U of M News Wire: June 14, 2007

 
A strike against stroke
The University of Minnesota’s stroke initiative takes aim at a swift, silent killer

By Deane Morrison
U of M News Wire

For Sue Bardill, a morning this spring started like any other. After getting ready for work, the Minneapolis resident started to tell her husband it was time to go. Then the first warning sign hit.
 
"I heard my voice change," says Bardill. "I heard myself saying 'Something's wrong.' I saw the right side of my face sliding. I knew it was a stroke."
 
Bardill's husband called 911. In minutes, an ambulance crew was inserting an IV tube in Bardill--who now could neither speak coherently nor move anything on her right side -- and radioing ahead to Fairview-University Hospital.
 
Twenty minutes after the first symptom appeared, Bardill was in the emergency room, and within an hour University of Minnesota stroke neurologist Robert Taylor had administered a drug to dissolve the blood clot that was blocking an artery in her brain. Another 30 minutes, and it may have been too late for the drug to work. But it did, and Bardill was walking and talking in a matter of days.
 
As Bardill's experience shows, strokes strike suddenly, but prompt and expert treatment can minimize the damage. That's the goal of the university's new Minnesota Stroke Initiative, an ambitious effort begun in August 2006 to counter this stealthy killer through top-quality research, clinical services and education.
 
"We want to excel in all three components," says Adnan Qureshi, executive director of the initiative. Qureshi, along with Taylor and Vallabh Janardhan, forms the inner core of the initiative. All three are interventional neurologists trained to interrupt a stroke in progress. A neurosurgeon specializing in blood vessel repair and a neurocritical care specialist will join the U of M later this summer.
 
A formidable foe

Stroke is the leading cause of longterm disability in the United States and the third leading cause of death, after heart disease and cancer. According to Stroke Center statistics, stroke claims about 2,300 victims in Minnesota every year, and state hospitals report 10,000 admissions for stroke. The American Heart Association reports that adults over 55 have more than a one-in-six lifetime risk for stroke.
 
"In the United States, there are about 700,000 new cases a year," says Janardhan. "But we've identified only about half the risk factors."
 
Stroke comes in two varieties. About 85 percent are ischemic strokes, which are similar to heart attacks in that a blood clot blocks an artery--but in the brain, not the heart muscle. The remaining 15 percent are called hemorrhagic strokes. One type of hemorrhagic stroke occurs when an artery balloons out-an aneurysm-and ruptures. Another cause of hemorrhagic stroke is uncontrolled high blood pressure. The buildup of blood puts pressure on the brain and can cause widespread damage.
 
Risk factors for stroke include smoking, high blood pressure, diabetes, high cholesterol, and lack of exercise. Among the symptoms are numbness or weakness in the face, arm, or leg, especially on one side; difficulty speaking or moving; dizziness or balance problems; and trouble seeing in one or both eyes. Often, hemorrhagic stroke is preceded by a severe headache.
 
In every case, time is of the essence in treating stroke.
 
"We start worrying immediately," says Taylor. "Damage can be done very quickly."
 
Interventional neurologists can, if a patient's situation warrants, perform treatments to stop a stroke in its tracks. The clotbuster drug called TPA (tissue plasminogen activator) is used to dissolve the clots that form in ischemic strokes. The physicians may also insert a catheter into the blocked vessel in the skull; there, they use a tiny device to secure a clot, which they then pull out of the body. They can also administer drugs right to the site of the clot. Stents, too, can be placed in arteries to keep them open.
 
To treat aneurysms, the weakened, expanded section of artery is plugged with a coiled platinum wire that aids in clotting and, therefore, helps disconnect the aneurysm from the blood vessel. Other blood vessel problems that cause hemorrhagic stroke include abnormal connections between arteries and veins that can be treated with injections of special substances that act like glue and seal the injury.
 
Cutting the wait, expanding the options

As Bardill's experience shows, the university is already well equipped to deal with strokes. But through the initiative, Qureshi and his colleagues aim to shorten the time between stroke onset and treatment and to improve existing therapies. The effects of all this work will be felt from the very beginning, with a dedicated emergency medical service for stroke patients.
 
"This could reduce the time to treatment by half," says Qureshi.
 
With strong support from neurology department head David C. Anderson, the Zeenat Qureshi Stroke Research Center at the university is opening new vistas for treatment. Taylor, for example, is studying gene function in the cells that line blood vessels to see if they hold clues to future "events" such as the deposition of plaque, which is as dangerous in arteries of the brain as in those of the heart. Also, Qureshi is conducting a multicenter clinical trial funded by the National Institutes of Health to test the safety and benefit of blood pressure medications in the treatment of hemorrhagic stroke. He is also studying new ways to inhibit future clot formation following an ischemic stroke.
 
Working with colleagues at the U's Stem Cell Institute, Center for Magnetic Resonance Research, and the Stroke Center, Janardhan is investigating the use of stem cells from the same patient to repair stroke damage. Often, ischemic stroke patients arrive at a hospital with a core of dead brain cells surrounded by dying cells that can be saved if treated in time.
 
"To salvage the dying cells, we use drugs to dissolve the clot, or tiny devices to pull out the clot," says Janardhan. "The next step would be to inject bone marrow stem cells from the patient through a catheter to replace the dead cells." The work is in the preliminary stages, but the university team is the first to try this approach.
 
"The science of [stroke] is expanding rapidly," says Qureshi. Thanks to the initiative, the University of Minnesota has "the largest interventional neurology training program in the world."
 
As for Bardill, her speech now sounds perfectly normal. But, she says, "I read and understand about two-thirds as fast as before. However, if I were to get no better than today, I'd have a full life."
 

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Minnesota and Purdue teaming up to launch national study of air emissions from livestock facilities
 
By Justin Ware
U of M News Wire

A first-ever, nationwide study to measure amounts of various airborne substances emitted from livestock facilities, including poultry, dairy and swine operations, is underway at a western Wisconsin dairy farm.
 
University of Minnesota professor Larry Jacobson, department of bioproducts and biosystems engineering, is coordinating the monitoring effort at the farm, which is one of 20 monitoring sites in nine states. The two-and-a-half year, $14.6 million study will continuously record levels of hydrogen sulfide, particulate matter, ammonia, nitrous oxide, volatile organic compounds and non-methane hydrocarbons released from livestock facilities.  The U of M is receiving approximately $200,000 for its part in the study.
 
“The opportunity to study emissions from a dairy barn is especially intriguing, because we don’t have much air emissions data from these facilities.” The typical Midwest dairy barn is naturally ventilated, making it difficult to monitor air emissions.
 
“The barns involved in this study are mechanically ventilated, which greatly improves the accuracy of our sampling,” Jacobson said.
 
The National Air Emissions Monitoring Study, or NAEMS, is led by Purdue University and conducted under the advisement of the Environmental Protection Agency. The study is funded by the livestock industry, specifically through the Agricultural Air Research Council, a nonprofit organization that receives its funds from livestock industry groups.
 
The monitoring equipment at the research sites also may be used to test strategies for mitigating emissions. For example, researchers have found that when hogs are fed a certain diet, they emit significantly less ammonia.
 
The NAEMS project is one of three air emissions projects in which Jacobson is involved. The other projects are based on Minnesota turkey and swine farms. Other states involved in the study include California, New York, Iowa, North Carolina, Indiana, Texas and Washington.
 
 
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Growing Concerns
A parenting question-and-answer column with Dr. Martha Erickson of the University of Minnesota

Question: Our 5-year-old son and his best friend from preschool seem to be obsessed with bathroom humor. They think it’s hilarious just to say words like “butt, fart, or pee-pee” and sometimes encourage each other to say them in front of adults (even strangers) just to get a reaction. What’s the best way to put a lid on this tiresome behavior? And is it anything to worry about?     
 
Answer: As tiresome as this behavior is for parents, it is not at all unusual for children this age. At four or five, children have become very interested in their bodies and bodily functions.  They have begun to learn that some body parts are private, and that when they talk about those parts (or sometimes even display them), adults and older children may laugh or become embarrassed. Although preschool children have not quite learned to be embarrassed themselves, they are trying to figure out the rules and limits of what is acceptable to others. To determine what those limits are, they find all kinds of ways to test them like seeing how many bathroom words they can say before mom and dad lose their cool.
 
As you are observing, young children’s notions of humor are different from adults'. In a 5-year-old’s mind, bathroom talk probably really is hilarious. Young children are not sophisticated enough to understand more subtle or complex humor. And at any age, surprise (and even embarrassment) is common elements of humor.  Kids find both when they shout “poop” to the stranger who is walking by!
 
All in all, your son’s behavior is nothing to worry about. In time, he probably will outgrow it even if you don’t intervene. Nonetheless, there are a few things you can do to “put a lid on it,” as you say, and at the same time teach your son important lessons about socially appropriate behavior. If you can persuade his friend’s parents to use the same approach, you’re likely to be even more effective.
 
• The first and simplest step is to avoid overreacting to his attempts at humor. If he doesn't get a reaction from you, potty talk will lose much of its appeal. If there are older children in your household, it will be important to get them to join you in this approach.  
 
• In public, set clear limits on what's not acceptable and explain how it affects others. For example, say firmly and matter-of-factly, "It's not OK to say those words at the store. People are embarrassed and don’t like to be around you when you talk that way."
 
• Although you want your son to cut out the bathroom humor, it's important to balance those limits with a clear message that his body and its functions are nothing to be ashamed of. The best way to send that message is to answer any questions he has about his body in a straightforward way, use accurate names for body parts, and let him know, without embarrassment, that bodily functions are a natural part of everyone's life.
 
• Finally, because humor is a fun and important part of life, help your son and his friend find other ways to be funny. This follows a good general rule of child rearing: give a child a substitute for the behavior you want him to stop. For example, it’s fun for preschoolers to make up silly words, rhyme, or tell simple riddles. Of course, when your son tells you the same “knock-knock” joke for the tenth time in one day, you may find that preschool humor still wears a bit thin!