Alzheimer’s Disease. J Alzheimers Dis JAD. 2009;17(4):827- 844. Presley TD, Morgan AR, Bechtold E, et al. Acute effect of a high nitrate diet on brain perfusion in older adults. Nitric Oxide. 2011;24(1):34-42. doi:10.1016/j.niox.2010.10.002    

  Click here for a machine-generated transcript. We know that COVID-19 causes stroke in many cases. You can recover from the disease and then still have a stroke caused by the virus. Sometimes the only way you find out you have a COVID-19 infection is that you go to the hospital with a stroke and they tell you. In the US, about 1500 strokes a week are caused by COVID-19. But why is this happening? We're starting to get some answer about how COVID-19 causes stroke thanks to the work of Dr. Jason Hinman and his colleagues at the University of California Los Angeles (UCLA). In this episode Jason and I talk about his research and the relationship between Stroke and COVID-19. Bio Jason Hinman, M.D., Ph.D. - Dr. Hinman is Assistant Professor of Neurology at the David Geffen School of Medicine and Interim Director of the Stroke Program at the West Los Angeles VA Medical Center. Dr. Hinman received his MD/PhD degrees from Boston University School of Medicine. He completed adult neurology residency training at Ronald Reagan UCLA Medical Center with fellowship training in vascular neurology and stroke rehabilitation also at UCLA. His NIH-funded research laboratory focuses on the molecular pathways at the interface of stroke and Alzheimer's dementia using basic and translational models of stroke and cerebrovascular disease.  The Model The technology Jason, Dr. Naoki Kaneko,  and their colleagues use is fascinating. They've taken scans (MRIs, CT scans, Angiograms, etc.) of patients' brains and used those scans to build a physical, 3-D model of the networks of veins and arteries in the brain. This allows them to see just how blood flows and where it struggles. It also means neurosurgeons who may be planning to fix a patient's aneurysms with a stent or coil could practice on an actual model before going into the patient's brain. With Jason's research, they line the fake vessels in their model with human epithelial cells. These cells are the same ones that line our real blood vessels. As a result, they were able to observe the way the virus interacts with the blood vessels. Then they learn how that interaction can lead to clots and other blood vessel damage, which, in turn, causes a stroke. Here's a link to the study: https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032764 And here's a link to the press release about the study: https:/newsroom.ucla.edu/releases/covid-19-increased-stroke-risk The Solution If you've survived a COVID-19 infection, how can you reduce your chances of having a stroke? Right now, the best research says to eat right, exercise, hydrate, and get good sleep. In other words, do the things the medical establishment has been telling us to do for years. There's no magic solution. We just have to do the hard work of doing the right thing. Which, of course, is also how you reduce your chances of having a stroke even if you haven't had COVID. I know. It sucks. But at least it's cheap. BEFAST More people are having stroke due to COVID-19. Younger people are having strokes. Many of these strokes can be treated and result in minimal disability if the person gets to the right hospital quickly enough. So make sure everyone you know can recognize a stroke. Teach them to BEFAST. Sudden loss or change in Balance, Eyesight, Facial droop, Arm control, Speech or language means that it is Time to call an ambulance. The Important Takeaway Don't catch COVID-19. The impacts are long lasting. Even if you survive (and most people will) it still damages your blood vessels, your heart, your kidneys, your lungs, and more. If you survive, the Grim Reaper gets another bite at that apple through COVID inspired stroke and other conditions. Mask up when you go outside. The mask isn't to protect you. It's to protect anyone else that you see and their families. The fact is there is no way to know for sure if you are infected right now. You could be. I could be. Since symptoms may not show up for a couple weeks, we can't know. Mask up so you don't kill someone or give them a stroke. Minimize social contact. When you do have that contact, keep your distance. Avoid crowded indoor spaces. If you see someone without a mask, stay away from them. If they get offended, so what? Let them. Afterall they're the ones trying to infect and kill you. Take advantage of delivery and curbside pickup. Work from home if you can. Not everyone has those options. Respect people who do have to go out to work by respecting rules intended to reduce transmission. Many of us don't have to stay locked up 24-7 for months on end. We can go out on occasion, but we have to be responsible about it. Hack of the Week It's winter, my Dysport (Botox alternative) is wearing off, and we've had a stressful start to 2021. All that adds up to my tone and spasticity getting stronger and tighter. When I want to undo that fist I make by default, I could just forcefully  open my fingers, but that just encourages more resistance. What's for effective is to bend my wrist down (flexion) in the direction the wrist tone want to go anyway. When you bend your wrist down, that naturally encourages your fingers to open up. The reason for that is that the finger extensors -- the muscles that open your fingers run from your forearm over the top of your wrist and the back of your hand. Bending your wrist down causes them to pull on your fingers, opening your fist. Give it a try. Links Where do we go from here? Visit the Strokecast Gift Guide for stroke books and other stroke-related item at http://Strokecast.com/GiftGuide Follow Dr. Hinman on Twitter at @HinmanLabUCLA Consider donating to the American Heart Association to support research like Dr. Hinman's into the causes, prevention, and treatment of stroke Share this episode with a friend, colleague or relative by giving them the link http://Strokecast.com/Jason Don't get best…get better

Today we have a very special guest interviewer, Dr Yasmin Whately. She will be joining us from time to time on Deep Breaths to have in-depth chats with consultant anaesthetists about how they approach various procedures in different settings. Today, she discusses all things clot retrieval for acute ischaemic stroke with her guest Dr Wendy Morris. If you have any questions, comments or suggestions for future episodes, be sure to write to us at deepbreathspod@gmail.com. Thanks for listening, and happy studying. References for this episode include: https://journals.lww.com/anesthesia-analgesia/Fulltext/2019/04000/Anesthetic_Management_of_Emergency_Endovascular.15.aspx https://journals.lww.com/anesthesia-analgesia/Fulltext/2019/04000/Anesthetic_Management_of_Emergency_Endovascular.16.aspx https://www.ahajournals.org/doi/10.1161/STROKEAHA.113.003412?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed& 

In this episode from the ACEP-EQUAL series, guest Dr. Lantha Ganti reviews how to evaluate and treat blood pressure in the setting of ICH. She reviews the major existing data, BP targets, and medications to use. Guests: Latha Ganti, MD, MS, MBA, FACEP, FAHA Professor of Emergency Medicine & Neurology Vice Chair for Research and Academic Affairs University of Central Florida College of Medicine Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.org/equal References: 1. Butcher KS, Jeerakathil T, Hill M, et al. The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial. Stroke. 2013;44(3):620-626. doi:10.1161/STROKEAHA.111.000188 2. Butcher KS, Baird T, MacGregor L, Desmond P, Tress B, Davis S. Perihematomal edema in primary intracerebral hemorrhage is plasma derived. Stroke. 2004;35(8):1879-1885. doi:10.1161/01.STR.0000131807.54742.1a 3. https://www.mdcalc.com/modified-rankin-scale-neurologic-disability

Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we're joined by Dr. Shadi Yaghi, an associate professor in the Department of Neurology at NYU Grossman School of Medicine and the Director of Clinical Vascular Neurology Research at NYU Langone Health and of Vascular Neurology at NYU Langone Hospital-Brooklyn. Dr. Yaghi offers his perspective on a recent study he and colleagues conducted of patients with stroke and COVID-19 and the difficulties in understanding their relationship.  For more neurology news and expert-driven content, visit neurologylive.com (https://www.neurologylive.com/) . REFERENCE Yaghi, S, Koto I, Torres J, et al. SARS2-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020;51:00–00. doi: 10.1161/STROKEAHA.120.030335

Dr. Patrick Lyden discusses what neurologists need to know about stroke as is relates to COVID-19. You can read more here: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030023

First and foremost, we would like to thank all pre-hospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work that you do matters now more than ever. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies still deserve our excellent care and diligence not to miss. So although we plan to have another special-edition, COVID-update episode we don’t want to neglect these other emergencies. So let's talk about Large Vessel Occlusions. Ep. 2 Large Vessel Occlusion (LVO) Show Notes First and foremost we would like to thank all prehospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work you do now more than ever matters. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But that being said, patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies too still deserve our excellent care and diligence not to miss. So although we plan to have another special edition COVID update episode soon we don’t want to neglect these other emergencies. This month we talk Large Vessel Occlusions. Endovascular Stroke therapy (EST) for large vessel occlusion (LVO) - This is the hottest therapy since PCI - 12 studies since 2013, 5 studies in 2015 alone https://rebelem.com/endovascular-therapy-for-acute-ischemic-stroke-the-new-shiny-toy-in-stroke-care/For a nice review of all of the studies and evolution of endovascular therapy visit: How is EST performed? A catheter is guided through one of the femoral arteries and up through the carotid and into the distal internal carotid, anterior cerebral artery or the middle cerebral arteryA clot retrieval device is fed through the catheter in order to retrieve the clotUnlike tPA which has only shown very marginal benefit in just a few studies that were admittedly methodologically flawed. EST has recently had multiple strongly positive trials showing impressive benefits (although these benefits are likely over estimated, see the link above for a deep dive on the researches strengths and weaknesses) Who Qualifies for EST?Similar to the early days of PCI for myocardial infarctions when cath lab centers were farer and fewer betweenWill likely vary based on your stroke center and may change with future studies so make sure you stay up to date with your local protocols.Initial studies looked at less than 6 hour time window and is what the American stroke guidelines currently recommend. A lot of places have started pushing this time window further out and locally here we us a cut off of less than 24 hoursInitially studies for all comers with stroke receiving EST found no benefitIt wasn’t until they identified a subset of patients with Large Vessel Occlusions (LVO) that they began to see these impressive benefitsAn LVO is defined as clot located in either the distal internal carotid, proximal anterior cerebral artery (ACA), or the proximal middle cerebral artery (MCA)Not every stroke center has the capability to perform ESTWhat is the timeline to qualify for ESTSo do we need to start re-organizing our transport priorities and transporting all of our suspected strokes to EST centers similarly to how we transport all of our STEMI’s to cath centers?With STEMI we have a clear diagnostic tool with our EKG to determine if somebody needs the cath lab. In order to know for sure if our patient would need EST we would need a CT scanner. And not just CT but also the ability to do CT with contrast in order to see which vessel the clot is in.If there is even a clot at all. Given so many mimickers of stroke on a very small percentage of patients evaluated for concern for stroke actually end up having a strokeWhich brings us to the second point of why we don’t want to start transporting to only EST centers: Only a select number of stroke patients, those with clots in the large proximal vessels, will benefit from this therapy. It wasn’t until later trials when they narrowed the patients they were treating to those with identified LVO in the arteries mentioned before: distal internal carotid, proximal ACA, and proximal MCA that they started finding benefit. It turns out that only 1 in 770 of stroke patients will have an occlusion meeting criteria for EST. And that's in patients who WE KNOW are having a stroke. Can you imagine what that number would be if we included everyone we just suspected of having a stroke? We would overwhelm the hospital. Early trials from 2013 looked at utilizing this therapy for all comers with stroke and found no benefit when compared to tPA alone. So even if we were sure our patient was having a stroke based on our exam they still would only benefit from transport to an EST if it was in one of these specific large and proximal vessels.No, here’s where we don’t wanna get ahead of ourselves So are there any physical exam findings to help us determine those likely to have a LVO and thus should be transported to one of these centers?There’s not strong enough evidence to suggest such a protocol yet so for now keep transporting to your nearest local stroke center per your protocol But there are researchers looking at some prehospital scores to help with this question and we should be aware of and keep on the lookout for future data and research on this. See some of the prehospital scores and their associated ealy research below.VAN score - vision, aphasia, neglect62 patients, 31% (19) were VAN positive90% of those had an LVO and no LVO’s occured in the VAN neg group. This is a small feasibility study. This means it was a smaller study done solely to determine if a larger more robust trial should be completed. Feasibility trials should not be used to change current care.Start with bilateral arm raise for 10 seconds if any drift then proceed with the VAN assessment, If any of the following are positive in a patient with arm drift then they are considered VAN positiveCheck all 4 quadrants one eye at a timeI cover one eye and ask 1 or 2 fingers in each quadrant. If the patient is having difficulty cooperating you can blink to threat in all quadrants. Move your hand quickly towards their eye from the quadrant you are testing (but don’t actually hit them).If they blink you assume the vision is intact.Blink to threatAphasia either expressive or receptive. Can’t say words or doesn’t say the right words Unable to understand what you are saying. ExpressiveReceptiveImportant: Aphasia is different from dysarthria which is slurred speech.Dysarthria is not what we are testing or scoring here.Have the patient close both eyes and then you touch both of their arms with your fingers and ask which arm you are touching, if the patient fails to identify the weak arm (the arm you identified with a drift earlier) this is considered neglect. Other signs of neglect are an inability to track your finger beyond midline or a forced gaze deviation to one side. Visual fieldsThe next component is AphasiaFinally NeglectAbout the data: https://jnis.bmj.com/content/neurintsurg/9/2/122.full.pdfHow do you do the exam? Cincinnati pre-hospital severity stroke scaleIn the original derivation study it was found to have a sensitivity 83% and specificity 40% for identifying patients with a LVO. Katz BS, Mcmullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale. Stroke. 2015;46(6):1508-12.Kummer BR, Gialdini G, Sevush JL, Kamel H, Patsalides A, Navi BB. External Validation of the Cincinnati Prehospital Stroke Severity Scale. J Stroke Cerebrovasc Dis. 2016;25(5):1270-4.However, in an externally it was found to have a sensitivity of 70% and specificity of 86%. About the data:See MDcalc for the scoring details: https://www.mdcalc.com/cincinnati-prehospital-stroke-severity-scale-cp-sss#next-stepsRACEIn the original study a RACE Scale value of ≥5 had a sensitivity 85% and a specificity of 68% for identifying an LVO. Pérez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45(1):87-91.A second study was designed to assess whether or not bypassing patients to a Comprehensive Stroke Center with a RACE Scale ≥5 would improve outcomes. Zaidi SF, Shawver J, Espinosa morales A, et al. Stroke care: initial data from a county-based bypass protocol for patients with acute stroke. J Neurointerv Surg. 2016; Jun 24. pii: neurintsurg-2016-012476. doi: 10.1136/neurintsurg-2016-012476. [Epub ahead of print]The results of this study showed an increased treatment rate, improved door-to-CT times, and improved door-to-needle times. The rate of mechanical thrombectomy also increased with improved arrival-to-puncture and arrival-to-recanalization times as well. However, there was only a small trend toward improved outcomes that did not reach statistical significance.About the data:See MDcalc for the scoring details: https://www.mdcalc.com/rapid-arterial-occlusion-evaluation-race-scale-strokeFAST EDLima FO, Silva GS, Furie KL, et al. Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes. Stroke. 2016;47(8):1997–2002. doi:10.1161/STROKEAHA.116.013301 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961538/https://www.ahajournals.org/doi/full/10.1161/strokeaha.116.016026The data:There’s an app for thatELVO screen Kentaro Suzuki , Nobuhito Nakajima, Kenta Kunimoto, et. al. Emergent Large Vessel Occlusion Screen Is an Ideal Prehospital Scale to Avoid Missing Endovascular Therapy in Acute Stroke.. Stroke. 2018;49:2096–2101.The data:American stroke algorithm for when to bypass and transport to an EST capable facilityAlgorithm: https://www.heart.org/-/media/files/professional/quality-improvement/mission-lifeline/2_25_2020/ds15698-qi-ems-algorithm_update-2142020.pdf?la=en&hash=A0AB5E209AC78933C54E41C3FF235B60F9CC4A7CComplete reference:https://www.heart.org/en/professional/quality-improvement/mission-lifeline/mission-lifeline-strokeJoin Triage Apphttps://apps.apple.com/us/app/jointriage/id1099779970https://play.google.com/store/apps/details?id=net.allm.fasted&hl=en_USApple:Google Play:

We’re back with a new episode after a week of exhausting President’s Day and National Sticky Bun Day celebrations. In today’s episode, Greg shares some Feats of Strength, along with an announcement about how to participate in a Reddit Program Party featuring his new program, Average to Savage 2.0. This episode also features discussions about two new articles on the website; one article discusses everything lifters would want to know about antioxidants, and the other discusses which factors influence injury risk in powerlifters. After that, we discuss some research about muscle protein synthesis and links between artificial sweeteners and stroke risk, followed by some Q&A questions. We also debut a new segment called “On the Rise,” in which we showcase up-and-coming creators of fitness content that are worth a follow. Finally, to close out the show, Greg shares some cooking-related information, then I totally upstage and outshine him with my spicy chicken recipe. TIME STAMPSPreparing for Leap Day (0:00:53). Announcement: Reddit Program Party, featuring Average to Savage 2.0 (0:01:32). Link. Happy President’s Day and National Sticky Bun Day from the Stronger By Science Family (0:03:22). Feats of Strength (0:04:47). SBS Article Discussion: “Antioxidants for Lifters: A Review of the Evidence” (0:10:17). Link. SBS Article Discussion: “What Factors Influence Injury Risk in Powerlifters? (Injury series, Part 3)” (0:36:57). Link. Artificial Sweeteners and Risk of Stroke and Dementia (0:51:04). Links: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023100https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024456https://www.ahajournals.org/doi/full/10.1161/strokeaha.116.016027https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.117.017198https://www.tctmd.com/news/new-aha-advisory-waffles-artificially-sweetened-drinks-citing-dearth-studieshttps://www.sciencealert.com/everything-we-eat-both-causes-and-prevents-cancerQuick Research Review about factors influencing muscle protein synthesis (1:08:05)Study title: The effect of sleep restriction, with or without high‐intensity interval exercise, on myofibrillar protein synthesis in healthy young men. Link: https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP278828?fbclid=IwAR0rI37tD9XvmnkVCmknqqsRzZSLobHkQ4QPIyqFv_qq2A1XanfHYWpENlE. Q&A (1:21:02). Does mouthwash affect blood pressure and muscle pumps by altering nitric oxide production? (1:21:09). What is Greg’s stance on the conjugate method for raw lifters? How would he adjust it, if necessary, for a raw lifter? (1:24:45). Is it okay to mix your creatine drink the night before you drink it? (1:35:50). New segment: On the Rise (1:39:55). Meghan Callaway: https://www.instagram.com/meghancallawayTo Play Us Out: Dueling Cooking Tips (1:45:41). Greg’s attempt: Cooking with mushrooms. Eric’s triumph: Easy spicy chicken recipe. 

In this podcast, Dr. Mark Young, a stroke Neurologist with Abbott Northwestern Hospital, discusses current guidelines for ischemic stroke management and care. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Summarize the latest guidelines and management for acute ischemic stroke. Describe current interventional management for large vessel occlusion with thrombectomy. Identify modified Rankin scores and the impacts on stroke patients. Demonstrate an understanding of new timelines to guide therapy such as Diffuse-3 and DAWN trials. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Stroke Updates: Guidelines and Management for 2018-2019" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”    FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: One large impact on stroke care 2018 is the thrombectomy window expansion time for large vessel occlusion out to 24-hours. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023310 Current perfusion imaging available is able to identify core infarct- establish the quantity and mismatch ration of available brain that is salvageable. Futile reperfusion is something that should not be undertaken due to high risk of reperfusion hemorrhage which can ultimately worsen outcomes. Last known well time means exactly that. When was the patient last seen well. So if they go to bed and then come in with a wake up stroke then LKW is when they went to bed. Some studies on wake up strokes showed that the majority developed symptoms 2-3 hours prior to waking up. LKW and wake up stroke are different but can often help us guide therapy. For instances pt goes to bed is LKW time and then wakes up with stroke like symptoms. Perfusion imaging is instrumental in the decision process for these patients often guiding us with further management. The NINDS trials came out in '95-'96. However the bottom line showed - in patients, with ischemic stroke within 3 hours, tPA administration significantly improved HIHSS scores but did not confer survival benefit. https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 Stroke neurologist typically want a call early in clinical course. Don't wait for CT prior to calling. Then when was the last known well time. Blood glucose, blood pressure, PMH and deficits (ie NIHSS), 'what are you observing'. Don't wait on labs - consideration is warfarin. There are trials following the NINDS trial that show evidence that patient with low HIHSS with potentially disabling deficits and rapidly improving stroke improve with TPA treatment and that the hemorrhage rates are lower. Definitely consider treating rapidly improving stroke sxs. With stutter stroke sxs, the clock resets when the patient returns back to baseline. CHAPTER 2: Most stroke centers uses -0-4.5 hours time frame for IV thrombolytics. Absolute and relative contraindications for thrombolytics include: greater than 2/3 MCA territory don't treat as there is little benefit. Patient on warfarin with INR greater than 1.7. Recent stroke or ICH. Endocarditis. Coagulopathy. People on DOACs. Significant thrombocytopenia. There are many more but these are the highlights. American Stroke Association says patient must be off DOAC's for 48-hours before lytic treatment as relative contraindication. Dr. Young's standard conversation with pt who are experiencing a stroke when discussing TPA. First, it is the standard of care, next the chance of hemorrhage is around 6-7%, but Abbott has a much lower rate of around 2.5%. We know that even with that risk patients do much better overall. At 90 days, the chance that the patient will be living independently are much better. 90-day Modified Rankin Scores are standards that we use to measure stroke outcomes. Modified Rankin Scale score of 0 is no deficit, no residual. MR of 1 can do everything you use to do although may still have mild symptoms that patient may notice. MR of 2 - you have some limitations but can live independently and do all ADLs MR of 3 - is dependent with ADLs although can walk with or without a device. MR or 4. Can't walk. MR of 5 - bed bound. MR of 6. DEAD. Some criteria for TPA with lower HIHSS with compelling deficits are #1, what's disabling #2. Others include limb ataxia, aphasia, paresis, dominant hand problem, dysphagia, dysarthria. Controversy Hemianopsia. Greater than or equal to NIHSS of 6 is generally recommended to get a CTA to evaluate for LVO stroke. Imaging generally requires CT/CTA of the head and neck. Always include imaging of the neck. Rapid perfusion imaging for LVO used in Diffuse 3 - (6-16 hours) for the window vs DAWN out to 24-hours. CHAPTER 3: So the order of imaging includes noncom CT head, CTA, CT perfusion. When evaluating the imaging studies we want the core infarct to be less than 70ccs and the ratio of the core infarct to at risk brain penumbra to be greater than 1.8. The use of rapid sequencing MRI has utility for post circulate symptoms, ie vertigo with/out nystagmus, abrupt onset. Generally diffusion weighted gradient echo/T2 flair images looking for blood. Other indications maybe for subacute findings/duration. LVO's that can be intervened on include: anterior communicating, distal carotid or carotid terminus, MCA M1, M2, basilar, distal verts, maybe PCA/P1. Important point if a patient has a LVO lesion and is within the 4.5 hour window at a small rural setting with lytic capabilities and the patient is going to a large tertiary stroke center does the patient still need to receive IV lytic therapy - knowing that the patient will require thrombectomy and answer is YES. No increased risk when using lytic with thrombectomy. A little controversial but we maybe seeing the bypass of non-stroke hospitals specifically with LVO to tertiary stroke centers with a new scoring system that EMS can do called RACE (Rapid Arterial oCclusion Evaluation)  https://neuronewsinternational.com/racecat-trial-update/ CHAPTER 4: After care by the PMD what can we expect from these patients follow a LVO? 90-day Rankin  50% with modified Rankin 2 less to live independently following LVO. 50% of LVO have a 90 mortality. 70-80% will not live independently. Discharge meds for these patients will include DOACs or Warfarin, antiplatelet agents - such as Plavix. Occasionally patient will end up on dual antiplatelet therapy depending on disease state. Stoke mimics that have been given thrombolytics have less than 1/2% chance of hemorrhage.

In this episode from the ACEP-EQUAL series, Drs. Godwin and Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin, Professor and Chair, Department of Emergency Medicine University of Florida Dr. Richard Shih, Professor of Integrated Medical Science and Program , Charles E Schmidt College of Medicine at Florida Atlantic University Host: Jason Woods, MD www.acep.org/equal References: Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642

As stroke survivors, we have to find the #StrokePerks where we can. My GF recently hurt her ankle on the way to work. Fortunately, I have an assortment of canes that she can choose from to get around the apartment safely while she recovers. Keep Trying Getting from the car to the apartment, though, meant she had to use the can I had brought with me. Fortunately, I was able to walk a bit without it. As I walked down the hall, I reflected on my early days of recovery. I spent time going up and down that same hall with Elissa, my PT from Rehab Without Walls. It took a lot longer to cover that distance back then. And trying it without the can worked for only a few feet. Even a year ago, it took longer. Today, I need the cane to walk longer, faster, safer, with a better gait, and with less fatigue. The point is that I continue to get better. It's just a little bit at a time. And sometimes it's hard to notice. But it's happening. 28 months later. Anyone who tells you recovery stops at 6 months or 12 months is WRONG. That's utter nonsense. Recovery may be fastest early on, but recovery continues for years. But you cannot get better if you don't do the work or if you don't believe you can. The right, action-oriented attitude is essential to long term continued recovery. Focus on getting just a little bit better every day. Walking Predicts Return to Work A study recently published in the AHA Journal reports that post-stroke walking speed is an accurate indicator of whether a survivor will return to work: This study is the first to capture walking performance parameters of young adults who have had a stroke and identifies slower and less efficient walking. Walking speed emerged as the strongest predictor for return to employment. It is recommended that walking speed be used as a simple but sensitive clinical indicator of functional performance to guide rehabilitation and inform readiness for return to work post-stroke. You can read the full details here https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.025614 It's an interesting article, and the story has been popping up in various news feeds that I follow. I'm not sure how actionable this is, though. First, it doesn't appear to draw a distinction between knowledge work and physical work. It also doesn't appear to address the concerns of stroke survivors living with aphasia or other cognitive challenges who have no trouble walking. Really what they seem to be looking at is the cognitive load involved in walking and extrapolating from there. So this may be slightly useful early indicator in the early post stroke days, but when reading articles like this, there are a few things to keep in mind: Correlation does not equal causation. Headlines do not tell the whole story. Look at this stuff critically. Nuance does not fit nicely into bullet points. Eat More Bananas! A new study says eating more bananas will prevent stroke! Actually, it doesn't say that. But that's a headline you are likely to see. A study from the University of Alabama at Birmingham demonstrated that a lack of dietary potassium in mice led to hardening and calcification of arteries. Such damage to the arteries in humans can lead to stroke and heart disease. Here's what the article says: University of Alabama at Birmingham researchers have shown, for the first time, that reduced dietary potassium promotes elevated aortic stiffness in a mouse model, as compared with normal-potassium-fed mice. Such arterial stiffness in humans is predictive of heart disease and death from heart disease, and it represents an important health problem for the nation as a whole. The UAB researchers also found that increased dietary potassium levels lessened vascular calcification and aortic stiffness. Furthermore, they unraveled the molecular mechanism underlying the effects of low or high dietary potassium. So how do we get to the conclusion? We assume the mice model applies to humans. We assume we can get more dietary potassium by eating more bananas. We assume that more dietary potassium in humans results in less hardening of the arteries. We assume that less hardening of the arteries will lead to reduced risk of stroke in humans. Therefore eating more bananas leads to fewer strokes. Those facts may all be independently true. But at any point, that chain could break down and the results would not follow. So what do you do with this information? As a researcher, you might try more direct research to get to fewer links in the chain. As a consumer, look at what you can learn from. What is the benefit and risk of adopting this behavior? In this case: Bananas are tasty. Bananas are cheap. Bananas have minimal to no health risks for most people. Bananas may increase dietary potassium and that may reduce the risk of stroke. And have I mentioned that bananas are tasty? So eat more bananas. And have I mentioned you can eel them with one hand? #WeSpeakUpAgainstStroke For World Stroke Day, Joe Borges (@JoseSoRocks) and Nefre (@StrokeLifeAlive) are doing a campaign to raise awareness. And you can participate             View this post on Instagram                     My friends @joesorocks and @strokelifealive are working on an Awareness Campaign for Young Stroke Survivors for World Stroke Day in October.⁣⁣ ⁣⁣ Are you a #youngstrokesurvivor? ⁣⁣ You can take part in the campaign? ⁣⁣ ⁣⁣ Here are a few simple things you will need to do: ☑️Take a Black & White photo of you wearing a black or white shirt

Podcast # 499: Posterior Circulation Strokes Contributor: Neal O’Connor, MD Educational Pearls: Dizziness is a very common complaint in the emergency department, but how can we find patients with a dangerous cause of their symptoms, namely a posterior circulation stroke? Consider a posterior circulation stroke in those with an abrupt onset of headache with neck pain, balance problem, blurred vision, or dysphagia  Thorough cranial nerve exam can be important to screen for posterior circulation stroke, as much of the brainstem is supplied by the posterior circulation.  The most common posterior circulation stroke is a lateral medullary infarct (Wallenberg Syndrome), which produces dysphagia due to cranial nerve IX and XII involvement Other physical exam findings include truncal ataxia, extremity ataxia, visual field cuts, and Horner syndrome (Ptosis, Miosis, Anhidrosis)  The HINTS exam (Head Impulse - Nystagmus - Test of Skew)can be used to differentiate between peripheral and central causes of dizziness Concerning exam findings for central cause may include vertical nystagmus, gaze skew, or inability to track with head impulse References Áine Merwick, David Werring. Posterior circulation ischaemic stroke. BMJ 2014;348:g3175 doi: 10.1136/bmj.g3175 Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–3510. doi:10.1161/STROKEAHA.109.551234 Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol. 2014;5:30. Published 2014 Apr 7. doi:10.3389/fneur.2014.00030   From CarePoint PA Academy, 2019

Strokecast regular, neurologist Dr. Nirav Shah joins us again this week to talk about Remote Ischemic Conditioning. Essentially it makes the body more resistant to oxygen deprivation by depriving it of oxygen. It's a fascinating area. In some respects, it does the opposite of hyperbaric oxygen therapy. As we learned in episode 48, the theory is that Hyperbarics, which floods the body with extra oxygen at high pressure can bring back the stroke damaged brain tissue and help with recovery. And while hyperbaric oxygen therapy does help for a lot of conditions, the science doesn't back it up for stroke. Remote Ischemic conditioning does appear to have positive results in the early studies and may be helpful in the future. Does this mean you should go ahead and tie a tourniquet around your limbs to give it a shot? Absolutely not. That would be a terrible idea. At least for now. I like the potential in Remote Ischemic Conditioning. I also like that it is potentially simple, inexpensive, and something I can do at home. Sure, it might be physically uncomfortably, but if it works, I think Io can get past that. For many of us, that discomfort may be minor compared to the other things we deal with on a regular basis. Of course this is all still preliminary. There's research to be done. Another thing that's interesting to think about is how something that's bad can still have positive outcomes. And yet that doesn't make up for the problem itself. It's sort of a Mussolini made the trains run on time kind of thing. Specifically, the issue of smoking. Smoking causes some remote ischemic conditioning. As we talked about that means smokers may have less severe stroke. Good, right? Except smoking causes many of those strokes in the first place! The best way to minimize the effect of stroke is not to have one in the first place. Finally, the other thing about this episode that makes me smile is that it added the phrase "vascular milieu' to my vocabulary. And that's just delightful. To hear more from Nirav, head on over to Strokecast.com/nirav to find all his Strokecast interviews. Bio Dr. Nirav H. Shah is a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging. He is a practicing neurohospitalist and served as the stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. He enjoys mentoring trainees and collaborating on publications and conference presentations. Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit. Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer. Hack of the Week If you struggle with communicating and meeting new people, prepare a preprinted bio and bring it with you. An attendee with aphasia came to our support group recently and brought such a Bio. When it was her turn to introduce herself, she was able to hand me that sheet to read for the group.  This can be a great way to meet other people and can relieve a lot of anxiety. If you want to get fancy, you could even laminate it. This can also be helpful even if you can usually speak well. Sometimes stressful situations (like traffic stops) can make the words tougher to grab. A preprinted bio or introduction can help quite a bit. Links   Nirav's other Appearances http://strokecast.com/nirav Hyperbaric Oxygen Therapy http://strokecast.com/hyperbaric Kristen Talks about Sleep Apnea http://strokecast.com/kristen Nirav  on LinkedIn https://www.linkedin.com/in/nirav-h-shah/ Nirav at Swedish https://www.swedish.org/swedish-physicians/profile.aspx?name=nirav+h+shah&id=271893 Nirav on Twitter http://twitter.com/NeuroNirav The Neurohospitalist http://journals.sagepub.com/home/nho Nirav’s Photography www.thoughtpotential.com Sentinel Healthcare https://www.sentinel.healthcare/ Remote Ischemic Conditioning: From Bench to Bedside https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282534/ RECAST (Remote Ischemic Conditioning After Stroke Trial) https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.116.016429 Remote ischemic conditioning for stroke: clinical data, challenges, and future directions https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.691 Immediate remote ischemic postconditioning reduces cerebral damage in ischemic stroke mice by enhancing leptomeningeal collateral circulation https://onlinelibrary.wiley.com/doi/full/10.1002/jcp.27858 Remote limb ischemic postconditioning promotes motor function recovery in a rat model of ischemic stroke via the up‐regulation of endogenous tissue kallikrein https://onlinelibrary.wiley.com/doi/full/10.1111/cns.12813   Where do we go from here? To hear more from Nirav, head on over to Strokecast.com/nirav to find all his Strokecast interviews. Tell a friend, colleague, relative or patient about Strokecast. Don't get best…get better.  

Stroke recovery is a marathon; it's not a sprint. Regaining cognitive skills, physical skills, sensory skills, and more takes time and work. During that time, life can be really hard and unpleasant for many folks. The may or may not be able to work. Relationships get turned upside down, and after a while you just want it to go away. Surely, with all the advances in medicine, there must be something…some fancy technology or machine…some magic technique that will fix these problems, right? That leads folks to look for and explore alternatives. It also means that many survivors start pursuing things that don't work. Hyperbaric oxygen therapy appears to be one of those therapies. In Hyperbaric Oxygen Therapy, the patient spends time in a pressure chamber where the air pressure is 2-3X normal and breathes pure oxygen. They get roughly 8-12X as much oxygen as in their normal lives. This, supposedly, should grow new blood vessels in the brain and revive the dead neurons that were killed by the stroke, or drive new growth through neuroplasticity. I saw a number of people asking about it in Facebook groups and twitter feeds, so I began talking with folks to learn more. Strokecast regular, neurologist Dr Nirav Shah, introduced me to one of the world's leading authorities on Hyperbaric Oxygen therapy, Dr. Mike Bennett in Australia. This week I talk with Dr. Bennett about the theory and the research around hyperbaric medicine. We answer the key questions about it -- is it safe, and does it work. The short version is that it is mostly safe, but there is no reliable research demonstrating that it works. The main risk is to the patient's wallet. Bio Professor Bennett is the Academic Head of the Department of Anaesthesia, a Senior Staff Specialist in diving and hyperbaric medicine at Prince of Wales Hospital and Conjoint Professor in the faculty of Medicine, University of New South Wales in Sydney, Australia. He graduated from the University of New South Wales in 1979 and spent his early post-graduate training at the Prince Henry/Prince of Wales Hospitals before undertaking training in Anaesthesia in the UK. He returned to Sydney in 1990 as a retrieval specialist on the Lifesaver Helicopter and here developed an interest in both diving and hyperbaric medicine. He also has a strong interest in clinical epidemiology and is an experienced clinician and researcher. In 2002 he was the recipient of the Behnke Award for outstanding scientific achievement from the Undersea and Hyperbaric Medical Society. Since 2004 he has been highly involved in the teaching of Evidence-based Medicine within the Medical faculty at UNSW and in 2005 was appointed co-director of the Quality Medical Practice Program there. He is the author of over 150 peer-reviewed publications including 15 Cochrane reviews of the evidence in Diving and Hyperbaric Medicine. Prof. Bennett was the convenor of the Australia and New Zealand Hyperbaric Medicine Group Introductory Course in Diving and Hyperbaric Medicine from its inception in 1999.to 2014. He is an executive member of the Australia and New Zealand College of Anaesthetists (ANZCA) special interest group in diving and hyperbaric medicine, chief examiner for the ANZCA Certificate in diving and hyperbaric medicine and Chair of the ANZCA Scholar Role Subcommittee. He is a past Vice-President of the UHMS and currently the Past President of SPUMS. Hack of the Week -- Rocker Knife Last week, I talked about cutting meat at a restaurant -- don't. This week, let's talk about doing the same thing at home where you may not have a kitchen staff. Sure, at home you can just pick up a hunk of meat with your hands. But sometimes you still want to slice it for some reason. I use a Verti-Grip knife. It's designed for folks with use of one hand. I hold it in my fist, rock it against the meat, and it cuts right through. It doesn't require you to brace what you're cutting with a fork. For a $14 gadget, it works really well. Links Dr. Michael Bennet https://powcs.med.unsw.edu.au/people/professor-michael-bennett Hyperbaric Oxygen Therapy on MedLink http://www.medlink.com/article/hyperbaric_oxygenation_for_the_treatment_of_stroke Hyperbaric Oxygen Therapy for Acute Ischemic Stroke on AHA Journals https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.008296 HBO Evidence http://hboevidence.unsw.wikispaces.net/Stroke Medical News Today -- Hyperbaric https://www.medicalnewstoday.com/search?q=hyperbaric&p=1 DMI Verti-Grip Curved Cutting Kitchen and Dinner Knife https://www.amazon.com/Verti-Grip-Individuals-Strength-Dishwasher-Stainless/dp/B00NZ0ZKES/ref=sr_1_7_a_it Bill on Pure Mind Magic https://victoriamavis.podbean.com/e/60-pmm-changing-your-brain-changing-your-body-wiht-bill-monroe/   Pure Mind Magic A few months back, German podcaster, magician, and mindset expert Victoria Mavis joined me to talk about the intersection between public speaking and magic on my other podcast, 2-Minute Talk Tips. You can find that interview at 2-MinuteTalkTips.com/magic. During December, I had the pleasure of appearing on her show, Pure Mind Magic. We talked about speaking, sure, but much of the conversation was about my stroke story and the power of mindset in recovery. You can listen to it here or subscribe for free to Pure Mind Magic in your favorite podcast app   Where do we go from here? Have you tried Hyperbaric Oxygen Therapy? Let us know in the comments at http://strokecast.com/hyperbaric Pick up a Verti-Grip knife if you need to cut thing one-handed. Share this episode with someone in your circle who is interested in alternative therapies with the link http://strokecast.com/hyperbaric Don't get best…get better     Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

  When I had my stroke at 46, it took a little while for the medical team to settle on the cause. I suppose that's a good thing. We don't want them to rush to a conclusion. Ultimately, they concluded the probable cause was a history of high blood pressure. It didn't make sense to me at the time. In 2015 I developed high blood pressure, AKA hypertension, but I didn't know. That's the thing about high blood pressure -- it doesn't hurt. There was no pain. I only found out because during the last week of December, I began have massive 30 minute pouring nosebleeds every other day. I checked my blood pressure on a home blood pressure machine, and it registered more than 200 over 160. That and the random surprise bleeding got me into the doctor's office. They measured my BP at 162/102. So it had dropped from apparently ER levels by that time. Over the course of the next few months, we worked to get my BP under control through medication and some diet tweaks. By March of 2016, my BP was coming in at 105/75. Be February of 2017, it was down to 100/70. And on June 3, 2017, I had my stroke. I had serious high blood pressure for maybe a year to a year and a half. I had it under control for a year before my stroke. So how could previous high blood pressure cause a stroke? This week, Dr. Nirav Shah, a neurologist at Swedish Medical Center in Seattle and the founder and CEO of Sentinel Healthcare, returns to Strokecast to answer that very question as we talk about just how high blood pressure causes stroke.   Bio Dr. Nirav H. Shah is a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging. He is a practicing neurohospitalist and served as the stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. He enjoys mentoring trainees and collaborating on publications and conference presentations. Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit. Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer. Hack of the Week After I lost the use of my left arm, eating became a challenge for some dishes. Sushi was easy. Steak was difficult because to cut a steak, you need to hold it still with your fork and slice with the steak with the knife in your other hand. So how do you manage this out at a restaurant?  You've got a couple options. One, of course is to just skip cutting it, pick up the slab of meat with the one usable hand and start chowing down. Of course your dining companions may not prefer that choice. The other option is incredibly simple. When you place your order, ask them to have the kitchen cut up the steak for you.  That's it. It's a simple request that will take them just seconds and it solves your problem. Links Lipohyalinosis https://en.wikipedia.org/wiki/Lipohyalinosis C. Miller Fisher on Wikipedia https://en.wikipedia.org/wiki/C._Miller_Fisher C. Miller Fisher On AHA Journals https://www.ahajournals.org/doi/10.1161/STROKEAHA.112.661512 Atherosclerosis on WebMD https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569 Arteriosclerosis / atherosclerosis on Mayo Clinic https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569 Lacunar Stroke on Wikipedia https://en.wikipedia.org/wiki/Lacunar_stroke Lacunar Infarction and Small Vessel Disease: Pathology and Pathophysiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325635/ Effect of reducing blood pressure with medications immediately following ischemic stroke https://medicalxpress.com/news/2013-11-effect-blood-pressure-medications-immediately.html Blood Pressure-Lowering Treatment After Subacute Stroke to Prevent Recurrent Stroke, Major Vascular Events, and Dementia https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023087?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed Higher Blood Pressure May Be Linked to Brain Disease, Alzheimer’s https://www.rush.edu/news/press-releases/higher-blood-pressure-may-be-linked-brain-disease-alzheimers Nirav  on LinkedIn https://www.linkedin.com/in/nirav-h-shah/ Nirav at Swedish https://www.swedish.org/swedish-physicians/profile.aspx?name=nirav+h+shah&id=271893 Nirav on Twitter http://twitter.com/NeuroNirav The Neurohospitalist http://journals.sagepub.com/home/nho Nirav’s Photography www.thoughtpotential.com Where do we go from here? Control your blood pressure. If you don't know what it is, find out. Talk with your doctor to develop a plan to drive it to safe levels -- under 120/80 Post a link to this episode on your Facebook, LinkedIn, or Twitter account by using the link http://strokecast.com/bloodpressure  If you'd like to hear more from Nirav, check out his other appearances by going to http://Strokecast.com/Nirav Don't get best…get better   Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

  Shortly after I started this show I began asking folks at Swedish about who I should speak with about this project. I got really lucky, and the team there connected me with Dr. Nirav H Shah. He's involved with research, clinical patient care, and development of new technologies.   What's really awesome is how his face lights up when he talks not only about his work, but the work other researchers are doing in this field to improve the quality of life of stroke survivors and to reduce the amount of strokes to begin with.   Bio Dr Nirav H Shah a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in t: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging. He is a practicing neurohospitalist and stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. H enjoys mentoring trainees and collaborating on publications and conference presentations. Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit. Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer.   Notes on Audio Quality My audio is not great this week. I think the batteries were too low in my recorder when we met onsite at Swedish. This mainly affected my side of the conversation. I spent some time tweaking it and pulling it out from the low-volume graveyard to get it to the point where it works, but you'll notice it seems a little thinner this week. Relevant Links Nirav H Shah on LinkledIn https://www.linkedin.com/in/nirav-h-shah/ Nirav H Shah at Swedish https://www.swedish.org/swedish-physicians/profile.aspx?name=nirav+h+shah&id=271893 Nirav on Twitter http://twitter.com/NeuroNirav The Neurohospitalist http://journals.sagepub.com/home/nho ARTSS-2 Study https://www.ahajournals.org/doi/abs/10.1161/strokeaha.117.016720 Nirav H Shah Letter on ARTSS-2 https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.018121 ARCADIA Study https://clinicaltrials.gov/ct2/show/NCT03192215 Sentinel Healthcare http://www.sentinel.healthcare/ Nirav's Photography www.thoughtpotential.com   Where do we go from here? What questions do you have about neurology? What would you like Nirav to talk more about in the future? Let us know in the comments below. Do you know anyone else who finds brains interesting? Send them the link http://strokecast.com/nirav so they can listen, too. Subscribe to Strokecast in your favorite podcast app. Don't get best...get better.  

Podcast sobre os conceitos básicos, indicações e benefícios do tratamento endovascular do AVC isquêmico agudo. Referências: 1)http://stroke.ahajournals.org/content/49/3/e46 2)http://stroke.ahajournals.org/content/early/2018/01/24/STROKEAHA.117.020200?download=true 3)https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00163-X/fulltext 4) https://www.nejm.org/doi/full/10.1056/NEJMoa1713973 5)https://www.nejm.org/doi/full/10.1056/NEJMoa1706442

What are misconceptions about steroids? What to make of the new study linking artificial sweeteners with strokes and dementia? References: http://www.wbur.org/hereandnow/2017/04/21/diet-soda-stroke-dementia http://stroke.ahajournals.org/content/early/2017/04/20/STROKEAHA.116.016027 https://www.walkforthewaiting.org/Team/View/36535/Chasing-Zero Architects of Aesthetics - Building a Bette rYou www.architectsofaesthetics.com

We have a look at papers covering platelet transfusions for patients on antiplatelets who suffer intracerebral bleeds, the optimal dose for procedural sedation with ketamine in children, a new meta-analysis on the sensitivity of early CT in suspected sub arachnoid haemorrhage and finish up with an amazing case report regarding a hypothermic cardiac arrest Make sure you go and have a look at the papers yourself to see what the evidence means to you. Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial. Kannikeswaran N. Am J Emerg Med. 2016 Apr 2. pii: S0735-6757(16)30011-0. doi: 10.1016/j.ajem.2016.03.064. [Epub ahead of print] Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Baharoglu MI. Lancet. 2016 May 9. pii: S0140-6736(16)30392-0. doi: 10.1016/S0140-6736(16)30392-0. [Epub ahead of print]  Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Dubosh NM. Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Epub 2016 Jan 21. HEMS advanced trauma team retrieval of a patient with accidental hypothermic cardiac arrest for ECMO therapy. McCormack J. Resuscitation. 2016 May 30