Monthly blood transfusions combined with daily medication to remove the resulting excess iron remains the best approach for reducing the risk of recurrent strokes in young patients with sickle cell anemia, according to a preliminary analysis of a multicenter trial that includes St. Jude Children's Research Hospital. The study compared the efficacy of two treatments for the potentially life-threatening problem of iron overload caused by chronic transfusion therapy. The transfusions are used to guard against additional strokes in young sickle cell anemia patients. The trial, known as SWiTCH or Stroke with Transfusion Changing to Hydroxyurea, was halted in May after an interim safety review determined the alternative therapy was not significantly better than the standard treatment at reducing iron buildup and was associated with an increased stroke risk.
Russell Ware, M.D., Ph.D., chair of the St. Jude Children's Research Hospital Department of Hematology and principal investigator of SWiTCH, discussed the results at the 52nd Annual Meeting of the American Society of Hematology. The meeting is being held December 4 -7 in Orlando, Fla.
Jonathan Flanagan, Ph.D., a staff scientist at St. Jude, presented results of another study that provide the first independent validation of an association between five common genetic variations and stroke risk in young sickle cell patients.
Between 70,000 and 100,000 individuals in the U.S. have sickle cell anemia. They make an abnormal hemoglobin molecule that sometimes takes on a twisted or sickle shape, disrupting blood flow and oxygen delivery throughout the body. Patients are vulnerable to a variety of problems, including organ damage, episodes of acute pain and stroke. Five to 10 percent of patients will suffer strokes before their 20th birthday. Up to 90 percent of patients will experience a recurrence.
Flanagan and his colleagues tried to validate earlier reports linking 38 genetic polymorphisms to stroke risk in sickle cell disease. Researchers compared the genetic makeup of 130 young sickle cell anemia (SCA) patients enrolled in the SWiTCH trial with 103 SCA patients enrolled in another study. The SWiTCH participants had suffered documented strokes while patients in the other trial had not.
Investigators validated the association between stroke risk and five single nucleotide polymorphisms (SNPs) in four genes. SNPs are small inherited variations in the makeup of particular genes and are sometimes used as markers of disease risk. "These findings reinforce earlier observations suggesting there is a genetic component to stroke risk in sickle cell anemia. We are now focusing on how these five SNPs might play a role in stroke development," said Flanagan, the poster's first author. Ware is the senior author.
Investigators also confirmed that the alpha-thalassemia trait is associated with a reduced stroke risk. Affected individuals carry two or three, rather than the usual four, genes for making one of the hemoglobin proteins needed to ferry oxygen throughout the body. Researchers reported no association between another inherited condition, G6PD deficiency, and strokes.
SWiTCH was a Phase III trial funded by the National Heart, Lung, and Blood Institute. Between October 2006 and April 2009, 133 children and adolescents ages 5 through 18 enrolled at one of 25 participating U.S. centers. All had a diagnosis of sickle cell anemia, had an average age of almost 13, had suffered at least one stroke and had undergone monthly blood transfusions for an average of seven years.
Sixty-six were randomly assigned to continue monthly transfusions and to take the drug deferasirox, or Exjade, daily to remove excess iron from their bodies. The remaining 67 patients were assigned to treatment with hydroxyurea daily for 30 months to reduce stroke risk and to undergo monthly blood removal to reduce iron buildup.
Monthly blood transfusions are 90 percent effective at preventing future strokes in sickle cell patients. But Ware said the resulting iron overload and other factors have fueled interest in alternative approaches to stroke prevention.
Hydroxyurea received U.S. Food and Drug Administration approval in 1998 for use in adults with SCA. The medication works by stimulating production of fetal hemoglobin, an alternative form of the molecule. A pilot study found the drug offered a possible alternative for managing stroke risk.
The SWiTCH study was halted after a review of data from 62 patients found no statistically significant difference in iron concentrations in the liver biopsies of the two treatment groups.
As expected, strokes were more common among patients receiving hydroxyurea than those who continued transfusion therapy. Seven of the 67 patients in the hydroxyurea group had another stroke. There were no additional strokes in the chronic transfusion patients.
Source: St. Jude Children's Research Hospital
**Published in "EScience News"
06 December 2010
Virginia Tech, Carilion team with physician to create digital ER pediatric response chart
A well-known paper-based medical chart used by pediatric emergency personnel across America is undergoing a 21st century boost in an collaborative effort between Virginia Tech's College of Engineering, Roanoke-based Carilion Clinic Children's Hospital, and the physician who created the original method some 25 years ago. The Broselow Pediatric Emergency Tape – otherwise known as the Broselow Tape -- has been a staple of ERs and child trauma units for nearly three decades. Created by Hickory, N.C.-based physician James Broselow, the Broselow Tape is a long, durable tape measure used on a child during a medical emergency. Using a color coded-format, it provides specific medical instructions – amounts of medicines to dispense or level of shock voltage to emit from a defibrillator, for instance – to medical caregivers based on the height and then subsequent weight of the child.
This information now will be displayed on a large LCD monitor within emergency rooms, for all personnel to see.
"We are converting the existing Broselow Tape into an electronic format to improve resuscitation team communications and patient safety," said Andre A. Muelenaer Jr., an associate professor of pediatrics at the Virginia Tech Carilion School of Medicine, adjunct professor at Virginia Tech-Wake Forrest University School of Biomedical Engineering and Science (http://www.sbes.vt.edu/), and director of the Pediatric Medical Device Institute, located in Roanoke, Va.
Additional displayed information will include medicines administered to the patient, including the time of administration and the next scheduled allotment. In the instance of burns, an automated calculation of the affected surface area will be displayed, along with automated calculation of fluid resuscitation.
A click of a mouse/remote control can move responders from one screen to another. The software running the newly-dubbed eBroselow software program runs on LabVIEW, owned by National Instruments. Known as TEAM Broselow, the method is being tested at various hospitals, including facilities in Roanoke, Va., Austin, Texas, and Winston-Salem, N.C., and will be fine tuned as additional input comes in from doctors, nurses and other medical personnel, said Muelenaer.
Many of the new features already include input from medical personnel around the country, Muelenaer said. One example: The ability to track by barcode-scan the exact types and amounts of medicine administered to the patient. "The idea is to give multiple people access to the same info, on a big screen," said Al Wicks (http://www.me.vt.edu/people/faculty/wicks.html), an associate professor of mechanical engineering at Virginia Tech, who serves on the Pediatric Medical Device Institute's leadership team with Muelenaer.
Much of the work to digitize the Broselow Tape for display on LCD televisions was completed by Carlos Guevara, a Virginia Tech master's student in mechanical engineering from El Salvador who recently became an American citizen. Emergency medical personnel still will rely on the physical laminated tape to determine the child's care-need level, before utilizing the digital display version.
"Doing this was a rather simple task," said Guevara. "The challenges arose in an attempt to take advantage of current technology in order to develop a much more enhanced device, such as using the available drug concentration information to calculate volume to administer once a drug has been scanned."
The idea for a digital version of the Broselow Tape came two-fold, hundreds of miles apart. In Hickory, Broselow was working with a collaborator on a Web-based adaptation as far back as three years ago. Meanwhile, more than a year ago, Stacy Steans, a pediatric physician at Roanoke's Carilion Clinic Children's Hospital, had his own epiphany about converting the paper-based data to a wireless format displayed on a monitor. Eventually, Steans and Muelenaer at Carilion, the Virginia Tech College of Engineering and Broselow himself all came together to work on the process.
"We showed them what we had developed and they showed us what they had developed," said Broselow, who developed the tape after moving from a private practice set-up to emergency room, and seeing the need for large medical teams to have set standards for child emergency care response. "The initial content on the large screen was a combination of what their thinking was and the content information we had."
Funding for the project came from the Childress Institute for Pediatric Trauma. Rural hospitals, such as those located throughout Southwest Virginia, could benefit most from the software device, more so than urban hospitals with high-capita populations of children. "There are not as many children, so there are not as many cases," he said.
The tape itself is designed for children 12-years-old or younger, and having a maximum weight of roughly 80 pounds. Separately, Broselow and his company are continuing work on several digital formats for emergency rooms of all types and additional user formats such as iPhone applications and several publications, plus additional emergency response needs such as wounds sustained from chemical weapons.
This information now will be displayed on a large LCD monitor within emergency rooms, for all personnel to see.
"We are converting the existing Broselow Tape into an electronic format to improve resuscitation team communications and patient safety," said Andre A. Muelenaer Jr., an associate professor of pediatrics at the Virginia Tech Carilion School of Medicine, adjunct professor at Virginia Tech-Wake Forrest University School of Biomedical Engineering and Science (http://www.sbes.vt.edu/), and director of the Pediatric Medical Device Institute, located in Roanoke, Va.
Additional displayed information will include medicines administered to the patient, including the time of administration and the next scheduled allotment. In the instance of burns, an automated calculation of the affected surface area will be displayed, along with automated calculation of fluid resuscitation.
A click of a mouse/remote control can move responders from one screen to another. The software running the newly-dubbed eBroselow software program runs on LabVIEW, owned by National Instruments. Known as TEAM Broselow, the method is being tested at various hospitals, including facilities in Roanoke, Va., Austin, Texas, and Winston-Salem, N.C., and will be fine tuned as additional input comes in from doctors, nurses and other medical personnel, said Muelenaer.
Many of the new features already include input from medical personnel around the country, Muelenaer said. One example: The ability to track by barcode-scan the exact types and amounts of medicine administered to the patient. "The idea is to give multiple people access to the same info, on a big screen," said Al Wicks (http://www.me.vt.edu/people/faculty/wicks.html), an associate professor of mechanical engineering at Virginia Tech, who serves on the Pediatric Medical Device Institute's leadership team with Muelenaer.
Much of the work to digitize the Broselow Tape for display on LCD televisions was completed by Carlos Guevara, a Virginia Tech master's student in mechanical engineering from El Salvador who recently became an American citizen. Emergency medical personnel still will rely on the physical laminated tape to determine the child's care-need level, before utilizing the digital display version.
"Doing this was a rather simple task," said Guevara. "The challenges arose in an attempt to take advantage of current technology in order to develop a much more enhanced device, such as using the available drug concentration information to calculate volume to administer once a drug has been scanned."
The idea for a digital version of the Broselow Tape came two-fold, hundreds of miles apart. In Hickory, Broselow was working with a collaborator on a Web-based adaptation as far back as three years ago. Meanwhile, more than a year ago, Stacy Steans, a pediatric physician at Roanoke's Carilion Clinic Children's Hospital, had his own epiphany about converting the paper-based data to a wireless format displayed on a monitor. Eventually, Steans and Muelenaer at Carilion, the Virginia Tech College of Engineering and Broselow himself all came together to work on the process.
"We showed them what we had developed and they showed us what they had developed," said Broselow, who developed the tape after moving from a private practice set-up to emergency room, and seeing the need for large medical teams to have set standards for child emergency care response. "The initial content on the large screen was a combination of what their thinking was and the content information we had."
Funding for the project came from the Childress Institute for Pediatric Trauma. Rural hospitals, such as those located throughout Southwest Virginia, could benefit most from the software device, more so than urban hospitals with high-capita populations of children. "There are not as many children, so there are not as many cases," he said.
The tape itself is designed for children 12-years-old or younger, and having a maximum weight of roughly 80 pounds. Separately, Broselow and his company are continuing work on several digital formats for emergency rooms of all types and additional user formats such as iPhone applications and several publications, plus additional emergency response needs such as wounds sustained from chemical weapons.
Source: Virginia Tech
**Published in "EScience news"
Los hombres sudan más que las mujeres
Los hombres ganan en sudores a las mujeres según un estudio de las Universidades japonesas de Osaka y Kobe tras examinar la sudoración en diferentes intensidades de ejercicio. La conclusiónn del informe comprueba que los hombres son más eficaces sudando, mientras que las mujeres necesitan de una mayor actividad física para comenzar a sudar.
Según el doctor Inoue, coordinador del proyecto, "parece que las mujeres están en desventaja cuando necesitan sudar mucho durante el ejercicio". Estos resultados podrían deberse a una adaptación del organismo ante la menor cantidad de fluido corporal del que disponen las féminas, y en el caso de los hombres, a la mejora de la eficacia en situaciones de acción o de trabajo intenso.
El parto aumenta el cerebro de la madre
La motivación y el comportamiento están directamente relacionados con la maternidad. Esto se desprende de un estudio llevado a cabo por el Instituto Nacional de Salud Mental de EEUU a 19 mujeres que habían dado a luz en el Hospital Yale-New Haven.
En concreto, las áreas del cerebro que afectan a dichos factores aumentaron a las cuatro semanas y a los tres meses de haber parido. Esto es consecuencia, según los investigadores, de los cambios hormonales que se producen en el organismo de la mujer tras el parto. Es decir, al aumento de los estrógenos, de oxitoctina y de la prolactina.
Estas hormonas serían la causa de que la madre activara su actitud de protección hacia el bebé, por lo que el instinto maternal quedaría en un segundo plano. Ahora los científicos se decantan por el cambio repentino del tamaño y de la estructura de la masa cerebral como base de esta necesidad de cuidar al recién nacido.
Las luces de la ciudad influyen en el ánimo de la población
Algo que puede pasar tan inadvertido para el ciudadano como la iluminación nocturna de una ciudad influye directamente en su estado de ánimo. Así puede favorecer el sentimiento de arraigo y de valoración del entorno y, al contrario, provocar rechazo. Según un estudio de investigación desarrollado por la arquitecta Berenice Calvillo, presentado en la ETS de Arquitectura de Barcelona, la luz ámbar ofrece una mayor sensación de inseguridad que la blanca, que ofrece más información a la vista. Además, la luz intensa incita emociones como la diversión, según asegura la autora.
Nobel Biocare extends syndicated loan facility
Nobel Biocare announced today the extension of its existing EUR 330 million committed syndicated banking facility for 5 years (through 2015). Besides the extension, Nobel Biocare was able to improve the implied funding terms in the new facility, which was done with the same 6 international banks as with the original line.
Dirk Kirsten, Chief Financial Officer, said: “The amendment and extension of the existing line reflects Nobel Biocare's continued balance sheet strength and its ability to generate a positive cash flow even in a difficult economic environment. Furthermore, the facility also supports our financial flexibility going forward. I am pleased that the same 6 banks have reconfirmed their commitment for a longer period.”
II Concurso Cortos de Mayores - Premios NICO 2010
Concurso Nacional de Videos de Mayores organizado por MundoMayor TV. El primer certamen nacional de cortos senior... ¡¡Conectando Generaciones!!
Subscribe to:
Comments (Atom)