The results of a major international Medical Research Council (MRC) trial, undertaken in collaboration with the Stroke Association, show that early surgery is not always the best treatment for one of the commonest and most lethal forms of stroke. The results of the trial, published in this week’s edition of The Lancet, will help doctors decide the best way to care for patients with the condition.
Supratentorial intracerebral haemorrhage (ICH) is a type of stroke caused by the spontaneous rupture of a blood vessel in the brain and there has been much uncertainty about the best way to treat it. Anecdotal evidence suggests that early surgery to remove the resulting blood clot limits damage to the surrounding tissue and improves recovery by allowing the blood to circulate more freely. However, brain imaging studies to date have failed to provide conclusive evidence for or against this and previous clinical trials have given mixed results.
The MRC STICH* trial was specifically designed to answer this question. The scientists studied over 1,000 patients recruited from 27 countries to find out if early surgery is better than careful observation.
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Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.
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