Top News Zone: Health

Garlic sprouted for five days has improved antioxidant potential

"Sprouted" garlic - old garlic bulbs with bright green shoots emerging from the cloves - is considered to be past its prime and usually ends up in the garbage can. But scientists are reporting in ACS' Journal of Agricultural and Food Chemistry that this type of garlic has even more heart-healthy antioxidant activity than its fresher counterparts. 
 
Jong-Sang Kim and colleagues note that people have used garlic for medicinal purposes for thousands of years. Today, people still celebrate its healthful benefits. Eating garlic or taking garlic supplements is touted as a natural way to reduce cholesterol levels, blood pressure and heart disease risk. It even may boost the immune system and help fight cancer. But those benefits are for fresh, raw garlic. Sprouted garlic has received much less attention. When seedlings grow into green plants, they make many new compounds, including those that protect the young plant against pathogens. Kim's group reasoned that the same thing might be happening when green shoots grow from old heads of garlic. Other studies have shown that sprouted beans and grains have increased antioxidant activity, so the team set out to see if the same is true for garlic. 
 
They found that garlic sprouted for five days had higher antioxidant activity than fresher, younger bulbs, and it had different metabolites, suggesting that it also makes different substances. Extracts from this garlic even protected cells in a laboratory dish from certain types of damage. "Therefore, sprouting may be a useful way to improve the antioxidant potential of garlic," they conclude.

Garlic sprouted for five days has improved antioxidant potential

"Sprouted" garlic - old garlic bulbs with bright green shoots emerging from the cloves - is considered to be past its prime and us...

3D-printed membrane 'could predict heart attack risk'

Health 1:25 AM

According to The Heart Foundation, more than 920,000 Americans will have a heart attack this year. But now, researchers have created a 3D custom-fitted elastic membrane that can be implanted onto the outer layer of the heart wall, which they say could predict the occurrence of heart attacks and "transform" patient treatment. 
 
The research team, including Prof. Igor Efimov of the School of Engineering and Applied Science at Washington University, recently published details of the creation in the journal Nature Communications. 
 
Using an inexpensive 3D printer, the creators were able to develop an elastic membrane made of a soft and flexible silicon material. This membrane is made to match the shape of a patient's epicardium - the outer layer of the heart wall. 
 
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3D-printed membrane 'could predict heart attack risk'

According to The Heart Foundation, more than 920,000 Americans will have a heart attack this year. But now, researchers have created a 3D cu...

Prenatal screening for fetal aneuploidy by testing mothers blood at 10 weeks of pregnancy

Health 1:25 AM

A study in the New England Journal of Medicine potentially has significant implications for prenatal testing for major fetal chromosome abnormalities. The study found that in a head-to-head comparison of noninvasive prenatal testing using cell free DNA (cfDNA) to standard screening methods, cfDNA testing (verifi® prenatal test, Illumina, Inc.) significantly reduced the rate of false positive results and had significantly higher positive predictive values for the detection of fetal trisomies 21 and 18. 
 
A team of scientists, led by Diana W. Bianchi, MD, Executive Director of the Mother Infant Research Institute at Floating Hospital for Children at Tufts Medical Center, reports the results of their clinical trial using non-invasive cell-free DNA prenatal testing in a general obstetrical population of pregnant women, in an article entitled "DNA sequencing versus standard prenatal aneuploidy screening." 
 
The multi-center, blinded study analyzed samples from 1,914 pregnant women, and found that noninvasive cfDNA testing had a ten-fold improvement in the positive predictive value for trisomy 21, commonly known as Down syndrome, compared to standard prenatal aneuploidy screening methods (aneuploidy is a term for one or more extra or missing chromosomes). Importantly, the cfDNA test performed consistently well in a general population of pregnant women, regardless of their risk for fetal chromosomal abnormalities. Previous studies have shown that the tests were more accurate for women who had higher risks for fetal chromosomal abnormalities, but this was the first time that the cfDNA tests were compared in a general obstetrical population to the variety of blood and ultrasound tests that comprise the current standard of care in the United States. 
 
"We found that the major advantage of noninvasive prenatal DNA testing was the significant reduction of the false positive rate," said Bianchi. "Prenatal testing using cell-free DNA as a primary screen could eliminate the need for many of the invasive diagnostic procedures (such as amniocentesis) that are performed to confirm a positive screen." 
 
Prenatal screening for fetal aneuploidy is recommended by the American College of Obstetricians and Gynecologists as part of routine prenatal care. Researchers compared current standard noninvasive aneuploidy testing techniques - serum biochemical assays and nuchal translucency measurements using ultrasound - with a noninvasive, cell-free DNA test. Serum biochemical assays identify biomarkers for chromosomal abnormalities while nuchal translucency measurements use ultrasound examinations to measure the thickness of a space at the back of the baby's neck. With Down syndrome, more fluid is present, making the space appear thicker. Cell-free DNA testing works by mapping and counting DNA fragments in a mother's blood sample and comparing the measurements to normal reference samples. The cell-free DNA is obtained through a simple blood draw from the mother after 10 weeks of pregnancy. 
 
The study's endpoint was a comparison of false positive rates for trisomies 21 and 18 between the two methods. The false positive rate for combined trisomies 18 and 21 among those undergoing DNA testing was 0.45 percent while the rate for standard testing was 4.2 percent, a statistically significant difference. 
 
Another comparison was made for positive predictive value of test results: DNA results for trisomy 21 had a predictive value of 45.5 percent compared to 4.2 percent in standard testing; DNA results for trisomy 18 had a predictive value of 40.8 percent compared to 8 percent for standard testing, a significant improvement. 
 
"A strength of our study is that it was conducted in a variety of clinical settings that mirror real-world medical practices," said Bianchi. "The majority of the patients in the study were less than 30 years old, were having their first baby, and conceived spontaneously. Our study population was racially and ethnically diverse, which also makes our results very relevant to actual clinical practice. We also obtained pregnancy outcome information on every patient in the study."

Prenatal screening for fetal aneuploidy by testing mothers blood at 10 weeks of pregnancy

A study in the New England Journal of Medicine potentially has significant implications for prenatal testing for major fetal chromosome abno...

Mayo Clinic discovers African-Americans respond better to rubella vaccine

Health 3:26 AM

Somali Americans develop twice the antibody response to rubella from the current vaccine compared to Caucasians in a new Mayo Clinic study on individualized aspects of immune response. A non-Somali, African-American cohort ranked next in immune response, still significantly higher than Caucasians, and Hispanic Americans in the study were least responsive to the vaccine. The findings appear in the journal Vaccine. 
 
"This is fascinating," says Gregory Poland, M.D., Mayo Clinic vaccinologist and senior author of the study. "We don't know why these groups reacted so differently to the vaccine - that's a subject for further studies - but this new information will help us as we design the vaccines of the future. It will ultimately change how we practice medicine." 
 
The researchers studied a sample of 1,100 healthy children and young adults in Rochester, as well as over 1,000 participants from the U.S. Naval Health Research Center in San Diego as the control group. The Navy members, aged 18 to 40, were all healthy and recently vaccinated, and represented a cross-section of ethnic groups. The study also looked at a subset of a recent immigrant population from Somalia in Rochester. The Minnesota case studies were done in cooperation with the Rochester Epidemiology Project. 
 
The researchers hypothesized that race, sex or ethnicity might contribute to differences in immune response. They found no difference in gender - a surprise, says Dr. Poland, because in most studies women consistently have a better immune response to vaccines than men. 
 
"The significance of the findings is that in the future we may be able to create vaccines for specific groups or even individuals based on their genomic and other characteristics," says Dr. Poland. "That may mean adjusting doses for some or being able to treat larger populations with the same vaccine if the dosage is less." 
 
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Mayo Clinic discovers African-Americans respond better to rubella vaccine

Somali Americans develop twice the antibody response to rubella from the current vaccine compared to Caucasians in a new Mayo Clinic study o...

IVF technique increases pregnancy rates by 20%, study shows

Health, News 9:01 AM

It may not sound pleasant, but a procedure known as endometrial scratching has been shown to improve both pregnancy and birth rates when it is performed once in women who are undergoing reproductive treatment. 
 
Endometrial scratching is medically assisted damage to the womb, specifically the inner lining, and researchers say it was first successfully demonstrated to be beneficial in 2003. 
 
The procedure is intrusive, however, and the results of its effectiveness have not been fully documented. 
 
But a team of Brazilian scientists, in collaboration with Dr. Nick Raine-Fenning, of the Nottingham University Research and Treatment Unit (NURTURE), have demonstrated a benefit to the specific timing of endometrial scratching in a clinical trial. 
 
Results of the trial were published in the journal Ultrasound in Obstetrics & Gynecology. 
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Scratching yielded more live births 
 
In the trial, Dr. Raine-Fenning and his colleagues sought to investigate the effect of endometrial scratching within a certain time frame - 7-14 days before core reproductive treatment began. 
 
There were a total of 158 women who took part in the trial, and all of them had previously received unsuccessful reproductive treatment. They were all taking an oral contraceptive pill (OCP) just before the trial treatment commenced. 
 
On the importance of having women on an OCP beforehand, Dr. Raine-Fenning told Medical News Today: 
 
"Many units use the 'pill' to control cycles and provide a degree of 'down regulation' prior to IVF. It gives them control of when treatment will happen and some believe it can improve outcome, although this is far from clear and of great debate." 
 
The researchers say that 77 of the women were randomized to receive the scratching technique, and it was indeed given 7-14 days before any reproductive treatment began. 
 
Of the 77 women who received the scratching technique, 39 became pregnant and 33 cases resulted in live births. This is in comparison with 23 live births from the control group. 
 
The difference represents a 20% increased clinical pregnancy rate in women who underwent endometrial scratching. 
 
The study also shows that the technique did not affect miscarriage or multiple pregnancy rates, compared with the standard protocols. 
 
Hope, but in the future 
 
The researchers note that up to 15% of women who are of reproductive age have trouble conceiving, and reproductive treatment failure can cause psychological distress for many couples, which is why the prospect of better chances may provide hope. 
 
Dr. Raine-Fenning explains: 
 
"This is the first well-designed trial conducted into endometrial scratching and the results are promising. Other trials have provided anecdotal evidence, but these have been limited and many questioned the validity of the technique." 
 
He says that he and his team are now conducting a follow-up study in Nottingham to create further guidance on endometrial scratching. "Early results are encouraging," he says. 
 
Though the scratching technique does increase the chances of live birth and clinical pregnancy, the researchers do caution that it might cause considerable pain. 
 
When asked how long until this procedure may become widely available to patients, Dr. Raine-Fenning told Medical News Today that there are still a number of clinical trials and repeated work that needs to be done before it would become common practice. 
 
However, he added: 
 
"For privately funded patients [in the UK], many clinics are offering this already, including ourselves, although reluctantly as we want to do the trial and do not feel there is enough evidence yet to warrant charging patients." 
 
He did say, however, that "it is hard to refuse someone who may be facing their last chance, especially if this takes 5 years to become mainstream."

IVF technique increases pregnancy rates by 20%, study shows

It may not sound pleasant, but a procedure known as endometrial scratching has been shown to improve both pregnancy and birth rates when it ...

Sleeping longer linked to faster decline in brain function

Health, News 9:01 AM

Sleeping in regularly may not be a good idea if you want to keep your brain sharp, according to a new study that found people in their 60s and 70s who slept on average 9 hours or more in a 24-hour period showed a more rapid decline in cognitive function over 3 years than counterparts who slept 6-8 hours. 
 
Decline in cognitive function, such as memory and thinking, is a feature of Mild Cognitive Impairment (MCI), a known risk factor for dementia. 
 
The study, which was conducted by researchers from the University Hospital Madrid and Columbia University in New York, was published online recently in the Journal of Psychiatric Research. 
 
The researchers, led by Dr. Julián Benito-León, looked at data from a large cohort of over 2,700 people in their 60s and 70s who were followed for 3 years. 
 
At the beginning and end of the study period, the participants underwent assessment of brain function using the mini-mental state examination (MMSE), one of a battery of tests used to assess dementia. 
 
Over the 3 years they were followed, the participants also filled in reports that included details of their sleeping patterns. 
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The results showed that 49% of participants were normal sleepers (they slept on average 6-8 hours over a 24-hour period, this was the "reference group"), 40% were long sleepers (9 or more hours) and 11% were short sleepers (5 hours or less). 
 
Over the follow-up, the MMSE scores declined in all three groups, with long sleepers showing nearly double the amount of decline in cognitive function of normal sleepers. 
 
The authors note that the "difference between long sleepers and the reference group was significant," and the result remained "robust," even when they took into account factors that might influence it, such as age, education, and smoking and drinking habits. 
 
The researchers say further studies are needed to confirm these findings. 
 
It is important to note finding a link does not establish that longer sleep actually causes the mental decline. There could be other explanations, and one question that could be explored is does mental decline cause people to sleep longer? 
 
Another study published recently found that too much or too little sleep is linked to chronic diseases, such as diabetes, coronary heart disease, obesity and anxiety in those aged 45 and over.

Sleeping longer linked to faster decline in brain function

Sleeping in regularly may not be a good idea if you want to keep your brain sharp, according to a new study that found people in their 60s a...

Brain training may boost memory, but not intelligence

Health, News 9:01 AM

With their promise of improved mental abilities, it is easy to see why brain training games are so popular. But new research shows that the perceived benefits may be limited to memory instead of IQ. 
 
Most people would love a boost in brain power. And marketing departments are quick to tap into these desires. But an advertisement promising to improve your intelligence may be too alluring to resist, and probably too good to be true. 
 
Psychological scientist Randall Engle of the Georgia Institute of Technology explains: 
 
"It is hard to spend any time on the web and not see an ad for a website that promises to train your brain, fix your attention, and increase your IQ. These claims are particularly attractive to parents of children who are struggling in school." 
 
Prof. Engle believes the claims are based on evidence that shows a strong correlation between working memory capacity (WMC) and general fluid intelligence. 
 
Working memory capacity - or short-term memory - refers to our ability to keep information either in mind or quickly retrievable, particularly in the presence of distraction. General fluid intelligence is the ability to infer relationships, do complex reasoning, and solve problems. 
 
The link between WMC and fluid intelligence seems to suggest that increasing WMC should increase fluid intelligence, but, as Prof. Engle notes: "this assumes that the two constructs are the same thing, or that WMC is the basis for fluid intelligence." 
 
No boost to intelligence 
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To test the theory, the team at Georgia Tech invited 55 undergraduate students to complete 20 days of training on certain cognitive tasks. To ensure the students remained motivated and engaged in their training, they were paid extra for improving their performance each day. 
 
Students in the two experimental conditions trained on either complex span tasks, which have been consistently shown to be good measures of WMC, or simple span tasks. 
 
With the simple span tasks, the students were asked to recall items in the order they were presented, while for complex span tasks, the students had to remember items while performing another task in between item presentations. A control group trained on a visual search task which, like the other tasks, became progressively harder each day. 
 
The researchers administered a battery of tests before and after training to gauge improvement and transfer of learning, including a variety of WMC measures and the measures of fluid intelligence. 
 
The results were clear: only students who trained on complex span tasks showed transfer to other WMC tasks. None of the groups showed any training benefit on measures of fluid intelligence. 
 
Tyler Harrison, a Georgia Tech graduate student and lead author on the paper, says: 
 
"For more than 100 years, psychologists have argued that general memory ability cannot be improved, that there is little or no generalization of 'trained' tasks to 'untrained' tasks. So we were surprised to see evidence that new and untrained measures of working memory capacity may be improved with training on complex span tasks." 
 
The main benefit seems to be that this could have important implications for real-world multitasking. 
 
But the benefits of training did not transfer to fluid intelligence. Prof. Engle points out that just because WMC and fluid intelligence are linked, it does not mean that they are the same. 
 
As he sensibly points out: 
 
"Height and weight in human beings are also strongly correlated, but few reasonable people would assume that height and weight are the same variable. If they were, gaining weight would make you taller and losing weight would make you shorter - those of us who gain and lose weight periodically can attest to the fact that that is not true." 
 
Earlier studies, reported on Medical News Today, have linked intelligence to the ability to block out destractions, while another showed that keeping active mentally could preserve memory. 
 
The researchers acknowledge that more work needs to be done. They plan to continue this research to see how training specific aspects of cognition can lead to positive transfer to other tasks, both in the laboratory and in the real world.

Brain training may boost memory, but not intelligence

With their promise of improved mental abilities, it is easy to see why brain training games are so popular. But new research shows that the ...

New treatment regimen may prevent fatal leukemia progression

Health, News 1:21 AM

Two gene alterations pair up to promote the growth of leukemia cells and their escape from anti-cancer drugs, according to a study in The Journal of Experimental Medicine. 
 
Chronic myeloid leukemia (CML) is an aggressive cancer of the blood that is often treated with a drug called Imatinib (a.k.a. Gleevec). Although Gleevec is highly effective, some cancer cells can develop resistance to the drug. The mechanism that drives this resistance is not completely understood, but there is evidence that cancerous stem-like cells are particularly resistant and help to perpetuate disease. 
 
CML stem-like cells rely on a protein called β-catenin for their survival and maintenance, and deletion of this protein in mice delays cancer growth. Another protein, IRF8, inhibits the survival of cells and is often reduced in CML cells, particularly in patients with advanced disease. 
 
A group of scientists from the Max Delbrück Center for Molecular Medicine in Berlin now show that CML cells with activating β-catenin mutations are particularly resistant to Imatinib. Resistance is boosted further when this defect teams up with those that abolish IRF8 expression, rendering CML cells highly aggressive in mice. In fact, in CML cells lacking IRF8, β-catenin activation was essential for the cell's growth and survival. 
 
Combined treatment with drugs that restore the expression of IRF8 and those that inactivate β-catenin may force these cells to surrender to treatment, preventing fatal leukemia progression.

New treatment regimen may prevent fatal leukemia progression

Two gene alterations pair up to promote the growth of leukemia cells and their escape from anti-cancer drugs, according to a study in The Jo...

For our collective happiness its people that count

Health, News 1:21 AM

Swedish soccer star Zlatan is associated with happiness, but not iPhones. A new study at the Sahlgrenska Academy and Lund University suggests that our collective picture of what makes us happy is more about relationships, and less about things. 
 
News articles published online by Swedish dailies during 2010 were analyzed in the study. By analyzing which words most often occurred in the same articles as the Swedish word for happiness, the researchers could pinpoint our collective happiness. 
 
"It's relationships that are most important, not material things, and this is in line with other findings in happiness research," says Danilo Garcia, researcher in psychology at the Sahlgrenska Academy's Centre for Ethics, Law and Mental Health. 
 
The article analysis, which embraces more than one and a half million words, shows that words like "Prince Daniel", "Zlatan", "grandmother" and personal pronouns (such as you/me, us/them) often appear with the Swedish word for happiness. Words like "iPhone", "millions" and "Google" on the other hand, almost never appear with the word for happiness. 
 
"This doesn't mean that material things make you unhappy, just that they don't seem to come up in the same context as the word for happiness," says Danilo Garcia. 
 
The study is a part of a larger research project on how people describe both positive and negative events in their lives. The researchers believe that the word analysis reflects a collective perception among the members of our society as to what should make us happy. 
 
"Just as the Beatles sang, most people understand that money can't buy you happiness or love," says Danilo Garcia. "But even if we as individuals can understand the importance of close and warm relationships on a social level, it isn't certain that everyone is aware that such relationships are actually necessary for our own personal happiness." 
 
The study: "A Collective Theory of Happiness: Words Related to the Word 'Happiness' in Swedish Online Newspapers" was published in the scientific periodical Cyberpsychology, Behavior, and Social Networking.

For our collective happiness its people that count

Swedish soccer star Zlatan is associated with happiness, but not iPhones. A new study at the Sahlgrenska Academy and Lund University suggest...

Physicians reach quality-improvement goals at Mass. General with the help of incentives

Health, News 1:21 AM

A program offering modest financial incentives to salaried Massachusetts General Hospital-affiliated physicians who achieve specific quality improvement targets has helped the organization meet goals related to the adoption of electronic health technology, improved quality and efficiency, and communication with patients and other providers. In their report in the October issue of Health Affairs, leaders of the Massachusetts General Physicians Organization (MGPO) describe results of the first six years of the MGPO Quality Incentive Program. 
 
"Incentive programs like this - which can help organizations focus the attention of busy clinicians on tasks that help deliver better, more cost-effective care - are very valuable at a time when the health care system is transitioning from fee-for-service to new payment models," says Timothy Ferris, MD, MGPO medical director and a co-author of the report. "One of the ways this differs from traditional pay-for-performance programs is that it was designed by physicians for physicians, who determined what the goals and priorities were." 
 
The MGPO employs more than 98 percent of the physicians on the MGH staff and is part of Partners Community Healthcare Inc. (PCHI) - a network of providers working within Partners HealthCare System, a regional system including Mass. General, Brigham and Women's Hospital, and several additional Massachusetts hospitals. While PCHI has maintained pay-for-performance contracts with coverage providers for more than a decade, the goals of such programs were worked out with payors, focus mostly on primary care and are set on an institutional level. Insurer pay-for-performance payments are based on claims, which can lead to a delay of as much as two years, and often have little impact on individual physicians. 
 
The MGPO Quality Incentive Program, in contrast, was designed to focus on clinical priorities applying to all physicians, to reward achievement of those priorities in a timely manner, and to be flexible enough to address new demands or challenges facing the clinical staff. The program - available to MGPO physicians and psychologists who participate in managed care contracts and spend a significant amount of time in clinical practice - is funded by redirecting a portion of physician earnings. Based on a system used by Medicare and other payors to calculate physician reimbursement, participants are categorized as having high, medium or low levels of clinical activity. 
 
The program sets specific quality improvement goals for six-month terms, with three different measures and performance targets for each term. Two measures are chosen by the program leaders and apply to all participating physicians, with alternatives available for specialties that a measure does not apply to. The third measure is chosen on a departmental or divisional level. Some measures continue over several terms, with increasing targets for succeeding terms. For example, measures related to adoption of an electronic health record started with attending training sessions in the system. Later terms required timely incorporation of 80 and then 90 percent of preliminary outpatient notes into the system, and eventually physicians were asked to complete final notes within eight days. 
 
Physicians with high levels of clinical activity who achieved their targets could receive a maximum of $5,000 a year; payments for medium levels could reach $2,500, and up to $1,000 was offered to those with low clinical activity. Around 1,300 physicians were eligible for the program when it began in December 2006, and 1,700 are currently eligible. The Health Affairs article reports on results covering 13 terms from the program's inception through the end of 2012. Throughout that period, an average of 62 percent of physicians met all performance goals during a term, and only a few missed all of a term's targets. 
 
Along with the consistent use of the electronic medical record, the program also focused on increasing use of an electronic prescription system, preparation for Joint Commission on the Accreditation of Healthcare Organization reviews and implementation of its recommendations, and improved communication with patients. Departmental targets included reducing excessive use of emergency care, more timely and accurate completion of radiology reports, and increased standardization of chemotherapy protocols. In addition to helping the MGPO reach these and other goals, the program contributed to the achievement of many of the federal government's criteria for meaningful use of health information technology. 
 
"By setting realistic targets that were increased in an incremental way, we could introduce more demanding goals at a pace that physicians found tolerable," explains Deborah Colton, MGPO senior vice president and a co-author of the report. "We wanted goals that were important but also achievable, and hoped that physicians would meet the targets about 80 percent of the time. They actually exceeded our expectations, and 90 percent of the available funds were paid out over the six years. Although the maximum annual incentive payment amounts to only a small percentage of the average physician's income, it proved to be a powerful motivating force among a group of physicians who pride themselves on excellent performance." 
 
David Torchiana, MD, MGPO chief executive officer and first author of the report, says, "In the current, rapidly changing health care environment, where our physicians face incessant new administrative demands, this program helped convey to our clinicians our assessment of the most important current priorities. The program is designed for constant evaluation and revision, so that as the health care system evolves, the incentives can change at the same time. We've been pleased with the program's success so far and hope that sharing our experience will help other institutions take on this important but challenging task."

Physicians reach quality-improvement goals at Mass. General with the help of incentives

A program offering modest financial incentives to salaried Massachusetts General Hospital-affiliated physicians who achieve specific quality...

In Phase 3 children's study, malaria vaccine candidate reduces disease over 18 months of follow-up

Health, News 1:21 AM

Multilateral Initiative on Malaria Pan African Conference, Durban, South Africa - Results from a large-scale Phase III trial, presented today in Durban, show that the most clinically advanced malaria vaccine candidate, RTS,S, continued to protect young children and infants from clinical malaria up to 18 months after vaccination. Based on these data, GSK now intends to submit, in 2014, a regulatory application to the European Medicines Agency (EMA). The World Health Organization (WHO) has indicated that a policy recommendation for the RTS,S malaria vaccine candidate is possible as early as 2015 if it is granted a positive scientific opinion by EMA. 
 
These latest results demonstrated that over 18 months of follow-up, RTS,S was shown to almost halve the number of malaria cases in young children (aged 5-17 months at first vaccination) and to reduce by around a quarter the malaria cases in infants (aged 6-12 weeks at first vaccination). 
 
Vaccine efficacy was also assessed separately at each of the trial sites, which represent a wide range of malaria transmission settings; efficacy was found to be statistically significant at all sites in young children and at four sites in infants. 
 
Eleven African research centres in seven African countries1 are conducting this trial, together with GlaxoSmithKline (GSK) and the PATH Malaria Vaccine Initiative (MVI), with grant funding from the Bill & Melinda Gates Foundation to MVI. 
 
"In Africa we experience nearly 600,000 deaths annually from malaria, mainly children under five years of age," says Halidou Tinto, Principal Investigator from the Nanoro, Burkina Faso trial site and chair of the Clinical Trials Partnership Committee (CTPC), which oversees the RTS,S Phase III programme. "Many millions of malaria cases fill the wards of our hospitals. Progress is being made with bed nets and other measures, but we need more tools to battle this terrible disease." 
 
Efficacy and cases prevented 
 
The efficacy and public health impact of RTS,S were evaluated in the context of existing malaria control measures, such as insecticide treated bed nets, which were used by 78% of children and 86% of infants in the trial. In these latest results over 18 months of follow-up, children aged 5-17 months at first vaccination with RTS,S experienced 46% fewer cases of clinical malaria, compared to children immunised with a control vaccine. An average of 941 cases of clinical malaria were prevented over 18 months of follow-up for every 1,000 children vaccinated in this age group, noting that a child can contract more than one case of malaria. Severe malaria cases were reduced by 36%; 21 cases of severe malaria were prevented over 18 months of follow-up for every 1,000 children vaccinated. Malaria hospitalisations were reduced by 42%. 
 
Infants aged 6-12 weeks at first vaccination with RTS,S had 27% fewer cases of clinical malaria. 
 
Over 18 months of follow-up, 444 cases of clinical malaria were prevented for every 1,000 infants vaccinated. The reduction of severe malaria cases and malaria hospitalisations by 15% and 17%, respectively, were not statistically significant. 
 
"It appears that the RTS,S candidate vaccine has the potential to have a significant public health impact," says Tinto. "Preventing substantial numbers of malaria cases in a community would mean fewer hospital beds filled with sick children. Families would lose less time and money caring for these children and have more time for work or other activities. And of course the children themselves would reap the benefits of better health." 
 
Overall, vaccine efficacy declined over time: Previous results from one year follow-up of the Phase 3 trial showed that efficacy of RTS,S was 56% against clinical malaria and 47% against severe malaria for the 5-17 month-old age group and 31% against clinical malaria and 37% against severe malaria in the 6-12 week-old age group. 
 
Safety 
 
RTS,S continued to display an acceptable safety and tolerability profile during the 18 month follow-up. Apart from the meningitis signal previously reported2, no other safety signal was identified. The occurrence of meningitis will be followed closely during the remainder of the trial. 
 
Next year 
 
Further data from 32 months follow-up and the impact of a fourth 'booster' dose given 18 months after the initial three doses are expected to become available in 2014. 
 
Comments on results 
 
Sir Andrew Witty, CEO of GSK, said: "We're very encouraged by these latest results, which show that RTS,S continued to provide meaningful protection over 18 months to babies and young children across different regions of Africa. While we have seen some decline in vaccine efficacy over time, the sheer number of children affected by malaria means that the number of cases of the disease the vaccine can help prevent is impressive. These data support our decision to submit a regulatory application for the vaccine candidate which, if successful, would bring us a step closer to having an additional tool to fight this deadly disease. We are grateful to the scientists across Africa and GSK and to our partners who have worked tirelessly for almost 30 years to bring us to this point." 
 
Dr David C. Kaslow, vice president of product development at PATH, said: "Given the huge disease burden of malaria among African children, we cannot ignore what these latest results tell us about the potential for RTS,S to have a measurable and significant impact on the health of millions of young children in Africa. While we want to be careful about not getting ahead of the data, this trial continues to show that a malaria vaccine could potentially bring an important additional benefit beyond that provided by the tools already in use."

In Phase 3 children's study, malaria vaccine candidate reduces disease over 18 months of follow-up

Multilateral Initiative on Malaria Pan African Conference, Durban, South Africa - Results from a large-scale Phase III trial, presented toda...

Babies learn to anticipate touch in the womb

Health, News 1:21 AM

Babies learn how to anticipate touch while in the womb, according to new research by Durham and Lancaster universities. 
 
Using 4-d scans psychologists found, for the first time, that fetuses were able to predict, rather than react to, their own hand movements towards their mouths as they entered the later stages of gestation compared to earlier in a pregnancy. 
 
The Durham-led team of researchers said that the latest findings could improve understanding about babies, especially those born prematurely, their readiness to interact socially and their ability to calm themselves by sucking on their thumb or fingers. 
 
They said the results could also be a potential indicator of how prepared babies are for feeding. 
 
The researchers carried out a total of 60 scans of 15 healthy fetuses at monthly intervals between 24 weeks and 36 weeks gestation. 
 
Fetuses in the earlier stage of gestation more frequently touched the upper part and sides of their heads. 
 
As the fetuses matured they began to increasingly touch the lower, more sensitive, part of their faces including their mouths. 
 
By 36 weeks a significantly higher proportion of fetuses were observed opening their mouths before touching them, suggesting that later in pregnancy they were able to anticipate that their hands were about to touch their mouths, rather than reacting to the touch of their hands, the researchers said. 
 
Increased sensitivity around a fetus' mouth at this later stage of pregnancy could mean that they have more "awareness" of mouth movement, they added. 
 
Previous theories have suggested that movement in sequence could form the basis for the development of intention in fetuses. 
 
The researchers said their findings could potentially be an indicator of healthy development, as arguably fetuses who are delayed in this development due to illness, such as growth restriction, might not show the same behaviour observed during the study. 
 
The research, published in the journal Developmental Psychobiology, involved eight girls and seven boys and the researchers noticed no difference in behaviour between boys and girls. 
 
Lead author Dr Nadja Reissland, in the Department of Psychology, at Durham University, said: "Increased touching of the lower part of the face and mouth in fetuses could be an indicator of brain development necessary for healthy development, including preparedness for social interaction, self-soothing and feeding. 
 
"What we have observed are sequential events, which show maturation in the development of fetuses, which is the basis for life after birth. 
 
"The findings could provide more information about when babies are ready to engage with their environment, especially if born prematurely." 
 
Brian Francis, Professor of Social Statistics at Lancaster, added: "This effect is likely to be evolutionally determined, preparing the child for life outside the womb. Building on these findings, future research could lead to more understanding about how the child is prepared prenatally for life, including their ability to engage with their social environment, regulate stimulation and being ready to take a breast or bottle." 
 
The study builds on previous research by Durham and Lancaster into fetal development. Earlier this year another of their studies showed that unborn babies practise facial expressions in the womb in what is thought to be preparation for communicating after birth. 
 
And in 2012 Dr Reissland published research showing that unborn babies yawn in the womb, suggesting that yawning is a developmental process which could potentially give doctors another index of a fetus' health.

Babies learn to anticipate touch in the womb

Babies learn how to anticipate touch while in the womb, according to new research by Durham and Lancaster universities. Using 4-d scans ps...

Unhealthy lifestyles should be targeted by healthcare providers

Health, News 1:21 AM

Healthcare providers should treat unhealthy behaviors as aggressively as they treat high blood pressure, cholesterol and other heart disease risk factors, according to an American Heart Association science advisory published in Circulation. 
 
"We're talking about a paradigm shift from only treating biomarkers - physical indicators of a person's risk for heart disease - to helping people change unhealthy behaviors, such as smoking, unhealthy body weight, poor diet quality and lack of physical activity," said Bonnie Spring, Ph.D., lead author of the statement and a professor of preventive medicine and psychiatry and behavioral sciences at Northwestern University in Chicago. 
 
"We already treat physical risk factors that can be measured through a blood sample or a blood pressure reading in a doctor's office, yet people put their health at risk through their behaviors. We can't measure the results of these behaviors in their bodies yet." 
 
Among the statement's recommendations, healthcare providers should create "inter-professional practices" to connect patients with behavior change specialists such as dietitians or psychologists and implement the five A's when caring for patients: 
 
Assess a patient's risk behaviors for heart disease. 
Advise change, such as weight loss or exercise. 
Agree on an action plan. 
Assist with treatment. 
Arrange for follow-up care. 
For inter-professional practices to work, reimbursement policies must be revised, Spring said. 
 
Under an effective healthcare system, professionals can work with patients and draw on community and technology resources to provide intensive behavior interventions. 
 
"This isn't a problem that can be solved alone by the patient or the doctor who is strapped for time," Spring said. "We need to break out of our silos and get ahead of the curve in prevention." 
 
She said to achieve the American Heart Association's 2020 impact goals - to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent - we must make preventing cardiovascular diseases a priority.

Unhealthy lifestyles should be targeted by healthcare providers

Healthcare providers should treat unhealthy behaviors as aggressively as they treat high blood pressure, cholesterol and other heart disease...

As bacteria become increasingly resistant, new more effective antimicrobials might rise from old

Health, News 1:21 AM

By tinkering with their chemical structures, researchers at the University of California, San Diego School of Medicine have essentially re-invented a class of popular antimicrobial drugs, restoring and in some cases, expanding or improving, their effectiveness against drug-resistant pathogens in animal models. 
 
Writing in the Early Edition of PNAS, Lars Eckmann, MD, professor of medicine, and colleagues describe creating more than 650 new compounds by slightly altering structural elements of metronidazole and other 5-nitromidazoles (5-NI), a half-century-old class of antimicrobial drugs used to combat everything from an ulcer-causing stomach bacterium to a gut-churning protozoan found in contaminated water. 
 
"The basic building blocks of 5-NI drugs are the same for all. We decorated around them, adding extra molecular pieces to change their shapes and sizes," said Eckmann, who published the paper with colleagues at UC San Diego, The Scripps Research Institute and the Queensland Institute of Medical Research in Australia. The result: The altered shapes changed how many of the new compounds attacked pathogens in animal models, overcoming previous microbial resistance. 
 
The findings could have major ramifications in the on-going struggle against evolving drug resistance by many disease-causing pathogens. The Centers for Disease Control and Prevention recently estimated at least 2 million Americans fall ill to antibiotic-resistant bacteria each year, with at least 23,000 dying as a direct result of those infections. The World Health Organization (WHO) deems antimicrobial resistance to be an escalating global threat to public health. 
 
"Antibiotic resistance is rising for many different pathogens that are threats to health," said CDC director Tom Frieden, MD, MPH. "If we don't act now, our medicine cabinet will be empty and we won't have the antibiotics we need to save lives." 
 
To be sure, antibiotic drug resistance varies. "It spans the spectrum," said Eckmann. "We have some disease-causing bugs where the situation is critical, where we're really at risk of losing the ability to treat any infection. At the other end, some infections are not much impacted at all. It depends upon the particular bug." 
 
The antimicrobial resistance to current 5-NI drugs is equally varied. For example, metronidazole, which is used to treat a wide range of bacterial and parasitic infections, is highly effective against the parasitic protozoan Entamoeba histolytica, which can cause life-threatening gut and liver infections. For Trichomonas vaginalis, a sexually transmitted parasite that infects more Americans than any other eukaryotic pathogen, and Giardia lamblia, a water-borne pathogen that causes diarrheal disease, resistance-linked treatment failure occurs in up to 20 percent of cases. And in some developing countries, more than half of all infections with Helicobacter pylori, a stomach bacterium that causes ulcers and cancer, are resistant to metronidazole. 
 
Eckmann and colleagues say the full antimicrobial potential of 5-NI drugs is not known because efforts to continue commercial development stalled after their introduction in 1960, due in part to unfounded fears they might be mutagenic or increase the frequency of genetic mutations. Subsequent clinical studies have shown 5-NI compounds are safe, with no relevant long-term toxicity in humans. 
 
The challenge now is to re-new interest and investment in the amended drugs. Eckmann would like to further refine them in preparation for eventual human clinical trials. It will be an uphill struggle, he said. While the WHO has classified metronidazole as an "essential medicine," it's no guarantee of a future, lucrative market for any new and approved drugs. 
 
"Pharmaceutical companies are generally reluctant to pursue new drugs unless there's a real market for it," said Eckmann. "They ask themselves, 'Does the drug treat a disease at costs that justify the initial financial investments into drug development?'" 
 
Thanks to their enormous versatility, he is hopeful the answer will be yes for the revamped 5-NI drugs. "These drugs have half-a-dozen or more human targets," he said. "Treating Giardia might not be a major clinical challenge, at least in the United States, but 5-nitro antimicrobials also treat Clostridium difficile." 
 
As its name implies, C. difficile is indeed problematic. The bacterium causes symptoms ranging from diarrhea to life-threatening inflammation of the colon. An estimated half-million Americans get sick each year from C. difficile infections, which are becoming more frequent, severe and hard-to-treat as the bacterium grows increasingly resistant to metronidazole and other antibiotic therapies. Eckmann said new therapeutic options against this difficult-to-treat infection may find broader commercial interests.

As bacteria become increasingly resistant, new more effective antimicrobials might rise from old

By tinkering with their chemical structures, researchers at the University of California, San Diego School of Medicine have essentially re-i...

New decision-making model helps women with early-stage breast cancer decide on most appropriate treatment

Health, News 1:21 AM

Women with early-stage breast cancer in one breast are increasingly opting to undergo a more aggressive operation to remove both breasts called contralateral prophylactic mastectomy (CPM). Rates of double mastectomies have more than doubled over the last decade for women with early-stage cancer, but for women with cancer in one breast, having the healthy breast removed may not provide a survival benefit, according to new research findings presented at the 2013 Clinical Congress of the American College of Surgeons. 
 
According to the American Cancer Society, more than 232,000 women are diagnosed with breast cancer in the U.S. every year,* making breast cancer the second most common type of cancer in women, after skin cancer. Many women who face this diagnosis worry about cancer recurring in the healthy breast and therefore choose to have both breasts removed, even though the risk of developing cancer in the other breast is very low. Women at high risk include those with a family history of breast or ovarian cancer and women who test positive for the BRCA1 and BRCA2 gene mutations. 
 
Importantly, until now no study has looked at the decision-making processes that lead women to choose CPM. "There have been several studies in the last couple of years indicating that there may be a survival benefit for selected patients by having their healthy breast removed," said study coauthor Todd M. Tuttle, MD, FACS, chief of surgical oncology, University of Minnesota, Minneapolis. "This research will provide physicians and patients with accurate and easily understood information about whether removal of the healthy breast will impact their survival at all." 
 
To better understand the effect of CPM on life expectancy, the researchers conducted an analytic modeling study among women without a BRCA gene mutation. Within this group, the researchers compared women who underwent CPM with women who did have early-stage breast cancer in one breast and no prophylactic operation to remove the second breast. 
 
The study authors primarily analyzed data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) and the Surveillance, Epidemiology, and End Results (SEER) program to determine the risk of developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and the reduction in CBC due to CPM. The two databases include information on the treatment and survival of early breast cancer and include more than 100,000 women who have participated in randomized trials over the last 30 years across the United States. 
 
For the study, the researchers estimated the life expectancy gain of CPM among sub-groups of women newly diagnosed with cancer in one breast by age 40 to 60 years, estrogen receptor status as positive or negative, and stage of cancer I or II. They found that the maxi- mum life expectancy gain for women who underwent CPM was six months for all scenarios including age, estrogen receptor status, and cancer stage groups. 
 
Because many women are driven by their fears of contracting a second cancer in their healthy breast, they choose a double mastectomy, the more aggressive treatment. This procedure is a bigger operation associated with a longer recovery period and potentially more complications. Thus, experts are concerned that some patients are being overtreated with a prophylactic procedure. 
 
"I think this decision model study will provide women who are considering these extensive operations with more accurate information about whether or not CPM is going to improve their survival," Dr. Tuttle said. With this analytic modeling tool, women and physicians can make more informed and better decisions when choosing between different treatments. These results can help educate women that a contralateral mastectomy will not improve their survival rate if they don't have hereditary breast cancer, he explained. 
 
"This information may ultimately help them answer an important question: 'If I have that opposite breast removed, is that procedure really going to improve the likelihood that I will be alive 10 to 20 years from now?'"

New decision-making model helps women with early-stage breast cancer decide on most appropriate treatment

Women with early-stage breast cancer in one breast are increasingly opting to undergo a more aggressive operation to remove both breasts cal...

Some bat-infecting malaria pathogens are close cousins to those in rodents

Health, News 1:21 AM

Researchers have discovered a surprising diversity of malaria parasites in West African bats as well as new evidence of evolutionary jumps to rodent hosts. Led by scientists at the American Museum of Natural History, the Max Planck Institute for Infection Biology, and the Museum für Naturkunde, Berlin, the new study reveals that two bat-infecting parasites are closely related to parasites in rodents that are commonly used to model human malaria in laboratory studies. The results will be published this week in the Proceedings of the National Academy of Sciences. 
 
"Bats, which are important reservoir hosts for many pathogens, particularly viruses, have been hosts to malaria parasites for more than a century," said coauthor Susan Perkins, an associate curator in the Museum's Division of Invertebrate Zoology. "Understanding the evolution of malaria parasites in bats and other animals, and how they fit into the tree of life, is key to understanding this important human disease." 
 
Malaria is caused by a handful of species of parasites in the genus Plasmodium through the bite of mosquitos and remains a widespread vector-borne infectious disease, sickening almost half a billion people every year around the planet. Experimental research on drugs, immunology, and the development of malaria is typically done on related Plasmodium species that infect rodents, including laboratory-reared mice. The parasites' natural hosts are African thicket rats that use shrubs and trees as habitat. 
 
To further investigate how bats fit into this picture, the researchers surveyed more than 250 bats in remote forest ecosystems in Liberia, Guinea, and Cote d'Ivoire in Western Africa. They found a vast diversity of malaria parasites that included not just the Plasmodium species, but also members of three other genera. The DNA from several genes of the bat parasites was sequenced at the Museum's Sackler Institute for Comparative Genomics, resulting in the most comprehensive evolutionary tree of life for malaria parasites of bats to date. 
 
The authors report that two parasites, Plasmodium voltaicum and Plasmodium cyclopsi, show patterns of evolutionary jumps from the rodent lineage into bats and then likely a reverse jump, with a bat parasite re-infecting rodent hosts. The authors suggest that the bat hosts, which roost in trees, may have been exposed to the same mosquito vectors that transfer the parasites between the tree-dwelling rodent hosts. 
 
"It is unknown what the physiological effects of the parasites are on the bats, but the high diversity of parasites as well as the high proportion of individuals that are infected with the parasites suggest that this may be yet another example of the unusually high tolerance of these flying mammals for pathogens," said co-author Juliane Schaer, a researcher at the Max Planck Institute for Infection Biology and the Museum für Naturkunde, Berlin. "Other work has suggested that the evolution of flight may have triggered parallel strengthening of the immune system of bats and may explain why they are able to host viruses such as Ebola, rabies, and the recently discovered Middle East Respiratory System (MERS) virus, which are highly pathogenic to other mammals, including humans."

Some bat-infecting malaria pathogens are close cousins to those in rodents

Researchers have discovered a surprising diversity of malaria parasites in West African bats as well as new evidence of evolutionary jumps t...

Why diabetic retinopathy is difficult to treat

Health, News 1:21 AM

Damage to the retina due to diabetes can be ameliorated only partially, despite treatment with the standard drug metformin. Scientists of Helmholtz Zentrum München have discovered that metformin treatment normalizes the alterations induced by diabetes in only about half of the altered retinal proteins. The results of the study were published in the journal Diabetologia. 
 
Retinal damage is one of the most common complications of diabetes, affecting about 90 percent of type 1 diabetics and 75 percent of type 2 diabetics. According to the World Health Organization (WHO), diabetic retinopathy is the leading cause of blindness in adults of working age, and its incidence is showing an upward trend. 
 
The retina is the part of the eye that converts optical images into nerve signals, which are then transmitted to the brain where vision is interpreted. Numerous proteins and molecules are involved in the process of signal transduction. Diabetic retinal damage leads to impaired function of these proteins. Within the framework of research projects of the German Center for Diabetes Research (DZD), scientists of the Research Unit Protein Science (PROT) and the Institute of Experimental Genetics (IEG) at Helmholtz Zentrum München (HMGU) have now investigated how drug treatment affects these signal carriers. They compared the concentrations of proteins in the retinas of non-diabetic mice, of mice with type 2 diabetes without treatment and of type 2 diabetic mice that were treated with the standard drug metformin, which lowers blood glucose levels and thus reduces diabetes complications. A total of 98 proteins were differentially abundant in the diabetic animals. About half of the proteins were normalized by treatment with metformin. The other proteins were unchanged, however, despite treatment and improved blood glucose levels. Among these was the protein VGLUT1, which is essential for signal transduction in specific nerve cells. 
 
"Our results show that normalized blood glucose levels alone are not sufficient to fully treat diabetic retinopathy," said Dr. Alice Ly (PROT), lead author of the study. "In further studies we want to examine how different combination therapies affect the retinal proteins, in order to achieve a better understanding of the causes and treatment of this diabetes complication," added Dr. Stefanie Hauck (PROT). 
 
The most common diseases in the population, such as type 2 diabetes, are the focus of research at Helmholtz Zentrum München. The aim is to develop new approaches to diagnosis, treatment and prevention.

Why diabetic retinopathy is difficult to treat

Damage to the retina due to diabetes can be ameliorated only partially, despite treatment with the standard drug metformin. Scientists of He...

Despite effective interventions, adult ADHD often remains untreated

Health, News 1:21 AM

Up to two-thirds of children with attention deficit/hyperactivity disorder (ADHD) find their disorder persists into adulthood yet only a small proportion of adults ever receive a formal diagnosis and treatment, research suggests. 
 
ADHD, a chronic neurodevelopmental disorder that begins in childhood, continues into adulthood in the majority of children. Prevalence figures show that 3-4% of adults are affected by ADHD and it is associated with a broad range of psychosocial impairments. 
 
Dr Esther Sobanski investigates the pharmacological management of adult ADHD at the Department of Psychiatry and Psychology, Central Institute of Mental Health, Mannheim, Germany. "In contrast [to the 3-4% prevalence rate], diagnostic prevalence is below 0.5%, indicating that a majority of cases go undiagnosed and untreated," she said. 
 
Reviewing the impact of ADHD in adults, Dr Sobanski noted that peer-group, relationship and parenting difficulties, poor work and academic performance, as well as a tendency towards dangerous driving habits like speeding and accident proneness in daily living were all associated with the disorder. 
 
"In addition to ADHD core symptoms, patients often experience associated symptoms like emotional dysregulation, sleep disturbances or low self-esteem, as well as suffering from comorbid disorders, particularly depressive episodes, substance use and anxiety disorders," she explained. 
 
Dr Sobanki's research suggests that medication can have an impact beyond ADHD core symptoms, improving psychosocial functioning like managing on-road driving or parenting while treating symptoms such as emotional dysregulation or sleep problems. 
 
Current guidelines recommend a multimodal approach for treatment of adult ADHD, including psycho-education, pharmacotherapy, disorder-oriented psychotherapy and occupational rehabilitation. 
 
However, although pharmacotherapy has been shown to be highly effective, and a growing body of evidence supports disorder-oriented psychotherapy in residual symptoms, many adults remain untreated. 
 
"New pharmacological treatment approaches not only target ADHD core symptoms but also co-morbid psychiatric disorders like alcohol use disorders or social phobia," Dr Sobanksi noted. "However, in the European Union only two medications are approved for de novo use in adult ADHD." 
 
"Available data from a cross national suggest that most adults with ADHD in Europe are untreated," she added.

Despite effective interventions, adult ADHD often remains untreated

Up to two-thirds of children with attention deficit/hyperactivity disorder (ADHD) find their disorder persists into adulthood yet only a sma...

Venous narrowing not linked to MS

Health, News 1:21 AM

There is no association between MS (multiple sclerosis) and venous narrowing, specifically the narrowing of the veins from the brain to the heart (extracranial veins), researchers reported in The Lancet. 
 
Canadian scientists found no statistically significant difference between venous narrowing rates in patients with MS compared to other people without MS, including siblings. 
 
These findings challenge a controversial theory that MS is linked to CCSVI (chronic cerebrospinal venous insufficiency). 
 
In 2009, Dr. Zamboni and a group of researchers defined CCSVI as "ultrasound-detectable abnormalities in the anatomy and blood flow in the veins draining blood from the brain and back." According to Zamboni's study, CCSVI was much more prevalent in people with MS compared to the rest of the population. 
 
Those who support this theory believe that MS is a consequence of the narrowing of extracranial nerves which leads to flow abnormalities and blockage. They suggest that a number of MS patients may be effectively treated by angioplasty to unblock or widen the veins (liberation procedure). 
 
There is research currently underway on whether angioplasty treatment might benefit patients with MS. So far, imaging studies have had inconclusive results regarding a potential link between venous narrowing and MS. 
 
In this latest study, Dr. Katherine Knox at the University of Saskatchewan in Saskkatoon, and Dr. Anthony Traboulsee at the University of British Columbia and Vancouver Coastal Health in Vancouver, both in Canada, set out to examine the extracranial veins of 79 MS patients, 55 of their siblings (without MS), and 43 controls (healthy unrelated volunteers). 
 
The researchers used ultrasound and catheter venography. Catheter venography involves injecting a special dye into the vein and then taking an x-ray - the dye shows up in the images. 
 
Dr Traboulsee explained: 
 
"Until now, most studies of venous narrowing have used ultrasound imaging to establish whether venous narrowing is present. While ultrasound is a relatively simple and inexpensive way of looking at veins, it's not necessarily the most accurate imaging technique, so in our study, we also used catheter venography - usually thought of as the gold standard of venous imaging - to measure whether any narrowing of the veins was present." 
 
Narrowing of the extracranial veins was similar across the three groups 
 
The team found that at least two thirds of the participants across all three groups had narrowing of the extracranial veins greater than 50%, according to the catheter venography scans. 
 
Narrowing of extracranial veins was present in: 
 
74% of the MS patients 
66% of their unaffected brothers and sisters 
70% of the controls 
Dr. Traboulsee said there was not a statistically significant difference within the three groups. 
 
When they used the overall CCSVI criteria put forward by Zamboni and his team, this latest study found that just one of the MS participants, one of their siblings and one of the controls tested positive. 
 
The team also found that Zamboni's ultrasound criteria for CCSVI was not accurate - it only identified venous narrowing in 42% of cases confirmed by the more reliable imaging technique. 
 
Dr Traboulsee said: 
 
"Our results confirm that venous narrowing is a frequent finding in the general population, and is not a unique anatomical feature associated with multiple sclerosis. This is the first study to find high rates of venous narrowing in a healthy control group, as well as the first to show that the ultrasound criteria usually used to 'diagnose' CCSVI are unreliable, so if there is a connection between venous narrowing and MS, it remains unknown, and it would certainly appear to be much more complicated than current theories suggest." 
 
Hypothesis of CCSVI looks unlikely - linked Comment 
 
In the same journal, Dr. Friedemann Paul and Dr. Mike Wattjes write in a linked Comment that these new results sound like the "death knell" for Zamboni's CCSVI hypotheses as a disease entity. 
 
They wrote "If chronic cerebrospinal venous insufficiency actually existed, the ultrasound findings of this study and previous studies would suggest that up to half of the general and otherwise healthy population should be judged to be seriously ill because of venous insufficiency of the cervical veins. The fact that some changes in the venous system have been described in association with multiple sclerosis does not imply causality." 
 
"A lively discussion has emerged recently as to whether funding of chronic cerebrospinal venous insufficiency research is, or was, a waste of valuable time, money, and intellectual energy. The work by Traboulsee and colleagues should be viewed as the definitive conclusion to this discussion. Although it is laudable that the Multiple Sclerosis Society of Canada and other sources have funded this seminal study, which would probably not have received funding otherwise, now it is absolutely clear that no reason exists to allocate any further resources to chronic cerebrospinal venous insufficiency research, be they financial or intellectual." 
 
The study was funded by the MS Society of Canada. It is part of a series of studies examining CCSVI. 
 
In a landmark pilot study of "liberation treatment", scientists at the University of Buffalo found that opening veins does not help MS patients. In fact, they reported that in some cases patients got worse after treatment.

Venous narrowing not linked to MS

There is no association between MS (multiple sclerosis) and venous narrowing, specifically the narrowing of the veins from the brain to the ...

Better community engagement and stronger health systems are needed to tackle polio

Health, News 3:31 PM

In PLOS Medicine two independently written articles call for a shift away from the leader-centric approach that polio eradication campaigns are currently pursuing in the three countries (Nigeria, Pakistan and Afghanistan) where the disease remains endemic. 
 
In a Policy Forum article, authors from Nigeria, Pakistan and Afghanistan led by Seye Abimbola from the National Primary Health Care Development Agency, Nigeria, argue that the global health community and governments involved in polio eradication efforts need to build trust and prioritise polio eradication as part of routine health services in order to address the problem of polio. 
 
The authors highlight that increasing militancy, political unrest, lack of trust, and deteriorating security conditions are common denominators that threaten polio eradication efforts in all three countries, although these are embedded in country-specific contexts. However, the authors are concerned that current strategies being used to tackle polio may not be best suited to the situation within the three countries. 
 
The authors say, "[i]n our view, the ambition of the global health community to eradicate polio appears to be blinding it to lessons learned about health systems over the past 30 years. Polio eradication will only be achieved with stronger health systems and bottom-up community engagement, which is likely to require more time and more investment than is currently available in Pakistan, Nigeria, and Afghanistan because of their political fragility." 
 
In an independently written Essay, Svea Closser and Rashid Jooma from Middlebury College, United States and Aga Khan University, Pakistan highlight the importance of Lady Health Workers in Pakistan who are crucial for the country's polio eradication efforts. 
 
There are approximately 106,000 Lady Health Workers in Pakistan who in addition to working on polio campaigns, visit families monthly to promote family planning; advise on nutrition and hygiene; and create demand for antenatal care, childhood immunization, and use of skilled birth attendants. 
 
However, the authors describe how Pakistan's Lady Health Workers are often in desperate financial straits, have little opportunity for career advancement and risk their lives as frontline health workers. The authors call for a shift away from the "leader-centric" model being employed by partners involved in the polio eradication effort and for increased support for Lady Health Workers in Pakistan. 
 
The authors conclude, "Pakistan's [Lady Health Workers] have the potential to achieve universal immunization and polio eradication in the country. In fact, both of these goals are probably impossible without their full support. Achieving them depends on a shift from treating frontline female health staff as disposable labor to truly engaging them as well-supported, active partners in achieving a healthier Pakistan."

Better community engagement and stronger health systems are needed to tackle polio

In PLOS Medicine two independently written articles call for a shift away from the leader-centric approach that polio eradication campaigns ...