This edition features two stroke updates: how smart technology may aid in clinical decision-making for ischemic stroke, as well as the cognitive risks for those who grew up in the “Stroke Belt.” Plus: the “human textile” extracellular matrix that could add a significant tool to the tissue repair arsenal, and the two common drugs that may be the solution to a “broken heart.”
A new study indicates that mobile devices and laptops are reliable and accurate enough for clinical decision-making as it pertains to the administration of intravenous thrombolysis in acute stroke patients. The was conducted to assess accuracy and reliability of IV thrombolysis recommendations following the interpretation of head computed tomography images of patients with symptoms of acute stroke that were displayed on either a smartphone or laptop reading system, comparing them to those interpreted on a standard medical workstation monitor. They study included 2,256 interpretations (from 188 patients, four neuroradiologists, and three reading systems). The researchers calculated intraobserver variables like hemorrhagic lesions, intra-axial neoplasm, stroke dating, hyperdense arteries, and infarct size assessment. For reliability, the researchers calculated intraobserver and interobserver agreement using the intraclass correlation coefficient. They then performed equivalence tests for accuracy, and evaluated sensitivity, specificity, and ROC curves. The researchers reported good or very good interobserver and intraobserver agreements following the interpretations of each variable. The authors noted that this finding was important because “it reflects the good performance of mobile devices to evaluate the most significant imaging variables for clinical decisions.”
New research suggests that people who grew up in the “Stroke Belt” – eight states in the southeastern United States with elevated stroke rates (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee) – have a greater risk of developing cognitive impairment later in life. In the study, researchers compared approximately 11,500 people with a mean age of 64 living in the Stroke Belt with nearly 9,000 with a mean age of 65 people living outside of it. No participant in the study suffered a stroke before enrolling in the study at the age of 45 or older, and at baseline all were considered cognitively healthy. According to the results of the study, compared to lifelong Stroke Belt residents, those who grew up outside the Stroke Belt were 24% less likely to develop cognitive impairment; those who spent some of their childhood elsewhere were 18% less likely to show impairment; those who spent all their early adulthood (ages 19-30) outside the Stroke Belt were 30% less likely to develop cognitive impairment; and individuals who spent part of the early adulthood elsewhere were 14% less likely to show impairment.
Previous research has indicated that there is an elevated risk for a heart attack early on in a period of bereavement (sometimes called having “broken heart” syndrome). However, new research suggests that preventing this outcome may be as simple as taking two common drugs. The randomized clinical trial of 85 recently bereaved participants (73 for spouses and 12 for parents; 55 females and 30 males; average age, 66 years) was performed to determine whether a beta-blocker (metropolol 25 mg) and aspirin (100 mg) were able to reduce cardiovascular risk markers and anxiety without interfering with or affecting bereavement intensity. Participants were assessed within two weeks of bereavement and randomized to six weeks of treatment with either placebo or daily treatment with the metropolol/aspirin combination therapy. According to the results, those taking the metropolol and aspirin had lower home systolic levels, a lower average 24-hour heart rate, and lower anxiety platelet response to arachidonic acid, as well as reduced depression symptoms, compared to placebo. The authors reported no difference in standard deviation of NN intervals index, von Willebrand Factor antigen, platelet-granulocyte aggregates, or bereavement intensity. There were also no adverse effects on safety.
A team of researchers from France have succeeded in creating a “human textile” extracellular matrix that could add a significant tool to the tissue repair arsenal. The study described how the team was able to cultivate human cells to get extracellular matrix deposits high in collagen. The team then cut these extracellular matrix sheets to form a “yarn” from them, which can then be sewn or braided or knitted into any number of forms. The upshot, one of the authors explained, is that the matrix sheets can be used to repair or replace blood vessels. The authors wrote that they had succeeded in creating woven tissue-engineered vascular grafts that were not only adequate for clinical standards, but surpassed requirements for burst pressure, suture retention strength, and transmural permeability. According to a news release, the chief advantage of this therapy would be that the implants would be well-tolerated by all patients, given that collagen does not vary between individuals, and therefore would not be rejected by the body as foreign substances. The authors noted that they plan to pursue this technique and study further in animal trials, leading eventually (upon success, it is hoped) to clinical trials.