Philadelphia Adult Congenital Heart Program Reports Excellent Outcomes in Heart Transplants in ACHD Patients


A research team from the Philadelphia Adult Congenital Heart Program reported excellent outcomes in performing heart transplants in patients who had adult congenital heart disease (ACHD). Seventeen consecutive adult heart transplant patients, including seven in the highest-risk category, had a 100 percent survival rate. The researchers, members of a joint program between The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, presented their findings were recently at the American College of Cardiology 65th Annual Scientific Session in Chicago.

Philadelphia Adult Congenital Heart Program

“The Philadelphia Adult Congenital Heart Program is multidisciplinary. All patients with complex CHD being evaluated for transplant automatically see both a cardiologist and a cardiac surgeon,” said Yuli Kim, MD, medical director of the Program. “Most of the patients originate from the ACHD Program, which is the destination at the Hospital of the University of Pennsylvania (HUP) for adult patients who transition from a CHOP pediatric cardiologist, and need adult care that might necessitate a heart transplant.”

“We are a stepping stone and a bridge for some of these adults at CHOP, for example from the Single Ventricle Survivorship Program to the Adult Congenital Heart Program team to transplant,” said Dr. Kim. Patients might also have a heart rhythm problem or be a sudden cardiac arrest survivor who transition to the Adult Congenital Heart Program and then to transplant,” added Dr. Kim.

About the study

The research team examined data from 17 consecutive patients with ACHD who underwent heart transplantation between March 2010 and July 2015. Patients were evaluated by a multidisciplinary team of adult and pediatric subspecialists, including experts in heart failure and transplant, ACHD cardiology, cardiac surgery, and in some cases, hepatology and pulmonary medicine.

The transplanted patients ranged in age from 23 to 57. Of the 17 patients, eight underwent a heart and liver transplant, one underwent a heart and lung transplant, and none of the patients required post-operative mechanical support. Of the eight heart and liver transplants, seven were in patients with single ventricles — as opposed to two ventricles in normal hearts — who previously underwent a Fontan, a pediatric surgical procedure used to reconfigure the heart’s circulation to maximize the efficiency of the single ventricle without overworking it. These patients are among the highest risk transplants undertaken. Researchers found that with an average follow-up of 35 months, as of September 2015, there was 100 percent survival at both 30 days and one year.

While there is little data to inform best practices in treating patients with ACHD, the researchers conclude that their integrated, team-based approach presents a promising start in treating patients with this unique physiology and anatomy.

Do Antibiotics Raise Diabetes Risk via Gut Microbiota?


People who take multiple courses of antibiotics may face an increased risk of developing both type 1 and type 2 diabetes, potentially through alterations in gut microbiota, conclude US researchers.

The team, led by Ben Boursi, MD, a postdoctoral researcher in the department of gastroenterology at the University of Pennsylvania, Philadelphia, found that the risk of diabetes was increased by up to 37%, depending on the type of antibiotic and the number of courses prescribed.

“Overprescription of antibiotics is already a problem around the world as bacteria become increasingly resistant to their effects,” commented Dr Boursi in a statement.

“Our findings are important, not only for understanding how diabetes may develop, but as a warning to reduce unnecessary antibiotic treatments that might do more harm than good.”

The study was published online ahead of print March 24 in the European Journal of Endocrinology.

The More Courses of Antibiotics, the Greater the Risk

Dr Boursi explained that studies both in animal models and humans have shown an association between changes in gut microbiota in response to antibiotic exposure and obesity, insulin resistance, and diabetes.

Speaking to Medscape Medical News, he noted: “In mice, we know that germ-free mice are lean and, by fecal transplantation, we can transmit obesity to them. We also know that low dose of penicillin may induce obesity in mice models.”
He added that there have been several studies in humans indicating that exposure to antibiotics in early childhood is associated with an increased risk of obesity in later life, while other investigations have reported differences in gut microbiota between people with and without diabetes.

To investigate further, Dr Boursi and colleagues conducted a nested case-control study using data from the Health Improvement Network (THIN), a UK population-based database, from which they identified 1,804,170 patients with acceptable medical records.

As diabetes is associated with an increased risk of infection, the team wanted to exclude all cases with prediabetes or undiagnosed diabetes. To do that, they removed all patients diagnosed with diabetes within 183 days of starting follow-up and included only patients with exposure to antibiotics more than 1 year prior to the index date.
From the original cohort, they were able to select 208,002 diabetes patients and 815,576 controls matched for age, sex, general practice site, and duration of follow-up before the index date.

Conditional logistic regression analysis revealed that exposure to a single antibiotic prescription was not associated with an increased risk of diabetes, adjusted for body mass index (BMI), smoking, last blood glucose level, and the number of infections before the index date, alongside a history of coronary artery disease and hyperlipidemia.

However, treatment with two to five courses of antibiotics was linked to an increased risk of diabetes with penicillin, cephalosporins, macrolides, and quinolones, at adjusted odds ratios (ORs) ranging from 1.08 for penicillin to 1.15 for quinolones.

The highest risk for diabetes was seen among people who received more than five courses of quinolones, at an adjusted OR of 1.37. An increased risk of diabetes was also seen in patients who took more than five courses of tetracyclines, at an adjusted OR of 1.21.

Interestingly, the researchers were unable to find an association between diabetes risk and treatment with imidazole, antiviral drugs, and antifungals, regardless of the number of courses.

To account for further possible confounding factors, the researchers repeated the analysis only in individuals without skin or urinary-tract infections, which are more common among diabetes patients. This had no impact on the results.

Next Steps

When the analysis was restricted to type 1 diabetes, the risk was increased only following exposure to more than five courses of penicillin or two to five courses of cephalosporin, at odds ratios of 1.41 and 1.63, respectively.

Commenting on the findings, study coauthor Yu-Xiao Yang, MD, assistant professor of medicine and epidemiology, University of Pennsylvania, pointed out their investigation was observational in nature.

“We are not able to establish cause and effect necessarily, but it is actually pretty consistent with the experimental data, which is more definitive in terms of the animal data than in humans.”

Dr Yang said that the next step for the team will be to expand their focus, as the antibiotics data “provide indirect evidence suggesting the importance of gut microbiota on metabolic outcomes, including diabetes.”

Describing their findings as “important evidence,” he concluded: “Based on this indirect evidence and existing data in animals, we are planning to more directly investigate the effect of altered microbe environments in humans.”

Why it’s time for brain science to ditch the ‘Venus and Mars’ cliche.


Reports trumpeting basic differences between male and female brains are biological determinism at its most trivial, says the science writer of the year
brains illustration male female

There is little evidence to suggest differences between male and female brains are caused by anything other than cultural factors. Photograph: Alamy

As hardy perennials go, there is little to beat that science hacks’ favourite: the hard-wiring of male and female brains. For more than 30 years, I have seen a stream of tales about gender differences in brain structure under headlines that assure me that from birth men are innately more rational and better at map-reading than women, who are emotional, empathetic multi-taskers, useless at telling jokes. I am from Mars, apparently, while the ladies in my life are from Venus.

And there are no signs that this flow is drying up, with last week witnessing publication of a particularly lurid example of the genre. Writing in the US journal Proceedings of the National Academy of Sciences, researchers at the University of Pennsylvania in Philadelphia revealed they had used a technique called diffusion tensor imaging to show that the neurons in men’s brains are connected to each other in a very different way from neurons in women’s brains.

This point was even illustrated by the team, led by Professor Ragini Verma, with a helpful diagram. A male brain was depicted with its main connections – coloured blue, needless to say – running from the front to the back. Connections within cranial hemispheres were strong, but connections between the two hemispheres were weak. By contrast, the female brain had thick connections running from side to side with strong links between the two hemispheres.

Men and women brains U.Penn studyA photo issued by University of Pennsylvania researchers showing intra-hemispheric connections (blue) and inter- hemispheric connections (orange) in men’s and women’s brains. Male top row, female bottom row. Photograph: National Academy Of Sciences/PA”These maps show us a stark difference in the architecture of the human brain that helps provide a potential neural basis as to why men excel at certain tasks and women at others,” said Verma.

The response of the press was predictable. Once again scientists had “proved” that from birth men have brains which are hardwired to give us better spatial skills, to leave us bereft of empathy for others, and to make us run, like mascara, at the first hint of emotion. Equally, the team had provided an explanation for the “fact” that women cannot use corkscrews or park cars but can remember names and faces better than males. It is all written in our neurons at birth.

As I have said, I have read this sort of thing before. I didn’t believe it then and I don’t believe it now. It is biological determinism at its silly, trivial worst. Yes, men and women probably do have differently wired brains, but there is little convincing evidence to suggest these variations are caused by anything other than cultural factors. Males develop improved spatial skills not because of an innate superiority but because they are expected and encouraged to be strong at sport, which requires expertise at catching and throwing. Similarly, it is anticipated that girls will be more emotional and talkative, and so their verbal skills are emphasised by teachers and parents. As the years pass, these different lifestyles produce variations in brain wiring – which is a lot more plastic than most biological determinists realise. This possibility was simply not addressed by Verma and her team.

Equally, when gender differences are uncovered by researchers they are frequently found to be trivial, a point made by Robert Plomin, a professor of behavioural genetics at London’s Institute of Psychiatry, whose studies have found that a mere 3% of the variation in young children’s verbal development is due to their gender. “If you map the distribution of scores for verbal skills of boys and of girls, you get two graphs that overlap so much you would need a very fine pencil indeed to show the difference between them. Yet people ignore this huge similarity between boys and girls and instead exaggerate wildly the tiny difference between them. It drives me wild.”

I should make it clear that Plomin made that remark three years ago when I last wrote about the issue of gender and brain wiring. It was not my first incursion, I should stress. Indeed, I have returned to the subject – which is an intriguing, important one – on a number of occasions over the years as neurological studies have been hyped in the media, often by the scientists who carried them out. It has taken a great deal of effort by other researchers to put the issue in proper perspective.

A major problem is the lack of consistent work in the field, a point stressed to me in 2005 – during an earlier outbreak of brain-gender difference stories – by Professor Steve Jones, a geneticist at University College London, and author of Y: The Descent of Men. “Researching my book, I discovered there was no consensus at all about the science [of gender and brain structure],” he told me. “There were studies that said completely contradictory things about male and female brains. That means you can pick whatever study you like and build a thesis around it. The whole field is like that. It is very subjective. That doesn’t mean there are no differences between the brains of the sexes, but we should take care not to exaggerate them.”

Needless to say that is not what has happened over the years. Indeed, this has become a topic whose coverage has been typified mainly by flaky claims, wild hyperbole and sexism. It is all very depressing. The question is: why has this happened? Why is there such divergence in explanations for the differences in mental abilities that we observe in men and women? And why do so many people want to exaggerate them so badly?

The first issue is the easier to answer. The field suffers because it is bedevilled by its extraordinary complexity. The human brain is a vast, convoluted edifice and scientists are only now beginning to develop adequate tools to explore it. The use of diffusion tensor imaging by Verma’s team was an important breakthrough, it should be noted. The trouble is, once more, those involved were rash in their interpretations of their own work.

“This study contains some important data but it has been badly overhyped and the authors must take some of the blame,” says Professor Dorothy Bishop, of Oxford University. “They talk as if there is a typical male and a typical female brain – they even provide a diagram – but they ignore the fact that there is a great deal of variation within the sexes in terms of brain structure. You simply cannot say there is a male brain and a female brain.”

Even more critical is Marco Catani, of London’s Institute of Psychiatry. “The study’s main conclusions about possible cognitive differences between males and females are not supported by the findings of the study. A link between anatomical differences and cognitive functions should be demonstrated and the authors have not done so. They simply have no idea of how these differences in anatomy translate into cognitive attitudes. So the main conclusion of the study is purely speculative.”

The study is also unclear how differences in brain architecture between the sexes arose in the first place, a point raised by Michael Bloomfield of the MRC’s Clinical Science Centre. “An obvious possibility is that male hormones like testosterone and female hormones like oestrogen have different effects on the brain. A more subtle possibility is that bringing a child up in a particular gender could affect how our brains are wired.”

In fact, Verma’s results showed that the neuronal connectivity differences between the sexes increased with the age of her subjects. Such a finding is entirely consistent with the idea that cultural factors are driving changes in the brain’s wiring. The longer we live, the more our intellectual biases are exaggerated and intensified by our culture, with cumulative effects on our neurons. In other words, the intellectual differences we observe between the sexes are not the result of different genetic birthrights but are a consequence of what we expect a boy or a girl to be.

Why so many people should be so desperate to ignore or obscure this fact is a very different issue. In the end, I suspect it depends on whether you believe our fates are sealed at birth or if you think that it is a key part of human nature to be able to display a plasticity in behaviour and in ways of thinking in the face of altered circumstance. My money is very much on the latter.

WHAT THE NEW STUDY SHOWS

In their study, Verma and her colleagues, investigated the gender differences in brain connectivity in 949 individuals – 521 females and 428 males – aged between eight and 22 years. The technique they used is known as diffusion tensor imaging (DTI), a water-based imaging technology that can trace and highlight the fibre pathways that connect the different regions of the brain, laying the foundation for a structural connectome or network of the whole brain. These studies revealed a typical pattern, claim Verma and her team: men had stronger links between neurons within their cranial hemispheres while women had stronger links between the two hemispheres, a difference that the scientists claimed was crucial in explaining difference in the behaviour of men and women.

But the technique has been criticised. “DTI provides only indirect measures of structural connectivity and is, therefore, different from the well validated microscopic techniques that show the real anatomy of axonal connections,” says Marco Catani, of London’s Institute of Psychiatry. “Images of the brain derived from diffusion tensor MRI should not be equated to real connections and results should always be interpreted with extreme caution.”This point is backed by Prof Heidi Johansen-Berg, of Oxford University, who attacked the idea that brain connections should be considered as hard-wired. “Connections can change throughout life, in response to experience and learning. As far as I can tell, the authors have not directly related these differences in brain connections to differences in behaviour. It is a huge leap to extrapolate from anatomical differences to try to explain behavioural variation between the sexes. The brain regions that have been highlighted are involved in many different functions.”

 

Men can’t multitask, women have better memory, study led by Indian-origin scientist reveals.


Men can’t multitask and women have better memory because their brains are wired differently, a new study led by an Indian-origin scientist has found.

The research found striking differences in the neural wiring of men and women, which explains why males excel at certain tasks and females at others.

In one of the largest studies looking at the “connectomes” of the sexes, Ragini Verma, an associate professor in the department of radiology at the Perelman School of Medicine at the University of Pennsylvania, and colleagues found greater neural connectivity from front to back and within one hemisphere in males.

This suggests male brains are structured to facilitate connectivity between perception and coordinated action.

In contrast, in females, the wiring goes between the left and right hemispheres, suggesting that they facilitate communication between the analytical and intuition.

“These maps show us a stark difference – and complementarity – in the architecture of the human brain that helps provide a potential neural basis as to why men excel at certain tasks, and women at others,” said Verma, who has a PhD in computer vision and mathematics from Indian Institute of Technology Delhi.

In the study, Verma and colleagues investigated the gender-specific differences in brain connectivity during the course of development in 949 individuals (521 females and 428 males) aged 8 to 22 years using diffusion tensor imaging.

DTI is water-based imaging technique that can trace and highlight the fiber pathways connecting the different regions of the brain, laying the foundation for a structural connectome or network of the whole brain.

Researchers found that females displayed greater connectivity in the supratentorial region, which contains the cerebrum, the largest part of the brain, between the left and right hemispheres.

Males, on the other hand, displayed greater connectivity within each hemisphere.

By contrast, the opposite prevailed in the cerebellum, the part of the brain that plays a major role in motor control, where males displayed greater inter-hemispheric connectivity and females displayed greater intra-hemispheric connectivity.

These connections likely give men an efficient system for coordinated action, where the cerebellum and cortex participate in bridging between perceptual experiences in the back of the brain, and action, in the front of the brain, researchers said in the journal Proceedings of National Academy of Sciences.

The female connections likely facilitate integration of the analytic and sequential processing modes of the left hemisphere with the spatial, intuitive information processing modes of the right side.

The authors observed only a few gender differences in the connectivity in children younger than 13 years, but the differences were more pronounced in adolescents aged 14 to 17 years and young adults older than 17.

Study shows side-channel phone risk via microphone and camera.


Researchers exploring smartphone security vulnerabilities are increasingly turning to information about smartphone sensors as pathways to security breach. Earlier this year, a Stanford University team warned that sensors such as accelerometers could identify a device and track it. In 2012, a paper titled “Practicality of Accelerometer Side Channels on Smartphones” by researchers from the University of Pennsylvania reported that by analyzing data gathered by accelerometers they were able to get a good idea of the PIN or pattern used to protect a phone. Now a study by two researchers at Cambridge University set out to show that a smartphone PIN can be identified via the smartphone camera and microphone. Smartphone rsearchers Ross Anderson, Professor of Security Engineering at the Computer Laboratory at the University of Cambridge and Laurent Simon, also of the Computer Laboratory, demonstrated an attack that can reveal the PIN codes for sensitive apps, such as those for banking, by tapping into the microphone and camera.. They wrote about their finding in the paper, “PIN Skimmer: Inferring PINs Through the Camera and Microphone.” Their study was presented at a recent workshop on Security and Privacy in Smartphones and Mobile Devices (SPSM) in Berlin.

“In this paper,” they wrote, “we aim to raise awareness of side-channel attacks even when strong isolation protects sensitive applications. Previous works have studied the use of the phone accelerometer and gyroscope as side channel data to infer PINs. Here, we describe a new side-channel attack that makes use of the video and to infer PINs entered on a number-only soft key-board on a smartphone.”

Their attack was achieved through a program called PIN Skimmer. They found that codes entered on a number-only soft keypad could be identified. Their feat involves software that watches the smartphone user’s face by means of the camera and listens to clicks through the microphone as the victim types. The microphone can detect touch as a user enters the PIN, taking in the clicks made by the smartphone from the user pressing on the virtual number keys. The camera estimates the orientation of the phone as the user is doing this and correlates it to the position of the user-tapped digit.

Writing about their work in the security weblog “Light Blue Touchpaper,” Ross Anderson said, “We found that software on your can work out what PIN you’re entering by watching your face through the camera and listening for the clicks as you type. Previous researchers had shown how to work out PINs using the gyro and accelerometer; we found that the camera works about as well. We watch how your face appears to move as you jiggle your phone by typing.”

https://i1.wp.com/cdn.physorg.com/newman/gfx/news/2013/vcgnfxguyv.jpg

The paper reported these results: When selecting from a test set of 50 four-digit PINs, PIN Skimmer correctly infers more than 30 percent of PINs after two attempts, and more than 50 percent of PINs after five attempts on Android-powered phones. When selecting from a set of 200 eight-digit PINs, PIN Skimmer correctly infers about 45 percent of the PINs after five attempts and 60 percent after 10 attempts.

The authors reserved a special section in the paper where they presented possible countermeasures to mitigate side-channel attacks on PIN input. Blogged Anderson: “Meanwhile, if you’re developing payment apps, you’d better be aware that these risks exist.”

Dyson Award for wearable robotic arm


A battery-powered robotic arm that boosts human strength has won the 2013 James Dyson award.

The Titan Arm, designed by four mechanical engineering students from the University of Pennsylvania, could help people with back injuries rebuild and regain control of muscles.

Man wearing Titan Arm raised aloft

It can also be used by people to lift heavy objects as part of their work.

The team, who spent eight months creating the exoskeleton, will share a prize of £30,000 ($48,000).

“Titan Arm is obviously an ingenious design, but the team’s use of modern, rapid – and relatively inexpensive – manufacturing techniques makes the project even more compelling,” said Sir James Dyson.

“We are ecstatic,” team member Nick Parrotta told the BBC. “It was totally unexpected – just incredible.”

‘Inexpensive aluminium’

Team wearing titan arm
The University of Pennsylvania team shows off its award-winning Titan Arm

The team produced its prototype for £1,200, which they say is a 50th of the typical cost of similar exoskeletons currently on the market.

“We wanted Titan Arm to be affordable, as exoskeletons are rarely covered by health insurance,” said Mr Parrotta, 23, currently studying for a masters in mechanical engineering.

“This informed our design decisions and the materials we used. Most structural components are machined from inexpensive aluminium.”

Academic and commercial interest in wearable robotics is growing according to Conor Walsh, Professor of of Mechanical and Biomedical Engineering at the Harvard School of Engineering and Applied Sciences.

But costs will have to continue falling if robotics are to feature more often in daily life, he said.

“Reducing cost will be critical for commercial systems, however the total cost is not just the cost of the hardware but also the added cost associated with research and development, quality assurance and regulatory compliance.”

The Titan arm incorporates a rigid back brace to maintain posture, a shoulder featuring rotational joints, and sensors that can track motion and relay data back to doctors for remote prognosis.

It can augment human weight-lifting strength by 40lbs (18kg), say the inventors, while the batteries can last for up to eight hours, depending on intensity of usage and workload.

Electrical signals

The current prototype is operated by a separate joystick, but future versions may incorporate electromyography technology, said Mr Parrotta, which picks up electrical signals produced by muscle tissue, thus allowing users to operate such prosthetics almost without thinking.

Photo of prosthetic hand
Handie, a prosthetic hand with sensors that can read brain signals, won second place

All of the inventors who took part in the competition used 3D-printing to develop and produce their prototypes much more cheaply than would have been possible before.

“Prototyping technology, previously reserved only for companies with big research and development budgets, is enabling young inventors to develop sophisticated concepts at university,” said Sir James.

“They can revitalise industries on a small budget – it is a good time to be an inventor.”

The second prize went to a Japanese team who created Handie, a prosthetic hand with sensors that can read brain signals.

A 3D-printed plastic cast for broken limbs, invented by a team from New Zealand, took the third prize.

The James Dyson Foundation runs the annual award across 18 countries with the aim of encouraging problem-solving inventions.

Concurrent Naltrexone and Prolonged Exposure Therapy for Patients With Comorbid Alcohol Dependence and PTSDA Randomized Clinical Trial.


Importance   Alcohol dependence comorbid with posttraumatic stress disorder (PTSD) has been found to be resistant to treatment. In addition, there is a concern that prolonged exposure therapy for PTSD may exacerbate alcohol use.

Objective   To compare the efficacy of an evidence-based treatment for alcohol dependence (naltrexone) plus an evidence-based treatment for PTSD (prolonged exposure therapy), their combination, and supportive counseling.

Design, Setting, and Participants   A single-blind, randomized clinical trial of 165 participants with PTSD and alcohol dependence conducted at the University of Pennsylvania and the Philadelphia Veterans Administration. Participant enrollment began on February 8, 2001, and ended on June 25, 2009. Data collection was completed on August 12, 2010.

Interventions   Participants were randomly assigned to (1) prolonged exposure therapy plus naltrexone (100 mg/d), (2) prolonged exposure therapy plus pill placebo, (3) supportive counseling plus naltrexone (100 mg/d), or (4) supportive counseling plus pill placebo. Prolonged exposure therapy was composed of 12 weekly 90-minute sessions followed by 6 biweekly sessions. All participants received supportive counseling.

Main Outcomes and Measures   The Timeline Follow-Back Interview and the PTSD Symptom Severity Interview were used to assess the percentage of days drinking alcohol and PTSD severity, respectively, and the Penn Alcohol Craving Scale was used to assess alcohol craving. Independent evaluations occurred prior to treatment (week 0), at posttreatment (week 24), and at 6 months after treatment discontinuation (week 52).

Results   Participants in all 4 treatment groups had large reductions in the percentage of days drinking (mean change, −63.9% [95% CI, −73.6% to −54.2%] for prolonged exposure therapy plus naltrexone; −63.9% [95% CI, −73.9% to −53.8%] for prolonged exposure therapy plus placebo; −69.9% [95% CI, −78.7% to −61.2%] for supportive counseling plus naltrexone; and −61.0% [95% CI, −68.9% to −53.0%] for supportive counseling plus placebo). However, those who received naltrexone had lower percentages of days drinking than those who received placebo (mean difference, 7.93%; P = .008). There was also a reduction in PTSD symptoms in all 4 groups, but the main effect of prolonged exposure therapy was not statistically significant. Six months after the end of treatment, participants in all 4 groups had increases in percentage of days drinking. However, those in the prolonged exposure therapy plus naltrexone group had the smallest increases.

Conclusions and Relevance   In this study of patients with alcohol dependence and PTSD, naltrexone treatment resulted in a decrease in the percentage of days drinking. Prolonged exposure therapy was not associated with an exacerbation of alcohol use disorder.

Source: JAMA

Migraine associated with brain artery defect..


The network of arteries supplying blood flow to the brain is more likely to be incomplete in people who suffer migraine, a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania reports. Variations in arterial anatomy lead to asymmetries in cerebral blood flow that might contribute to the process triggering migraines.

The arterial supply of blood to the brain is protected by a series of connections between the major arteries, termed the “circle of Willis” after the English physician who first described it in the 17th century. People with migraine, particularly migraine with aura, are more likely to be missing components of the circle of Willis.

migraine-aura-1

Migraine affects an estimated 28 million Americans, causing significant disability. Experts once believed that migraine was caused by dilation of blood vessels in the head, while more recently it has been attributed to abnormal neuronal signals. In this study, appearing in PLOS ONE, researchers suggest that blood vessels play a different role than previously suspected: structural alterations of the blood supply to the brain may increase susceptibility to changes in cerebral blood flow, contributing to the abnormal neuronal activity that starts migraine.

“People with migraine actually have differences in the structure of their blood vessels; this is something you are born with,” said the study’s lead author, Brett Cucchiara, MD, Associate Professor of Neurology. “These differences seem to be associated with changes in blood flow in the brain, and it’s possible that these changes may trigger migraine, which may explain why some people, for instance, notice that dehydration triggers their headaches.”

In a study of 170 people from three groups—a control group with no headaches, those who had migraine with aura, and those who had migraine without aura—the team found that an incomplete circle of Willis was more common in people with migraine with aura (73 percent) and migraine without aura (67 percent), compared to a headache-free control group (51 percent). The team used magnetic resonance angiography to examine blood vessel structure and a noninvasive magnetic resonance imaging method pioneered at the University of Pennsylvania, called Arterial spin labeling (ASL), to measure changes in cerebral blood flow.

“Abnormalities in both the circle of Willis and blood flow were most prominent in the back of the brain, where the visual cortex is located. This may help explain why the most common migraine auras consist of visual symptoms such as seeing distortions, spots, or wavy lines,” said the study’s senior author, John Detre, MD, Professor of Neurology and Radiology.

Both migraine and incomplete circle of Willis are common, and the observed association is likely one of many factors that contribute to migraine in any individual. The researchers suggest that at some point diagnostic tests of circle of Willis integrity and function could help pinpoint this contributing factor in an individual patient. Treatment strategies might then be personalized and tested in specific subgroups.

In addition to Dr. Cucchiara and Dr. Detre, the research team at Penn includes Scott Kasner, MD, Ritobrato Datta, PhD, Geoffrey Aguirre, MD, PhD from Neurology, and Ronald Wolf, MD, PhD, from Radiology. Radiologists Lidia Nagae, MD, from the Children’s Hospital of Philadelphia, and Quan Zhang, PhD, from Tianjin Medical University in Tianjin, China, contributed to the study.

Source: http://machineslikeus.com

Prostate Cancer Risk Linked To Early-Onset Baldness In New Study.


African american shaved head

French researchers said it, and now a team from the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania in Philadelphia have released new evidence to support their claim: Men who lose their hair early in life have a greater risk of developing prostate cancer.

In a study of 537 African-American men — 318 with prostate cancer and 219 controls — investigators discovered that baldness of any kind was associated with a 69 percent increased risk of prostate cancer, particularly among African-American men.

According to the study, which was published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, black men with frontal baldness, and not vertex baldness, were more than twice as likely to have been diagnosed with advanced prostate cancer. The association was even stronger among those who were diagnosed when younger than 60, with a sixfold increase in high-stage prostate cancer and a fourfold increase in high-grade prostate cancer.

The findings concur with a 2011 report showing that men who start to go bald at age 20 may be more likely to develop prostate cancer in later life. Though grim, the team conducting that study suggested that their findings be used as a basis for early screening or preventative therapy for those at higher risk.

“Early-onset baldness may be a risk factor for early-onset prostate cancer in African-American men, particularly younger men,” said Charnita Zeigler-Johnson, Ph.D., research assistant professor at the Center for Clinical Epidemiology and Biostatistics at UPenn and lead author of the study. “Pending future studies to confirm our results, there is a potential to use early-onset baldness as a clinical indicator of increased risk for prostate cancer in some populations of men,” he added.

Black men have the highest incidence rate for prostate cancer in the United States and are more than twice as likely as White men to die of the disease, according to the National Cancer Institute.

 

Coating on Aspirin Might Reduce Its Cardioprotective Effects.


Enteric coating can affect aspirin‘s inhibition of platelet aggregation, according to a study in Circulation.

Researchers used three assays — platelet aggregation, serum thromboxane formation, and urinary excretion of a thromboxane metabolite — to test response to an oral dose of 325-mg immediate-release or enteric-coated aspirin in 400 healthy volunteers (median age, 26). The study was partly funded by Bayer HealthCare.

No participant showed resistance to the immediate-release formulation. Up to 49% showed resistance to enteric-coated aspirin, but most were not resistant upon retesting.

The authors conclude that “we failed to find a single case of true drug resistance” and that their findings show “inconsistent platelet inhibition” after ingestion of enteric-coated aspirin.

Source: Circulation