Stroke: Cerebellar Stimulation Improved Motor Function

MedicalResearch.com Interview with:

Giacomo Koch, MD, PhD Laboratorio di Neurologia Clinica e Comportamentale Fondazione S. Lucia I.R.C.C.S. taly

Dr. Koch

Giacomo Koch, MD, PhD
Laboratorio di Neurologia Clinica e Comportamentale
Fondazione S. Lucia I.R.C.C.S.
Italy

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We show in this paper that non invasive stimulation of the cerebellum in patients with stroke is able to improve motor functions.

In particular we found that after three weeks of repetitive TMS of the intact cerebellum patients with hemiparesis due to stroke in the cerebral hemisphere remarkably improved their ability to walk and keep their balance, thus highly reducing the risk of fall. 

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Heroin Fires Off Reward-Seeking Neurons In Less Than a Minute

MedicalResearch.com Interview with:
"Be careful what you wish for #drugs #heroin #addiction #camp #church" by Matthew Kang is licensed under CC BY-ND 2.0Michaël Loureiro, PhD

Research Assistant – Group Lüscher
Dpt. of Fundamental Neuroscience
University of Geneva – Faculty of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Addiction refers to the repeated and irrepressible urge to consume a drug even in the light of negative consequences.

All addictive drugs are initially rewarding and have powerful reinforcing properties, which drive users to use the drug again and again. Within the scientific community, it has been repeatedly argued that for opioids, this initial reinforcing effect does not involve dopamine, and no consensus was emerging.

In our study we used some of the most advanced genetic tools to observe that in less than a minute heroin strongly increased the activity of neurons in the midbrain causing a release of dopamine in the striatum, a brain region essential for reward seeking. We further used neuroanatomical tracing methods and found that dopamine neurons activated by heroin were projecting to the very medial region of the ventral striatum.

Finally, when we silenced dopamine neurons, heroin lost its reinforcing power, confirming the validity of the dopamine activation hypothesis for opioids.

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Serum Neurofilament Biomarker Helps Determine if Brain Function Will Recover After Cardiac Arrest

MedicalResearch.com Interview with:

Dr-Marion Moseby-Knappe

Dr. Moseby-Knappe

Marion Moseby-Knappe, MD
Neurologist and Researcher
Center for Cardiac Arrest at Lund University and
Skane University Hospital
Lund, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research focuses on improving methods for examining unconscious patients treated on intensive care units after cardiac arrest. If a patient does not wake up within the first days after cardiac arrest, physicians need to evaluate how likely it is that the patient will awaken at all and to which extent there is brain injury.

According to European and American guidelines, decisions on further medical treatment of cardiac arrest patients should always be based on a combination of examinations and not only one single method. Various methods are combined when assessing the patient such as examining different neurologic reflexes, head scans (computed tomography or magnetic resonance imaging), other specialist examinations (electroencephalogram or somatosensory evoked potentials) or blood markers.

Our research focuses on patients included in the largest cardiac arrest trial to date, the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial.

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Errors in Dementia Drugs Surprising Common in Parkinson’s Disease

MedicalResearch.com Interview with:

Allison W. Willis, MD, MS Assistant Professor of Neurology Assistant Professor of Biostatistics and Epidemiology Senior Fellow, Leonard Davis Institute Senior Scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine

Dr. Willis

Allison W. Willis, MD, MS
Assistant Professor of Neurology
Assistant Professor of Biostatistics and Epidemiology
Senior Fellow, Leonard Davis Institute
Senior Scholar, Center for Clinical Epidemiology and Biostatistics
University of Pennsylvania School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was motivated by my own experiences as a neurologist-neuroscientist.

I care for Parkinson disease patients, and over the year, have had numerous instances in which a person was taking a medication that could interact with their Parkinson disease medications, or could worsen their PD symptoms.
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Need For Better Treatments For Chronic Nerve Pain After Trauma Remains Serious Problem

MedicalResearch.com Interview with:

John Douglas Markman, M.D. Director, Translational Pain Research Program Department of Neurosurgery Associate Professor University of Rochester School of Medicine and Dentistry

Dr. Markman

John Douglas Markman, M.D.
Director, Translational Pain Research Program
Department of Neurosurgery
Professor
University of Rochester School of Medicine and Dentistry 

MedicalResearch.com: What is the background for this study?

Response: Peripheral nerve injury after trauma and surgery is a leading cause of chronic pain and disability. These pain syndromes are often considered to have an underlying neuropathic mechanism because there is altered sensory processing (e.g., numbness, allodynia) at the site of trauma or surgical incision that localizes to the anatomic distribution of a peripheral nerve. A previous eight-week randomized clinical trial demonstrated efficacy for pregabalin in patients with chronic post-traumatic or -surgical pain.(10) The longer duration of treatment of this study was designed to meet the regulatory standard for a chronic pain indication in the US, 12 weeks of treatment at maintenance or fixed dosing.

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Physical Activity Could Reduce Risk of Parkinson disease, esp. in Men

MedicalResearch.com Interview with:
Fudi Wang, M.D., Ph.D. Qiushi Chair Professor Nutrition Discovery Innovation Center School of Public Health/School of Medicine Zhejiang University Hangzhou 310058, ChinaFudi Wang, M.D., Ph.D.
Qiushi Chair Professor
Nutrition Discovery Innovation Center
School of Public Health/School of Medicine
Zhejiang University
Hangzhou  China

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Parkinson disease (PD) is the second most common neurodegenerative disease affecting approximately 10 million people around the world. To date, the cause of PD remains poorly understood. It is reported that 90% PD cases have no identifiable genetic cause. What’s worse, few therapeutic advances for the treatment of PD have been made in the past decades. Nevertheless, growing prospective longitudinal studies shed lights on the potential beneficial effect of lifestyle factors on reducing the risk of developing Parkinson disease. In this study, we performed a a dose-response meta-analysis of more than half a million participants.

We found that physical activity, particularly moderate to vigorous physical activity, could significantly reduce PD risk.

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Cannabis Users Have Increased Neural Activity, Even at Rest

MedicalResearch.com Interview with:

Dr. Francesca M. Filbey PhD Professor Program Head, Cognition and Neuroscience PhD Bert Moore Chair in BrainHealth UT Dallas

Dr. Filbey

Dr. Francesca M. Filbey PhD
Professor
Program Head, Cognition and Neuroscience PhD
Bert Moore Chair in BrainHealth
UT Dallas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The cannabis literature has generally focused on changes in brain function when engaged in a task. We were interested in examining whether these differences are present when not engaged in a task (i.e., during resting state) to understand baseline functional organization of the brain. Changes to baseline functional organization may reflect changes in brain networks underlying cognition. We also wanted to investigate whether specific brain waves, as measured by electroencephalography (EEG), are associated with measures of cannabis use, such as craving.

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Insights into Neurobiology of Restless Legs Syndrome

MedicalResearch.com Interview with:

Rachel Marie E. Salas, MD, MEHP, FAAN Associate Professor, Neurology and Nursing at Johns Hopkins Medicine Director, Interprofessional Education and Interprofessional Collaborative Practice Director, Neurology Clerkship Director, PreDoc Program Meyer/Neuro Sleep Baltimore, MD

Dr Salas

Rachel Marie E. Salas, MD, MEHP, FAAN
Associate Professor, Neurology and Nursing at Johns Hopkins Medicine
Director, Interprofessional Education and Interprofessional Collaborative Practice
Director, Neurology Clerkship
Director, PreDoc Program Meyer/Neuro Sleep
Baltimore, MD

MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by RLS  and who suffers from it?

Response: Restless Legs Syndrome (RLS) is a common neurological disorder characterized by an irritating, overwhelming urge to move (akathisia) the legs while at rest or sleep (conditions of diminished arousal), which almost immediately abates with mental or physical activity (conditions of maintained arousal).

One of the most clinically-profound and scientifically relevant consequences of this disease process is an increased arousal state producing significant wake during sleep times and a relative sustainable degree of daytime alertness despite the degree of diseased-imposed sleep loss. The focus of most previous RLS research has been on the (limb) akathisia with associated periodic movements and reduction of these with dopaminergic treatment. Little research has been done to understand the broader biological dimensions​ of RLS. Patients with RLS have altered sleep-wake homeostasis with increased arousal and wakefulness (hyperarousal) not only driving the signature clinical symptoms (“the urge to move” and sleep loss) but also supporting arousal over sleep drive at night and in the day. We hypothesize that there is a basic glutamate-hyperarousal process producing both disrupted sleep (increased wake time) and cortical excitability (as demonstrated by transcranial magnetic stimulation (TMS)).​  Continue reading

Bigger Amygdalas Linked to Procrastination

MedicalResearch.com Interview with:
MedicalResearch.comCaroline Schlüter, M.Sc. Psychologie

Fakultät für Psychologie
AE Biopsychologie
Ruhr-Universität Bochum

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Individuals differ in their ability to initiate intended actions. While some people tend to put tasks off, others easily manage to tackle them directly. Although interindividual differences in what we call ‘action control’ make a major contribution to our everyday life by affecting our physical and mental health as well as our academic and occupational performance, their neural foundation was mostly unknown.

Our study is the first to use both structural and functional neuroimaging methods to investigate the neural correlates of action control. We were able to show that poorer action control is significantly related to greater amygdala volume. The amygdala is considered to be a neuroanatomical hub for fear-motivated behavior. It processes sensory information in order to evaluate a given situation, behaviour or outcome. Hence, it is conceivable that individuals with a larger amygdala tend to evaluate future actions and their possible consequences more extensively. This, in turn, might lead to greater concern and hesitation, as observed in individuals with poorer action control.

Further, we were able to show that weaker functional resting-state connectivity between the amygdala and the dorsal anterior cingulate cortex (dACC) is significantly associated with lower action control scores, which are typical for procrastinators. Previous studies indicate that the dACC has reciprocal connections with the amygdala, playing a significant role in purposive behaviour and self-control mechanisms. Thus, a weaker functional connection between both brain areas might hinder successful action control, as interfering negative emotions and  Continue reading

Brain Signaling Finds Dominant Individuals Make Accurate Decisions Faster

MedicalResearch.com Interview with:

Prof. Carmen Sandi Director, Brain Mind Institute Laboratory of Behavioral Genetics Brain Mind Institute Ecole Polytechnique Federale de Lausanne Lausanne, Switzerland 

Prof. Sandi

Prof. Carmen Sandi
Director, Brain Mind Institute
Laboratory of Behavioral Genetics
Brain Mind Institute
Ecole Polytechnique Federale de Lausanne
Switzerland 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Social hierarchies are pervasive and social status has deep consequences for health, wellbeing and societal organizations. Socially dominant individuals have priority access to resources and are more likely to become leaders. Although there are drastic differences in the predisposition of individuals to attain or strive for dominance, very little is known regarding the factors that predispose individuals to attain dominance. Does dominance become visible only in social context?

Here, we performed five behavioral experiments and consistently found that individuals high in dominance are faster than less dominant ones to respond in choice situations, though not less accurate, which suggests that promptness to respond may predispose individuals to become dominant. Strikingly, using high-density EEG, we find that promptness to respond in dominant individuals is reflected in a strongly amplified brain signal at approximately 240 ms post-stimulus presentation. At this latency, participants’ reaction times were negatively correlated with activity in the cingulate cortex. Our results may open a new research approach using EEG signatures as a measure for dominance, independent of social context.

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Brain Circuits in Compulsive Alcohol Drinkers Identified

MedicalResearch.com Interview with:

Erica Grodin, Ph.D. Postdoctoral Fellow Dept. of Psychology and Psychiatry  University of California

Dr. Grodin

Erica Grodin, Ph.D.
Postdoctoral Fellow
Dept. of Psychology and Psychiatry
University of California 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The hallmark of addictive disorders, including alcohol use disorder, is drug use that continues despite negative consequences. This pattern of use is referred to as “compulsive” and is one of the major barriers to treating addiction. We don’t yet fully understand what brain regions are responsible for compulsive alcohol use.

Our study used a neuroimaging method called functional magnetic resonance imaging which allows us to see which areas of the brain are more active when an individual is performing a task. To investigate what brain regions are involved in compulsive alcohol seeking, we designed a task during which study participants could try to earn alcohol and food points at the risk of receiving a negative consequence, an electric shock. Study participants were light drinkers (men who drank <15 drinks/week and women who drank <10 drinks/week) and heavy drinkers (men who drank ≥20 drinks/week and women who drank ≥15 drinks/week).

We found that heavy drinking individuals were more likely to try to earn alcohol points that were paired with a potential negative consequence than light drinkers were. This behavior of compulsive alcohol seeking was associated with increased brain activation in the medial prefrontal cortex, anterior insula, and ventral and dorsal striatum.  Continue reading

Maybe Spinal Repair Cells Can Be Turned On and Off

MedicalResearch.com Interview with:

Pier Lorenzo Puri, M.D PhD Professor in the Development, Aging and Regeneration Program Sanford Burnham Prebys Medical Discovery Institute 

Dr. Puri

Pier Lorenzo Puri, M.D PhD
Professor in the Development, Aging and Regeneration Program
Sanford Burnham Prebys Medical Discovery Institute 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My lab has been studying special repair cells called fibro-adipogenic progenitors (FAPs) and how these cells change in models of motor neuron diseases. These cells usually repair muscles after acute injury. But we are finding the FAPs change dramatically in disease settings.

In this study we looked at these cells in models of spinal cord injury, ALS and spinal muscular atrophy, including muscle tissue from ALS patients. We found that FAPs change radically in several ways.

Most importantly, the cells used a different signaling pathway, IL-6-STAT3, and when we blocked this signaling muscle atrophy and fibrosis halted. While further studies in humans are needed, this is a promising finding as FDA-approved medicines that block IL-6 and STAT3 are available.  Continue reading

Pregabalin Linked To Increased Risk for Opioid-Related Deaths

MedicalResearch.com Interview with:

Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada

Tara Gomes

Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada 

MedicalResearch.com: What is the background for this study?

Response: Pregabalin is a medication increasingly being prescribed to manage pain, however there is emerging evidence that this drug may increase one’s risk of opioid overdose when prescribed with opioids.

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How Our Brain Lets Us Believe What We Want To Believe

MedicalResearch.com Interview with:

People demonstrate biased belief updating: They tend to regard good news indicating that personal risks are lower than expected, and to disregard bad news indicating that personal risks are higher than expected. Kuzmanovic and colleagues show that this optimism bias depends on the update valuation by the ventromedial prefrontal cortex (vmPFC) and its influence on the dorsomedial prefrontal cortex (dmPFC) associated with self-referential reasoning. Credit: Bojana Kuzmanovic

People demonstrate biased belief updating: They tend to regard good news indicating that personal risks are lower than expected, and to disregard bad news indicating that personal risks are higher than expected. Kuzmanovic and colleagues show that this optimism bias depends on the update valuation by the ventromedial prefrontal cortex (vmPFC) and its influence on the dorsomedial prefrontal cortex (dmPFC) associated with self-referential reasoning.
Credit: Bojana Kuzmanovic

Dr. Bojana Kuzmanovic PhD
Max Planck Institute for Metabolism Research
Translational Neurocircuitry Group
Cologne, Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Do our beliefs depend on what we want to believe? Until now, researchers failed to show how interactions between brain regions mediate the influence of motivation to adopt desirable notions on ongoing reasoning. Our study used optimized design and analyses to rule out alternative explanations and to identify underlying neurocircuitry mechanisms.

MedicalResearch.com: What are the main findings?

Response: First, we demonstrated that people’s belief formation behavior depends on their preferences. When people were asked to reconsider their beliefs about their future outcomes, they tended to rely more strongly on good news and to disregard bad news.

Second, we showed that favorable belief updating activated the brain valuation system known to be responsive to rewards such as food or money (ventromedial prefrontal cortex, vmPFC). That is, the valuation system was activated when participants incorporated good news to improve their risk estimates, and when they disregarded bad news to avoid a worsening of their risk estimates.

And third, the valuation system influenced other brain regions that are involved in deriving conclusions about oneself (dorsomedial prefrontal cortex, dmPFC). Importantly, the more participants were biased in their belief formation behavior, the stronger was the engagement and the influence of the valuation system.

The influence of the valuation system on the reasoning system helps to understand how motivation can affect reasoning. It supports the idea that memories and knowledge we recall to form our beliefs are selected in such a way as to yield the desired conclusions. For example, when we wish to convince ourselves that our risk of having a heart attack is low although federal statistics indicate a higher risk, we might recall our healthy life style but not our family history of heart-related diseases, or neglect the fact that the federal population may have a comparable life style. Continue reading

PITS Gene Linked To Rare Neurologic Disorders

MedicalResearch.com Interview with: 

Paul C Marcogliese, Ph.D. Postdoctoral Associate, Laboratory of Dr. Hugo Bellen Department of Molecular and Human Genetics Baylor College of Medicine Houston, Texas 77030

Dr. Marcogliese

Paul C Marcogliese, Ph.D.
Postdoctoral Associate,
Laboratory of Dr. Hugo Bellen
Department of Molecular and Human Genetics
Baylor College of Medicine
Houston, Texas 77030

Loren D. Pena, MD PhD Pediatric Medical Genetics Specialist Division of Medical Genetics, Department of Pediatrics Duke University School of Medicine, Durham, NC

Dr. Peña


Loren D. Pena, MD PhD
Division of Human Genetics
Cincinnati Children’s Hospital Medical Center
Department of Pediatrics
University of Cincinnati
Cincinnati, OH 45229


MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Undiagnosed Diseases Network (UDN) is a multi-site collaboration across the US that seeks to help diagnose patients with rare disorders that are ill-defined.

Dr. Loren D.M. Pena and Dr. Vandana Shashi at the Duke-Columbia clinical site of the UDN had seen a patient with a severe neurological disorder. While the patient had no symptoms at birth, the patient began falling at about 3 years of age, eventually losing motor coordination and developing seizures. In the interim, the regression has progressed to a severely debilitating state. Re-analysis of the participant’s exome data by our site bioinformatician at Columbia (Nicholas Stong) in Dr. David Goldstein’s laboratory revealed a truncating variant in the single exon gene IRF2BPL that could be the candidate disease-causing gene. The UDN clinicians at Duke then contacted the UDN Model Organism Screening Center (MOSC) led by Dr. Hugo Bellen at Baylor College of Medicine and the Howard Hughes Medical Institute for functional analysis. In parallel, four more patients were found with truncating mutations causing a similar disorder though the UDN and GeneMatcher.org. Additionally, two patients with missense variants in IRF2BPL were identified that displayed seizures and some developmental delay or autism spectrum disorder but no motor regression.

Work in MOSC by Dr. Paul Marcogliese using fruit flies revealed that the IRF2BPL truncating variants are severe loss of function mutations and one of the missense variants was a partial loss of function. Additionally, it was found that the fruit fly IRF2BPL gene, called pits, is expressed in the neurons of the adult fly brain. Lowering the levels of pits by about 50% in fly neurons leads to progressive behavioural abnormalities and neurodegeneration. By combining the human genetics, bioinformatics and model organism data, IRF2BPL was found to be a novel disease-causing gene in humans.

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Statins May Reduce Need For Surgery in Chronic Subdural Hematoma

MedicalResearch.com Interview with:
Jianning Zhang MD, Ph.D Chairman, II, VII Chinese Medical Association of Neurosurgery President, Tianjin Medical University General Hospital, China  Jianning Zhang MD, Ph.D
Chairman, II, VII Chinese Medical Association of Neurosurgery
President, Tianjin Medical University General Hospital,
China  

MedicalResearch.com: What is the background for this study?

Response: The elderly population is growing dramatically world widely, especially in China. The incidence of chronic subdural hematoma has been rising over the past years. Although the surgery is not a difficult process, the risk of death and recurrence persist, and the affliction and economic expenditure of the patients are relatively higher in the elderly. For these reasons, it is urgent to develop novel pharmacological therapies with sufficient safety and efficacy. 

It has been known that the high expression of VEGF and inflammatory factors in chronic subdural hematoma can lead to abundant angiogenesis of immature vessels on the wall of hematoma. In our previous study, patients with chronic subdural hematoma have impaired ability to promote vascular maturation. For example, the number of endothelial progenitor cells in circulating blood is about 67% of the healthy individuals with similar age. 

Atorvastatin can mobilize endothelial progenitor cells to reduce inflammation. It increases the number of circulating endothelial cells that are inversely correlated with the volume of hematoma. We have demonstrated that atorvastatin can promote endothelial cell formation and reduce the leakage of endothelial cell barrier in vitro. Results from in vivo experiments in animal models of subdural hematoma suggest that atorvastatin can promote the maturation of blood vessels and reduce inflammation on the margin of hematoma, and thus improve the neurological outcome. Continue reading

Migraine Management Crucial For Treatment of Tinnitus

MedicalResearch.com Interview with:
“Day 50: Headache” by kizzzbeth is licensed under CC BY 2.0Jen-Tsung Lai, MD
Department of Otolaryngology
Kuang-Tien General Hospital
Shalu, Taichung, Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cochlear Migraine( CM ) is a new proposed diagnosis in 2018. CM could present as fluctuating hearing loss or sudden hearing loss that provoked the tinnitus.

Furthermore , CM with underlying hypersensitive brain might cause the tinnitus switch out of function.  

MedicalResearch.com: What should readers take away from your report? 

Response: Cochlear Migraine (could be one of the key code for chronic tinnitus. Similar to vestibular migraine (VM ) in vertigo diagnosis, Cochlear Migraine is a very important cause of tinnitus and heating loss.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The clinical implication : the migraine management is crucial for tinnitus treatment. 

Citation:

Hwang J, Tsai S, Liu T, Chen Y, Lai J. Association of Tinnitus and Other Cochlear Disorders With a History of Migraines. JAMA Otolaryngol Head Neck Surg. Published online July 12, 2018. doi:10.1001/jamaoto.2018.0939

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How Quickly and Accurately Can Ischemic Stroke Be Diagnosed and Treated with tPA?

MedicalResearch.com Interview with:

Perttu J. Lindsberg, MD, PhD Professor of Neurology Clinical Neurosciences and Molecular Neurology Research Programs Unit, Biomedicum Helsinki University of Helsinki Helsinki, Finland

Dr. Lindsberg

Perttu JLindsberg, MD, PhD
Professor of Neurology
Clinical Neurosciences and Molecular Neurology
Research Programs Unit, Biomedicum Helsinki
University of Helsinki Helsinki, Finland

MedicalResearch.com: What is the background for this study?

Response: The past 20 years in shaping the Helsinki model in stroke thrombolysis have proven that we can be very fast in examining the patient, completing the imaging and starting thrombolytic therapy. This is a university hospital center that receives roughly three stroke suspects per day for evaluation of recanalization therapies. Already seven years ago we were able to push the median ’door-to-needle’ time permanently below 20 minutes. What we had not been monitoring was how well we had kept up the accuracy of our emergengy department (ED) diagnostic process. Prehospital emergency medical services (EMS) have been trained to focus on suspecting thrombolysis-eligible stroke and we usually get also pre-notifications of arriving stroke code patients during transportation, but the diagnosis on admission is an independent clinical judgment as the CT findings are largely nondiagnostic for acute changes.

The admission evaluation of suspected acute stroke is therefore a decisive neurologic checkpoint, building the success of acute treatments such as recanalization therapy, but is complicated by differential diagnosis between true manifestations of stroke and numerous mimicking conditions. Although we have invested a lot on training and standardized ED procedures, time pressure and therapy-geared expectations may blur the diagnostic process.

With this background, we embarked on an in-depth-analysis of the admission and final diagnoses of stroke code patients, as well as misdiagnoses, immediate treatment decisions and their consequences.

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Multimodal Imaging Can Personalize and Predict Therapeutic Needs

MedicalResearch.com Interview with:

Yasser Iturria-Medina, PhD Primary Investigator, Ludmer Centre for Neuroinformatics & Mental Health Assistant Professor, Department of Neurology and Neurosurgery Faculty of Medicine McGill University

Dr. turria-Medina

Yasser Iturria-Medina, PhD
Primary Investigator, Ludmer Centre for Neuroinformatics & Mental Health
Assistant Professor, Department of Neurology and Neurosurgery
Faculty of Medicine
McGill University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are millions of patients following therapeutic interventions that will not benefit them. In this study, we aimed to illustrate that it is possible to identify the most beneficial intervention for each patient, in correspondence with the principles of the personalized medicine (PM). Our results show that using multimodal imaging and computational models it is possible to predict individualized therapeutic needs. The predictions are in correspondence with the individual molecular properties, which validate our findings and the used computational techniques.

The results highly also the imprecision of the traditional clinical evaluations and categories for understanding the individual therapeutic needs, evidencing the positive impact that would have to use multimodal data and data-driven techniques in the clinic, in addition to the medical doctor’s criterion/evaluations.   Continue reading

Understanding the Neuroscience of Creativity Through Music Improvisation

MedicalResearch.com Interview with:

Andrew Goldman PhD Laboratory for Intelligent Imaging and Neural Computing Department of Biomedical Engineering, Columbia University Presidential Scholar in Society and Neuroscience, Columbia University Andrew Goldman PhD
Laboratory for Intelligent Imaging and Neural Computing
Department of Biomedical Engineering, Columbia University
Presidential Scholar in Society and Neuroscience,
Columbia University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many Western musicians have difficulty improvising, despite having extensive training and experience. These musicians learn about and use similar musical structures in their playing (like chords, scales, rhythmic patterns, etc.) as experienced improvisers, but they may know about them in different ways. In other words, different musicians have different ways of knowing and learning about similar musical structures. To understand which ways of knowing facilitate the ability to improvise contributes to an understanding of how people are able to use knowledge creatively. Western music provides an important opportunity to compare these different ways of knowing because in other improvisatory domains of behavior (like speaking), it is difficult to find people who know how to do it but cannot improvise with it (e.g., if you know a language, you can very likely improvise with that language).

In order to advance our understanding of these improvisatory ways of knowing, we compared musicians with varying degrees of improvisation experience in a task that tested how they categorized musical chords. In Western music, different chords are theorized to have similar “functions.” For example, on a guitar, there are different ways to play a C chord, and you could often substitute one for the other. You might even play another chord in place of the C chord and have it sound similar, or lead to a similar subsequent harmony. Improvisers often use notation that specifies classes of chords rather than specific realizations (versions) of a chord whereas those who do not typically improvise use notation that specifies the full realization of the chord. By analogy, one chef might use a recipe that calls for “citrus” (in music, a class of musical chord) while another chef’s recipe might specifically call for “lemon” (in music, a specific realization of a functional class of chords). We tested whether improvisers categorize similar-functioning harmonies as more similar to each other than different-functioning harmonies, and compared how less experienced improvisers categorize the same harmonies.

Our task required the musicians to listen to a series of repeating harmonies (the “standard” stimuli) and pick out occasional chords that were different in any way (the “deviant” stimuli). Some deviant stimuli were different versions of the standard chord (like limes in place of lemons) and some deviant stimuli were chords with different musical functions (like bananas instead of lemons).

The more experienced improvisers were better at detecting the function deviants than the exemplar deviants whereas the less experienced improvisers showed little difference in their ability to detect the two types of deviants. In other words, because improvisers categorize the different versions of the same chord as similar, they have a relatively harder time picking out the similarly functioning harmonies. This was measured using behavioral data, and electroencephalography (EEG), which can be used to provide a neural measure of how different stimuli are perceived to be from each other.

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Investigational RNAi Drug Patisiran Show Promise in Hereditary Amyloidosis

MedicalResearch.com Interview with:
Prof. David Adams Head of the French National Reference Centre for Familial Amyloidotic Polyneuropathy (NNERF)/APHP/INSERM Paris FranceProf. David Adams
Head of the French National Reference Centre for Familial Amyloidotic Polyneuropathy (NNERF)/APHP/INSERM
Paris France

MedicalResearch.com:  What is the background for this study?

Response: Hereditary transthyretin amyloidosis is an autosomal dominant, multisystemic, progressive, life-threatening disease caused by mutations in the gene encoding transthyretin (TTR ).

The liver is the primary source of circulating tetrameric TTR protein. In hereditary transthyretin amyloidosis, both mutant and wild-type transthyretin deposit as amyloid in peripheral nerves and the heart, kidney, resulting in polyneuropathy and cardiomyopathy. Neuropathic changes result in profound sensorimotor disturbances, with deterioration in activities of daily living and ambulation, hypotension, diarrhea, impotence, and bladder disturbances.

Until now,  only few patients have access to anti-amyloid therapy : Liver Transplantation or TTR stabilizers which are able only to slow progression of the disease at very early stage of the disease.

Patisiran, an investigational RNA interference therapeutic agent, specifically inhibits hepatic synthesis of transthyretin and is specifically addressed to the liver by lipid nanoparticle (LNP) formulation.

This study carried out a multicenter, international, randomized, double-blind, placebo-controlled, phase 3 trial of patisiran in patients with hereditary transthyretin amyloidosis with polyneuropathy.

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CRISPR-Gold Has Potential To Edit Brain Genes

MedicalResearch.com Interview with:

Niren Murthy PhD Professor of Bioengineering University of California at Berkeley

Prof. Murthy

Niren Murthy PhD
Professor of Bioengineering
University of California at Berkeley

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this paper we delivered Cas9 RNP in the brain using a delivery vehicle termed CRISPR-Gold.  We were able to knock out the mGluR5 gene and rescue mice from autism using CRISPR-Gold.  The background here is that there is a great need for safe and effective CRISPR delivery vehicles, and that brain gene editing has great therapeutic potential.  This paper demonstrates for the first time that non-viral delivery of Cas9 RNP into the brain can have therapeutic effects.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Brain gene editing has tremendous therapeutic potential, and can be achieved with non-viral Cas9 RNP delivery

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response:   We need to be able to edit the brains of large animals.  The particles will need to be modified for this, we are currently working on this.  GenEdit, a start-up company spun out from our lab, is also working on this.

Disclosures: I was a co-founder of GenEdit, but now have no equity in GenEdit, there should be no conflict of interest

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Bumwhee Lee, Kunwoo Lee, Shree Panda, Rodrigo Gonzales-Rojas, Anthony Chong, Vladislav Bugay, Hyo Min Park, Robert Brenner, Niren Murthy, Hye Young Lee. Nanoparticle delivery of CRISPR into the brain rescues a mouse model of fragile X syndrome from exaggerated repetitive behaviours. Nature Biomedical Engineering, 2018; DOI: 10.1038/s41551-018-0252-8

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

Eye Sign of Dementia Risk? Thinning of Retinal Nerve Fiber Layer

MedicalResearch.com Interview with:

Dr. Paul Foster

Dr. Foster

Paul Foster BMedSci(Hons) BMBS PhD FRCS(Ed) FRCOphth FRCS(Eng)
Professor of Glaucoma Studies & Ophthalmic Epidemiology
Research Theme Lead Integrative Epidemiology & Visual Function
UCL Institute of Ophthalmology & Moorfields Eye Hospital
London 

MedicalResearch.com: What is the background for this study? 

Response:  Dementia is the medical challenge of the moment – increasingly common, adversely impacting quality of life for millions, and a great worry for all. Efforts to identify treatments or interventions rely on being able to identify those people at greatest risk. Our motivation was to help identify those people, primarily to aid in the development of treatments through clinical trials.

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Which Brain Circuits Determine Maternal Behavior?

MedicalResearch.com Interview with:
“Mother and Child” by Mary Cassatt (American, Pittsburgh, Pennsylvania 1844–1926 Le Mesnil-Théribus, Oise) via The Metropolitan Museum of Art is licensed under CC0 1.0Yi-Ya Fang

NYU School of Medicine
Dayu Lin, PhD
Neuroscience Institute, New York University Langone School of Medicine,  Department of Psychiatry,
Center for Neural Science
New York, NY

Response: Maternal behaviors are essential for survival of offspring across mammalian species. In rodents, mothers show several characteristic pup caring behaviors including grooming pups, crouching over pups and approaching and retrieving pups. Decades of research has been trying to understand how the neural circuit is wired to generate these elaborate maternal behaviors. Medial preoptic area (MPOA), which is located at anterior part of hypothalamus, has been indicated to be important for maternal behaviors. Many studies consistently found deficits in maternal behaviors after damaging the MPOA. To dissect the maternal circuits in the brain, we looked into the properties of the Esr1+ cells.

In this study, we identify estrogen receptor α (Esr1) expressing cells in MPOA as key mediators of pup approach and retrieval. We focused on Esr1 (Esr1) expressing cells in the MPOA since estrogen has been shown to facilitate maternal behaviors, presumably through its action of estrogen sensing cells. We found that reversible inactivation of MPOA Esr1+ cells impairs maternal behaviors whereas optogenetic activation of MPOA Esr1+ cells induces immediate pup retrieval. Additionally, we found that MPOA Esr1+ cells are preferentially activated during maternal behaviors, and the cell responses changed across reproductive states. Tracing studies revealed that MPOA Esr1+ cells project strongly to ventral tegmental area (VTA), a region that has been indicated in motivation and reward. Specifically, MPOA Esr1+ cells provide strong inhibitory inputs preferentially to the GABAergic cells in the VTA, which in turn could disinhibit the dopaminergic cells.  VTA dopaminergic cells are highly activated during maternal behaviors.

Altogether, our study provides new insight into the neural circuit that generates maternal behaviors.

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Duchenne Muscular Dystrophy: As Survival Increases, New Focus on Quality of Life

MedicalResearch.com Interview with:
David Birnkrant, MD
Professor of Pediatrics, Case Western Reserve University School of Medicine
Director of Pediatric Pulmonology & Student Education, MetroHealth Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study updates guidance on all aspects of the multi-disciplinary care of patients with Duchenne muscular dystrophy (DMD). The project was funded by the CDC’s National Center on Birth Defects and Developmental Disabilities and the results were recently published as three articles in The Lancet Neurology. The project was guided by a 25-member steering committee. Eleven expert committees worked over a period of three years to develop guidelines based on the RAND/UCLA appropriateness method, in which assessments and interventions were evaluated for appropriateness and necessity. The recommendations update those originally published in 2010.

Duchenne muscular dystrophy is transmitted by X-linked recessive inheritance and thus affects primarily boys and men. Patients affected by DMD do not produce functional dystrophin protein, resulting in progressive weakness of skeletal, respiratory, and heart muscles, causing a shortened life span. Teens and young men may require surgery for curvature of the spine, a ventilator device to assist breathing, and a feeding tube to help ensure adequate nutrition. The approach of the various subspecialties involved in DMD management has evolved, with more anticipatory assessment and therapy, identifying and addressing predictable medical complications as early as possible for optimal patient outcomes. With this kind of multi-disciplinary care, people with DMD now live into their 30s and beyond.

Along with the emergence of new genetic and molecular therapies, the recognition that people with DMD are living longer was one of the main motivations behind the need for these updated care considerations. Patients with DMD, their families and their advocacy organizations are driving a new emphasis on optimizing quality of life, not just prolongation of survival. Thus, there was a need to address issues related to transitions of care from childhood to adulthood, coordination of care across subspecialties, and other topics related to education, vocation, independence, personal relationships, emotional health, and intimacy. The updated care considerations thus include eleven topic areas, eight of which were part of the 2010 guidelines.

These are: (1) diagnosis, (2) neuromuscular management, (3) rehabilitation management, (4) gastrointestinal and nutritional management, (5) respiratory management, (6) cardiac management, (7) orthopedic and surgical management, and (8) psychosocial management. Three topics are new: (9) primary care and emergency management, (10) endocrine management (including growth, puberty, adrenal insufficiency, and bone health), and (11) transitions of care across the lifespan.

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