MSS study grants

[sbr487]

1. Are stenosis meeting Zamboni's criteria for CCSVI diagnosis more common in MS than normals?
2. Does eliminating those stenosis have a positive effect on MS?
3. What mechanisms are responsible for the positive effect?

This point was brought up by MarcW in the now famous "Marc vs Lyon" thread -
To qualify as a common treatment, I would guess only #2 is what is sufficient.

#3 is necessary as a long term study but to gate a treatment because we don't understand the complete mechanism might not be the right thing to do. When was the last time a treatment option was generally made available after the complete mechanism was understood?
The fact is that we simply can't begin to fathom the complexity of the system we are dealing with.

[garyak]

I still have major concerns regarding Freedman's involvment in this study. I think he will sabotage this entire research. Even if what he says may end up being flawed and biased, the lay person will only believe what the media will report on this study which I predict will shoot down the ccsvi theory.

[Jugular]

its pretty well known that results can be spun in multiple directions depending on what one is interested in. One need not even fudge the data for this. If this was not the case most of the MS drugs would not be a reality.

At this point it's all a matter of opinion but it seems in this situation things don't need to be nearly so complicated as determining whether the MS drugs work or determining their mode of action. In this situation things seem as simple as answering three questions:
1. Are stenosis meeting Zamboni's criteria for CCSVI diagnosis more common in MS than normals?
2. Does eliminating those stenosis have a positive effect on MS?
3. What mechanisms are responsible for the positive effect?

Although answering #3 would be hideously complicated, positive findings regarding #1 and #2 would open the floodgates and after that point no one would care whether #3 ever got answered. Hell, many years have past since the last of the vitamin deficiency diseases were "cured" and now that we've been put on notice to get our vitamins do any of us really care what the exact mechanisms of beri-beri or pellagra were?

Amen, brother. This is exactly what's needed. So there you have it - a so-called cynic and a so-called believer both aligning on the real questions that need to be addressed.

Unfortunately, It seems that much of the research is being directed at building a straw man out of Zamboni's constructs by designing experiments to refute Zamboni's theory on point #3. That's so they can come out and announce that their investigations have proven that that Italian doctor's research can't be replicated and therefore the entire CCSVI theory has no validity. Meanwhile point #1 and #2 can conveniently be swept under the carpet. And we can get back to our regularly scheduled EAE model tuning.

With how they are designing these studies you might as well put on your brown jackets now because the bs is about to really start flying.

[Lyon]

.

[Cece]

At this point it's all a matter of opinion but it seems in this situation things don't need to be nearly so complicated as determining whether the MS drugs work or determining their mode of action. In this situation things seem as simple as answering three questions:
1. Are stenosis meeting Zamboni's criteria for CCSVI diagnosis more common in MS than normals?
2. Does eliminating those stenosis have a positive effect on MS?
3. What mechanisms are responsible for the positive effect?

Although answering #3 would be hideously complicated, positive findings regarding #1 and #2 would open the floodgates and after that point no one would care whether #3 ever got answered. Hell, many years have past since the last of the vitamin deficiency diseases were "cured" and now that we've been put on notice to get our vitamins do any of us really care what the exact mechanisms of beri-beri or pellagra were?

It does seem simple enough when it is put that way.

[1eye]

The use of Doppler Ultrasound was the first step, and was used to verify a guess: that CCSVI prevalence and MS prevalence are the same. It can be used as a screening tool: to rule out people who for one reason or another do not have ongoing vein problems. It also demonstrates reflux very well, since if the blood is moving one way the Doppler shift is positive, and if it is moving the other way the Doppler shift is negative. Even in the low-velocity, low- pressure venous environment this is clear. It neatly displays one of the things that can be wrong.

It is also used to detect stenosis. Why is Doppler necessary for that? Only to show low or zero-flow situations, or high velocity jets. Doppler can help, but is not always even necessary.

More accurate and useful for this is the method used to a great extent in arteries: fluoroscopic venography. But before the catheter is inserted, stenosis etc. is detected using standard echo-cardiograms. I think Dr. Zamboni was trying to show this can be done with veins as well, to triage the CCSVI, as well as prevent unnecessary catheterization.

But once, using the cathether in controlled studies, it is proven to the neigh-sayers that yes, if you have MS there is a great likelihood of your having these venous problems, and ballooning can help, the skepticism will have no basis and can be ignored.

I agree. Use of a screening tool not even designed to do that much perfectly, is nothing but a red herring. If Dr. Zamboni had had positive DUS results and done nothing with them, we would be nowhere. Catheters are necessary. Free them from the meddling crooks who want to go on prescribing $50,000/year drugs. Free them from red placebo herrings. Prove what can be proven, using the gold standard. Don't waste time and money on negative proofs using questionable tools. Then start directing your donations to Prof.Haacke, and we will get closer to the real truth.

[malden]

The use of Doppler Ultrasound was the first step, and was used to verify a guess: that CCSVI prevalence and MS prevalence are the same. It can be used as a screening tool: to rule out people who for one reason or another do not have ongoing vein problems. It also demonstrates reflux very well, since if the blood is moving one way the Doppler shift is positive, and if it is moving the other way the Doppler shift is negative. Even in the low-velocity, low- pressure venous environment this is clear.
...

That's not the true - it can be unclear. Dopler shift depends on frequent sampling:
The Nykvist phenomenon is an effect of the relation between the sampling frequency and the observed velocity. If you sample at a certain frequency, the direction of the motion becomes ambiguous, more frequent sampling will give the correct direction, less frequent sampling results in an apparent motion in the opposite direction. This can be observed with a stroboscopic light, for instance illuminating the flow of water, or with old fashioned wagon wheels in old moves which often seem to revolve slowly backwards when the wagon moves forwards. So, it's all in the eye of the beholder ;)
And Zamboni has a "good eye" to publish dopler shifts artifacts as "reflux" in his papers.
M.

[LivabirdsHubbie]

Team doing this study is:

Additional Personnel (all are affiliated with The Ottawa Hospital, the Ottawa
Hospital Research Institute and the University of Ottawa):
 Dr. Ian G. Cameron, Department of Diagnostic Imaging (MRI Unit)
 Dr. Matthew J. Hogan, Division of Neurology
 Dr. Mark E. Schweitzer, Department of Radiological Sciences and Department of
Diagnostic Imaging
 Dr. Cheemun Lum, Department of Diagnostic Imaging
 Dr. Miguel E. Bussière, Division of Neurology
 Dr. Santanu Chakraborty, Department of Diagnostic Imaging
 Dr. Mark S. Freedman, Division of Neurology (MS Research Unit)

Call me naive, but would it not make sense to involve a Vascular Specialist in this as the whole idea being a Vascular condition... maybe it is just me...

[sbr487]

Call me naive, but would it not make sense to involve a Vascular Specialist in this as the whole idea being a Vascular condition... maybe it is just me...

I think all they really need is people from diagnostic side - like imaging and scanning experts. They have them. They can include a vascular specialist if they wanted to ... but we know they won't

[Jugular]

That's not the true - it can be unclear. Dopler shift depends on frequent sampling:
The Nykvist phenomenon is an effect of the relation between the sampling frequency and the observed velocity. If you sample at a certain frequency, the direction of the motion becomes ambiguous, more frequent sampling will give the correct direction, less frequent sampling results in an apparent motion in the opposite direction. This can be observed with a stroboscopic light, for instance illuminating the flow of water, or with old fashioned wagon wheels in old moves which often seem to revolve slowly backwards when the wagon moves forwards. So, it's all in the eye of the beholder ;)
And Zamboni has a "good eye" to publish dopler shifts artifacts as "reflux" in his papers.
M.

Thinking about the problem from a fluid dynamics perspective, I would think that seeing actual flow reversal at the jugular level would be an extreme case. Depending on the structure of the narrowing, you might see some eddies on the periphery but flow should be in the direction of the pressure gradient. I think they should be looking for back pressure rather than reflux. Back pressure would experienced upstream in the tiny collection tributaries feeding the jugular river causing the pooling and micro-leakage upon which the CCSVI MS model is based.

[Jugular]

double post sorry

[concerned]

Egos, should checked at the door.

Let your id run wild!!!!!

[concerned]

Team doing this study is:

Additional Personnel (all are affiliated with The Ottawa Hospital, the Ottawa
Hospital Research Institute and the University of Ottawa):
 Dr. Ian G. Cameron, Department of Diagnostic Imaging (MRI Unit)
 Dr. Matthew J. Hogan, Division of Neurology
 Dr. Mark E. Schweitzer, Department of Radiological Sciences and Department of
Diagnostic Imaging
 Dr. Cheemun Lum, Department of Diagnostic Imaging
 Dr. Miguel E. Bussière, Division of Neurology
 Dr. Santanu Chakraborty, Department of Diagnostic Imaging
 Dr. Mark S. Freedman, Division of Neurology (MS Research Unit)

Call me naive, but would it not make sense to involve a Vascular Specialist in this as the whole idea being a Vascular condition... maybe it is just me...

There is someone from the Department of Radiological Sciences, couldn't he be a diagnostic or interventional radiologist?

[malden]

...I think they should be looking for back pressure rather than reflux. Back pressure would experienced upstream in the tiny collection tributaries feeding the jugular river causing the pooling and micro-leakage upon which the CCSVI MS model is based.

Sry... Back presure? What do you mean with that?

M.

[Jugular]

Sry... Back presure? What do you mean with that?

M.

No problem. Certainly not back ache. I was using a fluid dynamics concept.

The easiest way that I can think of to explain it is to think of a syringe without a needle on it compared to one with. The increased resistance that you feel on your thumb whilst pushing the plunger down with the one with a needle – that’s back pressure.

To assist, here are a few definitions of “back pressure” pulled from the internet - one from the engineering field and the other medical:

Pressure developed in opposition to the flow of liquid or gas in a pipe, duct, conduit, etc.; due to friction, gravity, or some other restriction to flow of the conveyed fluid.

Pressure exerted upstream in the circulation as a result of obstruction to forward flow, as when congestion in the pulmonary circulation results from failure of the left ventricle.

Getting back to the jugulars, I consider these to be the exhaust pipes of the brain, and the arteries its fuel supply. Seen thusly, an obstruction in the jugulars should cause an inefficient fuel “burn” in the brain or reduction in volumetric efficiency considering how back pressure should affect such a system.

The arteries are not connected to the veins. That’s why arterial pressure would not necessarily go up due to narrowing of the jugulars. You would expect pooling though and increased pressure in the small blood vessels as described in the CCSVI model.

Note as well that flow will find the path of least resistance and the venous system in the brain does have redundancy built into it. But you would be putting increased load on these other pathways. Further, the back pressure does not have to be dramatic, just chronic such that, over time and with aging, it causes damage.

That's why I think that back pressure is a more accurate term to use than reflux as I would think that to actually see venous flow reverse direction would be a rare event.