Why Are Some People More Prone To Mosquito Bites?


And by “some people” I mean me. Why is it that an evening stroll leaves me feeling eaten alive while my companions are left blissfully un-bitten?

First of all, it’s probably not all in my head (although it could be — most people are bad sources about their own mosquito attractiveness). Studies suggest that about 20 percent of people are “high attractor types” who are especially appealing to the female mosquitoes seeking out blood for the extra protein they need to lay eggs. Of course, not all mosquitoes are the same. There are 150 different species in the United States, each with their own blood-sucking proclivities. But since you probably won’t know — or care — if the bugger biting you is Culex pipiens or Aedes aegypti, let’s consider some of the more general properties that affect your mosquito appeal.

Clothing Color

It’s true, mosquitoes have discerning fashion taste. Or at least, they’re more likely to spot you as a target if you stand out from your environment. Dark colors, especially, will attract more of the insect.

Movement

Similarly, the more you move, the easier you are to identify as a living, breathing, vessel full of delicious blood.

Body Heat

Visual clues allow the mosquito to locate you from relatively far away, but as she approaches, it’s your body heat that draws her in. This puts pregnant women, who average about 1.26 degrees Fahrenheit warmer than others, at a particular risk — a fact which has been substantiated by a number of studies.

Carbon Dioxide

This is another reason pregnant women are at a disadvantage. Mosquitoes can detect carbon dioxide using a special organ called a maxillary palp from as far as 164 feet away. Since everyone emits CO2 simply by exhaling, it comes down to relative amounts. Unfortunately for mothers-to-be, pregnancy causes women to emit 21 percent more CO2. This is also why kids are often safe from bites, when bigger, more CO2-emitting adults are around.

Alcohol Intake

On the flip side, pregnant women are (presumably) avoiding another mosquito attractor: alcohol. Although it’s unclear how mosquitoes go about detecting the presence of ethanol, studies show that drinking even just 12 ounces of beer will significantly increase the attention you receive from the pests.

The Properties of Your Skin and Sweat

Up to 85 percent of your susceptibility to mosquito bites has nothing to do with what you’re drinking or wearing — it’s just genetic. Specifically, the composition of your skin bacteria — the kind that naturally and healthily exists there — can serve as an attractor. As can the levels of lactic acid, uric acid, ammonia, and other substances present in your sweat.

Blood Type

Another factor you can’t control? Your blood type. And it stands to reason that, if the mosquito is there to suck your blood, she cares what kind she’s getting. People with blood type O are more prone to mosquito bites than those with type B, with type A folks bringing up the rear.

5 Types of Medicinal Mushrooms and How They Boost Health.


Understanding how food interacts with our bodies and the role it plays in healing various health conditions can be helpful. Whether food is used as part of a medical treatment or a prevention-focused diet, knowledge is power. Though some may disregard medicinal food, medical researchers have proven how prescriptive diets have been used to minify health risks. One such functional food is mushrooms. There are currently 38,000 discovered and classified species of mushrooms that hold medicinal benefits.

In the last two decades there has been widespread interest in the role of the immune system for maintaining good health. According to a study on medicinal mushrooms, diseases related to immune dysfunction “such as cancer, chronic fatigue syndrome, AIDS/HIV, hepatitis and autoimmune conditions” are gaining wide attention from medical researchers and clinicians. As a result, practitioners are looking to mushrooms for their medicinal effects on the immune system.

The immune-strengthening benefits of certain fungi and their extracts have even shown to have an anti-cancer effect. While research foundations such as Cancer Research UK confirm that there is no evidence that mushrooms or mushroom extracts can prevent or cure cancer, specific fungi can prolong and improve the lives of cancer patients, as well as enhance their recovery process.

Given that medicinal mushrooms improve and modulate immune response, people from all over the world have used their medicinal properties to reduce health risks and boost the immune system. More specifically, research has indicated mushrooms have possible anti-cancer, antiviral, anti-inflammatory, and hepatoprotective (liver protective) properties.

Let’s look at how specific types of mushrooms can boost your overall health.

1. Shiitake (Lentinula edodes)

Shiitake mushrooms have powerful immune-enhancing and antiviral properties, contributing to lower cholesterol while exhibiting virus-inhibiting effects. Shiitake mushrooms contain lentinan which not only strengthens the immune system, but, according to the American Cancer Society, is believed to slow tumor growth. The fungus, native to Asia, is also a good source of iron and antioxidants, which help reduce the damage from free radicals.

2. Reishi Mushroom (Lingzhi)

Reishi is a well-known Chinese mushroom, regarded as the “herb of spiritual potency.” Reishi has shown to contribute to the healing of tumors, while lowering blood sugar and cholesterol levels. According to one report, Reishi helps with the modulation of the immune system and provides hepatoprotection and bacteriostasis (the inhibition of bacteria growth) in the body. It’s been used for over 2,000 years, and is unique in that its pharmaceutical value is more significant than its nutritional value, setting it apart from other medicinal mushrooms. Reishi can be taken in many forms including powder, dietary supplements, and tea.

3. Lactarius salmonicolor (Russulaceae)

The edible mushroom has potent medicinal benefits. One study identified antioxidant constituents in the rare mushroom. The researchers observed the antioxidant agents by detecting ten fatty acids and fatty acid esters from an extract, then evaluated the antioxidant activity. Due to its antioxidant constituents, Russulaceae contribute to the overall health of the immune system. Namely, the fungus can serve as an anti-cancer and anti-viral advocate. There are more than 400 species worldwide, most commonly grow in coniferous woods.

4. Coriolus Versicolor (Trametes versicolor)

Commonly known as “Turkey Tail”, the mushroom has traditionally been used in Asian herbal remedies. According to the American Cancer Society, two extracts from the mushroom—polysaccharide K (PSK) and polysaccharide-peptide (PSP)—are under evaluation for cancer treatments. In fact, “clinical trials suggest that PSK may help people with certain types of cancer by increasing survival rates and lengthening periods of time without disease, without causing major side effects.” Turkey Tail mushroom is also advantageous in boosting the immune system, and is used in the naturopathic treatment of various HPV infections.

In the study, Phase 1 Clinical Trial of Trametes versicolor in Women with Breast Cancer, Coriolus Versicolor mushroom therapy (administered orally) in the postradiotherapy environment may enhance lymphocyte numbers and natural killer cell activity (NK). By increasing NK cell counts, remaining cancerous cells are attacked, improving the health of breast cancer patients after radiation treatment.

5. Morel (Morchella esculenta)

High in Vitamin D, morels are polymorphic, varying in shape, color and size. They possess an earthy flavor, and are high in iron and B vitamins. Due to similar appearance, it’s important to identity “true morels” from “false morels” (poisonous mushrooms). Even with “true morels” there have been documented cases of allergic reactions to these edible mushrooms, so it’s important to take precautionary steps when consuming morels.

The immune-boosting nutrients and health benefits of medicinal mushrooms continue to contribute to the large and persuasive body of scientific research. In fact, scientific studies of medicinal mushrooms have increased during the last two decades primarily in Japan, Korea, China, and the US. Be sure to take the necessary precautions when identifying edible mushrooms, prior to utilizing them as part of a medical treatment or nutritional diet. By learning about the medicinal benefits of fungi, we can develop a more holistic approach to our overall immune health.

These statements have not been evaluated by the FDA and are not intended to diagnose, treat, or cure any disease. Consult with your physician before making any medical decisions. 

Appropriate Antibiotic Prescribing? Some Clinicians Resistant


A significant minority of clinicians have antibiotic prescribing habits that worsen the public health crisis of antibiotic resistance, according to a new WebMD/Medscape survey.

One in 10 clinicians who prescribe antibiotics without clinical certainty say the drug “won’t hurt if not needed.” And when clinicians know an antibiotic is not indicated, 1 in 10 write the script anyway if the patient demands the drug, the survey found.

Patients might not pressure their healthcare provider like this if both parties have discussed how taking unneeded antibiotics can lead to ‘antibiotic resistance, but only 53% of patients report having such an exam-room talk, according to the survey.

 

Overall, the findings suggest a prescribing landscape with positives as well as negatives. Almost all patients surveyed are at least aware of antibiotic resistance, and close to 90% say they understand that antibiotics are useless for some infections. When patients ask for a prescription — roughly 1 in 4 do this — and a clinician says no, they generally accept the decision. Meanwhile, 95% of clinicians prescribe antibiotics even when they are not absolutely sure they are needed. It’s sometimes understandable, especially in light of slow-poke lab tests. However, the belief among some clinicians that antibiotics won’t hurt “is an indication that we’ve got some educating to do,” said Daniel McQuillen, MD, a past chairman of the Clinical Affairs Committee of the Infectious Diseases Society of America and current president of the Massachusetts Infectious Diseases Society. Better patient education about antibiotics, added Dr. McQuillen, could reduce the number of misguided demands for the drugs. With only about 1 in 2 patients reporting that they’ve had an antibiotic talk with their clinician, “there’s room for improvement,” he said.

And improvement can’t come too soon. At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the Centers for Disease Control and Prevention (CDC). The World Health Organization calls antibiotic resistance “an increasingly serious threat to global public health that requires action across all government sectors and society.”

The Myth of the Harmless Antibiotic

WebMD/Medscape surveyed both consumers and clinicians to better understand how prescribing practices contribute to the problem. The consumer portion was completed on the WebMD Web site earlier this month by 1174 individuals, largely older, white, and female. To get the professional side, WebMD reached out to active users of Medscape and received email responses from 796 clinicians: 407 physicians, 200 nurse practitioners (NPs), and 189 physician assistants (PAs).

 

Although the vast majority of clinicians say they order antibiotics even when they have their doubts, only 12% do it most of the time. As a whole, these clinicians are uncertain prescribers about 21.5% of the time, with hardly any difference between physicians (20.2%) and NPs (20.3%). PAs are significantly higher at 25.3%.

For 53% of clinicians who prescribe antibiotics without absolute clinical certainty, being “certain enough” of the diagnosis is reason enough to put in the order. Forty-two percent say they are uncomfortable not treating a possible bacterial infection, and 31% say that the lab work to identify the bug may take too long to help an ill patient.

Other reasons exist for prescribing what are called empirical antibiotics, but the one most worrisome to infectious disease experts is the notion that the antibiotic “won’t hurt if not needed.”

“It’s important for providers to know that prescribing antibiotics when they are not needed can cause patients harm,” said Lauri Hicks, DO, medical director of the CDC’s program to promote smart antibiotic prescribing, in an email interview with Medscape Medical News. “They put them at harm for allergic reactions, antibiotic resistant infections, and deadly diarrhea caused by the bacteria [Clostridium] difficile.”

The diarrhea scenario sometimes occurs when a clinician immediately orders an antibiotic for a suspected case of acute bacterial rhinosinusitis, said Dr. McQuillen. By way of collateral damage, the antibiotic will knock out most of the bacteria in the gastrointestinal tract, but usually not C difficile, which mushrooms out of control and leads to diarrhea “which is almost like cholera,” Dr. McQuillen told Medscape Medical News.

Patients seen at an early stage of an upper respiratory tract infection typically turn out to have a virus, said Dr. McQuillen. While such viral infectious often resolve in several days without medication, bacterial infections tend to persist and worsen. Accordingly, many physicians write postdated prescriptions for antibiotics in case the culprit is a bacterium, instructing the patient to fill it in 3 or 4 days if their symptoms intensify.

In the WebMD/Medscape survey, 49% of clinicians say they occasionally write such postdated prescriptions, and another 4% say they did it most of the time. In contrast, 47% report never writing postdated scripts, reflecting the prescribing community’s mixed feelings about the practice.

“The rationale is sound, but whether it’s effective, nobody knows,” said infectious disease expert Brad Spellberg, MD, a recently appointed professor of medicine at the Keck School of Medicine of the University of Southern California in Los Angeles. “It’s a clinician trying to make the best of the bad situation.”

One potential problem with postdated antibiotic prescriptions, according to Dr. Spellberg and others, is that the patient may get them filled immediately and start treatment right then, contrary to the instructions. However, only 2% of patients with these prescriptions jump the gun like this, according to the WebMD/Medscape survey.

There’s an even riskier possibility, though, with postdated prescriptions: errant self-diagnosis. Someone who initially presents with a respiratory infection, for example, may develop pneumonia but delay seeing a clinician because he or she misreads the problem and resorts to the postdated prescription, said Russell Steele, MD, head of pediatric infectious diseases at the Ochsner Health Center for Children in New Orleans, Louisiana.

“This is what happens,” Dr. Steele told Medscape Medical News, “when patients treat themselves.”

Clinicians Want Better Patient Ed Material, Better Tests

Clinicians have solutions for the pitfalls of antibiotic prescribing, and they shared them in the WebMD/Medscape survey.

Improved patient education materials (58%) top the list of answers chosen by clinicians who answered the question of what would make them a “better antimicrobial steward.” A close second (54%) is better diagnostic tests to determine the cause of the infection.

Other solutions identified by clinicians include more readily available information on local patterns of antibiotic resistance (47%), more time to talk to patients and get needed tests done (37%), clearer clinical guidelines (36%), and advice on how to talk to patients who expect antibiotics.

Add life-long antibiotic training for clinicians to the list, said Dr. Steele. He pointed to a survey of house officers showing that interns and residents judiciously prescribe antibiotics in their academic medical center, “but once they’re out in practice, they start sliding, and use antibiotics indiscriminately.”

“Education wears off in 5 years,” explained Dr. Steele. “Doctors need reminders.”

Fukushima Monkeys’ Blood Shows Signs of Radiation Exposure


Wild monkeys living in forests of Fukushima — the Japanese city that was the site of a nuclear power plant meltdown in 2011 — have lower blood cell counts than monkeys from northern Japan, and carry detectable levels of cesium in their bodies, researchers have found.

The researchers studied blood changes and signs of radiation exposure in 61 monkeys living 43 miles (70 kilometers) from the Fukushima Daiichi nuclear power plant, about one year after an earthquake and tsunami struck the region in 2011, causing a meltdown of three of the plant’s reactors, which released a large amount of radioactive material into the environment.

The results showed Fukushima monkeys had lower counts of red and white blood cells, and other blood parts compared with 31 monkeys from Shimokita Penisula in northern Japan. The researchers also found radioactive cesium in the muscles of Fukushima monkeys, ranging from 78 to 1778 becquerels (units of radioactivity representing decay per second) per kilogram, but they didn’t find any in Shimokita monkeys. [7 Craziest Ways Japan’s Earthquake Affected Earth]

Exposure to radioactive materials may have contributed to the blood changes seen in Fukushima monkeys, study researchers Shin-ichi Hayama and colleagues wrote in their study, published today (July 24) in the journal Scientific Reports. Low blood cell counts could be a sign of a compromised immune system and could potentially make the monkeys vulnerable to infectious diseases, the researchers said.

 

“The findings are consistent with what our group had found with red blood cells and hemoglobin content for children living around Chernobyl,” said Tim Mousseau, a biologist at University of South Carolina, who wasn’t involved with the study.

The Chernobyl nuclear power plant in Ukraine exploded in 1986. Research on the aftermath of the disaster found concerning effects of radiation exposure on people, animals, insects and plants. The new study of Fukushima monkeys indicate the Japanese plant’s meltdown could have similarly negative consequences.

“The fact that they are seeing a signal in monkeys living in Fukushima city means that there’s some potential direct relevance to the human population,” Mousseau told Live Science. “These monkeys are living at levels of contamination that are very similar to what many of the people are also living in.”

In Fukushima, researchers have so far seen significant abnormalities in butterflies and strong effects on bird populations following the leaked radioactive material.

“Whether these effects will persist into the future, whether they increase or decrease, nobody really knows,” Mousseau said. [In Photos: Fukushima Butterflies Plagued With Defects]

The studyresearchers also found that among juvenile monkeys, those with higher radioactive cesium concentrations in their muscles showed lower white blood cell counts. These findings suggest that younger monkeys may be more vulnerable to radioactive materials, the researchers said.

The levels of radioactive cesium found in Fukushima monkeys are higher than what is being reported for the human population in the area, Mousseau said.

“It may be because monkeys are eating the fruits, mushrooms and insects that are quite contaminated, so they are probably getting a much larger exposure than people who are eating relatively uncontaminated food,” Mousseau said.

However, it is difficult to determine how dangerous the levels are, because the effects of exposure to radioactive cesium are not well known, and more studies are needed to understand this and other consequences of radioactive material in the environment Mousseau said.

“It’s really surprising how little research is being supported, given the important questions that can be answered by this research, the implications for human populations in the area, as well as the potential utility of such research for any future nuclear accident that might occur.”

More research will be needed to confirm that the low blood counts in Fukushima monkeys are, in fact, caused by exposure to radiation, Mousseau said. The researchers have ruled out infectious disease or malnutrition as the cause of blood changes in the Fukushima monkeys, but it is still possible that their lower blood cell counts are simply random variations among populations of monkeys, Mousseau said.

Scientists will need to compare Fukushima monkeys living in areas with different levels of radioactive contamination with different populations of monkeys living in uncontaminated areas, to be able to say “with 100 percent confidence that this is due to the radiation,” Mousseau said.

 

Genetics of cancer: Non-coding DNA can finally be decoded .


Cancer is a disease of the genome resulting from a combination of genetic modifications, or mutations. We inherit from our parents strong or weak predispositions to developing certain kinds of cancer; in addition, we also accumulate new mutations in our cells throughout our lifetime. Although the genetic origins of cancers have been studied for a long time, researchers were not able to measure the role of non-coding regions of the genome until now.

Cancer is a disease of the genome resulting from a combination of genetic modifications (or mutations).

Cancer is a disease of the genome resulting from a combination of genetic modifications (or mutations). We inherit from our parents strong or weak predispositions to developing certain kinds of cancer; in addition, we also accumulate new mutations in our cells throughout our lifetime. Although the genetic origins of cancers have been studied for a long time, researchers were not able to measure the role of non-coding regions of the genome until now. A team of geneticists from the University of Geneva (UNIGE), by studying tissues from patients suffering from colorectal cancer, have succeeded in decoding this unexplored, but crucial, part of our genome. Their results can be found in Nature.

To better understand how cancer develops, scientists strive to identify genetic factors — whether hereditary or acquired — that could serve as the catalyst or trigger for tumor progression. Until now, the genetic basis of cancers had only been examined in the coding regions of the genome, which constitutes only 2% of it. However, as recent scientific advances have shown, the other 98% is far from inactive: it includes elements that serve to regulate gene expression, and therefore should play a major role in the development of cancer.

In order to better understand this role, Louis-Jeantet professor Emmanouil Dermitzakis and his team, from the Department of Genetic and Developmental Medicine in UNIGE’s Faculty of Medicine, studied colorectal cancer, one of the most common and most deadly cancers. Indeed, each year, one million new cases are detected around the world, and for almost half of these patients, the disease will prove fatal. Using genome sequencing technology, the UNIGE geneticists compared the RNA between healthy tissue and tumor tissue from 103 patients, searching for regulatory elements present in the vast, non-coding portion of the genome that impact the development of colorectal cancer. The goal was to identify the effect, present only in cancerous tissue, of acquired mutations whose activation would have triggered the disease. This approach is totally new: it is the first study of this scale to examine the non-coding genome of cancer patients.

Unknown Mutations

The UNIGE team was able to identify two kinds of non-coding mutations that have an impact on the development of colorectal cancer. They found, on one hand, hereditary regulatory variants that are not active in healthy tissue, but are activated in tumors and seem to contribute to cancer progression. It shows that the genome we inherit not only affects our predisposition towards developing cancer, but also has an influence on its progression. On the other hand, the researchers identified effects of acquired mutations on the regulation of gene expression that affect the genesis and progression of colorectal tumors.

‘The elements responsible for the development and progression of cancers located in the non-coding genome are as important as those found in the coding regions of the genome. Therefore, analyzing genetic factors in our whole genome, and not only in the coding regions as it was done before, gives us a much more comprehensive knowledge of the genetics behind colorectal cancer,’ explains Halit Ongen, the lead author of this study. ‘We applied this completely innovative methodology to colorectal cancer, but it can be applied to understand the genetic basis of all sorts of cancers,’ underlines Professor Dermitzakis.

Story Source:

The above story is based on materials provided by Université de Genève. Note: Materials may be edited for content and length.

Journal Reference:

  1. Halit Ongen, Claus L. Andersen, Jesper B. Bramsen, Bodil Oster, Mads H. Rasmussen, Pedro G. Ferreira, Juan Sandoval, Enrique Vidal, Nicola Whiffin, Alexandra Planchon, Ismael Padioleau, Deborah Bielser, Luciana Romano, Ian Tomlinson, Richard S. Houlston, Manel Esteller, Torben F. Orntoft, Emmanouil T. Dermitzakis. Putative cis-regulatory drivers in colorectal cancer. Nature, 2014; DOI: 10.1038/nature13602

Study Reveals How Sleep Removes Toxic Waste from the Brain.


Although we don’t know exactly why, there is no question that sleep is crucial for brain and overallhealth. Without proper sleep, the chance of disease and stress increases notably. Now, researchers at the University of Rochester Medical Center (URMC) Center for Translational Neuromedicine have found that sleeping actually helps detoxify the brain, potentially offering clues into dementia and Alzheimer’s disease.

The study, published in the journal Science, reveals that your brain has a unique method of removing toxic waste through ‘the glymphatic system. Even more interesting, it seems that brain cells shrink by about 60% during sleep, allowing for waste to be removed more easily.

“Sleep changes the cellular structure of the brain,”said Maiken Nedergaard, co-author of the study. “It appears to be a completely different state.”

http://themindunleashed.org/wp-content/uploads/2014/04/sleeeepp.jpg

HOW SLEEP AIDS THE BRAIN

The research looked at something called the glymphatic system of the brain. Injecting dye into the brains of mice, they watched the flow of cerebrospinal fluid (CSF) and found that the CSF flowed rapidly when the mice were unconscious (whether asleep or sedated) and barely moved when the mice were awake.

“We were surprised by how little flow there was into the brain when the mice were awake,” said Nedergaard.“It suggested that the space between brain cells changed greatly between conscious and unconscious states.”

Then, they measured the space between brain cells to test their theory. Using electrodes inserted into the brain, they found the space between these cells grew by 60% during sleep, allowing the CSF to flow more freely.

“These results may have broad implications for multiple neurological disorders,” said Jim Koenig, Ph.D. “This means the cells regulating the glymphatic system may be new targets for treating a range of disorders.”

While scientists and drug makers will now scramble to create drugs that can work alongside the glymphatic system, the study should also underscore the importance of getting a good night’s sleep, every single night.

“This study shows that the brain has different functional states when asleep and when awake,” said Nedergaard. “In fact, the restorative nature of sleep appears to be the result of the active clearance of the by-products of neural activity that accumulate during wakefulness.”

Glucose control complicates therapy for UC patients with type 1 diabetes.


Treating ulcerative colitis in patients with type 1 diabetes presents numerous challenges as commonly prescribed corticosteroids can affect glucose control, and the diseases share other comorbidities.

Researchers surveyed existing studies and discussed shared complications — including hepatic steatosis, neuropathy, osteoporosis and venous thrombosis — and treatment strategies for UC patients with type 1 diabetes.

“It is still unknown whether coexistence of these diseases may increase their occurrence,” the researchers wrote, and added that genetic links invite further study, and that hyperglycemia also can cause postoperative complications.

According to researchers, type 1 diabetes is the third most common comorbidity in UC patients after psoriasis and rheumatoid arthritis. Because corticosteroids are the preferred treatment for UC patients with type 1 diabetes, clinicians must be mindful of the potential for increased blood glucose levels. Researchers wrote that patients with severe UC should be hospitalized and treated with 60 mg methylprednisolone daily or 100 mg hydrocortisone four times daily for 7 to 10 days. They said that higher doses are no more effective, and lower doses are less effective. About 67% of patients respond favorably to treatment, and secondary treatment could include colectomy, cyclosporine, infliximab or tacrolimus.

Patients with diabetes should be monitored closely for hyperglycemia, dehydration and electrolyte imbalance to avoid complications such as hyperosmolar hyperglycemic state or diabetic ketoacidosis. Similar factors also can complicate postoperative healing in UC patients. Hypokalemia and hypomagnesemia are potential morbidities caused by poorly controlled blood sugar, and increase the risk for toxic megacolon.

Researchers said patients with type 1 diabetes with mild to moderate UC symptoms are likely to experience favorable UC outcomes with administration of topical mesalazine. Other treatments such as beclomethasone dipropionate, budesonide multimatrix system, fluticasone or prednisolone metasulphobenzoate also are discussed in the review, along with UC complications related to drugs such as metformin often administered for diabetes.

iPhone modified bronchoscope doesn’t intubate better than Glidescope or DL.


A recent study in BMC Anesthesiology compared an iPhone modified bronchoscope (iPMB) with existing intubation methods. Using a manikin, the iPMB was compared to flexible fiberoptic bronchoscope, glidescope, and a macintosh blade.

Sixty-three participants that were experienced with intubation used each device on a manikin. They intubated using the devices in both simple intubations as well as simulated difficult situations (where the neck was immobilized). The time to view the vocal cords (TVC) and the time taken for successful intubation (TSI) were measured for each intubation.

Screenshot 2014-06-26 11.06.04

Results for TVC for the iPhone were similar to the macintosh blade and bronchoscope. TSI was longer with the iPhone than with the unmodified bronchoscope and macintosh blade. The glidescope had better results in TVC and TSI than the other devices. There was also a higher rate of failure to intubate with the iPhone modified device.

This study does show that iPMB could be useful in training situations, since like the Glidescope, it provides a video display that can be seen by instructors and trainees simultaneously.

Screenshot 2014-06-26 11.05.32

Further, authors stressed how the iPhone’s built in capabilities of data and taking pictures would allow it to stream content remotely, or even to local devices.

This is a great study to highlight how sticking an iPhone onto a traditional device doesn’t necessarily make the procedure easier. I’m glad this study was done as I know some of my own colleagues have thought about putting a mobile device that captures videos onto a bronchoscope — it sounds like a fantastic idea. But in reality, we should stick to the Glidescope and direct Laryngoscopy.

Source: BMC Anesthesioogy

Stress tied to change in children’s gene expression related to emotion regulation, physical health.


Children who have been abused or neglected early in life are at risk for developing both emotional and physical health problems. In a new study, scientists have found that maltreatment affects the way genes are activated, which has implications for children’s long-term development. Previous studies focused on how a particular child’s individual characteristics and genetics interacted with that child’s experiences in an effort to understand how health problems emerge. In the new study, researchers were able to measure the degree to which genes were turned “on” or “off” through a biochemical process called methylation. This new technique reveals the ways that nurture changes nature—that is, how our social experiences can change the underlying biology of our genes.

The study, from researchers at the University of Wisconsin, Madison, appears in the journalChild Development. Nearly 1 million children in the United States are neglected or abused every year.

The researchers found an association between the kind of parenting children had and a particular gene (called the glucocorticoid receptor gene) that’s responsible for crucial aspects of social functioning and health. Not all genes are active at all times. DNA methylation is one of several biochemical mechanisms that cells use to control whether genes are turned on or off. The researchers examined DNA methylation in the blood of 56 children ages 11 to 14. Half of the children had been physically abused.

They found that compared to the children who hadn’t been maltreated, the maltreated children had increased methylation on several sites of the glucocorticoid receptor gene, also known as NR3C1, echoing the findings of earlier studies of rodents. In this study, the effect occurred on the section of the gene that’s critical for nerve growth factor, which is an important part of healthy brain development.

There were no differences in the genes that the children were born with, the study found; instead, the differences were seen in the extent to which the genes had been turned on or off. “This link between early life stress and changes in genes may uncover how early childhood experiences get under the skin and confer lifelong risk,” notes Seth D. Pollak, professor of psychology and pediatrics at the University of Wisconsin, Madison, who directed the study.

Previous studies have shown that children who have experienced physical abuse, sexual abuse, and neglect are more likely to develop mood, anxiety, and aggressive disorders, as well as to have problems regulating their emotions. These problems, in turn, can disrupt relationships and affect school performance. Maltreated children are also at risk for chronic health problems such as cardiac disease and cancer. The current study helps explain why these childhood experiences can affect health years later.

The gene identified by the researchers affects the hypothalamic-pituitary-adrenal (HPA) axis in rodents. Disruptions of this system in the brain would make it difficult for people to regulate their emotional behavior and stress levels. Circulating through the body in the blood, this gene affects the immune system, leaving individuals less able to fight off germs and more vulnerable to illnesses.

“Our finding that children who were physically maltreated display a specific change to the glucocorticoid receptor gene could explain why abused children have more emotional difficulties as they age,” according to Pollak. “They may have fewer glucocorticoid receptors in their brains, which would impair the brain’s stress-response system and result in problems regulating stress.”

The findings have implications for designing more effective interventions for children, especially since studies of animals indicate that the effects of poor parenting on gene methylation may be reversible if caregiving improves. The study also adds to what we know about how child maltreatment relates to changes in the body and mind, findings that were summarized recently in an SRCD Social Policy Report by Sara R. Jaffee and Cindy W. Christian.

FDA Approves Targiniq ER.


Today, the U.S. Food and Drug Administration approved Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride extended-release tablets), an extended-release/long-acting (ER/LA) opioid analgesic to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Targiniq ER is the second ER/LA opioid analgesic with FDA-approved labeling describing the product’s abuse-deterrent properties consistentwith the FDA’s 2013 draft guidance for industry, Abuse-Deterrent Opioids – Evaluation and Labeling.

Targiniq ER has properties that are expected to deter, but not totally prevent, abuse of the drug by snorting and injection. When crushed and snorted, or crushed, dissolved and injected, the naloxone in Targiniq ER blocks the euphoric effects of oxycodone, making it less liked by abusers than oxycodone alone. Naloxone is a medication that is commonly used to reverse the effects of opioid overdose. Targiniq ER can still be abused, including when taken orally (by mouth), which is currently the most common way oxycodone is abused. It is important to note that taking too much Targiniq ER for purposes of abuse or by accident, can cause an overdose that can result in death.

“The FDA is committed to combatting the misuse and abuse of all opioids, and the development of opioids that are harder to abuse is needed in order to help address the public health crisis of prescription drug abuse in the U.S.,” said Sharon Hertz, M.D., deputy director of the Division of Anesthesia, Analgesia and Addiction Products in the FDA’s Center for Drug Evaluation and Research. “Encouraging the development of opioids with abuse-deterrent properties is just one component of a broader approach to reducing abuse and misuse, and will better enable the FDA to balance addressing this problem with meeting the needs of the millions of people in this country suffering from pain.”

Targiniq ER is not approved, and should not be used, for as-needed pain relief. Given Targiniq ER’s risks for abuse, misuse and addiction, it should only be prescribed to people for whom alternative treatment options are ineffective, not tolerated or would be otherwise inadequate to provide sufficient pain management.

The safety and effectiveness of Targiniq ER was evaluated in a clinical trial of 601 people with chronic low back pain. The safety database supporting approval included treatment of more than 3,000 people with Targiniq ER. Data from in vitro (in a laboratory) and in vivo (testing with people) abuse liability studies demonstrated the abuse deterrent features of Targiniq ER as they relate to certain types of abuse (snorting, injecting). The most common side effects of Targiniq ER are nausea and vomiting.

The FDA is requiring postmarketing studies of Targiniq ER, to assess the serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose, and death associated with long term use beyond 12 weeks. The FDA is also requiring postmarketing studies to further assess the effects of the abuse-deterrent features on the risk for abuse of Targiniq ER.

In addition, Targiniq ER is part of the ER/LA Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS), which requires companies to make available to health care professionals educational programs on how to safely prescribe ER/LA opioid analgesics and to provide Medication Guides and patient counseling documents containing information on the safe use, storage, and disposal of ER/LA opioids.