Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons
What we don’t appreciate is the vital role that our own natural biomolecules play in the healing process, including their contribution to the growth of new cells and the development of new blood vessels that provide nutrients to those cells.
Now, UCLA researchers led by Heather Maynard, a professor of chemistry and biochemistry and a member of UCLA’s California NanoSystems Institute, are working to take advantage of our body’s ability to heal itself by developing new bio-mimicking therapeutics that could be used to treat skin wounds.
Among the key players involved in natural wound-healing is a signalling molecule known as basic fibroblast growth factor, or bFGF, which is secreted by our cells to trigger processes that are involved in healing, as well as embryonic development, tissue regeneration, bone regeneration, the development and maintenance of the nervous system, and stem cell renewal.
bFGF has been widely investigated as a tool doctors could potentially use to promote or accelerate these processes, but its instability outside the body has been a significant hurdle to its widespread use, Maynard said.
Now, Maynard and her team have discovered how to stabilise bFGF based on the principle of mimicry. Relying on the growth factor’s ability to bind heparin
A new study found that between 40 to 50 percent of older adults with visually impairing eye disease limit their activities due to a fear of falling. Vision scientists warn that this protective strategy puts seniors at risk for social isolation and disability.
In the paper, ‘Activity Limitation Due to a Fear of Falling in Older Adults with Eye Disease,’ researchers report on their examination of patients with age-related macular degeneration (AMD), glaucoma and Fuchs corneal dystrophy, as compared to a control group of older adults with good vision. Of the three groups with visual limitations, the patients with Fuchs corneal dystrophy were the mostly like to report activity limitation due to fear of falling, followed by those with glaucoma and the AMD group.
‘I expected all of the groups to limit their activities due to a fear of falling but I was a bit surprised that the group with Fuchs corneal dystrophy was the most likely to limit their activities,’ says Ellen E. Freeman, PhD, Department of Ophthalmology at the University of Montreal, Qu
Most children with isolated skull fractures may not need to stay in the hospital, which finding has the potential to save the health care system millions of dollars a year (‘Isolated Skull Fractures: Trends in Management in U.S. Pediatric Emergency Departments’). In addition, a new device more accurately estimates children’s weights, leading to more precise drug dosing in the ER (‘Evaluation of the Mercy TAPE: Performance Against the Standard for Pediatric Weight Estimation’). Two studies showcase some of the work emergency physicians are doing to improve care for children in the nation’s emergency departments.
One study posits that most children who are hospitalised with isolated skull fractures may instead be discharged home safely from the ER. Researchers found that of children hospitalised with isolated skull fractures between 2005 and 2011, 85 percent were discharged within 1 day and 95 percent were discharged within 2 days. A very small number
Abuse of the anaesthesia drug propofol is a ‘rapidly progressive form of substance dependence’ that is being more commonly seen among health care professionals, reports a study.
‘Propofol addiction is a virulent and debilitating form of substance dependence’ with a ‘rapid downhill course,’ write Drs. Paul Earley and Torin Finver of Georgia Health Professionals Program, Inc, Atlanta. Their study identifies some emerging characteristics and consequences of propofol abuse among health care professionals.
Data from an addiction centre specialising in substance abuse problems among health care professionals identified 22 patients treated for propofol abuse from 1990 to 2010. Propofol is a drug widely used to induce anaesthesia for surgery and sedation for other procedures. It is commonly used because it has a rapid onset and quick recovery time, with fewer side effects than other anaesthetics.
The number of health care professionals treated for propofol abuse increased steadily during the period studied, although increased recognition by addiction centre staff may have played a role. The patients were thirteen physicians, eight nurses, and one dentist. Most of the physicians and all of the nurses were anaesthesia providers, who had ready access to propofol.
Patients using propofol were more likely to be women, compared to health care professionals abusing alcohol or other drugs. Most propofol abusers had depression, along with a history of childhood sexual or physical abuse. In addition, most of the propofol-abusing health care professionals reported a family history of substance abuse, and a higher than expected number had family members with schizophrenia.
The patients generally started using propofol to get to sleep. However, they quickly developed characteristics of addiction, with propofol becoming a preferred drug of abuse. Most patients came for addiction treatment within a few months after starting to use propofol. Five patients came to treatment after a single propofol binge.
‘When humans abuse propofol, unintended side effects begin almost immediately,’ Drs. Earley and Finver write. About half of propofol abusers entered addiction treatment after dramatic events such as car crashes or other injuries. Some sustained facial injuries when they passed out immediately after injecting propofol.
Five patients were admitted into treatment when they were discovered unconscious. These characteristics reflect the ‘narrow window between desired effect and unconsciousness’ and the rapid loss of control over propofol use, according to the authors.
‘Propofol dependence is a rapidly progressive form of substance dependence seen in 1.6 percent of all health care addiction cases reporting to treatment,’ Drs. Earley and Finver conclude. Within the limitations of the data, the study suggests that propofol abuse by health care professionals is increasing
Severity of emphysema, as measured by computed tomography (CT), is a strong independent predictor of all-cause, cardiovascular, and respiratory mortality in ever-smokers with or without chronic obstructive pulmonary disease (COPD), according to a study from researchers in Norway. In patients with severe emphysema, airway wall thickness is also associated with mortality from respiratory causes.
‘Ours is the first study to examine the relationship between degree of emphysema and mortality in a community-based sample and between airway wall thickness and mortality,’ said lead author Ane Johannessen, PhD, post-doctoral researcher at Haukeland University Hospital in Bergen, Norway. ‘Given the wide use of chest CT scans around the world, the predictive value of these measures on mortality risk is of substantial clinical importance.’
The study included a community-based cohort of 947 ever-smokers with and without COPD who were followed for eight years. All subjects underwent spirometry and CT scanning. Degree of emphysema was categorised as low, medium, or high based on the percent of low attenuation areas (areas with lower density than normal) on CT. COPD was diagnosed by spirometric measurement of airway obstruction. Of the 947 patients, 462 had COPD.
During follow-up, four percent of the 568 subjects with a low degree of emphysema died, compared with 18 percent of the 190 patients with a medium degree of emphysema and 44 percent of the 189 patients with a high degree of emphysema.
After adjustment for sex, COPD status, age, body mass index, smoking and measures of lung function, survival in the low emphysema group was 19 months longer than survival in the middle and high emphysema groups for all-cause mortality. Compared with subjects in the low emphysema group, subjects with a high degree of emphysema had 33 months shorter survival for respiratory mortality and 37 months shorter survival for cardiovascular mortality.
Emphysema was a significant predictor of all cause-specific mortalities, with increasing emphysema levels predicting shorter survival. While airway wall thickness was not an independent predictor of mortality, increased airway wall thickness reduced survival time in patients with more severe emphysema.
‘The relationship between emphysema levels and mortality we found can be used in the risk assessment of these patients,’ concluded Dr. Johannessen. ‘Accurately predicting mortality risk may help target patients for specific therapeutic interventions which may improve outcomes.’
EurekAlert
A simple formula can predict at birth a baby
Severe and life-threatening complications in pregnancy can have a big impact on fathers as well as mothers.
That’s one of the key findings of work by Oxford University researchers who spoke to couples who had been through this, in compiling a new resource for the award-winning patient website www.healthtalkonline.org.
The new pages covering life-threatening conditions in childbirth and pregnancy have just been launched.
Other points that emerged from the interviews included the huge difference that little examples of thoughtful care from doctors and midwives could make to how couples coped when emergency care was needed around the time of the birth of their child.
Examples included an anaesthetist who stepped out of theatre to show the waiting father a photo of his new baby on an iPhone; staff who kept a diary of the newborn baby’s day in a neonatal unit that was in a different hospital to the mother; and a midwife who greeted a woman with major bleeding arriving in an ambulance with a monitor so she could hear her baby’s heartbeat and know nothing had happened to him.
Severe complications in labour and childbirth aren’t common. But perhaps because of this, there can be difficulties for couples in getting the support they might need or finding others that have gone through similar experiences. And for doctors and midwives who don’t see many such cases, they may not be aware of what follow-up care could help.
Oxford University
Patches giving oestrogen through the skin could be an easy and safe alternative to hormone therapies used to treat prostate cancer.
The Cancer Research UK funded study found that oestrogen patches, usually used to treat menopause symptoms in women, reduced levels of testosterone in men to a similar extent as the current hormone treatment, LHRHa injections.
Many prostate cancers need the male hormone testosterone to grow. Using drugs to reduce testosterone in advanced stages of the disease can shrink the tumour or slow growth.
In the 1960s this was done by using oestrogen tablets, but this caused heart and blood clotting side effects for some men. Now, LHRHa injections are the main treatment for reducing testosterone but these may also cause serious side effects including hot flushes, osteoporosis, bone fractures and diabetes.
The trial was run by researchers from Imperial College London and the Medical Research Council Clinical Trials Unit with clinicians at Imperial College Healthcare NHS Trust.
They compared LHRHa injections to oestrogen patches in 254 men with locally advanced prostate cancer or prostate cancer that had spread, in order to test the benefits and side effects from the patches.
The results showed that patches appeared to suppress testosterone levels to a similar extent as LHRHa injections. After 12 months, the researchers also found that those having the LHRHa treatment had higher blood glucose and cholesterol levels, which can increase the risk of heart disease, compared to men treated with patches. The patches did not cause the same degree of heart and blood clotting problems caused by oestrogen tablets.
The initial trial has now been extended to study the long-term effectiveness and side effects of oestrogen patches in a larger group of 660 men.
Dr Ruth Langley, a study author from the Medical Research Council Clinical Trials Unit, said: ‘These promising new findings suggest that we might be able to use oestrogen patches or an oestrogen gel to treat prostate cancer without significantly increasing the risk of heart disease and stroke. We think the reason oral oestrogen causes these side effects is because the oestrogen reaches the liver in high concentrations straight from the stomach, whereas if the oestrogen can be absorbed through the skin, the effect on the liver is avoided.’
Professor Paul Abel, from the Department of Surgery and Cancer at Imperial College London and an honorary consultant in urology at Imperial College Healthcare, said: ‘The next step is to test if the oestrogen patches are as effective at stopping the growth of prostate cancer as the current hormone treatments. We
Most people know a colonoscopy requires some preparation by the patient. Now, a Mayo Clinic physician suggests an additional step to lower the risk of colorectal cancer: Ask for your doctor’s success rate detecting easy-to-miss polyps called adenomas.
The measure of success is called the adenoma detection rate, or ADR, and has been linked to a reduced risk of developing a new cancer after the colonoscopy. The current recommended national benchmark is at least 20 percent, which means that an endoscopist should be able to detect adenomas in at least 1 of 5 patients getting a colonoscopy.
Recently, the Mayo Clinic in Florida developed a two-hour course designed to increase a doctor’s ADR rate in order to reduce development of colorectal cancer.
They found the short course made a big difference in even experienced endocopsists, the physicians who perform colonoscopies.
‘Numerous studies have shown that increased detection and removal of potentially pre-cancerous polyps lowers the incidence of colorectal cancer,’ says Michael Wallace, M.D., M.P.H., chair of the Division of Gastroenterology and Hepatology at Mayo Clinic in Florida. ‘We also know that there is a lot of variability in how proficient physicians are at finding those polyps.’
A team of Mayo physicians and researchers led by Dr. Wallace, has long been working to help endoscopists better detect polyps.
Dr. Wallace and his team developed a two-hour training course that describes polyps that can be difficult to see, such as flat lesions, but are often the most dangerous.
The research team turned to Mayo Clinic endoscopists to study whether the course helps. Researchers first looked at the adenoma detection rate in 15 physicians and found it was 35 percent
April 2024
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