(Press-News.org) Receiving a clot-busting drug in an ambulance-based mobile stroke unit (MSU) increases the likelihood of averting strokes and complete recovery compared with standard hospital emergency care, according to researchers at Weill Cornell Medicine, NewYork-Presbyterian, UTHealth Houston, Memorial Hermann-Texas Medical Center and five other medical centers across the United States.
The study, published online in the Annals of Neurology on Oct. 6, determined that MSU care was associated with both increased odds of averting stroke compared with hospital emergency medical service (EMS) – 18 percent versus 11 percent, respectively – and a higher percentage of patients – 31 percent versus 21 percent – had early symptom resolution, within 24 hours after stroke.
Patients in this study were treated with tissue plasminogen activator (t-PA), a mainstay medication delivered intravenously (IV) in stroke cases. The drug dissolves the clot in an artery that is blocking blood flow to the brain, making treatment time critical. “While this is known to improve patient outcomes, how many patients fully recover afterward wasn't clear from prior research,” said lead author Dr. Babak Benjamin Navi, associate professor, vice chair for hospital neurology services and chief of stroke and hospital neurology, in the neurology department at Weill Cornell Medicine. He is also acting medical director of the MSU, operated by NewYork-Presbyterian, in collaboration with Weill Cornell Medicine, Columbia University Irving Medical Center, and the Fire Department of New York.
Every Minute Counts When Treating Stroke
“On average, the faster you treat someone, the more likely you are to have a good functional outcome because you’re able to preserve more brain tissue,” Dr. Navi said, who is also associate professor of neuroscience at the Feil Family Brain and Mind Research Institute at Weill Cornell and the medical director of the stroke center at NewYork-Presbyterian/Weill Cornell Medical Center. “The brain can only sustain reduced blood flow for so long before permanent injury develops.”
Using multicenter trial data from 2014-2020, the researchers evaluated 1,009 patients: 644 received t-PA in an MSU, and 365 received EMS care. Overall, patients received t-PA at a median interval of 87 minutes after the onset of stroke symptoms. The study found that with t-PA treatment in this time frame, about one in four patients who had a suspected stroke recovered within 24 hours and one in six averted a stroke with no demonstrable trace of brain injury on an MRI.
The outcome improved for patients treated by an MSU since the time from symptom onset to treatment was 37 minutes faster than for EMS care, meaning many more patients received vital t-PA within the crucial first hour. MSU care further increased the odds of averting a stroke with nearly one-third of patients recovering to normal within 24 hours. In addition, the researchers found other factors that contributed to better patient outcome: treatment within the first 45 minutes, younger age, being female, history of high cholesterol, lower blood pressure, lower stroke severity and no blockage of large blood vessels.
Bringing the Treatment to the Patient
Every 40 seconds, someone in the United States has a stroke, according to the American Heart Association. This study highlights the need for optimizing stroke systems of care, Dr. Navi said. Further expediting the delivery of t-PA through MSUs should be a priority to increase the proportion of averted strokes.
Dr. Navi is also hoping that Medicare will assign MSU services a billing code in the near future so that it can be embedded within stroke systems of care and become a financially viable model.
Currently, he is working with researchers from UTHealth Houston on a study to evaluate the cost effectiveness of MSUs, which should be published next year. “Such studies will hopefully lead to a shift in regulations and reimbursements, and how MSUs are led, managed and integrated within emergency medical services,” he said.
Co-principal investigators for the BEST-MSU trial, which produced the data for this analysis, were Dr. James C. Grotta, director of stroke research at the Clinical Innovation and Research Institute at Memorial Hermann - Texas Medical Center and director of the Mobile Stroke Unit Consortium; and Dr. Jose-Miguel Yamal, department of biostatistics at UTHealth Houston School of Public Health.
Also, contributing to this effort was Dr. John Volpi, director of the Eddy Scurlock Stroke Center Houston Methodist Stanley H. Appel Department of Neurology and associate professor of clinical neurology in neurology at Weill Cornell Medicine.
END
Mobile stroke units increase odds of averting stroke
2023-10-26
[Attachments] See images for this press release:
ELSE PRESS RELEASES FROM THIS DATE:
Why are so many migrant families still separated? Chaos in the data
2023-10-26
U.S. government reached a settlement with thousands of families separated under the zero-tolerance policy
Experts highlight ‘mountain of a challenge’ that U.S. Family Reunification Task Force has had in accounting for separations
Task force reuniting families is working within a limited scope of separated families
‘If using DNA data to reunite families could help even one child, it’s worth giving it a shot,’ says researcher
CHICAGO --- Five years since the retraction of the Trump-era zero-tolerance policy on illegal border crossings, which resulted in the separation ...
Mammalian cells may consume bacteria-killing viruses to promote cellular health
2023-10-26
Bacteriophages, also called phages, are viruses that infect and kill bacteria, their natural hosts. But from a macromolecular viewpoint, phages can be viewed as nutritionally enriched packets of nucleotides wrapped in an amino acid shell. A study published October 26th in the open access journal PLOS Biology by Jeremy J. Barr at Monash University, Victoria, Australia, and colleagues suggests that mammalian cells internalize phages as a resource to promote cellular growth and survival.
Phage interactions with bacteria are well known, and interactions between bacteria and their mammalian host can lead ...
New research finds stress and strain changes metal electronic structure
2023-10-26
New research from the University of Birmingham shows that the electronic structure of metals can strongly affect their mechanical properties.
The research, published today (26th October) in the journal Science, demonstrates experimentally, for the first time, that the electronic and mechanical properties of a metal are connected. It was previously understood theoretically that there would be a connection, but it was thought that it would be too small to detect in an experiment.
Dr Clifford Hicks, Reader in Condensed Matter Physics, who worked on the study said: “Mechanical properties are typically described ...
A superatomic semiconductor sets a speed record
2023-10-26
Semiconductors—most notably, silicon—underpin the computers, cellphones, and other electronic devices that power our daily lives, including the device on which you are reading this article. As ubiquitous as semiconductors have become, they come with limitations. The atomic structure of any material vibrates, which creates quantum particles called phonons. Phonons in turn cause the particles—either electrons or electron-hole pairs called excitons—that carry energy and information around electronic devices to scatter in a matter of nanometers and femtoseconds. This means that energy is lost in the form of heat, and that information transfer has ...
Uncovered in Uganda: Evidence for menopause in wild chimpanzees
2023-10-26
To date, research has suggested that only humans and some species of toothed whales live many years of active life after the loss of reproductive ability. But now, a new study shows female chimpanzees in Uganda show signs of menopause – surviving long past the end of their ability to reproduce. Signs of menopause in wild chimpanzees may provide insights into the evolution of this rare trait in humans. The vast majority of mammals stay fertile until the very ends of their lives, with humans and several species of toothed whales as the outliers; they experience menopause. In humans, menopause ...
A new “species” of legal subject: AI-led corporate entities, requiring interspecific legal frameworks
2023-10-26
For the first time in human history, say Daniel Gervais and John Nay in a Policy Forum, nonhuman entities that are not directed by humans – such as artificial intelligence (AI)-operated corporations – should enter the legal system as a new “species” of legal subject. AI has evolved to the point where it could function as a legal subject with rights and obligations, say the authors. As such, before the issue becomes too complex and difficult to disentangle, “interspecific” legal frameworks need to be developed by which AI can be treated as legal subjects, they write. Until now, the legal system has been univocal ...
Special Issue: The hypothalamus
2023-10-26
While small, the hypothalamus – a complex structure located deep in the brain – plays a gargantuan role in coordinating the wide array of neuronal signals that are responsible for keeping the body in a stable state. In a Special Issue of Science, authors across four Reviews unpack this key brain region’s impact on physiological and behavioral homeostasis.
The hypothalamus consists of a complex collection of neural circuits. These circuits receive, process, and integrate sensory inputs to drive coordinated communication via a range of behavioral, ...
A safer alternative to CRISPR-Cas approaches?: Retroelement-based genome editing tools
2023-10-26
In a Perspective, Stephen Tang and Samuel Sternberg discuss retroelement-based gene editing as a safer alternative to CRISPR-Cas approaches. Precision genome editing technologies have transformed modern biology. Capabilities for programable DNA targeting have improved rapidly, largely due to the development of bacterial RNA-guided CRISPR-Cas systems, which allow precise cleavage of target DNA sequences. However, CRISPR-Cas9 systems generate a DNA double strand break (DSB), which activates cellular DNA repair pathways that can lead to unwanted and complex byproducts, ...
UCLA researcher finds first proof of menopause in wild chimpanzees
2023-10-26
Key takeaways
Female chimpanzees in Uganda’s Ngogo community experienced a menopausal transition similar to women.
Fertility among chimpanzees studied declined after age 30, and no births were observed after age 50.
The data can help researchers better understand why menopause and post-fertile survival occur in nature and how it evolved in the human species.
A team of researchers studying the Ngogo community of wild chimpanzees in western Uganda’s Kibale National Park for two decades has published a report in Science showing that females in this population can ...
Conduction electrons drive giant, nonlinear elastic response in Sr2RuO4
2023-10-26
The hardness of materials is determined by the strength of the chemical bonds that are formed between the electrons of the neighbouring atoms. For example, the bonds in diamond are very strong, so it is one of the hardest materials known. The bonding is rooted in the laws of quantum mechanics, and the complex compounds that are of most interest in forefront research today are known as ‘quantum materials.’ In many quantum materials, layers of strongly bonded atoms separate layers in ...