High intensity Walking Exercise Program Enhances Stroke Recovery, suggests study

A progressively higher-intensity walking exercise program, combined with standard physical therapy, significantly improved the quality of life and mobility in stroke survivors,  according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. 

Regaining walking ability is an important part of stroke recovery. The 2016 American Stroke Association Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Health Care Professionals recommends that stroke survivors who can participate in three hours of therapy five days a week and who are medically stable should receive care from an inpatient rehabilitation facility.

“Although guidelines recommend structured, progressive exercise after stroke, the uptake of these approaches that have sufficient intensity for rehab programs is still lagging,” said study coauthor Janice Eng, Ph.D., a stroke rehabilitation specialist and a professor in the department of physical therapy at the University of British Columbia in Canada. “Structured and progressively more challenging exercise, aided by wearable devices to provide feedback on intensity, can help people maintain safe intensity levels that are crucial for neuroplasticity — which is the brain’s ability to heal and adapt. The first couple of months after a stroke are when the brain has the greatest ability to change. Our study shows positive results during the initial rehabilitation stage.”

In the study conducted at 12 stroke units across Canada, 306 people were admitted to stroke rehabilitation on average of one month of experiencing anischemic (clot-caused) or hemorrhagic (bleeding) stroke. They were asked to walk for six minutes. At this point, people could walk an average of 152 meters (498 feet — almost the distance of two average city blocks).

Researchers then conducted a blinded trial in which participants were randomized to standard-of-care physical therapy or a new protocol. Based on the participants’ starting point, the protocol objective is a minimum of 30 minutes of daily weight-bearing and walking activities that increase in intensity over time. Participants wore an activity-tracking watch that measured heart rate and number of steps while they walked, which gauged intensity. The new protocol goal was to achieve 2,000 steps with the heart exercising at a moderate intensity for 30 minutes during physical therapy sessions five days a week.

All clinical sites started in the control phase, with 162 participants receiving usual care only and 144 receiving the progressively higher intensity walking intervention. Physical and cognitive abilities, and quality of life were measured at the start of the study and at discharge, about four weeks later. The analysis was adjusted for age, sex and the baseline six-minute walk test time.

The analysis found:

  • The improvement on the six-minute walk test was about 43.6 meters (143 feet) greater in the progressively higher intensity walking group compared to the usual care group.
  • The progressively higher intensity walking group significantly improved quality-of-life measures, balance and mobility and gait speed.

“The major advance for this study was that we trained all front-line therapists in the stroke units at the 12 sites. The therapists completed the safety screening and ensured the participant’s eligibility for this protocol. We wanted to see what would happen if we moved this protocol into standard-of-care practice so all therapists and all participants could follow this protocol. This was a very successful, real-world trial,” Eng said.

“It is very difficult to change practice. The researchers show that it can be done on the inpatient rehabilitation unit, at a critical period after stroke when the brain is most plastic. The protocol increased endurance and further reduced disability after stroke. This is very positive data for stroke recovery,” said Preeti Raghavan, M.D., chair of the American Stroke Association Rehab and Recovery committee and associate professor of physical medicine and rehabilitation in the Johns Hopkins Department of Physical Medicine and Rehabilitation. Raghavan was not involved in this study.

The limitation of the study is that participants had to be able to take five steps, although assistance from one person was allowed. In some cases, people were not included in the trial because they could not walk, even with assistance.

Study details, background or design:

  • There were 306 participants (average age 68; 188 men, 118 women), averaging 29 days since their stroke.
  • Researchers used a new study design called a Step Wedge trial, a randomized, blinded study conducted at 12 stroke units across Canada between 2020 and 2022.
  • Physical therapists implemented the progressively higher-intensity walking protocol over the first four weeks of the participants’ inpatient rehabilitation stay, when the participants had, on average, been in the hospital for one month since their stroke. The six-minute walk test was measured at the start of the trial and four weeks later to determine its effectiveness.
  • All therapists at each stroke unit delivered this protocol to their patients as part of an improved standard of care. The unit was responsible for onboarding new therapists and keeping the protocol in operation.

Reference:

Changing therapy practice to add higher-intensity walking improves early stroke recovery, American Heart Association, Meeting: ASA International Stroke Conference 2025

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Does Radiation Timing Impact Outcomes of Artificial Urinary Sphincter for post-prostatectomy incontinence?

A new study published in the recent issue of journal of Urology revealed the effect of radiation timing on outcomes for patients receiving artificial urinary sphincters (AUS) for post-prostatectomy incontinence. Radiation therapy is often necessary for prostate cancer patients and has been linked to complications such as higher rates of device erosion and infection in AUS recipients. However, whether radiation administered before or after AUS placement makes a difference has been unclear until now.

This study conducted a retrospective review of 315 post-prostatectomy patients treated with AUS over a 5-year period, excluding the individuals undergoing salvage prostatectomy. A total of 181 patients who had undergone radiation were divided into 2 groups where one received radiation before AUS placement (123 patients) and the other received it afterward (16 patients).

The study revealed that the timing of radiation relative to AUS placement did not significantly influence key outcomes such as continence improvement or complication rates. Both groups underwent similar improvements in urinary control. The patients in the pre-AUS group reduced their pad use by an average of 3.0 pads per day, while the post-AUS group saw an average reduction of 3.8 pads per day. This difference was not statistically significant (p=0.379).

Over the median follow-up periods of 15.6 months (pre-AUS) and 27.7 months (post-AUS), complications such as device erosion occurred at rates of 12.2% for the pre-AUS group and 6.6% for the post-AUS group. Device infections occurred only in the pre-AUS group (4.8% of cases).

The need for revision surgeries was comparable between the two groups (25.2% for pre-AUS vs. 18.8% for post-AUS, p=0.761). These results suggest that the timing of radiation has no significant impact on overall outcomes. The patients in both groups showed meaningful improvements in continence with similar rates of complications and surgical revisions.

The slightly lower infection and erosion rates in the post-AUS radiation group, though not statistically significant, may warrant further investigation. Also, younger average age in the post-AUS group highlighted a potential variable to consider in future research. Overall, this study provided strong insights for urologists and patients deciding on the sequencing of radiation therapy and AUS placement. The findings indicate that patients can expect consistent benefits and risks regardless of radiation timing by offering flexibility in treatment planning.

Source:

Bochner, E., Johnson, B., Franzen, B., Hertz, A., Matz, E., Hudak, S., & VanDyke, M. (2025). Artificial urinary sphincter placement before or after radiation therapy: Does timing of radiation impact surgical complications and continence? Urology. https://doi.org/10.1016/j.urology.2025.01.003

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Eating a Mediterranean-style diet improved brain health, reveals research

A preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025 suggests that closely following a Mediterranean diet is associated with better brain health among Hispanic/Latino adults. 

A Mediterranean-style diet typically includes eating plenty of fruits, vegetables, whole grains; beans, nuts and seeds; with olive oil as a primary fat source; and low-to-moderate amounts of dairy products, eggs, fish and poultry.

Researchers noted that the positive impact of the Mediterranean diet on brain health is not entirely influenced by cardiovascular risk factors such as blood pressure, cholesterol levels and blood sugar, nor by behavioral risk factors such as smoking and physical activity, all known to affect brain health.

“We have observed that cardiovascular health directly impacts brain structures; the effect of the Mediterranean diet on communication between regions of the brain remains somewhat independent of cardiovascular health,” said lead researcher Gabriela Trifan, M.D., assistant professor of neurology at the University of Illinois in Chicago. “Even when considering age and cardiovascular health in people who ate a Mediterranean diet, the brain demonstrated improved organization of the fibers connecting different brain regions and enhanced communication, known as white matter integrity.”

“Other studies have shown that adherence to the Mediterranean diet is associated with less brain shrinkage – called atrophy. This is the first large study focused solely on Hispanics/Latinos – who are projected to be the fastest-growing ethnic group in the U.S.,” she said.

Researchers tapped into a multisite, population-based longitudinal study of Hispanic/Latino adults aged 18 to 74 years to explore how to preserve their brain integrity.

Researchers used specialized imaging techniques to investigate the microscopic and the visible changes in the brain. Adherence to Mediterranean diet intake was measured at baseline, and each participant received a score between 0-9, with higher scores indicating higher adherence. The average Mediterranean diet score was 5.01.

After considering other factors that could affect brain health, the analysis found that for each point increase in the Mediterranean diet score:

  • there was an improvement in white matter integrity (organization and communication within the brain); and
  • there was less evidence of structural damage in the brain, as assessed by the white matter hyperintensity burden (an important marker of small vessel brain disease).

“This suggests that even small improvements in diet improved brain integrity,” Trifan said. “It has been suggested that healthy diets, and particularly the Mediterranean diet, improve white matter integrity by reducing inflammation, reducing oxidative stress and through maintaining the health of the brain’s blood vessels’ function and stable blood sugar levels, all important factors for optimal brain health.”

“These results matter because many health care professionals may not know about the eating habits of Hispanic/Latino adults, who consume many foods from the Mediterranean diet. The findings support the American Heart Association’s advice to follow this diet as one of the dietary plans that may help prevent strokes and potentially avoid cognitive issues. The study suggests that the Mediterranean diet can benefit brain health and integrity, specifically concerning white matter. White matter is a crucial part of the brain that connects different areas and networks, helping us to function effectively. However, we still need to learn more about brain health and the Mediterranean diet, as the positive effects were only partly related to vascular risk factors,” said Philip B. Gorelick, M.D., M.P.H., FAHA, immediate past chair of the American Heart Association’s Stroke Brain Health Science Subcommittee and professor of neurology in the Ken & Ruth Davee Department of Neurology at Northwestern University’s Feinberg School of Medicine in Chicago. Gorelick was not involved in the study.

Study background and details:

  • Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary study included approximately 2,800 participants aged 18 to 74 years old, 45% men, 55% women.
  • Participants completed 24-hour dietary recalls of predefined food and nutritional categories at baseline (2008-2011). A second dietary recall was conducted roughly 30 days later. Dietary intake was determined for participants with two dietary recalls by calculating the average of both recall questionnaires to calculate the Mediterranean diet score (range 0-9). The Mediterranean diet was confirmed only at the baseline visit.
  • The magnetic resonance imaging (MRI) acquisition began in 2017 and ended in 2022.
  • Researchers used specialized brain MRI techniques and sequencing called diffusion tensor imaging and fluid-attenuated inversion recovery (FLAIR) to investigate microscopic and visible changes in the brain.
  • Cardiovascular health was assessed using the American Heart Association Life’s Simple 7 score components — exercising regularly, eating a healthy diet, not smoking, avoiding excess weight, and keeping blood pressure, cholesterol and blood sugar levels within a healthy range. Note: In June 2022, the Association updated Life’s Simple 7 to Life’s Essential 8, adding sleep.

Among the study’s strengths are its focus on the largest, diverse group of middle-aged and older Hispanics/Latinos living in the U.S.

The study’s limitations include that many variables were self-reported with possible recall bias. Also, as MRI measurements were collected between 2017 and 2022, individuals may have adopted new dietary and lifestyle habits that may have altered the association documented at baseline.

“Many Mediterranean diet components are already staple Latin foods (beans, corn, tomatoes, peppers, avocado and fish). Our study will help guide Hispanic/Latino individuals toward consuming more of the beneficial dietary components of the Mediterranean diet without significantly altering their already established diet,” Trifan said.

Reference:

Eating a Mediterranean-style diet improved brain health in study of Hispanic/Latino adults, American Heart Association, Meeting: ASA International Stroke Conference 2025.

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AI-Enhanced ECG May Detect Premature Aging and Cognitive Decline: Study

Electrocardiogram (ECG) tests could potentially be used alongside an artificial intelligence (AI) model to detect premature aging and cognitive decline, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. 

Stroke can contribute to age-related cognitive decline, affecting quality of life and functioning. An electrocardiogram (ECG) measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. Researchers designed an AI model, termed deep neural network (DNN), to predict people’s biological age (age of body cells and tissues) from their ECG data.

“Unlike chronological age, which is based on years lived, ECG-age reflects the functional status of the heart and potentially the entire organism at the tissue level, providing insights into aging and health status,” said Bernard Ofosuhene, B.A., lead author of the study and clinical research coordinator in the department of medicine at the UMass Chan Medical School in Worcester, Massachusetts.

Previous research has found that ECG-age can help predict heart disease and death. Before this new study, little was known about ECG-age’s relationship to cognitive impairment.

Researchers analyzed data from more than 63,000 participants in the UK Biobank, a large and ongoing study of more than 500,000 volunteers from the United Kingdom who enrolled when they were between 40 and 69 years old. Participants underwent a battery of cognitive tests. Cognitive performance was analyzed during assessment visits to align with the timing of ECG testing and the artificial intelligence model was used to determine their ECG-age. This approach ensured that the cognitive data accurately captured the participants’ cognitive status at the same time their ECG age was estimated.

Based on the ECG-age results in comparison to their actual ages, participants were divided into three groups: normal aging, accelerated ECG-aging (older than their chronological age), and decelerated ECG-aging (younger than their chronological age).

The analysis found that compared with the normal aging group, based on ECG-age, those:

  • younger than their chronological age group performed better on 6 of 8 cognitive tests.
  • older than their chronological age group performed worse on 6 of 8 cognitive tests.

“There is a lot of ECG-data available for stroke treatment and I encourage health care professionals to use this data to look for signs of cognitive decline. Doing so may help with early diagnosis and timely intervention,” Ofosuhene said.

The study has several limitations. Because the analysis was conducted on people between the ages of 43 and 85 (ages of the UK Biobank subset analyzed), it is unclear whether the findings apply to other ages. This cross-sectional study, with all measures taken at the same time, does not provide information about changes in cognitive function over time. Results from this study on UK Biobank participants may not be generalizable to other populations.

“In future research, we aim to investigate whether gender differences affect the relationship between ECG-age and cognitive performance. Additionally, considering that most of UK Biobank participants are of European ancestry, we are interested in determining if our findings can be replicated in more diverse populations,” Ofosuhene said.

“Researchers increasingly recognize the strong connection between heart and brain health. This study shows that when AI analyzes ECG data, a higher biological age is linked to poorer cognitive performance. Using ECG data to assess cognitive ability seems like a futuristic idea. If this study is validated, it could have several important outcomes. For instance, ECG data collected in a doctor’s office or remotely with wearables could help assess cognition at home or in rural areas lacking neuropsychiatric specialists. Additionally, using ECG data and AI might be quicker and more objective than traditional neuropsychological assessments. However, one important question remains: can ECG data predict future cognitive decline? Answering this could lead to valuable treatments since some ECG issues can be fixed,” said Fernando D. Testai, M.D., Ph.D., FAHA, chair of the October 2024 American Heart Association scientific statement Cardiac Contributions to Brain Health and professor of neurology and rehabilitation at the University of Illinois College of Medicine in Chicago. Testai was not involved in the study.

Study details, background or design:

  • Researchers analyzed 63,800 participants (average age 65, 52% women) from August 2023 to July 2024. Most participants were of white European descent in the UK Biobank, a large and ongoing study of more than 500,000 volunteers in the United Kingdom who enrolled between 2006 and 2010.
  • Biobank participants were excluded from this study if ECG or cognitive data were missing or invalid.
  • There were 15,563 adults in the normal aging group, 24,671 participants in the accelerated aging group and 23,566 people in the decelerated aging group.
  • Eight cognitive tests were analyzed for this study. Some participants in the UK Biobank underwent more testing. Results of the cognitive tests were compared between the three groups after adjusting for chronological age, sex and education level.

Reference:

ECG tests may someday be used by AI model to detect premature aging and cognitive decline, American Heart Association, Meeting: ASA International Stroke Conference 2025

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Study Highlights Lower Uterine Segment Thickness as Key Predictor for Uterine Rupture Risk During TOLAC

Canada: A recent secondary analysis of the PRISMA cluster randomized trial has shed new light on the role of lower uterine segment thickness (LUST) in predicting the risk of uterine rupture during the trial of labor after cesarean (TOLAC). The study, which focused on third-trimester measurements, highlights the potential of LUST as a key indicator for assessing uterine rupture risk, offering valuable insights for obstetric care.

The research published in the American Journal of Obstetrics & Gynecology MFM found that a LUST measurement between 2.0 and 2.4 mm in the third trimester was associated with a low risk of uterine rupture in women attempting TOLAC under specific conditions. However, the study also revealed that women with LUST measurements between 2.5 and 3.0 mm, who did not meet these special conditions had a higher incidence of uterine rupture. 

These findings suggest that the current threshold for safe TOLAC might need to be adjusted, potentially extending the definition to include women with LUST measurements under 3.0 mm.

The study also found that LUST measurements greater than or equal to 3.0 mm, when combined with both vaginal and abdominal ultrasound, were associated with an exceptionally low risk of uterine rupture.

Third-trimester lower uterine segment thickness has been linked to the risk of uterine rupture during trial of labor after cesarean, with threshold values differing depending on the type of ultrasound used—lower values with vaginal ultrasound and higher values with abdominal ultrasound. Given this variability, Emmanuel Bujold, Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada, and colleagues sought to determine the optimal LUST cut-off value by combining both vaginal and abdominal ultrasound measurements to more accurately predict uterine rupture during TOLAC.

For this purpose, the researchers conducted a secondary analysis of the PRISMA cluster randomized trial, which included women with a single previous cesarean who underwent LUST measurement at 34-38 weeks. The thinnest measurement was obtained by combining transvaginal and transabdominal ultrasounds. Participants were categorized into three LUST risk groups: ≥2.5 mm (low risk, TOLAC safe), 2.0-2.4 mm (intermediate risk, TOLAC safe under specific conditions), and <2.0 mm (high risk for uterine rupture).

Delivery outcomes, including uterine rupture, were analyzed using non-parametric methods and receiver operating characteristics (ROC) curves.

The key findings of the study were as follows:

  • Among 3,460 participants, 81% were classified as low-risk, 11% as intermediate-risk, and 8% as high-risk for uterine rupture.
  • Low-risk participants were more likely to attempt TOLAC (49%) and undergo labor induction (16%) compared to intermediate-risk (46% and 12%) and high-risk participants (13% and 3%).
  • Four cases of uterine rupture occurred during TOLAC among 1,382 low-risk participants, but there were no uterine ruptures in intermediate-risk (0/178) or high-risk (0/35) groups.
  • In low-risk participants, uterine rupture was strongly associated with LUST measurements (vaginal + abdominal ultrasound), with an area under the ROC curve of 0.93.
  • All uterine rupture cases occurred in women with a LUST between 2.5 and 3.0 mm (4/371, 1.1%), while no ruptures occurred in those with LUST ≥3.0 mm (0/1,011).

“We emphasize the critical importance of using a combined transabdominal and transvaginal approach for LUST measurement, supported by both extensive literature and the findings of this study,” the researchers wrote.

“A large-scale study utilizing these new parameters could potentially show a reduction in uterine ruptures during TOLAC,” they concluded.

Reference:

Bujold, E., Dubé, E., Girard, M., & Chaillet, N. (2024). Lower uterine segment thickness to predict uterine rupture: A secondary analysis of PRISMA cluster randomized trial. American Journal of Obstetrics & Gynecology MFM, 101543. https://doi.org/10.1016/j.ajogmf.2024.101543

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New Drug Regimens Offer Hope Against Drug-Resistant Tuberculosis: NEJM

Tuberculosis remains one of the deadliest infectious diseases worldwide, with drug-resistant strains posing a significant challenge. In a major breakthrough, an international clinical trial has identified three new safe and effective drug regimens for tuberculosis resistant to rifampin, the most potent first-line antibiotic for TB treatment.

The research, published in the New England Journal of Medicine, was led by Harvard Medical School and members of the endTB project—a global collaboration involving Partners In Health, Médecins Sans Frontières, and Interactive Research and Development, along with researchers and clinicians from academic medical centers worldwide.

The newly identified regimens take advantage of recently discovered drugs to expand the treatment arsenal and give physicians new ways to shorten and personalize treatment, minimize side effects, and treat patients using only pills instead of daily injections. They also offer alternatives in case of drug intolerance, medication shortages or unavailability, or drug resistance, the researchers said.

The endTB trial is one of four recent efforts to use randomized controlled trials to test new, shorter, less toxic regimens for drug-resistant TB. endTB uses two new drugs –bedaquiline and delamanid-which, when brought to market in 2012-2013, were the first new TB medicines developed in nearly 50 years.

To find shorter, injection-free drug combinations for people infected with TB resistant to rifampin, endTB tested five new, all-oral 9-month regimens using the two new drugs in combination with older medications.

A third drug, pretomanid, received emergency authorization from the FDA for specific use within a regimen against highly drug-resistant TB in 2019, after the endTB clinical trial was underway, and is not included in the regimens used in these trials.

Trial regimens were considered effective if they performed at least as well as the control group, which received a well-performing standard of care composed in accordance with a stringent interpretation of World Health Organization (WHO) recommendations.

The three successful new regimens were successful for between 85 and 90 percent of patients, compared with 81 percent success for people in the control group. The control group was treated with longer treatments, which also included the recently discovered medicines.

The trial launched in 2017 and enrolled 754 patients across seven countries: Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa. The goal was to improve treatment for patients with tuberculosis resistant to rifampin. The WHO estimates that some 410,000 people become sick with rifampin-resistant TB each year, including people who have multidrug-resistant TB (MDR-TB). Only 40 percent are diagnosed and treated, 65 percent of them successfully.

The study population included children as well as people infected with HIV or hepatitis C, both common in populations with high rates of TB. In another innovation, women who became pregnant while on treatment were included in the endTB trial. These groups are often excluded from clinical trials. In a special report published in August 2024, the WHO added the three noninferior regimens from the endTB trial to the list of treatment options for rifampin-resistant and multidrug-resistant TB (MDR-TB) treatment; the recommendations extend to these neglected groups as well as to pregnant women.

With recent efforts to end patent exclusivity on bedaquiline, two of the endTB regimens and the WHO-recommended pretomanid-containing regimen can all be purchased for less than $500, an access target set by activists more than 10 years ago, which has only just now been achieved. All of these innovations together mean the new shortened, all-oral regimens are available to more people than ever.

The endTB trial is part of a major transformation in how the world treats tuberculosis, said the trial’s co-principal investigator, Carole Mitnick, professor of global health and social medicine in the Blavatnik Institute at HMS and PIH’s director of research for the endTB project.

“This Harvard-led partnership among NGOs, ministries of health, and other academic partners identified three new regimens that will make lifesaving care dramatically more accessible,” Mitnick said. “We also resolved a critical question left open by pharmaceutical industry trials that brought bedaquiline and delamanid to market: How can these new drugs be used to shorten and simplify treatment while retaining efficacy?”

Until recently, Mitnick said, poor treatment options and low-quality evidence made it difficult to stem the tide of preventable deaths from tuberculosis. For many years, the only approved treatment regimens lasted years and included daily injections and highly toxic medications with often-severe side effects.

Reference:

Lorenzo Guglielmetti, Uzma Khan, Gustavo E. Velásquez, Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis, New England Journal of Medicine, DOI:10.1056/NEJMoa2400327 

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Propranolol May reduce ischemic stroke risk alongside preventing Migraine in women: Study

For patients with migraine, the clinical benefits of propranolol, a beta-blocker medication, may extend beyond just migraine prophylaxis, according to a study to be presented at the American Stroke Association’s International Stroke Conference 2025.

Propranolol, a beta blocker medication used for treating high blood pressure and preventing migraines, had a stronger protective effect for ischemic stroke risk in women with migraine, particularly those without aura. However, the medication did not have the same protective effect on men.

Migraine headaches are common in the general population, but they occur three times more often in women than in men. This debilitating condition is associated with an increased risk of stroke. While the beta blocker propranolol can be used to prevent migraines, its effectiveness in reducing overall stroke risk is still uncertain.

“Migraine is an often-ignored risk factor for cardiovascular issues. Until recently, preventive treatments for people who have migraines were not available,” said lead study author Mulubrhan Mogos, Ph.D., M.Sc., FAHA, an assistant professor at Vanderbilt University School of Nursing in Nashville, Tennessee. “Many women suffer from migraines, and it’s important to note that propranolol may be beneficial for these women, particularly those who experience migraine without aura. This is an important discovery for those dealing with migraines.”

Mogos also noted that migraine disproportionately affects women from historically under-resourced communities, and this disparity may impact the ability to achieve education goals or maintain stable employment, creating a vicious cycle. While new treatments have proven effective, they may not be accessible to women in these groups due to high costs.

For the study, researchers reviewed more than 3 million electronic health records from two large databases. In separate analyses, researchers identified people with migraine who developed stroke and those with migraine who did not develop stroke (control group). They then assessed whether the individuals were treated with propranolol for migraine and whether that treatment had impacted stroke risk.

“We initially looked at overall stroke and then ischemic stroke specifically. We refined our analysis further by controlling for possible confounders and found the association is significant and stronger for ischemic stroke,” Mogos said.

After adjusting for potential variables, such as demographics (age, sex, race), other conditions (high blood pressure, diabetes, etc.) and hormonal factors (use of birth control, pregnancy – considered separately for each woman) that might affect results the analysis found:

  • Propranolol was significantly associated with a reduced risk of ischemic stroke in women with migraine, particularly in those without aura. The risk of developing a stroke was 52% lower for women taking the medication in one database analysis and 39% lower in the other. No stroke risk reduction was seen in men in either analysis group.
  • The protective effect of propranolol was stronger for ischemic stroke and in women with migraine without aura. Migraine aura can include disturbances, such as flashing lights, blind spots, zigzag patterns or seeing colored spots. Other symptoms include tingling or numbness in the face or hands, difficulty speaking, dizziness or confusion.
  • Secondary analyses showed lower overall stroke rates in women taking propranolol at multiple time points in both databases.

“Our findings indicate that women and health care professionals should discuss the advantages of preventive migraine interventions. For under-resourced individuals who bear a greater burden from this condition and may lack access to new treatments, we must ensure these treatments are available to them. This approach can help reduce health disparities,” Mogos said.

“Migraine without aura may often be overlooked as a risk factor for stroke, especially in women, in whom previous literature has demonstrated that migraine is a stronger, more important risk factor compared with men. The study’s findings are not surprising since we have strong evidence that medications similar to propranolol used to treat blood pressure reduce stroke risk substantially. The findings are potentially quite helpful, though, for women living with frequent migraine, as they suggest we have a good medication option that helps to prevent both migraines and strokes. This study is a great example of the important information that can be gained by studying women and men separately – we can take advantage of known sex differences in stroke risk factors and move towards more personalized care,” said Tracy E. Madsen, M.D., Ph.D., chair of the American Heart Association Clinical Cardiology (CLCD)/Stroke Women’s Health Science Committee and associate professor of emergency medicine at The Robert Larner, M.D. College of Medicine at The University of Vermont. Madsen was not involved in the study.

The main limitation is that this was a review of past data using electronic health records, which may introduce biases, such as misclassification errors from reliance on ICD codes (codes used to classify and report health conditions and diseases). These findings highlight the need for studies that look forward in time to confirm these results.

Study details, background or design:

  • Using existing data, the study evaluated the effect of migraine treatments in lowering the risk of stroke. The study used two de-identified electronic health record databases: the Synthetic Derivative (SD) maintained by Vanderbilt University Medical Center (VUMC) and the All of Us Research Program managed by the National Institutes of Health (NIH).
  • The study was conducted at Vanderbilt University School of Nursing and the Department of Biomedical Informatics at Vanderbilt University Medical Center in Nashville.
  • The SD database from Vanderbilt University Medical Center comprises de-identified longitudinal research data of over 3 million people spanning more than 15 years. As of May 2024, the All of Us Research Program has electronic health record data for over 230,000 diverse participants across the United States.
  • The SD database is more region-specific with a relatively similar population, while the All of US database includes a broader, more diverse population representative of various regions of the United States. This could account for some of the differences found.
  • Researchers included men and women with a primary diagnosis of stroke after onset of first migraine. People in the control group had no stroke diagnosis after the first onset of migraine.
  • The analysis looked at the association between propranolol use and stroke risk at four points in time over ten years.

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Vitamin D and keloid scars: A new path to treatment

In an exciting advancement for dermatological science, researchers have uncovered the pivotal role of vitamin D and the enzyme CYP24A1 in the development of keloid scars-an elusive and challenging skin condition marked by high recurrence rates and resistance to conventional treatments. By targeting CYP24A1, the study highlights a novel therapeutic pathway that could mitigate the fibrotic characteristics of keloids, offering a beacon of hope for improved treatment outcomes.

Keloids are fibrotic scars that extend beyond the boundaries of the original wound, often causing physical disfigurement and emotional distress. These scars are driven by an overproduction of extracellular matrix components like type I collagen, linked to an imbalance in tissue repair mechanisms. Current treatments show limited efficacy due to an incomplete understanding of the molecular processes behind keloid formation, leaving patients with few reliable options. Addressing this gap, the study delves deeper into the molecular drivers of keloid pathology, identifying potential targets for more effective interventions.

A study  published in Burns & Trauma has shed light on how inhibiting CYP24A1, an enzyme involved in vitamin D metabolism, affects keloid keratinocytes. Conducted by researchers at the University of Cincinnati, the investigation revealed that suppressing CYP24A1 could reduce the expression of profibrotic genes, offering a fresh perspective on keloid treatment strategies.

The study employed an innovative approach, isolating primary keratinocytes from normal and keloid skin samples. By culturing these cells with and without vitamin D, alongside inhibitors such as ketoconazole and VID400, the researchers assessed their impact on gene expression and cell behavior. Their findings were striking: CYP24A1 was significantly overexpressed in keloid keratinocytes at both mRNA and protein levels. While ketoconazole broadly reduced cell proliferation, VID400 specifically targeted the growth of keloid keratinocytes without affecting migration. Furthermore, both inhibitors effectively suppressed the expression of profibrotic genes, such as periostin and hyaluronan synthase 2. When combined with vitamin D, these inhibitors amplified gene-specific effects, suggesting their potential as adjunct therapies for keloids.

Renowned dermatologist Dr. Dorothy M Supp hailed the research as a milestone in understanding keloid pathology, stating, “The identification of CYP24A1 as a key factor in keloid keratinocytes marks a transformative moment in dermatology. This study provides a deeper understanding of the molecular mechanisms driving keloid formation and opens the door to targeted therapies. By modulating the activity of CYP24A1, we may improve treatment efficacy and address the recurrence challenges that patients face. This innovative work lays the groundwork for a new era in keloid management.”

The implications of these findings extend beyond immediate clinical applications. By spotlighting CYP24A1 as a critical player in keloid pathology, the research signals a shift from reactive treatment strategies to proactive prevention of keloid formation. This new paradigm not only enhances scientific understanding but also promises more precise, effective therapies that could significantly improve the quality of life for those affected by keloids. With this pioneering work, dermatological science takes a bold step forward, offering renewed hope for patients and advancing the quest for tailored, impactful treatments.

Reference:

Jennifer M Hahn, Kelly A Combs, Caitlin M Phillips, Petra M Warner, Uzair A Qazi, Heather M Powell, Dorothy M Supp, CYP24A1 is overexpressed in keloid keratinocytes and its inhibition alters profibrotic gene expression, Burns & Trauma, Volume 13, 2025, tkae063, https://doi.org/10.1093/burnst/tkae063

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Urine-based test detects aggressive prostate cancer

Traditional approaches to prostate cancer screening involve blood tests, MRI, and biopsies.

However, in addition to being uncomfortable, some of these procedures result in overdiagnosis of low-grade cancers.

In a new study, researchers at the University of Michigan Health Rogel Cancer Center have clinically validated a previously developed urine test, which can potentially bypass these invasive procedures among men who are unlikely to benefit.

Prostate cancers are categorized based on their Gleason Grade or Grade Group.

Those with Gleason 3+4=7, or Grade Group 2, or higher are more likely to grow and cause harm in comparison with Gleason 6 or Grade Group 1 prostate cancers, which are considered non-aggressive.

The urine test, called MyProstateScore 2.0, or MPS2, looks at 18 different genes linked to high-grade prostate cancer.

The researchers had previously demonstrated that the test was effective in identifying GG2 or higher cancers, helping patients avoid unnecessary biopsies.

However, in that study, urine samples were obtained after a digital rectal examination.

Its primary benefit is that the test can accurately predict your probability of developing aggressive prostate cancer, putting both the patient and physician at ease.” -Ganesh Palapattu, M.D.

“The process requires the prostate to be compressed, causing the release of cellular debris into a urine sample that the patient provides after the rectal exam,” said Ganesh S. Palapattu, M.D., a professor of urology.

Such an examination may not be practical for many and is associated with some discomfort.

Developing a potential at-home test

In the study, the team modified the urine collection approach so that the MPS2 test could detect markers for prostate cancer, without requiring a prior rectal exam.

Using urine samples from a cohort of 266 men who did not undergo a rectal exam, they found that the test could detect 94% of GG2 or higher cancers and was more sensitive than blood tests.

Further, the team used mathematical models to demonstrate that the use of MPS2 would have avoided up to 53% of unnecessary biopsies.

“These results show that MPS2 has promise as an at-home test,” Palapattu said.

“Its primary benefit is that the test can accurately predict your probability of developing aggressive prostate cancer, putting both the patient and physician at ease.”

MPS2 can also help patients save on healthcare costs since it is significantly cheaper than an MRI.

The team is interested in repeating the study and corroborating their results with a larger, diverse population of men.

They’re also hoping to study the test’s performance in men as a surveillance screen for low-risk prostate cancer.

“MPS2 could potentially improve the health of our patients by avoiding overdiagnosis and overtreatment and allowing us to focus on those who are most likely to have aggressive cancers,” Palapattu said.

Reference:

Tosoian JJ, Zhang Y, Meyers JI, Heaton S, Siddiqui J, Xiao L, Assani KD, Barocas DA, Ross AE, Chopra Z, Herron GC, Edelson JA, Graham NJ, Singhal U, Salami SS, Morgan TM, Palapattu GS, Wei JT, Chinnaiyan AM. Clinical Validation of MyProstateScore 2.0 Testing Using First-Catch, Non-DRE Urine. J Urol. 2025 Jan 21:101097JU0000000000004421. doi: 10.1097/JU.0000000000004421. 

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Cochrane Review Confirms Antidepressants Effectively Treat Generalized Anxiety Disorder

A new Cochrane review confirms that antidepressants effectively reduce symptoms of generalized anxiety disorder (GAD) in clinical trials. However, data on their long-term use remains limited. 

GAD affects millions of people worldwide and is characterized by excessive worry about everyday issues. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are recognized treatments for GAD, recommended by many national bodies including the UK’s National Institute for Health and Care Excellence. However, misconceptions remain among some healthcare professionals and patients who do not realise that ‘antidepressants’ have wider uses beyond depression, while the term also carries stigma for many people.

The review analyzed 37 randomized controlled trials with over 12,000 participants, comparing antidepressants to a placebo. Most trials were primarily conducted in high-income countries, including the United States of America and various European countries, and recruited adults of both sexes. In most cases, there were slightly more female participants (~60%) which reflects the clinical prevalence of GAD.

Results showed that antidepressants were more effective than placebo in reducing anxiety symptoms, with a 41% higher response rate among those taking the medication compared to those taking a placebo. The review found no significant difference in dropout rates between those taking antidepressants and those taking a placebo, indicating that these medications are generally well-tolerated.

“The research shows that antidepressants are highly effective at treating GAD, at least in the specific circumstances seen in trials,” says senior author Dr Giuseppe Guaiana, Associate Professor of Psychiatry at the Schulich School of Medicine & Dentistry, Western University, and Chief of Psychiatry at St Thomas Elgin General Hospital. “For people with Generalized Anxiety Disorder and no other conditions, we have good evidence that antidepressants lead to clinically meaningful improvements over a one- to three-month period compared to placebo.

“We don’t have enough evidence to say how effective they may be in patients with GAD alongside other mental health conditions, which is much more common in clinical practice. Most of the patients I see with GAD also have other mental health conditions, so future trials should investigate the effects of different treatment strategies on patients with multiple conditions.”

The review also highlights the lack of data on the long-term effects of antidepressants. Most included trials lasted between 4 to 12 weeks, with no long-term follow-up.

“We don’t have enough information on the potential long-term benefits and harms of antidepressants, even though people often take them for years,” says first author Katarina Kopcalic, who conducted the review at Western University. “This is an area that needs further exploration in future trials.”

Despite these limitations, the review delivers a clear message: antidepressants are effective for managing GAD, particularly for patients who do not respond well to non-pharmacological treatments. However, more independent, long-term research is needed to understand their full impact, especially in patients with multiple conditions.

Reference:

Katarina Kopcalic, Justin Arcaro, Antonio Pinto, Shehzad Ali, Antidepressants versus placebo for generalised anxiety disorder (GAD), Cochrane Database of Systematic Reviews, https://doi.org/10.1002/14651858.

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