RxPG News : Medicine

Workplace safety program can reduce injuries if aggressively enforced, study finds

Fri, 27 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) A longstanding California occupational safety program requiring all businesses to eliminate workplace hazards can help prevent injuries to workers, but only if it is adequately enforced, according to a new study by the RAND Corporation.

The first-ever evaluation of the California Injury and Illness Prevention Program found evidence that the program reduces workplace injuries, but only at businesses that had been cited for not addressing the regulation's more-specific safety mandates.

We found the safety effects to be real, but not very large, said John Mendeloff, lead author of the study and a senior public policy researcher for RAND, a nonprofit research organization. We think that the most important reason for the limited impact of this program is that inspectors often did not go beyond a review of the employer's written document.

When California Division of Occupational Safety and Health inspectors did investigate further and found failures to comply with provisions to train workers, identify and abate hazards, and investigate injury causes, the average injury rates at targeted businesses declined more than 20 percent in the following two years, Mendeloff said.

However, these provisions were cited in only about 5 percent of Cal-OSHA inspections, RAND researchers found. In the other 20 percent of inspections where a violation of the rule was cited, it was only for the section requiring the employer have a written program. Such a violation carries an average penalty of $150.

The California Injury and Illness Prevention Program, which became effective in 1991, requires all employers to adopt certain procedures. These include communicating to employees about risks, carrying out regular workplace surveys and abating the hazards that are found, training employees about how to work safely, and investigating the causes of the injuries that occur. In contrast, almost all other safety standards address specific hazards -- for example, those dealing with protection against falls.

The program has been the most frequently violated Cal-OSHA standard in every year since 1991, being cited in about 25 percent of all inspections. The California program is also one possible model for federal OSHA's current rule-making effort to develop a safety and health program rule.

The RAND study notes that higher penalties for noncompliance with the program and more extensive activities to make employers aware of their obligations could enhance compliance. However, two other approaches could have a greater impact: having inspectors conduct more in-depth assessments of employer programs and having inspectors link the violations they find and the injuries that have occurred to the program by asking Why weren't these prevented by your Injury and Illness Prevention Program?

The study found that employers who were cited for violations of the Injury and Illness Prevention Program in one inspection usually came into compliance in future inspections. However, the overall percentage of inspections finding program violations did not change over time.

Moreover, the percentage of first-time inspections finding violations was the same in 2007 as it was in 1993. These findings indicate that information about the program requirements failed to reach many employers, they failed to be convinced to comply by the threat of penalties, or both.

The 20 percent reduction in injuries following citations for the specific requirements of the California Injury and Illness Prevention Program translates to about 1 injury per year at a workplace with 100 employees. Most estimates of the value of preventing a work injury are in the range of $15,000 to $50,000. The RAND study did not find evidence that the statewide workplace fatality rate had decreased after the introduction of the program standard.

The study of injury effects was carried out using several different injury data sets. In all cases, inspections were included in the data if before and after injury rates could be obtained for the inspected business. The study was limited to workplaces in the manufacturing, transportation, utilities, wholesale trade and health care sectors. It included inspections through 2006.

NIH launches trials to evaluate CPR and drugs after sudden cardiac arrest

Thu, 26 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) The National Institutes of Health has launched two multi-site clinical trials to evaluate treatments for out-of-hospital cardiac arrest. One will compare continuous chest compressions (CCC) combined with pause- free rescue breathing to standard cardiopulmonary resuscitation (CPR), which includes a combination of chest compressions and pauses for rescue breathing. The other trial will compare treatment with the drug amiodarone, another drug called lidocaine, or neither medication (a salt-water placebo) in participants with shock-resistant ventricular fibrillation, a condition in which the heart beats chaotically instead of pumping blood.

The majority of the approximately 350,000 people who have cardiac arrest in the United States each year are assessed by emergency medical service (EMS) providers. During a cardiac arrest, the heart stops beating, and unless it is restarted within minutes, the person usually dies. Although immediate CPR can be lifesaving, more than 90 percent of people who experience a cardiac arrest outside of a hospital die before reaching a hospital or soon thereafter.

Increasing survival rates for people who experience out-of-hospital cardiac arrest is a major public health goal, said Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung, and Blood Institute, which is the lead federal sponsor of the studies. These new trials could provide critical insight about which resuscitation efforts are most effective for cardiac arrest.

The trials will serve a combined population of nearly 21 million people from diverse urban, suburban, and rural regions across the U.S. and Canada.

The CCC trial will compare survival-to-hospital-discharge rates for two CPR approaches delivered by paramedics and fire fighters. Persons experiencing cardiac arrest will be randomly assigned to receive continuous chest compressions, or standard CPR by emergency responders. Standard CPR, the approach recommended by the American Heart Association (AHA) for use by emergency responders, includes chest compressions with short pauses for assisted breathing. This approach has been called into question by emerging data suggesting that stopping chest compressions to provide assisted breathing interrupts overall blood flow, thereby lowering survival.

Previous studies have shown that people who suffer cardiac arrest outside of the hospital and are treated by bystanders are more likely to survive when given compressions alone, according to Graham Nichol, M.D., M.P.H., principal investigator of the CCC trial and a professor of medicine and director of the Center for Prehospital Emergency Care and medical director of the Clinical Trials Center at the University of Washington, Seattle. In 2010, AHA adopted new guidelines that recommended continuous chest compressions only for bystanders.

The CCC trial will help to determine if continuous compressions is equal to or better than standard professional CPR when paramedics, who are better able to provide assisted breathing than bystanders, intervene, said Nichol.

Trained emergency personnel will give all participants in the CCC trial three cycles of CPR followed by heart rhythm analysis and, if needed, an electrical shock (defibrillation), applied to the chest. Half will be randomly assigned to receive continuous compressions combined with pause-free rescue breathing and half will receive standard professional CPR.

The CCC trial will enroll up to 23,600 participants at eight major regional locations across the U.S. and Canada.

The Amiodarone, Lidocaine, or neither (Placebo) for Out-Of-Hospital Cardiac Arrest Due to Ventricular Fibrillation or Tachycardia study (ALPS) will determine whether amiodarone or lidocaine improves survival-to-hospital-discharge rates for participants with shock-resistant ventricular fibrillation. Participants will receive one or the other drug or a placebo.

About 25 percent of cardiac arrests are due to ventricular fibrillation. When shock treatment with a defibrillator fails to restore normal heart rhythm during ventricular fibrillation, medications such as amiodarone or lidocaine are often given, but their effectiveness in improving survival is unknown.

Answering these questions is crucial and will determine the role of these drugs for patients who experience out-of-hospital cardiac arrest, said Peter Kudenchuk, M.D., principal investigator of the ALPS trial and the Seattle-King County Resuscitation Outcomes Consortium (ROC) clinical site, and professor of medicine and heart rhythm specialist at the University of Washington School of Medicine (UW Medicine).

The ALPS trial will enroll up to 3,000 participants at nine locations across the U.S. and Canada.

CCC and ALPS are part of the NIH-supported Resuscitation Outcomes Consortium (ROC), the first large-scale clinical research network in the world designed to study, improve, and standardize how EMS teams deliver very early, pre-hospital interventions to improve patient survival after cardiac arrest or trauma. ROC has forged innovative multidisciplinary research partnerships between emergency physicians, cardiologists, EMS workers, trauma surgeons, and neurosurgeons to bring diverse perspectives to research that ultimately will lead to better clinical practice. As with all clinical trials funded by the NIH, an independent group of experts will monitor patient safety throughout both trials.

The NHLBI is the lead federal sponsor for both of the new studies, and the U.S. Army Medical Research and Materiel Command is a federal co-sponsor. Additional funding is provided by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, the Defense Research and Development Canada, and the AHA.

Almost 60 fire and EMS organizations will participate in the ALPS trial, and approximately 125 EMS organizations will participate in the CCC trial.

Participating centers include:

New forms of torture leave 'invisible scars,' say researchers

Tue, 03 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Use of torture around the world has not diminished but the techniques used have grown more complex and sophisticated, according to new research from Queen Mary, University of London.

The study* suggests that these emerging forms of torture, which include various types of rape, bestiality and witnessing violent acts, are experienced by people seeking asylum in the UK.

In many cases the techniques cause no visible effect but are responsible for a variety of serious mental health problems. The researchers say that their findings are vital for understanding what many asylum seekers have endured and for ensuring the correct medical treatments are available.

The majority of countries signed a UN convention banning all forms of torture almost thirty years ago but the new research joins a body of evidence showing that the use of torture not only persists but is also widespread.

The researchers, led by Dr Nasir Warfa, based their study on asylum seekers who were being detained at Oakington Immigration Centre in Cambridgeshire. They carried out an audit of reports of torture over a six-month period. The results showed that 17 per cent of people at the Centre reported that they were tortured in their home countries.

Some reported cases of physical methods of torture such as being beaten with blunt objects, barbed wire, or fire. Other physical torture included various types of stabbing, covering with sugar water then exposed to insects, burning, finger or toenail extraction and foreign objects placed under nails.

Others experienced sexual torture including rape, forced bestiality, genital mutilation and forced abortion. Others still were suffocated or immersed in water, or forced to witness rape, violence or murder.

The majority of those who reported such incidents were fleeing African countries. Others had come from Asia, the Middle East and Europe.

The torture reported by these people is horrific, said Kate Izycki, Senior Nurse who specialises in Transcultural Psychiatry. This highlights that the use of torture continues and that the perpetrators are finding more elaborate methods; some of which often leave no physical mark.

Dr Warfa's previous research has shown that victims of torture are highly likely to suffer from severe mental health problems including post-traumatic stress disorder, depression, anxiety and feeling suicidal.

He adds: Finding yourself in a foreign country where you must negotiate a difficult asylum system, where you cannot work and where you may not be able to speak the language would be difficult for anyone. Then add mental health problems caused by torture and the ever-present possibility of deportation.

This new study clearly shows that we need to identify and address the health needs of those who have fled to the UK following torture in their home countries.

Having epilepsy is not linked to committing violent crime

Tue, 27 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Despite current public and expert opinion to the contrary, having the neurological condition epilepsy is not directly associated with an increased risk of committing violent crime. However, there is an increased risk of individuals who have experienced previous traumatic brain injury going on to commit violent crime according to a large Swedish study led by Seena Fazel from the University of Oxford, UK, and colleagues at the Karolinska Institutet, Sweden, and Swedish Prison and Probation Service, and published in this week's PLoS Medicine.

The authors say: The implications of these findings will vary for clinical services, the criminal justice system, and patient charities.

In their study, the authors identified all people with epilepsy and traumatic brain injury recorded in Sweden between 1973 and 2009 and matched each case with ten people without these brain conditions from the general population. The investigators linked these records to subsequent data on all convictions for violent crime using the personal identification numbers that identify Swedish residents in national registries.

Using these methods, the authors found that 4.2% of people with epilepsy had at least one conviction for violence after their diagnosis compared to 2.5% of the general population. However, after controlling for the family situation (in which individuals with epilepsy were compared with their unaffected siblings), the association between being diagnosed with epilepsy and being convicted for violent crime disappeared. In contrast, the authors found that after controlling for substance abuse or comparing individuals with brain injury to their unaffected siblings, there remained an association between experiencing a traumatic brain injury and committing a violent crime.

The authors say: With over 22,000 individuals each for the epilepsy and traumatic brain injury groups, the sample was, to our knowledge, more than 50 times larger than those used in previous related studies on epilepsy, and more than seven times larger than previous studies on brain injury.

They continue: In conclusion, by using Swedish population-based registers over 35 years, we reported risks for violent crime in individuals with epilepsy and traumatic brain injury that contrasted with each other, and appeared to differ within each diagnosis by subtype, severity, and age at diagnosis.

The authors suggest that the lack of a causal association with epilepsy and violent crime may be valuable for patient charities and other stakeholders in tackling one of the causes of stigma associated with this condition. In contrast, improved screening and management of some patients and prisoners with traumatic brain injury may reduce offending rates,

Scientists identify cell death pathway involved in lethal sepsis

Thu, 22 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Sepsis, a form of systemic inflammation, is the leading cause of death in critically ill patients. Sepsis is linked with massive cell death; however, the specific mechanisms involved in the lethality of sepsis are unclear. Now, a new study published by Cell Press in the December 23rd issue of the journal Immunity finds that inhibition of a specific cell death pathway called necroptosis protected mice from lethal inflammation. The research may lead to new therapeutic interventions for fatal inflammatory conditions that are notoriously hard to control.

Systemic inflammatory response syndrome (SIRS) is a body-wide inflammatory response that can be caused by an infection, such as in the condition sepsis, or by some sort of physical trauma, such as a severe burn. Sepsis and SIRS are thought to be caused by the cytokine tumor necrosis factor (TNF). However, although research has shown that TNF functions in inflammation, cell death, and survival, the specific mechanisms linking TNF with SIRS are not well understood.

Engagement of TNF receptor 1 activates two diametrically opposed pathways: survival/inflammation and cell death, explains senior study author, Dr. Peter Vandenabeele, from Ghent University and Flanders Institute for Biotechnology (VIB) in Belgium. An additional switch decides, depending on the cellular context, between apoptosis and necroptosis, two different cell death pathways. In our study, we explored the involvement of both of these cell death pathways in SIRS.

Dr. Vandenabeele and colleagues found that while disruption of molecules required for apoptosis had no impact on lethal SIRS, inhibition or genetic deletion of RIPK molecules, which are required for necroptosis, provided complete protection against SIRS lethality. Basically, inhibition of one type of cell death did not protect mice from lethal inflammation while disruption of a different cell death pathway improved survival. The researchers went on to confirm their findings in a clinically relevant setting by demonstrating that RIPK deficiency provided protection in a mouse model of peritonitis.

Taken together, the results demonstrate a crucial role for RIPK in sepsis-mediated lethality and uncover potential therapeutic targets for treatment of SIRS and sepsis. Selectively targeting the necroptosis process may be more advantageous than globally blocking TNF because it leaves space for the important anti-infectious functions of TNF, concludes Dr. Vandenabeele. New insight into the precise regulatory pathways associated with necroptosis and the molecular interactions involved in the RIPK pathways will provide additional targets for intervention in these high mortality pathological conditions, which have previously been classified as uncontrollable.

New predictor of heart attack or stroke

Mon, 19 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- A hike in your blood pressure during middle age significantly raises the risk of having a heart attack or a stroke during your lifetime, according to new Northwestern Medicine research. The study offers a new understanding on the importance of maintaining low blood pressure early in middle age to prevent heart disease later in life.

Men and women who developed high blood pressure in middle age or who started out with high blood pressure had an estimated 30 percent increased risk of having a heart attack or stroke compared to those who kept their blood pressure low.

Previous estimates of a person's risk of cardiovascular disease were based on a single blood pressure measurement. The higher the blood pressure reading, the greater the risk. The new Northwestern Medicine study expands on that by showing a more accurate predictor is a change in blood pressure from age 41 to 55.

The study is published in Circulation: Journal of the American Heart Association.

We found the longer we can prevent hypertension or postpone it, the lower the risk for cardiovascular disease, said lead author Norrina Allen, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. Even for people with normal blood pressure, we want to make sure they keep it at that level, and it doesn't start increasing over time.

There hasn't been as much of a focus on keeping it low when people are in their 40's and 50's, Allen added. That's before a lot of people start focusing on cardiovascular disease risk factors. We've shown it's vital to start early.

People that maintain or reduce their blood pressure to normal levels by age 55 have the lowest lifetime risk for a heart attack or a stroke.

The study used data from 61,585 participants in the Cardiovascular Lifetime Risk Pooling Project. Starting with baseline blood pressure readings at age 41, researchers measured blood pressure again at age 55, then followed the patients until the occurrence of a first heart attack or stroke, death or age 95.

Men who developed high blood pressure in middle age or who started out with high blood pressure had a 70 percent risk of having a heart attack or stroke compared to a 41 percent risk for men who maintained low blood pressure or whose blood pressure decreased during the time period. Women who developed high blood pressure had almost a 50 percent risk of a heart attack or stroke compared to a 22 percent risk for those who kept their blood pressure low or saw a decrease.

Men generally have a 55 percent risk of cardiovascular disease in their lifetimes; women have a 40 percent risk.

Our research suggests people can take preventive steps to keep their blood pressure low early on to reduce their chances of a heart attack or stroke, said Donald M. Lloyd-Jones, MD, study co-author, chair of preventive medicine at Northwestern's Feinberg School and a cardiologist at Northwestern Memorial Hospital. Maintaining a healthy diet, combined with exercise and weight control, can help reduce blood pressure levels and, consequently, your risk for cardiovascular disease later in life.

QUT to study appropriate level of medical treatment for dying patients

Wed, 23 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Queensland University of Technology (QUT) will undertake a study into why futile medical treatment is, at times, provided to dying patients.

The study will be conducted by a cross-disciplinary team of academics from QUT and the University of Queensland, in partnership with the Royal Brisbane and Women's Hospital.

The research, lead by Professor Lindy Willmott and Associate Professor Ben White from QUT's Health Law Research Program, will reveal why treatment which is considered unnecessary from a strictly medical point of view is sometimes provided.

Professor Willmott said administering treatment to those coming to the end of their life through either diagnosed illnesses or sudden accidents was a complex issue, and could affect the quality of the patient's dying experience.

She said providing futile treatment can also have adverse effects on the health professionals involved with giving such treatment.

She also said while limited research had been conducted in the US and Canada and anecdotal evidence collected in Australia, this would be the first comprehensive study to determine the size of the issue and the best ways of dealing with it.

We know patients near their deaths are sometimes provided with treatment that may not be in their best interests, and that simply delays the dying process, she said.

Associate Professor White said such treatment appeared to be performed for a range of reasons including doctors' concern about potential legal liability of not providing treatment, especially when family members insisted that it be done.

When a loved one is dying a range of complex family issues can come into play, for example with family members who may not have seen the patient for a long time and are unprepared for them to die, he said.

The delivery of care appears also to be influenced by doctors' perceptions of patient death as a failure, uncertainty about what patients who are now unable to communicate would have wanted, communication issues between specialists when a patient is being treated for a range of illnesses, as well as a doctor's religious views.

He said the delivery of futile medical treatment to the dying would also be looked at from an economic point of view to gauge how often it occurred and the cost of providing the treatment.

The three year study, 'Futile treatment at the end of life: legal, policy, sociological and economic perspectives' has been allocated $260,000 from the Australian Research Council.

It will incorporate a legal and policy review to gauge the context in which current end of life treatments are made. Researchers will also conduct in-depth interviews with doctors, including those in intensive care, emergency, palliative care and oncology, in a range of hospitals to determine why and how often they provide treatment that they don't consider to benefit the patient.

An audit of patient charts over a six month period will also be conducted to determine the frequency and cost of such care.

Professor Willmott said at the conclusion of the research the team expected to have evidence to identify the extent to which unnecessary treatment was being provided, its cost and suggestions for addressing its causes.

LGBT seniors face harder old age, national study finds

Wed, 16 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Aging and health issues facing lesbian, gay, bisexual and transgender baby boomers have been largely ignored by services, policies and research. These seniors face higher rates of disability, physical and mental distress and a lack of access to services, according to the first study on aging and health in these communities.

The study, released Nov. 16 and led by Karen Fredriksen-Goldsen and colleagues at the University of Washington's School of Social Work, indicates that prevention and intervention strategies must be developed to address the unique needs of these seniors, whose numbers are expected to double to more than 4 million by 2030.

The higher rates of aging and health disparities among lesbian, gay, bisexual, and transgender older adults is a major concern for public health, said Fredriksen-Goldsen, a UW professor of social work and director of UW's Institute for Multigenerational Health.

The health disparities reflect the historical and social context of their lives, and the serious adversity they have encountered can jeopardize their health and willingness to seek services in old age.

She presented some of the study's key findings last week during a congressional briefing.

The study highlights how these adults have unique circumstances, such as fear of discrimination and often the lack of children to help them. Senior housing, transportation, legal services, support groups and social events were the most commonly cited services needed in the LGBT community, according to the study.

Fredriksen-Goldsen and her co-authors surveyed 2,560 lesbian, gay, bisexual and transgender adults aged 50-95 across the United States. The researchers found that the study participants had greater rates of disability, depression and loneliness and increased likeliness to smoke and binge-drink compared with heterosexuals of similar ages.

Those seniors are also at greater risk for social isolation, which is linked to poor mental and physical health, cognitive impairment, chronic illness and premature death, Fredriksen-Goldsen said. Study participants were more likely to live alone and less likely to be partnered or married than heterosexuals, which may result in less social support and financial security as they age.

Histories of victimization and discrimination because of sexual orientation or gender identity also contribute to poor health. The study showed that 80 percent had been victimized at least once during their lifetimes, including verbal and physical assaults, threats of physical violence and being outed, and damaged property. Twenty-one percent of respondents said they were fired from a job because of their perceived sexual orientation or gender identity. Nearly four out of 10 had considered suicide at some point.

Twenty-one percent of those surveyed did not tell their doctors about their sexual orientation or gender identity out of fear of receiving inferior health care or being turned away for services, which 13 percent of respondents had endured. As one respondent, a 67-year-old gay man, put it, I was advised by my primary care doctor to not get my HIV tested there, but rather do it anonymously, because he knew they were discriminating.

Lack of openness about sexuality prevents discussions about sexual health, risk of breast or prostate cancer, hepatitis, HIV risk, hormone therapy or other risk factors, Fredriksen-Goldsen said.

First bilateral hand transplant performed at the Hospital of the University of Pennsylvania

Tue, 01 Nov 2011 04:00:00 PST

( from http://www.rxpgnews.com ) PHILADELPHIA, PA - For the first time in the Delaware Valley Region, a patient has undergone a complex and intricate bilateral hand transplant that could significantly enhance the quality-of-life for persons with multiple limb loss. The procedure was performed by Penn's Hand Transplant Program which operates under the leadership of the Penn Transplant Institute and in collaboration with Gift of Life Donor Program, the nonprofit organ and tissue donor program which serves the eastern half of Pennsylvania, southern New Jersey and Delaware. The highly-trained team's first bilateral hand transplant was performed in September. At this time, the patient is progressing well and both the patient and donor family wish to remain anonymous.

Working closely with their partners at Gift of Life Donor Program, a team of 30 members - 12 surgeons, three anesthesiologists and 15 nurses - performed the 11-and-one-half hour procedure which is Penn's first venture into the emerging field of Vascularized Composite Allotransplantation (VCA). The team included experts in solid organ transplantation, orthopaedic surgery, plastic surgery, reconstructive microsurgery, and anesthesia.

At Penn, we have the level of surgical and academic expertise required to not only offer complicated VCA procedures, but also the capabilities to help establish the standards for this emerging field, said L. Scott Levin, MD, FACS, director of the Penn Hand Transplant Program, chairman of the Department of Orthopaedic Surgery, the Paul. B. Magnuson Professor of Bone and Joint Surgery, Professor of Surgery (Division of Plastic Surgery).

As a top academic medical center, we have the range of expertise required to perform these complex procedures involving multiple, interacting structures and systems in the body, added Benjamin Chang, MD, co-director of Penn's Hand Transplant Program, program director and associate chief of the Division of Plastic Surgery and associate professor of Clinical Surgery. We will continue our three-pronged mission of striving for clinical, educational and research excellence in VCA which will help many amputees.

Double hand transplantation is a complex procedure that involves surgical and non-surgical components. First, the proposed recipient must undergo extensive medical screenings and evaluations before surgery. During the surgery, the hands and forearms from a donor are attached which includes connecting bone, blood vessels, nerves, muscles, tendons and skin. First, the forearm bones - the radius and ulna - are connected with steel plates and screws. Next, the arteries and veins are attached via delicate microvascular surgical techniques. Once blood flow is established through the re-connected blood vessels, surgeons repair each muscle individually and rejoin tendons and tendons to muscles, one-by-one. After the muscles and tendons are completed, surgeons reattach nerves before the final careful closing of the skin occurs.

After surgery, hand transplant patients are prescribed daily immunosuppressant medications to prevent their bodies from rejecting the new limbs, which is then followed-up by months, perhaps years of rigorous physical therapy to regain hand function and use. Physicians expect that patients compliant with follow-up care will see significant improvement in function within the first year after the initial surgery.

In contrast to the requirements of identifying a solid organ donor, selecting a donor for hand transplants involved additional matching criteria such as gender, ethnicity, race, skin color and tone, and size. These procedures raise difficult and novel ethical challenges. Respect for donors and their families and careful selection of recipients along with commitment to informed consent are essential.

For 37 years, Gift of Life Donor Program has partnered with the transplant centers throughout this region to bring innovative transplant procedures to patients in need, stated Richard Hasz, vice president of Clinical Services for Gift of Life. As with all types of transplant, surgeries such as this one could not take place without the generosity of a donor and a donor family. We thank them for their selflessness and for their gift that made this surgery possible.

Reconstructive VCA surgeries are the new frontier of surgical transplantation and the results are very promising, said Abraham Shaked, MD, PhD, director of Penn's Transplant Institute, vice chairman of the Department of Surgery, and the Eldridge L. Eliason Professor of Surgery. Our decades of experience in solid organ transplantation can successfully be applied to Vascularized Composite Allotransplantation and we're prepared to continue moving ahead with the major advancement in the care of patients in need of limb transplantation.

For now, the Penn Hand Transplant Program will only perform bilateral transplants, particularly treating quadramembral amputees. Someone who has had both arms and legs amputated is completely and totally dependent, said Dr. Levin. The most basic functions of life are virtually impossible to perform such as locomotion, eating, personal grooming and hygiene. It's our goal at Penn Medicine for our multi-disciplinary team to work seamlessly together in the field of VCA so we can successfully treat these patients - from victims of trauma or infection, to war veterans - and give them their lives back.

Psychological traumas experienced over lifetime linked to adult irritable bowel syndrome

Mon, 31 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Washington, DC -- The psychological and emotional traumas experienced over a lifetime -- such as the death of a loved one, divorce, natural disaster, house fire or car accident, physical or mental abuse -- may contribute to adult irritable bowel syndrome (IBS), according to the results of a study unveiled today at the American College of Gastroenterology's (ACG) 76th Annual Scientific meeting in Washington, DC.

In, A Case-Control Study of Childhood and Adult Trauma in the Development of Irritable Bowel Syndrome (IBS), researchers from the Mayo Clinic in Rochester, MN, found that childhood and adult traumas are more common among adults with IBS, but to a lesser degree among affected and unaffected case relatives. In addition, general life traumas were more commonly reported than physical, emotional or sexual abuse. Of the 2623 study participants, patients reported more traumas over a lifetime than controls with traumas common before age 18 as well as after age 18.

While stress has been linked to IBS, and childhood abuse has been reported to be present in up to 50 percent of patients with IBS, at a prevalence twice that of patients without IBS, most studies of abuse have focused on sexual abuse with sparse detail and also have not looked at other forms of psychological trauma, said Yuri Saito-Loftus, MD, who presented the findings. This is the first study that looks at multiple forms of trauma, the timing of those traumas, and traumas in a family setting.

IBS is a chronic functional gastrointestinal disorder which for many sufferers is marked by abdominal discomfort, bloating, constipation and/or diarrhea and can be categorized based on these symptoms: IBS-D is accompanied by diarrhea, IBS-C is accompanied by constipation and IBS-M includes both diarrhea and constipation.

Research suggests that IBS is caused by changes in the nerves and muscles that control sensation and motility of the bowel. IBS is 1.5 times more common in women than in men and is most commonly diagnosed in people under the age of 50.

Trauma may sensitize the brain and the gut, according to Dr. Saito-Loftus, who said that the results of this study indicate that patients with IBS experience or report traumas at a level higher than patients without IBS.

In the United States, it is estimated that 10-15 percent of the adult population suffers from IBS symptoms, yet only 5 to 7 percent of adults have been diagnosed with the disease. IBS is the most common disease diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians. According to studies, IBS patients make more visits to their physicians, undergo more diagnostic tests, are prescribed more medications, miss more workdays, have lower work productivity, are hospitalized more frequently, and account for greater overall direct healthcare costs than patients without IBS. The burden of illness for IBS is significant: research suggests that IBS can have such a severe impact on Health-Related Quality of Life that it has been linked to an increase in suicidal behavior.

Patients and their families frequently wonder, 'why me?', 'why did this [IBS] happen?,' said Dr. Saito Loftus. She said it's important for patients' and their healthcare providers' to understand the potential link between prior stressful experiences and IBS. This will help them understand why IBS happened to them, why stress continues to play a role in their IBS symptoms.

She also urged patients and their healthcare providers not to underplay the role of stress in their symptoms. Someone who thinks they have coped with their traumatic experiences adequately on their own and continues to have IBS symptoms should be encouraged to explore professional evaluation and treatment for traumatic life experiences.

Spousal death key link to loss of independent living for seniors

Fri, 21 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The death of a spouse is always a tragedy, but for seniors, that tragedy can spur some significant life changes. And one University of Alberta researcher says the choices they make are something policymakers need to pay attention to.

Sociologist Lisa Strohschein says that losing a partner can precipitate the need for the surviving spouse to leave the residence they once shared. And the bereavement period is often key for them or their family members to decide whether it makes sense for that person to continue living alone or whether they give up living independently.

Two people can take care of each other; they can share the burden of household tasks and may share income sources that allow them to live the kind of life that allows them to live independently, she said. What this study shows is that, in fact, bereavement is a triggering mechanism (for the surviving spouse to move out of independent living).

Strohschein's research noted that these seniors choose to either move into an institution or to reside with family members, most often their adult children. She says that when it came to these decisions, men and women were both equally likely to having to move when their partner died. She also noted that immigrants to Canada were more likely to reside with their families than their Canadian-born counterparts. Yet, she says, more needs to be done to help seniors make the final choice of where to live, but when to move should be left to the seniors themselves.

Perhaps we can do a better job of providing services and/or counseling for recently widowed seniors to help them make decisions that are going to be right for them, said Strohschein, and provide more services for those ones that really do want to move out of independent living who say, 'I can no longer bear these burdens,' to ensure that they are supported.

Strohschein says that understanding the processes that lead to seniors' decisions to leave their homes is important for the government to acknowledge, especially with an aging population. She says that developing processes and putting services in place would allow these people to retain their independence and their dignity in their twilight years, which is critical to ensuring the system does not become needlessly taxed.

How do we delay that onset of moving a person to institutional care, care that tends to be quite costly, and can be depersonalizing for the person who's receiving it, Strohschein said. As people come towards the end of their lives, how do we give them the most ability and the greatest dignity to exercise their right or their need for independence?

Coming up with other kinds of options that are going to maintain seniors' independence as long as possible and give them the services that they need to help maintain that are going to be absolutely critical.

ASE-EAE to issue guidelines for the echocardiographic evaluation of cancer patients

Thu, 20 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Considering that the early detection of cardio toxicity is a critical issue for patients undergoing chemotherapy, the ASE and the EAE have come together to write guidelines which will highlight the technical advantages of echocardiography in identifying cardio toxicity early, explained Prof Juan Carlos Plana, Co-Director of the Cardio-oncology Center, Cleveland Clinic, from the ASE. This would help select patients who would benefit from cardio protective regimens, so that heart failure does not become an obstacle to the oncologist during therapy, and to the patient during his/her survival.

In the last decade cancer therapy has had an enormous progress leading to an important reduction of morbidity and mortality of several types of cancer. The therapeutic management of patients with cancer includes a combination of drugs, radiation therapy, and surgery. Several of these therapies, mainly anthracyclines, produce potential adverse cardiac reactions which can negatively impact the quality of life as well as the prognosis of oncologic patients. The new generation of targeted therapies (i.e. trastuzumab in breast cancer) has also been associated with unexpected unfavorable side effects on myocardial function. Currently, 17% of patients have to stop cancer therapy due to heart involvement.

Detecting cardio toxicity is a critical issue in the clinical setting, in order to appropriately modulate and, hopefully, not interrupt cancer therapy. The traditional screening of patients with cancer includes a cardiac examination, and both an electrocardiogram (EKG) and a 2D echocardiogram with Doppler at baseline. The monitoring of cardiovascular toxicity might be more accurate using endomyocardial biopsy. However, the test is highly invasive and not free from complications, stated Dr Maurizio Galderisi, from the Federico II University in Naples, Italy and chairperson of the EAE task force.

Echocardiography has emerged as the modality of choice for noninvasive evaluation of cardiac disease in the cancer patient. This tool is essential for the evaluation of left ventricular systolic and diastolic dysfunction, pericardial and valvular heart disease. However, echocardiograms are only routinely performed at the beginning of cancer therapy, in order to document a normal left ventricular systolic function. Further echocardiographic follow up during cancer therapy is performed only as a consequence of the onset of cardiac symptoms and/or signs, in particular following the administration of recognized cardiotoxic drugs or radiation therapy.

Dr Rosa Sicari, FESC, from the CNR Institute of Clinical Physiology, Pisa, Italy and chairperson of the EAE Scientific Committee adds that the assessment of cardiac toxicity remains a critical issue in oncology. Ejection fraction, the time honored parameter of function is not useful for the detection of early and subtle forms of cardiac dysfunction. New tools are needed and the evidence should be built in the near future with appropriately designed studies and with the common efforts of oncologists, cardiologists and pharmacologists. This document is not meant to fill the gap of knowledge but to provide the state of the art of ultrasound in this field and indicate new research pathways.

On these premises, the upcoming joint recommendations of the American Society of Echocardiography and European Association of Echocardiography will present the need and clinical usefulness of serial echocardiographic evaluations, and the potential impact of more advanced ultrasound technologies in patients undergoing cancer therapy.

Project leads next decade of ageing research across Europe

Tue, 18 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) An ambitious project led by researchers at the University of Sheffield is set to tackle the grand challenge of Europe's ageing population over the next 10 years.

The FUTURAGE Road Map, created by Alan Walker, Professor of Social Policy and Social Gerontology in the Department of Sociological Studies, will provide the European research agenda for ageing over the next 10 years.

The Road Map was launched today at a meeting of the European Parliament entitled Meeting the Grand Challenge of Ageing: the New European Research Agenda and hosted by MEPs of the Science and Technology Options Assessment (STOA) Panel.

The document is the result of the unprecedented FUTURAGE project which presents a major step forward in European ageing research. FUTURAGE has brought together 24 partners, 14 European countries, eight stages of consultation and over 700 individual contributors and organisations, representing many thousands of people to create a better future for ageing in Europe.

Europe is currently the oldest region in the world, and the upward trajectory of European ageing has been linear for more than 150 years. The share of the population aged 65 and over will rise from 17% in 2010 to 30% in 2060, with those aged 80 and over being the fastest growing age group, increasing from 5% to 12% over the same period.

The current average of healthy life years (years of life in full health without disability) at 65 in the EU is eight years for both men and women. However, this varies among Member States from three years in Estonia to 13 years for women and 14 years for men in Denmark. The healthy life years gap between European countries exceeds the gap in life expectancy. Both these gaps are driven mainly by the low levels of life expectancy and healthy life expectancy in Central and Eastern European countries. The Road Map aims to tackle the health inequalities across Europe and will aid the EU's target to increase healthy active life by two years by the year 2020.

Despite Europe's ageing population, Professor Alan Walker, leader of the FUTURAGE project and a Fellow of the British Academy, argues in the Road Map:There continues to be a structural lag between this socio-demographic forward leap and societal institutions and attitudes, for example in the labour market and media. Hence the need for a new vision. This has to be a positive vision in which all older people, regardless of competence and capability, are included as full citizens, expected to contribute and participate and in which they feel empowered.

The reality of the plasticity and diversity of old age must replace the outdated model of inevitable decline and disability. Later life is but one part of a life course which is characterised by lifelong development. The concept that best captures this life course perspective is 'active ageing', an inclusive paradigm which does not exclude inactive or frail older persons.

The impact of the Road Map is set to be felt across Europe from research settings to end users of services over the next 10 years. Older people featured significantly in the consultation process of FUTURAGE, ensuring that both their views are represented and their complex needs understood to inform the Road Map's recommendations.

In addition to the detailed research priorities, four key recommendations of the Road Map are:

Falls prevention in Parkinson's disease

Wed, 12 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A study carried out by the Primary Care Research Group at the Peninsula College of Medicine and Dentistry, supported by the National Institute for Health Research (NIHR) and NIHR PenCLAHRC, has analysed the results of an exercise programme to prevent falls in those with Parkinson's disease.

The study was instigated because, to date, there are few trials that have examined the benefit of such interventions to people with Parkinson's disease. The research team used a randomised controlled trial to track the effectiveness of an exercise programme for people with Parkinson's disease who had a history of falls and reported a reduction in falls among those that received the intervention.

Despite limitations in the number of people who took part in the study, the research team was able to log significant improvements in balance, a decrease in the fear of falling and increased levels of physical recreational activity.

As a result, the findings of the study add to the evidence base for physiotherapy and exercise in the management of people with Parkinson's disease. Further studies involving a greater number of people with Parkinson's disease and a longer follow-up period will help to support this case, as well as identify which interventions work the best under which circumstances.

Up to two-thirds of people with Parkinson's experience falls each year: this compares with a third of the general community-based elderly population who experience falls. When a person with Parkinson's falls, the impact is widespread affecting patients, families and health and social care organisations. Falls and associated injuries are the main cause of hospital admissions among people with Parkinson's, resulting in extended hospital stays which put pressure on both the patient and the NHS.

Dr. Vicki Goodwin, PenCLAHRC Senior Research Fellow at the Peninsula College of Medicine and Dentistry and who conducted this study as part of her PhD funded by a NIHR Researcher Development Award, commented: Ours is one of the first studies to seek evidence for the effectiveness of interventions, and as such it is an important step towards understanding the best ways in which to help those with Parkinson's disease both deal with and prevent further falls. As well as the physical effects of a fall, people with Parkinson's also suffer psychologically, often reporting a lack of confidence across the spectrum of everyday life activities, thus affecting quality of life.

She added: It is clear that intervention programmes to prevent falls in those with Parkinson's disease do have the potential to work, but more research is needed before we have the knowledge necessary to recommend definitive approaches to this growing issue.

Earlier tracheostomies result in better patient outcomes

Wed, 05 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A tracheostomy performed within the first seven days after a severe head injury results in better overall patient outcome, according to a team of Penn State College of Medicine researchers. This is especially true for patients who have a greater chance of surviving when admitted to the hospital.

A tracheostomy is an opening created in the front of the neck directly into the trachea to allow unimpeded breathing. (A tracheotomy is the act of making that opening.)

The CDC estimates that more than 200,000 individuals are hospitalized annually for traumatic brain injury, said Kevin M. Cockroft, M.D., associate professor, neurosurgery. Severely head-injured patients, particularly those with additional injuries, often require tracheostomy at some point during their hospital stay.

Previous studies have shown mixed results.

Traditionally, tracheostomy, or 'trach,' has been recommended to prevent airway complications, Cockroft said. Early trach has been advocated as a means to improve outcome, with various studies suggesting that it may decrease the incidence of pneumonia, reduce intensive care unit days and shorten overall length of stay. Some evidence also exists to suggest that early trach does not improve outcomes. As a result, the timing of trach in these critically ill patients remains controversial.

Early trach patients are defined as those who have a tracheostomy performed during the first seven hospital-stay days. Late trach patients are defined as those who have a tracheostomy performed at greater than seven days after admission.

Researchers used data collected from January 1990 through December 2005 by the Pennsylvania Trauma Society Foundation for its statewide trauma registry. Because of a lack of patients with only head injury, researchers looked at patients with injury to at least one other body system. In total, 3,104 patients were included in the study, with 1,577 in the early trach group and 1,527 in the late trach group. It is the largest study to date to report the effects of tracheostomy timing on outcome after a severe head injury.

In the study population, later trach patients were in the hospital three times longer than early trach patients and also spent an average of four times longer in the ICU. Early trach patients were 1.5 times more likely to be discharged in an independent state. However, later trach patients were twice as likely to live to be discharged from the hospital, potentially because more severe cases would receive an earlier trach.

In addition, later trach patients were about twice as likely to suffer from an adverse pulmonary occurrence such as pneumonia, about 1.5 times as likely to suffer a cardiac event such as a heart attack, and 1.5 times more likely to have an infection.

Researchers reported their results in the journal

The mark of the beast: tradition or stress?

Wed, 28 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) For a variety of reasons it is important to be able to identify farm animals, horses and small companion animals. Farm animals have generally been marked by branding with hot irons or by ear-tagging, while more recently dogs and cats are being uniquely identified by the implant of a microchip transponder. Horses have traditionally been branded but many countries are now moving towards the use of microchips. Branding is still permitted in Austria and Germany, although the German parliament is currently discussing following the lead of Denmark, which banned the practice in 2009. Similar discussions are taking place in the USA and Australia. The underlying belief is that the use of microchips is more humane but is this really the case? The group of Christine Aurich at the University of Veterinary Medicine, Vienna (Vetmeduni Vienna) has now shown that the short-term differences are far less dramatic than animal rights activists may have us believe but that hot-iron branding has prolonged effects that may negatively affect the welfare of the foals.

Previous work had suggested that branding was significantly more stressful than implanting a microchip but the studies were carried out in adult horses and no investigations had been undertaken in foals, although horses are generally marked as foals. In collaboration with other scientists at the Vetmeduni Vienna, Regina Erber in Aurich's group therefore examined the levels of stress hormones in the saliva of foals when they were branded or when a microchip was implanted in their necks. She also monitored the behaviour, the body temperature and the heart rates of the foals while they were marked and afterwards (changes in heart beat are associated with stress). The results showed that both methods were associated with similar acute levels of stress to the animals: cortisol concentrations in the saliva increased similarly and in each case there was a similar transient increase in heart rate and in aversive behaviour. It seems, then, that the immediate behavioural and physiological changes caused by both methods are extremely similar. Furthermore, they appear at least in part to be caused by handling and fixation of the foals and not by the actual marking procedures.

Not surprisingly, branding caused a skin burn that lasted for about a week. However, branding was also found to be accompanied by a generalized increase in skin temperature that lasted for several days. This is comparable to the response of humans to severe burn injuries. These changes were not found in foals that were not branded but instead marked by means of a microchip. The new results thus show that tissue damage caused by branding in foals is far more pronounced than expected.

Commonly used supplement may improve recovery from spinal cord injuries

Wed, 28 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) LEXINGTON, Ky. -- A commonly used supplement is likely to improve outcomes and recovery for individuals who sustain a spinal cord injury (SCI), according to research conducted by University of Kentucky neuroscientists.

Sasha Rabchevsky, associate professor of physiology, Patrick Sullivan, associate professor of anatomy and neurobiology, and Samir Patel, senior research scientist -- all of the UK Spinal Cord and Brain Injury Research Center (SCoBIRC) -- have discovered that in experimental models, severe spinal cord injury can be treated effectively by administering the supplement acetyl-L-carnitine or ALC, a derivative of essential amino acids that can generate metabolic energy, soon after injury.

The researchers previously reported that following spinal cord injury, the mitochondria, or energy-generation components of cells, are overwhelmed by chemical stresses and lose the ability to produce energy in the form of the compound adenosine triphosphate (ATP). [1,2] This leads to cell death at the injury site and, ultimately, paralysis of the body below the injury level.

Rabchevsky, Sullivan and Patel have recently demonstrated that ALC can preserve the vitality of mitochondria by acting as an alternative biofuel providing energy to cells, thus bypassing damaged mitochondrial enzymes and promoting neuroprotection. [3]

Results soon to be published show that systemic administration of ALC soon after a paralyzing injury promoted the milestone recovery of the ability to walk. Unlike the animal control group given no ALC, which regained only slight hindlimb movements, the group treated with ALC recovered hindlimb movements more quickly and were able to stand on all four limbs and walk a month later. Critically, such remarkable recovery was correlated with significant tissue sparing at the injury site following administration of ALC.

Because ALC can be administered orally, and is well-tolerated at relatively high doses in humans, researchers believe that their discovery may be translated easily to clinical practice as an early intervention for people with traumatic spinal cord injuries.

Initial funding for these studies was provided by the Kentucky Spinal Cord and Head Injury Research Trust (KSCHIRT). Based on their findings, the research team has been awarded additional grant funding from the National Institutes of Health (NIH) and the Craig H. Neilsen Foundation, with the aim of enabling the investigators to study the beneficial effects of combining ALC with an antioxidant agent known as N-acetylcysteine amide (NACA). The results were reported at the recent National Neurotrauma Society Symposium in July 2011, and will be presented again at the Society for Neuroscience meeting in November 2011.

When translated into clinical practice, this research is expected to offer a viable pharmacological option for promoting neuroprotection and maximizing functional recover following traumatic spinal cord injury.

Liver cancer incidence lower in patients with nonalcoholic fatty liver disease than hepatitis C

Tue, 27 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Patients with non-alcoholic fatty liver disease (NAFLD) with advanced fibrosis or cirrhosis have a lower incidence of liver-related complications and hepatocellular carcinoma (HCC) than patients infected with hepatitis C virus (HCV), according to the prospective study published in the October issue of Hepatology, a journal of the American Association for the Study of Liver Diseases. Patients with both NAFLD and HCV had similar mortality rates.

NAFLD has become the most prevalent cause of chronic liver disease worldwide, with studies reporting up to 30% of the general population and 75% of obese individuals having the disease. A minority of cases develop fibrosis or cirrhosis of the liver, and NAFLD with advanced fibrosis or cirrhosis can lead to hepatic-related complications, HCC, liver failure or death. While the incidence of NAFLD has increased, studies of the natural history of the disease in conjunction with advanced fibrosis or cirrhosis and later outcomes have been limited.

Our study reports on the long-term morbidity and mortality of NAFLD patients with advanced fibrosis or cirrhosis by prospectively following up cases from four international collaborating hepatology centers, explains lead author Dr. Neeraj Bhala from the University of Oxford in the UK. Understanding the long term prognosis of NAFLD patients compared with patients affected by other liver diseases such as chronic HCV was an important aspect of our study. Medical evidence suggests that while HCV is currently the leading indication for liver transplantation, affecting more than 5 million individuals in the U.S, HCV incidence has plateaued, while that for NAFLD is on the rise.

In the largest prospective study of participants with advanced fibrosis or cirrhosis to date, the team recruited 247 patients with NAFLD and 264 patients with HCV infection who were not previously treated or were unresponsive to therapy from centers in Australia, Italy, the UK and the USA. Patients in both groups were Child-Pugh class A and had advanced fibrosis (stage 3) or cirrhosis (stage 4) confirmed by liver biopsy at the onset of the study. Follow-up in the NAFLD and HCV groups was a mean of 86 and 75 months, respectively.

Of those patients in the NAFLD group, 19% had liver-related complications and 13% died (or received transplants). Liver-related complications and deaths (or transplants) in the HCV cohort were lower at 17% and 9%, respectively. However, after adjusting for age and gender, the incidence of liver-related complications, including liver cancer, was lower in the NAFLD group compared to the HCV cohort. Researchers found that cardiovascular complications and overall mortality were comparable between the groups, although moderate differences cannot be excluded, highlighting the need for even larger collaborative prospective studies.

In a related editorial published this month in Hepatology, Dr. Mary Rinella with Northwestern University Medical School in Chicago, Illinois said, The study by Bhala and colleagues expands our knowledge of the natural history of NAFLD and NASH. While HCC was not surprisingly higher in untreated patients with HCV compared to NAFLD, this study highlights the potential of HCC development in non-cirrhotic patients with HCV and NASH. If patients with NAFLD or HCV are likely to develop HCC before the development of cirrhosis, this has tremendous implications for how and when liver cancer screening should begin in patients with liver disease.

Surgically treating GERD helps preserve lung function before and after transplantation

Mon, 19 Sep 2011 17:34:04 PST

( from http://www.rxpgnews.com ) Surgery to correct gastroesophageal reflux disease, or GERD, can preserve lung function in patients with end-stage pulmonary disease both before and after transplantation, according to a new study from the University of Pittsburgh School of Medicine. The findings, published in the Archives of Surgery, suggest that esophageal testing should be performed more frequently among these patients to determine if anti-reflux surgery is needed.

Many end-stage lung disease patients, particularly those with idiopathic pulmonary fibrosis or cystic fibrosis have GERD, and the reflux problem is very common after lung transplantation, said Blair Jobe, M.D., professor of surgery, Department of Cardiothoracic Surgery, Pitt School of Medicine. Also, GERD has been associated with bronchiolotis obliterans syndrome (BOS), which is a progressive impairment of air flow that is a leading cause of death after lung transplantation. Its cause is not yet known.

"It's possible that reflux, which is due to a weak sphincter between the stomach and esophagus, allows acid and other gastric juices to leak back not only into the esophagus, but also to get aspirated in small amounts into the lungs," Dr. Jobe said. "That micro-aspiration could be setting the stage for the development of BOS."

Lead author Toshitaka Hoppo, M.D., Ph.D., research assistant professor, Department of Cardiothoracic Surgery, Pitt School of Medicine, stressed the importance of esophageal testing for reflux in patients with end-stage pulmonary disease. He noted that "almost one-half of the patients in our series did not have symptoms but were having clinically silent exposure to gastric fluid. Based on this finding, there should be a very low threshold for esophageal testing in this patient population."

For the study, Dr. Jobe's team reviewed medical charts of 43 end-stage lung-disease patients with documented GERD, 19 of whom were being evaluated for lung transplant and 24 who had already undergone transplantation. All the patients were on GERD medications at the time they were evaluated for antireflux surgery (ARS), which prevents fluid from leaking back into the esophagus. Prior to ARS, nearly half of the patients had either no or mild symptoms of GERD and only a fifth had the typical symptoms of heartburn and regurgitation.

The researchers found that nearly all measures of lung function improved after ARS in both the pre- and post-transplant groups. There also were fewer episodes of acute rejection and pneumonia after ARS in the post-transplant group.

"The surgery appeared to benefit even those who hadn't yet had a transplant," Dr. Jobe noted. "Given the shortage of donor organs, ARS might help preserve the patient's own function and buy some more time."

UC Davis neurosurgeons use adult stem cells to grow neck vertebrae

Tue, 06 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Neurosurgery researchers at UC Davis Health System have used a new, leading-edge stem cell therapy to promote the growth of bone tissue following the removal of cervical discs -- the cushions between the bones in the neck -- to relieve chronic, debilitating pain.

The procedure was performed by associate professors of neurosurgery Kee Kim and Rudolph Schrot. It used bone marrow-derived adult stem cells to promote the growth of the bone tissue essential for spinal fusion following surgery, as part of a nationwide, multicenter clinical trial of the therapy.

Removal of the cervical disc relieves pain by eliminating friction between the vertebrae and/or nerve compression. Spinal fusion is used following surgery for degenerative disc disease, where the cusioning cartilage has worn away, leaving bone to rub agains bone and herniated discs, where the discs pinch or compress nerves.

We hope that this investigational procedure eventually will help those who undergo spinal fusion in the back as well as in the neck, said Kim, who also is chief of spinal neurosurgery at UC Davis. And the knowledge gained about stem cells also will be applied in the near future to treat without surgery those suffering from back pain.

Millions of Americans are affected by spine diseases, with approximately 40 percent of all spinal fusion surgery performed for cervical spinal fusion. Some 230,000 patients are candidates for spinal fusion, with the numbers of potential patients increasing by 2 to 3 percent each year as the nation's population ages.

This is an exciting clinical trial to test the ability of the bone-forming stem cells from healthy donors to help patients with spinal disease, said Jan Nolta, director of the UC Davis Institute for Regenerative Cures.

For the past 50 years, bone marrow-derived stem cells have been used to rebuild patients' blood-forming systems. We know that subsets of stem cells from the marrow also can robustly build bone. Their use now to promote vertebral fusion is a new and extremely promising area of clinical study, she said.

The stem cell procedure at UC Davis took place early in August. The patient was a 53-year-old male from the Sacramento region with degenerative disc disease.

In the surgery, called an anterior cervical discectomy, a cervical disc or multiple discs are removed via an incision in the front of the neck. The investigational stem cell therapy then is applied to promote fusion of the vertebrae across the space created by the disc removal.

The stem cells are derived from a healthy single adult donor's bone marrow, and thus are very homogenous, Kim said. They are grown in culture to high concentration with minimal chance for rejection by the recipient, he said.

Adequate spinal fusion fails to occur in 8 to 35 percent or more of patients, and persistent pain occurs in up to 60 percent of patients with fusion failure, which often necessitates additional surgery.

A lack of effective new bone growth after spine fusion surgery can be a significant problem, especially in surgeries involving multiple spinal segments, said Schrot, co-principal investigator for the study. This new technology may help patients grow new bone, and it avoids harvesting a bone graft from the patient's own hip or using bone from a deceased donor.

Current methods of promoting spinal fusion include implanting bone tissue from the patient's hip or a cadaver to encourage bone regrowth as well as implanting bone growth-inducing proteins. However, the Food and Drug Administration has not approved the use of bone morphogenetic proteins for cervical spinal fusion. Their use has been associated with life-threatening complications, particularly in the neck.

The leading-edge stem cell procedure is part of a prospective, randomized, single-blinded controlled study to evaluate the safety and preliminary efficacy of an investigational therapy: modified bone marrow-derived stem cells combined with the use of a delivery device as an alternative to promote and maintain spinal fusion.

The study includes 10 investigational centers nationwide. The UC Davis Department of Neurological Surgery anticipates enrolling up to 10 study participants who will be treated with the stem cell therapy and followed for 36 months after their surgeries. A total of 24 participants will be enrolled nationwide.

Poll finds two-thirds of California voters unprepared for costs of growing older

Tue, 16 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) California's weak economy has voters cutting back on current expenses and largely unable to meet essential future ones, such as the cost of long-term care, according to a new poll from The SCAN Foundation and the UCLA Center for Health Policy Research.

The poll, in its second year, sought to better understand health and long-term care issues facing middle-aged voters, given the state's current economic crisis and the rising number of Californians older than 60, a figure that is projected to nearly double to 12 million people in the next 25 years.

The poll found that Californians, regardless of political party or income level, were worried about the costs of growing older. Two-thirds (66 percent) of respondents said that they are apprehensive about being able to afford long-term care. Sixty-three percent worry as much about paying for long-term care as they do about paying for their future health care.

Voters' ability to save for long-term care expenses is hampered by California's weak economy. Nearly half (48 percent) of voters 40 and older said their household income has declined in the past 12 months, and 50 percent said they had to take money out of savings to meet their expenses. Four in ten (41 percent) have had to cut down on the amount they spend on food in the past year.

Californians need affordable options to age with dignity and independence so that they can live how they want in the place they call home, said Dr. Bruce Chernof, president and CEO of The SCAN Foundation. With so many Californians struggling financially today, it is hard for them to think about the future, yet planning for future needs is an essential component of growing older and necessary for one's personal health, as well as the state's fiscal health, especially given the high cost of long-term care.

Conducted by Lake Research Partners and American Viewpoint, the poll surveyed 1,490 registered California voters age 40 and older in English and Spanish. Findings show that regardless of their political party affiliation or income level, voters have continuing aging-related concerns over the loss of independence (73 percent), losing memory or other mental abilities (70 percent), and worsening health (70 percent).

The costs associated with living with these potentially debilitating health conditions are high, yet Californians underestimate their potential need for support and services. Sixty-three percent predicted they would need help, but according to the U.S. Department of Health and Human Services, 70 percent of Americans over the age of 65 will need long-term care services at some point in their lives, and more than 40 percent will receive care in a nursing home for even a short period of time.

Among other findings, California voters age 40 and older:

Breast-feeding babies staves off asthma risk

Mon, 25 Jul 2011 18:36:33 PST

( from http://www.rxpgnews.com ) Breast-feeding a baby for six months post birth can stave off their risk of developing asthma-related symptoms in early childhood, says a scientific study.

The study looked at the impact of the duration of breast-feeding and the introduction of alternative liquids or solids in addition to breast milk.

Generation R Study researchers from Erasmus Medical Centre in The Netherlands, used questionnaires to gather data about over 5,000 children, the European Respiratory Journal reports.

They ascertained in the first 12 months after birth whether the children had ever been breast-fed, when breast-feeding was stopped, and whether any other milk or solids were introduced.

Further questionnaires were completed when the children were aged 1, 2, 3 and 4 years to check whether they had any asthma-related symptoms.

The results showed that children who had never been breast-fed had an increased risk of wheezing, shortness of breath, dry cough and persistent phlegm during their first four years, compared to children who were breast-fed for more than six months.

The strongest links were seen with wheezing and persistent phlegm, as children were 1.4 and 1.5 times more likely to develop these symptoms if they had never been breast-fed.

Children who were fed other milk or solids during their first four months in addition to breast milk had an increased risk of wheezing, shortness of breath, dry cough and persistent phlegm during the first four years, compared to children who were exclusively breast-fed for their first four months.

Agnes Sonnenschein-van der Voort, researcher at Generation R, who led the study, said: 'These results support current health policy strategies that promote exclusive breastfeeding for 6 months in industrialised countries.'

--Indo-Asian News service

st/vd/vt

Vitamin D can help elderly women survive

Tue, 05 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Giving vitamin D3 (cholecalciferol) to predominantly elderly women, mainly in institutional care, seems to increase survival. These women are likely to be vitamin D deficient with a significant risk of falls and fractures. This is the key conclusion in a systematic review published in the latest edition of The Cochrane Library.

Up until now there has been no clear view on whether there is a real benefit of taking vitamin D. A Cochrane meta-analysis published only a couple of years ago found that there was some evidence for benefit, but it could not find an effect on mortality. We were, however, aware that more trials had been published and wanted to assess the effects of vitamin D when you added all the data together, said Dr Goran Bjelakovic, who works at Department of Internal Medicine - Gastroenterology and Hepatology, at the University of Nis, in Serbia and at The Cochrane Hepato-Biliary Group at The Copenhagen Trial Unit in Copenhagen, Denmark.

The eight-strong international team of researchers identified 50 randomised trials that together had 94,148 participants. They had a mean age of 74 years, and 79% were women. Our analyses suggest that vitamin D3 reduces mortality by about 6%. This means that you need to give about 200 people vitamin D3 for around two years to save one additional life, says Bjelakovic.

There were no significant benefits of taking other forms of vitamin D such as vitamin D2, and the active forms of the vitamin, alfacalcidol or calcitriol. However, the researchers point out that they could only find much less data relating to these types of vitamin D and so these conclusions should be taken with caution. We need to have more randomised trials that look specifically to see whether these forms of vitamin D do or don't have benefits, says Bjelakovic. His team did conclude that alfacalcidol and calcitriol significantly increased the risk of hypercalcaemia, and vitamin D3 combined with calcium significantly increased the risk of kidney stones.

There have been reports and comments that taking vitamin D can reduce the risk of getting cancer, but this work showed no evidence that vitamin D reduced cancer-related mortality.

Previous reviews of preventive trials of vitamin D have not included as much information and have not examined the separate influence of different forms of vitamin D on mortality. By taking data from a larger number of trials we have been able to shed much more light on this important issue, says Bjelakovic.

Cutting down on salt doesn't reduce your chance of dying

Tue, 05 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Moderate reductions in the amount of salt people eat doesn't reduce their likelihood of dying or experiencing cardiovascular disease. This is the main conclusion from a systematic review published in the latest edition of The Cochrane Library.

There is lots of evidence that reducing dietary salt intake reduces blood pressure and the researchers did see some indication of this occurring. Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months, says lead author Professor Rod Taylor who works at the Peninsula College of Medicine and Dentistry at the University of Exeter.

What we wanted to see was whether this dietary change also reduced a person's risk of dying or suffering from cardiovascular events, says Taylor.

An earlier Cochrane review of dietary advice published in 2004 could not find enough evidence to allow the researchers to draw any conclusions about the effects of reducing salt intake on mortality or cardiovascular events. In Taylor's newly published research, however, the team managed to locate seven studies that together included 6,489 participants. This gave a sufficiently large set of data to be able to start drawing conclusions. Even so, Taylor believes he would need to have data from at least 18,000 individuals before he could expect to reveal any clear health benefits.

Most experts are agreed that consuming too much salt is not good for you and that salt reduction is beneficial in people with normal and high blood pressure. We believe that we didn't see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large, says Taylor. He believes that health practitioners need to find more effective ways of reducing salt intake that are both practicable and inexpensive.

Many countries have government-sanctioned recommendations that call for reduced dietary sodium. In the UK, the National Institute of Health and Clinical Guidance (NICE) has recently called for an acceleration of the reduction in salt in the general population from a maximum intake of 6g per day per adult by 2015 to 3g by 2025.

With governments setting ever lower targets for salt intake, and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake, says Taylor.

Hospital outcomes research named 'Article of the Year'

Mon, 13 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Health services researchers who studied controversial aspects of Medicare spending and quality of patient care received a prestigious award yesterday from the nation's largest health services research professional association.

The organization, AcademyHealth, presented its 2011 Article of the Year Award to Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, and his collaborator, Robert Kaestner, Ph.D., of the University of Illinois at Chicago. The award presentation occurred yesterday at AcademyHealth's Annual Research Meeting in Seattle.

The Article of the Year Award recognized two companion studies by Silber and Kaestner: Aggressive Treatment Style and Surgical Outcomes, published in the December 2010 issue of the journal Health Services Research, and Evidence on the Efficacy of Inpatient Spending on Medicare Patients, published the same month in The Milbank Quarterly.

As an indicator of aggressive care, Silber and Kaestner used the Dartmouth Index, a prominent set of measures of inpatient spending on elderly patients. In studying over 5 million Medicare admissions for various surgeries between 2000 and 2005, they found that surgical patients in hospitals with a more aggressive treatment style were less likely to die within 30 days of admission compared to patients in less aggressive hospitals. They also found that this benefit was stable, persisting after the 30-day mark.

Silber, who is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said that these findings contradicted cost-cutting arguments made by those who assert that patients would not be harmed by reductions in Medicare spending. People have recently argued that more spending does not yield gains in quality of care, said Silber. Our study suggests that such a belief may be incorrect, and that cutting spending through reductions in aggressiveness may lead to worse outcomes. We should not kid ourselves that the process of reducing Medicare expenditure will be a painless one.

Much of the high cost associated with surgery is the result of complications. We studied whether more aggressive measures lead to more complications, and found there was no difference in complication rates between aggressive and less-aggressive hospitals, said Silber, adding, However, when complications arise, patients are more likely to survive those complications if they receive aggressive treatment.

The survival rates after 30 days were important, said Silber. After that period, patients at both aggressive and less aggressive hospitals had equal survival rates one year after admission; there was just a greater initial chance of surviving at the more aggressive hospitals. It appears, said Silber, that the survival benefits gained at aggressive hospitals are as stable as in patients who survive at less aggressive ones, suggesting that the life saved at more aggressive hospitals is not more fragile or fleeting than a survivor in the less aggressive hospital.

Researchers discover biochemical weakness of malaria parasite -- vaccine to be developed

Tue, 07 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Every year, 10,000 pregnant women and up to 200,000 newborn babies are killed by the malaria parasite. Doctors all around the globe have for years been looking in vain for a medical protection, and now researchers from the University of Copenhagen have found the biochemically weakness of the lethal malaria parasite, and will now start developing a vaccine to combat pregnancy related malaria.

The malaria parasite travels via the spit of an infected mosquito to the liver of the new host, where it spreads to the red blood corpuscles and starts to reproduce itself.

Pregnant women and children below the age of five years are particularly vulnerable to malaria because of the parasite's survival mechanisms. The parasite has a protein hook designed to attach it to the placenta and this leads to amnesia of the mother who in worst case can die or deliver prematurely. This increases the maternal mortality - and infant mortality, explains Associate Professor Ali Salanti from the University of Copenhagen's Centre for Medical Parasitology who manages the project.

The body's immune system normally attacks any foreign body but since our spleen constantly filters our blood and removes ruined or deform blood cells, the body's natural defense does not need to check the blood. And the malaria parasite exploits this fact.

An infected red blood corpuscle is more stiff than in its normal state and this would usually trigger the spleen to destroy the cell and parasite, but the malaria parasite has an advanced arsenal of protein hooks. With these hooks the parasite attaches itself to the inner side of the blood vessel and even if our immune system succeeds in defeating one hook, the parasite has 60 different hooks, which again differ from one malaria parasite to another.

Researchers have for years been looking for a vaccine which can attack the malaria parasite's specific placenta hook. This is tricky not least due to the fact that the parasite's hooks are long proteins which are difficult to produce artificially in the lab when developing of a vaccine.

After intensive research efforts, the researchers have now succeeded in identifying a fragment of the placenta hook (VAR2CSA) which not only is crucial for the parasite's ability to attach itself to the placenta, but also is possible to produce artificially for a vaccine.

A vaccine must stimulate the immune system to quickly attack something foreign in the body. Therefore, it was a matter of finding the part of the placenta hook, which the parasite cannot manage without and which we could target a vaccine against, says Associate Professor Ali Salanti.

With a grant of 15 million DKK (approximately 3 million USD) from the Danish National Advanced Technology Foundation and close corporation with two Danish biotech companies, the researchers can now start developing the vaccine and take it through the first trials to test its safety.

Ali Salanti and his colleagues will collaborate with the biotech companies ExpreS2ion Biotechnologies and CMC Biologics A/S to develop a method for mass production of the vaccine.

Once this has fallen into place, the researchers can start up the clinical trials on animals and human beings. If the trials are successful the parasistologists from the University of Copenhagen and their partners will make a significant contribution in reaching the UN's Millennium Development goal number 4 and 5. These two goals encourage every country in the world to work on lowering global child mortality with two thirds and maternal mortality with three quarters.

Stevens biomedical engineering students fight hypothermia on the battlefield

Mon, 23 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A Biomedical Engineering Senior Design team at Stevens Institute of Technology is working with the U.S. Army and New Jersey physicians to develop a new device to combat hypothermia among wounded soldiers.

Team Heat Wave is composed of seniors Walter Galvez, Amanda Mendez, Geoffrey Ng, and Dalia Shendi, in addition to Biomedical Engineering graduate student Maia Hadidi. The team's faculty advisor is Dr. Vikki Hazelwood and consulting physician is Dr. Herman Morchel from Hackensack University Medical Center. Additional expert support from industry and military was provided by Jan Skadberg, RN, Colonel Boots Hodges, Stevens Burrows, and Major Jim Fulton.

Stevens unique Senior Design approach gave students real-world experience developing a practical technology in collaboration with the military, says Dr. Hazelwood. This is a fantastic project with a life-saving application as well as entrepreneurial potential.

Developing a portable device to re-warm patients suffering from hypothermia has the potential to substantially impact battlefield medicine. Loss of blood after trauma is the number one cause of combat fatalities in the United States armed forces. Hypothermia complications associated with loss of blood are shown to reduce the rate of survival after severe trauma by 22.5%.

Current methods for fighting hypothermia in combat zones are to use an IV drip and wool blanket, says Geoffrey. With these means it takes up to 16 hours to increase the core body temperature to a more stable point.

The Heat Wave system uses heated, humidified air delivered through an oxygen mask to capitalize on the patient's respiratory system. Capitalizing on the fact that the entire blood volume passes through the lungs, this heat is rapidly transferred to the blood via convection. Tests of their system show it is more effective than current treatments.

We can decrease the time needed to resuscitate a hypothermic patient to just four hours, a 75% reduction in treatment time, reports Maia. Not only does this increase survival rates for the patient, but it also frees up field medics so they can attend to others.

The team developed a prototype to test their concept. A heater/humidifier pumps air into an insulated container simulating the lungs, which is connected to an additional container representing the cardiovascular system. Heat transfers between the containers via a water-filled tube to simulate convection between lungs and blood. Heat and humidity are continually recorded via sensors wired to a laptop computer.

The hands-on Senior Design process is very helpful, Dalia says. Before Stevens, I had little real experience, and now I know I can research a problem, look at the market for a product, and build and test a successful prototype.

In addition to presenting their research at Senior Projects Expo April 27, the team is participating in the Student Elevator Pitch competition during Research and Entrepreneurship Day on April 29.

Now that we have proof of concept, we want to pass this idea to someone who can make it into a portable device viable for field treatment, Amanda says.

Not only is it a life-saving product, but it also has great market potential, says Geoffrey, who is representing the team for the elevator pitch. The Heat Wave system does not replace current treatments, but is used in parallel, so it has no direct competition.

The students report tremendous satisfaction knowing that their invention will save lives. Contributions like this are a constant fixture for biomedical engineers, a fact that has helped make careers in Biomedical Engineering one of the top-rated in the United States.

We all felt that this project offered us a unique opportunity, Walter recalls. We were able to collaborate with the military to save the lives of our soldiers.

New tool to measure outcomes could help improve arm surgery for devastating nerve injury

Fri, 20 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The way that clinicians report outcomes of surgery for a traumatic nerve injury involving the arm is not standardized, and it is thus difficult to compare the efficacy of different surgical treatments, according to a study by researchers at Hospital for Special Surgery (HSS) in New York. In a second HSS study, investigators say they have developed a tool to measure outcomes that they hope can be refined and used worldwide. Both studies will be presented at the International Symposium on Brachial Plexus Surgery, which will be held in Lisbon, Portugal, May 19-21.

There is a great deal of discrepancy in how the results of brachial plexus surgery are reported. This makes it hard to compare and contrast studies and understand outcomes of brachial plexus surgeries across centers and across continents. From this work, we have determined that there is a need for a standardized outcomes measurement system or tool, said Steve K. Lee, M.D., who will be joining HSS in August to help launch the Hospital for Special Surgery Center for Brachial Plexus and Complex Nerve Injury and will serve as the center's research director.

To advance the science, you can only compare what we are doing here and what others are doing in other countries if we are all speaking the same outcomes language and using the same tool, noted Dr. Lee, who is currently an associate professor in the Department of Orthopedic Surgery at New York University Hospital for Joint Diseases. He points out that many of the studies are conducted in Thailand and Brazil, where brachial plexus injury is common because of the popularity of mopeds and motorcycles.

Injuries to the brachial plexus, the nerves that conduct signals to the shoulder, arm, and hand, can have devastating consequences, including loss of function and chronic pain. These nerves originate at the spinal cord and correspond to four neck vertebrae and one thoracic (upper back) vertebrae. Symptoms include partial or complete inability to move the arm. The injury most frequently occurs from high-energy impact activities such as motor vehicle or motorcycle accidents, falls from significant heights, and high impact sporting injuries. In recent years, clinicians have made great strides in improving the surgery to treat this condition. After surveying the literature, however, HSS investigators began to discern that studies that reported outcomes of this surgery were not looking at the same characteristics.

To investigate this further, they conducted a search of Medline, the National Library of Medicine's premier bibliographic database, using the keywords brachial plexus, surgery, and outcomes. The search identified 660 articles on adult brachial plexus injuries over the past three years. After excluding articles that did not discuss surgical outcomes for this condition, they identified 49 articles that qualified for the final analysis. Drs. Lee, Scott W. Wolfe and Rohit Garg analyzed the type of brachial plexus outcome parameters and the consistency of outcomes-reporting between authors and centers. They found that reporting was very inconsistent.

Muscle strength, the most commonly reported outcome, was discussed in 84 percent of articles. Range of motion, however, was reported in less than half of the papers. No papers measured motion of the entire upper extremity and only 14 percent of papers detailed how the motion was measured. Functional outcome scores were recorded in only 12 percent and scores were recorded using different tools, so comparing studies was difficult. Functional outcome scores were recorded using a variety of different tools, including the DASH (Disabilities of the Arm, Shoulder, and Hand measure), a 30-item, self-report questionnaire designed to measure physical function and symptoms, as well as other tools such as the Constant Score for Shoulder Function, VAS functional score, or institution-specific questionnaires. Only 27 percent of papers measured sensation and only 8 percent recorded assessments of pain. No article reported all five outcome measurements: strength, range of motion, functional scores, sensibility, and pain. The maximum number of outcomes a paper reported was three (14 percent of papers), and the remaining articles reported only one or two outcomes.

In a second study, the same investigators describe a first draft of a tool that they hope clinicians can use so that the reporting of outcomes is standardized. What we are doing is presenting this to the international community to get buy in on the concept, said Scott W. Wolfe, M.D., hand and upper extremity surgeon and director of the soon-to-open Hospital for Special Surgery Center for Brachial Plexus and Complex Nerve Injury. This is a first iteration and we hope the group will respond favorably, but we'd like to get researchers and plexus surgeons from the Far East, Europe, the States and South America to work together to design a system that we all feel will function effectively for our patients.

Dr. Wolfe said they had looked at different tools that doctors were using to see if they could come up with one that would work for brachial plexus surgery, but none of them were adequate and inclusive. We had to take elements of different instruments as well as elements that we designed to derive a complete system, Dr. Wolfe said. We're studying an injury of several critical nerves, an injury that affects the arm in a way that is very different from that of a fracture or degenerative disease. We needed to design an innovative way to analyze and report outcomes, because we're simultaneously assessing nerve, muscle and joint recovery. By way of example, although a patient's nerves could recover beautifully in a particular case, if their shoulder is frozen or their hand atrophied, the patient may not have a functional recovery; unless all elements are assessed, the analysis is incomplete.

The key elements of the instrument are measurements of motion, strength and function for seven critical domains of the upper extremity: shoulder elevation, shoulder external rotation, elbow flexion, elbow extension, wrist extension, finger flexion and intrinsics (the distance the fingers can be spread apart). The tool involves assessing tasks such as touching the back of your head, touching your mouth and holding a utensil.

The researchers hope that with help from the international community, the tool can be refined and outcomes can be standardized across research centers and across continents.

Egyptian princess was first person with diagnosed coronary artery disease

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Embargo: 17 May 2011 18:00 CET-- The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) this week in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

The Egyptian princess Ahmose-Meryet-Amon, who lived in Thebes (Luxor) between 1580 and 1550 BC and who is now known to be first person in human history with diagnosed coronary artery disease, lived on a diet rich in vegetables, fruit and a limited amount of meat from domesticated (but not fattened) animals. Wheat and barley were grown along the banks of the Nile, making bread and beer the dietary staples of this period of ancient Egypt. Tobacco and trans-fats were unknown, and lifestyle was likely to have been active.

The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) currently taking place in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

Both presentations will be based on findings from the Horus study, in which arterial atherosclerosis was investigated in 52 ancient Egyptian mummies. Results have shown that recognisable arteries were present in 44 of the mummies, with an identifiable heart present in 16. Arterial calcification (as a marker of atherosclerosis) was evident at a variety of sites in almost half the mummies scanned, prompting the investigators to note that the condition was common in this group of middle aged or older ancient Egyptians; the 20 mummies with definite atherosclerosis were older (mean 45.years) than those with intact vascular tissue but no atherosclerosis (34.5 years).

Although relatively common at other vascular sites, atherosclerosis in the coronary arteries was evident in only three of the mummies investigated, but was clearly visualised in Princess Ahmose-Meryet-Amon (in whom calcification was present in every vascular bed visualised).

The CT scan image below shows that the princess, who died in her 40s, had atherosclerosis in two of her three main coronary arteries. Today, said Dr Gregory S Thomas, director of Nuclear Cardiology Education at the University of California, Irvine, USA, and co-principal investigator of the Horus study, she would have needed by-pass surgery.

Overall, it was striking how much atherosclerosis we found, said Dr Thomas. We think of atherosclerosis as a disease of modern lifestyle, but it's clear that it also existed 3500 years ago. Our findings certainly call into question the perception of atherosclerosis as a modern disease.

If, however, the princess enjoyed a diet deemed to be healthy and pursued a lifestyle probably active, how could this disease of modern life affect her so visibly? Dr Thomas and his co-principal investigator Dr Adel Allam of Al Azhar University, Cairo, suggest three possibilities.

First, that there is still some unknown risk factor for cardiovascular disease, or at least a missing link in our understanding of it. Dr Allam noted a likely effect of genetic inheritance, pointing out that much of the human predisposition to atherosclerosis could be secondary to their genes. He similarly raised the possibility that an inflammatory response to the frequent parasitic infections common to ancient Egyptians might predispose to coronary disease - in much the same way that immunocompromised HIV cases seem also predisposed to early coronary disease. Nor can a dietary effect be excluded, despite what we know of life in ancient Egypt. Princess Ahmose-Meryet-Amon was from a noble family, her father, Seqenenre Tao II, the last pharaoh of the 17th Dynasty.

So it's likely that her diet was not that of the common Egyptian. As a royal, she would have eaten more luxury foods - more meat, butter and cheese. Moreover, foods were preserved in salt, which may also have had an adverse effect.

Despite the suggestion of a genetic, inflammatory or unknown effect, Drs Thomas and Allam were keen not to discount those risk factors for heart disease which we do know about. Indeed, even in the study's apparent association of atheroma with increasing age, there was a pattern of prevalence consistent with our own epidemiology today. Recent studies have shown that by not smoking, having a lower blood pressure and a lower cholesterol level, calcification of our arteries is delayed, said co-investigator Dr Randall C Thompson of the St Luke's Mid-America Heart Institute in Kansas City, USA. On the other hand, from what we can tell from this study, humans are predisposed to atherosclerosis, so it behoves us to take the proper measures necessary to delay it as long as we can.

Results from study of 8,000 older people in Ireland launched

Wed, 11 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The first results from The Irish Longitudinal Study on Ageing (TILDA), a national study of 8,000 older people aged 50 and over in Ireland, were launched this week by the Minister for Health and Children, Dr James Reilly.

TILDA is the most comprehensive study ever conducted on ageing in Ireland. Between 2009- 2011, over 8,000 people aged 50 and over were randomly selected across the country and interviewed about many aspects of their lives including issues such as health, financial circumstances and quality of life. Almost 85 per cent of the participants also underwent a rigorous health assessment. The same group will be interviewed every two years until 2018. Further health assessments will be undertaken on the participants in 2014 and 2018. This report, Fifty Plus in Ireland 2011: First Results from the Irish Longitudinal Study on Ageing, contains initial findings from the study. TILDA is funded by the Department of Health and Children, Irish Life and The Atlantic Philanthropies.

Commenting on the significance of the study, Principal Investigator of TILDA and Professor of Medical Gerontology, Professor Rose Anne Kenny said: The importance of this study cannot be understated. By collecting and analysing this data, we will be able to develop a much deeper understanding of the lives and circumstances of older people and of the factors which lead to good health and good quality of life in older ages. This will mean that Ireland will be better placed to plan for the ageing of our population and to help policy makers ensure that limited resources are correctly targeted to those in need. TILDA provides exciting opportunities for Research and Development and new models of service delivery to create employment in this rapidly developing demographic. We are deeply grateful to our participants. Because of their generosity in taking the time to provide us with this crucial information, Ireland now and in the future will greatly benefit.

When launching the report, the Minister said that the Study's high quality objective and subjective measurements of health coupled with its longitudinal design will provide a truly unique knowledge base that will inform policies for older people in the years ahead.

The findings in the report cover many topics and show that there is considerable diversity across older adults in terms of the various dimensions of their lives. A selection of findings is highlighted below.

When the participants were asked about their quality of life, the following emerged.

Heart failure treatment options have come a long way

Thu, 05 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year the Heart Failure Congress 2011, organised by the Heart Failure Association of the European Society of Cardiology (ESC), offers a strong scientific programme featuring 11 late breaking trials and clinical updates, over 1000 original abstracts (submitted by delegates from 61 countries), 14 industry sponsored satellites and mini satellites and over 70 separate sessions.

The presentations will demonstrate the fantastic improvements we've seen in both treatment options for heart failure and understanding of the mechanisms behind the disease. The field has come an awfully long way since the ESC first started holding dedicated heart failure meetings in 1995, said Professor Karl Swedberg, Scientific Chairperson of the Congress programme.

Highlights of the late breaking trials and clinical updates programme will include the SHIFT trial with ivadrabine, EMPHASIS-HF with eplerenone, an update on the MADIT CRT trial on how to predict optimal benefits from CRT, Northstar, and two telemonitoring trials - The TEHAF study and TIM-HF.

The Heart Failure Congress, which represents the largest meeting on heart failure in the world, offers the opportunity for everyone in the heart failure community to come together. It will help get delegates up to speed on the core topics and associated technologies that they need in their daily clinical practice, said Professor Piotr Ponikowski, President of the Heart Failure Association.

Delegates attending the Heart Failure meeting, which expects to attract around 2500 attendees, will include cardiologists, internists, general physicians, basic scientists, epidemiologists, nurses, and industry affiliates.

The overall theme of the congress will be co-morbidities, with sessions focusing on heart failure and diabetes, lung disease, renal impairment, hypertension, cancer, cardio-renal syndrome and anaemia. More and more patients with heart failure are suffering from co-morbidities. The problem heart failure clinicians face on a daily basis is how best to integrate the different medications and approaches to treatments, said Swedberg.

Other important topics that will be covered in depth are devices and technologies, including ICDs, CRT and LVAD, with sessions exploring how to apply the new findings in clinical practice.

One event likely to attract high attendance is an over view of the Surgical Treatment for Ischemic Heart Failure (STICH) trial, which will be presented by Christopher O'Connor (Durham, US) in a debate session at 14.15 on Monday in the Stockholm Lecture Room. The STICH trial, comparing CABG therapy and medical therapy in patients with left ventricular ejection fractions less than 35%, was first presented at the American College of Cardiology meeting in April. This session will provide a good opportunity for delegates to get to grips with how to interpret the results of this really important trial, with opportunities to ask the presenters questions, said Swedberg.

A highlight on Saturday will be the presidential debate that is being held as a joint session with the Heart Failure Society of America, to explore two controversial issues in heart failure treatment. One debate will feature whether ICDs are being over used in Europe, and the other will explore the controversy over whether heart rate reduction beyond beta blockers is effective in heart failure. Other joint sessions that will be held include Imaging heart failure, with the European Association of Echocardiography on Saturday, and the impact of new atrial fibrillation guidelines on heart failure management on Sunday with the European Heart Rhythm Association (EHRA).

For the first time the meeting will not offer a dedicated nursing tract. This was a conscious decision because we want to emphasize the team spirit that goes on in the management of heart failure patients. The work of physicians and nurses in heart failure should be properly integrated, explained Swedberg. Sessions that may be of particular interest to nurses will include palliative care for patients with end-stage heart failure, and how to talk to your patients.

In the opening ceremony a life time achievement award will be presented for the first time to Professor John Kjekshus, from the University of Oslo, Norway, who over the past 40 years has been involved in many trials in the development of treatments for heart failure, including the TIMOLOL trial, CONSENSUS trial, the 4 S trial, the MERIT trial and the CORONA trial.

To recognise the contribution of young researchers the Heart Failure Association Board are inviting delegates under 35 years to a special reception with faculty members that will be held on Monday evening. We want to emphasise the importance that we place on young researchers because they represent our new blood, said Ponikowski. The idea is to provide them with a clear picture of our aims, mission and on-going initiatives in the hope that we can inspire them to get more involved.

On Sunday a poster session providing updates from industry on the latest ongoing trials will be co chaired by John McMurray (Glasgow, GB) and Stefan Anker (Berlin, DE). The objective is to provide industry with an opportunity to present their ongoing trials and the audience to ask questions. It will be a real opportunity for delegates to get a feel for what's in the pipeline, said Ponikowski.

The city of Gothenburg provides an ideal venue for the congress. The many advantages include close proximity between hotels and the congress centre, together with many cultural and social attractions said Swedberg, adding that the closeness to the sea makes Gothenburg particularly special with a half-hour tram ride taking you straight into the southern archipelago.

Pharmacogenetics testing offers way to reduce deaths from drug toxicity

Mon, 11 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) On average, a drug on the market works effectively for only 50% of the people who take it. Would you want to prevent a potential adverse drug effect or even toxicity through a simple test? It's not science fiction, but a reality. Pharmacogenetics (PGx) is the study of an individual's variation in DNA sequence related to drug response. The goal is to select the right drug at the right dose, and to avoid adverse drug reactions or ineffective treatment.

Dr. Tara Sander, Associate Professor of Pathology, Pediatric Pathology, Medical College of Wisconsin, and Scientific Director of Molecular Diagnostics, Children's Hospital of Wisconsin, is first author of a poster to be presented at Experimental Biology 2011 in Washington, DC, on Monday, April 11, in an American Society for Investigative Pathology session on Better Research Through BioOmics. She led a study that aimed to develop a PGx test for forensics. The PGx test can be used on a living or deceased person; in cases of death, the test can help identify whether the drug toxicity was due to the person's genotype and therefore provide forensic evidence that supplements medical history, scene investigation, autopsy, and toxicology for death certification. Sander and colleagues looked at specific genetic variants to see if the selected assays detected the correct genotype in the samples. The results showed that ABI TaqMan Drug Metabolism Genotyping and Copy Number Variant assays detected the correct genotype in 52 of 54 samples with 96% accuracy.

Sander's clinical test refers to the promise of Personalized Medicine, a term used frequently by former NIH Director Elias Zerhouni to define the use of information about an individual patient to select or optimize their medical care. More recently, the term Personalized Justice has been defined as using genotypic information to complement Personalized Medicine and to help explain drug-related toxicity, sensitivity, impaired performance, and behavioral changes. These two ideas complement each other and can lead to better drug therapy.

Moving forward, pharmacogenetics testing is at the forefront of reducing adverse drug reactions and increasing drug effectiveness. Hopefully more physicians will apply this to their drug treatment plans and reduce toxic cases/deaths, said Sander. Patients would ideally be tested in advance to determine which medications would work best and at what dosage.

There are still cases in which a person receives the wrong drug or the wrong dose. With knowledge of their genotype, this could be avoided, said Sander. Because insufficient genotype-phenotype associations still remain, research needs to be done to show a direct correlation between variation and side effect for specific drugs. Sander hopes that clinical studies will further elucidate the correlation between the genetic variation and the studied phenotypic side effect.

Mannose receptor plays a key role in allergic responses to cat dander

Thu, 10 Mar 2011 06:16:04 PST

( from http://www.rxpgnews.com ) The team of immunologists led by Drs Ghaem-Maghami and Martinez-Pomares in the University's School of Molecular Medical Sciences, and funded by the charity Asthma UK, have identified a cell component which plays a key role in triggering allergic responses to cat dander.

The discovery furthers our understanding of how the body's immune system identifies and reacts to allergens, which could pave the way in developing new ways of treating allergies.

The development is especially good news for the millions of people with asthma whose condition is often worsened by their allergy to airborne allergens from cat dander or house dust mite. Cat dander consists of microscopic pieces of cat skin which easily become airborne.

Dr Amir Ghaem-Maghami said: "There has been a sharp increase in the prevalence of allergies over the past few decades and allergic asthma among children has reached epidemic proportions in many industrialised countries, including the UK.

"Despite improvements in patient care, three people die every day in the UK from asthma, and most therapies target symptoms rather than curing the condition.

"Many people with asthma are highly sensitive to airborne allergens such as cat dander or house dust mite — in fact many studies have shown that up to 40 per cent of children with asthma are allergic to cat allergens.

"A better understanding of how the interaction between allergens and the immune system leads to allergy is vital if we are to develop more effective and efficient treatments for this debilitating condition."

Dr Elaine Vickers, Research Relations Manager at Asthma UK, says: "We are delighted to see the rapid progress that Dr Ghaem-Maghami and his colleagues are making in such a complex area of research.

"This is a great example of where Asthma UK's research funding is leading to a better understanding of asthma which could ultimately benefit thousands of people with both asthma and allergies."

Allergy is a disorder caused by the body's immune system reacting to usually harmless substances found in the environment, known as allergens. Believing itself under attack, the immune system produces a molecule called IgE, which eventually leads to release of further chemicals (including histamine) by certain immune cells which together cause an inflammatory response and the classic symptoms of allergy — itchy eyes, sneezing, runny nose and wheezing.

The Nottingham work, recently published in the Journal of Biological Chemistry, has focused on the role of the mannose receptor (MR), a receptor found on the surface of dendritic cells. These cells are among the first cells in the immune system that come into contact with allergens.

The team recently found that the MR binds to a wide range of allergens and plays an important role in the allergic response to house dust mite allergens. In their latest study they looked at the contribution of MR to allergy caused by a major cat allergen called Fel d 1.

They were able to prove that MR is needed for the body to recognise Fel d 1 as a potential foreign invader and for the production of IgE against Fel d 1. The discovery shows that MR plays a pivotal role not only in recognising allergens but also in provoking the body's allergic response to them.

Emergency mental health lessons learned from Continental Flight 3407 disaster

Tue, 01 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- When a disaster's physical evidence is gone -- debris removed, shooter arrested, ashes cold -- the psychological effects of the disaster on emergency responders and civilians involved still may burn.

Emergency mental health, a field often overlooked in the chaos, is a vital component of any disaster response, but may not be well represented in emergency preparedness planning.

Trained mental health responders to the Continental Flight 3407 disaster outside Buffalo in 2009 share their lessons learned on mental health preparedness in an article that appears in the current issue of Disaster Medicine and Public Health Preparedness.

Gregory G. Homish, PhD, assistant professor of community health and health behavior at the University at Buffalo School of Public Health and Health Professions and a specialist in emergency preparedness, is first author.

We hope our lessons learned will be useful to others to help them prepare for future disasters, he said.

Although it is a gross understatement, the crash of Flight 3407 was a tremendous loss for the families and friends of those on the aircraft, on the ground and for the community at large, Homish continues. However, pre-disaster planning, training and evaluations of previous responses help to ensure a coordinated approach to providing mental health services to all of the individuals in need.

The assessment found several key successes. Perhaps the most important was that authority and relationships among responders were clearly identified in advance.

Each emergency mental health team was assigned to a specific population, and leadership from all three teams communicated regularly by telephone or in person to ensure adequate coverage and no duplication of services, says Homish.

Many first responders are members of multiple teams in which they play different roles. For Flight 3407, responders chose a single team and had to stay with that team for the duration. This requirement was a lesson learned from a previous disaster, when it wasn't clear which team the individual was representing. This creates communication and coordination problems.

Other positive results were: Responders covered all persons who might be affected by the crisis, including responders and community members as well as victims and families.

Mental health referrals were long lasting and included nontraditional mental health approaches, such as canine therapy and massage therapists.

Also, preparedness includes ongoing recruiting of new members and providing frequent low-cost or free training, which keeps all responders up to date and familiar with other team members. Homish points out that these interactions provide essential skills training and increase efficiency during a deployment.

The report also discusses some areas in need of improvement. It points out that during a crisis one person may need to be assigned to focus entirely on administrative services, such as scheduling and coordinating the emergency mental health functions, to increase efficiency.

An additional recommendation noted the importance of integrating emergency mental health personnel into the overall command structure from the beginning.

The emergency mental health function was not represented initially during command briefings, says Homish.

For the first 24 hours, command staff made decisions about mental health needs of the community without having an expert available to provide consultation and direction. This resulted in a slight delay in the delivery of a comprehensive response to those affected by the disaster.

A final recommendation emphasizes that employers of volunteer responders need to be prepared to release emergency team members quickly from their jobs.

It's also important to note that traditional mental health services such as therapists, and complimentary approaches, such as canine therapy teams, are available to everyone, families as well as responders, Homish adds.

Mount Sinai develops first screening tool for war veterans to assess traumatic brain injury

Wed, 05 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A team of researchers at Mount Sinai School of Medicine has developed the first web-based screening tool for Traumatic Brain Injury (TBI). This instrument has recently been used by soldiers returning from the wars in Iraq and Afghanistan who participated in the Sixth Annual Road to Recovery Conference and Tribute in Orlando to determine if they sustained a TBI.

Traumatic brain injury is underdiagnosed, and left untreated can have long-term cognitive, behavioral and physical effects, said Wayne Gordon, PhD, the Jack Nash Professor of Rehabilitation Medicine and an Associate Director of the Department of Rehabilitation Medicine at Mount Sinai School of Medicine, who led the project. If we can intervene and diagnose TBI early, then we can prevent further complications.

Dr. Gordon and his team began working on this screening tool 20 years ago. Working in local schools, they found a surprising number of students with TBI but never reported it nor received medical attention, often because the injuries were sustained as a result of abuse or assault. Dr. Gordon wanted to develop an anonymous screening tool to help people assess their risk and avoid long-term complications.

The Brain Injury Screening Questionnaire (BISQ) is a web-based tool that allows users to anonymously answer a series of questions about whether they sustained a blow to the head in which they were unconscious or dazed, confused or disoriented. Their symptoms include sleep disturbances, irritability, memory disturbances, difficulties organizing daily tasks, and difficulty concentrating. At the end of the survey, participants receive a computer-generated report. Those who are found to be at risk are advised to seek further evaluation from a qualified health care professional.

According to Mark Wiederhold, MD, who presented at the conference, TBI was diagnosed in 41 percent of patients being treated in the Walter Reed Army Medical Center in Washington, DC. Dr. Gordon hopes that more veterans' organizations will embrace the tool in this population so that they are treated early.

I applaud the Coalition to Salute America's Heroes and The American Legion for taking the first step toward bringing this serious issue to the forefront, and encouraging veterans to get screened, said Dr. Gordon. I hope more organizations around the country will follow suit.

It is estimated that about seven percent of people in the United States have diagnosed or undiagnosed TBI. Dr. Gordon and his team from the Department of Rehabilitation Medicine at Mount Sinai plan to conduct research using the screening tool in other populations as well. The researchers are using BISQ to assess TBI in the prison population in Texas to determine how the condition may contribute to criminality.

The software is $15.00. For more information visit

In the lab, engineer's novel liquid provides a solid fix for broken bones

Tue, 07 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Here's the vision: an elderly woman comes into the emergency room after a fall. She has broken her hip. The orthopaedic surgeon doesn't come with metal plates or screws or shiny titanium ball joints. Instead, she pulls out a syringe filled with a new kind of liquid that will solidify in seconds and injects into the break. Over time, new bone tissue will take its place, encouraged by natural growth factors embedded in the synthetic molecules of the material.

Although still early in its development, the liquid is real. In the Brown engineering lab of professor Thomas Webster it's called TBL, for the novel DNA-like twin-base linker molecules that give it seemingly ideal properties. The biotech company Audax Medical Inc., based in Littleton, Mass., announced on Dec. 7 an exclusive license of the technology from Brown. It brands the technology as Arxis and sees similar potential for repairing broken vertebrae.

The reason we're excited about this material is because it gets us away from metals, Webster said. Metals are not in us naturally and they can have a lot of problems with surrounding tissues.

In some of his work, Webster employs nanotechnology to try to bridge metals to bone better than traditional bone cement. But TBL is an entirely new material, co-developed with longtime colleague and chemist Hicham Fenniri at the University of Alberta. Fenniri synthesized the molecules, while Webster's research has focused on ensuring that TBL becomes viable material for medical use.

The molecules are artificial, but made from elements that are no strangers to the body: carbon, nitrogen, and oxygen. At room temperature their aggregate form is a liquid, but the material they form solidifies at body temperature. The molecules look like nanoscale tubes (billionths of a meter wide), and when they come together, it is in a spiraling ladder-shaped arrangement reminiscent of DNA or collagen. That natural structure makes it easy to integrate with bone tissue.

In the space within the nanotubes, the team, which includes graduate student Linlin Sun, has managed to stuff in various drugs including antibiotics, anti-inflammatory agents, and bone growth factors, which the tubes release over the course of months. Even better, different recipes of TBL, or Arxis, can be chemically tuned to become as hard as bone or as soft as cartilage, and can solidify in seconds or minutes, as needed. Once it is injected, nothing else is needed.

We really like the fact that it doesn't need anything other than temperature to solidify, Webster said. Other compounds that people have developed require exposure to ultraviolet light and cannot therefore be injected through a tiny syringe hole. They require larger openings to be created.

For all of TBL's apparent benefits, they have only been demonstrated in cow bone fragments in incubators on the lab bench top, Webster said. TBL still needs to be proven in vivo and, ultimately, in human trials. Part of the agreement with Audax will include support to continue the material's clinical development. Audax research and development director Whitney Sharp, a Brown alumna (Sc.B., 2008; Sc.M., 2009), is now working with Webster's group.

They see the future where hopefully we will get to the point where we won't be implanting these huge pieces of metal into people, Webster said. Instead we'll be implanting things through a needle that could be used to heal a hip that's more natural.

Patients receiving dialysis are at a heightened risk for sudden cardiac death

Sun, 14 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Approximately 500,000 Americans require dialysis to treat kidney disease; of that population nearly half of the deaths that occur are caused by cardiovascular disease. Dialysis patients are at elevated risk for sudden cardiac death, but physicians are unclear why these deaths occur because little research has been done to examine how to best manage heart disease in this high-risk population.

Northwestern Medicine cardiologist Rod Passman, MD, medical director for the Center for Atrial Fibrillation at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital will present a paper at the American Heart Association's Scientific Sessions being held November 13 through 17 in Chicago about sudden cardiac death in dialysis patients. Passman is working to increase understanding within the medical community about this heightened mortality risk and how to prevent sudden cardiac death among this rapidly growing patient population.

Dialysis patients have extraordinarily high mortality rates with cardiac disease accounting for 43 percent of deaths in this population; data indicates that approximately 27 percent of the mortalities are due to sudden cardiac death, said Passman, who is also an associate professor of cardiology at Northwestern University's Feinberg School of Medicine. Patients on dialysis are excluded from clinical trials examining sudden cardiac death because of their kidney disease. The lack of research complicates clinicians' ability to understand the connection between renal disease and cardiovascular disease. The medical community needs to stop neglecting this community of patients because it is a rapidly growing group.

Sudden cardiac death is unexpected natural death from a cardiac cause within a short time period, generally less than an hour from the onset of symptoms in a person without prior condition that would appear fatal. In most cases, sudden cardiac death occurs because of ventricular arrhythmias (abnormal heart rhythms), including ventricular tachycardia (VT) or ventricular fibrillation (VF).

Risk of cardiac arrest in dialysis patients is related to age and dialysis duration, said Passman. A study by the United States Renal Disease Data System (USRDS) indicates longer dialysis duration is associated with higher mortality. This data also leads us to believe that end-stage renal disease is a primary promoter of cardiac disease and increased risk for sudden cardiac death.

By analyzing USRDS data, Passman and other researchers are beginning to better understand how cardiovascular disease affects renal patients and developing plans for preventing sudden cardiac death. The more understanding we gain in regards to why these patients are dying from sudden cardiac death, the better chance we have to save them, Passman explained. The best methods for prevention are medicinal options, including beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin type II receptor blockers (ARB), or both external and implantable defibrillators.

Data also indicates a connection between potassium levels in a patient's dialysate prescription and sudden cardiac death. Patients who suffered a cardiac arrest during dialysis were twice as likely to be on low-potassium dialysate versus higher levels of potassium, which were associated with the best survival rates. According to Passman, clinicians should evaluate and modify dialysate prescription on an ongoing basis in an effort to minimize risk of sudden cardiac death.

By highlighting the issue of sudden cardiac death in dialysis patients, Passman hopes that he and other physicians will be able to better understand this unique patient population. There is very little research related to prevention of sudden cardiac death in dialysis patient; this group remains a mystery in terms of medical research, even though their numbers are growing, said Passman. The lack of research and study of cardiovascular disease in kidney patients is a problem that must be addressed. By understanding why dialysis patients are at such great risk for sudden cardiac death, we can begin to develop better standards for prevention.

Vitamin D deficit doubles risk of stroke in whites, but not in blacks

Sun, 14 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Low levels of vitamin D, the essential nutrient obtained from milk, fortified cereals and exposure to sunlight, doubles the risk of stroke in whites, but not in blacks, according to a new report by researchers at Johns Hopkins.

Stroke is the nation's third leading cause of death, killing more than 140,000 Americans annually and temporarily or permanently disabling over half a million when there is a loss of blood flow to the brain.

Researchers say their findings, to be presented Nov. 15 at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, back up evidence from earlier work at Johns Hopkins linking vitamin D deficiency to higher rates of death, heart disease and peripheral artery disease in adults.

The Hopkins team says its results fail to explain why African Americans, who are more likely to be vitamin D deficient due to their darker skin pigmentation's ability to block the sun's rays, also suffer from higher rates of stroke. Of the 176 study participants known to have died from stroke within a 14-year period, 116 were white and 60 were black. Still, African Americans had a 65 percent greater likelihood of suffering such a severe bleeding in or interruption of blood flow to the brain than whites, when age, other risk factors for stroke, and vitamin D deficiency were factored into their analysis.

Higher numbers for hypertension and diabetes definitely explain some of the excess risk for stroke in blacks compared to whites, but not this much risk, says study co-lead investigator and preventive cardiologist Erin Michos, M.D., M.H.S., an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. Something else is surely behind this problem. However, don't blame vitamin D deficits for the higher number of strokes in blacks.

Nearly 8,000 initially healthy men and women of both races were involved in the latest analysis, part of a larger, ongoing national health survey, in which the researchers compared the risk of death from stroke between those with the lowest blood levels of vitamin D to those with higher amounts. Among them, 6.6 percent of whites and 32.3 percent of blacks had severely low blood levels of vitamin D, which the experts say is less than 15 nanograms per milliliter.

It may be that blacks have adapted over the generations to vitamin D deficiency, so we are not going to see any compounding effects with stroke, says Michos, who notes that African Americans have adapted elsewhere to low levels of the bone-strengthening vitamin, with fewer incidents of bone fracture and greater overall bone density than seen in Caucasians.

In blacks, we may not need to raise vitamin D levels to the same level as in whites to minimize their risk of stroke says Michos, who emphasizes that clinical trials are needed to verify that supplements actually do prevent heart attacks and stroke. In her practice, she says, she monitors her patients' levels of the key nutrient as part of routine blood work while also testing for other known risk factors for heart disease and stroke, including blood pressure, glucose and lipid levels.

Michos cautions that the number of fatal strokes recorded in blacks may not have been statistically sufficient to find a relationship with vitamin D deficits. And she points out that the study only assessed information on deaths from stroke, not the more common brain incidents of stroke, which are usually non-fatal, or even mini-strokes, whose symptoms typically dissipate in a day or so. She says the team's next steps will be to evaluate cognitive brain function as well as non-fatal and transient strokes and any possible tie-ins to nutrient deficiency.

Besides helping to keep bones healthy, vitamin D plays an essential role in preventing abnormal cell growth, and in bolstering the body's immune system. The hormone-like nutrient also controls blood levels of calcium and phosphorus, essential chemicals in the body. Shortages of vitamin D have also been tied to increased rates of breast cancer and depression in the elderly.

Michos recommends that people maintain good vitamin D levels by eating diets rich in such fish as salmon and tuna, consuming vitamin-D fortified dairy products, and taking vitamin D supplements. She also promotes brief exposure daily to the sun's vitamin D-producing ultraviolet light. And to those concerned about the cancer risks linked to too much time spent in the sun, she says as little as 10 to 15 minutes of daily exposure is enough during the summer months.

If vitamin supplements are used, Michos says that daily doses between 1,000 and 2,000 international units are generally safe and beneficial for most people, but that people with the severe vitamin D deficits may need higher doses under close supervision by their physician to avoid possible risk of toxicity.

The U.S. Institute of Medicine (IOM) previously suggested that an adequate daily intake of vitamin D is between 200 and 600 international units. However, Michos argues that this may be woefully inadequate for most people to raise their vitamin D blood levels to a healthy 30 nanograms per milliliter. The IOM has set up an expert panel to review its vitamin D guidelines, with new recommendations expected by the end of the year. Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women have unhealthy amounts of vitamin D, with nutrient levels below 28 nanograms per milliliter.

Exposure of humans to cosmetic UV filters is widespread

Tue, 02 Nov 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Amsterdam, 2 November, 2010 - An investigation conducted in the context of the Swiss National Research Programme (NRP50), Endocrine Disrupters: Relevance to Humans, Animals and Ecosystems, demonstrates for the first time that internal exposure of humans to cosmetic UV filters is widespread.

In the course of the Summer and Fall 2004, 2005 and 2006 (3 cohorts), human milk was sampled by mothers who had given birth at the University Women's Hospital in Basel. The participants filled out a detailed questionnaire with general questions and, as special feature, in depth questions on use of different types of cosmetic products.

Chemicals out of a large range of products including modern chemicals and classical persistent organic pollutants (POPs) were analyzed in the same human milk sample by analytical laboratories in Freiburg, Erlangen and Baden. The list comprised cosmetic UV filters, synthetic musk fragrances, pesticides, phthalates, parabens, flame retardants (polybrominated diphenylethers), and polychlorinated biphenyls (PCBs); in total 89 analyses per milk sample. The chemical analytical data of milk samples of individual mothers were then compared with the information obtained through the questionnaire.

The investigation revealed that one and the same human milk sample contained a large range of chemical contaminants, most of which are known to interact with endocrine systems. Individual exposure patterns differed between different types of chemicals. The study demonstrates for the first time that internal exposure of humans to cosmetic UV filters is widespread. Cosmetic UV filters were present in 85% of human milk samples, at concentrations comparable to PCBs. Synthetic musk fragrances were also present in the milk samples. The presence of UV filters in human milk was significantly correlated with the use of cosmetic products containing these UV filters. As a result, exposure patterns differed between individuals.

It seems plausible that exposure to other cosmetic constituents such as synthetic fragrances is also linked to the use of the corresponding products. However, this could not be investigated because musk fragrances are not declared. In contrast, classical contaminants such as PCBs, DDT and metabolites of DDT as well as some other persistent organochlor pesticides represented a rather uniform background exposure. Their levels were in part correlated with each other and also with fat-rich nutrition.

A total daily intake of each individual chemical was calculated for each individual infant from their individual levels in human milk. Calculation included fat content of individual milk samples, total daily milk intake per infant and body weight of the infant. Some infants exhibited values of daily intake of PCBs and several organochlor pesticides that were above US EPA reference dose values.

Margret Schlumpf and Walter Lichtensteiger, who lead the research said, Research on the effects of endocrine disrupters (chemicals interfering with hormone actions) has shown that it is of utmost importance to obtain information on simultaneous exposure of humans to different types of chemicals because endocrine active chemicals can act in concert. Information on exposure is particularly important for the developing organism at its most sensitive early life stages. Human milk was chosen because it provides direct information on exposure of the suckling infant and indirect information on exposure of the mother during pregnancy.

An important question during the research was: To what extent lifestyle can influence the presence of chemicals in breast milk? This question was the foundation for the preparation of the questionnaire. The questions were focused particularly on the use of cosmetic products; information on the relationship between the exposure of human populations to constituents of cosmetics and the presence of these constituents in the human body was limited and, in the case of UV filters, absent.

Gert-Jan Geraeds, Executive Publisher of

Chicago racial disparities in breast cancer mortality significantly higher than national average

Thu, 21 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Disparities in breast cancer mortality continue to be unacceptably high in Chicago and significantly larger than the national average according to new data released today at a rally sponsored by the Metropolitan Chicago Breast Cancer Task Force. The Task Force also announced results of the first year of data collection by the Chicago Breast Cancer Quality Consortium, which found many hospitals in Chicago are not meeting accepted quality standards.

The Sinai Urban Health Institute has been tracking mortality data since it first brought attention to the problem in 2006 and can now better demonstrate long-term trends. In the early 1980s, although the breast cancer mortality rates for white women in Chicago were higher than that of black women, the disparity between the two was comparatively low, only about 9%. Then, rates for white women went down dramatically but the rates for black women did not go down at all; in fact, they increased. Disparities began to widen dramatically in the early 90s and continued to widen through 2007. From 2005 through 2007, the death rate from breast cancer for black women was an average of 62% higher than that for white women.

These levels continue to be much higher than breast cancer mortality disparities found across the United States (41%), and in New York City (27%).

At the rally held at the First United Methodist Church, The Chicago Breast Cancer Quality Consortium, a project of the Task Force, also released new data collected during its first year.

In 2009, the Quality Consortium became the nation's first federally designated Patient Safety Organization dedicated solely to breast health. With the federal protections provided by this designation, 55 hospitals and the Chicago Department of Public Health signed up in 2009 to join the Chicago Breast Cancer Quality Consortium project and share quality data to identify deficits and implement strategies to improve breast cancer screening and treatment and reduce disparities. This represents 70 percent of Metropolitan Chicago hospitals.

We have achieved a remarkably high level of participation in this quality data sharing project, which is entirely voluntary, said Dr. David Ansell, chair of the Task Force and Chief Medical Officer, Rush University Medical Center. This demonstrates a very strong commitment on the part of our medical community to impact on the overall quality of care for breast health in Chicago and gives us every reason to believe that this project will have a significant long-term impact.

In this first phase of data collection, the Consortium received screening data from 37 hospitals and treatment data from 19 hospitals. The Consortium analyzed the results and provided individual reports to each participating hospital showing them how they did and how they compared to all the others.

The current data shows that there are many opportunities for improvement.

Grant to fund aging research

Fri, 15 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) For the second time this year, a postdoctoral fellow in UT Dallas' Center for Vital Longevity has earned a prestigious, highly competitive career-development grant from the National Institutes of Health (NIH).

Dr. Karen M. Rodrigue was selected to receive the K99/R00 Pathway to Independence Award. The five-year, two-phase grant totals just under $1 million. It comes from the National Institute on Aging, which usually awards only seven or eight K99s per year.

The central aim of Rodrigue's grant is to examine a vascular hypothesis of aging that involves the role of risk factors, such as hypertension, and specific cerebrovascular mechanisms such as hypoperfusion, in shaping the course of brain and cognitive aging.

An additional goal of her project is to test the hypothesis that vascular risk factors lead to the deposition of a sticky protein found in the brains of people with Alzheimer's disease and in about 30 percent of non-demented healthy adults.

Rodrigue sees this area of research as vital to future preventive approaches. Understanding the contributions of vascular health to successful, as well as pathological aging, is fundamentally important, given both the prevalence of vascular risk in the aging population and its amenability to prevention and treatment, she said.

The first phase of the K99 grant provides $90,000 per year for two years to support Rodrigue's postdoctoral work in the School of Behavioral and Brain Sciences. She then will transition into a faculty position at UT Dallas or another institution, and the grant will follow her, providing three more years of research funding at $250,000 per year.

I'm deeply honored to the be a recipient of such a competitive award and am particularly excited to embark on my first series of funded studies here at UT Dallas, where we have a great depth of resources to conduct cutting-edge cognitive neuroscience research, Rodrigue said.

The NIH career-development programs are designed to ensure a wide range of highly trained scientists are available in adequate numbers and in appropriate areas to address vital clinical, biomedical and behavioral research needs. The K99/R00 program was created to ease the transition from postdoctoral positions into junior faculty roles and to provide earlier independent research support to the most promising young investigators.

After her next two years at UT Dallas, Rodrigue will decide whether to stay and continue her projects here or go elsewhere. The grant probably will make her attractive to many universities and give her a competitive edge when she seeks her first professor position.

The grant requires that 75 percent of Rodrigue's time as a newly minted faculty member be devoted directly to research. So her teaching load will be lower than most assistant professors face. She will be able to set up an independent lab and hire research assistants to facilitate projects.

Dr. Kristen Kennedy, another center researcher, received a K99 grant last spring, to support her research into the role of white matter in the reorganization of age-related brain function.

Dr. Denise Park, director of the center and Distinguished University Chair in Behavioral and Brain Sciences, has served as a mentor to Rodrigue.

These awards are given to the most elite new PhDs to support the next generation of scientists in the United States, Park said. They provide significant resources to further the careers of the best and see that they are provided with everything they need for the first five years of their career. To have one young scientist at the Center for Vital Longevity with such an award is a significant honor. To have two is unprecedented. Dr. Rodrigue will play an important role in understanding how cardiovascular health and Alzheimer's disease are intertwined.

Researchers find nonprofit weight loss program beats obesity

Thu, 14 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) AURORA, Colo. (October 14, 2010) - In the battle against obesity, new research has found that it may not be necessary to spend a lot on a weight loss program when cheaper, nonprofit alternatives may work just as well.

Researchers at the University of Colorado Anschutz Medical Campus found those who spent three years in the nonprofit Take Off Pounds Sensibly (TOPS) program lost five to seven percent of their body weight and kept it off.

This is the first time a study of this size and duration has ever been done on a weight loss program, said Nia Mitchell, MD, MPH, and a primary care physician who worked on the study. The natural history of weight loss is weight regain and we were happy to see that people were able to keep off the weight.

The three-year study, published last month in the research journal, Obesity, followed thousands of people enrolled in TOPS. The program provided access to their database, but no funding for the research. Milwaukee-based TOPS helps members lose weight through group support and education. They are encouraged to get a weight goal from their doctors and make it their target. At the same time, they attend weekly meetings and weigh-ins. Members receive a booklet with a six week lesson plan, a one-year subscription to TOPS News and membership in the local chapter.

The study points out the large price difference between TOPS and other well-known weight loss programs. TOPS costs about $90 a year while Weight Watchers is between $480 and $625 annually. Programs like Nutrisystem and Jenny Craig, which include the price of food, can cost between $3,600 and $6,500 a year.

Mitchell said there have been studies of popular commercial weight loss programs but little investigation of nonprofits like TOPS or Overeaters Anonymous. A 1974 study concluded that behavior modification resulted in greater weight loss than other methods. TOPS incorporated the technique into its program along with group support, exercise, and monitoring food intake. It also uses volunteers to run meetings rather than paid staff.

Peer mentoring has been shown to encourage behavioral change in other areas and appears to be effective when it comes to weight loss, Mitchell said.

During the study, 42,481 people renewed their TOPS membership at least once including 2,427 with nonconsecutive renewals. Those who renewed each year lost the most weight and kept it off for up to three years. Those who didn't renew every year, lost less. The research shows that the weight lost by those who remained in TOPS is similar to the weight loss seen in a previous study of individuals who completed one year of Weight Watchers.

The lesson in all of this, says Mitchell, is that the TOPS results are comparable to more expensive commercial programs. She said future studies should look more closely into the use of nonprofits to reach populations most at risk for obesity.

Reducing blood transfusions improves patient safety and cuts costs

Thu, 07 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- A Loyola University Hospital study has demonstrated how the hospital has improved patient safety and cut costs by reducing the number of blood transfusions.

In 2009, the average amount of blood products transfused per patient at Loyola was 10 percent lower than it was in 2008, saving $453,355. The average amount of blood products transfused dropped from 2.03 units per patient in 2008 to 1.82 units per patient in 2009.

Results were reported at the recent annual meeting of the College of American Pathologists.

We are giving the right blood component, in the right amounts, to the right patient at the right time, with the goal of improving patient care, said Phillip J. DeChristopher, MD, PhD, medical director of Transfusion Medicine, Blood Bank and Apheresis.

DeChristopher is senior author of the study. First author is Omar Habeeb, MD, a fourth-year pathology resident at Loyola.

Blood transfusions save lives, but they also carry risks. Studies during the past 10 years have found that transfusions make patients more susceptible to infections and increase the risks of poor outcomes such as longer hospital stays, cancer recurrences and multi-organ system failures. The more you transfuse, the higher you put patients at risk for unintended consequences, DeChristopher said.

Transfusions of red blood cells, platelets, plasma and other blood products were approved decades ago without randomized controlled clinical trials to establish optimal uses. Consequently, doctors sometimes order more transfusions than necessary, DeChristopher said. He noted, for example that the amount of plasma transfused per patient in the United States is two to three times higher than the amounts transfused in Canada and Europe.

Loyola launched a new initiative for blood utilization as part of its Blood Management Program. The program implemented blood-use protocols that included evidence-based indications, educational programs for doctors and nurses and oversight of the Blood Utilization Review Committee.

The initiative resulted in some patients receiving less blood or no blood at all -- without compromising patient care. For example, instead of successively administering two units of blood, a doctor might now instead order one unit and then reassess later to see if a second unit is needed.

We don't want to expose patients to blood products unless we have to, DeChristopher said.

While patient safety is the primary goal, blood management also can result in significant cost savings. The study documented only the amount saved in purchasing blood. It did not include the larger savings involved in storing, compatibility testing, transfusing blood and treating adverse effects. The savings we documented are just the tip of the iceberg, DeChristopher said.

Blood management also can help relieve chronic shortages in the blood supply, especially during summers and holiday seasons when donations drop.

Blood products are a vital community resource, and we need to be good stewards, DeChristopher said. The less blood we use, the more patients benefit, and the less strain we put on the blood supply.

Additional $38M awarded to expand orthopedic trauma care research

Thu, 07 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health has been awarded $38.6 million by the Peer Reviewed Orthopaedic Research Program (PRORP) of the U.S. Department of Defense (DOD) to expand its Major Extremity Trauma Research Consortium (METRC). The Consortium, which was established in September 2009 with an award of $18 million from DOD, conducts multi-center studies relevant to the treatment and outcomes of major orthopedic injuries sustained on the battlefield. The additional funding allows for growth both in the size of the Consortium and in the scope of its research.

The initial funding was critical to establishing the consortium and providing the resources to address some of the immediate research needs of the military in the acute management of severe limb injuries, explained Ellen MacKenzie, PhD, principal investigator and the Fred and Julie Soper Professor and Chair of the Bloomberg School's Department of Health Policy and Management, the Department in which the Center for Injury Research and Policy is housed. With the additional funding, we will be able to expand the size of the consortium to address many other priority topics of relevance to both the rehabilitation and treatment of the wounded warrior, including the prevention of bone infection, chronic pain and overall disability.

The Bloomberg School serves as the coordinating center for the Consortium that includes a network of core civilian trauma centers working together with the major military medical centers that provide treatment to service members who sustain major trauma while on active duty. Under this new award, the number of core civilian centers will increase from 12 to 24. An additional 30 satellite trauma centers around the country have pledged support for the Consortium and are eager to participate in one or more of the studies sponsored under its umbrella.

Increasing the number of centers allows for more efficient designs and increased generalizability of the studies we conduct, said Michael Bosse, MD, of Carolinas Medical Center, chair of the Consortium and co-PI with Dr. MacKenzie. In this way, we will be in an even better position to deliver on our goal of establishing treatment guidelines for the optimal care of the wounded warrior and improve the outcomes of both service members and civilians who sustain serious injury to the extremities.

The need for such a consortium is evident, said Renan Castillo, PhD, an assistant professor in the Johns Hopkins Center for Injury Research and Policy and Deputy Director of the METRC Coordinating Center. Eighty-two percent of all service members injured in Operation Iraqi Freedom and Operation Enduring Freedom sustain significant extremity trauma. Many are burdened with injuries to multiple limbs. The research conducted by the Consortium will help us better understand what works and what doesn't in treating these injuries and ensure that our service members are provided with the best care possible.

We are thrilled to be partnering with Drs. MacKenzie and Bosse and the incredible team of investigators they have assembled, says Joseph Wenke, MD, of the U.S. Army Institute of Surgical Research at Fort Sam Houston, Texas, and Program Manager for the Consortium. Together we will address the most pressing issues in orthopedic trauma care. The results of our studies are likely to change practices, said Wenke.

Mackenzie concludes: It is an honor to work collaboratively with the military on issues that are critical to the care of the wounded warrior. In some small way we are able to give back to our service men and women in a meaningful way and recognize the significant sacrifices they make for us.

UCLA develops combat casualty care educational program for US armed forces

Mon, 27 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) With American troops leaving Iraq and military efforts continuing in Afghanistan, UCLA has helped develop a first-of-its-kind educational program to train U.S. armed forces medical personnel in critical combat casualty care. The program will not only help advance military care, the program's developers say, but civilian care as well.

Based on lessons gleaned from experiences in the field during Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, Combat Casualty Care: Lessons Learned from OEF and OIF will first be distributed to care providers in the U.S. armed forces. It represents a synergistic effort between the military and academic medicine.

We captured the latest medical advances, procedures and patient-care video footage and integrated them into an easy-to-use educational package that will be useful for military as well as civilian medical personnel, said the program's editor-in-chief, Dr. Eric Savitsky, a professor of emergency medicine at the David Geffen School of Medicine at UCLA and a board member of the UCLA Center for Advanced Surgical and Interventional Technology (CASIT).

Savitsky noted that in civilian settings, these new methods are applicable for trauma care, as well as preparation for the possibility of an explosion-related terrorist attack in the U.S.

In collaboration with Pelagique LLC, a spin-out of CASIT, UCLA educators worked with military care providers to develop a computer-based training program that provides original, evidence-based combat casualty care literature, videos based on real-life cases in the field, and instructional procedure tutorials.

Explosion-related casualties, most often due to improvised explosive devices, or IEDs, make up 80 percent of injuries in a war zone. Military medical personnel frequently encounter wounded individuals suffering multi-system trauma from high-velocity explosive fragments that cause life-threatening hemorrhages, organ injuries and infections. The unique wounding

pattern of blast injuries causes more severe and complex injuries relative to those seen in the civilian sector.

Pre-deployment training of combat casualty care providers proved challenging, and more effective training solutions were needed, the program developers said.

Effective, up-to-date training in combat casualty care is extremely important for deploying military medical personnel, said Col. John Kragh, a U.S. Army orthopedic surgeon featured in the DVD program. Blast injuries are almost always multi-system wounds that are very different from what you see in civilian settings. The CCC training program has captured lessons learned from Operation Enduring Freedom and Operation Iraqi Freedom medical care and serves as an excellent resource for care providers en route to Afghanistan and other wartorn regions.

More than 100 combat casualty care, trauma care and media experts contributed to the collaborative project, including 35 military experts from the U.S. Joint Services. A recently established patient database known as the Joint Theater Trauma Registry helped provide critical evidence-based medical data that the team used to create the educational program.

In developing the video cases, Pelagique videographers spent six weeks in the Level III Air Force Theater Hospital in Baldad, Iraq, filming more than 100 hours of patient cases, including men, women and children. In fact, 75 percent of the patients treated at the hospital were civilian casualties.

Patients with cancer who stop hospice care

Thu, 23 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers at Mount Sinai School of Medicine have found that the costs of care for patients with cancer who disenrolled from hospice were nearly five times higher than for patients who remained with hospice. Patients who disenroll from hospice are far more likely to use emergency department care and be hospitalized. The results are published in the October 1 issue of the Journal of Clinical Oncology.

Led by Melissa D.A. Carlson, PhD, Assistant Professor of Geriatrics and Palliative Medicine, and Elizabeth H. Bradley, PhD, Professor of Public Health at Yale University, the research team evaluated data from 90,826 patients with cancer served by 1,384 hospices in the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 1998 and 2002. Nearly 11 percent of these patients disenrolled from hospice care and had significantly higher health care use and costs than those who remained in hospice until death.

Our data suggest that oncologists should be aware of the dramatic financial and physical toll that disenrolling from hospice can have on a patient with cancer, said Dr. Carlson. According to Dr. Bradley, We do not really understand why some patients disenroll from hospice, especially as many had conditions that typically fit hospice care. The number was higher than we expected and would be good to investigate further. The paper recommends that oncologists should connect with palliative care teams where available and try to ensure that the patient and family are supported following hospice disenrollment.

The researchers found that 33.9 percent of the patients who had disenrolled from hospice care were admitted to an emergency department, while only 3.1 percent of those who remained in hospice care until death were. Additionally, 39.8 percent of disenrolled patients were admitted to the hospital as an inpatient where only 1.6 percent of enrolled patients were. Disenrolled patients also spent an average of 19.3 days in the hospital, whereas enrolled patients spent an average of 6.7 days.

The Medicare expenditures that the researchers evaluated included hospice care, hospitalizations, physician visits, outpatient care, medical equipment and supplies, and home health care services. Patients who stayed with hospice incurred $6,537 in expenses from the time of hospice enrollment to death, while those who did not incurred $30,848 in expenses.

The study did not investigate why patients disenrolled from hospice care and does not include individuals who were enrolled in a Medicare managed care organization before hospice enrollment. The researchers recommend that future studies include patient and caregiver interviews to help understand the hospice disenrollment process.

Currently, 39 percent of decedents in this country were under the care of a hospice, continued Dr. Carlson. Rather than focusing on how to decrease Medicare expenditures by restricting access to the Medicare Hospice Benefit, policy makers should focus on how to decrease the potential barriers to remaining enrolled with hospice until death, with an eye to both decreasing Medicare costs and potentially improving patient and family outcomes.

Northwestern first site open for spinal cord stem cell trial

Wed, 22 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- Northwestern Medicine is the first site open for enrollment in a national clinical research trial of a human embryonic stem cell-based therapy for participants with a subacute thoracic spinal cord injury. Following the procedure, participants will receive rehabilitation treatment at The Rehabilitation Institute of Chicago (RIC).

Northwestern also is the lead site of the trial, sponsored by Geron Corporation (Nasdaq: GERN). The trial eventually will include up to six other sites and enroll up to 10 participants nationally.

We are very pleased to be the first participating center in the world's first human embryonic stem cell clinical trial for spinal cord injury, said lead national investigator Richard Fessler, M.D., professor of neurological surgery at Northwestern University Feinberg School of Medicine and a surgeon at Northwestern Memorial Hospital.

Injection of oligodendrocyte progenitor cells directly into the spinal cord lesion is a rational way to attempt to arrest or reverse the structural damage in the spinal cord caused by severe trauma, Fessler said. We are eager to begin evaluating the effects of these cells in subjects with severe spinal cord injuries.

RIC is a vital member of the research team for this novel stem cell clinical trial, said David Chen, M.D., medical director of the RIC Spinal Cord Injury Rehabilitation Program. RIC's team of spinal cord injury rehabilitation specialists is responsible for customizing the rehabilitation care plan and therapeutic intervention for each participant, which may include robotic walking therapy and other procedures to facilitate the participant's neurologic repair and recovery. At RIC, restoring the participant's ability is our objective and the scientific application of embryonic stem cells offers new hope for recovery.

The primary objective of the phase I trial is to assess the safety and tolerability of special cells called human embryonic stem cell-derived oligodendrocyte progenitor cells when they are injected into the spinal cord injury of paralyzed subjects. The injuries have to have occurred within two weeks for someone to be eligible for the procedure.

In addition to evaluating safety, the secondary aim of the trial is to see if the stem cells improve neuromuscular control or sensation in the trunk or lower extremities.

In previous animal studies, these stem cells have demonstrated the ability to remyelinate or recoat damaged nerve cells that have lost their ability to conduct electrical impulses down the axon. The stem cells also have shown nerve-growth stimulating properties leading to restoration of function in animal models of acute spinal cord injury.

The trial is supported by positive animal research, Fessler said. He noted the trial is using the lowest dose possible for a human based on the animal studies.

Subjects eligible for the Phase I trial will have documented evidence of functionally complete (ASIA Impairment Scale grade A) spinal cord injury with a neurological level of T3 to T10 spinal segments and agree to have GRNOPC1 injected into the lesion sites between 7 and 14 days after injury.

Gene-environmental interactions and MS progression is focus of new study

Tue, 21 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A $634,000 grant from the Department of Defense is allowing researchers at the University at Buffalo to investigate a trio of environmental factors and their influence on the progression of multiple sclerosis.

The two-year project, headed by Murali Ramanathan, PhD, tests the hypothesis that nicotine metabolism, the byproducts of vitamin D metabolism and increased levels of anti-Epstein-Barr virus (EBV) each interact with variations in specific genes to cause increased neurodegeneration and increased lesions in MS patients.

Ramanathan is a professor of pharmaceutical sciences and neurology in the School of Pharmacy and Pharmaceutical Sciences and the School of Medicine and Biomedical Sciences, respectively.

The study is a collaboration between the UB and investigators from Charles University in Prague, Czech Republic, and will be conducted on samples obtained at both universities' MS centers.

The research aims to identify gene-environmental interactions between key molecules in the vitamin D pathway, anti-Epstein-Barr virus antibodies, cigarette smoking and key genetic variants that are implicated in conversion of patients with clinically isolated syndrome (CIS) to definite MS.

They will assess the risk of developing clinically definite MS and the time to progression, as well as the neurodegeneration in the brain of MS patients, as measured by brain atrophy, and the extent of brain injury caused by lesions.

We will use a novel approach to measure the levels of vitamin D and its metabolites, EBV exposure and nicotine metabolites from cigarette smoking, says Ramanathan. We have developed sensitive and selective measurements for key metabolites in the vitamin D and nicotine metabolism pathways using mass spectrometry, a method that has not been used previously to study vitamin D metabolism.

The novel study design will include the genetic variations that were associated with the risk of developing MS, as well as genes that determine the levels and responses to environmental factors. MS patients will be divided into two equal groups: a training group that will be used to identify gene-environmental interactions, and a group that will be used to replicate the training group result.

Identifying gene-environmental interactions is critical for developing better strategies for slowing the progression of MS, because it could enable patients with preexisting genetic risk factors to reduce the rate of disease progression through lifestyle modification, Ramanathan says.

The study results will identify the gene-environment interactions that promote disease progression in MS and facilitate the development of preventive and therapeutic interventions for MS that disrupt these interactions, notes Ramanathan.

K-State research project offers insight into superstitious behavior

Thu, 02 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) MANHATTAN, KAN. -- People who believe that fate and chance control their lives are more likely to be superstitious -- but when faced with death they are likely to abandon superstition altogether, according to a recent Kansas State University undergraduate research project.

The project, led by Scott Fluke, a May 2010 K-State bachelor's graduate in psychology, Olathe, focuses on personality traits that lead to superstition. Fluke received a $500 Doreen Shanteau Undergraduate Research Fellowship in 2009 to work with the team of Russell Webster, graduate student in psychology, Shorewood, Ill., and Donald Saucier, K-State associate professor of psychology.

For the project, Re-Examining the Form and Function of Superstition, the team defined superstition as the belief in a casual relationship between an action, object, or ritual and an unrelated outcome. Such superstitious behavior can include actions like wearing a lucky jersey or using good luck charms.

After performing two studies, the researchers developed three reasons for superstitious behavior: individuals use superstitions to gain control over uncertainty; to decrease feelings of helplessness; and because it is easier to rely on superstition instead of coping strategies.

People sometimes fall back on their superstitions as a handicap, Saucier said. It's a parachute they think will help them out.

In the first study, the researchers conducted questionnaires with 200 undergraduates, asking about how pessimistic they were, whether they believed in chance or fate, if they liked to be in control and other questions. One of the major discoveries was that people who believe that chance and fate control their lives are more likely to be superstitious.

In the second study the researchers wanted to know how participants reacted to death, and asked them to write about how they felt about their own death. The team was surprised to find that participants' levels of superstition went down when they thought about their own death, which the researchers attributed to death being a situation of extreme uncertainty.

We theorized that when people thought about death, they would behave more superstitiously in an effort to gain a sense of control over it, Fluke said. What we didn't expect was that thinking about death would make people feel helpless -- like they cannot control it -- and that this would actually reduce their superstitious belief.

Fluke got the idea for his research in an undergraduate methods research course his first semester at K-State, when he realized there were many unanswered questions about psychology and superstition. He decided to pursue the topic further as a research project.

I was interested in superstition because it frustrates me when people do things that don't make sense, Fluke said. It boggled me that people would use a good luck charm to do well on a test rather than studying for it. We wanted to know why people would go about almost actively hurting themselves.

The research is part of Saucier's overall research program, and the team is now preparing results of their study for publication.

Saucier offers some tips to avoid superstitious behavior:

Study describes health effects of occupational exposures in Paducah Gaseous Diffusion Plant workers

Thu, 22 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A five-year study into the causes of deaths of workers at Paducah Gaseous Diffusion Plant (PGDP) shows significantly lower death rates from all causes and cancer in general when compared to the overall United States population. This is known by occupational health researchers as the healthy worker effect. However, death from lymphatic and bone marrow cancers such as leukemia or multiple myeloma were slightly above national rates.

The study was conducted by faculty at the University of Louisville School of Public Health and Information Sciences and collaborators from the University of Cincinnati and the University of Kentucky. It was funded through the National Institute for Occupational Safety and Health, thanks to the effort of U.S. Senator Mitch McConnell, who was instrumental in getting the study off the ground.

This was an important study, because it addressed lingering concerns about the health of workers at the Paducah Gaseous Diffusion Plant, said David Tollerud, MD, MPH, professor of environmental and occupational health sciences at UofL's School of Public Health and Information Sciences. It is important for occupational health and public health research to attempt to answer pressing concerns of impacted populations, and we were able to report that we didn't find unexpectedly high rates of disease in this workforce.

Security workers had higher overall death rates than other employees, while chemical operators had higher death rates from leukemia and multiple myeloma than the rest of the workers.

The increased number of lymphatic and bone marrow cancer deaths is consistent with what we expected. Based on other studies, these forms of cancer have been linked to low levels of radiation exposure, Tollerud said.

The team compiled data on thousands of employees who worked at the plant for at least 30 days in different job classifications from 1952 through 2003. The data were used to assess exposure levels. Overall, 1,638 workers died out of the 6,759 in the study. This is less than the 2,253 deaths that would have been expected in the general public during the same time.

The team now plans to present its findings to PGDP workers and distribute a study fact sheet that summarizes the main findings and directs workers to resources that are available if they have concerns or questions.

The Paducah Gaseous Diffusion Plant, located in western Kentucky, is the only operating uranium enrichment facility in the United States, and the only one where a worker mortality study had not been conducted. The plant was commissioned in 1952 under the U.S. Department of Energy as part of a U.S. government program to produce enriched uranium to fuel military reactors and nuclear weapons. The plant's mission changed in the 1960s from enriching uranium for nuclear weapons to enriching uranium for use in commercial nuclear reactors to generate electricity.

Study finds lifelong doubling in death risk for men who are obese at age 20 years

Tue, 13 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Stockholm, Sweden: Men who enter adult life obese face a life-long doubling of the risk of dying prematurely, new research has found.

In a study presented today (Tuesday) at the International Congress on Obesity in Stockholm, researchers tracked more than 5,000 military conscripts starting at the age of 20 until up to the age of 80. They found that at any given age, an obese man was twice as likely to die as a man who was not obese and that obesity at age 20 years had a constant effect on death up to 60 years later. They also found that the chance of dying early increased by 10% for each BMI point above the threshold for a healthy weight and that this persisted throughout life, with the obese dying about eight years earlier than the non-obese.

As the obesity epidemic is still progressing rapidly, especially among children and adolescents, it is important to find out if obesity in early adulthood has lifelong mortality effects, said the study's leader, Esther Zimmermann, a researcher at the Institute of Preventive Medicine, Copenhagen University Hospital and the Institute of Biomedical Sciences at University of Copenhagen in Denmark. Previous studies have investigated obesity and mortality in middle-aged populations, which only tells us about the detrimental effects of obesity in middle age. Our study sheds light on how obesity at age 20 years affects obesity throughout adult life. It is the first study with such a long follow-up time and thus the first study to investigate the lifelong effect.

In the study, the researchers compared mortality in a sample of 1,930 obese male military conscripts with that in a random sample of 3,601 non-obese male conscripts. Body mass index (BMI) was measured at the average ages of 20, 35 and 46 years, and the researchers investigated that in relation to death in the next follow-up period. A total of 1,191 men had died during the follow-up period of up to 60 years. The results were adjusted to eliminate any influence on the findings from year of birth, education and smoking.

At age 70 years, 70% of the men in the comparison group and 50% of those in the obese group were still alive and we estimated that from middle age, the obese were likely to die eight years earlier than those in the comparison group, Zimmermann said. The researchers also investigated the effect of the broad BMI range on mortality from the age of 20 and found the lowest death risk in the men who had a BMI of 25. Underweight men had a slightly elevated risk, and the risk of early death crept up steadily by 10% for each BMI unit above 25 for those men who were overweight or obese.

Zimmermann said it is unclear whether it is being obese at age 20 that conferred the men's increased death risk or whether the lifelong effect is due to obesity often being a lifelong condition for them. She said more research is warranted to find the answer to that question.

More than 70% of the obese young men were still obese at the follow-up examinations, whereas only 4% of the men in comparison group developed obesity during follow-up. Obesity seems to be a persistent condition and it appears that if it has not occurred in men by the age of 20, the chance of it developing later are quite low. The persistence of obesity may partly explain why obesity at 20 years of age has lifelong mortality effects, but it needs to be proven whether that is the full explanation or whether, by itself, being obese at an early age increases the risk of early death, she said.

Zimmermann said her group plans to study the patterns of ill health that caused the early death in the obese group, in order to determine whether the same diseases are causing death at different ages. Such information may shed some light on the mechanisms through which obesity works at different ages, she said.

Defensin-1 in honey can work as antibiotic

Thu, 01 Jul 2010 15:34:00 PST

( from http://www.rxpgnews.com ) Bees make a protein called defensin-1 that they add to honey, which could one day be used to treat burns and skin infections and to develop new drugs that could combat antibiotic-resistant infections.

'We have completely elucidated the molecular basis of the antibacterial activity of a single medical-grade honey, which contributes to the applicability of honey in medicine,' said Sebastian A.J. Zaat, researcher in medical microbiology at the Academic Medical Centre, Amsterdam.

'Honey or isolated honey-derived components might be of great value for prevention and treatment of infections caused by antibiotic-resistant bacteria,' Zaat said.

To make the discovery, Zaat and colleagues investigated the antibacterial activity of medical-grade honey in test tubes against a panel of antibiotic-resistant, disease-causing bacteria. 3

They developed a method to selectively neutralise the known antibacterial factors in honey and determine their individual antibacterial contributions.

Ultimately, researchers isolated the defensin-1 protein, which is part of the honey bee immune system and is added by bees to honey.

After analysis, the scientists concluded that the vast majority of honey's antibacterial properties come from that protein.

This information also sheds light on the inner workings of honey bee immune systems, which may one day help breeders create healthier and heartier honey bees, said a release of Academic Medical Centre.

'We've known for millennia that honey can be good for what ails us, but we haven't known how it works,' said Gerald Weissmann, editor-in-chief of FASEB Journal, which published these findings.

'Now that we've extracted a potent antibacterial ingredient from honey, we can make it still more effective and take the sting out of bacterial infections,' he said.

ESC supports traffic light food labeling vote

Wed, 16 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Sophia Antipolis, 16 June 2010: The European Society of Cardiology (ESC) http://www.escardio.org/ and its branch, the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) http://www.escardio.org/communities/EACPR/Pages/welcome.aspx are joining forces with 12 other European Health and consumer communities to urge MEPs to vote in favour of a traffic light system for food labelling today.

If MEPs vote against the traffic light system they will be failing the next generation. Widespread introduction of the system would enable people in Europe to make informed choices about eating healthily. That would make a significant contribution to reducing the toll of cardiovascular disease. The plain facts are that four out of five cases of heart disease are directly related to diet, physical activity and smoking, said ESC spokesperson Joep Perk, from the School of Health and Caring Sciences at Linnaeus University (Sweden). A vote against the traffic light system, he adds, would give out the message to society that European politicians are hand in glove with the food industry.

In 2008, the European Commission proposed new legislation on providing food information to consumers. The idea behind traffic light labelling is simple: consumers deserve clear information about the key nutrients in food. Traffic light labels use colours (red, orange and green) to signal whether products contain high, medium or low levels of the harmful nutrients. The actual levels of these nutrients (salt, fat, saturated fat, and sugars) in every product are also given in absolute grams per 100-gram (or 100 millilitre).

Sadly, on 16 March 2010, the European Parliament's environment, public health and food safety committee voted against the introduction of a mandatory traffic-light labelling system. Regulation, they said, should lay down general rules on how information should be displayed, which would allow different countries to keep or adopt national rules. This vote is then taken forward as a recommendation from the committee, to the plenary session, taking place 16 June 2010, where all MEPs have the opportunity to vote.

Failure to introduce the traffic lights system, says Perk, will widen the health differences that already exist between different socio economic classes in Europe. The beauty of the traffic light approach is that people don't have to be highly educated or even literate to understand the information. It gives everyone equal opportunities to make informed choices about eating healthily, he says, adding that people can make these decisions where ever they are in Europe, regardless of whether they speak the local language.

One of the criticisms levelled against the traffic light system is that insufficient research has been undertaken to measure its effectiveness.

That is nonsense, said ESC spokesperson Simon Capewell, Professor of Clinical Epidemiology at the University of Liverpool (UK). Extensive solid evidence exists showing that more people understand the simple traffic light system than other, more complicated schemes.

It is also sad, he added, that some companies have been lobbying MEPs to oppose traffic lights, and thus keep consumers ignorant about what is actually hidden in the packet. In truth, millions of deaths from heart disease and stroke could be prevented if the industry halved the amount of salt, saturated fat and sugar hidden in our food. This is technically feasible, and has already been achieved in some countries.

Children's sense of threat from parental fighting determines trauma symptoms

Mon, 29 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) If children feel threatened by even very low levels of violence between their parents, they may be at increased risk for developing trauma symptoms, new research suggests.

A study by psychologists at Southern Methodist University in Dallas found that children who witness violence between their mother and her intimate partner report fewer trauma symptoms if they don't perceive the violence as threatening.

The research highlights the importance of assessing how threatened a child feels when his or her parents are violent toward one another, and how that sense of threat may be linked to symptoms of trauma.

Our results indicated a relation between children's perception of threat and their trauma symptoms in a community sample reporting relatively low levels of violence, said Deborah Corbitt-Shindler, a doctoral candidate in the psychology department at SMU. The results of the study suggest that even very low levels of violence, if interpreted as threatening by children, can influence the development of trauma symptoms in children.

The researchers presented their findings February 24 at the National Summit on Interpersonal Violence and Abuse Across the Lifespan: Forging a Shared Agenda in Dallas. The scientific conference was sponsored by the National Partnership to End Interpersonal Violence Across the Lifespan.

Family violence experts estimate that more than half of children exposed to intimate partner violence experience trauma symptoms, such as bad dreams, nightmares and trying to forget about the fights.

The SMU study of 532 children and their mothers looked at the link between intimate partner violence and trauma symptoms in children. The families were recruited from communities in the urban Dallas area. The National Institute of Mental Health funded the research. For more information see www.smuresearch.com.

In the study, mothers were asked to describe any violent arguments they'd had with their intimate partners, and they were asked about trauma symptoms they may have experienced because of the violence.

Similarly, the children in the study, age 7 to 10 years old, were asked to appraise how threatened they felt by the violence they witnessed, and about trauma symptoms they may have experienced because of the violence. The researchers defined threat as the extent to which children are concerned that: a family member might be harmed, the stability of the family is threatened, or a parent won't be able to care for them.

To assess trauma, children were asked questions such as if they've had bad dreams or nightmares about their mom's and dad's arguments or fights; if thoughts of the arguments or fights ever just pop into their mind; if they ever try to forget all about the arguments and fights; and if they ever wish they could turn off feelings that remind them of the arguments and fights.

The SMU researchers found that even when mothers reported an episode of intimate partner violence, their children reported fewer trauma symptoms when they didn't view the episode as threatening. Although a mother's emotions sometimes affect their children's emotions, in this study the mothers' trauma symptoms were unrelated to the children's traumatic responses to the violence.

Survival in metastatic breast cancer patients is improving: targeted therapies have contributed

Fri, 26 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Trends indicate that survival is improving in patients with metastatic breast cancer, especially in those patients whose tumours are described as being HER2 (human epidermal growth factor receptor-2) positive, a surgical oncologist will say today (Friday 26 March) at the seventh European Breast Cancer Conference (EBCC7).

Dr Marie Sundquist, from the Department of Surgery, County Hospital, Kalmar, Sweden, will say that the median survival times for five-year intervals of 557 metastatic breast cancer patients in Kalmar, Sweden, increased steadily, from 10 months for the 1985 to 1990 period, to 22 months for the 2000 to 2004 period.

She will be reporting the findings of a retrospective analysis of follow-up data of breast cancer patients who were diagnosed in hospitals in Kalmar County since 1985. A strength of our work is that we have studied a consecutive population in a defined geographical area for a continuous period of 25 years, Dr Sundquist will tell the conference.

Dr Sundquist will tell delegates that for 288 patients with grade III tumours, the most aggressive type of breast cancer, the median survival time increased from 10 months for the 1985 to1990 period to 17 months for the 2000 to 2004 period. The increased use of the chemotherapy drugs called anthracyclines and taxanes led to the improved survival outcomes in this group of patients with the aggressive form of metastatic breast cancer, she said.

Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. Breast cancer hormone-receptor status can affect the individual patient's treatment options as well as overall prognosis. Analysis of the data by HER2 positive status revealed that HER2 positive patients with metastatic breast cancer had improved survival rates. Prior to the year 2000, 40 HER2 positive patients had a median survival of 14 months compared to 21 months for 40 HER2 positive patients diagnosed with breast cancer from the year 2000 onwards.

Dr Sundquist said: There is no doubt that trastuzumab (Herceptin), which targets the HER2 gene, is the most important reason for the improved survival in this group of patients, and use of the chemotherapy drugs known as anthracyclines also contributed.

In the group of HER2 positive patients that had the most aggressive type of breast cancer (grade III), 45% of those patients that received trastuzumab had survived more than three years and 30% more than five years, Dr Sundquist added.

Patients whose breast tumours have spread outside of the breast and armpit areas are essentially incurable. However, some patients live even decades with a good quality of life despite an initially widespread tumour burden, while others fail to respond to any therapy. To explore and try to understand these mechanisms would make it easier to tailor the treatment for each individual patient, Dr Sundquist will say.

A new era of breast cancer treatment started with the gene-targeted therapy of trastuzumab. Since then, a number of similar targeted therapies including antibodies or inhibitors of specific genes have been developed. This will open new avenues in the treatment of all metastatic breast cancers and also of primary breast cancer.

These new targeted therapies will, at least in the beginning after their development, be very costly for healthcare systems. On the other hand they will make it possible for many women to lead almost normal lives, work and contribute to society for an increased number of years, she concluded.

The researchers intend to follow up their work by performing genetic analyses of the tumours with different responsiveness to specific treatments. Health care systems will need to provide tools for the routine clinical assessment of a number of genes related to treatment response, she added.

Using stem cells to mend damaged hips

Tue, 23 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Bone stem cells could in future be used instead of bone from donors as part of an innovative new hip replacement treatment, according to scientists at the University of Southampton.

A team from the University's School of Medicine believe that introducing a patient's own skeletal stem cells into the hip joint during bone grafting would encourage more successful regrowth and repair.

The grafting technique is used to repair the thigh bone and joint during replacement (known as 'revision') hip replacement therapy, a procedure in which surgeons introduce donor bone to the damaged area to provide support for the new hip stem.

In this collaborative study between the University of Southampton and The University of Nottingham, researchers will use adult stem cells from bone marrow in combination with an innovative impaction process and polymer scaffolds.

In a two-year study, funded by the Medical Research Council (MRC), researchers aim to improve the outcomes of this high impact procedure.

Surgeons currently use bone from donors during bone grafting, so introducing a patient's own stem cells to create a living cell or material composite would be a totally new approach, comments Professor Richard Oreffo, an expert in musculoskeletal science at the University of Southampton, who is leading the project.

This is very much the beginning of a project to investigate the potential for this new technique, but our preliminary work suggests this may have significant therapeutic implications.

When a hip joint is damaged, part of the thigh bone or femur, including the ball, can be removed and a new, artificial joint fixed to the remaining thigh bone. Revision hip replacement occurs when that artificial joint needs to be changed.

Professor Oreffo will introduce the stem cells to the hip joint using a scaffold, or support structure, which is designed to protect them, and a new impaction process. The polymer scaffolds will be developed by Professors Steve Howdle and Kevin Shakesheff, experts in chemistry and tissue engineering at the University of Nottingham.

Professor Howdle explains: Building upon strong collaborations with tissue engineering experts, this new grant will allow researchers at Nottingham to take their materials nearer to the clinic.

This could have great benefits for patients, and also offer a significant cost saving for healthcare authorities; but first we need to verify and build upon our preliminary data.

A major part of the work at Nottingham will involve scaling up the supercritical fluid processing apparatus to create larger and more uniform batches of polymer scaffolds for testing.

Dr Chris Watkins, MRC's Translation Theme Leader, says: Resilience, repair and replacement is a priority research area in the MRC's strategic plan, 'Research Changes Lives'. This study highlights how a regenerative approach can offer real hope in addressing a significant problem for an ageing population.

This funding will allow the groups to build on initial studies that show that degradable polymer scaffolds prepared using supercritical carbon dioxide technology can have a dramatic effect on surgical procedures, such as inserting a hip implant in revision hip surgery.

The provisional studies carried out in Southampton show that the polymers can aid bone formation through the creation of a living cell/material composite and aid attachment of the hip implant.

Osteoporosis drug improves healing after rotator cuff surgery

Wed, 10 Mar 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Tears in the shoulder's rotator cuff, a common sports injury, are painful and restricting. Surgery to repair the damage is successful for pain management, but in many patients it does not result in full recovery of function due to poor healing. New research shows an approved therapy for osteoporosis, Forteo, may speed healing and improve patient outcomes. The preliminary study from Hospital for Special Surgery in New York is being presented at the American Academy of Orthopaedic Surgeons (AAOS) meeting in New Orleans March 9-13.

According to a previous study, only 69 percent of rotator cuff repairs were completely healed when evaluated two years after the surgery, said Scott Rodeo, M.D., co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery and senior author on the study. Although not all of the patients with failed rotator cuff tendon healing had poor clinical outcomes, we wanted to look for ways to further improve patient outcomes.

The rotator cuff is a set of four smaller muscles in the shoulder that rotate the upper arm. A rotator cuff tear happens when the tendon part of the muscle tears away from the bone of the upper arm. The repair surgery reattaches the tendon to the bone, but the success depends on how well the interface between the tendon and bone heals. Much of the time scar tissue forms at that interface, which is not as strong as the original tissue and can lead to a failed repair.

The healing process occurs from both the bone and the tendon, which is made up of collagen, said Carolyn Hettrich, M.D., MPH, fifth year resident in orthopedic surgery at Hospital for Special Surgery and lead author. We knew the drug Forteo is osteogenic and can stimulate bone growth, but we found reports in the literature that it is also chondrogenic, so it can promote cartilage formation as well.

Forteo is a synthetic version of parathyroid hormone, which is the body's primary regulator of calcium and phosphate levels in bone. Recently approved by the FDA, it is prescribed for osteoporosis as it not only stimulates bone growth but it also slows the rate of bone loss.

The researchers hypothesized that because Forteo stimulated both bone and cartilage formation, it might enhance the healing process after rotator cuff surgery. Using a rat model, they performed the surgery and then gave some rats Forteo injections in amounts comparable to human doses.

Initially, at two weeks after the surgery, the repair was not as strong in the rats who received the Forteo. But when the researchers looked at weeks four through eight, the tendon to bone interface in those rats appeared much more like normal tissue. Closer examination showed that not only had those rats that received Forteo produced more bone and cartilage cells, but the organization of the tissue was better and more closely resembled normal tissue. The tendon was also significantly stiffer, a sign of proper healing, at 8 weeks.

The results are positive, but now we want to understand why at week two the tendon wasn't healing as well, said Dr. Hettrich. Our next experiments will look to pinpoint these causes and determine the optimum delivery time of the drug after surgery.

The researchers caution that it would be risky to use Forteo in patients undergoing rotator cuff surgery just yet as further studies are needed. Instead, they encourage patients to talk to their surgeons about other steps they can do to improve healing, such as not smoking after the surgery to optimize their biology.

Athletes who use overhead movements, like baseball or tennis players, are prone to this injury. It is also common in adults over 40 because the tendons begin to degenerate and weaken.

The sea squirt offers hope for Alzheimer's sufferers

Tue, 02 Mar 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Alzheimer's disease affects an estimated 27 million people worldwide. It is the most common form of age-related dementia, possibly the most feared disease of old age. There is no cure, and the available drugs only help to relieve symptoms without slowing progression of the disease. One of the characteristic changes in the brains of Alzheimer's patients is the accumulation of plaques and tangles; currently, the best hope for curing or at least slowing the disease lies in developing drugs that target this buildup. Some drugs are already in clinical trials, but there is still a pressing need for more research, and for more and better drugs directed against both known and novel targets.

One of the big problems in rapidly screening potentially useful drugs has been the lack of a good model system in which Alzheimer's plaques and tangles appear quickly. However, Mike Virata and Bob Zeller, scientists working at San Diego State University, California, have come up with a new, and perhaps unlikely candidate; the humble sea squirt, Ciona intestinalis. Sea squirts are tunicates, marine organisms protected by an outer hard tunic with a soft body inside. Adults spend their lives attached to one spot on underwater structures like the pilings of piers, sucking in water through one siphon, filtering out small plants to eat, and squirting the water back out through another siphon. However, as long ago as Darwin, it has been recognized that sea squirts may be our closest invertebrate relatives; in their immature, tadpole form, they resemble proper vertebrates, and they share about 80% of their genes with us.

Bob Zeller has been a fan of sea squirt tadpoles since starting work with them in the 1990s, when he helped develop a way of introducing foreign DNA into fertilized sea squirt eggs with almost 100% efficiency, opening the way for their use as model organisms. He and his colleague Mike Virata decided to see whether it would be possible to model Alzheimer's disease in the tiny animals, which share all the genes needed for the development of Alzheimer's plaques in humans. Incredibly, dosing the sea squirt tadpoles with a mutant protein found in human families with hereditary Alzheimer's resulted in aggressive development of plaques in the tadpoles' brains in only a day, and these, along with the accompanying behavioral defects seen in the tadpoles, could be reversed by treating with an experimental anti-plaque forming drug. This is an important breakthrough, as all other invertebrates tested have been unable to process the plaque-forming protein, and vertebrates take months or years to make plaques. These exciting results make it a real possibility that sea squirts are an excellent model for testing new drugs in the fight against Alzheimer's disease.

Cancer patients find relief in integrative medicine services

Thu, 25 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO- The very instant Penny Kukovec was diagnosed with breast cancer her world permanently changed. Suddenly, it felt as if her life was out of her control. She felt powerless and overwhelmed. There were so many unanswered questions. Why me? What's next? What about my family? The feelings Kukovec experienced are felt by many cancer patients following their initial diagnosis and as they pursue treatment. In an effort to effectively and compassionately respond to these worries, as well as address common side effects associated with cancer treatment, Northwestern Memorial Hospital and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University now offer integrative oncology services.

When a patient is diagnosed with cancer many of them want to fully participate in their recovery, but don't know where to begin. This program gives them control over their treatment, said Julian Schink, MD, chief of Gynecologic Oncology at Northwestern Memorial and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

The integrative oncology services are part of a larger 360 Care Program that recently launched aimed to address cancer patients' needs from every angle through treatment that extends beyond medical therapies, to include counseling, stress management and integrative medicine. Integrative oncology services include acupuncture, massage, energy healing and naturopathic medicine offered by Northwestern Memorial Physicians Group's Center for Integrative Medicine and Wellness.

Our goal is to treat the whole person, not just their illness, said Melinda Ring, MD, medical director of the Center for Integrative Medicine and Wellness. Research suggests that a holistic approach can alleviate stress and anxiety, as well as the physical pain and discomfort patients often experience while undergoing cancer treatments by activating the body's innate healing process.

While there is little research to explain exactly how integrative approaches like acupuncture work, researchers at the National Institute of Health state complementary therapy such as acupuncture do improve the body's immune system. In an oncology setting, integrative approaches provide an effective way to manage symptoms, alleviate side effects, and help patients restore their sense of control and vitality.

My body was hit hard with trauma. I was so tired, my joints hurt and my muscles were tense. I knew I needed more help. When I began massage therapy my muscles relaxed, and it helped me release my emotions. It reminded my body that it can relax in spite of what I am going through, said Penny Kukovec, patient at Northwestern Memorial.

Common side effects of chemotherapy and radiation treatment for cancer include muscle tension, aches, pains nausea, vomiting and fatigue. The main role of complementary medicine is to provide supportive care and reduce adverse effects while helping the patient cope.

Unfortunately, the side effects associated with conventional therapies often cause patients to end their treatments prematurely, or require that we take a less aggressive approach, said Schink. We've seen this occurrence decrease with the addition of integrative oncology services.

The medicine I was taking for my cancer caused nerve damage in my hands and feet. It was very uncomfortable. Acupuncture helped relieve the pain, said Nancy Amicangelo, patient at Northwestern Memorial.

There is evidence that integrative approaches may also play a role in reducing the rate of depression among cancer patients. Services such as massage therapy are believed to have a short-term effect on reducing anxiety related to depression among patients.

You're sick, your hair falls out, and your family is stressed. When you are diagnosed it's sometimes all that you can think about. The massages offer me a chance to escape, said Kukovec.

While integrative medicine does not offer a cure for cancer, there is strong evidence that it positively affects the patient. Studies show 77 percent of cancer patients who incorporate complementary approaches believe it improves their quality of life, and 73 percent state it makes them feel hopeful. In addition, 71 percent say it helps to boost their immune system.

Changes during menopause increases risk of heart disease and stroke

Tue, 23 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO- When women hear the word menopause, they often think about hot flashes, hormone shifts and mood swings. But what about heart disease? Studies show a woman's risk of heart disease intensifies drastically around the time of natural menopause, which for most women is around the age of 50. This news may come as a surprise, but experts explain that understanding risk factors is an important first step, and reassure women that there are ways to lower your risk.

Many women younger than 50 have not yet gone through menopause and still have high levels of the female hormone estrogen in their blood, which is thought to help protect the heart. After menopause, however, the levels of estrogen in a woman's body drop significantly and can contribute to the higher risks of cardiovascular disease, explains Vera Rigolin,MD, associate director of the Center for Women's Cardiovascular Health in the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital.

Weight gain is also a factor that may play a role in postmenopausal risk of heart disease. Maintaining a healthy weight often becomes difficult after your body experiences a change in hormone levels. Extra mass can take a toll on the body causing physical inactivity, high blood pressure, diabetes, and high cholesterol, all risk factors that can lead to heart attack and stroke.

Detecting heart disease in women can be difficult. Many women are unaware that symptoms of the disease may differ from those of men. Although women often experience chest discomfort when presenting with a heart attack, they commonly have other, more subtle symptoms, including fatigue, nausea, shortness of breath, jaw pain and general discomfort in the chest and abdominal area.

In some women, plaque can build in the smallest blood vessels called the microvascular circulation. These blockages do not show up in an angiogram, says Rigolin. In these cases, we often use Magnetic Resonance Imaging (MRI) with medication to visualize blood flow within the small blood vessels when other standard tests do not provide us answers.

Women, especially those who are menopausal can reduce the risk of heart disease by adopting a healthy lifestyle.

If you are a smoker, quit immediately and avoid second hand smoke. Eat a diet rich in fruits and vegetables and exercise at least three times per week to maintain a healthy body weight, says Rigolin.

Rigolin also recommends visiting your health care provider at least once per year to have your blood pressure, blood sugar and cholesterol levels checked.

Scientists discover new treatment for chronic pain condition

Mon, 01 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Scientists at the University of Liverpool have discovered that treating the immune system of patients with Complex Regional Pain Syndrome (CPRS) leads to a significant reduction in pain.

CRPS is an unexplained chronic pain condition that usually develops after an injury or trauma to a limb, and continues after the injury has healed. CPRS I - formerly called Reflex Sympathetic Dystrophy - can arise after any type of injury. CRPS II, previously called causalgia (a term coined in the American Civil War when it was first diagnosed), follows partial damage to a nerve. In some cases the pain can be so severe that patients request amputation, only to find that the pain returns in the stump.

CRPS pain can improve within one year after the injury, but if it is still unchanged after 12 months (longstanding CRPS), then it will often not improve at all. Longstanding CRPS affects about 1 in 5,000 people in the UK.

The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks. The results of this study may change the future treatment of patients with CRPS, and have an impact on research in other severe chronic pain areas. Intravenous immunoglobulin treatment for CRPS is currently not available on the NHS.

Although the cause of the syndrome is unknown, precipitating factors include injury or damage to the body's tissue. Changes in the way nerves send messages to the brain about pain may occur at the injury site. These changes may then lead to more changes in the nerves of the spinal chord and brain. All these changes are thought to play a role in causing and prolonging the condition. Conventional pain drugs either don't work, or have considerable side effects.

Dr Goebel, Senior Lecturer in Pain Medicine, explains: In CRPS, the real effect of this treatment in clinic may turn out to be even greater than what we have already seen, because IVIG can be given in higher doses, and repeated treatment may have additional effects. IVIG is normally repeated every four weeks and we are working to develop ways which would allow patients to administer the treatment in their own home.

The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions; if one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond.

The research is published in the journal

Extremity war injuries symposium seeks to improve patient care for wounded warriors

Wed, 27 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) WASHINGTON, D.C. - Since the beginning of Operations Iraqi Freedom and Enduring Freedom, there have been nearly 36,000 battle- injured warriors, of which approximately 82 percent suffer extremity trauma. Many of these injuries are complicated by the effects of improvised explosive devices which cause injury patterns distinct from civilian trauma. Traditional wound-management guidelines simply fall short. In an effort to address the increasing number and severity of extremity war injuries among the nation's warriors serving in Iraq and Afghanistan, the American Academy of Orthopaedic Surgeons (AAOS), the Society of Military Orthopaedic Surgeons (SOMOS), the Orthopaedic Trauma Association (OTA), and the Orthopaedic Research Society (ORS) will bring together the nation's top civilian and military orthopaedic trauma surgeons and researchers for a two-day symposium January 27 - 29 to discuss barriers of return of function and duty and develop treatment principles.

Over the past several years, peer-reviewed orthopaedic research has been an essential element of our continued efforts to encourage researchers to focus on improving the treatment of high-energy extremity war injuries, said Michael Bosse, MD, CAPT, USNR (Ret.), past OTA President and co-chair of the EWI Symposium. The EWI Symposium gives us a valuable opportunity to discuss this type of research and to learn more about helping our military orthopaedic surgeons discover new and innovative ways to best treat these complex injuries. To improve the quality of life for these injured troops, we have to recognize the need for sustained, robust investment in this type of research.

The distinguished service of our military surgeons never ceases to amaze me, noted COL James R. Ficke, MD, current Chairman of the Department of Orthopaedic Surgery and Rehabilitation at Brooke Army Medical Center, the Orthopaedic Surgery Consultant to the US Army Surgeon General, and co-chair of the EWI Symposium. The continued dedication of surgeons and the incredible courage of our patients inspires advances that enhance the treatment, research, and knowledge of blast injuries. The body of research to characterize these injuries demonstrates that the majority of battlefield wounds affect extremities. Extremity wounds are responsible for two-thirds of inpatient hospital and disability costs, and are the main reasons why up to one third of our warriors never fully recover. This underscores the fact that current therapy options are not capable of restoring full function after these devastating injuries.

In January 2006, AAOS, SOMOS, and OTA hosted the first Extremity War Injuries (EWI) symposium in Washington, DC, which defined current knowledge of the management of extremity war wounds and produced a prioritized list of objectives for future research. Now in its fifth year, the EWI symposium will focus on barriers to return of function and duty and will include a session on disaster preparedness and response. The session is co-moderated by Christopher T. Born, MD, Director of Orthopaedic Trauma at Rhode Island Hospital, who will discuss his recent experiences in Haiti after the earthquake disaster.

WPI receives $1.6 million allocation for research on advanced implantable neuroprosthetics

Tue, 05 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) WORCESTER, Mass. -- The conflicts in Iraq and Afghanistan have left a terrible legacy: more than 1,200 returning American soldiers have lost one or more limbs. To address this growing national need, researchers at Worcester Polytechnic Institute (WPI) are laying the groundwork for a new generation of advanced prosthetic limbs that will be fully integrated with the body and nervous system. These implantable neuroprosthetics will look and function like natural limbs, enabling injured soldiers and the more than 2 million other amputees in the United States lead higher quality, more independent lives.

As part of the recently approved Department of Defense appropriations bill, the U.S. Congress has allocated $1.6 million to the Center for Neuroprosthetics and BioMEMS (CNB), part of WPI's Bioengineering Institute, to advance this groundbreaking work. Sponsored by Massachusetts Senators John Kerry and Paul G. Kirk Jr and Massachusetts Representative James P. McGovern, the allocation will, in particular, fund work at WPI on neural control for advanced prosthetics. The allocations will be directed by the U.S. Army's Telemedicine and Advanced Technology Resource Center (TATRC).

WPI's involvement with neuroprosthetics began with the encouragement and support of Senator Ted Kennedy, who helped secure the funds that launched our neuroprosthetics center, said Dennis D. Berkey, WPI president and CEO. We are grateful for the leadership of Senators Kerry and Kirk and the support of Congressman McGovern, who have made it possible for the important work Senator Kennedy started to continue. These funds will generate extraordinary technological advances that will give hundreds of soldiers, veterans, and other Americans a quality of life they might have thought impossible.

These federal investments will not only substantially increase the quality of life of our injured soldiers and veterans, but will also help stimulate the Massachusetts economy by fostering local innovation, expanding our strengths in health care and medical devices, and creating good-paying jobs, Rep. McGovern said.

In all, 30 WPI researchers, from multiple science and engineering disciplines, including regenerative biology, tissue engineering, surface science and nanotechnology, and biomedical signal processing, are engaged in work related to neuroprosthetics. Their research focuses on two primary goals: regenerating tissue to create a robust soft-tissue seal around an implanted limb to make possible natural movement and deter infection; and using engineered micro-wires as scaffolds for the recruitment of neural stem cells and the regeneration of nerves. Ultimately, by regenerating nerves, it is anticipated that it will be possible to connect the limb directly to the nervous system, enabling it to send feedback to and receive commands from the brain.

With advances in body armor and battlefield medicine, soldiers are far more likely to survive combat injuries today than during past conflicts, says W. Grant McGimpsey, Professor of Chemistry and Biochemistry and director of WPI's Bioengineering Institute and the CNB. But too often, they return home to find their quality of life curtailed. We owe it to those who have made sacrifices for our country to apply our know-how and expertise to making them whole again. This is the goal that drives everyone engaged in this research.

WPI's research in implantable, neurally controlled prosthetics began in 2007 as a result of $1 million Congressional allocation to support CNB, championed by Senators Kennedy and Kerry, and Congressman McGovern. An award from the John Adams Innovation Institute enabled the new center to explore relationships with other research institutions, and to establish the nation's first symposium series dedicated to advancing the field of neuroprosthetics. The first national symposium was held at WPI in September 2009 and planning is under way for Neuroprosthetics 2010.

New genetic variants for COPD discovered in a groundbreaking study by SpiroMeta Consortium

Tue, 15 Dec 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Scientists have discovered five genetic variants that are associated with the health of the human lung. The research by an international consortium of 96 scientists from 63 centres in Europe and Australia sheds new light on the molecular basis of lung diseases.

The research, part-funded by the Medical Research Council (MRC) and Asthma UK, is published today in Nature Genetics. It represents a significant advance because it is the first time that these five common genetic variations have been definitely linked with lung function.

The new findings provide hope for better treatment for lung diseases like Chronic Obstructive Pulmonary Disease (COPD) and asthma. In the past it has been difficult to develop new treatments because the molecular pathways that affect the health of the lung are not completely understood. It's hoped the new pathways discovered could in the future be targeted by drugs.

The ground-breaking research involved a genetic study of 2.5 million sites across the human genome involving samples from 20,000 people across the world. The consortium was led by Dr Martin Tobin from the University of Leicester and Professor Ian Hall from The University of Nottingham.

Lung function is commonly expressed using two measures recorded using a simple device called a spirometer. These measures are termed the FEV1 (or forced expiratory volume in 1 second) which is the volume of air that can be breathed out in 1 second, and the FVC (forced vital capacity) which is the total volume of air that can be breathed out. In chronic obstructive pulmonary disease (COPD), which encompasses chronic bronchitis and emphysema, narrowing of the airways causes a disproportionate reduction in FEV1. Cough, phlegm and shortness of breath are common symptoms of COPD. The simplest way to diagnose COPD is through spirometry, which is usually available in general practitioners' surgeries. Although there is no cure for COPD, stopping smoking and treatments can improve symptoms and reduce the impact of COPD on exercise and daily activities. Drug treatments include bronchodilators and, for exacerbations, may include short-term steroids. Patients with COPD are more susceptible to serious lung infections, so flu vaccination each winter is important.

The genetic determinants of COPD can be studied by investigating the genetic variants that affect the risk of developing COPD itself or by studying lung function itself, on which the diagnosis of COPD is based. Reduced lung function may also occur in patients with other airway diseases such as asthma.

Further research will be needed to study in detail the molecular alterations in the lung that result from the genetic variants identified, and to investigate whether these might be targeted by drugs. At this time there is no case for testing for common genetic variants that might predispose to COPD.

The scientists said: "This work is important because until now we have known very little about the genetic factors that determine an individual's lung function. By identifying the genes important in determining lung function, we can start to unravel the underlying mechanisms which control both lung development and lung damage. This will lead to a better understanding of diseases such as chronic obstructive pulmonary disease (COPD) and asthma. Crucially, it could open up new opportunities to manage and treat patients with lung conditions".

The authors added: "A large reduction in lung function occurs in chronic obstructive pulmonary disease (COPD), which affects around 1 in 10 adults above the age of 40 and is thought to be the fourth most common cause of death worldwide. Smoking is the major risk factor for development of COPD. Lung function and COPD cluster within families, indicating that variations in genes also predispose individuals to reduced lung function.

"The scientists of the SpiroMeta consortium compared genetic variants at each of 2.5 million sites across the human genome in over 20,000 individuals of European ancestry with their lung function measures. In five different locations in the human genome, genetic variants resulted in alterations in lung function. The scientists showed that these were real findings by checking the effects of the same variants in over 33,000 additional individuals. They also compared their results to those of a second consortium, CHARGE, which has published a paper in the same issue of the journal.

The scientists emphasise that they do not expect these findings to lead to immediately to genetic tests to predict who will develop lung disease. What is more important, they say, is that the findings will help understand the underlying causes of lung diseases and thus may indicate new ways of treating the condition.

"The research would not have been possible without the generous support of the participants of the contributing studies from the UK, Europe and Australia, to whom we offer our thanks."

Horse barn workers at high risk of respiratory symptoms

Sun, 22 Nov 2009 09:29:00 PST

( from http://www.rxpgnews.com ) The estimated 4.6 million Americans involved in the equine industry may be at risk of developing respiratory symptoms due to poor air quality in horse barns, according to a questionnaire study undertaken earlier this year by investigators at Tufts University’s Cummings School of Veterinary Medicine.

The study—which polled more than 80 New England horse barn workers—found that 50 percent of individuals working in barns complained of coughing, wheezing, or other ailments in the last year, compared to just 15 percent in the control group of 74 people. Moreover, increased exposure to barns yielded higher rates of self-reported respiratory symptoms, the study reports. The study was published in the journal Occupational Medicine and funded by the National Institutes of Health.

“It has long been known that lower respiratory illness is common in horses, and this is typically attributed to the amount of dust in barns,” said Melissa R. Mazan, DVM, associate professor of clinical sciences at the Cummings School and the study’s lead author. “Our hope was to see whether this poor air quality affects horse owners, and it appears that it might.”

For the study, Mazan and her colleagues at the Cummings School—including Jessica Svatek, Louise Maranda, and Andrew M. Hoffman—collaborated with researchers from the Harvard School of Public Health, the University of Connecticut, and the National Health and Environmental Effects Research Laboratory at the Environmental Protection Agency’s Research Triangle Park.

Although further study is necessary to determine the causes of respiratory distress, Dr. Mazan says, the results are striking—and may be similar among pig, dairy and chicken farmers, who work in environments similarly high in organic dust. A 2001 study of European animal farmers found similar results.

Investigation of exposure to the dust, lung function and horse dander allergies in the barn-exposed group will be necessary to determine how best to protect the health of this group, Dr. Mazan says.

Pulmonology research is one of four NIH-funded basic science divisions at the Cummings School, which also conducts research on infectious diseases, liver and hepatic illness, and reproduction and neurobiology, in addition to robust clinical, international, and sustainability research.

Depression as deadly as smoking

Tue, 17 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) A study by researchers at the University of Bergen, Norway, and the Institute of Psychiatry (IoP) at King's College London has found that depression is as much of a risk factor for mortality as smoking.

Utilising a unique link between a survey of over 60,000 people and a comprehensive mortality database, the researchers found that over the four years following the survey, the mortality risk was increased to a similar extent in people who were depressed as in people who were smokers.

Dr Robert Stewart, who led the research team at the IoP, explains the possible reasons that may underlie these surprising findings: 'Unlike smoking, we don't know how causal the association with depression is but it does suggest that more attention should be paid to this link because the association persisted after adjusting for many other factors.'

The study also shows that patients with depression face an overall increased risk of mortality, while a combination of depression and anxiety in patients lowers mortality compared with depression alone. Dr Stewart explains: 'One of the main messages from this research is that 'a little anxiety may be good for you'.

'It appears that we're talking about two risk groups here. People with very high levels of anxiety symptoms may be naturally more vulnerable due to stress, for example through the effects stress has on cardiovascular outcomes. On the other hand, people who score very low on anxiety measures, i.e. those who deny any symptoms at all, may be people who also tend not to seek help for physical conditions, or they may be people who tend to take risks. This would explain the higher mortality.'

In terms of the relationship between mortality and anxiety with depression as a risk factor, the research suggests that help-seeking behaviour may explain the pattern of outcomes. People with depression may not seek help or may fail to receive help when they do seek it, whereas the opposite may be true for people with anxiety.

Dr Stewart comments: 'It would certainly not surprise me at all to find that doctors are less likely to investigate physical symptoms in people with depression because they think that depression is the explanation, but may be more likely to investigate if someone is anxious because they think it will reassure them. These are conjectures but they would fit with the data.'

The researchers point out that the results should be considered in conjunction with other evidence suggesting a variety of adverse physical health outcomes and poor health associated with mental disorders such as depression and psychotic disorders.

In light of the findings, Dr Stewart makes suggestions on the focus of future developments in the treatment of depression and anxiety: 'The physical health of people with current or previous mental disorder needs a lot more attention than it gets at the moment.

'This applies to primary care, secondary mental health care and general hospital care in the sense that there should be more active screening for physical disorders and risk factors, such as blood pressure, cholesterol, adverse diet, smoking, lack of exercise, in people with mental disorders. This should be done in addition to more active treatment of disorders when present, and more effective general health promotion.'

Researchers focus on helping dying patients take care of unfinished business

Tue, 17 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) CLEVELAND--Hospice workers have watched patients emerge from comas and cling to life long enough to tell someone they love or forgive them.

This phenomenon of taking care of unfinished business has been observed, but researchers from the Frances Payne Bolton School of Nursing and the College of Arts and Sciences at Case Western Reserve University will begin groundbreaking studies to understand what drives the dying to live long enough to resolve these issues.

With the research data, they will design interventions to help patients in hospice care and families before and after the person passes.

Before now, end of life research primarily focused on making the patient comfortable by easing suffering or discomfort from the illness.

But, the approach of Barbara Daly and Mary Jo Prince-Paul from the School of Nursing and Julie Exline from Arts and Sciences is to relieve psychological distress by marshaling the patient's inner strengths and social connections.

These qualities include the resilient feelings of hope, optimism and connectedness that they mustered to make it through difficult and even life-threatening situations before their terminal illnesses. Marshaling these inner resources has been shown to improve the psychological outlook of healthy people, and the researchers want to find out the benefits for those severely ill.

In the past, researchers have shied away from approaching dying patients with questions, but among the goals of these projects is to give hospice patients options to participate in research. They also will organize a biomedical research group interested in palliative care that focuses on the patients' and family members' inner strength.

Daly, the Gertrude Perkins Oliva Professor of Oncology Nursing at Case Western Reserve and clinical ethics director at University Hospitals Case Medical Center, will establish the BEST Center (Building End-of-Life Science through Positive Human Strengths and Traits) to encourage research and recruit faculty in this area. The National Institute of Nursing Research funds the research.

Over the next year, three faculty members will receive support to concentrate 75 percent of their time on research. Each faculty member will receive $30,000 to launch a new project. As part of the hiring requirements, researchers must have a project ready to begin at their start date.

Approximately 20 faculty members across the Case Western Reserve campus work in the area of end-of-life issues. As one function of the BEST Center, the Palliative Care Education and Research Leadership (PEARL) group will meet regularly with the opportunity to collaborate and share ideas and findings.

Many people want the end-of-life experience to be meaningful, says Prince-Paul, assistant professor of nursing and hospice nurse at Hospice of the Western Reserve who has worked in hospice and palliative care for nearly 20 years.

With funding from the American Cancer Society, 163 patients ages 18 and older with an advanced cancer diagnosis will participate and test a new communication tool developed by Prince-Paul.

Patients will be interviewed three times over the course of a year or at the time they enter hospice care about what they feel is important. They will see how life goals and key communication expressions, such as love, gratitude, and forgiveness might change.

Prince-Paul explains, when people come face to face with death, hospice care workers have noticed that people want to clean up unfinished business.

At the end of life, people have limited ability and energy to communicate. We need to strategize and capitalize on the time they have to facilitate those things that matter most in their life, says Prince-Paul.

Families sometimes have unresolved issues to settle, too. Exline, a psychologist and associate professor of psychology, and Prince-Paul will lead the study of 200 family members who have someone near the end of life or have died.

Among those issues can be forgiveness. Exline, who has studied forgiving oneself, others and God over the past decade, will survey family members before and after the death of the loved one to see how hospice workers can help them as they undergo the emotional stress of caring for this seriously ill family member and then the challenges of bereavement.

With Fetzer Foundation support, Exline will lead the researchers in testing new survey tools to help determine how hospice workers can help family members.

The researchers will collaborate with healthcare workers from the Hospice of the Western Reserve, who will distribute questionnaires for those with a family member in hospice home care. Another group of family members will be interviewed during the bereavement period.

A primary caretaker in the family will answer questions that define some of the issues and emotions experienced at this time. The researchers will start by asking an open-ended question such as If you had an opportunity to say something to your family member, what would it be? Other detailed questions will follow.

The researchers will conduct another study during bereavement to assess if there are any unresolved issues with the deceased family member and if there is a continued bond with that family member.

Exline is interested in how people experience struggle and how forgiveness is part of that process.

Your own stem cells can treat heart disease

Tue, 17 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk. The transplant subjects also experienced fewer deaths than those who didn't receive stem cells.

In the 12-month Phase II, double-blind trial, subjects' own purified stem cells, called CD34+ cells, were injected into their hearts in an effort to spur the growth of small blood vessels that make up the microcirculation of the heart muscle. Researchers believe the loss of these blood vessels contributes to the pain of chronic, severe angina.

This is the first study to show significant benefit in pain reduction and improved exercise capacity in this population with very advanced heart disease, said principal investigator Douglas Losordo, M.D., the Eileen M. Foell Professor of Heart Research at the Northwestern University Feinberg School of Medicine and a cardiologist and director of the program in cardiovascular regenerative medicine at Northwestern Memorial Hospital, the lead site of the study.

Losordo, also director of the Feinberg Cardiovascular Research Institute, said this study provides the first evidence that a person's own stem cells can be used as a treatment for their heart disease. He cautioned, however, that the findings of the 25-site trial with 167 subjects, require verification in a larger, Phase III study.

He presented his findings Nov. 17 at the American Heart Association Scientific Sessions 2009.

Out of the estimated 1 million people in the U.S. who suffer from chronic, severe angina -- chest pain due to blocked arteries -- about 300,000 cannot be helped by any traditional medical treatment such as angioplasty, bypass surgery or stents. This is called intractable or severe angina, the severity of which is designated by classes. The subjects in Losordo's study were class 3 or 4, meaning they had chest pain from normal to minimal activities, such as from brushing their teeth or even resting.

The stem cell transplant is the first therapy to produce an improvement in severe angina subjects' ability to walk on a treadmill. Twelve months after the procedure, the transplant subjects were able to double their improvement on a treadmill compared to the placebo group. It also took twice as long until they experienced angina pain on a treadmill compared to the placebo group, and, when they felt pain, it went away faster with rest. In addition, they had fewer overall episodes of chest pain in their daily lives.

In the trial, the CD34+ cells were injected into 10 locations in the heart muscle. A sophisticated electromechanical mapping technology identifies where the heart muscle is alive but not functioning, because it is not receiving enough blood supply.

Discoveries at NJIT including drug to stop brain injury receives $1.4M funding

Thu, 12 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) A drug to stop bleeding during a brain injury and a mattress that will prevent bedsores are among the scientific discoveries at NJIT that received earlier this week more than a million dollars in funding from the New Jersey Commission on Science and Technology. The discoveries are the work of five early stage companies based at NJIT's Enterprise Development Center (EDC), the state's oldest business incubator program.

EDC, which is home to 95 new companies, received a $300,000 grant from the Commission, the largest award given to any organization of this kind in New Jersey. The money will go toward maintaining and supplementing EDC's unique specialized training initiatives and other programs made available to tenant companies on a weekly basis.

We will receive this year a total of almost $1.4 million from the Commission to strengthen both our most promising companies as well as our actual programs which help companies succeed, said Judith Sheft, associate vice president, technology development.

Support from the Commission to these early stage companies in a variety of technology disciplines will help them accelerate their path to success and ultimately add to job growth in the state. A recent study from the Kauffman Foundation shows that newly created and young companies such as these are the primary drivers of job creation in the United States.

The following five companies received awards from the Commission.

Edge Therapeutics Inc., a recipient of $500,000, has three drugs to treat serious types of brain injury. The drugs are based on a patent-pending drug delivery platform technology that provides for targeted, site specific delivery to the brain of FDA-approved off-patent drugs.

Phoenix Labs, LLC, a recipient of $250,000, has developed and validated a patent-pending algorithm for precision-timing synchronization. Precision-timing synchronization is essential for the evolution of 3G and 4G wireless networks that will account for the most substantial growth in telecommunications industry revenue over the next decade.

Simphotek, Inc, a recipient of $250,000, is developing simulation software for biomedical, nanotechnology, renewable energy and photonic materials markets.

Healthy Functions received a $50,000 fellowship for the development of a mechanical pressure reduction mattress. This mattress will prevent pressure ulcers or bedsores on bedridden, comatose, paraplegic, and other patients who are neuro-muscularly disabled.

AcquiSci Inc received $21,936 fellowship to develop a systemic anti-inflammatory treatment of cardiovascular diseases with underlying inflammation.

American Academy of Nursing strengthened by induction of palliative care expert

Mon, 09 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Patricia Berry, PhD, APRN, FAAN, associate professor at the University of Utah College of Nursing was formally inducted into the American Academy of Nursing Saturday as one of the 2009 new Fellows. Berry was nominated for this honor by two current Academy Fellows and was selected by the Academy's 15-member Fellow Selection Committee for her outstanding achievements in the nursing profession. The induction of Berry and 97 other nurse leaders took place during the Academy's Annual Awards Ceremony in Atlanta, GA.

The American Academy of Nursing invites a select group of nursing leaders to become fellows of the academy, said University of Utah College of Nursing Dean and Louis H. Peery Presidential Endowed Chair, Maureen R. Keefe, RN, PhD, FAAN. This honor is indicative of Dr. Berry's numerous contributions to the field of nursing, particularly in the areas of end-of-life care and pain symptom management. According to Keefe, Berry joins a select group of College of Nursing faculty members who have received this distinguished honor.

The Academy is constituted to anticipate national and international trends in health care, and address resulting issues of health care knowledge and policy. Not only is the invitation to Fellowship recognition of one's accomplishments within the nursing profession, but it also affords the chance to work with other leaders in health care in addressing the issues of the day.

In addition to being a certified gerontological nurse practitioner and an advanced practice palliative care nurse, Berry is associate director, education and practice for the University of Utah's Hartford Center of Geriatric Nursing Excellence. With 32 years of experience in hospice and palliative care, Berry has contributed to critical policy, educational, and scientific initiatives to improve the management of pain and symptoms, especially for individuals with life-limiting illness and their families. She is a member of the national faculty for the Geriatric End of Life Nursing Education Consortium (ELNEC) and serves on the research committees of the National Hospice and Palliative Care Organization and the American Board of Nursing Specialties.

By sustaining her commitment to pain and symptom management, especially for older adults at the end of life, Dr. Berry will join other members of the Academy as an important force in disseminating nursing knowledge nationally and internationally, said Regina Fink, RN, PhD, FAAN, AOCN, a research nurse scientist with University of Colorado Hospital and one of Berry's nominators. Added Ginette Pepper, PhD, RN, FAAN, professor, Helen Lowe Bamberger Colby Endowed Chair in Gerontological Nursing, who joined with Fink in nominating Berry, One of the most expensive and agonizing aspects of our health care system is inappropriate care at the end of life. Dr. Berry's voice and expertise will help to further the mission of the Academy and assure the promotion of humane and effective health care.

Findings show nanomedicine promising for treating spinal cord injuries

Mon, 09 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Researchers at Purdue University have discovered a new approach for repairing damaged nerve fibers in spinal cord injuries using nano-spheres that could be injected into the blood shortly after an accident.

The synthetic "copolymer micelles" are drug-delivery spheres about 60 nanometers in diameter, or roughly 100 times smaller than the diameter of a red blood cell.

Researchers have been studying how to deliver drugs for cancer treatment and other therapies using these spheres. Medications might be harbored in the cores and ferried to diseased or damaged tissue.

Purdue researchers have now shown that the micelles themselves repair damaged axons, fibers that transmit electrical impulses in the spinal cord.

"That was a very surprising discovery," said Ji-Xin Cheng, an associate professor in the Weldon School of Biomedical Engineering and Department of Chemistry. "Micelles have been used for 30 years as drug-delivery vehicles in research, but no one has ever used them directly as a medicine."

Findings are detailed in a research paper appearing Sunday (Nov. 8) in the journal Nature Nanotechnology.

A critical feature of micelles is that they combine two types of polymers, one being hydrophobic and the other hydrophilic, meaning they are either unable or able to mix with water. The hydrophobic core can be loaded with drugs to treat disease.

The micelles might be used instead of more conventional "membrane sealing agents," including polyethylene glycol, which makes up the outer shell of the micelles. Because of the nanoscale size and the polyethylene glycol shell of the micelles, they are not quickly filtered by the kidney or captured by the liver, enabling them to remain in the bloodstream long enough to circulate to damaged tissues.

In research led by biomedical engineering doctoral student Yunzhou Shi, the micelles also were shown to be non-toxic at the concentrations required.

"With the micelles, you need only about 1/100,000th the concentration of regular polyethylene glycol," Cheng said.

Ongoing research at Purdue has shown the benefits of polyethylene glycol, or PEG, to treat animals with spinal cord injuries. The work is led by Richard Borgens, director of the Center for Paralysis Research and the Mari Hulman George Professor of Neurology in the School of Veterinary Medicine.

Findings have shown that PEG specifically targets damaged cells and seals the injured area, reducing further damage. It also helps restore cell function.

The new findings were made possible by the interdisciplinary nature of the work, which involves Borgens and other Purdue researchers, Cheng said. The collaboration included Borgens; Riyi Shi, an associate professor of biomedical engineering and basic medical sciences; and Kinam Park, Showalter Distinguished Professor of Biomedical Engineering and a professor of pharmaceutics.

Findings showed that cores made of particular materials work better than others at restoring function to damaged axons, which are slender extensions of nerve cells.

The research also showed that without the micelles treatment about 18 percent of axons recover in a segment of damaged spinal cord tested in a "double sucrose gap recording chamber." The micelles treatment boosted the axon recovery to about 60 percent. The researchers used the chamber to study how well micelles repaired damaged nerve cells by measuring the "compound action potential," or the ability of a spinal cord to transmit signals.

The experiment mimics what happens during a traumatic spinal cord injury. Findings showed that micelles might be used to repair axon membranes damaged by compression injuries, a common type of spine injury.

The researchers also tracked dyed micelles in rats, demonstrating that the nanoparticles were successfully delivered to injury sites. Findings also showed micelles-treated animals recovered the coordinated control of all four limbs, whereas animals treated with conventional polyethylene glycol did not.

Carbon nanotubes can affect lung lining

Tue, 03 Nov 2009 23:06:00 PST

( from http://www.rxpgnews.com ) Carbon nanotubes which are used in everything from sports equipment to medical applications can affect the lining of the lungs, say researchers.

The long term effects, however, remain unclear.

The study was a collaboration between North Carolina State University -, The Hamner Institutes for Health Sciences, and the National Institute of Environmental Health Sciences.

Using mice in an animal model study, researchers set out to determine what happens when multi-walled carbon nanotubes are inhaled.

Specifically, researchers wanted to determine whether the nanotubes would be able to reach the pleura, which is the tissue that lines the outside of the lungs and is affected by exposure to certain types of asbestos fibres which cause cancer.

Researchers found that inhaled nanotubes do reach the pleura and cause health effects. Short-term studies described in the paper do not allow conclusions about long-term responses such as cancer.

The 'unique reaction' began within one day of inhalation of the nanotubes, when clusters of immune cells - began collecting on the surface of the pleura.

Localised fibrosis, or scarring on parts of the pleural surface that is also found with asbestos exposure, began two weeks after inhalation.

The study showed the immune response and fibrosis disappeared within three months of exposure. However, this study used only a single exposure to the nanotubes, says an NCSU release.

It remains unclear whether the pleura could recover from chronic, or repeated, exposures.

'More work needs to be done in that area and it is completely unknown at this point whether inhaled carbon nanotubes will prove to be carcinogenic in the lungs or in the pleural lining,' an NCSU release said.

These findings were published in Nature Nanotechnology.

Prostate cancer gives a new outlook on life

Mon, 05 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Men who have prostate cancer often feel quite healthy, but the diagnosis still gives them a whole new outlook on life. Once they have learned to live with their cancer, they choose to focus on valuable relationships and appreciate the little things in life, shows a dissertation thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

We need a better understanding of how men with prostate cancer experience their illness and how they choose to adapt their new circumstances, says district nurse Annikki Jonsson, who interviewed 37 men with prostate cancer for her thesis. We can then support them better and tailor their treatment to the phase they are in.

The results show that the men go through different phases of adjustment in succession after getting their diagnosis, and that their everyday lives are affected differently according to which phase they are in.

Those with less serious prostate cancer find themselves in an emotional vacuum immediately after receiving their diagnosis. During this phase, which normally lasts around a week, it is pointless for medical personnel to try to give men information about their illness.

But they do appreciate positive reception without pity during this initial phase. And, of course, if they do choose to get in touch and ask some questions, it's important to answer and tell where you can turn to with diffrent thoughts.

Once these men have negotiated this initial phase, they regain control over their lives and find their driving force for life. They begin actively seek out information about their illness.

Men who learn that they have an aggressive form of prostate cancer find that the disease is allways at present and they feel often a sense of emptiness during the initial period following the diagnosis. For these men, the disease is an existential threat.

They think a lot about how the future will be and how they will die.

The men I interviewed said that they lived life more intense, but that they had their ups and downs, says Jonsson. Sometimes they felt more alive, and in the next minute got a feeling that they risked losing control or being reminded of their changed masculinity.

The men were interviewed again two years after receiving their diagnosis. They told that they had realised that life is fragile, and they were aware that they did not know how long the life will be. They got more faith and trust in life and had discovered that they could preserve their autonomy and integrity despite their illness.

Life changes, and it's important to achieve some kind of balance, says Jonsson. The men focused their energy on the relationships which were valuable for them. They appreciated the little things in life in a different way nowadays and developed an inner strength to be true to themselves.

Weill Cornell Institute for Geriatric Psychiatry awarded $10 million grant

Thu, 24 Sep 2009 04:00:00 PST

( from http://www.rxpgnews.com ) WHITE PLAINS, NY (Sept. 24, 2009) -- The Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division announced today it has received the largest grant in its 20-year history. One of a handful awarded nationally, the new $10 million, five-year Center Grant from the National Institute of Mental Health (NIMH) will enable NewYork-Presbyterian/Weill Cornell investigators to advance their pioneering work in understanding the biological, medical, cognitive and psychosocial problems of depressed seniors. The grant is one of the largest ever given by NIMH to study geriatric depression.

The grant's principal investigator is Dr. George Alexopoulos, founder and director of the Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian/Westchester, professor of psychiatry at Weill Cornell Medical College and director of the NIMH-supported Advanced Center for Interventions and Services Research (ACISR) in late-life depression. He is recognized as one of the world's leading geriatric psychiatry researchers in late-life depression and its treatment.

Dr. Alexopoulos, who has spent his career of more than 30 years investigating late-life depression, said, To receive a Center Grant by NIMH, a team must have a critical mass of competitively-funded research projects and demonstrate that the Center's new projects and structures will result in a scientific product that will be greater than the sum of its individual projects. As such, the Center Grant represents an endorsement by NIMH of the scope and importance of our team's work.

He added: This is an exciting time in the history of the Weill Cornell Institute of Geriatric Psychiatry. The 'Center Grant' is significant because it will enable our investigators to synthesize their findings in a meaningful way and develop new tools and practices needed to reduce the burden of depression and disability in elderly persons who have limited access to quality care.

As in the past, the Institute will seek individuals over the age of 60 from the community to participate in research studies.

Since its inception in 1994, the Weill Cornell Institute of Geriatric Psychiatry has consistently received support by NIMH. This is the fourth and largest Center Grant awarded to the Institute since its inception.

Dr. Alexopoulos noted that the Institute demonstrated in its grant application that we have the infrastructure and unique mix of innovative findings and synergies in place to take our research to the next level by developing new treatments and improving the care offered to elderly patients in the community.

The research efforts of Weill Cornell Institute's team of 13 NIMH-funded investigators, five at the full professor's level, have concentrated in three interrelated core areas:

University of Maryland Shock Trauma Center to participate in extremity research consortium

Fri, 11 Sep 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The University of Maryland R Adams Cowley Shock Trauma Center in Baltimore, Md., will serve as one of 12 core clinical centers in a newly established Extremity Trauma Clinical Research Consortium funded by the U.S. Department of Defense.

The consortium will work closely with several major military treatment centers and the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston, Texas, to conduct multi-center clinical research studies relevant to the treatment and outcomes of severe orthopaedic trauma sustained on the battlefield. These studies will help establish treatment guidelines and facilitate the translation of new and emerging technologies into clinical practice.

This clinical research network offers us a unique opportunity to investigate treatments for a variety of injuries common in military and civilian patients, says Andrew N. Pollak, M.D., co-chair of the consortium and head of the division of orthopaedic traumatology at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and associate professor of orthopaedics at the University of Maryland School of Medicine. We needed more funding to conduct definitive studies on severe wounds to the legs and arms. The results of this research will give us better insight into the best ways to treat severe, high-impact injuries to the limbs.

Dr. Pollak, who served as chair of the American Academy of Orthopaedic Surgeons' Extremity War Injury Project Team, will lead the orthopaedics studies at Shock Trauma as part of the new initiative. He has championed the need for increased funding for trauma research, citing the devastating extremity injuries suffered by U.S. soldiers in Iraq and Afghanistan. There is a profound need for targeted medical research to help military surgeons find new limb-sparing techniques to save injured extremities, avoid amputations and preserve and restore the function of injured extremities, he told the U.S. Senate Appropriations Subcommittee in 2007.

The Johns Hopkins Bloomberg School of Public Health will serve as the coordinating center for the consortium. The Orthopaedic Extremity Trauma Research Program (OETRP) of the Department of Defense has awarded the Bloomberg School of Public Health $18.4 million over five years to establish the consortium.

The need for such a consortium is evident, says Ellen MacKenzie, Ph.D., principal investigator and the Fred and Julie Soper Professor and Chair of the Bloomberg School's Department of Health Policy and Management. Eighty-two percent of all service members injured in Operation Iraqi Freedom and Operation Enduring Freedom sustain significant extremity trauma. Many sustain injuries to multiple limbs. The research to be conducted by the consortium will help us better understand what works and what doesn't in treating these injuries and ensure that our service members are provided with the best care possible.

E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, says, The University of Maryland R Adams Cowley Shock Trauma Center is internationally recognized for its expertise in caring for the most critically injured patients and is a leader in trauma research. Our faculty members will play a very active role in this new consortium, working together with trauma specialists at other centers to develop innovative new therapies to treat traumatic limb injuries.

Initial funding of the consortium will help establish the research network and provide resources to address some of the critical needs in acute clinical care identified by the military. These include the reconstruction of significant bone defects and the management of musculoskeletal infections. Over time, the consortium will expand and leverage its expertise to address many other priority topics relevant to the long-term management of severe extremity trauma, including the prevention of osteomyelitis, chronic pain and disability.

An important feature of the consortium will be its ability to expand the number of clinical sites participating in any one study. More than 30 trauma centers across the country have pledged support for the consortium and are eager to participate in one or more of the studies.

We are thrilled to be partnering with the consortium and the incredible team of investigators they have assembled, says Joseph Wenke, Ph.D., of the USAISR. Together we will develop the infrastructure critically needed to address some of the most pressing issues in orthopaedic trauma care. Without a large, multi-center effort such as this, many of these issues would never be solved.

The other core clinical centers currently participating in the consortium are: Boston University Medical Center; The Florida Orthopaedic Institute; Carolinas Medical Center; Denver Health and Hospital Authority; OrthoIndy and the Indiana Orthopaedic Hospital; Orthopaedic Associates of Michigan; The Orthopaedic Trauma Institute at the University of California at San Francisco, San Francisco General Hospital; The University of Mississippi Medical Center; The University of Texas Southwestern Medical Center; The University of Washington Harborview Medical Center and Vanderbilt University Medical Center.

Piece from childhood virus may save soldiers' lives

Sun, 06 Sep 2009 03:59:12 PST

( from http://www.rxpgnews.com ) A harmless shard from the shell of a common childhood virus may halt a biological process that kills a significant percentage of battlefield casualties, heart attack victims and oxygen-deprived newborns, according to research presented Sunday, September 6, 2009, at the 12th European meeting on complement in human disease in Budapest, Hungary.

Introducing the virus's shell in vitro shuts down what's known as the complement response, a primordial part of the immune system that attacks and destroys the organs and vascular lining of people who have been deprived of oxygen for prolonged periods, according to researchers at Children's Hospital of The King's Daughters (CHKD) and Eastern Virginia Medical School (EVMS), in Norfolk, Va.

The complement response kicks in after the victim has been revived, in what is known as a reperfusion injury. It does its work slowly but unrelentingly, killing soldiers, infants or heart attack victims over the course of days.

To find a way to manipulate the complement system pharmacologically has been like a search for the Holy Grail, said one of the lead researchers, Dr. Kenji Cunnion, an infectious disease physician at CHKD and an associate professor of pediatrics at EVMS.

While Cunnion and Neel Krishna, Ph.D., a pediatric virologist at CHKD and assistant professor of microbiology at EVMS, focus on pediatric research, they see clear military applications.

The complement reaction is one of the major causes of death of the battlefield, said Krishna. By the time you get a victim to the hospital, it may be too late.

Dr. L.D. Britt, M.D., MPH, Brickhouse professor and chairman of surgery at EVMS, agrees.

Hemorrhagic shock is the leading cause of death in combat trauma and reperfusion injury plays a significant role both in increased mortality and increased brain damage, said Britt, senior consultant to the military on combat trauma. This research could help save the lives of soldiers, as well as the lives of other trauma victims who have been without oxygen for extended periods.

Britt has joined Cunnion in Krishna in seeking a grant from the Department of Defense to expedite research and development.

The complement system ranks as one of the oldest biological mechanisms in life's evolution and exists in almost identical form in everything from seagulls to starfish.

Essentially, the complement system recognizes and destroys potentially toxic substances that gain entry into an organism's bloodstream. When a starfish loses a limb, for instance, the complement system sends a contingent of killer cells to block and attack anything that tries to work its way inside.

In human evolution, complement provided an essential natural defense.

Up until 100 years ago, the vast majority of humans died from infectious diseases, said Cunnion. Nobody died of old age and almost nobody lived long enough to die of a heart attack.

Thanks to modern medicine, people now live long enough to die from trauma, such as car accidents, or from conditions, such as heart attack and stroke, that can leave cells throughout the body starved for oxygen. Cells deprived of oxygen often undergo biochemical changes, essentially marking themselves for death. When blood flow and oxygen are restored, these changes trigger the complement cascade. The marauding cells unleashed by complement cascade are indiscriminate, killing not only the cell with the biochemical marker but innocent bystander cells as well.

It's like throwing a grenade, said Krishna.

A patient, who has suffered survivable brain damage from oxygen deprivation, might die over several days as swaths of cells are destroyed by this seemingly unstoppable reaction. Animal research has shown that stopping this complement reaction significantly reduces brain damage.

The complement system is so complex that research scientists spend entire careers studying it, publishing in journals that specialize in this primordial defense mechanism.

In the case of Cunnion and Krishna, discovering how to shut down the complement system resulted from happenstance. As they worked in neighboring labs, they noticed a similarity in the structure of molecules Cunnion used in his experiments and the protein shell of the astrovirus Krishna studied. They wondered what would happen if they introduced the astrovirus shell into an assay routinely used in Cunnion's lab to assess complement activation.

It was kind of a shot in the dark, Krishna said. We didn't expect anything to happen.

The complement reaction completely stopped.

LLNL research reveals how blast waves may cause human brain injury even without direct head impacts

Wed, 26 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) LIVERMORE, Calif. - New research on the effects of blast waves could lead to an enhanced understanding of head injuries and improved military helmet design.

Using numerical hydrodynamic computer simulations, Lawrence Livermore scientists Willy Moss and Michael King, along with University of Rochester colleague Eric Blackman, have discovered that nonlethal blasts can induce enough skull flexure to generate potentially damaging loads in the brain, even without direct head impact.

Traumatic brain injury (TBI) results from mechanical loads in the brain, often without skull fracture, and causes complex, long-lasting symptoms. TBI in civilians is usually caused by direct head impacts resulting from motor vehicle and sports accidents. TBI also has emerged among military combat personnel exposed to blast waves. As modern body armor has substantially reduced soldier fatalities from explosive attacks, the lower mortality rates have revealed the high prevalence of TBI.

There has been extensive research on how head impacts, for example from automobile accidents, cause traumatic brain injury (TBI). But TBIs resulting from blast waves without head impacts have not been well understood.

To tackle this puzzle, the team used three-dimensional hydrodynamic simulations to prove that direct action of the blast wave on the head causes skull flexure, producing mechanical loads in brain tissue comparable to those in an injury-inducing impact, even at nonlethal blast pressures as low as 1 bar above atmospheric pressure.

In particular, the team showed that blast waves affect the brain very differently from direct impacts. The primary source of injury from direct impacts is the force resulting from the bulk acceleration of the head. In contrast, a blast wave squeezes the skull, creating pressures as large as an injury-inducing impact and pressure gradients in the brain that are much larger. This occurs even when the bulk head accelerations induced by a blast wave are much smaller than from a direct impact.

The blast wave sweeps over the skull like a rolling pin going over dough, said King, LLNL co-principal investigator.

Although the simulations show that the skull is deformed only about 50 microns (the width of a human hair), this is large enough to generate potentially damaging loads in the brain, according to Moss.

Because blast waves and direct impact affect the head in fundamentally different ways, armor systems that are designed to protect soldiers from impacts and projectiles may not be optimal for blast wave protection. The team studied how helmets and their suspension systems influence the blast-induced mechanical loads in the brain. They looked at two common systems: a nylon web system formerly used in the Personnel Armor Systems Ground Troops infantry helmet and viscoelastic foam pads like those in advanced combat helmets. Both helmets were modeled as hemi-ellipsoidal Kevlar shells.

In the first case, the 1.3 centimeter gap between the webbing and the shell allows the blast wave to wash under the helmet. In this case, the blast wave is focused by the shape of the helmet and the pressures under the helmet exceed those outside, so the helmet doesn't prevent the rippling deformation of the skull and pressure gradients in the brain.

In the second case, this under wash effect is mostly prevented by the presence of the foam pads, but under blast loading, the pads can become stiffer so that the blast wave-induced motion or deformation of the helmet is transferred to the skull. This can result in dangerous loads in the brain.

The possibility that blasts may contribute to traumatic brain injury has implications for injury diagnosis and improved armor design, Moss said.

Blackman added: By comparing the effect of blasts on the head with the effect of head impacts we'd be able to make some sense of the distinct mechanisms of injury, the damage a solider might incur, and how a helmet might be designed to minimize both.

Ellison Medical Foundation awards more than $1 million to mid-career scientists

Tue, 25 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK, August 25, 2009 -- Charleen T. Chu, MD, PhD, associate professor at the University of Pittsburgh and David M. Sabatini, MD, PhD, associate professor, Massachusetts Institute of Technology, received the 2009 Julie Martin Mid-Career Awards in Aging Research. Sponsored by The Ellison Medical Foundation, the grants provide funding of $550,000 to mid-career scientists whose research has great potential in advancing understanding of basic aging and its impact on age-related diseases. Through a partnership with the American Federation for Aging Research established in 2005, to date The Ellison Medical Foundation has disbursed $4.4 million to eight researchers.

In Parkinson's disease, dopaminergic neurons lose their ability to function and eventually die. Autophagy or self-eating is an important process by which damaged or unneeded structures in the cell are delivered to specialized compartments called lysosomes for digestion into building blocks that can be reused. The capacity for this recycling process, however, declines with age. Dr. Chu's research will develop methods to cause impairment of autophagy in adult mice to see if this factor contributes to the development of neurodegeneration on its own or in combination with genetic alterations that model familial parkinsonism. Dr. Chu's laboratory also studies the effects of overactivation of autophagy, which may also negatively alter neuritic and synaptic function. The ability to identify and correct age- or disease-related factors that disrupt the balance of autophagy could aid in the development of future therapies for neurological diseases.

The mammalian target of rapamycin (mTOR) signaling pathway is a key regulator of growth and metabolism in response to nutrients. mTOR signaling regulates protein synthesis, as well as cell size and proliferation, and has recently been linked to increased health and lifespan in a variety of organisms including yeast, worms, flies, and mice. Using mice with deletions of key mTOR genes, Dr. Sabatini seeks to learn more about the mechanisms underlying mTOR and its relationship to health and lifespan. The potential of such research is that one day this pathway may be able to be tweaked in people to provide some health benefits and protect against age-related diseases.

These grants address two pressing needs: to sustain the promising work of mid-career researchers and to encourage less conservative approaches to advance research on aging that may be deemed too risky for other sources of funding, said Stephanie Lederman, executive director, American Federation for Aging Research. We thank The Ellison Medical Foundation for their solid commitment to these scientists and the field.

One of the great opportunities in a scientist's career is the point where he/she has recently achieved tenure status and can begin to take greater risks with less concern about career security, said Richard L. Sprott, executive director, The Ellison Medical Foundation. We created this program in collaboration with AFAR in order to capitalize on the unique opportunities at this career stage by providing a funding source that encourages faster development of new ideas and approaches than is possible with more traditional funding.

Cardiac arrest resuscitation: Passive oxygen flow better than assisted ventilation

Tue, 11 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Arizona researchers have added another piece to the mounting body of evidence that suggests during resuscitation efforts to treat patients in cardiac arrest, passive ventilation significantly increases survival rates, compared to the widely practiced assisted ventilation.

The study, published in an online edition of Annals of Emergency Medicine, compared the numbers of patients who had suffered a cardiac arrest outside a hospital setting and were resuscitated in the field by Emergency Medical Services personnel. Rescuers used either bag-valve-mask ventilation, which forces air into the patient's lungs, or facemasks with a continuous flow of oxygen, which work in a similar fashion to those carried on airplanes in case the cabin pressure drops.

Among the 1,019 adult out-of-hospital cardiac arrest patients in the analysis, 459 received passive ventilation and 560 received bag-valve-mask ventilation. Neurologically normal survival after witnessed cardiac arrest with a shockable heart rhythm was higher for the passive oxygen flow method (38.2 percent) than bag-valve-mask ventilation (25.8 percent).

These results are strikingly similar to earlier observations from Wisconsin, where survival rates went up from 15 percent to 38 percent after paramedics abandoned the official guidelines for the modified protocol that we developed, says Gordon A. Ewy, MD, a co-author of the study and director of the Sarver Heart Center at The University of Arizona College of Medicine. The Sarver Heart Center's Resuscitation Research Group developed a modified protocol for treating out-of-hospital cardiac arrest called Cardiocerebral Resuscitation, as opposed to Cardiopulmonary Resuscitation, which should be reserved for respiratory arrest (such as near-drowning or drug overdose).

Under the new concept, first tested in Wisconsin, EMS personnel no longer intubated the patient for ventilation. Instead, they applied a facemask delivering a continuous, low-pressure flow of oxygen.

Our findings provide compelling evidence that positive pressure ventilation is not optimal in the initial management of out-of-hospital cardiac arrest, says lead author Bentley Bobrow, MD, emergency physician at Maricopa Medical Center in Phoenix and associate professor of emergency medicine at the UA College of Medicine. The work from our EMS providers in Arizona further questions the longstanding dogma of tracheal intubation and ventilation for cardiac arrest.

We are most pleased that while we are helping to advance the science of resuscitation, we are saving more victims of cardiac arrest in Arizona than ever before, adds Dr. Bobrow, who also is the medical director for the Arizona Department of Health Services Bureau of Emergency Medical Services.

This study reinforces our belief that survival of out-of-hospital cardiac arrest has more to do with circulating the blood through quality and uninterrupted chest compressions than with ventilation, Dr. Ewy adds.

Stories we tell about national trauma reflect our psychological well-being

Tue, 28 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A new study by psychologists at the University at Buffalo and the F. W. Olin College of Engineering finds that in the aftermath of national trauma, the ability to make sense out of what happened has implications for individual well-being and that the kinds of stories people tell about the incident predict very different psychological outcomes for them.

The study, The Political is Personal: Narrating 9/11 and Psychological Well-Being, is by Jonathan M. Adler, Ph.D., assistant professor of psychology at Olin, and Michael J. Poulin, Ph.D., assistant professor of psychology at UB.

Understanding the stories people tell about national events provides a unique opportunity to understand how individual well-being is linked to the state of the society, Poulin explains.

The study is published in the August issue of Journal of Personality. An online version of the study can be found online at the journal site: http://www3.interscience.wiley.com/cgi-bin/fulltext/122387789/HTMLSTART

Our findings suggest that different ways of writing about the events of 9/11 relate to different psychological outcomes, Poulin says, and that the different ways people describe traumatic national events -- even those they do not experience directly -- are linked to different levels of psychological adaptation.

To sum up, he says, we found that psychological well-being was associated with post-trauma stories that were high in closure, high in redemptive imagery and high in themes of national redemption. Psychological distress, on the other hand, was significantly related to accounts that were low in closure, high in contaminative imagery and high in themes of personal contamination.

The researchers looked at personal accounts about experiences of the terrorist attacks of 9/11 written by 395 adults from across the country, some of whom were more intimately connected to the events in question than were others. They then compared the narratives with various measures of their psychological well-being.

Accounts high in 'closure' are those that demonstrate an emotional conclusion or a coherent resolution of a difficult life event, Poulin says, and perhaps not surprisingly, participants who described the terrorist attacks with a sense that they were really over and no longer exerted an emotional influence had low levels of distress and high levels of well-being.

However, we also found that a high level of psychological well-being was significantly related to accounts that were high in references to national redemption and, among those more directly exposed to the attacks, high in redemptive imagery in general, he says.

He describes redemptive accounts as those that tell a story of something positive coming out of something negative. Adler notes that the theme of redemption has been characterized as a particularly American theme, observed in national rhetoric throughout history and in the personal stories of many well-known Americans.

On the opposite end of the spectrum, Adler and Poulin found that psychological distress was significantly related to accounts low in closure and high in contamination imagery or themes of personal contamination.

Contamination, Poulin says, is reflected in stories in which what was 'good' or 'acceptable' becomes contaminated, ruined, undermined, undone or spoiled. It is basically the opposite of redemption and may therefore be somewhat opposed to the themes of traditional American stories.

The study, funded by the National Science Foundation, is grounded in the theoretical tradition of the narrative study of lives. It involved a nationally representative sample of adults who wrote accounts about the 9/11 terrorist attacks approximately two months after they occurred.

The study participants were among more than 1,000 respondents who earlier had completed a two-month post-9/11 survey that included a number of open-ended questions related to their 9/11 experiences: their individual experiences on Sept. 11, 2001, how they made sense of the attacks and their aftermath, and whether they had been able to find positive consequences.

Those selected for the study were respondents who had contributed enough descriptive material to be coded for narrative themes of closure redemption and contamination.

The participants also completed a demographic survey, a mental-health questionnaire and answered questions about whether they had ever experienced any of 30 negative life events such as natural disaster or child abuse. They were assessed for their degree of exposure to the events of 9/11, and their levels of psychological well-being and distress were analyzed using well-known psychological scales.

Online obituaries are changing the way we publicly remember the dead and how newspapers cover deaths

Tue, 16 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The ways we deal with death are finding a new life online, according to research being published by a Kansas State University journalism professor and her colleague.

You're accustomed to clipping an obituary from the newspaper and putting it in the family Bible, but with online obituary services you can e-mail them to anyone you know, said Bonnie Bressers, associate professor of journalism and mass communications at K-State.

She and Janice Hume at the University of Georgia, who is the principal researcher on the project, have studied the phenomenon of newspapers publishing obituaries online and what it means not only for mourners and the public memory of the dead but also the ethical implications for newspapers. They will present their work in August at the Association for Education in Journalism and Mass Communications conference in Boston.

Hume was a K-State journalism and mass communications faculty member from 1999-2001.

Hume and Bressers looked at obituaries in the largest circulation newspapers in each of nine geographic regions across the United States. All of these newspapers had a partnership with Legacy.com, an online obituary service. When readers click on a paid obituary from the newspaper's Web site, they're redirected to the Legacy site, which adds an online guestbook that allows visitors to post comments. The family can later e-mail the entire guestbook to other mourners.

The researchers found that although this capability has positive implications for a community of mourners, it poses a conundrum for newspapers. In part, this is because the Legacy pages recreate the look of the hosting newspaper.

To the user who isn't savvy, he or she would assume it's still the newspaper's site, Bressers said. In a hundred years, will readers distinguish the two? The ethical implications need to be considered.

Legacy vets comments for the subjective quality of appropriateness, which Bressers said makes it unlikely to read comments about a person that aren't a glowing -- and perhaps more accurate -- account of their character. At the same time, comments aren't edited for accuracy in the way a newspaper report would be.

If I were a newspaper, I'd also be concerned that outside companies like this are making money providing the kind of public access people want, Bressers said. Newspapers have long been the holders of public memory, remembering people and reflecting the values of the time. At one time, for example, an examination of newspaper obituaries would make it look like women and African-Americans didn't die. We see online obituaries opening up the possibility that more people won't be forgotten.

Bressers said that she and Hume also see how online obituaries are bringing mourners together in a way that would have been impossible before. Friends and family who wouldn't have been able to attend a funeral to sign a physical guest book can send their condolences from anywhere they have an Internet connection. The researchers found comments from friends and family members sharing stories -- often humorous ones -- that painted a clearer picture of what the deceased person was really like.

Bressers said they were struck by the remarkable connections not just between people who have died and their childhood friends and co-workers, but also between complete strangers. If the deceased was a veteran, strangers express gratitude for that person having served the country. Strangers who shared a medical condition with the deceased convey empathy with the family.

The messages that are perhaps more specific to online mourning are those speaking to the dead themselves. Hume and Bressers found such guestbook comments often make a request of the deceased, such as 'Say hi to Mom.'

Although comments can be left anonymously, mourners can leave an e-mail address with the contact me button, allowing the grieving to connect outside of the guestbook.

These obituaries go beyond what a reporter would write and what a family would pay for, Bressers said. Something may be lost in families not getting cards in the mail, but what is lost is outsized by allowing more people to participate in an online guestbook. The implications for community-building are immense.

Acute computer related injuries on the rise

Tue, 09 Jun 2009 06:01:21 PST

( from http://www.rxpgnews.com ) While back pain, blurred vision and mouse-related injuries are now well-documented hazards of long-term computer use, the number of acute injuries connected to computers is rising rapidly. According to a study published in the July 2009 issue of the American Journal of Preventive Medicine, researchers from the Center for Injury Research and Policy and The Research Institute at Nationwide Children's Hospital; and The Ohio State University College of Medicine, Columbus have found a more-than-sevenfold increase in computer-related injuries due to tripping over computer equipment, head injuries due to computer monitor falls and other physical incidents.

According to data from the National Electronic Injury Surveillance System database, over 78,000 cases of acute computer-related injuries were treated in U.S. emergency departments from 1994 through 2006. Approximately 93% of injuries occurred at home. The number of acute computer-related injuries increased by 732% over the 13-year study period, which is more than double the increase in household computer ownership (309%).

Injury mechanisms included hitting against or catching on computer equipment; tripping or falling over computer equipment; computer equipment falling on top of the patient; and the straining of muscles or joints. The computer part most often associated with injuries was the monitor. The percentage of monitor-related cases increased significantly, from 11.6% in 1994 to a peak of 37.1% in 2003. By 2006, it had decreased to 25.1%. The decrease since 2003 corresponds to the replacement of heavier cathode ray tube (CRT) monitors with smaller and easier-to-lift liquid crystal display (LCD) monitors.

Children aged <5 years had the highest injury rate of all age groups. The most common cause of injury was tripping or falling by patients aged <5 years (43.4%) and ≥60 years (37.7%) and hitting or getting caught on computer equipment for individuals of all other ages (36.9% of all cases). While injuries to the extremities were most common (57.4%), children aged <10 years most often had injuries to the head (75.8% for those aged <5 years and 61.8% for those aged 5𔃇 years).

According to Lara B. McKenzie, PhD, MA, Nationwide Children's Hospital Center for Injury Research and Policy, Columbus, "Future research on acute computer-related injuries is needed as this ubiquitous product becomes more intertwined in our everyday lives. More information is needed on the types of computers and equipment used, the layout of these systems, and the furniture utilized in order to develop household-safety practices in this area…Given the large increase in acute computer-related injuries over the study period, greater efforts are needed to prevent such injuries, especially among young children."

Common chemotherapy drug triggers fatal allergic reactions

Mon, 08 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO -- A chemotherapy drug that is supposed to help save cancer patients' lives, instead resulted in life-threatening and sometimes fatal allergic reactions.

A new study from the Research on Adverse Drug Events and Reports (RADAR) pharmacovigilance program at Northwestern University Feinberg School of Medicine identified 287 unique cases of hypersensitivity reactions submitted to the FDA's Adverse Event Report System between 1997 and 2007 with 109 (38 percent) deaths in patients who received Cremophor-based paclitaxel, a solvent-administered taxane chemotherapy.

Adverse event reports generally only represent from 1 to 10 percent of actual incidence, so the number of hypersensitivity reactions and deaths is likely significantly higher. The severe allergic reactions are believed to be caused by Cremophor, the chemical solvent - a derivative of castor oil -- that is used to dissolve some insoluble drugs before they can be injected into the blood stream.

Two patients who died from an allergic reaction had early-stage breast cancer, which had been surgically removed, and were being treated with Cremophor-containing paclitaxel to prevent the cancer from coming back. Both of these patients had received medications before the chemotherapy to reduce the risk of hypersensitivity reactions.

The study was led by Charles Bennett, M.D., RADAR program coordinator and a professor of hematology/oncology at Northwestern's Feinberg School, and Dennis Raisch, a professor of pharmacy at the University of New Mexico.

The deaths of women with early-stage breast cancer are particularly disturbing because without the adverse reaction, they could have likely had 40 years of life ahead of them, Bennett said.

RADAR investigators also found that 22 percent of all fatalities occurred in patients despite patients having received premedication to prevent hypersensitivity reactions, while another 15 percent of such patients experienced life-threatening respiratory arrest.

The report was presented at the 45th Annual Meeting of the American Society of Clinical Oncology held recently in Orlando, Fla.

Cremophor-containing paclitaxel has been associated with hypersensitivity reactions, with responses ranging from mild skin conditions to more severe effects, including anaphylaxis and cardiac collapse. Current U.S. product labeling for Cremophor containing paclitaxel includes a black-box warning alerting physicians and patients of potential toxicity and recommending the use of corticosteroids and other medications before chemotherapy administration to reduce the risk of hypersensitivity reactions.

The results of our review suggest that physicians should be vigilant in monitoring the safety of their patients undergoing chemotherapy treatment, said Bennett, who also is the A.C. Buehler Professor in Economics and Aging at the Feinberg School and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Patients receiving Cremophor-based paclitaxel should be given medications to prevent hypersensitivity reactions, but what is sobering, as the study has shown and as the black-box warning indicates, women suffer anaphylaxis despite receiving steroid premedication, Bennett said. Physicians should be diligent in reporting adverse events to regulatory agencies to better monitor the impact of Cremophor on patient safety. Physicians may also want to consider exploring other alternative chemotherapy options that do not include Cremophor.

In addition to the two women with early-stage breast cancer who died after treatment with the Cremophor-based paclitaxel, four other women with early-stage breast cancer experienced life-threatening anaphylaxis reactions. Each of them had received prior medications to prevent the reactions.

The fatal outcomes observed in patients with early-stage breast cancer were particularly striking as this is a patient population with a good prognosis that is generally treated with curative intent, said Raisch.

For the report, Bennett and Raisch reviewed adverse event reports submitted to regulatory agencies in the U.S., Europe and Japan. The most common cancer diagnosis for these patients with allergic reactions was lung cancer followed by breast cancer and ovarian cancer.

Comprehensive cardiogenetic testing for families of sudden unexplained death victims can save lives

Tue, 26 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Vienna, Austria: Relatives of a young person who dies suddenly should always be referred for cardiological and genetic examination in order to identify if they too are at risk of sudden death, a scientist told the annual conference of the European Society of Human Genetics today (Tuesday 26 May). Dr. Christian van der Werf, a research fellow at the Department of Cardiogenetics, Academic Medical Centre, Amsterdam, The Netherlands said that, although his team's research showed that inherited heart disease was present in over 30% of the families of sudden unexplained death (SUD) victims, the majority of such relatives were currently not being referred for examination.

When an individual aged 1-50 years dies suddenly, autopsy reveals an inheritable heart disease in the majority of the victims. But in approximately 20% autopsy does not reveal the cause of death. We thought that cardiological and genetic examination of surviving first degree relatives of these SUD patients might reveal an inherited heart disease, said Dr. van der Werf.

In the largest such study to date, the team looked at the outcome of first degree relative screening in 127 families who had suffered an SUD and where either there had been no autopsy (53.8%), or the autopsy did not reveal a cause of death. The average age at death of the SUD victims was only 29.8 years old.

The initial examination of the relatives consisted of taking personal and family medical history and a resting ECG. A second cardiac autopsy of the SUD victim was undertaken if tissue had been stored and was available. Additional cardiological examinations of the relatives were performed where necessary. Genetic analysis of the associated candidate gene(s) was performed in material obtained from the deceased person or in those relatives who showed clinical abnormalities.

The researchers found inherited heart disease in 36, or 32% of the families. These results meant that doctors were able to treat affected relatives and try to prevent their succumbing to sudden cardiac death. The scale of heart disease that we found in such families underlines the necessity for general practitioners to refer first degree relatives of SUD victims to a specialised cardiogenetics department as soon as possible, said Dr. van der Werf. Currently we estimate that only 10% of SUD families are being examined for inherited heart conditions.

The study is the second report from the registry of families who attended the Amsterdam centre's cardiogenetics department because of unexplained sudden death of a relative aged 1-50 years. The scientists intend to continue to report the yield of family screening in an increasing number of families.

At present we are conducting a study to stimulate general practitioners and other involved physicians to request autopsy and DNA-storage for SUD patients and to refer relatives to a cardiogenetics department after a case of sudden death at young age. We hope this will lead to identification of more families at risk of sudden cardiac death, in which preventive measures then can be taken said Dr. van der Werf.

Relatives of young sudden death victims are often referred to cardiologists for cardiological examination. We believe relatives should instead be referred to cardiogenetics departments, where clinical geneticists, cardiologists and psychosocial workers cooperate. These professionals specialise in inherited heart diseases and their clinical and psychosocial implications, and can provide a better quality of care. Additionally, cardiologists should receive more education in inherited heart diseases. By taking these measures we can save lives and avoid further distress for families who have already suffered enough, he said.

Pirfenidone could be new agent for treatment of Idiopathic pulmonary fibrosis.

Sun, 17 May 2009 10:59:07 PST

( from http://www.rxpgnews.com ) A large, well-controlled, multi-national clinical trial program has demonstrated the effectiveness and safety of what may become the first FDA-approved medicine for idiopathic pulmonary fibrosis, or IPF.

In a Phase III clinical study program called "CAPACITY," investigators discovered that the oral anti-fibrotic and anti-inflammatory agent, pirfenidone, could slow the deterioration of lung capacity in patients suffering from IPF.

The researchers presented their findings on Sunday, May 17, at the American Thoracic Society's 105th International Conference in San Diego.

The CAPACITY trial consisted of two multi-national, randomized, double-blind, placebo-controlled Phase III trials (CAPACITY 1 and CAPACITY 2) designed to evaluate the safety and efficacy of pirfenidone in IPF patients with mild to moderate impairment in lung function. The primary endpoint of change in percent predicted forced vital capacity (FVC) at week 72 was met with statistical significance in CAPACITY 2 (p=0.001), along with the secondary endpoints of categorical change in FVC and progression-free survival (PFS), defined as time to either death, a 10-percent decrease in FVC or a 15-percent decrease in DLCO (diffusing capacity of the lung for carbon monoxide). The primary endpoint was not met in CAPACITY 1 (p=0.501), but evidence of a pirfenidone treatment effect on the primary endpoint was observed at several periods in that trial. Importantly, greater than 80 percent of patients in the trials completed treatment and greater than 90 percent completed the study.

An exploratory analysis of pooled data from both trials revealed that treatment with pirfenidone resulted in a 30-percent relative reduction in the percentage of patients who experienced an absolute decline in percent predicted FVC of at least 10 percent. This magnitude of decline is considered clinically meaningful, as a 10-percent decline in percent predicted FVC has been shown in multiple studies to be an independent predictor of mortality in patients with IPF. Exploratory analyses of pooled data from the two CAPACITY studies also demonstrated a statistically significant treatment effect on the primary endpoint of change in percent-predicted FVC at week 72, progression-free survival time and change in six-minute walk test distance.

"While it was disappointing that the primary endpoint was not met in CAPACITY 1, important consistencies between the two CAPACITY studies were observed in the overall treatment effect of pirfenidone," said Paul Noble, M.D., co-chair of the CAPACITY program and professor of medicine and chief of Pulmonary, Allergy and Critical Care Medicine at Duke University Medical Center. "The treatment effect observed in the CAPACITY studies was generally consistent with that observed in the Phase III study in IPF patients conducted by Shionogi in Japan. Collectively, these three studies give us a very good sense of the impact that pirfenidone has on the progression of IPF over at least one year."

According to the National Heart, Lung, and Blood Institute, about 200,000 Americans have idiopathic pulmonary fibrosis, a condition that scars tissue deep in the lungs. Most patients are diagnosed with the disease in their 50s and 60s, and many people live only three to five years after being diagnosed. There are no approved medications in the United States or Europe to treat the disease. Pirfenidone is approved in Japan for the treatment of IPF.

A total of 779 patients were enrolled in the CAPACITY trials at 110 sites in 11 countries. The mean age of participants was 66. To be eligible for the study, patients had to have a definitive diagnosis made by high-resolution CT scan or by biopsy, and a FVC ≥ 50 percent of predicted values and a DLCO ≥ 35 percent of predicted value.

Dr. Roland du Bois, M.D., professor of medicine at National Jewish Health, in Denver, Colo., and CAPACITY co-chair, concurred that these studies were very encouraging for IPF sufferers and added that "the safety and tolerability of pirfenidone was reassuring. The principal side effects experienced by patients in the studies were gastrointestinal discomfort and photo-sensitivity, both of which were manageable in the majority of patients."

The CAPACITY trials follow a Phase III clinical study conducted in Japan that was reported at the American Thoracic Society's 2008 International Conference in Toronto. That trial, which demonstrated the ability of pirfenidone to reduce the decline of lung capacity and improve progression-free survival, served as the basis for the Japanese regulatory authorities' approval of the medicine for the treatment of IPF in Japan.

Dr. du Bois concluded, "When taken in the context of the urgent unmet medical need for new medicines to treat IPF patients, the collective efficacy and safety data from the two CAPACITY studies, corroborated by a similar study in Japan, make a case for the use of pirfenidone in this disease setting."

InterMune, Inc., the developer of the medication, is preparing a New Drug Application (NDA) for pirfenidone for the treatment of IPF, which it expects to submit to the FDA in the summer of 2009, to be followed by a Marketing Authorization Application (MAA), which will be submitted to the European Medicines Agency (EMEA) around the end of 2009. Meanwhile, all patients in the study have been offered pirfenidone as part of an open-label, long-term safety study called RECAP.

Injectable Testosterone Undecanoate In Tea-seed Oil Found an an Effective Male Contraceptive

Mon, 11 May 2009 13:37:51 PST

( from http://www.rxpgnews.com ) Injectable testosterone could be the way to male contraception, that is effective, reversible, and minus serious short-term side-effects, according to a new study.

'For couples who can not, or prefer not to, use only female-oriented contraception, options have been limited to vasectomy, condom and withdrawal,' said Yi-Qun Gu, National Research Institute for Family Planning - in Beijing.

'Our study shows a male hormonal contraceptive regimen may be a potential, novel and workable alternative,' he added.

Gu said this study is the largest multi-centre, male hormonal contraceptive efficacy clinical trial of an androgen preparation in the world.

Participants included 1,045 healthy fertile Chinese men aged between 20-45 years. Each participant had fathered at least one child within the two years before the study and had a normal medical history.

Their female partners were between 18 and 38 years of age and had normal reproductive function.

Males were injected monthly with 500 mg of a formulation of testosterone undecanoate - in tea seed oil for 30 months. Results showed a cumulative contraceptive failure - rate of 1.1 per 100 men in the 24-month efficacy phase.

No serious adverse events were reported and reproductive function returned to the normal fertile reference range in all but two participants, said a NRIFP release.

'Despite the present encouraging results, the long-term safety of this hormonal male contraceptive regimen requires more extensive testing with a focus on cardiovascular, prostate and behavioural safety,' said Gu.

NC State develops new test method to measure stored heat in firefighter suits

Tue, 14 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) For decades, researchers have evaluated the thermal performance of protective clothing worn by firefighters. A particular area of current interest is how to address the burns received by firefighters when they are not directly in contact with fire - called stored heat burns. Researchers at North Carolina State University have developed a testing apparatus and measurement protocol that allow firefighter suits to be evaluated for their ability to prevent and minimize stored heat burns.

You can compare the burn to when you sit close to a fireplace, and then press down on your jeans and you can feel the heat, says Dr. Roger Barker, professor of textile engineering chemistry and science, and director of the Textile Protection and Comfort Center (T-PACC). Firefighters are getting burns without ever coming in direct contact with the flames. It is a serious issue.

Barker and his colleagues were contacted to develop and evaluate this new test method for stored heat measurement in a two-phase study. During the first phase, sponsored by the National Institute for Occupational Safety and Health, Barker and his team developed a laboratory testing apparatus to conduct the stored energy test which measures transferred and discharged heat in turnout suit materials. The second phase, sponsored by the National Fire Protection Research Foundation, involved using that apparatus to test a variety of firefighter suits and develop a database that will facilitate a new national standard that firefighter suits are measured against and certified.

All firefighter turnout suits are made of three layers - an outer shell, moisture barrier and thermal liner. There are many different combinations of fabrics and barriers used, and reinforcements and reflective trim are attached to the outer shell. Regardless of the combination of materials used, suits must go through a battery of tests to meet the standard set by the National Fire Protection Association, or NFPA.

One of the major objectives of our study was to better understand the role moisture - mostly the sweat from firefighters - plays in transferred and stored heat burns, Barker says. When moisture accumulates in the turnout suit materials, it has a big effect on the thermal properties of those materials and changes its heat capacity and thermal conductivity. These changes affect its thermal protective insulation and ability to store thermal energy.

The stored energy test protocol we developed includes having suit test materials pre-conditioned with moisture - similar to the sweat of a firefighter - in order to determine the effect on transferred and stored heat, Barker adds.

Throughout the development process, various stakeholders - including firefighters, suit manufacturers and members of the NFPA - provided feedback and input to NC State's researchers in order to develop a protocol that met the needs of the firefighters, while understanding the challenges and limitations of the manufacturing process. The NFPA is currently reviewing the protocol supplied by NC State's College of Textiles, and will consider adopting this test method as part of the requirements that manufacturers will need their suits to meet in order to have their suits certified as complying with the NFPA standard.

We know there is no lab test that measures with absolute accuracy what a firefighter encounters, because every fire is a different set of conditions and thermal threats, Barker says. However, we now have a better understanding of the general causes and mechanisms behind transferred and stored heat, and a test method to measure these effects. This research and recommended testing protocol is a major development that could significantly improve the health and safety for firefighters everywhere.

Milkshakes are medicine for anorexic teens in family-based outpatient therapy

Thu, 02 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (April 2, 2009) -- Getting your teenager to drink a chocolate milkshake isn't something most parents need to worry about. But this is just the approach used in one treatment for anorexia nervosa. Known as Behavioral Family Therapy, or the Maudsley Approach, parents are called up on to supervise the eating habits of their anorexic child, feeding them high-calorie meals like milkshakes and macaroni and cheese until they regain a healthy weight.

For the first time, the Maudsley Approach is being compared with a more established treatment known as Family Systems Therapy as part of an ongoing National Institutes of Health (NIH)-funded treatment study at NewYork-Presbyterian Hospital/Westchester Division and five other centers nationally. Both are outpatient therapies for adolescents, aged 12 to 18.

Anorexia is a life-threatening condition. Treating it early is very important since it is during the teenage years that this disorder usually takes hold, says Dr. Katherine Halmi, founder of the Eating Disorders Program at NewYork-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College. Traditionally, patients with anorexia have been treated in a hospital setting or through one-on-one outpatient therapy. While inpatient treatment is still appropriate in acute cases, we have increasingly seen the value of family-oriented outpatient therapy for adolescents.

The current study is designed to compare two different therapeutic approaches that involve the family -- one is a behavioral therapy initially focused on weight gain, and the other examines various underlying issues in the family dynamic.

In the Maudsley Approach, named after the hospital in London where it was developed in the 1980s, the anorexic teenager attends therapy sessions together with their parents and siblings. Parents work with the Maudsley therapist to develop ways in which they can monitor their child's intake, choosing the amounts and types of foods necessary for them to regain to a healthy weight. Siblings are encouraged to act as a support system for their sister or brother. Once patients achieve a healthy weight, they graduate toward taking more responsibility for their intake. At this point, family and developmental issues relevant to the patient maintaining a healthy weight are addressed.

In Family Systems Therapy, families also attend regular therapy sessions, but discussions do not necessarily focus on eating. Instead, family members are free to broadly explore and challenge any problematic communication patterns or stressors within the family unit.

In Maudsley, food is medicine that restores the body and mind. When the body is starving, the mind also weakens, becoming more susceptible to anorexia's rigid, often obsessive logic. Supervised feeding helps to break this vicious cycle. With the anorexia in charge, the adolescent really cannot regain the weight on his or her own. Nutritional rehabilitation gives the brain the nutrition it needs to re-establish healthy eating habits, says Dr. Dara Bellace, a clinical psychologist at NewYork-Presbyterian Hospital/Westchester Division and an instructor of psychology in psychiatry at Weill Cornell Medical College.

This approach does not blame parents, but rather calls on their ability to nurse their child back to health. It requires a strong commitment to be with them for every meal -- something that can mean rearranging schedules and taking a tag-team approach to sharing the responsibility, adds Dr. Bellace. The adolescent must also dedicate themselves to the therapy, understanding that, until they regain the weight, their parents will be feeding them much as they did when they were younger, deciding what and how much they eat and making sure they finish.

Previous research has shown the Maudsley Approach successfully prevented hospitalization and helped adolescents recover their normal weights, with at least 75 percent of patients maintaining their recovery after five years.

A total of 240 adolescents aged 12 to 18 are being recruited for the study at six centers: NewYork-Presbyterian/Westchester; Stanford University in Palo Alto, Calif.; Sheppard Pratt in Baltimore, Md.; University of California at San Diego; University of Toronto; and Washington University in St. Louis. Those eligible must be medically stable individuals ages 12 to 18 with a body weight between 75 percent and 87 percent of its healthy range. Families are randomized to receive either the Maudsley Approach or Family Systems Therapy. In each family treatment, they attend 16 one-hour sessions over the course of nine months. Sessions are held weekly for the first seven to eight weeks, bimonthly for the next six sessions, and monthly for the remaining sessions.

Anorexia nervosa is an eating disorder characterized by extreme low body weight and body image distortion with an obsessive fear of gaining weight. The condition largely affects adolescent females, who make up more than 40 percent of all cases. As much as 3 percent of American girls and women are anorexic. Contributing causes may include genetics, personality type, hormones, stress and societal pressures.

Anorexia carries the highest mortality rate of any psychiatric condition. Previous research by Dr. Halmi found that 7 percent of affected women died within 10 years. In a Swedish study that followed patients for 30 years, 18 percent to 20 percent of the women died. Even when anorexia is not fatal, it can cause long-term complications, including damage to the heart and bones.

Codeine use and accident risk

Tue, 24 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The risk of being involved in a traffic accident with personal injury is significantly higher among codeine users than non-users. However, sporadic or moderate use of codeine alone does not carry an increased risk, according to a newly published study from the Norwegian Institute of Public Health.

Codeine and tramadol are painkillers in the opiate group, used for mild to moderate pain. In Norway, codeine is included in Paralgin forte and Pinex forte, and tramadol, amongst others, in Nobligan. Norway has a higher consumption of codeine preparations than other European countries.

Earlier studies have given conflicting results when evaluating traffic accident risk linked to the use of codeine and tramadol. In this new study from the Norwegian Institute of Public Health, anonymised data from the Norwegian Prescription Database and Road Traffic Accident Register was used to study whether codeine- or tramadol users have an increased risk of being involved in a traffic accident with personal injury.

During the 33 months of the study, 181 road traffic accidents were registered with personal injury where the driver had been exposed to codeine and 20 after exposure to tramadol. Exposure is defined as the first 7 days after the dispensing of a prescription for a codeine- or tramadol preparation.

The study showed that the risk of being involved in a road traffic accident with personal injury was twice as high in the period after having a prescription for codeine dispensed. For those who had used more than approximately 400 tablets per year, the risk of being involved in a traffic accident was 3 times as large. When the use of other potential impairing medicines was excluded, the risk of accident sank significantly. For sporadic codeine users there was no increased risk of accident. There was not a significantly higher risk for tramadol.

- We have previously seen that large users of codeine preparations often use benzodiazepines (anxiolytics- and hypnotics) or carisoprodol (muscle relaxants /painkillers) in addition. This is an important contributory factor when evaluating the accident risk, says the study's leader Liliana Bachs.

98 of the 181 drivers exposed to codeine who were included in the study had also been dispensed other medicines with abuse potential in the week prior to the accident.

- One can conclude that sporadic or moderate use of codeine alone to a small degree increases the chance of being involved in accidents with personal injury. Simultaneous use of benzodiazepines or carisoprodol gives a clear increase in the risk of accidents, explains Bachs.

New surgical option for wrist arthritis

Fri, 13 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Feb. 13, 2009) -- Breaking a fall, such as a tumble on the sidewalk, with your hands and wrists is everyone's natural reflex. But, if you fall hard enough, you'll often fracture your radius bone, or even one of the smaller wrist bones and wrist ligaments. Left untreated, these injuries could lead to disabling wrist arthritis.

For patients who develop wrist arthritis, a new surgical option known as OCRPRC (OsteoChondral Resurfacing in Proximal Row Carpectomy) is available at NewYork-Presbyterian Hospital/Columbia University Medical Center, where it is offered by one of the orthopedic surgeons who originally developed and described the technique -- Dr. Peter Tang. His research shows that the procedure reduces pain and improves hand function.

I often see patients who had a wrist injury in the past who either did not seek medical attention or whose original injury was not diagnosed. As with most things in medicine, the earlier a diagnosis is made, the better the outcome. So if you continue to have pain after a month, you should make an appointment to see a hand surgeon for an evaluation, says Dr. Tang, who is an orthopedic hand surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of orthopedic surgery at Columbia University College of Physicians and Surgeons.

Because the biomechanics of the wrist is both delicate and complex, an alteration in the normal anatomy can lead to arthritis. Once disabling arthritis develops, surgery cannot simply fix the injured structure, but rather must remove the arthritis and improve wrist function. The two most common operations for wrist arthritis are a partial fusion of the small wrist bones (intercarpal fusion) and excision of the first row of carpal bones (proximal row carpectomy, or PRC). There are various reasons to choose one operation over the other, but PRC has a quicker recovery, may be better for older patients, gives equal grip strength to intercarpal fusion, and usually results in more wrist motion.

Once the three carpal bones are removed during the PRC procedure, the capitate bone becomes the point where the wrist articulates with the arm; as such, it is important that the arthritis has not progressed to the capitate bone.

For these patients whose arthritis has progressed, Dr. Tang has adapted a cartilage-grafting technique that is used effectively in sports medicine treatments for cartilage disorders in the knee, ankle and elbow. The results are promising, according to his study in the Journal of Hand Surgery, with improvement in grip strength and decrease in pain levels.

The goal of this new procedure is to give the best possible outcome by improving the cartilage status of the capitate bone. Another plus is that we do not have to take the graft from another part of the body. Even though we take out the three carpal bones for arthritis, there is usually one area of the bones where we can find undamaged cartilage for grafting, says Dr. Tang.

The study followed eight patients who underwent osteochondral resurfacing over 18 months. Preoperatively, seven patients described their pain as moderate to severe, while postoperatively, seven patients described their pain as mild to no pain, and one patient described the pain as moderate. Preoperative grip strength increased from 62 percent of their healthy side to postoperatively, 71 percent. Preoperative Mayo wrist score improved from a score of 51, which rates as poor, to a postoperative score of 68, which rates as fair.

Smokers putting their loved ones at risk of heart attacks

Wed, 11 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Researchers at University College London and St George's, University of London measured recent exposure to tobacco smoke in non-smoking middle-aged men taking part in the British Regional Heart Study by measuring the levels of cotinine - a compound carried in the blood - at two time points 20 years apart. A blood cotinine level above 0.7ng/mL is associated with a 40% increase in the risk of a heart attack (2), and other studies have suggested that even a level of 0.2ng/mL may increase the risk (3). The researchers found that while in 1978-80, 73% of men had a cotinine level above 0.7ng/mL, by 1998-2000 that proportion had fallen to 17%.

However, despite the number of non-smoking men at risk having fallen, half of those who still had a high cotinine level (above 0.7 ng/ml) in 1998-2000 lived with a partner who smoked. Non-smoking men who had a partner who smoked had average cotinine levels of 1.39ng/mL, almost twice the level associated with an increased risk of a heart attack. Their cotinine levels were nearly eight times higher than the cotinine levels of men whose partner did not smoke.

During the period the study looked at, national data shows that the prevalence of smoking amongst adults across the UK declined from 40% to 27% and the number of cigarettes consumed by smokers fell from 114 to 97 per week. Restrictions on smoking in public spaces and workplaces were also introduced, although the study period was before the national legislative bans on smoking in public places introduced between 2006 and 2007.

Dr Barbara Jefferis, from University College London who led the research, said: The decline in smoking together with restrictions on smoking in public places has created an environment where people are exposed to far less tobacco smoke. This has resulted in the dramatic fall in the number of non-smokers at an increased risk of a heart attack.

However, we can clearly see that living with someone who smokes puts you at a heightened risk. If we are going to reduce people's exposure to tobacco smoke further then we will need to focus efforts on reducing smoking in the home.

Professor Peter Weissberg, Medical Director at the BHF, said: This research shows that a great deal of progress has been made in reducing exposure to potentially damaging environmental tobacco smoke over the past 20 years. Importantly, it also shows that people are now more at risk of exposure in their own homes than in public places.

We cannot stop people smoking in their own home, but we would urge smokers to think of the risk they're exposing their non smoking friends and relatives to when they have a cigarette in the house.

The BHF are calling for a proper plan to reduce the harm from smoking including measures in the NHS Bill that will put an end to point of sale displays and prohibit cigarette vending machines, which are disproportionately used by underage smokers.

Unexplained chest pain can be due to stress

Mon, 09 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Each year, many people seek emergency treatment for unexplained chest pains. A thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden, indicates several common factors among those affected, including stress at work, anxiety, depression and a sedentary lifestyle.

Chest pain is a common reason for patients to seek emergency treatment. A considerable number of patients are diagnosed with unexplained chest pain, which means that the pain cannot be linked to biomedical factors such as heart disease, or some other illness. The patient group is significant in size, with just over 20,000 patients seeking hospital treatment in 2006, and so far researchers have been unable to identify specific causes for unexplained chest pain.

Many suffer from recurring bouts of pain over several years, while the healthcare services are unable to find out what's causing it, says Registered nurse Annika Janson Fagring, the author of the thesis.

In her thesis, Annika Janson Fagring describes and analyses symptoms among patients with unexplained chest pain. The results show that most of them are middle-aged, and that over a third of those affected were born outside Sweden. The chest pain had a negative impact on the patients' daily life in the form of tiredness, anxiety and fear of death.

The main difference between women and men with unexplained chest pain is that men were more likely to perceive their lives and jobs as being stressful, while women tended more to suffer from symptoms of depressions and anxiety, says Annika Janson Fagring.

The patients, both men and women, experienced more symptoms of depression and anxiety, and work-related stress when compared with a reference group of people who were not suffering from heart disease. The male patients were more physically active in their spare time than the female patients, but compared with the reference group, both the men and the women with unexplained chest pain led a more sedentary lifestyle.

The thesis also looks at the development of symptoms and the prognosis for patients with unexplained chest pain over a period of time, compared with patients suffering from angina and patients who had suffered a heart attack. A register study revealed that from 1987 up until 2000, the number of patients with diagnosed unexplained chest pain increased, and then levelled out. The number of patients with angina increased up until 1994 and has since fallen, while the number of patients who have suffered heart attacks has fallen throughout the whole period examined.

There were fewer deaths among patients with unexplained chest pain a year after they became ill, compared with patients that became ill with angina or suffered heart attacks. Deaths among men a year after falling ill with unexplained chest pain were a third higher compared with men in the rest of the population, while women did not display any increased risk of death.

Annika Janson Fagring says that the thesis shows that it is important to improve knowledge and understanding of the symptoms experienced by patients with unexplained chest pain, in order to be able to offer more individualised care.

Computerized writing aids make writing easier for persons with aphasia

Tue, 03 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) It is possible to improve writing skills for those with aphasia with the aid of computerised writing aids. This is the conclusion of a doctoral thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Aphasia affects the ability to understand and use spoken language, and the ability to read and write. Persons with aphasia were trained in the use of computerised writing aids in the study on which speech and language pathologist Ingrid Behrns' doctoral thesis is based. The subjects were aided by a computer-based spell-checker and a program for word prediction, similar to that used when writing SMS messages on mobile telephones.

The thesis shows that writing ability improved in several ways with the aid of these programs.

A fairly high reading and writing ability is necessary in order to benefit from the most common spell-checkers. So we used two writing aids that have been specially developed for persons with dyslexia, instead. These programs were also useful for persons who have writing problems arising from aphasia, says Ingrid Behrns.

The programs are easy to use and cheap to purchase, and may be beneficial for many people who have aphasia. The greatest benefit for those who were members of the group receiving writing training was that it became easier to make corrections in what they had written. They also wrote longer sentences with fewer spelling errors.

But is important to remember that time must be invested in learning how to use the computer programs. It was particularly encouraging to find that it is possible to improve writing ability even though several years have passed since the participants developed aphasia, says Ingrid Behrns.

Previous research into writing ability and aphasia has focussed on the spelling of single words, but the work presented in the thesis investigated not only the completed text but also revisions that were made when writing a story. This makes it possible to see the aspects of the writing process for which the writer has had to use most energy. The thesis also shows that persons with aphasia can write stories with high coherence and a good overall structure, despite their language difficulties. The results also show that it is sometimes easier for persons with aphasia to express themselves in writing rather than in spoken language.

The good results from the writing training are very encouraging since the ability to express oneself in writing opens many possibilities for communication using the Internet, says Ingrid Behrns.

APHASIA: Aphasia is a collective term for language difficulties that can arise after a stroke, for example, or from head injuries such as may be suffered in a traffic accident. Older persons are affected more often than younger, but aphasia can affect persons of any age. A person with aphasia has difficulty understanding, speaking, reading and writing, while their intellectual abilities are not impaired in any way. Approximately 12,000 Swedes are affected by aphasia each year.

Fainting, stomach upsets and heart conditions most common in-flight medical conditions

Sat, 24 Jan 2009 16:26:18 PST

( from http://www.rxpgnews.com ) Fainting is the most common in-flight medical emergency. Research recently published in BioMed Central's open access journal Critical Care details the number, type and frequency of medical emergencies on board two airlines.

Michael Sand led a team of researchers from the University of Bochum, Germany, and the University of California Los Angeles (UCLA), who analysed 10,189 different emergencies. He said, "Although in-flight medical emergencies are rare in general, they can have a significant effect on other passengers and crew, potentially with operational implications for the flight. The breakdown of the various medical emergencies encountered in our study showed that fainting was by far the most frequent medical condition, followed by stomach upsets, and heart conditions".

In all, the authors found 5307 cases of fainting (53.5%), 926 cases of gastrointestinal problems (8.9%) and 509 cases related to a cardiac condition (4.9%). The highly publicized problem of thrombosis accounted for a very small number of cases, although they do occur most often after a flight, rather than during. According to the authors, "Surgical illnesses accounted for a minor percentage of all on-board emergencies. There were 47 cases of thrombosis (0.5%), 27 appendicitis cases (0.25%) and just one case of gastrointestinal bleeding (less than 0.1 %). There were two births and 52 deaths".

The authors highlight that there are major problems with record keeping about in-flight emergencies. Out of 32 airlines approached to take part, 27 did not have the data available, one had data that was unsuitable and two refused to take part due to company policy. Sand said, "Standardization of in-flight medical emergency reporting is necessary for further larger studies to be conducted, as the current quality of data is poor".

The limited scope of the data available makes it difficult to make strong recommendations based on the information, but the authors do note that not all of the airlines had defibrillators as part of their medical flight kits. Sand said, "Considering the fact that cardiac conditions were the third most common condition seen in this study, patients with cardiac irregularities may profit from an on-board automatic external defibrillator. The same is true for patients with a suspected myocardial infarction."

Researcher wins $1.2 million grant for gene regulation work

Fri, 09 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) TALLAHASSEE, Fla. -- A unique discovery in a Florida State University College of Medicine laboratory is the basis for research with the potential to one day help scientists learn how to stop cancer and other diseases in the tissue where they are forming.

Jamila Horabin, associate professor of biomedical sciences at the College of Medicine, has received a four-year, $1.2 million grant from the National Institutes of Health to pursue her work. Horabin recently discovered a direct link between RNA silencing and the genetic master switch controlling the sex determination process in fruit flies.

With that knowledge, she is now seeking to fully understand how a cellular process in gene regulation called the RNA-induced silencing complex (RISC) might interfere with or silence the genes assumed to be at work in nearly all forms of disease and cancer. With a greater understanding of the process, her hope is that scientists will one day be able to switch off the gene activity causing cancerous tumors and cardiovascular disease.

We want to know how RNA silencing affects fundamental gene expression, Horabin said. Many genes are regulated by this process, and it will have far-reaching impact if we understand how it works, which is really the hope and dream of a basic scientist.

Myra Hurt, associate dean for research and graduate programs at the College of Medicine, said Horabin's work has great potential for finding a new way of fighting disease.

There are a number of genes involved with tumor development and metastasis, for example, Hurt said. Imagine if you could target those genes and silence them in the tissue where they are. Here is one more layer of gene regulation that we really didn't know about until fairly recently, and now if we can understand it maybe we can use this technology to target genes involved in disease conditions very specifically and silence them.

The fruit fly offers numerous advantages for such research. Its genome has been fully mapped, so every gene is known and can be studied for cause and effect relationships in the laboratory. Additionally, the fruit fly reaches full maturity in a matter of days, is plentiful, inexpensive and, most importantly, shares remarkable similarities to humans at the level where gene activity is regulated.

Sometimes you find that the fly gene that you are working with is similar to a human gene that is involved in directing a disease, Horabin said. So if the fly gene is being regulated in a particular way, then odds are the human gene is being regulated the very same way.

Study to explore ethical challenges health professionals face while caring for children with LTNMDs

Wed, 07 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) (Baltimore) The Greenwall Foundation recently awarded two core faculty members of the Johns Hopkins Berman Institute of Bioethics a grant that will allow Drs. Gail Geller and Cynda Hylton Rushton to explore the ethical challenges health professionals face while caring for children and families affected by life-threatening neuromuscular diseases (LTNMD).

The concept for this latest LTNMD study grew out of the work of the international HeartSongs Project funded by the Stavros Niarchos Foundation. The goal of the HeartSongs Project is to develop a worldwide network of professionals from a range of disciplines, parents and affected children who share a common vision of comprehensive care for children with LTNMD. In addition to the United States, countries involved in the HeartSongs project include the United Kingdom, Canada, Australia, France, Denmark and Greece. The Project aims to integrate the principles of pediatric palliative care (PPC) into the care of individuals living with LTNMDs. PPC can be described as a holistic, interdisciplinary model of care that incorporates emotional, spiritual, developmental, and physical dimensions. The HeartSongs' International Consortium will develop recommendations regarding promising practices in comprehensive and integrated care. The two-year project, co-directed by Geller and Rushton, opened with a summit in England this past April and will culminate in a second summit to be held in Greece in March 2009. Hopes for a HeartSongs II call for expanding the project to include more European countries as well as countries in South America, Africa, Asia and the Middle East.

The HeartSongs Project is named in honor of the young American poet Mattie J.T. Stepanek who lived with a rare form of muscular dystrophy. Mattie's messages of love, hope and peace have stirred the hearts and souls of millions worldwide. The author of 7 books, Mattie shared hope through his 'Heartsongs' poetry, and collaborated with Former President Jimmy Carter on an essay book, Just Peace. (http://www.mattieonline.com/) Mattie died in 2004 just before his fourteenth birthday. According to Dr. Rushton, Mattie's legacy for a better world for all children has inspired our work to improve the lives of children, like Mattie, who live with LTNMDs.

Geller and Rushton's earlier research, also funded by the Stavros Niarchos Foundation, revealed that many parents of children living with LTNMD often do not take advantage of Advanced Care Planning (ACP) as early as experts recommend. Because the life expectancy of LTNMDs is uncertain and unpredictable, Drs. Geller and Rushton claim that ACP, and palliative care more broadly, should not be restricted solely to children who are considered close to death.

Geller and Rushton's newest Greenwall Foundation funded study will focus on the attitudes and behaviors of health professionals who care for patients living with Duchnne Muscular Dystrophy (DMD) and Spinal Muscular Atrophy (SMA Type 1), the two most common pediatric LTNMDs worldwide. Although both diseases are life threatening, says Dr. Geller, each has a unique life expectancy and disease trajectory thereby creating distinct ethical challenges for the children, their families and the health care team. Dr. Rushton says, based on a review of the literature and our own prior work, there is a need to more fully understand the nature, prevalence, and consequences of ethical challenges experienced by Neuromuscular Disease specialists who care for these children, adolescents and their families. These findings will fill an important gap that will inform the development of targeted interventions to support patient/family centered care of children with LTNMD's and their families.

Rushton and Geller say results of the national survey of health care practitioners will be presented to a focus group of regional Muscular Dystrophy Association-clinic directors and pediatric palliative care specialists to develop clinical and policy recommendations for enhancing ethically appropriate care for children with LTNMD.

Persistent Sexual Arousal Syndrome Renamed As Restless Genital Syndrome

Sun, 28 Dec 2008 13:03:07 PST

( from http://www.rxpgnews.com ) Restless legs and overactive bladder could trigger imminent orgasms in women, according to a study.

Neuropsychiatrist Marcel Waldinger and his colleagues of Utrecht University and The Hague's HagaHospital studied 18 Dutch women with Persistent Sexual Arousal Syndrome -.

Their findings were recently published in the Journal of Sexual Medicine.

Women affected by this rare and mysterious syndrome experience persistent genital sensations as if they are continuously on the verge of an orgasm.

All participants received in depth interviews and various medical examinations such as MRI-scans of the brain and pelvis. The study showed that most women in this research also had restless legs, symptoms of an overactive bladder and pelvic varicosis.

'These results are a very important breakthrough in the research of this syndrome and show that this is a real physical disorder,' Waldinger emphasised.

In 2001, PSAS was mentioned for the first time in medical literature. Only 22 case reports have been described so far. A key feature of the syndrome is that sexual contact does not lead to diminishment but to aggravation of the symptoms. The complaints may lead to desperate and depressive feelings.

The majority of women in the study, the largest on PSAS so far, reported that their complaints were accompanied by restless legs and frequent urge to void.

Some of them reported to have restless legs symptoms long before their genital complaints. MRI-scan and ECHO-Doppler investigations of the pelvis and genitals also demonstrated a high prevalence of pelvic varicosis.

Notably, varicosis and restless legs are associated. The researchers are currently continuing their research on restless legs and bladder functioning in women with PSAS, said a Utrecht University release.

According to Waldinger, PSAS is a genital form of restless legs. Based on scientific observations, he postulated the view that the weird genital sensations are equivalent to the sensations belonging to the Restless Legs Syndrome.

'In order to emphasise this equivalence, we decided to change PSAS into Restless Genital Syndrome -', Waldinger explained.

Both theories about human cellular aging supported by new research

Tue, 16 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Aging yeast cells accumulate damage over time, but they do so by following a pattern laid down earlier in their life by diet as well as the genes that control metabolism and the dynamics of cell structures such as mitochondria, the power plants of cells.

These research findings, presented at the American Society for Cell Biology (ASCB) 48th Annual Meeting, Dec. 13-17, 2008 in San Francisco, support the theories that old age is the final stage of a developmental program AND the result of a lifelong accumulation of unrepaired cellular and molecular damage.

The diet plus metabolic genes pattern is a modular longevity network, says Vladimir Titorenko of Concordia University in Montreal, who studies baker's yeast, Saccharomyces cerevisiae, as a simpler model for the complex mechanisms of human cellular aging.

Through the yeast model, Titorenko and colleagues identified five groups of novel anti-aging small molecules that significantly delayed aging.

The scientists first identified a mechanism closely linking life span to the dynamics of such lipids as cholesterol, triglycerides and fatty acids: When fatty acids build up, yeast cells explode from within, scattering their contents and spreading inflammation to neighboring cells.

In addition to cell death, the accumulation of fatty acids sets off chemical reactions that ultimately produce a lipid called diacylglycerol, which impairs many of the yeast's stress response-related defenses.

Knowing the link between life span and lipid dynamics, the scientists next evaluated aging effects of both calorie-rich and low-calorie diets.

The calorie-rich diet suppressed the oxidation of fatty acids in peroxisomes, structures in cells that use enzymes to neutralize toxic peroxides.

These fatty acids are constantly synthesized in the endoplasmic reticulum (ER), the cell's protein manufacturing factory. Without peroxisome processing, fatty acids end up deposited within lipid bodies.

Low-calorie diets, which have been shown to increase lifespan and delay age-related disorders in nonhuman primates and other organisms, altered the way fats were processed in the yeast cells.

The researchers assessed calorie restriction along with a number of known mutations that extend yeast lifespan against a variety of age-related changes in fat metabolism and lipid transport.

To determine whether the diet-aging mechanism could be manipulated by a therapeutic drug, Titorenko and his colleagues developed a life-span assay for a high-throughput screening of multi-compound chemical libraries.

The assay identified five groups of novel anti-aging small molecules that significantly delayed yeast aging by remodeling lipid dynamics in the ER, peroxisomes and lipid bodies or by activating stress response-related processes in mitochondria.

These small molecules can be used as research tools to investigate the mechanisms of longevity, says Titorenko, and as possible pharmaceutical agents for age-related disorders that affect lipid metabolism such as heart disease, chronic inflammation, and Type 2 diabetes.

Bittersweet milestones

Mon, 24 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) For many of the elderly, the golden years are anything but. Faced with health problems, financial issues and the death of a spouse or loved one, many adults 65 years and older suffer from depression. While research is emerging to help this group understand and treat the problem, another group - centenarians - has been left largely in the dark.

Centenarians are still rare, and depression hasn't been studied thoroughly in this group, said Adam Davey, a developmental psychologist in the College of Health Professions at Temple University. We've found that it's a very under diagnosed condition among people over 100 years old, yet it's one of the most easily treated forms of mental illness.

According to the U.S. Bureau of the Census, more than 60,000 people in the U.S. are 100 years old or over, and as baby boomers start to hit their 100-year mark, that number is expected to more than quadruple to 274,000. As a result of this new boom, a group of researchers have been studying this group more and more to learn about successful late-life aging.

In a study presented at the Gerontological Society of America's annual meeting on Nov. 24, lead author Davey and colleagues from institutions across the country looked at indicators of depression among respondents enrolled in the Georgia Centenarian Study, a three-phased project to study quality of life for those over age 100.

Based on responses given in the survey by a sample of 244 centenarians, researchers found that more than 25 percent showed clinically relevant levels of depressive symptoms, yet only 8 percent reported having a current diagnosis of depression.

Davey notes that further study will need to pinpoint the reason for these high levels, but his research suggests a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and past history of anxiety.

People who suffer from depression tend to have a high risk of mortality, so it's puzzling to see higher numbers among the oldest old, he said.

In an earlier phase of the Georgia Centenarian Study, researchers found that centenarians living in a community setting were found to have higher levels of depression than their younger counterparts. Davey noted that since caregivers play a large role in the lives of many centenarians, it is important for doctors, nurses and even family members to focus on the larger picture to ensure a better quality of life.

Funerary monument reveals Iron Age belief that the soul lived in the stone

Tue, 18 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Archaeologists in southeastern Turkey have discovered an Iron Age chiseled stone slab that provides the first written evidence in the region that people believed the soul was separate from the body.

University of Chicago researchers will describe the discovery, a testimony created by an Iron Age official that includes an incised image of the man, on Nov. 22-23 at conferences of biblical and Middle Eastern archaeological scholars in Boston.

The Neubauer Expedition of the Oriental Institute at the University of Chicago found the 800-pound basalt stele, 3 feet tall and 2 feet wide, at Zincirli (pronounced Zin-jeer-lee), the site of the ancient city of Sam'al. Once the capital of a prosperous kingdom, it is now one of the most important Iron Age sites under excavation.

The stele is the first of its kind to be found intact in its original location, enabling scholars to learn about funerary customs and life in the eighth century B.C. At the time, vast empires emerged in the ancient Middle East, and cultures such as the Israelites and Phoenicians became part of a vibrant mix.

The man featured on the stele was probably cremated, a practice that Jewish and other cultures shun because of a belief in the unity of body and soul. According to the inscription, the soul of the deceased resided in the stele.

The stele is in almost pristine condition. It is unique in its combination of pictorial and textual features and thus provides an important addition to our knowledge of ancient language and culture, said David Schloen, Associate Professor at the Oriental Institute and Director of the University's Neubauer Expedition to Zincirli.

Schloen will present the Kuttamuwa stele to a scholarly audience at the meeting of the American Schools of Oriental Research on Nov. 22 in Boston, the major annual conference for Middle Eastern archaeology. Dennis Pardee, Professor of Near Eastern Languages and Civilization at the University of Chicago, will present his translation of the stele's 13-line inscription the following day at the annual meeting of the Society of Biblical Literature, also in Boston, in a session on Paleographical Studies in the Near East.

German archaeologists first excavated the 100-acre site in the 1890s and unearthed massive city walls, gates and palaces. A number of royal inscriptions and other finds are now on display in museums in Istanbul and Berlin. Schloen and his team from the University of Chicago have excavated Zincirli for two months annually since 2006.

Zincirli is a remarkable site, said Gil Stein, Director of the Oriental Institute. Because no other cities were built on top of it, we have excellent Iron Age materials right under the surface. It is rare also in having written evidence together with artistic and archaeological evidence from the Iron Age. Having all of that information helps an archaeologist study the ethnicity of the inhabitants, trade and migration, as well as the relationships of the groups who lived there.