When actor John Ritter died suddenly in 2003 from a tear in his thoracic aorta – the large artery that carries blood from the heart to the rest of the body – that tragedy brought attention to a rare but deadly condition that takes the lives of an estimated 10,000 Americans each year. Now, new clinical guidelines spearheaded by the American College of Cardiology (ACC) and the American Heart Association (AHA) not only offer new recommendations for the diagnosis and management of thoracic aortic disease (TAD), they deliver a powerful message to physicians and patients: Early diagnosis and treatment can save lives.

“If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable,” said Loren F. Hiratzka, M.D., who chaired the guidelines writing committee and is the medical director of cardiac surgery for TriHealth, Inc. (Bethesda North and Good Samaritan Hospitals) in Cincinnati, OH. “The results of treatment for stable disease are far better than for acute – and often catastrophic – aortic rupture or dissection.”

The new guidelines appear in the April 6, 2010, issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, as well as on web sites of the ACC and the AHA. They were developed in collaboration with the American Association for Thoracic Surgery (AATS), American College of Radiology (ACR), American Stroke Association (ASA), Society of Cardiovascular Anesthesiologists (SCA), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of Thoracic Surgeons (STS), and Society for Vascular Medicine (SVM). The American College of Emergency Physicians (ACEP) and the American College of Physicians (ACP) were also represented on the writing committee.

Recent scientific and clinical advances drove the development of guidelines to aid physicians in the diagnosis and management of aortic dissection, aortic aneurysm and other forms of TAD, said Kim A. Eagle, M.D., director of the University of Michigan Cardiovascular Center in Ann Arbor and co-author of the guidelines.

“We now have a deeper understanding of the genetic underpinnings of TAD, and we continue to expand our knowledge in this area,” he said. “There have been rapid advances in noninvasive imaging. Medical therapy is much better. Open surgical techniques with anesthesia have improved dramatically. We can even use endovascular (minimally invasive, catheter-based) approaches in some patients.”

An aortic aneurysm occurs when a portion of the aorta balloons out, increasing the diameter of the blood vessel by at least 50 percent at that spot. Although the wall of the aorta can become dangerously thin, patients with an aortic aneurysm often have no symptoms unless the aneurysm ruptures.

In the case of aortic dissection, a tear in the inner lining of the aorta (the intima) allows blood to invade the middle layer (the media), creating a false passageway through which blood can flow. This false passageway steals a portion of the blood supply from the rest of the body. Classical symptoms include the sudden onset of intense pain in the chest, back, shoulder or abdomen. However, patients often experience less definite symptoms, which makes diagnosis difficult.

In aortic rupture, all three layers of the aortic wall burst, resulting in massive bleeding inside the body.

Risk factors for TAD include poorly controlled high blood pressure, advancing age, male gender, atherosclerosis, inflammatory diseases that damage the blood vessels, and certain genetic conditions that weaken connective tissue, such as Marfan syndrome. In addition, people whose aortic valve has only two leaflets (bicuspid valve) instead of the normal three leaflets may be at increased risk for an aortic aneurysm. Pregnancy, intense weight lifting and cocaine use increase the risk of aortic dissection.

One of the most important messages in the guidelines is that TAD often runs in families. As a result, family history is a critical tool for uncovering undiagnosed cases of TAD. Patients should tell their physicians not only about close relatives with aortic aneurysm, dissection, or rupture, but also about any family history of unexplained sudden death. “Family history is very important,” Dr. Eagle said. “Sudden cardiovascular collapse could have been a heart attack, but it could also have been sudden catastrophic aortic dissection.”

Additional highlights from the TAD guidelines include:
Imaging of the thoracic aorta by computed tomography (CT), magnetic resonance imaging (MRI) or, in some cases, echocardiography is the best way to detect TAD and determine future risk. A chest x-ray alone is not sufficient.

Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.

All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating, or widening.

The symptoms of acute aortic dissection, which can mimic those of a heart attack or another cause of chest pain, often make it difficult to arrive at a prompt diagnosis and may delay life-saving treatment. Physicians should keep aortic dissection in mind when asking questions about medical history, family history, and the type and pattern of pain, and when examining the patient.

Aortic dissection involving the ascending aorta (the portion nearest the heart) is a life-threatening emergency that should be treated surgically.

Aortic dissection involving the descending thoracic aorta may often be managed with medications that control the blood pressure and heart rate, unless life-threatening complications develop. Additional medical therapy may include statins to lower elevated blood cholesterol levels.

Minimally invasive endovascular techniques are an option in some patients with aneurysm or dissection of the descending thoracic aorta.

All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.

Not all health insurers pay for aortic imaging in high-risk asymptomatic patients, particularly based on family history, Dr. Hiratzka said.

“I hope the new guidelines will change that,” he said. “It could be lifesaving.”

“People with aortic disease do not have to die prematurely; they can live a long lifespan if they are diagnosed and receive treatment,” said Carolyn Levering, president and chief executive officer of the National Marfan Foundation, which convened the TAD (Thoracic Aortic Disease) Coalition of nonprofit, patient and professional groups. “That’s why the TAD Coalition has come together to launch a comprehensive public and medical awareness campaign to help maximize the impact of the new guidelines. Our first initiative is the dissemination of Ritter Rules, named to honor John Ritter. The purpose of Ritter Rules is to help people remember the important facts about aortic dissection so they can avoid the same kind of tragedy that took the life of the beloved actor.”

Source:
Amanda Jekowsky

American College of Cardiology

UroToday- Traditionally, venous involvement, bulky retroperitoneal adenopathy, and large tumors with extracapsular extension have served as relative contraindications to radical nephrectomy performed through a laparoscopic approach. Increased experience and skill with this approach over time has resulted in expanding the indications of laparoscopic surgical techniques to deal with more and more complex surgical issues. Here Kapoor and colleagues report on their experience with laparoscopic management of level I tumor thrombi during laparoscopic radical nephrectomy.

The authors report on 12 patients with level I tumor thrombi that were diagnosed preoperatively. This report differs from previous studies in the literature in that all patients were known to have tumor thrombi preoperatively. Of these 12, 6 were done with a hand assisted laparoscopic technique, primarily because of large tumors with hilar adenopathy precluded a pure laparoscopic approach. Intraoperative laparoscopic ultrasound was used in 4 to delineate the extent of the thrombus to facilitate surgical management of the renal vein. Two cases were electively converted to open surgery due to more extensive venous involvement than perceived preoperatively. Seven of the 12 patients had metastatic disease at the time of surgery and two of these died of progressive disease after surgery, prior to the administration of systemic therapy. Mean blood loss was 200 ml and mean OR time was 220 minutes. The median length of stay was 4 days. There were no intraoperative complications and no positive margins or local recurrences in the series. The authors noted that the hand assisted approach was particularly useful in “milking back” the thrombus prior to application of the vascular stapler.

Increasing use of laparoscopic approaches in the management of renal cell carcinoma has resulted in the development of surgical skills that allow approaches to more complex surgical problems. As a consequence, selected patients with even locally advanced disease can enjoy the decreased morbidity associated with laparoscopic surgery.

Kapoor A, Nguan C, Al-Shaiji TF, Hussain A, Fazio L, Al Omar M, Luke PPW
Urology 68(3): 514-517, 2006.

Reviewed by UroToday Contributing Editor Christopher G. Wood, MD, FACS

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2006 – UroToday

This month, UnitedHealthcare will offer two free Medicare education seminars aimed at helping Hispanic-American seniors understand the basics of Medicare. Following the seminar, seniors are encouraged to take a free Zumba® Gold class, a Latin-infused fitness program that blends the rhythms of merengue, salsa, cumbia, rumba, and tango.

UnitedHealthcare will offer these seminars in Spanish so participants feel comfortable and engaged when learning about their health care options. There are approximately 60,000 Hispanic-American seniors living in Santa Barbara County who are eligible for Medicare.

“Seniors will receive health care information in a simple, clear manner, and they can also actively participate in the seminar so they feel confident in their health care decisions,” said Susan Morisato, president, Ovations Insurance Solutions – UnitedHealthcare’s Medicare Supplement business.

The Medicare education seminars will provide information on how Medicare works, who is eligible for Medicare, and the differences between Medicare Part A, B, C, and D. Seniors attending the Zumba® Gold fitness class will find a low-impact aerobic workout tailored for the older adult. Seniors should dress comfortably and wear sneakers.

UnitedHealthcare, the insurer of AARP® Medicare Supplement insurance plans, will conduct two educational seminars:

Wednesday, April 21st
9:00 a.m.
Maramonte Community Center
620 East Sunrise Drive
Santa Maria, CA 93458

Wednesday, April 21st
2:30 p.m.
Maramonte Community Center
620 East Sunrise Drive
Santa Maria, CA 93458

Seniors interested in learning more about the Medicare education program should call 1-866-305-0081.

Source
Ovations Insurance Solutions

Bladder stones are small mineral masses that develop in the bladder, usually when the urine becomes concentrated. Urolithiasis refers to stones in any part of the urinary tract, including the kidneys, bladder or urethra. The stones can be called calculi. Spinal cord injuries that result in urinary incontinence, an enlarged prostate, or recurring urinary tract infections are common causes of concentrated and stagnant urine. If urine remains too long in the bladder, urine chemicals start clumping together, forming crystals which grow and eventually develop into bladder stones.

Bladder stones used to be much more common in the UK, USA and other developed countries, when people’s diets lacked a good balance of carbohydrates and proteins. Today, however, most patients in industrialized nations with bladder stones have an underlying bladder problem.

Sometimes, patients with bladder stones first know about it after tests for other problems reveal them – they may exist without any symptoms. Signs and symptoms of bladder stones may include abdominal pain, pain when urinating, or blood in urine.

A tiny bladder stone may pass out of the body on its own. However, larger ones require medical intervention to get them out. Untreated bladder stones can eventually result in infections and complications.

In medical English:
A calculus is a stone within the body.
The plural of calculus (stone) is calculi (stones)
The Latin word calculus means “pebble”
A urinary calculus is a stone in the urinary tract, such as the kidney, bladder or urethra (urine leaves the bladder to outside the body through a tube called the urethra)
A bladder calculus is a bladder stone
Bladder calculi are bladder stones
A renal calculus is a kidney stone
A urethral calculus is a stone in the urethra

According to Medilexicon’s medical dictionary:

A bladder stone is a “urinary tract calculi in the bladder. Throughout most of the history of humans, this was the predominant form of urinary tract stone disease, mentioned in the Hippocratic oath, and giving rise to the common ancient surgical procedure, lithotomy. In much of the world, bladder stone disease has become uncommon and renal and ureteral stones (usually of different origins) have become more common. Bladder stones are now typically seen in patients with neurogenic bladders, urinary tract reconstruction, or infravesical obstruction”

What are the signs and symptoms of bladder stones?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Some patients never know they had a bladder stone, which was small and eventually passed out during urination. Others with no symptoms find out after undergoing tests for some other condition. The majority of people with bladder stones do have symptoms though, which may include:
Lower abdominal pain
Back, buttocks or hip pain, which worsens with physical activity
Blood in urine, or the urine may be abnormally dark
Getting up during the night from sleep to urinate
Intermittent urination (urination stops and starts)
Males may experience penile and scrotal pain or discomfort
More frequent urination
Pain when urinating
Some patients may find it hard to start urinating (have to wait for the flow to come)
Urinary incontinence (unintentional leaking)

Bladder stones may be:
So small that they come out during urination
So large that they fill the entire bladder
Soft
Hard
Smooth
Jagged
Spiked
A single stone or many of them

What are the risk factors for bladder stones?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Being a child in a developing nation – bladder stones are common in children in developing nations. Mainly because of dehydration and a diet that lacks protein.

Being an elderly male in developed nations – bladder stones occur much more frequently in elderly males, compared to other humans.

Age – people in developed nations aged over 50 years have a higher risk than younger people..

Bladder outlet obstruction – this term refers to any condition that undermines the flow of urine from the bladder to the urethra, such as an enlarged prostate, cystocele, bladder diverticula, certain medications and narrowing of the urethra.

Nerves that control bladder function – any condition that damages the nerves that control bladder function make the likelihood of bladder stones greater, such as a spinal cord injury, Parkinson’s disease, diabetes, herniated disk, and stroke. Patients who have a neurological problem as well as some kind of bladder outlet obstruction, such as an enlarged prostate have an even greater chance of developing bladder stones.

Recurrent bladder infections – chronic (recurrent, long-term) bladder infections cause inflammation, which may result in the development of bladder stones.

Urinary catheters – these are slender tubes which are inserted through the urethra to the bladder to help drain urine. Urinary catheter use, especially long-term use, can increase the risk of developing bladder stones.

Kidney stones – very small kidney stones can travel down the tubes that connect the kidneys to the bladder (ureters) and enter the bladder, where they may eventually grow into bladder stones.

Other factors – bladder stones are more likely if a person’s diet is high in fat, sugar or salt. A vitamin A and/or vitamin B deficiency may also increase the risk. These other factors are more likely to affect people in developing nations.

What are the causes of bladder stones?
By far the most common cause of bladder stones is the bladder’s inability to empty itself completely.

Urine, which is produced in the kidneys, consists of water and waste products which have been removed from blood.

Urea, one of the waste products, is made of carbon and nitrogen – (NH2)2CO. Stagnant urine – urine that remains in the bladder because it could not empty itself fully – leads to the clumping together of the chemicals inside urea, eventually resulting in the formation of crystals.
Diagnosing bladder stones
A GP (general practitioner, primary care physician), often the first health care professional the sufferer will go to, will interview the patient and carry out a physical exam. The doctor will feel the lower abdomen to determine whether there is any bladder distention (swelling). If the individual is male a rectal exam may be done, to check the size of the prostate.

If the GP suspects there may be bladder stones, the patient will be referred to a hospital for tests, which may include:
Urine test (urinalysis) – a urine sample is examined for blood, bacteria and crystallization of minerals.

Cystoscopy – a cystoscope, a slender tube with a tiny camera at the end is inserted through the urethra and into the bladder. Water flows through the cystoscope into the bladder, filling it up. This stretches the bladder wall so that the doctor can see the inside of it more clearly. With a cystoscope the doctor can determine whether there are any bladder stones, how many there are, what they are like, and where exactly they all are.

Spiral CT (computerized tomography) scan – the CT scanner uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. The 3-D image is made after many 2-dimensional (2-D) X-ray images are taken around a single axis of rotation – in other words, many pictures of the same area are taken from many angles and then placed together to produce a 3-D image. It is a painless procedure. A spiral CT scans more rapidly and with greater definition – even tiny stones can be detected. This is considered the most sensitive test for detecting all types of bladder stones.

Ultrasound scan – this device uses ultrasound waves which bounce off tissues; the echoes are converted into a sonogram (an image) which the doctor can see on a monitor. The doctor can get an inside view of soft tissues and body cavities; which in this case would be the bladder and inside the bladder.

X-ray – may be used to determine whether there are stones anywhere in the urinary system, including the kidneys, ureters and bladder. X-rays may not detect all types of stones.

Intravenous pyelogram (intravenous urogram) – a dye is injected into a vein in the arm. The dye flows into the kidneys, ureters and bladder, which are revealed in X-ray images. Several X-rays are taken, at specific points in time.

What are the treatment options for bladder stones?
Bladder stones should not remain in the bladder. Small ones may usually be flushed out by drinking more water – at least 6 to 8 glasses (1.2 liters) of water a day. Patients should be guided by what their doctor tells them.

If the bladder stone is too large to be flushed out on its own, the doctor may need to remove it.
Cystolitholapaxy – crushing the stones followed by irrigation to remove fragments. A cystoscope is inserted through the urethra and into the bladder. Ultrasound waves or lasers are transmitted from the cystoscope and aimed at the stones, breaking them up. They are then flushed out.

The patient will have either a local or general anesthetic for the procedure. Complications are rare, but if they do occur may include urinary tract infections, a bladder tear, and bleeding. Patients are usually administered antibiotics to reduce infection risk.

Approximately one month after the cystolitholapaxy there is a follow-up meeting with the doctor to check that no fragments remained behind in the bladder.

Surgery – if the bladder stones are too hard to crush, or too large, open surgery may be needed. The surgeon makes an incision just above the pubic hair, and another incision in the bladder and directly removes the stones. If there is an underlying condition linked to bladder stones, such as an enlarged prostate, this may be corrected too. The patient may need to use a urinary catheter until the bladder heals.

What are the possible complications of bladder stones?
Untreated bladder stones can eventually lead to:
Chronic bladder dysfunction – the bladder does not work properly and the individual may have to urinate frequently, there may be some varying degrees of urinary incontinence as well. A stone may become stuck in the opening where the urethra joins the bladder, causing blockage and consequent urination difficulties.

Urinary tract infections – bladder stones significantly increase the risk of recurrent urinary tract infections.

Bladder cancer – untreated bladder stones can increase the risk of bladder cancer.

Obese older women who have never used hormone replacement therapy have nearly twice the risk of their normal weight peers of developing ovarian cancer, according to a study by the researchers at the National Cancer Institute, the New York Times reports. When assessing ovarian cancer across all older women, researchers found that obese women faced only a slightly higher risk for ovarian cancer than those of normal weight.

The study — which will appear in the Feb. 15 issue of Cancer — examined data on 94,525 women ages 50 to 71. After seven years, 303 of the women developed ovarian cancer. Women who were obese — defined as having a body mass index of 30 or more — were 1.26 times more likely to develop the cancer than women with a BMI of less than 25, which is considered normal weight. This difference was not statistically significant. However, among a subgroup of women who had not taken HRT, obese women were 1.83 times more likely than women of normal weight to develop ovarian cancer. The study found no association between BMI and ovarian cancer among women who had taken hormones or among women with a family history of the disease.

Because HRT might play a role in the development of cancer, comparing cancer rates among women who have never used hormones helps tease out the effects of other risk factors, the study’s authors said. Michael Leitzmann, a former investigator at the NCI and an author of the study, said, “We speculate that what may be driving the increased risk among the obese is the surplus estrogen produced by fat cells in the body.” Previous studies on the association between obesity and ovarian cancer have been inconsistent and contradictory, and experts believe the new findings will not be the last word on the matter, the Times reports. A 2007 review of earlier clinical trials found that being overweight or obese was associated with a higher risk for ovarian cancer, but a 2008 pooled analysis found that BMI was linked to the disease only in premenopausal women, who have a very low risk to begin with.

Leo Schouten, an author of the pooled analysis, said, “This needs to be replicated in other populations (with lower proportions of postmenopausal hormone users) before we can decide whether this is a real and not a chance finding.” James Lacey — an author of the new study — said that previous analyses of studies examining the link between obesity and ovarian cancer included older data and that different risks may be emerging now that more U.S. residents are obese. “It’s another piece to the puzzle,” he said (Rabin, New York Times, 1/7).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.

Nursing homes with repeated safety compliance problems usually face only minimal penalties from the federal government, according to a Government Accountability Office report, the New York Times reports. Congress established “stringent” standards for nursing homes in 1987, but a 1998 GAO report found that nursing homes that repeatedly harmed residents were insufficiently penalized. Former President Bill Clinton, President Bush and the nursing home industry have since announced a number of initiatives to improve care. However, according to the new GAO report, HHS still “fails to hold homes with a long history of harming residents accountable for the poor care provided,” and “[s]ome of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs.” The report, which focuses on nursing homes with a history of compliance problems, uses as an example a California nursing home where a patient choked to death in part because machinery needed to save his life was broken. The facility has been cited for more than 170 serious deficiencies but still was open in late 2006, according to the report. The report also looks at a Michigan nursing home that remained open despite repeated citations for poor care quality, poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

Additional Findings
The report found that the Bush administration rarely denies federal payments to nursing homes with compliance problems and usually imposes fines that are much smaller than the maximum of $10,000 per day. Federal officials generally impose fines no greater than $200 per day in part because of concern that larger penalties “could bankrupt some homes,” according to the report. Nursing homes facing exclusion from Medicare and Medicaid often avoid penalties by temporarily improving care quality and then resume noncompliant practices, the report found. The report also states that immediate sanctions the federal government is supposed to take against nursing homes that repeatedly cause “actual harm” to residents “are often not immediate” because the Bush administration provides homes a grace period. Grace periods are provided even to “some homes with the worst compliance histories,” the report states. GAO recommends more frequent inspections and closer scrutiny of nursing homes with a history of compliance problems, in addition to making information about compliance problems at specific nursing homes available to the public.

Reaction
Federal officials said that higher fines were a good idea in some circumstances and that they would ask Congress for more power to collect fines without first having to wait for the resolution of appeals. Acting CMS Commissioner Leslie Norwalk said that her agency was taking steps to improve enforcement but added that larger fines “may simply not be very effective.” Norwalk said that nursing homes denied Medicare and Medicaid payments are likely to close, thereby reducing some patients’ access to care. In addition, Norwalk said that CMS’ budget is too small to increase inspections of nursing homes with histories of compliance problems. Federal officials said that they plan to post information about the quality of nursing homes’ care on the Internet. Senate Finance Committee ranking member Chuck Grassley (R-Iowa), who requested the study, said that the findings are “very discouraging.” Grassley said, “After the tremendous reform effort of the last 10 years, the federal agency that’s supposed to coordinate regulatory affairs is taking an approach that is undermining the sanctions that are available to try to improve care in the most questionable nursing homes.” Members of Congress “are likely to use the report as a map for legislation requiring stiffer penalties for the most serious violations,” the Times reports. Bruce Yarwood, president of the American Health Care Association, a trade group, said that the quality of care at the average nursing home — which was not the focus of the GAO report — has improved during the past decade (Pear, New York Times, 4/22).


The report is available online.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Embryonic stem (ES) cells, known for their capacity to proliferate indefinitely and differentiate into almost all types of cells including hepatocytes, have raised the hope of cellular replacement therapy for liver failure. There have been several protocols available for hepatic fate specification from ES cells, however, most of the protocols currently used result in low yield or purity of functional hepatocytes. Valproic acid (VPA), a histone deacetylase inhibitor, has been demonstrated to facilitate the hepatic differentiation of mesenchymal stem cells. However, little is know about whether VPA could induce the hepatic differentiation of ES cells.

A research team from China reported such research and the development of a protocol for direct hepatic lineage differentiation, from early developmental progenitors to a population of mature hepatocytes, based on sequential induction with VPA and cytokines. Results showed that VPA can direct the hepatic specification of ES cells and largely participates in the differentiation of ES cells into hepatic progenitors. Further differentiation of hepatic progenitors into mature hepatocytes requires supplementation with cytokines. Their study was published on November 7, 2009 in the World Journal of Gastroenterology.

Their research may not only be helpful for the clinical application of hepatocyte transplantation, but also provide an in vitro research model for the better investigation and understanding of the entire developmental process of hepatocytes, from ES cells to hepatic progenitors, and then to mature hepatocytes. Furthermore, as VPA is an epigenetic modulator, their results may also be of benefit to the research of mechanisms of epigenetic modifications during liver development.

Reference: Dong XJ, Zhang GR, Zhou QJ, Pan RL, Chen Y, Xiang LX, Shao JZ. Direct hepatic differentiation of mouse embryonic stem cells induced by valproic acid and cytokines. World J Gastroenterol 2009; 15(41): 5165-5175
wjgnet/1007-9327/15/5165.asp

Source: Ye-Ru Wang

World Journal of Gastroenterology

A study led by sports medicine researcher Anne Hoch, D.O. at The Medical College of Wisconsin in Milwaukee has found that oral folic acid may provide a safe and inexpensive treatment to improve vascular function in young female runners who are amenorrheic (not menstruating). The study is published in the May 2010 issue of Clinical Journal of Sport Medicine.

While the benefits for women leading an active lifestyle, including running, are profound and well-known, there are serious exercise-associated health risks. Young female athletes who do not eat enough to offset the energy they expend exercising can stop menstruating or develop irregular menses as a consequence. Their resulting estrogen profile is similar to that of postmenopausal women who have low estrogen levels placing the young women at higher risk for early onset heart disease.

There are nearly three million girls in high school sports and approximately 23 million women who run at least six times a week. The prevalence of athletic-associated amenorrhea among these runners is now estimated at 44 percent. A previous study by Dr. Hoch conducted at Divine Savior Holy Angels High School, Milwaukee, revealed that 54 percent of the varsity athletes were currently or had a history of amenorrhea.

“The earliest sign of heart disease can be measured by reduced dilation in the brachial artery of the arm in response to blood flow. Reduced vascular dilation can limit oxygen uptake and affect performance,” says Anne Hoch, D. O., the study’s lead author. Dr. Hoch is a professor of orthopaedic surgery and director of the Froedtert & the Medical College Women’s Sports Medicine Center.

The current study by Dr. Hoch’s research team found that folic acid supplement improved blood flow-mediated dilation in the brachial artery which correlates with increased blood flow to the heart.

Both children and adults require folic acid to produce healthy red blood cells and prevent anemia. Folic acid, also known as vitamin B9, folacin and collate, is the form of the vitamin needed during periods of cell growth.

The researchers recruited 20 female college or recreational runners, ages 18 to 35, who were not on birth control pills and had been running at least 20 miles a week for the past 12 months. At the start of the study, women who were amenorrheic had reduced blood vessel dilation similar to postmenopausal women. Women who were menstruating were included in the control group. Both groups were given 10 mg. of folic acid per day for four weeks. Vascular function returned to normal in the amenorrheic women after folic acid supplementation. Despite supplementation, vascular function remained at normal levels in the control group.

More research is needed to determine the lowest optimal dose of folic acid for athletic amenorrhea which offers the maximum benefit. Folic acid supplementation is important because folic acid may not only decrease cardiovascular risks but also improve athletic performance for these women.

The study was partially funded by a grant from the Cardiovascular Center and the Department of Orthopaedic Surgery at the Medical College.

Source:
Medical College of Wisconsin

Progress has been made in combating malaria, particularly in Africa where the disease is most prevalent, but more must be done to address the global scourge, UNICEF said, as it released a new joint report on the eve of World Malaria Day.

View report: Malaria & Children: Progress in Intervention Coverage pdf

“We are, for the first time in history, poised to make malaria a rare cause of death and disability,” said Ann M. Veneman, UNICEF Executive Director. “The report shows that endemic African countries received enough nets during 2004-2008 to cover more than 40 per cent of their at-risk populations.”

Data presented in the ‘Malaria and Children, Progress in Intervention Coverage’ report, a joint effort with the Roll Back Malaria (RBM) Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria, show major signs of progress across Africa in the fight against malaria, particularly in the increase in distribution of insecticide-treated nets (ITNs). Since 2004 the number of ITNs produced worldwide has more than tripled-from 30 million to 100 million in 2008.

“However every year, this disease still kills an estimated one million people, most of them children in Africa,” said Veneman. “Malaria also affects around 50 million pregnant women annually, contributing to maternal anaemia, low birth weight babies and even maternal death.”

The theme of this year’s World Malaria Day, which is marked on April 25, is “Counting malaria out”, and there are now just over 600 days remaining until 31 December 2010, the Secretary-General’s deadline for all endemic countries to achieve universal coverage with essential malaria control interventions.

“Scaling-up effective interventions has led to declines in malaria cases and deaths at health facilities in many countries, including Eritrea, Rwanda, Zambia and Madagascar,” said Veneman. “This has the added benefit of reducing the burden on over-stretched hospitals and clinics and having less absentees in the workplace and in school.”

Malaria control is now a major global development priority and is critical for achieving the Millennium Development Goals in Africa. Increased global awareness about malaria has contributed to a significant rise in available resources over recent years, thanks to the Global Fund to Fight AIDS, TB and Malaria, the US President’s Malaria Initiative, the World Bank, and others.

“The report shows financing is now available to purchase enough nets to put Africa well on the way to achieving universal coverage by 2010,” said Veneman.

Background information

UNICEF is the world’s largest global procurer and deliverer of ITNs with 20 million procured in 2008. The number of nets procured by UNICEF is 20 times greater today than in 2000. More than 90 per cent of these were long lasting insecticide-treated nets that do not require re-treatment. These nets are distributed to pregnant women and young children as part of integrated programmes that include antenatal care and immunization.

UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, safe water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

Source
UNICEF

Springer is launching a new quarterly journal Translational Stroke Research, which aims to help translate scientific discoveries from basic stroke research into the development of new strategies for prevention, assessment, treatment and repair after stroke and other forms of neurotrauma. The first issue will appear in March 2010.

Translational Stroke Research will focus on translational research and will be relevant to both basic scientists and physicians, including neuroscientists, vascular biologists, neurologists, neuroimagers and neurosurgeons. The journal will provide an interactive forum for the dissemination of original research articles, review articles, methods papers, letters, comments and research protocols in stroke and stroke-related areas. Its distinguished editorial board, headed by Dr. John H. Zhang of Loma Linda University School of Medicine in California, is made up of leading stroke researchers and physicians from North America, Europe, and Asia.

Ann Avouris, Senior Editor for Neuroscience at Springer, said, “Although basic stroke research is thriving, new and effective therapies for stroke patients have not been developed. We believe it is time to create a new journal to facilitate the translation of basic research discoveries into effective therapies. Translational Stroke Research will cover the fields from molecular biology to stroke clinical trials, but it will especially focus on translational studies.”

Translational Stroke Research will be available in print and electronically on springerlink. The journal includes Online First™, a feature where articles are published online before they appear in print, Cross Reference Linking, and Alert services. In addition, all authors, via the Springer Open Choice™ program, have the option of publishing their articles using the open access publishing model.

Source:
Joan Robinson

Springer ccess publishing model.