Health posts

March 21, 2013
10:39 AM
78 views

CrossFit Games Competition: Recovery between WODs

CrossFit Games Competition and New Research. There have been several new papers out on recovery from repeated sets of resistance exercise. These may be important for people headed to theThe post CrossFit Games Competition: Recovery between WODs appeared first on WODMasters Stiff Competition.... Read more »

Bacon NT, Wingo JE, Richardson MT, Ryan GA, Pangallo TC, & Bishop PA. (2012) Effect of two recovery methods on repeated closed-handed and open-handed weight-assisted pull-ups. Journal of strength and conditioning research / National Strength , 26(5), 1348-52. PMID: 22516908

March 20, 2013
01:00 PM
113 views

Suck It: The Ins and Outs of Mouth Pipetting

by Rebecca Kreston in BODY HORRORS

If you ever find yourself working in an infectious disease laboratory, whether it’s of the diagnostic or research variety, the overarching goal is not to put any microbes in your eye, an open wound or your mouth. Easy enough, right? Wear gloves, maybe goggles, work in fume hoods and don’t mouth pipette. When working with pathogenic bacteria and viruses, priority number one is Do Not Self-Inoculate.

Today our manual pipettes are rather sophisticated, plastic-y devices perfectly calibrated for moving precisely exact milliliters, microliters and picoliters of valuable solution from one vessel to another, whether it's of a urine sample, some spare radioactive material you have lying about or toxic solvents. But before the development of cheap mechanical pipettes in the '70s, using your mouth to pipette solutions was more than a common sight, it was a way of the lab.... Read more »

HILL, N. (1999) Laboratory-acquired Infections: History, Incidence, Causes and Preventions, 4th edition. Eds. C. H. Collins and D. A. Kennedy. Butterworth Heinemann, Oxford 1999. Pp. 324. ISBN 0 7506 4023 5. Epidemiology and Infection, 123(1), 181-181. DOI: 10.1017/S0950268899002514

March 20, 2013
10:39 AM
209 views

Social Experiences Affect Our Genes and Health

by amikulak in Daily Observations

Prevailing wisdom suggests that our genes remain largely fixed over time. But, an emerging field of research is beginning to prove this intuition wrong. Scientists are uncovering increasing evidence that ... Read more »

Slavich, G., . (2013) The Emerging Field of Human Social Genomics. Clinical Psychological Science. DOI: 10.1177/2167702613478594

March 20, 2013
08:59 AM
120 views

1 in 50 children with parent-reported autism in the US

by Paul Whiteley in Questioning Answers

An estimated 1 in 50 US children aged between 6 - 17 years old present with an autism spectrum disorder (ASD). Attention-grabbing isn't it?Today's post is based on the source of that soundbite, the publication by Stephen Blumberg and colleagues* (open-access) describing results from data mining of the 2007 and 2011-2012 US National Survey of Children's Health (NSCH) relevant to the numbers of cases of ASD.Testing 1, 2, 3 @ Wikipedia The autism-numbers game is something that has been discussed previously on this blog; most recently with the CDC 1 in 88 estimate in mind (see here) and the even more recent data from New Jersey (see here). The direction of the figures seems only one way - up - but the reason(s) for the increase still remain the source of discussion.The Blumberg report is open-access, but a few pointers might be useful:Based on 91,642 telephone interviews in 2007 and 95,677 interviews between 2011-2012, parental reports of receipt of an ASD diagnosis (autism, Asperger syndrome, PDD) in offspring were noted, alongside other variables such as age of the child, severity of presentation (mild, moderate, severe) and aged when first diagnosed.Actually in the age range 6-17 years old, data were collected from 63,967 interviews (2007) and 65,556 (2011-2012).Results: "based on parental reports, the prevalence of diagnosed ASD in 2011-2012 was estimated to be 2.00% for children aged 6-17". This compared with 1.16% or 1 in 86 for 6-17 year olds in 2007.The increase in prevalence was noted across the age ranges when they were sub-categorised and perhaps not surprisingly, there was a greater increase in prevalence in boys (2007: 1.8% vs. 2011-2012: 3.23%) than girls (2007: 0.49% vs. 2011-2012: 0.70%). Reported severity also shifted between the various data points (and age ranges) indicating that there was a trend towards less severe presentation (milder ASD) post 2008 diagnosis.The authors were able to some degree, rule out "survey-based measurement error" as being a major contributor to the prevalence increase and there is some discussion about the data not necessarily reflecting "factors that exist prior to or occur just after birth". Indeed the authors very firmly suggest that the changes are a consequence of either "recognition of ASD by health professionals or survey-based measurement changes over time". They also conclude that increases in the prevalence of parent-reported ASD especially for children aged 6-13 "was the result of diagnoses of children with previously unrecognized ASD".As per the report on this story in USA Today "15% to 20% of children who were once diagnosed with autism no longer have the condition". Which raises similar questions as to that of the Fein study on 'outgrowing autism' and 'optimal outcomes' which created so many column inches recently (see here and here).Bearing in mind that this was a prevalence study not an incidence study (see here for the difference) and issues with regards to response rates (2007: 46.7% vs. 2011-2012: 23.0%), and the sole reliance on parental judgement of variables like severity, the data being presented are indeed stark.That the rates of autism have seen an inordinate shift from what was once considered a rare condition to something which theoretically should appear in every school classroom at least once is an eye-opener. As mentioned, the debates rumble on about factors such as better awareness of autism, better case ascertainment, diagnostic switching and broadening, etc. as being the source of the increase. A real increase in cases? Hardly a mention in this latest data. The implication that for example our screening methods and skilled professionals have been able to miss or mis-diagnoses a staggering number of children presenting with an ASD is truly mind-boggling and worthy of an inquiry or two in the US and beyond. Indeed better be quick with that investigation with the DSM-V revision deadline fast approaching and the potential impact that might have on the autism numbers game (including adult numbers**).So 1 in 50 children with an ASD. What happens next? Sure, many children were described as falling into the mild and moderate ability ranges but as I've said before, terms like 'high-functioning' don't necessarily mean 'can function' with regards to daily living skills, quality of life and onwards translating into positive outcomes in adulthood. Certainly society has to play its role in helping people with autism reach their potential (I have a post scheduled on job interviews and autism coming up soon) and changes are indeed on-going (e.g. the implementation of the Autism Act here in the UK). But let's not be too proud of the achievements done in this area, as still many people on the autism spectrum, their families and concerned others have to fight daily for appropriate recognition, provisions and services.Another important issue also springs to my mind on the basis of the new prevalence figure. Comorbidity, of which autism is by no means immune from, are not mentioned. The realisation that autism is often very much more than the sum of its triad - soon to be dyad - in terms of comorbidity must surely factor into the potential impact of the latest figures. Not least because of the quite startling health inequalities which seem to be present when an ASD is diagnosed and how as was very recently detailed in the CIPOLD report, such inequality can in some cases, have the most profound and far-reaching effects. I'm not trying to scare anyone; just sayin' that we need to be mindful of the whole person not just their autism.----------* Blumberg SJ. et al. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012. National Health Statistics Reports. 2013: 65.** Wilson CE. et al. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic. J Autism Dev Disord. March 2013.----------... Read more »

Wilson, C., Gillan, N., Spain, D., Robertson, D., Roberts, G., Murphy, C., Maltezos, S., Zinkstok, J., Johnston, K., Dardani, C.... (2013) Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an Adult Autism Spectrum Disorder Diagnostic Clinic. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-013-1799-6

March 19, 2013
09:41 AM
92 views

Blood flow to tumours – new drugs and detection

by Rebecca Nesbit in The birds, the bees and feeding the world

Tumours develop a chaotic system of blood vessels to raid the body’s normal blood supply. Some of the latest anti-cancer drugs (Vascular Disrupting Agents) work by damaging these vessels: the tumour is then denied access to nutrients essential for its growth. However, to reveal the extent to which such therapies actually conquer the tumour we need to measure blood flow in the tumour vessels.... Read more »

Brunker J, & Beard P. (2012) Pulsed photoacoustic Doppler flowmetry using time-domain cross-correlation: accuracy, resolution and scalability. The Journal of the Acoustical Society of America, 132(3), 1780-91. PMID: 22978905

March 19, 2013
01:23 AM
139 views

The Evolution of Religion

by Drexid in Neurobrainstorm

Religions tend to evolve and adapt to benefit a society the most. The first religion can be uncovered from ancient anthropomorphic sculptures 42,000 years ago.... Read more »

WU Fei-fei,JIN Li-ji,LI Xiao-yu,LI Hua-qiang,CAO Zhen-hui,YOU Jian-song,XU Yong-ping(Ministry of Education Center for Food Safety of Animal Origin,College of Life Science and Technology, Dalian University of Technology,Dalian 116024,China). (2012) Research progress in active ingredients and pharmacological effects of deer antler. Chinese Journal. info:/

March 18, 2013
03:03 PM
119 views

Nutrition Skepticism – Worry less and be healthy

by Tony Ingram in BBoy Science

Q: Why don’t I write much about nutrition? A: I barely believe anything I read about it. After spending the last decade with my head in the ‘health and fitness’ industry, I’ve developed a healthy skepticism – literally. It’s probably because I’ve seen so many fads come and go, myths busted, and contradictory research. Now, I take most of what I read with a grain of salt – and I’m probably healthier because of it.

Here’s why:... Read more »

Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, & Gluud C. (2012) Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane database of systematic reviews (Online). PMID: 22419320

Smith-Spangler C, Brandeau ML, Hunter GE, Bavinger JC, Pearson M, Eschbach PJ, Sundaram V, Liu H, Schirmer P, Stave C.... (2012) Are organic foods safer or healthier than conventional alternatives?: a systematic review. Annals of internal medicine, 157(5), 348-66. PMID: 22944875

Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, Durant N, Dutton G, Foster EM, Heymsfield SB.... (2013) Myths, presumptions, and facts about obesity. The New England journal of medicine, 368(5), 446-54. PMID: 23363498

Health

March 18, 2013
01:12 PM
155 views

Blood and Taxes

by Aurametrix team in Environmental health

Nothing is certain, but blood pressure does increase in the end of winter and beginning of spring. According to Aurametrix users and google statistics. As a matter of fact, it highly correlates with tax fever - as found by Google Correlate algorithm comparing millions of web queries. But the reason for raising blood pressure is not always taxes. Seasonal variation in blood pressure was noticed and described more than 50 years ago and was connected to periods of decreasing outdoor temperature. It happens to healthy individuals and those who suffer from high blood pressure, especially in the elderly. The figure shows fluctuations in blood pressure observed by French researchers in a large study of 9294 65+ old residents of Bordeaux, Dijon, and Montpellier. Both systolic and diastolic parts of blood pressure as well as heart rate measurements significantly differed across the seasons with a clear trend for increase in colder months. And decreases following warmer weather - the higher the temperature, the larger the blood pressure decreases. Changes in blood pressure relative to outdoor temperature were largest in the elderly (80+ years old). On average, for a 15°C decrease in outdoor temperature, Systolic blood pressure (SBP) increased 0.8 mm Hg in those aged 65 to 74 years compared with 5.1 mm Hg in the oldest group (≥80 years). For a 15°C increase in temperature, SBP decreased 9.9 mm Hg in the youngest group vs 13.8 mm Hg in those 80 years or older. Winter increases in blood pressure did not seem to be caused by increased alcohol consumption and decreased activity. Neither were they dependent on the indoor temperatures - spending over 12 hours in warm rooms did not help.The inverse correlation of blood pressure and outdoor temperature is even stronger for "apparent temperature"- aka the perceived coldness derived from the combination of temperature and wind. And it was observed all over the world - as documented in studies performed in US, Denmark, China, Japan... Possible explanations include direct thermoregulation-mediated vasoconstriction, hypothalamic-pituitary-adrenocortical axis (HPAA) and sympathetic nervous system (SNS) activation, sodium/volume retention and impaired endothelial-dependent vasodilatation. Reduced sleep duration or quality could be also contributing.Environmental hypertensionology is a very young science. Many things in our environment can cause high blood pressure. The exact mechanisms are not well understood, but systems like Aurametrix could utilize the wealth of empirical evidence and use it for prediction and prevention.The high blood pressure season is almost over. Fortunately, many critically ill people made it through and, hopefully, learned more. Let's gear up to make the next time easier.======================================================================= REFERENCES Alpérovitch, A. (2009). Relationship Between Blood Pressure and Outdoor Temperature in a Large Sample of Elderly IndividualsThe Three-City Study Archives of Internal Medicine, 169 (1) DOI: 10.1001/archinternmed.2008.512Halonen, J., Zanobetti, A., Sparrow, D., Vokonas, P., & Schwartz, J. (2010). Relationship between outdoor temperature and blood pressure Occupational and Environmental Medicine, 68 (4), 296-301 DOI: 10.1136/oem.2010.056507Brook RD, Weder AB, & Rajagopalan S (2011). "Environmental hypertensionology" the effects of environmental factors on blood pressure in clinical practice and research. Journal of clinical hypertension (Greenwich, Conn.), 13 (11), 836-42 PMID: 22051429... Read more »

Alpérovitch, A. (2009) Relationship Between Blood Pressure and Outdoor Temperature in a Large Sample of Elderly IndividualsThe Three-City Study. Archives of Internal Medicine, 169(1), 75. DOI: 10.1001/archinternmed.2008.512

Halonen, J., Zanobetti, A., Sparrow, D., Vokonas, P., & Schwartz, J. (2010) Relationship between outdoor temperature and blood pressure. Occupational and Environmental Medicine, 68(4), 296-301. DOI: 10.1136/oem.2010.056507

Brook RD, Weder AB, & Rajagopalan S. (2011) "Environmental hypertensionology" the effects of environmental factors on blood pressure in clinical practice and research. Journal of clinical hypertension (Greenwich, Conn.), 13(11), 836-42. PMID: 22051429

March 18, 2013
05:33 AM
129 views

Folic-ing around in schizophrenia

by Paul Whiteley in Questioning Answers

I seem to have been focusing a lot on folic acid (vitamin B9) and vitamin B12 these days. It's not that I'm in anyway choosing the direction taken, it just happens that the published papers are appearing that way.And as if to prove my point, enter the paper by Joshua Roffman and colleagues* (open-access) reporting results from a gold-standard, randomised, double-blind, placebo-controlled study on the addition of folic acid and vitamin B12 supplement to antipsychotic medication for a group of adults with chronic schizophrenia.MTHFR, FOLH = word score @ Wikipedia The paper is open-access but a few summary points are worth mentioning bearing in mind Dr Emily Deans has already discussed this research:One hundred and forty participants diagnosed with schizophrenia but psychiatrically stable were included for initial study. They were all taking an antipsychotic for 6 months "but displayed persistent symptoms despite antipsychotic treatment".As per the study protocol, participants were randomly split into folate-vitamin B12 supplementation or placebo. Actually whilst it was random, it was stratified random, meaning that randomisation took into account serum folate levels which were measured at baseline and formed an important part of the study outcomes. Indeed, the split was also not 50:50 in each group; instead weighted towards the supplementing group. On most other variables the groups showed no significant difference (age, gender splits, medications, SES). That is aside from serum vitamin B12 levels, where the experimental group showed a significantly higher mean level at baseline compared to the placebo group (631 pg/ml vs. 511 pg/ml respectively).The primary outcome measure was the change in negative symptoms as judged by the SANS. Not being an expert on schizophrenia, I was interested to read about the characterisation of positive and negative symptoms in schizophrenia and, as the authors put it, "considerable disability is associated with negative symptoms and cognitive deficits, for which effective treatment is not available".Results: after 16 weeks of study, there were lots and they were mixed in with some DNA genotyping data pertinent to genes involved in the folate metabolism cycle. So our old Scrabble friend MTHFR (see here) got a look in, as did MTR (methionine synthase) - as per my previous post. One gene in particular seemed to get quite well caught up in the study results: FOLH1 - which among other things is involved in folate transfer and absorption. Mention of the words 'glutamate excitotoxicity' alongside FOLH1 also stirs up some interesting thoughts. So, yadda, yadda, "folate and vitamin B12 improves negative symptoms of schizophrenia" but only modestly given the "15% difference in SANS scores" between the experimental and placebo groups. Importantly in these days of personalised medicine, the FOLH1 gene was the focus, in that FOLH1 484C>T variant seemed to tie into treatment response. This was slightly at odds with what had been noted on another occasions**.So, if a participants was homozygous - as in identical copies of the same allele - for FOLH1 484T, they were more likely to show greater benefit from the supplements. I'll come back to this shortly.That's not also to say that there weren't other gene related findings tied into intervention response. As the authors note about MTHFR 677C>T "only T allele carriers exhibited a significant benefit for active treatment over placebo for negative symptoms". Thankfully in line with what has previously been discussed***.Every paper covered on this blog is a learning journey for me and this one is no exception. Likewise, it is always interesting to see when results don't exactly pan out as they are predicted to. In the case of the Roffman paper, it was the FOLH1 gene findings which didn't go to plan, and how contrary to the expected role of the 484C variant, the so-called low-functioning variant which one would expect to have reduced folate absorption - as was demonstrated in a separate asymptomatic cohort - it was actually the presence of the high-functioning variant (484T) which governed a positive treatment response.In light of these findings, and the fact that red blood cell (RBC) levels of folate grew and grew in the experimental group over the course of the trial (although not significantly related to the change in negative symptoms), one starts to ponder other explanations to account for the results.I've gone over MTHFR so won't say much more on that. The authors touch upon one potentially pertinent issue - DNA methylation - which is where I always seem to end up back to when talking about folate and MTHFR and the like. That for example, the supplementation of folic acid and vitamin B12 might, just might, impact on important reactions such as the recycling of homocysteine back to methionine onward to the production of SAMe is one possible effect. Indeed, it is a shame that elements of the methionine cycle were not measured over the course of the current trial. I could go on. I could ask what kind of vitamin B12 was used as a supplement, whether the oral dosage form is the ideal way to get vitamin B12 into the body, whether outside of the reported symptoms, there may have been other variables affected by the results and whether despite increasing levels of folate, there were corresponding increases to levels of the active form of folic acid, 5-methyltetrahydrofolate? Indeed on that last point apparently there are plans afoot to look at the use of 5-methyltetrahydrofolate (or as the authors call it 1-methylfolate)...Please stop now... and so I shall.----------* Roffman JL. et al. Randomized multicenter investigation of folate plus vitamin B12 supplementation in schizophrenia. JAMA Psychiatry. March 2013.** Roffman JL. et al. Genetic variation throughout the folate metabolic pathway influences negative symptom severity in schizophrenia. Schizophr Bull. 2013; 39: 330-338.*** Hill M. et al. Folate supplementation in schizophrenia: a possible role for MTHFR genotype. Schizophr Res. 2011; 127: 41-45.----------... Read more »

Roffman JL, Lamberti JS, Achtyes E, Macklin EA, Galendez GC, Raeke LH, Silverstein NJ, Smoller JW, Hill M, & Goff DC. (2013) Randomized Multicenter Investigation of Folate Plus Vitamin B12 Supplementation in Schizophrenia. JAMA psychiatry (Chicago, Ill.), 1-9. PMID: 23467813

March 17, 2013
06:00 PM
57 views

Science needs to be mainstream; but not that mainstream!!!

by Stuart Miller in UKSportSci

The Journal of Strength and Conditioning Research is a good portal for the S&C coach. However, I keep reading articles in it that make me question its scientific rigour. I’ve already written about a recent paper in which a completely invalid methodology was used (although I must thank them for this as it was a great teaching tool). Now, they have published an article entitled “Changes in Height, Body Weight, and Body Composition in American Football Players From 1942 to 2011″.... Read more »

Anzell AR, Potteiger JA, Kraemer WJ, & Otieno S. (2013) Changes in height, body weight, and body composition in American football players from 1942 to 2011. Journal of strength and conditioning research / National Strength , 27(2), 277-84. PMID: 23222088

March 17, 2013
03:00 PM
136 views

On Equilibrium & Balance in Your Microbial Universe

by Rebecca Kreston in BODY HORRORS

Two recent studies - the ominously named "fecal transplant" study and another on acne-causing bacteria - reinforce a compelling idea about our microbiomes that has been brewing for a few years: that some infectious diseases may be due in part to a disharmonious balance between pathogenic bad-guy bacteria and our resident commensal good-guy bacteria. ... Read more »

van Nood, E., Vrieze, A., Nieuwdorp, M., Fuentes, S., Zoetendal, E., de Vos, W., Visser, C., Kuijper, E., Bartelsman, J., Tijssen, J.... (2013) Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. New England Journal of Medicine, 368(5), 407-415. DOI: 10.1056/NEJMoa1205037

March 16, 2013
03:21 PM
38 views

Big Tobacco Easily Evades “Light” Cigarette Ban

by Dirk Hanson in Addiction Inbox

Color coding allows smokers to easily identify their former brands.

The tobacco industry has once again made a mockery of the Food and Drug Administration’s attempts to ban ‘light” cigarettes from the marketplace, by simply eliminated the objectionable wording and substituting an easily-decoded color scheme. In a brochure prepared for cigarette retailers marked “For trade use only: not to be shown or distributed to customers,” tobacco giant Philip Morris wrote that “some cigarettes and smokeless packaging is changing, but the product remains the same.”

Research done at Harvard demonstrates "the continued attempts of the industry to avoid reasonable regulation of tobacco products,” said Hillel Alpert, co-author of a new study on light cigarettes, in a prepared statement. The Family Smoking Prevention and Tobacco Control Act (FSPTCA) of 2009 highlights the banning of light cigarettes as a critical mission, since cigarettes marketed in this way are in fact no safer than regular cigarettes. What makes a cigarette Light or Ultra-light is a series of tiny holes drilled through the filter (See earlier post). This “filter ventilation” was calibrated to the descriptors: Ultra-lights had more holes drilled in the filter than Lights. Studies have demonstrated conclusively that such filter schemes do not make smoking safer or cut down on related diseases. A 2001 report from the National Cancer Institute documented how smokers were compensating for the ventilation holes by smoking more cigarettes, smoking them more intensely, or by blocking the filter holes with fingers or lips.

In a study for Tobacco Control, Gregory Connolly and Hillel Alpert of the Harvard School of Public Health documented the process. In 2010, Philip Morris sent manuals to retailers detailing how they were to deal with the new sales situation. Philip Morris made clear that “current pack descriptors such as light, ultra-light and mild will be removed from all packages.” All well and good. However, the Philip Morris material also specified how a series of new package names were to be doled out. Marlboro Light became Marlboro Gold. Marlboro Mild morphed into Marlboro Blue. And Marlboro Ultra-light reemerged as Marlboro Silver.

When the researchers commissioned a large public survey to document the state of affairs one year after the official “light” ban, they found that “88%-91% of smokers found it either ‘somewhat easy’ or ‘very easy’ to identify their usual brand of cigarettes by the banned descriptor names, Lights, Mediums or Ultra-Lights.” Sales figures for these brands in the first two quarters of 2010 were essentially unchanged, the authors report. They conclude that “the majority of smokers of brands in all categories correctly identified their brands’ pack color.”

The lesson here may well be that countries like Australia and the UK are on the right track: Plain packaging may be best. If lawmakers allow “misleading numbers, the use of colors, imagery, brand extensions, and other devices that contribute to deception” in place of words, nothing has really changed. “The findings of the present research strongly suggest that tobacco manufacturers have evaded one of the most important provisions of the FSPTCA for protecting the public health from the leading cause of preventable death and disease,” the authors conclude.

In a press release, co-author Gregory Connolly, director of the Center for Global Tobacco Control at Harvard, explained that the industry “was found guilty by a federal court in 2006 for deceptively promoting ‘light’ cigarettes as safer after countless smokers who switched to lights died prematurely, thinking they had reduced their health risks.”

Connolly G.N. & Alpert H.R. (2013). Has the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors?, Tobacco Control, PMID: 23485704

Photo Credit:http://www.mydiscountcigarette.net
... Read more »

Connolly Gregory N, & Alpert Hillel R. (2013) Has the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors?. Tobacco control. PMID: 23485704

March 15, 2013
06:12 AM
162 views

Autism, maternal immune activated mice and suramin

by Paul Whiteley in Questioning Answers

Avid followers of the autism research circuit must have noticed the increasing tide of studies looking at a possible role for maternal immune activation (MIA) in relation to risk of offspring autism spectrum disorder (ASD). It's a topic I've covered more than once on this blog; predominantly in relation to the work of people like Paul Patterson and his colleagues (see here), observations on things like C-reactive protein (see here) and the various ways to experimentally mimic such MIA in the mouse model of autism / schizophrenia / other for example (see here).Squeakers @ Wikipedia So it is in this post that I'm serving a double helping of the MIA model of autism as per the publication of studies from Jared Schwartzer and colleagues from the MIND Institute* (open-access) and Robert Naviaux and colleagues** (open-access).Both studies looked at the effects of artificial induction of MIA in the mouse model following poly I:C use as an immunostimulant. Thereafter the two studies went their separate ways as Schwartzer looked at the variable of mouse strain on the after-effects of MIA on offspring and Naviaux looked at the role of purinergic signaling.I'll say right now that I am neither qualified nor experienced enough to go into these papers with any great detail. So I won't; instead a brief overview of each - bearing in mind their open-access status - and some interesting factoids which have already been mentioned in the autism research peer-reviewed domain which might tie into results.The work of Schwartzer and colleagues basically "indicate[s] the need to consider how genetic predisposition may exacerbate or protect against the effects of environmental insults in the etiology of ASD". In other words, based on a mouse model looking at different strains of mouse, the specific genetic make-up of that mouse model might impact on offspring presentation after an artificial MIA event.In their case they looked at the C57BL/6J and BTBR T+tf/J inbred mouse strains and concluded that the dangermouse that is the BTBR strain combined with the poly I:C stressor seemed to "be synergistic resulting in greater behavioral impairment than from either factor alone" when compared with the C57BL/6J mouse strain. Some interesting variables are noted including elevations in cytokines like IL-6 (see here) and IL-17 (see here) in the BTBR offspring mice compared to C57BL/6J mice alongside some sex specific behavioural differences. All in all, some very interesting observations; and on that sex-specific notion, not completely at odds with other work in this area (see here).The work of Naviaux and colleagues - summarised quite well here - has definitely taken the interest of the media as per headlines such as 'New drug that may help reverse autism' or should that be 'Century old drug could beat autism'. I'm confused. The long-and-short of it is that based on the analysis of the MIA mouse model - C57BL/6J mice - there was a suggestion that "hyperpurinergia is a fundamental and treatable feature of the multisystem abnormalities in the poly(IC) mouse model of autism spectrum disorders". Treatable via "antipurinergic therapy (APT)" which in this study was via the drug suramin. The observant reader should immediately be comparing Schwartzer and Naviaux and the MIA mouse models chosen and results obtained.Anyhow, Naviaux et al continue in their observations on how MIA affected offspring mice and how the administration of suramin seemed to have some pretty wide-ranging effects on offspring mice. Alongside various behavioural effects on social and coordination issues, suramin administration was reported to show important effects such as "the preservation of cerebellar Purkinje cells", which as I discussed in a recent post, have more than a token link to cases of autism. "Suramin treatment strongly increased the expression of the nicotinic acetylcholine receptor subunit α7 (nAchRα7) in cerebral synaptosomes of MIA animals" was another potentially important finding in view of other work in this area. In all, "16 multisystem features of this model were either corrected or improved by suramin treatment".Impressive stuff I hear you say. Indeed all the more impressive given that the authors on purpose did not start suramin treatment until 6 weeks because they "wished to test the hypothesis that many of the autism-like features of the MIA model were treatable after they appear". And apparently there is more to come according to the authors, with the promise of human trials of suramin...But just before you pop down to your local doctor or pharmacist to ask for suramin (off-label), it might be worth pointing out a few things. Mice. Yep, this was a study of mice and as per the Schwartzer study, not necessarily the best and only mouse model of autism from an MIA point of view. Indeed if I needed to go back to the BTBR mouse and its overlap with autism, I might also recall some work looking at that most forgotten of autism research parameters, sulphate (sulfate) and findings related to the BTBR model (see here). Mice are not humans and suramin is to be added to a growing list of mouse findings with an autism slant (see here and here).That the US National Cancer Institute holds an entry for suramin should also give you some idea as to what uses the drug has and why bearing in mind it was injected into the study mice. Alongside its anti-parasitic effects related to things like sleeping sickness, the activity of suramin has been linked to its blocking of various growth factor binding which might yet hold some clue to other effects of the drug outside of competitive inhibiting of purinergic signalling (see here and here). As with most medicines, there are other effects to keep in mind which might also tie into results. And then there are the reported side-effects...I'm not by any means trying to belittle the Naviaux results of suramin in the MIA mouse model of autism so please do not take this post as such. I am very keen to see some replication studies done in other mouse and other anim... Read more »

Schwartzer JJ, Careaga M, Onore CE, Rushakoff JA, Berman RF, & Ashwood P. (2013) Maternal immune activation and strain specific interactions in the development of autism-like behaviors in mice. Translational psychiatry. PMID: 23481627

Naviaux, R., Zolkipli, Z., Wang, L., Nakayama, T., Naviaux, J., Le, T., Schuchbauer, M., Rogac, M., Tang, Q., Dugan, L.... (2013) Antipurinergic Therapy Corrects the Autism-Like Features in the Poly(IC) Mouse Model. PLoS ONE, 8(3). DOI: 10.1371/journal.pone.0057380

March 14, 2013
09:30 PM
146 views

Should We Use Immobilization For Penetrating Injuries To The Neck - Comments at Paramedic's Edge

by Rogue Medic in Rogue Medic

Are you required to backboard a patient who was shot in the neck no matter how the patient is presenting? [1]

That is the entire question that was asked at The Paramedic’s Edge.

There are really several questions being asked.... Read more »

Stuke, L., Pons, P., Guy, J., Chapleau, W., Butler, F., & McSwain, N. (2011) Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations From the Prehospital Trauma Life Support Executive Committee. The Journal of Trauma: Injury, Infection, and Critical Care, 71(3), 763-770. DOI: 10.1097/TA.0b013e3182255cb9

. (2001) The cause of neurologic deterioration after acute cervical spinal cord injury. Journal of Neurosurgical Anesthesiology, 13(3), 280-281. DOI: 10.1097/00008506-200107000-00022

March 14, 2013
12:54 PM
177 views

NSAIDs mobilize hematopoietic stem cells into the blood stream

by beredim in Stem Cells Freak

A recent study on mice, baboons and few volunteering patients revealed that a non-steroidal anti-inflammatory drug (NSAID) called meloxicam increases significantly the number of hematopoietic stem cells entering the blood stream. The study can potentially help patients requiring a hematopoietic stem cell (HSC), most notably leukemia victims. The study was carried out by researchers, led by Louis Pelus, at Indiana University's School of MedicineFull Story... Read more »

Hoggatt, J., Mohammad, K., Singh, P., Hoggatt, A., Chitteti, B., Speth, J., Hu, P., Poteat, B., Stilger, K., Ferraro, F.... (2013) Differential stem- and progenitor-cell trafficking by prostaglandin E2. Nature. DOI: 10.1038/nature11929

March 14, 2013
07:12 AM
199 views

Ejaculating Every Day Keeps the Doctor Away?

by Carian Thus in United Academics

This image, spreading over the Internet, suggests that frequent ejaculation lowers the risk of prostate cancer with one third. But is it also true? We checked the original research paper to find out.
... Read more »

Giles, G., Severi, G., English, D., McCredie, M., Borland, R., Boyle, P., & Hopper, J. (2003) Sexual factors and prostate cancer. BJU International, 92(3), 211-216. DOI: 10.1046/j.1464-410X.2003.04319.x

March 13, 2013
10:12 AM
150 views

ECT Reverses Depression Brain Connectivity Deficit

by William Yates, M.D. in Brain Posts

Electroconvulsive treatment (ECT) remains one of the most effective treatments for major depressive disorder (MDD).The mechanism of action for ECT in MDD is unclear. Research targeting brain changes in ECT is an important pathway to understanding the mechanism of action for ECT.Patients with MDD show disruptions in brain functional connectivity as measures by functional magnetic resonance imaging (fMRI). The connectivity abnormalities in MDD have included changes in limbic, cortical and default networks.Abbott and colleagues recently published an analysis of resting state connectivity changes with ECT in a series of subjects with MDD. Key elements of the design of their study included:Subjects: 12 subjects with MDD with an average age of 66 years including three subjects with psychotic depressionECT parameters: Subjects received an average of 11 standard right unilateral or bitemporal treatmentsfMRI: Functional connectivity measures were assessed before and after ECT using independent component analysis techniquesStatistical analysis: Connectivity measures were compared within subjects pre and post ECT using paired t-tests. Additionally, subjects were compared to a group of non-depressed individual using two-sample t-tests The key findings from the study included:At baseline depressed subjects showed deficits in connectivity involving the posterior default mode network, the dorsomedial prefrontal cortex and the dorsolateral prefrontal cortexRemission of depression in ECT-treated subjects reversed the baseline deficits in posterior default mode network, the dorsomedial prefrontal cortex and the dorsolateral prefrontal cortexRemission with ECT was specifically linked to changes functional connectivity in the dorsomedial prefrontal cortex and the dorsolateral prefrontal cortex The authors note their findings may be useful in the eventual development of identifying MDD subjects most likely to benefit from ECT. Additionally, they note research into the mechanism of action of ECT may provide insight into less intense and more accessible treatment approaches such as transcranial magnetic stimulation therapies.This is an important study and holds promise that better targeted treatment for MDD may include non-pharmacologic brain stimulation approaches.Interested readers can learn more about the specifics of this manuscript by clicking on the link below.Photo of black-bellied whistling ducks from Venice, FL rookery from the authors files.Abbott, C., Lemke, N., Gopal, S., Thoma, R., Bustillo, J., Calhoun, V., & Turner, J. (2013). Electroconvulsive Therapy Response in Major Depressive Disorder: A Pilot Functional Network Connectivity Resting State fMRI Investigation Frontiers in Psychiatry, 4 DOI: 10.3389/fpsyt.2013.00010... Read more »

Abbott, C., Lemke, N., Gopal, S., Thoma, R., Bustillo, J., Calhoun, V., & Turner, J. (2013) Electroconvulsive Therapy Response in Major Depressive Disorder: A Pilot Functional Network Connectivity Resting State fMRI Investigation. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2013.00010

March 13, 2013
05:32 AM
141 views

Just say NO to sapropterin for autism

by Paul Whiteley in Questioning Answers

Actually the title of this post is a bit of a misnomer.I'm not really asking readers to say 'no' to sapropterin, otherwise known as tetrahydrobiopterin or BH4, for autism as if it were some kind of Zammo-esque drugs in the toilet scenario (note: for anyone born post-Grange Hill golden era or for my non-UK readers, you might want to follow this link to see what I'm going on about). But neither am I saying yes, as per my prime directive on this blog: no medical or clinical advice given or intended (resistance is futile... and all that).Mr Bronson / Admiral Ozzel @ BBC NewsThe 'no' actually refers to NO - nitric oxide - and in particular the findings reported by Richard Frye and colleagues* (including Jill James yet again) on the potential involvement of NO metabolism in the behavioural changes noted when BH4 was introduced to a small cohort of children diagnosed with autism. I think we might have seen shadows of this study presented at IMFAR 2012.OK, a quick description might be in order first. I've covered BH4 previously on this blog (see here) and some of the various roles that it plays; not least in its co-factor duties for the metabolism of some important aromatic amino acids eventually into things like neurotransmitters. Also not forgetting the potential role for BH4 in relation to managing conditions like PKU also (see here). Similarly, NO has also appeared on this blog before (see here). The Frye paper stresses the important role that BH4 has in the production of NO.A few details from the Frye paper bearing in mind it is open-access:Starting with 10 participants (aged 2-6 years) diagnosed with an autism spectrum disorder (ASD) whose parents agreed "to not change any traditional or alternative medical or behavioral therapy during the study", various measures of behaviour and language function were charted over the course of a 16-week open-trial of BH4 (Kuvan).Alongside the behavioural and psychometric measures used (which included the VABS and PLS), CSF samples were collected via lumbar puncture (not normally recommended because of its invasiveness) and blood samples used to measure for various marker compounds including BH4, the amino acids L-arginine and L-citrulline and everyone's favourite redox coverboy/covergirl, glutathione.Results: bearing in mind that this was an open-trial and that no control group or placebo arm was used, the authors report some interesting changes to various parameters. So language (receptive at least) showed a significant improvement across the group across the testing periods (baseline, 8 weeks, 16 weeks). Some of the VABS subscales also indicated some positive changes (albeit one of them, VABS personal daily living, presented with a p-value of 0.061, I assume to denote Nick Berry style 'we nearly made it').The biological stuff: well there was an increase in the reduced-to-oxidised glutathione ratio (good thing) and a decrease in levels of 3-Chlorotyrosine (3CT) (also a good thing) over the course of intervention, positive in terms of oxidative stress (redox status) and the presence of "reactive nitrogen species" respectively (see below).Findings also pointed to "a fundamental change in pterin metabolism" coinciding with BH4 supplementation. I won't pretend to know all the ins-and-outs but it all has to do with supplementation modifying the reduced-to-oxidised pterin ratio and degradation of BH4 onwards to the appearance of something called peroxynitrite which is not particularly a good thing. I think this article** (open-access) might explain it a little better than I could.The authors also reported that despite no significant change in NO metabolism markers (arginine and citrulline, and their ratio), it did appear that baseline levels of these compounds were allied to behavioural outcomes. Specifically improvements on the behavioural parameters "were related to higher baseline arginine and arginine-to-citrulline ratio".Importantly, BH4 supplementation was generally well tolerated with "only one patient discontinuing the medication because of mild adverse effects".Yes, this was a very small trial, and yes again, there was no control group, no placebo and no blinding. It is preliminary work, of that there is no doubt. I find it a little unusual that the authors also chose HPLC with electrochemical detection when it came to the measurement of important metabolites like CSF levels of BH4. A little bit '80s' if you'll forgive me, given the startlingly increased precision offered by mass spec and NMR techniques as exemplified by papers like this one. Indeed even more odd that LC-MS was used for the analysis of amino acids: why not all metabolites? It should also be noted that Dr Frye is listed as having a potential conflict of interest in this paper via receipt of funding from the producers of Kuvan for this trial; not that this should or did influence the findings in any way, shape or form.Nevertheless there are a number of interesting observations which might require some follow-up from this paper. That for example, a higher baseline level of arginine seemed to quite strongly correlate (r=0.91) with the PLS total raw score (language) as a result of BH4 supplementation is a point worth following up, particularly in these days emphasising the identification of best- and non-responders to various interventions for the autisms. The implication being that "only some of the participants were able to significantly change their NO metabolism with the dose o... Read more »

Frye RE, Delatorre R, Taylor HB, Slattery J, Melnyk S, Chowdhury N, & James SJ. (2013) Metabolic effects of sapropterin treatment in autism spectrum disorder: a preliminary study. Translational psychiatry. PMID: 23462988

March 12, 2013
05:00 PM
148 views

Mesenchymal stem cells may aid in Diabetic foot ulcers

by beredim in Stem Cells Freak

In a recent preclinical study on rabbits, researchers from the National University of Ireland Galway showed that administering allogeneic mesenchymal stem cells (MSCs) has the potential to speed up wound recovery in diabetic patients. The study may help one day help treat wounds of diabetic patients, especially the ones presenting with diabetic foot ulcers, which often lead to debilitating leg amputations.Full Story... Read more »

O'Loughlin, A., Kulkarni, M., Creane, M., Vaughan, E., Mooney, E., Shaw, G., Murphy, M., Dockery, P., Pandit, A., & O'Brien, T. (2013) Topical Administration of Allogeneic Mesenchymal Stem Cells Seeded in a Collagen Scaffold Augments Wound Healing and Increases Angiogenesis in the Diabetic Rabbit Ulcer. Diabetes. DOI: 10.2337/db12-1822

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