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Artificial Bone Marrow Could Be Used to Treat Leukemia

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Artificial bone marrow may be used to reproduce hematopoietic stem cells. A prototype has now been developed by scientists of KIT, the Max Planck Institute for Intelligent Systems, Stuttgart, and Tübingen University. The porous structure possesses essential properties of natural bone marrow and can be used for the reproduction of stem cells at the laboratory. This might facilitate the treatment of leukemia in a few years.

The researchers are now presenting their work in the journal Biomaterials.
Blood cells, such as erythrocytes or immune cells, are continuously replaced by new ones supplied by hematopoietic stem cells located in a specialized niche of the bone marrow. Hematopoietic stem cells can be used for the treatment of blood diseases, such as leukemia. The affected cells of the patient are replaced by healthy hematopoietic stem cells of an eligible donor.

However, not every leukemia patient can be treated in this way, as the number of appropriate transplants is not sufficient. This problem might be solved by the reproduction of hematopoietic stem cells. So far, this has been impossible, as these cells retain their stem cell properties in their natural environment only, i.e. in their niche of the bone marrow. Outside of this niche, the properties are modified. Stem cell reproduction therefore requires an environment similar to the stem cell niche in the bone marrow.

The stem cell niche is a complex microscopic environment having specific properties. The relevant areas in the bone are highly porous and similar to a sponge. This three-dimensional environment does not only accommodate bone cells and hematopoietic stem cells but also various other cell types with which signal substances are exchanged. Moreover, the space among the cells has a matrix that ensures a certain stability and provides the cells with points to anchor. In the stem cell niche, the cells are also supplied with nutrients and oxygen.

The Young Investigators Group “Stem Cell-Material Interactions” headed by Dr. Cornelia Lee-Thedieck consists of scientists of the KIT Institute of Functional Interfaces (IFG), the Max Planck Institute for Intelligent Systems, Stuttgart, and Tübingen University. It artificially reproduced major properties of natural bone marrow at the laboratory. With the help of synthetic polymers, the scientists created a porous structure simulating the sponge-like structure of the bone in the area of the blood-forming bone marrow. In addition, they added protein building blocks similar to those existing in the matrix of the bone marrow for the cells to anchor.

The scientists also inserted other cell types from the stem cell niche into the structure in order to ensure substance exchange.
Then, the researchers introduced hematopoietic stem cells isolated from cord blood into this artificial bone marrow. Subsequent breeding of the cells took several days. Analyses with various methods revealed that the cells really reproduce in the newly developed artificial bone marrow. Compared to standard cell cultivation methods, more stem cells retain their specific properties in the artificial bone marrow.

The newly developed artificial bone marrow that possesses major properties of natural bone marrow can now be used by the scientists to study the interactions between materials and stem cells in detail at the laboratory. This will help to find out how the behavior of stem cells can be influenced and controlled by synthetic materials. This knowledge might contribute to producing an artificial stem cell niche for the specific reproduction of stem cells and the treatment of leukemia in ten to fifteen years from now.

Source: Science daily

Sleep During the Day May Throw Genes Into Disarray

Sleeping during the day a necessity for jet-lagged travelers and those who work overnight shifts disrupts the rhythms of about one-third of your genes, a new study suggests.

What’s more, shifted sleep appears to disrupt gene activity even more than not getting enough sleep, according to the research.

For the new study, which was published in this week’s issue of the journal Proceedings of the National Academy of Sciences, British researchers put 22 healthy, young volunteers in a dimly lit sleep lab for three days.

During the first day, they disrupted the participants’ sleep at regular intervals to reset their body clock to its innate rhythm. On the second and third days, the volunteers ate and slept on a 28-hour schedule, so their longest period of sleep was from noon until about 6:30 p.m.

The researchers drew blood samples all three days so they could watch what happened to the timing of gene activity.

During the first day, when the body reset its circadian rhythm, nearly 1,400 genes — about 6.4 percent of all genes that were analyzed — were in sync with that rhythm. On the days of shifted sleep, however, the number of genes tied to the body’s clock dropped dramatically, to 228 genes, or only 1 percent of genes analyzed.

The researchers estimated that the sleep disruptions would ultimately impact about a third of a person’s genes.

That’s an even greater disruption than scientists saw in a previous study when they tested the effects of sleep deprivation on gene activity. In that study, which had study volunteers sleeping about five and half hours each night, the number of genes that were in sync with the body’s clock dropped from about 9 percent to 7 percent.

“These are quite fundamental processes that are being affected,” said senior study author Derk-Jan Dijk, a professor of sleep and physiology at the University of Surrey, in the United Kingdom.

“We think that may be related to the negative health outcomes associated with long-term shift work,” Dijk said. Shift workers are at higher risk for many health problems, including obesity, diabetes, high blood pressure, heart disease, disrupted menstrual cycles and cancer, he said.

This study didn’t directly connect health problems and night-shift work, but experts said it does start to help them understand why sleep might have such a powerful influence on a person’s health.

“This study suggests that mistimed sleep can alter circadian rhythms, so the cycling of many, many genes is impaired,” said Dr. Mark Wu, assistant professor of neurology, medicine, genetic medicine and neuroscience at Johns Hopkins University. “What this could cause, they can’t really say — except it’s probably not good.” Wu was not involved in the new research.

Genes carry the instructions for making proteins. Proteins make up just about every kind of chemical signal, hormone and tissue in the body, the researchers said.

The timing of when proteins are made is important because their production should correspond to our behaviors, said Frank Scheer, a neuroscientist at Harvard and director of the Medical Chronobiology Program at Brigham and Women’s Hospital in Boston.

When the body anticipates a meal, for example, the liver has to stop releasing into the blood the carbohydrates it has stored and the pancreas has to make more insulin, while the muscles have to become more sensitive to insulin that’s released so they can take in blood sugar, Scheer said.

Source: web md

Device uses heartbeat to create electrical source in body

Imagine if one day, a person’s heart and other organs could be used to power medical devices in their body that they need to survive.

That day may be closer than you think. Researchers have developed a tin, flexible device that generates electricity when moved. Then, they implanted the item directly on animal hearts, lungs and diaphragms to see if the natural processes of the body could create power.

“If you look at the trends these days, you’re seeing more and more electronic implantable devices,” author John Rogers, director of the Frederick Seitz Materials Research Laboratory, said to New Scientist. “I think there’s going to be a growing demand for in-body power.”

The researchers relied on the concept of the piezoelectric effect, which is when electricity is created in certain kinds of solid materials when something puts continuous force on it. In this case, they created nanoribbons made from a piezoelectric-able material called lead zirconate titanate. These nanoribbons were placed on a flexible silicone surface that could be put on an organ and move as it moved.
The researchers found that the best place to put these devices without interfering with the body’s natural processes and movements was on one of the heart’s ventricles. At its best, the device created 0.2 microwatts per square centimeter, which was enough to power an average pacemaker.

While this isn’t the first study to look at this kind of technology, it was the first time it was tested in animals that had organs that were comparable in size to humans. This device can also be stacked on top of each other to create more electrical power if necessary. Rogers said it was a good start but further research needs to be done.

“I think the concept of creating electrical power from motions in internal organs is really interesting,”Rogers said. “The key thing is, if you’re going to do this, you need to be able to achieve efficiency and ultimately power output that is of practical use.”

Their research as published Jan. 20 in Proceedings of the National Academy of Sciences.

Michael McAlpine, a professor of mechanical engineering at Princeton University who was not involved in the research, told The Scientist that the technology is important because it could mean less surgery for people who have battery-powered devices like pacemakers, implantable cardioverter-defibrillators, neural devices and cochlear implants.

“A pacemaker runs off a battery and it’s installed in your body. Every time the battery dies, they actually have to open up your chest to replace the pacemaker completely,” he explained. “If there was some way that you could . . . harvest power from (organ) motion, maybe you could prolong the life of the battery or even replace the battery all together.”

Some experts voiced concern that the device was made out of a lead-based material, and even though it is sealed up, it could leak. However, McAlpine said there are other non-lead based piezoelectric materials that are almost as efficient as lead zirconate titanate, and further research in this area may reveal a better alternative.

“The innovation of this paper is taking what has been done on a small scale and integrating it up to a much more significant scale,” McAlpine.

Source: one news page

Many hospitalized older people need decision help

When the time comes for making critical medical decisions while in the hospital, a new study says older people often rely on family members or other surrogates to make those calls.

Researchers found that about half of the older patients they tracked needed help making decisions within two days of being admitted to the hospital.

Considering the aging U.S. population and the mental burden borne by the family and friends making those decisions, the study’s lead author told Reuters Health that hospitals should work to accommodate surrogate decision makers.

“The long-term goal would be to improve hospital processes,” Dr. Alexia Torke, a center scientist at the Indiana University Center for Aging Research in Indianapolis, told Reuters Health.

Previous studies have examined the role of surrogate decision makers in some medical settings, but Torke and her colleagues write in JAMA Internal Medicine that they couldn’t find research showing how often people rely on others to make decisions while in the hospital.

“We set out to describe the scope of the problem as a whole,” Torke said.

For the study, she and her fellow researchers analyzed data on people who were over 65 years old and admitted to either of two hospitals in one Midwestern city between November 2008 and December 2011.

To be included in the study, a person had to have been hospitalized for 48 hours. After that time, a doctor was interviewed about the decision making process for that patient. Other information was taken from the patient’s medical record.

Of 1,598 study participants, the researchers found that 1,083 faced at least one major medical decision that was discussed with the patient or a surrogate.

Of those cases, about 570 patients made all of their decisions alone, 264 made their decisions with the help of a surrogate and surrogates made all of the decisions for 249 patients.

Most patients with surrogates were in the hospitals’ general wards, not the intensive care units.

Surrogate decision makers were most often the patients’ daughters, followed by sons and spouses.

Within the first two days of patients being admitted to the hospital, the researchers found that about 60 percent of surrogates had to make decisions about life-sustaining treatments and about half had to make decisions about operations and where the patients would go after leaving the hospital.

The study participants who required the help of a surrogate were also most likely to have worse outcomes. They were more likely to need a ventilator or a feeding tube, to be sent to a nursing home and to die.

“It’s not so much that having a family member make decisions for you makes things worse,” Torke said. “It’s that people who need decision makers are sicker.”

In a commentary accompanying the new study, Drs. Yael Schenker and Amber Barnato from the University of Pittsburgh write that the frequent use of surrogate decision makers across hospital settings suggests there are ways to broaden how doctors approach these types of decisions.

“I think there are multiple ways that we can support both patient and family involvement in decision making,” Schenker, an assistant professor, told Reuters Health.

For example, she and Barnato write that doctors should ask about people’s preferences when they are admitted to the hospital. That includes asking people who they want involved in the decision making process and how they want that person involved.

Doctors should also be trained in how to facilitate discussions between themselves, the patients and their chosen surrogate, they write. Part of that may include overcoming a tendency to only consider short-term outcomes instead of a patient’s overall illness and goals.

“I think it’s always helpful for patients and families to start conversations about these things,” Schenker said. “I think it’s also important for patients when they’re hospitalized to let doctors know how they want to approach decisions. It’s also unfortunately the case that they won’t always be asked.”

In the study, the researchers found that only about 25 percent of the patients had living wills or some kind of advanced directive to explain their choices. Torke said those documents may help some people but will not cover everything a surrogate may encounter.

“For older adults and their family members, I hope people will have more conversations about the possibilities about going into the hospital and what the older people’s preferences are,” she said.

Source: Chicago tribune

NHL injuries cost an estimated $218M US a year

About half of NHL players suffer an injury such as a concussion that benches them, costing the league an estimated $218 million in lost time, say Canadian doctors who want arenas to be safer workplaces.

About 63 per cent of National Hockey League players missed at least one game because of an injury over three seasons between 2009 and 2012, researchers said in Monday’s issue of the British Medical Journal’s Injury Prevention.

The injuries added up to a total salary cost of about $218 million US a year.

“While league owners and management are wary of making changes to the game to decrease aggression that could in turn affect profits, they must also consider the costs of injuries,” Dr. Michael Cusimano, a neurosurgeon at St. Michael’s Hospital in Toronto, and his co-authors concluded.

“It is hoped that consideration of these costs will provide sufficient motivation for professional sports leagues like the NHL to consider taking further action to prevent player injuries.”

Cusimano is particularly concerned about concussions, which he said is related to violent acts in 88 per cent of cases.
The researchers pegged salary loss to concussions at $42.8 million a year. After head/neck injuries, leg and foot injuries were the most common injury in the sample, accounting for 30 per cent of the total cost and about $68.2 million.

They estimated games lost to concussions cost insurance companies $7.2 million a year and teams $15 million a year. Insurance companies pick up part of the salary tab for players with long-term injuries.

Head shot rule changes enough?

In 2010, the NHL enacted Rule 48, banning blindside hits to the head. The following season, the rule was expanded to include targeted head shots from any direction.

Both of these seasons were included in the study. Cusimano said the findings show the need for stiffer penalties, such as red cards in soccer that mean losing a player for the game.

The full costs of injuries are greater than estimated if the costs of treatment, personal suffering, potential later lost income and future medical care are considered.

At a practice, some Toronto Maple Leafs players said there’s not much more that the league can do.

“I think it’s always going to be a dangerous game,” said forward Joffrey Lupul. “The league is doing a great job taking some of the high hits away and the checking from behind and those are two cases where there’s been a lot of injuries.”

Fellow forward James van Riemsdyk said he’s seen improvements over the last couple of years.

“Instead of hitting him in the head, you’re making more of an effort to hit in a place where you’re not going to basically kill him,” he said.

A concussion lawsuit against the NHL originally launched by 10 former players argues the league did not do enough to protect them from concussions. The NHL has said it intends to defend it case.

In August 2013, the National Football League agreed to pay nearly $800 million US to settle lawsuits from thousands of former players over concussion-related brain injuries.

The NHL did not immediately respond to a request for comment on the study’s findings from CBC News.

Source: CBC news

 

Unexpected diagnosis: Some medical tests may be harmful to your health

Everyone’s heard a story: Someone got an MRI for a sports injury or dizziness and the radiologist found a tumor, just in the nick of time. Or maybe it was an aneurysm, just about to burst. Lives were saved. It was great luck.

Some of the stories are dramatic. Joan Rachlin of Boston got what seemed to be a routine Pap smear 27 years ago. Like most Pap smears, it was deemed normal. “I got a call something like seven months later from a gynecological pathologist at Brigham and Women’s Hospital in Boston,” Rachlin told NBC News.

“He was doing research on Pap smear tissue and he had come across mine. He discovered that my Pap smear had been misread and that, in fact, I had a cancerous lesion.”

It’s what’s called an incidental finding — the researcher, who Rachlin says does not wish to be named, was studying something else and in fact had to go to some trouble to match the sample to a real person. “He thought my Pap smear had really been so poorly interpreted that my life was in danger,” said Rachlin, who is executive director of Public Responsibility in Medicine and Research. “I am alive today because a very, very conscientious researcher had read my Pap and decided to break the code and find me.”

Joan Rachlin found out she had cancer 27 years ago, purely by accident. There were no guidelines at the time for telling her.
Courtesy of Joan Rachlin
Joan Rachlin found out she had cancer 27 years ago, purely by accident. There were no guidelines at the time for telling her.
There were no guidelines — the researcher just went rogue. More checks showed Rachlin did indeed have cancer, but it was early stage and surgery took care of it.

Today whole industries are building up around the possibility that a test will find a medical problem that was just about to kill you. The latest entry — whole genome tests that promise to detail your medical future in a drop of spit.

But it’s starting to become clear that not all these findings are lifesaving, and some can be downright harmful. Take the case of the elderly woman whose chest lung X-ray showed what looked like lung tumors. She had a biopsy done — a tricky procedure that involves poking a long needle through the chest wall, or sending a bronchoscope down into the delicate lungs. Her lung collapsed and she died. The tumor, it turned out, was harmless. Were it not for the scan, she would have still been alive.

Her case is outlined in a report issued last month by the Presidential Commission for the Study of Bioethical Issues.

As more and more tests become available and standard, from MRIs to CT scans, to genetic tests and ultrasounds, these issues will come up more often. There’s even a name for these often harmless tumors that get discovered — they’re called incidentalomas.

For instance, 10 percent of brain scans and more than 30 percent of abdominal CT scans turn up something that doctors weren’t looking for and that may need more tests, says Dr. Stephen Hauser, who heads the neurology department at the University of California, San Francisco and who helped lead the Bioethics Commission panel in its report on the issue.

Source: Nmc news

Medical student finds real illness in actor faking symptoms

Diagnosing medical conditions can be a tricky business at the best of times, but University of Virginia medical student Ryan Jones recently made the perfect call during a training exercise.

During the simulation last March, medical actor Jim Malloy’s job was to accurately and convincingly portray a patient with the symptoms of abdominal aortic aneurysm, a condition in which a small section of the lower aorta begins to balloon.

The university medical facility says the condition is common in men between 65 and 75 years old, adding that such aneurysms can easily go undetected and possibly be fatal if they burst.

Even though it was just a simulation, Jones said he detected the symptoms of a real aneurysm. He felt a mass in Malloy’s abdomen.

“I figured [the university] must have found a man with an aneurysm who was willing to volunteer,” Jones said.

“I thought it was all prearranged,” he said, adding that Malloy even kept in character when he informed him what he had found.

Jones informed an attending physician, who advised Malloy to consult a cardiologist.

A subsequent ultrasound revealed Malloy had a 5.9-centimetre-long aneurysm.

Last August, he underwent stent placement surgery at the university medical centre, and is now doing fine.

Since making that very real diagnosis, Jones has graduated from medical school and is currently applying for residency.

Click the audio at left to hear the interview from As It Happens with Jones and Malloy.

Source: CBC news

New lung cancer screening guidelines approved for older smokers

Guidelines recommending annual low-dose CT lung cancer screening for older smokers have been approved by the US Preventive Services Task Force. The recommendations apply to individuals aged between 55 and 80 who are at high risk for lung cancer as a result of heavy smoking.

The guidelines are published in the journal Annals of Internal Medicine.

According to the American Cancer Society, approximately 228,190 new cases of lung cancer will have been diagnosed during 2013, with 159,480 deaths from the disease. This accounts for around 27% of all cancer deaths.

Background information from the guidelines states that around 85% of all cases of lung cancer are caused by smoking, and the risk of lung cancer increases with age, particularly for those aged over 55.

Dr. Michael LeFevre, co-vice chair of the US Preventive Services Task Force (USPSTF), says these factors suggest that the longer a person smokes, the higher their risk is for developing lung cancer.

Guidelines recommending annual low-dose CT lung cancer screening for older smokers have been approved by the US Preventive Services Task Force. The recommendations apply to individuals aged between 55 and 80 who are at high risk for lung cancer as a result of heavy smoking.

The guidelines are published in the journal Annals of Internal Medicine.

According to the American Cancer Society, approximately 228,190 new cases of lung cancer will have been diagnosed during 2013, with 159,480 deaths from the disease. This accounts for around 27% of all cancer deaths.

Background information from the guidelines states that around 85% of all cases of lung cancer are caused by smoking, and the risk of lung cancer increases with age, particularly for those aged over 55.

Dr. Michael LeFevre, co-vice chair of the US Preventive Services Task Force (USPSTF), says these factors suggest that the longer a person smokes, the higher their risk is for developing lung cancer.

He adds:

“When clinicians are determining who would most benefit from screening, they need to look at a person’s age, overall health, how much the person has smoked, and whether the person is still smoking or how many years it has been since the person quit.”

Low-dose CT scanning ‘more accurate’
The 2004 lung cancer screening recommendation from the USPSTF stated that the “evidence was insufficient to recommend for or against screening for lung cancer in asymptomatic persons with LDCT (low-dose computed tomography), chest radiography, sputum cytologic evaluation or a combination of these tests.”

With the aim of updating these recommendations, a panel from the USPSTF reviewed more than 33 studies involving current or former smokers who were at average or high risk for developing lung cancer.

The analysis included a study of more than 50,000 people who were a part of the National Lung Screening Trial.

From their research, the panel found that low-dose computed tomography (CT) lung cancer screening was more accurate in identifying the disease in its early stages, compared with alternative screening tests.

Their findings have led the USPSTF to “recommend annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.”

A 30-pack year is the equivalent to one pack a day for 30 years, or two packs a day for 15 years.

Screening not recommended when smoking ceased for 15 years
However, they note that screening should be stopped once a person has not smoked for 15 years or develops a health problem that shortens life expectancy or the willingness or ability to undergo potential lung surgery.

Dr. Virginia Moyer, chair of USPSTF emphasizes that it is important to assess a patient’s overall health to determine whether screening is appropriate.

“The benefit of screening may be significantly less in people with serious medical problems and there is no benefit in screening someone for whom treatment is not an option,” she says.

“In these people, screening may lead to unintended harms such as unnecessary tests and invasive procedures.”

She also adds that although screening for lung cancer is beneficial, it should not be seen as an alternative to giving up smoking.

Source: medical news today

Finley Boyle: Girl Dies After Dental Procedure

A three-year-old girl has died after suffering brain damage during a visit to the dentist.

Finley Boyle visited Island Dentistry for Children in Kailua, Hawaii, with her mother Ashley on December 3 to get four root canals done.

According to court documents, she was given different drugs to sedate her but she then went into cardiac arrest.

The lawsuit claims she was left unattended for 26 minutes without CPR, leading to extensive brain damage.

Her family has said it will file a wrongful death lawsuit against the Honolulu dentist.

Family lawyer Rick Fried told KHON-TV her death was “tragic”.

He said: “I think the parents felt that Finley wouldn’t want to live. I don’t think anyone of us would.

“She didn’t know she was alive basically.”

Source: Sky news

USDA allows more meat, grains in school lunches

The Agriculture Department says it’s making permanent rules that allow schools to serve larger portions of lean meat and whole grains in school lunches and other meals.

Guidelines restricting portion size were originally intended to combat childhood obesity, but many parents complained their kids weren’t getting enough to eat. School administrators say that rules establishing maximums on grains and meats are too limiting and make it difficult to plan daily meals.

The department eliminated limits and on meats and grains on a temporary basis more than a year ago. On Thursday officials made the rule change permanent.

The change was announced by Kevin Concannon, an undersecretary for food, nutrition and consumer services.

He says the department has delivered on its promise to give school nutritionists more flexibility in meal planning.

Source: USA Today