Study Suggests Need For More Aggressive Outpatient Monitoring Of Patients’ Hearts When Cause Of Stroke Is Unclear

In nearly one third of all people who suffer from a stroke, the underlying cause of the injury is not readily evident to doctors. Atrial fibrillation (AF), or an irregular heartbeat, is believed to be a significant factor in many of these cases.

Stroke researchers at Allegheny General Hospital (AGH) in Pittsburgh are reporting in the journal Neurology (neurology/cgi/content/abstract/71/21/1696) that a new diagnostic approach that extends the monitoring of patients’ hearts after hospital discharge greatly improved their ability to detect AF and treat it appropriately.

Led by Ashis Tayal, M.D., a stroke neurologist and medical director of AGH’s Comprehensive Stroke Center, the AGH team explored the use of mobile outpatient cardiac telemetry over a period of 2-3 weeks to monitor patients who have experienced a stroke or a transient ischemic attack (TIA) of unknown cause.

Atrial Fibrillation was diagnosed in 23% of the study participants where conventional diagnostic protocols had failed.

“Stroke is an extremely challenging disease to treat and prevent when we know the cause or an individual’s specific risk factors. That so many patients actually leave the hospital without a precise reason for their injury is a very frustrating scenario for physicians and one that has potentially devastating implications for patients and their families,” Dr. Tayal said.

The nation’s third leading cause of death, stroke is the number one cause of serious, long-term disability.

“If we can indeed identify AF more promptly in these cases, our ability to treat patients and perhaps prevent a second, more catastrophic injury would be significantly enhanced,” he said.

Atrial fibrillation is the most common heart rhythm abnormality that people develop. During AF the heart’s two upper chambers (the atria) beat chaotically and irregularly. The condition causes poor blood flow and the development of blood clots within the heart which can subsequently release into the arteries of the brain and cause a stroke.

Dr. Tayal said the conventional approach to evaluating stroke patients is an extensive in-hospital diagnostic work-up that includes neurological imaging such as MRI and angiography and cardiovascular studies, such as telemetry and holter monitoring, that assess the heart’s rhythm.

“Intermittent AF becomes more common as we grow older and as a known risk factor for stroke, the current standard of care when the cause of injury is unclear is to monitor patients with telemetry for several days in the hospital. Unfortunately, our probability of detecting AF in this brief window of time is less than 1%,” Dr. Tayal said.

Using a newer, mobile telemetry system called CardioNet, Dr. Tayal and his AGH colleagues evaluated 56 patients with stroke of unknown etiology and no previous history of AF for a period of three weeks post-discharge. Hospital based telemetry and holter monitoring results for all were normal.

The CardioNet System requires no patient interaction. Via three leads attached to a lightweight sensor worn on a neck strap or belt clip, the monitor analyzes a patient’s heart rhythm in real time during normal daily activities. When the system identifies an abnormal rhythm, the data is automatically transmitted to the medical team.

Over the course of three weeks, thirteen of the 56 patients in AGH’s study were found to have either prolonged or brief episodes of AF. For those with prolonged incidents — a clear indication of stroke cause — the discovery prompted immediate therapeutic intervention with medication designed to better protect the patient from a repeat stroke.

Dr. Tayal said the results are equally important relative to those found to have brief episodes of AF.

“AF of relatively short duration — 10, 15 seconds or so — does not place a patient at imminent risk of a blood clot or stroke, but it may be a maker of those who are prone to a more dangerous, prolonged episode that does. Knowing that someone is predisposed to AF substantially alters our approach to treating them and may ultimately improve outcomes,” Dr. Tayal said.

Allegheny General Hospital

British Forces Clinic Allied Joint Forces Command Headquarters Naples Wins National Award For No Smoking Day, UK

The British Forces Clinic Allied Joint Forces Command Headquarters Naples in Italy wins a national award for organising an event for No Smoking Day 2007. Lt Cdr Lorraine England QARNNS representing the British Forces team won three prestigious awards for newcomer of the year, best community activity and best Armed Forces activity by designing a children’s and young persons workbook for classroom use and, co-ordinating the delivery of a number of stop-smoking activities within the local British Forces community.

Lt Cdr Lorraine England QARNNS who works as the Senior Nursing Officer and stop-smoking co-ordinator within the British Forces Clinic said: “We are very pleased to win an award for our 2007 No Smoking Day activities as it recognises the strength of collaboration and partnership between the military medical services, service education agencies, SSAFA (Soldiers, Sailors, Airmen and Families Association), HIVE (Help, Information, Volunteer, Exchange) and the No Smoking Day campaign team in delivering effective education about the risks associated with smoking.”

Dan Tickle, Chief Executive of the charity No Smoking Day said: “Thanks to the passionate support of our local organisers, No Smoking Day has remained the UK’s leading public health event for a quarter of a century. For their dedication and commitment – as well as their willingness to spend wet Wednesdays in March dressed as a giant cigarette – we’re indebted to each and every one.”
Next year’s No Smoking Day will be on Wednesday 12 March 2008.


No Smoking Day (NSD) is organised by a charity of the same name run by four full time staff. Based in London, the charity is funded by a coalition of governmental and voluntary sector organisations with an interest in health.

NSD aims to help people who want to stop smoking by creating a supportive environment for them, and by highlighting the many sources of help available to people who want to quit.

Now in its 25th year it is a firm fixture in the UK calendar because of its popularity amongst smokers and continued success. Three quarters of smokers would like to stop and on NSD over a million try. NSD isn’t just about the Day. Stopping smoking requires much planning, encouragement, support and motivation. Helping others to prepare to quit can be done year round, but the Day provides an excellent focus and motivation for many smokers to stop.


Possible Connection Between Marijuana Abuse And Stroke Or Heart Attacks

Long-term harmful effects of marijuana (MJ) include risk for heart attacks and strokes in addition to impaired learning and memory. The active chemical in MJ called delta-9-tetrahyrdocannabinol (THC) is believed to exert these effects by binding to cannabinoid (CB) receptors located on several cell types in various organs. Scientists have found CB receptors in many organs including the brain, heart, liver, kidney, and spleen.

In this study, researchers investigated if persistent heavy MJ use might be associated with changes in different blood proteins in order to check if the abnormalities in the identified proteins might be related to other side-effects of marijuana.

The study was conducted with 18 long term heavy MJ users and 24 non-drug using volunteers. People with major medical and psychiatric illnesses, hypertension, head injury, HIV positive, alcohol dependency and other drug usage, were excluded from the study. Blood proteins were measured in both control volunteers and MJ users using a new method (protein chip) that has the potential to identify several new target proteins. That approach showed that apolipoprotein C-III (apoC-III) showed significant increases in MJ abusers. ApoC-III belongs to a large family of proteins that interact with lipids and helps lipids to move into and out of cells. ApoC-III is involved in transport of triglycerides and delays the breakdown of triglycerides. Increases in apoC-III levels in the blood occur in parallel with increases in triglyceride levels.

Even though we still don’t understand how heavy MJ use might cause increases in apoC-III levels, this protein might be one of the reasons why some MJ users have increased risks of heart attack and strokes.


Citation source:

Heavy Marijuana Users show Increased Serum Apolipoprotein C-III levels: Evidence from proteomic analyses

S Jayanthi1 S Buie1 S Moore3 RI Herning1 W Better1 NM Wilson1 C Contoreggi2 JL Cadet1

1Molecular Neuropsychiatry Branch
2Office of the Clinical Director, National Institute on Drug Abuse-Intramural Research Program, NIH, BRC, 251 Bayview Boulevard, Baltimore, MD, USA
3Ciphergen Biosystems, Freemont, CA, USA

Molecular Psychiatry advance online publication 13 May 2008

Molecular Psychiatry is a peer-reviewed independent journal that publishes groundbreaking research in psychiatry and related fields. The journal’s Impact Factor is 11.804, 2nd of 95 in Psychiatry

Journal Website: nature/mp
Editor: Julio Licinio, M.D.
University of Miami Miller School of Medicine

Source: Dorie Hightower

Molecular Psychiatry

Evotec Reports Results Of Phase II Proof-Of-Concept Study With EVT 302

Evotec AG (Frankfurt Stock Exchange: EVT; NASDAQ: EVTC) announced the results of a Phase II proof-of-concept study investigating the potential of EVT 302, a reversible and highly selective inhibitor of monoamine oxidase B (MAO-B), as an aid to smoking cessation.

EVT 302 failed to demonstrate any significant improvement in the quit rate compared with placebo. The combination of EVT 302 with a nicotine replacement patch also failed to demonstrate any significant benefit over nicotine replacement therapy (NRT) alone. The study was well performed and the placebo quit rate was well within expectations ensuring adequate power to demonstrate any treatment effect. Throughout this study EVT 302 was well tolerated with subjects experiencing very few treatment-related adverse events.

The study reported today was performed double blind in Germany with 414 otherwise healthy smokers who were motivated to quit smoking. The study assessed whether 8 weeks treatment with EVT 302 resulted in an increase in quit rate compared to placebo. The study also included a comparison of EVT 302 added to NRT (21 mg patch once daily) vs NRT alone to see if there was any additive benefit for the two treatments taken together.

Dr Tim Tasker, Executive Vice President Clinical Development at Evotec, commented: “We are disappointed with the results of this proof-of-concept study which has failed to demonstrate any convincing support for the use of EVT 302 as an aid to smoking cessation. Once a full analysis of all the data is completed Evotec will re-assess the future of EVT 302, given the overall potential of MAO-B-inhibitors in a number of indications and the excellent safety profile demonstrated by EVT 302 in this study.”

Dr Werner Lanthaler, Chief Executive Officer of Evotec, added: “Strict cost containment by focusing our pipeline and de-risking our business according to the “Evotec 2012 – Action Plan to Focus and Grow” is the right strategy also in light of this clinical outcome.”

About Evotec AG

Evotec is a leader in the discovery and development of novel small molecule drugs. Both through its own discovery programs and through research collaborations, it is generating the highest quality research results to its partners in the pharmaceutical and biotechnology industries. In proprietary projects, Evotec specializes in finding novel therapies for neuroscience, pain, and inflammation. Evotec’s portfolio comprises five clinical compounds: EVT 101, a subtype selective NMDA receptor antagonist for the treatment of depression in partnership with Roche, EVT 201, a partial positive allosteric modulator (pPAM) of the GABAA receptor complex for the treatment of insomnia, EVT 302, a MAO-B inhibitor in development for smoking cessation, a P2X7 antagonist for the treatment of inflammatory diseases and a vanilloid receptor (VR1) antagonist for the treatment of pain in partnership with Pfizer. In addition, Evotec has a number of proprietary projects in preclinical development.

Forward-Looking Statements

Information set forth in this press release contains forward-looking statements, which involve a number of risks and uncertainties. Such forward-looking statements include, but are not limited to, statements about our expectations and assumptions concerning future reductions in operating expenses and cash burn, regulatory, clinical and business strategies, the progress of our clinical development programs and timing of the results of our clinical trials, strategic collaborations and management’s plans, objectives and strategies. These statements are neither promises nor guarantees, but are subject to a variety of risks and uncertainties, many of which are beyond our control, and which could cause actual results to differ materially from those contemplated in these forward-looking statements. In particular, the risks and uncertainties include, among other things: risks that product candidates may fail in the clinic or may not be successfully marketed or manufactured; risks relating to our ability to advance the development of product candidates currently in the pipeline or in clinical trials; our inability to further identify, develop and achieve commercial success for new products and technologies; competing products may be more successful; our inability to interest potential partners in our technologies and products; our inability to achieve commercial success for our products and technologies; our inability to protect our intellectual property and the cost of enforcing or defending our intellectual property rights; our failure to comply with regulations relating to our products and product candidates, including FDA requirements; the risk that the FDA may interpret the results of our studies differently than we have; the risk that clinical trials may not result in marketable products; the risk that we may be unable to successfully secure regulatory approval of and market our drug candidates; and risks of new, changing and competitive technologies and regulations in the U.S. and internationally.

The list of risks above is not exhaustive. Our most recent Annual Report on Form 20-F, filed with the Securities and Exchange Commission, and other documents filed with, or furnished to the Securities and Exchange Commission, contain additional factors that could impact our businesses and financial performance. We expressly disclaim any obligation or undertaking to release publicly any updates or revisions to any such statements to reflect any change in our expectations or any change in events, conditions or circumstances on which any such statement is based.

Evotec AG

(DH) New Primary Care Approach Boosts Referrals To NHS Stop Smoking Services By 49%, Uk

The Department of Health is rolling out a new systems-based approach to improve stop smoking interventions in primary care. This new approach has increased referrals to local NHS Stop Smoking services by up to 49% in pilot areas.

People who are referred to local NHS Stop Smoking Services are up to four times more likely to quit.

The new approach was developed to ensure stop smoking interventions by healthcare professionals are routine and systematic, providing a tailored and consistent approach to patient referral. It will be rolled out to practices over the next few months by trained local NHS Stop Smoking Service advisers who will support its implementation in local primary care settings.

The approach recognises smoking as a key clinical issue requiring treatment or referral to a specialist, joining standard issues such as hypertension or high cholesterol.

The system ensures that basic advice on stopping smoking is offered to all smokers, which doubles the likelihood of a quit attempt. Practices which have this systems-based approach in place are expected to see improved quit rates in their patients. There are also two stages within the system for practices to earn QOF points, increasing the potential revenue and funding for the practice.

The systems-based approach for delivering stop smoking in primary care comprises:
* a tiered approach to stop smoking support that establishes three different levels of interventions according to time available; a supportive delivery system of 10 components that ensures that quality stop smoking support becomes routine; and a supportive practice environment that demonstrates commitment to support all patients in stopping smoking.

This new approach, which was successfully pioneered by local NHS Stop Smoking Services in the Yorkshire and Humber region, has been put into practice by trained stop smoking service advisers in Rotherham from January 2007 to September 2008. Over this time, referrals to local NHS Stop Smoking Services increased on average by 49% (from 292 to 432) across nine GP practices in Rotherham, with one practice doubling its referrals.

Paul Aveyard, Senior Lecturer at the Department of Primary Care and General Practice at Birmingham University and senior consultant on the development of the primary care project, said:

“The approach works by offering patients three levels of intervention, from 30 second very brief advice to intensive support. The primary care programme establishes a supportive delivery system of 10 components that ensures quality stop smoking treatment becomes routine in the practice.

“What we are trying to do is to make the treatment of tobacco addiction routine, in a similar way to hypertension. Previously, the primary care system encouraged GPs to give their patients advice in terms of stop smoking. The difference here is that GPs will now be required to actively manage their patients – such as referring them to a specialist stop smoking service.”

The project was pioneered in Yorkshire and Humber from 2007 and data from the regional pilot in Rotherham shows how successful the approach has been in practices there.

Jacqueline Watson, local NHS Stop Smoking Adviser, Rotherham PCT, said:

“The rollout of Stop Smoking Interventions in Primary Care will help us improve the health of patients and save more lives, in addition to helping practices improve their performance by securing extra QOF points and therefore increasing their potential revenue. I have found that getting practice managers engaged and supportive is key, but in those practices I’ve been working with in Rotherham, it has already enabled managers to transform performance and boost QOF scores.”

The Dinnington Group practice in Rotherham worked alongside their local Stop Smoking Service to boost referrals to the local Stop Smoking Service by over 80%. Irene Botham, Clinical Nurse Manager of the practice said: “Our nurses received expert training from the local NHS Stop Smoking Service in smoking interventions. We worked hard to drive forward the initiative in my practice and saw great results – since we implemented the new systems based approach our referral rates have increased by 82%. There are clear clinical benefits to following this approach and health care professionals have a duty of care to help smokers to quit. In addition, our patients can benefit from the assistance of NHS support with which they are up to four times more likely to quit.”

National evaluation of the project’s rollout across England is due to take place in April 2010.

For more information, healthcare professionals should contact their local NHS Stop Smoking Service, which they can find by using the ‘Local Services Search’ at smokefree.nhs/resources


1. The majority of local NHS Stop Smoking Services in England have been trained to introduce primary care practitioners to the new system and its benefits and will be contacting GP practices imminently. A toolkit for local NHS Stop Smoking Services (LSSS) advisers and resources for practices have been developed to support the rollout. Evaluation is taking place in July & October 2009 and a final evaluation in April 2010.

2. Local NHS Stop Smoking Services

Local NHS Stop Smoking Services offer ongoing free support and advice close to people’s homes. There are over 150 throughout the country, offering a range of services including one-to-one or group support sessions with trained stop smoking advisers.

Advisers help smokers understand their addiction to tobacco and work together on a personalised plan to stop smoking. They can also provide information about nicotine replacement products and other stop smoking medicines. These are available on prescription from the NHS.

A total of 680,289 people in England set a quit date through the local NHS Stop Smoking Services in 2007/8 and over half (350,800 people) reported that they were still smokefree at their four-week follow-up.

3. The evidence is clear that local NHS stop smoking interventions are very successful:

* Offering brief advice to stop smoking is the single most cost-effective and clinically proven preventive action that a healthcare professional can undertake: Anczak J, Nogler R. Tobacco cessation in primary care: maximizing intervention strategies. Clinical Medicine & Research 2003; 1(3): 201-216.

* Smokers are up to four times more likely to quit smoking successfully with support from their local NHS Stop Smoking Services: Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction 2008; 100 (Suppl. 2): 59-69 and West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax 2000; 55(12): 987-99.

* When stop smoking messages are received from trusted practitioners, motivation and the chances of action is likely to be increased. Fiore M, Bailey W, Cohen S et al. Treating Tobacco Use and Dependence. US Department of Health and Human Services, Public Health Service, 2000.

4. Supportive delivery system – the 10 components to success: The healthcare setting needs to establish a support system to ensure that successful smoking advice becomes routine. There are 10 components that work together and these are essential in making sure that the healthcare team can provide quality stop smoking support. In essence they demonstrate the team’s complete commitment to helping patients quit. Smokers are supported at every level, as is the team in the primary care setting. Managers give their team strong incentives to do well, backed up by the right resources, training and facilities. Each component is a link in the chain. If one link is missing, the whole system becomes weakened.

The 10 components are:

* Senior level commitment
* Incentives
* Protocol
* Teamwork
* Training
* Environment
* Resources
* Therapies
* NHS Stop Smoking information
* feedback

5. Smoking remains the main cause of preventable morbidity and premature death in England, leading to an estimated 82,900 deaths in 2007 (18 per cent of all deaths of adults aged 35 and over) estimated to be caused by smoking. (Statistics on Smoking, England 2008, Health Information Centre).

NICE (National Institute for Health and Clinical Excellence) recommends that all healthcare practitioners give brief stop smoking messages to all smokers (unless exceptional circumstances make it inappropriate to discuss smoking).

Department of Health, UK

Androgenic Regulation Of Hedgehog Signaling Pathway Components In Prostate Cancer Cells

UroToday – Tumors share many characteristics with developing embryonic tissues including the presence of rapidly dividing cells and cells in multiple states of differentiation. Therefore, it should not be surprising that the cellular signaling processes that govern normal embryonic development play some role in tumor biology. Hedgehog (Hh) is one of the fundamental developmental signaling pathways that is believed to have a role in prostate cancer. Hh signaling is driven by a family of ligands, referred to as “hedgehogs”, that bind to a cell surface receptor protein, Patched, activating a signaling cascade that upregulates gene transcription mediated by Gli transcription factors. For prostate cancer, reports that hedgehog ligands and Gli are overexpressed in the tumor cells supports the idea that these tumor cells might have abnormally activated autocrine Hedgehog signaling. Likewise, experimental evidence that the Hh signaling inhibitor, cyclopamine, or Gli knockdown suppresses prostate cancer cell growth provides pre-clinical evidence to support the use of Hh inhibitors for prostate cancer. However, a recent study from Dr. Wade Bushman’s group at the University of Wisconsin1 failed to find any evidence for autocrine hedgehog signaling in the most commonly utilized human prostate cancer cell lines and this report raises important questions regarding the nature of the molecular pathway through which Hh signaling components become dysregulated in prostate cancer.

Our experimental work, described in this publication, shows that androgen regulates the expression of key components of the Hh signaling pathway, at least in the androgen-sensitive human prostate cancer LNCaP cells and in other derivatives of this cell line. When grown in the presence of androgen, these cells express very little, if any, hedgehog ligand. Yet, when they are switched to an androgen-depleted growth medium, they become virtual “hedgehog factories”, upregulating Sonic, Indian and Desert hedgehog mRNA and protein expression up to 30,000-fold. The burst of hedgehog production was accompanied by the awakening of autocrine hedgehog signaling in the tumor cells as measured by upregulation of endogenous GLI target genes. Moreover, the induced hedgehog ligands were secreted out into the medium of androgen-deprived cells and we showed that they are paracrine-active and able to drive Hh signaling in mouse bone pre-osteoblasts, an activity that is associated with osteoblastic differentiation of these cells. Finally, in contrast to hedgehog ligands that were upregulated by androgen deprivation, GLI1 expression was upregulated by androgen in LNCaP cells. We attribute this novel activity to the potential consequence of the ETS gene fusion in these cells since GLI is known to be a target of the EWS:ETS fusion gene in Ewing Sarcoma cells2. In summary, our experimental work showed that some of the most important components of the Hh signaling pathway are regulated by androgen action in this model prostate cancer cell system. Whereas, the published work was restricted to the use of LNCaP cell derivatives, we have also observed these same results using androgen-sensitive VCaP cells. Moreover, the clinical relevance of our findings is supported by a recent report from a group of French investigators that describes upregulated hedgehog ligand expression in prostate tumors from hormone-treated patients3.

Based upon the cumulative evidence, we believe that the data support consideration of the use of anti-Hh therapy as an adjuvant for hormone therapy in the treatment of advanced or castration-resistant prostate cancer. For these tumors, Hh signaling blockade might supplement hormone therapy by further slowing the proliferative rate of tumor cells as well as by suppressing their potential for further metastatic spread or bone-related co-morbidity. Whereas the common anti-hedgehog agent, cyclopamine, is a difficult drug to work with due to its extreme hydrophobicity, there are other anti-Hh therapeutics currently in development and we would encourage clinical trials to assess effectiveness of these new agents along with hormone therapy.

1 Zhang J, Lipinski R, Shaw A, Gipp J, Bushman W. J Urol, 177: 1179-85, 2007.
2 Zwerner JP, Joo J, Warner KL, Christensen L, et al. Oncogene, 22: 3282-91, 2008.
3 Azouly S, Terry S, Chimingqi M, Sirah N, et al. J Pathol, 216: 460-70, 2008.

Ralph Buttyan, PhD, et al. as part of Beyond the Abstract on UroToday

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:

Copyright © 2009 – UroToday

Patients with atrial fibrillation undertreated for stroke risk

Contact: Eileen Korey
University Hospitals of Cleveland

(CLEVELAND)USA : A study published in this week’s Journal of the American Medical Association (JAMA) suggests new guidelines for determining a patient’s risk of having a stroke or dying after being newly diagnosed with atrial fibrillation, a common heart rhythm problem affecting more than two million Americans.

And according to University Hospitals of Cleveland’s Albert L. Waldo, MD, the new scoring system should help doctors identify patients who are currently not being treated with medication and, therefore, at high risk of stroke and death.

Dr. Waldo, writing in an editorial in the August 27th issue of JAMA, comments that less than half of patients who would be good candidates for treatment with blood thinners to reduce their risk of stroke are actually receiving the drugs.

Elderly patients are least likely to be treated, says Waldo, who is also a professor of medicine at Case Western Reserve University School of Medicine.

‘In short, not enough patients with atrial fibrillation at recognized risk for ischemic stroke receive warfarin (Coumadin) therapy, and patients with the greatest risk of ischemic stroke in the face of atrial fibrillation are the ones who receive it least.’

The JAMA article suggesting a new way to ‘score’ a patient’s risk was Thomas J. Wang, MD, and colleagues of the Framingham Heart Study in Framingham, Mass. They developed a scoring system involving the following risk predictors: advancing age, female, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes.

The scores can be used to ‘easily stratify patients at particularly high or low risk,’ for stroke or death, according to Dr. Wang. Once risk is properly assessed, patients can be provided appropriate counseling and/or treatment.

Patients who have been diagnosed with atrial fibrillation have a four-fold to five-fold increase in their risk of ischemic stroke (interruption of blood flow to the brain due to a clot).

Warfarin or Coumadin therapy can reduce that risk by approximately 70 to 80 percent. Studies indicate that warfarin or Coumadin is much more effective than aspirin in preventing ischemic stroke.

Dr. Waldo notes that many physicians are wary of using warfarin, especially among elderly patients, because of the risk of bleeding due to falls or frailty.

However, ‘the risk of stroke in the absence of warfarin therapy is greater than the risk of intracranial bleeding while receiving warfarin,’ says Waldo. Careful attention to monitoring and maintaining appropriate blood clotting factors maximizes the benefit and minimizes the risk.

University Hospitals of Cleveland and University Hospitals Health System offers a Coumadin Clinic to more than 700 patients who are regularly monitored for treatment of various disorders, including atrial fibrillation. Roche Diagnostics recently recognized the UHC Coumadin Clinic for excellence in establishing a systematic and effective approach toward managing anti-coagulation therapy.

University Hospitals Health System (UHHS) is the region’s premier healthcare delivery system, serving patients at more than 150 locations throughout northern Ohio.

The System’s 947-bed, tertiary medical center, University Hospitals of Cleveland (UHC), is the primary affiliate of Case Western Reserve University (CWRU). Together, they form the largest center for biomedical research in the State of Ohio. The System provides the major clinical base for translational researchers at the Case Research Institute, a partnership between UHC and CWRU School of Medicine, as well as a broad and well-characterized patient population for clinical trials involving the most advanced treatments. Included in UHC are Rainbow Babies & Children’s Hospital, among the nation’s best children’s hospitals; Ireland Cancer Center, northern Ohio’s only National Cancer Institute-designated Comprehensive Cancer Center (the nation’s highest designation); and MacDonald Women’s Hospital, Ohio’s only hospital for women.

Committed to advanced care and advanced caring, University Hospitals Health System offers the region’s largest network of primary care physicians, outpatient centers and hospitals. The System also includes a network of specialty care physicians, skilled nursing, elder health, rehabilitation and home care services, managed care and insurance programs, and the most comprehensive behavioral health services in the region.

View drug information on Warfarin Sodium tablets.

Method Of Clustered Gene Expression Analysis May Lead To Glaucoma Prevention

Glaucoma is the second-most common cause of blindness in the US, and occurs due to loss of retinal ganglion cells and degeneration of the optic nerve. Although it is known that high levels of pressure within the eye predispose individuals to the development of glaucoma, the molecular mechanisms involved are poorly defined.

In new research from The Jackson Laboratory in Bar Harbor, Maine, Simon John and colleagues analyzed gene expression patterns in the retina and optic nerves of mice that develop age-related glaucoma. Using a method that involved the clustering of samples that showed similarity in expression profiles, the researchers were able to identify molecular signatures of early events in glaucoma progression- events that were detectable before there was morphological evidence of damage.

Activation of part of the innate immune system called the complement cascade, and upregulation of endothelin 2 – a protein that can increase blood pressure – were among these early changes. Notably, the researchers found that genetically and pharmacologically interfering with these changes protected mice from developing glaucoma.

The researchers believe that they have identified pathways that might be targeted in the development of new glaucoma therapeutics, and hope that their method of clustered gene expression analysis will be useful in uncovering the early molecular events that underlie other diseases.

Joyce Peterson
Jackson Laboratory

Stem Cell Therapy May Provide New Approach To Fight Infection

A new study from researchers in Ottawa and Toronto suggests that a commonly used type of bone marrow stem cell may be able to help treat sepsis, a deadly condition that can occur when an infection spreads throughout the body.

The study, published in the American Journal of Respiratory and Critical Care Medicine, shows that these cells can triple survival rates in an experimental model of sepsis.

This work was a collaboration between research groups led by Dr. Duncan Stewart at the Ottawa Hospital Research Institute (OHRI), Dr. Arthur Slutsky at St. Michael’s Hospital and Dr. W. Conrad Liles at the University Health Network in Toronto.

The cells used in this study are called mesenchymal stem cells. In addition to their stem cell properties, they are also known to influence the immune system and help repair tissue damage. They are found in adult bone marrow and they have been used extensively in clinical trials for other diseases.

The researchers tested these cells in mice with sepsis. Bacteria from the gut were released into the abdomen, resulting in severe infection, inflammation and organ damage throughout the body. Six hours after inducing the infection, approximately half the mice were given an intravenous injection of mouse mesenchymal stem cells, while the other half received a control injection of a salt solution. Both groups of animals also received antibiotics, which is the standard treatment for sepsis in the clinic. After five days, 50 per cent of the animals that received the cells were alive, compared to just 15 per cent of the control animals that did not receive the cells.

Other experiments showed that mice that were treated with mesenchymal stem cells had healthier lungs and other organs, lower levels of bacteria and a more moderate level of inflammation. Further analysis revealed that the treatment caused a global change in the expression of genes that are associated with inflammation, such that the damaging effects of inflammation were reduced while the ability to clear the infection was increased.

“Our results suggest that mesenchymal stem cells may provide a promising new approach for treating organ damage caused by severe infection and we are looking to test this in patients in the near future,” said Dr. Stewart.

“Sepsis is a life-threatening medical condition caused by the body’s response to infection,” said Dr. Slutsky. “About a quarter of patients with severe sepsis die, and there are very few specific therapies for this devastating condition. That’s why this study is potentially important.”

“To achieve approximately 70 per cent reduction in mortality is pretty remarkable, even in a mouse model,” said Dr. Liles. “By using a cell therapy, we can target multiple pathways that feed into this complex physiology rather than just one single pathway or factor.”

Sepsis is the second leading cause of mortality in Canadian and U.S. intensive care units, resulting in more than 200,000 deaths each year and more than $16 billion in health care costs.

This research was supported by the Canadian Institutes of Health Research and Northern Therapeutics. Dr. Stewart is the CEO and Scientific Director of OHRI, VP Research at The Ottawa Hospital and Professor of Medicine at the University of Ottawa. Dr. Slutsky is VP Research at St Michael’s Hospital and Professor of Medicine at the University of Toronto. Dr. Liles is Vice-Chair of Medicine, Canada Research Chair in Inflammation and Infectious Diseases, McLaughlin-Rotman Centre for Global Health, University of Toronto and University Health Network.

American Thoracic Society (ATS)

Improved Care For Sick & Injured Animals Bill Moves Forward – Assembly Committee Unanimously Approves Aanestad Legislation, USA

The Assembly Business & Professions Committee unanimously approved legislation today authored by Senator Sam Aanestad (R-Grass Valley), which is designed to improve care for sick and injured animals in need of veterinary care. SB 969 seeks to remove the bureaucratic barriers and contradictory regulations concerning Registered Veterinary Technicians (RVTs) and Unregistered Assistants (UAs) that threaten to prevent timely treatment for animals under veterinary care.

“This legislation will improve access to veterinary care in California by allowing sick or injured animals to receive proper treatment from trained individuals,” said Senator Aanestad. “This change, in turn, will give licensed veterinarians more time to focus on additional patients.”

There are conflicting legal opinions regarding the laws on this issue. For years, RVTs and UAs working in veterinary practices in California and other states have been allowed to administer drugs under the indirect supervision of a veterinarian. However, a recent interpretation of the law by the California Veterinary Medical Board’s legal counsel has opined that this practice is not authorized.

“This new interpretation has created a problem for veterinarians who do not have RVTs on staff,” said Senator Aanestad. “There is a shortage of RVT’s in California and veterinarians who employ unregistered assistants face a real problem.”

SB 969 attempts to alleviate this problem by allowing Registered Veterinary Technicians OR Unregistered Assistants to administer controlled substances under the indirect supervision of a licensed veterinarian. The change in law would not only help veterinarians in private practice, but also city and county animal shelters, which often do not have a veterinarian present on site.

“Veterinarians cannot physically be on the premises at all times and must be able to delegate the administration of drugs to qualified, trained personnel under indirect supervision,” said Senator Aanestad. “Many epileptic animals, for example, require twice daily administration of an anti-seizure oral medication. My legislation will allow trained staff to administer these pills over the weekend, or at a time when veterinarians are not present.”

SB 969 has the full support of the California Veterinary Medical Association (CVMA) and numerous veterinarians who operate private practices in California.