UroToday – Together with Drs. Heruti, Bechor, Justo and Galor, we studied 815 Israeli male adults of whom 305 had complete data and were included in the statistical analysis. In the analyzed population, 2.1% of people without erectile dysfunction (ED) had advanced periodontal disease (defined as recession of periodontal bone of 6 mm or more) in comparison to 9.8% of the mild ED and 15.8% of the moderate/severe ED populations, respectively. However, due to the relatively small groups, we could not present the odds ratio. We are now planning a large-scale study to further establish the association between the two conditions.

The proposed pathogenesis for this association is based on the previous findings of DNA of periodontal pathogenic bacteria in athermanous plaques and the epidemiological association between periodontal disease and coronary heart morbidity found in many world-wide large-scale studies. And since ED too was proven to be an early sign of coronary heart disease, it is reasonable to believe that extra-oral inflammation induced by periodontal bacteria might be associated with atherosclerosis and dysfunction of vessels first in the small vessels, such as the penile vasculature, and later in larger vessels such as the coronaries. Thus, as we conclude in the article, “CPD might be associated first with ED in young men and later with coronary artery disease in middle-aged men.” Laboratory studies are needed, however, to confirm that hypothesis.

Indeed, it is too early to make practical recommendations based on these initial results. However, the general population, as well as healthcare providers, have to remember that oral and periodontal health conditions as well as sexual function are both parts of individual well-being. Both conditions are linked to other serious diseases such as coronary heart disease and diabetes mellitus, thus the healthcare provider has to pay attention to early signs of impaired health or function and refer the patient for evaluation by the appropriate health care worker.

Yehuda Zadik, DMD MHA as part of Beyond the Abstract on UroToday

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to:
www.urotoday

Loyola University Hospital is launching an interdisciplinary Geriatric Fracture Program to reduce hospital stays and complications from broken hips and other age-related fractures.

Many elderly patients who break bones have underlying health conditions such as heart failure, diabetes and chronic obstructive pulmonary disease that can delay surgery. But the longer surgery is put off, the greater the risk of complications such as pneumonia and blood clots.
Moreover, elderly patients who are bedridden while awaiting surgery rapidly lose muscle strength. The longer surgery is delayed, the longer the hospitalization and rehab, and the less likely a patient will fully recover.

At Loyola, the goal is to begin surgery to repair a fracture within 24 hours whenever possible, and within 48 hours in all cases, said orthopaedic surgeon Dr. Erika Mitchell, who initiated Loyola’s Geriatric Fracture Program.

The Geriatric Fracture Program is developing protocols to assess surgical risks and address underlying health conditions, so that surgery can be performed as safely and as soon as possible, said hospitalist Dr. Theresa Kristopaitis. (A hospitalist is a physician who specializes in the care of hospital patients.)

As more and more baby boomers reach retirement age, there will be a sudden and dramatic increase in the number of patients who experience fragility fractures due to age and osteoporosis.

“I think the health-care system is under-prepared for this,” Mitchell said.

A fragility fracture, such as slipping on the ice and breaking a hip, typically is caused by a fall from a standing height or less. Fragility fractures also can be caused by ordinary activities such as sneezing or even rolling over in bed.

Fragility fractures occur in bones weakened by osteoporosis. Common fragility fractures include broken hips, wrists and vertebrae. Fragility fractures affect up to one half of women and one-third of men over age 50.

Loyola’s program puts it at the forefront of treating fractures in the elderly, said Dr. Pauline Camacho, director of Loyola’s Osteoporosis and Metabolic Bone Disease Center.

The geriatric fracture program will address osteoporosis and fractures from a multidisciplinary perspective. The program will attempt to lower re-fracture rates, which are very high in untreated patients. Initial workups will be started in the hospital, and osteoporosis therapy started as soon as possible after surgery.

“Osteoporotic fractures are a huge and costly burden to the health care system,” Camacho said. “Programs such as ours will have an impact on reducing this burden. We are hoping other hospitals will follow our lead.”

Treating fragility fractures is challenging. Plates, screws and other hardware that surgeons use to hold bones in place can come loose in bones softened by osteoporosis. And elderly patients are at higher risk for complications from surgery.

But Mitchell finds the work rewarding. “Older patients just want to stay independent and get back to their lives,” she said. “When we can help them do that, they are the most thankful patients.”

Source: Loyola University Health System

Scientists for the first time have identified a fault in the brain waves of schizophrenics that may explain their
hallucinations and disturbed thinking. The study, by a team at the Veterans Affairs (VA) Boston Healthcare System and Harvard
Medical School, appears in the Nov. 8 Proceedings of the National Academy of Sciences.

The researchers studied the brain waves of normal and schizophrenic patients as they responded to images. Those with the
disorder showed no electrical activity in a certain frequency-the “gamma” range, from 30 to 100 brain waves per second-that
healthy brain cells use to exchange information about the environment and form mental impressions. “The schizophrenics did
not show this gamma-band response at all. There was a pretty dramatic difference,” said senior author Robert W. McCarley, MD,
deputy chief of staff for mental health services at the VA Boston Healthcare System and chair of the Harvard psychiatry
department.

The brain contains hundreds of billions of neurons, or nerve cells. Researchers believe our thoughts are created when large
groupings of these neurons “fire”-send messages to each other, through bursts of electrical activity-at the same frequency.
Different frequencies, measured in hertz, or cycles per second, indicate different levels and types of activities. Delta
waves, below 4 hertz, occur during sleep. Alpha waves, 8 to 13 hertz, occur at relaxed, quiet times. Beta waves are the next
fastest, occurring when we are actively thinking.

Gamma waves are harder for scientists to detect because of their low amplitude. But McCarley, lead author Kevin M. Spencer,
PhD, and colleagues used a method that checks for synchronicity of the wave cycle-that is, high and low points that line
up-to capture gamma activity. Successive waves “in phase” mean brain cells are communicating.

The team used electroencephalogram (EEG) to record the brain waves of 20 schizophrenic and 20 normal patients as they looked
at either of two images containing “Pac-man” figures. In one image, the four shapes were arranged to optically suggest a
square in the center. The participants had to press a button to show if they perceived the square or not.

Both groups were able to respond within a second, but those with schizophrenia made more errors and took about 200
milliseconds longer to process the images. More significantly, they showed no evidence of gamma activity “phase-locked” to
the pressing of the button, which would have indicated that the brain was normally processing the visual perception guiding
their response.

“What some of them did show was a response at a lower frequency, outside the gamma band, which may indicate less efficient
communication among neurons,” said McCarley. “If the most efficient communication between assemblies of neurons is at 40
hertz, and the schizophrenics are using a lower frequency, it’s likely they have defective communication between cell
assemblies and brain regions.” He added that the strongest non-gamma activity was shown by patients with the worst
schizophrenia symptoms.

Schizophrenia affects about one percent of the population, or 2.2 million Americans. It is the most common psychotic illness,
and accounts for some 40 percent of VA’s mental health costs. Contrary to popular notion, it does not involve a “split
personality”; that is a rare and separate condition. The disease does involve delusions, in which patients may think others
are plotting against them; hallucinations, where they hear voices or see figures that aren’t real; and disorganized thinking
and behavior, where they may have trouble conversing or focusing on a task.

Antipsychotic medications help many patients control symptoms, but often have unwanted side effects. McCarley said drugs that
promote a normal gamma response among neurons would likely help the condition. His VA-Harvard group is exploring which
receptors in the brain are involved. “If you know the neurochemical identity of the neurons and synapses involved in
generating gamma activity, you can try to target treatments toward them,” he said.

The study was supported by grants from the Department of Veterans Affairs and the National Institute of Mental Health, and a
grant to Spencer from the National Alliance for Research on Schizophrenia and Depression. Spencer is also a VA Research
Enhancement Award Fellow.

Contact: Diane Keefe
diane.keefemed.va
617-594-3850
VA Research Communications Service

The aged care sector needs an injection of funds because the hard working nurses and personal carers workloads are becoming unmanageable, said Australian Nursing Federation Acting Federal Secretary Lee Thomas.

“Residents are forced to wait long periods for care and this situation will only worsen as the population ages.”

“As part of the Because We Care campaign, the ANF has a four point plan to address these issues and ensure Australia has a high quality aged care sector.

“Firstly, we need to halt the exodus of Registered and Enrolled nurses from aged care and ensure our nursing homes have the right mix of staff to get the job done by introducing a minimum staffing ratio.

“Secondly, we need to lift skill levels across the board, from nurses to personal carers by ensuring there is a minimum qualification requirement and a well structured career path for nurses and personal carers.

“Thirdly, to get more people into the industry and to hold onto the excellent staff we already have, we need to increase pay.

“And finally, we need make sure that any extra funding from the Federal Government flows through to aged care staff so they can deliver the best care possible – that means proper acquittal processes for aged care funding,”

Source
Australian Nursing Federation

Some adults and children with acute leukemia could benefit from certain transplants of blood stem cells, but the benefits are not equal across all cases of leukemia, according to a new review of 15 studies.

Acute leukemias classified as either acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) are fast-moving cancers that attack the bone marrow and blood. Along with chemotherapy, the treatment for the disease can include transplanting stem cells that can replenish the body’s supply of healthy blood cells.

The new stem cells can come from donors, such as a patient’s sibling, whose blood cells carry matching molecular markers to the patient. The transplant can also be made using some of the patient’s own stem cells.

Stem cell therapy is an alternative treatment that could “reduce the risk of relapse or even cure the disease when chemotherapy alone fails to eradicate the disease,” said review co-author Yen-Fu Chen, Ph.D., of the University of Birmingham, in England, and project leader from the West Midlands Health Technology Assessment Collaboration.

However, the transplants, used in place of or along with chemotherapy, have varying rates of success “depending on the type of leukemia and certain risk factors that individual patients possess,” said Khalid Ashfaq, M.D., the first author of the review.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program, part of the National Institute for Health Research in the United Kingdom.

The researchers found that treatment using a sibling’s stem cells might be more effective than chemotherapy in children and adults with AML who have entered their first remission from the disease. “This is the case except in some adults, who have a good risk profile,” said Chen. Adults with ALL in their first remission also live longer and suffer fewer relapses with the stem cell transplants, they found.

When using the patient’s own stem cells, however, stem cell treatment generally fared no better and sometimes fared worse than chemotherapy, according to Chen and colleagues.

The 15 analyses reviewed by the researchers, which comprised more than 2,000 patients, revealed several significant gaps in the evidence about stem cell treatments. For patients who had suffered more than one relapse of their leukemia, for instance, there were not enough data to say whether a stem cell transplant would be a better treatment than chemotherapy.

Decisions surrounding the specific techniques used in the transplantation, “such as to what extent the patient’s blood generating system needs to be destroyed before the transplant, using different conditioning regimes,” Chen said, might also play a role in how well a stem cell treatment works. Yet, “there is not enough good-quality evidence to really be able to make a recommendation at the moment,” he added.

“It is encouraging that several clinical trials addressing this issue are underway, and we will have much more evidence to answer the question in a few years’ time,” Chen said.

The study also looked into whether stem cell transplantation for treating acute leukemia “is of good value for the money” under various health services plans internationally, but there was not enough information on cost “for a comprehensive assessment,” Ashfaq said.

Source: Health Behavior News Service

While seemingly invincible teenage athletes at the height of good health and fitness aren’t likely candidates for doctor’s visits, even the fit need to visit a physician before practice. Sports physicals, often called pre-participation sports examinations, are key to making sure athletes are healthy enough to play and avoiding tragic occurrences, like sudden cardiac death, says a Saint Louis University sports medicine expert.

“Sports are fast-paced, working your heart and muscles, often in outdoor summer heat or cold winter weather, and those circumstances are enough to tax anyone, even the young and healthy,” said Will Mitchell, M.D., SLUCare sports medicine specialist and assistant team physician for the SLU Billikens. “It’s important that every athlete is cleared to play before they start practice.”

“We’re learning more about the dangers associated with concussions and exercise-related heart issues,” Mitchell said. “Sports physicals are more important than ever.”

Comprised of two parts, a medical history and physical exam, sports physicals are an opportunity to screen for potentially life-threatening heart problems, manage conditions like asthma, and evaluate old and new injuries, maximizing playing time and keeping athletes off the bench.

Often required before participation in school sports programs or summer sports camps, sports physicals are the best defense against problematic injuries and serious conditions.

In spite of the temptation to breeze through your physical, take your doctor’s visit seriously. Follow these tips, and you’ll avoid spending extra time on the bench and reduce your risk for potentially life-threatening scenarios.

Schedule six weeks ahead: Schedule your appointment several weeks in advance of summer sports camps and school sports seasons to avoid losing playing time. If your doctor finds you’ll need physical therapy for an old injury, for example, you’ll still have time before practice starts.

Fill out personal and family history: Fill out the history completely and accurately. If you aren’t sure about your family history, take time to ask. Request forms before your doctor’s visit and fill it out at home where you will have access to your records.

A medical history isn’t just paperwork; your genetic history and past health issues are the best way to predict your risk factors for many health issues.

Tell your doctor: Mention previous health issues while playing sports, such as blacking out suddenly while in the middle of a game, suffering from heat illness or having a concussion. These are serious concerns that may signal increased risk for future issues. In some cases, your doctor may want to do additional screening tests to make sure you’re healthy enough to play.

Ask questions: Take the initiative and ask your doctor about any concerns or questions you have. This is also a good chance to ask questions about diet, sleep or other health issues. Before you leave your appointment, make sure you understand any instructions your doctor has given.

“Once we know an athlete is healthy enough to play, participating in a sport can be a very healthy activity,” Mitchell said.

Source
Saint Louis University Medical Center

Researchers at UT Southwestern Medical Center have for the first time used drug-treated blood stem cells to repair heart damage in an animal model, results that might point to methods for healing injuries from heart attacks or disease.

In the study, researchers screened about 147,000 molecules to find one that could transform human blood stem cells into a form resembling immature heart cells. When they implanted blood stem cells activated by this compound into injured rodent hearts, the human cells took root and improved the animals’ heart function.

“The clinical potential is enormous,” said Dr. Jay Schneider, assistant professor of internal medicine and senior author of the study, which appears online this week and in a future issue of the Proceedings of the National Academy of Sciences.

Despite medical advances in treating and preventing heart attacks, once the heart is damaged it cannot repair itself, said Dr. Schneider, a cardiologist.

“Heart attack is a man-made problem,” he said. “It’s a function of increased longevity and atherosclerosis, which have occurred at no other time in human evolution.”

In the first stage of the current study, which involved mouse stem cells, the researchers screened some 147,000 compounds in UT Southwestern’s Small Molecule Library to see which ones would activate genes known to be at work in the early stages of heart development.

This initial screening sifted out about 1,600 compounds, but the researchers narrowed their focus to a related group of molecules, among the most potent and easy to make, called Shz for sulfonyl-hydrazone.

The researchers then tested the effects of one Shz compound, Shz-3, a molecular variant synthesized by chemists at UT Southwestern, on human blood stem cells. These cells, called PBMCs for peripheral blood mononuclear cells, were cultured with Shz-3 for three days, then for seven days without the drug.

Tests showed that the Shz-treated cells began to create RNAs and proteins found only in heart cells. They were then implanted into the hearts of rats with heart damage. After a week, the function of the rats’ hearts had significantly improved, and after three weeks, the organs contracted as strongly as they did before the damage. Tests showed that the human cells were alive and had incorporated themselves into the heart tissue, although the researchers could not tell whether the human cells had become fully functional, contracting heart cells.

“This functional test is a good first step,” Dr. Schneider said “What this shows is that this drug can act on blood stem cells that are already being used in other clinical trials. This may speed its movement into clinical trials for heart repair.”

Shz compounds do not appear to be toxic in mice, and because the human blood stem cells are washed for seven days after treatment, the compounds are likely not to be harmful to humans, although further tests are needed, Dr. Schneider said.

Further studies will examine precisely what the Shz drugs are doing to the cells, and to identify additional chemical signals that might drive the cells toward a more mature form of heart cell, the researchers said.

Other UT Southwestern researchers in internal medicine involved in the study were lead author Dr. Hesham Sadek, instructor; Britta Hannack, research assistant; Dr. Elizabeth Choe and Dr. Jessica Wang, former residents; Dr. Shuaib Latif, former cardiology fellow; Dr. Mary Garry, former assistant professor; Dr. Daniel Garry, former associate professor; Jamie Longgood, senior research associate in biochemistry; Dr. Douglas Frantz, assistant professor of biochemistry; Dr. Eric Olson, chairman of molecular biology; and Dr. Jenny Hsieh, assistant professor of molecular biology.

The work was supported by the Donald W. Reynolds Foundation, the Esther A. and Joseph Klingenstein Fund, the Ellison Medical Foundation, the Texas Higher Education Coordinating Board, the Welch Foundation and the Haberecht Wild-Hare Idea Program.

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Source: Aline McKenzie

UT Southwestern Medical Center

Obesity in children significantly increases the risk of major and minor respiratory complications following surgery to correct sleep disordered breathing (SDB), according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.

The study, which followed the post-operative recovery of 49 obese children compared with a control group, revealed that 75.5 percent of the obese children experienced one or more post-surgical respiratory complications, compared with just 26.5 percent of the control group. Particularly, airway obstruction in the obese was significantly more frequent than that of the control group. Obese children were also more likely to be admitted to the hospital, and had a longer duration of stay.

The likelihood of developing these adverse events was greater as the body mass index increased, and in boys.

Obstructive sleep apnea, the most common type of SDB, occurs when the upper airway obstructs or collapses during sleep, causing a decrease in oxygenation. This can result in cognitive and behavioral consequences in children. The main treatment for SDB in children is to surgically remove the tonsils and adenoids that could obstruct the upper airway.

The authors believe this information impacts the risk/benefit assessment of surgery for SDB in obese populations, especially since the benefit of surgery for this group is limited, if not questionable.

Title: Respiratory Morbidity in Obese Children’s Adenotonsillectomy
Author: Elaine Fung, MD; Hamdy El-Hakim, MD; Dominic Cave; Manisha Witmans, MD, FRCPC, FAAP, ABSM; Kenton Dang Gan, BSc

Source:
Matt Daigle

American Academy of Otolaryngology — Head and Neck Surgery

The presentation of the PLATO (A Study of Platelet Inhibition and Patient Outcomes), showed that ticagrelor (Brilinta®) reduced the rate of cardiovascular (CV) events (CV death, myocardial infarction or stroke) from 11.7% to 9.8% compared clopidogrel (Plavix®) XX% (p

The Woods Institute for the Environment has awarded five faculty planning grants to develop long-term research programs at Stanford that help solve the world’s urgent demands for fresh water.

“Fresh water is crucial to human survival and well-being, yet in poor countries more than a billion people have no access to safe water supplies, and more than 2 billion lack basic sanitation facilities,” said Woods Institute Senior Fellow Richard Luthy, a professor of civil and environmental engineering. “Waterborne diseases and contaminated drinking water are major causes of illness and contribute to the death of millions of children each year, and unsustainable diversions of water for agriculture have resulted in the collapse of fisheries worldwide.”

The demand for fresh water is also a major issue in the developed world, he added: “Here in California, we are facing one of our worse droughts in two decades. This is an immediate reminder about our vulnerability to ‘business as usual’ in the West, and it’s apparent the era of cheap water and wasteful practices is closing.”

To address these and other environmental challenges, the Woods Institute launched a campus-wide freshwater initiative in 2007 that included a series of water seminars for faculty and students. “Stanford already has excellent programs in various aspects of fresh water,” said Woods Senior Fellow Rosemary Knight, a professor of geophysics. “What the freshwater initiative allows us to do is to pull people together, in new ways, to work on critical problems associated with fresh water.”

Last spring, the Woods Institute invited Stanford researchers to submit proposals for freshwater planning grants to an evaluation committee chaired by Woods Co-Director Jeff Koseff, a professor of civil and environmental engineering. In July, the committee awarded the following five projects a total of $312,520 over the next nine months:

Water and Development: Scaling Local Solutions (jointly funded by the Woods Institute and the Stanford School of Medicine): Researchers will organize workshops in two regions of the world most affected by a lack of safe drinking water: Sub-Saharan Africa and South/Southeast Asia. The workshops will be designed to foster dialogue and debate among academics, business leaders and regulators, with the goal of identifying promising solutions to freshwater challenges now being implemented at the local level.

Principal investigators: Jenna Davis (Civil and Environmental Engineering/Woods Institute) and Len Ortolano (Civil and Environmental Engineering)

An Integrated Model of the California Water System: This project will bring together scholars, industry participants and policymakers for a series of meetings that lead to the design of an integrated model of the California water system, incorporating agricultural, residential, industrial, commercial, environmental and recreational uses of fresh water throughout the state.

Principal investigator: Frank Wolak (Economics)

Comprehensive Studies of Aquifer Depletion and Salinization: This proposal is to develop a large-scale research project focusing on the depletion and salinization of aquifers, which are significant problems in the arid West and other parts of the world that rely heavily on groundwater.

Principal investigators: Peter Kitanidis and Martin Reinhard (Civil and Environmental Engineering); Rosemary Knight (Geophysics); Frank Wolak (Economics)

Water in the West: A Regional Approach (jointly funded by the Woods Institute, the School of Medicine and the Bill Lane Center for the Study of the North American West at Stanford): Researchers will develop a series of workshops endeavoring to lead to regional solutions to major water challenges in the western United States. Participants will include regional utilities, government organizations, non-governmental organizations and experts from Stanford and other universities in the West.

Principal investigators: David M. Kennedy (History) and Richard Luthy (Civil and Environmental Engineering)

Global Change and Water Resource Vulnerability: Researchers will develop a strategy to identify regional freshwater systems around the world that are most vulnerable to the combined impact of people and nature, from expanding populations to climate change.

Principal investigators: Steven Gorelick (Environmental Earth System Science), Buzz Thompson (Law School), Scott Rozelle (Freeman Spogli Institute for International Studies).

“A common theme among the planning grants is the gathering of multidisciplinary expertise within and beyond Stanford to encourage wide-ranging thinking about water problems and the development of research agendas targeting specific solutions,” Luthy said.

“These grants will facilitate the formation of new partnerships among people inside and outside of Stanford, partnerships that are needed to deal with the complexity of the issues associated with fresh water,” Knight added.

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RELEVANT WEB URLS:

WOODS INSTITUTE FOR THE ENVIRONMENT
woods.stanford.edu/

SCHOOL OF MEDICINE
med.stanford.edu/

BILL LANE CENTER FOR THE NORTH AMERICAN WEST
west.stanford.edu/

Source: Mark Shwartz

Stanford University