Surprising rate of recurring heart attacks, strokes globally
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Despite many medicines and other treatments for patients with vascular disease, a large international study shows these patients have a surprisingly high rate of recurring events such as strokes, heart attacks and hospitalizations as well as mortality.
Also unexpected: patients in North America (including the U.S.) experienced an above-average rate of these events. Patients in Eastern Europe had the highest rate, and those in Australia and Japan had the lowest.
The results from the international REACH (Reduction of Atherothrombosis for Continued Health) Registry, presented by a researcher from Northwestern University Feinberg School of Medicine, examined data for 32,247 patients one and three years after they enrolled in the registry. Patients who had symptomatic vascular disease had a 14.4 percent rate at one year and 28.4 percent rate at three years of having a heart attack, stroke, rehospitalization for another type of vascular event or vascular death. Patients with vascular disease in more than one location of the body had the highest event rate at 40.5 percent at three years.
New European guidelines on syncope revise diagnostic definitions and re-evaluate extent of risk
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Barcelona, Spain, 31 August: A new definition of syncope – most commonly perceived as an episode of fainting – makes its diagnosis more precise and now dependent on a specific cause. New 2009 ESC Guidelines for the Diagnosis and Management of Syncope define syncope as “a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery”.(1)
The definition, says Professor Angel Moya from the University Hospital Vall d’Hebrón in Barcelona and Chair of the Guideline Task Force, now includes an aetiological requirement of reduced cerebral blood flow, which is new to the 2009 Guidelines. Indeed, he explains, a sudden cessation of cerebral blood flow for as short as six to eight seconds is sufficient to cause complete loss of consciousness. “Without this diagnostic addition,” he says, “the definition of syncope becomes wide enough to include other disorders such as epileptic seizures and concussion - in fact, would be nothing more than ‘loss of consciousness’, irrespective of mechanism and duration.”
The Guidelines note that syncope is also associated with a decrease in systolic blood pressure to 60 mmHg or lower, which in turn is determined by cardiac output and total vascular resistance; a fall in either can cause syncope, but a combination of both mechanisms is often present.
New European guidelines on pulmonary hypertension provide new 6-group clinical definition
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New 2009 Guidelines for the diagnosis and treatment of pulmonary hypertension are made public today. The Guidelines have been jointly produced by a Task Force of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS); the Task Force also included experts from the International Society of Heart and Lung Transplantation (ISHLT).
The new 2009 Guidelines provide a new clinical classification of pulmonary hypertension which identifies six different clinical groups. However, whatever the underlying causative mechanism, pulmonary hypertension is characterised by a poor prognosis. Indeed, says Professor Nazzareno Galiè, from the Institute of Cardiology at the University of Bologna, Italy, and Chairperson of the Guidelines Task Force: “It is the multidisciplinary nature of pulmonary hypertension and its severity which have made the new guidelines necessary.”
Pulmonary hypertension (the increase of blood pressure within the lung circulation) is a condition which may complicate the majority of heart and of lung diseases, or may develop without a clear initiating cause. The new 2009 Guidelines identify six different clinical groups.
Predicting cancer prognosis
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Researchers led by Dr. Soheil Dadras at the Stanford University Medical Center have developed a novel methodology to extract microRNAs from cancer tissues. The related report by Ma et al, “Profiling and discovery of novel miRNAs from formalin-fixed paraffin-embedded melanoma and nodal specimens,” appears in the September 2009 issue of the Journal of Molecular Diagnostics.
Cancer tissues from patients are often stored by a method that involves formalin fixation and paraffin embedding to retain morphological definition for identification; however, this method frequently prevents further molecular analysis of the tissue because of mRNA degradation. Even so, these tissues contain high numbers of microRNAs (miRNAs), which are short enough (~22 nucleotides) to not be broken down during the fixation process.
In this study, Dr. Dadras and colleagues optimized a new protocol for extracting miRNAs from formalin-fixed paraffin-embedded tissues. Using their new procedure, they identified 17 new and 53 known miRNAs from normal skin, melanoma, and sentinel lymph nodes. These miRNAs were well-preserved in a 10-year-old specimen.
September is National Childhood Cancer Awareness Month
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While rare, pediatric cancer is the leading cause of death by disease in children younger than 15, according to the American Cancer Society. More than 10,700 children nationwide will be diagnosed with cancer this year. However the prognosis for these youngsters is not as poor as it used to be. The five-year survival rate for children with cancer is 80 percent, which is up from 50 percent in the early 1970s. The Cancer Institute of New Jersey (CINJ) is making experts available to discuss the latest in comprehensive treatment, research, and service offerings for this unique population during the month of September, which is National Childhood Cancer Awareness Month. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.
Along with cutting-edge treatment, pediatric cancer patients at CINJ have access to unique services. For instance, a state-accredited classroom setting is available, providing educational support to children from pre-school through high school.
After 11 Years of Back Pain Following Accident, Woman Finds Relief in Neurosurgery for the Spine
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Newport Beach resident Dorys Balboa spent 11 years in pain after being involved in a car crash that injured her low back. Medication, pain management techniques and alternative therapies, such as acupuncture, offered only limited respites, but decompression surgery performed by a neurosurgeon at Cedars-Sinai Medical Center brought immediate, complete relief.
“I came out of the recovery room and I remember I could move my feet again, and I couldn’t do that for a long time. My right toe had been numb and I’d had excruciating pain all the way up my leg. I couldn’t flex my foot forward and backward,” said Balboa, 41.
“When I got out of surgery, I was moving my foot and thinking, ‘I’m probably not feeling the pain because I’m still medicated.’ So I was trying to reason with myself not to get too excited. But I was thinking, ‘I can feel a little pressure on my back, and if I can feel that, I should be able to feel the pain in my foot.’ And then it just dawned on me: ‘Oh, my gosh, I am OK.’”
Pitt study finds molecular link between insulin resistance and inflammation
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An exploration of the molecular links between insulin resistance and inflammation may have revealed a novel target for diabetes treatment, say scientists at the John G. Rangos Sr. Research Center, Children’s Hospital of Pittsburgh of UPMC. Their findings were published earlier this month in the online version of Diabetes, one of the journals of the American Diabetes Association.
Signs of low-grade systemic inflammation are not uncommon among people who have the pre-diabetic condition known as metabolic syndrome, as well as in animal models of obesity and type 2, or insulin-resistant, diabetes, said senior author H. Henry Dong, Ph.D., assistant professor, Department of Pediatrics, University of Pittsburgh School of Medicine.
“But it’s not yet clear if there is a cause-and-effect relationship between chronic exposure to low-grade inflammation and the onset of insulin resistance,” he explained. “Other studies have shown that in patients who have inflammation and diabetes, insulin-sensitizing drugs seem to reduce inflammation while anti-inflammatory therapies improve sensitivity to insulin.”
Kennedy’s death another chapter in healthcare saga
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Senator Edward Kennedy’s death comes as a political struggle appears to be chipping away at the Democratic power-broker’s vision for what he called “the cause of my life,” providing affordable healthcare coverage to all Americans.
After decades of laying the groundwork to overhaul the U.S. healthcare system, Kennedy, who died late on Tuesday at age 77, was forced into a limited role in the fight to enact such legislation since being diagnosed in May 2008 with brain cancer.
Yet despite being away from Congress most of the year, Kennedy, one of the most effective lawmakers in U.S. history, managed to help draft a preliminary bill to overhaul the $2.5 trillion U.S. healthcare system.
Vietnam to curb smoking, raise tobacco tax
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Vietnam will ban smoking in all indoor public places next year and raise tariffs on tobacco products to reduce consumption, the government said.
Starting from January 1, smoking in schools, hospitals, libraries, cinemas, factories, offices and on public transport will be prohibited, a government statement seen on Tuesday said.
The ban will extend to all indoor public spaces by the end of 2010, the statement said, adding the government also plans to apply “high tariff levels” on tobacco products next year to cut consumption.
Minorities have poorer results, higher rates of inappropriate carotid-artery surgery to prevent stro
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Minorities have poorer results, higher rates of inappropriate carotid-artery surgery to prevent stroke
Minorities have poorer results and higher rates of unnecessary surgery from a common procedure used to remove plaque from inside the carotid artery, according to a UT Southwestern Medical Center doctor who is lead author of the study in the journal Stroke.
The multicenter study, available online and appearing in the July issue of the journal, found that higher rates of poor surgical outcomes for carotid endartectomy (CEA) — a procedure performed to prevent stroke — appeared to be due not only to elevated patient clinical risk in African-American and Hispanics, but also to the individual skill and experience of the doctor performing the operation.
“Identifying how various patient, physician and hospital-level factors may contribute to disparities has important implications for the design of clinical and health policy strategies for reducing them,” said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.
Cancer Researchers, IT Specialists Win Bioinformatics Award
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A team of researchers and information technology specialists at the University of Alabama at Birmingham (UAB) Comprehensive Cancer Center has won the caBIG® 2009 Deployment Award from the National Cancer Institute (NCI).
The award honors the university’s progress towards adopting the cancer Biomedical Informatics Grid®, or caBIG®. The project is a NCI-led, secure online resource of shared data and software used to improve and boost cancer-research collaboration. Today, more than 1,500 individuals from more than 450 research centers and organizations worldwide use caBIG and contribute to its projects.
“This team from the University of Alabama at Birmingham undertook a major initiative to adapt its existing data-entry system to work with caBIG tools and within the caBIG infrastructure,” NCI officials said at an award ceremony in July in Washington, D.C. “The pioneering efforts of the team have resulted in a tremendous amount of institutional knowledge about the adaptation process.
New treatment option for ruptured brain aneurysms
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Researchers in Finland have identified an effective new treatment option for patients who have suffered a ruptured brain aneurysm, a potentially life-threatening event. Results of the new study on stent-assisted coil embolization were published today in the online edition of Radiology.
An aneurysm is a bulge or sac that develops in a weak area of a cerebral artery wall. Subarachnoid hemorrhage occurs when an aneurysm ruptures, diverting oxygen-rich blood from vital areas to the space between the brain and the skull. The ruptured vessel can be repaired surgically or through a minimally invasive procedure called embolization, in which the sac is filled with metal coils in order to prevent repeat bleeding from the aneurysm and to restore normal blood flow in the artery.
“The treatment decision is complicated in cases of acutely ruptured aneurysms,” said the study’s lead author, Olli Tähtinen, M.D., assistant professor of radiology at Tampere University Hospital in Tampere, Finland.
Strong link found between concussions and brain tissue injury
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Concussions, whether from an accident, sporting event, or combat, can lead to permanent loss of higher level mental processes. Scientists have debated for centuries whether concussions involve structural damage to brain tissue or whether physiological changes that merely impair the way brain cells function, explain this loss. Now, for the first time, researchers at Albert Einstein College of Medicine of Yeshiva University have linked areas of brain injury to specific altered mental processes caused by concussions.
The research, described in the August 26 edition of Radiology, provides compelling evidence that concussions involve brain damage. The findings suggest that diffusion tensor imaging (DTI), the brain scanning method used by the Einstein scientists, could help in diagnosing concussions and in assessing the effectiveness of treatments.
“DTI has been used to look at other brain disorders, but this is the first study to focus on concussions,” said Michael Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center (MRRC) and associate professor of radiology, of psychiatry and behavioral sciences, and of neuroscience at Einstein and lead author of the study. “It proved to be a powerful tool for detecting the subtle brain damage that we found to be associated with concussions.”
Mild glucose intolerance in pregnancy may be associated with cardiovascular risk
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Mild glucose intolerance in pregnancy may be an early identifier of women who are at increased risk of heart disease in the future, found a new study http://www.cmaj.ca/press/cmaj090569.pdf published in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca.
In a large population-based cohort study, researchers from the University of Toronto and the Institute for Clinical Evaluative Sciences (ICES) studied data on 435,696 women in Ontario, Canada, who gave birth between April, 1994 and March, 1998. All women were followed until March 31, 2008. The study excluded women with pre-existing diabetes.
As cardiovascular disease is the leading cause of death in Canadian women, it is important to identify early predictors of future vascular risk. While women with gestational diabetes have a higher risk of cardiovascular disease than those without, it previously has not been known whether mild glucose intolerance in pregnancy is associated with heart disease. The study sought to answer this question.
Landmark survey highlights needs of unpaid caregivers of people with diabetes
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The Hormone Foundation, the public education affiliate of The Endocrine Society, in collaboration with the National Alliance for Caregiving, today released key findings from a first-of-its-kind survey (http://www.hormone.org/Public/diabetes_caregiver.cfm) aimed at better understanding the daily needs and struggles of unpaid caregivers of people with diabetes.
The online survey completed by 1,002 respondents in April 2009 found that the major challenges in caring for those with diabetes include exercise and diet compliance, patient depression and maintaining target sugar levels. Caregivers reported that the physician is their top information source, followed by the Internet. However, while 73 percent of caregivers reported using the Internet to obtain diabetes information, many expressed frustration in evaluating the quality and reliability of online content.
Specific survey findings include:
