alcohol

Does moderate, prudent drinking protect the heart and arteries? Two analyses say, actually that the answer is yes. But they raise a bigger issue: What should we do with this information? The answer to that question may come as a surprise. Let's look at the findings first. Researchers from the University of Calgary, University of Texas Health Science Center, and Harvard Medical School scoured the medical literature for long-term studies that compared drinking habits with the development of cardiovascular disease. Of the 4,235 studies they identified, 84 met the researchers' strict criteria. When combined, these studies included more than two million men and women who were followed for an average of 11 years. Using a technique called meta-analysis, the researchers pooled results from the 84 publications and analyzed the data as if they were from one gigantic study. Compared with no alcohol use, moderate alcohol use over the average study duration

• reduced the risk of a new diagnosis of coronary artery disease by 29%
• reduced the risk of dying from any cardiovascular disease by 25%
• reduced the risk of dying from a heart attack or coronary artery disease by 25%
• reduced the risk of dying from any cause by 13%
• reduced the risk of having an ischemic (clot-caused) stroke by 8%
• increased the risk of dying from a stroke by 6%
• increased the risk of having a hemorrhagic (bleeding) stroke by 14%.
The amount of alcohol consumed influenced the effect. For coronary artery disease and death from it, any amount of alcohol, from just under one-half drink per day on up , reduced heart disease risk by about 25%. But this was offset by stroke risk: at four drinks per day, the risk of having a stroke was 62% higher than it was with no alcohol use, and the risk of dying from a stroke was 44% higher. The lowest risk for any cause of death was at one drink per day (BMJ, Feb. 26, 2011). A companion article by the same authors summarized the strong evidence for how alcohol might influence cardiovascular disease, by boosting protective HDL and adiponectin (a hormone that has beneficial effects on blood sugar, the breakdown of fats in the bloodstream, and the inner lining of arteries), and reducing levels of fibrinogen (a protein that helps form blood clots). Wine, beer, and spirits appeared to have similar effects.
In the United States, a standard drink contains about 0.6 fluid ounces of alcohol. The drinks shown above contain roughly that amount of alcohol. Moderate drinking is generally defined as no more than two drinks a day for men and no more than one drink a day for women. The National Institute on Alcohol Abuse and Alcoholism defines drinking as low risk, increased risk, and highest risk.
You might expect the authors of this work to conclude that drinking alcohol is good for the heart and arteries and might be recommended to some people. Instead, they concluded that "our findings lend further support for limits on alcohol consumption." The researchers based this conclusion on the complexity of alcohol's effects on health. Moderate drinking offers some protection against coronary artery disease, but it does just the opposite for hemorrhagic stroke, while heavier drinking significantly increases the risk of having or dying from a stroke. And then there's the rest of the body to consider. Alcohol affects every system in the body, from the brain on down. For people who aren't addicted to alcohol, a little bit has no long-lasting ill effects and may, in some instances, be beneficial, as with the heart and arteries. For example, a small amount of alcohol taken with a meal improves tissues' sensitivity to insulin, which may decrease the chances of developing type 2 diabetes. Excessive consumption of alcohol is only harmful. It is a major cause of preventable deaths and contributes to liver disease, a variety of cancers, and other health problems. Too much alcohol can dissolve the best intentions and the closest relationships. "Few people know what so-called safe drinking is, and many have no idea of the harm alcohol can cause," says Dr. Kenneth J. Mukamal, an author of the two BMJ papers and an internist at Harvard-affiliated Beth Israel Deaconess Medical Center.
When it comes to health, alcohol is a sharp, double-edged sword. A little bit of alcohol, in the neighborhood of a drink a day, may be beneficial for the heart and arteries. With excessive drinking, which differs from person to person, the risks or hazards outweigh the benefits. The CDC estimates that excessive alcohol use contributes to almost 80,000 deaths a year in the United States. These come from motor vehicle accidents and violence, liver disease and hemorrhagic stroke, and 50 other causes.
Immediate health risks
• motor vehicle accidents, falls, drownings, burns
• violence, including intimate partner violence and child maltreatment
• risky sexual behaviors that can result in unintended pregnancy, sexually transmitted diseases, or intimate partner violence
• miscarriage, stillbirth, physical and mental birth defects
• alcohol poisoning
Long-term health risks
• dementia and stroke
• heart attack, cardiomyopathy, atrial fibrillation, hypertension
• depression, anxiety, suicide
• family problems, unemployment
• cancer of the mouth, throat, esophagus, liver, colon, breast
• cirrhosis of the liver, alcoholic hepatitis
• pancreatitis, gastritis
For some people, having a glass of wine, a beer, or a cocktail is a pleasurable social or relaxing activity. For others, drinking alcohol leads to nothing but problems. There are more people in the latter category than we'd like to think. A nationwide survey of 43,000 adults conducted by the National Institutes of Health tells a cautionary tale. Among those who said they drink alcohol, four in 10 were heavy drinkers or at risk for becoming one. To look at it another way, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that nearly 19 million Americans have a problem with alcohol. The terms "moderate" and "excessive" have long been used to describe drinking habits. The NIAAA now uses more descriptive terms — low risk, increased risk, and highest risk. In this case, risk refers to the chances of developing alcohol-related health problems, alcoholism, or both.
Low-risk drinking. For men, this is no more than four drinks in a single day and no more than 14 drinks in a week; for women, no more than three drinks in a single day and no more than seven drinks in a week. (About 57% of Americans who drink alcohol fall into this category.) Increased-risk drinking is drinking more than either the single-day limit or the weekly limit (29% of drinkers). Highest-risk drinking is drinking more than the single-day limit and the weekly limit (14% of drinkers).
No prescription for alcohol: Studies supporting the cardiovascular benefits of drinking alcohol have often raised the question of whether some older people should start drinking, or if doctors should sometimes recommend it. "From a health perspective, there are few, if any, situations in which it makes sense for someone to begin drinking alcohol," says Dr. Mukamal. The potential benefit is limited (more exercise would be a better choice). It would take more time than most doctors can give to have a nuanced conversation about the risks and benefits of alcohol. And encouraging nondrinkers to begin drinking "doesn't make good medical sense, since there's no proof they can do it safely," Dr. Mukamal cautions. If alcohol affected only the coronary arteries, drinking it might be good medicine. But it affects almost every other part of the body, and the amount consumed determines the ultimate outcome. That means a more careful approach to this two-faced beverage is in order.

Poor Glucose Control

Poor glycemic control , whether too high or too low, is associated with decreased survival in diabetic patients on hemodialysis, Kamyar Kalantar-Zadeh, MD, MPH, PhD, professor of medicine, pediatrics, and epidemiology at the University of California at Los Angeles David Geffen School of Medicine, reported here at Kidney Week 2011: American Society of Nephrology 44th Annual Meeting. Dr. Kalantar-Zadeh reported that in a 6-year study, moderate hyperglycemia raised the risk for all-cause or cardiovascular mortality of hemodialysis patients with diabetes, and levels of glycated hemoglobin (HbA1c) below 6% or blood glucose below 100 mg/dL were associated with an elevated risk for death. According to most studies, he said, if glucose is well controlled, there are improvements in mortality, microvascular complications, and cardiovascular disease. One study showed that for every 1% decrease in HbA1c, deaths related to diabetes decreased 21%, microvascular complications decreased 37%, and myocardial infarctions decreased 14%. "Diabetes mellitus is a potent cardiovascular risk factor in both the general population and dialysis patients, almost half of whom suffer from diabetes in the United States," Dr. Kalantar-Zadeh said during a news conference. "Some guidelines recommend that diabetic dialysis patients follow the same HbA1c target area as the American Diabetic Association." However, he said, although there are some data from studies with varying methodologies, there is no clear guidance on glucose targets for the dialysis patient population. He and his colleagues examined the predictive value of glycemic control on all-cause and cardiovascular mortality, using a large database (n = 54,757) of hemodialysis patients with HbA1c data from 2001 to 2006, and follow-up to 2007. Random (not necessarily fasting) serum glucose measurements correlated moderately well with HbA1c (correlation coefficient, r = 0.56). Examining a range of HbA1c values (from less than 5% to more than 10%), they found the lowest all-cause mortality between 6% and 8%. Above 8%, the higher the HbA1c, the greater the mortality; it is "up to 50% higher for HbA1c above 10%," Dr. Kalantar-Zadeh said. "At the same time,...a very low HbA1c level, below 5%...increased mortality." A similar relation was seen for cardiovascular mortality. A subgroup analysis showed that HbA1c above 7% had a detrimental effect on mortality for all parameters and groups of maintenance hemodialysis diabetic patients examined, including race, sex, age, and serum albumin, hemoglobin, and ferritin levels. The same sort of relation held when random glucose measurements were considered. All-cause mortality rose at glucose levels below 100 mg/dL, and rose dramatically above 200 mg/dL. The lowest death rates were seen at glucose levels between 100 mg/dL and 200 mg/dL. Cardiovascular mortality was lowest in this same range. Subgroup analyses in terms of glucose levels yielded results very similar to those of HbA1c. Potential limitations of the study are that it was observational, Dr. Kalantar-Zadeh noted. Patients were not randomized to receive treatments, treatments for diabetes were not considered, and medication data were lacking. In addition, HbA1c and glucose measurements were taken at random times. Dr. Kalantar-Zadeh concluded that poor glycemic control, with HbA1c above 8% or glucose above 200 mg/dL, "appears to be associated with decreased survival in prevalent diabetic dialysis patients, and moderate hyperglycemia increases the risk for all-cause or cardiovascular mortality of diabetic hemodialysis patients, especially in...Caucasians, men, and individuals with serum albumin less than 3.8 g/dL." Levels of HbA1c below 6% or glucose below 100 mg/dL "are bad, too," he said. He suggested performing controlled trials to target a certain range of HbA1c in diabetic dialysis patients to verify these observational findings. News conference moderator Katherine Tuttle, MD, executive director for research at Providence Sacred Heart Medical Center and professor of medicine at the University of Washington School of Medicine in Spokane, who was not involved in the study, said that clinical guidelines have been updated and will be issued soon. Although she could not elaborate before they are published, she said: "You will see a change in several things, including targets for glycemic control based on published data. I think the data presenting will only add to that." She said previous Kidney Disease Outcomes Quality Initiative guidelines were based on the primary prevention of kidney disease, and an HbA1c below 7% was shown to prevent new-onset kidney disease. But there were no data on the treatment of patients with kidney disease; those data are expected to figure in the new guidelines, with higher HbA1c targets for people with multiple comorbidities and limited life expectancies, which would include the dialysis population.

Child abuse

Women who suffer either physical or sexual abuse early in life have a significantly increased risk for subsequent cardiovascular events, including myocardial infarction and stroke, a new study suggests. The study, using data from the Nurses' Health Study II, shows that women who reported they had experienced forced sexual activity during childhood or adolescence had a greater than 50% increased risk for cardiovascular disease. The relationship with physical abuse was significant but less robust, the authors note, and will have to be confirmed in other data sets.

This is the third study to show that forced sex among girls is linked with at least a 50% increase in cardiovascular event risk, lead author Janet Rich-Edwards, ScD, MPH, associate professor in the Department of Medicine at Brigham and Women's Hospital in Boston, Massachusetts, said at a press conference here. The relationship was only partially explained by traditional cardiovascular risk factors. "The consistency of the sexual abuse studies suggests that we continue our abuse prevention efforts in childhood, and that we also develop specific cardiovascular disease prevention strategies tailored to the needs of women who've experienced abuse in childhood," Dr. Rich-Edwards concluded. The results were presented here at the American Heart Association (AHA) 2011 Scientific Sessions. A national survey of 8000 women conducted by the National Institute of Justice and the Centers for Disease Control and Prevention in 1995 to 1996 showed that 52% of women "were willing to report to a stranger on the telephone that they had been physically assaulted during their lives, and 18% reported completed or attempted rape," Dr. Rich-Edwards said. "I have to say that no matter how many times I see this, the data shock me every time." Most attacks took place in childhood, with 54% of those who reported a rape, or 9% of the overall group, reporting that the assault occurred before the age of 18 years, "so this is an exposure of girls and adolescent women." There are 2 other studies in the literature looking at cardiovascular outcomes after physical or sexual abuse, she noted. One, the Adverse Childhood Experience Study of 17,000 men and women, found an increased risk for coronary heart disease of 50% for physical abuse and 40% for sexual abuse. The other, the National Comorbidity Survey of 4251 women, showed divergent findings for physical and sexual abuse, with no increased risk for coronary heart disease for those reporting physical abuse, but a 5-fold increased risk for those with a history of sexual abuse. "Both of these studies are considerably smaller than the study I'm going to show you today, and much less rigorous in terms of defining coronary heart disease and stroke," Dr. Rich-Edwards noted. Her report used data from the Nurses' Health Study II, which includes 116,640 female registered nurses, from 14 US states, who were aged 25 to 42 years at baseline in 1989.b"At the end of follow-up for this particular analysis in 2007, they were age 43 to 60, so take note, these are very early cardiovascular events for women," she said. The study's biennial questionnaire in 2001 asked women about their life experience with violence. "This allows us to look at events prospectively after they reported the violence to us, and retrospectively from the beginning of the study until 2001, when we asked the questions."For both periods, cardiovascular events were validated by medical records. Self-reported unvalidated events were also included; both previous studies used only self-reported events. After excluding those who did not return the violence questionnaire or who had a history of cancer, myocardial infarction, or stroke before baseline, the study group included 67,315 women free of cardiovascular disease or cancer. Child abuse was assessed using the Conflict Tactics Scale, a questionnaire that assesses levels of exposure. Spanking for discipline was not included as abuse. Physical abuse was classified as mild, moderate, or severe, depending on responses, and sexual abuse was classified as unwanted sexual touching or forced sexual activity while the woman was a child or teenager. Physical abuse, classified as mild, moderate, or severe, was reported by 54% of the cohort, and 9% reported severe physical abuse, the researchers report. Sexual abuse was reported by 33% of the women, and 11% reported forced sexual activity before age 18 years. They found that mild or moderate physical abuse in childhood and adolescence was not associated with cardiovascular disease, but a 46% increase in risk was seen in those with a history of severe physical abuse after adjustment for age, race, parental cardiovascular history, body type of the girl at age 5 years, and parental education, Dr. Rich-Edwards noted. After further adjustment for risk factors in adulthood that are likely themselves to be linked to a history of abuse, including smoking, alcohol use, body mass index, diabetes, and hypertension, the association between physical abuse and cardiovascular events was "dampened," she noted. "In fact, 47% (95% confidence interval, 24% - 71%) of the association between severe physical abuse and adult cardiovascular disease is explained by these established cardiovascular risk factors." The relationship with sexual abuse was stronger. Women with a history of forced sexual activity had a 56% increase in risk for cardiovascular events; there was no increased risk seen with sexual touching only. When the researchers adjusted for cardiovascular risk factors in adulthood, the relationship was again mitigated, but not as much as with physical abuse; these risk factors accounted for about 38% of the excess risk (95% confidence interval, 25% - 53%). "So just shy of 40% of the association between forced sex in childhood and cardiovascular disease in adulthood is explained by established risk factors, which is a lot left unexplained," Dr. Rich-Edwards noted. Additional analyses showed that the associations were stronger for women without adult abuse, and for stroke than for myocardial infarction. Simultaneous adjustment for both sexual and physical abuse again dampened both associations "modestly," the researchers note. There was also a relationship between case confirmation and risk for cardiovascular events, with the lowest risk seen in the "definite" confirmed cases of physical and sexual abuse, although the association with forced sex was still statistically significant. When they included definite, probable, and unconfirmed cases of physical and sexual abuse, hazard ratios increased to 1.77 for physical abuse and 2.06 for forced sex (P < .05 for both). "I think what this points to is, first and foremost, the need for prevention; not only the prevention of child abuse, but in pediatrics offices and other agencies that spot child abuse, understanding that it's not just a short-term problem, but there's really a long tail of chronic disease that ensues from this," Dr. Rich-Edwards concluded. About 40% of the increased risk appears to stem from lifestyle risk factors, so those events might be prevented, "just by applying what we know." In the adult primary care setting, where these women will most probably first be seen, it is important that physicians talk about the issue, and let women know that, "though they may have had their bodies disrespected as children, there's a lot they can do as adults to take good care of themselves," she said. Tailored approaches for these women taking into account their experiences might also be developed. "Finally, the fact that we can explain only about half of it through our known pathways means we have a lot more work to do in terms of understanding the other ways in which this early psychosocial stress is literally embodied," she concluded. Factors like stress reactivity, for example, which appears heightened in women with a history of abuse, are just beginning to be investigated now. Asked for comment on these findings, Donna K. Arnett, PhD, professor and chair of epidemiology at the University of Alabama, Birmingham, and president-elect of the American Heart Association, called these results "disturbing on a number of levels." "First, the prevalence of abuse is much higher than many of us realize, and that it's associated with these other cardiovascular risk factors and other cardiovascular disease in later life provides a compelling case that we need to address this early in childhood said" Dr. Arnett. "We need to screen for it, we need to understand it, and we need to intervene at the cause, which is this physical or sexual abuse in children, so that we prevent downstream cardiovascular disease." Interestingly, known cardiovascular disease risk factors did not entirely account for the increased risk, particularly for the sexual abuse, she noted, "and that's one that gets underreported, because it's often unseen."

Autism

Autism may be an advantage in some settings and should not be viewed as a defect that needs suppressing, according to a provocative article published online November 2 in Nature.


Recent data and my own personal experience suggest it's time to start thinking of autism as an advantage in some spheres, not a cross to bear," said author Laurent Mottron, MD, PhD, from the University of Montreal's Centre for Excellence in Pervasive Development Disorders. According to the article, the definition of autism itself is biased, being characterized by "a suite of negative characteristics," focusing on deficits that include problems with language and social interactions. However, in certain settings, such as scientific research, people with autism exhibit cognitive strength."We think that the kind of strengths and cognitive profile that we find in autistics are much more specific than scientists usually acknowledge," said Dr. Mottron."Unfortunately, there is no gold standard for the diagnosis of autism. Clinical diagnoses are reliable among scientists, but it is just a consensus...everybody may fail."He noted that as a result of a diagnosis, many individuals with autism end up working at repetitive, menial jobs despite their potential to make more significant contributions to society."After 18 years of age they're not kids anymore, and they're forgotten," he said. "People have a cliché, that if he's autistic you can do nothing with him. That's not true. The fact that you have some terrible autistic life is not representative of autism in general. Dr. Mottron has 8 individuals with autism people in his research group including 4 assistants, 3 students, and 1 researcher, Michelle Dawson, whom he met almost 10 years ago during a television documentary about autism. Following the show, Ms. Dawson experienced problems in her job as a postal worker and was asked by Dr. Mottron to edit some of his papers. "She gave exceptional feedback, and it was clear that she had read the entire bibliography," Dr. Mottron noted. Her single-minded autistic abilities to discern patterns out of mountains of data and instant recall of correct information made her perfectly suited to a career in science, he said. Though lacking a formal doctorate, Ms Dawson has since coauthored 13 papers and several book chapters. Dr. Mottron said Ms. Dawson and other individuals with autism have convinced him that more than anything, people with autism "need opportunities, frequently support, but rarely treatment." As a result, he believes that "autism should be described and investigated as an accepted variant within human species, not as a defect to be suppressed." Dr. Mottron noted that autistic brains do function differently, relying less on verbal centers and demonstrating stimulation in regions that process both visual information and language. Advantages may include spotting a pattern in a distracting environment, auditory tasks such as discriminating sound pitches, detecting visual structures, and mentally manipulating complex 3-dimensional shapes. Individuals with autism also perform Raven's Matrices at an average of 40% faster than nonautistics, using their analytical skills to complete an ongoing visual pattern. Other benefits of autism include the ability to simultaneously process large amounts of perceptual information as data sets and the presence of instantaneous and correct recall. Because data and facts are of paramount importance to people with autism, they also tend not to get bogged down in career politics or seek popularity via promotional publishing; online essays such as those posted by Ms. Dawson in her blog may instead receive unintentional acclaim. "I no longer believe intellectual disability is intrinsic to autism," Dr. Mottron said, noting that intelligence in people with autism should be measured with nonverbal tests. In his article, Dr. Mottron cites recent data, including an epidemiological study that showed the disorder is 3.5 times more prevalent than common statistics suggest. He noted that the study showed that many of those with autism have "no adaptive problems at all," and can function relatively normally. However, he added, a focus on "normocentrism" prevails in some countries. France, for example, has proposed mandatory interventions aimed at forcing children with autism to adopt "typical" learning and social behaviors, rather than allowing them to make the most of their differently wired brains. Dr. Mottron finds such a concept concerning. "There is no current treatment for autism, just educational strategies that do not put the emphasis on learning abilities for nonsocial information...We need to take their learning style for what it is and feed it," he said.


"What we know is that if we reach these individuals at a young age, when their brains are malleable, we can cognitively redirect the transmission of information via the corpus callosum to the speech areas in the left hemisphere of the brain, and oftentimes speech and language will kick in." She continued: "The audio processing of music in the brain combined with the forward, backward, and side-to-side movements stimulate and activate the dormant areas of the brain that, in autism, do not generally receive transmission of neurons. "Movement and music, when combined with gross motor and visual processing, oftentimes helps the areas of the brain of the individual with autism to work together to allow for a whole-brain processing approach," she added.


"I think it's critically important to acknowledge the potential strengths associated with autism, but it's equally important, if not more important, to reiterate the notion of the right to effective treatment, said " Jonathan Tarbox, PhD, BCBA-D, director of research and development at the Center for Autism and Related Disorders, Tarzana, California. "If an individual with autism is having a difficult time in their life because they don't know how to do something that they want to do, and there is a proven effective method to teach that skill, then we as fellow humans have a moral and ethical responsibility to provide the treatment that addresses it," he said. Behavioral intervention programs, he said, should be used in a supportive environment to treat skill deficits in individuals with autism wanting to learn, similar to those used for literacy and mathematics. He added that autism is no different: People who have skill deficits and want to learn have a right to effective treatment. Dr. Tarbox took exception to Dr. Mottron's contention that individuals with autism need opportunity more than treatment. Environmental support, he said, does create opportunity. In addition, he noted that research shows that early intensive behavioral intervention increases the ability to communicate and function independently. "How can a newly found ability to communicate not be considered an opportunity?" he said. One of Dr. Mottron's main points is that the performance of individuals with autism on visual intelligence tests is often overlooked, showing that the true intelligence of people with autism is higher overall than verbal intelligence tests would indicate. "This is, of course, true, but true intelligence is of little relevance to a person's everyday quality of life. What really matters is one's ability to do what one wants to do in life independently; that is, without having to rely on support from others," said Dr. Tarbox. "There are many people, autistic and nonautistic, who have superior intelligence but still have much difficulty in life and suffer for it. Unfortunately, vocal language is the medium with which most humans interact, so deficits in one's ability to vocally communicate are going to create barriers for people." Dr. Mottron also states that no education programs are tailored to the unique ways that people with autism learn. However, Dr. Tarbox noted that there are "many tens of thousands of special education teachers, speech and language pathologists, and applied behavior analysts working to change what they do to help individuals with autism learn." The aim of behavioral interventions, he added, is not to try to teach individuals with autism to adopt typical learning and behavior but, rather, to teach skills that help increase independence. Such programs, he said, "teach skills that open doors for individuals with autism, but they do not dictate which door to take."
"I think what Dr. Mottron was getting to is the idea that autism is a different way of being, not necessary a disordered way of being, and the difference can give us strengths and abilities that other people may not have," said Stephen M. Shore, EdD, assistant professor at Adelphi University in Long Island, New York."At the same time, there are many challenges that come with being on the autistic spectrum, such as sensory issues, communication, interacting with others. These things are challenges, and we do have to address them," Dr. Shore noted.


Diagnosed himself with autism at age 2 and a half years, and nonverbal until age 4 years, Dr. Shore was originally recommended for institutionalization. With the help of family and others, he completed a doctoral dissertation at Boston University in Massachusetts that was focused on matching best practice to the needs of people on the autism spectrum. He now spends his time researching, teaching, writing books, and conducting autism workshops around the world. According to Dr. Shore, the best way to address those issues is to find a way to use a person's strengths to overcome their challenges. "There is a point in time when you have to get off the remediation and start moving on to finding a way the person can be successful in communication," he said. Methods may include use of a computer keyboard, rather than a pen, to write, or pointing at pictures to communicate, he said. Adjusting the environment also plays a vital role and often benefits people without autism. "Many autistics have sensory issues and perceive fluorescent lights as most people strobe lights, which will really affect productivity at work and school," Dr. Shore said. "Research shows that everybody's productivity is affected by fluorescent lamps, so everyone benefits by using alternate lighting." With respect to the plethora of methodologies used to address autism in children, Dr. Shore notes that the wide variety of diversity within the autism spectrum disorders necessitates a tailored approach. Parents and educators are encouraged to pick one or more approaches that best suits the child's needs and abilities. This may include use of Applied Behavioral Analysis, Treatment and Education of Autistic and Related Communication-Handicapped Children, Daily Life Therapy, the Miller Method, the Developmental/Individual Difference/Relationship-based method, relationship development intervention, and social communication/emotional regulation. "You can have a right or wrong approach on an individual basis, but not on a generic basis," he said.

Fat Melter

Deep in the jungles of West Africa, there are places where obesity is completely unknown.
The natives just don’t get fat.
A professor doing population studies discovered this curious fact. After watching this group and comparing them to others, he found something unique about their diet:
The locals use a paste derived from the seed of a “bush mango” to thicken their soups.
This professor, an expert in nutritional biochemistry at the University in nearby Cameroon, created an extract of this seed and ran his own tests.
After 10 weeks, the people taking this extract dropped an average of 28 pounds and dropped 6 inches around their waist.
The results were published in a national, peer-reviewed medical journal.
FOX News picked up the story from Reuters when the study hit the media last year.
Along with a healthy diet and regular exercise, you can use this very same natural extract to help drop unwanted fat.

Clot lysis treatment

A clot lytic treatment strategy with low-dose recombinant tissue-type plasminogen activator (rtPA) speeds clot removal in patients with intracerebral hemorrhage (ICH) that is complicated by intraventricular hemorrhage (IVH), results of a phase 2 trial confirm. Moreover, it does so with an "acceptable safety profile compared to placebo and historical controls," the authors, led by Neal Naff, MD, from Johns Hopkins University, Baltimore, Maryland, write. One caveat with the novel treatment, however, is that it appears to be associated with more bleeding,said senior author Daniel F. Hanley, MD, also from Johns Hopkins. Still, the aim in treating this condition, which can be almost 100% fatal, is to reduce the patient's exposure to blood, thereby reducing injury to the brain. "This drug has to be used carefully because of the increased risk of bleeding, but it will dissolve the blood clot that has formed in the intraventricular space," Dr. Hanley said. "Most of the blood clot is like an iceberg that sits under the water, doing nothing. Getting that blood clot out eliminates one big part of that iceberg that can damage the brain." Results of this phase 2 trial were published in the November issue of Stroke. The current study was done to assess the safety of low-dose rtPA administered via extraventricular drainage catheter for the treatment of ICH with massive IVH with regard to mortality, ventricular infection, and bleeding events. The study also tested whether administration of 3 mg of rtPA via external ventricular device (EVD) every 12 hours increased the rate of intraventricular clot lysis compared with placebo (normal saline)-irrigated catheters. The study included 48 patients aged between 18 and 75 years with a small supratentorial ICH of 30 mL or less and massive IVH. All had an EVD already placed for the treatment of obstructive hydrocephalus. A computed tomography scan was done to ensure that the EVD had been properly placed and that the clot was stable. The patients were then randomly assigned to receive either 3 mg/3 mL of rtPA (n = 26 patients) or 3 mL of normal saline (n = 22 patients) injected into the ventricular spaces via the EVD. This continued every 12 hours until computed tomography showed that clot resolution was sufficient for safe removal of the catheter or until the occurrence of symptomatic bleeding, infection, or death. The median duration of dosing was 7.5 days for rtPA and 12 days for placebo. The researchers report that the frequency of death and ventriculitis was substantially lower than expected. The predicted 30-day mortality was 75% for both treatment groups. The actual mortality was 19% in the rtPA-treated group and 23% in the placebo group. Ventriculitis occurred in 8% of the rtPA-treated group and 9% of the placebo group. Symptomatic bleeding was higher with rtPA, affecting 23% of patients compared with 5% of patients receiving placebo (P = .1). The study showed that the greatest amount of lysing activity in patients receiving rtPA occurred during the first 3 days. There was a significant beneficial effect of rtPA on the rate of clot resolution. The authors report that the estimated resolution for rtPA-treated patients during the first 3 days was 22.3% per day (95% confidence interval, 16.7% - 28.0%), and for patients receiving placebo, it was 9.9% per day (95% confidence interval, 3.5% - 16.2%). As a result of these findings, the researchers concluded that low-dose rtPA for the treatment of ICH with IVH has an acceptable safety profile and call for more data from a "well-designed phase 3 clinical trial, such as [Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR)] III," to fully evaluate the treatment. "We concluded that because there was no difference in infection, no difference in death rate, and the difference in bleeding rate was not statistically significant," Dr. Hanley explained. He added that the dose of rtPA should probably be lower, "or at least lower doses should be tested," because of the increased bleeding that was seen in this study. This treatment strategy for ICH with IVH has been explored in other studies by the same group. In 2008, at the 17th European Stroke Conference, Dr. Hanley presented results of the CLEAR-IVH trial, which showed that administration of 1 mg of tissue plasminogen activator every 8 hours for up to 4 days reduced expected mortality by 70% and also resulted in a dramatic improvement in functional outcomes in patients with IVH. The next year, at the American Stroke Association International Stroke Conference 2009, Dr. Hanley announced that the National Institutes of Health was set to fund a multicentre, 500-patient study to expand on the findings of the CLEAR-IVH trial. Finally, in July 2010, the American Heart Association/American Stroke Association released a new guideline on the management of spontaneous ICH, emphasizing that ICH is a very treatable disorder. The new guideline makes mention of the CLEAR-IVH trial, noting that the efficacy and safety of intraventricular rtPA in IVH are still "uncertain and considered investigational." In an accompanying editorial, Heinrich P. Mattle, MD, and Andreas Raabe, MD, from the University of Bern in Switzerland, point out that the results raise the issue of whether rtPA is the best thrombolytic for this application. Most of the animal and early patient work with this approach was done with urokinase, and there is some evidence to suggest rtPA may be toxic or enhance formation of edema, they write. In fact, they note, "the principal investigators of this trial were forced to terminate an earlier study because commercial withdrawal of urokinase in the United States precluded additional enrollment of patients. Was the choice of rtPA in this study a regulatory issue, or is there a good scientific reason for the selection of rtPA?" Nevertheless, they conclude that Dr. Naff, Dr. Hanley, and their team "have made a great achievement and they have to be congratulated for this successful phase II trial." The editorialists concur with the researchers that the treatment must be studied in further phase 3 trials and point out that CLEAR III is already underway, as is the Dutch Intraventricular Thrombolysis after Cerebral Hemorrhage study (DITCH), a smaller trial being conducted in the Netherlands. They also voice concern about the bleeding that was seen in the rtPA-treated patients. The current study "shows the slippery slope of using thrombolytics in cerebral hemorrhage," they note. "It is nothing else but logical to accelerate clot removal with rtPA," but the trend toward more bleeding "could be a signal that the expected benefit of rtPA might easily turn into harm.

Early Exposure to Anesthesia

Repeated exposure to anesthesia for early-life surgeries may lead to neurodevelopmental problems in children, new research suggests. A large cohort study showed that children who underwent 2 or more anesthetic/surgery episodes before the age of 2 years had a nearly 2-fold increased risk for developing learning disabilities (LDs) by their late teens compared with their counterparts who had not received anesthesia. Receiving multiple early-age exposures was also significantly associated with the need for school-based individualized educational programs (IEPs) related to speech and language impairment and for lower scores on tests of cognitive ability and academic achievemen "It's important to reassure parents that single exposures to anesthesia don't seem to be associated with a problem and that the need for repeated surgeries among young children is relatively unusual," added Dr. Flick. "This is likely to affect a relatively small number of children. Nonetheless, it's quite concerning." According to the researchers, studies of young animals have shown than most anesthetic drugs can cause neurodegeneration. However, previous research examining the link between anesthetics/surgery and cognition in human children "have been few, have relied on single outcome measures, and have not controlled for comorbidity." A population-based, matched cohort study, first published by the Mayo Clinic investigators in 2001, included 8548 children born in Rochester, Minnesota, between January 1976 and December 1982. As reported in 2009 by Medscape Medical News, the investigators examined the link between anesthesia exposure and LDs in some of these participants. However, Dr. Flick said that a criticism of that study was that it did not control for health status. "After it was published, some people said that the problem we were measuring was not anesthesia exposure but comorbidity. In other words, the kids who required multiple surgeries were not healthy. And because they were not healthy, then they had [LDs]. So the US Food and Drug Administration [FDA] asked us to do a study that would control for the effects of comorbidity." For the analysis, the investigators evaluated data on 350 of the participants who were exposed to anesthesia before the age of 2 years (68% male) and then age-matched each of these "cases" to 2 healthy controls who were not exposed (n = 700, 68% male). The controls were also matched according to "factors known to influence the incidence of LDs," including sex, mother's education, birthweight, and gestational age. Health status was determined through the use of the American Society of Anesthesiologists Physical Status and the Johns Hopkins adjusted clinical groups Case-Mix System. All children underwent the group-administered Test of Cognitive Skills and California Achievement Test, as well as the individually administered Wechsler Intelligence Scale for Children and Woodcock-Johnson Battery test for academic achievement through their schools. Study outcome measures included the need for an IEP for emotion/behavior (such as anxiety, depression, unusual behavior patterns, aggression, and impulsivity), LDs before the age of 19 years (in reading, written language, and/or mathematics), and achievement and cognition scores. Results showed that 286 of the children exposed to general anesthesia before surgery by the age of 2 years received it only once, whereas 64 were exposed more than once. The median duration of anesthetic exposure was 75 minutes, and combinations using halothane (87.5%) or nitrous oxide (88.1%) were the most frequently used anesthetic medications. Of the children exposed to anesthesia/surgery just once, 23.6% developed LDs by the age of 19 years vs 21.3% of the unexposed participants. However, 36.6% of those with multiple exposures developed LDs. After adjustment for health status, this translated into a significantly increased risk for LDs in those with the multiple exposures (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.26 - 3.54), but not for those with just 1 exposure.
"The size of the study was not sufficient to differentiate what specific type of [LD] may occur. There's a good deal of overlap; kids who have 1 type often have another type as well," explained Dr. Flick. Although exposure was not a significant factor in children receiving an IEP for emotion/behavior, multiple exposures were found to be a significant risk factor for the need for an IEP for speech/language (HR, 4.76; 95% CI, 2.48 - 9.12). "We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequences," write the study authors. Because regional anesthesia seems to be free of risk from neurotoxicity, this option should be explored…in appropriate cases. However, most surgical procedures will require general anesthesia, and neither surgery nor anesthesia should be withheld from children in need.

Healthy Brain

A combination of brain exercises and healthy lifestyle changes can improve memory performance in healthy elderly adults, new research suggests. In a sample study of 115 participants from 2 live-in retirement communities, those who underwent a new educational program (that included memory training, physical activity, stress reduction, and better diet) showed significant improvements on a variety of measures after just 6 weeks, including word recognition and recall. Gary Small, MD, professor of aging at the University of California–Los Angeles (UCLA) and director of the UCLA Longevity Center noted that the investigators wanted to test whether this intervention improved both objective and subjective memory performance. "Subjective memory is a person's self-perception of how they're doing, and objective is how well they do on a pen-and-paper test. It was gratifying to see that this program seemed to be helping people in day-to-day memory challenges." Lead author Karen Miller, PhD, associate clinical professor at the Semel Institute for Neuroscience and Human Behavior at UCLA, said in a release that "it was exciting" to see the subjects' participation, as well as their improvements in the memory fitness program. "The study demonstrates that it's never too late to learn new skills to enhance one's life," added Dr. Miller. "Despite the effectiveness of memory training interventions in clinical trials, few community-based programs exist, and their effects have not been systematically tested," write the investigators. The new memory training program, which was created by Dr. Small and Dr. Miller, uses a standardized curriculum consisting of brain exercises for association and visual imagery, education on a "healthy brain diet" and stress reduction, physical activity, and even assigned memory exercises to be performed at home. The investigators have previously offered this program in a number of settings, including the UCLA campus and senior centers. However, this is the first time it was offered in a retirement living community, which made participation easier because "users did not have to drive to a class off-site," said Dr. Small. "Our group tends to study memory training and healthy lifestyle techniques from the point of view of first developing a program that we think is user friendly and then testing it out. However, many times there's the approach where a scientific study is done first. So a program may be proven to be effective or not, but the question is: Will people use it? And will it be adaptable to a lot of communities?" he said. For the study, 115 residents of 2 continuing-care communities in Maryland older than 62 years (mean age, 80.9 years; 79% women; 98% white) who had slight memory complaints but no diagnosis of dementia were enrolled and tested for memory performance. After testing, participants were randomly assigned either to undergo the memory fitness program, consisting of 12 twice-weekly, hour-long sessions (15 - 20 per class), or to be placed on a waiting list for the program and considered study controls. Objective cognitive measures during the pretesting phase, as well as at baseline and at study's end, assessed changes in immediate and in delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. Subjective measures evaluated domains of memory self-awareness, including frequency and severity of forgetting, mnemonics use, and retrospective functioning. Results showed that the patients who underwent the memory fitness program showed significant improvements postintervention on recognition memory for word pairs (P < .001) and retention of verbal list learning (P < .01). In addition, their retrospective functioning scores increased (P < .0001), "indicating a belief in having a better memory," write the investigators.
"These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information as well as self-perception of memory ability in older adults," they write, noting that it may be generalizable to a real-world setting.
"As a community-based educational intervention, the program has the potential to meet the community's need for an affordable and sustainable memory program over time."
John Parrish, PhD, executive director of the Erickson Foundation, which oversees the retirement communities used in this study, said in a release that the foundation is now offering the program in all 16 of their communities across the country.
"The study suggests that the memory fitness program may be a cost-effective means of addressing some memory-related concerns of healthy older adults," he said.
Dr. Small said that he hopes that clinicians will see from this study and others that mild, age-related memory complaints can improve with specific training.
"There are a lot of ways to learn memory techniques. I think physicians should first ask people about their memory concerns and then try to refer them to get some help," he said.
"It's important to empower people and teach them about healthy brain lifestyle. Although there's no absolute proof that you can prevent Alzheimer's disease, we know that physical exercise and healthy diet can prevent diabetes, which is itself a major risk factor for Alzheimer's. So it all seems to tie together."

A powerful antioxidant: epigallocatechin-3-gallate – or EGCG

Researchers first discovered evidence of a “longevity gene” about 20 years ago. It’s a gene that may increase your life span. There’s a few ways you can turn on this “longevity gene.” One way is by calorie restriction.
Researchers found that giving mice a diet with very few calories significantly extended their life spans.1 Later studies found the same was true with a wide range of living creatures from single-celled organisms to plants and animals. The results showed that taking in fewer calories does turn on the longevity gene, and the organisms live longer.2
It wasn’t until recently an explanation was found. Researchers isolated a family of life-protecting genes called sirtuins (silent information protein regulators).
Under conditions of severe stress, such as starvation, the sirtuins are turned on. And they transmit signals to every cell in your body to cancel out the effects of aging.
This would be a great solution to aging … if starving were an option.
That’s where EGCG comes in.
EGCG helps switch on your longevity genes similar to restricting your eating. Mentioned in the medical journal Rejuvenation Research, “The protective effects of high-dose EGCG against oxidative stress were comparable with the effects of caloric restriction, a well-established dietary intervention that retards aging.”
EGCG can also help slow the aging process because it:
• Zaps harmful free radicals
• Supports DNA, leaving cells stable and healthy
• Helps boost your exercise capacity
• Is 25 to 100 times more potent than vitamins C and E
• Wards off the problems that come with aging

Prostate Surgery

Nearly half of men who undergo surgery for prostate cancer find themselves with greater incontinence problems and less sexual function than they anticipated, according to a new poll. Before the surgery, some men in the study had expected to have better urinary and sexual function a year after the procedure than before it -- a misbelief the researchers say is out of step with reality. As part of the new survey, 152 men undergoing radical prostatectomy filled out a questionnaire before they had surgery but after they had received counseling on the risks of the procedure. The questions asked about their expectations of urinary, bowel and sexual function a year after the surgery. About half of men expected the same function after surgery as before, but 17% anticipated better sexual function after the surgery. On a follow-up survey one year later, just 36% of the men said their expectations for urinary function matched the true outcomes, and 40% said their expectations for sexual function matched reality. Daniela Wittmann, the sexual health coordinator in the urology department at the University of Michigan and the lead author on the study, noted it's hard to predict how likely a patient is to recover his urinary and sexual function. "We can only (inform them) in terms of overall statistics, we can't predict for the individual man" how well he will recover, Wittmann said, "which means that, if in doubt, people tend towards being hopeful and optimistic." One recent study showed that, one year after surgery, only one out of four men recovered the ability to have intercourse. (See Reuters Health report, April 21, 2011.) Another research team recently found that some degree of incontinence was common, too, although men tended not to be significantly bothered by it. (See Reuters Health report, June 3, 2011.) Dr. Tracey Krupski of the University of Virginia, who wrote an editorial published along with the study online June 15th in the Journal of Urology, said men's unrealistic expectations can be a double-edged sword. On the one side, she told Reuters Health, optimism is known to help people heal, but on the other side, "it may ultimately lead to disappointment when adjusting to a long term disability." A different study, published along with Wittman's, found that when men were educated about the risks and benefits of nerve sparing prostatectomy, and then given the power to choose the type of procedure, they were likely to make choices similar to their surgeons'. In this study, by Dr. Hugh Lavery and colleagues at Ohio State University, the men had both a routine pre-operative counseling session and a separate appointment with a surgeon to discuss the risks and benefits of each procedure. Dr. Krupski said additional pre-operative visits would be beneficial, but are generally not covered by insurance plans. She said that a network of men who have been through the experience and can support new cancer patients might help them understand the realities of life after surgery. Wittmann said that involving patients' partners is also vital to successfully regaining sexual relationships. "Sex is a partnered activity for most people. The partner can be very effective as part of an intimate team recovering from the side effects of this surgery," she told Reuters Health. The study did not examine whether men would make a different treatment decision given their hindsight after the surgery. Wittmann said she thinks only a small proportion of men would choose not to have surgery if they fully understood the potential for erectile dysfunction, because there are other cancer-related reasons that drive their decision.

Chronic NSAID in Elderly

Older patients with hypertension and coronary artery disease who use nonsteroidal anti-inflammatory drugs (NSAIDs) chronically for pain are at significantly increased risk of cardiovascular events, a new post hoc analysis from the International Verapamil-Trandolapril Study (INVEST) demonstrates [1]. The research is published in the July 2011 issue of the American Journal of Medicine. "We found a significant increase in adverse cardiovascular outcomes, primary driven by an increase in cardiovascular mortality," lead author Dr Anthony A Bavry (University of Florida, Gainesville) told heartwire . "This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern." He says the observational study, conducted within the hypertension trial INVEST, is particularly relevant to everyday practice because the patients included were typical of those seen in internal-medicine, geriatric, and cardiology clinics--they were older, with hypertension and clinically stable CAD. Bavry and colleagues were not able to differentiate between NSAIDs in the study--most people were taking ibuprofen, naproxen, or celecoxib--and he says until further work is done, he considers the risks of NSAIDs "a class effect," and their use should be avoided wherever possible. However, "Patients should not terminate these medicines on their own," he says. "They should have a discussion with their physician. When I see patients like these taking NSAIDs I will have an informed discussion with them and tell them there is evidence that these agents may be associated with harm. I try to get them to switch to an alternative agent, such as acetaminophen, or if that's not possible I at least try to get them to reduce the dose of NSAID or the frequency of dosing. But ultimately, it's up to them if this potential risk is worth taking depending upon the indication for their use." Within the large cohort of more than 22 000 patients in INVEST, Bavry and colleagues identified patients who reported taking NSAIDs at every follow-up visit and termed them chronic users (n=882). Most often, patients were taking these agents for conditions such as rheumatoid arthritis, osteoarthritis, and lower back pain, Bavry said. They compared the chronic NSAID users with those who only intermittently (n=7286) or never (n=14 408) used NSAIDs over an average of 2.7 years and adjusted the findings for potential confounders. The primary outcome--a composite of all-cause death, nonfatal MI, or nonfatal stroke--occurred at a rate of 4.4 events per 100 patient-years in the chronic-NSAID group vs 3.7 events per 100 patient-years in the nonchronic group (adjusted hazard ratio 1.47; p=0.0003). As noted by Bavry, the end point was primarily driven by a more than doubling in the risk of death from CV causes in the chronic-NSAID group compared with never or infrequent users (adjusted HR 2.26; p<0.0001). The association did not appear to be due to elevated blood pressure, the researchers say, because chronic NSAID users actually had slightly lower on-treatment BP over the follow-up period. They note that a recent American Geriatrics Society panel on the treatment of chronic pain in the elderly recommends acetaminophen as a first-line agent and suggests that nonselective NSAIDs or COX-2 inhibitors be used only with extreme caution. "Our findings support this recommendation," they state.

H1N1 Flu Vaccine

The risk for Guillain-Barré syndrome is not increased after use of adjuvanted pandemic influenza (H1N1) 2009 vaccine, but the upper limit does not exclude a potential increase in risk up to 2.7-fold, according to the results of a multinational case-control study reported online July 12 in the BMJ. "A concern with the pandemic influenza A (H1N1) 2009 vaccine was the possible occurrence of neuroimmunological adverse events, including Guillain-Barré syndrome," write Jeanne Dieleman, senior pharmacoepidemiologist from the Department of Medical Informatics at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues. "A more than sevenfold increased risk of Guillain-Barré syndrome was observed with the swine origin influenza A (H1N1) subtype A/NJ/76 vaccine applied in the United States in 1976, when the vaccination campaign had to be discontinued abruptly. Subsequent prospective surveillance studies and retrospective epidemiological studies on seasonal influenza vaccines used in 1978, 1979, 1980, 1992, 1993, and beyond showed no or modest increases (up to twofold) in risk of Guillain-Barré syndrome." The goal of this case-control study, performed in 5 European countries, was to evaluate the relationship between pandemic influenza A (H1N1) 2009 vaccine and Guillain-Barré syndrome. Patients (n = 104) with Guillain-Barré syndrome or its variant Miller-Fisher syndrome were classified according to the Brighton Collaboration definition and matched to 1 or more control participants by age, sex, index date, and country. The primary study endpoint was the relative risk estimate for Guillain-Barré syndrome after vaccination with pandemic influenza vaccine. Countries varied substantially in case recruitment and vaccine coverage. Adjuvanted vaccines (Pandemrix and Focetria) were used most commonly. For all countries, the unadjusted pooled risk estimate was 2.8 (95% confidence interval [CI], 1.3 - 6.0). However, vaccination with pandemic influenza vaccine was not associated with a heightened risk for Guillain-Barré syndrome after adjustment for influenza-like illness or upper respiratory tract infection and seasonal influenza vaccination (adjusted odds ratio [OR], 1.0; 95% CI, 0.3 - 2.7). On the basis of the 95% CI, the absolute effect of vaccination could vary from 1 less case of Guillain-Barré syndrome within 6 weeks after vaccination in 1 million people, to up to 3 excess cases. "The risk of occurrence of Guillain-Barré syndrome is not increased after pandemic influenza vaccine, although the upper limit does not exclude a potential increase in risk up to 2.7-fold or three excess cases per one million vaccinated people," the study authors write. "When assessing the association between pandemic influenza vaccines and Guillain-Barré syndrome it is important to account for the effects of influenza-like illness/upper respiratory tract infection, seasonal influenza vaccination, and calendar time." Study limitations include the fact that the study was performed in a pandemic situation; under-reporting of cases in the Netherlands; substantial delays in inclusion of cases in Sweden and France; possible residual confounding; and some missing information on vaccination, mostly in control participants. In an accompanying editorial, Frank DeStefano, from the Immunization Safety Office (MS-D26), Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues discuss the safety of adjuvanted pandemic influenza A (H1N1) 2009 vaccines. "Although pandemic influenza A (H1N1) 2009 monovalent vaccines are no longer being used, data on their safety are relevant to current clinical practice because the H1N1 strain in the pandemic vaccine has been incorporated into the currently recommended trivalent seasonal vaccine," the editorialists write. "Most of the trivalent seasonal flu vaccines currently used in Europe do not contain an adjuvant, and no adjuvanted flu vaccines are used in the US. Nonetheless, the safety findings on adjuvanted flu vaccines will be important if such vaccines become more common in the future, whether in seasonal flu vaccines or for the next pandemic."
This study was funded by the European Centre for Disease Prevention and Control. Some of the study authors have disclosed various financial relationships with GSK, SPMSD, Wyeth/Pfizer, Boehringer, Lilly, AstraZeneca, and/or Baxter. The editorialists have disclosed no relevant financial relationships.

Your memory

As we age, most of us will find our short-term memory and ability to process new information “not what it used to be.” This is the cognitive equivalent of creaky knees , an inconvenient reminder that we’re getting older. Dementia, though, is something different. With dementia, multiple areas of thinking are compromised and the deficits are likely to get worse. By definition, dementia means memory and other cognitive areas deteriorate to the point that everyday tasks and decisions become difficult, and sometimes impossible. The causes of dementia are many, but in this country, Alzheimer’s disease is responsible for between 60% and 80% of dementia cases. Are there ways to avoid Alzheimer’s disease? Not according to the 2010 National Institutes of Health conference on preventing Alzheimer’s disease and cognitive decline. The group’s consensus statement said there is no evidence of “even moderate scientific quality” that nutritional supplements, herbal preparations, diet, or social and economic factors can reduce the chances of getting Alzheimer’s. Interventions intended to delay the onset of Alzheimer’s didn’t fare much better. In terms of staying sharp (versus developing dementia) as we get older, the outlook was a little better, according to the group. Diet and nutritional supplements still didn’t pass muster, and no medication was billed as preventing cognitive decline, but physical activity and cognitive “engagement” seem to hold some promise. Why the difference? For one thing, by the time people are diagnosed with Alzheimer’s disease (even mild or moderate cases), there may already be too much brain damage for exercise and other interventions to do much good. In some studies depression has been associated with mild cognitive impairment and cognitive decline. Successful treatment of depression may not alter Alzheimer’s, but the aspects of a person’s thinking clouded by depression may improve with treatment. A healthy mind relies on a healthy body. Elevated blood pressure and cholesterol, diabetes, excess weight, smoking, and a sedentary lifestyle all contribute to cognitive declines. Working to stay healthy helps you stay sharp. Stop smoking. In 2010, a National Institutes of Health panel noted that current smokers were 41% more likely to exhibit cognitive declines than former smokers or nonsmokers. Challenge your mind. Engaging in challenging board games, reading, working crossword puzzles, playing a musical instrument, and acquiring new skills may help keep your mind fit. These activities seem to expand the web of neuronal connections in the brain and help keep neurons nimble and alive. Challenge your body. Brain cells crave a steady diet of oxygen. Physically active people lower their risk for developing dementia and are more likely to stay mentally active. Get your rest. Too little sleep can affect memory. Six hours may be the minimum needed, although researchers testing college students found those who had eight hours were better able to learn new skills. Watch your weight. Staying within a normal weight range lowers your risk for illnesses such as diabetes, hypertension, metabolic syndrome, and stroke, which can compromise the brain to varying degrees. Check with your doctor. Are there any factors — such as medication side effects, vitamin deficiencies, depression, or chronic conditions — that could be better managed to help you stay as mentally sharp as possible? Discuss these issues with your doctor.

Διαδερμική χειρουργική σπονδυλικής στήλης

συγγραφέας Δαλαμάγκα Μαρία

Μετά από παρακολούθηση ενός έτους σε ασθενείς με στένωση στην οσφυϊκή μοίρα της σπονδυλικής στήλης , οι οποίοι υποβλήθηκαν σε μια νέα χειρουργική επέμβαση στη σπονδυλική στήλη , κατέληξαν στο συμπέρασμα ότι η επέμβαση οδήγησε σε σημαντική βελτίωση του πόνου και της κινητικότητας , χωρίς σοβαρές ανεπιθύμητες ενέργειες.
Ο Timothy Deer ιατρός από το Κέντρο Πόνου στο Τσάρλεστον , στη Δυτική Βιρτζίνια , παρουσίασε τη μελέτη στην 27η ετήσια συνάντηση της Αμερικάνικης Ακαδημίας Πόνου , που πραγματοποιήθηκε στη Ουάσιγκτον.
Ο Dr. Deer είπε «ο λόγος που ασχοληθήκαμε με τη συγκεκριμένη τεχνική , είναι ότι μπορεί να αποτελέσει σημαντικό επίτευγμα στο πεδίο των ελάχιστα επεμβατικών τεχνικών , σε αντίθεση με τη σύντηξη και την πεταλεκτομή , καθώς οδηγεί σε μικρές τροποποιήσεις όσον αφορά τη σταθερότητα και τη βιομηχανική συμπεριφορά της σπονδυλικής στήλης».
Τεχνική MILD
Η τεχνική , γνωστή ως MILD(ήπια) : ελάχιστα επεμβατική αποσυμπίεση της σπονδυλικής στήλης , χρησιμοποιεί ειδικό εξοπλισμό και διαδερμική αποσυμπιεστική πεταλεκτομή , υπό τη καθοδήγηση ακτινοσκοπικής απεικόνισης .Οι συσκευές MILD έχουν διάμετρο πύλης εισόδου 5mm , έτσι ώστε το τραύμα που προκαλούν είναι συγκριτικά μηδαμινό.
Η τεχνική MILD χρησιμοποιεί μια οπίσθια προσέγγιση. Αυτό που χρειάζεται είναι πολύ καλή ακτινοσκοπική απεικόνιση και τοπική αναισθησία με ήπια καταστολή. Ο μέσος χρόνος για μια διμερή διαδικασία ενός επιπέδου είναι 40 λεπτά.
Η μελέτη του Dr. Deer περιελάμβανε 58 ασθενείς , οι περισσότερες επεμβάσεις ήταν διμερείς σε ένα ή δύο επίπεδα της σπονδυλικής στήλης και ο μέσος όρος ηλικίας των ασθενών ήταν τα 70 έτη.
Σε «follow up» των ασθενών σε ένα χρόνο παρατηρήθηκε σημαντική βελτίωση του πόνου – συνολική μείωση κατά 40%. Τα σκορ της οπτικής αναλογικής κλίμακας βελτιώθηκαν στο 79% των ασθενών , από έναν μέσο όρο 7.4 πριν την επέμβαση σε 4.5 μετά από ένα έτος .
Η κινητικότητα επίσης βελτιώθηκε στο 71% των ασθενών , με συνολική μέση τιμή του δείκτη αναπηρίας (Oswestry Disability Index) , από 48.6(σοβαρή αναπηρία) σε 36.7 (μέτρια αναπηρία).
Δεν αναφέρθηκαν επιπλοκές όπως ρήξη σκληράς μήνιγγας, μετάγγιση αίματος , βλάβη νευρικών ριζών ή αιμάτωμα. Η συμβατική χειρουργική επέμβαση συνδέεται με μια συχνότητα 20% των προαναφερόμενων επιπλοκών.
American Academy of Pain Medicine 27th Annual Meeting: Poster 286

Septic shock

Patients who present to the emergency department demonstrating clinical signs of circulatory shock constitute a medical emergency, often associated with significant mortality. Severe sepsis, characterized as infection with systemic manifestations and accompanying organ dysfunction or tissue hypoperfusion, can lead to septic shock.Septic shock is defined as severe sepsis plus sepsis-induced hypotension not reversed with adequate fluid resuscitation. Hypotension may be defined by a drop in systolic blood pressure (SBP) to < 90 mm Hg or by at least a 40-mm Hg from baseline. The inadequate perfusion of critical organs (heart, liver, and kidneys) may lead to significant morbidity and mortality.Initial hemodynamic management of patients presenting with hypotension and concern for septic shock should consist of fluid therapy with 10-40 cc/kg of crystalloids, preferably normal saline, or lactated Ringer's solution. Various medications are used in the treatment of patients in circulatory shock.The use of vasopressors is an important component of resuscitation efforts, with the goal of therapy to maintain mean arterial pressure (MAP) at least 65 mm Hg. Dopamine and norepinephrine have generally been considered first-line agents in patients presenting with septic shock; in fact, recent consensus guidelines and expert recommendations have suggested that either agent may be used as a first-choice vasopressor in patients who have septic shock. Epinephrine, vasopressin, and neosynephrine may be useful second-line agents. Inotropic therapy with dobutamine may also be necessary in myocardial dysfunction.Because hypotension may be life-threatening, vasopressors help to maintain adequate blood flow and tissue perfusion despite hypovolemia. Dopamine increases heart rate and stroke volume, leading to an increase in cardiac output and MAP. In contrast, norepinephrine is a vasoconstrictor and thereby increases MAP with little effect on heart rate and stroke volume. While norepinephrine is considered to be more potent and thereby more effective in increasing blood pressure in septic shock, dopamine may be useful in patients with systolic dysfunction, but is also associated with more tachycardia and dysrhythmias. There is also concern regarding adverse effects on the endocrine and immune systems with dopamine. It has also been noted that norepinephrine may potentially decrease cardiac output, oxygen delivery, and blood flow to vulnerable organs despite adequate perfusion pressure.. Meanwhile, vasopressin, an endogenously released peptide hormone, has emerged as an adjunct to catecholamines for patients who have severe septic shock. The rationale for its use is the relative vasopressin deficiency in patients in septic shock and the hypothesis that exogenously administered vasopressin can restore vascular tone and blood pressure, thereby reducing the need for the use of catecholamines. Observational studies involving the use of vasopressin infusion rates below 0.1 units per minute in patients in vasodilatory shock have repeatedly shown improved short-term blood pressure responses.However, vasopressin infusion may also decrease blood flow in the heart, kidneys, and intestine.Interestingly, despite the widespread use of vasopressin in clinical practice, only 2 small randomized trials have evaluated its use in patients in septic shock. Vasopressin increased blood pressure, decreased catecholamine requirements, and improved renal function as compared with a control medication. However, the trials were only powered to evaluate mortality, organ dysfunction, or safety.

General anesthetics

General anesthetics are administered to approximately 50 million patients each year in the United States. Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. All the volatile anesthetics that are currently used are halogenated compounds destructive to the ozone layer. These halogenated anesthetics could have potential significant impact on global warming. The widely used anesthetic gas nitrous oxide is a known greenhouse gas as well as an important ozone-depleting gas. These anesthetic gases and vapors are primarily eliminated through exhalation without being metabolized in the body, and most anesthesia systems transfer these gases as waste directly and unchanged into the atmosphere. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Our estimation using the most recent consumption data indicates that the anesthetic use of nitrous oxide contributes 3.0% of the total emissions in the United States. Studies suggest that the influence of halogenated anesthetics on global warming will be of increasing relative importance given the decreasing level of chlorofluorocarbons globally. Despite these nonnegligible pollutant effects of the anesthetics, no data on the production or emission of these gases and vapors are publicly available.. Since Fox et al. first published their warning in 1975, concern has been repeatedly expressed about the potential harm that the release of halogenated general anesthetic gases poses to the global environment.All the volatile anesthetics that are currently used (halothane, isoflurane, enflurane, sevoflurane, and desflurane) are halogenated compounds potentially destructive to the ozone layer. The widely used anesthetic gas nitrous oxide (N2O) is an established greenhouse gas.A recent report suggests that N2O is also an important ozone-depleting gasAs the world population continues to grow and as modern anesthesia becomes available to more regions of the world, the global use of volatile anesthetics and N2O will rapidly grow. General anesthetics were administered to approximately 50 million patients in the United States in 2006, according to data released by the National Center for Health Statistics Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. A key attribute that differentiates all of these anesthetic gases from other medical drugs is that they are substantially eliminated through exhalation, without being metabolized in the body. At present, most anesthesia systems transfer these waste gases directly and unchanged into the atmosphere. Although the introduction of scavenging systems has significantly reduced spillage of general anesthetics into the operating room, they are still exhausted into the environment. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Chemically, halogenated volatile anesthetics are closely related to the chlorofluorocarbons (CFCs), which play major roles in ozone depletion. The effect of a volatile anesthetic on ozone depletion will depend on its molecular weight, the number and type of halogen atoms, and its atmospheric lifetime (defined as the time taken to remove or transform 1/e, or 63%, of an emitted gas). The atmospheric lifetime of these trace gases depends on their removal by chemical reaction with radicals, photolysis, and dry or wet deposition, such as “rainout.” Those species with a tropospheri lifetime of more than 2 years are then believed to reach the stratosphere in significant quantities. The tropospheric lifetime of halogenated anesthetics is much shorter than that of CFCs, because hydrogen atoms of the anesthetic molecules are susceptible to attack by hydroxyl radicals in the troposphere, making them less likely to reach the stratosphere. However, a concern has been raised about very short-lived compounds (with a lifetime of a few months or less) and their potentially significant contribution to ozone destruction. Once anesthetics reach the stratosphere, chlorine-containing anesthetics such as halothane, isoflurane, and enflurane may be more destructive to the ozone layer than are newer drugs, such as sevoflurane and desflurane, which are halogenated entirely with fluorine. By measuring the rate of reaction with hydroxyl radicals, Brown et al. have calculated that the tropospheric lifetimes of halothane, enflurane, and isoflurane are 2, 6, and 5 years, respectively. A more recent evaluation of the lifetimes of halogenated volatile anesthetics and their potential contribution to ozone depletion has been reported by Langbein et al.Using measurements of hydroxyl radical reaction kinetics and ultraviolet absorption spectra of anesthetics, we estimated the total atmospheric lifetimes of these anesthetics at 4.0 to 21.4 years. Contributions to total stratospheric ozone depletion were reported as approximately 1% for halothane and 0.02% for enflurane and isoflurane, suggesting that these anesthetics can play important roles in ozone depletion. The global warming potential (GWP) of halogenated anesthetics is reported to range from 1230 (isoflurane) to 3714 (desflurane) times the GWP of carbon dioxide (CO2) . Recently, Ryan and Nielsen reported on the impact of halogenated volatile anesthetics on global warming within the framework of common clinical practice, an approach that has not been taken before. Their study suggests that all the anesthetics (isoflurane, sevoflurane, and desflurane) can have a significant influence on global warming with the greatest impact produced by atmospheric desflurane.With an atmospheric lifetime of approximately 120 years, N2O is a remarkably stable gas.N2O traps thermal radiation escaping from the Earth's surface, contributing to what is known as the “greenhouse effect”. The GWP of N2O is approximately 300 times more than that of CO2. N2O, along with CO2 and methane, are the most influential long-lived greenhouse gases among all gases encompassed by the Kyoto Protocol. N2O is produced by human sources including agriculture (nitrogen-based fertilizers) and the use of fossil fuels, as well as natural sources in soil and water, such as microbial action in moist tropical forests. The N2O concentration is reported to be steadily increasing at a rate of 0.7 to 0.8 parts per billion (ppb) per year in past decades, and N2O currently contributes about 6% of the total radiative forcing (difference between incoming and outgoing radiation energy within the Earth's atmosphere). In addition, N2O is a primary source of stratospheric nitrogen oxides, referring specifically to NO and NO2. Both destroy ozone. Although the ozone depleting potential (ODP) of N2O (0.017) is lower than that of CFCs (only 10% of N2O is converted to nitrogen oxides), N2O emission is reported to be the single largest ODP-weighted emission and is expected to remain the largest for the rest of this centurySherman and Cullen first reported in 1988 that N2O, the most popular anesthetic gas, could contribute to global warming, and estimated that approximately 1% of total N2O production was used for clinical anesthesia on the basis of the number of surgical procedures in the United States, approximately 21 million cases at that time. They estimated the worldwide annual use of N2O for anesthesia to be 0.5 to 1.0 × 109 moles (2.2 to 4.4 × 104 tons). Although the precise quantities manufactured for medical use are unavailable to the public, we can estimate the most recent consumption of N2O for anesthetic purposes. Our institution consumed 20.2 tons of N2O for anesthetic use in 2006 for approximately 40,000 procedures that were performed with an anesthesiologist present. In the United States, approximately 70 million procedures were performed in 2006 with an anesthesia provider (all types of anesthesia included), according to data from the National Center for Health Statistics. Extrapolating from these figures, we estimate that approximately 3.5 × 104 tons of N2O were used for anesthetic purposes for 70 million patients in 2006 in the United States. The latest inventory of greenhouse gas emissions by the United States Environmental Protection Agency reports that total United States emissions of N2O were 1.187 × 106 tons in 2006, a reduction of 8% from 1996 levels. The anesthetic use of N2O is therefore estimated to be 3.0% of total 2006 N2O emissions in the United States. These numbers are provided only as an example of the volume of N2O liberated by 1 country, because there seems to be a declining trend in the use of N2O in European countries. However, the data on the worldwide anesthetic use of N2O, including all developed and developing countries, are not available. Until those data are obtained, a warning that the medical use of N2O can be a significant contributor to overall greenhouse gas emissions should be maintained. The use of volatile anesthetics could be reduced by up to 80% to 90% if closed circuit anesthesia were widely used for all patients, and to a lesser degree if “low-flow” anesthesia were routinely used. Although closed-circuit anesthesia is not a difficult technique with modern anesthesia systems for well-trained anesthesiologists, continuous accurate gas monitoring is required to prevent inadequate oxygenation or volatile anesthetic concentration. Shifting to total IV anesthesia would eliminate the use of anesthetic gases. Nevertheless, many anesthesiologists may still prefer volatile anesthetics and N2O, and their use is almost always required for anesthesia in infants and children. Modifying our practice towards more conservation of anesthetic gases can usually be done without compromising patient care if appropriate monitoring is used, and these techniques should be available to most anesthesiologists in developed countries. Doyle et al. have shown that silica zeolite (Deltazite™) was effective at completely removing isoflurane (1% in exhaled gases) in the scavenging line for a period of 8 hours. The trapped halogenated agents could then be reprocessed by steam extraction or fractional distillation for reuse. Reprocessing techniques are essential to reducing the amount of the anesthetics released into the atmosphere because disposal does not change the eventual fate of the anesthetics. A technique for conserving halogenated anesthetic vapors using a zeolite filter at the Y-piece connector has been proposed by Thomasson et al and the principles of this technique have been used to develop an anesthetic conserving device (ACD). The system is closed to volatile anesthetics, but it is open to oxygen; volatile anesthetics are supplied to the ACD through a syringe pump. This system has been shown to successfully reduce the total amount of volatile anesthetics released by 40%–75%, suggesting that the ACD may provide an alternative to low-flow systems. First reported >50 years ago, the anesthetic property of xenon has been revisited. Xenon is a naturally occurring atmospheric trace gas, existing at 0.08 parts per million (ppm), with no known detrimental ecotoxicological effect. The pharmacokinetic benefits of xenon include profound analgesia, neuroprotection, and hemodynamic stability. Xenon also has an extremely low blood–gas partition coefficient, which lends itself to rapid induction and emergence. However, clinical use of xenon has been limited mostly by its high cost of manufacture, which involves fractional distillation of liquid air. Furthermore, the production of xenon consumes enormous amounts of energy (220 W/h per 1 L of xenon gas), significantly more energy than that required for N2O production. Routine use of xenon for clinical anesthesia would only be economically possible with a closed-circuit system that recycles the rare gas.An ideal inhaled anesthetic should be safe, effective, and environmentally benign. This third characteristic has received insufficient consideration in part because of uncertainties on the environmental effects of gaseous anesthetics. Key criteria that will determine the global environmental impact of alternatives to halogenated anesthetics and N2O are their atmospheric lifetime, GWP, and ODP. These characteristics should be determined for existing anesthetics, and for any new anesthetic gases before widespread clinical use. Novel anesthetic gases should be adopted only if the clinical benefits outweigh any adverse environmental consequences. Although anesthetic gases are considered medically essential, an appreciable change is occurring in medical society. CFC propellants were previously considered medically essential for metered dose inhalers, but these have now been replaced with hydrofluoroalkane propellants. Current evidence may be insufficient for determining whether the contribution of waste anesthetics to the global climate change is significant. However, it is likely that anesthetic gas contributions, calculated in full carbon equivalents, will become an important part of efforts to limit the production of greenhouse and ozone-depleting gases. In summary, the use of N2O in medicine contributes to both global warming and ozone depletion. The use of halogenated anesthetics is a concern for producing global warming. In addition, the influence of halogenated anesthetics on ozone depletion will be of increasing relative importance, given the decreasing level of CFC usage globally. Furthermore, it should be recognized that other uses of anesthetic gases, including the use of N2O in dental offices and anesthetic gases in veterinary clinics and animal laboratories, may make significant additional contributions to adverse environmental change. It is essential to collect primary information on the quantities of N2O and halogenated volatile anesthetics manufactured or used, especially in consideration of serious international efforts to successfully reduce the emissions of ozone-depleting substances and greenhouse gases. We should develop tools for monitoring the use of ecotoxic gases, and initiate an international dialogue on these medically useful pollutants.
References

Fox JW, Fox EJ, Villanueva R . Letter: Stratospheric ozone destruction and halogenated anaesthetics. Lancet 1975;1:864
Brown AC, Canosa-Mas CE, Parr AD, Pierce JM, Wayne RP . Tropospheric lifetimes of halogenated anaesthetics. Nature 1989;341:635–7
Byrick R, Doyle DJ . Volatile anaesthetics and the atmosphere: an end to ‘scavenging'? Br J Anaesth 2001;86:595–6
Langbein T, Sonntag H, Trapp D, Hoffmann A, Malms W, Roth EP, Mors V, Zellner R . Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane. Br J Anaesth 1999;82:66–73
Logan M, Farmer JG . Anaesthesia and the ozone layer. Br J Anaesth 1989;63:645–7
McCulloch A . Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane. Br J Anaesth 2000;84:534–6
Pierce JMT, Linter SPK . Anesthetic agents and the ozone layer. Lancet 1989;333:1011–2
Rogers RC, Ross JAS . Anaesthetic agents and the ozone layer. Lancet 1989;333:1209–10
Sherman SJ, Cullen BF . Nitrous oxide and the greenhouse effect. Anesthesiology 1988;68:816–7

Biology of Lupus

Researchers think they may have discovered the mechanism that drives the body’s attack on its own cells and tissues in the autoimmune disease lupus.
Two new studies published in the journal Science Translational Medicine point to a cycle of cell death and chronic inflammation involving blood cells called neutrophils, versatile soldiers of the immune system that race to the site of infection to destroy invaders, as a key engine in the disease.
The discoveries come during a week when the FDA is expected to announce its decision on the biologic drug Benlysta, which could be the first drug approved to treat lupus in nearly 50 years.
According to the Lupus Foundation of America, lupus affects about 1.5 million Americans, many of them younger women.
The disease can affect many different parts of the body, including the skin, joints, lungs, heart, blood, and kidneys, which often makes it a challenge for doctors to diagnose.
One of the hallmarks of lupus is that patients make antibodies to their own DNA, called anti-nuclear antibodies, or ANAs. Blood tests for ANAs are sometimes helpful as an initial step in diagnosing lupus.
Researchers had long wondered how that happens since DNA was thought to be protected inside cells. Then, in 2004, a team of researchers discovered that neutrophils can die in an explosive way, shooting strings of cellular material studded with proteins and bits of nuclear DNA out like webs to entangle harmful bacteria, viruses, or fungi.
These neutrophil extracellular traps, or NETs, get slung outside the cell.
“They’re called NETs because they really look like a net, like a spider web,” says study researcher Michel Gilliet, MD, a dermatologist at University Hospital Lausanne, in Switzerland. The cells, he says, “shoot them out.”
In healthy people, once these NETs enter the liquid space between cells, the bits of nuclear DNA degrade quickly and probably don’t cause any problems, but Gilliet and his team found that patients with lupus have antimicrobial proteins called LL37 and HNP that appear to protect these bits of DNA from being broken down by the body.
Together, these proteins and DNA can trigger another type of immune cell, a kind of chemical factory called a plasmacytoid dendritic cell, which pumps out proteins that stoke the immune response.
One of those proteins, called type 1 interferon, is often present in high amounts in patients that have lupus, which has largely been another mystery of the disease.
Type 1 interferon, it turns out, triggers neutrophils to release more NETs, setting up an apparently self-perpetuating disease process.
“What this suggests is that there is a vicious cycle between the production of interferon, the way the neurtrophils die and the increase in the production of auto-antibodies, so this is a very, very efficient pathogenic loop that amplifies itself,” says study researcher Virginia Pascual, MD, an instructor of medicine at Baylor Institute of Immunology Research in Dallas.
Gilliet and his team are already testing the blood of lupus patients to see if one of these proteins may turn out to be a more specific marker for the disease, and thus useful in diagnosis.
That’s important because right now, doctors have to rely on a set of 11 criteria, which can overlap with many other diseases, to try to make a diagnosis.
“It is one of the most complex clinical diagnoses,” says Pascual, who is also a practicing pediatric rheumatologist.
“It might lead to better diagnostic tests, but we don’t know that yet,” Pascual says. Other experts say the discoveries will most certainly lead to new drug targets.
“It really provides a model for understanding why interferon is released, and that’s important because the more we understand why this very inflammatory cytokine is released, the more we can think about therapeutic options to block its production,” says Joseph E. Craft, MD, a rheumatologist and immunologist at Yale University in New Haven, Conn., who wrote a perspective article on the discoveries.