Feeling Fruity?

I’m sure all of our readers are familiar with the old saying, “An apple a day keeps the doctor away.”

Which, of course, got us musing, what about other fruit?  Well, it turns out that “An orange a day may keep strokes away!”  At least, it seems, for women.

According to a study just published in Stroke eating high amounts of citrus fruit, such as oranges and grapefruit, reduces the risk of ischemic stroke by 19%.

Researchers say the key to the reduced risk is a certain flavinoid found in citrus – flavonones. Citrus fruits and juices are the main dietary source of flavanones.

The findings were part of the Nurses’ Health Study, which included nearly 70,000 women who were followed for 14 years and reported on their dietary intake every four years.

While the risk of stroke was lower in those who ate citrus fruit, not all of the women’s flavonoid consumption came from citrus fruit. Flavonoids are also found in other types of fruit, vegetables, tea, and best news of all…dark chocolate and red wine.

This study confirms a previous findings that vitamin C and potassium, both of which are found in citrus fruits can protect against  heart disease, ischemic stroke and intracerebral hemorrhage.

Although some experts say that further prospective studies are needed to confirm these associations, we know what we’ll be putting in our shopping carts this week.

Bigger is better – when it comes to stroke prevention

Brain aneurysm is a condition in which a blood vessel in the brain weakens and bulges.

While the sufferer is often unaware of their existence there is a risk that the vessel wall will rupture and result in a brain bleed or hemorrhagic stroke.

Approximately 5% of the US population will develop a brain aneurysm, most commonly women between the ages of 35 and 60.

And while the risk of rupture is only 1%, approximately 30% of such patients die within 24 hours and an additional 25-30% die within four weeks.

The traditional treatment for both ruptured and unruptured aneurysms involves clipping. During the procedure, surgeons open the skull, expose the brain and place a tiny metal clip on the abnormal blood vessel.

A less invasive technique known as endoscopic coiling, has been available since the mid-1990s. This involves inserting a catheter into the femoral artery and guiding it to the location of the aneurysm, where it is packed with platinum coils to prevent blood flow into the affected area.

Despite the introduction of coiling the outcomes of treatment of unruptured brain aneurysms, have remained stagnant over the last 10 years.

Now a new study published in the journal Stroke, suggests that this less than impressive result can be explained by the dramatic proliferation of procedures being performed at lower-volume community hospitals, where outcomes are inferior.

The research team of neurologists, neurosurgeons and neuro-anesthesiologists at NewYork-Presbyterian Hospital and Columbia University Medical Center compared hospital discharges for unruptured intracranial aneurysms (UIAs) in two time periods: 2005 to 2007 and 1995 to 2000.

They found that since 1995, there has been a six-fold increase in the treatment of UIAs by coiling at smaller community hospitals.

“This isn’t a problem with technology but rather the way it has been delivered,” says study co-author Dr. Robert A. Solomon, neurosurgeon-in-chief at NewYork-Presbyterian Hospital. “Endoscopic coiling has been hugely helpful for the vast majority of patients, and it has actually been shown to have the potential for better outcomes relative to open surgery. It just hasn’t improved the overall picture, at least in New York state, where we focused our study.”

The authors say the increased popularity of coiling in smaller community hospitals may stem from the perceived ease of doing the procedure as well as cost concerns, with poor outcomes the result of technical shortcomings or errors in judgment.

Boosting overall outcomes, the authors say, will take a return to greater centralization of care at academic medical centers.  “Centers that offer comprehensive cerebrovascular care with both surgical and endovascular capabilities are best equipped to make treatment decisions based on what’s best for the patient,” says Dr. Solomon.

As a woman in the at-risk age group, should I ever need to clip or coil I’ll be sure to go comprehensive!

Stemming the Damage from Stroke?

UK based stem cell technology company ReNeuron announced this week that it has treated its first patient in the Phase I PISCES (Pilot Investigation of Stem Cells in Stroke) study.

The trial is designed to recruit a total of 12 men (> 60 years of age). Participants will receive a direct injection of ReN001 cells into the affected brain region between six and 24 months following their stroke. While the study will primarily evaluate the safety of the stem cells, a number of efficacy measures will also be evaluated over two years of follow-up.

The first patient was treated with the stem cells at the Institute of Neurological Sciences, Southern General Hospital, in Glasgow, Scotland; and was safely discharged two days after the straightforward neuro-surgical procedure. Southern General is one of Europe’s most innovative and well-recognized stroke treatment centers and is perhaps best known as the place where the Glasgow Coma Scale was developed.

Assuming a satisfactory independent Data Safety Monitoring Board review of the first patient’s progress in December 2011, the additional patients will be treated shortly thereafter. Subject to satisfactory safety data ReNeuron intends to pursue an accelerated clinical development pathway with ReN001, focusing on particular stroke patient groups who are expected to most benefit from the therapy.

Principal investigator Professor Keith Muir suggested that “if the therapy works it may allow new nerve cells to grow or regeneration of existing cells and actual recovery of function in patients who would not otherwise be able to regain function.”

Stroke is the third largest cause of death and the single largest cause of adult disability in the developed world.  It occurs when blood flow leading to, or in, the brain is blocked (ischemic stroke) or a blood vessel in the brain ruptures (hemorrhagic stroke). This results in damage to the nerve cells in the brain and a loss of bodily functions.

Stroke is the single largest cause of adult disability in the developed world. Over 700,000 people suffer a stroke each year in the US, of which, approximately 80% are ischemic in nature.

In the US, the annual direct and indirect costs of stroke are estimated to be in excess of $50 billion.

The type of stroke treatment a patient should receive depends on the stage of disease:

• Prevention – treatments to prevent a first or recurrent stroke are based on treating associated risk factors, e.g. high cholesterol, smoking and diabetes
• Immediately after the stroke – treatments attempt to arrest a stroke whilst it is happening by dissolving the blood clot that has caused the infarct
• Post stroke rehabilitation – aims to improve both functional and cognitive recovery in the patient weeks or months after the event.

ReN001 stem cell therapy seeks initially to target ischemic stroke patients in the third stage.  These patients constitute approximately one half of stroke survivors.

SRxA’s Word on Health will be following this story and will bring you updates as they happen.