Research - Cerebral Ischemia,
Cerebrovascular Diseases
Chocolate consumption and risk of stroke among men and women: A large population-based, prospective e cohort study
Jia-Yi Dong, Hiroyasu Iso, Kazumasa Yamagishi, Norie Sawada, Shoichiro Tsugane
Abstract
Background and aims: Chocolate consumption may have a beneficial effect on cardiovascular health, but evidence from prospective cohort studies is still limited. We aimed to examine the prospective associations between chocolate consumption and risk of stroke among men and women in a large population-based cohort.
Methods: A total of 38,182 men and 46,415 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline in 1995 and 1998, were followed up until the end of 2009 and 2010, respectively. We obtained data on chocolate consumption for each participant using a self-administrated food frequency 31 questionnaire that included 138 food and beverage items. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of stroke in relation to chocolate consumption
Results: During a median follow-up of 12.9 years, we identified 3558 incident strokes cases (2146 cerebral infarctions and 1396 hemorrhagic strokes). After adjustment for age, body mass index, life styles, dietary intakes, and other risk factors, chocolate consumption was associated with a significant lower risk of stroke in women (HR = 39 0.84; 95% CI, 0.71–0.99). However, the association in men was not significant (HR = 40 0.94; 95% CI, 0.80–1.10). In addition, the association did not vary by stroke subtypes in either men or women.
Conclusions: Findings from this large Japanese cohort supported a significant inverse association between chocolate consumption and risk of developing stroke in women. However, residual confounding could not be excluded as an alternative explanation for our findings.
Source : Journal Atherosclerosis
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Epigallocatechin-3-Gallate Protects against Homocysteine-Induced Brain Damage in Rats
Lili Wang, Xuan Tian
Abstract
High levels of homocysteine are implicated in many neurovascular and neurodegeneration diseases. Epigallocatechin 3-gallate (EGCG), one of green tea polyphenols, has potential anti-oxidative and anti-inflammatory activities. However, it has not been explored whether EGCG has an effect on homocysteine-induced neuro-inflammation and neurodegeneration. In this study, we investigated the effects of EGCG on memory deficit, oxidative stress, neuro-inflammation, and neurodegeneration in hyper-homocysteinemic rats after a 2 wk homocysteine injection by vena caudalis. We found that supplementation of EGCG could rescue deficit of spatial memory induced by homocysteine. Treatment of EGCG significantly reduced the expression of malondialdehyde, glial fibrillary acidic protein, tumor necrosis factor-α, and interleukin-1β and increased glutathione level in the homocysteine-treated group. In TdT-mediated dUTP nick end labeling (TUNEL) assay and Fluoro-Jade B staining, supplementation of EGCG could attenuate the apoptotic neurons and neurodegeneration. Interestingly, EGCG significantly ameliorated homocysteine-induced cerebrovascular injury. Our data suggest that EGCG could be a promising candidate for arresting homocysteine-induced neurodegeneration and neuro-inflammation in the brain.
Source : Planta Medica Journal
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Xingnao Jieyu Decoction Ameliorates Poststroke Depression through the BDNF/ERK/CREB Pathway in Rats
Tao Li,1 Dou Wang,1 Bingbing Zhao,2 and Yongmei Yan
Abstract
Background. The neurotrophic pathway regulated by the brain-derived neurotrophic factor (BDNF) plays a crucial role in the pathogenesis of poststroke depression (PSD). How the traditional Chinese medicine compound preparation Xingnao Jieyu (XNJY) decoction regulates the neurotrophic pathway to treat PSD is unclear. Objective. This study aimed to investigate the antidepressant effect of XNJY decoction on a rat model of PSD and the molecular mechanism intervening in the neurotrophic pathway. Methods. After a middle cerebral artery occlusion model was established, chronic unpredictable mild stress was applied for 21 days to prepare a PSD model. XNJY groups and a fluoxetine (Flu) group of rats were intragastrically administered with XNJY and Flu, respectively, for 21 consecutive days. Depressive-like behaviors, including sucrose preference, open field test, and forced swimming test, were assessed. The survival and apoptosis of cortical and hippocampal neurons were evaluated by immunofluorescence assay and TUNEL staining. The contents of serotonin (5-HT), norepinephrine (NE), and BDNF in the cortex and hippocampus were determined by ELISA. The protein levels of BDNF, p-ERK/ERK, and p-CREB/CREB in the cortical and hippocampal regions were tested by Western blot. Results. The depressive-like behaviors markedly improved after XNJY and Flu treatment. XNJY and Flu promoted neuronal survival and protected cortical and hippocampal neurons from apoptosis. XNJY also increased the contents of 5-HT, NE, and BDNF and recovered the protein levels of p-ERK/ERK, p-CREB/CREB, and BDNF in the cortical and hippocampal regions. Conclusion. These results indicated that the XNJY decoction exerts an obvious antidepressant effect, which may be due to the regulation of the BDNF/ERK/CREB signaling pathway.
Source : Evidence Based Complementary and Alternative Medicine
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Acupuncture for insomnia after stroke: a systematic review and meta-analysis
- Sook-Hyun Lee and
- Sung Min Lim
Background Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke.
The aim of the present study was to summarize and evaluate evidence on the effectiveness of acupuncture in relieving insomnia after stroke.
Methods Seven databases were searched from inception through October 2014 without language restrictions. Randomized controlled trials (RCTs) were included if acupuncture was compared to placebo or other conventional therapy for treatment of insomnia after stroke. Assessments were performed using the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI), the Athens insomnia scale (AIS), and the efficacy standards of Chinese medicine.
Results A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI (weighted mean difference, 4.31; 95 % confidence interval [CI], 1.67–6.95; P = 0.001) and by the efficacy standards of Chinese medicine (risk ratio, 1.25; 95 % CI, 1.12–1.40; P < 0.001). Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI (weighted mean difference, 4.44; 95 % CI, 2.75–6.13; P < 0.001) and the AIS (weighted mean difference, 3.64; 95 % CI, 2.28–5.00;P < 0.001).
Conclusions Our results suggest that acupuncture could be effective for treating insomnia after stroke. However, further studies are needed to confirm the role of acupuncture in the treatment of this disorder.
Source : BMC Complementary and Alternative Medicine
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Effectiveness of Gotu Kola Extract 750 mg and 1000 mg Compared with Folic Acid 3 mg in Improving Vascular Cognitive Impairment after Stroke.
Farhana KM1, Malueka RG1, Wibowo S1, Gofir A1
Abstract
This study aimed to determine the effectiveness of gotu kola (Centella asiatica) in improving cognitive function in patients with vascular cognitive impairment (VCI). This study uses a quasi-experimental design. Subjects in this study were patients with poststroke cognitive impairment who were treated at two hospitals in Yogyakarta, Indonesia. The number of subjects was 48: 17 subjects were treated with 1000 mg/day of gotu kola extract, 17 subjects treated with 750 mg/day of gotu kola extract, and 14 subjects treated with 3 mg/day of folic acid for 6 weeks. A Montreal Cognitive Assessment-Indonesian version (MoCA-Ina) was conducted at the beginning of treatment and after 6 weeks of therapy. It was found that all trials effectively improved poststroke VCI based on MoCA-Ina scores over the course of the study. There is no significant difference in ΔMoCA-Ina (score at the 6th week of treatment - score at the beginning) mean score among the three groups, indicating that gotu kola is as effective as folic acid in improving poststroke VCI. Gotu kola was shown to be more effective than folic acid in improving memory domain. This study suggested that gotu kola extract is effective in improving cognitive function after stroke.
Source : Journal Evidence Based Complementary and Alternative Medicine
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Efficacy of whole extract of licorice in neurological improvement of patients after acute ischemic stroke
- Parsa Ravanfara, ,
- Golnaz Namazia,
- Mahsa Atigha,
- Shaghayegh Zafarmanda,
- Azadeh Hamedib,
- Alireza Salehic,
- Sadegh Izadia, ,
- Afshin Borhani-Haghighia
Objective Licorice root has been reported to contain several neuroprotective compounds. In the present study we investigated its benefit in the treatment of acute ischemic stroke for which, treatment modalities are limited.
Design Randomized double-blind placebo controlled trial.
Subjects75 patients admitted to the neurology emergency department of Namazi hospital affiliated to Shiraz University of Medical Sciences, Iran, diagnosed with acute ischemic stroke.
InterventionPatients were randomly prescribed oral 450 mg or 900 mg licorice extract or placebo capsules three times daily for 7 days. National institute of Health stroke scale (NIHSS) and Modified Rankin Scale (MRS) scores were assessed before initiation of therapy and 3 months after treatment. Improvement of these scores were compared between study and control groups.
Results Mean NIHSS scores in 450 mg and 900 mg groups decreased from an initial score of 10.68 and 10.44 to 6.4 and 5.48 after 3 months respectively; while in the control group changed from 8.36 to 5.64. The decline in NIHSS scores were significantly greater in licorice treated groups than the control group. Similarly the decrease in MRS was greater in the licorice treated groups (4.2–2.9 in 450 mg licorice group, and 4.4–2.8 in 900 mg licorice group) versus the control group (3.9–2.8). None of the participants developed adverse reactions attributed to licorice overdose.
Conclusions The results of this study support the beneficial effect of whole licorice extract in neurologic improvement of patients with acute ischemic stroke. Licorice may be useful as a medication for the treatment of the adverse effects caused by acute ischemic stroke
Source : Journal of Herbal Medicine
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Post-ischemic Treatment of WIB801C, Standardized Cordyceps Extract, Reduces Cerebral Ischemic Injury via Inhibition of Inflammatory Cell Migration.
Hwang S1, Cho GS1, Ryu S1, Kim HJ1, Song HY1, Yune TY2, Ju C3, Kim WK4.Author information
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:Anti-inflammatory therapy has been intensively investigated as a potential strategy for treatment of cerebral stroke. However, despite many positive outcomes reported in animal studies, anti-inflammatory treatments have not proven successful in humans as yet. Although immunomodulatory activity and safety of Cordyceps species (Chinese caterpillar fungi) have been proven in clinical trials and traditional Asian prescriptions for inflammatory diseases, its anti-ischemic effect remains elusive.
AIM OF THE STUDY:In the present study, therefore, we investigated the potential therapeutic efficacy of WIB801C, the standardized extract of C. militaris, for treatment of cerebral ischemic stroke.
MATERIALS AND METHODS:The anti-chemotactic activity of WIB801C was assayed in cultured rat microglia/macrophages. Sprague-Dawley rats were subjected to ischemic stroke via either transient (1.5-h tMCAO and subsequent 24-h reperfusion) or permanent middle cerebral artery occlusion (pMCAO for 24-h without reperfusion). WIB801C was orally administered twice at 3-and 8-h (50 mg/kg each) after the onset of MCAO. Infarct volume, edema, blood brain barrier and white matter damages, neurological deficits, and long-term survival rates were investigated. The infiltration of inflammatory cells into ischemic lesions was assayed by immunostaining.
RESULTS:WIB801C significantly decreased migration of cultured microglia/macrophages. This anti-chemotactic activity of WIB-801C was not mediated via adenosine A3 receptors, although cordycepin, the major ingredient of WIB801C, is known as an adenosine receptor agonist. Post-ischemic treatment with WIB801C significantly reduced the infiltration of ED-1-and MPO-positive inflammatory cells into ischemic lesions in tMCAO rats. WIB801C-treated rats exhibited significantly decreased infarct volume and cerebral edema, less white matter and blood-brain barrier damages, and improved neurological deficits. WIB801C also improved survival rates over 34 days after ischemia onset. A significant reduction in infarct volume and neurobehavioral deficits by WIB801C was also observed in rats subjected to pMCAO.
CONCLUSIONS:In summary, post-ischemic treatment of WIB801C reduced infiltration of inflammatory cells into ischemic lesions via inhibition of chemotaxis, which confers long-lasting histological and neurological protection in ischemic brain. WIB801C may be a promising anti-ischemic drug candidate with clinically relevant therapeutic time window and safety.
Source : Ethnopharmacology
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Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study
Sun-Fa Chuang1†, Chun-Chuan Shih2†, Chun-Chieh Yeh34, Hsin-Long Lane2, Chin-Chuan Tsai25, Ta-Liang Chen678, Jaung-Geng Lin9, Tainsong Chen1† and Chien-Chang Liao6789*†
Abstract
Background Whether acupuncture protects stroke patients from acute myocardial infarction (AMI) has not been studied previously. The purpose of this study was to investigate the risk of AMI among stroke patients receiving acupuncture treatment.
Methods Taiwan’s National Health Insurance Research Database was used to conduct a retrospective cohort study of 23475 stroke patients aged 40–79 years receiving acupuncture treatment and 46950 propensity score-matched stroke patients not receiving acupuncture treatment who served as controls from 2000 to 2004. Both stroke cohorts were followed until the end of 2009 and were adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) for new-onset AMI in multivariate Cox proportional hazard models.
Results Stroke patients who received acupuncture treatment (9.2 per 1000 person-years) exhibited a lower incidence of AMI compared with those who did not receive acupuncture treatment (10.8 per 1000 person-years), with an HR of 0.86 (95 % CI, 0.80–0.93) after adjusting for age, sex, low income, coexisting medical conditions and medications. The relationship between acupuncture treatment and AMI risk was investigated in female stroke patients (HR, 0.85; 95 % CI, 0.76–0.95), male stroke patients (HR, 0.87; 95 % CI, 0.80–0.95), patients from 50 to 59 years of age (HR, 0.75; 95 % CI, 0.63–0.90), patients from 60 to 69 years of age (HR, 0.85; 95 % CI, 0.75–0.95), patients suffering from ischemic stroke (HR, 0.87; 95 % CI, 0.79–0.95), and patients suffering from hemorrhagic stroke (HR, 0.62; 95 % CI, 0.44–0.88).
Conclusions We raised the possibility that acupuncture may be effective in lowering the risk of AMI in stroke patients aged 50–69 in this study, which was limited by a lack of information regarding stroke severity and acupuncture points. Our results suggest that prospective randomized trials are needed to establish the efficacy of acupuncture in preventing AMI.
Source : BMC Complementary and Alternatve Medicine
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Tai Chi Chuan for the Primary Prevention of Stroke in Middle-Aged and Elderly Adults: A Systematic Review
Guohua Zheng,1 Maomao Huang,1 Feiwen Liu,1 Shuzhen Li,1 Jing Tao,1 andLidian Chen2
1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road, Shangjie University Town, Fuzhou 350108, China
2Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road, Shangjie University Town, Fuzhou 350108, China
Abstract
Background. Stroke is a major healthcare problem with serious long-term disability and is one of the leading causes of death in the world. Prevention of stroke is considered an important strategy.
Methods. Seven electronic databases were searched.
Results. 36 eligible studies with a total of 2393 participants were identified. Primary outcome measures, TCC exercise combined with other intervention had a significant effect on decreasing the incidence of nonfatal stroke (n=185, RR = 0.11, 95% CI 0.01 to 0.85, P=0.03) and CCD (n=125, RR = 0.33, 95% CI 0.11 to 0.96, P=0.04). For the risk factors of stroke, pooled analysis demonstrated that TCC exercise was associated with lower body weight, BMI, FBG level, and decreasing SBP, DBP, plasma TC, and LDL-C level regardless of the intervention period less than half a year or more than one year and significantly raised HDL-C level in comparison to nonintervention. Compared with other treatments, TCC intervention on the basis of the same other treatments in patients with chronic disease also showed the beneficial effect on lowering blood pressure.
Conclusion. The present systematic review indicates that TCC exercise is beneficially associated with the primary prevention of stroke in middle-aged and elderly adults by inversing the high risk factors of stroke.
Source : Journal Evidence Based Complementary and Alternative Medicine
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An Updated Meta-Analysis of the Efficacy and Safety of Acupuncture Treatment for Cerebral Infarction
Li Li, Affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
Hong Zhang ,Affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
Shu-qing Meng,Affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
Hai-zhou Qian
Abstract
BackgroundIschemic stroke is the second most common cause of death and the primary cause of disability throughout the world. Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this study was to update the clinical efficacy and safety of acupuncture for cerebral infarction.
Methods
Randomized controlled trials (RCT) on acupuncture treating cerebral infarction were searched from the following databases: PubMed, EMBASE, Cochrane Library, CNKI, CMB and VIP from inception to October 2013. The data of RCTs meeting the inclusive criteria were extracted according to Cochrane methods. The meta-analyses were conducted using Rev Man 5.0 software.
Results
A total of 25 trials involving 2224 patients were included. The results of this meta-analysis showed that the groups receiving acupuncture (observation group) were superior to the comparison groups (control group), with significant differences in the Clinical Efficacy Rates [OR = 4.04, 95%CI (2.93, 5.57), P<0.001], Fugl-Meyer Assessment [MD = 11.22, 95%CI (7.62, 14.82), P<0.001], Barthel Index Score [MD = 12.84, 95%CI (9.85, 15.82), P<0.001], and Neurological Deficit Score [MD = −2.71, 95% CI (−3.84, −1.94), P<0.001]. Three trials reported minor adverse events.
Conclusion
Current evidence provisionally demonstrates that acupuncture treatment is superior to either non-acupuncture or conventional therapy for cerebral infarction. Despite this conclusion, given the often low quality of the available trials, further large scale RCTs of better quality are still needed.
Source : PLOSOne
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Acupuncture for Spasticity after Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Sung Min Lim,1 Junghee Yoo,2 Euiju Lee,2 Hyun Jung Kim,3 Seungwon Shin,2 Gajin Han,2 and Hyeong Sik Ahn3
1Department of Motor & Cognition Rehabilitation, Korean National Rehabilitation Research Institute, 111 Gaorigil, Gangbuk-gu, Seoul 142-884, Republic of Korea
2College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Republic of Korea
3Institute for Evidence-Based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, 126-1 Anam-dong, Seongbuk-gu, Seoul 136-705, Republic of Korea
The aim of this systematic review was to determine how effective acupuncture or electroacupuncture (acupuncture with electrical stimulation) is in treating poststroke patients with spasticity. We searched publications in Medline, EMBASE, and the Cochrane Library in English, 19 accredited journals in Korean, and the China Integrated Knowledge Resources Database in Chinese through to July 30, 2013. We included randomized controlled trials (RCTs) with no language restrictions that compared the effects of acupuncture or electroacupuncture with usual care or placebo acupuncture. The two investigators assessed the risk of bias and statistical analyses were performed. Three RCTs in English, 1 in Korean, and 1 in Chinese were included. Assessments were performed primarily with the Modified Ashworth Scale (MAS). Meta-analysis showed that acupuncture or electroacupuncture significantly decreased spasticity after stroke. A subgroup analysis showed that acupuncture significantly decreased wrist, knee, and elbow spasticity in poststroke patients. Heterogeneity could be explained by the differences in control, acupoints, and the duration after stroke occurrence. In conclusion, acupuncture could be effective in decreasing spasticity after stroke, but long-term studies are needed to determine the longevity of treatment effects.
Source : Journal Evidence Based Complementary and Alternative Medicine
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Dietary Fiber Intake Is Inversely Associated with Stroke Incidence in Healthy Swedish Adults
Abstract
Background: Prospective studies of dietary fiber intake in relation to stroke risk have reported inconsistent results.
Objective: This study assessed the association between intake of total fiber and fiber sources and stroke incidence in healthy Swedish adults.
Methods: The analysis was based on 69,677 participants (aged 45–83 y) from the Swedish Mammography Cohort and the Cohort of Swedish Men who were free from cancer, cardiovascular disease, and diabetes at baseline (1 January 1998). Diet was assessed with a food-frequency questionnaire. Cases of stroke were ascertained through linkage to the Swedish Inpatient Register and the Swedish Cause of Death Register. Cox proportional hazards regression model was used to calculate RRs, adjusted for potential confounders.
Results: During 10.3 y of follow-up, 3680 incident stroke cases, including 2722 cerebral infarctions, 363 intracerebral hemorrhages, 160 subarachnoid hemorrhages, and 435 unspecified strokes, were ascertained. High intakes of total fiber and fiber from fruits and vegetables but not from cereals were inversely associated with risk of stroke. After adjustment for other risk factors for stroke, the multivariable RRs of total stroke for the highest vs. lowest quintile of intake were 0.90 (95% CI: 0.81, 0.99) for total fiber, 0.85 (95% CI: 0.77, 0.95) for fruit fiber, 0.90 (95% CI: 0.82, 1.00) for vegetable fiber, and 0.94 (95% CI: 0.84, 1.04) for cereal fiber.
Conclusion: These findings indicate that intake of dietary fiber, especially fruit and vegetable fibers, is inversely associated with risk of stroke.
Source : The Journal of Nutrition
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A Meta-Analysis of Acupuncture Use in the Treatment of Cognitive Impairment After Stroke
Fang Liu, MS,1Zhuang-Miao Li, MS,2Yi-Jing Jiang, MS,1and Li-Dian Chen, PhD3
Abstract
Objective:This meta-analysis was conducted to evaluate the efficacy of acupuncture on cognitive impairment(function) after a stroke.
Design:Randomized controlled trials (RCTs) comparing acupuncture with no acupuncture in addition to medicine or rehabilitation were identified from databases (PubMed, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wangfang Chinese Periodical Database, Chinese Bio-medicine Database, Cochrane Library, and Chinese medical literature da-tabases) and two relevant journals (Chinese Acupuncture and Moxibustion and the Journal of Shanghai Acupuncture and Moxibustion). Meta-analyses were conducted for the eligible RCTs.
Results:Twenty-one trials with a total of 1421 patients met inclusion criteria. Pooled random-effects estimates of the change in the Mini-Mental State Examination were calculated for the comparison of acupuncture with no acupuncture in addition to medicine or rehabilitation. Following 4 weeks and 8 weeks of intervention with acupuncture, the merged mean difference was 3.14 (95% confidence interval [CI], 2.06–4.21;p<.00001) and2.03 (95% CI, 0.26–3.80;p=0.02), respectively. For the comparison of 3–4 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the merged MD in Neurobehavioral Cognitive State Examination total scores was 5.63 (95% CI, 3.95–7.31;p<.00001). For the comparison of 8–12 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the P300 latency merged MDwas-12.80 (95% CI,-21.08 to-4.51;p<.00001), while the P300 amplitude merged MD was 1.38 (95% CI,0.93–1.82;p<.00001). Overall, the study quality was rated as moderate on the basis of the Cochrane Handbook for Systematic Reviews of Interventions(part 2: 8.5).
Conclusions:This meta-analysis suggests that acupuncture had positive effects on cognitive function after stroke and supports the need for additional research on the potential benefits of this therapeutic approach
Source : Journal Alternative and Complementary Medicine
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Decreased Risk of Stroke in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study
Chun-Chuan Shih, Yi-Ting Hsu, Hwang-Huei Wang, Ta-Liang Chen, Chin-Chuan Tsai, Hsin-Long Lane, Chun-Chieh Yeh, Fung-Chang Sung, Wen-Ta Chiu, Yih-Giun Cherng equal contributor, Chien-Chang Liao
Abstract
Background
Patients with traumatic brain injury (TBI) face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied.
Methods
Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000–2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset stroke in the multivariable Cox proportional hazard models.
Results
TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50–0.69) after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20–44, 45–64, and ≥65 years). The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001).
Conclusion
Patients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.
Source : PLOS One
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The flavanol (−)-epicatechin prevents stroke damage through the Nrf2/HO1 pathway
This work was supported in part by grants from the National Institutes of Health (AT001836, AA014911, AT002113, and NS046400) and from the American Heart and Stroke Association to S.D.
Zahoor A Shah1,7, Rung-chi Li1,7, Abdullah S Ahmad1, Thomas W Kensler2, Masayuki Yamamoto2,3,4, Shyam Biswal2,5 and Sylvain Doré1,6
- 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- 2Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- 3Center for Tsukuba Advanced Research Alliance, University of Tsukuba, Tsukuba, Japan
- 4Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Japan
- 5Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- 6Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland, USA
- The flavanol (−)-epicatechin prevents stroke damage through the Nrf2/HO1 pathway This work was supported in part by grants from the National Institutes of Health (AT001836, AA014911, AT002113, and NS046400) and from the American Heart and Stroke Association to S.D.
Zahoor A Shah1,7, Rung-chi Li1,7, Abdullah S Ahmad1, Thomas W Kensler2, Masayuki Yamamoto2,3,4, Shyam Biswal2,5 and Sylvain Doré1,6 - 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- 2Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- 3Center for Tsukuba Advanced Research Alliance, University of Tsukuba, Tsukuba, Japan
- 4Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Japan
- 5Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
- 6Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland, USA
Abstract
Epidemiologic studies have shown that foods rich in polyphenols, such as flavanols, can lower the risk of ischemic heart disease; however, the mechanism of protection has not been clearly established. In this study, we investigated whether epicatechin (EC), a flavanol in cocoa and tea, is protective against brain ischemic damage in mice. Wild-type mice pretreated orally with 5, 15, or 30 mg/kg EC before middle cerebral artery occlusion (MCAO) had significantly smaller brain infarcts and decreased neurologic deficit scores (NDS) than did the vehicle-treated group. Mice that were posttreated with 30 mg/kg of EC at 3.5 hours after MCAO also had significantly smaller brain infarcts and decreased NDS. Similarly, WT mice pretreated with 30 mg/kg of EC and subjected to N-methyl-D-aspartate (NMDA)-induced excitotoxicity had significantly smaller lesion volumes. Cell viability assays with neuronal cultures further confirmed that EC could protect neurons against oxidative insults. Interestingly, the EC-associated neuroprotection was mostly abolished in mice lacking the enzyme heme oxygenase 1 (HO1) or the transcriptional factor Nrf2, and in neurons derived from these knockout mice. These results suggest that EC exerts part of its beneficial effect through activation of Nrf2 and an increase in the neuroprotective HO1 enzyme.
Source : Journal of Cerebral Blood Flow and Metabolism
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Chinese herbal formula Qi-Lian-Gui-Shou Tang protects against acute ischemic cerebral injury in rats
Juexian Song,, Haiping Zhao, Ping Liu, Ning Li, Liyuan Huang, Pingping Wang, Li Gao, Yumin LuoIntroductionQi-Lian-Gui-Shou Tang (QLGST) is a Chinese herb formula composed of Astragalus mongholicus, Coptis chinensiss, Radix Angelicae Sinensis, and Radix Polygoni Multiflori, and is normally used for treatment of patients with acute cerebral ischemic injury in Xuanwu Hospital, Capital Medical University, China. This study explores the efficacy and underlying mechanism of QLGST in a rat model with acute ischemic stroke.
MethodsMale Sprague-Dawley rats (n=95) were subjected to sham operation or middle cerebral artery occlusion (MCAO) for 2h to induce ischemia followed by 72h reperfusion with or without administration of QLGST. QLGST at low (19.58g/kg), moderate (39.16g/kg) and high dosage (78.32g/kg) (N=19 each group) was administrated by gavage starting 30min after reperfusion, twice a day for 3 days. Behavioral deficit was tested after 72h reperfusion, followed by infarct volume and cell apoptosis, detected by TTC and TUNEL staining, respectively. The expression of activated proteins in Akt/GSK3β pathway was assessed by western blot and immunofluorescence staining.
ResultsQLGST at all three dosages decreased neurological functional impairment, but the infarct volume was only significantly decreased by QLGST at the moderate dosage (clinic equivalent dose) compared to MCAO model without treatment. Furthermore, QLGST at moderate dosage inhibited neuronal apoptosis and increased the activation of Akt/GSK3β pathway as compared to MCAO model without treatment.
ConclusionOur results exhibited the neuroprotective effect of Chinese herb formula QLGST on acute ischemic brain injury in a rat model. We suggest this effect might be mediated by activation of the protective signaling Akt/GSK3β pathway.
Source : EU Journal of Integrative Medicine
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Exploring the Benefits of Unilateral Nostril Breathing Practice Post-Stroke: Attention, Language, Spatial Abilities, Depression, and Anxiety
Marshall Rebecca Shisler, Basilakos Alexandra, Williams Tiffany, and Love-MyersKim.
Abstract Objective: Unilateral nostril breathing (UNB) is a yogic pranayama technique that has been shown to improve verbal and spatial cognition in neurologically intact individuals. Early study of UNB in healthy individuals has shown benefits for attention and memory. This preliminary study explored whether UNB influenced various measures of attention, language, spatial abilities, depression, and anxiety in post-stroke individuals, both with and without aphasia.
Design: A within-subjects repeated-measures design was used to determine whether UNB improved cognitive, linguistic, and affect variables in post-stroke individuals. Within-subjects comparisons determined UNB's effects over time, and between-subjects comparison was used to determine whether changes in these variables differed between post-stroke individuals with and without aphasia.
Setting: Athens and Atlanta, Georgia.
Participants: Eleven post-stroke individuals participated in a 10-week UNB program. Five individuals had stroke-induced left hemisphere damage with no diagnosis of aphasia (left hemisphere damage control group; LHD), and six individuals experienced left hemisphere damage with a diagnosis of aphasia (individuals with aphasia group; IWA).
Measures: Individuals were assessed on measures of attention, language, spatial abilities, depression, and anxiety before, during, and after UNB treatment.
Results: UNB significantly decreased levels of anxiety for individuals in both groups. Performance on language measures increased for the individuals with aphasia.
Conclusions: Significant findings for language and affect measures indicate that further investigation regarding duration of UNB treatment and use of UNB treatment alongside traditional speech-language therapy in post-stroke individuals is warranted.
Source : Journal Alternative and Complementary Medicine
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Vitamin C linked to Reduced Stroke Risk
A study due to be presented at a conference later this year suggests that eating foods containing vitamin C, such as oranges, peppers, strawberries, papaya and broccoli, may be linked to a reduced risk for hemorrhagic stroke.
According to the US Centers for Disease Control and Prevention (CDC), stroke is the fourth leading cause of death in the US, where every year 795,000 Americans suffer a stroke and 130,000 die from one.
There are two main types of stroke: ischemic and hemorrhagic. Ischemic stroke, by far the most common type, is where a blockage in a blood vessel stops blood from getting to one or more parts of the brain. Hemorrhagic stroke is much rarer but more deadly and occurs when a weakened blood vessel in the brain ruptures and allows blood to leak into and around the brain.
Study author Dr. Stéphane Vannier, of Pontchaillou University Hospital in Rennes, France, says:
"Our results show that vitamin C deficiency should be considered a risk factor for this severe type of stroke, as were high blood pressure, drinking alcohol and being overweight in our study."
The study compared 65 patients who had experienced a hemorrhagic stroke with 65 healthy counterparts.
Both groups underwent blood tests that checked their vitamic C levels. The results showed that 41% of all participants had normal levels, 45% had depleted levels, and 14% had levels so low they were considered deficient in vitamin C.
Participants who experienced stroke had depleted levels of vitamin C However, on average, the participants who had experienced a stroke had depleted levels, while the ones who had not had a stroke had normal levels of vitamin C in their blood.
The results have not been published in a peer-reviewed journal. The American Academy of Neurology released these details to the media in advance of its 66th Annual Meeting, due to take place in Philadelphia, PA, at the end of April, when fuller details of the study will be presented.
Dr. Vannier says more research is now needed to confirm the findings and find out how vitamin C works to reduce stroke risk.
He suggests one way vitamin C might reduce stroke risk could be by reducing blood pressure, and he adds that vitamin C has other benefits, like helping to make collagen, a protein that gives structure to skin, bones and tissue.
Source : Medical News Today
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Neuroprotective response of the hippocampus region of the brain to Withania somnifera and Asparagus racemosus root extract: An in vitro study
Maheep Bhatnagar*, Prahlad Meena, Satyendra Barbar and Chetan Joshi
Neuroscience Laboratory, Department of Zoology, University College of Science, Mohanlal Sukhadia University, Udaipur-313001, India.
Abstract
Neuroprotective effects of two medicinally important herbs Withania somnifera (WS) and Asparagus racemosus (AR) were investigated in primary hippocampal neuron cell culture. The root extracts of WS and AR were obtained by Soxhlet extraction using distilled water as solvent. The 7 to 8 days old hippocampal cells in culture were treated with100 µM Glutamate (Glu) for 10 min at room temperature in Hank's balanced saline solution (HBSS). One hour (1 h) after exposure to Glu, cells were treated with root extract of WS, AR or WS + AR [10 µg/ml dissolved in dimethyl sulfoxide (DMSO)], respectively. Results of the study suggested that percent cell viability [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay] was more significant in groups treated with Glu + WS and Glu + WS + AR, when compared to group treated with Glu + AR. More than two-fold increase in free Ca2+ was observed in culture in presence of Glu, but after treatment with WS, this increase was significantly reduced (P < 0.01). No significant change was observed in presence of AR. A significant decrease in lactic dehydrogenase (LDH) was observed after WS, AR as well as WS + AR, when compared with Glu treated group. There was significant (P < 0.01) decrease in malondialdehyde (MDA) in presence of WS or AR. Reactive oxygen species (ROS) level was significantly inhibited in both Glu + WS and Glu + AR treated group, compared to Glu and Glu + WS + AR treated group. Significant elevation of reduced glutathione (GSH) and glutathione disulfide (GSSG) was also obtained after WS and AR treatment. A marked increase in nerve growth factor (NGF) and pro-brain derived growth factor (pro-BDNF) expression was observed after AR and WS + AR treatment; whereas no observable change was observed in WS treated group. It was therefore, concluded that both plants in combination (WS + AR) have more effective role in neuroprotection. Study also showed neurotrophic factor modulatory activity of these plants. Present study suggest that WS + AR in combination could have alternative therapeutic potency for treatment of diseases associated with neuron cell loss.
Source : Journal of Medicinal Plants Research
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Prospective Study and Meta-Analysis of Chocolate and Reduction of Stroke Risk
by Risa N. Schulman, PhD
Reviewed: Larsson SC, Virtamo J, Wolk A. Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis. Neurology. 2012;79(12):1223-1229.
Much evidence has accumulated to show that cocoa (Theobroma cacao, Sterculiaceae) and chocolate may have benefits for cardiovascular health through antioxidant, antiplatelet, anti-inflammatory, and blood pressure-lowering effects. In this paper, effects on stroke have been examined in four studies, with two having statistically significant results. However, none of these studies examined exclusively male populations, and only one made its evaluation based on stroke type. The prospective study assessed the association between chocolate consumption and risk of stroke and stroke subtypes in a cohort of Swedish men. In addition, the authors conducted a meta-analysis of prospective studies involving chocolate and stroke risk.
The study used data from the 1997 Cohort of Swedish Men (aged 45 to 79 years). Questionnaires with 350 items on diet and lifestyle were gathered from 48,850 men who were a good representation of the general population with respect to age distribution, relative body weight, and education level, compared with representative data from the Official Statistics of Sweden. After excluding questionnaires that were not completely filled in, and patients who had died or had a history of cancer, cardiovascular disease, diabetes, or an implausible total energy intake, 37,103 men remained.
Consumption of chocolate was assessed using a self-administered food-frequency questionnaire that included 96 foods and beverages. Consumption in grams was computed by multiplying the frequency of chocolate consumption by four age-specific portion sizes (43-54 years, 42 g; 55-63 years, 34 g; 64-71 years, 27 g; 72-77 years, 26 g), which were obtained from the authors’ validation study in Swedish men. Approximately 90 percent of chocolate consumption during the time frame of the study was in the form of milk chocolate.
Incidence of stroke was identified via the Swedish Hospital Discharge Registry and was classified as cerebral infarction (ICD-10 [International Statistical Classification of Diseases and Related Health Problems 10th Revision] code I63), intracerebral hemorrhage (I61), subarachnoid hemorrhage (I60), and unspecified stroke (I64).
In 10.2 years of follow-up, 1,995 cases of first-time stroke were identified, including 1,511 cerebral infarctions, 321 hemorrhagic strokes (254 intracerebral hemorrhages and 67 subarachnoid hemorrhages), and 163 unspecified strokes.
Patients in the highest quartile of chocolate consumption (62.9 g/week) had a statistically significantly lower risk of total stroke by 17 percent (95% confidence interval [CI]: 1-30) after adjustment for age and stroke risk factors, including blood pressure. This association was similar across stroke types. There was an inverse relationship between chocolate consumption and risk of total stroke observed in men without hypertension (relative risk [RR]: 0.76; 95% CI: 0.62-0.93), but not in men with a history of hypertension (RR: 1.04; 95% CI: 0.77-1.41; P for interaction = 0.04). The age-standardized incidence rates of stroke were 85 per 100,000 person-years among men in the lowest quartile of chocolate consumption and 73 per 100,000 person-years among men in the highest quartile.
For the meta-analysis, the databases PubMed and EMBASE were searched up to January 13, 2012, with no restrictions imposed. Four prospective studies examining the association between chocolate consumption and stroke were identified, plus the current study, making a total of five. These studies included a total of 4,260 stroke cases over a range of eight to 16 years of follow-up. Highest and lowest consumption of chocolate were compared, and dose response also was analyzed.
The RR of stroke in the highest compared to the lowest quartiles of chocolate consumption was 0.81 (95% CI: 0.73-0.90), with no heterogeneity. Dose response could be assessed in four out of five of the studies; for a 50 g increment per week, the RR was 0.86 (95% CI: 0.76-0.97), with no heterogeneity among studies (P=0.21; I2=34.1%).
The highest levels of chocolate consumption were associated with a decreased risk of stroke in men, and this was confirmed by the meta-analysis. The results can be extrapolated to men in general because of the wide representation of men present in the sample population. Though the exact mechanism of action for the stroke benefit has not been elucidated, it is likely due to the pleiotropic (producing multiple effects from one gene) cardiovascular benefits of chocolate, including the lowering of blood pressure. The strengths of the study are its large population and its nearly complete data regarding stroke incidence. Its limitations include a lack of differentiation between types of chocolate consumed, self-reporting of consumption, and evidence of small study effects in the meta-analysis. The authors caution that chocolate should be consumed in moderation because of its high fat and sugar content.
Source : American Botanical Council
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Dietary Fiber Nibbles Down Stroke Risk
Eating more fiber may modestly reduce the risk of stroke, although details remain uncertain and it might just be a surrogate for other healthy behaviors, a meta-analysis determined.
Each additional 7 g of daily dietary fiber intake was associated with a significant 7% lower risk of hemorrhagic and ischemic stroke combined, Diane Threapleton, MSc, of the University of Leeds, England, and colleagues reported online in Stroke.
"Our study supports current guidelines to increase fiber consumption," the researchers concluded, although they noted that too little data were available to narrow down what sources or types of fiber were most protective.
They called a 7-g per day boost in roughage doable, it being the equivalent of an extra serving of beans or two servings of fruit like apples and oranges.
The average American falls short of the daily recommended fiber intake by more than that, though, getting an average of just 13 g for women and 17 g for men compared with the 21 to 25 g and 30 to 38 g, respectively, called for by guidelines.
Although the observational data couldn't ascribe causality, a role for dietary fiber is plausible, Threapleton's group noted.
"Soluble types of fiber form gels in the stomach and small intestine, slowing the rate of nutrient absorption and slowing gastric emptying, which increases satiety and influences the overall amount of food eaten, resulting in lower levels of overweight," they wrote. "Bacterial fermentation of resistant starch and soluble fibers in the large intestine produces short-chain fatty acids which inhibit cholesterol synthesis by the liver, consequently lowering serum levels."
Prior studies have shown links to stroke risk factors, including hypertension and high cholesterol, as well as insulin resistance.
The literature search turned up eight prospective cohort studies from the U.S., northern Europe, Australia, and Japan reporting on fiber intake in healthy individuals (defined as not recruited based on history of disease or poor health) and incidence of first ever stroke.
Pooled results showed a steadily declining stroke risk with higher total fiber intake, with a relative risk of 0.93 per 7 g per day (95% CI 0.88 to 0.98).
Few individuals had fiber levels above 25 g per day, "so extrapolation of risk at higher intakes should be undertaken with caution," the researchers warned.
There was some evidence of heterogeneity among the studies, with a difference by study size.
Ischemic stroke appeared less common with higher total dietary fiber intake in two of the four studies that reported on this outcome, while a third showed a similar trend but with wide confidence intervals.
Hemorrhagic stroke occurred less often at higher fiber levels in one of the three studies looking at that outcome.
Soluble fiber showed a nonsignificant trend, with 6% lower relative risk of stroke per 4 g/day increase in daily intake across the studies.
The insoluble fiber results couldn't be pooled. One of the three studies reporting on this measure suggested a 38% lower stroke risk, while the others indicated no association.
Fiber from grain sources appeared protective in several studies, as did vegetable fiber, but again results couldn't be pooled.
The reviewers cautioned about the "inherent problem of unadjusted confounding" since fiber may be acting as a surrogate for other healthy behaviors like less smoking and more exercise that also would reduce stroke risk.
"All of the pooled studies did, however, include adjustment for potentially important confounding variables such as age, body mass index, blood pressure or history of hypertension, smoking status, alcohol intake, physical activity, and sex (where applicable), and also a variety of other health and lifestyle variables," Threapleton and colleagues noted.
Source : MedPage Today
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Coffee, Green Tea, May Help Lower Stroke Risk
Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet, according to research published in Stroke: Journal of the American Heart Association.
"This is the first large-scale study to examine the combined effects of both green tea and coffee on stroke risks," said Yoshihiro Kokubo, M.D., Ph.D., F.A.H.A., F.A.C.C., F.E.S.C., lead author of the study at Japan's National Cerebral and Cardiovascular Center. "You may make a small but positive lifestyle change to help lower the risk of stroke by adding daily green tea to your diet."
Researchers asked 83,269 Japanese adults about their green tea and coffee drinking habits, following them for an average 13 years. They found that the more green tea or coffee people drink, the lower their stroke risks.
- People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.
- People who drank two to three cups of green tea daily had a 14 percent lower risk of stroke and those who had at least four cups had a 20 percent lower risk, compared to those who rarely drank it.
- People who drank at least one cup of coffee or two cups of green tea daily had a 32 percent lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. (Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13 percent of strokes are hemorrhagic.)
During the 13-years of follow-up, researchers reviewed participants' hospital medical records and death certificates, collecting data about heart disease, strokes and causes of death. They adjusted their findings to account for age, sex and lifestyle factors like smoking, alcohol, weight, diet and exercise.
Green tea drinkers in the study were more likely to exercise compared to non-drinkers.
Previous limited research has shown green tea's link to lower death risks from heart disease, but has only touched on its association with lower stroke risks. Other studies have shown inconsistent connections between coffee and stroke risks.
Initial study results showed that drinking more than two cups of coffee daily was linked to increasing coronary heart disease rates in age- and sex-adjusted analysis. But researchers didn't find the association after factoring in the effects of cigarette smoking -- underscoring smoking's negative health impact on heart and stroke health.
A typical cup of coffee or tea in Japan was approximately six ounces. "However, our self-reported data may be reasonably accurate, because nationwide annual health screenings produced similar results, and our validation study showed relatively high validity." Kokubo said. "The regular action of drinking tea, coffee, largely benefits cardiovascular health because it partly keeps blood clots from forming."
Tea and coffee are the most popular drinks in the world after water, suggesting that these results may apply in America and other countries.
It's unclear how green tea affects stroke risks. A compound group known as catechins may provide some protection. Catechins have an antioxidant anti-inflammatory effect, increasing plasma antioxidant capacity and anti-thrombogenic effects.
Some chemicals in coffee include chlorogenic acid, thus cutting stroke risks by lowering the chances of developing type 2 diabetes.
Further research could clarify how the interaction between coffee and green tea might help further lower stroke risks, Kokubo said.
Source : Science Daily
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Tai Chi is a martial art dating back to ancient China. It includes physical movements, mental concentration and relaxed breathing.
"Learning how to find and maintain your balance after a stroke is a challenge," said Ruth E. Taylor-Piliae, Ph.D., R.N., the study's principal investigator and assistant professor at the University of Arizona College of Nursing in Tucson, Ariz. "Tai Chi is effective in improving both static and dynamic balance, which is important to prevent falls. Tai Chi is readily available in most U.S. cities and is relatively inexpensive."
Stroke survivors experience seven times as many falls each year than healthy adults, Taylor-Piliae said. These falls can cause fractures, decrease mobility and increase fear of falling that can result in social isolation or dependence. Tai Chi has significantly reduced falls in healthy older adults.
Researchers recruited 89 stroke survivors -- most of whom had ischemic strokes -- for a randomized prospective study outside of a hospital setting. Participants were an average 70 years old, 46 percent were women and most Caucasian, college educated and living in the Tucson area, and suffered a stroke on average three years prior to beginning the study.
Among the participants, 30 practiced Tai Chi, 28 took part in usual care and 31 participated in SilverSneakers®. The Tai Chi and SilverSneakers® groups participated in a one-hour exercise class three times each week for 12 weeks. The usual care group received a weekly phone call and written material about participating in community-based physical activity.
During the 12-week trial, there were a total of 34 reported falls in participants' homes mainly from slipping or tripping: five falls in the Tai Chi group; 15 falls in the usual care group; and 14 falls in the Silver Sneakers group. Only four people sought medical treatment.
Yang-style Tai Chi, as practiced in the study, is the most popular of five styles used in the United States because of its emphasis on health benefits, both physical and psychosocial benefits, researchers said.
"The main physical benefits of Tai Chi are better balance, improved strength, flexibility and aerobic endurance," Taylor-Piliae said. "Psycho-social benefits include less depression, anxiety and stress, and better quality of life."
Source : Science Daily
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Walking linked to fewer strokes in women
Women who walk at least three hours every week are less likely to suffer a stroke than women who walk less or not at all, according to new research from Spain.
"The message for the general population remains similar: regularly engaging in moderate recreational activity is good for your health," lead author José María Huerta of the Murcia Regional Health Authority in Spain told Reuters Health.
Past studies have also linked physical activity to fewer strokes, which can be caused by built-up plaque in arteries or ruptured blood vessels in the brain.
While the current study cannot prove that regular walking caused fewer strokes to occur in the women who participated, it contributes to a small body of evidence for potential relationships between specific kinds of exercise and risk for specific diseases.
Women who walked briskly for 210 minutes or more per week had a lower stroke risk than inactive women but also lower than those who cycled and did other higher-intensity workouts for a shorter amount of time.
In all, nearly 33,000 men and women answered a physical activity questionnaire given once in the mid-1990s as part of a larger European cancer project. For their study, Huerta and his team divided participants by gender, exercise type and total time spent exercising each week.
The authors, who published their findings in the journal Stroke, checked in with participants periodically to record any strokes. During the 12-year follow-up period, a total of 442 strokes occurred among the men and women.
The results for women who were regular walkers translated to a 43 percent reduction in stroke risk compared to the inactive group, Huerta said.
There was no reduction seen for men based on exercise type or frequency, however.
"We have no clear explanation for this," Huerta wrote in an email. He hypothesized that the men may have entered the study in better physical condition than the women, but there was no evidence to support that guess.
Huerta also declined to compare the study participants' risk levels to those of the general population, citing the subjects' unusual characteristics: a majority of men and women in the study were blood donors, who tend to be in good health in order to give blood.
"I wouldn't make much of the results because they are for a very specific population," Dr. Wilson Cueva of the University of Chicago in Illinois said.
Cueva, who was not involved with the research, pointed out that the study relied too heavily on subjective measurements, like the participants' memory of exercise routines.
"There is no objective way to measure how much exercise they actually did," he said.
Each year in the U.S., about 795,000 people suffer a stroke, according to the American Heart Association. Put another way, one American has a stroke every 40 seconds and dies from one every four minutes.
Despite a recent dip in strokes attributed to better blood pressure control and anti-smoking campaigns, the World Health Organization (WHO) predicts that stroke cases will increase as the global population continues to grow older.
Guidelines set by the WHO and U.S. Centers for Disease Control and Prevention recommend at least 150 minutes - or two-and-a-half hours - of moderate exercise such as brisk walking each week.
Cueva urged health consumers to heed those guidelines for now. The way the Spanish study was designed, it's difficult to draw any conclusions he told Reuters Health. But, "We know that exercise is related to reduced risk of stroke and other diseases."
Source : Reuters
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Soft drink intake in relation to incident ischemic heart disease, stroke, and stroke subtypes in Japanese men and women: the Japan Public Health Centre–based study cohort I
- Ehab S Eshak,
- Hiroyasu Iso,
- Yoshihiro Kokubo,
- Isao Saito,
- Kazumasa Yamagishi,
- Manami Inoue, and
- Shoichiro Tsugane
Abstract
Background: Soft drink intake has been associated with obesity and diabetes, but its relation with risk of cardiovascular disease (CVD) is limited.
Objective: We examined the association between soft drink intake and risk of CVD in a Japanese population.
Design: This was a prospective study in 39,786 Japanese men and women aged 40–59 y in which soft drink intake was determined by using a self-administered food-frequency questionnaire. Follow-up was from 1990 to 2008. HRs and 95% CIs of incidence were calculated according to categories of soft drink intake.
Results: During 18 y of follow-up, we ascertained 453 incident cases of ischemic heart disease (IHD) and 1922 cases of stroke, including 859 hemorrhagic and 1047 ischemic strokes. Soft drink intake was positively associated with risk of total stroke and more specifically ischemic stroke for women; the multivariable HR (95% CI) in the highest soft drink intake (almost every day) category compared with the lowest intake (never or rarely) category was 1.21 (0.88, 1.68; P-trend = 0.02) for total stroke and 1.83 (1.22, 2.75; P-trend = 0.001) for ischemic stroke. That association did not change significantly after the exclusion of early incident cases within 3–9 y from baseline. A nonsignificant inverse trend for risks of total and ischemic strokes was shown for men, and it was weakened after the exclusion of early incident cases or after the exclusion of participants with baseline comorbidities. Soft drink intake was not associated with risk of IHD or hemorrhagic stroke for either sex.
Conclusion: Soft drink intake is associated with higher risk of ischemic stroke for women.
Source : The American Journal of Clinical Nutrition
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Chocolate: A Sweet Method for Stroke Prevention in Men?
Eating a moderate amount of chocolate each week may be associated with a lower risk of stroke in men, according to a new study published in the August 29, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“While other studies have looked at how chocolate may help cardiovascular health, this is the first of its kind study to find that chocolate, may be beneficial for reducing stroke in men,” said study author Susanna C. Larsson, PhD, with the Karolinska Institute in Stockholm, Sweden. For the study, 37,103 Swedish men ages 49 to 75 were given a food questionnaire that assessed how often they consumed various foods and drinks and were asked how often they had chocolate. Researchers then identified stroke cases through a hospital discharge registry. Over 10 years, there were 1,995 cases of first stroke.
Men in the study who ate the largest amount of chocolate, about one-third of a cup of chocolate chips (63 grams) per week, had a lower risk of stroke compared to those who did not consume any chocolate. Those eating the highest amount of chocolate had a 17-percent lower risk of stroke, or 12 fewer strokes per 100,000 person-years compared to those who ate no chocolate. Person-years is the total number of years that each participant was under observation.
In a larger analysis of five studies that included 4,260 stroke cases, the risk of stroke for individuals in the highest category of chocolate consumption was 19 percent lower compared to non-chocolate consumers. For every increase in chocolate consumption of 50 grams per week, or about a quarter cup of chocolate chips, the risk of stroke decreased by about 14 percent.
“The beneficial effect of chocolate consumption on stroke may be related to the flavonoids in chocolate. Flavonoids appear to be protective against cardiovascular disease through antioxidant, anti-clotting and anti-inflammatory properties. It’s also possible that flavonoids in chocolate may decrease blood concentrations of bad cholesterol and reduce blood pressure,” said Larsson.
“Interestingly, dark chocolate has previously been associated with heart health benefits, but about 90 percent of the chocolate intake in Sweden, including what was consumed during our study, is milk chocolate,” Larsson added.
Source : Newswise
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Yoga May Help Stroke Survivors Improve Balance
Group yoga can improve balance in stroke survivors who no longer receive rehabilitative care, according to new research in the American Heart Association journal Stroke.
In a small pilot study, researchers tested the potential benefits of yoga among chronic stroke survivors -- those whose stroke occurred more than six months earlier.
"For people with chronic stroke, something like yoga in a group environment is cost effective and appears to improve motor function and balance," said Arlene Schmid, Ph.D., O.T.R., lead researcher and a rehabilitation research scientist at Roudebush Veterans Administration-Medical Center and Indiana University, Department of Occupational Therapy in Indianapolis, Ind.
The study's 47 participants, about three-quarters of them male veterans, were divided into three groups: twice-weekly group yoga for eight weeks; a "yoga-plus" group, which met twice weekly and had a relaxation recording to use at least three times a week; and a usual medical care group that did no rehabilitation.
The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation, and meditation. Classes grew more challenging each week.
Compared with patients in the usual-care group, those who completed yoga or yoga-plus significantly improved their balance.
Balance problems frequently last long after a person suffers a stroke, and are related to greater disability and a higher risk of falls, researchers said.
Furthermore, survivors in the yoga groups had improved scores for independence and quality of life and were less afraid of falling.
"For chronic stroke patients, even if they remain disabled, natural recovery and acute rehabilitation therapy typically ends after six months, or maybe a year," said Schmid, who is also an assistant professor of occupational therapy at Indiana University-Purdue University in Indianapolis and an investigator at the Regenstrief Institute.
Improvements after the six-month window can take longer to occur, she said, "but we know for a fact that the brain still can change. The problem is the healthcare system is not necessarily willing to pay for that change. The study demonstrated that with some assistance, even chronic stroke patients with significant paralysis on one side can manage to do modified yoga poses."
The oldest patient in the study was in his 90s. All participants had to be able to stand on their own at the study's outset.
Yoga may be more therapeutic than traditional exercise because the combination of postures, breathing and meditation may produce different effects than simple exercise, researchers said.
"However, stroke patients looking for such help might have a hard time finding qualified yoga therapists to work with," Schmid said. "Some occupational and physical therapists are integrating yoga into their practice, even though there's scant evidence at this point to support its effectiveness."
Researchers can draw only limited conclusions from the study because of its small number of participants and lack of diversity. The study also didn't have enough participants to uncover differences between the yoga and control groups. The scientists hope to conduct a larger study soon.
Researchers also noticed improvements in the mindset of patients about their disability. The participants talked about walking through a grocery store instead of using an assistive scooter, being able to take a shower and feeling inspired to visit friends.
"It has to do with the confidence of being more mobile," Schmid said. Although they took time to unfold, "these were very meaningful changes in life for people."
Source : Science Daily
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An Orange a Day Keeps Stroke Away.
A compound found in oranges, grapefruit, and other citrus fruit may modestly reduce stroke risk among women, an observational study determined.
Women with the highest levels of flavanone in their diet were 19% less likely to have an ischemic stroke during 14 years of follow-up than those with the least flavanone intake (P=0.04), Aedín Cassidy, PhD, of the University of East Anglia in Norwich, England, and colleagues found.
As the main source of these antioxidants, citrus fruit and juice showed a similar trend (relative risk 0.90, 95% CI 0.77 to 1.05), they reported in the April issue of Stroke: Journal of the American Heart Association.
Vitamin C has gotten most of the praise for the protective effect of citrus found in prior stroke studies, but in Cassidy's analysis of the Nurses' Health Study, the vitamin didn't correlate with total or ischemic stroke or attenuate the link to flavanones.
Most of the flavanones consumed by women in the study came from orange and grapefruit juice (63%). But eating the whole fruit would likely be a better way to boost intake, the researchers suggested.
"Given the higher flavanone content of citrus fruits and the sugar content of commercial fruit juices, public health recommendations should focus on increasing citrus fruit intake," they recommended in the paper.
Flavanones are one of six types of commonly consumed flavonoids, which various studies have linked individually to different benefits -- hypertension risk reduction with anthocyanins, lower stroke risk in some studies of flavonols -- but never looked at all simultaneously.
Cassidy's group broke down food frequency data from nearly 70,000 women participating in the Nurses' Health Study for total flavonoid intake and for each component.
With dietary reports every four years over a total 14 years of follow-up, the researchers found big variations in total flavonoid intake, ranging from an average 761 mg per day in the top quintile to 97 mg per day in the bottom quintile.
Tea was the biggest contributor to those levels, followed by apples and oranges or orange juice.
However, total flavonoid intake didn't predict ischemic stroke risk in the multivariate-adjusted model (P=0.36 for trend).
These results suggested "that flavanones may be another important cardioprotective constituent of citrus fruits," Cassidy's group wrote. "However, in a population-based study like ours, it is impossible to disentangle the relative influence of all the constituents of citrus fruits."
An impact from flavanones is plausible, they noted, pointing to experimental evidence that two flavanones, naringenin and hesperetin, act on neuroprotective pathways with effects on nitric oxide release. Naringenin was the strongest anti-inflammatory of all the flavonoids tested in one study.
A trend appeared for the flavones at the highest intake level of more than 3 mg per day compared with the lowest at less than 1 mg per day, but the difference wasn't statistically significant (adjusted relative risk 0.88, 95% CI 0.72 to 1.08).
The same was true for anthocyanins (blueberries were the main source) and flavan-3-ols (predominantly consumed from tea).
None of the compounds impacted hemorrhagic stroke risk.
Individual flavonoids are likely to differ in benefits because of different mechanisms through their specific structural characteristics, the researchers noted.
They cautioned that residual or unmeasured confounding was possible despite the detailed adjustment used in the study.
Another limitation is that the actual flavonoid content in foods consumed may have differed from levels recorded because of wide variability based on where the food was grown and during what season and how it was cultivated and processed.
Randomized trials are needed to test flavanone and citrus foods for reduction of ischemic stroke risk, the group concluded.
Source : Medpage Today
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Simple Tests May Flag Dementia, Stroke Risk
Walking speed and hand-grip strength during middle age correlated with cognitive function and stroke risk in older adults, suggesting simple tests might aid diagnosis of the two conditions, according to data from a large cohort study.
During 11 years of follow-up, slower walking speed at baseline was associated with a 50% rise in the hazard for dementia. Brain volume and performance on a variety of tests of cognitive function also were significantly lower in slower walkers.
Grip strength did not influence stroke risk in the overall cohort, but a higher baseline grip strength was associated with a 42% reduction in stroke risk among individuals 65 and older, as will be reported here in April at the American Academy of Neurology meeting.
"These are basic office tests [that] can provide insight into the risk of dementia and stroke and can be easily performed by a neurologist or general practitioner," Erica C. Camargo, MD, PhD, of Boston Medical Center, said in a statement.
"While frailty and lower physical performance in elderly people have been associated with an increased risk of dementia, we weren't sure until now how it impacted people of middle age," she added.
The findings came from an analysis of data from the Framingham Offspring Cohort, children of the original participants in the long-running study of the natural history of cardiovascular disease.
Camargo and colleagues analyzed data for 2,410 participants in the offspring cohort study, mean age 62, all of whom were stroke- and dementia-free at baseline. The initial workup included assessments of walking speed, grip strength, and cognitive function, as well as MRI scans of the brain.
The investigators statistically related age-standardized grip strength and walking speed with baseline cerebral volume estimated by MRI, with age- and education-standardized cognitive function and with stroke and dementia incidence.
During follow-up, 34 participants developed dementia, and 79 had strokes or transient ischemic attacks (TIAs). Slower walking speed had a significant correlation with:
- Increased stroke risk (HR 1.50, P=0.020)
- Lower total cerebral volume (P=0.007)
- Poorer performance on tests of various aspects of memory (visual reproduction, P=0.009; paired associate learning, P<0.001; executive function, P=0.004; visuo-perceptual function, P=0.002; and language, P=0.006)
Increasing grip strength also was associated with:
- Total cerebral brain volume (P<0.001)
- Visual reproduction (P<0.001)
- Executive function (P=0.009)
- Visuo-perceptional function (P<0.001)
- Language (P=0.002)
- Better abstraction (P=0.009)
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Anti-inflammatory effects of Chinese medicinal herbs on cerebral ischemia
Shan-Yu Su1, Ching-Liang Hsieh 1, 2, 3 *
1 Department of Chinese Medicine, China Medical University Hospital, Taichung
40447, Taiwan
2 Graduate Institute of Acupuncture Science, China Medical University, Taichung
40402, Taiwan
3 Acupuncture Research Center, China Medical University, Taichung, 40402, Taiwan
Abstracts
Recent studies have demonstrated the importance of anti-inflammation, including cellular immunity, inflammatory mediators, reactive oxygen species, nitric oxide and several transcriptional factors, in the treatment of cerebral ischemia. This article reviews the roles of Chinese medicinal herbs as well as their ingredients in the inflammatory cascade induced by cerebral ischemia. Chinese medicinal herbs exert neuroprotective effects on cerebral ischemia. The effects include inhibiting the activation of microglia, decreasing levels of adhesion molecules such as intracellular adhesion molecule-1, attenuating expression of pro-inflammatory cytokines such as
interleukin-1β and tumor necrosis factor-α, reducing inducible nitric oxide synthase and reactive oxygen species, and regulating transcription factors such as nuclear factor-κB.
Conclusion
Many Chinese medicinal herbs that act on the inflammation process were used to treat ischemia stroke. These herbs suppress inflammatory cascades in cellular immunity, adhesion molecules, cytokines, arachidonic acid, metabolites, NO, ROS, and
transcriptional factors. In the future, more clinical trials should be down to Chinese herbs that have been demonstrated effective in animal studies but not been proven in human.
Source : Chinese Medicine 2011, 6:26 doi:10.1186/1749-8546-6-26
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