New research from Trinity College Dublin published in this month’s Annals of Surgery points to a potentially significant advance in the treatment of patients undergoing major cancer surgery. The study was carried out by the esophageal research group at Trinity College Dublin and St James’s Hospital. A randomized controlled trial showed omega-3 fatty acids given as part of an oral nutritional supplement resulted in the preservation of muscle mass in patients undergoing surgery for esophageal cancer, a procedure normally associated with significant weight loss and quality of life issues.

The trial was designed by Professor John V Reynolds, Professor of Surgery at Trinity College Dublin  and  St James’s Hospital, Dublin,  and Dr Aoife Ryan PhD, a research dietitian at St James’s Hospital, Dublin*.

Omega 3 fats are essential fats found naturally in oily fish, with highest concentrations in salmon, herring, mackerel, and sardines. Recently food manufacturers have begun to add omega 3 to foods such as yogurt, milk, juice, eggs and infant formula in light of a body of scientific evidence which suggests that they reduce cardiovascular disease risk, blood pressure, clot formations, and certain types of fat in the blood.

Previous studies had found that nutritional supplements containing one form of omega 3 fat, eicosapentaenoic acid (EPA), significantly reduced weight loss among inoperable cancer patients. The researchers hypothesized that a nutritional supplement rich in calories and a high dose of EPA would stem the debilitating weight loss seen in patients following esophageal surgery. The group chose to study patients undergoing surgery for esophageal cancer as this surgery is one of the most stressful and serious operations a patient can undergo.

Professor John V Reynolds, Professor of Surgery at TCD and  St James’s Hospital and the lead researcher on the study said: “There are almost 450 new cases of esophageal cancer diagnosed every year in Ireland and Ireland has one of the highest rates of esophageal cancer in Europe. An increasing number of patients are treated with chemotherapy alone or in combination with radiation therapy before they undergo surgery. The surgery is a serious operation lasting several hours and can take weeks to recover from surgery and up to six months to recover pre-illness quality of life. Weight loss is extremely common both before and especially after this type of surgery, and any approach that can preserve weight, in particular muscle weight and strength, may represent a real advance”.
 
In a double-blinded randomized control trial, the gold standard in medical research, patients awaiting esophagectomy surgery were randomly assigned to treatment and control groups. While both groups received a 240ml nutritional supplement twice daily starting five days before surgery (which was identical in calories, protein, micronutrients and flavor),  patients in the treatment group received an enriched formula with omega 3 (2.2 gram EPA/day).  Immediately following surgery, the supplement was given through a feeding tube for 14 days while patients recovered in hospital. Once patients could resume oral feeding, they continued drinking the supplement until 21 days post surgery.

Results:

The esophageal research group at Trinity College Dublin and St  James’s Hospital found that patients given the standard feed (without omega 3) suffered clinically severe weight loss post surgery ““ losing an average of 4 lbs of muscle mass post surgery, where as in the omega 3 group patients maintained all aspects of their body composition

Commenting on the significance of the results, Dr Aoife Ryan said: “The results were extraordinary in the sense that no previous nutritional formulation had revealed such an outcome, with supplemented patients maintaining all aspects of their body composition in the three weeks following surgery. Patients given the standard supplement without omega 3 lost a significant amount of weight comprising 100% muscle mass. In fact 68% of patients suffered “Ëœclinically severe’ weight loss post surgery in the standard group (without omega 3) versus only 8% in the omega 3 group. The significant finding was that the patients did not lose just fat, as one would expect with weight loss, but instead they depleted their muscle stores significantly. Research has shown that a loss of 5lbs of weight produces significant effects on quality of life and a patient’s ability to mobilize and perform simple activities of daily living.  Losing 4 lbs of muscle is even more significant”.

Professor John Reynolds said: “Omega 3 enriched nutrition appears to prevent loss of muscle mass by reducing the amount of inflammatory markers in the blood ““ this means the metabolism is not as stressed as it usually is post surgery.  We also saw that the omega 3 group was less likely to have a fever in the first week post surgery which points to the ability of omega 3 to suppress inflammation. Looking at their blood tests omega 3 fed patients had much lower “Ëœinflammatory compounds’ circulating in their blood which points to the ability of omega 3 to reduce inflammation”.

Using specialized nutritional feeds with a highly purified form of EPA, the researchers were able to administer a dose of omega 3 that was much higher than that typically found in food. They noted that treatment with omega 3 enriched supplement is only slightly more expensive than traditional nutritional therapy, and previous studies have yielded significant cost-savings in the form of fewer complications following surgery using immuno-nutrition feeds similar to this. “Initial treatments like this may be cost-effective for our cash-strapped health care system”, said  Dr Ryan.

Commenting in an accompanying editorial in the Annals of Surgery Dr Michael Meguid, Professor of Surgery at State University of New York  noted: “This study is a significant step forward because it underscores the message to surgeons of the importance of using omega 3 based nutrition as an adjunct therapy started at least 5 days before surgery. It should no longer be a surgeon’s preference, but the standard of expected norm for the practice of elective complex gut cancer surgery”.

In conclusion, Professor John Reynolds said: “This study has provided an interesting insight into how nutritional therapy can positively impact on the major stress of cancer surgery. More studies need to be done, in particular to address whether such approaches lead to more rapid recovery of quality of life, reduce complications, and improve outcomes. Throughout cancer care, many patients undergoing therapy nowadays have a combination of surgery, chemotherapy and radiation therapy, and studies addressing whether nutritional supplementation with omega 3 for the entire duration of treatment should be considered. Finally, we do not expect these findings are unique to cancer surgery, and similar benefits may accrue to patients needing complex surgical care for non-cancer problems, for instance liver transplantation or major cardiac surgery.”

1.Full title of the Annals of Surgery article: “Enteral Nutrition Enriched with Eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double blinded randomized controlled trial”. Authors: Aoife Ryan, John V Reynolds, Laura Healy, Miriam Byren, Jennifer Moore, Niamh Brannelly, Aisling McHugh, Deirdre McCormack, Philomena Flood.

2. Dr Aoife Ryan PhD, a research dietitian at St James’s Hospital, Dublin has since taken up an appointment as Assistant Professor of Nutrition at New York University.

3. This trial was supported by a research grant from Abbott Laboratories

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On the Net:

• Trinity College Dublin
• Annals of Surgery

Businesses and health authorities are increasingly rewarding people who lose weight, quit smoking or take medicine with money, despite doubts that such incentives work longer than a few months, according to a new report published online by the British Medical Journal (BMJ) on Friday.

The trend raises an ethical dilemma for some, as physicians are put in a position of offering gifts in exchange for healthier lifestyles.

Theresa Marteau, a health psychologist at King’s College London, and her colleagues analyzed the outcome of a variety of such incentive plans. The programs included a project in a suburban London county in which pregnant women were offered $28 in food vouchers if they stopped smoking for a week, $60 if they kept off cigarettes for four weeks, and an additional $60 after one year.

In Varallo, Italy, health authorities offered $67 dollars to overweight residents if they reached a target weight.  The residents were given $268 if they maintained that weight for five months and another $670 after one year.  In Tanzania, citizens aged 15-30 were offered $45 dollars for consistently testing negative for a sexually transmitted disease.  And in East London, psychotic patients were offered between $7 and $21 for receiving an injection of antipsychotic medication.

After examining the published evidence, the report’s authors said quit-smoking incentives generally failed after six months, while weight-loss incentives typically failed beyond one year.

Weight-loss incentives that offered a larger financial reward exceeding 1.2 percent of a person’s income, and incentives targeted at low-income people who need a vaccine or TB treatments, were generally more successful.

According to the report, many physicians were concerned about the moral subtext of incentives, and whether they amounted to bribes, paternalism or a violation of doctor-patient trust.

The report argued that some incentive programs could be a useful in promoting better health and cutting costs, and called on the healthcare providers to consider which ones were acceptable and would work best.

“Ultimately, if personal financial incentives prove to be effective and acceptable in only a few contexts, they may still offer an important means by which to improve population health,” the report said.

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On the Net:

• British Medical Journal
• King’s College London

China’s prevalence of selective abortion in favor of males has left the nation with 32 million more boys than girls, according to an investigation released Friday.

The imbalance will persist for decades, said the report, which supports experts who predict China’s fixation with a male heir may produce some unintended consequences as men face a life of bachelorhood and are forced to compete for a bride.

“Although some imaginative and extreme solutions have been suggested, nothing can be done now to prevent this imminent generation of excess men,” said the report.

In most areas of the world males slightly outnumber females, with roughly 103 to 107 male births for every 100 female births.

However, in China and other Asian nations that ratio has widened significantly as the preference for boys is further reinforced by the availability of low-cost ultrasound diagnostics and abortion.

The practice has enabled Chinese couples to terminate pregnancies to prevent a female birth, something that is both illegal and officially condemned.

Complicating matters further is China’s official “one-child” policy, in which most parents who have a second child are subject to fines and must contribute disproportionately towards the child’s education.

However, in some provinces a second child is allowed if the first is a girl, or if the parents are living in “hardship” conditions.  A few others allow second children, and even a third, regardless of sex.  

In conducting their study, Zhejiang University professors Wei Xing Zhu and Li Lu and Therese Hesketh of University College London found that China had more than 1.1 million excess male births in 2005 alone.

The largest gender imbalances in those under 20 were among one-to-four-year-olds, where there were 124 male births for each 100 female births. 

The figures were 126 to 100 in rural areas of China, the researchers found. In addition to rural areas, the gap was also significant in provinces where the one-child policy was strictly enforced. For example, in Jiangxi and Henan provinces, ratios of over 140 male births for every 100 female births were observed in the 1-4 age group. The ratios were even higher for second births, with 143 male births occurring for every 100 female births.  The ration peaked at an astounding 192 boys to 100 girls in Jiangsu province.

Only Tibet and Xinjiang, the most lenient about the one-child policy, had normal sex ratios.

“Sex selective abortion accounts for almost all the excess males,” the researchers wrote in their report.

“Enforcing the existing ban on sex selective abortion could lead to normalization of ratios.”

Other options are to relax enforcement of the one-child policy to allow couples to have a second child if the first is a girl, the report said.

The report does examine the social consequences of the gender imbalance, but suggests there is reason for hope.

Since 2000, the Chinese government has enacted policies seeking to counter the imbalance, including a “care for girls” initiative and an overhaul of the nation’s inheritance laws.

These programs are partially responsible for unchanged birth ratios between 2000 and 2005.  Indeed, in many urban areas the ratio for the first birth is now within the normal range.

The figures in the report were based on a mini-census in China in 2005 that covered one percent of the nation’s population.  The updated census sought to rectify flaws in a prior census in 2000.

Tao Liu and Xing-yi Zhang of Jilin University wrote in a commentary that China’s preferences for sons were beginning to subside with urbanization and industrialization.  Additionally, pensions, social systems and higher living standards have eased the son’s conventional role of caring for his parents.

China might ultimately follow the lead of South Korea, which in 1992 had “an astounding” 229-to-100 gender imbalance in fourth births among couples, the researchers said. The ratio prompted South Korea to launch a public-awareness campaign and strictly enforced gender selection laws.

The program worked, and by 2004 there were just 110 male births to every 100 female.  The ratio was 116-100 in 1998.

The current study was published online by the British Medical Journal (BMJ).

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On the Net:

• University College London
• British Medical Journal

UK researchers say a drug designed to reduce scarring after surgery or injury has shown promising results in early human trials, BBC News reported.

The drug, called Avotermin, was tested in healthy volunteers with scars monitored over the period of a year and found that wounds injected with the treatment were less red, raised and visible than those treated with a dummy drug.

The researchers said further trials are now starting across Europe.

The Lancet medical journal reported that the University of Manchester performed early work on the drug before Renovo, a spin-off biotechnology company, was set up to continue its development.

The study involved three trials of participants who were given identical 1cm full thickness skin incisions on both arms and were then given an injection of avotermin in one arm and placebo in the other.

The drug was administered when the wounds were made and then given to patients again after 24 hours. The researchers then had doctors assess the subsequent appearance of the scars on a 100-point scale.

Many of those doctors did not know which wound was treated with which drug after the treatment was administered.

The results showed that the scars treated with Avotermin looked more like normal skin than the scars treated with placebo, the study said.

Researchers have been struggling for decades to identify the active ingredient in the drug and found that a signaling protein in the body called TGF-3 showed anti-scarring properties.

Now advanced clinical studies are currently underway, according to Study leader Professor Mark Ferguson, an expert in wound healing at the University of Manchester and co-founder and CEO of Renovo.

He said his team was recruiting 350 patients undergoing scar revision operations where the bad scar is cut out and one end of the new scar is injected with the drug and one end with placebo.

If proven to be successful, Ferguson said the treatment could be used in the early management of wounds from surgery and injury.

“What we know from our studies is you have to give the treatment when you close up the wound so if someone has had trauma it could be given within 48 hours of the injury,” he said.

However, Ferguson said some people had a tendency to scar worse than others.

“If you look at people who scar badly, with this drug they had an acceptable scar rather than an ugly scar and with people who scar well you end up with a scar that is almost unnoticeable,” he added.

Other experts, like Brendan Eley, chief executive of The Healing Foundation, described TGF-3 as one of the “holy grails” of anti-scarring therapy, indicating that the impact on scar formation being both structural and aesthetic was “very promising”.

He said the development could have a significant impact on patients with complicated and potentially disfiguring wounds.

“The results are promising but patients should not get their hopes up of the treatment being available any time soon,” said Rajiv Grover, a consultant plastic surgeon and secretary of the British Association of Aesthetic Plastic Surgeons.

He said the study only involved patients with very controlled scars.

“The difficulty is the bad scars are not just a centimeter long with no tension in them,” he added.

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On the Net:

• The Lancet
• University of Manchester

Medical College of Wisconsin’s Data Analysis Cluster makes proteomics research more accessible to scientists worldwide

Researchers at the Medical College of Wisconsin Biotechnology and Bioengineering Center in Milwaukee have just made the very expensive and promising area of protein research more accessible to scientists worldwide.

They have developed a set of free tools called ViPDAC (virtual proteomics data analysis cluster), to be used in combination with Amazon’s inexpensive “cloud computing” service, which provides the option to rent processing time on its powerful servers; and free open-source software from the National Institutes of Health (NIH) and the University of Manitoba.

Their research appears online in Journal of Proteomic Research and is funded by the NIH Heart Lung and Blood Institute’s Proteomics Innovation Center at the Medical College. Proteomics is a biomedical research term used to describe the large-scale study of all the proteins expressed by an organism. It usually involves the identification of proteins and determination of their modifications in both normal and disease states.

One of the major challenges for many laboratories setting up proteomics programs has been obtaining and maintaining the very costly computational infrastructure required for analysis of the vast flow of proteomics data generated by mass spectrometry instruments used to determine the elemental composition as well as chemical structure of a molecule, according to senior investigator, Simon Twigger, Ph.D., assistant professor of physiology.

“We’re applying this technology in our Proteomics Center to study cardiovascular disease, the effects of radiation damage, and in our collaboration with the University of Wisconsin- Madison stem cell research group,” he says.

With cloud computing making the analysis less expensive and more accessible, many more users can set up and customize their own systems. Investigators can analyze their data in greater depth than previously possible, making it possible for them to learn more about the systems they are studying.

“The tools we have produced allow anyone with a credit card, anywhere in the world, to analyze proteomics data in the cloud and reap the benefits of having significant computing resources to speed up their data analysis,” says lead author Brian Halligan, Ph.D., research scientist in the Biotechnology and Bioengineering Center.

“For researchers currently without access to large computer resources, this greatly increases the options to analyze their data. They can now undertake more complex analyses or try different approaches that were simply not feasible for them before.”

Until recently, the standard software programs used for proteomics data analysis were almost exclusively commercial, proprietary and expensive. Fees for commercial applications typically rivaled or exceeded the cost of the hardware to run them.

In 2004, a group from the NIH developed and distributed an open-source alternative to commercial proteomics search programs, entitled Open Mass Spectrometry Algorithm (OMSSA). A second open-source proteomics database search is also now available; the X!Tandem, developed and released by the Bevis Laboratory at the University of Manitoba.

A link on the College’s Proteomics Center website http://proteomics.mcw.edu/vipdac provides detailed step-by-step instructions on how to implement the virtual proteomics analysis clusters, as well as a list of current available preconfigured Amazon machine images containing the OMSSA and X!Tandem search algorithms and sequence databases.

“We describe a system that combines distributed-on-demand cloud computing and open source software to allow laboratories to set up scalable virtual proteomics analysis clusters without a huge investment in computational hardware or software licensing fees,” says Dr. Halligan.

“The pricing structure of distributed computing providers such as Amazon Web Services allows laboratories, or even individuals, to have large-scale computational resources at their disposal at very low cost per run.”

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On the Net:

• Medical College of Wisconsin
• Journal of Proteomic Research

Artificial heart pacemakers have saved and extended the lives of thousands of people, but they have their shortcomings ““ such as a fixed pulse rate and a limited life. Could a permanent biological solution be possible?

Richard Robinson and colleagues at New York’s Columbia and Stony Brook Universities certainly think so, and their work published in the latest issue of The Journal of Physiology brings the dream a step closer to reality.

The body’s own natural pacemaker, called the sinoatrial (SA) node, is extremely vulnerable to damage during a heart attack, often leaving the patient with a weak, slow or unreliable heartbeat. The heart has limited ability to recover from the damage, so the conventional approach is to fit an electronic device to monitor and control the beat directly.

Therapies to help raise the heart rate biologically could be a much better solution, but there are some major hurdles. The way electrical signals are generated in the SA node ““ and hence the heart rate ““ are far from simple. There are three separate electrical pathways between cells, called HCN or ‘funny’ channels (because of their complex behaviour), that could be involved.

Dr Robinson’s work helps to shed light on the secrets of the HCN channels, but more importantly describes a cell culture they have developed that accurately mimics HCN function in whole mammalian hearts, making future research in the area far quicker and easier.

The researchers used their new cellular model to genetically ‘rewire’ two of the HCN channels. The resulting heart rate was very rapid with irregular pauses, just as has already been observed in dogs and mice.

It is early days ““ but the valuable new computer and cellular models are ideal for testing potential new drugs to influence heart rate and pave the way for new genetic biological pacemakers to be developed.

Dr Robinson commented that the new developments “will facilitate the development of practical biological pacemakers by allowing more complete and rapid assessment of individual channel mutations through combined culture and simulation studies prior to full testing in animal models.”

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On the Net:

• Wiley-Blackwell
• Journal of Physiology

In a major study on Sudden Infant Death Syndrome (SIDS), German researchers believe they may have found several previously unrecognized risk factors for the disease, such as sleeping away from home and sleeping outside of the parent’s bedroom.

Dr. Mechtid M. Vennemann of the University of Munster explained in a recent medical journal article that various studies in the 1980’s and 1990’s revealed that sleeping face down presents a significantly increased risk of SIDS.  Following these studies there was a marked decrease of SIDS deaths in numerous countries as scientists and health professionals discouraged parents from allowing their infants to sleep on their stomachs.

Dr. Vennemann and his colleagues in the German SIDS study chose to look for new SIDS risk factors in a population in which relatively few infants sleep face down.  The study included 333 infants who had died from SIDS as well as 998 age-matched control infants.

The study revealed a statistically significant increased risk of SIDS among infants who slept outside of their parent’s home, such as at friend’s or relative’s houses.  Another portion of the study showed that infants who slept in the living room as opposed to their parent’s bedroom were also at a higher risk of SIDS.  Other factors examined included the use of duvets, sleeping face down on sheepskin, bed sharing and infants that did not breastfeed – all of which showed an increased risk of SIDS.

Though only 4.1 percent of the infants studied slept face down, these infants were at a dramatically increased risk of SIDS.  Particularly affected were infants who were not accustomed to sleeping on their stomachs and managed to roll themselves over into the face down position.

Researches of the German SIDS study conclude that their findings further reinforce the current recommendations of the American Academy of Pediatrics that parents put infants to sleep on their backs rather than their stomachs.

Since first being recognized as a distinct disease in the late 1960’s, SIDS has been the subjects of numerous research studies. These studies have led to the identification of a diverse array of risk factors as well as various theories regarding its ultimate causes, none of which have been proven entirely conclusive.

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On the Net:

• University of Munster
• Pediatrics

New research suggests that water, in place of soda and other sugar-sweetened drinks, will help maintain healthy weights in your kids, Reuters reported on Monday. 

Children and teens in the United States consume an average of 235 “empty” calories in sugar-sweetened beverages daily, according to one analysis. 

Just because a child eliminates these drinks does not mean they will replace the calories with eating or drinking other things.  Most of the children, the researchers reported, responded in this way.  A second Dutch study found that children would quit consuming sugary drinks before they exercise or eliminate snacks. 

Dr. Claire Wang of Columbia University in New York confirmed, “The evidence is now clear that replacing these ‘liquid calories’ with calorie-free beverage alternatives both at home and in schools represents a key strategy to eliminate excess calories and prevent childhood obesity.”

Wang and her colleagues reviewed data from the 2003-2004 National Health and Nutrition Examination Survey that detailed questions about diet.

They found that every 1 percent drop in soft drink ingestion compared to more than six fewer calories. 

It is possible, according to two other investigations, to see children make the change. 

A research team at the University of Southern California, facilitated by Emily Ventura, successfully influenced 54 overweight Latino teens to participate in a four-month study to improve their diets. 

Results indicated that one-third of the participants did nothing, one-third took one nutrition class per week and one-third took part in the class as well as strength training twice a week.

Fifty-five percent reduced their sugar intake by 47 grams a day, which equals one can of soda.  Also, 59 percent ingested more fiber, up to five grams a day.

This consisted of even the “control” teens that did not do anything additionally, Ventura’s team stated in the journal.

Not only did the researchers witness healthier blood sugar levels in the children who ate less sugar, but also losses on average of 10 percent of visceral body fat in those who ate more fiber.  This is the dangerous type of fat surrounding the internal organs.

Ventura’s team wrote, “Our results suggest that intensive interventions may not be necessary to achieve modifications in sugar and fiber intake.” 

In another research program conducted in the Netherlands, 1,108 children of ages 12 and 13 were tested under the direction of Amika Singh and colleagues of VU University Medical Center in Amsterdam.

The participants engaged in an eight-month health education program involving 11 lessons in studies of biology and physical education.  The children reportedly cut soft drink intake by an average of 10 ounces a day for nearly a year afterward as a result of the study. 

Unfortunately, however, the children did not indicate an increase in walking or biking to school nor did they snack less often. 

Based on Singh and research team’s findings, they concluded that, “Reducing intake of sugar-containing beverages should therefore be considered a good behavioral target for future interventions aimed at the prevention of overweight among adolescents.”

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On the Net:

• Columbia University
• 2003-2004 National Health and Nutrition Examination Survey
• University of Southern California

It’s one of the most difficult decisions some families are forced to make:  when is it time for a loved one with Alzheimer’s disease to stop driving?

The fact that much of the country lacks public transportation can make the decision all the more challenging, since quitting too soon restricts independence for those who otherwise may function well for many years. 

“That’s a real cost to the individual and family and society,” Jeffrey Dawson of the University of Iowa told the Associated Press.

Dawson, a biostatistics professor, and his team have created a test to show when a person may be a danger on the road.

“You have to have some sort of trade-off between the individual’s independence along with the safety of the driver and with other people on the road,” he said.

Experts say patients usually begin by gradually scaling back their driving — avoiding night trips, busy freeways or left-turn intersections, for example.

Sue Pinder, 58, an adviser with the Alzheimer’s Association, recently gave up driving in large cities despite the fact it meant fewer visits to her daughter in Dallas.

Shortly after Pinder was diagnosed in 2004, she designated her husband to make the ultimate determination on when she would quit driving.  For her last birthday, he gave her a GPS system, which helped Pinder navigate unfamiliar streets. 

“That’s helped a lot where I don’t have to worry, I can concentrate on my driving and not the directions,” Pinder told the AP.

Working on ways to help other patients in similar circumstances, Dawson’s team developed an sophisticated behind-the-wheel exam consisting of a 35-mile drive through urban, rural and residential streets in a customized Ford Taurus able to record nearly every action the driver takes.  The modified car works much like an airplane “black box”.  Small video cameras were also positioned to show oncoming traffic as well.

Researchers recruited 40 participants with early-stage Alzheimer’s who still had their driver’s licenses to take the road test, and compared their results with 115 older drivers without dementia who took the same test.

The study’s results were remarkable, with the Alzheimer’s drivers on average committing 42 safety mistakes, compared with just 33 for the other drivers.

Lane violations, such as swerving as another vehicle approached, were the most common problems for the Alzheimer’s drivers, who performed 50 percent worse.

Total errors increased with rising age, regardless of whether or not the driver had Alzheimer’s.  Indeed, an additional 2 1/2 mistakes were made for every five years of age.

However, some Alzheimer’s patients drove just as well as their healthy counterparts, Dawson emphasized.

The team also checked whether any of the large number of neuropsychological tests given before the test had accurately predicted who would drive worse, which some did.

Flunking basic memory tests didn’t make a difference, the researchers found.  But standard neurological tests of multitasking abilities did.  These tests assess if people’s visual, cognitive and motor skills work together rapidly to make quick decisions.

Examples include showing Alzheimer’s patients geometric figures for a few seconds, and then having them draw the shape from memory.  Other tests had patients drawing paths between a sequence of letters and numbers.

Patients who scored average or better on those kinds of written tests were no worse drivers than other older drivers, the study found.  However, Dawson said those who scored worse than average tended to commit about 50 percent more errors on the road.

Although additional research is needed, the researchers’ ultimate goal is provide a simple doctor’s-office exam to help guide when patients should stop driving.

Each year, roughly 600,000 elderly adults stop driving for some health reason, according to an AP report citing data from the National Institute on Aging.  However, there’s little guidance for the 2 million people estimated to be in early stage Alzheimer’s, and the disease is expected to surge in the next twenty year as the general population ages.

States laws vary on when aging drivers must pass a road test for a license renewal, but they rarely address specific diseases.  California currently requires the reporting of all Alzheimer’s diagnoses so driving ability can be determined.   The Alzheimer’s Association also warns families of signs of potentially unsafe driving. 

One particular challenge is that as the condition worsens, patients often passionately deny that they’re a danger on the road, according to Dr. Gary Kennedy, head of geriatric psychiatry at New York’s Montefiore Medical Center.

“I can be the bad guy,” he says to families, sometimes advising relatives to disable a car, or reporting patients to the state Department of Motor Vehicles for a driving test.

“Giving up the car is not like going into the nursing home,” Kennedy tells his patients.

“If as a society we recognize this as a danger, we need to help them compensate,” he told the Associated Press.

The study was reported in the journal Neurology.

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On the Net:

• University of Iowa
• Neurology

Scientists have revealed why scratching is best method of getting rid of a bothersome itch.

Glenn J. Giesler, Jr., a neuroscientist at the University of Minnesota in Minneapolis, led a team of researchers who studied sedated long-tailed macaques in their experiment.

Researchers used an injection of a chemical that causes the sensation of itching. Once injected, they noted a large amount of electrical signals. They used a metal device that was designed to resemble monkey fingers to scratch the area of the leg affected by the chemical.

After scratching the itch, researchers noted that the rate of electrical signals dropped dramatically, implying that it had been relieved.

Researchers also used the metal device to scratch the leg of a monkey that had not received the itchy injection. They noted that the scratch actually caused the firing rate to increase, which suggests that the nerves react much differently when there isn’t an itch to be scratched.

“It’s like there’s a little brain” in the spinal cord, Giesler told the AP. “We really want to understand that, because then we think we’ll understand how to relieve itch.”

A better understanding of how itchiness occurs could help scientists develop better treatments for people who suffer from chronic itching.

Giesler said more than 50 health conditions can cause serious itching, such as AIDS, Hodgkin’s disease and many pain treatments have side effects of itchiness.

But scratching as a method of stopping the itch can lead to skin damage and sometimes infections, Giesler said, so scientists hope to find revolutionary ways to stop the itch “without tearing up their skin.”

“Although there is a long way to go, methods that can induce a pleasurable scratch sensation without damaging the skin, via mechanical stimuli or drugs that can inhibit these neurons, could be developed to treat chronic itch,” he said.

Gil Yosipovitch, an expert on itching from Wake Forest University, argues that itching is a result of factors such as emotions as well as physiology.

“The main open question is what happens in patients who suffer from chronic itch where scratching may actually aggravate itch perception.”

Professor Patrick Haggard, of University College London, told the BBC: “We all know that scratching helps alleviate itch, but this elegant study helps to show how this mechanism works.

“It’s an interesting illustration of a very general principle of the brain controlling its own inputs, in this case by making movements that triggers an interaction between scratchy touch and itch.”

Giesler’s team’s findings appear in the online edition of the journal Nature Neuroscience.

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On the Net:

• Nature Neuroscience
• University of Minnesota

Fetal alcohol spectrum disorder (FASD) and Fetal alcohol syndrome (FAS) cause malformations in babies, including facial defects, short stature, and mental and behavioral abnormalities. The African frog, Xenopus, is a valuable tool for understanding early vertebrate development since these embryos are large, easy to work with and very responsive to environmental cues. New research uses this system to address the mechanism underlying the characteristics associated with maternal consumption of alcohol in early pregnancy.

Alcohol consumption prevents normal development by inhibiting the production of retinoic acid. Under normal conditions, the levels of retinoic acid made in different areas of the embryo provide cells with necessary information about their proper location and fate. Researchers now show that alcohol steals away the molecules that make retinoic acid and use them for its own process of detoxification, resulting in cellular disorientation during a critical period of development.

The new study, published in Disease Models & Mechanisms (DMM), provides evidence that the characteristics associated with FASD and FAS come from competition of alcohol for key molecules in a pathway that produce retinoic acid from vitamin A. Retinoic acid is needed for correct positioning of cells in developing embryos and by preventing its normal production, alcohol keeps cells from migrating to their correct positions and maturing properly. The researchers, at the Hebrew University in Israel, found that shutting down a molecule needed to produce retinoic acid, called retinaldehyde dehydrogenase or RALDH2, increased sensitivity of developing embryos to low doses of alcohol. Conversely, more of the molecule RALDH2 protected embryos from the negative effects of alcohol. This provides evidence that alcohol ‘hijacks’ RALDH2 molecules for its own breakdown process and steals it away from its important role in synthesizing positional and maturation cues during development.

Fetal alcohol spectrum disorder (FASD) and Fetal alcohol syndrome (FAS) cause malformations in babies, including facial defects, short stature, and mental and behavioral abnormalities. The African frog, Xenopus, is a valuable tool for understanding early vertebrate development since these embryos are large, easy to work with and very responsive to environmental cues. New research uses this system to address the mechanism underlying the characteristics associated with maternal consumption of alcohol in early pregnancy.

The report was written by Hadas Kot-Leibovich and Abraham Fainsod at the Hebrew University in Israel. The report, titled: Ethanol induces embryonic malformations by competing for the retinaldehyde dehydrogenase activity during vertebrate gastrulation is published in the May/June 2009 issue of the research journal, Disease Models & Mechanisms (DMM), published by The Company of Biologists, a non-profit based organization in Cambridge, UK.

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Scientists at the Centers for Disease Control and Prevention have discovered the presence of percholrate ““ a chemical used in rocket fuel and also linked to thyroid disease – in 15 different types of baby formulas.

Percholrate has been discovered in the water supplies of some cities, and although it can occur naturally, it is usually found in high concentrations due to defense and aerospace sites, according to the AP.

Researchers said that levels of the chemical in baby formula could exceed the safe adult does amount if it mixed with water that already contained percholrate.

The study’s findings were published last month, but a press release from the Environmental Working Group on Thursday highlighted the results.

No tests have been able to show a direct link between perchlorate and thyroid disease, but scientists claim that high levels of the chemical can affect thyroid function, which can impact fetal and infant brain development.

Regulators require that iodine be added to formula in order to counteract perchlorate’s effects.

According to the AP: “the U.S. Food and Drug Administration, aware of the debate over perchlorate in food and water, has not recommended that people alter their diet or eating habits because of the chemical.”

Dr. Joshua Schier, one of the study’s authors, said it “wasn’t a study of health effects.”

The study compared 15 different types of formula and found perchlorate levels in each of them. Formulas that came from cows milk had the highest amount of perchlorate, researchers noted.

“This study provides no data on potential health effects of perchlorate. Health authorities continue to emphasize that infant formula is safe,” said Haley Curtis Stevens of the International Formula Council, which represent formula manufacturers.

The EPA has announced it is considering new limits on the legal amount of perchlorate in drinking water.

According to USA Today, “Sen. Barbara Boxer, D-Calif., said the FDA “should immediately inform the public on how best to protect children from perchlorate contamination in powdered infant formula.” In addition, she called on the Environmental Protection Agency to set a safe drinking water standard for perchlorate and ensure that drinking water is tested for perchlorate contamination.”

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Researchers are comparing differences in brain scans of soldiers with post-traumatic stress disorder (PTSD) and those without it in hopes of one day being able to use scans to identify the condition.

Researchers from Duke University studied a total of 42 soldiers, both male and female. Their findings will be presented to the World Psychiatric Association congress in Florence.

Soldiers involved in the study had served in Iraq of Afghanistan. One group of 22 had been previously diagnosed with PTSD and the other group of 20 had not. Fifty-two percent of the participants were male.

PTSD is as an anxiety disorder triggered by exposure to traumatic events. Symptoms include intrusive memories of the trauma, avoidant behavior and hyperarousal, where those affected are more likely to perceive a threat in seemingly neutral situations or people. Impaired concentration is also characteristic. Right now, the condition is only diagnosed through an interview with a mental health professional.

Researchers presented each volunteer with photographs of three similar faces, followed by a delay period to allow their brains to retain the information. Then they were shown a single photo of a face and asked if it was the same one they saw before.

About two seconds into the delay period, the soldiers were randomly shown photos irrelevant to the faces ““ either two photos depicting combat scenes from Iraq or Afghanistan, two photos of non-combat (neutral) scenes such as a man playing the trombone, or two digitally scrambled pictures depicting nothing. After a break to allow brain activity to return to normal, the test was repeated 40 times, with no repetition in the photos.

Researchers used functional magnetic resonance imaging scans to study the brain patterns of each soldier.

Scientists noted in the dorsal lateral prefrontal cortex ““ an area responsible for staying focused ““ that the group without PTSD was far more distracted by the traumatic photos than by the neutral ones.

“This sensitivity to neutral information is consistent with the PTSD symptom of hypervigilance, where those afflicted are on high alert for threats and are more distracted by not only threatening situations that remind them of the trauma, but also by benign situations,” said Dr Rajendra Morey, an assistant professor of psychiatry at Duke University.

“This has not been seen at the brain level before. If further research confirms this preliminary finding, this pattern could be useful in distinguishing the PTSD brain.”

“As technology improves, imaging research is increasingly providing insights into the brains of people with post-traumatic stress disorder, pointing to potential biological markers distinguishing the PTSD-affected brain,” said Dolcos, a co-author of the study, performed at Duke University in Durham, USA.

“The field is still in its infancy, but this raises the possibility that one day we may be able to see the disorder in the body as plainly as we now can see conditions such as heart disease and cancer.”

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On Thursday, President Barack Obama’s pick to head the US healthcare system, Kansas Governor Kathleen Sebelius, will go before the Senate Finance Committee where she is expected to receive confirmation.

“I think she should be confirmed,” said committee Chairman Max Baucus.

“Congress is going to need a strong partner at the Department of Health and Human Services to achieve comprehensive health reform this year, and we have that partner in Gov. Sebelius,” Baucus said.

“There is absolutely no doubt in my mind that Gov. Sebelius has the political experience, determination, and bipartisan work ethic to get the job done with Congress this year. She’s the right person for the job.”

Sebelius will lead the charge to revamp the current US healthcare system so that coverage is more accessible for all Americans ““ a daunting task that will “will test the political skills of the former Kansas insurance commissioner, a rising star in the Democratic Party,” according to Reuters.

Sebelius said she backs a government-run plan to anyone, while continuing to allow commercial insurers to off their own private plans.

Obama told a health care forum in Washington this month that his plan “gives consumers more choices, and it helps keep the private sector honest because there’s some competition out there.”

Critics of President Obama’s plan say that government intervention will eventually “push out the private insurers, leaving the government option as the only option,” according to the New York Times.

The insurance industry wants a mandate for Americans to purchase private coverage because it would help insurers lower the price of premiums, thus making it more affordable for the sick.

The US spent an estimated $2.2 trillion ““ 7,421 per person ““ on healthcare in 2007. “This comes to 16.2% of GDP, nearly twice the average of other developed nations,” according to a Health and Human Services report earlier this week.

Healthcare costs are projected to rise to 25 percent of GDP in 2025 and 49 percent in 2082, it found.

“As a result of these crushing health care costs, American businesses are losing their ability to compete in the global marketplace. Health care at General Motors puts the company at a $5 billion disadvantage against Toyota, which spends $1,400 less on health care per vehicle.”

“In spite of the vast resources invested, the health care system has not yet reached the goal of high-quality care,” the report said.

Sen. Charles Grassley, R-Iowa said he was anticipating hearing Sebelius answer for her recent payment of $8,000 in back taxes and interest.
“As has been reported already, you’ve addressed some tax irregularities,” Grassley said. “I take these tax matters very seriously, and I’m eager for you to address those tax matters today.”

In a letter addressed to senators on Tuesday, Sebelius said that the “unintentional errors” were due to charitable contributions, the sale of a home and business expenses.

Grassley said on Wednesday that Sebelius’ tax issues would not lead to him blocking her confirmation.
Tax issues have seemed to haunt those nominated to the position, as previous nominee Sen. Tom Daschle was forced to step down after reports that he owed almost $140,000 in back taxes and interest.

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A parent-teacher group and the American Dietetic Association said on Tuesday that Congress can fight the epidemic of childhood obesity by getting “junk” food out of school stores, as well as snack machines, Reuters reported.

Both groups are pushing for new federal rules that would require all food sold in schools to adhere to certain nutritional standards similar to school lunches.

They said that high-fat, high-sugar or high-calorie “competitive” foods now could be sold anytime outside of school cafeterias.

The Centers for Disease Control and Prevention said that obesity increases the risk of diabetes, heart disease, arthritis and other chronic illnesses.

It also reported that roughly 17 percent of school-age children are obese””triple the rate in 1980.

Byron Garrett of the National Parent Teacher Association said during a Senate Agriculture Committee hearing on “reforming nutrition for kids in school” that the best interests of our children demand that the nutrition standards be modernized.

The dietitian group stated that national standards were needed so all children “have equal opportunity to a healthy school environment.”

The year should see the renewal of U.S. child nutrition programs like school lunch and the Women, Infants and Children feeding program, which cost some $21 billion annually.

Tom Harkin, an Agriculture Committee chairman, said school meals comply for the most part with the Dietary Guidelines for Americans, which encourage exercise and more consumption of fruits and vegetables.

However, Harkin said sugary drinks, candy and high-fat snacks undermine the investment in good food.

“On an average day, only 62 percent of American kids who could do so eat the federally sponsored lunch,” he added.

While Sens Richard Lugar and Amy Klobuchar spoke in favor of national standards during the hearing, others in Congress like Sen. Mike Johanns said he disliked heavy-handed regulation and Sen. Saxby Chambliss said physical exercise should be part of the school day.

But some schools rely on snack sales to help cover costs, according to Reginald Felton of the National School Boards Association.

He noted that students would simply buy snack food outside of school if it were unavailable inside the building.

“There has been a 58 percent decrease in beverage calories shipped to schools under a 2006 voluntary guideline,” said Susan Neely of the American Beverage Association, who suggested the guideline should become mandatory.

An update of school nutrition standards has even received the support of Mars Snackfood US.

The company said it supported and described the work of the nonprofit Alliance for a Healthier Generation to limit fat and sugar content in snack foods.

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U.S. researchers reported on Wednesday that people with the most germs in their mouths are the most likely to have heart attacks.

The researchers said that their study compared heart attack victims to healthy volunteers and found the heart patients had higher numbers of bacteria in their mouths.

Their findings add to a growing body of evidence that oral hygiene is linked to overall health.

Oelisoa Andriankaja and colleagues at the University at Buffalo, New York were trying to find if any particular species of bacteria might be causing heart attacks.

Their test on 386 heart attack victims and 840 people free of heart trouble showed two types were more common among the heart attack patients, Tannerella forsynthesis and Prevotella intermedia.

However, the people who had the most bacteria of all types in their mouths were the most likely to have had heart attacks, the researchers said in a meeting of the International Association of Dental Research in Miami.

“In other words, the total number of ‘bugs’ is more important than one single organism.”

It is still unsure how bacteria might be linked with heart attacks but several studies have shown an association between gum disease and heart disease.  Bacteria may set off general inflammation that in turn causes blood to clot.

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German researchers have found that patients who are taking drugs to reduce their risk of heart disease gain no extra benefits by adding a dose of omega-3 fatty acid to their daily regimen.

Dr. Jochen Senges of the University of Heidelberg led the research team, which studied the effects of 1-gram daily dose of a prescription version of highly purified omega-3 fatty acid, called Omacor and Lovaza in the United States and as Zodin in Europe, among 3,827 patients from 104 German hospitals who had suffered a heart attack within two weeks prior to the start of the study.

“The OMEGA trial found no significant differences in the rates of heart attack, stroke, sudden cardiac death or death from any cause among patients assigned to guidelines-based optimal medical care alone or optimal medical care plus Omega-3 fatty acids,” researchers wrote in the study presented at the 58th conference of the American College of Cardiology in Orlando, Florida.

Ninety percent of the patients involved in the study were already prescribed to drugs intended to prevent heart attacks, such as aspirin, and anti-cholesterol medications.

Some participants received the 1-gram daily dose of omega-3 fatty acid, which comes from fish oil, while others were given a placebo.

One year after the study began, researchers noted no difference between patients who were given omega-3 fatty acids and those who received dummy pills. 

According to the AP, in both groups, fewer than 2 percent had suffered sudden cardiac death, 4 percent had another heart attack, and fewer than 2 percent had suffered a stroke.

The new findings contradict those of previous studies which suggested that omega-3 supplements were beneficial in reducing the risk of heart attack.

Researchers of the new study noted that those studies had been conducted when the treatment for heart conditions was not as advanced as it is today, according to AFP.

In our study, we saw no beneficial effect. In patients who are already taking optimal medical therapy, cardiac event rates become very low and Omega-3 do not further improve them,” said Jochen Senges, a professor of cardiology at the Heart Center Ludwigshafen, University of Heidelberg, Germany.

“It would be incorrect to say that Omega-3 fatty acids are not effective, but we could not find any additional benefits after optimizing medical therapy,” Senges added.

Alice Lichtenstein, a Tufts University nutrition professor and spokeswoman for the American Heart Association, said it is recommended that adults eat fish at least twice a week. 

“A modest, 3-ounce cooked salmon has a little more than a gram,” she said.

The Association also advises that people with heart disease should add a 1-gram daily supplement of omega-3 to their daily regimen.

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Observing how a child reacts to animated cartoons may aid in identifying autism, new research has implied.

Babies normally start watching movement shortly after birth, and retrieve information from the things they observe, but children afflicted with autism usually do not.

A study, available in the journal Nature, was conducted by showing two-year-olds simple animations linked with sound.

In the Yale study, researchers fashioned five different kinds of animated children’s games, like ‘peek-a-boo’ and ‘pat-a-cake,’ where light outlined movement, each connected with a sound.

On half of the screen, a similar animation was shown upside down and backwards, but with the same sound as the original one. Prior research has indicated that children’s attention focuses on these alterations at eight months old.

Twenty-one toddlers with autistic-spectrum disorders (ASD), 39 with normal development, and 16 who had other developmental issues but not ASDE, were researched.

Mutually, the toddlers without development issues and those with developmental problems obviously preferred the unaltered animations. On the other hand, those with ASD did not have a preference and their attention wavered back and forth.

However, when viewing the ‘pat-a-cake’ animation, those with ASD had a definitive preference for the altered animation 66% of the time.  The other toddlers preferred the upright version.

Dr Ami Klin, of the Yale Child Study Center said: “Our results suggest that, in autism, genetic predispositions are exacerbated by atypical experience from a very early age, altering brain development.”

“Attention to biological motion is a fundamental mechanism of social engagement, and in the future, we need to understand how this process is derailed in autism, starting still earlier, in the first weeks and months of life.”

Thomas Insel, director of the National Institute of Mental Health, stated that: “For the first time, this study has pinpointed what grabs the attention of toddlers with ASDs.”

“In addition to potential uses in screening for early diagnosis, this line of research holds promise for development of new therapies based on redirecting visual attention in children with these disorders.”

A spokeswoman for the National Autistic Society added: “This is a really interesting study which suggests that children with autism are on a different learning pathway from other children from a very early age.”

“We warmly welcome all research which helps us further our understanding of autism, and how best to help and support those with the condition.”

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Study shows drinking water contaminated with potent estrogen

Plastic packaging is not without its downsides, and if you thought mineral water was “Ëœclean’, it may be time to think again. According to Martin Wagner and Jörg Oehlmann from the Department of Aquatic Ecotoxicology at the Goethe University in Frankfurt am Main, Germany, plastic mineral water bottles contaminate drinking water with estrogenic chemicals. In an analysis1 of commercially available mineral waters, the researchers found evidence of estrogenic compounds leaching out of the plastic packaging into the water. What’s more, these chemicals are potent in vivo and result in an increased development of embryos in the New Zealand mud snail. These findings, which show for the first time that substances leaching out of plastic food packaging materials act as functional estrogens, are published in Springer’s journal Environmental Science and Pollution Research.

Wagner and Oehlmann looked at whether the migration of substances from packaging material into foodstuffs contributes to human exposure to man-made hormones. They analyzed 20 brands of mineral water available in Germany ““ nine bottled in glass, nine bottled in plastic and two bottled in composite packaging (paperboard boxes coated with an inner plastic film). The researchers took water samples from the bottles and tested them for the presence of estrogenic chemicals in vitro. They then carried out a reproduction test with the New Zealand mud snail to determine the source and potency of the xenoestrogens.

They detected estrogen contamination in 60% of the samples (12 of the 20 brands) analyzed. Mineral waters in glass bottles were less estrogenic than waters in plastic bottles. Specifically, 33% of all mineral waters bottled in glass compared with 78% of waters in plastic bottles and both waters bottled in composite packaging showed significant hormonal activity.

By breeding the New Zealand mud snail in both plastic and glass water bottles, the researchers found more than double the number of embryos in plastic bottles compared with glass bottles. Taken together, these results demonstrate widespread contamination of mineral water with potent man-made estrogens that partly originate from compounds leaching out of the plastic packaging material.

The authors conclude: “We must have identified just the tip of the iceberg in that plastic packaging may be a major source of xenohormone* contamination of many other edibles. Our findings provide an insight into the potential exposure to endocrine-disrupting chemicals due to unexpected sources of contamination.”

*man-made substance that has a hormone-like effect

Reference: Wagner M & Oehlmann J (2009). Endocrine disruptors in bottled mineral water: total estrogenic burden and migration from plastic bottles. Environ Sci Pollut Res; [10.1007/s11356-009-0107-7]

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