54-Year-Old ‘Nonbeliever’ Gets His Flu Shot After Close Call With H1N1

ECMO technology saves patient’s life

Newswise, November 15, 2016 — Like many people his age, Jerry Lucier, 54, of Northville, never got the flu shot.

Then, in April, he almost died as a result of an H1N1 flu infection and was transferred by medical helicopter to the ECMO unit at Beaumont Hospital, Royal Oak.

ECMO stands for extracorporeal membrane oxygenation. H1N1 is a flu strain especially aggressive in individuals aged 25 to 64.

“I didn’t used to believe in the flu shot,” said Lucier, who has no underlying medical issues.

Lucier’s condition deteriorated rapidly when his flu turned into pneumonia, filling his lungs with fluid, making it nearly impossible for him to breathe.

Not even a ventilator could save him.

“Now, I tell everybody: ‘You’ve got to get the vaccine’,” said Lucier, who spent four months in the hospital. “’Otherwise, you might die.’”

For Lucier, early transfer to a hospital that provided ECMO, was key.

Beaumont, Royal Oak is one of three Extracorporeal Life Support Organization hospitals in Michigan providing ECMO to adult patients. This technology helps patients unable to breathe on their own take in oxygen.

“People die every year from the flu. And while the groups most likely to be affected are the very young and the very old, there’s a bit of randomness in how and who it strikes,” said Felicia Ivascu, M.D, medical director of the ECMO program at Beaumont, Royal Oak said. “That’s what makes the flu so scary.”

Getting an annual flu vaccine is still the first and best way people age 6 months and older, can prevent getting the flu in the first place.

“Even if you don’t think you need the protection the vaccine offers,” Dr. Ivascu said. “It’s important to protect those around you. Especially if they include vulnerable populations.”

For optimum results, vaccinations should be administered just before cases start appearing, which is in October or November, explained Dr. Matthew Sims, director of Infectious Disease Research for Beaumont Hospital, Royal Oak.

“A few cases of the flu have already been reported, so it’s good timing to get the vaccine right now,” Dr. Sims said. “If you get it too early in the year, August for example, you might not be protected the entire season.”

As long as new cases continue to flare, it’s not too late to get the vaccine, Dr. Sims said, adding the flu season usually peaks in February and lasts until May. 

“Just remember, it takes about two weeks from when you get the shot to be protected by it,” Dr. Sims said. “And some years we run out.”

Now, six months after diagnosis, Lucier is still working hard to get back to his old self.

He’s lost 58 pounds, uses oxygen parts of each day and recently registered for another round of physical and occupational therapy to regain strength and stamina.

If things go as planned, Lucier will finally return to his job as an electrician for Ford Motor Co. in April 2017.

“I’m feeling better every day,” said Lucier, who looks forward to going back to work and the gym and spending time out with his wife, Minwa, their family and friends.

“And yes, I’ve already received my seasonal flu shot. I hope everybody gets one.”

FLU Facts

• For the 2016/2017 flu season, only injectable flu shots are recommended.
• You cannot get the flu from the vaccine.
• If you get the vaccine and still catch the flu, it wasn’t all for naught. Experts say you likely would have been sicker, longer without the vaccine’s protection.
• Because flu strains are constantly changing, previous vaccinations won’t protect you against a new season of flu bugs.
• Egg-free vaccinations are available for those who may be allergic.

Motivation To Move: Study Finds Mild Exercise Helps Decrease Pain And Improve Activity Level In Older Adults

Newswise, November 15, 2016 — It's never too late to reap the benefits of exercise, and that includes older adults with arthritis and other muscle and joint conditions, according to a study.

Researchers at Hospital for Special Surgery (HSS) found that a low-impact exercise program in senior centers in New York City’s Chinatown and Flushing, Queens communities helped decrease pain, improve mobility and enhance quality of life for many participants.

The study, titled, “Effects of a Culturally Tailored Low-Impact Exercise Program for Chinese Older Adults in NYC,” was presented at the American Public Health Association annual meeting on November 1 in Denver.

According to the Centers for Disease Control and Prevention, Asian seniors had the highest rate of physical inactivity (defined as no physical activity beyond basic daily life activities), 29% of them lived in poverty, and 75% had limited English language proficiency in 2012.

 In addition, Chinese Americans were less likely to seek health care because of cost and language and cultural barriers.

"In 2011, HSS developed the Asian Community Bone Health Initiative, a culturally-tailored low-impact exercise program aimed at improving musculoskeletal health in the underserved Chinese older adult community," said Minlun (Demi) Wu, MPA, research coordinator, Department of Public & Patient Education at Hospital for Special Surgery.

"Joints will often stiffen if not used, and muscles will weaken if not exercised. Our bodies are meant to move, and inactivity leads to weakness and stiffness, and joints with arthritis often worsen with inactivity," said Theodore Fields, MD, director, Rheumatology Faculty Practice Plan at HSS.

The exercise classes, which were free and open to community members, took place once a week for eight weeks.

 Participants performed chair and floor mat exercises using stretch bands and other gentle exercises. Certified bilingual instructors made the sessions culturally relevant by integrating Chinese breathing techniques and meditation into the program.

A survey was distributed to participants before the classes started and again after they ended to evaluate pain, physical function, stiffness, fatigue, balance and other health indicators.

A total of 256 adults completed the questionnaires between September 2011 and June 2016. Ninety-three percent of participants were female, and 73 percent were between 60 and 79 years of age.

"Overall, the program was very well-received," said Wu. "After completing the classes, statistically significant differences were found in pain intensity, physical function, balance, and confidence about exercising without making symptoms worse."

Participants also reported significant improvements in the ability to perform activities of daily living, such as lifting or carrying groceries; climbing stairs; bending, kneeling and stooping; and bathing and getting dressed.

Additional findings:

• 84% of respondents reported less pain after participating in the program
• 95% of participants reported less stiffness
• 92% of participants reported less fatigue
• 95% of participants reported that their balance improved
• 100% of participants said they were very satisfied with the program and would recommend it to others

"The study results are consistent with the experience of rheumatologists and with prior studies showing that exercise, even of mild degree, helps with pain," said Dr. Fields.

"Getting people up and moving does appear to help with mood, pain and overall functioning."

"Given the social and financial implications of musculoskeletal diseases, it is paramount to identify effective programs that reduce the impact of these debilitating conditions," said Wu.

"Our findings indicate that implementing a bilingual low-impact exercise program can play an important role in pain relief, improved quality of life and improved levels of physical activity in the underserved Chinese community." The classes are ongoing and have become so popular there is a waiting list. 

Study Bodes Well For Low-Carb Eaters

Newswise,  November 15, 2016—Three low-carb meals within 24 hours lowers post-meal insulin resistance by more than 30 percent, but high-carb meals sustain insulin resistance, a condition that leads to high blood pressure, prediabetes and diabetes, according to a University of Michigan study.

The study also found that two hours of moderate-intensity exercise, which is supposed to lower insulin resistance and blood sugar levels, has no impact on these results.

To the contrary, blood sugar levels increase after the exercise, said Katarina Borer, professor in the School of Kinesiology and principal investigator in a study done with doctoral student Po-Ju Lin, now at the University of Rochester Medical Center.

Insulin is a hormone critical in metabolism. Insulin sensitivity refers to insulin's ability to efficiently respond to and regulate glucose in the blood, so that our cells can use it for energy and other functions.

If we're insulin resistant, insulin is less effective in removing glucose from the bloodstream and the pancreas must produce more insulin to help. This can eventually lead to diabetes.

The study sample was small, Borer said, but the results are significant, in part, because they reinforce results in two preceding studies and one 2015 review on high-carbohydrate diets and their negative effects on insulin.

In the U-M study, 32 post-menopausal metabolically healthy women were divided into four groups and given meals of either 30 or 60 percent carbohydrates with or without moderate-intensity exercise before meals. The low-carb group showed a reduction in insulin resistance after the third meal in the evening, but the high-carb group sustained high post-meal insulin, Borer said.

The high-carb group's diet fell in line with the 45-to-60 percent daily carbohydrate intake the departments of Agriculture and Health and Human Services recommend, Borer said.

"We showed an acute, one-day reduction in insulin resistance after the third low-carbohydrate meal eaten in the evening, so one could argue that this is transient and insignificant," Borer said.

"But at least two other studies where high-carbohydrate meals were fed to volunteers for 5 and for 14 days show that the outcome was worrisome.

“These subjects developed increased fasting insulin secretion and insulin resistance, increased glucose release by the liver which produced high blood sugar, and dramatically lowered fat oxidation that contributes to obesity. These then were more persistent effects that could be a path to prediabetes and diabetes.

"What is remarkable about our findings is that they show that a simple dietary modification of reducing the carbohydrate content of the meals can, within a day, protect against development of insulin resistance and block the path toward development of prediabetes while sustained intake of high carbohydrate diets as shown in the two mentioned studies lead to increased fasting insulin secretion and resistance.

“ And even more surprising and amazing is that exercise before the meals made the subjects more carbohydrate intolerant—that is, it increased evening blood sugar levels."

Because exercise did not lower insulin resistance, it suggests that the insulin reaction the subjects experienced after the evening meal was driven by an intestinal response to the carbohydrate, and not by exercise. But this doesn't mean exercise doesn't influence insulin, she said.

Going forward, Borer's lab will examine the timing of meals and whether insulin-lowering effect can be produced in the morning and whether blood sugar will decline when women exercise after low-carbohydrate meals.

The study, "Third exposure to a reduced carbohydrate meal lowers evening postprandial insulin and GIP responses and HOMA-IR estimate of insulin resistance," appears in the Oct. 31 edition of PLOS ONE.

Healthy Living Linked To Higher Brain Function, Delay Of Dementia

Newswise, November 7, 2016- It's tempting to dip into the leftover Halloween treats, but new research out of York University has found eating plenty of fruits and vegetables, combined with regular exercise, leads to better cognitive functioning for younger and older adults, and may delay the onset of dementia.

York U post-doctoral fellow Alina Cohen and her team, including Professors Chris I. Ardern and Joseph Baker, looked at cross-sectional data of 45,522 participants, age 30 to 80+, from the 2012 annual component of the Canadian Community Health Survey.

What they found was that for those who are normal weight or overweight, but not obese, eating more than 10 servings of fruit and vegetable daily was linked to better cognitive functioning. When moderate exercise was added, those eating less than five servings, reported better cognitive functioning.

Higher levels of physical activity were linked to the relationship between higher daily fruit and vegetable consumption and better cognitive performance. Those with higher body mass indexes, low activity levels and fruit and vegetable consumption were associated with poorer cognitive functioning.

"Factors such as adhering to a healthy lifestyle including a diet that is rich in essential nutrients, regular exercise engagement, and having an adequate cardiovascular profile all seem to be effective ways by which to preserve cognitive function and delay cognitive decline," said Cohen.

With rising rates of inactivity and obesity, the researchers wanted to know if there was a relationship between clusters of risk factors for cognitive decline, and how lifestyle factors might help prevent or delay it.

 Few studies have looked at the relationship between physical activity and eating fruit and vegetables and the effect it has on the brain for both younger and older adults.

"It is pertinent that we develop a better understanding of the lifelong behaviours that may contribute to cognitive decline in late life by implementing a life-span approach whereby younger, middle-aged, and older adults are collectively studied, and where lifestyle risk factors are evaluated prior to a diagnosis of dementia," said Cohen.

The paper, "Physical Activity Mediates the Relationship between Fruit and Vegetable Consumption and Cognitive Functioning: A Cross-Sectional Analysis," was published today in the Journal of Public Health, Oxford University Press.

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York University is known for championing new ways of thinking that drive teaching and research excellence. Our students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-discipline programming, innovative course design and diverse experiential learning opportunities. York students and graduates push limits, achieve goals and find solutions to the world's most pressing social challenges, empowered by a strong community that opens minds. York U is an internationally recognized research university - our 11 faculties and 26 research centres have partnerships with 200+ leading universities worldwide. Located in Toronto, York is the third largest university in Canada, with a strong community of 53,000 students, 7,000 faculty and administrative staff, and more than 295,000 alumni. York U's fully bilingual Glendon campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education.

Words Matter When Talking About Alzheimer’s

Newswise, November 7, 2016 — Using war metaphors in reference to Alzheimer’s disease should be replaced with messages of resilience against a complex, age-associated condition that may not be fully defeatable, according to a team of researchers.

Framing a health issue through comparisons to warfare is common in popular media and medical and research communities.

While it can motivate efforts to deal with the issue, this type of language and messaging can also create fear and stigma, turn patients into victims and divert resources from critically important prevention and care, said Daniel R. George, assistant professor of medical humanities, Penn State College of Medicine.

Despite decades of failures in Alzheimer’s drug development, scientific attention continues to focus on drugs that “attack” a molecular compound called beta amyloid, with the goal of curing the disease.

Amyloid is a key component of the plaques in the brain that are a hallmark of Alzheimer’s disease.

Research, however, shows that the appearance of amyloid does not correlate with clinical symptoms and beta amyloid has repeatedly been found in the brains of one-third of “normal” elderly people.

This suggests that amyloid may be a symptom rather than a cause of damage. A growing number of researchers believe that declaring “war” on Alzheimer’s by “attacking” amyloid may ultimately be an exercise in self-harm, particularly if amyloid is representative of the brain’s repair response, and may be channeling resources away from other drug-based approaches that do not assume amyloid toxicity.

Scholars have argued that metaphors and narratives that treat disease as something to be attacked can be socially damaging to those affected.

The value of such metaphors may be clearer for infectious diseases caused by single pathogens.

It becomes more problematic when discussing diverse, age-associated syndromes like Alzheimer’s that may not be fully curable. In this way, war metaphors in medicine can invite ways of thinking that may not be scientifically or socially productive.

“If applied in a careless manner, war metaphors can delude our sense of what’s possible therapeutically, and give false hope to people and caregivers who are suffering,” George said.

George and his co-authors propose moving toward different types of metaphors – those that encourage use of words like “slow” or “postpone” rather than “prevent” or “cure,” and emphasize building “resilience” to aging processes in the brain rather than aiming at “absolute victory” over a disease.

While “fighting” and “defeating” Alzheimer’s through drug development is important, the authors argue it may be wiser to acknowledge that Alzheimer’s is not a disease disconnected from the aging process like polio or malaria.

The authors note that Alzheimer’s has been classified as a disease for the past 40 years.

They suggest it may be more beneficial to take a lifespan-oriented approach that includes education about known biological, psychosocial and environmental risk factors, investment in societal programs and infrastructure that support brain health, and ensuring proper care for those affected and their caregivers.

“While not as profitable as drug development, public health initiatives that reduce vascular risk factors, modulate oxidative stress and inflammation, guard against traumatic brain injuries, promote social engagement and lifelong learning, and reduce exposure to neurotoxins, and other commonsense actions should be an explicit component of our societal response (to Alzheimer’s)," the researchers wrote in the American Journal of Bioethics.

George drew particular attention to the residents of Flint, Michigan being exposed to lead, a neurotoxin, through the water supply.

“It is inexcusable that we could let our public infrastructure fail to the point where it becomes a contributor to Alzheimer’s disease risk for socio-economically disadvantaged citizens,” George said.

“If we’re really serious about addressing the problem of Alzheimer’s, we must start by not poisoning our citizens.”

Moving beyond the notion of being at war against Alzheimer’s could also serve to humanize cognitive aging.

“There’s a widely-accepted myth that people who have Alzheimer’s are sort of non-people, akin to zombies,” George said.

“There are ways to construct meaning around memory loss that show greater compassion and solidarity toward people with cognitive frailty rather than seeing them as passive victims in our biological war against the disease.

“We believe in a more humane message – that even if you have a diagnosis of ‘probable Alzheimer’s’ you can still have a life with deep purpose, social contribution and meaningful relationships.”

Other researchers on this paper were Erin R. Whitehouse, Johns Hopkins University School of Nursing; and Peter J. Whitehouse, Case Western Reserve University.

About Penn State College of Medicine
Located on the campus of Penn State Health Milton S. Hershey Medical Center in Hershey, Pa., Penn State College of Medicine boasts a portfolio of nearly $82 million in funded research. Projects range from the development of artificial organs and advanced diagnostics to groundbreaking cancer treatments and understanding the fundamental causes of disease. Enrolling its first students in 1967, the College of Medicine has more than 1,600 students and trainees in medicine, nursing, the health professions and biomedical research on its campus.

'Corkscrew' Shape Of Blood Flow In Heart's Upper Chamber May Signal Lower Stroke Risk

 Proof-of-concept study conducted in two patients

Newswise, November 7, 2016 — Using specialized CT scans of a healthy heart and one with heart disease, a team of Johns Hopkins cardiologists and biomedical engineers say they've created computer models of the "shape" of blood flow through the heart's upper left chamber that someday may help predict stroke risk.

Specifically, their computer visualizations found that blood in the diseased heart failed to flow in corkscrewlike "eddies" that most effectively moved blood out of the left atrium in the healthy heart and "showed us exactly how this motion would increase the risk of developing a blood clot," says Hiroshi Ashikaga, M.D., Ph.D., assistant professor of medicine and member of the Heart and Vascular Institute at the Johns Hopkins University School of Medicine.

The researchers say the same fluid motion analysis used in their two-heart proof-of-concept study may one day offer an accurate way to predict stroke risk in people with heart disease marked by enlargement and weakness of the cardiac muscle.

A description of the study and its results was published in the November print issue of Annals of Biomedical Engineering.

"By looking at blood flow through the atrium, we think we can accurately assess stroke risk better than such risk factors as heart size and pumping strength," says Ashikaga.

"Our study fills in a missing diagnostic link between heart function and fluid motion in our understanding of how each can affect stroke risk."

Before this study, Ashikaga notes, researchers knew that enlargement of the heart, particularly the left upper chamber, was linked to increased stroke risk, particularly in people with atrial fibrillation, an irregular and often very rapid heart rate.

Heart disease experts estimate that more than 1.6 million Americans each year are diagnosed with symptoms of atrial fibrillation that put them at risk for strokes caused by blood that pools in the heart and forms a clot, then travels to the brain.

The new study, Ashikaga says, sheds significant light on just how an enlarged and "floppy" atrium led to blood clot formation.

To collect the data needed to create the blood flow models, the Johns Hopkins team recruited two patients with a history of atrial fibrillation -- a 58-year-old woman with a healthy heart and a 68-year-old man with an enlarged heart. Each underwent a CT scan of their heart.

Using the images, the researchers then computed the movement of blood flow as it entered the left atrium from the pulmonary veins, then passed through a valve into the left lower chamber, or ventricle.

Finally, they fashioned a video representation of the fluid motion of the blood.

In visualizing the healthy heart, the researchers saw that the blood flow formed into tight, corkscrewlike motions that circled around into doughnut formations, known as vortexes.

The researchers say the vortexes helped move the blood efficiently through the atrium quicker and with less contact with the atrium's surface tissue. See blood flow modelled in a healthy heart here.

The diseased heart they chose to examine was enlarged due to overuse, muscle fatigue and scarring, all of which can promote atrial fibrillation.

In the enlarged heart, the researchers noticed that at the top of the atrium, the blood never fully forms the corkscrews that loop around into vortexes.

Instead, by the time the blood reaches the bottom of the atrium, it seems to be falling in "sheets" that coat the surface of the heart. See blood flow through a diseased heart here.

"As the blood comes in contact with the atrium's surface, it slows down due to shearing forces similar to friction, and this appears to prevent the blood from exiting the chamber as smoothly as it might," says Ashikaga.

"The slower the blood moves and the more contact it has with the atrium, the more risk there is for a clot to form."

Ashikaga says his team is currently conducting a larger long-term study looking at the blood flow of many more people with normal and ailing hearts, and monitoring the incidence of stroke and other signs of blood clots over time.

He also hopes to develop the CT scan and computer analysis into a tool to predict stroke risk.

According to the Centers for Disease Control and Prevention, an estimated 3 million to 6 million people have atrial fibrillation and nearly 800,000 people have strokes each year in the United States.

The most common symptom of stroke is numbness or weakness on one side of the body. Physicians use CT scans of the brain, blood tests, EKGs, MRI scans or other imaging test to determine if a person has suffered from a stroke. Strokes may be treated with clot-busting drugs, blood thinners and sometimes surgery to remove the clot.

Cause Of Inflammation In Diabetes Identified

Could be target for preventing related heart attacks, strokes

Too much fat in the diet promotes insulin resistance by spurring chronic inflammation. Researchers at Washington University School of Medicine have developed a way to block production of fatty acids in these immune cells in mice and protect them from diet-induced diabetes.

Newswise, November 7, 2016 — Inflammation is one of the main reasons why people with diabetes experience heart attacks, strokes, kidney problems and other, related complications.

Now, in a surprise finding, researchers at Washington University School of Medicine in St. Louis have identified a possible trigger of chronic inflammation.

Too much fat in the diet promotes insulin resistance by spurring chronic inflammation. But the researchers discovered, in mice, that when certain immune cells can’t manufacture fat, the mice don’t develop diabetes and inflammation, even when consuming a high-fat diet.

The study is available Nov. 2 as an advance online publication from the journal Nature.

“The number of people with diabetes has quadrupled worldwide over the last 20 years,” said senior investigator Clay F. Semenkovich, the Irene E. and Michael M. Karl Professor and director of the Division of Endocrinology, Metabolism & Lipid Research at the School of Medicine.

“We have made modest progress in making it less likely for some people with diabetes to have heart attacks and strokes.

“However, those receiving optimal therapy are still much more likely to die from complications driven by chronic inflammation that is, at least in part, generated by these immune cells.

“But by blocking the production of fat inside these cells, it may be possible to prevent inflammation in people with diabetes and even in other conditions, such as arthritis and cancer, in which chronic inflammation plays a role. This could have a profound impact on health.”

Semenkovich’s team made genetically altered mice that could not make the enzyme for fatty acid synthase (FAS) in immune cells called macrophages. Without the enzyme, it was impossible for the mice to synthesize fatty acids, a normal part of cell metabolism.

“We were surprised to find that the mice were protected from diet-induced diabetes,” said first author Xiaochao Wei, PhD, an instructor of medicine. “They did not develop the insulin resistance and diabetes that normally would have been induced by a high-fat diet.”

Through a series of experiments in the animals and in cell cultures, the researchers, including Douglas F. Covey, PhD, a professor of developmental biology and biochemistry, and Daniel S. Ory, MD, a professor of medicine and of cell biology and physiology, found that if macrophages could not synthesize fat from within, the external membranes of those cells could not respond to fat from outside the cells. That prevented the cells from contributing to inflammation.

But eliminating inflammation altogether is not the answer to preventing diabetic complications because inflammation is also vital for clearing infectious pathogens from the body and helps wounds heal. Still, Semenkovich said the new findings may have profound clinical implications.

“An inhibitor of fatty acid synthase actually is now in clinical trials as a potential cancer treatment,” he explained.

“And other drugs have been developed to inhibit fatty acid synthase in diabetes, too. One possibility that our work suggests is that altering the lipid content in the cell membrane may help block cancer metastases and complications of diabetes.”

Drugs currently in use to block fatty acid synthase, as well as other developing strategies, potentially could allow for chronic inflammation to be blocked, without completely eliminating the ability of macrophages to fight infection.

The researchers also plan to take a look at existing drug compounds that change the lipid composition in cells. Such medications failed in clinical trials, but they may have an effect on the membranes of macrophages and therefore may lower the risk of diabetes complications, Semenkovich said.

Wei X, Song H, Rizzo MG, Sidhu R, Covey DF, Ory DS, Semenkovich CF. Fatty acid synthesis configures the plasma membrane for inflammation in diabetes. Nature. Nov. 2, 2016. http://www.dx.doi.org/10.1038/nature20117

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases; the National Heart, Lung, and Blood Institute; and the National Center for Research Resources of the National Institutes of Health (NIH), grant numbers DK101392, DK076729, DK088083, DK20579, DK56341, RR00954 and HL067773. Additional funds came from the Taylor Family Institute for Innovative Psychiatric Research.

Washington University School of Medicine‘s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals.

The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.