RxPG News : Surgery

Scientists shed new light on walking

Sun, 24 Jan 2010 04:59:12 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 13:51:00 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 04:59:36 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 04:59:36 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 13:13:04 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 16:19:50 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 04:59:36 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 04:59:36 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 04:59:36 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 04:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 11:11:49 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 03:59:36 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 03:59:36 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 10:48:38 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 03:59:36 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 03:59:36 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 03:59:36 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 22:55:29 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 03:59:36 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 04:59:36 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 04:59:36 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 14:49:53 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 04:59:36 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 04:59:37 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 04:59:37 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 04:59:37 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 17:37:00 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 04:59:37 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 04:59:37 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 04:59:37 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 14:37:40 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 04:59:37 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 04:59:37 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 04:59:37 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 04:59:37 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 04:59:37 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 12:24:48 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 03:59:37 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 03:59:37 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 03:59:37 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 03:59:37 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 03:59:37 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 03:59:37 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.

Prosthetic vein valve for chronic venous insufficiency

Mon, 15 Sep 2008 12:11:58 PST

( from http://www.rxpgnews.com ) Engineers at the Georgia Institute of Technology have developed a prosthetic vein valve to help improve the lives of those suffering from a condition known as chronic venous insufficiency. The condition, which affects more than seven million people in the United States alone, occurs when valves in a person's veins can no longer ensure a one-way flow of blood back to the heart.

"Blood flows to the toes because of gravity, but the body uses vein valves to pump blood in one direction back to the heart," said David Ku, the Lawrence P. Huang Endowed Chair in Engineering and Entrepreneurship and Regents' Professor in the George W. Woodruff School of Mechanical Engineering at Georgia Tech. "However, sometimes a vein valve dissolves away after a blood clot. The loss of the valve leaflets allows blood to flow the wrong way, causing swelling in the legs and ankles."

Ku is leading a research team that has developed a prosthetic vein valve to replace damaged, non-functioning valves. The prosthetic vein valve design and results from laboratory studies were presented at the Society for Biomaterials Fall Symposium in Atlanta on September 12. The research – under way for the past five years – is funded by the Wallace H. Coulter Foundation and the National Collegiate Inventors and Innovators Alliance.

Ku's collaborators on this project include Rudy Gleason, an assistant professor with joint appointments in the Georgia Tech School of Mechanical Engineering and Department of Biomedical Engineering; Ross Milner, an assistant professor of surgery at Emory University; consultant Harris Bergman, a former Georgia Tech graduate student and now president of Amigent; former Georgia Tech graduate students Rahul Sathe and Laura-Lee Farrell; and current graduate students David Bark and Prem Midha.

Individuals with chronic venous insufficiency are commonly prescribed therapies – including anticoagulants, bed rest and compression hosiery – that target their symptoms rather than the cause. Damaged vein valves can sometimes be repaired, but when that isn't possible, some surgical options are available to replace deep venous valves, such as valve transplantation. However, replacing the valve with a prosthetic one is likely the better option because finding a suitable donor valve in one of the patient's legs can be difficult, according to Ku.

"Previous studies have shown that even if a donor valve is found, implanting it can cause significant trauma to the patient's leg," explained Ku, who has doctoral degrees in mechanical engineering and medicine. "To avoid these complications, other prosthetic vein valves have been designed, but most have demonstrated poor clinical potential for humans."

Ku and his collaborators believe the valve they have developed will overcome previous difficulties. The one-way flap is made of poly(vinyl alcohol) cryogel, a material patented by Georgia Tech in 1999. The material has many useful attributes, including its biocompatibility with body tissue because of its attraction to water; the ability to adjust its mechanical strength; flexibility comparable to that of natural body tissue; and composition of organic polymer, rather than silicone.

The researchers will begin conducting preclinical animal trials at Emory University in October to test the in vivo biocompatibility and performance of the prosthetic vein valve prototype in sheep. Sheep were chosen because their cardiovascular geometry and physiology are similar to those of humans.

In each animal trial, two prosthetic vein valves will be implanted by Milner. The researchers will test the biocompatibility and performance of the devices for four weeks, using imaging techniques to check that the valves remain in the proper location, are open and allow blood to pass through the vein.

The animal trials will be conducted after several years of optimizing the valve design and testing it in the laboratory. When the Georgia Tech researchers started designing the valve, they wanted it to be as similar as possible to normal, anatomic venous valves. They focused on two major design criteria: the valve had to withstand high pressures without leaking and the valve had to open with small pressure gradients, even after 500,000 cycles of opening and closing, which is equivalent to a half year.

"It was important for us to test the long-term feasibility of these valves because they're going to be implanted and used for years," explained Ku. "But since test methods have not been well established for evaluating a prosthetic vein valve, we developed our own."

Sathe conducted the initial laboratory tests and found that the valve met the mechanical design criteria – it could withstand pressures of more than 500 millimeters of mercury and opened with a pressure gradient of 2.6 millimeters of mercury, which matched physiologic vein valve function. Detailed laboratory testing procedures and results were described in the June 2007 issue of the Journal of Medical Devices.

Next, Farrell developed a laboratory method to test whether blood clots would form inside the prosthetic valve. Results showed that the new generation of valves remained open with no clot formation after 120 minutes of blood flow, whereas control valves lined with polyester closed up after approximately six minutes of perfusion and showed blood cells adhering to the valves.

The laboratory tests showed that the prosthetic vein valve exhibited low flow resistance, strong competency, fatigue-resistance, low clot formation probability and material flexibility, which allowed the researchers to move forward to the animal studies.

The next step after conducting the animal studies will be human clinical trials. The device will require an investigational device exemption from the Food and Drug Administration so that the device can be used in a clinical study to collect safety and effectiveness data.

"There are 400,000 patients per year who are just miserable with the complications from this disease and could benefit from these valves, so we'd like to help them as soon as possible," added Ku.

UIC leads multi-center study to evaluate blood flow and stroke risk

Tue, 09 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The University of Illinois at Chicago has been awarded a five-year, $2.1 million grant from the National Institute of Neurological Disorders and Stroke to lead a multi-center study to assess blood flow and stroke risk.

Ischemic strokes -- the type caused by clots rather than bleeds in the brain -- account for 80 percent of all strokes and represent a major source of death and disability. They are often caused by atherosclerosis, a build-up of plaque inside the walls of blood vessels.

Advances in endovascular techniques, such as threading a catheter to open up a blockage, or placing a stent in a vessel, provide new treatment options for patients with stroke. But these interventions carry risks, and physicians don't always know which patients are appropriate candidates for these procedures.

There's been a lot of emphasis in prior medical research on the type of stroke that affects the anterior circulation, or blood supply to the major lobes in the front of the brain, says Dr. Sepideh Amin-Hanjani, UIC assistant professor of neurological surgery and principal investigator of the study.

But there's another set of arteries that supply the back part of the brain, including the brainstem, which is a smaller, but in some ways, a much more functionally important part of the brain with a lot of important real estate, she said.

Even a very small stroke in this area of the brain can have very devastating consequences, Amin-Hanjani said.

Until recently, it has been difficult for researchers to measure blood flow in the vertebral arteries to the back of the brain. But they hypothesize that patients with vascular disease in these arteries have low blood flow and are at higher risk of stroke.

The study will enroll 80 patients at five sites who have first-time stroke symptoms caused by 50 percent or greater blockage of the arteries leading to the back of the brain.

Patients will receive standard brain imaging with MRI or CT, imaging of the blood vessels, and possible medication therapy, which might include aspirin, anti-cholesterol medication, or blood pressure lowering medication.

As part of the study, patients will additionally undergo magnetic resonance (MR) perfusion and quantitative magnetic resonance angiography (QMRA) that measures blood flow using NOVA technology developed by UIC neurosurgeon Dr. Fady Charbel. The Noninvasive Optimal Vessel Analysis measures the volume of blood flow, direction, and provides a four-dimensional view of the shape and form of blood flow.

Patients will be imaged when they are first enrolled in the study and six and 12 months later. They will be monitored monthly for any recurrent symptoms that would suggest a stroke.

After following the participants for a minimum of one year, researchers will compare the blood flow of patients who had a stroke since their initial symptoms with those patients who did not have stroke.

We hypothesize that patients who have better blood flow to their brains are going to be the ones that don't have new strokes, and those that have low blood flow on their brain scans will be at higher risk of having strokes, said Amin-Hanjani.

If this is demonstrated, then patients with low blood flow to their brain -- even when they first have stroke symptoms -- may be candidates for intervention such as stenting or angioplasty to increase blood flow, said Amin-Hanjani. At the same time, people who have stroke symptoms but normal blood flow could be reassured that their risk of stroke on medication therapy is low, and there may be no need for further intervention exposing them to unnecessary risk.

If we know who is at highest risk, we may be able to figure out who is going to benefit the most from interventional treatment, said Amin-Hanjani. Given that treatment such as stenting is not entirely risk free, it would be important to know that you're treating the highest risk population and offering them a benefit, rather than treating patients who may not need it.

Study points to 1 cause of higher rates of transplanted kidney rejection in blacks

Fri, 29 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A Johns Hopkins research team reports it may have an explanation for at least some of the higher organ rejection rates seen among black - as compared to white - kidney transplant recipients.

In a study of 50 healthy adult men, 25 black and 25 white, significantly different amounts of certain immune system cells were found between the races.

These cells, known as human leukocyte antigen-specific, or HLA-specific B cells, when sensitized produce antibodies linked to transplanted kidney rejection, says Andrea Zachary, professor of medicine at Johns Hopkins and lead researcher of the study.

It's been long known that HLA-reactive antibodies produced by B cells are one of the ways that transplanted organs are rejected. Zachary developed a novel method for counting HLA-specific B cells more accurately, leading to the hypothesis that B cell numbers make a difference in transplant retention and rejection.

Now that we have an accurate way to count these cells, we are able to confirm what we long suspected, that blacks might have a bigger army of HLA-specific B cells, says Zachary who presented her findings at the Congress of the International Transplant Society in Sydney, Australia on Aug. 12.

Zachary says that patients become sensitized when exposed to HLA in blood or tissue that is not their own. Sensitized HLA-specific B cells then produce antibodies that attack transplanted organs containing foreign HLA. Patients can become sensitized from a blood transfusion, transplantation or pregnancy.

If the recipient is not sensitized, B cells represent only a patient's potential for making antibodies, says Zachary. However about a third of patients in need of a kidney are sensitized since they're often on their second or third transplantation and may have undergone transfusions. In the study, Zachary and her team gathered blood samples from 25 adult black males and 25 adult white males. They were all healthy and all non-sensitized. They also gathered blood samples from 10 sensitized adult black males and 25 sensitized white males.

Results showed that the black non-sensitized males tested had an average of 17.2 percent more HLA-sensitive B cells than the white non-sensitized males tested. Among the sensitized group, black males had an average of 22.9 percent more HLA-sensitive B cells than white males.

HLA antigens are proteins that sit on the surface of blood and tissue cells. Each person has a specific set, similar to a fingerprint. Rejection of a transplant occurs when the recipient's immune system sees the donor's HLA antigens as foreign and attacks those antigens with cells or antibodies. The amount of antibody made depends on the number of B cells a recipient has.

Knowing that blacks have an increased number of HLA-specific B cells - which increases their opportunity for antibody-mediated rejection - we may be able to customize treatments for black recipients to account for these differences and lessen the likelihood that the organ will be rejected, says Zachary.

Caesarean babies more likely to develop diabetes

Tue, 26 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Babies delivered by Caesarean section have a 20 per cent higher risk than normal deliveries of developing the most common type of diabetes in childhood, according to a study led by Queen's University Belfast.

The team, led by Dr Chris Cardwell and Dr Chris Patterson, examined 20 published studies from 16 countries including around 10,000 children with Type 1 diabetes and over a million control children.

They found a 20 per cent increase in the risk of children born by Caesarean section developing the disease. The increase could not be explained by factors such as birth weight, the age of the mother, order of birth, gestational diabetes and whether the baby was breast-fed or not, all factors associated with childhood diabetes in previous studies.

Dr Cardwell, from the School of Medicine, Dentistry and Biomedical Sciences, said: This study revealed a consistent 20 per cent increase in the risk of Type 1 diabetes. It is important to stress that the reason for this is still not understood. It is possible that children born by Caesarean section differ from other children with respect to some unknown characteristic which consequently increases their risk of diabetes, but it is also possible that Caesarean section itself is responsible.

Type 1 diabetes occurs when the immune system destroys the insulin producing cells in the pancreas, and one theory suggests that being born by Caesarean section may affect the development of the immune system because babies are first exposed to bacteria originating from the hospital environment rather than to maternal bacteria.

Dr Chris Patterson said: The study findings are interesting, but unless a biological mechanism is established it would be unwise to read too much into this association between Caesarean section delivery and diabetes.

Fortunately figures from the Northern Ireland Type 1 diabetes register indicate that only around two per 1,000 children will develop diabetes by their 15th birthday so a 20 per cent increase is on quite a low baseline risk.

Diabetes is a serious condition that, if not managed, can lead to fatal complications including heart disease, stroke, kidney failure and amputations. There are 2.3 million people in the UK diagnosed with diabetes and 250,000 with Type 1 diabetes. In Northern Ireland over 62,000 people have diabetes, 6,000 of them with Type 1 diabetes.

Around one in four babies in Northern Ireland are delivered by Caesarean section, which is significantly higher that the World Health Organisation's recommended rate of 15 per cent.

Iain Foster, Director of Diabetes UK Northern Ireland, said: Not all women have the choice of whether to have a Caesarean section or not, but those who do may wish to take this risk into consideration before choosing to give birth this way.

We already know that genetics and childhood infections play a vital role in the development of Type 1 diabetes in children, but the findings of this study indicate that the way a baby is delivered could affect how likely it is to develop this condition later in life. Diabetes UK Northern Ireland would welcome more research in this area.

State's first single incision robotic kidney removal

Mon, 25 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) For the first time in Michigan, a diseased kidney has been surgically removed at Henry Ford Hospital using highly sophisticated 3D robotics through a single incision.

We made several improvements in the technique that could allow us to perform this type of procedure routinely, says Craig Rogers, M.D., Henry Ford's director of robotic renal surgery. He performed the delicate operation last week using the da Vinci Surgical System, which has already been used in thousands of successful surgeries for complete and partial removal of diseased prostates.

The kidney, damaged by four tumors, was extracted through an incision of about three inches near the patient's navel of a 50-year-old patient during a complex minimally invasive robotic procedure that lasted approximately 2.5 hours.

The procedure takes its name in part from its minimally invasive approach: SIRS or Single Incision Robotic Surgery.

We traditionally try to save the kidney for smaller tumors, performing a robotic partial nephrectomy, says Dr. Rogers. For larger tumors, however, patients would get a very large incision on their side. Now, we can remove kidneys with cancer through a single three- inch incision near the patient's belly button.

The potential benefits to performing the SIRS nephrectomy are improved cosmetics, quicker recovery times, less scarring and blood loss.

Dr. Rogers and his colleagues have also pioneered robotic surgery for smaller kidney tumors, allowing them to perform a partial nephrectomy to remove tumors that might otherwise require total kidney removal or a large open incision. While these procedures are considered revolutionary because they preserve the healthy portion of the kidney and shorten recovery time, they are not practical for patients with large tumors.

I think this is going to be a big advance for having to remove the entire kidney because of large kidney tumors. This could be a great improvement over traditional open and laparoscopic surgeries. Henry Ford doctors have performed more than 130 robotic kidney surgeries using four or five incisions of less than one inch. When Henry Ford doctors perform robotic surgery with the da Vinci system, a camera and small robotic instruments are inserted through small incisions and controlled by the surgeon from a nearby console machine.

In the SIRS procedure, Dr. Rogers inserts the robotic arms through a single incision near the belly button, and sits at a nearby machine controlling the robot throughout the operation.

I control every movement made by the robotic arms, says Dr. Rogers. The robotic instruments are like having my hands inside the body.

Working through the single small incision, the robot-assisted surgeon inflates the abdomen; moves the large intestine aside to reach the kidney; clips or ties off the vein and artery that take blood to and from the kidney; detaches the rest of the kidney, and removes it.

Kidney cancer is diagnosed in approximately 55,000 people a year and the most common treatment option is an open surgery with a large incision about a foot long. Surgeons sometimes must remove a rib, and they must go through muscle to remove the kidney. Recovery can be up to two months with a weeklong hospital stay.

Besides cancer patients, candidates for SIRS nephrectomy include those with nonfunctioning kidneys due to blockage, stones, or congenital abnormalities.

This week's innovative and successful kidney procedure comes after Henry Ford has established itself as the leading facility worldwide for robot-assisted surgical treatment of prostate cancer. More than 4,000 such procedures have been performed by Henry Ford surgeons since 2001.

We think we'll see the same advantages with robotic kidney surgery as we have with robotic prostatectomy, says Dr. Rogers.

Coatings to help medical implants connect with neurons

Thu, 21 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBUS, Ohio -- Plastic coatings could someday help neural implants treat conditions as diverse as Parkinson's disease and macular degeneration.

The coatings encourage neurons in the body to grow and connect with the electrodes that provide treatment.

Jessica O. Winter, assistant professor of chemical and biomolecular engineering at Ohio State University described the research Thursday, August 21 at the American Chemical Society meeting in Philadelphia. She is also an assistant professor of biomedical engineering.

Worldwide, researchers are developing medical implants that stimulate neurons to treat conditions caused by neural damage. Most research focuses on preventing the body from rejecting the implant, but the Ohio State researchers are focusing instead on how to boost the implants' effectiveness.

We're trying to get the nerve tissue to integrate with a device -- to grow into it to form a better connection, Winter said.

She and her colleagues are infusing water-soluble polymers with neurotrophins, proteins that help neurons grow and survive.

They are combining different polymers, some shaped like tiny spheres and fibers, to create composite coatings that release neurotrophins in a steady dose over time. The coatings also give nerves a scaffold to cling to as they grow around an implant.

The researchers coated two kinds of electrodes -- one, a flat electrode used in retinal implants, and the other a cylindrical electrode array used in deep brain stimulation. The first is being used in experimental treatments for macular degeneration, while the second holds promise for suppressing tremors in people who have Parkinson's disease.

The first coating they developed was made of polyethylene glycol-polylactic acid (PEGPLA) -- a polymer often used in medical implants.

They placed the PEGPLA-coated electrodes in an array of cell cultures and measured how long the coating dispensed the neurotrophins, and how the cells responded.

They tested the retinal implants with retinal cells taken from rabbits, and the deep brain electrodes with PC12 cells -- cells that grow into neurons -- which were taken from cancer tissue in rats. In both cases, neurons grew from the cells and extended toward the electrodes.

Ideally, Winter explained, coatings would release neurotrophins for up to three months, since that's the length of time that nerves in the body require to heal after implant surgery.

Using only PEGPLA, they found that the implant would release neurotrophins for three weeks.

That's why the researchers are now combining it with two other biodegradable polymers: polylactic co-glycol acid (PLGA) microspheres and polycaprolactone (PCL) polyester nanofibers.

In this scheme, one polymer releases an initial burst of the chemical, then another polymer begins its release, and then another.

At the time of the American Chemical Society meeting, Winter and her team were still measuring the performance of the PEGPLA-PLGA-PCL coating. But the initial results look promising.

To get long-term release, we think these multi-component systems are the way to go, Winter said. We can control the release by combining the materials in different ways, and we're confident that we can extend the release time further -- even to 90 days.

As researchers work to develop neural implants, they face many challenges, including how to provide enough electrical stimulation to nerves without damaging surrounding tissue.

Because the coatings encourage neurons to connect directly with electrodes, this technology could allow researchers to develop smaller implants -- ones that contain many densely packed electrodes to provide a high amount of stimulation in a small space, thus better preserving surrounding tissue.

Brain surgery is getting easier on patients

Wed, 20 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- Dr. Edward Duckworth is part of a new generation of neurosurgeons who are making brain surgery a lot easier on patients.

At Loyola University Hospital, Duckworth is using less-invasive techniques to remove tumors, to repair life-threatening aneurysms and to dramatically reduce seizures in epilepsy patients.

Rather than removing large sections of the skull or face, Duckworth is reaching the brain through much smaller openings. And in certain cases, he goes through the nose to get to the brain.

It's not necessary to expose a large surface of the brain in order to access a small abnormality, said Duckworth, an assistant professor, neurological surgery, at Loyola University Chicago Stritch School of Medicine.

Less-invasive brain surgery can result in decreased pain and shorter hospital stays. It also makes patients less apprehensive, Duckworth said.

Duckworth recently performed a less-invasive aneurysm repair on David Shoblaske of Riverside, Ill. An aneurysm is a bulge in a blood vessel. Shoblaske's aneurysm was in the right side of his brain. It was spotted on a CT done in an attempt to find the source of Shoblaske's nonstop headaches. If the aneurysm had burst, Shoblaske likely would have suffered a serious stroke. To prevent that from happening, Duckworth closed off the aneurysm with a small titanium clip.

In a traditional aneurysm repair, the surgeon cuts out a piece of skull roughly 3 inches high and 3 inches wide. After repairing the aneurysm, the surgeon uses small plates and screws to reattach the skull piece. By contrast, the opening Duckworth created in Shoblaske was only about one inch across.

It's difficult to work with such a small opening. You have to be much more meticulous, Duckworth said.

But the effort paid off for Shoblaske, a 64-year-old retired business executive with a history of heart disease that also has been treated successfully at Loyola. Despite the complexity of the procedure and the additional risks Shoblaske faced as a heart patient, he experienced no surgical complications or changes in his cognitive abilities. And, his headaches went away. It was a complete success, he said.

Duckworth has performed more than 50 similar aneurysm repairs at Loyola; at the University of South Florida, where he trained and at Northwestern Memorial Hospital, where he did a fellowship. Duckworth gave a presentation on the procedure at a recent meeting of the American Association of Neurological Surgeons.

Duckworth also performs less-invasive brain surgeries on epilepsy patients. In this procedure, Duckworth removes a small part of the brain that is triggering seizures. In a recent issue of the journal Neurosurgery, Duckworth and a colleague reported results on 201 of their patients at the University of South Florida. After being followed a minimum of two years, 78 percent were free of the most disabling type of seizures. And only 1.5 percent experienced complications. Patients stayed in the hospital an average of 2.6 days. By comparison, an earlier study found that patients who underwent surgery with a larger opening stayed seven days.

In certain cases, Duckworth can reach the brain by passing instruments through the nose and cutting a 1-centimeter-wide hole in the skull. A surgical instrument goes through one nostril and an endoscope through the other. An endoscope is a tube with a light and a lens. It enables the surgeon to see tissue. Using this technique, Duckworth can remove certain tumors located in the pituitary gland or at the base of the skull.

Duckworth predicts less-invasive brain surgery will become increasingly common because it offers big advantages. Because the openings are smaller, less brain tissue is exposed, he said. There's less blood loss. Surgery times are shorter, and patients spend less time in the hospital. It's better cosmetically, too. Smaller incisions leave smaller scars.

New male circumcision device for HIV prevention studied by NewYork-Presbyterian/Weill Cornell

Fri, 01 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (July 31, 2008) -- With the recent endorsement by the World Health Organization (WHO) and scientists worldwide of adult male circumcision as an important strategy for HIV prevention, there is increased urgency to develop safe and cost-effective circumcision services. This is especially the case in Africa where HIV/AIDS continues to spread at an epidemic rate.

Studying this method are Dr. Marc Goldstein and physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who are evaluating an innovative circumcision device developed in China and will initiate a study of the device in Africa in the coming months.

The device, named the ShangRing after its inventor, Mr. Jian-Zhong Shang, consists of two concentric plastic rings that sandwich the foreskin, allowing it to be cut away without suturing and with minimal bleeding. Performed in a clinic under local anesthesia, the procedure takes less than five minutes, compared with approximately 20 to 30 minutes for a traditional free hands circumcision that requires suturing. The patient returns in one week for device removal.

Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods, says Dr. Goldstein, the study's principal investigator. He is urologist and specialist in reproductive medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and senior scientist at The Population Council, Center for Biomedical Research, located on the campus of The Rockefeller University.

The hope is that with these advantages, circumcision will become more commonplace (currently only between 15 and 50 percent of sub-Saharan males are circumcised). Its advantages include reduced risk of a variety of sexually transmitted diseases (STDs), notably HIV.

Circumcision is the only new HIV prevention method to demonstrate consistent efficacy in randomized controlled trials, notes co-principal investigator Dr. Philip S. Li, associate research professor of urology and reproductive medicine and director of microsurgical research and training at the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College.

Three randomized controlled trials in Kenya, Uganda and South Africa reported a protective effect (up to 60 percent) of circumcision against HIV infection. The World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other global reproductive health organizations such as EngenderHealth have recognized circumcision as an important method to reduce HIV infection.

The ShangRing has been used to circumcise several thousand Chinese men since 2005. Preliminary reports of 1,200 patients indicate good results with minimal complications. The ShangRing, with 15 patents pending in 85 countries, is currently available only in China. FDA evaluation is under way.

The beauty of this device is its simple, innovative design, says Dr. Howard Kim, a fellow in male reproductive medicine and microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and member of the Weill Cornell team that traveled to China to learn this new technique. Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique.

Even non-physician health care providers will be able to learn this procedure to safely perform circumcisions in resource-poor regions, adds Dr. Richard Lee, a chief resident in urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and another member of the China team.

The NewYork-Presbyterian/Weill Cornell team, in collaboration with the nonprofits EngenderHealth and The Population Council, are planning a small pilot study in Nyanza, Kenya, to test efficacy, safety and acceptability of the technique. Local health providers who perform circumcisions in a clinical setting will be recruited and trained in the procedure by the NewYork-Presbyterian/Weill Cornell team. The pilot study is expected to be followed by a multicenter clinical trial that will compare the ShangRing technique to traditional circumcision methods.

Male circumcision has been performed as far back as ancient Egypt, and the practice has continued through the ensuing centuries for religious, cultural and sociopolitical reasons. Performing circumcision for potential health benefits gained momentum in the 19th century with the advent of anesthesia and the initial epidemiological studies demonstrating lower rates of venereal diseases in circumcised men. Recent studies have shown that circumcised men are at significantly lower risk of urinary tract infections and sexually transmitted infections such as syphilis and chancroid. Additional studies point to lower risk of invasive penile carcinoma, gonorrhea and chlamydia (in female partners).

Gallbladder removed without external incisions

Mon, 28 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (July 28, 2008) -- In April of last year, surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center made headlines by removing a women's gallbladder through her uterus using a flexible endoscope, aided by several external incisions for added visibility. Now, they have performed the same procedure without a single external incision in what surgeons report may be the first surgery of its kind in the United States.

Led by Dr. Marc Bessler the procedure is offered as part of an ongoing clinical research trial and could prove to have advantages over traditional endoscopic surgery, including reduced pain, quicker recovery time and absence of visible scarring.

Employing this technique, called NOTES (natural-orifice translumenal endoscopic surgery), the endoscope was inserted through a one-inch incision behind the uterus and into her body cavity. Using that scope, the gallbladder was detached and removed through the incision behind the uterus. The area where the gallbladder was removed was then sutured. The three-hour outpatient procedure was performed to treat painful gallstones, which form when bile in the gallbladder hardens into pieces of stone-like material. Removal of the gallbladder is necessary in persistent and painful cases. A small and non-essential organ, the gallbladder stores and releases bile as part of the digestive process.

This procedure marks the culmination of 15 years of advances that have made surgery less invasive in order to improve safety and reduce recovery time, says Dr. Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons.

Beginning in the late 1980s, surgeons pioneered laparoscopic techniques for gallbladder surgery. Instead of the traditional 10-inch abdominal incision necessary for traditional open surgery, surgeons operated by inserting a camera and surgical instruments through a few small incisions. Nine out of 10 gallbladder surgeries are now performed this way.

Natural-orifice surgery has been mainly confined to treating conditions within the gastrointestinal tract. However, the NOTES approach now goes a step further with this surgery -- into the patient's abdominal cavity.

Internal incisions, such as in the uterus, are less painful and may allow for quicker recovery than incisions in the abdominal wall, says Dr. Bessler.

In addition to gallbladder surgery, the NewYork-Presbyterian/Columbia clinical trial offers the NOTES procedure for appendectomy, abdominal exploration and biopsy. Currently the procedure is only available through the uterus. In the future, NOTES may be performed though the mouth or the rectum, making it available to men.

The NOTES procedure was performed by the team of Dr. Marc Bessler, Dr. Dennis L. Fowler (vice president and medical director for perioperative services at NewYork-Presbyterian Hospital/Columbia University Medical Center and the United States Surgical Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons) and Dr. Andrew Gumbs, instructor in surgery at Columbia University College of Physicians and Surgeons and surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center.

First developed at Johns Hopkins, the first NOTES procedure is believed to have been performed by surgical teams in India and Brazil before it was available at NewYork-Presbyterian/Columbia.

Guidelines for role of endoscopy in bariatric surgery

Fri, 25 Jul 2008 23:41:51 PST

( from http://www.rxpgnews.com ) The American Society for Gastrointestinal Endoscopy (ASGE) has issued guidelines on the role of endoscopy in the bariatric surgery patient. The rising prevalence of obesity in the United States and the success in surgical interventions led to a marked increase in the number of weight-loss surgeries performed in the U.S., from 13,365 in 1998 to 102,794 in 2003. The guidelines discuss endoscopy in the preoperative patient and the postoperative patient, and appear in the July issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the ASGE.

Endoscopy is a procedure that uses an endoscope, a thin, flexible tube with a light and a lens on the end to look into the esophagus, stomach, duodenum, small intestine, colon, or rectum, in order to diagnose or treat a condition. There are many types of endoscopy, including colonoscopy, sigmoidoscopy, gastroscopy, enteroscopy, and esophogogastroduodenoscopy (EGD). ASGE is known as the profession's leader in setting standards of excellence in endoscopy and is committed to setting the highest-quality standards for GI endoscopy through its safety guidelines and the training of its members so that patients receive the best and safest care possible. The guideline, "Role of Endoscopy in the Bariatric Surgery Patient," was prepared by the ASGE Standards of Practice Committee.

"Obesity in this country is a major health problem that contributes to increased morbidity, mortality and a host of diseases. Bariatric surgery results in durable and significant weight loss," said Jason A. Dominitz, MD, MHS, chair of ASGE's Standards of Practice Committee. "Endoscopy plays an important role in the preoperative bariatric patient to detect and/or treat lesions in the gastrointestinal tract that might potentially affect the type of surgery performed. In addition, endoscopy is used to diagnose and treat many of the postoperative symptoms or conditions the patient may develop."

The role of upper endoscopy in the preoperative evaluation of patients undergoing bariatric surgery may be based, in part, on the presence or absence of symptoms. The rationale for performing an EGD is to identify and treat lesions that affect the type of surgery performed, cause complications in the immediate postoperative period, or result in symptoms after surgery.

When an endoscopy is considered in a patient who has had bariatric surgery, the endoscopist should be aware of the operative procedure performed, the findings on preprocedural imaging studies and they must understand the expected anatomy. The guidelines advise direct communication with the surgeon if possible. Endoscopy in the postoperative patient may be used to evaluate and treat a variety of conditions including: symptoms of nausea, vomiting and abdominal pain; marginal ulcers; gastroesophageal reflux disease (GERD); gastric leaks and gastrogastric fistulas; stenosis (abnormal narrowing of the stomach or intestine); dumping syndrome (rapid emptying from the stomach into the small bowel); bezoars (food that forms into a hard mass); band erosion or slippage; bleeding and anemia; diarrhea and nutritional deficiencies; choledocholithiasis (the presence or formation of gallstones); and weight regain.

SUMMARY AND RECOMMENDATIONS:
Bariatric surgical intervention presents new challenges to the endoscopist:

An upper endoscopy should be performed in all patients with upper-GI-tract symptoms who are to undergo bariatric surgery.

Upper endoscopy should be considered in all patients who are to undergo a Roux-en-Y gastrojejunal bypass (RYGB), regardless of the presence of symptoms.

In patients without symptoms and who are not undergoing an endoscopy, noninvasive H pylori testing followed by treatment, if positive, is recommended.

In patients without symptoms and who were undergoing gastric banding, a preoperative upper endoscopy should be considered to exclude large hernias that may change the surgical approach.

An endoscopic evaluation is useful for diagnosis and management of postoperative bariatric surgical symptoms and complications.

An endoscopic retrograde cholangiopancreatography (ERCP) is difficult in patients who had a RYGB, and a magnetic resonance cholangiopancreatography (MRCP) should be performed in cases where other noninvasive imaging studies are inconclusive. An ERCP in RYGB patients should be selectively performed.

For your eyes only: Custom interfaces make computer clicking faster, easier

Tue, 15 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Insert your key in the ignition of a luxury car and the seat and steering wheel will automatically adjust to preprogrammed body proportions. Stroll through the rooms of Bill Gates' mansion and each room will adjust its lighting, temperature and music to accommodate your personal preference. But open any computer program and you're largely subject to a design team's ideas about button sizes, fonts and layouts.

Off-the-shelf designs are especially frustrating for the disabled, the elderly and anybody who has trouble controlling a mouse. A new approach to design, developed at the University of Washington, would put each person through a brief skills test and then generate a mathematically-based version of the user interface optimized for his or her vision and motor abilities. A paper describing the system, which for the first time offers an instantly customizable approach to user interfaces, was presented today in Chicago at a meeting of the Association for the Advancement of Artificial Intelligence.

Assistive technologies are built on the assumption that it's the people who have to adapt to the technology. We tried to reverse this assumption, and make the software adapt to people, said lead author Krzysztof Gajos, a UW doctoral student in computer science and engineering. Co-authors are Dan Weld, a UW professor of computer science and engineering, and Jacob Wobbrock, an assistant professor in the UW's Information School.

Tests showed the system closed the performance gap between disabled and able-bodied users by 62 percent, and disabled users strongly preferred the automatically generated interfaces.

This shows that automatically generating personalized interfaces really does work, and the technology is ready for prime time, Weld said.

The system, called Supple, begins with a one-time assessment of a person's mouse pointing, dragging and clicking skills. A ring of dots appears on the screen and as each dot lights up, the user must quickly click on it. The task is repeated with different-sized dots. Other prompts ask the participant to click and drag, select from a list, and click repeatedly on one spot. Participants can move the cursor using any type of device. The test takes about 20 minutes for an able-bodied person or up to 90 minutes for a person with motor disabilities.

An optimization program then calculates how long it would take the person to complete various computer tasks, and in a couple of seconds it creates the interface that maximizes that person's accuracy and speed when using a particular program.

Researchers tested the system last summer on six able-bodied people and 11 people with motor impairments. The resulting interfaces showed one size definitely did not fit all.

A man with severe cerebral palsy used his chin to control a trackball and could move the pointer quickly but spastically. Based on his skills test, Supple generated a user interface where all the targets were bigger than normal, and lists were expanded to minimize scrolling.

By contrast, a woman with muscular dystrophy who participated in the study used both hands to move a mouse. She could make very precise movements but moved the cursor very slowly and with great effort because of weak muscles. Based on her results, Supple automatically generated an interface with small buttons and a compressed layout.

There is a temptation to think that we can come up with a universal design. But if we look at the results, the design that helps one person will actually be hurtful to a person with a different set of abilities, Gajos said.

From an accessibility standpoint, it's always better to change the environment, rather than use specialized assistive technologies, said Kurt Johnson, a UW professor of rehabilitation medicine who coordinated the tests. Supple could be useful for many people with limitations in function, ranging from the elderly, to people with low vision, to people with hand tremors.

The program could also be used to create interfaces that can adapt to different sizes of screen, for example on handheld devices.

But deploying this system would require a radically different approach to designing computer interfaces, Gajos said. He predicts the first applications are likely to be for Web-based applications. The researchers also plan to look at adapting interfaces that were designed in the traditional way into ones that Supple can use.

New clinical trial for patients with asbestos-associated lung cancer

Thu, 26 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (June 26, 2008) - The Mesothelioma Center within the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital and Columbia University Medical Center is now recruiting patients for a clinical research study of a new targeted radiation and chemotherapy protocol for pleural mesothelioma, a cancer of the lung's lining that is almost always caused by previous exposure to asbestos.

The standard treatment for pleural mesothelioma is currently surgery to remove the patient's lung - a potentially debilitating consequence.

Current surgical and chemotherapy treatments of patients with malignant pleural mesothelioma are unsatisfactory, and have not been shown to significantly prolong survival. In this study, we will investigate whether a combination of chemotherapy and radiation targeted directly at the lung's lining can improve outcomes while avoiding surgery, says Dr. Robert Taub, the study's principal investigator, director of the Mesothelioma Center at NewYork-Presbyterian/Columbia and professor of clinical medicine at Columbia University College of Physicians and Surgeons. In addition, this approach has shown to have minimal toxic side effects compared to systemic chemotherapy.

This trial is also significant because our center is the only one nationwide that is offering this experimental therapy to treat pleural mesothelioma, added Dr. Taub. We are very focused on offering these patients the best treatment that medical technology can offer while simultaneously working to preserve quality of life.

Researchers also anticipate that the radiation therapy will kill the cancer cells on surface of the lung while sparing other parts of the lung and surrounding vital tissues.

Delivery of radiation therapy directly into the pleural cavity is a strategy that has been employed since 1945. Today, direct injection of radioactive isotope P-32 may prove to be a significant and effective therapeutic approach for selected mesothelioma patients, adds Dr. Rashid Fawwaz, study co-investigator, radiologist at NewYork-Presbyterian/Columbia and professor of clinical radiology at Columbia University College of Physicians and Surgeons.

Overall, it is hoped that this study will decrease the need for patients to undergo radical surgery, states Dr. Joshua Sonett, study co-investigator, chief of general thoracic surgery, surgical director of the Lung Transplant Program and surgical director of the High-Risk Lung Assessment Program at NewYork-Presbyterian/Columbia and professor of clinical surgery at Columbia University College of Physicians and Surgeons.

Participating patients will receive several rounds of targeted chemotherapy using the drugs cisplatin and doxorubicin via surgically implanted catheters. Some patients will be randomly selected to receive additional systemic (intravenous) chemotherapy using the drugs cisplatin and pemetrexed. All patients will receive targeted radiotherapy using the P-32 radioisotope. Patients may elect to receive additional surgical treatment, including removal of the affected lung lining or lung. Subsequently, patients will be offered outpatient systemic chemotherapy with cisplatin and pemetrexed.

The investigators previously led a prospective study that employed a similar protocol for patients with pleural mesothelioma as well as those with the more retractable sarcomatous disease. Completed in 2002, the study reported a median survival of 70 months, and a three-year survival of 67 percent (

Glaucoma procedure now available at Mayo Clinic aims to prevent further eye damage

Wed, 25 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) JACKSONVILLE - For the first time in Florida, patients with glaucoma have a new treatment option known as the Trabectome. The minimally invasive procedure, which is available at Mayo Clinic and takes about 20 minutes, is designed to decrease pressure within the eye and stabilize the vision.

The goal of this procedure is to prevent further damage within the eye, says ophthalmologist Rajesh Shetty, M.D. He says that some patients have been able to reduce or eliminate use of daily eye drop medications that regulate intraocular pressure.

Glaucoma, the second leading cause of blindness, is a disease that causes irreversible damage to the optic nerve from increasing pressure within the eye. This occurs because the eye produces a clear fluid that does not drain adequately and raises the eye pressure. The first sign of glaucoma is a loss of peripheral vision that is usually not noticed by the patient until it affects the central vision. Unfortunately, vision lost to glaucoma can't be restored so treatment aims to reduce eye pressure to prevent further damage.

Traditionally, ophthalmologists first prescribe eye drops to reduce the eye pressure, and if that doesn't work, they can perform a laser procedure (trabeculoplasty) to the existing internal drainage canal around the base of the cornea. A more invasive treatment is trabeculectomy, a surgical technique to create a new drain for the eye.

The Trabectome procedure uses a small probe that opens the eye's drainage system through a tiny incision in the eye's cornea. It removes a small portion of the eye's natural drainage system so that it functions better, says Dr. Shetty. He says it should be used when eye drops and laser trabeculoplasty fail to reduce pressure and before trabeculectomy is considered. I see this as another rung in the ladder of treatment for glaucoma, he says.

So far, more than a dozen patients have had the procedure at Mayo Clinic in Florida, although the technique has been available at Mayo Clinic in Rochester for a few years. To date, several thousand procedures have been done nationwide, according to Dr. Shetty.

The procedure requires very little sedation and patients generally recover within a week. We have been pleased with the results, he says, noting that although lost vision cannot be restored with the procedure, some patients have reported improved vision overall after surgery.

An estimated 4 million Americans are affected by glaucoma. Glaucoma screenings are suggested for anyone over 40 every two to four years. A routine exam can help identify risk for glaucoma and early signs of the disease. Risk factors for glaucoma include: a family history of the disease, African or Hispanic ancestry, diabetes, certain rare eye diseases and having had an eye injury or having used any corticosteroid preparation for a prolonged period.

Online service lets blind surf the Internet from any computer, anywhere

Wed, 25 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Visions of future technology don't involve being chained to a desktop machine. People move from home computers to work computers to mobile devices; public kiosks pop up in libraries, schools and hotels; and people increasingly store everything from e-mail to spreadsheets on the Web.

But for the roughly 10 million people in the United States who are blind or visually impaired, using a computer has, so far, required special screen-reading software typically installed only on their own machines.

New software, called WebAnywhere, launched today lets blind and visually impaired people surf the Web on the go. The tool developed at the University of Washington turns screen-reading into an Internet service that reads aloud Web text on any computer with speakers or a headphone connection.

This is for situations where someone who's blind can't use their own computer but still wants access to the Internet. At a museum, at a library, at a public kiosk, at a friend's house, at the airport, said Richard Ladner, a UW professor of computer science and engineering. The free program and both audio and video demonstrations are at

Ladner will demonstrate the tool next week in Dallas at the National Federation of the Blind's annual convention. WebAnywhere was developed under Ladner's supervision by Jeffrey Bigham, a UW doctoral student in computer science and engineering. The research was funded by the National Science Foundation.

Free screen readers already exist, as do sophisticated commercial programs. But all must be installed on a machine before being used. This is the first accessibility tool hosted on the Web, meaning it doesn't have to be downloaded onto a computer. It processes the text on an external server and then sends the audio file to play in the user's Web browser.

You don't have to install new software. So even if you go to a heavily locked-down computer, say at a library, you can still use it, Bigham said.

In May, Bigham was named the winner of the Accessible Technology Award for Interface Design for the Imagine Cup, a student programming contest sponsored by Microsoft Corp. The prize comes with $8,000 and a trip to Paris in early July.

For the past month WebAnywhere has been available on request. Bigham said he's received inquiries from librarians who would like to make all their machines accessible on a limited budget. He's also had interest from teachers who struggle to find the time to locate free software, get permission to install it on a school computer and then maintain the program so that a single computer is accessible to a visually impaired student. This software would make any computer in the lab instantly accessible for Internet tasks. The Web-based service also eliminates the need for local technical support: there is no software to install or update because each time a person visits the site he or she gets the latest version.

To test the software, researchers had people use the tool to do three things typically done at public machines: check e-mail, look up a bus schedule and search for a restaurant's phone number. People using WebAnywhere were able to successfully complete all three tasks, using a variety of machines and Internet connections.

Like other screen readers, WebAnywhere converts written text to an electronically generated voice. So far the system works only in English. But the source code was released a few weeks ago and a Web developer in China has expressed interest in developing a Chinese version.

The UW team plans to create updates that will allow users to change the speed at which the text is read aloud and add other popular features found in existing screen readers. The service is currently hosted on a server at the UW campus.

Bigham is also working with Benetech, a Palo Alto, Calif., technology nonprofit that distributes free electronic books, to make its collection of more than 30,000 books accessible to blind users without them having to install any screen-reading software.

He believes this could be the first of many Web-based accessibility tools.

Traditional desktop tools such as e-mail, word processors and spreadsheets are moving to the Web, Bigham said. Access technology, which currently runs only on the desktop, needs to follow suit.

FDA approves NeuRx diaphragm pacing system for use in spinal cord- injured patients

Wed, 18 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The U.S. Food and Drug Administration (FDA) has approved the NeuRx Diaphragm Pacing System (DPS) for spinal cord-injured patients who are dependent on ventilators for breathing. The light-weight, battery-powered electronic DPS allows patients to breathe and speak more naturally, while eliminating the need for a power source and concern over power outages.

The system was developed over the course of 20 years through a joint research effort of physicians and engineers, primarily at University Hospitals Case Medical Center, Case Western Reserve University and Louis Stokes Cleveland Veterans Affairs Medical Center, all located in Cleveland. NeuRx DPS is manufactured commercially by Synapse Biomedical, Inc., based in Oberlin, Ohio.

DPS gained national attention in 2003 when University Hospitals Case Medical Center (UHCMC) surgeon Raymond Onders, M.D., implanted the system in actor Christopher Reeve. Dr. Onders is the director of minimally invasive surgery at UHCMC.

This is a major step in improving the quality of life for patients who have spinal cord injuries and cannot breathe without the help of a ventilator, said Dr. Onders. Based on testimonials that I've received from patients who have been in the clinical trials, DPS provides patients with a freedom of mobility that they never imagined. They've sent photographs or videos themselves parachuting from planes, sailing solo, or enjoying rides at amusement parks with their families; activities impossible to do with a ventilator.

NeuRx DPS is a technology providing electrical stimulation to muscle and nerves running through the diaphragm, the major muscle involved in breathing. When stimulated by NeuRx DPS, the diaphragm contracts, allowing patients to breathe more naturally than having air forced into their lungs as a mechanical ventilator does.

FDA approval is based on 50 patients implanted with the system at hospitals in the United States and Canada, including UHCMC; Shepherd Center in Atlanta; Methodist Neurological Institute in Houston; and Vancouver General Hospital. Dr. Onders, a founder and shareholder of Synapse, trained all of the implanting surgeons. Dr. Onders will continue to oversee initial surgeries as regional trauma centers are certified to offer the system.

According to information from Synapse, in the DPS clinical trial, more than 50 percent of spinal cord-injured patients were able to completely eliminate their need fro mechanical ventilation.

The system is implanted through minimally invasive laparoscopic surgery. Patients and caregivers who want to find a doctor who can evaluate their case for possible treatment should visit

Cartilage regeneration '20,000 Leagues Under the Sea'

Wed, 04 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) HOUSTON, June 4, 2008 -- Bioengineers at Rice University have discovered that intense pressure -- similar to what someone would experience more than a half-mile beneath the ocean's surface -- stimulates cartilage cells to grow new tissue with nearly all of the properties of natural cartilage. The new method, which requires no stem cells, may eventually provide relief for thousands of arthritis sufferers.

This tissue-engineering method holds promise not only for cartilage but also for tissues to repair bladders, blood vessels, kidneys, heart valves, bones and more, said lead researcher Kyriacos Athanasiou, Rice's Karl F. Hasselmann Professor of Bioengineering.

The findings appear this week in the journal PLoS ONE. They are the latest from the emerging field of tissue engineering, a new discipline that aims to capitalize on the body's innate healing abilities to develop new ways of growing tissues that can be used to surgically repair wounds without risk of rejection.

Cartilage, a tissue in the human body that cannot heal itself, has long been a target of tissue engineers. Cartilage is the skeleton's shock absorber, and its stiffness, strength and other mechanical properties derive not from living cartilage cells but from the densely woven matrix of collagen and proteoglycan that surrounds them. This extracellular matrix, or ECM, is produced during cartilage development in children, but cannot be repaired following injury in adulthood.

Injured cartilage often serves as the focal point for arthritis formation, so tissue engineers have long sought a means of growing new cartilage that can be transplanted into adults to repair damaged joints before arthritis can develop. Unfortunately, cartilage is difficult to engineer, in part because there are no natural healing processes to mimic.

Athanasiou's Musculoskeletal Bioengineering Laboratory has focused on cartilage for more than 10 years, and he said the new process is the first he has studied that produces cartilage that's almost identical to the body's own tissue.

The combination of hydrostatic pressure and growth factors used in this process result in an engineered cartilage ECM with properties nearly identical to that of native cartilage, he said. This research appears very promising for treating arthritis, as cartilage can now be produced in our lab that is almost identical in composition to native tissue.

So far, the process has been tried only with cells from cows and has yet to be tested in live animals. Athanasiou cautions that it will be several years before the process will be ready for clinical testing in humans.

The new findings are based on three years of data collected by graduate student Benjamin Elder, who is simultaneously earning a doctorate in bioengineering at Rice and a medical degree at Baylor College of Medicine under Rice and Baylor's Medical Scientist Training Program.

In the study, Elder took small samples of cartilage from calves' knees, dissolved the ECM and isolated the living cartilage cells, or chondrocytes. The calf chondrocytes were used to create tissue-engineered cartilage. The engineered cartilage was placed into a chemical bath of growth factors and sealed inside soft plastic containers that were placed inside a chamber connected to a hydraulic press. For one hour per day, the bags were squeezed at intense pressures.

Our knees are filled with fluid, and when we walk or run the hydrostatic pressure on the cartilage cells in the knee approaches the pressures we used in our experiments, Elder said. But in daily activities, these pressures are fleeting, just a second or so at a time.

Most of the prevailing strategies in tissue engineering attempt to reproduce the conditions that cells experience in the body. Athanasiou said the unconventional approach of using unnaturally high-pressure stemmed from insights gained during years of previous experiments.

Elder said, By combining high pressure and growth factors, we were able to more than triple the biomechanical properties of the cartilage. We're not sure why they reinforce one another, but we do not get the same results when we apply them independently.

Elder, who earned both a bachelor's and master's degree from Yale in four years, has a 4.2 grade point average at Rice and is on track to earn his bioengineering doctorate in just three years. He's already finished two years of medical school and will resume his medical studies in the fall.

Ben's an exceptional student and he embodies the future of this field, Athanasiou said. He plans to pursue a career in neurosurgery, where he will be able to conduct future work in tissue engineering and translate it from the laboratory bench to the patient's bedside.

U of M sets course for cure of fatal childhood skin disease

Tue, 03 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Physicians at the University of Minnesota and University of Minnesota Children's Hospital, Fairview have set the path to a cure for a young boy's fatal genetic skin disease, recessive dystrophic epidermolysis bullosa (RDEB), by using a cord blood and bone marrow transplant. Nate Liao, a 25-month-old from Clarksburg, N.J., underwent the experimental therapy in October 2007.

We have established a new standard of care for these EB patients, beginning with Nate, said John Wagner, M.D., the lead University of Minnesota Medical School physician who developed the clinical trial. Nate's quality of life is forever changed.

Because they lack collagen type VII, children with RDEB have skin that is exquisitely delicate. The skin and lining of their gastrointestinal (GI) tract is fragile; tearing and blistering occur with minimal friction. Coughing and vomiting often result in tears in the lining of the esophagus and stomach. Those affected must have their entire body continuously wrapped in bandages. Those who do not succumb from malnutrition and infection in childhood will acquire a uniformly fatal, aggressive cancer of the skin in young adulthood.

In collaboration with Angela M. Christiano, Ph.D., professor of dermatology and genetics and development at Columbia University Medical Center (New York, N.Y.), and investigators at Asahikawa Medical College (Asahikawa, Japan), and Jefferson Medical College (Philadelphia, Penn.), University of Minnesota researchers, Jakub Tolar, M.D., Ph.D., and Bruce Blazar, M.D., discovered that certain stem cells found in bone marrow could correct the biochemical defect in RDEB in a mouse model of the disease. Marrow-derived stem cells greatly lengthened the life expectancy of the mice and healed existing blisters. Further testing by Columbia demonstrated that for the first time, these mice were producing collagen type VII and anchoring fibrils, the structures needed to bind skin to the body.

This is the first time physicians have approached the treatment of RDEB from a systemic perspective, using marrow-derived stem cells as a means to replace the missing protein, collagen type VII, throughout the body. Through the infusion of cells obtained from a healthy donor, the stem cells produce collagen type VII and correct the underlying genetic defect.

In October 2007, Nate Liao received marrow- and umbilical cord blood-derived stem cells and progenitor cells from his healthy, tissue-matched brother. Over the next six months, the skin and lining of his GI tract slowly improved, and skin biopsies on days 60, 130, and 200 documented increasing amounts of collagen type VII. By day 130, Nate's skin and the lining of his GI tract were beginning to show clinical signs that his skin was anchoring to his body.

Wagner and his team sought an external review of the skin biopsies. Photographs of the biopsies have been sent to dermatopathologists in London, England, and Portland, Ore., for independent analysis. Based on the success seen in Nate, Wagner will enroll additional RDEB patients into the clinical trial. Jacob Liao, Nate's brother who also has RDEB, received an unrelated donor cord blood transplant on May 30.

Toad research could leapfrog to new muscle model

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A toad sits at a pond's edge eyeing a cricket on a blade of grass. In the blink of an eye, the toad snares the insect with its tongue. This deceptively simple, remarkably fast feeding action offers a new look at how muscles work.

This fresh perspective could lead to designing more efficient electric motors, better prostheses and new medical treatments for neuromuscular diseases like Parkinson's.

Science has long held that muscles behave largely like motors. Northern Arizona University researcher Kiisa Nishikawa suggests that muscle acts more like a spring.

Existing theories don't explain how muscles shorten rapidly, Nishikawa said. Muscles can only shorten to do work; they can't do work by lengthening. A spring also can only do work by shortening.

By example, Nishikawa explains that the jaw muscles in toads and chameleons shorten in the lower jaw, and the opening of the jaws causes the tongue to stretch by its own momentum.

When a toad or chameleon captures prey with its tongue, it exerts force over a distance. Figuring out how they do it has immense application to any device that actually moves.

A toad's jaw muscles can produce forces greater than 700 times the animal's weight. The best electric motor achieves about one-third of that force-to-weight ratio, Nishikawa noted.

Muscles also function as self-stabilizing springs.

They have built-in self-correcting mechanisms. Before the brain can even react, muscles are changing their elasticity adaptively, she said. Think of walking down a flight of steps and missing a step. Leg muscles instantly become less stiff to afford better shock absorption. It's an intrinsic property of muscle, Nishikawa said.

Tom Sugar and his colleagues Arizona State University have been inspired by biology in designing a robotic tendon. After meeting with Nishikawa about her work, Sugar said, We were amazed at the speed, energy storage and power of muscle. We learned how a frog tongue will store energy and release it in a powerful burst.

At ASU's Human Machine Integration Laboratory, Sugar and his team are building SPARKy (Spring Ankle with Regenerative Kinetics) that mimics biology by storing and releasing energy during the ankle gait cycle.

Energy is stored as the leg and body rolls over the ankle, and then this energy is released in a powerful burst to propel the user forward. By mimicking biology, we are able to build a very lightweight and functional device, Sugar said.

Putting motors and springs together in a smart way is something nature hit on about 600 million years ago (with the earliest vertebrates), Nishikawa said.

It's a notion that captured the interest of Discovery Channel Canada, which spent a day at NAU and a day at ASU taping for a segment of its Daily Planet show that will air in the fall.

The NAU researcher wants to know more about how the brain controls movement. About decade ago Nishikawa realized that how the brain and body work together to produce coordinated movement means understanding what muscles contribute to the whole process.

Understanding what the neurological part is and what the muscular part is can help establish cause and effect, she said.

Identifying these mechanisms at the molecular level might aid medical research in developing better treatments for sufferers of Parkinson's, whose low force output results in stiff movements.

Nishikawa's studies of the neuromuscular basis for extremely rapid movements in animals, such as the toad snaring prey with its tongue, could leapfrog to a new model of muscle function, changing the standard representation of muscle as a motor.

Data re-analysis shows drug finasteride reduces risk for most prostate cancers

Tue, 20 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (May 20, 2008) -- A re-analysis of data from the landmark Prostate Cancer Prevention Trial (PCPT) finds that finasteride reduces the risk for prostate cancer without boosting the odds of aggressive tumors.

PCPT, which involved more than 18,000 men 55 years of age or over, was stopped early in June 2003 because researchers noted that while it reduced prostate cancer in men taking finasteride (Proscar) by up to 25 percent, men taking finasteride also appeared to have more aggressive prostate tumors if and when they did develop the disease.

That caused some experts to worry that finasteride was encouraging higher-grade cancers.

But a new analysis led by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center should lay that worry to rest.

Finasteride has long been used by doctors to treat benign enlarged prostate -- it shrinks the prostate. So when we accounted for this shrinkage in prostate volume, the disparity in tumor aggressiveness between the finasteride and placebo groups vanished, says study lead author Dr. Steven A. Kaplan, professor of urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

He and his colleagues will present their findings Tuesday, May 20, at the annual meeting of the American Urological Association, in Orlando.

Physicians grade the aggressiveness of prostate tumors on what's called the Gleason Score -- a grading of tumor characteristics, with scores ranging from 2 to 10 (10 indicating the most highly aggressive cancers). After their initial analysis, the PCPT investigators discovered that men taking finasteride had fewer prostate cancers overall, but a higher incidence of grades 7, 8, 9 and 10 cancers, Dr. Kaplan explains.

This was worrying, since it is higher-grade, potentially metastatic prostate cancers that are the real cause for clinical concern. Lower-grade cancers are often what we call 'indolent,' meaning they grow so slowly they pose little real threat to the patient, Dr. Kaplan says. So it was important to find out if this finding was real, or some kind of methodological artifact.

His team had one theory: We know that finasteride shrinks the prostate. So perhaps that simply meant that doctors were better able to spot a highly aggressive tumor in patients taking the drug, because there was less tissue in which it could hide, explains senior author Dr. E. Darracott Vaughan, the James J. Colt Professor of Urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

With that in mind, the researchers looked once more at PCPT data on biopsies taken from the 18,882 men in the study. They adjusted for treatment type, age, race, family history of prostate cancer, baseline prostate-specific antigen (PSA) levels, and the individual patient's prostate volume.

What we found was a significant reduction in the incidence of prostate cancers for men taking finasteride vs. placebo -- even for the higher-grade cancers, Dr. Kaplan says. Most importantly, finasteride was associated with significant declines in tumors with Gleason scores 5, 6 and 7, which comprise 72 percent of all prostate cancers diagnosed in the United States. For tumors with Gleason scores of 8, 9 and 10, the incidence for men taking finastride was no higher than for men not taking the drug, after we had adjusted for prostate volume.

This means that men who are prescribed finasteride should not be concerned that the drug will boost their odds for aggressive prostate cancer. In fact, while it's too early to say that the drug prevents the disease, it may sometimes help suppress it when it occurs, the researchers say.

I believe that the drug is chemo-suppressive, Dr. Kaplan says. We know that it reduces PSA levels, which are indicative of prostatic disease. Finasteride appears to be particularly adept at suppressing the more indolent cancers. So in the future, it might be useful to use the drug to determine just how aggressive -- and needful of treatment -- a particular tumor is. If the patient takes finasteride and his PSA levels quickly drop, he probably has a less-threatening tumor that may just require 'watchful waiting.' But if PSA levels rise, that tumor may need more active treatment. All of this needs to be tested in a controlled, randomized trial.

In the meantime, researchers need to keep prostate volume in mind whenever they conduct trials assessing the anticancer properties of prostate-shrinking medications. Right now, drug maker GlaxoSmithKline is testing out a similar drug, Avodart, as a possible agent against prostate cancer. We hope that they will incorporate prostate volume in their analysis, to help avoid the confusion that dogged PCPT, Dr. Kaplan says.

The spring in your step is more than just a good mood

Wed, 23 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Scientists using a bionic boot found that during walking, the ankle does about three times the work for the same amount of energy compared to isolated muscles---in other words, the spring in your step is very real and helps us move efficiently.

While much has been done measuring the efficiency of individual muscles, this is the first known study to measure the energy efficiency of a body part such as the ankle, said Daniel Ferris, associate professor with the University of Michigan Division of Kinesiology and lead researcher on the project.

The results suggest manufacturers should rethink prosthesis design so the ankle part can do more of the work, said Ferris, who also holds an appointment in the Department of Biomedical Engineering. It also sheds light on why rehabilitation and mobility is so exhausting for people with unhealthy ankles or neurologic problems.

Greg Sawicki, a graduate student working with Ferris and now at Brown University, built a bionic ankle equipped with fake muscles that mimic real muscle activity in the ankle, Ferris said.

Healthy subjects wore two of the boots, which were attached to the nervous system by electrodes. Sawicki measured the amount of oxygen consumed when walking with or without the boot and compared the two. Muscles use oxygen when they burn fuel, which means the more oxygen used the more energy expended, Ferris said.

The ankle is incredibly efficient at working so the amount of energy you burn with the ankle is much lower than what would be predicted with just isolated muscle studies, Ferris said.

Researchers suspect this is largely because the Achilles tendon is so long and compliant, and is able to store and return energy during the stride cycle.

Amputees and people with neurologic disorders don't have the bounce of the stored energy in the ankle, Ferris said.

For amputees, we need to come up with a better way for them to have a powered push off at the ankle, Ferris said.

An example of this for running is the prosthetic used by controversial Olympic hopeful Oscar Pistorius, a double-amputee who wears a special curved blade called a Cheetah. As the blade compresses on strides it stores energy, which is released during push off, similar to a human ankle.

However, the Cheetah is great for sprinting but would not work for walking. The foot is on the ground too long to take advantage of the energy return during walking. The muscle and tendon act more like a catapult during walking, storing energy slowly and releasing it at just the right moment.

The next step, Ferris said, is to build a bionic hip and measure the efficiency of the hip during walking.

Surgeons announce advance in atrial fibrillation surgery

Mon, 07 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Heart surgeons at Washington University School of Medicine in St. Louis report that by adding a simple 10-20 second step to an operative procedure they achieved a significant improvement in the outcome for the surgical treatment of atrial fibrillation (AF).

Reporting in the April issue of the Journal of Thoracic and Cardiovascular Surgery, the surgeons describe an enhancement to the Cox-Maze procedure, a surgical procedure that redirects wayward electrical impulses causing AF by creating precisely placed scars, or ablations, in the heart muscle. The Cox-Maze procedure is highly effective, offering the best long-term cure rate for persistent atrial fibrillation.

The surgeons added one ablation to the series of ablations typically made during the Cox-Maze procedure and that short step improved how well patients did after surgery. As a result, they recommend using this extra ablation in all patients undergoing the procedure.

The single additional ablation creates what we call a box lesion, explains Ralph J. Damiano Jr., M.D., the John Shoenberg Professor of Surgery at the School of Medicine. The box lesion surrounds and electrically isolates the pulmonary veins and the posterior left atrial wall from the rest of the left atrium. Our study shows excellent success when using the box lesion, and we recommend it for any patient with long-standing atrial fibrillation.

AF is the most common irregular heart rhythm and affects more than 2 million people in the United States. During atrial fibrillation, the upper chambers (atria) of the heart beat rapidly and quiver instead of contracting, drastically reducing the amount of blood they pump. AF can cause fatigue, shortness of breath, exercise intolerance, heart palpitations and stroke.

The area of the heart near the pulmonary veins is a common source of the irregular electrical impulses that can cause AF. Without the box lesion, in some patients this area could still support electrical signals that disrupt the regular contractions of the heart's upper chambers.

Led by Damiano, also chief of cardiac surgery at the School of Medicine and a cardiac surgeon at Barnes-Jewish Hospital, the Washington University surgeons revolutionized AF treatment in 2002 by helping develop a radiofrequency clamp that creates the ablation lines needed to reroute electrical impulses in the heart. The clamp directs radiofrequency energy into the heart muscle and creates a full-thickness scar.

The radiofrequency clamp procedure is quicker and easier than the original cut and sew Cox-Maze procedure, which was developed by James Cox, M.D., at Washington University in 1987. The original procedure relied on a complex series of 10 incisions in the heart muscle, creating a maze to channel errant electrical impulses where they should go. In the newer version, called Cox-Maze IV, most of these incisions were replaced by radiofrequency ablations, reducing the operation from an average of 90 minutes to about 30 minutes.

The current study involved two groups of patients with AF. One group underwent radiofrequency ablation-assisted Cox-Maze IV procedures without a box lesion and the other with a box lesion. The box lesion group had a 48 percent lower occurrence of atrial flutter and fibrillation in the first weeks after surgery. These patients also had shorter hospital stays (nine days on average) than patients who had the standard Cox-Maze IV procedure (average stay of 11 days).

Three months after surgery, 95 percent of patients who had the box lesion had no signs of AF, while only 85 percent of the patients who had the standard Cox-Maze IV procedure were free from AF. By six and 12 months postsurgery, all of the patients in the box lesion group were free from AF compared to 90 percent of the other group, although that difference was not statistically significant.

We also saw that the use of antiarrhythmic drugs was lower after three and six months in those who received a box lesion, Damiano says. These drugs can have serious side effects, and if patients can stop using them they often feel better. Overall, the use of the box lesion set was associated with shorter hospitalization, fewer medications and reduced recurrence of atrial fibrillation. We were very pleased with these results.

Compared to those without atrial fibrillation, people with the disorder are five times more likely to suffer from stroke and have up to a two-fold higher risk of death. For some patients, medications can control the abnormal heart rhythms and the risk of clotting associated with atrial fibrillation, but unlike the Cox-Maze procedure, the drugs usually do not cure the disorder.

Young patients with knee disorder get active after new Stanford surgical procedure

Tue, 01 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - At 14 years old, Adam Vasser of Los Altos, Calif., was an active kid who loved baseball. Then a mysterious virus attacked his heart, making a heart transplant necessary to save his life.

He underwent long-term steroid treatment to prevent transplant rejection, which left him with an excruciating knee disorder called osteonecrosis. Now 23 and nearing graduation from college, after enduring 15 surgeries for his knee and heart, he's finally been able to return to sports.

Thanks to a new surgical technique used on Vasser's left knee called cellular grafting, the 23-year-old is out cycling and refereeing soccer games on a virtually pain-free knee. The procedure was done for the first time on three young patients with steroid-induced osteonecrosis of the knee by orthopedic surgeon Stuart Goodman, MD, PhD, and is described in a preliminary report to be published in the April issue of the Journal of Arthroplasty.

Even though a knee sounds like a little thing after all Adam's been through, it was big to get it fixed, said Adam's mother, Karen Vasser of Los Altos, who took her son from one doctor to another looking for help. He was real athletic so the knee was one of the things that prevented him from getting back.

The new surgical technique involves transplanting cellular material from the pelvic area into the knee. Two years after surgery, Goodman said, all three patients had returned to nearly normal activity and knee function with no complications.

It's a fairly simple procedure, said Goodman, the Robert L. and Mary Ellenburg Professor in Surgery at the Stanford University School of Medicine.

Osteonecrosis of the knee is a rare disorder. When it occurs in young people, it's most often the result of steroid therapy and is called secondary osteonecrosis. The bones in the knee start to die from a loss of blood supply, leading to severe pain, progressive arthritis and eventually the need for artificial joint replacement.

Many patients do OK without surgical treatment, Goodman said. With those patients, I wait and prescribe pain medication. But for young patients who still have a lifetime of activity ahead of them, Goodman wanted alternatives.

When Vasser first started looking for knee treatments, he was told by several doctors to simply use crutches until the knee collapsed and then get an artificial knee replacement. Pain medication was discouraged because of its effects on his kidneys after all the heart transplant treatment drugs. He, too, was searching for a better answer when he met Goodman.

All three of Goodman's patients were between the ages of 18 and 21 and suffering from steroid-induced osteonecrosis. Among the two other patients, one had a diagnosis of Crohn's disease and the other had been treated with high-dose steroids for severe optic nerve swelling associated with the use of minocycline.

The 60-minute surgery, called osteoprogenitor cellular grafting, involves scooping out the dead bone and then filling the space in with new cellular matter.

The key is to arrest or reverse the death of the bone, Goodman said. If the cartilage is good, you get the dead bone out and give the cartilage a better foundation. If you have a salvageable joint in a young knee, you get in viable cells to repopulate that area of dead bone.

Goodman theorized that instead of using traditional bone grafting - a more invasive and painful solution - a better method might be using bone cells. The bone cells include young stem cells and progenitor cells that can actually grow into new bone. He withdrew bone marrow from the pelvic area, concentrated the stem cells and progenitors, then used a scaffolding device to help the cells adhere to the defect in the knee.

Based on the success of these three surgeries, Goodman recommends a longer-term follow-up study with a larger number of patients.

Vasser underwent the knee surgery the summer after he graduated from high school. He described a painful, monthlong recuperation period, but said that since then his knee has improved to be almost like new five years later. His mother showed a photo of him crouching behind the home plate, playing umpire in a baseball game the year following surgery.

My knee has felt good ever since, Vasser said. It's much stronger than it used to be. It used to lock up. Towards the end before the surgery, it got really bad. I'm refereeing, riding a bike. It doesn't affect it. It's fine.

'Wildcat Power Cord' repairs cruciate ligament in dairy cow's knee

Thu, 27 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) MANHATTAN, KAN. -- An 8-year-old Jersey dairy cow is back at her Kansas farm thanks to a decade of research and an experimental surgery performed at Kansas State University's Veterinary Medical Teaching Hospital.

The cow, named Wilhelmina Jolene by the veterinary students assigned to her case, sustained a breeding injury in December 2007 when the cruciate ligament in her right knee ruptured. Dr. David Anderson, professor and head of agricultural practices at K-State's College of Veterinary Medicine, replaced the ligament using synthetic material called monofilament nylon. The procedure's success could have enormous implications for breeding quality cows and bulls with the same injury.

Fortunately, Wilhelmina's owner recognized the value of saving her. Mike Frey is the son of Dr. Russ Frey, a prominent professor at K-State's College of Veterinary Medicine. She's owned by the son of an important faculty member in our college's history, Anderson said. It's wonderful that there is a connection to Dr. Frey with this case and that Mike understands the teaching value.

Mike Frey said he was happy to be part of an effort that could help animals, producers and students.

I was always under the assumption that an animal with this problem was going to be heading down the road, he said. If they could perfect this so that a cow could be kept in production, that would be worth quite a bit.

The cruciate ligament is a dense tissue that connects the bones in the knee joint. Injuring it can be career-ending and often life-ending - until now, Anderson said.

The three surgical techniques for cruciate ligaments in large animals have a failure rate of approximately 50 percent, Anderson said. This fact caused him and surgery colleagues Drs. Guy St-Jean and Andre Desrochers to investigate alternatives in the 1990s. That's when the team designed a cruciate ligament using braided polyester; however, the material was not strong enough for heavy cattle.

Anderson continued to experiment with a variety of materials until he discovered an unusual form of nylon monofilament, a solid material about the diameter of a coffee straw. But the question remained: Could this man-made material replace the natural ligament of a 1,500 pound animal?

On Jan. 17, Anderson replaced Wilhelmina's torn ligament with the artificial one, dubbed the Wildcat Power Cord. Anderson's surgery team included surgery residents Drs. Kara Schulz and Jose Bras, intern Dr. Manuel Chamorro, along with anesthesiologists, veterinary students and technicians.

The next day, the Jersey cow was led across the hospital's video synchronization pressure mat to determine her level of lameness. Her stride length had increased 30 percent, and she bore 25 percent more weight on her operated leg, Anderson said. To have that much improvement is spectacular.

His long-term goal is to develop a replacement ligament strong enough for bulls. Lab tests reveal that the Wildcat Power Cord can withstand up to 12,000 newtons of pressure - roughly 50 percent more than an adult bull requires.

Wilhelmina retuned home and was kept in a box stall for a week or so, Mike Frey said. After that, she had the run of the free stall. It's been a tough winter with all of the snow and ice, he said. I didn't think she'd get around as good as she did.

Shelby Reinstein, a senior veterinary student from Tulsa, Okla., was one of the K-State students who worked with -- and named -- Wilhelmina the cow.

Reinstein said she appreciated the learning opportunities this case presented, especially those relative to anatomy of the stifle and monitoring Wilhelmina for specific conditions dairy cows are at risk for developing. These include inflammation of the udder (mastitis) or of the uterus (metritis), a metabolic imbalance (ketosis), ulcers and displacement of the abomasum, the fourth compartment of a ruminant's stomach.

We worked really hard for her and spent long hours at the hospital, but it was definitely worth it after seeing how well she did post-op, Reinstein said. I love being part of the discovery aspect of veterinary medicine, and it is always really rewarding to try something you're not sure about and have it work. And, my parents were quite impressed that I could milk a cow!

226.3% increase in male sclerotherapy since 2002

Sat, 15 Mar 2008 04:01:06 PST

( from http://www.rxpgnews.com ) The American Academy of Cosmetic Surgery (AACS) is pleased to announce the results of its 2007 Procedural Data. This information is collected by polling the Academy’s U.S.-based members.

Findings conclude that sclerotherapy, the standard treatment for spider and varicose veins, is now the number two most performed cosmetic surgical procedure, due in large part to men. Sclerotherapy has seen a 226.3% increase in males over the past five years. A drastic comparison to the 3.5% increase in females since 2002.

On the opposite end, males have strayed away from hair transplants. Cost is likely to be a cause of this decline. Over five years, the price of hair transplants increased by $1,296, while sclerotherapy decreased by $103.

“Cosmetic surgeons have experienced a boost of males wishing to receive sclerotherapy,” says Dr. Steven Hopping, MD, President of the AACS. “Now, there are notably fewer stigmas associated with men receiving this procedure.”

The top three most performed cosmetic surgical procedures in 2007 include: liposuction, sclerotherapy and blepharoplasty; while the most popular non-surgical cosmetic procedures were Botox® injections, microdermabrasion and chemical peels.

The 2007 Procedural Data is based on a survey of U.S.-based AACS members completed in December 2007. The entire report, conducted by RH Research, is available by contacting the Academy.

Spectral imaging system for colon surgery- study done on mice

Sun, 02 Mar 2008 03:20:29 PST

( from http://www.rxpgnews.com ) Researchers at Cedars-Sinai Medical Center are developing a spectral imaging system that could result in shorter operating times for infants undergoing surgery for Hirschsprung’s disease, according to a mouse study reported in the Journal of Biophotonics.

The study documents that in addition to its diagnostic potential, spectral imaging may provide an “optical biopsy,” allowing precise localization of a needed intervention.

Spectral imaging is based on the fact that light reflected from a target can be captured and measured by highly sensitive equipment to develop a characteristic “signature” based on wavelength. In this study, the colon tissue of six mice with the equivalent of Hirschsprung’s disease was analyzed and compared to that of controls. With repeated measurements and calculations, unique signatures for normal tissue and for diseased tissue emerged.

Spectral imaging does not detect the presence or absence of ganglion cells themselves. Instead, the spectral signature reflects differences in the composition of normal and diseased tissue.

As a result of this study in laboratory mice, human clinical trials will be planned, providing spectral imaging for intraoperative decision-making in Hirschsprung's disease, a congenital condition affecting nerve cells of the large intestine. The technology, developed at Cedars-Sinai’s Minimally Invasive Surgical Technologies Institute (MISTI) is adaptable to other types of surgery.

Hirschsprung’s usually affects specialized nerve (ganglion) cells in the lower portion of the large intestine, although the entire colon can be involved. Ganglion cells normally stimulate smooth muscle of the intestinal wall to push stool through the colon, but in sections where ganglia are missing (aganglionosis) the process comes to a halt, causing severe constipation that can lead to obstruction, massive infection and even death.

Estimated to affect one in 5,000 babies, the disease can be treated in a minimally invasive surgical procedure that removes the diseased portion of the colon and attaches the healthy colon to the anus. One of the critical portions of the operation is the accurate and precise determination of the point at which normal colon ends and disease begins. If too little colon is removed, the patient is likely to continue to develop significant constipation, but if too much is removed, chronic diarrhea may result, which can lead to other major health problems.

“The location and length of the transition zone between healthy and abnormal tissue varies considerably in Hirschsprung’s disease patients and must be precisely identified to properly perform the operation,” said Philip K. Frykman, M.D., Ph.D., Associate Director of Pediatric Surgery at Cedars Sinai and first author of the article. “The determination is routinely done by taking a number of small samples from the colon wall and sending them to the lab where a pathologist looks for the presence or absence of ganglion cells and other features. But this process may take 45 to 60 minutes, during which the operation is essentially on hold and the patient remains under general anesthesia.

“Spectral imaging, on the other hand, could provide immediate results, increasing patient safety and operating room efficiency,” added Frykman, who specializes in minimally invasive surgery for infants and children and holds a research grant from Cedars-Sinai to study Hirschsprung’s disease.

There is a financial factor, too. Reducing time in the operating room could make a difference of several thousand dollars.

“The images showed a clear distinction, and this was confirmed by pathological analysis. Based on our results, it appears that spectral imaging methods could be used during operations, in real time, to help surgeons distinguish normal from abnormal tissue, without requiring traditional biopsy,” said Daniel L. Farkas, Ph.D., vice-chairman for research in the Department of Surgery, director of the Minimally Invasive Surgical Technologies Institute, and senior author of the journal article.

Biophotonics – the interdisciplinary field dealing with interactions between biological entities and photons, basic units of light – is an emerging research area, with translational potential. Although spectral imaging and other photonic technologies have been used in advanced applications such as satellite reconnaissance for many years, only very recently have scientists begun translating these approaches into biological and medical uses.

At Cedars-Sinai and a few biophotonic research centers in the United States and Europe, spectral imaging is being studied for possible use in a variety of surgical situations. For each potential application, newly developed devices, software and criteria are evaluated in animal studies to show "proof of concept" before human clinical trials are launched.

Financial struggles plague families of children with autism

Fri, 29 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo. - The information that a child has been diagnosed with autism often throws parents into an emotional tailspin. A new study from a University of Missouri researcher says most people don't immediately consider the major financial struggles that follow. She suggests more outreach is needed to help families plan and cope with the profound financial life changes they may face.

As a parent, the diagnosis of autism upends your world, said Deanna Sharpe, associate professor of personal financial planning in the MU College of Human Environmental Sciences and whose own son was diagnosed with the disorder. It is important for us to hear the voices of families who have financial struggles. There is strong pressure to do everything you can for your child. However, there is a great potential for families to spend a lot of money on therapy or new ideas that may be ineffective. Careful evaluation of therapies is important.

Some of the costs include specialized child care, speech and language therapy, other types of one-on-one therapy, special interventions, and costly food or drug supplements. Applied Behavior Analysis (ABA), a widely respected and recommended behavioral intervention, can be expensive. This intervention requires children to work one-on-one with a trained therapist for 30 to 40 hours each week. In the study, some parents reported paying as much as $30,000 a year for ABA therapy. Parents whose child with autism was destructive also reported paying compensation and replacements costs for items that were destroyed.

Some families quoted in the study reported skipping meals to be able to afford therapy for their children. Others talked about robbing their future by depleting savings, emptying their 401K plans, selling stocks and even filing for bankruptcy. More costs are added to some families who need counseling and medication for themselves in order to cope with the stress of raising a child with autism, further straining the family budget.

Sharpe says it is important to begin financial planning as soon as a diagnosis is made. She suggests financial planners need to help direct families to available resources and help them think seriously about the implications of spending all their retirement money on various therapies or having one parent step out of the job force to care for a child when other options could be available.

Autism has a startlingly huge impact on society, Sharpe said. We know early intervention can influence how well a child will do later in life. It's a human capital investment that can prevent or reduce the need for public support when a child with autism becomes an adult. However, it is costly to obtain this intervention.

Study finds good outcomes for older lung transplant patients

Tue, 05 Feb 2008 06:39:37 PST

( from http://www.rxpgnews.com ) In the world of organ donation, it has been common practice to exclude older patients from receiving transplants because of limited donor supply and lower survival rates.

However, patients such as Lois Tumanello, who received a successful lung transplant at 65, are proving that perhaps age does not always matter.

A new UCLA Medical Center study shows that select patients age 65 and older can safely undergo lung transplantation and have acceptable outcomes. The findings are reported in the February issue of the peer-reviewed Journal of Thoracic and Cardiovascular Surgery.

Since 1999, UCLA has been one of the few transplant centers in the country to offer lung transplants to patients 65 and older who were otherwise healthy candidates for the procedure.

Over the past decade, various reports have shown that older recipients undergoing all types of solid-organ transplantation can have good outcomes, said study co-author Dr. Abbas Ardehali, associate professor of cardiothoracic surgery and director of the UCLA Lung Transplant Program. We wanted to define the short- and medium-term outcomes of lung transplantation in these older patients to determine whether the outcomes were acceptable.

The study reviewed records of UCLA patients who received lung transplants between March 2000 and September 2006. During this period, 50 transplant surgeries were performed on 48 patients between the ages of 65 and 72. A group of 50 patients younger than 65 were matched to the older cohort for comparison purposes.

Survival rates for both groups were similar. The early survival rate of the older patients was 95.7 percent, compared with 95.9 percent for the younger cohort. The one-year survival rate was 79.7 percent for the older group and 91.2 percent for the younger, and the three-year survival rate was 73.6 for the older group and 74.2 percent for the younger.

Researchers found that older patients were more likely to receive single-lung transplants (76 percent, compared with 16 percent for the younger group) and to receive nonstandard lungs (46 percent, compared with 28 percent). Nonstandard lungs are those considered less than perfect but still acceptable for transplantation.

Stanford study finds transplant patient thrives 2 years after stopping immunosuppressive drugs

Wed, 23 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - Luck smiled on Larry Kowalski when his brother agreed to donate a kidney Kowalski needed to live. He was even luckier that his brother's kidney was such a good match.

That last stroke of luck led Kowalski to connect with a team of researchers at the Stanford University School Medicine, whose efforts have enabled him for two years to live free of the heavy-duty drugs that transplant patients normally have to take for the rest of their lives.

The researchers describe Kowalski's case in a brief report to be published in the Jan. 24 issue of The New England Journal of Medicine on the technique they developed, based on 25 years of research by Samuel Strober, MD, professor of immunology and rheumatology. The journal issue also includes two reports from other research groups, describing their efforts to achieve organ transplantation without long-term immunosuppressive drugs.

Kowalski, now 50, was 3 years old when doctors discovered he had been born with only one kidney. His single kidney held out until he was 47. Then a blood test indicated that it was beginning to fail.

Kowalski's 49-year-old brother agreed to help, and that turned out to be crucial. His brother was a perfect fit of the six proteins most important in matching the immune systems of transplant donors with recipients.

Transplant recipients are matched as closely as possible with the donor organs to minimize the body's normal response to reject the organs. The biggest danger with organ transplantation lies not in the surgery, but in the recipient's own body rejecting the organ as a foreign invader. Without drugs to suppress that reaction, usually the recipient's immune system encounters unfamiliar proteins on the transplanted organ, attacks the organ and eventually destroys its function.

But unless the recipient has an identical twin, there will always be some minor differences between the organs, so even close matches require a lifetime of immunosuppressive drugs. Long-term use of these drugs can cause cancer, bothersome side effects and, most ironic for kidney transplant recipients, kidney damage.

The ultimate goal for transplant patients is to get their bodies to tolerate their donor organs without drugs. Transplant doctors have been trying to develop ways to do this for years, with little success.

The fact that Kowalski had such a good match with his brother's kidney made him an ideal candidate for the Stanford clinical study. The researchers were investigating whether a procedure that involved adjusting Kowalski's immune system, plus infusing blood cells from the brother who donated the kidney, could allow Kowalski's body to tolerate his brother's kidney.

The therapy was first developed in mice by Strober, the senior author of the study. In the last few years, Strober worked with Robert Lowsky, MD, associate professor of blood and marrow transplantation, to adapt this strategy from mice for human lymphoma and leukemia patients. The procedure combines localized blasts of irradiation and antibody treatments to tweak the recipient's immune cells. Then the recipient gets an infusion of blood cells from the donor. The procedure boosts levels of a type of immune cell called regulatory T cells. These cells function as the immune system's peacekeepers and can avert the attack that causes rejection.

When the Stanford transplant team approached Kowalski with the offer, he jumped at the chance that might allow him to forego a lifetime of immunosuppressive drugs.

In February 2005, Kowalski received his brother's kidney at Stanford Hospital. He was started on an immunosuppressive drug with the intention that it would be temporary. His only notable complication came about a month after his transplant, when Kowalski had to be hospitalized briefly for a fever. He returned to work as a restaurant owner three months after the transplant.

Doctors began to taper the use of the immunosuppressive drug and, after six months, Kowalski was drug-free.

Essentially, my immune system contains half my brother's immune cells and half of my own, said Kowalski. It's enough that my body thinks my brother's kidney is mine.

After all the mouse studies leading up to testing in patients, Kowalski's case is rewarding for Strober. It's been a long, long road that ends up with clinical trials that could lead to somebody's benefit, he said. Tolerance has been the goal for decades, and we are just now beginning to see the fruits of all that labor.

Kowalski could be called the poster child of the procedure so far, but others in the same research study haven't fared as well. Six other patients treated before him haven't been able to go off of their drugs, but their kidneys came from donors not as perfectly matched as Kowalski's was.

He was the first patient in a new iteration of the technique that is being tried only in perfectly matched donors and recipients. So far, one patient that followed Kowalski is showing promising results but is not yet off the drugs, said lead author John Scandling, MD, professor of nephrology and Kowalski's kidney transplant specialist.

The research team found Kowalski remains in good health 34 months after he stopped taking the immunosuppressive drugs. An interview with Kowalski shows this to be an understatement. Not only does he run four restaurants in California, but he bikes, snowboards, scuba dives, goes to the gym regularly and, most taxing of all, is the father of a 3-year-old. By anyone's definition, he is in great health.

The idea of getting off drugs holds tremendous appeal for patients, said Scandling. So far, there is hope, but we still have a long way to go.

Researcher transplants stem cells to try to save patients' legs

Mon, 21 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO -- A Northwestern University Feinberg School of Medicine researcher has launched the first U.S. trial in which a purified form of subjects' own adult stem cells was transplanted into their leg muscles with severely blocked arteries to try to grow new small blood vessels and restore circulation in their legs.

The first two subjects in the 20-site national trial recently underwent the stem cell transplant process at Northwestern Memorial Hospital.

Severely blocked arteries in the leg and sharply diminished blood flow can result in wounds that don't heal, the breakdown of tissue and gangrene. This painful condition is called critical limb ischemia (CLI) and results in the amputation of more than 100,000 limbs every year in the United States. It's a serious, emerging health problem that affects 1.4 million people. An estimated 15 percent of the population will have this disease by the time they reach age 70.

The Northwestern-led phase I/IIa study -- which will include 75 people with CLI around the country -- targets patients who have exhausted all other medical options including angioplasty, stents and bypass surgery to repair blocked circulation in their legs.

They're at the end of the therapeutic road and they're ultimately facing potential amputation, said Douglas Losordo, M.D., the Eileen M. Foell Professor of Heart Research and principal national investigator for the study. This is hopefully a way to help them avoid that.

Losordo is director of the university's Feinberg Cardiovascular Research Institute and director of cardiovascular regenerative medicine at Northwestern Memorial Hospital.

The stem cells themselves can assemble into blood vessels, Losordo said. They can also secrete growth factors that stimulate and recruit other stem cells to come into the tissue and help with the repair. It's an amazing biology we're trying to leverage in these folks.

He said preclinical studies transplanting stem cells into the limbs have shown this approach to be effective in mice and rats. Based on that, we think it has a good chance of helping humans, Losordo noted.

This is a dreadful disease in which the profession has failed to offer much in the way of relief for these patients, Losordo said. We're hoping this will have some impact.

Critical limb ischemia is the result of advanced peripheral artery disease, which affects about 10 million people in the United States. In peripheral artery disease, people develop blockages in their arteries and vessels that slow or stop the blood flow to their legs. When they have pain at rest in their lower legs and wounds on their legs or feet that will not heal, the condition is called CLI. If left untreated, CLI can result in a patient having toes, a foot or even a leg amputated.

As CLI progresses, people begin to experience pain when they walk, then when just sitting. The worst pain is at night because blood flow is decreased when people lie down. Some have to sleep in chairs to aid the blood flow and lessen the pain.

Peripheral artery disease is a big health problem, Losordo said. There is an emerging awareness of this disease on public health.

High blood pressure, high cholesterol, smoking and diabetes all raise the risk of having the condition. But some people don't smoke, have diabetes or high blood pressure and can still have blocked arteries in their legs, Losordo said.

For the randomized, double blind, placebo-controlled trial, Losordo uses the subject's own purified stem cells. The subject first takes a drug for five days to stimulate the release of his or her stem cells, called CD34+ cells, from bone marrow. An intravenous line is then inserted into a subject's vein to collect blood through a machine that removes a population of blood cells that contains the CD34+ stem cells. Losordo further selects and enriches the cells to select only CD34+ cells.

Z-shaped incision enhances minimally-invasive surgery

Mon, 17 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) A novel surgical technique allowing doctors to operate on patients by making a Z-shaped incision inside the stomach could potentially replace certain types of conventional surgery in humans, according to Penn State medical researchers who have successfully demonstrated the procedure in pigs.

If the technique ultimately proves successful in human trials, researchers say it could circumvent the long painful recovery times and medical complications associated with surgery.

The new approach, known as NOTES (natural orifice transluminal endoscopic surgery), involves using a natural opening in the body, in this case the mouth, to advance a flexible video endoscope into the stomach.

Using this tube, and the instruments contained within it, doctors currently make a small straight incision in the stomach to gain access to the abdominal cavity and the organs requiring attention.

Theoretically, by eliminating body wall wounds with their associated complications and allowing some procedures to be done without general anesthesia, this method could leave a truly minimal surgical footprint, and may even allow certain procedures to be done outside a traditional operating room, said Matthew Moyer, M.D., a gastroenterology fellow at Penn State Milton S. Hershey Medical Center.

But he cautioned that NOTES is still in the developmental phases and even a simple procedure may be fraught with potential complications at this point.

One of those barriers is the closure of the access site, said Moyer. In other words, the opening made in the stomach must be reliably and safely sealed off at the end of the procedure.

Moyer and his Hershey Medical Center colleagues Eric M. Pauli, M.D.,resident surgeon; Randy S. Haluck, M.D., director of minimally invasive surgery and assistant professor, and Abraham Mathew, M.D., director of endoscopy and assistant professor, all at Penn State College of Medicine, believe their technique elegantly solves the problem.

The key to their approach lies in the way the flexible probe exits the stomach. Instead of cutting straight through the stomach wall the researchers guide the endoscope so that it first tunnels under the mucous membrane of the stomach wall for a while before exiting near an organ to be operated on. The endoscope essentially charts a Z-shaped path.

This new technique, known as STAT (self-approximating transluminal access technique), has two main advantages according to Moyer. There is significantly less bleeding involved and the Z-shaped tract effectively seals itself due to pressure created on the abdominal wall by normal breathing.

The team published its findings in a recent issue of Gastrointestinal Endoscopy.

The technique has other advantages as well. Most people operate straight through the gastric wall and then use a bunch of complex maneuvers to get the endoscope where it needs to be, said Pauli. And it can get difficult to operate because the endoscope is upside down and in a reverse position.

By tunneling through instead, he points out, doctors can maintain a directional sense and guide the endoscope more accurately.

There are landmarks in the mucous membrane such as specific blood vessels and groupings of blood vessels. We can also see through the wall of the stomach in some areas to guide the endoscope to the organ we want to operate on, Pauli said.

The researchers have so far operated on 17 animals and only one of them has developed a minor complication.

Once they have perfected their tunneling technique, Moyer and colleagues will try to figure out how exactly to remove surgical specimens from an operation.

The gall bladder, small tumors, even the ovaries are potentially removable through this technique, said Mathew. We could in theory make the tunnel as big as we want, and take something out into the stomach and cut it into small pieces before extracting it.

If successful, the procedure in humans could translate into significantly shorter recovery times, little or no pain, less anesthesia and without surgical scars. But the researchers acknowledge it may be a while before their surgical technique reaches human trials.

Mathew said he and his colleagues are confident that their technique lets them get the endoscope out of the stomach and back in safely with currently available instruments. We have to perfect the technique so we can fully understand the risks, he added.

The Penn State researcher envisions minimally invasive surgery being employed to help patients who are critically ill and may not be able to tolerate a traditional surgery or leave the ICU. In such cases, doctors could access the internal organs and perform procedures such as a biopsy to make a better diagnosis or even perform intestinal bypass surgery.

According to Pauli, these findings could accelerate the pace of research in minimally invasive surgery and ease the way for other breakthroughs.

We are looking at some fundamental questions: can we get the endoscope in safely, can we get it out safely, and can we get it at the organ we want to operate on. Those are the questions nobody has really answered, he said.

Light and sound -- the way forward for better medical imaging

Wed, 12 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) Detection and treatment of tumours, diseased blood vessels and other soft-tissue conditions could be significantly improved, thanks to an innovative imaging system being developed that uses both light and sound.

The system uses extremely short pulses of low-energy laser light to stimulate the emission of ultrasonic acoustic waves from the tissue area being examined. These waves are then converted into high-resolution 3D images of tissue structure.

This method can be used to reveal disease in types of tissue that are more difficult to image using techniques based on x-rays or conventional ultrasound. For example, the new system is better at imaging small blood vessels, which may not be picked up at all using ultrasound. This is important in the detection of tumours, which are characterised by an increased density of blood vessels growing into the tissue.

The technique, which is completely safe, will help doctors diagnose, monitor and treat a wide range of soft-tissue conditions more effectively.

The first of its kind in the world, the prototype system has been developed by medical physics and bioengineering experts at University College London, with funding from the Engineering and Physical Sciences Research Council (EPSRC). It is soon to undergo trials in clinical applications, with routine deployment in the healthcare sector envisaged within around 5 years.

The emission of an acoustic wave when matter absorbs light is known as the photoacoustic effect. Harnessing this basic principle, the new system makes use of the variations in the sound waves that are produced by different types of soft human tissue to identify and map features that other imaging methods cannot distinguish so well.

By appropriate selection of the wavelength of the laser pulses, the light can be controlled to penetrate up to depths of several centimetres. The technique therefore has important potential for the better imaging of conditions that go deep into human tissue, such as breast tumours, and for contributing to the diagnosis and treatment of vascular disease.

The prototype instrument, however, has been specifically designed to image very small blood vessels (with diameters measured in tens or hundreds of microns) that are relatively close to the surface. Information generated about the distribution and density of these microvessels can in turn provide valuable data about skin tumours, vascular lesions, burns, other soft tissue damage, and even how well an area of tissue has responded to plastic surgery following an operation.

The development process has included theoretical and experimental investigations of photoacoustic interactions with soft tissue, development of appropriate computer image-reconstruction algorithms, and construction of a prototype imaging instrument incorporating the new technique.

Exercise testing may help predict seriousness of mitral regurgitation

Tue, 11 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 11, 2007) -- In as many as one in five people over age 55, when the heart contracts to send blood around the body, some degree of backward leakage occurs across the mitral valve, a condition known as mitral regurgitation (MR). When sufficiently severe, MR causes buildup of blood in the lungs, leading to difficulty in breathing (dyspnea, or shortness of breath), a serious condition called congestive heart failure. MR also can cause heart rhythm irregularities (arrhythmias) such as atrial fibrillation, which can lead to strokes and other problems, and ventricular tachycardia, which can cause sudden death.

A new study finds that monitoring the capacity of these patients to exercise on a treadmill -- an evaluation called exercise tolerance testing (ETT) -- may be useful in predicting the condition's progression and whether the patient will need surgery. Led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the American Journal of Cardiology.

Mitral regurgitation can be very benign, going unnoticed for many years, or can be severe, impeding the heart's proper function and leading to complications, even death. There are few accurate ways to predict the seriousness of a single case, and these methods require fairly sophisticated and expensive imaging. Our study shows that exercise tolerance testing, a simple procedure often performed in doctors' offices, is an excellent tool for predicting if the patient is deteriorating and needs surgery, says Dr. Jeffrey S. Borer, a study co-author ; director of the Howard Gilman Institute for Valvular Heart Diseases at NewYork-Presbyterian/Weill Cornell; and the Gladys and Roland Harriman Professor of Cardiovascular Medicine and professor of cardiovascular medicine in cardiothoracic surgery at Weill Cornell Medical College.

We found that exercise testing is a simple and relatively inexpensive way to predict outcomes. Patients with mitral regurgitation who perform well on the treadmill will likely remain healthy and not have to undergo further testing for a number of years. This gives these patients peace of mind, says principal investigator Dr. Phyllis G. Supino, associate research professor of public health in medicine and associate research professor of public health at Weill Cornell Medical College.

Developed in its most simple form in the 1920s, exercise tolerance testing (ETT) is used commonly to assess the progression of coronary artery disease and the severity of aortic stenosis.

In mitral regurgitation, the mitral valve does not close completely, as it should, when the heart contracts, allowing blood to flow backward instead of forward, limiting blood flow to the body. Symptoms include shortness of breath, fatigue, cough, heart palpitations, swollen feet or ankles, and excessive urination. A characteristic heart murmur can be heard with a stethoscope.

In the current study, researchers followed 38 patients with chronic severe nonischemic MR (that is, MR not due to a prior heart attack) for an average of seven years. All underwent ETT at study entry. Patients who could continue exercising for 15 minutes or longer (of a maximum total of 18 minutes) had a fivefold lower annual risk of developing heart failure or other evidence of severe heart dysfunction necessitating surgery, compared to patients who were unable to exercise for that length of time.

In patients with chronic severe nonischemic MR, progression to surgical indications generally is rapid. There are two surgical options for the treatment of MR: mitral valve replacement and mitral valve repair.

Implanting embryonic cardiac cells prevents arrhythmias

Wed, 05 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) When researchers at Cornell, the University of Bonn and the University of Pittsburgh transplanted living embryonic heart cells into cardiac tissue of mice that had suffered heart attacks, the mice became resistant to cardiac arrhythmias, thereby avoiding one of the most dangerous and fatal consequences of heart attacks.

The discovery, reported in this week's issue of Nature, has profound implications for using cell-transplant therapies to restore damaged heart tissue.

The researchers, including Michael Kotlikoff, the Austin O. Hooey Dean of Cornell's College of Veterinary Medicine, one of the paper's senior authors, discovered that a protein called connexin43, expressed by the transplanted embryonic heart cells, improved electrical connections to other heart cells. The researchers showed that the improved connections helped activate the transplanted cells deep within the damaged section of the heart tissue. The technique reversed the risk of developing ventricular arrhythmias after a heart attack, the number one cause of sudden death in the Western world.

In the past, scientists have transplanted a variety of cell types into failing hearts with modest improvement of function, although transplanting skeletal muscle cells made things worse and led to more arrhythmias. Surprisingly, when co-author Bernd Fleischmann at the University of Bonn and colleagues transplanted embryonic cardiac cells, the hearts' electrical stability and function returned to normal.

Scientists recognize the untapped potential of using cell-based therapies to counter many debilitating diseases, but they have not had tools to assess the function of the cells once transferred. In Kotlikoff's laboratory, the researchers determined that the transplanted embryonic cells were making electrical connections with normal heart cells. Using genetically modified heart cells that express a fluorescent sensor, they established that transplanted heart cells were activated during normal heart contractions.

For the first time we were able to see how cells used in therapy are working with other cells in a complex organ within a living animal, establishing the mechanism of the therapeutic effect, Kotlikoff said.

Professor Guy Salama at the University of Pittsburgh School of Medicine was also able to map voltage signals across the surface of the hearts, establishing that the implanted cells improve conduction of electrical signals within the damaged heart tissue.

While doctors could never use cells from a human embryonic heart for transplantation, researchers at the University of Bonn engineered skeletal muscle to express connexin43 and achieved the same restorative results as they did with the embryonic heart cells.

These results have important implications for therapy, although they must be verified in the context of naturally occurring heart damage, Kotlikoff said. One can envision using a patient's own cells by deriving heart cells from stem cells to improve heart function and decrease arrhythmia risk.

Robotics lab helps stroke patients with recovery

Tue, 04 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) HOUSTON, Dec. 4, 2007 -- Robotics engineers at Rice University are teaming with doctors from Memorial Hermann|TIRR to develop a PC-based system for physical rehabilitation.

It can take months of physical therapy for stroke patients to regain the use of their limbs, said system architect Marcia O'Malley, director of Rice's Mechatronics and Haptic Interfaces Laboratory (MAHI). We hope to refine our system to allow patients to recover faster and to allow therapists to more precisely monitor patients' recovery.

O'Malley and Memorial Hermann|TIRR doctors this fall began a two-year study of a prototype rehabilitation system developed at MAHI that uses a joystick to help patients with eye-to-hand coordination. The study involved 16 patients. In one exercise, the patients use the joystick to move an object from one part of the computer screen to another. Like all the systems in O'Malley's lab, the rehab program uses force-feedback technology called haptics that allow people to feel their environment while they are in virtual reality.

The term haptic refers to the perception of touch, and in the prototype rehab system, the joystick is outfitted with motors that push the stick to resist moves in the wrong direction. As a result, the patient's hands are guided along the right path. By repeating the exercise over and over, patients can gradually learn to control the objects on the screen in a smooth, precise way.

We're interested in measuring how smooth the movements are, compared to what might be optimal, said O'Malley, assistant professor of mechanical engineering and materials science. The computer can precisely measure how a patient responds to every single exercise. This lets the doctors and physical therapists know exactly what their patient most needs to work on. This precise, measurable feedback provides a great advantage over the subjective evaluations currently in use.

O'Malley said researchers have been using computer-controlled robots for physical rehabilitation since the early 1990s, but so far the technology has been too expensive to use on a large scale. She thinks this will change within the next few years.

O'Malley said patients' enthusiasm for the technology is one reason it's likely to catch on.

The patients who get a chance to try this tend to get very excited, said O'Malley, who has previously worked with doctors and patients from the Department of Veterans Affairs. I've been inspired to see how hard patients are willing to work to regain their mobility, and our technology really plays to that strength. The machine never gets tired. It allows them to work as long and as hard as they want.

Huge numbers willing to go under knife to alter their appearance, study finds

Fri, 26 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Most women, and large numbers of men, are interested in having cosmetic surgery, UCLA scientists report in the October issue of the Journal of Plastic and Reconstructive Surgery.

Forty-eight percent of women surveyed said they would be interested in cosmetic surgery, liposuction or both, and another 23 percent said they would possibly be interested.

Among men, 23 percent said they would be interested in surgery, with 17 percent expressing possible interest.

Interest in cosmetic surgery is far more widespread than we had anticipated, said David Frederick, a UCLA psychology graduate student and lead author of the study. The majority of women expressed some interest in cosmetic surgery, and more than one-third of men expressed some degree of interest, which I found really surprising. We know there is tremendous pressure for women to be thin and have a certain appearance and for men to be fit and muscular, but I would not have guessed that so many people would be interested in surgical body alteration.

In addition, 21 percent of women and 11 percent of men described themselves as unattractive, and 31 percent of women and 16 percent of men reported feeling so uncomfortable in a swimsuit that they avoid wearing one in public, Frederick and his colleagues reported.

There is so much pressure, especially on women, to be thin and beautiful and to look younger, Frederick said. Many people are willing to pay thousands of dollars to permanently alter their bodies surgically. The interest in cosmetic surgery is widespread across the full life span. Especially for women, there never seems to be a reprieve. Your appearance is judged to be an important part of who you are.

Frederick was surprised to find no relation between people's body image and their interest in cosmetic surgery � even those without a poor body image expressed interest in surgical alteration.

This isn't about poor body image, Frederick said. People interested in cosmetic surgery did not report less satisfaction with their body or face than people who are not interested. People interested in liposuction, however, did report lower body satisfaction, even when statistically controlling for body weight.

According to the American Association of Plastic Surgeons, nearly 11 million cosmetic surgery procedures were performed in 2006 � a 48 percent increase from 2000. Roughly 90 percent of cosmetic surgeries in 2004 were performed on women.

For the study, UCLA researchers analyzed the responses of more than 52,000 people � ranging in age from 18 to 65, with an average age in the mid-30s � to an online survey conducted by MSNBC.com and Elle.com in 2003.

Procedure helps to eliminate sleep apnea

Wed, 24 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) (Chicago, IL, October 24, 2007) � A procedure known as uvulopalatopharyngoplasty (UPPP) may help some patients improve or even eliminate their obstructive sleep apnea (OSA), according to a new study. The research, presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), says the procedure, which removes excess tissue in the throat or mouth to widen the airway, can reduce the amount of treatment required by patients with OSA. In addition, researchers say UPPP also can eliminate OSA completely in some patients.

�Continuous positive airway pressure, or CPAP, is a well-established treatment for sleep apnea,� said lead study author Akram Khan, MD, Assistant Professor, University of Florida Jacksonville, �and while most patients tolerate it well, some are unable to tolerate it or don�t want to, and those patients need alternative means of treatment.�

To determine if UPPP provided improvement in sleep parameters, Dr. Khan and his colleagues from the Mayo Clinic, Rochester, MN, evaluated the success of the procedure in 63 patients aged 18-80, with OSA, over a 7-year period. All patients underwent UPPP and were assessed with polysomnography within a 6-month period, pre-procedure and post-procedure.

Results showed that UPPP eliminated OSA in approximately one quarter to one-third of patients, depending on the definition of success. Of those who experienced residual OSA and returned to CPAP use, the required CPAP setting was modestly lower. In addition, researchers reported that UPPP also reduced the mean apnea-hyponea index in patients.

�The apnea-hyponea index basically tells us the number of times a patient with sleep apnea quits breathing per hour,� Dr. Khan explained. �We found that the surgical procedure reduced patients� apenic (nonbreathing) episodes by more than half.� According to Dr. Khan, UPPP provided an improvement in oxygen levels and other parameters of sleep, as well.

First described in 1981, UPPP has been used widely with varying results. Though researchers are unclear on what characteristics make up the ideal UPPP candidate, they suggest that patients with mild OSA, who are relatively young, lean, and healthy, may have the best results with this procedure. Researchers also believe that a decrease in CPAP requirements would likely improve compliance in patients who don�t have their OSA completely resolved.

�Obstructive sleep apnea increases the risk of other illnesses, such as heart disease, high blood pressure, and stroke, among others,� said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. �Patients and physicians need to work together to recognize the signs of sleep apnea and to identify which method of treatment is most suitable.�

2 carotid artery stenting studies show results comparable to AHA guidelines

Tue, 23 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Washington D.C., October 23, 2007 - Two carotid stenting trials examining patient outcomes demonstrated results that are comparable to guidelines established by the American Heart Association (AHA) for patients treated with carotid artery surgery. The results of these studies were presented today at the Cardiovascular Research Foundation's 19th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium by William A. Gray, M.D., FACC, associate professor of clinical medicine at Columbia University College of Physicians and Surgeons and director of Endovascular Services at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center in New York. Dr. Gray is the director of Endovascular Services at the Cardiovascular Research Foundation.

An interim analysis of patients treated with carotid stents in Abbott�s CAPTURE 2 (Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events) and EXACT (Emboshield and Xact Post Approval Carotid Stent Trial) post-marketing trials, which enrolled 4,111 patients in over 150 sites, demonstrated 30 day patient outcome results consistent with longstanding AHA guidelines for patients with a severe carotid stenosis but who do not have symptoms. These guidelines recommend that rates of complications for carotid artery surgery to prevent stroke be less than 3 percent for patients without symptoms of stroke (asymptomatic) and 6 percent for patients with symptoms of stroke (symptomatic).

�In these two well-conducted carotid artery stenting studies, carotid stenting has achieved outcomes comparable guidelines established for patients who undergo carotid surgery, and has done so in a population of patients who are at high risk for experiencing adverse events from surgery,� said Dr. Gray. �This is a significant report because this is the first time that these guidelines have been achieved by any revascularization therapy in a large, multi-center examination of such patients, and although the guidelines were established for surgery (before stenting was practiced), there are no comparable surgical results in this group of patients.�

In 1998, the American Heart Association published its 30 day outcome guidelines in Circulation for patients treated with carotid artery surgery. These guidelines were based on the observed stroke and death rates in patients with carotid artery disease who had undergone surgery, called carotid endarterectomy, to treat their condition. The guidelines were based on studies of surgery in patients who did not have excessive risks for anesthesia, etc., but left unanswered what the best therapy is for patients for whom surgery was risky. These two studies are the first demonstration of a therapy providing stroke prevention (carotid artery stenting) in these patients and they provide an option to those facing difficult decisions regarding the risks of surgery.

The CAPTURE 2 study included 1,987 patients and utilized Abbott's ACCULINK(tm) Carotid Stent System and ACCUNET(tm) Embolic Protection System. The EXACT study included 2,124 patients and utilized Abbott's Xact(r) Rapid Exchange Carotid Stent System and Emboshield BareWire(tm) Rapid Exchange Embolic Protection System. The key objective of both trials was to determine whether carotid stenting could be performedsafely in the real-world clinical setting by physicians with varying levels of experience. The primary endpoints were death, stroke and MI at 30 days. The demographics of patients in both trials were similar.

The 30-day composite endpoints of stroke and death for patients in the CAPTURE 2 and EXACT studies were:

An eye for an eye: using stem cells to treat damaged eyes and a rare skin disorder

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Doctors and scientists in Italy have shown how stem cells can be used to treat damaged eyes and, in combination with gene therapy, a rare and debilitating skin disease.

Professor Michele De Luca of the University of Modena and Reggio Emilia described the work to an international meeting of stem cell scientists in Milan (30 Sep � 2 Oct, �Challenges in Stem Cell Differentiation and Transplantation�) organised by the European Science Foundation�s EuroSTELLS stem cell programme in conjunction with the National Research Council of Italy.

Stem cell therapy involves the use of stem cells � �blank� cells (�toti- or �pluripotent�) that have not differentiated into specialised cells � to generate new tissues or organs. While widespread stem cell therapy lies some way in the future, Professor De Luca pointed out that it has been used already for many years in the treatment of burns. Many tissues of the body are continuously regenerated by their own population of stem cells. In the skin, such cells are called holoclones and for decades doctors have taken small samples of these cells from burns patients and cultured the cells into new skin that can be grafted onto the wound.

Professor De Luca�s team showed that cells of the transparent outer covering of the eye, the cornea, are constantly being replaced by new cells deriving from an area surrounding the cornea called the limbus. The cells differentiate into corneal epithelium and migrate to the cornea.

�If the cornea is damaged severely by a chemical burn or infection, for example, it can become opaque and necessitates a transplant,� Professor De Luca told the meeting. �However, a transplant will only be successful if the patient�s limbus has remained intact so that it can continue to replenish the new cornea.�

For many years doctors did not understand why some transplants failed � because they did not appreciate the requirement for the limbus.

In cases where the limbus is destroyed there has been little hope to restore the patient�s sight. Professor De Luca�s team decided to take a leaf from the way that burns are treated and grow a new cornea from limbar stem cells taken from the healthy eye.

By removing a small sample of these cells it was possible to culture a new cornea and graft it on to the damaged eye. The team showed that of 240 patients who were operated on in this way, the cornea regenerated successfully in 70% of cases.

The researchers then turned their attention to a rare but debilitating genetic disease of the skin resulting in a syndrome known as Epidermolysis Bullosa, in which the skin is highly fragile and prone to blistering due to faulty proteins that effectively anchor the surface layers of skin to the body.

In one form of the disease there is a mutation in one of these anchoring proteins called laminin 5. The Italian researchers obtained consent to carry out a small-scale trial of a novel gene therapy using skin holoclones on one patient, a 37-year-old male, on small part of his body .

�Because the patient�s body was so badly affected it was difficult to isolate any stem cells from his skin,� Professor De Luca told the conference. �Most people have between seven and ten per cent of holoclones. Our man had none. Eventually we found a few in the palms of his hand and cultured them from a biopsy.�

The team then used gene therapy to insert the correct laminin gene into the growing cells and grafted the new tissue onto the patient�s body. The graft was successful and after several months the skin remained to all intents normal, without the blistering and flaking.

�This demonstrates that it is possible to use stem cells in gene therapy for genetic skin disorders,� Professor De Luca said.

UCLA doctor develops new technique to treat varicose veins

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Dr. Peter Lawrence, UCLA's chief of vascular surgery, picks up size 7 crochet hooks from a fabric store � not to make sweaters or scarves but to use in a new technique he has developed to treat varicose veins.

Early results of the new outpatient procedure, called light-assisted stab phlebectomy, or LASP, appear in a study in the October issue of the journal The American Surgeon.

More than 250 patients at UCLA have undergone Lawrence's procedure, which is designed to remove branch varicose veins from the thighs, calves and ankles. The technique combines two current varicose vein-removal methods � powered phlebectomy and stab phlebectomy � which excise veins through a small incision in the skin. Lawrence's method also employs transilllumination, in which a light source is placed beneath the skin to help highlight the veins during the procedure.

In addition, Lawrence has developed new, minimally invasive surgical instruments to remove the veins.

This new, sutureless technique allows complete and rapid varicose branch vein removal with few missed varicose veins, little bruising and an excellent cosmetic result, said Lawrence, author of the study and a professor at the David Geffen School of Medicine at UCLA.

Varicose veins affect over 40 percent of the adult population, mostly women. The inherited condition occurs frequently in the legs, where weakened valves in the veins lack the strength to push blood back to the heart, allowing it to pool in the lower extremities.

During the LASP procedure, in which the patient is sedated but remains conscious, Lawrence makes a tiny incision near the varicose veins and threads a slender tube with a light source at its tip underneath the vein cluster.A mixture of saline, lidocaine and epinephrine is infused into the area, providing a further anesthetic and plumping up the veins so that they are easily visible. The lights of the operating room are turned off so that Lawrence can see the veins illuminated under the skin.

This is one of the first times that transillumination is used during the actual vein-removal procedure, which offers maximum visibility for the surgeon, Lawrence said. Usually the veins are mapped before the procedure, which is not as effective.

Lawrence then makes a very small incision immediately adjacent to a varicose vein. Taking a size 7 crochet hook that has been filed down and modified for the procedure, he passes it through the incision, hooks a vein and pulls it through the opening. After turning on the operating room lights, Lawrence assesses the vein, sets the crochet hook aside and grasps the vein at its base with a tiny mosquito clamp. Using a gentle circular motion, he dislodges the vein from the skin. Further incisions are made to remove remaining veins.

The empty vein channels are flushed with solution to help collapse them and prevent bruising and hematomas from any residual blood remaining in the channels. No sutures are used; this allows for continued drainage if needed. A compression dressing is applied to the affected area, and within an hour, the patient goes home with instructions to elevate the leg for 48 hours. The resulting scars look like small freckles.

Between 2004 and 2006, 268 patients received LASP treatment at UCLA � 49 of them underwent LASP alone, and 184 had it combined with another varicose vein-removal procedure. Researchers followed up with patients roughly a year after their procedures and found few early postoperative complications, such as infection, hematoma formation or severe pain requiring additional pain prescriptions.

According to Lawrence, LASP may provide lower residual varicose vein occurrence due to the greater ease in identifying the veins in the operating room through transillumination.

The next step is a larger study and longer follow-up with patients, Lawrence said.

Currently, various procedures are used to treat varicose veins, depending on their size. In addition to powered stab phlebectomy, other methods include laser and radiofrequency treatments, which employ heat or energy to seal off veins; vein ligation and stripping, surgical procedures that involving the tying off or removal of veins; and sclerotherapy, a method that involves the injection of a solution to dissolve smaller spider veins.

Lawrence said that LASP is often used to treat branch veins in the calf � in conjunction with either laser or radiofrequency procedures that are used to close the main saphenous vein that runs from the bottom of the foot to the thigh.We believe that LASP will provide surgeons with an additional tool to be used to treat varicose veins, he said. With more options, we can better target individual treatment.

Cross-species transplant in rhesus macaques is step toward diabetes cure for humans

Thu, 18 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) St. Louis, Oct. 18, 2007 � With an eye on curing diabetes, scientists at Washington University School of Medicine in St. Louis have successfully transplanted embryonic pig pancreatic cells destined to produce insulin into diabetic macaque monkeys � all without the need for risky immune suppression drugs that prevent rejection.

The transplanted cells, known as primordia, are in the earliest stages of developing into pancreatic tissues. Within several weeks of the transplants, the cells became engrafted, or established, within the three rhesus macaque monkeys that received them. The cells also released pig insulin in response to rising blood glucose levels, as would be expected in healthy animals and humans.

The approach reduced the animals' need for insulin injections and has promise for curing diabetes in humans, says senior investigator Marc Hammerman, M.D., the Chromalloy Professor of Renal Diseases in Medicine. The transplants worked without a need for immune suppression and that is a major obstacle we have overcome.

The researchers' results appear online and will be published in the journal Xenotransplantation in November.

Although the transplants fell short of producing sufficient insulin to cure the macaques' diabetes, Hammerman predicts that with additional research, including the transplantation of additional embryonic pig cells into the animals, he will be able to reduce their need for insulin injections entirely.

The new research follows on the heels of reports by Hammerman and his colleagues demonstrating that transplanted pig pancreatic primordia can cure both type 1 and type 2 diabetes in rats, without using immune suppression drugs. Other scientists have tried different types of pancreatic cell transplants � in animals and humans � as a stepping stone to curing diabetes, but they all require anti-rejection drugs. These drugs must be taken daily to stave off rejection and have adverse effects of their own that limit the success of the transplants.

As a treatment for diabetes in people, pig insulin typically works as well as the human form. Before recombinant DNA technology enabled pharmaceutical companies to manufacture human insulin in the 1980s, pig and cow insulin were routinely given to diabetic patients.

The primates in the current study had type 1 diabetes, the form that occurs when islet cells in the pancreas stop producing insulin all together. The Washington University researchers transplanted 19 embryonic pig pancreatic primordia into each diabetic monkey. Each primordium is smaller than the diameter of a period that ends a sentence and is transplanted into a membrane that envelops the intestines and other digestive organs.

The transplanted cells were retrieved from the pig embryos early in their development, which is believed to render them invisible to the primates' immune system or induce a state of tolerance, either of which eliminates the need for immune suppression.

The researchers determined by multiple methods that the transplanted cells became established within the primates. And as the cells matured, they began to release pig insulin. We found using every method that the cells engraft long-term and, thus, are not rejected by the animals' immune systems, Hammerman says. It's been more than two years since our first transplant was carried out. That particular primate doesn't produce any primate insulin, but has pig insulin circulating in its bloodstream that has reduced by more than 50 percent the amount of injected insulin the animal needs, compared to levels before the transplant. The animals have never received immune suppression drugs.

Two of the macaques remain healthy. One, however, became anemic about six weeks post-transplant and was euthanized a month later after developing acute respiratory distress. The researchers could not find a link between this animal's illness and the pancreatic cell transplants.

The two remaining macaques have each received two transplants of embryonic pancreatic cells. One of the animals has been followed for 23 months after his first transplant, and the amount of insulin he needs to have injected has declined by some 55 percent over baseline levels. The other macaque has been followed for 10 months after his initial transplant, and his need for injected insulin continues to decline over time.

Hammerman and his colleague Sharon Rogers, research instructor in medicine, are leaders in the emerging field of organogenesis, which focuses on growing organs from transplanted embryonic organ precursors known as primordia. Unlike embryonic stem cells, which can become virtually any cell type, primordia are locked into becoming cells of a particular organ.

We are encouraged by these results, Rogers says. The absence of a need for immune suppression in diabetic rats gave us hope that we were on the right track. But many findings in rats do not hold true for species that are more closely related to humans, such as non-human primates. This one did.

The team will now determine how best to eliminate the need for injected insulin in the diabetic macaques that receive transplants, thus demonstrating long-term effectiveness of the technique, and establish the absolute safety of pancreatic primordia transplants. If these experiments succeed, the researchers plan to conduct clinical trials in humans with diabetes.

We hope to find out how to apply our findings to human type 1 and type 2 diabetics because the embryonic pig primordia would represent an unlimited source of tissue for transplantation, Hammerman says.

Reunion with patient inspires follow-up study on treatment for DiGeorge syndrome

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) More than 20 years ago, doctors at Mattel Children's Hospital UCLA performed a successful bone marrow transplant on a baby girl who was born without a thymus gland and was suffering from severe immune deficiency. It marked the first time a bone marrow transplant, rather than a thymic transplant, had been used to treat the genetic condition known as DiGeorge Syndrome (DGS).

The doctors lost track of the young girl when her family moved away but were reunited with her when she returned to UCLA for heart treatment in 2005. Upon rechecking the young woman's immune system, they were pleased to learn that she continued to do well.

Inspired by her positive long-term outcome � along with a handful of other DGS bone marrow transplant patients worldwide � UCLA researchers embarked on a study to follow up on the benefits of bone marrow transplant treatment. Their findings are published in the October 2007 issue of the peer-reviewed Journal of Allergy and Clinical Immunology.

Overall, the researchers found that survival with bone marrow transplant was greater than 75 percent, similar to thymic transplantation.

We believe that this long-term follow-up study indicates that bone marrow transplant is a good procedure � and more readily available than thymic transplantation � for complete DiGeorge syndrome, said co-author Dr. E. Richard Stiehm, professor of pediatrics in the division of immunology, allergy and rheumatology at Mattel Children's Hospital UCLA. This also suggests that the thymus may not be necessary for immune development after birth, or that other tissues, such as the skin, may serve as a thymus equivalent.

DiGeorge syndrome is a common genetic immunodeficiency that occurs in one out of every 2,000 people. The syndrome includes thymic and parathyroid deficiency, chromosome abnormalities, low calcium levels and decreased immunity. Patients often have heart problems and developmental delay, which bone marrow or thymic transplants do not correct. Only a few patients have the severely deficient immune systems characteristic of complete DGS, which is similar to severe combined immunodeficiency (also known as bubble boy syndrome) and is fatal if untreated.

In this first report of extended survival in patients with complete DGS who were treated with bone marrow transplant with long-lasting immune reconstitution, researchers described the medical history and current immune function of two DGS patients who received transplants more than two decades ago. Now in their 20s, both patients lead normal lives free of serious infections and have preserved immune function.

The study also reviewed nine additional cases from other centers internationally and assessed the current status of all patients but one.

The thymus produces hormones that stimulate the production of certain infection-fighting cells. It is also of central importance in the maturation of T-cells (thymic cells), which help build immunity.

According to Stiehm, the thymus gland is the university of the immune system.

Stem cells must go there to be educated before entering the circulation to fight organisms, he said. The thymus continues to put out T-cells for a lifetime. It puts out naive T-cells that are then exposed to microbes to become memory T-cells. It was previously thought that the body needs a continuous supply of new naive cells to keep the immune system functioning, but now we think that maybe it's not necessary, since the memory cells from the donor may serve for a lifetime.

The significance is that adult memory cells from bone marrow, or peripheral blood, can persist in the circulation for several decades and keep the patient well, even though new naive T-cells from the thymus are not produced.

A bone marrow transplant works by replacing the patient's marrow with healthy marrow from a matched donor. Ultimately, the new marrow helps the patient produce normal blood cells.

A thymic transplant is an effective but complicated procedure that involves transferring the thymus tissue of another infant undergoing heart surgery, culturing it, and then surgically implanting it in the patient. It then takes several months for the thymus gland to grow and allow the patient to develop a functioning immune system.

Thymus transplantation is available in the U.S. only at Duke University's medical center. By contrast, bone marrow transplant is a standard procedure available at many large medical centers across the country and internationally.

Chemistry turns killer gas into potential cure

Mon, 15 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Despite its deadly reputation, the gas carbon monoxide (CO) could actually save lives and boost health in future as a result of leading-edge UK research.

Chemists at the University of Sheffield have discovered an innovative way of using targeted small doses of CO which could benefit patients who have undergone heart surgery or organ transplants and people suffering from high blood pressure.

Although the gas is lethal in large doses, small amounts can reduce inflammation, widen blood vessels, increase blood flow, prevent unwanted blood clotting � and even suppress the activity of cells and macrophages* which attack transplanted organs. The researchers have developed innovative water-soluble molecules which, when swallowed or injected, safely release small amounts of CO inside the human body.

Research carried out in the last decade had already highlighted possible advantages, as CO is produced in the body as part of its own natural defensive systems. However, the problem has been finding a safe way of delivering the right dose of CO to the patient. Conventional CO inhalation can run the risk of patients or medical staff being accidentally exposed to high doses. Now for the first time, thanks to chemistry, an answer appears to have been found.

The new CO-releasing molecules (CO-RMs) have been developed in partnership with Dr Roberto Motterlini at Northwick Park Institute for Medical Research (NPIMR) and with funding from the Engineering and Physical Sciences Research Council (EPSRC).

�The molecules dissolve in water, so they can be made available in an easy-to-ingest, liquid form that quickly passes into the bloodstream,� says Professor Brian Mann, from the University's Department of Chemistry, who led the research. �As well as making it simple to control how much CO is introduced into a patient�s body, it will be possible to refine the design of the molecules so that they target a particular place while leaving the rest of the body unaffected.�

The CO-RMs consist of carbonyls** of metals such as ruthenium, iron and manganese which are routinely used in clinical treatments. They can be designed to release CO over a period of between 30 minutes and several hours, depending on what is required to treat a particular medical condition.

As well as boosting survival rates and cutting recovery times, the new molecules could ease pressure on hospital budgets by reducing the time that patients need to spend in hospital, for example after an operation. They could even help some patients to avoid going into hospital in the first place.

Professor Mann added: �This project provides an excellent example of how non-biological sciences like chemistry can underpin important advances in healthcare.�

hemoCORM Ltd, a spinout company set up in 2004 by the University of Sheffield and NPIMR, is now taking the research towards commercialisation. It is hoped that, after further development work, Phase 1 clinical trials can begin in around two years, with deployment in the healthcare sector potentially achievable in around five years.

Some obese patients more likely to return to work following gastric bypass surgery

Mon, 15 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Obese Medicaid patients who undergo Roux-en-Y gastric bypass surgery may be more likely to return to work than obese Medicaid patients who do not undergo the surgery, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery.

About 65 percent of adults in the U.S. are overweight and 5 percent are morbidly obese, having a body mass index (BMI) greater than 40, according to background information in the article. �Obesity is associated with a variety of diseases, including diabetes mellitus, hypertension, hyperlipidemia, degenerative arthritis, sleep apnea and left ventricular hypertrophy. Depression, social isolation and discrimination further compound the disability associated with morbid obesity,� the authors write. �As a result, morbid obesity results in dramatic increases in health care costs.�

Amy J. Wagner, M.D., and colleagues at Virginia Mason Medical Center, Seattle, studied 38 medically disabled patients receiving Medicaid who between 1997 and 2002 underwent Roux-en-Y gastric bypass performed by a single surgeon and compared these patients with 16 patients receiving Medicaid who were seen by the same surgeon, but did not undergo surgery. Patients� medical data were obtained by a review of their clinical charts and long-term follow-up telephone interviews.

Patients who underwent surgery had an average age of 48 and an average BMI of 58 before surgery and were followed for an average of 44 months, while those who did not undergo surgery had an average age of 51 and an average BMI of 54 at the beginning of the study and had an average of 32 months of follow-up. Average follow-up BMIs for the operative and non-operative groups were 36.2 and 52, respectively.

�The patients who underwent Roux-en-Y gastric bypass were more likely to return to work, with 14 (37 percent) working, compared with 1 (6 percent) of the non-operative control patients,� the authors write. �Return to work was more likely in patients who had resolution of comorbid conditions [co-occurring illnesses] after surgery.� Those who returned to work no longer required Medicaid funding.

�The practical implication of these findings is that the presence of reversible obesity-related comorbidities may be an appropriate prerequisite for approval of bariatric surgery in this population,� the authors conclude. �Surgical treatment of morbid obesity has a profound effect on patients� quality of life as evidenced by the sustained long-term weight loss, reversal of comorbidities, improved rating of quality of life and the patients� ability to return to the workforce.�

Weight loss before bariatric surgery linked to shorter hospital stay, faster weight loss

Mon, 15 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) High-risk morbidly obese patients who lose 5 to 10 percent of their excess body weight before undergoing gastric bypass surgery appear to have shorter hospital stays and more rapid postoperative weight loss, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery.

Bariatric surgery is an effective long-term treatment for morbidly obese patients with co-occurring medical problems, according to background information in the article. �To that end, older and higher-risk patients with multiple uncontrolled medical problems (such as diabetes mellitus, obstructive sleep apnea, steatohepatitis [liver inflammation], degenerate joint disease, venous stasis disease [loss of vein function in the legs] and cardiopulmonary vascular disease) are opting for bariatric surgery,� the authors write. �Moreover, patients are seeking referral for bariatric surgery when the disease burden from their comorbidities eliminates meaningful quality of life.� These patients may face more complications following surgery.

Christopher D. Still, D.O., and colleagues at Geisinger Health System, Danville, Penn., assessed patients who underwent open or laparoscopic gastric bypass surgery between 2002 and 2006. �Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional and surgical interventions and education,� the authors write. �In addition, patients were encouraged to achieve a 10 percent loss of excess body weight prior to surgical intervention.�

Of the 884 patients (average age 45), 169 (19 percent) lost 5 to 10 percent of their excess body weight prior to the operation and 425 (48 percent) lost 10 percent or more of excess weight prior to the operation. Those who lost more than 5 percent were less likely to stay in the hospital longer than four days, whereas those who lost more than 10 percent of their excess weight before surgery were more than twice as likely to have lost 70 percent of excess weight one year afterward, compared with those who lost between none and 5 percent of their excess pounds before surgery.

The authors speculate that physiologic improvements associated with weight loss decreased surgical complications, reducing the length of hospital stay. �Numerous reports have confirmed the beneficial effects of even limited weight loss on co-morbid medical conditions, such as hypertension [high blood pressure], diabetes mellitus, degree of visceral [among internal organs] fat, liver size, thromboembolism [blood clot] predisposition and severity of sleep apnea,� the authors write. �Additional studies will be required to pinpoint which comorbidity (or comorbidities) is responsible for reduced lengths of stay.�

In addition, further research is needed to determine how preoperative weight loss could help with long-term weight loss following surgery, they note.

Stanford analysis shows little difference in risk rates for angioplasty, bypass procedures

Mon, 15 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - Patients with heart disease who undergo coronary angioplasty have an equivalent risk of death and heart attack as patients who undergo coronary bypass surgery, according to Stanford University School of Medicine researchers. The analysis is the largest comparison of bypass surgery and angioplasty, two of the most common major medical procedures performed in North America.

The researchers also found that the survival rates for bypass surgery and angioplasty were similar for patients with diabetes, refuting previous reports that angioplasty was associated with a significantly higher risk of death among diabetic patients.

It is reassuring that the long-term safety of these two procedures is roughly the same, said senior author Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine. Patients and their doctors can have a more informed discussion about which procedure should be done, based on other outcomes that are important to the patient.

The study, which was funded by the Agency for Healthcare Research and Quality and conducted by the Stanford-UCSF Evidence-based Practice Center, will be published in the Oct. 16 advance online issue of Annals of Internal Medicine.

Two types of medical interventions are available to patients with coronary artery disease, which affects about 15 million Americans. One is bypass surgery, in which surgeons take a healthy blood vessel from another part of the body to create a detour around the blocked part of the coronary artery. The other is angioplasty, in which a tiny balloon is used to open a blocked artery; a mesh tube called a stent is often inserted to hold open the artery after the procedure.

Bypass surgery is the preferred treatment for patients with blockages in three arteries, while angioplasty is typically used for those patients with single-vessel disease. Patients with heart disease between these extremes are candidates for either procedure, but Hlatky said it's not always clear which is the best treatment choice.

To gain a better understanding of the differences between the two procedures, Hlatky and his colleagues analyzed data from 23 randomized clinical trials that compared treatments for patients with mid-range coronary disease. The studies involved nearly 10,000 patients in Europe and the United States; 4,944 patients were randomly assigned to surgery and 5,019 patients were randomly assigned to angioplasty.

After reviewing the data, the researchers determined that the procedural survival rate for the two was virtually the same - 98.2 percent for bypass surgery and 98.9 percent for angioplasty. Bypass surgery was, however, associated with a small but significantly greater risk of stroke within 30 days of the procedure.

Long-term survival rates were comparable, with about 90 percent of patients living five years after either procedure, as was the risk of post-procedure heart attack. About 12 percent of surgery patients and 10.9 percent of angioplasty patients had a heart attack within five years.

The researchers also looked specifically at patients with diabetes, a key risk factor for coronary artery disease, and found no difference in survival rates between the two procedures. Hlatky said this was surprising, given the 1995 results from the Bypass Angioplasty Revascularization Investigation by the National Institutes of Health. The BARI study showed that diabetic patients who underwent bypass surgery had a higher five-year survival rate than those who had angioplasty.

A lot of patients with diabetes were worried about angioplasty after the BARI finding came out, said Hlatky. But after reviewing all the published data, we didn't see a significant difference in survival rates between these procedures.

Among the researchers' other findings, bypass surgery led to fewer repeat procedures - 9.8 percent of bypass patients had repeat procedures after five years, compared with 46.1 percent of patients who had angioplasty without a stent and 40.1 percent who had angioplasty with a stent. Bypass surgery was also found to be more effective than angioplasty in relieving chest pain known as angina.

Hlatky said once patients and doctors are sure there is no major difference in the risk of death and heart attacks between the two procedures, they can turn their attention to more subjective outcomes, such as control of angina, patient concern about major surgery or about a stent, and the chance of needing a second procedure. In many ways, it makes the decision a little easier, he said.

The authors noted that their analysis did not include angioplasties involving stents coated with drugs that are released over time, which may reduce the chance that arteries will become clogged again. Because these drug-eluting stents are relatively new, clinical trials are still ongoing and have not yet been published. However, Hlatky said the comparative effectiveness of bypass surgery and drug-eluting stents should not differ dramatically from the findings of this study.

New 'seed' therapy helps pinpoint breast tumors with more accuracy

Thu, 11 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) DALLAS � Oct. 11, 2007 � Physicians at UT Southwestern Medical Center are the first in Texas to use a new technique in which a small radioactive pellet, or �seed�, is implanted into a mass or suspicious lesion in the breast to pinpoint its exact location for surgical removal.

During the procedure, a radiologist uses a needle to insert a small radioactive seed, about the size of a grain of rice, into the mass. Once lodged, surgeons use a wand that detects radioactivity to locate the mass and find the best pathway for removal.

�The new technique is less invasive for the patient and allows us to be more precise when removing possible breast-cancer tumors,� said Dr. Roshni Rao, a surgical oncologist who specializes in breast cancer.

Dr. Rao, an assistant professor of surgery, teamed up with Dr. Michael Ulissey, an associate professor of radiology at UT Southwestern, to use this new procedure at Parkland Memorial Hospital. The procedure is offered at only two other U.S. medical centers. Dr. Rao said the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern also will soon begin offering the procedure.

Previously, a radiologist would lance a thin, hooked wire into the breast to help guide the surgeon to the location of the mass. While one end of the wire was lodged at or near the mass, the other end protruded from the patient�s skin.

Often, Dr. Rao said, the entry site of the wire was distant from the ideal site where a surgeon would prefer to make an incision. The wire also did not always take a direct path to the lesion.

The seed procedure pinpoints the location of a nonpalpable tumor more accurately than the wire and it is more efficient, Dr. Rao said. The wire method, on the other hand, requires patients to undergo the pre-operative procedure just hours before surgery because if left in longer, the wire could become dislodged.

�With the seed technique, the patient can have the seed inserted up to five days before surgery, any time of day,� Dr. Ulissey said. �The seed procedure also increases efficiency in the radiology department since we are not locked into a two-hour window to insert the wire on the day of the surgery.�

For patient Joan Hollers, 58, the pre-operative procedure was quick, easy and painless, she said.

After a mammogram had detected a suspicious mass in her left breast, Ms. Hollers consulted with Dr. Rao who decided on the seed procedure.

Dr. Ulissey numbed Ms. Hollers� breast before inserting the radioactive seed, which gives off less radiation than the amount emitted by a standard X-ray.

�I felt the prick of what felt to me like a tiny needle,� said Ms. Hollers. �I went home with a small Band-Aid and went to work the next day.�Several days later, the Rowlett resident returned to the hospital so that Dr. Rao could remove the suspicious mass.

While the mass in the left breast has been eliminated, Ms. Hollers will undergo chemotherapy for a cancerous tumor that was found in her right breast and can�t be surgically removed until the therapy is complete.

Despite the surgery and long road ahead, Ms. Hollers is optimistic.

�When I got the news that I didn�t have cancer anywhere else in my body I told myself, �I�m not dying from this disease,�� said Ms. Hollers, a mother of three grown children and grandmother to eight grandchildren.

Generating 'oohs' and 'aahs': Vocal Joystick uses voice to surf the Internet

Tue, 09 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Internet offers wide appeal to people with disabilities. But many of those same people find it frustrating or impossible to use a handheld mouse. Software developed at the University of Washington provides an alternative using one of the oldest and most versatile modes of communication: the human voice.

There are many people who have perfect use of their voice who don't have use of their hands and arms, said Jeffrey Bilmes, a UW associate professor of electrical engineering. I think there are several reasons why Vocal Joystick might be a better approach, or at least a viable alternative, to brain-computer interfaces. The tool's latest developments will be presented this month in Tempe, Ariz. at the Assets Conference on Computers and Accessibility.

Vocal Joystick detects sounds 100 times a second and instantaneously turns that sound into movement on the screen. Different vowel sounds dictate the direction: ah, ee, aw and oo and other sounds move the cursor one of eight directions. Users can transition smoothly from one vowel to another, and louder sounds make the cursor move faster. The sounds k and ch simulate clicking and releasing the mouse buttons.

Versions of Vocal Joystick exist for browsing the Web, drawing on a screen, controlling a cursor and playing a video game. A version also exists for operating a robotic arm, and Bilmes believes the technology could be used to control an electronic wheelchair.

Existing substitutes for the handheld mouse include eye trackers, sip-and-puff devices, head-tracking systems and other tools. Each technology has drawbacks. Eye-tracking devices are expensive and require that the eye simultaneously take in information and control the cursor, which can cause confusion. Sip-and-puff joysticks held in the mouth must be spit out if the user wants to speak, and can be tiring. Head-tracking devices require neck movement and expensive hardware.

Vocal Joystick requires only a microphone, a computer with a standard sound card and a user who can produce vocal sounds.

A lot of people ask: 'Why don't you just use speech recognition' Bilmes said. It would be very slow to move a cursor using discrete commands like 'move right' or 'go faster.' The voice, however, is able to do continuous commands quickly and easily. Early tests suggest that an experienced user of Vocal Joystick would have as much control as someone using a handheld device.

In the laboratory, doctoral student Jonathan Malkin, who helped develop the tool, uses Vocal Joystick to play a game called Fish Tale. It takes two minutes to train the program for Malkin's voice. He then moves the fish character easily around the screen, raising his voice slightly to speed up and avoid being eaten by a predator fish.

The newest development, which will be presented at the October meeting in Tempe, uses Vocal Joystick to control a robotic arm. The pitch of the tone moves the arm up and down; other commands are unchanged. This is the first time that vocal commands have been used to control a three-dimensional object, Bilmes said.

One initial concern, he said, was whether people would feel self-conscious using the tool.

But once you try it you immediately forget what you're saying, Bilmes said. I usually go to the New York Times' Web site to test the system and then I get distracted and start reading the news. I forget that I'm using it.

To test the device, the group has been working with about eight spinal-cord injury patients at the UW Medical Center since March.

It's a really exciting idea. I think it has tremendous potential, said Kurt Johnson, a professor of rehabilitation medicine who is helping with the tests.

Bilmes said he hopes people will become more adept at using the system over time. Future research will incorporate more advanced controls that use more aspects of the human voice, such as repeated vocalizations, vibrato, degree of nasality and trills.

While people use their voices to communicate with just words and phrases, Bilmes said, the human voice is an incredibly flexible instrument, and can do so much more.

MIT aids creation of neural prosthetic devices

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) CAMBRIDGE, Mass.--MIT researchers have developed a new algorithm to help create prosthetic devices that convert brain signals into action in patients who have been paralyzed or had limbs amputated.

The technique, described in a paper published as the cover article in the October edition of the Journal of Neurophysiology, unifies seemingly disparate approaches taken by experimental groups that prototype these neural prosthetic devices in animals or humans.

�The work represents an important advance in our understanding of how to construct algorithms in neural prosthetic devices for people who cannot move to act or speak,� said Lakshminarayan �Ram� Srinivasan (MIT S.M., Ph.D. '06), lead author of the paper.

Srinivasan, currently a postdoctoral researcher at the Center for Nervous System Repair at Massachusetts General Hospital and a medical student in the Harvard-MIT Division of Health Sciences and Technology (HST), began working on the algorithm while a graduate student in MIT's Department of Electrical Engineering and Computer Science (EECS).

Both trauma and disease can lead to paralysis or amputation, reducing the ability to move or talk despite the capacity to think and form intentions. In spinal cord injuries, strokes, and diseases such as amyotrophic lateral sclerosis (Lou Gehrig's disease), the neurons that carry commands from the brain to muscle can be injured. In amputation, both nerves and muscle are lost.

Neural prosthetic devices represent an engineer's approach to treating paralysis and amputation. Here, electronics are used to monitor the neural signals that reflect an individual's intentions for the prosthesis or computer they are trying to use. Algorithms form the link between neural signals that are recorded, and the user's intentions that are decoded to drive the prosthetic device.

Over the past decade, efforts at prototyping these devices have divided along various boundaries related to brain regions, recording modalities, and applications. The MIT technique provides a common framework that underlies all these various efforts.

The research uses a method called graphical models that has been widely applied to problems in computer science like speech-to-text or automated video analysis. The graphical models used by the MIT team are diagrams composed of circles and arrows that represent how neural activity results from a person's intentions for the prosthetic device they are using.

The diagrams represent the mathematical relationship between the person's intentions and the neural manifestation of that intention, whether the intention is measured by an electoencephalography (EEG), intracranial electrode arrays or optical imaging. These signals could come from a number of brain regions, including cortical or subcortical structures.

Until now, researchers working on brain prosthetics have used different algorithms depending on what method they were using to measure brain activity. The new model is applicable no matter what measurement technique is used, according to Srinivasan. �We don't need to reinvent a new paradigm for each modality or brain region,� he said.

Srinivasan is quick to underscore that many challenges remain in designing neural prosthetic algorithms before they are available for people to use. While the algorithm is unifying, it is not universal: the algorithm consolidates multiple avenues of development in prostheses, but it isn't the final and only approach these researchers expect to see in the years to come. Moreover, energy efficiency and robustness are key considerations for any portable, implantible bio-electronic device.

Through a better quantitative understanding of how the brain normally controls movement and the mechanisms of disease, he hopes these devices could one day allow for a level of dexterity depicted in movies, such as actor Will Smith's mechanical arm in the movie I Robot.

The gap between existing prototypes and that final goal is wide. Translating an algorithm into a fully functioning clinical device will require a great deal of work, but also represents an intriguing road of scientific and engineering development for the years to come.

Treatment blocks pain without disrupting other functions

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A combination of two drugs can selectively block pain-sensing neurons in rats without impairing movement or other sensations such as touch, according to a new study by National Institutes of Health (NIH)-supported investigators. The finding suggests an improved way to treat pain from childbirth and surgical procedures. It may also lead to new treatments to help the millions of Americans who suffer from chronic pain.

The study used a combination of capsaicin � the substance that makes chili peppers hot � and a drug called QX-314. This combination exploits a characteristic unique to pain-sensing neurons, also called nociceptors, in order to block their activity without impairing signals from other cells. In contrast, most pain relievers used for surgical procedures block activity in all types of neurons. This can cause numbness, paralysis and other nervous system disturbances.

The Holy Grail in pain science is to eliminate pathologic pain without impairing thinking, alertness, coordination, or other vital functions of the nervous system. This finding shows that a specific combination of two molecules can block only pain-related neurons. It holds the promise of major future breakthroughs for the millions of persons who suffer with disabling pain, says Story C. Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke (NINDS) at the NIH, which funds the investigators' research along with the National Institute of Dental and Craniofacial Research (NIDCR) and the National Institute of General Medical Sciences (NIGMS). NINDS and NIDCR are co-chairs of the NIH Pain Consortium. The study appears in the October 4, 2007, issue of Nature.*

Lidocaine, the most commonly used local anesthetic, relieves pain by blocking electric currents in all nerve cells. Although it is a lidocaine derivative, QX-314 alone cannot get through cell membranes to block their electrical activity.

That's where capsaicin comes in. It opens large pores called TRPV1 channels � found only within the cell membrane of pain-sensing neurons. With these channels propped open by capsaicin, QX-314 can pass through and selectively block the cells� activity.

The research team, led by Clifford J. Woolf, M.D., Ph.D., of Massachusetts General Hospital and Harvard Medical School and Bruce Bean, Ph.D., at Harvard Medical School, tested the combination of capsaicin and QX-314 in neurons isolated in Petri dishes and found that it blocked pain-sensing neurons without affecting other nerve cells. They then injected the drugs into the paws of rats and found that the treated animals could tolerate much more heat than usual. They also injected the two drugs near the sciatic nerve that runs down the hind leg. The treated rats did not show any signs of pain, and five of the six animals continued to move and behave normally. This showed that the drugs could block pain without impairing motor neurons that control movement.

The drug combination took half an hour to fully block pain in the rats. However, once it began, the pain relief lasted for several hours.

Current nerve blocks cause paralysis and total numbness, Dr. Woolf says. This new strategy could profoundly change pain treatment in the perioperative setting.

The treatment tested in this study is unique in that it uses a type of ion channel (TRPV1 channels) as an avenue to deliver medication. Ion channels are pores in the cell membrane that control the flow of electrically charged ions in and out of cells. I'm not aware of any other strategy that uses a channel within cells to deliver a drug to a select set of cells, Dr. Woolf says. The strategy builds on research done since the 1970's, largely supported by NIH, that shows how electrical signaling in the nervous system results from expression of dozens of different types of ion channels. Some of these ion channels are found only in specific types of neurons.

This project is a nice illustration of how research trying to understand very basic biological principles can have practical applications, says Dr. Bean.This type of treatment has great potential to improve pain treatment during childbirth, dental procedures, and surgery, the researchers say. Surgical pain is the obvious first application for this type of treatment, Dr. Woolf says. However, similar therapies might eventually be useful for treating chronic pain, he adds. Chronic pain continues for weeks, months, or even years and can cause severe problems, and is often resistant to standard medical treatments.

While the researchers focused on finding a treatment for pain, this strategy might also be useful for treating itch from eczema, poison ivy rashes, and other conditions, Dr. Woolf says. Like pain sensations, itch signals come from nociceptors. One problem with the combination treatment is that the capsaicin can cause unpleasant burning sensations until the QX-314 takes effect, Dr. Woolf says. Administering the QX-314 ten minutes before the capsaicin minimized this problem in rats. The investigators are now looking for ways to open the TRPV1 channels without the burning sensations, perhaps by finding an alternative to capsaicin. They also hope to find ways of prolonging the pain relief. Eventually, they might be able to develop pills that will stop pain signals without requiring injections, Dr. Woolf adds.

Trial seeks 'genetic fingerprint' for predicting drug effectiveness

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) CINCINNATI�University of Cincinnati (UC) physician-scientists believe identifying a genetic �fingerprint� could help predict which specific therapies will be most effective for patients with gastric cancer.

Syed Ahmad, MD, is leading a national, phase-2 trial to test the effectiveness of combined chemotherapy and radiation therapy given to patients with gastric cancer before surgery. His team will also collect biological samples in an attempt to obtain genetic data that could be used to formulate targeted therapies.

Previous studies have established that either chemotherapy or radiation therapy after surgery can improve patient survival compared with surgery alone. Overall survival rates, however, remain low�with 20 to 30 percent of American patients surviving more than five years after treatment.

�Everyone agrees that without surgery, gastric cancer in not curable, and numerous studies have shown a benefit to follow-�up therapy with either chemotherapy or radiation therapy,� says Ahmad, assistant professor of surgery at UC and principal investigator of the trial.

�The problem is you can�t give both radiation therapy and chemotherapy after surgery�it�s too toxic and patients can�t tolerate it,� he says. �But you can give it before surgery when patients are healthiest.�

This trial addresses what Ahmad calls the �future of cancer therapy�: targeted drug regimens, based on the characteristics of a patient�s specific tumor.

His goal is to identify a genetic �fingerprint� that could help predict whether patients will respond to therapy, and then identify drugs to address the specific molecular characteristics of that patient�s tumor.

�Right now treatment is based on the assumption that site-based cancers are all the same, so every patient who has stage-3 gastric cancer will get the same chemotherapy drugs,� Ahmad explains. �But the reality is that every cancer has a different expression of hormones, growth factors and genetic factors that must be addressed individually.

The UC-led national team is looking for about 70 patients across the United States with up to stage-3 gastric cancer to participate in the trial.

Prior to surgery, all study participants will have a biopsy to set baseline standards for genetic testing to determine which patients have a complete response to the multi-treatment therapy. Participants will receive daily doses of the platinum-containing drug oxaliplatin (ox-AL�-ih-plah-tin, marketed as Eloxatin) for six to eight weeks.

Approved by the Food and Drug Administration, oxaliplatin is currently used to treat advanced colorectal cancer. Studies have shown the drug has fewer toxicity complications compared with other therapies.

After six weeks of chemotherapy, the patient will get five consecutive days of three-dimensional, external-beam radiation therapy. Patients will be reevaluated two to three weeks after radiation to determine if they are eligible for surgery. Those who are suitable will have another tissue biopsy after surgery.

Researchers will compare pre- and post-surgery tissue samples to obtain the genetic data necessary to establish associations between molecular markers and drug resistance, with the goal of reducing toxicity associated with chemotherapeutic agents and improving patient survival.