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In the first public opinion poll since the discovery reported internationally in November that human skin cells can be used to create stem cells or their near equivalents, the VCU Life Sciences Survey found that 63 percent of Americans believe that both embryonic and non-embryonic stem cell research is still needed. The survey also found that three-quarters of the U.S. public supports stem cell research that does not involve human embryos while one-quarter oppose it. Majorities of nearly all groups in society, including those with differing beliefs about abortion and religious commitment, favor non-embryonic stem cell research, according to the survey. The findings are part of VCU’s annual nationwide survey, which was conducted via telephone with 1,000 adults nationwide from Nov. 26, 2007, to Dec. 9, 2007. The poll’s margin of error is plus or minus 3 percentage points.

 

Researchers at the University of Texas Southwestern Medical Center have found that the existing body mass index (BMI) criteria for obesity surgery often excludes a group of obese patients at risk of cardiovascular disease but who could be helped by the surgery. The study in the journal Surgery for Obesity and Related Diseases, is among the first to evaluate the risk-factor relationship between BMI and cardiovascular disease as it relates to bariatric surgery criteria. The researchers examined patient data from the Third National Health and Nutrition Examination Survey database for the presence of known cardiovascular risk factors as a function of obesity. They said their results show that cardiovascular risk factors do not necessarily worsen with increasing obesity. They also support the concept that obesity, by itself, doesn’t trigger an adverse cardiovascular risk profile or increased risk of death. Bariatric weight-loss surgery is currently recommended for patients with a BMI greater than 40, as well as for patients with a BMI greater than 35 who also suffer from a life-threatening illness, such as non-insulin dependent diabetes, sleep apnea, or heart disease. But, the researchers found that cardiovascular risk factors can be much worse in many individuals with a BMI as low as 30 than they are for some surgical candidates with higher BMIs. In fact, the study findings show that some morbidly obese patients have better cardiovascular disease risk profiles than those who are less obese. This suggests that some patients who are obese, but not morbidly obese, could benefit from bariatric surgery, which can help reduce cardiovascular disease.  

 

An antibody used to treat certain cancers and rheumatoid arthritis appears to greatly delay Type 1 diabetes in mice, Yale School of Medicine researchers report in the Journal of Clinical Investigation. The antibody, rituximab (anti-CD20), depletes B cells. Experimental evidence in mutant mice indicates that B cells play a role in autoimmune diseases by interacting with T cells of the immune system. It is T cells that destroy insulin-producing cells directly in the pancreas, leading to Type 1 diabetes. The researchers said their work shows, for the first time, that after successful B cell depletion, regulatory cells emerge that can continue to suppress the inflammatory and autoimmune response even after the B cells return. The researchers tested a mouse version of the drug to deplete B cells in mice either before diabetes onset, or within days of diagnosis with diabetes. The drug treatment significantly delayed diabetes onset in pre-diabetic mice. This translated to a 10- to 15-week delay in developing diabetes compared to mice given a “sham” treatment. The equivalent period for humans would be approximately 10 to 15 years. Of the 14 mice that already had diabetes, five stopped needing insulin for two to five months while all the sham-treated mice remained diabetic.

 

Heart attacks among cigarette smokers may have less to do with tobacco than genetics. A common defect in a gene controlling cholesterol metabolism boosts smokers’ risk of an early heart attack, according to a study in Annals of Noninvasive Electrocardiology. The findings also show that smokers without the defect normally have heart attacks no sooner than their non-smoking peers. Although the link between smoking and heart disease was established decades ago, the reasons for that link were unclear. More recent studies suggest smoking interferes with cholesterol metabolism, lowering smokers’ levels of high-density lipoprotein, the good cholesterol that protects against heart-attack risk. An estimated 55 to 60 percent of smokers face the added risk of a defective gene that also lowers levels of the protective high-density lipoprotein. The combination of smoking plus a defective gene substantially accentuates the risk of heart attacks in these patients, the researchers said.

OBESITY: SIGNIFICANTLY OVERWEIGHT PATIENTS WAIT LONGER FOR KIDNEY TRANSPLANTS

Research from Johns Hopkins University specialists suggests that obese kidney disease patients face not only the usual long odds of a tissue match and organ rejection, but also are significantly less likely than normal-weight people to receive a kidney transplant at all. The Johns Hopkins study results, published online in the Journal of the American Society of Nephrology, reveal that morbidly obese patients (those who on average weigh 100 pounds more than their ideal weight) are on the transplant waiting list for a median of five years—two years more than the median wait time for a patient of normal weight. Because patients tend to get sicker the longer they wait on dialysis, obese patients are 44 percent less likely than normal-weight patients to ever receive a kidney transplant, the researchers report. Each year, 8 percent of the patients on the list die waiting for a kidney. The researchers said their finding may be explained by economic pressures as well as medical ones. Medicare—the principal insurer for kidney transplants—pays a fixed amount for the operation regardless of a patient’s overall health, difficulty of the operation, length of stay, postoperative care, and complications, all of which may increase substantially with obese patients. Transplant centers, therefore, may be under pressure to avoid operating on these individuals. In addition, centers with lower surgical survival rates overall risk losing Medicare funding.

 

Vietnam War veterans who suffered brain injuries during the conflict show a faster decline in their cognitive functioning as they grow older than veterans without such injuries, according to a study published online in the journal Brain. The study from researchers at the National Institute of Neurological Disorders and Stroke found that the rate of decline can be predicted by how intelligent the veterans were before they were injured, their level of education, the size and location of the injury, and certain genetic markers that have been linked to brain injury and neurodegeneration. Greater intelligence and a higher level of education before the injury was sustained were associated with a lesser decline in cognitive functioning in the years afterwards. The researchers said that governments need to bear these findings in mind, particularly in the light of the head injuries being sustained in the on-going conflicts in Iraq and Afghanistan.

 

Researchers from the University of Exeter have shown that people have a built-in ability to judge how hard their bodies are working, often with remarkable precision. A series of studies over the last two years, culminating in three academic papers in the past two months, has shown a consistently close correlation between actual and perceived exertion in people of all levels of fitness. The team has found that an individual’s own sense of how hard he or she is working corresponds exactly with actual level of exertion, measured by heart-rate and oxygen uptake. The researchers said their work could lead to a more personalized approach to exercise, with personal trainers and gym instructors putting the onus on their clients to judge their own appropriate level of exercise intensity.

 

A new brain imaging study by researchers in the Abramson Cancer Center of the University of Pennsylvania shows that cigarette cravings in smokers who are deprived of nicotine are linked with increased activation in specific regions of the brain. Using a novel method of measuring brain blood flow, the study is the first to show how abstinence from nicotine produces brain activation patterns that relate to urges to smoke. The findings, published in The Journal of Neuroscience, contribute to understanding smoking urges—a key risk factor for relapse—at the brain level. The researchers found that abstinence-induced, unprovoked cravings to smoke are associated with increased activation in brain regions important in attention, behavioral control, memory, and reward.

 

An international team of researchers led by the Mayo Clinic have designed a technique that uses the body’s own cells and a virus to destroy cancer cells that spread from primary tumors to other parts of the body through the lymphatic system. In addition, their study shows that this technology could be the basis for a new cancer vaccine to prevent cancer recurrence. The work, published in Nature Medicine, used technology that combines infection-fighting T-cells with the vesicular stomatitis virus that targets and destroys cancer cells while leaving normal cells unharmed. The study has not yet been replicated in humans, but the researchers said it is significant because it describes a potential new therapy to treat and prevent the spread of cancer in patients.

 

Investigators at Hospital for Special Surgery in New York City have identified two new targets for drugs aimed at controlling lupus, an autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys, and brain. If companies are able to develop drugs that hone in on these targets, patients may be able to control their disease with few side effects, the researchers said. In the past, researchers have developed drugs that block interferon because people with lupus have abnormally high levels of interferon-alpha. The problem with this approach is that it can have immunosuppressive effects that leave patients vulnerable to infection. Instead, the researchers identify two proteins, STAT1 and STAT2, which mediate the autoimmune and inflammatory functions of interferons, as possible drug targets. If researchers are able to develop drugs for these targets, they may be able to avoid the immunosuppressive effects associated with lupus drugs.

 

An antibiotic long abandoned as a weak, low-dose treatment for tuberculosis may have found renewed purpose as a potent, high-dose fighter against the most common and actively contagious form of the lung disease, according to researchers at Johns Hopkins University. In the online version of the Public Library of Science, the researchers report that the antibiotic rifapentine in studies in mice was found to be promising as an initial treatment for active TB. Clinical trials are scheduled to begin next year in at least eight countries. The mouse studies showed that substituting higher and daily doses of rifapentine for another antibiotic, rifampin, cured mice two to three times faster than the much older, standard regimen of drugs that includes rifampin. The nonprofit Global Alliance for TB Drug Development estimates that worldwide, more than 9 million people are infected with the highly contagious and active form of TB, caused by Mycobacterium tuberculosis. Another 424,000 are infected with the more dangerous, multidrug-resistant form of the disease. After 10 weeks of drug therapy, TB-infected mice taking rifapentine and moxifloxacin tested negative for active TB and remained so when retested three months later. Those treated with rifapentine and isoniazid also tested clear of the bacterium by 10 weeks, but were at least 10 percent more likely to relapse unless treatment persisted for another month. Meanwhile, the traditional treatment mostly took the full six months to work.

 

Elderly adults at risk for physical disabilities who are able to adhere to a regular program of moderate exercise for one year, enjoy improvements in physical function, researchers at Tufts University report. In a study published in the journal Medicine & Science in Sports & Exercise, the researchers said that participants who reported exercising 150 minutes or more per week showed the greatest improvement in physical function. The participants ranged in age from 70 to 89, were sedentary when they enrolled, had health problems, such as cardiovascular disease and osteoporosis, and some physical limitations such as difficulty walking or climbing stairs. They followed a moderate exercise program that consisted of walking, strength, flexibility, and balance training. The authors observed that physical activity adherence was consistent with earlier studies that followed older adults for shorter durations. But they also found that people in this age group and physical condition can commit to a regular program of physical activity and that the better their adherence to a program of physical activity the greater their improvements in physical functioning.

Research from Duke University Medical Center shows that even a modest amount of brisk walking weekly is enough to trim waistlines and cut the risk of metabolic syndrome, an increasingly frequent condition linked to obesity and a sedentary lifestyle.

It’s estimated that about a quarter of all U.S. adults have metabolic syndrome, a cluster of risk factors associated with greater likelihood of developing heart disease, diabetes, and stroke: large waist circumference, high blood pressure, high levels of triglycerides, low amounts of HDL, or “good” cholesterol, and high blood sugar. To be diagnosed with metabolic syndrome, patients must have at least three of these five risk factors, and according to many studies, a growing number of people do. The researchers report that a person can lower their risk of developing the syndrome by walking just 30 minutes a day, six days per week. The study, which appears in the American Journal of Cardiology, showed that people who do this will benefit even if they don’t make any dietary changes. It found that 41 percent of the participants in the study met the criteria for metabolic syndrome before exercising regularly. At the end of the eight-month exercise program, only 27 percent did.

 

Researchers at Oregon Health & Science University have uncovered new information about the body’s immune system in a study that suggests new strategies may be in order for protecting aging populations against disease. The research, published in the Proceedings of the National Academy of Science, focused on an important component of the body’s immune system, a certain type of white blood cell called naive T-cells. These cells are called naive because they have no experience of encountering germs. However, once they encounter germs, they learn and adapt to become strong defenders of the organism. These cells play an important role in the vaccination process because vaccines, which contain either weakened or dead viruses, teach naïve T-cells how to recognize germs and prepare the body for fighting infectious diseases at a later date. Previous research shows that an individual’s supply of naive T-cells diminishes over their lifetime, meaning that in old age a person is more susceptible to infections such as the flu. Naive T-cells divide very slowly, which helps maintain a sufficient population of these cells when people are young. But as people age, naive T-cells are lost and the remaining ones speed up their division to make up for the losses in their numbers. After a certain point, this actually causes the numbers of naive T-cells to dwindle. The naive T-cells also become short-lived when their population drops below a certain point. The researchers said their findings suggests that some elderly people may be better protected against disease by finding a way to jumpstart production of new naive T-cells instead of through revaccination.

 

Two recently released studies confirm that a majority of Americans who should be getting screened for colorectal cancer are not. Men and women over the age of 50 should be screened for colorectal cancer, but according to a study in the journal Cancer, researchers found that among Medicare beneficiaries between 1998 and 2004, only 25.4 percent of people were screened, despite Medicare coverage for colorectal cancer screening. According to figures released by the Agency for Healthcare Research and Quality, only half of all Americans age 50 and over have had a screening colonoscopy. The American Society for Gastrointestinal Endoscopy, in response to the findings, said that the disease is preventable and treatable when caught in its early stages and that screening and the removal of precancerous polyps were among the reasons credited with a 5 percent drop in colorectal cancer deaths between 2002 and 2004.

 

CANCER: INSURANCE STATUS LINKED TO PATIENT OUTCOMES
A report from the American Cancer Society finds evidence that lack of adequate health insurance coverage is associated with less access to care and poorer outcomes for cancer patients. The report finds people who are uninsured are less likely to receive recommended cancer screening tests, are more likely to be diagnosed with later stage disease, and have lower survival rates than those with private insurance for several cancers. The new findings on stage-at-diagnosis and survival by insurance status use data from the National Cancer Database, a hospital-based registry sponsored by the American College of Surgeons and the American Cancer Society, the only national registry that collects information on patient insurance status. The report, published in CA: A Cancer Journal for Clinicians, said while advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14 percent drop in the death rates from all cancers combined from 1991 to 2004 in the United States, not all segments of the population have benefited equally from this progress. The study found patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance.

 

Using robotic teleconferencing to monitor patients after urologic surgery appears to result in similar patient outcomes and satisfaction as traditional bedside rounds, according to a report in the journal Archives of Surgery. Researchers at the University of California at Davis compared two groups of patients undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours. One group received traditional bedside rounds and the other received robotic telerounds with a 60-inch tall, wheel-driven device featuring a high-definition digital camera, flat screen monitor, and microphone. Data to and from the robot is transferred over a high-speed wireless network, and the physician connects to it through a base station. Both types of visits followed a set script and included reviewing objective data, including vital signs and laboratory results, as well as a discussion regarding treatment goals for the day. The researchers said telerounding did not appear to lengthen hospital stays and there were no instances in which detection of complications appeared to be delayed because of telerounding. Patient satisfaction was equally high in both groups.