Showing posts with label Study. Show all posts
Showing posts with label Study. Show all posts

Friday, 2 August 2013

Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Public Health
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion
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In an epidemic or a bioterrorist attack, the response of government officials could range from a drastic restriction of mobility - imposed isolation or total lockdown of a city - to moderate travel restrictions in some areas or simple suggestions that people remain at home. Deciding to institute any measure would require officials to weigh the costs and benefits of action, but at present there's little data to guide them on the question of how disease spreads through transportation networks.

However, a new MIT study comparing contagion rates in two scenarios - with and without travel restrictions - shows that even moderate measures of mobility restriction would be effective in controlling contagion in densely populated areas with highly interconnected road and transit networks. The researchers called the difference between infection rates in the two scenarios the "price of anarchy," a concept from game theory that's frequently used as a metric in studies of the controlled use of transportation networks.

The study, published online July 31 in the Journal of the Royal Society Interface, is the first to link the concept of price of anarchy to the spread of contagion. It assumes that transmission of the news of the epidemic (which influences how people select travel routes) and the epidemic itself follow the same mobility network, and uses standard epidemiological models to simulate the flow of contagion.

The researchers - Ruben Juanes, the ARCO Associate Professor in Energy Studies in MIT's Department of Civil and Environmental Engineering, graduate student Christos Nicolaides and research associate Luis Cueto-Felgueroso - used data from the 2000 U.S. census to establish the aggregate daily flux of people commuting between counties.

Previous research had shown that when individuals become aware of an epidemic, they travel not by taking the shortest route, but by taking the shortest route that avoids infected areas - even if they're already infected - a strategy that exposes people in uninfected areas to disease. Such "selfish behavior," as it's called in game theory, is in direct opposition to the strategy of policymakers, who presumably would act in the benefit of the greater social good by routing infected individuals through areas where infection rates were already high.

The MIT study shows that the price of anarchy in some regions of the United States, such as along Interstate 95 in the Northeast, would be considerable. For a moderately contagious disease - one in which every infected person infects, on average, two others - restricting individuals to specific travel routes would decrease infection rates by as much as 50 percent.

"In an area with high connectivity, the outcome of action coordinated by officials is going to be better than selfish action, but the economic and social costs of disruption could sometimes be too high," Juanes says. "In other cases, there would be an enormous benefit to having authorities impose travel restrictions. The price of anarchy is a quantitative measure that identifies areas where intervention might pay off."

"Although the study is an idealized scenario, it does give insight to authorities about when and where it would be important to impose route restrictions on human mobility in the case of an emergent outbreak or in the extreme case of bioterrorism," says Nicolaides, the paper's first author, who was funded by a Vergottis Fellowship from the MIT School of Engineering. "But you have to take into account the structure of the underlying mobility network and its traffic properties. Imposing policy-initiated action in areas with low traffic would not render substantial benefits for the containment of an epidemic."

In their models, the researchers tracked an infectious disease as it spread via commuting networks in the contiguous United States, and found that the price of anarchy for contagion varies depending on the proximity of a network to major commuting corridors.

"A commuting network may be very local, but some contagion is related to more distant travel networks," Cueto-Felgueroso says. "That's why we see a higher price of anarchy near major arteries, like Interstate 95 in the northeastern United States."

The researchers had previously studied the spread of disease through the air transportation network and found that the interconnectivity and location of an airport in the network, not just the number of travelers moving through it, were key to its ability to spread disease.

Juanes says the next step in this work is to measure the price of anarchy for contagion in the world's 7,000 airports.

Written by Denise Brehm

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 01 Aug 2013 - 13:00 PDT Current ratings for:
Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness
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A study suggests that after aesthetic facial plastic surgery the average number of apparent"years saved" (true age minus guessed age) was 3.1 years but there was only an insignificant increase in attractiveness scores, according to a report published by JAMA Facial Plastic Surgery, a JAMA Network publication.

Patients seek out aesthetic facial surgery to look younger and more attractive but there is minimal literature about the effect of the surgery on perceived age and attractiveness, according to the study background.

A. Joshua Zimm, M.D., of the Lenox Hill Hospital and Manhattan Eye, Ear & Throat Institute of North Shore-LIJ Health System, New York, and colleagues quantitatively evaluated the degree of perceived age change and improvement in attractiveness following surgical procedures.

Independent raters examined preoperative and postoperative photographs of 49 patients who underwent aesthetic facial plastic surgery between July 2006 and July 2010 at a private practice in Toronto, Canada. The photographs were shown to 50 blind raters. Patients in the study ranged in age from 42 to 73 years at the time of surgery with an average age of 57 years.

On average, raters estimated their patients' ages to be about 2.1 years younger than their chronological age before surgery and 5.2 years younger than their chronological age after surgery. The average overall years saved following surgery was 3.1 years, according to the results. There also was a small and insignificant increase in attractiveness scores in postprocedural photographs, the results indicate.

"In conclusion, the subjective nature of facial rejuvenation surgery presents a challenge in the assessment of successful results," the study concludes. "Given the limitations of the attractiveness component of this study as described herein, further investigation is warranted to verify these findings."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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JAMA Facial Plast Surg. Published online August 1, 2013. doi:10.1001/jamafacial.2013.268.

JAMA

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Tuesday, 30 July 2013

Mathematical biologists study how to best prevent bullet deaths

Main Category: Public Health
Article Date: 30 Jul 2013 - 1:00 PDT Current ratings for:
Mathematical biologists study how to best prevent bullet deaths
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Aiming to quell heated national debate about gun control with factual answers, two UC Irvine mathematicians have designed parameters to measure how to best prevent both one-on-one killings and mass shootings in the United States. Their paper appears in the journal PLOS ONE.

"It's time to bring a scientific framework to this problem," said lead author Dominik Wodarz, a mathematical biologist who works on disease and evolutionary dynamics. His co-author and wife, Natalia Komarova, a mathematician who studies biomedical and social trends, added: "Can we design a rational way to argue about guns?"

Both were appalled not just by the December shooting deaths of 20 youngsters and eight adults in Newtown, Conn., but also by the bitterly emotional dispute over weapons that erupted anew. They decided to put their professional expertise to work.

"This debate cannot be settled satisfactorily by verbal arguments alone, since these are often driven by opinion and lack a solid scientific backing," the authors write. "What is under debate is essentially an epidemiological problem: How do different gun control strategies affect the rate at which people become killed by attackers, and how can this rate be minimized?"

The duo reviewed available data stretching as far back as World War I, then drew up equations to compute whether policies ranging from a total firearm ban to "arm everyone" increase or decrease homicides. After running the numbers, they found that in more common domestic and one-on-one crimes, reduced legal gun availability - if properly enforced - is likelier to lower deaths. But in rare mass shootings, armed citizens might save lives if sufficiently trained to avoid accidentally shooting fleeing bystanders.

They note that data is missing that could strengthen their results. For instance, homeowners who used a weapon to stop a robbery might not make a report to police. "Stand your ground" laws being widely discussed in the wake of Trayvon Martin's killing could influence the parameters too. "Whether such laws better protect the public or increase deaths needs to be determined statistically," Wodarz said. "Do you have a greater chance of dying if you run or if you face your attacker with a weapon?"

The authors say key parts of their equations should be studied more closely: the fraction of offenders who illegally possess a gun, the statistical degree of protection provided by legal gun ownership, and the number of people who are legally carrying a gun when attacked. Comprehensive data in those areas, they say, could further aid the development and implementation of effective policies.

Federal funding for gun control research was essentially nonexistent for nearly two decades, but President Barack Obama in January labeled firearm deaths a public health crisis and ended the longstanding freeze. About 11,000 Americans die each year from gunshot homicides.

A large number of peer reviews - 11 in total - were solicited by journal editors; two or three are the norm. A wide array of opinions were expressed, ranging from enthusiastically positive and constructive to a critic who stated that scientific methods would never be useful in this area.

The authors were warned to be prepared for heated responses to their paper but believe it's critical to bring the best tools of research to the issue.

"If the current discussion could be steered toward science, rather than having a heated debate without much of a logical foundation, a big step forward toward saving lives would be achieved," they said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Restless legs syndrome: Study raises hope for better drugs

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Main Category: Restless Legs Syndrome
Also Included In: Neurology / Neuroscience
Article Date: 30 Jul 2013 - 8:00 PDT Current ratings for:
Restless legs syndrome: Study raises hope for better drugs
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John Hopkins researchers may have discovered why insomnia persists in patients with restless legs syndrome (RLS), despite successful treatment of the condition. 

People with restless legs syndrome, sometimes called "jimmy legs," have an uncontrollable urge to move their legs. The condition varies in severity and can be painful, distressing and interrupt daily activities as well as disturb sleep. 

In spite of effective drugs to relieve RLS, studies have shown that they do not improve sleep outcomes and only treat the restless legs. 

A research team led by Dr. Richard Allen, associate professor of neurology at John Hopkins University School of Medicine, has looked into solving the sleep anomaly, using MRI to image the brain in a group of 28 RLS patients and 20 non-RLS patients. 

Glutamate, the neurotransmitter involved in arousal, was found in abnormally high levels in the RLS group. The higher the level of glutamate recorded in the brain of those with RLS, the worse the patient's sleep. 

The research team recorded MRI images and glutamate activity in the thalamus - the part of the brain involved with the regulation of consciousness, sleep and alertness. 

RLS patients included in the study had severe symptoms: 

On six or seven nights a weekPersisting for at least six monthsWith an average of at least 20 involuntary movements a night.

The second stage of the experiment involved a two-day sleep study. RLS patients were reported to have received 5.5 hours sleep on average. The researchers identified a direct link in this group between glutamate levels in the thalamus and the number of hours of sleep. There was no such association in the non-RLS control group. 

Dr. Richard Allen is hopeful that the team may have discovered the reason why restless legs syndrome also affects sleep. He says:

"We may have solved the mystery of why getting rid of patients' urge to move their legs doesn't improve their sleep.

We may have been looking at the wrong thing all along, or we may find that both dopamine and glutamate pathways play a role in RLS."

The results of the study could lead to developments in the way RLS is treated, potentially helping to eradicate sleepless nights for people with restless legs syndrome. 

Dopamine-related drugs do work for many people with RLS, yet some lose benefit and require ever-higher doses. If the dose is too high, medication can aggravate symptoms to a state worse than that prior to treatment.

Dr. Richard Allen points out that despite drugs already being available that can reduce glutamate levels in the brain, such as the anticonvulsive drug gabapentin enacarbil (Horizant), they have not been given as a first-line treatment for RLS patients.

Dr. Allen adds that as more is understood about the neurobiology, his findings could apply to some forms of insomnia as well as restless legs syndrome.

Dr. Richard Allen says:

"It's exciting to see something totally new in the field - something that really makes sense for the biology of arousal and sleep."

Written by Sally Burr

See Sally's blog


Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our restless legs syndrome section for the latest news on this subject.

Allen RP, Barker PB, Horská A and Earley CJ, Neurology, 2013 vol. 80 no. 22, pp2028-2034. Abstract/summary

The study was funded in part by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (R01 NS075184 and NS044862), the National Institute on Aging (P10-AG21190) and the National Center for Research Resources (M01RR02719).

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Study finds potential well water contaminants highest near natural gas drilling

Main Category: Water - Air Quality / Agriculture
Also Included In: Public Health
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Study finds potential well water contaminants highest near natural gas drilling
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A new study of 100 private water wells in and near the Barnett Shale showed elevated levels of potential contaminants such as arsenic and selenium closest to natural gas extraction sites, according to a team of researchers that was led by UT Arlington associate professor of chemistry and biochemistry Kevin Schug.

The results of the North Texas well study were published online by the journal Environmental Science & Technology. The peer-reviewed paper focuses on the presence of metals such as arsenic, barium, selenium and strontium in water samples. Many of these heavy metals occur naturally at low levels in groundwater, but disturbances from natural gas extraction activities could cause them to occur at elevated levels.

"This study alone can't conclusively identify the exact causes of elevated levels of contaminants in areas near natural gas drilling, but it does provide a powerful argument for continued research," said Brian Fontenot, a UT Arlington graduate with a doctorate in quantitative biology and lead author on the new paper.

He added: "We expect this to be the first of multiple projects that will ultimately help the scientific community, the natural gas industry, and most importantly, the public, understand the effects of natural gas drilling on water quality."

Researchers believe the increased presence of metals could be due to a variety of factors including: industrial accidents such as faulty gas well casings; mechanical vibrations from natural gas drilling activity disturbing particles in neglected water well equipment; or the lowering of water tables through drought or the removal of water used for the hydraulic fracturing process. Any of these scenarios could release dangerous compounds into shallow groundwater.

Researchers gathered samples from private water wells of varying depth within a 13 county area in or near the Barnett Shale in North Texas over four months in the summer and fall of 2011. Ninety-one samples were drawn from what they termed "active extraction areas," or areas that had one or more gas wells within a five kilometer radius. Another nine samples were taken from sites either inside the Barnett Shale and more than 14 kilometers from a natural gas drilling site, or from sites outside the Barnett Shale altogether. The locations of those sites were referred to as "non-active/reference areas" in the study.

Researchers accepted no outside funding to ensure the integrity of the study. They compared the samples to historical data on water wells in these counties from the Texas Water Development Board groundwater database for 1989-1999, prior to the proliferation of natural gas drilling.

In addition to standard water quality tests, the researchers used gas chromatography - mass spectrometry (GC-MS), headspace gas chromatography (HS-GC) and inductively coupled plasma-mass spectrometry (ICP-MS). Many of the tests were conducted in the Shimadzu Center for Advanced Analytical Chemistry on the UT Arlington campus.

"Natural gas drilling is one of the most talked about issues in North Texas and throughout the country. This study was an opportunity for us to use our knowledge of chemistry and statistical analysis to put people's concerns to the test and find out whether they would be backed by scientific data," said Schug, who is also the Shimadzu Distinguished Professor of Analytical Chemistry in the UT Arlington College of Science.

On average, researchers detected the highest levels of these contaminants within 3 kilometers of natural gas wells, including several samples that had arsenic and selenium above levels considered safe by the Environmental Protection Agency. For example, 29 wells that were within the study's active natural gas drilling area exceeded the EPA's Maximum Contaminant Limit of 10 micrograms per liter for arsenic, a potentially dangerous situation.

The areas lying outside of active drilling areas or outside the Barnett Shale did not show the same elevated levels for most of the metals.

Other leaders of the Texas Gas Wells team were Laura Hunt, who conducted her post-doctoral research in biology at UT Arlington, and Zacariah Hildenbrand, who earned his doctorate in biochemistry from the University of Texas at El Paso and performed post-doctoral research at UT Southwestern Medical Center. Hildenbrand is also the founder of Inform Environmental, LLC. Fontenot and Hunt work for the EPA regional office in Dallas, but the study is unaffiliated with the EPA and both received permission to work on this project outside the agency.

Scientists note in the paper that they did not find uniformity among the contamination in the active natural gas drilling areas. In other words, not all gas well sites were associated with higher levels of the metals in well water.

Some of the most notable results were on the following heavy metals:

Arsenic occurs naturally in the region's water and was detected in 99 of the 100 samples. But, the concentrations of arsenic were significantly higher in the active extraction areas compared to non-extraction areas and historical data. The maximum concentration from an extraction area sample was 161 micrograms per liter, or 16 times the EPA safety standard set for drinking water. According to the EPA, people who drink water containing arsenic well in excess of the safety standard for many years "could experience skin damage or problems with their circulatory system, and may have an increased risk of getting cancer." Selenium was found in 10 samples near extraction sites, and all of those samples showed selenium levels were higher than the historical average. Two samples exceeded the standard for selenium set by the EPA. Circulation problems as well as hair or fingernail loss are some possible consequences of long-term exposure to high levels of selenium, according to the EPA. Strontium was also found in almost all the samples, with concentrations significantly higher than historical levels in the areas of active gas extraction. A toxicological profile by the federal government's Agency for Toxic Substances and Disease Registry recommends no more than 4,000 micrograms of strontium per liter in drinking water. Seventeen samples from the active extraction area and one from the non-active areas exceeded that recommended limit. Exposure to high levels of stable strontium can result in impaired bone growth in children, according to the toxic substances agency.

"After we put the word out about the study, we received numerous calls from landowner volunteers and their opinions about the natural gas drilling in their communities varied," Hildenbrand said. "By participating in the study, they were able to get valuable data about their water, whether it be for household or land use.

"Their participation has been incredibly important to this study and has helped us bring to light some of the important environmental questions surrounding this highly contentious issue."

The paper also recommends further research on levels of methanol and ethanol in water wells. Twenty-nine private water wells in the study contained methanol, with the highest concentrations in the active extraction areas. Twelve samples, four of which were from the non-active extraction sites, contained measurable ethanol. Both ethanol and methanol can occur naturally or as a result of industrial contamination. Historical data on methanol and ethanol was not available, researchers said in the paper.

The paper is called "An evaluation of water quality in private drinking water wells near natural gas extraction sites in the Barnett Shale formation." A Just Accepted version is available on the journal website.

Many from the research team are now conducting well water sampling in the Permian Basin region of Texas, establishing a baseline set of data prior to gas well drilling activities there. That baseline will be used for a direct comparison to samples that will be collected during and after upcoming natural gas extraction. The team hopes that these efforts will shed further light on the relationship between natural gas extraction and ground water quality.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our water - air quality / agriculture section for the latest news on this subject.

The paper is called “An evaluation of water quality in private drinking water wells near natural gas extraction sites in the Barnett Shale formation.” A Just Accepted version is available on the journal website.

Other co-authors include: Qinhong “Max” Hu, associate professor of earth and environmental sciences at UT Arlington; Doug D. Carlton Jr., a Ph.D. student in the chemistry and biochemistry department at UT Arlington; Hyppolite Oka, a recent graduate of the environmental and earth sciences master’s program at UT Arlington; Jayme L. Walton, a recent graduate of the biology master’s program at UT Arlington; and Dan Hopkins, of Carrollton-based Geotech Environmental Equipment, Inc.

Alexandria Osorio and Bryan Bjorndal of Assure Controls, Inc. in Vista, Calif., also are co-authors. The team used Assure’s Qwiklite™ system to test for toxicity in well samples and those results are being prepared for a separate publication.

The research published this week is representative of the important work going on at The University of Texas at Arlington, a comprehensive research institution with about 33,800 students and more than 2,200 faculty members in the heart of North Texas.

University of Texas at Arlington

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Study shows how viruses in gut bacteria change over time

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Study shows how viruses in gut bacteria change over time
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Humans are far more than merely the sum total of all the cells that form the organs and tissues. The digestive tract is also home to a vast colony of bacteria of all varieties, as well as the myriad viruses that prey upon them. Because the types of bacteria carried inside the body vary from person to person, so does this viral population, known as the virome.

By closely following and analyzing the virome of one individual over two-and-a-half years, researchers from the Perelman School of Medicine at the University of Pennsylvania, led by professor of Microbiology Frederic D. Bushman, Ph.D., have uncovered some important new insights on how a viral population can change and evolve ?" and why the virome of one person can vary so greatly from that of another. The evolution and variety of the virome can affect susceptibility and resistance to disease among individuals, along with variable effectiveness of drugs.

Their work was published in the Proceedings of the National Academy of Sciences.

Most of the virome consists of bacteriophages, viruses that infect bacteria rather than directly attacking their human hosts. However, the changes that bacteriophages wreak upon bacteria can also ultimately affect humans.

"Bacterial viruses are predators on bacteria, so they mold their populations," says Bushman. "Bacterial viruses also transport genes for toxins, virulence factors that modify the phenotype of their bacterial host." In this way, an innocent, benign bacterium living inside the body can be transformed by an invading virus into a dangerous threat.

At 16 time points over 884 days, Bushman and his team collected stool samples from a healthy male subject and extracted viral particles using several methods. They then isolated and analyzed DNA contigs (contiguous sequences) using ultra-deep genome sequencing .

"We assembled raw sequence data to yield complete and partial genomes and analyzed how they changed over two and a half years," Bushman explains. The result was the longest, most extensive picture of the workings of the human virome yet obtained.

The researchers found that while approximately 80 percent of the viral types identified remained mostly unchanged over the course of the study, certain viral species changed so substantially over time that, as Bushman notes, "You could say we observed speciation events."

This was particularly true in the Microviridae group, which are bacteriophages with single-stranded circular DNA genomes. Several genetic mechanisms drove the changes, including substitution of base chemicals; diversity-generating retroelements, in which reverse transcriptase enzymes introduce mutations into the genome; and CRISPRs (Clustered Regularly Interspaced Short Palindromic Repeats), in which pieces of the DNA sequences of bacteriophages are incorporated as spacers in the genomes of bacteria.

Such rapid evolution of the virome was perhaps the most surprising finding for the research team. Bushman notes that "different people have quite different bacteria in their guts, so the viral predators on those bacteria are also different. However, another reason people are so different from each other in terms of their virome, emphasized in this paper, is that some of the viruses, once inside a person, are changing really fast. So some of the viral community diversifies and becomes unique within each individual."

Since humans acquire the bacterial population -- and its accompanying virome -- after birth from food and other environmental factors, it's logical that the microbial population living within each of us would differ from person to person. But this work, say the researchers, demonstrates that another major explanatory factor is the constant evolution of the virome within the body. That fact has important implications for the ways in which susceptibility and resistance to disease can differ among individuals, as well as the effectiveness of various drugs and other treatments.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our infectious diseases / bacteria / viruses section for the latest news on this subject.

The research was supported by Human Microbiome Roadmap Demonstration Project (UH2DK083981) the Penn Genome Frontiers Institute, and the University of Pennsylvania Center for AIDS Research (CFAR; P30 Al 045008).

Samuel Minot, Alexandra Bryson, Christel Chehoud, Gary D. Wu, James D. Lewis, all from Penn, are co-authors.

University of Pennsylvania School of Medicine

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Sunday, 28 July 2013

Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study

Main Category: Colorectal Cancer
Article Date: 24 Jul 2013 - 2:00 PDT Current ratings for:
Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study
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Financial incentives for Ontario surgeons are likely a key factor driving greater use of laparoscopic colon cancer surgery, says a study led by a McMaster University surgeon.

The research, published online by the Annals of Surgical Oncology, found that between 2002 and 2009 there was an increase in laparoscopic versus traditional open techniques for colon and rectal cancer surgery. These increases were associated with only minimal decreases in how long patients stayed in hospital after surgery and no changes in the survival of patients.

The authors point out that in October 2005, the Ontario physician billing schedule was altered, providing surgeons with a 25% premium if laparoscopic rather than open techniques were used for colon cancer. Most of the incentives went to surgeons already enthusiastic about laparoscopic approaches.

"Our paper highlights two important issues," said principal investigator Dr. Marko Simunovic, an associate professor of surgery of McMaster's Michael G. DeGroote School of Medicine.

"First, in our publicly funded health care system we need to critically review the advantages and disadvantages of new expensive technologies or treatments before they're widely introduced into the province. Second, Ontario physicians provide high quality care to the best of their abilities - one should question the logic of financial incentives."

Simunovic added: "A 25% bonus for laparoscopic surgery sends a strong signal to surgeons that they should provide this service, even though the available evidence to date does not demonstrate superiority for laparoscopic versus open techniques."

The more expensive laparoscopic surgery usually results in a smaller visible scar and a slightly shorter hospital length of stay.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our colorectal cancer section for the latest news on this subject.

The research was funded by Canadian Institutes for Health Research.

Annals of Surgical Oncology

DOI: 10.1245/s10434-013-3123-2

McMaster University

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Stem cell study uncovers brain-protective powers of astrocytes

Main Category: Stroke
Also Included In: Stem Cell Research;  Neurology / Neuroscience
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Stem cell study uncovers brain-protective powers of astrocytes
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One of regenerative medicine's greatest goals is to develop new treatments for stroke. So far, stem cell research for the disease has focused on developing therapeutic neurons - the primary movers of electrical impulses in the brain - to repair tissue damaged when oxygen to the brain is limited by a blood clot or break in a vessel. New UC Davis research, however, shows that other cells may be better suited for the task.

Published in the journal Nature Communications, the large, collaborative study found that astrocytes - neural cells that transport key nutrients and form the blood-brain barrier - can protect brain tissue and reduce disability due to stroke and other ischemic brain disorders.

"Astrocytes are often considered just 'housekeeping' cells because of their supportive roles to neurons, but they're actually much more sophisticated," said Wenbin Deng, associate professor of biochemistry and molecular medicine at UC Davis and senior author of the study. "They are critical to several brain functions and are believed to protect neurons from injury and death. They are not excitable cells like neurons and are easier to harness. We wanted to explore their potential in treating neurological disorders, beginning with stroke."

Deng added that the therapeutic potential of astrocytes has not been investigated in this context, since making them at the purity levels necessary for stem cell therapies is challenging. In addition, the specific types of astrocytes linked with protecting and repairing brain injuries were not well understood.

The team began by using a transcription factor (a protein that turns on genes) known as Olig2 to differentiate human embryonic stem cells into astrocytes. This approach generated a previously undiscovered type of astrocyte called Olig2PC-Astros. More importantly, it produced those astrocytes at almost 100 percent purity.

The researchers then compared the effects of Olig2PC-Astros, another type of astrocyte called NPC-Astros and no treatment whatsoever on three groups of rats with ischemic brain injuries. The rats transplanted with Olig2PC-Astros experienced superior neuroprotection together with higher levels of brain-derived neurotrophic factor (BDNF), a protein associated with nerve growth and survival. The rats transplanted with NPC-Astros or that received no treatment showed much higher levels of neuronal loss.

To determine whether the astrocytes impacted behavior, the researchers used a water maze to measure the rats' learning and memory. In the maze, the rats were required to use memory rather than vision to reach a destination. When tested 14 days after transplantation, the rats receiving Olig2PC-Astros navigated the maze in significantly less time than the rats that received NPC-Astros or no treatment.

The investigators used cell culture experiments to determine whether the astrocytes could protect neurons from oxidative stress, which plays a significant role in brain injury following stroke. They exposed neurons co-cultured with both types of astrocytes to hydrogen peroxide to replicate oxidative stress. They found that, while both types of astrocytes provided protection, the Olig2PC-Astros had greater antioxidant effects. Further investigation showed that the Olig2PC-Astros had higher levels of the protein Nrf2, which increased antioxidant activity in the mouse neurons.

"We were surprised and delighted to find that the Olig2PC-Astros protected neurons from oxidative stress in addition to rebuilding the neural circuits that improved learning and memory," said Deng.

The investigators also investigated the genetic qualities of the newly identified astrocytes. Global microarray studies showed they were genetically similar to the standard NPC-Astros. The Olig2PC-Astros, however, expressed more genes (such as BDNF and vasoactive endothelial growth factor, or VEGF) associated with neuroprotection. Many of these genes help regulate the formation and function of synapses, which carry signals between neurons.

Additional experiments showed that both the Olig2PC-Astros and NPC-Astros accelerated synapse development in mouse neurons. The Olig2PC-Astros, however, had significantly greater protective effects over the NPC-Astros.

In addition to being therapeutically helpful, the Olig2PC-Astros showed no tumor formation, remained in brain areas where they were transplanted and did not differentiate into other cell types, such as neurons.

"Dr. Deng's team has shown that this new method for deriving astrocytes from embryonic stem cells creates a cell population that is more pure and functionally superior to the standard method for astrocyte derivation," said Jan Nolta, director of the UC Davis Institute for Regenerative Cures. "The functional improvement seen in the brain injury models is impressive, as are the higher levels of BDNF. I will be excited to see this work extended to other brain disease models such as Huntington's disease and others, where it is known that BDNF has a positive effect."

Deng added that the results could lead to stem cell treatments for many neurodegenerative diseases.

"By creating a highly purified population of astrocytes and showing both their therapeutic benefits and safety, we open up the possibility of using these cells to restore brain function for conditions such as Alzheimer's disease, epilepsy, traumatic brain disorder, cerebral palsy and spinal cord injury," said Deng.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our stroke section for the latest news on this subject.

Peng Jiang of UC Davis and Shriners Hospitals for Children was the study lead author. Deng and Jiang's co-authors were Chen Chen, Olga Chechneva, Seung-Hyuk Chung and David Pleasure of UC Davis and Shriners Hospitals for Children; Quanguang Zhang and Ruimin Wang of the Medical College of Georgia; Mahendra Rao of the National Institutes of Health (NIH) Center for Regenerative Medicine; and Ying Liu of the University of Texas Health Science Center.

This research was funded in part by the NIH (grants R01NS061983, R01ES015988 and R01NS025044), National Multiple Sclerosis Society, Shriners Hospitals for Children, California Institute for Regenerative Medicine, Memorial Hermann Foundation (Staman Ogilvie Fund) and the Bentsen Stroke Center.

University of California - Davis Health System

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Study finds druggable target for pulmonary hypertension

Main Category: Respiratory / Asthma
Also Included In: Hypertension;  Genetics
Article Date: 27 Jul 2013 - 0:00 PDT Current ratings for:
Study finds druggable target for pulmonary hypertension
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Columbia University Medical Center (CUMC) scientists have identified new genetic mutations that can cause pulmonary arterial hypertension (PAH), a rare fatal disease characterized by high blood pressure in the lungs. The mutations, found in the gene KCNK3, appear to affect potassium channels in the pulmonary artery, a mechanism not previously linked to the condition. Cell culture studies showed that the mutations' effects could be reversed with a drug compound known as a phospholipase inhibitor. The study was published in the online edition of the New England Journal of Medicine.

"The most exciting thing about our study is not that we've identified a new gene involved in pulmonary hypertension, but that we've found a drug that can 'rescue' some mutations," said co-senior author Wendy K. Chung, MD, PhD, associate professor of pediatrics and medicine at CUMC. "In genetics, it's common to identify a gene that is the source of a disease. However, it's relatively rare to find potential treatments for genetic diseases."

PAH is a progressive disorder characterized by abnormally high blood pressure in the pulmonary artery, which reduces blood flow from the right side of the heart to the lungs. The heart can compensate by pumping harder, but over time this can weaken the heart muscle and lead to right-sided heart failure. Common symptoms of PAH include shortness of breath, dizziness, and fainting. About 1,000 new cases are diagnosed in the United States each year. The disorder is twice as common in females as in males. There is no cure for PAH and few effective treatments. Most patients with PAH die within 5-7 years of diagnosis.

Some cases of PAH are caused by inherited genetic defects. Most of these "familial" cases have been linked to mutations in a gene called BMPR2 (bone morphogenetic protein receptor, type II), which was identified simultaneously in 2000 by two independent research teams, one led by the late Robin Barst and Jane Morse, CUMC researchers. However, the majority of cases are idiopathic in origin (of unknown cause). Other forms of PAH can be triggered by autoimmune diseases, congenital heart defects, infections (such as schistosomiasis), and medications (such as the now-banned diet-drug combination commonly known as fen-Phen).

Dr. Chung and her colleagues discovered the new mutations by sequencing the exomes (the portion of the genome that codes information to make proteins) of families with PAH without identified mutations. KCNK3 mutations were found in 3.2 percent of those with familial disease and in 1.3 percent of those with idiopathic PAH.

The team found that the mutations alter the function of potassium channels by reducing the activity of these channels. Potassium channels help maintain the vascular tone of the pulmonary artery and help it respond to low levels of oxygen.

"We were surprised to learn that KCNK3 appears to play a role in the function of potassium channels in the pulmonary artery," said Dr. Chung. "No one had suspected that this mechanism might be associated with PAH." The other gene linked to the disorder, BMPR2, is thought to cause PAH by ultimately promoting growth and multiplication of smooth muscle cells in the pulmonary artery, thereby restricting blood flow.

Dr. Chung also found, working in collaboration with co-senior author, Robert S. Kass, PhD, the Alumni and David Hosack Professor of Pharmacology, chair of the department, and vice dean for research at CUMC, that the effects of the KCNK3 mutations could be reversed with an experimental phospholipase inhibitor called ONO-RS-082. The findings were made in cell cultures. Further study is needed to determine whether treatment with this or other drugs that affect potassium channels might be useful in the treatment of people with PAH, said Dr. Chung.

"KCNK3 mutations are a rare cause of PAH, so I don't want to oversell our findings," said Dr. Chung. "Still, it's exciting that we've found a mechanism that can lead to the disease that is a new, druggable target. It's also possible that targeting KCNK3 may be beneficial for patients who have PAH independent of their KCNK3 genetic status."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our respiratory / asthma section for the latest news on this subject.

The paper is titled, "A Novel Channelopathy in Pulmonary Arterial Hypertension." The other contributors are: Lijiang Ma, Danilo Roman-Campos, Eric D, Mélanie Eyries, Kevin Sampson, Florent Soubrier, Marine Germain, David-Alexandre Trégouët, Alain Borczuk, Erika Berman Rosenzweig, Barbara Girerd, David Montani, Marc Humbert, and James E. Loyd.

The authors declare no financial or other conflicts of interests.

The study was supported by grants from the National Institutes of Health (R01 HL060056, P01 HL072058, K23 HL098743, and R01 HL56810) and by a Vanderbilt Clinical and Translational Science Awards (UL1 RR024975) from the National Center for Research Resources.

Columbia University Medical Center

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Saturday, 27 July 2013

Study features practical solution for MRI-ultrasound fusion to enable tumor-targeted, tissue-preserving prostate HIFU treatment

Main Category: MRI / PET / Ultrasound
Also Included In: Prostate / Prostate Cancer
Article Date: 27 Jul 2013 - 0:00 PDT Current ratings for:
Study features practical solution for MRI-ultrasound fusion to enable tumor-targeted, tissue-preserving prostate HIFU treatment
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Study results published in the current issue of British Journal of Urology International (10.1111/bju.12223) demonstrate that new software to register and fuse information from magnetic resonance imaging (MRI) and ultrasound (US) images enables intraoperative visualization of tumors, not ordinarily seen in a US image. This technology has the potential to support new tissue-preserving treatments for prostate cancer, such as focal therapy.

In the study, "Image-Directed, Tissue-Preserving Focal Therapy of Prostate Cancer: a Feasibility Study of a Novel Deformable MR-US Registration System" researchers from University College London (UCL) evaluated the feasibility of using a computer-assisted, deformable image registration software to enable three-dimensional, multi-parametric MRI derived information on tumor location and extent to inform both the planning and treatment phase of focal high intensity focused ultrasound (HIFU) therapy using SonaCare Medical's Sonablate® 500 system.

Nested within the multi-center INDEX Trial, this pilot study employed computer assisted MRI-US image registration software within the planning of the first 26 men with a MRI-visible tumor treated at UCL with HIFU using a tissue-preserving quadrant, hemispheric (hemi) or extended hemi ablation therapy. Results demonstrated that thesoftware, developed at UCL, enables information of tumor location to be used for therapy planning using the Sonablate® 500 system without adding significant extra time to the standard procedural workflow. Such planning is particularly important for new tissue-preserving treatment approaches to ensure that the tumor is completely treated.

"Multi-parametric MRI has shown promise as an accurate method for determining the focality of tumors, and has promise as a potentially important enabler for minimally-invasive, tissue-preserving, or focal, HIFU treatments. However, most ablative technologies for localized prostate cancer use an ultrasound platform to plan and deliver treatment, on which the tumor cannot be accurately localized. This often results in discrepancies between the tumor and target volumes, potentially leading to under-treatment at the margins, or treatment of larger tissue volumes to compensate for inaccuracies in targeting," said lead author Louise Dickinson of UCL. "We are very pleased that the results of this pilot study demonstrate that deformable image registration is feasible and safe when introduced into a HIFU ablative therapy setting and suggests potential for improving the accuracy of targeting lesions using a tissue-preserving focal therapy approach."

The researchis based on breakthrough image analysis algorithms developed at the UCL Centre for Medical Image Computing and has undergone extensive clinical evaluation as part of clinical research studies led by Professor Mark Emberton, MD, Professor of Interventional Oncology and Director of the Division of Surgery and Interventional Science at UCL. Twenty-six prostate cancer patients have been successfully treated at UCLH using the Sonablate(®) 500 with the aid of this software as part of the INDEX Trial.

Dr. Dickinson added: "Indeed, if on-going clinical trials demonstrate clinical utility for focal therapy as an alternative to current standards of care, it is possible that image registration software may be essential for the efficient implementation of truly focal therapy techniques in which individual tumors are treated within an appropriate and safe surgical margin. The use of MRI-US registration potentially provides a cost-effective solution that, as shown in this study, can be easily integrated within existing workflows and interfaces, using standard surgical equipment."

Subsequent to this research, the team at UCL, led by Dr. Dean Barratt, is now developing a commercial version of their prostate image registration/fusion software, called "SmartTarget", with funding from the UK Department of Health and Wellcome Trust Health Innovation Challenge Fund. The SmartTarget project focuses on translating technology, which combines state-of-the-art diagnostic imaging with advanced image guidance technology to provide doctors with information on cancer location, size and shape so that it can be used to direct and guide prostate biopsy and minimally-invasive cancer treatments. In particular, the SmartTarget system exploits MRI, which can detect and characterize clinically significant cancers in a large proportion of patients.

"The adoption of tissue preserving approaches for the treatment of prostate cancer has been hampered by limitations in diagnosing and localizing clinically significant prostate cancers," said Mark Carol, M.D., Chief Development Officer for SonaCare Medical. "The publication of these results in the British Journal of Urology International is a tremendous validation of UCL's pioneering research in image registration and fusion technology that has led to significant advances in the validation and adoption of focal HIFU. We are proud to work with UCL to expand access to this breakthrough technology designed to enable targeted treatment of clinically significant prostate cancers."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our mri / pet / ultrasound section for the latest news on this subject.

Recently SonaCare Medical, a global leader in minimally-invasive High-Intensity Focused Ultrasound (HIFU) technologies, and UCL Business PLC (UCLB), a leading technology transfer company that supports and commercializes research and innovations from UCL, announced a partnership to integrate SmartTarget image registration and fusion software into SonaCare Medical's innovative Sonablate® 500 HIFU system.

SonaCare Medical

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Wednesday, 24 July 2013

Study examines sustained inattentional blindness in expert observers

Main Category: Psychology / Psychiatry
Article Date: 24 Jul 2013 - 0:00 PDT Current ratings for:
Study examines sustained inattentional blindness in expert observers
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If you were working on something at your computer and a gorilla floated across your computer screen, would you notice it? You would like to think yes, however, research shows that people often miss such events when engaged in a difficult task. This is a phenomenon known as inattentional blindness (IB). In a new study from Brigham and Women's Hospital (BWH) in Boston, researchers have found that even expert searchers, operating in their domain of expertise, are vulnerable to inattentional blindness. This study is published in Psychological Science.

"When engaged in a demanding task, attention can act like a set of blinders, making it possible for stimuli to pass, undetected, right in front of our eyes," explained Trafton Drew, PhD, post-doctoral researcher at BWH and lead author on this study. "We found that even experts are vulnerable to this phenomenon."

The researchers asked 24 radiologists to perform a familiar lung nodule detection task. They examined five scans; each scan contained an average of 10 nodules. A gorilla, 48 times larger than the average nodule, was inserted in the last scan. The researchers found that 83 percent of radiologists did not report seeing the gorilla. With the help of Melissa Le-Hoa Vo, post-doctoral researcher at BWH, the researchers tracked the eye-movements of the radiologists and found that that the majority of those who missed the gorilla looked directly at it.

"The radiologists missed the gorillas not because they could not see them, but because the way their brains had framed what they were doing. They were looking for cancer nodules, not gorillas," explained Jeremy Wolfe, senior psychologist and director of the Visual Attention Laboratory at BWH. "This study helps illustrate that what we become focused on becomes the center of our world, and it shapes what we can and cannot see."

The researchers note that it would be a mistake to regard these results as an indictment of radiologists and stress that even this high level of expertise does not immunize against inherent attentional limitations of what we perceive. The results suggest that even expert searchers typically only see what they are looking for, and are often unaware of the unexpected. The researchers hope that the results will lead more expert searchers to recognize the important role of attention in determining what the searcher will find and what they may miss.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our psychology / psychiatry section for the latest news on this subject.

This work was funded by a NRSR post-doctoral fellowship from the NIBIB to TD.

Brigham and Women's Hospital

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Study allows a rare glimpse of evolution in progress

Main Category: Genetics
Article Date: 24 Jul 2013 - 1:00 PDT Current ratings for:
Study allows a rare glimpse of evolution in progress
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In a twist on "survival of the fittest," researchers have discovered that evolution is driven not by a single beneficial mutation but rather by a group of mutations, including ones called "genetic hitchhikers" that are simply along for the ride. These hitchhikers are mutations that do not appear to have a role in contributing to an organism's fitness and therefore its evolution, yet may play an important role down the road.

Researchers from Princeton University found in a study of 1,000 generations of adaptation in 40 yeast populations that about five to seven specific mutations, rather than just a one, are needed for an organism to succeed. The knowledge of how mutations drive evolution can inform our understanding of how tumors resist chemotherapeutics and how bacteria evolve resistance to antibiotics. The study was published in the journal Nature.

Evolution occurs when an individual experiences spontaneous beneficial mutations in its genome that improve its ability to adapt to its environment. The common view was that a single mutation could boost the survival of an individual, which would then reproduce and pass on the mutation to its offspring.

Instead, the Princeton researchers found that rather than just one mutation causing enhanced survival, about five to seven mutations are required. These extra mutations are termed hitchhikers because they don't appear to contribute to the enhanced fitness of the organism.

"Our study indicates that evolution is more of a group effort," said Gregory Lang, first author on the paper and an associate research scholar in the laboratory of David Botstein, the Anthony B. Evnin '62 Professor of Genomics at Princeton University's Lewis-Sigler Institute for Integrative Genomics. The research team included co-first author Daniel Rice at Harvard University, who made key contributions to the bioinformatics and data analysis; Michael Desai, an assistant professor at Harvard University and a former Lewis-Sigler Fellow at Princeton; Mark Hickman at Rowan University; and Erica Sodergren and George Weinstock at the Washington University School of Medicine.

"The finding goes against the traditional view of evolution being determined by individual mutations that provide a large fitness advantage by themselves," Desai said. "We found that small groups - which we call cohorts - of mutations were associated with increased survival. No single mutation is driving adaptation. The whole group, which includes hitchhikers, drives adaptation together."

The study helps expand our understanding of how evolution arises from a combination of genetic mutations, which are thought of as occurring spontaneously, and environmental pressures, said Botstein. "We've shown that this first component, the genetics, involves not just one gene mutation but several that need to co-exist before evolution can happen."

The relatively small subset of gene mutations that were found to enhance survival, Botstein said, suggests that there are only a limited number of ways in which organisms can substantially increase their fitness. "Understanding the basic process in yeast translates to other organisms," he said.

The study explored how the process of mutation and selection unfolded over time at the genetic level. To look at mutations and survival, the researchers observed 40 different yeast strains that reproduced asexually for 1,000 generations. Over time the researchers noted the appearance of specific mutations that conferred a survival advantage, allowing certain yeast colonies to thrive. As time progressed, additional mutations cropped up, until researchers found that all of the best survivors contained the same group of five to seven mutations.

Although the researchers refer to the groups of mutations as containing drivers and hitchhikers, Desai said that additional research is being done to explore which mutations are necessary for adaptation and which ones are along for the ride. He noted that the mutations are not located near each other, nor do they appear to have similar functions.

Previous evidence suggests that yeast may experience beneficial mutations that inactivate genes they no longer need. For example, Lang and Botstein in collaboration with Andrew Murray at Harvard University reported in the journal Proceedings of the National Academy of Sciences in 2009 that, if grown in conditions where the yeast can only reproduce asexually, mutations that inactivate genes for proteins involved in sexual reproduction boost survival because the organisms do not waste metabolic energy producing unneeded proteins. The team plans to explore whether the mutations identified in the new study confer specific survival advantages.

"By following genomic changes across cell populations over time, this study allows a rare glimpse of evolution in progress," said Stefan Maas of the National Institute of Health's National Institute of General Medical Sciences, which partially funded the research. "This systems biology approach yields insights that could help us understand how mutations spread through other evolving systems, such as cancer cells or disease-causing microbes."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our genetics section for the latest news on this subject.

The study was funded with support from a National Science Foundation Graduate Research Fellowship, the National Institute of General Medical Sciences Centers of Excellence grants GM071508 and NIH grant GM046406, the James S. McDonnell Foundation, the Alfred P. Sloan Foundation, and the Harvard Milton Fund.

Princeton University

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Study suggests that turning on a gene may prevent diabetes

Main Category: Diabetes
Also Included In: Genetics
Article Date: 24 Jul 2013 - 1:00 PDT Current ratings for:
Study suggests that turning on a gene may prevent diabetes
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Type 2 diabetes accounts for 90 % of cases of diabetes around the world, afflicting 2.5 million Canadians and costing over 15 billion dollars a year in Canada. It is a severe health condition which makes body cells incapable of taking up and using sugar. Dr. Alexey Pshezhetsky of the Sainte-Justine University Hospital Research Center, affiliated with the University of Montreal, has discovered that the resistance to insulin seen in type 2 diabetics is caused partly by the lack of a protein that has not previously been associated with diabetes. This breakthrough could potentially help to prevent diabetes.

"We discovered that Neu1, a protein nicknamed after "neuraminidase 1", turns the absorption of sugar "on" or "off" in body cells, by regulating the amount of sialic acid on the surface of cells", Dr. Pshezhetsky explains.

"We are now trying to find a way to restore Neu1 levels and function in diabetes. If we can remove sialic acid residues from the cell surface, this will force the insulin receptor do its job of absorbing blood sugar properly. This could give doctors an opportunity to reduce the use of insulin therapy, and might help to reduce the diabetes epidemic, says Dr. Pshezhetsky.

The results of his study done on cells and mice were published this month in the journal Diabetes. Dr Pshezhetsky and his team are now testing their results in diabetic patients.

Although type 2 diabetes is initially treated with diet, exercise and tobacco avoidance, doctors try to restore normal levels of insulin by prescribing it when this fails. The number of cases diagnosed around the world continues to grow incredibly quickly: according to the United States Center Disease Control, cases in that country grew on average by 82% between 1995 and 2010. In Oklahoma, the number increased by 226%. The disease accounts for 90% of diabetes cases around the world, and its prevalence has increased in parallel with the obesity epidemic. Obesity is in fact thought to cause this disease which can in turn lead to heart disease, strokes and even limb amputation due to poor circulation.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our diabetes section for the latest news on this subject.

About this study: Dr Alexey Pshezhetsky and his colleagues published "Positive Regulation of Insulin Signaling by Neuraminidase 1" in the July, 2013 edition of Diabetes. The study was partially supported by research grants from Canadian Diabetes Association and the Canadian Institutes for Health Research.

University of Montreal

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Sunday, 21 July 2013

Predicting STEMI, the most severe heart attack: JACC study

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics
Article Date: 19 Jul 2013 - 2:00 PDT Current ratings for:
Predicting STEMI, the most severe heart attack: JACC study
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Infraredx, Inc., a medical device company committed to advancing the diagnosis and management of coronary artery disease, has announced the publication of key data supporting the ability of its TVC Imaging System to detect lipid core plaque in patients with ST-Segment Elevation Myocardial Infarction (STEMI). The study, published in JACC: Cardiovascular Interventions, details the identification of a specific cholesterol signature by Near Infrared Spectroscopy (NIRS) at the site of the culprit lesions causing STEMI, a dangerous type of heart attack. While the TVC Imaging System has been used in more than 3,000 patients worldwide, the present study is the first report of its use in a consecutive series of STEMI patients.

The research was led by Ryan D. Madder, M.D., a practicing interventional cardiologist at Spectrum Health, in Grand Rapids, Mich. The study utilized the TVC Imaging System, which is a first-in-class intravascular imaging system that integrates near-infrared spectroscopy (NIRS) lipid core plaque detection and enhanced intravascular ultrasound (IVUS) imaging technology to assess vessel composition and structure.

"We have discovered a near-infrared spectroscopic signature of the plaques which cause myocardial infarction, a leading cause of morbidity and mortality worldwide," said Dr. Madder. "This signature is detectable at the time of cardiac catheterization using a novel intracoronary imaging device. It is our hope that this signature may be capable of predicting a myocardial infarction before it happens. Through an international collaboration with several other centers, further studies are currently underway and others are being planned to validate this signature and to determine if near-infrared spectroscopy can accurately predict future myocardial infarction."

In this study, researchers utilized the TVC imaging system to image the culprit vessel, as identified by angiography, in 20 STEMI patients referred acutely for primary percutaneous coronary intervention. In 19 of the 20 patients, a distinct signature of lipid core plaque (LCP) was identified with NIRS specifically at the location of the culprit lesion. To confirm plaque composition, the researchers compared the NIRS imaging results from the sites causing the blockage and subsequent heart attack to results from non-culprit segments of the patients' vessels as well as to 46 autopsy specimens serving as the gold-standard of histology. The study's novel in vivo findings of lipid core plaque at STEMI culprit sites correspond with multiple autopsy studies that have demonstrated that rupture of a large lipid core plaque is the most frequent cause of a fatal myocardial infarction. Most importantly for predictive and preventive purposes, it is likely that the large lipid core plaques observed at STEMI culprit sites were present and detectable before plaque rupture and thrombus formation and the acute coronary event.

"There are many possible treatments already available for coronary plaques at increased risk for rupture and thrombosis," said James E. Muller, M.D., founder and chief medical officer of Infraredx. "The primary challenge cardiologists have faced has been the identification of plaques likely to cause major adverse events, including heart attacks. The identification of a clear signal so closely associated with culprit plaques in patients suffering STEMI is a major step forward in the effort to identify and treat vulnerable coronary plaques before they cause a catastrophic event."

Myocardial infarctions (heart attack) occur when a plaque ruptures and its contents are exposed to blood, creating a thrombus (blood clot) that, in turn, leads to a rapid, complete blockage of an artery. ST-Segment Elevation Myocardial Infarction (STEMI) is the more severe type of heart attack. In the United States alone, more than 1 million individuals experience a myocardial infarction or sudden cardiac death each year.[1]

The TVC Imaging System™ is a first-in-class intravascular imaging system that holds the potential to revolutionize the management of coronary artery disease by providing information that is critical for evaluating vessel structure and composition, also known as true vessel characterization. The TVC Imaging System helps interventional cardiologists identify which patients are prone to complications during stenting. The device enables cardiologists to predict peri-procedural heart attacks by assessing not only the degree of stenosis, but also the presence and extent of lipid-rich plaques (LRP).

The device is the only multimodality imaging system to combine both intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS). Through IVUS technology, the TVC Imaging System provides clear and relevant information about vessel structure, in real time. The TVC Imaging System is the only device available in both the U.S. and Europe for the detection of LCPs. NIRS measurements have been made in over 5,000 patients in over 90 hospitals worldwide.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject.

[1] Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation 2012; 125;e2-e220.

The paper: "Detection of Near-infrared Spectroscopy of Large Lipid Core Plaques at Culprit Sites in Patients with Acute ST-Segment Elevation Myocardial Infarction," is available online.

Infraredx

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Study Looks At Patients' Experience Of Direct-To-Consumer Genetic Testing

Main Category: Genetics
Also Included In: Public Health
Article Date: 19 Jul 2013 - 0:00 PDT Current ratings for:
Study Looks At Patients' Experience Of Direct-To-Consumer Genetic Testing
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Several companies sell genetic testing directly to consumers, but little research has been done on how consumers experience such tests. The tests have raised questions about the validity and accuracy of the information provided to consumers - especially without the involvement of a qualified health-care professional.

Now a study led by a researcher at Loyola University Chicago Stritch School of Medicine is providing insight into how a diverse group of primary care patients experience genetic testing.

Lead researcher Katherine Wasson, PhD, MPH, and her colleagues conducted in-depth interviews with 20 patients recruited from primary care clinics. Among the findings, published online ahead of the print edition, in the Journal of Community Genetics:

Most participants thought results were fairly easy to understand - with the help of a genetic counselor (provided by the study, not the testing company). But fewer than half said they might be able to understand results on their own. Most participants expressed no concern or hesitation about testing. But a few worried about confidentiality, especially whether the results could affect their health insurance coverage. A few also expressed fears about getting bad results. As one participant explained, "I mean, you want to know, but then you don't want to know." Participants gave several reasons why they decided to undergo testing. Most simply said they were curious. "I don't have a scientific background, so a lot of it is just fascinating to see how all of that can spin out," one participant said. Many also said test results would provide knowledge they could act on and help them prepare for the future. Said one: "If you know that there's something going on, you can go ahead and fix it now and not have to try to fix it later when it's already unfixable." A few participants wanted to help their families or the next generation, or more broadly, contribute to research and medical science. Most participants were pleased with results of the tests, mainly because they had not received bad news, despite the uncertainty of the results. "This makes me feel great," said one such participant. "I know I'll be around at least another year or two." About half the participants said they had made no changes in response to results, mainly because there was nothing on which to act. But among a few participants, receiving "low-risk" results was a motivating factor to improve their health behavior, mainly through more exercise and a better diet. One year after testing, most participants said they would take the test again and recommend it to others. "It's as if you stepped into a time capsule and you went ahead in time and you can see something," one participant said.

Patients were interviewed individually four times: during an initial session in which a saliva sample was given; four to six weeks later, when they received results; three months after receiving results; and 12 months after receiving results. All interviews were recorded and transcribed verbatim.

The patients ranged in age from 29 to 63; the average age was 49.5. Sixty percent were female, 50 percent were white and 50 percent were African-American. Thirty percent were high school graduates, 40 percent had some college, 25 percent were college graduates and 5 percent were postgraduates.

Researchers concluded: "This longitudinal, qualitative study adds more in-depth information to the emerging data on participants' decision-making process about, the experience of and reactions to direct-to-consumer testing over time . . . It is possible that our findings could be relevant to more general consumers with similar demographics, though further investigation is needed."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our genetics section for the latest news on this subject.

Companies such as 23andMe and Navigenics test consumers’ genomes for single-gene disorders, such as cystic fibrosis; for risks of developing complex disorders involving multiple genes, such as cancer, heart disease and diabetes; for sensitivities to drugs such as Coumadin; and for traits such as baldness. Costs range from approximately $100 to $1,500. Consumers can order these tests directly and receive results without the involvement of a qualified health-care professional, such as a geneticist or genetic counselor.

Wasson, first author of the study, is an assistant professor in the Neiswanger Institute for Bioethics in Loyola’s Stritch School of Medicine. Other authors were Tonya Nashay Sanders, MA, PhD, an assistant professor at Morgan State University in Baltimore; Nancy S. Hogan, PhD, RN, a distinguished professor in Loyola’s Niehoff School of Nursing; Sara Cherny, MS, CGC, of Cadence Health; and Kathy J. Helzisouer, MD, MHS, of Mercy Medical Center in Baltimore.

Loyola University Health System

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