Multidisciplinary Team At UQ Research Foods For The Elderly

Improved foods for elderly patients with swallowing difficulties are a potential outcome from a new industry linkage grant awarded to a team of University of Queensland researchers.

Led by the Australian Institute for Bioengineering and Nanotechnology’s (AIBN) Associate Professor Peter Halley, the multidisciplinary team will bring a more scientific process to the design of texture modified foods.

“About 40 percent of elderly people have difficulty chewing and swallowing food, and this difficulty has an obvious flow on effect for their health in terms of nutrition, well being and general quality of life,” he said.

“Current texture modified foods have been made largely by trial and error processes generating desired levels of texture, however overall most texture modification processes tend to make foods considerably less appealing in terms of appearance, flavour and aroma.

“By applying rheology (the study of the flow of fluids), developing a new texture models and looking at the nutrition and swallowing behaviour of the foods, this project aims to bring a more scientific approach to the formulation and design of novel texture modified food.

“The outcome will hopefully be more appealing, safe to swallow foods that will improve the general well being of our elderly.”

According to Associate Professor Halley this successful grant builds on 10 years of collaborative work between the investigators, who come from UQ’s AIBN, the Schools of Chemical Engineering (Dr Tim Nicholson), Molecular and Microbial Sciences (Associate Professor Leigh Ward), Land, Crop and Food Science (Associate Professor Bhesh Bhandari) and Health and Rehabilitation Sciences (Dr Julie Cichero).

It also links with industry partner RSL Care, one of Australia’s most respected, not-for-profit providers of HomeCare, retirement living and residential care to the ex-service and wider communities. RSL Care has significant experience in texture modified foods and will be heavily involved in all stages of development.

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The AIBN is a multi-disciplinary research institute based at UQ, which brings together the skills of world-class researchers in the areas of bioengineering and nanotechnology to produce positive health and environmental outcomes such as biomedical delivery; bio-devices; tissue regeneration; and cell therapies.

Source: Associate Professor Peter Halley

Research Australia

Improved Water Purification, Design Of Better Polymer Batteries Enabled By New Insights On An Old Material

Designing new materials depends upon understanding the properties of today’s materials. One such material, Nafion ©, is a polymer that efficiently conducts ions (a polymer electrolyte) and water through its nanostructure, making it important for many energy-related industrial applications, including in fuel cells, organic batteries, and reverse-osmosis water purification. But since Nafion was invented 50 years ago, scientists have only been able to speculate about how to build new materials because they have not been able to see details on how the molecules come together and work within Nafion.

Now, two Virginia Tech research groups have combined forces to devise a way to measure Nafion’s internal structure and, in the process, have discovered how to manipulate this structure to enhance the material’s applications.

The research is published in the June 19 issue of Nature Materials in the Letters article, “Linear coupling of alignment with transport in a polymer electrolyte membrane,” by Jing Li, Jong Keun Park, Robert B. Moore, and Louis A. Madsen, all with the chemistry department in the College of Science and the Macromolecules and Interfaces Institute at Virginia Tech.

Nafion is made up of molecules that combine the non-stick and tough nature of Teflon with the conductive properties of an acid, such as battery acid. A network of tiny channels, nanometers in size, carries water or ions quickly through the polymer. “But, due to the irregular structure of Nafion, scientists have not been able to get reliable information about its properties using most standard analysis tools, such as transmission electron microscopy,” said Madsen, assistant professor of physical, polymer, and materials chemistry.

Madsen and Moore, professor of physical and polymer chemistry; Madsen’s post-doctoral associate Jing Li; and Moore’s Ph.D. student Jong Keun Park, of Korea, were able to use nuclear magnetic resonance (NMR)to measure molecular motion, and a combination of NMR and X-ray scattering to measure molecular alignment within Nafion. “We were looking at water molecules inside Nafion as internal reporters of structure and efficiency of conduction,” said Madsen. “The new feature we discovered is the locally aligned aggregates of polymer molecules in the material. The molecules align like strands of dry spaghetti lined up in a box. We can measure the speed (diffusion) of the water molecules and the direction they travel within those structures, which relates strongly to the alignment of the polymer molecule strands.”

The researchers observed that the alignment of the channels influenced the speed and preferential direction of water motion. And a startlingly clear picture presented itself when the scientists stretched the Nafion and measured its structure and water motion.

“Stretching drastically influences the degree of alignment,” said Madsen. “So the molecules move faster along the direction of the stretch, and in a very predictable way. These materials actually share some properties with liquid crystals — molecules that line up with each other and are used in every LCD television, projector, and screen.”

These relationships have not been previously recognized in a polymer electrolyte, Madsen said.

The ability to observe motion and direction, and understand what is happening within Nafion, has implications for using the material in new ways, and for designing new materials, the researchers write in the Nature Materials article. Ion-based applications could include actuator devices such as artificial muscles, organic batteries, and more energy efficient fuel cells. A water-based application would be improved reverse osmosis membranes for water purification.

Madsen and Moore started this collaborative project shortly after they arrived at Virginia Tech (Madsen in 2006, Moore in 2007), and they are furthering their work together by investigating new polymeric materials using their unique combination of analysis techniques.

“Alignment provides for a better flow of the molecules through the polymer,” Madsen said.

Notes:

The research is supported by Madsen’s National Science Foundation Faculty Early Career Development (CAREER) Award. His research focuses on improving advanced polymers for fuel cells and reverse-osmosis water purification by combining detailed analysis of these materials with theoretical understanding. The research is also supported by the US Army Research Office under Ionic Liquids in Electro-Active Devices (ILEAD) Multidisciplinary University Research Initiative (MURI) grant.

Moore is also associate director for research of the Institute for Critical Technology and Applied Science at Virginia Tech.

Source:
Susan Trulove

Virginia Tech

Spectranetics Introduces First Advanced System For Simulation Of Peripheral Vascular Arterial Occlusions

Spectranetics Corporation (NASDAQ: SPNC) today announced it will showcase a new advanced peripheral atherectomy simulation system at the New Cardiovascular Horizons meeting in New Orleans. The new simulation system is intended to augment traditional procedural training for physicians on plaque removal procedures by permitting hands-on practice with Spectranetics’ industry leading tools and techniques to cross, prepare, and remove peripheral arterial occlusions in virtual case scenarios both above the knee and below the knee.

Given the rapidly growing problem of peripheral arterial disease in an aging, growing population, Spectranetics is committed to creating a safe, realistic learning environment via simulation for fellows seeking additional laser training as well as experienced physicians looking to enhance a specific skill in the procedure. Once again, Spectranetics has partnered with Medical Simulation Corporation (MSC) to develop the customized Laser Atherectomy Simulator in conjunction with MSC’s SimSuite® simulation technology platform. Last year, Spectranetics unveiled a laser lead extraction simulator at the Heart Rhythm Society meeting in May. Building on the success of simulation training, this new simulation system features simulated patient scenarios that allow physicians to manipulate lesion crossing and ablating tools with tactile feedback and visual diagnostics such as “virtual” x-ray and IVUS imagery that closely mimics real-world patient scenarios. Physicians are able to experience the force interactions coinciding with successful techniques and encounter potential complications to learn avoidance and management skills. The simulation system specifically incorporates use of the Spectranetics QuickCross® Crossing Catheters, Turbo Elite® peripheral laser ablation catheter, and the Turbo Tandem® peripheral laser ablation catheter designed for larger vessels. Only Spectranetics offers a solution for crossing lesions without a guidewire via industry leading laser technology as well as the ability to treat from the tip in distal lesions.

“I am so pleased to be a part of this needed project in the peripheral atherectomy space,” said Dr. Grayson Wheatley, Vascular Surgeon at Arizona Heart. “You can’t underestimate the power and need of effective training in today’s patient care environment. I am looking forward to offering this simulation to my fellows as part of their fellowship training.” Dr. Richard Kovach, Director, Cardiac Catheterization Lab and Chair, Endovascular Medicine at Deborah Heart and Lung Center in Browns Mills, New Jersey, said, “The degree of visual realism is remarkable and the tactile feedback very closely mimics what is actually encountered in a live case.”

“There is a growing emphasis and need to train physicians on complex cases in a safe, virtual environment,” said Jason Hein, Senior Vice President of Sales, Marketing and Business Development. “The peripheral vascular excimer laser simulation system further demonstrates our commitment to providing physicians with tools to assist them in achieving safe and effective patient outcomes.” The Simulation system, along with Spectranetics’ solutions for coronary and peripheral vascular lesion management, can be viewed at Booth 202 at New Cardiovascular Horizons Exhibit, which is taking place June 1-4, 2011 at the New Orleans Convention Center in New Orleans, Louisiana. Simulation opportunities for physicians will become available this summer through a variety of educational forums.

Source:

Spectranetics

Statins Could Provide Cost-Effective Prevention Of Heart Attack And Stroke

A new analysis suggests that broader statin use among adult patients may be a cost-effective way to prevent heart attack and stroke. The Stanford University School of Medicine study also found that using a popular test – a screening for high sensitivity C-reactive protein, or CRP – to identify patients who may benefit from statin therapy would be cost-effective, but only under certain scenarios.

“If statins are really as safe and effective as they appear to be, broadening the indications for statin therapy would be an effective and cost-effective strategy,” said Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine. “But under different assumptions, targeted CRP screening would be a reasonable approach,” Hlatky is the senior author of the findings, which appear online in Circulation.

The study comes almost two years after a major clinical trial, known as the JUPITER study, showed that millions more people could benefit from taking statins, even if they have low cholesterol. That study involved patients with low cholesterol levels but elevated levels of CRP, which indicates inflammation in the body and suggests a greater risk of heart attack and stroke.

Under current clinical guidelines, statin therapy is recommended for individuals at high risk: those identified as having a 20 percent or more risk of some sort of cardiovascular event in the next 10 years. But heart attacks and stroke also occur in many people at lower risk levels, and the findings from the JUPITER study suggested that measuring CRP levels might identify patients who would benefit from statin therapy.

Still, that research did not address whether it would be cost-effective to do more screening and/or to give more people statin therapy. Accordingly, Hlatky and his colleagues sought to compare the cost-effectiveness of different strategies to prevent heart disease.

For their study, the researchers developed a model to analyze the cost-effectiveness of three approaches: following current guidelines; doing CRP screening in individuals who don’t meet the current guidelines for treatment, with statin therapy for those with elevated CRP levels; and providing statin therapy based on an individual’s cardiovascular risk alone, without CRP testing. Their model followed hypothetical patients, starting at 40 years of age, with normal lipid levels and no clinical evidence of heart disease or diabetes.

The researchers then looked at which approaches met the threshold of costing no more than $50,000 per quality-adjusted-life-year, a common metric that takes into account quality of life as well as length of survival. (Therapies costing around $50,000 or less per quality-adjusted life-year are generally considered cost-effective.)

Their conclusion? Assigning statin therapy based on risk alone, without CRP testing, was the most cost-effective strategy. The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55.

“Initiation of statin treatment at lower risk levels without CRP testing would further improve clinical outcomes at acceptable cost, making it the optimally cost-effective strategy in our analysis,” the researchers wrote in their paper.

The researchers found, however, that the optimal strategy for prevention changed if the assumptions in the model were altered. For instance, if patients with normal CRP levels get little or no benefit from statin therapy, CRP screening would be the optimal strategy. And if harms from statin use are only slightly greater than currently thought, statin therapy would not be reasonable in low-risk individuals, and following current clinical guidelines would be the most cost-effective strategy.

Clearly, there are a lot of unknowns and assumptions – all of which tempered the researchers’ conclusion. “This is not a slam-dunk decision in terms of: You should take people at low risk and put them all on treatment,” said Hlatky. “If you run the model and change the assumptions even a little bit, you get a different answer. Our model shows that we need better data to be confident about the best approach to drug treatment of lower-risk individuals.”

For co-author Douglas Owens, MD, the study points to a high priority for determining whether statins work as well in low-risk people (i.e. those with normal CRP levels) or just high-risk ones. “That’s a big uncertainty,” he said, and the answer would inform how cost-effective both screening and broad therapy are.

The researchers also said it would be important to know whether high CRP levels do more than identify people who are at risk of developing heart disease, but also identify which people are more likely to have lower risk of heart attack or stroke when treated with a statin. (The test could then spare certain patients from unnecessary treatment.)

“Ideally, a marker would tell us who will benefit from drug treatment and who will not,” said Hlatky. “If a test could give us that information, it would be very cost-effective. But there’s not good evidence yet that CRP, or any other test, works that well.”

Hlatky said a National Heart, Lung, and Blood Institute working group is now updating the clinical guidelines for statin therapy, and he hopes this research will inform their recommendations. “Maybe the threshold for statin treatment ought to be lower than is currently recommended,” he said.

In the meantime, the researchers have developed an interactive tool that physicians can reference to determine the most cost-effective approach to statin therapy for individual patients. The calculator can be found here

Notes:
Keane Lee, MD, who did the work at Stanford and is now with Kaiser Permanente of Northern California, is the lead author of the paper. Stanford co-authors include graduate student Lauren Cipriano and Owens, an investigator at the Veterans Affairs Palo Alto Health Care System and professor of medicine and of health research and policy at the medical school.

Funding for the study came from an American Heart Association-Pharmaceutical Roundtable Outcomes Research Award, the National Institutes of Health and the Social Science and Humanities Research Council of Canada.

Source:
Michelle Brandt
Stanford University Medical Center

Quark Pharmaceuticals, Inc. Announces First Systemic SiRNA Dosing In Humans

Quark Pharmaceuticals, Inc., a
development-stage pharmaceutical company focused on discovering and
developing novel RNA interference-based therapeutics, announced that
it has commenced systemic dosing in humans of its proprietary product
candidate, AKIi-5, a siRNA compound discovered and developed by Quark for
the treatment of Acute Renal Failure (ARF), also called Acute Kidney Injury
(AKI). Based on publicly available information, Quark believes that this is
the first human clinical trial involving the systemic delivery of siRNA.

The Phase I clinical trial is a multi-center, double-blind, placebo
controlled, dose-escalation trial assessing the safety and pharmacokinetics
of AKIi-5 administered intravenously as a single dose to patients
undergoing major cardiac surgery. Patients will be enrolled in the trial in
a number of centers in the United States, Europe and Israel. Quark expects
to complete the trial in early 2008. Depending on the results of this
trial, Quark expects to initiate a dose-ranging Phase II clinical trial
measuring AKIi-5 clinical activity.

Daniel Zurr, Chief Executive Officer, commented, “The initiation of
human dosing in our Phase I trial in ARF signifies a very important step in
Quark’s clinical program and marks an important milestone in the RNAi
industry. For Quark, the trial serves to further validate the strength of
our pipeline and our overall expertise in the RNAi arena. With AKIi-5 now
in the clinic, RTP801i-14, which we licensed to Pfizer, in a Phase I/IIa
clinical trial for the treatment of wet age-related macular degeneration,
AHLi-11 in IND-enabling studies and additional RNAi-based candidate drugs
in pre-clinical testing, we believe Quark has one of the most robust RNAi
product portfolios in the industry.

“For the RNAi industry, the trial may be even more noteworthy as it
represents the first documented systemic dosing of siRNA in humans. While
the science of RNAi has been well-established, a key step in the acceptance
of the technology as a promising therapeutic is the ability to deliver
RNAi-based compounds systemically. We look forward to leading this
important advance for the industry and, at the same time, continuing the
development of this and other siRNA products in our pipeline.”

Quark was granted an IND by the Food and Drug Administration (FDA) for
AKIi-5 for the prevention of Acute Renal Failure in high-risk patients
undergoing major cardiovascular surgery. AKIi-5 is a synthetic, chemically
modified siRNA molecule discovered and patented by Quark that has an
AtuRNAi technology-based structure licensed from Silence Therapeutics.
Quark has also licensed certain intellectual property from Alnylam.

Quark has conducted pre-clinical studies of AKIi-5 for the prevention
of acute renal failure in rats and monkeys. Rats treated with a single
bolus injection of AKIi-5 were significantly protected from
ischemia/reperfusion- induced acute kidney injury. In the rat studies,
AKIi-5 effectively prevented the development of acute renal failure.
Quark’s pharmacokinetic, distribution, and toxicity studies in rats and
monkeys indicate that AKIi-5 appears to have a favorable safety profile and
has a relatively short residence time in the kidney.

About AKIi-5

AKIi-5 is a synthetic, chemically modified siRNA molecule designed to
temporarily inhibit the expression of p53, a gene which plays a significant
role in ARF by inducing tubular cell death (apoptosis) in response to
injury. AKIi-5 is based on Quark’s proprietary, patented concept of
temporary and reversible inhibition, for therapeutic purposes, of the
expression of the transcription factor human p53, which is associated with
DNA repair and apoptosis. The concept was first published by Quark with the
University of Illinois in a breakthrough paper in Science magazine
(Science. 1999 Sep 10;285). Using RNA interference technology to
temporarily inhibit p53 in acute settings such as acute kidney injury,
apoptosis is delayed thereby allowing natural repair mechanisms to restore
normal DNA and cellular integrity.

About Acute Renal Failure (ARF) / Acute Kidney Injury (AKI)

ARF is a syndrome characterized by a rapid decline of kidney function
leading to death in a high percentage of cases. Major cardiac surgery is
one of the many causes of ARF. During cardiac bypass surgery, lack of
oxygen caused by reduced local blood flow to the kidneys, followed by rapid
reintroduction of oxygen, or reperfusion, to the kidneys upon removal of
the patient from cardiopulmonary bypass, initiates a chain of events that
can lead to ARF. Currently, there are no approved drug therapies that
effectively prevent or treat ARF.

About Quark Pharmaceuticals, Inc.

Quark Pharmaceuticals, Inc. is a development-stage pharmaceutical
company focused on discovering and developing novel therapeutics based on
its proprietary gene discovery science and technology, with an initial
focus on drug candidates that work through the natural mechanism in the
cell known as RNA interference, or RNAi, for the treatment of diseases
associated with oxidative stress. Quark believes that its proprietary
target gene discovery platform, BiFARTM, combined with its ability to
design and successfully deliver synthetic molecules of the new class of
RNAi therapeutics known as small-interfering RNA, or siRNA, to specific
organs in the body, enables the Company to rapidly develop drug candidates.
Quark has two internally discovered and developed clinical stage lead
product candidates: RTP801i-14 in phase I/IIa clinical trial for the
treatment of wet age-related macular degeneration, and AKIi-5 in phase I
for the prevention of acute renal failure both of which have an AtuRNAi
technology-based structure licensed from Silence Therapeutics, as well as a
license from Alnylam. The Company has licensed RTP801i-14 to Pfizer on an
exclusive worldwide basis. Quark has, in addition, a product candidate
portfolio of RNAi therapeutics based on novel targets and therapeutic
concepts discovered using BiFAR(TM) and designed for the treatment of
oxidative stress associated diseases of the inner ear, lungs and additional
organs of the body.

Quark is headquartered in Fremont, California and operates research and
development facilities in Boulder, Colorado and Ness-Ziona, Israel.
Additional information is available at quarkpharma

Quark Pharmaceuticals, Inc.
quarkpharma

Erectile Function, Sexual Drive, And Ejaculatory Function Analyzed After Reconstructive Surgery For Anterior Urethral Stricture Disease

UroToday- There are few studies that address the subject of sexual function after reconstructive surgery for anterior urethral stricture disease. In an effort to better define sexual dysfunction after urethroplasty for anterior strictures, a recent study was performed by Chris Gonzalez and colleagues from Northwestern University in Chicago. The paper is published in the March 2007 issue of BJU International.

The study group was composed of 52 men with a median age of 44 years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. Sexual function was assessed using the O’Leary Brief Male Sexual Function Survey (OBSFI) before and after surgery. The mean follow-up was 22.3 months.

The operations performed included bulbar excision and primary anastomosis (EPA; 23 of 52, 44%), dorsal or ventral buccal mucosa onlay reconstructions (22 of 52, 42%), and two-stage repairs using buccal mucosa (7 of 52, 14%). The mean stricture length was 4.85 cm.

Analysis of the sexual function scores revealed that there were no significant differences in the mean scores within the sexual drive and erectile function domains before and after surgery. It did appear that those patients that had at least 12 months of recovery after their urethroplasties had a better chance of achieving an improved status. In the ejaculatory function domain, there was a significant increase in the overall EjF score after surgery as a whole and the improvement was the most robust in men < 49 years old. This result can be expected partly because of the absence of obstruction but some authors, such as Guido Barbagli, have postulated that some aspect of post-void dribble and EjD can be expected after this surgery due to disruption of the bulbospongiosum expulsion mechanism due to the separation of these muscle fibers during reconstruction.

Bradley A. Erickson, James S. Wysock, Kevin T. McVary and Christopher M. Gonzalez

BJU Int. 2007 Mar; 99(3): 607-11
Reviewed by UroToday Contributing Editor Michael J. Metro, MD

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:
www.urotoday

Copyright © 2006 – UroToday

Recipe For Cell Reprogramming Adds Protein – Embryonic-Like Stem Cells Can Be Created Without Cancer-Causing Gene

A drug-like molecule called Wnt can be substituted for the cancer gene c-Myc, one of four genes added to adult cells to reprogram them to an embryonic-stem-cell-like state, according to Whitehead researchers. Researchers hope that such embryonic stem-cell-like cells, known as induced pluripotent (IPS) cells, eventually may treat diseases such as Parkinson’s disease and diabetes.

Demonstrated in mice, the elimination of c-Myc represents an important step in creating IPS cells in a manner that in the future may be applied to human therapeutics.

“This is a good sign for the possible replacement of the other three genes used to reprogram cells,” says Ruth Foreman, a MD/PhD student in the lab of Whitehead Member Rudolf Jaenisch and a lead co-author on the paper, published online in Cell Stem Cell on August 6. The other lead co-authors are Alex Marson, an MD/PhD student in the labs of Jaenisch and Whitehead Member Richard Young, and Brett Chevalier, a research scientist in the Young lab.

“IPS cells hold great potential for future medicine, but we must learn how to generate these cells in a manner that is safe for clinical therapies,” says Young, who is also a professor of biology at Massachusetts Institute of Technology. “This advance in reprogramming is one key step toward that goal,”

Currently, IPS cells can be created by reprogramming adult cells through the use of viruses to transfer four genes (Oct4, Sox2, c-Myc and Klf4) into the cells’ DNA. The activated genes then override the adult state and convert the cells to embryonic-like IPS cells.

However, this method poses significant risks for potential use in humans.

First, the viruses employed in the process, called retroviruses, are associated with cancer because they insert DNA anywhere in a cell’s genome, thereby potentially triggering the expression of cancer-causing genes, or oncogenes. Second, c-Myc is a known oncogene whose overexpression can also cause cancer. For IPS cells to be employed to treat human diseases such as Parkinson’s, researchers must find safe alternatives to reprogramming with retroviruses and oncogenes.

Earlier research has shown that c-Myc is not strictly required for the generation of IPS cells. However, its absence makes the reprogramming process time-consuming and highly inefficient.

To bypass these obstacles, the Whitehead researchers replaced c-Myc and its retrovirus with a naturally occurring signaling molecule called Wnt3a. When added to the fluid surrounding the cells being reprogrammed, Wnt3a promotes the conversion of adult cells into IPS cells.

“We’re not sure if the Wnt molecule is doing the same thing as c-Myc or complementing c-Myc’s activity,” says Chevalier. “But it does increase stem cell growth similar to c-Myc.”

“This is a good start toward using external cues instead of genetic manipulation to reprogram cells,” says Marson. “But we still need to eliminate the need for retroviruses for the three other genes.”

Although the technique is promising in mouse cells, its potential applications in humans have not been studied, emphasizes Jaenisch, who is also a professor of biology at MIT. “Is the same pathway acting in the human system and can Wnt molecules be used to reprogram human cells?” he asks. “We don’t know, but I think those are very important questions to investigate.”

This research was supported by the National Institutes of Health.

Nicole Giese

Rudolf Jaenisch and Richard Young’s primary affiliations are with Whitehead Institute for Biomedical Research, where their laboratories are located and all their research is conducted. Jaenisch and Young are also professors of biology at Massachusetts Institute of Technology.

Full citation:

Wnt stimulation substitutes for c-Myc in reprogramming somatic cells to induced pluripotent stem cells
Alexander Marson (1,2), Ruth Foreman (1,2), Brett Chevalier (1), Michael Kahn (3,4), Richard A. Young (1,2), Rudolf Jaenisch (1,2).
Cell Stem Cell August 7, 2008 (online August 6, 2007).

1. Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142, USA.

2. Department of Biology, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA.

3. Institute for Stem Cell and Regenerative Medicine, University of Southern California, Los Angeles, California 90033, USA.

4. Department of Biochemistry and Molecular Biology, University of Southern California, Los Angeles, California 90033, USA.

Whitehead Institute for Biomedical Research

High-Risk Stroke Patients More Likely To Get Follow-up Care After Motivational Talk

Even though many Americans learn through community health screenings that they are at high risk for having a stroke, they rarely follow-up with their doctor for care.

But a new University of Michigan study shows high-risk stroke patients are twice as likely to get follow-up care from a primary care doctor if they receive a pep talk over the telephone.

“It is unfortunate that these high-risk patients often have a lower rate of follow-up with their primary care physicians,” says Rajesh Balkrishnan, Ph.D., associate professor in the College of Pharmacy and School of Public Health at the U-M. “They should not ignore their results and seek medical help.”

Stroke is one of the leading causes of death and disability in the United States.
But controlling high blood pressure and high cholesterol helps reduce the chance of fatty deposits building up in the arteries that can lead to a stroke.

The U-M study, published in the July-August issue of the Journal of Stroke and Cerebrovascular Diseases, tested the effectiveness of telephone interventions with those who had two or more stroke risk factors.

More than 200 people participated in the study. All participants lived in North Carolina, a state in the ‘stroke belt,’ the southeastern region of the country with the nation’s highest incidence of stroke.

They received either standard information on strokes, such as risk factors, or a telephone call — a brief intervention known as the Health Belief Model which offers specific health advice and discusses barriers to seeing a primary care physician.

“Patients who had the telephone intervention were twice as likely to visit their primary care physician and discuss stroke screening results,” says Balkrishnan. “Telephone interviewers worked with these patients and reinforced the need for stroke care with a primary care doctor,” he says.

These patients also modified their diet and even talked about seeing stroke specialists, he adds.

Three months after the screening, 56 percent in the intervention group, compared to 38 percent who did not get a call, had visited their primary care doctor specifically to discuss the stroke screening results.

Stroke is the third leading cause of death in the United States. Nearly 800,000 Americans have a stroke each year, and 137,000 die of stroke. Strokes are more common among older people, but there’s evidence of stroke declining in recent decades as more people control high cholesterol and high blood pressure and fewer people smoke.

Source: University of Michigan Health System

The Number Of Lungs Available For Transplant Could Be Doubled By Ventilation Changes

Simple changes to how ventilators are used could almost double the number of lungs available for transplants, according to new international research involving a doctor at St. Michael’s Hospital.

Many potential donor lungs deteriorate between the time a patient is declared brain dead and the time the lungs are evaluated to determine whether they are suitable for transplant. The study involving Dr. Arthur Slutsky, the hospital’s vice president of research, said the deterioration could be in part because of the ventilatory strategy used while potential donors were observed just prior to being declared brain dead.

His team, lead by Dr. Marco Ranieri of the University of Turin in Italy, tested a “lung protective strategy” on patients in 12 hospitals in Spain and Italy that resulted in a significant increase in the number of viable donor lungs that were transplanted. Their results are published in the current issue of the Journal of the American Medical Association.

The strategy involved using smaller “tidal volumes,” meaning less air was pumped into the lungs with each breath, to prevent injury to the lungs. It also used higher “positive-end expiratory pressure,” the amount of pressure applied by the ventilator at the end of an exhalation, to prevent lungs from collapsing.

“A lot of patients who are waiting for lung transplants die before they get a transplant because there aren’t enough organs,” said Dr. Slutsky, the only Canadian on the research team. “By using this lung protective strategy, one can essentially double the number of lungs available for transplant.”

The randomized study involved 118 patients. Of the 59 patients treated with conventional ventilation, 32 (54 per cent) met lung donor eligibility criteria. Of those on the lung protective strategy, 56 (95 per cent) met the criteria. Ultimately, double the number of lungs was transplanted in the group treated with the lung protective strategy.

According to the Canadian Institute for Health Information, 1,222 lung transplants were performed in Canada between 1997 and 2006, but 299 people died while waiting for a transplant. There were 252 people waiting to receive lung transplants in 2006, up from 119 in 1997.

“This is pretty simple and easy to implement,” Dr. Slutsky said. “It’s not like a fancy new drug or equipment. You just have to change the ventilator a little bit.”

Dr. Slutsky said some doctors and hospitals may already be following a similar “lung protective strategy” but this is the first published randomized clinical trial showing it works, which could lead to standards that all hospitals would follow.

“If this is adopted widely, we think it will increase the number of lungs available for transplant, increase the quality of life for some people and probably save the lives of some people who are on the waiting list,” he said.

Source:
Leslie Shepherd
St. Michael’s Hospital

After An Operation Patients With Larger Social Networks May Fare Better

A new study published in the February issue of the Journal of the American College of Surgeons shows that patients with a large support network of family and friends report feeling less pain and anxiety prior to having a surgical procedure, which can have a substantially positive impact on their postoperative recovery.

The findings suggest that it is important for clinicians to be aware of the close relationship between patients’ social networks and their impact on preoperative pain and anxiety, and how these relationships can affect patient recovery after major operations.

“Strong social connectedness can have a tremendous impact on patient recovery by helping blunt the effect of stress caused by postoperative pain, as well as ease concerns about health, finances and separation from family members,” said Allison R. Mitchinson, MPH, NCTMB, research health science specialist, Department of Veterans Affairs, Ann Arbor (MI) Healthcare System.

Social network size and social connectedness have long been known to affect health and well-being. Stressful events such as having an operation can further increase the need for social support.

“Since patients with limited social connections will likely require more pain medications, have longer hospital stays, and need additional caregiver attention after a surgical procedure, it is important that physicians are aware of this link,” added study co-author Daniel B. Hinshaw, MD, FACS, a researcher with the Department of Veterans Affairs, Ann Arbor Healthcare System. “Patients should be preoperatively screened for pain and anxiety because these are strong predictors of a more difficult postoperative recovery.”

Patients undergoing major thoracic or abdominal operations at two Veterans Affairs’ medical centers (n=605) participated in a randomized controlled trial of massage as adjuvant treatment for postoperative pain. Prior to the operations, patients were given a questionnaire assessing their number of friends and relatives and how frequently contact was made with the members of their social networks. Patients rated levels of pre- and postoperative pain intensity and unpleasantness, as well as postoperative levels of anxiety, depression, relaxation, and inner peace using visual analogue scales. Daily opiate use, postoperative complications, and length of stay were also evaluated. The study found that patients reporting a smaller social network had higher preoperative pain intensity, unpleasantness, and anxiety (p