Shawn's Health Blog

2009-02-15T22:40:00.000-05:00

Is too much exercise a bad thing?

2009-02-15T22:37:00.000-05:00

Doctors at the University of Maryland Medical Center had a mystery on their hands. A 51-year-old physician colleague who looked the picture of healthno cardiovascular risks, a marathon runner who had exercised vigorously each day for 30 yearshad just flunked a calcium screening scan of his heart.The...

Doctors at the University of Maryland Medical Center had a mystery on their hands. A 51-year-old physician colleague who looked the picture of health%26#8212;no cardiovascular risks, a marathon runner who had exercised vigorously each day for 30 years%26#8212;had just flunked a calcium screening scan of his heart.

The patient had expected a score indicating a healthy cardiovascular system. Instead, the images indicated a high score: a build-up of calcium in his coronary arteries put him at high risk for blocked blood vessels and a possible heart attack.

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The mystery was all the more intriguing because his resting blood pressure and fasting cholesterol levels, the usual measures of cardiovascular health, were in the normal range.

In the March 1, 2007, issue of the American Journal of Cardiology, the researchers say this is the first case, to their knowledge, of advanced coronary calcification in an otherwise healthy middle-aged male marathon runner who lacked traditional cardiac risk factors and had no symptoms of heart disease.

The researchers conclude that the physician%26#8217;s intense, long-term exercise regime, coupled with a predisposition toward a type of hypertension, contributed to his cardiovascular disease. "In this particular individual, we think that oxidative stress was an important contributor," says the study%26#8217;s senior author, Michael Miller, M.D., director of preventive cardiology at the University of Maryland Medical Center and associate professor of medicine at the University of Maryland School of Medicine. "But we also found that this individual has exercise-induced hypertension, which I think is vastly under-diagnosed."

Oxidative stress is a byproduct of the normal cellular metabolism of oxygen. It refers to cell, tissue or organ damage from a class of molecules associated with oxygen metabolism, including unstable molecules called "free radicals." Oxidative stress plays a role in many heart, lung, blood and sleep disorders, including atherosclerosis, or hardening of the arteries, hypertension, heart failure, asthma and sleep apnea.

To help gage the impact of oxidative stress on the patient%26#8217;s cardiovascular system, his doctors evaluated the response to exercise of the endothelium, the lining of his arteries. An ultrasound device was used to measure what is known as flow-mediated vasodilation. It shows how well the endothelium responds to a sudden increase in the flow of blood through an artery in the upper arm. The endothelium in a healthy vessel typically dilates or expands during this test to accommodate the increased blood flow, while an impaired vessel constricts or narrows.

The patient's blood vessel dilation was normal before exercising. But after exercise, vessel constriction occurred immediately and showed no improvement after an hour. To put this response into perspective, the researchers administered the same exercise/blood vessel response test to a group of ten men whose mean age was 41. The vessels of these men initially constricted, but improved significantly one hour after exercise.

Several weeks later, the patient was given vitamins C and E just before exercise and was tested again for endothelial response. These vitamins are known as antioxidants and may protect cells from free radical damage. This time, the test revealed a partial reversal of the blood vessel constriction after one hour, and normalization after two hours.

"As he took the vitamin C and vitamin E, you could see improvements in his brachial arteries," says Dr. Miller. "We recommended that the patient take these vitamins before he runs."

With half the mystery solved, the research team explored another possible cause of the calcium buildup%26#8212;elevated blood pressure. Hypertension can cause artery walls to thicken and the endothelium to narrow. This narrowing can promote the formation of fatty plaque deposits in artery walls. The plaque, from cholesterol and fats, can eventually harden or calcify.

Although hypertension did not seem to be a risk factor for this patient, exercise is a major factor in his life. So, the researchers turned to a treadmill stress test to measure his blood pressure during exercise. At the start of the treadmill test, his baseline blood pressure was normal, 118/78 millimeters of mercury (mmHg). He was in such great shape that it took 20 minutes to reach high blood pressure levels, and this happened only after the treadmill speed and incline had been raised. But by the end of the test, his blood pressure had soared to 230/78 mmHg. A check of several of his previous treadmill tests indicated a similar rise in blood pressure.

On the basis of running duration and intensity, the researchers estimated that the patient spent about 30 minutes a day at a systolic blood pressure above 200 mmHg. This number is well into the blood pressure danger zone and meets one definition of exercise-induced hypertension%26#8212;a jump of at least 60 mmHg from baseline after exercise.

This finding should be investigated further, says co-investigator Matthew R. Weir, M.D., head of nephrology at the University of Maryland Medical Center and professor of medicine and head of the division of nephrology at the University of Maryland School of Medicine. %26#8220;Because we know that blood pressure rises during a stress test, we tend not to pay attention to it. We%26#8217;re more interested in changes in electrical activity and the redistribution of blood during exercise, which could indicate inadequate blood supply to the heart muscle,%26#8221; says Dr. Weir. %26#8220;The question is, should we pay more attention to treadmill-induced changes in blood pressure as a means to identify people at risk for developing coronary artery disease?%26#8221;

Dr. Miller adds another question, "Should we screen all middle-aged individuals who want to participate in an exercise program to make sure they don%26#8217;t have exercise-induced high blood pressure?"

Unlike cholesterol or triglyceride levels, blood pressure levels fluctuate dramatically throughout the day, depending on a variety of factors such as exercise, emotions and even the time of day. In light of that phenomenon, Dr. Weir says the study raises another issue. "This research indicates that we need a more dynamic measure of blood pressure to truly profile the risk of an individual. We%26#8217;ve been using casual, at-rest office readings of blood pressure for more than 50 years. It%26#8217;s not bad, but it%26#8217;s not the answer." The treadmill is one way to gather a more dynamic measurement, but he says there%26#8217;s an easier option. "It can even be done at home if you have a blood pressure cuff and someone who can take your blood pressure at peak exercise."

The patient in the study continues to run, but is now taking medications to lower both his cholesterol and blood pressure. Despite his exercise regime, he appears to be in the same boat as millions of Americans who do not exercise regularly. So, is too much exercise a bad thing? The physicians answer to the contrary. "We are not publishing this report to suggest in any way that people should not be exercising. Exercise has stood the test of time as being one of the best ways to modify cardiovascular risk," says Dr. Miller. %26#8220;But what we%26#8217;re looking at are improved detection methods for predicting those at risk. Exercise-induced high blood pressure may be a part of that.%26#8221;

Source:

Drug delivery system consists of nanocrystals of a hydrophobic drug

2009-02-15T22:35:00.000-05:00

The problem of efficiently delivering drugs, especially those that are hydrophobic or water-repellant, to tumors or other disease sites has long challenged scientists to develop innovative delivery systems that keep these drugs intact until reaching their targets.Now scientists in the University at ...

Now scientists in the University at Buffalo's Institute for Lasers, Photonics and Biophotonics and Roswell Park Cancer Institute have developed an innovative solution in which the delivery system is the drug itself.

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They describe for the first time in Molecular Pharmaceutics a drug delivery system that consists of nanocrystals of a hydrophobic drug.

The system involves the use of nanocrystals measuring about 100 nanometers of pure HPPH, (2-devinyl-2-(1'-hexyloxyethyl) pyropheophorbide), a photosensitizer currently in Phase I/II human clinical trials at RPCI for treating various types of cancer.

The UB researchers found that the nanocrystals of HPPH were taken up by tumors in vivo, with efficacy comparable to conventional, surfactant-based delivery systems.

A patent has been filed on this work.

"In this case, the drug itself acts as its own carrier," said Haridas Pudavar, Ph.D., UB research assistant professor of chemistry and a co-author.

The nanocrystals present a major advantage over methods of delivery involving other carriers, according to Paras Prasad, Ph.D., SUNY Distinguished Professor in the Department of Chemistry in UB's College of Arts and Sciences, executive director of the institute and a co-author.

Because other delivery systems, especially those containing surfactants, commonly used with HPPH and many other drugs, may add to the toxicity in the body, they have been considered imperfect solutions.

"Unlike formulations that require separate delivery systems, once this drug is approved, no additional approvals will be needed," said Prasad.

"Our published data in animal models demonstrate no difference in drug activity with the nanocrystal formulation," said Ravindra Pandey, Ph.D., Distinguished Professor of Biophysical Sciences at RPCI and a co-author on the paper.

"This is a case where the easiest formulation works the best," added Indrajit Roy, Ph.D., UB research assistant professor of chemistry and another co-author.

The researchers found that because HPPH is amphiphillic, i.e., partially soluble in water and oil, nanocrystals of it will self-assemble, that is, in solution the molecules aggregate, but not into such big clusters that they settle to the bottom.

"It's a controlled formation of a colloidally stable suspension of nanosized crystals," explained Tymish Ohulchanskyy, Ph.D., UB senior research scientist and a co-author.

The researchers originally were investigating nanocrystals as a delivery method for hydrophobic dyes in bioimaging applications, another promising use for nanocrystals that they continue to pursue.

Further in vivo studies with HPPH nanocrystals are being conducted by scientists at UB and RPCI, including Pandey and Allan R. Oseroff, M.D., Ph.D., chair of the department of dermatology at RPCI and in UB's School of Medicine and Biomedical Sciences.

The UB/RPCI team is exploring the use of the same technique for delivering other hydrophobic drugs, including those used in chemotherapy.

Source: University at Buffalo

Scientists build new model of enzyme responsible for all aerobic life on Earth - May help researchers gain insights into causes of cancer and other major diseases

2009-02-15T22:32:00.000-05:00

The protein cytochrome c oxidase (CcO) is the ultimate enzyme responsible for all aerobic life on Earth, from bacteria to people. It is also a crucial component of the cellular machinery that generates energy in our body. With such impressive credentials, you might expect that scientists would have a clear understanding of how CcO works. But they don't, according to James P. Collman, professor emeritus of chemistry at Stanford University.

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To help scientists achieve a better understanding of how CcO works, Collman and his colleagues have built a new model of the enzyme's active site-a region on the protein's surface where chemical reactions occur. According to Collman, this new model might eventually help researchers gain insights into the causes of cancer and other major diseases, and might even prove useful in the development of new forms of alternative energy. The team's findings appear in the March 16 issue of the journal Science.

Energy source

Many organisms, including humans, derive their energy from tiny organelles in cells known as mitochondria. Embedded in the membrane of each mitochondrion is a structure called the electron transport chain, which produces adenosine triphosphate (ATP), a molecule that is the source of the cell's energy. The transport chain is made up of a series of proteins known as electron carriers. Each carrier receives electrons from the preceding one, then transfers them down the chain. The final receptor of the electrons is a molecule of oxygen that is transformed into water and, in the process, generates energy in the form of ATP and heat.

CcO is the last electron carrier in the transport chain. It receives four electrons from the other carriers and transfers the electrons to the molecule of oxygen, converting it into two molecules of water.

"CcO has to behave perfectly," Collman said. "If it adds less than four electrons, it can produce partially reduced oxygen molecules, and these are known to be very toxic." The two most deleterious forms of reduced oxygen are superoxide and hydrogen peroxide, which have been implicated in cancer, heart failure, Alzheimer's disease and other illnesses, he added.

The good news is that CcO rarely fails, said Stanford postdoctoral fellow Neal K. Devaraj, whose doctoral dissertation was the basis of the Science paper. According to Devaraj, CcO has more than 99 percent efficiency in transforming oxygen into water.

To understand why CcO is so efficient, Collman's group, led by Stanford research associate Richard Decreau, created an artificial version of the enzyme active site using organic compounds as building materials. The imitation site, which involves an elaborate sequence of 32 chemical steps, was built from scratch and took several years to develop.

The site contains the three active centers found in the naturally occurring enzyme: an organic molecule called phenol, an iron atom and a copper atom. Working together, these three centers provide the four electrons necessary to transform oxygen into water. "How all four electrons are added to oxygen has always been mysterious," Collman said. "Very few people study it. It's quite complex, and it's been broadly ignored."

Each electron is brought to the enzyme one at a time, Collman said: "It's like a bucket brigade in a Western movie." But the electrons are consumed too fast to study individually, he noted. Therefore, the researchers had to invent a technique that supplied electrons to their enzyme model in a slow and continuous way. They solved the problem by attaching the model to a liquid crystalline film on a gold electrode, which provided a nonstop supply of electrons to the model as it transformed oxygen molecules into water-a process called steady turnover.

"The biochemists that study the enzyme typically study single turnover," Collman said. "They let the enzyme have only one oxygen molecule and watch what happens." He said that single turnover is like taking a single photograph of an event, while steady turnover is like shooting a movie.

Damaged enzymes

Once Collman's group had solved the continuous electron supply problem, the scientists systematically removed each of the three active centers-phenol, iron and copper-one at a time, as if the enzyme had been damaged and a specific active center was missing. "We found that great damage occurred, and that partially reduced oxygen species were produced in large amounts," Collman said. This finding led the researchers to conclude that all three active sites are essential for the proper functioning of the enzyme.

According to Devaraj, the new laboratory techniques developed in this experiment may have applications for research involving other enzymes. Understanding what makes CcO so efficient in reducing oxygen to water may even be useful to the study of fuel cells-very efficient power sources that convert chemical energy to electricity. "If we can develop better catalysts to do that reduction, we can get better fuel cells," Devaraj explained.

Source: Stanford University

Soy foods decreased risk of localized prostate cancer but increased risk of advanced prostate cancer

2009-02-15T22:29:00.000-05:00

The largest study examining the relationship between the traditional soy-rich Japanese diet and development of prostate cancer in Japanese men has come to a seemingly contradictory conclusion: intake of isoflavone chemicals, derived largely from soy foods, decreased the risk of localized prostate ca...

The prospective study of 43,509 men, published in the March issue of Cancer Epidemiology, Biomarkers %26amp; Prevention, suggests that the effects of isoflavones on prostate cancer development may differ according to disease stage, say researchers at the National Cancer Center in Japan.

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One possible explanation is that isoflavones may delay the progression of latent prostate cancer only; once tumors lose estrogen-receptor beta expression and become aggressive, isoflavones may fail to protect against the development of advanced cancer, and might even increase the risk of progression, possibly by reducing serum testosterone, researchers say. It is also possible that advanced and localized prostate cancer may be different tumor subtypes, which may react differently to isoflavones.

"The present findings provide no clear understanding of when or how localized cancer will develop to aggressive cancer, and of the related effect of isoflavones," said the study's first author, Norie Kurahashi, M.D., of the Epidemiology and Prevention Division of the National Cancer Center.

"Given that Japanese consume isoflavones regularly throughout life, we do not know the period during which the effects of isoflavones on prostate cancer are preventive, and further research is required to find that out, including well-designed clinical trials," she said.

Until those studies are done, the researchers recommend that Japanese men continue to consume isoflavones through their food and not through supplements.

"Consumption of isoflavones from traditional Japanese food throughout life may protect against the incidence of prostate cancer, but we cannot recommend the use of isoflavones from supplements for people who do not regularly consume these chemicals, because the relationship between isoflavones and the risk of advanced prostate cancer is not yet clear," Kurahashi said.

Isoflavones act as both strong antioxidants and plant-based estrogens. Soybeans are the most common source of isoflavones, especially genistein and daidzein, which have been shown in some animal studies to exert a protective effect against prostate cancer.

Japanese men eat significantly more soy-based foods than do Western men, and the incidence of prostate cancer is much lower in Asian countries than in Western countries. Still, reviews of latent, or clinically insignificant, prostate cancer findings in autopsy reports have revealed no difference between the populations so scientists have theorized that isoflavones stop latent cancers from developing further.

But because smaller epidemiological studies in Japan have reached differing conclusions about the protective effects of soy on prostate cancer development, this research team conducted the most comprehensive analysis to date. They polled thousands of men age 40-69 about their consumption of 147 foods, the most popular of which were miso soup (primarily made from fermented soybeans), natto (also a product of fermented soybeans) and tofu, made from soy milk. Japanese consume miso soup more frequently, usually daily, than other soy foods, and miso, natto, and tofu account for about 90 percent of the population's consumption of daidzein and genistein, according to Kurahashi.

The researchers then followed participants from 1995 through 2004 and found that 307 men were diagnosed with prostate cancer. In this group, 74 cases were advanced, 218 were confined to the prostate organ, and 15 were of undetermined stage.

They concluded that intake of genistein, daidzein, miso soup and soy food had no overall link to diagnosis of prostate cancer. However, they calculated that the risk of developing localized prostate cancer was 50 percent lower in men who ate the most isoflavones compared to men who ate the least %26#8722; meaning that men in the top category ate between two and three times as much isoflavone-rich food.

However, in a discovery they cannot explain, they also calculated that the risk of developing advanced prostate cancer was twice as high in men who consumed two or more bowls of miso soup a day than in men who ate less than one bowl of soup.

They also found that the protective effect of isoflavone-rich food was strongest in men who were older than 60: the more isoflavones they ate, the more they reduced their risk of developing localized prostate cancer. "Isoflavone may be protective for localized prostate cancer only in men aged more than 60 years, and may not have a protective effect in the early stage of prostate cancer in younger men," the researchers conclude in their study.

The inconsistencies in the finding %26#8722; that isoflavones decreased the risk of localized prostate cancer, but not the risk of advanced prostate cancer %26#8722; could be errors in food measurement, or

could be due to the fact that the number of participants who developed advanced prostate cancer was small, said Kurahashi. Or, as researchers speculate, isoflavones could interact with the estrogen receptor on prostate tissue enough to inhibit production of testosterone, which can fuel prostate cancer. When tumors lose all of their estrogen receptors and stop responding to isoflavone-induced hormonal interference, they grow aggressively.

"A broad body of research is required to clarify the timing and period of isoflavones' preventive effect on prostate cancer development," Kurahashi said.

Source: American Association for Cancer Research

2009-02-15T22:27:00.000-05:00

Success of long term hip replacement surgery may lie in your genes

2009-02-15T22:24:00.000-05:00

The success of long term hip replacement surgery may lie in the genes, suggests research published ahead of print in the Annals of the Rheumatic Diseases.The researchers analysed genetic variations in 312 people, just over half of whom (162) had problems after hip replacement in the 10 years followi...

The success of long term hip replacement surgery may lie in the genes, suggests research published ahead of print in the Annals of the Rheumatic Diseases.

The researchers analysed genetic variations in 312 people, just over half of whom (162) had problems after hip replacement in the 10 years following surgery.

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Among those with symptoms, 91 had early signs of %26#8220;aseptic loosening,%26#8221; which describes a condition in which the artificial joint comes loose and the surrounding bone begins to dissolve. The other 71 patients had deep-seated infection, which occurs when the body is unable to control infection caused by bacteria colonising the artificial implants.

DNA samples were taken from all participants to test for genetic variations in genes responsible for generating matrix metalloproteinase 1, or MMP1 for short, interleukin 6, and vitamin D synthesis.

MMP1 is an enzyme that breaks down collagen, the main protein found in bone and cartilage, while interleukin 6 is a chemical involved in bone metabolism and the immune response.

Vitamin D synthesis is important for strong healthy bones.

Variations in the interleukin 6 gene did not seem to have any effect. But those with variations in MMP1 were more than three times as likely to have aseptic loosening as those who did not carry the genetic variation.

And variations in the vitamin D receptor gene almost doubled the chances of bone dissolution and deep infection.

The authors conclude that if confirmed in other research, these findings could be used to predict long term success in patients undergoing hip replacement surgery. And they could also be used to develop targeted genetic treatments.

Source: British Medical Journal

Embryonic stem cells implanted in brain appear to develop into fully differentiated granule neurons

2009-02-15T22:21:00.000-05:00

In order to differentiate and specialize, stem cells require very specific environmental cues in a very specific order, and scientists have so far been unable to prod them to go through each of the necessary steps. But now, for the first time, a study in mice by Rockefeller University scientists shows that embryonic stem cells implanted in the brain appear to develop into fully differentiated granule neurons, the most plentiful neuron in the cerebellum. The findings were reported Feb. 20 in the online edition of Proceedings of the National Academy of Sciences.

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Image: When differentiated embryonic stem cells were implanted into the cerebellums of newborn mice (green), they migrated to the internal granule layer -- the area where fully differentiated granule neurons extend dendrites (bottom right).

Embryonic stem cells have shown a great deal of promise for alleviating heart disease and regenerating organs. But for some of the conditions for which people hold out the most hope -- Alzheimer's and Parkinson's, for example -- there's been little evidence to date that stem cells can work. Part of the problem is that neural stem cells, especially those involved in brain development, specialize as they mature and lose their ability to diversify. They require very specific environmental cues in a very specific order, and scientists have so far been unable to prod them to go through each of the necessary steps. But now, for the first time, a new study in mice shows that embryonic stem cells implanted in the brain appear to develop into fully differentiated granule neurons, the most plentiful neurons in the cerebellum.

The cerebellum, which is tucked into the lower, rear portion of the mammalian brain, contains neural circuits that are responsible for motor learning, motor memory and sensory perception. It's also the location of 40 percent of pediatric brain tumors. Mary E. Hatten, Rockefeller's Frederick P. Rose Professor and head of the Laboratory of Developmental Neurobiology, has been studying granule cells for 30 years; she sees her results as a step toward understanding how embryonic stem cells could be regulated in vivo and ultimately used for cell replacement therapy, especially after childhood tumors, in the central nervous system.

Hatten and postdoc Enrique Salero found that in order to get the embryonic stem cells to differentiate, progressing through each of the known steps of granule neuron maturation as they did so, the cells had to be treated with signals that induce specific transcription factors - proteins that can turn genes on and off - in a specific order. The researchers then implanted the newly differentiated cells into a specific spot in the brains of newborn mice, the gray layer on the surface of the cerebellum called the cerebellar cortex. Once in the brain, the cells extended parallel fibers, migrated to and incorporated themselves into the internal granule cell layer, and extended short projections called dendrites, something that neurons use to communicate with each other. Each of these steps, Hatten says, is characteristic of a typical granule cell.

Salero and Hatten then looked for evidence that their embryonic stem cells had not just gone through the developmental steps of young granule neurons, but that they also had the known markers of young granule neurons, including those indicating that the neurons had formed in the cerebellum. "We're excited about this paper because it's the first time that anybody has shown that a cell not only migrates to where it's supposed to go, but extends dendrites," Hatten says. "So they're actually in the synaptic network that's sitting on the cortex."

Hatten isn't yet convinced that the cells differentiated into true granule neurons. "There is such wild-eyed enthusiasm over stem cells," she says, "but it's very hard to know when you've provided sufficient evidence that a cell is actually what you say it is." So her next step will be to work with Nathaniel Heintz, an HHMI investigator and Rockefeller's James and Marilyn Simons Professor, to determine how close a genetic match the native granule cells are to the embryonic stem cell-derived versions.

"This whole field of stem cell biology is exciting, but also frightening because of the potential harm that could be done," Hatten says. "We have made a lot of progress with stem cells outside the brain, especially with the heart and skin. But neurons in the brain seem to undergo more complicated genetic changes as they progress through a long series of maturation steps. So we want to be absolutely sure that we're generating neurons that will aid, rather than hamper, brain function."

Source: Rockefeller University

Intercessory prayer has positive effect among people with psychological or medical problems

2009-02-15T22:19:00.000-05:00

Does God or some other type of transcendent entity answer prayer?The answer, according to a new Arizona State University study published in the March journal Research on Social Work Practice, is yes. David R. Hodge, an assistant professor of social work in the College of Human Services at Arizona St...

Does God or some other type of transcendent entity answer prayer?

The answer, according to a new Arizona State University study published in the March journal Research on Social Work Practice, is %26#8220;yes.%26#8221; David R. Hodge, an assistant professor of social work in the College of Human Services at Arizona State University, conducted a comprehensive analysis of 17 major studies on the effects of intercessory prayer %26#8211; or prayer that is offered for the benefit of another person %26#8211; among people with psychological or medical problems. He found a positive effect.

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%26#8220;There have been a number of studies on intercessory prayer, or prayer offered for the benefit of another person,%26#8221; said Hodge, a leading expert on spirituality and religion. %26#8220;Some have found positive results for prayer. Others have found no effect. Conducting a meta-analysis takes into account the entire body of empirical research on intercessory prayer. Using this procedure, we find that prayer offered on behalf of another yields positive results.%26#8221;

Hodge%26#8217;s work is featured in the March, 2007, issue of Research on Social Work Practice, a disciplinary journal devoted to the publication of empirical research on practice outcomes. It is widely recognized as one of the most prestigious journals in the field of social work.

Hodge noted that his study is important because it is a compilation of available studies and is not a single work with a single conclusion. His %26#8220;Systematic Review%26#8221; takes into account the findings of 17 studies that used intercessory prayer as a treatment in practice settings.

%26#8220;Some people feel Benson and associates%26#8217; study from last year, which is the most recent and showed no positive effects for intercessory prayer, is the final word,%26#8221; said Hodge, referring to a 2006 article by Dr. Herbert Benson of the Harvard Medical School that measured the therapeutic effect of intercessory prayer in cardiac bypass patients. %26#8220;But, this research suggests otherwise. This study enables us to look at the big picture. When the effects of prayer are averaged across all 17 studies, controlling for differences in sample sizes, a net positive effect for the prayer group is produced.

%26#8220;This is the most thorough and all-inclusive study of its kind on this controversial subject that I am aware of,%26#8221; said Hodge. %26#8220;It suggests that more research on the topic may be warranted, and that praying for people with psychological or medical problems may help them recover.%26#8221;

The use of prayer as a therapeutic intervention is controversial. Yet, Hodge notes that survey research indicates that many people use intercessory prayer as an intervention to aid healing, which raises questions about its effectiveness as an intervention strategy.

%26#8220;Overall, the meta-analysis indicates that prayer is effective. Is it effective enough to meet the standards of the American Psychological Association%26#8217;s Division 12 for empirically validated interventions? No. Thus, we should not be treating clients suffering with depression, for example, only with prayer. To treat depression, standard treatments, such as cognitive therapy, should be used as the primary method of treatment.%26#8221;

In addition to his inclusion in the upcoming issue of Research on Social Work Practice, Hodge is widely published and has appeared on the pages of Social Work, Social Work Research, Journal of Social Service Research, Journal of Marital and Family Therapy, and Families in Society. He has also authored the book %26#8220;Spiritual assessment: A handbook for helping professionals.%26#8221;

Source: Arizona State University

Scientists able to shut down gene that plays a crucial role in a leading cause of inherited blindness

2009-02-15T22:16:00.000-05:00

University of Florida researchers have used an experimental therapy in mice to shut down a gene that plays a crucial role in a leading cause of inherited blindness.The technique, detailed in an upcoming issue of Vision Research, involves injecting the eye with a bit of genetic material called interf...

University of Florida researchers have used an experimental therapy in mice to shut down a gene that plays a crucial role in a leading cause of inherited blindness.

The technique, detailed in an upcoming issue of Vision Research, involves injecting the eye with a bit of genetic material called interfering RNA, which helps disable the gene.

Normally the gene is essential for healthy eyesight, but mutated versions of it are passed from generation to generation in some families and can lead to blindness.

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Disabling the gene is a step toward developing a gene therapy to treat people with retinitis pigmentosa, an inherited disease that attacks the light-sensing cells in the eye. It affects about one in 60,000 people, with an estimated 1.5 million people afflicted worldwide.

"One of the causes of the disease is mutated gene expression," said Marina Gorbatyuk, Ph.D., an assistant professor of molecular genetics and microbiology in the UF College of Medicine. "We work with rhodopsin, which is the main retinal protein. Without it, or if it is mutated, people simply won%26#8217;t see."

Mutated forms of the rhodopsin produce a toxic protein in the retina that kills cells that receive light. People with the disease usually notice symptoms between the ages of 10 and 30. At first they have problems seeing in dimly lit places, followed by loss of their peripheral sight. The rate of progression varies, but most patients are blind by 40.

UF Genetics Institute researchers engineered the interfering RNA into a virus, which in turn was injected below the retinas in more than a dozen normal mice. Analysis showed the technique reduced the amount of rhodopsin by about 60 percent.

With the gene drastically muzzled, scientists have begun experiments to create a therapy in which healthy versions of the gene can be introduced into the eye using an apparently harmless virus to deliver the genetic material.

"If we reduce the amount of protein formed by mutated rhodopsin, that may be sufficient to maintain vision in people who are affected by retinitis pigmentosa," Gorbatyuk said. "The second step, introducing the normal gene to the retina, will show whether we are able to restore vision in this model or not."

If both steps are perfected, scientists plan to study the treatment in a larger animal model and then possibly move to a human clinical trial.

Source: University of Florida

Tiny gene mutations increase risk of autism

2009-02-15T22:13:00.000-05:00

Tiny gene mutations, each individually rare, pose more risk for autism than had been previously thought, suggests a study funded in part by the National Institute of Mental Health, a component of the National Institutes of Health.
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These spontaneous deletions and duplications of genetic mater...

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These spontaneous deletions and duplications of genetic material were found to be ten times more prevalent in sporadic cases of autism spectrum disorders than in healthy control subjects %26#8211; but only twice as prevalent in autism cases from families with more than one affected member. The results implicate the anomalies as primary, rather than just contributory, causes of the disorder in most cases when they are present, according to the researchers. Although they might share similar symptoms, different cases of autism could thus be traceable to any of 100 or more genes, alone or in combination.

Drs. Jonathan Sebat, Michael Wigler, Cold Spring Harbor Laboratory (CSHL), and 30 colleagues from several institutions, report on their discovery online, March 16, 2007 in Science Express.

"These structural variations are emerging as a different kind of genetic risk for autism than the more common sequence changes in letters of the genetic code that we%26#8217;ve been looking for," explained NIMH director Thomas Insel, M.D. "The best evidence yet that such deletions and duplications are linked to the disorder, these findings certainly complicate the search for genes contributing to autism. These are rare changes, dispersed across the genome, and they tell us that autism may be the final common path for many different genetic abnormalities."

"Our results show conclusively that these tiny glitches are frequent in autism, occurring in at least ten percent of cases, and primarily in the sporadic form of the disease, which accounts for 90 percent of affected individuals," added Sebat. "Understanding such sporadic autism will require different genetic approaches and stepped-up recruitment of families in which only one individual has the disease."

Sebat and colleagues used new high resolution array technology to detect mutations that were present in a child but not in either parent. They screened genetic material from 264 families drawn, in part, from the Autism Genetic Resource Exchange (AGRE) and the NIMH Center for Collaborative Genetic Studies of Mental Disorders.

They found the spontaneous mutations in 14 of 195 people with autism spectrum disorders compared to two of 196 unaffected individuals. Among the 14 autism patients with mutations, 12 were the only affected members of their family, while two were in families with other affected individuals.

Since the rate of mutations was much lower in families with more than one affected member, the researchers propose that "two different genetic mechanisms contribute to risk: spontaneous mutation and inheritance, with the latter being more frequent in families that have multiple affected children."

The two mutations detected in 196 healthy controls were duplications, while 12 of those in people with autism were deletions of genetic material. Relatively more females had the mutations, suggesting that the anomalies may contribute to disease more equally across the sexes than other causes of autism. Boys with autism outnumber girls 4 to 1.

Since each mutation is individually rare %26#8211; few were seen more than once %26#8211; the results suggest that many different sites in the genome likely contribute to autism.

"Failure to develop social skills and repetitive and obsessive behavior may in fact be the consequence of a reaction to many different cognitive impairments," note the researchers.

Source: National Institute of Mental Health

New approach kills bacteria by interfering with a key bacterial nutrient

2009-02-15T22:10:00.000-05:00

A new antimicrobial approach can kill bacteria in laboratory experiments and eliminate life-threatening infections in mice by interfering with a key bacterial nutrient, according to research led by a University of Washington scientist. The joint project, conducted at the UW, the University of Iowa, ...

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Bacteria are increasingly resistant to antibiotics, and existing drugs work poorly against chronic infections like those that occur in wounds, on medical devices and in the lungs of people with cystic fibrosis. For these reasons, a great deal of research is focused on finding new antibiotic compounds.

In this study, researchers took a different approach. Rather than trying to find agents that best killed bacteria in test tubes, they sought to intensify the stress imposed on microbes by one of the body's own defense mechanisms.

"The competition for iron is critical in the struggle between bacteria and host," explained the study's senior author, Pradeep Singh, associate professor of medicine and microbiology at the UW. "The body has potent defense mechanisms to keep iron away from infecting organisms, and invaders must steal some if they are to survive."

Iron is critical for the growth of bacteria and for their ability to form biofilms, slime-encased colonies of microbes that cause many chronic infections. "Because iron is so important in infection, we thought infecting bacteria might be vulnerable to interventions that target iron," explained Yukihiro Kaneko, senior fellow in microbiology at the UW and the study's lead author.

To accomplish this, the researchers used gallium, a metal very similar to iron.

"Gallium acts as a Trojan horse to iron-seeking bacteria," said Singh. "Because gallium looks like iron, invading bacteria are tricked, in a way, into taking it up. Unfortunately for the bacteria, gallium can't function like iron once it's inside bacterial cells."

The researchers showed that gallium killed microbes, and prevented the formation of biofilms. Importantly, gallium's action was intensified in low iron condition, like those that exist in the human body. Gallium was even effective against strains of Pseudomonas aeruginosa from cystic fibrosis patients that were resistant to multiple antibiotics. In mice, gallium treatment blocked both chronic and acute infections caused by this bacterium.

The idea of using gallium as a substitute for iron was developed by a group led by Bradley Britigan, a researcher at the University of Cincinnati and a co-author on this study. The general approach of targeting stresses already applied by natural defense mechanisms could be a promising new way to treat infections.

"We badly need new approaches to fight bacteria," said Singh. "The gallium strategy isn't ready for clinical use yet," he added. "However, we think this approach is promising, and we can't afford to leave any stone unturned."

Source: University of Washington

Small molecule plays key role in preventing embryonic stem cells from differentiating into one or more specific cell types

2009-02-15T22:08:00.000-05:00

A newly discovered small molecule called IQ-1 plays a key role in preventing embryonic stem cells from differentiating into one or more specific cell types, allowing them to instead continue growing and dividing indefinitely, according to research performed by a team of scientists who have recently joined the stem-cell research efforts at the Keck School of Medicine of the University of Southern California. Their findings are being published today in an early online edition of the Proceedings of the National Academy of Sciences.

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This discovery takes scientists another step closer to being able to grow embryonic stem cells without the %26#8220;feeder layer%26#8221; of mouse fibroblast cells that is essential for maintaining the pluripotency of embryonic stem cells, says the study%26#8217;s primary investigator, Michael Kahn, Ph.D., who was recently named the first Provost%26#8217;s Professor of Medicine and Pharmacy at USC. Such a layer is needed because it is currently the only proven method to provide the stem cells with the necessary chemical signals that prompt them to stay undifferentiated and to continue dividing over and over.

Still, growing human embryonic stem cells on a layer of mouse fibroblasts has never made much sense to the scientists forced to do just that. %26#8220;Stem cells that grow on feeders are contaminated with mouse glycoproteins markers,%26#8221; Kahn says. %26#8220;If you use them into humans, you%26#8217;d potentially have a horrible immune response.%26#8221;

And so, in order to take any eventual stem cell-based treatments from the laboratory to the clinic, there needs to be a way to keep the cells growing and dividing without the use of mouse fibroblasts. The discovery of IQ-1, says Kahn, is a significant step in that direction.

What IQ-1 does, Kahn explains, is to block one arm of a cell-signaling pathway called the Wnt pathway, while enhancing the signal coming from the other arm of the Wnt pathway. The Wnt pathway is known to have dichotomous effects on stem cells i.e. both proliferative and differentiative. More specifically, IQ-1 blocks the coactivator p300 from interacting with the protein %26#223;-catenin; this prevents the stem cells from being %26#8216;told%26#8217; to differentiate into a more specific cell type. At the same time, IQ-1 enhances the interaction between the coactivator CBP and %26#223;-catenin, which signals the cells to keep dividing and to remain as fully potent stem cells. %26#8220;This way, you can essentially maintain the stem cell%26#8217;s growth and potency for as long as you want,%26#8221; Kahn says.

The studies of IQ-1 and its effects reported in the newly published PNAS paper were performed at the University of Washington in Seattle by Kahn and his colleagues (along with collaborators from the Asahi Kasei Corporation in Shizuoka, Japan) using mouse embryonic stem cells, but Kahn notes that subsequent pilot studies using human embryonic stem cells, in collaboration with Dr. Qilong Ying at the Center for Stem Cell and Regenerative Medicine at the Keck School of Medicine, have confirmed that IQ-1 plays a similar role in that system as well.

Source: University of Southern California

Saliva test detects breast cancer

2009-02-15T22:05:00.000-05:00

Sebastian Z. Paige and Charles F. Streckfus, DDS, MA, the authors of the study, "Salivary analysis in the diagnosis and treatment of breast cancer," published in the March/April 2007 issue of General Dentistry, the Academy of General Dentistry"s (AGD) clinical, peer-reviewed journal, researched a ne...

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They found that the protein levels in saliva have great potential to assist in the diagnosis, treatment, and follow-up care of breast cancer. And general dentists are perfect candidates to assist with this diagnosis samples because they can easily remove saliva samples from a patient"s mouth during routine visits. As the AGD"s Vice-President Paula Jones, DDS, FAGD says, "Since a patient visits the dentist more frequently than their physician, it makes sense that this diagnostic tool could be very effective in the hands of the general dentist."

Salivary testing has some advantages over blood testing. The authors of the study argue that saliva is a clear, colorless liquid, while blood undergoes changes in color, which might affect test results. The authors also say that saliva collection is safe (no needle punctures), non-invasive, and can be collected without causing a patient any pain.

This method of early diagnosis is not yet approved by the Food and Drug Administration (FDA). If it does receive approval, dentists and physicians could use it to collaboratively diagnose breast cancer.

But Dr. Jones also warns that this is not the only means for diagnosis. "It would not eliminate the need for regular mammogram screening or blood analysis; it would just be a first line of defense for women," she says. "For example, if the salivary screening did show a positive result, a mammogram or other imaging test would be necessary to determine in which breast the cancer was located."

Advantages of salivary testing:

-- Salivary testing is safe (no needle punctures) and can be collected without causing the patient any pain.

-- Salivary testing does not require any special training or equipment.

-- Patients who may not have access to or money for preventive care could easily be tested through saliva.

Source: Academy of General Dentistry

Notorious cancer gene may contribute to tumor growth

2009-02-15T22:02:00.000-05:00

A new study suggests how a notorious cancer gene may contribute to tumor growth.The insight emerged from a long-running study of a protein called PMR1, the key player in an unusual mechanism that cells use to quickly stop production of certain important proteins.Researchers discovered that PMR1 is a...

Researchers discovered that PMR1 is activated %26#8211; or %26#8220;turned on %26#8211; by another molecule, an energy-packing protein called Src (pronounced %26#8220;sark%26#8221;).

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Discovered in 1977, Src became the first %26#8220;oncogene%26#8221; %26#8211; mutated genes that help make cells cancerous. Oncogenes are altered forms of genes that control cell growth and cell division.

These findings provide insight into how Src might contribute to cancer development.

The study by researchers with the Ohio State University Comprehensive Cancer Center is published in the March 9 issue of the journal Molecular Cell.

%26#8220;The link between Src and cancer was discovered 30 years ago, but to this day, we still don't know its exact role in tumor development,%26#8221; says principal investigator Daniel R. Schoenberg, professor of molecular and cellular biochemistry.

%26#8220;Our data suggest that Src may promote cancer by causing PMR1 to halt production of proteins that normally put the brakes on cell growth %26#8211; tumor-suppressor proteins, for example, or other growth-regulating proteins.%26#8221;

In healthy cells, Src helps control cell proliferation, differentiation, survival and movement. Mutated Src is found in about half of all colon, liver, lung, breast and pancreatic tumors, and the amount of Src can be significantly higher in cancer cells compared to normal cells.

Earlier research led by Schoenberg found that PMR1 helps control protein production by destroying particular messenger RNAs (mRNAs), molecules that carry the information used to assemble a protein.

That work showed that PMR1 attaches to the mRNAs and remains there as a silent passenger. If it receives the proper signal, however, the protein chops up and destroys the mRNA, which instantly stops production of that protein.

Cells use that mechanism to control the production of proteins such as growth factors, which activate genes in response to a hormone or other signal.

PMR1 also plays a key role in Cooley's anemia, which causes the loss of red blood cells in infants and children.

For the present study, Schoenberg and coauthor Yong Peng, a research associate in Schoenberg's laboratory, wanted to learn how PMR1 is activated to attach to mRNAs.

They found that activation occurs when PMR1 is momentarily joined by an unidentified enzyme. Contact with this enzyme changes the properties of PMR1, and this enables it to join with, or bind to, its target mRNA.

Peng then used monoclonal antibodies to isolate PMR1 and the enzyme while the two were bound together, capturing both. After separating the two, the investigators identified the enzyme as Src, which is a member of a large family of molecules called tyrosine kinases. These molecules act like switches that turn other molecules on and off, including PMR1.

%26#8220;That's the real excitement about this paper,%26#8221; Schoenberg says. %26#8220;We came at this with an interest in mRNA decay, and we may have stumbled across a fundamental mechanism of cancer.%26#8221;

Next, Schoenberg and his associates Xiaoqiang Liu and Elizabeth Murray will use three cancer-cell lines to try to identify what messenger RNAs %26#8211; which will also tell them what proteins %26#8211; are targeted and destroyed by PMR1.

%26#8220;That will help tell us whether Src works through PMR1 to contribute to cancer,%26#8221; Schoenberg says.

Funding from the National Institute for General Medical Sciences supported this research.

Source: Ohio State University

New gene appears to increase risk of developing schizophrenia

2009-02-15T22:00:00.000-05:00

Psychiatric researchers at The Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research have uncovered evidence of a new gene that appears to increase the risk of developing schizophrenia, a disorder characterized by distorted thinking, hallucinations and a reduced ability to ...

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Working in conjunction with researchers at the Harvard Medical School Partners Center for Genetics and Genomics in Boston, MA, the Zucker Hillside team utilized a cutting-edge technology called whole genome association (WGA) to search the entire human genome in 178 patients with schizophrenia and 144 healthy individuals. WGA technology was used to examine over 500,000 genetic markers in each individual, the largest number of such markers examined to date, and the first published study to utilize WGA technology in a psychiatric illness. Previous studies have been much more limited in scope, often incorporating less than 10 markers.

The study results are scheduled to be published online Tuesday in Molecular Psychiatry, which can be accessed at http://www.nature.com/mp/journal/vaop/ncurrent/index.html.

Of the 500,000 genetic markers, the researchers found that the most significant link with schizophrenia came from a marker located in a chromosomal region called the pseudoautosomal region 1 (PAR1), which is on both the X and Y chromosomes. The marker was located adjacent to two genes, CSF2RA and IL3RA, which previously were thought to play a role in inflammation and autoimmune disorders. Those two genes produce receptors for two cytokines, GM-CSF and interleukin-3. Cytokines are involved in the body%26#8217;s response to infection, and may play a role in the brain%26#8217;s response to injury.

By then examining the DNA sequence of those genes in a separate group of patients with schizophrenia and healthy individuals, the research team %26#8211; working in conjunction with PGx Health in New Haven, CT -- observed multiple gene abnormalities in patients with schizophrenia that were not found, or were found much less commonly, in healthy individuals.

%26#8220;WGA technology allowed us to shine a light across virtually the entire genome, rather than looking at just one gene at a time,%26#8221; said Todd Lencz, PhD, the first author of the study, and an investigator at Zucker Hillside and The Feinstein Institute. %26#8220;Using WGA, we found genes that had not been previously considered in studies of schizophrenia.%26#8221; Dr. Lencz added that %26#8220;the critical next step is confirming these results in independent datasets.%26#8221;

Source: The Feinstein Institute for Medical Research

Brucellosis: The fact sheet

2009-02-12T01:13:00.000-05:00

Brucellosis is a contagious, costly disease of ruminant animals which also affects humans. Although brucellosis can attack other animals, its main threat is to swine, cattle, and bison. This disease is also known as contagious abortion or Bang’s disease.In humans, it's known as undulant fever ...
Brucellosis is a contagious, costly disease of ruminant animals which also affects humans. Although brucellosis can attack other animals, its main threat is to swine, cattle, and bison. This disease is also known as contagious abortion or Bang%26rsquo;s disease. In humans, it's known as undulant fever because of the severe intermittent fever it causes. This fever is accompanying human infection, also known as Malta fever because it was first recognized as a human disease on the island of Malta.

Should we be afraid of brucellosis?

Considering the damage done by the infections in animals, this must be considered as one of the most serious livestock diseases. In animals, brucellosis can cause a decreased milk production, weight loss, loss of young, infertility, and lameness. This disease can spread very rapidly, and is transmissible to humans. These facts make it all the more serious.

What can cause brucellosis?

Brucellosis is caused by a group of bacteria known scientifically as the genus Brucella. There are three species of Brucella that cause the most concern. Those are B. abortus, principally affecting cattle and bison, B. suis, principally affecting swine and reindeer but also cattle and bison, and B. melitensis, principally affecting goats. In cattle and bison, the disease currently localizes in the reproductive organs. Bacteria are shed in milk or via the aborted fetus, afterbirth, or other reproductive tract discharges of the affected animal.

Signs and symptoms of brucellosis

There is no effective way to detect infected animals by symptoms of brucellosis. The most obvious signs in pregnant animals are abortion or birth of weak calves. Milk production may be reduced from changes in the normal lactation period. This is caused by abortions and delayed conceptions. It is not true that all infected cows abort.
However, those that do abort, usually abort between the fifth and seventh month of pregnancy.

Infected cows usually abort once, but a percentage will abort during additional pregnancies too. Calves born from later pregnancies may be weak and unhealthy due to brucellosis. Even though their calves may appear healthy, infected cows continue to harbor and discharge infectious organisms. Those animals should be regarded as dangerous sources of the disease. Other symptoms of brucellosis include an apparent lowering of fertility with poor conception rates. It is retained after births with consequential uterine infections and occasionally enlarged, arthritic joints.

How does brucellosis spread?

Brucellosis is commonly transmitted onto susceptible animals by direct contact with infected animals. It can also transmit through an environment that has been contaminated with discharges from infected animals. Aborted fetuses, placental membranes or fluids, and other vaginal discharges present after an infected animal has aborted or calved are all highly contaminating as well. These discharges and fluids have a lot of Brucella organisms. Cows commonly lick those materials or the genital area of other cows. Cows could also ingest the disease-causing organisms with contaminated food or water. Despite occasional exceptions, the general rule is that brucellosis is carried from one herd to another by an infected animal. This mode of transmission occurs when a herd owner buys replacement cattle or bison that are infected. It could also happen when the owner%26rsquo;s animals were exposed to infection prior to purchase. The disease may also be spread when wild animals or animals from an affected herd mingle with brucellosis-free animals.

How to fight brucellosis?

In the past, brucellosis control was limited mainly to individual herds. These days there is a Cooperative State Federal Brucellosis Eradication Program working to eliminate the disease from the entire country. Like other animal disease-eradication efforts, the success of the program depends on the support and participation of each livestock producer. States are designated brucellosis-free when none of their cattle or bison is found to be infected for 12 consecutive months. The question is, how do epidemiologists help fight brucellosis? Epidemiologists are specially trained veterinarians who investigate disease sources and the means of eliminating infection in affected herds and areas. They are concerned with diseases in a group or population of animals, and evaluate circumstances connected with the occurrence of brucellosis. These veterinarians help eliminate brucellosis by identifying factors essential to its control and prevention in their region.

How does the brucellosis ring test surveillance work?

The BRT procedure, or brucellosis ring test procedure, makes it possible to perform surveillance on whole dairy herds quickly and economically. Milk or cream from each cow in the herd is pooled, and a sample is taken for testing for brucellosis. Then a suspension of stained, destroyed Brucella organisms is added to a small quantity of milk. If the milk from one or more infected animals is present in the sample, a bluish ring forms at the cream line as the cream rises, which is good sign the animals could have brucellosis. With certain exceptions, herd tests must include all cattle and bison over 6 months of age.

What is the incubation period of brucellosis?

An incubation period is the interval of time between exposure to an infectious dose of organism and the first appearance of disease signs for that animal. The incubation period of brucellosis in cattle, bison, and other animals is quite variable, ranging from about 2 weeks to a full year, and even longer in certain instances. When abortion is the first sign observed, the minimum incubation period is about 30 days in most animals. Some animals abort before developing a positive reaction to the brucellosis diagnostic test. Other infected animals may never abort. There are also infected animals that do not abort but develop a positive reaction to the diagnostic test within 30 to 60 days after infection. Some animals may not develop a positive reaction for several months to over a year after exposed to brucellosis.

Can brucellosis in animals be cured?

Put simply %26ndash; no, brucellosis cannot be cured. Repeated attempts to develop a cure for brucellosis in animals have failed. Occasionally, animals may recover after a period of time but it is more common that only the signs disappear and the animals remain diseased. Such animals are dangerous sources of infection for other animals with which they associate.

Can brucellosis be prevented?

The disease may be avoided by employing good sanitation and management practices for each animal. In fact, for cattle and bison in heavily infected areas or replacement animals added to such herds, officials recommend vaccinating heifers with an approved Brucella vaccine as the best prevention. The vaccine is a live product and must be administered only by an accredited veterinarian. It is important is that tattoo identifies the year in which vaccination took place. Brucella abortus vaccine produces a bodily response that increases the animal%26rsquo;s resistance to this disease. However, vaccination is not 100% effective in preventing brucellosis. The vaccine typically protects about 65% of the vaccinated cattle from becoming infected by an average exposure to Brucella.

How does brucellosis affect humans?

People infected with the brucellosis organism usually develop symptoms similar to a severe influenza. However, this disease (called undulant fever) persists for several weeks or months and may get progressively worse. Farmers, ranchers, veterinarians, and packing plant workers are infected most frequently, because they come into direct contact with infected animals. The initial symptoms of brucellosis are fatigue and headaches, followed by high fever, chills, drenching sweats, joint pains, backache, and loss of weight and appetite. Undulant fever usually does not kill its victims, but the disease is too serious to be dealt with lightly.

What are the main sources of human infection?

In years past, prior to pasteurization, raw milk was considered the prime source of brucellosis in humans, but today most humans contract the disease by coming in direct contact with infected material. Those are aborted fetuses, afterbirth, and uterine discharges of diseased animals, or infected carcasses at slaughter.

Can people get brucellosis by eating meat?

There is no danger from eating cooked meat products, because the disease-causing bacteria are not normally found in muscle tissue. Besides, these bacteria are killed by normal cooking temperatures. The disease could only be transmitted to humans while slaughtering infected animals or processing contaminated organs from freshly killed animals.

How to protect against brucellosis?

Ranchers, farmers, or animal managers should clean and disinfect calving areas and other places likely to become contaminated. Each individual should wear sturdy rubber or plastic gloves when assisting calving or aborting animals. They should also scrub hands well with soap and water afterward. Precautions against drinking raw milk or eating un-pasteurized milk products are also important. Ultimately, the best prevention for brucellosis is to eliminate brucellosis from all animals in the area.

Wegener's Granulomatosis: Diagnosis & Treatment

2009-02-12T01:09:00.000-05:00

Wegener’s granulomatosis is not a contagious disease as many people believe. There is no evidence suggesting that it is hereditary either. It is a very rare disease, affecting only 1 in every 30,000-50,000 people which is probably why most of us are not aware of this problem. About 500 new cas...
Wegener%26rsquo;s granulomatosis is not a contagious disease as many people believe. There is no evidence suggesting that it is hereditary either. It is a very rare disease, affecting only 1 in every 30,000-50,000 people which is probably why most of us are not aware of this problem. About 500 new cases are diagnosed each year, with the disease occurring at any age. However, it mostly affects individuals in their 30s and 40s. It affects males and females equally, but 97% of all patients are Caucasian, 2% are Negroid and 1% are of another race. With Wegener%26rsquo;s granulomatosis it is extremely important to know more about diagnosis and its treatment once it is diagnosed.

What is Wegener%26rsquo;s granulomatosis?

Wegener%26rsquo;s granulomatosis is a rare disorder that causes blood vessels in the upper respiratory tract (nose, sinuses, and ears), followed by lungs, and kidneys, to become swollen and inflamed. The eyes, skin, and joints may also be affected with arthritis occurring in about half the cases. Wegener's granulomatosis is thought to be an autoimmune disorder. This uncommon disease usually begins as a localized granulomatous inflammation of upper or lower respiratory tract mucosa, and may progress into generalized necrotizing granulomatous vasculitis and glomerulonephritis. The cause of Wegener%26rsquo;s granulomatosis is unknown. Although the disease resembles an infectious process, no causative agent has been isolated yet. Because of the characteristic histological changes, hypersensitivity has been postulated as the basis of the disease.

Symptoms of Wegener%26rsquo;s granulomatosis

Frequent sinusitis is the most common symptom for Wegener%26rsquo;s granulomatosis.

Other early symptoms include persistent fever without an obvious cause, night sweats, fatigue, and malaise (an %26ldquo;ill feeling%26rdquo;). Chronic ear infections may preclude a diagnosis of Wegener%26rsquo;s granulomatosis.

Other upper respiratory symptoms include nose bleeds, pain, and sores around the opening of the patient%26rsquo;s nose. Loss of appetite and weight loss are common as well. Skin lesions typically occur, but there is no one typical lesion associated with this disease. Symptoms of kidney disease may be present, but this does not always happen. The urine may be bloody, and usually it first appears as red or smoky urine. Eye problems develop in a significant number of patients, which may range from mild conjunctivitis to severe swelling of the eye. Other symptoms include weakness, cough, or coughing up blood, as well as bloody sputum. The patient commonly complains about shortness of breath, wheezing, chest pain, rashes, and joint pains.

Diagnosis of Wegener%26rsquo;s granulomatosis

Wegener's granulomatosis is diagnosed by characteristic clinical, serologic, and pathologic findings. Wegener%26rsquo;s granulomatosis must be diagnosed and treated early to prevent complications. Common complications include kidney disease, lung disease, heart attacks, and brain damage. A doctor can usually recognize the distinctive pattern of symptoms, although blood test results cannot specifically identify Wegener%26rsquo;s granulomatosis.

However, these blood tests can strongly support the diagnosis. A blood test can detect antineutrophil cytoplasmic antibodies in the blood, which suggest this disease. If the nose, throat, or skin is not affected, a diagnosis can be difficult. This is because the symptoms and x-rays can resemble those of several lung diseases. Chest x-ray may show cavities or dense areas in the lungs similar to cancer. To definitely diagnose Wegener%26rsquo;s granulomatosis a variety of tests may be performed, including a biopsy of abnormal tissue. The doctor could chose to have open lung biopsy, upper airway biopsy, nasal mucosal biopsy, bronchoscopy with transtracheal biopsy, or kidney biopsy. Urinalysis is helpful to look for signs of kidney disease such as protein and blood in the urine. In fact, the presence of kidney disease is necessary to make a definitive diagnosis of Wegener%26rsquo;s granulomatosis.

Treatment of Wegener%26rsquo;s granulomatosis

Corticosteroids may be used alone to treat the early symptoms. However, most people also need another immunosuppressive drug, such as cyclophosphamide to treat Wegener%26rsquo;s granulomatosis.

Imuran is a common choice. This drug is able to control the disease by reducing the body%26rsquo;s inappropriate immune reaction, which improves the prognosis significantly. Without treatment, this form of the disorder is fatal. Treatment is usually continued for at least a year after the symptoms for Wegener%26rsquo;s granulomatosis disappear.

Corticosteroids, given at the same time to suppress inflammation, can usually be tapered off and discontinued during other treatment still last. For people receiving immunosuppressive drugs, a doctor treats any suspected infection as early as possible. This is because of the body%26rsquo;s decreased ability to fight infections during this therapy. Pneumonia is particularly common when the lungs are affected by Wegener%26rsquo;s. Moreover, antibiotic may be used to prevent infections in people who have been taking immunosuppressive drugs for years. Treatment with corticosteroids, cyclophosphamide, methotrexate, or azathioprine produces a long-term remission in over 90% of patients afflicted by Wegener%26rsquo;s granulomatosis.

With treatment, most people recover within months although some may develop chronic renal failure. Without treatment, patients can die within a few months, which is why complications usually result from lack of treatment. Possible complications include chronic kidney failure, hemoptysis (coughing up blood), respiratory failure, or inflammation of the eyes. Common complications are also nasal septum perforation and rash. Moreover, medications used to treat the disease can cause side effects. These side effects may also lead to complications.

It is important to know when to call the health care provider. Anyone who experiences chest pain, coughing up blood, blood in the urine, or other symptoms of this disorder should call their health care provider. The problem is that no preventive measures are currently known.

Prognosis of Wegener%26rsquo;s granulomatosis

With proper treatment, most people diagnosed with Wegener%26rsquo;s granulomatosis recover within months. However, some may develop chronic renal failure. The complete syndrome usually progresses rapidly to renal failure once the diffuse vascular phase begins due to Wegener%26rsquo;s granulomatosis.

Patients with limited disease may have nasal and pulmonary lesions, with little or no systemic involvement, where pulmonary manifestations may improve or worsen spontaneously. A previously fatal prognosis can be been dramatically improved by treatment with immunosuppressive cytotoxic drugs. Early diagnosis and treatment are crucial, because a high remission rate is now possible. In fact, critical renal complications can be avoided or reduced. Cyclophosphamide, 1 to 2 mg/kg/day with oral hydration, or by initial rapid IV infusion as a single dose q 2 to 3 weeks is the drug of choice for Wegener%26rsquo;s granulomatosis.

Corticosteroids, which reduce the vasculitic edema, are given concurrently. It could be prednisone 1 mg/kg/day. After 2 to 3 mo, prednisone is tapered until the patient is maintained solely on cyclophosphamide. This means long-term IV dosing appears to be less efficacious.

In Wegener%26rsquo;s granulomatosis treatment, Azathioprine is less effective. However, this drug may be an alternative or adjunct to cyclophosphamide for patients who cannot tolerate cyclophosphamide. Pulse treatment with methotrexate seems to be a better alternative. Long-term prophylactic trimethoprim-sulfamethoxazole seems to be highly effective for upper respiratory tract lesions and may suffice as the sole long-term treatment once all systemic features have been ablated by cyclophosphamide and corticosteroids. Occasionally, the associated anemia may be so profound that blood transfusions are required due to this therapy.

Long-term complete remission can be achieved with proper therapy, even in the case of advanced disease. Kidney transplantation has been successful in renal failure, although a report of one patient who received a cadaver kidney implant showed that typical renal lesions of Wegener's granulomatosis developed at the end. An increased incidence of solid tumors after many years may reflect high-dose cyclophosphamide use as a therapy of choice. The high incidence of bladder cancer many years after treatment is an alarming consequence of the hemorrhagic cystitis associated with excreted cyclophosphamide breakdown products. It is often unmitigated by high fluid output during initial therapy. Kidney lesions cause glomerulonephritis, which may result in blood in the urine and kidney failure at the end as serious consequences of Wegener%26rsquo;s granulomatosis.

Kidney disease can quickly worsen, and if left untreated, kidney failure and death occur in more than 90% of patients. Wegener's granulomatosis is most common in middle-aged adults and some doctors think that men are affected twice as often as women. It is rare in children, but the disease has been seen in infants as young as 3 months of age.

Biceps Tendinitis

2009-02-12T01:04:00.000-05:00

Tendinitis is also known as tendonitis. This is an inflammation of a tendon, which is a band of fibrous tissue connecting muscle to bone. The inflammation causes pain, tenderness, and occasionally restricted movement of the muscle attached to the tendon. When we talk about biceps tendonitis, it is a...
Tendinitis is also known as tendonitis. This is an inflammation of a tendon, which is a band of fibrous tissue connecting muscle to bone. The inflammation causes pain, tenderness, and occasionally restricted movement of the muscle attached to the tendon. When we talk about biceps tendonitis, it is an inflammation of the biceps muscle tendon.

What is tendinitis?

Tendinitis can cause permanent damage to the tendons where a natural tendency to favor the painful area can also lead to stiffness. A vague discomfort at the age of 30, if overuse is continued for years, can lead to a loss of flexibility. Most commonly, this is due to scarring of the tissues. Sometimes the discomfort of tendinitis disappears within weeks, especially if you rest the affected area. In elderly people and those who continue to use the affected area, tendinitis often heals more slowly, and could even progresses to a chronic condition. Almost any tendon in the body can be affected. However, those located around the knee, foot, elbow and shoulder are most frequently affected.

Knee tendonitis is a common location for this inflammation type. Actually, there are three types of knee tendonitis %26ndash; patellar tendinitis, quadriceps tendinitis, and popliteus tendinitis. Patellar tendinitis is also called %26ldquo;jumper%26rsquo;s knee%26rdquo;. It affects the patellar tendon just below the patella (kneecap). The patient complains of pain during an activity such as landing from a jump and going downstairs, or during a lack of activity - for example sitting for long periods of time. Quadriceps tendinitis affects the patellar tendon just above the kneecap; this condition is likely to be found in athletes who do a lot of rapid acceleration and deceleration. Popliteus tendinitis affects the site of insertion of the popliteus tendon on the lateral epicondyle of the femur, so runners, particularly those who run down hills or along sloping surfaces, are likely to complain of this type of tendinitis.

Reducing the symptoms is the first step in alleviating the tendonitis and establishing a diagnosis. The doctor may tell you to use ice or heat, take certain medications, and limit physical activity. This might help control the pain and swelling along with self-massaging the area. Ice helps prevent swelling and reduces pain, so placing ice on the painful area for 10 minutes at a time, several times a day, may be a good idea. If you already have a swelling, heat may help; apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day. Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms. However, this is not going to cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief. However, this relief only lasts for 24-72 hours. In rare cases, surgery is necessary to repair damage. Rest allows the tissues to heal after the surgery. On the other hand, returning to activity too soon may cause the symptoms to reoccur.

Self-massage using a heat-inducing cream or oil may also help with tendonitis. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day. You should continue with this process until healed.

Shoulder tendinitis has three types, which are rotator cuff tendinitis, calcific tendinitis and biceps tendinitis. The rotator cuff consists of four muscles around the shoulder joint that help control the shoulder%26rsquo;s position. This tendon keeps it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder. This pain is felt when reaching overhead or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications, or an injection of cortisone and a local anesthetic into the area surrounding the tendon. Patients with rotator cuff tendonitis should also exercise using light weights. If pain is not relieved with exercise and medication alone, an x-ray of the shoulder may reveal bony anatomy. This occurs between a bone at the top of the shoulder and the ball at the top of the arm bone. A procedure called an acromioplasty is performed to make more room for the rotator cuff tendons and relieve this problem. Using an arthroscope it is inserted into the shoulder and the surgeon is able to remove some of the bone from the acromion through two or three small 1/4%26quot; incisions.

Calcific tendinitis is caused by calcium deposits in the rotator cuff region, and symptoms include excruciating pain and severe restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus and treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break it up and relieve the symptoms of tendinitis. If conservative treatment is ineffective, arthroscopic calcium removal and subacromial bursectomy are viable alternatives.

Biceps tendinitis is an inflammation of the biceps tendons that attach to the shoulder, usually affecting individuals whose occupations involve repetitive biceps flexion against resistance, or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic. All this is placed into the area surrounding the tendon, as well as a sling to immobilize the shoulder. With biceps tendinitis surgery is occasionally required to stabilize a displaced tendon.

More on biceps tendinitis

The biceps muscle is a large, strong muscle in the front of the upper arm. This muscle divides into two major sections. The larger section of the bicep, called the long head of the muscle, is connected to the shoulder by a long tendon that passes through a groove in the upper end of the arm bone, called the bicepital groove. That is the point where tendinitis strikes, and beyond the groove, the tendon enters the shoulder joint and attaches to the top of the shoulder socket. Biceps tendon is held in the groove of the upper arm bone by the inter-tubercular ligament. If this ligament is injured or stretched, the tendon slides in the groove causing problems. This is because sliding irritates the tendon, and the result is biceps tendinitis. A second cause of biceps tendinitis may be a deformity in the groove itself that can be too shallow or have rough edges. In any overhead position, the tendon is forced to curve, but the groove is fixed, so if the tendon is not firmly held down, it will slide out.

Signs and symptoms of biceps tendinitis

Injuries to the biceps tendons are commonly caused by repetitive overhead activity, so symptoms include pain when the arm is overhead or bent. It could also appear as localized tenderness as the tendon passes over the groove in the upper arm bone. Occasionally, a snapping sound or sensation in the shoulder area could also be a sign of biceps tendinitis. If you notice anything similar, it would be good to have doctor%26rsquo;s exam.

Diagnosis and treatment of biceps tendinitis

Like most shoulder ailments, biceps tendinitis is painful, especially in the throwing or serving position. The pain is focused on the front of patient%26rsquo;s shoulder, so for simple cases of biceps tendinitis, it is recommended to apply ice and rest. This means initial treatment is conservative. A patient should also start pendulum exercises as soon as the pain decreases.

Usually, the irritation disappears in a week, but you should know if you put too much pressure on the tendon too soon, the tendinitis will flare up again. For the more severe cases of biceps tendinitis, the doctor could prescribe oral anti-inflammatory medication and two weeks of rest. The icing should continue twice a day and patient should also perform pendulum exercises if they are not too painful. Very rarely does biceps tendinitis require surgery as the only treatment option that works. It only happens when the tendon will not stay in the bicipital groove and the irritation is chronic; the operation procedure involves surgically detaching the tendon from the shoulder joint. It is reattached to the coracoid process, a lip in the front of the shoulder, so this operation alleviates the pain and, almost unbelievably, there is very little loss of strength or mobility.

Surgical options for biceps tendinitis

If the pain results from shoulder instability or from pressure on the tendon from the shoulder bones, your orthopaedist may recommend arthroscopic surgery as the best treatment. Using fiber optic technology and miniature instruments inserted through a small incision, the surgeon can examine the shoulder joint. This way he will also be able to anchor the tendon properly. After surgery, your orthopaedist will prescribe a rehabilitation program. This program includes stretching and strengthening exercises. Early movement is important, but patient should wait for physician%26rsquo;s approval before doing any heavy lifting or returning to sports. However, once diagnosed with biceps tendonitis, the doctor will examine you and see which treatment options is the best choice in your case. Every patient might require different treatment, depending on many variable factors of this disease.

Morton's Neuroma: Symptoms & Treatment

2009-02-12T01:00:00.000-05:00

A neuroma is a thickening of nerve tissue. This problem may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma. It occurs at the base of the third and fourth toe. It is sometimes referred to as an inter-metatarsal neuroma, where inter-metatarsal des...

A neuroma is a thickening of nerve tissue. This problem may develop in various parts of the body. The most common neuroma in the foot is a Morton%26rsquo;s neuroma. It occurs at the base of the third and fourth toe. It is sometimes referred to as an inter-metatarsal neuroma, where inter-metatarsal describes its location (in the ball of the foot between the metatarsal bones, extending from the toes to mid-foot). Neuromas may also occur in other locations in the foot. The thickening or enlargement of the nerve that defines a neuroma is the result of nerve compression and irritation. This compression creates a swelling, eventually leading to permanent nerve damage as a serious consequence of Morton%26rsquo;s neuroma.

What is Morton%26rsquo;s neuroma?

Morton's neuroma is an enlarged nerve that usually occurs in the third inter-space. This inter-space is between the third and fourth toe. Problems often develop in this area because a part of the lateral plantar nerve combines with a part of the medial plantar nerve here. When the two nerves combine, they are typically larger in diameter than nerves going to the other toes. Moreover, the nerve lies in subcutaneous tissue, just above the fat pad of the foot, close to arteries and veins. Above the nerve, there is a structure called the deep transverse metatarsal ligament. This ligament is very strong, holding the metatarsal bones together. This ligament also creates the ceiling of the nerve compartment. With each step, the ground pushes up on the enlarged nerve and the deep transverse metatarsal ligament pushes down, which causes compression in a confined space. The reason the nerve enlarges has not been determined yet. Flat feet can cause the nerve to be pulled toward the middle more than normal. This could lead to irritation and possibly enlargement of the nerve. The syndrome is more common in women than men, possibly because women wear confining shoes more often.

High heels cause more weight to be transferred to the front of the foot, and tight toe boxes create lateral compression.

Because of this, more force is being applied in the area and the nerve compartment is squeezed from all sides. Under such conditions, even a minimal enlargement in the nerve can elicit pain as one of the symptoms.

Signs and symptoms of Morton%26rsquo;s neuroma

The most common symptom of Morton's neuroma is a localized pain in the inter-space between the third and fourth toe. The pain could be sharp or dull, and is worsened by wearing shoes and by walking. However, the pain is usually less severe when the foot is not bearing weight. Patient diagnosed with Morton%26rsquo;s neuroma will probably have one or more of these symptoms where the nerve damage occurs. These symptoms are tingling, burning, or numbness, pain, and a feeling that something is inside the ball of the foot, or that there is a rise in the shoe or a sock is bunched up. The progression of a Morton%26rsquo;s neuroma often follows the same pattern. The symptoms begin gradually, and at first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities. Symptoms may be suppressed temporarily by massaging the foot or by avoiding aggravating shoes or activities. Over time the symptoms progressively worsen and may persist for several days or weeks even when you avoid walking. The symptoms become more intense as the neuroma enlarges and the temporary changes in nerve become permanent.

What causes Morton%26rsquo;s neuroma?

Anything that causes compression or irritation of the nerve can lead to neuroma. One of the most common offenders is wearing shoes that have a tapered toe box. High-heeled shoes that cause the toes to be forced into the toe box could also cause Morton%26rsquo;s neuroma. People with certain foot deformities, such as bunions, hammertoes, flatfeet, or more flexible feet are at higher risk for developing Morton%26rsquo;s neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to Morton%26rsquo;s neuroma.

Diagnosing Morton%26rsquo;s neuroma

To diagnose Morton%26rsquo;s neuroma the podiatrist commonly palpates the area to elicit pain. He will try to diagnose you by squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace of the foot. The podiatrist then tries to elicit Mulder%26rsquo;s sign. He or she will do this by holding the patient%26rsquo;s first, second, and third metatarsal heads with one hand and the fourth and fifth metatarsal heads in the other and pushing half the foot up and half the foot down slightly, where in many cases of Morton%26rsquo;s neuroma, this causes an audible click. This click is known as Mulder%26rsquo;s sign, which can help with Morton%26rsquo;s neuroma diagnosis. An x-ray should be taken to ensure that there is not a fracture of the foot. X-rays also can be used to examine the joints and bone density, ruling out arthritis and osteoarthritis. An MRI scan or magnetic resonance imaging is used to ensure that the compression is not caused by a tumor. An MRI also determines the size of the neuroma and how the syndrome should be treated - whether conservatively or aggressively. If surgery is indicated, the podiatrist can determine how much of nerve must be resected. This is important because there are different surgical techniques available, depending on the size and the position of the neuroma. However, MRIs are expensive, which is why some insurance companies are reluctant to pay for them. If the podiatrist believes an MRI is necessary, he or she can persuade the insurance company to pay for it. To establish a diagnosis, the foot and ankle surgeon will also need to obtain a thorough history of your symptoms and examine your foot. The best time to see a foot and ankle surgeon is early in the development of symptoms. This is because early diagnosis of a Morton%26rsquo;s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Treatment of Morton%26rsquo;s neuroma

In most cases, initial treatment consists of padding and taping. The goal is to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated so the patient will be instructed to wear shoes with wide toe boxes and avoid shoes with high heels. The doctor could recommend an injection of a local anesthetic to relieve pain and a corticosteroid to reduce inflammation. The patient is advised to return in a week or two sothat the progress of the disease could be monitored. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient%26rsquo;s foot and the type of the patient%26rsquo;s shoes. It can be relieved by a custom-fitted orthotic that helps keep the foot in a better position to prevent further damage. Conservative treatment does not work for most of patients and minor surgery usually is necessary to treat Morton%26rsquo;s neuroma.

There are two surgical procedures available in Morton%26rsquo;s neuroma treatment. The dorsal approach involves making an incision on the top of the foot, which permits the patient to walk soon after surgery. This is because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament. This ligament typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention after treatment. The second procedure involves a plantar approach. In this procedure the incision is made on the sole of the foot. The patient must use crutches for about three weeks and the scar that forms can make walking uncomfortable as a side effect of this approach.

The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures in the foot. However, before surgery, while developing a treatment plan, the foot and ankle surgeon will first determine how long the patient has had the neuroma. He will also need to evaluate its stage of development, because treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include padding, which are techniques that provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking. Icing mean placing an icepack on the affected area helps reduce swelling. Orthotic devices issued by a foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve. Activity modifications are important to reduce especially those that put repetitive pressure on the neuroma. You should avoid these activities until the condition improves.

Changes in shoe wear could help, because it is important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. Non-steroidal anti-inflammatory drugs such as Ibuprofen help reduce the pain and inflammation. If there is no significant improvement after the initial treatment, injection therapy may be tried as a treatment option for Morton%26rsquo;s neuroma. Surgery may be considered in patients who have not received adequate relief from other treatment options. The foot and ankle surgeon will determine which approach is optimal for your condition. The length of the recovery period after surgery will vary depending on the procedure or procedures performed. Regardless of whether you've undergone surgical or non-surgical treatment, your foot and ankle surgeon will recommend long-term measures, since it is important to help keep your symptoms from returning.

Hashimoto's Disease & Hyperthyroidism

2009-02-12T00:56:00.000-05:00

Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto’s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control ho...
Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto%26rsquo;s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control how the body uses energy. When someone has Hashimoto%26rsquo;s disease, their immune system begins to attack its own thyroid gland. This causes the thyroid gland to become swollen and irritated. When this happens, the thyroid cannot make hormones as it should. Hyperthyroidism is a condition when the thyroid gland produces more of its hormones then it should.

What is Hashimoto%26rsquo;s disease?

Hashimoto's disease is sometimes known as Hashimoto%26rsquo;s thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis. This is an autoimmune disease.
In Hashimoto's, antibodies react against the proteins in the thyroid, causing gradual destruction of the gland itself. It also affects its ability to produce the thyroid hormones the body needs. The thyroid gland is found low in the neck and is shaped like a butterfly. It produces two hormones, thyroxine (T4) and triiodothyronine (T3).
These hormones are released into the bloodstream, controlling the speed of all the body%26rsquo;s functions or metabolism. In hypothyroidism the output of these hormones is reduced, resulting in a decrease of metabolism. This causes various symptoms.
General muscle slow-down leads to tiredness, while reduced body metabolism causes dry skin, hair loss, constipation and weight gain. Joints commonly swell up, while shortage of breath may develop due to effects on the heart. In women, periods may become heavy and slower brain activity might result in memory loss or poor concentration. Youngsters may fail to grow and may not do well at school, although some people have no symptoms at all. However, the doctor may notice only a slow pulse or another minor change in appearance.

If the thyroid gland is enlarged, the doctor may identify the condition as Hashimoto%26rsquo;s disease, named after the Japanese physician who first described this combination of abnormalities.

How does Hashimoto%26rsquo;s disease occur?

The body sometimes produces substances called antibodies which are defense chemicals. Antibodies are usually made only to deal with foreign substances such as viruses, other germs, and things like pollen. In hypothyroidism, the antibodies and the cells that make them are directed against the bodies own cells, in this case the thyroid cells. This is called auto-immune destruction, and is almost impossible to prevent or reverse, so once thyroid cell damage occurs in this way, it is usually permanent.

Symptoms of Hashimoto%26rsquo;s disease

Symptoms that those afflicted with Hashimoto%26rsquo;s disease may have are varied. Because the thyroid gland may swell due to Hashimoto%26rsquo;s disease, patient may have a feeling of fullness or tightness in the throat. Trouble swallowing food or liquids is also common. A patient might notice a swelling or bump (goiter) in the front of the neck. Tiredness, forgetfulness, depression, coarse dry skin, slow heartbeat, weight gain, constipation and intolerance to cold are also symptoms of Hashimoto%26rsquo;s disease. Many people with this disease have no symptoms at all, where ordinary blood test may just show that the thyroid hormones are out of balance.

Who gets Hashimoto%26rsquo;s disease?

Although Hashimoto%26rsquo;s disease can affect people of all ages, it is most common in women between 30 and 50 years of age. If someone in your family has had thyroid disease, you may have an increased risk for Hashimoto%26rsquo;s disease, but no one is entirely sure why people get this disease.

Treatment of Hashimoto%26rsquo;s disease

There is no known cure for Hashimoto%26rsquo;s disease, but the doctor can treat low thyroid function, which is why a patient probably will not suffer any long-term effects. Thyroid medicine can replace the hormones that the thyroid gland usually makes. How long a patient needs to take the medicine will depend on the blood test results.
For most people, thyroid hormone medicine causes no problems at all. Taking thyroid medicine and having regular blood tests to see how the thyroid gland is working can help prevent symptoms like tiredness, weight gain, and constipation. Tablets of synthetic thyroxine (T4) are the usual treatment for Hashimoto%26rsquo;s disease, taken once daily. If you forget a dose once in a while no harm should follow. It is interesting that the body can make all the triiodothyronine (T3) which it needs from this T4, and it does not need to be given separately in most cases. However, because T3 works more rapidly, in some situations your doctor may decide to commence T3 out of preference. Moreover, thyroid extract is no longer recommended. Although it contains a mixture of T4 and T3, the content is not very consistent and giving mixtures of T4 and T3 at the same time has also not been shown to have any advantages. Thyroxine is often started in doses as low as 25 micrograms a day, and the dose is gradually built up every month or two to give the body a chance to adjust.

The doctor will use a regular examination, a blood test, and perhaps a heart examination to decide about the final thyroxine dose. Final dose is usually between 50 to 200 micrograms a day. You should always check the strength of thyroid tablets each time they are dispensed, since mistakes can happen. Some improvement usually occurs within 2 weeks of starting treatment but it takes 4 to 6 weeks of daily tablets to get the full benefit of a particular dose.
The older you are, the longer the doctor will take to build up the dose of thyroid hormones. Most symptoms will improve, but occasionally chest pain or shortness of breath develops. If this happens, the doctor needs to be told straight away. If your under-active thyroid was picked up by chance in a screening test, you may not feel much better after this treatment. If the thyroid gland was enlarged before treatment, it may get much smaller after the treatment of Hashimoto%26rsquo;s disease.
If too much thyroxine is taken, palpitations, trembling and sweating may appear. Even without these symptoms, mild over-dosage over several years may weaken the bones, making them more likely to be painful and to fracture. With the sensitive tests now available, it is possible for the doctor to be absolutely certain whether the dose being taken for treating this condition is correct or not.

Hashimoto%26rsquo;s disease and hyperthyroidism

A tendency to develop auto-immune thyroid disorders is commonly inherited. Some people develop an under-active thyroid following an overactive thyroid condition earlier in life. Overactive thyroid condition is called hyperthyroidism. About one person in l00 develops this quite common condition caused by hyperthyroidism. Both thyroid operations and the use of radioactive iodine for an overactive thyroid often result in an under-active thyroid state. That is why we could see the connection between Hashimoto%26rsquo;s disease and hyperthyroidism. In fact, sometimes certain foods and medicines (especially those containing iodine) can cause it. A particular type of under-active thyroid occurs 4 to 6 months after childbirth, approximately once in 15 pregnancies. This so-called post-partum thyroiditis may cause temporary or permanent thyroid under-activity, which is sometime preceded by a temporary overactive state. In many cases the onset of Hashimoto%26rsquo;s and the elevation of antibodies will be accompanied by a variety of symptoms. These symptoms are fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, infertility, and recurrent miscarriages, among others.

Many conventional endocrinologists will not treat Hashimoto%26rsquo;s disease if the thyroid function tests are in the normal range, despite these symptoms. However, in some cases Hashimoto%26rsquo;s involves a slow but steady destruction of the gland that eventually results in the thyroid%26rsquo;s inability to produce sufficient thyroid hormone. This is the condition known as hypothyroidism. Along the way there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, and then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto%26rsquo;s disease. That is why we cannot say that Hashimoto%26rsquo;s disease is just refers to hypothyroidism. Ultimately, the thyroid slowly becomes less able to function, and when hypothyroidism itself can be measured by blood tests, many practitioners will finally treat it exclusively with thyroid hormone replacement drugs.

However, there are some endocrinologists, osteopaths and other practitioners, who believe that Hashimoto%26rsquo;s disease, as confirmed by the presence of thyroid antibodies, along with its symptoms, is enough to warrant treatment with small amounts of thyroid hormone. The practice of treating patients who have Hashimoto%26rsquo;s thyroiditis but a normal range of thyroid function tests is supported by study. In that study, German researchers reportedly used levothyroxine treatment for cases of Hashimoto%26rsquo;s autoimmune thyroiditis where TSH had not yet elevated beyond normal range. The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto%26rsquo;s disease reduced the various markers of autoimmune thyroiditis. They speculated that such treatment might even be able to stop the progression of Hashimoto%26rsquo;s disease, or perhaps even prevent the development of hypothyroidism.

Smoking and lung cancer

2009-02-12T00:51:00.000-05:00

Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen ...
Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen substances poses the biggest risk for lung cancer development and the most common mean of exposure to such substances is tobacco smoking. The risk of developing lung cancer increases sharply the more you smoke and the longer you smoke.

Incidence

Lung cancer is one of the most lethal of cancers worldwide, causing up to 3 million deaths annually. Only one in ten patients diagnosed with this disease will survive the next five years. Although lung cancer was previously an illness that mostly affected men, the lung cancer rate for women has been increasing in the last few decades, which has been attributed to the rising number of female smokers. Lung cancer is the number one cause of cancer deaths in both men and women in the United States. More than 154,000 Americans died from lung cancer in 2002. Still, more than 90% of lung cancers are preventable.

Signs and symptoms of lung cancer

Symptoms that suggest lung cancer include:

* dyspnea (shortness of breath)
* hemoptysis (coughing up blood)
* chronic cough or change in regular coughing pattern
* wheezing
* chest pain or pain in the abdomen
* cachexia (weight loss), fatigue and loss of appetite
* dysphonia (hoarse voice)
* clubbing of the fingernails (uncommon)
* difficulty swallowing

Possible causes of lung cancer

There are four major causes of lung cancer (and cancer in general):

* Carcinogens such as those in cigarette smoke

* Radiation exposure

* Genetic susceptibility

* Viral infection

Cigarette smoking

Lung cancer is directly related to smoking.

It is proven that there are over 40 carcinogens in the cigarette smoke including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue.

Unfortunately, the risk of getting cancer is not removed immediately after you stop smoking. In fact up to 40% of newly diagnosed lung cancer occurs in former smokers. In the United States, smoking is estimated to account for 87% of lung cancer cases.

Exposure to asbestos and certain chemicals

* Asbestos has been known to increase the risk of getting lung cancer.
* Uranium, chromium and nickel can all cause lung cancer too.

Exposure to radon gas

Radon gas is a naturally occurring radioactive gas that can seep out of the soil into buildings. It is thought that radon gas in very high concentrations may cause lung cancer.

Air pollution

Air pollution may cause lung cancer, although this has only been proven in people exposed to large amounts of diesel exhaust fumes for many years through their work. This type of long term occupational exposure may increase lung cancer risk by up to 47%.

Genetic susceptibility

Experts are still looking into the impact of family history on lung cancer. There is some evidence that there is at least one lung cancer gene because family history of lung cancer does have an impact on the risk. Families of smokers will all be exposed to cigarette smoke and so have an increased risk of lung cancer whether they carry the gene or not.

Passive smoking

Passive smoking refers to inhalation of the smoke coming from someone else%26rsquo;s cigarette. It has recently been identified as a much more possible cause of lung cancer in non-smokers than previously believed. Several researches have been conducted on this subject and they all came to the same conclusion- passive smoking causes lung cancer in non-smokers.

The study found that there was an estimated 16% increased risk of lung cancer among the non-smoking spouses of smokers. It is estimated that workplace exposure increases the risk for 17%.

Histological types of lung cancer

There are two major types of lung cancer:

* Non-small cell lung cancer %26ndash; This type of cancer is much more common. It usually spreads to different parts of the body more slowly than small cell lung cancer.
o squamous cell carcinoma
o adenocarcinoma,
o large cell carcinoma

* Small cell lung cancer- small cell lung cancer also called oat cell cancer, accounts for about 20% of all lung cancers.

Diagnosis of lung cancer

Unfortunately, lung cancer is usually diagnosed too late for treatment to be possible. In over half of people with lung cancer the disease has already spread at the time of the diagnosis.

Early diagnosis is difficult because many of the common symptoms of lung cancer are similar to those of chronic obstructive pulmonary disease.

* X-ray examination

The first investigation of lung cancer should be a chest X-ray. However, this method can't detect all tumors because it needs to be at least a centimeter in diameter to be detectable by an ordinary X-ray.

* Blood tests

Some simple blood tests and further examinations may also be carried out.

* Bronchoscopy

This is a very good diagnostic tool and it represents a direct inspection of the inside of the breathing tubes with a thin instrument called bronchoscope. It is all done using local anaesthetic and is the best method for the diagnosis of tumors in the bronchi in the centre of the chest.

* Biopsy

Depending on the site of the cancer, a biopsy will be obtained either by a bronchoscopy or a needle biopsy.

* Sample of sputum

A sample of sputum, the material coughed up from the respiratory tract, will also be examined for cancer cells.

* CT-scan

A CT scan provides more information about how much the tumor may have spread.

Metastatic lung cancer

The lung is a common place for metastasis from tumors in other parts of the body. These cancers, however, are identified by the site of origin, i.e., a breast cancer metastasis to the lung is still known as breast cancer. The adrenal glands, liver, brain, and bone are the most common sites of metastasis from primary lung cancer itself.

Treatment of lung cancer

Treatment of lung cancer can depend on the size, location and extent of the tumor, and general health of the patient. There are many treatments, which may be used alone or in combination. These include:

SURGERY

Surgery may cure lung cancer but it is used in limited stages of the disease. The type of surgery depends on where the tumor is located in the lung.

RADIATION THERAPY

Radiation therapy is a form of high energy X-ray that kills cancer cells. It is used:

* In combination with chemotherapy and sometimes with surgery.
* To offer relief from pain or blockage of the airways.

CHEMOTHERAPY

Chemotherapy is the use of drugs that are effective against cancer cells. Chemotherapy may be injected directly into a vein or given through a catheter, which is a thin tube that is placed into a large vein and kept there until it is no longer needed.

Chemotherapy may be used:

* In conjunction with surgery.
* In more advanced stages of the disease to relieve symptoms.
* In all stages of small cell cancer.

How come some smokers don%26rsquo;t develop lung cancer?

The fact is that not all smokers develop cancer but it is still not known why. Different people react differently to the 4,000 chemicals contained in cigarette smoke depending on their genetic and biological make-up. However, the fact is that the risk of developing lung cancer increases sharply the more you smoke and the longer you smoke. According to some researches, 1 in 11 men and 1 in 17 women will develop lung cancer in their lifetime.

Tobacco and other types of cancers

* Cancers of the mouth and throat

Several researches have tried to prove that smoking cigarettes is a risk factor for all cancers associated with the larynx, oral cavity and esophagus. It is proven that over 90% of patients with oral cancer use tobacco by either smoking or chewing it. The risk for these cancers increases with the number of cigarettes smoked and those who smoke pipes or cigars experience a risk similar to that of cigarette smokers.

* Bladder cancer

Tobacco smoking is the principal risk factor for bladder cancer in both men and women. It is estimated that current smokers are 2-5 time more likely to develop bladder cancer than non-smokers.

* Breast cancer

Some studies have proven that there is a link between smoking and breast cancer. Most epidemiological studies have found no association between active smoking and breast cancer but a new study found that among women who have smoked for 40 years or longer the risk of breast cancer was 60% higher that that of women who have never smoked.

* Cervical cancer

Cancer of the cervix has been found to be associated with cigarette smoking in many case-control studies. Smoking is the second most significant environmental factor after human papilloma virus.

Hallucinations

2009-02-12T00:47:00.000-05:00

Hallucinations are medically defined as apparent perception of an external object while the fact is that no such object is present. They are false or distorted sensory experiences that appear to be real perceptions to the person which is hallucinating. What is important about these sensory impressions? It is important to know that they are generated by the mind rather than by any external stimuli. Hallucinations could be seen, heard, felt, and even smelled or tasted by the person who is hallucinating. People may experience hallucinations as part of their normal developmental stages, especially during the preschool years, in the 2-5 year old range.

Possible causes of hallucinations

It is proven that the hallucinatory experience has a wide range of etiologies like:

%26middot; neurological insult,

%26middot; seizure and sleep disorders,

%26middot; substance abuse,

%26middot; grief,

%26middot; stress- It is proven that prolonged or extreme stress can impede thought processes and trigger hallucinations

%26middot; metabolic, endocrine and infectious diseases

%26middot; Electrical or neuro-chemical activity in the brain- It is proven that a hallucinatory sensation, often appears before, and gives warning of, a migraine. They are also reported as hallucinations!

%26middot; Mental illness- several researches done in the past have came to the conclusion that there is up to 75% of schizophrenic patients admitted for treatment which reported hallucinations.

%26middot; Brain damage or disease. Lesions or injuries to the brain may alter brain function and produce hallucinations.

The fact is that patients suffering from dementia and psychotic disorders such as schizophrenia frequently mostly experience hallucinations, but there is no rule because, hallucinations can also occur in patients who are not mentally.

In most cases we are talking about a result of stress overload, hypertension or exhaustion. It is also proven that sleep deprivation for a longer period can also lead to hallucinations.

Drug reactions %26ndash; Several researches done in the past have came to the conclusion that the use of psychotomimetics and many medication's side-effects could trigger hallucinations: ecstasy, LSD, mescaline, and psilocybin trigger hallucinations.

Top 10 drugs or classes associated with hallucinations.

SSRIs

tramadol

bupropion

venlafaxine

quinolones

proton pump inhibitors

clarithromycin

zopliclone

ropinirole

%26beta;-adrenoreceptor antagonists

Other drugs such as marijuana and PCP have hallucinatory effects. Hallucinogens can be classified by:

%26middot; quality of action,

%26middot; mechanisms of action,

%26middot; by chemical structure

Almost all hallucinogens contain nitrogen and are classified as alkaloids. THC and Salvinorin A are exceptions. Many hallucinogens often have chemical structures similar to those of human neurotransmitters, such as serotonin, and temporarily interfere with the action of neurotransmitters and/or receptor sites.

Beside these pathological causes- there are also some medical and psychiatric causes of hallucinations. Common causes include:

Fever, which can occur with almost any infection,

Intoxication or withdrawal from drugs

Delirium or dementia

Sensory deprivation such as blindness or deafness

Severe medical illness including liver failure, kidney failure, and brain cancer

Some psychiatric disorders, particularly schizophrenia, psychotic depression, and post-traumatic stress disorder

The mechanism of hallucination

Various theories have tried to explain the occurrence of hallucinations. Hallucinations were first seen as a projection of unconscious wishes and desires, but biological theories have claimed that hallucinations are more often thought of as being caused by functional deficits in the brain. Important thing to know is that the function of the neurotransmitter dopamine is thought to be particularly important. Hallucinations may result from biases in meta-cognitive abilities. These are abilities that allow us to monitor or draw inferences from our own internal psychological states.

Types of hallucinations

Hallucinations occur while a person is awake and conscious and some of the common hallucinations include:

Hearing voices when no one has spoken (auditory-hallucinations)

Seeing patterns, lights, beings or objects that aren't there (visual-hallucinations)

Feeling a crawling sensation on the skin (tactile-hallucinations)

Hallucinations related to smell or taste are rare, but possible

Visual Hallucination

Hypnagogic Hallucination

These hallucinations occur just before falling asleep and can last from seconds to minutes; all the while the subject usually remains aware of the true nature of the images.

Peduncular Hallucinosis

These hallucinations occur most often in the evenings but unlike the previous type-the subject is usually fully conscious.

Delerium Tremens

The subject which suffers from delirium tremens is usually agitated and confused, especially in the later stages of this disease. It is also accompanied with sleep disorders!

Parkinson's Disease and Lewy body Dementia

Parkinson disease is associated with Lewy body dementia because they produce similar hallucinatory symptoms. These hallucinations start with illusions and they typically last for several minutes. What is the cause? Well, it is a known fact that Parkinson's disease is usually associated with a degraded substantia nigra pars compacta.

Migraine Coma

This type of hallucination is usually experienced during the recovery from a comatose state. Some researches have proven that these hallucinations occur during states of full consciousness.

Charles Bonnet Syndrome

Symptoms characteristic to this syndrome are being felt by blind patients who experience visual hallucinations. The hallucinations usually occur during the morning or evening, but are not dependent on low light conditions.

Focal Epilepsy

It is well known that some focal epilepsy could produce hallucinations which are characterized by being brief, and stereotyped.

Auditory Hallucinations

The definition is simple- they occur when people hear voices or other noises although nothing is there. It is also very important to rule out possible causes such as physical illness and the side-effects of medication. How to recognize? One sign that the person may be having hallucinations involving voices is when they talk to themselves although there are no rules!

Several researches has been conducted and the results are:

38% percent of subjects described the sound as stereophonic,

6% said it came from the right side,

4% said left.

10% ascribed the origin of sound as coming from behind them

9% percent said from the front

52% percent of subjects could not ascribe a gender to the voice, and considered it to be a mix,

24% considered the voice to be male and 5% female.

Auditory hallucinations are more common in psychotic conditions such as schizophrenia, although they may sometimes be associated with high doses of cocaine, amphetamine or other stimulants.

Hallucinations- a symptom of dementia

It is a proven fact that people with dementia often have hallucinations. It's still not clear if this is an indication that the dementia is getting worse, but the fact is that most dementia does worsen over time. When a person with dementia has hallucinations, it's important to rule out delirium as a cause.

Causes of delirium include:

heart or lung disease,

infections,

poor nutrition,

drug interactions

hormone disorders

Hallucinations due to delirium usually go away with treatment of the underlying cause. When hallucinations occur as a symptom of dementia, treatment may include several medications.

Diagnosis

There is no doubt that every person should seek evaluation, if experienced hallucinations more then once and in unusual occasion!

Differential diagnosis

A general physician, psychologist, or psychiatrist will try to rule out possible organic, environmental, or psychological causes through a detailed medical examination and social history. If a psychological cause such as schizophrenia is suspected, a psychologist will typically conduct an interview with the patient and his family and administer one of several clinical inventories, or tests, to evaluate the mental status of the patient.

Occasionally, people who are in good mental health will experience a hallucination. If hallucinations are infrequent and transitory, and can be accounted for by short-term environmental factors such as sleep deprivation or meditation, no treatment may be necessary. However, if hallucinations are hampering an individual's ability to function, a general physician, psychologist, or psychiatrist should be consulted to pinpoint their source and recommend a treatment plan.

Treatment and prognosis

Every patient should know that hallucinations which are symptoms of a mental illness such as schizophrenia should be treated by a psychologist or psychiatrist.

Medications

Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed.

Psychosocial therapy

If hallucinations persist, psychosocial therapy can be helpful in teaching the patient the coping skills to deal with them. Hallucinations due to sleep deprivation or extreme stress generally stop after the cause is removed.

Morton's Neuroma

2009-02-12T00:43:00.000-05:00

A Morton's neuroma, also called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma, is a benign swelling along a nerve in the foot that carries sensations from the toes. It is important to know that this isn't some cancerous growth and that the reason the nerve starts to swell is unknown. Problem is that, once swelling begins, the nearby bones and ligaments put extra pressure on the nerve, causing more irritation and inflammation which is causing burning pain, numbness, tingling and other abnormal sensations in the toes. This swelling usually develops between the third and fourth toes and other locations are rare. Important thing to know is also that it is rare for a Morton's neuroma to develop in both feet at the same time.

Incidence of the condition

Several researches done in the past have came to the conclusion that the condition is much more common in women than men, probably as a result of wearing high-heeled and narrow-toed shoes. It is also much more common in obese people because being overweight also increases the risk of a Morton's neuroma. Highest prevalence of Morton's neuroma is found in patients aged 15-50 years, but the condition may occur at any age.

Symptoms of a Morton's Neuroma

When someone has a Morton%26rsquo;s neuroma, he or she will probably have one or more of these symptoms where the nerve damage in occurring:

Tingling, burning, or numbness

Pain

A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

The progression of a Morton's neuroma often follows this pattern:

The symptoms begin gradually and at first- they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.

The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.

Over time the symptoms progressively worsen and may persist for several days or weeks.

The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Typically, the pain is relieved temporarily by taking off shoes, flexing toes and rubbing feet. Symptoms may be aggravated by standing for prolonged periods.

Possible causes of Morton%26rsquo;s neuroma

The fact is that experts don't understand exactly what causes Morton's neuroma. However- there are some theories that tried to explain the cause of the condition and most of them are considering injury to be the direct cause! The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to toes. The growth of thickened nerve tissue is part of body's response to the irritation or injury. It is proven also that, in some cases, Morton's neuroma may result from abnormal mechanics of the foot. This includes the presence of different bunions, hammertoes, flatfeet or excessive flexibility. Certain activities carry increased risk of excessive toe deformities, such as prolonged walking, running, squatting, and ballet%26hellip;

Factors that appear to contribute to Morton's neuroma include:

Wearing high-heeled shoes or shoes that are tight or ill-fitting, including those that box in feet and place pressure on toes

High-impact athletic activities, such as jogging, that subject your feet to repetitive trauma

Injury to your foot

Diagnosis of Morton%26rsquo;s neuroma

Detailed patient%26rsquo;s history

Every doctor should suspect that a patient has a Morton's neuroma based on the nature and location of her or his foot pain. That%26rsquo;s why- doctor should ask questions about shoes %26mdash; what type of shoes a patient usually wears and whether these shoes have narrow toes or high heels. Differential diagnosis is easy! To rule out other causes of foot pain, doctor should ask questions about medical history, especially any history of arthritis, nerve and muscle problems or previous foot or leg injury.

Physical examination

To confirm the diagnosis, every doctor should examine patient%26rsquo;s feet. He should look for areas of tenderness, swelling, calluses, numbness, muscle weakness and limited motion. It is very easy to confirm the diagnosis by squeezing the sides of patient%26rsquo;s foot. Squeezing should compress the neuroma and trigger patient%26rsquo;s typical pain. In some cases, doctor will find numbness in the area between the affected toes. It is also important to know one thing- pain in two or more locations on one foot more likely indicates that the toe joints are inflamed rather than a Morton' neuroma.

X-ray and MRI imaging

Sometimes, a foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, doctor should request magnetic resonance imaging (MRI) of the foot.

Differential diagnosis

There are some condition that should be mixed with this Morton%26rsquo;s neuroma and these may include:

Stress fracture of the neck of the metatarsal

Rheumatoid arthritis and other systemic arthritis conditions

Hammer toe

Metatarsalgia

Neoplasm

Metatarsal head osteonecrosis

Freiburg osteochondrosis

Ganglion cysts

Intermetatarsal bursal fluid collections

True neuromas

Treatment of Morton%26rsquo;s neuroma

Every patient should know that in developing a treatment plan- foot and ankle surgeon will first determine how long does the condition last and evaluate its stage of development.

For mild to moderate cases of neuroma, treatment options include:

Padding

It is proven that padding techniques provide support for the metatarsal arch, because it involves lessening the pressure on the nerve and decreasing the compression when walking. It could be very beneficial method!

Icing

Placing an icepack on the affected area helps reduce swelling. Ice is also beneficial to decrease the associated inflammation.

Orthotic devices

All patients will confirm- custom orthotic devices provided by foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve and sometimes %26ndash;relieve pain completely!

Activity modifications

Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. These include prolonged walking, running, squatting%26hellip;

Changes in shoewear

It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. This will significantly relieve pain and reduce risk for complications!

Medications

Several patients have reported that some nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

Injection therapy

If there is no significant improvement after initial treatment, injection therapy may be tried. Some simple analgesics or nonsteroidal anti-inflammatory medications may be used to relieve pain and inflammation! However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure, so people usually receive only a limited number of injections.

Physical therapy

The physical therapist can help the physician in decisions regarding the modification of footwear, which is the first step to treatment. Every therapist should recommend soft-soled shoes with a wide toe box and low heel. High-heeled narrow non-padded shoes should not be worn; because it is proven that they aggravate the condition. A plantar pad is used most often for elevation. Other possible physical therapy treatment ideas for patients with Morton neuroma include:

cryotherapy,

ultrasound,

deep tissue massage,

stretching exercises

Surgical solutions

Most patients are confused because they don%26rsquo;t know when exactly is surgery needed? Well, it is simple- surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma:

%26middot; removing of the affected nerve

%26middot; releasing of the affected nerve

Recovery period

Every patient should know that the length of the recovery period will vary, depending on the procedure or procedures performed. Regardless the type of treatment, every foot and ankle surgeon should recommend long-term measures to help keep your symptoms from returning.

Possible surgical Complications

The surgical area contains very small blood vessels, nerves, and muscles and complications can occur.

Haematoma

Once the neuroma is removed, the empty space may fill with blood, resulting in a painful haematoma.

Infection

There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.

Recurrence of the pain

Every patient should know that the recurrence is another very common possibility. Problem is that the stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.

Some useful tips for the patients

Take anti-inflammatory medications.

Try ice massage.

Change your footwear and avoid high heels or tight shoes.

Wear supports or pads

Take a break for a few weeks and reduce activities such as jogging, aerobic exercise or dancing.

About 25% of patients will experience complete resolution of their symptoms by taking these steps.

What is GHB?

2009-02-12T00:38:00.000-05:00

Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is...
Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is unclear.

The law and abuse

GHB was sold in health food stores as a performance enhancing booster until the Food and Drug Administration banned it in 1990. It is currently marketed in some European countries as an adjunct to anesthesia.
GHB is abused for its ability to produce euphoric and hallucinogenic states and for its alleged function as a growth hormone that releases agents to stimulate muscle growth.

Common street-names of GHB

Blue nitro
Cherry fX bombs
Cherry meth
Easy lay
Everclear
Firewater
Gamma G
Georgia homeboy
GHB
G.H. revitalizer
Gib
Goops
Great hormones at bedtime
Grievous bodily harm
G-riffick
Growth hormone booster
Insom-X
Invigorate
Lemon fX drops
Liquid ecstasy
Liquid E
Liquid X
Longevity
Natural sleep-500
Nature's quaalude
Orange fX rush
Organic quaalude
Oxy-sleep
Poor man's heroin
Remforce
Revivarant
Salty water
Scoop
Soap
Somatomax PM
Somsanit
Vita-G
Water
Wolfies
Zonked

Incidence

GHB is often ingested with alcohol by young adults and teens at nightclubs and parties. It is used as a pleasure enhancer that depresses the central nervous system and induces intoxication.
Several researches have shown that annual GHB use by secondary school students in 2000 ranged from

%26bull; 1.1% among 10th graders
%26bull; 1.2% among 8th graders
%26bull; 1.9% among 12th graders

In 2001, estimates of annual GHB use ranged from 1.0% among 10th graders to 1.1% among 8th graders and 1.6% among 12th graders.

Production of GHB

GHB can be easily manufactured. In the United States, GHB is produced in laboratories with no guarantee of quality or purity, making its effects less predictable and more difficult to diagnose.

Abusers have figured out that this drug can be manufactured with inexpensive ingredients and using recipes on the Internet. There are some substances such as Gamma butyrolactone (GBL) and 1,4-butanediol which represent the analogs of GHB and can be substituted for it. Once ingested, these analogs convert to GHB and produce the identical effects. The FDA has issued warnings for both GBL and 1,4-butanediol, stating that the drugs have a potential for abuse and are a public health danger.

Medical used of GHB

From the date it was synthesized it has been used as a general anesthetic, and a hypnotic in the treatment of insomnia. GHB has also been used to treat clinical depression, and improve athletic performance. Food and Drug Administration have permitted the use of GHB under the trade name Xyrem in patients with narcolepsy, a form of sleep disorder. GHB is also used in the treatment of alcoholism. It is used to treat both, acute alcohol withdrawal and medium to long term detoxification.

The use and effects of GHB

%26bull; The appearance
GHB is usually taken orally, and in most cases it is sold as a light-colored powder that easily dissolves in liquids. It can also be found as a pure liquid packaged in vials or small bottles. In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink.

%26bull; The costs
GHB is typically consumed by the capful or teaspoonful at a cost of $5 to $10 per dose.

%26bull; The effects
Several studies have shown that the average dose is 1 to 5 grams. In most cases it produces effects in 15 to 30 minutes and the effects last from 3 to 6 hours. It is proven that consumption of:

o Less than 1 gram of this drug produce relaxing effects, causing a loss of muscle tone and reduced inhibitions.
o 1 to 2 grams causes a strong feeling of relaxation and slows the heart rate and respiration.
o 2 to 4 grams, pronounced interference with motor and speech control occurs. A coma-like sleep may be induced, requiring intubation to wake the user.

When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory depression, unconsciousness, coma, and overdose.

%26bull; Side effects

Side effects associated with GHB may include:

o nausea,
o vomiting,
o delusions,
o depression,
o vertigo,
o hallucinations,
o seizures,
o respiratory distress,
o loss of consciousness,
o slowed heart rate,
o lowered blood pressure,
o amnesia,
o coma

Mechanism of GHB action

Experts are still researching the exact mechanism of GHB effects because they are still not fully understood. GHB clearly has at least two sites of action, stimulating the:

%26bull; GHB receptor
%26bull; The GABAB.

Some researches tried to prove that GHB is nothing more then a neurotransmitter, which in high concentrations can also reach to the GABAB receptor causing the sedative effects.

GHB and cases of rape

The drug-facilitated rape is defined as a sexual assault made easier by the offender's use of an anesthetic-type drug that renders the victim physically incapacitated or helpless and unable to consent to sexual activity.

According to several researches, GHB is the most common substance used in drug-facilitated sexual assaults because it can mentally and physically paralyze an individual. Victims may not seek help until days after the assault, in part because the drug impairs their memory and in part because they may not identify signs of sexual assault. Even when they do seek help, GHB is only detectable in the system for a limited amount of time and the opportunity to detect the drug can quickly pass.

Dangers of usage

%26bull; Mixing GHB with alcohol is extremely dangerous and has caused many deaths due to respiratory failure.
%26bull; Passing out on GHB by itself is also dangerous and potentially life-threatening.
%26bull; Driving a car while on GHB could be extremely dangerous! It is proven that only one dose can impair motor coordination by as much as six drinks of alcohol.
%26bull; Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms.
%26bull; GHB is illegal and possession can result in long prison terms.

Withdrawal from GHB

Patients with a history of around-the-clock use of GHB (every 2 to 4 hours) exhibit withdrawal symptoms including:

%26bull; anxiety,
%26bull; insomnia,
%26bull; tremors,
%26bull; episodes of tachycardia
%26bull; delirium
%26bull; agitation

Because GHB has a short duration of action and quickly leaves the user's system, withdrawal symptoms may occur within 1 to 6 hours of the last dose. These symptoms may last for many months.

Other signs and symptoms of acute GHB abstinence syndrome may include

%26bull; Anorexia, abdominal cramps
%26bull; Nightmares
%26bull; Impaired concentration, memory, and judgment
%26bull; Increased sensitivity to sounds and tactile sensations
%26bull; Delusions
%26bull; Tonic-clonic activity (it is unclear if actual seizures occur during GHB withdrawal)
%26bull; Elevated temperature
%26bull; Dehydration

Therapy of GHB dependence

Benzodiazepines
Benzodiazepines such as Lorazepam (Ativan%26reg;, Temesta%26reg;), chlordiazepoxide (Librium%26reg;, Mitran%26reg;, Poxi%26reg;), and diazepam (Valium%26reg;, T-Quil%26reg;), are useful in relieving some of the signs and symptoms of GHB withdrawal.
Big doses of oral or intravenous benzodiazepines do not decrease the likelihood of withdrawal delirium, but are important for controlling psychotic agitation. The big problem is that most patients in GHB withdrawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal. Such large benzodiazepine doses require close medical attention and the application of continuous pulse oximetry to monitor for oxygen desaturation.

Barbiturates
Barbiturates in combination with benzodiazepines have been used successfully to improve withdrawal symptoms. Pentobarbital, a short acting barbiturate, can be titrated intravenously in 100-200 mg increments to symptoms.

Sedating Agents
Propofol is an anesthetic agent used for sedation which has been reported to provide relief for the psychotic agitation in patients with severe GHB withdrawal symptoms.

Antihypertensive Medications
It is not uncommon for patients to request medications such as beta-blockers for the treatment of minor autonomic hyperactivity such as elevated heart rate, elevation of blood pressure, sweating, tremor, or panic attacks. Beta-blockers used to control vital sign abnormalities via peripheral beta-blockade, without central nervous system sedation, may be detrimental.

Haloperidol and Other Antipsychotic medications
Clinicians have reported using large doses of antipsychotic medication in an attempt to control GHB withdrawal psychosis and they provided limited control of symptoms. Neuroleptics may also increase the risk of neuroleptics malignant syndrome and malignant hyperthermia.

Obsessive jealousy

2009-02-10T21:36:00.000-05:00

It is very difficult to explain what jealousy is. The most common definition would be that jealousy is an emotion by one who perceives that another person is giving something that he or she feels is due to them to an alternate. The examples of jealousy are everywhere around us. Children may become j...
It is very difficult to explain what jealousy is. The most common definition would be that jealousy is an emotion by one who perceives that another person is giving something that he or she feels is due to them to an alternate. The examples of jealousy are everywhere around us. Children may become jealous when their siblings get something that they haven%26rsquo;t. An adult may become jealous if their lover is flirting with someone else. Although a small amount of jealousy is not considered to be pathological, this emotion, when seriously expressed, can invade every relationship, whether it be with husbands, wives, boyfriends, girlfriends, brothers, sisters, mothers or fathers. A form of jealousy called Delusional jealousy or Othello syndrome is a psychiatric disorder in which a person thinks that their spouse or sexual partner is being unfaithful. In some cases this type of behaviour is acquired through past experiences - people who have already been cheated on tend to be more possessive and controlling for fear of repetition. In most cases however, jealousy is a byproduct of one's own issues with self-confidence and self-esteem.

Fear and lack of trust

Fear is the number one cause of unfounded jealousy. The person who is jealous may not be willing to admit it at first, but at the core of almost all jealousy is a fear that they may lose their partner and their needs for love, friendship and affection will no longer be met. The second ingredient that is almost always present when someone is jealous is a lack of trust in a relationship. This can either be a lack of trust in their partner because of past actions or a lack of trust in their partner's ability to make conscious choices and decisions about their conduct when they are with other people.

Jealousy and envy

Some experts strictly distinguish between jealousy and envy on the ground that jealousy involves the wish to keep what one has while envy involves the wish to get what one does not have.

To oversimplify, jealousy causes anger, envy causes wistfulness. Jealousy is destructive, but envy rarely is. Envy is the desire for something in general, whereas jealousy is the desire to have something in particular.

Some even claim a distinction between jealousy and envy insofar as while envy is the carnal desire to possess something that is not yours, jealousy is the righteous feeling that one has towards that which is rightly his.. For this reason, some have suggested that jealousy mostly concerns one's perception of oneself.

Jealousy and self-esteem

Scientific research has not clearly established a link between jealousy and self-esteem although some experts claim that there is a strong link between thess two.

Is jealousy insecurity?

Several psychiatric studies have come to the conclusion that feelings of jealousy always appear to stem from one's sense that something about their life is not secure. In some cases, the insecurity is not founded on realistic dangers to the relationship and if that is the case, the jealous partner may wish to consider where the insecurities are coming from. Of course, solving these sorts of insecurities isn't easy, but until a person does it there is no chance for a healthy relationship without the excessive jealousy.

Totally non-jealous!

By the late 1960s and the 1970s, jealousy, particularly sexual jealousy, had come to be seen as irrational and shameful among the proponents of free love. People who practiced those non-exclusive sexual relationships believed that they ought not to be jealous and sought to banish or deny jealous reactions to their partners' sexual involvement with others. Many found this unexpectedly difficult. For some, conscious blocking of the jealous reaction is relatively easy from the start, and over time the reaction can be effectively extinguished.

Multiple intimate relationships

Several studies suggest that jealousy may be reduced in multilateral relationships. Contemporary practitioners of what is now called multiple intimate relationships for the most part treat jealousy as an inevitable problem, best handled by accommodation and communication.

Delusional jealousy

Delusional jealousy is a psychiatric disorder in which a person holds a delusional belief that their spouse or sexual partner is being unfaithful. Delusional jealousy is also known as the Othello syndrome, erotic jealousy syndrome, morbid jealousy, Othello psychosis, or sexual jealousy. This syndrome may appear alone or in the course of paranoid schizophrenia, alcoholism, or cocaine addiction.

The most common symptoms of Othello syndrome:

%26bull; recurrent accusations of infidelity,
%26bull; searches for evidence,
%26bull; repeated interrogation of the partner,
%26bull; tests of partner's fidelity,
%26bull; stalking

The affected person typically makes these accusations based on insignificant or minimal evidence. They may also frequently monitor their partner%26rsquo;s behavior and movements. This may be taken to extremes. This type of behaviour is more often found in males than females and it has a strong association with violence.
Some studies have also found that the constant accusations and suspicion from the delusional partner have driven some partners to actually have an affair.

Treatment of jealousy

The first step is that the person stops denying jealousy and starts dealing with it. There are several ways in which jealousy can be treated.

%26bull; Self-treatment

It is proven that one of the biggest mistakes that jealous person can make is to try and hide it. It is important to figure out that jealousy is usually a signal that something in the life of this person needs to be fixed. Ignoring usually only makes things worse. Jealous persons should ask themselves the following questions:

%26bull; What do I feel insecure about?
%26bull; Do I feel unattractive or uninteresting myself?
%26bull; Do I doubt the other persons love for me?
%26bull; Do I doubt that I can have the type of relationship I want?

Once a person figures out what the reason of discomfort is, they should ask themselves if these fears are well-founded. If the person is really sure that fears are unwarranted, but they feel insecure anyhow, they should try to change in order to avoid the situations which cause their insecurity in the future!

Sometimes jealous feelings can be triggered because we have unspoken expectations from our partner that aren't met. In such cases it may be helpful to ask the partner how they feel about it and, by clarifying the partners intentions, ending up feeling disappointed and hurt will be less likely. There is a lot of hope in being able to change ourselves, whether we are working on our personal defects of character, or we just need to change our attitude.

Some useful tips are:

%26bull; Learn from past experiences.
It is important to look at how your behavior affected the past relationships. You may soon discover that these frequent suspicions are the cause of your troubled love life.
You should realize that getting upset with your partner for no reason won't help your situation.
%26bull; Deal with reality
Focusing on what is really happening, not what you perceive to be happening is crucial. This is because with time, person may end up having difficulty distinguishing fact from fiction.
%26bull; Respect yourself
The partner chose you for a reason and there is no need for them to be so easily tempted elsewhere.
%26bull; Get a third party's opinion
It might be useful to ask a good friend to take note of your behavior around your partner. It may help you to fully understand the extent of your actions. Neutral perspective is the most objective criteria.

%26bull; Psychiatric therapy
Therapy can be another good way of dealing with unfounded internal fears. Unfortunately, there is often a stigma attached to therapy but you need to know that visiting a therapist doesn%26rsquo;t mean that you are crazy.

%26bull; Medications

Some patients with pathological jealousy have a predominant obsessional component to their jealous thoughts. Since obsessions and compulsions often respond to medications called serotonin reuptake blockers, these drugs may also be useful for obsessional jealousy. It is proven that obsessional jealousy has phenomenological similarities to other obsessions and compulsions, and therefore jealousy may respond to standard anti-obsessional medications.

Antisocial Personality Disorder

2009-02-10T21:30:00.000-05:00

Antisocial personality disorder is a specific psychiatric disorder characterized by antisocial and impulsive behaviors. This is a pathological disorder which means that modern psychiatry defines no potential benefits of positive antisocial behavior. Professional psychiatry generally compares Antisoc...
Antisocial personality disorder is a specific psychiatric disorder characterized by antisocial and impulsive behaviors. This is a pathological disorder which means that modern psychiatry defines no potential benefits of positive antisocial behavior. Professional psychiatry generally compares Antisocial Personality Disorder to sociopathy. That%26rsquo;s why the term %26ldquo;sociopath%26rdquo; is sometimes used to describe an individual with anti-social personality disorder. People with anti-social personality disorder show a chronic lack of concern for the rules and expectations of society, and repeatedly violate the rights of others. Anti-social personality disorders are difficult to treat. Group counseling and treatment of coexisting conditions may help some people.

Personality disorders

A personality disorder is a severe disturbance in the logical constitution and behavioral tendencies of an individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to manifest into adulthood.

Currently, there are 10 distinct personality disorders identified in the DSM-IV:

1. Antisocial Personality Disorder
2. Avoidant Personality Disorder
3. Borderline Personality Disorder
4. Dependent Personality Disorder
5. Histrionic Personality Disorder
6. Narcissistic Personality Disorder
7. Obsessive-Compulsive Personality Disorder
8. Paranoid Personality Disorder
9. Schizoid Personality Disorder
10. Schizotypal Personality Disorder

Incidence

Approximately 3% of men and 1% of women are thought to have some form of antisocial personality disorder according to DSM-IV.

The incidence of antisocial personality is higher in people who have antisocial biological parents.

The cause of Antisocial Personality Disorder

The cause of this disorder is unknown, although most experts believe that the biological or genetic factors may play a role.

%26bull; Genetic factors
The incidence of antisocial personality is higher in people who have antisocial biological parents. There is almost always a history of similar behaviors before age 15, such as repetitive lying, truancy, delinquency, and substance abuse. Several researches have confirmed the genetic factors of antisocial behavior in adults and shown that genetic factors are more important in adults than in antisocial children. Antisocial Personality Disorder in the biological parents predicted antisocial disorder in the adopted away children.

Symptoms of the condition

%26bull; Antisocial behavior
People with this disorder appear to be charming at times, and make relationships, but to them, these relationships are not filled with true emotions. The relationships of the persons with this disorder including marriages, are shallow and meaningles and are ended whenever it suits them. They have the ability to find the weakness in people, and are ready to use these weaknesses to their own ends through manipulation.
%26bull; Lack of true emotions
These people appear to be incapable of any true emotion. They are quick to get angry, but just as quick to let go, without holding grudges.
%26bull; Living for the moment
The are rarely able to have a steady job. They live for the moment, forgetting the past, and not planning the future, not thinking ahead what consequences their actions will have. They want immediate rewards and gratification.

Most commonly, the sociopath:

%26bull; Repeatedly breaks the law
%26bull; Displays reckless or impulsive behavior
%26bull; Exhibits persistent irritability and aggressive behavior
%26bull; Repeatedly lies to and manipulates others
%26bull; Is unable to sustain long-term relationships
%26bull; Shows consistent irresponsibility, such as failing to pay bills or hold a steady job
%26bull; Abuses alcohol or drugs
%26bull; Shows little or no remorse for their actions

Five-factor model of personality

1. High Neuroticism

Some of the common symptoms are:

%26bull; chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame;
%26bull; difficulty in inhibiting impulses: to eat, drink, or spend money;
%26bull; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self,
%26bull; unwarranted pessimism;
%26bull; unfounded somatic concerns;
%26bull; helplessness and dependence on others

2. Low Extraversion

This is characterized by social isolation, interpersonal detachment, and lack of support networks, flattened affect, lack of joy for life, social inhibition and shyness.

3. Low Openness

It is characterized by low tolerance or understanding of different points of lifestyles, emotional blandness and inability to understand and verbalize own feelings.

4. Low Agreeableness

The most common symptoms are cynicism, paranoid thinking and inability to trust even friends or family.

5. Low Conscientiousness

It is characterized by poor academic performance relative to ability.

The person with APD is hardly fulfilling their intellectual or artistic potential.

Aggressive sociopaths

These people derive strong gratification from harming others. It is proven that they like to hurt, frighten, tyrannize, bully, and manipulate. They do it for a sense of power and control, and will often only drop subtle hints about what they are up to. They seek out positions of power, such as parent, teacher, bureaucrat, supervisor, or police officer.

Diagnosis of APD

Most of the manuals for diagnosing mental and behavioral disorders, define antisocial personality disorder as a pervasive pattern of three (or more) of the following:

%26bull; failure to conform to social norms with respect to lawful behaviors
%26bull; deceitfulness, repeated lying, use of aliases,
%26bull; impulsivity or failure to plan ahead
%26bull; irritability and aggressiveness, as indicated by repeated physical fights or assaults
%26bull; reckless disregard for safety of self or others
%26bull; lack of remorse
%26bull; The individual is at least age 18 years.
%26bull; There is evidence of conduct disorder with onset before age 15 years.

Differential Diagnosis

Some disorders have similar symptoms. That is why the clinician has to differentiate against the following disorders to establish a precise diagnosis.

These conditions are:

%26bull; Substance-Related Disorder;
%26bull; Schizophrenia
%26bull; Manic Episode
%26bull; Narcissistic Personality Disorder
%26bull; Histrionic Personality Disorder
%26bull; Borderline Personality Disorders
%26bull; Paranoid Personality Disorder
%26bull; Adult Antisocial Behavior.

Treatment of Antisocial personality disorder

Treatment Goals

Experts are saying that the treatment for all individuals with personality disorders should include:

%26bull; preventing further deterioration,
%26bull; establishing or regaining an adaptive equilibrium,
%26bull; alleviating symptoms,
%26bull; restoring lost skills,
%26bull; fostering improved adaptive capacity

Another treatment goal is to assist family members and significant others to set limits.

Counseling and Psychotherapy

The effective treatment of antisocial behavior and personality is limited but it is proven that group psychotherapy can be helpful.
The main goal of the psychotherapy is for the patient to develop a sense of trust. Only then the individual psychotherapy or cognitive behavioral therapy can be beneficial. It is likely, that intensive, psychoanalytic approaches are inappropriate for this population.

Pharmacotherapy

There is no research that supports the use of medications for direct treatment of antisocial personality disorder. It is proven that medications should only be utilized to treat clear, acute and serious diagnoses.

Self-Help

There are several self-help methods for the treatment of this disorder. Unfortunately they are often overlooked by the medical profession. Group therapy could be the key because individuals feel more at ease while discussing their problems in front of their peers..

Prognosis

The prognosis is not very good mostly because this disorder is characterized by a failure to conform to society's norms. People with this disorder are often incarcerated because of criminal behavior. A lack of insight into the disorder is also very common. People with antisocial personality disorder rarely seek treatment and rarely realize that they have a problem in the first place.

Effexor - experiences

2009-02-10T21:25:00.000-05:00

Venlafaxine (Effexor®) is a new antidepressant with a chemical structure that does not resemble those of any currently used antidepressants. Effexor XR® (Venlafaxine HCL) is a medication available to treat depression and generalized anxiety disorder .It is important to know that Effexor®...
Venlafaxine (Effexor%26reg;) is a new antidepressant with a chemical structure that does not resemble those of any currently used antidepressants. Effexor XR%26reg; (Venlafaxine HCL) is a medication available to treat depression and generalized anxiety disorder .It is important to know that Effexor%26reg; is not a tricyclic antidepressant or an MAO inhibitor. The fact is that everyone responds to medications differently. Effexor XR%26reg; will work well for some people, and not so well for others. Research has shown that Venlafaxine is the most effective among six commonly prescribed antidepressants.

What makes it so different from other antidepressants?

Effexor seems to have the relative freedom from side-effects associated with the:

%26bull; SSRIs such as fluoxetine (Prozac%26reg;), sertraline (Zoloft%26reg;), paroxetine (Paxil%26reg;), and fluvoxamine (Luvox%26reg;) and
%26bull; The impact on both serotonin and norepinephrine associated with the tricyclic antidepressants [amitriptyline (Elavi%26reg;l), imipramine (Tofranil%26reg;).

Effexor is different than other antidepressants because it contains the drug known as Venlafaxine which should be prescribed only to people suffering from major depression or extreme anxiety. This drug has been successful in treating people with depression that have not responded to other antidepressants.

Metabolism and mechanism of action

This drug belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRI). As Venlafaxine and its active metabolite have relatively short half-lives, 4 hours and 11 hours respectively, Effexor should be administered in divided does, two or three times a day. Venlafaxine is well absorbed, with peak plasma concentrations occurring approximately 2 hours after dosing. Structurally different from any other antidepressant, it affects two neurotransmitters involved in depression, serotonin and norepinephrine. Several researches have proven that this medication works by correcting the balance of two brain chemicals serotonin and norepinephrine.

Why are these substances so important? It is proven that these two chemicals help control moods, concentration, impulses, appetites, irritability and emotions.
That%26rsquo;s why imbalances of these substances create the cycle of depression and the nervousness and irritability associated with anxiety disorders.

It is proven that at low and medium dosages, Effexor diminishes serotonin reuptake alone and at higher dosages, it inhibits the reuptake of norepinephrine as well as serotonin and dopamine.

Like most other medications used for depression, Effexor may take several weeks before it is fully effective and that%26rsquo;s why it is important to give the medication sufficient time before judging whether it works for a given person.

Before using this medicine

Before you start taking Effexors, there are several things you should know about it and it%26rsquo;s side effects:

%26bull; Allergies
The doctor needs to be informed about any allergic reaction to Venlafaxine or about allergy to any other substances, such as foods, preservatives, or dyes.
%26bull; Pregnancy
Some research conducted on animals showed that Effexor may have serious side effects on pregnancy. You need to inform your doctor that you%26rsquo;re pregnant before he prescribes you this medicine.
%26bull; Breast-feeding
This medicine passes into breast milk and may cause unwanted effects.
%26bull; Children
Venlafaxine must be used with caution in children with depression because several studies have shown occurrences of suicidal tendencies in children who participated in clinical trials for this medicine.
%26bull; Other medicines
You should consult the physician if you plan to start taking Effexor while already on:

%26bull; Buspirone
%26bull; Bromocriptine
%26bull; Certain tricyclic antidepressants
%26bull; Dextromethorphan
%26bull; Levodopa
%26bull; Lithium
%26bull; Meperidine
%26bull; Nefazodone
%26bull; Pentazocine
%26bull; Selective serotonin reuptake inhibitors
%26bull; Street drugs (LSD, MDMA [e.g., ecstasy], marijuana)
%26bull; Sumatriptan
%26bull; Tramadol
%26bull; Trazodone
%26bull; Tryptophan
%26bull; Clozapine
%26bull; Monoamine oxidase (MAO) inhibitor activity
%26bull; Warfarin

Effexor indications

%26bull; Depression and generalized anxiety disorder
Effexor XR is recognized as an effective first-time medication for patients who suffer from depression or who have generalized anxiety disorder. It doesn%26rsquo;t matter whether they are hospitalized or treated on an outpatient basis.
%26bull; Longstanding depressive illness
It can also be useful for patients who have had longstanding depressive illness and have not responded adequately to previous treatments.
%26bull; Unsuccessful previous treatments
A great deal of so-called refractory patients or those who have not had positive results from past treatment have had success with Effexor XR.

Recommended dosage

%26bull; Effexor%26reg;
The usual starting dose is 75 milligrams a day, divided into 2 or 3 smaller doses. It should always be taken with food. If needed, the doctor may gradually increase the daily dose in steps of no more than 75 milligrams at a time up to a maximum of 375 milligrams per day.
%26bull; Effexor XR%26reg;
For both depression and anxiety the usual starting dose is 75 milligrams once a day, although some people begin with a dose of 37.5 milligrams for the first 4 to 7 days. Your doctor may gradually increase the dose, in steps of no more than 75 milligrams, up to a maximum of 225 milligrams daily.

Possible side effects of Effexor

A warning is being issued with Effexor and with other SSRI and SSRN anti-depressants advising of risk of suicidality. Family members should be advised of this potentially fatal side effect so they may bring the patient to a hospital emergency for surveillance and protection.

Common side effects include:

%26bull; Nausea
%26bull; Dizziness
%26bull; Sleepiness
%26bull; Insomnia
%26bull; Vertigo
%26bull; Dry mouth
%26bull; Sexual dysfunction
%26bull; Sweating
%26bull; Vivid dreams
%26bull; Increased blood pressure
%26bull; Electric shock like sensations

Less Common side-effects include:

%26bull; Panic Attacks
%26bull; Drowsiness
%26bull; Depressed feelings
%26bull; Cardiac arrhythmia
%26bull; Increased serum cholesterol
%26bull; Gas or stomach pain
%26bull; Abnormal vision
%26bull; Nervousness, agitation or increased anxiety
%26bull; Suicidal thoughts suicidal ideation
%26bull; Confusion
%26bull; Neuroleptic malignant syndrome
%26bull; Loss of appetite
%26bull; Constipation
%26bull; Tremor
%26bull; Tardive dyskinesia
%26bull; Difficulty swallowing
%26bull; Lack of sexual desire
%26bull; Raised blood pressure
%26bull; Allergic skin reactions
%26bull; External bleeding
%26bull; Serious bone marrow damage
%26bull; Hepatitis
%26bull; Pancreatitis
%26bull; Seizure

Effexor and other medications

Effexor XR%26reg; does not interact significantly with many other medications, including Lithium%26reg;, Valium%26reg; (diazepam), and Tagamet%26reg; (cimetidine, an anti-ulcer medication). While taking Tagamet %26reg; for high blood pressure or liver disease the patient should be cautious in taking Effexor XR%26reg; because the interaction may be more pronounced when these disorders are present. Effexor XR%26reg; definitely should not be taken at the same time as the MAOIs (Parnate%26reg; or Nardil%26reg;). Interactions with these compounds could be lethal.

Physical and Psychological Dependence

Although no researches have been conducted on humans, several in vitro studies revealed that Effexor has virtually no affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors.

There was no indication of drug-seeking behavior in the clinical trials. However, it is not possible to predict on the basis of experience the extent to which a CNS active drug will be misused, diverted, or abused once marketed.

Withdrawal symptoms

Effexor%26reg; may cause potentially serious withdrawal symptoms upon sudden discontinuation. These withdrawal symptoms have a tendency to be significantly stronger than the withdrawal effects of other antidepressants including the tricyclic antidepressants.

Discontinuation effects may include:

%26bull; irritability,
%26bull; hostility,
%26bull; headache,
%26bull; nausea,
%26bull; fatigue,
%26bull; dysphoria
%26bull; brain shivers

Rarer withdrawal symptoms include:

%26bull; shaking legs,
%26bull; tremor,
%26bull; vertigo,
%26bull; Abdominal or stomach pain;
%26bull; agitation;
%26bull; black, tarry stools;
%26bull; bleeding gums;
%26bull; blistering,
%26bull; peeling,
%26bull; loosening of skin;
%26bull; bloating of abdomen;
%26bull; blood in eye;
%26bull; bloody urine;
%26bull; confusion
%26bull; dizziness
%26bull; paresthesia
%26bull; impaired concentration,
%26bull; bizarre dreams,
%26bull; agitation
%26bull; suicidal thoughts

Effexor and suicide

The possibility of a suicide attempt in seriously depressed patients is inherent to the illness and may persist until significant remission occurs.
Close supervision of high-risk patients should accompany initial drug therapy, and consideration should be given to the need for hospitalization. In order to reduce the risk of overdose, prescriptions for Effexor should be written for the smallest quantity of tablets consistent with good patient management.

Am I pregnant?

2009-02-10T21:21:00.000-05:00

“Am I pregnant” is a favorite question of anyone who is trying to get pregnant and a good question for everyone. Since there are so many different signs and symptoms, many women do not know how to be sure. That is why you should read this article if you are interested in signs and sympto...
%26ldquo;Am I pregnant%26rdquo; is a favorite question of anyone who is trying to get pregnant and a good question for everyone. Since there are so many different signs and symptoms, many women do not know how to be sure. That is why you should read this article if you are interested in signs and symptoms of pregnancy.
While a missed period is one of the biggest clues that a woman is pregnant, it is not the first sign. Some women suspect they are pregnant before their menstrual cycle is late, but also symptoms that might indicate you are pregnant include tenderness of the breasts and nipples, fatigue that occur 1-6 weeks after conception, frequent urination occurring 6-8 weeks after conception, nausea, queasiness, vomiting in first half of pregnancy and food cravings that happens during entire pregnancy. While some women are sure they are pregnant from the moment of conception, others may take five positive pregnancy tests, as well as a host of symptoms, until they are really sure. You must remember that all women are different so you may not experience all, or even any of these common signs of pregnancy.

Missed period

This is probably one of the more reliable signs that pregnancy has happened. Although some women will experience implantation bleeding about the time of their period, it is usually lighter and shorter than normal period. This is why each woman who suspects she might be pregnant will be asked for the first day of last normal period she has had. There are even a few women who will have periods throughout their pregnancy. This is a rare occurrence but it can happen. When a woman is planning for pregnancy, the day that she expects her period is probably well marked in her mind, and that it is the official day that she can take a home pregnancy test. These tests measure the levels of hCG (human chorion gonadotropine), a hormone secreted during pregnancy in woman%26rsquo;s urine.

The amount of urine each test can detect varies widely and amount of hormone each woman secret may also vary, but not as widely.

The better tests on the market will measure 25-50 mIUs of hCG, which is usually the amount found in urine between the 4thand 5th weeks of pregnancy. The levels of hCG in your urine and blood will be different. First morning urine will always contain the highest concentration of hCG but most tests do not require that you use first morning urine.

You can help better your chances of having enough hCG in your urine by waiting four hours after you last urinated, and then taking the home pregnancy test. This will allow hCG to build up in your urine if you really are pregnant. These tests rarely give false results but it would be better for your gynecologist to confirm that you are pregnant. A negative answer that is later revealed to be a pregnancy is usually the result of the test being performed too early, while positive ones that later prove to be false signs of pregnancy usually indicate a very early miscarriage. You can always talk to your practitioner if you have questions about your pregnancy tests. You must know also that blood tests are the most accurate and can be performed 7-10 days post-ovulation.

Tender breasts or nipples

If you are pregnant you will notice that your breasts and nipples become tender. It happens around three weeks after conception or when your period is about one week late. They may also feel swollen similar to the way they feel when you expect your period.

Slight spotting or cramping

If you are pregnant, light pink spotting can occur at the time of implantation. This happens when the embryo attaches to the lining of the uterus. Most commonly woman will notice it around eight to ten days following ovulation, a bit earlier than menstrual period is due. Women can usually differentiate implantation bleeding from menstrual period if it occurs a bit earlier than expected. Moreover, this will probably be cramping if it is scanty, spotty, pinkish and not red and heavy like a period, and does not follow the normal pattern of a period that should be light, progressing to heavy and then again to light. Cramping can also be common in early pregnancy, until the uterus assumes its mid-position and becomes better supported by the bony pelvis in the second trimester. During that time, it is prone to menstrual-like cramping. Contractions of the uterus occur regularly, increasing with exercise, orgasm, and even simple changes in position of the woman.

Darkening areolas

This is a famous and very common sign in very early pregnancy, around the time of your expected period. At this time the woman may notice that her areola (darker areas that ring the nipples) begin to darken and increase in diameter. It is believed that the darker color of the areola helps the newborn to find the nipple for breastfeeding after the baby is born.
You may also notice that the veins in your breasts become more visible and that Montgomery's tubercles (the tiny bumps scattered around the areola) enlarge and may increase in number. The number is averaging between 4 and 28 per areola.

Extreme fatigue

If a woman is pregnant, a very common symptom in the first eight to ten weeks is exhaustion, s her body is going through significant metabolic changes. Her entire body needs to adjust to the new process of growing a baby. For most women fatigue starts to go away by the 12th week of their pregnancy.

Nausea and vomiting

When a woman is pregnant, she may find quite early on, as early as a week after conception, that she is experiencing morning sickness. She may also find that morning sickness is a misnomer. Nausea can occur at anytime, day or night.

Frequent urination

By the time the woman%26rsquo;s period is one to two weeks late, she may find that she is peeing more frequently than usual. This is because the baby growing in uterus is putting pressure on the bladder.

Constipation

Women commonly notice a change in bowel movement in early pregnancy. The extra hormones produced during pregnancy cause the intestines to relax and become less efficient, so constipation could occur.

Raised basal body temperature

A woman may very well be pregnant if her basal body temperature remains elevated even past the time her period is due. She may notice that it does not decline to pre-ovulatory levels. When woman conceive, the egg is fertilized in the fallopian tube. After that, it takes about a week to travel to the uterus, where it will implant. It is at this time that the woman%26rsquo;s body is finally able to detect that she is pregnant. When hCG or human chorionic gonadotropine is released, women often experience a third temperature rise. This is not as dramatic as the first, but can usually be seen anywhere from about a week to 12 days after the first temperature rise at ovulation.

A positive pregnancy test

This is something each woman should do if her period is late and she could expect to become pregnant. She could do it after her period is at least a day late, and when she is ready to know the truth. In this case, she may want to take a home pregnancy test.
A urine pregnancy test can be accurate as early as 10 to 14 days after fertilization happened. If woman cannot wait until a missed period, a blood pregnancy test can be accurate as early as 8 to 10 days after fertilization. However, you should keep in mind that pregnancy tests are not 100 percent foolproof, and neither are blood tests. If you have a negative result and still feel pregnant, be sure to retest a week later and check in with your health care provider.

What if I am pregnant?

When a woman suspects that she is pregnant, she should visit a doctor to confirm her condition as soon as possible; after that she should change her life style a little bit. Laboratory blood tests can verify pregnancy as soon as 6 or 7 days after conception, while urine test may detect pregnancy as early as 10 days after conception. The blood and urine test both measure the level human chorionic gonadotropin or HCG. This is a hormone produced only in a woman%26rsquo;s body when she has placental tissue growing there. The placenta is the tissue within the uterus or womb through which the mother provides nourishment to the fetus.

The importance of prenatal care

One of the most important things that woman can do for herself and her baby is to seek proper prenatal care. Prenatal care consists of regular appointments starting early and continuing throughout the pregnancy. Laboratory testing for potential problems with the developing baby or herself and monitoring for problems such as abnormal changes in blood pressure, blood chemistry, urine chemistry, and weight are very important. Getting plenty of exercise and eating properly, giving up bad habits such as smoking, drinking alcohol, or using street drugs is something that doctor should definitely recommend. It is also important for a woman to alert her doctor immediately if anything unusual occurs during pregnancy, such as if the baby%26rsquo;s movement greatly reduce or stop, if she experiences vaginal bleeding or cramping, develops swelling of her hands and face, or persistent headaches, if she leaks amniotic fluid from her vagina, or if she develops pain in abdomen. Improved technologies and more accurate prenatal tests now make it possible to spot complications earlier. This also helps to get appropriate action in time to save the fetus and mother. A woman%26rsquo;s habits greatly influence the health of her unborn child, so when pregnant, woman should avoid few things. Alcohol is the first thing because consuming alcohol while pregnant can cause birth defects and other problems. In fact, consistent alcohol use during pregnancy can cause fetal alcohol syndrome, a permanent and lifelong condition. Cigarettes, medications, narcotics, caffeine and contact with cat feces are also things pregnant women should avoid.

Guillain-Barre Syndrome: Causes, Symptoms & Treatment

2009-02-10T21:17:00.000-05:00

The Guillain-Barre syndrome can affect anybody; it can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, afflicting only about one person in 100,000. Usually Guillain-Barre occurs a few days or weeks after the patient has had symptoms. It is not so hard to rec...
The Guillain-Barre syndrome can affect anybody; it can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, afflicting only about one person in 100,000. Usually Guillain-Barre occurs a few days or weeks after the patient has had symptoms. It is not so hard to recognize symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery or vaccinations will trigger Guillain-Barre syndrome. This disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear. By the third week of the illness 90 percent of all patients are at their weakest.

What is the Guillain-Barre syndrome?

Guillain-Barre syndrome is disorder in which the body%26rsquo;s immune system attacks part of peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations. These symptoms most commonly occur in the legs. In many instances the weakness and abnormal sensations spread to the arms and upper body while disease progresses. These symptoms can increase in intensity until certain muscles cannot be used at all. When it is severe the patient could be almost totally paralyzed. In these cases the disorder is life threatening. It is potentially interfering with breathing and, at times, with blood pressure or heart rate. That is why Guillain-Barre syndrome is considered as a medical emergency. Such a patient is often put on a respirator to assist with breathing. Patient should also be watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most patients, recover from even the most severe cases of Guillain-Barre syndrome. However, some patients continue to have a certain degree of weakness.

Causes of Guillain-Barre syndrome

No one yet knows why Guillain-Barre syndrome strikes some people and not others.

Moreover, nobody knows exactly what sets the disease in motion. What scientists do know is that the body%26rsquo;s immune system begins to attack the body itself. It causes what is known as an autoimmune disease. Usually the cells of the immune system attack only foreign material and invading organisms but with the Guillain-Barre syndrome the immune system starts to destroy the myelin sheath that surrounds the axons of many peripheral nerves. This disease could even destroy the axons themselves. Axons are long, thin extensions of the nerve cells, which carry nerve signals. The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances of the body. In diseases in which the peripheral nerves%26rsquo; myelin sheaths are injured or degraded, the nerves cannot transmit signals as efficiently as they should. That is why the muscles begin to lose their ability to respond to the brain%26rsquo;s commands. These commands should be carried through the nerve network. The brain also receives fewer sensory signals from the rest of the body. This is resulting in an inability to feel textures, heat, pain, and other sensations. Alternately, the brain may receive inappropriate signals that result in tingling, crawling-skin, or even painful sensations. Because the signals to and from the arms and legs must travel the longest distances they are most vulnerable to interruption due to Guillain-Barre syndrome. Therefore, muscle weakness and tingling sensations usually first appear in the hands and feet, after those areas they could progress upwards. When Guillain-Barre is preceded by a viral or bacterial infection, it is possible that the virus has changed the nature of cells in the nervous system. That is why the immune system treats them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it recognizes as its own. It allows some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin. Sensitized T lymphocytes cooperate with B lymphocytes to produce antibodies against components of the myelin sheath. That may contribute to destruction of the myelin. Scientists are investigating these and other possibilities to find why the immune system goes awry in Guillain-Barre syndrome as well with other autoimmune diseases. The cause and course of Guillain-Barre syndrome is an active area of neurological investigation. This topic incorporates the cooperative efforts of neurological scientists, immunologists, and virologists.

Diagnosis of Guillain-Barre syndrome

Guillain-Barre is called a syndrome rather than a disease because it is not clear whether or not a specific disease-causing agent is involved. A syndrome is a medical condition characterized by a collection of symptoms that the patient feels. It is also characterized by signs which a doctor can observe or measure. The signs and symptoms of the syndrome can be quite varied, so doctors may on rare occasions find it difficult to diagnose Guillain-Barre. This is especially difficult in its earliest stages. The problem is what several disorders have symptoms similar to those found in Guillain-Barre. Therefore, doctors examine and question patients carefully before making a diagnosis. Collectively, the signs and symptoms form a certain pattern that helps doctors differentiate this syndrome from other disorders. For example, physicians will note whether the symptoms appear on both sides of the body that is most common in Guillain-Barre syndrome, and the quickness with which the symptoms appear.
It is important to know that in other disorders, muscle weakness may progress over months rather than days or weeks. In Guillain-Barre syndrome, reflexes such as knee jerks are usually lost. Because the signals traveling along the nerve are slower, a nerve conduction velocity test can give doctor clues to aid the diagnosis. In Guillain-Barre patients, the cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual so a physician may decide to perform a spinal tap - a procedure in which the doctor inserts a needle into the patient%26rsquo;s lower back to draw cerebrospinal fluid from the spinal column.

Treatment of Guillain-Barre syndrome

There is no known cure for the Guillain-Barre syndrome but there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of Guillain-Barre. Currently, plasmapheresis and high-dose immunoglobulin therapy are used as the best treatment option. Both of them are equally effective, but immunoglobulin is easier to administer for most doctors.
Plasmapheresis is a method by which whole blood is removed from the body and processed. This way red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still do not know exactly why plasmapheresis works. However, this technique seems to reduce the severity and duration of the Guillain-Barre episode. This may be because the plasma portion of the blood contains elements of the immune system that may be toxic to myelin.
In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins. The immune system naturally produces these proteins in small quantities to attack invading organisms. Investigators have found that giving high doses of these immunoglobulin to Guillain-Barre patients can lessen the immune attack on the nervous system. Investigators do not know why or how this works, although there are several hypotheses proposed.
The use of steroid hormones has also been tried as a way to reduce the severity of Guillain-Barre syndrome. However, controlled clinical trials have demonstrated that this treatment is not only ineffective, but may even have a deleterious effect on Guillain-Barre syndrome.
The most critical part of the treatment of this syndrome consists of keeping the patient%26rsquo;s body functioning during recovery of the nervous system. This can sometimes require placing the patient on a respirator, a heart monitor, or other machines to assist body function. The need for this sophisticated machinery is one of the reasons why Guillain-Barre syndrome patients are usually treated in hospitals. In the hospital, doctors can also look for and treat the many problems that can afflict any paralyzed patient. These are complications such as pneumonia or bed sores. Often, even before recovery begins, caregivers may be instructed to manually move the patient%26rsquo;s limbs. This is recommended to help keep the muscles flexible and strong. Later, as the patient begins to recover limb control, physical therapy for Guillain-Barre syndrome begins. Carefully planned clinical trials of new and experimental therapies are the key to improving the treatment of these patients. Such clinical trials begin with the research of basic and clinical scientists who identify new approaches to treating patients with the disease. The problem is, the Guillain-Barre syndrome can be a devastating disorder because of its sudden and unexpected onset. In addition, recovery is not necessarily quick, so patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or months. The recovery period may be as short as a few weeks or as long as a few years, where about 30 percent of those with Guillain-Barre still have a residual weakness after 3 years.

Ear Piercing by infants: Pros and cons

2009-02-10T21:12:00.000-05:00

It is common for adults to have piercings and tattoos, but it could be a little bit different when it comes to children and infants. People who have had many piercings and tattoos in the past could feel that it’s a bad idea to pierce infant ears. Although the advisors experiences worked for th...
It is common for adults to have piercings and tattoos, but it could be a little bit different when it comes to children and infants. People who have had many piercings and tattoos in the past could feel that it%26rsquo;s a bad idea to pierce infant ears. Although the advisors experiences worked for them, the children in question are clearly very sensitive. In fact, some of them have allergic problems. That is why when you decide to have your child pierced, you should discuss or think about each problem you could face with.

Cons of infant ear piercing

First you should know that gold is not really the best metal to use, as many people have allergic reactions to it. Stainless steel is best for piercings, because stainless steel is hypoallergenic. It is also non-porous and smooth, unlike gold, so detritus does not stick as vigorously, and it is easier to keep clean. Hoops are the best shape, as they slide easier, and you can move them around. As for cleaning the piercing, alcohol is far, far too harsh for new piercings but obviously, many people do fine with it. However, for those with tender, sensitive skin, particularly with a fresh wound, alcohol is too caustic and drying, and can thus hinder the healing process as well as cause additional irritation problems.

There are specific piercing products recommend. The use of piercing guns, such as those usually used at Beadazzled, is entirely antiquated, even condemned by the piercing community. The gun causes a different type of wound than piercing needles do, but in addition, the piercing can take much longer to heal. The gun is a poor option also because it is very tight against the swollen earlobe, and the shaft is ridged creating a great place for pus and scabs to accumulate. These are hard to turn, and when turned often pull away the healing scabs, leaving newly exposed raw areas so healing takes longer. Moreover, you must know that piercing at home is not a good idea. There is no way for the needle of the novice piercer to get as sterile as it must be for optimum healing that the human organism needs.

If we factor in an infant%26rsquo;s sensitivity, this could be disastrous.
Lastly, reputable piercing parlors are found all over the place, and they generally do not charge too much. This makes alternatives obsolete and dangerous. Therefore, it is recommended to have all piercings done by a professional. You should find one who has sterile equipment and years of experience.

However, maybe the best option is to wait. There are many reasons for that, such as tetanus. Even though the disease is not very common thanks to immunizations, the tetanus bacteria is everywhere. That bacteria usually enters the body through puncture wounds. Most people prefer that a baby has at least one, preferably two tetanus shots behind her before her big day. Two would put the event at 3-5 months old for most kids, and also babies are better at handling the more common minor skin infections they might get once they are more than 3 months old.

Ear piercing and infection

Women, children and even men have worn earrings dating back to Biblical times and ear piercing used to be considered a rite of passage into adulthood. However, we now see young children and even babies with pierced ears. Even if it is quite common to see infants with earrings, there are some health issues parents should consider before proceeding with the piercing of their infant%26rsquo;s ears. The major concerns are infections their babies could catch. Piercing should be done by a reputable expert who follows aseptic procedures. This means he or she should wear gloves, sterilize equipment, and use alcohol or another antiseptic on the skin. Earring posts should be hypo-allergenic stainless steel or gold to reduce the chances of an allergic reaction. This could also lead to infection. The initial posts should stay in place for about six weeks, and the pierced area of the ear should be cleaned, front and back, with alcohol several times a day during this time. You should try to keep the baby%26rsquo;s hands away from her newly pierced ears to avoid complications.

Second to infection, it is very important that the piercing not be done before infants have completed their DPT shots as you might have already heard. Infants should only wear stud earrings, or earrings that lie close to the skin because loops or dangling earrings can get caught in clothing or on objects and tear the ear lobe. Children are also much more prone to play with and pull on dangling earrings, so avoid those. With any earring, parents should make sure the back of the earring is secure and does not become loose or fall off, creating the risk of swallowing the earring and further complications.

Parents may also be confronted by older children who not only want to pierce their ear lobes, but the cartilage on the outer ear as well. It is recommended to avoid this, since cartilage is easily injured, easily infected, and has such poor blood supply that it will heal very poorly. There are known instances where cartilage piercings have lead to severe infection and ultimate disfiguration of the ear itself as side effects. Some people, regardless of age, are prone to form keloids, which are scar tissue-like growths. These keloids possibly occur after tissue injury and become large, unsightly growths that are difficult to correct. If there is any family history of keloid formation, it is advisable not to pierce your infant%26rsquo;s ears until it is much older - a teenager or young adult.

It may make good sense not to pierce your child%26rsquo;s ear until he or she is old enough to make the personal decision herself. In our society, ear piercing is considered a fashion statement and is popular among both boys and girls, as well as among men and women. If you do consider ear piercing for your child, no matter what their age, you should discuss the pros and cons with your child once he or she is old enough. You could also discuss it with your physician and make sure you take the necessary steps to prevent infection or injury. There is no reason to risk a serious health problem for a cosmetic effect. Some people pierce their children%26rsquo;s ears while they are still newborns if there is no medical reason to wait. But the procedure is not without risk because not all ear-piercing operations have the proper equipment or staff trained to work specifically with young children. For example, ear piercing guns cannot be sterilized. This means it is possible to contract hepatitis or some other infection from them. If you wish to have your infant%26rsquo;s ears pierced, it is probably safer to ask you pediatrician if she would do it for you with a needle.

Ear piercing is usually done without painkillers because the piercing itself hurts less than a shot of anesthetic would. However, you can give your baby a dose of infants%26rsquo; acetaminophen or ibuprofen before the procedure if you want. Another thing to remember is that your child will be constantly touching her ears and the pierced area. This is why it can easily become infected. To help guard against this, you will need to clean the posts and the area around the ear with alcohol or hydrogen peroxide several times a day. You could clean it as often as your doctor recommends though. Watch for increased redness or tenderness around the piercing hole and on the earlobe that could indicate infection of your infant%26rsquo;s ear. There is also a chance that your child will have an allergic reaction to metal. This is a common problem after someone gets their ears pierced. If your infant develops a rash around the piercing, you will need to take the earrings out. To avoid this, you can try to make sure that the parts of the earrings that touch her ear are made of surgical steel or 14karat gold, and this includes not only the posts but the backs as well. If the rash does not subside, your child will probably not be able to wear earrings.

It is also a common problem that babies rip one earring out of the ear during the night. After that the hole seems a little black and blue so you might find it hard to put her earrings back in.

Pros of infant ear piercing

Although you might find it scary, it is most often that an infant%26rsquo;s ear piercing is worth the hassle. Your child would have nice earrings, but in any case, each parent should check what is most important for them and their child first. Is it better to look nice or to be sure there will be no side effects after you decide to have your infant%26rsquo;s ears pierced? You could find it useful to read more about the anatomy of the ear and local nerves. Maybe you would also like to hear more about ear piercing instruments of modern design.

It is interesting that until the rise of the professional body piercing industry in the early 1990s, most piercings were performed either with guns, at home, or by medical professionals. Before the advent of piercing instruments most piercings have been done using a sharp implement, such as a needle or a blade. This was used to make an entry through which jewelry is placed. In Western culture, visiting a mall store to get an ear piercing is a common experience for both girls and boys. Amongst body modification and body piercing enthusiasts and professionals, there is a strong bias against the use of mechanical piercing instruments, although body piercers generally operate their businesses to much higher standards of sterility. They usually have more experience or training than the intended users of piercing instruments. A commonly seen sticker in body piercing circles is a red circle with a line crossing out the silhouette of a piercing gun so when legal regulation is placed upon the body piercing industry, exemptions are usually made for these devices or the businesses that use them.

Exercise During Pregnancy

2009-02-10T21:08:00.000-05:00

Although women may not feel like running a marathon, most of them benefit greatly from exercising throughout their pregnancies. However, during that time, pregnant women should discuss exercise plans with their doctors or another health care provider, and make a few adjustments to their normal exerc...
Although women may not feel like running a marathon, most of them benefit greatly from exercising throughout their pregnancies. However, during that time, pregnant women should discuss exercise plans with their doctors or another health care provider, and make a few adjustments to their normal exercise routine. The level of exercise recommended will depend, in part, on woman's level of pre-pregnancy fitness. However, many people wonder if there are more benefits or side effects of exercising during pregnancy.

What are the benefits of exercising during pregnancy?

Off course, exercise is a big plus both for the woman and for her baby, especially if complications limit her ability to exercise throughout the pregnancy. Moreover, exercise during pregnancy can help one feel better. At a time when the woman wonders if this strange body can possibly be her own, exercise can increase her sense of control.
Exercise could also boost a pregnant woman%26rsquo;s energy levels. Not only does it make her feel better by releasing endorphins (chemicals occurring naturally in the brain), but appropriate exercise can also relieve backaches and improve the woman%26rsquo;s posture by strengthening and toning the muscles in her back, butt, and thighs. It could reduce constipation by accelerating intestine movements, prevent wear and tear on the joints (which become loosened during pregnancy due to normal hormonal changes) by activating the lubricating synovial fluid in them.
Exercise could also help a pregnant woman sleep better by relieving the stress and anxiety that might make her restless at night. She will probably look better because exercise increases the blood flow to the skin, giving a healthy glow.

Prepare yourself and your body for birth

Each pregnant woman should know that strong muscles and a fit heart can greatly ease labor and delivery. Gaining control over her breathing can help a woman manage pain and in the event of a lengthy labor, increased endurance can be a real help.

Therefore, a woman should try to regain her pre-pregnancy body more quickly. By continuing to exercise, she will gain less weight during the pregnancy (assuming she used to exercise before becoming pregnant). However, a woman should not expect or try to lose weight by exercising while pregnant. For most women, the goal is to maintain their fitness level throughout the pregnancy.

Exercise has become a vital part of many women's lives. However, theoretic concerns have been raised about the safety of some forms of exercise during pregnancy. Because of the physiologic changes associated with pregnancy, as well as the hemo-dynamic response to exercise, some precautions should be observed with exercise. The physician should screen for any contraindications to exercise. The doctor should also encourage patients to avoid overly vigorous activity, especially in the third trimester. During that time most pregnant women have a decreased tolerance for weight-bearing exercise. Adequate hydration and appropriate ventilation are important in preventing possible teratogenic effects of overheating and over-exercising. Pregnant women should avoid exercise that involves the risk of abdominal trauma, falls, or excessive joint stress. This happens in contact sports and vigorous racquet sports.
In the absence of any obstetric or medical complications, most women can maintain a regular exercise regimen during their pregnancies. Some studies have found a greater sense of well-being, shorter labor and fewer obstetric interventions in physically well-conditioned women.

More about exercise during pregnancy

The benefits of regular exercise for non-pregnant women are generally acknowledged, and an exercise regimen has become an integral part of daily life for many women. However, theoretic concerns arise regarding the effects of exercise on pregnant women. Objective data on the impact of exercise on the mother, the fetus and the course of pregnancy are limited. The results of the few studies in humans are often equivocal or contradictory. Although various exercise guidelines are available, they are usually conservative and frequently based on controversial opinions, so consequently, the pregnant woman and her physician may be uncertain about the safety of exercise during pregnancy.

Physiologic changes of pregnancy

There are some important physiological changes during pregnancy that a woman should keep in mind.

Musculoskeletal changes %26ndash; This is one of the most obvious changes in pregnancy, an alteration of the woman's body, including mechanical changes related to the weight of growing breasts, uterus, and fetus. This could also increase lumbar lordosis, resulting in a shift in the woman's center of gravity, causing problems with balance. In addition, weight-bearing exercise becomes a greater concern when vertical impact forces are further increased during pregnancy. These vertical impact forces, which should usually be taken at twice an individual's body weight, are further increased during pregnancy. Sudden movements may exacerbate these mechanical difficulties and increase the potential for injury for pregnant woman.

Most women report greater discomfort with exercise in the later stages of their pregnancies. Abdominal and pelvic discomfort from weight-bearing exercise is most likely secondary to tension on the round ligaments, increased uterine mobility, or even pelvic instability. Increases in joint laxity may lead to a higher risk of strains or sprains, because during pregnancy, hormonal changes are thought to induce a greater laxity in joints. This assists the softening of the pubic symphysis to accommodate delivery. One study has demonstrated increased mobility of the metacarpophalangeal joints, but an increased injury rate in pregnant patients has not been documented.

Maternal and fetal temperature %26ndash; The metabolic rate increases during both exercise and pregnancy. This results in greater heat production. Fetoplacental metabolism generates additional heat, which maintains fetal temperature at 0.5 goes to 1.0%26deg;C or 0.9 to 1.8%26deg;F above maternal levels. Theoretically, when exercise and pregnancy are combined, a rise in maternal core temperature could decrease fetal heat dissipation to the mother and some data suggest a teratogenic potential when maternal temperatures rise above 39.2%26deg;C or 102.6%26deg;F. This is especially the case in the first trimester.

Hemodynamic %26ndash; Exercise acts in concert with pregnancy to increase the heart rate, stroke volume, and cardiac output, but during exercise, blood is diverted from abdominal viscera, including the uterus, to supply exercising muscles. The decrease in splanchnic blood flow can reach 50 percent and raises concerns about fetal hypoxemia. Studies of flow velocity profiles in the fetal aorta and umbilical circulation have yielded contradictory and inconclusive results still. Several factors may mitigate exercise-induced decreases in splanchnic blood flow, and these factors are increases in maternal plasma volume and heart rate, as well as decreased systemic vascular resistance. The resultant changes maximize cardiac output and optimize blood flow to the placenta and the developing fetus where these alterations in cardiovascular response to exercise may take as long as seven months to return to ante-partum levels. Maternal body position also affects cardiac output during pregnancy because after the first trimester, the supine position is associated with a 9 percent decrease in cardiac output.
Cardiac output is optimal when the patient assumes a left or right side-lying position and prolonged, motionless standing during pregnancy is associated with a decrease in cardiac output of up to 18 percent. The effect of exercise on cardiac function during pregnancy remains uncertain, despite decades of studies.

Oxygen demands %26ndash; It is important to understand that adaptive changes occur in the pulmonary system during pregnancy and exercise. During rest, pregnant and non-pregnant women have an equivalent respiratory frequency, but mild increases in tidal volume and oxygen consumption are noted in pregnant women. This is presumably as an adaptive response to the increased oxygen requirement of the fetus. With mild exercise, pregnant women have a greater increase in respiratory frequency and oxygen consumption to meet their greater oxygen demand she has as pregnant. As exercise increases to moderate and maximal levels, however, pregnant women demonstrate decreased respiratory frequency. They will also demonstrate lower tidal volume and maximal oxygen consumption. The oxygen demand at high levels of activity appears to overwhelm the adaptive changes that occur at rest and this may be partially due to the obstructive effect of an enlarged uterus on diaphragmatic movement.

Energy demands %26ndash; Both exercise and pregnancy are associated with a high demand for energy a woman needs. In the first two trimesters, an increased intake of 150 calories per day is recommended. An increase of 300 calories per day is required in the third trimester. Caloric demands with exercise are even higher, although no studies have focused on exact requirements, so competing energy demands of the exercising mother and the growing fetus raise the theoretic concern that excessive exercise might adversely affect fetal development.

Genetically encoded cells allow tracking once inside body

2009-02-09T22:05:00.000-05:00

Scientists' inability to follow the whereabouts of cells injected into the human body has long been a major drawback in developing effective medical therapies. Now, researchers at Johns Hopkins have developed a promising new technique for noninvasively tracking where living cells go after they are put into the body. The new technique, which uses genetically encoded cells producing a natural contrast that can be viewed using magnetic resonance imaging (MRI), appears much more effective than present methods used to detect injected biomaterials.

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Described in the February edition of Nature Biotechnology, the method was developed by a team of researchers from Johns Hopkins' Russell H. Morgan Department of Radiology and Radiological Science, the Hopkins Institute for Cell Engineering, and the F.M. Kirby Research Center for Functional Brain Imaging at the Kennedy Krieger Institute in Baltimore.

In their study, the researchers used a synthetic gene, called a reporter gene, which was engineered to have a high proportion of the amino acid lysine, which is especially rich in accessible hydrogen atoms. Because MRI detects energy-produced shifts in hydrogen atoms, when the "new" gene was introduced into animal cells and then "pelted" with radiofrequency waves from the MRI, it became readily visible. Using the technique as a proof of principle, the researchers were able to detect transplanted tumor cells in animal brains.

"This prototype paves the way for constructing a family of reporter genes, each with proteins tailored to have a specific radiofrequency response," says MRI researcher Assaf Gilad, Ph.D., lead author of the study.

"The specific frequencies can be processed to show up as colors in the MRI image," adds collaborator Mike McMahon, Ph.D., an assistant professor of radiology at the Johns Hopkins School of Medicine "In a way, it's the MRI equivalent of the green and red fluorescent proteins found in nature and used by labs everywhere in the world for multiple labeling of cells."

The problem with using fluorescent proteins, however, is that tissue must be removed from the body for examination under a microscope, which means that the method isn't suitable for use in patients. "In contrast," says Hopkins radiology professor Jeff Bulte, Ph.D., "MRI is noninvasive, allowing serial imaging of cells and cellular therapies with a high resolution unmatched by any other clinical whole-body imaging technique."

Current MRI contrast agents also have several disadvantages. "Their concentration becomes lower every time cells divide," says Peter van Zijl, Ph.D., founding director of the Kirby Research Center for Functional Brain Imaging, "so our ability to see them diminishes.. Also, using magnetic metal allows us to detect only one type of labeled cell at a time." The new approach is not hampered by these limitations.

Source: Johns Hopkins Medical Institutions

Computer-simulations help zero in on causes of Parkinson’s disease, Alzheimer’s disease, rheumatoid arthritis and other diseases

2009-02-09T22:02:00.000-05:00

Using the massive computer-simulation power of the San Diego Supercomputer Center (SDSC) at UC San Diego, researchers are zeroing in on the causes of Parkinsons disease, Alzheimers disease, rheumatoid arthritis and other diseases.A study published in this weeks Federation of European Biochemical Soc...

Using the massive computer-simulation power of the San Diego Supercomputer Center (SDSC) at UC San Diego, researchers are zeroing in on the causes of Parkinson%26#8217;s disease, Alzheimer%26#8217;s disease, rheumatoid arthritis and other diseases.

A study published in this week%26#8217;s Federation of European Biochemical Societies (FEBS) Journal offers %26#8211; for the first time %26#8211; a model for the complex process of aggregation of a protein known as alpha-synuclein, which in turn leads to harmful ring-like or pore-like structures in human membranes, the kind of damage found in Parkinson%26#8217;s and Alzheimer%26#8217;s patients.

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The researchers at SDSC and UC San Diego also found that the destructive properties of alpha-synuclein can be blocked by beta-synuclein %26#8211; a finding that could lead to treatments for many debilitating diseases.

The current journal%26#8217;s cover features an image from the research that helps illustrate the scientists%26#8217; work.

%26#8220;This is one of the first studies to use supercomputers to model how alpha-synuclein complexes damage the cells, and how that could be blocked,%26#8221; said Eliezer Masliah, professor of neurosciences and pathology at UC San Diego. %26#8220;We believe that these ring- or pore-like structures might be deleterious to the cells, and we have a unique opportunity to better understand how alpha-synuclein is involved in the pathogenesis of Parkinson%26#8217;s disease, and how to reverse this process.%26#8221;

Igor Tsigelny, project scientist in chemistry and biochemistry at UC San Diego and a researcher at SDSC, said that the team%26#8217;s research helped confirm what researchers had suspected. %26#8220;The present study %26#8211; using molecular modeling and molecular dynamics simulations in combination with biochemical and ultrastructural analysis %26#8211; shows that alpha-synuclein can lead to the formation of pore-like structures on membranes.%26#8221;

In contrast, he said, %26#8220;beta-synuclein appears to block the propagation of alpha-synucleins into harmful structures.%26#8221;

The complex calculations for the study were performed on Blue Gene supercomputers at SDSC and the Argonne National Labs.

Source: University of California, San Diego

Novel gene mutation causes X-linked mental retardation

2009-02-09T21:59:00.000-05:00

Researchers have identified a novel gene mutation that causes X-linked mental retardation for which there was no previously known molecular diagnosis, according to an article to be published electronically on Tuesday, March 20, 2007 in The American Journal of Human Genetics.Investigators F. Lucy Ray...

Investigators F. Lucy Raymond (Cambridge Institute of Medical Research, University of Cambridge, Cambridge, UK) and Patrick S. Tarpey (Wellcome Trust Sanger Institute, Hixton, UK) describe the ZDHHC9 gene found in those with severe retardation as being mutated to the point of entirely losing function.

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"ZDHHC9 is a novel gene," explains Dr. Raymond. "This gene would not have been predicted to play a role in mental retardation based on the previous genetics work. It was found only because we were systematically looking at all the genes on the X chromosome irrespective of what they do."

X-linked mental retardation is severe. Some patients require total care and may not have language ability. The condition runs in families and only affects the male offspring. So far only a few of these genes have been identified.

Working through a large, international collaboration, the researchers collected genetic samples from 250 families in which at least two boys have mental retardation to help identify novel genes that cause X-linked mental retardation. The investigators systematically analyzed the X chromosome for gene mutations.

Dr. Raymond says that the families are receiving information from the study and using it to make decisions in their lives. "We cannot currently make their children better, but knowing that we found a genetic abnormality gives them an explanation for what has happened," she explains. "We had one family that said this knowledge was the best news they had ever been given."

"We have identified the cause of problems in certain families and are able to tell whether or not women are carriers of the condition," Dr. Raymond comments. "Consequently, the families that had previously chosen to forego having children because there was no method of testing can now be tested. We have been able to test a substantial number of people to identify whether are not they are carriers, and we can offer prenatal testing to the carriers who want it."

In the broader picture, this research is not only benefiting families with X-linked mental retardation, but it is also defining the genes involved in intellectual development. "If you find genes that are abnormal, it is a reasonable assumption that the identified genes are involved in the formation of normal intellectual processing as well," concludes Dr. Raymond.

Now that a posttranslational modification enzyme has been found to be mutated in X-linked mental retardation, the researchers expect to find similar genes related to other mental retardation syndromes.

Source: University of Chicago

Brain scans of smokers studied

2009-02-09T21:56:00.000-05:00

Within the mind of every smoker trying to quit rages a battle between the higher-order functions of the brain wanting to break the habit and the lower-order functions screaming for another cigarette, say researchers at Duke University Medical Center. More often than not, that cigarette gets lit.
[Mo...

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Brain scans of smokers studied by the researchers revealed three specific regions deep within the brain that appear to control dependence on nicotine and craving for cigarettes. These regions play important roles in some of the key motivations for smoking: to calm down when stressed, to achieve pleasure and to help concentration.

"If you can't calm down, can't derive pleasure and can't control yourself or concentrate, then it will be extremely difficult for you to break the habit," said lead study investigator Jed E. Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research. "These brain regions may explain why most people try to quit several times before they are successful."

Understanding how the brain responds to cigarette cravings can help doctors change nicotine cessation treatments to address all three of these components of withdrawal, Rose said. Drugs or therapies that target these regions may help smokers stave off the cravings that often spoil their attempts to quit.

The team's findings are now online in the journal Neuropsychopharmacology. The research was funded by Phillip Morris USA.

Approximately one in five Americans smokes. Even though 70 percent of smokers report that they would like to quit, only 5 percent do so successfully.

In this study, the researchers manipulated the levels of nicotine dependence and cigarette craving among 15 smokers and then scanned their brains using positron emission tomography, or PET scans, to see which areas of the brain were most active.

Three specific regions of the brain demonstrated changes in activity when the smokers craved cigarettes versus when they did not.

One region that lights up, called the thalamus, is considered to be the key relay point for sensory information flowing into the brain. Some of the symptoms of withdrawal among people trying to quit stem from the inability to focus thoughts and the feeling of being overwhelmed, and could thus be explained by changes in this region, according to the researchers. The researchers found that changes in this region were most dramatic among those who said they smoked to calm down when under stress.

Another region that lights up is a part of the pleasure system of the brain. Changes in this region, called the striatum, were most notable in people who smoked to satisfy craving and for pleasurable relaxation, the researchers said.

A third region that lights up, called the anterior cingulate cortex, is vital to cognitive functions such as conflict, self regulation, decision making and emotion. People whose brain scans showed the most differences in this region also reported that they smoked to manage their weight.

"This knowledge gives us new clues about brain mechanisms underlying addiction to cigarettes and could allow us design better methods to help smokers quit," Rose said.

Rose and his colleagues are now planning to perform brain scans on smokers undergoing nicotine replacement therapy, such as the nicotine patch, to determine how these treatments affect the same regions of the brain.

Source: Duke University Medical Center

New gene that may put individuals at higher risk of developing cardiovascular disease

2009-02-09T21:54:00.000-05:00

Geneticists have discovered a new gene that may put individuals at higher risk of developing cardiovascular disease.The identification of the gene, called kalirin, implicates a biological mechanism never before linked to cardiovascular disease, according to the Duke researchers who led the study. Fu...

Geneticists have discovered a new gene that may put individuals at higher risk of developing cardiovascular disease.

The identification of the gene, called kalirin, implicates a biological mechanism never before linked to cardiovascular disease, according to the Duke researchers who led the study. Further study of this new clue could lead to novel ways to treat or even prevent the disease, the researchers said.

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"The ultimate goal is to determine who will develop cardiovascular disease," said lead study investigator Liyong Wang, Ph.D., a research associate at the Duke Center for Human Genetics. "Our discovery could lead to a clinical tool for assessing a person's risk of coronary artery disease, so that physicians can try to prevent the disease from progressing."

The team, which includes researchers from several universities in the United States and the United Kingdom, reports its findings in the April 2007 issue of American Journal of Human Genetics. The research was sponsored by the National Institutes of Health.

Coronary artery disease affects more than 13 million Americans and is one of the nation's leading causes of death. The disease occurs when the arteries supplying blood to the heart become narrowed or clogged by plaque deposits. Left untreated, the disease can completely block the blood flow to the heart, leading to a heart attack.

While risk factors such as smoking, high blood pressure and high cholesterol are known to contribute to coronary artery disease, little is known about genes that render an individual susceptible to developing the disease, said study co-investigator Elizabeth R. Hauser, Ph.D., an associate professor of medicine at the Duke Center for Human Genetics.

In a previous study, the researchers had scanned the entire genome -- the body's genetic blueprint -- of a group of families in which at least two siblings had early onset coronary artery disease, looking for regions of "linkage" where DNA variations appeared to be inherited along with the disease. They found just such a region: a small section of the long arm of chromosome 3 where just a handful of genes were located. Chromosome 3 is one of the 23 pairs of chromosomes that comprise the human genome.

In the current study, the researchers focused on specific gene variants, called single nucleotide polymorphisms (SNPs), that occur when a single nucleotide building block in the long strand of DNA is altered. The researchers sought SNPs that occurred more or less often in individuals with coronary artery disease than in individuals without it, as such a link would indicate that these gene variants were associated with the disease.

The researchers first obtained DNA from 500 patients who had volunteered to be studied while being examined at the cardiac catheterization laboratories at Duke University Hospital. Using these DNA samples, the researchers scanned the same small section of chromosome 3 for SNPs that differed in sequence between individuals with and without coronary heart disease.

One SNP, in the kalirin gene, varied between individuals with heart disease and those without. The researchers repeated the same experiment in four additional patient populations, scanning the DNA of a total of 4,000 individuals, and turned up the same result.

"This finding opens up a whole new area of study for looking at risks of cardiovascular disease," said senior study investigator Jeffrey M. Vance, M.D., Ph.D., director of the Center for Molecular Genetics and Genomic Medicine, Miami Institute for Human Genomics at the Miller School of Medicine.

The researchers are now studying kalirin in the blood vessels to see how variations in the gene contribute to cardiovascular disease.

So far, they have found that this particular SNP is significantly correlated with the degree of atherosclerosis in human aortas, the large blood vessel that brings blood from the heart to all parts of the body.

Kalirin contains the hereditary information for the production of a protein that is involved in the migration of cells from one spot to another within smooth muscle. According to the researchers, the newly identified SNP may change the level of this protein in blood vessels, causing cells to congregate in one spot and form a plaque in the vessels to the heart.

In addition to identifying the genetic variations in the kalirin gene, the researchers also identified two genes that are involved in the same biological pathway, known as the Rho-GTPase signal transduction pathway.

Source: Duke University Medical Center

Process simplifies production of medicine based on natural products

2009-02-09T21:51:00.000-05:00

Chemists are currently able to synthetically produce almost any compound, but they must typically resort to expensive, complex processes that can require dozens of individual steps. Such natural product syntheses have traditionally relied on the ubiquitous use of %26#8220;protecting groups,%26#8221; which are extra compounds chemists use to shield reactive portions of a molecule during specific stages of a synthesis scheme. The protecting groups are eventually cleaved chemically to expose the reactive portion during later chemical reactions to complete a product's synthesis. Each protecting group used adds at least two steps to a synthesis, and the groups themselves have reactivity of their own that must be controlled to prevent adverse reactions.

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%26#8220;Protecting groups are almost always a direct result of an inability to address selectivity in synthesis,%26#8221; says project leader Phil Baran, a chemist with The Scripps Research Institute. %26#8220;It is ironic that they often add an additional layer of problems on top of the preexisting ones.%26#8221;

Organic chemistry textbooks have long declared that the use of protecting groups was essential in natural product synthesis. %26#8220;Textbooks have pointed out that avoiding protecting groups is like %26#8216;avoiding death and taxes,%26#8217;%26#8221; says Baran, who, along with Scripps Research Kellogg School of Science and Technology graduate students Thomas Maimone and Jeremy Richter, has now disproved the belief.

To avoid the need for protecting groups, the Baran group took an unorthodox approach. Rather than assume that reactive portions of a molecule had to be shielded during various syntheses, the researchers calculated ways to use such reactivity in an overall scheme to produce the desired final product. Baran says the reason such an approach had not been successfully developed before was likely a by-product of education. %26#8220;From the beginning, we were always taught that the way to solve these types of problems is to protect functionality rather than to try to embrace it,%26#8221; he says.

In the Nature paper, the group showed that, without using a single protecting group, they could produce the representative members of a whole family of over 60 different marine natural products produced by the Stigonemataceae family of cyanobacteria. This family of products has a wide range of bioactivities including anticancer and antibacterial, and some may eventually be developed as commercial pharmaceutical products. The compound family was only used as an example, however, as the demonstrated concepts and principles should be applicable to the synthesis of a wide range of marine and terrestrial natural products.

To synthesize the products, the team designed a variety of chemical reactions that maximize the bonding of carbon atoms between different molecules. In many cases, the products were synthesized in gram quantities in less than 10 steps, as compared to traditional syntheses using protecting groups that have taken as many as 30 steps to produce milligrams of product.

Use of the techniques the group has developed could therefore lead to substantially reduced production costs for natural products. This is a critical concern, as identification of a reasonably economic means of production for marine and other natural products is typically one of the most challenging hurdles in a potential drug's commercial development. An overly complex and expensive synthesis can even slow or halt the development of an otherwise promising drug candidate.

Beyond economic ramifications, Baran hopes the research will offer additional benefits to the drug discovery field. Many pharmaceutical companies' potential drug pipelines are drying up, leading some to suggest that interest in natural products should be renewed. A range of drugs from aspirin to the widely used cancer treatment Taxol has been discovered in nature, but the complexity of producing natural products has made some companies reluctant to focus on them.

%26#8220;There is this far-ranging and damaging perception that natural products are too complex to be used in a drug discovery setting despite their overwhelming track record in medicine,%26#8221; says Baran. %26#8220;I think if our work has helped in even a small way to revive the use of natural products, then we've served our purpose.%26#8221;

The Baran team has focused its work to date on marine natural products, because these chemical compounds from sponges, algae, and other organisms have proven a rich source of bioactivity with pharmaceutical potential, but have also been challenging to work with. Marine natural products are ideal targets for simplified synthesis techniques because they tend to be exceptionally complex, and because they are typically difficult to collect. Researchers often struggle to amass marine organism samples in quantities great enough to yield the volume of a given compound needed for research and clinical trials, much less commercial production, making better and cheaper production means all the more critical.

For the production of some products, both natural and man-made, the use of protecting groups will still be the most efficient route, says Baran. %26#8220;We are not advocating that one should blindly throw away the protecting groups book just for the fun of throwing it away,%26#8221; he says. %26#8220;It's something that should be strategically applied.%26#8221;

Baran, Maimone, and Richter were all authors on the study, %26#8220;Total Synthesis of Marine Natural Products Without Using Protecting Groups.%26#8221;

Source: Scripps Research Institute

New gene appears to increase risk of developing schizophrenia

2009-02-09T21:49:00.000-05:00

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The study results are scheduled to be published online Tuesday in Molecular Psychiatry, which can be accessed at http://www.nature.com/mp/journal/vaop/ncurrent/index.html.

Source: The Feinstein Institute for Medical Research

2009-02-09T21:46:00.000-05:00

Cells use biochemical "noise" to transform from one state to another

2009-02-09T21:43:00.000-05:00

Electrical noise, like the crackle heard on AM radio when lightning strikes nearby, is a nuisance that wreaks havoc on electronic devices. But within cells, a similar kind of biochemical "noise" is beneficial, helping cells transform from one state to another, according to a new study led by a UT So...

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Dr. G%26#252;rol S%26#252;el, assistant professor of pharmacology, said his research and that of his colleagues published today in the journal Science represents "a new paradigm," suggesting that rather than being bad for biology, cellular noise might have an important function, such as prompting stem cells to transform into a specific tissue type.

Electronic noise is an unwanted signal characteristic of all electrical circuits, typically caused by random fluctuations in the electric current passing through the components of a circuit. Similarly, within each living cell there are myriad "genetic circuits," each composed of a distinct set of biochemical reactions that contribute to some biological process. Randomness in those reactions contributes to biological noise, technically referred to as stochastic fluctuations.

"Noise in biological systems is a fact of life," said Dr. S%26#252;el, a member of the systems biology division of the Cecil H. and Ida Green Comprehensive Center for Molecular, Computational and Systems Biology at UT Southwestern. "Even though each cell may have the same set of genes turned on %26#8211; the same hard-wired genetic circuit %26#8211; there will still be slight variations in the amount of the various proteins those genes produce, some fluctuation in the amount of each circuit component. No two cells are alike in terms of their chemical composition."

Conventional scientific thinking has been that the random nature of such fluctuations within cells interferes with the reliable operation of biological systems. However, Dr. S%26#252;el's research team hypothesized that noise in one particular genetic circuit might be beneficial, linked to a process that controls cell fate.

To determine the biological role for noise, the researchers analyzed a genetic circuit that controls the transformation of bacteria cells from one state to another. This process, called differentiation, is akin to that used by human stem cells to change into a specific tissue type.

In a series of theoretical calculations and actual experiments, the researchers found that the particular circuit they investigated appears to have evolved in this bacterium to amplify cellular noise. Dr. S%26#252;el and his colleagues determined that by dampening the noise level within the bacterial cells, they could prevent the cells' transformation between states, essentially "tuning" cellular behavior.

"The amplitude of cellular noise correlates with the probability of triggering differentiation," Dr. S%26#252;el said. "This is experimental evidence that a genetic circuit utilizes noise to drive a biological process."

Typically, scientists examine genes and proteins individually to try to determine their functions within a cell. However, Dr. S%26#252;el said that's like examining each capacitor or switch in an electrical circuit in an attempt to understand the function of the electrical device in which the circuit is housed.

"Our research provides a systems-level view of how gene circuits work as a whole," he said.

Dr. S%26#252;el said the next step in his research would be to uncover the theoretical design principles of genetic circuits and what role interactions between distinct circuits play in regulating complex biological processes, such the differentiation of multipotent stem cells.

Source: UT Southwestern Medical Center

Computers simulating populations of hundreds of thousands of people search for genetic causes of cancer, other diseases

2009-02-09T21:40:00.000-05:00

More powerful computers are allowing scientists and engineers to conduct simulations that grow more realistic each year. While companies are using these tools to slash the costs of producing everything from airliners to antibiotics, researchers in Houston are using them to refine their search for th...

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In a new study published today in the journal PLoS Genetics, statisticians and genetic epidemiologists from Rice University and The University of Texas M. D. Anderson Cancer Center used computer simulations to trace genetic changes over thousands of generations in a simulated population of hundreds of thousands of people. The goal: find out whether the tools that statistical geneticists use to pinpoint disease genes are up to the task of identifying multiple genes that cause complex diseases like cancer.

"In a real population, you never have the complete genetic picture, particularly for complex diseases where more than one gene is implicated and where environmental factors play a role," said lead author Bo Peng of M. D. Anderson. "If we only see the people who get sick, we can never be sure how many people with the disease variant of the gene avoided getting sick. And there's always the question about how many people got the disease even though they didn't carry the variant."

In order to simulate the evolution of complex human diseases, Peng developed a computer program called simuPOP that generates genetic profiles for large multi-generation populations. The program, which Peng developed during his doctoral studies at Rice, allows researchers to sample individuals from a simulated population and test whether statistical methods are up to the task of accurately identifying genes that interact to cause complex diseases.

"Though they have much in common, the disciplines of statistical genetics, population genetics, molecular genetics and genetic epidemiology have traditionally used their own tools and techniques," said co-author Marek Kimmel, professor in the Statistics Department at Rice. "simuPOP is one of the first examples of a new paradigm where the tools of the various disciplines are being used in concert to create a clearer picture of genetic health effects."

"Complex diseases like hypertension and cancer are usually caused by multiple disease-susceptibility genes, environmental factors and interactions between environmental and genetic factors," said co-author Christopher Amos, professor of epidemiology at M. D. Anderson. "In the current study, we show that our method of simulating populations as they move forward in time, over multiple generations, is a practical and useful approach for simulating complex diseases."

Peng said the latest findings are preliminary but they confirm that known statistical genetic methods are limited in their ability to accurately identify the genetic interactions implicated in complex diseases. Peng said the findings are useful because they identify which methods work best with particular types of populations. He said simuPOP could be useful in developing and testing new methods for gene mapping, and he's already gotten interest from more than 20 research groups that are interested in using the program.

Source: M. D. Anderson Cancer Center

NeuroRobotic system helps stroke patients restore motor function

2009-02-09T21:38:00.000-05:00

At age 32, Maggie Fermental suffered a stroke that left her right side paralyzed. After a year and a half of conventional therapy with minimal results, she tried a new kind of robotic therapy developed by MIT engineers. A study to appear in the April 2007 issue of the American Journal of Physical Medicine %26amp; Rehabilitation shows that the device, which helped Fermental, also had positive results for five other severe stroke patients in a pilot clinical trial.

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Fermental, a former surgical nurse, used the rehabilitation device 18 times over nine weeks. After 16 sessions, Fermental, now a stroke education nurse at Beth Israel Hospital, was able to fully bend and straighten her elbow on her own for the first time since the stroke. "It was incredible to be able to move my arm again on command," she said. "Cooking, dressing, shopping, turning on light switches, opening cabinets--it's easier now that I have two arms again."

The device--which sensed Fermental's electrical muscle activity and provided power assistance to facilitate her movements--also altered her brain.

Following a stroke, the destruction of brain cells leads to loss of motor function. With painstakingly repetitive exercise therapy, other neurons can take over some of the lost function. Devices such as the MIT-developed robotic brace can help people exploit their neural plasticity--the increasingly recognized ability of the brain to rewire itself in response to experience and training.

The robotic therapy device, which is awaiting FDA approval, was tested on stroke patients at MIT's Clinical Research Center and at Spaulding Rehabilitation Hospital in Boston. According to the researchers, the results show that "the ability of the device to provide a 'power assist' to %26#8230; muscle groups may help close the feedback loop of brain intention and actual limb movement that is believed to be a key component of cerebral plasticity in motor recovery."

The study showed that the severely impaired patients' arm function improved, on average, 23 percent after using the brace, and the arm muscle tightness typical of stroke victims was significantly reduced.

Cost-effective rehabilitation

In the United States, there are 5.7 million stroke survivors and 700,000 new cases per year. Stroke is the single leading cause of disability in the United States. Many of the medical devices aimed at treating patients afflicted with neurological disorders have not fundamentally changed in decades, or require costly, high-risk brain implants.

The robotic therapy device was one of the first recipients of a grant from MIT's Deshpande Center for Technological Innovation. The center funds novel early-stage research and connects MIT's innovators with the resources needed to increase their commercial viability. The robotic therapy device received Deshpande grants in 2002 and 2003.

"We saw this as a novel technology with the potential to have a significant impact on the quality of life for people," said Charles Cooney, faculty director of the Deshpande Center and a professor in the Department of Chemical Engineering. "This study proves we were right."

The wearable, portable, lightweight robotic brace slides onto the arm. By sensing the patient's electrical muscle activity through electromyography (EMG)--which detects muscle cells' electrical activity when they contract--and sending that data to a motor, it allows stroke patients to control their affected limbs.

When used under the supervision of an occupational or physical therapist, the device can be used to help patients progress from basic motor training, such as lifting boxes or reaching for a light switch, to more complex tasks such as carrying a laundry basket or flipping a light on and off while holding an object with the unaffected limb.

According to the study researchers--Dr. Joel Stein, Kathryn Krebs and Richard Hughes of Harvard Medical School and Spaulding Rehabilitation Hospital and MIT graduates Kailas Narendran and John McBean--even people who have experienced a stroke years ago may be able to use the device to regain mobility.

"This brace will allow people who have suffered from neurological trauma to rebuild strength, rehabilitate and gain independence," said Woodie Flowers, Pappalardo Professor of Mechanical Engineering at MIT, who led the original research team that developed the device. "The joint brace is easily controlled by the user and appears to be cost-effective. It could afford self-driven therapy for a large patient population."

Relearning how to move

In 2002 and 2003, Flowers, along with then-students Narendran and McBean, developed a working prototype of the active joint brace. The first prototype system enabled paralyzed victims with certain kinds of spinal cord injuries to move their arms. In 2004, Narendran and McBean won the MIT $50K business plan competition and shortly afterward started the Boston-based company Myomo (an acronym for "my own motion") to develop a new class of medical technology they call NeuroRobotics.

"NeuroRobotics noninvasively helps people suffering from neurological trauma regain mobility by facilitating their ability to relearn how to control affected muscles and neurological pathways," Narendran said.

"Unlike other systems that stimulate or move the muscle for a patient, NeuroRobotics is embedded in lightweight wearable devices that actually adjust to a person's body and use the person's own electrical muscle activity signal to initiate and control movement," McBean said.

"Without the device, many of the individuals we tested were simply unable to complete the movement, and thus had no practical way to improve their performance through practice," Stein said. "By allowing the user to complete an intended movement through its 'power assist' function, the device helps the user improve his or her performance through practice. Thus the device acts as a facilitator of the innate capability of the human brain to improve function through practice."

Source: MIT

Biologists solve vitamin B12 puzzle

2009-02-09T21:35:00.000-05:00

Solving a mystery that has puzzled scientists for decades, MIT and Harvard researchers have discovered the final piece of the synthesis pathway of vitamin B12--the only vitamin synthesized exclusively by microorganisms.B12, the most chemically complex of all vitamins, is essential for human health. ...

B12, the most chemically complex of all vitamins, is essential for human health. Four Nobel Prizes have been awarded for research related to B12, but one fragment of the molecule remained an enigma--until now.

The researchers report that a single enzyme synthesizes the fragment, and they outline a novel reaction mechanism that requires cannibalization of another vitamin.

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The work, which has roots in an MIT undergraduate teaching laboratory, "completes a piece of our understanding of a process very fundamental to life," said Graham Walker, MIT professor of biology and senior author of a paper on the work that will appear in the March 22 online edition of Nature.

Vitamin B12 is produced by soil microbes that live in symbiotic relationships with plant roots. During the 1980s, an undergraduate research course taught by Walker resulted in a novel method for identifying mutant strains of a soil microbe that could not form a symbiotic relationship with a plant.

Walker's team has now found that one such mutant has a defective form of an enzyme known as BluB that leaves it unable to synthesize B12.

BluB catalyzes the formation of the B12 fragment known as DMB, which joins with another fragment, produced by a separate pathway, to form the vitamin. One of several possible reasons why it took so long to identify BluB is that some bacteria lacking the enzyme can form DMB through an alternate pathway, Walker said.

One of the most unusual aspects of BluB-catalyzed synthesis is its cannibalization of a cofactor derived from another vitamin, B2. During the reaction, the B2 cofactor is split into more than two fragments, one of which becomes DMB.

Normally, the B2-derived cofactor would assist in a reaction by temporarily holding electrons and then giving them away. Such cofactors are not consumed in the reaction.

Cannibalization of a cofactor has very rarely been observed before in vitamin synthesis or any type of biosynthetic pathway, says Michiko Taga, an MIT postdoctoral fellow in Walker's lab and lead co-author of the Nature paper.

"There are almost no other examples where the cofactor is used as a substrate," she said.

One early clue to BluB's function was that a gene related to it is located near several other genes involved in B12 synthesis in a different bacterium. Still, the researchers were not convinced that one enzyme could perform all of the complicated chemistry needed to produce DMB.

"It looked like a number of things had to happen in order to make the DMB," said Walker. "We originally thought that BluB might be just one of several enzymes involved in DMB synthesis."

Therefore, it came as a surprise when Taga isolated the BluB protein and showed that it could make DMB all by itself.

Nicholas Larsen, lead co-author and a former college classmate of Taga's now at Harvard Medical School, did a crystallographic analysis of the protein after Taga told him about her research over coffee one day. The protein structure he developed clearly shows the "pocket" of BluB where the DMB synthesis reaction takes place.

Still to be explored is the question of why soil bacteria synthesize B12 at all, Walker said. Soil microorganisms don't require B12 to survive, and the plants they attach themselves to don't need it either, so he speculates that synthesizing B12 may enable the bacteria to withstand "challenges" made by the plants during the formation of the symbiotic relationship.

More than 30 genes are involved in vitamin B12 synthesis, and "that's a lot to carry around if you don't need to make it," Walker said.

The full implications of the new research will probably not be known for some years, which is often the case with basic research, Walker said. "I've been in many other situations in research where we did something very basic and did not immediately realize the importance of it, and subsequently the implications were found to be much more broad-reaching," he said.

Source: MIT

Creating tissues that can augment or replace injured, defective, or diseased body parts

2009-02-09T21:32:00.000-05:00

Tissue engineering is a relatively new field of basic and clinical science that is concerned, in part, with creating tissues that can augment or replace injured, defective, or diseased body parts. The approach to fabricating the tissues involves adding specific cell types to grow on a polymer scaffold having the shape of the tissue to be restored. The scaffold gradually disappears, while the cells continue developing in the scaffold shape. With the use of non-human animal cells, there has been considerable recent progress made in the engineering of skin, bladder, cartilage, and several other tissues.

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Today, during the 85th General Session of the International Association for Dental Research, scientists are reporting on experiments applying human cells from cartilage (chondrocytes) on a scaffold. If the chondrocytes could be successfully grown in this manner, they were also interested in determining whether their development could be enhanced by a protein (osteogenic protein-1) that was known to increase production by chondrocytes of a major cartilage extracellular matrix component, proteoglycan. This study had not been undertaken previously.

Experiments were conducted as follows: Normal ankle cartilage was obtained from a deceased adult through the Gift of Hope Organ %26amp; Tissue Donor Network in Elmhurst, IL. The chondrocytes from the cartilage were isolated and purified by standard laboratory procedures. They were then applied to small polymer (polyglycolic acid) scaffolds that were disc-shaped. Three such constructs were created for comparison of possible cell growth and proteoglycan production. The first consisted of a scaffold treated with cells only, the second a scaffold with cells to which osteogenic protein-1 (from Stryker Biotech, Hopkinton, MA) was added drop-wise, and the third a scaffold incorporating timed-release capsules of osteogenic protein-1 together with cells. The constructs were maintained for 4 weeks and then analyzed for the presence of chondrocytes and production of proteoglycan. Results showed successful tissue engineering of the chondrocytes on scaffolds and enhancement of proteoglycan production with osteogenic protein-1 delivered to the cells by either droplet addition or timed release.

The studies established that human chondrocytes are able to develop cartilage by the tissue-engineering methods used, and promise further advances toward therapeutic tissue engineering by laboratory means.

Source: International %26amp; American Association for Dental Research

Oral fluids hold promise as a potential alternative to blood as a diagnostic fluid

2009-02-09T21:30:00.000-05:00

Oral fluids hold promise as a potential alternative to blood as a diagnostic fluid. Currently, diseases like HIV, hepatitis, and certain cancers can be detected through the analysis of oral fluids. In the past, it has been difficult to detect meaningful amounts of disease markers in oral fluids, because they are not always found in the same abundance as in blood. Proteomics is a relatively new method of studying the amounts and types of protein in cells and body fluids on a much smaller scale than was previously possible. The analysis of oral fluids using proteomics has opened new doors for the study of oral diseases and links between oral and systemic diseases.

[More:]

Researchers at the Mayo Clinic in Rochester, MN, reporting today during the 85th General Session of the International Association for Dental Research, are conducting a study using proteomics to analyze two different oral fluids: saliva and gingival crevicular fluid, the fluid which is present in the pocket between the teeth and gum tissue. The purpose of the study is to demonstrate how these fluids contribute unique proteins to oral fluid, and to establish what proteins are found in healthy, "normal" oral fluid. In the future, this information will be compared with that obtained from individuals who have disease, to discover new ways to diagnose and treat disease.

Source: International %26amp; American Association for Dental Research

Scientists re-grow dental enamel from cultured cells

2009-02-09T21:27:00.000-05:00

Dental enamel is the hardest tissue produced by the body. It cannot regenerate itself, because it is formed by a layer of cells that is lost by the time the tooth appears in the mouth. The enamel spends the remainder of its lifetime vulnerable to wear, damage, and decay. For this reason, it is exciting to consider the prospect of artificially growing enamel, or even whole teeth, using culturing and transplantation techniques. In the emergent field of tooth-tissue engineering, several groups have developed their own approaches. Although there has been some success in producing enamel-like and tooth-like tissues, problems remain to be solved before the technology comes close to being tested in humans. One of the issues has been how to produce, in culture, sufficient numbers of enamel-forming cells.

[More:]

Today, during the 85thth General Session of the International Association for Dental Research, a team of researchers from the Institute of Medical Science, the University of Tokyo (Japan), reports on a new technique for culturing cells that have the capacity to produce enamel. This group has recently shown that epithelial cells extracted from the developing teeth of 6-month-old pigs continue to proliferate when they are cultured on top of a special feeder layer of cells (the feeder-layer cells are known as the 3T3-J2 cell line). This crucial step boosts the number of dental epithelial cells available for enamel production. In the study being reported today, the researchers seeded the cultured dental epithelial cells onto collagen sponge scaffolds, along with cells from the middle of the tooth (dental mesenchymal cells). The scaffolds were then transferred into the abdominal cavities of rats, where conditions were favorable for the cells in the scaffolds to interact and develop. When removed after 4 weeks, the remnants of the scaffolds were found to contain enamel-like tissue. The key finding of this study was that even after the multiple divisions that occurred during propagation of the cells in culture, the dental epithelial cells retained the ability to produce enamel, as long as they were later provided with an appropriate environment.

The idea for the culturing technique originates from 1975, when Dr. J.G. Rheinwald and Dr. H. Green of Harvard Medical School reported the use of feeder layers for culturing epithelial cells from the skin (the 3T3-J2 cells used in the current study were gifted by Dr. Green). The cell-scaffold approach is based on tissue-engineering technology developed at the Forsyth Institute (MA) and was applied by one of the Tokyo researchers to produce enamel-like tissues in 2002. Now that dental epithelial cells can be propagated in culture, the next step will be to achieve the same success with their partners in tooth formation, the dental mesenchymal cells. Further development of this technique will be aimed toward production of tissue to replace damaged or missing enamel, and ultimately, regeneration of whole teeth.

Source: International %26amp; American Association for Dental Research

Tai chi chih significantly boosts the immune systems of older adults

2009-02-09T00:43:00.000-05:00

Tai chi chih, the Westernized version of the 2,000-year-old Chinese martial art characterized by slow movement and meditation, significantly boosts the immune systems of older adults against the virus that leads to the painful, blistery rash known as shingles, according to a new UCLA study.The 25-we...

The 25-week study, which involved a group of 112 adults ranging in age from 59 to 86, showed that practicing tai chi chih alone boosted immunity to a level comparable to having received the standard vaccine against the shingles-causing varicella zoster virus. When tai chi chih was combined with the vaccine, immunity reached a level normally seen in middle age. The report appears in the April issue of the Journal of the American Geriatrics Society, currently online.

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The results, said lead author Michael Irwin, the Norman Cousins Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA, confirm a positive, virus-specific immune response to a behavioral intervention. The findings demonstrate that tai chi chih can produce a clinically relevant boost in shingles immunity and add to the benefit of the shingles vaccine in older adults.

"These are exciting findings, because the positive results of this study also have implications for other infectious diseases, like influenza and pneumonia," said Irwin, who is also director of the UCLA Cousins Center for Psychoneuroimmunology. "Since older adults often show blunted protective responses to vaccines, this study suggests that tai chi is an approach that might complement and augment the efficacy of other vaccines, such as influenza."

The study divided individuals into two groups. Half took tai chi chih classes three times a week for 16 weeks, while the other half attended health education classes %26#8212; including advice on stress management, diet and sleep habits %26#8212; for the same amount of time and did not practice tai chi chih. After 16 weeks, both groups received a dose of the shingles vaccine Varivax. At the end of the 25-week period, the tai chi chih group achieved a level of immunity two times greater than the health education group. The tai chi chih group also showed significant improvements in physical functioning, vitality, mental health and reduction of bodily pain.

The research follows the success of an earlier pilot study that showed a positive immune response from tai chi chih but did not assess its effects when combined with the vaccine.

The varicella zoster virus is the cause of chickenpox in kids. Children who get chickenpox generally recover, but the virus lives on in the body, remaining dormant. As we age, Irwin said, our weakening immune systems may allow the virus to reemerge as shingles. Approximately one-third of adults over 60 will acquire the infection at some point.

"It can be quite painful," Irwin said, "and can result in impairment to a person's quality of life that is comparable to people with congestive heart failure, type II diabetes or major depression."

Tai chi chih is a nonmartial form of tai chi and comprises a standardized series of 20 movements. It combines meditation, relaxation and components of aerobic exercise and is easy to learn.

Source: University of California, Los Angeles

Biopolymer suture stronger, safer

2009-02-09T00:40:00.000-05:00

With the help of a new type of suture based on MIT research, patients who get stitches may never need to have them removed.A biopolymer suture cleared last month by the FDA is made of materials that the human body produces naturally, so they can be safely absorbed once the wound is healed. They are ...

With the help of a new type of suture based on MIT research, patients who get stitches may never need to have them removed.

A biopolymer suture cleared last month by the FDA is made of materials that the human body produces naturally, so they can be safely absorbed once the wound is healed. They are also 30 percent stronger than sutures now used and very flexible, making them easier for surgeons to work with.

The sutures were developed by Tepha, Inc., a Cambridge company that hopes to use the same material to produce an array of absorbable medical devices, including stents, surgical meshes and possibly a heart valve scaffold, says Simon Williams, CEO of Tepha and a former MIT postdoctoral associate.

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Williams said he envisions that the new sutures will be used for abdominal closures, which are prone to re-opening, and to stitch tendons and ligaments.

Developed using a method created at MIT, the absorbable sutures are the first made from material produced by genetically modified bacteria.

About 20 years ago, researchers in the laboratory of MIT biology professor Anthony Sinskey started swapping genes between different bacteria, hoping to achieve industrial production of desirable natural compounds synthesized by those bacteria.

The researchers focused their "biopolymer engineering" efforts on a group of genes that code for enzymes in a pathway that produces polyesters. Those polyesters can be broken down into metabolites naturally produced by humans, so they cause no harm when absorbed.

Once the genes were identified, they could be transferred into a strain of industrial E. coli that can produce large quantities of the strong, flexible polymer.

The FDA cleared the biopolymer sutures on Feb. 8, and Williams said Tepha plans to start marketing them soon, in partnership with another company.

"Not only is it technically and in an engineering sense a tremendous victory, but it's also a victory for society because this leads to new medical devices that can help people in new and novel ways," said Sinskey, who is one of the founders of Tepha and sits on its board of directors.

The new suture is the first of what the researchers hope will be many medical devices made from the natural polyesters.

"What we've found is that this one material seems to be finding a lot of use in different applications," because of its wide range of desirable properties, Williams said.

Tepha is now working on developing other medical devices, such as surgical meshes, multifilament fibers and stents. Ultimately, the researchers hope to develop an artificial scaffold that could be used to grow heart valves after being implanted in a patient, which would spare children with heart valve defects from undergoing repeated surgeries.

Tests of the device in animals have shown promise.

"We've been able to show we can produce a valve scaffold that functions better and can grow with the animal," Williams said. "If the valve can grow with the patient, you don't need the repeated surgeries."

Source: MIT

Major breakthrough in treatment of Type 1 diabetes

2009-02-09T00:38:00.000-05:00

More than 12 million people worldwide are afflicted with Type I diabetes, an autoimmune disease in which insulin-producing pancreatic islets are damaged, thereby impeding the body%26#8217;s ability to regulate glucose concentrations in the blood. One proposed therapy for this disease involves the transplantation of pancreatic islets from a donor source. The main problem with this approach is the possibility of rejection by the body%26#8217;s immune system.

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Now, in a major breakthrough, a collaborative team of chemists, physicists, and clinical researchers at the University of Chicag have devised a technique for coating pancreatic islets with a thin polymer shell that allows the transport of glucose and insulin but protects the islets from being attacked by the immune system.

Milan Mrksich, Sidney Nagel, Marc Garfinkel, and their colleagues have developed an encapsulation method based on the flow of water and oil through a thin tube. The islets are pulled from the water%26#8211;oil interface so that they are surrounded by a uniform microscopic layer of water. In the method used by the researchers, a polymeric component present in the aqueous phase is stitched together by shining green light from a laser to start the crosslinking process. A thin and porous polymer shell is thus obtained around the islets.

%26#8220;The thin coats produced by this technique may allow for more flexibility in choosing a transplantation site%26#8221;, said Garfinkel, proposing that the islets could be transplanted into the portal vein that flows into the liver. The large sizes of encapsulated islets obtained by conventional methods have precluded their transplantation in these sites because of their tendency to obstruct the flow of blood in terminal blood vessels.

By controlling the thickness of the shell and the crosslinking density of the polymer, the researchers are able to exclude the smallest components of the immune system from attacking the islets, while still allowing the rapid diffusion of glucose and insulin. Remarkably, these encapsulated islets are able to match bare islets in producing insulin in response to varying concentrations of glucose.

Nagel pointed out that unlike other encapsulation methods which give a fixed outer diameter of the resulting core%26#8211;shell structures, this approach enables coatings of the same thickness to be formed for islets of varying sizes. This is especially important since the islets can vary in size by a factor of five.

%26#8220;The properties of the microcapsule can be systematically tuned by adding functional molecules to each polymeric layer%26#8221;, added Mrksich, %26#8220;for example, the outer layer can be equipped with vascular growth factors and anti-inflammatory drugs, whereas the inner layer can be modified to enhance insulin secretion%26#8221;. The protection afforded to the islets from the immune system suggests that it may be possible to use islets from animal sources in replacement therapy for Type I diabetes.

Source: Wiley

Bioengineering heart tissue - Laboratory-grown muscle may replace damaged areas after heart attack

2009-02-09T00:35:00.000-05:00

Some day, heart attack survivors might have a patch of laboratory-grown muscle placed in their heart, to replace areas that died during their attack. Children born with defective heart valves might get new ones that can grow in place, rather than being replaced every few years. And people with clogg...

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These possibilities are all within reach, and could transform the way heart care is delivered, say University of Michigan Medical School researchers in the new issue of the journal Regenerative Medicine. Technology has advanced so much in recent years, they write, that scientists are closer than ever to %26#8220;bioengineering%26#8221; entire areas of the heart, as well as heart valves and major blood vessels.

But hurdles still remain before the products of this tissue engineering are ready to be implanted in patients as replacements for diseased or malformed structures, the team notes. Among the hurdles: determining which types of cells hold the most potential, and finding the best way to grow those cells to form viable cardiac tissue that is strong, long-lasting and structured at a cellular level like natural tissue.

The new article reviews the current state of cardiac tissue engineering, both at the U-M Cardiac Surgery Artificial Heart Laboratory and in labs worldwide.

%26#8220;Tissue engineering is a rapidly evolving field, and cardiovascular tissue is one of the most exciting areas but also one of the most challenging,%26#8221; says Ravi Birla, Ph.D., the paper%26#8217;s senior author and director of the U-M Artificial Heart Laboratory. %26#8220;With this paper, we%26#8217;re presenting the current state of the art as it exists in our lab and others, and pointing out both potential applications and hurdles that remain.%26#8221;

The paper presents a model for collaborative research between engineers, clinicians and biologists for successful cardiovascular tissue engineering research.

%26#8220;Although there remain tremendous technological challenges, we are now at a point where we can engineer first-generation prototypes of all cardiovascular structures: heart muscle, tri-leaflet valves, blood vessels, cell-based cardiac pumps and tissue engineered ventricles,%26#8221; says Birla.

Research at the Artificial Heart Laboratory has focused on comparing different platforms to engineer functional heart muscle in the laboratory. Last December, Birla and first author Yen-Chih Huang, PhD, published a paper describing their success in growing pulsing, three-dimensional patches of bioengineered heart muscle, or BEHM. That paper describes the use of an innovative technique, using a fibrin hydrogel, that is faster than others, but still yields tissue with significantly better properties.

The gel was able to support rat cardiac cells temporarily, before the fibrin broke down as the cells multiplied and organized into tissue within a few days. Tests showed that the BEHM was capable of generating pulsating forces and reacting to stimulation more like real muscle than ever before.

Previously, the group described the results of a self organization strategy, showing that it was possible to engineer heart muscle that closely resembles normal heart muscle physiology without any synthetic scaffolding material. The U-M team and others have also shown how polymeric scaffolds can be used to engineer heart muscle of any shape or size to match the area of the damaged heart muscle %26#8211; raising the possibility of engineering customized patches to meet the specific requirements of patients. All of these approaches are described in the recent review article.

The new article, by Birla and lead author Louise Hecker, a graduate student in the U-M Department of Cell %26amp; Developmental Biology, describes the %26#8220;bioreactor%26#8221; that the team uses to grow their BEHM. It also details many other discoveries that have been made by other teams using different cell-growing surfaces and conditions, as well as hurdles that still lie ahead. In all, the authors say, bioengineered cardiac tissue holds immediate promise as a way to study heart disease and its treatment in cell cultures %26#8211; and promise over the longer term as a source of new patient treatments.

As part of the effort to make the leap from the lab to the clinic, U-M is applying for patent protection on the Artificial Heart Laboratory%26#8217;s developments and is actively looking for a corporate partner to help bring the technology to market.

The U-M team%26#8217;s bioreactor was developed Robert Dennis, Ph.D., formerly of the U-M College of Engineering and now at the University of North Carolina. It allows up to 11 specimens of tissue to be grown in the same conditions at the same time, while allowing each specimen to be %26#8220;stretched%26#8221; using a specially made device that can both apply forces and measure the forces generated when the tissue begins contracting and beating on its own. In the new paper, the team reports that it has achieved a doubling of the contracting force in just seven days, by stretching the BEHM at 1 Hertz.

The growing of heart muscle, heart valve and blood vessel tissue in the lab also requires careful control of conditions such as temperature, oxygen and carbon dioxide levels, nutrients and pH level. This can then encourage the cells to begin producing the kinds of molecules needed to signal to and connect with other cells, and to produce the extracellular matrix that supports cells in tissue.

The U-M Artificial Heart Laboratory has teamed up with a commercial partner to develop a novel perfusion system that can deliver controlled nutrient exchange to the tissue engineered heart muscle. The perfusion system is the first of its kind, because it does not rely on a traditional cell culture incubator, giving the researchers the ability to carefully control the culture environment of the cells during heart muscle formation and foster a higher degree of functionality.

Even if cell-growing conditions can be perfected to produce tissue that is strong, durable and shaped like the native tissue it is designed to replace, another major challenge remains: which type of cells to use. Or more clearly, which types of cells to use %26#8211; because heart muscle tissue is made up of several types of cells. Human heart cells are hard to come by, and %26#8220;adult%26#8221; stem cells haven%26#8217;t yet been shown to be changeable into cardiac cells. Embryonic stem cells, while promising, come with political baggage. And other types of muscle cells taken from elsewhere in the body %26#8212; including skeletal muscles %26#8212; have been used in early clinical trials, but results are mixed.

Source: University of Michigan

Bioengineering heart tissue - Laboratory-grown muscle may replace damaged areas after heart attack

2009-02-08T23:29:00.000-05:00

[More:]

The new article reviews the current state of cardiac tissue engineering, both at the U-M Cardiac Surgery Artificial Heart Laboratory and in labs worldwide.

The paper presents a model for collaborative research between engineers, clinicians and biologists for successful cardiovascular tissue engineering research.

Source: University of Michigan

Herbal extract extends life for congestive heart failure patients

2009-02-08T23:26:00.000-05:00

An herbal medicinal substance, Crataegus Extract WS1442, safely extends the lives of congestive heart failure patients already receiving pharmacological treatment for the disease, according to a study presented today at the American College of Cardiologys 56th Annual Scientific Session. Crataegus Ex...

An herbal medicinal substance, Crataegus Extract WS%26#174;1442, safely extends the lives of congestive heart failure patients already receiving pharmacological treatment for the disease, according to a study presented today at the American College of Cardiology%26#8217;s 56th Annual Scientific Session. Crataegus Extract WS%26#174;1442 is an extract of leaves of the Crataegus tree, and is a natural antioxidant. The herb is currently approved for use in some European countries to treat early congestive heart failure, a condition in which the heart cannot pump enough blood to the body%26#8217;s other organs. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further breakthroughs in cardiovascular medicine.

[More:]

The randomized, double-blind trial, known as the SPICE study, was conducted at 156 centers in Europe. The majority of the patients were male (84 percent) and nearly half the group (44 percent) were classified as NYHA III, meaning they were significantly impaired by their heart condition. The primary endpoint of the study was time to first cardiac event, including sudden cardiac death, death due to progressive heart failure, fatal heart attack, non-fatal heart attack or hospitalization due to heart failure.

A total of 2,681 patients with markedly impaired left ventricular function %26#8211; indicating advanced congestive heart failure %26#8211; were randomized to WS%26#174;1442 or placebo for a duration of two years. All patients were already receiving pharmacological therapy with ACE-inhibitors (83 %), beta-blockers (64 %), glycosides (57 %), spironolactone (39 %) and diuretics (85 %).

Dr. Christian J. F. Holubarsch and his team saw a 20 percent reduction in cardiac-related deaths among patients on WS%26#174;1442, extending patients%26#8217; lives by four months during the first 18 months of the study. The safety of the compound was confirmed by a lower number of adverse events among the study group than those on placebo.

"WS 1442 is safe in patients with more severe congestive heart failure and left ventricular ejection fraction lower than 35 percent,%26#8221; said Dr. Holubarsch of Median Kliniken Hospitals in Bad Krozingen, Germany, and lead study author. %26#8220;It postpones death of cardiac cause after 18 months and sudden cardiac death in an important subgroup of patients."

Source: American College of Cardiology

Rice bran could reduce risk of intestinal cancer

2009-02-08T23:23:00.000-05:00

A study by biomedical scientists at the University of Leicester has revealed for the first time that rice bran could reduce the risk of intestinal cancer.The research in the University's Department of Cancer Studies and Molecular Medicine has not been tested on humans, but research in the laboratory...

A study by biomedical scientists at the University of Leicester has revealed for the first time that rice bran could reduce the risk of intestinal cancer.

The research in the University's Department of Cancer Studies and Molecular Medicine has not been tested on humans, but research in the laboratory has produced promising results.

[More:]

The research has been published in the British Journal of Cancer.

The results of a controlled laboratory study in a preclinical model of gastrointestinal adenoma demonstrated that consumption of a high daily dose of stabilized rice bran caused an average 51% reduction in the number of precancerous adenomas in the intestinal tract.

Professor Andreas Gescher of the University of Leicester in the UK, the principal investigator, said:

"We compared the cancer-preventive efficacy of rice bran with respect to prostate, breast and intestinal cancers. Whilst there was no effect of rice bran on the development of prostate or breast cancer, rice bran significantly retarded the development of intestinal adenomas. The effect was dependent on the fibre content of the bran. The dose we used translates into approximately 200g rice bran per day in humans. We believe a promising area of future research would be to study the potential colorectal cancer-preventing properties of stabilized rice bran.

"It is known that bran from wheat and rye have anti-cancer properties but this is the first time that this has been shown for rice bran. It appears that rice bran may have a role to play in reducing the development of adenomas, which can be a pre-cursor to cancer. No one has compared the efficacy of the different brans, such as rice, wheat, rye or oat and this may be an interesting future direction for researchers."

Source: University of Leicester

Adult bone marrow stem cells regenerate healthy human liver tissue

2009-02-08T23:20:00.000-05:00

For the first time, researchers have used adult bone marrow stem cells to regenerate healthy human liver tissue, according to a study published in the April issue of the journal Radiology.When large, fast-growing cancers invade the liver, some patients are unable to undergo surgery, because removing...

For the first time, researchers have used adult bone marrow stem cells to regenerate healthy human liver tissue, according to a study published in the April issue of the journal Radiology.

When large, fast-growing cancers invade the liver, some patients are unable to undergo surgery, because removing the cancerous tissue would leave too little liver to support the body.

Researchers at Heinrich-Heine-University in D%26#252;sseldorf, Germany, used adult bone marrow stem cells to help quickly regenerate healthy liver tissue, enabling patients to eventually undergo a surgical resection.

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%26#8220;Our study suggests that liver stem cells harvested from the patient%26#8217;s own bone marrow can further augment and accelerate the liver%26#8217;s natural capacity to regenerate itself,%26#8221; said G%26#252;nther F%26#252;rst, M.D., co-author and professor of radiology.

In the study, researchers compared the results of portal vein embolization (PVE), a technique currently used to help regenerate liver tissue, to a combination of PVE and an injection of bone marrow stem cells into the liver.

PVE blocks blood flow to the diseased portion of the liver and diverts blood to the organ%26#8217;s healthy tissue, promoting liver growth. Bone marrow stem cells extracted from the patient%26#8217;s hip bone and injected into the liver also help the liver regenerate.

The study included 13 patients with large central liver malignancies who were unable to undergo surgery because resection would leave less than 25 percent of their total liver volume.

Six of the patients underwent both PVE and injection of bone marrow stem cells. Seven patients underwent only PVE. Computed tomography (CT) scans were performed before and up to five weeks after PVE to determine the degree of liver growth.

Patients who received the combination of PVE and stem cell injection had double the liver growth rate and gain in liver volume, compared with those who underwent PVE alone. As a result, the patients who received the combined treatment were able to undergo surgery an average of 18 days sooner than patients who received PVE only.

%26#8220;Our research demonstrates that stem cells are a powerful adjunct to PVE for patients undergoing surgical resection,%26#8221; said Jan Schulte am Esch, M.D., co-author and surgery staff member. %26#8220;Based on our results, we also believe that adult stem cell administration may be a promising therapy for regenerating livers damaged by other chronic and acute diseases.%26#8221;

The researchers are currently embarking on a randomized controlled trial of the therapy.

Source: Radiological Society of North America

Nanotechnology helps doctors track cells used in medical treatments

2009-02-08T23:18:00.000-05:00

To the delight of researchers at Washington University School of Medicine in St. Louis, living cells gobbled up fluorine-laced nanoparticles without needing any coaxing. Then, because of the unusual meal, the cells were easily located with MRI scanning after being injected into mice.Developed in the...

Developed in the laboratories of Samuel A. Wickline, M.D., and Gregory Lanza, M.D., Ph.D., the nanoparticles could soon allow researchers and physicians to directly track cells used in medical treatments using unique signatures from the ingested nanoparticle beacons.

[More:]

In an article that will appear in the June issue of the FASEB Journal, lead author Kathryn C. Partlow, a doctoral student in Wickline's lab, describes using perfluorocarbon nanoparticles to label endothelial progenitor cells taken from human umbilical cord blood. Such cells can be primed to help build new blood vessels when injected into the body. The researchers believe nanoparticle-labeled stem cells like these could prove useful for monitoring tumors and diagnosing and treating cardiovascular problems.

The nanoparticles contain a fluorine-based compound that can be detected by MRI scanners. Fluorine is most commonly known for being an element included in fluoride toothpastes. Wickline, who heads the Siteman Center of Cancer Nanotechnology Excellence, says this technology offers significant advantages over other cell-labeling technologies under development.

"We can tune an MRI scanner to the specific frequency of the fluorine compound in the nanoparticles, and only the nanoparticle-containing cells will be visible in the scan," he says. "That eliminates any background signal, which often interferes with medical imaging. Moreover, the lack of interference means we can measure very low amounts of the labeled cells and closely estimate their number by the brightness of the image."

The researchers believe that nanoparticle-labeled adult stem cells could be used to evaluate tumors. Under an MRI scan, the presence of the labeled cells would reveal that the tumor was adding new blood vessels and therefore aggressively growing.

Adult stem cells are also under investigation in therapies that enhance new blood vessel growth to improve the blood supply to diabetic patients' limbs or to repair blood vessels after a heart attack or bypass surgery. Tracking nanoparticle-labeled cells used in such treatments by MRI imaging would allow physicians to monitor the treatment's success or failure.

The nanoparticles %26#8212; called "nano" because they measure only about 200 nanometers across, or 500 times smaller than the width of a human hair %26#8212; are made up largely of perfluorocarbon, a safe compound used in artificial blood. The fluorine atoms in the particles can be detected by tuning an MRI scanner to the unique signal frequency emitted by the perfluorocarbon compound used.

Since several perfluorocarbon compounds are available, different types of cells potentially could be labeled with different compounds, injected and then detected separately by tuning the MRI scanner to each one's individual frequency, says Wickline.

That makes the labeled cells potentially useful for vascular research as well. "Many kinds of cells are involved in the formation of new blood vessels," Partlow says. "Because we can create a separate MRI signature for different cells with these various types of unique nanoparticles, we could use them to better understand each cell type's role."

The nanoparticles are very compatible with living cells, according to the research findings. "The cells just take these particles in naturally %26#8212; no special sauces have to be added to make them tasty to these cells," says Wickline, also professor of medicine, of physics and of biomedical engineering and a Washington University heart specialist at Barnes-Jewish Hospital. "And then the cells just go about their business and do what they're supposed to do by homing in on targeted regions of the body."

Laboratory tests showed that the cells retained their usual surface markers and that they were still functional after the labeling process. The labeled cells were shown to migrate to and incorporate into blood vessels forming around tumors in mice.

The researchers believe the cells could soon be used in clinical settings. "Kathy and colleagues showed that we can scan for these cells at the same MRI field strength we are using in medical imaging," Wickline says. "Although we reported the first use of perfluorocarbon molecular imaging for detection of certain pathologies a few years ago, no one would have predicted that you could get enough signal from such small quantities of perfluorocarbons in labeled stem cells to actually see them. I think we've dispelled that notion, and the fluorine imaging approach already is becoming more popular for molecular imaging of various cell and tissue types."

Next the research group will evaluate how nanoparticle-labeled cells function in living organisms. "We'll track injected cells in real time and see where they accumulate and how long they live," Partlow says. "Then we'll go on to investigate how they work in therapeutic applications."

Source: Washington University School of Medicine

Light-based probe instantly detects earliest signs of cancer

2009-02-08T23:15:00.000-05:00

In its first laboratory tests on human tissue, a light-based probe built by researchers at Duke University's Pratt School of Engineering almost instantly detected the earliest signs of cancer in cells that line internal organs.If the preliminary success of the "optical biopsy" is confirmed through c...

If the preliminary success of the "optical biopsy" is confirmed through clinical trials, such a device could ultimately provide a particular advantage for early diagnosis, treatment and prevention of many types of cancer, according to the researchers. The vast majority of cancers start in the body's epithelial cells, which line the mucous membranes in the lungs, esophagus and gut.

[More:]

"About 85 percent of all cancers start in the epithelium. It may be, for example, brain cancer that causes a patient's death, but that cancer might have originated in the colon or other site of epithelial tissue," said Adam Wax, professor of biomedical engineering. "Being able to detect pre-cancer in epithelial tissues would therefore help prevent all types of cancer by catching it early, before it has a chance to develop further or spread."

In some instances, the technique, known as "fa/LCI" (frequency-domain angle-resolved low coherence interferometry), might ultimately enable doctors and their patients to avoid removal of tissue for biopsy, Wax said. In other instances, he added, fa/LCI could help physicians pinpoint suspicious cells during a traditional biopsy procedure, making it less likely for a cancerous lesion to escape detection.

Wax and his former graduate student John Pyhtila reported in the March 2007 issue of Gastrointestinal Endoscopy that their fiber-optic device reliably differentiated between healthy and precancerous digestive tissue taken from the stomach and esophagus of three patients known to have a precancerous form of a condition called Barrett's esophagus. In less than a second, their fa/LCI-enhanced version of an endoscope, instruments used to visualize internal organs, provided the clinical information required for diagnosis.

The work was supported by the National Cancer Institute and the National Science Foundation.

"Our initial study is very promising," Wax said of the findings. "We looked at tissue removed from just a handful of patients and were able to get 100 percent sensitivity. We could detect pre-cancer in the esophagus and distinguish it from normal tissue like you would find in the stomach."

The fa/LCI device detects irregularities in the nucleus, or central component, of cells, through changes in the way laser light scatters. "The size and shape of cell nuclei are powerful indicators of this precancerous condition called dysplasia, which literally means 'bad growth'," Wax said. "Typically, nuclei are a fairly consistent size. However, when you go down the road toward cancer, you get irregular and enlarged cell nuclei.

"Our device lets us measure those changes with much better accuracy than any imaging technique," Wax said.

His team plans to begin a small clinical trial of the advanced endoscope in collaboration with researchers at Duke University Medical Center. The team also is conducting animal studies to test the feasibility of incorporating fa/LCI into instruments for examining the colon, lung and other organs. Based on a study in hamsters, Wax and Duke postdoctoral researcher Kevin Chalut reported in the February 2007 issue of Cancer Epidemiology Biomarkers %26amp; Prevention that the technique might also be used in the identification of early lung cancer.

Wax said he and his colleagues have launched a company, called Oncoscope, to pursue the commercial development of fa/LCI devices. If all goes well, a new and improved endoscope might be ready for the clinic in three to five years, he said.

Source: Duke University

Ultrathin, nanoscale films allow controlled release of DNA from surfaces - Novel way to route useful genes to exactly where they could do the most good

2009-02-08T23:13:00.000-05:00

Gene therapy - the idea of using genetic instructions rather than drugs to treat disease - has tickled scientists' imaginations for decades, but is not yet a viable therapeutic method. One sizeable hurdle is getting the right genes into the right place at the right time.
[More:]
Engineers at the Uni...

[More:]

Engineers at the University of Wisconsin-Madison are now developing a tool to tackle this problem. David M. Lynn and his colleagues have created ultrathin, nanoscale films composed of DNA and water-soluble polymers that allow controlled release of DNA from surfaces. When used to coat implantable medical devices, the films offer a novel way to route useful genes to exactly where they could do the most good. Lynn, a UW-Madison professor of chemical and biological engineering, has used his nanoscale films to coat intravascular stents, small metal-mesh cylinders inserted during medical procedures to open blocked arteries. While similar in concept to currently available drug-coated stents, Lynn's devices could offer additional advantages. For example, Lynn hopes to deliver genes that could prevent the growth of smooth muscle tissue into the stents, a process which can re-clog arteries, or that could treat the underlying causes of cardiovascular disease.

Preliminary laboratory tests of the DNA-coated materials are promising. "The films survive basic mechanical forces associated with placement and expansion of stents," Lynn says. He and his colleagues have also demonstrated gene delivery to cells grown in a dish.

In preliminary experiments conducted in collaboration with Matthew Wolff, Timothy Hacker, and Jose Torrealba in the UW School of Medicine and Public Health, Lynn has shown that DNA film-coated stents can successfully deliver a gene encoding a fluorescent protein into a rabbit's artery, demonstrating that the films can also work in the complex environment of living tissue. Lynn presented a summary of the work at the annual spring meeting of the American Chemical Society in Chicago on Monday, March 26.

When placed in or near a body tissue, the films are designed to degrade and release the DNA. Large strands of DNA cannot normally penetrate cells, so Lynn constructs his films with special polymers designed to bundle the genes into small tight packages that cells can import. Once inside, the genes instruct the cells to make proteins.

Lynn and his colleagues create the films one layer at a time using a dip-coating method, dunking first in one solution, then another. The individual layers are so thin it would take roughly 10,000 of them to equal the thickness of a single sheet of paper.

As it turns out, making the DNA-containing films is relatively straightforward, Lynn says, but "getting [the DNA] back out of the films is the hard part."

The secret to films that release DNA is in the choice of the polymer and the layer-cake design. The researchers alternate layers of DNA with layers of a polymer that is stable when dry but that degrades when exposed to water. Because the polymers carry a positive electric charge that is attractive to DNA, each polymer layer also "primes" the surface to accept the next layer of DNA. While electrostatic forces between the layers keep the film stable in dry, room-temperature conditions, the polymers break down easily in a wet biological environment - like the inside of a patient's body.

Lynn's laboratory has engineered a whole toolbox of different polymers to fine-tune the DNA delivery properties of their films. Using the layering method, they can control the amount of DNA by adding more layers, or can even layer multiple ingredients in a specific order. Tweaking the polymer structure slightly can change how quickly the films erode and thus how long cells are exposed to the gene therapy. "We ultimately need an effect prolonged enough to be therapeutically relevant - whatever time scale that might turn out to be, " explains Lynn.

The films start to break down when they come into contact with water. "The architecture of the film determines the manner in which [DNA] is released," Lynn says. In his lab, they have developed some films that fall apart all at once, releasing all the ingredients simultaneously.

More recent designs erode like a bar of soap, with the effect that outer layers are released before inner layers. By placing one gene in the outer layers and another in the inner layers, they can deliver different products sequentially.

"This kind of control is extremely difficult to achieve using conventional materials," Lynn explains. A bigger arsenal of tools may allow researchers to tailor films for specific applications. In addition to delivering DNA from stents, Lynn envisions using these nanoscale films to deliver DNA from other implantable devices. The films may also improve methods for engineering lab-grown tissues, in which precisely controlled delivery of multiple DNA- or protein-based agents is required to coax cells to develop into functional tissues and organs. "Our long-term goal is to develop materials useful for localized gene therapy," he says.

Source: University of Wisconsin, Madison

New magnetic system promises surgery without scars

2009-02-08T23:10:00.000-05:00

Physicians at UT Southwestern Medical Center and engineers at UT Arlington have collaborated to invent a groundbreaking system that could be key to delivering on the promise of surgery without scars.The new technique, which is still in the developmental stage, allows for magnetically maneuvering lap...

Physicians at UT Southwestern Medical Center and engineers at UT Arlington have collaborated to invent a groundbreaking system that could be key to delivering on the promise of surgery without scars.

The new technique, which is still in the developmental stage, allows for magnetically maneuvering laparoscopic surgical tools inserted into the abdominal cavity through the bellybutton or throat. The challenge remains, however, to design the new instruments and determine just how to move them once they%26#8217;re inside the human body.

[More:]

%26#8220;A fixed hole has a limited working envelope that is conical in shape,%26#8221; said Dr. Jeffrey Cadeddu, associate professor of urology and radiology and director of the Clinical Center for Minimally Invasive Treatment of Urologic Cancer. He and his colleagues describe the new surgical concept, called the Magnetic Anchoring and Guidance System, in the March edition of Annals of Surgery.

The idea of using magnets to manipulate the instruments in the abdominal cavity was formulated after Dr. Cadeddu watched a television show featuring teens who used magnets to hold studs on their lips to avoid getting their lips pierced.

%26#8220;Once you think about, it%26#8217;s an obvious thing,%26#8221; said Dr. Cadeddu, whose team of urologists and surgeons worked with engineers from UTA%26#8217;s Automation and Robotics Research Institute and the Texas Manufacturing Assistance Center to build the prototype.

The system uses a stack of magnets outside the abdomen to attract other magnets attached to laparoscopic instruments inside the abdomen. Surgeons can then move the outside magnets to position an internal camera at the best spot for seeing or to move a retractor or other surgical instrument. Once optimally positioned, the instruments can be locked in place. That allows a much greater range of maneuverability and the surgical team can more easily reposition the camera or instrument, said Dr. Cadeddu.

In animal studies, surgeons have been able to successfully remove a kidney using the Magnetic Anchoring and Guidance System.

While working on the system, Dr. Daniel Scott, assistant professor of surgery, joined UT Southwestern as director of the Southwestern Center for Minimally Invasive Surgery. He said the technology may solve the fundamental problem of guiding instruments through the abdomen for natural orifice surgery, which now inserts the instruments through the throat, colon or vagina.

%26#8220;The current state of the art for laparoscopic surgery requires four or five holes. The question behind this is, can we do the surgery through only one hole and can we hide the hole in a cosmetically advantageous or less painful location,%26#8221; Dr. Cadeddu said.

Study researchers concluded that %26#8220;the ability to reduce the number of trocars (holes) necessary for laparoscopic surgery has the potential to revolutionize surgical practice,%26#8221; but noted that there will be a learning curve for the new system and that because of the expanded maneuverability, surgeons will likely need to develop new techniques.

Also, until the system is fully tested in humans, surgeons won%26#8217;t know whether fewer entry points will result in fewer complications or faster healing, advantages usually seen in moving from conventional surgery to laparoscopic surgery.

Source: UT Southwestern

Nanocrystal research may lead to a new generation of vaccines

2009-02-08T23:07:00.000-05:00

Maren Roman is taking nanocrystal research to a new level that may lead to a new generation of vaccines and better computer printer ink.The assistant professor in the wood science and forest products department of the College of Natural Resources at Virginia Tech will be delivering her findings at t...

Maren Roman is taking nanocrystal research to a new level that may lead to a new generation of vaccines and better computer printer ink.

The assistant professor in the wood science and forest products department of the College of Natural Resources at Virginia Tech will be delivering her findings at the American Chemical Society 233rd National Meeting and Exposition in Chicago on March 25-29. The focus of her research deals with cellulose drug delivery and ink jet printing.

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Roman experimented with taking cellulose nanocrystals and attaching antibodies to the surface of the crystals. This design enables the nanocrystals to block cell receptors in the body. The process may eventually be used to create vaccines. Through the same receptor-blocking method, this process can combat the effects of some diseases involving inflammation of blood vessels, including diabetes, rheumatoid arthritis, and certain cancers.

Ink jet printing was another research project for Roman. She experimented with using ink jet printers to deposit the crystals because the printers%26#8217; main focus is precision. Nanocrystals are tiny and pose many difficulties to the people using them. A typical remedy involves converting the nanocrystals to a powder. This has risks as well, as the powder can be a serious health hazard if inhaled. The ink jet printing allows for a safe method of deposition of the nanocrystals.

Source: Virginia Tech

Healthier pizza? - Food chemists boost the antioxidant content of pizza

2009-02-08T23:04:00.000-05:00

In an effort to improve health, many popular foods are undergoing a more nutritious make-over. Now, a team of food chemists at the University of Maryland has discovered how to boost the antioxidant content of pizza dough by optimizing baking and fermentation methods, a finding that could lead to hea...

Pizza bakers have known for some time that longer-baking times and higher temperatures can enhance the flavor of pizza. The new study shows that these intense baking conditions also may boost antioxidant levels in dough, especially whole wheat varieties, the researchers say. Their findings were presented today at the 233rd national meeting of the American Chemical Society.

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That%26#8217;s good news for fans of deep-dish, Chicago-style pizza, whose longer baking time and thicker crust %26#8220;may have the potential to deliver higher levels of antioxidants in comparison to other pizza styles,%26#8221; says study co-author Jeffrey Moore, a doctoral student in food chemistry at the University of Maryland, College Park. Diets rich in antioxidants are thought to reduce the risk of cancer and heart disease.

%26#8220;We chose to investigate pizza dough because it%26#8217;s one of the most popular wheat-based food products in the U.S.,%26#8221; says Moore. %26#8220;Making popular food more healthy using the tools of chemistry may have a larger impact on public health.%26#8221;

The study is part of an ongoing effort by researchers at the university to discover and develop new technologies that enhance the levels of natural antioxidants in grain-based food ingredients such as whole wheat flour. That effort is lead by Liangli Lucy Yu, Ph.D., an associate professor of food chemistry at the school and Moore%26#8217;s graduate advisor.

To demonstrate the effect of different baking conditions on the antioxidant levels in pizza dough, Moore exposed whole grain pizza dough from two different varieties of wheat to different baking temperatures, from 400 to 550 degrees Fahrenheit, and to different baking times, from 7 to 14 minutes. A number of tests were used to measure changes in antioxidant properties.

Longer baking times or higher temperatures generally corresponded to higher levels of antioxidants in comparison to less intense baking conditions, Moore found. Antioxidant levels increased by as much as 60 percent during longer baking times and by as much as 82 percent during higher baking temperatures, depending on the type of wheat flour and the antioxidant test used, the researcher says. The exact mechanisms involved are not yet fully understood, he says.

Both baking time and temperature can be increased together at the same without burning the pizza, according to Moore, if the process is monitored carefully.

As pizza dough is often allowed to ferment before baking, Moore tested the effect of different fermentation times, ranging from zero to 48 hours, on antioxidant properties. Longer fermentation times also boosted antioxidant levels, in some cases by as much as 100 percent, he says. The increase likely resulted from chemical reactions induced by yeasts, which had more time to release the antioxidant components that were bound in the dough, Moore says.

Although only whole wheat pizza was used in this study, it is possible that these same cooking factors %26#8212; longer baking time, higher temperature and longer fermentation %26#8212; also will have an antioxidant boosting effect on refined pizza dough, but the effect will likely be less obvious, Moore says. That%26#8217;s because most of the antioxidants in wheat are found in the bran and endosperm components, which have been largely removed in refined flour, he says.

Funding for this study was supported by a grant from the U.S. Department of Agriculture%26#8217;s National Research Initiative, along with grants from the Colorado Wheat Research Foundation, Maryland Grain Producers Utilization Board, the Colorado Agricultural Experiment Station and the Maryland Agricultural Experiment Station. This research was not funded by the pizza industry, Moore says.

Source: American Chemical Society

Molecular mechanism involved in the development of schizophrenia

2009-02-08T23:02:00.000-05:00

A study led by scientists from the University of North Carolina at Chapel Hill may have identified a molecular mechanism involved in the development of schizophrenia.In studying the postmortem brain tissue of adults who had been diagnosed with schizophrenia, the researchers found that levels of cert...

A study led by scientists from the University of North Carolina at Chapel Hill may have identified a molecular mechanism involved in the development of schizophrenia.

In studying the postmortem brain tissue of adults who had been diagnosed with schizophrenia, the researchers found that levels of certain gene-regulating molecules called microRNAs were lower among schizophrenia patients than in persons who were free of psychiatric illness.

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"In many genetic diseases, such as Huntington's disease or cystic fibrosis, the basis is a gene mutation that leads to a malformed protein. But with other complex genetic disorders %26#8211; such as schizophrenia, many cancers, and diabetes %26#8211; we find not mutated proteins, but correctly formed proteins in incorrect amounts," said study lead author and UNC professor of psychiatry Dr. Diana Perkins.

The research appears this week in the online edition of the journal Genome Biology. "To our knowledge this study is the first to associate altered expression of microRNAs with schizophrenia," the authors stated.

Since the 1950s, scientists have known that the genetic code stored in DNA is first transcribed into messenger RNA (mRNA) which is then the template from which the body's protein building blocks are made. MicroRNAs are a newly discovered class of mRNA that does not carry the code for a protein. Instead, these tiny strands of RNA act by binding to matching pieces of the protein coding mRNA, thus preventing the translation of mRNA to protein. When a cell needs certain proteins, the microRNAs may disconnect, thus allowing protein expression to resume.

Using postmortem prefrontal cortical brain tissue of people with schizophrenia and persons who had no psychiatric illness, the researchers found for the first time a significant difference in the microRNA expression profile. Fifteen microRNAs were expressed at a lower level and one at a higher level in the brain tissue from persons with schizophrenia. The basic activity of this "executive" brain region is the orchestration of thoughts and actions in accordance with internal goals.

Previous studies have shown that microRNAs play a role in regulating brain development. They also figure importantly in "synaptic plasticity," the ability of neurons to make connections with one another. "And those connections between neurons come and go all the time. It's a normal process for them to be pruned and grow again, depending on what the brain needs to do to interact with the environment," Perkins explained.

"There is growing evidence that schizophrenia may related to disordered synaptic plasticity," she added. "Our study found a striking, significant difference in microRNA expression between people with schizophrenia and healthy people. Using bioinformatic analyses, we found that the distinguishing microRNAs appear to regulate genes involved in synaptic plasticity."

Acknowledging this was a pilot study, Perkins and her colleagues plan further research with larger tissue samples.

Source: University of North Carolina

Freezing kidney tumors through percutaneous cryoablation shows promise for patients who are not good candidates for surgery

2009-02-08T22:59:00.000-05:00

Mayo Clinic researchers report that freezing kidney tumors through percutaneous cryoablation shows promise for patients who are not good candidates for surgery. Their early findings showing short-term success in more than 90 percent of selected patients are published in this months issue of Radiolog...

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The standard treatment for kidney tumors is surgery, providing a high likelihood of a long-term cure. For some patients, surgery is not an option, and Mayo%26#8217;s urologists and radiologists collaborated to find alternatives for these individuals. If these patients are frail due to age or illness or are not able to have surgery because of other factors, percutaneous cryoablation may be an option.

"This procedure appears to be a good option for some patients," says Thomas Atwell, M.D., Mayo Clinic radiologist and the study%26#8217;s primary investigator. "It makes their hospital stay and recovery time very short and surgical stress is minimal." He cautions that this procedure is not ideal for everyone, noting that it is an option for only a relatively small subset of patients.

Percutaneous ablation uses needles to penetrate the skin and deliver directly to the tumor either high-intensity, tissue-destroying heat through radiofrequency ablation, or freezing cold through cryoablation. Mayo Clinic%26#8217;s radiologists are among the most experienced in the world in performing ablation techniques, and have treated nearly 300 kidney tumors either with radiofrequency ablation or cryoablation. Radiofrequency ablation (RFA) burns away the tumor, while cryoablation freezes it.

Mayo Clinic doctors had previous experience with liver tumor cryoablation when they added kidney tumor cryoablation in 2003. Today%26#8217;s report contains the largest published results for percutaneous cryoablation patients. Mayo researchers report that not only can this technique be an alternative to surgery, but that in some cases, it has benefits over RFA.

Previous experience in percutaneous RFA led the researchers to recognize that it has two important limitations. Tumors larger than 3 centimeters are difficult to treat with RFA, with increased rates of technical failures and tumor recurrence. Also, the area being treated cannot be effectively monitored with computed tomography (CT) or ultrasound. The Mayo study findings show that cryoablation can be used for some larger tumors with simultaneous operation of multiple cryoprobes guided by ultrasound. The ablation margin (the edge of the frozen tissue) can be accurately monitored with CT, to ensure that the total tumor mass is treated.

The researchers reviewed the records of the 23 men and 17 women with kidney cancer treated with percutaneous cryoablation at Mayo Clinic between March 12, 2003, and Aug. 4, 2005. They found that this treatment was chosen over RFA for reasons such as larger tumor size, proximity of tumor to ureter or bowel, or a central location on the kidney. Cryoablation was successful in 38 of the 40 patients, with no repeat treatment necessary.

In percutaneous cryoablation, one or more hollow needles are inserted through the skin directly into a tumor. Doctors can observe and guide the insertion by combined use of ultrasound and CT. The needle, or cryoprobe, is filled with argon gas, which results in rapid freezing of the tissue to temperatures of -100%26#176; C; and the tissue is then thawed by replacing the argon with helium. The procedure consists of two freezing and thawing cycles, seeking a frozen margin of approximately 5 millimeters beyond the tumor edge to ensure death of the entire tumor. After the cryoprobes are removed, small bandages are placed over the skin puncture sites, and the patient spends one night in the hospital before returning home.

Surgeons continue to seek less invasive methods than the traditional radical nephrectomy (removal of cancerous kidney) for the treatment of small tumors, and percutaneous cryoablation is now on the list. With the incidence of kidney cancer steadily increasing over the last 20 years, and the American Cancer Society predicting nearly 52,000 people will be diagnosed this year, with nearly 13,000 dying from it, another option for some patients is good news say the researchers.

"Additional study is still necessary, but we are confident that percutaneous cryoablation will continue to be a good option for some of our patients," says Bradley Leibovich, M.D., study co-author and Mayo Clinic urologist. "We%26#8217;ve seen good results in the initial follow-up with these patients, and hope that the long-term results prove this to be a safe alternative for some kidney tumors." While the researchers caution that they need five to 10 years of follow-up to be able to consider this a curative treatment, they are optimistic about future findings.

Source: Mayo Clinic

First complete high-resolution map of important structures that control how genes are packaged and regulated

2009-02-08T22:56:00.000-05:00

Scientists at Penn State University will reveal in the 29 March 2007 issue of the journal Nature the first complete high-resolution map of important structures that control how genes are packaged and regulated throughout an entire genome. "For the first time, we are seeing in very high resolution on a genome-wide scale how nucleosomes control the expression of an organism's genes," said B. Franklin Pugh, professor of biochemistry and molecular biology and the study's lead investigator.

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The map pinpoints the locations of certain key gene-controlling nucleosomes -- spool-like structures that wrap short regions of DNA around a protein core. The research suggests how these nucleosomes, positioned at important transcription-promoter sites throughout the cell's DNA, control whether or not a gene's function can be turned on in a particular cell.

The study's many surprising findings together reveal an intimate relationship between the architecture of nucleosome structures and the underlying DNA sequences they regulate. "We now know exactly where these nucleosomes are positioned on the DNA molecule and which DNA building blocks they have wrapped up under their tight control," Pugh said. Among those building blocks, Pugh and his colleagues revealed the architecture of a critical gateway, controlled by the nucleosome, which must be unlocked before a gene can be transcribed.

The study revealed that almost all genes have the same kind of structure where transcription begins, that this beginning contains a critical gateway for transcription, and that the transcription gateway of each gene almost always is located at the same place on a nucleosome. The researchers also discovered some genes whose pattern is somewhat different from this norm, and these unusual sequences also are reported in the Nature paper. "We previously had a low-resolution idea that these structures all could be roughly in the same position, but now this high-resolution map makes it very clear that they really are in exactly the same position. It's a remarkably consistent arrangement," Pugh said.

The study also revealed that the nucleosomes at the transcription-promoter control centers occupy several overlapping positions on the DNA molecule, typically 10 base pairs apart, which exactly matches the periodic rotation of the DNA double helix. "It is striking how well these positions match with the architecture of the DNA as it wraps around the nucleosome's protein core," Pugh said.

This result powerfully simplifies previous theories about the possible architecture of gene packaging. "There is a certain DNA sequence that shapes the gene's architecture in the same way, producing the same structure in every gene," Pugh said. The overall sequence of DNA building blocks is different in each gene, but the underlying architecture is the same."

To obtain their high-resolution map, the researchers first isolated 322,000 nucleosomes from the 6,000 regions that control gene transcription in the DNA of baker's yeast, S.cerevisiae, an organism widely studied as a model of how human cells work. These promoter nucleosomes are the only ones in the yeast DNA that contain in their core a histone protein called H2A.Z. Led by Pugh and Stephan Schuster, associate professor of biochemistry and molecular biology, the Penn State research team then used antibodies that bind only to this H2A.Z protein as a tool for separating all these promoter nucleosomes from the other parts of the yeast's DNA. Next, the team used a state-of-the-art DNA-sequencing machine to identify, or "read," the sequence of base-pair building blocks along the DNA of each of the H2A.Z nucleosomes. The scientists then pinpointed the original location of the H2A.Z nucleosomes by matching the sequence of each one with the identical sequence on the previously published yeast genome. "Obtaining the exact DNA sequences for all these nucleosomes allows us to precisely map their positions across the entire genome," explains Schuster. The map reveals, for the first time, precisely which DNA sequences are part of the control-center's H2A.Z nucleosome for each gene in the yeast genome. Also for the first time, researchers now have a clear picture of how H2A.Z nucleosomes help to control whether or not a gene can be turned on.

Another discovery is that transcription-control centers tend to be located on the outside edge of the nucleosome and tend to face outward on the DNA helix, allowing the cell's transcription proteins to find them more easily. "This arrangement makes sense, because when signaling proteins arrive at a control center they are well situated to help push the nucleosome out of the way so the reading of the gene can begin," Pugh said.

"Previous research had indicated that DNA sequences located upstream of a gene might be a region that controls whether that gene is read or not, but we did not know the architecture of those sequences -- whether they were exposed and therefore ready for work. Now we know that the gateway to transcription is a part of this control region and that the nucleosome keeps it locked so the gene cannot be turned on until it is needed," Pugh said. When the gene is needed, the cell's molecular machinery loosens the DNA wrapping around the nucleosome, unlocking the transcription gateway to give access to the cell's molecular transcription machinery. "We think that the function of the nucleosome is to control the gateway to transcription," Pugh said.

The research reveals how the pieces of DNA that regulate genes at the transcription-promoter sites are packaged on nucleosomes. The knowledge that these sites are located on the outside edge of the nucleosome spool will help to focus research designed to manipulate gene expression. "Our study has provided a much clearer picture of the architecture of the DNA in the control regions, allowing us to understand much better how genes are regulated, which is important because gene regulation is a critical process for the survival of living things," Pugh explains.

The paper by Pugh's team marks the leading edge of a new wave of anticipated discoveries about gene regulation, made possible by recently developed laboratory equipment for high-volume, or massively parallel, DNA sequencing. "Traditional DNA sequencing methods processed one DNA strand at a time, but now we can sequence hundreds of thousands of DNA strands at once, rapidly learning incredible amounts of new information," Pugh said.

The knowledge that most genes are packaged basically the same way is powerful information with implications for future research and potential applications. "One implication that I think is important is that we now have a better idea about how packaging the DNA in nucleosomes controls the expression of a gene," Pugh said. "We don't yet know where all the important gene-regulation features are located on the DNA molecule, but now we know we should start looking for some of them on the edges of nucleosomes," Pugh said. "We might even discover some sites that regulate genes that we didn't even know existed."

Source: Penn State University

When to start infant cereal and baby food?

2009-02-08T01:53:00.000-05:00

It is important to know that at 4 months of age your baby should be ready to begin solids. Start byintroducing cereal into your baby’s diet but use only single grain cereals. Those are rice, barley, and oatmeal. You could try each new cereal for 3-4 days before starting the next one. You shoul...

It is important to know that at 4 months of age your baby should be ready to begin solids. Start byintroducing cereal into your baby%26rsquo;s diet but use only single grain cereals. Those are rice, barley, and oatmeal. You could try each new cereal for 3-4 days before starting the next one. You should use cereals that are high in iron and vitamins. Avoid using cereal that comes mixed with formula because formula may be different than the one your baby takes. Moreover, the cereal may be a mixture of grains. That is why you should start with one teaspoon of dry cereal and mix it with one ounce of formula once a day. Gradually increase the dry cereal to three tablespoons, and then to three tablespoons twice a day, the best is at the morning and evening. Make sure the cereal is thin and runny at first, as the baby will be unused to the texture of thick cereal and do not aid sugar, honey, syrup or salt to the baby%26rsquo;s cereal. The baby does not know the difference so do not aid it. watches and opens their mouth for the spoon, and does not push food out with their tongue. You should not offer your child high-nitrate vegetables such as beets, broccoli, carrots, cauliflower, green beans, spinach and turnips, until after 6 months of age. The best is to let your baby decide how much to eat. When feeding your baby, look for signs of hunger and fullness, the way your baby will shut their mouth, turn their head, or push food away when they have had enough to eat. You should not force your baby to eat more when they have had enough. Babies who are still hungry will continue to open their mouths for food and may be upset when the food is taken away of him or her. It is the best to offer one new food at a time. Try to wait at least 3 days before adding another new food and do not put cereal or other solids in a bottle.

From birth to six months of age

Breast milk is the best food for your baby so babies who are not breastfed should be offered iron-fortified infant formula.

It is important to know that babies do not need solid foods until they are 6 months of age. Breastfed babies need 400 IU of vitamin D each day from a vitamin supplement so formula fed babies can get enough vitamin D from formula. If your baby drinks both breast milk and formula, ask a dietitian if they need a vitamin D supplement or not. The answer is because at 6 months old your baby needs more nutrients, especially iron. Your baby needs to try different tastes and textures, and most babies are ready for solid foods. Signs of babies readiness include when baby sits and holds their head up, and

From six to nine months of age

Continue to breastfeed or offer iron-fortified infant formula.

Do it whenever your baby is hungry - about 720 -1250 ml each day. As your baby eats more solids, they will gradually drink less breast milk or formula then they used to. Sips of water may be offered in a cup, but you should not let your baby fill up on water. You should also know that your baby does not need juice. If offering juice, limit to 60 ml or 1/4 cup per day. It is the best way to serve it in a cup. When starting solids, choose a time when baby is content, interested and alert and begin by offering solids 1-2 times per day and increase to 3-4 times per day. It would be nice if you could sit down and eat with your baby. Start with small amounts of high iron foods like iron-fortified infant cereal or well-cooked finely minced meat, poultry or fish, mix with breast milk, formula, or water. You could also use a single-grain iron-fortified infant cereal to start with. Try to gradually increase cereal to about 60-125 ml each day. If your baby does not eat meat, aim for at least 125 ml of cereal, on average, each day by 9 months of age. You shoudl also offer cooked, well-mashed vegetables like yams, sweet potatoes, potatoes, squash, carrots, and mashed fruit like pears, peaches, and bananas. Start with small amounts and gradually increase to about 60-125 ml per day. Continue to offer meat, poultry and fish, while adding other high iron foods like cooked egg yolk, lentils, beans, and tofu. Add about 100 ml total per day. Around time when your baby is nine months old, try cottage cheese, plain yogurt, and pasteurized cheeses.

Pureed foods are not needed, but baby can enjoy mashed foods and finger foods before teeth appear. Offer finger foods such as pieces of cooked vegetables or soft fruit without the peel, like potato, yam, avocado, apricot, pear, banana, peach, plum. You could also offer strips of toast, cooked rice, cooked pasta, and oat rings cereal.

From 9 to 12 months of age

Breast milk or iron-fortified formula, about 625-950 ml per day, and water in a cup are something your baby definitelly needs. Your baby does not need juice, so if offering juice, limit to 125 ml per day, served in a cup. Offer 100 per cent juice only and do not let your baby sip on juice or diluted juice often during the day. This can cause tooth decay. Try to offer foods 5-6 times per day and offer solid foods before breast or formula feeding. Iron-fortified infant cereal, about 125 ml or more per day and meat, fish, poultry, cooked egg yolk, lentils, beans, and tofu are important. Soft vegetables and fruit are also recommended to include into baby%26rsquo;s nutrition from 9 to 12 months. You could also try with soft, diced family foods, but let your baby feed themselves, with fingers or a spoon. By 1 year, your baby should be eating the same meals as the rest of the family, except foods that may cause choking. Health professionals recommend that egg white not be given to babies until 1 year to lower the chance of an allergic reaction baby could develop.

What about cow%26rsquo;s mlk?

Breastfeeding is recommended until your baby is 2 years old and longer so when your baby is 9-12 months old and taking a variety of solid foods, it is okay to offer small amounts of whole milk. Whole milk may be substituted for breast milk or formula when your baby is 1 or more year old. Babies and toddlers need fat in their diets for brain development. That is why, choose whole milk until age of two years. Lower-fat milk can be offered after that age. Other drinks such as soy or rice beverages may be offered after baby is two years old, but check the label to make sure they are fortified with calcium and vitamin D. If you choose whole goat milk, make sure it is pasteurized, and since most goat milk does not contain vitamin D, in which case your baby would need a vitamin D supplement.

Fruit juice

Fruit juices may be introduced at 4 months, but do not introduce a new juice the same day as a new food. Vitamin C fortified and no sugar added infant juices are an excellent source of vitamin C for baby. Start with single ingredient juices of apple, grape and pear. You should not start the citrus juices such as orange and grapefruit until 6 months, as these are not tolerated well. It is very important for you to know not to give soda, fruit punch, fruit drinks, or kool aid. You must know these are not fruit juices. They are mostly food coloring, sugar, and water, so read the label to be sure that juice is the first ingredient and avoid juice with added sugar. Your baby%26rsquo;s stools will change with the introduction of new foods so you should not be worried about that.

Introducing vegetables and fruits

You have probably heard that it is better to offer vegetables before offering fruit to your baby. The reason is that fruit is sweeter, so your baby may not accept vegetables if they are started after fruit. Start with the orange vegetables first as well with carrots, squash, sweet potatoes, then try green vegetables such as peas and green beans. Try one new vegetable for 3-4 days before starting another one. Start with one to three teaspoons once a day. You could gradually increase this to four tablespoons a day. Once the baby is doing well with vegetables, you may add fruits to its nutrition. Start with plain, single ingredient fruits such as bananas, applesauce, pears, apricot, peaches or plums, around one to three teaspoons once a day. Gradually increase this to four tablespoons, but do not feed the baby directly from the jar. Take out the amount needed for a feeding and put it in a dish, and cover the jar of leftover baby food and refrigerate it immediately. This will avoid spoiling the rest of the jar, so that one jar of baby food can be used few days, not more then three. Do not add salt, sugar, honey or spices to baby foods and never give honey to a baby less than 1 year old. The reason is that honey can give a baby Botulism, a type of food poisoning that can cause death. Help your baby develop healthy food habits and a relaxed feeling about eating, so offer appropirate food at regular times. Sit down and eat with your child because babies and children enjoy company while eating. You decide what foods to offer but let your baby decide how much and whether to eat.

Safety tips

Always stay with your baby while he or she is eating or drinking and avoid foods that can cause choking such as popcorn, peanuts, nuts, hard candies, carrots. Try to avoid other hard raw vegetables, whole marshmallows, jellybeans, globs of peanut butter, ice cubes, and chips. Hot dogs and grapes should be sliced lengthwise first, then into small pieces, while milk, juice, and soft cheese, such as feta, brie and camembert should be pasteurized. Feed only breast milk or infant formula until your baby is 4 months old and at 4 months of age, you may begin to introduce solid foods. Start with the single grain iron-fortified cereals such as rice, barley and oatmeal. Next you may start orange vegetables, then green vegetables and fruits should be introduced last.

Anxiety symptoms and treatment

2009-02-07T23:16:00.000-05:00

Anxiety attacks can be reduced and eliminated by changing one’s behavior. Stress management techniques, aerobic exercise, and meditation may help people suffering from anxiety. The goal is to calm, for everyone who has experienced anxiety attacks must know that caffeine, illicit drugs, and eve...
Anxiety attacks can be reduced and eliminated by changing one%26rsquo;s behavior. Stress management techniques, aerobic exercise, and meditation may help people suffering from anxiety. The goal is to calm, for everyone who has experienced anxiety attacks must know that caffeine, illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorder. However, it is very important to recognize the anxiety symptoms and be aware of the correct treatment once an attack occurs.

What is anxiety?

Fear is the human%26rsquo;s body innate response to actual danger or threat. Anxiety is also a body's reaction to a perceived, anticipated or imagined danger or threatening situation. Anxiety comes in many different forms. This disorder might be a fear of snakes or spiders, or stage fright before an important speech. However, it may also be a non-stop worry about one%26rsquo;s parenting skills, or a constant fretting about success at work. Others might not think that someone%26rsquo;s feelings of anxiety are rational or logical, but in the patient%26rsquo;s mind the dangers or fears they perceive are very real.
Anxiety is a common occurrence. Most people experience it before or after stressful situations or traumatic events. Anxiety symptoms could also develop spontaneously, even when a threatening situation is not immediately apparent. Anxiety represents a continuum including everything from ordinary symptoms of distress up to life consuming disabilities, and most people who suffer from anxiety fall somewhere in between.

What is an anxiety attack, and what is an anxiety disorder?

If a patient is suffering from an anxiety disorder, anxiety is much more than an occasional nervousness and fear. Characteristics of an anxiety disorder include anxiety which is constant, unrelenting and all-consuming. It also includes anxiety that causes self-imposed isolation or complete emotional withdrawal, and an anxiety that prevents certain normal activities, such as going outside or interacting with other people.

Anxiety attacks, also known as panic attacks, are unexpected episodes of intense terror or fear that usually come without warning. Although the fear is generally irrational, the perceived danger is very real, and the person experiencing an anxiety attack will often feel as if they are about to die or pass out, so this could be particularly frightening. It is because overwhelming fear and worry can easily take over and make life seem like it is just too hard for these people to live.

What are the symptoms of anxiety attacks and disorders?

Anxiety produces physical symptoms such as rapid or irregular heartbeat (palpitations), stomach problems or gnawing feeling, nausea, butterflies, diarrhea, irritated bowel syndrome, sweating, or feeling cold and clammy. Possible symptoms are also headaches, lightheadedness or dizziness, body tension or aches, fatigue or shortness of breath, shaking, trembling or twitching, difficulty or staying asleep, hot flashes or chills, as well as chest pain, rubbery legs, and a tingling in fingers or toes.
At the same time, emotional symptoms of anxiety include a general sense of apprehension and dread, nervousness, jumpiness, irritation, fearfulness or terror, isolation from others, feeling incredibly self-conscious and insecure, and a fear of dying or going crazy, as well as a strong desire to escape. General anxiety may produce symptoms that are chronic and long-lasting. The symptoms of an anxiety attack will usually come on suddenly and without warning, unless you know what triggers your attacks. Symptoms may last only while an attack is taking place, or may be present all the time.

What are the types of anxiety disorders?

There are several of the most commonly experienced types of anxiety attacks and disorders.

-Generalized anxiety disorder occurs if you feel consistently anxious for reasons which are not always apparent. Anxiety related to GAD often manifests itself in physical symptoms like headaches, upset stomachs, and fatigue.

-Obsessive compulsive disorder has unwanted thoughts or behaviors that seem impossible to stop or control as the main symptom.

-Panic attacks/panic disorder is a type of anxiety characterized by repeated, unexpected panic attacks. Panic disorders may also be accompanied by agoraphobia, a type of anxiety associated with being in places where escape or help is not perceived to be possible.

-Phobia is a type of anxiety that involves an extreme, unrealistic fear of a specific object or activity, such as a particular animal, or of flying, or of certain situations such as being in open spaces, or in social situations. Usually phobias cause unrelenting fear and physical symptoms that prevent the person from facing that fear.

-Separation anxiety is a normal developmental stage experienced by a child when separated from its primary caregiver. It consists of crying and distress when a child is away from a parent or home. If separation anxiety continues to occur beyond a certain age or when it negatively impairs life or activities, it may need to be addressed and treated.

-Social anxiety/social phobia can be thought of as an extreme shyness. It could be extreme to the point of avoiding social situations and causing disruption to social and professional relationships.

Self-treatments for anxiety control

To a certain extent, anxiety is a normal part of everyday life, but anxiety disorders occur when anxiety symptoms become uncontrollable and overwhelming. The combination of factors that cause an anxiety disorder may be out of your control. If you are feeling overwhelmed, you should seek help. Social and lifestyle choices do play a role in feeling anxious, and you can learn techniques to manage your daily anxiety. You could also learn to take steps to reduce sources of anxiety. There are some strategies that may help combat the anxiety, stress and fear you feel on a day-to-day basis.

-Physical exercise is very important, so try to exercise regularly. Pay special attention to exercises involving the large muscle groups, like walking or jogging. Give up alcohol and drugs. Eat a healthy, balanced diet rich in fruits and vegetables. Eliminate caffeine from your life and do it slowly. You should notice a difference in your stress and anxiety levels during the time.

-Social treatment could also help, so cultivate a support system. Try to spend as much time as possible with people who make you feel good. Share your troubles, thoughts and fears with friends, family or a therapist. A journal might also be a helpful way of recording things that cause make you anxious, stressed or hurt. You should also know that helping someone else can take your mind off your worries and give you a different perspective. Volunteering on a regular basis, or helping someone in need from your neighborhood, church, or community can give you a break from yourself. Try to improve your intimate love relationships. especially if your anxiety stems from early life issues that interfere with your ability to build safe, trusting relationships. If this is the case with you, you may benefit from learning ways to improve love relationships.

-Mental exercise and relaxing is important, so take a time-out for play, recreation and relaxation, and try to spend time doing hobbies or activities you really enjoy. Identify your stress or anxiety triggers and try to limit the known stress factors in your life. Avoid difficult colleagues, family members, and acquaintances as much as it is possible. It would be wise to lower your expectations, so if you are feeling anxious because people or situations are not living up to your expectations, adjust them appropriately.

Try to shift gears, and if you notice an anxiety or panic attack coming on, try to break the cycle before it takes over. Stop what you are doing and do something athletic, like going for a walk or a run, or do something that you really enjoy, such as painting or knitting, to shift your thoughts. You could also become your own expert, read books, visit websites, go to lectures and workshops, and talk to your doctor and therapist. Learning more about your anxiety will help you get the best treatment and enable you to conquer your fears and improve the best treatment results. You probably know that laughter is very healthy, so laugh as much as possible and seek out things and people that you find amusing. It would be nice to find humor or absurdity in stressful situations.

Medications for anxiety disorders

Some kinds of anxiety are readily controlled by medications, which can be prescribed and monitored by a psychiatrist. The use of medications is somewhat controversial so be sure to research the options before deciding if medication is the best course of treatment. Most antidepressants are started at a low dosage and gradually increased to minimize the risk of serious side effects that are possible to occur. Antidepressants typically take weeks to affect symptoms of anxiety disorder. Some commonly prescribed drugs include fluoxetine or Prozac, sertraline or Zoloft, fluvoxamine or Faverin, paroxetine or Paxil and citalopram or Celexa. Anti-anxiety medications should only be taken for short time periods because they can become addictive and less effective over time. When going off benzodiazepines, it is important to gradually reduce the dosage amount to prevent possible withdrawal symptoms. Common brand names for benzodiazepines are Valium, Xanax, Klonopin, and Ativan.