Stroke future

M. A. Rogowski and co-workers, ia B. S. Meldmm and M. WiUiams, eds.. Current and Future Trends in Anticonvulsant, Anxiety, and Stroke Therapy, Wiley-Liss, New York, 1990, pp. 91—111. 

Oxidation Catalyst. An oxidation catalyst requires air to oxidize unbumed hydrocarbons and carbon monoxide. Air is provided with an engine driven air pump or with a pulse air device. Oxidation catalysts were used in 1975 through 1981 models but thereafter declined in popularity. Oxidation catalysts may be used in the future for lean bum engines and two-stroke engines. 

By far, the most widely used and most empirically studied tissue viability imaging techniques are those that study tissue perfusion, and discussion of perfusion imaging techniques will dominate this section. We will also mention a few emerging techniques that currently are not as widely used in the acute stroke setting, but show promise for the future. 

The second hypothesis, that patients should be selected for thrombolysis depending on whether or not they exhibit a diffusion-perfusion mismatch, may have enormous implications for stroke therapy in the near future, and is one of the most actively investigated and debated subjects in neuroimaging. 

Researchers are actively at work improving both the speed of ASL sequences and the quality of the resulting images, and ASL may prove an important acute stroke imaging technique in the future. 

The clinical role of permeability imaging has yet to be assessed by a large clinical trial, but these techniques continue to hold promise for the future, as intracranial hemorrhage is the most significant potential complication of what is currently the only FDA-approved treatment for acute stroke. 

Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vase Interv Radiol 2004 15 S103-S110. 

Kawaguchi S, Okuno S, Sakaki T. Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease. JNeurosurg 2000 93 397 01. 

While the role of PHD inhibitors in the treatment of anemia is now validated, therapeutic validation is less certain in other HIF-associated pathologies such as wound healing, ulcerative colitis, therapeutic angiogenesis, and treatment of acute ischemic events such as myocardial ischemia and stroke. All of these indications are supported by a compelling array of in vitro and in vivo preclinical studies but their utility in the clinical setting remains to be evaluated and represents exciting possibilities for the future of small-molecule inhibitors of PHD enzymes. 

Essentially, the eCTD is a transport format for facilitating electronic submissions. The eCTD serves as an interface for industry-to-agency transfer of regulatory information while at the same time, taking into consideration the facilitation of the creation, review, life cycle management, and archival of the electronic submission. The eCTD specification lists the criteria that will make an electronic submission technically valid. The eCTD represents a major advance in the submission of information to support an NDA. In the future, companies may be able to send their submissions to several regulatory authorities simultaneously with a single stroke of a computer key. 

Too many strokes that end to the left can be destructive. Because all goals are in the future, spending too much time dwelling on the past can be detrimental to a healthy attitude. 

There is considerable evidence that the form in which data is reported has an impact on the understanding of the results, and on the decisions, which are taken on the basis of the data. For example, Misselbrook and Armstrong report the results of an investigation in which hypertensive and matched nonhypertensive patients were offered treatment for chronic mild hypertension. They were provided information of the positive impact of the offered treatment on the likelihood of their suffering a future stroke. The information was presented in different formats, including RR and ARR. When the information of the benefit of treatment was given in the form of RR, 92% percent of patients responded that they would accept treatment. In contrast, when the same information was presented in the form of ARR only 75% patients reported that they would accept treatment. The confusion is not restricted to patients. Forrow et al report the results of a study in which physicians reported they were more likely to treat both hypertension and hypercholesterolemia when data were presented in the form of RR rather than ARR. 

Stent therapy in STEMI remained intriguing because it allows for establishment of vessel patency and the ability to protect the culprit lesion. Several trials evaluated PCI versus PTCA, all showing a marked benefit in the combined endpoints of mortality and the requirement of revascularization with stenting [47-49]. The STENT PAMI trial helped shape the future of STEMI treatment. Overall mortality was not significantly different between the two groups however, the combined end point of mortality, reinfarction, stroke, or revascularization was positive at 6 months owing to a marked increase in the requirement for revascularization in the PTCA... 

The use of traditional (unffactionated) heparin has therefore been replaced by LMWHs to a large extent.18,100 LMWHs are clearly safer and more convenient to their unfractionated counterparts, and these drugs have become the primary method of treating acute venous thrombosis.47,100 LMWHs are now used routinely to prevent or treat deep vein thrombosis (DVT) following various types of surgery or medical conditions (ischemic stroke, cancer).70,127 It has also been suggested that LMWHs will produce optimal effects if they are administered for more than a few days, and some patients who are at high risk for thrombosis may receive LMWHs via subcutaneous injection for several weeks or months.80 Future research will help determine the best way to use LMWHs to prevent or treat venous thrombosis in specific clinical situations. 

Bushnell CD. Hormone replacement therapy and stroke the current state of knowledge and directions for future research. Semin Neurol. 2006 26 123-130. 

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