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Shoulder Repair Technique Borrows From Cadavers

March 9th, 2010

Patients who frequently experience shoulder dislocations can benefit from a procedure that “sculpts” a new shoulder using bone and cartilage from cadavers, new research suggests.

The study, published in the December issue of the American Journal of Sports Medicine, finds that the procedure could be an alternative to methods that stabilize or reconstruct a shoulder joint by repairing ligaments and tissues.

“In situations where there’s missing bone… the soft tissues see forces that are much higher than they can withstand and they fail,” Dr. Jon Sekiya, surgeon and associate professor at the University of Michigan Health System, said in a university news release.

In the new procedure, doctors “transfer and transplant the tissue from a cadaver to a human by matching it with X-rays to make sure the sizes are appropriate, then in surgery we actually shape it to be the same shape and consistency as the patient and then secure it in there and let it heal,” Sekiya explained.

“We’ve been very successful at this. We’ve been able to stabilize shoulders that have been dislocating recurrently and have even failed one, two, sometimes three surgical procedures that did not address the bone and cartilage damage,” he added in the news release.

Loneliness May Be Catching

February 21st, 2010

A new study suggests that lonely people attract fellow “lonelies” and influence others to feel lonely, too.

“Loneliness can spread from person to person to person — up to three degrees of separation,” said James H. Fowler, co-author of the study published in the December issue of the Journal of Personality and Social Psychology, and professor of political science at the University of California, San Diego.

“What this means is that if I don’t know anything about you, but I know your friend’s friend is lonely, then I can do better than chance at predicting whether or not you will be lonely,” he said.

Indeed, the study suggests that not only is loneliness contagious, but lonely people tend to isolate themselves in small groups that somehow compound or increase those feelings of solitude.

According to Fowler, the data suggests that the average person feels lonely about 48 days a year, but for the lonely, that feeling can be ever-present. In addition, the study indicated that people who felt lonely were more likely to be friendless, or constantly shedding friends, a few years later: Compared with those who are never lonely, lonely people can lose about 8 percent of their friends over a four-year period, for instance.

Fowler co-authored the findings, funded by the U.S. National Institute on Aging, with John T. Cacioppo, professor at the University of Chicago, and Nicholas A. Christakis, professor at Harvard University. The researchers worked with more than 5,100 participants who were the offspring of the original subjects of the landmark Framingham Heart Study.

The team constructed graphs tracking the participants’ ongoing friendship patterns over two to four years. They found that, among neighbors, an increase of loneliness of just one day per week triggered a rise in loneliness among neighbor-friends, as well. And that loneliness actually spread throughout the community as affected neighbors saw each other less, the researchers said.

Women appeared more vulnerable than men to “catching” loneliness, the researchers found.

Mark R. Leary, professor and director of the social psychology program at Duke University, whose work zeroes in on the need for social acceptance, called the study impressive in its sample, analysis and conclusion. He added that the contagion of loneliness could be, to some degree, a situation of people mimicking the styles of those around them.

“Non-lonely people who are exposed to lonely people may make others in their network a little more lonely by behaving in these less-affirming ways. Perhaps this is why the effect of loneliness can be seen at three degrees of separation. My friend has a lonely friend, so my friend starts acting less affirming overall, which makes me act a little less positively, which then affects my other friends.”

So what can be done to help the lonely, to integrate them better with others? Leary suggested that those who interact with lonely people recognize that their tendency to pull inward emotionally and be less outgoing is a trait of loneliness, not of something else. “It reflects loneliness and a need for connection, rather than indifference, dislike or rejection. People can reach out to their lonely loved one rather than withdraw themselves,” he said.

Fowler agreed. “For the mental health provider, this means treating not just the patient, but potentially also the patient’s friends,” he said. “For the employer, this means emphasizing activities that help their employees to connect to one another socially. For the family member, this means you should tend to your own networks, too, while you help your kin feel more connected.”

Taxol Boosts Odds of Chronic Pain

February 15th, 2010

The chemotherapy drug paclitaxel (Taxol) increases the risk of chronic neuropathic pain in breast cancer survivors, a new study shows.

It included 240 women who took part in clinical trials of Taxol between 1994 and 2001. Those who experienced chemotherapy-induced peripheral neuropathy during their treatment with Taxol were three times more likely to eventually be diagnosed with chronic neuropathic pain.

The study is published in the November issue of the Journal of Pain.

The findings indicate that patients treated with Taxol should be regularly monitored for neuropathic pain after their chemotherapy ends, said the researchers from the University of Texas M.D. Anderson Cancer Center.

In certain cases, patients and doctors should review the risks and benefits for continuing treatment with Taxol if a patient is likely to experience worsening neuropathy, the study authors added.

They noted that the same cellular mechanism that’s altered by Taxol to kill tumors can be toxic to normal tissue.

New Heart Attack Treatment Guidelines Stress Coordination

February 7th, 2010

There’s a message for doctors, hospitals and communities in new guidelines for treatment of coronary disease and heart attacks: Get organized.

Every community should have an organized system of emergency care for heart attacks, including programs to identify patients before they get to hospitals and strategies for getting them to medical centers equipped to perform artery-opening procedures, say the guidelines issued by the American Heart Association, the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.

“The focus on integrated systems for patients with STEMI is important,” said Dr. Sidney C. Smith Jr., a professor of medicine at the University of North Carolina, a past president of the American Heart Association and co-chair of the group that wrote the guidelines. “It affects a large number of the population that have heart attacks and will improve their treatment for sure.”

STEMI is an acronym derived from the pattern seen on an electrocardiogram in the most severe form of heart attacks. The goal is to get a heart attack victim as quickly as possible to a medical center for what is formally called percutaneous coronary intervention (PCI) — insertion of a balloon-tipped catheter into a blocked heart artery to reopen the blood vessel, usually followed by implantation of a stent, a thin tube, to be sure it remains open.

“The general recommendation is to move a patient if at all possible directly to hospitals where they are able to do immediate angioplasty [PCI],” said Dr. Spencer B. King III, president of the St. Joseph’s Heart and Vascular Institute in Atlanta, a past president of the American College of Cardiology and co-chair of the guidelines group. “If that is not possible, then there should be very rapid transport to hospitals that do angioplasty.”

The guidelines include recommendations on changes in treatment of heart attacks and coronary disease based on new research findings. For example, stenting now is recommended in many cases where the left main coronary artery, which provides blood to the majority of the heart, is blocked.

“It was previously thought not advisable to do it, but to go directly to bypass surgery,” King said. “But evidence continues to build that for some patients with left main blockage, stenting should be considered.”

Several studies, notably one from Korea, found similar outcomes for stenting or surgery in treating left main artery blockage, King said.

Other technical issues covered by the guidelines include:
Recommendations on use of a powerful new clot-dissolving drug, prasugrel (Effient), as an alternative to clopidogrel (Plavix), commonly prescribed after PCI. The greater ability of the new drug to dissolve clots does carry an added danger of excessive bleeding.
Use of a wire threaded into the coronary artery to gauge whether build-up of plaque deposits are great enough to warrant PCI.
Use of aspiration thrombectomy, in which the clot causing a heart attack is sucked out before a stent is implanted.
Recommendations on use of blood thinners and clot-dissolvers before, during or after PCI.
Recommendations on the types of X-ray dye used to view the heart arteries during PCI in patients with chronic kidney disease.

“But the big recommendation is that we need to improve the system of how patients get into one hospital when they are having a heart attack and then get into another hospital, if necessary,” Smith said.

To eat less, your body may want you to eat slowly

January 24th, 2010

Your mother’s advice to slow down at meal time may have been wise after all: a new study suggests that shoveling down your food blocks the body’s natural appetite-control process.

“Most of us have heard that eating fast can lead to food overconsumption and obesity, and in fact some…studies have supported this notion,” Dr. Alexander Kokkinos, the lead researcher on the study, said in a written statement.

What has been missing, however, is biological evidence that a leisurely meal is better for appetite control, according to Kokkinos and his colleagues at Athens University Medical School in Greece and the Imperial College London in the UK.

To study the question, the researchers had 17 healthy men eat a generous portion of ice cream under two different conditions: in one, they ate the treat in two servings over 5 minutes; in the other, they ate it in small servings over 30 minutes.

Although the groups’ feelings of fullness and hunger did not seem to differ, the researchers found that when the men ate slowly, they showed higher blood levels of two hormones — peptide YY (PYY) and glucagon-like peptide 1 (GLP-1) — for roughly three hours after the meal.

Both PYY and GLP-1 are released from the digestive tract as a “fullness” signal to the brain, curbing appetite and calorie intake.

The findings, to be published in an upcoming issue of the Journal of Clinical Endocrinology & Metabolism, give more weight to the conventional wisdom that people should savor their food.

Some previous research has found that when people take the time to chew their food thoroughly and enjoy a meal, they tend to eat fewer calories than when they have that same meal at an eat-and-run pace.

The reasons for that have been unclear, however.

“Our study provides a possible explanation for the relationship between speed eating and overeating by showing that the rate at which someone eats may impact the release of gut hormones that signal the brain to stop eating,” Kokkinos said.

The findings are particularly relevant in a time when many people are relying on fast food and regularly eating on the run, according to Kokkinos. The study suggests that slowing down at meal time could aid appetite control, and ultimately weight control.

They are a possible scientific explanation for “the warning we were given as children that ‘wolfing down your food will make you fat,’” Kokkinos said.

Pneumonia Can Be Prevented – Vaccines Can Help

January 8th, 2010

Pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. Globally, pneumonia causes more deaths than any other infectious disease, such as AIDS, malaria or tuberculosis. However, it can often be prevented with vaccines and can usually be treated with antibiotics or antiviral drugs.

Every 15 seconds, somewhere in the world, a child dies from pneumonia. Many of these deaths are preventable through vaccination and appropriate treatment.

What Is Pneumonia?

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia. This includes adults 65 years of age or older and children less than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia.

Causes

When bacteria, viruses or, rarely, fungi living in your nose, mouth, sinuses, or the environment spread to your lungs, you can develop pneumonia or other infections. You can catch the bacteria or viruses from people who are infected with them, whether they are sick or not.

Types of Pneumonia

You may have heard of community-acquired pneumonia (CAP). When someone who hasn’t recently been in the hospital or another healthcare facility develops pneumonia, it’s called community-acquired.

Pneumonia is associated with healthcare when someone gets the infection during or following a stay in a healthcare facility (like hospitals, long-term care facilities, and dialysis centers). These infections are labeled healthcare-associated pneumonias, which includes healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).

In the U.S., the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) and the most common viral causes are influenza, parainfluenza, and respiratory syncytial viruses. In children less than 1 year of age, respiratory syncytial virus (RSV) is the most common cause of pneumonia. Other common bacterial and viral causes of pneumonia in the U.S. include Staphylococcus aureus and adenovirus. Pneumocystis jirovecii, a fungus formerly known as Pneumocystis carinii, is a common cause of pneumonia in patients with AIDS.

Reduce Your Risk

Pneumonia can be prevented with vaccines. Following good hygiene practices can also help prevent respiratory infections. This includes washing your hands regularly, cleaning hard surfaces that are touched often (like doorknobs and countertops), and coughing or sneezing into a tissue or into your elbow or sleeve. You can also reduce your risk of getting pneumonia by limiting exposure to cigarette smoke and treating and preventing conditions like diabetes and HIV/AIDS.

In the U.S., there are several vaccines that prevent infection by bacteria or viruses that may cause pneumonia. These vaccines include:
Pneumococcal,
Haemophilus influenzae type b (Hib),
Pertussis (whooping cough),
Varicella (chickenpox),
Measles; and
Seasonal and 2009 H1N1 influenza (flu) vaccines.
National and Global Impact

In 2006, 1.2 million people in the U.S. were hospitalized with pneumonia and 55,477 people died from the disease.

Globally, pneumonia kills more than 4 million people every year – half of these deaths occur among children less than 5 years of age. This is greater than the number of deaths from any other infectious disease, such as AIDS, malaria or tuberculosis. Access to vaccines and treatment (like antibiotics and antivirals) can help prevent many pneumonia-related deaths. Pneumonia experts are also working to prevent pneumonia in developing countries by reducing indoor air pollution and encouraging good hygiene practices.

Noise Hurts Men’s Hearing More, Study Shows

December 23rd, 2009

New research suggests that men — especially married white men — are much more likely to develop noise-induced hearing loss than women. But there’s some good news: Another study finds that older men who take high doses of folate can decrease their risk of hearing loss by 20 percent.

The figures regarding hearing loss in men and women come from a study of hearing-test data from 5,290 people aged 20 to 69. An estimated 13 percent of them will suffer from noise-induced hearing loss, which researchers think affects about 24 million Americans.

The condition, caused by exposure to loud noise, is preventable.

Among the subjects, men were two-and-a-half times more likely than women to develop this type of hearing loss. Married, non-Hispanic white men had the highest risk, the study authors pointed out.

In another study, researchers found that increased doses of antioxidant vitamins don’t improve a man’s chances of avoiding hearing loss. But folate — a type of vitamin B — reduced the risk by 20 percent in men older than 60.

The findings came from a study of 3,559 men with hearing loss. Higher doses of antioxidant vitamins, such as vitamins C, E and beta carotene, had no effect, the researchers said.

Foods with high levels of folate include leafy vegetables such as spinach, lettuce and asparagus; dried or fresh beans; peas; liver products; and fortified cereal products.

The researchers pointed out that their study is the largest to look into links between diet and hearing loss.

Routine Testing Would Improve Herceptin Use in Breast Cancer

December 1st, 2009

New research suggests that the anti-breast cancer drug trastuzumab, also known as Herceptin, isn’t reaching its full potential. Many patients aren’t receiving tests that determine whether it’s appropriate or are taking it when they don’t need to.

Under current guidelines, women with breast cancer in its early stages should receive tests to see if Herceptin might be appropriate for them.

In the new study, researchers analyzed medical data to see if testing has become routine. Their findings will appear in the Nov. 15 issue of the journal Cancer.

As many as two-thirds of patients who were eligible for the testing didn’t appear to have had it. And about 20 percent of those who did take the drug appeared to have not taken the test to see if it could work for them in the first place, the researchers found.

In another complication, the research suggests that about one in five tests is inaccurate.

Filling the gaps in care “may help optimize limited health-care resources and improve care for women with breast cancer,” said study co-author Dr. Elena Elkin, a researcher at Memorial Sloan-Kettering Cancer Center in New York, in a news release from the journal’s publisher.

Doctors are increasingly trying to fine-tune treatments so they specifically target the disease in a particular patient, the researchers noted.

Routine Testing Would Improve Herceptin Use in Breast Cancer

December 1st, 2009

New research suggests that the anti-breast cancer drug trastuzumab, also known as Herceptin, isn’t reaching its full potential. Many patients aren’t receiving tests that determine whether it’s appropriate or are taking it when they don’t need to.

Under current guidelines, women with breast cancer in its early stages should receive tests to see if Herceptin might be appropriate for them.

In the new study, researchers analyzed medical data to see if testing has become routine. Their findings will appear in the Nov. 15 issue of the journal Cancer.

As many as two-thirds of patients who were eligible for the testing didn’t appear to have had it. And about 20 percent of those who did take the drug appeared to have not taken the test to see if it could work for them in the first place, the researchers found.

In another complication, the research suggests that about one in five tests is inaccurate.

Filling the gaps in care “may help optimize limited health-care resources and improve care for women with breast cancer,” said study co-author Dr. Elena Elkin, a researcher at Memorial Sloan-Kettering Cancer Center in New York, in a news release from the journal’s publisher.

Doctors are increasingly trying to fine-tune treatments so they specifically target the disease in a particular patient, the researchers noted.