RxPG News : Surgery

Physiotherapy after surgery best for shoulder problems

Tue, 21 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Most patients who receive physiotherapy after surgery experience that pain is reduced by a half within a few months. Most of them are free of pain after one to two years. This is the conclusion of a thesis presented at the University of Gothenburg, Sweden.

Age-related changes in tissue combined with acute trauma can contribute to shoulder problems. The most common cause of such problems, however, is compression of the tendons in the shoulder due to a reduction in the space available, says Ingrid Hultenheim Klintberg, physiotherapist and researcher at the Institute of Neuroscience and Physiology.

Patients with these symptoms should initially be treated by physiotherapy. Those for whom physiotherapy does not have an adequate effect are offered surgical treatment, in which the space available is enlarged and the tendons repaired, if necessary. The two most common procedures are known as arthroscopic subacromial decompression and rotator cuff repair.

The aim is that the patient should become free of pain, regain muscular strength, regain mobility, and be able to resume work and leisure activities. Patients who undergo either of these two procedures are offered physiotherapy, following a tailored programme of treatment.

The results presented in the thesis show that most patients state that pain and discomfort are reduced by 50%, 3-6 months after the surgery. They had achieved full mobility and muscle strength compared with reference values at the two-year follow up after the surgery, says Ingrid Hultenheim Klintberg.

Follow up 8-11 years after the surgery showed that many of the patients had retained good shoulder function, mobility and strength.

Their quality of life was good and they display the same pattern of physical activity as do Swedish people in general, states Ingrid Hultenheim Klintberg.

Hospital outcomes research named 'Article of the Year'

Mon, 13 Jun 2011 04:00:00 PST

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

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

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

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

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

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

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

ACSM: Yoga helped older stroke victims improve balance, endurance

Sat, 04 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) An Indiana University study that exposed older veterans with stroke to yoga produced exciting results as researchers explore whether this popular mind-body practice can help stroke victims cope with their increased risk for painful and even deadly falls.

The pilot study involved 19 men and one woman, average age of 66. For eight weeks, they participated in a twice weekly hour-long group yoga class taught by a yoga therapist who dramatically modified the poses to meet the veterans' needs.

A range of balance items measured by the Berg Balance Scale and Fullerton Advance Balance Scale improved by 17 percent and 34 percent respectively by the end of the program. But equally exciting to lead researcher Arlene A. Schmid, rehabilitation research scientist at the Richard L. Roudebush VA Medical Center in Indianapolis, was the measurable gain in confidence the study participants had in their balance.

It also was interesting to see how much the men liked it, said Schmid, assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. Many of the veterans wanted the study to continue or asked for a take-home exercise plan so they could continue the practice. They enjoyed it so much partly because they weren't getting any other treatment. They had already completed their rehabilitation but felt there still was room for improvement.

Schmid will discuss her findings on Saturday during the American College of Sports Medicine meeting in Denver. Her poster presentation, Preliminary Evidence of Yoga on Balance and Endurance Outcomes for Veterans with Stroke will be from 7:30 a.m.-11 a.m. in Hall B in the session for Fitness and Performance Testing for Posture, Stability and Balance.

Statistics concerning strokes and falls are grim, with studies showing that strokes can quadruple the risk of falling and greatly increase the risk of breaking a hip after a fall. An estimated 80 percent of people who have strokes will also have some degree of impaired balance.

The study participants performed poses initially while seated in chairs and then progressed to seated and standing poses. Eventually, they all performed poses on the floor, something Schmid considers significant because of a reluctance many older adults have to working on the floor.

Everything was modified because we wanted them to be successful on day one, Schmid said. Everyone could be successful at some level.

A score of less than 46 on the Berg Balance Scale indicates a fall risk. Schmid said the study participants on average began the study with a score of 40 and then improved to 47, moving them past the fall risk threshold. The study participants also showed significant improvements in endurance based on a seated two-minute step test and a six-minute walk test.

Schmid said research into therapeutic uses for yoga is really taking off, particularly in mental health fields. Clinically, she has been watching a small trend of occupational therapists and physical therapists also becoming yoga therapists. The yoga performed in the study was modified to the extent that Schmid said it would be very difficult to find a comparable class offered publicly. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities. Schmid hopes to expand the study so she and her colleagues can explore whether such classes are effective on a larger scale.

First controlled clinical trial for Juvenile Batten disease to start

Tue, 31 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) After years of building hope for a treatment, Rochester researchers and clinicians will begin the first controlled clinical trial for Juvenile Batten disease this summer, thanks to $1 million in grants from the Food and Drug Administration (FDA) and the Batten Disease Support and Research Association (BDRSA). The trial will examine whether mycophenolate mofetil, a drug FDA-approved to suppress the immune system and prevent organ rejection in children, is safe for these children and whether it can slow or halt the progression of the fatal neurodegenerative disease.

Families have been anxiously awaiting word on when we could launch this clinical trial, said Frederick Marshall, M.D., principal investigator of the trial and Associate Professor of Neurology. Juvenile Batten Disease is very rare, but the families are very close and well-informed about potential treatments. They have been watching the progress of this research and hoping for the day when we could launch the trial.

Juvenile Batten disease is a lysosomal-storage disease that strikes seemingly healthy children and progressively robs them of their abilities to see, reason and move. It ultimately kills them in late adolescence or young adulthood. Batten disease is in the same family of diseases as Krabbe disease to which former Buffalo Bills quarterback Jim Kelly lost his son, Hunter, in 2005.

Juvenile Batten disease is a very rare recessively inherited genetic condition. That means both parents must pass on the abnormal gene in order for a child to develop the disease, but it also means there is a 1 in 4 chance another child in a family has it. Because the onset of symptoms usually occurs sometime between 4- and 8-years-old, parents often have more children before they know they are carriers and before they can obtain genetic counseling.

The trial will enroll 30 patients who are already showing symptoms of the disease. Each child will be their own control during the study, taking the medication for eight weeks, and a placebo for eight weeks. The children will take a break in the middle of the trial to clear the body of medication. Because it is a double-blind study, the researcher-clinicians and the families will not know when the child is taking a placebo or the active medication. Patients will have to travel to Rochester four times over the 22 weeks they are in the trial, which is no small feat, considering the difficulties of traveling with children who may be blind and/or seizure-prone.

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

Fri, 20 May 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

Terry Strom, M.D., honored by International Society of Nephrology

Fri, 29 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) BOSTON -- Terry Strom, MD, Co-director of the Transplant Institute at Beth Israel Deaconess Medical Center (BIDMC) and a leader in the field of immune tolerance research, was awarded the 2011 Alfred Newton Richards Award from the International Society of Nephrology during a program held earlier this month as part of the World Congress of Nephrology 2011 in Vancouver, Canada.

The award, which recognizes outstanding basic research in fields relevant to nephrology, is named in honor of Alfred Newton Richards, a renowned physiologist known for the development of the micropuncture procedure.

A Professor of Medicine at Harvard Medical School, Strom's career spans more than 30 years. To date, he has published more than 700 manuscripts in the fields of immunbiology and transplantation and has conducted pioneering investigations of the cellular and molecular bases of immune tolerance, the immune system's ability to recognize and tolerate the body's own cells and molecules in order to prevent organ rejection.

Dr. Strom's groundbreaking work in understanding the basic mechanisms underlying immunosuppressive agents has evolved to include the design of new therapeutics and the development of immune-tolerance therapies for patient care, notes BIDMC Chief Academic Officer Vikas Sukhatme, MD, PhD. His contributions have provided the field of nephrology with a critically important foundation in the biology of immune cells and tolerance, and his work is a tremendous example of how translational science can successfully move basic laboratory discoveries into promising new patient therapies.

Strom has elucidated the basic mechanisms of action of immunosuppressives and has designed new therapeutics, work leading to the development of anti-CD25 monoclonal antibodies. Two new therapies created in the Strom laboratory will soon enter human clinical trials, and his inquiries into the molecular signature of allograft rejection are under development for individualized patient care. Using newly developed molecular and imaging tools, the Strom laboratory is now revealing interactions between the adaptive and innate immune systems that are of both scientific and clinical importance.

A founding member and past president of both the American Society of Transplantation and the Clinical Immunology Society, Strom has trained over 90 doctoral and post-doctoral students who now hold prominent positions in academia and industry throughout the world. At BIDMC's Transplant Institute, which Strom co-directs with Laurence Turka, MD, PhD, he continues to guide and mentor 55 full-time investigators.

Strom was educated as an Illinois State Scholar, and went on to receive an NIH Career Development Award and was honored as Lilly Lecturer of the Royal College of Physicians.. Throughout his prolific career, Strom has been honored with numerous awards, including the 1997 Sandoz Transplant Established Investigator Award of the American Society of Transplant Physicians, the 2001 Roche American Society of Transplantation Distinguished Achievement Award and the Homer Smith Award from the American Society of Nephrology. He has served on the U.S. Senate-appointed Task Force on Transplantation.

Mayo Clinic finds robotic surgery effective for removing hard-to-reach throat cancer

Fri, 29 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) ROCHESTER, Minn. -- Robotic surgery has become a mainstream tool for removing an ever-increasing variety of head and neck tumors. Now, a team of head and neck surgeons from Mayo Clinic has found robotic surgery can treat cancer in the narrow, hard-to-reach area beyond the tongue at the top of the voice box. Some patients were able to avoid further treatment with chemotherapy or radiation, and most could resume normal eating and speaking.

We've known it's useful for tongue base and tonsil cancers, but we wanted to assess its effectiveness in the larynx, says Kerry Olsen, M.D., Mayo Clinic otolaryngologist and senior author of the study that was presented April 29 at the Combined Otolaryngological Spring Meetings in Chicago.

The investigation of transoral robotic surgery (TORS) followed nine patients for up to three years following removal of supraglottic squamous cell carcinoma, which affects the area of the larynx above the vocal cords. Most of the patients had advanced-stage disease. The results showed TORS effectively removed cancer, with clean, disease-free margins, and was easier to perform than the approach of transoral laser microsurgery via a laryngoscope. The patients also underwent the surgical removal of their adjacent neck nodes at the same operation.

We were pleased with the cancer outcomes, Dr. Olsen says. We also found patients had minimal trouble after surgery, in most cases resuming normal eating, swallowing and speaking.

With TORS, the robotic arms that enter the mouth include a thin camera, an arm with a cautery or laser, and an arm with a gripping tool to retract and grasp tissue. The surgeon sits at a console, controlling the instruments and viewing the three-dimensional surgical field on a screen. The camera improves visibility, Dr. Olsen says. We also gain the ability to maneuver and see around corners and into tight spaces, and we believe we'll now be able to take out more throat tumors than with traditional approaches of the past.

The new application of TORS comes at the right time, Dr. Olsen notes. Cancers of the tongue and throat are on the rise. Not all patients will be candidates for robotic surgery; its use will depend on the architecture of a patient's throat and neck, along with the type and extent of the tumor. What we know from this study is that for larynx cancer, we have another effective surgical tool available to us, he says. We can further tailor the cancer treatment for each patient and provide individualized care.

Sweet chemistry: Carbohydrate adhesion gives stainless steel implants beneficial new functions

Wed, 27 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A new chemical bonding process can add new functions to stainless steel and make it a more useful material for implanted biomedical devices. Developed by an interdisciplinary team at the University of Alberta and Canada's National Institute for Nanotechnology, this new process was developed to address some of the problems associated with the introduction of stainless steel into the human body.

Implanted biomedical devices, such as cardiac stents, are implanted in over 2 million people every year, with the majority made from stainless steel. Stainless steel has many benefits - strength, generally stability, and the ability to maintain the required shape long after it has been implanted. But, it can also cause severe problems, including blood clotting if implanted in an artery, or an allergenic response due to release of metal ions such as nickel ions.

The University of Alberta campus is home to a highly multidisciplinary group of researchers, the CIHR Team in for Glyconanotechnology in Transplantation, that is looking to develop new synthetic nanomaterials that modify the body's immune response before an organ transplant. The ultimate goal is to allow cross-blood type organ transplants, meaning that blood types would not necessarily need to be matched between donor and recipient when an organ becomes available for transplantation. Developing new nanomaterials that engage and interact with the body's immune system are an important step in the process. In order to overcome the complex range of requirements and issues, the project team drew on expertise from three major areas: surface science chemistry and engineering, carbohydrate chemistry, and immunology and medicine.

For the transplantation goals of the project, sophisticated carbohydrate (sugar) molecules needed to be attached to the stainless steel surface to bring about the necessary interaction with the body's immune system. Its inherent stainless characteristic makes stainless steel a difficult material to augment with new functions, particularly with the controlled and close-to-perfect coverage needed for biomedical implants. The Edmonton-based team found that by first coating the surface of the stainless steel with a very thin layer (60 atoms deep) of glass silica using a technique available at the National Institute for Nanotechnology, called Atomic Layer Deposition (ALD), they could overcome the inherent non-reactivity of the stainless steel. The silica provide a well-defined chemical handle through which the carbohydrate molecules, prepared in the Alberta Ingenuity Centre for Carbohydrate Science, could be attached. Once the stainless steel had been controlled, the researchers demonstrated that the carbohydrate molecules covered the stainless steel in a highly controlled way, and in the correct orientation to interact with the immune system.

We are immensely pleased with this progress. We have every expectation that this set of steps creating novel tools for immune system engagement will lead us closer to clinical application aimed at preparing patients for successful organ transplants. stated Dr. Lori West, Professor of Pediatrics, Surgery and Immunology, and Director of Heart Transplant Research at Univ. of Alberta.

Mount Sinai researchers present critical MS data at American Academy of Neurology meeting

Thu, 14 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers from Mount Sinai School of Medicine will present several key studies at the American Academy of Neurology (AAN) annual meeting, including research providing critical insight into the prognosis and clinical treatment course of people with a certain subtype of Multiple Sclerosis (MS). The meeting is taking place April 9-16 in Honolulu.

In a study titled Evaluation of Progressive Relapsing MS Patients in the PROMISE Trial, Fred Lublin, MD, Saunders Family Professor of Neurology and the Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at The Mount Sinai Medical Center and Michelle Fabian, MD, Neurology Fellow at Mount Sinai School of Medicine, conducted a subanalysis of the PROMISE trial. The clinical trial is a multinational, multicenter, double-blind, placebo-controlled trial evaluating the effects of glatiramer acetate treatment over three years in patients with primary progressive multiple sclerosis (PPMS). PPMS is characterized by steady disease progression, rather than attacks or exacerbations followed by remissions, which people with relapsing-remitting MS experience.

We were able to analyze data from a well-controlled clinical trial to determine the frequency and clinical consequences of the occurrence of relapses in MS patients who initially have a progressive course, said Dr. Lublin. Our data indicate that baseline characteristics and disease progression in PRMS differ from those in PPMS. As such, clinicians should consider evaluating the PRMS subgroup differently from those with PPMS in assessing prognosis and clinical course.

The research team evaluated differences in baseline characteristics and disease progression between patients with PPMS and patients with another subtype called progressive relapsing multiple sclerosis (PRMS) to help determine whether disease prognosis and treatment course should be evaluated differently in these subgroups. People with PRMS have steady disease progression, but also experience exacerbations, or relapses.

Using the data from the PROMISE trial, researchers found that 42 of the 943 PPMS patients in the PROMISE trial had documented relapses over the 53 months of the study, which indicates they could be categorized as PRMS. At the end of the study, the PRMS patients had a larger change in the Expanded Disability Status Scale, a method of quantifying disability in multiple sclerosis (0.92 vs. 0.59) than the PPMS patients, and increased risk for sustained disability progression. These results indicate that there is a definable subgroup that will inevitably convert to PRMS, and that disease progression is more rapid in this group. The data will be presented Thursday, April 14, 2011, at 2:00 PM HST.

Attacking bowel cancer on 2 fronts

Wed, 30 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Stem cells in the intestine, which when they mutate can lead to bowel cancers, might also be grown into transplant tissues to combat the effects of those same cancers, the UK National Stem Cell Network (UKNSCN) annual science meeting will hear today.

Professor Nick Barker of the Institute of Medical Biology in Singapore will explain how he and his team identified that the stem cells which are crucial to maintaining a healthy intestine are also the site at which bowel cancers first begin, and how he also hopes to use healthy stem cells to regenerate tissues to help patients with Crohn's disease and some cancers.

Having discovered a gene that is only turned on in these particular stem cells Professor Barker and his team have been able to isolate the cells in mice and grow small pieces of intestine in the lab. The researchers hope that if they are able to grow larger pieces, they will be able to produce transplant tissues to replace damaged intestines.

Professor Barker explains: Processing our dinner every day is a tough job so the lining of our intestines quickly get worn out. To keep the intestine working stem cells in little pockets along the surface replace the lining, cell by cell, about once a week.

We already knew these stem cells existed for a while we didn't know much about them because it was difficult to distinguish them from all of the other types of cells in our intestines. Our team was able to single them out and study them because we discovered a gene that is only turned on in these particular stem cells.

Once the researchers had found this gene they were able to track where the stem cells occur throughout the body finding that, as well as the intestine, the stomach lining and in hair follicles, the cells were also present in bowel tumours.

Professor Barker continues: We hope that studying these stem cells will be doubly useful: One day we hope to grow large enough pieces in the lab to form replacement tissues for transplant; and by studying the cells we will be able to find new ways to prevent them from mutating and hence leading to cancer.

Bowel cancer is the third most common type of cancer in England and an estimated 38,000 new cases are diagnosed each year. We know these stem cells are both implicated in causing the cancer but that they also could be useful for treating disease so we hope that studying them will help us to understand how to attack the disease on two fronts.

Barrow researcher launches depression study

Wed, 09 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A top medical researcher at Barrow Neurological Institute at St. Joseph's Hospital in Phoenix, Arizona, has launched a clinical trial to pinpoint brain activity in depressed people by using scientifically designed sad and heartrending photos and music. Results will be used to help neurosurgeons at the new Barrow Center for Neuromodulation treat clinically depressed patients with deep brain stimulation.

Neuropsychologist Leslie Baxter, PhD, who also is an expert in medical brain mapping, is leading the novel depression study that could help revolutionize treatment of depressed patients.

Treatment for severe depression has been a medical challenge for decades, says Dr. Baxter. We hope through this clinical trial to help make deep brain stimulation a mainstream treatment for this devastating condition. Depression affects 121 million people worldwide and ranks among the leading causes of disability. At least 20 percent of patients do not respond to traditional treatments.

Deep brain stimulation (DBS) is the cornerstone of the new Barrow Neuromodulation Center. Deep brain stimulation involves the implantation of an electrode deep within the brain in the area associated with a disorder. A medical device, sometimes called a brain pacemaker, sends electrical signals to the brain, alleviating symptoms. An established treatment for movement disorders, Barrow is now pioneering its use in other behavioral and neurological disorders including depression, obsessive compulsive disorder (OCD), pain and autism.

In the depression clinical trial, non-depressed and depressed patients undergo a Functional MRI for the hour-long MRI study. The patients are shown photos and videos of sad and tragic scenes to elicit sadness. As the Functional MRI lights up brain circuitry, the researchers are able to identify the exact point of individuals' brains that are being activated and the circuits that can be changed during depression.

Dr. Baxter says that thus far nine non-depressed people have been studied. We have developed the testing and established its ability to highlight circuitry associated with depression in these participants. We are now starting the study with depressed patients. We want to include at least 20 depressed and 20 non-depressed.

One of the participants in the clinical trial says it is high time that more research is done on depression. For too long the topic of depression has been taboo in society, but it can no longer be ignored, says Melissa Schultz, a Phoenix art teacher who has suffered from depression most of her life. I'm not a candidate for deep brain stimulation since my condition is managed effectively with other treatments. I hope this study helps other people, however, who suffer from serious depression. It's like a whole new life when a person is treated effectively for depression. I'm very grateful to be in the study.

Working with Dr. Baxter on the study is Phoenix psychiatrist Dr. Gary Grove. Dr. Baxter emphasizes that only depressed patients who are under the clinical care of a psychiatrist are eligible for the clinical trial.

While DBS has been used experimentally on a few depressed patients, experts like Dr. Baxter are trying to improve its effectiveness. Our study has already shown that people's brain circuitry differs slightly from person to person and that we must develop more exact pre-trial testing such as the use of this Functional MRI. Currently, the neurosurgeons use landmarks and a general idea of where the area should be based on structure. We would add in functional information.

$1.9 million NIH grant supports research in the most common soft tissue tumor in children

Mon, 21 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A nearly $2 million grant from the National Institutes of Health (NIH) will help investigators at Nationwide Children's Hospital search for biomarkers that may be linked to the development and outcome of hemangiomas, the most common soft tissue tumor in children. Nationwide Children's is home to the only Hemangioma and Vascular Malformations Clinic in the United States with an NIH-sponsored clinical study.

A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. Hemangiomas appear as a red to reddish-purple, raised lesion or as a massive, raised tumor.

Hemangiomas can be extremely disfiguring and life-threatening, resulting in significant distress for the families of affected children, said the grant's principal investigator, Gayle Gordillo, MD, director of the Hemangioma and Vascular Malformations Clinic in Plastic and Reconstructive Surgery at Nationwide Children's Hospital. A critical barrier to improving the clinical outcomes for affected children is the lack of low-risk treatment options. The most effective treatment options all have life-threatening side effects.

Dr. Gordillo's laboratory research using a mouse-model has shown that the formation of these soft tissue tumors depends on nox-4. Nox-4 is an enzyme involved in the production of reactive oxygen species, a natural part of a healthy cellular environment. However, excessive production of reactive oxygen species can result in significant damage to the cell.

As part of the NIH-funded study, Dr. Gordillo and colleagues at both Nationwide Children's Hospital and The Ohio State University Medical Center, will examine urine and blood samples from patients with hemangioma beginning from the time they enroll in the study until they are 2 years of age. They will also perform ultrasound on each patient to measure the size of the hemangioma and velocity of the blood flowing to the tumor. Recruitment for study participants will take place at Nationwide Children's.

By comparing samples from these patients with samples from age-matched healthy children, Dr. Gordillo's team will be able to investigate how nox-4 regulates growth of endothelial cells that develop into tumors. They will also search to determine whether biological products caused by nox-4 function can be used as biomarkers to determine patient outcome.

This is the first prospective, longitudinal study aimed at identifying biomarkers in children with hemangiomas, said Dr. Gordillo, also a faculty member at The Ohio State University College of Medicine. Our goal is to further understand the role oxidant production has on hemangioma formation. Our findings could help identify potential new treatment targets and establish biomarkers that can be used to design clinical trials to test new therapeutics to treat these soft tissue tumors.

Large study of arthroscopic rotator cuff repair reveals some surprises

Sat, 19 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Arthroscopic rotator cuff repair is highly effective and provides durable results five years after surgery, according to a large, prospective study by Hospital for Special Surgery investigators. The study also surprisingly revealed that the rotator cuff has the ability to heal even when early imaging studies have found a defect at the site of repair. The research will be presented at the upcoming American Shoulder and Elbow Surgeons (ASES) 2011 Specialty Day meeting, to be held Feb. 19 in San Diego, Calif., following the annual meeting of the American Academy of Orthopaedic Surgeons.

Our study demonstrates that arthroscopic rotator cuff repair results remain excellent when followed over five years, and we found that some tendons that were incompletely healed at two years appeared to heal fully by five years, suggesting that rather than deteriorating over time, results may in fact improve over time, said David Altchek, M.D., attending orthopedic surgeon and co-chief in the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS) in New York, who was involved with the study.

These days, arthroscopy is the standard of care for repairing rotator cuffs. Most patients who have this procedure have excellent clinical results, but surprisingly the results sometimes don't correlate to whether the rotator cuff is healed or not. When your rotator cuff is torn, you attribute all your pain and dysfunction to your torn rotator cuff, then you have it fixed and you feel better, but sometimes when you take an ultrasound or an MRI, the rotator cuff looks exactly like it did before you had the surgery, said Lawrence Gulotta, M.D., who led the study and is a sports medicine and shoulder surgeon at HSS. Before this study, we thought that once a rotator cuff had re-torn or failed to heal following surgery, it had no capacity to heal in the future. Now we know that the rotator cuff does have the capacity to heal itself, even if early radiographic studies showed there was a defect at the repair site.

At one year following surgery, ultrasound results showed that 64.3 percent of patients had a healed rotator cuff. This percentage went up to 75.4 percent at two years and 81.2 percent at five years.

The study involved 193 patients who underwent arthroscopic rotator cuff repair at HSS and then were evaluated annually for five years. In 2003, HSS established the Arthroscopic Rotator Cuff Registry to prospectively evaluate the functional and radiographic outcomes of patients undergoing this procedure and this study comes from that registry. When the study was started, arthroscopic rotator cuff repairs were really just coming onto the scene, so the HSS Sports Medicine and Shoulder Service decided to start a prospective study to evaluate the outcomes of them, Dr. Gulotta said.

Common hip disorder can cause sports hernia

Sat, 19 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Sports hernias are commonly found in individuals with a mechanical disorder of the hip and can be resolved with surgery to fix the hip disorder alone in some cases, according to a recent study. The research, conducted by investigators at Hospital for Special Surgery, will be presented at the American Orthopedic Society for Sports Medicine 2011 Specialty Day meeting, held Feb. 19 in San Diego following the annual meeting of the American Academy of Orthopaedic Surgeons.

If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete, said Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery who led the study. If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one. He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.

In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.

To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.

The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.

This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain, said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed.

Increased drop out rates among HIV infected patients on the liver transplantation wait list

Tue, 25 Jan 2011 19:32:02 PST

( from http://www.rxpgnews.com ) French researchers determined that infection with human immunodeficiency virus (HIV) impaired results of transplant surgery for liver cancer, with more HIV infected patients dropping off the transplantation wait list. The team found that overall survival and recurrence-free survival was not impacted following liver transplantation in patients with controlled HIV disease. Details of this single center study—the largest to date—are published in the February issue of Hepatology, a peer-reviewed journal of the American Association for the Study of Liver Diseases (AASLD).

More than 40 million individuals are infected with HIV; of these roughly two to four million and four to five million are also carriers of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. With the introduction of highly active antiretroviral therapy (HAART) in 1996 the survival of patients with HIV infection has improved dramatically and now end-stage liver disease has become the principal cause of death among HIV- positive patients co-infected HBV or HCV. Prior studies have shown that 25% of liver-related mortality in HIV-positive patients is attributable to hepatocellular carcinoma (HCC), or liver cancer.

"Liver transplantation is the optimum treatment for HCC and can also be considered for controlled HIV-positive patients with liver cancer," said René Adam, MD, PhD, from Hospital Paul Brousse in France and lead author of the current study. "Our study showed that HIV infection impaired the results of liver transplantation on an intent-to-treat basis but exerted no significant impact on overall survival and recurrence-free survival following transplantation."

The research team analyzed data from 21 HIV-infected and 65 HIV-negative patients with HCC who were listed for liver transplantation between 2003 and 2008. All HIV-positive patients were treated with HAART and had not experience any AIDS event or opportunistic infections prior to being place on the wait list.

Researchers observed a trend towards a higher drop-out among HIV-positive wait listed patients (23%) compared to patients without HIV (10%). Patients with HIV who dropped out had significantly higher alpha-fetoprotein (AFP) levels at the time of listing than those who received a transplant—98 μg/L versus 12 μg/L, respectively. A similar difference in AFP levels was not found in HIV-negative patients—18 μg/L in those who dropped out versus 13 μg/L for those who underwent liver transplantation. Only one HIV-positive patient who did not have increased AFP levels while on the wait list dropped out due to progression from controlled HIV to AIDS.

Medical evidence indicates a major predictive factor for HCC recurrence post-transplantation is an increase in patient's AFP level of more than 15 μg/L per month while on the waiting list. "Our study confirmed the importance of this preoperative factor (AFP levels), as all HIV-positive patients who dropped out displayed a rise in AFP levels," Dr. Adam concluded. "There is clearly a critical need for more effective neoadjuvant therapy in HIV-positive patients with HCC, however there are no objective arguments to contraindicate liver transplantation in this group if strict criteria are used for selection and patients are closely monitored until surgery."

Researchers unzip MRSA and discover route for vaccine

Sun, 16 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) University of Rochester Medical Center orthopaedic scientists are a step closer to developing a vaccine to prevent life-threatening methicillin-resistant staphylococcus aureus (MRSA) infections following bone and joint surgery.

Other MRSA vaccine research has failed to produce a viable option for patients because of the inability to identify an agent that can break through the deadly bacteria's unique armor. Most other research has targeted the surface of the bacteria, but the URMC team discovered an antibody that reaches beyond the microbe's surface and can stop the MRSA bacteria from growing, at least in mice and in cell cultures.

The Orthopaedic Research Society invited URMC researchers to present their findings on Jan. 16, 2011, at the ORS annual meeting in Long Beach, Calif. The team is led by Edward M. Schwarz, Ph.D., professor of Orthopaedics and associate director of the URMC Center for Musculoskeletal Research. John Varrone, a second-year graduate student in Schwarz's lab, will discuss the data at ORS and the ongoing search for attractive molecular candidates for use in a vaccine.

Staph infection is the leading cause of osteomyelitis, a serious bacterial infection of the bone. Up to half of these infections are due to MRSA, a particular strain of staph known as a superbug because of its antibiotic resistance. MRSA causes nearly 500,000 hospitalizations and 19,000 deaths a year in the United States. Although improvements in surgical techniques and use of prophylactic antibiotics prevents some MRSA infections, osteomyelitis is expected to remain a serious problem in the future as people live longer and request more joint replacements and reconstructive surgery.

Management of MRSA infections due to bone and joint surgery is very challenging, Schwarz said, and therefore a vaccine to prevent the infection is badly needed.

It is difficult to pin down the source of most post-surgical MRSA infections, but the health and financial consequences are severe. Hospital stays can last up to six months. Standard treatment includes removing the MRSA-colonized prosthetic joint replacement, then an extensive washing and draining of the infected area in an attempt to clear out all bacteria before it seeds in nearby tissue and bone. Antibiotic spacers are usually placed near the joint for six to eight weeks.

A second joint replacement is an option only if the antibiotic-spacer treatment is successful and the health of the patient remains stable. However, the re-infection rate is very high (40 to 50 percent) and remains a risk for months or even years after the initial assault. In some cases the patient never fully regains the use of the infected joint, said Regis O'Keefe, chief of Orthopaedics at URMC and an expert in the treatment of MRSA.

It's essential that we have mechanisms in place to prevent this awful infection, O'Keefe said. We are very excited about our vaccine research. It'll have a phenomenal impact on individuals locally and across the country if we are successful.

University of Houston researchers helping Pentagon build mind-controlled prosthetics

Tue, 11 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) University of Houston researchers are helping the Pentagon build reliable mind-controlled prosthetic devices that military and civilian amputees can use the rest of their lives.

Prosthetic limbs that can be maneuvered by neural implants have shown promise in the laboratory, but there are challenges to making them work in the real world. Chief among these obstacles is the neural implants' nearly inevitable failure over time, often in a matter of weeks.

Badrinath Badri Roysam, chair of UH's department of electrical and computer engineering and Hugh and Lillie Cranz Cullen University Professor, is leading a multi-institution team effort to identify the combination of factors that cause neural implants to fail.

Roysam and his group have received a three-year, $5.4 million grant from the Defense Advanced Research Projects Agency (DARPA), the military's high-tech research agency. Researchers from Seattle Children's Research Institute, the University of Michigan, Rensselaer Polytechnic Institute and two companies also are involved in the project.

The grant is part of DARPA's Histology for Interface Stability Over Time program, which is the next phase of its Revolutionizing Prosthetics project that began in 2000. The grant money is allocated in two phases, with $3.2 million being awarded immediately and the remaining $2.2 million being awarded based on performance.

Roysam said neural implants can fail within six to eight weeks. Once implanted, the brain treats these tiny devices like foreign objects and immediately begins to try to isolate them for its own protection.

The tissue surrounding the device undergoes complex changes that in the end isolate it electrically. At this point, it (the implant) stops functioning, Roysam said. Researchers understand the fundamentals of the brain's reaction to the implants, but they still have many questions that Roysam's team will seek to answer.

The work begins in Michigan, where a team led by professor Daryl Kipke will build specialized neural implants for use in laboratory testing. Researchers at the Seattle institute, under the direction of William Shain, will take three-dimensional images of how different brain cells are reacting to an implant. Shain's lab is a world leader in multispectral laser scanning confocal microscopy, an imaging technique that produces high-resolution three-dimensional images of brain tissue, with each different type of tissue and cell assigned a unique color.

Those images will be transmitted to UH, where Roysam's team will run them through a sophisticated and powerful software platform called FARSIGHT, which will analyze the histology, or cellular makeup, of the images. Developed by a collaborative team led by Roysam with the support of the National Institutes of Health, FARSIGHT will translate these images into data that quantifies the response of each individual brain cell and cell type to the implant.

RPI researchers Kristin Bennett and Mark Embrechts will then use advanced pattern recognition software and techniques to identify the factors that cause implants to fail prematurely.

Using this information, they will recommend design changes to researchers in Michigan, restarting the whole process.

Roysam, who joined UH last year after working as professor of electrical, computer and systems engineering and professor of biomedical engineering at RPI, noted that each contributing group is a world leader in its respective field.

I am blessed with a dream team, he said. We have pre-eminent leaders in implant design, 3-D multispectral imaging, quantitative histology, and pattern recognition on our team. Ideally, the team will be able to make great strides in the understanding of neural implant failure.

DARPA has a vision of a future where a soldier who has lost a limb will regain full use of that limb again through advanced technology. We're proud to be part of this effort, which will also benefit civilians, he said.

ICU communication study reveals complexities of family decision-making

Wed, 05 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) While a much hailed communication intervention works for families making decisions for chronically-ill loved ones in medical intensive care units, Case Western Reserve University researchers found the intervention was less effective for surgical and neurological ICU patients.

Barbara Daly and Sara Douglas, the study's lead researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve, attribute the varied results to different types of patients served by the three types of ICUs and differences among ICU cultures.

We found the same approach is not going to have the same results for everyone, Daly said

With the number of ICU patients predicted at more than 600,000 patients annually by 2020, researchers search for ways to help families make critical decisions for their loved ones. This study contributes to those ICU practices involving complex communication issues.

The researchers repeated a study from a Boston hospital that resulted in shorter stays and less unneeded tests and treatments when families were routinely informed through a systemized communications intervention about their family member's progress in a medical ICU. They compared the effect of the new communication system in 346 patients to usual practice in 135 patients.

The intervention involved a 30-minute communication meeting between the clinical staff and family, beginning five days after a patient requiring a ventilator was admitted to the ICU. The staff and family covered five components: medical update, preferences and goals for the patient, treatment plans, prognosis, and milestones (the markers that can tell whether a person is improving).

The meetings continued weekly until the patient was transferred to a regular hospital ward, to a long-term facility, went home or died.

According to Daly, the discussions are important because up to 40% of these ICU patients do not survive beyond two months if they have spent more than five days on a mechanical ventilator.

For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.

Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.

The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. We took the study into real-life situations.

Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.

Adult fat cell-derived stem cells useful in tissue reconstruction

Mon, 27 Dec 2010 08:53:39 PST

( from http://www.rxpgnews.com ) Adipose-derived stem cells maintain their "stemness" and could be useful for cell-based therapies. A team of researchers from several institutions in Italy isolated and characterized adult fat cell-derived stem cells from patients undergoing lipoaspiration (surgical removal of fat deposits) in order to investigate the ability of the fat cells to maintain their stem cell characteristics in in vitro cultures to the point where once transplanted they could aid in tissue regeneration.

According to the study's corresponding authors Dr. Stefami Bucher of the San Gallicano Institute (Rome) and Dr. Rita Falcioni of the Regina Elena Cancer Institute (Rome), adipose tissues share several biological properties with bone marrow, they can be found in abundance, they can be obtained from patients undergoing noninvasive lipoaspirate procedures, and they have the potential to be useful in a range of therapeutic applications.

"The use of lipoaspirate as filling material is a powerful technique for tissue repair in plastic surgery," said Dr. Falcioni. "Increasingly, it is used in oncology to repair tissue damaged by surgical treatments, such as mastectomy. The use of purified adipose-derived stem cells might improve this surgical procedure by shortening the time to achieve esthetic results and thereby improving patient quality of life."

The researchers described adipose tissues as "highly specialized connective tissues" that help provide the body with an energy source, yet little research has investigated the transplant potential of adipose-derived stem cells.

"We strongly suggest that the adipose-derived stem cells we purified in our study could be applied in the near future for cell therapy using the cell-assisted lipotransfer technique."

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

Tue, 07 Dec 2010 05:00:00 PST

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

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

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

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

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

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

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

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

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

'Vast majority' of acoustic tumor patients benefit from surgery

Tue, 07 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- Surgery to remove tumors under the brain known as acoustic neuromas produces favorable outcomes in the vast majority of patients, according to one of the largest studies of its kind.

Loyola University Hospital surgeons Dr. Douglas Anderson and Dr. John Leonetti followed 730 patients whom they had jointly operated on during a 21-year period. Patients ranged in age from 9 to 79, with a median age of 48. The average clinical followup was 32 months.

Every patient survived the surgery, and the surgeons were able to completely remove the tumors in 95.1 percent of the patients. Ninety percent of patients experienced little or no facial paralysis. And among those who still retained hearing in the affected ear before surgery, 44 percent came out of the surgery with useful hearing in that ear, and 63 percent had at least some hearing.

These results are as good as or better than any other series of acoustic neuromas reported in the medical literature.

With careful microsurgical technique, one can achieve gross total resection [removal] of the vast majority of acoustic tumors with minimal major morbidity or mortality and at the same time, achieve a high percentage of normal to near normal facial function, the study authors concluded.

Anderson is first author of the study. He presented results at the 2010 Congress of Neurological Surgeons, which awarded him the prestigious Synthes Skull Base Surgery Award.

An acoustic neuroma, also known as a vestibular schwannoma, is a slow-growing, usually benign tumor, located behind the ear on the nerve that connects the ear to the brain. The tumor can cause hearing loss in one ear and paralysis on one side of the face. If the tumor grows large enough, it can be fatal. Treatment options include microsurgery (surgery with a microscope), radiation or simply keeping a watchful eye on the tumor.

In the study, the average tumor diameter was 2.2 cm, and 89.5 percent of the patients had experienced partial or complete loss of hearing in one ear. Other pre-surgery symptoms included tinnitus (43.7 percent of patients), dizziness/imbalance (26.8 percent), facial numbness (11.1 percent), headache (10.3 percent) and facial weakness (2.6 percent).

Leonetti and Anderson work as a team, with Leonetti gaining access to the tumor and Anderson removing it. If the patient still retains hearing, Leonetti uses one of two surgical techniques, called the retrosigmoid approach or the middle fossa approach. If the patient has lost all hearing, Leonetti uses a technique called the translabyrinthine approach. Leonetti is a professor in the departments of Otolaryngology and Neurological Surgery and program director of Cranial Base Surgery, and Anderson is a professor in the Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine.

In recent years, the adoption of techniques to monitor neural structures during surgery has enabled surgeons to frequently preserve hearing and facial nerves. Before, the goal simply was to get the tumor out and be glad if the patient survived, Anderson said.

While Anderson and Leonetti have their own practices, they also collaborate to remove acoustic neuromas and other tumors. Over the past 23 years, they have performed about 1,250 surgeries together.

It's been a long and successful partnership, Anderson said. We have had wonderful results. It's like a nice marriage.

Anderson said Leonetti is a very innovative surgeon, and extremely adept at the myriad of approaches to the skull base. He also has a wonderful attitude -- highly professional but also fun to work with.

Leonetti also has high praise for Anderson. He is the most technically gifted neurosurgeon I have ever seen, Leonetti said. More importantly, he is a kind, compassionate and wonderful person -- but he'll never beat me at golf.

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.

Increased mortality risk in later years in obese children following Liver transplantation

Thu, 28 Oct 2010 18:27:35 PST

( from http://www.rxpgnews.com ) A new study from the University of Washington reported obese children are at increased mortality risk in later years following primary liver transplantation (LT). Pediatric patients who are thin or severely thin, experience an early mortality risk—within the first year post-LT. Details of the ten-year survival analysis are published in the November issue of Liver Transplantation, a peer-reviewed journal of the American Association for the Study of Liver Diseases (AASLD).

Childhood obesity is a serious public health concern worldwide. According to the World Health Organization (WHO), the prevalence of obesity has been increasing at an alarming rate, with 22 million children under the age of five worldwide who are overweight. In the U.S., the National Center for Health Statistics estimates that 17% of children between the ages of 2 and 19 years old are overweight or obese.

"Controversies exist regarding the mortality of patients undergoing liver transplantation at the extremes of body mass index (BMI), and in pediatric patients weight is typically the only factor considered in survival analysis," explained lead study author André Dick, M.D., from Seattle Children's Hospital and the University of Washington. "Our study is the largest thus far to report on the impact of pre-transplant BMI on post liver transplant survival in the pediatric population." Prior studies in adult populations have shown there to be a negative impact on post transplantation survival for LT patients with extreme BMIs.

For the present study, researchers reviewed data from the Organ Procurement and Transplantation Network (OPTN) and found that 7,942 patients less than 18 years of age (who had full BMI data) underwent primary liver transplantation between 1987 and 2007. Using the WHO BMI criteria, the authors categorized patients as severely thin, thin, normal weight, overweight, or obese. During the study period 61% of patients were at normal weight.

Results indicate that children who were thin or severely thin had a significantly lower survival (84%) at one year compared to the survival (89%) of children in the normal and overweight groups. Researchers found no significant difference in survival during the first year after transplantation for obese pediatric patients. However, by the twelfth year following LT, those in the obese group had significantly lower survival (72%) than the survival (77%) of normal weight or overweight pediatric patients.

The authors observed that obesity had a significantly negative impact on pediatric patient survival more than five years after LT. They speculate post metabolic syndrome (PTMS) could contribute to the late morbidity and mortality due to the time it takes to develop long-term obesity-related conditions such as diabetes, hypertension, and hyperlipidemia. Moreover, long-term use of immunosuppressive therapy following transplantation, which while improving patient survival, can exacerbate the effects of PTMS. "Further research is needed to determine the optimal immunosuppressive regimen that will lessen the effects of PTMS," concluded Dr. Dick. "Pre- and post-transplant identification of malnourished or obese pediatric patients, along with optimization of their modifiable risk factors will help to best use scarce donor organs and maximize patient survival."

National research study to assess new treatment for painful vertebral fractures

Thu, 28 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Physicians at The Medical College of Wisconsin are conducting the KAST clinical trial at Froedtert Hospital to assess the safety and effectiveness of a new vertebral augmentation treatment (Kiva) for painful vertebral compression fractures (VCFs) due to osteoporosis.

Sean Tutton, M.D, associate professor of radiology and surgery at the Medical College, is principal interventional radiology investigator for this multi-institutional, national trial. This prospective, randomized, controlled trial will compare outcomes of the investigational Kiva device using a coil implant with cement, to the current treatment, kyphoplasty using small orthopedic balloons and cement to repair painful fractures of the spine.

The study will evaluate whether the Kiva procedure, using a more elastic implant and less cement placed strategically, will be equally safe and effective to kyphoplasty says Dr. Tutton. It may also demonstrate that the more elastic implant and use of less cement will prove superior to kyphoplasty.

VCFs occur when a vertebra cracks, fractures, or collapses. These fractures are extremely painful and often debilitating. Over 700,000 osteoporosis-related vertebral compression fractures occur each year in the US alone. It is estimated that two-thirds of vertebral compression fractures are never diagnosed because many patients dismiss their back pain as a sign of aging and/or arthritis.

When bones become fragile and brittle from osteoporosis, everyday activities can trigger vertebral compression fractures. Bending to lift an object, missing a curb, or slipping on a wet surface can put the spine at risk of fracture. Multiple vertebral compression fractures significantly changes the structure and shape of the spine and can affect the internal organs and body functions, negatively impacting the overall health of the individual, daily activities, and quality of life.

The primary treatment for VCFs is typically conservative care consisting of bed rest, analgesics, and physical therapy. Interventional treatments for VCFs, include balloon kyphoplasty and vertebroplasty. These treatments aim to stabilize the fractures, providing earlier pain relief, and functional improvement.

Dr. Tutton pointed out that recent studies comparing vertebroplasty to sham procedures have resulted in confusion as they, on first glance, failed to demonstrate significant clinical improvement. When the trials are evaluated more critically, it is apparent that difficulties with patient selection and under-enrollment limited these trials' ability to prove their hypotheses. The prospective randomized FREE trial and recently published Vertos II trial (Lancet) both support the efficacy and safety of kyphoplasty and vertebroplasty. From the available data we know that patients who failed conservative care at four to six weeks and then received vertebroplasty or kyphoplasty experienced significant reduction in pain, earlier resumption of normal activities and most importantly preservation of independence.

Individuals eligible for the KAST study must have one or two osteoporotic spine fractures, be over age 50, and have been unsuccessfully treated by conservative care for at least 6 weeks.

The Kiva System, considered the next generation in the treatment for VCFs, is approved in Europe. The results of the current study will be submitted to the FDA for potential clearance in the US.

Studies show everolimus-eluting stent implantation reduces restenosis and repeat revasculariztion

Thu, 21 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Two new studies have determined that everolimus-eluting stent (EES) implantation reduced the incidence of restenosis and repeat revascularization in patients with calcified culprit lesions, and had fewer clinical events. Results show the rate of major cardiac adverse events in EES-treated patients with calcified lesions were higher than in those for noncalcified lesions, but remained lower than the results of previously reported stent studies. Details of both studies are published in the November issue of Catheterization and Cardiovascular Intervention, a peer-reviewed journal from The Society for Cardiovascular Angiography and Interventions.

The treatment of calcified coronary stenosis is associated with a high frequency of restenosis and target lesion revascularization (TLR). Drug-eluting stents (DES), known to reduce the rates of restenosis and TLR in patients with relatively simple coronary artery lesions when compared with bare metal stents (BMS), are now successfully being used for more advanced lesions such as calcified coronary stenoses.

The XIENCE V EES emerged in 2008 as a new option in DES. Following favorable results with this device in the SPIRIT FIRST randomized study, the SPIRIT II and III trials were performed to evaluate the EES in comparison with the widely used TAXUS paclitaxel-eluting stent (PES) in the treatment of patients with coronary artery disease. The SPIRIT studies suggested positive outcomes for EES implantation in calcified culprit lesions, with the aim of the current analysis to confirm its safety and efficacy in patients with calcified and noncalcified culprit lesions.

In the first study, researchers from the Erasmus Medical Center in the Netherlands identified 212 patients with 247 lesions, who were treated with EES alone. Target lesions were angiographically classified as none/mild, moderate, or severe grades of calcification. The population was divided into two groups: those with at least one target lesion moderately or severely calcified (the calcified group: 68 patients with 75 calcified lesions) and those with all target lesions having mild or no calcification (the noncalcified group: 144 patients). Six-month and 2-year angiographic follow-up and clinical follow-up to 3 years were completed.

At the 6-month and 2-year follow-ups, the calcified group (compared with the noncalcified group) had significantly higher rates of in-stent angiographic binary restenosis (ABR) and ischemia-driven (ID) TLR, resulting in numerically higher major cardiac adverse events (MACE). While at 3 years, only ID-TLR tended to be higher in the calcified group than in the noncalcified group, resulting in numerically higher MACE.

The geometry and rigidity of calcified culprit lesions often prevent optimal device delivery, deployment, and conformability, explained study leader Patrick Serruys, M.D., Ph.D. Consequently, the treatment of this lesion subset with percutaneous coronary intervention (PCI) is associated with a high frequency of acute complications and a low-success rate. Our study showed high-clinical device success (98.7%), excellent clinical procedural success (100%), and the absence of MACE during the acute phase (up to 30 days after stent implantation) in the calcified group.

Additionally, no patient in the calcified group suffered from stent thrombosis up to 3 years after PCI, while two thrombotic complications occurred in the noncalcified group. Although large population studies with long-term follow-up are mandatory, the authors concluded that EES implantation for calcified culprit lesions appears to be safe up to 3 years. This study also demonstrated that the rates of in-stent ABR (4.3%) and ID-TLR (5.9%) at 6 months for calcified culprit lesions are remarkably lower than that in previous BMS studies, in which these rates ranged from 12 to 23% and from 18 to 23%, respectively, suggesting that EES implantation is more effective for calcified culprit lesions than BMS implantation.

In a related study, researchers from the Wake Forrest University School of Medicine in North Carolina analyzed data from SPIRIT III clinical trial to evaluate whether EES, with thinner stent struts and polymer, results in less adverse outcomes. Findings from the SPIRIT III trial indicated that the newer generation of DES, the EES, was associated with fewer clinical events than the first generation PES. In an effort to determine whether this benefit extended to all patient subgroups, Robert Applegate, MD, FSCAI, and colleagues assessed the impact of jailed side branches on clinical outcomes and periprocedural myonecrosis within each stent treatment group.

The Wake Forest researchers identified 113 patients in the EES group and 63 patients in the PES group who met the criteria of having a lesion with a jailed side branch (less than 2 mm diameter, and less than 50% stenosis). Two-year clinical outcomes were evaluated, revealing that MACE (cardiac death, myocardial infarctions (MI), or TLR) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients, with numerically lower rates of MI and TLR in the EES group, with comparable rates of cardiac death.

Use of a PES was associated with an increase in rates of periprocedural creatine kinase-MB fraction (CK-MB) elevation, which was most prevalent in those patients with a jailed side branch. In contrast, rates of CK-MB elevation were similar in those patients receiving an EES, and lower when compared to PES, regardless of the presence or absence of a jailed side branch. The clinical outcomes at 1 and 2 years were similar in the EES treated patients with and without a jailed side branch, but were numerically higher in the PES treated patients with a jailed side branch compared to those without a jailed side branch.

Dr. Applegate concluded, Our observations confirm previous studies demonstrating a relative increase in the incidence of periprocedural elevation of biomarkers with PES use, and demonstrate the absence of this phenomenon with EES.

Reducing blood transfusions improves patient safety and cuts costs

Thu, 07 Oct 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

Researchers find faster, less-intrusive way to identify transplant recipients' organ rejection

Thu, 23 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - A simple, inexpensive blood test could soon help doctors halt organ rejection before it impairs transplanted hearts and kidneys.

In the past, we couldn't spot rejection episodes until they harmed the organ, said Atul Butte, MD, PhD, who is co-senior author of the new research and an associate professor of medical informatics and of pediatrics at the Stanford University School of Medicine, in addition to director of the Center for Pediatric Bioinformatics at Lucile Packard Children's Hospital. Our goal is to develop blood tests that will keep transplanted organs functioning so that patients can avoid a second transplant.

Butte and his collaborators have made a big step toward that goal. The Stanford team found three easily measured proteins that rise in the blood during acute rejection, in which a patient's immune system attacks his or her transplanted organ. The research, which will be published online Sept. 23 in PLoS-Computational Biology, is the first-ever report of an immune-rejection signal that is shared by two kinds of transplanted organs. The protein signals are now being validated in liver- and lung-transplant recipients as well.

The new blood test circumvents the invasive, expensive, slow system now used to keep tabs on transplants. Currently, all organ recipients receive functional monitoring of their new body parts. Heart transplant patients get regular echocardiograms, for instance. If organ function drops, doctors cut a tiny sample from the transplanted tissue to check for rejection, and then adjust patients' immune-suppressing drugs accordingly. About 25 percent of kidney recipients and 40 percent of heart recipients experience an episode of acute rejection in the first year after transplant.

The new blood test will let doctors skip directly to drug dosing before a transplant is damaged. As well as treating rejection early, doctors could use the test to reduce doses of immune-suppressing drugs for patients whose bodies are handling their transplanted organs well, thus reducing unnecessary drug side effects. Butte predicts the test will be commercially available in three to five years.

The new technique makes use of an existing method to detect proteins in blood, called enzyme-linked immunosorbent assay, or ELISA, that is already used to diagnose diseases such as strep throat. The Stanford team found new proteins for diagnostic ELISA kits to target.

To identify the new protein markers, the researchers started from publicly available data documenting changes during transplant rejection in levels of messenger RNA, the molecule that tells cells to make new proteins from the instructions in the genetic code. These changes gave the team clues about which proteins might appear in the blood during rejection.

From 45 protein candidates identified via mRNA data, the team zeroed in on 10 for which ELISA-based laboratory test kits were already available. Using blood samples from 39 kidney and 63 heart transplant recipients, the kits found three proteins that reliably increased in the blood during acute rejection.

Because ELISA-based diagnostics are already used in clinical settings, it won't be hard to modify the technology for transplant patients, Butte said. Stanford University has filed patent applications for the new test.

The researchers also independently validated their method of using public RNA data to identify marker proteins by confirming that the computational method detected known biomarkers for several other diseases. The new discovery method is exciting, Butte said, because it could be applied to many diseases that lack good diagnostic tools.

For a disease like pancreatic cancer, where we find it late and patients die quickly, we have a huge medical need for identifying good diagnostic markers, he said. Why don't we use public data to help us with this process?

Northwestern first site open for spinal cord stem cell trial

Wed, 22 Sep 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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.

Drug trial results refine treatment during angioplasty operations

Tue, 31 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A landmark international study, coordinated by McMaster University, has found that lower doses of a blood thinner called unfractionated heparin (UFH) during angioplasty did not reduce bleeding or vascular complications compared to standard dose UFH in patients initially treated with a blood thinner, fondaparinux.

In a prior study, the OASIS 5 trial, researchers from McMaster University showed that a blood thinner fondaparinux compared to another blood thinner, enoxaparin, reduced serious bleeding and prevented deaths in patients with heart attacks. A limitation of this new agent, fondaparinux, was its higher rates of clot formation in equipment during angioplasty. As a result, an additional blood thinner UFH had been recommended during angioplasty to prevent clotting in those who had received fondaparinux, but there was uncertainty about the optimal dose.

Even though UFH has been used during angioplasty since the procedure was first performed, little is known about the optimal dose of the agent.

An international group of researchers from 18 countries found patients undergoing angioplasty did not benefit from a lower dose of UFH compared to a standard dose in those on fondaparinux.

Importantly, the addition of either low or standard dose UFH to fondaparinux did not increase serious bleeding and prevented clot formation in equipment during angioplasty when compared to patients treated with fondaparinux alone in OASIS 5. As a result, adding standard dose UFH to fondaparinux maintains the major advantage of fondaparinux (lower bleeding) while preventing clotting during the angioplasty procedure.

Our data clearly shows that adding UFH to fondaparinux maintains a low rate of major bleeding and prevents catheter thrombosis, said interventional cardiologist Dr. Sanjit Jolly, an assistant professor of medicine in the Michael G. DeGroote School of Medicine at McMaster University.

Dr. Jolly is scheduled to present the results of the FUTURA-OASIS 8 (Fondaparinux with UnfracTionated heparin dUring Revascularisation in Acute coronary syndromes) trial at the annual European Society of Cardiology Congress in Stockholm, Sweden on August 31. The study was also published simultaneously in the Journal of the American Medical Association (JAMA).

FUTURA-OASIS 8 is a Phase III, multicentre, multinational, randomized, parallel-group trial of 2,026 patients undergoing angioplasty within 72 hours of arriving in a hospital with unstable angina or a heart attack. As soon as possible after their arrival, patients were enrolled and received fondaparinux 2.5 mg daily. Patients who required angioplasty were then randomized to low fixed dose heparin or standard dose heparin with activated clotting time (ACT) guidance during angioplasty. The low fixed dose UFH regimen consisted of a dose of 50 U/kg irrespective of use of GP IIb/IIIa inhibitors (another group of drugs used to prevent clots at time of angioplasty). The standard dose UFH regimen consisted of a dose of 85 U/kg or 60 U/kg when GP IIb/IIIa inhibitor used, adjusted by blinded ACT.

The low dose regimen did not reduce the risk of major or minor bleeding or vascular access complications compared to standard dose regimen. The low dose regimen did not lower the risk of major bleeding but did lower minor bleeding by 60 per cent. There was a trend, however, for higher risk of death, myocardial infarction or target vessel revascularization with low dose vs. standard dose UFH. The rates of catheter thrombosis were very low (0.5 per cent and 0.1 per cent in the low and standard dose UFH groups). In the standard dose arm, only about one in five patients required an additional UFH bolus to reach target ACT.

Tinnitus study looks for cure to 'ringing in the ears'

Wed, 11 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The NIH has granted a University of Texas at Dallas researcher and a university-affiliated biomedical firm $1.7 million to investigate whether nerve stimulation offers a long-term cure for tinnitus.

Described as a ringing in the ears, tinnitus affects 20 percent to 40 percent of recently returned military veterans and about 10 percent of all people over 65 years old. The U.S. Veterans Administration spends about $1 billion a year in disability payments related to tinnitus, said Dr. Michael Kilgard, associate professor in UT Dallas' School of Behavioral and Brain Sciences. The disorder causes mild irritation for some people but is disabling and painful for many others.

Kilgard will use his portion of the grant, $448,000 over two years, to continue testing whether vagus nerve stimulation (VNS) can retrain the brain to ignore the nerve signals that simulate ringing. The researchers in earlier tests found that VNS stimulation, when paired with the presentation of alternative tones, appeared to reverse the effects of tinnitus.

We're glad to get an opportunity to further our research on tinnitus, Kilgard said. This grant will support advances in our understanding of VNS treatment, and it will move the technological development forward so we can better deliver that therapy to patients.

The researchers plan to change the pattern for stimulation, increasing the frequency to see if more intensive therapy might reverse the effects of tinnitus faster. The primary aim of the new research is to accumulate enough data to design clinical trials using VNS to treat tinnitus in human subjects in the United States.

VNS previously translated successfully to humans for the treatment of epilepsy, depression and other neurological disorders.

The new grant resulted from the NIH's partnership with the federal government's Small Business Innovation Research program (SBIR). Part of the grant will go to Kilgard and his work in the lab, and the other portion will further research by MicroTransponder, a biomedical start-up company that works in conjunction with UT Dallas researchers and has helped bring in more than $6 million in grants in the past two years.

MicroTransponder is attempting to develop a less invasive method for delivering the electric charge that stimulates the vagus nerve in the neck. Currently, Kilgard uses wires attached to the neck to stimulate the nerve. The goal is to create a remotely controlled device similar to the technology used for toll tags on highways, Kilgard said.

Will Rosellini, a PhD student in neuroscience at UT Dallas, is CEO of MicroTransponder. Dr. Larry Cauller, associate professor of neuroscience, developed the neural interface technology that led to MicroTransponder. He is the company's chief science officer.

For medical devices, the ultimate goal is to have the least invasive procedure possible, but this is usually accomplished in an iterative fashion, with each new version being less invasive than the past, Rosellini said. The eventual goal is to have our SAINT System be injectable via a needle, but there are several intermediary versions of the device that must be developed and thoroughly tested before that will be possible.

Rosellini said Dr. Roger Miller, a scientific program director at the National Institute on Deafness and Other Communication Disorders, has been a champion of MicroTransponder's efforts to use VNS to combat tinnitus. Kilgard said Miller has been extremely helpful in advancing the new therapy closer to a clinical reality.

The VNS treatment would be an improvement over current therapies involving medications or counseling because it offers a possible permanent end to the condition, an actual cure instead of just a treatment, Kilgard said. Current therapies have limited success and frequently must be modified over time because they cease to be effective.

MicroTransponder and Kilgard now are working with researchers in Belgium to set up a protocol for conducting the first round of tests in humans. Less than half of therapies that are successful in animals prove successful when tested on people, Kilgard said.

We want to find out as much as we can about how well this works in rats. That is what this phase of the research is about, he said. Once we have that additional data, we can try out a similar therapy on humans, and we hope to find this offers a permanent end to their tinnitus discomfort.

Dr. Bert Moore, dean of the School of Behavioral and Brain Sciences, said UT Dallas' relationship with MicroTransponder continues to yield results.

The story behind this research is a wonderful example of how investigators such as Drs. Cauller and Kilgard, exploring basic mechanisms of how the brain adapts and learns, can collaborate with corporate partners to develop new technologies to address a variety of human problems, he said. This is the goal of our research mission at UT Dallas, creating new knowledge so that we can impact and improve people's lives.

Toolkit allows anyone to test for ADA compliance

Mon, 19 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Twenty years after the signing of the Americans with Disabilities Act, there is finally a tool kit for non-experts to measure whether public facilities are in compliance.

This is designed to meet the needs of anyone who is reasonably intelligent but not necessarily a techie, explains Denis Anson, director of research for the Assistive Technology Research Institute (ATRI) at Misericordia University in Dallas, Pennsylvania, and the kit's developer.

The ADA-CAT (Americans with Disabilities Act - Compliance Assessment Toolkit) provides simple pass-fail assessments of ADA requirements. It comes in two parts: a physical kit with assessment instruments and a website which defines the features of an accessible and usable environment and provides just in time instruction on how to use the tools to measure features of the environment.

The kit costs around $500 and has been brought to market by the Augmentative and Alternative Communication Institute of Ohio and Pittsburgh, a non-profit organization. That cost includes one-year access to the website which is maintained by Misericordia University. After the purchase year, or for those who have not purchased the toolkit, a subscription to the website service costs $70 annually. Proceeds from the sale of ADA-CAT will be shared evenly between ATRI and the AAC Institute.

Mr. Anson says the market for the kit includes educators in the Occupational and Physical Therapy fields who teach others how to assess facilities for ADA compliance. It also includes managers of public facilities ranging from schools to independent living centers to public parks and county fair grounds. Disability support groups in communities could also make use of it.

Mr. Anson got the idea for the compliance assessment kits when he was teaching a course in environment assessment for Misericordia University's occupational therapy program.

Some of the standards for facilities accessibility are hard to grasp without actual demonstration, he says, and sometimes I would catch that 'deer in the headlights' look that all teachers get from time to time when we see that students aren't quite getting it. In the effort to find a better way to enable the students, I came up with instruments to help them test the difficult features more easily.

The items in the compliance assessment kit include the StoryStick, the Magic Slope Block, the Multitool, the Door Force Tool, the Font Guide, and the Key Torque tool. There are also sound and light level meters and a good old-fashioned measuring tape.

The Story Stick can do several things. It identifies barriers to wheeled accessibility along paths, in hallways and in rooms. Barriers than an able-bodied assessor might step over without noticing are reliably located by the Story Stick, Anson says. It also measures a wide range of heights required by ADA. If a wall outlet is too low, the Story Stick will tell you. Ditto if a toilet seat is too high. Is there enough room for a wheel chair to turn around? The Story Stick provides the answer.

Slopes are specified by the ADA in grade ratios such as 1:12 or 1:48. Those with limited facility in math may find assessing slopes difficult. The Magic Slope Block takes the difficulty out of the process. The Magic Slope Block provides a simple pass-fail test for all ADA-mandated slopes. In addition, it tests the maximum gaps between an elevator and the floor of a building or the maximum allowable gap in a grating that is part of an accessible path.

The ADA standards for accessible signage are very complex, and are described in terms of ratios that are based on the height of a letter. The ratios are complex enough that many sign makers cannot reliably interpret them. The ADA-CAT Font Guide helps determine whether signage is accessible. Although the allowable sizes are hard to figure without a tool, says Anson, the Font Guide allows an assessor to test whether the letter height, width, spacing and line-spacing meet the ADA guidelines, without performing any mathematical calculations. All the calculations are done by the tool in one, simple adjustment.

Is that fire extinguisher extended too far out from the wall? Does the height of water flow from a drinking fountain meet acceptable standards? The Multitool can determine that.

The Door Force tool measures whether a door is too hard to open or close. The key tool assesses the ability of a person with limited hand function to turn a key in a lock. The sound level and light level meters check whether sounds and illumination are in appropriate specified ranges. And the measuring tape marks the width of hallways and doors, the height of signage and barriers and clearances under desks and tables.

My goal is to change the world, Anson says, with objective standards that are easily determined through a series of yes-no, pass-fail answers that just about anyone can employ.

He emphasizes that the hardware is only half of the ADA-CAT. The website provides you with the checklists of what to measure and how to measure it. The website gives an objective measure of accessibility, and saves your results for future use.

Simple, accurate in-office tool predicts athletes at high-risk for ACL injury, study details

Sat, 17 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) PROVIDENCE, R.I. -- Previously, determining athletes at high-risk for ACL (anterior cruciate ligament) injuries required expensive and complex laboratory-based motion analysis systems, such as those used in creating video games. But a new study presented today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting, offers physicians a low-cost, in-office, tool to help identify athletes at increased risk.

ACL injuries are devastating to athletes, and the risk factor for female athletes is much higher, said Greg Myer, sports biomechanist at the Cincinnati Children's Hospital. In an earlier study, we used motion analysis systems to measure and calculate torques on ligaments which accurately predicted which athletes are high-risk, but this method was expensive, labor intensive and required sophisticated equipment. So in this study, we looked for a low-cost, in office, simpler method to predict which athletes are high-risk.

Unfortunately, women are two to eight times more likely to injure their ACL than men, according to recent studies. Researchers believe this may be due to differences in hormone levels on ligament strength and stiffness, neuromuscular control and fatigue, lower limb biomechanics, ligament strength, as well as a difference in neuromuscular control in women when landing jumps (women appear to have less hip and knee flexion or bending and land more knock kneed than men.)

The good news, according to Myer, is that those athletes who have the higher risk factors of increased knee torques or load are those who also benefit the most from the remedy of neuromuscular training in jumping, posture and building landing strength.

The simpler, lower-cost measure to predict high-risk athletes for ACL injury provides the next critical step to bridge the gap between expensive in-laboratory identification of injury and identification of these injuries in the doctor's office. The simplified method, which can be done in the doctor's office combines measuring the tibia or shin bone with a standard measuring tape and an athlete's weight in combination with motions of the knee during landing captured with standard camcorders. These simple factors can quickly identify young females who demonstrate a primary risk for ACL injury. The in-office method strongly correlated to the expensive laboratory method with variables that ranged from 0.87 to 0.98.

This method may be used as a training camp protocol in partnership with team clinicians or set up and run in the athletic training setting, said Myer. Current evidence indicates that athletes identified as high-risk for ACL injury using this approach are more responsive to neuromuscular training aimed at reducing this risk factor. This tool can also be used to get high-risk athletes into appropriate interventions to further reduce their potential of injury risk which may increase both the efficacy and efficiency of future interventions aimed to prevent ACL injury in female athletes.

New joint program for high-risk pregnant women and their babies

Fri, 16 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The Children's Hospital and the University of Colorado Hospital (UCH) have finalized an agreement to jointly establish a center for advanced maternal fetal medicine offering state-of-the-art care for high-risk pregnant women and their babies.

The two leading academic medical centers have individually provided such services for more than three decades, and by building on already existing adult and pediatric expertise, they together will be able to provide unparalleled care and treatment for the region's most at-risk moms and babies.

The rapid development of technology and clinical innovation now enables caregivers to not only diagnose but also provide intervention for certain medical conditions before a baby is born. The ability to provide such interventions can reduce, and in some cases eliminate, the adverse consequences of many chronic diseases.

The new center initially will focus on babies needing highly-specialized surgical care within 72 hours of birth, and both mother and baby will be cared for at The Children's Hospital. Under the unique program, mothers who are carrying high-risk babies may receive their outpatient care and ultimately deliver at The Children's Hospital starting in early 2011. UCH will continue treating other serious neonatal conditions and high-risk mothers while also offering its routine labor and delivery services to more than 3,000 families each year.

The unique collaboration of research, education and clinical care that exists on the Anschutz Medical Campus allows for rapid clinical intervention by some of the most renowned providers in the world. Our multidisciplinary approach ensures the best possible outcomes for mother and child, said Children's President and CEO Jim Shmerling. Often, when it comes to treating these tiny patients, timing is everything.

This center will offer personalized support services to families that are unique to this region, including a Perinatal Mental Health Program to support mothers with post partum depression and a Fetal Concerns Program to provide support and education to families who have learned their unborn baby has a medical condition.

The high-risk mother-baby program in particular provides unparalleled care and treatment for mothers and their babies while offering them access to more coordinated medical specialties than any other program in the Rocky Mountain region, said Bruce Schroffel, president and CEO of University of Colorado Hospital. Formalizing the program recognizes the superior care that comes with combining the talents of the medical teams at both hospitals and proves to be an example of the unique specialty programs found only at the Anschutz Medical Campus, a point of destination for excellence in patient care, education and research.

Arthroscopic treatment of common hip problem allows athletes to return to play

Thu, 15 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Patients who undergo arthroscopic surgery for a mechanical disorder of the hip have a good chance of being able to return to their sport at a high level of competition, according to a study that will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, held July 15-18 in Providence, R.I. Almost 80 percent of patients were able to return to play after hip arthroscopy at an average of 9.4 months after surgery, and roughly 90 percent were able to return to the same level of competition.

This study demonstrates that there is high rate of return to pre-injury level of function with arthroscopic intervention, said Bryan Kelly, M.D., sports medicine orthopedic surgeon and co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery. Before this study we knew that hip impingement occurred in athletes, but we were not certain as to the degree of our ability to treat this arthroscopically with a successful return to full function. He says arthroscopic surgery provides a viable alternative to open surgery and may allow for a faster recovery without compromising ultimate function in appropriately selected patients. Dr. Kelly will be presenting the study (abstract 9291) at the AOSSM meeting.

In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis.

While this syndrome can affect anyone who is genetically disposed to develop the condition, symptoms often appear earlier in those who are athletic. Athletes with the syndrome often present with complaints of pain, decreased range of motion, and the inability to perform at a high level of competition. In athletic activities which require a high degree of motion and significant force through the joint, there can be earlier onset of symptomatic injury, Dr. Kelly said.

Previously, a few small studies had shown that hockey players could successfully return to play after undergoing arthroscopic surgery for FAI. To find out if this was the case with other athletes, investigators at HSS launched a study involving athletes from a variety of sports and in a much larger population. Investigators looked through the records of high level athletes at HSS who underwent arthroscopic surgery for FAI and had a minimum of one year of follow-up. Patients who had FAI in both hips were excluded.

Investigators reviewed demographic characteristics of the athletes, X-rays, and data collected during the operations. An independent blinded examiner recorded athlete's strength after the operation, range of motion, and complications. All patients completed questionnaires that measured hip-specific outcomes including the Modified Harris Hip Score (MHHS) and Hip Outcome Score. Investigators also collected information about how soon athletes were able to return to play, return to competition, and return to the same level of competition they were at before they started having problems.

In all, doctors scrutinized records of 47 patients; the average age was 22.8 years, with a range of 17 to 56 years. The average follow-up was 16.4 months. Athletes from a variety of sports were represented including ice hockey (11), soccer (7), baseball (6), swimming (4), lacrosse (4), field hockey (4), football (4), running (3), tennis (2), crew (1), and horse back riding (1). Slightly over half, 53.8%, were college varsity level athletes; 26.9% played varsity high school and 19.2% were professionals. Thirty-three patients or roughly 70% were available for follow-up.

X-rays showed an improvement in the anatomy of the hips, and investigators identified statistically significant improvements in the average MHHS scores before surgery, 68.6, compared with the post-op scores, 88.5. The MHHS score is a subjective outcome score that is used to measure the level of patient performance or ability to do certain activities on a scale of 1 to 100, with 100 being unlimited function and one not able to do anything, Dr. Kelly said. Hip Outcome Scores, also measured using a similar scale, also improved from 78.8 before surgery to 91.4 after surgery.

Seventy-eight percent of patients were able to return to play after hip arthroscopy at an average of 9.4 months after surgery, and 91.7% were able to return to the same level of competition. Only two patients were unable to return to competition due to persistent hip injury. Dr. Kelly says there are no large studies assessing return to play after open surgery for FAI, but it is thought that the results would definitely not be as good given that open surgery is much harder on the body.

The researchers say that arthroscopic treatment of FAI allows a large percentage of athletes to return to a high level of competition and is a good alternative to open surgery in the appropriate patient. This is important given arthroscopy surgery has a number of advantages over traditional open surgery. Although technically challenging, appropriately performed arthroscopic surgery results in less soft tissue trauma, less blood loss, shorter hospitalizations, and likely provides a faster return to a full recovery, Dr. Kelly said.

Improving clinical use of stem cells to repair heart damage

Tue, 13 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Presenting at the UK National Stem Cell Network annual science conference today(13 July), Professor Michael Schneider describes a new approach to treating heart attack and cardiomyopathy using stem cells.

Professor Schneider, British Heart Foundation Professor at Imperial College London, said Recent clinical trials using stem cells to treat heart damage have been successful in terms of safety but unfortunately the bone marrow stem cells used tend to give only a small improvement in how well the heart is pumping.

We really want to use stem cells from the patients themselves that we know can give rise to beating heart cells and these are not found in bone marrow. The good news is that we're now finding ways to identify and purify such cells.

Around 1000 patients have been treated in approximately 20 trials worldwide, mostly using bone marrow stem cells or derivatives of bone marrow cells to repair damage caused by heart attack. There has also been a significant body of work looking at ways of producing beating heart cells from stem cells. The best proven approaches to creating new beating heart cells are using embryonic stem cells, induced pluripotent cells and heart-derived stem cells.

Professor Schneider continued: Using heart-derived stem cells to treat heart attack and cardiomyopathy has some advantages over embryonic and induced pluripotent cells as they are potentially safer. It's also notable that of these three cell types, it's only heart-derived cells that are in current human clinical trials for this sort of treatment.

The biggest challenge is to make an ideal product for transplant, which would be either a mixture of heart muscle- and blood vessel-forming cells or a pure population of some sort of precursor that could give rise to both muscle and blood vessel cells.

Professor Schneider's team have discovered a way to identify heart stem cells so as to purify them for transplant. They first developed the method in mice and although the identifying markers are quite different in human cells, they have been able to successfully map their knowledge from mice onto humans. This research is funded by the British Heart Foundation, the European Research Council, the European Union (through the EU FP7 CardioCell consortium), the Leducq Foundation and the Medical Research Council.

Professor Schneider said We've developed a method to identify cells that have three important characteristics: They are definitely stem cells; they have the right molecular machinery turned on in order to become heart muscle or blood vessel; and they don't yet have any of the full characteristics of heart muscle or blood vessel cells such as producing cardiac myosin - an important protein in heart muscle cells.

The next stage of the research is to develop this technique into a method for extracting, purifying and multiplying heart stem cells in the clinic to be used to repair heart damage arising from heart attack or cardiomyopathy. Professor Schneider's laboratory uses advanced robotics, automated microscopy and other high-throughput methods to screen many thousands of experimental conditions in order to devise the best ways to grow the cells and instruct them to go down the route of becoming heart muscle.

New surgery improves outcomes for severe flat foot deformity

Thu, 08 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A surgery developed at Hospital for Special Surgery can improve patient outcomes in individuals with severe adult flat foot deformity, a problem that is increasingly being seen inhospitals across the country. Patients who undergo the new surgery have better long-term outcome and mobility than those who undergo traditional surgery. The paper will be presented at the annual meeting of the American Orthopaedic Foot and Ankle Society (AOFAS, abstract 348) in National Harbor, Md., on July 8.

Before this study, we were not sure whether you could salvage patients with flat foot and ankle deformity and correct their ankle as well as their foot deformity, said Jonathan Deland, M.D., chief of the Department of Foot and Ankle Surgery at Hospital for Special Surgery (HSS). Now we know that with this technique you can save the ankle, and it provides a correction of the deformity even at nine years after surgery. Dr. Deland developed the surgery and is senior author of the study.

Adult acquired flat foot deformity is basically a severe type of flat foot that develops for unknown reasons in individuals who have had flat feet all their life. It is more prevalent in women and those who are overweight, and it usually develops in individuals in their 40s and 50s. In stage I of the deformity, the tendon that runs along the inside of the ankle begins to degenerate. In stage II, the arch starts to fail, and a person develops a more severe case of flat foot. As the arch continues to collapse and the flat foot becomes more pronounced, mobility becomes difficult, and the foot becomes stiff, which is considered stage III.

In the most severe stage, stage IV, the ankle starts tilting and is at risk of developing arthritis as a result of the deformity. These people have tremendous flat foot to the point that their ankle is involved, said Scott Ellis, M.D., foot and ankle orthopedic surgeon at HSS and first author of the study. In these people, the extreme flat foot has injured the deltoid ligament, a strong, flat triangular ligament that is located on the inside of the ankle that provides support to prevent the ankle from over pronating. In stage IV, the deltoid ligament has become stretched and incompetent, which is what allows the ankle to tilt.

If the ankle deformity is severe and symptomatic enough, then surgeons either perform an ankle replacement, which is very difficult, or, more commonly, fuse the ankle. The fusion is not ideal because it takes all the motion away in the ankle in a patient who already has a foot problem, Dr. Ellis said. Imagine walking without motion in your ankle. It changes your gait and it leads to arthritis in the other joints of the foot over time, eight to 10 years down the line, because you start having to use those joints to take up the slack of motion that is not occurring in the ankle.

In the new surgery for stage IV deformity developed at HSS, surgeons not only reconstruct the flat foot deformity, but they also reconstruct the deltoid ligament using a tendon that runs along the outside of the calf called the peroneus longus. A person can function without their peroneus longus. Alternatively, the peroneus longus can be kept and a cadaver tendon used.

In the study presented at the AOFAS meeting, HSS investigators conducted the new surgery in five patients, four men and one woman, and monitored the surgery's success. The mean age was 67 years. Patients underwent X-rays that showed the surgery improved the alignment in the ankle and the effects were long-lasting. The X-rays showed the maintenance of the correction of the tilt. The alignment was still improved nine years later, Dr. Ellis said. Patients had excellent mobility at eight to 10 years following the surgery and none of the patients had arthritis.

Doctors also measured outcomes through several questionnaires including the Foot and Ankle Orthopedic Survey, an outcome scale that assessed 42 items divided among six categories. The average FAOS scores were 61.4 for symptoms, 1.5 for stiffness, 78.3 for pain, 87.9 for function/daily living, 71.7 for function/sports/recreational activities, and 42.1 for quality of life. The FAOS scores were good, Dr. Ellis said.

Patients were asked how far they could walk in blocks or miles and the cohort of patients was able to walk an average of 25 blocks (range 10 to 40), equivalent to 1.25 miles, after surgery. Two patients continued to play golf without significant problems, another exercised regularly on a treadmill, one was involved in circuit training, and the final patient played volleyball, although he did notice some stiffness. All patients reported they were satisfied with the procedure and, given the result, would have the operation again.

Dr. Ellis says he thinks the new surgery may be increasingly useful with stage IV flat foot deformity. No surgeons that the authors know of at other hospitals are currently using the surgery. The procedure is expected to become more popular. I see a lot of this deformity in my office. It's one of the major problems I deal with, Dr. Ellis said, pointing out that it is very prevalent.

Ovarian transplantation restores fertility to old mice and also lengthens their lives

Tue, 29 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Rome, Italy: Scientists have discovered that when they transplant ovaries from young mice into aging female mice, not only does the procedure make the mice fertile again, but also it rejuvenates their behaviour and increases their lifespan. The question now is: could ovarian transplants in women have the same effect?

Dr Noriko Kagawa will tell the 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome today (Tuesday) that successful ovarian transplants increased the lifespan of the mice by more than 40%. At present ovarian transplants are performed with the aim of preserving a woman's fertility after cancer treatment for instance, or of extending her reproductive lifespan. However, the completely unexpected extra benefit of fertility-preserving procedures in our mouse studies indicates that there is a possibility that carrying out similar procedures in women could lengthen their lifespans in general, she said.

A very small number of women in the world have had ovarian transplants, and some have been more successful than others. Dr Kagawa stressed that there was still a lot of research to be carried out before it would be known whether ovarian transplants had similar, rejuvenating effects in women, particularly as it would involve waiting for many years until the patients became older.

Dr Kagawa, Associate Director for Research at the Kato Ladies' Clinic in Tokyo (Japan), told the conference that she and her colleagues had conducted two mouse experiments. In the first, both ovaries were removed from young female mice (about 140 days old), and transplanted in to six older mice (aged over 525 days) that were too old to be fertile any more. In the second experiment, only one ovary was removed from the young mice (about 170 days old) and transplanted into eight aged mice (over 540 days old). The average normal lifespan for this particular breed of mice (C57BL/6J) is 548 days, and they normally reach a mouse menopause at about 525 days old.

All the mice that received transplants in both experiments became fertile again, while control mice that had not received transplants did not. In the first experiment the mice resumed normal reproductive cycles that lasted for more than 80 days, and in the second experiment, they lasted for more that 130 days.

Dr Kagawa said: All the mice in both experiments that had received transplants resumed the normal reproductive behaviour of young mice. They showed interest in male mice, mated and some had pups. Normally, old mice stay in the corner of the cage and don't move much, but the activity of mice that had had ovarian transplants was transformed into that of younger mice and they resumed quick movements. Furthermore, the lifespan of the mice who received young ovaries was much longer than that of the control mice: the mice that had received two ovaries lived for an average of 915 days, and the mice that had received one ovary, for an average of 877 days. The newest of our data show the life span of mice that received transplants of young ovaries was increased by more than 40%.

The results show that transplanted normal ovaries from young mice can function in old, infertile mice, making them fertile again, but, in addition, extending their lifespan. Women who have ovarian tissue frozen at young ages, perhaps because they are about to embark on cancer treatment, can have their young ovarian tissue transplanted back when they are older. Normally we would be doing this simply to preserve their fertility or to expand their reproductive lifespan. However, our mice experiment suggests that this might also improve overall longevity. Further research has to be conducted before we can know whether or not this is the case.

Dr Kagawa said it was not known why the ovarian transplant increased the lifespan of the mice, but it might be because the transplants were prompting the continuation of normal hormonal functions.

She and her colleagues have been collaborating for the past six years with Dr Sherman Silber, from St Luke's Hospital, in St Louis, Missouri (USA), who has performed a number of successful ovarian transplants in women, either because they were about to be treated for cancer or because they had not yet found the right partner in life. Their future collaborative research will include investigating whether it is possible for a woman to have a transplant using an ovary that is not her own and with minimal drugs to suppress the body's natural immune response to what it perceives as a foreign body. They are also looking at culturing follicles in ovarian tissue in the laboratory in order to obtain mature eggs that can be used for IVF.

In the meantime, the researchers believe it is very important for doctors and patients to know that women have options when faced with cancer treatment that could destroy their fertility. We have been successful in getting frozen ovaries to function completely normally after thawing and transplantation, said Dr Kagawa. So this should no longer be considered an 'experimental' procedure. Ovarian transplantation is the proper and necessary accompaniment to otherwise sterilising treatment for young cancer patients. We must not neglect to freeze and save at least one of their ovaries before cancer treatment.

New possibility to determine the severity of appendicitis

Mon, 21 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The symptoms of appendicitis are often diffuse and it can be difficult to obtain an accurate diagnosis early in the course of the disease. It may be possible to predict the severity from a blood sample, and in this way determine the treatment on an individual basis. This is the conclusion of a thesis presented at the University of Gothenburg, sweden.

We don't know what causes appendicitis. There is evidence that the cause may be multi-factorial, since some patients gets a perforated appendix while the course is less severe in others. The course of the disease is unpredictable and typical symptoms do not appear in a third of cases. It would be better, says Anna Solberg, one of the scientists at the Fibrinolysis Laboratory at the Sahlgrenska Academy, and specialist at the Surgical Clinic at Sahlgrenska University Hospital, if we didn't treat all patients in the same way. Each case is unique.

Patients often are sent for surgery to be on the safe side, only to discover that the appendix was not inflamed. It is possible that antibiotics or observation alone would have been sufficient in many cases, and the patients would not have needed to undergo surgery. But the appendix perforates in 20% of patients leading to an increased risk for complications such as wound infections, abscesses in the abdominal cavity and the formation of adhesions, which can in turn lead to bowel obstruction and further surgery.

The work presented in the thesis shows how enzymes known as proteases, which break down tissue, are distributed at and around the region which the appendix has perforated. Tissue samples have been taken at different grades or stages of appendicitis in order to investigate whether the quantities of proteases are correlated with the severity of the inflammation, says Anna Solberg.

The results show that there is an imbalance between the proteases and the anti-protease, TIMP-1, with the task to inhibit the enzymes that break down tissue. It turns out that this imbalance is important for how damage to the tissue can lead to perforation of the appendix.

This means that we know more about the molecular mechanisms behind the process that can lead to a perforated appendix, says Anna Solberg.

Furthermore, TIMP-1 reflected the degree of inflammation in the blood at the time for surgery. It is possible that a blood sample measuring the amount of TIMP-1 could become a part of the clinical diagnostic process in the future, and thus determines the severity of the inflammation. However, Anna Solberg points out that more studies with repeated blood samples taken during the course of the disease are required.

I plan to continue research in the field in order to see whether TIMP-1 can function as a marker of inflammation, in order to determine the diagnosis and predict the disease course. This could lead to more focussed surgery, fewer complications and shorter hospital stays, and it could improve the possibility of giving individual treatment, which also considers the risk of increased resistance to antibiotics.

Hip exercises found effective at reducing, eliminating common knee pain in runners

Fri, 04 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A twice weekly hip strengthening regimen performed for six weeks proved surprisingly effective at reducing -- and in some cases eliminating -- knee pain referred to as patellofemoral pain (PFP) in female runners.

The study by Tracy Dierks, assistant professor in the Department of Physical Therapy at Indiana University-Purdue University Indianapolis, was based on the theory that stronger hips would correct running form errors that contribute to PFP, even though study participants were given no instruction in gait training. The study used a pain scale of 0 to 10, with 3 representing the onset of pain and 7 representing very strong pain -- the point at which the runners normally stop running because the pain is too great. The injured runners began the six-week trial registering pain of 7 when they ran on a treadmill and finished the study period registering pain levels of 2 or lower; i.e. no onset of pain.

I wasn't expecting such huge reductions, to be honest, Dierks said. We've had a couple of runners who have been at level 2, but the overwhelming majority have been a 2 or below.

PFP, one of the most common running injuries, is caused when the thigh bone rubs against the back of the knee cap. Runners with PFP typically do not feel pain when they begin running, but once the pain begins, it gets increasingly worse. Once they stop running, the pain goes away almost immediately. Dierks said studies indicate PFP essentially wears away cartilage and can have the same effect as osteoarthritis. His study participants showed many of the classic signs of PFP, the most prominent being their knees collapsing inward when running or doing a squat exercise move.

The pilot study thus far involved five runners and a control group that comprised another four runners. Hip strength measurements were taken before and after the runners in the control group maintained their normal running schedule for six weeks. Hip strength measurements were taken for all of the runners before and after the next six-week period in which they all performed the hip-strengthening exercises. The exercises, performed twice a week for around 30 to 45 minutes, involved single-leg squats and exercises with a resistance band, all exercises that can be performed at home. This study is part of an ongoing study involving hip exercises and PFP pain, with 11 runners successfully using the intervention. Dierks said he plans to seek funding to test the exercises on a larger group of runners.

Earlier research had focused on the feet as a possible root of PFP, with studies only recently looking more closely at the hips. Dierks said studies have found an association between PFP in women and weak hips, but his study is the first to test a possible treatment. He noted that PFP is considered multi-factorial, so his study is examining one of several possible causes of the pain.

Some patients with hepatitis B faring better after liver transplant

Tue, 04 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) ROCHESTER, Minn. -- Treatment to reduce recurrence of hepatitis B appears to improve liver transplant outcomes for some patients, according to a Mayo Clinic study presented at the American Transplant Congress under way May 1-5 in San Diego.

We found that in patients with hepatitis B, the number of patients who were listed for a second transplant within three years decreased by 50 percent between 1996 and 2005, says Ray Kim, M.D., the senior investigator of the research team.

Hepatitis B infection is a major cause of liver damage that can eventually lead to end-stage liver disease and the need for a liver transplant. In the past, hepatitis B recurred in some transplant patients, causing liver damage and the need for a second transplant.

In the past 10 years, new medications have improved our ability to control hepatitis B, says Dr. Kim. Today, transplant recipients routinely are treated with antiviral therapy and hepatitis B immune globulin to reduce the risk of recurrence. We wanted to know if the medication protocols were making a difference in patient outcomes, he says.

Researchers reviewed data provided by the Organ Procurement and Transplantation Network of 31,242 liver transplants in the United States. The underlying reasons for transplantation were categorized as hepatitis B, hepatitis C or other.

From 1996 to 1998, 6.5 percent of liver transplant patients with hepatitis B were listed for a second transplant. For 2003 to 2005, the number of liver transplant patients with hepatitis B listed for a second transplant was 3.3 percent -- roughly a 50 percent reduction.

For patients with hepatitis C or other underlying liver disease, there were smaller declines in relisting numbers. Preventing recurrence of hepatitis C has proved to be more challenging than preventing recurrence of hepatitis B, says Dr. Kim.

Over the same periods, mortality rates increased for all three groups. For patients with hepatitis B, the death rate was 10.8 percent from 1996 to 1998. The rate increased to 12.8 percent for 2003 to 2005.

Our results show that transplant outcome is consistently improving for patients with hepatitis B with a significant decrease in need for second transplants, says Dr. Kim. The increases in mortality rates are concerning. The incidence of liver cancer has increased and it may explain some of the mortality. However, more work needs to be done to understand the reasons.

Dr. Kim says the study results are significant because an estimated 800,000 Americans have hepatitis B. That number is likely an under-representation, he says. In some U.S. immigrant communities, which often are excluded in disease tracking national surveys, the hepatitis B infection rate is 5 to 15 percent.

Those high numbers portend a continued high demand for liver transplants. In the United States, nearly 16,000 people are waiting for liver transplants.

Study shows liver transplant center impacts patient outcomes

Sun, 02 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) ROCHESTER, Minn. -- For patients in need of a liver transplant, their choice of a transplant center can make a noteworthy difference in their outcomes, according to a Mayo Clinic study presented at the American Transplant Congress under way May 1-5 in San Diego.

We did find significant variation between centers in patient outcomes in the first year after transplant, says Ray Kim, M.D., one of the lead investigators on the study. Previous studies have looked at outcomes based on factors about the recipients and donors involved, but no known previous study has focused on what effect the transplant center could have on patient outcomes.

Researchers documented an average 30 percent difference in risk for failed transplant between centers. Between centers with the best and worst outcomes, there may be as much as a fourfold difference in risk. Failed transplant was defined as either patient death or the need for a subsequent liver transplant within a year. Though one intuitively expects a certain amount of difference between centers, this effect seems larger than previously thought. The bottom line for patients: do your homework before selecting a transplant center, he says.

But transplant center size alone, measured in patient volume, didn't account for the difference in outcomes. Results showed that the number of transplants performed didn't materially affect outcomes, says Dr. Kim. This implies the largest center won't necessarily have the best results. Similarly, a smaller center may deliver similar outcomes.

Using data from the Organ Procurement and Transplantation Network, Mayo Clinic researchers reviewed data from 12,233 patients who received liver transplants to treat chronic liver disease. The data included transplants performed at more than 100 U.S. hospitals that performed at least one liver transplantation surgery from 2005 to 2008.

Of those transplants, 15 percent failed within a year. The outcome differences between transplant centers were greatest during the first three months post-transplant.

Data used in the study was combined and analyzed without naming the transplant centers. The goal of the research is not to point fingers, says Dr. Kim. The study was undertaken with the hope of finding ways for the transplant community to make the best use of a very limited resource, namely the donated organs. The data clearly showed that where the transplantation is done makes a difference whether the outcome of a transplant will be successful. In the United States, nearly 16,000 people are waiting for liver transplants.

Dr. Kim notes that there may be several ways transplant center factors can affect transplant outcomes. The most immediate factor is quality of care provided at the center, including surgical, medical and nursing expertise. In addition, how patients and donor organs are selected for transplantation also contributes to the outcome. And last, where the center is located geographically has a substantial impact on availability and quality of donated organs.

Strategy to help doctors determine when to treat retinopathy of prematurity

Thu, 29 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (April 29, 2010) -- Scientists have shown that through eye examinations, doctors can identify infants who are most likely to benefit from early treatment for a potentially blinding eye condition called retinopathy of prematurity (ROP), resulting in better vision for many children.

These long-term results of the Early Treatment for Retinopathy of Prematurity (ETROP) study confirm that the visual benefit of early treatment for selected infants continues through six years of age. The research is published in the April 12 online issue of Archives of Ophthalmology and was supported by the National Eye Institute (NEI), part of the National Institutes of Health. The Edward S. Harkness Eye Institute at NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian/Morgan Stanley Children's Hospital were among the 26 participating study sites.

We showed that early treatment for high-risk premature babies can improve their vision. This research promises to transform the way babies with ROP are treated, says Dr. John Flynn, study principal investigator and the Anne S. Cohen Professor of Clinical Pediatric Ophthalmology at Columbia University College of Physicians and Surgeons and an ophthalmologist at NewYork-Presbyterian/Morgan Stanley Children's Hospital and professor of medicine at Weill Cornell Medical College.

We showed there isn't a single treatment strategy that works for all infants with ROP, but rather that doctors need to determine whether the baby has a mild or severe form of the disease before proceeding with retinal surgery, adds study co-author Dr. Michael Chiang, associate professor of ophthalmology at Columbia University College of Physicians and Surgeons and an ophthalmologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. This can be determined with a simple bedside exam using an ophthalmoscope to look at blood vessels in the retina.

An estimated 15,000 premature infants born each year in the United States are affected by some degree of ROP. At-risk infants generally are born before 31 weeks of the mother's pregnancy and weigh 2.75 pounds or less.

This disease, which usually develops in both eyes, is one of the most common causes of vision loss in children. About 90 percent of infants with ROP have a mild form that does not require treatment, but those who have a more severe form can develop lifelong visual impairment, and possibly blindness.

During pregnancy, the blood vessels of the eye gradually grow to supply oxygen and essential nutrients to the light-sensitive retina. If a baby is born prematurely, growth of the blood vessels may stop before they reach the edge of the retina. In these newborns, abnormal, fragile blood vessels and retinal tissue may develop at the edges of the normal tissue. The abnormal vessels can bleed, resulting in scars that pull on the retina. The main cause of visual impairment and blindness in ROP is retinal detachment. Laser therapy or cryotherapy, using freezing temperatures, are the most effective treatments to slow or stop the growth of abnormal blood vessels.

Previously, doctors treated infants with ROP when they estimated their risk for retinal detachment to be 50 percent, a strategy developed through the NEI-supported Cryotherapy for Retinopathy of Prematurity study. Although this was a major finding, many infants still went on to develop severe eye disease. Therefore, the first phase of the ETROP study aimed to discover if doctors could identify infants at a higher risk for progression of the disease and intervene early to improve their vision.

In 2003, the ETROP study found that early treatment -- upon diagnosis as higher risk for severe ROP -- improved the vision and retinal health of certain infants after nine months. These infants had dilated or twisted blood vessels in the retina and substantial growth of new blood vessels, classified as Type 1 disease. Eyes with Type 2 ROP, or a more moderate amount of new blood vessel growth, did not benefit from early treatment. Doctors could predict which infants were more likely to benefit from early treatment by identifying certain eye characteristics, such as the appearance and location of the blood vessels.

The current study followed the same 370 children through six years of age, when researchers checked their vision and examined the development of their eyes. The nine-month study recommendations were confirmed through six years. Type 1 eyes benefitted from early treatment, and Type 2 eyes had similar results with either early treatment or treatment at the standard time. Seventy-five percent of the early-treated Type 1 eyes were spared legal blindness, compared with 67 percent of Type 1 eyes that received treatment at the standard time. Of the Type 2 eyes that were carefully monitored for disease progression through the standard protocol, more than half improved without treatment.

Nutrition researchers to develop new growth charts for children with Down syndrome

Thu, 22 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Parents and doctors have known for a long time that children with Down syndrome tend to grow more slowly and are considerably shorter than most other children. But pediatricians needing to record growth milestones at regular office visits have an outdated set of growth charts based on data collected more than 25 years ago. Since that time, there have been major advances in the medical care of children with Down syndrome. In addition, the demographics of the general U.S. population have changed, and children are taller, but also more overweight.

Now researchers at The Children's Hospital of Philadelphia will be measuring children with Down syndrome from birth to age 21 to develop updated growth charts. A four-year, $1.2 million grant from the Centers for Disease Control and Prevention (CDC) is supporting this effort, which brings together experts from the Hospital in growth and nutrition, Down syndrome (also called trisomy 21), and general pediatrics.

One of the most common birth defects, Down syndrome occurs in approximately one in 700 births. The National Down Syndrome Society estimates that there are more than 400,000 people living with Down syndrome in the U.S. It is a genetic disorder, usually resulting from having three copies of chromosome 21, instead of the usual two copies.

Because the extra chromosome generally occurs in every cell in the body, it can affect many different systems, causing congenital heart disease, recurrent ear and sinus infections, hearing loss, thyroid disorders, visual impairment, and gastrointestinal disorders. Neurological effects include developmental disability, which can range from low-average abilities to severe intellectual impairment.

The past 20 years have seen significant improvements in the care of children with Down syndrome, accompanied by longer life expectancy, said the grant's principal investigator, Babette S. Zemel, Ph.D., director of the Nutrition and Growth Laboratory at The Children's Hospital of Philadelphia. We believe that children with Down syndrome are growing better now than they were 20 years ago. We also want to look at how they are growing throughout childhood, from infancy to young adulthood, at how body mass index changes across time, and how that relates to body fat composition.

If we can better understand the growth patterns and the rates of other illnesses that co-occur with Down syndrome, researchers may be better able to plan treatment and design preventive health programs, added Zemel. The CDC has recognized updated growth charts as an important tool for people providing health care to children with Down syndrome. In its grant guidelines, the CDC states that new growth charts produced from the study will be broadly distributed free of charge.

Under the grant, Zemel and colleagues will recruit approximately 600 children with Down syndrome, from birth to 20 years old, from Southeastern Pennsylvania, New Jersey and Delaware. In regularly scheduled follow-up visits, the researchers will measure the patients' growth and body dimensions and collect data about their health, dietary patterns and physical activities.

In addition to developing more representative growth charts, we also expect to better understand what factors may contribute to growth-related problems in children with Down syndrome, added Zemel. Another important goal is to develop a screening tool for identifying children at risk for overweight and obesity, which are common concerns for adolescents and young adults with Down syndrome.

New studies on surgical options in inherited breast cancer show drastic treatment is not always best

Fri, 26 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Two studies to be presented at the seventh European Breast Cancer Conference (EBCC7) in Barcelona today (Friday) and tomorrow (Saturday), shed light on the treatment options facing women carrying the BRCA1 and BRCA2 genetic mutations which predispose them to breast cancer. In the first, Ms Annette Heemskerk-Gerritsen, a PhD student in the Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands, will tell the conference this afternoon (Friday) that prophylactic mastectomy (where women who have been treated for breast cancer in one breast have the remaining breast tissue removed as a risk-reducing measure) does not improve disease-free or overall survival in this group of patients.

In the second, to be presented to the conference tomorrow (Saturday) Professor Lori Pierce, Professor of Radiation Oncology at the University of Michigan, Ann Arbor, USA, will report the findings of an international study of treatment outcomes after either breast conserving therapy (BCT) or mastectomy in 655 BRCA1 and BRCA2 carriers. The study found more recurrences in the breast with BCT compared to recurrences at the chest wall following mastectomy, but similar rates of recurrence when BCT patients also received chemotherapy.

Women who carry a mutated BRCA1 or BRCA2 gene have a risk of between 55% and 85% of developing cancer in their lifetime, and those who do develop it have to make difficult decisions about their treatment, often opting for the most radical therapy in the belief that they will have a better chance of overcoming their disease. Until now there has been little data on the longer-term effects of such treatments on these patients.

Ms Heemskerk-Gerritsen and her team looked at the efficacy of risk-reducing mastectomy (RRM) on disease-free and overall survival in 390 patients who carried the BRCA1/2 mutation and who had already had cancer in one breast. Of these, 138 patients underwent RRM, while the others continued regular surveillance. There were no differences in age at diagnosis, hormone-receptor status, and adjuvant hormonal treatment between the RRM and non-RRM groups. The numbers of women receiving adjuvant chemotherapy as well as numbers of women undergoing risk-reducing salpingo-oophorectomy (removal of the fallopian tubes and ovaries) were higher in the RRM group.

During 2033 person years observation (PYO - the total sum of the number of years that each member of the study population has been under observation), 54 patients in the non-RRM group developed metastatic disease as opposed to 18 patients during 642 PYO in the RRM group, incidence rates of 0.027 and 0.028 respectively. As for overall survival, 56 women in the non-RRM group died during 2164 PYO, and 16 in the RRM group during 682 PYO, mortality rates of 0.026 and 0.023, respectively.

While RRM obviously reduces the incidence of breast cancer in the other breast to zero, as opposed to 66 cases in the non-RRM group, we found that there was very little difference in disease-free and overall survival between the two groups, says Ms Heemskerk-Gerritsen. We intend to follow up this study by identifying a set of prognostic factors related to survival in breast cancer patients with a BRCA1 or BRCA2 mutation. In this way, we hope to be able to identify a subgroup of patients who may benefit from RRM. In the meantime, we hope that our findings will provide additional information to improve the counselling of breast cancer patients considering risk-reducing mastectomy, by emphasising that the gain that may be obtained by this radical surgery is mainly in respect of reducing the risk of contralateral breast cancer. As yet we have found no benefits with respect to disease-free and overall survival.

Patients requesting prophylactic mastectomies overestimate their breast cancer risk

Thu, 25 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Women who have been diagnosed with breast cancer believe the risk of the disease occurring in their unaffected breast is as much as ten times higher than it actually is. As a result, they are choosing to have prophylactic mastectomies based on a false perception of increased risk, according to new research.

However, Mr Ajay Sahu MD, a consultant breast surgeon at the Frenchay Hospital (Bristol, UK), will tell the seventh European Breast Cancer Conference (EBCC7) today (Thursday) that if the women are given time to think and counselling to help them understand their actual risk, they often decide against a prophylactic mastectomy. The results of his research could lead to a reduction in the numbers of prophylactic mastectomies, as well as saving women from unnecessary side-effects caused by the treatment.

Mr Sahu reached his conclusions after conducting a study of 27 consecutive patients, aged between 31-65, who were diagnosed with breast cancer between April 2007 and October 2009, and who were having surgery on one breast but were requesting that the other breast should be removed too.

I set out to do this study because the incidence of contralateral prophylactic mastectomy was increasing in my unit, he said. I felt that the time of diagnosis was a moment of increased stress and not the right time to make such a decision. There are two aspects to this study. One is the patients' perception of risk at the time of diagnosis and the other is whether this perception can be influenced by deferring the decision-making process.

There is no evidence that women who have a single, small breast tumour or who are at low to moderate risk of developing a further breast cancer, gain any survival benefit from a mastectomy or a contralateral prophylactic mastectomy (removal of the other, unaffected breast). Yet these procedures are increasingly being accepted as patient choice and offered by clinicians who do not address the possibility of an inaccurate perception of risk as the reason behind their patient's request, said Mr Sahu. The incidence of contralateral prophylactic mastectomy has almost doubled in recent times without any evidence of survival benefit and the reasons for this need to be addressed and alternative strategies considered.

The reasons given by the 27 Frenchay patients for requesting a contralateral prophylactic mastectomy included: young age, but without a family history (three patients), lobular cancers (seven patients), family history, which was deemed low risk by the surgeon (12 patients), bad experience of treatment outcome among family or friends (four patients), and a desire to avoid radiotherapy (one patient). All the patients thought that they would not live longer than five years, and all overestimated their risk of contralateral breast cancer by a factor of five to ten.

Mr Sahu asked about the patients' perception of risk and the reason behind a request for prophylactic mastectomy at the time of diagnosis and then the operation was deferred. Breast care nurses counselled the patients at the time of diagnosis and when the post-operative results and plans for adjuvant treatment were discussed. The patients received adjuvant chemotherapy and/or radiotherapy and were followed up at six months by the breast care nurses and at 12 months by the surgeon. At the end of twelve months those who still requested prophylactic surgery were offered the operation.

However, at the end of the 12 months all the patients were less anxious about their risk. Four patients (three with a family history and one with lobular cancer) were happy with the actual risk but still asked for prophylactic surgery. The remaining 23 patients were pleased to have had the opportunity to rethink and chose not to have prophylactic surgery.

Mr Sahu said that the 12 months delay before any prophylactic surgery did not make the women more anxious. The 'cooling off period' actually helped to reduce anxiety (although we did not explore this specifically) and helped the women to be comfortable with the decision they made in the end. Patients were happy with the alternative strategy to prophylactic surgery: in other words, they had an understanding of actual risk of bilateral breast cancer, an understanding that the risk can be reduced by treatment and surveillance by annual mammography, and that no survival benefit is conferred by the operation.

Although this study is small and should be treated with caution at this early stage, the important message is that the patient's choice may be based on inaccurate overestimation of risk at the time of diagnosis, and, given time, they may not have the same risk perception later on. Healthcare professionals should be aware of this and offer a 'cooling off' period to facilitate appropriate decision-making. The study is continuing and when we have recruited more patients we hope to be able to make more definite recommendations.

Mr Sahu is continuing his research by studying the psychological aspects of patients' decision-making processes.

Using stem cells to mend damaged hips

Tue, 23 Mar 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Osteoporosis drug improves healing after rotator cuff surgery

Wed, 10 Mar 2010 05:00:00 PST

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

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

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

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

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

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

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

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

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

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

Patient and doctor expectations from joint replacement surgeries not always aligned

Wed, 10 Mar 2010 05:00:00 PST

( from http://www.rxpgnews.com ) While physicians strive to set realistic expectations for patients undergoing knee and hip joint replacements, a new study reveals that doctor and patient expectations are sometimes not aligned. The study, reported by Hospital for Special Surgery researchers at the American Academy of Orthopedic Surgeons held March 9-13 in New Orleans (poster P140), suggests that steps need to be taken to bridge the expectation gap.

This study is among the first to examine discrepancies in patient and physician expectation with joint replacement surgeries, according to Hassan Ghomrawi, Ph.D., MPH, outcomes research scientist, Biostatistics and Epidemiology, at Hospital for Special Surgery (HSS) in New York, who led the study.

The two joint replacement surgeries studied are known technically as total hip replacement (THR) and total knee replacement (TKR). These procedures are common in individuals over 50 and usually result from normal wear and tear that causes osteoarthritis. At Hospital for Special Surgery alone, nearly 4,000 THRs and 4,000 TKRs are performed each year.

At HSS, patients are required to attend a 90 minute class before surgery where they receive education from a specialized nurse about what they can expect during the surgery and recovery. A leader in offering such classes, HSS has been giving a preoperative class for many years. This practice is becoming a trend in big hospitals for this type of surgery, Dr. Ghomrawi said. The results from this study indicate that such classes could be refined and steps can be taken to use these classes to improve patient and physician dialogue.

In a study that compared expectations of 42 patients with their doctors through surveys, investigators found clinically meaningful disagreement in 68 percent of patients with 53 percent of the patients' expectations exceeding the expectations of the surgeons.

The take home message for the surgeon is that inexpensive, educational interventions like a preoperative class can be used to better align the patient's and the surgeon's expectations prior to surgery, said Alejandro Gonzalez Della Valle, M.D., associate attending orthopaedic surgeon at HSS, who was involved with the study. This may ultimately result in higher perceived outcome.

If a patient has unrealistic expectations that are not properly trimmed preoperatively or achieved after surgery, the patient will most likely be dissatisfied with some aspects of the final result. Conversely, if the patient has low expectations for function after surgery, it is likely that he or she will not enthusiastically engage in the different phases of the postoperative recovery including physically therapy. That patient will probably have a lower than expected functional result.

For the patient, the take home message is that it is paramount to discuss the expectations for pain relief and function with the surgeon and in the class before undergoing a total joint replacement to make sure that the expectations of the physician and the patient are similar, said Dr. Gonzalez Della Valle.

The study included patients who were scheduled to receive a hip or knee replacement by a dedicated hip and knee surgeon. Both patient and doctor completed either a THR or TKR recovery expectation questionnaire. The surveys involved various questions with a scale from 1 to 5, ranging from a 1 being return to normal, to a 4 being very little improvement, and 5 being I don't have this expectation.

The hip joint replacement survey had 18 questions involving improvement in psychological well-being, pain relief, ability to walk, ability to stand, getting rid of a limp, getting rid of a cane, ability to go up and down stairs, ability to raise from the sitting position, and improvement in social activities that range from working at a job or doing housework to recreation including the participation in sports. Other questions evaluated the mobility of an individual's hip such as whether a person could cut their own toenails.

The knee joint replacement survey had 19 questions involving improvement in psychological well-being, pain relief, ability to walk different distances, getting rid of a cane, going up and down stairs, kneeling, squatting, using transportation, the ability to be employed, and the ability to participate in recreation, social activities, sports, and sexual activity.

The numbers from each of the questions on the survey were then plugged into a formula that calculated a score ranging from 0 to 100, with 100 being the highest expectation. The study involved 25 patients undergoing THR and 17 patients undergoing TKR. Both patients and doctors completed surveys. The average surgeon expectation score was 75 (range 43 to 93) and the average patient expectation score was 84 (range 47 to 100).

We observed a lot of variability between what the surgeon expected and what the patient expected. In an ideal world, the expectations of the patient and the surgeon should be similar, Dr. Gonzalez Della Valle said.

Based on results from this pilot study, the National Institutes of Health has awarded Dr. Ghomrawi a five-year career development award. The hope is to be able to study the relationship between expectation discordance and several outcomes down the road, including rehabilitation outcomes at discharge, and six month and two-year follow-up functional outcomes, Dr. Ghomrawi said. We are trying to see which items of discordance are clinically meaningful. And then we want to use all this information to improve the doctorpatient dialogue as well as to reassess the class content, so that expectations are aligned.

The larger study will be more complex. We will try to analyze the discrepancies that different doctors may have for the same patient and that different doctors have between themselves when assessing the same patient, Dr. Gonzalez Della Valle said. What are the physician factors and patient factors that can predict higher or lower expectations? The goal of THR and TKR surgeries is to provide durable pain relief and improvement of function so that patients can go back to an enjoyable, productive life. We want to make patients satisfied. We know that hip and knee replacement operations are very successful. But we are trying to go a step further, looking at the psychology of the patient recovery.

Bypass procedure used during infant heart surgery does not impair later neurological outcomes

Tue, 26 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Congenital heart defects (CHD) are the most common birth defects in humans, affecting 8 per 1000 live births with one third of affected children requiring intervention in early infancy. Increasing numbers of survivors combined with developmental expectations for independence, behavioral self-regulation and academic achievement have led to a growing identification of neurobehavioral symptoms in some survivors. A study now suggests that a cooling technique often used in heart operations does not impair neurological outcomes.

Congenital heart disease and its treatment were originally thought to potentially increase neurologic injury in these patients. The technique of deep hypothermic circulatory arrest (DHCA) is used in order to repair these congenital cardiac defects by providing a bloodless surgical field, which may facilitate completion of the best physiologic repair, and decrease the duration of blood exposure to the bypass circuit. However, it involves a period of reduced blood flow in the brain. Cooling is a protective mechanism to reduce metabolism of the brain and other organs during periods of low blood flow.

Stephanie Fuller, M.D., a cardiothoracic surgeon at The Children's Hospital of Philadelphia, presented these research findings yesterday in the prestigious J. Maxwell Chamberlain Lecture at the annual meeting of the Society of Thoracic Surgeons in Fort Lauderdale, Fla. According to the study, DHCA does not impair language skills, attention, and other neurocognitive abilities in school-age children.

Dr. Fuller and colleagues from Children's Hospital and the University of Washington assessed the use of DHCA as a predictor of neurodevelopmental outcomes in children who had cardiac surgery as infants. The infants were enrolled in a prospective study of apolipoprotein-E (APOE) polymorphisms and neurodevelopmental outcome after cardiac surgery and underwent formal neurodevelopmental testing at four years of age.

Neurodevelopmental testing was completed in 238 out of 307 eligible patients. The surgeons used DHCA in 92 of those infants as deemed necessary to provide better operative exposure with a bloodless and less cluttered surgical field and therefore a shorter total cardiopulmonary support time. Use of DHCA was not predictive of worse performance for any neurodevelopmental outcome. Significant predictors of worse outcome included lower socioeconomic status, preoperative mechanical ventilation and babies that were younger and smaller at the time of first operation. Neurodevelopmental assessment included cognition, language skills, attention, impulsivity, executive function, social competence, and visual-motor and fine-motor skills.

Selective use of DHCA during cardiac surgery in infancy may facilitate operative repair and is not associated with impaired neurodevelopmental outcomes, said Dr. Fuller. Despite added risk factors, the selective use of DHCA during infancy for repair of congenital heart disease without an obstruction in the aorta was not predictive of worse performance at four years of age.

Dr. Fuller added use of DHCA as a support technique during cardiac surgery in infancy has many advantages; it is not necessary to sacrifice these advantages merely to avoid use of DHCA. Our study adds to the growing literature showing no adverse influence of limited periods of DHCA. New support techniques must be carefully evaluated prior to wide-spread acceptance to confirm they are not inferior to conventional management strategies.

Scientists shed new light on walking

Sun, 24 Jan 2010 04:59:36 PST

( from http://www.rxpgnews.com ) Researchers at the medical university Karolinska Institutet have created a genetically modified mouse in which certain neurons can be activated by blue light. Shining blue light on brainstems or spinal cords isolated from these mice produces walking-like motor activity. The findings, which are published in the scientific journal Nature Neuroscience, are of potential significance to the recovery of walking after spinal cord injury.

"This new mouse model will impact the way in which future studies examining the organization of neurons involved in walking are performed. We hope that our findings can provide insight that eventually will contribute to treatments for spinal cord injured patients", says Professor Ole Kiehn, who lead the study.

Excitatory neurons have been suggested to play an important role for the initiation and maintenance of locomotion, or walking. However, this has not been demonstrated directly. In order to test the hypothesis that activation of excitatory neurons is essential to locomotion, a research team at the Department of Neuroscience, Karolinska Institutet, created a genetically modified mouse which expresses a light sensitive protein in excitatory neurons.

The light sensitive protein, Channelrhodopsin2 (ChR2), is normally found in algae and activates the cell it is expressed in when exposed to blue light. ChR2 has previously been introduced into rodent cells by viral infection, but this can be problematic due to exposure and replication demands. The researchers circumvented the problems by creating the first genetically modified mouse to successfully express ChR2 in a specific set of neurons.

By inserting ChR2 into nerve cells expressing Vglut2 – a transporter found in most excitatory neurons in the brainstem and spinal cord as well as many excitatory neurons in other regions of the brain – they created a Vglut2-ChR2 mouse . The reason for doing this was to be able to selectively activate excitatory neurons in specific regions of the brainstem and spinal cord, as the excitatory neurons are believed to be important for initiating locomotion, or walking.

The researchers then recorded from motor nerves leaving the spinal cord. When blue light was shined directly on the spinal cord, walking-like activity began and was maintained for the duration of the light pulse. This proved that activation of Vglut2-expressing excitatory neurons in the spinal cord is sufficient for walking. Walking-like activity could also be initiated by exposing the lower brainstem to blue light, demonstrating that excitatory cells in the brainstem provide a sufficient 'go' signal to the spinal neurons involved in walking.

All the experiments were made in vitro in the laboratory and not in living animals.

Appendicitis may be a viral disease

Mon, 18 Jan 2010 13:51:24 PST

( from http://www.rxpgnews.com ) Researchers at UT Southwestern Medical Center evaluated data over a 36-year period from the National Hospital Discharge Survey and concluded in a paper appearing in the January issue of Archives of Surgery that appendicitis may be caused by undetermined viral infection or infections, said Dr. Edward Livingston, chief of GI/endocrine surgery at UT Southwestern and senior author of the report.

The review of hospital discharge data runs counter to traditional thought, suggesting that appendicitis doesn't necessarily lead to a burst appendix if the organ is not removed quickly, Dr. Livingston said.

"Just as the traditional appendix scar across the abdomen is fast becoming history, thanks to new single-incision surgery techniques that hide a tiny scar in the bellybutton, so too may the conventional wisdom that patients with appendicitis need to be operated on as soon as they enter the hospital," said Dr. Livingston. "Patients still need to be seen quickly by a physician, but emergency surgery is now in question."

Appendicitis is the most common reason for emergency general surgery, leading to some 280,000 appendectomies being performed annually.

Appendicitis was first identified in 1886. Since then, doctors have presumed quick removal of the appendix was a necessity to avoid a subsequent bursting, which can be an emergency. Because removing the appendix solves the problems and is generally safe, removal became the standard medical practice in the early 20th century.

But this latest research studying appendicitis trends from 1970 to 2006 suggests immediate removal may not be necessary. Evidence from sailors at sea without access to immediate surgery and from some children's hospitals, whose practice did not call for emergency surgery, hinted that non-perforated appendicitis may resolve without surgery, said Dr. Livingston.

In undertaking the study, the researchers screened the diagnosis codes for admissions for appendicitis, influenza, rotavirus and enteric infections. They found that seasonal variations and clustering of appendicitis cases support the theory that appendicitis may be a viral disease, like the flu, Dr. Livingston said.

Statistical data revealed peaks, which may be outbreaks of appendicitis, in the years 1977, 1981, 1984, 1987, 1994 and 1998. In addition, researchers uncovered some seasonal trends for appendicitis, documenting a slight increase in appendicitis cases during the summer.

"The peaks and valleys of appendicitis cases generally matched up over time, suggesting it is possible that these disorders share common etiologic determinates, pathogenetic mechanisms or environmental factors that similarly affect their incidence," Dr. Livingston said.

Researchers have been able to rule out flu and several other common infections as a direct cause. They also were able to rule out several types of intestinal viruses.

Appendicitis afflicts about one in 10 people during their lifetime. The condition occurs when the appendix becomes obstructed, but doctors are unsure why. Dr. Livingston and other UT Southwestern researchers in 1995 identified an unexpected rise in appendicitis cases, reversing a downward trend throughout the previous 25 years.

"Though appendicitis is fairly common, it still remains a frustrating medical mystery," Dr. Livingston said. "While we know surgical removal is an effective treatment, we still don't know the purpose of the appendix, nor what causes it to become obstructed."

Startup at UCLA tech incubator to begin clinical trials for wireless body-monitoring system

Tue, 12 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) MediSens Wireless, a startup company in UCLA's on-campus technology incubator at the California NanoSystems Institute, has obtained approval under federal Food and Drug Administration guidelines to begin clinical trials on its novel wireless body-monitoring system, which assesses muscle and neuromotor functions in the upper extremities.

The Clinical Movement Assessment System (CMAS) is designed for a wide variety of medical applications and could potentially benefit health care professionals and facilities specializing in the areas of physical medicine and rehabilitation, neurology, orthopedics, and physical and occupational therapy, among others.

MediSens moved to the new CNSI incubator in 2009 to begin commercializing licensed technology originally invented by a team led by Majid Sarrafzadeh, a UCLA professor of computer science and engineering and co-director of the Wireless Health Institute at UCLA. The company's mission is to design and deliver personal medical monitoring systems that advance human health.

The data gathered by our monitoring system, CMAS, has the potential to enable health care professionals to improve care through early intervention and better tracking of outcomes and response to treatment, said Dr. Jay Rindenau, M.D., the company's chief medical officer.

The system also has potential for in-home use to assess patient progress following neurotraumas and as a rehabilitative tool to expand the reach of telemedicine. In addition, CMAS could possibly be used to differentiate and help diagnose diseases states, such as Parkinson's disease, at an early stage with sensitive assessments of fine movements, according to Reggie Edgerton, Ph.D., a professor of neurophysiology at UCLA and co-inventor of CMAS.

The CMAS system consists of a clinical assessment device and associated software that will allow health care providers to capture current and ongoing muscle and neuromotor functions, thereby providing them with quantifiable, real-time data for their decision-making.

Clinical trials will establish the viability of CMAS. It is anticipated that the system will provide clinical assessments of fine motor movement, gross muscle strength, hand-eye coordination and patient response to treatment. Closely captured repeat assessments will lead to early warning and detection of deteriorating conditions.

According to MediSens' medical director, Dr. Nick Terrafranca, D.P.M., the trials are planned as a multicenter, multidiscipline study that will involve community hospitals and public health facilities, as well as Ronald Reagan UCLA Medical Center.

The first phase of the trial will deal with baseline evaluations and therapeutic exercise. The second phase will involve an in-depth analysis of different sensory-motor pathways. The success of the trial will be evaluated by the efficacy and cost effectiveness of the system in testing early interventions for better outcomes and long-term patient care.

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

Tue, 05 Jan 2010 05:00:00 PST

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

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

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

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

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

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

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

Aortic grafts using patients own veins superior to synthetic and cadaveric grafts

Wed, 30 Dec 2009 13:13:28 PST

( from http://www.rxpgnews.com ) A vascular surgical technique pioneered at UT Southwestern Medical Center and designed to replace infected aortic grafts with the body’s own veins has proved more durable and less prone to new infection than similar procedures using synthetic and cadaver grafts.

Aortic graft infections are one of the most serious complications in patients undergoing aortic grafting procedures for peripheral arterial disease (PAD) and aortic aneurysms. PAD reduces blood circulation in the pelvis and lower extremities, and aortic aneurysms result in a weakening of the aortic wall that can cause lethal rupture of the aorta, the largest artery in the body. Patients with PAD and aortic aneurysms often require surgery, and aortic grafting procedures using synthetic grafts are typically the first line of treatment.

For patients with PAD, the procedure restores blood circulation to the legs, and for patients with aneurysm, it replaces the weakened aortic wall and prevents rupture. Synthetic grafts made of Dacron, a polyester material, are placed in the aorta and femoral arteries in the abdomen and groin, which feed blood to the legs. But in about 1 percent to 2 percent of these patients, the grafts become infected – a complication that causes amputation and death if left untreated.

Dr. G. Patrick Clagett, chief of vascular surgery at UT Southwestern, pioneered a technique called the neo-aortoiliac system (NAIS) that repairs these aortic-graft infections. The procedure involves removing the infected graft and replacing it with sections of femoral-popliteal veins harvested from the patient’s thighs, rather than another synthetic graft or vessels harvested from human cadavers.

In a recent study published in the Journal of Vascular Surgery, Dr. Clagett and his team reported on 187 patients at UT Southwestern treated for aortic graft infections who underwent the NAIS procedure from 1990 to 2006. It is the largest group of such patients ever studied, and the researchers found that the incidence of re-infection was lower and the procedure resulted in superior durability with much lower long-term amputation rates when compared with other operations to treat this condition.

“This operation has gained favor worldwide in the treatment of this devastating condition,” said Dr. Clagett. “Since performing the first operation here in the 1990s, we have accumulated data over the years and have found this procedure to be far superior in overall patient outcomes.”

Simply replacing the old Dacron graft with a new synthetic graft can result in devastating infection of the new one, said Dr. Clagett, who is immediate past president of the Society for Vascular Surgery. His team and others also have found that the new synthetic or cadaver grafts tend to develop clots and new blockages.

“When we use the patient’s own tissue to construct a new graft, it provides an advantage because they are less likely to form clots within the graft and less likely to develop new blockages,” Dr. Clagett said. “Patients also need fewer subsequent procedures, a common problem with the other treatments for this complication.”

He added that patients who have the NAIS procedure don’t need to be on lifelong antibiotic therapy. Because the aortic reconstruction is fashioned with the patient’s own tissue, there is no foreign material that is prone to re-infection.

Other UT Southwestern researchers who contributed to the study included Dr. J. Gregory Modrall, associate professor of surgery; Dr. R. James Valentine, professor of surgery; and Jennie Hocking, assistant professor of physician assistant studies. Dr. Ahsan Ali, a former vascular surgery fellow at UT Southwestern now at the University of Arkansas, was the lead author of the study.

Renal sympathetic nerve ablation may cure high blood pressure

Mon, 28 Dec 2009 16:20:14 PST

( from http://www.rxpgnews.com ) British medical scientists have demonstrated a revolutionary new operation that can effectively 'cure' persistent high blood pressure and takes under an hour to carry out.

The surgery, described as relatively straightforward and cheap, could reduce the risk of a major heart attack or stroke in those patients on whom medication has no effect.

Although doctors say there is no substitute for diet and exercise, one in 10 of the 15 million Britons suffering from high blood pressure - also known as hypertension - either do not respond to medication or cannot tolerate drugs.

The new procedure, called renal sympathetic-nerve ablation, involves placing tiny burns in the nerve responsible for hypertension in some people.

It disrupts signals from the brain telling the kidneys to keep blood pressure raised. Initial tests suggest it can be effective within three months, scientists said.

'This is the most exciting development in hypertension since the advent of anti-hypertensive medication 50 years ago. It is hard to forecast the limitations and it could eventually be compared to medication,' said Mel Lobo, a doctor and specialist in clinical hypertension with Britain's National Health Service.

The Daily Telegraph said its reporter watched the operation being performed on a 68-year-old London chef, who is diabetic and has already suffered a stroke and a deep vein thrombosis.

The patient was awake throughout the procedure carried out at the London Chest Hospital - the first such in Britain and part of an international clinical trial.

Although the patient was kept in the hospital overnight, once greater experience is gained with the technique, patients will be able to go home the same day.

His blood pressure has come down just two weeks after the operation and it is thought most patients will see an improvement within three months, the paper said.

Martin Rothman, the cardiologist who performed the operation said: 'This relatively trivial procedure has the potential to make a serious improvement in the quality of life for the patient. It is very efficient and can lower the blood pressure enough to reduce stroke mortality by 50 percent.'

Paul Sobotka, chief medical officer of Ardian, a company which has developed the equipment for the surgery, said: 'For the first time we can think of a cure for hypertension.'

David Collier, a doctor and senior clinical trials fellow at the Biomedical Research Unit at Queen Mary University London, told the paper the operation offers real hope of an alternative to a life on pills for patients whose blood pressure is difficult to control.

However, he warned that it was not the 'lazy person's answer' to diet and exercise.

Sticks and stones break bones, but this UH study may prevent it

Wed, 09 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) The best way to prevent a fracture is to stop bones from reaching the point where they are prone to breaking, but understanding the process of how bones form and mature has been challenging. Now researchers at the University of Houston department of health and human performance have created a process that grows real human bone in tissue culture, which can be used to investigate how bones form and grow.

We have manufactured a structure that has no synthetic components, said Mark Clarke, associate professor and principal investigator. It's all made by the two cell types bones start with inside the body. What you end up with is a piece of material that is identical to newly-formed, human, trabecular bone, including its mineral components, its histology and its growth factor content.

Being in a microgravity environment causes astronauts' bodies to lose more bone mineral than they can replace, which makes them vulnerable to fractures and breaks. Even when they return to Earth, the bone loss continues as their bodies slowly begin the process of replacing the bone mineral content.

The NASA-funded study, which included Clarke's collaborators at NASA-Johnson Space Center, Dr. Neal Pellis and Dr. Alamelu Sundaresan, used human osteoblasts and osteoclasts, the two major cell types involved in the formation of and breaking down of bone. The 3-dimensional bone constructs allowed for ideal conditions to investigate how bone forms and, more importantly, how bone is lost in environments such as space flight and conditions present in post-menopausal women and spinal cord patients.

Clarke has worked with NASA on other bone loss studies. He served as a principal investigator in a NASA study of micro-fabricated skin patches that collect sweat for analysis of biomarkers of bone loss, like calcium.

His research on bone formation also is proving to be market-ready, as a newly formed start-up company, OsteoSphere Inc., examines ways the breakthrough research can be used in a clinical setting for applications such as spinal fusions, facial reconstructions following bomb blasts or the re-growing of an individual bone outside of the patient,.

UH has now licensed the technology to OsteoSphere Inc. which is looking at ways to commercialize the technology in a clinical setting, including culturing an individual's own bone for subsequent transplantation back into the patient, developing other products for use in orthopedic reconstruction or using the technology as a screening tool for development of pharmaceuticals for combating bone loss or stimulating bone regeneration, Clarke said.

Epilepsy patients caught in treatment gap are not getting state-of-the-art care

Fri, 04 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Boston, December 4, 2009 -- Substantial progress has been made over the last 15 years in the healthcare community's ability to diagnose and treat epilepsy and its complications. Yet this progress in epilepsy management has not reached most of the 50 million people around the world, including many of the nearly three million people in the United States who have the disorder,

According to Steven C. Schachter, M.D., president of the American Epilepsy Society (AES), there is an enormous gap between what is currently being done and what is possible today to lessen the burden of epilepsy around the world. The consequences are not insignificant, as uncontrolled epilepsy leads to a diminished quality of life, and a greater risk of disability and death.

Patrick Kwan, MD, PhD, of the Chinese University of Hong Kong, and Eric R. Hargis, president and CEO of the Epilepsy Foundation, joined Dr. Schachter to address the treatment gap in epilepsy at the AES 63rd Annual Meeting held here at the Hynes Convention Center. Dr. Kwan participated in an international committee of epilepsy experts that has developed the first ever global, consensus definition of refractory epilepsy. The newly developed definition will be presented during a special symposium on Tuesday. (ILAE Symposium: Redefining Treatment Resistant Epilepsy)

Citing data from the World Health Organization (WHO), Dr. Schachter says, An astonishing three-quarters of the global population with epilepsy get no treatment whatsoever for their seizures. While most patients here in the U.S. receive some form of therapy, there are racial, ethnic, and socioeconomic disparities in access to treatment, surgery in particular, and significant under-diagnosis and treatment of associated complications of mood, memory and cognition. (Platforms B.03)

In a study scheduled for presentation on Sunday, for example, researchers at a specialized epilepsy center will report on eighty-three pediatric epilepsy patients referred to the center for pre-surgical evaluation. Some of these patients had been previously evaluated but remained untreated for complications secondary to their epilepsy. (Abstract 2.169)

Researchers in another study to be reported here have found there continues to be a major gap averaging seventeen years between the diagnosis of epilepsy and pre-surgical evaluation at a specialized epilepsy center in the U.S.. Professional guidelines recommend that patients be evaluated as potential surgery candidates after failing appropriate trials of first-line antiepileptic drugs, trials typically taking less than two years. The research team says reasons for the wide gap in time to treatment need to be studied. (Abstract 1.114 and Platform C.09)

Even with the plethora of epilepsy therapies now available, Dr. Schachter says, the CDC estimates that at least 45 percent of people with epilepsy here in the U.S. continue to experience seizures. Complete freedom from seizures is not a possibility for everyone who has epilepsy. But it is important for patients with continuing seizures and their healthcare providers to make every effort toward that goal.

Seizures are not benign. Mounting evidence suggests that they can lead directly to brain injury, permanent disability and death. Animal research suggests the injury may be due to seizures affecting the structure and function of dendrites, neuronal branches that connect brain cells. (Abstracts 3.028 and 3.136) Leading epilepsy experts recommend early aggressive treatment to prevent these possible severe consequences.

Dr. Kwan notes that this recommendation is followed less often in practice than actually observed. The care that is provided is further complicated by a variety of standards for defining refractory epilepsy which can also contribute to the sub-optimal care that some epilepsy patients are getting.

The new consensus definition represents, for the first time, a common language in recognizing refractory epilepsy that can be applied by clinicians at all healthcare levels, Kwan says. We believe its general adoption into clinical practice can have a significant impact in improving patient care by providing clinicians a framework to recognize and refer patients fulfilling the definition to specialist centers promptly for further assessment and management. Perhaps equally important, it will improve the interpretation of research results, which, in itself, can help in raising the level of epilepsy care.

The new definition is but one of many measures focused on the healthcare community that is needed to assure patients get state-of-the-art care. Beyond this there is much that people with epilepsy themselves can do to improve the care they receive, according to Mr. Hargis. Many patients feel that what they experience from epilepsy and its treatment is 'as-good-as-it-gets'. A perception they may get from healthcare providers. Programs are needed to inform patients that there are solutions to their feelings of depression and the treatment of side effects they experience. And, one of the keys is better communication with their doctors.

A number of recent studies, including research supported by the Epilepsy Foundation, have found that mood disorders and drug toxicity affect quality of life of patients, more than the frequency or severity of their seizures. Educational programs are needed that encourage healthcare providers to question patents and to offer appropriate remedial options for reducing co-morbidities and the impact of the disorder itself, Hargis says.

The heavy toll that undiagnosed, untreated and sub-optimally treated epilepsy imposes on the millions of people with epilepsy in the U.S. and around the globe has led the World Health Organization to raise the international campaign against the disorder to the highest level within its organization. Closing the wide gap in treatment will require major efforts on the part of governments, healthcare communities, researchers, and affected individuals and families everywhere. But, with people's lives at stake, the epilepsy representatives say, there is no other course.

Your own stem cells can treat heart disease

Tue, 17 Nov 2009 05:00:00 PST

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

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

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

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

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

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

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

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

Minimally invasive surgery shown safe and effective treatment for rectal cancer

Tue, 10 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Laparoscopic surgery has been used in the treatment of intestinal disorders for close to 20 years, but its benefits have only recently begun to be extended to people with rectal cancer. In a prospective study of 103 patients who underwent straightforward or hand-assisted laparoscopic surgery for rectal cancer, a team of colon and rectal surgeons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center has shown that the minimally invasive approach can be as effective as traditional open surgery in treating rectal cancers.

The advantages of laparoscopic and other minimally invasive surgical techniques are well known. After laparoscopic surgery, patients experience shorter hospital stays, smaller scars, far less pain and faster recovery, compared with open surgery. NewYork-Presbyterian/Weill Cornell has offered these procedures for many years, and continues to be at the forefront of innovation, applying the minimally invasive approach to diseases and conditions once considered treatable mainly using open surgery techniques. Until recently, rectal cancer was one such disease -- and its treatment via laparoscopic surgery is still seen by some as controversial.

Rectal surgery, according to Dr. Jeffrey Milsom, chief of colon and rectal surgery at NewYork-Presbyterian/Weill Cornell, is inherently more challenging than colon surgery. For one, the pelvic cavity of the body where the rectum lies, is a narrow space, making rectal tumors difficult to access. Surgical success depends not only on the complete removal of the cancerous tumor and repair of the rectum, but also on restoring continence. For these reasons, rectal cancer has been a difficult arena to apply advances in minimally invasive surgery.

Delaying matters further, initial reports on the use of laparoscopic surgery in patients with rectal cancer described a higher incidence of cancer-positive cells at the edges of removed tumors compared with open surgery, says Dr. Milsom. Early data suggested that as a result, more patients could experience a local recurrence of their rectal cancer after laparoscopic surgery than open surgery. But the current study refutes these initial findings.

Between January 1999 and December 2006, three colon and rectal surgeons at NewYork-Presbyterian/Weill Cornell (Dr. Milsom and his colleagues Dr. Toyooki Sonoda and Dr. Sang Lee) treated 103 patients with mid or low rectal cancer using an operation called total mesorectal excision (TME), performed via laparoscopic-assisted (LAP) or hand-assisted laparoscopic surgery (HALS). To gather the relevant data and analyze outcomes, Dr. Milsom and his team relied on inpatient and outpatient medical records, telephone interviews with patients, and standard actuarial survival calculations. Patients received regular follow-up for five years.

More than 90 percent of the patients in our study were able to undergo laparoscopic surgery successfully, says Dr. Sonoda, one of the study's key surgeons. We define 'success' in both the short- and long-term sense: More than 95 percent emerged with an intact and functioning rectum and, as expected after a minimally invasive procedure, recovered rapidly. None had cancer-positive tumor margins, which has been a major concern in the medical literature all along. In fact, after five years, overall survival has remained high at 91 percent, with more than 73 percent of patients completely free from disease.

In terms of cancer cure and recovery, says Dr. Lee, the other key surgeon on the study, these outcomes are at least as good as the best outcomes seen with open surgical techniques. And when you add in all the advantages of laparoscopic surgery, it seems clear that this is an approach that could evolve to become the surgical standard.

Reported earlier this year in the professional journal of the

Advances in treating hip pain to be focus of International Society for Hip Arthroscopy meeting

Sat, 26 Sep 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Recent advances in diagnostic imaging techniques and hip arthroscopy procedures are giving physicians and surgeons better tools with which to treat hip pain. The 2009 International Society for Hip Arthroscopy meeting, hosted by Hospital for Special Surgery in New York, brings together leading surgeons from all over the world to take an in-depth look at hip arthroscopy and its potential benefits.

This inaugural meeting by the International Society for Hip Arthroscopy will concentrate on the rapidly changing field of arthroscopic hip surgery, said Robert Buly, M.D., attending orthopedic surgeon at Hospital for Special Surgery and course director of the ISHA meeting. Presentations will be focused on the current research and outcomes data associated with both common and new procedures.

Hip arthroscopy, a minimally invasive treatment option, is an alternative for some patients over open, invasive surgery. Through a few tiny incisions, doctors are able to insert tools to trim bone or repair cartilage. Previously, surgeons only had the option of opening up the entire hip with a large incision and dislocating the hip to access the joint. This procedure can be used to treat patients with femoro-acetabular impingement (FAI), also known as hip impingement, where there is a change in the bony form of the hip joint causing a decreased range of motion and pain, damage to the cartilage within the hip joint, such as labral tears, and other conditions.

It is not uncommon for hip pain due to hip impingement or labral tears to be misdiagnosed. The difficulty in diagnosing the underlying causes of hip pain doesn't affect only professional athletes like Alex Rodriguez, Carlos Delgado or Mike Lowell, who have been in the news for their injuries and subsequent treatment, but week-end warriors and everyday active individuals as well. Hospital for Special Surgery's Center for Hip Pain and Preservation uses the latest imaging technology and arthroscopic techniques to provide those experiencing hip pain with proper diagnosis and treatment.

Research highlights include outcomes data presented by Special Surgery's Dr. Buly and Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery and a study by Marc Philippon, M.D., of the Steadman Hawkins Research Foundation in Colorado, on how to assess the ability of a patient to return to sports after arthroscopy. Two imaging advances, one on techniques that allow greater visibility into the hip joint and a second on a method that may identify the earliest onset of arthritis will be presented, as well as a British study on siblings that addresses the genetics underlying hip impingement.

The meeting will take place in New York on October 9 and 10, 2009 at the Roosevelt Hotel on Madison Avenue and 45th Street.

75 percent would consider letting an unsupervised trainee perform surgery if it could be done quicker

Wed, 09 Sep 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Three-quarters of surgical patients would consider allowing a competent unsupervised trainee junior doctor perform their entire operation if it meant they could have it done more quickly, according to a survey published in the September issue of BJUI.

The responses were high regardless of how complex the surgery was, with 80 per cent of those facing minor surgery and 68 per cent of those facing major surgery saying they would consider the suggestion.

Eighty patients took part in the survey at the John Radcliffe Hospital in Oxford, UK, after a hundred questionnaires were distributed to patients who had just undergone urological surgery. Just under two-thirds (65 per cent) were men, their average age was 69 and 42.5 per cent were in for major surgery.

We were surprised by the results, as only 50 per cent of patients felt it was appropriate in general for trainees - even those just about to take up a consultant post - to operate unsupervised and this figure went down to 10 per cent when it came to their own operation says specialist trainee Mr Robert Ritchie.

But when waiting times were factored into the equation, it became very clear that patients were prepared to rethink their views if it meant having their operation more quickly.

Most of the respondents (90 per cent) felt that trainees needed to operate under supervision to improve their skills and 77 per cent were happy for a supervised trainee to do their operation. The majority (96 per cent) felt they should be told if a trainee was involved in their procedure.

The opportunity to learn, repeat and perfect surgical skills is an essential component of any surgical training programme and allowing trainee surgeons to operate on patients is important says Mr Ritchie.

However, surgical training often fails to take into account individual patients and their right to know who is doing their operation. National Health Service consent forms currently state that the hospital cannot say who will be performing the operation, only that the surgeon will be competent to perform the procedure.

This can be at odds with informed consent, which under common law requires that patients should be provided with clear and accurate information about the risks of any proposed investigation or treatment.

It also appears to be at odds with General Medical Council (GMC) Guidelines. These say that surgeons must tell patients who will be mainly responsible for their care and what their roles are. They also state that the surgeon must make sure that the patient agrees to the participation of other professionals in their operation.

Mr Ritchie and his co-author, consultant urologist Mr John Reynard, are calling for a fundamental change in the level of information provided to patients about the identity of the surgeon carrying out their operation, to bring practice in line with this GMC guidance.

Whether informing patients that trainees will be involved in their operation will lead to a reduction in training opportunities is unclear says Mr Reynard.

A study of orthopaedic patients published in 2004 showed that 74 per cent were happy for a trainee to perform all or part of their procedure, but a 2005 study of cataract patients showed that only 16 per cent agreed to go ahead if a supervised trainee was directly involved.

The authors say that it is reassuring that patients understand the need for junior doctors to perform procedures as part of their training. But they also feel that it is important to try and address the issues around consent, without this resulting in a loss of training opportunities.

The results of our study create a challenge for the consultant who has to balance his or her role as a trainer with the responsibility for overall care of the patient adds Mr Reynard.

We recommend that both the trainer and trainee see patients before surgery and take the opportunity to explain their respective roles in the operating theatre. It is a good time to stress how important training is in ensuring that high standards of surgical care and operative skills are maintained for present and future generations.

It is also clearly time for consultant surgeons who allow unsupervised trainees to operate to reappraise this practice.

Learning how to cope with burn injuries

Thu, 20 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Aug. 27-29, 2009) -- More than half a million Americans are treated for burn injuries every year, but many do not have the specific skills necessary to cope with the experience of living with a burn injury after they leave the hospital.

More than 850 burn survivors and their families, firefighters and specialists in burn treatment from across the country are expected to attend the Phoenix Society for Burn Survivors' 21st Annual World Burn Congress to share their experiences and practical advice about how to continue on the road to recovery after severe burn injury. This year's conference -- which has its largest attendance to date -- will also include a large group of U.S. servicemen and women who were injured in Iraq and Afghanistan.

New York City Fire Commissioner Nicholas Scoppetta will be on hand at the opening ceremony scheduled for Thursday, Aug. 27, at 9:00 a.m. at the Sheraton New York Hotel and Towers, 811 7th Ave. and 53rd St. Held for the first time in New York, the three-day conference -- Aug. 27 to Aug. 29 -- is sponsored by the Hearst Burn Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the busiest burn center in the nation; and the New York Firefighters Burn Center Foundation, a not-for-profit organization of firefighters dedicated to the advancement of burn care, research and prevention. The Phoenix Society for Burn Survivors is the largest national non-profit organization serving the burn survivor community.

The New York City Fire Department is both a benefactor and supporter of the incredible work done by the Phoenix Society, says Fire Commissioner Scoppetta. Long after the fire has been extinguished, the Phoenix Society helps burn survivors recover, not only physically, but mentally and emotionally as well.

Survivors will participate in a wide range of workshops -- from how to use cosmetics to improve the appearance of burn injuries to improving your child's self-esteem after a burn injury. In addition, firefighters and former military personnel will discuss their personal experiences with burn injury in the line of duty. Additional speakers include CBS News Correspondent Kimberly Dozier, who will discuss her recovery from injuries sustained while on assignment in Baghdad, and J.R. Martinez, an actor on the long-running ABC soap opera All My Children and Iraq War veteran.

When burn patients arrive on our unit they are victims, but as they receive treatment and understand the resources and community available to them, they become survivors. We are proud to sponsor an event that supports our patients' life-long healing process, says Dr. Roger Yurt, director of the Hearst Burn Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and professor of surgery at Weill Cornell Medical College.

We are committed to ensuring that every burn survivor and their loved ones have the necessary support and resources they need to recover and live their lives, says Amy Acton, executive director of the Phoenix Society.

World Burn Congress Speakers and Workshops

100th heart valve replacement implanted without open-heart surgery at NewYork-Presbyterian/Columbia

Wed, 22 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (July 22, 2009) -- Over the last four years, heart specialists at NewYork-Presbyterian Hospital/Columbia University Medical Center have implanted an innovative aortic heart valve replacement using a catheter-based approach that does not require open-heart surgery in a total of 100 patients -- the most of any U.S. medical center to date.

Open-heart surgery can require a two- to three-month recovery period, compared to only a few days for the transcatheter approach.

The procedures were conducted as part of multiple clinical research studies of the Edwards SAPIEN transcatheter heart valve. Currently ongoing is the PARTNER (Placement of AoRTic traNscathetER valves) trial, a Phase 3 multicenter study led by national co-principal investigators Dr. Martin Leon and Dr. Craig Smith and focused on the treatment of patients who are at high risk or not suitable for open-heart valve replacement surgery.

The SAPIEN heart valve, made of bovine pericardial tissue leaflets hand-sewn onto a metal frame, is implanted via one of two catheter-based methods -- either navigated to the heart from the femoral artery in the patient's leg, or through a small incision between the ribs and into the left ventricle. It is then positioned inside the patient's existing valve, using a balloon to deploy the frame, which holds the valve replacement in place. Both procedures are performed on a beating heart, without the need for cardiopulmonary bypass and its associated risks.

This breakthrough technology could save the lives of thousands of patients with heart valve disease who have no other therapeutic options, says Dr. Leon, the study's national co-principal investigator, associate director of the Cardiovascular Interventional Therapy (CIVT) Program at NewYork-Presbyterian Hospital and Columbia University Medical Center, and professor of medicine at Columbia University College of Physicians and Surgeons.

Annually, some 200,000 people in the U.S. need a new heart valve, but nearly half of them do not receive a new valve for a variety of reasons.

This study may show that transcatheter valve replacement is a safe and effective alternative to open surgery, which remains the 'gold standard' for most patients, says Dr. Smith, study co-principal investigator, interim surgeon-in-chief and chief of cardiothoracic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and acting Chairman of the Department of Surgery and the Calvin F. Barber Professor of Surgery at Columbia University College of Physicians and Surgeons.

The transcatheter valve procedures take about 90 minutes, compared with four to six hours for open-heart surgery. In open-heart surgery, the surgeon cuts through the breastbone, stops the heart, removes the valve and replaces it.

The PARTNER trial is a prospective randomized study with two separate treatment arms. In the surgical arm, patients are randomized to receive either the Edwards SAPIEN transcatheter heart valve or an Edwards surgical valve via open-heart surgery. In the non-surgical, medical management arm, patients considered to be non-operative are randomized to receive either the Edwards SAPIEN transcatheter heart valve or appropriate medical therapy.

The PARTNER trial is designed for patients with severe aortic stenosis -- a narrowing of the valve that restricts blood flow from the heart -- who are not good candidates for surgery due to age or other concurrent health factors. Interested patients may contact NewYork-Presbyterian/Columbia at (212) 305-6061.

The PARTNER trial is also available at NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Ronald O. Perelman Heart Institute, led by Dr. Karl H. Krieger (vice chairman of cardiovascular surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the Philip Geier Professor of Cardiothoracic Surgery at Weill Cornell Medical College) and Dr. Shing-Chiu Wong (director of cardiac catheterization laboratories at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and professor of medicine at Weill Cornell Medical College).

Nondrug interventions may comfort children having an anesthetic

Tue, 07 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Parental acupuncture, clown doctors, hypnotherapy, low sensory stimulation and hand-held video games are promising non-drug interventions that are likely to help reduce children's anxiety during the onset of their anaesthetic, is the main conclusion of a new Cochrane Systematic Review.

The review was conducted because undergoing a general anaesthetic can be a frightening experience for a young child and distressing to parents. Children can be given a premed to sedate them when anaesthesia is being administered, but these drugs can have unwanted harmful effects. Some non-drug alternatives have been tested to see if they could be used instead of sedative drugs when anaesthesia is being administered to children. A new study is the first systematic review to investigate whether non-drug interventions are helpful in alleviating stress in children undergoing general anaesthetics.

The researchers reviewed data from 17 trials that together involved 1,796 children between the ages of 10 months and 17 years. The eight studies focusing on parental presence did not find parental presence to be helpful in alleviating anxiety or improving cooperation in their children whilst the anaesthetic was being administered. It is interesting that parental presence is often encouraged, even though there it has not been shown to help, says lead researcher Allan Cyna of the Women's and Children's Hospital in Adelaide, Australia. Based on our findings, we would recommend that parents do not need to stay for their child's anaesthetic unless they are keen to do so.

The Cochrane Researchers concluded that a number of different interventions show promise in being effective in increasing cooperation and reducing anxiety in children during anaesthetic administration and need further research. In single studies, clown doctors, a quiet environment, video games and computer packages (but not music therapy) each showed benefits. These promising interventions need to be tested in additional trials.

The authors also suggest that relaxation techniques targeted at parents merit further investigation, since in one trial children seemed to benefit when their parents were given acupuncture to reduce anxiety. Parental stress can be transmitted to the child. It is likely that parents who are relaxed are more likely to help their children stay calm during the administration of anaesthesia. Yoga, hypnosis and meditation may help parents relax and could be explored in future studies.

We also need more trials investigating the effects of the promising non drug interventions for children identified in this review. These, and other, methods need to be tested in further trials. says Dr Cyna.

Ovarian transplantation: First baby is born after a new technique

Mon, 29 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Amsterdam, The Netherlands: A new technique for transplanting the ovaries of women who have lost their fertility as a result of cancer treatment was outlined to the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday 29 June). Dr. Pascal Piver, manager of the IVF Centre at Limoges University Hospital, Limoges, France, described a new, two-step method of ovarian transplant that has produced excellent results in women whose ovaries have been frozen because of cancer treatment. He said that his team's technique worked to restore ovarian function quickly and already one patient from his clinic had had a baby and another had become pregnant.

On June 22, a baby girl was born to a mother who had been menopausal for two years as a result of treatment for sickle cell anaemia. After transplanting her own ovarian tissue she started ovulating in four months and became pregnant naturally six months after transplantation. Both mother and baby are doing well, he said.

Dr. Piver and colleagues set out to tackle one of the biggest problems of ovarian transplantation: the low response to stimulation caused by insufficient vascularisation of the transplanted tissue.

In order for a woman to become pregnant, the ovaries need to be responsive to the action of hormones that cause them to release eggs each month, he explained. If the blood supply to the ovaries is insufficient, this will not happen, even though the transplant may look as though it has been successful.

To overcome this problem they carried out a two-stage procedure, first grafting small pieces of the frozen ovarian tissue in the ovarian and peritoneal areas three days before the real transplant. The first graft encourages the growth of blood vessels and paves the way for the ovary to become fully functioning in a shorter time scale than would be possible if all the tissue were to be transplanted at the same time.

The researchers have so far utilised this technique with two patients who had been treated for cancer and had their ovaries frozen. In addition to the first patient, treated for sickle cell anaemia, the second patient had been treated for periarteritis nodosa, an inflammation of medium-sized arteries, which become swollen and damaged from attack by rogue immune cells.

She suffered menopause for eight and a half years before transplantation, said Dr. Piver. But after transplanting half of the frozen ovary, she recovered spontaneous ovulation in four months. Her right fallopian tube had been destroyed by the ovarian retrieval, and the function of the ovary and hence the chances of pregnancy are limited in time. Hence we decided to collect the highest number of eggs we could, and carry out an IVF procedure on this patient.

Six months after the operation, we transferred two blastocysts. A total of 22 oocytes were retrieved and produced 16 embryos, which in turn produced seven blastocysts. Unfortunately the first time round this patient developed an ectopic pregnancy, but she is now pregnant again.

The technique was developed by Dr. Piver and his team, he told the conference. This is the first time that a pregnancy has been obtained after a ten year gap between ovarian cryopreservation and grafting. We believe that it represents a considerable advance on the methods of ovarian transplantation used until now, not least because we are able to obtain large numbers of oocytes. We hope that it will enable more young patients who have been cured of cancer to regain their reproductive health and become pregnant with their own children, he said.

Ovarian transplantation: New technique gives greatly improved results in this delicate operation

Mon, 29 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Amsterdam, The Netherlands: Ultra-fast freezing of ovarian tissue from women who have lost their fertility as a result of cancer treatment can lead to it being used in transplants with the same success rate as fresh tissue, a researcher told the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday 29 June). Dr. Sherman Silber, Director of the St. Louis Infertility Centre, St. Louis, Missouri, USA, said that freezing tissue by the vitrification method, which avoids ice formation, meant that oocyte (egg) viability was almost identical with that seen in fresh oocytes.

Dr. Silber and colleagues used standard viability testing with fluorescent microscopy to determine the loss or preservation of oocytes in fresh and frozen ovarian tissue of 15 young women undergoing cancer treatment. They also followed up nine homozygotic twin patients after fresh ovary transplantation for the duration of ovarian function and pregnancy outcome, and tested spare tissue that had also been frozen from their ovaries at the time of transplant. Tissue was preserved either by rapid cooling vitrification or by classical slow freezing methods.

We found that 91.9% of the fresh oocytes were viable compared with 88.9% of those vitrified. However, slow freezing resulted in a 56% loss of viability, said Dr. Silber.

Transplantation of the tissue resulted in a duration of ovarian function of more than four years in five of the seven cases followed up for that long, and all patients regained a normal ovarian cycle within four to five months after the transplant. There was no difference in terms of pregnancy or ovulatory menstrual cycling between fresh and frozen grafts. The scientists used the cortical grafting technique, where very thin slices of tissue are transplanted. This technique is much easier to perform than the delicate microvascular technique, which they described last year in an effort to prevent egg loss and to lengthen the duration of ovarian graft function.

With the microvascular technique, the tiny blood vessels supplying the ovary are directly linked, and ischemia time, during which blood supply is restricted, is minimised. However, this is a very difficult operation not available in most reproductive centres. With the cortical grafting technique, ischemia time for revascularisation was always thought to be a limiting factor, not to mention the deleterious effect of freezing. However, very thin cortical slices not only allow the tissue to be frozen by vitrification, but also accelerate the speed of revascularisation of the ovarian graft.

We believed that microvascular transplant would give us a longer duration of ovarian function, said Dr. Silber, but our current research has proved us wrong. This is not only good news for surgeons, but also for patients who will be able to undergo a simpler procedure with equally successful results.

Out of the eight women who received cortical transplants, six have had one or more spontaneous pregnancies, resulting in the birth of seven healthy babies.

We are in the middle of a massive global infertility epidemic, caused by the new structure of our society where women choose not to have children until they are older, said Dr. Silber. As a result, many of them become infertile because of the ageing of their eggs and ovaries.

This procedure is a solution to that social dilemma, allowing women to have children when they are older by preserving their ovaries when they are younger and transplanting them back at a later date. It can also be used to preserve the fertility of young women with cancer who are likely to be cured of their cancer, but who will become sterile as a result of the cancer treatment without such intervention, he said.

Study finds transplant patients have worse outcomes from cancer

Sun, 17 May 2009 11:12:13 PST

( from http://www.rxpgnews.com ) After comparing two patient cancer registries—one featuring transplant patients and the other the general population—researchers at the University of Cincinnati (UC) have found that transplant patients experience worse outcomes from cancer.

These results will be published in the May 15, 2009, edition of the journal Transplantation, which is currently in press.

Yun Miao, MD, PhD, Jason Everly, PharmD, Steve Woodle, MD, and colleagues at UC compared lung, colon, breast, prostate, bladder, kidney and skin cancer data in 635 adult transplant recipients from the Israel Penn International Transplant Tumor Registry with that of about 1.2 million adults from the general population in the Surveillance, Epidemiology and End Results (SEER) database.

"It has been known for some time that transplant recipients are at an increased risk of developing cancer, but the outcomes of cancers that arise in organ transplant recipients have not been defined," says Woodle, professor and chief of transplant surgery and co-author of the study.

"In this study, we wanted to examine the influence of transplantation on the outcomes of individual types of cancers arising in organ transplant recipients," adds Miao, co-author and research fellow in the division.

The Israel Penn International Transplant Tumor Registry is the largest and most comprehensive transplant tumor registry in the world and was created by doctors at the UC College of Medicine.

The SEER registry collects information on cancer incidence, survival and prevalence for roughly 26 percent of the United States population and compiles reports and statistics based on this information along with cancer mortality rates for the entire nation.

A comparison of results in transplant recipients to the general population also demonstrated that transplant patients were more likely to have early stage renal cell (kidney) cancer and more advanced colon, breast, bladder and skin cancer at the time of diagnosis.

Disease-specific survival was worse in the transplant population for each of these seven cancers analyzed and was a negative risk factor for survival.

Now, researchers want to conduct further studies to find out why this may be the case.

"Transplant patients receive immunosuppressive therapies to prevent them from rejecting transplanted organs," says Woodle. "We want to see if immunosuppressive therapies contribute to the poorer outcomes in transplant recipients."

He says the worse outcomes in transplant recipients may have occurred because this population is not as healthy as the general population or because their cancers may be more aggressive as a result of their immunosuppression treatments.

"Some of our data supports this premise, as the extent of the cancers at diagnosis were greater in the transplant recipients," Woodle continues. "This was surprising since transplant recipients are generally followed more closely than the general population."

Everly, co-author and board-certified oncology pharmacist in the division, says that this data may change the way physicians screen transplant patients for cancer.

"We found that most cancers developed within five years following transplantation," he says, noting that more frequent and detailed checks should be made in order to catch the cancer in its earliest stages. "This may alter the way doctors should screen these patients for cancer."

Surgery may not be necessary for Achilles tendon rupture

Thu, 14 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The two ends of a ruptured Achilles tendon are often stitched together before the leg is put in plaster, in order to reduce the risk of the tendon rupturing again. However, Katarina Nilsson Helander, MD, PhD at the Sahlgrenska Academy, University of Gothenburg, Sweden, now suggests that surgery may be unnecessary. Patients who do not undergo surgery have just as good a chance of recovery.

The Achilles tendon, which attaches the calf muscle to the heel, is the body's strongest tendon. The tendon may rupture on sudden tensing of the muscle, something that affects middle-aged men in particular, typically when playing badminton or tennis.

When the Achilles tendon ruptures, it feels like a sudden, violent and intensely painful snap in the calf or tendon above the heel. It is an injury that has become increasingly common in recent years, probably because exercise is increasingly popular. But whether or not one should operate has been the subject of debate for quite some time, says orthopaedic surgeon Katarina Nilsson Helander, MD, PhD.

When the Achilles tendon has ruptured, the foot is put in plaster with the toes pointing downwards, so that the torn ends of the tendon come into contact and join together as they heal. The torn ends of the tendon are often stitched together before the foot is put in plaster, to make sure they stay in place. In recent times, a removable orthosis has begun to replace plaster casts, making it possible for the patient to start to move the foot sooner. Other studies have shown that early motion stimulates healing.

Surgery increases the risk of infections and sores but is often carried out anyway, as studies have shown that the operation reduces the risk of the tendon rupturing again.

One hundred patients were randomly assigned to surgery with early mobilisation or to early mobilisation alone with the removable orthosis and without prior surgery. In every other respect, all the patients in the study had the same treatment. The thesis shows that there is no difference in the re-rupture rate. A year after the injury, there was no difference in the patients' own impression of symptoms and function, but irrespective of which treatment the patient received, the function tests showed that there remained a substantial difference between the healthy and the injured foot.

I have concluded that not everybody needs to have surgery, but it is important that those who suffer an Achilles tendon rupture discuss the treatment options with their orthopaedic surgeon, says Katarina Nilsson Helander.

New pill to treat MS

Wed, 29 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) A new drug for multiple sclerosis can dramatically reduce the chances of a relapse or a deterioration of the condition, according to a new study from researchers at Queen Mary, University of London.

The results of a major trial presented at the Annual Meeting of the American Academy of Neurology in Seattle show that taking a course of cladribine tablets just a few times a year can reduce the chances of a relapse by well over 50 per cent. And patients who took part in the study suffered very few side effects.

If it becomes available to patients, cladribine will be the first licensed treatment for MS which does not involve regular injections.

Multiple sclerosis is a disabling neurological condition which usually starts in young adulthood. It is the result of the body's own immune system damaging the central nervous system. This interferes with transmission of messages between the brain and other parts of the body and leads to problems with vision, muscle control, balance and memory.

For the 85,000 people in the UK who suffer from MS, the treatments which are currently available have to be given by frequent injections or intravenous infusions, and the benefits have to be weighed up against a number of side effects.

The new study involved over 1,300 MS patients who were followed up for nearly two years. Patients were given either two or four treatment courses of cladribine tablets per year, or a placebo. Each course consists of a single tablet per day for four or five days, adding up to just eight to 20 days of treatment each year. During the trial patients were monitored using MRI scans.

Compared to patients who were taking a placebo, those taking cladribine tablets were over 55 per cent less likely to suffer a relapse and 30 per cent less likely to suffer worsening in their disability due to MS.

The study's lead researcher is Professor Gavin Giovannoni of Barts and The London School of Medicine and Dentistry, part of Queen Mary, University of London. He said: These results are really exciting. MS can be a very debilitating illness and at the moment treatment options remain limited. Having an effective oral therapy will have a major impact for people with MS.

Our study shows that cladribine tablets prevent relapses and slow down the progression of the disease making patients feel better. Importantly, it does so without the need for constant injections that are associated with unpleasant side effects

We will continue to follow the patients in the trial to see how they fare in the long-term.

Cladribine tablets work by suppressing the immune system, reducing the risk of further damage to a patient's nervous system.

Scientists trick immune system into accepting organ transplant

Tue, 07 Apr 2009 10:49:02 PST

( from http://www.rxpgnews.com ) Sydney, April 7 - In a significant breakthrough, scientists have tricked the immune system into accepting a new organ transplant as its own, eliminating dependence on toxic immunosuppressive drugs for a lifetime.

Jonathan Sprent and Kylie Webster from Sydney's Garvan Institute of Medical Research, with colleagues Shane Grey and Stacey Walters, have successfully tested the method on mice.

'Under normal circumstances, the body would attack a transplanted organ unless immunosuppressive drugs such as cyclosporin were given,' said Sprent.

'In this project, mice were given a substance, or 'complex', that altered their immune systems, so that they accepted transplanted cells as their own.'

Sprent developed the 'complex' with Charles Surh from California's Scripps Research Institute and Onur Boyman, physician, who heads the Basic Immunology Unit at the University Hospital of Lausanne in Switzerland, said a Garvan release.

The results are now online in the current edition of the Journal of Experimental Medicine.

Is intervention beneficial for brain vessel malformations?

Wed, 01 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (April 1, 2009) -- Individuals diagnosed with a brain arteriovenous malformation (BAVM) -- an abnormal tangle of arteries and veins -- are at increased risk of vessel rupture and bleeding that can cause permanent brain damage. Traditionally, doctors have prescribed preventive interventions like surgery, but there is suggestive evidence that this invasive approach may actually increase risk of a rupture, at least in some patients.

Now, physician-scientists at Columbia University Medical Center and NewYork-Presbyterian Hospital are the principal investigators of an ongoing international, multicenter, NIH-funded study examining whether intervention or a hands-off approach is best for the two-thirds of individuals with a BAVM that has not bled.

Before modern imaging was widely available, most BAVMs were discovered only after they had bled. At that time it was generally assumed that the few patients discovered with the condition that had not bled would require prophylactic intervention, but there was no conclusive evidence. This study will help answer this question, says Dr. Timothy A. Pedley, neurologist-in-chief at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Henry and Lucy Moses Professor and chairman of the Department of Neurology at Columbia University College of Physicians and Surgeons.

The clinical trial, called A Randomized Unruptured Brain Arteriovenous Malformation (ARUBA), is comparing the best possible invasive treatment strategy (any combination of endovascular, neurosurgical or radiation therapy) for unbled BAVM randomized against noninvasive medical management. The trial will recruit 800 patients to see whether invasive treatment or noninvasive management reduces the risk of death or symptomatic stroke over five years. There are more than 100 participating sites in the U.S. and around the world.

Previous research, including studies conducted by NewYork-Presbyterian/Columbia, has suggested that the annual risk of spontaneous hemorrhage may be as low as 1 percent for many non-ruptured BAVMs, especially among those for whom intervention appears feasible. But those with large and more complex BAVMs have higher hemorrhage rates and pose greater technical problems for intervention, and as a result treatment is deferred for many, given the risks. Age, deep brain location, associated aneurysms, and deep venous drainage add to hemorrhage risk factors.

All told, it has been difficult for neurovascular teams to determine how to balance the possible risk of intervention against the potentially low hemorrhage risk in patients whose BAVMs have not bled. ARUBA has been undertaken to obtain information that will improve clinical decision-making, says study principal investigator Dr. J.P. Mohr, neurologist at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Daniel Sciarra Professor of Neurology at Columbia University College of Physicians and Surgeons.

Brain surgery on Monday, home on Tuesday

Wed, 25 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- Norma Wooley checked into Loyola University Hospital on a recent Monday morning for brain surgery to repair a life-threatening aneurysm.

She went home on Tuesday, cured of the slurred speech, drooping face and worst headache of her life.

Dr. John Whapham used a less-invasive technique that's becoming increasingly common in brain surgery. The Loyola University Health System neurologist inserted a catheter (thin tube) in an artery in Wooley's leg and guided it up to her brain. The catheter released tiny platinum coils into the bulging aneurysm, effectively sealing it off.

She went home the next morning with a Band Aid on her leg, Whapham said.

Whapham, 36, is part of a new generation of neurologists who are using catheters to repair aneurysms, open clogged arteries, extract blood clots and repair blood vessel malformations in the brain. He also opens blocked carotid arteries in the neck. The catheter technique is much less invasive and risky than traditional brain surgery, which involves cutting a large opening in the skull.

Catheter technology, originally developed for heart surgery, has been modified for narrower and more challenging blood vessels in the brain. There has been a huge evolution in devices over the last five years, Whapham said. Whapham is an assistant professor in the Departments of Neurology and Neurological Surgery, Loyola University Chicago Stritch School of Medicine.

Whapham recently joined Loyola University Health System. He is board certified in neurology and has completed fellowships in endovascular neurosurgery, diagnostic cerebral angiography and stroke/neuro-critical care.

Wooley, 54, of St. Charles, Ill., is one of Whapham's first patients at Loyola. Her successful treatment illustrates the benefits of performing brain surgery with catheters rather than scalpels.

Wooley had a cerebral aneurysm, a weak spot in a blood vessel that balloons out and fills with blood. About six million Americans -- 1 in 50 people -- have brain aneurysms that could rupture. Each year, aneurysms burst in about 25,000 people, and most die or suffer permanent disabilities, according to the Brain Aneurysm Foundation.

Wooley's aneurysm was roughly one-fourth inch across, and shaped like a gumball. It could burst at any time and cause a debilitating or fatal stroke. Her clinical presentation was suspicious for what's called a sentinel hemorrhage, in which an aneurysm on the brink of rupture will often perforate without catastrophic clinical or radiographic findings. One day at work, Wooley began slurring her words, as if she had been drinking. Her mouth and eyelid drooped, and she had a headache that felt like someone was hitting her on the back of her head with a baseball bat. An ambulance took her to a local hospital, and she was transferred to Loyola.

My brain was ready to explode, she said.

Traditional open-brain surgery to repair aneurysms is highly invasive, and recovery can take months. Many patients wind up with cognitive deficits that can, for example, make it impossible to do complex jobs.

Between 80 percent and 90 percent of brain aneurysms can be repaired with less-invasive catheters. Tiny coils of platinum wire are passed through the catheter and released into the bulging aneurysm. The aneurysm fills up with coils, causing the blood to clot. It's like filling a bathtub with concrete, Whapham said.

A landmark clinical trial known as ISAT randomly assigned aneurysm patients to receive either open brain surgery or catheter surgery. The catheter group had significantly lower rates of death and disability. Whapham said catheter surgery techniques and devices have improved dramatically since the study was published in 2002 in the British journal

Stroke survivors improve balance with tai chi

Mon, 23 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Stroke can impair balance, heightening the risk of a debilitating fall. But a University of Illinois at Chicago researcher has found that stroke survivors can improve their balance by practicing the Chinese martial art of tai chi.

Christina Hui-Chan, professor and head of physical therapy at UIC, has studied and used tai chi as a way to improve balance and minimize falls among healthy elderly subjects. Now she and a colleague have seen similar results in a group of stroke survivors.

The study used 136 subjects in Hong Kong who had suffered a stroke more than six months earlier. Participants were randomly assigned to a tai chi group or a control group that practiced breathing, stretching and other exercises that involved sitting, walking, memorizing and reasoning.

Tai chi consists of constant coordinated movement of the head, trunk and limbs requiring tremendous concentration and balance control. Participants learned a simplified form that had been shown to be beneficial to arthritis patients.

Patients were trained in small groups by physical therapists in a weekly class, then practiced at home three days a week for one hour. They received 12 weeks of training but were able to learn the technique in as little as eight. The goal was to make the patients as independent in their treatment as possible, Hui-Chan said.

They were then tested for their ability to maintain balance while shifting weight, leaning in different directions, and standing on moving surfaces to simulate a crowded bus. In these tests the tai chi group out-performed the control exercise group. The two groups performed about the same on another test, which was not focused solely on balance but involved sitting, standing, walking, and returning to sit down.

The tai chi group did particularly better in conditions that required them to use their balance control, Hui-Chan said. In only six weeks, we saw significant improvements. The ability to shift your weight is very important because all reaching tasks require it.

While learning tai chi is not easy, Hui-Chan has found that most people can learn the art if taught by a trained instructor. Many Chinese practice tai chi in morning group exercises, and Hui-Chan thinks the experience can work for Americans and other western nationalities.

It can be taught at community centers, YWCAs or YMCAs, or in parks in the summer, she said.

Hui-Chan said that benefits of tai chi include improved strength and cardio fitness. Group classes also provide a healthy social gathering for isolated seniors at a fraction the cost of physiotherapy or personal training.

Lung transplantation a viable option in patients under 70

Tue, 10 Mar 2009 22:55:53 PST

( from http://www.rxpgnews.com ) New research published in the March issue of the Journal of the American College of Surgeons suggests that lung transplantation should be used with caution in patients older than 60 years and that the procedure is associated with high rates of mortality after one year in patients 70 and older.

Lung transplantation has been the gold-standard treatment for a variety of end-stage lung diseases, but candidate selection varies greatly among transplantation centers. The International Society for Heart and Lung Transplantation (ISHLT) reports that since 1985 the percentage of older patients receiving lung transplantation has increased steadily, with 24 percent of recipients in 2006 being older than age 60. This trend has raised concerns among transplant centers, since there is no consensus on potential age limits for the operation.

"These data underscore the importance of carefully considering age among potential lung transplantation recipients," said Eric S. Weiss, MD, division of cardiac surgery, The John Hopkins Hospital, Baltimore, MD. "Although age is only one of many important criteria, advanced age appears to have a major impact on post-surgical mortality. Our findings suggest that lung transplantation remains a viable option for appropriate candidates younger than age 70."

This new research study in JACS expands on previous findings reported by Dr. Weiss and colleagues. In October 2007 (93rd annual Clinical Congress Congress of the American College of Surgeons), Dr. Weiss reported that lung transplants improved survival rates in patients over 60 years of age. In this previous study the Johns Hopkins researchers looked at factors that create positive results in a 60-plus patient population, which has typically been regarded as not being the best candidates for lung transplantation. Upon analyzing patient outcomes, the researchers found that the survival rates between older and young patients were not all that different, especially at the 30-day survival period, and they concluded that this elderly patient population should not be categorically excluded from being offered the procedure as a treatment option. In the study just released in JACS, the researchers are able to make more specific recommendations for patients in the 60 to 70-years of age range, and beyond.

This new retrospective study examined 8,363 adult patients who underwent lung transplantation between 1999 and 2006. The United Network for Organ Sharing (UNOS) database provided the data, which was stratified into four quartiles (Q) of age: Q1, 18 to 45 years; Q2, 46 to 55 years; Q3, 56 to 60 years; Q4, 61 to 79 years. Patients in Q4 were further examined in smaller increments of age to assess differences in outcomes among the oldest groups of transplant recipients.

Patients in all four age quartiles had similar 30-day and 90-day mortality rates, but patients in Q4 experienced the highest mortality rates at 1-year post-transplant (21.4 percent, p=0.002). Of the 57 patients identified as 70 or older, 34 percent of the patients died during the study period. Additionally, both the 90-day and the 1-year mortality rates of the 70 years or older cohort was significantly higher than those patients under 70 (27 percent versus 9 percent for 90 day; and 42 percent versus 18 percent for 1 year; p< 0.001 for both comparisons).

New staging technique might save bladders in some bladder cancer patients

Mon, 09 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- Pathologists today (March 9, 2009) reported encouraging results from a new technique to increase the accuracy of staging bladder cancer tumors that could reduce the need to remove bladders from some patients.

The technique is performed by pathologists before surgery. It can confirm that in certain cases, tumors are at an early enough stage so that the cancer can be treated without removing the bladder.

In a study of 70 bladder cancer specimens, the technique was 95.2 percent accurate, Dr. Gladell Paner of Loyola University Health System reported at a meeting of the United States and Canadian Academy of Pathology annual meeting in Boston.

The American Cancer Society estimates there were about 69,000 new cases of bladder cancer in the United States last year, and about 14,000 people died of the disease.

There are five stages of bladder cancer, ranging from Stage 0 (earliest) to Stage 4 (most advanced). Stage 0 and Stage 1 cancers generally do not require removal of the bladder. Stage 2 and above typically require removal of part of or the entire bladder.

In Stage 0 and Stage 1, the tumor is confined to the surface of the bladder, or just below the surface. In Stage 2, the tumor has penetrated down to a deep muscle layer. But in some cases, Stage 2 cancer can look like Stage 1. The reason is that a layer of muscle near the surface can look like the deep muscle layer. Such a mistake can result in the bladder being needlessly removed. In as many as 4 percent of biopsies, it is extremely difficult to distinguish between Stage 1 and Stage 2 cancer, Paner said.

In the new technique, developed by Paner, the specimen is exposed to an antibody called smoothelin. Smoothelin reacts strongly with deep muscle, and this reaction shows up as a stain when seen under the microscope. By contrast, smoothelin does not react or leave stains on muscle near the surface.

The goal is to avoid the potential mistake of calling a tumor Stage 2 when it actually is Stage 1, Paner said. Paner is an assistant professor in the Department of Pathology at Loyola University Chicago Stritch School of Medicine.

In Paner's study, the technique correctly identified 97.9 percent of the specimens that had deep muscle and 95.2 percent of the specimens that did not have deep muscle.

These results are very encouraging, Paner said. However, we still need to be cautious. The technique needs to be studied further.

At the USCAP meeting, Paner and other Loyola researchers are lead authors of 16 study abstracts and co-authors of another nine abstracts.

The USCAP meeting is the world's largest gathering of physician-pathologists. Researchers from more than 430 medical schools and universities around the world will present nearly 2,800 study abstracts. Loyola is among the top 20 centers in the number of first-authored abstracts. All abstracts undergo a blind, peer-reviewed process.

Your institution has worked hard to support and generate these important studies which will help advance the specialty of pathology as well as medicine in general, USCAP Executive Vice President Dr. Fred Silva wrote in a letter to Dr. Eva Wojcik, chair of the Department of Pathology, Loyola University Chicago Stritch School of Medicine.

New surgical option for wrist arthritis

Fri, 13 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Feb. 13, 2009) -- Breaking a fall, such as a tumble on the sidewalk, with your hands and wrists is everyone's natural reflex. But, if you fall hard enough, you'll often fracture your radius bone, or even one of the smaller wrist bones and wrist ligaments. Left untreated, these injuries could lead to disabling wrist arthritis.

For patients who develop wrist arthritis, a new surgical option known as OCRPRC (OsteoChondral Resurfacing in Proximal Row Carpectomy) is available at NewYork-Presbyterian Hospital/Columbia University Medical Center, where it is offered by one of the orthopedic surgeons who originally developed and described the technique -- Dr. Peter Tang. His research shows that the procedure reduces pain and improves hand function.

I often see patients who had a wrist injury in the past who either did not seek medical attention or whose original injury was not diagnosed. As with most things in medicine, the earlier a diagnosis is made, the better the outcome. So if you continue to have pain after a month, you should make an appointment to see a hand surgeon for an evaluation, says Dr. Tang, who is an orthopedic hand surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of orthopedic surgery at Columbia University College of Physicians and Surgeons.

Because the biomechanics of the wrist is both delicate and complex, an alteration in the normal anatomy can lead to arthritis. Once disabling arthritis develops, surgery cannot simply fix the injured structure, but rather must remove the arthritis and improve wrist function. The two most common operations for wrist arthritis are a partial fusion of the small wrist bones (intercarpal fusion) and excision of the first row of carpal bones (proximal row carpectomy, or PRC). There are various reasons to choose one operation over the other, but PRC has a quicker recovery, may be better for older patients, gives equal grip strength to intercarpal fusion, and usually results in more wrist motion.

Once the three carpal bones are removed during the PRC procedure, the capitate bone becomes the point where the wrist articulates with the arm; as such, it is important that the arthritis has not progressed to the capitate bone.

For these patients whose arthritis has progressed, Dr. Tang has adapted a cartilage-grafting technique that is used effectively in sports medicine treatments for cartilage disorders in the knee, ankle and elbow. The results are promising, according to his study in the Journal of Hand Surgery, with improvement in grip strength and decrease in pain levels.

The goal of this new procedure is to give the best possible outcome by improving the cartilage status of the capitate bone. Another plus is that we do not have to take the graft from another part of the body. Even though we take out the three carpal bones for arthritis, there is usually one area of the bones where we can find undamaged cartilage for grafting, says Dr. Tang.

The study followed eight patients who underwent osteochondral resurfacing over 18 months. Preoperatively, seven patients described their pain as moderate to severe, while postoperatively, seven patients described their pain as mild to no pain, and one patient described the pain as moderate. Preoperative grip strength increased from 62 percent of their healthy side to postoperatively, 71 percent. Preoperative Mayo wrist score improved from a score of 51, which rates as poor, to a postoperative score of 68, which rates as fair.

Lung transplants: Doing more is better and safer, a Johns Hopkins study suggests

Tue, 27 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Transplant surgeons at Johns Hopkins have evidence that hospitals performing at least 20 lung transplant procedures a year, on average, have the best overall patient survival rates and lowest number of deaths from the complex surgery.

Researchers say their latest findings, to be presented Jan. 27 at the 45th annual meeting of the Society of Thoracic Surgeons in San Francisco, could serve as a patient safety benchmark or national standard for all hospitals to meet. The study is believed to be the first overall assessment since the procedure was perfected and widely adopted in the 1990s of how each of the 79 U.S. and Canadian medical centers licensed to perform lung transplantation measure up.

Institutions performing 20 more lung transplants annually, the researchers say, see the chances of an organ recipient surviving the critical first month of recovery plateau, at over 95 percent. Chances of recipients surviving the first year post-surgery are practically the same, at 83 percent. The contrast is sharp for the three-quarters of hospitals performing significantly fewer lung transplants. Then, an organ recipient's chances of dying within the first month after surgery nearly doubles, dropping survival rates to 90 percent if the hospital performs two or less per year, and to 73 percent after one year.

This, researchers say, occurred despite lower-volume centers having less severely ill patients than higher-volume centers.

Lung transplantation is an incredibly complex procedure, and our results show that the so-called '-center-effect-' is a very real phenomenon: Hospitals that do more, do them better, says study senior investigator and transplant surgeon Ashish Shah, M.D., who has performed over 100 lung transplants in the past decade For best patient outcomes, you need the right staff operating at peak skill level, with patient support systems ingrained in both their clinical operations and their organization's culture.

More than 1,400 lung transplants occurred in the United States in 2007, the last full year for which statistics are available. Thirty-nine percent of patients have survived for at least a year; 6 percent died within a month of surgery. Another 2,000 Americans remain on lung waiting lists, while 90 more are waiting for both a heart and lung.

Shah, an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, says lung transplantation is unlike other kinds of transplant surgery. The lungs are at increased risk of infection during the procedure because the organ is exposed to the outside air and potential bacteria. Recuperation also takes longer than with other types of organ transplant, such as kidney, with patients often spending up to a week in post-surgical intensive care, plus many more months of specialized physical therapy.

The actual surgery, he points out, can cost $150,000 to $300,000 and involves a team of roughly 20 specially trained personnel, such as surgeons, an anesthesiologist, critical care specialists, many specially trained nurses, physical, respiratory and speech therapists, and dietitians.

As part of the latest analysis, researchers reviewed 10,494 patient records for all single-lung and double-lung transplants performed in the United States and Canada from 1998 to 2007. The data came from the United Network for Organ Sharing (UNOS), a national network that allocates donated organs across the country.

Our findings do not mean that only high-volume centers should perform lung transplantation, says lead study investigator Eric Weiss, M.D., a postdoctoral research fellow in cardiac surgery at Hopkins

But it does mean that patients should consider consistently high volumes when evaluating their choices of where to have their transplant done, and it does mean that lower-volume centers really do need to learn from the higher-volume hospitals, taking a careful look at what they are doing right to raise their survival rates and lower a recipient's chances of dying or suffering complications from surgery, says Weiss.

Weiss also performed a similar analysis of the center-volume effect in heart transplants, presented at the same meeting held last year.

Our hope is that this evidence will be useful in establishing budgets and staffing objectives so that low-volume centers, too, can steadily improve their patient outcomes in lung transplantations, says Shah.

Roughly 20 institutions perform 20 or more lung transplants annually, on average. They include The Johns Hopkins Hospital, with 25 in 2006, 21 in 2007 and 15 in 2008. On average, one-year survival rates at The Johns Hopkins Hospital, Shah says, have risen consistently with volume increases, from 70 percent in the early 1990s to 95 percent in 2007.

Discovery to help trick body into accepting transplants

Sat, 24 Jan 2009 14:50:17 PST

( from http://www.rxpgnews.com ) Sydney, Jan 24 - A discovery can trick the body into accepting tissues or transplants as its own, eliminating the necessity for immunity suppressing medicines.

Stacey Walters, a researcher in immunology at Garvan Institute of Medical Research, has found that mice genetically engineered to produce large amounts of B cell activating factor - do not reject transplants.

She has shown that increased numbers of B cells - in turn stimulate the production of T regulatory cells, which then control T cells, the body's killer cells.

The surprising thing about the results is that B cells, which make antibodies, were not known to have any role in the production of T regulatory cells. Nor would it have been thought possible for them to influence the body's response to a transplant, which has been considered a function of T cells only.

'In normal situations, something has to turn the immune system off once your body's fought an invader, such as a virus. It's the T regulatory cells that come in and say 'enough's enough',' Walters explained.

Just to make sure it was the B cells that were provoking the changes, she repeated her experiments on a mouse in which B cells were genetically knocked out, but high BAFF levels preserved. She found that when there are no B cells, normal allograft rejection occurs, said a Garvan release.

Walter's results provide an insight into previously unknown interrelationships between various classes of immune cells. Manipulating these relationships may offer a way of preserving organ grafts in the future without the need for toxic immunosuppressive drugs.

The findings have been published in the Journal of Immunology.

Heart valves implanted without open-heart surgery

Fri, 09 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Jan. 7, 2009) -- An innovative approach for implanting a new aortic heart valve without open-heart surgery is being offered to patients at NewYork-Presbyterian Hospital/Columbia University Medical Center. Known as the PARTNER (Placement of AoRTic traNscathetER valves) trial, this Phase 3 multicenter study is being led by national co-principal investigators Dr. Martin Leon and Dr. Craig Smith and is focused on the treatment of patients who are at high risk or not suitable for open-heart valve replacement surgery.

The Edwards SAPIEN transcatheter heart valve, made of bovine pericardial tissue leaflets hand-sewn onto a metal frame, is implanted via one of two catheter-based methods -- either navigated to the heart from the femoral artery in the patient's leg, or through a small incision between the ribs and into the left ventricle. It is then positioned inside the patient's existing valve, using a balloon to deploy the frame, which holds the artificial valve in place. Both procedures are performed on a beating heart, without the need for cardiopulmonary bypass and its associated risks.

This breakthrough technology could save the lives of thousands of patients with heart valve disease who have no other therapeutic options, says Dr. Leon, the study's national co-principal investigator, associate director of the Cardiovascular Interventional Therapy (CIVT) Program at NewYork-Presbyterian Hospital and Columbia University Medical Center, and professor of medicine at Columbia University College of Physicians and Surgeons.

Annually, some 200,000 people in the U.S. need a new heart valve, but nearly half of them do not receive a new valve for a variety of reasons.

This study may show that transcatheter valve replacement is a safe and effective alternative to open surgery, which remains the 'gold standard' for most patients, says Dr. Smith, study co-principal investigator, interim surgeon-in-chief and chief of cardiothoracic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the Calvin F. Barber Professor of Surgery at Columbia University College of Physicians and Surgeons.

The transcatheter valve procedures take about 90 minutes, compared with four to six hours for open-heart surgery. In open-heart surgery, the surgeon cuts through the breastbone, stops the heart, removes the valve and replaces it. Open-heart surgery can require a two- to three-month recovery period, compared to only a few days for the transcatheter approach.

The PARTNER trial is a prospective randomized study with two separate treatment arms. In the surgical arm, patients are randomized to receive either the Edwards SAPIEN transcatheter heart valve or an Edwards surgical valve via open-heart surgery. In the non-surgical, medical management arm, patients considered to be non-operative are randomized to receive either the Edwards SAPIEN transcatheter heart valve or appropriate medical therapy.

Single adult stem cell can self renew, repair tissue damage in live mammal

Sun, 14 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) The first demonstration that a single adult stem cell can self-renew in a mammal was reported at the American Society for Cell Biology (ASCB) 48th Annual Meeting, Dec. 13-17, 2008 in San Francisco.

The transplanted adult stem cell and its differentiated descendants restored lost function to mice with hind limb muscle tissue damage.

The adult stem cells used in the study, conducted at Stanford University, were isolated from a mixed population of satellite cells in the skeletal muscle of mice.

The skeletal adult muscle stem cells (MusSC), which live just under the membrane that surrounds muscle fibers, normally respond to tissue damage by giving rise to progenitor cells that become myoblasts, fusing into myofibers to repair the tissue damage.

The scientists transplanted the MusSC into special immune-suppressed nude mice whose muscle satellite cells had been wiped out in a hind limb by irradiation.

The mice would only be able to repair injury if the transplanted MuSC took. The scientists, Alessandra Sacco and Helen Blau, had genetically engineered the transplanted MusSC to express Pax7 and luciferase proteins. As a result, every transplanted cell glowed under ultraviolet light and was easy to trace.

To be able to detect the presence of the cells by bioluminescence was really a breakthrough, says Blau. It taught us so much more. We could see how the cells were responding, and really monitor their dynamics.

Through luminescent imaging as well as quantitative and kinetic analyses, Sacco and Blau tracked each transplanted stem cell as it rapidly proliferated and engrafted its progeny into the irradiated muscle tissue.

The scientists then injured the regenerated tissue, setting off massive waves of muscle cell growth and repair, and subsequently showed that the MuSC and descendents rescued the second animal's lost muscle healing function.

After isolating the luciferase-glowing muscle stem cells from the transplanted animal, the scientists duplicated, or cloned, the cells in the lab. Like the original MuSC, the cloned copies were intact and capable of self-renewal.

We are thrilled with the results, says Sacco. It's been known that these satellite cells are crucial for the regeneration of muscle tissue, but this is the first demonstration of self-renewal of a single cell.

The ability to isolate and then transplant skeletal adult muscle stems cells could have a wide impact in treating not only a variety of muscle wasting diseases such as muscular dystrophy but also severe muscle injuries or loss of function from aging and disuse.

In other experiments, the researchers transplanted between 10 and 500 luciferase-tagged MuSC into the leg muscles of mice.

These cells also proliferated and engrafted, forming new myofibers and fusing with injured fibers.

Unlike tumor cells, the transplanted stem cells achieved homeostasis, growing to a stable, constant level and ceasing replication.

After demonstrating that the transplanted stem cells proliferated and fully restored the animal's lost function, Sacco and Blau recovered new stem cells from the transplant with full stem cell potency, meeting the final gold standard test for adult multipotent stem cells.

'Intelligent' materials to revolutionize surgical implants

Wed, 03 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) A brand new process that could revolutionise the reliability and durability of surgical implants, such as hip and knee replacements, has today , 2 December 08, received recognition for its medical and commercial potential by achieving one of the world's most sought after accolades. A team of researchers, led by the Science and Technology Facilities Council (STFC), has received a Medical Futures Innovation Award for its high technology process designed to coat surgical implants with fibres that, for the first time, will encourage the implant to 'bond' with living bone and to last the lifetime of the patient.

This unique surface engineering process is being developed at the Micro-Nano Technology Centre (MNTC) at STFC. In collaboration with the Electrospinning Company Ltd (TECL) and Anglia Ruskin University, the concept will be taken forward under the guidance of a Medical Futures team, and eventually exclusively licensed to TECL, a spin out company of STFC.

This advanced nanotechnology technique builds on an existing technique known as electrospinning, and will utilise a vastly superior electrospinning source to create bespoke fibrous materials. Electrospinning is a process that uses an electrical charge to turn polymers into extremely thin fibres that are 'spun' to form a mat of fine fibres. It is seen as a platform technology for the medical sector with a wide range of applications including tissue regeneration and drug delivery. The MNTC has developed systems to increase the production rate of nanofibres which has been previously prevented this technology from being adopted by industry.

In this case, nanosized hair- like structures, a thousand times thinner than the width of a human hair, are electrospun at MNTC and added to the surface of an orthopaedic implant to create a 'living interface' between the artificial implants and living bone. Not only does this improve the performance of the implants it also significantly increases their durability to last the lifetime of the patient. Any stress on the implant is relieved, making it more reliable and durable. Additionally, it is also possible to add a unique biological coating that can facilitate growth and improve the bonding of healthy tissue to the implant, primarily benefitting patients with osteoarthritis in the aging population and sports injuries in the younger population.

This process will be transferred to UK industry and TECL will provide access to state-of-the-art electrospinning systems. TECL has spun out from STFC to provide open access to electrospinning equipments and expertise to organisations that would like to explore the technique's potential. The main benefit is that this can be done without commercial companies committing to capital investment or developing in-house expertise until the potential value of electrospinning to the organisation is fully understood. TECL is based both at the Daresbury Science and Innovation Campus in Cheshire and at STFC's Rutherford Appleton Laboratory in Oxfordshire, and was founded by CLIK, the wholly-owned technology exploitation company of STFC. TECL's specialised facilities are designed to extend current electrospinning capabilities so that nanofibres can be reproduced in volume.

Dr Robert Stevens, Head of the MNTC at STFC said: This award provides a major step forward for the future of patients requiring surgical implants and I am thrilled that this concept was selected as an award winner over several hundred entries. Our award is given for translational research innovation to meet the current and future orthopaedic needs of patients.

Delays in radiation therapy lead to increased breast cancer recurrence

Mon, 01 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) A new analysis of the National Cancer Institute's cancer registry has found that as many as one in five older women experience delayed or incomplete radiation treatment following breast-conserving surgery, and that this suboptimal care can lead to worse outcomes.

Dr. Heather Taffet Gold of Weill Cornell Medical College and colleagues found that among a nationally representative sample of nearly 8,000 breast cancer registry patients aged 65 and older, almost 1,300 women experienced delayed radiotherapy and approximately 270 had incomplete radiotherapy. Of these women, those with Stage 1 breast cancer had worse health outcomes associated with this less-than-ideal therapy, while those with a precancerous lesion called ductal carcinoma in situ (DCIS) were not as affected.

Timeliness of post-surgical radiotherapy is important in reducing the risk of subsequent recurrence or new breast malignancies in patients with early breast cancer. Delaying treatment by eight weeks or more significantly increased the odds for recurrence, says Dr. Gold, the study's lead author and an assistant professor of public health in the Division of Health Policy in the Department of Public Health at Weill Cornell Medical College. One possible reason for the delays is that the coordination of care can be a challenge as treatment is usually delivered by multiple providers from different specialties, including surgeons, radiation oncologists and medical oncologists.

Stage 1 breast cancer patients with radiation treatment delayed by eight weeks were 1.4 times more likely to have a recurrence or subsequent new primary breast tumor compared with those receiving timely treatment; they also had reduced survival. Patients whose radiotherapy was delayed by 12 weeks or longer were four times more likely to have a recurrence or subsequent new breast tumor. And women who had incomplete radiation treatment for Stage 1 breast cancer -- those who underwent fewer than three weeks of the typical five-to-seven-week regimen -- had a higher rate of overall mortality, with a 32 percent higher likelihood of death.

The researchers also found treatment disparities in subgroups of older women. Older black women were more likely to delay radiation treatment, whereas women living in areas with a high concentration of radiation oncologists were less likely to delay. Additionally, older women living in high-poverty areas were less likely to complete radiation treatment, says Dr. Gold.

The work appears in the latest online issue of the journal Cancer and the Dec. 1, 2008, print issue. Research collaborators include Huong T. Do, M.A., and Andrew W. Dick, Ph.D., senior economist at the RAND Corporation in Pittsburgh, Pa.

The study is based on an evaluation of women aged 65 and older diagnosed with either DCIS or Stage 1 breast cancer from 1991 to 1999 and followed through 2002 in registries of the Surveillance, Epidemiology, and End Results (SEER) Program sponsored by the National Cancer Institute.

This nationally representative, population-based study of older women provided a unique opportunity to study the effects of suboptimal treatment in the community setting. Our findings indicate that radiation treatment should be made easier for all patients to ensure completion and that delays should be minimized. To improve health outcomes following treatment for breast cancer, health care facilities and providers should implement supportive services, such as transportation, and provide educational materials to encourage and ease access to optimal radiation treatment, thereby improving disease-free and overall survival, said Dr. Andrew Dick, senior author on the study.

Spanish surgeons achieve tracheal transplant breakthrough

Thu, 20 Nov 2008 17:37:23 PST

( from http://www.rxpgnews.com ) London, Nov 19 - In a surgical first, Spanish surgeons have achieved the world's first whole organ transplant using a windpipe made with the patient's own stem cells.

The tissue-engineered transplant resolves the danger of the body's rejection of foreign organs, making anti-rejection drugs redundant.

The transplant was carried out on Claudia Castillo, a 30-year old mother of two, at the Hospital Clinic of Spain's Barcelona in July when her windpipe narrowed after she contracted tuberculosis and needed a replacement to save her lung from being infected, BBC said.

To make the new airway, the doctors took a donor windpipe, or trachea, from a patient who had recently died.

They washed the tissues of the donor trachea with chemicals and relocated the organ with Castillo's own cells in a special chemical process.

The re-populated windpipe, when transplanted, convinced the body that it was a part of it, thereby avoiding the danger of rejection.

Five months on, Castillo is in perfect health, The Lancet reports.

Scientists from Bristol helped to grow the cells for the transplant and the European team believes such tailor-made organs could become the norm.

'Before this, we had been doing this work only on pigs,' Surgeon Professor Paolo Macchiarini of the Hospital Clinic of Barcelona, Spain, who led the operation, said. 'I was scared, but it went well.'

It went so well that four days after the transplant the organ merged with the body indistinguishably.

Castillo is living an active, normal life, and is able to look after her children Johan, 15, and Isabella, four. She can walk up two flights of stairs without getting breathless, medical reports said.

Martin Birchall, professor of surgery at the University of Bristol who helped grow the cells for the transplant, said: 'This will represent a huge step in surgery. Surgeons can now see and understand the potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases.'

He said that in 20 years time, virtually any transplant organ could be made in this way.

US scientists have already successfully implanted bladder patches grown in the laboratory from patients' own cells into people with bladder disease.

The European research team, which also includes experts from the University of Padua and the Polytechnic of Milan in Italy, is applying for funding to do windpipe and voice box transplants in cancer patients.

New technique eliminates toxic drugs in islet transplant in diabetic mice

Thu, 20 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO -- The body's immune system hates strangers. When its security patrol spots a foreign cell, it annihilates it.

This is the problem when people with type 1 diabetes undergo human islet cell transplantation. The islet cells from a donor pancreas produce robust amounts of insulin for the recipient -- often permitting independence from insulin therapy. However, the immune system tries to kill the new hard-working islets.

A person who has the transplant procedure must take powerful immunosuppressive drugs to prevent their bodies from rejecting the cells. The drugs, however, are toxic to the new islet cells and put patients at risk for infections and cancer.

Now researchers at Northwestern University's Feinberg School of Medicine have found a way to trick the immune system of mice into believing those transplanted islets are its own cells. This new technique eliminated the need for the immunosuppressive drugs in mice with chemically-induced diabetes after they had islet transplantation.

We made the recipient feel that the donor cells are their own, explained Stephen Miller, co-principal investigator and the Judy Gugenheim Research Professor of Microbiology-Immunology at the Feinberg School. This technique is a highly attractive potential therapy for human islet cell transplantation. The findings were reported in the journal Proceedings of the National Academy of Science in the fall.

As many as 3 million people in the U.S. may have type 1 diabetes, a disease that develops in children and adolescents. There are about 50 to 70 islet transplants, an experimental procedure, annually in North America.

Miller said he was happily surprised to see that such a high percentage of recipients of the transplanted islet cells -- greater than 70 percent -- maintained transplants long-term. His research showed the host's tolerance to these transplanted cells seemed to be permanent, lasting for at least 150 days. Xunrong Luo, assistant professor of medicine in nephrology at the Feinberg School, was co-principal investigator for the study.

In the study, researchers took a type of white blood cell from the islet donor's spleen, called splenocytes, and treated them with a chemical that masked the cells' identity. They then injected these chemically treated cells into diabetic mice before and after the mice underwent islet cell transplantation. As a result, the immune system of the mice didn't try to reject the cells, because it didn't perceive them as foreign and dangerous.

When the same test was done without pre-treated cells, the immune system rejected the transplanted islets within 15 days.

In an upcoming study, Miller and Luo will work with mice that have autoimmune disease that destroys their islet cells, as occurs in type 1 diabetes. Researchers will use therapies that prevent the autoimmune system's response against its own beta cells (which are part of the islets) as well as prevent the recipient's immune responses against the transplanted islet cells.

We have ways we can do both, Miller said. Hopefully this next study will show we can take combined therapies for underlying autoimmune disease and transplanted islets. If we do that together, we hopefully can cure an animal who became diabetic from autoimmune disease. If successful, the next step would be testing the technique on human subjects.

Miller said this technique also has applications for treating other autoimmune diseases such as multiple sclerosis.

Pure insulin-producing cells produced in mouse

Thu, 20 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Singapore researchers have developed an unlimited number of pure insulin-producing cells from mouse embryonic stem cells (ESCs).

These pure insulin-producing cells, which according to electron microscopy studies, have the same sub-cellular structures as the insulin-producing cells naturally found in the pancreas, were highly effective in treating diabetes in the mouse model.

The transplants of pure insulin-producing cells reduced the blood glucose levels of diabetic mice with high blood glucose levels.

The experiments also showed that the subsequent removal of the transplanted cells from the diabetic mice restored the blood glucose to its original high level.

None of the diabetic mice involved in the transplant experiments developed teratoma, which are a type of tumour often associated with ESCs and which could complicate their use in human therapeutic treatment.

Furthermore, the pure insulin-producing cells managed to retain their insulin-production and glucose-sensing capacity over time.

The Singapore researchers' achievement provides proof of principle that this strategy could be applied to human ESCs to obtain similar pure insulin-producing cells.

These research findings were published in two separate papers in the July and August 2008 online versions of the journal Stem Cell Research.

Conducting the research were scientists at the Institute of Medical Biology (IMB), which is under Singapore's Agency for Science, Technology and Research (A*STAR), and the Yong Loo Lin School of Medicine (YLLSoM ) at the National University of Singapore (NUS).

The team of researchers was co-led by Dr. Lim Sai Kiang, an IMB principal investigator and a research associate professor at the YLLSoM Department of Surgery, and Dr. Li Guodong, a research associate professor at National University Medical Institutes, YLLSoM, NUS.

Commenting about these findings, Dr. Gordon Weir, Director of the Clinical Islet Transplantation Program at Harvard Medical School, who also holds appointments at the Harvard Stem Cell Institute and Joslin Diabetes Centre, said, The amount of careful work done by this group of researchers is impressive. We need something to put into diabetic patients to treat their condition, and these findings tell us interesting things about the development of beta cells.

The strategic approach by the group offers avenues for further research in the treatment for diabetes. Said Dr. Lim, Our ability to isolate and then multiply insulin-producing cells from differentiating ESCs provides an unlimited supply of pure insulin-producing cells to study in unprecedented detail many aspects of these cells.

Added Dr Li, Besides providing a tool to facilitate basic research in test tubes and animals, these insulin-producing cells may be also used to replace the isolated native pancreatic cells that are hard to obtain in a large amount, for pharmacological tests.

Cooling the brain prevents cell death in young mice exposed to anesthesia

Mon, 17 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) New research from Washington University School of Medicine in St. Louis suggests cooling the brain may prevent the death of nerve cells that has been observed in infant mice exposed to anesthesia. The effects of anesthesia on human infants and young children have been debated among neuroscientists, but growing evidence suggests exposure to anesthetic drugs during brain development may contribute to behavioral and developmental delays.

The same researchers previously had reported that when young rodents were exposed to alcohol, anesthetics or anticonvulsants, large numbers of their brain cells died through a process known as neuroapoptosis. This latest work suggests such damage may be preventable.

The new findings are reported today at Neuroscience 2008, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news about brain science and health.

Cooling the brain seems to be quite effective in suppressing nerve cell death after an infant animal has been exposed to an anesthetic drug, says John W. Olney, M.D., the study's senior investigator and the John P. Feighner Professor of Neuropsychopharmacology. We don't yet know whether this cooling only temporarily suppresses or whether it permanently prevents this brain damage from occurring. We're currently working to clarify that.

Olney's research team previously had demonstrated that a small dose of anesthetic drugs, enough to lightly anesthetize an infant mouse for about one hour, was sufficient to trigger neuroapoptosis.

It has been widely assumed that the benefits of anesthesia can be achieved without adverse consequences, Olney says. But that assumption has been called into question in recent years by work from our laboratory and others around the world.

In this study, Olney found the anesthetic drugs isoflurane and ketamine increased neuroapoptosis in infant mice at normal or high temperatures. However, hypothermia during exposure to anesthesia blocked neuroapoptosis and also reduced the low level of neuroapoptosis that occurs normally during brain development.

Some cells fail to make the normal connections that they are supposed to make in order to become integrated into a neural network, he explains. It's necessary for those cells to die and to be removed from the brain. Cooling the brain also suppresses that process.

If Olney's research team can demonstrate cooling the brain only delays that healthy process temporarily, but permanently prevents unhealthy neuroapoptosis due to anesthesia exposure, the technique may be useful someday in preventing cognitive and developmental problems in some children exposed to anesthesia during surgery.

Olney says it's tricky to demonstrate links between developmental deficits and exposure to anesthetic drugs because the type of deficit can vary depending upon the developmental age at which exposure occurs. Different parts of the brain develop at different times, so exposure during one period of development may have a very different effect than exposure earlier or later in brain development.

We believe there are certain early periods when the damage is not only more likely to be severe, but it's also likely to be more widespread throughout different regions of the brain, he says. Naturally, if more of the brain is involved and damage to those regions is more severe, it's going to cause more pronounced neural and cognitive consequences.

Olney says it is likely that the protective effects of hypothermia can be achieved either by cooling the entire body or by applying a cooling helmet to the head.

In addition, Olney has demonstrated in other research that it may be possible to prevent neuroapoptosis by treating mice with other drugs. He recently reported that the drug lithium may provide similar protection against damage from anesthesia.

Beware of malnutrition, if you are going in for body contouring surgery

Sun, 16 Nov 2008 14:38:03 PST

( from http://www.rxpgnews.com ) Washington, Nov 13 - Beware of malnutrition if you are going in for a body contouring procedure following weight loss surgery.

Proper nutrition cuts down surgical complications, accelerates wound healing, improves scar quality and boosts your energy levels,

'Body contouring procedures - are major operations with large incisions in many areas that demand a lot of the body during the healing process,' said Dennis Hurwitz of American Society of Plastic Surgeons -, co-author of a new study on the subject.

'By carefully monitoring nutritional deficiencies pre-operatively and supplementing the patient with the necessary nutrients, minerals and vitamins, I have seen a significant decrease in complications and improved postoperative healing.'

The study was performed in two parts; First, medical literature regarding nutrition's effect on healing from the 1940s to the present was reviewed.

The authors then compared healing and wound problems in 75 of their body contouring patients from 2001 to 2005 who did not receive supplementation, with 37 patients from 2006 to present, who participated in a nutritional supplement programme prior to surgery.

The study found that complications and wound problems occurred in 66 percent of the 75 patients who did not receive supplementation before 2006.

In the 37 patients on the nutritional supplement regimen after 2006, major complication rates were reduced to 19 percent, according to an ASPS release.

The study found specifically that improving nutritional deficiencies in massive weight loss patients improved the healing process, wound tension and scar quality, in addition to increasing patients' energy levels.

Because of reduced calorie intake for massive weight loss patients, they are highly susceptible to malnutrition, the study observed.

Nearly 67,000 body contouring procedures after massive weight loss were performed in 2007, said ASPS.

These findings are scheduled for publication in the December issue of Plastic and Reconstructive Surgery.

Research 'A' team to fast track Bionic Eye, Australian consortium announced

Wed, 12 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Tens of thousands of people with severe vision loss are set to benefit after the announcement today of a landmark partnership of world-leading Australian research institutes.

Bionic Vision Australia will pursue the development of the most technologically advanced bionic eye to improve the sight of people with degenerative or inherited retinal disease.

Bionic Vision Australia's members include the University of Melbourne, the University of New South Wales, the Bionic Ear Institute, Centre for Eye Research Australia and the Victoria Research Laboratory of NICTA.

Bionic Vision Australia Chairman, Professor Emeritus David Penington A.C, said the partnership brings together Australia's international experts in medical bionics, covering the many disciplines required to develop a safe and technologically advanced device able to restore functional vision.

Our team is well placed to undertake the critical research required to deliver an advanced Bionic Eye, which would deliver improved quality of life for patients suffering from common causes of severe loss of vision and blindness, he said.

Over 50,000 Australians have severe to profound vision loss. The major cause of severe vision impairment is degeneration or death of the cells in the eye that receive light signals.

It has been estimated that the cost of severe and profound vision loss in Australia is approximately $3B per year, and rising.

A bionic eye will assist in restoring patient mobility, independence and quality of life by effectively replacing the function of damaged light-sensing cells in the eye.

While the clarity and definition of vision will not be equal to normal sight, the device will allow patients to move around, detect large objects and, in time, read text and recognise faces and emotions.

Bionic Vision Australia has submitted a detailed plan and funding request to the Australian Government to enable it to undertake the required research and early clinical testing.

The New South Wales and Victoria governments have both provided support to the partnership to enable the development of the detailed plan.

The proposal follows an 18-month feasibility study undertaken by members of the consortium and heightened public interest in the bionic eye, most notably at the recent Australia 2020 Summit where it was flagged as a big idea worthy of consideration for Australia to pursue.

Bionic Vision Australia proposes to have its first advanced prototype ready for the first human implant by early 2012 that delivers significant benefits to patients with severe mobility and light perception difficulties.

This device is the result of research undertaken over a 10-year period by the Australian Vision Prosthesis Group at the University of New South Wales.

An enhanced second prototype developed at the Victoria Research Laboratory of NICTA could be available for the first human implant by late 2013 and would provide further improved quality of life for patients where image perception is the primary consideration.

This is an exciting opportunity for Australia to reinforce its leadership in medical bionics, first demonstrated with the development in Melbourne of the bionic ear in the 1970's, said Professor Anthony Burkitt, Research Director of Bionic Vision Australia and Chair of the Department of Electrical and Electronic Engineering at the University of Melbourne.

BVA is inspired by the bionic ear experience to build a world-class multi-disciplinary team capable of restoring functional vision to sufferers of inherited and degenerative retinal diseases and thereby make a contribution to addressing the significant cost this disease imposes on the Australian and other economies.

The implications for improved health are significant, he said.

No drop in IQ seen after bypass for child heart surgery

Mon, 10 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) The use of cardiopulmonary bypass does not cause short-term neurological problems in children and teenagers after surgery for less complex heart defects, according to pediatric researchers. The new finding contrasts favorably with previous studies that showed adverse neurological effects after newborn surgery for more complex heart conditions.

This is good news for school-aged children who receive surgery for these less complex heart defects, said study leader Michael D. Quartermain, M.D., a pediatric cardiologist at The Children's Hospital of Philadelphia. Quartermain presented the study group's results at the American Heart Association's Scientific Sessions today in New Orleans.

The research, conducted at the Cardiac Center of Children's Hospital, studied 41 patients, aged five to 18, who underwent heart surgery at the hospital while a heart-lung machine circulated their blood (under cardiopulmonary bypass, or CPB). All the patients had milder forms of congenital heart disease usually characterized by an abnormal heart valve or by a hole between the heart's chambers.

Such defects, while present from birth, are often not detected until a patient is school age or even older. Patients do not show obvious symptoms and are otherwise healthy, but surgical intervention is often recommended to prevent complications later in life. In contrast, more complex congenital heart defects, such as hypoplastic left heart syndrome, a severely underdeveloped ventricle, are life-threatening in infancy, and require urgent surgical repair.

Previous studies of survivors of more complex heart surgery have found neurological problems, such as impaired motor development, lower I.Q. scores and reduced language skills. As medical regimens and surgical techniques have advanced, more recent studies have found milder neurological problems or normal neurological outcomes, but long-term outcomes remain a concern. Likewise, adults with acquired heart disease have sometimes suffered adverse neurological outcomes after surgery with CPB.

In the current study, researchers compared 41 pediatric heart patients who underwent CPB to a control group receiving non-heart-related surgery without CPB. Neurological and developmental testing were performed two weeks before and six months after surgery in both groups. When controlling for the effects of hospitalization and anxiety, the researchers found no significant difference between the two groups in I.Q. scores and tests of memory, motor skills or attention. Neither of the surgical groups showed a decline in neuropsychological scores after surgery.

Regarding the implications of the study, Quartermain said, It is often challenging for the cardiologist to determine the optimal time to refer a child without symptoms to the operating room for repair of an underlying congenital heart defect. It is now clear that the potential neurodevelopmental sequelae of cardiopulmonary bypass in this group of school-aged patients should not be a major factor in this important decision.

First trial of gene therapy for advanced heart failure shows promising results

Mon, 10 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Nov. 10, 2008) -- Phase I results of the first clinical trial of gene therapy for patients with advanced heart failure show the approach to be promising, with improvements in several measures of the condition's severity.

In Phase I clinical trials, researchers test a new treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

Patients enrolled in the multicenter CUPID trial (Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease) undergo a minimally invasive cardiac catheterization procedure which introduces a specially engineered gene that stimulates production of an enzyme necessary for the heart to pump more efficiently.

NewYork-Presbyterian Hospital/Columbia University Medical Center was the first to offer the therapy in the New York City area. The Hospital is now recruiting patients for the Phase II CUPID trial to further assess safety and effectiveness in patients with advanced heart failure.

Data from the Phase I trial, which was initiated in May of 2007, were presented at the American Heart Association (AHA) Scientific Sessions 2008 in New Orleans yesterday. Seven of nine patients who were given the drug showed improvements over six months in several areas: symptomatic (five patients), functional (four patients), biomarker (two patients) and left ventricular function/remodeling (six patients). Two patients with pre-existing antibodies to the viral vector delivery system did not show improvements. Importantly, the approach was shown to have an acceptable safety profile, as determined by an independent safety committee and by the study investigators.

We are encouraged by these initial findings, which indicate that this therapy has the potential to help patients with advanced heart failure, says Dr. Donna Mancini, the study's principal investigator at NewYork-Presbyterian Hospital/Columbia University Medical Center, where she is medical director of cardiac transplantation and is professor of medicine at Columbia University College of Physicians and Surgeons.

The Phase II randomized, double-blind, placebo-controlled clinical trial will compare the therapy at two- or three-dose levels with placebo. CUPID is expected to enroll 46 patients with advanced heart failure at 13 U.S. hospitals.

Gene therapy is a technique for correcting defective genes responsible for disease development by inserting genes into a patient's cells and tissues. In most gene therapy studies, a normal gene is inserted into the genome to replace an abnormal disease-causing gene. A carrier molecule called a vector must be used to deliver the therapeutic gene to the patient's target cells. Currently, one of the most common vectors is a non-pathogenic virus most people have been exposed to in adolescence that has been genetically altered to carry normal human DNA.

More than 5 million people in the U.S. have heart failure. Patients with severe form of the disease have trouble breathing because the heart muscle is not strong enough to pump fluid out of their lungs. Approximately 70 percent die of the disease within 10 years, and the five-year survival rate is less than 50 percent. Heart failure is the only cardiovascular disease whose incidence has been increasing rather than decreasing in recent years.

Experts discuss effects of chronic kidney disease on women's sexual health

Fri, 07 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Chronic kidney disease (CKD) exacts a significant toll on a woman's sexuality and gynecologic health. The various effects of kidney failure and its treatments on women's sexual health from adolescence through menopause will be the topic of an in-depth series of presentations at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia, Pennsylvania.

Women whose kidneys are failing experience hormonal changes that can have numerous adverse effects on the body. In a program moderated by Margaret J. Bia, MD, of the Yale University School of Medicine in New Haven, Connecticut, and Denyse Thornley-Brown, MD, of the University of Alabama at Birmingham, experts will explore the sexual life cycle of women with CKD and discuss the medical impacts that kidney disease has on their sexuality from childhood through advanced age.

Lynne P. Yao, MD, of the Inova Fairfax Hospital for Children in Fairfax, Virginia, will highlight the latest information on issues of adolescence, revealing the abnormalities that can develop in girls with CKD. These children are particularly vulnerable and can experience impaired growth and abnormal menstrual cycles due to altered metabolism and hormone deficits. Physicians face a number of challenges that are unique to treating these patients.

Next, Tracy Breen, MD, of the Mount Sinai School of Medicine in New York City will discuss how CKD can contribute to ovarian failure and premature menopause. Because kidney disease disrupts the balance of hormones produced by the body, women with the condition can experience symptoms of menopause at a young age.

Susan H. Hou, MD, of the Loyola University Health System in River Forest, Illinois, will then provide an overview of issues related to pregnancy and fertility in female kidney disease patients. Fertility is decreased in these women, and when they do conceive, the likelihood of a healthy and successful pregnancy is less than that seen in women without kidney disease. Females with kidney disease who become pregnant also risk developing hypertension and kidney function loss. Dr. Hou will highlight the many strides that have been made in improving the health of pregnant women with kidney disease as well as the serious issues that must still be addressed to make it safe for these women to become pregnant and give birth.

Finally, Manjula Kurella-Tamura, MD, of Stanford University in Palo Alto, California, will present information on menopause and hormone replacement therapy in women with CKD. Because estrogen may have a protective effect against developing kidney disease, many women are not diagnosed with kidney disease until they reach menopause. Between 40 and 70% of women with CKD are menopausal and therefore are likely to consider taking hormone replacement therapy to relieve their symptoms. Dr. Kurella-Tamura will discuss the controversies regarding the use of hormone replacement therapy in these women and whether recommendations should be any different than those for women with normally functioning kidneys.

ERSD, heart disease and African-Americans with hypertensive nephrosclerosis

Thu, 06 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) For most patients with chronic kidney disease (CKD), the risk of experiencing a cardiovascular related death is greater than the risk of progressing to end-stage renal disease (ESRD). According to research being presented at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia, Pennsylvania, African Americans with CKD caused by high blood pressure (hypertensive nephrosclerosis) demonstrated a higher risk of progressing to ESRD than dying from heart disease related events.

Tahira Alves, MD, of Vanderbilt University in Nashville, Tennessee, will present the cardiovascular and renal results from the AASK (African American Study of Kidney Disease) Cohort Study (2002-2007), which followed the original AASK Trial (1996-2001). Of 1,094 eligible patients from the original AASK Trial, 691 were enrolled in the subsequent AASK Cohort study. The patients received intensive follow-up to keep their blood pressure at a target level of less than 130/80 mm Hg (millimeters of mercury). The average age at the start of the study was 55 years.

During 11 years' follow-up, the patients were at higher risk of progressing to ESRD than of experiencing cardiovascular disease events such as myocardial infarction (heart attack). For each 100 patient-years of follow-up, there were four cases of ESRD (permanent loss of kidney function requiring dialysis or transplantation). By comparison, the rate of cardiovascular disease events was 3.2 per 100 patient-years.

The risk of death from cardiovascular disease was 0.8 per 100 patient-years. Of 74 deaths that occurred during the Cohort period of the AASK Study, more than 60 percent were from causes other than cardiovascular disease.

The finding that ESRD risk is higher than cardiovascular risk for African Americans with hypertensive nephrosclerosis is in direct contrast to what has been previously reported in other CKD populations. The AASK trial and the subsequent cohort study allow the medical community to gain a broader understanding of incident cardiovascular disease and mortality during long-term follow-up in an entirely African-American population with nondiabetic hypertensive nephrosclerosis, comments Dr. Alves.

The findings are limited by the fact that the primary goal of the AASK trial was to detect changes in kidney function, ESRD, and/or risk of death. Cardiovascular events were measured as a secondary outcome.

The results may provide additional insight into the relationship between high blood pressure and kidney disease in African Americans, as well as some of the reported racial differences in the rates and outcomes of ESRD. The study is timely given the increased recognition of medical health disparities observed among African American patients, Dr. Alves adds. This type of information is needed if solutions are to be sought at the clinical and policy levels.

Breakthrough to nip transplant rejection in the bud

Fri, 31 Oct 2008 12:25:11 PST

( from http://www.rxpgnews.com ) London, Oct 31 - A chance discovery by biologists will help trick the immune system into believing that a transplanted organ is the body's own, not a foreign element, nipping its rejection in the bud.

The scientists confirmed the two-way transfer of a molecule called MHC that instructs the immune system to tell 'self' from 'non-self'. By disrupting this, transplanted organs should become 'invisible' to the host's immune system, hence out of the pale of attacks.

Such an advance would be a major medical breakthrough because current methods of preventing organ rejection involve weakening the host's immune system, which can lead to life-threatening infections.

The researchers made this discovery when they transplanted kidneys or hearts from one set of mice into another, with each set of mice having a different version of the molecule being studied.

They then conducted tests to see if the molecules were transferred. In the recipient mice, the donated kidneys or hearts and the host tissue expressed both types of molecules. This is the first time that this transfer has been shown to happen in a living system.

Wilson Wong, senior researcher from King's College London, said that 'that this study will lead to a better understanding of the immune system to benefit the development of new therapies in areas related to transplantation.'

'The medical potential of this finding is enormous,' says Gerald Weissmann, a doctor and editor-in-chief of The FASEB Journal, which carried the report.

'Understanding molecular miscegenation - should not only make transplantation more widespread and effective, but also shed light on how microbes disrupt our body's immune apparatus for distinguishing self from non-self,' he added.

The FASEB Journal - is published by the Federation of American Societies for Experimental Biology - and is the most cited biology journal worldwide, according to the Institute for Scientific Information.

Dr. Henry Barnett becomes first person outside Europe to receive Karolinska Stroke Award

Wed, 29 Oct 2008 04:00:00 PST

( from http://www.rxpgnews.com ) Dr. Henry JM Barnett, London, Ontario, receives the Karolinska Stroke Award for Excellence in Stroke Research. The prize amounts to 100,000 SEK. The laureate will receive the prize from the President of Karolinska Institutet Harriet Wallberg-Henriksson during the Karolinska Stroke Update meeting in Stockholm November 17, 2008. Barnett is the first non-European to receive this prestigious award. The Karolinska Institutet also awards the Nobel Prize annually.

Barnett's key research field is prevention of stroke. For younger colleagues, he will be primarily remembered as an enthusiastic coordinator of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Together with a European study of similar design this trial provided the scientific evidence for operation on tight atherosclerotic manifestations on the carotid artery of the neck, since then one of the most important interventions to prevent recurrent stroke after transient or mild cerebrovascular warning symptoms.

Before the NASCET study, Barnett was leading another extensive trial, with quite a different outcome. In North America, and some other medical centres in the world, clinics were established to perform extracranial-intracranial (EC-IC) bypass surgery, in patients with total occlusion of one of the major supplies to the brain, the internal carotid artery. Through an opening of the skull bone, arteries on the outside of the skull were connected with those on the surface of the brain. The EC-IC bypass study showed that these operations did not benefit patients and in the mid 1980s, these operations were almost totally stopped. Today we know that before any conclusions can be made on the severity of an occluded carotid artery, an evaluation of alternative (collateral) blood flow supply to the brain is essential.

Even earlier, in 1970, Barnett was leading the Canadian Aspirin Trial which established, for the first time, that any antiplatelet drug could prevent diseases (in this case stroke) due to arterial thrombosis.

Barnett was born in Newcastle upon Tyne in England and moved with his parents to Canada as a child. He entered medicine at the University of Toronto where he graduated in 1944. He did his junior rotating internship at the Toronto General Hospital and later completed training in neurology in Toronto in 1950. After two years at Queen Square in London, UK, and later a research assistant in Oxford, he obtained a fellowship from the Royal College of Physicians and Surgeons of Canada (F.R.C.P.(C.)). From 1952 to 1967 he was neurologist at the Toronto General Hospital and from 1966 to 1969 Chief of the Division of Neurology at Sunnybrook Medical Centre. In 1969 he was invited to become the Chief of the Division of Neurology at The University of Western Ontario and Victoria Hospital in London, Ontario. From 1974 to 1984 he served as Chairman of the Department of Clinical Neurological Sciences at The University of Western Ontario. In 1986, he co-founded the Robarts Research Institute and was named its first Scientific Director.

Barnett's extraordinary contributions to stroke research have changed the management of millions of stroke patients. The implementation of his research has prevented an unaccountable number of strokes. He has shown the strength of research by revealing that some routinely used procedures were supported by science, others were not.

For these contributions, Dr. Henry JM Barnett is awarded the Karolinska Stroke Award for Excellence in Stroke Research in 2008.

Anti-seizure drug could be fatal

Tue, 28 Oct 2008 04:00:00 PST

( from http://www.rxpgnews.com ) Patients treated for their prolonged seizures with the sedative propofol may be at high risk for complications and even death. New research presented at CHEST 2008, the 74th annual international scientific assembly of the American College of Chest Physicians (ACCP), shows that the use of propofol as an antiepileptic agent in patients with refractory status epilepticus (RSE), prolonged seizures that do not respond to initial treatment, was associated with significant mortality and morbidity.

RSE is a difficult clinical problem seen in patients with primary epilepsy and in those with other conditions such as trauma, tumors, and infections affecting the brain. Although propofol is used to treat patients with RSE, it is more commonly used for sedation during surgeries or other patient procedures but at a much lower dose and shorter duration than that used for the control of seizures.

Patients with RSE treated with propofol are at high risk for propofol-related side effects because of the high propofol infusion rates and prolonged treatment duration necessary in these patients, said Vivek Iyer, MD, Mayo Clinic, Rochester, MN. However, it is well described that propofol toxicity can occur even with brief exposure to the drug.

Dr. Iyer and his colleagues from Mayo Clinic reviewed 39 consecutive patients (median age of 54 years) from 1997 to 2007, who were admitted to the ICU with RSE, in order to examine the link between propofol use and related side effects, including propofol infusion syndrome (PRIS). PRIS is a usually fatal complication of propofol use that has been reported especially at high infusion rates for prolonged periods. For this study, PRIS was defined by the unexplained presence of at least one or more of the following: metabolic acidosis, rhabdomyolysis, bradycardia, and/or cardiac arrest.

Propofol was used in 32 (82 percent) of the patients (group A) for a median of 63 hours and a median peak infusion rate of 67 mcg/kg/min. Other agents, such as midazolam and pentobarbital, were used in the other seven (18 percent) patients (group B). Within group A, three patients had sudden unexplained cardiac arrest while on propofol infusions, resulting in two deaths, while no deaths occurred in group B. Median hospital stay (12 days) and ICU length of stay (9 days) did not differ between the two groups. The overall occurrence of PRIS was 30 percent of patients in group A (seven patients with bradycardia, three patients with sudden unexplained cardiac arrest) compared with less than 3 percent (one patient with bradycardia) in group B.

In light of the new data, Dr. Iyer advises that caution should be taken with the use of propofol to treat patients with RSE. There are several other medications we can turn to in the case of uncontrolled seizures, he said. Alternative agents should first be tried for patients with RSE, and propofol should only be used after exhausting all other options.

With increasing awareness of the risks of propofol, physicians may become more cautious about using propofol for prolonged periods and at high doses, James A. L. Mathers, Jr., MD, FCCP, President of the American College of Chest Physicians.

Revolutionary operation performed live for heart rhythm congress

Mon, 20 Oct 2008 04:00:00 PST

( from http://www.rxpgnews.com ) A revolutionary heart operation technique using cutting edge technology will be performed on Monday 20 October and broadcast live to delegates at the Heart Rhythm Congress 2008 taking place in Birmingham.

The procedure to tackle heart rhythm disorder will be performed by Dr Andre Ng, Senior Lecturer in Cardiology at the University of Leicester and a Consultant Cardiologist at the University Hospitals of Leicester NHS Trust.

He will use technology that allows rapid and accurate location of the origin of the heart rhythm disturbance in a 3-dimensional geometry of the heart chambers and guides successful treatment with the use of catheter ablation.

Dr Ng said the procedure would highlight not only the advanced technology itself but also of the leading position his team at Glenfield Hospital in the management of heart rhythm disorders as well as the world-class research in the Department of Cardiovascular Sciences at the University of Leicester.

Dr Ng said: I have been invited to operate on a patient in a catheter ablation procedure as a live case demonstration at the coming Heart Rhythm Congress 2008. The meeting is the 2nd Annual Congress of the Heart Rhythm UK which is the national society for heart rhythm disorders.

I will perform the ablation procedure using cutting-edge technology with advanced 3-dimensional mapping with the Ensite Catheter in Southampton and the procedure will be broadcast to the audience at the auditorium in the Congress at Birmingham during the morning of 20 October 2008.

I am very pleased to be invited to perform the live ablation procedure. Although doing the procedure live can put extra pressure, especially considering the unexpected as anything could happen during the procedure, this is an excellent way of communicating and discussing specific aspects of the technology during the progress of the procedure.

Dr Ng has extensive experience in the management of heart rhythm disorders, especially in catheter ablation procedures and advanced mapping techniques. He is an expert in the use of the non-contact array balloon catheter (Ensite , St Jude Medical) in mapping the source of heart rhythm disturbance and identifying the location for ablation to cure the rhythm disorder.

Dr Ng has hosted 3 previous international Ensite courses at Glenfield Hosptial, University Hospitals of Leicester where live case demonstration of the use of this cutting-edge technology in different types of heart rhythm disturbance was shown to over 300 visiting physicians and cardiac technicians from many countries in Europe, Middle East and Canada.

Dr Ng leads a team of clinical and non-clinical researchers in active research programmes at the University of Leicester. His research focus is on cardiac arrhythmias and electrophysiology aimed at understanding the mechanisms underlying different types of heart rhythm disorders which occur in normal hearts and in heart diseases. Much development has occurred in these areas over the past decade and the availability of new data have significant implications in the training of medical students and clinical trainees. The research results also relate directly to improving management of patients with heart rhythm problems and help develop new and effective ways of treatment.

FSU researcher's discovery leads to $1.5 million grant, potential new treatment of liver fibrosis

Fri, 17 Oct 2008 04:00:00 PST

( from http://www.rxpgnews.com ) TALLAHASSEE, Fla. -- The discovery of a protein involved in the life-threatening mechanism of liver fibrosis has helped a researcher at the Florida State University College of Medicine attract a $1.5 million grant from the National Institutes of Health.

Branko Stefanovic, associate professor in the department of biomedical sciences at the College of Medicine, hopes his discovery could lead to treatment methods that may stem the process of liver fibrosis. Cirrhosis, the terminal phase of the disease, kills 26,000 Americans each year -- the ninth leading cause of death in the United States.

Liver fibrosis refers to the accumulation of excess scar tissue in the liver through excess deposits of collagen, a fibrous protein found in skin, bone, and other connective tissues. The formation of scar tissue is a normal bodily response to injury, but in fibrosis the scarring begins to accumulate to unacceptable levels. The process can result from one of multiple causes, the most frequent of which are alcohol abuse and hepatitis C infection.

Fibrosis is difficult to detect until collagen deposits reach a point where the scarring has severely impaired organ function, meaning individuals suffering from the disease typically do not receive any treatment until it's too late.

The capacity of liver cells to regenerate is great, so therefore normally the primary diseases that can lead to fibrosis do not kill the patient, Stefanovic said. What kills the patient is secondary scarring and the replacement of normal liver tissue with scar tissue. Once this happens a liver cannot regenerate anymore.

Stefanovic and his research team made the important discovery of a protein involved in the scar formation process while working on a previous NIH grant. The RNA-binding protein, which Stefanovic has successfully cloned in his lab at the College of Medicine, is found at the place and specific time when the body is making collagen as part of the normal wound healing resulting from the body's efforts to repair injured tissue.

We had evidence of its existence, but we didn't have the protein, Stefanovic said. We had been looking for this particular protein for several years until we used some very sophisticated methods of cloning. When I saw the results of the binding of the protein to our target I knew immediately we had found the right one.''

Stefanovic said he doesn't believe there will ever be a cure for liver fibrosis but that research and development will one day lead physicians to be able to slow down the progress of the disease.

At least if we slow down the chronic process, instead of dying in five years the patient will live 15 years or more,'' he said.

The goal is to suppress excessive collagen synthesis. In order to do that we have to know the molecular mechanisms that regulate manufacture of the protein and then see what has gone wrong when the liver is creating excess collagen.

Then we will be able to find specific points in this process where we can intervene, by designing either a drug of some kind or a therapeutic agent that will allow us to block these key points and slow down the scarring. Cloning of this protein is a major step toward this goal.

Space tech helps to reach long-jump world record

Fri, 03 Oct 2008 04:00:00 PST

( from http://www.rxpgnews.com ) German athlete Wojtek Czyz, running with a space-tech enhanced prosthetic leg, set a new world record at the Paralympics 2008 in Beijing, reaching an amazing 6.50 m and beating the previous world record by 27 cm.

In spring 2004, ESA's Technology Transfer Programme (TTP) technology broker MST Aerospace met with Wojtek Czyz and his trainer to perform a pre-screening of the most crucial elements of the prosthesis used by Czyz. Having lost part of his left leg three years before in a sports accident, he now uses a prosthesis in two athletic disciplines: long jump and sprint competitions.

The objective was to see how to improve his performance, and we found the most important problem was related to a connection angle, the so-called L-bracket, between the knee joint and the foot module, explains Dr Werner Dupont, MST Aerospace Managing Director.

In collaboration with the German company ISATEC, we developed a new L-bracket using materials originating from the Alpha Magnetic Spectrometer (AMS), an instrument that will be mounted on the International Space Station to study extraterrestrial anti-matter, matter and missing matter.

The advantage of these space materials is that they are extremely strong and at the same time lighter than conventional products available, both important advantages for top athletes' performance. The problem with Czyz' previous prosthesis was that it tended to break when he performed to the maximum of his capacity.

At the previous Paralympics Games in Athens Czyz competed with a space-tech enhanced prosthetic leg and won a gold medal in three disciplines: 100 m sprint, 200 m sprint and long jump.

Following this success, MST and ISATEC, a German engineering company dealing with light materials, continued to work on improving the prosthesis. In a series of investigations undertaken by MST, including a number of advanced calculations on the dynamic performance of the materials done by ISATEC, a single-part foot module made in carbon fibre reinforced plastics proved to be the most promising solution for a sprint prosthesis.

For the long jump discipline, the previous design consisting of an L-bracket and a foot module was proven to be the most efficient.

We first started working on improving the prosthesis for the sprint discipline, and then further improved the long jump prosthesis as well, continues Dupont.

This latest development turned out to be a great success at the Paralympics 2008, and helped Wojtek Czyz beat the world record by an incredible 27 cm.

The use of lighter and extremely strong space materials in the development of new prostheses for top athletes has proven its worth both in Athens in 2004 and now again in Beijing in 2008. The next step, which we are already looking into with our partners, is to use this expertise for similar developments of prostheses for other disabled people.

New Bluetooth system orients blind and sighted pedestrians

Thu, 18 Sep 2008 04:00:00 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.--- A new Bluetooth system designed primarily for blind people places a layer of information technology over the real world to tell pedestrians about points of interest along their path as they pass them.

The Talking Points urban orientation system was developed at the University of Michigan. Researchers will present their work at two conferences on Sept. 24.

Blind people can get from point A to point B. They learn to count steps if they have to, but they miss the journey because they don't always know what they're passing. The idea behind Talking Points is to enhance the journey, said James Knox, adaptive technology coordinator for the University's Information Technology Central Services and one of the system's developers.

Talking Points can be viewed as a first step in the direction of an audio virtual reality designed for people with blindness and very useful to the sighted community as well, Knox said.

For the sighted community, the system could give passersby a peek at the specials or sales inside a business. It could offer on-the-go access to customer reviews. For blind pedestrians, it could do the same, but it would also fill those gaps in knowledge. Talking Points could help visually-impaired people find public restrooms, police stations, public transportation and restaurants with Braille menus, for example.

If it caught on, this would be an effective way to tag the whole world, said Jason Stewart, a master's student in the School of Information who is involved in the project. Anyone with a reader could use it to find out more information about where they are.

Similar systems exist, but Talking Points is the first known to use Bluetooth, cater to both the sighted and the visually-impaired, allow people to operate it entirely with voice commands, and incorporate community-generated content through a website.

Knox and collaborators in the School of Information and the Department of Electrical Engineering and Computer Science created an early version of Talking Points years ago.

A group of master's students and undergraduates has given the project new energy. They shrunk the receiver and switched the transmitting technology from RFID to the more popular Bluetooth. They are also exploring other technologies such as GPS.

Stewart and fellow School of Information master's students Jakob Hilden and Michelle Escobar will present papers about Talking Points on Sept. 24. Stewart and Hilden will present at the Ubicomp 2008 conference in South Korea. Escobar will present at the Accessible Design in the Digital World conference in the United Kingdom.

The Talking Points system includes several components:

A mobile device picks up the Bluetooth signals and speaks or displays information to the user. In the future, a cell phone could be the receiver, but this prototype isn't a phone. It is slightly larger, about the size of a paperback book. If a user wants more information about a beacon, she can tell the device by voice or touch.

Bluetooth beacons, or tags, would be located at points of interest where owners wish to give information to Talking Points users. Businesses could purchase these beacons, which cost less than $20. Cities could tag information centers, parks or other buildings, for example.

A website would allow Talking Points beacon owners to program their tags. They could update their messages regularly. Once a beacon is added, other community members could add their comments about the point of interest. Pedestrians using the system could then choose to get those comments.

This project enables a type of augmented reality, said Hilden, one of the students who will present the research at Ubicomp. It shows how we can take user-generated information from the Internet and lay it over reality to help people make sense of where they are in their environment and what the possibilities are around them.

In addition to developing a prototype receiver, the students tested their system in field simulations with visually-impaired and sighted people and conducted focus groups.

Location-based guide systems of one kind or another have been built and re-built by academic researchers for over a decade now, but this is the first project that has really focused on the needs of the visually impaired and gone out to make sure the system is being developed to meet those needs, said Mark Newman, an assistant professor in the School of Information and the Department of Electrical Engineering and Computer Science. Newman is a co-author of the papers that will be presented.