Scientists at Queen
Using an endoscope to guide the removal of leg veins used in heart surgery is as safe as using large, ankle-to-groin incisions, according to a study by Duke University Medical Center researchers.
The data shows the two procedures have similar mortality rates after three years. The endoscopic method has lower rates of infection and wound complications. Today
Scientists at Washington University School of Medicine in St. Louis have found new clues to why some urinary tract infections recur persistently after multiple rounds of treatment.
Their research, conducted in mice, suggests that the bacteria that cause urinary tract infections take advantage of a cellular waste disposal system that normally helps fight invaders. In a counterintuitive finding, they learned that when the disposal system was disabled, the mice cleared urinary tract infections much more quickly and thoroughly.
‘This could be the beginning of a paradigm shift in how we think about the relationship between this waste disposal system, known as autophagy, and disease-causing organisms,’ says senior author Indira Mysorekar, PhD, assistant professor of obstetrics and gynaecology and of pathology and immunology. ‘There may be other persistent pathogens that have found ways to exploit autophagy, and that information will be very useful for identifying new treatments.’
Urinary tract infections are very common, particularly in women. In the United States alone, annual treatment costs are estimated to run as high as $1.6 billion. Scientists believe 80 percent to 90 percent of these infections are caused by the bacterium Escherichia coli (E. coli).
Data from the new study and earlier results have led Mysorekar and her colleagues to speculate that E. coli that cause recurrent urinary tract infections may hide in garbage-bin-like compartments within the cells that line the urinary tract.
These compartments, found in nearly all cells, are called autophagosomes. They sweep up debris within the cell, including harmful bacteria and worn-out cell parts. Then, they merge with other compartments in the cell that are filled with enzymes that break down the contents of autophagosomes.
‘We think, but can
When given early treatment, children with autism spectrum disorders (ASD) made significant improvements in behaviour, communication, and most strikingly, brain function, Yale School of Medicine researchers report in a new study.
The study was published by Yale Child Study Center researchers Dr. Fred Volkmar, Kevin A. Pelphrey, and their colleagues.
The results suggest that brain systems supporting social perception respond well to an early intervention behavioural program called pivotal response treatment. This treatment includes parent training, and employs play in its methods.
ASDs are complex neurobiological disorders that inhibit a person
Researchers have created a new type of miniature pump activated by body heat that could be used in drug-delivery patches powered by fermentation.
The micropump contains Baker’s yeast and sugar in a small chamber. When water is added and the patch is placed on the skin, the body heat and the added water causes the yeast and sugar to ferment, generating a small amount of carbon dioxide gas. The gas pushes against a membrane and has been shown to continually pump for several hours, said Babak Ziaie, a Purdue University professor of electrical and computer engineering and biomedical engineering.
Such miniature pumps could make possible drug-delivery patches that use arrays of ‘microneedles’ to deliver a wider range of medications than now possible with conventional patches. Unlike many other micropumps under development or in commercial use, the new technology requires no batteries, said Ziaie, who is working with doctoral student Manuel Ochoa.
‘This just needs yeast, sugar, water and your own body heat,’ Ziaie said.
The robustness of yeast allows for long shelf life, and the design is ideal for mass production, Ochoa said.
‘It would be easy to fabricate because it’s just a few layers of polymers sandwiched together and bonded,’ he said.
The paper was written by Ochoa and Ziaie, and the research is based at Purdue’s Birck Nanotechnology Center in the university’s Discovery Park.
The ‘the microorganism-powered thermopneumatic pump’ is made out of layers of a rubberlike polymer, called polydimethylsiloxane, which is used commercially for diaphragms in pumps. The prototype is 1.5 centimeters long.
Current ‘transdermal’ patches are limited to delivering drugs that, like nicotine, are made of small hydrophobic molecules that can be absorbed through the skin, Ziaie said.
‘Many drugs, including those for treating cancer and autoimmune disorders cannot be delivered with patches because they are large molecules that won’t go through the skin,’ he said. ‘Although transdermal drug delivery via microneedle arrays has long been identified as a viable and promising method for delivering large hydrophilic molecules across the skin, a suitable pump has been hard to develop.’
Patches that used arrays of tiny microneedles could deliver a multitude of drugs, and the needles do not cause pain because they barely penetrate the skin, Ziaie said. The patches require a pump to push the drugs through the narrow needles, which have a diameter of about 20 microns, or roughly one-fourth as wide as a human hair.
Most pumps proposed for drug-delivery applications rely on an on-board power source, which is bulky, costly and requires complex power-management circuits to conserve battery life.
‘Our approach is much more simple,’ Ziaie said. ‘It could be a disposable transdermal pump. You just inject water into the patch and place it on your skin. After it’s used up, you would throw it away.’
Purdue University
Cardiologists at Washington University School of Medicine in St. Louis have developed a non-invasive imaging technique that may help determine whether children who have had heart transplants are showing early signs of rejection. The technique could reduce the need for these patients to undergo invasive imaging tests every one to two years.
The invasive imaging test, a coronary angiogram, involves inserting a catheter into a blood vessel and injecting a dye to look for dangerous plaque on the walls of arteries feeding blood to the heart. This plaque build-up indicates coronary artery disease and is a sign that the body may be rejecting the new heart. Since pediatric heart transplant patients are at high risk of developing coronary artery disease, doctors monitor their arteries on a regular basis. But recurring angiograms become problematic.
‘Many of these children have undergone so many operations, we have lost access to their big blood vessels,’ says Charles E. Canter, MD, professor of pediatrics. ‘Sometimes it
A new study by Weill Cornell Medical College researchers provides compelling evidence that electronic health records (EHRs) enhance the quality of patient care in a community-based setting with multiple players, which is representative of how medicine is generally practiced across the United States.
The use of EHRs is on the rise, in part because the federal government has invested up to $29 billion in incentives promoting the meaningful use of these systems, with the aim of tracking and improving patient outcomes. Previous studies have provided conflicting evidence about the impact of EHRs, and until now it had been not clear whether they improved the quality of patient care, particularly in typical communities that use commercially available systems.
‘The previous studies on the effects of electronic health records in the outpatient setting have been mixed,’ says the study’s lead investigator, Dr. Lisa M. Kern, associate professor of public health and medicine at Weill Cornell Medical College. ‘This is one of the first studies to find a positive association between the use of EHRs and quality of care in a typical community-based setting, using an off-the-shelf electronic health record that has not been extensively tailored and refined. This increases the generalisability of these findings.’
‘This study starts to grow the evidence that the use of these systems can systematically improve the quality of care, although their maximum value likely lies in their ability to support new health care delivery models,’ says the study’s senior investigator Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell Medical College. ‘The findings of this study lend support to the very significant investments in health information technology that are being made by the federal government, states, and health care providers.’
This study was conducted with the Health Information Technology Evaluation Collaborative (HITEC)
UCSF researchers found that poor HIV-infected individuals living in San Francisco are significantly more likely to visit emergency rooms and to have hospital stays if they lack access to food of sufficient quality and quantity for a healthy life.
‘In the prior three months, a quarter of participants in the study reported an ER visit, and just over a tenth reported a hospitalisation, which shows that we are dealing with a population with high levels of illness. But the food insecure people were even sicker than the food secure, which is consistent with their experiencing higher rates of chronic diseases,’ said the study’s primary investigator, Sheri Weiser, MD, assistant professor of medicine in the UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center.
The study recruited 347 HIV-infected urban poor participants living in substandard housing in San Francisco. To determine levels of food insecurity, the participants were questioned about their anxiety and uncertainty about their food supply, whether they were able to access sufficient quality and variety of food, and their experience of insufficient food intake and the physical consequences. Just over half of the group, 56 percent, was classified as food insecure. The entire cohort of food secure and food insecure individuals was followed for two years, looking at healthcare utilisation as a primary outcome.
‘Compared to food secure participants, the odds were approximately two times higher that a food insecure participant was hospitalised or that a food insecure participant had visited the ER over the study’s time period,’ said Weiser. ‘For a long time we have known that adequate nutrition is crucial for HIV-positive patients to live long healthy lives. Our findings that food insecure individuals are also more likely to use costly services from hospitals and emergency rooms build on our previous work showing that food insecure individuals experience poorer HIV treatment outcomes.’
Food insecurity among HIV-infected homeless and marginally housed individuals in the City is higher than the rate of food insecurity seen nationally in non HIV-infected homeless persons, with about a quarter to a third experiencing food insecurity. For the general population, about one in seven Americans is food insecure.
‘Roughly three quarters of our participants are accessing some form of food aid. Project Open Hand, Glide, and other programs providing food assistance to San Francisco’s urban poor do a phenomenal job, but with falling levels of funding and increasing client loads, their efforts have not been enough to take people out of food insecurity,’ said the study’s senior investigator, Margot B. Kushel, MD, associate professor in the UCSF Division of Internal Medicine at San Francisco General Hospital and Trauma Center.
‘One part of the problem lies in housing,’ she said. ‘While about a tenth of participants had a recent experience of homelessness, most of the rest were housed in single-room occupancy hotels, many of which do not include kitchen facilities. Providing secure housing with functional kitchens is an important part of addressing the problem.’
Surprisingly, said Weiser, less than a fifth of the participants had received federal food assistance through the Supplemental Nutrition Assistance Programs (SNAP) over the previous year and only about a tenth had received SNAP over the previous month. ‘We were alarmed to see such low numbers accessing SNAP, since presumably this program is intended to serve urban poor who experience food insecurity. But many of our food insecure participants have a monthly income that is slightly above the $1,080 a month SNAP cut-off.’ In other words, SNAP does not seem to be reaching the majority of HIV-infected persons in need of food assistance.
EurekAlert
What makes laparoscopic surgery ‘minimally invasive’
Researchers from the University of Cambridge, the Wellcome Trust Sanger Institute, and Cambridge University Hospitals used advanced DNA sequencing technologies to confirm the presence of an ongoing outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a Special Care Baby Unit in real time. This assisted in stopping the outbreak earlier, saving possible harm to patients. This approach is much more accurate than current methods used to detect hospital outbreaks.
Using this technology, the team revealed that the outbreak had extended into the wider community, a conclusion that could not be reached with available methods. They also used sequencing to link the outbreak to an unsuspecting carrier, who was treated to eradicate MRSA.
‘We are always seeking ways to improve our patient care and wanted to explore the role that the latest sequencing technologies could play in the control of infections in hospitals,’ says Dr Nick Brown, author, consultant microbiologist at the Health Protection Agency and infection control doctor at Addenbrooke‟s Hospital Cambridge. ‘Our aim is to prevent outbreaks, and in the event that they occur to identify these rapidly and accurately and bring them under control.
‘What we have glimpsed through this pioneering study is a future in which new sequencing methods will help us to identify, manage and stop hospital outbreaks and deliver even better patient care.’
Over a six month period, the hospital infection control team used standard protocols to identify 12 patients who were carrying MRSA. However, this standard approach alone could not give enough information to confirm or refute whether or not an ongoing outbreak was actually taking place.
In this study, the researchers analysed MRSA isolates from these 12 patients with DNA sequencing technology and demonstrated clearly that all the MRSA bacteria were closely related and that this was an outbreak. They also revealed that the outbreak was more extensive than previously realised, finding that over twice as many people were carrying or were infected with the same outbreak strain. Many of these additional cases were people who had recent links to the hospital but were otherwise healthy and living in the community when they developed a MRSA infection.
While this sequencing study was underway, the infection control team identified a new case of MRSA carriage in the Special Care Baby Unit, which occurred 64 days after the last MRSA-positive patient had left the same unit. The team used advanced DNA sequencing to show in real time that this strain was also part of the outbreak, despite the lack of apparent links between this case and previous patients. This raised the possibility that an individual was unknowingly carrying and transmitting the outbreak MRSA strain.
The infection control team screened 154 healthcare workers for MRSA and found that one staff member was carrying MRSA. Using DNA sequencing, they confirmed that this MRSA strain was linked to the outbreak. This healthcare worker was quickly treated to eradicate their MRSA carriage and thus remove the risk of further spread.
‘Our study highlights the power of advanced DNA sequencing used in real time to directly influence infection control procedures,’ says Dr Julian Parkhill, lead author from the Wellcome Trust Sanger Institute. ‘There is a real health and cost burden from hospital outbreaks and significant benefits to be gained from their prevention and swift containment. This technology holds great promise for the quick and accurate identification of bacterial transmissions in our hospitals and could lead to a paradigm shift in how we manage infection control and practice.’
In this instance, DNA sequencing was a key step in bringing the outbreak to a close, saving possible harm to patients and potentially saving the hospital money.
Cambridge University
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