10 CLINICAL NEUROSCIENCES UPDATE SUMMER 2018 • Carolyn Cronin, MD, Assistant Professor of Neurology, led the University of Maryland team participating in the POINT trial, a practice-changing trial recently published in the New England Journal of Medicine. The study found that patients with minor ischemic stroke or high-risk TIA treated within 12 hours with combination aspirin and clopidogrel had fewer major ischemic events than patients treated with aspirin alone. The benefit of aspirin plus clopidogrel was concentrated in the first month of the trial, whereas the risk of hemorrhage remained relatively constant throughout the three months of follow-up. www.nejm.org/doi/full/10.1056/ NEJMoa1800410 • Francois Aldrich, MD, Professor and Director of Cerebrovascular Surgery, coauthored a paper reporting a Phase 1/2 clinical trial of the safety and clinical effects of intraventricular sustained-release nimodipine, compared to enteral nimodipine, in aneurysmal subarachnoid hemorrhage. The findings, published in Stroke, suggest that the intraventricular route of administration reduced both delayed cerebral ischemia and hypotension side effects, and paved the way for a recently started Phase 3 trial. www.ncbi.nlm.nih.gov/pmc/articles/PMC5176000/ •John Cole, MD and Dr. Steven Kittner and were coauthors and key contributors on a 2018 Nature Genetics paper (doi: dx.doi. org/10.1038/s41588-018-0058-3) that identified 22 new genetic risk factors for stroke, tripling the number of gene regions known to affect stroke risk. The findings demonstrated shared genetic influences with multiple related vascular conditions, especially blood pressure, but also identified independent loci that provide novel clues on stroke mechanisms with the potential to become drug targets for stroke therapy. The study was an international collaboration, including 67,000 persons with stroke; University of Maryland was the coordinating center for the NINDS Stroke Genetics Network, one of the largest consortia that contributed to the study. • Michael Phipps, MD, MHS, Assistant Professor of Neurology, coauthored a series of papers on quality measurement and improvement in stroke and stroke rehabilitation in the journals, Neurology, Circulation: Cardiovascular Quality and Outcomes, and JAMA Neurology. The papers collectively updated the American Academy of Neurology stroke quality measures, demonstrated the feasibility of using the electronic medical record to assess quality of stroke care, and identified opportunities to improve the quality of care of patients with TIA and minor stroke. www.ncbi.nlm.nih. gov/pubmed/?cmd=HistorySearch&querykey=8 • The members of the Division of Stroke and Cerebrovascular Diseases, Drs. Cole, Cronin, Merino, Phipps, Wozniak and Kittner, published a paper in the journal Stroke on the dose-response relationship between cigarette smoking and ischemic stroke in young men (www.ncbi.nlm.nih.gov/pubmed/29674522). Division members mentored a medical student, Janina Markidan, in this research who presented the findings at the International Stroke Conference in Houston Texas earlier this year. The article was featured on the American Heart Association website under the byline, “The more you smoke, the more you stroke.” newsroom.heart.org/news/ men-younger-than-50-the-more-you-smoke-the-more- you-stroke • Steven Kittner, MD, MPH, coauthored a focused update on stroke risk factors unique to women in the journal Stroke. stroke.ahajournals.org/content/strokeaha/ early/2018/02/07/STROKEAHA.117.018415.full.pdf The paper highlights that it is the peripartum and postpartum periods, rather than the three trimesters of pregnancy, that are associated with an increase in stroke risk and points out the need for more research on whether pregnancy confers an increased risk of stroke recurrence among women with a prior stroke. • Dheeraj Gandhi, MD, Professor and Director of the Division of Interventional Neuroradiology, coauthored a series of papers about small unruptured intracranial aneurysm. One paper, published in the American Journal of Neuroradiology surveyed neuroradiologists regarding their imaging surveillance of small, ≤ 7 mm, aneurysms and found significant heterogeneity in practice although the majority favored indefinite yearly noncontrast MRA. www.ncbi.nlm.nih.gov/pubmed/29650787 The other paper, published in JAMA Neurology, www.ncbi.nlm. nih.gov/pubmed/29159405 reported on a comparative effectiveness analysis of the management of tiny, ≤ 3 mm, incidentally detected, unruptured aneurysms. No preventive treatment or imaging follow-up was found to be the most effective strategy, compared to aneurysm coiling or imaging surveillance. • James Russell M.B., Ch.B., Vice Chair for research and Director of the Neuro-muscular Medicine section recently published a paper entitled “mGluR2/3 activation of the SIRT1 axis preserves mitochondrial function in diabetic neuropathy” in the Annals of Clinical and Translational Neurology. This study determined if a selective mGluR2/3 receptor agonist prevented or treated experimental diabetic peripheral neuropathy (DPN) through glutamate recycling and improved mitochondrial function. The authors showed that ADVANCES IN RESEARCH