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Juicing for health

MR images showing a patient with recurrent glioblastoma responding to anti-angiogenic therapy by reduction on abnormal tumor vessel calibers and a change in the direction of the vessel vortex curve estimated from a combined gradient-echo (GE) and spin-echo (SE) MR signal readout. The change from a predominantly counter-clockwise vessel vortex direction at baseline (days -5 and -1) to a predominantly clockwise vessel vortex direction during anti-angiogenic therapy (days 1, 28, 56 and 112) indicates a dramatic transformation in vascular morphology during anti-angiogenic therapy and resulting in increased overall survival. Credit: Kyrre E. Emblem

New MR analysis technique reveals brain tumor response to anti-angiogenesis therapy

A new way of analyzing data acquired in MR imaging appears to be able to identify whether or not tumors are responding to anti-angiogenesis therapy, information that can help physicians determine the most appropriate treatments and discontinue ones that are ineffective. In their report receiving online publication in Nature Medicine, investigators from the Martinos Center for Biomedical Imaging at Massachusetts General Hospital (MGH), describe how their technique, called vessel architectural imaging (VAI), was able to identify changes in brain tumor blood vessels within days of the initiation of anti-angiogenesis therapy.

“Until now the only ways of obtaining similar data on the blood vessels in patients’ tumors were either taking a biopsy, which is a surgical procedure that can harm the patients and often cannot be repeated, or PET scanning, which provides limited information and exposes patients to a dose of radiation,” says Kyrre Emblem, PhD, of the Martinos Center, lead and corresponding author of the report. “VAI can acquire all of this information in a single MR exam that takes less than two minutes and can be safely repeated many times.”

Previous studies in animals and in human patients have shown that the ability of anti-angiogenesis drugs to improve survival in cancer therapy stems from their ability to “normalize” the abnormal, leaky blood vessels that usually develop in a tumor, improving the perfusion of blood throughout a tumor and the effectiveness of chemotherapy and radiation. In the deadly brain tumor glioblastoma, MGH investigators found that anti-angiogenesis treatment alone significantly extends the survival of some patients by reducing edema, the swelling of brain tissue. In the current report, the MGH team uses VAI to investigate how these drugs produce their effects and which patients benefit.

Advanced MR techniques developed in recent years can determine factors like the size, radius and capacity of blood vessels. VAI combines information from two types of advanced MR images and analyzes them in a way that distinguishes among small arteries, veins and capillaries; determines the radius of these vessels and shows how much oxygen is being delivered to tissues. The MGH team used VAI to analyze MR data acquired in a phase 2 clinical trial – led by Tracy Batchelor, MD, director of Pappas Center for Neuro-Oncology at MGH and a co-author of the current paper – of the anti-angiogenesis drug cediranib in patients with recurrent glioblastoma. The images had been taken before treatment started and then 1, 28, 56, and 112 days after it was initiated.

In some patients, VAI identified changes reflecting vascular normalization within the tumors – particularly changes in the shape of blood vessels – after 28 days of cediranib therapy and sometimes as early as the next day. Of the 30 patients whose data was analyzed, VAI indicated that 10 were true responders to cediranib, whereas 12 who had a worsening of disease were characterized as non-responders. Data from the remaining 8 patients suggested stabilization of their tumors. Responding patients ended up surviving six months longer than non-responders, a significant difference for patients with an expected survival of less than two years, Emblem notes. He adds that quickly identifying those whose tumors don’t respond would allow discontinuation of the ineffective therapy and exploration of other options.

Gregory Sorensen, MD, senior author of the Nature Medicine report, explains, “One of the biggest problems in cancer today is that we do not know who will benefit from a particular drug. Since only about half the patients who receive a typical anti-cancer drug benefit and the others just suffer side effects, knowing whether or not a patient’s tumor is responding to a drug can bring us one step closer to truly personalized medicine – tailoring therapies to the patients who will benefit and not wasting time and resources on treatments that will be ineffective.” Formerly with the Martinos Center, Sorensen is now with Siemens Healthcare.

Study co-author Rakesh Jain, PhD, director of the Steele Laboratory in the MGH Department of Radiation Oncology, adds, “This is the most compelling evidence yet of vascular normalization with anti-angiogenic therapy in cancer patients and how this concept can be used to select patients likely to benefit from these therapies.”

Lead author Emblem notes that VAI may help further improve understanding of how abnormal tumor blood vessels change during anti-angiogenesis treatment and could be useful in the treatment of other types of cancer and in vascular conditions like stroke. He and his colleagues are also exploring whether VAI can identify which glioblastoma patients are likely to respond to anti-angiogenesis drugs even before therapy is initiated, potentially eliminating treatment destined to be ineffective. A postdoctoral research fellow at the Martinos Center at the time of the study, Emblem is now a principal investigator at Oslo University Hospital in Norway and maintains an affiliation with the Martinos Center.

Researchers Gain Insight into How Ion Channels Control Heart and Brain Electrical Activity

Virginia Commonwealth University researchers studying a special class of potassium channels known as GIRKs, which serve important functions in heart and brain tissue, have revealed how they become activated to control cellular excitability.

The findings advance the understanding of the interaction between a family of signaling proteins called G proteins, and a special type of cell membrane ion pore called G protein-sensitive, inwardly rectifying potassium (GIRK) channels. The findings may one day help researchers develop targeted drugs to treat conditions of the heart such as atrial fibrillation.

In the study, published this week in the Online First section of Science Signaling, a publication of the American Association for the Advancement of Science (AAAS), researchers used a computational approach to predict the interactions between G proteins and a GIRK channel.

Rahul Mahajan, a M.D./Ph.D. candidate in the VCU School of Medicine’s Department of Physiology and Biophysics, undertook this problem for his dissertation work, under the mentorship of Diomedes E. Logothetis, Ph.D., chair of the Department of Physiology and Biophysics and the John D. Bower Endowed Chair in Physiology in the VCU School of Medicine. They developed a model and tested its predictions in cells, demonstrating how G proteins cause activation of GIRKs.  

“Malfunctions of GIRK channels have been implicated in chronic atrial fibrillation, as well as in drug abuse and addiction,” said Logothetis, who is an internationally recognized leader in the study of ion channels and cell signaling mechanisms.  

“Understanding the structural mechanism of Gβγ activation of GIRK channels could lead to rational based drug design efforts to combat chronic atrial fibrillation.”

In chronic atrial fibrillation, the GIRK channel is believed to be inappropriately open. According to Logothetis, if researchers are able to target only the specific site that keeps the channel inappropriately open, then any unrelated channels could be left unaltered, thus avoiding unwanted side effects.

Crystal structures of GIRK channels, which preceded the current study, have revealed two constrictions of the ion permeation pathway that researchers call “gates”: one at the inner leaflet of the membrane bilayer and the other close by in the cytosol, which is the liquid found inside cells.  

“The structure of the Gβγ -GIRK1 complex reveals that Gβγ inserts a part of it in a cleft formed by two cytosolic loops of two adjacent channel subunits,” Logothetis said. “This is also the place where alcohols bind to activate the channel. One can think of this cleft as a clam that has its shells either open or shut closed. Stabilization of this cleft in the ‘open’ position stabilizes the cytosolic gate in the open state.”

GIRKs are activated when they interact with G proteins coupled to receptors bound to stimulatory hormones or neurotransmitters. In heart tissue, acetylcholine released by the vagus nerve activates these channels, which hyperpolarize the membrane potential and slow heart rate. In brain tissue, GIRKs inhibit excitation by acting at postsynaptic cells.  

G proteins are composed of three subunits, a, b, and g. Since 1987, researchers have known that the Gbgsubunits directly activate the atrial GIRK channel, but an atomic resolution picture of how the two proteins interact remained elusive until now.

Moving forward, the team would like to use computational and experimental approaches to build and test the structures of the rest of the components of the G protein complex – for example, the Ga subunits and the G protein-coupled receptor – around the Gβγ-channel complex, which is the structure the team has already achieved.

It’s Time To Rediscover The IUD, Women’s Health Advocates Say

What will it take to make intrauterine devices sexy?

IUDs are highly effective forms of contraception, but fear of side effects, lack of training for doctors and costs can keep women away. Health organizations and private companies are trying to change that by breaking down misconceptions and broadening access.

The contraceptives are inserted into the uterus and can prevent pregnancy for years. And they’re reversible. Shortly after they’re taken out, a woman can become pregnant.

IUDs are more than 99 percent effective. The World Health Organization reports they are “the most widely used reversible contraceptive method globally.” But few women in the U.S. use them; the percentage is only in the single digits, in part because IUDs have a checkered past. The Dalkon Shield IUD, marketed nationwide beginning in 1971, was found to raise the risk of pelvic inflammatory disease. Medical complications and deaths sparked lawsuits with thousands of claimants.

“So we had a whole generation in the ‘70s and '80s … where doctors and clinicians weren’t trained and women didn’t have that option,” says Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis.

The two common intrauterine devices in the U.S. are ParaGard, which releases copper to interfere with sperm, and Mirena, which prevents pregnancy with the hormone progesterone. There is still a slight risk of pelvic inflammatory disease. But Bayer Healthcare Pharmaceuticals, the maker of Mirena, says fewer than 1 percent of users of its device get the infection. More common side effects for women using IUDs are irregular bleeding or cramping.

Upfront costs also limit access; the price of the device and getting it inserted can cost hundreds of dollars.

But Mirena works for up to five years, and the copper IUD up to 10. So over time, they can actually be cheaper than monthly payments for, say, the pill. And IUDs, like other contraceptives approved by the Food and Drug Administration, are expected to be covered for most users under the Affordable Care Act.

Continue reading.

Image: An IUD is seen on pelvic X ray (© Nevit Dilmen found at Wikimedia commons)

beemsterboer:

The Center for Investigative Reporting won an Emmy in the “New Approaches” category last night for the film titled, “Jennifer’s Room,” which details the abuse of one intellectually disabled woman in a California developmental center.

That they managed to make a visual presentation of this story is pretty incredible.

Chilling and sad story. 

Vaccine Refusals Fueled California’s Whooping Cough Epidemic

When the whooping cough vaccine was invented in the 1940s, doctors thought they had finally licked the illness, which is especially dangerous for babies. But then it came roaring back.

In 2010, a whooping cough outbreak in California sickened 9,120 people, more than in any year since 1947. Ten infants died; babies are too young to be vaccinated.

Public health officials suspected that the increased numbers of parents who refused to vaccinate their children played a role, but they couldn’t be sure.

Vaccine refusal was indeed a factor, researchers now say. They compared the location and number of whooping cough, or pertussis, cases in that outbreak with the personal belief exemptions filed by parents who chose not to vaccinate for reasons other than a child’s health. (Some children with compromised immune systems aren’t able to be vaccinated.)

Pertussis is very contagious, spreading quickly through a community. So the researchers had to map not only the location of outbreak clusters, but also when they appeared.

They found that people who lived in areas with high rates of personal belief exemptions were 2 ½ times more likely to live in a place with lots of pertussis cases. “The exemptions clustered spatially and were associated with clusters of cases,” Jessica Atwell, a graduate student at Johns Hopkins Bloomberg School of Public Health and lead author on the study, told Shots. It was published online in the journal Pediatrics.

Continue reading.

The photograph above show Bordetella pertussis, the bacterium that causes whooping cough, under the electron microscope. Image by Sanofi Pasteur/Flickr.com.

nursingisinmyblood:

pubhealth:

Kit Yamoyo

We know how to treat diarrhea. Zinc and oral rehydration solution (ORS) are proven, affordable treatments, yet diarrhea still kills nearly 600,000 children annually. In rural areas, it’s often easier to find a bottle of Coca-Cola than these lifesaving medicines. ColaLife developed Kit Yamoyo to bundle and deliver zinc and ORS to African children by piggybacking on the beverage company’s delivery system and local social marketing. The kit contains zinc, ORS, and soap, and the packaging serves multiple purposes: a measuring guide, a mixing and storage device, and a cup.

(FromPATH)

This awesome. I love to see this kind of stuff!

For $3,400, Volunteers Get Doused With The Flu

What would it take to persuade you to allow government researchers to squirt millions of live flu viruses up your nose?

A recently concluded project at the National Institutes of Health found, among other things, that $3,400 each was enough to attract plenty of volunteers.

“I am happy I could contribute in some way,” says Kelli Beyer, 24, one of 46 healthy people who volunteered for the project. To get the money, the research subjects had to commit to several days of testing, then nine days in a hospital isolation ward once the virus was administered in a nasal spray.

All the subjects got varying amounts of a laboratory-synthesized version of the H1N1 strain of swine flu that touched off a pandemicback in 2009 that sickened millions and contributed to the deaths of more than 18,000 people.

Since one aim of the study was to see how much virus it takes to make people moderately sick, researchers ramped up the dose given to seven successive groups of volunteers. Beyer was in the last of seven groups, so she got the highest dose.

More on what happened to her later. First, you might be wondering why scientists felt they needed to give people the flu.

“Despite 100 years of studying influenza, we still have somewhat limited knowledge of how flu causes disease in humans,” study director Matthew Memoli tells Shots. “These kinds of studies have been done before, but not since the early 1990s.”

Continue reading.

Image above shows influenza viruses (blue) attaching to the cells of the upper respiratory tract. Viruses floating in the air are breathed in and bind to the hair-like microvilli and cilia on the surface of the cells that line the trachea. Image by R. Dourmashkin,Wellcome Images.

How A Pregnant Woman’s Choices Could Shape A Child’s Health

Pregnant women hear a lot about things they should avoid: alcohol, tobacco, chemical exposures, stress. All of those have the potential to affect a developing fetus. And now scientists are beginning to understand why.

One important factor, they say, is something called epigenetics, which involves the mechanisms that turn individual genes on and off in a cell.

There’s growing evidence that epigenetics is critical in determining a child’s risk of developing problems ranging from autism to diabetes, says Dani Fallin, who studies the genetics of mental disorders at Johns Hopkins Bloomberg School of Public Health.

Epigenetic control of genes is part of what allows a tiny cluster of identical cells in the womb to grow into a fully formed baby. By switching certain genes on and off, some cells become heart cells while others become brain cells.

It’s a delicate process that can be disrupted by exposure to certain chemicals or hormones, says Susan Kay Murphy, an associate professor of obstetrics and gynecology at Duke University School of Medicine. And the first week or so after conception appears to be “a particularly vulnerable time where environmental influences can directly affect an epigenetic outcome,” she says.

Murphy’s interest in epigenetics is personal as well as professional. She entered the field in the 1990s after her young son died from a rare form of liver cancer that has been linked to epigenetic changes. She also has a son with autism and a daughter with ADHD.

Continue reading.

Illustration by Katherine Streeter for NPR

Africa’s ‘Brain Drain’ In Health Care Continues To Soar

The number of doctors from sub-Saharan Africa working in the U.S. has risen by nearly 40 percent in the past decade, researchers from Vanderbilt University reportedTuesday in the journal PLOS Medicine.

By analyzing data from the World Health Organization, Akhenaten Benjamin Siankam Tankwanchi and his team estimated that 10,819 physicians were born or trained in 28 sub-Saharan countries. For all of these countries, except South Africa, migration to the U.S. increased from 2002 to 2011. Nigeria and Ghana saw a more than 50 percent rise, while Ethiopia and Sudan suffered a more than 100 percent increase. Liberia was hardest hit with an estimated 77 percent of their doctors moving to the U.S.

Once the doctors leave sub-Saharan Africa, they don’t return home quickly. On average, the physicians trained in Africa have been in the U.S. for 18 years, the researchers said.

“Unless far-reaching policies are implemented by the U.S. and sub-Saharan countries, the current emigration trends will persist," Tankwanchi and his team wrote. "And the U.S. will remain a leading destination for SSA physicians emigrating from the continent of greatest need.”

Learn more.

Top graph: Since the 1960s, the number of sub-Saharan trained doctors who have moved to the U.S. (SSA-USMG) has increased exponentially.

Bottom graph: Length of service provided to the home country by medical graduates trained in sub-Saharan Africa before moving to the U.S.

One of the essays written in our Justice in Medicine special issue. Check out the issues with the link in bio.
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#blm #whitecoatsforblacklives #blacknessis #medicine
https://www.instagram.com/p/CBmDv7EH7qu/?igshid=uzwerz0u8k5o

It can be hard to process everything going on right now. If you are not sure of what to say or do, you can always listen. Listen to those with a voice. And allow everyone to have a voice. Because listening cultivates learning. . . This was a previous issue of The Medical Chronicles, and yet, these problems still remain. Articles talk about #racism and #sexism in #medicine. Link is in the bio (https://www.magcloud.com/browse/issue/1222666?__r=184846). Please consider buying a copy, and proceeds from this issue will be donated to @colorofchange, an organization that “designs campaigns powerful enough to end practices that unfairly hold Black people back, and champion solutions that move us all forward. Until justice is real.” . . . #BlackLivesMatter #WhiteCoatsforBlackLives #justice #medicine https://www.instagram.com/p/CA6XqNDh3aq/?igshid=6d8syavu1vv8

Deadline: June 19, 2020
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#themedicalchronicles #medicine #magazines #blog #art #science #humanities #doctors #physicians #nurses #healthcareprofessionals #healthcare #writing #essays #shortstories #narratives #callforsubmission #covid19
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Orgooooooo

Mr. Porter asked me to illustrate outfits for different careers or professions as toy box outfits, referencing the old Action Man outfit sets from the 60′s and 70′s. Basically a dream job for me. Action figures, fashion, retro imagery, andall of that in monochromatic colour schemes? Yes. Count me in.

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Everybody is talking about the high cost of prescription drugs. Here’s who’s actually responsible for the prices you pay.