1.5 Million Cancer Deaths Avoided in 2 Decades in the US

American Cancer Society: Annual statistics reporting from the American Cancer Society shows the death rate from cancer in the US has fallen 22% from its peak in 1991. This translates to more than 1.5 million deaths from cancer that were avoided. 

New Treatment Strategy Allows Lower Doses of Toxic Tuberculosis Drug Without Compromising Potency

Johns Hopkins. US: While an effective treatment is available for combating multidrug-resistant tuberculosis, it carries serious side effects for patients. New research conducted at the Center for Tuberculosis Research at the Johns Hopkins University School of Medicine shows that lower doses of the toxic drug bedaquiline — given together with verapamil, a medication that’s used to treat various heart conditions — can lead to the same antibacterial effects as higher toxic doses of bedaquiline. The combination of the two drugs could potentially shorten treatment time, reduce the side effects of bedaquiline and improve patient outcomes for those suffering from TB.

Children with Autism Who Live With Pets Are More Assertive

University of Missouri. US: Dogs, cats and other animals may improve social skills of children with autism.
Dogs and other pets play an important role in individuals’ social lives, and they can act as catalysts for social interaction, previous research has shown. Although much media attention has focused on how dogs can improve the social skills of children with autism, a University of Missouri researcher recently found that children with autism have stronger social skills when any kind of pet lived in the home.

Consuming High-Protein Breakfasts Helps Women Maintain Glucose Control

University of Missouri. US: In healthy individuals, the amount of glucose, or sugar, in the blood increases after eating. When glucose increases, levels of insulin increase to carry the glucose to the rest of the body. Previous research has shown that extreme increases in glucose and insulin in the blood can lead to poor glucose control and increase an individual’s risk of developing diabetes over time. Now, a University of Missouri researcher has found that when women consumed high-protein breakfasts, they maintained better glucose and insulin control than they did with lower-protein or no-protein meals.

MU researchers close in on possible autism detection method

University of Missouri. US: Early detection of autism in children is key for treatment, and researchers at the University of Missouri are inching closer to determining the viability of using facial measurements as a potential detection marker.

Is ginger efficient and safe in osteoarthritis?

Osteoarthritis and Cartilage Journal: According to a recent study, ginger could be, although it's modestly efficient, a better treatment option than NSAIDs (anti-inflammatory drugs like ibuprofen) judged on possible adverse effects of the latter, to treat osteoarthritis.

Juvenile arthritis

NIH. US: Juvenile idiopathic arthritis is currently the most widely accepted term to describe various types of chronic arthritis in children. In general, the symptoms of juvenile idiopathic arthritis include joint pain, swelling, tenderness, warmth, and stiffness that last for more than 6 continuous weeks.

Scale-up in effective malaria control dramatically reduces deaths

WHO: The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World malaria report 2014. 

Malaria

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.
Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.
Key interventions to control malaria include: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.

UK Ebola case confirmed but risk remains low

NHS. UK: A case of Ebola has now been confirmed in the UK, but the risk to the general public remains very low. Ebola can only be transmitted by direct contact with the blood or bodily fluids of an infected person.

Ebola

Ebola is a virus that can be spread through blood and bodily fluids. The virus originated in the West African rainforest and is thought to have spread to humans by handling or butchering infected animals.

Once the virus enters the body it can replicate very quickly, causing a range of increasingly harmful symptoms, including internal bleeding. Left untreated, it can have a mortality rate as high as 90%.

Longer cooling, lower temperature no improvement for infant oxygen deprivation

NIH. US: The standard treatment for newborns whose brains were deprived of oxygen appears to work better than proposed alternatives, according to a study from a National Institutes of Health research network. The standard treatment involves lowering an infant ’s body temperature by about 6 degrees Fahrenheit for 72 hours. Attempts to improve on this treatment by further lowering body temperature or increasing the duration of cooling were of no additional benefit, the researchers concluded.

Stem cell transplants may halt progression of multiple sclerosis

NIH. US: Three-year outcomes from an ongoing clinical trial suggest that high-dose immunosuppressive therapy followed by transplantation of a person's own blood-forming stem cells may induce sustained remission in some people with relapsing-remitting multiple sclerosis (RRMS).

Gene Disruptions Associated with Autism Risk

NIH. US: Autism is a complex brain disorder characterized by difficulties with social interactions and communication. The symptoms and levels of disability can range from mild to severe. The wide range of disorders is collectively referred to as autism spectrum disorder (ASD). ASD affects about 1 in 68 American children.

Lost Connections in Pompe Disease

NIH. US: Mistletoe? Holly? Not exactly. This seemingly festive image is a micrograph of nerve cells (green) and nerve-muscle junctions (red) in a mouse model of Pompe disease. Such images are helping researchers learn more about this rare form of muscular dystrophy, providing valuable clues in the ongoing search for better treatments and cures.

Oral cancer

NIH. US: Oral cancer accounts for roughly two percent of all cancers diagnosed annually in the United States. Approximately 42,000 people will be diagnosed with oral cancer each year and about 8,000 will die from the disease.  On average, 60 percent of those with the disease will survive more than 5 years.
Oral cancer most often occurs in people over the age of 40 and affects more than twice as many men as women.

Oral cancer includes cancers of the mouth and the pharynx (the back of the throat).

Make 5 a day fruit and veg into "7 a day"

NHS. UK: “7 a day fruit and veg 'saves lives’” reports BBC News, while The Daily Telegraph states that “10 portions of fruit and vegetables per day” is best.
The headlines have been prompted by the results of a UK-based study that used information on more than 65,000 randomly selected adults who were participating in the Health Survey for England.

Youth tobacco smoking rates putting millions at risk of premature death

Almost 23 percent of high school students currently use a tobacco product, according to new data published by the Centers for Disease Control and Prevention in today’s Morbidity and Mortality Weekly Report (MMWR). Of particular concern, more than 90 percent of those using a tobacco product are using combustible tobacco products such as cigarettes, cigars, hookahs, and pipes.
Extensive use of combustible products is of special concern because tobacco smoking causes most of the tobacco-related disease and death in the United States.

FDA approves Viekira Pak to treat hepatitis C

FDA. US: The U.S. Food and Drug Administration today approved Viekira Pak (ombitasvir, paritaprevir and ritonavir tablets co-packaged with dasabuvir tablets) to treat patients with chronic hepatitis C virus (HCV) genotype 1 infection, including those with a type of advanced liver disease called cirrhosis.

More than 300 million people in at least 70 countries use smokeless tobacco

CDC. US: The first-ever report on the global use and public health impact of smokeless tobacco finds that more than 300 million people in at least 70 countries use these harmful products. The report, Smokeless Tobacco and Public Health: A Global Perspective, is being released today by the CDC and the National Cancer Institute at the National Conference on Smoking or Health in Mumbai, India. Thirty-two leading experts from around the world contributed to the report.The serious health effects of smokeless tobacco have been documented. As the report explains, there is sufficient evidence to conclude that smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer in humans.

Ibuprofen

NIH. US: Prescription ibuprofen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). It is also used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a menstrual period). Nonprescription ibuprofen is used to reduce fever and to relieve minor aches and pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Ibuprofen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

Ibuprofen unlikely to extend life

NHS. UK: The Daily Mirror today reports that, “taking ibuprofen every day could extend your life by up to 12 YEARS”. The Daily Express also has a similar front page headline, while the Mail Online suggests that these extra years would be of “good quality life”.If you read these headlines and felt sceptical, you’d be right to do so.

Lynparza recommended for approval in ovarian cancer

The European Medicines Agency (EMA) has recommended granting a marketing authorisation for Lynparza (olaparib), a first-in-class medicine for the treatment of women with a subtype of ovarian cancer for which there are limited approved treatment options.

FDA approves Lynparza to treat advanced ovarian cancer

The U.S. Food and Drug Administration today granted accelerated approval to Lynparza (olaparib), a new drug treatment for women with advanced ovarian cancer associated with defective BRCA genes, as detected by an FDA-approved test.

FDA approves Xtoro to treat swimmer’s ear

The U.S. Food and Drug Administration today approved Xtoro (finafloxacin otic suspension), a new drug used to treat acute otitis externa, commonly known as swimmer’s ear.

Shift workers more likely to report poor health

NHS. UK: "Higher rates of obesity and ill-health have been found in shift workers than the general population," BBC News reports. These are the key findings of a survey into health trends among shift workers; defined as any working pattern outside of the normal fixed eight-hour working day (though start and finish times may vary).
According to the survey (The Health Survey for England 2013), shift workers were more likely to report general ill-health, have a higher body mass index (BMI) and increased incidence of chronic diseases such as diabetes.

Electromagnetic smog unlikely to harm humans

NHS. UK: Are mobile phones likely to harm human health? Is there a potential health impact of environmental exposure to what some commentators have called “electromagnetic smog”? This is a term used to refer to a mix of low-level magnetic fields that exist in the modern environment. This "smog" is not just generated by mobile phones, but also by Wi-Fi routers, tablets, laptops, power lines and cell towers. In the modern world, you are never far away from a magnetic field.

Fathers-to-be experience hormone changes

NHS. UK: “Men suffer pregnancy symptoms too: Fluctuating hormones make fathers-to-be … more caring,” the Mail Online reports. A small US study found evidence of changes in hormonal levels that may make fathers-to-be more able to cope with the demands of fatherhood. The story comes from a study that looked at whether expectant fathers and their partners experience any changes in their hormone levels during pregnancy. It found that, as expected, women experienced a large increase in four hormones associated with pregnancy. Their male partners also experienced small changes in the hormones testosterone and oestradiol.
The researchers, as well as the media, speculate that these small changes in hormone levels could lead to men becoming less aggressive, less interested in sex, and more caring. Though whether such changes are linked to subsequent changes in their behaviour is unproven.

Fragile X syndrome

Orphanet: Fragile X syndrome (FXS) is a rare genetic disease associated with mild to severe intellectual deficit that may be associated with behavioral disorders and characteristic physical features.

Frequency is estimated at approximately 1/4000-1/5000 although it may vary depending on where the screening was carried out in the world.

Primary ovarian insufficiency

NIH. US: Primary ovarian insufficiency (POI) is the term used to describe when a woman’s ovaries stop working normally before she reaches the age of 40. POI is not the same as early or premature menopause. Many women with POI do not get monthly menstrual periods, or they have them irregularly. Problems with ovulation may make it difficult for women with POI to get pregnant. In addition, women with POI are at higher risk for certain health conditions, such as osteoporosis, than are women who do not have POI.

Study finds genetic clue to menopause-like condition in young women

NIH. US: Six young women with a disorder that mimics menopause have gene alterations that hamper the repair of damaged DNA, report researchers supported by the National Institutes of Health. The mutations, occurring in women with primary ovarian insufficiency (POI), are in genes that repair damaged DNA in cells of the ovary that eventually become egg cells. It may also contribute to understanding normal menopause.

Blood group O associated with a lower risk of developing type 2 diabetes

INSERM: Is there a relationship between blood group and the risk of developing type 2 diabetes? This is the question studied by Guy Fagherazzi and his collaborators from Joint Research Unit 1018, “Centre for Research in Epidemiology and Population Health” (Inserm/University Paris-Sud) at Gustave Roussy Institute. The analysis, carried out on 82,104 women from the E3N cohort who were monitored for 18 years, suggests for the first time that the risk of type 2 diabetes may be lower for individuals with blood group O than for those with blood groups A, B or AB.

Trulicity

EMEA: Trulicity can be used on its own in patients whose blood glucose levels are not satisfactorily controlled on diet and exercise alone and who cannot take metformin (another diabetes medicine).
It can also be used as an ‘add-on’ to other diabetes medicines, including insulin, when these medicines together with exercise and diet are not providing adequate control of blood glucose.
Trulicity contains the active substance dulaglutide.

Mysimba recommended for approval in weight management in adults

The European Medicines Agency (EMA) has recommended granting a marketing authorisation for Mysimba (naltrexone / bupropion) for weight management of overweight or obese adults. The medicine is recommended for use in addition to a reduced-calorie diet and physical activity.

FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV

The U.S. Food and Drug Administration today approved Gardasil 9 (Human Papillomavirus 9-valent Vaccine, Recombinant) for the prevention of certain diseases caused by nine types of Human Papillomavirus (HPV). Covering nine HPV types, five more HPV types than Gardasil (previously approved by the FDA), Gardasil 9 has the potential to prevent approximately 90 percent of cervical, vulvar, vaginal and anal cancers.

Cervical cancer

IQWiG, Germany: Cervical cancer is the term used to describe tumors that can grow at the lower end of the womb. As far back as the 1960s it was discovered that cervical cancer is nearly always caused by a long-term infection with particular viruses. Cervical screening has been shown to reduce the risk of developing cervical cancer.

More than 16 million children live in states where they can buy e-cigarettes legally

CDC. US: More than 300 million Americans live in states without protection against indoor e-cigarette aerosol exposure

Forty states have enacted laws prohibiting the sale of electronic nicotine delivery systems (ENDS), including e-cigarettes, to minors, but 10 states and the District of Columbia still permit such sales, according to a report published by the Centers for Disease Control and Prevention in today’s Morbidity and Mortality Weekly Report (MMWR).

National mass media anti-smoking campaign exceptionally cost-effective

CDC. US: The 2012 Tips From Former Smokers campaign spent only $480 per smoker who quit and $393 per year of life saved, according to an analysis by the Centers for Disease Control and Prevention. The results of the study were published today in the American Journal of Preventive Medicine.

E-cigarettes could help some smokers quit

NHS. UK: “E-cigarettes can help smokers quit or cut down heavily,” The Guardian reports. An international review of the evidence, carried out by the well-respected Cochrane Collaboration, found evidence that they can help some smokers quit.However, the available body of evidence was slim – just two randomised controlled trials (RCTs), involving around 950 participants.

Chronic high blood sugar may be detrimental to the developing brain of young children

NIH. US: Study shows young children with type 1 diabetes have significant difference in brain developmentYoung children who have long-term high blood sugar levels are more likely to have slower brain growth, according to researchers at centers including the National Institutes of Health.

Gene therapy could help with inherited blindness (retinitis pigmentosa)

NHS.UK: "Procedure to restore sight in dogs gives hope for future blindness cure," The Independent reports. Researchers have restored some modest degree of light sensitivity (though not full vision) in animals who have a similar condition to retinitis pigmentosa.
Retinitis pigmentosa is an umbrella term for a group of human inherited eye conditions, affecting around 1 in 4,000 people, in which the normal light-sensing cells contained in the retina become damaged or die.

Retinitis pigmentosa

Orphanet. Retinitis pigmentosa (RP) is an inherited retinal dystrophy leading to progressive loss of the photoreceptors and retinal pigment epithelium and resulting in blindness usually after several decades.

Frequency of RP is reported to be 1/3,000 to 1/5,000. No ethnic specificities have been reported although founder effects are possible.

Feeling 'young at heart' may increase lifespan

NHS. UK: “Feeling young at heart wards off death, scientists find,” The Daily Telegraph reports. A UK study found that people who reported feeling younger than their actual age were less likely to die than those who reported feeling their actual age or older.

Teen prescription opioid abuse, cigarette, and alcohol use trends down

NIH. US: Use of cigarettes, alcohol, and abuse of prescription pain relievers among teens has declined since 2013 while marijuana use rates were stable, according to the 2014 Monitoring the Future (MTF) survey, released today by the National Institute on Drug Abuse (NIDA). However, use of e-cigarettes, measured in the report for the first time, is high.

Chronic low-back pain research standards announced by NIH task force

NIH. US: The Institute of Medicine (2011) has identified chronic pain as a U.S. societal problem of enormous impact. It affects about 100 million adults and has an estimated annual cost of $635 billion, including for direct medical expenditures and loss of work productivity.

“Centers Without Walls” to study sudden unexpected death in epilepsy

NIH. US: Projects build a virtual center for research on death associated with epilepsySeizures are common, affecting almost 1 in 20 people. Each year, sudden unexpected death in epilepsy (SUDEP) occurs in 1 out of 1000 people with epilepsy, often in people between 20 to 40 years old. SUDEP refers to deaths with no known causes in individuals with epilepsy; there are no strategies for preventing it.

Blood cancers could come from early mutations in life

Cancers arise from multiple acquired mutations, which presumably occur over many years. Early stages in cancer development might be present years before cancers become clinically apparent, according to a new study published in the New England Journal of Medicine.
Data where analysed from 12,380 persons blood cells DNA. Some types of mutations (permanent changes of the genes) were observed in 10% of persons older than 65 years of age but in only 1% of those younger than 50 years of age. Approximately 42% of hematologic cancers in this cohort arose in persons who had that mutations at the time of DNA sampling, more than 6 months before a first diagnosis of cancer. Analysis of bone marrow–biopsy specimens obtained from two patients at the time of diagnosis of acute myeloid leukemia revealed that their cancers arose from the earlier clones. A subset of the genes that are mutated in patients with myeloid (bone marrow) cancers is frequently mutated in apparently healthy persons; these mutations may represent characteristic early events in the development of hematologic cancers.

Drug found to help repair spinal cord injuries

NHS: A new drug could help people with spinal cord injuries, from a study in rats.
This hope is due to the possibility of developing a new drug based on a molecule called intracellular sigma peptide. The drug helped restore varying degrees of nerve functions in rats that had spinal cord injuries.

Nitrate-rich foods

Nitrate-rich vegetables include:

• lettuce
• beets
• carrots
• green beans
• spinach
• parsley
• cabbage
• radishes
• celery
• collard greens

Do time-restricted eating habits reduce obesity?

NHS. UK: “Want to lose weight? Eat all your food in an eight-hour time frame – and never snack at night,” reports the Mail Online.
However, these tips are based on a mouse study – no humans were involved.Nearly 400 mice were studied in a series of experiments for up to 26 weeks. Sets of mice were given unrestricted 24-hour access to high-fat food, high-fat and high-sugar food or low-fat, high-fruit sugar foods. Their weight gain was compared to mice given the same types of food, but restricted to 9, 12, or 15 hours per day.
Mice ate the same number of calories per day irrespective of the number of hours they had access. All mice on high-fat or high-fat and high-sugar diets gained a large amount of weight regardless of access timescales. However, those with time-restricted access gained less weight.
The current stage of this research has limited application for people. We already know that high-fat and high-sugar diets cause weight gain, as was found here. It may be that future randomised controlled trials in humans will show that the amount of weight gain is more if the calories are consumed at times which do not make the most of our natural metabolic rhythm. However, despite the continued quest to “have your cake and eat it”, at present the best advice to combat obesity is to eat a balanced diet and to take regular exercise.

Where did the story come from?

The study was carried out by researchers from the Salk Institute for Biological Studies in La Jolla and the University of California. It was funded by the US National Institutes for Health, grants from the American Federation for Aging Research, Leona M and Harry B Helmsley Charitable Trust, the Glenn Center for Aging, the American Diabetes Association, the Philippe Foundation and the American Association for the Study of Liver Diseases.
The study was published in the peer-reviewed medical journal Cell Metabolism.
BBC News reported the story accurately; however, the Mail Online’s report was misleading. Its headline implies this study was conducted on humans, when it was only on mice. It also says that people should stop “eating after 4pm”. The restricted feeding times used in this study were for mice with nocturnal eating habits. There is no evidence from this study that weight gain would be avoided in people if we stopped eating at 4pm.

What kind of research was this?

This was a piece of animal research that aimed to look at whether restricting the timing of feeding could prevent weight gain or cause weight reduction in obese mice.
Obesity rates are increasing at an alarming rate and traditional methods of weight control – such as calorie restriction, change in diet and increase in exercise – are hard for many people to adhere to.
A person’s metabolic rhythm changes over the course of the day. Previous research has shown that this rhythm is heavily dependent on eating at the same time each day. Therefore, the researchers wanted to see if sticking to the optimal time of eating within this rhythm would prevent weight gain. They called this time-restricted feeding (TRF). As this study was conducted on mice, the optimal nine-hour feeding time was chosen to be during the night.
Research such as this is a good starting point for understanding the biological processes within an animal’s body, and seeing what can influence this, but we don’t know that the results will be directly applicable to people.
As the researchers conclude, a randomised controlled trial in people would be required.

What did the research involve?

The researchers used 392 male wild-type mice aged 12 weeks for a series of experiments lasting up to 26 weeks.
The mice were given free access to food 24 hours a day or TRF for either 9, 12 or 15 hours overnight. Some mice were switched from one type of access to the other.
The mice were given one of the following types of diets:

• high-fat (32%), high-sucrose (25% table sugar) diet
• high-fat (62%) diet
• low-fat (13%) and fructose (60% fruit sugar) diet
• normal chow diet

The weights of the mice on each regime and diet were compared. Further studies looked at the effect of obese mice switching to TRF regimes.

What were the basic results?

Mice fed a high-fat, high-sucrose diet for 12 weeks gained at least a fifth of their body weight. Weight gain doubled if they could eat at any time, despite eating the same number of calories:

• 9 hours of access caused 21% weight gain
• 24-hour access caused 42% weight gain

Mice fed a high-fat diet had higher weight gain with longer periods of food accessibility, despite consuming the same number of calories:

• 9-hour access caused 26% weight gain
• 15-hour access caused 43% weight gain
• 24-hour access caused 65% weight gain

To measure whether a “lapse” in TRF had any effect, mice were fed a high-fat diet for five days using TRF and two days of unrestricted feeding (to mimic the two-day weekend). They gained 29% body weight over 12 weeks, similar to the weight gain without the lapse.
Mice fed a low-fat, high-fructose diet had a 6% weight gain in both feeding situations over 12 weeks, which was similar to control mice fed a normal chow diet.
Mice fed a high-fat diet for 13 weeks using TRF and then given 24-hour access for 12 weeks, rapidly gained weight after switching so that they gained the same amount of weight as mice with unrestricted access for the whole 15 weeks (111% to 112% body weight). A control set who had TRF for the 25 weeks gained 51% body weight.
In mice with pre-existing dietary-induced obesity from having 24-hour access to a high-fat diet, switching to TRF caused them to consume the same number of calories within a few days. However, they lost weight:

• switching from 13 weeks of unrestricted access to 12 weeks TRF caused a drop in weight from 40g to 38g (5% body weight loss)
• switching from 26 weeks of unrestricted access to 12 weeks TRF caused a drop in weight from 53.7g to 47.5g (12% body weight loss)

MRI images showed that the difference in body weight for all of these experiments was due to fat mass rather than lean body mass. There were also inflammatory markers in the fatty tissue of mice with round the clock access compared to no inflammatory markers in TRF mice.

How did the researchers interpret the results?

The researchers concluded that these “results highlight the great potential for TRF (time-restricted feeding) in counteracting human obesity and its associated metabolic disorders”. They believe “it is worth investigating whether the physiological observations found in mice apply to humans” and say that “a large-scale randomised control trial investigating the role of TRF would show whether it is applicable to humans”.

Conclusion

Time-restricted feeding caused less weight gain than all-hour access for mice eating a high-fat, high-sugar diet over 12 to 26 weeks. It also led to weight loss of up to 12% when applied to mice that were already obese. TRF does not appear to have an influence on weight gain for mice eating a healthy or normal diet.
The current stage of this research means it has limited application for humans. We already know that high-fat and high-sugar diets cause weight gain, as was found here. It may be that future randomised controlled trials in humans will show that the amount of weight gain is more if the calories are consumed at times that do not make the most of our natural metabolic rhythm.
Even if the timing of eating patterns do have an effect on weight gain, we suspect that any beneficial effects would be modest. If you regularly consume high-fat and high-sugar foods, and do not exercise, you will put on weight regardless of any time-restricted eating habits. Sadly, there is no quick fix to weight loss.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Nitrate-rich leafy greens 'good for the heart'

NHS. UK: “Leafy vegetables contain chemical nitrate that improves heart health,” the Mail Online reports. In a recent study, researchers looked at the effects of a nitrate-rich diet on rats.
Nitrate is a chemical that can react to a number of different substances in a range of ways. For example, it can be used as a fertiliser or as the active ingredient in a bomb. Some nitrates are used as medication for angina, as they dilate the blood vessels.
This study found that rats given nitrate had lower levels of red blood cells (which carry oxygen) compared to a control group. This was associated with a reduction in the hormone erythropoietin (EPO), which regulates red blood cells.
Excessive amounts of red blood cells (polycythaemia) can sometimes trigger blood clots.
Blood clots can sometimes lead to serious complications, such as a stroke.
This study found that increasing nitrate in your diet stops low oxygen levels causing the over-production of EPO. The increased nitrate optimises the production of EPO from the liver and kidneys, which in turn reduces the blood’s thickness, but without compromising oxygen supply.
While the study involved rats not people, it’s always a good idea to eat up your greens. They contain a number of nutrients thought to help prevent cancer and heart disease.

Where did the story come from?

The study was carried out by researchers from the Universities of Cambridge and Southampton. It was funded by the British Heart Foundation, the Research Councils UK, the WYNG Foundation of Hong Kong, the European Union Framework 7 Inheritance project, the Wellcome Trust and the University of Southampton.
The study was published in the peer-reviewed Journal of the Federation of American Societies for Experimental Biology.
The reporting in the Mail Online and the Daily Express appears to be based on a press release that combined the findings of three related studies on nitrates:

• The study we are analysing today (we chose this, as it is the most recent research).
• A study on the effects that nitrates have on how efficient the heart is in pumping blood around the body.
• A study into whether nitrates could have a protective effect against obesity and type 2 diabetes.

The reports in both the Express and the Mail overstate the results of all the studies, including the one we are discussing today. Neither paper mentioned that these were laboratory studies carried out in rats. Perhaps this is not surprising, given that the accompanying press release – and the authors quoted by it – did not mention it either.

What kind of research was this?

This was a laboratory study, which looked at the effect of nitrate supplementation on the red blood cells of rats.
EPO is responsible for regulating red blood cells in mammals, to meet the need for oxygen. In conditions of severe oxygen shortage, such as during critical illness and at high altitude, EPO increases, stimulating the production of more oxygen-carrying red blood cells.
While red blood cells are needed to supply enough oxygen, they can also lead to an increase in the blood’s “viscosity” or thickness, which may impair blood flow, as happens in chronic obstructive pulmonary disease, preventing it from flowing through small blood vessels in the lungs.
There is also the risk of a blood clot developing, which can lead to serious complications, such as a heart attack, stroke or pulmonary embolism.
A balance therefore needs to be met to get the optimum number of red blood cells and oxygen around the body.
Nitrate has already been shown to have beneficial effects on the heart and circulation. Here, the researchers wanted to test the theory that dietary nitrate might limit rises in the red blood cells needed for oxygen delivery by improving the efficiency of the body’s use of oxygen.

What did the research involve?

Two rat studies were performed to assess the effect of dietary supplementation with nitrates.
The first involved 40 rats. Half of them had nitrate added to their drinking water, while the other half acted as a control group with no supplementation. After four days, both groups were put in a chamber of low oxygen (12% rather than normal air, which is 21%). They continued to have either nitrate supplement or no supplement for 14 days.
The researchers compared their food and water intake, any change in body weight and plasma nitrate and haemoglobin (oxygen carrying component of red blood cells) levels in normal air and in low oxygen.
The second study aimed to see how fast and at what concentration the nitrate made changes to the haemoglobin levels. 24 rats were kept in normal oxygen conditions. After 12 days, half the group had their water supplemented with 0.7mm of nitrate. They measured the haemoglobin level in the blood after 0, 2, 4, 6, 9 and 12 days.

What were the basic results?

The researchers report that in both experiments rats given nitrate had lower concentrations of red blood cells in normal and low oxygen conditions compared with control groups.
They found that these rats also had lower levels of EPO. They say this suggests that the effects of nitrate were mediated via changes in EPO production.
The researchers found that nitrates reduced the amount of EPO released by the liver, but increased the amount released by the kidneys. They report that this balance meant that the nitrates were able to help the body produce the optimum minimum amount of haemoglobin that they required.
Nitrate supplementation did not alter the amount of food or water intake of the rats, or on their weight or growth.

How did the researchers interpret the results?

They conclude that nitrate acts to suppress the production of EPO by the liver, thereby lowering circulating red blood cells. Nitrate prevented an expected rise in circulating red blood cells in rats deprived of oxygen and also decreased red blood cells in rats with a normal oxygen supply.
They point out that nitrate levels used are readily achievable in humans via the diet, through eating green leafy vegetables.
In an accompanying press release, co-author Professor Martin Feelisch, from the University of Southampton, said: "These findings suggest simple dietary changes may offer treatments for people suffering from heart and blood vessel diseases that cause too many red blood cells to be produced. It is also exciting as it may have broader implications in sport science, and could aid recovery of patients in intensive care by helping us understand how oxygen can be delivered to our cells more efficiently."

Conclusion

It’s always a good idea to eat up your greens. This research suggests that one possible benefit is through the mechanism of nitrate “thinning” the blood and protecting against heart disease.  While the research is interesting, it’s a pity that no one thought to mention that this was a laboratory study on rats. It is important to remember that high levels of nitrates can be toxic, which is why there are safety limits for the level of nitrates in drinking water. High nitrate levels are especially harmful for infants.
A healthy diet – including plenty of vegetables – and regular exercise are important for a healthy heart and weight.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Robots can assist people with disabilities

NIH: Robots interact with patients to help in rehabilitation and movement. New research in robotics might help with stroke rehabilitation, guide wheelchairs, and assist children with Autism Spectrum Disorder.
This is the third year NIH has participated in the Interagency National Robotics Initiative (NRI) to support research to develop innovative co-robots — robots that work cooperatively with people. Other participants are the National Science Foundation, the National Aeronautics and Space Administration, and the U.S. Department of Agriculture. Funding for these projects totals approximately $2.3 million over the next five years, subject to the availability of funds.
“Technology is becoming more and more adaptable in all areas of our life, from GPS in cars to speech recognition technology on smart phones,” said Grace Peng, Ph.D., program director of Rehabilitation Engineering at the National Institute of Biomedical Imaging and Bioengineering (NIBIB). “With these awards, we hope to encourage robotics researchers to think of new ways to apply their technology in the realm of health care.”

• Wearable exoskeletons to induce recovery of function
  
  Recovering limb movement after a stroke can be difficult and frustrating for patients. Research suggests that repeatedly using the affected arm in goal-directed, purposeful movements after a stroke can help promote recovery. This kind of movement is most successful when supervised by therapists. This project hopes to extend therapy into the home by providing patients with a lightweight robotic exoskeleton that can be placed on an affected arm and provide the kind of therapeutic guidance found at a rehabilitation center.
  
  Richard Brent Gillespie, Ph.D., University of Michigan, Ann Arbor
  
  Funded by NIBIB, EB019834
• A computer vision-based active learning co-robot wheelchair
  
  This project hopes to provide a solution for elderly and disabled patients who have limited hand functionality and who rely on wheelchairs for mobility. Researchers hope to create a system and chair that can be controlled by the user’s head movements and will adapt to the individual user. A camera placed on glasses worn by the user can capture head movements designed to control the chair as well as adapt to individual users by gaining information as  the patient responds to various situations in natural ways (such as turning their head as their attention shifts). The hope is that the robotic wheelchair will be able to operate almost completely autonomously and only ask for human control on an as-needed basis — learning from the human controls so as to reduce the necessity for human participation in the future.
  
  Gang Hua, Ph.D., Stevens Institute of Technology, Hoboken, New Jersey
  
  Funded by the National Institute of Nursing Research, NR015371
• Music-based interactive robotic orchestration for children with Autism Spectrum Disorder
  
  Many new technologies for children with autism spectrum disorder (ASD) have been developed and demonstrated the possibilities of robotic applications in therapy, but most rely on speech interaction and task-based scenarios. To more effectively stimulate the various emotional and social interactivities of children with ASD, researchers need to take further steps to incorporate multiple types of stimuli. Recent studies have shown improvements in social skills among children with autism who were encouraged to improvise with musical instruments or song. This project aims to develop a music-based system that will help children with ASD interact with a robotic companion in a safe and natural manner. The results of this study have the potential to help develop innovative interventions for ASD.
  
  Chung Hyuk Park, Ph.D., New York Institute of Technology, New York City
  
  Funded by the Eunice Kennedy Shiver National Institute of Child Health and Development, HD082914

The funding opportunity announcement (FOA) for NRI funding in 2015 was announced in Oct. 16, 2014 and NIH is specifically promoting assistive robotic technology. NIH will accept applications for exoskeletons or surgical robotics directly through NIH FOAs, and not through the NRI, http://grants.nih.gov/grants/guide/notice-files/NOT-EB-14-008.html.
About the National Institute of Biomedical Imaging and Bioengineering: NIBIB’s mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants, collaborations, and training. More information is available at the NIBIB website: http://www.nibib.nih.gov.
NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the website at http://www.ninr.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Researchers conduct comprehensive genomic study of sub-Saharan Africans

NIH: New data resource will enhance disease research and genomic diversity studiesAn international team that includes researchers from the National Institutes of Health has completed the first comprehensive characterization of genomic diversity across sub-Saharan Africa. The region is the most genetically diverse in the world, yet few studies have looked into genomic risk factors for disease in Africa.
The study provides clues to medical conditions in people of sub-Saharan African ancestry, and indicates that the migration from Africa in the early days of the human race was followed by a migration back into the continent.
The study, published in the Dec. 3, 2014, online issue of Nature, is the first to use both dense genotyping and whole-genome sequence data to explore the genomic-variation landscape of several African ethno-linguistic groups.
A genotype is a subset of a whole-genome sequence, which is the complete read-out of an individual’s DNA. Dense genotyping packs millions of test points onto a microarray — a laboratory test chip — that can detect genomic signatures in an individual’s DNA. Researchers assemble data from genotyping or from whole-genome sequencing to identify the particular pattern of DNA differences that makes each individual unique.
“The rich genomic diversity in sub-Saharan African populations can offer new insights about disease susceptibility that could easily be overlooked using less-tailored analyses,” said Dan Kastner, M.D., Ph.D, scientific director of the NIH’s National Human Genome Research Institute. “This is an important study that demonstrates how a one-size-fits-all approach is not always best when it comes to population genomics.”
The research team identified novel evidence of how diverse local environmental forces, such as climate and exposure to infectious agents, have shaped the genomes of Africans and their susceptibility to many conditions, including malaria, Lassa fever and trypanosomiasis. The genetic variant frequency in populations from endemic and non-endemic regions suggests that this effect may be in response to the different environments these populations have been exposed to over time.
The researchers have begun contributing genomic data from African populations to international databases, and have proposed African-specific population studies that will take advantage of the rich genomic diversity among sub-Saharan African populations. Despite being among the most genomically diverse people in the world, Africans are underrepresented in genetics and genomics research.
“To date, African populations and their scientists have not participated fully in the ongoing global effort to use genomics to understand human history and health,” said senior co-author Charles Rotimi, Ph.D., director of the NIH Center for Research on Genomics and Global Health (CRGGH). “Researchers have carried out only a modest number of genome-wide association studies, or GWAS, using continental African populations, while thousands have been conducted that include populations with mainly European ancestry.”
The GWAS approach involves rapidly scanning markers across the complete sets of DNA, or genomes, of many people to find genetic variations associated with a particular disease. Once new genetic associations are identified, researchers can use the information to develop better strategies to detect, treat and prevent the disease. Such studies are particularly useful in finding genetic variations that contribute to common, complex diseases, such as asthma, cancer, diabetes, heart disease and mental illnesses.
Along with clues about disease susceptibility among sub-Saharan Africans, the researchers also documented patterns of Eurasian-African population mixture and differentiation, echoing thousands of years of human population history. As humans migrated out of Africa, they carried in their genomes a subset of African ancestral genomic variation. The structure of subsequent non-African populations reflected less genomic variation, so that today, populations outside of Africa tend to be less genomically diverse. The presence of Eurasian genomic mixture in present-day African populations provides evidence of reverse migration back to Africa from Europe and other parts of the world, the researchers say.
Dr. Rotimi explained that the few studies that have been conducted among African-ancestry populations have used less efficient genotyping platforms that were designed, for the most part, with European-ancestry populations in mind.
In their study, the researchers obtained generated data from 1,481 individuals from 18 ethno-linguistic groups across seven African countries using a genotyping array that tested 2.5 million sites in the genome. In addition, they included whole-genome sequence data from 320 individuals representing seven ethno-linguistic groups from South Africa, Uganda and Ethiopia. From the whole-sequence data, the researchers detected 30 million genomic variants, 24 percent of which were not present in other populations. The detection of previously undetected African genomic variants underscores the importance of sequencing more genomes from Africans.
The team then added their research information to the available data from the 1000 Genomes Project for subsequent analyses. The 1000 Genomes Project is an international public-private consortium producing an extensive catalog of human genomic variation as a resource for medical research.
“By sequencing the genomes from additional individuals from Africa who were not originally participants in the 1000 Genomes Project, we were able to improve the accuracy of estimating genomic variants missing in the genotyping array,” said Fasil Tekola-Ayele, Ph.D., co-lead author and a CRGGH research fellow. “Just two African populations had been represented in the first phase of the 1000 Genomes Project, but we have added genotype information from 18 African population groups and whole-genome sequence from seven groups, each from a specific ethno-linguistic group.”
The authors have proposed the development of an African-specific microarray of just 1 million genomic variants, compared to twice that number built into the array platform used in the current study. The array would include novel genomic variants from their study and also reflect the wide genomic diversity in the continent that is not found in Africans alone.
“We can have a very good, inexpensive array that can be used for future genome-wide association studies,” Dr. Tekola-Ayele said. “Having this array would aid African researchers with ongoing genomic studies.”
The current study is part of the researchers’ work on the African Genome Variation Project (AGVP), a collaboration begun in 2011 to map the genomic variation landscape of African populations and to enable design of large-scale GWAS in the region. “The African Genome Variation Project is facilitating the development of local resources for epidemiology and genomic research and is strengthening research capacity, training, and collaboration across the African continent,“ Dr. Rotimi said.
According to Manjinder Sandhu, Ph.D., co-senior author from the Wellcome Trust Sanger Institute in England and the Department of Medicine at the University of Cambridge, “To better understand the genetic landscape of Africa we need to study modern genetic sequences from previously under-studied African populations, along with ancient DNA from archaeological sources.”
All data assembled by the African Genome Variation Project will be available to all investigators around the world and will be deposited in the European Genome Archive and the H3Africa Bionet.
NHGRI is one of the 27 institutes and centers at the NIH, an agency of the Department of Health and Human Services. The NHGRI Division of Intramural Research develops and implements technology to understand, diagnose and treat genomic and genetic diseases. Additional information about NHGRI can be found at its website, http://www.genome.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH researchers link chromosome region to gigantism

NIH: Duplication of gene on X chromosome appears to cause excessive growth

Researchers at the National Institutes of Health have found a duplication of a short stretch of the X chromosome in some people with a rare disorder that causes excessive childhood growth. They believe that a single gene within the region likely has a large influence on how much children grow. The research comes from a lab at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which seeks to understand growth.
“Finding the gene responsible for childhood overgrowth would be very helpful, but the much wider question is what regulates growth,” said Constantine Stratakis, M.D., D.Sc., lead author of the new paper and the scientific director of the Division of Intramural Research at NICHD.
In theory, the causes of overgrowth and undergrowth in children should be regulated by the same mechanisms, Dr. Stratakis explained. “As pediatricians and endocrinologists, we look at growth as one of the hallmarks of childhood. Understanding how children grow is extraordinarily important, as an indicator of their general health and their future well-being.”
The study, appearing in the New England Journal of Medicine, was part of the intramural research program at the NICHD. Support also came from NIH ’s National Institute of Neurological Disorders and Stroke and the National Human Genome Research Institute.
The research started with a family who came to the NIH Clinical Center for treatment in the mid-1990s. A mother who had been treated for gigantism had two sons who were also growing rapidly. People with this condition are abnormally tall and may have delayed puberty, large hands and feet, and double vision. A second family, with an affected daughter, came to NIH from Australia. The girl had the same duplication the researchers saw in the first family. Dr. Stratakis then contacted Albert Beckers, M.D., Ph.D., at the University of Liege, Belgium. For more than 30 years, Dr. Beckers has been following people with gigantism and acromegaly, a disorder in which excessive growth begins after adulthood. Dr. Beckers agreed to test these patients and identified the same duplication in a group of his patients as well.
Gigantism results from a defect in the pituitary, a pea-sized gland at the base of the brain that makes growth hormones and controls the activity of other glands in the body. Some people with gigantism have a tumor in the pituitary that secretes extra hormone; others just have an oversized pituitary. Gigantism is often treated by removing the tumor, or even the entire pituitary, but can sometimes be treated with medication alone.
“Giants are very rare. If you have three cases in the same family, that is veryrare,” Dr. Stratakis said. He explained that most of the pituitary gland of the mother in the first family was removed when she was 3 years old, and in adulthood she was only a little above average height. Both of her sons had gigantism, too, and had pituitary surgery.
In their study, the researchers used whole-genome analysis to find major changes in the DNA. Every person in the study who had gigantism as an infant or a toddler had the same defect, a duplication of a stretch of the X chromosome. Family members without gigantism did not have the duplication.
In all, the researchers studied 43 people with gigantism, most from the international cohort studied by Dr. Beckers.
Next the researchers sought to identify which gene might be responsible for the excessive growth. The length of the DNA duplication varied among the patients. But the researchers found the same four genes that were duplicated in all of the patients. After testing the genes, the researchers isolated the most likely suspect: a gene called GPR101. Its activity was up to 1,000 times stronger in the pituitaries of children with the duplication than in the pituitaries of typically developing children.
“We believe GPR101 is a major regulator of growth,” Dr. Stratakis said.
The researchers also looked at samples from the pituitary tumors of 248 people with acromegaly, a condition in which adults produce excess growth hormone. None of the patients had the duplication that was seen in people with gigantism. However, 11 of the acromegaly patients did have a mutation in GPR101, suggesting that the gene also may play a role in that condition as well.
Figuring out exactly how the protein derived from GPR101works is the next frontier, Dr. Stratakis said. The team is now working on that question in the lab.
The researchers hope their discovery will lead to new treatments for gigantism in children. It may also provide insights into undergrowth. Undergrowth is currently treated by giving children growth hormone.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Medications for patients with first episode psychosis may not meet guidelines

National Institute of Health. Researchers call for more prescriber educatio

Many patients with first-episode psychosis receive medications that do not comply with recommended guidelines for first-episode treatment , researchers have found. Current guidelines emphasize low doses of antipsychotic drugs and strategies for minimizing the side effects that might contribute to patients stopping their medication. A study finds that almost 40 percent of people with first-episode psychosis in community mental health clinics across the country might benefit from medication treatment changes.
Psychosis is a mental disorder in which thoughts and emotions are impaired and contact with reality is diminished. People experiencing a first episode of psychosis have different treatment requirements than those with multi-episode psychosis.  A recent analysis of prescribing patterns for first-episode psychosis suggests that more effort is needed to promote awareness of first episode-specific medication practices at community facilities. The research was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, and funds from the Recovery Act.
Dr. John Kane of Hofstra North Shore-Long Island Jewish School of Medicine and The Zucker Hillside Hospital, Glen Oaks, New York, led the RAISE Early Treatment Program team studying 404 individuals between the ages of 15 and 40 with first-episode psychosis who presented for treatment at 34 community-based clinics across 21 states.  The study participants had been treated with antipsychotic drugs for six months or less.
Delbert Robinson, M.D. , of the Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, and colleagues report their findings on Dec. 4, 2014 in the American Journal of Psychiatry.
The authors identified 159 people (39.4 percent of those enrolled in the study) who might benefit from changes in their medication. Of the 159 patients identified by researchers, 8.8 percent were prescribed higher-than-recommended doses of antipsychotics; 23.3 percent were prescribed more than one antipsychotic; 36.5 percent were prescribed an antipsychotic and an antidepressant without a clear need for the antidepressant; 10.1 percent were prescribed psychotropic medications without an antipsychotic medication; and 1.2 percent were prescribed stimulants. In addition, 32.1 percent were prescribed olanzapine, a medication not recommended for first-episode patients. Some of the 159 fell into multiple categories.
Better medication treatment early in the illness, particularly strategies that minimize uncomfortable side effects, may lead to better results for patients. To improve prescription practices, the authors recommend additional education for those prescribing medication for patients with first-episode psychosis.
The study is among the first of several to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by NIMH to examine first-episode psychosis before and after specialized treatment was offered in community settings in the United States.  RAISE seeks to change the path and prognosis of schizophrenia through coordinated and intensive treatment in the earliest stages of illness. The findings from these studies identify opportunities for improving the lives of people experiencing first-episode psychosis by highlighting ways existing treatments can be enhanced. For example, the studies make recommendations for improving coordination of mental health care and primary care, and for ensuring that medications follow established guidelines.
“Our data were for prescriptions individuals received before they started the RAISE-Early Treatment Program study.  Community mental health clinicians usually have extensive experience treating individuals with multi-episode psychosis,” said Robinson.  “The challenge for the field is to develop ways to transmit the specialized knowledge about first episode treatment to busy community clinicians. “ 
NIMH is working with the Substance Abuse and Mental Health Services Administration (SAMHSA) to use the RAISE results to improve treatment for people with early onset of serious mental illness – including psychosis. This effort includes all US states and territories via SAMHSA’s Community Mental Health Services Block Grant.
About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit http://www.nimh.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Barrier-breaking drug may lead to spinal cord injury treatments

NIH. Scientists take first step towards developing promising new drug
Injections of a new drug may partially relieve paralyzing spinal cord injuries, based on indications from a study in rats, which was partly funded by the National Institutes of Health.

Sophisticated HIV diagnostics adapted for remote areas

Diagnosing HIV and other infectious diseases presents unique challenges in remote locations that lack electric power, refrigeration, and appropriately trained health care staff. To address these issues, researchers funded by the National Institutes of Health have developed a low-cost, electricity-free device capable of detecting the DNA of infectious pathogens, including HIV-1. The device uses a small scale chemical reaction, rather than electric power, to provide the heat needed to amplify and detect the DNA or RNA of pathogens present in blood samples obtained from potentially infected individuals.
“This highly creative technical solution brings sophisticated molecular diagnostics to underserved populations and represents a potentially groundbreaking advance in global health care for HIV as well as tuberculosis and malaria, which remain significant health challenges in many remote areas,” said Roderic Pettigrew, Ph.D., M.D., director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at NIH.
The work was performed by a team at the Seattle-based international non-profit PATH, led by Paul LaBarre, senior technical officer, and is reported in the Nov. 26 issue of PLOS ONE. The core technology they developed and continue to improve is a system known as NINA, for non-instrumental nucleic acid amplification. The goal is to expand access to accurate diagnostics wherever they are needed, especially those areas that lack reliable electricity.

Early on-site diagnosis allows immediate treatmen

LaBarre explains the problem their research endeavors to address. “In low-resource settings, the lack of on-site molecular diagnostic testing is a barrier to the control of infectious diseases. The need to transport the samples from local sites to a distant central diagnostic facility results in delays, lost results, and increased costs.” One of the biggest problems, he says, is loss to follow-up, where individuals who have provided samples may fail to return to the local clinic, and therefore will not receive treatment if their test result indicates they are infected. Given these significant impediments to effective disease control, the goal of the NINA technology is to enable on-site point of care (POC) testing and subsequent treatment regardless of the available infrastructure.
A critical feature of the nucleic acid test is the ability to detect infection at very early stages. The currently available test sold over the counter is antibody-based, and cannot detect HIV until antibodies to the pathogen are produced by the body, which can take as long as several months after infection. The PATH method can detect HIV in the early stage of the disease, when the patient can be most infectious. Early detection is essential for POC medicine, where the goal is to diagnose infection and begin treatment in a single visit to the local clinic. For testing babies born to HIV-positive mothers, a nucleic acid-based test must be used because the mother’s antibodies in the baby’s blood can result in false positives.

Addressing the challenge one idea at a time

The amplification process involves extracting nucleic acids from an individual’s blood sample, mixing it with a nucleic acid segment from the pathogen of interest, and using constant temperature heat in a process that makes many copies of (amplifies) pathogen nucleic acids present in the blood sample. The results of the test are highly accurate and easily visualized with a simple dipstick that reveals a colored band indicating the presence of the pathogen nucleic acids.
LaBarre and his team are developing the NINA system using an inexpensive insulated thermos where the source of heat is the chemical reaction. The newest version of the incubator produces heat using magnesium iron alloy (MgFe). MgFe was chosen because it costs just $0.06 per reaction and can be supplied in a self-contained packet. To start the heat-producing reaction, a technician simply adds saline solution to the packet at the bottom of the thermos.
In this study, the researchers engineered each component of the incubator for maximum performance, ensuring that the amplification reaction that takes place in tiny test tubes maintains a constant temperature. To achieve this, the group identified a special compound that can store and regulate the heat created by the chemical reaction and can also be easily configured to the tube-holder design, guaranteeing uniform heating on each tube’s surface. When designing the main body of the device, the research team used a thermal imaging camera to assess the performance of inexpensive materials, and eventually chose a reusable thermos and cover that minimize system heat loss.

Another critical factor is the setting in which the incubator must operate. Although a sophisticated diagnostic laboratory would have equipment operating at room temperature in a controlled environment, the device must operate in extreme ambient temperatures. The reaction inside the incubator must maintain a temperature of 140 degrees Fahrenheit for one hour. Therefore, the research team checked the ability of the NINA incubator to function properly over a range of ambient temperatures. The device maintained the required 140 degrees when tested in environments ranging from 50 to 90 degrees.
The group demonstrated that their amplification system provides sensitive and repeatable detection of HIV-1 in just 80 minutes. They are now working to pair their amplification system with a simple technique for preparing nucleic acids from blood samples in the field. LaBarre explains: “To complete this low-resource setting diagnostic, one remaining need is the integration of a simple method for isolating nucleic acids from patient blood samples before amplification. Current methods are expensive and technically difficult. Fortunately, there are several methods we are testing that look promising.”

Identifying high-performance, yet inexpensive materials

Because the NINA system can quickly determine whether an individual has an infectious disease, it is a critical technology that will enable POC health services, which combine testing and treatment in a single visit. This is an essential step toward the control and eventual eradication of infectious diseases across regions of small, isolated villages.
This work was supported by NIH through the National Institute of Biomedical Imaging and Bioengineering under award number R01EB012641 and the National Institute of Allergy and Infectious Diseases under award number R01AI097038.
NIBIB’s mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants, collaborations, and training. More information is available at the NIBIB website: http://www.nibib.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Nearly 55 percent of U.S. infants sleep with potentially unsafe bedding

Source: NIH
Nearly 55 percent of U.S. infants are placed to sleep with bedding that increases the risk of sudden infant death syndrome, or SIDS, despite recommendations against the practice, report researchers at the National Institutes of Health, the Centers for Disease Control and Prevention, and other institutions.
Soft objects and loose bedding — such as thick blankets, quilts, and pillows — can obstruct an infant’s airway and pose a suffocation risk, according to the NIH’s Safe to Sleep campaign. Soft bedding has also been shown to increase the risk of SIDS Infants should be placed to sleep alone, on their backs, on a firm sleep surface, such as in a mattress in a safety-approved crib , covered by a fitted sheet. Soft objects, toys, crib bumpers, quilts, comforters and loose bedding should be kept out of the baby’s sleep area.
Based on responses from nearly 20,000 caregivers, the researchers reported that, although such potentially unsafe bedding use declined from 85.9 percent in 1993-1995, it still remained high, at 54.7 percent, in 2008-2010.
“Parents have good intentions but may not understand that blankets, quilts and pillows increase a baby’s risk of SIDS and accidental suffocation,” said the study’s first author, Carrie K. Shapiro-Mendoza, Ph.D., M.P.H., senior scientist in the CDC’s Division of Reproductive Health in Atlanta.
The current study is an analysis of data from the National Infant Sleep Position Study (NISP), which collected information on the influence of infant sleep position and other safe sleep recommendations on infant care practices. Funded by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the survey collected information by telephone from a random sample of more than 1,000 caregivers in U.S. households from 1992-2010.
“Parents receive a lot of mixed messages,” said study author Marian Willinger, Ph.D., special assistant for SIDS at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. “Relatives may give them quilts or fluffy blankets as presents for the new baby, and they feel obligated to use them. Or they see magazine photos of babies with potentially unsafe bedding items. But babies should be placed for sleep on a firm, safety approved mattress and fitted sheet, without any other bedding.”
Drs. Shapiro-Mendoza and Willinger conducted the analysis with colleagues at CDC, the Yale School of Medicine in New Haven, Connecticut, the Boston University School of Public Health and the Boston University School of Medicine. The study was published online in Pediatrics.
SIDS is the unexplained death of a child within the first year of life. In 1992, the AAP issued its recommendation that infants be put to sleep on their backs. Two years later, the NICHD and its partners launched the Back to Sleep campaign, later renamed Safe to Sleep. The rate of SIDS in the United States has fallen 50 percent since 1992. However, since 2000, the SIDS rate has declined slowly, and researchers have reported an increase in other unexpected infant deaths, resulting from such causes as accidental suffocation, entrapment in bedding material or other causes. These accidental suffocation deaths have increased from 7.0 per every 100,000 live births in 2000 to 15.9 in 2010.
As part of the survey, caregivers were asked whether infants were placed to sleep on such items as blankets, bean bag chairs, rugs, sheepskin, cushions, or pillows. Caregivers were also asked about whether the infant was covered with such bedding materials as a blanket, quilt or comforter, sheepskin, or a pillow. The Safe to Sleep campaign advises against blankets or other coverings, and recommends sleep clothing, such as a one-piece sleeper, and keeping the room at a comfortable temperature.
“Bedding use for infant sleep remains common despite recommendations against this practice,” the study authors wrote.
By 2007-2010, most respondents reported following these Safe to Sleep recommendations: placing the infant to sleep in a crib or bassinet, placing the infant on his or her back, and not sharing a sleep surface with the infant. However, use of bedding was consistently 50 percent or higher for each of these years.
From 1993-1995 to 2008-2010, covering with thick blankets declined from 56 percent to 27.4 percent and covering with quilts or comforters declined from 39.2 percent to 7.9 percent. However, the authors did not see significant declines such bedding materials placed under infants, with 25.5 percent-31.9 percent reporting placing blankets under infants and 3.1 percent-4.6 percent placing cushions under infants.
“Interestingly, we also observed a greater decline in bedding use over the infants (quilts/comforters and thick blankets) compared with bedding (blankets) under infants,” the study authors wrote. “This finding raises a concern that parents may incorrectly perceive the recommendations as only pertaining to items covering or around the infant, and not include items under the infant.”
The researchers speculate that among the reasons mothers used bedding were to provide warmth and comfort or to prevent falls from an adult bed or sofa by using pillows as a barricade. They noted that a study of images from popular magazines targeting women of childbearing age found that more than two thirds of these images showed infants sleeping with potentially hazardous bedding such as blankets and pillows.
“Seeing images such as these may reinforce beliefs and perceptions that having these items in the infant sleep area is not only a favorable practice, but also the norm,” the researchers wrote.
The authors also found that caregivers of Hispanic and African-American infants were more likely to use potentially hazardous bedding compared to caregivers of white infants. In addition, younger mothers were more likely to use this bedding than were older mothers, as were non-college educated mothers compared to college-educated mothers.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.