Higher mortality following stroke was seen among hospital inpatients than among admitted patients, according to a report in the June 3 BMJ. Patients who had been admitted to the University Hospital Aintree in Liverpool, the United Kingdom, with a primary diagnosis other than stroke, and who had subsequently had a stroke, had a mortality rate of 60%; patients who had been admitted following a stroke had a mortality rate of 28%. Outcome may improve, the authors suggested, by emphasizing to medical and surgical ward staff the importance of early identification and documentation of known risk factors for stroke.

Adult neural stem cells converted to muscle cells of the heart, lungs, intestines, kidneys, and nervous system in a Karolinska Institute, Stockholm, study. According to the report in the June 2 Science, the neural stem cells—which had been removed from the brains of adult mice, cultivated, and genetically tagged—were transplanted into embryonic mice and chickens. The transformation may be a response to extracellular signals or secretions from the embryonic cells, speculated the authors.

Gulf War syndrome is associated with a 20% loss of brain cells in the brainstem, a 12% loss in the right basal ganglia, and a 5% loss in the left basal ganglia, according to a report in the June Radiology. Magnetic resonance spectroscopy identified areas of brain damage as the cause of joint pain, fatigue, dizziness, and mental confusion in veterans from different branches of the services. "Finding the same level of brain cell abnormality in the veterans from a different branch of service and a different part of the country increases the likelihood that the findings are widespread among the nation's veterans," said lead author Robert Haley, MD, Chief of Epidemiology at the University of Texas Southwestern Medical Center.

Calpain may contribute to the pathogenesis of Alzheimer's disease, according to a report in the May Nature. The Harvard Medical School, Boston, study indicated that calpain cleaves activator p35 to p25, which disrupts the cytoskeleton and promotes the apoptosis of primary neurons. Researcher Li-Huei Tsai, PhD, suggested that calpain regulation could reduce neurodegeneration in Alzheimer's disease; however, "complete inhibition of calpain or cdk5 might not be desirable because cdk5 is necessary for normal neuronal functioning, and calpain may also be necessary," she said.

The most comprehensive animal model of Alzheimer's disease has been developed by researchers at the International School for Advanced Studies in Trieste, Italy. The mice, which had very high levels of the neurotrophin nerve growth factor antibody, developed amyloid plaques, insoluble and hyperphosphorylated tau, and neurofibrillary tangles in cortical and hippocampal neurons. According to the report in the June 6 Proceedings of the National Academy of Sciences, the mice also showed neuronal loss in the cortex, cholinergic deficit in the basal forebrain, and behavioral deficits.

Noninvasive gene therapy crossed the blood-brain barrier in a rat model, according to a study in the June 6 Proceedings of the National Academy of Sciences. The authors administered a 6- to 7-kb expression plasmid (encoding either luciferase or ß-galactosidase) packaged in the interior of neutral pegylated immunoliposomes. The conjugation of the stable liposome formation with OX26 monoclonal antibody to the rat transferin receptor allows targeting of the plasmid DNA to the brain, said the authors. Packaged with the liposome was a blue marker gene; after injection, the rats' neural structures were outlined in blue, providing evidence of gene absorption and production.

A gene mutation that raises the level of triglycerides doubles the risk of ischemic cerebrovascular disease in women, according to a report in the May 23 Circulation. The authors are uncertain why the Asn291Ser mutation of LPL does not effect men. However, they suggested that possible explanations may lie in the hormonal regulation of metabolic processes: estrogen decreases lipoprotein lipase activity, while testosterone increases lipoprotein lipase activity. As 5% of the women participating in the Danish study carried the mutation, the authors estimated that 5% of all white women carry it.

Higher caffeine and coffee consumption was associated with a decreased risk of Parkinson's disease, according to data from the Honolulu Heart Program. The incidence of Parkinson's disease was 10.5 per 10,000 person-years among non—coffee drinkers, 5.5 among drinkers of 4 to 8 oz per day, 4.7 among drinkers of 12 to 16 oz, 3.6 among drinkers of 20 to 24 oz, and 1.7 among drinkers of more than 28 oz. The association appears independent of the effect of smoking and unrelated to nutritional additives of coffee, reported the authors in the May 24 JAMA.

Treatment with gavestinal (a selective antagonist at the glycine site of the N-methyl-D-asparte receptor) after ischemic stroke was not significantly associated with any benefits or serious side effects over placebo, according to a study in the June 17 Lancet. Within six hours of ischemic stroke, 891 patients were randomized to gavestinal and 897 to placebo. Outcome for the gavestinal cohort was rated good (34.1%), moderate (18.8%), or poor (47.8%), while outcome for the placebo cohort was rated good (34.9%), moderate (13.3%), or poor (47.0%). Mortality at three months was 20.4% and 18.8%, respectively.

Direct access to medical specialists by patients may not increase physician costs for health maintenance organizations, reported US Agency for Healthcare Research and Quality researchers in the June Medical Care Research and Review. In fact, the overall physician costs were 4% higher in the gatekeeper plan than in the point-of-service plan. Only 3% of the point-of-service patients consulted a specialist without a referral from their primary care physician, according to the authors.

The human monoclonal antibodies reactive to oligodendrocytes promoted remyelination in a mouse model of multiple sclerosis, according to a report in the June 6 Proceedings of the National Academy of Sciences. The two monoclonal antibodies were isolated from the sera of patients with Waldenström's macroglobulinemia. The authors noted that the mechanism of remyelination is unclear. The monoclonal antibodies may alter the biology of oligodendrocytes and myelin, activating signaling molecules, or they may enhance the clearance of cellular debris, facilitating spontaneous repair of the central nervous system, suggested the authors.

Short-term estrogen therapy may not improve cognitive performance, dementia severity, behavior, mood, or cerebral perfusion in women, reported researchers in Taiwan. According to the report in the June 13 Neurology, 50 women with mild to moderate Alzheimer's disease were randomized to estrogen or placebo for 12 weeks. Future studies of the efficacy of estrogen should use longer periods, test it in conjunction with other therapies, and use different methods of delivery, suggested the authors.

Poststroke complications may be underestimated, according to researchers in the June Stroke. The authors followed 311 patients consecutively admitted to three hospitals in Western Scotland. During the average five-week hospital stay, complications included recurrent stroke (9%), epileptic seizure (3%), urinary tract infection (24%), chest infection (22%), other infections (19%), falls (25%), falls with serious injury (5%), pressure sores (21%), deep venous thrombosis (2%), pulmonary embolism (1%), shoulder pain (9%), other pain (34%), depression (16%), anxiety (14%), emotionalism (12%), and confusion (56%). Rigorous attention to detail in the prevention and treatment of poststroke complications could reduce the risk of morbidity and hospital readmission, suggested the authors.

Three common methods of assessing tremor in multiple sclerosis are valid, according to a report in the June Journal of Neurology, Neurosurgery, and Psychiatry. The posture test was the most reliable, limitations were noted for the handwriting and spiral test, and the kinetic tremor test was the least reliable, according to the authors. In addition, the nine-hole peg test and the finger-tapping test were reliable but dependent on upper limb function, noted the authors.

Children with febrile seizure do not use more health care resources than controls, reported Dalhousie University, Halifax, researchers. They compared the health care resource use of 75 children with first febrile seizure with 150 febrile and 150 afebrile controls. Data were derived from the provincial hospital admissions/separations database and the physician services database. Although children in the febrile seizure group were taken to the pediatrician's office more often than controls in the first 12 months following diagnosis, and to the otolaryngologist more frequently in the first three to nine months following seizure, they visited the pediatrician less frequently in the first one to four years. Management decisions for children with febrile seizure should not be based on concern of excessive use of health care resources, advised the authors in the June Archives of Pediatric and Adolescent Medicine.

Long-term daily aspirin initiated promptly after suspected acute ischemic stroke may reduce the risk of recurring stroke and mortality, according to a report in the June Stroke. Data from the Chinese Acute Stroke Trial and the International Stroke Trial (combined cohort, 40,000) showed that the risk of recurrent stroke was reduced by one third. The authors cautioned that contraindications such as hemorrhage should be considered before the initiation of therapy.

Return to table of contents