Newswise,
January 29, 2016– Older people with higher amounts of a key protein in their
brains also had slower decline in their memory and thinking abilities than
people with lower amounts of protein from the gene called brain-derived
neurotrophic factor, or BDNF, according to a study published in the January 27,
2016, online issue of Neurology®, the medical journal of the American
Academy of Neurology.
“This
relationship was strongest among the people with the most signs of Alzheimer’s
disease pathology in their brains,” said study author Aron S. Buchman, MD, of
Rush University Medical Center in Chicago and a member of the American Academy
of Neurology.
“This
suggests that a higher level of protein from BDNF gene expression may provide a
buffer, or reserve, for the brain and protect it against the effects of the
plaques and tangles that form in the brain as a part of Alzheimer’s disease.”
For
the study, 535 people with an average age of 81 were followed until death, for
an average of six years.
They
took yearly tests of their thinking and memory skills, and after death, a
neurologist reviewed their records and determined whether they had dementia,
some memory and thinking problems called mild cognitive impairment or no
thinking and memory problems.
Autopsies
were conducted on their brains after death, and the amount of protein from BDNF
gene expression in the brain was then measured. The participants were part of
the Rush Memory and Aging Project and the Religious Orders Study.
The
rate of cognitive decline was about 50 percent slower for those in the highest
10 percent of protein from BDNF gene expression compared to the lowest 10
percent.
The
effect of plaques and tangles in the brain on cognitive decline was reduced for
people with high levels of BDNF. In the people with the highest amount of
Alzheimer’s disease hallmarks in their brains, cognitive decline was about 40
percent slower for people with the highest amount of protein from BDNF gene
expression compared to those with the lowest amount.
On
average, thinking and memory skills declined by about 0.10 units per year on
the tests. Higher levels of protein from BDNF gene expression reduced the
effect of plaques and tangles in the brain on cognitive decline by 0.02 units
per year.
The
researchers found that the plaques and tangles in the brain accounted for 27
percent of the variation in cognitive decline, demographics accounted for 3
percent and BDNF accounted for 2 percent.
Michal
Schnaider Beeri, PhD, of the Icahn School of Medicine at Mount Sinai in New York,
noted in an accompanying editorial that exercise has been shown to increase
levels of BDNF in the blood, but that the relationship between BDNF protein
levels in the blood and in the brain is not clear.
“More
research is needed to confirm these findings, determine how this relationship
between protein produced by BDNF gene expression and cognitive decline works
and see if any strategies can be used to increase BDNF in the brain to protect
or slow the rate of cognitive decline,” said Buchman.
Buchman
noted that the study does not prove that BDNF is the cause of a slower rate of
cognitive decline; further work is needed to determine if activities which
increase brain BDNF gene expression levels protect or slow the rate of
cognitive decline in old age.
The
study was supported by the National Institutes of Health, Illinois Department
of Public Health and the Robert C. Borwell Endowment Fund.
The
American Academy of Neurology, an association of 30,000 neurologists and
neuroscience professionals, is dedicated to promoting the highest quality
patient-centered neurologic care. A neurologist is a doctor with specialized training
in diagnosing, treating and managing disorders of the brain and nervous system
such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain
injury, Parkinson’s disease and epilepsy
Newswise,
January 29, 2016 — A recent study by Jamie Desjardins, Ph.D., an assistant
professor in the speech-language pathology program at The University of Texas
at El Paso, found that hearing aids improve brain function in persons with
hearing loss.
Hearing
loss, if left untreated, can lead to serious emotional and social consequences,
reduced job performance and diminished quality of life. Untreated hearing loss
also can interfere with cognitive abilities because so much effort is put
toward understanding speech.
“If
you have some hearing impairment and you’re not using hearing aids, maybe you
can figure out what the person has said, but that comes with a cost,”
Desjardins explained. “You may actually be using the majority of your cognitive
resources – your brain power – in order to figure out that message.”
As
people age, basic cognitive skills – working memory, the ability to pay
attention to a speaker in a noisy environment, or the ability to process
information quickly – begin to decline.
Desjardins
studied a group of individuals in their 50s and 60s with bilateral sensorineural
hearing loss who had previously never used hearing aids.
They
took cognitive tests to measure their working memory, selective attention and
processing speed abilities prior to and after using the hearing aids.
After
two weeks of hearing aid use, tests revealed an increase in percent scores for
recalling words in working memory and selective attention tests, and the
processing speed at which participants selected the correct response was
faster.
By
the end of the study, participants had exhibited significant improvement in
their cognitive function.
“Most
people will experience hearing loss in their lifetime,” said Desjardins, who
joined UTEP in 2013. “Think about somebody who is still working and they’re not
wearing hearing aids and they are spending so much of their brainpower just
trying to focus on listening.
“They
may not be able to perform their job as well. Or if they can, they’re exhausted
because they are working so much harder. They are more tired at the end of the
day and it’s a lot more taxing. It affects their quality of life.”
Hearing
loss affects more than 9 million Americans over the age of 65 and 10 million
Americans ages 45 to 64, but only about 20 percent of people who actually need
hearing aids wear them, Desjardins said.
Desjardins’
new study focuses on the use of hearing aids by Hispanics. Research shows that
only five percent of Mexican-Americans wear hearing aids. She has developed a
survey to investigate their attitudes toward hearing loss. The survey will be
conducted at health fairs in the community, including the Mexican Consulate in
El Paso, Texas.
Desjardins
also will begin work on another study that will look at older bilingual people
and their ability to understand speech.
Data
from the Salk Institute shows brain’s memory capacity is in the petabyte range,
as much as entire Web
Newswise,
January 27, 2016—Salk researchers and collaborators have achieved critical
insight into the size of neural connections, putting the memory capacity of the
brain far higher than common estimates.
The
new work also answers a longstanding question as to how the brain is so energy
efficient and could help engineers build computers that are incredibly powerful
but also conserve energy.
“This
is a real bombshell in the field of neuroscience,” says Terry Sejnowski, Salk
professor and co-senior author of the paper, which was published in eLife.
“We
discovered the key to unlocking the design principle for how hippocampal
neurons function with low energy but high computation power.
“Our
new measurements of the brain’s memory capacity increase conservative estimates
by a factor of 10 to at least a petabyte, in the same ballpark as the World
Wide Web.”
Our
memories and thoughts are the result of patterns of electrical and chemical
activity in the brain.
A key part of the activity happens when
branches of neurons, much like electrical wire, interact at certain junctions,
known as synapses. An output ‘wire’ (an axon) from one neuron connects to an
input ‘wire’ (a dendrite) of a second neuron.
Signals
travel across the synapse as chemicals called neurotransmitters to tell the
receiving neuron whether to convey an electrical signal to other neurons. Each
neuron can have thousands of these synapses with thousands of other neurons.
“When
we first reconstructed every dendrite, axon, glial process, and synapse from a
volume of hippocampus the size of a single red blood cell, we were somewhat
bewildered by the complexity and diversity amongst the synapses,” says Kristen
Harris, co-senior author of the work and professor of neuroscience at the
University of Texas, Austin.
“While I had hoped to learn fundamental principles
about how the brain is organized from these detailed reconstructions, I have
been truly amazed at the precision obtained in the analyses of this report.”
Synapses
are still a mystery, though their dysfunction can cause a range of neurological
diseases. Larger synapses—with more surface area and vesicles of
neurotransmitters—are stronger, making them more likely to activate their
surrounding neurons than medium or small synapses.
The
Salk team, while building a 3D reconstruction of rat hippocampus tissue (the
memory center of the brain), noticed something unusual.
In
some cases, a single axon from one neuron formed two synapses reaching out to a
single dendrite of a second neuron, signifying that the first neuron seemed to
be sending a duplicate message to the receiving neuron.
At
first, the researchers didn’t think much of this duplicity, which occurs about
10 percent of the time in the hippocampus.
But
Tom Bartol, a Salk staff scientist, had an idea: if they could measure the
difference between two very similar synapses such as these, they might glean
insight into synaptic sizes, which so far had only been classified in the field
as small, medium and large.
To
do this, researchers used advanced microscopy and computational algorithms they
had developed to image rat brains and reconstruct the connectivity, shapes,
volumes and surface area of the brain tissue down to a nanomolecular level.
The
scientists expected the synapses would be roughly similar in size, but were
surprised to discover the synapses were nearly identical.
“We
were amazed to find that the difference in the sizes of the pairs of synapses
were very small, on average, only about eight percent different in size. No one
thought it would be such a small difference. This was a curveball from nature,”
says Bartol.
Because
the memory capacity of neurons is dependent upon synapse size, this eight
percent difference turned out to be a key number the team could then plug into
their algorithmic models of the brain to measure how much information could
potentially be stored in synaptic connections.
It
was known before that the range in sizes between the smallest and largest
synapses was a factor of 60 and that most are small.
But
armed with the knowledge that synapses of all sizes could vary in increments as
little as eight percent between sizes within a factor of 60, the team
determined there could be about 26 categories of sizes of synapses, rather than
just a few.
“Our
data suggests there are 10 times more discrete sizes of synapses than
previously thought,” says Bartol. In computer terms, 26 sizes of synapses
correspond to about 4.7 “bits” of information.
Previously,
it was thought that the brain was capable of just one to two bits for short and
long memory storage in the hippocampus.
“This
is roughly an order of magnitude of precision more than anyone has ever
imagined,” says Sejnowski.
What
makes this precision puzzling is that hippocampal synapses are notoriously
unreliable. When a signal travels from one neuron to another, it typically
activates that second neuron only 10 to 20 percent of the time.
“We
had often wondered how the remarkable precision of the brain can come out of
such unreliable synapses,” says Bartol.
One
answer, it seems, is in the constant adjustment of synapses, averaging out
their success and failure rates over time. The team used their new data and a
statistical model to find out how many signals it would take a pair of synapses
to get to that eight percent difference.
The
researchers calculated that for the smallest synapses, about 1,500 events cause
a change in their size/ability (20 minutes) and for the largest synapses, only
a couple hundred signaling events (1 to 2 minutes) cause a change.
“This
means that every 2 or 20 minutes, your synapses are going up or down to the
next size. The synapses are adjusting themselves according to the signals they
receive,” says Bartol.
“Our
prior work had hinted at the possibility that spines and axons that synapse
together would be similar in size, but the reality of the precision is truly
remarkable and lays the foundation for whole new ways to think about brains and
computers,” says Harris.
“The
work resulting from this collaboration has opened a new chapter in the search
for learning and memory mechanisms.” Harris adds that the findings suggest more
questions to explore, for example, if similar rules apply for synapses in other
regions of the brain and how those rules differ during development and as
synapses change during the initial stages of learning.
“The
implications of what we found are far-reaching,” adds Sejnowski. “Hidden under
the apparent chaos and messiness of the brain is an underlying precision to the
size and shapes of synapses that was hidden from us.”
The
findings also offer a valuable explanation for the brain’s surprising
efficiency. The waking adult brain generates only about 20 watts of continuous
power—as much as a very dim light bulb.
The
Salk discovery could help computer scientists build ultraprecise, but
energy-efficient, computers, particularly ones that employ “deep learning” and
artificial neural nets—techniques capable of sophisticated learning and
analysis, such as speech, object recognition and translation.
“This
trick of the brain absolutely points to a way to design better computers,” says
Sejnowski. “Using probabilistic transmission turns out to be as accurate and
require much less energy for both computers and brains.”
Other
authors on the paper were Cailey Bromer of the Salk Institute; Justin Kinney of
the McGovern Institute for Brain Research; and Michael A. Chirillo and Jennifer
N. Bourne of the University of Texas, Austin.
The
work was supported by the NIH and the Howard Hughes Medical Institute.
International Collaborative Study Led by Nova
Southeastern University Researcher
Newswise,
January 27, 2016 – A new study published in the online journal, Public Library
of Science One (PLOS One) found that Vitamin B12 levels in the brain are
significantly decreased in the elderly and are much lower in individuals with
autism or schizophrenia, as compared to their peers at similar ages.
For
example, children with autism under the age of 10 were found to have three
times lower brain B12 levels, which is similar to levels for generally healthy
adults in their 50s, indicating a premature decrease.
The
international research team led by Richard Deth, Ph.D., professor of
pharmacology at Nova Southeastern University’s (NSU) College of Pharmacy,
analyzed tissue from otherwise healthy deceased donors along with tissue from
donors who had autism or schizophrenia to make the comparisons.
“These
are particularly significant findings because the differences we found in brain
B12 with aging, autism and schizophrenia are not seen in the blood, which is
where B12 levels are usually measured.” said Dr. Deth.
“The
large deficits of brain B12 from individuals with autism and schizophrenia
could help explain why patients suffering from these disorders experience
neurological and neuropsychiatric symptoms.”
The
study also found healthy elderly people in the age range of 61-80 have about
three times lower levels of total brain B12 than younger age groups, which is a
result of normal aging. This normal decrease may help adjust brain metabolism
to sustain its function across the lifespan.
An
active form of B12 called methylcobalamin, or methyl B12, supports normal brain
development by its control through a process known as epigenetic regulation of
gene expression.
Remarkably,
the brain level of methyl B12 was found to be more than 10 times lower in
healthy elderly people than in healthy younger people. A lower than normal
level of methyl B12 in the brain could adversely affect neurodevelopment in
younger years and could disrupt learning and memory later in life.
Both
autism and schizophrenia are associated with oxidative stress, which also plays
an important role in aging, and oxidative stress may underlie the decreased
brain B12 levels observed in this study.
The
findings suggest the need for further research to determine if the use of
supplemental methyl B12 and antioxidants like glutathione could help prevent
oxidative stress and be useful in treating these conditions.
The
research team consisted of Dr. Deth; Yiting Zhang (Northeastern University);
Nathaniel Hodgson (Harvard University); Malav S. Trivedi (Nova Southeastern
University); Hamid Abdolmaleky (Boston University); and Margot Fournier, Michel
Cuenod and Kim Quang Do (Lausanne University, Switzerland).
Their
findings are published in the peer-reviewed journal, PLOS1 in an article titled
“Decreased brain levels of vitamin B12 in aging, autism and schizophrenia.”
Read the full article at: http://dx.plos.org/10.1371/journal.pone.0146797
Colorectal cancer in younger people linked to more
advanced disease but better survival
Newswise, January 27, 2016 — Nearly 15 percent of patients diagnosed with colorectal
cancer were younger than 50, the age at which screening recommendations begin.
The
study by researchers at the University of Michigan Comprehensive Cancer Center
also found that younger patients were more likely to have advanced disease. The
authors suggest this is in part because they are diagnosed only after their
cancers have grown large enough to cause symptoms.
“Colorectal
cancer has traditionally been thought of as a disease of the elderly. This
study is really a wake-up call to the medical community that a relatively large
number of colorectal cancers are occurring in people under 50,” says study
author Samantha Hendren, M.D., M.P.H., associate professor of surgery at the
University of Michigan Medical School.
“To
put this in context, breast cancer screening often begins at age 40, and less
than 5 percent of invasive breast cancers occur in women under that age. Our
study found that about 15 percent of colorectal cancers are diagnosed before
the screening age of 50,” she adds.
The
study identified 258,024 patients diagnosed with colon or rectal cancer from
the Surveillance, Epidemiology and End Results database, a national database of
cancer incidence. Results appear in the journal Cancer.
The
authors found that younger patients were more likely to receive aggressive
surgery and radiation therapy. In addition, this group had better survival
rates, both overall and by stage.
Among
patients whose cancer had spread to distant organs, 21 percent of younger
patients survived beyond five years, compared to 14 percent of older patients.
The
improved survival could be in part due to the more aggressive treatment, the
authors suggest.
The
findings suggest the need for more awareness of warning signs of colorectal
cancer: anemia, a dramatic change in the size or frequency of bowel movements,
and bleeding with bowel movements.
The
authors also say that more people need to consider family history of colorectal
cancer, which is a significant risk factor.
Should
guidelines change to begin screening at an earlier age? Hendren says not so
fast.
“This
would be a big and costly change, and I don’t know whether it would help more
people than it would hurt,” she says. “A lot of research would be required to
understand this before any changes should be made.”
Meanwhile,
the more aggressive treatment and longer survival for younger patients suggest
the need to improve long-term survivorship resources.
“The
cancer community needs to prepare for the increasing number of very young
colorectal cancer survivors who will need long-term support to cope with the
physical and psychological consequences of their disease and treatments,”
Hendren says.
Newswise,
January 27, 2016— Expanding lung cancer screening to include people who quit
smoking more than 15 years ago could detect more cases and further reduce
associated mortality, according to a study by Mayo Clinic researchers published
in the Journal of Thoracic Oncology.
“A
decline in smoking rates has been, and continues to be, a critical step to
reduce lung cancer risk and deaths,” says the study’s lead author Ping Yang,
M.D., Ph.D., an epidemiologist at Mayo Clinic Cancer Center.
“But,
it also means that fewer people have benefited from early detection of lung
cancer, because more patients don’t qualify for low-dose CT scans.”
The
current lung cancer screening criteria set by the U.S. Preventive Services Task
Force (USPSTF) recommends CT screening for adults between the ages of 55 and 80
who have smoked at least one pack a day for 30 years and are still smoking, or
have quit within 15 years.
In
a study published in JAMA in 2015, Dr. Yang and her colleagues found that
two-thirds of patients in the U.S. with newly diagnosed lung cancer would not
meet the current USPSTF screening criteria, suggesting a need to adjust the
definition of patients at high risk.
In
the current study, Dr. Yang and her colleagues set out to identify which
specific populations of individuals are at risk, but are being missed by the
current lung cancer screening criteria.
Researchers
retrospectively tracked two groups of people with lung cancer: a hospital
cohort made up of 5,988 individuals referred to Mayo Clinic and a community
cohort consisting of 850 residents of Olmsted County, Minnesota.
They
found that, compared to other risk categories, patients who quit smoking for 15
to 30 years accounted for the greatest percentage of patients with lung cancer
who didn’t qualify for screening.
The
newly defined high-risk group constituted 12 percent of the hospital cohort and
17 percent of the community cohort.
“We
were surprised to find that the incidence of lung cancer was proportionally
higher in this subgroup, compared to other subgroups of former cigarette
smokers,” says Dr. Yang.
“The
common assumption is that after a person has quit for so many years, the lung
cancer rate would be so low that it wouldn’t be noticeable. We found that
assumption to be wrong.
“This
suggests we need to pay attention to people who quit smoking more than 15 years
ago, because they are still at high risk for developing lung cancer.”
Equally
important, the current study found that expanding the criteria for CT screening
would not significantly add to the number of false-positive cases and would
save more lives with an acceptable amount of radiation exposure and cost.
Dr.
Yang and her colleagues showed that expanding the criteria to include this risk
category could add 19 percent more CT examinations for detecting 16 percent
more cases.
They
calculated the expansion would result in minimal increases in false-positive
results (0.6 percent), over diagnosis (0.1 percent), and radiation-related lung
cancer deaths (4 percent).
"Lung
cancer rates are dropping, because smoking is decreasing, but that doesn’t mean
that our current screening parameters are good enough,” Dr. Yang says.
“It
is understandable, because the relative importance of risk factors changes over
time. We need to adjust screening criteria periodically, so we can catch more
lung cancers in a timely fashion.
“Based
on our data, which are more recent and come from a well-defined population, I
think that we should take action to screen this group, which is at high risk of
developing the disease.”
She
recommends additional research to confirm if similar trends are being seen in
populations beyond Olmsted County Minnesota.
If
confirmed, she recommends that policymakers consider changing the lung cancer
screening guidelines to include people who quit smoking more than 15 years ago.
She also recommends that policymakers continue to re-examine lung cancer
screening criteria to account for changes in groups that are most at risk.
Visits
were made by cardiac surgery PAs actively involved in the patients’ care
Newswise, January 27, 2016 — Two home visits by a
physician’s assistant (PA) during the week after hospital discharge
significantly reduces the chance that a heart surgery patient will be
readmitted, and reduces overall costs associated with the heart surgery,
according to a scientific presentation at the 52nd Annual Meeting of The
Society of Thoracic Surgeons.
“Adult cardiac surgery
has one of the highest readmission rates for all hospitalized patients,” said
John P. Nabagiez, MD, from Staten Island University Hospital in New York, who
led the study. “Our study was designed to determine if two home visits by a
physician’s assistant could help reduce readmission rates following heart
surgery.”
Dr. Nabagiez and
colleagues analyzed hospital readmission rates of 1,185 patients who underwent
cardiac surgery from September 2008 through August 2012 at Staten Island
University Hospital in New York.
Patients were divided
into those who received home visits and those who did not receive visits
(control group). Readmission rates, lengths of stay, and healthcare costs were
compared between the two groups.
The patients who
received visits from PAs on days 2 and 5 following hospital discharge had a
significantly lower rate of readmission (10%) compared with those who did not
receive home visits (17%). This represents a 41% reduction in the rate of
readmission within the first 30 days following cardiac surgery.
“The physician’s
assistants who made the house calls in our study were fully trained cardiac
surgery PAs who were actively involved in the preoperative, intra-operative,
and postoperative care of our patients,” said Dr. Nabagiez.
“Unlike standard
visiting nurses, our PAs knew each patient personally and understood all of the
pertinent issues of the patient’s medical history. They also knew the patient’s
individual postoperative course prior to discharge, so they entered the
patient’s home already knowing the concerns, if any, of the surgeon and the
patient.”
The analysis also showed
an overall reduction in healthcare expenditures during the course of the study.
It cost $23,500 to make house calls to 363 patients, which saved $977,500 in
readmission costs. This translated to $39 in healthcare savings for every $1
spent.
“It is essential for
patients to comply with all prescribed medications and physical rehabilitation
after heart surgery, and two house calls in the first week after discharge
helped patients remain focused on these goals,” said Dr. Nabagiez.
“Complications can arise
in the first week after surgery, and these initial home visits can help
diagnose problems earlier, which can keep patients out of the emergency
department. We found that making these two visits is cost effective and keeps
patients on the road to recovery, while also reducing hospital readmissions.”
Note: One co-author
disclosed a commercial relationship as Speakers Bureau/Honoraria, Medtronic
Inc.
For a copy of the
abstract, “Cost Analysis of a Physician Assistant Home Visit Program to Reduce
Readmissions Following Cardiac Surgery,” contact Cassie McNulty at 312-202-5865
or cmcnulty@sts.org.
Founded in 1964, The
Society of Thoracic Surgeons is a not-for-profit organization representing more
than 7,100 cardiothoracic surgeons, researchers, and allied health care
professionals worldwide who are dedicated to ensuring the best possible
outcomes for surgeries of the heart, lung, and esophagus, as well as other
surgical procedures within the chest. The Society’s mission is to enhance the
ability of cardiothoracic surgeons to provide the highest quality patient care
through education, research, and advocacy.
SLU occupational therapist shares tips for staying
upright and what to do if you fall
Newswise, January 21, 2016 — Winter precipitation can bring an
increased risk for slips and falls on the ice and snow. Julia Henderson-Kalb,
M.S., OTR/L an instructor in the Department of Occupational Science and
Occupational Therapy at Saint Louis University, recommends some simple steps to
minimize fall risk.
Safety begins before you leave the house. Shoe choice can
impact stability. Henderson-Kalb recommends avoiding boots or shoes with smooth
soles or heels. Instead, wear shoes or boots that provide traction on snow and
ice; boots made of non-slip rubber or neoprene with grooved soles are best.
A heavy, bulky coat that will cushion you if you should fall
is also a wise idea, Henderson-Kalb said.
“During the day, wear sunglasses to help you see better and
avoid hazards,” she said. “Make sure whatever you wear doesn't block your
vision.”
In addition to keeping your line of vision clear, it is
important to remember to not overdo it. While it may be tempting to grab all
your groceries in one load to more quickly escape the cold, it could impact
your stability.
“You want to leave your hands and arms free to balance
yourself. It’s better to make more trips,” she said. “Beware if you are
carrying a heavy backpack or other load — your sense of balance will be off.”
If there is snow or ice on the ground, Henderson-Kalb
recommends bending slightly and walking flat-footed. “Put your center of
gravity directly over your feet as much as possible,” she said. “Take short
steps or shuffle. It also helps to stop occasionally to break momentum.”
Extending your arms out to your sides can help to maintain balance.
Look ahead when you walk. Walking along the grassy edge of snow- or ice-covered
sidewalks or driveways provides better traction. Use hand railings when walking
on steps.
“In cold temperatures, assume that all wet, dark areas on
pavements are slippery and icy,” she said. “Some spots can be nearly invisible
layers of ice even if they just look wet.”
In addition to planning for weather-related delays in traffic,
taking your time on foot is also a good idea.
“Allowing more time lets you focus on safety and to be aware
of the surroundings, both of which are important to avoid falling in winter
weather,” Henderson-Kalb said. “Walking more slowly will also help your
reaction time to changes in traction.”
What happens if you do find yourself slipping?
* Anytime you are walking on possibly slick surfaces, keep
your hands out of your coat pockets. This lowers your center of gravity while
walking and increases balance.
“You can help break your fall with your hands free if you do
start to slip, although this does increase the risk of a wrist injury.
* If you fall backwards, quickly tuck your head forward, chin to chest. Try to
extend your arms away from your body and “slap” the ground with your palms and
forearms. This maneuver will help prevent your head, wrists and elbows from
hitting the ground.
* If you fall to the side, try to allow your forearm to make contact with the
ground first, not your hand. Lift your head to the opposite shoulder and
continue to roll.
* If you fall forward, try to roll to one side, and follow the same procedure
as if you were falling to the side.
If you do fall, the first thing to do is assess yourself for
injuries. If you have struck your head or you think you have broken a bone,
attempt to get help before moving. If you think you are uninjured, go ahead and
try to get up.
“If you have not hit your head, it is helpful to get off the
cold surface rather than staying on it,” Henderson-Kalb said.
She recommends turning over onto your hands and knees. Take
one foot and place it between your hands, then bring the other foot between
your hands. Trying to keep feet shoulder width apart, push yourself up from
there.
The bottom line on walking in snowy and icy conditions is be
prepared, be aware and be careful.
Long a leader in educating health professionals, Saint Louis
University offered its first degree in an allied health profession in 1929.
Today the Doisy College of Health Sciences offers degrees in
physical therapy, athletic training education, clinical laboratory science,
nutrition and dietetics, health informatics and information management, health
sciences, medical imaging and radiation therapeutics, occupational science and
occupational therapy, and physician assistant education.
The college's unique curriculum prepares students to work with
health professionals from all disciplines to ensure the best possible patient
care.
Newswise, January 21, 2016– Bradycardia – a slower than normal
heartbeat – does not increase the risk of developing cardiovascular disease,
according to a study conducted by researchers at Wake Forest Baptist Medical
Center. The study is published in the Jan.19 online edition of the Journal of
American Medical Association Internal Medicine.
“For a large majority of people with a heart rate in the 40s
or 50s who have no symptoms, the prognosis is very good,” said Ajay Dharod,
M.D., instructor in internal medicine at Wake Forest Baptist and corresponding
author of the study.
“Our results should be reassuring for those diagnosed with
asymptomatic bradycardia.”
The heart usually beats between 60 and 100 times a minute in
an adult at rest. But with bradycardia, the heart beats fewer than 50 times a
minute.
The condition can cause light-headedness, shortness of breath,
fainting or chest pain due to the heart not pumping enough oxygen-rich blood
through the body.
However, until now, there had not been any research to
determine if a slow heart rate contributed to the development of cardiovascular
disease.
In the Wake Forest Baptist study, the scientists conducted an analysis of 6,733
participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
This study, which was sponsored by the National Heart Lung and
Blood Institute, included men and women ages 45 to 84 who did not have
cardiovascular disease when first recruited into this study, but who may have
been on heart rate-modifying medications frequently used to treat hypertension.
Study participants were followed for more than 10 years to monitor
cardiovascular events and mortality.
The researchers found that a heart rate (HR) of less than 50
was not associated with an elevated risk of cardiovascular disease in
participants regardless of whether they were taking HR-modifying drugs, such as
beta blockers and calcium channel blockers.
However, the study did show a potential association between
bradycardia and higher mortality rates in individuals taking HR-modifying
drugs.
“Bradycardia may be problematic in people who are taking
medications that also slow their heart rate,” Dharod said. “Further research is
needed to determine whether this association is causally linked to heart rate
or to the use of these drugs.”
This research was supported by contracts N01-HC-95159,
N01-HC-95160, N01-HC-95161,N01-HC-95162, N01-HC-95163, N01-HC-95164,
N01-HV-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from
the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and
UL1-TR-001079 from NCRR.
Co-authors include Elsayed Z. Soliman, M.D., Farah Dawood,
M.D., Haiying Chen, M.D., Ph.D., and Alain G. Bertoni, M.D., of Wake Forest
Baptist; Steven Shea, M.D., of Columbia University; and Saman Nazarian, M.D.,
Ph.D., of Johns Hopkins Health System.
Newswise, January 21, 2016 — Researchers long have known that
some portion of the risk of developing cancer is hereditary and that inherited
genetic errors are very important in some tumors but much less so in others.
In a new analysis, researchers have shed light on these
hereditary elements across 12 cancer types — showing a surprising inherited
component to stomach cancer and providing some needed clarity on the
consequences of certain types of mutations in well-known breast cancer
susceptibility genes, BRCA1 and BRCA2.
The study, from Washington University School of Medicine in
St. Louis, appears in the journal Nature Communications.
The investigators analyzed genetic information from more than
4,000 cancer cases included in The Cancer Genome Atlas project, an initiative
funded by the National Institutes of Health (NIH) to unravel the genetic basis
of cancer.
“In general, we have known that ovarian and breast cancers
have a significant inherited component, and others, such as acute myeloid
leukemia and lung cancer, have a much smaller inherited genetic contribution,”
said senior author Li Ding, PhD, associate professor of medicine and assistant
director of the McDonnell Genome Institute at Washington University.
“But this is the first time on a large scale that we’ve been
able to pinpoint gene culprits or even the actual mutations responsible for
cancer susceptibility.”
The new information has implications for improving the
accuracy of existing genetic tests for cancer risk and eventually expanding the
available tests to include a wider variety of tumors.
Past genomic studies of cancer compared sequencing data from
patients’ healthy tissue and the same patients’ tumors. These studies uncovered
mutations present in the tumors, helping researchers identify important genes
that likely play roles in cancer.
But this type of analysis can’t distinguish between inherited
mutations present at birth and mutations acquired over the lifespan.
To help tease out cancer’s inherited components, the new study
adds analysis of the sequencing data from the patients’ normal cells that
contain the “germline” information.
A patient’s germline is the genetic information inherited from
both parents. This new layer of information gives a genetic baseline of a
patient’s genes at birth and can reveal whether cancer-associated mutations
were already present.
In all the cancer cases they analyzed, the investigators
looked for rare germline mutations in genes known to be associated with cancer.
If one copy of one of these genes from one parent is already
mutated at birth, the second normal copy from the other parent often can
compensate for the defect. But individuals with such mutations are more
susceptible to a so-called “second hit.” As they age, they are at higher risk
of developing mutations in the remaining normal copy of the gene.
“We looked for germline mutations in the tumor,” Ding said.
“But it was not enough for the mutations simply to be present;
they needed to be enriched in the tumor — present at higher frequency. If a
mutation is present in the germline and amplified in the tumor, there is a high
likelihood it is playing a role in the cancer.”
In 114 genes known to be associated with cancer, they found
rare germline mutations in all 12 cancer types, but in varying frequencies
depending on the type. They focused on a type of mutation called a truncation
because most truncated genes can’t function at all.
Of the ovarian cancer cases the investigators studied, 19
percent of them carried rare germline truncations. In contrast, only 4 percent
of the acute myeloid leukemia cases in the analysis carried these truncations
in the germline.
They also found that 11 percent of the stomach cancer cases
included such germline truncations, which was a surprise, according to the
researchers, because that number is on par with the percentage for breast
cancer.
“We also found a significant number of germline truncations in
the BRCA1 and BRCA2 genes present in tumor
types other than breast cancer, including stomach and prostate cancers, for
example,” Ding said.
“This suggests we should pay attention to the potential
involvement of these two genes in other cancer types.”
The BRCA1 and BRCA2 genes
are important for DNA repair. While they are primarily associated with risk of
breast cancer, this analysis supports the growing body of evidence that they
have a broader impact.
“Of the patients with BRCA1 truncations in
the germline, 90 percent have this BRCA1 truncation enriched
in the tumor, regardless of cancer type,” Ding said.
Genetic testing of the BRCA1 and BRCA2 genes
in women at risk of breast cancer can reveal extremely useful information for
prevention. When, for example, the genes are shown to be normal, there is no
elevated genetic risk of breast cancer. But if either of these genes is mutated
in ways that are known to disable either gene, breast cancer risk is
dramatically increased. In this situation, doctors and genetic counselors can
help women navigate the options available for reducing that risk.
But mutations come in a number of varieties. Genetic testing
also can reveal many that have unknown consequences for the function of these
genes, so their influence on cancer risk can’t be predicted.
To help clarify this gray area in clinical practice, Ding and
her colleagues Jeffrey Parvin, MD, PhD, professor and director of the division
of computational biology and bioinformatics at The Ohio State University, and
Feng Chen, PhD, associate professor of medicine at Washington University, investigated
68 germline non-truncation mutations of unknown significance in the BRCA1 gene.
For each mutation, they tested how well the BRCA1 protein
could perform one of its key DNA-repair functions. The researchers found that
six of the mutations behaved like truncations, disabling the gene completely.
These mutations also were enriched in the tumors, supporting a likely role in
cancer.
“It is important to be able to show that these six mutations
of unknown clinical significance are, in fact, loss-of-function mutations,”
Ding said.
“But I also want to emphasize the contrasting point. Many more
show normal function, at least according to our analysis. Many of these types
of mutations are neutral, and we would like to identify them so that
health-care providers can better counsel their patients.”
Ding said more research is needed to confirm these results
before they can be used to advise patients making health-care decisions.
“Our strategy of investigating germline-tumor interactions
provides a good way to prioritize important mutations that we should focus on,”
she said. “For the information to eventually be used in the clinic, we will
need to perform this type of analysis on even larger numbers of patients.”
Newswise January
11, 2016 – Taking a high dose of vitamin D3 is safe for people with multiple
sclerosis (MS) and may correct the body’s hyperactive immune response,
according to a study published in the December 30, 2015, online issue of Neurology®,
the medical journal of the American Academy of Neurology.
Low
levels of vitamin D in the blood are tied to an increased risk of developing
MS. People who have MS and low levels of vitamin D are more likely to have
greater disability and more disease activity.
For the
study, 40 people with relapsing-remitting MS received either 10,400 IU or 800
IU of vitamin D3 supplements per day for six months. The current recommended
daily allowance of vitamin D3 is 600 IU.
Blood
tests at the start of the study and again at three and six months measured the
amount of vitamin D in the blood and the response in the immune system’s T
cells, which play a key role in MS.
Side
effects from the vitamin supplements were minor and were not different between
the people taking the high dose and the people taking the low dose. One person
in each group had a relapse of disease activity.
The
people taking the high dose had a reduction in the percentage of T cells
related to MS activity.
When the
increase in vitamin D in the blood was greater than 18 nanograms per milliliter
(ng/ml), every 5 ng/ml increase in vitamin D led to a 1 percent decrease in the
percentage of interleukin 17 T cells in the blood. The people taking the low
dose did not have any changes in their T cells.
While
researchers are still determining the optimal level of vitamin D in the blood
for people with MS, the people in the study taking the high dose of vitamin D
reached a level that has been proposed as a target for people with MS. Vitamin
D levels above 30 ng/ml are considered sufficient for the general population,
but researchers noted that for people with MS, it may be that levels above 50
ng/ml are necessary to reduce disease activity. The group taking the low dose
did not reach this target.
“These
results are exciting, as vitamin D has the potential to be an inexpensive, safe
and convenient treatment for people with MS,” said study author Peter A.
Calabresi, MD, of Johns Hopkins University School of Medicine in Baltimore, MD,
and a Fellow of the American Academy of Neurology. “More research is needed to
confirm these findings with larger groups of people and to help us understand
the mechanisms for these effects, but the results are promising.”
The study
was supported by the Kenneth and Claudia Silverman Family Foundation, Montel
Williams Foundation and National Multiple Sclerosis Society.
MD and NP applaud steps
to define the concept of primary care in JAGS co-authored editorial; call for
better data, measures to help achieve best outcomes for older adults with
chronic illnesses
MD and NP applaud steps
to define the concept of primary care in JAGS co-authored editorial; call for
better data, measures to help achieve best outcomes for older adults with
chronic illnesses.
Newswise,
January 11, 2016 — There is an ongoing national debate, heated at times,
amongst health professionals concerning nurse practitioners (NPs) taking on the
role of primary care physicians (MDs).
An
increasing number of states have been allowing NPs with advanced degrees to
practice without the direct oversight of an MD, effectively allowing NPs to be
the sole provider of primary care.
Such
legislation has been the response to a general shortage of primary care
physicians, especially in rural areas.
In a
recent issue of the Journal of the American Geriatrics Society (JAGS) [Vol. 63,
#10, October 2015], the lead article, “Diabetes Mellitus Care Provided by Nurse
Practitioners vs Primary Care Physicians,” by Yong-Fang Kuo, PhD, compares
processes and cost of care among older diabetes patients cared for by NPs
versus MDs in a retrospective cohort study.
Alongside
the study, JAGS’ editors also chose to publish a commentary editorial entitled
“The Eye of the Beholder,” authored by Dr. Robert Kane, MD,
School of Public Health, University of Minnesota, and Eileen M. Sullivan-Marx,
PhD, RN, College of Nursing, New York University.
Kuo and
his colleagues, utilized data from patients with a diagnosis of diabetes in
2009 (n=64,354) who received all their primary care from NPs or MDs, selected
from a national sample of Medicare beneficiaries.
They
concluded that compared to MDs, NPs were either similar or slightly lower in
their rates of diabetes guideline concordant care. NPs used specialist
consultations more often but had similar overall costs of care to MDs.
“The
basic message is that the original study found a very small difference that was
statistically significant because of very large sample sizes from an
administrative data base,” said Dr. Kane. “Pragmatically the results suggest no
clinically important difference.”
“This is
a case of cup perspective—an example of the phenomenon of point of view,” notes
Sullivan-Marx. “Kuo and his team use these findings to suggest that the quality
of care that NPs provide is less than that of physicians, but the performance
seems similar.”
“At the
very time when society faces a boom in chronic disease, there is a bust in
primary care,” Sullivan-Marx adds. “NPs represent an important resource to help
address this imbalance.”
Dr. Kane
and Sullivan-Marx note that the Kuo study limits the definition of “primary
care provider” by stipulating that care be provided by only one type of
practitioner.
Such a
definition marginalizes the idea that primary care can be a collaborative
effort between practitioners, and “what we do know about diabetes care,” says
Dr. Kane, “is that personal engagement, use of teams of caregivers, including
nutritionists, leads to better overall patient outcomes.”
Dr. Kane
and Sullivan-Marx stress that the concept of primary care remains elusive, but
not unattainable.
“Efforts
to use the best available administrative data to identify processes and
outcomes of primary care have been frustrating, particularly so for older
adults with complex chronic illnesses,” admitted Sullivan-Marx.
“The data
are incomplete in these databases, and incomplete data can be misleading.”
“Sadly,
the range of concerns underlying today’s concept of coordinated, continuous,
comprehensive primary care gets lost on specialists, who too often are
delivering the bulk of the care to many older people.” said Dr. Kane.
“At a
time when it is a struggle to fill the primary care gap, NPs should be viewed
as valued partners.”
“Kuo et
al. have embraced the challenge to ascertain answers to these important
questions using available, if incomplete data,” concludes Dr. Kane and
Sullivan-Marx, “leaving us to recognize that better data and better measures
are needed to understand how to achieve the best outcomes.”
