RxPG News : Traumatology

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

Fri, 27 Jan 2012 05:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

Thu, 26 Jan 2012 05:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Participating centers include:

Having epilepsy is not linked to committing violent crime

Tue, 27 Dec 2011 05:00:00 PST

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

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

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

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

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

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

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

Scientists identify cell death pathway involved in lethal sepsis

Thu, 22 Dec 2011 05:00:00 PST

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

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

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

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

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

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

Tue, 01 Nov 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

Psychological traumas experienced over lifetime linked to adult irritable bowel syndrome

Mon, 31 Oct 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

Earlier tracheostomies result in better patient outcomes

Wed, 05 Oct 2011 04:00:00 PST

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

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

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

Previous studies have shown mixed results.

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

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

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

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

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

Researchers reported their results in the journal

The mark of the beast: tradition or stress?

Wed, 28 Sep 2011 04:00:00 PST

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

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

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

Commonly used supplement may improve recovery from spinal cord injuries

Wed, 28 Sep 2011 04:00:00 PST

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

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

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

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

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

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

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

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

UC Davis neurosurgeons use adult stem cells to grow neck vertebrae

Tue, 06 Sep 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stevens biomedical engineering students fight hypothermia on the battlefield

Mon, 23 May 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fri, 20 May 2011 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

Emergency mental health lessons learned from Continental Flight 3407 disaster

Tue, 01 Mar 2011 05:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wed, 05 Jan 2011 05:00:00 PST

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

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

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

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

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

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

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

The software is $15.00. For more information visit

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

Tue, 07 Dec 2010 05:00:00 PST

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

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

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

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

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

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

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

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

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

Reducing blood transfusions improves patient safety and cuts costs

Thu, 07 Oct 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional $38M awarded to expand orthopedic trauma care research

Thu, 07 Oct 2010 04:00:00 PST

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

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

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

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

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

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

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

UCLA develops combat casualty care educational program for US armed forces

Mon, 27 Sep 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

Northwestern first site open for spinal cord stem cell trial

Wed, 22 Sep 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

Mon, 29 Mar 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

Using stem cells to mend damaged hips

Tue, 23 Mar 2010 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Osteoporosis drug improves healing after rotator cuff surgery

Wed, 10 Mar 2010 05:00:00 PST

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

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

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

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

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

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

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

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

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

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

Scientists discover new treatment for chronic pain condition

Mon, 01 Feb 2010 05:00:00 PST

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

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

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

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

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

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

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

The research is published in the journal

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

Wed, 27 Jan 2010 05:00:00 PST

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

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

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

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

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

Tue, 05 Jan 2010 05:00:00 PST

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

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

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

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

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

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

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

Findings show nanomedicine promising for treating spinal cord injuries

Mon, 09 Nov 2009 04:59:36 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fri, 11 Sep 2009 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

Piece from childhood virus may save soldiers' lives

Sun, 06 Sep 2009 03:59:12 PST

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

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

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

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

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

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

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

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

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

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

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

In human evolution, complement provided an essential natural defense.

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

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

It's like throwing a grenade, said Krishna.

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

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

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

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

The complement reaction completely stopped.

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

Wed, 26 Aug 2009 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tue, 28 Jul 2009 04:00:00 PST

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

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

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

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

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

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

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

Accounts high in 'closure' are those that demonstrate an emotional conclusion or a coherent resolution of a difficult life event, Poulin says, and perhaps not surprisingly, participants who described the terrorist attacks with a sense that they were really over and no longer exerted an emotional influence had low levels of distress and high levels of well-being.

However, we also found that a high level of psychological well-being was significantly related to accounts that were high in references to national redemption and, among those more directly exposed to the attacks, high in redemptive imagery in general, he says.

He describes redemptive accounts as those that tell a story of something positive coming out of something negative. Adler notes that the theme of redemption has been characterized as a particularly American theme, observed in national rhetoric throughout history and in the personal stories of many well-known Americans.

On the opposite end of the spectrum, Adler and Poulin found that psychological distress was significantly related to accounts low in closure and high in contamination imagery or themes of personal contamination.

Contamination, Poulin says, is reflected in stories in which what was 'good' or 'acceptable' becomes contaminated, ruined, undermined, undone or spoiled. It is basically the opposite of redemption and may therefore be somewhat opposed to the themes of traditional American stories.

The study, funded by the National Science Foundation, is grounded in the theoretical tradition of the narrative study of lives. It involved a nationally representative sample of adults who wrote accounts about the 9/11 terrorist attacks approximately two months after they occurred.

The study participants were among more than 1,000 respondents who earlier had completed a two-month post-9/11 survey that included a number of open-ended questions related to their 9/11 experiences: their individual experiences on Sept. 11, 2001, how they made sense of the attacks and their aftermath, and whether they had been able to find positive consequences.

Those selected for the study were respondents who had contributed enough descriptive material to be coded for narrative themes of closure redemption and contamination.

The participants also completed a demographic survey, a mental-health questionnaire and answered questions about whether they had ever experienced any of 30 negative life events such as natural disaster or child abuse. They were assessed for their degree of exposure to the events of 9/11, and their levels of psychological well-being and distress were analyzed using well-known psychological scales.

NC State develops new test method to measure stored heat in firefighter suits

Tue, 14 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) For decades, researchers have evaluated the thermal performance of protective clothing worn by firefighters. A particular area of current interest is how to address the burns received by firefighters when they are not directly in contact with fire - called stored heat burns. Researchers at North Carolina State University have developed a testing apparatus and measurement protocol that allow firefighter suits to be evaluated for their ability to prevent and minimize stored heat burns.

You can compare the burn to when you sit close to a fireplace, and then press down on your jeans and you can feel the heat, says Dr. Roger Barker, professor of textile engineering chemistry and science, and director of the Textile Protection and Comfort Center (T-PACC). Firefighters are getting burns without ever coming in direct contact with the flames. It is a serious issue.

Barker and his colleagues were contacted to develop and evaluate this new test method for stored heat measurement in a two-phase study. During the first phase, sponsored by the National Institute for Occupational Safety and Health, Barker and his team developed a laboratory testing apparatus to conduct the stored energy test which measures transferred and discharged heat in turnout suit materials. The second phase, sponsored by the National Fire Protection Research Foundation, involved using that apparatus to test a variety of firefighter suits and develop a database that will facilitate a new national standard that firefighter suits are measured against and certified.

All firefighter turnout suits are made of three layers - an outer shell, moisture barrier and thermal liner. There are many different combinations of fabrics and barriers used, and reinforcements and reflective trim are attached to the outer shell. Regardless of the combination of materials used, suits must go through a battery of tests to meet the standard set by the National Fire Protection Association, or NFPA.

One of the major objectives of our study was to better understand the role moisture - mostly the sweat from firefighters - plays in transferred and stored heat burns, Barker says. When moisture accumulates in the turnout suit materials, it has a big effect on the thermal properties of those materials and changes its heat capacity and thermal conductivity. These changes affect its thermal protective insulation and ability to store thermal energy.

The stored energy test protocol we developed includes having suit test materials pre-conditioned with moisture - similar to the sweat of a firefighter - in order to determine the effect on transferred and stored heat, Barker adds.

Throughout the development process, various stakeholders - including firefighters, suit manufacturers and members of the NFPA - provided feedback and input to NC State's researchers in order to develop a protocol that met the needs of the firefighters, while understanding the challenges and limitations of the manufacturing process. The NFPA is currently reviewing the protocol supplied by NC State's College of Textiles, and will consider adopting this test method as part of the requirements that manufacturers will need their suits to meet in order to have their suits certified as complying with the NFPA standard.

We know there is no lab test that measures with absolute accuracy what a firefighter encounters, because every fire is a different set of conditions and thermal threats, Barker says. However, we now have a better understanding of the general causes and mechanisms behind transferred and stored heat, and a test method to measure these effects. This research and recommended testing protocol is a major development that could significantly improve the health and safety for firefighters everywhere.

Codeine use and accident risk

Tue, 24 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The risk of being involved in a traffic accident with personal injury is significantly higher among codeine users than non-users. However, sporadic or moderate use of codeine alone does not carry an increased risk, according to a newly published study from the Norwegian Institute of Public Health.

Codeine and tramadol are painkillers in the opiate group, used for mild to moderate pain. In Norway, codeine is included in Paralgin forte and Pinex forte, and tramadol, amongst others, in Nobligan. Norway has a higher consumption of codeine preparations than other European countries.

Earlier studies have given conflicting results when evaluating traffic accident risk linked to the use of codeine and tramadol. In this new study from the Norwegian Institute of Public Health, anonymised data from the Norwegian Prescription Database and Road Traffic Accident Register was used to study whether codeine- or tramadol users have an increased risk of being involved in a traffic accident with personal injury.

During the 33 months of the study, 181 road traffic accidents were registered with personal injury where the driver had been exposed to codeine and 20 after exposure to tramadol. Exposure is defined as the first 7 days after the dispensing of a prescription for a codeine- or tramadol preparation.

The study showed that the risk of being involved in a road traffic accident with personal injury was twice as high in the period after having a prescription for codeine dispensed. For those who had used more than approximately 400 tablets per year, the risk of being involved in a traffic accident was 3 times as large. When the use of other potential impairing medicines was excluded, the risk of accident sank significantly. For sporadic codeine users there was no increased risk of accident. There was not a significantly higher risk for tramadol.

- We have previously seen that large users of codeine preparations often use benzodiazepines (anxiolytics- and hypnotics) or carisoprodol (muscle relaxants /painkillers) in addition. This is an important contributory factor when evaluating the accident risk, says the study's leader Liliana Bachs.

98 of the 181 drivers exposed to codeine who were included in the study had also been dispensed other medicines with abuse potential in the week prior to the accident.

- One can conclude that sporadic or moderate use of codeine alone to a small degree increases the chance of being involved in accidents with personal injury. Simultaneous use of benzodiazepines or carisoprodol gives a clear increase in the risk of accidents, explains Bachs.

New surgical option for wrist arthritis

Fri, 13 Feb 2009 05:00:00 PST

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

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

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

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

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

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

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

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

Unexplained chest pain can be due to stress

Mon, 09 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Each year, many people seek emergency treatment for unexplained chest pains. A thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden, indicates several common factors among those affected, including stress at work, anxiety, depression and a sedentary lifestyle.

Chest pain is a common reason for patients to seek emergency treatment. A considerable number of patients are diagnosed with unexplained chest pain, which means that the pain cannot be linked to biomedical factors such as heart disease, or some other illness. The patient group is significant in size, with just over 20,000 patients seeking hospital treatment in 2006, and so far researchers have been unable to identify specific causes for unexplained chest pain.

Many suffer from recurring bouts of pain over several years, while the healthcare services are unable to find out what's causing it, says Registered nurse Annika Janson Fagring, the author of the thesis.

In her thesis, Annika Janson Fagring describes and analyses symptoms among patients with unexplained chest pain. The results show that most of them are middle-aged, and that over a third of those affected were born outside Sweden. The chest pain had a negative impact on the patients' daily life in the form of tiredness, anxiety and fear of death.

The main difference between women and men with unexplained chest pain is that men were more likely to perceive their lives and jobs as being stressful, while women tended more to suffer from symptoms of depressions and anxiety, says Annika Janson Fagring.

The patients, both men and women, experienced more symptoms of depression and anxiety, and work-related stress when compared with a reference group of people who were not suffering from heart disease. The male patients were more physically active in their spare time than the female patients, but compared with the reference group, both the men and the women with unexplained chest pain led a more sedentary lifestyle.

The thesis also looks at the development of symptoms and the prognosis for patients with unexplained chest pain over a period of time, compared with patients suffering from angina and patients who had suffered a heart attack. A register study revealed that from 1987 up until 2000, the number of patients with diagnosed unexplained chest pain increased, and then levelled out. The number of patients with angina increased up until 1994 and has since fallen, while the number of patients who have suffered heart attacks has fallen throughout the whole period examined.

There were fewer deaths among patients with unexplained chest pain a year after they became ill, compared with patients that became ill with angina or suffered heart attacks. Deaths among men a year after falling ill with unexplained chest pain were a third higher compared with men in the rest of the population, while women did not display any increased risk of death.

Annika Janson Fagring says that the thesis shows that it is important to improve knowledge and understanding of the symptoms experienced by patients with unexplained chest pain, in order to be able to offer more individualised care.

Stroke patients soon may have fun, high-tech tool

Mon, 10 Nov 2008 05:00:00 PST

( from http://www.rxpgnews.com ) The University of Central Florida will immerse stroke survivors in a virtual world full of flying insects to help expand their range of movement.

Researchers in UCF's Media Convergence Lab (MCL) are teaming up with the California-based Virtual Reality Medical Center (VRMC) to create the program and software that can track patients' progress.

VRMC obtained a contract last year from the National Science Foundation to develop the virtual program, and the company teamed up with the UCF researchers for preliminary work. The research team since has landed a $199,000 contract to create a fully functional virtual game.

Although the game could change slightly, the design will require patients to put on goggles while sitting at a table. A few bugs would fly around nearby. The patients' mission is to smash all of the virtual insects. Each time they succeed, they would earn a point. As patients improve their range of motion, more bugs would appear at greater distances, forcing patients to work harder and increase their range of motion. Think of a 21st-century version of the childhood game Whack-a-Mole.

It has to be fun so patients will actually do their physical therapy exercises, said Eileen Smith, associate director of UCF's Media Convergence Lab at the Institute of Simulation and Training.

One of the sad things about stroke is that it is very isolating, she said. If we can make the game fun for everyone, maybe grandchildren will jump in while grandma is doing her exercises. Then it won't just be a physical therapy session; it will be family time. It will help patients re-engage.

Smith is collaborating with the project's lead researcher, Charles Hughes, director of the Media Convergence Lab and a professor in UCF's School of Electrical Engineering and Computer Science. During their preliminary work, they found that UCF could produce a viable and reproducible program with software to track patients' progress.

Funding for the second phase also will include $99,000 from the Florida High Tech Corridor.

We're ecstatic, Smith said. It's our lab's first phase II contract, and it is exactly the kind of thing we want. It goes with our lab's philosophy. We don't want to create cool widgets. We want to create things people can actually use to better their lives.

Smith and her team are working with a doctor and a physical therapist along with VRMC to create the prototype. UCF will deliver it to VRMC by the end of 2009 and provide a license to VRMC to enable commercialization.

VRMC plans to introduce the program to physical therapy clinics. Eventually, Mark Wiederhold, VRMC's president, said the company would market the product as a take-home program that patients could run on their computers or hand-held devices.

Wiederhold is a physician who has authored more than 200 journal articles. He said he partnered with UCF because it is a leader in simulation technology.

UCF is in a leadership position in this area of research, Wiederhold said. They are a very important team member on this project. UCF has a collaborating spirit. . . They get it.

That's part of the reason Wiederhold will be opening a new office in Lake Nona's Medical City. VRMC, which already has an office in Orlando, then will be close to UCF's new College of Medicine, with which Wiederhold is collaborating on other projects.

15 years later: Landmark hearing study follows up on farm youth

Fri, 12 Sep 2008 04:00:00 PST

( from http://www.rxpgnews.com ) (MARSHFIELD, Wis.) A landmark study conducted by Marshfield Clinic Research Foundation (MCRF) 15 years ago found that an educational intervention improved hearing protection use among farm youth.

Now, the National Institute for Occupational Safety and Health (NIOSH) has awarded a $954,000 grant to MCRF to study the same group of Wisconsin youth to see whether the increase in hearing protection use continued into adulthood and whether it helped preserve hearing.

The new three-year study, under principal investigator Barbara Marlenga, Ph.D., a research scientist with the National Farm Medicine Center, MCRF, will evaluate whether the hearing conservation program conducted with farm youth from 1992-96 had long-term benefits to safeguard hearing. Although that hearing conservation program was conducted with farm youth, the impact of this new study goes beyond agriculture.

Noise-induced hearing loss is a big problem, Marlenga said. Ten million people in the United States, including children and youth, have hearing loss from exposure to loud noises. More than 30 million workers are estimated to be exposed to hazardous noise levels on the job.

The key to success of this study is the ability to find the youth from the original research study. To qualify for the new grant, Marlenga and colleagues conducted a search for the earlier participants, who are now young adults. She sent a letter to a small number of the original 689 people, then called and asked if they would be willing to participate in the follow-up study. More than 90 percent of those she reached said they would participate in a follow-up study.

Being able to demonstrate that we could find these students again was crucial to our receiving the grant, Marlenga said. This is a one-of-a-kind opportunity to see if early intervention to prevent noise-induced hearing loss can be sustained over time, Marlenga said.

The original study, conducted through the National Farm Medicine Center, MCRF, evaluated hearing of 689 farm youth in junior and senior high school. Half the participants received ear muffs and ear plugs as well as training and reminders about using hearing protection over a four-year period while in school. At the end of the study, the youth who received the intervention reported using hearing protection more consistently than those who did not, although at that time hearing test results were not different between the two groups.

After 15 years, we expect that noise-induced hearing loss would start to appear, Marlenga said.

For the new study, participants will again have their hearing tested and will be asked about work and home noise exposure. They will also be asked about hearing protection and whether they are required to use it where they work.

Explosions and blast related injuries

Tue, 05 Aug 2008 04:00:00 PST

( from http://www.rxpgnews.com ) There has been a rise in global terrorism against nonmilitary targets. Recent events in Oklahoma City, New York City, Madrid, London, and Mumbai have demonstrated that mass casualties are more likely from explosive devices than from biological, chemical, radioactive, or nuclear weapons. Editors Nabil M. Elsayed, James L. Atkins and Nikolai Gorbunov have assembled an impressive list of international experts in the mechanisms and treatment of blast related injuries in this timely book.

This authoritative text begins with a section on the epidemiology of blast and explosion injuries which details issues of triage, morbidity and mortality, as well as clinical experiences treating casualties at combat support hospitals. The next section covers the pathology and pathophysiology of blast injuries on the lungs and nervous system as well as quaternary blast effects resulting in burns. In a section devoted to primary research on the mechanisms of primary blast injuries, there are chapters devoted to computational modeling of lung blast injuries and the biochemical mechanisms primary blast injuries to include the role of free radicals and oxidative stress and the inflammatory response in primary blast injuries. The final section of the book relates global experiences of blast injuries and their mass casualty management.

Other than the physicians who have treated trauma victims in settings such as Iraq and Afghanistan, few physicians in the United States have been trained in the care of the injured blast victim or have taken care of patients who have sustained injuries from explosions. The assessment of acute injuries from blast is still poorly understood and no reliable prognosticators of blast injuries currently exist. While this text is not meant to serve as a text for the treatment of blast-related injuries, it is meant to provide a better understanding of explosion blast injury mechanism which will in turn help in the design of better protective armor and improve medical care.

Co-Editor Colonel (retired) James L. Atkins, M.D., PhD stated he was thrilled we were able to assemble such a qualified international group of contributors for the book. This shows this is a worldwide problem, not just a military problem Dr. Atkins also added that These threats are constantly changing and it is important that medical professional recognize the patterns of blast related injuries and the inflammatory response precipitated by blast injuries that may take up to 48 hours to manifest. He hopes this book helps clinicians and researchers understand what is already known about blast injuries and that in turns helps to guide the treatment of mass casualties resulting in blast related injuries.

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

Wed, 18 Jun 2008 04:00:00 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 04:00:00 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.

Exposure therapy may help prevent post-traumatic stress disorder

Mon, 02 Jun 2008 04:00:00 PST

( from http://www.rxpgnews.com ) Exposure-based therapy, in which recent trauma survivors are instructed to relive the troubling event, may be effective in preventing the progression from acute stress disorder to post-traumatic stress disorder, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Individuals who develop acute stress disorder during or soon after a traumatic event are likely to subsequently develop post-traumatic stress disorder (PTSD), according to background information in the article. PTSD is associated with other mental and physical illnesses, a reduced quality of life and increased health care costs. Both exposure therapy and cognitive restructuring, which focuses on changing maladaptive thoughts and responses to a traumatic event, have been used as early interventions to prevent PTSD in those with acute stress disorder. However, there is evidence that some clinicians do not use exposure therapy because it causes distress for recent trauma survivors.

Richard A. Bryant, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues conducted a randomized controlled trial involving 90 patients who developed acute stress disorder following a non-sexual assault or motor vehicle crash between March 2002 and June 2006. Thirty participants each were randomly assigned to five weekly 90-minute sessions of exposure therapy or cognitive restructuring, while the remaining 30 were put on a waitlist for treatment. All the patients were assessed at the beginning of the study, after six weeks and six months following treatment.

Sixty-three participants completed the study. After completing treatment, fewer patients in the exposure therapy group (10, or 33 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent) or the wait-list group (23, or 77 percent). At the six-month follow-up, fewer patients in the exposure therapy group (11, or 37 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent), and 14 patients (47 percent) in the exposure group vs. four patients (13 percent) in the cognitive restructuring group achieved full remission.

Despite some concerns that patients may not be able to manage the distress elicited by prolonged exposure, there was no difference in drop-out rates for the prolonged exposure and cognitive restructuring groups (17 percent vs. 23 percent), the authors write. In addition, distress ratings were more significantly reduced in the exposure therapy group than the cognitive restructuring group after three sessions.

Exposure therapy may be more effective than cognitive restructuring because it eases the anxiety associated with the traumatic memory and corrects the belief that the memory must be avoided, in addition to encouraging self-control by managing the exposure exercise, the authors note. The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with acute stress disorder, they conclude. Exposure should be used in early intervention for people who are at high risk for developing PTSD.

Risk of hospitalization from violent assault increases when local alcohol sales rise

Mon, 12 May 2008 04:00:00 PST

( from http://www.rxpgnews.com ) The risk of being hospitalized from being violently assaulted increases when there is increased alcohol sales near the victim's residence, finds a new study in this week's PLoS Medicine.

Joel Ray and colleagues at the University of Toronto and the Institute for Clinical Evaluative Sciences, Canada, studied the link between alcohol sales and violent assaults in Canada's largest province, Ontario. Most alcohol in Ontario is sold in government-run liquor stores and the province is able to track these sales. In addition, Ontario keeps detailed computerized medical records of people hospitalized as a result of violent assault.

The researchers identified 3,212 people aged over 13 years who had been hospitalized over a 32-month period because of a serious assault. They compared the volume of alcohol sold at the liquor store nearest to the victim's home the day before the assault with the volume sold at the same store a week earlier (this type of study is called a case-crossover study).

For every extra 1,000 l of alcohol sold per store per day (a doubling of alcohol sales), the overall risk of being hospitalized for assault increased by 13%. At peak times of alcohol sales, the risk of assault was 41% higher than at times when alcohol sales were lowest.

Dr Ray and colleagues found that the risk was highest in three subgroups of people: men (18% increased risk for every 1,000 l alcohol sold daily), youths aged 13 to 20 years (21% increased risk for every 1,000 l alcohol sold daily), and those living in urban areas (19% increased risk for every 1,000 l alcohol sold daily).

A total of 1,150 assaults (36%) involved the use of a sharp or blunt weapon, and 1,532 (48%) arose during an unarmed brawl or fight.

Because the study considers only serious assaults and alcohol sold in shops (i.e., not including alcohol sold in bars), it probably underestimates the link between alcohol and assault. It also does not indicate whether the victim or perpetrator of the assault (or both) had been drinking, and its findings may not apply to countries with different drinking habits.

In an expert commentary on this study, Russell Bennetts and Rachel Seabrook of the Institute of Alcohol Studies, London, UK, who were not involved in conducting the research, say: This new study illustrates the role that alcohol sales from retail outlets play in affecting the risk of suffering a serious assault. The findings suggest that the relevant officials should consider restricting availability of alcohol from retail stores if they wish to reduce the likelihood of violence in their area of jurisdiction.

National scientific meeting on child mental health at Kentucky

Tue, 06 May 2008 04:00:00 PST

( from http://www.rxpgnews.com ) As the nation observes National Children's Mental Health Awareness Day on Thursday, the University of Kentucky Center for the Study of Violence Against Children (CSVAC) will host national experts at the scientific meeting From Neuroscience to Social Practice: Translational Research on Violence Against Children. The two-day event, being held May 7-8 in Lexington, Ky., includes the unveiling of research findings on violence against children that will be published in an upcoming issue of the Journal of Loss and Trauma.

The scientific meeting is expected to draw a national audience of researchers, clinicians and policymakers, including state officials from the Commonwealth. Hosted by CSVAC, the event is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

The two-day program will include three major research presentations: Relational Poverty and Vulnerability to Developmental Trauma: A Neurodevelopmental Perspective presented by Dr. Bruce Perry, senior fellow of The ChildTrauma Academy in Houston; The Importance of Early Experience: Clinical, Research and Policy Perspectives presented by Dr. Charlie Zeanah Jr., executive director of the Institute of Infant and Early Childhood Mental Health at Tulane University in New Orleans; and The Effects of Psychotherapy on the Adult Brain: Do they Apply to Children presented by Dr. Jerald Kay, chairman of the Department of Psychiatry at Wright State University in Dayton, Ohio.

All three research presentations will be followed by formal discussion sessions on the presenter's findings and how it will translate into practice at various levels.

Perry's research, Relational Poverty and Vulnerability to Developmental Trauma is developing ways to assess the health of a child's brain at an early developmental age. Secondly his research is looking at a variety of interventions, including creative and artistic forms of play, which target the areas in the brain that need the most attention.

Robert Walker, a researcher and assistant professor in behavioral science at UK's Center on Drug and Alcohol Research with conjoint appointments in the College of Social Work and Department of Psychiatry, describes Perry as moving toward the translation of neuroscience into clinical practice. Perry is encouraging the use of clinical practices that build on what is known about the environment/brain interactions in child development. His treatment approaches take into account the neurodevelopmental effects of abuse and severe neglect when working with children who have been maltreated.

He is starting the dialogue on how we bring brain science into behavioral interventions -- one of the primary missions of CSVAC, said Walker.

The Importance of Early Experience is Zeanah's research on data from clinical, research and policy perspectives as it pertains specifically to the importance of early experiences. His findings argue in the clinical arena a liberal approach must hold sway, as specific treatment plans must be proposed and implemented for the patient as problems arise, while conclusions derived from research are inherently conservative and policy decisions tend to fall between the extremes due to funding priorities and the need for reasonable evidence before definitive answers are known.

The two-day scientific meeting will conclude with Kay's presentation on The Effects of Psychotherapy on the Adult Brain and its corresponding discussion sessions. Kay's research evaluates the challenges of translating of neurobiological findings to following psychotherapy in adulthood into practice in treatment of children. This research focusing on children comes on the heels of a newfound greater appreciation of the psychobiology of attachment and its disorders in adults, as well as an increasing sophistication in the study of gene-environment interaction.

CSVAC houses the Child and Adolescent Trauma Treatment Institute and is a member of the National Child Traumatic Stress Network. The center is dedicated to the enhancement of the health and well-being of children and their families through research, clinical services and dissemination of information about child abuse and trauma. It is also home to UK's Comprehensive Assessment and Training Services project, a statewide translational research center within CSVAC that focuses on testing and refining best practices technologies in a living laboratory setting, then disseminating these practices to build community capacity to identify, assess and treat traumatized children and their families.

Zebrafish may help solve ringing in vets' ears

Wed, 30 Apr 2008 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO -- Ernest Moore, an audiologist and cell biologist at Northwestern University, developed tinnitus -- a chronic ringing and whooshing sound in his ears -- twenty years ago after serving in the U.S. Army reserves medical corps. His hearing was damaged by the crack of too many M16 rifles and artillery explosions. He suspects his hearing also suffered from hunting opossum with rifles as a kid on his grandmother's farm in Tennessee.

Ever since his ears began ringing, Moore has been researching a cure. He's at the forefront of just a small band of such scientists in the country. There's a lot riding on his work.

Half of the soldiers returning from Iraq and Afghanistan exposed to explosive devices suffer from tinnitus. The major cause is exposure to loud noises, which can damage and destroy hair cells of the inner ear. It's the number one war-related disability.

Nearly 400,000 troops collected disability for service-related tinnitus in 2006, which cost $539 million in 2006. The number climbs nearly 20 percent each year. It could hit $1 billion by 2011, according to the American Tinnitus Association.

An additional 12 million Americans have tinnitus severe enough to seek medical attention. In about two million of those cases, patients are so debilitated they can't function normally.

Despite the widespread suffering, there has only been a paltry $3 million allotted for public and private research. As a tinnitus researcher, Moore feels like a cross between Rodney Dangerfield and Sisyphus.

It's been tough to snare research money from the small purse and hard to garner respect for tinnitus. Ears don't bleed from tinnitus, Moore explained. It's a hidden problem. It's not obvious and dramatic like a heart attack or cancer -- although it torments its sufferers. Only one out of ten grant proposals he submits each year have been funded.

The research itself is challenging because Moore can't ask mice and rats if their ears are ringing. Now, he's working with zebrafish (yes, they do have ears, which are remarkably similar to humans' ears.) He's been able to cause ringing in their ears -- he thinks -- by exposing them to certain drugs and tracking their erratic swimming on video. Moore then looks at the cells in their ears to see if the electrical firing has increased, an early sign of damage and tinnitus. His early findings show an increased firing.

Then Moore attempts to block this effect with drugs to return the cells to their normal activity. In preliminary research, it appears the drugs he has tested do slow down the increased electrical firing or tinnitus-like behavior of the hair cells in the ear.

Moore is beginning to meet with doctors to discuss launching a clinical trial to test these drugs for patients with tinnitus.

If these drugs are found to be safe -- and some are already on the market for other uses -- and if they are found to have efficacy in humans, then they might be used to treat an individual's tinnitus, Moore said.

If the hair cell is not totally damaged -- just beginning to break down, and you administer these drugs, you might be able to prevent it from further damage and interfere with the cells' ability to generate tinnitus, he explained.

Tinnitus finally will begin to get some respect in April when The Department of Defense 2008 Appropriations Bill will open up $50 million in new research funding for tinnitus related to service in the armed forces. Ernest Moore has applied to launch the clinical trial with the drugs he has used with the zebrafish.

Naked mole-rats bear chili pepper heat

Mon, 28 Jan 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Pity the tiny naked mole-rat. The buck-toothed, sausage-like rodent lives by the hundreds in packed, oxygen-starved burrows some six feet under ground. It is even cold-blooded -- which, as far as we know, is unique among mammals.

You can feel their pain. But, they can't feel ours.

Evolution has benefited naked mole-rats by ridding them of a body chemical called Substance P, a neurotransmitter released by pain fibers that send signals to the central nervous system in mammals after making contact with things that cause long-lasting, achy pain.

A better understanding of how Substance P works in the strange rodents may lead to new analgesic drugs for people with chronic pain who do not respond well to current medication, according to Thomas Park, associate professor of biological sciences at the University of Illinois at Chicago, and Gary Lewin of the Max-Delbrück Center for Molecular Medicine in Berlin, principal authors of a study appearing Jan. 29 in the free-access journal PLoS Biology.

Park, Lewin and their laboratory teams in Chicago and Berlin used a modified herpes cold sore virus to carry genes for Substance P to the rodents' nerve fibers.

We were able to rescue their ability to feel pain, said Park. His research group restored Substance P and the naked mole-rats' ability to sense the burning sensation other mammals feel when subjected to capsaicin, the active ingredient in chili peppers.

The restored sensitivity was limited to just one rear foot of each tested rodent. They'd pull their foot back and lick it, in response to the stimulus, said Park. Other feet were impervious to the sting of capsaicin.

Capsaicin is very specific for exciting the fibers that normally have Substance P, said Park. They're not the fibers that respond to a pin prick or pinch, but the ones that respond after an injury or burn and produce longer-lasting pain.

But the researchers found that mole-rats remained completely insensitive to acids, indicating a fundamental difference in how their nerves respond to this stimulus.

Acid acts on the capsaicin receptor and on another family of receptors called acid-sensitive ion channels, Park said. Acid is not as specific as capsaicin. The mole-rat is the only animal that shows completely no response to acid.

Park said the research adds to knowledge about the neurotransmitter Substance P.

This is important specifically to the long-term, secondary-order inflammatory pain. It's the pain that can last for hours or days when you pull a muscle or have a surgical procedure, he said.

Park said naked mole-rats provide a new model system that is different from all other animals he has studied.

We're learning which nerve fibers are important for which kinds of pain, so we'll be able to develop new strategies and targets.

Naked mole-rats, native to east-central Africa, developed a protective reaction to acids through evolution. Living in tight underground quarters, the mole-rats exhale high levels of carbon dioxide, which becomes acid when it touches skin and mucous tissue in the nose, eyes and mouth. But the mole-rats have evolved to become desensitized to the stinging pain of acid.

The UIC biologist plans to study other animals, both closely related and unrelated -- such as Alaskan marmots that burrow in high CO2 environments -- to examine how they have evolved similar strategies to cope with acid-rich living conditions.

Dr. Nicholas Schiff receives research award for Innovation in Neuroscience

Thu, 13 Dec 2007 05:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 13, 2007) -- A leading authority on neurological disorders of consciousness, Dr. Nicholas Schiff of NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City has received a prestigious Research Award for Innovation in Neuroscience from the Society for Neuroscience, the world's largest organization of physicians and scientists who study the brain and nervous system.

The award -- for imaginative, innovative research that will advance novel ideas and have the potential to lead to significant breakthroughs in the understanding of the brain and nervous system and related diseases, -- was presented at the Society's recent annual meeting in San Diego.

Dr. Schiff was the lead author of a breakthrough study in the Aug. 2 journal Nature, reporting that a 38-year-old man who spent more than five years in a minimally conscious state as a result of a severe head injury is now communicating regularly with family members and recovering his ability to move after having his brain stimulated with pulses of electric current. The findings provide the first rigorous evidence that any procedure can initiate and sustain recovery in such a severely disabled person, years after the injury occurred.

Study investigators included NewYork-Presbyterian/Weill Cornell's Dr. Joseph Fins and physician-scientists at the JFK Johnson Rehabilitation Institute (Edison, N.J.) and the Cleveland Clinic Foundation.

Dr. Schiff is associate professor of neurology and neuroscience at Weill Cornell Medical College and associate attending neurologist at NewYork-Presbyterian/Weill Cornell. He is an inventor at Cornell University of some of the technology used in the study described in Nature and is a paid consultant and advisor to IntElect Medical Inc., to which the technology has been licensed by Cornell University and in which Cornell University has an equity interest. A Conflict Management Plan relating to IntElect and its relationship with Dr. Schiff and Cornell University is in place.

A diplomate of the American Board of Psychiatry and Neurology, he received his medical degree from Cornell University Medical College (now Weill Cornell Medical College). He completed his residency in neurology at The New York Hospital (now NewYork-Presbyterian/Weill Cornell), where he trained with Drs. Fred Plum and Jerome Posner and developed his subspecialty interest in the field of impaired consciousness. He is a co-author of the fourth edition of Dr. Plum and Posner's classic textbook The Diagnosis of Stupor and Coma. Dr. Schiff is an elected member of the American Neurological Association. His long-range goals are to develop strategies and improved diagnostics to treat of chronic cognitive disabilities resulting from brain injuries.

Imaging shows structural changes in mild traumatic brain injury

Thu, 25 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury.

The study is published in the October issue of the journal Brain.

We studied patients with all severities of traumatic brain injury -- mild to severe -- and found that abnormalities in white matter existed on the spectrum, said Dr. Marilyn Kraus, associate professor of psychiatry and neurology at the University of Illinois at Chicago College of Medicine and lead author of the study. Even in patients with mild TBI -- those identified as having minimal or no loss of consciousness -- there were structural deficits.

Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. This imaging modality allows researchers to quantify and qualify structural changes in white matter, particularly in chronic TBI patients.

Thirty-seven TBI patients (20 mild and 17 moderate to severe) and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention, and executive function. All subjects were at least six months post-injury, and the majority were high-functioning people who were employed or in school at the time of evaluation.

The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention. Patients with more severe injuries had greater white matter abnormalities, representing a permanent change in the brain.

We know that discreet brain areas are important for specific types of functioning, such as thinking, memory, cognition and motor skills, said Kraus. But what's also very important is that the white matter serves as the connection between these significant areas of the brain.

In some ways, the brain is similar to a computer, said Deborah Little, director of MRI research in the department of neurology and rehabilitation medicine at UIC and co-author of the study. You have the CPU and the memory, but they are worthless unless they are connected to each other. The white matter of the brain has the same function as the cables of the computer.

When white matter is damaged, areas of the brain may appear healthy but they are actually unplugged and cannot function.

This study validates that getting smacked in the head is not a good thing, despite the fact that some clinicians still believe a patient can recover fully after a concussion, said Little.

A significant percentage of patients in the study had no self-reported cognitive deficits, yet they did have permanent damage that was apparent to researchers.

TBI has been a long-standing public health problem and a significant source of disability, but the recent increase in veterans returning from war and athletes who have experienced multiple concussions has generated greater public attention to TBI.

Very often in TBI there are forces being applied to the brain that stress the tracts of white matter -- pulling them, yanking them -- and the white matter becomes damaged, Kraus said.

Patients who have a contusion, or bruising of the brain, can also suffer from subtle and diffuse damage to the white matter. The researchers believe that not only the focal lesion but the damage to the white matter is very important.

In the study, the researchers were also able to determine axonal damage (tearing of the axons that allow one neuron to communicate with another) in white matter versus abnormalities in the myelin (the protective sheath that, if damaged, can disrupt signals between the brain and other parts of the body.) If an axon is severed, the damage generally cannot be repaired.

We found that the milder injuries had less myelin damage, and the more severe injuries had both axonal and myelin damage, said Kraus.

This research helps us to understand how early on, particularly in milder injuries, there may be some ability for myelin to repair, Little said. When athletes, for example, are sustaining head injuries over and over -- without being told to sit out -- it may have a huge impact on their recovery. This could affect decisions clinicians make about when someone with a mild injury should return to the battlefield or playing field.

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

Mon, 22 Oct 2007 04:00:00 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.

UCSD findings could lead to new therapy for spinal cord injury-induced spasticity and rigidity

Tue, 16 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Research led by scientists at the University of California, San Diego (UCSD) School of Medicine has identified a target with potential as an effective new therapy for chronic spasticity and rigidity, a painful condition that often results from spinal cord injury.

In work with rats, Martin Marsala, M.D., a professor in the Department of Anesthesiology at the University of California, San Diego (UCSD) School of Medicine, demonstrated that an AMPA receptor antagonist called NGX424 (tezampanel), being developed by TorreyPines Therapeutics, Inc., of La Jolla, California, is highly potent in suppressing spasticity and rigidity. The study will be published in the October 17 issue of the Journal of Neuroscience.

Paraplegia from spinal cord ischemia is a serious complication that occurs in 20 to 40 percent of patients undergoing a surgical process called aortic cross-clamping. When the surgeon works on the aorta to correct a potentially lethal aneurysm, this large vessel carrying all of the blood flow from the heart must be temporarily blocked. If clamping occurs for more than 30 minutes, the procedure can result in the loss of specialized spinal cord neurons called spinal inhibitory neurons. Loss of these neurons can lead to irreversible spasticity and rigidity, or loss of muscle control, in the lower limbs.

�This exaggerated muscle tone, or uncontrolled spasms, is a serious complication of either ischemic or traumatic injury to the spinal cord -- such as injuries resulting from a diving or car accident,� said Marsala. Several other conditions can lead to spasticity/rigidity, including brain trauma, multiple sclerosis, cerebral palsy or Parkinson�s disease � all of which lead to increased peripheral muscle tone.

The most effective treatment for the spastic muscle condition � which results in pain and tremendous spasms, even in those patients who have partial motor recovery � has been a drug called Baclofen, a GABA-B receptor agonist that is delivered either systemically or spinally to patients. However, according to Marsala, patients taking this drug often develop tolerance and need increased dosage to achieve the same effect.

�A new therapy to control spasticity is very important,� said lead author Michael P. Hefferan, Ph.D., of UCSD�s Department of Anesthesiology. �This AMPA receptor blockade offers a novel means of reducing the spasticity and rigidity in muscles because it works through a totally different receptor system than current drugs being used.�

Spinal spasticity is the result of increased spinal neuronal excitability. The NGX424 compound � which is delivered via intrathecal catheters that inject the drug into the fluid surrounding the spinal cord � suppresses the AMPA-mediated neuronal excitation, relieving otherwise increased muscle tone.

The authors also demonstrated that intrathecal delivery of GluR1 antisense (a treatment that blocks expression of one of the subunits in the AMPA receptor complex) provides a similar antispasticity effect. This further demonstrates a role for AMPA receptors in spasticity and rigidity, and indicates that blockade of this subunit by NGX424 likely plays a key role in the observed antispasticity effect.

Marsala added that additional large animal safety testing will be required before the researchers can consider clinical trials in humans. However, the rat data from this study indicates no toxicity using infused NGX424. Subcutaneous delivery of the drug is currently being evaluated for treating migraines.

Prostate cancer increases hip fracture risk by eight times in 50 to 65 year-olds

Thu, 11 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Men who have prostate cancer are on average four times more likely to suffer a hip fracture, with rates rising to eight times in men aged 50 to 65, according to a study of more than 60,000 men published in the October issue of the urology journal BJU International.

Danish researchers looked at 62,865 men aged 50 and over, with an average age of just under 67.

15,716 had suffered a fracture of some description and 47,149 formed the non-fracture control group.

They discovered that prostate cancer made men 1.8 times more likely overall to suffer a fracture and 3.7 times as likely to suffer from a hip fracture. But the hip fracture risk was eight times higher in men from 50 to 65 years of age. No increased risk of vertebral fractures was found by the research.

�Our study showed that more than three per cent of hip fractures in men aged 50 and over can be attributed to prostate cancer� says lead researcher Dr Bo Abrahamsen from Copenhagen University Hospital, Gentofte. �And the risk remains even when men have recovered from the disease.�

The researchers - urologists and endocrinologists from Danish hospitals attached to the University of Southern Denmark and Copenhagen University - now plan to establish a multi-centre initiative focussing on the early diagnosis and treatment of osteoporosis in men with prostate cancer.

�Prostate cancer is now the cancer that men are most likely to develop and is a leading cause of male deaths in Europe and the USA� stresses Dr Abrahamsen.

�American research has also shown that men have a 17 per cent chance of prostate cancer during their lifetime. And Danish research has discovered that deaths from the disease have more than tripled since the Second World War.

�Medical advances are improving survival rates, but the downside is that treatment can lead to osteoporosis, where the bone loses density and becomes more fragile. This is turn increases the risk of fractures.�

The researchers used data from the Danish National Hospital Discharge Register, the National Bureau of Statistics and the National Prescription Database to identify patients aged 50 and over who had suffered a fracture. They then used the same data to identify an age-matched control group.

�Our research showed that the increased fracture risk became apparent in the early stages after diagnosis and remained pronounced even in long-term survivors� says Steen Walter, Professor of Urology at Odense University Hospital.

�Men who received hormone therapy (ADT) or had their testicles surgically removed to slow the progression of the disease were 1.7 times more likely to suffer a fracture.�

The authors point out that the research only covered the 15 per cent of ADT doses issued on prescription. The majority of the doses are issued by hospital departments, which means they cannot be traced to individual patients. So the actual impact of ADT on national fracture levels could be even greater.

Other issues were also found to lead to increased fracture rates.

�The study showed that the men in the fracture group were almost three times as likely as the control group to have suffered a previous fracture. They were also more likely to live alone and be in a lower income group� says Dr Abrahamsen.

Virtual game helps children escape realities of burn unit

Mon, 08 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) COLUMBUS, Ohio -- Nurses and physicians at Nationwide Children�s Hospital are using the latest technology to help young burn victims endure the extreme pain of dressing changes and wound care. Instead of traditional distraction devices, such as books and music, Nationwide Children�s Hospital Burn Center is now using virtual reality games to distract patients while nurses attend to the patients� burn wounds.

�It�s long been known that the actual treatment for a burn is far worse than the actual injury. Initially, the wound has to be cleaned and the dressing applied, and that can be a very painful and lengthy procedure,� said Dr. Catherine Butz, PhD, a psychologist at Nationwide Children�s Hospital and an Assistant Professor at The Ohio State University College of Medicine.

Following this initial treatment, patients must endure subsequent wound care procedures, some of which can be both extensive and painful, depending on the extent of the burn. During these procedures, anxiety often plays a major role in the patient�s pain level.

�Research shows a very strong connection between anxiety and pain,� said Dr. Butz. �Distraction does a great job in decreasing any kind of anxiety that might be associated with the anticipated procedures, so by distracting patients and keeping anxiety at a minimum, procedures tend to go much more smoothly and be much less painful for the child.�

The device, made possible by a donation from the Aladdin Shriner�s Hospital Association for Children, allows patients to escape into a computer-generated world complete with its own environment, creatures and sounds. Patients wear a virtual reality helmet, and once in this new world, they interact in the virtual environment with the help of child life specialists, trained to assist kids through stressful medical treatments.

Since Nationwide Children�s Hospital began using the device in May 2007, it has already resulted in positive feedback from burn patients. Burn nurses report several patients have noticeably improved in terms of their ability to tolerate dressing changes.

In order to better understand the effect on pain, doctors at Nationwide Children�s have launched a study to compare the results of virtual reality pain distraction with traditional distraction techniques, such as watching television, listening to music, counting and deep breathing. Patients will be randomly assigned to receive virtual reality or another pain distraction technique. Following the procedure, they will be asked to gauge their level of pain on a scale of zero to 10. The study will also assess the perspectives of parents and nurses in terms of the child�s pain and level of distress.

The burn program�s goal is to be able to better engage the child in a distraction activity which will hopefully have a beneficial affect on the procedure. An added benefit for patients may be a decrease in the amount of pain and anxiety medications needed. However doctors point out that pain is a very individual experience, and the benefits of virtual reality distraction as well as the level of medication must be determined on a case by case basis.

UT Southwestern investigating hypothermic technique in treating pediatric head injuries

Wed, 03 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) DALLAS � Oct. 3, 2007 � UT Southwestern Medical Center has been selected to take part in an $11.5 million multicenter clinical trial that is examining the effectiveness of induced hypothermia as a therapy for brain swelling in children who have suffered severe traumatic brain injuries.

The 12 centers that are participating in the trial are expected to enroll a total of 340 children up to age 16 in the five-year trial, which is being funded by the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health. Children�s Medical Center Dallas, which has a Level I pediatric trauma center, will serve as the local coordinating site. The study is being led by Children�s Hospital of Pittsburgh.

Pediatric patients who are eligible for the trial must have severe brain injury caused by blunt trauma. This excludes patients who have suffered injuries that penetrate the skull such as gunshot wounds.

Those patients selected to receive hypothermia therapy will be cooled to between 32 and 33 degrees Celsius (89 to 90 degrees Fahrenheit), using special cooling blankets and/or cooled saline given intravenously. In addition to normal emergency care, they will remain cooled for 48 hours while being closely monitored in the intensive care unit. Children will be tracked by researchers for one year to record outcomes, with a battery of tests being conducted at six and 12 months following the injury.

�Trauma is the leading cause of death and disability in children, more than all other causes combined,� said Dr. Pam Okada, associate professor of pediatrics at UT Southwestern and lead investigator of the Dallas trial. �Previous studies have shown hypothermia is not only safe in children following severe traumatic brain injury, but may improve their chance of survival.�

It had been thought that children had better outcomes than adults following traumatic brain injury, Dr. Okada said. In fact, it has been demonstrated that younger children (those younger than 4) actually have worse outcomes. Problems that develop with motor, behavior, learning, memory and other higher-level functions are common even in children with only �moderate� or �mild� concussions or injuries, she said.

�In head injuries where the skull remains intact there is little room for swelling,� Dr. Okada said. �This causes diminished blood flow resulting in brain damage. Cooling the body may reduce the swelling and possibly prevent continuing damage. If this therapy proves effective, it would be a major breakthrough in the treatment of traumatic brain injuries.�

According to federal and state laws, those who participate in a clinical research study must provide or, in the case of a child, have a guardian provide informed consent. Because of the nature of this trial and the fact that hypothermia must be induced within six hours of injury, it may be sometimes impossible to obtain consent at the time of brain injury.

For this reason, researchers are notifying the public that informed consent will be waived. Every attempt to contact family members to provide notification and obtain consent for continued participation will be made as soon as possible after enrollment.

Researchers: No faking it, crocodile tears are real

Wed, 03 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) GAINESVILLE, Fla. � When someone feigns sadness they �cry crocodile tears,� a phrase that comes from an old myth that the animals cry while eating.

Now, a University of Florida researcher has concluded that crocodiles really do bawl while banqueting � but for physiological reasons rather than rascally reptilian remorse.

UF zoologist Kent Vliet observed and videotaped four captive caimans and three alligators, both close relatives of the crocodile, while eating on a spit of dry land at Florida�s St. Augustine Alligator Farm Zoological Park.

He found that five of the seven animals teared up as they tore into their food, with some of their eyes even frothing and bubbling.

�There are a lot of references in general literature to crocodiles feeding and crying, but it�s almost entirely anecdotal,� Vliet said. �And from the biological perspective there is quite a bit of confusion on the subject in the scientific literature, so we decided to take a closer look.�

A paper about the research appears in the latest edition of the journal BioScience.

Vliet said he began the project after a call from D. Malcolm Shaner, a consultant in neurology at Kaiser Permanente, West Los Angeles, and an associate clinical professor of neurology at the University of California, Los Angeles.

Shaner, who co-authored the paper, was investigating a relatively rare syndrome associated with human facial palsy that causes sufferers to cry while eating. For a presentation he planned to give at a conference of clinical neurologists, he wanted to know if physicians� general term for the syndrome, crocodile tears, had any basis in biological fact.

Shaner and Vliet uncovered numerous references to crocodile tears in books published from hundreds of years ago to the present.

The term may have gained wide popularity as a result of a passage in one book, �The Voyage and Travel of Sir John Mandeville,� first published in 1400 and read widely, they write.

Says the passage, �In that country be a general plenty of crocodiles �These serpents slay men and they eat them weeping.�

Shaner and Vliet also found reference to crocodiles crying in scientific literature, but it was contradictory or confusing, to say the least.

One scientist, working early last century, decided to try to determine if the myth was true by rubbing onion and salt into crocodiles� eyes. Shaner said. When they didn�t tear up, he wrongly concluded it was false. As Shaner said, �The problem with those experiments was that he did not examine them when they were eating. He just put onion and salt on their eyes.�

As a result, Vliet decided to do his own observations.

In the myth, crocodiles often cry while eating humans. However, deadpanned Shaner, �we were not able to feed a person to the crocodiles.�

Instead, Vliet had to settle for the dog biscuit-like alligator food that is the staple at the St. Augustine alligator farm. He decided to observe alligators and caimans, rather than crocodiles, because they are trained at the farm to feed on dry land. That�s critical to seeing the tearing because in water the animals� eyes would be wet anyway.

The farm�s keepers don�t train the crocodiles to feed on land because they are so agile and aggressive, Vliet said. But he said he feels sure they would have the same reaction as alligators and caimans, because all are closely related crocodilians.

What causes the tears remains a bit of a mystery.

Vliet said he believes they may occur as a result of the animals hissing and huffing, a behavior that often accompanies feeding. Air forced through the sinuses may mix with tears in the crocodiles� lacrimal, or tear, glands emptying into the eye.

But one thing is sure: faux grief is not a factor. �In my experience,� Vliet said, �when crocodiles take something into their mouth, they mean it.�

War more traumatic than tsunami

Wed, 03 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The long-running civil war in Sri Lanka is causing more mental health problems and social breakdown than the catastrophic 2004 tsunami, according to research published in the online open access publication International Journal of Mental Health Systems.

The study, conducted by Professor Daya Somasundaram, currently at the University of Adelaide, is based on published data and qualitative research methods including participatory observation, key informant and focus group interviews, highlights the importance of the family and community in maintaining good mental health. For example, the terrorisation of many Tamil communities and the destruction caused by the tsunami meant many villages were abandoned and the villagers separated. Even when people returned, the village was not the same. The old structures and institutions were no longer functioning and the protective environment, the social fabric, provided by the village was no longer there.

The natural disaster was a one off catastrophic event that left a trail of destruction and loss, says Somasundaram, but it did not continue to exert a prolonged effect. As a result the severity of the collective trauma was much less. In fact, having lived through a prolonged war situation has meant that Tamil communities have learned skills and strategies that make them better able to cope with disasters.

The ecological research study suggests that grass roots work within communities may work best. Somasundaram found that the protocol developed by the Transcultural Psychosocial Organization (a WHO collaborating centre, working around the world to relieve the psychosocial problems of people affected by internal conflict and war) was very effectively adapted to the situation in northern Sri Lanka. Community-level approaches empower the community to look after their own problems, he says, through psychoeducation to transfer basic psychosocial knowledge and skills, and through encouragement, support , affirmation and re-establishment of traditional practices, rituals, resources and community relationships.

To combat post-disaster mental health problems Somasundaram argues that it is helpful to consider the extent of collective traumatisation. In the aftermath of war communities suffer from mistrust, suspicion, silence, brutalization, deterioration in morals and values, poor leadership, dependency, passivity and despair. Apart from attending to the immediate basic needs and other acute problems in the rescue and relief phases after a major disaster, rehabilitation, reconstruction and development strategies need to include collective-level interventions. In fact, our experiences show that many individually oriented mental health interventions appear to fair much better when undertaken within an overall framework of a community strategy.

FDA approves knee-injury device for humans

Tue, 02 Oct 2007 04:00:00 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo. � A new knee-surgery device investigated by University of Missouri-Columbia researchers that will help to repair meniscus tears, which were previously defined as irreparable, has been approved by the FDA for use in humans.

Previous treatment options forced surgeons to completely remove the damaged portion of the meniscus. Typically the removal of the meniscus leads to painful, debilitating arthritis in the knee. Herb Schwartz, president and CEO of Schwartz Biomedical, LLC, and James Cook, MU professor of veterinary medicine and surgery and William C. Allen Endowed Scholar for Orthopedic Research in MU�s College of Veterinary Medicine, developed the BioDuct Meniscal Fixation Device. Schwartz and Cook believe that patients with meniscus tears will now be able to have their meniscus saved along with long-term knee function.

�In the past, when faced with meniscus injuries, surgeons were often forced to completely remove the torn meniscal cartilage, leaving a deficient knee that was doomed to develop arthritis,� Cook said. �With the BioDuct Meniscal Fixation Device, surgeons will be able to repair torn menisci and induce healing. People with meniscus injuries now have a better future ahead.�

The meniscus, a padding tissue that provides shock absorption and joint stability in the knee, is crucial for normal knee function. Surgeries for meniscus tears are common with approximately one million occurring in the United States each year. When meniscus function is deficient, bone rubs on bone and arthritis is likely to develop and progress. Because two-thirds of the meniscus is avascular (lacks a blood supply), a tear in that region will not repair itself. This new device will transport blood and cells from the vascular portion of the knee to the avascular portion of the meniscus. Supplied with blood and cells for healing, the previously untreatable meniscal tear now has the potential for allowing the knee joint to be saved.

Cook�s research team performed the BioDuct surgery on 25 dogs that had worst-case scenario meniscal tears. With the BioDuct Meniscal Fixation Device, the meniscus in the dogs� knees had complete or partial repair after a few weeks in all cases.

�Currently, there are no other devices that can provide improved fixation over time,� Schwartz said. �Therefore, the BioDuct device is set apart from the rest of the field.�

In his research, Cook found that the device will significantly improve healing of avascular meniscal tears both biologically and biomechanically, which should lessen the long-term effects of meniscus injuries, including osteoarthritis. Cook�s recent findings were published in the American Journal of Sports Medicine.

�The BioDuct device could impact the industry by improving repairs of the meniscus to such an extent that fewer patients develop arthritis that results from removing the meniscal tissue,� Schwartz said. �Thus, with fewer patients developing arthritis, the result could be fewer total joint replacements or at least delaying the need for a total joint replacement.�

Center gets national funding for child trauma research

Fri, 28 Sep 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded a four-year $1.6 million grant to the newly established University of Kentucky Center for the Study of Violence Against Children (CSVAC). The grant, one of only 10 being presented across the nation, is going to organizations helping children and adolescents deal with traumatic experiences.

These grants will strengthen the nation's capacity to provide help to children of all ages who experience traumatic events, such as interpersonal violence, natural disasters, or acts of terrorism, said Terry Cline, a SAMHSA administrator.

CSVAC received one of the 10 Community Treatment and Services (CTS) Center grants, which are designed to promote and evaluate effective treatment systems in community and youth-oriented settings. These grants also promote enhanced network systems for clinical, methodological, policy, financing and training issues. Each grant recipient will receive up to $400,000 per year for up to four years. Likewise, the CTS grant officially establishes CSVAC as a member of the National Child Traumatic Stress Network.

We are honored that CSVAC was chosen as one of the select group of organizations to participate in this national endeavor, said Ginny Sprang, principal investigator for the project, director of CSVAC and nationally recognized expert in trauma. This grant will provide us with opportunities to adapt and test best practice approaches to treating traumatic stress in children exposed to violence.

As a grant recipient, CSVAC will use the federal funding to establish the Child and Adolescent Trauma Treatment Institute (CATTI), which will provide clinical training and information on evidence-based practices in eastern, western, southern and central regions of Kentucky. CATTI will present three specific intervention methods, Parent Child Interaction Therapy (used with children 2 to 12), Trauma-Focused Cognitive Behavioral Therapy (for children 3 to 17), and Abuse-Focused Cognitive Behavioral Therapy (for school-age children). These approaches were selected due to the exposure profile of at-risk children in these four regions of the Commonwealth, where the majority of this group of kids suffer from exposure to interpersonal, family and community-based violence.

Based on needs and readiness assessments found through CATTI, CSVAC clinical staff will train regional partners to deliver services in their area to children in need using a train the trainer approach. This collaboration will benefit regional sites by educating area staff in new interventions and supplying them with colleagues at UK practicing cutting-edge research and practices in child welfare. The project, through these relationships, will also enjoy a positive ripple effect as newly educated staff become best practice ambassadors in their areas of the state and share the practices they learned with additional child welfare staff in the region. Key stakeholders across the Commonwealth, including the state's public child welfare system and various school systems, consumer groups, community mental health representatives, and advocacy organizations, will serve as advisers on the project.

Other UK researchers from the College of Social Work, Center for Drug and Alcohol Research (CDAR) and Department of Psychiatry will work with Sprang on CATTI. These co-principal investigators are Allen Brenzel, associate director of CSVAC and chair of the Child and Adolescent Division-Department of Psychiatry; James Clark, associate director of CSVAC and associate dean for research in the College of Social Work; Carlton Craig, assistant professor of social work; Otto Kaak, associate director of CSVAC and professor of psychiatry and pediatrics; Michele Tindall, assistant professor in both the Department of Behavioral Science and College of Social Work with an appointment at CDAR; and Bob Walker, assistant professor of psychiatry at CDAR with appointments in the College of Social Work and Department of Behavioral Science.

The CATTI project is housed at CSVAC, which gained its center status at UK earlier this month. The translational research center, established in the College of Social Work, combines clinical practice, research and training on child and family violence in an effort to develop, assimilate and disseminate knowledge and best practices that will contribute to reducing and ending violence against children and the effects of that violence across the life cycle.

The other nine CTS grant recipients are: Children's Institute, Inc., of Los Angeles; Denver Department of Human Services; Children's Home Society of Florida, of Pensacola; Mental Health Services for Homeless Persons, Inc., of Cleveland; Latino Health Institute, of Boston; Kennedy Krieger Research Institute, Inc., of Baltimore; Community Counseling Center, of Portland, Maine.; Catholic Charities, Inc., of Jackson, Miss.; and Aliviane, Inc., of El Paso, Texas.

High school footballers wearing special helmets to monitor brain injuries

Thu, 27 Sep 2007 04:00:00 PST

( from http://www.rxpgnews.com ) As they root for the home team from the bleachers this fall, high school gridiron fans in the small Illinois town of Tolono don�t necessarily see anything out of the ordinary down on the field.

But just out of sight, tucked inside many of the maroon helmets worn by the Unity High School Rockets, a revolution of sorts is taking place. This season, 32 varsity team members are sporting helmets outfitted with the same electronic encoder modules now used by a handful of college teams.

The purpose of the high-tech headgear, which uses six strategically placed, spring-loaded accelerometers to wirelessly beam information to a Web-based system on a laptop computer on the sidelines, is to more effectively � and more immediately � detect when blows to players� heads may result in concussions or more severe brain injuries.

In addition, impact data � including location of hits, magnitude of force and length of hits � is recorded for analysis by a University of Illinois research team led by kinesiology and community health professor Steven Broglio.

�Unity is the only high school in the country using the Head Impact Telemetry System, or HITS,� Broglio said. �There are 12 million high school football players across the nation,� he said. �This is a huge population we don�t know much about.�

The system being used in the research partnership between the U. of I. and Unity was developed by Simbex, a research and product-development company based in New Hampshire. It works in tandem with helmets made by Riddell, the nation�s largest helmet manufacturer, and was first tested on the Virginia Tech football team in 2002.

Broglio said a number of other researchers at universities across the nation, including Virginia Tech, the University of North Carolina and Dartmouth, also are using the system as the basis for studies of biomechanical processes caused by concussions and traumatic brain injuries.

At Unity, each varsity player was given a baseline assessment for neurocognitive function prior to the start of the season.

�The baseline assessments are all over the map,� Broglio said. �Because the kids� brains are still developing, they have different ranges and abilities.�

On the field during practice or on game day, when the encoder in an athlete�s helmet registers a hit, the system beams impact information to the sidelines laptop, which is monitored by the team�s athletic trainer.

�If an athlete is diagnosed with a concussion, he will not return to play until neurocognitive function returns to baseline performance,� Broglio said.

The fact that high school athletes� brains may not yet be as fully developed as their college or professional counterparts is a large part of Broglio�s motivation for studying the system�s effectiveness on the younger players.

The U. of I. researcher noted in many high schools across the country it�s not unusual for players to take a forceful hit, sit out briefly, then return to play. And sometimes they�ll even mask symptoms from coaches and trainers because they don�t want to miss the action.

Unfortunately, Broglio said, �what other researchers are finding is that people with multiple concussions have incurred Alzheimer�s Disease at a higher rate. Getting their �bell rung� as high school athletes may have permanent repercussions. There seems to be a link.�

He noted that there�s also some evidence in the literature that among high school athletes, the force of an impact may actually be less than it is with older players.

The main focus of Broglio�s continuing research is to sort it all out � to determine how the younger players actually function on the field, and gather data that �will ultimately protect and treat athletes who suffer concussive head injuries.�

�We will look at how hard and where they get hit,� he said, adding that one possible outcome of the work may be determining the need to develop a different type of helmet for high school athletes.

�We may find they�re getting hit in different places and need more padding in those areas of the helmet, for example.�

In Tolono, the system�s ability to monitor where athletes are incurring hits has already led to another discovery, just a couple of weeks into the season.

�The system picked up one athlete who was hitting with the top of his head, a practice that could result in spinal-cord injury,� Broglio said. Because they were able to identify the pattern, the team�s coaches were able to work with the athlete to correct the habit.

�As we�ve gone through this first few weeks using the system, for the most part it�s been very good,� said Scott Hamilton, the Rockets� head coach. �As this revolutionizing (of the sport) gets better and better, it will be great. Anything to protect our kids is a wonderful concept.�

As is often the case with most innovative technologies when they�re first developed, however, the initial cost of the system is likely to prohibit widespread use � especially at the high school level. Broglio said the system being tested at Unity has a price tag of about $60,000; each helmet costs an additional $1,000.

Nonetheless, he and Hamilton remain hopeful that as more companies compete and additional systems enter the marketplace, the cost eventually will become more affordable for more schools.

�Anytime you talk about money, it�s a fine line between how much money do you spend, and how much is it worth to protect the kids.�

Medication appears helpful for treatment of erectile dysfunction in men with spinal cord injuries

Mon, 10 Sep 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The drug tadalafil appears to improve erectile function in men with spinal cord injuries, according to an article posted online today that will appear in the November 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.

Between 10.4 and 83 individuals per million worldwide experience spinal cord injuries every year, according to background information in the article. �Throughout the world, spinal cord injury occurs most often in young men, resulting in negative physical, social and psychological consequences,� the authors write. �Erectile dysfunction, defined as the inability to attain and maintain penile erection sufficient for satisfactory sexual performance, is a common complication in men with spinal cord injury.� Only 25 percent of men with spinal cord injuries are able to have erections that are adequate for having intercourse.

Francois Giuliano, M.D., Ph.D., of the Raymond Poincare Hospital, Garches, France, and colleagues, conducted a randomized, double-blind study of tadalafil in 197 men with spinal cord injuries (average age 38). After a four-week period during which none of the men received treatment, 142 were randomly assigned to the tadalafil treatment group and 44 to the placebo group. During the 12-week treatment phase, the participants were instructed to take the medication as needed before the potential for sexual activity, with a maximum of one dose daily. Those assigned to take tadalafil were given a 10-milligram dose at first and were evaluated every four weeks, at which time patients were switched to a 20-milligram dose based on their response to the treatment.

At the beginning of the study, the men�s average score on the International Index of Erectile Function�a 15-item questionnaire on which a score of 25 or lower indicates erectile dysfunction�was 13.4. After 12 weeks of treatment, men taking tadalafil had an average score of 22.6 (indicating mild erectile dysfunction) and men taking placebo had an average score of 13.6 (indicating moderate erectile dysfunction). Men taking tadalafil were, on average, successful 75.4 percent of the times they attempted penetration and 47.6 percent of the times they attempted intercourse, compared with a 41.1 success rate for penetration and 16.8 percent for intercourse among men taking placebo.

�Tadalafil was safe and well tolerated with few treatment-emergent side effects,� the authors write. Fifty (35 percent) of patients in the tadalafil group and 15 (34 percent) of those in the placebo group experienced at least one adverse effect. Among those taking tadalafil, the most common side effects were headache (8.5 percent of patients) and urinary tract infection (7.7 percent of patients).

�As in other erectile dysfunction studies that include patients who were difficult to treat owing to pre-existing conditions (e.g., prostatectomy, diabetes mellitus), tadalafil was efficacious for the treatment of erectile dysfunction after a traumatic spinal cord injury,� the authors write. �On-demand treatment with tadalafil (10 milligrams or 20 milligrams) may help improve the sex lives of patients with erectile dysfunction and spinal cord injury and their partners.�

(Arch Neurol. 2007;64(11):(doi:10.1001/archneur.64.11.nct70001). Available pre-embargo to the media at

Large intensive care study reveals vital recommendations for treatment of brain injury patients

Mon, 03 Sep 2007 04:00:00 PST

( from http://www.rxpgnews.com ) A landmark Australian and New Zealand intensive care study has provided vital information for the treatment of patients with brain injuries. The results of the SAFE-TBI Study, published today in the New England Journal of Medicine, confirm that the choice of resuscitation fluids affects the chances of patients with brain injury surviving.

Study leader Professor John Myburgh, from the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG)and The George Institute for International Health explains, �Patients with brain injury require resuscitation fluids to promptly restore blood flow to the brain following trauma. Until now,clinicians were uncertain which fluid to use in this situation and there was wide variation in the types of fluids used in these patients. Our study confirmed that patients resuscitated with albumin-based fluidsimmediately following brain injury, had a higher death rate than those who received saline.�

In 2004, researchers from the ANZICS CTG, The George Institute for International Health and the Australian Red Cross Blood Service published the largest study ever performed in intensive care in the New England Journal of Medicine. The study, called the SAFE Study, was prompted by earlier reports from the United Kingdom, which suggested that the administration of albumin-based fluids used for the resuscitation of critically ill patients was associated with a higher rate of death. The SAFE Study, which studied almost 7000 patients in Australia and New Zealand, concluded that the death rate was the same when patients were given either albumin-based or saline-based fluids. However, a higher death rate was seen in those patients who had brain injuries due to trauma, caused by road traffic crashes or falls, and who received albumin-based fluids.

Given the importance of these results, the SAFE Study researchers conducted a detailed analysis of the patients with brain injuries (the SAFE-TBI Study) that included determining the death rate two years after the original injury as well as an assessment of the level of disability in those who survived.

Professor Myburgh said, �Our study provides compelling new data to guide clinicians in the choice of resuscitation fluids in patients with traumatic brain injury. These results will have a major impact on clinical practice guidelines for resuscitation of these patients.�

The SAFE-TBI Study also raises an important public health issue for millions of patients with brain injuries worldwide. �Given that traumatic brain injury results in considerable death and disability in all societies, but particularly in the developing world where trauma rates are increasing, it is important for doctors to know that a patient�s chances of survival can be substantially improved by the administration of a readily available and inexpensive fluid such as saline,� Professor Myburgh added.

Star Trek medical device uses ultrasound to seal punctured lungs

Thu, 30 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) A stretcher races through the entrance of a busy hospital. The car-accident victim lies on top and grimaces in pain. While surface injuries look gruesome, the real medical danger is invisible - internal organ damage caused by being crushed against the steering wheel.

This isn't a scene from Seattle Grace Hospital, the set of the popular television drama Grey's Anatomy, but from its real-life model, Harborview Medical Center. Engineers at the University of Washington are working with Harborview doctors to create new emergency treatments right out of Star Trek: a tricorder type device using high-intensity focused ultrasound rays. This summer, researchers published the first experiment using ultrasound to seal punctured lungs.

No one has ever looked at treating lungs with ultrasound, said Shahram Vaezy, a UW associate professor of bioengineering. Physicists were skeptical it would work because a lung is essentially a collection of air sacs, and air blocks transmission of ultrasound. But the new experiments show that punctures on the lung's surface, where injuries usually occur, heal with ultrasound therapy.

The results are really impressive, Vaezy said. He cautions that this is still in the early stages and the technique is not yet being tested on humans.

High-intensity focused ultrasound is now being investigated for a number of different treatments. It promises bloodless surgery with no scalpels or sutures in sight. Doctors would pass a sensor over the patient and use invisible rays to heal the wound. Researchers are exploring the use of high-intensity focused ultrasound – with beams tens of thousands of times more powerful than used in imaging – for applications ranging from numbing pain to destroying cancerous tissue.

In this case, lenses focus the high-intensity ultrasound beams at a particular spot inside the body on the patient's lungs. Focusing the ultrasound beams, in a process similar to focusing sunlight with a magnifying glass, creates a tiny but extremely hot spot about the size and shape of a grain of rice. The rays heat the blood cells until they form a seal. Meanwhile the tissue between the device and the spot being treated does not get hot, as it would with a laser beam.

You can penetrate deep into the body and deliver the energy to the bleeding very accurately, Vaezy said. Recent tests on pigs' lungs showed that high-intensity ultrasound sealed the leaks in one or two minutes. More than 95 percent of the 70 incisions were stable after two minutes of treatment, according to results published this summer in the Journal of Trauma.

The findings suggest that ultrasound might replace what is now a painful, invasive procedure. Lung injuries are relatively common because the chest is a big surface that's often exposed to crushing or puncture wounds, said Gregory Jurkovich, chief of trauma at Harborview Medical Center in Seattle and a UW professor of surgery. A busy trauma room like Harborview's, he said, admits about two patients with bleeding lungs per day.

Often the bleeding can be stopped simply by packing the wound and applying pressure. In other cases, doctors insert a straw and drain the blood and air so the wound can heal. But in about one in 10 cases neither of these methods is successful, and doctors must operate to stop the bleeding. That means making a long incision and separating the ribs, and then either sewing up the organ or removing a section of the lung.

The new research shows that in these difficult cases, high-intensity focused ultrasound applied from outside could stop bleeding and air leaks. Vaezy and colleagues in the Center for Industrial and Medical Ultrasound in the UW's Applied Physics Laboratory have been developing ultrasound for surgery for more than a decade, concentrating on frequencies in the 1000 to 10,000 hertz (cycles per second). The device producing the ultrasound rays, about the size of a golf ball, is inserted into a handle that doctors use to scan the outside of the body. Previous experiments used the tool to seal blood vessels and stop bleeding in the spleen.

Someday, Jurkovich predicts, this tool might be used for image-guided therapy.

Doctors will scan the body from the outside, recognize where the injury is, focus the beam on the injury and use the beams to seal the wound, Jurkovich said. The futuristic medical technology's promise is substantial, he said. It would be non-invasive and it would stop the bleeding from the outside. When it happens, that's going to revolutionize how we would care for some of these injuries.

Facial transplantation may be a safer option, study shows

Tue, 28 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CINCINNATI/LOUISVILLE�Researchers in Cincinnati and Louisville report that immunosuppressive risks associated with facial transplantation may be lower than thought, possibly making the procedure a safer option for people who have suffered severe facial injuries.

Previous data on the immunosuppression risks involved in facial transplantation were misleading, according to Rita Alloway, PharmD, and Steve Woodle, MD, of the University of Cincinnati (UC), and a University of Louisville team led by John Barker, MD, PhD. Their findings appear in the September edition of the journal Plastic and Reconstructive Surgery.

The first recorded facial transplant was performed in France in 2005 on a 38-year-old woman whose nose, lips and chin had been bitten off by a dog. Tissues, muscles, arteries and veins were taken from a brain-dead donor and successfully transplanted to the patient�s lower face.

There have been only two similar attempts since.

In 2004, the British Royal College of Surgeons published a controversial report predicting a high incidence of immunological complications for facial transplants. This data became a benchmark for facial transplant teams and review boards and greatly influenced the facial transplantation debate.

According to Woodle, however, the report did not provide the best risk assessment.

�In estimating the risks of immunosuppression for face transplant recipients, the biggest problem is comparing apples to oranges,� Woodle says. �What we have tried to do is to address the apples and oranges problem by a comprehensive and up-to-date consideration of the issue.�

Both the health status of solid organ transplant recipients and the tissue composition of the solid organs reported in the earlier studies are very different from that of face transplant recipients and their facial tissues, he says.

In the current study, the Cincinnati and Louisville researchers compared the 2004 data with that taken from clinical studies describing kidney and hand transplants using the latest immunosuppression techniques.

They found the outcomes to be very different from those in the 2004 study.

Based on kidney and hand transplantation cases, in which the same drug regimen was used, researchers found that acute, or immediate, rejection may occur in 10 to 70 percent of patients. In of all these cases, however, rejection was reversible by adjusting the immunosuppression medications.

They also found that fewer than 10 percent of patients would experience chronic rejection over five years.

�In considering the most recent and relevant data, we came to the conclusion that the expectations for face transplant recipients should be significantly better than those previously published,� Woodle says.

Coauthor Barker says that the lack of comparable �apples-to-apples� risk data in the field has led to debate over the ethics of face transplantation, which was the inspiration for the Cincinnati-Louisville study.

�This risk-benefit equation is at the center of controversy over facial transplantation,� he says. �Physicians and scientists question whether the risks of life-long immunosuppression for patients justify the benefits of this new treatment.�

Cincinnati coauthor Alloway says that physicians often don�t realize how much patients will endure to gain relief.

�Surveys from transplant professionals have shown that doctors underestimate what people will do for a cure,� Alloway says. �Often, living disfigured is worse than risk associated with this sort of operation and the immunosuppressive risks that accompany it.�

Researchers hope this study will provide a solid foundation for future work with facial transplantation.

�We�re trying to meld the fields of transplantation and immunosuppression to produce maximum expertise on the subject,� Alloway continued. �We�re hoping to decrease toxicity and create a more manageable risk spectrum for surgeons and patients.�

Nanowire coating for bone implants, stents

Mon, 27 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) FAYETTEVILLE, Ark. - University of Arkansas researchers have found a simple, inexpensive way to create a nanowire coating on the surface of biocompatible titanium that can be used to create more effective surfaces for hip replacement, dental reconstruction and vascular stenting. Further, the material can easily be sterilized using ultraviolet light and water or using ethanol, making it useful in hospital settings and meat-processing plants

Wenjun Dong, Tierui Zhang, Lisa Cooney, Hong Wang, Yanbin Li, Andrew Cogbill, Vijay Varadan and Z. Ryan Tian of the University of Arkansas, Ying-Bing Jiang of the University of New Mexico, and Joshua Epstein of the University of Arkansas for Medical Sciences report their findings in an upcoming issue of the journal Chemistry of Materials.

The researchers used an alkali and heat to create titanium oxide-based ceramic nanowires that coat the surface of a titanium medical device.

We can control the length, the height, the pore openings and the pore volumes within the nanowire scaffolds by varying the time, temperature and alkali concentration in the reaction, said Z. Ryan Tian, assistant professor of chemistry and biochemistry in the J. William Fulbright College of Arts and Sciences. This process is also extremely sustainable, requiring only that the device be rinsed in reusable water after the heating process.

Reconstructive bone surgeries, such as hip replacements, use titanium implants. However, muscle tissue may not adhere well to titanium's smooth surface, causing the implant to fail after a decade or so and requiring the patient to undergo a second surgery.

Tian and his colleagues created a nanowire-coated joint and placed it in mice. After four weeks, the researchers found that tissue had adhered to the joint.

We saw beautiful tissue growth - lots of muscle fibers, Tian said. We've added one more function to the currently-in-use titanium implant.

Because the researchers can control the size and shape of the pores in the nanowire scaffold, the material also could be coated onto stents used in patients with coronary artery disease and in potential stroke victims. Conventional stents sometimes become reclogged with fat after implantation. The most recent stent used to address this problem, called the drug-eluting stent, consists of a polymer coating mixed with the drugs, but the coating may be vulnerable to biodegradation, and may not function for long. The nanowire coating without the degradation problem could be used to carry drugs that would help keep the arteries clear over a long period of time.

This drug release could be applied to the angioplasty catheter's surface, Tian said.

In addition to these biomedical applications, the nanofiber scaffold has a property that may make it useful in both hospitals and food processing plants: The material, when rinsed in water and exposed to ultraviolet light, kills more than 99 percent of bacteria on its surface. This effect occurs because photons from the light cause a charge separation on the material, splitting water molecules into free radicals that destroy the bacteria. Alternatively, immersion in 70 percent ethanol completely sterilizes the material, allowing growth of cells/tissues in the laboratory prior to implantation.

This property could prove extremely useful in bacteria-prone environments, performing such functions as sterilizing on-site surgery hospitals used during military actions or cleaning surfaces in meat-processing plants.

You could just use water to rinse and UV light to sterilize surfaces, Tian said.

The researchers have applied for a provisional patent for the multifunctional nanowire bioscaffolds on titanium or titanium-containing alloys such as Nitinol.

FEMA fire grant to assess heat stress in firefighters awarded to University of Pittsburgh

Wed, 22 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) PITTSBURGH, Aug. 22 � Researchers at the University of Pittsburgh School of Medicine�s department of emergency medicine, in collaboration with the Allegheny County Fire Academy, have received a Federal Emergency Management Agency (FEMA) Fire Prevention and Safety grant to conduct a study designed to develop optimal methods of reducing acute cardiovascular risk resulting from exposure to heat stress during fire suppression.

According to a July 2007 National Institute for Occupational Safety and Health (NIOSH) report, sudden cardiac death represents the most common cause of line-of-duty deaths among firefighters, killing approximately 45 each year. It is suspected that many of these deaths are triggered by heat stress, which can be caused by exposure to the fire and the use of personal protective garments.

The report also found that, for firefighters, coronary artery disease and sudden cardiac death involve a combination of personal and work-related factors. Personal factors can include age, gender, family history, diabetes, hypertension, smoking, high cholesterol, obesity and lack of exercise. Work-related factors can include exposure to fire smoke, heavy physical exertion, heat stress and other physical stresses.

�The Allegheny County Department of Emergency Services through the County Fire Training Academy is pleased to work with the University of Pittsburgh�s department of emergency medicine to enhance fire safety and reduce the amount of line-of-duty deaths among fire and rescue workers,� said Robert A. Full, Chief of Emergency Services and Fire Marshal, Allegheny County. �What an advantage it is to have the resources of a world-class health organization available to us in order to perform our jobs to the best of our ability.�

The two-year study, known as the Fire ground Rehab Evaluation (FIRE) Trial, will assess the best methods for maintaining the health and safety of firefighters while in the line of duty, called fire ground rehabilitation.

Currently, fire ground rehabilitation is inconsistent across the profession due to size and scope of each organization. Changing behavior can be difficult especially in the fire and rescue community, where taking a break can be viewed as a sign of weakness.

�During the FIRE trial, we will be looking for the right threshold at which fire ground rehabilitation should be administered and investigating the efficacy of different methods of rehabilitation that can be administered at fire scenes. The study is designed to improve firefighter health and safety by providing an improved understanding of the mechanisms of heat stress and its effects on the heart. We anticipate that the study will result in improved methods of prevention and treatment of heat-related cardiovascular stress that can be adopted by fire departments across the United States,� said David Hostler, Ph.D., NREMT-P, research assistant professor, University of Pittsburgh department of emergency medicine and volunteer firefighter of the Guyasuta Volunteer Fire Department, O�Hara Township.

Firefighters from the Guyasuta Volunteer Fire Department and other departments across Allegheny County will be tested in the department of emergency medicine�s specially-designed Emergency Responder Human Performance Lab. Physiological monitoring will include pulse, heart rate, blood pressure and core body temperature, while at rest and during exercise and while wearing the firefighter protective clothing. Blood samples will be taken before and after exercise to look for elevations in chemicals that promote blood clotting and are associated with increased cardiovascular risk. After exercise, various cooling and hydration treatments will be administered (e.g., oral fluids versus IV fluids, cooling blankets) to determine the most practical and effective method to reduce cardiovascular risk among firefighters. Similar tests will be performed during exposure to fire, smoke and heat when the firefighters are training at the Allegheny County Fire Academy.

Key to out-of-control immune response in lung injury found

Thu, 16 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers at the University of Illinois at Chicago College of Medicine have discovered how a protein modulates the inflammatory response in sudden, life-threatening lung failure. The protein's previously unknown role is reported in the August issue of Nature Medicine.

Acute Respiratory Distress Syndrome, or ARDS, is an often fatal complication of severe traumatic injury, bacterial infections, blood transfusions and overdoses of some medications. In ARDS, the lungs become swollen with fluid and breathing becomes impossible. Thirty percent to 40 percent of patients die. There is no effective treatment.

Sepsis, an overwhelming bacterial infection of the blood and organs, is the most common cause of ARDS. When the immune system responds to the infection, molecules called inflammatory cytokines and chemokines are released. These molecules attract inflammatory white blood cells and destroy bacteria, but also lead to fever, swelling and other symptoms of shock and can wreak havoc on the patient in the course of fighting off the infection.

Without an inflammatory response, bacterial invaders in the lungs can kill, but too intense a response can also be fatal, said Kurt Bachmaier, UIC research assistant professor in pharmacology and first author of the study. We need a better understanding of how the immune system modulates this defense so that we can understand what goes wrong in life-threatening lung failure.

The researchers created a mouse model that lacks the gene for a protein, called Cblb, which was known to play a crucial role in chronic inflammation and auto-immunity through regulation of T- and B-cells.

When sepsis was induced in mice with and without the Cblb gene, there was a marked difference in the level of the inflammatory response and survival. Mice lacking the Cblb gene were much less likely to survive than control mice.

The UIC researchers were able to show how Cblb regulates the immune response. They showed that in normal mice, a receptor found in lung tissue that induces the release of inflammatory cytokines and chemokines disappears from the cell surface after about an hour, ending the signaling of the immune response.

In the Cblb-deficient mice the receptor stays on the surface, and the inflammatory response is not turned off.

The researchers were also able to show that a protein that controls the production of inflammatory cytokines, called NF-kB, is induced in lung tissue after sepsis by that receptor to a much greater extent from the Cblb-deficient mice than in normal mice. NF-kB is known to induce swelling of tissues.

There are already early-stage drug trials of treatments for ARDS targeting NF-kB, said Bachmaier. This discovery has real clinical implications in the treatment and prevention of life-threatening lung failure.

Cblb is a potential drug target that may lead to a new class of anti-bacterial drugs, says Dr. Asrar Malik, distinguished professor and head of pharmacology and a senior author on the paper. Malik and Bachmaier have recently filed a patent on the basis of these findings.

Electrical implant steadies balance disorder in animals

Mon, 06 Aug 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Hearing and balance experts at Johns Hopkins report successful testing in animals of an electrical device that partly restores a damaged or impaired sense of balance.

Though human testing of the so-called multichannel vestibular prosthesis remains a few years away, the scientists say such a device, which is partially implanted in the inner ear, could aid the 30,000 Americans the experts own estimates show are coping with profound loss of inner ear balance. These people often suffer from unsteadiness, disequilibrium or wobbly vision. Problems with vestibular sensation can be inherited at birth or result from use of antibiotics, chemotherapy drugs, Ménières disease, viral infection, stroke or head trauma.

The Hopkins study, done in chinchillas because their inner ear function is well studied, is proof of concept that we can restore three-dimensional sensation of head movement with a multichannel vestibular prosthesis, says Charles C. Della Santina, M.D., Ph.D., director of the Vestibular Neuroengineering Laboratory at Hopkins.

While everyone knows about the five senses of sight, smell, taste, touch and hearing, few people think about a possible sixth sense - the sensation of head orientation and movement - until the system fails, says Della Santina, who has been working on this prosthesis since 2002.

In their report in the June 2007 edition of the journal I.E.E.E. Transactions on Biomedical Engineering, the Hopkins team showed that a matchbox-size prototype device, weighing less than 3 ounces, effectively mimics the workings of the inner ears three semicircular canals by sensing head rotation and transmitting that information to the brain.

Adapting the design of cochlear implants, which restore hearing through electrical stimulation of the cochlear nerve, researchers constructed a circuit that could measure and transmit 3-D balance information to the brain through multiple electrodes connected to the vestibular nerve.

The device, which researchers started testing more than a year ago, consists of a head-mounted, battery-operated box containing the sensors, which are positioned outside the head so that the sensors are parallel to the animals actual semicircular canals, where head rotation is normally sensed. The sensors are connected to a microprocessor and up to eight electrodes surgically implanted in the inner ear and separately connected to nerve endings. Each electrode can act as one information channel.

Della Santina says people disabled by loss of vestibular sensation often feel chronically off balance and lose the ability to keep the eyes steadily pointed at an object when they move their head, seeing the world like the wobbly image on a shaky handheld video camera.

According to Della Santina, an assistant professor of otolaryngology - head and neck surgery and biomedical engineering at The Johns Hopkins University School of Medicine, this is the first implantable device made with multiple sensors and channels of processing that can measure and encode head rotation in all directions.

Each of the three sensors, he notes, can measure the speed of head rotation about one of three axes, or directional planes.

Della Santina says that previous implants developed elsewhere were limited to one functioning sensor and electrode and one plane or axis of rotation, when in reality, we move in multiple directions.

Every measurement in the balance device is processed in the implanted central microprocessor unit, using computer software developed by Della Santina and his team.

Once processed, the information is used to tailor timing of brief, electronic pulses through the electrodes implanted near the three branches of the vestibular nerve that respond to changes in head rotation. These branches normally carry signals from the inner ears three semicircular canals.

In the chinchilla tests, pulses lasting less than a millisecond were delivered with timing patterns that mimicked normal nerve activity.

Della Santina and his colleagues first caused imbalance in chinchillas by treating them with a high dose of gentamicin, an antibiotic known to wipe out the tiny hairlike projections on cells in the inner ear canals that are normally key to sensory balance function. Treated animals displayed unsteady walking and wobbly eye movements commonly seen in people with impaired balance. Precise measurements of eye movements, using a technique of video-tracking adapted by researchers, were made during a fixed set of head movements. Results confirmed profound loss of normal eye-stabilizing reflexes.

The animals were then fitted with the vestibular prosthesis, with sensors oriented parallel to the semicircular canals they replaced. Post-activation eye testing showed, in three chinchillas mentioned in the report, that animals partially regained their vision-stabilizing reflex.

Researchers say many hurdles remain before a human device will be available. Efforts are underway to reduce electrical interference to other nerve branches and to refine the timing patterns of electrical stimulation to make them more like normal. In addition, they plan to work on making the device smaller and hermetically sealed so that it can fit completely inside the head beneath the skin.

The resulting vestibular implant, they say, could ultimately serve as a safety net for people who need high-dose gentamicin therapy, for example, to combat severe abdominal infections after bowel surgery.

People with profoundly impaired balance need better treatment options, says Della Santina. Many cope through rehabilitation exercises or by restricting their activities, but the chronic disequilibrium and blurry vision can be disabling.

RAND study finds senior drivers less likely than youngest drivers to cause accidents

Wed, 18 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Drivers 65 and older are just one-third as likely as drivers 15 to 24 to cause auto accidents, and not much more likely than drivers 25 to 64 to cause accidents, according to a RAND Corporation study issued today.

While driving ability declines with age for most people, those seniors who continue to drive appear to be safer drivers than the general public might think, said David Loughran, a RAND senior economist and professor at the Pardee RAND Graduate School who is the lead author of the study. By far, it is the youngest drivers who pose the greatest risk to traffic safety.

Researchers found that in 2001, people 65 and older accounted for about 15 percent of all licensed drivers but caused only about 7 percent of all accidents in the United States. By contrast, people ages 15 to 24 accounted for just 13 percent of all licensed drivers, but caused 43 percent of all accidents.

Because senior citizens are generally in poorer health and more frail than younger people, drivers 65 and older are at much greater risk of serious injury or death when they do have an accident, according to the study by RAND, a nonprofit research organization. Senior drivers are nearly seven times more likely than younger drivers to be killed in a two-car accident.

Seniors who drive pose a much larger risk to themselves than to others, Loughran said. As the U.S. population ages, injury rates will increase -- not because seniors cause more accidents, but because seniors are more vulnerable to injury when they get into an accident.

It is projected that by 2025, drivers 65 and older will represent 25 percent of the driving population, compared with 14 percent in 2001. Previous research has shown that as people age, their driving ability becomes impaired.

Seniors appear to make fairly sound decisions about when to reduce the amount they drive or stop driving altogether, Loughran said. Not only do seniors drive much less than younger drivers, but they drive at safer times during the day and avoid poorer road conditions.

The study estimated accident risks by examining more than 330,000 fatal traffic accidents around the United States between 1975 and 2003 among drivers in three age groups: 15 to 24; 25 to 64; and 65 and older.

In response to an aging driving population, many states have imposed more stringent licensing requirements, such as in-person renewals and mandatory vision testing for senior drivers. While only Illinois and New Hampshire require older drivers to take a road test, several recent high-profile accidents involving older drivers have caused legislators in a number of states to consider tightening licensing requirements for older drivers.

The study argues that it is costly to both states and seniors to impose more stringent age-based licensing requirements and that the benefits of doing so have not been rigorously validated. Instead, the study concludes that more accidents could be prevented and lives saved by improving car and road design to make auto travel safer for older drivers and passengers.

Policies that lead to improvements in overall traffic safety will have much larger impacts on injury rates than will efforts to identify the relatively small number of older drivers whose licenses should be revoked, Loughran said.

MIT IDs mechanism behind fear

Sun, 15 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CAMBRIDGE, Mass.--Researchers from MIT's Picower Institute for Learning and Memory have uncovered a molecular mechanism that governs the formation of fears stemming from traumatic events. The work could lead to the first drug to treat the millions of adults who suffer each year from persistent, debilitating fears - including hundreds of soldiers returning from conflict in Iraq and Afghanistan.

The team will report their results in the July 15 advance online publication of Nature Neuroscience.

A study conducted by the Army in 2004 found that one in eight soldiers returning from Iraq reported symptoms of post-traumatic stress disorder (PTSD). According to the National Center for PTSD in the United States, around eight percent of the population will have PTSD symptoms at some point in their lives. Some 5.2 million adults have PTSD during a given year, the center reports.

Li-Huei Tsai, Picower Professor of Neuroscience in the Department of Brain and Cognitive Sciences, and colleagues show that inhibiting a kinase (kinases are enzymes that change proteins) called Cdk5 facilitates the extinction of fear learned in a particular context. Conversely, the learned fear persisted when the kinase's activity was increased in the hippocampus, the brain's center for storing memories.

Cdk5, paired with the protein p35, helps new brain cells, or neurons, form and migrate to their correct positions during early brain development. In the current work, the MIT researchers looked at how Cdk5 affects the ability to form and eliminate fear-related memories.

Remarkably, inhibiting Cdk5 facilitated extinction of learned fear in mice. This data points to a promising therapeutic avenue to treat emotional disorders and raises hope for patients suffering from post-traumatic stress disorder or phobia, Tsai said.

Emotional disorders such as post-traumatic stress and panic attacks stem from the inability of the brain to stop experiencing the fear associated with a specific incident or series of incidents. For some people, upsetting memories of traumatic events do not go away on their own, or may even get worse over time, severely affecting their lives.

Treating these disorders involves methods geared toward making the behavior go away, or become extinct, but the molecular mechanisms underlying the extinction process are not well understood. However, Tsai said, studies have shown that some of the molecular machinery that initially encodes the troubling memories also regulates their extinction.

In the current work, genetically engineered mice received mild foot shocks in a certain environment and were re-exposed to the same environment without the foot shock. Mice with increased levels of Cdk5 activity had more trouble letting go--or extinguishing--the memory of the foot shock and continued to freeze in fear. Conversely, in mice whose Cdk5 activity was inhibited, the bad memory of the shocks disappeared when the mice learned that they no longer needed to fear the environment where the foot shocks had once occurred.

In our study, we employ mice to show that extinction of learned fear depends on counteracting components of a molecular pathway involving the protein kinase Cdk5, said Tsai, a Howard Hughes Medical Institute investigator. We found that Cdk5 activity prevents extinction, at least in part by negatively affecting the activity of another key kinase.

Groin injuries averted by preseason injury prevention

Thu, 12 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CALGARY, Alberta -- Professional soccer players who participated in a special preseason groin injury prevention program had fewer groin injuries during that subsequent season than those who were not in the program, according to new research released today at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center (July 12-15).

The researchers enrolled 315 major league soccer players in a preseason groin injury prevention program to evaluate the effectiveness of the program. The 20-minute program was used as a prepractice warm-up two to three times a week during the preseason period. It included three phases warm-up, dynamic stretching, and strengthening.

The participating athletes had a groin injury incidence of 0.44 injuries per 1,000 hours, while a control group had a groin injury rate of 0.61 injuries per 1,000 hours.

Our 28% injury reduction rate is highly significant, says principal investigator Michael B. Gerhardt, M.D., director of the Center for Athletic Hip and Groin Disorders in Santa Monica, Calif., and team physician for US Soccer and Chivas USA, a major league soccer team. We were anticipating a 5-10% reduction rate, so we were pleasantly surprised that the injury reduction number was so high.

Most professional soccer teams in Europe and the United States recognize groin injury as a major problem, according to Dr. Gerhardt. Groin injury accounts for a large amount of lost playing time. They are common in elite soccer players and especially problematic among male soccer players. The term groin injury encompasses a wide range of injuries ranging from minor groin strains to chronic groin injuries, such as sports hernias, which often require surgery.

The number of groin surgeries was also evaluated. Although not statistically significant, the athletes in the prevention session had fewer surgeries (0.13/1,000 hours) than the control subjects (0.18/1,000) who did not participate in the program. While we were able to prevent the total number of groin injuries, we were unable to significantly reduce the number of surgeries, comments Dr. Gerhardt. Once an injury reaches the chronic stage it is hard to manage with any treatment regimen, including ours. These players typically go on to require surgery.

Chronic injuries are defined as lasting a month or longer. Avoiding acute injuries, which the studys preseason injury prevention program was able to reduce, can hopefully prevent them.

If a simple 15- to 20-minute program can reduce the number of groin injuries that are occurring in professional athletes, I think it will gain widespread use, notes Dr. Gerhardt. Weve seen this with ACL prevention programs, which have been implemented successfully by a variety of teams around the world. I anticipate that professional soccer teams will want their players to participate in a program if it is simple, cost effective, and, most importantly, proven to reduce groin injury.

Dr. Gerhardt attributes the success of the prevention program to the multidisciplinary efforts of several expert therapists, trainers, and physicians.

Neoprene sleeve equal to knee brace during recovery from ACL surgery

Thu, 12 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CALGARY, Alberta -- Users of functional knee braces and neoprene sleeves have similar recoveries from anterior cruciate ligament (ACL) reconstruction, according to new research presented today at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center (July 12-15).

For patients returning to sport after ACL reconstruction, a functional knee brace, which is sturdy, elaborate, and expensive, does not provide advantages over a soft neoprene elastic sleeve, says principal investigator Trevor Birmingham, Ph.D., P.T., Canada Research Chair in musculoskeletal rehabilitation at the University of Western Ontario and the Fowler Kennedy Sport Medicine Clinic in London, Ontario.

ACL reconstruction surgery is common, particularly in young, athletic individuals. The ACL is an important ligament inside the knee that helps keep it stable. ACL reconstruction involves replacing the torn ACL with a strip of tendon called a graft. Approximately 100,000 ACL reconstructions are performed annually according to the American Academy of Orthopaedic Surgeons.

It is widely believed that the rigid support provided by a functional knee brace protects the graft and improves knee stability and function when the patient returns to sport after surgery and rehabilitation, explains Dr. Birmingham. Others believe that the additional support provided by a brace is not necessary.

To address this uncertainty, Dr. Birmingham and colleagues studied 150 athletes preparing to return to sport following ACL reconstruction. Seventy-six patients were randomized to receive a functional knee brace and 74 to receive a neoprene sleeve. The patients were instructed to wear the orthosis during all physical activities. The researchers found no significant differences between the groups at the one- and two-year follow-up visits.

Based on our clinical experience, we were not completely surprised by the results, Dr. Birmingham comments. These findings provide strong evidence that the average patient does not require a functional knee brace when returning to sport after ACL reconstruction. There may be some patients who will benefit from a brace, and identifying these individuals requires further research. Until then, these decisions are left to the surgeons discretion.

ACL functional knee braces are made by several different companies and have a variety of looks and fitting instructions. They are intended to limit abnormal movement of the knee and prevent excessive strain on the ACL or new graft. They generally provide a rigid support to restrain the knee, although they may also improve neuromuscular control of the knee. Most laboratory studies suggest that different types of functional knee braces perform similarly.

Neoprene sleeves are also made by several different companies and have different looks. Rather than providing rigid support, they are only intended to gently compress the area around the knee and improve neuromuscular control.

The study was large enough and had enough statistical power to detect even slight differences between the functional knee brace and sleeve groups. We can be confident that even if small but true differences between these groups exist, these differences are not large enough to be clinically important, concludes Dr. Birmingham. He notes that the study was not designed to test whether using a neoprene sleeve was better than using nothing at all.

Cigarette smoking impairs ligament healing, researchers find

Mon, 09 Jul 2007 10:00:00 PST

( from http://www.rxpgnews.com ) The list of reasons you shouldn't smoke has gotten longer. Researchers at Washington University School of Medicine in St. Louis are reporting that smoking interferes with ligament healing.

Studying mice with knee ligament injuries, the team discovered cigarette smoking impairs the recruitment of cells to the injury site and delays healing following ligament-repair surgery. They reported their findings in the Journal of Orthopaedic Research.

The researchers looked at the mouse medial collateral ligament (MCL), a ligament that supports the knee joint in both mice and people. Each year in the United States there are more than 20 million reported ligament injuries, and MCL injuries are the most common. They also are the most common injuries seen in competitive and recreational sports. It's not clear exactly how many MCL injuries occur annually because many go unreported.

A lot of MCL injuries never make it to an emergency room because patients will have a sore knee but don't seek treatment, says Rick W. Wright, M.D., associate professor of orthopaedic surgery and a senior investigator on the MCL study.

Previous studies have demonstrated that the mouse provides a good paradigm for what happens in injured human knees.

This is a good model for knee ligament injury, but it could be a model for ligament injuries anywhere in the body, says co-investigator Linda J. Sandell, Ph.D., professor of orthopaedic surgery. It's likely the biology is transferable to other knee ligaments, elbow ligaments, shoulder ligaments, you name it.

To look at the effects of smoking, Sandell, Wright and their colleagues used a system developed at the School of Medicine in which mice are placed inside smoking chambers six days per week. The mice don't actually have cigarettes in their mouths, but they get enough passive fumes to smoke two cigarettes daily, the equivalent of a person smoking about four packs per day. Mice were placed in the smoking chambers for two months prior to MCL surgery and then again after surgery to mimic the behavior of humans who continue to smoke following an injury.

The researchers say athletes who smoke should keep these findings in mind before driving for a lay-up, sliding into second base or lacing up a pair of ice skates.

The soft tissue healing that occurs following ligament injuries occurs in stages. There is an immediate pooling of blood near the injury, the sort of hemorrhaging that will cause swelling right away. This initial response is followed by several days of inflammation, in which cells called macrophages flock to the injury site and secrete substances called cytokines and chemokines. Those, in turn, recruit more cells to assist in healing. That process of cellular proliferation and synthesis lasts for several days to several weeks. The final stage of healing involves remodeling of the tissue and can continue for months and even years.

An earlier study found an increase in cell density and in gene activity to produce type I collagen in the first week following MCL injury, so in this study the researchers paid close attention to cell density, biomechanical function and gene expression during the first week after MCL repair. In mice exposed to cigarette smoke, cell density was lower and type I collagen gene expression was reduced.

Our studies also have shown a decreased macrophage response that may help explain why we see this delayed or decreased healing response, Wright says.

Between 20 and 25 percent of the U.S. population smokes. Wright and Sandell say that although the prevalence of smoking among athletes is slightly lower, a significant percentage of recreational and even professional athletes continue to smoke. Many others use chewing tobacco, which may cause some of the same effects. But that's not yet clear since the mice in this study were exposed to smoke rather than to nicotine only.

There are two ways to do smoking studies in animal models, Sandell explains. One looks only at a single component, like nicotine. The other way is to use a method like the one we employed that includes all of the toxins found in smoke. We think exposing the mice to cigarette smoke itself is most relevant because when people smoke, they don't get individual components. They get everything.

Sandell and Wright say their findings point to yet another reason smokers would do well to quit.

Many patients don't want to hear it, but these results suggest that smoking affects anyone who needs ligament-repair surgery. Wright says. I counsel surgery patients to at least try to decrease smoking because, if nothing else, that will improve the healing of their surgical incisions. Quitting smoking is good health management regardless, but in patients having this kind of surgery, there are extra advantages.

Wright and Sandell are conducting more studies. Currently they are comparing mice exposed to smoke before MCL surgery to those exposed both before and after surgery to see whether ending smoking might assist ligament healing.

Because ligament injuries usually occur suddenly, it's unlikely people will stop smoking until after their injury, Sandell says. So we want to learn whether smoking cessation near the time of surgery might help reverse the healing delays we saw in this study.

Children's scientists discover fundamental protein instrumental to brain development and repair

Sun, 08 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Washington, DCScientists at Childrens National Medical Center have demonstrated conclusively that a specific protein and its signaling activity are instrumental in myelination and remyelination, processes essential to the creation and repair of the brains white matter. This groundbreaking discovery in mouse models points the way to developing treatments or interventions to enhance healthy brain development and/or brain disease repair in children and adults. The paper will be published in the August issue of Nature Neuroscience.

By understanding the fundamental mechanisms of brain development, we get closer to finding clear instructions to repairing developmental brain disorders and injuries, said Vittorio Gallo, PhD, Director, Center for Neuroscience Research, Childrens Research Institute at Childrens National Medical Center.

Dr. Gallo and colleagues study used mouse models to identify an essential protein and its signaling activity in the processes of myelination and remyelination. These processes are relevant to white matter development and repair. When white matter is injured or defective, the essential functions of information relay are impaired. Underdeveloped white matter or white matter injuries are linked to conditions including mental retardation, cerebral palsy and multiple sclerosis.

Childrens National Medical Center is the ideal environment for complex research, said Dr. Gallo. We work collaboratively with research institutes around the world, and then we walk down the hall to confer with colleagues who are on the front line of direct clinical care. My colleagues in clinical research and care pioneered whole body cooling, which slows down brain damage underway in compromised newborns. Our breakthrough at the level of laboratory research will soon translate to the bedsides where they care for newborns.

If we can marry whole body cooling with new approaches that boost the activity of this essential protein, we may be able to slow down injury and enhance myelination, continued Dr. Gallo. Some day we may be able to repair brain damage and subsequent affects such as mental retardation, developmental disabilities or other disorders that result from incomplete myelination or white matter damage.

Myelination in humans begins in utero at around 5 months of gestation and continues throughout the first three years of life, but can be impaired for a number of reasons, most commonly intrauterine infection, reduced or interrupted blood flow (which carries oxygen and nutrients) to the forming infant brain, or perinatal injury. These conditions affect up to 30 percent of preterm babies, many with severe motor and cognitive deficits, such as in patients affected by cerebral palsy.

Remyelination is a natural attempt by the brain to repair damage of the white matter; however the brain does not have the ability to completely repair itself.

Dr. Gallo and colleagues work used enhanced epidermal growth factor receptor (EGFR) protein and activity to clearly demonstrate the role that this molecule plays as a catalyst to the natural processes of proliferation and migration of progenitor cells, which are integral to white matter development and repair. By first inserting enhanced EGFR protein and showing enhanced myelination/remyelination, and then using an EGFR protein with reduced biological activity and showing the decrease in myelination/remyelination Dr. Gallo and colleagues demonstrate that EGFR protein is an essential ingredient and that its signaling is instrumental in progenitor cell proliferation, migration, and in myelination and functional repair of white matter.

Dr. Gallos work reported in this paper specifically demonstrates the following:

University of Cincinnati receives $1.7M to research molecular treatment of brain injury

Thu, 05 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CINCINNATIThe National Institutes of Health has awarded $1.7 million to a University of Cincinnati (UC) scientist to do molecular research that could lead to better treatments for brain injury patients.

Kenneth Strauss, PhD, will study two types of molecules known as eicosanoids (eye-KO-sa-noids), which are created by injured brain cells, to confirm that they can actually protect healthy brain cells from further damage.

If successful, Strausss research could lead to a new class of drugs designed to enhance the levels of these helpful molecules, and thereby improve outcomes in patients who have suffered traumatic brain injury, the leading cause of death and disability among people aged 16 to 45.

One of my goals, says Strauss, a research associate professor of neurosurgery at UC and director of the Mayfield Neurotrauma Research Lab, is to develop therapies for traumatic brain injury, a condition for which there is no effective medical treatment.

When the brain suffers traumatic injury, Strauss explains, it automatically takes self-protective action. The brain cells release arachidonic acid, which triggers a series of events that draw additional cells to the injured site.

While some of the compounds resulting from the initial trauma appear to be protective and to inhibit harmful inflammation, Strauss says, others are harmful if they remain for too long. Their fight to save the injured brain can spill over into nearby areas, damaging neighboring structures.

Brain cells and immune system cells in the blood stream alter their function and essentially gather at the damage site, Strauss says. They can proliferate and release chemicals that cause the region to swell up. In their effort to either cordon off or repair the damage, they can also constrict blood vessels or attract even more cells into that area.

Thus far doctors have been unable to prevent or manipulate these progressive changes that follow traumatic brain injury.

Strauss and other researchers previously found that the enzyme COX-2 is one of the contributors to harmful inflammation. COX-2 increases following injury and, to the brains detriment, remains elevated for many days.

Strauss had originally been studying the potential of the arthritis drug Vioxx, a COX-2 inhibitor, for reducing inflammation in the injured brain. But his plan was shelved when Merck withdrew Vioxx in 2004 after clinical trials showed that long-term use increased the risk of heart attack and stroke.

Strauss then shifted his focus from suppression of the harmful COX-2 enzyme to the potential for elevating two theoretically helpful eicosanoids, known as HETEs and EETs.

We believe eicosanoids reduce the number of inflammatory cells that fester around the injury site and cause chronic tissue degeneration, Strauss says. We think this plays a role in impairment not only after trauma, but also after other brain injuries, including strokes, seizures and the chronic neurodegenerative conditions like Alzheimers disease.

Strauss hypothesizes that manipulating the chemistry of the injured brain cells to favor the creation of the beneficial eicosanoids will aid recovery from traumatic brain injury.

He will first study the phenomenon in rodents that have been genetically manipulated so that they produce either an abundance or an insufficient amount of the molecules.

He will also study unique compounds, provided by colleagues at the University of Texas Southwestern Medical Center and the University of California, Davis, that boost beneficial eicosanoids that occur naturally in the brain. These compounds could set the stage for the development of drugs that would benefit traumatic brain injury patients.

War trauma set to increase in the UK

Tue, 03 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The number of UK veterans suffering the debilitating effects of war trauma is set to increase, according to a University of Nottingham academic.

Research by Dr Nigel Hunt, Associate Professor in the Institute of Work, Health and Organisations, shows that, with no end in sight for the conflicts in Iraq and Afghanistan, more and more veterans will return home suffering the effects of war trauma. The condition covers a variety of problems relating to stress and emotion, and memory, social, work and family difficulties.

But by looking at the varying ways that different countries cope with their afflicted veterans, Dr Hunt hopes to identify the most effective ways of treating the condition. He has already visited Finland to examine the countrys well-established infrastructure for supporting veterans. And after speaking at Tehrans First Annual Congress of Social Security and Justice in May, Dr Hunt hopes to further explore support networks in Iran.

War trauma is a psychological condition caused by experiencing a traumatic event during conflict. The memory of the event triggers strong emotions, causing any number of reactions from depression and self-harm to anger, violence and drug addiction. Often, the symptoms will be so extreme that the veteran will be unable to live a normal life. Work prospects, family life and other relationships may be affected, exacerbating the symptoms and leading to an ever-increasing sense of isolation and worthlessness.

War trauma is a notoriously difficult disorder to assess and measure. The traumatic memories can be triggered by seemingly unrelated events, and in many case the symptoms do not appear for some time after the event a veteran can return home healthy with years passing before the condition develops.

And this is where the problems with treatment arise, according to Dr Hunt. If you start showing symptoms of war trauma during service you are the responsibility of the Ministry of Defence and you have access to a strong network of support and treatment, he said. But many people do not develop the condition until they have left the services, once they have lost the supportive network, spending time day to day with people who understand what they have been through and how they feel. Once out of the services, they are the responsibility of the NHS, where many practitioners dont have the experience and specialist knowledge to deal with people suffering from war trauma. And once they have been diagnosed, they can spend up to two years on a waiting list waiting to be treated.

During treatment, patients work with a psychologist to address their traumatic memory, revisiting and examining it again and again until the emotional response connected to it is disabled. If successful, the memory will always be unpleasant to recall, but will no longer trigger the extreme symptoms.

Dr Hunts research has also examined the universal and the cultural effects of war trauma.

The universal elements of the condition include the traumatic event, and the memory of that event, which triggers an emotional response. Also universal are the two basic elements of coping with the condition either addressing it or choosing to ignore it.

The cultural elements of war trauma cover the acknowledgement, treatment and support networks for the condition, as well as the way it manifests itself. This can vary broadly depending on the nationality, social background and religion of those suffering from the symptoms.

For example, in Finland veterans are the focus of a great deal of respect from their government and population. They are also offered annual respite care sessions at specially-built camps across the country. Here they can spend two weeks a year with other veterans, in a relaxing environment, with access to expert advice and help. As a result, Finland sees a very limited incidence of war trauma among its veterans.

But for veterans coming home to the UK find no such support network in place. Often, the only place for them to turn is oversubscribed charities such as Combat Stress and the Royal British Legion.

In Iran, theres a very strong religious support network in place, said Dr Hunt. The existence of war trauma is recognised, particularly in relation to the Iran-Iraq War, and people are supported by their religious belief and their relationship to their imam and mosque. Their reasons for going to war were just, because they were fighting for God, and their memories and injuries are justified by their devotion.

Here in the UK we dont have such a strong belief system. Those fighting in Iraq and Afghanistan are more likely to ask what they are fighting for. When they see horrific incidents, they might struggle to justify it in the context of the wider conflict. Unlike Iranian soldiers, they know they dont have the full support of the people back home. And when they do return home, a system isnt in place to deal with the resulting psychological problems. All of these factors will mean that war trauma amongst UK veterans will increase over the coming months and years unless significant extra funding and effort is dedicated to supporting them.

Blood clotting protein may inhibit spinal cord regeneration

Tue, 03 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Fibrinogen, a blood-clotting protein found in circulating blood, has been found to inhibit the growth of central nervous system neuronal cells, a process that is necessary for the regeneration of the spinal cord after traumatic injury. The findings by researchers at the University of California, San Diego (UCSD) School of Medicine, may explain why the human body is unable to repair itself after most spinal cord injuries.

The study, led by Katerina Akassoglou, Ph.D., assistant professor in UCSDs Department of Pharmacology, is the first evidence that when blood leaks into the nervous system, the blood protein contributes to the neurons inability to repair themselves. The findings, which show the molecular link between vascular and neuronal damage during injury to the central nervous system, was published in the online issue of the Proceedings of the National Academy of Sciences on July 2.

The research team studied three types of spinal cord injuries in mice and rats which resulted in cellular and vascular damage, and leakage of fibrinogen from the blood vessels. Once injured, neurons cannot be repaired because of various inhibitors that are present in the brain and the spinal cord after damage, which results in a patients paralysis. The researchers were surprised at the massive deposits of fibrinogen found at the sites of injury. That discovery led them to investigate the proteins effect on neuronal cells ability to regenerate.

Our study shows that fibrinogen directly affects neurons by inhibiting their ability for repair, said Akassoglou. Fibrinogen contained in the blood which leaks at the site of injury begins the process of inhibiting axonal growth by binding to the beta 3 integrin receptor. This binding, in turn, induces the activation of another receptor on the neuronal cells, called the epidermal growth factor receptor. When the second receptor is activated, it inhibits the axonal growth. Other inhibitors have been identified that use the same epidermal growth factor receptor, but this is the first blood-derived inhibitor that has been found.

The discovery may open the door to a possible strategy to improving recovery after spinal cord injury by discovering a way to block activation of neuronal receptors by fibrinogen. Identifying the specific inhibitors that impede the repair process could provide ways to regenerate and connect the damaged nerves and initiate recovery from paralysis after spinal cord injury.

Inhibiting the damaging effects of fibrinogen on neurons may potentially facilitate repair in the nervous system after injury said Akassoglou. A similar mechanism could be at work in other neurological diseases that result in paralysis, such as multiple sclerosis or hemorrhagic stroke, where blood vessels break and bleed into the brain. She added that such a therapeutic approach wouldnt interfere with fibrinogens essential role in coagulation, because its blood-clotting mechanism depends on binding with a different receptor.

More than just bare bones -- New research suggests emotions can affect recovery from hip surgery

Tue, 26 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) ST. LOUIS -- A patients emotional state plays a significant role in his or her recovery from hip surgery, suggests Saint Louis University research published this month.

Orthopaedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function given by the doctor, and the second is a questionnaire patients answer that considers a wide variety of factors in determining the overall success of the surgical procedure.

We started out simply looking to see if the results of the two tests were correlated; the one doctors give has been used for decades to evaluate hip function, and the other that the patient answers is much newer, says Berton Moed, M.D., chair of the department of orthopaedic surgery at Saint Louis University School of Medicine. What we found was surprising the clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery.

The disparity, says Moed, can be explained by a section of questions on the self-test not addressed by the clinical test: those dealing with emotional well-being. A patients emotional status was the second-most important factor in determining how well he or she thought recovery was going, Moed found. (Mobility was the first.)

Patients come in for check-ups after their hip surgery and the doctor says, Looks like youre doing fabulously, and they respond, No, Im not. I ache, Moed says. Theyre not doing well, but why It appears to have a lot to do with their emotional state. Its the elephant in the exam room that is, something doctors need to acknowledge is a real issue.

Rather than retool the established clinical test to include an emotional component, Moed says orthopaedic surgeons should make efforts to use both exams for a more comprehensive measure of the patients recovery.

Do we need to look at other interventions besides fixing their hip I think we might have to, he says. That could include bringing in social workers and psychologists to work with the patients in the areas that surgeons, who often are super subspecialists, may not be able to deal with.

Moed says both underlying depression and new depression brought on by the injury and/or surgery could be to blame for slowing a patients recovery.

When an active person is suddenly confined to the bed or to limited activity, it can take a toll, Moed says. Not being able to do the things one used and feeling powerless over it may play a larger role than we thought in how well the patient feels theyre recovering.

While Moed says some patients may be taken aback by the suggestion that they see a psychologist after surgery, he thinks developing better and more customized treatment plans has the potential to help patients recover more fully and not just after hip surgery.

The number one issue is recognition we need to acknowledge that theres more going on with patients than what current clinical tests tell us, he says.

Old memory traces in brain may trigger chronic pain

Mon, 04 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- Why do so many people continue to suffer from life-altering, chronic pain long after their injuries have actually healed

The definitive answer -- and an effective treatment -- has long eluded scientists. Traditional analgesic drugs, such as aspirin and morphine derivatives, havent worked very well.

A Northwestern University researcher has found a key source of chronic pain appears to be an old memory trace that essentially gets stuck in the prefrontal cortex, the site of emotion and learning. The brain seems to remember the injury as if it were fresh and cant forget it.

With new understanding of the pain source, Vania Apkarian, professor of physiology, and of anesthesiology, at Northwesterns Feinberg School of Medicine, has identified a drug that controls persistent nerve pain by targeting the part of the brain that experiences the emotional suffering of pain. The drug is D-Cycloserine, which has been used to treat phobic behavior over the past decade.

In animal studies, D-Cycloserine appeared to significantly diminish the emotional suffering from pain as well as reduce the sensitivity of the formerly injured site. It also controlled nerve pain resulting from chemotherapy, noted Apkarian, who is a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

The drug has long-term benefits. Animals appeared to be pain free 30 days after the last dose of a 30-day regime of D-Cycloserine.

The study, funded by the National Institutes of Health, will be published in the journal Pain this fall. (It has been published on-line.)

In some ways, you can think of chronic pain as the inability to turn off the memory of the pain, Apkarian said. Whats exciting is that we now may be relieving what has clinically been the most difficult to treatthe suffering or the emotional component of pain.

Scientists have always tried to understand pain from the viewpoint of sensation, Apkarian said. To control it, they tried to stop the sensory input to the brain. We are saying theres a cognitive memory and emotional component in the brain that seems abnormal. Easing that may have a bigger effect on suffering.

Chronic pain is not caused by a single mechanism, Apkarian noted. Sensory abnormalities in people with chronic pain probably drive this memory abnormality.

About 10 percent of the United States population suffers from chronic pain, of which the majority is back pain.

One of Apkarians studies with rats tried to separately measure their emotional suffering and their physical pain after being treated with the drug. (The rats had chronic pain from a healed limb injury.) The results indicated the animals emotional suffering decreased much more than their physical pain. While the physical pain appeared to be reduced 30 percent their emotional suffering completely disappeared.

Rat are nocturnal animals that prefer to be in the dark and are averse to bright light. Researchers placed the rats in a two-compartment chamber - one side light, one dark. When the rats were in their preferred dark side, scientists mechanically stimulated their sensitive limbs. The rats didnt like that and bolted into the bright chamber, where they remained. Next scientists took the same rats and treated them with DCycloserine. Again, scientists stimulated the rats sensitive limbs. This time, however, the rats remained in the dark chamber.

Their aversive reaction to the stimulation disappeared, Apkarian said.

Based on the animal results, the next step will be to test the drug in clinical trials, Apkarian said.

When we do this in a clinical trial, we expect people to say I still have the pain, but its not bothering me anymore, Apkarian said. We think they will have a physical awareness of the pain, but its emotional consequences will have decreased. He said the drug potentially may lower the amount of standard analgesics people have to use.

In Apkarians previous study, published in late 2006, he revealed that chronic back pain appears in a different part of the brain than the discomfort of burning your finger, for example. With a functional MRI, he found that chronic back pain shows up in the prefrontal cortex. By contrast, the acute sensory pain of the burned finger appears in the sensory part of the thalamus.

Apkarian also found that the longer a person has been suffering from chronic pain, the more activity in the prefrontal cortex. He was able to predict the years of their suffering from the MRI.

Its cumulative memory, he explained. I can predict with 90 percent accuracy how many years they have been living in that pain without even asking them the question.

Explaining a link between strokes and Alzheimer's

Mon, 04 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) University of Leeds scientists have shown how stroke victims could be more vulnerable to Alzheimers disease years or even decades after making a full recovery.

It has been known for some time that the two conditions were linked, but now the Leeds team has shown how an incident of reduced oxygen to the brain caused by the stroke can leave the patient vulnerable to the gradual build-up of toxic chemicals which can cause Alzheimers.

The research was led by Professor Chris Peers of the Universitys school of medicine, who explained: Our research is looking into what happens when oxygen levels in the brain are reduced by a number of factors, from long-term conditions like emphysema and angina, to sudden incidents such as a heart attack, stroke or even head trauma. Even though the patient may outwardly recover, the hidden cell damage may be irreversible.

It could even be an issue for people who snore heavily, whose sleep patterns are such that there will be times in the night when their brain is hypoxic deprived of sufficient oxygen. It can be anything that stops the heart and lungs working together to their optimal capabilities.

The research centred on the damage done by these low-oxygen incidents to a group of brain cells called astrocytes. When the brain is functioning normally, it makes connections through the release of tiny amounts of chemical across the synapses. Once the chemical has been transmitted, it is mopped up by the astrocytes.

The Leeds team which also includes Dr John Boyle in the Faculty of Medicine and Health and Dr Hugh Pearson of the Faculty of Biological Sciences has shown that if at some point the astrocytes have become hypoxic, they are less able to mop up these transmitters, allowing the residual chemicals to accumulate and become toxic.

This is an important factor in whats going on in hypoxic brains, said Prof Peers, whose work received funding from the Alzheimers Society and the Alzheimers Research Trust. Astrocytes are just as essential as neurones for normal brain function and we have ten times as many of them.

Professor Susanne Sorensen, head of research at the Alzheimer's Society, added: The team examined the role of cells that support neurones in the brain. This is exciting because rather than focussing on neurones they looked at processes in the brain, which until now have not be researched in so much detail.

In another project, the team is investigating two key signalling molecules which are very sensitive to fluctuations in oxygen levels. The scientists suspect that in low oxygen conditions these molecules could begin the increased production of a toxic protein called amyloid which builds up in the brains of people with Alzheimers.

The work at Leeds is part of a network of research projects nationally and internationally, which are adding to the sum of knowledge about a disease which costs the UK more than cancer, heart disease and stroke combined.

There are around 700,000 people in the UK currently suffering with dementia a figure that is set to more than double by 2050, simply because we are living longer. And the disparity between funding levels for research into different conditions is stark, as Prof Peers explained: For every cancer patient in this country, between £300 and £400 is spent every year on research. For Alzheimers sufferers it is closer to £15, yet sufferers can need full-time care for the last 20 to 30 years of their lives, so any research into intervention can be really cost-effective in the long term.

Researchers use MRI to predict recovery after spinal cord injury

Tue, 29 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) OAK BROOK, Ill. -- Using magnetic resonance imaging (MRI), radiologists can better predict the likelihood of full or partial recovery of patients with acute spinal cord injuries (SCI), according to a study published in the June issue of the journal Radiology.

Our study demonstrates that the possibility and extent of neurological recovery after SCI can be predicted within 48 hours after injury by rigorous assessment of MR images, said co-author Michael G. Fehlings, M.D., Ph.D., F.R.C.S.C., professor of neurosurgery at the University of Toronto and medical director at the Krembil Neuroscience Centre at Toronto Western Hospital. In addition, Dr. Fehlings said, these findings could result in a more aggressive clinical strategy for patients who may appear to have a severe SCI but may indeed have the capacity for substantial neurological recovery.

According to the National Spinal Cord Association, 250,000 to 400,000 people in the United States are living with SCI or spinal dysfunction. An estimated 7,800 new cases of SCI occur each year. Motor vehicle accidents account for 44 percent of these injuries in the U.S.

An initial MRI examination is typically performed on patients with SCI to determine the degree of neurological damage, as well as a possible prognosis. MRI findings may include cord hemorrhage, swelling, soft tissue and ligament injury, blood clots or herniated discs.

Dr. Fehlings study included 100 patients with traumatic cervical SCI. The group consisted of 79 men and 21 women between the ages of 17 and 96. Complete motor and sensory SCI was seen in 26 patients, incomplete SCI was seen in 51 patients, and 22 patients were neurologically intact upon admission. One patient could not be classified. The majority of the patients had been injured in motor vehicle accidents.

MRI exams were obtained within 24 to 48 hours of injury. The research team studied three measurable imaging parameters: maximum spinal cord compression (MSCC), maximum canal compromise (MCC) and length of lesion (LOL). They also looked at other factors, including bleeding within the spine, swelling and soft tissue injury.

The results showed that severity of MSCC, bleeding and cord swelling were key indicators of a poor prognosis after SCI. Conversely, the absence of these symptoms indicated a good chance for neurological recovery even if the injury otherwise appeared severe.

Since the severity of spinal cord compression is a predictor of outcome after SCI, this study suggests that MRI may predict which patients would benefit the most from decompressive surgery, Dr. Fehlings said.

He added that MRI should be performed on all patients with acute SCI whenever feasible as it provides information with prognostic value and serves to guide the clinician to optimize clinical care.

Scientists find war vets' hand dexterity determines susceptibility to PTSD

Tue, 22 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) DANVILLE, PA. A recent study conducted by investigators with the Geisinger Center for Health Research shows a clear link between combat veterans' use of both hands for common tasks and the likelihood that they will experience post-traumatic stress disorder (PTSD).

Combat veterans with an extreme level of mixed handedness are nearly twice as likely to develop (PTSD) after combat compared to veterans who use both hands less often, according to the study, which is being published in the May issue of Psychosomatic Medicine.

The study also found that veterans with extreme mixed handedness and high combat exposure were nearly five times more likely to have PTSD than those with lower degrees of mixed handedness.

Joseph Boscarino, PhD, MPH and Stuart Hoffman, DO of the Geisinger Center for Health Research measured PTSD and handedness among a national sample of 2,490 Vietnam veterans exposed to combat.

These findings suggest the possibility of a pre-existing biological vulnerability for PTSD, said Boscarino, the study's principal investigator. We know generally what type of soldier is likely to suffer from PTSD, before they go into combat.

While other studies on handedness and PTSD have yielded similar results, those prior studies were too small to draw significant conclusions. Boscarino's groundbreaking study examined a much larger group of patients, and therefore the results are more applicable to a large group of veterans.

Given the research, it might be beneficial to screen people entering high-risk occupations such as the military for handedness, Boscarino said. If pre-screening doesn't occur, the healthcare community should at least make sure that these people receive adequate post stress exposure help.

In today's context, even brief psycho-social interventions for military personnel returning from Iraq and Afghanistan could significantly reduce the risk of PTSD, said Boscarino, a Vietnam combat veteran himself.

Although therapy doesn't necessarily have to be extensive, it should occur shortly after a person has experienced a traumatic event such as combat or a natural disaster. Treatment may be critical to avoiding depression, PTSD and substance abuse related problems following such exposures, Boscarino said.

It has been theorized that people with a lesser de¬gree of cerebral lateralization, as measured by mixed handedness, would have a greater likelihood of developing PTSD. This is because the right brain hemisphere is believed to be significant in threat identification and in the regulation of emotion responses.

People with reduced cerebral lateralization for language, as indexed by increased mixed-handedness, were thought to be more sensitive to perceived threat and prone to experience emotions more intensity. This was because their cerebral organization was thought to give primacy to right hemisphere contri¬butions in cognitive processes.

What we've found is a near conclusive link between handedness and a person's predisposition toward PTSD, Boscarino said. These findings may be useful in mitigating some of the adverse outcomes associated with traumatic stressor exposures.

Nanomedicine opens the way for nerve cell regeneration

Sun, 20 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The ability to regenerate nerve cells in the body could reduce the effects of trauma and disease in a dramatic way. In two presentations at the NSTI Nanotech 2007 Conference, researchers describe the use of nanotechnology to enhance the regeneration of nerve cells. In the first method, developed at the University of Miami, researchers show how magnetic nanoparticles (MNPs) may be used to create mechanical tension that stimulates the growth and elongation of axons of the central nervous system neurons. The second method from the University of California, Berkeley uses aligned nanofibers containing one or more growth factors to provide a bioactive matrix where nerve cells can regrow.

It is known that injured neurons in the central nervous system (CNS) do not regenerate, but it is not clear why. Adult CNS neurons may lack an intrinsic capacity for rapid regeneration, and CNS glia create an inhibitory environment for growth after injury. Can these challenges be overcome even before we fully understand them at a molecular level why axons in central nervous system do not regenerate Dr. Mauris N. De Silva describes the novel nanotechnology based approach designed that includes the use of magnetic nanoparticles and magnetic fields for addressing the challenges associated with regeneration of central nervous system after injury. By providing mechanical tension to the regrowing axon, we may be able to enhance the regenerative axon growth in vivo. This mechanically induced neurite outgrowth may provide a possible method for bypassing the inhibitory interface and the tissue beyond a CNS related injury. Using optic nerve and spinal cord tissues as in vivo models and dissociated retinal ganglion neurons as an in vitro model, De Silva and his colleagues are currently investigating how these magnetic nanoparticles can be incorporated into neurons and axons at the site of injury. Although, this study is at a very preliminary stage to explore the possibility of using magnetic nanoparticles for enhancing in vivo axon regeneration, this work may have significant implications for the treatment of spinal cord injuries, and is a vital next step in bringing this new technology to clinical use.

The second presentation focuses on peripheral nerve injury, which affects 2.8% of all trauma patients and quite often results in lifelong disability. Since peripheral nerves relay signals between the brain and the rest of the body, injury to these nerves results in loss of sensory and motor function. Upper extremity paralysis alone affects more than 300,000 individuals annually in the US. The most serious form of peripheral nerve injury is complete severance of the nerve. The severed nerve can regenerate; the nerve fibers from the nerve end closest to the spinal cord have to grow across the injury gap, enter the other nerve segment and then work their way through to their end targets (skin, muscle, etc). Usually, when the gap between the severed nerve endings is larger than a few millimeters, the nerve does not regenerate on its own. If left untreated, the end result is permanent sensory and motor paralysis. A few hundred thousand people suffer from this debilitating condition annually in the US.

Currently, the most successful form of treatment is to take a section of healthy nerve (autograft) from another part of the patient's body to bridge the damaged one. This autograft then serves as a guide for nerve fibers to cross the injury gap. Although successful, this autograft procedure has major drawbacks including loss of function at the donor site, multiple surgeries and, quite often, it's just not possible to find a suitable nerve to use as a graft. Various synthetic nerve grafts are currently available but none work better than the autograft and can't bridge gaps larger than 4 centimeters.

Researchers at the University of California, Berkeley have developed a technology that has the potential to serve as a better alternative than currently available synthetic nerve grafts. The graft material is composed entirely of aligned nanoscale polymer fibers. These polymer fibers act as physical guides for regenerating nerve fibers. They have also developed a way to make these aligned nanofibers bioactive by attaching various biochemicals directly onto the surfaces of the nanofibers. Thus, the bioactive aligned nanofiber technology mimics the nerve autograft by providing both physical and biochemical cues to enhance and direct nerve growth.

This technology has been tested by culturing rat nerve tissue ex vivo on our bioactive aligned nanofiber scaffolds. When the nerve tissue was cultured on unaligned nanofibers there was no nerve fiber growth onto the scaffolds. However, on aligned nanofiber scaffolds, they not only observed nerve fibers growing from the tissue but the nerve fibers were aligned in the same orientation as the nanofibers. Furthermore, when there were biochemicals present on the nanofibers, the nerve fiber growth was enhanced 5 fold. In a matter of just 5 days, nerve fibers had extended 4 millimeters from the nerve tissue in a bipolar fashion on the bioactive aligned nanofiber scaffolds. Thus, this technology can induce, enhance and direct nerve fiber regeneration in a straight and organized manner.

In order to make the technology clinically viable, they have also developed a novel graft fabrication technology in their laboratory. The most common method for fabricating polymer nanofibers is to use an electrical field to spin very thin fibers. This technique is called electrospinning and can be used to make nanofiber scaffolds in various shapes such as sheets and tubes. They have made a key innovation to this technology that enables us to fabricate tubular nerve grafts composed entirely of polymer nanofibers aligned along the length of tubes. This technology also allows customization of the length, diameter and thickness of the aligned tubular nanofiber grafts. The group will evaluate the performance of these aligned nanofiber nerve grafts in small animal pre-clinical studies starting in mid-May.

The technology presented herein is being patented by the University of California, Berkeley and has been licensed to NanoNerve, Inc.

According to Principal Investigator, Shyam Patel, Speed is the key to successful nerve regeneration. Our aligned nanofiber technology takes full advantage of the fact that the shortest distance between damaged nerve endings is a straight line. It directs straightforward nerve growth and never lets them stray from the fast lane.

Bali bomb lessons helped shape Australia's mental health response to terrorism and trauma

Thu, 17 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Australian healthcare professionals were able to offer better mental health support to the victims of the 2005 Bali bombings, thanks to improved procedures and services introduced after the first explosions in 2002, according to the May issue of the UK-based Journal of Psychiatric and Mental Health Nursing.

Staff at the Royal Darwin Hospital who treated many of the casualties - also received vital personal support from mental health nurses, especially as they waited anxiously for the first victims to arrive.

The 2002 bombings were Australia's first large-scale introduction to terrorist activity in the immediate geographical area and they initiated a new phase of trauma response for public health services in the country says Anthony Guscott of Top End Mental Health Services, which provides in-patient and consultation liaison nursing services at the Royal Darwin Hospital.

A national mental health response to mass trauma was established and this proved particularly useful to the Royal Darwin Hospital, which handled a large number of casualties from both bombings.

The national group driving the national mental health guidance were also able to draw on their experiences of other traumatic events, including the Eyre Peninsula bushfires that killed nine people and injured 110 in South Australia in January 2005.

This national guidance was then used to shape more effective local front line mental health services to cover both day-to-day needs and cope with major incidents. For example, the Royal Darwin Hospital now has a round-the-clock mental health presence in the emergency department and other departments can call on out-of-hours' support as needed.

Many of the bomb victims suffered profound mental health problems immediately after the bombings. In 2002 the mental health response was poorly planned, but the lessons learnt from the first incident meant that in 2005 patients' physical and mental health needs were better co-ordinated by staff who had already recognised and established a stronger link between trauma and psychiatric support.

Just over 200 people were killed by the 2002 bombs, including 88 Australians, and hundreds more suffered burns and other injuries. Many of the victims injured in the suicide bombings at Paddy's Bar and the Sari Club in Kuta were taken to the Royal Darwin Hospital to be stabilised before being moved to other hospitals. A high proportion had suffered chemical burns.

A senior psychiatrist and the director of mental health nursing were available to provide advice, but no psychiatric reviews were requested by staff who treated the victims or prepared them for transfer to hospitals in their home states.

The experience in 2005 was very different.

Twenty people were killed and 129 wounded in the bombings in October 2005 four Australians died and 19 were injured. On this occasion the majority of deaths and injuries were caused by shrapnel rather than burns.

Top End Mental Health Services' staff were involved in the trauma planning sessions as soon as word of the bombings reached the hospital.

The experienced mental health nurses who had previously worked with people affected by the Eyre Peninsula bushfires provided a high profile presence in the emergency department, for patients and staff alike, from the moment casualties were admitted. And all patients underwent a mental health review before being moved to hospitals in their home states.

Staff saw victims who had severe shrapnel wounds and were physically and emotionally affected by the bombings says Guscott.

They experienced depersonalisation, disassociation, disbelief and anger. Many described greater physical pain than their injuries would be expected to cause, together with a physical ache over their losses, thoughts of what could have been and the futility of the situation.

All spoke in their own ways of how they felt their safety and personal space had been violated.

And because the 2005 bombs were detonated at dinner time, some victims found it difficult to eat and became anxious at mealtimes.

The early intervention by mental health nurses proved invaluable for many of the patients.

In a short period many changed from providing limited verbal responses to starting to communicate more confidently.

The mental health nurses also provided vital, confidential support for other hospital healthcare staff while they were waiting for the victims to arrive and ongoing support while they treated them.

Some staff described the eeriness of the ward waiting to receive incoming patients and other were anxious about what to expect having been involved in caring for bomb victims three years earlier says Guscott. And a number of general nurses and support staff also experienced disturbing phenomena such as the smell of burning flesh a throwback to the chemical burn victims treated by the hospital in 2002.

Following the 2005 incident hospital staff also took part in feedback sessions run by mental health staff so that their comments could be used to make any further improvements to the major incident plan and identify any ongoing staff support that was needed.

Guscott doubts whether the Royal Darwin would have handled the second bombing as effectively without the lessons learnt from the first.

The fact that mental health nurses had become a recognised part of the hospital establishment between the two incidents meant that staff worked together in a much more co-ordinated way to help the victims of the second bombing he says. They also recognised that the mental health nurses could provide them with the support they needed to handle the trauma.

Obesity increases risk of injury on the job

Tue, 15 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Having a body mass index (BMI) in the overweight or obese range increases the risk of traumatic workplace injury, according to researchers at the Johns Hopkins Bloomberg School of Public Health's Center for Injury Research and Policy. Employer-sponsored weight loss and maintenance programs should be considered as part of a well-rounded workplace safety plan. The study was Advance Access published on May 7, 2007, by the American Journal of Epidemiology.

BMI is a measure of body fat based on an adult's height and weight. It is used to screen for weight categories that may lead to health problems. According to the Centers for Disease Control and Prevention, a BMI below 18.5 is considered underweight, 18.524.9 is normal; 2529.9 is overweight and over 30 is obese.

Clearly, limited resources for workplace injury prevention and control should target the most prominent and modifiable risk factors, but we cannot neglect the fact that our study and other recently published studies support an association between BMI and the risk, distribution and prevalence of workplace injury, said Keshia M. Pollack, PhD, MPH lead author of the study and an assistant professor in the Bloomberg School of Public Health's Department of Health Policy and Management.

The researchers used medical and injury surveillance data on hourly workers employed in eight plants of the same aluminum manufacturer to determine whether increased BMI was a risk factor for workplace injury. The plants were scattered across the United States. BMI was calculated using National Institutes of Health criteria. Employees were grouped into five categories: underweight, normal, overweight, obesity levels I and II and obesity level III.

Of the 7,690 workers included in the study, 29 percent were injured at least once between January 2, 2002, and December 31, 2004. Approximately 85 percent of the injured workers were classified as overweight or obese. More than 28 percent of injuries occurred among employees classified as overweight, 30 percent in the obese I and II category and almost 34 percent in the obese III category.

The severely obese group who had a BMI of greater than 40 also had the most injuries to the hand/wrist/finger (22 percent) when compared to the same injuries in the other weight categories. Almost 10 percent of all injuries in the obese III group were to the leg/knee, compared to 7 percent of workers classified as overweight, which was the next highest injury rate.

We know that obesity prevention policies and programs in the workplace are important simply because of likely improvements in employee health, said Pollack, the Leon S. Robertson Faculty Development Chair in Injury Prevention. What we do not know is if obesity prevention in the workplace will also have the added benefit of improving injury rates and reducing lost work time. Evaluations of worksite health promotion and obesity prevention efforts should measure changes not only in employee health, but also traumatic injury.

The researchers say that more work will be needed to test the effectiveness for reducing weight among hourly (non-office) employees who face a number of barriers to participating in worksite physical activity programs, such as the need to remove protective clothing for midday exercise and a lack of time because of additional employment or home responsibilities.

Weill Cornell researchers use 'Virtual Iraq' simulation to study post-traumatic stress disorder

Mon, 14 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (May 14, 2007) -- Weill Cornell Medical College researchers are using a virtual reality simulation called Virtual Iraq to better understand how symptoms of post-traumatic stress disorder (PTSD) develop. In their ongoing research trial, participating Iraq War and Gulf War veterans with and without PTSD are shown a brief, 3-D virtual-reality simulation of an urban combat scenario. They wear a headset, through which they hear, see, and -- using a keypad -- move through a virtual world in which images change in a natural way along with head and body movement.

A recent Archives of Internal Medicine study found that as many as 13 percent of recent veterans are diagnosed with PTSD.

The Weill Cornell researchers are testing whether physiological arousal (heart rate, stress hormones) and anxiety while viewing the simulation -- as well as suppressing memories after viewing the simulation -- affect the ability to remember the scenario and suppress intrusive scenario memories.

The study's principal investigator, Dr. Loretta Malta, a clinical psychologist at Weill Cornell Medical College, states: It isn't possible after a traumatic event to study, in a controlled way, conditions that lead to the development of specific types of PTSD symptoms. Usually this is studied by comparing people who develop PTSD months or even years after trauma exposure. With this pilot study, we are trying to develop a paradigm in which we can use virtual reality to learn more about how the responses of people exposed to trauma contribute to the development of PTSD re-experiencing symptoms, like intrusive memories or physiological reactivity to trauma reminders. By better understanding how PTSD symptoms develop, we hope to create effective prevention programs and improve current treatments.

The researchers are testing the hypothesis that verbalizing the traumatic experience, instead of suppressing it, enables patients to better integrate the experience into regular conscious memory, in turn, making the triggering of intrusive traumatic memories (and other re-experiencing symptoms, like flashbacks) less likely. Research suggests that memories formed during trauma exposure are easily cued by environmental stimuli, and memory suppression has been associated with the development, maintenance and severity of PTSD, adds Dr. Malta.

One of every 10 persons will develop PTSD during their lifetime, potentially resulting in chronic distress and debilitation. Exposure to aversive events evokes the release of stress hormones and neurotransmitters that, in animal models, have been shown to facilitate the learning of highly persistent conditioned fear associations and responses.

The study includes a diagnostic assessment of PTSD and other mental health problems, and veterans in need of treatment are provided with treatment referrals. It is open to Iraq War or Gulf War English-speaking veterans, aged 18 to 55, with and without PTSD. A total of 44 patients will be recruited throughout 2007.

The Virtual Iraq virtual-reality environment was developed by Dr. Albert Rizzo of the University of Southern California (USC) Creative Technologies Laboratory and Ken Graap of Virtually Better, Decatur, Ga., with funding from the U.S. Naval Research Office.

Study offers clues to 'Broken Heart Syndrome'

Thu, 10 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) (May 10, 2007ORLANDO, FL)The causes of broken heart syndrome remain a mystery, but doctors will soon have an easier time recognizing and treating this rare, life-threatening condition, thanks to data being reported at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI), May 912, 2007, in Orlando, FL.

Researchers from Brown University in Providence, RI, have developed the largest registry of patients in the United States with Takotsubo cardiomyopathy, informally known as broken heart syndrome because it is often preceded by an emotional or physical shock of some kind and almost always strikes women. One thing is certain: Patients are usually critically ill during the first 48 hours.

These patients can be difficult to manage for emergency physicians and cardiologists alike, said cardiology fellow Richard Regnante, M.D. They may be in cardiac arrest, cardiogenic shock, or severe heart failure. They may require advanced life support with airway management and medications to support blood pressure.

In fact, based on symptoms, electrocardiographic (ECG) tracings, and blood tests for heart damage, it often seems as if the patient is having a heart attack. The mystery deepens in the cardiac catheterization laboratory, when the interventional cardiologist finds no blockage in the coronary arteries.

To date, the registry has enrolled 40 patients diagnosed with Takotsubo cardiomyopathy at two major hospitals in Rhode Island over a period of nearly 2½ years. Ninety-five percent were women, and 60 percent experienced some type of stress shortly before coming to the emergency room. The intensity of the stress varied dramatically, however, ranging from armed robbery to a heated argument, tooth extraction, or preparation for a colonoscopy.

We don't know why some women develop this syndrome after what appears to be minimal stress, while other women experience severely stressful events but don't develop Takotsubo cardiomyopathy, Dr. Regnante said. A surge of stress hormones likely plays a role, he said, but it is also possible that a blood clot temporarily blocks a major artery of the heart, then dissolves before being detected during coronary angiography.

The most common symptom of broken heart syndrome was chest pain, in 70 percent of patients, followed by shortness of breath in 33 percent. All patients had ECG changes suggestive of an acute coronary syndrome, a term that encompasses both heart attack and unstable angina. Troponin-I, a blood test for heart damage, was positive in 95 percent of patients. Twenty percent of patients were unable to breathe on their own and needed a respirator. In all patients, cardiac catheterization showed characteristic abnormalities in the motion of the heart. One patient died of acute heart failure.

The good news is that most patients who survived the first 48 hours had a steady recovery. Thirty one, or 78 percent, of patients had follow-up echocardiography within a few weeks. Heart function was found to be normal in 29 of 30.

Dr. Regnante said that long-term follow-up will be critical to improved understanding of Takotsubo cardiomyopathy. In addition, he and his colleagues are gathering information on patients who have intravascular ultrasound during cardiac catheterization. This imaging test, in which a tiny ultrasound probe is threaded into the coronary arteries on the tip of a catheter, may show whether the patient has clogged arteries or unstable plaques that are not visible on coronary angiography. These findings will help guide long-term treatment.

Because we don't yet know what causes this phenomenon, we don't know what the best long-term management should include, he said. As we gather more information on these patients, we can start to understand who is affected by Takotsubo cardiomyopathy, offer more focused long-term care, and make predictions about their outcomes.

Researchers publish first marsupial genome sequence

Wed, 09 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) BETHESDA, Md., Wed., May 9, 2007 An international team, led by researchers at the Broad Institute of MIT and Harvard, and supported by the National Institutes of Health (NIH), today announced the publication of the first genome of a marsupial, belonging to a South American species of opossum. In a comparison of the marsupial genome to genomes of non-marsupials, including human, published in the May 10 issue of the journal Nature, the team found that most innovations leading to the human genome sequence lie not in protein-coding genes, but in areas that until recently were referred to as junk DNA.

The effort to generate the high-quality genome sequence of the gray short-tailed, South American opossum, Monodelphis domestica, began in 2003 and cost approximately $25 million. The sequencing work was funded by the National Human Genome Research Institute (NHGRI), part of the NIH, and carried out at the Broad Institute Sequencing Platform, which is a member of NHGRI's Large-Scale Sequencing Research Network.

The opossum genome occupies a unique position on the tree of life. This analysis fills a crucial gap in our understanding of how mammalian genomes, including our own, have evolved over millions of years, said NHGRI Director Francis S. Collins, M.D., Ph.D. These new findings illustrate how important it is to understand all of the human genome, not just the fraction that contains genes that code for proteins. We must identify all functional elements in the genome if we are to have the most complete toolbox possible to explore human biology and improve human health.

Marsupials are unique among mammals because their young are born at an extremely early stage of development, attach to their mother's teats and complete their subsequent development while in a protective pouch. This makes the young readily available for early developmental research.

There are many other areas of biomedical research for which Monodelphis serves as a model. For example, it is the only laboratory animal known in which ultraviolet radiation alone can cause melanoma, a type of skin cancer that also strikes humans exposed to too much of the sun's ultraviolet rays. Having the sequence of the opossum genome will give researchers the ability to learn more about the molecular basis of melanoma and its progression, as well as explore development of new therapies and preventive treatments.

The opossum genome sequence also provides researchers with a fresh perspective on the evolutionary origins of the human genome. It sheds light on the genetic differences between placental mammals, such as humans, mice and dogs, and marsupial mammals, such as opossums and kangaroos.

Marsupials are the closest living relatives of placental mammals. Because of this relationship, the opossum genome offers a unique lens though which to view the evolution of our own genome, said Kirstin Lindblad-Toh, Ph.D., co-director of the Broad Institute's genome sequencing and analysis program and the study's senior author.

Marsupials and the ancestors of placental mammals diverged 180 million years ago. By comparing the opossum and human genomes, researchers were able to pinpoint genetic elements that are present in placental mammals, but missing from marsupials that is, the genetic factors that may underlie many of the differences between the two types of mammals.

Interestingly, about one-fifth of the key functional elements in the human genome arose during this relatively recent evolutionary period. By focusing on the recent genetic innovations, the scientists made two major findings:

Agent protects cells from lethal effects of radiation even if given after exposure

Tue, 08 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) No drugs exist to protect the public from the high levels of radiation that could be released by a dirty bomb or nuclear explosion. Such excessive exposure typically causes death within weeks as the radiation kills blood cells vital to clotting and fighting infection, along with the stem cells needed to replenish their supply. But now researchers at Washington University School of Medicine in St. Louis report they have developed an agent that protects cells from the lethal effects of radiation, regardless of whether it is given before or after exposure.

Using this agent in mice, the investigators found that the treatment helped shield rapidly dividing cells that are most vulnerable to radiation-induced death, providing proof in principle that it is possible to fend off radiation damage, according to a study published in the April issue of Biochemical and Biophysical Research Communications.

Current treatments for severe radiation exposure, also called acute radiation syndrome, are limited to drugs that boost the production of blood cells and platelets, but this approach is futile if underlying stem cells are also killed off. Moreover, there are no available treatments that can be given after exposure to limit damage to cells.

We are using an entirely different approach, says Clayton Hunt, Ph.D., of the Department of Radiation Oncology. Rather than ramp up the production of blood cells, we are trying to prevent radiation-induced cell death from occurring in the first place.

The researchers developed the agent by attaching a portion of the Bcl-xL protein already known to block cell death - a snippet called BH4 - to the HIV protein TAT, which can deftly carry other molecules into cells. They gave the agent intravenously to mice exposed to 5 Grays of radiation. In humans, this level of exposure would cause a sharp drop in blood cells, leaving individuals with an increased risk of infection and bleeding.

They found the treatment helped protect rapidly dividing T cells and B cells in the spleen - immune system cells that are prone to radiation damage - whether it was given 30 minutes before radiation exposure or 30 minutes afterward.

As part of the research, the investigators monitored the levels at which old or damaged cells in the spleen were dying, a process called apoptosis. In a group of control mice that were not exposed to radiation, the researchers determined that 4.7 percent of T cells and 5.1 percent of B cells in the spleen were undergoing apoptosis. This level is considered normal as cells naturally die and are replaced by new ones. After the mice received 5 Grays of whole body radiation, apoptosis increased to 15.6 percent of T cells and 38.7 percent of B cells.

But when the researchers gave TAT-BH4 to the mice prior to whole body radiation, levels of apoptosis dropped significantly, to 8.6 percent of T cells and 16.9 percent of B cells. In mice given TAT-BH4 after radiation exposure, the proportion of cells undergoing apoptosis dropped even further, to 5.7 percent of T cells and 12.3 percent of B cells.

The Washington University approach appears to halt apoptosis by targeting pathways within cells that are far removed, or downstream, from the initial radiation insult. In particular, BH4 is thought to block a release of the electrical charge across the membrane of mitochondria - the powerhouses of cells - a key event in initiating cellular self-destruction. This gives us a window of opportunity to treat patients and still prevent cells from undergoing programmed cell death, said Richard Hotchkiss, M.D., professor of anesthesiology, medicine and surgery. We have a lot more work to do, but we are encouraged by these early findings.

Follow-up data suggest that TAT-BH4 is still effective when it is given to irradiated mice one hour after exposure, and the researchers plan further studies to determine how long after exposure the agent can prevent radiation-induced apoptosis.

In the past several years, the federal government has devoted increasing resources to the development of countermeasures that protect the public from chemical, biological, radiological or nuclear attack. TAT-BH4 may one day be a viable candidate because theoretically it could be given after radiation exposure, administered in pill form, and synthesized and stored in large quantities - all properties that would be desirable for treating large groups of individuals exposed to high levels of radiation, Hotchkiss said.

The researchers contend that developing such a drug would be less challenging than finding a way to protect healthy cells from radiation therapy aimed at destroying cancer cells. In radiation therapy, you want to give a dose of radiation to a tumor and reduce the exposure to surrounding, healthy tissues, Hunt said. This is difficult because a drug has to distinguish between tumor and normal tissue. But with people exposed to a large dose of radiation over the entire body, you want to protect all the cells in the body. To me, that is an easier problem to solve.

Traumas like Sept. 11 make brains more reactive to fear

Sun, 06 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) According to a new brain study, even people who seemed resilient but were close to the World Trade Center when the twin towers toppled on Sept. 11, 2001, have brains that are more reactive to emotional stimuli than those who were more than 200 miles away.

That is the finding of a new Cornell study that excluded people who did not have such mental disorders as post-traumatic stress disorder (PTSD) or major depression. One of the first studies to look at the effects of trauma on the brains of healthy people, it is published in the May issue of the journal Emotion.

These people appear to be doing okay, but they may, indeed, be having more sensitive responses to upsetting stimuli, said Elise Temple, a co-author and assistant professor of human development at Cornell.

More than half the population experiences trauma, which makes people more likely to develop PTSD, depression, anxiety and physical illness later in life, according to other studies. Also, trauma has been found to make the brain's emotional processing centers -- particularly the amygdalae, the parts of the brain that judge emotional intensity and make emotional memories -- more sensitive in cases of PTSD.

The findings suggest that events that trigger shock, fear and horror that are within a normal range -- may cause similar changes in the brain that traumas do. Victims may experience lingering symptoms (bad dreams, jumpiness, thinking about the incident and avoiding the site of the trauma), but they are not severe. However, the kinds of changes that these traumas cause in the brain, the researchers suspect, create vulnerability to developing future mental disorders.

Specifically, the Cornell researchers found that three years after Sept. 11, 2001, the amygdalae were most sensitive in those who were close to the World Trade Center. These individuals tended to still experience lingering symptoms that were not severe enough to be diagnosed as a mental disorder. Those with lingering symptoms showed significantly more sensitive emotional reactions in the brain when stimulated by photographs of fearful faces.

Our study suggests that there may be long-term neural correlates of trauma exposure, even in people who have looked resilient, said lead author Barbara Ganzel, Cornell M.S. '99, Ph.D. '02, a postdoctoral researcher in human development at Cornell. Up until now, there has been very little evidence of that.

Using functional magnetic resonance imaging to see how people's brains responded to photographs of fearful versus calm faces, the scans of 11 people who were within 1.5 miles of the World Trade Center on Sept. 11, 2001, were compared with those who were living more than 200 miles away at the time; none of the subjects had psychiatric disorders.

We know that looking at fearful faces in normal adults tends to activate the amygdalae relative to looking at neutral faces, said Ganzel. So we were looking to see if people who have had a very bad experience would have more response to this relatively mild everyday stimulus.

Indeed, the amygdalae of those who were close to the twin towers were significantly more activated than that of others, even when other factors were controlled for in the analysis.

People who had experienced traumas that left them with more lingering symptoms were the ones who had higher activity in their fear centers, said Temple. We think that the World Trade Center experience was traumatic enough that it left them with hyperactive amygdalae.

For Iraq veterans, migraines may be sign of other problems

Thu, 03 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) BOSTON Soldiers returning from combat in Iraq who have migraine headaches are more than twice as likely to also have symptoms of post-traumatic stress, depression or anxiety than soldiers who do not have migraines, according to research that will be presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 May 5, 2007.

The study involved 3,621 United States Army soldiers who were given a health screening questionnaire within 90 days after returning from one year of combat duty in Iraq. A total of 2,167 of the soldiers, or 60 percent, completed the questionnaire. Of those, 19 percent screened positive for migraine headaches, 32 percent screened positive for depression, 22 percent screened positive for post-traumatic stress disorder, and 13 percent screened positive for anxiety.

The researchers found that 50 percent of those with migraine also had depression, compared to 27 percent of those without migraine. A total of 39 percent of those with migraine also had post-traumatic stress disorder, compared to 18 percent of those without migraine. And 22 percent of those with migraine also had anxiety, compared to 10 percent of those without migraine.

Previous studies in non-military populations had revealed a higher prevalence of certain psychiatric conditions, such as depression and anxiety, among people with migraine, said study author Maj. Jay C. Erickson, MD, PhD, of Madigan Army Medical Center in Tacoma, WA. We hypothesized that there would be a similar relationship between migraine and psychiatric conditions in soldiers. The precise reasons for such an association are not fully understood, but may be related to similarities in the mechanisms underlying migraines and some psychiatric disorders.

The study also found that those with migraine and depression also had more frequent headaches than those who had migraine with no depression an average of 3.5 headache days per month for those with depression compared to 2.5 days per month for those with no depression. The findings were similar for those with migraine and post-traumatic stress disorder.

These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, about the frequent association of migraine headaches and psychiatric conditions in soldiers returning from deployment, Erickson said. We recommend that health care providers who evaluate combat veterans for headaches perform mental health screening in order to ensure that psychiatric disorders are identified and properly treated. All soldiers returning from deployment presently undergo mental health screening.

Research demonstrates link between domestic violence and asthma

Tue, 01 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Boston, MA -- The link between environmental exposures and asthma has been clearly described, but a new study from researchers at the Harvard School of Public Health (HSPH) finds a strong association between domestic violence and asthma. The study, in the upcoming June issue of the International Journal of Epidemiology, (published advance online Feb. 28, 2007) raises questions about the role of stress in the development of this common respiratory condition.

Classic environmental triggers for asthma have been carefully studied, but there is less information on the role of stress in asthma episodes, says lead researcher S.V. Subramanian, Assistant Professor in the Department of Society, Human Development and Health at HSPH. The risk posed by domestic violence - and perhaps other psychosocial factors - could be as high as some well known environmental risk factors such as smoking.

The authors performed their research using a large nationally representative database of 92,000 households in India, where domestic violence is highly prevalent. Each respondent was surveyed in a face-to-face interview in one of 18 Indian languages. Respondents were asked if anyone in the household suffered from asthma, and were also asked about a personal history of experiencing or witnessing domestic violence. Researchers also accounted for many other factors that have been associated with asthma, including exposure to tobacco smoke and level of education and income.

The study found that women who had experienced domestic violence in the past year had a 37 percent increased risk of asthma. For women who had not experienced domestic violence themselves but lived in a household where a woman had been beaten in the past year, there was a 21 percent increased risk of asthma than for women who did not live in such households. In addition, living in a household where a woman experienced domestic violence also increased the risk of reported asthma in children and adult men.

While the authors caution that the study cannot prove a causal link between domestic violence and asthma, there are several possible mechanisms to explain such a strong relationship between the two. Exposure to violence, and other major psychosocial stressors, is known to affect the immune system and inflammation, which have a role in asthma development. In addition, those exposed to violence may adopt certain coping behaviors that predispose them to asthma, such as cigarette smoking.

This study is the first to examine the relationship between violence and asthma in India, where domestic violence is at relatively high levels, and where the World Health Organization estimates 15-20 million asthmatics live. Subramanian adds, Our study suggests a new method for identifying stress-induced episodes and also reveals another terrible health risk of domestic violence.

Exercise science principles strengthen swallowing rehabilitation

Mon, 30 Apr 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Just thinking about swallowing makes it harder to do.

Head and neck cancer, a stroke, brain tumor, brain injury or even a tracheostomy tube and mechanical ventilation needed to sustain life can make it impossible.

Dysphagia, or swallowing problems, can also result from aging and accompanying loss of muscle strength.

We swallow a thousand times or more per day, just our own saliva, without even thinking about it, says Dr. Lori Burkhead, speech-language pathologist and clinical research scientist at the Medical College of Georgia Department of Otolaryngology Head and Neck Surgery. We swallow in our sleep. Babies do it in utero. It is something we do without giving it much thought, but it's actually a very complex act that involves an intricate coordination between the brain, muscles and respiratory system.

An estimated 18 million Americans have difficulty with this routine function that, at worst, can lead to aspiration pneumonia, malnutrition, dehydration and death.

Evidence suggests that the same exercise science principles that strengthen bodies can help restore this fundamental function using mouth and throat muscles. Because swallowing muscles are not easy to access, applying the usual principles of exercise is more difficult. Physical therapists can put a weight in someone's hand and exercise them or they can give patients external assistance and get them to complete a movement, says Dr. Burkhead. I can't put weights on throat muscles for strengthening and I can't get at those muscles to help patients finish the movements they cannot do on their own.

Theories about the amount of resistance needed to strengthen a muscle, the number of repetitions and specificity of exercise along with technology such as biofeedback may help speech-language pathologists put more science and success into helping patients regain the ability to swallow, according to a review article authored by Dr. Burkhead available online in the scientific journal Dysphagia at http://dx.doi.org/10.1007/s00455-006-9074-z.

At present, there remain more questions than answers regarding how to most effectively and efficiently approach dysphagia rehabilitation, Dr. Burkhead and her co-authors write. Historically, research has focused on compensatory maneuvers such as changing body position or modifying the amount or consistency of food and liquid. Compensation is important, but the problem still remains unless it is addressed through rehabilitation efforts, they say.

Although exercise principles used in physical rehabilitation and sports training have been gaining attention in dysphagia rehabilitation, Dr. Burkhead proposes more emphasis on these theories and more studies to learn to optimize these principles.

Dr. Burkhead asserts that many of the treatment techniques used in physical rehabilitation or athletic training are applicable and beneficial in dysphagia rehabilitation. Physical therapists won't just tell a stroke patient to get up and walk; they first work on strengthening muscles of interest and discrete movements until patients can stand and take a few steps. They start with the components of a movement and then ultimately train the movement of interest, which in this case would be walking. The same thing goes for swallowing therapy. We can start with tongue movement or lip closure, but then we must be very conscious of moving toward task-specific exercise and working our patients at more challenging levels of intensity, which is something that our field is now starting to pay more attention to, says Dr. Burkhead.

There also is heightened interest in using tools such as neuromuscular electrical stimulation and biofeedback to boost the effects of exercise. She already routinely incorporates biofeedback. It provides concrete information for the therapist as well as the patient and empowers them to take a more active role in their recovery. We frequently ask patients to swallow with greater emphasis or to swallow in unusual ways as part of their exercise regimen. Biofeedback helps them know if they are doing it correctly and with the right amount of intensity.

Computer-aided biofeedback provides patients a graphic representation on a computer screen of what their muscles are doing. The therapist can challenge patients to reach for higher and higher goals, which challenges the muscles more and more. This helps the patient understand what they are doing right and to do more of it, she says. This empowers patients and helps them not only judge but then modify their own performance.

Dr Burkhead also is developing a strengthening technique that incorporates a creative way to access hard-to-reach muscles. Her technique incorporates the use of the Therabite® device, developed by Atos Medical in Sweden, to improve mouth opening. The device holds the jaw in position while the patient places his tongue at the roof of the mouth and swallows. The rationale is based on exercise principles known to work in other parts of the body. Her studies in healthy patients have shown that swallowing in this unusual position significantly increases activation of the swallowing muscles.

Despite advances in this field, many questions remain about how to best help patients resume safe swallowing. We use the evidence available to us along with what we know about how the body works to design treatment plans that target the problems as best we can. Many patients have improved with traditional therapy techniques, but I think that more research will lead to better therapy and greater outcomes in a shorter amount of time.

Clemson bioengineer gets national boost

Mon, 23 Apr 2007 04:00:00 PST

( from http://www.rxpgnews.com ) CLEMSON A Clemson University researcher will use a $1.6-million grant to pursue an innovative way to ease the disability and pain experienced by 200,000 Americans.

Clemson bioengineer Xuejun Wen is seeking ways to repair spinal cord nerves. Each year, 11,000 Americans suffer spinal cord injuries or other central nervous system (CNS) disabilities that can be permanent and paralyzing. Current treatments fall short of sparking a robust regenerative process that leads to a decent degree of functional recovery.

Assistant professor Xuejun Wen wants to change that situation. He will use his five-year grant from the National Institutes of Health (NIH) and the National Institute of Neurological Disorders and Stroke (NINDS) for research in tissue engineering aimed at spinal cord regeneration.

We've observed the promise of tissue regenerating itself, said Wen. This has potential for use in repairing acute and chronic damage, such as in spinal cord injuries or in diseases such as Parkinson's.

Wen proposes to awaken the ability of spinal cord nerve bundles to regenerate through a controlled environment created by an implantable bridging device. By mimicking the spinal cord, using biomaterials and scaffolds along with therapeutic agents loaded in nanostructured biomaterials, scar formation at the lesion site will be inhibited and nerve bundle growth will be promoted.

Wen is a faculty member in the Clemson bioengineering department and works in Charleston in the Clemson University-Medical University of South Carolina (CU-MUSC) bioengineering program. Previously, he has looked at ways to manipulate the microenvironment of the brain to improve the long-term life of transplanted healthy, human dopamine-producing neurons to treat Parkinson's disease. His past research has led to international recognition and funding from such organizations as the Michael J. Fox Foundation.

Wen's work as a prolific inventor has generated commercial interest.

Dr. Wen's research couples the possibility of improving lives with significant commercial potential, said Matt Gevaert, who handles the commercialization of Clemson's biomedical sciences and biotechnology intellectual property.

We are always looking at opportunities to commercialize our technology and transition it from the laboratory into the operating room. The technology transfer process includes companies willing to step forward to develop procedures and to manufacture and sell associated medical devices.

Bioengineering, sometimes termed biomedical engineering, involves the application of science, mathematics and engineering principles to biomedical systems. A key goal of bioengineers is to develop devices, processes and biotechnologies to improve medical practice and healthcare delivery.

Carnegie Mellon University research shows how sensory-deprived brain compensates

Tue, 17 Apr 2007 04:00:00 PST

( from http://www.rxpgnews.com ) PITTSBURGH -- Whiskers provide a mouse with essential information to negotiate a burrow or detect movement that could signal a predator's presence. These stiff hairs relay sensory input to the brain, which shapes neuronal activity. In a first, studies of this system by Carnegie Mellon scientists show just how well a mouse brain can compensate when limited to sensing the world through one whisker. Published April 4 in the Journal of Neuroscience, the results should help shape future studies of sensory deprivation that results from stroke or traumatic brain injury, say the authors.

Our findings are the first to show this degree of brain adaptability in a setting with significantly limited sensory input, said Alison Barth, assistant professor of biological sciences and a member of the Center for the Neural Basis of Cognition (CNBC). This finding tells us that brain function is plastic, or reparable, when a sense like touch has been profoundly diminished. Plasticity is an important indicator that the brain is reorganizing to compensate for an injury or deficit.

For a decade, neuroscientists have known that the brain can increase its plasticity, or adapt, in response to injury that limits bodily motion. This latest study is the first to show such an impressive enhancement of brain activity in an animal with sensory loss. Losing sight, hearing, taste, smell or touch are common disabling side effects of traumatic brain injury and stroke.

In her study, Barth recorded brain activity in mice with various degrees of whisker removal. As a first step in her research, Barth removed all but one whisker and recorded neural activity in a brain region located on the opposite side of the animal. (Flicking a whisker on one side of a mouse stimulates a part of the brain on the animal's opposite side). Over the course of a week, Barth found that one whisker could not only stimulate a predicted cluster of neurons inside the brain; it could also activate nearby neurons. While some degree of plasticity would be expected, the growth of brain activity seen in the experiments was striking, Barth says.

What this tells us is that the parts of the brain processing sensory information are extremely adaptive and can strengthen in the presence of limited sensory input, Barth said.

In another experiment, Barth found something more surprising a single-whiskered mouse was more likely to generate new brain activity than a mouse with a whisker on one side of its head and a full complement of whiskers on the other side.

These findings show us that a fully functioning set of whiskers on one side of the body dramatically inhibits the ability of a single whisker to remodel the brain, said Barth. This finding suggests that we could boost the brain's plasticity if we 'turn off' sensory input from the opposite side of the body.

Hypothetically, in a clinical setting, doctors could temporarily remove a patient's ability to see, hear, smell or touch on one side of the body to force the same sense on the other side of the body to expand its activity within the brain, thereby remodeling it to perceive a limited sensation much better.

This kind of forced use therapy is already applied in the clinic for patients with motor deficits. For example, a patient who suffers a brain injury is made to use a poorly performing arm with the expectation that the brain may be plastic enough to assist that arm in recovering motion.

We think that our well-designed model is extremely good for future in-depth studies of brain plasticity in response to changes in how an animal senses its environment. Ultimately, we want to understand at the molecular level the dynamic between sensory use and neural plasticity, Barth said.

Guns in homes strongly associated with higher rates of suicide

Tue, 10 Apr 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Boston, MA -- In the first nationally representative study to examine the relationship between survey measures of household firearm ownership and state level rates of suicide in the U.S., researchers at the Harvard School of Public Health (HSPH) found that suicide rates among children, women and men of all ages are higher in states where more households have guns. The study appears in the April 2007 issue of The Journal of Trauma.

We found that where there are more guns, there are more suicides, said Matthew Miller, Assistant Professor of Health Policy and Management at HSPH and lead author of the study.

Suicide ranks as one of the 15 leading causes of death in the U.S.; among persons less than 45 years old, it is one of the top three causes of death. In 2004, more than half of the 32,439 Americans who committed suicide used a firearm.

Miller and his colleagues Steven Lippmann, David Hemenway and Deborah Azrael, used survey data to estimate rates of household firearm ownership in each of the 50 states and examined whether rates of suicide were related to rates of household gun ownership. They controlled for measures of poverty, urbanization, unemployment, drug and alcohol dependence and abuse, and mental illness. The researchers found that states with higher rates of household firearm ownership had significantly higher rates of suicide by children, women and men. In the 15 states with the highest levels of household gun ownership, twice as many people committed suicide compared with the six states with the lowest levels, even though the population in both groups was about the same.

The association between firearm ownership and suicide was due to higher gun-related suicides; non-gun-related suicide rates were not significantly associated with rates of firearm ownership. Also, suicide attempts using firearms, which constitute just 5% of all fatal and non-fatal attempts, are highly lethal--more than 90% of all suicidal acts by firearm are fatal. By comparison, individuals who use drugs to attempt suicide, which constitute 75% of all attempts, die in the attempt less than 3% of the time.

The researchers recommend that firearm owners take steps to make their homes safer. Removing all firearms from one's home is one of the most effective and straightforward steps that household decision-makers can take to reduce the risk of suicide, says Miller. Removing firearms may be especially effective in reducing the risk of suicide among adolescents and other potentially impulsive members of their home. Short of removing all firearms, the next best thing is to make sure that all guns in homes are very securely locked up and stored separately from secured ammunition. In a nation where more than half of all suicides are gun suicides and where more than one in three homes have firearms, one cannot talk about suicide without talking about guns, he adds.

The bottom line, says Miller, is that people are less likely to die from attempting suicide when they don't have access to guns in homes.

Deflecting damage: Flexible electronics aid brain injury research

Fri, 06 Apr 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Flexible electronic membranes may overcome a longstanding dilemma faced by brain researchers: How to replicate injuries in the lab without destroying the electrodes that monitor how brain cells respond to physical trauma.

Developed by a team of engineers at Princeton University, Columbia University and the University of Cambridge, the membranes feature microelectrodes that are able to withstand the sudden stretching that is used to simulate severe head trauma. The systems could allow far more nuanced studies of brain injury than previously possible and may lead to better treatments in the minutes and hours immediately following the injury. The work also has implications for other areas of medicine, including next-generation prosthetics, as well as myriad industry and military applications.

This is an immediate application of the electronics of the future, said Sigurd Wagner, a Princeton professor of electrical engineering. Wagner and former Princeton postdoctoral researcher Stephanie Lacour are part of a National Institutes of Health-funded project to develop flexible arrays of microelectrodes for brain research. Led by Barclay Morrison III, an assistant biomedical engineering professor at Columbia, members of the team will present their work at the April 9-13 conference of the Materials Research Society in San Francisco.

Existing techniques to study traumatic brain injury have been limited because it is almost impossible to insert an electrode into a cell to obtain a recording, remove the probe, injure the cell, and then reinsert the probe into the same cell, Morrison said. Because of this limitation, researchers rely on other surrogate markers of injury, such as cell death.

In terms of traumatic brain injury, there can be a lot of functional damage to the brain in other ways than just killing a cell, Morrison said. Neurons can still be alive, but not properly firing, which leads to problems ranging from comas to epilepsy.

These improperly functioning neurons can now be assessed by the electrodes in the stretchable membranes. After brain cells have been placed on the flexible surface and allowed to grow, the researchers measure their normal activity. The membrane is then suddenly stretched and returned to its original form. Having withstood the shock, the electrodes embedded in the membrane continue to monitor the cellular activity, providing a before and after picture of traumatic brain injury.

Future work will continue to refine these measurements and also attempt to obtain readings from cells during the injury events themselves, Morrison said. The flexible electrodes also can be used to provide electrical input to brain tissue and may one day be used to induce learning in brain cells damaged by trauma. This technology also has promising applications for the engineering of nervous, muscular and skeletal tissue. For instance, Morrison said, the electrodes could potentially be used to train heart tissue grown in the lab to contract appropriately when stimulated.

The new membranes build upon work done by Lacour during her time at Princeton in Wagner's lab. Lacour now is managing research in flexible electronics for neuroscience at the University of Cambridge in England. She has been recognized by Technology Review magazine, which named her to its 2006 list of 35 leading innovators under age 35.

Together, the engineers created the first working stretchable circuits by linking tiny pieces of traditional semiconductors mounted on a rubbery membrane with thin pieces of gold. Even when stretched, the circuits maintained their ability to conduct electricity.

Research on the flexible membranes also is likely to contribute to the longstanding challenge of connecting electronic devices to the human nervous system, Wagner said. Prosthetic devices, for example, could be coated with electronic skin that senses touch and temperature and sends that information back to the brain like any natural human limb.

A basic problem with the interface between electronics and living tissue is that electronics are hard and tissues are soft, he said, noting that nerve cells quickly become irritated when in contact with the hard electrodes of today. The hope is that the devices of the future will flex with living tissue, maintaining a connection without damaging the human cells.

Enabling nerve regeneration means evicting the cleanup crew

Wed, 28 Feb 2007 05:00:00 PST

( from http://www.rxpgnews.com ) Macrophages are the immune cells that engulf and destroy the debris of damaged tissue to enable the healing process to begin. Their presence at the scene of damage is critical, but once their task is complete, it is just as critical that macrophages exit rapidly, ending the inflammatory process and making way for regrowth. In fact, the continued presence of macrophages could damage tissue, compromising repair.

While researchers know a great deal about the molecular machinery that launches this cellular cleanup crew into action, little has been known about the just-as-critical exit process.

Now, researchers have identified a key process by which macrophages are cleared from sites of peripheral nerve injury. The scientists say their findings could also have implications for understanding the same fundamental mechanism in spinal cord injury, stroke and multiple sclerosis.

Samuel David and colleagues published their findings in the March 1, 2007 issue of the journal Neuron, published by Cell Press.

The researchers concentrated on a family of cell receptors known as Nogo receptors, already known to be present on nerve cells and to play a role in nerve growth. Specifically, David and colleagues explored the role of one such Nogo receptor, NgR1. Receptors such as NgR1 are protein switches that nestle in the membranes of cells, and which induce a cellular response when triggered by a specific chemical signal, or ligand.

In the researchers' experiments, they induced damage in the sciatic nerve in the thigh of rats and mice and analyzed the role of NgR1 in the repair process.

They found that macrophages showed the presence of NgR1 on their surface once they arrive at the injury site and began their cleanup. Further experiments revealed that as the healing nerve began to form the protein myelinthe insulating sheath around nervesthis receptor not only caused a reduction in the macrophages' binding to myelin, but also an outright repulsion from the forming myelin. In fact, when the researchers created nerve injury such that new myelin would not be formed, the macrophages continued to lurk around the injury site. The researchers' experiments also identified specific molecules on myelin that triggered such repulsion.

The findings could also apply to nerves other than peripheral nerves, because macrophages activated during stroke, multiple sclerosis injury, and spinal cord injury also express NgR1 on their surface, pointed out the researchers.

Our discovery of this novel (to our knowledge) role for NgRs in mediating the efflux of macrophages from inflamed neural tissue via interactions with myelin could therefore have broader implications for the regulation of inflammatory responses not only in other peripheral nerve pathologies, but also in [central nervous system] inflammation such as in spinal cord injuries, stroke, and multiple sclerosis, they concluded.

Fast and slow -- How the spinal cord controls the speed of movement

Wed, 28 Feb 2007 05:00:00 PST

( from http://www.rxpgnews.com ) ITHACA, N.Y. -- Using a state-of-the-art technique to map neurons in the spinal cord of a larval zebrafish, Cornell University scientists have found a surprising pattern of activity that regulates the speed of the fishs movement. The research may have long-term implications for treating injured human spinal cords and Parkinsons disease, where movements slow down and become erratic.

The study, A Topographic Map of Recruitment in Spinal Cord, published in the March 1 issue of the journal Nature, maps how neurons in the bottom of the fishs spinal cord become active during slow movements, while cells further up the spinal cord activate as movements speed up.

By removing specific neurons in the lower spinal cord with laser beams, the researchers rendered the fish incapable of slow movements. By removing nerves further up the backbone, the fish had difficulty moving fast.

No one had any idea that organization like this existed in a spinal cord, said Joseph Fetcho, a Cornell professor of neurobiology and behavior and an author of the study. Now that we know the pattern, we can begin to ask how that changes in disease states.

David McLean, Cornell postdoctoral researcher in Fetchos laboratory, was the first person to discover the pattern of neural activation and how it was associated with speed of movement. He is the lead author on the study.

The researchers worked with 4 millimeter-long larval zebrafish (Danio rerio) because they are transparent and researchers can see their cells. Fetcho and his colleagues injected the fishes spinal cords with a fluorescent dye, which then lit up when calcium ions flooded in as the nerve cells activated. A confocal microscope with lasers allowed the researchers to image the cells at very high resolutions. Using this set up, they watched nerve cells light up as the animals moved at different speeds.

While no one knows how this pattern relates to other vertebrates, the research opens a door toward basic understanding of the architecture and function of nerves in spinal cords. With regard to regeneration of spinal cords following injury, for example, medical researchers need a template for a normal spinal cord in order to know if nerves are re-growing normally, Fetcho said.

In Parkinsons disease, researchers believe that a neurotransmitter released by brain cells may contribute to activating a system of nerves and muscles that allow for faster movement. They suspect that damage to these brain cells may disrupt the release of dopamine, further complicating free movement. Fetcho and his group are building a transgenic line of fish with those brain cells labeled so they may be targeted and removed with lasers.

Modified ligament surgery improves outcomes for baseball pitchers, other athletes

Wed, 28 Feb 2007 05:00:00 PST

( from http://www.rxpgnews.com ) In the largest study of its kind, surgeons at Hospital for Special Surgery have determined that by modifying a classic ligament surgery, they can return more athletes, such as baseball players, to their prior level of competition. The modified surgery repairs a torn medial collateral ligament (MCL), which links and stabilizes bones of the lower and upper arm where they meet at the elbow.

Less traumatic than the classic Tommy John surgery, the modified surgery called the docking procedure, with time, is likely to become the gold standard for treating these injuries.

This paper, in the largest series of patients ever published, shows that this particular operation in throwing athletes demonstrates better results than the classic operation, said David W. Altchek, M.D., senior author of the study and co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS) in New York. The study was presented at a special session of the American Shoulder and Elbow Surgeons, held during the American Academy of Orthopedic Surgeons annual meeting.

MCL injury is most common in professional and amateur athletes involved in so-called overhead throwing sports, such as baseball, softball, football, lacrosse and tennis. These sports involve a throwing motion at high velocity that exerts an exceptional force at the elbow. Repeated over time, this motion can cause inflammation and microtrauma, which can eventually lead to an MCL tear. When this ligament is torn, an individual has a full range of motion and can go about daily life, but a professional or semi-professional athlete cannot perform at their usual level because they cannot exert a significant force.

Specifically, the MCL attaches the ulna, one of two long bones that run from the elbow down to the wrist, with the humerus, the bone of the upper arm. For 30 years, athletes have undergone the Tommy John surgery or Jobe surgery (named after its inventor), in which a tendon is taken from a person's forearm or hamstring and then grafted into the elbow to act as a replacement for the injured ligament. Surgeons weave the harvested tendon in a figure eight pattern through bone tunnels drilled in the ulna and humerus bones and suture the tendon into place. Dr. Altchek's technique modifies the Jobe procedure in several ways. First, he begins with an arthroscopic evaluation of the elbow to examine and fix residual problems. An unstable ligament leads to a shifting elbow, which can cause further problems such as cartilage damage.

Second, Dr. Altchek gains access to the bone in a different way. In the Jobe surgery, surgeons detach major muscles and move the so-called ulnar nerve out of the way to gain access to the bone. Dr. Altchek uses a muscle splitting technique through which surgeons can gain access to the bone by gently prying apart muscle fibers, similar to the way you can poke a finger through a knitted sweater. He doesn't have to detach major muscles and, in most cases, the nerve can be left intact, reducing the problems of postoperative nerve damage. Damage to the ulnar nerve results in numbness and tingling in the ring and small fingers.

Dr. Altchek's procedure also differs from the traditional Jobe surgery by minimizing the number of holes drilled into the bones, thus decreasing the risk of postoperative bone fracture. In Dr. Altchek's surgery only one hole instead of three is drilled into the humerus. Instead of a figure eight design, one can think of the pattern as an elongated D, says Christopher Dodson, M.D., a resident in the Department of Orthopaedic Surgery at HSS and an author of the study.

In the classic operation, the graft enters the humerus bone in one hole, exits in another and goes into another and then the graft gets tied to itself, Dr. Altchek explained. In the docking procedure, the graft enters the humerus bone, but never exits. Instead, sutures secure the tendon and exit the bone through much smaller exit punctures.

Dr. Altchek first developed the docking surgery in 1994, but it wasn't until now, that it was tested in such a large patient population.

In a study of 100 athletes (mean age 22) who had the docking surgery, with an average follow-up of three years, 90 percent had an excellent result (returned to the same or higher level of competition) and 7 percent had a good result (able to compete at a lower level for more than 12 months). Only 3 percent had postoperative nerve complications. With the traditional Jobe surgery, studies have shown that only 68 percent of elite level throwers return to either their prior or a higher level of throwing and 20 percent have nerve complications.

Surgeons and athletes have applauded Dr. Altchek's modifications. Many surgeons have already been employing his technique in the clinic to improve outcomes, and with time, it is likely that the docking procedure will become the gold standard for treating these athletes.

This study recently appeared in the December issue of the American Journal of Sports Medicine (Am J Sports Med 2006;34(12):1926-1932). The Institute for Sports Medicine Research supported the work.

An attending orthopaedic surgeon at Special Surgery, Dr. Altchek serves as medical director for the New York Mets professional baseball team and medical director for the Nets professional basketball team.

Surprising airbag hazards among research findings at hearing safety conference

Thu, 08 Feb 2007 05:00:00 PST

( from http://www.rxpgnews.com ) At the National Hearing Conservation Associations 32nd annual conference, top experts in the field will reveal new findings related to automobile airbags, military hearing protection, and farm-work related trauma. Several hundred people are expected to attend the conference, titled A Passion to Preserve, which will be held Feb. 15-17 at the Hyatt Regency in Savannah, Ga.

Permanent hearing loss is the third most common chronic health condition in people over the age of 65, and roughly 30 million people in the United States have significant permanent hearing loss.

The extent of the problem in society is much greater than people realize, said NHCA Director of Education Brian Fligor. It deserves so much of our time, attention and resources because so much of it is preventable, and it has such a profound effect on our quality of life, productivity, and general well being.

The conference will host dozens of presentations, including auditory physiologist Dr. G. Richard Prices Intense Impulse Noise: Hearing Conservations Poison Gas, which has surprising new data on hearing loss as a result of automobile airbag deployment. He will present data predicting that 17 percent of people who are exposed to car airbag deployment in the United States will suffer some permanent hearing loss. Price will also describe research that concludes, counterintuitively, that having car windows rolled up when airbags are deployed is actually less hazardous to the ear than rolled-down windows. Previously experts thought rolled-up windows were more dangerous because they allow for higher pressure to be created inside the cabin.

Dr. Nancy Sprince, of the University of Iowa College of Public Health, will be presenting Hearing Loss: A Risk Factor for Farm-Work Related Traumatic Injury, in which she will discuss a new study showing that hearing difficulties increase farmers risk of work-related traumatic injuries. She will advocate the prevention of agricultural injuries by controlling the noise exposure that leads to hearing loss.

A luncheon presented by Dr. Charles D. Ross of Longwood University will discuss how acoustical phenomena affected the outcomes of Civil War battles. He will explain how acoustic shadows, a catch-all term that encompasses several types of phenomena, can make a person not hear a sound he or she would ordinarily hear or make a person hear a sound he or she would not ordinarily hear. Also among the presentations will be an Army study assessing an improved version of the combat arms earplug. Previous concerns over the plugs fit, comfort and size have been improved, and the plug has been evaluated for performance in a number of different functions.

Female lacrosse players at higher risk than males for head, face and eye injuries

Thu, 01 Feb 2007 05:00:00 PST

( from http://www.rxpgnews.com ) Rosemont, Ill. February 1, 2007 -- Despite playing a game with less physical contact, female lacrosse players in high school and college sustain a higher rate of injuries to the head, face, and eye than their male counterparts, according to a study published in the February issue of The American Journal of Sports Medicine.

Although high school injury rates are lower than those of college, the nature of the injuries, body parts affected, and mechanisms of injury are similar, writes Andrew E. Lincoln, ScD. MS, of the Medstar Research Institute, Hyattsville, Md., and coauthors. Female players sustained more head, face, and eye (HFE) injuries partly because of a lack of protective equipment. Before 2005, protective eyewear was not required for females at any level of play. Our findings offer support to US Lacrosse's (2005) mandate of protective eyewear for all female lacrosse players, the authors say.

Lacrosse is one of the fastest growing sports in the U.S. The number of both youth and collegiate participants has grown dramatically, with the biggest increase occurring in the number of women's NCAA lacrosse teams (which has nearly doubled since 1993). On all levels of play, lacrosse is a fast-paced team sport. The hard rubber ball used in lacrosse can travel at speeds of up to 90 mph in the men's game and 60 mph in the women's game. The use of protective equipment has differed between the sexes because the women's game prohibits deliberate body-to-body contact.

Using sport-specific injury surveillance systems, the researchers collected data on HFE injuries during 4 seasons (2000-2003) of high school and college lacrosse (both practice and competition). High school data came from 23 high schools in the Fairfax County (Va.) Public School System; at the college level, HFE injury data were collected through the NCAA Injury Surveillance System and consisted of a sampling of men's and women's lacrosse programs during the 2000-2003 seasons. Teams from all three NCAA divisions were represented in the sample. [The data collection period preceded the mandate for protective eyewear in girls' and women's lacrosse.]

Based on athletic exposures, both high school girls and college women sustained more HFE injuries than did male players in high school and college. Boys, girls, and collegiate men sustained a majority of HFE injury during games, whereas collegiate women sustained a majority of such injuries during practice. The most common types of HFE injuries for all players were concussions, contusions, and fractures. Despite wearing a required helmet, males suffered more concussions than females in both high school and collegiate play. Concussions in male players were most often caused by direct contact with another player, whereas females sustained concussions by incidental contact with the lacrosse stick, ball, or ground.

In contrast to the concussions sustained by high school boys and college men, females in high school and college experienced significantly higher proportions of injuries to the nose and eyes than did their male counterparts. Fractures and contusions were common in both high school girls and collegiate women. At the time that this study was conducted, the only required piece of protective equipment for female lacrosse players in the field was a mouth guard; goalies also were required to wear a face mask. All male players wear helmets with face masks, mouth guards, and gloves.

The injury patterns we found largely reflect the protection offered by this equipment in that high school boys and college men sustained few facial and eye injuries, whereas a significant proportion of girls' and women's injuries involved the face and eyes, the authors write. This is most likely because of the lack of any required head/face protection other than a mouth guard.

Head, face, and eye injuries are a concern for all lacrosse players, but the mechanisms and types of injuries for males and females are different because of the differences in rules, protective equipment, and the nature of the game. We used prospectively gathered data to develop a program aimed at preventing HFE injuries in women's lacrosse. This program includes the addition of protective equipment, enforcement of rules, and education of the lacrosse community, says study co-author Richard Y. Hinton, MD, MPH, of the Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Md.

Unbelted backseat passengers produce deadly results

Thu, 21 Dec 2006 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- Holiday travelers: Listen up and buckle up.

New research shows that unbelted backseat passengers risk injury or death to themselves and the driver seated in front of them in the event of a head-on crash.

Automobile sled tests simulating head-on crashes between two vehicles and using crash-test dummies have demonstrated the likelihood of severe head and chest traumas for driver and passenger caused by an unbelted passenger slamming into the seat of a belted driver.

The risk of severe injury was not evident during sled tests involving driver and passenger dummies restrained by seat belts, according to theresearchers. A driver's side airbag was used in all tests.

The tests show clearly that unrestrained rear-seat passengers place themselves, as well as their driver, at great risk of serious injury when involved in a head-on crash, says lead researcher James Mayrose, Ph.D., adjunct assistant professor of mechanical and aerospace engineering in the University at Buffalo School of Engineering and Applied Sciences.

Tests using unbelted adult crash dummies and dummies approximating the size and weight of a six-year-old child showed similar results:severe chest and head trauma for both passenger and belted driver, according to Mayrose.

The injuries were indicated by sensors mounted to and within the dummies. The sensors showed significant acceleration of the dummies'head, neck and chest, as well as dramatic impact loads to these bodyparts. All sled tests were conducted according to the protocols of theFederal Motor Vehicle Safety Standard.

It doesn't matter if it's an adult-sized person seated behind you, a small child, or even if you have packages or luggage placed in the seat behind you, if they are not belted or safely secured, they can inflict fatal injuries to a driver, Mayrose warns.

The researchers also tested the possibility of injury occurring duringa side-impact collision to the driver's side of a car. The resultsshowed that an unbelted backseat passenger on the driver's side would receive severe or fatal injury, but the belted driver was not at greater risk for injury.

The results, published in November in the Journal of Trauma, validate previous findings by Mayrose and co-researchers that were based on analysis of data from nearly 300,000 fatal crashes over seven years and on preliminary sled tests.

Mayrose points out that seat-belt use has increased significantly over the years, reaching 82 percent compliance in 2005, according to the U.S. Department of Transportation. But most seat-belt laws for adults, including New York State law, do not require adult rear-seat passengers to buckle up.

Based on our results, state law should mandate that everyone in the vehicle must wear a safety belt, no matter where they sit, Mayrose concludes.

Workers' compensation ratings don't accurately predict disabilities

Tue, 19 Dec 2006 05:00:00 PST

( from http://www.rxpgnews.com ) CHAPEL HILL -- A study of settlement decisions in workers' compensation claims for low back pain has found almost no relationship between the rating of the disability's severity when the claim was settlement and reported pain and disability 21 months later.

Findings were counterintuitive: Claimants with higher disability ratings, which suggest higher severity and less ability to work, fared better than those with lower ratings.

The study shows that administrative decisions made at the end of the workers' compensation claim process about the ability of someone to work after back injury has very little predictive validity, said Dr. Norton Hadler, a professor of medicine and microbiology/immunology in the University of North Carolina at Chapel Hill's School of Medicine.

Hadler is a co-author of the paper, which was published in the December issue of the Journal of Pain, with colleagues from St. Louis University and the University of Florida. It was based on administrative records in Missouri of workers' compensation claims for low back pain.

Workers' compensation is an important part of America's health-care system, accounting for 3 percent of an employer's gross income, Hadler said.

Clearly, the rating schemes for workers' compensation are inconsistent, and that fact is stirring enormous pots across the country, Hadler said. If the outcomes from Missouri generalize, then there is a need to reform how disability is determined.

Another paradoxical finding showed that white claimants faired no better than blacks, even though previous reviews found that blacks were much less likely than whites to be diagnosed with a herniated disk or to have back surgery, had less money spent on their care and received lower disability ratings and smaller settlements.

It's one of the more perverse observations in our study, said Hadler. African-Americans were much less likely to be operated on, but the care that the whites got, even though it looks like more care, because it's surgery and it's more expensive, didn't do anything for them.

For their study, the researchers interviewed 580 black and 892 white workers' compensation claimants an average of 21 months after claim settlement to assess how well they were functioning and to determine the contribution of impairment, race and socioeconomic status to their disability ratings.

Hadler said that workers' compensation claims for low back pain represent only 20 to 30 percent of all claims filed but consume a majority of the workers' compensation budget.

The article concludes that the pattern of results suggests that race/ethnicity and other sociodemographic factors influence medical decision making and the outcomes of medical care. Furthermore, the flaws in the system are not distributed evenly but are visited disproportionately on minorities and persons of lower socioeconomic status.