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Residual Shunt Size Matters After PFO Closure

Having a residual shunt after percutaneous patent foramen ovale (PFO) closure was associated with an elevated risk of stroke or transient ischemic attack (TIA) recurrence years after the procedure, researchers found in a prospective cohort study.

The incidence of these events reached 2.32 per 100 patient-years with a shunt on transthoracic echocardiography (TTE) compared with 0.75 per 100 patient-years with a complete seal. The elevated risk persisted after adjustment for other factors (adjusted HR 3.01, 95% CI 1.59-5.69).

Whereas small residual shunts were not significantly linked to increased risk (HR 2.02, 95% CI 0.87-4.69), moderate or large residual shunts were (HR 4.50, 95% CI 2.20-9.20), reported MingMing Ning, MD, MMSc, of Massachusetts General Hospital and Harvard Medical School, and colleagues. Their findings were published online in the Annals of Internal Medicine.

Noting that stroke and TIA recurrence most often occurred within the first few years after PFO closure, Ning's team suggested that patients with moderate or large residual shunts undergo long-term follow-up of at least 5 years with a multidisciplinary team, with TTE with bubbles performed every 3 to 6 months during the first year and every 6 to 12 months thereafter to evaluate shunt size.

And because shunts can be expected to diminish over time as the closure device gets further epithelialized, stepping up antithrombotic treatment is reasonable until the shunt stabilizes, they added.

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University of Wisconsin-Madison professor receives 2020 John Dystel Prize for MS research

University of Wisconsin-Madison professor receives 2020 John Dystel Prize for MS research

Reviewed by James Ives, M.Psych. (Editor)May 11 2020

This year's John Dystel Prize for Multiple Sclerosis Research goes to Ian D. Duncan, a neuroscientist and Professor of Neurology at the University of Wisconsin-Madison, for groundbreaking research on how myelin (the protective nerve coating in the brain and spinal cord) is damaged, particularly in Multiple Sclerosis (MS), and how it may be repaired.

The Dystel Prize is given jointly by the National MS Society and the American Academy of Neurology. It was established by the late Society National Board member Oscar Dystel and his wife, Marion, in honor of their son, John Jay Dystel.

Professor Duncan has made a series of critical research advances that bring us closer to understanding how to restore function in people with MS by promoting myelin repair."

Bruce Bebo, PhD, Executive Vice President of Research for the National MS Society

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MS Society-Supported Wellness Research Group Publishes Strategies for Improving Diet Studies in People with MS

April 27, 2020
Can a person’s diet make their MS worse or better? Is there an ideal diet for people with MS? Evidence-based answers to these and other questions require results from well-designed studies. A Wellness Research Group supported by the National MS Society has published new strategies for improving diet studies in people affected by MS, based on studies that have already been completed or are underway. These recommendations can inform studies going forward to ensure they provide the answers people and their healthcare providers need to enhance well being. See how a healthy diet, regular exercise, stress management and other wellness strategies can help you manage your symptoms and feel your best.

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As part of its ongoing wellness initiative, the National MS Society convened a group of researchers with experience in MS and  diet-related research, as well as a person living with MS, to develop recommendations regarding unmet needs and opportunities in diet -related research. The group’s primary mission is to promote scientific evidence to support lifestyle, behavioral, and psychosocial approaches for promoting wellness in people living with MS.Based on lessons learned from recent or ongoing diet studies, the group discussed several recommendations going forward, including the following:Begin dietary studies with an education session led by a nutritionist and include local options for food shopping. Include partners/significant others, to ease implementation at home. Make sure that people fully understand the dietary interventions they are being asked to follow, and what will be expected in terms of time, finances, and travel.Let people who already cook be creative with the diet plan to increase flexibility, but include highly specific guidance for people who do not, to decrease anxiety.Depression, anxiety, fatigue, and mobility impairments – common in the course of MS – may affect adherence and need to be considered in study design.Studies may involve collecting blood, urine or stool samples, but it’s important to balance the need for samples with the fact that collecting them too frequently may deter recruitment or compliance. “Conducting dietary intervention trials in people with multiple sclerosis: Lessons learned and a path forward” is published by Dr. Kathryn Fitzgerald, Dr. Ellen Mowry (Johns Hopkins University, Baltimore) and colleagues in the journal MS & Related Disorders.

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Original author: Stuart
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