Feb. 5, 2013 — An individual’s breath alcohol concentration (BrAC) following alcohol intake is influenced by several factors, including food. While it is known that food delays the stomach emptying, thus reducing BrAC, only recently has the role of nonalcoholic drink mixers used with alcohol been explored as a factor influencing BrAC. A new comparison of BrACs of alcohol consumed with an artificial sweetener versus alcohol consumed with a sugared beverage has found that mixing alcohol with a diet soft drink can result in a higher BrAC.

Results will be published in the April 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“More attention needs to be paid to how alcohol is being consumed in the ‘real world,’” said Cecile A. Marczinski, assistant professor of psychology at Northern Kentucky University. She referenced an earlier field study of bar patrons. “Researchers found that, one, individuals who reported consuming alcohol with diet beverages had the highest BrACs, as compared to all other bar patrons, and two, that women tended to be more frequent consumers of diet mixers with their alcohol. These good naturalistic observations give researchers many ideas to explore in a controlled laboratory setting.”

Dennis L. Thombs, professor and chair of the department of behavioral and community health at UNT Health Science Center, was the author of the field study referenced by Marczinski. “Research on artificially sweetened drink mixers is new,” he said. “I believe this might be only the third study published to date on this issue, and the findings are quite consistent with ours.”

“I am really interested in drinking and driving as a problem, so I wanted to know if the simple choice of mixer could be the factor that puts a person above or below the legal limit,” added Marczinski. “I also wanted to determine if any BrAC difference would be something that subjects would notice, since this has implications for safe drinking practices, including decisions to drive.”

Study authors had 16 participants (8 females, 8 males) attend three sessions where they received one of three doses — 1.97 ml/kg vodka mixed with 3.94 ml/kg Squirt, 1.97 ml/kg vodka mixed with 3.94 ml/kg diet Squirt, and a placebo beverage — in random order. The participants’ BrACs were recorded, as well as their self-reported ratings of subjective intoxication, fatigue, impairment, and willingness to drive. Their objective performance was assessed using a cued go/no-go reaction time task.

“Alcohol consumed with a diet mixer results in higher BrACs as compared to the same amount of alcohol consumed with a sugar-sweetened mixer,” said Marczinski. “The subjects were unaware of this difference, as measured by various subjective ratings including feelings of intoxication, impairment, and willingness to drive. Moreover, their behavior was more impaired when subjects consumed the diet mixer.”

When asked why mixing alcohol with a diet drink appears to elevate BrACs, Thombs explained that the stomach seems to treat sugar-sweetened beverages like food, which delays the stomach from emptying. “The best way to think about these effects is that sugar-sweetened alcohol mixers slow down the absorption of alcohol into bloodstream,” he said. “Artificially sweetened alcohol mixers do not really elevate alcohol intoxication. Rather, the lack of sugar simply allows the rate of alcohol absorption to occur without hindrance.”

Both Marczinski and Thombs were concerned about the risk that diet mixers can pose for alcohol-impaired driving. “In this study, subjects felt the same whether they drank the diet or regular mixed alcoholic beverage,” said Marczinski. “However, they were above the limit of .08 when they consumed the diet mixer, and below it when they drank the regular mixed beverage. Choices to drink and drive, or engage in any other risky behavior, often depend on how people feel, rather than some objective measurement of impairment. Now alcohol researchers who are interested in prevention have something new to consider when developing or modifying intervention programs.”

Thombs agreed. “Research on alcohol mixers is critically important for improving serving practices in on-premise drinking establishments,” he said. “About one-half of all drinking and driving incidents are estimated to occur in persons leaving these settings. This type of research can provide guidance to policy-makers interested in improving the safety of bars and nightclubs.”

“We have an obesity crisis in this country,” added Marczinski. “As such, individuals tend to be conscious about how many calories they are consuming, and they might think that mixing alcohol with diet drinks is a healthy choice. Yet the average reader needs to know that while mixing alcohol with a diet beverage mixer may limit the amount of calories being consumed, higher BrACs are a much more significant health risk than a few extra calories.”

“In natural drinking settings, such as bars and nightclubs, young women are significantly more likely than young men to order drinks mixed with diet cola,” said Thombs. “I suspect this occurs because young women tend to be more weight conscious than young men. Thus, from a public health perspective, artificially sweetened alcohol mixers may place young women at greater risk for a range of problems associated with acute alcohol intoxication.”

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The above story is reprinted from materials provided by Alcoholism: Clinical & Experimental Research, via EurekAlert!, a service of AAAS.

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Journal Reference:

1. Cecile A. Marczinski, Mark T. Fillmore. Letter to the Editor in Response to The Alcohol Mixed with Energy Drinks Debate: Masking the Facts!. Alcoholism: Clinical and Experimental Research, 2013; DOI: 10.1111/acer.12019

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 5, 2013 — New research in animals triggered by a combination of serendipity and counterintuitive thinking could point the way to treating fractures caused by rapid bone loss in people, including patients with metastatic cancers.

A series of studies at the University of North Carolina School of Medicine found that steroid drugs, known for inducing bone loss with prolonged use, actually help suppress a molecule that’s key to the rapid bone loss process. A report of the new findings appears online Feb. 5, 2013 in the journal PLOS ONE.

Osteoporosis or the loss of bone mass is a major public health problem in the Western world and commonly results in hip and spine fractures. “But rib fractures are the most common and yet most unreported osteoporotic fractures and also occur in many cancers such as breast cancer, malignant melanoma, and myelomas, that metastasize and spread to the ribs,” says Arjun Deb, MD, assistant professor in the departments of Medicine and Cell Biology and Physiology at UNC.

“While little is known about the biology of rib fractures, we have identified a molecular mechanism that could have important implications for the treatment of fractures in cancers and other conditions often associated with rapid bone loss,” adds Deb, who also is a member of UNC’s McAllister Heart Institute and Lineberger Comprehensive Cancer Center.

The UNC researcher indicated that his lab arrived at the study “via serendipity.” From stromal cells of adult mice, they had deleted a gene called beta catenin. These cells, also known as fibroblasts, form the connective tissue of almost all organs in the body. The Deb lab was working on the molecular regulation of these cells.

But something “amazing” occurred, he said. Following beta catenin deletion, the mice died within three weeks. The researchers looked at the functioning of every organ — heart, kidney, lung, spleen — wherever this gene could possibly be expressed. All appeared normal, except lung function. “With just a whiff of anesthesia, their blood oxygen saturation dropped precipitously. This was a first clue of a problem in the respiratory system of these animals.” But the lungs looked absolutely fine under the microscope.

Deb then turned to UNC’s Department of Physics and Astronomy, which had developed a novel contactless fiber-optic displacement sensor for monitoring respiration during mouse CT scans. In association with the department of radiology and the Biomedical Research Imaging Center at UNC, 3-D lung reconstruction revealed profound lung collapse on one or both sides. This was a puzzle. “How can an animal with normal lung tissue under a microscope have lung collapse and respiratory problems?” Deb wondered whether the chest wall could be the culprit.

CT scans of the chest wall in these animals revealed multiple spontaneous fractures affecting multiple ribs. The affected ribs had 60-70 percent less bone compared to normal ribs. Essentially the bony rib cage had disappeared within 3 weeks, said Deb, and he immediately realized that the animals were dying from respiratory failure because the frail chest wall was unable to support respiration.

Bone mass is usually maintained by a close functional coupling of osteoblasts (cells that form bone) and osteoclasts (cells that resorb bone). The study team found a huge infiltration of osteoclasts into the animals’ ribs. Other bones, including the spine and femur, also showed some resorption but not as dramatic as in the ribs.

And when drugs such as bisphosphonates, commonly used to preserve bone mass in humans were given to the animals, their survival was prolonged only briefly. This led the study team to think that the osteoclast formation was so aggressive that the body was unable to form new bone to keep apace with the bone loss.

In conditions such as rheumatoid arthritis and other problems involving inflammation, many types of inflammatory cells promote bone resorption, which led the researchers to see if treatment with corticosteroids might be helpful in these animals. And it was: a 30-40 percent increase in bone mass, compared to animals that did not get steroids. They also found 60-70 percent of the ribs were preserved.

“Notably, 75 percent of the animals survived,” Deb said. “And after 80 days, we saw that the ribs showed evidence of repair, they were able to form new bone. And when we looked at new CT lung scans, the lungs were expanded and the ribs contained far less numbers of osteoclasts.”

As to mechanism, Deb explains that a molecule in bone called rank ligand (RANKL) is important for osteoclast formation. “We found that steroids were suppressing RANKL to the extent that RANKL levels in these animals were the same as healthy animals.”

“From that perspective, these studies are interesting and challenge the existing paradigm: that steroids are drugs that cause bone loss. They do, but in rapid bone loss from aggressive osteoclast overactivity, steroids may be helpful. That’s the principle message of this story.”

Study co-authors were JinZhu Duan, Yueh Lee, Corey Jania, Jucheng Gong, Mauricio Rojas, Laurel Burk, Monte Willis, Jonathon Homeister, Stephen Tilley, and Janet Rubin. The study was funded by the National Institutes of Health and the Ellison Medical Foundation.

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The above story is reprinted from materials provided by University of North Carolina School of Medicine, via Newswise.

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Journal Reference:

1. JinZhu Duan, Yueh Lee, Corey Jania, Jucheng Gong, Mauricio Rojas, Laurel Burk, Monte Willis, Jonathon Homeister, Stephen Tilley, Janet Rubin, Arjun Deb. Rib Fractures and Death from Deletion of Osteoblast βcatenin in Adult Mice Is Rescued by Corticosteroids. PLoS ONE, 2013; 8 (2): e55757 DOI: 10.1371/journal.pone.0055757

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 5, 2013 — Native Americans are at much greater risk of suicide after acute alcohol intoxication, according to a study led by researchers at The University of Texas Health Science Center at Houston (UTHealth).

The study examined the prevalence and social demographic correlates of suicide involving acute alcohol intoxication among United States ethnic minorities. Results will be published in the May 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Some reviews suggest that people with alcohol use disorders are nine times more likely to die by suicide than the general population,” said Raul Caetano, M.D., Ph.D., M.P.H., the study’s corresponding author and regional dean of The University of Texas School of Public Health Dallas Regional Campus, part of UTHealth. “Our paper looks at the issue more specifically, examining suicide and acute intoxication among U.S. ethnic minorities. It is not the first study to do so, but few among them have used such large data set as the National Violent Death Reporting System (NVDRS).”

Suicide is the 10th leading overall cause of death in the United States in 2009, according to the Centers for Disease Control and Prevention. Prior research has also shown that alcohol use disorders confer increased risk for suicide.

“Other studies have found that large numbers of people who have recently committed suicide, or attempted to commit suicide, have alcohol in their blood,” added Sarah Zemore, Ph.D., a scientist at the Alcohol Research Group and an associate adjunct professor at the University of California, Berkeley. “There is also reason to believe that binging on alcohol is a risk for suicide attempt regardless of whether the person is dependent on alcohol. Yet research has not fully answered the question of why alcohol misuse increases the likelihood of a suicide attempt, whether due to major depression, increases in impulsivity or poorer life conditions common among alcohol-dependent people.”

Caetano and his colleagues used data derived from the 2003-2009 NVDRS, analyzing sociodemographic and toxicological information for 59,384 suicide decedents from 16 states. Acute alcohol intoxication at the time of death was defined as having a blood alcohol content (BAC) equal to or greater than 0.08.

“We showed considerable differences across ethnic groups in the association between alcohol intoxication and suicide and types of suicide,” said Caetano, professor of epidemiology at the UT School of Public Health. “Although alcohol intoxication is important for all groups, American Indians are much more at risk than other groups.”

Zemore added, “This study is consistent with the larger literature suggesting that more than a third of those committing suicide use alcohol prior to the event. The study also extends the literature by showing that alcohol use and intoxication prior to suicide is particularly prevalent among American Indian and Alaskan Native populations and, to some extent, Latinos, compared to Whites, but less prevalent among Blacks and Asians. Finally, this article highlights the fact that suicide is a particular problem among young American Indian and Alaskan Native people. In this sample, 22 percent of those completing suicide were under 21, and half were under 29.”

The authors suggest that alcohol-related prevention strategies focus on suicide as a consequence of alcohol use, especially among American Indian and Alaskan Native youth and young adults.

“These associations indicate that heavier drinkers are more at risk and should be targeted for prevention efforts,” said Caetano. “Alcohol treatment facilities should focus on suicide, and be aware of the potential risk that their clients have in regard to suicide. Clinicians working with heavier drinkers, especially those who are depressed, should be aware of the increased risk that these patients have.”

“Suicidal threats or insinuations by individuals who misuse alcohol should be taken particularly seriously,” said Zemore. “Family and friends play an important role here, as people intending to commit suicide often fail to seek formal help — though they do often inform their social circle in some manner. Findings also suggest a need for emergency room departments and health care providers to more broadly screen for suicidal ideation among alcohol-dependent individuals.”

 The study was funded by the National Institute on Alcohol Abuse and Alcoholism. 

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The above story is reprinted from materials provided by University of Texas Health Science Center at Houston.

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Journal Reference:

1. Raul Caetano, Mark S. Kaplan, Nathalie Huguet, Bentson H. McFarland, Kenneth Conner, Norman Giesbrecht, Kurt B. Nolte. Acute Alcohol Intoxication and Suicide Among United States Ethnic/Racial Groups: Findings from the National Violent Death Reporting System. Alcoholism: Clinical and Experimental Research, 2013; DOI: 10.1111/acer.12038

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 5, 2013 — Natural chemicals found in green tea and red wine may disrupt a key step of the Alzheimer’s disease pathway, according to new research from the University of Leeds.

In early-stage laboratory experiments, the researchers identified the process which allows harmful clumps of protein to latch on to brain cells, causing them to die. They were able to interrupt this pathway using the purified extracts of EGCG from green tea and resveratrol from red wine.

The findings, published in the Journal of Biological Chemistry, offer potential new targets for developing drugs to treat Alzheimer’s disease, which affects some 800,000 people in the UK alone, and for which there is currently no cure.

“This is an important step in increasing our understanding of the cause and progression of Alzheimer’s disease,” says lead researcher Professor Nigel Hooper of the University’s Faculty of Biological Sciences. “It’s a misconception that Alzheimer’s is a natural part of aging; it’s a disease that we believe can ultimately be cured through finding new opportunities for drug targets like this.”

Alzheimer’s disease is characterised by a distinct build-up of amyloid protein in the brain, which clumps together to form toxic, sticky balls of varying shapes. These amyloid balls latch on to the surface of nerve cells in the brain by attaching to proteins on the cell surface called prions, causing the nerve cells to malfunction and eventually die.

“We wanted to investigate whether the precise shape of the amyloid balls is essential for them to attach to the prion receptors, like the way a baseball fits snugly into its glove,” says co-author Dr Jo Rushworth. “And if so, we wanted to see if we could prevent the amyloid balls binding to prion by altering their shape, as this would stop the cells from dying.”

The team formed amyloid balls in a test tube and added them to human and animal brain cells. Professor Hooper said: “When we added the extracts from red wine and green tea, which recent research has shown to re-shape amyloid proteins, the amyloid balls no longer harmed the nerve cells. We saw that this was because their shape was distorted, so they could no longer bind to prion and disrupt cell function.

“We also showed, for the first time, that when amyloid balls stick to prion, it triggers the production of even more amyloid, in a deadly vicious cycle,” he added.

Professor Hooper says that the team’s next steps are to understand exactly how the amyloid-prion interaction kills off neurons.

“I’m certain that this will increase our understanding of Alzheimer’s disease even further, with the potential to reveal yet more drug targets,” he said.

Dr Simon Ridley, Head of Research at Alzheimer’s Research UK, the UK’s leading dementia research charity, which part-funded the study, said: “Understanding the causes of Alzheimer’s is vital if we are to find a way of stopping the disease in its tracks. While these early-stage results should not be a signal for people to stock up on green tea and red wine, they could provide an important new lead in the search for new and effective treatments. With half a million people affected by Alzheimer’s in the UK, we urgently need treatments that can halt the disease — that means it’s crucial to invest in research to take results like these from the lab bench to the clinic.”

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The above story is reprinted from materials provided by University of Leeds, via EurekAlert!, a service of AAAS.

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Journal Reference:

1. Jo V. Rushworth, Heledd H. Griffiths, Nicole T. Watt and Nigel M. Hooper. Prion protein-mediated neurotoxity of amyloid-β oligomers requires lipid rafts and the transmembrane LRP1. Journal of Biological Chemistry, 2013 DOI: 10.1074/jbc.M112.400358

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 1, 2013 — Researchers at Moffitt Cancer Center and colleagues at the Mayo Clinic in Rochester, Minn., have developed a novel computer algorithm to easily quantify a major risk factor for breast cancer based on analysis of a screening mammogram. Increased levels of mammographic breast density have been shown in multiple studies to be correlated with elevated risk of breast cancer, but the approach to quantifying it has been limited to the laboratory setting where measurement requires highly skilled technicians. This new discovery opens the door for translation to the clinic where it can be used to identify high-risk women for tailored treatment.

“We recently developed an automated method to estimate mammographic breast density that assesses the variation in grayscale values in mammograms,” explained study lead author J. Heine, Ph.D., associate member of the Cancer Epidemiology Program and Cancer Imaging and Metabolism Department at Moffitt.

According to the authors, mammographic breast density, or the proportion of fibroglandular tissue pictured on the mammogram, is an established risk factor for breast cancer. Women with high mammographic breast density have a greater risk of developing breast cancer. However, mammographic breast density has not been used in clinical settings for risk assessments due in large part to the lack of an automated and standardized measurement.

Using their new method, the researchers compared the accuracy and reliability of their measurements of variation in breast density with the performance of tests that use the degree of dense breast tissue in a mammogram to assess breast cancer risk. A study describing their novel method and its utility was published in a recent issue of the Journal of the National Cancer Institute.

According to Heine, they found that the variation measure was a “viable, automated mammographic density measure that is consistent across film and digital imaging platforms” and “may be useful in the clinical setting for risk assessment.”

In addition, they found that the association between variation and the risk of breast cancer was strong for mammograms carried out four years prior to diagnosis. The automated method also made clearer distinctions between breast cancer case subjects and controls who did not have breast cancer.

While many clinicians use the risk predictive value of percent of breast density seen on the mammogram as the amount or proportion of bright tissue in an image, Heine and his co-authors found the variation of dense tissue is also relevant to breast cancer, suggesting a relationship between percent of breast density and variation in breast density.

“The strengths of this study include the evaluation and validation of a novel breast density measure across three well-designed epidemiological studies,” said study co-author Thomas A. Sellers, Ph.D., M.P.H., center director of Moffitt. “Because we were able to compare this novel breast density measure with an established percent density measure that was available four years before diagnosis, we were allowed to show that variation was present for at least four years, and in some cases, more than eight years. Offering clinicians and patients the advantage of more timely, reliable and accurate risk could open the door for interventions to lower risk and, hopefully, prevent the disease from occurring.”

The researchers concluded that the simplicity of the measure, and the ability to standardize and automate the measure across sites, could hold promise for clinicians and their patients if the measurements were incorporated into clinical risk assessment practices.

This work was supported with grants by the United States Department of Defense (DAMD 17-00-1-0331) and National Cancer Institute (R01 CA 128931; R01 CA 128931Z1; R01 CA 114491; R01 CA 122340; R01 CA97396 and P50 CA116201).

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The above story is reprinted from materials provided by Moffitt Cancer Center.

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1. J. J. Heine, C. G. Scott, T. A. Sellers, K. R. Brandt, D. J. Serie, F.-F. Wu, M. J. Morton, B. A. Schueler, F. J. Couch, J. E. Olson, V. S. Pankratz, C. M. Vachon. A Novel Automated Mammographic Density Measure and Breast * Cancer Risk. JNCI Journal of the National Cancer Institute, 2012; 104 (13): 1028 DOI: 10.1093/jnci/djs254

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 1, 2013 — Sugars are needed to provide us with energy and in moderate amounts contribute to our well-being. Sustained high levels of sugars, as is found in diabetics, damages our cells and now is shown that can also increase our chance to get cancer: The dose makes the poison as Paracelsus said.

It is well known that obesity is a leading cause of diabetes, a disease where the body fails to control blood sugar levels. High blood sugar levels are characteristic in obesity and diabetes. What is less well known is that diabetes and obesity are also linked to an increase in cancer risk. That is, the diabetic population has up to double chances to suffer pancreatic or colon cancer among others, according to well sustained epidemiological studies. With obesity in British and Spanish children reaching 16%, the highest in Europe, this epidemic has major health implications. How obesity or diabetes increase cancer risk has been a major health issue.

Scientists led by Dr. Custodia Garcia-Jimenez at the University Rey Juan Carlos in Madrid have uncovered a key mechanism that links obesity and diabetes with cancer: high sugar levels, which increase activity of a gene widely implicated in cancer progression.

Dr Garcia Jimenez’s laboratory was studying how cells in the intestine respond to sugars and signal to the pancreas to release insulin, the key hormone that controls blood sugar levels. Sugars in the intestine trigger cells to release a hormone called GIP that enhances insulin release by the pancreas.

In a study published in Molecular Cell, Dr Garcia Jimenez’s team showed that the ability of the intestinal cells to secrete GIP is controlled by a protein called β-catenin, and that the activity of β-catenin is strictly dependent on sugar levels.

Increased activity of β-catenin is known to be a major factor in the development of many cancers and can make normal cells immortal, a key step in early stages of cancer progression. The study demonstrates that high (but not normal) sugar levels induce nuclear accumulation of β-catenin and leads to cell proliferation. The changes induced on β-catenin, the molecules involved and the diversity of cancer cells susceptible to these changes are identified.

Dr. Custodia García said “We were surprised to realize that changes in our metabolism caused by dietary sugar impact on our cancer risk. We are now investigating what other dietary components may influence our cancer risk. Changing diet is one of easiest prevention strategies that can potentially save a lot of suffering and money.”

Colin Goding, Professor of Oncology at the University of Oxford, UK said ‘Previously we were unsure about how increased blood sugar found in diabetes and obesity could increase cancer risk. This study identifies a key molecular mechanism through which high blood glucose would predispose to cancer. It opens the way for potential novel therapies aimed at reducing cancer risk in the obese and diabetic populations.’

Estimations published by the World Health Organisation (WHO): Obesity predisposes to diabetes and its prevalence is doubling every 20 years worldwide. More than 1 in 10 adults worldwide (12%) are obese (BMI>30). 1 in 6 children in UK and Spain suffer obesity.

Diabetes caused 4.6 million deaths in 2011, more than 2 deaths per hour in Spain, more in USA. Worldwide, 1 in 10 adults (10%) suffered from diabetes in 2010 and more than one-third of individuals with diabetes are unaware they suffer from the disease. The national cost of diabetes or cancer is in the order of billions of pounds or euros in Spain or England.

More than half (63%) of premature deaths worldwide are due to non communicable diseases (NCD) of which cancer and diabetes are among the 4 causes more frequent. At least 1 in 3 of the main cancers (27-39%) can be prevented by improving diet, physical activity and body composition.

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Feb. 1, 2013 — There is general agreement among hospital infection preventionists (IPs) with respect to which practices have weak or strong evidence supporting their use to prevent healthcare-associated infection, according to a new study published in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

Furthermore, IPs with certification in infection prevention and control (CIC®) are two to three times more likely to perceive the evidence behind certain infection prevention practices as strong, compared to their non-certified peers.

IPs lead programs in hospitals and other healthcare facilities that protect patients and healthcare personnel from infections. The study was conducted to understand how those who lead infection prevention activities perceive the strength of evidence behind practices aimed at preventing device- and procedure-associated infections and lessening the risk of cross transmission of microorganisms in healthcare facilities.

A research team led by Sanjay Saint, MD, MPH, of the VA Ann Arbor & University of Michigan Medical School collected survey responses from infection prevention personnel at 478 U.S. hospitals to determine the perceived strength of evidence behind 28 of the most common hospital infection prevention practices. The following practices were perceived by 90 percent or more of the respondents as having strong evidence to support their use: alcohol-based hand rub, aseptic urinary catheter insertion, chlorhexidine for antisepsis prior to central venous catheter insertion, maximum sterile barriers during central venous catheter insertion, avoiding the femoral site for central venous catheter insertion, and semi-recumbent positioning of patients on ventilators.

Conversely, practices with the weakest perceived evidence were routine central catheter changes, using silver-coated endotracheal tubes for ventilator-associated pneumonia (VAP), nitrofurazone-releasing urinary catheters, and the use antimicrobials in the urinary catheter drainage bag.

According to Dr. Saint, lead study author, “the perceived strength of evidence among infection prevention personnel across the country generally tracked with the actual strength of the evidence for various practices that have been reported in evidence-based guidelines.”

The research team further examined the perceptions of evidence supporting practice use between certified and non-certified IPs. Compared to their non-certified counterparts, CIC® IPs were more likely to perceive the strength of evidence as strong for a number of infection prevention practices including: regular interruption of sedation for VAP patients, nurse-initiated urinary catheter discontinuation to prevent catheter-associated urinary tract infection, and antimicrobial stewardship programs.

“Understanding the impact of board certification on the effectiveness of an infection prevention program is imperative,” said Russell Olmsted, MPH, CIC, study co-author. “This study adds to mounting evidence that suggests that CIC® may lead to greater evidence-based practice, which may result in the reduction of both healthcare-associated infections and hospital costs.”

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The above story is reprinted from materials provided by Elsevier, via AlphaGalileo.

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Journal Reference:

1. Sanjay Saint, M. Todd Greene, Russell N. Olmsted, Vineet Chopra, Jennifer Meddings, Nasia Safdar and Sarah L. Krein. Perceived strength of evidence supporting best practices to prevent healthcare-associated infection: Results from a national survey of infection prevention personnel. American Journal of Infection Control, Volume 41, Issue 2 (February 2013)

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Feb. 1, 2013 — According to a study in the January issue of the Journal of the American College of Radiology, the use of volume-modulated arc therapy (VMAT) to deliver intensity-modulated radiation therapy (IMRT) to prostate cancer patients results in an overall reduction in treatment time of approximately 14 percent. The study was performed at Winship Cancer Institute of Emory University in Atlanta.

Treatment with IMRT is increasingly standard for prostate cancer. However, although the benefits of IMRT in the treatment of prostate cancer are ample, it remains a complex and time-consuming treatment modality that requires numerous gantry positions, a large number of monitor units and considerable daily treatment time commitments by patients.

“Given the time requirement by patients for daily prostate cancer treatment, we aimed to measure the true efficiency of VMAT treatment compared with IMRT using custom institutional software to record the actual in-room times,” said William A. Hall, MD, author of the study.

Custom institutional software was used to mine the treatment times from the record-and-verify database. The in-room time (the time between patient entry and exit) was computed for each patient. Average room time was compared between VMAT patients and IMRT patients. Subgroup comparisons (1-arc or 2-arc VMAT, 5-field or 7-field IMRT, and electromagnetic transponder Calypso or gold-marker tracking) were performed.

Average room time was significantly shorter for all VMAT versus DMLC IMRT procedures. The average room time for all DMLC IMRT patients was found to be 14.69 ± 4.36 min, and the average room time for all VMAT patients was found to be 12.6 ± 2.62 min. Room time was longer for Calypso versus gold seed patients, but VMAT reduced treatment time in Calypso patients. This resulted in Calypso VMAT patients’ having similar treatment times to non-Calypso DMLC IMRT patients.

“With an aging population and rapidly rising rates of prostate cancer, the ability to determine the most efficient modality by which patients with adenocarcinoma of the prostate should be treated is critical. It seems from our analysis that 5-field IMRT and VMAT are the most efficient modalities by which to deliver prostate IMRT,” said Hall.

“Furthermore, our analysis shows that if more advanced methods of IMRT delivery are used, localization devices can be incorporated without any statistically significant differences in the overall treatment time. This may provide important information to prostate cancer practices looking to improve their efficiency while maximizing the quality of their radiation therapy delivery,” said Hall.

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Feb. 1, 2013 — A study of more than 12,000 children from emergency departments throughout the country in the Pediatric Emergency Care Applied Research Network (PECARN) has identified seven factors that can help physicians determine the need for a computed tomography (CT) scan following blunt trauma to the abdomen. Because CT scans pose radiation hazards for youngsters, the findings may enable doctors to determine which children do not need to be exposed to such tests after a traumatic injury.

The study is online first in advance of an upcoming issue of the Annals of Emergency Medicine.

“CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation’s effects,” said principal investigator and lead author of the study James Holmes, a professor of emergency medicine at the UC Davis School of Medicine. “We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure.”

The prospective study involved children who arrived at emergency departments in the PECARN network after blunt trauma to their torsos, such as sustained from a car or bicycle crash, a fall or an assault. A variety of factors related to the children’s histories and clinical presentations were evaluated. Among these, seven were identified by statistical analysis to correlate with risk for involving a clinically important injury. The factors included evidence of trauma on the abdomen or chest (such as seat-belt marks), neurological changes, abdominal pain or tenderness, abnormal breath sounds and vomiting.

Children who had none of the factors when evaluated in the emergency department had only a 0.1 percent chance of having an abdominal injury that required acute intervention. For the great majority of these cases, therefore, a CT scan would not likely provide additional useful information. According to the authors, the risk of developing a future cancer from radiation exposure from a CT scan in this situation (i.e., when lacking all seven factors) outweighs the risk of having a significant medical problem from the abdominal injury.

The authors stated that the prediction rule is intended only to help “rule out” the need for CT for children when none of the seven factors is present. However, the rule does not mandate a CT solely based on any one of the factors being present. If the prediction rule were used in that way, CT usage would actually increase over current levels. The authors emphasized that clinical judgment must play an important role in determining whether a CT is needed in each case. Extending the period of observation in the emergency department, and using findings from laboratory tests and ultrasonography, can also contribute to decision-making in cases of abdominal trauma.

According to Holmes, the prediction rule must be tested in another clinical trial designed specifically to evaluate its validity before being generally adopted. He expects that this will be carried out in the near future.

Another related ongoing study at UC Davis Medical Center is investigating the role of ultrasonography in the evaluation of abdominal trauma in children, and whether increasing its usage can lead to further reduction of the need for CT scans.

This study also was conducted through PECARN, a network of pediatric emergency departments throughout the United States that enables researchers to gather enough data to perform significant studies on critical issues in pediatric emergency medicine. PECARN studies have previously led to new standards of care for infants or children presenting with head trauma, diabetic crisis and infections.

“Because of PECARN, we are uniquely positioned to perform large studies that can provide important information,” said Nathan Kuppermann, senior investigator of the study, who is professor of pediatrics and emergency medicine and chair of the Department of Emergency Medicine at the UC Davis School of Medicine. “The results of such studies are making emergency medicine decision-making more of a science and leading to better and safer outcomes for children.”

Kuppermann is founding chair of PECARN and leads one of the network’s research nodes, which is centered at UC Davis Medical Center and includes the children’s hospitals of the University of Utah and University of Pennsylvania.

Other UC Davis Medical Center investigators involved in the study are Peter Sokolove, professor of emergency medicine, David Wisner, professor of surgery, and Sandra Wootton-Gorges, professor and medical director of radiology at the ShrinersHospital for Children Northern California. Other authors were from emergency departments in Maryland, Massachusetts, Michigan, Missouri, New York, Ohio, Utah, Wisconsin and Washington, D.C. A complete listing of the authors and their affiliations can be found in the article.

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The above story is reprinted from materials provided by University of California – Davis Health System.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. James F. Holmes, Kathleen Lillis, David Monroe, Dominic Borgialli, Benjamin T. Kerrey, Prashant Mahajan, Kathleen Adelgais, Angela M. Ellison, Kenneth Yen, Shireen Atabaki, Jay Menaker, Bema Bonsu, Kimberly S. Quayle, Madelyn Garcia, Alexander Rogers, Stephen Blumberg, Lois Lee, Michael Tunik, Joshua Kooistra, Maria Kwok, Lawrence J. Cook, J. Michael Dean, Peter E. Sokolove, David H. Wisner, Peter Ehrlich, Arthur Cooper, Peter S. Dayan, Sandra Wootton-Gorges, Nathan Kuppermann. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Annals of Emergency Medicine, 2013; DOI: 10.1016/j.annemergmed.2012.11.009

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Jan. 31, 2013 — Malaria in pregnancy causes a range of adverse effects, including abortions, stillbirths, premature delivery and low infant birth weight. Many of these effects are thought to derive from a placental inflammatory response resulting from interaction of infected red blood cells with the placental tissue. In a study published in the latest issue of the journal PLOS Pathogen, a researchers’ team led by Carlos Penha-Gonçalves at the Instituto Gulbenkian de Ciência (IGC), Portugal, observed, for the first time, the mouse placental circulation and showed how it can influence the malaria parasite behavior and infection. Their results indicate a higher accumulation of parasites in placental regions with low blood flow, being these areas more prone to an inflammatory response.

In humans, red blood cells infected with the malaria parasite, Plasmodium falciparum, accumulate in the placenta via interaction with a molecule expressed on the placental tissue — a process called sequestration. In response to this event, placental cells secrete substances that recruit inflammatory cells leading to placental damage and negatively impacting fetal growth. Until now placental circulation has not been linked to the infected red blood cell sequestration. In fact, it is not trivial to investigate this hypothesis in human placenta, due to technical constraints

Luciana Moraes, an investigator of Carlos Penha-Gonçalves laboratory, has provided new insights to this issue by developing an experimental system that allowed the live observation of the blood flow in the mouse placenta. Mating two strains of mice, one of them with cells stained with a colorful marker, Luciana was able to identify the placental tissue (fetus origin). In collaboration with Carlos Tadokoro’s laboratory at the IGC, the investigators developed a microscopy technique that allowed the observation of the placenta in a living mouse. Immediately before exposure to the microscope the mouse was injected with a fluorescent substance that labels the blood. With this set-up it was possible to distinguish maternal blood and placental tissue. The results showed for the first time how the circulation occurs in the placenta, and that the blood flows with different speeds in different regions of the placenta.

Next, the investigators infected red blood cells with the malaria parasite Plasmodium berghei, stained with a different color, and observed — live — the behavior of the parasite inside the placenta. They observed that in the areas with higher blood flow, the parasite never stops moving and does not interact with the placental tissue. The accumulation of parasite just occurs in areas of low or absence of flow. In these regions, placental macrophages engulf the infected red blood cells to attempt parasite clearance. Their observations also suggest that movements of the placental tissue may control the blood flow.

Luciana Moraes says: “Our results indicate that binding of infected red blood cells to a molecule expressed in the placenta may not be the only mechanism of parasite sequestration. The dynamics of placental circulation may also play an important role, and should be considered when designing therapeutics.”

Carlos Penha-Gonçalves adds: “This is the first study done that shows live how placental blood circulation impacts on the local infection by the malaria parasite. It would be interesting and worthwhile to explore if a similar process occurs in the placenta of humans, taking in consideration that microcirculation in human placenta is quite different.”

This study was done in collaboration with University of Vigo, Spain, and was funded by Fundação para a Ciência e a Tecnologia, Portugal.

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Story Source:

The above story is reprinted from materials provided by Instituto Gulbenkian de Ciência (IGC).

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Luciana Vieira de Moraes, Carlos Eduardo Tadokoro, Iván Gómez-Conde, David N. Olivieri, Carlos Penha-Gonçalves. Intravital Placenta Imaging Reveals Microcirculatory Dynamics Impact on Sequestration and Phagocytosis of Plasmodium-Infected Erythrocytes. PLoS Pathogens, 2013; 9 (1): e1003154 DOI: 10.1371/journal.ppat.1003154

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.