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Archive for category: E-News

E-News

Precise nerve stimulation via electrode implants offers new hope for paralysis

, 26 August 2020/in E-News /by 3wmedia

Patients with spinal cord injuries might one day regain use of paralyzed arms and legs thanks to research that demonstrates how limbs can be controlled via a tiny array of implanted electrodes.

The work focused on controlling electrical stimulation pulses delivered to peripheral nerve fibres. When a patient is paralyzed, one of the possible causes is damage to the spinal cord, which along with the brain makes up the central nervous system. The brain is working, and so are motor and sensory nerves in the peripheral nervous system, but electrical signals can’t flow between those nerves and the brain because of the spinal cord injury.

That communication problem is what researchers sought to address, through experiments that involved transmitting precisely controlled electrical pulses into nerves activating plantar-flexor muscles in an ankle of an anesthetized cat.

V John Mathews, professor of electrical engineering and computer science in the Oregon State University College of Engineering, lead researcher Mitch Frankel, then a Ph.D. student at the University of Utah, and three other researchers, all faculty members at Utah, conducted the study.

Researchers sent the pulses using an optimized PIV controller – proportional-integral-velocity – and the cat’s nerves received them via a 100-electrode array whose base measured just 16 square millimeters; it’s known as the Utah Slanted Electrode Array, named for where it was developed and the angled look produced by the electrode rows’ differing heights.

Thanks to specific electrodes being able to activate the right nerve fibres at the right times, the controller made the cat’s ankle muscles work in a smooth, fatigue-resistant way.

The results suggest that someday a paralyzed person might be equipped with a wearable, smartphone-sized control box that would deliver impulses to implanted electrodes in his or her peripheral nervous system, thus enabling at least some level of movement.

‘Say someone is paralyzed and lies in bed all day and gets bed sores,’ Mathews said. ‘Early versions of this technology could be used to help the person get up, use a walker and make a few steps. Even those kinds of things would have an enormous impact on someone’s life, and of course we’d like people to do more. My hope is in five or 10 years there will be at least elemental versions of this for paralyzed persons.’

While this particular study focused on helping the paralyzed, a related research area involves amputees: neuroprostheses that can be controlled by thought based on decoding what goes on electrically inside a person’s brain when he or she wants to, for example, move his or her arm or leg.

‘We can learn from the brain what the intent is and then produce the signals to make the movement happen,’ Mathews said. ‘Another way to get the control information is from the peripheral nerves,’ via electromyography, a diagnostic procedure for evaluating muscle and nerve health.

Generally, Mathews said, an electromyogram can produce the necessary control information.

Putting sensors in a person’s brain, either by deep brain implant or just inside the cranium, is another way to crack the intent code. Electroencephalography – electrode plates attached to the scalp that upload the brain’s electrical activity to a computer – can be used as well.

‘There are a lot of things going on right now in the prosthetic arena,’ Mathews said.

OSU College of Engineering oregonstate.edu/ua/ncs/archives/2016/nov/precise-nerve-stimulation-electrode-implants-offers-new-hope-paralysis-patients

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Faster and better healing of infected wounds using negative pressure technique

, 26 August 2020/in E-News /by 3wmedia

Shorter wound healing time, fewer dressing changes and the opportunity for earlier discharge from the hospital. These are some of the benefits of negative pressure wound therapy to treat wound infections in connection with vascular surgery at the groin. The method, which has become increasingly common, is also cost-effective. This is shown in a thesis from Lund University in Sweden in which the method has undergone its first major scientific evaluation in deep perivascular groin infections after vascular surgery.

In connection with surgery, the patient is at risk of an infection in the surgical wound, and this is the second most common form of healthcare -associated infections in Sweden. However, despite the fact that wound therapy is a fundamental and crucial part of healthcare, there are relatively few scientific studies on the subject, and the level of expertise among healthcare practitioners is insufficient. This is argued by Christina Monsen, doctoral student at Lund University and registered nurse, specialising in wound therapy at the Skane University Hospital.

‘Personal experience is not enough to determine whether a certain wound therapy method actually works. But this is a difficult field of research, randomized trials in particular, especially when there is already strong beliefs and attitudes favouring one wound therapy among personal staff’, says Christina Monsen.

Christina Monsen’s current thesis compares the use of negative pressure wound therapy of infected wounds at the groin after vascular surgery with a previously established method: alginate dressings. The study is the first more extensive scientific evaluation of negative pressure techniques to treat infected wounds, and it has taken several years to execute.

‘On average, the wound healing time was almost cut in half for patients who received negative pressure wound therapy – from 104 days to 57. The in-hospital care time was also reduced by a week, to an average of 13 days compared to 20’, says Christina Monsen.

The negative pressure technique entails placing a foam sponge inside the cleaned wound, which is then covered by a tightly sealed plastic film. Through a small opening, a portable vacuum pump is attached, sucking up all the excess exudates while allowing the wound to gradually contract during the time of healing.

The groin is a commonly used point of entry during vascular surgery as it allows surgeons to reach several vital bodily systems and organs. At the same time, it involves an increased risk of infection because of its proximity to the intestinal bacterial flora. Refractory infections at the groin can in serious cases lead to amputation of the patient’s leg or even death.

Negative pressure wound therapy was introduced in Swedish hospital clinics just before the turn of the millennium, and has gradually grown. However, despite increasing use it has remained poorly scientifically evaluated.

The thesis also finds that negative pressure wound therapy requires fewer dressings and is cost-effective and timesaving for staff. The comparative studies, based on patient data from Skane University Hospital (SUS) in Malmo, were supplemented with interview studies. From these studies it emerged that the patients wanted to receive more knowledge and be more prepared on how to care for themselves after being discharged from the hospital, something which the clinic at SUS will now review.

Lund University www.med.lu.se/english/news_archive/161018_healing

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Increased BMI during adolescence predicts fatal cardiovascular events in adulthood

, 26 August 2020/in E-News /by 3wmedia

Overweight and obesity in adolescents have increased substantially in recent decades, and currently affect a third of the adolescent population in some developed countries. This is an important public health concern because obesity early in life is considered to be a risk factor for death from cardiovascular disease and from all causes in adulthood.
Some studies suggest that an elevated body-mass index is associated with an increased risk of death from cardiovascular causes. However, a determination of the BMI threshold that is associated with increased risk of fatality remains uncertain. (BMI is a calculation of a person’s weight in kilograms divided by the square of their height in meters, to quantify body mass and enable categorization as underweight, normal weight, overweight, or obese.)
In light of the worldwide increase in childhood obesity, Prof. Jeremy Kark from the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, in the Hebrew University of Jerusalem’s Faculty of Medicine, together with Dr. Gilad Twig of Sheba Medical Center, and Dr. Hagai Levine also of the Braun School of Public Health and other colleagues in Israel, set out to determine the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood.
Their study was based on a national database of 2.3 million Israeli 17-year olds in whom height and weight were measured between 1967 and 2010. The researchers assessed the association between BMI in late adolescence and death from coronary heart disease, stroke, and sudden death in adulthood by mid-2011.
During 42,297,007 person-years of follow- up, 2918 of 32,127 deaths (9.1percent) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. The results showed an increase in the risk of cardiovascular death in the group that was considered within the ‘accepted normal’ range of BMI, in the 50th to 74th percentiles, and of death from coronary heart disease at BMI values above 20. The researchers concluded that even BMI considered ‘normal’ during adolescence was associated with a graded increase in cardiovascular and all-cause mortality during the 40 years of follow-up. This included increased rates of death from coronary heart disease, stroke, and total cardiovascular causes among participants.
As BMI scores increased into the 75th to 84th percentiles, adolescent obesity was associated with elevated risk of death from coronary heart disease, stroke, sudden death from unknown causes, and death from total cardiovascular causes, as well as death from non-cardiovascular causes and death from all causes. Participants also had an increased risk of sudden death.
The rates of death per person-year were generally lowest in the group that had BMI values during adolescence in the 25th to 49th percentiles, although higher rates were observed among those below the 5th percentile.
How might adolescent BMI influence cardiovascular outcomes in adulthood? The researchers considered two possible pathways. First, obesity may be harmful during adolescence, since it has been associated with unfavourable metabolic abnormalities through risk factors such as unfavourable plasma lipid or lipoprotein levels, increased blood pressure, impaired glucose metabolism, insulin resistance, and formation of coronary and aortic atherosclerotic plaques. Furthermore, the timing of exposure to obesity during a person’s lifetime may play an important role. Second, BMI tends to ‘track’ along the life course so that overweight adolescents tend to become overweight or obese adults, and overweight or obesity in adulthood affects the risk of cardiovascular disease.
‘Our findings appear to provide a link between the trends in adolescent overweight during the past decades and coronary mortality in midlife,’ said the paper’s senior author, Prof. Jeremy Kark. ‘The continuing increase in adolescent BMI, and the rising prevalence of overweight and obesity among adolescents, may account for a substantial and growing future burden of cardiovascular disease, particularly coronary heart disease.’

The Hebrew University of Jerusalem http://tinyurl.com/zwt4n4d

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New wireless heart pump makes no contact with blood

, 26 August 2020/in E-News /by 3wmedia

EPFL researchers have developed an innovative cardiac support system in
the form of a small ring placed on the aorta. This device is less invasive than traditional methods and avoids problems of hemolysis and the need for
regular transfusions because it does not come into direct contact with the blood.
The heart is sometimes in a weakened state when recovering from certain diseases or while waiting for a transplant. To help the tired heart pump blood, researchers at EPFL’s Integrated Actuators Laboratory (LAI) came up with a clever solution. Their device is made up of three tiny rings made out of a material with special electrical properties. The device, called a Dielectric Electro Active polymer (DEAP), dilates when a current is applied and contracts when it is switched off . Because the reactions are immediate, the back-andforth movement can be controlled in real time.
The researchers’ innovation was to place these rings around the aorta – the body’s main artery – at the exact spot where it exits the left ventricle. Each ring has two electrodes that are drawn together by an electrostatic force whenever the electric field is activated. ‘The electrodes squeeze the polymer as they come together,’ said Jonathan Chavanne, a PhD student at the LAI. ‘Yet because this material is incompressible, its volume remains constant. So its surface area increases and stores up elastic energy.’
The electrical pulse is provided to the device by magnetic induction. Each of the three rings contracts in turn, in a movement reminiscent of an earthworm. This series of contractions, called peristalsis, creates a wave that moves the liquid inside the artery. This double action – simultaneously vertical and horizontal – helps the heart pump and transport blood.
‘This method does not require us to enter the heart,’ said Yves Perriard, he director of the LAI. ‘This means it is significantly less invasive
than other cardiac support systems, which work by implanting valves or screw pumps inside the ventricle.’
In addition, by avoiding direct contact with the blood, this new solution eliminates the risk of excessive hemolysis, in which enough red blood cells are destroyed that regular transfusions may be required. And because the system is powered by magnetic induction, there are no wires coming out of the body.
The invention is currently in the prototype stage and has several more hurdles to overcome. The researchers plan to improve the device’s performance before testing it on a liquid with similar fluidic properties to those of the blood, such as glycerol. The team has been in contact with the University Hospital of Bern, where clinical trials could be conducted.

EPFL http://tinyurl.com/hxa53ss

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How a small implanted device could help limit metastatic breast cancer

, 26 August 2020/in E-News /by 3wmedia

A small device implanted under the skin can improve breast cancer survival by catching cancer cells, slowing the development of metastatic tumours in other organs and allowing time to intervene with surgery or other therapies. These findings, reported in Cancer Research, suggest a path for identifying metastatic cancer early and intervening to improve outcomes.

‘This study shows that in the metastatic setting, early detection combined with a therapeutic intervention can improve outcomes. Early detection of a primary tumour is generally associated with improved outcomes. But that’s not necessarily been tested in metastatic cancer,’ says study author Lonnie D. Shea, Ph.D., William and Valerie Hall Department Chair of Biomedical Engineering at the University of Michigan.

The study, done in mice, expands on earlier research from this team showing that the implantable scaffold device effectively captures metastatic cancer cells. Here, the researchers improve upon their device and show that surgery prior to the first signs of metastatic cancer improved survival.

‘Currently, early signs of metastasis can be difficult to detect. Imaging may be done once a patient experiences symptoms, but that implies the burden of disease may already be substantial. Improved detection methods are needed to identify metastasis at a point when targeted treatments can have a significant beneficial impact on slowing disease progression,’ says study author Jacqueline S. Jeruss, M.D., Ph.D., associate professor of surgery and biomedical engineering and director of the Breast Care Center at the University of Michigan Comprehensive Cancer Center.

Jacqueline Jeruss and Lonnie SheaThe scaffold is made of FDA-approved material commonly used in sutures and wound dressings. It’s biodegradable and can last up to two years within a patient. The researchers envision it would be implanted under the skin, monitored with non-invasive imaging and removed upon signs of cancer cell colonization, at which point treatment could be administered.

The scaffold is designed to mimic the environment in other organs before cancer cells migrate there. The scaffold attracts the body’s immune cells, and the immune cells draw in the cancer cells. This then limits the immune cells from heading to the lung, liver or brain, where breast cancer commonly spreads.

‘Typically, immune cells initially colonize a metastatic site and then pave the way for cancer cells to spread to that organ. Our results suggest that bringing immune cells into the scaffold limits the ability of those immune cells to prepare the metastatic sites for the cancer cells. Having more immune cells in the scaffold, attracts more cancer cells to this engineered environment,’ Shea says.

In the mouse study at day 5 after tumor initiation, the researchers found a detectable percentage of tumor cells within the scaffold but none in the lung, liver or brain, suggesting that the cancer cells hit the scaffold first.

At 15 days after tumour initiation, they found 64 percent fewer cancer cells in the liver and 75 percent fewer cancer cells in the brains of mice with scaffolds compared to mice without scaffolds. This suggests that the presence of the scaffold slows the progress of metastatic disease.

The researchers removed the tumours at day 10, which is after detection but before substantial spreading, and found the mice that had the scaffold in place survived longer than mice that did not have a scaffold. While surgery was the primary intervention in this study, the researchers suggest that additional medical treatments might also be tested as early interventions.

In addition, researchers hope that by removing the scaffold and examining the cancer cells within it, they can use precision medicine techniques to target the treatment most likely to have an impact.

This system is early detection and treatment, not a cure, the researchers emphasize. The scaffold won’t prevent metastatic disease or reverse disease progression for patients with established metastatic cancer.

The team will develop a clinical trial protocol using the scaffold to monitor for metastasis in patients treated for early stage breast cancer. In time, the researchers hope it could also be used to monitor for breast cancer in people who are at high risk due to genetic susceptibility. They are also testing the device in other types of cancer.

University of Michigan Comprehensive Cancer Center. www.mcancer.org/news/archive/how-small-implanted-device-could-help-limit-metastatic-breast-cancer

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Rule could take 1/3 of chest pain patients off emergency department heart monitors

, 26 August 2020/in E-News /by 3wmedia

Ottawa researchers have validated a rule that could safely take a third of chest pain patients in the emergency department off heart monitors, according to a study. Implementing this made-in-Ottawa rule could free up these monitored beds for sicker patients and reduce wait times.
‘Chest pain is one of the most common reasons people visit Canadian emergency departments, with around 800,000 visits a year,’ said Dr. Venkatesh Thiruganasambandamoorthy, lead author of the study and a scientist and emergency physician at The Ottawa Hospital and an assistant professor at the University of Ottawa.
About 70 percent of chest pain patients who come to the emergency department are put in beds with heart monitors in order to detect potentially dangerous arrhythmia. However, previous studies have shown that this condition is rare, with less than two percent of chest pain patients experiencing it during their stay.
This is why Ottawa researchers had previously developed a simple, highly sensitive tool to identify those patients who can be safely removed from heart monitors. According to the Ottawa Chest Pain Cardiac Monitoring Rule, patients can be removed if they have no current chest pain and there are no significant abnormalities in the electrocardiogram reading.
Patients are normally taken off the monitor after about eight hours, when they are discharged home. Applying this rule will allow patients to be taken off monitors much sooner. If implemented when they first arrive, the rule will allow them to be redirected to a non-monitored area of the emergency department.
To verify the rule, researchers observed chest pain patients in the emergency department. Then they tested whether the tool could accurately predict which patients had needed to stay on heart monitors because of irregular heartbeat.
They found that 15 of the 1,125 patients admitted to The Ottawa Hospital emergency departments for chest pain between November 2013 and April 2015 experienced irregular heartbeat during their eight-hour stay. The rule was able to predict with 100 percent accuracy the 15 patients who needed to stay on heart monitors. It also indicated that 36 percent of the 796 patients who were monitored during the study could have been safely removed from the monitors.
‘This rule now has the potential to take a large number of low risk chest pain patients off of heart monitors,’ said Dr, Thiruganasambandamoorthy. ‘We started using this rule in The Ottawa Hospital emergency departments a few months ago, and we’re watching the outcomes very closely. We have also spoken to several emergency departments across the country who are excited about bringing this rule into their hospitals.’

The Ottawa Hospital Research Institute http://tinyurl.com/j5dm7xl

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Ancient Chinese malaria remedy fights TB

, 26 August 2020/in E-News /by 3wmedia

A centuries-old herbal medicine, discovered by Chinese scientists and used to effectively treat malaria, has been found to potentially aid in the treatment of tuberculosis and may slow the evolution of drug resistance.

In a promising study led by Robert Abramovitch, a Michigan State University microbiologist and TB expert, the ancient remedy artemisinin stopped the ability of TB-causing bacteria, known as Mycobacterium tuberculosis, to become dormant. This stage of the disease often makes the use of antibiotics ineffective.

‘When TB bacteria are dormant, they become highly tolerant to antibiotics,’ Abramovitch said, an assistant professor in the College of Veterinary Medicine. ‘Blocking dormancy makes the TB bacteria more sensitive to these drugs and could shorten treatment times.’

One-third of the world’s population is infected with TB and the disease killed 1.8 million people in 2015, according to the Centers for Disease Control and Prevention.

Mycobacterium tuberculosis, or Mtb, needs oxygen to thrive in the body. The immune system starves this bacterium of oxygen to control the infection. Abramovitch and his team found that artemisinin attacks a molecule called heme, which is found in the Mtb oxygen sensor. By disrupting this sensor and essentially turning it off, the artemisinin stopped the disease’s ability to sense how much oxygen it was getting.

‘When the Mtb is starved of oxygen, it goes into a dormant state, which protects it from the stress of low-oxygen environments,’ Abramovitch said. ‘If Mtb can’t sense low oxygen, then it can’t become dormant and will die.’

Abramovitch indicated that dormant TB can remain inactive for decades in the body. But if the immune system weakens at some point, it can wake back up and spread. Whether it wakes up or stays asleep’ though, he said TB can take up to six months to treat and is one of the main reasons the disease is so difficult to control.

‘Patients often don’t stick to the treatment regimen because of the length of time it takes to cure the disease,’ he said. ‘Incomplete therapy plays an important role in the evolution and spread of multi-drug resistant TB strains.’

He said the research could be key to shortening the course of therapy because it can clear out the dormant, hard-to-kill bacteria. This could lead to improving patient outcomes and slowing the evolution of drug-resistant TB.

After screening 540,000 different compounds, Abramovitch also found five other possible chemical inhibitors that target the Mtb oxygen sensor in various ways and could be effective in treatment as well.

‘Two billion people worldwide are infected with Mtb,’ Abramovitch said. ‘TB is a global problem that requires new tools to slow its spread and overcome drug resistance. This new method of targeting dormant bacteria is exciting because it shows us a new way to kill it. ‘

Michigan State University msutoday.msu.edu/news/2016/ancient-chinese-malaria-remedy-fights-tb/

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New catheter lets doctors see inside arteries for first time

, 26 August 2020/in E-News /by 3wmedia

Removing plaque from clogged arteries is a common procedure that can save and improve lives. This treatment approach was recently made even safer and more effective with a new, high-tech catheter that allows cardiologists to see inside the arteries for the first time, cutting out only the diseased tissue. Interventional cardiologists at Sulpizio Cardiovascular Center at UC San Diego Health are the first in the region to use this technology.
The new image-guided device, Pantheris Lumivascular atherectomy system, allows doctors to see and remove plaque simultaneously during an atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.
The new technology treats patients suffering from the painful symptoms of peripheral artery disease (PAD), a condition caused by a build-up of plaque that blocks blood flow in the arteries of the legs and feet, preventing oxygen-rich blood from reaching the extremities. Patients with PAD frequently develop life threatening complications, including heart attack, stroke, and in some severe cases, patients may even face amputation.
‘Peripheral artery disease greatly impacts quality of life, with patients experiencing cramping, numbness and discoloration of their extremities,’ said Mitul Patel, MD, cardiologist at UC San Diego Health. ‘This new device is a significant step forward for the treatment of PAD with a more efficient approach for plaque removal and less radiation exposure to the doctor and patient.’
X-ray technology was previously used during similar procedures, but those images are not nearly as clear and do not allow visualization inside the blood vessel. The new catheter, with a fibre-optic camera the size of a grain of salt on the tip, is fed through a small incision in the groin that does not require full anesthesia. Once inside, the interventional cardiologist is able to see exactly what needs to be removed without damaging the artery wall, which can cause further narrowing.

UC San Diego Health http://tinyurl.com/jh8r23f

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New technique slashes diagnosis time during brain surgery

, 26 August 2020/in E-News /by 3wmedia

Neurosurgeons want the quickest, most accurate information to help them make decisions during brain tumour surgery. A new method could accelerate that process.

Neurosurgeons and pathologists at Michigan Medicine are the first to execute stimulated Raman histology (SRH), a method that improves speed and diagnostic efficiency, in an operating room.

The researchers imaged tissue from 101 neurosurgical patients using conventional methods and the new method. Both techniques produced accurate results, they found, but the new method was much faster.

SRH, if applied widely, could change the pace and structure of an operation.

‘By achieving excellent image quality in fresh tissues, we’re able to make a diagnosis during surgery,’ says first author Daniel A. Orringer, M.D., assistant professor of neurosurgery at the University of Michigan Medical School. ‘This eliminates the lengthy process of sending tissues out of the OR for processing and interpretation.’

Today’s workflow for determining a diagnosis during an operation requires the surgeon wait 30 to 40 minutes while tissue is sent to a pathology lab for processing, sectioning, staining, mounting and interpretation. The entire team in the operating room may be idle while waiting for pathology results, Orringer says.

‘Our technique may disrupt the intraoperative diagnosis process in a great way, reducing it from a 30-minute process to about three minutes,’ Orringer says. ‘Initially, we developed this technology as a means of helping surgeons detect microscopic tumour, but we found the technology was capable of much more than guiding surgery.’

Stimulated Raman scattering microscopy, the technology behind SRH, was developed in 2008, but the hazardous lasers involved made it unsuitable for use in an operating room. A clinical version has now been developed and tested in the operating room for more than a year at U-M, with the fibre-laser-based microscope mounted onto a clinical cart that plugs into the wall.

To interpret the samples, researchers developed SRH, which creates images similar to those currently in use.

SRH uses virtual colouring to highlight the cellular and architectural features of brain tumours, with a result resembling traditional staining. The pathologist is then able to differentiate the tumour tissue from normal brain as usual.

‘It’s very similar to what we currently do in our intraoperative diagnosis, with the exception that the tissue is fresh, has not been processed or stained,’ says senior author Sandra Camelo-Piragua, M.D., assistant professor of pathology at U-M.

In the Nature Biomedical Engineering study, neuropathologists were given 30 specimen samples processed by SRH or traditional methods. They were told the same information about each patient’s medical history and the location of the tumour and asked to make a diagnosis.

Those pathologists, the U-M researchers found, were equally likely to make a correct diagnosis, whether they used SRH or conventional slides.

‘SRH imaging will ensure that appropriate and good-quality tissue is collected to reach our ultimate goal: accurate diagnosis,’ Camelo-Piragua says.

University of Michigan labblog.uofmhealth.org/health-tech/new-technique-slashes-diagnosis-time-during-brain-surgery

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Adding ADHD drug to therapy improves cognitive outcomes in traumatic brain injury patients

, 26 August 2020/in E-News /by 3wmedia

A combination of the stimulant drug methylphenidate with a process known as cognitive-behavioural rehabilitation is a promising option to help people who suffer from persistent cognitive problems following traumatic brain injury, researchers at Indiana University School of Medicine have reported.

The researchers, led by Brenna McDonald, PsyD, associate professor of radiology and imaging sciences, and Thomas McAllister, MD, chairman of the Department of Psychiatry, compared the effectiveness of two forms of cognitive therapy with and without the use of methylphenidate, a drug used to treat attention-deficit/hyperactivity disorder and better known by its trade name, Ritalin.

‘We found that the combination of methylphenidate and Memory and Attention Adaptation Training resulted in significantly better results in attention, episodic and working memory, and executive functioning after traumatic brain injury,’ said Dr. McDonald.

In the Memory and Attention Adaptation Training intervention – also used to assist patients with cognitive issues following breast cancer chemotherapy – therapists work with patients to help them develop behaviours and strategies to improve performance in memory and other cognitive tasks. In this study, this ‘metacognitive’ approach was compared with Attention Builders Training, which Dr. McDonald likened to more of a ‘drill and practice’ approach.

The 71 participants who completed the six-week trial were adults who had experienced a traumatic brain injury of at least mild severity – a blow to the head with some alteration of consciousness – at least four months previously, and who either complained of having cognitive problems, or who had been identified with cognitive problems in testing.

The participants were divided into four groups: the two cognitive therapy approaches with the drug therapy, and the two approaches with placebo. After six weeks, the researchers found that participants in the combination metacognitive-Ritalin group improved significantly better in word list learning, nonverbal learning and measures of attention-related and executive function.
However, Dr. McDonald cautioned that due to the relatively small number of participants in the each of the four arms of the trial – 17 to 19 people each – the results of the trial should be considered preliminary.

Nonetheless, she said, the work breaks new ground in providing evidence for the combination therapy.
‘There have been a few small studies suggesting methylphenidate could help with attention and executive function after traumatic brain injury, which makes senses because it’s used to improve attention and focus. But this is the first to test it in combination with cognitive-behavioral therapy for treatment in traumatic brain injury,’ said Dr. McDonald.

Indiana University news.medicine.iu.edu/releases/2016/11/ritalin-cognitive-therapy-traumatic-brain-injury.shtml

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Beukenlaan 137
5616 VD Eindhoven
The Netherlands
+31 85064 55 82
info@interhospi.com

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