Pentagon Says 11 More US Troops In Syria Diagnosed With Traumatic Brain Injuries

 Via The Cradle,

The spokesperson for the US Central Command (CENTCOM) Colonel Joe Buccino disclosed on Thursday that 11 more US troops based in Syria have been diagnosed with traumatic brain injury after a series of retaliatory strikes against illegal US bases in March.

According to CNN, Buccino affirmed that the US military’s medical teams are continuing to evaluate and assess their troops for indications of permanent and traumatic brain injuries.

The US personnel wounded in these attacks in Syria amount to 25 troops, including a US military contractor, who was killed at a facility in Syria’s northeastern Hasakah province on March 23. Washington claims the perpetrators of the attack were affiliated with Iran’s Islamic Revolutionary Guard Corps (IRGC).

On the same day of the attack on the US base, US troops carried out "precision airstrikes" in eastern Syria. The presence of the US occupation forces in Syria is deemed illegal under international law.

According to a March 30 CNN report, six US soldiers had also been diagnosed with traumatic brain injuries as a result of attacks from Iran-backed groups in Syria.

Similar brain injuries were sustained by over 100 US soldiers in 2020 after Iranian forces targeted the Ain al-Asad military base in Iraq, where US forces were stationed.

Iran attacked the US base in retaliation for the US assassination of IRGC General Qassem Soleimani and Iraqi resistance leader Abu Mahdi al-Muhandis in a drone strike at the Baghdad airport on January 3 that year.

When Washington’s effort to topple the Syrian government through militias failed, US planners partnered with the Kurdish-led Syrian Democratic Forces (SDF) to fight ISIS and thereby occupy Syria’s strategic oil and grain-producing northwest, which had been under ISIS control.

This has allowed US officials to limit Syrian efforts at rebuilding the country and has exacerbated US-imposed economic sanctions, which have further harmed Syria’s economy and increased suffering among Syria’s civilian population.

https://www.zerohedge.com/geopolitical/pentagon-says-11-more-us-troops-syria-diagnosed-traumatic-brain-injuries

Healing the unhealable: New approach helps bones mend themselves

 Young babies and newborn mice can naturally heal damage to the bones that form the top of the skull, but this ability is lost in adults. In a new study published in Proceedings of the National Academy of Sciences, University of Pittsburgh researchers developed a novel approach that promoted bone regeneration in mice without implantation of bone tissue or biomaterials.

The technique uses a device similar to an orthodontic wire used to realign teeth to carefully stretch the skull along its sutures, activating skeletal stem cells that reside in these wiggly seams. In adult mice, the technique repaired damage to the skull that otherwise would not have healed on its own.

"Our approach is inspired by babies because they have an amazing ability to regenerate bone defects in the calvarial bones that make up the top of the skull," said senior author Giuseppe Intini, D.D.S., Ph.D., associate professor of periodontics and preventive dentistry at the Pitt School of Dental Medicine, member of the McGowan Institute for Regenerative Medicine and an investigator at UPMC Hillman Cancer Center.

"By harnessing the body's own healing capacity with autotherapies, we can stimulate bone to heal itself. We hope to build on this research in the future to develop novel therapies for people."

Trauma, congenital defects and surgery to treat cancer or other diseases are common causes of damage to the skull. After people reach the age of about 2 years, such injuries don't heal on their own.

"In babies, the calvarial bones are not completely fused, so the sutures where stem cells reside are still open," said Intini. "We wondered whether the unfused sutures had something to do with the bone regenerative capacity observed in babies and hypothesized that we could reverse engineer this in adults by mechanically opening the sutures to activate the stem cell niche and boost stem cell numbers."

In mice—which have very similar skull development to humans—the researchers used a so-called bone distraction device to carefully apply a controlled pulling force to the calvarial bones, strong enough to slightly widen the sutures but not enough to cause a fracture. Using single-cell RNA sequencing and live-imaging microscopy, they found that the number of stem cells in the expanded sutures of these animals quadrupled.

As a result, mice treated with the device regenerated bone to heal a large defect in the skull.

"If you can effectively activate the stem cell niche, you can increase the number of stem cells and sustain regeneration of bone defects," said Intini. "Remarkably, we showed that the defect can heal even if it's away from the suture."

Although the approach was effective in healing skeletally mature 2-month-old mice, the age that roughly translates to young adulthood in humans, it did not work in 10-month-old, or middle-aged, rodents.

"In older mice, the quantity of stem cells in calvarial sutures is very low, so expanding this niche is not as effective in boosting healing capacity," Intini explained. "Overcoming this challenge is a focus of research to come."

Current treatments for damage to the skull are usually bone grafts or implantation of biomaterials that act as scaffolds for bone regeneration, but these approaches are not always effective and come with risks, said Intini.

The researchers are investigating how their findings could be used to inform novel therapies in people, not just to heal skull injuries but also fractures in long bones such as the femur. Bone distraction devices are already used to treat certain conditions such as a birth defect called craniosynostosis, in which the calvarial bones fuse too early, so expanding this technique to promote bone regeneration could be a future focus of clinical trials.

Intini and his team are also investigating non-mechanical approaches to activate skeletal stem cells such as medications.

More information: Zahra A. Aldawood et al, Expansion of the sagittal suture induces proliferation of skeletal stem cells and sustains endogenous calvarial bone regeneration, Proceedings of the National Academy of Sciences (2023). DOI: 10.1073/pnas.2120826120

https://medicalxpress.com/news/2023-04-unhealable-approach-bones.html

Study of cerebral blood vessels uncovers potential new drug targets for treating stroke

 Strokes cause numerous changes in gene activity in affected small blood vessels in the brain, and these changes are potentially targetable with existing or future drugs to mitigate brain injury or improve stroke recovery, according to a study led by Weill Cornell Medicine scientists.

In the study, which appears Apr. 14 in the Proceedings of the National Academy of Sciences, the researchers performed a comprehensive survey, in a preclinical model, of gene activity changes in small blood vessels in the brain following stroke. Comparing these changes to those that have been recorded in stroke patients, they catalogued hundreds of genes with significant stroke-driven changes and likely relevance in human strokes.

"Our findings provide a knowledge base that improves our understanding of strokes and points to specific molecules and pathways that can now be investigated as potential targets for future stroke treatments," said study senior author Dr. Teresa Sanchez, assistant professor of pathology and laboratory medicine and principal investigator of the Laboratory of Molecular and Translational Vascular Research at Weill Cornell Medicine. "It is also increasingly recognized that vascular disease is associated with and contributes to cognitive dysfunction and dementia. This study has identified molecular features associated with vascular dysfunction in the human brain after stroke, a major cause of dementia."

Stroke is and has long been a leading cause of mortality and long-term disability worldwide. The vast majority of strokes are ischemic strokes involving a blood clot in a vessel serving the brain. The blockage or severe reduction of blood flow reduces oxygen and nutrient delivery to downstream brain cells, killing or injuring them and triggering inflammatory processes that can cause further damage.

The small cerebral blood vessels—or "cerebral microvasculature"—downstream of the blockage are also affected, and the changes in them are thought to contribute further to brain damage post-stroke. Yet these microvascular changes have been technically challenging to record accurately, and thus have not been as well studied as other aspects of stroke—nor do they have any specific treatment.

In the new study, Dr. Sanchez and her team, including co-first authors Drs. Keri Callegari, Sabyasachi Dash and Hiroki Uchida, used the latest optimized methods, recently published by the Sanchez laboratory in Nature Protocols, for studying stroke-affected vessels to surmount these challenges. They comprehensively recorded post-stroke changes in gene activity in the cerebral microvasculature in mice and identified the changes that have also been seen in studies of human stroke patients.

In all, the team found 541 genes whose activity was altered similarly in both mice and human cerebral microvessels post-stroke. Dividing these genes into groups based on their functional roles and disease links, they identified several major clusters. These included clusters relating to general inflammation, brain inflammation, vascular disease, and the type of vascular dysfunction that would cause cerebral microvessels to become leaky. This leakiness implies a weakening of the "blood-brain barrier," the cellular lining of cerebral microvessels that protects the brain by keeping most components of circulating blood out of it.

"We found that, following stroke, some molecules that would weaken the blood-brain barrier were upregulated, while others that should protect the blood-brain barrier were downregulated," said Dr. Sanchez, who is also an assistant professor of neuroscience in the Feil Family Brain and Mind Research Institute. "This is consistent with clinical observations of blood-brain-barrier disruptions following stroke."

The analysis also identified the disruption of normal activity in genes controlling the levels of sphingolipids. These fat-related molecules are heavily involved in regulating blood vessels, and disruptions of their normal workings have been observed in stroke, atherosclerosis and vascular dementia. The team discovered that some types of these sphingolipids are highly enriched in cerebral blood vessels compared with brain tissue. In addition, they identified alterations in these sphingolipids in the cerebral microvasculature induced by stroke as well as the changes in key molecules that control the levels of these lipids. These new findings will permit the pharmacological targeting of these pathways for stroke therapeutic discovery.

The study included assessments confirming the "druggability," or suitability for targeting with small-molecule drugs, of many of the molecules with altered production post-stroke. Indeed, some of the identified molecules are already being targeted by candidate drugs to treat other pathological conditions, which could facilitate the repurposing of these drugs for the treatment of stroke and dementia.

Dr. Sanchez and her team are now following up with preclinical experiments using candidate drugs or genetic methods to reverse some of the specific microvascular changes identified in their study, to investigate if this could be beneficial for stroke patients.

"We've generated this knowledge platform and we're using it, but we also hope that other scientists will join us in these efforts to develop the first therapies targeting the microvasculature in stroke," she said.

More information: Keri Callegari et al, Molecular profiling of the stroke-induced alterations in the cerebral microvasculature reveals promising therapeutic candidates, Proceedings of the National Academy of Sciences (2023). DOI: 10.1073/pnas.2205786120

https://medicalxpress.com/news/2023-04-cerebral-blood-vessels-uncovers-potential.html

China Rejects US Intel Leak Pointing To Covert Arms Transfers To Russia

 China is again vowing that it won't sell weapons to Russia, or either side of the war for that matter, after new accusations fueled by speculation over a leaked US intelligence document.

Earlier this week The Washington Post published analysis of a top secret intelligence summary dated to February 23 of this year, which purported to show that China approved the provision of lethal aid to Moscow amid its military operations in Ukraine. 

If true it would confirm what have been months of White House accusations which Beijing has consistently and vehemently denied, also at a time that President Xi Jinping advanced his 12-point peace plan to promote ceasefire negotiations. But US official allegations have so far been limited to asserting that Beijing is merely mulling and discussing the possible provision of lethal aid, not that it's already done so.

According to a description of the leaked intelligence document in The Washington Post:

The intercept, apparently obtained through U.S. eavesdropping on Russia’s Foreign Intelligence Service (SVR), was included in a top-secret summary, dated Feb. 23, of recent Ukraine- and Russia-related “products” compiled by the Office of the Director of National Intelligence. It was among a number of previously unreported documents that The Washington Post obtained from a trove of images of classified files posted on a private server on the chat app Discord.

According to “signals intelligence,” the intelligence summary said, the SVR reported that China’s Central Military Commission had "approved the incremental provision" of weapons and wanted it kept secret. The report did not indicate the source of the SVR’s information.

On Friday China's Foreign Minister Qin Gang issued new statements on the controversy, explicitly denying arms sales to Russia.

"Regarding the export of military items, China adopts a prudent and responsible attitude," Qin said. He issued the words on the occasion of a visit by his German counterpart Annalena Baerbock.

"China will not provide weapons to relevant parties of the conflict, and manage and control the exports of dual-use items in accordance with laws and regulations," he stressed. At the same time, German Foreign Minister Annalena Baerbock said that a change in Taiwan’s status would potentially bring about the "horror scenario" of conflict for the whole world.

Despite the intelligence leak, the Biden administration maintains that it doesn't believe China has pulled the trigger yet: "We have not seen evidence that China has transferred weapons or provided lethal assistance to Russia. But we remain concerned and are continuing to monitor closely,” a senior administration official was quoted in The Washington Post as saying. "A senior defense official agreed with that assessment. Both officials spoke on the condition of anonymity to discuss information about the top-secret document."

https://www.zerohedge.com/geopolitical/china-rejects-us-intel-leak-pointing-covert-arms-transfers-russia

Risk for Long COVID Drops With Second Infection: Study

 The chances of having long COVID appear to decrease sharply between a person's first and second infections, a new study from the United Kingdom shows.

More than 500,000 people self-reported their symptoms in an ongoing survey, according to the U.K.'s Office for National Statistics. 

Around 4% of responding adults said they had long COVID symptoms 4 weeks after the first infection. But only 2.4% of those who did not have long COVID symptoms after the first infection reported such symptoms after the second infection.

"It does seem that the risk is significantly lower the second time around than the first time around for developing long COVID," Daniel Ayoubkhani, a statistician at the Office for National Statistics in the United Kingdom, told NPR. 

The most common long COVID symptoms were fatigue, a hard time concentrating, muscle aches, and shortness of breath.

The U.K. study didn't say why people are less likely to have long COVID after a second infection. But Ayoubkhani said it may be because they got immunity from the first infection or are simply less prone to COVID-19 infections in the first place.

The study's conclusions are similar to those found in a U.S. study of the VA medical system.

"Undeniably, we are seeing very, very clearly that for the second infection, the risk is lower than the first infection," Ziyad Al-Aly, MD, an epidemiologist at Washington University in St. Louis who led that study, told NPR.

Sources:

U.K. Office for National Statistics: "Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 30 March 2023."

https://www.medscape.com/viewarticle/990788

Exercise or Neuromuscular Stimulation in Type 2 Diabetes?

Studies indicate that physical activity improves glucose metabolism in patients with type 2 diabetes. In addition, other data suggest a decrease in cardiovascular morbidity and mortality through physical activity.

In the consensus report, Management of Hyperglycemia in Type 2 Diabetes, 2022, the American Diabetes Association and the European Association for the Study of Diabetes, therefore, recommend at least 150 minutes per week of moderate- to vigorous-intensity aerobic activity, supplemented with two to three resistance, flexibility, or balance training sessions per week.

But even when such recommendations are integrated into a therapeutic education program, adherence is often transient or partial.

In this context, Michael Joubert, MD, PhD, and his team at France's Caen University Hospital wondered about neuromuscular electrical stimulation (NMES), a physical treatment routinely used in functional rehabilitation to improve muscle strength and volume. Could NMES improve glycemic control in patients with type 2 diabetes, and thus, be an alternative to traditional physical activity?

To answer this question, they conducted a crossover randomized controlled trial called ELECTRODIAB2. The results were presented at the 2023 Congress of the Francophone Diabetes Society.

A few small pilot studies found that NMES improved insulin sensitivity and glycemic control; therefore, it could indeed be an alternative. The metabolic effect of NMES, however, has not been widely studied.

A total of 40 patients were enrolled in ELECTRODIAB2. Of these participants, 35 were randomly assigned to one of three groups: 6 weeks without NMES (control, no intervention), electrostimulation on 3 days per week for 6 weeks (20-minute ambulatory bi-quadricipital electrostimulation sessions) (NMES3), and electrostimulation on 5 days per week 6 weeks (20-minutes ambulatory bi-quadricipital electrostimulation sessions) (NMES5). The goal was to assess the glucose levels of sedentary patients with type 2 diabetes during these periods. At each session, NMES was applied at the maximum-tolerated intensity.

Data from 32 participants were analyzed. Mean age was 58 ± 10 years, and body mass index was 33.0 ± 4.3 kg/m². Duration of diabetes was 8.6 ± 5.9 years. Regarding diabetes treatments, 47%, 31%, 9%, and 13% of the patients were taking 0, 1, 2, and 3 oral hypoglycemic agents or glucagon-like peptide 1 agonists, respectively.

No significant differences in glucose levels were observed between the three groups. The primary outcome was mean glucose level based on a 6-day continuous glucose monitoring (CGM) recording. Those levels were 181.4 ± 42.5 mg/dL (control, no intervention), 180.6 ± 45.8 mg/dL (NMES3), and 181.1 ± 48.9 mg/dL (NMES5).

Furthermore, secondary outcomes (rates of hyperglycemia and hypoglycemia) did not differ between the three groups.

The researchers concluded that "with regard to the CGM criteria, this crossover randomized controlled trial did not show that the 6-week bi-quadricipital NMES sessions had any benefit. This finding conflicts with the results of preliminary pilot studies but it does not encourage further research on NMES in this population of patients with early stage diabetes."

Therefore, at this point, it does not look like NMES can be recommended as an alternative to physical activity for sedentary patients with type 2 diabetes.

https://www.medscape.com/viewarticle/990795

French Citizens Contribute to Forthcoming End-of-Life Bill

 After 4 months of careful consideration, France's Citizens' Convention on the End of Life has overwhelmingly declared that, as long as certain conditions are met, individuals should be permitted to obtain active assistance in dying through assisted suicide or euthanasia. Though he did not commit to saying "which of the two forms" would be taken up, President Emmanuel Macron has stated that the country's end-of-life laws would be changed, with a bill coming out by the end of the summer.

This announcement was made on April 3, the day after the 184 citizens of the Convention submitted their final report — a 173-page document adopted almost unanimously (92%) after 4 months of deliberation, nine working sessions, and 27 days of debate. Whether Macron will incorporate its conclusions into the forthcoming proposed legislation remains an open question.

In the report, the group unequivocally calls for "radical changes." They believe that modifications need to be made to the Claeys-Leonetti law, which, in 2016, gave end-of-life patients the right to request the discontinuation of treatments and receive continuous deep sedation until death.

Numerous Guardrails

Seven years after that law went into effect, the Citizens' Convention is urging public authorities to go further. To bring a sense of coherence to a course of action that some say is circuitous for current patients, a majority (75.6%) voted in favor of medical aid in dying.

The Citizens' Convention has brought forward a majority position "with many nuances," one of which is the need to implement assisted suicide and euthanasia (40% of votes), as neither assisted suicide (10% of votes) nor euthanasia (3% of votes) alone would cover every case.

In addition, 28% of the participants said that they favored assisted suicide without euthanasia to avoid involving healthcare professionals, while 18% opposed opening access to active assistance in dying (1% abstaining).

Believing that such access should include a support pathway, the Convention has set up guardrails to prevent things from veering off course. Whether the lethal drug would be administered by the patient (assisted suicide) or by a caregiver (euthanasia), the individual must express the request clearly, free from coercion, and be allowed to change his or her mind at any time.

The patient must have an incurable disease with physical pain and psychological suffering that cannot be treated. Medical and mental health support must be provided. In addition, the patient's capacity to make this kind of decision must be assessed before moving forward.

The Convention recommends that a "collegial multidisciplinary procedure" be carried out to review case files and that a monitoring and control committee ensure compliance with these rules.

Should everyone, regardless of age, have the right to access active assistance in dying? How old should one have to be? On this topic, the report noted, "the debates were not conclusive."

Conscience Clause

The group would like there to be an option for physicians to invoke their conscience clause if they do not wish to participate in carrying out a patient's request regarding active assistance in dying. The French Medical Association has stated that it is "not in favor" of practitioners participating in a "process that would lead to euthanasia" should the laws be changed, as "a physician may not deliberately cause death by administering a lethal product."

End-of-Life Support

The final report of the Citizens' Convention also presents the arguments of those opposed to active assistance in dying. Most of these individuals believe that the current Claeys-Leonetti law is not fully known and therefore is little used.

Some argue that modifying the law could put vulnerable people at risk. Others hold that allowing active assistance in dying "would have a detrimental effect on our model of society and on the spirit of solidarity."

Given "the alarming state of our country's healthcare system," the Citizens' Convention also considers it essential to bolster efforts to improve end-of-life support. With that goal in mind, they put forth 65 proposals.

One proposal is that a patient's choice and desire to decide where to end their life should be better respected. There is also a call for expanding home-based care and developing ways to ensure that "everyone, everywhere will have access to palliative care."

Palliative Care

The day after they submitted their report, the members of the Citizens' Convention were welcomed by President Macron at the Élysée Palace. He commended them for their hard work and affirmed his desire to "move toward the establishment of a French end-of-life model."

Acknowledging that current end-of-life support was "poorly suited" to deal with the matters at hand, the president went on to declare that a national 10-year plan would be created for the management of pain and palliative care.

Most importantly, Macron announced that an end-of-life bill would be introduced by the end of the summer. The Convention's recommendations for framing the issue of active assistance in dying constituted "a starting point," he said, that would help orient him in his consideration of the matter. "I do have a personal opinion, and that can evolve. I also have a responsibility as president of the Republic to ensure harmony."

https://www.medscape.com/viewarticle/990810