RxPG News : Neurosciences

New device performs better than old for removing blood clots

Fri, 03 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) An experimental blood clot-removing device outperformed the FDA-approved MERCI; retriever device, according to late-breaking science presented at the American Stroke Association's 2012 International Stroke Conference.

The SOLITAIRE; Flow Restoration Device is a self-expanding stent-based design that mechanically removes blood clots from blocked vessels after a stroke. After insertion into the clot using a thin tube, or catheter, the device traps the clot then both device and clot are removed, restoring blood flow. The MERCI retriever uses a tiny corkscrew, guided by a balloon-tipped wire, to snare and remove the blood clot.

In the Solitaire With the Intention for Thrombectomy (SWIFT) trial, the first U.S. clinical trial to compare the two devices, 113 stroke patients at 18 hospitals were randomly assigned to undergo clot removal with either device within eight hours of stroke onset between Feb. 2010-Feb. 2011.

The trial was ended at the suggestion of a safety monitoring committee nearly a year earlier than planned due to significantly better outcomes with the new device. The experimental device opened blocked vessels without causing symptomatic intracranial hemorrhage in 61 percent of patients. The currently approved device had the same result in 24 percent of cases - a statistically significant difference, said Jeffrey L. Saver, M.D., lead author of the study, professor of neurology and director of the Stroke Center in the Geffen School of Medicine at the University of California in Los Angeles.

The use of the new device also led to better survival three months after stroke. There was a 17.2 percent mortality rate with the new device versus 38.2 percent with the older one.

Stroke caused by a blood clot blocking a blood vessel supplying the brain is the most common type of stroke, accounting for about 87 percent of all strokes. The FDA-approved treatment for stroke with the most robust body of evidence is use of a clot-busting drug, but the drug must be given within 4.5 hours of symptom onset, and more quickly in older patients. When clot-busting drugs cannot be used or are ineffective, the clot can sometimes be mechanically removed, during or even after the 4.5 hours. The study didn't compare mechanical clot removal to drug treatment.

Although not yet approved in the United States, the new device is approved in Europe.

Other specific findings - all of which were statistically significant - were:

Two percent of SOLITAIRE-treated patients had symptoms of bleeding in the brain compared to 11 percent of MERCI patients.

At the 90-day follow-up, overall adverse event rates, including bleeding in the brain, were similar for the two devices.

Fifty-eight percent of SOLITAIRE-treated patients had good mental/motor functioning at 90 days compared to 33 percent of MERCI patients.

The SOLITAIRE device also opened more vessels when used as the first treatment approach, necessitating fewer subsequent attempts with other devices or drugs.

Patients' average age was 67 years and 68 percent were male. Forty percent had not improved with standard clot-busting medication prior to the study, while the remainder had not received it.

The time from the start of symptoms to start of the clot retriever treatment was on average 4.9 hours for SOLITAIRE and 5.3 hours for MERCI. The study results account for this time difference.

This heralds a new era in acute stroke care, said Saver. We're going from our first generation of recanalization procedures, which were only moderately good in reopening target arteries, to now having a highly effective recanalization device. This really is a game-changing result.

Cardiovascular Nursing Spring Meeting

Thu, 02 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) New scientific findings and hot topics in cardiovascular nursing will be the focus of the 12th Annual Spring Meeting on Cardiovascular Nursing. Managing in today's challenging financial environment and dealing with the increasing issue of cardiovascular disease in dementia patients are just two items on the packed agenda.

Some 200 abstracts will be presented by nurses and allied professionals on a wide range of topics including arrhythmias, heart failure, prevention, acute care, myocardial infarction and implantable devices. There's such a breadth of research and quality improvement projects that nurses and AHPs (allied health professionals) bring to this congress, says Professor Christi Deaton, immediate past-chairperson of the Council on Cardiovascular Nursing and Allied Professions (CCNAP).

This year's meeting, 'Health at Heart', is organised jointly by the (CCNAP) of the European Society of Cardiology (ESC) and the Professional Society for Cardiovascular and Thorax Surgery Nurses, based in Denmark. It will be held 16-17 March 2012 at the state of the art Bella Centre in Copenhagen, Denmark.

New scientific findings will be presented on risky behaviours in adolescents with congenital heart disease, the links between depression and heart disease, the impact of art on quality of life in stroke survivors, and numerous other subjects of interest to journalists and the wider public.

This year will see a record number of moderated posters presented, a great opportunity for journalists to get stories and speak to the researchers. We increased the number of moderated poster sessions because it was such a popular forum last year, says Dr Kaat Siebens, chairperson of the CCNAP. It was an excellent opportunity to see the posters up close and have a good discussion with the scientists.

In addition to the abstracts, sessions will be held on hot topics in cardiovascular nursing that affect large numbers of patients. A session on fear in cardiovascular patients will consider whether fear is a positive coping strategy or negative emotional status, how fear can lead to delays in seeking treatment, and the relationship between fear and inflammation, which is associated with worse outcomes. Another session will explore the growing problem of how to manage complex cardiovascular problems in older patients with dementia.

A session will be devoted to leadership and management in difficult times, including how to get nurse-patient ratios right and how to motivate and retain experienced nurses. This is particularly newsworthy given today's financial climate. We are in difficult financial times and that affects healthcare, says Professor Deaton. Oftentimes healthcare systems decrease staffing when there is an economic crisis.

For the first time a daily congress news will be distributed which highlights events not to be missed by delegates and the press, and the day's top three abstracts (oral, moderated poster, and poster), chosen by the CCNAP and dubbed the 'Reviewers Choice'.

Also new will be on-site interviews with key figures, including a nurse prescriber who can discuss this important subject ahead of the 2013 meeting in Glasgow, where nurses can prescribe.

The meeting attracts around 600 nurses, allied professionals and technicians from Europe and beyond. Delegates and journalists will stay at the striking Bella Sky Comwell Hotel, which is attached to the congress centre. For those who wish to visit the city centre, Copenhagen Central Station is just 10-15 minutes' drive away.

We drafted the scientific programme with topics that are really important for our delegates, concludes Dr Siebens. And everybody is feeling the crisis, so I think one of the most important sessions will be the one regarding leadership and management in difficult times.

Clot-busting drugs appear safe for treating 'wake-up' stroke patients

Wed, 01 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Clot-busting drugs may be safe for patients who wake up experiencing stroke symptoms, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2012.

In wake-up stroke, the person wakes up with symptoms after going to sleep with none. Not knowing when the stroke began excludes these patients from anti-clotting drugs that must be given within 4.5 hours of the beginning of the stroke.

Because wake-up strokes are common, occurring in up to a quarter of stroke sufferers, more research is needed on how to treat these patients, said Dulka Manawadu, M.D., lead researcher and a stroke medical consultant at King's College Hospital in London, U.K. Patients who experience stroke symptoms should call Emergency Medical Services urgently and get to the hospital fast, regardless of the time of onset. This will help specialists decide if novel interventions are appropriate and feasible.

In the study, researchers used a stroke registry to compare clot busting treatments received by 326 patients within 4.5 hours of symptom onset to 68 wake-up stroke patients, with unknown onset.

All the patients were treated in the same London medical center, where 20 percent suffered wake-up stroke. Researchers didn't randomly assign patients to receive different treatments for comparison, which is the gold standard and, thus, a limitation of the study.

Our study shows that administering clot-busting drugs to patients with wake-up stroke who have the same clinical and imaging features as those treated within current guidelines is feasible and safe, Manawadu said.

Researchers analyzed information on patients who received the clot-buster alteplase, sold under the name Activase, between January 2009 and December 2010. Wake-up stroke patients received clot-busting treatments if their clinical presentation and early stroke changes on CT scan images were comparable to those treated with a known time of onset. Both groups had similar blood pressure, blood sugar levels and scores on the National Institutes of Health Stroke Scale, which is a standardized method used by healthcare professionals to measure the level of impairment caused by a stroke.

After three months, the researchers found the wake-up stroke patients' death rates, risk of bleeding inside the brain, and the proportion that made a good recovery were similar to those patients treated within a known 4.5 hours of stroke onset.

Sometimes, doctors are reluctant to give clot-busting drugs to patients in whom the time of stroke onset is not known, because the risks of bleeding are not known, Manawadu said. However, a significant proportion of patients who have stroke symptoms on waking may have suffered stroke in the early hours of the morning and may still be within the window of time where clot-busting treatments are known to be effective. It is also likely that advanced imaging techniques may help to identify patients with wake-up stroke who have the potential to benefit from clot-busting drugs.

This is an area of growing importance because it may allow us to extend the indication for this effective treatment, Manawadu said. Research has been limited to date but the time is ripe to investigate effective treatments in this group of patients.

Infections in childhood linked to high risk of ischemic stroke

Wed, 01 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Common infections in children pose a high risk of ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference 2012.

In a review of 2.5 million children, the researchers identified 126 childhood ischemic stroke cases and then randomly selected 378 age-matched controls from the remaining children without stroke. They discovered that 29 percent of those who suffered a stroke had a medical encounter for infection in the two days preceding the stroke versus one percent of controls during the same dates.

In the three- to seven-day window, 13 percent of children had an infection compared to 2 percent of controls.

The elevated risk of stroke didn't persist after the first month of infection, researchers said.

This is the first large study to establish the relationship between infection and stroke in children, said Heather Fullerton, M.D., the study's principal investigator and director of the Pediatric Stroke and Cerebrovascular Disease Center at the University of California in San Francisco.

Researchers analyzed diagnostic and radiologic databases of children enrolled in the Kaiser Permanente healthcare plan from 1993 to 2007. They evaluated medical records and chart reviews for infections during the two years prior to the childhood stroke, and the same time period for the age-matched controls.

The children with stroke ranged from infants to adolescents, average 10.5 years old (oldest child was 19). Researchers identified three stroke-free controls per case. Findings between girls and boys or ethnic groups didn't differ.

Researchers found acute infections are more important in triggering stroke than chronic infections over time.

These were predominantly minor acute infections and represented a variety of infections, including upper respiratory infections, urinary tract infections and ear infections, Fullerton said. No particular type of infection predominated.

The study findings hold implications for the secondary prevention of stroke in children, she said.

Most previously healthy children with an ischemic stroke have a disease of the blood vessels to the brain, and these children are at highest risk of recurrent stroke. This study may provide some insight into why children develop this arteriopathy: the inflammatory process that results from an infection which may lead to stroke by causing vascular injury, researchers said.

The standard treatment for ischemic stroke in children is blood thinners. But the study suggests that future research should focus on the potential role for anti-inflammatory medications in preventing the recurrence of stroke in this population.

The incidence of stroke in childhood is about five per 100,000 in the United States each year, Fullerton said.

About half of childhood strokes are hemorrhagic (bleeding in the brain), according to American Heart Association statistics.

Childhood infections are exceedingly common, while childhood strokes are uncommon, Fullerton said. Parents should not be alarmed at the findings of this study. We suspect that there are rare genetic factors that may place some children at risk for this uncommon effect of common infections.

Infection is an established risk factor for ischemic stroke in adults. In the United States, stroke is the fourth leading cause of death and a leading cause of serious disability among adults.

Group settings can diminish expressions of intelligence, especially among women

Sun, 22 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) In the classic film 12 Angry Men, Henry Fonda's character sways a jury with his quiet, persistent intelligence. But would he have succeeded if he had allowed himself to fall sway to the social dynamics of that jury?

Research led by scientists at the Virginia Tech Carilion Research Institute found that small-group dynamics -- such as jury deliberations, collective bargaining sessions, and cocktail parties -- can alter the expression of IQ in some susceptible people. You may joke about how committee meetings make you feel brain dead, but our findings suggest that they may make you act brain dead as well, said Read Montague, director of the Human Neuroimaging Laboratory and Computational Psychiatry Unit at the Virginia Tech Carilion Research Institute, who led the study.

The scientists used functional magnetic resonance imaging (fMRI) to investigate how the brain processes information about social status in small groups and how perceptions of that status affect expressions of cognitive capacity.

We started with individuals who were matched for their IQ, said Montague. Yet when we placed them in small groups, ranked their performance on cognitive tasks against their peers, and broadcast those rankings to them, we saw dramatic drops in the ability of some study subjects to solve problems. The social feedback had a significant effect.

Our study highlights the unexpected and dramatic consequences even subtle social signals in group settings may have on individual cognitive functioning, said lead author Kenneth Kishida, a research scientist with the Virginia Tech Carilion Research Institute. And, through neuroimaging, we were able to document the very strong neural responses that those social cues can elicit.

The researchers recruited subjects from two universities and administered a standard test to establish baseline IQ. The results were not viewed until after a series of ranked group IQ tasks, during which test takers, in groups of five, received information about how their performances compared to those of the other group members.

Although the test subjects had similar baseline IQ scores -- a mean of 126, compared to the national average of 100 -- they showed a range of test performance results after the ranked group IQ tasks, revealing that some individuals' expressed IQ was affected by signals about their status within a small group.

The researchers wanted to know what was happening in the brain during the observed changes in IQ expression. The subjects were divided into two groups based on the results of their final rank -- the high performers, who scored above the median, and the low performers, who scored at or below the median. Two of every group of five subjects had their brains scanned using fMRI while they participated in the task.

Canada's first renal denervation procedure to reduce high blood pressure performed today

Tue, 17 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Doctors at the Peter Munk Cardiac Centre today performed a minimally invasive surgical procedure to treat high blood pressure, called renal denervation, for the first time in Canada. The procedure can significantly reduce high blood pressure in patients who cannot effectively treat their hypertension through drugs. These patients, numbering approximately 250,000 Canadians, have to endure an especially high risk of heart attacks and stroke, which continues to kill thousands of Canadians every year.

The first Canadian patient to undergo renal denervation, a 57-year-old male from Toronto, will be discharged tomorrow after overnight observation. The procedure was performed by a multi-disciplinary team, led by Dr. Dheeraj Rajan, Interventional Radiology Specialist; Dr. Douglas Ing, Cardiologist and Dr. George Oreopoulos, Vascular Surgeon. The team recently returned from Germany, where they trained for the procedure. Germany has approved the use of renal denervation to treat selected patients with hypertension.

The Peter Munk Cardiac Centre was the first centre in Canada to receive approval for renal denervation from Health Canada under the Special Access Program that allows practitioners to request access to procedures or drugs that are currently not otherwise approved for use in Canada. As the Health Canada web site notes: This access is limited to patients with serious or life-threatening conditions on a compassionate or emergency basis when conventional therapies have failed, are unsuitable, or are unavailable.

Said Dr. Barry Rubin, Medical Director at the Peter Munk Cardiac Centre: Decreasing a patient's systolic blood pressure from 160 to 130 mm Hg over a period of six months, which this procedure has been shown to do, could prevent many heart attacks and strokes from ever happening.

In addition, renal denervation could also save the health care system countless millions of dollars by minimizing the need for anti-hypertension drugs that patients have to take, often for the rest of their lives, to say nothing of the millions more in savings from not having to treat heart attacks and strokes that don't happen.

The procedure was first used in patients in Melbourne, Australia, and its effects were reported in a clinical trial published in the December 4, 2010 issue of The Lancet. This trial saw cardiologists from Australia, New Zealand, the United Kingdom and several European countries de-activate the nerves located on the outside of the artery that feeds blood to the kidney, with a resulting drop in blood pressure. It has been known for over 50 years that the kidney plays a defining role in determining blood pressure.

Said Dr. Rubin: Our multidisciplinary renal denervation program, which also includes hypertension and kidney specialists, will treat many more patients with hypertension in the months ahead. Our focus will be directed at studying the safety and efficacy of the procedure, which could also have important secondary benefits. For example, many Canadians with heart failure have high blood pressure. Using renal denervation to treat high blood pressure in these patients could improve heart failure, a major cause of death of Canadians.

Deep brain stimulation is effective at improving motor symptoms patients with advanced Parkinson's disease

Thu, 12 Jan 2012 01:54:41 PST

( from http://www.rxpgnews.com ) Researchers from the University of Florida and 14 additional medical centers reported results in the online version of The Lancet Neurology journal indicating that deep brain stimulation — also known as DBS — is effective at improving motor symptoms and quality of life in patients with advanced Parkinson's disease.

The study, sponsored by St. Jude Medical Inc., tested the safety and effectiveness of a constant current DBS device developed by St. Jude Medical to manage the symptoms of Parkinson's disease. The device aimed to reduce tremors, improve the slowness of movement, decrease the motor disability of the disease and reduce involuntary movements called dyskinesia, which are a common side effect of Parkinson's drugs.

After treatment, analysis of 136 patient diaries revealed longer periods of effective symptom control — known as "on time" — without involuntary movements. "On time" for patients who received stimulation increased by an average of 4.27 hours compared with an increase of 1.77 hours in the group without stimulation. Patients also noted overall improvements in the quality of their daily activities, mobility, emotional state, social support and physical comfort.

"I think it is safe to say since dopamine treatment emerged in the 1960s, DBS has been the single biggest symptomatic breakthrough for Parkinson patients who have experienced the fluctuations associated with levodopa therapy," said Michael S. Okun, M.D., first author of the study, administrative director of the UF College of Medicine's Center for Movement Disorders and Neurorestoration, and the National Medical Director for the National Parkinson Foundation. "This study validates the use of mild electrical currents delivered to specific brain structures in order to improve Parkinson's disease in select patients with advanced symptoms, and additionally, it explored a new stimulation paradigm. Future improvements in devices and the delivery systems for DBS will hopefully provide exciting new opportunities for Parkinson's sufferers."

Only patients who have had Parkinson's disease for five years or more were included in the study. They were randomly assigned to a control group that delayed the onset of stimulation for three months, or a group whose stimulation began shortly after surgery. All patients were followed for 12 months.

The deep brain stimulation procedure involves surgeons implanting small electrodes into an area of the patient's brain that controls movement. The electrodes are connected to a device precisely programmed to use mild electrical current to modulate problematic brain signals that result in movement problems.

Today's voltage-controlled DBS devices deliver pulses of current that vary slightly with surrounding tissue changes. The DBS devices tested in this study are intended to provide more accurate delivery and control of the electrical pulses.

"We are committed to driving research that will provide solutions for physicians and their patients whose needs are currently unmet," said Rohan Hoare, president of St. Jude Medical Neuromodulation Division. "These results are significant as they offer evidence that stimulation with the Libra™ constant current system enabled patients to have better motor control and an improvement in their quality of life when compared to the control group."

The U.S. Food and Drug Administration approved the use of DBS for Parkinson's disease in 2002. At least 500,000 people in the United States suffer from Parkinson's with about 50,000 new cases reported annually, according to the National Institute of Neurological Disorders and Stroke. These numbers are expected to increase as the average age of the population rises.

"The study answered some very important questions concerning cognition and mood with lead implantation (alone) versus implantation with stimulation. It also refutes the hypothesis that DBS increases depressive symptoms," said Gordon H. Baltuch, M.D., Ph.D., a professor of neurosurgery in the Perelman School of Medicine at the University of Pennsylvania and a study author. "The group's results also showed a decrease in the infection rate to 4 percent from previously published 10 percent. It shows that American neurosurgeons and neurologists with their industry partners are improving the safety of this procedure and working in a collaborative fashion."

Comparable with other large DBS studies, the most common serious adverse event revealed was infection, which occurred in five patients. Likewise, some participants also reported an increase in the occurrence of slurred speech, known as dysarthria.

"Technology is on the move, and we expect to see continued improvements to DBS approaches, equipment and materials," said Okun, who is also affiliated with UF's McKnight Brain Institute. "DBS has set the bar high for the development of new therapies for advanced Parkinson's disease patients. DBS will be the standard of care gene therapy and other cell-based therapies that are now being conceived will be measured against, and this will hopefully translate into significant improvements in what we can offer our patients."

New strategies for treatment of disease of protein unfolding

Sun, 08 Jan 2012 18:11:09 PST

( from http://www.rxpgnews.com ) Two related studies from Northwestern University offer new strategies for tackling the challenges of preventing and treating diseases of protein folding, such as Alzheimer's, Parkinson's and Huntington's diseases, amyotrophic lateral sclerosis (ALS), cancer, cystic fibrosis and type 2 diabetes.

To do its job properly within the cell, a protein first must fold itself into the proper shape. If it doesn't, trouble can result. More than 300 diseases have at their root proteins that misfold, aggregate and eventually cause cellular dysfunction and death.

The new Northwestern research identifies new genes and pathways that prevent protein misfolding and toxic aggregation, keeping cells healthy, and also identifies small molecules with therapeutic potential that restore health to damaged cells, providing new targets for drug development.

The genetic screening study is published by the journal PLoS Genetics. The small molecule study is published by the journal Nature Chemical Biology.

"These discoveries are exciting because we have identified genes that keep us healthy and small molecules that keep us healthy," said Richard I. Morimoto, who led the research. "Future research should explain how these two important areas interact."

Morimoto is the Bill and Gayle Cook Professor of Biology in the department of molecular biosciences and the Rice Institute for Biomedical Research in Northwestern's Weinberg College of Arts and Sciences. He also is a scientific director of the Chicago Biomedical Consortium.

The genetic study reported in PLoS Genetics was conducted in the transparent roundworm C. elegans, which shares much of the same biology with humans. The small animal is a valued research tool because of this and also because its genome, or complete genetic sequence, is known.

In the work, Morimoto and his team tested all of the approximately 19,000 genes in C. elegans. They reduced expression of each gene one at a time and looked to see if the gene suppressed protein aggregation in the cell. Did the gene increase aggregation or lessen it or have no effect at all?

The researchers found 150 genes that did have an effect. They then conducted a series of tests and zeroed in on nine genes that made all proteins in the cell healthier. (These genes had a positive effect on a number of different proteins associated with different diseases.)

These nine genes define a core homeostastis network that protects the animal's proteome (the entire set of proteins expressed by the organism) from protein damage. "These are the most important genes," Morimoto said. "Figuring out how nine genes -- as opposed to 150 -- work is a manageable task."

In the Nature Chemical Biology study, Morimoto and his colleagues screened nearly one million small molecules in human tissue culture cells to identify those that restore the cell's ability to protect itself from protein damage.

They identified seven classes of compounds (based on chemical structure) that all enhance the cell's ability to make more protective molecular chaperones, which restore proper protein folding. The researchers call these compounds proteostasis regulators. They found that the compounds restored the health of the cell and resulted in reduction of protein aggregation and protection against misfolding. Consequently, health was restored when diseased animals were treated with the small molecules.

Morimoto and his team then conducted detailed molecular analyses of 30 promising small molecules, representing all seven classes. They discovered some compounds were much more effective than others.

"We don't yet know the detailed mechanisms of these small molecules, but we have identified some good drug targets for further development," Morimoto said.

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.

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.

A new age in brain research

Tue, 18 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Melbourne will become a magnet for the world's best and brightest brain researchers after the official opening of the Melbourne Brain Centre at The University of Melbourne Parkville by the Premier Ted Baillieu and Federal MP Michael Danby on Monday.

The $225M Melbourne Brain Centre is the largest neuroscience research centre in the Southern Hemisphere.

Across its three sites, it hosts 700 staff from around the globe who are working towards a better understanding of brain disorders.

The Melbourne Brain Centre will use a collaborative approach to improve understanding of disorders and conditions affecting the brain.

It is home to the Florey Neuroscience Institutes, the Mental Health Research Institute, and the University of Melbourne's neuroscientists. It also partners with Royal Melbourne Hospital and Austin Health to take neurosciences to the bedside.

Researchers working at the centre will investigate a broad range of conditions affecting the brain, including Multiple Sclerosis, stroke, Alzheimer's Disease, Parkinson's Disease, trauma, depression and anxiety, epilepsy and Motor Neuron disease.

The Parkville facility, opened by Premier Ted Baillieu and Federal Member for Melbourne Ports Michael Danby, is the final centrepiece in a project that received major funding from the State and Federal governments.

Speaking after the ceremony, Mr Baillieu said the centre will strengthen Melbourne's and Victoria's reputations as first-rate career destinations for medical researchers.

The Victorian Government invested $53 million in this project to reinforce Victoria's ability to attract and retain some of the best scientific minds in the world, Mr Baillieu said.

The Centre is playing a key role in attracting leading scientists to come to Australia or retaining talented Australian researchers who might have otherwise moved or stayed overseas.

Dr Ben Emery is an Australian neuroscience researcher who returned from Stanford University California to continue his research at the Melbourne Brain Centre.

Dr Emery's research focuses on the role of myelin in the brain and its role in Multiple Sclerosis.

Being able to return to Australia and continue this important work in this fantastic Centre will assist me and my team to investigate myelin as a new treatment target to reverse the nerve damage done in MS.

Dr Rachel Hill is investigating the differences in males and females suffering Schizophrenia. She spent some time in the USA but returned to Australia to continue her research.

The Melbourne Brain Centre offers fantastic opportunities for collaboration between researchers, she said.

Just prior to working in the Centre, if I wanted to meet with a colleague from another laboratory it would involve quite a bit of coordination and travelling to another site. Now they might be working at the next bench in the same laboratory. Having such great access to so many talented researchers made it an easy choice to continue my research career in Melbourne, she said.

The Melbourne Brain Centre was co-funded by the Victorian Government ($53M), the Federal Government's Department ($76.8M), three project partners and philanthropy.

By reprogramming skin cells into brain cells, scientists gain new insights into mental disorders

Wed, 12 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) For many poorly understood mental disorders, such as schizophrenia or autism, scientists have wished they could uncover what goes wrong inside the brain before damage ensues.

Now in a significant advancement, researchers are using genetic engineering and growth factors to reprogram the skin cells of patients with schizophrenia, autism, and other neurological disorders and grow them into brain cells in the laboratory. There, under their careful watch, investigators can detect inherent defects in how neurons develop or function, or see what environmental toxins or other factors prod them to misbehave in the petri dish. With these diseases in a dish they can also test the effectiveness of drugs that can right missteps in development, or counter the harm of environmental insults.

It's quite amazing that we can recapitulate a psychiatric disease in a petri dish, says neuroscientist Fred Gage, a professor of genetics at the Salk Institute for Biological Studies and member of the executive committee of the Kavli Institute for Brain and Mind (KIBM) at the University of California, San Diego. This allows us to identify subtle changes in the functioning of neuronal circuits that we never had access to before.

Prior to this disease-in-a-dish approach, the only main avenue researchers had to study human brain disorders in detail was to look for abnormalities in brain tissue removed from patients after their deaths. But such specimens were usually of poor quality, and often were taken from patients when they were in the end stages of a brain disorder. This made it difficult to assess what went awry earlier before much brain damage ensued and treatments would be more likely to be effective.

So there was great excitement when Gage reported this year that using this disease in a dish approach, he could see subtle anatomic differences between the neurons of normal and schizophrenic patients too small to be seen in imaging studies. When comparing the genes expressed in the neurons derived from schizophrenic patients to that of normal neurons, he also discovered altered expression of several genes that govern certain neuronal developmental pathways.

The most amazing developments in the field over the last year or so are these examples where you can see differences in cells isolated from controls and patients, Anirvan Ghosh, a neurobiologist at the University of California at San Diego and executive committee member of KIBM. It's something people have been speculating about for awhile, but to actually see the differences is very exciting from a scientific point of view.

The findings are helping explain the causes of mental disorders that have baffled researchers for generations because they couldn't peer inside the brains of patients. Drug companies are also excited about these models. Now we can use cultures derived from individuals who are living to test drugs on their neurons to see their effectiveness and toxicity, Gage said, pointing out that this personalized approach for assessing treatment is more likely to be effective than standard drug tests, given the variability in what causes mental disorders and people's varied reactions to the same drugs.

Stroke rate 25 percent higher for Metis

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- The stroke rate among Manitoba Metis is nearly 25 percent higher than for other Manitobans, according to a study by the University of Manitoba and the Manitoba Metis Federation (MMF) presented today at the Canadian Stroke Congress.

The higher stroke rate is driven by a 53 percent higher smoking rate, 34 percent higher rate of diabetes, and 13 percent higher rate of high blood pressure among Metis aged 40 years and older, compared to all other Manitobans. High blood pressure, smoking and diabetes are leading risk factors for stroke.

Being historically of both First Nation and European ancestries, but not really identifying as either one, Metis are a very unique people, but little research has been done on this population, says Dr. Judith Bartlett of the University of Manitoba and the MMF. It's really difficult for a health system to put in place Metis-specific programs if they don't understand what that means. Our job through this study is to link the health authorities with the Metis to bridge that knowledge gap.

The study linked the MMF membership list and several Canadian Community Health Survey cycles with Manitoba Health's hospital records throughout the province to create the Metis Population Data-Base, a one-of-a-kind registry of the 73,000 Metis in the province.

Despite universal health care, it is clear that stroke and related conditions are even more significant issues for Manitoba Metis than for all other residents in the province, the study says.

What are called knowledge networks of Metis and provincial Regional Health Authority (RHA) staff have now been established in each of the Manitoba Metis Federation's seven regions to look at the information from the study and interpret it within a local context, says Julianne Sanguins, Ph.D, of the Faculty of Medicine at the University of Manitoba and the MMF.

During the first few meetings of these knowledge networks, Metis Regions learned about available resources and the health-care providers discovered the strength of the Metis presence in their community, Dr. Sanguins says.

The ultimate purpose of these networks is to raise awareness about existing health services and then to make any necessary changes to the programs in each of the MMF/RHA regions to better meet the cultural needs of the Metis citizens.

It is important to learn more about the unique health challenges of Canada's Metis population in order to control risk factors and prevent stroke, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. This study provides valuable information to create targeted education and outreach initiatives.''

Aboriginal people are twice as likely to die from stroke than the general Canadian population, says Heart and Stroke Foundation spokesperson Dr. Michael Hill. They are more likely to have high blood pressure and type 2 diabetes, putting First Nations, Inuit and Metis people at an even greater risk of stroke than the general population.

He says that culturally appropriate prevention strategies and novel health-care solutions will improve outcomes. Awareness of how to control risk factors such as high blood pressure, obesity, physical activity, diabetes, and smoking is essential.

Telestroke the next best thing

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- The use of long-distance video and data hookups to link remote community hospitals with stroke neurologists in large centres provides the same level of care as having everyone in the same room, according to a new study presented today at the Canadian Stroke Congress.

The study found that rural patients examined with the aid of a technology called Telestroke received an important stroke drug, tPA, at the same rate as patients treated in specialized urban centres, says Dr. Thomas Jeerakathil, a neurologist at the University of Alberta Hospital. The drug tPA (tissue plasminogen activator) is used to break up blood clots. It can help reverse stroke damage if administered within 4.5 hours of the onset of symptoms.

Besides providing better care to remote communities, early projections show that Telestroke resulted in more than $1 million in health-care savings over four years, Dr. Jeerakathil says.

Telestroke is a way to bring the expert out to the rural centre to provide treatment that wouldn't otherwise be available, Dr. Jeerakathil says. And there is no delay in treatment despite the time required to set up video conferencing equipment and examine CT scans and blood work.

In the study, an initiative of the Alberta Provincial Stroke Strategy, University of Alberta Hospital neurologists observed the use of Telestroke in 10 primary stroke centres throughout remote parts of Northern Alberta over a four-year period.

During this time, tPA was administered to more than 500 people and, of those, 119 patients were treated with the help of Telestroke. Without access to the technology, these patients would have gone without treatment or been transferred to a bigger hospital and faced delays, says Dr. Jeerakathil.

Effective Telestroke treatment in remote areas contributed to a 50-per-cent decrease in emergency room transfers from rural areas to the University Hospital in Edmonton, says Dr. Jeerakathil. Some remote hospitals reported a decrease in transfers as high as 92 per cent.

Cost savings are occurring while outcomes are improving and stroke mortality is decreasing in the province, says Dr. Jeerakathil.

Telestroke allows small hospitals to be designated as primary stroke centres with many of the services of a major stroke unit. These primary stroke centres have a small sectioned off area with staff specially trained in stroke care, 24-hour access to a CT scan and the ability to give tPA.

Telestroke is severely under-utilized in Canada, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. An audit of stroke care in Canada showed that fewer than 1 per cent of stroke patients received a Telestroke consultation. This study undeniably proves that Telestroke saves both lives and money.

Providing stroke patients fast and seamless access to stroke services regardless of where one lives in Canada will save lives and reduce disability, says Heart and Stroke Foundation spokesperson Dr. Michael Hill. Telestroke is another way that technology allows for an easy, cost-effective way to bridge geographic barriers to smoothly link stroke specialists with communities where on- site stroke care does not exist.

There are about 50,000 new strokes in Canada each year and 315,000 Canadians living with the after-effects of a stroke.

Undetected strokes increase risk

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- Everyday, 1,000 people in Canada turn 65, entering a stage of life that has increasing risk of stroke and Alzheimer's disease.

Recent national and international imaging studies on the brains of people aged 65 and older show that 95 per cent have brain small vessel disease seen as white spots and patches on magnetic resonance images, says Dr. Sandra Black, director of the Brain Sciences Research Program at Sunnybrook Research Institute at the University of Toronto.

These studies also show that a quarter of healthy senior volunteers, average age 70, living in the community, have evidence of small silent strokes. Even in younger people (average age 60), this number may be as high as 14 per cent, according to preliminary results of the Canadian PURE MIND study, presented at the Canadian Stroke Congress in Ottawa, where Dr. Black addressed more than 900 researchers and clinicians.

Microbleeds, another type of small vessel disease, are associated with high blood pressure and with Alzheimer's disease, she says. Unlike major stroke events, these types of small vessel disease gradually build up and increase the risk of clinical stroke events, depression, falls and Alzheimer's dementia.

Alzheimer's and small vessel disease often live together in the brains of the elderly in a way that is very disabling, says Dr. Black. People become depressed, off balance when walking, have trouble thinking and often cannot live on their own. Unfortunately, so far there is no cure for either disease but there are actions we can all take to delay onset or progression.

The time is now for the brain to be the top priority for Canada's health research community, says Dr. Black. In the next 20 years the number of people with dementia and Alzheimer's disease is expected to reach more than one million in Canada alone, increasing ten-fold the current health care costs of$15 billion/year, she says.

Stroke is adding to the increasing incidence of dementia: 65 per cent of stroke patients experience difficulty with thinking, memory, goal setting and motivation after a stroke and 20 to 30 per cent become clinically demented within three months post-stroke, says Dr. Black.

Research for a cure is being actively pursued but, in the meantime, there are important counter measures people can take to delay and prevent these devastating diseases. This is because stroke and Alzheimer's share the same vascular risk factors, such as high blood pressure, obesity, diabetes, high cholesterol, smoking and a lifestyle of physical inactivity.

It turns out protecting the blood vessels in your heart and body also helps to protect your brain and its blood vessels. This can delay the onset of dementia, says Dr. Black.For example, regular aerobic exercise throughout the lifespan can help delay the onset of late life dementia, even more so in people who may be genetically prone to dementia.

Researchers from all fields are going to need to work together, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network

Lifestyle choices will have the biggest impact in protecting the hearts and brains of our aging population, says Heart and Stroke Foundation spokesperson Dr. Michael Hill.

Our brain keeps growing well into our 20s

Sat, 24 Sep 2011 14:54:46 PST

( from http://www.rxpgnews.com ) Our brain continues to grow well into our 20s -- not just stopping at adolescence as once thought in medical science.

New evidence to this effect has been unearthed by biomedical engineering researchers Christian Beaulieu and his doctoral student Catherine Lebel, from University of Alberta in Canada.

Lebel recently moved to the US to work at the University of California in Los Angeles where she is a post-doctoral fellow working with an expert in brain-imaging research.

'This is the first long-range study using a type of imaging that looks at brain wiring to show that in the white matter, there are still structural changes happening during young adulthood,' says Lebel, the Journal of Neuroscience reports.

'The white matter is the wiring of the brain; it connects different regions to facilitate cognitive abilities. So the connections are strengthening as we age in young adulthood,' Lebel added, according to an Alberta statement.

The researchers relied on magnetic resonance imaging - to scan the brains of 103 healthy people aged between five and 32 years.

Each subject was scanned at least twice, with a total of 221 scans being conducted overall. The study demonstrated that parts of the brain continue to develop post-adolescence within individual subjects.

The results revealed that young adult brains were still wiring the frontal lobe; tracts responsible for complex cognitive tasks such as inhibition, high-level functioning and attention.

Researchers speculated that this may be due to a plethora of life experiences in young adulthood, such as pursuing post-secondary education, starting a career, independence and developing new social and family relationships.

'What's interesting is a lot of psychiatric illness and other disorders emerge during adolescence... it may be one of the factors that makes someone more susceptible to developing these disorders,' says Beaulieu.

Mental demands of managing people boosts hippocampus size

Sun, 11 Sep 2011 23:43:13 PST

( from http://www.rxpgnews.com ) Managing other people at the workplace promotes brain health, protects memory and the learning centre well into old age.

University of New South Wales (UNSW) researchers have identified a clear link between managerial experience and larger size of one's hippocampus, the brain area responsible for learning and memory at the age of 80.

The findings refine our understanding of how staying mentally active promotes brain health, potentially warding off neurodegenerative diseases such as Alzheimer’s. The study was presented this week at the Brain Sciences UNSW symposium Brain Plasticity –The Adaptable Brain.

The Symposium focused on research that is revealing the brain’s ability to repair, rewire and regenerate itself, overturning scientific dogma that the brain is “hard-wired”.

“We found a clear relationship between the number of employees a person may have supervised or been responsible for and the size of the hippocampus,” says Dr Michael Valenzuela, Leader of Regenerative Neuroscience in UNSW’s School of Psychiatry.

“This could be linked to the unique mental demands of managing people, which requires continuous problem solving, short term memory and a lot of emotional intelligence, such as the ability to put yourself in another person’s shoes. Over time this could translate into the structural brain changes we observed.”

The research comprises the doctoral work of Mr Chao Suo, supervised by Dr Valenzuela in collaboration with Scientia Professor Perminder Sachdev’s Memory and Ageing Study based in Sydney.

Using MRI imagery in a cohort of 75-92 year-olds, researchers found larger hippocampal volumes in those with managerial experience compared to those without, even after accounting for any of a number of possible alternative explanations. While many male participants followed traditional management career paths, the effect was also seen in women who had taken on managerial roles in nursing or teaching.

Taste sensing brain areas mapped for first time

Thu, 08 Sep 2011 16:05:30 PST

( from http://www.rxpgnews.com ) Each taste, from sweet to salty, is sensed by a set of neurons in the brain. Now scientists have mapped for the first time how taste is represented in the mammalian brain.

The sweetness of a ripe peach or the saltiness of a potato chip is unmistakable, partly due to highly specialised tongue cells that detect each unique taste, the journal Science reports.

Now, Howard Hughes Medical Institute scientists have showed that four of our basic tastes -- sweet, bitter, salty, and 'umami' or savoury -- are also processed by distinct areas of the brain, according to an institute statement.

'This work further reveals coding in the taste system,' said Howard Hughes investigator Charles S. Zuker.

'The way that we perceive the sensory world has been something that's fascinated humanity throughout our whole existence,' said Nicholas J.P. Ryba of the National Institute of Dental and Craniofacial Research who collaborated with Zuker.

'What is a taste, really? It's the firing of a set of neurons in the brain, and that's what we want to understand,' Ryba added.

Signs of aging may be linked to undetected blocked brain blood vessels

Thu, 01 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Many common signs of aging, such as shaking hands, stooped posture and walking slower, may be due to tiny blocked vessels in the brain that can't be detected by current technology.

"This is very surprising," said Aron S. Buchman, M.D., lead author of the study and associate professor of neurological sciences at Rush University Medical Center in Chicago. "There is a very big public health consequence because we're not capturing this 30 percent who have undiagnosed small vessel disease that is not picked up by current technology. How would you even get them on your radar? We need additional tools in our toolkit."

In 1994, the researchers began conducting annual exams of 1,100 older nuns and priests for signs of aging. The participants also donated their brains for examination after death. This study provides results on the first 418 brain autopsies (61 percent women, average 88 years old at death).

Although Parkinson's disease occurs in only 5 percent of older people, at least half of people 85 and older have mild symptoms associated with the disease.

Before the study, researchers believed that something more common, such as microscopic blocked vessels, might be causing the physical decline. The study's autopsies found the small lesions could only be seen under a microscope after participants died.

The lesions couldn't be detected by current scans.

During the annual exams of the nuns and priests, researchers used the motor skills portion of a Parkinson's disease survey to assess their physical abilities.

"Often the mild motor symptoms are considered an expected part of aging," said Buchman, who is also a member of the Rush Alzheimer's Disease Center. "We shouldn't accept this as normal aging. We should try to fix it and understand it.

If there is an underlying cause, we can intervene and perhaps lessen the impact."

Treating chronic migraine with Botox

Tue, 30 Aug 2011 11:44:46 PST

( from http://www.rxpgnews.com ) The anti-ageing drug Botox was until now an answer to your beauty concerns, but now the treatment can also benefit sufferers of chronic migraine, a neurological disorder characterised by severe headaches, say experts.

Chronic migraine can leave sufferers in pain for at least half of every month. The World Health Organization - ranks migraine as the 19th most disabling disease and notes that a day lived with severe migraine can be more disabling than blindness, paraplegia, angina or rheumatoid arthritis. Although these debilitating headaches occur in both men and women, women are believed to be three times more likely than men to suffer from migraines.

Patients of migraine often experience anxiety and depression along with the headaches. Stress, dietary, sleeping and other inappropriate lifestyle habits are known to influence the state of chronic migraine sufferers. Now studies and clinical trials have revealed that when injected in labelled doses and in the recommended locations in the head and neck, Botox is expected to produce results lasting up to three months depending on the individual patient.

'Since using Botox for chronic migraines is a relatively new treatment on the block, many people are still not aware of it and most do not understand it well, but the response that I have received from my patients has been very good. This will surely pick up in years to come,' Sumit Singh, senior consultant, headache & movement disorder, Medanta - The Medicity, Gurgaon, told IANS on the phone.

'Botox treatment is just evolving in our country. At this moment, there is not enough data on the number of patients being treated with it for their condition. However, it surely seems to be catching up and is well-received by our patients. The treatment will become popular in coming years,' echoed Rajashekar Reddi, senior consultant neurologist, Max Hospitals, New Delhi.

For the treatment of chronic migraine, measured doses of Botox are injected at 29-32 sites in a patient. These sites include six-seven on the forehead, eight on the temples and six each on the back of the head, the neck and the shoulders. It takes 10-15 minutes to administer the dosage. Besides, two additional sites - the temples or the back of the head on each side - can also be injected, depending upon whether extreme pain is felt by the patient at these sites.

Although there aren't any major side effects of the treatment, patients may feel slight pain around the injected areas.

'When the drug is injected by an expert, the chances of any side-effects are negligible. Usually, there occurs slight pain and bruising at the site of injection,' said Charulata Sankhla, senior consultant, neurology, Hinduja Hospital, Mumbai.

'There are mild and transient side-effects such as drooping of eyelids that is observed when the wrong or an overenthusiastic dose of Botox is administered to the patient,' added Reddi.

Although the treatment lasts for up to three months, it doesn't come very cheap. Including the procedural fee and the drug costs, the price of this treatment is about Rs.25,000.

The treatment is already making its mark in big cities like Mumbai, Bangalore, Delhi and Kolkata but is yet to find a following in the smaller ones.

'It is available in all the bigger medical centres/hospitals in major cities, including the metros. Patients in Tier-2 cities are yet to be sensitised about this treatment as it is not available there,' revealed Reddi.

The treatment is suitable for chronic migraine sufferers in the 18-80 years age group.

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USF researchers get $2.6 million NIH grant to investigate new post-stroke therapy

Thu, 11 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) University of South Florida Department of Neurosurgery and Brain Repair faculty members have received a $2.6 million grant from the National Institutes of Health to investigate the potential for cells derived from human bone marrow to benefit post-stroke patients by repairing the blood-brain barrier (BBB). The BBB prevents harmful substances in circulating blood from entering the brain while allowing passage of needed substances.

According to the researchers, current treatment for ischemic stroke is limited to one FDA-approved drug, the serine protease tissue-type plasminogen activator (tPA) that to be effective must be administered during a three-hour window following a stroke.

Although there are almost 800,000 stroke cases yearly in the US, less than three percent of patients benefit from tPA treatment, said Dr. Svitlana Garbuzova-Davis, assistant professor in the Department of Neurosurgery and Brain Repair and co-principal investigator on the grant. Because of the drug's narrow three-hour therapeutic window, and its detrimental side effects that can exacerbate stroke injury and counteract the benefits provided by reperfusion of the occluded artery, new drugs are desperately needed.

According to Dr. Garbuzova-Davis, any treatment aimed at repairing stroke deficits should consider the pivotal role of BBB repair in order to maintain central nervous system (CNS) stability and enhance neuronal regeneration.

Permanent BBB damage can lead to harmful serum protein leakage into ischemic brain tissue and may result in the formation of severe brain swelling in the hours and days following a stroke, she explained. This damage could negatively influence CNS regenerative processes after a stroke.

Using animal models of stroke, the researchers will investigate how blood-brain barrier repair might mitigate the functional recovery in the stroke animals, and determine if BBB reconstitution can lead to positive therapeutic outcomes. Their research is aimed at discovering a potential mechanism underlying the BBB repair produced by stem cell transplantation.

We believe that a regenerative mechanism involving the repair of the damaged BBB by endothelial progenitor cells (EPCs) derived from bone marrow is critical to the successful outcome of cell therapy in stroke, explained Dr. Garbuzova-Davis. Whereas other cell-based technologies are largely designed to circumvent the BBB for delivery of cells or drugs from the periphery into the brain, we are taking a novel approach of repairing the BBB damage to lead to a therapeutic outcome for stroke victims.

According to the investigators, the site-specific EPC recruitment, followed by blood vessel repair processes, is important to exploiting BBB repair, a neglected therapeutic approach in stroke therapy. As these studies are designed to examine whether EPC transplantation extends the therapeutic window of tPA for stroke, the current research builds on the their long-standing goal of translating cell therapy from the laboratory to the clinic.

If BBB restoration via EPC transplantation alone or in combination with tPA is proven effective, the researchers believe that direct clinical application of this cell therapy could help a large population of ischemic stroke patients who may have missed the limited 3-hour tPA window, explained Dr. Paul R. Sanberg, director of USF's Center of Excellence for Aging and Brain Repair.

High frequency oscillation analysis on EEGs offers a new surgical approach to improve seizure control

Sat, 30 Jul 2011 19:27:47 PST

( from http://www.rxpgnews.com ) New research focusing on high-frequency oscillations, termed ripples and fast ripples, recorded by intracranial electroencephalography (EEG), may provide an important marker for the localization of the brain region responsible for seizure activity. According to the study now available in Epilepsia, a journal of the International League Against Epilepsy (ILAE), the resection of brain regions containing fast ripples, along with the visually-identified seizure-onset zone, may achieve a good seizure outcome in pediatric epilepsy.

High-frequency oscillations at 80-200 Hz are known as ripples and those above 200 Hz are considered fast ripples. Medical evidence suggests that fast ripples are a specific surrogate marker of the seizure generation zone. Studies in adults have suggested that resection of the brain region containing fast ripples was associated with good seizure outcome. However, these studies used a small number of electrode (EEG) contacts, with limited brain coverage, which may not be optimal for pediatric patients who often exhibit a more generalized epileptic network than adults.

Hiroshi Otsubo, MD, with The Hospital for Sick Children in Toronto, Canada and lead researcher of the current study explains, "In pediatric patients, extensive surgical resection are often used, but may overestimate the link between high-frequency oscillations and seizure outcome. Good surgical success may also be achieved by more limited surgeries that include both the brain region with high-frequency oscillations and the brain region that appears to initiate seizures, even when they are independent." To further explore this hypothesis, the research team evaluated the relationship of resection of brain regions containing high-frequency oscillations and the area of seizure onset in pediatric epilepsy patients.

Researchers retrospectively analyzed 28 pediatric patients with epilepsy who underwent intracranial EEG monitoring prior to focal resection surgery. Brain regions containing a high occurrence of high-frequency oscillations were determined, and spatial relationships between regions with fast ripples and seizure-onset zones were investigated. The team compared seizure outcome with the size of these regions, the surgical resection, and amount of the regions with fast ripples and areas of seizure onset within the resection area.

Results show that 2 years after surgery, 10 patients were completely seizure free and 18 continued to have some seizure activity. Complete resection of the brain regions exhibiting fast ripples was significantly associated with better seizure outcome. Improved seizure outcome was also observed with complete resection of brain regions with ripples; surprisingly, however, resection of the area of seizure onset did not correlate with seizure outcome. The size of surgical resection was not linked to seizure outcome.

Furthermore, the authors, Drs. Akiyama and Otsubo et al., noted that the visually- determined seizure onset zone partially overlapped with regions containing high-rate fast ripples. "The entire epileptic network, containing fast ripples, ripples and seizure onset zones, must be thoroughly analyzed to ensure complete resection of the area causing seizures with the smallest resection possible," advised Drs. Akiyama and Otsubo et al. "While our results are preliminary and further validation is necessary, the analysis of high frequency oscillations offers clinicians a new surgical approach that could potentially improve seizure outcome in children with epilepsy."

Genes linked to migraine discovered - TRPM8, LRP1 and PRDM16

Mon, 13 Jun 2011 01:10:13 PST

( from http://www.rxpgnews.com ) US scientists have discovered three gene variants linked to migraine, a move that could help understand the cause of severe headaches.

Inheriting any one of the three gene variants raises risk of severe headaches by 10 to 15 percent, the researchers said in a study published online by the journal Nature Genetics.

The three genes are TRPM8, LRP1 and PRDM16. The first plays a role in sensitivity to cold and pain, while the second is involved in the transmission of signals between neurons, Xinhua reported quoting the study Sunday.

'While migraine remains incompletely understood and its underlying causes difficult to pin down, identifying these three genetic variants helps shed light on the biological roots for this common and debilitating condition,' said lead author of the study, Daniel Chasman, assistant professor in the preventive medicine division at Brigham and Women's Hospital and Harvard Medical School.

The researchers based their findings on analysis of genetic data from more than 23,000 women, including over 5,000 migraine sufferers.

Although the researchers said the findings are encouraging, they noted that more research is needed to better understand exactly how each of these genes is associated with migraine.

Migraine headache, an abnormality in the response of nerve cells to stimuli, is characterized by recurring severe headaches, which often result in nausea as well as sensitivity to light and sound.

3-D movie shows, for the first time, what happens in the brain as it loses consciousness

Fri, 10 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Amsterdam, The Netherlands: For the first time researchers have been able to watch what happens to the brain as it loses consciousness. Using sophisticated imaging equipment they have constructed a 3-D movie of the brain as it changes while an anaesthetic drug takes effect.

Brian Pollard, Professor of Anaesthesia at The University of Manchester (UK), will tell the European Anaesthesiology Congress in Amsterdam that the real-time 3-D images seemed to show that losing consciousness involves a change in electrical activity deep within the brain, changing the activity of certain groups of nerve cells (neurons) and hindering communication between different parts of the brain.

He said the findings appear to support a hypothesis put forward by Professor Susan Greenfield, of the University of Oxford, about the nature of consciousness itself. Prof Greenfield suggests consciousness is formed by different groups of brain cells (neural assemblies), which work efficiently together, or not, depending on the available sensory stimulations, and that consciousness is not an all-or-none state but more like a dimmer switch, changing according to growth, mood or drugs. When someone is anaesthetised it appears that small neural assemblies either work less well together or inhibit communication with other neural assemblies.

Our findings suggest that unconsciousness may be the increase of inhibitory assemblies across the brain's cortex. These findings lend support to Greenfield's hypothesis of neural assemblies forming consciousness, said Prof Pollard.

The team use an entirely new imaging method called functional electrical impedance tomography by evoked response (fEITER *), which enables high speed imaging and monitoring of electrical activity deep within the brain and is designed to enable researchers to measure brain function.

The new device was developed by a multidisciplinary team drawn from the Schools of Medicine and Electrical and Electronic Engineering at The University of Manchester (UK) led by Professor Hugh McCann and with support from a Wellcome Trust Translation Award.

The machine itself is a portable, light-weight monitor, which can fit on a small trolley. It has 32 electrodes that are fitted around the patient's head. A small, high-frequency electric current (too small to be felt or have any effect) is passed between two of the electrodes, and the voltages between other pairs of electrodes are measured in a process that takes less than one thousandth of a second.

An electronic scan is thus carried out and the machine does this whole procedure 100 times a second. By measuring the resistance to current flow (electrical impedance), a cross sectional image of the changing electrical conductivity within the brain is constructed. This is thought to reflect the amount of electrical activity in different parts of the brain. The speed of the response of fEITER is such that the evoked response of the brain to external stimuli, such as an anaesthetic drug, can be captured in rapid succession as different parts of the brain respond, thus tracking the brain's processing activity.

We have looked at 20 healthy volunteers and are now looking at 20 anaesthetised patients scheduled for surgery, said Prof Pollard. We are able to see 3-D images of the brain's conductivity change, and those where the patient is becoming anaesthetised are most interesting.

We have been able to see a real time loss of consciousness in anatomically distinct regions of the brain for the first time. We are currently working on trying to interpret the changes that we have observed. We still do not know exactly what happens within the brain as unconsciousness occurs, but this is another step in the direction of understanding the brain and its functions.

The team at Manchester is one of many worldwide teams investigating electrical impedance tomography (EIT), but this is its first application to anaesthesia. Prof Pollard said that a huge amount of research still needed to be done to fully understand the role EIT could play in medicine.

If its power can be harnessed, then it has the potential to make a huge impact on many areas of imaging in medicine. It should help us to better understand anaesthesia, sedation and unconsciousness, although its place in medicine is more likely to be in diagnosing changes to the brain that occur as a result of, for example, head injury, stroke and dementia.

The biggest hurdle is working out what we are seeing and exactly what it means, and this will be an ongoing challenge, he concluded.

UT Dallas' Moller receives teaching award

Fri, 20 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Dr. Aage Moller of UT Dallas is known throughout the world for his innovative research on sensory systems and neural plasticity. But back at The University of Texas at Dallas, he's known to many students simply as a terrific teacher.

Moller received the President's Teaching Excellence Award for Tenure-Track Faculty during the annual Honors Convocation on May 13. He was selected from among more than 100 eligible faculty members who were nominated by undergraduate students. The award carries a stipend of $5,000.

Moller holds the Margaret Fonde Jonsson Endowed Chair in the School of Behavioral and Brain Sciences. He and his wife, Margareta, also are donors to UT Dallas, helping establish scholarships and professorships at the school.

Moller said he enjoys working with students and is pleased that his time in the classroom and labs helps move their education forward.

I am naturally greatly honored by this award, he said. I love teaching, and my students are great - I learn a lot from them. It is very rewarding to be able help young people get the best possible start in a professional or academic life.

While Moller is invited to lecture around the world on his research, he still derives a great deal of satisfaction from working side-by-side with students and sharing what he has learned during a long career.

He offers the following advice to young faculty members: Provide your very best in making the topic you teach interesting. Have respect for your students, and remember that we as teachers work for the students. They have paid dearly and suffered many sacrifices to get our help in learning the basis for a professional or academic life.

Moller received another honor recently, when he was chosen to present BBS' first Distinguished Lecture in Behavioral and Brain Sciences. Slated to be an annual event, this lecture will be the final talk in the school's annual colloquium series. He will present the lecture in April 2012.

The distinguished lecture is designed to recognize the careers of faculty members and to enable faculty members to hear the talks their colleagues regularly deliver to audiences around the world.

Moller said his lecture will focus on neural plasticity, a feature of the brain important for childhood development, new skill acquisition and recovery after strokes and other injuries. He recently published a new book, A New Epidemic: Harm in Health Care.

Among Moller's most important contributions to neuroscience is his development of methods to reduce the risk of serious complications from brain operations. The technique is used worldwide and known as intraoperative neurophysiological monitoring.

Dr. Bert Moore, dean of BBS, praised the teaching and research accomplishments of Moller.

These parallel honors reflect the contributions that Aage Moller makes as a scientist, scholar and instructor, he said. We are very proud of his winning the President's Teaching Award, and also the recognition that our most distinguished researchers are also some of our most esteemed classroom teachers.

Following trail of cell death in epilepsy patients to find ways to preserve brain health

Thu, 05 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Scientists have known for years that seizures in patients with epilepsy cause progressive cell death in the brain. What they did not know was why this was happening.

That may change with a new line of research led by Professor Wilma Friedman of the Department of Biological Sciences at Rutgers University, Newark. The research is funded by a recently awarded, four-year, $2 million grant from the National Institutes of Health.

Researchers have identified a likely culprit in this post-seizure damage, and its name is P75, says Friedman, professor of cellular neurobiology. P75 is a receptor for a specific type of chemical in the brain called a growth factor. Growth factors can regulate the normal functions of a cell, or they can tell a cell to self-destruct.

When a growth factor called ProNGF binds to the P75 receptor on damaged nerve cells following a seizure, it causes them to die, Friedman says. Understanding this process can help researchers determine how to prevent cell death from happening.

This research has the potential not only to benefit people with epilepsy, but also those who suffer seizures as a consequence of traumatic brain injuries and strokes. In addition, it may shed some light on how to prevent cell death in degenerative conditions such as Alzheimer's disease.

Friedman and her team of Rutgers researchers are working in an ongoing collaboration with Barbara Hempstead, MD, Ph.D., at Weill Cornell Medical College in New York City. They have also recently developed a working relationship with Helen Scharfman, Ph.D., Nathan S. Kline Institute for Psychiatric Research, who is associated with New York University's Langone Medical Center.

A key to learning how the ProNGF growth factor works with the P75 receptor is following it through the brain after a seizure. Similar in concept to how the migration of birds is monitored with tagging, scientists will biologically tag the proNGF growth factor in mice. That will allow them to follow where the growth factor goes in the brain, what it does, and how it functions in the cell-death process. Once the process is better understood, researchers will test various molecules, already approved by the Federal Drug Administration, in hopes of finding one that blocks the P75 receptors and thereby prevents cell death.

Friedman has worked at the Department of Biological Sciences at Rutgers University, Newark, for nearly a decade. She has been involved in neurobiological research for more than 30 years at several prestigious institutions including Columbia University, the University of Medicine and Dentistry of New Jersey, Karolinska Institute in Sweden, and the Rockefeller University in New York. She is a graduate of The Rockefeller University (Ph.D.) and Oberlin College (B.A.).

I find research on the brain to be one of the most fascinating fields of scientific study, Friedman says. There's still so much we don't know and need to discover. It's a mystery that is constantly being unraveled bit by bit. The more we know about it, the more potential there is for the development of new therapeutic treatments. That's very exciting.

International organizations join forces to promote cardiovascular health

Wed, 06 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year's EuroPRevent meeting, 14 -16 April, is taking full advantage of its Geneva location and the close proximity to the European Headquarters of the World Health Organisation (WHO), the World Heart Federation (WHF), the United European Football Association (UEFA), and the International Olympics Committee (IOC).

On Thursday 14 April the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) will host joint sessions including a session looking at the medical, legal and ethical aspects of eligibility screening for competitive sport with the IOC, a session looking at Cardiovascular prevention in Russia with WHO and WHF, a session looking at the Global challenges in CVD with the WHO and WHF, and a session looking at competitive sports in high risk patients with the IOC. It's a marvelous opportunity to be able to bring together all these organisations that are engaged in prevention and rehabilitation to fight heart disease and to provide science and practical tools to improve cardiovascular health both in Europe and also around the world, says Hugo Saner, the local organizer of the Congress.

EuroPRevent 2011, which represents the biggest meeting in Europe on cardiovascular prevention and rehabilitation, expects to attract over 1,500 delegates including epidemiologists, clinical cardiologists, sports physiologists, basic scientists, nutrition counsellors, physical therapists, nurses, sports teachers and psychologists. The field of cardiovascular prevention is currently gaining real momentum, says Volker Adams, chair person of the EuroPRevent Congress Programme Committee. For a while we've had the scientific knowledge, but now big strides are being made in improving the diagnostic technology and we're starting to see real political will power to bring about change. EuroPRevent 2011 brings all these aspects of prevention together.

The congress will be arranged around four main tracks: global challenges in prevention, new strategies and developments, sports cardiology and corporate health and prevention programmes.

This year, explains Adams, the sessions have been put together in a completely novel way with the intention of making them more inclusive and attractive to wider audiences. We've taken a topic and got different professionals to talk about them from different perspectives. The idea is that viewing topics from different angles will allow delegates to gain greater insights, says Volker Adams.

Sports cardiology is a major theme of the meeting with sports sessions running continually throughout the programme in room 2. Sport is really important for prevention because it helps promote healthy lifestyles across all age groups whether children or middle aged adults, says Hugo Saner.

Highlights of the meeting include two sessions on corporate health. Industry is beginning to appreciate that with an ageing population there's a real danger that they'll lose good employees to health problems and that this could lead to a lack of skilled workers. Companies are starting to appreciate that they need to take preventive measures to avert disaster, says Saner.

Distinguished speakers at EuroPRevent include Klaus Schwab, the founder of the World Economic Forum who is looking to promote a good attitude towards corporate health; Salim Yusuf from McMaster's University, Canada, who will be giving a personal view of what is needed in cardiac prevention; and Srinath Reddy, president of the Public Health Foundation of India, who will talk about the cardiovascular challenges facing India.

For the first time this year EuroPRevent will feature one late breaking session with six presentations of new research. In addition, 420 abstracts have been selected including 270 on prevention and epidemiology, 152 on rehabilitation and implementation, 45 on sports cardiology and 61 on exercise and translational science. Abstracts are really important because they give the young people starting out in the field a platform to showcase their work, says Adams.

Early indications of Parkinson's disease revealed in dream sleep

Mon, 28 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) During a large-scale study of the socioeconomic costs of this neurodegenerative disease, Danish researchers, some from the University of Copenhagen, discovered that very early symptoms of Parkinson's disease may be revealed in dream or REM sleep.

Parkinson's disease is a brain disease best known for the trembling it causes. It is an incurable, chronic disease and gradually affects the muscles and mental capacity, seriously afflicting the lives if the patient and his or her immediate relatives.

In the study we saw that eight years before diagnosis, Parkinson's sufferers exhibited work and health indications that something was wrong, says Poul Jennum, professor of clinical neurophysiology at the Center for Healthy Ageing, University of Copenhagen, and the Sleep Centre at Glostrup Hospital.

Among the very early symptoms is the sleep disorder RBD, or REM sleep behaviour disorder. REM is a particular stage of sleep in which we dream, and our eyes flicker rapidly behind our eyelids, hence the term REM, or Rapid Eye Movement. To prevent us from actually acting out our dreams the body usually shuts down our muscle movement during REM sleep, but in RBD it is still active, and REM sleepers with RBD display a range of behaviours from simple arm and leg spasms to kicking, shouting, seizing or jumping out of bed.

In some cases their behaviour may be violent and result in injuries to the patients or their partners, Professor Jennum explains.

Our hypothesis is that the very earliest stages of Parkinson's disease show up as various other diseases such as RBD, Jennum says.

In recent years, great advances have been made in the treatment of Parkinson's disease, but we still do not have therapies to mitigate the later symptoms, costs and increased mortality of the disease.

This may become possible if we are able to intervene earlier, and if we are able to find clear indications of Parkinson's disease eight years sooner than we are now, this may give us an important tool. The question is of course whether we can actually say that RBD is always a very early marker for Parkinson's disease. That is what we are now investigating at the Sleep Centre at Glostrup Hospital, says Jennum.

Not surprisingly the study showed that Parkinson's sufferers are more often in contact with all sections of the health service, more often unemployed, more often on benefits, and on average cost the health service DKK 50,000 a year more than healthy control subjects.

For the study, researchers used the National Patient Register to identify all the patients diagnosed with Parkinson's disease between 1997 and 2007. 13,700 patients were compared to 53,600 healthy patients of the same sex, social class, educational background etc.

The study was carried out by researchers from the Center for Healthy Ageing, the Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Bispebjerg Hospital and the Danish Institute of Health Research, and was published in the

Zileuton may help in treatment of Alzheimer's disease

Fri, 25 Mar 2011 08:04:49 PST

( from http://www.rxpgnews.com ) The drug Zileuton used to treat asthma has been shown to help reduce the formation of amyloid beta, a peptide in the brain that is implicated in the development of Alzheimer's disease, according to researchers at Temple University's School of Medicine.

The researchers published their findings, "Pharmacologic Blockade of 5-Lipoxygenase Improves the Amyloidotic Phenotype of an AD Transgenic Mouse Model," in the American Journal of Pathology.

In previous studies, the Temple researchers discovered that 5-lipoxygenase, an enzyme long known to exist in the brain, controls the activation state of gamma secretase, another enzyme that is necessary and responsible for the final production of amyloid beta. When produced in excess, amyloid beta causes neuronal death and forms plaques in the brain. The amount of these amyloid plaques in the brain is used as a measurement of the severity of Alzheimer's.

In their current study, led by Domenico Praticò, an associate professor of pharmacology in Temple's School of Medicine, the researchers tested the drug Zileuton, an inhibitor of 5-lipoxygenase typically used to treat asthma, in a transgenic mouse model of Alzheimer's disease. At the end of the treatment they found that this drug, by blocking the 5-lipoxygenase, reduced gamma secretase's production of amyloid beta and the subsequent build up of amyloid plaques in the brain by more than 50 percent.

Praticò said that gamma secretase is present throughout the body and, despite its role in the development of amyloid plaques, plays a significant role in numerous important functions. Direct inhibitors of gamma secretase are known, he said, but blocking the enzyme completely may cause problems such as the development of cancer. Unlike classical gamma secretase inhibitors, Zileuton only modulates the protein expression levels, which keeps some of its vital functions in tact while blocking many of its bad effects, which in this case is the development of the amyloid plaques.

Praticò and his colleagues have begun working with researchers in Temple's Moulder Center for Drug Discovery Research to create more potent inhibitors that can target 5-lipoxygenase in the brain and increase the ability to reduce amyloid plaque formation and the development of Alzheimer's. Because Zileuton is already FDA approved, it is known that 5-lipoxygenase inhibition is an acceptable target that is not associated with overt toxicity and therefore not harmful to patients. The new drug derivative might be expected to advance to clinical trials relatively easily.

"This drug is already on the market and, most importantly, is already FDA-approved, so you don't need to go through an intense drug discovery process," said Praticò. "So we could quickly begin a clinical trial to determine if there is a new application for this drug against a disease where there is currently nothing."

Miniature 'wearable' PET scanner ready for use

Sun, 13 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) UPTON, NY - Scientists from the U.S. Department of Energy's (DOE) Brookhaven National Laboratory, Stony Brook University, and collaborators have demonstrated the efficacy of a wearable, portable PET scanner they've developed for rats. The device will give neuroscientists a new tool for simultaneously studying brain function and behavior in fully awake, moving animals.

The researchers describe the tool and validation studies in the April 2011 issue of Nature Methods.

Positron emission tomography (PET) is a powerful tool for studying the molecular processes that occur in the brain, said Paul Vaska, head of PET physics at Brookhaven with a joint appointment at Stony Brook, who led the development of the portable scanner together with Brookhaven colleagues David Schlyer and Craig Woody. PET studies in animals at Brookhaven and elsewhere have helped to uncover the molecular underpinnings of conditions such as drug addiction.

But studying animals with PET has required general anesthesia or other methods to immobilize the animals. Immobilization and anesthesia make it impossible to simultaneously study neurochemistry and the animals' behavior - the actions resulting from what goes on in the brain, Schlyer said. Our approach was to eliminate the need for restraint by developing a PET scanner that would move with the animal, thus opening up the possibility of directly correlating the imaging data with behavioral data acquired at the same time.

After several years of development, the scientists have arrived at a design for a miniature, portable, donut-shaped PET scanner that can be worn like a collar on a rat's head for simultaneous studies of brain function and behavior. Weighing only 250 grams, the device - dubbed RatCAP, for Rat Conscious Animal PET - is counterbalanced by a system of springs and motion stabilizers to allow the animal significant freedom of movement. Measurements of the rats' stress hormones indicated only moderate and temporary increases.

Rats wearing the device appear to adapt well and move freely about their environment, Woody said.

To validate the use of the wearable scanner for simultaneous studies of brain function and behavior, the scientists conducted tests with 11C-raclopride, a commonly used PET radiotracer, which incorporates a radioactive, positron-emitting isotope of the element carbon. When the positrons interact with electrons in ordinary matter, they immediately annihilate one another, emitting back-to-back gamma rays. Detectors in the circular PET scanner pick up the signals from these back-to-back gamma rays to identify the location and concentration of the tracer in the body.

The tracer 11C-raclopride binds to receptors for dopamine, a brain chemical involved in movement, reward, and memory formation. A higher signal from the tracer means that less natural dopamine is in that particular part of the brain; a low signal indicates that that particular part of the brain has released dopamine (which binds to its receptors, thus blocking the tracer from binding).

The main test was to see if the wearable scanner could be used to correlate dopamine levels with behavior - in this case, the rats' activity (i.e., movement) within their chambers. Surprisingly the level of activity was inversely related to dopamine levels - that is, the more active the animals were, the lower the level of dopamine (as indicated by a stronger tracer signal).

This is perhaps a counterintuitive result because behavioral activation is typically associated with an increase in dopamine release, said Daniela Schulz, a Brookhaven behavioral neuroscientist and lead author of the paper. So our method provides data which may challenge traditional paradigms and ultimately improve our understanding of the dopamine system.

But regardless of the direction, the results clearly demonstrate that RatCAP can correlate brain function measurements with behavioral measures in a useful way, she said.

The scientists also present results comparing RatCAP-wearing rats moving freely about their cages with animals that had been anesthetized, as well as comparisons of two methods of administering the tracer - injecting it all at once and in a steady infusion to maintain a constant concentration in the blood.

These measurements will help us further refine the technique and aid in our assessment of results obtained with RatCAP in comparison with other study techniques, Schulz said.

The researchers' next step will be to use RatCAP to explore distinct behavioral expressions that can be correlated with simultaneously acquired PET data.

University Hospitals system-approach to stroke care increases the use of tPA therapy by 13.5-fold

Fri, 11 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) University Hospitals (UH) Stroke and Cerebrovascular Center recently reported that it has increased the use of tPA or clot busting therapy for ischemic stroke by 13.5 times throughout UH system hospitals since implementing the System Stroke Program (SSP). Launched in 2008, SSP sought to increase access to the lifesaving treatment for acute (urgent) ischemic stroke patients in the 15 counties surrounding Cleveland.

tPA is Tissue Plasminogen Activator, a drug that dissolves blood clots and must be administered intravenously within 4.5 hours of the onset of stroke symptoms to be effective. tPA is the only drug approved by the U.S. Food and Drug Administration for the acute treatment of stroke and although tPA was approved for use in 1995, many hospitals did not have systems in place to evaluate or treat patients with this therapy.

Nationally, administration for stroke has increased in recent years through the development of Stroke Centers. However, the overall rate of use remains very low. According to a recently published study, the use of tPA increased nationally from less than 1 percent in 2001 to 2.4 percent in 2006.

When UH launched the SSP, the rate among UH hospitals was similar to the national rate, about 2 percent. Through the SSP efforts, that rate has increased dramatically to 27 percent.

According to Dr. Cathy Sila, director of the UH Stroke and Cerebrovascular Center, UH used its hub and spoke model, with UH Case Medical Center at the center offering stroke specialty teams around the clock, and the community hospitals acting as spokes off that hub. The stroke specialist doctors and nurses provided community hospital staff in the UH health system with education to accurately identify, assess, and treat patients who present with stroke symptoms and standard protocols to ensure that any patient coming to any UH hospital would receive the same high quality, evidence-based stroke care. Community hospital emergency medicine teams were trained to evaluate stroke patients for tPA eligibility, conduct urgent brain imaging scans and consult with the UH Case Medical Center stroke service to coordinate appropriate treatment plans.

As rapid tPA treatment is associated with better patient outcomes, patients need to receive treatment as soon as possible. Empowered by training and supported by the stroke specialists at UH Case Medical Center, our community hospitals have done a tremendous job in identifying eligible patients for tPA treatment and initiating that treatment without delay, said Dr. Sila. Patients are then transferred to UH Case Medical Center with trained critical care transport which is called 'drip and ship' therapy. The stroke team is waiting for them on arrival and if the patient has not responded to the tPA therapy, they are rapidly evaluated for other treatment options such as angiography.

The success of the SSP program was recently presented at the International Stroke Conference in Los Angeles.

Acute anemia linked to silent strokes in children

Fri, 11 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Silent strokes, which have no immediate symptoms but could cause long-term cognitive and learning deficits, occur in a significant number of severely anemic children, especially those with sickle cell disease, according to research presented at the American Stroke Association's International Stroke Conference 2011.

One-quarter to one-third of children with sickle cell disease have evidence of silent strokes in their brains, according to Michael M. Dowling, M.D., Ph.D., lead author of the study and assistant professor of pediatrics and neurology at the University of Texas Southwestern Medical Center in Dallas.

These are 5- to 10-year-old children who have brains that look like the brains of 80-year-olds, Dowling said. These strokes are called 'silent' because they don't cause you to be weak on one side or have any obvious neurologic symptoms. But they can lead to poor academic performance and severe cognitive impairments.

Sickle cell disease is a blood disorder characterized by low levels of hemoglobin, the iron-containing component of red blood cells that carries oxygen. Low hemoglobin causes anemia. In sickle cell disease, the blood cells are misshapen (sickle-shaped) and may form clots or block blood vessels. About 10 percent of children with sickle cell disease suffer a stroke. Blood transfusions can reduce the high risk of repeat strokes.

Dowling and colleagues hypothesized that silent strokes occur during severe anemia and may be detectable by MRI. They used MRI on the brains of 52 hospitalized children 2- to 19-years-old at Children's Medical Center Dallas with hemoglobin concentrations dropping below 5.5 g/dL. They compared severely anemic children with sickle cell disease to a group of children without sickle cell disease who had hemoglobin levels below 5.5 g/dL.

They identified silent strokes in about 20 percent of the children with sickle cell disease who were experiencing acute anemia. They also saw evidence of silent strokes, though not as often, in severely anemic children who didn't have sickle cell disease.

The many reasons, besides sickle cell disease, why children could have anemia include trauma, surgery, iron deficiency or cancer such as leukemia.

These are brain injuries that go unnoticed by doctors, unless the children have testing with a special MRI, he said. We looked at every child who went to the hospital for a 30-month period and identified about 400 children that came in with hemoglobin below 5.5 g/dL. That represented about 12 percent of the admissions for sickle cell disease and about 1 percent of the total admissions to Children's Medical Center.

The findings suggest that children with or without sickle cell disease who have acute anemia could be suffering undetected brain damage. The researchers suggest that all children with severe anemia need careful examination for silent strokes.

Improved recognition and timely transfusion to increase blood hemoglobin levels could prevent permanent brain damage in children with silent strokes, according to the study.

Future studies should look at larger groups of children for longer periods to better understand the impact of acute anemia on children, Dowling said.

Final data show experimental agent better than aspirin at preventing stroke

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A new anti-clotting agent is vastly superior to aspirin at reducing stroke risk (1.6 percent per year versus 3.6 percent per year) in atrial fibrillation (AF) patients unable to take stronger drugs, according to final data reported today at the American Stroke Association's International Stroke Conference 2011. Researchers found the drug also works better in people with a history of stroke or a warning stroke.

Atrial fibrillation is a heartbeat abnormality that can cause blood clots which raise the risk of stroke, particularly in the elderly.

The AVERROES: Apixaban Versus Acetylsalicylic Acid (ASA) to Prevent Strokes trial is a randomized trial of 5,600 AF patients at moderate to high risk of stroke who were not willing or able to take oral vitamin-K antagonists like warfarin, a drug commonly prescribed to prevent blood clots in people with AF. They were treated at 520 medical centers worldwide. A May 2010 interim analysis found evidence that the investigational oral drug apixaban was so much more superior to aspirin that the researchers were advised to end the trial early, said Hans-Christoph Diener, M.D., professor and chairman, Department of Neurology and Stroke Center, University Hospital Essen, Essen, Germany.

In releasing the study's final results, he reported that apixaban was far superior to aspirin at preventing stroke or systemic embolism (blood clot) and was also very safe. The drug blocks factor Xa, a crucial step in blood clot formation, said Diener, co-chair of the study's adjudication committee.

Apixaban was highly superior to aspirin. We had not anticipated that apixaban would show such a big difference compared with aspirin while showing no significant increase in major bleeds, he said. Everyone had expected that a more powerful drug like apixaban would be associated with more severe bleeding complications compared to aspirin, but it wasn't.

The study's primary endpoint was the reduction of ischemic stroke (stroke caused by blockages in the brain's circulation), hemorrhagic stroke (stroke due to bleeding in the brain) and systemic embolism (blockages due to blood clots elsewhere in the body), he said. The primary safety endpoint was major bleeding incidents.

Up to 50 percent of all AF patients with moderate or high stroke risk are unsuitable for the most effective class of anti-clotting treatment known as vitamin K antagonists (VKA). That class includes the well-known drug warfarin.

All of the AVERROES patients were unsuitable for VKA therapy, which carries an increased risk of hemorrhage and requires frequent blood testing to monitor its effectiveness. For such patients the only alternate treatment is aspirin, which is just modestly effective, Diener said.

The patients in this study, all over age 50, were at moderate to high risk because they had at least one stroke risk factor in addition to AF, such as being age 75 or older, having high blood pressure, heart failure, diabetes or having a history of stroke or transient ischemic attack (a possible precursor of stroke), he explained.

Patients were randomized to receive either apixaban at 5 milligrams (mg) twice a day (2.5 mg twice a day in selected patients) or between 81 mg and 324 mg of aspirin per day. The study's double-dummy design mandated that patients randomized to receive apixaban took an aspirin-placebo and those randomized to receive aspirin got an apixaban-placebo, he explained.

During an average of 1.1 years of follow up, the researchers found 51 strokes or systemic embolism events in the 2,808 patients taking apixaban compared to 113 strokes and systemic embolic events in the 2,791 patients taking aspirin. That represents an annual rate of 1.6 percent for apixaban vs. 3.6 percent for aspirin, meaning apixaban carries about half the relative risk of stroke or systemic embolism compared to aspirin. Although bleeding events were slightly higher with apixaban, the difference fell short of statistical significance.

The researchers will also report on a subgroup of patients with a history of stroke or transient ischemic attack (TIA), often a precursor to stroke.

If validated by future studies I think this is the end of aspirin as a drug to prevent stroke in patients with AF, he added.

Diener said the study's major limitation is the limited time period of observation, shortened further by the study's early conclusion. AF patients need anticoagulation for the rest of their lives and we would have liked to see a much longer duration of the trial, he said.

By evaluating the use of apixaban as a replacement for aspirin in AF patients who are unsuitable for VKA therapy, the AVERROES study is addressing an important unmet clinical need.

Robot therapy can improve arm, shoulder mobility after stroke

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Therapy in which robots manipulate paralyzed arms, combined with standard rehabilitation, can improve arm and shoulder mobility in patients after stroke, according to research presented at the American Stroke Association's International Stroke Conference 2011.

Patients on robotic therapy showed marked improvement in two measures of upper extremity function: the Fugl-Meyer flexor synergy score, a 0 to 12 scale with higher numbers reflecting recovery of voluntary arm movement; and the Fugl-Meyer shoulder/elbow/forearm score, a 0 to 36 scale with higher numbers reflecting recovery of motor function in the shoulder, elbow and forearm.

Combining robotic exercise with regular rehabilitation may be the key to successful intervention, said Kayoko Takahashi, Sc.D., O.T.R., lead author of the study and clinician and research associate in the Department of Occupational Therapy in Kitasato University East Hospital in Kanagawa, Japan. Robots could allow therapists to focus on helping patients master daily activities while maintaining repetitive training, Takahashi said.

The new study involved 60 stroke survivors with hemiplegia (paralysis on one side of the body) treated at six rehabilitation centers in Japan. The patients, average age 65, had suffered a stroke in the previous four to eight weeks. All received standard rehabilitation therapy from an occupational therapist.

Half the group received robotic therapy every day for six weeks, in sessions lasting 40 minutes. The other half spent the same amount of time working through a standard self-training program for hemiplegic patients, performing stretches and passive-to-active exercises of their affected arm.

With a recent trend in helping patients function with one arm, many post-stroke patients have given up hope of recovery of their affected arms. Takahashi said. Participating in such robotic exercise is therefore expected to give patients insights about their future ability and a more positive image regarding their affected arm, increasing their self-efficacy and motivation toward rehabilitation.

The group assigned to robotic therapy used a Reo Therapy System by Motorika Ltd. in Israel. For the therapy, the patient's forearm, either resting on or strapped to a platform, is moved in multiple directions based on pre-programmed exercise movements.

Researchers selected five such pre-programmed movements. For instance, in one of the movements, forward reach, the robot helps patients extend their arms forward as if reaching for something in front of them.

Therapists also selected from five levels of robotic assistance according to what was most appropriate for the patient, from movement entirely guided by the robot and passive on the patient's part, to movement actively performed by the patient.

The successful test of robots adds a new wrinkle to stroke rehabilitation strategies, Takahashi said. While repetitive movement is an essential therapy, physical and occupational therapists aren't always available to provide care, and self-training, if not done correctly, can result in pain and disability.

Robots, on the other hand, can carry out the repetitive movement exercise with exactly the right movement pattern to prevent misuse, Takahashi said.

WSU study finds younger stroke victims benefit from earlier MRIs, ambulance rides to ER

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Detroit - While the American Stroke Association reports that stroke is the third leading cause of death and one of the top causes of disability in the United States, young adults showing signs of suffering a stroke are sometimes misdiagnosed in hospital emergency rooms, preventing them from receiving early effective treatment that can prevent serious damage.

Performing magnetic resonance imaging sooner on younger stroke patients entering emergency rooms can lower the rate of misdiagnosis and lead to faster appropriate treatment, according to a team of Wayne State University School of Medicine and Wayne State University Physician Group neurologists.

The Wayne State University-Detroit Medical Center Stroke Program team presented its findings Thursday during the American Heart Association/American Stroke Association's International Stroke Conference 2011 in Los Angeles, Calif.

In Early Performance of MRI is Associated with Lower Rate of Stroke Misdiagnosis in Young Adults, the team examined the cases of 77 patients with a mean age of 37.9 years who reported to an emergency room displaying stroke symptoms. Of those cases, 14.5 percent of the patients were initially misdiagnosed.

The chances of a misdiagnosis decreased if physicians performed an MRI of the patient within 48 hours. The likelihood of a misdiagnosis increased as the age of the patients decreased. The study concluded that early performance of an MRI leads to greater accuracy of a stroke diagnosis in young adults brought to emergency rooms, and patients younger than 35 years of age are at greater risk of being misdiagnosed when exhibiting stroke symptoms. However, if a patient demonstrating stroke symptoms arrived via ambulance, there was a lower rate of misdiagnosis. The team hypothesized that arrival by ambulance may increase an emergency room staff's perception of the gravity of the patient's condition.

Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems, said Seemant Chaturvedi, M.D., professor of Neurology and director of the WSU-DMC Stroke Program. We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical.

Part of the problem is that the emergency room staff may not be thinking 'stroke' when the patient is younger, Dr. Chaturvedi said. Physicians must realize that a stroke is the sudden onset of these symptoms. Patients arriving with seemingly trivial symptoms like vertigo and nausea should be assessed meticulously, he said.

Delay can be costly. After 48 to 72 hours, there are no major interventions available to improve stroke outcome, he said.

Intravenous delivery of the clot-dissolving agent tissue plasminogen activator is the only U.S. government-approved treatment for acute stroke. The drug must be administered within three hours of symptom onset to reduce permanent disability.

The findings build on the team's 2009 study in which members reviewed seven years worth of data covering 57 patients between the ages of 16 and 50. The patients were enrolled in the Young Stroke Registry at the Comprehensive Stroke Center at the WSU School of Medicine. Four males and three females (average age 34) in the study were misdiagnosed with migraine headaches, vertigo, alcohol intoxication or other conditions. They were discharged from the emergency room, but later were found to have suffered a stroke.

Advanced macular degeneration is associated with an increased risk

Wed, 09 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Older people with late-stage, age-related macular degeneration (AMD) appear to be at increased risk of brain hemorrhage (bleeding stroke), but not stroke caused by brain infarction (blood clot), according to research presented at the American Stroke Association's International Stroke Conference 2011.

Other studies have found there are more strokes in older individuals with late AMD, but ours is the first to look at the specific types of strokes, said Renske G. Wieberdink, M.D., study researcher and epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands. We found the association is with brain hemorrhage, but not brain infarction.

AMD is degeneration of the macula, which is the part of the retina responsible for the sharp, central vision needed to read or drive. Because the macula primarily is affected in AMD, central vision loss may occur. Age-related macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss from AMD include shadowy areas in your central vision or unusually fuzzy or distorted vision.

Because the number of brain hemorrhages observed in the study was small, the findings will need to be corroborated in a larger group, Wieberdink said.

These findings should be considered preliminary, she said. Patients and physicians must be very careful not to over-interpret them. We don't know why there are more brain hemorrhages in these patients or what the relationship with AMD might be. This does not mean that all patients with late-stage AMD will develop brain hemorrhage.

Beginning in 1990, the Rotterdam Study is a prospective, population-based cohort investigation into factors that determine the occurrence of cardiovascular, neurological, ophthalmological, endocrinological and psychiatric diseases in older people.

The researchers tallied stroke incidence among 6,207 participants 55 years and older. All of the participants were stroke-free at the study's outset. AMD was assessed during scheduled eye examinations, and participants with the condition were divided into five different stages of AMD, and whether their condition was wet AMD or dry AMD. Participants were tracked for an average of 13 years. Of the 726 persons who suffered a stroke in that time, 397 were brain infarctions, 59 were brain hemorrhages and the stroke type was not available for 270.

Late AMD (stage 4) was associated with a 56 percent increased risk of any type of stroke. Late AMD, both the dry and the wet form, was strongly associated with more than six times the risk of brain hemorrhage, but not with brain infarction. Early AMD (stages 1-3) did not increase the risk of any stroke. Associations were adjusted for possible confounders, such as diabetes, blood pressure, anti-hypertensive medications, smoking status, body mass index, alcohol use and C-reactive protein levels.

Genes of the immune system are associated with increased risk of mental illness

Mon, 07 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Genes linked to the immune system can affect healthy people's personality traits as well as the risk of developing mental illness and suicidal behaviour, reveals a thesis from the University of Gothenburg, Sweden.

Inflammation is part of the immune system and is responsible for defending humans against infection as well as fascilitating the healing of injuries, and is therefore vital for our survival. Research has demonstrated that inflammatory processes also have other roles to play as inflammatory substances produced by the body influence mechanisms in the brain involving learning and memory.

Inflammatory substances produced in moderate quantities in the brain can be beneficial during the formation of new brain cells, for example. However, an increase in the levels of these substances as is the case during illness, can result in damage to the brain.

Previous studies have shown that individuals suffering from various mental illnesses have an increased peripheral inflammation, but the reason behind this increase is not known, says Petra Suchankova Karlsson, who wrote the thesis. It has been suggested that the stress that goes with mental illness activates the body's immune system, but it is also possible that inflammation in the body affects the brain, which in turn results in mental illness.

Previous studies have focused on how environmental and psychological factors affect the immune system's impact on the brain. Suchankova's thesis presents, for the first time, results that suggest that several different genes linked to the immune system are associated with healthy people's personality traits. It also demonstrates that some of these genes are associated with an increased risk of developing schizophrenia or suicidal behaviour.

One of the things we studied was a gene variant that increases impulsiveness in people who carry it, says Suchankova. We already knew that the risk of attempting suicide is higher in impulsive people and therefore analysed this gene variant in a group of patients who had attempted to take their life. We found that these patients more often carried the particular gene variant when compared to the general population which meant that this variant was not only associated with increased impulsiveness in healthy individuals but also with increased risk of suicidal behaviour.

The change in the levels of inflammatory substances in the blood of patients suffering from a mental illness as previously noted may have been caused by inflammation-related genes affecting the risk of mental illness, rather than the illness itself leading to a change in levels, as is traditionally believed.

It could well be that some variants of the genes play a role in the development of mental illness by controlling how the brain is formed, perhaps during the embryonic stage, or by affecting the transfer of signal substances, says Suchankova.

The results of this thesis support the proposed role of the immune system in mental illness, and could be used as a basis for further studies that, it is hoped, will lead to the development of new treatment methods.

The thesis has been successfully defended.

Incidence of stroke after coronary artery bypass grafting surgery has decreased

Tue, 25 Jan 2011 19:14:17 PST

( from http://www.rxpgnews.com ) An analysis of data on more than 45,000 patients who underwent coronary artery bypass graft (CABG) surgery at an academic medical center over the past 30 years finds that the occurrence of stroke after CABG has declined, despite an increase in risk profiles of patients, according to a study in the January 26 issue of JAMA.

Stroke is a devastating and potentially preventable complication of CABG surgery. Because it increasingly is being reserved for elderly patients with extensive coronary disease and co-existing conditions, prevalence of stroke after CABG is likely to remain substantial. Many studies have identified patient factors associated with post-CABG stroke; however, information about timing of perioperative (around the time of surgery) stroke and the influence of different surgical techniques remains limited, according to background information in the article.

Khaldoun G. Tarakji, M.D., M.P.H., of the Cleveland Clinic, and colleagues examined the prevalence and timing of perioperative stroke, along with associated patient and surgical factors. The study included data from 45,432 patients (average age, 63 years) who underwent primary or reoperative CABG surgery from 1982 through 2009 at a U.S. academic medical center. Strokes occurring following CABG were recorded prospectively and classified as having occurred intraoperative or postoperatively. Data also included information on 4 different CABG operative strategies: off-pump (not on heart-lung machine), on-pump with beating heart, on-pump with arrested heart, on-pump with hypothermic circulatory arrest (in which a heart-lung machine is used to cool the body during surgery, which lowers blood pressure and slows circulation to near standstill).

Among the patients in the study, 705 (1.6 percent) experienced a stroke. Occurrence of stroke peaked in 1988 at 2.6 percent, then slowly declined by 4.69 percent per year, despite increasing patient risk profile, such as higher prevalence of preoperative stroke, hypertension, and diabetes. Of the 705 patients experiencing stroke, intraoperative stroke occurred in 40 percent (n = 279) and postoperative stroke in 58 percent (n = 409), with timing undetermined in 17 patients.

Risk factors common to both intraoperative and postoperative stroke included older age, previous stroke, preoperative atrial fibrillation, and on-pump CABG with hypothermic circulatory arrest. As number of arteriosclerotic (hardening and thickening of the walls of the arteries) co-existing conditions increased, stroke risk increased.

Different surgical techniques were associated with different risks of intraoperative stroke. Unadjusted rates of stroke were highest among patients who had on-pump CABG with hypothermic circulatory arrest (5.3 percent) and lowest among those who had off-pump CABG (0.14 percent) and on-pump beating-heart CABG (0 percent). Risk of intraoperative stroke was intermediate for those undergoing on-pump arrested-heart CABG (0.50 percent)

Patients who experienced a stroke had substantially worse hospital outcomes, even after adjustment for preoperative factors: 19 percent mortality vs. 3.7 percent; 44 percent prolonged ventilation vs. 15 percent; and 13 percent renal failure vs. 4.3 percent. They also experienced substantially longer intensive care unit and postoperative lengths of stay.

The authors speculate that the reason the occurrence of stroke among patients undergoing CABG has decreased over the last 3 decades despite an increasing patient risk profile may be the result of improving preoperative assessment, intraoperative anesthetic and surgical techniques, and postoperative care.

"Further studies are needed to develop better strategies to minimize the occurrence of stroke among patients undergoing CABG," the researchers conclude.

Repeated migraines and headaches do not increase the risk of cognitive decline

Wed, 19 Jan 2011 17:22:03 PST

( from http://www.rxpgnews.com ) Previous work, in particular the CAMERA study, has used MRI to study the brains of migraine sufferers and has shown that a higher proportion of these patients exhibit lesions of the brain microvessels than the rest of the population.

Lesions of the brain microvessels, visible on cerebral MRI images, can be of various kinds: white-matter hyperintensities and, more rarely, silent infarcts leading to loss of white-matter tissue.

They result from a deterioration of the small cerebral arteries that supply blood to the brain's white matter, the material which ensures, among other things, the passage of information between different parts of the brain.

These lesions are observed in almost all elderly people. However, their severity varies greatly from one individual to the next. Moreover, it has been shown that they are more severe among hypertension sufferers and diabetics.

A large quantity of hyperintensities leads to many cerebral complications: cognitive deterioration, increased risk of Alzheimer's disease, depression, movement disorders and increased risk of stroke.

Moreover, according to several studies, the presence of a large quantity of this type of brain lesion increases the risk of cognitive deterioration (reasoning, memory, etc.) and of Alzheimer's disease. This is why the research team coordinated by Christophe Tzourio, director of the Inserm-Université Pierre et Marie Curie Mixed Research Unit 708 "Neuroepidemiology", advanced the hypothesis that migraines could "damage" the brain.

To test this hypothesis, the researchers evaluated the impact of migraine on cognitive function. The team used the EVA study-group of individuals aged over 65 years, recruited from the general population in Nantes, and monitored them over a 10-year period. Cerebral MRI was performed on more than 800 of the participants and these individuals were also questioned about their headaches by a neurologist. "The advantage of this cohort is that it involves relatively elderly individuals. However, since migraine often begins before age 30, if it did indeed have a deleterious and cumulative effect on the brain, then we should observe cerebral damage and a higher level of cognitive decline among the migraine sufferers", explains Christophe Tzourio.

The cognitive tests performed, involved an evaluation of the volunteers orientation in time and space, their short-term memory and their capacity and speed to correctly carry out specific tasks.

The results show that 21% of people suffer or have suffered from severe headaches over the course of their lives. For more than 70% of these, this involves migraines, some of which are with aura (see box below). The MRI scans for those participants having severe headaches confirm that they are twice as likely to have a large quantity of microvascular brain lesions as subjects without headaches.

In contrast, the cognitive scores were identical for individuals with or without severe headaches and for those having or not having cerebral microvascular lesions.

Among participants having a migraine with aura (2% of the total sample), a specific increase in silent cerebral infarcts and certain lesions was observed, hence confirming previous studies, but without detectable cognitive harm.

"This is a very reassuring result for the many people who suffer from migraine. In spite of the increased presence of lesions of the brain microvessels, this disorder does not increase the risk of cognitive decline. Therefore, we have not observed negative consequences of migraine on the brain ", concludes Tobias Kurth, lead author of the study, who designed and carried out these analyses.

Headaches (or cephalgias) are very common among the general population. This is particularly the case for migraine, a very painful, chronic and debilitating variety of headaches. It is estimated that around 12% of adults and 5 to 10% of children are afflicted, which represents 11 million migraine sufferers in France. There are two types of migraine, migraine without aura, by far the most frequent, and migraine with aura (15% of migraines). Migraine aura involves the appearance of, often visual, phenomena (zigzag lines of light, the impression of viewing the world through frosted glass, etc) in the minutes preceding the appearance of the headache.

The mechanisms of migraine and migraine aura are still largely unknown. However, it is suspected that a transitory contraction of the blood vessels could be responsible for a reduction of blood flow in the brain promoting the appearance of migraine aura. Much research elsewhere has shown that people suffering from migraine with aura have an increased risk of cerebral infarction (or strokes). Extremely fortunately, this risk remains low among migraine sufferers. However, the research confirms the existence of a link between migraine and blood vessels in the brain.

Statins: Benefits questionable in low-risk patients

Tue, 18 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) There is not enough evidence to recommend the widespread use of statins in people with no previous history of heart disease, according to a new Cochrane Systematic Review. Researchers say statins should be prescribed with caution in those at low risk of cardiovascular disease (CVD).

CVD is the most common cause of death, accounting for nearly a third of all deaths worldwide. Cholesterol-lowering statins are first line treatments for heart patients and the benefits are well established. However, there is less evidence that statins are beneficial for preventing heart problems in those who have no history of CVD. Given that low cholesterol has been shown to increase the risk of death from other causes, statins may do more harm than good in some patients.

The researchers reviewed data from 14 trials involving 34,272 patients. Outcomes in patients given statins were compared to outcomes in patients given placebos or usual care. Combined data from eight trials involving 28,161 patients that provided data on deaths from all causes showed that statins reduced the risk of dying from 9 to 8 deaths for every 1000 people treated with statins each year. Statins reduced fatal and non-fatal events, including heart attack, stroke and revascularization surgery, as well as blood cholesterol levels.

However, the researchers say that the conclusions of their review are limited by unclear, selective and potentially biased reporting and that careful consideration should be given to patients' individual risk profiles before prescribing statins.

It is not as simple as just extrapolating the effects from studies in people who have a history of heart disease, said lead researcher Fiona Taylor, from the Cochrane Heart Group at the London School of Hygiene and Tropical Medicine in London, UK. This review highlights important shortcomings in our knowledge about the effects of statins in people who have no previous history of CVD. The decision to prescribe statins in this group should not be taken lightly.

The researchers point out that all but one of the trials they reviewed were industry-sponsored. We know that industry-sponsored trials are more likely to report favourable results for drugs versus placebos, so we have to be cautious about interpreting these results, said Taylor. The numbers eligible for treatment with statins are potentially great so there might be motivations, for instance, to stop trials earlier if interim results support their use.

A separate Cochrane Systematic Review, conducted by some of the same authors, considered the effects of combined approaches to reducing the risk of heart disease, including using education and counselling to encourage people to change their diets and stop smoking. The authors concluded that combined interventions had little or no impact on deaths or disease caused by CVD. In an editorial accompanying the reviews, Carl Heneghan, University of Oxford, concluded that, Although various multiple prevention strategies exist, the most effective and cost-effective intervention for primary prevention in adults at low risk currently remains unclear.

New technique to study neurons microscopically developed by Stanford Scientists

Mon, 17 Jan 2011 08:16:08 PST

( from http://www.rxpgnews.com ) Standard light microscopes don't allow researchers to look into the interior of the living brain, where memories are formed and diseases such as dementia and cancer can take their toll.
But Stanford scientists have devised a new method that not only lets them peer deep inside the brain to examine its neurons but also allows them to continue monitoring for months.

The technique promises to improve understanding of both the normal biology and diseased states of this hidden tissue.
Other recent advances in micro-optics had enabled scientists to take a peek at cells of the deep brain, but their observations captured only a momentary snapshot of the microscopic changes that occur over months and years with aging and illness.
The Stanford development appears online Jan. 16 in the journal Nature Medicine. It also will appear in the February 2011 print edition.

Scientists study many diseases of the deep brain using mouse models, mice that have been bred or genetically engineered to have diseases similar to human afflictions.
"Researchers will now be able to study mouse models in these deep areas in a way that wasn't available before," said senior author Mark Schnitzer, associate professor of biology and of applied physics.

Because light microscopy can only penetrate the outermost layer of tissues, any region of the brain deeper than 700 microns or so (about 1/32 of an inch) cannot be reached by traditional microscopy techniques. Recent advances in micro-optics had allowed scientists to briefly peer deeper into living tissues, but it was nearly impossible to return to the same location of the brain and it was very likely that the tissue of interest would become damaged or infected.

With the new method, "Imaging is possible over a very long time without damaging the region of interest," said Juergen Jung, operations manager of the Schnitzer lab. Tiny glass tubes, about half the width of a grain of rice, are carefully placed in the deep brain of an anaesthetized mouse. Once the tubes are in place, the brain is not exposed to the outside environment, thus preventing infection. When researchers want to examine the cells and their interactions at this site, they insert a tiny optical instrument called a microendoscope inside the glass guide tube. The guide tubes have glass windows at the ends through which scientists can examine the interior of the brain.

"It's a bit like looking through a porthole in a submarine," said Schnitzer.
The guide tubes allow researchers to return to exactly the same location of the deep brain repeatedly over weeks or months. While techniques like MRI scans could examine the deep brain, "they couldn't look at individual cells on a microscopic scale," said Schnitzer. Now, the delicate branches of neurons can be monitored during prolonged experiments.

To test the use of the technique for investigating brain disease, the researchers looked at a mouse model of glioma, a deadly form of brain cancer. They saw hallmarks of glioma growth in the deep brain that were previously known in tumors described as surficial (on or near the surface).

The severity of glioma tumors depends on their location. "The most aggressive brain tumors arise deep and not superficially," said Lawrence Recht, professor of neurology and neurological sciences. Why the position of glioma tumors affects their growth rate isn't understood, but this method would be a way to explore that question, Recht said.

In addition to continuing their studies of brain disease and the neuroscience of memory, the researchers hope to teach other researchers how to perform the technique.

Academy of Science-St. Louis announces recipients of Outstanding St. Louis Scientist Awards

Thu, 13 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) ST. LOUIS, JANUARY 12, 2011: The 17th annual Academy of Science-St. Awards dinner, honoring top scientists and engineers from the St. Louis region, will be held at the Chase Park Plaza on April 13, 2011.

The academy's Peter H. Raven Lifetime Award recognizes local scientists with a distinguished career in science, engineering or technology. The 2011 prize goes to Marcus E. Raichle, MD, Professor of Radiology, Neurology, Neurobiology, BioMedical Engineering and Psychology at the Washington University School of Medicine. Dr. Raichle has an exceptional body of leading-edge research work inHuman cognitive neuroscience and neuroimaging.

Dr. Raichle has profoundly influenced biomedical science by discovering and then creatively applying methods of image human brain function. His PET studies in the late 1980's and early 1990's on language, attention and memory were the turning point for the field of human cognitive neuroscience.

Over the past three decades, Raichle and his colleagues have pioneered a revolution in brain science using noninvasive neuroimaging methods to study human brain function. His specific contributions include advances in the methodology of imaging and groundbreaking work in elucidating cognitive aspects of human brain function. The PET experiments of Raichle and his colleagues on the manner in which the brain processes single words is among the most emulated and cited studies in the functional neuroimaging literature. His impact is evident in myriad fields of study, including memory, emotion, personality differences, depression, anxiety and blindness.

The Science Leadership Award honors an individual or organization that has played an important leadership role in the development of science and scientists in the region. This year's honorees are Emerson and Timothy Eberlein, MD, Director of the Siteman Cancer Center at Barnes-Jewish Hospital.

An innovative technology leader, St. Louis-based Emerson has been recognized by FORTUNE as a Global 500 Company and one of the World's Most Admired Companies.

Thanks to strong global technological innovations, such as the modernization of 100 hydroelectric turbine generators in Ukraine; power inverters and plant-wide controls for what will be California's largest photovoltaic facility; climate technologies that preserve globally transported fruit and vegetables; and scroll compressor heating technology is now being used by major heat pump manufacturers in Asia.

Emerson is a global leader in bringing technology and engineering together to provide innovative solutions for customers in industrial, commercial, and consumer markets through its network power, process management, industrial automation, climate technologies, and appliance and tools businesses. With more than 500 new products per year, Emerson just ended 2010 with net sales of $21 billion.

Timothy Eberlein, MD is the Bixby Professor and Chairman of the Department of Surgery at Washington University School of Medicine. He also serves as the Olin Distinguished Professor and Director of the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University Medical Center. Dr. Eberlein serves as the Surgeon-in-Chief at Barnes-Jewish Hospital.

Dr. Eberlein was the founding Director of the Siteman Cancer Center, a NCI Comprehensive Cancer Center and member of the National Comprehensive Cancer Network. Under his leadership, the Center has become one of the largest clinical cancer centers in the country with integrated research programs involving all Departments of the School of Medicine, as well as the Schools of Engineering, Social Work and Arts and Sciences. The Center treats more than 40,000 cancer patients each year and just received a $23 million research grant from the NCI.

Eberlein has held a series of national leadership positions, currently serves as editor-in-chief of the Journal of the American College of Surgeons and is President-Elect of the American Surgical Association.

The James B. Eads Award for outstanding achievement in technology or engineering will be presented to Alexander Rubin, PhD, Senior Technical Fellow, Boeing Research and Technology, The Boeing Company, and Ettigounder (Samy) Ponnusamy, PhD, Principal Scientist, Sigma-Aldrich.

UIC Distinguished University Professor named AAAS Fellow

Tue, 11 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Mark M. Rasenick, Distinguished University Professor in physiology and biophysics and psychiatry and founding director of the Neuroscience Program at the University of Illinois at Chicago College of Medicine, has been named a Fellow by the American Association for the Advancement of Science.

Election as a Fellow is an honor bestowed upon AAAS members by their peers.

Rasenick was cited for distinguished contributions advancing our understanding of neurotransmitter signaling and the biology of mood-disorders and for his and advocacy for science policy.

Mark has been a leader in the neuroscience efforts of the department and was instrumental in obtaining a neuroscience-oriented training grant and in making neuroscience a degree granting program, said R. John Solaro, Distinguished University Professor and head of physiology and biophysics at UIC. Rasenick pioneered the establishment of a role of cytoskeletal elements in G protein signaling, Solaro said, which is now widely recognized to be a significant element in signaling cascades.

In his study of G protein signaling and the interaction with structural proteins in the brain, Rasenick and his colleagues found evidence that a change in the location of this protein could serve as a biomarker for depression, suggesting molecular and cellular targets for antidepressant treatment. A biomarker could make it possible to identify patients with depression with a simple laboratory test and to determine whether therapy was providing a successful response.

Rasenick has worked to use science as a tool of diplomacy and outreach all over the world. During 1999 and 2000, Rasenick worked on the staff of the late Senator Edward M. Kennedy as a Robert Wood Johnson Fellow. In addition he serves on the advocacy committees of several scientific societies -- neuroscience, biochemistry and molecular biology, and neuropsychopharmacology.

Rasenick received his B.A. from Case Western Reserve University in biology and political science and a Ph.D. in developmental biology from Wesleyan University. After post-doctoral research at Yale Medical School, Rasenick joined the faculty of the UIC College of Medicine as an assistant professor in 1983. He was named Distinguished University Professor in 2006. In addition to his research and teaching, Rasenick worked to develop UIC's interdisciplinary graduate program in neuroscience, which he directs along with Simon Alford and Daniel Corcos.

The tradition of AAAS Fellows began in 1874. This year 503 Fellows were named for their scientifically or socially distinguished efforts to advance science or its applications. They will be honored Feb. 19 at the AAAS annual meeting in Washington.

Anti-epileptic drugs increase risk of fractures in patients above the age of fifty years

Mon, 10 Jan 2011 21:18:44 PST

( from http://www.rxpgnews.com ) Most anti-epileptic drugs are associated with an increased risk of non-traumatic fracture in individuals 50 years of age and older, according to a report in the January issue of Archives of Neurology, one of the JAMA/Archives journals.

Anti-epileptic drugs are considered a secondary risk factor for osteoporosis, according to background information in the article, because epilepsy is highly prevalent in older adults, a population already at risk for osteoporosis. Additionally, anti-epileptic drugs are associated with greater bone density reduction in post-menopausal women with epilepsy.

While there have been studies that examined the link between anti-epileptic drugs and bone density loss in adults older than 65, little evidence exists for the association of individual anti-epileptic drugs with bone loss. Nathalie Jetté, M.D., M.Sc., of the University of Calgary, Foothills Hospital, Alberta, Canada, and colleagues studied medical records of 15,792 individuals who experienced non-traumatic fractures between April 1996 and March 2004. Each person was matched with up to three controls, persons without a history of fracture, for a total of 47,289 controls.

The individual anti-epileptic drugs studied included carbamazepine, clonazepam, ethosuximide, gabapentin, phenobarbital, phenytoin and valproic acid. Additional anti-epileptic drugs with fewer numbers of users were included together under "other anti-epileptic drugs."

The likelihood of fractures was highest for persons taking phenytoin followed by carbamazepine, other, phenobarbital, gabapentin and clonazepam. The only anti-epileptic drug not associated with an increased likelihood of fracture was valproic acid.

Similar results were found when testing for the use of anti-epileptic drugs in monotherapy (individuals taking only one anti-epileptic drug) and in polytherapy (individuals taking more than one anti-epileptic drug). All anti-epileptic drugs used in monotherapy were associated with a significantly increased risk of fracture except for valproic acid, phenobarbital and "other anti-epileptic drugs." The greatest risk of fracture was found in individuals in the polytherapy subgroups.

"In conclusion, our study showed that most anti-epileptic drugs except for valproic acid are associated with an increased likelihood of non-traumatic fracture in individuals aged 50 years or older," the authors write. "Future prospective studies of anti-epileptic drugs in newly treated drug-naïve patients are needed to better examine the individual effects of anti-epileptic drugs on bone health."

More research and attention needed for epilepsy

Tue, 28 Dec 2010 09:38:39 PST

( from http://www.rxpgnews.com ) Epilepsy, a common and serious neurologic disorder that affects millions of people, is not getting the public attention and funding for research it deserves, according to an editorial on a study published in the January 4, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology.

"We have almost nonexistent epilepsy surveillance, or ongoing collection of data on newly diagnosed epilepsy, in the United States," said Edwin Trevathan, MD, MPH, Dean of the St. Louis University School of Public Health in St. Louis and a member of the Neurology® Editorial Board. "As a result, we do not have good data to inform decisions made by our health leaders, and some of our best researchers are analyzing data that are 30 to 50 years old."

Trevathan points to narrowly focused funding lines from Congress to the Centers for Disease Control and Prevention (CDC) as one cause of inadequate epilepsy data. For example, these narrow funding lines result in funding for public awareness campaigns instead of essential public health infrastructure, such as public health surveillance for epilepsy. Major federal agencies such as the CDC also have other priorities that receive the limited, optional funding.

"Epilepsy has a major impact on public health. A national approach to monitoring epilepsy trends is desperately needed in order to monitor the impact of improvements in epilepsy care, to identify problems with epilepsy care that need to be corrected, and to provide up-to-date data for researchers," said Trevathan.

In the corresponding study, scientists aimed to discover the lifetime risk of developing epilepsy. They analyzed data on 412 people from Rochester, Minn., diagnosed with epilepsy between 1960 and 1979. The study found that at least one in 26 people will develop epilepsy in their lifetime. The risk was higher in the elderly, with a risk of 1.6 percent in people under age 50 and a 3.0 percent risk for people up to age 80.

"Our results highlight the need for more research using epilepsy surveillance data, especially given the aging population in the United States. Such surveillance will also provide useful information for health care planners as they address the service needs of people with epilepsy," said study author Dale C. Hesdorffer, PhD, associate professor of clinical epidemiology in the Sergievsky Center at Columbia University Medical Center.

Study suggests Spirulina beneficial for Amyotrophic Lateral Sclerosis patients

Tue, 21 Dec 2010 23:24:05 PST

( from http://www.rxpgnews.com ) Nutritional supplementation with Spirulina, a nutrient-rich, blue-green algae, appeared to provide neuroprotective support for dying motor neurons in a mouse model of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, University of South Florida neuroscientists have found. Although more research is needed, they suggest that a spirulina-supplemented diet may provide clinical benefits for ALS patients.

A spirulina dietary supplement was shown to delay the onset of motor symptoms and disease progression, reducing inflammatory markers and motor neuron death in a G93A mouse model of ALS. Spirulina, an ancient food source used by the Aztecs, may have a dual antioxidant and anti-inflammatory effect on motor neurons, the researchers said.

Their study is published in the current issue of The Open Tissue Engineering and Regenerative Medicine Journal (3:36-41).

"ALS is a degenerative motor neuron disease," said the study's lead author, Svitlana Garbuzova-Davis, PhD, DSc, assistant professor in the Department of Neurosurgery and Brain Repair at USF. "Most available treatments relieve symptoms without altering the underlying disease. However, evidence for oxidative stress has been associated with ALS and, in our past studies, we demonstrated potent decreases in markers of oxidative damage and inflammation in aged rats fed diets supplemented with spirulina or spinach. In this initial study, the diet supplement was fed only to pre-symptomatic mice. Further studies showing the diet supplement's effect on the lifespan of symptomatic ALS mice are needed to prove the treatment's effectiveness."

Specifically, when the USF researchers tested compounds found in blueberries and spirulina for effectiveness in animal models of stroke and aging in past experiments, they noted neuroprotective effects of the nutritional supplements.

The current study compared ALS mice receiving a spirulina-supplemented diet over a 10-week period with mice that did not receive the diet supplementation. The spirulina-fed ALS mice showed reduced inflammatory markers and motor neuron degeneration over that period.

"The focus of our future ALS experiments will include motor neuron counts and an examination of lifespan following dietary spirulina supplementation in symptomatic ALS mice," said study co-author Paula C. Bickford, PhD, a professor in the USF Department of Neurosurgery and Brain Repair and a senior research biologist at the James A. Haley Veterans' Hospital in Tampa, Florida.

The high price of sleep disorders

Fri, 17 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Danish sleep researchers at the University of Copenhagen and the Danish Institute for Health Services Research have examined the socio-economic consequences of the sleep disorder hypersomnia in one of the largest studies of its kind. The sleep disorder has far-reaching consequences for both the individual and society as a whole.

Hypersomnia is characterised by excessive tiredness during the day. Patients who suffer from the disorder are extremely sleepy and need to take a nap several times a day. This can occur both at work, during a meal, in the middle of a conversation or behind the steering wheel.

- Hypersomnia is often a symptom of sleep disorders such as narcolepsy, sleep apnoea, restless leg syndrome, violent snoring and/or obesity-related breathing difficulties, explains Professor of Clinical Neurophysiology Poul Jennum from the Center for Healthy Aging at the University of Copenhagen. The professor also leads the Danish Center for Sleep Medicine at Glostrup Hospital, which each year treats patients from across the country.

- Previous studies have indicated that these sleep disturbances affect people's quality of life to a considerable degree both socially and economically. Our studies show that people who e.g. snore violently but especially those who suffer from sleep apnoea, narcolepsy and obesity-related breathing difficulties use the health services more frequently, take more medicine, and are more frequently unemployed. The more serious the sleep disorder the higher the socio-economic cost.

Each person who snores violently, suffers from narcolepsy or hypersomnia is calculated to cost Danish society an annual figure of EURO 10,223 and EURO 2190 respectively. The figures refer to the direct cost of frequent doctor's visits, hospital admissions or medicine expenses and indirect costs in the form of lost working hours. In addition to this, costs are also incurred in the form of state benefits. The researchers demonstrated that hypersomnia patients received state benefits more often than healthy subjects and took state subsidised medicine more frequently. The study has highlighted the high costs that have arisen, especially those born by society and which is largely due to frequent absence from the work force and lower incomes among the sick.

Our study is the first to show the actual socio-economic consequences of untreated hypersomnia, explains Poul Jennum and refers to the fact that last year he and his colleagues carried out a similar study on the socio-economic consequences of the sleep disorder, narcolepsy. Here they also found an increase in the intake of medication, a higher rate of hospital admissions, and 30% more unemployment when the disease went undiagnosed and untreated. There is, however, significant potential for better diagnosis and treatment.

We have gotten better in the last few years at diagnosing and treating hypersomnia and the underlying diseases, explains Poul Jennum. This can be a help to patients because we know that there are a lot of people who go around incredibly tired during the day who do suffer from hypersomnia, but have never been diagnosed or discovered the reason for their tiredness. The question is whether their tiredness is owing to narcolepsy or is the fact that they sleep badly at night owing to some other reason?

It's clear to us that those who suffer from hypersomnia are more often ill and where hypersomnia is chronic, the economic costs to society can be quite considerable. That's why it is essential that people with the disorder have access to a system of treatment - otherwise the illness can affect their education, ability to work and thus their economic circumstances and health.

Ion channel responsible for pain identified by UB neuroscientists

Fri, 17 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- University at Buffalo neuroscience researchers conducting basic research on ion channels have demonstrated a process that could have a profound therapeutic impact on pain.

Targeting these ion channels pharmacologically would offer effective pain relief without generating the side effects of typical painkilling drugs, according to their paper, published in a recent issue of The Journal of Neuroscience.

Pain is the most common symptom of injuries and diseases, and pain remains the primary reason a person visits the doctor, says Arin Bhattacharjee, PhD, UB assistant professor of pharmacology and toxicology in the School of Medicine and Biological Sciences, director of the Program in Neuroscience and senior author on the paper.

Fifty million Americans suffer from chronic pain, costing between $100-200 billion a year in medical expenses, lost wages and other costs, says Bhattacharjee. The need to understand pain mechanisms remains paramount for human health and for society.

Inflammatory pain can result from penetration wounds, burns, extreme cold, fractures, arthritis, autoimmune conditions, excessive stretching, infections and vasoconstriction.

There are efficacious treatments for inflammatory pain, such as corticosteroids and non-steroidal anti-inflammatory drugs, says Bhattacharjee, but the adverse side effects associated with these drugs limit their long-term use and compromise patient compliance. As a result, there is a great need to understand the cellular processes involved in inflammatory pain to create less toxic, less addictive, analgesic drugs.

Pain-responsive nerve cells, known as nociceptors, are electrical cells that normally respond to pain stimuli. Nociceptors then relay information to the central nervous system, indicating the location, nature and intensity of the ensuing pain. Nociceptors are sensitized during inflammation, their ionic properties are altered and their firing characteristics changes. This sensitization causes a state of hyperalgesia, or increased sensitivity to pain.

Merely touching the inflamed area can be very painful, notes Bhattacharjee. The ionic mechanisms that are chiefly responsible for this inflammatory-mediated change in nociceptive firing had not been clearly identified.

We were able to demonstrate that a certain class of potassium channels is removed from the surface of nociceptive cells during inflammatory signaling. The removal of these ion channels is linked to the hypersensitivity of these nerve cells. We demonstrated that reducing the expression of these channels by gene interference techniques produced a similar nociceptor hyperexcitability.

Bhattacharjee says his team plans to extend their ion channel trafficking studies to in vivo models, using peptide inhibitors to try to prevent the removal of the potassium channels from the surface of nociceptors during inflammation.

We expect to show that maintaining these channels at the surface during inflammation will be effective for pain relief. Successful completion of our studies will provide the impetus for direct human clinical trials.Megan O. Nuwer, PhD, and Kelly E. Picchione, PhD, both in the neuroscience program, are co-authors on the paper.

Laboratory studies show promise for new multiple sclerosis treatment

Thu, 18 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Successfully treating and reversing the effects of multiple sclerosis, or MS, may one day be possible using a drug originally developed to treat chronic pain, according to Distinguished Professor Linda Watkins of the University of Colorado at Boulder.

Watkins and her colleagues in CU-Boulder's department of psychology and neuroscience discovered that a single injection of a compound called ATL313 -- an anti-inflammatory drug being developed to treat chronic pain -- stopped the progression of MS-caused paralysis in rats for weeks at a time.

Lisa Loram, a senior research associate who spearheaded the project in Watkins' laboratory, presented the findings at the Society for Neuroscience's annual meeting held in San Diego this week.

MS is an inflammatory disease where the body's immune system attacks a protective sheath called myelin that encompasses nerves in the spinal cord and brain. As the disease progresses, the myelin develops lesions, or scars, that cause permanent neurological problems.

What happens now with MS drugs is they slow or stop the progression of MS, but they don't treat it, Watkins said. They don't take people back to normal because the lesions caused by MS don't heal.

Watkins, Loram and their colleagues hope to use spinal cord and brain-imaging technology to extend their studies to determine if lesions are being healed in rats that received an ATL313 injection.

If we have a drug that is able to heal these lesions, this treatment could be a major breakthrough in how we treat the symptoms of MS in the future, she said.

The new findings were quite a surprise to Watkins. The team had originally wanted to look at the drug's potential in treating pain associated with MS, because about 70 to 80 percent of MS patients suffer from chronic pain that is not treatable.

What we had originally thought about this class of compounds is that they would calm down glial cells in the spinal cord because their pro-inflammatory activation is what causes pain, she said.

Under normal circumstances glial cells are thought to be like housekeepers in the nervous system, Watkins said, essentially cleaning up debris and providing support for neurons. Recent work by Watkins and others has shown that glial cells in the central nervous system also act as key players in pain enhancement by exciting neurons that transmit pain signals.

What's become evident is that glial cells have a Dr. Jekyll and Mr. Hyde personality, Watkins said. Under normal circumstances they do all these really good things for the neurons, but when they shift into the Mr. Hyde formation they release a whole host of chemicals that cause problems like neuropathic pain and other chronic pain conditions.

They discovered that ATL313 appears to reset the glial cells from an angry activated state to a calm anti-inflammatory state that may heal MS lesions.

Why estrogen makes you smarter

Wed, 17 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- Estrogen is an elixir for the brain, sharpening mental performance in humans and animals and showing promise as a treatment for disorders of the brain such as Alzheimer's disease and schizophrenia. But long-term estrogen therapy, once prescribed routinely for menopausal women, now is quite controversial because of research showing it increases the risk of cancer, heart disease and stroke.

Northwestern Medicine researchers have discovered how to reap the benefits of estrogen without the risk. Using a special compound, they flipped a switch that mimics the effect of estrogen on cortical brain cells. The scientists also found how estrogen physically works in brain cells to boost mental performance, which had not been known.

When scientists flipped the switch, technically known as activating an estrogen receptor, they witnessed a dramatic increase in the number of connections between brains cells, or neurons. Those connections, called dendritic spines, are tiny bridges that enable the brain cells to talk to each other.

We created more sites that could allow for more communication between the cells, said lead investigator Deepak Srivastava, research assistant professor in neuroscience at Northwestern University Feinberg School of Medicine. We are building more bridges so more information can go from one cell to another.

The findings will be presented Nov. 17 at Neuroscience 2010 in San Diego. Peter Penzes, associate professor of physiology and of psychiatry and behavioral sciences at the Feinberg School, is the senior investigator.

Previous research has shown an increase in dendritic spines improves mental performance in animals. In humans, people who have Alzheimer's disease or schizophrenia often have a decrease in these spines.

We think there is a strong link between the number of dendritic spines and your mental performance, Srivastava said. A major theory is if you increase the number of spines, it could be a way to treat these significant mental illnesses.

Northwestern scientists also found strong clues that estrogen can be produced in cortical brain cells. They identified aromatase, a critical protein needed to produce estrogen, to be in precisely the right spot in the brain cell to make more dendritic spines.

We've found that the machinery needed to make estrogen in these brain cells is near the dendritic spines, Srivastava said. It's exactly where it's needed. There's a lot of it in the right place at the right time.

Next, Srivastava said, he wants to further identify the key molecules involved in the dendritic spine production and target them in the same way as the estrogen receptor in order to ultimately be able to treat schizophrenia and other mental disorders.

Nick Brandon, head of psychiatry at Pfizer Inc., whose group collaborated with the Penzes lab for this work, added, We are very excited by the emerging data in this area. There is a great deal of literature and precedent for a role of estrogen and estrogen signaling in major mental illnesses. This adds to our understanding of the specific neuronal functions. As we understand the effects of these specific estrogen receptor beta compounds in preclinical models, we are discovering effects on specific neuronal functions, which could be relevant for the treatment of cognitive disorders, depression and schizophrenia.

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.

Rett Syndrome research gets 'SMART' with Pepsi Challenge funding

Thu, 28 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Cincinnati, OH - The International Rett Syndrome Foundation (IRSF) believes that accelerating the pace of meritorious research, supporting families, and raising awareness are the minimum effort necessary to successfully search for treatments and a cure for one of the most devastating neurological diseases to affect young girls. On October 1, IRSF became the recipient of a $250,000 grant from the Pepsi Refresh contest that was officially confirmed later in the month. The contest was a highly-publicized and competitive online grant program to benefit non-profit organizations. In March 2010, IRSF entered the challenge when Donna Wright contacted IRSF's Director of Family Support, Paige Nues, to discuss the competition on behalf of her granddaughter, Naomi, who suffers from Rett syndrome.

The Pepsi Challenge funds will be put to immediate use in part, to launch the Selected Molecular Agents for Rett Therapeutics (SMART) Initiative - a new Rett syndrome-specific drug development program. The SMART Initiative was the outcome of an intensive two day meeting convened in March, where IRSF brought together a blue ribbon panel of advisors to discuss the development of new medicines for reversing the symptoms of Rett syndrome. The panel drew on the expertise of leading clinicians and researchers working on Rett syndrome, experts drawn from the biotech and pharma industries together with advisors from the FDA and the NIH.

The SMART Initiative will be directed by two leading medicinal chemists: Professor Alan Kozikowski and Dr. Irina Gaisina at the University of Illinois, Chicago, in consultation with external advisors Drs. John McCall and Clark Eid--key participants at the March meeting. The new consortium's first task will be to assemble a collection of brain-specific drugs which target select biological mechanisms important in Rett syndrome. The research team in Chicago will select compounds on the basis of their mechanism of action, and their drug-like qualities. They will create an electronic database of all of the drugs that are procured or synthesized, and keep records ensuring their purity. The database will also obtain information on all drugs that are assayed. Rett researchers from around the globe will have access to the compound collection upon written request to facilitate studies of these selected agents.

Commenting on the SMART Initiative, Dr. Kozikowski said, In the first phase of this program, the consortium will be highly selective in choosing the most appropriate drugs for testing. As the identification of effective therapeutics requires a strong marriage between chemistry and biology, we believe that this initiative will help advance the development of new drugs for Rett syndrome. Dr. Kozikowski added, The chemistry group in Chicago is extremely grateful to the grass roots effort that played a key role in obtaining the Pepsi Challenge funding on behalf of IRSF.

Dr. McCall, said, Drug discovery is often driven by access to compounds that target specific mechanisms. The consortium will provide valuable tools allowing researchers to efficiently explore new approaches to treatment. We often talk about looking for keys under the street lamp - we intend to provide the street lamp, he added.

To win the Pepsi Refresh competition, IRSF launched an intensive grassroots effort, mobilizing thousands of volunteers who voted every day for four months until the Foundation was chosen as the winner on the eve of Rett Syndrome Awareness Month. Ms. Nues, whose daughter Katie has Rett syndrome, commented, The true win goes to our girls and women who wait patiently while our researchers work diligently for new treatments and an eventual cure for this devastating disease.

Stem cells repair damaged spinal cord tissue

Sun, 10 Oct 2010 06:06:53 PST

( from http://www.rxpgnews.com ) A joint study by Professor Jonas Frisén's research group at Karolinska Institutet and their colleagues from France and Japan, and published in Cell Stem Cell, shows how stem cells and several other cell types contribute to the formation of new spinal cord cells in mice and how this changes dramatically after trauma.

The research group has identified a type of stem cell, called an ependymal cell, in the spinal cord. They show that these cells are inactive in the healthy spinal cord, and that the cell formation that takes place does so mainly through the division of more mature cells. When the spinal cord is injured, however, these stem cells are activated to become the dominant source of new cells.

The stem cells then give rise to cells that form scar tissue and to a type of support cell that is an important component of spinal cord functionality. The scientists also show that a certain family of mature cells known as astrocytes produce large numbers of scar-forming cells after injury.

"The stem cells have a certain positive effect following injury, but not enough for spinal cord functionality to be restored," says Jonas Frisén. "One interesting question now is whether pharmaceutical compounds can be identified to stimulate the cells to form more support cells in order to improve functional recovery after a spinal trauma."

Study gets measure of how best to prevent blood clots

Mon, 20 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Treating hospital patients with thigh-length surgical stockings, rather than knee-high socks, can reduce life threatening blood clots, a new study suggests.

Researchers found that knee-high stockings, which are similar to flight socks, do little in stroke patients to prevent deep vein thrombosis (DVT), a life threatening form of blood clot that can travel up into the heart and lungs, .

The CLOTS (Clots in Legs Or sTockings after Stroke) study from the University of Edinburgh highlights that the clot rate in stroke patients was higher among those fitted with the shorter stockings than for those with longer stockings.

Another study, published last year by the same researchers, showed that thigh-length stockings did not usefully cut the risk of DVT in stroke patients.

This new study shows that short stockings are even less likely to help patients. The National Institute for Clinical Excellence have changed their guidelines based on these findings and no longer recommends that stockings are used for stroke patients.

However, stockings are also very widely used to prevent blood clots in patients who undergo surgery. Clinicians mostly use short stockings, which are cheaper and easier to fit than thigh-length stockings. In Scotland, for example, about three-quarters of stockings used by the NHS are short.

This study questions whether the widespread use of short stockings is appropriate given the greater risk of clots associated with their use. Use of short stockings may result in many more patients suffering potentially life-threatening clots.

The CLOTS trial included more than 3,000 stroke patients from 112 hospitals in nine countries.It is by far the biggest study to test stockings.

Stroke patients fitted with below-the-knee, stockings were 30 per cent more likely to develop deep vein thrombosis than patients fitted with thigh-length stockings. This could be because the most serious type of blood clots tend to be in the thigh, researchers suggest,

Martin Dennis, Professor of Stroke Medicine at the University of Edinburgh, said: Although we have shown in previous work that thigh-length stockings are not very effective in reducing the risk of DVT after a stroke, we believe that the results of this trial may have important implications for the millions of patients undergoing surgery each year.

Millions of patients worldwide are fitted with stockings each year. Unless reliable evidence emerges that short stockings do actually reduce the risk of DVT, long stockings should always be used in preference.

Although trials have shown that stockings reduce the risk of DVT in patients undergoing surgery, these have only tested long stockings. The researchers have not identified any studies which show that below-knee stockings work.

Success stops drug trial

Tue, 31 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The data monitoring committee of the AVERROES study, seeing overwhelming evidence of the success of apixaban in the prevention of stroke in patients with atrial fibrillation who are unsuitable for the conventional treatment of warfarin, has recommended early termination of this study. The decision came after repeated review and careful consideration of all efficacy and safety data.

The study leaders, principal investigator Dr. Stuart J. Connolly, chairman of the steering committee Dr. Salim Yusuf, and project officer Dr. John Eikelboom, have accepted this recommendation, as have the study sponsors, Bristol-Myers Squibb and Pfizer.

Results of the study were presented by Connolly at the annual European Society of Cardiology Congress in Stockholm, Sweden, on August 31.

The AVERROES study enrolled 5,600 patients with atrial fibrillation at risk for stroke who were unsuitable for therapy with a Vitamin K antagonist such as warfarin. These patients were randomized, double-blind, to receive either apixaban or the standard therapy which is Aspirin. The primary efficacy outcome of the AVERROES study was a composite of stroke or systemic embolism and the major safety outcome was major bleeding.

The data monitoring committee observed a relative risk reduction for stroke and systemic embolism of more than 50 per cent, which was highly statistically significant and which met the highly conservative monitoring boundaries of the AVERROES study. There was only a modest increase in major hemorrhage that was not statistically significant.

The results of AVERROES are truly impressive, said Connolly, a professor of medicine at the Michael G. DeGroote School of Medicine at McMaster University. The reduction in stroke and systemic embolism is very important and the increased risk of hemorrhage is small. It appears that apixaban will be an excellent treatment for the many patients with atrial fibrillation who are unsuitable for warfarin. These findings will reduce the burden of stroke in society.

Atrial fibrillation is a common heart rhythm disorder, in which the upper chamber of the heart beats improperly. Patients with atrial fibrillation are at increased risk of stroke due to the formation of blood clots in the upper chamber of the heart. The standard therapy for the prevention of stroke and other embolic events in atrial fibrillation is to use a type of anticoagulant known as a Vitamin K antagonist. The most common Vitamin K antagonist is warfarin, which is very effective for reducing stroke but is a difficult drug to use because of numerous interactions with food and other drugs and due to a need for long-term monitoring each patient's blood coagulation.

There are many patients who are unsuitable for warfarin and for them the only effective therapy for prevention of stroke in atrial fibrillation is aspirin, which is not very effective. The purpose of the AVERROES study was to test whether the new Factor Xa inhibitor, apixaban, is superior to aspirin for the prevention of stroke in these patients, with an acceptable risk of bleeding.

Apixaban is a new type of anticoagulant known as a Factor Xa inhibitor, which is being jointly developed by Bristol-Myers Squibb and Pfizer. This agent blocks the coagulation system and can be used without the need for monitoring necessary in traditional treatments. It has been studied and shown promising results in patients with deep vein thrombosis, in patients with recent orthopedic surgery and after acute coronary syndrome. It had not previously been studied in patients with atrial fibrillation.

AVERROES investigators have been informed of the decision to stop follow up of patients in AVERROES, and soon they will be informing their patients who are participating in the study. All patients in AVERROES who are still receiving study medication will be offered a long-term, open-label extension phase of the study in which they will receive apixaban, once the extension has been approved by regulatory bodies and local ethics committees.

Medical Cannabis beneficial for chronic pain control

Mon, 30 Aug 2010 09:59:07 PST

( from http://www.rxpgnews.com ) The medicinal use of cannabis has been debated by clinicians, researchers, legislators and the public at large for many years as an alternative to standard pharmaceutical treatments for pain, which may not always be effective and may have unwanted side effects. A new study by McGill University Health Centre (MUHC) and McGill University researchers provides evidence that cannabis may offer relief to patients suffering from chronic neuropathic pain. The results of the groundbreaking study are published in the latest issue of the Canadian Medical Association Journal.

"This is the first trial to be conducted where patients have been allowed to smoke cannabis at home and to monitor their responses, daily," says Dr. Mark Ware, lead author of the study, who is also Director of Clinical Research at the Alan Edwards Pain Management Unit at the MUHC and an assistant professor of anesthesia in McGill University's Faculty of Medicine, and neuroscience researcher at the Research Institute of the MUHC.

In this study, low doses (25mg) of inhaled cannabis containing approximately 10% THC (the active ingredient in cannabis), smoked as a single inhalation using a pipe three times daily over a period of five days, offered modest pain reduction in patients suffering from chronic neuropathic pain (pain associated with nerve injury) within the first few days. The results also suggest that cannabis improved moods and helped patients sleep better. The effects were less pronounced in cannabis strains containing less than 10% THC.

"The patients we followed suffered from pain caused by injuries to the nervous system from post-traumatic (e.g. traffic accidents) or post-surgical (e.g. cut nerves) events, and which was not controlled using standard therapies" explains Dr. Ware. "This kind of pain occurs more frequently than many people recognize, and there are few effective treatments available. For these patients, medical cannabis is sometimes seen as their last hope."

"This study marks an important step forward because it demonstrates the analgesic effects of cannabis at a low dose over a shot period of time for patients suffering from chronic neuropathic pain," adds Dr. Ware. The study used herbal cannabis from Prairie Plant Systems (under contract to Health Canada to provide cannabis for research and medical purposes), and a 0% THC 'placebo' cannabis from the USA.

However, larger-scale studies with a longer time frame and higher doses of THC are needed to further evaluate the efficacy and long-term safety of medical cannabis. "Our challenge as researchers is to continue to conduct rigorous clinical studies on the medical use of cannabis with strict attention to details such as quality and dosage," says Dr. Ware. "This will allow us to move the debate forward by providing reliable scientific clinical data."

Experimental treatments for cocaine addiction may prevent relapse

Thu, 26 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Doctors have used the drug disulfiram to help patients stay sober for several decades. It interferes with the body's ability to metabolize alcohol, giving a fierce hangover to someone who consumes even a small amount of alcohol.

More recently, disulfiram was shown to be effective in treating cocaine addiction as well, even though alcohol and cocaine affect the nervous system in different ways.

Now, researchers at Emory University School of Medicine have identified how disulfiram may exert its effects, and have shown that a newer drug with fewer side effects works by the same mechanism.

The results are published online this week by the journal Neuropsychopharmacology. Research assistant professor Jason Schroeder, PhD, and graduate student Debra Cooper are co-first authors of the paper, and the research also involved collaborations with P. Michael Iuvone, PhD, director of research at the Emory Eye Center, Gaylen Edwards, DVM, PhD, head of the department of physiology and pharmacology at the University of Georgia's College of Veterinary Medicine, and Philip Holmes, PhD, professor of psychology at the University of Georgia.

Disulfiram has several effects on the body: it interferes with alcohol metabolism, but it inhibits several other enzymes by sequestering copper, and can also damage the liver, says senior author David Weinshenker, PhD, associate professor of human genetics at Emory University School of Medicine. We wanted to figure out how disulfiram was working so we could come up with safer and potentially more effective treatments.

In treating cocaine addiction, there are several challenges: not only getting people to stop taking the drug, but also preventing relapse. Cocaine boosts the levels of several neurotransmitters, including dopamine and norepinephrine, at the junctions between nerve cells by blocking the machinery the brain uses to remove them.

Under normal conditions, dopamine is important for the sensation of pleasure produced by natural rewards such as food or sex, Weinshenker says. Cocaine hijacks the dopamine system, which plays a large role in addiction. Similarly, norepinephrine has a role in attention and arousal, but its overactivation can trigger stress responses and relapse, he says.

Weinshenker's team showed that disulfiram prevents rats from seeking cocaine after a break, a model for addicts tempted to relapse. At the same time, it doesn't stop them from taking cocaine when first exposed to it, or from enjoying their food.

Disulfiram appears to work by inhibiting dopamine beta-hydroxylase, an enzyme required for the production of norepinephrine. A dose of disulfiram that lowers the levels of norepinephrine in the brain by about 40 percent is effective, while doses that do not reduce norepinephrine have no effect on relapse-like behavior in rats.

To confirm that the beneficial effects of disulfiram were because of dopamine beta-hydroxylase inhibition, the researchers turned to a drug called nepicastat, which was originally developed for the treatment of congestive heart failure in the 1990s.

Nepicastat is a selective dopamine beta-hydroxylase inhibitor that does not sequester copper or impair a host of other enzymes like disulfiram, Weinshenker says. We reasoned that if disulfiram is really working through dopamine beta-hydroxylase, then nepicastat might be a better alternative.

Researchers at the University of Texas Medical Branch at Galveston have recently completed a Phase I safety trial studying nepicastat for the treatment of cocaine addiction in human subjects.

15 new US patents awarded this past year to NJIT researchers

Mon, 23 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) NJIT researchers were awarded 15 new U.S. patents this past year, increasing the total number of issued patents for NJIT to 97. More than 150 applications are in process. With projected research expenditures greater than $90 million for 2010-11, NJIT ranks as a leader in size and growth of research programs among technological universities. The patents were awarded from July 1, 2009-June 30, 2010. Specifics follow.

Yeheskel Bar-Ness, distinguished professor of electrical and computer engineering and Foundation Chair of the Center for Communication and Signal Processing Research, received a patent for Equal BER Power Control for Uplink MC-CDMA with MMSE Successive Interference Cancellation, a system designed to increase efficiency and reduce interference in wireless telecommunications.

Ken Chin, professor of physics, gained a patent for an Aligned Embossed Diaphragm Based Fiber Optic Sensor which can be used in optical, mechanical, pressure, temperature, chemical, biometric or acoustic sensing. One specific application is the detection of on-line acoustic signatures of sparking and arcing in a multitude of applications including: large electric utility transformers, auto-transformers, tap-changers, phase angle regulators, voltage regulators, reactors, circuit breakers, pipe-type high- voltage cables, and other oil insulated utilities.

Ivan Dentcho, research professor in biomedical engineering and director of the NJIT Microelectronics Fabrication Center, earned a patent in collaboration with Joseph R. Madsen, associate professor of neurosciences at Harvard Medical School, for a Waveform Sensing and Regulating Fluid Flow Valve that is used to drain excess cerebrospinal fluid from the brain in hydrocephalus patients.

Anthony East and Michael Jaffe, research professors of biomedical engineering, were awarded a patent for Thermoset Epoxy Polymers from Renewable Resources, a substance made from sugar derived from corn that can be used commercially in adhesives and coatings.

Reginald Farrow, research professor of physics, was awarded a patent for Method of Forming Nanotube Vertical Field Effect Transistor, a new technique to make nanoscale transistors that are oriented vertically from the surface of a silicon wafer.

Sergiu M. Gorun, associate professor of chemistry, was awarded a patent, Functional Coating Compositions of Perfluoroalkyl Perfluoro-Phthalocyanine Compounds, disclosing a new self-contained subclass of molecules. These new materials are comprised of organic scaffolds with metal centers, which can be applied as either an opaque or transparent hydrophobic coating.

Professors Yehoshua Perl and James Geller, of computer science, were awarded a patent for Intersection Ontologies for Organizing Data, a method for organizing sets of data into forms that are more easily usable.

Robert Pfeffer, professor emeritus of chemical engineering, gained patents for System and Method for Nanoparticle and Nanoagglomerate Fluidization, as well as a filter composed of nanoparticles, Fractal Structured Nanoagglomerates as Filter Media.

Nuggehalli Ravindra, professor of physics, received a patent for Method of Assembly Using of Programmable Magnets, a new technique for assembling integrated circuits.

Yun-Qing Shi, professor of electrical and computer engineering, received four patents for his work in data hiding. The patents included: Method For Identifying Marked Content, Such as By Using a Class-Wise Non-Principal Component Approach; System and Method for Data Hiding Using Inter-Word Space Modulation; System and Method for Robust Lossless Data Hiding and Recovering From the Integer Wavelet Representation; and System and Method for Reversible Data Hiding Based on Integer Wavelet Spread Spectrum.

Proof that a gut-wrenching complaint -- irritable bowel syndrome -- is not in your head

Thu, 19 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Irritable bowel syndrome makes life miserable for those affected -- an estimated ten percent or more of the population. And what irritates many of them even more is that they often are labeled as hypochondriacs, since physical causes for irritable bowel syndrome have never been identified. Now, biologists at the Technische Universitaet Muenchen (TUM) have shed new light on the matter: They have discovered mini-inflammations in the mucosa of the gut, which upset the sensitive balance of the bowel and are accompanied by sensitization of the enteric nervous system.

Flatulence, constipation and diarrhea, nausea and stomach cramps: Irritable bowel syndrome (IBS) can turn digestion into a nightmare. Frequent visits to the bathroom are often accompanied by sleep disturbances, headaches, and backaches. In Germany alone, some seven million people are affected by the disorder -- and by the fact that their irritable bowel syndrome is often deemed psychosomatic. This is because the organic trigger of the disease has never been discovered, and consequently the various therapeutic interventions are disappointing for both the patients and their doctors. That may soon change, however, because now, for the first time, biologists in Munich have nailed down hidden physical causes of this bowel disorder.

Professor Michael Schemann's research team at the TUM Department for Human Biology has managed to demonstrate that micro-inflammations of the mucosa cause sensitization of the enteric nervous system, thereby causing irritable bowel syndrome. Using ultrafast optical measuring methods, the researchers were able to demonstrate that mediators from mast cells and enterochromaffin cells directly activate the nerve cells in the bowel. This hypersensitivity of the enteric nervous system upsets communication between the gut's mucosa and its nervous system, as project leader Prof. Schemann explains: The irritated mucosa releases increased amounts of neuroactive substances such as serotonin, histamine and protease. This cocktail produced by the body could be the real cause of the unpleasant IBS complaints.

The TUM researchers in human biology are blazing a trail as they follow this lead. Their current focus is to what extent nerve sensitization correlates with the severity of symptoms. Working with colleagues from Amsterdam, they have already substantiated the clinical relevance of their results: Irritable bowel symptoms improved after treatment with an antihistamine known for its immune-stabilizing effect in the treatment of allergic reactions such as hay fever. Thanks to funding from the German Research Foundation (DFG), the scientists are now investigating whether the improved symptoms are accompanied by a normalization of nerve activity.

Successful identification of the active components could enable the development of effective drugs to treat irritable bowel syndrome. Even now, though, the TUM team have made life easier for many IBS patients, in that they have shown that the chronic disorder does have physical causes and is not merely in their heads.

Health care using telephone and telemonitoring technology benefits heart failure patients

Sat, 07 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Providing patients with chronic heart failure access to remote monitoring, for example by telephone or telemonitoring using wireless technology, reduces deaths and hospitalisations and may provide benefits on health care costs and quality of life. These are the conclusions of a new Cochrane Systematic Review by an international team of researchers.

Remote monitoring of patients can reduce pressure on resources, particularly for conditions like chronic heart failure, which exert a large burden on health services. In structured telephone support, patients provide vital data, such as heart rate and rhythm, blood pressure and weight, over the phone, whereas telemonitoring usually involves digital, wireless or Bluetooth transmission of data to a heart specialist.

The review included studies involving over 9,500 participants, comparing both of these technologies to usual care for patients with chronic heart failure. Studies that provided intensified specialist follow-up to patients in the intervention and/or control arms were excluded, since the additional resources provided may have confounded the effects of the intervention.

Details on deaths and hospitalisations for 25 peer-reviewed studies were analysed. The length of follow-up of these studies ranged from three to 18 months, with many studies reporting outcomes after 12 months. Telemonitoring was effective in reducing mortality in patients with chronic heart failure (102 per 1000 vs. 154 per 1000 in the control group). However, no significant benefit was seen with structured telephone support on mortality for patients in these trials (112 per 1000 vs. 127 per 1000 in the control group).

Both structured telephone support and telemonitoring significantly reduced the number of patients who were admitted to hospital due to worsening of heart failure. Hospitalisations due to heart failure occurred at a rate of 164 per 1000 with structured telephone support compared to 213 in a control group, and at a rate of 225 per 1000 with telemonitoring compared to 285 in a control group.

There are benefits of structured telephone support and telemonitoring for patients with chronic heart failure, said lead researcher Dr Sally Inglis of Baker IDI Heart and Diabetes Institute in Melbourne, Australia. These technologies can provide specialised care to a large number of patients who otherwise may have limited access to this type of specialised healthcare.

Some studies also showed patients' quality of life improved and that health care costs had been reduced. More work is required on the cost-effectiveness of telemonitoring to establish the best business models. These may vary depending on the local organisation of health services. The optimal duration of monitoring has not yet been addressed said Dr Inglis.

This review can only reflect the individual included studies. Of all the relevant evidence on these technologies which was included in the review, some studies were not as well conducted or reported as the authors would have liked - a point picked up in an Editorial published to accompany the review.

Image-processing algorithm reduces CT radiation dose by as much as 95 percent

Tue, 20 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) PHILADELPHIA, PA (July 20, 2010) -- Perfusion CT scanning, an emerging imaging technology, got a bad rap last year when a machine set to incorrect radiation levels overdosed hundreds of people in Los Angeles. In the wake of this incident, researchers at the Mayo Clinic, excited by the technology's promise for diagnosing stroke, cancer, and possibly heart disease, have developed a way to reduce the amount of radiation involved in the procedure -- which, when done properly, already involves very little risk.

At the correct dose, there should be no injury, said Cynthia McCollough. We believe in the clinical value of perfusion CT, so we're trying to lower the dose and reduce the stigma.

McCollough and her colleagues created a new image-processing algorithm that can give radiologists all of the information they need using as up to 20 times less radiation, depending on the diagnostic application. The research will be presented at the 52nd Annual Meeting of the American Association of Physicists in Medicine (AAPM) in Philadelphia.

A typical CT perfusion procedure lasts about half a minute and scans the same tissue many times, each scan at a low dose. These scans both reveal the internal anatomy of the patient and show how levels of a contrast agent, such as iodine injected into the bloodstream, change of over time. Changing concentrations of iodine can be used to calculate blood volume and flow in order to detect injuries to blood vessels or tumor responses to treatment.

The new adaptive algorithm compares these 20-30 scans and can differentiate between anatomical regions that do not change from moment to moment and those regions that carry the contrast agent --effectively reducing image noise while preserving iodine signal. The quality of each scan improves through non-linear comparisons with scans acquired earlier and later in the exam.

When we use very low doses, the noise gets so high that it's hard to tell what you are seeing, said Juan Carlos Ramirez Giraldo. With this algorithm, we're trying to maintain both the image quality, so that a doctor can recognize the anatomic structures, and the functional information, which is conveyed by analyzing the flow of the contrast agent over the many low dose scans.

At the AAPM meeting, the researchers will present animal data showing the effectiveness of the technique. They have also begun to process data from clinical brain perfusion CT exams in patients.

We're up to 15 or 20 cases that we've shown to the docs, and they're all giving us the thumbs up, said McCollough.

The presentation 20-Fold Dose Reduction Using a Gradient Adaptive Bilateral Filter: Demonstration Using in Vivo Animal Perfusion CT by J Ramirez Giraldo et al. will be at 7:30 a.m. on Tuesday, July 20 in room 201B of the Philadelphia Convention Center.

ABSTRACT:

Study finds brain imaging and biomarker assessments helpful in early identification of Alzheimer’s disease

Sat, 10 Jul 2010 09:07:22 PST

( from http://www.rxpgnews.com ) Abnormal brain images combined with examination of the composition of the fluid that surrounds the spine may offer the earliest signs identifying healthy older adults at risk of developing Alzheimer’s disease, well before cognitive problems emerge, a study by researchers at UC Davis has found.

“Our findings indicate that a distinctive pattern of imaging and biomarker deviations from typical adults may be an early warning sign of neurobiological pathology and an early sign of Alzheimer’s disease,” said Laurel Beckett, a professor of public health sciences at UC Davis and the lead study author. "By the time people get diagnosed with Alzheimer’s using cognitive tests, there’s already a lot of brain damage. We hope that in the future methods that combine brain imaging and biomarker assessments can push the diagnosis back, while learning more about the mechanisms causing Alzheimer’s disease, so we can develop better treatments.”

Published in the journal Neurobiology of Aging in June, the study analysis picked out a subgroup of healthy adults who later would experience a decline in memory performance typical of early Alzheimer’s disease long before other study participants.

For the study, Beckett and her team used data from the Alzheimer’s Disease Neuroimaging Initiative, which provides researchers with access to brain scans, clinical data and other laboratory results from spinal fluid and blood tests from more than 800 older adults. Some study participants began with a clean slate of cognitive health, some with mild cognitive impairment — a condition that often presages Alzheimer’s — and others with mild or moderate Alzheimer’s disease.

The researchers analyzed data from 220 normal older adults who had undergone structural magnetic resonance imaging (MRI) and clinical examinations. About half also provided spinal fluid samples. Among the 96 participants, cluster analysis identified three distinct subgroups of individuals based solely on their baseline imaging and laboratory measures. During the next three years, few of these healthy people showed any cognitive change. But cognitive tests for people in one of the subgroups — about 10 percent of the sample — declined at nearly five times the rate as healthy older adults. The researchers believe this group, which had the most extreme MRI and spinal fluid measurements, may represent the earliest stages of subclinical cognitive decline and Alzheimer’s disease.

Beckett said that the finding is an important step toward discovering the constellation of imaging and fluid biomarkers that foreshadow cognitive decline, as well as a means of determining whether new treatments are effective.

“The problem with current clinical trials is that we don’t know who is on the edge of experiencing dementia. And even if we did, how would we know if a treatment was working, since they haven’t shown any clinical problems?” Beckett said. “This method could improve clinical trials for prevention and reduce the numbers of study participants necessary to speed drug discovery — and eventually change how the pharmaceutical industry and National Institutes of Health conduct Alzheimer's disease clinical trials."

Virus 'explorers' probe inner workings of the brain

Mon, 28 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Imagine an exceedingly complex circuit board. Wires often split -- seemingly at random -- and connect in strange and unexpected ways.

This is how Princeton University researchers developing a new method for studying brain connectivity see the brain.

Because of its intricate organization, figuring out the wiring diagram that explains how the billions of neurons in the brain are connected, and determining how they work together, remains a formidable task. But success in this endeavor could transform the field of neuroscience, offering a map toward increased knowledge of how the brain works, with implications for learning more about conditions ranging from depression and schizophrenia to Alzheimer's and Parkinson's disease.

Funded by a $993,000 National Institutes of Health Challenge Grant through the American Recovery and Reinvestment Act, Lynn Enquist, a professor in Princeton's Department of Molecular Biology and in the Princeton Neuroscience Institute, is leading an effort to use genetically engineered viruses as explorers that travel throughout the nervous system, tracing the connections between neurons and reporting on their activity along the way.

Over the years, the understanding of how cells in the brain are connected has been a major problem, said Enquist, Princeton's Henry L. Hillman Professor in Molecular Biology. How can this blob of tissue do everything? We're missing a lot of information about how the brain works.

The NIH-funded project hinges on the creation and use of a genetically engineered virus that causes neurons to produce colorful fluorescent proteins. As the virus spreads, it leaves a colorful path through the brain in its wake. Some of the engineered viruses are designed to make the neurons glow brightly when they are active, like an On Air sign in the brain.

These DNA-based technologies allow us to put little labels on neurons that tell who they are connected to, said team member Samuel Wang, an associate professor in the Department of Molecular Biology and in the Princeton Neuroscience Institute. It's as if you could immediately tell on Facebook the difference between 'friends' and 'friends of friends.' And when we add proteins that get brighter when neurons are active, now our little labels tell us not only where a neuron is, but what it is doing. Combined with microscopy, it's like seeing all your Facebook friends' status updates at once, in real time -- basically watching the whole conversation at once.

Chemicals exist that can be used to trace brain connectivity, including certain molecules from the horseradish plant and the cholera toxin, but they become increasingly dilute as they spread throughout the brain, just as a drop of food coloring disperses in a cup of water. Other chemicals can change brightness or color when a neuron is active, but they label all cells indiscriminately, leading to a murky image. Because viruses replicate, they are self-amplifying and do not become less concentrated as they move away from their entry point into the brain, making them a promising tool for researchers seeking to probe the hidden depths of the brain. Viruses also can target subsets of neurons, making them glow -- and therefore stand out -- in sharp relief. Enquist and his collaborators presently are conducting laboratory experiments in test tubes and mice as they seek to increase fundamental knowledge about neural connectivity, which has significant implications for understanding the human brain.

The Princeton-led team's virus of choice is pseudorabies virus (PRV), which normally infects pigs but can also attack a variety of other organisms, including chickens and rodents. PRV does not infect people, but it is a member of the alpha herpes virus family, which includes the viruses that cause chicken pox and cold sores in humans.

To make the virus capable of coloring brain cells as it infects them, team member Oren Kobiler, a postdoctoral research fellow in Enquist's lab, is incorporating into its genetic material a cell-marking technique known as Brainbow. The technology was developed at Harvard University by a research team led by Jean Livet, Joshua Sanes and Jeff Lichtman, and first reported in a 2007 issue of the journal Nature. Brainbow works by inserting into neurons three genes that direct the production of blue, green and red fluorescent proteins. There are some 90 possible hues that can be made from different combinations of the blue, green and red proteins, and the color of a given neuron is determined by the specific amount of each color being made by the cell.

The Brainbow technique also incorporates into neurons a genetic mechanism that randomly mixes and matches the genes that direct the production of the blue, green and red proteins. This shuffling system is activated by the presence of a protein called CRE, which causes neurons that produce CRE to turn different colors from other neurons around them.

By inserting Brainbow into a virus, the research team is hoping to design a viral tracer with capabilities that exceed conventional viral tracers being used today, he explained. Current tracers are able to map out entire circuits, but they cannot distinguish among different sections within a given circuit.

Enquist and his collaborators are using genetic engineering techniques to direct certain neurons, such as those that control a particular body function, to produce CRE. When the neurons that have been engineered to make CRE are infected by the new viral tracer, they will be different colors from infected neurons that are not making CRE. This will allow the researchers to see different subcircuits in the brain, Enquist explained.

For example, he is working with J. Patrick Card, a neuroscientist at the University of Pittsburgh, to make neurons in the brainstem involved in blood pressure regulation in mice produce CRE. When the mice are then infected with the Brainbow virus, the neural circuits that control blood pressure should be different colors from the rest of the circuits in the brain, he said.

For a minute, think of the brain like a car battery, Enquist said. The Brainbow virus will let us label all of the wires in the car that connect to the battery, but to label those that connect to the radio in a different color from the rest of the circuit.

In addition to the Brainbow technology, the research team is adding genetic instructions to the virus that tell cells to produce a special fluorescent protein that gets brighter in the presence of calcium, the levels of which rise inside neurons when they are sending signals. This technology, which is being refined in Wang's lab, will allow the researchers to mark neural circuits and watch them work, according to Enquist.

To continue the analogy, our viral tracer should not only label the wires to the radio in a different color, but also cause them to glow as power travels through them, he said.

Beyond using the Brainbow virus to study the structure and function of neural circuits in living mice, the researchers intend to investigate simple neural circuits built in the lab to understand how they function in a less complicated environment. Jason Puchalla, a faculty member in Princeton's physics department, is fabricating microfluidic devices on which the researchers will grow neurons and explore how they function. This will provide opportunities for the scientists to learn more about how alpha herpes viruses spread, which has implications for treatment of these infectious diseases. At the same time, increasing the fundamental understanding of how neurons connect to one another may generate new insights into neurological disorders, which can arise when normal neural circuitry is disturbed.

The Brainbow project is characteristic of Lynn Enquist's ability to see beyond the horizon and generate an experimental plan that merges, and advances, scientific disciplines, in this case virology and neuroscience, Card said. Successful completion of the experiments funded through this grant will represent a huge advance in the power of technology. The collaborative studies with Sam Wang are particularly important in that they not only define the synaptic organization of neural circuits but also promise to provide insights into the functional activity of the circuit under study. The novel insights into brain organization and function that are likely to emerge from those investigations cannot be overestimated.

Recent - onset seizures affect white matter development

Wed, 19 May 2010 14:19:59 PST

( from http://www.rxpgnews.com ) A newly published study reported that children with new/recent onset epilepsy have significantly slowed expansion of white matter volume compared to healthy children over a two year interval. The reduced white matter volume may affect brain connectivity and influence cognition. Results of this study conducted by researchers from the University of Wisconsin School of Medicine and Public Health are now available online and will appear in the July issue of Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.

Epilepsy, a common nervous system disorder, frequently develops in early childhood and causes recurrent seizures. Seizures can range from mild staring spells to major convulsions. According to the Epilepsy Foundation there are 326,000 children under the age of 15 with epilepsy in the U.S. More than 45,000 new cases of epilepsy are diagnosed in children each year.

A research team, led by Bruce Hermann, Ph.D., investigated the neurodevelopmental changes in brain structure in children with new or recent-onset epilepsy. Thirty-four healthy children (control group) and 38 with new/recent onset epilepsy were enrolled in the study. The epilepsy group contained 21 children with localization-related epilepsy and 17 with idiopathic generalized epilepsy. Children in both groups had a mean age of 12.9 years and underwent magnetic resonance imaging (MRI) at baseline and 2 years later.

At the 2 year follow-up, seizure frequency was evaluated. During the prior year, 53% of children with epilepsy were seizure free; 34% reported only one seizure. In the remaining children with epilepsy, 5% reported monthly, 5% weekly, and 3% daily seizures.

"Our study determined that children with new or recent-onset epilepsy exhibited an altered brain development pattern characterized by delayed age-appropriate increase in white matter volume," said Dr. Hermann. The research team found that total cerebral white matter volume increased significantly in the healthy control group over the 2-year period. However, the epilepsy group did not show significant change in white matter volume in the total cerebrum and across all lobes—the difference from normal controls being most pronounced in the frontal lobes.

Researchers suspect that the delayed white matter volume increase in children with epilepsy may affect cognitive development by reducing brain connectivity. With altered brain development, children with epilepsy may also experience impaired executive function—mental tasks such as organizing, planning, and paying attention which are commonly reported in people with epilepsy.

"Research into the symmetry between patterns of cognitive change and age-appropriate brain development remains to be addressed in childhood epilepsy," concluded Dr. Hermann. "Further exploration of how subtle neurodevelopmental alterations in brain development affect cognition is needed. Longer term follow-up is also needed to determine whether this finding represents a temporary delay in brain development versus a fixed difference."

SSRIs and cardiovascular health

Mon, 26 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may provide a boost to cardiovascular health by affecting the way platelets, small cells in the blood involved in clotting, clump together, say researchers at the Loyola University Medical Center in Maywood, Ill.

In a study of 50 adults, the researchers found that platelets were slower to clump together, or aggregate, in participants who were taking an SSRI to treat depression. As depression is associated with an increased risk of cardiovascular disease, this finding could indicate a beneficial side effect for people who take SSRIs to treat depression, said Evangelos Litinas, MD, Research Associate in the Center's Pathology Department. Dr. Litinas will present the team's research at the American Physiological Society's annual Experimental Biology 2010 conference being held in Anaheim, CA from April 24-28.

SSRIs and Platelet FunctionSSRIs function to modulate the effect of serotonin in the brain. Neurotransmitters, like serotonin, are messages sent across the gap called the synapse between nerve cells in the brain. The cell sending the message, called the pre-synaptic cell, releases serotonin into the synapse. The serotonin is taken in by the receiving, post-synaptic cell, or be taken back by the pre-synaptic cell.

In a depressed patient, the post-synaptic cell doesn't take in enough serotonin and the message gets lost. To treat the depression, SSRIs decrease the ability of the pre-synaptic cell to reuptake the serotonin, leaving the message in the synapse longer and giving the post-synaptic cell a better chance of receiving the serotonin.

However, this blocking activity of SSRIs may have an effect on other cells in the body that require serotonin uptake. Small cells called platelets, which are involved in blood clotting, absorb serotonin only once and use it for their activation in response to injury.

When a blood vessel is injured in a healthy patient, their platelets are exposed to proteins that normally reside beneath the endothelium, the thin layer of cells lining blood vessel walls. These proteins activate the platelets and prompt them to send out finger-like projections that grab onto each other. This also activates the clotting system so that a clot will form at the wound site. This kind of platelet activation also occurs when blood vessel walls become inflamed in atherosclerosis (hardening of the arteries).

Once activated, the platelets release the contents of small packages that they carry called delta granules. These packages contain calcium, various energy-containing molecules, and serotonin. When the delta granules are released by activated platelets, the serotonin and other molecules work in the injured area to amplify the coagulation response.

However, Dr. Litinas and his team believe that in depressed patients who have an associated risk of cardiovascular problems, the blocking activity of SSRIs may have a side-effect of preventing the serotonin uptake by platelets, making them less responsive to aggregation and may thereby improving the patients' cardiovascular health.

To test their hypothesis, the researchers recruited 50 volunteers, 25 who were healthy and were not taking antidepressant medications and 25 who were being treated for depression with an SSRI. The team collected blood samples from each volunteer at the beginning of the protocol and again at the study's fourth week and eighth week. After each round of blood-drawing, the team separated the blood into its components to obtain the platelet-rich plasma for study.

The researchers then treated all of the samples with platelet-activating substances and with saline, which does not activate platelets. They observed platelet activity and quantified the amount of aggregation in each sample by using an aggregometer, a machine that aims light into liquid samples. Cells that do not aggregate tend to prevent light from getting all the way through a sample to the other side, whereas cells that aggregate form large clusters that sink down out of the way, allowing the light to shine through.

When the platelets from healthy volunteers were treated with platelet-activating substances at the 4-week time point, 95% of the cells aggregated. In contrast, the platelets of participants taking an SSRI showed only 37% aggregation, indicating that the SSRI had somehow inhibited or changed the platelets' ability to clump together.

As the study progressed, the researchers noticed something peculiar: The platelets taken from SSRI-treated patients at the 8-week mark aggregated more than those drawn at the 4-week mark. This suggested that SSRIs have the greatest impact on preventing platelet activation early on in treatment. Dr. Litinas and his team believe this may be because the body takes several weeks to start modulating SSRIs in the body. The team has extended the study to include samples drawn at the 12-week mark. They will also conduct a study using another brand of SSRI.

The reason we're doing this is to better the lives of depressed patients, said Dr. Litinas. There is clear evidence that depressed patients have a higher risk of cardiovascular disease, and we want to eliminate that. Since depression can be treated with an SSRI, maybe the cardiovascular disease risk can also be decreased. We want our patients to live longer and happier lives, without depression or the risk of heart problems.

Dr. Litinas' colleagues for this study are Dr. Jawed Fareed and Dr. Omer Iqbal, both of whom are affiliated with the Department of Pathology, Loyola University Medical Center, Maywood, IL; and Erin Tobin, Dr. John Piletz, Dr. Edwin Meresh, and Dr. Angelos Halaris, all of the Department of Psychiatry, Loyola University Medical Center.

Neurons growing in line

Thu, 15 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) In order to be able to understand complex organs such as the brain or the nervous system, simplified model systems are required. A group of scientists led by the Frankfurt brain researcher Erin Schuman has successfully developed a novel method to grow cultured neurons in order to investigate basic mechanisms of memory. The researchers grew two separate populations of neurons in microfluidic platforms. These neurons extended their processes through tiny grooves, to meet each other and form synaptic connections. Perpendicular to the grooves, a perfusion channel was constructed that allows the researchers to manipulate very small populations of synapses with drugs or neurotransmitters. The chambers are amenable to imaging, allowing researchers to visualize the dynamics of synapses, the movement of molecules within the neurons.

Studying cultured neurons makes it possible to reduce the complex three-dimensional network in living organisms to two dimensions. However, even in the laboratory, cell growth is totally disorganized, which makes a systematic study difficult. Neurons consist of a nucleus whose signals are transmitted to adjacent cells through a long extension (axon). Shorter extensions (dendrites) absorb the incoming signals. While the stimulus transfer along the axon and dendrites occurs electrically, the contact points between two neurons, the synapses, are bridged by biochemical signals. To understand how synapses are formed and which neurotransmitters play a part in their formation is not only an interesting topic for brain research, but may also aid the development of new pharmaceutical agents.

After demonstrating that functional synapses were formed in the approximately 150 microgrooves of the chamber, the brain researchers developed the device further in order to be able to stimulate the synapses directly. Here, they made use of the fact that cultured dendrites have a characteristic length so that the contact points with the axons of the neighboring cell populations could develop in about the same compartment of the microgrooves. There, the group implemented another small perfusion channel pervading the relevant area perpendicular to the neuronal channels. This supply channel enables a direct manipulation of the synapses via solute substances.

A further refinement of the test arrangement was reached by restricting the biochemically effective fluid in the supply channel from infiltrating the channels containing the nerve fibers. Schuman and her collaborators managed to do so by letting in a solution on both sides of the main stream shielding the main stream. The three parallel fluid streams have the additional advantage that the perfusate may be exactly dosed by varying the width of the middle stream.

Besides, the amount of the perfusate is also subject to increased temporal control: The supply can be turned on and off within one minute. It is thus possible to imitate the short duration signals that are the language of the nervous system.

Erin Schuman who relocated several months ago from the renowned California Institute of Technology (Caltech) to the Max Planck Institute for Brain Research in Frankfurt is interested in the function of synapses in the context of memory. How do synapses change during the storage of memory? And what happens during these processes at the molecular and cellular level? Years ago, her group discovered that dendrites can make the proteins required to change the functional capacity of synapses. The nucleus transcribes the required information as messenger RNA (mRNA), which is then sent out to the dendrites. When certain signals arrive, the dendrites translate the mRNA into protein using ribosomes present in the dendrite.

Frankfurt is not only appealing to the native-born Californian because of the possibility to run the Max Planck Institute for Brain Research together with her husband, brain researcher Gilles Laurent (the other director is Wolf Singer). The cooperation with scientists of the excellence cluster Macromolecular Complexes at Goethe University with which Schuman is associated as Principle Investigator also promises many interesting collaborations, for example with the Paul-Ehrlich-Young Academics awardee Amparo Acker-Palmer or with the Heisenberg-Professor Alexander Gottschalk. With respect to the new building of the MPI for Brain Research, the mother of two daughters at the age of ten and seven already has a plan: Many employees of the institute have children who come into contact with science already at an early age through their parents. We also want to make the new institute family-friendly. We hope to organize Science Saturdays for our kids to see how exciting it is to explore something on their own.

New studies reveal that age-related nerve decline is associated with inflammation, differs by gender

Wed, 14 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) New research investigating neurological decline in a population of super healthy elderly subjects found that the decline in neurological function of the peripheral nervous system attributed to aging may be related to metabolic factors, such as blood sugar levels, even if these factors are within the normal range.

In a related study of peripheral nerve function, the same group found that aging affects the nerves of men more than women later in life.

The findings imply, the researchers say, that age-related declines in peripheral nerve function may not be the consequence of the aging process alone but instead the consequence of aging, gender, plus metabolic factors that may be modifiable. The peripheral nerves are the nerves in the limbs that connect to the central nervous system (brain and spinal cord).

Outcomes from the two studies were presented today by UCSF researchers during the annual American Academy of Neurology scientific meeting in Toronto.

Reduced sensation from a decline of nerve function may contribute to overall morbidity and reduced quality of life in the elderly, said Ari Green, MD, co-lead investigator, assistant director of UCSF's Multiple Sclerosis Center and director of the Neurodiagnostics Center. The medical community considers this decline a consequence of aging. Our findings suggest that low levels of inflammation and impairment in glucose metabolism may accelerate the decline of nerve function.

Both studies involved a unique population of healthy elderly individuals between the ages of 65-90 called the Myelin and Aging Cohort. As part of this work, subjects underwent extensive neurological, laboratory and physical testing, and had to be free of any major chronic illnesses such as diabetes, hypertension, cognitive impairment, neuropathy and cardiovascular disease. For this project, researchers focused on the results from peripheral nerve conduction studies and laboratory findings.

We know that the function of peripheral nerves declines with age but wondered whether other biologic processes were at play and if we could eventually predict this decline, said John W. Engstrom, MD, co-lead investigator and clinical chief of the UCSF Neurology Service. These findings provide an opportunity to identify risk factors for the decline in peripheral nerve function.

In the first study, the team assessed conduction velocity, or the speed at which information traveled along peripheral nerves using nerve conduction studies. They found an association between age and slower nerve conduction in elderly men only.

Everyone ages differently; there are different levels of normal, said co-investigator Chris Songster, a specialist in the UCSF Department of Neurology. We want to understand if there are modifiable risk factors that, if addressed, could help people age well.

In the second study, the research team measured blood levels for highly sensitive C-reactive protein (hs-CRP) and hemoglobin A1c, which are standard tests for diabetes and systemic inflammation. Using the same conduction studies but evaluating the amplitude of the response to an electrical stimulus rather than its speed, the researchers found decline even in subjects with mild elevations in hs-CRP and hemoglobin A1c. The subjects' levels were within the normal, non-diabetic range for those measures.

Even within 'normal ranges' for measures of inflammation and glucose metabolism, we are seeing an accelerated aging process that could contribute to progressive neuropathy, said Green. These findings suggest that age, mild inflammation and mildly impaired glucose metabolism may be bad for nerve cells. Perhaps in the future, we can investigate whether a therapeutic intervention could delay the effect of age on peripheral nerve function. This may just be the tip of the iceberg. We have a lot to learn from this study population.

Both studies are important elements of a broad UCSF effort to learn how nerves age, developed in a groundbreaking collaboration between the UCSF Memory and Aging Center (Drs. Bruce Miller and Joel Kramer), the UCSF Multiple Sclerosis Center (Drs. Stephen Hauser, Ari Green and Jorge Oksenberg) and the UCSF Nerve Injury Clinic (Drs. John Engstrom and Amy Lee). The work was developed in advance of these groups moving together to the new Neurosciences Laboratory and Clinical Research Building at Mission Bay. Laboratory measures were performed in collaboration with the UC Davis Department of Pathology (Drs. Ralph Green and Josh Miller).

The UCSF team is looking at many factors related to how aging effects the connections between nerves and plans many future research studies with this population.

An important next step is to test whether modification of risk factors like inflammation has an impact on nerve function, Green said.

Depression associated with sustained brain signals

Tue, 06 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Depression and schizophrenia can be triggered by environmental stimuli and often occur in response to stressful life events. However, some people have a higher predisposition to develop these diseases, which highlights a role for genetics in determining a person's disease risk. A high number of people with depression have a genetic change that alters a protein that cells use to talk to each other in the brain. Imaging of people with depression also shows that they have greater activity in some areas of their brain. Unfortunately, the techniques that are currently available have not been able to determine why stress induces pathological changes for some people and how their genetics contribute to disease.

A new mouse model may provide some clues about what makes some people more likely to develop depression after experiencing stress. A collaborative group of European researchers created a mouse that carries a genetic change associated with depression in people. This model has good validity for understanding depression in the human, in particularly in cases of stress-induced depression, which is a fairly widespread phenomenon says Dr. Alessandro Bartolomucci, the first author of the research published in the journal, Disease Models and Mechanisms (DMM).

The scientists made genetic changes in the transporter that moves a signaling protein, serotonin, out of the communication space between neurons in the brain. The changes they made are reminiscent of the genetic changes found in people who have a high risk of developing depression.

There is a clear relationship between a short form of the serotonin transporter and a very high vulnerability to develop clinical depression when people are exposed to increasing levels of stressful life events. says Dr. Bartolomucci, This is one of the first studies performed in mice that only have about 50% of the normal activity of the transporter relative to normal mice, which is exactly the situation that is present in humans with high vulnerability to depression.

Mice with the genetic change were more likely to develop characteristics of depression and social anxiety, which researchers measure by their degree of activity and their response to meeting new mice. The work from this study now allows researchers to link the genetic changes that are present in humans with decreased serotonin turnover in the brain. It suggests that the genetic mutation impedes the removal of signaling protein from communication areas in the brain, which may result in an exaggerated response to stress.

Dr. Bartolomucci points out that many of the chemical changes they measured occurred in the areas of the brain that regulate memory formation, emotional responses to stimuli and social interactions, which might be expected. What we were surprised by was the magnitude of vulnerability that we observed in mice with the genetic mutation and the selectivity of its effects.

Studies find treating vitamin D deficiency significantly reduces heart disease risk

Mon, 15 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Preventing and treating heart disease in some patients could be as simple as supplementing their diet with extra vitamin D, according to two new studies at the Intermountain Medical Center Heart Institute in Murray, Utah.

Researchers at the Intermountain Medical Center Heart Institute last fall demonstrated the link between vitamin D deficiency and increased risk for coronary artery disease. These new studies show that treating vitamin D deficiency with supplements may help to prevent or reduce a person's risk for cardiovascular disease and a host of other chronic conditions. They also establish what level of vitamin D further enhances that risk reduction.

Study findings will be presented at the American College of Cardiology 59th annual scientific session in Atlanta at 3:30 pm, EST, on March 15, 2010. PLEASE NOTE EMBARGO REQUIREMENTS.

Vitamin D replacement therapy has long been associated with reducing the risk of fractures and diseases of the bone, says Dr. J. Brent Muhlestein, MD, director of cardiovascular research at the Intermountain Medical Center Heart Institute. But our findings show that vitamin D could have far greater implications in the treatment and reduction of cardiovascular disease and other chronic conditions than we previously thought.

For the first study, researchers followed two groups of patients for an average of one year each. In the first study group, over 9,400 patients, mostly female, reported low initial vitamin D levels, and had at least one follow up exam during that time period. Researchers found that 47 percent of the patients who increased their levels of vitamin D between the two visits showed a reduced risk for cardiovascular disease.

In the second study, researchers placed over 31,000 patients into three categories based on their levels of vitamin D. The patients in each category who increased their vitamin D levels to 43 nanograms per milliliter of blood or higher had lower rates of death, diabetes, cardiovascular disease, myocardial infarction, heart failure, high blood pressure, depression, and kidney failure. Currently, a level of 30 nanograms per milliliter is considered normal.

Heidi May, PhD, a cardiovascular clinical epidemiologist with the Intermountain Medical Center Heart Institute, and one of the study's authors, says the link between low levels of vitamin D and increased risk for a variety of diseases is significant.

It was very important to discover that the 'normal' levels are too low. Giving physicians a higher level to look for gives them one more tool in identifying patients at-risk and offering them better treatment, says Dr. May.

Dr. Muhlestein says the results of these studies will change the way he treats his patients.

Although randomized trials would be useful and are coming, I feel there is enough information here for me to start treatment based on these findings, he says.

Treatment options in this case are simple, starting with a blood test to determine a patient's vitamin D level. If low levels are detected, supplements and/or increased exposure to sunlight may be prescribed.

Increasing vitamin D intake by 1000 to 5000 international units (IU) a day may be appropriate, depending on a patient's health and genetic risk, says Dr. Muhlestein. He says supplements are the best source of vitamin D because they are relatively inexpensive and can be found at almost any supermarket or drug store. Most supplements provide an average of 400 IU per tablet.

While exposure to 20-30 minutes of sunlight can provide up to 10,000 IU, Dr. Muhlestein says it is important to use sunscreen and avoid the hottest parts of the day in order to avoid sunburn and the harmful UV rays associated with skin cancer.

New risk score tool more accurately predicts patients' risk for cardiac disease and death

Sun, 14 Mar 2010 04:59:36 PST

( from http://www.rxpgnews.com ) Researchers from the Heart Institute at Intermountain Medical Center in Murray, Utah, have devised a better way to determine an individual's risk for problems, such as heart attack and heart failure, according to a new study.

The research team has developed the Intermountain Risk Score, a measurement tool that looks at age and sex, but also adds the results of routine blood tests, which are not included in the assessment system commonly used by physicians today.

Researchers at Intermountain compared the Intermountain Risk Score with the Framingham Risk Score, currently the gold standard for measuring future coronary heart disease risk. The Framingham index looks at total cholesterol, HDL cholesterol, blood pressure, diabetes, age, and gender.

Framingham does a good job of classifying groups of patients. But it's not as good at indentifying an individual's risk for disease, says Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the Heart Institute at Intermountain Medical Center, and the principal author of the study.

That's where the Intermountain Risk Score can help.

Our research has shown that the Intermountain Risk Score really improves a doctor's ability to measure patient risk. And it does it by including two simple and inexpensive tests: the complete blood count and metabolic profiles, he says.

Results of the study from the Heart Institute at Intermountain Medical Center will be presented at 1:30 pm, EST, on Sunday, March 14, at the American College of Cardiology's 59th annual scientific session in Atlanta.

Researchers followed over 5,000 patients who were treated for angiography, or vascular imaging. By combining the patients' Framingham Risk Score with their Intermountain Risk Score, researchers found that they were 30 percent more likely to correctly determine a woman's risk, and 57 percent more likely to determine a man's risk for a cardiovascular problem or death within 30 days of the angiography. The results remained substantially better than the Framingham score alone after one year (23 percent for women and 46 percent for men) and at five years (29 percent for women and 25 percent for men).

Adding the Intermountain Risk Score to the Framingham Risk Score substantially improves our ability to determine an individual's risk of future coronary heart disease and associated problems, says Dr. Horne.

The Framingham Risk Score was developed as part of the Framingham Heart Study, which began in 1948 as a project of the National Heart, Lung and Blood Institute and Boston University. The objective of the study was to identify common characteristics that contribute to cardiovascular disease by following its development over a long period of time in a large group of participants who had not yet developed symptoms or suffered a heart attack or stroke.

Researchers at Intermountain Medical Center followed patients an average of three years after their angiogram, and some were followed for up to 10 years.

We are in the process of replicating these findings at an academic center in North Carolina. Our previous studies of the Intermountain Risk Score showed that it applies very well both to patients and to the general population in different geographic settings, so we expect it will improve on the Framingham Risk Score in that East Coast population as well, Dr. Horne said. We are also evaluating which health conditions are best predicted by the Intermountain Risk Score, and how changes over time in laboratory values influence the scoring system's ability to predict health outcomes.

Dr. Horne says that the goal at Intermountain Healthcare is to create an online risk score calculator to help clinicians around the world better assess their patients' health.

Ethosuximide - most effective treatment for childhood absence epilepsy

Sun, 14 Mar 2010 02:08:39 PST

( from http://www.rxpgnews.com ) One of the oldest available anti-seizure medications, ethosuximide, is the most effective treatment for childhood absence epilepsy, according to initial outcomes published in this week's New England Journal of Medicine.

OHSU Doernbecher Children's Hospital is one of 32 comprehensive pediatric epilepsy centers nationwide selected to participate in this landmark clinical trial as part of the NIH Childhood Absence Epilepsy Study Group.

The study group compared three medications typically used to treat the most common childhood epilepsy syndrome, childhood absence epilepsy, which is characterized by frequent non-convulsive seizures that cause the child to stop what he or she is doing and stare for up to 30 seconds at time.

Prior to this study, there was no definitive evidence on which drug worked best.

"Much of our scientific understanding of childhood epilepsy care today comes from historical experience or studies involving adult patients with related, but not identical, conditions," explained Colin Roberts, M.D., OHSU Doernbecher's principal investigator for the study, assistant professor of pediatrics and neurology, and director of OHSU Doernbecher's Pediatric Epilepsy Program,

"This study is an important milestone in our understanding of childhood absence epilepsy. Never before have we been able to document in such a comprehensive, scientific fashion the best options to treat children with this condition."

The study group enrolled 453 children newly diagnosed with childhood absence epilepsy from July 2004 to October 2007. Study participants were randomly assigned to ethosuximide, valproic acid or lamotrigine. Drug doses were incrementally increased until the child was seizure-free. After 16 weeks of therapy, the researchers found ethosuximide and valproic acid were significantly more effective than lamotrigine in controlling seizures, with no intolerable side effects. They also determined ethosuximide was associated with significantly fewer negative effects on attention.

Nick and Michelle Skimas, of Vancouver, Wash., enrolled their daughter Julia in the study in April 2007. Julia stopped having seizures after starting medication.

Before diagnosis and treatment, Julia, now 8, would stop abruptly while reading aloud, pause for 10 to 15 seconds, then resume where she left off, not aware that anything had occurred. Michelle assumed Julia was just taking breaks to look at the pictures.

This went on for two to three weeks, and Michelle didn't think anything of it. Then, while on a family vacation, Julia suddenly stopped in the midst of pitching a baseball and began slowly turning in a circle. Julia was unaware of what was happening and had no recollection of what had occurred.

"That did it," said Michelle. "We took Julia to be evaluated as soon as we got back." After an EEG, and an MRI to rule out a brain tumor, Julia was diagnosed with childhood absence epilepsy. Her primary care physician recommended she enroll in a new drug trial at OHSU Doernbecher. Nick and Michelle were leery of giving their daughter medication, but Roberts and his team explained that without treatment Julia's seizures would have a serious impact on her learning and development.

"They said to think of Julia's brain as a classroom in which one child is continuously disruptive. The rest of the class can't function. It was a hard decision, but we are glad we participated. We feel blessed that she has been seizure-free for more than 2 ½ years."

The national study group recommended long-term follow up for the study participants and recently received a five-year extension from the NIH.

Julia, who stopped taking the medication several months after she became seizure-free because it increased her BMI, or body mass index, continues to participate in the newly extended trial, representing one of three study groups: participants who took medication, became seizure-free and stopped taking the medication. The other groups comprise children who are taking the medication but still having seizures, and children taking the medication who are not experiencing seizures, respectively.

"We told Julia all along that what she was doing could very well help other kids in her position, and now she knows it did. That will make a big difference in her life," said Michelle.

"The initial outcomes from this study describe one of many aspects of childhood absence epilepsy evaluated by the study group. Collaborative studies like this lay the groundwork for many critically important studies to follow that will define the proper care of children with seizures," said Roberts.

Multicenter EPIC study found that the FiberNet Embolic Protection System had a 97.5% success rate

Mon, 01 Mar 2010 12:57:26 PST

( from http://www.rxpgnews.com ) A multicenter EPIC (FiberNet® Embolic Protection System in Carotid Artery Stenting Trial) study found that the FiberNet Embolic Protection System (EPS) had a 97.5% success rate when used in patients undergoing carotid artery stenting (CAS). Full findings are published early online in Catheterization and Cardiovascular Interventions, the official journal of The Society for Cardiovascular Angiography and Interventions.

Carotid artery stenosis or carotid artery disease occurs when plaque forms in the carotid artery, causing it to narrow and increasing risk for ischemic stroke. According to the National Institutes of Health, a blockage of a blood vessel is the most frequent cause of stroke, responsible for 80% of the estimated 700,000 strokes in the U.S. annually. Carotid artery stenosis is often treated with CAS, the placement of a tiny flexible tube in the diseased vessel.

Unfortunately, stenting procedures carry the risk of embolism, where plaque breaks away from the site of formation and blocks another artery downstream. Embolic protection devices have emerged to prevent strokes by catching the debris that may break away during CAS surgery. Over the past decade, several protection systems have emerged with varying degrees of success.

A research team led by Subbarao Myla, M.D, FSCAI, evaluated the safety and efficacy of this new design concept for embolic protection during CAS. The study was designed to demonstrate that the 30-day major adverse event (MAE) rate of all death, stroke, and myocardial infarction (MI) is significantly less than the performance goal of 8.3% from the ARCHeR 3 results.

The trial enrolled 237 patients with a mean age of 74 years from 26 centers across the U.S. and Europe. Study participants were 64% male and 20% had symptomatic carotid artery disease (CAD). Results indicate the combined MAE rate at 30 days following carotid endarterectomy (CEA) for all death, stroke and heart attack was 3.0%.

"The 30-day death, stroke, and MI rate of 3.0% is encouraging," says Dr. Myla. The researchers concluded that the FiberNet EPS, when used with commercially available stents, produced low stroke rates following CAS in high surgical risk patients with CAD.

Dr. Myla describes the team's experience with the new embolic protection device: "The low crossing profile and integration of a primary guidewire shortened procedure time, and facilitated lesion crossing and filter placement, especially in the presence of tortuous anatomy. The 0.014" guidewire tip demonstrated good torque response and the guidewire provided excellent support…it was ideal for procedures in which tortuosity would preclude placement of a more structured DPD with a stiff delivery catheter. Conformability of the expanded fiber network to the vessel wall and the short landing zone of the device made it ideal for challenging anatomy distal to the lesion. Anecdotally, investigators have commented the FiberNet EPS resulted in fewer vessel spasms."

Blacks more likely to have undiagnosed key stroke risk factor, have higher stroke incidence

Fri, 26 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Blacks are more likely to have an undiagnosed key risk factor for stroke and are more likely to have a stroke than whites, according to two studies presented at the American Stroke Association's International Stroke Conference 2010.

In two separate reports using data from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, researchers found significant racial and geographic disparities in stroke incidence and in receiving the recommended treatment to prevent stroke.

The REGARDS study enrolled 30,239 participants across the United States, age 45 or older, between January 2003 and October 2007 and continues to follow them for health events.

In the first analysis (Meschia, Abstract P160), researchers found that among 432 study participants (88 blacks; 344 whites) who had atrial fibrillation (AF), blacks were two-thirds less likely to know they had the disorder and three-fourths less likely to be treated with the gold standard of care, the blood thinner warfarin.

These disparities are a problem, said James F. Meschia, M.D., the study's lead author and a neurologist at the Mayo Clinic in Jacksonville, Fla. For patients who are able to take warfarin, it makes a huge difference. Stroke trials have shown that warfarin reduces the risk of stroke by 60 percent.

Meschia notes that warfarin is not for everyone, because of the risk of bleeding. AF, which affects more than 2.2 million Americans, occurs when one of the heart's upper chambers quivers and doesn't effectively pump blood out, which allows blood to pool and clot. These dangerous clots can cause stroke if they lodge in an artery in or leading to the brain. This research is also simultaneously published in Stroke: Journal of the American Heart Association.

Because atrial fibrillation is such a powerful risk factor for stroke, these findings suggest that lower awareness of atrial fibrillation and reduced likelihood of treatment among blacks may place blacks at higher risk of a stroke, which in turn could contribute to the higher stroke mortality among blacks, Meschia said.

The healthcare system needs to better screen for and inform people about whether they have AF, and more study is needed to shed light on the causes of the disparity in warfarin treatment, he said.

In the second analysis (Howard, abstract P158), researchers provide the first national data describing racial and regional disparities in stroke incidence. Researchers reviewed data on about 26,580 REGARDS participants who had not had a stroke at baseline and documented 299 strokes during the almost five-year period.

Total fat, trans fat linked to higher incidence of ischemic stroke

Wed, 24 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Post-menopausal women who reported consuming the most daily dietary fat had a 40 percent higher incidence of clot-caused strokes compared to women who ate the least amount, according to research presented at the American Stroke Association's International Stroke Conference 2010.

The incidence of ischemic stroke also increased by 30 percent in the quartile of women consuming the highest daily amount of trans fat (average intake 7 grams per day) compared to those who consumed the least (average 1 gram/day). Two common sources of trans fat are processed foods and fried foods.

Ischemic strokes are caused by blockages in blood vessels in or leading to the brain.

We found positive associations between total fat intake and ischemic stroke incidence and between trans fat intake and ischemic stroke incidence, said Sirin Yaemsiri, M.S.P.H., a doctoral student in the department of epidemiology in the Gillings School of Global Public Health at the University of North Carolina in Chapel Hill.

The study is the first to examine the associations of different fats and different subtypes of ischemic stroke in post-menopausal women, who face a higher stroke risk than men of a similar age.

Evidence from other studies shows that different types of fat have different effects on the incidence of coronary heart disease (CHD), with trans fat implicated in the development of CHD. However, studies of ischemic stroke and fat have been inconclusive, possibly because earlier studies had small numbers of ischemic stroke cases.

Before menopause, women have a lower risk of stroke compared to men of similar age, a situation that reverses after menopause, Yaemsiri said.

The analysis included data on 87,230 post-menopausal women ages 50 to 79 who participated in the Women's Health Initiative (WHI) Observational Study, a project sponsored by the National Institutes of Health and the National Heart, Lung and Blood Institute. The women answered a food frequency questionnaire when they entered the study and were followed for an average of 7.6 years, the researchers said. During that time, 1,049 ischemic strokes occurred.

Researchers looked for links between dietary fat intake and four ischemic stroke subtypes, which were characterized by their size or point of origin. However, the data on ischemic stroke subtypes fell short of statistical significance, perhaps because strokes are difficult to characterize and 43 percent (445 cases) of the ischemic strokes in the study were of unknown type, Yaemsiri said.

Researchers divided the women into quartiles based on the amount of total dietary fat and types of fat (saturated fat, monounsaturated fat, polyunsaturated fat and trans fat) they reported consuming per day.

Variables included age, race, smoking status, physical activity, alcohol or aspirin use, body mass index, hormone therapy, heart disease history, diabetes, systolic blood pressure and whether the women took medication for high blood pressure or to reduce cholesterol, vitamin E supplementation, fruit/vegetable intake, total calories and dietary fiber.

Women in the top quartile for total fat intake had an average intake of 86 grams of total fat per day. Those in the lowest quartile consumed an average of 26 grams a day.

I think our findings support the American Heart Association recommendations for keeping trans fat intake at less than 1 percent of energy, said Ka He, M.D., Sc.D., M.P.H., senior author of the study and associate professor of nutrition and epidemiology at the UNC Gillings School of Global Public Health.

Vitamin B3 shows early promise in treatment of stroke

Wed, 24 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) An early study suggests that vitamin B3 or niacin, a common water-soluble vitamin, may help improve neurological function after stroke, according to Henry Ford Hospital researchers.

When rats with ischemic stroke were given niacin, their brains showed growth of new blood vessels, and sprouting of nerve cells which greatly improved neurological outcome.

Now research is underway at Henry Ford to investigate the effects of an extended-release form of niacin on stroke patients. Henry Ford is the only site nationally conducting such a study.

If this proves to also work well in our human trials, we'll then have the benefit of a low-cost, easily-tolerable treatment for one of the most neurologically devastating conditions, Michael Chopp, Ph.D., scientific director of the Henry Ford Neuroscience Institute.

Dr. Chopp will present results from the animal model study at the International Stroke Conference in San Antonio.

According to the National Stroke Association, stroke is the third-leading cause of death in America and a leading cause of disability.

Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain. Ischemic stroke accounts for about 87 percent of all cases. One underlying condition for this type of obstruction is the development of fatty cholesterol deposits lining the vessel walls.

Niacin is known to be the most effective medicine in current clinical use for increasing high-density lipoprotein cholesterol (HDL-C), which helps those fatty deposits.

Dr. Chopp and his colleagues found that in animals niacin helps restore neurological function in the brain following stroke.

In 2009, stroke physicians at Henry Ford Hospital published research which showed that HDL-C is abnormally low at the time stroke patients arrive at the hospital.

Dr. Chopp's research found that in animals, niacin increased good cholesterol (HDL-C), which increased blood vessels in the brain and axonal and dendritic growth leading to a substantial improvement in neurological function.

Niacin essentially re-wires the brain which has very exciting potential for use in humans, says Dr. Chopp. The results of this study may also open doors in other areas of neurological medicine, including brain injury.

Andrew Russman, D.O., is the principal investigator of the team at Henry Ford Hospital who will evaluate in clinical trials whether niacin improves recovery for human stroke patients.

If we are able to prove that treating patients with niacin helps to restore neurological function after stroke, we're opening a whole new avenue of treatment for the leading cause of serious long-term disability in adults, says Dr. Russman.

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.

High prevalence of AF found among cross-country skiers

Tue, 09 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Next month, in the Norwegian town of Rena, 12,000 elite cross-country skiers will line up for this year's Birkebeiner ski marathon, an annual endurance race which will take them through 54 kilometres of snow-covered countryside to the winter sports resort of Lillehammer. The race has been run almost every year since 1932, and in 1976 almost 150 participants were invited to take part in a long-term study designed to discover the extent of latent heart disease in these elite cross-country skiers. Now, after some 30 years, the results of the follow-up study have been published and suggest that long-distance competition skiers - as well as other endurance athletes - are at an unusually high risk of atrial fibrillation, the most common abnormality of the heart's beating rhythm.(1)

Results showed that participants in the study are at a high risk of atrial fibrillation (AF) without known structural heart disease or other known causes (a condition termed lone AF). A prevalence of 12.8% found among the skiers who completed the study's investigations in 1976, 1981 and 2004-2006, when echocardiographic (ECG) and heart rate tests were performed at rest and at exercise. In the general population studies have found the prevalence of AF to be as low as 0.5%, with rates only rising to around 15% in men over the age of 75.

When the study began in 1976 participants were classified according to age - group I 26-33 years, group II 43-50 years, and group III 58-64 years; all had been competing in long-distance skiing events and were in the top 25% for age related performance. When the final follow-up examinations were performed during 2004-2006, a large proportion from group III (28/39) had died, leaving 78 of the original 122 available for further tests and questioning.

This analysis showed that 13 of those 78 skiers (16.7%) had experienced AF at some time during the 28-30 years of follow-up, with a current prevalence of 12.8% AF with no other known heart disease. The latter, say the investigators, is the highest prevalence yet described in long-term endurance sport practitioners. In age group I the prevalence was found to be 18.2%. The mean age at which the AF occurred was 58 years.

The study also detected two characteristics in the skiers which may predict their risk of AF: a slow heart rate at rest (known as bradycardia) and a large left atrium of the heart.(2) Both have been suggested in previous studies as common findings in the hearts of endurance athletes. However, the study found no association between the years of training in cross-country skiing (an average of 36 years in this study) and the occurrence of AF. As a result, the authors advise that there is still not enough evidence to recommend a specific age to reduce training volume and/or intensity. However, they do recommend that after the appearance of AF practice should be stopped or reduced until rhythm control is attained.

Disturbances in heart rhythm, which are the most common cause of sudden cardiac death, represent one of the major cardiovascular reasons for hospital admission. Professor Josep Brugada, President of the European Heart Rhythm Association of the ESC (and Medical Director at the Hospital Clinic in Barcelona), has described their impact as enormous, noting that around 5% of all medical expenditure in Europe is related to atrial fibrillation, the most common arrhythmic condition.

So far, only three case-control studies have found a higher prevalence of AF in athletes than in controls. However, a population-based study from 2009 showed that those with the highest level of endurance training also had the highest prevalence of AF.

Studies aiming to find an explanation for a higher AF prevalence have also found that the size of the heart muscle and chambers was larger in athletes than in controls, and this seemed a predictor for AF.

Commenting on the findings from the Birkebeiner study, principal investigator Dr Jostein Grimsmo from the Feiring Heart Clinic in Norway, agreed that enlargement of the heart's left atrium - along with bradycardia - appeared to be an important risk factor for AF among long-term endurance cross-country skiers. This atrial enlargement, he said, is the heart's adaptation to endurance training.

As many as 20% of young competitive athletes have been found to have an enlarged left atrium in some studies, said Dr Grimsmo. But we are not aware of any documentation of such a high prevalence as we have found either in athletes or in controls under the age of 75!

But despite our findings, he added, we still can't say why some athletes end up with AF and others don't. Genetic factors predisposing to 'athlete's heart', with enlarged cardiac dimensions and a slow heart rate, may be important as risk factors. And while it may be that prolonged endurance training over many years may not always be good for the heart, we do not yet have sufficient evidence to make specific recommendations.

NHLBI funds preclinical tests on devices for infants and children with congenital heart defects

Thu, 04 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has awarded four contracts totaling $23.6 million to begin preclinical testing of devices to help children born with congenital heart defects or those who develop heart failure. The four-year program is called Pumps for Kids, Infants, and Neonates (PumpKIN).

Each year in the United States, nearly 1,800 infants die as a result of congenital heart defects and another 350 develop heart disease, which leads to heart failure for many. Approximately 60 infants and children under 5 years old who are placed on the heart transplant waiting list die each year before receiving one. Mechanically assisted circulatory support could be used to sustain these young patients as they seek to recover or wait to receive a heart transplant.

This research seeks to develop technologies to expand life-saving options for infants and children born with congenital heart defects or those who develop heart failure, said NHLBI Acting Director Susan B. Shurin, M.D., a pediatrician. The NHLBI is committed to saving the lives of our youngest patients. Well-designed circulatory support devices are expected to substantially improve the outcomes of the infants and young children who need them as they seek to recover or wait to receive a heart transplant.

The options for chronic circulatory support devices for infants and young children are limited, and all have substantial risks for serious adverse events such as infection, stroke, and device failure. With this in mind, the NHLBI launched the Pediatric Circulatory Support Program in 2004 by funding the development of five novel circulatory support devices for infants and young children with congenital and acquired cardiovascular disease.

The PumpKIN program is the next phase of NHLBI support for the development and clinical realization of these devices. The program's goal is to complete the needed animal studies and other tests in artificial environments for the most promising devices in order to gain approval from the FDA to begin clinical testing.

Devices in the program will provide suitable circulatory support for newborns, older infants, and children less than 55 pounds who experience heart failure due to congenital and acquired cardiovascular disease. They are designed to supply adequate blood flow to prevent organ damage while minimizing the risk of blood vessel damage, infection, breakdown of red blood cells, excessive bleeding, brain damage, and dangerous blood clots. The devices are intended to support circulation in pediatric patients for one to six months, be sufficiently small and reasonably portable, and be able to be routinely positioned and functioning in less than one hour, among other specifications.

Similar devices are used in adults, Shurin noted. As an adult, your heart is normally about the size of your fist; devices for small children require radically different designs from adult devices to adapt to the differences in the size of the patients.

The program will test ventricular assist devices (VADs) and advanced extracorporeal membrane oxygenator (ECMO) devices. The VADs in the PumpKIN program are very small rotary pumps which are implanted to provide circulatory support for extended periods of use. They work by drawing blood from the heart and pumping it to the body. ECMO devices circulate and supply oxygen to the blood, and are commonly used for patients who need both heart and lung support. For ECMO devices, tubes connecting the patient to the device are placed directly into large blood vessels near the base of the neck. Blood is drawn from the right side of the heart, pumped through the oxygenator, and then returned to the body on the left side of the heart so the oxygen-rich blood can be delivered throughout the body.

The contractors will conduct all preclinical animal testing and analysis in the first three years of the contract. During the third year, they will partner with a data coordinating center (the contract for which is still to be awarded) to complete the necessary activities to seek FDA approval to begin the clinical trial.

Study prompts calls for Europe-wide salt legislation

Tue, 26 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) This study provides excellent ammunition both to convince patients about the benefits of reducing their individual salt intakes and also to persuade the EU of the urgent need to introduce legislation to restrict the salt content of processed foods, said ESC spokesman Professor Frank Ruschitzka, a cardiologist and hypertension specialist from the University of Zurich, Switzerland.

This study represents the evidence that a reduction of salt intake not only lowers blood pressure but also prevents cardiovascular events. The case for population-wide salt reduction is now compelling, he added.

In the paper, Kirsten Bibbins-Domingo and colleagues, from the University of California, San Francisco, USA, undertook a computer simulation showing the effects of population wide reductions of dietary salt intakes in all adults aged 35 to 85 years in the USA. Reducing dietary salt intake by 3 g per day (1200mg less sodium per day) could result in 60,000 to 120,000 fewer cases of heart disease , 32,000 to 66,000 fewer strokes and 54,000 to 100,000 fewer heart attacks.

A reduction in dietary salt of 3g per day, the authors went on to say, would have approximately the same effect on reducing cardiac events as a 50 % reduction in tobacco use, a 5% reduction in body mass index among obese adults or the use of statins to treat people at low or intermediate risk for CHD events. Furthermore, reducing dietary salt intakes by 3g per day would save $10 billion to $ 24 billion in annual health care costs.

ESC spokesperson Professor Giuseppe Mancia, from the University of Milano-Bicocca, St. Gerardo Hospital (Milan, Italy), said the annual health cost savings outlined in the study would be likely to prove a persuasive argument for both the EU and individual European governments.

Recent studies clearly show that salt reduction reduces cardiovascular deaths.4

Epidemiological studies have also firmly established that increased intakes of salt directly increase blood pressure. High salt intakes are believed to exert their detrimental effects by influencing fluid retention, which in turn increases blood pressure. But it's important for patients to appreciate that not all cardiovascular problems relating to salt are mediated through hypertension. Salt can have an adverse effect on cardiovascular health, even among people with normal blood pressure, said Ruschitzka.

Salt intakes across Europe are known to vary widely, ranging from 8.6 g of salt per day in the UK, to around 12 g salt in Croatia. Even the best intakes, however, are falling widely short of the ESC Clinical Practice Guidelines for the Management of Arterial Hypertension(2), based on WHO data, that recommend that only 5g of salt should be consumed per day. This amounts to just one teaspoonful.

While individuals may use salt sparingly at home, around 75 % of the salt we eat is already in the food we buy. This, says the ESC, underlines the need for legislation to lay down guidelines. The reality of international food production in Europe means that such public health initiatives need to be tackled on a European wide basis, rather than an individual country basis, said Ruschitzka.

Furthermore, added Mancia, concerted action is usually more effective. It has the advantage of preventing country to country inequalities and furthermore prevents the reinvention of the wheel in each individual country, he said.

But calls for legislation do not mean that physicians should stop their efforts to persuade patients to introduce individual changes in lifestyle. Patients, they stress, need to be taught about the importance of reducing salt in their cooking and also for the need to check food labels. People need to learn to appreciate that the salt contents can vary widely even in the same product. Take bread, for example. Recent research from Consensus Action on Salt and Health (a charity lobbying food manufacturers in the UK) has shown that the highest salt content was 3g salt per 100 g of bread, while the lowest was 0.7 g salt per 100g.

To improve cardiovascular health, salt reduction cannot be undertaken in isolation. It needs to be remembered that lifestyle measures such as smoking cessation, weight reduction, increased physical exercise, and eating plenty of fruit and vegetables are also important for reducing cardiovascular disease, said Mancia.

Salt will again be on the agenda with World Salt Awareness Week 2010 , which runs from February 1- 7 (3). The week is being run by World Action on Salt and Health (WASH), a global group that works with governments to highlight the need for widespread introduction of population based salt reduction strategies.

Much can be done to reduce salt intakes through public health policy, say WASH. They cite the success of Consensus Action on Salt and Health (CASH), launched in 1996 to encourage food manufacturing companies in the UK to make voluntary reductions in their salt content. Since the start of the policy salt intakes among UK adults (calculated from 24-hour urine samples) have fallen from 9.5 to 8.6 g per day.

In July 2009, WASH surveyed over 260 food products available around the world from food manufacturers such as KFC, McDonalds, Kellogg's, Nestle, Burger King and Subway, finding surprisingly wide spread variations. For example, Kellogg's All Bran for sale in France, Norway, Sweden and the Netherlands contains 1.30 g salt per 100 g compared to salt levels of 0.65 g per 100g for the product in the US. Such data underlines the urgent need to eradicate country to country inequalities, and bring everyone up to the highest possible standards.

The paper by Bibbins-Domingo and colleagues is an urgent call to action. Policy makers in the European Community need to implement public health interventions that result in reductions in salt intake now. Reducing the salt content of our unneccesarily oversalted ,processed food is an inexpensive, yet highly effective public health intervention that we can't afford to miss, concluded Ruschitzka.

Mental lapses signal Alzheimer's disease

Mon, 18 Jan 2010 13:42:59 PST

( from http://www.rxpgnews.com ) Older people who have "mental lapses," or times when their thinking seems disorganized or illogical or when they stare into space, may be more likely to have Alzheimer's disease than people who do not have these lapses, according to a study published in the January 19, 2010, print issue of Neurology, the medical journal of the American Academy of Neurology.

These mental lapses, also called cognitive fluctuations, are common in a type of dementia called dementia with Lewy bodies, but researchers previously did not know how frequently they occurred in people with Alzheimer's disease and, equally important, what effect fluctuations might have on their thinking abilities or assessment scores.

The study involved 511 people with an average age of 78. Researchers interviewed the participant and a family member, evaluated the participants for dementia and tested their memory and thinking skills.

People with three or four of the following symptoms met the criteria for having mental lapses:

Feeling drowsy or lethargic all the time or several times per day despite getting enough sleep the night before
Sleeping two or more hours before 7 p.m.
Having times when the person's flow of ideas seems disorganized, unclear, or not logical
Staring into space for long periods

A total of 12 percent of the people with dementia in the study had mental lapses. Of 216 people with very mild or mild dementia, 25 had mental lapses. Of the 295 people with no dementia, only two had mental lapses.

Those with mental lapses were 4.6 times more likely to have dementia than those without mental lapses. People with mental lapses also tended to have more severe Alzheimer's symptoms and perform worse on tests of memory and thinking skills than people who did not have lapses.

"When older people are evaluated for problems with their thinking and memory, doctors should consider also assessing them for these mental lapses," said senior study author James E. Galvin, MD, MPH, of Washington University School of Medicine in St. Louis, who is a member of the American Academy of Neurology.

Artificial muscle to help in blinking in patients with eyelid paralysis

Mon, 18 Jan 2010 12:44:59 PST

( from http://www.rxpgnews.com ) Surgeons from UC Davis Medical Center have demonstrated that artificial muscles can restore the ability of patients with facial paralysis to blink, a development that could benefit the thousands of people each year who no longer are able to close their eyelids due to combat-related injuries, stroke, nerve injury or facial surgery.

In addition, the technique, which uses a combination of electrode leads and silicon polymers, could be used to develop synthetic muscles to control other parts of the body. The new procedure is described in an article in the January-February issue of the Archives of Facial Plastic Surgery.

“This is the first-wave use of artificial muscle in any biological system,” said Travis Tollefson, a facial plastic surgeon in the UC Davis Department of Otolaryngology – Head and Neck Surgery. “But there are many ideas and concepts where this technology may play a role.”

In their study, Tollefson and his colleagues were seeking to develop the protocol and device design for human implantation of electroactive polymer artificial muscle (EPAM) to reproducibly create a long-lasting eyelid blink that will protect the eye and improve facial appearance. EPAM is an emerging technology that has the potential for use in rehabilitating facial movement in patients with paralysis. Electroactive polymers act like human muscles by expanding and contracting, based on variable voltage input levels.

For people with other types of paralysis, the use of artificial muscles could someday mean regaining the ability to smile or control the bladder. Reanimating faces is a natural first step in developing synthetic muscles to control other parts of the body, said UC Davis otolaryngologist Craig Senders.

“Facial muscles require relatively low forces, much less than required to move the fingers or flex an arm,” said Senders.

Blinking is an essential part of maintaining a healthy eye. The lid wipes the surface of the eye clean and spreads tears across the cornea. Without this lubrication, the eye is soon at risk of developing corneal ulcers that eventually can cause blindness.

Involuntary eye blinking is controlled by a cranial nerve. In most patients with permanent eyelid paralysis, this nerve has been injured due to an accident, stroke, or surgery to remove a facial tumor. Many have no other functioning nerves nearby that can be rerouted to close the eyelid. Others were born with Mobius syndrome, characterized by underdeveloped facial nerves. These patients are expressionless and can neither blink nor smile.

Eyelid paralysis currently is treated by one of two approaches. One is to transfer a muscle from the leg into face. However, this option requires six to10 hours of surgery, creates a second wound, and is not always suitable for elderly or medically fragile patients.

The other treatment involves suturing a small gold weight inside the eyelid. The weight closes the eye with the help of gravity. Though successful in more than 90 percent of patients, the resulting eye blink is slower than normal and cannot be synchronized with the opposite eye. Some patients also have difficulty keeping the weighted lid closed when lying down to sleep. In the United States, an estimated 3,000 to 5,000 patients undergo this surgery every year and therefore might benefit from an alternative treatment.

For their study, Senders and Tollefson used a novel alternative method for eyelid rehabilitation in permanent facial paralysis. They used an eyelid sling mechanism to create an eyelid blink when actuated by an artificial muscle. Using cadavers, the surgeons inserted a sling made of muscle fascia or implantable fabric around the eye. Small titanium screws secured the eyelid sling to the small bones of the eye. The sling was attached to a battery-operated artificial muscle. The artificial muscle device and battery were into a natural hollow or fossa at the temple to disguise its presence.

Senders and Tollefson found that the force and stroke required to close the eyelid with the sling were well within the attainable range of the artificial muscle. This capability may allow the creation of a realistic and functional eyelid blink that is symmetric and synchronous with the normal, functioning blink. A similar system also could give children born with facial paralysis a smile.

The three-layered artificial muscle was developed by engineers at SRI International of Palo Alto, Calif., in the 1990s. Inside is a piece of soft acrylic or silicon layered with carbon grease. When a current is applied, electrostatic attractions causes the outer layers to pull together and squash the soft center. This motion expands the artificial muscle. The muscle contracts when the charge is removed and flattens the shape of the sling, blinking the eye. When the charge is reactivated, the muscle relaxes and the soft center reverts back to its original shape.

“The amount of force and movement the artificial muscle generates is very similar to natural muscle,” Tollefson said. An implanted battery source similar to those used in cochlear implants would power the artificial muscle.

For patients who have one functioning eyelid, a sensor wire threaded over the normal eyelid could detect the natural blink impulse and fire the artificial muscle at the same time. Among patients lacking control of either eyelid, an electronic pacemaker similar to those used to regulate heartbeats could blink the eye at a steady rate, and be deactivated by a magnetic switch.

The researchers are now refining the technique on cadavers and animal modes. They estimate the technology will be available for patients within the next five years.

New visual pathway linked to photophobia in migraines identified

Sun, 10 Jan 2010 14:42:07 PST

( from http://www.rxpgnews.com ) Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear.

Now scientists at Beth Israel Deaconess Medical Center (BIDMC) have identified a new visual pathway that underlies sensitivity to light during migraine in both blind individuals and in individuals with normal eyesight. The findings, which appear today in the Advance On-line issue of Nature Neuroscience, help explain the mechanism behind this widespread condition.

A one-sided, throbbing headache associated with a number of symptoms, including nausea, vomiting, and fatigue, migraines are notoriously debilitating and surprisingly widespread, affecting more than 30 million individuals in the U.S. alone. Migraine pain is believed to develop when the meninges, the system of membranes surrounding the brain and central nervous system, becomes irritated, which stimulates pain receptors and triggers a series of events that lead to the prolonged activation of groups of sensory neurons.

"This explains the throbbing headache and accompanying scalp and neck-muscle tenderness experienced by many migraine patients," explains the study's senior author Rami Burstein, PhD, Professor of Anesthesia and Critical Care Medicine at BIDMC and Harvard Medical School.

In addition, for reasons that were unknown, nearly 85 percent of migraine patients are also extremely sensitive to light, a condition known as photophobia.

"Migraine patients may wear sunglasses, even at night," he notes, adding that the dimmest of light can make migraine pain worse. Extremely disabling, photophobia prevents patients from such routine activities as reading, writing, working or driving.

It was the observation that even blind individuals who suffer from migraines were experiencing photophobia that led Burstein and first author Rodrigo Noseda, PhD, to hypothesize that signals transmitted from the retina via the optic nerve were somehow triggering the intensification of pain.

The investigators studied two groups of blind individuals who suffer migraine headaches. Patients in the first group were totally blind due to eye diseases such as retinal cancer and glaucoma; they were unable to see images or to sense light and therefore could not maintain normal sleep-wake cycles. Patients in the second group were legally blind due to retinal degenerative diseases such as retinitis pigmentosa; although they were unable to perceive images, they could detect the presence of light and maintain normal sleep-wake cycles.

"While the patients in the first group did not experience any worsening of their headaches from light exposure, the patients in the second group clearly described intensified pain when they were exposed to light, in particular blue or gray wavelengths," explains Burstein. "This suggested to us that the mechanism of photophobia must involve the optic nerve, because in totally blind individuals, the optic nerve does not carry light signals to the brain.

"We also suspected that a group of recently discovered retinal cells containing melanopsin photoreceptors [which help control biological functions including sleep and wakefulness] is critically involved in this process, because these are the only functioning light receptors left among patients who are legally blind."

The scientists took these ideas to the laboratory, where they performed a series of experiments in an animal model of migraine. After injecting dyes into the eye, they traced the path of the melanopsin retinal cells through the optic nerve to the brain, where they found a group of neurons that become electrically active during migraine.

"When small electrodes were inserted into these 'migraine neurons,' we discovered that light was triggering a flow of electrical signals that was converging on these very cells," says Burstein. "This increased their activity within seconds."

And even when the light was removed, he notes, these neurons remained activated. "This helps explain why patients say that their headache intensifies within seconds after exposure to light, and improves 20 to 30 minutes after being in the dark."

The discovery of this pathway provides scientists with a new avenue to follow in working to address the problem of photophobia.

"Clinically, this research sets the stage for identifying ways to block the pathway so that migraine patients can endure light without pain," adds Burstein.

Dystroglycan- potential therapy to treat congenital muscular dystrophies

Fri, 01 Jan 2010 11:15:13 PST

( from http://www.rxpgnews.com ) With the discovery of a new type of chemical modification on an important muscle protein, a University of Iowa study improves understanding of certain muscular dystrophies and could potentially lead to new treatments for the conditions.

The findings, which appear in the Jan. 1, 2010, issue of the journal Science, may also have implications for detecting metastasizing cancer cells.

After they are initially made, most proteins are modified through the addition of sugar chains, fats or other chemical groups. These modifications can completely change how a protein works and where it is located in the body. Disruption of these modifications can alter protein function, too, and can lead to disease.

The UI study focused on dystroglycan, a cell membrane protein that is disrupted in many forms of muscular dystrophy. Normal dystroglycan is modified with a unique sugar chain that allows the protein to "glue" muscle membranes to the basal lamina -- a tough layer of extracellular proteins. This arrangement reinforces the fragile muscle membrane and prevents small tears that occur naturally from expanding and damaging the membrane.

Recent work, including studies by the UI team, show that disrupting dystroglycan's ability to attach to the basal lamina causes congenital muscular dystrophies and also leads to cancer progression in epithelial cell cancer. In these conditions, the dystroglycan sugar chain is incompletely or incorrectly assembled and the dystroglycan cannot bind tightly to laminin.

"Dystroglycan is a complex and unusual glycoprotein. It is heavily covered with many types of sugars. We wanted to know the shape and make up of the unique sugar chain that allows dystroglycan to bind to laminin," said study leader Kevin Campbell, Ph.D., professor and head of molecular physiology and biophysics at the UI Roy J. and Lucille A. Carver College of Medicine and a Howard Hughes Medical Institute investigator.

Lead study author Takako Yoshida-Moriguchi, Ph.D., a postdoctoral researcher in Campbell's lab, used a combination of biochemical methods and chemical and structure analysis to determine that a critical link within the sugar chain involves a phosphate group. This type of link is found in yeast and fungi but has not previously been found in higher organisms like mammals.

"This phosphate link is very unusual, which may explain why the actual structure of dystroglycan's laminin-binding sugar chain has been a mystery for many years despite the efforts of numerous research teams," said Campbell, who also holds the Roy J. Carver Chair of Physiology and Biophysics. "The findings help explain what is happening in congenital muscular dystrophies where the dystroglycan sugar chain is truncated and ends at the phosphate. The bare phosphate does not bind laminin; it has to be further modified."

Several enzymes are involved in building the sugar chain beyond the phosphate, and mutations in these enzymes are the cause of congenital muscular dystrophies.

"If we can discover the entire structure and make up of the sugar chain beyond the phosphate link, we might be able to target some of the enzymes involved in building the sugar chain, and thus, develop therapies to treat congenital muscular dystrophies," Campbell said.

In certain cancer cells, one of these enzymes, known as LARGE, also is suppressed. Campbell speculated that loss of LARGE activity produces dystroglycan that is unable to interact with the basal lamina, which makes the cancer cells more mobile and allows them to escape into the bloodstream. The study's findings could lead to new methods for tracking metastasizing cancer cells.

Members of the European Parliament discuss achieving heart health in Europe

Wed, 09 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Brussels, 9 December 2009 - Members of the European Parliament Heart Group (MEP HG) meet today, in Brussels, with the Cardiology profession and representatives of national Heart Foundations to evaluate the achievements at EU level in combating Cardiovascular Disease (CVD), and to reveal the need for further action.

With the title 'Achieving Heart Health in Europe: Why the European Parliament Matters', the meeting is the first since the European elections in June this year. During the 2004-2009 term, the MEP Heart Group was the largest forum on health in the European Parliament. The group resumes now its activities which endeavour to raise heart health as a priority on the EU political agenda. CVD is the number one killer in Europe, accounting for over 2 million deaths in the EU alone and costing the EU over 190 billion Euros each year. (1)

Mr Dirk Sterckx MEP, Co-chair of the MEP HG, believes that the European Union has a major role to play in fostering heart health promotion and developing wide-ranging prevention strategies. The European Parliament has set the example with the 2007 Resolution on action to tackle cardiovascular disease (2). However, the recent declining trends in CVD deaths in Europe are now slowing down. This is very worrying; it represents an alarm call to the European Commission and the Council.

The EU cannot turn its back on CVD, agrees Linda McAvan MEP, Co-chair of the MEP HG. Evidence does exist that prevention brings significant health gains. It is therefore the task of decision makers at European and national level to ensure that effective policies supporting prevention are put in place.

CVD is currently THE public health challenge in Europe, says Prof. Simon Capewell, Professor of Clinical Epidemiology, Liverpool University, UK. There are widening gaps both between and within Member States. CVD mortality rates have been decreasing in the past 30 years but they are now flattening. This is extremely frustrating because 80% of premature CVD deaths can be prevented by tackling the major risk factors, diet and smoking. A comprehensive European heart health strategy addressing health promotion and disease prevention is a moral responsibility for policymakers.

Significant policy developments addressing cardiovascular disease have taken place in Europe in the last decade. These include the Council Conclusions to promote heart health (adopted in 2004), the European Heart Health Charter (launched in 2007), and the European Parliament Resolution on action to tackle cardiovascular disease (adopted with a large majority in July 2007). Despite this, a tangible European strategy to address CVD is still non-existent. The MEP HG is calling for action from the European Commission and Member States to fill the gap. We urgently need to address what should be the Number 1 public health priority in Europe.

UC Berkeley social scientists build case for 'survival of the kindest'

Tue, 08 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Researchers at UC Berkeley are challenging long-held beliefs that human beings are wired to be selfish. In a wide range of studies, social scientists are amassing a growing body of evidence to show we are evolving to become more compassionate and collaborative in our quest to survive and thrive.

In contrast to every man for himself interpretations of Charles Darwin's theory of evolution by natural selection, Dacher Keltner, a UC Berkeley psychologist and author of Born to be Good: The Science of a Meaningful Life, and his fellow social scientists are building the case that humans are successful as a species precisely because of our nurturing, altruistic and compassionate traits.

They call it survival of the kindest.

Because of our very vulnerable offspring, the fundamental task for human survival and gene replication is to take care of others, said Keltner, co-director of UC Berkeley's Greater Good Science Center. Human beings have survived as a species because we have evolved the capacities to care for those in need and to cooperate. As Darwin long ago surmised, sympathy is our strongest instinct.

Keltner's team is looking into how the human capacity to care and cooperate is wired into particular regions of the brain and nervous system. One recent study found compelling evidence that many of us are genetically predisposed to be empathetic.

The study, led by UC Berkeley graduate student Laura Saslow and Sarina Rodrigues of Oregon State University, found that people with a particular variation of the oxytocin gene receptor are more adept at reading the emotional state of others, and get less stressed out under tense circumstances.

Informally known as the cuddle hormone, oxytocin is secreted into the bloodstream and the brain, where it promotes social interaction, nurturing and romantic love, among other functions.

The tendency to be more empathetic may be influenced by a single gene, Rodrigues said.

While studies show that bonding and making social connections can make for a healthier, more meaningful life, the larger question some UC Berkeley researchers are asking is, How do these traits ensure our survival and raise our status among our peers?

One answer, according to UC Berkeley social psychologist and sociologist Robb Willer, is that the more generous we are, the more respect and influence we wield. In one recent study, Willer and his team gave participants each a modest amount of cash and directed them to play games of varying complexity that would benefit the public good. The results, published in the journal American Sociological Review, showed that participants who acted more generously received more gifts, respect and cooperation from their peers and wielded more influence over them.

The findings suggest that anyone who acts only in his or her narrow self-interest will be shunned, disrespected, even hated, Willer said. But those who behave generously with others are held in high esteem by their peers and thus rise in status.

Given how much is to be gained through generosity, social scientists increasingly wonder less why people are ever generous and more why they are ever selfish, he added.

Such results validate the findings of such positive psychology pioneers as Martin Seligman, a professor at the University of Pennsylvania whose research in the early 1990s shifted away from mental illness and dysfunction, delving instead into the mysteries of human resilience and optimism.

While much of the positive psychology being studied around the nation is focused on personal fulfillment and happiness, UC Berkeley researchers have narrowed their investigation into how it contributes to the greater societal good.

One outcome is the campus's Greater Good Science Center, a West Coast magnet for research on gratitude, compassion, altruism, awe and positive parenting, whose benefactors include the Metanexus Institute, Tom and Ruth Ann Hornaday and the Quality of Life Foundation.

Christine Carter, executive director of the Greater Good Science Center, is creator of the Science for Raising Happy Kids Web site, whose goal, among other things, is to assist in and promote the rearing of emotionally literate children. Carter translates rigorous research into practical parenting advice. She says many parents are turning away from materialistic or competitive activities, and rethinking what will bring their families true happiness and well-being.

I've found that parents who start consciously cultivating gratitude and generosity in their children quickly see how much happier and more resilient their children become, said Carter, author of Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents which will be in bookstores in February 2010. What is often surprising to parents is how much happier they themselves also become.

As for college-goers, UC Berkeley psychologist Rodolfo Mendoza-Denton has found that cross-racial and cross-ethnic friendships can improve the social and academic experience on campuses. In one set of findings, published in the Journal of Personality and Social Psychology, he found that the cortisol levels of both white and Latino students dropped as they got to know each over a series of one-on-one get-togethers. Cortisol is a hormone triggered by stress and anxiety.

Meanwhile, in their investigation of the neurobiological roots of positive emotions, Keltner and his team are zeroing in on the aforementioned oxytocin as well as the vagus nerve, a uniquely mammalian system that connects to all the body's organs and regulates heart rate and breathing.

Both the vagus nerve and oxytocin play a role in communicating and calming. In one UC Berkeley study, for example, two people separated by a barrier took turns trying to communicate emotions to one another by touching one other through a hole in the barrier. For the most part, participants were able to successfully communicate sympathy, love and gratitude and even assuage major anxiety.

Researchers were able to see from activity in the threat response region of the brain that many of the female participants grew anxious as they waited to be touched. However, as soon as they felt a sympathetic touch, the vagus nerve was activated and oxytocin was released, calming them immediately.

Sympathy is indeed wired into our brains and bodies; and it spreads from one person to another through touch, Keltner said.

The same goes for smaller mammals. UC Berkeley psychologist Darlene Francis and Michael Meaney, a professor of biological psychiatry and neurology at McGill University, found that rat pups whose mothers licked, groomed and generally nurtured them showed reduced levels of stress hormones, including cortisol, and had generally more robust immune systems.

Overall, these and other findings at UC Berkeley challenge the assumption that nice guys finish last, and instead support the hypothesis that humans, if adequately nurtured and supported, tend to err on the side of compassion.

This new science of altruism and the physiological underpinnings of compassion is finally catching up with Darwin's observations nearly 130 years ago, that sympathy is our strongest instinct, Keltner said.

Migraine raises risk of most common form of stroke

Mon, 16 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Pooling results from 21 studies, involving 622,381 men and women, researchers at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

The risk for those with migraines is 2.3 times those without, according to calculations from the Johns Hopkins team, to be presented Nov. 16 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando. For those who experience aura, the sighting of flashing lights, zigzag lines and blurred side vision along with migraines, the risk of so-called ischemic stroke is 2.5 times higher, and in women, 2.9 times as high.

Study participants, mostly in North America and Europe, were between the ages 18 and 70, and none had suffered a stroke prior to enrollment.

Senior study investigator and cardiologist Saman Nazarian, M.D., says the team's latest analysis, believed to be the largest study of its kind on the topic, reinforces the relationship between migraine and stroke while correcting some discrepancies in previous analyses. For examples, a smaller combination study in 2005 by researchers in Montreal showed a bare doubling of risk, yet mixed together different mathematical measures of risk, while the Hopkins study kept them separate, pooling together only like measures. As well, another half dozen recent and smaller studies from Harvard University yielded mixed results, some showing a link between migraines and ischemic stroke, while one did not show a tie-in.

Nazarian says that while nearly 1,800 articles have been written about the relationship between migraine and ischemic stroke, the Hopkins review was more selective, combining only studies with similar designs and similar groups of people, and more comprehensive, including analysis of unpublished data.

Identifying people at highest risk is crucial to preventing disabling strokes, says Nazarian, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. Based on this data, physicians should consider addressing stroke risk factors in patients with a history or signs of light flashes and blurry vision associated with severe headaches.

Prevention and treatment options for migraine, he says, range from smoking cessation and taking anti-blood pressure or blood-thinning medications, such as aspirin. In women with migraines, stopping use of oral contraceptives or hormone replacement therapy may be recommended.

Such widespread use of hormone-controlling drugs is what Nazarian says may explain why women with migraines have such high risk of ischemic stroke. Contraceptives and other estrogen therapies are both known to contribute to long-term risk factors for cardiovascular diseases and stroke, such as high blood pressure and increased reactivity by clot-forming blood platelets.

Nazarian says the researchers' next steps are to evaluate if preventive therapies, especially aspirin, offset the risk of ischemic stroke in people with migraines.

Women and cardiovascular health conference to highlight need for gender-specific research

Fri, 30 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The 'Red Alert for Women's Hearts' conference, taking place on 5 November 2009, at the European Heart House, Sophia Antipolis, France, will address the subject of Women and CVD. The conference is jointly organised by the European Society of Cardiology (ESC) and European Heart Network (EHN), as part of Work Package 6 of the EuroHeart project (1).

Heart disease and stroke are the leading causes of death for women worldwide, killing more than 8.6 million, more than the total number who die from cancer, tuberculosis, HIV/AIDS and malaria combined.

However, the risk for women is largely under-estimated, by both the general population and often by the medical profession itself. This is due to the fact that women usually suffer from CVD 10 years later in their life than men: the risk increases after menopause, partly because of ovarian hormone deficiency that favours hypertension, diabetes, hyperlipidemia, central obesity and the metabolic syndrome.

In the report that will be presented at the conference (2), Professor Stramba Badiale, MD, PhD at the Department of Rehabilitation Medicine, IRCCS Istituto Auxologico Italiano, finds that women are underrepresented in cardiovascular research in Europe. In the 62 randomized clinical trials published between 2006 and July 2009, only 33.5% of enrolled participants were women, he says.

This underrepresentation is particularly noticeable in the fields of cholesterol-lowering therapy, ischaemic heart disease and heart failure.

Professor Roberto Ferrari, President of the ESC says: With regard to cardiovascular health, we do lack data for women simply because the majority of clinical trials are conducted on men. It is important to have special clinical trials conducted only on women because their cardiovascular pathology is, at least at some point during their lives, different from that of men and it is incorrect to apply data derived from studies on men to women.

Another finding of the report that supports the conference programme is that only 50% of the clinical trials conducted in the last three years which enrolled both men and women reported the analysis of the results by gender.

Susanne Logstrup, director of the EHN, regrets that, as a result, safety and efficacy of several drugs have been evaluated predominantly in male populations.

Professor Stramba-Badiale is hopeful that the report and the conference will encourage new practice amongst the research community, with a systematic enrolment of women in clinical trials. New data should improve the clinical management of CVD and, in the future, develop possible gender specific diagnostic and therapeutic strategies, he says.

The research is part of the EuroHeart project, which aims at defining areas of policies and public health interventions which can contribute to prevent avoidable deaths and disability across Europe. It is led by the ESC, in partnership with the EHN, and is co-funded by the European Commission Public Health Programme 2003-2008.

The 'Red alert for women's hearts' conference will systematically review the place of women in all aspects of scientific literature, whether clinical trials, guidelines, medical curriculum or regulatory processes.

More than 60 awareness campaigns addressing the particular issue of women and cardiovascular diseases have been organised in the last 20 years in the 19 countries participating in WP 6 of the EuroHeart project. This is evidence that national Heart Foundations and Cardiac Societies have long been aware of the urgent need to promote the issue amongst the female population and health professionals. The results of campaigns showed an increased awareness that cardiovascular diseases are the leading cause of death for women. Despite this, gender-specific training for cardiologists is still lacking in the majority of European countries.

The objective of this conference is to create a series of recommendations for policy makers, research funding agencies and regulatory entities, at both national and EU level.

Red Alert for Women's Hearts is also the opportunity to look at how countries address the lack of information of the population and of health professionals, by giving an overview of past campaigns and their impact, country by country.

NHLBI to convene symposium on cardiovascular regenerative medicine

Thu, 08 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) With advancements in the field of stem cell research accelerating, the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) will hold its third Symposium on Cardiovascular Regenerative Medicine to review the latest findings in the field and examine future directions. The symposium will include a discussion on ways to move promising findings in the laboratory into clinical trials, in hopes of speeding stem cell-related treatments to patients.

The event will be held Oct. 14 -15 at the Natcher Conference Center on the NIH campus in Bethesda, Md.

This symposium will help us move forward to spur new scientific efforts that will advance the field of cardiovascular stem cell research, said NHLBI Director Elizabeth G. Nabel, M.D., who will deliver the keynote address on the NHLBI Roadmap for stem cell research. With more than 16 million Americans living with damage to heart muscles or blood vessels due to heart attacks, this area of research holds great promise to improve lives.

Nabel noted that the theme of the symposium coincides with the NHLBI's recent funding of stem cell research projects under the American Recovery and Reinvestment Act. The NHLBI has made stem cell research a Signature Project under the Recovery Act and is putting a priority on funding research that could lead to the development of regenerative treatment for heart, lung, and blood diseases, added Nabel.

Some symposium sessions will focus on cardiac development and how epithelial cells transform into mesenchymal cells, a process which is related to organ development and some fibrotic diseases. Another session will review recent advances, and future potential, for embryonic stem cells and induced pluripotent stem (iPS) cells that could be used for cell therapy in the heart. IPS cells are artificially derived stem cells that can give rise to any fetal or adult cell type. The symposium will also feature a series of talks related to the NHLBI's newly launched Progenitor Cell Biology Consortium, whose 18 teams of scientists are developing the field of stem and progenitor cell tools and therapies.

Stem cell experts from the United States, Canada, the Netherlands, Spain, and Sweden are scheduled to speak, and the symposium will also include a number of poster sessions. Among the highlights of the scheduled list of speakers:

George Q. Daley, M.D., Ph.D., Harvard Medical School/Children's Hospital of Boston. Modeling Blood Disease with iPS Cells. Wednesday, Oct. 14, 8:35 a.m. Daley will discuss ways to use induced pluripotent stem cells to model blood disease. This line of research could provide new targets for drug therapy.

Bernhard Kuhn, M.D., Harvard Medical School/Children's Hospital of Boston, Stimulating Myocardial Regeneration with Cardiomyocyte Proliferation Factors. Thursday, Oct. 15, 11 a.m. Kuhn will discuss ways to recruit existing heart tissue into producing new cells, which could help repair heart damage following heart attack or stroke.

Jonas Frisen, M.D., Ph.D., Karolinska Institute, Sweden, Cardiomyocyte Renewal in Humans. Thursday, Oct. 15, 11:20 a.m. Frisen will discuss his work using residual atmospheric radiation remaining from aboveground atomic bomb testing in the 1960s from sites around the world to determine the age of cardiomyocytes, or cardiac muscle cells, in humans. Until now, it has been difficult to determine the age of cells in the heart, so there was little information about whether new tissue was being generated in the heart. Frisen's research suggests that a tiny fraction of tissue cells within the heart are new cardiomyocytes, a finding which could lead to new ways to encourage more such tissue growth.

Life and death in the living brain

Mon, 10 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Like clockwork, brain regions in many songbird species expand and shrink seasonally in response to hormones. Now, for the first time, University of Washington neurobiologists have interrupted this natural annual remodeling of the brain and have shown that there is a direct link between the death of old neurons and their replacement by newly born ones in a living vertebrate.

The scientists introduced a chemical into one side of sparrow brains in an area that helps control singing behavior to halt apoptosis, a cell suicide program. Twenty days after introduction of the hormones the researchers found that there were 48 percent fewer new neurons than there were in the side of the brain that did not receive the cell suicide inhibitor.

This is the first demonstration that if you decrease apoptosis you also decrease the number of new brain cells in a live animal. The next step is to understand this process at the molecular level, said Eliot Brenowitz, a UW professor of psychology and biology and co-author of a new study. His co-author is Christopher Thompson, who earned his doctorate at the UW and is now at the Free University of Berlin.

The seasonal hormonal drop in birds may mimic what is an age-related drop in human hormone levels. Here we have a bird model that is natural and maybe similar genes have a similar function in humans with degenerative diseases such as Alzheimer's and Parkinson's, as well as strokes, which are associated with neuron death.

The research involved Gambel's white-crowned sparrows, a songbird subspecies that winters in California and migrates to Alaska in the spring and summer to breed and raise its young. The sparrow's brain regions, including one called the HVC, which control learned song behavior in males, expand and shrink seasonally. Thompson and Brenowitz previously found that neurons in the HVC begin dying within four days hours after the steroid hormone testosterone is withdrawn from the bird's brains. Thousands of neurons died over this time.

In the new work, the UW researchers received federal and state permission to capture 10 of the sparrows in Eastern Washington at the end of the breeding season. After housing the birds for three months, they castrated the sparrows and then artificially brought them to breeding condition by implanting testosterone and housing them under the same long-day lighting conditions that they would naturally be exposed to in Alaska. This induced full growth of the song control system in the birds' brains.

Next the researchers transitioned the birds to a non-breeding condition by reducing the amount of light they were exposed to and removing the implanted testosterone. They infused the HVC on one side of the brain with chemicals, called caspase inhibitors, that block apoptosis, and two chemical markers that highlight mature and new neurons. Twenty days later the birds were euthanized and sections of their brains were examined under a microscope.

These procedures were done with the approval of the UW's Institutional Animal Care and Use Committee and the National Institute of Mental Health. The latter funded the research.

The HVC straddles both hemispheres of the brain but the two sides are not directly connected. When Thompson counted the number of newly born neurons that had migrated to the HVC, he found only several hundred of them among the hundreds of thousands of mature neurons he examined. And there were nearly half the number of new neurons in the side of the HVC where brain cell death was inhibited compared with the other, untreated side of the HVC. This shows there is some direct link between the death of old neurons and the addition of new cells that were born elsewhere in the brain and have migrated, said Brenowitz. What allows new cells to be incorporated into the brain is the big question. This is particularly true on a molecular level where we want to know what is the connection between cell death and neurogenesis and which genes are responsible.

Salamanders can regenerate damaged lungs

Sat, 08 Aug 2009 14:19:39 PST

( from http://www.rxpgnews.com ) The salamander is a super hero of regeneration, able to replace lost limbs, damaged lungs, sliced spinal cord - even bits of lopped-off brain.

But it turns out that this remarkable ability isn't so mysterious after all - suggesting that researchers could learn how to replicate it in people.

Scientists had long credited the diminutive amphibious creature's outsized capabilities to 'pluripotent' cells that, like human embryonic stem cells, have the uncanny ability to morph into whatever appendage, organ or tissue happens to be needed or is due for a replacement.

But a team of seven researchers, including a University of Florida - zoologist, debunk that notion.

Based on experiments on genetically modified axolotl salamanders, the researchers have shown that cells from the salamander's different tissues retain the 'memory' of those tissues when they regenerate, contributing with few exceptions only to the same type of tissue from where they came.

Standard mammal stem cells operate the same way, albeit with far less dramatic results - they can heal wounds or knit bone together, but not regenerate a limb or rebuild a spinal cord.

What's exciting about the new findings is they suggest that harnessing the salamander's regenerative wonders is at least within the realm of possibility for human medical science.

Also, the salamanders heal perfectly, without any scars whatsoever, another ability people would like to learn how to mimic, said Malcolm Maden, professor of biology and author of the paper.

Axolotl salamanders, originally native to only one lake in central Mexico, are evolutionary oddities that become sexually reproducing adults while still in their larval stage.

When an axolotl loses, for example, a leg, a small bump called a blastema forms over the injury. It takes only about three weeks for this blastema to transform into a new, fully functioning replacement leg - not long considering these animals can live 12 or more years.

These findings appeared in the Thursday edition of Nature.

Smoking associated with rapid progression of multiple sclerosis

Mon, 13 Jul 2009 15:32:03 PST

( from http://www.rxpgnews.com ) Patients with multiple sclerosis who smoke appear to experience a more rapid progression of their disease, according to a report in the July issue of Archives of Neurology, one of the JAMA/Archives journals.

Cigarette smokers are at higher risk of developing multiple sclerosis (MS), according to background information in the article. However, the effect of smoking on the progression of MS remains uncertain.

Brian C. Healy, Ph.D., of Brigham and Women's Hospital, Harvard Medical School and Massachusetts General Hospital, Boston, and colleagues studied 1,465 patients with MS who visited a referral center between February 2006 and August 2007. Participants had an average age of 42 and had MS for an average of 9.4 years. Their progression was assessed by clinical characteristics as well as by magnetic resonance imaging (MRI) over an average of 3.29 years.

A total of 780 (53.2 percent) of the patients had never smoked, 428 (29.2 percent) had smoked in the past and 257 (17.5 percent) were current smokers. During follow-up, seven never-smokers began smoking and 57 current smokers quit. Current smokers had significantly more severe disease at the beginning of the study in terms of scores on disability scales and also in the analysis of MRI factors. Current smokers were also more likely to have primary progressive MS, characterized by a steady decline, rather than relapsing-remitting MS (involving alternating periods of attacks and symptom-free periods).

A group of 891 patients was assessed over time to evaluate the rate of conversion from relapsing-remitting MS to secondary progressive MS (steady decline that develops after a period of relapsing-remitting symptoms). During an average of 3.34 years, 72 patients (20 of 154 smokers, 20 of 237 ex-smokers, and 32 of 500 never-smokers) experienced this progression. "The conversion from relapsing-remitting MS to secondary progressive MS occurred faster in current smokers compared with never-smokers but was similar in ex-smokers and never-smokers," the authors write.

An adverse effect of smoking on the progression of MS would be consistent with previous research, the authors note. Components of cigarette smoke are known to have toxic effects on brain and neural tissue; for example, cyanides, which have been associated with the destruction of nerve cells' myelin coating (a characteristic feature of MS) in animals. "Other chemicals in smoke (e.g., nicotine) can compromise the blood-brain barrier or have immunomodulatory effects," the authors write. "Cigarette smoke increases the frequency and duration of respiratory infections, which have been linked to risk of MS and to the occurrence of MS relapses."

"In conclusion, the results of this large and in part prospective investigation support the hypothesis that cigarette smoking has an adverse effect on progression of MS as measured by clinical and MRI outcomes," they conclude. "Although causality remains to be proved, these findings suggest that patients with MS who quit smoking may not only reduce their risk of smoking-related diseases but also delay the progression of MS."

New research to reduce drug side-effects

Fri, 10 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) They are a group of drugs which millions of people rely on to keep pain at bay but they can have unwanted side-effects which are sometimes more serious than the original health problem. Now scientists at The University of Nottingham are taking part in the largest-ever study on the safety of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) that has ever been performed.

The project is called SOS (Safety Of non-Steroidal anti-inflammatory drugs) and will study the medical information of 35 million people in Europe to assess the incidence and nature of harmful side-effects on the cardiovascular and gastrointestinal systems of patients. It's hoped the results will lead to better guidance for doctors on how to balance the advantages of prescribing the drugs with the associated risks of heart and digestive problems.

NSAIDS are widely used in medicine for treating pain, inflammation and degenerative diseases like arthritis. The most commonly-used are aspirin and ibuprofen. But their use is associated with an increased risk of minor and serious gastrointestinal complications. It's estimated that there are thousands of these cases in the European Union every year. Prompted by these problems, a new class of NSAIDS called 'Coxibs' have been developed to reduce the risk of this type of side-effect, but the use of these new drugs has since been linked with an increased risk of heart problems such as heart attack and stroke.

Clinicians and scientists now agree that the risk of stomach problems has to be balanced against the risk of cardiovascular interference. Both risks may differ in one person and for the 30 different types of NSAIDS available in the EU. Up to now research studies have been too small to be effective in terms of providing decision models for doctors and drug regulators but it's hoped this new large survey will result in a much more accurate prescription method to minimize drug-related harm.

Over the next two and a half years, published literature on previous clinical trials and observational studies will be scrutinized to identify any methodological inconsistencies and knowledge gaps and this information will be used to design and carry out an EU-wide observational study. This study will be the biggest of its kind ever undertaken in this field. It will include data from more than 35 million Europeans, taken from existing healthcare databases in the UK, the Netherlands, Germany and Italy. The researchers will use the data to create a variety of decision models to help doctors prescribe the most suitable type of NSAID for a particular patient and lower the risk of unwanted gastrointestinal or cardiovascular side-effects.

The University of Nottingham is working with ten other leading European research institutions on the three-year project which is being funded with a 2.8 million Euros grant from the EC's 7th Framework Programme. Fundamental to the project is QResearch, a not-for-profit partnership between The University of Nottingham and leading primary care system supplier EMIS, which uses data collected over the past 17 years.

Professor of Clinical Epidemiology and General Practice, Julia Hippisley-Cox, who founded QResearch, said: The SOS project will help quantify and compare the risks of different NSAIDs based on an individual's profile and should help lead patients and doctors make better decisions regarding treatment options.

New research to reduce drug side-effects

Fri, 10 Jul 2009 04:00:00 PST

EUROPACE raises remote monitoring profile

Sun, 21 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Moving to a more continuous follow-up approach would have the tremendous advantages of enhancing patient safety, decreasing physician and nurse work load, and allowing health staff to focus on medical emergencies, urged Professor Angelo Auricchio, from the European Heart Rhythm Association (EHRA) and official spokesperson of the European Society of Cardiology (ESC), adding that such systems may have the additional advantage of being more cost effective for health care providers.

Currently only around 1 % of patients in Europe with implantable cardiac devices are being monitored with remote devices, the majority are still being followed up by routine face to face clinic visits. Despite wide availability of remote monitoring in many European countries, few countries offer patients such systems. Even in countries that have introduced remote monitoring there are widespread disparities between centres, added Professor Auricchio, who works at the Cardiocentre Ticino (Lugano, Switzerland).

Cardiovascular implantable electronic devices (CIEDs) - which include cardiac pacemakers, implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy (CRT) devices, implantable cardiovascular monitors and implantable loop recorders - have now been developed with numerous programmable features allowing for storage of substantial amounts of diagnostic information.

The European Heart Rhythm Association (EHRA) and Heart Rhythm Society (HRS) expert consensus on monitoring of cardiovascular electronic devices, published last year, estimated that in 2006 approximately 250,000 pacemakers and 50,000 ICDs were implanted in Europe (1). The numbers implanted are estimated to be increasing by 5 to 10 % per year. What has become increasingly apparent, explained Professor Auricchio, is that once the device has been implanted, it needs to be followed up effectively to allow it to work efficiently.

This means that more than two million follow-up encounters with device patients are now needed in Europe each year, which is pushing the health care system to breaking point. Services are so overstretched by routine follow ups that they do not have much spare capacity to deal with emergencies when they come in, said Professor Auricchio.

The solution, suggests Professor Auricchio, is to increase the number of devices that can be interrogated remotely. Technology is available to download data related to device function, arrhythmia frequency, cardiovascular hemodynamic parameters and patient activity, from specific CIEDs and transmit the encrypted data using telephone technology to remote-secure monitoring centres. Here health care staff can both identify errant device behaviour, as well as patient's physiological response to a multitude of programmable therapies.

There are many advantages for remote devices. With the current face to face visit approach, physicians commonly first learn about critical device malfunctions and physiological changes when the patient returns to the clinic for a regular scheduled follow-up and manual device interrogation, which only takes place two to four times per year, depending on the patient status. With remote monitoring, problems can be identified immediately.

Continuous control of the device will permit detection of possible device dysfunction at a very early stage which allows us to take immediate action, thus improving patient safety significantly. said Professor Josep Brugada, President of the EHRA.

The European Heart Rhythm Association (EHRA) and Heart Rhythm Society (HRS) expert consensus document, which set out to determine what was needed to provide appropriate levels of care, concluded: Globalization and new Internet-based technologies for monitoring CIEDs are imposing new rules for patient data management and data-sharing. Competent authorities, national ministries of health, and patient organizations need to find practical and easy solutions for physicians to have rapid and complete access to device relevant data for delivering the most appropriate therapy.

The document adds that payers and regulators need to improve their recognition of the importance of CIED follow-up and develop adequate reimbursement strategies. There is no point investing in the device without comparable investment in the long-term follow-up and therapy! write the authors.

To understand the new models of reimbursement, EHRA in conjunction with Eucomed, now plans to survey the costs involved with in hospital CIED follow-up throughout Europe. In addition to the direct medical costs the survey will also include indirect costs, such as those involved in relatives accompanying patients on hospital visits. We need to have a better idea of the baseline costs so that we can start to understand the cost efficiency of introducing remote monitoring, said Professor Auricchio.

Brain protein BDNF might get you hooked on drugs, alcohol

Wed, 17 Jun 2009 14:23:59 PST

( from http://www.rxpgnews.com ) A brain protein can practically hook you on to drugs and alcohol by hijacking the normal functioning of its reward circuitry.

Researchers investigating this addiction 'switch' have now implicated a naturally occurring protein, a dose of which allowed them to get rats hooked with no drugs at all.

Chronic drug users, as noted by previous research, can experience an increase in this protein called BDNF - in the brain's reward circuitry.

Researchers noted that a single injection of BDNF made rats behave as though they were dependent on opiates -.

Though rats instinctively prefer certain smells, lighting and texture, these rats left their comfort zone in search of a fix.

'If we can understand how the brain's circuitry changes in association with drug abuse, it could potentially suggest ways to medically counteract the effects of dependency,' said Scott Steffensen, neuroscientist at Brigham Young University -.

He co-authored the study with two of his undergraduate students, one of his graduate students, and a team of researchers at the University of Toronto, said a BYU release.

'This work may reveal a mechanism that underlies drug addiction,' said study co-author Hector Vargas-Perez, a Toronto neurobiologist.

The study was published in Science.

Nerve cells permit brain to regenerate itself with Activin A

Tue, 09 Jun 2009 15:19:57 PST

( from http://www.rxpgnews.com ) Nerve cells in the brain produce an anti-inflammatory molecule that allows the brain to repair itself, according to a new study.

Inflammation is the response of body tissues to injury or irritation -- characterized by pain, swelling, redness and heat.

New findings throw light on how the brain heals itself and may change the way we think about treating chronic neuro-degenerative diseases like Parkinson's and Alzheimer's.

Discovery of the brain's capacity to regenerate is very recent. Neural stem cells were first discovered in the brain in the early 1990s, but it took scientists a further 10 years to show that they can regenerate nerve cells in the brain.

'Given that we now know regeneration can occur, we want to understand what drives it and what blocks it, particularly in diseases like Parkinson's and Alzheimer's,' said Bryce Vissel, neuroscientist at the Garvan Institute of Medical Research -, Australia.

'We triggered rapid neuro-degeneration in the brains of mice, and it was immediately followed by a very rapid regenerative response. We wanted to know why this response could occur so effectively after acute neuro-degeneration,' he said.

'On further investigation, we found high levels of a molecule known as Activin A whenever regeneration occurred. This was especially interesting because Activin A is released from nerve cells.

'Clearly Activin A was playing an important part in the regenerative process, so we triggered neuro-degeneration and at the same time blocked Activin A. The difference was dramatic.

'Regeneration all but ground to a halt,' Vissel said, according to a GIMR release.

'After these initial experiments, we thought that nerve cells may directly drive regeneration by releasing Activin A. We came to realise, however, that the main action of Activin A was to block inflammation in the brain after neuro-degeneration or injury,' said Vissel.

These findings were published online in the journal Stem Cells.

Patients with primary insomnia compensate with higher brain activation

Tue, 09 Jun 2009 06:11:41 PST

( from http://www.rxpgnews.com ) According to a research abstract that will be presented on Tuesday, June 9, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, patients suffering from chronic primary insomnia (PIs) have higher levels of brain activation compared to normal sleepers during a working memory test.

Results show that PIs use increased brain activation relative to good sleepers during the working memory task, particularly in areas responsible for visual-spatial attention and coordination of cognitive processes. This activation may explain how PIs maintain performance on the task despite their sleep difficulties. PIs also were found to have decreased activation in visual and motor areas, which may suggest that PIs have higher baseline activation in these regions relative to good sleepers.

According to principal investigator Henry Orff, MS, at the University of California in San Diego, Calif., these findings show that PIs, like individuals who are acutely sleep deprived, may be able to maintain performance on different tasks if they are able to compensate with increased brain activation.

"The good news is that patients with insomnia are probably able to function well in their daily lives and likely do not show significantly impaired performance," said Orff. "That said, patients may have to work, concentrate, and attend more to tasks than people who sleep well."

The study included 12 people with primary insomnia (six females) with an average age of 39.4 years, and nine good sleepers (four females) with an average age of 35.7 years.

Performance was compared between the two groups on a working memory task. Functional MRIs (FMRI) taken during the task also were compared. Behavioral performance was measured by reaction time for correct responses, number of correct responses, and number of errors committed.

The authors state that they do not know yet whether the findings suggest potential long-term implications for cognitive functioning in the future if primary insomnia is left untreated.

ESC Congress 2009: World's biggest cardiology meeting to be held in Barcelona

Wed, 03 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The European Society of Cardiology Congress 2009, the world's biggest international meeting in Cardiology will be held in Barcelona, Spain, from 29 August to 2 September.

The meeting, which is expected to attract over 30,000 delegates, will provide opportunities for education, hearing about the latest ground breaking research and gaining deeper insights into the most recent developments and innovations in the diagnosis, treatment and prevention of Cardiovascular Disease. Delegates will include clinicians, basic scientists, epidemiologists, nurses, technicians and key opinion leaders in the field.

The latest results will be presented in the Hotline and Clinical trials sessions, with unique opportunities for delegates to have face to face interactions with the investigators. In addition, over 4,000 abstracts, featuring original research, will be show cased at the meeting.

The educational aspects of the congress include the Meet and Read with the Experts sessions and the highly acclaimed FOCUS Sessions with live transmissions and practical take home messages, not to mention reports on the latest ESC guidelines.

Prevention and risk factor identification is the special theme of this year's meeting, giving an opportunity for doctors, scientists, governments and the general public to come together to discuss ways of decreasing the burden of cardiovascular disease on society. Altogether there are 50 separate sessions on prevention in the pre arranged programme, and a special abstract session focusing on prevention research.

Additional highlights of this year's meeting include new joint sessions with sister societies, such as the European Society of Medical Oncology, looking at issues such as the cardiovascular effects of oncology drugs, a full day on Congenital Heart Disease and a new joint session with the European Commission exploring the issues around how the European Commission supports cardiovascular Research. A strong component is dedicated to basic science, including a hotline session looking at the latest development, a translational bench to bedside track and a special abstract session.

For the first time ESC 2009 will offer the opportunity for delegates to gain hands-on image and device education from clinical experts. The sessions, which are being held in purpose-built classrooms, have been organised by our industry partners, will be available free on a first come, first served basis. There will also be over 80 satellite symposia and workshops featuring the latest innovations in pharma and equipment.

All this is set against the truly inspirational city of Barcelona, with is magnificent Gaudi architecture, superb cuisine and world famous football team.

ESC 2009 promises to be a true festival of cardiology. There will be opportunities for hearing about the latest ground breaking trials, continuing education, not to forget the unrivalled opportunity for networking with colleagues from all disciplines of cardiology and finding out about practices in different countries, says Professor Fausto Pinto, Chairperson of the Congress Programme committee.

Better treatment selection and improved therapies -- key to improving prognosis in acute HF

Sat, 30 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Today, acute heart failure represents the most common reason for hospitalisation in the over-65 population. Although hospital care improves symptoms in the first 24 hours after admission in around 50% of these patients, acute heart failure events still remain associated with a more than 50% mortality and rehospitalisation rate at 6-12 months. Indeed, says Professor Marco Metra from the Cardiology Department of the University of Brescia, Italy, it is the very rapid onset of symptoms and the need for urgent therapy which characterise the condition.1,2

Treatments in acute heart failure, he adds, have not undergone any great change in recent decades, despite the demand of heart failure's increasing prevalence and huge personal and public impact. Professor Metra said that treatments are still based on loop diuretics (furosemide), peripheral vasodilators (nitrates) and inotropic agents. Even the more recently approved treatments, he added, such as levosimendan in Europe and nesiritide in the USA, have been associated with uncertain effects on outcomes in randomised trials. So hospitalisations for acute heart failure are still associated with high mortality and rehospitalisation rates, he says. The burden is tremendous because of the large number of patients involved, their poor prognosis and the costs of the treatment.

In a presentation at Heart Failure Congress 2009 Professor Metra defined two major pathways along which this burden might be reduced and treatment improved:

* Better selection of treatments. To date, he said, therapy in acute heart failure has been administered with little attention to the clinical presentation of each patient. Guidelines on heart failure issued by the European Society of Cardiology in 2008 define heart failure as a heterogeneous condition and recommend that different therapies are used on the basis of clinical presentation; for example, patients with fluid overload should undergo fluid removal through diuretics or other means, patients with high blood pressure should receive mainly vasodilators, and patients with low cardiac output should be treated with inotropic agents to improve the force of the heart muscle's contraction.3

* Improved therapies. Many new agents are currently under development, said Professor Metra, which include adenosine type 1 receptors antagonists to enhance the diuretic effects of furosemide and increase renal blood flow, new vasodilators with different mechanisms of action, and new inotropic agents.

Better treatment selection and the development of new agents give us some hope that we will finally be able to improve the symptoms and prognosis of such a large patient population as that suffering from acute heart failure, says Professor Metra. However, he also emphasised that urgent therapy is one of the key recommendations of the latest European guidelines.

UnMASCing diseases of the brain

Tue, 19 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Scientists at the Wellcome Trust Sanger Institute have discovered a set of brain proteins responsible for some of the most common and devastating brain diseases. The proteins underlie epilepsy, depression, schizophrenia, bipolar disease, mental retardation and neurodegenerative diseases including Alzheimer's and Huntington's diseases.

The reason such a remarkable number of diseases are relevant to this set of proteins is that these proteins are at the heart of how brain cells function, explains Professor Seth Grant, Director of the Genes to Cognition Programme at the Wellcome Trust Sanger Institute.

Rather than taking traditional methods for studying just one protein at a time, the researchers developed a method that finds whole sets of proteins that bind to each other and form microscopic molecular machines. They were hunting for the 'engine room' of nerve cells, which is known to be inside the connections between nerve cells called synapses.

Synapses join the billions of nerve cells together in the brain and they are the location where learning and memory and many other behaviours are controlled.

We developed a new method, which led to this discovery, says Dr Jyoti Choudhary, leader of the Proteomic Mass Spectrometry team, which collaborated with Professor Grant's team on the study, and it should be equally useful in finding the basis of many other diseases in other cells and tissues of the body.

To find this key set of proteins - called MASCs (a scientific acronym for MAGUK Associated Signaling Complexes and pronounced 'mask') - the researchers adapted a method that had previously been used in yeast cells.

The method involved making a 'molecular hook' and attaching it to one protein inside brain cells of mice. They then caught the hook and pulled it out and found it brought along another 100 proteins. The set contained dozens of disease causing proteins.

This points to the new concept that the molecular machines are defective in the diseases and that they present new ways to approach therapy, says Dr Choudhary.

Not only were there many disease proteins within the molecular machines but also proteins that control the communication between nerve cells and the mechanisms of learning and memory.

This research is an important convergence of basic and clinical science, says Professor Grant. Our findings are exciting because they suggest that the molecular machine itself is at the root of many important brain diseases. This was a blue-skies research project seeking the basic mechanisms of learning and memory and it has led us into some of the inner workings of the brain.

This is a key step toward new ways to fight mental illness.