DEAR MAYO CLINIC: A friend from my book club recently had a stroke. I learned that women have a higher risk of strokes. What are the risk factors, and are there signs to watch for that indicate someone is having a stroke? 

ANSWER: A stroke can happen at any time and to anyone. You might be talking to your loved one and notice they're suddenly slurring their words. Or, while grocery shopping, you realize you can't move your hand to pick up a jar from the shelf. You can go from feeling as usual to feeling sick within a matter of seconds to minutes. Here are five key things to know about stroke.

1. Strokes affect the oxygen and nutrients supplied to your brain.

Strokes occur when nutrients and oxygen are not delivered to the brain through blood vessels, leading to the death of brain cells. This lack of delivery can be caused by a clot in a blood vessel obstructing the blood flow to the brain, known as an ischemic stroke, or when a blood vessel ruptures and prevents blood flow to the brain, known as a hemorrhagic stroke.

Sometimes, the obstruction to the blood flow and the resulting symptoms are caused by a temporary clot and are transient, resulting in a transient ischemic attack, or TIA, often called a ministroke.

2. Strokes can happen to anyone.

Strokes can happen to anyone regardless of age, gender or race. Certain risk factors can put you at a higher risk of stroke.

Risk factors are divided into two categories:

• Controllable — the ones you can control or improve
• Uncontrollable — those that are not within your control

Common controllable risk factors include:

• Atrial fibrillation, which increases stroke risk by five times
• Diabetes
• Excessive alcohol intake — an average of more than one drink per day for women or more than two drinks a day for men
• High blood pressure
• High cholesterol
• Obesity
• Obstructive sleep apnea
• Physical inactivity
• Smoking or vaping

Uncontrollable risk factors include:

• Gender
• Heredity
• Increasing age
• Race

3. Be prepared to spot the signs of a stroke.

Learn to recognize the signs of stroke quickly.

The American Stroke Association lists these symptoms to help you know when to seek medical care:

F = Face drooping: Ask the person to smile and see if the smile is uneven.

A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down.

S = Speech difficulty: Ask the person to speak and see if the speech is slurred.

T = Time to call 911: Stroke is an emergency. Call 911 at once. Note the time when any of the symptoms first appear.

Other stroke symptoms to watch for include:

• Numbness of the face, arm or leg, especially on one side of the bod.
• Sudden confusion, trouble speaking or difficulty understanding speech.
• Sudden-onset, severe headache with no known cause.
• Sudden vision issues, such as trouble seeing in one or both eyes.
• Trouble walking, loss of balance, dizziness or coordination.

If you or someone you are with have any strokelike symptoms, seek immediate medical care.

4. A stroke is a medical emergency.

Every second counts when someone is experiencing a stroke. Once a stroke starts, the brain loses around 1.9 million neurons each minute. For every hour without treatment, the brain loses as many neurons as it typically does in nearly 3.6 years of regular aging.

While waiting for paramedics, do these things if possible:

• If the person is conscious, lay them down on their side with their head slightly raised and supported to prevent falls.
• Loosen any restrictive clothing that could cause breathing difficulties.
• If weakness is obvious in any limb, support it and avoid pulling on it when moving the person.
• If the person is unconscious, check their breathing and pulse, and put them on their side.
• If they do not have a pulse or are not breathing, start CPR straight away.

5. Women have an increased risk of stroke.

According to the American Stroke Association, stroke is the third most common cause of death in women. Over 90,000 women die from a stroke in the U.S. each year. Every 1 in 5 women will have a stroke, and about 55,000 more women than men have a stroke each year, with Black women having the highest prevalence of stroke.

The risk of stroke increases in women who smoke, have atrial fibrillation or migraines with aura, take birth control pills, use hormonal replacement therapy, are pregnant, or have preeclampsia.

Talk to your healthcare team about your stroke risk and ways to lower your risk by addressing controllable factors. — Prashant Natteru, M.B.B.S., M.D., Neurology, Mayo Clinic Health System, La Crosse, Wisconsin

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DEAR MAYO CLINIC: My neighbor had a stroke and received a "clot buster" medication. Then, I found out my uncle had a surgery after a stroke. Can you help me understand different kinds of stroke treatments? My neighbor seems almost back to normal, but my uncle is still in rehabilitation because of some paralysis on his left side.

ANSWER: We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time dependent. This is a good opportunity to remind people to seek emergency medical care — call 911 — as soon as possible at the first sign of a stroke.

Treatments also depend on the type of stroke. During an ischemic stroke, blood vessels in the brain are blocked or narrowed. During a hemorrhagic stroke, there's bleeding into the brain.

The first treatment for stroke is to potentially offer a medication called tissue plasminogen activator (TPA) that helps dissolve blood clots. This often is called a clot buster. It has to be given within 4.5 hours from when symptoms began.

These drugs are administered by IV, and they can help dissolve blood clots in the brain and restore blood flow. The faster you're able to restore blood flow, the less likely that the stroke symptoms are permanent. 

Another treatment for stroke is a flexible tube called a catheter that is placed in the blood vessels at the groin. The catheter is navigated up to that clot in the brain using X-ray. A device can be administered to help remove that blood clot. This procedure can help with large clots that can't be dissolved with TPA. This procedure often is performed in combination with TPA that's injected into the bloodstream.

Hemorrhagic stroke is treated by lowering blood pressure to help prevent continued bleeding. So if people are on blood thinners, we use other medications to try to reverse the blood thinner medications. If patients have a coagulopathy, or a tendency to bleed, medication is used to try to reverse that. 

Then there are surgical interventions that potentially help remove that blood in the brain to prevent the downstream swelling that can occur after a brain bleed.

Unfortunately, stroke outcomes are incredibly variable. We'd love to have excellent outcomes for every patient who experiences an acute stroke. But with timeliness of treatment, we are much more likely to have a favorable outcome. 

The goal is to keep people independent after their stroke. So the faster someone arrives to the hospital, the more likely to achieve that outcome. 

Stroke symptoms include trouble speaking and understanding others; numbness or weakness, often on one side of the face, arms or legs; vision problems; a severe headache; and trouble walking. 

We use an acronym you may have heard previously to help people recognize warning signs of a stroke:

FAST

• F = Face drooping: Ask the person to smile. Does one side of the face droop?
• A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down or if one arm is unable to be lifted.
• S = Speech difficulty: Ask the person to speak and see if the speech is slurred.
• T = Time to call 911: Stroke is an emergency.

With any of these signs, call 911 or emergency medical care at once to allow for the treatment of stroke. Note the time when any of the symptoms first appear. — Stephen English Jr., M.D., Neurology, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q and A: Clot buster? Surgery? What is the right treatment for stroke? appeared first on Mayo Clinic News Network.

A 3D animation of the region of the brain called the motor thalamus (shown in red and yellow) where Mayo Clinic researchers detected more precise information about brain cell activity in patients during deep brain stimulation (DBS). DBS electrodes are placed into the motor thalamus to treat movement disorders.

Mayo Clinic researchers have found a new way to more precisely detect and monitor brain cell activity during deep brain stimulation, a common treatment for movement disorders such as Parkinson's disease and tremor. This precision may help doctors adjust electrode placement and stimulation in real time, providing better, more personalized care for patients receiving the surgical procedure.

Deep brain stimulation (DBS) involves implanting electrodes in the brain that emit electrical pulses to alleviate symptoms. The electrodes remain inside the brain connected to a battery implanted near the collarbone and controlled by a remote control. While a neurologist and neurosurgeon monitor the brain waves throughout the surgery, the monitoring typically is limited to a narrow frequency range that provides a rough snapshot of brain activity.

However, Mayo Clinic researchers used more sensitive, research-grade equipment and custom algorithms to record a broader frequency range of brain cell activity that yielded higher resolution and more precise information on when and where brain cells were firing in patients during DBS surgery.

"We looked at brain activity in a different way and recorded a type of brain signal called 'broadband' that reflects the combined activity across all frequencies and is related to the firing of all brain cells in that region. We found that the broadband activity signal increased with movement and was more precise in location than the standard, more narrow frequency signal," says neurologist Bryan Klassen, M.D., lead author of the study published in the Journal of Neurophysiology.

Dr. Klassen and colleagues detected the broadband signal in the motor thalamus, a region deep within the brain that controls movement. Previous studies have detected it only on the surface of the brain.

The researchers recorded broadband signals associated with hand movement in 15 patients undergoing awake DBS. Each of the patients were instructed to open and close their hands while the researchers recorded brain cell activity in their thalamus. 

"This study enhances our understanding of how the thalamus, a brain region that is frequently targeted for deep brain stimulation, processes movement. It may lead to more precise mapping of the brain as well," says Mayo Clinic coauthor Matthew Baker, Ph.D., a postdoctoral fellow in the neurosurgery department.

Using broadband to monitor during DBS surgery may improve the treatment and outcomes for patients.

"These findings underscore the remarkable advances we can achieve through the close collaboration between the neurology and neurosurgery departments and will help us develop the next generation of brain stimulation therapies," says neurosurgeon Kai Miller, M.D., Ph.D., senior author of the study.

The next steps for this research involve further exploring how these brain activity patterns in the thalamus can be used to improve neurostimulation therapy, says Dr. Baker, a recent graduate of Mayo Clinic Graduate School of Biomedical Sciences.

"We will be investigating how this signal responds to different types of movements and whether we can use it to control new devices that only stimulate when patients need it, as opposed to constant stimulation, which is more prone to cause side effects," he says.

Review the study for a complete list of authors, disclosures and funding.

The post Thinking outside the box: Uncovering a novel approach to brainwave monitoring appeared first on Mayo Clinic News Network.

Dizziness, headaches, confusion, fatigue, blurry vision and sensitivity to light are among the most common symptoms of a concussion. Once these symptoms have subsided and patients begin to resume their regular activities, they also may experience often-overlooked, underlying effects of concussion — persistent ringing in their ears, sensitivity to noise and hearing difficulties.

A concussion is a mild form of traumatic brain injury caused by an impact to the head. It can change brain cells, including those associated with hearing. Some of these changes will heal, while others are permanent.

Hearing can be affected in adults and children who have been diagnosed with concussions following common incidents such as a head injury from a fall, vehicle accident or riding a bike without a helmet. Other people, like athletes or military service members, can be affected due to their sports activities or professions.

How a concussion can affect your ears

Tiny hair cells line your inner ears. These hair cells are crucial for changing the energy from the vibrations of your eardrum and middle ear bones into electrical energy that can move through the nerves to the brain for processing.

Think of these tiny hair cells as blades of grass. When you step on the grass, some blades spring back up, while others stay flattened or broken. The hairs in your ears are the same. Those that are damaged by a concussion can't be regrown or repaired, and they can no longer send signals to the brain.

This damage to the hair cells can cause ringing in the ears — known as tinnitus — hearing loss, noise sensitivity and the inability to correctly process sounds, such as speech.

How a concussion can affect sound processing

Tiny nerve cells in the ears detect sounds and pass the signals to the brain, where the sounds are processed. Any injury to the nerve cells can disrupt this process. Those who have experienced a concussion may have difficulty distinguishing words in noisy environments, although their overall hearing may be fine.

Researchers have tested athletes who have had concussions, using a tool called Speech-in-Noise exams. The athlete listened to a simple sentence such as "Sugar is sweet." The phrase was repeated with increasingly loud background noise. Researchers found that the louder the background noise, the less able the athlete was to distinguish the words.

Other tests have revealed that athletes who have had concussions also may be hypersensitive to sounds or have difficulty processing rapidly spoken words.

Don't ignore hearing issues

People of all ages can experience concussions from various activities or as the result of an accident, including:

• Accidental falls
• Basketball
• Bicycling
• Car accidents
• Football
• Hockey
• Inline skating
• Skateboarding
• Soccer
• Volleyball
• Winter sports like skiing and sledding

If your child has experienced a concussion, once their major concussion symptoms have eased it's essential to take note if they comment about dizziness, ringing in their ears or having trouble hearing. Some of these symptoms may improve, while others may be permanent.

Hearing or sound processing issues may also show up as difficulty concentrating or new challenges with schoolwork.

Where to seek help

When seeking help for suspected hearing issues from a concussion, consider consulting an ear, nose and throat (ENT) specialist who can assess ear health and determine if any previous underlying conditions could be contributing to the symptoms.

An audiologist can assist with dizziness and balance issues, test hearing and provide tools and strategies for managing symptoms. In more severe cases, an audiologist may determine if hearing aids are needed and discuss options to address hearing issues.

Katie Dease, Au.D., is an audiologist in Audiology in Owatonna, Minnesota.

This article first published on the Mayo Clinic Health System blog.

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Alzheimer's disease affects nearly seven million Americans over the age of 65, or 1 in 9 people in this age group, according to the Alzheimer's Association. Symptoms such as memory loss, trouble concentrating and performing familiar tasks, and personality changes start slowly and progress. Researchers have come a long way in understanding Alzheimer's disease and Alzheimer's Disease Related Dementias (AD/ADRD). A new consensus study report, "Preventing and Treating Dementia: Research Priorities to Accelerate Progress," identifies prevention and treatment strategies for the next decade.  

"We need cutting-edge treatments to help improve the lives of patients who are suffering from debilitating symptoms of dementia and prevention for those at risk," says Nilüfer Ertekin-Taner, M.D., Ph.D., chair of the Department of Neuroscience at Mayo Clinic and leader of the Genetics of Alzheimer's Disease and Endophenotypes Laboratory at Mayo Clinic's campus in Florida. "Neurodegenerative diseases not only affect patients but also the friends and family who care for them."

Dr. Ertekin-Taner served on the select ad hoc committee of the National Academies of Sciences, Engineering, and Medicine (NASEM) which conducted a study assessing the state of research on AD/ADRD and outlined critical research priorities for treatment and prevention, as well as potential barriers to progress. The National Institutes of Health, National Institute on Aging, and National Institute of Neurological Disorders and Stroke asked NASEM to form the committee in response to a request from the U.S. Congress to accelerate research into these diseases.

Researchers looked broadly at the field, including basic to translational to clinical research; lifestyle interventions aimed at preventing and treating AD/ADRD; barriers to advancing progress in the field; and the most promising areas of research. The study looked at Alzheimer's disease, frontotemporal dementia, Lewy body dementia and other vascular causes of cognitive impairment and dementia.

The report identified 11 research priorities for further NIH-funded biomedical research, including:

• Developing better tools, including novel biomarker tests and digital assessment technologies, to monitor brain health across the life course and to screen, predict and diagnose AD/ADRD at scale.

• Implementing advances in clinical research methods and tools to generate data from real-world clinical practice settings that can inform future research.

• Identifying factors driving AD/ADRD risk in diverse populations, particularly understudied and disproportionately affected groups, to better understand disease heterogeneity — including molecular subtypes and disparities in environmental exposures — and to identify prevention opportunities and advance health research equity.

• Characterizing the exposome and gene-environment interactions across the life course to gain insights into biological mechanisms and identify opportunities to reduce AD/ADRD risk and increase resilience.

• Integrating innovative approaches and novel tools into the planning, design and execution of studies to accelerate the identification of effective interventions.

• Advancing the development and evaluation of combination therapies (including pharmacological and nonpharmacological approaches) to better address the multifactorial nature of AD/ADRD.

• Evaluating precision medicine approaches for the prevention and treatment of AD/ADRD to better identify interventions likely to benefit specific groups of individuals.

The report calls for breaking down silos for more collaborative, multidisciplinary research; fostering inclusive research to eliminate health disparities; developing innovative funding strategies; and increasing innovation in research through the expansion of public-private partnerships, among others.

"The past decade of research investments in AD/ADRD has led to significant progress in our understanding of these diseases, bringing us closer to treatments," Dr. Taner said. "In the next decade, we must maintain the momentum of research and innovation to translate these advances to cures for millions of patients and caregivers affected by the dementia epidemic."

Note: Dr. Ertekin-Taner will participate in a webinar on Jan. 15 with other committee members to discuss the report.

The post Mayo Clinic contributes to national Alzheimer’s disease research priorities in new report appeared first on Mayo Clinic News Network.

Most patients with Alzheimer's disease and Alzheimer's Disease Related Dementias (ADRD) experience the gradual onset and progression of cognitive symptoms, leading to decline over years or decades. However, in a small subset of patients, symptoms begin rapidly, leading to dementia within one year and complete incapacitation within two years of symptom onset. A new study at Mayo Clinic aims to determine why patients with Alzheimer’s disease and ADRD develop this rapidly progressive dementia (RPD).

"The factors that give rise to extreme, rapidly progressive clinical traits are unknown," says Gregg Day, M.D., a neurologist and clinical researcher at Mayo Clinic in Florida. "These cases are challenging to treat in practice because there are many possible causes and diseases to consider, many tests that can be done and a clear need to coordinate evaluations rapidly."

Dr. Day will lead a team of researchers from Mayo Clinic in Florida and Rochester, Minnesota, to study the biology of RPD through a project funded by the National Institute on Aging of the National Institutes of Health (NIA/NIH).

Specifically, the research team and collaborators aim to:

• Determine the factors that make patients with Alzheimer's disease and ADRD susceptible to RPD.
• Study the contributions of amyloid and tau toxic proteins and vascular changes in the brain to rates of progression in patients with Alzheimer's disease and ADRD.
• Identify cellular pathways that contribute to rapid declines in patients with Alzheimer's disease and ADRD.

The researchers plan to collect clinical and genomic information from 120 diverse patients with rapid progressive Alzheimer's disease and ADRD over the next three years. Findings in patients with RPD, identified through Alzheimer's Disease Research Centers studies nationally, will be compared with data from participants with typical progressive Alzheimer's disease and ADRD enrolled in studies at the Alzheimer's Disease Research Center at Mayo Clinic.  

The team hopes to learn how factors such as age, sex, medical history, structural and social determinants of health, genetic variants and other brain changes may make some patients more susceptible to rapid decline. Findings will be validated through expansive protein analyses in cerebrospinal fluid from an independent group of patients with autopsy-confirmed rapid progressive Alzheimer's disease and ADRD. Results will be extended to identify biomarkers and disease-modifying targets that may improve diagnosis and treatment of patients with Alzheimer's disease and ADRD.

"This project represents a substantial investment from NIH to study patients with RPD," says Dr. Day. "We hope the results of our research will inform new approaches, diagnostic tests and treatment targets that will improve outcomes in patients with AD/ADRD. The ultimate goal is to slow down the pathologic progression of disease in these patients, independent of their rate of decline."

The research will combine Mayo Clinic's expertise in digital innovation and telemedicine to engage patients across the United States. This study will also leverage Mayo's Clinical Trials Beyond Walls program, which allows patients to complete some, if not all assessments from the comfort of their own homes or local community facilities. The decentralized clinical trials initiative is designed to remove barriers to clinical trial participation by providing digital solutions and remote services to reimagine the trial experience for all involved, including participants, investigators, study teams and clinical care providers. Decentralized research ― studies conducted outside the walls of traditional research facilities ― may use a wide range of technologies and services such as telehealth, remote monitoring, mobile phlebotomy, retail pharmacy and home healthcare.

Other Mayo Clinic researchers working on this project include:

• Christian Lachner, M.D.
• Neill Graff-Radford, M.D.
• Leonard Petrucelli, M.D., Ph.D.
• Tania Gendron, Ph.D.
• Manoj Jain, M.D.
• Owen Ross, Ph.D.
• Nilufer Ertekin-Taner, M.D., Ph.D.
• Dennis Dickson, Ph.D.
• Melissa Murray, Ph.D.
• Vijay Ramanan, M.D., Ph.D.
• David T. Jones, M.D.
• Prashanthi Vemuri, Ph.D.
• Alicia Algeciras-Schimnich, Ph.D.
• John R. Mills, Ph.D.
• Rickey Carter, Ph.D.
• Lauren Haydu, Ph.D.

The research will be made possible through NIH grant award number R01 AG089380.

Related:

Researchers identify new criteria to detect rapidly progressive dementia

Researchers find other diseases may mimic rare brain disorder linked to dementia

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Growing mini-organs to find new treatments for complex disease

Mayo Clinic investigators are growing three-dimensional human intestines in a dish to track disease and find new cures for complex conditions such as inflammatory bowel disease. These mini-organs function like human intestines, with the ability to process metabolites that convert food into energy on a cellular level and secrete mucus that protects against bacteria. These 3D mini-intestines in a dish, known as "organoids," provide a unique platform for studying the intricacies of the human gut.

"We think this has the potential to revolutionize the way we approach disease research. We hope to save time and resources and avoid the development of therapies that fail upon translation into patients," says Charles Howe, Ph.D., who leads the Translational Neuroimmunology Lab. "Understanding which treatments show potential for success in human organoids could dramatically accelerate the rate of new therapies for patients with unmet needs."

Brain stimulation shows promise in treating drug addiction

Physicians use neurostimulation to treat a variety of human disorders, including Parkinson's disease, tremor, obsessive-compulsive disorder and Tourette syndrome. A Mayo Clinic neurosurgeon and his colleagues believe one form of that treatment, called deep brain stimulation (DBS), is poised to solve one of the most significant public health challenges: drug addiction.

"Drug addiction is a huge, unmet medical need," says Kendall Lee, M.D., Ph.D., who has published nearly 100 journal articles on DBS along with his colleagues. Key to treating it, he says, is cutting off the pleasurable "high" that comes with the addiction — which DBS potentially can do.

A new class of AI aims to improve cancer research and treatments

Mayo Clinic researchers have invented a new class of artificial intelligence (AI) algorithms called hypothesis-driven AI, which is a significant departure from traditional AI models that learn solely from data. The researchers note that this emerging class of AI offers an innovative way to use massive datasets to help discover the complex causes of diseases, such as cancer, and improve treatment strategies.

"This fosters a new era in designing targeted and informed AI algorithms to solve scientific questions, better understand diseases and guide individualized medicine," says co-inventor Hu Li, Ph.D., a Mayo Clinic systems biology and AI researcher. "It has the potential to uncover insights missed by conventional AI."

What's lurking in your body? Mayo probes health risks of tiny plastic particles

Similar to natural elements like iron and copper, people can ingest, absorb, or even inhale microplastics and nanoplastics and their chemical additives. A landmark study published in the New England Journal of Medicine links microplastics and nanoplastics found in plaques of human blood vessels to a potential increased risk of heart attack, stroke or death.

"Plastics have made our lives more convenient and spurred many medical advances, but we must understand their impact on human health for the years to come," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for Mayo Clinic's Center for Individualized Medicine.

Mayo Clinic researchers' new tool links Alzheimer's disease types to rate of cognitive decline

Mayo Clinic researchers have discovered a series of brain changes characterized by unique clinical features and immune cell behaviors using a new corticolimbic index tool for Alzheimer's disease, a leading cause of dementia. The tool categorizes Alzheimer's disease cases into three subtypes according to the location of brain changes and continues the team's prior work, demonstrating how these changes affect people differently. Uncovering the microscopic pathology of the disease can help researchers pinpoint biomarkers that may affect future treatments and patient care.

"Our team found striking demographic and clinical differences among sex, age at symptomatic onset and rate of cognitive decline," says Melissa Murray, Ph.D., a translational neuropathologist at Mayo Clinic.

Mayo scientists explore swabs for early endometrial, ovarian cancer detection

Early detection improves treatment outcomes for endometrial and ovarian cancers, yet far too often, women are diagnosed when in advanced stages of these diseases. Unlike many other cancers, there are no standard screenings for early detection of endometrial and ovarian cancers. Mayo Clinic researchers have uncovered specific microbial signatures linked to endometrial and ovarian cancers, and they are working toward developing innovative home swab tests for women to assess their susceptibility.

"This research not only brings us closer to understanding the microbial dynamics in cancer, but also holds the potential to transform early detection and treatment strategies to positively impact women's health globally," says Marina Walther-Antonio, Ph.D., an assistant professor of surgery leading this research.

Reversing racism's toll on heart health

People who experience chronic exposure to racism may be affected by factors such as intergenerational trauma, reduced access to healthcare, differential treatment in healthcare settings and psychological distress. These negatively affect heart health and can have a cumulative effect throughout a person's life. Researchers from Mayo Clinic and the University of Minnesota published a paper which provides a new framework describing how racism affects heart health among people of color in Minnesota. The researchers are focused on reversing these disparities.

"This framework will help scientists explore and measure how chronic exposure to racism, not race, influences health outcomes," says Sean Phelan, Ph.D., a Mayo Clinic health services researcher. "This will help enable researchers to design interventions that address the root causes of these disparities and improve heart health for people of color everywhere."

Teamwork and research play a key role in Mayo Clinic's first larynx transplant

A team of six surgeons and 20 support staff combined expertise from the Department of Otolaryngology and the Department of Transplantation in an extraordinary 21-hour operation at Mayo Clinic. The team transplanted a donor larynx to a 59-year-old patient with cancer whose damaged larynx hampered his ability to talk, swallow and breathe. This groundbreaking surgery was only the third larynx transplant in the U.S., and the world's first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial.

"All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than other transplants," says David Lott, M.D., lead surgeon. "Mayo Clinic's team science approach made it possible for us to offer this type of transplant on a scale that was previously unattainable."

Space: A new frontier for exploring stem cell therapy

Two Mayo Clinic researchers say that stem cells grown in microgravity aboard the International Space Station have unique qualities that could one day help accelerate new biotherapies and heal complex disease. The research analysis by Abba Zubair, M.D., Ph.D., a laboratory medicine expert and medical director for the Center for Regenerative Biotherapeutics at Mayo Clinic in Florida, and Fay Abdul Ghani, Mayo Clinic research technologist, finds microgravity can strengthen the regenerative potential of cells. 

"Studying stem cells in space has uncovered cell mechanisms that would otherwise be undetected or unknown within the presence of normal gravity," says Dr. Zubair. "That discovery indicates a broader scientific value to this research, including potential clinical applications."

Mayo Clinic’s largest-ever exome study offers blueprint for biomedical breakthroughs

Mayo Clinic's Center for Individualized Medicine has achieved a significant milestone with its Tapestry study. It generated Mayo's largest-ever collection of exome data, which includes genes that code for proteins—key to understanding health and disease.  

Researchers analyzed DNA from over 100,000 participants of diverse backgrounds, providing important insights into certain genetic predispositions to support personalized and proactive medical guidance.  "The implications of the Tapestry study are monumental," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for the Center for Individualized Medicine. "As this study continues to inform and transform the practice of personalized medicine, it also sets a new standard for how large-scale medical research can be conducted in an increasingly digital and decentralized world."   

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Colette Gallagher, Mayo Clinic Communications, newsbureau@mayo.edu

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Dr. Amy Pollak, a Mayo Clinic cardiologist, explains how "holiday heart" can put too much stress on the heart.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Holiday heart" may sound like another joyous part of the holiday season.

"But, in the cardiology world, 'holiday heart' actually refers to this effect of the stress of too much alcohol, too much salt, higher blood pressure on the heart," says Dr. Pollak.

Dr. Pollak says all that stress on the heart can cause an irregular heartbeat known as atrial fibrillation.

"And, for some people, it feels like their heart is racing out of their chest," she says. "Their heart is just beating vigorously. For other folks, they just feel some irregularity – tired, short of breath, just wiped out, no energy."

Atrial fibrillation can lead to a stroke.

"So atrial fibrillation is something that is serious," Dr. Pollak says. "And, so, if you do feel that your heart is racing around the holidays, and it's not just from seeing someone underneath the mistletoe, but your heart is racing from irregularity, or you're feeling short of breath, any type of chest discomfort, overly fatigued, you really need to seek medical attention."

Dr. Pollak says the best way to avoid "holiday heart" is to avoid the excesses that are so prevalent during the holidays. She says that doesn't mean you have to skip a holiday party. Just skip some of the booze, cups of coffee and adding salt on your food.

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Research suggests machine learning can assist clinicians with diagnoses, treatment   

Imagine a world where neurological diagnoses are made with greater precision, treatment decisions are supported by data-driven insights and early detection is more frequent. This is the vision driving new research from the Mayo Clinic Neurology Artificial Intelligence Program (NAIP), where artificial intelligence (AI) serves as a powerful tool to support and augment the expertise of healthcare professionals. 

The NAIP team is testing StateViewer, a Mayo-created platform that can take an individual patient's PET scan and apply artificial intelligence to find similar cases of brain disease in Mayo's distributed data network. By enhancing diagnostic accuracy, researchers envision StateViewer will support care teams in determining a dementia diagnosis — such as Alzheimer's disease, Lewy body and frontotemporal dementia — and help guide treatment decisions for patients.  

 "By training AI models on vast datasets of patient brain scans, Mayo's Neurology Artificial Intelligence Program is researching a level of fast detection and precise diagnosis of neurodegenerative diseases that support human expertise," says Dr. David T. Jones, a Mayo neurologist and NAIP director. "Making more precise diagnostic support tools widely available will significantly accelerate progress toward finding cures for these devastating brain conditions and ensuring existing therapies are used for everyone who will benefit."  

Using AI to support clinicians' expertise 

 Typically, when a patient is being evaluated for a brain disease, a clinician carefully reviews the person's PET scan, looking for characteristic patterns that correlate with different types of dementia. These brain scans play a critical role in determining the cause and stage of a patient's condition, which directly informs the treatment plan. 

Mayo Clinic clinicians bring a wealth of expertise to interpreting these complex images. However, distinguishing between different brain diseases can be challenging, even for experts, which can occasionally lead to uncertainties in diagnosis and treatment. 

 To address these challenges, the NAIP team at Mayo Clinic began developing an advanced platform in 2019. This platform leverages machine learning and large-scale data processing to analyze brain scans. Working within the Mayo Clinic Cloud, an innovative technology platform developed in collaboration with Google Cloud, NAIP's multidisciplinary team — including software engineers, data scientists and neurologists — harnesses decades of clinical imaging data. This unified cloud environment allows real-time access and analysis, applying state-of-the-art machine learning techniques to support clinicians in making more precise diagnoses. 

 "Data is the bedrock for any tool of this kind, and our cloud data infrastructure was the essential technology for bringing this platform into the clinic," says Dr. Leland Barnard, head of data science and engineering with NAIP. "By integrating AI with clinician expertise, Mayo Clinic continues to push the boundaries of neurological care, improving diagnostic accuracy and patient outcomes." 

The StateViewer platform generates and displays the results of an individual patient's PET scan compared with PET scans of thousands of other Mayo Clinic patients with potentially similar neurodegenerative conditions whose diagnoses had been confirmed through extensive evaluations, including detailed longitudinal research and autopsy studies. Strict privacy and security measures have been implemented throughout the research process to protect patients' data.  

AI helps pick out the needle in the haystack  

 After verification and validation, StateViewer has been successfully piloted by Mayo neurologists as a research tool. These studies have demonstrated a significant enhancement in the accuracy of clinicians' interpretations of brain images, surpassing what is achievable with current tools alone. Under research, this tool can be used for patients in Mayo's Alzheimer's Disease Treatment Clinic with a PET scan available; the outputs of StateViewer may be reviewed at the weekly multidisciplinary case conference informing precision medicine-based recommendations for these patients.

 "By combining AI analysis with innovative tools, this technology revolutionizes the way clinicians interpret brain scans, enhancing their ability to diagnose and manage patients with neurodegenerative diseases," says Dr. John Stricker, NAIP lead software engineer.

 In a recent retrospective test, the NAIP team compared expert neurologists' diagnoses with StateViewer's ability to accurately detect Lewy body dementia compared with posterior cortical atrophy or other often indistinguishable degenerative conditions. It is difficult to distinguish these conditions visually as they affect similar brain regions, making it an ideal situation to demonstrate the advantages of using machine learning to assist with clinical decision-making. 

 As seen in this test, which is being considered for scientific journal publication, StateViewer's underlying machine learning model presents a probability of each diagnosis and clearly indicates how they were assigned. StateViewer's output helped clinicians double their speed while reviewing brain scans and triple their diagnostic accuracy.

 The technology "can pick out the needle in the haystack," Dr. Jones says.  

Expanding use of StateViewer technology 

Neurologic diseases are a common cause of death globally and a leading cause of disability. As the population ages, this burden grows. However, neurology expertise around the world is extremely limited, especially in low-income countries and in medical care deserts in some rural and urban areas where access to healthcare professionals may be unavailable or have long wait times. The NAIP team's goal is to expand the use of StateViewer technology outside of Mayo with the aim that it could be transformative on a global scale in the near future and expand access to these data-driven insights.  

"The goal is that a Mayo Clinic expert opinion would be available, with the help of one simple test, no matter how far the patient is from our campuses," says Dr. Jones.

 The NAIP team continues to develop several applications using the same cloud-computing approach. New data modalities, such as speech and cognition tests, are planned to be incorporated into StateViewer's analyses, providing a more comprehensive picture of patient health.  

 "I think this could be the first of many powerful innovations," Dr. Barnard says. "Our rich data resources tied to deep neurologic expertise still hold even more untapped potential to do good for our patients." 

 "A union of forces focused on the patient has always been the Mayo model of care," Dr. Stricker says. "Now that multidisciplinary team approach is bringing data scientists and software engineers together with clinicians to help transform healthcare."

Related content:

• Mayo Clinic Minute: Using AI and brain waves for early diagnosis of neurodegenerative disease
• AI boosts the power of EEGs, enabling neurologists to quickly, precisely pinpoint signs of dementia
• Mayo Clinic Minute: Testing gait to help in early diagnosis of neurodegenerative disease
• News release: New computational model proposed for Alzheimer's disease

The post Mayo Clinic Neurology AI Program tests platform to detect brain diseases   appeared first on Mayo Clinic News Network.

There is new hope in the fight against glioblastoma, the deadliest and most aggressive form of primary brain cancer.

Currently there is no cure, but results of a new study conducted at Mayo Clinic show patients experienced improved overall survival while maintaining quality of life after undergoing a novel approach to treatment.

Watch: Breakthrough in the fight against glioblastoma

Journalists: Broadcast-quality video (2:45) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Richard Casper was one of the study participants. The Arizona man enrolled in the clinical trial at Mayo Clinic in Phoenix after his diagnosis of glioblastoma in 2019. Richard was given only months to live, but his family says thanks to his strength, perseverance, and innovative medical care, he survived nearly double the amount of time.

"To be almost two and a half, three years in after being told you only have a few months, it's quite remarkable," says Susan Casper, Richard's daughter.

Richard succumbed to the disease in 2023. During the treatment, his family says he had little to no side effects. In the months before his passing, Richard stated, "I feel great. If someone didn't tell me I have the glioblastoma, I wouldn't even know it."

The clinical trial was led by Dr. Sujay Vora, a radiation oncologist at Mayo Clinic in Arizona. The small, single-arm study incorporated the use of advanced imaging technology combined with cutting-edge radiation therapy in patients over the age of 65 with newly diagnosed World Health Organization (WHO) grade 4 malignant glioblastoma.

"The patients lived longer than we expected. This patient population is expected to live six to nine months. Our average survival was 13.1 months. There were some patients that were out closer to two years. The results exceeded our expectations. We are very pleased," says Dr. Vora.

The study is published in The Lancet Oncology.

Why is glioblastoma so deadly?

Glioblastoma is among the most challenging cancers to treat. The disease is aggressive and invades healthy brain tissue with hairlike tentacles. "That is why doing a complete surgery is very difficult, as compared to say breast cancer, where a lumpectomy can be performed to remove not only the tumor, but a healthy rim of tissue around it," explains Dr. Vora.

Surgery for glioblastoma presents a different set of obstacles. "When it comes to glioblastoma, it is challenging to do that level of surgery. You try to surgically remove whatever you can safely without leaving the patient worse off after surgery."

Another factor that makes glioblastoma so lethal is that it can be fast- growing and unresponsive to treatment.

"These cancer cells are quite challenging to overcome," says Dr. Vora. "There are some patients we see after their surgery, and by the time we are ready to start their treatment, they've already had a recurrence of the disease."

An estimated 14,500 people will be diagnosed with glioblastoma in the U.S this year. "In the best of circumstances the average survival rates are in the 14-15 month range. But for patients 65 and older, the group that was the focus of our study, patients do even worse. The prognosis for this population is between six and nine months," says Dr. Vora.

Symptoms of glioblastoma

• Headache
• Nausea and vomiting
• Confusion or decline in brain function
• Memory loss
• Personality changes
• Vision changes
• Speech difficulties
• Trouble with balance
• Muscle weakness
• Seizures

Attacking glioblastoma with a triad

For the clinical trial, Dr. Vora and his team mapped out a plan that would allow them to be more intentional and precise with treating the location of the glioblastoma.

The imaging incorporated the use of ¹⁸F-DOPA PET and contrast-enhanced MRI. "¹⁸F-DOPA PET is an amino acid tracer that can cross the blood brain barrier, and it can accumulate within the glioblastoma cells itself," says Dr. Vora.

Researchers combined these images to determine the location of the most metabolically active "hot spots" of the cancer in the brain.

Taking aim with proton beam therapy

Study investigators used one of the most advanced forms of radiation treatment, called proton beam therapy.

"With standard radiation, the beams go through the brain tissue, so there's an entrance dose and the exit dose. But with proton beam therapy, we dial up how deeply we want the radiation to go," explains Dr. Vora. "It drops off its energy in the tumor, and then there's basically no radiation after that. It allows us to be more preferential into the delivery of radiation and protect more of the healthy surrounding tissue."

During proton beam therapy, a patient lies on a table while the machine rotates around the patient's head targeting the tumor with an invisible beam. The patient is awake for the procedure. It is painless with many patients reporting fewer to no side effects.

Unlike traditional radiation for glioblastoma, which is typically delivered over the course of three to six weeks, treatment with proton beam therapy for the study was conducted in one to two weeks.

"I am hopeful that this is the first step of many where we can continue to move the needle and allow patients to live longer and live well," says Dr. Vora. "The goal is to improve the outcomes for our patients allowing them to spend more time with their families."

Nadya's story

2022 was a tough year for Nadya El-Afandi. She was on the verge of celebrating a long but successful battle with breast cancer.

"Out of the blue, I had a seizure. I went to the hospital, they did an MRI. After additional tests they told me the news: 'You have a glioblastoma,'" recalls Nadya. She asked her doctor if she should continue her breast cancer treatment. "He said, 'No'-meaning the glioblastoma would kill me before the breast cancer."

Nadya was not about to give up.

Nadya is a wife and mother of four children. She lives just outside of Rochester, Minnesota. "My children said to me, 'Mom, you're a unicorn. Of course you'll live.' My mother has had a number of medical conditions and we never expected her to live this long. And she's still alive and with us," says Nadya. "My children have also said, 'You've got grandma's blood in you. You will live.'"

Nadya is receiving care at Mayo Clinic in Rochester. That's where she learned about a new clinical trial called SAGA, or stereotactic ablative radiation treatment for glioblastoma. The phase 2 clinical trial is building upon Dr. Vora's research and studying a larger group of patients. The study is being led by Dr. William Breen, radiation oncologist at Mayo Clinic in Rochester.

It has been 15 months since Nadya began treatment for glioblastoma. So far, there is no sign the glioblastoma has returned. "Nadya has already exceeded the time that's expected time to have a tumor recurrence, and she continues to do well," says Dr. Breen. "Nadya is beyond some measures of what the average, overall survival time would be."

While Nadya's progress in encouraging, Dr. Breen says it is important to note that it is too early to draw any conclusions about safety or efficacy of this approach to treatment until the study is completed.

Meanwhile, Nadya is focused on living her life to the fullest. Fifteen months after undergoing treatment, Nadya embarked on an adventure to Hawaii, where she spent time taking helicopter tours, snorkeling and hiking.

Related articles

• Breakthrough in treatment approach showing promise in the fight against glioblastoma, the deadliest and most aggressive type of brain cancer
• (VIDEO) Focus on hope: Brescia’s Story
• All-Star pitcher Liam Hendriks shares how he closed out cancer at Mayo Clinic in Arizona
• Cancer is tough. Evelyn Owens is tougher
• https://cancerblog.mayoclinic.org/2021/12/21/glioblastoma-in-older-adults-improving-survival-and-quality-of-life/
• https://cancerblog.mayoclinic.org/2024/05/15/technology-clinical-trials-offer-hope-after-glioma-diagnosis/

The post (VIDEO) Breakthrough in the fight against glioblastoma appeared first on Mayo Clinic News Network.