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Fewer Painful Procedures Could Help Preemies’ Brain Development: Study | Health News

By Steven Reinberg, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 21, 2020 (HealthDay News) — Giving fewer needle sticks to premature newborns in the intensive care unit may improve growth of a key brain area, a new study suggests.

The thalamus relays sensory data from the body to the rest of the brain, where it registers as pain, touch or temperature.

For the study, researchers compared 86 premature infants who had a catheter placed in their central veins and central or peripheral arteries for more than two weeks with 57 infants who had a catheter for less time. The catheters act as portals for blood draws, nutrition and medication, reducing the need for individual needle pokes.

Infants who had central lines for longer periods had fewer needle sticks and fewer painful procedures. Those babies also had a bigger thalamus. Studies have shown that the volume of the thalamus may be linked with early childhood brain development.

“Babies born very prematurely are exposed to multiple unpleasant and painful yet necessary procedures every day,” said study author Emma Duerden, who conducted the study while at The Hospital for Sick Children in Toronto, Canada.

Placing central lines to deliver care and monitor babies’ progress dramatically reduces the number of painful needle sticks. But, Duerden said, some clinicians avoid these catheters for longer periods due to infection concerns.

“Our research not only found that prolonged use of central arterial and venous lines was associated with larger thalamus volumes, it also found that prolonged use was not associated with a greater number of infections,” Duerden said in a news release from the American Academy of Neurology.

A few weeks after birth, babies had brain scans to measure the size of their thalamus. Then, they were followed up at an average age of 5 years.

Those with a larger thalamus in infancy did better on tests of thinking and memory than those whose thalamus was smaller, the study found.

“Babies born prematurely can have numerous health struggles, so if clinicians can reduce their pain during the first few weeks after they are born, this could possibly lead to improved brain development over time, with a potential to have a huge impact on their lives,” Duerden said.

While the study shows an association between pain reduction and brain development, it doesn’t prove cause and effect, so more research is needed, she said.

The report was published online Oct. 21 in the journal Neurology.

Copyright © 2020 HealthDay. All rights reserved.

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medicine

Keck Medicine of USC enrolling individuals in phase 3 clinical trial to treat mild Alzheimer’s disease using deep brain stimulation

IMAGE

IMAGE: Darrin Lee, MD, PhD, a neurosurgeon with Keck Medicine of USC and the principal investigator of the site’s clinical trial
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Credit: Image courtesy of Ricardo Carrasco III of Keck Medicine of USC

LOS ANGELES — An estimated 5.5 million people in the United States live with Alzheimer’s disease, which is the most common form of dementia.

Keck Medicine of USC is enrolling individuals in an international phase 3 clinical trial to examine the safety and effectiveness of deep brain stimulation to treat Alzheimer’s. The study uses electrical impulses to stimulate the region of the brain known as the fornix, which is associated with memory and learning.

“Deep brain stimulation has successfully treated conditions such as Parkinson’s disease by improving motor skills, and we are now investigating if this therapy can stabilize or improve cognitive function,” says Darrin Lee, MD, PhD, a neurosurgeon with Keck Medicine of USC and the site’s principal investigator of the study. “Based on the results of earlier phases of this clinical trial, the treatment offers a potential benefit for patients with mild Alzheimer’s.”

This randomized, double-blind study will last four years. Subjects will first take a standardized assessment test for Alzheimer’s to be used as a baseline measure of cognitive ability throughout the study.

Next, researchers will implant electrodes into subjects’ brains that connect to a battery pack, similar to a heart pacemaker, placed underneath the collarbone.

For the first year of the study, subjects will be given either low-frequency stimulation to the brain, high-frequency stimulation or a placebo — no stimulation.

“For those with Alzheimer’s disease, certain parts of the brain become atrophied,” Lee says. “We are testing to see if stimulating the brain’s fornix can reawaken brain activity in this area and stop the progression of the disease.”

During the first year, subjects will be given subsequent cognitive tests to check if their memory or learning skills have held steady or improved. At the end of the year, study researchers will examine data to determine which level of stimulation had the most impact on these skills.

For the next three years of the trial, all subjects in the study will receive what researchers have determined is the optimal frequency of deep brain stimulation, even those originally receiving the placebo. Patients will continue to be given cognitive assessments throughout the four-year period.

To qualify for the trial, patients must be 65 or older, have been diagnosed with mild Alzheimer’s and take Alzheimer’s medication, and have a caregiver or family member who can accompany them to doctor visits.

The clinical trial involves approximately 200 patients at some 20 sites in the United States, Canada and Germany. Keck Medicine plans to enroll 8-15 patients.

The trial is sponsored by Functional Neuromodulation, Inc.

Those interested in enrolling in the clinical trial with Keck Medicine can contact Amanda Romano at amanda.romano@med.usc.edu or 213-393-5640.

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Keck Medicine co-investigators of the trial include psychiatrist Carlos Manuel Figueroa, MD, and neurologist Elizabeth Joe, MD.

Deep brain stimulation has been

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fitness

Give your brain the ultimate workout with this science-backed cognitive-fitness app

 

The Hill may be compensated and/or receive an affiliate commission if you buy through our links.

Brain training exercises are hardly new—you’ve likely been finding ways to bolster your cognitive skills your whole life without realizing it, whether through crossword puzzles, Sudoku, or card games. What is relatively new, however, is having the ability to play scientifically-backed brain training games directly on your cellphone.

Among some of the most popular digital brain training solutions is CogniFit, an app that provides engaging content users can access on their iPhones, tablets, Android devices, or computers. CogniFit is recognized as a global leader in the Cognitive Assessment and Training Market, boasting games, puzzles, assessments, and teasers that are backed by scientific patented technology. The goal of these short, personalized activities is to improve several cognitive functions, including perception, concentration, memory, and hand-eye coordination, as well as improve your brain plasticity. 

More than that, the app will measure, train, and monitor your cognitive skills with each of these programs. And along the way, users will receive real-time feedback that will help them track their performance and compare these results to a cohort of their peers. 

Currently, CogniFit has a solid 4.4-star rating on both the App Store and Google Play Store from thousands of users. As one current subscriber notes, CogniFit offers a variety of “Fun games to keep you spry in the mind! It really does challenge you to focus…” 

If you are looking to upgrade your current brain exercises from the Sunday crossword puzzle to a personalized brain teaser designed for your age group and skillsets, maybe it is time you try out CogniFit, too. Currently, a one-year subscription is 58% off, making it just $49.99. 

Prices subject to change.

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health

Sentinel Uptake Wildly Variable, Brain Benefit Hazy

Use of the Sentinel (Boston Scientific) embolic protection device is highly variable and its ability to limit cerebral injury modest at best, a TVT Registry study suggests.

The primary analysis, using an instrumental variable approach, showed no significant reduction in in-hospital or 30-day stroke with the device among more than 120,000 transcatheter aortic valve replacements (TAVRs) performed in the United States since its approval.

“Nevertheless, the secondary propensity-weighted analysis and the confidence interval for the primary analysis are consistent with a possible modest relative risk reduction in stroke of about 20% and a number-needed-to-treat of about 300 to prevent one stroke,” David J. Cohen, MD, University of Missouri Kansas City School of Medicine.

“These findings support clinical equipoise and provide a strong rationale for ongoing large-scale randomized trials to test whether embolic protection devices provide meaningful clinical benefit,” he said during a late-breaking trial session at TCT Connect, the virtual meeting of Transcatheter Cardiovascular Therapeutics (TCT) 2020.

Stroke continues to occur in 2% to 5% of patients undergoing TAVR, however, embolic protection devices (EPDs) have only been tested in small randomized trials using primary imaging endpoints, Cohen observed. “Thus, there remains considerable uncertainty regarding the clinical benefits associated with these devices.”

The study included 123,186 elective or urgent transfemoral TAVR procedures between January 2018 and December 2019 in the Society of Thoracic Surgeons/American College of Cardiology TVT Registry. Of these, 12,409 were performed with an EPD and 110,777 were not. Sites performing less than 20 TAVRs/year and emergent, alternative access, or concurrent mitral/TAVR procedures were excluded.

The proportion of hospitals using EPD rose steadily from 7% in the first quarter of 2018 to 28% in the fourth quarter of 2019. The proportion of patients receiving the device increased from 5% to 13% over the same period.

Usage varied widely, with 66% of hospitals never using an EPD over the study period and only 5% using it more than 50% of the time, Cohen observed. “By Q4 2019, this had increased to 8% but was still an extreme minority of hospitals in the United States.”

In the instrumental variable analysis, the adjusted rate of the primary endpoint of in-hospital stroke was in 1.39% in patients treated with EPD and 1.54% in those with no EPD (relative risk [RR], 0.90; 95% CI, 0.68 – 1.13; P = .41).

Rates were also similar for in-hospital death or stroke (2.4% vs 2.6%), major bleeding (4.0% vs 4.4%), device success (97% vs 97.2%), 30-day stroke (2.0% vs 2.1%), and 30-day mortality (1.9% vs 2.2%).

In the propensity-weighted analysis, which accounted for 30 demographic, clinical, and hospital-level characteristics, however, in-hospital stroke occurred in 1.30% of patients with EPD and 1.58% without (RR, 0.82; 95% CI, 0.69 – 0.97; P = .02).

Significant differences were also observed in in-hospital death or stroke (2.1% vs 2.5%) and 30-day stroke (1.9% vs 2.2%) as well as mortality (1.7% vs 2.2%).

Accounting for Patient/Site Differences

EPD was more likely to be used in patients with bicuspid valves (6.8%), and less

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health

Prehospital Plasma Boosts Survival in Traumatic Brain Injury

Prehospital plasma, administered soon after injury, appears to improve survival for patients with traumatic brain injury (TBI), results of a new analysis suggest.

Administration of prehospital plasma demonstrated a strong survival benefit and was associated with a 45% lower risk for mortality in TBI patients, Danielle S. Gruen, PhD, and colleagues write in their report, published online October 15 in JAMA Network Open.

The finding is from a post hoc secondary analysis of a prespecified subgroup from the Prehospital Air Medical Plasma (PAMPer) randomized clinical trial, published in 2018 in The New England Journal of Medicine.

PAMPer studied the safety and efficacy of prehospital administration of thawed plasma in injured patients at risk for hemorrhagic shock. It included 501 patients; 230 received prehospital plasma, and 271 received standard-care resuscitation that did not include prehospital plasma administration.

Results showed that mortality at 30 days, the trial’s primary endpoint, was significantly lower in the plasma group than in the standard-care group (23.2% vs 33.0%; P = .03).

The current analysis explored the association between prehospital plasma resuscitation and survival in a subgroup of 166 patients with TBI. Of these, 74 patients received prehospital plasma, and 92 received standard care.



Dr Jason Sperry

“If you give prehospital plasma to injured patients, there is a survival benefit, as PAMPer showed, and the current study demonstrates that the signal is strongest in patients who have traumatic brain injury,” senior author Jason L. Sperry, MD, MPH, professor of surgery and critical care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, told Medscape Medical News.

“We think that giving plasma as soon as possible improves survival via several mechanisms,” he said. “These include volume expansion to restore perfusion, an alteration in the inflammatory response, a reduction in endothelial injury, and the prevention or mitigation of coagulopathy.”

The median age of the patients with TBI was 43 years (range, 25 – 60 years). Brain injury was shown on CT imaging. Most patients with TBI were men (n = 125, 75.3%), and all had blunt trauma injuries. The median Injury Severity Score was 29 (interquartile range [IQR], 22 – 38).

Patients with TBI were more severely injured than those without TBI, and the incidence of prehospital intubation was higher for those patients. In addition, they were more likely to receive in-hospital vasopressors, the length of stay in the intensive care unit was longer, they spent more days on mechanical ventilation, and 24-hour mortality rates (P = .001) and 30-day mortality rates (P = < .001) were higher.

Except for the plasma intervention, there were no significant differences in fluid administration during transport to the hospital. However, in-hospital transfusion requirements differed between the two groups. Patients with TBI who were treated with prehospital plasma received less crystalloid fluid, vasopressors, and packed red blood cells in the first 24 hours.

In addition, for patients with TBI who received prehospital plasma, international normalized ratios were lower (median, 1.20 [IQR, 1.10 – 1.40] vs 1.40 [IQR 1.20 – 1.80]).

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