Role of antiplatelet therapy in cardiovascular disease II: Ischemic stroke.

The etiology of cerebrovascular disease is heterogeneous, with the majority of strokes being of ischemic origin. Transient ischemic attack is now considered to be an important precursor and long-term risk factor for ischemic stroke. Given the lack of acute therapies for ischemic stroke, current treatments focus on secondary prevention through risk-factor management, pharmacotherapy and interventional approaches. As illustrated in this paper, antiplatelet agents (e.g. clopidogrel, aspirin, dipyridamole) are the cornerstone of therapy for prevention of recurrent ischemic stroke

Wind-tunnel evaluation of an advanced main-rotor blade design for a utility-class helicopter

An investigation was conducted in the Langley Transonic Dynamics Tunnel to evaluate differences between an existing utility-class main-rotor blade and an advanced-design main-rotor blade. The two rotor blade designs were compared with regard to rotor performance oscillatory pitch-link loads, and 4-per-rev vertical fixed-system loads. Tests were conducted in hover and over a range of simulated full-scale gross weights and density altitude conditions at advance ratios from 0.15 to 0.40. Results indicate that the advanced blade design offers performance improvements over the baseline blade in both hover and forward flight. Pitch-link oscillatory loads for the baseline rotor were more sensitive to the test conditions than those of the advanced rotor. The 4-per-rev vertical fixed-system load produced by the advanced blade was larger than that produced by the baseline blade at all test conditions

Motor cortex stimulation for enhancement of recovery after stroke: case report.

We present a case report of a 65-year-old patient who had a subcortical infarct and a right spastic hemiparesis that occurred 19 months before being treated with an investigational therapy consisting of low frequency subthreshold epidural motor cortex electrical stimulation delivered during structured occupational therapy repeated daily for three weeks. Before treatment the patient's affected arm rested in a flexion posture and he was unable to flex or extend the fingers. After three weeks of treatment, the resting tone of his arm had improved and he was able to grasp a pen and write letters. The Fugl-Meyer motor scale score improved from 36 to 46 and this improvement was sustained for four weeks after the conclusion of rehabilitation therapy. This is the first patient to be entered into a randomized clinical feasibility and safety study assessing functional improvement in stroke patients treated with epidural cortical stimulation concurrent with occupational therapy (an investigational therapy)

Vulnerability of the frontal-temporal connections in temporal lobe epilepsy.

ObjectiveIn temporal lobe epilepsy (TLE), frontal-temporal connections are integral parts of the epileptogenic network. Although frontal-temporal gray matter abnormalities have been consistently demonstrated in TLE, white matter connections between these two lobes require further study in this disease setting. We therefore investigated the integrity of two major frontal-temporal white matter association tracts, uncinate fasciculus (UF) and arcuate fasciculus (AF), and their clinical correlates.MethodsUsing diffusion tensor imaging (DTI) tractography, integrity of the UF and AF was examined in 22 individuals (12 subjects with TLE and 10 age-matched healthy controls). DTI indices of these tracts were compared between the two subject groups and correlates examined with clinical variables that included age of seizure onset, duration of epilepsy, history of febrile seizure and antiepileptic medication exposure.ResultsIn subjects with TLE, the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of UF and AF ipsilateral to the side of seizure onset were abnormal when compared to healthy controls. Furthermore, lower UF FA correlated with earlier age of seizure onset.ConclusionTLE is associated with abnormal integrity of frontal-temporal white matter tracts, but only on the side of seizure onset. This suggests that frontal-temporal white matter tracts are vulnerable to recurrent seizures and/or the factors precipitating the epilepsy

Motor cortex stimulation for the enhancement of recovery from stroke: a prospective, multicenter safety study.

ObjectiveFunctional magnetic resonance imaging and transcranial magnetic stimulation studies suggest that human cortex shows evidence of neuroplasticity. Preclinical studies in rats and monkeys suggest that motor cortical stimulation can enhance plasticity and improve recovery after stroke. This study assesses the safety and preliminary efficacy of targeted subthreshold epidural cortical stimulation delivered concurrently with intensive rehabilitation therapy while using an investigational device in patients with chronic hemiparetic stroke.MethodsThis is a prospective, multicenter, and nonblinded trial randomizing patients to rehabilitation with or without cortical stimulation. Patients aged 20 to 75 years who had had an ischemic stroke at least 4 months previously causing persistent moderate weakness of the arm were included. Functional magnetic resonance imaging localized hand motor function before surgery to place an epidural cortical electrode. Both groups then underwent rehabilitation for 3 weeks after which the electrode was removed. Outcome measures were obtained at baseline, during therapy, and at 1, 4, 8, and 12 weeks postprocedure.ResultsTen patients were randomized; six patients to surgery, four to the control group. No patient deaths, neurological deterioration, or seizures occurred. There were two infections from nonprotocol-related causes. Of the eight patients completing the treatment, the stimulation plus rehabilitation group improved significantly better than controls in the Upper Extremity Fugl-Meyer (P = 0.003 overall) and the hand function score of the Stroke Impact Scale (P =0.001 overall).ConclusionThe technique of cortical stimulation to enhance stroke recovery is well tolerated and safe

Motor cortex stimulation for the enhancement of recovery from stroke: a prospective, multicenter safety study.

ObjectiveFunctional magnetic resonance imaging and transcranial magnetic stimulation studies suggest that human cortex shows evidence of neuroplasticity. Preclinical studies in rats and monkeys suggest that motor cortical stimulation can enhance plasticity and improve recovery after stroke. This study assesses the safety and preliminary efficacy of targeted subthreshold epidural cortical stimulation delivered concurrently with intensive rehabilitation therapy while using an investigational device in patients with chronic hemiparetic stroke.MethodsThis is a prospective, multicenter, and nonblinded trial randomizing patients to rehabilitation with or without cortical stimulation. Patients aged 20 to 75 years who had had an ischemic stroke at least 4 months previously causing persistent moderate weakness of the arm were included. Functional magnetic resonance imaging localized hand motor function before surgery to place an epidural cortical electrode. Both groups then underwent rehabilitation for 3 weeks after which the electrode was removed. Outcome measures were obtained at baseline, during therapy, and at 1, 4, 8, and 12 weeks postprocedure.ResultsTen patients were randomized; six patients to surgery, four to the control group. No patient deaths, neurological deterioration, or seizures occurred. There were two infections from nonprotocol-related causes. Of the eight patients completing the treatment, the stimulation plus rehabilitation group improved significantly better than controls in the Upper Extremity Fugl-Meyer (P = 0.003 overall) and the hand function score of the Stroke Impact Scale (P = 0.001 overall).ConclusionThe technique of cortical stimulation to enhance stroke recovery is well tolerated and safe

Effects of a supplement designed to increase ATP levels on muscle strength, power output, and endurance

<p>Abstract</p> <p>Background</p> <p>The present study examined the acute effects of a nutritional supplement intended to improve adenosine triphosphate (ATP) concentrations on vertical jump height, isometric strength of the leg extensors, leg extension endurance, and forearm flexion endurance.</p> <p>Methods</p> <p>Twenty-four healthy men (mean age ± SD = 23 ± 4 yrs, stature = 181 ± 7 cm, and body mass = 82 ± 12 kg) volunteered to complete a familiarization trial plus 2 randomly-ordered experimental trials separated by a 7-day washout period. Participants received either 6 (body mass < 91 kg) or 8 (body mass ≥ 91 kg) tablets of the treatment (TR; 625 mg of adenylpyrophosphoric acid and calcium pyruvate, 350.8 mg of cordyceps sinensis extract and yohimbine hydrochloride) or placebo (PL; 980 mg of microcrystalline cellulose) 1 hour prior to the following tests: countermovement vertical jump (CVJ), forearm flexion repetitions to exhaustion, isometric maximal voluntary contractions (MVCs) of the leg extensors, and a 50-repetition maximal concentric isokinetic leg extension endurance test.</p> <p>Results</p> <p>There were no differences between the TR and PL trials for CVJ height (<it>P </it>> 0.05), isometric MVC peak torque (<it>P </it>> 0.05), maximal concentric isokinetic peak torque (<it>P </it>> 0.05), percent decline during the leg extension endurance tests (<it>P </it>> 0.05), or repetitions to exhaustion during the forearm flexion endurance tests (<it>P </it>> 0.05).</p> <p>Conclusion</p> <p>These findings indicated no improvements in the measured variables as a result of ingesting this nutritional supplement. Future studies should examine whether chronic supplementation or a loading period is necessary to observe any ergogenic effects of this supplement.</p

BDNF val66met polymorphism is associated with modified experience-dependent plasticity in human motor cortex.

Motor training can induce profound physiological plasticity within primary motor cortex, including changes in corticospinal output and motor map topography. Using transcranial magnetic stimulation, we show that training-dependent increases in the amplitude of motor-evoked potentials and motor map reorganization are reduced in healthy subjects with a val66met polymorphism in the brain-derived neurotrophic factor gene (BDNF), as compared to subjects without the polymorphism. The results suggest that BDNF is involved in mediating experience-dependent plasticity of human motor cortex

Paradoxical emboli from calf and pelvic veins in cryptogenic stroke.

PURPOSE: The increased prevalence of patent foramen ovale in patients with cryptogenic strokes suggests the occurrence of paradoxical embolism. The identification of deep venous thromboses (DVTs) in this population would strengthen this hypothesis. The purpose of this study was to image the subdiaphragmatic venous system in a cohort of patients with cryptogenic strokes. MATERIALS AND METHODS: In 37 patients with cryptogenic brain ischemia and interatrial communication, duplex studies of calf, popliteal, and femoral veins, and magnetic resonance imaging venograms of the pelvis veins were performed. RESULTS: In 10 patients, DVTs were diagnosed that were considered to be the cause of cryptogenic brain ischemia on probable (n = 6) or possible (n = 4) bases. In these patients, the median time from stroke to DVT was 3.25 days. In 5 of these 10 patients, DVTs did not involve popliteal and femoral veins, areas thought most important to pulmonary embolism, but instead were isolated to calf or pelvic veins. Although none of these 10 patients had abnormal blood hypercoagulation tests, 8 of the 10 did have clinical conditions suggesting predisposition to developing DVTs, such as concomitant neoplasms or pulmonary embolism. CONCLUSIONS: Increased evidence for paradoxical embolism may emerge when diagnostic strategies use multiple imaging methods and evaluate a broad extent of the subdiaphragmatic veins