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  • March 20, 2017
  • 11:25 AM
  • 122 views

Opioids, Benzos and Risk for Overdose

by William Yates, M.D. in Brain Posts

The evolving epidemic of opioid overdose and overdose deaths is receiving increased public and research attention.Opioids overdoses and overdose deaths are often unintentional or accidental. It has been known that concurrent use of opioids with alcohol or benzodiazepines (i.e. Valium or Xanax) increases risk for overdose toxicity.A recent study published in the British Medical Journal confirmed the association of concurrent benzodiazepine prescription with opioid overdose.This research team examined confidential medical database records from over 500,000 patients in the U.S.Those that were enrolled in a medical plan including pharmaceutical benefits between 2001 and 2013 were included in the analysis.The key findings from the study included the following:The percentage of opioid users concurrently using a benzodiazepine rose from 9% of opioid users in 2001 to 17% of opioid users in 2013Chronic users of opioids nearly doubled their risk of opioid overdose if they took a concurrent benzodiazepine medication (4/100 persons/year to 7-8/100 person years)If the association is causal, the authors estimate emergency room visits and inpatient admissions could be reduced by 15% by stopping concurrent prescriptionsThis association of risk seems reasonable given the toxicities of opioids and benzodiazepines. Both at higher doses decrease respiratory drive potentially contributing to hypoxia and death.The authors note several take home messages for clinicians. Chronic users of benzodiazepines should be prescribed opioids cautiously if at all. Opioid prescriptions should be for short periods of time and low doses for chronic benzodiazepine patients.Likewise, if chronic opioids are necessary they should rarely be combined with intermittent or long-term benzodiazepine prescriptions.Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.Photo of NCAA men's basketball tournament in Tulsa, OK is from my files.Follow me on Twitter WRY999Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, & Mackey S (2017). Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ (Clinical research ed.), 356 PMID: 28292769... Read more »

  • March 15, 2017
  • 12:57 PM
  • 155 views

Emotional Intelligence and the Physician

by William Yates, M.D. in Brain Posts

Emotional intelligence (EI) is characterized by the ability to recognize emotional states in self and in others.This emotional recognition may be helpful in guiding behavior and in improving interpersonal relationships.It seems logical on a face validity level to assume that higher levels of EI would be good in the selection of students for medical school.However, there are few studies assessing EI in physicians. There are fewer studies that examine whether EI influences physician behavior, patient satisfaction and ultimately patient outcomes.Rhamzan Shahid and colleagues at the Stritch School of Medicine at Loyola University Medical examined levels of EI in a group of resident physicians in training in the specialties of pediatrics and combined internal medicine-pediatrics.This was a cross-sectional study design that included comparison of residents in the first two years of training versus those in years 3 and 4. The main findings included the following:Residents tended to score high on EI overall with the highest scores on impulse control and the interpersonal composite subscaleResidents scored relatively lower on assertiveness and independence subscalesAssertiveness subscale scores were higher in the more senior residentsEmpathy scores were lower in the the more senior residentsIncreased assertiveness sub-scale scores in more senior residents might be a good thing, possibly indicating a growth in confidence and skill level. This cannot be stated definitely as this study was not longitudinally designed.The lower empathy sub-scale scores in senior residents is an interesting finding. Some might argue it is a negative consequence of training and reflects an increasing disenchantment with being a physician. The authors of the study encourage interventions to "ensure they (resident physicians) do not lose empathy".However, it may be that in a group selected for high empathy, a reduction may also represent a normal maturational process. Maybe high empathy contributes to higher physician distress in the clinical setting and potentially more burnout and depression. Maybe empathy levels that are too high produce emotional states that actually impair physician behavior and reduce effectiveness of clinical decision making.These possibilities should prompt studies correlating EI with patient satisfaction, patient outcome, physician satisfaction with medicine and their specialty and risk for physician burnout.The manuscript reviewed and commented on today is available in free full-text format by clicking on the link in the citation below.Follow me on Twitter @WRY999Photo of the lesser scaup duck is from my personal photography files.Shahid, R., Stirling, J., & Adams, W. (2016). Assessment of Emotional Intelligence in Pediatric and Med-Peds Residents Journal of Contemporary Medical Education, 4 (4) DOI: 10.5455/jcme.20170116015415... Read more »

  • March 10, 2017
  • 06:05 AM
  • 145 views

Spontaneous Pneumothorax and air travel in BHD Syndrome

by Joana Guedes in BHD Research Blog

Previous studies show that BHD syndrome causes spontaneous pneumothorax (SP) in 24-38% of patients, with a recurrence rate of up to 75% (Toro et al., 2007; Toro et al., 2008; Houweling et al., 2011). A common preventative strategy used following an initial SP in patients with BHD is pleurodesis, however, its efficacy in preventing recurrent episodes is not well known. Due to the pressure changes during air travel, cystic air spaces expand and compress in the thorax possibly leading to cyst rupture and pneumothorax. In their new study, Gupta et al. (2017) evaluate the risk of pneumothorax, the efficacy of pleurodesis, and the safety of air travel in patients with BHD.... Read more »

Gupta N, Kopras EJ, Henske EP, James LE, El-Chemaly S, Veeraraghavan S, Drake MG, & McCormack FX. (2017) Spontaneous Pneumothoraces in Patients with Birt-Hogg-Dubé Syndrome. Annals of the American Thoracic Society. PMID: 28248571  

  • March 7, 2017
  • 11:01 AM
  • 149 views

Can Older Drivers Benefit From Training?

by William Yates, M.D. in Brain Posts

Older drivers are over-represented in motor-vehicle driving accidents.The lowest rate of fatal vehicle crashes per 100 million miles driven is found in drivers between the ages of 30-69 years of age.Fatal vehicle driving rates per miles driven is 4 to 5 times higher in drivers over 80 years of age. (IIHS.org data)So can older drivers be trained or educated to improve their safety (and the safety o those around them)?A recent randomized controlled trial examined an educational intervention in drivers 75 years and older in Australia.This intervention targeted a reduction or avoidance of seven high-risk driving situations:Night drivingDriving in the rainRight-hand (left-hand in U.S.) turns across oncoming trafficDriving during heavy trafficDriving on high-speed roadsDriving during rush hourDriving aloneThe trial found participants in the intervention group showed a greater readiness to make changes that could reduce high-risk accident exposure. However, the intervention group did not reduce total miles driven in the year following the intervention.Additionally, the intervention group did not increase their use of alternate transportation (i.e. buses or cabs) in the follow-up period.This trial showed limited response to educational training in an older-aged drivers population. Alternate approaches (adoption of high safety feature vehicles, use of newer alternative driving programs like Uber, cognitive training programs to improve psychomotor speed) may hold more promise in reducing fatal accident rates in elderly populations.Follow me on Twitter WRY999Photo of moon is from my photography files.Coxon K, Chevalier A, Brown J, Clarke E, Billot L, Boufous S, Ivers R, & Keay L (2016). Effects of a Safe Transportation Educational Program for Older Drivers on Driving Exposure and Community Participation: A Randomized Controlled Trial. Journal of the American Geriatrics Society PMID: 27943260... Read more »

  • March 2, 2017
  • 12:19 PM
  • 163 views

Improving Hearing-Aid Access in Older Adults

by William Yates, M.D. in Brain Posts

There are significant barriers to widespread use of hearing-aids in older adults with age-related hearing loss.Sensitivity to the stigma of wearing a hearing-aid is one barrier.Cost is another significant barrier. In the U.S., bilateral hearing-aid purchase amounts to a cost of $2400 to $5800. This cost is typically not covered by Medicare or other health insurance plans.I ran into a interesting manuscript on looking at an alternative less costlier approach to hearing-aid selection and purchase.Larry Humes and colleagues compared the outcome of a older adults randomized to one of three hearing aid interventions. One was standard audiology best practices, one was a placebo hearing-aid (device without amplication). A third alternative was also studied that was called an over-the-counter (OTC) intervention. This intervention included the following elements:Self-selection of hearing aid tips, tubes and devicesThree types of hearing-aids were provided for selection. Each was programmed with one of the three most common patterns of hearing lossSubjects tried various combinations of devices and listened to sample sounds of speech, music and environmental soundsSubjects were assessed after a six week trial for hearing function, satisfaction and desire to keep the deviceSubjects were randomized to pay a fee of $3500 versus $600 for devices that were identical in features. This allowed for study of the effect of cost on outcome measures.Interestingly, the OTC intervention resulted in outcomes (i.e. hearing improvement) that were very similar to audiology best practices. However, OTC subjects showed a slightly lower satisfaction score and were somewhat more likely to return devices after the study for a refund. Higher price also predicted return for refund following the study.The authors conclude:"Efficacious OTC service-delivery models (and devices) may increase accessibility and affordability of hearing aids for millions of older adults, but further research is required to evaluate various devices and approaches as well as to examine the generalization of the findings from this clinical trial."This study provides an impetus for further study of the OTC model in hearing aid selection and use. Cost issues appear to continue to be a significant barrier to wider hearing-aid access.Readers with more interest in this study can access the free full-text manuscript by clicking on the link in the citation below.Photo of wood duck is from my photography file.Follow me on Twitter WRY999Humes, L., Rogers, S., Quigley, T., Main, A., Kinney, D., & Herring, C. (2017). The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial American Journal of Audiology DOI: 10.1044/2017_AJA-16-0111... Read more »

  • February 28, 2017
  • 10:43 AM
  • 165 views

Outcome in Early Education Interventions (Educare)

by William Yates, M.D. in Brain Posts

Despite centuries of experience in education, the best time to start formal education is still under debate. Is five years of age too old? Is three years of age too early?One issue with early education interventions is the potential for catch-up in children starting school later. In other words, early gains with younger children may evaporate overtime.One recent research study examines effectiveness of a child development intervention known as Educare. Educare seeks to reduce the achievement gap between low-income and economically advantaged peer children.Educare is operational in 21 cities in the United States. It is somewhat unique in entering children as infants (<1 year of age) for an intensive ongoing child and parent intervention. A recent study randomized 239 infants to receive Educare or no intervention. This study found superiority for the Educare children following one-year of intervention in the following domains:Expressive communicationAuditory comprehensionProblem behaviors (reduced level)Positive parental-child interactionThe authors note the size of the effects were in the modest to medium strength.  Additionally, they note they cannot know how enduring the effects of this type of intervention might be.Additional longitudinal assessments will be needed to examine the potential of catch up in the control group. Studies of elementary, middle and senior high achievement will be needed.Aggressive early intervention programs are expensive and will need to be validated before efforts to expand this type of early childhood intervention.Follow me on Twitter WRY999Photo of children playing on the beach at sunset is from my photography files.Yazejian, N., Bryant, D., Hans, S., Horm, D., St. Clair, L., File, N., & Burchinal, M. (2017). Child and Parenting Outcomes After 1 Year of Educare Child Development DOI: 10.1111/cdev.12688... Read more »

Yazejian, N., Bryant, D., Hans, S., Horm, D., St. Clair, L., File, N., & Burchinal, M. (2017) Child and Parenting Outcomes After 1 Year of Educare. Child Development. DOI: 10.1111/cdev.12688  

  • February 10, 2017
  • 07:19 AM
  • 201 views

BHD in patients undergoing chest CT and characteristics of BHD in Korea.

by Joana Guedes in BHD Research Blog

To date, there have been no prospective studies attempting to diagnose BHD syndrome or literature reviews on BHD in Korea. Park et al. (2017) address this in their new study that aims to detect BHD prospectively in patients undergoing chest computed tomography (CT) scans and to classify the characteristics of BHD in Korea.... Read more »

  • February 3, 2017
  • 11:22 AM
  • 96 views

Brain Shape and Personality Type

by William Yates, M.D. in Brain Posts

Personality has often been conceptualized a a human feature shaped largely by nurture and environment.Unlike major neuroscience medicine disorders, personality features have been considered less influenced by brain structure and genetic influences.A recent brain structure (morphology) study puts these assumptions at risk.Roberta Riccelli along with colleagues in Italy and Florida State University studied brain structural features across 507 participants in the Human Connectome Project.All subjects completed a personality assessment using the five-factor model (FFM), a widely validated measure of five personality features.Here were the key findings from the study for each personality feature:High neuroticism: increased cortical thickness in supramarginal gyrus, superior parietal cortex, superior temporal cortex, superior prefrontal cortex and frontal pole. Also decreased surface area of superior parietal cortex, middle temporal gyrus, cuneus, superior prefrontal cortex and frontal pole.High extraversion: increased cortical thickness in precuneus and lower surface area and volume of superior temporal gyrus. Also lower cortical volume of entorhinal cortex and greater folding in the fusiform gyrus.High openness: lower cortical thickness in the postcentral gyrus, rostral anterior cingulate cortex, superior prefrontal cortex and lateral occipital gyrus. Increased surface area, cortical volume and folding in a series of parietal, temporal and frontal regions.High Agreeableness: Decreased cortical thickness, surface area, cortical volume and local gyrus formation in frontotemporal regions. Increased local gyrus formation in inferior temporal gyrus.High concientiousness: increased cortical thickness in prefrontal cortex along with lower surface area and cortical volume in middle/inferior temporal gyrus and lateral occipital gyrus regions. Decreased cortical folding in prefrontal gyrus and several other regions.These findings are of note for the diffuse number and types of structural correlates of personality features in man. The authors note the importance of the prefrontal cortex in personality:  "significantly evolved in human beings and great apes relative to other species. This could reflect that several FFM personality traits are linked to high-level socio-congnitive skills as well as the ability to modulate "core" affective responses."Look for more structural, functional and genetic study of the five factor model of personality features in human to come.Readers with more interest in this research can access the free full-text manuscript by clicking on the PMID link in the citation below.Follow the author on Twitter WRY999Photo of bald eagle head in profile is from the author's bird photography file. Riccelli R, Toschi N, Nigro S, Terracciano A, & Passamonti L (2017). Surface-based morphometry reveals the neuroanatomical basis of the five-factor model of personality. Social cognitive and affective neuroscience PMID: 28122961... Read more »

  • January 27, 2017
  • 05:13 AM
  • 452 views

TSC1 expression is affected by VHL alterations and HIF-1α production in clear-cell RCC

by Joana Guedes in BHD Research Blog

VHL genetic alterations do not affect the production of HIF-α in clear-cell renal cell carcinoma (ccRCC). However, their effects on tuberous sclerosis proteins (TSC1/2) and heat shock protein 90 (Hsp90) expression are currently unknown. In a recent study, Damjanovic et al. (2016) evaluated the impact of VHL genetic alterations and HIF-α production on the expression of TSC proteins and Hsp90 in 47 sporadic ccRCCs and corresponding normal tissues.... Read more »

  • January 25, 2017
  • 12:06 PM
  • 285 views

Jet Lag and Baseball (MLB) Performance

by William Yates, M.D. in Brain Posts

Abrupt changes in the biological clock or circadian rhythm are noted to contribute to significant cognitive and psychomotor impairments.One practical area for this effect to potentially be important is in the area of sports performance.Alex Song and colleagues recently completed an interesting study of major league baseball (MLB) performance related to team travel patterns.The major leagues are divided into regional divisions (western, central and eastern) to minimize length of travel to and from away games. Nevertheless, significant travel continues to be part of the league and travel across the four U.S. time zones is not uncommon.This study included all MLB games between 1992-20o1. Baseball performance across a variety of variables was examined with attention to effects linked to travel and jet lag.The key findings from the study included:Most major jet lag performance impairment was noted for travel west to eastBoth east and west travel produced an increase in home runs allowedOffensive slugging percentage declines after teams travel home from away gamesThe authors conclude that starting pitchers appear to impacted by travel resulting in giving up more home runs following jet lag.The suggest teams might want to consider sending projected starting pitchers to away games a few days prior to the team's arrival.This is an important manuscript that demonstrates potential practical psychomotor effects of jet lag. Readers with more interest in the topic can access the free full-text manuscript by clicking on the PMID link in the citation below.Follow me on Twitter @WRY999Photo of Albert Pujols hitting is spring training is from the author's files.Song A, Severini T, & Allada R (2017). How jet lag impairs Major League Baseball performance. Proceedings of the National Academy of Sciences of the United States of America PMID: 28115724... Read more »

Song A, Severini T, & Allada R. (2017) How jet lag impairs Major League Baseball performance. Proceedings of the National Academy of Sciences of the United States of America. PMID: 28115724  

  • January 23, 2017
  • 10:59 AM
  • 262 views

Processing Speed Cognition in Elderly: Clinical Trial

by William Yates, M.D. in Brain Posts

Processing speed declines significantly with age and contributes to impairment and disability in old age.There is little known about whether age-related processing speed decline can be slowed with interventionA recent clinical trial by a Japanese group targeted processing speed training in a group of 72 elderly.This study found significant effects for a daily 15 minute processing speed training game over 4 weeks.In contrast to a control group, the intervention group found specific improvement in processing speed. Additionally, the study found a lower score on depressive mood symptoms following processing speed training. The game used in this study was specifically designed for the study and tested in pilot populations for the study.Readers with more interest in this study can access the free full-text manuscript by clicking on the link in the citation below.Follow the author on Twitter @WRY999Photo of gulf fritillary butterfly is from the author's files.Nouchi R, Saito T, Nouchi H, & Kawashima R (2016). Small Acute Benefits of 4 Weeks Processing Speed Training Games on Processing Speed and Inhibition Performance and Depressive Mood in the Healthy Elderly People: Evidence from a Randomized Control Trial. Frontiers in aging neuroscience, 8 PMID: 28066229... Read more »

  • January 20, 2017
  • 05:19 AM
  • 242 views

RCC: Updates on Guidelines for Adjuvant Therapy and new drug combination

by Joana Guedes in BHD Research Blog

The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) guidelines panel has recently updated its recommendation on adjuvant therapy with sunitinib in non-metastatic RCC after surgical tumour removal (Bex et al., 2016). These clinical guidelines provide urologists with evidence-based information and recommendations for the management of RCC and the panel includes urological surgeons, oncologists, pathologists, radiologists and patient advocates. Based on the conflicting results of two available clinical studies (ASSURE and S-TRAC), the panel rated the quality of the evidence of the trials, the harm-to-benefit ratio, the patient preferences and the costs. As a result, the EAU panel, including representatives from a patient advocate group (International Kidney Cancer Coalition) voted and reached a consensus recommendation that adjuvant therapy with sunitinib for patients with high-risk RCC after nephrectomy should not be given.... Read more »

  • January 13, 2017
  • 05:11 AM
  • 263 views

Nutrient-dependent FNIP degradation regulates FLCN localization and promotes renal cancer progression

by Joana Guedes in BHD Research Blog

Birt-Hogg-Dubé (BHD) syndrome is a rare disorder caused by mutations in FLCN and associated with increased risk of kidney cancer. It has been shown that FLCN-interacting protein 1 and 2 (FNIP1 and FNIP2) double knockout mice, like the FLCN knockout mice, develop renal carcinoma (Hasumi et al., 2015). However, the molecular mechanisms linking FNIP and FLCN remain unknown. In their new study, Nagashima et al. (2016) show that FNIP2 undergoes proteasome-dependent degradation via β-TRCP and Casein Kinase 1 (CK1)-directed ubiquitination in a nutrition-dependent manner. Degradation of FNIP2 leads to lysosomal dissociation of FLCN and association of mTOR, which promotes the proliferation of renal cancer cells.... Read more »

  • December 16, 2016
  • 05:25 AM
  • 334 views

Patient participation in clinical trials

by Joana Guedes in BHD Research Blog

Clinical trials are crucial to help doctors and scientists understand how to safely treat a particular condition, to evaluate new treatments and to test drug safety and efficacy. They have an important role in every step of managing a condition with different clinical trials helping with prevention, diagnosis, treatments and follow-up support.... Read more »

  • December 6, 2016
  • 12:07 PM
  • 392 views

Online Insomnia Therapy Effective in Clinical Trial

by William Yates, M.D. in Brain Posts

Insomnia of sufficient severity to meet clinical significance is estimated to affect up to 20% of the general population.This makes insomnia an important public health challenge.Effective, inexpensive and accessible programs to treat insomnia are needed.One recent controlled clinical trial supports the promise of an online intervention that incorporates key elements of cognitive behavioral therapy (CBT).Lee Ritterband and colleagues at the University of Virginia recently published a controlled clinical trial of online CBT in 303 adults with chronic insomnia. The key elements of design in their study included the following elements:Subjects: Adults with chronic insomnia defined as 30 minutes of insomnia (at onset or during night) 3 nights per week for the last 6 months. Subjects were also required to have total sleep times of 6.5 hours per night or less. Additionally, the insomnia was required to produce significant distress or impairment in function. Subjects had to have a reliable source of access to the internet.Intervention: The experimental intervention was a online automated program known as "Sleep Healthy Using the Internet (SHUTi). This intervention is a weekly internet-based program lasting 6 weeks. The program mimics elements of face-to-face CBT for insomnia. The control intervention consisted of a non-tailored internet-based informational program about insomnia.Outcome Measures: Self-report measure known as the Insomnia Severity Index (ISI) along with sleep diaries. The study demonstrated a statistically significant improvement in multiple sleep measures including the ISI score, duration of onset insomnia and duration of wake time after sleep onset with SHUTi compared to control.SHUTi subjects showed a reduction of sleep onset insomnia time from an average of around 45 minutes at baseline to about 20 minutes at one year follow up.Interestingly there was no difference between experimental treatment and control in total sleep time. However, both groups showed about a 50 minute increase in total sleep time at one year of follow-up.This study is important because it not only demonstrated a significant therapeutic effect for SHUTi but this effect was maintained for a full year. This supports the durability of the the therapeutic effect for this intervention.The authors note limitations to the study include a sample that tended to be highly educated with internet access. Additionally, it was impossible for complete blinding as some subjects likely could guess their assignment based on the content of their internet intervention.Readers with more interest in the SHUTi program can access the official site HERE.  The site allows completing the online program for a fee of $135. Readers can access the free full-text manuscript by clicking on the link located in the citation below.Follow me on Twitter WRY999Photo of Christmas lights at Rhema in Tulsa Oklahoma is from my files.Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, Quigg MS, Cohn WF, & Morin CM (2016). Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. JAMA psychiatry PMID: 27902836... Read more »

  • November 29, 2016
  • 11:24 AM
  • 403 views

Your Brain On God: Reward and Motivation

by William Yates, M.D. in Brain Posts

William James authored a seminal book titled The Varieties of Religious Experience: A Study in Human Nature that was published in 1902.In this work, James reviewed the nature of religious experiences and noted a lack of scientific inquiry into this human phenomenon.James would have been extremely interested in a recent scientific inquiry into the religious experience from brain researchers at the University of Utah and Harvard University.In this study, functional magnetic resonance imaging (fMRI) was used to study the brain during a religious experience cue in a group of 19 individuals who were devout Mormons.The key elements of this study design included:Subjects: 19 young adults (7 female, 12 male) reporting weekly church attendance and daily experience of spirtitual feelingsExperimental cues: Control cues: resting state and audiovisual control. Religious experience cues: quotations from religious authorities, a period of prayer and scripture readingBrain imaging/analysis: Standard fMRI imaging using a 3T MRI scanner with analysis of areas of activation with religious experience compared with control activationsThe research team was able to identify significant brain regional areas of activation with religious cue stimulation.The authors summarized their finding in the discussion section of the manuscript:"We demonstrated in a group of devout Mormons that religious experience, identified as "feeling the Spirit," was associated with consistent brain activation across individuals within bilateral nucleus accumbens, frontal attentional, and ventromedial prefrontal cortical loci."The figure above notes the location of the key nucleus accumbens region of the brain known to be important in the brain reward response network. This brain region has been identified as a key region activated by a variety of reward experiences including feeling love, music appreciation and the euphoria associated with euphoric states induced by stimulants such as cocaine and methamphetamine.The authors propose that the observed activation of the frontal and prefrontal cortex regions may indicate a network that includes individual perception of salience of religious experience and "representation of affective meaning for the religious stimuli".This is an important study of brain effects of the religious experience. The results show exposure to religious stimuli in devout individuals activates a non-specific powerful reward response. This reward response may contribute to the motivational mechanism for doctrinal beliefs and church attendance.It is likely this type of response is not limited to devout Mormons but similar in other Christian believers and non-Christian believers where a "spiritual experience" is part of the religious experience.Readers with more interest in this research can access the full free-text manuscript by clicking on the PMID link in the citation below.Figure is an iPad screenshot from the app 3D Brain.Follow me on Twitter @WRY999Ferguson MA, Nielsen JA, King JB, Dai L, Giangrasso DM, Holman R, Korenberg JR, & Anderson JS (2016). Reward, Salience, and Attentional Networks are Activated by Religious Experience in Devout Mormons. Social neuroscience PMID: 27834117... Read more »

Ferguson MA, Nielsen JA, King JB, Dai L, Giangrasso DM, Holman R, Korenberg JR, & Anderson JS. (2016) Reward, Salience, and Attentional Networks are Activated by Religious Experience in Devout Mormons. Social neuroscience. PMID: 27834117  

  • November 21, 2016
  • 11:10 AM
  • 404 views

Benefits of Physical Activity in Parkison's Disease

by William Yates, M.D. in Brain Posts

Parkinson's disease (PD) is a progressive neurodegerative disorder estimated to affect 7 to 10 million individual worldwide.The primary mechanism for Parkinson's disease is a reduction in the neurotransmitter dopamine in the midbrain region of the substantia nigra highlighted in red in the figure.PD impairs motor and cognitive functions and leads to significant decline in psychosocial functioning.Drugs for PD can be effective in reversing and slowing the progression of the illness. However, response is often limited with relapse over time.Physical exercise appears to be an adjunctive option in the multidisciplinary treatment of PD. Martine Lauze along with colleagues in France and the U.S. recently conducted a literature review of this topic.Their review covered 106 published papers between 1981 and 2015. A total of 868 outcome measures were examined. The key findings from their review included:Physical activity is most effective in improving physical capabilitiesPhysical activity is also effective in improving physical and cognitive function capacityPhysical activity appears to improve flexibilityLesser response to physical activity was found in the domains of PD clinical symptoms, depression, psychosocial function They noted clinical PD symptoms of bradykinesia, freezing of gait and tremor were very resistant to physical acitivity interverventions. On a more hopeful note, gait and postural alterations in PD are more responsive to physical activity.Physical therapy protocols that appear to have the best chance of producing improving PD include:Gait training, walking for increased speed and enduranceStrength training for improvement muscle mass in legs and armsFlexibility exercises for upper, lower extremities and trunkInterventions to reduce risk of falls (balance)The evidence supports routine referral for physical therapy and physical rehabilitation in those suffering from Parkinson's disease.You can access the free full text manuscript in this post by clicking on the citation link below.The figure in this post is a Creative Commons file from Wikipedia authored:By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7157181Follow me on Twitter.Lauzé M, Daneault JF, & Duval C (2016). The Effects of Physical Activity in Parkinson's Disease: A Review. Journal of Parkinson's disease, 6 (4), 685-698 PMID: 27567884... Read more »

Lauzé M, Daneault JF, & Duval C. (2016) The Effects of Physical Activity in Parkinson's Disease: A Review. Journal of Parkinson's disease, 6(4), 685-698. PMID: 27567884  

  • November 18, 2016
  • 07:25 AM
  • 347 views

Mutated mTOR regulator RRAGC proteins decrease interactions with FLCN

by Joana Guedes in BHD Research Blog

Follicular lymphoma is a B-cell lymphoma that remains incurable with conventional therapies. Ying et al. (2016) present a new study exploring the biological and genetic features of follicular lymphoma and identifying potential new therapeutic targets. The authors identified recurrent mutations in the mTOR regulator RRAGC, a small G-protein, in approximately 10% of follicular lymphoma cases. Mutations in RRAGC localized to one protein surface area surrounding the GTP/GDP–binding sites. In stable retrovirally transfected HEK293T cells, multiple RRAGC mutations showed higher mTOR activation. A similar phenotype was observed in lymphoma cell lines and in yeast. Mutated RRAGC proteins showed increased binding to RPTOR, a binding protein for RRAG heterodimers, and decreased interactions with FLCN , a known tumour suppressor that plays a role in mTOR signalling and the causative gene of BHD syndrome.... Read more »

Ying ZX, Jin M, Peterson LF, Bernard D, Saiya-Cork K, Yildiz M, Wang S, Kaminski MS, Chang AE, Klionsky DJ.... (2016) Recurrent Mutations in the MTOR Regulator RRAGC in Follicular Lymphoma. Clinical cancer research : an official journal of the American Association for Cancer Research, 22(21), 5383-5393. PMID: 27267853  

  • November 17, 2016
  • 11:00 AM
  • 454 views

Missed Opportunities in Stroke Prevention

by William Yates, M.D. in Brain Posts

Rates of myocardial infarction and stroke have been declining over the last decade in the U.S. and Europe. However, a recent manuscript suggests there are still significant missed opportunities to prevent stroke.This manuscript presents results of review of electronic primary care records in the United Kingdom.The authors examines a group of over 29,000 subjects with a diagnosis of stroke or transient ischemic attack over a 10 year period.Records were reviewed to assess for compliance with guideline drug treatments that are proven to reduce the incidence of stroke including:Lipid-lowering drugsAnticoagulant drug use in those with atrial fibrillationAntihypertension drug use in hypertensionThe record review found that around 50% of subjects experiencing stroke or TIA had indications but were not receiving lipid-lowering or anticoagulant drugs prior to their cerebrovascular event. For hypertension, compliance with antihypertension drug use was 75% with 25% not receiving drug.One of the attractive features of this type of primary prevention is the potential for electronic records. Centralized records could be scanned with identification of high-risk patients that might benefit from targeted drug therapy. Patients and physicians could be alerted and a medical visit triggered to address the issue.The authors conclude that improving prevention efforts in these areas could potentially reduce the number of first strokes in the U.K. by 12,000 every year.Here is a table from the Creative Commons free full-text manuscript that outlines the indications and methods in the study for use of stroke prevention drugs.I am not aware of a similar type of study of stroke prevention in the United States.We do know that despite some promising trends in stroke reduction, significant geographic challenges remain.This map from the U.S. CDC shows the clustering of high stroke rates in the Southeastern portion of the U.S.Stroke prevention intervention efforts could be directed to areas of high risk for stroke as these areas are likely to yield the greatest results.Readers with more interest in this research can access the free full-text manuscript by clicking on the link in the citation below.U.S. Stroke map is from the U.S. CDC with data source the National Vital Statistics System, National Center for Health Statistics.Follow me on Twitter WRY999Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, & Marshall T (2016). Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis. PLoS medicine, 13 (11) PMID: 27846215... Read more »

  • November 15, 2016
  • 11:38 AM
  • 414 views

Celebrex Boosts Antidepressant Response

by William Yates, M.D. in Brain Posts

I ran into an interesting article at ScienceDaily providing data on a small sample size study of the anti-inflammatory drug celecoxib (Celebrex) in depression.Access the ScienceDaily report on this study by clicking HERE.This study focused on subjects with bipolar depression. All subjects were in a depressed phase and received the antidepressant drug escitalopram (Lexapro).Although only 55 subjects participated in this study, the results were significant and large. Adding Celebrex to escitalopram increased depression remission rates from 10% to 63%. I have summarized the data from the article in this attached graph.Additionally, the study team found a more rapid response to antidepressant drug therapy when Celebrex was added.I have been involved in use of anti-inflammatory agents in the treatment of bipolar depression. Dr. Jonathan Savitz and our colleagues at the Laureate Institute of Brain Research and the University of Kansas examined aspirin and minocycline in a clinical trial that has not yet been published.I have included the methods manuscript for our study that can be accessed by clicking the the link provided below.Neuroinflammation may be a contributing factor in a variety of brain disorders including depression. Better understanding of the role and treatment of inflammation may improve depression outcomes.Follow me on Twitter WRY999Figure in this post is an original figure from data abstracted from the research report.Savitz, J., Preskorn, S., Teague, T., Drevets, D., Yates, W., & Drevets, W. (2012). Minocycline and aspirin in the treatment of bipolar depression: a protocol for a proof-of-concept, randomised, double-blind, placebo-controlled, 2×2 clinical trial BMJ Open, 2 (1) DOI: 10.1136/bmjopen-2011-000643... Read more »

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