Hospital team significantly reduced risk of further vascular events after 'mini strokes'

ScienceDaily (Oct. 27, 2011) — Patients who had a transient ischaemic attack (TIA), sometimes referred to as a "mini stroke," were much less likely to experience further vascular events in the first year if their care was co-ordinated by a special hospital team. That is the key finding from a study published in the November issue of the European Journal of Neurology.

Researchers from the Department of Neurology at Aarhus University Hospital in Denmark studied 306 patients admitted to the hospital with a TIA. They found that when the patients were treated by an acute TIA team their cumulated risk of having a stroke in the first seven days was 65% lower than expected. The cumulated risk in the first 90 days fell by 74%.

"The aim of our study was to see if patients had better clinical outcomes if they were under the care of a special team, which integrated outpatient care and stroke unit facilities and provided on-going nurse-led counselling" says lead author Dr Paul von Weitzel-Mudersbach.

"TIA, which is caused by a temporary lack of blood to part of the brain, is a serious condition associated with a high short-term risk of ischaemic stroke. Previous research has shown that the cumulated stroke risk in the first three months after a TIA is ten to 12% in unselected patients and more than 30% in patients with carotid stenosis, a dangerous narrowing of the largest blood vessels that deliver blood to the brain.

"Although urgent intervention has been shown to reduce the risk of stroke, a number of previous studies have shown poor long-term drug compliance in many patients."

The patients were referred directly to the acute TIA team by their family doctor or ambulance, bypassing the emergency department. Patients who had suffered a TIA in the last 48 hours, and those with multiple TIA, faced a high risk of stroke and were admitted to the stroke unit. This offered the option for immediate preventative action, including thrombolysis drugs, to break up blood clots in the case of recurrent stroke. The other patients were seen in the outpatients department within three days of referral.

All the patients seen by the team received acute treatment with antithrombotic and cholesterol lowering drugs and were offered fast-track surgery if they had carotid stenosis. Follow-up included nurse-conducted health counselling after seven, 90 and 365 days. Each contact included the importance of secondary prevention, such as drug compliance and stopping smoking.

Key findings of the study included:

Just under two-thirds of the patients were admitted immediately after their TIA (65%) with the rest being seen as outpatients. Inpatient stays averaged one day.Over half (58%) were seen within 24 hours of their TIA and 70% within 24 hours of the call for attention. The figures at one week were 76% and 89% respectively.Just over 5% had a stroke, non-fatal heart attack or died from a vascular event within a year of their TIA.The cumulated stroke risk was calculated and compared with the ABCD2 score, an established method of identifying individuals with a high early risk of stroke after a TIA. The actual scores in the Aarhus study were 1.6% and 2% after seven and 90 days, significantly lower than the ABCD2 predicted stroke scores of 4.5% and 7.5%.Early surgery to remove the build up of plaque in the carotid blood vessels was performed in 8.5% of patients. However, the authors believe this only played a minor role in the reduced risk.The majority of the patients (95%) fulfilled at least one secondary prevention measure: reduced blood pressure, reduced cholesterol, no smoking and self-reported adherence to antithrombotic treatment. 48% achieved three out of the four targets.Most of the patients (93%) adhered to their antithrombotic treatment.More than 60% of the patients who smoked at the time of their TIA changed their smoking habits -- 31% quit and 29.5% reduced their smoking by at least 50%. Most of the changes happened in the first seven days.

"Our study shows that urgent treatment of patients with TIA is feasible and associated with a substantial reduction in stroke risk during the first three months, which is consistent with previous studies from the UK and France" says Dr von Weitzel-Mudersbach.

"We believe that early and aggressive antithrombotic treatment may play a major role in the reduction of short-term stroke risk in most patients. Meanwhile, the combination of secondary prevention efforts with a relatively high compliance rate -- including the essential telephone follow-up provided by a specially trained nurse in the first three months -- was probably responsible for the low long-term risk of adverse clinical outcome.

"Treating TIA by deploying a specialist team that can admit patients when the risk of recurrent symptoms is highest and prompt thrombolysis can be used, combined with nurse-conducted health counselling, seems to be effective."

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P. v. Weitzel-Mudersbach, S. P. Johnsen, G. Andersen. Low risk of vascular events following urgent treatment of transient ischaemic attack: the Aarhus TIA study. European Journal of Neurology, 2011; 18 (11): 1285 DOI: 10.1111/j.1468-1331.2011.03452.x

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Testing Guam infants for hearing loss remotely

ScienceDaily (Oct. 27, 2011) — Venerannda Leon Guerrero cradled her slumbering infant in her arms in a CEDDERS testing center at the University of Guam as she watched an audiologist in Colorado conduct a diagnostic test to determine whether or not her baby has a hearing loss. The remote test was held on October 19 and marked the first technology-enabled distance diagnostic testing for hearing loss on very young infants on the island.

This event was made possible through the Teleaudiology Project, a collaboration between Dr. Debra Hayes and Dr. Susan Dreith of the Bill Daniels Center for Children's Hearing, Children's Hospital-Colorado, and the University of Guam CEDDERS Guam Early Hearing Detection and Intervention (EHDI) project, with support from the Guam Department of Education, Division of Special Education -- Early Intervention Program. Dr. Dreith and Dr. Ericka Schicke have obtained their licenses to practice as audiologists on Guam.

Drs. Dreith and Schicke at Children's Hospital-Colorado operate the diagnostic audiological equipment remotely from Colorado, after audiometrists on Guam prepare the parent and infant for testing. The Diagnostic Audiological Evaluation (DAE) may take 2 hours to complete, which requires the infant to be asleep during the evaluation. Parents know at the end of the test whether or not their infant has a hearing loss.

The urgent need for diagnosis of very young infants for hearing loss prompted this much-needed collaboration to bring this service to families on Guam. Infants on Guam that do not pass their newborn hearing screening can now be evaluated for any hearing loss before 3 months of age, thereby allowing early intervention services to be initiated, if needed, by the time the infant reaches 6 months of age. This timely early intervention service provides the infant and family the greatest opportunity for the child to develop speech and language in a timely manner for life-long success. Families no longer have to travel off-island to obtain diagnostic audiological evaluations for their infants.

"I think this accomplishment under UOG/Guam CEDDERS is a major step forward in the use of technology to support our community. Thanks to this partnership, babies on this island will get the needed pediatric audiological services from certified professionals, an area lacking on Guam," said Velma Sablan, professor at the University of Guam and experienced professional in the field of early hearing detection and intervention.

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Poorer countries, those spending less on health care have more strokes, deaths

ScienceDaily (Oct. 27, 2011) — Poorer countries and those that spend proportionately less money on health care have more stroke and stroke deaths than wealthier nations and those that allocate more to health care, according to new research in Stroke: Journal of the American Heart Association.

Poorer countries also had a greater incidence of hemorrhagic stroke -- caused by a burst blood vessel bleeding in or near the brain -- and had more frequent onset at younger ages.

Regardless of overall wealth, countries that spend less money proportionately on health care also had higher incidences of all four outcomes.

"Not only is the economic wellness of a country important, but also significant is what proportion of their gross domestic product is expended on health," said Luciano A. Sposato, M.D., M.B.A., study lead author and director of the neurology department at the Vascular Research Institute at INECO Foundation in Buenos Aires, Argentina. "This is very important for developing healthcare strategies to prevent stroke and other cardiovascular diseases."

In the large-scale literature review, researchers took a unique approach to identify stroke risk by correlating it to nationwide socioeconomic status.

Previous research tended to focus on the link between stroke and individual or family financial standing, said Sposato, also director of the Stroke Center at the Institute of Neurosciences, University Hospital Favaloro Foundation.

The study linked lower gross domestic product to:

32 percent higher risk of strokes;43 percent increase of post-stroke deaths at 30 days;43 percent increase in hemorrhagic stroke; and47 percent higher incidence of younger-age-onset stroke.

Similarly, a lower percentage of health spending correlated to a comparable increase in the 30-day death rate and:

26 percent higher risk of strokes;45 percent increase of post-stroke deaths at 30 days;32 percent increase in hemorrhagic stroke;36 percent higher incidence of younger-age-onset stroke.

Investigators analyzed 30 population-based studies conducted between 1998 and 2008 in 22 countries. They used statistical methods to link stroke risk, 30-day death rate, hemorrhagic stroke incidence and age at disease onset to three internationally accepted economic indicators. The indicators included gross domestic product, health expenditure per capita and unemployment rate. Unlike the other two indicators, unemployment rate didn't affect stroke or other outcomes.

"It is important to further discuss the health priorities for different countries," said Gustavo Saposnik, M.D., M.Sc., study co-author and director of stroke outcomes research at St. Michael's Hospital, University of Toronto, Canada. "This will provide the necessary background to help countries make the changes in how different resources and money are allocated."

Stroke is the fourth leading cause of death in the United States and a major cause of long-term disability. Worldwide, stroke is the second leading killer.

Dr. Sposato's participation was funded in part by the INECO Foundation.

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Journal Reference:

Luciano A. Sposato, Gustavo Saposnik. Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset: A Systematic Review. Stroke, 2011; DOI: 10.1161/STROKEAHA.111.632158

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Hard times during adolescence point to health problems later in life

ScienceDaily (Oct. 27, 2011) — Being hard up socially and financially during adolescence and early adulthood takes its toll on the body, and leads to physiological wear and tear in middle aged men and women, irrespective of how tough things have been in the interim. According to Dr. Per E. Gustafsson from Umeå University in Sweden and colleagues, experience of social and material stressors around the time of transition into adulthood is linked to a rise in disease risk factors in middle age, including higher blood pressure, body weight and cholesterol.

Their work is published online in Springer's journal Annals of Behavioral Medicine.

The authors looked at the influence of both social factors and material deprivation during adolescence and adulthood on the physiological wear and tear on the body that results from ongoing adaptive efforts to maintain stability in response to stressors. These adaptive efforts are known as 'allostatic load'. Allostatic load is thought to predict various health problems, including declines in physical and cognitive functioning, and cardiovascular disease and mortality.

The researchers analyzed data for 822 participants in the Northern Swedish Cohort, which follows subjects from the age of 16 for a 27-year period. They looked at measures of social adversity including parental illness and loss, social isolation, exposure to threat or violence and material adversity including parental unemployment, poor standard of living, low income and financial strain. They also examined allostatic load at age 43 based on 12 biological factors linked to cardiovascular regulation, body fat deposition, lipid metabolism, glucose metabolism, inflammation and neuroendocrine regulation.

They found that early adversity involved a greater risk for adverse life circumstances later in adulthood. The analyses revealed adolescence as a particularly sensitive period for women and young adulthood as a particularly sensitive period for men. Specifically, women who had experienced social adversity in adolescence, and men who had experienced it during young adulthood, suffered greater allostatic load at age 43. This was independent of overall socioeconomic disadvantage and also of later adversity exposure during adulthood.

The authors conclude: "Our results support the hypothesis that physiological wear and tear visible in mid-adulthood is influenced by the accumulation of unfavourable social exposures over the life course, but also by social adversity measured around the transition into adulthood, independent of later adversity."

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Per E. Gustafsson, Urban Janlert, Töres Theorell, Hugo Westerlund, Anne Hammarström. Social and Material Adversity from Adolescence to Adulthood and Allostatic Load in Middle-Aged Women and Men: Results from the Northern Swedish Cohort. Annals of Behavioral Medicine, 2011; DOI: 10.1007/s12160-011-9309-6

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Yeast model connects Alzheimer's disease risk and amyloid beta toxicity

ScienceDaily (Oct. 27, 2011) — In a development that sheds new light on the pathology of Alzheimer's disease (AD), a team of Whitehead Institute scientists has identified connections between genetic risk factors for the disease and the effects of a peptide toxic to nerve cells in the brains of AD patients.

The scientists, working in and in collaboration with the lab of Whitehead Member Susan Lindquist, established these previously unknown links in an unexpected way. They used a very simple cell type -- yeast cells -- to investigate the harmful effects of amyloid beta (Aß), a peptide whose accumulation in amyloid plaques is a hallmark of AD. This new yeast model of Aß toxicity, which they further validated in the worm C. elegans and in rat neurons, enables researchers to identify and test potential genetic modifiers of this toxicity.

"As we tackle other diseases and extend our lifetimes, Alzheimer's and related diseases will be the most devastating personal challenge for our families and one the most crushing burdens on our economy," says Lindquist, who is also a professor of biology at Massachusetts Institute of Technology and an investigator of the Howard Hughes Medical Institute. "We have to try new approaches and find out-of the-box solutions."

In a multi-step process, reported in the journal Science, the researchers were able to introduce the form of Aß most closely associated with AD into yeast in a manner that mimics its presence in human cells. The resulting toxicity in yeast reflects aspects of the mechanism by which this protein damages neurons. This became clear when a screen of the yeast genome for genes that affect Aß toxicity identified a dozen genes that have clear human homologs, including several that have previously been linked to AD risk by genome-wide association studies (GWAS) but with no known mechanistic connection.

With these genetic candidates in hand, the team set out to answer two key questions: Would the genes identified in yeast actually affect Aß toxicity in neurons? And if so, how?

To address the first issue, in a collaboration with Guy Caldwell's lab at the University of Alabama, researchers created lines of C. elegans worms expressing the toxic form of Aß specifically in a subset of neurons particularly vulnerable in AD. This resulted in an age-dependent loss of these neurons. Introducing the genes identified in the yeast that suppressed Aß toxicity into the worms counteracted this toxicity. One of these modifiers is the homolog of PICALM, one of the most highly validated human AD risk factors. To address whether PICALM could also suppress Aß toxicity in mammalian neurons, the group exposed cultured rat neurons to toxic Aß species. Expressing PICALM in these neurons increased their survival.

The question of how these AD risk genes were actually impacting Aß toxicity in neurons remained. The researchers had noted that many of the genes were associated with a key cellular protein-trafficking process known as endocytosis. This is the pathway that nerve cells use to move around the vital signaling molecules with which they connect circuits in the brain. They theorized that perhaps Aß was doing its damage by disrupting this process. Returning to yeast, they discovered that, in fact, the trafficking of signaling molecules in yeast was adversely affected by Aß. Here again, introducing genes identified as suppressors of Aß toxicity helped restore proper functioning.

Much remains to be learned, but the work provides a new and promising avenue to explore the mechanisms of genes identified in studies of disease susceptibility.

"We now have the sequencing power to detect all these important disease risk alleles, but that doesn't tell us what they're actually doing, how they lead to disease," says Sebastian Treusch, a former graduate student in the Lindquist lab and now a postdoctoral research associate at Princeton University.

Jessica Goodman, a postdoctoral fellow in the Lindquist lab, says the yeast model provides a link between genetic data and efforts to understand AD from the biochemical and neurological perspectives.

"Our yeast model bridges the gap between these two fields," Goodman adds. "It enables us to figure out the mechanisms of these risk factors which were previously unknown."

Members of the Lindquist lab intend to fully exploit the yeast model, using it to identify novel AD risk genes, perhaps in a first step to determining if identified genes have mutations in AD patient samples. The work will undoubtedly take the lab into uncharted territory.

Notes staff scientist Kent Matlack: "We know that Aß is toxic, and so far, the majority of efforts in the area of Aß have been focused on ways to prevent it from forming in the first place. But we need to look at everything, including ways to reduce or prevent its toxicity. That's the focus of the model. Any genes that we find that we can connect to humans will go into an area of research that has been less explored so far."

This work was supported by an HHMI Collaborative Innovation Award, an NRSA fellowship, the Cure Alzheimer's Fund, the National Institutes of Health, the Kempe foundation, and Alzheimerfonden.

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The above story is reprinted from materials provided by Whitehead Institute for Biomedical Research. The original article was written by Matt Fearer.

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Journal Reference:

Sebastian Treusch, Shusei Hamamichi, Jessica L. Goodman, Kent E. S. Matlack, Chee Yeun Chung, Valeriya Baru, Joshua M. Shulman, Antonio Parrado, Brooke J. Bevis, Julie S. Valastyan, Haesun Han, Malin Lindhagen-Persson, Eric M. Reiman, Denis A. Evans, David A. Bennett, Anders Olofsson, Philip L. Dejager, Rudolph E. Tanzi, Kim A. Caldwell, Guy A. Caldwell, Susan Lindquist. Functional Links Between Aß Toxicity, Endocytic Trafficking, and Alzheimer’s Disease Risk Factors in Yeast. Science, 2011; DOI: 10.1126/science.1213210

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Curiosity is critical to academic performance

ScienceDaily (Oct. 27, 2011) — Curiosity may have killed the cat, but it's good for the student. That's the conclusion of a new study published in Perspectives in Psychological Science, a journal of the Association for Psychological Science. The authors show that curiosity is a big part of academic performance. In fact, personality traits like curiosity seem to be as important as intelligence in determining how well students do in school.

Intelligence is important to academic performance, but it's not the whole story. Everyone knows a brilliant kid who failed school, or someone with mediocre smarts who made up for it with hard work. So psychological scientists have started looking at factors other than intelligence that make some students do better than others.

One of those is conscientiousness -- basically, the inclination to go to class and do your homework. People who score high on this personality trait tend to do well in school. "It's not a huge surprise if you think of it, that hard work would be a predictor of academic performance," says Sophie von Stumm of the University of Edinburgh in the UK. She co-wrote the new paper with Benedikt Hell of the University of Applied Sciences Northwestern Switzerland and Tomas Chamorro-Premuzic of Goldsmiths University of London.

von Stumm and her coauthors wondered if curiosity might be another important factor. "Curiosity is basically a hunger for exploration," von Stumm says. "If you're intellectually curious, you'll go home, you'll read the books. If you're perceptually curious, you might go traveling to foreign countries and try different foods." Both of these, she thought, could help you do better in school.

The researchers performed a meta-analysis, gathering the data from about 200 studies with a total of about 50,000 students. They found that curiosity did, indeed, influence academic performance. In fact, it had quite a large effect, about the same as conscientiousness. When put together, conscientiousness and curiosity had as big an effect on performance as intelligence.

von Stumm wasn't surprised that curiosity was so important. "I'm a strong believer in the importance of a hungry mind for achievement, so I was just glad to finally have a good piece of evidence," she says. "Teachers have a great opportunity to inspire curiosity in their students, to make them engaged and independent learners. That is very important."

Employers may also want to take note: a curious person who likes to read books, travel the world, and go to museums may also enjoy and engage in learning new tasks on the job. "It's easy to hire someone who has the done the job before and hence, knows how to work the role," von Stumm says. "But it's far more interesting to identify those people who have the greatest potential for development, i.e. the curious ones."

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S. von Stumm, B. Hell, T. Chamorro-Premuzic. The Hungry Mind: Intellectual Curiosity Is the Third Pillar of Academic Performance. Perspectives on Psychological Science, 2011; 6 (6): 574 DOI: 10.1177/1745691611421204

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Natural killer cells could be key to anthrax defense

ScienceDaily (Oct. 27, 2011) — One of the things that makes inhalational anthrax so worrisome for biodefense experts is how quickly a relatively small number of inhaled anthrax spores can turn into a lethal infection. By the time an anthrax victim realizes he or she has something worse than the flu and seeks treatment, it's often too late; even the most powerful antibiotics may be no help against the spreading bacteria and the potent toxins they generate.

Now, though, University of Texas Medical Branch at Galveston researchers have found new allies for the fight against anthrax. Known as natural killer cells, they're a part of the immune system normally associated with eliminating tumor cells and cells infected by viruses. But natural killer cells also attack bacteria -- including anthrax, according to the UTMB group.

"People become ill so suddenly from inhalational anthrax that there isn't time for a T cell response, the more traditional cellular immune response," said UTMB assistant professor Janice Endsley, lead author of a paper now online in the journal Infection and Immunity. "NK cells can do a lot of the same things, and they can do them immediately."

In test-tube experiments, a collaborative team led by Endsley and Professor Johnny Peterson profiled the NK cell response to anthrax, documenting how NK cells successfully detected and killed cells that had been infected by anthrax, destroying the bacteria inside the cells along with them. Surprisingly, they found that NK cells were also able to detect and kill anthrax bacteria outside of human cells.

"Somehow these NK cells were able to recognize that there was something hostile there, and they actually caused the death of these bacteria," Endsley said.

In further experiments, the group compared the anthrax infection responses of normal mice and mice that were given a treatment to remove NK cells from the body. All the mice died with equal rapidity when given a large dose of anthrax spores, but the non-treated (NK cell-intact) mice had much lower levels of bacteria in their blood. "This is a significant finding," Endsley said. "Growth of bacteria in the bloodstream is an important part of the disease process."

The next step, according to Endsley, is to apply an existing NK cell-augmentation technique (many have already been developed for cancer research) to mice, in an attempt to see if the more numerous and active NK cells can protect them from anthrax. Even if the augmented NK cells don't provide enough protection by themselves, they could give a crucial boost in combination with antibiotic treatment.

"We may not be able to completely control something just by modulating the immune response," Endsley said. "But if we can complement antibiotic effects and improve the efficiency of antibiotics, that would be of value as well."

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C. M. Gonzales, C. B. Williams, V. E. Calderon, M. B. Huante, S. T. Moen, V. L. Popov, W. B. Baze, J. W. Peterson, J. J. Endsley. Antibacterial Role for Natural Killer Cells in Host Defense to Bacillus Anthracis. Infection and Immunity, 2011; DOI: 10.1128/IAI.05439-11

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